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Summer 2012


The HealthTalk Edition written and produced by Andrew Scott Brooks All content reviewed by Dr. Saria Saccocio, Chief Medical Officer, Kelly Fitzgerald, Director of Marketing and Leslie Smith, Director of Community Relations for Danville Regional Medical Center

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Summer Safety Summer is the season of fun. It’s also the season when things can go wrong in a hurry. So as you prepare for get-togethers and getaways, remember to plan ahead. Pay close attention to the four elements of summer: Heat, Water, Food, and Skin. And remember, dress appropriately, stay hydrated, use sunscreen, and find the shade.

Consider Food Safety This Fourth of July In the summer and particularly on the Fourth of July, barbecues are a way of life. From grilled burgers and chicken to homemade potato salad and coleslaw, nothing beats a barbecue – especially when food safety remains a priority. According to the Centers for Disease Control and Prevention (CDC), one out of six people in the United States suffer a food-borne illness each year. As a result, more than 100,000 are hospitalized and 3,000 die. The young, the elderly, and the ill are most susceptible to severe reactions to food-borne illnesses. The good news is that food-borne illnesses are largely preventable. Just be sure to follow these guidelines:

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Give all fruits and vegetables a good washing. Washing decreases, but does not eliminate, the risk of contamination in fruits and vegetables. Thoroughly cook your meat and eggs. Raw animal products are most likely to be contaminated. Unpasteurized milk, raw eggs, raw shellfish, and raw meat are the most dangerous. Making sure your eggs have a firm yolk and cooking your meat to an internal temperature of at least 160 degrees helps kill parasites, bacteria, and viruses. “Perhaps most importantly, avoid cross-contamination by washing your cutting boards, knives and other utensils, and mixing bowls after each use. And don’t forget to wash your hands,” says Dr. Balaji Desai, a physician at Southside Internal Medicine. Do not prepare foods more than one day in advance, unless it is to be frozen. Cooking foods in advance allows more opportunity for bacteria to grow. Cooked foods should be rapidly cooled in shallow pans, rather than just left on the counter to cool. Keep foods covered to prevent contamination by insects. Many insects can carry harmful bacteria and viruses on their bodies. Refrigerate leftovers quickly or dispose of them. Food that sits at room temperature can very quickly develop bacteria. To preserve freshness and increase safety, refrigerate your leftovers as soon as possible. When in doubt, throw it out. So, this summer, consider food safety as you prepare, serve, and store food for your family and friends. Enjoy barbecues and picnics, and the many magnificent fruits and vegetables readily available during these months. In your spare time, research food processing practices and local growers and restaurants. And don’t forget to take in the colors and smells that come with cooking fresh ingredients. For more information on food safety, visit

HEALTH TALK EDITION Summer 2012 The Dog Days of Summer Are Here. Are You Poised to Beat the Heat? Heat is the number one weather-related killer in America. According to the National Weather Service, heat causes more fatalities per year than floods, lightning, tornadoes, and hurricanes combined. In fact, based on the 10-year average from 2000 to 2009, excessive heat claims an average of 162 lives a year. By contrast, hurricanes killed 117; floods, 65; tornadoes, 62; and lightning, 48. “Overexposure to heat can be incredibly dangerous, especially for children and the elderly,” says Dr. Curtis Merritt, physician with DRMC Family Medicine Residency Clinic. “With summer just beginning, it’s essential that we’re all heat smart. This means taking steps to prevent overexposure and learning to recognize and respond to the signs of heat stroke.” Merritt suggests these tips for beating the heat this summer:

• Be aware of temperatures and humidity levels, and modify your activities appropriately. • Limit outdoor activities from 11 a.m. to 2 p.m., when temperatures are highest. • Stay hydrated by drinking plenty of low-sugar or no-sugar fluids. • Stay in relatively cool areas, even when outside. • Avoid hot enclosed places, such as cars and garages. Never leave children or animals unattended in a car, especially when parked in the sun. • Wear loose-fitting, lightweight, and light-colored clothing. • Avoid or limit your use of alcohol, as it can impair your body’s ability to regulate its temperature.

In the event that overexposure to heat does occur, it’s important to be able to recognize the signs of heat stroke. According to Merritt, heat stroke is a form of hyperthermia (abnormally elevated body temperature) with accompanying physical and neurological symptoms. Unlike heat exhaustion, a less-severe form of hyperthermia, heat stroke is a true medical emergency that can be fatal if not quickly and appropriately treated. “Another cause of heat stroke is dehydration,” he adds. Signs of overexposure to heat include: • Pale, clammy skin • Nausea or vomiting • Muscle cramps • Confusion or disorientation • Headache • Becoming semi-conscious or passing out • Feeling tired and weak If you or someone you encounter is experiencing a heat-induced illness: • Call 9-1-1. • Get the person out of the sun immediately. • Apply water to help the person cool off. • Apply ice to the neck or armpits, where large blood vessels are close to the surface. • Remove any heavy clothing. For more information on heat safety, visit (keyword search: heat) or talk to your physician.

Heat stroke is a form of hyperthermia (abnormally elevated body temperature) that can be fatal if not quickly and appropriately treated. ENEWSLETTER NEW!

Danville Regional has a new online tool for you to manage your health, get the latest health news and personalize health topics for you and your family. It’s free and it’s available online, anytime: • My Health Newsletter™ – Each month receive newsletter that you have designed around only the topics that matter most to you. • My Health Reminders™ - Receive reminders of appointments and health screenings. • My Health Assessments™ – Interactive questionnaires. • My Baby Expectations™ – What to expect guide for all stages of pregnancy. Subscribe today at www.DanvilleRegional/

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HEALTH TALK EDITION Summer 2012 Skin Cancer: An Ounce of Prevention is Worth a Pound of Cure Year-round, our doctors, our friends and even our favorite talk show hosts remind us to wear sunscreen and hats, and to limit sun exposure. Despite these warnings, approximately two million people will be diagnosed with skin cancer this year. About 68,000 of these cases will be melanoma, the most life-threatening type of skin cancer. Melanoma is the most common type of skin cancer among young adults. Originating in the cells that produce skin coloring and pigmentation – called melanocytes – melanoma is below the surface and, therefore, more difficult to detect and diagnose. Malignant melanoma accounts for about 8,700 of the 11,790 skin cancer-related deaths each year. According to Dr. Anupreet Oberoi, of Family Healthcare Center on Piney Forest Road in Danville, “Many people don’t pay attention to their skin until a problem arises.” According to the American Cancer Society, skin cancer is often curable, if caught and treated in its early stages. Symptoms of skin cancer include: • Any change in the size or color of a mole or other darkly pigmented growth or spot • Any new skin growth • The spread of pigmentation beyond a growth’s border, such as dark coloring that spreads past the edge of a mole or mark • A change in sensation, itchiness, tenderness or pain of a growth or spot • Scaliness, oozing, bleeding, or a change in the overall appearance of a bump or nodule While unprotected sun exposure has been strongly linked to skin cancer, the American Cancer Society suggests these other skin cancer risk factors: • Unprotected and/or excessive exposure to ultraviolet radiation, such as that used in a tanning bed • A history of severe sunburns • Fair complexion • Family history • Multiple or atypical moles • Occupational exposures to coal tar, pitch, creosote, arsenic compounds, or radium “Being aware of risk factors and ensuring you get regular skin exams by your physician can greatly reduce your chances of developing skin cancer,” says Dr. Oberoi. “It’s also important to get suspicious moles or other growths looked at as soon as they’re discovered. Skin cancer can be highly treatable, but early detection is critical.” Consider these tips for helping prevent skin cancer:

• Avoid prolonged sun exposure, especially between 10 a.m. and 4 p.m.

• Use a sunscreen with an SPF of 15+ every day.

• When going outside for extended periods, reapply sunscreen every two hours and cover up

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with clothing, including a hat and UV-blocking sunglasses, whenever possible. • Examine your skin from head-to-toe every month, and see your physician for a professional skin exam each year. • Keep newborns out of the sun, as sunscreens should only be used on babies over the age of six months.

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HEALTH TALK EDITION Summer 2012 10 Tips for Playing It Safe in the Water This Summer Summer is here and few things feel better on a hot day than cool water. Whether you head to the pool, the beach, or the lake when you take a dip, consider these 10 tips for staying safe in and around the water: 1. Take swimming lessons. If you are an adult who can’t swim, consider a weekend swimming lesson. And if you have a child who has not yet learned to swim, sign them up for lessons as soon as possible. Learning to swim at an early age builds confidence and encourages water safety for a lifetime. 2. Never swim or boat alone. Not only is swimming/boating with a friend more enjoyable, it’s also smarter. Having someone there to assist in an emergency could save a life. 3. Install barriers and keep a close eye on children. Children between the ages of one and four, who drown in an at-home pool, are usually under parental supervision and out of sight for less than five minutes. Pool barriers can help restrict access to the pool. It is also important to teach children to ask before going near the water, and to remove pool toys, whenever possible, as they can attract a child’s attention and draw them to the water. 4. Do not use air-filled toys as flotation devices. Pool noodles, water wings, and blow-up rafts are not designed to be used in place of personal flotation devices. 5. Wear a U.S. Coast Guard-approved personal flotation device (PFD) when boating. According to the Centers for Disease Control and Prevention (CDC), 72 percent of boating incidents are drowning incidents, and nine out of 10 people who die from such incidents aren’t wearing personal flotation devices. 6. Know your limits. Swimming can be a lot of fun, but if you’re not a strong swimmer, or if you’re just learning to swim, don’t go in water that’s so deep you can’t touch the bottom. 7. Learn CPR. Effective bystander CPR, provided immediately after sudden cardiac arrest, can double or even triple a victim’s chance of survival. Need a crash course? Visit or contact the Danville Lifesaving Crew at 434.792.2739 for course offerings. 8. Don’t mix alcohol and water activities. Alcohol use is involved in a large percentage of swimming and boating incidents. Alcohol can dull your judgment, response time, balance, and the body’s ability to stay warm. 9. Use caution in natural water settings. Statistics show that as people get older, drowning incidents are more likely to occur in natural water settings. Be careful when boating or swimming in these areas. 10. Pay attention to local weather reports. When at the beach or in natural water areas, pay attention to weather reports and know the color of the flags that warn beachgoers of potential threats. Keep an eye out for dangerous waves, debris, and/or rocks. “About 3,500 Americans drown each year, averaging 10 deaths per day. Drowning is the sixth leading cause of unintentional injury death for people of all ages, and the second leading cause of death for children ages 1 to 14 years,” says Karen Wilkinson, Family Nurse Practitioner at Family Healthcare Center in Gretna. “Sadly, many drowning deaths could have been prevented, which is why taking simple precautions, like those listed above, are so important.” To learn more about keeping your family safe in the water, visit, keyword “water safety.”

“Drowning is the sixth leading cause of unintentional injury death for people of all ages, and the second leading cause of death for children ages 1 to 14 years,” says Karen Wilkinson, Family Nurse Practitioner at Family Healthcare Center in Gretna.


High Impact VS.

Low Impact

WORKOUTS High impact workouts like P90X and running interest men of all ages. Are they for everyone? High impact, high intensity exercise programs have become popular because they have been very effective in improving high velocity strength. One of the concerns is that as people get older they are more injury prone. They often don’t have as much flexibility or may have arthritis. So these programs must be tailored to each person. If overuse injuries develop these programs may need to be modified. A good trainer is helpful in developing a program customized for your age and level of fitness. It’s important to recognize problems early and avoid serious injuries.

Are low impact workouts just as effective? In general, lower impact exercises still promote overall fitness, increase flexibility, and are aerobic. As we get older, we lose muscle mass, so strength training helps reverse or slow that process. Also aerobic exercises are good for cardiac health. As we age, low impact workouts are often


The Art of Modern Orthopedics A Conversation with Dr. Mark Hermann of Danville Orthopedic Clinic Mark Hermann lives an active lifestyle. He’s an avid biker and outdoorsman who works hard and plays hard. He’s also an orthopedic surgeon who understands that our body is our strongest asset. We rely on it for everything from crawling to mountain climbing. General health and maintaining an active lifestyle is wise and when that lifestyle is interrupted or challenged by joint or muscle pain, you have options. Our muscles and joints evolve as we age. Some people think that activity is bad for your joints. But according to Dr. Hermann, “Joints were made to move. Being sedentary is actually counterproductive.” Of course, with activity, there is the risk of injury or accident. “In young people, you see more accidents from activities like biking, skiing, and skateboarding.” In young adults, most injuries are more a consequence of traumatic events such as car accidents, falls, sports injuries, and alcohol-related injuries. Overuse injuries, caused from repetitive microtrauma (repetitive motion injuries to muscles and ligaments) are common in all age groups, especially athletically active adults. In the elderly, falls cause most injuries. “As we age and yet remain active, we often have complaints of joint pain. These become more common in our fifties or early sixties, but sometimes earlier,” Dr. Hermann says. A little soreness is normal, especially after working out, but when it becomes painful or it affects normal activity then you need to think about getting treatment. It may be as simple as needing ice, rest, or over-the-counter medicines like Advil (Ibuprofen) and Tylenol (Acetaminophen). But if those aren’t helping or if the pain persists, you should probably see a doctor. In many people, joint pain becomes a problem as we get older. When you start to experience joint pain, you don’t necessarily have to quit being active; you may just have to modify your activity. Dr. Hermann says, “For instance, if you enjoy tennis and running you might back off on the running and keep the tennis if that’s the one you enjoy the most. It’s all about modifying behavior rather than becoming sedentary.” For those with joint pain, there are many non-surgical solutions. The best course of treatment is usually to work your way up from the simplest answer to the most complex. “You start with activity modification and the use of Tylenol or other over-the-counter anti-inflammatory medicines,” Dr. Hermann says. “Other forms of non-surgical procedures include injections of medicines like cortisone or joint lubricants which are often helpful.” But when those less intrusive measures are failing and one’s life is affected in a negative manner by their joint condition, then joint replacement surgery may offer a good solution. The most common forms of joint replacement surgery are knee and hip. Shoulder, ankle, and elbow replacements are less common. The purpose of surgery is to lessen pain and improve joint function. “Surgery is all about improving quality of life. It is generally a very successful operation and most people can improve their independence while remaining active,” Dr. Hermann says. “It is truly a life changing event for most people.”

better tolerated. Still, we should include strength training as part of a balanced and individualized exercise program.

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Of course there are some downsides. Some people develop stiffness after joint replacements, though most of these people had stiffness before surgery. Some are more inclined to develop scar tissue than others. To a large extent, you can influence the outcome of your joint replacement surgery. Doing the proper exercises before surgery and following through with all of your post-surgery rehabilitation is essential.

HEALTH TALK EDITION Summer 2012 Osteoarthritis, also called osteoarthroses or degenerative joint disease, is the most common type of arthritis. Osteoarthritis is a chronic condition characterized by the breakdown of the joint’s cartilage. The breakdown of cartilage causes the bones to rub against each other, causing stiffness, pain, and loss of movement in the joint. (source: Arthritis Foundation)

Having the team at Danville Regional Medical Center and the doctors at Danville Orthopedic Clinic handle your surgery is a step in the right direction. “In joint replacement surgeries, we have infection rates dramatically lower than the national average,” Dr. Hermann says. “Everyone is well trained. Our group has grown and developed and recently added rheumatology, spine surgery, and pain management. We are evolving into a multi-disciplinary, multi-specialty, orthopedic musculoskeletal center. We are committed to continuing to develop and grow in the future. Danville Regional provides us with state of the art facilities and equipment that allows us to treat most orthopedic injuries.” To take better care of your joints, maintaining good general health and an active lifestyle is wise. One factor leading to the need for joint replacements and affecting the outcome of joint replacement surgeries is obesity. Obesity is a growing problem in America and locally is an especially critical community health problem. Dr. Hermann, who is a recent member of the board of directors of the Danville Regional Foundation says that “addressing obesity is one of the initiatives of the foundation and other groups in town who are trying to influence this trend in a positive direction. Obesity contributes negatively to many health conditions such as sleep apnea, diabetes, and heart disease, in addition to its impact on orthopedic diseases.” Dr. Hermann is passionate about living an active lifestyle. “A healthy lifestyle has many benefits beyond staying fit. It leads to higher levels of endorphins so you feel more upbeat and positive.You sleep better.You have more energy.You don’t have to be excessive or obsessive in your exercise routine.You simply need to incorporate a reasonable amount of activity into your lifestyle.” Dr. Mark Hermann is an orthopedic surgeon and cycling enthusiasts who can often be found in the operating room at Danville Regional Medical Center. He has been with Danville Orthopedic Clinic since 1990. He is a member of the Arthroscopy Association of North America and a Fellow of the American Academy of Orthopedic Surgeons. He is a Diplomat of the Board of Orthopedic Surgery, a Member of the Wilderness Medical Society, and a Certified Physician Clinical Research Investigator. Dr. Hermann and his family enjoy many outdoor pursuits and active vacations together.

Active Vacations by Dr. Mark Hermann

I have always enjoyed the outdoors and being active. It was natural then that I would try to instill those values in my children. From a very young age my wife and I have stressed the importance of incorporating physical activity into our daily routine. We have made it a commitment in our lives and a part of our family activities. Many of our vacations were “active vacations”. These include skiing or whitewater rafting in pristine wilderness, cycling in Italy or camping and enjoying the mountains. I have felt it’s important to instill a respect and admiration for the beauty and wonder of the natural environment. I have been able to enjoy unique experiences with my family while at the same time feeling energized and refreshed. We have formed healthy memories that I know have helped contribute to the self-confidence, maturity, and stability of my children. Rather than simply telling them to respect our world, my wife and I have tried to share that value by living it with them. It has been part of our family bond and I believe it will live on with them as an important memory of their childhood. Though my children are now young adults, we still continue to share this love for the outdoors and pursue an active lifestyle. We have met interesting people who have touched our lives. We have developed lasting friendships while sharing our love for the outdoors. In these times of instant communication and constant entertainment we can loose touch with the simple joy of physical exertion and personal accomplishment one feels when immersed in “Nature’s outdoor gym.” While it has been important to my family, I think it is important to the mental and physical health of all Americans.

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Joint Replacements Danville Regional Medical Center’s State of the Art Surgical Services Your orthopedic doctor and you have decided that you need a joint replacement and now it’s time to prepare yourself for this new stage of your life. Although this is going to likely drastically improve your quality of life, it is not going to be an easy path. You are going to have some things to take care of before surgery, the day of surgery, and after surgery. The professionals at Danville Regional Medical Center are with you every step of the way.

What is Knee Replacement Surgery?

If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities such as walking or climbing stairs.You may even feel pain during rest, when sitting, or when standing. Successful joint replacement surgery can give most people a new lease on life. Once your joint has completely healed, you should expect the following benefits from your surgery: • Reduces or eliminates pain • Restores lost range of motion • Lets you resume many of your normal activities • Improves appearance of deformed joints

Before Surgery One of your first stops is at Joint Class where Jessica Bernardez, Clinical Manager at DRMC, will lay it all out for you. “Joint Class is held for patients who are going to have total hip and knee replacement surgery. We discuss what is going to happen before and after surgery,” Jessica says. “We have a two-way conversation that thoroughly explains the process so that every patient knows exactly what to expect. We provide a tour of the facility and help create a plan that makes the experience as seamless as possible. I walk them through exercises they can do before surgery to strengthen the different muscles they will need while their new joint heals. And the patient will also learn what to expect with their post-operative rehabilitation.”

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HEALTH TALK EDITION Summer 2012 Surgery Day The procedure itself takes two to four hours. The orthopedic surgeon will remove the damaged cartilage and bone and then position the new metal, plastic, or ceramic joint to restore the alignment and function of your joints. Cindy Smith is the Surgical Services Director overseeing all types of surgical procedures. “Our ultimate goal is high quality and safe care that results in the best possible outcomes for the patient.”

After Surgery

Before leaving the hospital, be sure to know the following things:


How to take your medications

After your surgery, there will be some routine activities that you will need to do a little differently. For a short period you will need a little extra help, so choose a relative or friend to be your coach. Recovery times are different for every patient and can be impacted by how much pre-surgery exercising and strengthening the patient underwent.You have your choice of rehabilitation centers and are not restricted to any particular provider. In fact, it’s important that you tour rehab facilities before your surgery so that you have a plan in place. Depending on whether it’s hip or knee, you should expect to be back on your feet in a few weeks with twelve weeks or more of rehabilitation. Danville Regional Medical Center has a comprehensive rehabilitation program and one that will move to the new YMCA when it opens in a year and half. Scott Oaks at Danville Regional Sports Medicine and Rehab (formerly Southside Spine and Rehab) says that it’s important to know that it will take a while for the body to adapt. “Getting that movement back after a surgery is uncomfortable. But rehab is not constantly painful. Each exercise basically lasts two or three minutes and the patient will have a little soreness afterwards. The pain shouldn’t last for hours and hours.” The success of your surgery also depends on how well you follow your surgeon’s instructions during the first few weeks after surgery. The proper amount of rest, a balanced diet, and appropriate exercise are critical components of your recovery. From start to finish, Danville Regional will help you through every step of the process.

P What supplies to use and when to change bandages

P When your stitches or staples will be removed

P When you will see your surgeon again for a follow-up

P Answers to any

questions you may have

Physical Therapy in the 21st Century Taking It One Step at a Time Physical Therapy or “rehab” as it’s often called is the process of relearning and reactivating a part of your body that has suffered a traumatic experience. The need for physical therapy and rehabilitation can stem from something as simple as a pinched nerve to as extensive as a joint replacement or spinal surgery. It covers a wide range of issues and is generally the way to help your body get back to full mobility. Although physical therapy and rehab cover a wide range of services, the most common reasons for rehab are joint and spinal ailments. Physical Therapy is like working with a fitness trainer.You need a bond that creates the necessary motivation. Scott Oaks, Director of Danville Regional Sports Medicine and Rehab (formerly Southside Spine and Rehab), is that kind of motivator. “My goal is to make sure the person I’m working with gets results and becomes the force behind the momentum. I explain to people what we are looking for is to see how their body reacts to whatever

techniques we do. Whether it be through exercises or range of motion movements.” Rehab is a natural way to treat pain. It’s one of the first steps before having to consider surgery because it can strengthen the muscles around your joints which may eliminate pain. Sometimes, simple things like sitting at a desk for 10-12 hours a day will create pain. Scott says, “The human body was designed for movement. We need to get up and move around. Small things like taking breaks from work and stretching can make a huge difference in someone’s body. We treat a lot of patients with back pain, neck pain, and shoulder pain, who are looking for a solution. We also treat neurological problems like strokes and multiple sclerosis.” Scott has a Doctorate in Physical Therapy and has Direct Access Certification which means a patient can visit him directly for rehabilitation needs. In fact, the entire team at Danville Regional Sports Medicine and Rehab are experts at creating personalized programs tailored to each patient.They offer other forms of therapy from Occupational Therapy to Speech Therapy. The team believes in a results oriented approach.

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Know Your

Numbers It’s as Easy as 1, 2, 3 Children usually learn their numbers before they even start kindergarten. As adults we are bombarded with numbers all day every day: phone numbers, dates, credit card numbers, and on and on. But more important than all those numbers are your health numbers. Five little numbers that can add years to your life. 1. Blood Pressure 2. Cholesterol Level 3. Body-Mass Index (BMI) 4. Waist Size 5. Blood Sugar and Hemoglobin A1c These numbers are like grades on your health report card. Good grades mean you are rewarding yourself with a healthy heart. Bad grades mean you need to quickly begin making healthier decisions. “Own your risk factors or they will own you,” says Dr. Sanjay Jaswani of Southside Internal Medicine. The numbers are simple and easy to check. And most importantly, unlike your grade school papers, higher numbers are not better numbers.

1. Blood Pressure “The Silent Killer”

There is no reason not to know your blood pressure. Devices used to measure blood pressure are inexpensive and readings are available for free at many local stores and pharmacies. Measure your blood pressure while calm and after sitting for at least five minutes. Also keep in mind that a blood pressure reading has two numbers such as “one-twenty over eighty.” Both numbers are important. The first number is systolic which indicates the pressure on your artery walls when the heart is pumping blood out. The second number is diastolic which measures the pressure between heartbeats, while the heart is filling with blood.

KNOW YOUR NUMBERS • Normal – 120/80 • Pre-hypertension – 120 to 139 over 80 to 89 • Hypertension (Stage 1) – 140 to 159 over 90 to 99 • Hypertension (Stage 2) – 160 or higher over 100 to higher

Statistics show that about 1/3 of adults have high blood pressure or pre-hypertension and deaths from high blood pressure have dramatically increased in recent years. You may ask yourself, “Why is my doctor so concerned because my blood pressure is a little bit high?” According to Dr. Jaswani, “The high blood pressure in and of itself isn’t the greatest concern. The biggest concern is that numerous studies have shown hypertension is a proven clinical risk factor for heart attacks and strokes.”

2. Cholesterol

“The Good, The Bad, and The Ugly”

Cholesterol is a type of fat that is produced in the liver and can be found in foods which come from animal products.Your body needs cholesterol to make hormones, vitamin D (which is important for healthy bones), and bile (which helps your body use dietary fat). But as you have likely already heard there is “good” cholesterol (HDL) and “bad” cholesterol (LDL). Regular wellness checkups are included under many insurance plans and depending on your risk factors, the

HEALTH TALK EDITION Summer 2012 doctor will likely test your blood for cholesterol as part of the standard tests. This is one of many good reasons to go for a checkup. But, if you want to check your cholesterol for yourself, without visiting a doctor’s office, you can visit one of two LabCare locations in Danville (201 South Main St or 159 Executive Dr, Suite K) and have a lipid profile completed for only $23 which includes testing for triglycerides. Make sure you don’t eat after 12AM the previous night before having your test done. If you are a do-it-yourselfer, kits are also available online, in drug stores, and at large retail stores for around $30. (online search phrase – “cholesterol test kit”). One of the benefits of doing it at LabCare is that a professional will handle the test for you, you’ll get results the same day (if you go in before 10AM), and if there are any issues, you have a local person to help you.

KNOW YOUR NUMBERS • Total cholesterol of 200 mg/dl or lower • HDL (Good – H for “Healthy”) for 40 mg/dl or higher (50 mg/dl or higher for women) • LDL (Bad – L for “Lousy”) of 130 mg/dl or lower (the target for some one with diabetes is 100 and depending on your risk factors, your doctor may set a different target) • Triglycerides of less than 150 mg/dl The numbers can change based on the state of health of the individual. According to Dr. Jaswani, “The more risk factors you have, the stricter the target becomes. So if you have high blood pressure or you smoke, then your target LDL becomes stricter. It’s important to set realistic targets so that you don’t get impatient with your progress.”

3. Waist Size “The One Number You Think You Already Know”

Forty is an interesting number. It is the number of home runs an all-star baseball player hits. The age when life gets complicated. The number of yards in a dash. There are a lot of things that the number 40 represents. But the most important thing this number represents for a man is his waist size. If your waist is 40 inches

or larger, it increases your risk of cardiovascular disease, diabetes, high blood pressure, and high cholesterol. Don’t think you’re getting off easy by saying you wear size 34 pants.You must measure around your belly button and in most men, there is a big difference between the size of your waistband and the size of your waist around your belly button. If it’s greater than 40 inches, then you need to realize that this is a major warning sign. For women, the magic number is 35. In people of Asian descent, the number is 36 for men and 32 for women.

4. Body Mass Index (BMI) Body Mass Index (BMI) is a number that is designed to represent your overall weight in relation to your height. It’s time for algebra class.

5. Blood Sugar and Hemoglobin A1c For those with Type 2 Diabetes or who are at high risk of Diabetes For people with type 2 diabetes, these are two additional numbers to which you should pay special attention.

KNOW YOUR NUMBERS • Normal - fasting blood sugar level is less than 100mg/dL or an A1c of less than 5.7% • Prediabetes – fasting blood sugar level of 100 to 125 mg/dL or an A1c of 5.7% to 6.4% • Probable Diabetes – fasting blood sugar level of 126 mg/dL or more or an A1c of 6.5% or higher and you’ve gotten these results two or more times.

BMI = ( Weight in Pounds / (Height in inches x Height in inches) ) x 703 That’s the formula. For example (175/(68x68))x703 = 26.6. Math hint: multiply your height in inches times itself first. (68x68=4624 in this example).Then divide your weight by the number you just got. (175/4624=.0378 in this example).Then multiply that number times 703. (.0378x703=26.6 in this example)

KNOW YOUR NUMBERS For adults 20 years and older: • 18.5 is considered underweight. • 18.5 to 24.9 is considered a normal weight. • 25 to 29.9 is considered overweight. • 30 or higher is considered obese. If you have a large change in BMI, regardless of where it falls on the chart, it should be evaluated. People of Asian descent may be at risk with a lower BMI. A clinical diagnosis for obesity includes waist size and risk factors.

Treating diabetes is about treating to targets based on an individual assessment. These numbers can fluctuate depending on the individual, and it’s important to work with a doctor who looks at the big picture. In patients with diabetes, doctors tend to be more aggressive on the rest of the important numbers (blood pressure, cholesterol, waist size, and BMI). “Most men don’t realize that they need to be screened for these factors before they experience any symptoms at all. Men can avoid most large problems by being screened for these cardiovascular risk factors,” Dr. Jaswani says. “Men don’t like to go to the doctor unless there is a symptom that is really bothersome to them. But it’s important to get these yearly checkups and to be screened for these silent risk factors before it’s too late.” KNOW YOUR NUMBERS! To stay informed about breaking news in health care, register for Danville Regional Medical Center’s eNewsletter by going to

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Threat Assessment - Men’s Health The Silent Threat

The Not-So-Silent Threat

Hypertension hy-per-ten-sion /hīpərˈtenSHən/ – Noun. 1. Abnormally high blood pressure. 2. A state of great psychological stress.

A partner who snores can be an impediment to getting a good night’s sleep. But, did you know that it can also be a sign of sleep apnea? All snoring is not sleep apnea, but when the snoring stops for a moment and there is a pause in breathing followed by a loud snort or choking sound, then it is likely sleep apnea. Sleep apnea is a very serious condition where an individual’s breathing is interrupted during sleep. It can have deadly repercussions.

I Have Hypertension, Now What?

Hypertension is the term used for high blood pressure. You can have high blood pressure for years without ever experiencing any symptoms. It increases your risk of many serious health issues including heart attack and stroke. Because it isn’t a condition that jumps out and bites you, it doesn’t appear on the radar screen of many people. It’s important to know your numbers and change your lifestyle accordingly, but once you are diagnosed with hypertension, what’s next? According to Dr. Jaswani, the best choice is the natural option. “Once someone has been diagnosed with hypertension, depending on how elevated their blood pressure is, I give them the option of a three to six month trial of lifestyle intervention. By lifestyle intervention I mean regular physical exercise, weight loss, low sodium diet, and avoiding alcohol. If within the agreed time span these conservative measures help to bring down high blood pressure then we don’t have to go down the route of medications.” When conservative measures fail it’s usually because the patient is unable to lose weight or stick to a low sodium diet. In that case, or when the blood pressure is extremely high (like 160 systolic - the first number in the blood pressure number) beginning medication immediately is the solution. Although normal blood pressure is 120/80, Dr. Jaswani says that “We tend to be a little more aggressive with our diabetic patients so we have stricter targets for them and those with a history of hypertension. Numerous studies have shown hypertension is a proven clinical risk factor for poor cardiovascular outcomes, like heart attacks and strokes. If you keep your blood pressure down, then you decrease your chances of heart attacks and strokes. It’s as plain as that.”

Snoring Your Way to an Early Grave

According to Dr. Jaswani, “Often times sleep apnea is caused by how your neck and throat change when you’re sleeping.Your muscle tone relaxes and all of the soft tissue collapses on your airway.You are basically depriving yourself of oxygen while you’re sleeping. When you wake up you have a headache, a dry mouth, and you feel terrible.” You are being jerked out of the deep restorative sleep and spend more time in light sleep.You end up with daytime sleepiness. This sluggishness can result in an increased risk of accidents, poor concentration, and slow reflexes. If left untreated, sleep apnea may worsen many different health issues including high blood pressure, stroke, diabetes, depression, ADHD, and heart conditions such as irregular heartbeat, heart attack, and heart failure. In fact, according to Dr. Jaswani, “Obstructive sleep apnea is a big problem with hypertension because, even though you are taking your blood pressure medications, you can’t get it under control. In fact, the real problem is the obstructive sleep apnea. “ There is a significant catch-22 centered around sleep apnea: Obesity and weight gain. Weight gain can bring on sleep apnea for several reasons, not the least of which is the increase in neck size. While at the same time, sleep apnea can lead to weight gain. It’s a deadly cycle. With treatment, you can control the symptoms and regain control over your sleep.You will quickly realize what you’ve been missing out on when you are refreshed and alert every day.Your primary care physician can speak with you about sleep apnea and make recommendations about the best course of treatment for your particular situation. In the interim, try sleeping on your side. For obstructive sleep apnea, this simple change to your routine can often help keep your airway open and help you get a restful night of sleep.

Dr. Sanjay Jaswani is a physician with Southside Internal Medicine. His wife is

Dr. Tamika Khan-Jaswani, who is a hospitalist at Danville Regional Medical Center. On April 26th they welcomed their first child, who was born at DRMC. Dr. Jaswani is an amateur photographer and enjoys music and outdoor activities. He is a graduate of University of the West Indies in Jamaica and did his residency at Carilion Clinic-Virginia Tech School of Medicine’s Internal Medicine Residency Program. He is extremely passionate about community involvement and focuses on outreach and screening programs designed to promote healthy lifestyles and disease prevention. Dr. Jaswani says, “It’s great to be a part of the family at Danville Regional. The community is warm and inviting and we look forward to raising our daughter here.”

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The Hidden Threat

I Have a Prostate Issue, Now What? Prostate pros-tate /ˈpräsˌtāt/ – Noun. 1. A gland surrounding the neck of the bladder in male mammals and releasing a fluid component of semen. Prostate cancer is a form of cancer that we often hear about, but if you ask the common person, chances are they know little about it. According to the American Cancer Society, other than skin cancer, prostate cancer is the most common cancer in men. It accounts for the second most number of cancer deaths in men. But don’t panic. In most cases, there is time to make an informed decision. The prostate is a gland found only in men. The size varies with age; in younger men it is the size of a walnut, while in older men, it is typically much larger. If you are diagnosed with one of the three general issues (inflammation, enlargement, or cancer) of the prostate, it’s important to discuss with your doctor all of your options. Inflammation is usually caused by an infection and is treated with antibiotics. Enlargement is usually caused by aging and is treated with medication or surgery. Cancer is treated with surgery, radiation, hormone therapy, and chemotherapy. And depending on the risk-reward matrix, some doctors may recommend watchful waiting, which is to delay treatment and see what happens. Prostate cancer may not cause signs or symptoms in its early stages, however in its more advanced stages, symptoms can include: • Trouble urinating • Decreased force in the stream of urine • Blood or semen in the urine • Swelling in the legs • Discomfort in the pelvic area • Bone pain A regular checkup usually includes a Digital (Finger) Rectum Exam. As you get older, a Prostate-Specific Antigen test will tell if the prostate has become overactive which indicates you should look deeper into the issue. A high PSA number may require you to have a biopsy to check for cancer. Danville Regional’s Center for Radiation Oncology offers a full range of treatments from high energy radiation therapy and chemotherapy to innovative clinical trials.There is no need to travel out of town for your treatments, thereby minimizing the stress on you and your family.You can contact them at 434.799.4592.

June is Men’s Health Month and June 11-17 is Men’s Health Week.

(Online Search Phrase – “Men’s Health”)

The Injury Threat A lot of men get hurt trying to do too much too quickly. Scott Oakes of Danville Regional Sports Medicine and Rehab says, “Men work during the week and then try to cram a lot in on the weekends. They may cut down a tree and move the firewood or go for a ten-mile walk. No matter how old you are, you will feel the results of overusing a muscle.” Any new fitness routine may overuse several muscles all at once. “Men should know that when they try out a new exercise program, they may get sore from very minor exercises. No matter what they get into, they are older than the last time they tried it, so they need to make sure that they have a graded progression. Otherwise they get injured or extremely sore from too much too soon.”

“Men should know that when they try out a new exercise program, they may get sore from very minor exercises.”

A recurring theme when it comes to men’s health is denial. It’s easy for a man to not want to accept their current physical condition which can lead to injuries. But, regular exercise can prevent many of the injuries that may lead to a need for physical therapy. “Consider a guy who works at Goodyear. He may be very physically active on his job, but they build one type of muscle, sometimes on only one side. This can lead to pain or even an injury when they go to do a different type of physical activity.” This muscle imbalance can even be seen in athletes. “The biggest problem with sports injuries are muscles and balance. A soccer player who tears their ACL may have really good quadriceps muscles, but almost nonexistent hamstrings. So in rehab, you start by finding where their deficiencies are and work on that. For example, baseball players rotate inside all of the time throwing and pitching, but they never do the opposite direction, so they will get an imbalance point of rotation and eventually bones start getting closer and closer. Even athletes need to have a wide range of exercises.” Scott Oaks is the Director of Danville Regional Sports Medicine and Rehab (formerly Southside Spine and Rehab). He can currently be found at 4819 Riverside Drive, Suite C, in Danville or by calling 434.822.0484. But, when the new YMCA opens, Scott and his team will occupy space in the new building on the River.

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the Maze of Life While Maintaining Your Mental Health

Our lives are constantly changing. Whether it’s childhood or retirement, our thirties or our fifties, just as we start to master one stage, it comes to an end and we move on to the next stage. Our experiences and educational background, our relationships with family and friends, and our faith and belief systems help prepare us for the unknown. Some enter the unknown, eager for new experiences; while others shy away from change and cling to the familiarity of the past. But sometimes, those changes can be overwhelming. Life is a maze and the decisions we make can get us closer to the exit or lead us directly into a dead end. Society puts a lot of pressure on men to be professional navigators. Men have traditionally been expected to be strong, physically and emotionally. And perhaps because of those expectations, we shy away from talking about our feelings. As though, it’s not masculine to discuss our thoughts and emotions. Unfortunately, not taking control over our health can lead to shorter lives and higher risk for all fifteen leading causes of death. One of the hardest things for a man to do is to ask for help. When men do seek medical help, it’s often for physical ailments, and they are less likely to discuss the feelings that accompany the issue. Dr. Aleem Khan is a psychiatrist at Piedmont Psychiatric Associates and he says, “It’s a general rule that men like to procrastinate and not deal with medical issues. With depression, they are even less likely to act because they think they can deal with whatever stress is going on in their life.” This reluctance, be it in our DNA or in the expectations of society, can have extreme consequences and can impact every area of our life. It can lead to depression, alcohol and drug abuse, relationship and employment troubles, even suicide. “Men sometimes start drinking alcohol to self-treat their depression. They will become irritable, angry, hopeless, and sad. They will experience low self-esteem. And usually won’t get a lot of sleep,” Dr. Khan said. It’s important to know that you aren’t alone. One in three people suffer some form of mental illness. And about one in five people has a prevalence of depression during their lifetime.

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What is Depression? Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness. Many people with a depressive illness never seek treatment. But the majority, even those with the most severe depression, can get better with treatment. Medications, counseling, and other methods can effectively treat people with depression.

What are the symptoms? Doctors often look for you to have five of the following eleven symptoms simultaneously. • Persistent sad, anxious, or “empty” feelings • Feelings of hopelessness or pessimism • Feelings of guilt, worthlessness, or helplessness • Irritability or restlessness • Loss of interest in activities or hobbies once pleasurable, including sex • Fatigue and decreased energy • Difficulty concentrating, remembering details, and making decisions • Insomnia, early-morning wakefulness, or excessive sleeping • Overeating or appetite loss • Thoughts of suicide or suicide attempts • Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment

Why am I depressed? According to Dr. Khan, “Most likely, depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depressive illnesses are disorders of the brain. Longstanding theories about depression suggest that important neurotransmitters—chemicals that brain cells use to communicate—are out of balance in depression.” Some types of depression tend to run in families. However, depression can occur in people without family histories of depression as well.

HEALTH TALK EDITION Summer 2012 Scientists are studying certain genes that may make some people more prone to depression. Some genetics research indicates that the risk for depression results from the influence of several genes acting together with environmental or other factors. In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Other depressive episodes may occur with or without an obvious trigger. When the conditions start to become obvious, it’s common for men to try to mask the issues and many times this leads to deeper feelings of depression and can cause other issues such as alcoholism or drug abuse. Alcohol and illegal drugs are multipliers that always make things worse.

What can I do? The first step towards solving the problem is to accept that there is a problem. For men, this is often easier said than done. There are at a minimum three different types of depression (Major – severe & long term, Dysthymia – less severe but still long term, and Minor – even less severe and shorter term) and it can all be confusing. Choosing a mental health care provider whom you can trust with your feelings is very important. There are several ways to treat depression. The three most popular ways are medication, counseling, and lifestyle changes. Each has its benefits and it’s important to discuss all of the available options when choosing your treatment choice. Dr. Khan says that each individual is different. “For some, counseling is the best choice. For others a good treatment is medication. Sometimes, you have to do both together. But exercising often helps as well. There’ve been a lot of clinical trials done showing that exercising will reduce physical pain and reduce emotional pain.” Do not wait too long to get evaluated or treated. There is research showing the longer one waits, the greater the impairment can be down the road. Try to see a professional as soon as possible. Try not to isolate yourself, and let others help you. Expect your mood to improve gradually, not immediately. Do not expect to suddenly “snap out of” your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts. Remember that positive thinking will replace negative thoughts as your depression responds to treatment. One thing to keep in mind is that many things in this world are out of your control. On the flip side, many things are completely within your control.You can’t control the actions of others, but you can control your own actions. You can’t control who you work with, but you can control where you work. You can’t control the expectations that others have for you, but you can control the expectations you have for yourself. The list is endless, but the recurring theme is that you only have control over yourself and your choices. continued on page 32

This Economy is Killing Me How to Handle Unemployment

Losing your job can trigger depression. Many times, the feelings of loss, helplessness, and hopelessness can be overwhelming. And then the bills start to pile up. The debt collectors start to call.Your spouse or significant other, or your parents, even your kids, start to harass you about a job. Perhaps the skills you’ve perfected over your working career are no longer in demand or you made a mistake that makes it even harder to find a job. Maybe an injury has changed you.You start to feel guilt for not providing and you’ve stopped helping out with your kids which gives you more guilt. The cycle pushes you farther and farther down the rabbit hole. This scenario could happen to any of us. It’s best to nip it in the bud.You’ve lost your job, now what? There are two types of people. Ones who can quickly and easily find another job and ones, who for whatever reason, have trouble finding another job. Let’s focus on the ones who have a problem finding a job.

Here are some tips to finding a new job. • Realize that finding a job is your current full-time job.You are your own boss and you must give 110 percent. While unemployment benefits may be there to help you, you should start seeking employment immediately. • Realize that people with jobs are more desirous to employers than those without, which means, a job is better than no job. • Networking is one of the best ways to find a job. Ask your friends and family for leads. Many jobs have been found using Facebook. • Focus on your church or join a church. Having supporting people around you can help keep you positive. • Join a service organization such a Rotary. Not only is the spirit of giving back present, so are many, many potential employers. • Volunteer. Not only does helping others help build your own self-esteem, it is one of the greatest networking programs available. Most volunteers at any non-profit organization are either employed or retired with ties to some company. If you are the hardest working volunteer, people notice. Seriously… People notice. • If your skill set isn’t in demand anymore, update or upgrade your skill set either at college or in one of the programs out there that retrain people.

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HEALTH TALK EDITION Summer 2012 Overeating Worthless Suicidal Thoughts

Lack of Concentration


Sleeping Restless Excessive Hopeless

Depression Sad

Indecisiveness Empty

Fatigue Pessimism

Digestive Problems


decreased energy

headaches Irritable Anxious Ignoring Hobbies Early Morning Wakefulness Less Sexual Desire

How can I help someone who’s depressed? Seeing someone close to you dealing with emotion problems is very taxing. Dr. Khan recommends “offering emotional support, understanding, patience, and encouragement. Talk to him or her, and listen carefully. Never dismiss feelings, but point out realities and offer hope. Never ignore comments about suicide, and report them to your loved one’s therapist or doctor. Provide assistance in getting to the doctor’s appointments. Remind your loved one that with time and treatment, the depression will lift.”

Can lack of sleep be causing my issue? Lack of sleep can be a major contributor to a lot of men’s health issues. Dr. Khan said, “Sleep has proven to be a critical thing. When a person can’t sleep, it is one of the first indicators that someone is having depression or anxiety. Sleep is also the number one treatment for depression. If someone starts sleeping better they will be able to slow down, focus better at their work, become more productive, and end up less depressed, because they are more productive. Sleep is also good for diabetes and high blood pressure, too. If you don’t sleep you will gain weight. Recently there was a study done at the Cleveland Clinic for heart patients that showed if you don’t sleep properly, you will gain 12 pounds in just one year. “ Gaining control over sleep can help you gain some positive momentum that can snowball into other areas of your life. It will reduce your stress and whether it’s with medication or through natural means, it is often the best starting point and one that shows an immediate return.

Regaining Control

Suicide Education Awareness & Services Contact Information Camilla McCoy at 434.836.8500 ext. 1062 32 Showcase Magazine

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Men often need to feel like they are in control to be happy. It’s obvious in everything from who handles the remote control to who turns off the GPS navigational systems. When we lose control over our feelings, we have to deal with feelings that are unfamiliar. The key to rebounding is to focus on one area at a time. A little positive momentum in one area will help you gain a foothold in another area. Clearly, the most important step is the first one. If you don’t feel like yourself, then you probably aren’t. It’s up to you to recapture the man you are. Dr. Aleem Khan is a psychiatrist at Piedmont Psychiatric Associates located at 201 South Main St, Suite 3400. He can be contacted at 434.799.4588.

Danville Regional Medical Center Health Talk Summer Edition 2012 (Showcase Magazine)  

The Summer 2012 edition of Health Talk . A quarterly guide to health, sponsored by Danville Regional Medical Center. Presented in Showcase M...

Danville Regional Medical Center Health Talk Summer Edition 2012 (Showcase Magazine)  

The Summer 2012 edition of Health Talk . A quarterly guide to health, sponsored by Danville Regional Medical Center. Presented in Showcase M...