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PLUS: State of Local Healthcare | High Blood Pressure Redefined | Too Young to Talk about Senior Living? Think Again! january • february 2018 ourhealthcville.com

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TABLE OF CONTENTS JANUARY • FEBRUARY 2018

10 THE PULSE

| KEEPING THE PULSE ON HEALTHCARE

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10 – NEW PEOPLE

A look at the healthcare landscape in Charlottesville & the Shenandoah Valley for 2018.

11 – NEW PLACES & ANNOUNCEMENTS 13 – HIGH BLOOD PRESSURE REDEFINED: WHAT SHOULD YOU KNOW?

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THE CHECK-UP

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16 – VOLUNTEER SPOTLIGHT: PEDAL FOR PURPLE

20 – Q&A ON HEALTH

BREAKING THE SILENCE: ORGAN TRANSPLANTATION This series explores medical conditions and procedures that can be devastating to patients and their families, but that no one is talking about. In this edition, OurHealth shares a local story about the impact of organ transplantation.

| LOCAL HEALTH & MEDICINE

18 – ASK THE EXPERT: T’AI CHI THE GENTLE HEALTH TO BETTER HEALTH

STATE OF HEALTHCARE IN CHARLOTTESVILLE & SHENANDOAH VALLEY

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KEEPING YOUR HEALTH IN THE GAME OF LIFE Patients share how local healthcare professionals enabled them to overcome their personal health challenges.

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TABLE OF CONTENTS JANUARY • FEBRUARY 2018

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WOMEN’S HEALTH

| HEALTH TIPS FOR WOMEN

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40 – HOLD FIRM: TREATING SAGGY BREASTS

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CHILDREN & TEENS

| YOUTH HEALTH

42 – DON’T PASS THE BREAD: WHY IS CELIAC DISEASE ON THE RISE IN KIDS?

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AGING WELL

NUTRITION

| LOCAL FOODS & RECIPES

47 – GET PUMPED: HEART HEALTHY TIPS 48 – COOL CUCUMBER DIP 49 – SALMON WITH CILANTRO PESTO 50 – PINEAPPLE UPSIDE-DOWN CAKE

| THE SCOOP ON SENIOR HEALTH

44 – TRANSITION TIMING: TOO YOUNG TO TALK ABOUT SENIOR LIVING? THINK AGAIN.

JOIN THE OURHEALTH COMMUNITY ON SOCIAL MEDIA We want to hear from you! Don’t forget to tag us, #OurHealthCVILLE 6

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TAB LE O F CO NTENTS

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MORE THAN A MAGAZINE ONLINE

JANUARY • FEBRUARY 2018

SOCIAL MEDIA

McClintic Media, Inc. Steve McClintic, Jr. | steve@ourhealthvirginia.com Jennifer Fields Hungate Karrie Pridemore Tori Meador Elissa Einhorn Lisa Spinelli Dalton Holody Laura Bower

CONTRIBUTING MEDICAL EXPERTS

Robert Carey, MD Kristin Koch, AuD, F-AAA Daniel Parks, MD Y. Michael Shim, MD Barton D. Weis, DDS

Stacy Bowen Catherine Brown Brandy Centolanza Matt Cox Susan Dubuque Michelle McLees Rick Piester Brandon Shuletta

E-NEWSLETTERS

PUBLISHER PRESIDENT/EDITOR-AT-LARGE VICE PRESIDENT OF PRODUCTION CHIEF DESIGNER GRAPHIC DESIGNER MEDIA EDITOR DIGITAL CONTENT MANAGER DIGITAL MEDIA STRATEGY ACCOUNTING MANAGER

CONTRIBUTING PROFESSIONAL EXPERTS & WRITERS

ADVERTISING AND MARKETING Kim Wood • Vice President of Business Development 540.798.2504 • kimwood@ourhealthvirginia.com Cindy Trujillo • Senior Media Consultant 434.907.5255 • cindy@ourhealthvirginia.com SUBSCRIPTIONS Subscriptions are $19.95 per year. To receive OurHealth Shenandoah Valley & Charlottesville via U.S. Mail, please contact Jenny Hungate at jenny@ourhealthvirginia.com

PRINT @ourhealthcville

COMMENTS/FEEDBACK/QUESTIONS We welcome your feedback. Please send all comments and/or questions to the following: U.S. Mail: McClintic Media, Inc., ATTN: Steve McClintic, Jr., President/ Publisher/Editor: 303 S. Colorado Street • Salem, VA 24153. | Email: steve@ourhealthvirginia.com | Phone: 540.387.6482 Ext. 1 Information in all print editions of OurHealth and on all OurHealth websites (websites listed below) and social media updates and emails is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2018 by McClintic Media, Inc. Reproduction in whole or part without written permission is prohibited. OurHealth Charlottesville/Shenandoah Valley is published bi-monthly • Special editions are also published • McClintic Media, Inc. • 303 S. Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. MAIN: ourhealthvirginia.com | ourhealthswva.com | ourhealthlbss.com | ourhealthrichmond.com | ourhealthcville.com | Advertising rates upon request.

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C R EDI TS

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THE PULSE

Mark Thomas Andres, MD

Virginia Baker, DO

Augusta Health Surgery Fishersville | 540.245.7705 www.augustahealth.com

Augusta Health Care for Women Fishersville | 540.213.7755 www.ahcfw.com

Joseph Freeze, NP

Erin Klaffky, MD

Augusta Health Gastroenterology Fishersville | 540.245.7350 www.augustahealth.com

Beverly Caldwell, NP Augusta Health Primary Care Lexington Lexington | 540.463.3381 www.augustahealth.com

Allergy Partners of Charlottesville Charlottesville and Waynesboro 434.951.2191 www.allergypartners.com/ charlottesville

Daniel Emery Parks, MD Kelvin Raybon, MD Augusta Health Urgent & Convenient Care Clinics Staunton, Stuarts Draft, Waynesboro and Weyers Cave www.augustahealth.com/ urgent-care

Augusta Health Cancer Center Fishersville | 540.332.5960 www.augustahealth.com

Polly Cason, FNP

Augusta Health Urgent & Convenient Care Clinics Staunton, Stuarts Draft, Waynesboro and Weyers Cave www.augustahealth.com/ urgent-care

Priya Kohli, MD

Dane Larsen, MD

Augusta Health Internal Medicine Waynesboro | 540.245.7950 www.augustahealth.com

James Scheiman, MD

Augusta Health Care for Women Fishersville | 540.213.7755 www.ahcfw.com

Laura Elizabeth Cook, PA-C

Madeline Dillon, MD

Augusta Health Behavioral Health Fishersville | 540.332.4060 www.augustahealth.com

Allergy Partners of Charlottesville Charlottesville and Waynesboro 434.951.2191 www.allergypartners.com/ charlottesville

Nishaki Mehta, MD

Gabrielle Murphy, NP

Cardiovascular Medicine UVA Heart & Vascular Center Charlottesville | 434.924.2031 heart.uvahealth.com

Kathleen Schwarz, MD Christine Stacy, NP

Gastroenterology and Augusta Health Hospitalist Hepatology Fishersville | 540.932.4075 UVA Health System www.augustahealth.com Charlottesville | 434.297.7206 www.uvahealth.com

Augusta Health Gastroenterology Fishersville | 540.245.7350 www.augustahealth.com

READ THIS EDITION OF

OurHealth

Charlottesville & Shenandoah Valley Mary Katherine Ward, FNP

ON YOUR TABLET OR SMARTPHONE

Augusta Health Family Practice Fishersville | 540.332.5687 www.augustahealth.com

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Augusta Health Urgent & Convenient Care Clinics Staunton, Stuarts Draft, Waynesboro and Weyers Cave www.augustahealth.com/ urgent-care

Emily Carole Stevens, FNP Augusta Health Staunton Medical Associates Staunton | 540.886.6259 www.augustahealth.com


THE P ULSE |

NEW OPENINGS

New People and Places

>> Ground breakings and openings in Charlottesville & Shenandoah Valley

Caption: Ribbon cutting event for the new Sentara Sports Medicine Center. From left, Jennifer Smiley, Director of Operations, Sentara Martha Jefferson Hospital; Catherine Hughes, Executive Director, Support Services; Steve Gunther, MD, Medical Director, Sentara Sports Medicine Center; Jonathan Davis, President, Sentara Martha Jefferson Hospital; Matt Panzarella, MD, Sentara Sports Medicine Center physician; Amy Black, Chief Operating Officer, Sentara Martha Jefferson Hospital; Deanna Radcliff, Practice Manager, Sentara Martha Jefferson Orthopedics.

SENTARA MARTHA JEFFERSON HOSPITAL’S new SENTARA SPORTS MEDICINE CENTER at the Outpatient Care Center at Pantops is now open. The sports medicine physicians providing care at the Center have experience caring for athletes of all levels, from novice to Olympian. X-ray services, physical therapy and outpatient surgery are all located in the same building as the Sentara Sports Medicine Center. For more information visit www.mjhortho.com.

PRIMARY EYECARE’S third Charlottesville location at 5TH STREET STATION is now open. The new location offers a full high-quality optical boutique with one of the largest selections of brand name eyewear in Central Virginia. For optometry appointments at the 5th Street Station office, call 434.760.2020 or visit www.cvilleeyecare.com.

ON THE MOVE

>> Local Healthcare Providers Announcing a Relocation CHARLOTTESVILLE T’AI CHI CENTER has a new home. The center has recently relocated to their new location at 206 East Water Street, next to City Market. To sign up for a T’AI CHI CH’UAN CLASS (martial art characterized by soft, slow flowing movements of the torso and arms coordinated with weight shifts and steps) or to learn more call 877.880.2479 or visit www.charlottesvilletaichi.org. www.OurHealthCville.com

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THE PULSE | High Blood Pressure Redefined THE P ULSE | High Blood Pressure Redefined

Q&A HIGH BLOOD PRESSURE REDEFINED What should you know? words | MICHELLE MCLEES

N

early half of American adults are at risk for major health problems because of high blood pressure, according to recently released guidelines by the American Heart Association and the American College of Cardiology. University of Virginia professor of medicine Robert Carey, MD, who served as vice chairman of the committee that wrote the guidelines, says, “The new rules should help catch warning signs of heart and kidney disease and encourage early treatment.” OurHealth Charlottesville & Shenandoah Valley Magazine sat down with Dr. Carey and asked him questions about the new guidelines and other related information we should all be aware of.

What is the new definition of high blood pressure? Dr. Carey: The guideline changes the definition of high blood pressure. It is now considered any measurement at or above 130 systolic or 80 diastolic. (Systolic is the term for the top number, diastolic the bottom.) High blood pressure used to be defined as readings at or above 140 systolic or 90 diastolic.

Why did the guidelines need updating? Dr. Carey: There is a growing body of evidence that lower blood pressure is better for your health. The 2017 guideline reflects this new information to help people prevent and treat high blood pressure sooner.

Why do the guidelines no longer identify prehypertension? Dr. Carey: The guideline committee moved away from the term “prehypertension” because the data shows the risk for heart attack, heart failure, stroke and other consequences of high blood pressure begins to occur at any level above 120 mmHg. Heart disease and stroke risk is doubled at 130-139/80-89 compared to blood pressure below 120/80.

How many Americans now have high blood pressure, according to the 2017 guidelines? Dr. Carey: We are going from one in three US adults with high blood pressure (32%) to nearly half of the US adult population (46%) with high blood pressure.

Does lowering the baseline for diagnoses increase the number of people taking meds? Dr. Carey: The new definition of high blood pressure results in more persons being actively counseled on lifestyle changes to reduce blood pressure but only a small increase (1.9%) in the percentage of US adults for whom antihypertensive medication is recommended in conjunction with lifestyle management.

How does this change the percent of Americans at risk for stroke and heart attack? Dr. Carey: Risk has not changed. The new guidelines recognize and identify that risk and encourage patients and providers to take significant action, and take it sooner, to prevent heart attacks and strokes.

The guidelines say I now have high blood pressure, when I didn’t before. What will change at my next doctor visit? Dr. Carey: Your doctor will talk to you about how this new definition changes the approach in managing your blood pressure and reducing future risk. Most of those who are newly diagnosed due to the guideline update will be advised to take action (dietary changes and increased physical activity, for example) to keep their blood pressure from rising further and may not require medication immediately.

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THE PULSE | High Blood Pressure Redefined

Robert M. Carey, MD

Professor of medicine and dean emeritus at the University of Virginia School of Medicine and vice chairman of the 2017 Hypertension Guideline Writing Committee.

What types of lifestyle changes will help me manage my blood pressure? Dr. Carey: The following lifestyle information should be considered: Regular physical activity (90-150 minutes per week) A healthy diet rich in fruits, vegetables, whole grains and low-fat dairy products with reduced content of saturated and total fat Maintaining a healthy weight Reduced intake of dietary sodium (<1,500 mg/d is optimal goal but at least reduce your current intake by 1,000 mg/d) Enhanced intake of dietary potassium Moderation in alcohol intake (for men, two or less drinks daily and for women, one drink daily)

My blood pressure level is now considered “Stage 2” – does that mean I’m at higher risk for heart attack or stroke? Dr. Carey: While the definitions for the stages of high blood pressure have changed, it doesn’t mean you face a dramatic increase in risk. Rather, the guideline is more aggressively identifying the risk that exists, and recommending action earlier. According to the new guidelines, most adults diagnosed with Stage 2 high blood pressure should be prescribed two antihypertensive medications in addition to lifestyle change recommendations.

HIGH BLOOD PRESSURE is now considered any measurement at or above:

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EXPERT CONTRIBUTOR Robert M. Carey, MD with the University of Virginia School of Medicine.

ON THE WEB

More at ourhealthcville.com


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THE CHECKUP | Volunteer Spotlight

Pictured: Bob Stroh along with Richard and Janice Johnson, members of the “Chain Gang” group that Bob rides with most often.

Pedal for Purple Retired businessman organizes bike ride for Alzheimer’s Association in honor of his wife words | BRANDY CENTOLANZA

Last year, when Bob Stroh’s wife of 45 years, Helen, was diagnosed with Alzheimer’s Disease, he knew he had to act at once. So he got involved with the Charlottesville chapter of the Alzheimer’s Association. Through them, he learned about the Longest Day, a fundraising initiative that coincides with the summer solstice. “I decided I wanted to do my own Longest Day Challenge, and I had a lot of success with it,” Stroh says. Stroh, already an avid cyclist, rode 100 miles with family members and friends in June 2017 and raised $3,500 for Alzheimer’s Disease awareness and research. The ride was so successful that he decided to organize a larger one. The High Bridge Ride is a 31-mile ride to benefit the Alzheimer’s Association. It is slated for April 21, 2018, and will take place at High Bridge Trail State Park near Farmville. “It is a remarkably beautiful trail,” Stroh says. “I wanted to make the bike ride interesting for people. I wanted to do something different.” Stroh’s sisters and the other members of the Chain Gang Bike team that he rides with every weekend have chipped in to help with the event, creating a website for the ride and promoting it on social media. “The support has been so amazing,” Stroh says. “The staff I’ve been working with at the Alzheimer’s Association have been very encouraging. They have been phenomenal.” 16

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Stroh has been cycling since he was a child. He’s ridden for other causes as well, including the Tour de Cure for the American Diabetes Association, the Tour de Midnight for the Epilepsy Foundation of Virginia, and Bike MS for the National MS Society. “I love biking,” he says. “I find it freeing and rewarding in every way.” Stroh also enjoys giving back to his community. He’s volunteered through his church and for Habitat for Humanity. While working with the Charlottesville Parking Center, he helped start the Downtown Business Association, and he later served as president of the Virginia Downtown Development Association. “Through the Virginia Downtown Development Association, I had the pleasure of working all over the state, and in the process I got some great bike rides in,” he says. Now that he’s retired, his focus is on spending time with his wife and helping in her fight against Alzheimer’s Disease. He hopes the High Bridge Ride will have a great impact. The ride is open to anyone, regardless of age or skill. “I hope for this to be a significant ride,” he says. “I want this to be a great experience for everyone. I want this to be the best ride for the riders and for the Alzheimer’s Association.”

For more information, visit highbridgeride.weebly.com.

ON THE WEB

More at ourhealthcville.com


Ask the Expert

T’ai Chi

THE GENTLE PATH TO

BETTER HEALTH words | RICK PIESTER

“After reviewing existing scientific evidence for its potential health benefits, I’ve concluded that the proper question to ask yourself may not be why you should practice T’ai Chi, but why not.” - Jane Brody, Personal Health Writer, the New York Times

The graceful, almost poetic movements of an ancient Chinese physical discipline are fast finding modern-day devotees seeking an effective, low-impact way to improve many aspects of their health. T’ai Chi (pronounced tie chee), with origins in the Chinese martial arts of the 12th Century, is the subject of mounting scientific and medical evidence of health benefits that range from better balance and lessened depression to improved heart health and reduced physical pain. It’s also high on many experts’ list of top methods to preserve good health. In Charlottesville, professionals at the Charlottesville T’ai Chi Center offer a variety of classes based upon the Cheng Ming form of T’ai Chi, a highly adaptable form of the exercises that bears much of the credit for the rising popularity of T’ai Chi in the United States. “The form can be tailored to different groups of people, depending upon physical limitations,” says Hiromi Hangai Johnson, the center’s lead instructor. A native of Tokyo, Johnson began studying T’ai Chi as a way

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THE C HEC K UP |

to help rehabilitate her own knees after surgery. She studied under T’ai Chi masters in Japan and in the United States before becoming certified as an instructor in 2008.

Ask the Expert

“T’ai Chi is for everyone, regardless of age and the gentle movements of T’ai Chi can be easily tailored for anyone, from the most fit athlete to people confined to a wheelchair or recovering from surgery.” - Hiromi Hangai Johnson

To make sure that the exercise is available to anyone, Johnson has created a simplified six-step (or movement) form of T’ai Chi from the 100-step foundation of the Cheng Ming approach. While the Charlottesville Center teaches the full 100-step version, the sixstep form is a popular way to learn T’ai Chi without fear of becoming overwhelmed by more complex versions. The six simple exercises are also non-strenuous and easy enough to be performed by older adults. The six-steps are further adapted for: •

People who are able to stand upright and move their legs. “This is a good foundation for further study of additional T’ai Chi movements,” Johnson notes.

Older people who have difficulty standing for a long period of time because of physical limitations. The exercises can be practiced while seated, and classes include a 103-year-old woman who uses the discipline to overcome pain and difficulty walking.

People who are physically or mentally challenged. It’s a valuable way for participants to work on coordination and motor skills.

Children improve focus and concentration with T’ai Chi practice, while gaining a strong sense of accomplishment.

Noting that T’ai Chi is often called “meditation in motion,” Johnson explains that the slow-flowing movements of the exercises help participants breathe naturally and focus attention on movement and balance within the body. “Physically, we gain balance, flexibility, cardiovascular fitness and strength, and more,” Johnson says. “Mentally, it helps develop confidence, and it reduces stress and anxiety. T’ai Chi can’t fix everything, but study after study has proven how it revitalizes our bodies in ways that help ward off serious illnesses. If only more people knew about it!” EXPERT CONTRIBUTOR Hiromi Hangai Johnson, lead instructor at the Charlottesville T’ai Chi Center.

ON THE WEB

More at ourhealthcville.com www.OurHealthCville.com

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HEALTH H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS

Diacetyl, the flavoring component used

in butter-flavored

microwave popcorn, is frequently used

in many e-cigarette

liquids. It is harmless if ingested (in

popcorn) but can cause a serious condition called obliterative bronchiolitis, or “popcorn lung,” if

inhaled in significant

I’ve heard that vaping causes a condition called “popcorn lung”. What is “popcorn lung” and how does vaping cause it? Electronic cigarettes, or e-cigarettes, are battery-powered devices that heat and vaporize a liquid mixture of nicotine and typically containing solutions with chemicals such as propylene glycol and/or vegetable glycerin. However, the health effects of vaping these heated components are unclear and potentially significant. Diacetyl, the flavoring component used in butter-flavored microwave popcorn, is frequently used in many e-cigarette liquids. It is harmless if ingested (in popcorn) but can cause a serious condition called obliterative bronchiolitis, or “popcorn lung,” if inhaled in significant quantities. This is a lung condition in which very small airways are progressively damaged, scarred and closed up. Eventually, this will result in a severe limitation of being able to breathe air in and out of the lung.

quantities. – Y. Michael Shim, MD

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How do I know what mattress will best support my sleeping position?

What are spacers and how long are they needed prior to braces?

The right mattress is the first part of the perfect sleep system. Choosing the right foundation for sleep, either flat or in a muscle-relaxing zero gravity position, is just as essential to a good night’s sleep. Many mattresses might initially feel similar, but will support your body differently depending on the base. With technology like ZeeZ from Grand Home Furnishings, our sleep experts can remove the guesswork from this equation. Pressure mapping the body will allow for customization of an in-stock sleep set for every person who enters the showroom. Finally, to complete the ideal sleep system, you need the perfect pillow. Everyone at some point has experienced neck or shoulder strain, headaches, and lost sleep from an improper pillow. Whether your sleep style is Armadillo, Cocoon, Cliffhanger, or Log, we have your complete sleep system available.

Separators, also referred to as “spacers,” are small, round pieces of elastic (rubber bands) that are used to create spaces between teeth.

Matt Cox Y. Michael Shim, MD

University of Virginia Health System Charlottesville | 434.924.5210 www.uvahealth.com

OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville

Grand Home Furnishings Charlottesville | 434.974.6480 www.grandhomefurnishings.com

Spacers are needed before placing molar bands (silver rings similar to a ring on your finger) on your back teeth. It is common for bands to be used on the back molars for different appliances, such as expanders. When two teeth are contacting, it can be difficult and uncomfortable to place a band around the desired tooth. This is where spacers come in handy. Spacers are placed with dental floss between the desired teeth to create space. It is ideal for spacers to stay in for at least three days and up to one week prior to band placement. This ensures that there is adequate space around the tooth, allowing the band to easily slide over it and giving the patient a comfortable and simple appointment.

Barton D. Weis, DDS

Charlottesville Orthodontics Charlottesville | 434.832.6630 www.charlottesvilleorthodontics.com


THE C HEC K UP | Q&A on Health

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HEALTH H E A LT H C A R E QUESTIONS ANSWERED BY LOCAL PROFESSIONALS

You could certainly encourage your mother to have her hearing checked annually, just like she has an annual physical or other health screenings. It is recommended that people have their hearing tested annually, beginning at age 55.

– Kristin Koch, AuD, F-AAA

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How do I know if my memory loss is the start of Alzheimer’s or if it’s just forgetfulness? Many people become concerned when they can’t find their keys or forget where they parked the car. Forgetting names and appointments, an occasional error in balancing the checkbook or temporarily loosing track of what day of the week it is may be considered typical age-related forgetfulness. However, forgetting important events, requiring help completing routine tasks, difficulty finding the words in a conversation or asking the same questions over and over may be a sign of something more serious. A decline in cognition is a symptom of many less serious conditions, many of which are treatable. If you are concerned, the best thing to do is seek medical advice. A thorough physical exam with appropriate blood work can rule out many conditions. If needed, your physician may order further neurological testing. Knowledge is far better than worry! Stacy Bowen

Regional Director of Nursing Commonwealth Senior Living at Charlottesville Charlottesville | 434.481.1631 www.commonwealthal.com

OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville

My mother’s hearing loss is beginning to have a noticeable effect on her social activities. How can I encourage her to have her hearing checked? This is a tricky question and one that we hear at our office almost every day. The honest answer is that you can’t force anyone to do something that they don’t want to do. You could certainly encourage your mother to have her hearing checked annually, just like she has an annual physical or other health screenings. It is recommended that people have their hearing tested annually, beginning at age 55. Another important factor is keeping her active and independent. Midlife hearing loss has now been identified as one of nine preventable risk factors for dementia. This makes identifying and treating hearing loss earlier much more important for her cognitive function and overall health. Correcting hearing loss through wearing hearing aids also reduces stress and strain, making her more likely to participate in conversations and activities.

Kristin Koch, AuD, F-AAA Evolution Hearing Charlottesville | 434.227.4100 www.evolutionhearing.com

Should I see my family care provider when suffering from cold symptoms? It will depend on symptoms, duration, and underlying chronic medical conditions. The symptoms of a common cold include fever, cough, runny nose, nasal congestion, sore throat, headache, and muscle aches. Colds are caused by respiratory viruses which concentrate in the nasal secretions and are transmitted through coughing, sneezing, and hand contact. They are self-limited and can last up to 10 days. Treatments are directed at symptom relief. There are no effective antiviral treatments and antibiotics are not effective for viruses. However, reasons to be seen in urgent care for a cold are: •

Symptoms are not improving with over-the-counter cold preparations and last more than a week.

You have a history of asthma, COPD, heart disease, diabetes, or other chronic medical conditions.

Your symptoms include wheezing, shortness of breath, chest pain, abdominal pain, intractable vomiting or diarrhea.

Daniel Parks, MD

Augusta Health Urgent Care Staunton, Stuarts Draft, Waynesboro and Weyers Cave www.agustahealth.com/urgent-care


THE C HEC K UP | Q&A on Health

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STATE OF

HEALTHCARE IN CHARLOTTESVILLE AND SHENANDOAH VALLEY words | BRANDON SHULLEETA

As the senior citizen population rises, health industry leaders from Charlottesville to the Shenandoah Valley continue to focus on ensuring medical facilities are expansive and modern, to meet growing health needs. Some of the recent developments and upcoming plans are impressive and signal that health leaders in the central and western swath of the state are being proactive in making sure residents are getting quality care. It’s no surprise the University of Virginia Health System is continuing to remain at the forefront of medical breakthroughs — a researcher recently developed a way to better track cancerous tumors, among other benefits of the technology, for example. There’s also little surprise Augusta Health, with a hospital and medical facilities in Augusta County, is positioning itself to improve upon patient care for the residents of its community with strong goals for 2020, while also dealing with insurance-related issues.

UNIVERSITY OF VIRGINIA MEDICAL CENTER POISED FOR MAJOR HOSPITAL EXPANSION The University of Virginia Medical Center’s hospital expansion project is one of the most extensive projects the University Medical Center has ever taken on. Construction for the expansion project has been ongoing since June 2016. There is approximately 425,000 square feet available for new space – roughly 50 percent of the size of the current hospital – and about 95,000 square feet of associated renovations. The project will expand the current emergency department into the adjacent site where the helipad used to be located. There will be an expansion of the surgical services suite on the second floor and the development of a six-story inpatient tower. The first two floors of the expansion are expected to be completed by the summer of 2019, with the first floor improving on the emergency department and the second floor as an interventional area. The improved ER will increase the capacity from 43 beds to 80 beds. The second floor will expand on the surgical services suite. It will include four new operating rooms, new cardiac catheterization labs and other procedural rooms. The third, fourth and fifth floors are expected to be completed near the end of 2019.

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FEATURES

The plan includes several other projects, such as: relocation of the MRIs from the annex pavilion, demolition of that existing pavilion, underground utility work at Lee Street and Crispell Drive and ambulance drop off areas. The expansion plan also includes renovations to the current hospital. These renovations are set to be completed in 2021.

SENTARA MARTHA JEFFERSON HOSPITAL OPENS SPORTS MEDICINE CENTER IN THE CHARLOTTESVILLE AREA Sentara Martha Jefferson Hospital launched the new year by opening the Sentara Sports Medicine Center at the Outpatient Care Center in the Pantops area of Albemarle County just outside of Charlottesville. The center was opened to the public on January 2nd with sports medicine physicians who have experience caring for athletes at every level of competence, from novice to Olympian, according to Sentara. The center will also rely on advanced techniques to help athletes dealing with everything from sprains and strains, to torn ligaments and tendons, dislocations and fractures. Both surgical and nonsurgical procedures will be performed at the center.

POWERFUL GLOW LIGHTS THE WAY TO MEDICAL BREAKTHROUGHS A University of Virginia School of Medicine researcher developed a way to better track cancerous tumors by making biological matter glow 100 times brighter. This tool – the bioluminescence reporter – will also help them to develop new drugs and treat and cure diseases. “It is approximately 100 times brighter than the most commonly used firefly luciferase, so it is basically 100 times more sensitive,” Hui-Wang Ai, PhD, of the Department of Molecular Physiology and Biological Physics says. “It means that you can better observe molecules, and if you are tracking, for example, a tumor migration, it means that you can track it much more accurately.”

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By using this tool, researchers and doctors could be able to see deeper into the tissue – about 15 to 150 times better – according to Dr. Ai. “By refining this technique, Dr. Ai has given scientists and medical researchers a new and better way to peer deep into tissues to better battle cancer and understand the roles of genes and to more easily develop new drugs and treatments to benefit scientists,” says Josh Barney, a spokesman for UVA Health. Barney says the new approach could lead to major breakthroughs. “This new approach offers advantages over previous methods because the shift in the color spectrum overcomes limitations that scientists view as they probe into the unknown,” Barney says. “This technique is much brighter than what has been used before and we hope it will help facilitate many new discoveries and medical breakthroughs.”

AUGUSTA HEALTH PARTS WITH ANTHEM Losing its contract with insurance carrier Anthem is among the biggest challenges this year facing Augusta Health, a medical powerhouse in the region. Augusta Health touts being the primary source of care for residents of Augusta County for the past 70 years, but disagreements over the rates Anthem would pay for healthcare led Augusta Health to drop Anthem at the end of 2017. Augusta Health no longer accepting Anthem could mean a big adjustment for many of the approximately 200,000 people who have access to its healthcare services. While emergency care services will still be provided, some patients could have to travel dozens of miles for some of their medical needs. Augusta Health has been negotiating with Anthem to make its services “in-network,” and Augusta Health has been encouraging local residents to call Anthem and ask that they provide “fair” rates


FEATUR ES |

Evident is Augusta Health’s commitment to serving its patients through the opening of the Augusta Health Anthem Member Assistance Center (AHAMAC). The center works one-on-one with individuals to evaluate his/her healthcare needs and provide several assistance and payment options. Patients are encouraged to contact the AHAMAC to discuss their specific circumstances. Some residents of Bath, Rockbridge and Highland counties also are among those receiving services from Augusta Health.

AUGUSTA HEALTH FOCUSED ON CONTINUED IMPROVEMENTS Augusta Health’s most recent Community Health Needs Assessment was completed in 2016 as a way to improve the health of their residents in Augusta County. In recent years, Augusta Health has set out to better understand the community’s healthcare and set goals for meeting those needs. With many of those goals marked for 2020, the healthcare provider is continuing to focus on improving in those areas this year. As part of Augusta Health’s 2016 Community Health Needs Assessment, for example, residents in Staunton, Waynesboro, Fishersville and the surrounding area, were invited to weigh in on the health needs of the people in the area. They found that nutrition, physical activity and weight were of the highest concern, followed by diabetes, mental health, heart disease and stroke, substance abuse, access to health care, cancer, tobacco, injury and violence, respiratory disease, dementia (including Alzheimer’s disease), chronic kidney disease and oral health.

AUGUSTA HEALTH ANTHEM MEMBER ASSISTANCE CENTER Augusta Health Business Office 221 Medical Center Circle | Fishersville

540.245.7565 Appointment Hours: Monday – Friday from 9AM to 6PM ahamac@augustahealth.com

After gathering this data, Augusta Health found that they could improve access to healthcare by increasing methods of transportation and primary care physicians. In 2012, Augusta Health found that their primary care physician-to-population ratio was well below the national and state average, something Augusta Health has been focused on improving. Their goal by 2020 is to create more access and affordability. They hope to increase the number of practicing primary care providers and to reduce the number of non-urgent emergency department visits. In 2014, the report found that cardiovascular disease (heart disease and stroke) and cancers accounted for half of all deaths in the area. By 2020, their goal is for more people know and be able to say whether their blood pressure is high through more screenings.

REMINDERS FROM

AUGUSTA HEALTH Emergency care is ALWAYS In-Network.

Lung cancer was the leading cause of cancer deaths, with its death rates, along with female breast and colorectal cancer, worse than the state and national rates.

Network does not matter for Medicare patients.

Their goal for 2020 is to improve upon the quality of life of cancer survivors as well as increase cancer screening programs.

Augusta Medical Group physicians are In-Network until January 31, 2018.

EXPERT CONTRIBUTORS Hui-Wang Ai, PhD, of the Department of Molecular Physiology and Biological Physics with the University of Virginia. Josh Barney, a spokesman for UVA Health.

ON THE WEB

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State of Healthcare in Charlottesville & Shenandoah Valley

comparable to rates being provided elsewhere. Exactly how the divide between Augusta Health and Anthem will pan out is still up in the air.


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FEATUR ES | Breaking the Silence: Organ Transplantation

Breaking the Silence:

Organ Transplantation words | SUSAN DUBUQUE

This series explores medical conditions and procedures that can be devastating to patients and their families, but that no one is talking about. We will talk openly about these disorders and dedicate our stories to the courageous individuals living with them and the health care providers and researchers committed to treating and curing these enigmatic diseases.

For five years, William “Dan” Andrews was tethered to a 45-foot length of tubing. His life, his every breath, depended on a chugging apparatus called an oxygen concentrator. Just leaving the house for dinner was an ordeal. It involved toting a 25-pound device along and watching the clock carefully to make sure its battery didn’t run down. But all that changed on June 7, 2017, when a single phone call gave Dan his life back. Always a prankster, Dan loves nothing more than teasing his wife Kathy and his four daughters, Annie, Liz, Lauren, and Meghan. But in 2012, Dan seemed to have lost his sense of humor and his zest for living. “Even the smallest effort left me feeling exhausted and breathless,” he recalls. “My wife finally convinced me to see a doctor.” After a trip to the emergency room and a short hospital stay, Dan learned he was suffering from severe chronic obstructive pulmonary disease (COPD), a progressive ailment of the lungs that causes reduced oxygenation, making it hard to breathe. “My lung capacity was only 13 percent of what it should have been, and the doctor immediately put me on oxygen and referred me to a pulmonologist, Dr. Donkor.” Dan continued to work, relying on an oxygen concentrator at the office to let him run his contracting business. “Even with the support of oxygen, I still tired easily,” he says. “It was a pretty depressing time for me.” But Dan isn’t one to stay down for long. He inquired about a pulmonary rehabilitation program he learned about through a brochure in his pulmonologist’s office. “My doctor thought it was a good idea and encouraged me to check it out,” says Dan. “I called Paula McNutt, the rehab nurse

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FEATURES

at Centra Southside Community Hospital, and she told me that each session would cost $250. So I quickly crossed that off my list. Fortunately, Paula looked into other options and called me back. She said I would only have to pay $40 per session, the equivalent of a doctor’s office visit.” Dan signed up and enthusiastically started the exercise and breathing regimen. “When Dr. Donkor retired in 2016, I started seeing Dr. John Plankeel, a pulmonologist in Lynchburg,” says Dan. “My first visit with him produced news — both good and bad. The bad news was that my tests showed that my pulmonary function was now only nine percent of normal. But the good news was that I might be a candidate for a lung transplant.” In May 2016, Dan went to the Transplant Center at UVA Health System for an evaluation. Four months later, he joined the waiting list for a double lung transplant. On June 7, 2017, at 1 PM, the transplant coordinator at UVA called Dan and asked him to come to the hospital immediately. “Fortunately, my oldest grandson overhead my part of the conversation,” says Dan. “Kathy and Lauren thought I was kidding.” But the family soon realized that this was really happening: Dan was getting a second chance at life. “We were excited and scared at the same time.” His go-bag was already packed, and at 3:30 PM Dan was admitted to the short-stay unit to wait until the lungs arrived. At 10 PM he was taken to pre-op, and by 11 PM he was in the operating room.

5k, and Lauren ran the half-marathon. It was a real celebration after all we had been through the past year,” says Dan. “I really believe that my fast recovery was in large part due to the pulmonary rehab program. Other than my lungs, I was basically in pretty good shape.” “Our whole family is incredibly grateful to UVA for giving us our father back,” says Lauren. “When we were young, Dad was involved in all our activities, like coaching our little league teams. I want my son Carter (11), and Annie’s children, James (13) and Sam (11), to have the same experience.” Meghan is recently married and is also excited that her future children will have the opportunity to know their grandfather. “It really is pretty amazing how the pieces just fell into place,” Dan recounts. “My primary care physician convinced me to go to the hospital. The hospital referred me to the pulmonologist, where I happened to see a brochure that led me to pulmonary rehab. Paula McNutt took the time to investigate the payment options so I could afford to participate in the program. My doctor retired, so I saw Dr. Plankeel, who in turn suggested the transplant. I truly believe this sequence of events involved more than just luck. There was a higher power up there pulling the strings.”

Kathy, Lauren, Annie, Meghan, and Meghan’s husband, Rob Orr, waited anxiously through the night. Dan’s life rested in the hands of Alexander Krupnick, MD, a thoracic surgeon in the UVA Health System. But the operation went flawlessly and was done by 3 AM “Dad was in his room by 5 AM and off the ventilator by noon,” Lauren remembers.

Dan’s life has changed in many ways since his transplant. “I’m semiretired now,” he says. “I want to enjoy every minute of every day. I have an immense feeling of gratitude. I am thankful for Paula McNutt for getting me back in shape so I was ready for surgery. For my transplant team — Drs. Weder, Kilbourne, and Mannem — who managed my care before my operation and keep me well now. And, of course, I am grateful for my surgeon Dr. Krupnik and his team. In fact, the whole staff at UVA — from the housekeepers and people who delivered my food, to the doctors and nurses — all treated me and my family with extraordinary care and compassion.”

Dan’s recovery was remarkable. Just three months after his surgery, he completed a local 5k. “Kathy and I walked and Meghan ran the

Today, Dan’s future looks bright. “My lung capacity is excellent,” he says. “Now I can devote my time to important things — like pestering

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FEATUR ES | Breaking the Silence: Organ Transplantation

“I don’t know who gave me this incredible gift, but I sometimes imagine that my donor was a man. And I envision that he had a family – perhaps two children. It saddens me to know someone had to die for my life to be restored. But I would like to assure my donor’s family that I will take very good care of my lungs and that a part of their loved one lives on.” - William ’Dan’ Andrews

my wife and grandkids, going fishing and turkey hunting, and getting back to fixing up my cabin in Cumberland County. It’s been lying dormant for five years and it needs some love and attention.” When Dan reflects on his life, he feels a deep connection to his organ donor. “I don’t know who gave me this incredible gift, but I sometimes imagine that my donor was a man,” says Dan. “And I envision that he had a family – perhaps two children. It saddens me to know someone had to die for my life to be restored. But I would like to assure my donor’s family that I will take very good care of my lungs and that a part of their loved one lives on.”

When it comes to healthcare, knowledge is power. So let’s learn more about organ transplantation: the number of people affected, the medical conditions that can require transplants, and the services that are available here in Virginia. If you think organ transplantation is a rarity, or if you assume that no one in your family will ever need a transplant, read on. The facts will astound you. More than 116,500 people in the United States are on the waiting list for a life-saving organ transplant. Even so, only 33,611 transplants were performed in the country last year. Every day, twenty people die while waiting for an organ and another person is added to the waiting list every 10 minutes. One day, that person could be you or a loved one.

Which organs can be transplanted? Most people are familiar with heart, kidney, and liver transplants, but you may be surprised to learn that the pancreas, intestines, and even hands and faces can be transplanted as well. Around 80 percent of the people on the list are waiting for a kidney, 12 percent for a liver,

What is COPD? COPD (chronic obstructive pulmonary disease) is a disease that causes reduced airflow to the lungs and makes it hard to breathe. It is also progressive, meaning that it worsens over time. COPD can include emphysema, chronic bronchitis, or both. Roughly 15 million adults in the US have been diagnosed with COPD, but millions more may not even know that they have it. Cigarette smoking is the most common cause of COPD, but other factors include long-term exposure to secondhand smoke, air pollutants, chemicals, and dust.

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FEATURES

3.4 percent for a heart, 1.2 percent for a lung, and 2.5 percent for another organ. Many medical conditions can lead to the need for an organ transplant. Kidney failure is most commonly linked to chronic high blood pressure and diabetes. Liver failure is not always the result of excessive alcohol use. It can also be due to hepatitis, viral infection, injection of a poisonous substance, or genetic disorders. A heart transplant may be needed due to weakened heart muscles (cardiomyopathy) resulting from coronary artery disease, heart valve disease, abnormal heart rhythms (ventricular arrhythmias), or congenital heart defects. Lung transplantation may be needed for a variety of conditions, such as cystic fibrosis, chronic obstructive pulmonary disease, pulmonary fibrosis, pulmonary hypertension, or sarcoidosis of the lung. A pancreas transplant — sometimes alongside a kidney transplant — may be needed for certain patients with diabetes.

percent of adults say they support organ donations, yet only 54 percent actually sign up as donors by checking the box on their driver’s licenses.

Where do I start if I need a transplant or want to donate an organ? The UVA Health System’s organ transplant program is celebrating its 50th anniversary this year. To date, more than 5,000 patients have received life-saving and life-altering organ transplants. There are nine transplant programs at UVA: adult heart, liver, kidney, lung, pancreas, and islet-cell, and pediatric heart, liver, and kidney. If you or a loved one needs an organ transplant, or if you would like to learn more about donating an organ, please contact: UVA Health System Transplant Program

800.257.0757 for heart and lung transplants or 800.543.8814 for kidney, liver, pancreas, and islet cell transplants Each program involves of a multidisciplinary team that includes physicians, nurses, a nutritionist, a social worker, a financial coordinator, a pharmacist and a neuropsychologist. Some of the members of the lung transplant team are:

The impact of being a donor is far reaching. One person can donate up to eight lifesaving organs: heart, liver, pancreas, two lungs, two kidneys, and intestines. In addition, donated tissues — including skin, bone, veins, cartilage, tendons, and ligaments, as well as the cornea, middle ear, and heart valves — can save or dramatically improve the quality of life for their recipients. As an organ or tissue donor, your generosity can have a remarkable effect on the lives of up to 50 people.

Jose Oberholzer, MD, Director of the Charles

O. Strickler Transplant Center, UVA Health System Max Weder, MD, Pulmonary and Critical Care

Medicine

What is a living donor? About 40 percent of donated organs come from living donors — typically a relative or friend of the patient. With so many people on the waiting lists, a living donor can shorten wait times significantly and improve transplant outcomes. For example, a kidney from a living donor lasts longer than one from a deceased donor. And even if a willing donor is not a good match with a loved one, the hospital can coordinate an organ exchange or organ chain to pair up compatible donors and recipients. And then there are Good Samaritan or altruistic donors — people like Laurie Miller of Harrisonburg, who donated one of his kidneys to an unknown recipient. Miller is the director of student programs at Eastern Mennonite University. He grew up in the Church of the Brethren and is now a member of the Mennonite Church. His faith is what motivated him to look for opportunities like this to help others. We could make a huge dent in the waiting list if more people would consider organ donation, either living or deceased. In the U.S., 95 32

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Hannah Mannem, MD,

Pulmonary and

Critical Care Medicine Sarah Kilbourne, MD, Pulmonary and Critical

Care Medicine Alexander

Krupnick,

MD,

Thoracic and

Cardiovascular Surgery Christine Lau, MD, Thoracic and Cardiovascular

Surgery

REFERENCES Donate Life America: donatelife.net United Network for Organ Sharing: unos.org U.S. Government Information on Organ Donation and Transplantation: organdonor.gov

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FEATUR ES | Keeping Your Health in the Game of Life

words | CATHERINE BROWN

We all know what we’re supposed to do to live a long, healthy life: eat fruits and vegetables, exercise every day, and avoid smoking or overindulging in alcohol and sweets. It seems so easy, but sometimes life just gets in the way. We work long hours and can’t find the time to shop or prepare healthy meals. Or we don’t have the money to join a gym, or the energy to work out. And it’s overwhelming to keep up with regular visits to primary-care physicians, dermatologists, and dentists. Unfortunately, if we don’t make time for a healthy diet, exercise, and medical visits, it can lead to a multitude of health problems, including diabetes, high blood pressure, heart disease, and even cancer. These conditions can profoundly alter our lives and those of our loved ones if we don’t work actively to stay healthy. Of course, some of us do all the right things, keeping fit and eating well through childhood and adulthood, but still end up with a debilitating disease because of genetics or just plain old bad luck. When that happens, are we doomed to suffer the rest of our lives? With the right attitude and the willingness to make health a priority, we can mitigate the impact of health problems on our lives. We can manage and sometimes reverse difficult health conditions by improving our habits, consulting knowledgeable healthcare providers, educating ourselves, and maintaining a positive outlook. Robert M. Kyler, MD, a radiation oncologist with Augusta Health, encourages his patients to be optimistic and hopeful when facing health problems. “Staying positive does have an impact on how they feel from an emotional standpoint,” Dr. Kyler says. “The less tangible aspect of hope, I believe, is that it can have a positive impact on the effectiveness of treatment.” In this article, several patients from the Charlottesville area share their experiences overcoming health difficulties and getting back on track. Some of their medical providers also share insights into coping with major health problems.

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FEATURES

HEALTH CONDITION

Lung Cancer ISSUES HAROLD EXPERIENCED No known symptoms; effects of six weeks of radiation therapy and chemotherapy

MEDICAL PROVIDER

Robert Kyler, MD Radiation oncologist, Augusta Health

Harold Knight AGE 56

D

espite his lung cancer diagnosis, Harold Knight considers himself lucky. Although he used to smoke, he never took a sick day in his life. “They always say I was a tough old guy,” he says. “I had never been sick before.” Then, about a year and a half ago, Knight fell while walking in the mountains. He consulted his primary-care physician, who didn’t seem particularly concerned. Knight, however, felt sure that something was wrong. He kept complaining until his provider x-rayed the spot. Knight was smart to listen to his instincts: the X-ray revealed a tumor in his lungs the size of a lime on the exact spot where he had fallen.

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recommendations, mention any symptoms and side effects, and continue to ask questions.” Dr. Kyler also recommends that patients stay active and eat healthfully throughout the treatment process. “Continue with an exercise regimen to the degree possible,” he says, “and you will be better able to withstand the rigors of treatment.” Knight did just that, and it seems to have helped him cope with the challenges of undergoing radiation and chemotherapy.

Knight was treated by Robert Kyler, MD, a radiation oncologist with Augusta Health in Fishersville. From the beginning, Knight appreciated Dr. Kyler’s warmth and accessibility. “His caring has helped me get through the process,” says Knight. “When you work with someone who appreciates you, you feel better.” Knight underwent radiation therapy five days a week for six weeks with Dr. Kyler, and thankfully, the tumor disappeared.

Knight says that Dr. Kyler and his team have helped him remain positive throughout the process. “They took away the thought of dying,” he says. “They made me feel like I’ll be fine, and I believe in that.” Dr. Kyler finds that, paradoxically, it is sometimes harder to manage emotions after treatment is done, because then the patient and provider are no longer actively fighting the cancer but simply monitoring it periodically. Knight visits Dr. Kyler’s office every six months for scans to ensure that his cancer has not returned, and he gets nervous before these appointments.

For patients with cancer, Dr. Kyler advises educating themselves as much as possible: “Make sure you understand everything you can about the diagnosis and recommendations, gather information about all the options, ask questions, and get comprehensible answers. Then, during treatment, follow

Dr. Kyler strongly encourages patients not to identify themselves by their diagnoses. “Mr. Knight is aware of the fragility of life, but he hasn’t let this experience define who he is,” he says. Although Knight still worries, he has found the strength and energy to return to the mountains he loves.

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FEATUR ES |

HEALTH CONDITION

Keeping Your Health in the Game of Life

Heart Attack ISSUES JOSEPH EXPERIENCED Chest pain, neck pain

MEDICAL PROVIDER

Brandy Patterson, MD UVA Heart and Vascular Center

Joseph Wood AGE 69

V

ietnam veteran Joseph Wood has met his share of health challenges. He survived cancer, and now he has diabetes, a disease to which he is genetically predisposed. When he was younger, he was very athletic; he ran for exercise and worked for a moving company. Over the years, however, he gained weight—in part, he jokingly explains, because his wife of forty years is an excellent cook. In 2005, Wood experienced shortness of breath and pains in his neck and shoulder. At the time, he worked in guest relations for the University of Virginia Health System, so he visited the emergency department there for a battery of examinations, including a stress test and several scans. They revealed that Wood had three blockages in his heart, so he then underwent triple bypass surgery. “The next day, I was fine,” Wood says. “I recuperated faster than they thought.” After this, Wood went through cardiac rehabilitation with Brandy Patterson, MD, who specializes in cardiovascular medicine. “He completed it with flying colors,” she says. But two years ago, Wood started experiencing neck pain again. This time he was diagnosed with arthritis. “Even though the

symptoms were different than prior to his coronary artery bypass grafting,” Dr. Patterson says, “I was suspicious that these symptoms were secondary to worsening coronary artery disease, especially given the age of his bypass grafts.” The stress test showed a reduction in Wood’s heart function, so she offered him cardiac catheterization. Since these events, Wood has worked to change his lifestyle and improve his health. He is retired, so he makes time to exercise every day. He also worked with a nutritionist and now eats healthier portions of healthier foods. As a side benefit, his sugar levels have improved dramatically, and he once again has the energy to participate in the activities he loves, like raising money for veterans and teaching schoolkids about the flag. Through these challenges, Wood learned the importance of paying attention to his body and following up with his physician. Dr. Patterson seconds that advice: “Never underestimate symptoms. Make sure you are not dealing with heart disease, which can be life threatening, before blaming your symptoms on aging, getting older, arthritis, or reflux.”

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HEALTH CONDITION

Obesity ISSUES ILENE EXPERIENCED Hypertension, diabetes, sleep apnea, acid reflux

MEDICAL PROVIDER

Jayme Stokes, MD Bariatric Medicine, Sentara Martha Jefferson Medical & Surgical Associates

BEFORE

AFTER

Ilene Stevens AGE 60

I

n 2016, Ilene Stevens consulted Jayme Stokes, MD at Sentara Martha Jefferson Medical & Surgical Associates about undergoing bariatric surgery. Stevens was obese and suffering from multiple associated health conditions, including hypertension, sleep apnea, diabetes, and acid reflux. “I was taking a great deal of meds,” Stevens says, “and I knew my life expectancy was being reduced.” Stevens and Dr. Stokes discussed her options. “She had not found long-term success with dieting,” Stokes says, “and was looking for a more permanent solution.” Because of her BMI (body mass index) and related conditions, Stevens was a good candidate for gastric bypass surgery, one of the two main operations Dr. Stokes performs. After the surgery, Stevens met with Dr. Stokes’ team, which included a nutritionist, for regular follow-ups. For bariatric surgery to succeed, patients must make a commitment to improving their eating and exercising habits. Dr. Stokes says that Stevens has done that well: “She treated the operation and recovery as a second 38

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job: she took it seriously, she did her homework, and she understood the changes she needed to make.” Dr. Stokes strongly encourages patients to read as much reliable information as they can and to talk to people who have been through the same thing. “This is a major lifestyle change,” Dr. Stokes says, “and you can never be too informed.” Stevens’ persistence and attention to detail have really paid off. A year after the surgery, she has lost more than 80 pounds. When describing the major changes she has undergone since, she says, “I now exercise regularly and can walk five miles at a time. I follow the high-protein, low-fat, nosugar diet, and I only eat 50 [calories of] carbohydrates a day. It can be a struggle at times, but I remind myself where I was a year ago.” Her renewed energy and peace of mind are worth the sacrifices.

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WOMEN’S HEALTH

Hold Firm TREATING SAGGY BREASTS Options for women range from supportive bras to surgery words | BRANDY CENTOLANZA

Many pregnant and nursing women experience changes in the shapes of their breasts, which could result in ptosis, or saggy breasts. Is there anything that can be done to alleviate the condition? “There are multiple causes of saggy breasts,” says Saied Asfa, MD, a board-certified plastic and reconstructive surgeon with Asfa Plastic Surgery and Medical Spa in Harrisonburg. Dr. Asfa specializes in the condition. Pregnancy and breastfeeding, weight fluctuation, and age and gravity may all play a role. Skin loses elasticity as women grow older, so breasts naturally begin to droop. “It is very common as a result of pregnancy,” says Dr. Asfa. “It could also be heredity.” Multiple pregnancies, a higher body mass index, and a larger breast cup size may also contribute to ptosis. There are three classifications of sagging breasts ranging from mild to severe, depending on the position of the breast nipple. The most severe cases are when the nipple falls below the infra-mammary fold, which is where the underside of the breast attaches to the chest wall. Diet and exercise or pills or creams that claim to help with saggy breasts do not work, according to Dr. Asfa. “There is not much that you can do to prevent saggy breasts,” he says. “A supportive bra could help, but that is not 100 percent.” Dr. Asfa recommends a bra with an underwire. 40

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For many women uncomfortable with droopy breasts, the best option may be plastic surgery, particularly a procedure known as mastopexy, or a breast lift. During a breast lift, excess skin is removed and breast tissue is reshaped to better firm and raise the breasts. It is routinely performed on women with saggy breasts or whose nipples point downward. Mastopexy only changes the shape of the breasts, not their size, though the surgery can be done in combination with a breast augmentation or breast reduction. “A breast lift is one of our most common procedures,” Dr. Asfa says. Breast lift surgery has increased by 70 percent since the year 2000. Lori Ross, one of Dr. Asfa’s patients, had a breast lift five years ago at the age of 45. She opted for the procedure in part because she had developed cysts in her breasts that needed to be removed. “I wish I had done it sooner,” Ross says. “The procedure and the recovery were better than expected. It was amazing. It’s been a few years, and my breasts are still where they should be.” Mastopexy is not covered by insurance, since it is considered a cosmetic procedure. Most issues with saggy breasts are cosmetic, although in the most severe cases, some women develop a fungal infection underneath the breast skin, where moisture from perspiration may become trapped. This situation would be considered a medical condition, and therefore if the breasts are very large with existence of the fungal infection, the corrective procedure may be covered by insurance.


WOMEN’S HEALTH |

“It is mostly an issue with women just not happy with the shape of their breasts following pregnancy, breastfeeding, or from gaining or losing weight,” Dr. Asfa says.

“That’s typically when breasts have returned to their normal size,” Dr. Asfa concludes. EXPERT CONTRIBUTOR

Hold Firm: Treating Saggy Breast

Recovery time from a breast lift is typically ten days to two weeks, depending on the technique. The surgery is not painful, although some women might experience a change in the sensation of their nipples. Roughly 30 percent of women are unable to breastfeed again after the surgery. These are all factors Asfa suggests women take under consideration before opting for plastic surgery. He advises consulting with a board certified surgeon before making any decisions. It is recommended that women also wait four to six months after they are done breastfeeding before having any surgery.

SAIED ASFA, MD, FACS A board certified plastic and reconstructive surgeon, and a member of the American Society of Plastic Surgeons.

Saied Asfa, MD, FACS is a board certified plastic and reconstructive surgeon, and a member of the American Society of Plastic Surgeons.

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For before and after photos of a mastopexy and other plastic and reconstructive surgeries by Dr. Asfa, view the article on our website at www.ourhealthcville.com.

ASFA PLASTIC SURGERY AND MEDICAL SPA 1502 Brookhaven Drive | Harrisonburg, VA | 540.432.0303 | www.asfaplasticsurgery.com COMPREHENSIVE PLASTIC AND RECONSTRUCTIVE SURGICAL SERVICES

Whether you are interested in a cosmetic or reconstructive procedure, Dr. Saied Asfa will help you achieve your goals with beautiful, natural results. Known for his compassionate care and surgical expertise, Dr. Asfa is a Board Certified plastic and reconstructive surgeon and a member of the American Society of Plastic Surgeons. With decades of surgical experience, Dr. Asfa and his friendly staff are committed to making your experience as comfortable and rewarding as possible.

PERSONAL CONSULTATIONS

During your initial consultation with Dr. Asfa, he will talk with you to learn about your personal situation, unique needs and desired goals. He will advise you of the potential results of the procedures you discuss and share before and after photos. He will provide you with the utmost care and compassion, and will take the time to make ensure that all of your questions and concerns have been discussed. Dr. Asfa’s goal is to make every patient comfortable with their decision for cosmetic or reconstructive surgery.

MEDICAL SPA SERVICES Our medical spa is the only facility of its kind in the region that is overseen by a Board Certified plastic and reconstructive surgeon. Offering the most scientifically proven skincare treatments and anti-aging procedures, our medical aestheticians will carefully assess your skin and develop a treatment plan and long-term goals. All treatments are personally customized for each patient’s individual needs. All medical grade skincare products and treatments recommended by our aestheticians are also

SAIED ASFA, MD, FACS Board Certified Plastic Surgeon

monitored by Dr. Asfa.

For a complete list of award winning services and procedures offered at Asfa Plastic Surgery and Medical Spa, visit www.asfaplasticsurgery.com.

www.OurHealthCville.com

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CHILDREN & TEENS

Don’t Pass the Bread WHY IS CELIAC DISEASE ON THE RISE IN KIDS? words | BRANDY CENTOLANZA

Celiac disease, a digestive disease that affects the small intestine, appears to be on the rise in children. What is the cause of this disease, and how does it impact the children who contract it? “Celiac disease is an autoimmune disease that primarily injures the upper gastrointestinal tract with inflammation leading to symptoms of maldigestion and malabsorption such as diarrhea, bloating, abdominal pain, anemia, poor weight gain and growth,” says Barrett H. Barnes, MD. Dr. Barnes is a pediatrician and associate professor with the division of Gastroenterology, Hepatology, and Nutrition at the University of Virginia’s Children’s Hospital in Charlottesville. “Although it primarily affects the gastrointestinal tract, celiac disease is a systemic disease and may also affect other organ systems, including the skin, bones and nervous system,” Dr. Barnes says. BARRETT H. BARNES, MD A pediatrician and associate professor with the division of Gastroenterology, Hepatology, and Nutrition at the University of Virginia’s Children’s Hospital in Charlottesville.

While the exact cause of celiac disease is unknown, some research studies indicate that it could be hereditary, meaning that it only occurs in people with a particular set of genes and tends to run in families. Other studies suggest that there may be a link between respiratory infections in children and the development of the disease. “Gluten, a protein found in wheat, rye and barley, is the primary trigger for the immune response in celiac disease,” notes Dr. Barnes. “We do not know why at-risk individuals move from being tolerant to this protein to intolerant.” Those who develop the disease must have the specific genes and must consume foods or drinks containing gluten to cause symptoms. The sensitivity to gluten appears almost immediately in some individuals, while others may not have a reaction for years. This could mean that other environmental factors are involved, including gastrointestinal and respiratory infections. Certain organizations, including the Celiac Disease Foundation (CDF) and the

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“Current studies are looking at additional genetic factors, family, and environmental factors including diet, early infection and antibiotic use to potentially prevent disease occurrence as well as other potential therapies besides diet, such as preventing the digestion of gluten by the GI tract into a form that promotes an immune response.”

Don’t Pass the Bread

“Current studies are looking at additional genetic factors, family, and environmental factors including diet, early infection and antibiotic use to potentially prevent disease occurrence as well as other potential therapies besides diet, such as preventing the digestion of gluten by the GI tract into a form that promotes an immune response,” says Dr. Barnes.

CHILDREN & TEENS |

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), continue to study the disease and lead efforts to educate and advocate for those who have it.

- Barrett H. Barnes, MD

No matter how children develop the disease, however, it is important to stay on top of it. Children with celiac disease must adhere to a strict diet, eliminating all foods and drinks that contain gluten. An appointment with a dietician is recommended as well as routine checkups to ensure that the disease is not impacting growth and physical development. “Children and adults develop the disease in the same manner,” Dr. Barnes points out. “It is still unclear as to why some individuals develop the disease as children and others as adults. Once the diagnosis is made, children are placed on a strict gluten-free diet that eliminates all wheat, rye and barley.” EXPERT CONTRIBUTOR Barrett H. Barnes, MD is a pediatrician and associate professor with the division of Gastroenterology, Hepatology, and Nutrition at the University of Virginia’s Children’s Hospital in Charlottesville.

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AGING WELL

Transition Timing Too young to talk about Senior Living? Think Again. words | BRANDY CENTOLANZA

As people grow older, they are often faced with the decision to remain in their homes or move into retirement communities. What should seniors keep in mind when considering downsizing and moving into an independent living community, and when exactly should they make this major decision?

DANA FULK The Community Relations Coordinator for Our Lady of Peace in Charlottesville.

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“It is never too early to begin your search for the retirement community that will best fit your needs,” says Dana Fulk of Our Lady of Peace Retirement Community in Charlottesville. “There are many things you may want to consider when starting your search. For instance, some communities have wait lists, so it’s best to begin planning at least five years in advance. Preplanning will give you peace of mind,” Fulk says. Preparing for a move well in advance is less stressful, as it gives seniors time to work out their finances and let go of the memories and possessions associated with their previous homes. Some people find it daunting to part with the lifestyle they’ve always

OurHealth | The Resource for Healthy Living in the Shenandoah Valley and Charlottesville


AGING WELL | Transition Timing

known, and others feel they just aren’t ready to take the next step, but there are plenty of benefits to living in a retirement home. These include a safe and secure community, freedom from worries about household and lawn maintenance, and easy access to healthcare. “One of the most frequent questions we get is ‘What happens when I need more care?’” notes Fulk. “No one wants to think they are going to need help, but the reality is most of us will, and when you are choosing a retirement community you may want to ask about their continuum of care. Can you move in as an independent resident and then transition to other levels of care as you need them?” Other things to consider are whether to rent or buy; what type of floor plan you want; whether to live in a place with social activities, clubs, and events; the amenities you want, including meals and transportation; the proximity of your neighbors; and what kind of healthcare and wellness services are provided. Is a licensed nurse available on site and around the clock? How friendly and welcoming is the staff? Can you envision yourself living there?

“Make a list of your favorite activities and ask for the current newsletter or activity calendar to be sure your social interests will be met,” Fulk suggests. “Location is also important. Is the community close to your family and friends? What about your physician and local hospitals? Shopping and dining spots?” If the move itself is something you dread, it’s important to note that some communities offer move-in incentives, providing seniors with turnkey services for downsizing, packing, and unpacking. Before you decide which community is right for you, do your research. Speak with representatives and express your needs and wants. “It is always best to visit several communities and then narrow them down,” Fulk recommends. “Revisit as often as possible. Ask if you can come for a meal or join in for an activity that may interest you. You will know when you have found the right community. You will feel it in your heart.” EXPERT CONTRIBUTOR Dana Fulk with the Our Lady of Peace Retirement Community in Charlottesville.

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NUTRITION

Get Pumped

WITH

HEART HEALTHY EATING TIPS words | MICHELLE MCLEES

The New Year is a perfect time to reflect on the past 12 months and assess what habits you want to take with you, and what you want to leave behind. Remember: it takes 21 days to make a habit and only one day to break it. To ensure your success, the American Heart Association recommends following these rules:

Make lifestyles changes to your diet by knowing what to keep, what to moderate and what to kick!

What to Keep:

1

CHOOSE WISELY, EVEN WITH HEALTHIER FOODS:

Ingredients and nutrient content can vary by brand and preparation.

2

COMPARE NUTRITION INFORMATION ON PACKAGE LABELS:

Select products with the lowest amounts of sodium, added sugars, saturated fat and trans fat and no partially hydrogenated oils.

Fruits and Vegetables | Nuts and Seeds | Beans and Legumes | Fat-free and Low-fat Dairy Products Whole Grains | Fish, Skinless Poultry, and Plant-based Alternatives | Healthier Fats and Nontropical Oils

What to Moderate:

Fatty or Processed Meats (if you choose to eat red meat, select the leanest cuts) | Saturated Fat Sweets and Added Sugars (including sugar-sweetened beverages) | Sodium and Salty or Highly Processed Foods

What to Kick: Trans fats, partially hydrogenated oils and excessive calories

3

WATCH YOUR CALORIE INTAKE:

To maintain weight, consume only as many calories as you use up through physical activity.

4

IF YOU WANT TO LOSE WEIGHT:

Consume fewer calories or burn more calories.

5

EAT REASONABLE PORTIONS:

6

EAT A WIDE VARIETY OF FOODS:

7

LOOK FOR THE HEART-CHECK MARK:

Often this is less than you are served.

This is the best way to get all the nutrients your body needs. Prepare and eat healthier meals at home: Youâ&#x20AC;&#x2122;ll have more control over ingredients.

Easily identify foods that can be part of an overall healthy diet. Learn more at heartcheck.org.

www.OurHealthCville.com

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NUTRITION

COOL CUCUMBER DIP SERVES 8 | Two tablespoons per serving Crushed toasted almonds provide crunch, and the just-right seasoning blend adds zing to this unusual dip. It’s convenient and stress-free for parties. You can make it up to four days in advance and serve it with colorful precut vegetables.

INGREDIENTS 1/4 cup plus one tablespoon sliced almonds 3/4 cup fat-free sour cream 1/4 medium cucumber, peeled, seeded, and coarsely chopped (about 1/2 cup)

2 medium green onions, cut into 1/2-inch pieces 2 teaspoons red wine vinegar 1

NUTRITION ANALYSIS (PER SERVING): Calories: 47, Total

Fat: 2.0g, Saturated Fat: 0.0g, Trans Fat: 0.0g, Polyunsaturated Fat: 0.5g, Monounsaturated Fat: 1.0g, Cholesterol: 4mg, Sodium: 20mg, Carbohydrates: 5g, Fiber: 1g, Sugars: 2g, Protein: 2g, Dietary Exchanges: 1/2 carbohydrate

HEALTH BENEFITS OF EATING MORE CUCUMBERS NATURAL HYDRATION: Cucumbers are made up of 96 percent water, therefore they are an excellent source of hydration.

VITAMIN C: Cucumbers are loaded with Vitamin C, an antioxidant that protects the body against illness due to damaged cells.

VITAMIN K: The peel of a cucumber is loaded with Vitamin K. Like

vitamin A, vitamin K plays a role in building bone, as well as other tissues of the body.

POTASSIUM: This mineral, also found in cucumbers, aids in metabolic functions and also plays a role in the development of muscle tissue.

source: Livestrong

teaspoon salt-free extra-spicy seasoning blend

DIRECTIONS 1.

In a medium skillet, dry-roast the almonds over medium heat for three to four minutes, or until golden brown, stirring occasionally. Put one tablespoon almonds in a small bowl. Set aside to use as a garnish.

2.

In a food processor or blender, process the remaining almonds for three to five seconds, or until coarsely crushed (1/4-inch irregular pieces). Transfer to a medium serving bowl.

3.

Process the remaining ingredients until the desired consistency, five to ten seconds if you prefer a chunky texture, 15 to 20 seconds for smooth. Stir into the crushed almonds.

4. To serve, sprinkle with the reserved almonds.

COOK’S TIP For a decorative presentation, peel a medium cucumber in lengthwise strips about 1/2 inch wide and 1/2 inch apart, leaving 1/2-inch strips of peel intact. Cut the cucumber crosswise into 3/4-inch slices. Using a melon baller or the tip of a small spoon, partially hollow out the slices, making little cups with enough of one end intact to hold the filling in place. Spoon the filling into the cups.

This recipe is brought to you by the American Heart Association’s Go Red For Women movement. Recipe copyright © 2005 by the American Heart Association. Look for other delicious recipes in American Heart Association cookbooks, available from booksellers everywhere or online at americanheart.org/cookbooks.

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NUTR I TI O N |

SERVES 4 | Three ounces fish and one tablespoon pesto per serving Vibrant orange salmon fillets get a double dose of crunchy almonds, one in the pesto and one in the topping. The lovely green pesto is easy to make and gets a delightful flavor boost—without salt—from the garlic-herb seasoning blend. For a quick and pretty dish, scatter the almonds over the surface, as instructed below. If you prefer a fancier presentation, after spreading the pesto over the salmon, slightly overlap the almonds on the fillets to resemble fish scales, then bake as directed.

INGREDIENTS CILANTRO PESTO 1/2 cup loosely packed fresh cilantro

NUTRITION ANALYSIS (PER SERVING): Calories: 206, Total

Fat: 9.5g, Saturated Fat: 1.5g, Trans Fat: 0.0g, Polyunsaturated Fat: 3.0g, Monounsaturated Fat: 4.0g, Cholesterol: 66mg, Sodium: 129mg, Carbohydrates: 2g, Fiber: 1g, Sugars: 0g, Protein: 28g, Dietary Exchanges: 3 1/2 lean meat

3

tablespoons fat-free, low-sodium chicken broth

2

tablespoons sliced almonds

2

tablespoons shredded or grated Parmesan cheese

1

teaspoon salt-free garlic-herb seasoning blend

SALMON 4 salmon fillets (about four ounces each), rinsed and patted dry

1/4 cup sliced almonds

HEALTH BENEFITS OF EATING MORE

DIRECTIONS

SALMON

OMEGA 3 FATTY ACIDS: The body cannot create Omega 3 on its own and requires intake from food or vitamins in order to supply the nutrients. Omega 3 reduces the risk of heart disease.

PROTEIN: Salmon contains up to 58 percent of the daily required

intake of protein per four-ounce serving. The protein found in salmon helps the body maintain metabolism at levels to promote weight loss.

VITAMIN ENRICHED: A three-ounce baked fillet will give you

more than 40 percent of your daily intake of vitamin B-12; over 30 percent of niacin; over 25 percent of vitamin B-6 and more than 10 percent of thiamin and pantothenic acid.

1.

Preheat the oven to 400°F. Line a baking sheet with aluminum foil or lightly spray with cooking spray.

2.

In a food processor or blender, process the pesto ingredients for 15 to 20 seconds, or until slightly chunky.

3.

Place the fillets about two inches apart on the baking sheet. Spread the pesto evenly over the top of the fillets. Sprinkle with 1/4 cup almonds.

4. Bake for 10 to 12 minutes, or until the fish flakes easily when tested with a fork.

source: Livestrong

This recipe is brought to you by the American Heart Association’s Go Red For Women movement. Recipe copyright © 2005 by the American Heart Association. Look for other delicious recipes in American Heart Association cookbooks, available from booksellers everywhere or online at americanheart.org/cookbooks. www.OurHealthCville.com

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Heart Health Recipes

SALMON WITH CILANTRO PESTO


NUTRITION

PINEAPPLE UPSIDE-DOWN CAKE SERVES 8 Say aloha to a heart-healthy version of an American favorite. This cake recipe has the familiar rich, fruity taste and topping of caramelized pineapple rings, but has shed the excess sugar and replaced the unhealthy fats in the batter with mashed banana. Covered with a design of pineapple rings but with banana used in place of additional fat in the recipe, this isn’t just impressive on the eyes, it’s also a healthy cake that tastes indulgent.

DIRECTIONS 1.

Preheat the oven to 350°F.

2.

Make the pineapple glaze: Drain pineapple juice from the canned pineapple slices (about one cup) into a medium heavy-duty pot. (Reserve pineapple slices.) Add low-calorie brown sugar blend and ¼ cup no-calorie granulated sweetener into the pot and bring to a boil over high heat. Let boil until bubbly and reduced by about one-fourth, around eight to ten minutes. (Make sure to keep an eye on it while boiling in case it reduces quickly.) Remove from heat; the amount of liquid should be around ¾ cup.

3.

Coat a 9-inch cake pan with cooking spray. Pour the pineapple glaze into the dish. Arrange as many pineapple rings as will fit over the glaze—about seven. Reserve the remaining pineapple rings.

NUTRITION ANALYSIS (PER SERVING): Calories: 188, Total

Fat: 3.3g, Saturated Fat: 0.6g, Trans Fat: 0.0g, Polyunsaturated Fat: 0.8g, Monounsaturated Fat: 1.6g, Cholesterol: 47mg, Sodium: 187mg, Carbohydrates: 35g, Fiber: 2g, Sugars: 17g, Protein: 4g, Dietary Exchanges: 1 fruit, 1 starch, 1/2 other carbohydrate, 1 fat

INGREDIENTS 1

(20-ounce) can pineapple slices in juice, undrained

1/4 cup low-calorie brown sugar blend 3/4 cup granulated, no-calorie sweetener (divided use) 1

cup all-purpose flour

1

teaspoon baking powder

4. Meanwhile, into a small bowl, add all the dry ingredients: ½ cup no-calorie, granulated sweetener, flour, baking powder, baking soda, cinnamon, and salt. 5.

1/2 teaspoon baking soda 1/2 teaspoon cinnamon 1

medium ripe banana (peeled, chopped)

1

tablespoon canola oil

1

tablespoon water

Into a large bowl, add the chopped banana. Use a fork to mash the banana. Add oil, water, eggs, buttermilk, and extract into the bowl with the banana, stirring together to combine. Stir in the dry ingredients until mixed together. Chop remaining pineapple rings and stir into the batter.

2 large eggs

6. Pour batter over the pineapple rings. Bake in the oven until a toothpick inserted in the center of the cake comes out clean, about 50 minutes.

½ cup 1 percent buttermilk

7.

1

teaspoon vanilla extract

pinch of salt

Remove cake from the oven and let cool 10 minutes. Run a butter knife along the edges of the cake pan to make sure the cake won’t stick. Place a plate on top of the pan and use pot holders to flip cake over to invert. Serve warm or at room temperature.

Copyright © 2017 American Heart Association, Healthy For GoodTM, heart.org/healthyforgood

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OurHealth Cville & ShenVA Jan/Feb 2018  
OurHealth Cville & ShenVA Jan/Feb 2018