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Women’s Pain & Depression

Maintaining Muscle Mass

Vanderbilt’s Program for Children’s Health

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Mayor Karl Dean

Taking the Initiative and Setting an Example

Heart Health and Obesity: Linked Together

JANUARY/FEBRUARY 2012


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contents | 9

19

14

13

28

26

Features Mayor Karl Dean 13 | Dear Fellow Nashvillians

Metro Health

Departments 4 | From the Editor Welcome Nashville!

6 | Women’s Health Chicken or Egg?

14 | Resolution for a Healthier City

9 | Men’s Health

Heart Healthier

24 | Senior Health

19 | Simple Steps to Save Your Life 21 | Blending Low Tech, High Tech to Foil the Widow Maker

Maintaining Muscle Mass Hitting Seniors’ Pocketbooks

26 | Children’s Health

Vanderbilt Children’s Health Improvement and Prevention

22 | The Mind-Body Connection

News in Brief

28 | Ditching the “D” Word

30 | Nashville Civic Design Center

4 | www.healthiernashville.com | January/February 2012

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| from the editor

Publisher Jackson Vahaly

Edit orial Editor Pepper Jeter Contributing Editor Cindy Sanders Contributing Writers Sharon Fitzgerald Melanie Kilgore-Hill Lynne Jeter Cindy Sanders

Ar t & Production Art Director Tracy Mitchell Contributing Photographers Eric England

Sal es & Mark eting SouthComm Publisher Mike Smith Advertising Director Ginny Staggs Account Executives Maggie Bond, Heather Cantrell, Jamie Day, Rachel Dean, Christy Martin Gibson, Scott Hylbert, Carla Mathis, Erin Mills, Stephanie Roselli, Stevan Steinhart, Keith Wright Marketing Christy Bryan, Joey Leslie Circulation Casey Sanders 526-6999 Production Manager Brent Rolen Graphic Designers Katy Barrett-Alley, Amanda George, Amy Gomoljak, Heather Hauser, Christie Passarello

Chris Ferrell Chief Executive Officer Todd Patton Director of Accounting Susan Torregrossa Director of Sales Operations Patrick Rains Director of Content/Online Development Heather Pierce Creative Director

Welcome Nashville!

W

e’re very excited you’ve picked up this inaugural issue of Healthier Nashville and hope you’ll enjoy and make use of the information inside. After publishing Nashville Medical News for nearly 25 years, a business publication geared to healthcare providers and administrators, we’ve created this sister publication just for you as the “go-to” magazine for consumer health advocacy. We brought along our best writers, who are informed and well-versed in healthcare matters facing Americans in the coming years. In each edition of Healthier Nashville, you’ll find important features on health trends concerning women, men, children and seniors. You’ll also find news from around town, such as the mayor’s healthcare initiative he touches on in his letter on page 13. Speaking of Mayor Dean, we’d like to thank him and his wife, Ann Davis, for gracing the cover of our inaugural publication. Their commitment to a healthier Nashville inspires us all. In our main package on Heart Care, you’ll learn what you can do proactively to help care for yourself or loved ones during a heart event, and dealing with the accompanying depression that sometimes occurs. In “Heart Monitor,” you’ll learn results in layman’s terms of the American Heart Association’s Heart Disease and Stroke Statistical Update 2012. You’ll better understand the difference between sudden cardiac arrest and a heart attack. In the men’s health section, “Maintaining Muscle Mass,” Denny Porr tells us why it’s important to include weight training and cardiovascular activity in a successful exercise regimen. Learn whether fatigue, low libido, moodiness, loss of strength, concentration problems and extra pounds results from a low testosterone level in “Is it Low T?” In “Hitting Seniors’ Pocketbooks,” seniors will discover upcoming changes resulting from healthcare reform that will impact their wallets. The women’s health feature – “Chicken or the Egg?” – discusses with area experts which comes first: depression or chronic pain? A sidebar lists helpful websites. In the next edition, which will be cancer-themed, we’ll look at advances and new treatments for the disease, help you organize your medical data, and tell you exactly what you’ll need in the era of electronic medical records. ber, this is your publication. We want to hear from you. What concerns you? What would you like to know more about? Please let me know your comments at PJeter@ HealthierNashville.com.

On The Cover Mayor Karl Dean and wife Ann Davis take advantage of the city’s extensive park system to enjoy an afternoon walk. Photo By Eric England

Pepper Jeter, Editor January/February 2012 | www.healthiernashville.com | 5

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Women’s Health |

Chicken or Egg?

Local experts weigh in on which typically comes first — depression or pain?

—By LYNNE JETER

C

hances are likely that one of three people you bump into today suffers from chronic pain or depression. It could be a family member, your next door neighbor, a coworker—or you. Medical experts have attributed the startling trend of increased diagnoses regarding chronic pain and depression to an aging baby boomer generation enduring arguably the greatest economic challenge of our time. Research shows that it’s unknown whether there’s a cause-and-effect relationship between chronic pain and depression. Yet if so, which condition causes the other? What role do other diseases and conditions play with this order? Medical experts scrambling to solve the riddle — which comes first: pain or depression? – have found more questions than answers. For example, do patients who are depressed perceive pain more acutely than those who aren’t depressed? Or does chronic pain have a debilitating effect on not just the body, but also the psyche, resulting in depression? “A lot of research shows there’s a cause and effect between chronic pain and both depressive and anxiety disorders,” said Michelle Cochran, MD, FATA, medical director of the NeuroScience & TMS Treatment Center in Michelle Cochran, MD Nashville. “Both illnesses are frequently concomitant, but many people don’t have both.”   To better understand the order of pain v. depression, it’s important to first define

Tracy Jackson, MD, of the Vanderbilt Division of Pain Medicine, performs an ultrasound-guided radio frequency stimulation procedure at the Vanderbilt Interventional Pain Clinic in Nashville

depression, or Major Depressive Disorder (MDD), said Cochran. “Depression is a title frequently used to refer to sadness, fatigue, loss of interest and functioning among individuals,” she said. “However, when psychiatrists refer to MDD, we’re specifically referring to an illness that’s a brain disease. Generally, MDD has to include an episode of at least two weeks duration and is characterized by a significant depressed mood, or a significant reduction of interests or pleasure. During this two-week period, the individual may have weight changes (gain or loss); sleep changes; activity changes that are observable by others; fatigue or loss of energy, worthlessness or excessive guilt nearly every day; diminished ability to think or concentrate or indecisiveness; and the patient may have thoughts of death or dying, or suicidal ideation.” Cochran pointed out the symptoms must

cause distress or impairment in social, occupational, or another area of functioning.   “Physicians rule out other causes of the symptoms, like direct or indirect effects of substances, medications, other medical conditions, and bereavement,” she said. “Unfortunately, despite knowing a lot about how the brain looks and acts in a depressive state and knowing many of the treatments of the disease, the causes of depression are not well understood,” she said. “We know that significant physical,  psychological, and social stressors and genetics play a large role in getting depression.” Having a relative that suffers from depression increases an individual’s likelihood of becoming depressed, Cochran noted. “But the exact process that causes the symptoms is elusive,” she said. “We do have good treatments including medications, individual and group psychotherapy, and neuromodulative treatments like

Where to Look for Help Lupus Foundation, Mid South Chapter www.lupus.org/webmodules/webarticlesnet/ templates/midsouth_home.aspx (615) 298-2273 Mental Health America of Middle Tennessee www.mhamt.org (615) 269-5355 National Fibromyalgia Association www.fmaware.org (615) 403-1515

Tennessee Suicide Prevention Network www.tspn.org (615) 297-1077 Vanderbilt Integrated Health www.vanderbilthealth.com/integrativehealth (615) 343-1554

6 | www.healthiernashville.com | January/February 2012

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| Women’s Health electroconvulsive treatments, Real, chronic pain is more deep brain stimulators, vagal than just having the flu for nerve stimulators and trana prolonged period, and it’s scranial magnetic stimulus. accompanied by bouts of The most effect treatments for being unproductive, isodepression are those that use lated, and never reaching a combination of approaches. one’s potential.” We have hypothesized a lot Marc Huntoon, MD, about the causes  because of professor of anesthesiolthe things we have found to Marc Huntoon, MD ogy and chief of the divitreat depression.” sion of pain medicine for Second, it’s important to define Vanderbilt University, said determinpain, a feat in itself. In its simplest ing the primary origin — depression terms, chronic pain is defined as a or pain?— is often tricky. duration of pain that extends beyond “Because we live in a dysfunctional the anticipated period of healing. world, some people may have psy“Depression magnifies pain,” said chological problems that stem from Cochran. “In MDD, there’s a physical loss or despair related to events such reduction, or ‘depression,’ in the funcas family separations, divorce and tioning of the brain. This reduction in death,” he said. “In some cases, they functioning causes the perception of become depressed. Others have prilife to be distorted on multiple levels. mary depression that can be traced to One area of perceptual disturbance a biological imbalance.” can be in the perceived worsening of A patient’s ability to cope with the painful sensations.” pain in the face of depression is going Among the most accepted theories to be lessened, noted Huntoon. is that chronic pain causes the body “Their coping mechanisms will to produce substances – adrenaline break down more readily in that situand corticosteroids – that can result ation,” he said. “Thus when depresin reduced functioning in areas of sion is the first problem, we need the pain, therefore causing or otherthe help of both psychologists and wise triggering a depression.   psychiatrists and sometimes drug Tom Starling, EdD, president and therapies and counseling. Once the CEO of the Mental Health Associadepression gets better, we can treat tion of Middle Tennessee, said most the pain more effectively.” people who contact their office with Conversely, sometimes the pain major depression have chronic pain. comes first, Huntoon said. “Some have been in motor vehicle “Most of the time, we’re able accidents, had back surgery, and/or to relieve pain in the early acute have chronic pain resulting from illphase, but after events such as surnesses such as fibromyalgia and lupus,” gery, trauma or disease processes, he explained. “Studies indicate that the pain can go on long enough people with chronic pain, such as fithat it becomes chronic,” he said. bromyalgia, may have more active pain “We now know that when chronic receptors or pain pathways, so they acpain goes on for several months tually feel more pain than others.” unabated, it can actually change Chronic pain almost always results in our brain in a permanent way. some level of depression, noted Starling. When those permanent neurologi“Although the pain alone may result cal changes occur, our nervous sysin some emotional drain, clients often tem responds to pain in a changed share that their depression is caused way. In some cases, if the associated by the many contributing factors asareas in the brain that govern our sociated with chronic pain,” he said. emotions and mood become in“Imagine never being able to take a volved, the patient’s sadness, anxivacation or well-deserved time off ety, and isolation can also become so you can rejuvenate and return to amplified, further increasing the work fresh. People with chronic pain overall experience of pain. use all their sick and vacation time to “The bottom line is: in some cases, endure prolonged pain and anguish. pain can initiate or exacerbate deThey cannot imagine coming to work pression, and in some cases, depresrefreshed. Who wouldn’t become desion can initiate or exacerbate painful pressed if they felt bad all the time? experiences.”HN

Coping with Fibromyalgia Tom Starling, EdD, president and CEO of the Mental Health Association of Middle Tennessee, knows intimately of what he speaks. As an undergraduate at Ole Miss 23 years ago, his wife, DeAnn, was diagnosed with Tom Starling, EdD fibromyalgia, a condition associated with widespread chronic pain, fatigue, memory problems and mood changes. Even though she holds a law degree from Vanderbilt Law School, DeAnn hasn’t been able to work a full-time job for more than a decade. “She’s a terrific wife, mother and friend, but is constantly challenged by physical limitations,” said Starling. “Few friends can cope with our unreliability as painful flares of fibromyalgia are unpredictable and often interfere with our plans.” Morning time and the change of seasons in March and October often herald painful flare-ups. “A strong system of support is rare for people with chronic pain,” he explained. “Loneliness and isolation are inevitable. The depression gains strength.” Ironically, most people with fibromyalgia have Type A personalities, Starling noted. “They’re ambitious but cannot make strides in accomplishing their dreams,” he said. “Being unable to fulfill one’s potential deepens the depression.” Finally, there’s the conundrum of pain medication. “No one wants to become addicted to prescription drugs, so people in pain may not take enough medicine to help,” he said. “Even a small amount of pain medication can make people drowsy and lethargic. Ultimately, the choice is to take little or no medication and become incapacitated by the pain, or take some medication and become incapacitated by the medicine. Such paralysis is a depression catalyst.” According to the Arthritis Foundation, because fibromyalgia is difficult to diagnose, women with the condition have typically undergone many tests and have seen several specialists in their search for answers. They’re often told that because they look well and their tests are normal, there’s nothing wrong with them. Their family and friends, as well as physicians, may doubt their complaints, increasing their feelings of isolation, guilt and anger. As a result, some patients attain the unwanted stigma of being a chronic complainer or not being tough enough to handle the pain. It can affect their relationships, their ability to perform on the job, and many other life issues. The good news is that once fibromyalgia patients are properly diagnosed, the medical team may create a specific treatment plan that could include medications to diminish pain and improve sleep, an exercise program to increase overall health, relaxation techniques to ease muscle tension and anxiety, and education programs that explain the symptoms and management of fibromyalgia. “Despite having had fibromyalgia for over two decades,” said Starling, “my wife is typically very positive and refuses to give up hope.”

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spirit It’s the

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To learn how Nashville is working to put healthier food on the menu at schools, visit NashVitality.org.

A student from Glenview Elementary embraces healthy cafeteria options.

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8 | www.healthiernashville.com | January/February 2012

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| men’s Health

Maintaining Muscle Mass Regimen should include weight training and cardiovascular activity

—By SHARON H. FITZGERALD

“T

he more you don’t use it, the faster you lose it.” Those are the words of Denny Porr, and he’s talking about the body’s muscle. With a doctorate in exercise science, Porr is Saint Thomas Health’s executive director of Associate Health and Safety, and he oversees the system’s wellness centers. It’s his job to give fitness advice, and he has some particular health counsel for men: Eat a balanced diet and exercise six days a week, doing both cardiovascular activities and weight or resistance training that concentrates on the major muscle groups. Denny Porr It’s that last phrase in italics that trips up so many men. In fact, Porr quipped that it’s a standard joke in his profession that if a fitness facility were built exclusively for men, the mirrors on the wall would be just from the waist up. That’s because men focus on their biceps and pectorals for cosmetic reasons, and they do so to their detriment. “Though they think they look good in the mirror, they’re not exercising major muscle groups,” he said. Thus, that’s one of Porr’s top tips for men working to regain or maintain their physical edge – to work their quadriceps, hamstrings, gluteal

muscles, abdominals and back. If men only have time to do one exercise, “do leg presses,” he said. The physiology of working out The “powerhouse” of muscle cells, Porr explains, is mitochondria. Men who are long-distance runners have more mitochondria per muscle fiber than men who are sprinters. Why? They need more oxygen over the long haul and providing the muscle with oxygen is something mitochondria do. Over time, mitochondria flourish in the muscles of men who perform consistent cardiovascular exercise that is challenging but not physically

overwhelming. “Any long, slow, distance training increases mitochondrial activity in muscle, and that’s good because it increases metabolism. It changes the way muscle maintains and grows,” he said. Men who are physically fit, whose metabolism is higher, literally burn more calories sitting still than men who are generally sedentary. Therefore, Porr recommends cardiovascular activity that is difficult enough to alter the breathing pattern but not so hard that the person can’t carry on a reasonable conversation. Gasping for air isn’t the goal. “That’s hard to convince guys of, because they have this macho, athletic

For More Info The Internet is full of advice, both good and bad, when it comes to fitness and nutrition. Here are some reliable resources to help you craft an exercise regimen and diet that work for you. Start slowly with attainable, short-term goals, gradually building your strength, stamina and ability to resist chocolate ice cream! The American Council on Exercise offers its ACE GetFit™ program on the web with free exercises, healthy recipes, workout and educational videos, an exercise library and even a body mass index calculator. It’s a top-notch resource with community discussion boards and blogs to encourage participants. Visit www.acefitness.org. The American College of Sports Medicine offers fitness information in a variety of categories on

its website. Find what you’re looking for by clicking on the “access public information” tab at www.acsm.org. The American Heart Association is doing its part to encourage a healthy lifestyle. Visit www.heart.org and click on the “getting healthy” tab for nutrition and exercise information and suggestions for weight and stress management. Take the President’s Challenge, a program sponsored by the U.S. Health and Human Services President’s Council on Physical Fitness and Sports. Visit www.fitness.gov and develop a routine mapped out for you, based on your age. Finally, remember this, your first stop to a healthy life is a visit with your physician.

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men’s Health | mindset that the harder they work the more benefit they get,” he says. “To some extent that is true, but it will also kill you.” Men in their 20s may scoff at that notion, but by the time they are in their late 30s, they should take heed. Porr says dramatically and rapidly increasing exercise can be dangerous if there are “underlying issues like plaque in the arteries.” Should that plaque break lose because of strenuous activity, it may float through the system, form a clot and prompt a heart attack or stroke.

pounds. “All of that will be fat, and that’s scary,” he said. Porr recommends “training for life,” with resistance training that consists of more sets and repetitions at a lower weight. He’s a fan of “combination exercises” that work several areas of the body simultaneously. Good examples are push ups and pull ups, which give men the arm workout they desire while also working core muscle groups. “You don’t think Marines look good? They do a lot of push ups,” he said.

Fitness as men age The nutrition equation Echoing Porr’s advice for While women face specific nustrength training is Andrew Gregtritional deficiencies like calcium ory, MD, a Vanderbilt and iron, men don’t University assistant deal with that chalprofessor of orthopaelenge. They do, howdics and rehabilitation ever, require sufficient and a team physician. carbohydrates to stay “One of the big things active. “Carbs are really that happens to people important for exercise,” over time is their muscle Gregory said. “They mass goes down, about are the main energy for 1 percent per year after exercise, so what you their 30s. So strength Andrew Gregory, MD find is that people can’t declines,” said Gregory, maintain these low-carb who’s not particular about whethdiets because they just don’t have er men use gym machines, dumbthe energy to do exercise. It’s fine bells and barbells, or exercises that to do that for a short period of use a person’s own body weight time, but realistically what you for resistance. “However you want need is a balanced diet.” to do it, I don’t think it matters as Gregory added, “Sugar really long as you’re doing some sort of doesn’t count in my mind as a strength or weight training.” carbohydrate.” He encourages inGregory also notes that such stead complex carbs such as those training is good for the bones, and found in multigrain bread, whole men aren’t immune to osteoporowheat pasta, potatoes, green vegsis. “Just like women, men’s bone etables and fruits such as oranges, density actually goes down with apricots and prunes. age. Men reach a higher peak than Porr remembers when the women in terms of bone density, federal government dissed fats so it takes longer for their bone altogether but “forgot to tell us” density to get down low enough that healthy fats are essential for to see these osteoporotic fractures good nutrition. “All your horlike you see much more commones are based on fat,” he said. monly in women, but their bone That’s why he encourages the use density certainly goes down.” of olive and canola oils and, yes, Both experts agree that most eating meat. “You just need to eat men throughout their 20s are so lean meat when you eat it, and active that a regimented workout you don’t need to eat as much as routine isn’t critical. But by the time they give you in a restaurant,” he they hit their 30s, things change. said. “They will give you a week’s “Now, they’re into the adult world worth at one meal.” with a 9-to-5ish job. Now, they’re If Americans just would move quite a bit more sedentary,” Porr “more toward” a plant-based diet, he said. He notes that between 30 and said, “you wouldn’t seen nearly the 55, the average male will gain 15 level of obesity that you see today.” HN

Is It Low T? By now, most television viewers have seen pharmaceuticalindustry commercials asking men to consider whether their fatigue, low libido, moodiness, loss of strength, concentration problems and extra pounds are results of a Phaythoune low testosterone level. Chothmounethinh, MD But is so-called “low T” really a valid cause of such symptoms suffered by men as they age? According to Phaythoune Chothmounethinh, a Goodlettsville primary-care physician, the answer just might be yes. “We’re now starting to see that some men really do have low levels of testosterone that could explain a lot of this. It is a legitimate concern,” Chothmounethinh said. “It seems like there’s more awareness about it, not just in the public, but in medical communities, too.” Recent data even suggest that testosterone levels are dropping in men across the board. Theories range from environmental pollutants to higher stress levels or newer medications on the market. Chothmounethinh says that while some symptoms attributed to low T could simply be the natural consequences of aging, when a multitude of certain symptoms combine, checking a patient’s testosterone level is the medically correct thing to do. Testosterone levels in men fluctuate during the day, so physicians like to check the level in the morning and then again another day to ensure accuracy. Unlike women, whose hormone levels drop precipitously at menopause, men’s hormone levels gradually decline. Thus, there isn’t a sudden onslaught of symptoms; it’s more like a slow creep of symptoms that men may initially ignore. Eventually, however, it becomes “a quality of life issue,” said Chothmounethinh, who has seen some marked improvement as a result of testosterone-replacement therapy. “If the testosterone replacement is appropriate and adequate, you’ll see some result in three to six months,” he said. In fact, he’s had patients come to him who previously had been prescribed an erectile-dysfunction drug such as Viagra or Cialis when, in fact, low T was the true problem. Testosterone replacement is usually by intramuscular injection or via a gel rubbed on the upper arms or chest. “The gel seems to give the most reliable levels of testosterone along with the fewest side effects,” Chothmounethinh said. He cautions against testosterone in pill form, which doesn’t maintain steady hormones levels and might have a toxic effect on the liver. Chothmounethinh also warns against over-the-counter products that claim to be an “all natural” testosterone replacement. “We still don’t know of any natural alternative to increasing testosterone levels in men,” he said. There’s a concern as well that such supplements aren’t regulated by the Food and Drug Administration. “What’s on the label may not actually be what’s in the product,” he noted. “There’s always this danger, also, that the product may contain stimulants that could increase blood pressure, cause agitation and other side effects.”

12 | www.healthiernashville.com | January/February 2012

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1/9/12 10:57 AM


Metro Photographer Gary Layda

I’ve always enjoyed the start of a new year. It’s an opportunity to start things anew. Like many of you, my resolution for 2012 is health-related. I know I want to eat better this year. Last year, I walked 100 miles and ran a 5K with a lot of fellow Nashvillians, but, frankly, I also ate a little too much pizza. So, I’m going to watch what I eat. I encourage everyone this year to eat better and take advantage of the many ways to get active in our city. Nashville has a real chance to become a national leader in the fight against obesity, and in the process, make our individual lives better. It’s not about how we look in our clothes – my focus on health is about how we look on the inside. Obesity is directly related to health problems such as cancer, diabetes and heart disease. Overweight or obese individuals also incur more health-related expenses and miss work more often. Nashville is an international center for the healthcare industry. We should be one of the healthiest cities in America. But instead, our state is ranked as one of the worst in the country for obesity and childhood obesity. Even more disturbing, this is the first generation of children expected to live shorter lives than their parents since our country began keeping records on life expectancy more than 100 years ago. Facing these startling statistics, I challenged Nashvillians last year to join me in two healthy-living campaigns. First, I asked you to walk 100 miles with me in our city’s parks and greenways. The highly-successful Walk 100 Miles with the Mayor campaign drew 4,000 Nashvillians who walked more than 100,000 miles in just three months. Then, I asked you to participate in the Mayor’s Challenge 5K, and more than 5,000 of you walked and ran 3.1 miles with me downtown on a beautiful Sunday afternoon in November. I know that a walking campaign or a single 5K event is not going to reverse the obesity trend in Nashville. But, as a community, these efforts are helping us create a culture that encourages being active and eating better. The other thing government can do in the fight against obesity is make healthy choices more accessible. That’s why in the last capital spending plan, I committed more than $20 million to improving and expanding our parks, greenways, sidewalks and bikeways. I also signed a Complete Streets executive order in 2010 to require the consideration of all modes of transportation in the planning, designing and construction of roadways in our city to make it

Mayor Karl Dean and wife Ann Davis

eric england

Dear Fellow Nashvillians

easier for people who want to walk or bike or take mass transit. Nashville is also getting an expanded bike share program. Right now, community members and visitors can borrow a bike from six different locations across the city at no cost through a program called Nashville GreenBikes. These bike stations are directly linked to more than  40 miles of greenways and  94 miles of on-road bike lanes and routes. And we’re working to expand the bike share program with a kiosk-based bike-rental system, which will be located primarily in the downtown urban core. When it comes to healthy eating, we have made good strides. Farmers’ markets have become more prevalent in all parts of our city. We’ve also worked to increase access to fresh fruits and vegetables in our schools and in the city’s food deserts. As well, school and community gardens have proliferated over the last several years. A natural extension of getting more fresh produce into Nashville homes is teaching families how to prepare healthy dishes with them, and that is why I am pleased that Metro operates two community kitchens, one at the Nashville Farmers’ Market and another at Coleman Community Center, with more to come. I have been focused on improving our health for a while now, and I plan to continue aggressively working on it in the years to come. I appreciate the attention on healthy living that this publication is providing. Please join me as we make Nashville a healthier, more active city. While the challenge is great, I believe if any city can embrace healthier living, it’s Nashville.

Have a great year! Mayor Karl Dean January/February 2012 | www.healthiernashville.com | 13

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1/9/12 11:01 AM


contributed health department

Resolution for a Healthier City

W

hen it comes to health, we’re always looking for a fresh start.  My New Year’s resolution – to improve my heart health by becoming a vegan Ironman triathlete – hasn’t gotten off the ground.  I’m starting out behind: the refrigerator is full of ham and cheese from the holidays. My schedule is already full. The changes seem extreme: inconvenient and time consuming for me and my family. If I were serious about it, I would pick a resolution that’s within reach. I’m more likely to succeed if I have support from family and friends. I can set my shopping policy to keep appealing healthy food at hand and make chips, beer, butter, and bacon less convenient and more exceptional. Even if I’m not an Ironman, I have time to take the stairs or walk to the store. Moving toward better health is not just a matter of willpower; it’s making healthy choices easier, and changing the conditions we live in so the default choices are healthy. Across Nashville, people are resolving to eat better, move more, and quit smoking.  But too many of us start out behind.  Whether it is a lack of social support, safety issues, or few healthy options in our environment, almost any healthy change seems unrealistic and out of reach for some.  And of course Nashville is located in a state with the 4th highest obesity rate. We have a long way to go.  But Nashville has been making a fresh start. School and community gardens are sprouting, reconnecting people with healthy food.  “Green Bikes” are being enjoyed in our parks and greenways. Some convenience stores are beginning to market fresher, healthier food.  Metro Schools are offering salad bars at lunch.  Mayor Dean has led thousands of us to more activity with Walk 100 miles and the Mayor’s 5k, and also made significant commitments to open spaces, pedestrians and bicyclists. Meanwhile, advocates, employers, medical providers and clergy have led and joined in to push toward healthy change. The NashVitality campaign celebrates the spirit of this movement toward a healthy, active, and green city. Our health rankings have improved a little.  Could Nashville’s New Year’s resolution be to become a healthier

East Nashville Cooperative Ministry garden

By WILLIAM STEVEN PAUL, MD, MPH

place to live?  It seems within reach.  To succeed, we need to keep making healthy choices easier, to change conditions so that resolving to be healthy is more realistic for everyone.  We need to be aware of the decisions that shape the places we live, learn, work, play, and worship and consistently steer them to support better health. One initiative that will unfold this year in support of such a resolution is the Shaping Healthy Cities: Nashville project, led by the Nashville Civic Design Center in partnership with the Metro Public Health Department. Over the next two years, this project will create a book and an action plan that sketch a roadmap for a healthier city.  Shaping Healthy Cities: Nashville will build awareness of the connections between the urban environment and our health, and make it easier to consider health when decisions are made about how our buildings, streets, and neighborhoods are built. This project will help paint a vision of a healthier city and provide practical tools to help Nashville take steps toward that vision. A healthier city is within reach.  We may not meet all of our goals with one project or within one year. It will take time and effort. Together, we can do it. Join the movement and support Nashville’s efforts to become a healthy, active and green city for everyone. Join NashVitality on Facebook and Twitter this month for 31 days of Resolutions. Get ideas on ways to be healthy, active and green all year, post your resolutions and suggest resolutions for how Nashville can become a healthier, more active and green city. www.facebook.com/NashVitality and @NashVitality Dr. Paul has been serving as Director of Nashville’s Public Health Department since July 2007. Before coming to Nashville, Dr. Paul served at the Chicago Department of Public Health. He has a Bachelor of Science from Stanford, and an MD and Master of Public Health from the University of Illinois. He is board certified in Internal Medicine and Infectious Diseases, and completed a 2-year assignment as an Epidemic Intelligence Services officer at the Centers for Disease Control.

14 | www.healthiernashville.com | January/February 2012

HN_JanFeb_2012_Health Dept.indd 14

1/9/12 10:36 AM


Va n d e r b i lt H e a lt H p r e s e n t s

HealthGuide B e w e l l , g e t B e t t e r a n d s tay i n f o r m e d

Jan/feB 2012

treated without surgery. t treatment depends on age, fitness level and other conditions and should take into account the patient’s goals, which might include getting back to walking, gardening, tennis, golf or other pursuits. t I p s t o h o l d l ow bac k pa I N at bay

Oh, my aching back! by Cynthia Floyd Manley Pinpointing the cause of low back pain can be the key to successful treatment.

I

f yo u r l ow bac k h u rt s , yo u a r e

not alone. low back pain affects more than 80 percent of americans at some point in their lives. It most often occurs between ages 30-50 and affects men and women equally, says the National Institutes of health. It’s a symptom, not a disease, and treatment is most successful when the cause is pinpointed. once the source is found, most cases can be

while low back back is common, you can reduce your risk. keep pressure off the spine by maintaining a healthy body weight or losing excess weight. be physically active and include in your routine exercises to strengthen back and abdominal muscles. don’t forget to stretch regularly to increase flexibility. other tips include maintaining good posture, avoiding sitting for long times (stand up to stretch periodically while at work), and using care to lift heavy items with your legs. sleeping on your side with a pillow between your legs may also provide relief. so m e Caus e s o f low baC k pa in

— Injury to the spine due to abnormal stress, such as from improper lifting

meCHaniCal spine disorders

— body’s protective response to irritation, injury or infection

inflammation

—w wearing down of the vertebrae and the discs that pad them

degeneratiVe spine disorders

—t tumor of the pelvic organs or bones, such bladder or reproductive organs

pelViC tumor

— a bulging in the wall of the body’s largest blood vessel

aortiC aneurysm

osteoartHritis of tHe Hips

breakdown of the joint

— age-related

to schedule an appointment with the Vanderbilt Comprehensive spine Center, call (615) 875-5100 or visit Vanderbiltspine.com. Vanderbilt University Medical Center | VanderbiltHealth.com

vandy.indd 1

1/6/12 4:18 PM


Cancer care unique as you are by Cynthia Floyd Manley insight into a tumor’s dna is helping doctors tailor therapy.

C

anCers may look alike under a miCrosCope or start

in the same part of the body yet still be very different at the level of the tumor’s genome (dna). “that’s important, it turns out, for what kind of therapy, especially targeted therapies, may work for some patients and not work for others,” explained dr. William pao, director of personalized Cancer medicine at Vanderbilt-ingram Cancer Center.

for example, an abnormality (mutation) in a lung cancer cell’s dNa can result in a specific protein on the cell surface — a protein that is targeted by a particular pill. That mutation occurs in only 10 percent of lung cancer patients.

starting to use this “genomic” information to personalize treatment based on the dNa of an individual patient’s tumor. tissue from a patient’s tumor is tested for a set of mutations that have a known impact on treatment response. These are changes in the dNa of the cells that make them malignant and different from normal cells. The test results are included — Dr . William PaO in Vanderbilt’s electronic medical record so the “If we gave that pill to 100 patients, only 10 oncologist can use the information to pick the would benefit,” pao said. “by looking at the right treatment. genetic make-up of their tumors, we can tell Vanderbilt is among the first in the nation ahead of time who those 10 patients are. Then to use this approach. currently, testing of lung we can give the right medicine to the right cancer and melanoma patients is a matter of patients at the right time, and avoid the wrong routine. breast cancer patients may also undermedicine for the others.” go testing to see if they are candidates for a new pao and his colleagues at Vanderbilt are drug being tested in a clinical trial.

We can give the right medicine to the right patients at the right time, and avoid the wrong medicine for the others.

learn more at ViCC.org/personalized or call (615) 936-8422 for an appointment.

Vanderbilt University Medical Center | VanderbiltHealth.com

vandy.indd 2

1/6/12 4:19 PM


signs of to n g u e -ti e • baby has difficulty latching on • motHer experiences pain or bleeding • baby breastfeeds for up to an hour at a time • baby becomes frustrated during feeding • baby falls asleep before full Source: Monroe Carell Jr. Children’s Hospital at Vanderbilt

Helping babies nurse by Jeremy Rush treating an easily missed condition may help more mothers breastfeed.

M

o t h e r s s t ru g g l I N g t o

breastfeed their newborns may want to ask their pediatrician to check for an easily missed “tongue-tie” condition before abandoning nursing. In up to 10 percent of newborns, an abnormally tight frenum, the membrane that connects the tongue to the floor of the mouth, restricts the tongue’s movement. “for an infant to properly breastfeed, the tongue must move to the lips to allow sucking to occur,” said dr. dale t tylor, a pediatric earnose-and-throat specialist (otolaryngologist). “In tongue-tie, the baby has a hard time latching on and uses the gums or lips. It becomes painful for mom and can even cause bleeding.”

The condition, ankyloglossia, has two subtypes; anterior, in the front of the mouth, is relatively easy to spot, while posterior, in the back of the mouth, can be harder to detect. tylor and her colleagues have developed t a streamlined process to quickly identify and treat the problem. when that happens, they have found that two-thirds of women can successfully breastfeed. The team is working with lactation consultants to direct frustrated mothers quickly to Vanderbilt’s pediatric otolaryngology clinic. widespread knowledge about the health benefits of breastfeeding may cause a mother anxiety, frustration or guilt when things don’t go as planned. “The goal is to increase public awareness among doctors and more importantly among parents, who can then advocate for themselves,” t tylor said. Story adapted from the VUMC Reporter.

Vanderbilt University Medical Center | VanderbiltHealth.com

vandy.indd 3

1/6/12 4:19 PM


The way to a man’s heart? it might be through the wrist by Jessica Turner Catheterizations are faster, easier with new procedure.

t

h e way t o a M a N ’ s h e a rt I s

through his stomach, the old adage goes. but when it comes to heart catheterization, it just might be the wrist. each year, a million americans undergo heart catheterization and in more than 80 percent of cases, doctors start with an incision in the larger artery in the groin called the femoral artery. an increasingly popular approach starts instead in the radial artery in the wrist. In both approaches, doctors access the coronary arteries to find if and where blood flow to the heart muscle is being blocked and/or to do angioplasty to open a blockage. Vanderbilt heart physicians have embraced the radial technique with 40 percent of the hospital’s heart catheterizations now being done through the wrist, which is more than double the national average. They have found that the new procedure often reduces complications, improves outcomes and is more cost effective. frank hughes w wright will tell you that the “transradial” approach can also improve the overall patient experience. he knows. he’s had them both. “I had a very hard time when they went in through my groin,” w wright said. “I had a lot of bruising and I had to lie still for about nine hours without moving. “with the radial, it was like night and day. It was so easy for me. as soon as the procedure was complete, I could sit up and within 30 minutes, I was walking around.” for certain types of patients, including

Dr. Waleed N. Irani talks with Frank Hughes Wright during a follow-up appointment.

women, the elderly and those who are obese or have peripheral vascular disease, transradial access offers documented reductions in back pain and bleed complications such as bruising or swelling. These patients are often discharged sooner, and for patients with heart attack, transradial access may reduce risk of dying or major complications. dr. david Zhao, director of interventional cardiology at Vanderbilt, said that wright’s w experience is not unusual. “general speaking, our patients prefer this procedure because they are able to be mobile much faster and experience less post-procedure pain than those who have transfemoral access.”

to learn more about Vanderbilt Heart or to make an appointment, call (615) 322-2318 or visit VanderbiltHeart.com.

about HealtH guide Health guide offers information from the experts at Vanderbilt university medical Center to help you and your family get better, be well and stay informed about the latest in medical care and research. a part of Vanderbilt university, the medical center’s mission is to advance health and wellness through comprehensive and nationally renowned programs in patient care, medical and nursing education and biomedical research. ConneCt witH Vanderbilt

vandy.indd 4

facebook.com/VanderbiltHealth

twitter.com/VumCHealth

scan for a listing of free health events Vanderbilt University Medical Center | VanderbiltHealth.com

1/6/12 4:19 PM


Va n d e r b i lt H e a lt H p r e s e n t s

HealthGuide B e w e l l , g e t B e t t e r a n d s tay i n f o r m e d

Jan/feB 2012

treated without surgery. t treatment depends on age, fitness level and other conditions and should take into account the patient’s goals, which might include getting back to walking, gardening, tennis, golf or other pursuits. t I p s t o h o l d l ow bac k pa I N at bay

Oh, my aching back! by Cynthia Floyd Manley Pinpointing the cause of low back pain can be the key to successful treatment.

I

f yo u r l ow bac k h u rt s , yo u a r e

not alone. low back pain affects more than 80 percent of americans at some point in their lives. It most often occurs between ages 30-50 and affects men and women equally, says the National Institutes of health. It’s a symptom, not a disease, and treatment is most successful when the cause is pinpointed. once the source is found, most cases can be

while low back back is common, you can reduce your risk. keep pressure off the spine by maintaining a healthy body weight or losing excess weight. be physically active and include in your routine exercises to strengthen back and abdominal muscles. don’t forget to stretch regularly to increase flexibility. other tips include maintaining good posture, avoiding sitting for long times (stand up to stretch periodically while at work), and using care to lift heavy items with your legs. sleeping on your side with a pillow between your legs may also provide relief. so m e Caus e s o f low baC k pa in

— Injury to the spine due to abnormal stress, such as from improper lifting

meCHaniCal spine disorders

— body’s protective response to irritation, injury or infection

inflammation

—w wearing down of the vertebrae and the discs that pad them

degeneratiVe spine disorders

—t tumor of the pelvic organs or bones, such bladder or reproductive organs

pelViC tumor

— a bulging in the wall of the body’s largest blood vessel

aortiC aneurysm

osteoartHritis of tHe Hips

breakdown of the joint

— age-related

to schedule an appointment with the Vanderbilt Comprehensive spine Center, call (615) 875-5100 or visit Vanderbiltspine.com. January/February 2012 | www.healthiernashville.com | 15

Vanderbilt University Medical Center | VanderbiltHealth.com

HEN_01_02-12.indd 15

1/6/12 4:12 PM


sponsored Content

s

Cancer care unique as you are by Cynthia Floyd Manley insight into a tumor’s dna is helping doctors tailor therapy.

C

anCers may look alike under a miCrosCope or start

in the same part of the body yet still be very different at the level of the tumor’s genome (dna). “that’s important, it turns out, for what kind of therapy, especially targeted therapies, may work for some patients and not work for others,” explained dr. William pao, director of personalized Cancer medicine at Vanderbilt-ingram Cancer Center.

for example, an abnormality (mutation) in a lung cancer cell’s dNa can result in a specific protein on the cell surface — a protein that is targeted by a particular pill. That mutation occurs in only 10 percent of lung cancer patients.

starting to use this “genomic” information to personalize treatment based on the dNa of an individual patient’s tumor. tissue from a patient’s tumor is tested for a set of mutations that have a known impact on treatment response. These are changes in the dNa of the cells that make them malignant and different from normal cells. The test results are included — Dr . William PaO in Vanderbilt’s electronic medical record so the “If we gave that pill to 100 patients, only 10 oncologist can use the information to pick the would benefit,” pao said. “by looking at the right treatment. genetic make-up of their tumors, we can tell Vanderbilt is among the first in the nation ahead of time who those 10 patients are. Then to use this approach. currently, testing of lung we can give the right medicine to the right cancer and melanoma patients is a matter of patients at the right time, and avoid the wrong routine. breast cancer patients may also undermedicine for the others.” go testing to see if they are candidates for a new pao and his colleagues at Vanderbilt are drug being tested in a clinical trial.

We can give the right medicine to the right patients at the right time, and avoid the wrong medicine for the others.

learn more at ViCC.org/personalized or call (615) 936-8422 for an appointment.

16 | www.healthiernashville.com | January/February 2012 Vanderbilt University Medical Center | VanderbiltHealth.com

HEN_01_02-12.indd 16

1/6/12 4:13 PM


sponsored Content

signs of to n g u e -ti e • baby has difficulty latching on • motHer experiences pain or bleeding • baby breastfeeds for up to an hour at a time • baby becomes frustrated during feeding • baby falls asleep before full Source: Monroe Carell Jr. Children’s Hospital at Vanderbilt

Helping babies nurse by Jeremy Rush treating an easily missed condition may help more mothers breastfeed.

M

o t h e r s s t ru g g l I N g t o

breastfeed their newborns may want to ask their pediatrician to check for an easily missed “tongue-tie” condition before abandoning nursing. In up to 10 percent of newborns, an abnormally tight frenum, the membrane that connects the tongue to the floor of the mouth, restricts the tongue’s movement. “for an infant to properly breastfeed, the tongue must move to the lips to allow sucking to occur,” said dr. dale t tylor, a pediatric earnose-and-throat specialist (otolaryngologist). “In tongue-tie, the baby has a hard time latching on and uses the gums or lips. It becomes painful for mom and can even cause bleeding.”

The condition, ankyloglossia, has two subtypes; anterior, in the front of the mouth, is relatively easy to spot, while posterior, in the back of the mouth, can be harder to detect. tylor and her colleagues have developed t a streamlined process to quickly identify and treat the problem. when that happens, they have found that two-thirds of women can successfully breastfeed. The team is working with lactation consultants to direct frustrated mothers quickly to Vanderbilt’s pediatric otolaryngology clinic. widespread knowledge about the health benefits of breastfeeding may cause a mother anxiety, frustration or guilt when things don’t go as planned. “The goal is to increase public awareness among doctors and more importantly among parents, who can then advocate for themselves,” t tylor said. Story adapted from the VUMC Reporter. January/February 2012 | www.healthiernashville.com | 17

Vanderbilt University Medical Center | VanderbiltHealth.com

HEN_01_02-12.indd 17

1/6/12 4:13 PM


sponsored Content

The way to a man’s heart? it might be through the wrist by Jessica Turner Catheterizations are faster, easier with new procedure.

t

h e way t o a M a N ’ s h e a rt I s

through his stomach, the old adage goes. but when it comes to heart catheterization, it just might be the wrist. each year, a million americans undergo heart catheterization and in more than 80 percent of cases, doctors start with an incision in the larger artery in the groin called the femoral artery. an increasingly popular approach starts instead in the radial artery in the wrist. In both approaches, doctors access the coronary arteries to find if and where blood flow to the heart muscle is being blocked and/or to do angioplasty to open a blockage. Vanderbilt heart physicians have embraced the radial technique with 40 percent of the hospital’s heart catheterizations now being done through the wrist, which is more than double the national average. They have found that the new procedure often reduces complications, improves outcomes and is more cost effective. frank hughes w wright will tell you that the “transradial” approach can also improve the overall patient experience. he knows. he’s had them both. “I had a very hard time when they went in through my groin,” w wright said. “I had a lot of bruising and I had to lie still for about nine hours without moving. “with the radial, it was like night and day. It was so easy for me. as soon as the procedure was complete, I could sit up and within 30 minutes, I was walking around.” for certain types of patients, including

Dr. Waleed N. Irani talks with Frank Hughes Wright during a follow-up appointment.

women, the elderly and those who are obese or have peripheral vascular disease, transradial access offers documented reductions in back pain and bleed complications such as bruising or swelling. These patients are often discharged sooner, and for patients with heart attack, transradial access may reduce risk of dying or major complications. dr. david Zhao, director of interventional cardiology at Vanderbilt, said that wright’s w experience is not unusual. “general speaking, our patients prefer this procedure because they are able to be mobile much faster and experience less post-procedure pain than those who have transfemoral access.”

to learn more about Vanderbilt Heart or to make an appointment, call (615) 322-2318 or visit VanderbiltHeart.com.

about HealtH guide Health guide offers information from the experts at Vanderbilt university medical Center to help you and your family get better, be well and stay informed about the latest in medical care and research. a part of Vanderbilt university, the medical center’s mission is to advance health and wellness through comprehensive and nationally renowned programs in patient care, medical and nursing education and biomedical research. | www.healthiernashville.com | January/February 2012 ConneCt witH Vanderbilt facebook.com/VanderbiltHealth 18

HEN_01_02-12.indd 18

twitter.com/VumCHealth

scan for a listing of free health events Vanderbilt University Medical Center | VanderbiltHealth.com

1/6/12 4:13 PM


HEART HEALTHIER

Simple Steps

to Save Your Life W By CINDY SANDERS

P r i m a ry P r e v e n t i o n o f H e a r t D i s e a s e

hile not all types of heart disease are preventable and not all risk factors can be mitigated, there are a number of simple steps that everyone can take to optimize heart health. Emily G. Kurtz, MD, director of Preventive Cardiology for Vanderbilt Heart and Vascular Institute, said an easy way to think about heart disease is to liken it to a home. • The first area of concern is the structure of the house. Is the foundation solid? Heart disease impacting structure includes congenital heart disease, congestive heart failure and valvular heart disease. • Next is the electrical system. Is the home wired properly? Examples of disease impacting the heart’s electrical system include atrial fibrillation, premature ventricular contractions and fast or slow heart rhythms. • The third system that can cause problems is the plumbing. This includes coronary artery and peripheral blood vessel disease. “The most common type of plumbing problem is atherosclerosis, which is plaque build-up in the heart and peripheral vessels,” said Kurtz. “It can lead to

heart attack, stroke, and … in some cases … sudden cardiac death. Atherosclerosis represents the largest burden, and in most cases, the most dangerous type of heart and vascular disease. “When we talk about atherosclerotic plaques, they are a little bit like dormant volcanoes that are stuck up against the side of the blood vessels. Previously, our focus was on the severity of stenoses … or blockage … within a blood vessel wall.” However, she continued, “We understand now that plaque rupture depends more on the active state of inflammation of the plaque rather than how severely blocked it is.” About 50 percent of heart attacks originate when blockage is 30-50 percent, making it unlikely to be detected on a stress test or to have caused warning symptoms like chest pain, Kurtz explained.

For this reason, she said, “We’ve shifted our attention to improving cardiovascular risk prevention so we can identify people at risk earlier and manage them more aggressively to prevent a first cardiovascular event.” Kurtz added that while structure and electrical issues are less predictable and less preventable, the plumbing system is greatly impacted by the choices we make. P. Robert Myers, MD, a cardiologist with Centennial Heart, concurred, “There are certain things you can’t do anything about … the family genes, your receding youth … but you can do something about modifiable risk factors.” Unfortunately, too few Americans are taking the necessary steps to manage risks. According to the American Heart Association’s “Heart Disease and Stroke StaJanuary/February 2012 | www.healthiernashville.com | 19

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HEART HEALTHIER

Seven Simple Steps to a Healthier Heart • Get Active (150 or more minutes per week of moderate intensity aerobic exercise) • Control Your Cholesterol (total cholesterol <200) • Eat Better • Manage Your Blood Pressure (<120/80) • Lose Weight (BMI <25 or waist circumference <35 inches in women and <40 inches in men) • Reduce Blood Sugar (fasting glucose <100) • Stop Smoking

tistical Update 2012,” 94 percent of U.S. adults have at least one “poor” ranking when looking at the seven key factors for cardiovascular health – abstinence from tobacco, maintaining a healthy weight, engaging in regular physical activity, following a healthy diet, and controlling cholesterol, blood pressure and fasting glucose levels. Additionally, 38 percent of adults received a poor ranking in at least three of the seven areas. Adding to the concern, half of American adolescents ages 12 to 19 meet four or less of the criteria for ideal cardiovascular health. Managing Risks “The AHA has recently released evidence-based guidelines for risk stratification, which categorize a patient as ‘high risk,’ ‘at risk,’ or ‘ideal cardiovascular health,’” Kurtz said of a 2011 update for women, which is also applicable to men. “I think many people will be surprised to find they fall into the ‘at risk’ category based on the new guidelines.” Don B. Chomsky, MD, a cardiologist with Saint Thomas Heart, said smoking is by far and away the biggest impediment to heart health. “It’s certainly the single most important modifiable risk factor. The act of smoking a single cigarette has been shown to have an immediate effect on the coronary arteries.” Not only is the damage immediate, Chomsky continued, but it is progressive over time. Quitting, of course, isn’t easy. In fact, Myers said it is one of the most difficult risk factors to manage because of the habit’s addictive nature. He works with patients to find the best strategy for them … whether it’s cutting down the number

of cigarettes smoked daily over several weeks time, engaging in activity to divert attention from the social behaviors conducive to smoking, or utilizing cessation therapies now on the market. “There are prescription medications out there that have been proven to aid in smoking cessation, specifically nicotine receptor antagonists,” he said. However, Myers continued, “If people don’t have the discipline component, all the pills in China won’t keep them from smoking.” In Tennessee, where nearly two-thirds of adults are clinically defined as overweight or obese, adopting healthy eating habits has also proven difficult. Chomsky, Kurtz and Myers all said the AHA website (www.heart.org) has a number of useful tools, tips and recipes under the “Getting Healthy” tab to assist in ascertaining your optimal body weight and improving nutritional choices. “A diet that is low in fat and low in salt is important from both the standpoint of atherosclerosis and the frequency of hypertension (high blood pressure),” Chomsky noted. Myers added Weight Watchers and the South Beach program also offer sensible eating plans. In talking to patients, he added, “We don’t use the ‘d’ word. We actually talk about fundamental lifestyle changes. Diets are temporary.” Unfortunately, Myers noted, there are many societal pressures to misbehave. “There are a lot of forces that don’t encourage us to lead a heart-healthy lifestyle … there are too many temptations out there.” Chomsky added, “The fast food industry is probably the most detrimental thing in our common lives to heart health.” To combat the pressure, Myers said it’s important to educate yourself. “Learn all you can about cardiac risk management. That includes learning about healthy menus.” It also comes down to discipline and decisions. Myers pointed out that when grocery shopping, “If you don’t bring it home, you don’t eat it.” Similarly, a lack of physical activity increases cardiovascular risk and compounds the impact of poor diet decisions. Kurtz noted the updated AHA guidelines call for 150 minutes of moderate intensity aerobic exercise weekly. While 30 minutes a day, five times a week is optimal, Chomsky added that any amount of activity is better than nothing. If access to a fitness facility or workout equipment is a barrier, then Chomsky said to look for other options … from taking the stairs rather than an elevator to passing up the closest parking space in favor of a

spot that will require a few more steps. Myers counsels patients to find activities they truly enjoy, whether that is walking, bicycling or playing a sport … just so they don’t fall off the ‘exercise wagon.’ “I also suggest getting an exercise partner. It’s a little bit of peer pressure to keep you on track,” he said. Chomsky added it is critical that our nation find a way to effectively address obesity in terms of the population’s health. “The epidemic of obesity has led to a progressive rise in the incidence of diabetes … and diabetes is one of the most important risk factors for cardiovascular disease.” When it comes to glucose control and management of cholesterol and blood pressure, the physicians agreed lifestyle modifications are a first line of defense but noted medication therapy is often required. “There are extremely effective drug therapies to reduce cholesterol levels,” said Chomsky. “It is interesting that as a class, statin drugs are incredibly effective and have more data on the reduction of cardiovascular events and have a tremendous amount of safety data. Yet, it is probably the class of drugs patients are most scared of because of the public perception of side effects.” Chomsky countered that the most dire side effects listed on commercials are rare and that for many patients, the benefits of cholesterol-lowering medicine far outweigh the risks. Kurtz, Myers and Chomsky were unanimous in asserting the first step to optimizing heart health is by knowing your numbers in comparison to ideal levels. Kurtz added it’s also essential to establish a relationship with a primary care provider. “Having a quarterback who is invested in your preventive cardiovascular care is very important.” HN

Nashville’s Largest Heart Programs Nashville is in the unique position to have three highly-regarded heart programs in the city … all of which are involved in both clinical care and research. More information on each of the programs is available online through their websites. Centennial Heart: www.CentennialHeart.com Saint Thomas Heart: www.SaintThomasHeart.com Vanderbilt Heart and Vascular Institute: www.VanderbiltHealth.com/Heart

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HEART HEALTHIER

Blending Low Tech, High Tech to Foil the Widow Maker By CINDY SANDERS

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s a nurse in the busy Emergency Department of Skyline Medical Center, Darlene Cleveland, RN, has used her clinical knowledge and calm demeanor to help countless patients, but she never dreamed she would be called upon to put those skills to test in her own home. On a lazy Saturday morning at the end of last October, Darlene and her husband, Jerry, were still in their pajamas and half dozing in the living room. “He sat up and coughed,” Cleveland recalled. “I looked at him and said, ‘Are you OK?’ He leaned back in his chair and never responded.” Patting his cheeks, she couldn’t get a response. “His eyes were still open, but he was not there,” she said. Fearing a stroke or airway issue, Cleveland rushed to the bedroom to grab her stethoscope and pulse oximeter to listen for a heartbeat and breath sounds, but she didn’t find either. “He was in the recliner, and I pulled him onto the floor and immediately began doing CPR … breaths and compression,” she explained. The couple’s adult daughter was home that morning so Cleveland called to her to dial 911 while she continued working on Jerry. “I was running on adrenaline. I went into automatic mode. Jerry stopped being my husband for a minute and became my patient.” Cleveland recognized her daughter, who doesn’t know CPR, felt panicky and helpless in the situation. Although Darlene had the benefit of clinical expertise, she was quick to say that CPR is a skill easily learned by anyone. “Had I not known CPR, I’m sure we would have had a different outcome,” she stated. Within 10 minutes, the Robertson County EMS team arrived and immediately took over CPR duties and got Jerry on a monitor. “He was in vertical fibrillation, V-Fib, which is a shockable rhythm. They gave him one shock here in the living room at home, and he responded with a sinus rhythm,” she explained, adding that a sinus rhythm is a normal heart rhythm. The paramedics intubated Jerry in the home, used a bag and valve mask to manage his airway and keep oxygen flowing, and put him on IV fluids. Stabilized enough to travel, Cleveland requested the ambulance take them to Skyline. “I was still thinking stroke and Skyline

(L-R): Darlene Cleveland, RN, Jerry Cleveland and Solange Colburn, RN, one of Jerry’s Critical Care Unit nurse’s that fateful day, share a special reunion on Thursday, Nov. 17, 2011 in the Skyline CCU. Jerry was one of the lucky ones to survive sudden cardiac arrest outside a hospital thanks to the CPR skills of his wife, Darlene, and the team members of Centennial Heart at Skyline.

is a Stroke Center … besides, I wouldn’t go anywhere else,” she said. “From the time we hit the door at Skyline, we were about 85 minutes getting him to the cath lab once they determined he was having an acute MI and needed stenting,” she said. Skyline’s ‘door-to-balloon’ goal is 65 minutes, well under the American College of Cardiology’s recommended interval of no more than 90 minutes. Door-toballoon refers to the time it takes from the minute a patient arrives in the ER in cardiac distress to the point where that patient has a guidewire crossing the culprit lesion in a cardiac catheterization lab. In myocardial infarction (MI) … otherwise known as a heart attack … time is muscle. The longer it takes to inflate a collapsed artery and restore blood flow, the more extensive the cardiac muscle damage. Once in the cath lab, Jerry had two stents put in the left anterior descending (LAD) artery, which was 80 percent blocked. “In nursing school, we learned the LAD artery is called the widow maker,” Cleveland said. Additionally, Centennial Heart at Skyline implemented Arctic Sun, a hypothermia protocol, which is now employed by several hospitals in the Nashville area when appropriate. Using cooling pads and a Foley catheter with a probe to monitor the core body temperature, a patient is cooled for 12-24 hours until reaching a

therapeutic temperature between 32º and 34º C (roughly six to eight degrees below the normal body temperature of 98.6º F). Cleveland explained, “It decreases the chance of brain damage because it decreases the oxygen demand on the brain. It slows the metabolism … the body slows down and doesn’t have to work as hard so it allows the body to just rest.” In order to implement this protocol, which has been in use at Skyline since July 2011, Cleveland continued, “A patient has to have cardiac arrest or other trauma that is witnessed. Unless we know the timeframe, we don’t use it.” She added that a patient who is found unconscious and might have been in that state for a long time isn’t a candidate because too much damage could have already occurred. When appropriate, though, the results have been outstanding. “One of the cardiologists told me the last five patients he’s had on therapeutic hypothermia have walked away with no deficits,” she said. After nearly a week in the hospital, Jerry Cleveland left Skyline with another new technology being deployed around Nashville … the ZOLL LifeVest, the world’s first and only wearable automatic defibrillator. Patients at risk for sudden cardiac arrest wear the lightweight vest while physicians monitor their condition to determine if an implantable device is necessary. The LifeVest continuously monitors the patient’s heart. If a life-threatening rhythm is detected, the device delivers a treatment shock to restore normal rhythm. Happily for Jerry, who retired from the Tennessee Wildlife Resources Agency but still works as an active farmer, his echocardiograms showed enough improvement within three weeks that it was determined he could take off the vest and wouldn’t need an implantable device. “And we don’t have to see the cardiologist for six months unless we have a problem … and we’re not going to,” Darlene Cleveland said with a determined laugh. For all the high tech devices that ultimately saved her husband’s life and kept him from losing brain and muscle function, Cleveland said two low tech interventions were the foundation of his survival … CPR and lots of prayers. HN January/February 2012 | www.healthiernashville.com | 21

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HEART HEALTHIER

The Mind-Body Connection

By CINDY SANDERS

Depression A Major Concern Following a Cardiac Event

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lthough physicians tions for improvement. “There used to think it was is a lot of depression data that ‘normal’ to be a bit shows it is very treatable with blue after having a standard selective serotonin heart attack or being diagnosed reuptake inhibitor (SSRI) anwith heart failure, they now tidepressants,” Raj said. know depression is a co-morbid Although the SSRIs help with condition for a significant numthe desire to comply with the ber of patients … and one that is medical plan, Raj said the jury Vidya Raj, MB ChB potentially deadly. is still out on whether or not the “One in five people will have major therapeutic medication impacts the mordepression after a heart attack or heart tality risk. However, she continued, there failure,” said Vidya Raj, MB ChB, who are a couple of large-scale studies that received her medical degree in Mansuggest it might reduce your risk of morchester, England and completed her tality from another cardiac event in the residency at Vanderbilt University. future. Raj, who has both a clinical and “Increasingly, research shows depresresearch interest in psychiatric disorders sion in people with a heart attack or in cardiac patients, also noted Vanderbilt heart failure is associated with much is adding to the body of research through worse outcomes from both the physical the Vanderbilt Heart Institute Regisand medical points of view,” continued try database, which records depression the assistant professor of Psychiatry at scores and assesses outcomes. Vanderbilt University. While the individual might not recogRaj noted, “What makes it even worse nize symptoms in himself, Raj said friends is if you are depressed, you are twice as and relatives are very good at picking up likely to die of another cardiac event as on signs such as a desire for isolation, someone who is not.” Compounding the not wanting to leave the house, not takproblem, she continued, is that research ing medications, very low mood, tearfulhas clearly shown depression linked with ness and a loss of sociability. “They know any medical condition indicates a patient when their loved one isn’t doing well.” is three times less likely to take the approWhen it becomes apparent there is a priate care needed to recover or manage problem, Raj said it is important to alert a condition. the cardiologist at the next appointment. “So it’s a killer in two ways,” Raj said, If, however, the issue seems to veer to adding that someone who is depressed is the far end of the spectrum – suicidal not inclined to take part in cardiac rehathoughts – then Raj said it is critical to bilitation programs, adhere to medication intervene quickly and get an immediate regimens, or to stop smoking and modify mental health assessment for the patient. lifestyle choices. “The message is it’s not Either way, she noted, time is of the esokay to be depressed anymore after a sence since the patient most likely isn’t heart attack because it can severely affect taking proper care of himself while sufferyour outcomes.” ing from depression. “Every minute really In fact, the American Heart Associadoes count,” Raj stressed. tion added routine screening for depresShe added the evidence-based outsion post-heart attack to the standards of comes among cardiac patients suffering care in 2008. Anyone who screens posifrom depression clearly illustrate the tive for depression, the guidelines state, strong mind-body connection that exshould be referred to a mental health ists in humans. “The way you feel really professional for additional evaluation does affect your health outcomes. We’re and treatment. learning that increasingly … .and not While the problem is serious, the just in cardiology, but in other disease good news is that there are many opstates, too.” HN

Saint Thomas Heart Announces Healthy Cooking Classes What is good for the heart is also good for the stomach … and thighs … and that annoying back fat. Saint Thomas Heart recently announced the 2012 Winter/Spring schedule for its popular Heart Healthy Cooking School, a series of cooking demonstrations and tastings. Classes are free and open to the public, but space is limited to the first 75 registrants. To register for a class, please call 800-588-3270. Each month’s class has a different theme. The following classes will be held in the Saint Thomas Hospital cafeteria and begin at 3 pm. Feb. 7 – Cajun Encore March 6 – St. Patrick’s Day April 3 – Easter Brunch May 1 – Father’s Day Prelude Registered dietitian, Kitty Fawaz, and executive chef, Julian Osmond, lead the classes, which also feature Saint Thomas Heart cardiac specialists who discuss the importance of healthy eating in improving overall cardiac health. The Heart Healthy Cooking School offers classes throughout the year at Baptist Hospital, Middle Tennessee Medical Center, Saint Thomas Hospital and other Middle Tennessee locations.   Nutritious and Delicious Recipe from Saint Thomas Heart’s Cooking School Pork Medallions with Sweet Peppers • Yield: 4 Servings • 1/4 cup flour • 1/4 teaspoon whole basil • 1/8 teaspoon salt • 1/8 teaspoon pepper • 1 pound pork medallions • Julienne strips of red, yellow and green bell peppers • 3 tablespoons dry white wine • Fresh basil sprigs Combine the flour, basil, salt and pepper in a shallow bowl and mix well. Coat the pork with the flour mixture. Spray a large nonstick skillet with nonstick cooking spray. Heat over mediumhigh heat until hot. Add the pork to the skillet. Cook for 4-to-5 minutes on each side or until cooked through, stirring frequently. Drain and pat dry. Arrange on a serving platter. Cover to keep warm. Wipe the drippings from the skillet with a paper towel. Spray the skillet with nonstick cooking spray. Sauté the red, yellow and green peppers in the prepared skillet over medium-high heat for 5-to-7 minutes or until tender-crisp. Stir in the white wine. Arrange around the pork; sprinkle with basil sprigs. Additional recipes are available online at Saint Thomas Heart: www. saintthomasheart.com/eat.php.

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Saturday 10AM - 5PM Sunday 12N - 5PM Cloud Gate 2 U.S. Tour Premiere Saturday, February 4 • Langford Auditorium The United States tour premieres Taiwan’s pillar dance legacy in Nashville, which started with Cloud Gate Dance Theatre. “...a work of genius… to fall in love with.” —Allgemeine Zeitung, Frankfurt

Spirit of uGanda Saturday, February 25 • Langford Auditorium Standing drums, choreography, layered rhythms, and call-and-response vocals, the performers ages 8–18, share East Africa’s homeland and are ambassadors for 2.4 million orphans.

Get healthy in 2012! Free health screenings, samples, demonstrations, help with nutrition, exercise information, and MORE!

“The pounding feet and agile bodies, the drums and vibrant human voices all send a message — one of courage and hope.”—The Village Voice

the aCtinG Company

Come see your favorite anchors from

Julius Caesar Rob Melrose, Artistic Director Wednesday, February 29 • Langford Auditorium The struggle of power. The clash of arms. This classic story of pride and envy, arrogance and honor, opportunity and tragic errors is some of the finest rhetoric and verse in the Shakespearean canon. “The Acting Company endures as the major touring classical theatre in the US.” —The New York Times

red Baraat Friday, April 13 • Student Life Center The rapidly ascending Bhangra Funk band aka Dhol ‘n’ Brass brings their nine piece explosive group to Nashville including dhol, drum-set, percussion, sousaphone, and horns.

If your business is interested in participating, please call 615-664-2484 or email candaceprice@clearchannel.com.

“An irresistible dhol ‘n’ brass nine-piece from New York City. He [Sunny Jain] invented ‘dhol ‘n’ brass’ – and … Red Baraat rules it.” —The Philadelphia Inquirer

For complete season details: www.vanderbilt.edu/greatperformances

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senior Health |

Hitting Seniors’ Pocketbooks Upcoming healthcare reform provisions will dip deep in surprising ways

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ith rumors swirling about ways the new healthcare reform law will affect senior Americans – Medicare D changes, Medicaid reimbursement cuts, death panels, and other hot-button issues – what changes should concern them? First, here’s some good news, according to many political pundits. Or is it? Two primary “upgrades” to government Medicare benefits include wellness and prevention services and the prescription “donut hole.”

On the upside, many preventive services will be free for Medicare recipients, from annual checkups to cancer screenings. No co-pays or deductibles will be required. Already, Medicare patients have access to a comprehensive health risk assessment and a free personalized prevention plan to help recipients and their primary care providers continue to focus on wellness rather than only illness. On the downside, the prescription drug “donut hole” represents the greatest change, with the gap in coverage of drugs

—By LYNNE JETER

for Medicare patients closing over the next several years. For reference, the gap totaled more than $3,600 in 2010. “The healthcare reform plan gradually closes the donut hole through 2020,” said Dana B. Perry, CELA, of the National Association of Elder Law Attorneys Inc. (NAELA) office in Middle Tennessee. “Who knows what will happen after the next presidential election?” Over the next several years, seniors will be responsible for less of the cost of their drugs, depending on their income levels.

Helpful Link To learn more about the future of healthcare reform mandates, visit www.FactCheck.org, a website operated by the Annenberg Public Policy Center, and Politifact, a Pulitzer Prize-winning fact-checking website operated by the St. Petersburg Times.

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| senior Health Therein lies the rub. In actuality, the issue of “the shrinking donut hole” is monumental, said Perry. To put it bluntly, Perry explained: “Basically, the law giveth, and the law taketh away.” “It’s not uncommon to see seniors with $300 to $600 drug bills, so they blow through the initial benefit level,” she said. “Then there’s the donut hole with an amount they have to pay. If they get past the next gap – the out-of-pocket maximum – then catastrophic coverage kicks in; Medicare pays 95 percent.” Even though the concept of the Patient-Centered Medical Home took root in 1967 – a model that provides a primary care provider as a medical home for every American— it didn’t gain significant momentum until Congress passed healthcare reform. “You’d be surprised at the number of seniors who don’t have a coordinated care plan,” said Perry. “It’s quite common for folks to have different doctors for different things. Meanwhile, no one’s looking at the big picture. As a start, you’ll hear more about the model that requires a medical professional to review the panel of medications seniors are taking. They’re living independently and may not want to burden friends or loved ones. Yet someone needs to see if generic medication might lower costs, or if an advantage plan with enhanced coverage might help.” Simply because select populous groups representing the interests of seniors such as the AARP have been convinced that the mandated cuts won’t have a negative impact on their members doesn’t mean they won’t. Even though $400 billion in Medicare reimbursement cuts over the next sev-

eral years were pre-arranged with hospitals regarding care in the emergency room (ER), proponents of the plan reason that money will no longer be paid to hospital ERs when 32 million new recipients are added to the Medicare rolls. Dissention about specific issues such as these continues to escalate among political and bipartisan groups and American seniors in general who continue culling the voluminous healthcare reform law.

Dana B. Perry

“For example, the CLASS (Community Living Assistance Services and Supports) Act provision disappeared from healthcare reform,” noted Perry. The CLASS program would have established a national, voluntary insurance program for funding community living services and supports designed to expand options for people who become functionally disabled and require longterm care (LTC). “The idea was an effort to provide voluntary LTC insurance,” explained Perry. “The issue might be that you shouldn’t have to have some type of LTC insurance, but again and again, people are confused about what Medicare covers for the chronically ill elderly versus what Medicaid covers. If you gathered five people in a room and asked: what would happen to a 90-year-

old living alone who could no longer live alone and needs custodial care? Does Medicare cover that benefit? They’d say, ‘of course!’ But it’s doesn’t. The CLASS program was designed to get more people on board with LTC coverage, yet even at the baby boomer stage, nobody’s buying LTC coverage.” Statistics show a very large percentage of people will need LTC before they pass away, Perry noted. “This notion that people will have a happy life until they’re 95, and then just not wake up one morning, is not borne out,” she said. “If you’re in a profession where you’re dealing with the elderly’s legal, medical or related needs on a regular basis, you know that’s not true. But if it’s not staring you in the face every day, you think it’ll happen to someone else. You might figure your family members have lived a long time so you won’t need LTC coverage. Regardless, Congress pulled the plug on CLASS reform.” The assumption of a safety net isn’t realistic, Perry emphasized. “Many families are shocked there’s no insurance to pay for LTC,” said Perry. “By the time it’s needed, they’re scrambling. Unfortunately, there’s so much misinformation. State and federal rules have changed, making it harder to plan five years or more in advance if you want to get eligible for Medicaid to cover LTC. By the time you need it, you realize there are few available options. Most people don’t want to give away the family home, but you can’t blame the government for basically saying, ‘don’t look to us until you’ve exhausted all your efforts and assets.’ Many middle class people think ‘Mama should be able to keep her house and pass it on to us.’ The situation will get worse as baby boomers age.” HN

Timeline of significant

national healthcare reform efforts: In 1965, President Lyndon Johnson pushed legislators to introduce Medicare to cover hospital and general medical insurance for seniors financed by a federal employment tax; states would manage and co-finance the same services for the poor under Medicaid. In 1985, COBRA (Consolidated Omnibus Budget Reconciliation Act) amended ERISA (Employee Retirement Income Security Act of 1974) to provide some employees the ability to continue health insurance coverage after leaving employment. In 1997, the federal government established SCHIP (State Children’s Health Insurance Program) to provide health insurance to children living in poverty.

In 2010, Congress passed President Barack Obama’s signature Patient Protection and Affordable Care Act (PPACA). The unprecedented legislation included provisions for sweeping change in the way medicine is practiced, moving financial models from volume- to value-based.

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children’s Health |

Vanderbilt Children’s Health Improvement and Prevention Vanderbilt Children’s Health Improvement and Prevention ensures a healthier future for Nashville’s kids

Sixty-five schools participated in “Walk to School Day” this past October. Cosponsored by VCHIP, the local effort was part of International Walk to School Day.

Families play and learn at a VCHIP community car seat check sponsored by Kohl’s.

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chool gardens, literacy programs and safety workshops are priceless tools for any community. In Middle Tennessee, they’re the work of Vanderbilt Children’s Health Improvement and Prevention program (VCHIP). An initiative of the Monroe Carell Jr. Children’s Hospital at Vanderbilt, the team is improving lives through outreach, education, treatment, intervention and prevention. Meeting a need “Our goal is to improve child health outcomes by changing environments and behaviors,” said Kim Harrell, director of Children’s Health Advocacy at the Children’s Hospital. “We’re motivated by opportunities to empower parents to better care for their children.” Created in 2004, the program resulted from conversations with pediatricians and school leaders concerned that many families lacked access to healthy foods, and the knowledge to make better lifestyle choices. “The Children’s Hospital wanted to improve outcomes in a way that was more robust than a single community event,” Harrell said. “VCHIP enables us to take

Kim Harrell

—By MELANIE KILGORE-HILL

Shari Barkin

Vanderbilt’s health expertise and translate it in a way that we can educate families and provide preventive measures, so kids can stay healthy before they have to come see us for chronic diseases.” Today, VCHIP’s community and school outreach programs impact nearly 100,000 Nashville-area children each year. Much of their $1.5 million budget is provided through federal, state and corporate grants and individual contributions. Nutrition and kids Arming kids with better foods and the knowledge to make smarter choices are goals of VCHIP’s Healthy Children Program. Public services campaigns, school partnerships and weight management programs all aid in the fight against child-

hood obesity. “We have the challenge of an environment that makes it difficult to make healthy choices,” said Shari Barkin, MD, chief of General Pediatrics and director of Pediatric Obesity Research at Children’s Hospital. “Overcoming will take people working from multiple perspectives in multiple parts of society to develop healthy environments that make it easy to support good habits.” According to Barkin, today’s youth are expected to live 10 to 17 years shorter than their parents, and one-third of kids born in 2000 will develop type 2 diabetes. They’re statistics Barkin hopes to changes through ongoing awareness and education. VCHIP in the schools In 2011, students in nine Metro Nashville Public Schools participated in VCHIP’s school gardens initiative. Named for the hospital’s popular canine mascot, CHAMP’s Gardens is a school and community based program bringing school gardens and nutrition education to a younger generation. “We’re trying to change the environment for students,” Harrell said. “We’re not just telling them to eat their fruits and

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| children’s Health veggies, but providing access to them.” The Glencliff Garden Project at Glencliff High School was VCHIP’s first school garden, and is well on its way to self-sustainability. Three years later, students, staff and community partners are expanding the year-round organic garden, which now includes an outdoor classroom. Produce is enjoyed by students and faculty, used in Glencliff ’s culinary arts program and sold at The Veggie Project sites locally and in desert communities. The project also facilitates gardening clubs and helps students learn about nutrition, food systems and skill building. VCHIP employees also coordinate wellness programs at Metro Schools, encouraging teachers to get healthy and serve as role models for students. “The program provides an excellent mentoring opportunity for teachers, who often take walks between classes and take students with them, or talk to them about their progress,” Harrell said. Nashville Kids Triathlon Getting kids off the couch is an important mission for VCHIP, which sponsors the annual Nashville Kids Triathlon. “The triathlon is growing every year, and helps kids discover how strong they really are,” said Barkin, who recommends kids engage in one to two hours of weightbearing activity each day. She encourages parents to model healthy behaviors by training alongside their children and making workouts a family event. “The good news is that parents set normative expectations for their kids, which means the more active parents are, the more active their children will be,” Barkin said. Safe Children Program Keeping kids safe – at home, in the water and on the road – is a constant concern for staff at Children’s Hospital. Through

VCHIP’s Safe Children Program, families learn how to avoid unintentional injuries – the leading cause of death in children under 14. VCHIP’s Child Passenger Safety program includes free car seat checks available by appointment or at scheduled community events. A Special Needs Transportation Clinic also is held twice monthly. Staffed by highly trained technicians, the clinic is one-of-a-kind in Tennessee and one of few in the nation. Booster seats, cabinet locks, bike helmets and more can be purchased “at cost” in the Safety Store, located on the second floor of Children’s Hospital. The first of its kind in Tennessee, the Safety Store is staffed by trained safety educators and also carries hard-tofind items for children with healthcare needs or disabilities. Literacy outreach Language and literacy programs are critical to VCHIP, which serves as a regional operations center for Books from Birth of Middle Tennessee. Part of Dolly Parton’s Imagination Library, the pro-

gram allows children to receive a free book by mail each month until his or her fifth birthday. Staff also instruct parents and childcare center staff on how to maximize a child’s learning and development through books. “Any parent, regardless of language or literacy level, can use our techniques to help their child learn to read better,” Harrell said. “In fact, we find that what we have to offer in any program transcends educational and socioeconomic levels. A parent can have multiple degrees and still want to learn how to better care for their child.” From literacy to public policy, VCHIP offers parents and schools consultations, recommendations, and, above all, the opportunity to change an environment. “The most rewarding thing we do is empower people to improve their families’ health and the health of their communities,” Harrell said. “We want to know, ‘what is it you want to do, what are you willing to do, and how can we collectively develop a sustainable program to get it done?’” HN

More VCHIP Info VCHIP works with state legislators to ensure Tennessee’s child passenger safety laws are among the toughest in the nation. To learn more, visit www.tn.gov/safety/newCRD.shtml. Developed by a Vanderbilt graduate student, The Veggie Project brings farmers markets to children living in areas of poverty. In 2011, more than 4,000 pounds of produce were sold at 42 Nashville-area markets. To volunteer or learn more about Vanderbilt Children’s Health Improvement and Prevention, call 615-936-5317 or visit http://childrenshospital.vanderbilt.org and search for “VCHIP”

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Nutritionists Stress Healthy Eating for Weight Loss Rather than Dieting By CINDY SANDERS t fits all the criteria for a “four-letter” word. The very name conjures up unpleasant feelings, and it’s not something you typically talk about in polite society. Yet the “d-bomb” will be dropped countless times over the next few weeks as individuals resolve to undo the damage of their recent holiday eating binge by going on a diet. Actually, if dropping five pounds gained over the holidays was all that needed to be done, then a diet might be the appropriate answer. Unfortunately, the majority of Americans need to shed much more than a few unwanted pounds. In fact, according to the latest statistics from the Centers for Disease Control and Prevention, 33.8 percent of American adults are obese, and a similar percentage is overweight. Additionally, 12.5 million children and adolescents … approximately 17 percent … are also clinically obese. How We Got in This Mess Lona Sandon, RD, MEd, an assistant professor in the Department of Clinical Nutrition at the University of Texas Southwestern, said in comparison to 30 years ago, “People are consuming about 300 calories per day more than we did back then. We’re eating more and burning less … it’s a perfect recipe for weight gain.” She added that plentiful food sources are anothLona Sandon, MEd, RD er issue. A generation ago, food was consumed at the table. Today, it can be consumed on the go and at any hour. “Food was reserved for a meal. Now, some people eat all day long. We’ve gone snacking mad. There’s not a good physiological reason why we’re eating all day long,” stated Sandon, who is a national spokesperson for the Academy of Nutrition and Dietetics (formerly the American Dietetic Association). Nixing the Quick Fix With two-thirds of the American population battling their weight, most nutritionists and registered dietitians are calling for a different approach to eating other than restrictive diets and weight loss gimmicks.

Gluten-free food is the latest craze. South Beach and Atkins have their own disciples, and a host of other options promise fat will simply melt away when you take a specific pill, eat a certain berry, or drink a speciallyformulated metabolic potion. But nutritionists argue these approaches ultimately fail even if there is short-term success. “If it’s a fad diet, the promise is quick fixes where you don’t have to exercise or where you cut out certain food groups. People should avoid those,” said Sandon. “These are ones that are not going to be sustainable for the long run. They’re seen as temporary … not as a lifestyle change.” In fact, Sandon generally discourages meal plans that eliminate entire food groups, call for exotic foods or require supplements unless there is a medically sound reason behind the decision. Gluten-free makes perfect sense for someone with Celiac disease … not so much for someone who is trying to lose weight. The mystic, magical Chinese goji berry is another quick fix that makes Sandon laugh. “When was the last time you saw goji berries anywhere?” she questioned. “Things like that should trigger people to think, ‘hmmm … maybe I should find something more reasonable.’” Supplements, Sandon noted, should be approached with caution. While B-12 does work in the body to help break down carbohydrates and fats to convert them to energy, the effectiveness of a pill or shots has not been proven in weight loss. “You should not be getting B-12 shots unless your doctor has documented a B-12 deficiency,” she said. If that’s not the case, she added, “I’d say get your B-12 from real food like a lean steak or low-fat milk.” Sandon continued, “Certainly in cases of chronic diseases — diabetes, rheumatoid arthritis, heart disease — there’s probably some benefit to having nutritional supplements.” However, in the general population, she noted, “When you look at supplement research, it’s not all that promising, and some recent research has been fairly negative, actually.” The unregulated nature of the business, she said, means that consumers have no real way of knowing which products are good, which are bad, and which ones are actually harmful. Breaking Down Barriers So what is a better solution to achieving sustained weight loss? The first order of business is to address the barriers that have caused

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someone to get off track in the past. Often, speaking with a physician or registered dietitian can help uncover those stumbling blocks and find workable solutions. “Motivational interviewing helps resolve ambivalence,” said Melissa Joy Dobbins, RD, MS, CDE. Dobbins, a dietitian and diabetes educator at NorthShore University HealthSystem in Evanston, Ill. and a national spokesperson for the Academy of Nutrition and Dietetics, added, “The premise behind it is the patient has the answer … you just have to draw it out of them. You can’t just hand somebody a standard diet. It’s not going to help solve their ambivalence.” Melissa Joy Dobbins Neither, she continued, is dismissing the MS, RD, LDN, CDE reasons behind past failures as mere excuses. “Look at excuses as barriers,” Dobbins said. When a patient says they know they should exercise more but can’t afford a gym, she likes to look at this as an opportunity to help empower individuals to address their personal challenges. “What could you do that would increase your activity but not cost anything?” she said she might ask. Perhaps the patient used to walk with a neighbor or owns an old exercise video that was fun. “You get them to think about realistic solutions instead of beating themself up with their own excuses.” Time is another huge barrier. Sandon noted that many people don’t have time to do a lot of meal prep or to even plan healthy menus or go to the grocery store. Convenience, after all, is one of the huge lures of fast food. Dobbins agreed that being tired and not having time are two issues that come up again and again. “I think it’s really important to acknowledge that and validate it. What is it they say? People don’t care how much you know until they know how much you care.” She added that sharing personal experiences could be a good way to make that connection. In her case, she’ll let patients know, “I have a three-year-old and a 12-year-old and a husband who travels. I know there’s no time for breakfast so that’s why I always have a bowl of hard-boiled eggs in my refrigerator.” Sometimes, she continued, it’s just a matter of giving people simple solutions and letting them know little things add up. “You’ve got to move people past thinking about it to acting on it.” Probably the biggest barrier to sustainability, however, is the cardboard taste of many diet food products. “Taste is the number one driver,” said Sandon. “If it doesn’t taste good, people won’t stick with it.” She added that meals are often associated with family and social events so naturally people want them to be enjoyable. “Somewhere along the line, we got this perception that if it’s good for you, it doesn’t taste good; and that’s simply not true.” Resources to Help Establish Better Habits Registered Dietitian and Certified Diabetes Educator Melissa Joy Dobbins said there are a number of good resources to help individuals get off to a good start. A few of her favorites are: ChooseMyPlate.gov: The plate has replaced the traditional food pyramid in the hopes that it will visually make more sense to individuals. The site also has

a number of interactive tools. “What I really like is the ‘Ten Tips’ nutrition education series. It’s 10 simple suggestions for each topic,” Dobbins said. EatRight.org: This is the website for the Academy of Nutrition and Dietetics (formerly the American Dietetic Association). The section for the general public includes statistics, healthy alternatives for snacking, reviews of various diet plans, meal plan options, time-saving tips and recipes.

What Does Work Sandon favors food options that have some flexibility and sound science behind them. She likes the support system and social connection that comes with Weight Watchers, which doesn’t limit any specific food. She also favors DASH (Dietary Approaches to Stop Hypertension). “It’s actually aimed at preventing hypertension, but it’s a diet that is high in fruits and vegetables, low in saturated fat and total fat but does include things like nuts and seeds that bring in the heart-healthy fats,” she explained. Sandon added, “They are all nutrient-rich foods you would find right there in the regular grocery store.” Dobbins said it’s important for people to know they can start small and build on their success. She tells patients a healthy breakfast really is the most important way to start the day. “I would say 95 percent of my overweight clients were skipping breakfast, eating a piddly lunch, a huge dinner and then snacks. You’ve got to stimulate that metabolism first thing in the morning and spread those calories throughout the day,” she counseled. She added that most people eat too many carbohydrates and don’t balance out with protein. “A traditional high carb breakfast like cereal and milk won’t hold you,” Dobbins explained. “If you’ll spread your protein better throughout the day, you’ll have more hunger control.” Easy breakfast options, she continued, include hard-boiled eggs, half a peanut butter sandwich, reduced fat cheese and whole grain crackers, or eggs with a whole grain English muffin. Like Dobbins, Sandon said small steps make a big difference. “It’s not getting up for a second helping … or if you do, take half of what you normally would.” She added that portion sizes are out of control. “We have no idea what we’re eating. We’re terrible judges, and we always underestimate.” To help put portions in perspective, she will have people take out measuring cups in the beginning so they see what a half-cup of vegetables actually looks like. Sandon said she also suggests patients make little changes like eliminating 100 or 200 calories a day. “When you cut out too many calories, you actually stimulate hormones that tell you, you are hungry.” Often, a few days of hunger leads to either giving up, eating to make up for lost time, or both. Ultimately, Sandon said it’s critical to get people away from the roller coaster dieting mentality. “That really weights on somebody’s psyche after a time, and they lose motivation.” Dobbins also said people need to cut themselves some slack. “Everybody knows we’re supposed to get more fruits and vegetables. They think it needs to be fresh, and they’re feeling pressure that it needs to be organic. Even I find it difficult to put fresh fruits and vegetables on my family’s plate every night. Stop the insanity. Have some fresh, but it’s okay to have dried fruit. It’s okay to have frozen and canned vegetables.” HN NutritionBlogNetwork. com: “This lists all the different blogs by registered dietitians. You can look up by name or category. A lot of these blogs are very food oriented and recipe oriented.” There are also a number of sites that provide calorie and nutritional information for popular chain restaurants that are helpful when making choices while dining out. January/February 2012 | www.healthiernashville.com | 29

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Nashville Civic Design Center Announces New Project at the 2011 Living the Plan of Nashville

T

he Nashville Civic Design Center (NCDC), in partnership with the Metropolitan Nashville and Davidson County Office of the Mayor, and Metropolitan Nashville and Davidson County Public Health Department (MPHD), announced the Shaping Healthy Cities: Nashville project at their annual ‘Living The Plan of Nashville’ event. Shaping Healthy Cities: Nashville is a two-year project culminating in a book—based on extensive research yet readable for the general public—that enhances awareness of the impacts of the built environment on health, and facilitates the inclusion of health impacts on future design decisions in Nashville, Davidson County, Tennessee. In the past decade, public health officials have established links between qualities of the built environment and the startling rise of preventable diseases, such as obesity, type II diabetes, heart disease and asthma. Today, Tennessee has the unfortu-

nate distinction of ranking the least active state, with the fourth highest adult obesity prevalence in the nation. The Shaping Healthy Cities: Nashville project is a catalyst to transform Nashville into one of the healthiest cities in the South. Shaping Healthy Cities: Nashville is developing partnerships and products to take on the public health and planning challenge of designing our city to foster good health. The project is guided by a 16-member Steering Committee representing 15 public and private organizations engaged in the design, development, education and health of Nashville as well as Tennessee. Shaping Healthy Cities: Nashville outcomes will include: • A narrative book scheduled for publication in January 2013 by Vanderbilt University Press. • An action plan to guide policy makers, planners and communities in adapting Nashville’s built environments to benefit our county’s health.

• Targeted materials for specific user groups such as a built environment design checklist for developers, designers, planners, engineers, city officials, and community members. • Novel, engaging multi-media products to engage the wider community, including short videos, posters, social media content, web-based information and tools, information graphics, and maps. • A venue and structure to facilitate public participation, education and discussion on built environment design for health. The initial phase of the project involved identifying and compiling all of Nashville’s current built environment plans, health reports, relevant community initiatives, and developments. Such existing efforts will be reviewed and incorporated into the forthcoming action plan. The project has so far identified six groups of built environment factors that have been found to impact people’s health. Currently the project is identifying

CLINICAL TRIAL For Lumbar Spinal Stenosis Dr. Christopher Taleghani of the Cumberland Brain and Spine Institute is the Principal Investigator for a research study of an investigational device for lumbar spinal stenosis (LSS). LSS is a narrowing of the spinal canal that can cause nerve root irritation. This painful and sometimes debilitating condition affects more than 300,000 people every year. LSS is defined as leg, buttock or groin pain, with or without back pain, that may improve with sitting or bending forward. This trial will investigate the use of the FLEXUS™ Interspinous Spacer (Globus Medical, Audubon, PA) placed between the affected vertebrae without spinal

fusion. The device is inserted using a unilateral approach between two spinous processes, which is the part of the vertebrae you feel along the back of your spine. The spacer is implanted through a small incision which may require a shorter operating time than traditional surgery. FLEXUS™ is manufactured from PEEK radiolucent polymer rather than titanium, to more closely match the biomechanical properties of bone and help eliminate MRI scatter. The surgery allows the vertebral structures to remain intact with potentially less disruption to normal anatomy. Both male and female patients may participate provided you are 50 years of age or older and have had at least 6 months of non-surgical treatment. Additional criteria must also be met. In this study patients will be randomized to the FLEXUS™ device or the FDA approved

For more information please call Melissa Collings, PA-C at 615-884-0001 or email: mcollings@cumberlandbrainandspine.com 30 | www.healthiernashville.com | January/February 2012

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| briefs examples of these health-defeating and health-promoting factors throughout Davidson County. We are also seeking personal narratives from Nashvillians to illustrate how people negotiate the built environment in their daily lives. NCDC is leading the project in partnership with MPHD, which is partly funding the project through Nashville’s Communities Putting Prevention to Work (CPPW) Federal grant, awarded to Nashville by the Federal Department of Health and Human Services, as part of the American Recovery and Reinvestment Act of 2009. NCDC is a non-profit organization dedicated to “elevating the quality of Nashville’s built environment and to promoting public participation in the creation of a more beautiful and functional city for all.” NCDC’s 2005 publication The Plan of Nashville: Avenues to a Great City offers a 50-year vision for the future design and development of Nashville. Over 800 Nashvillians participated in the development of ‘The Plan’ and its ‘Ten Principles’ to guide public policy, development practice, urban planning, and design. The Shaping Healthy Cities: Nashville project will bring the lens of health to these ‘Ten Principles’ to determine ways to move ‘The Plan’s’ vision for-

ward with designs that foster better health among all our citizens. We encourage all community members to get involved with Shaping Healthy Cities: Nashville. If you are interested in sharing your story, joining the action team or receiving our monthly newsletter, please contact Patricia Conway, or visit the project webpage for more information: www.civicdesigncenter.org/ projects/shapinghealthycities Free App for Skin Cancer Awareness The Mollie Biggane Melanoma Foundation, has announced the launch of an Android OS version of their information skin cancer app which was previously launched for iPhone, iPod Touch and iPad.  The new Android version can be downloaded free from the Android Market. Mollie’s Fund, with the assistance of MCS Advertis-

ing and Arc Design Studio, created this interactive guide to provide users with facts about the evolution of skin cancer and melanoma.  The application illustrates a self-exam, exhibits mole changes and reinforces behaviors to protect against skin cancer.  The program emphasizes the necessity of a professional dermatology examination and includes a monthly skin check log to keep track of monthly examinations. Skin cancer is the most common cancer in the United States.  One person each hour dies from melanoma.  Melanoma can be cured---if diagnosed and treated early.  This initiative supports the mission of Mollie’s Fund of creating programs for education and prevenThe Paper tion of skin cancer melanoma. crop ad to 2.125and x 4.5 For more information about the Mollie Biggane Melanoma Foundation, visit, www. molliesfund.org.

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Joshua Talley and daughter at Elizabeth Park.

in full by the U.S. Department of Health and Human Services. 2012 32 | www.healthiernashville.com | January/FebruaryFunded

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