Dear readers: The solutions to West Virginia’s persistent health problems won’t come from outside our borders. We know that the key to turning around decades of dismal statistics is in developing our own successful approaches to prevention and community health. West Virginia University’s responsibility is to help lead this change from within. In developing this issue of WVUhealth, we asked ourselves: What are we doing that’s unique and innovative to help prevent illness and disease in West Virginia? The change is under way: Our students are becoming their own first patients so that they’ll know from the start of their education that patients must be at the center of healthcare. Diet and exercise experts are helping patients live longer. Physicians, nurses, pharmacists, and others are developing a team approach to wellness that keeps patients from returning to the hospital. A community in southern West Virginia is learning to change its health status with a little help from WVU faculty and students. With involvement at the community level, our preventive healthcare and research efforts are enriching lives and contributing to the overall health of West Virginians. We’re proud to be a part of this effort. Christopher C. Colenda, MD, MPH Chancellor for Health Sciences West Virginia University
WVUhealth FALL 2013 Vol. 4, Issue 2
A publication of the Robert C. Byrd Health Sciences Center West Virginia University, Morgantown, West Virginia www.hsc.wvu.edu
Virginia est W
ADMINISTRATION James P. Clements, PhD President, West Virginia University
H EA L
Christopher C. Colenda, MD, MPH Chancellor for Health Sciences Patricia A. Chase, PhD Dean, School of Pharmacy Jeffrey Coben, MD Interim Dean, School of Public Health David A. Felton, DDS, MS Dean, School of Dentistry Konrad C. Nau, MD Dean, Eastern Division J. Gregory Rosencrance, MD Interim Dean, Charleston Division Arthur Ross, MD Dean, School of Medicine Elisabeth “Betty” Shelton, RN, PhD Interim Dean, School of Nursing Judie Charlton, MD Chief Medical Officer, WVU Healthcare
CONTENTS 2 MEDICAL HOME
J. Thomas Jones President and CEO, WV United Health System Bruce McClymonds President and CEO, WVU Hospitals WVUhealth STAFF Bill Case, Executive Editor Heidi Specht, Executive Creative Director Danielle Conaway, Managing Editor Autumn Hill, Creative Director
4 COMMUNICATE, CONNECT, TREAT
Writers and Editors Kevin Hamric April Henry Amy Johns
6 PRACTICE WHAT THEY PREACH
Photographers Bob Beverly Tyler Crowe Tonia Fullen April Henry
Autumn Hill Angela Jones-Knopf Brian Persinger
Editorial Board Stephanie Bock Geri Dino, PhD Norman Ferrari, MD Amy Johns Gary Murdock Amy Newton
Lynda B. Nine Tricia Petty Julia W. Phalunas Shelia Price, DDS, EdD Misti Woldemikael
8 DIET AND EXERCISE
NEIGHBORS HELPING NEIGHBORS
12 ‘A WIN-WIN-WIN SITUATION’
14 TOBACCO FREE: HAPPIER & HEALTHIER
16 WHY IS BLACK LUNG BACK?
Angela Jones-Knopf Leigh Limerick Ashley Thomas
EDITORIAL OFFICES WVU HSC Planning, Marketing and Communications PO Box 9083 Morgantown, WV 26506- 9083 304-293-7087 CHANGE OF ADDRESS West Virginia University Foundation, Inc. One Waterfront Place 7th Floor PO Box 1650 Morgantown, WV 26507-1650 Phone: 304.284.4000 or 800.847.3856 Fax: 304.284.4001 Email: firstname.lastname@example.org www.connecttowvu.com WVUhealth is published twice a year and features content on education, research, patient care, and service to the state of West Virginia in the WVU Schools of Dentistry, Medicine, Nursing, Pharmacy, and Public Health. For the latest WVU HSC and WVU Healthcare news, visit: wvuhealthcare.com, and click on Media
Medical Home Team approach puts focus on staying well By Bill Case Photos: Bob Beverly and Autumn Hill
Doctor Nurse or
Elaine Markley Patient
“In the medical home, you are part of our practice. We train everyone in the office who interacts with a patient that they own that patient’s care and their outcomes.” – Karen Fitzpatrick, MD, medical director, Sleeth Family Medicine Center
WVU Healthcare patient Elaine Markley sees her team of caregivers at Sleeth Family Medicine Center.
One Sunday early this year, Elaine Markley opened her mouth to sing at the Tygart Valley Presbyterian Church in Huttonsville, West Virginia, but no words came out. “I couldn’t get my breath to sing,” she said. “By Monday night, I was in the emergency room in Elkins, and they sent me straight to Morgantown.” Markley, an active 79-year-old, had developed a blood clot in her lung. “My son told me later he wasn’t sure I’d make it that night. I wasn’t either.” At Ruby Memorial Hospital, doctors treated her with blood thinners and other medication and got her breathing normally again. But the incident took a toll on her health. “It set off my diabetes. It really went berserk,” she said. “I used to just take a pill, and that was it. Now, I need an insulin shot every day.” A week after she left the hospital, Markley showed up for a follow-up appointment at WVU’s Clark K. Sleeth Family Medicine Center. She had a couple of questions she hoped to get a chance to ask. “The doctors who saw me at Ruby were there,” she said. “That was a surprise.” And so were a lot of others: a case manager, a pharmacist, and someone to talk with her about monitoring her blood sugar. “I don’t even remember them all now,” she said. “I’ve never seen that many people at one appointment before.” What Markley gained that day is a “medical home.” The concept is simple: identify the patients most at risk for medical complications or hospitalization, and concentrate the efforts of an entire team of health professionals on keeping them healthy. But it flies in the face of long-standing economic incentives that rewarded doctors and hospitals for the specific services they provide – with higher payments for complex
procedures and hospital visits. Recent initiatives – both by private insurers and government programs under the Affordable Care Act – are reversing the incentives to reward caregivers whose good work resulted in good health. At WVU, faculty members are leading a number of efforts to apply the concept to patients who turn to WVU physicians for care. “In the medical home, you are a part of our practice,” said Karen Fitzpatrick, MD, who serves as medical director for the year-old family medicine project. “Your healthcare is delivered by a team that’s working together to give you the support and tools you need to improve your health. We train everyone in the office who interacts with a patient that they own that patient’s care and their outcomes.” The medical home team provides extra support to patients after a hospital stay. Instead of waiting for the patient to call and schedule a post-discharge appointment, they’re signed up for a visit to the clinic before leaving the hospital. The patients meet with all the members of their medical home team on their first visit to the clinic and are set up for a customized follow-up plan that can include multiple appointments and phone check-ins. For Markley, learning to control her diabetes – and adjusting her dose of the blood thinners she needs to take to avoid another clot – took some time. Case manager Lisa Metts, RN, saw her every two weeks after she left the hospital in February, monitoring her blood thinner medication and diabetes. She set her up with home test equipment, so that she could get her meds checked without a trip to either Elkins or Morgantown. “The weeks she didn’t come in, we talked on the phone,” Metts said. “Once everything
was stable, we cut her visits back to every month, then every three months. But, I still call every month to check up on her.” “I had a lot of questions,” Markley said. “And sometimes, when you have a doctor’s appointment, you forget to ask something, or you think you’re wasting the doctor’s time with a silly question. They never made me feel that way. “They really listen. I was a teacher – I can tell when people are listening to me.” Her evaluation of the medical home concept: “I think it’s wonderful. It’s comforting. You feel more secure in your care. It’s just a more efficient way of dealing with a patient.” Her WVU doctors appreciate that feedback. But they are not relying on anecdotes to test the effort. Every patient’s record is reviewed to see if the visits and calls are having an impact on health outcomes, repeat hospitalizations, and other statistical indicators of health. By summer, Markley’s medication was under control, and she had learned to give herself insulin shots and call in test results to the team in Morgantown. She started back at doing the things she loves: enjoying the hummingbirds and butterflies that congregate around her flower-filled yard, cooking for church events, reading, and talking on the phone with her friends and family. She hasn’t been back to the hospital. But her favorite activity is an added one. She’s spending as much time as she can with her new granddaughter. “Her name is Abigail Elaine,” she said with a smile. “Don’t forget the ‘Elaine.’” FALL 2013 3
Communicate Connect Treat
WVU Health Sciences Center students learn to care for diverse populations By April Henry Photos: Tyler Crowe and April Henry
Well-rounded. Accepting. Approachable. Understanding. Passionate. These are the words WVU Health Sciences Center students use to describe the kind of healthcare providers they want to be in the future. And thanks to the thread of diversity weaving throughout all educational programs, students believe they are on their way to fulfilling those expectations. “Learning about diversity gives us a better understanding of different cultures and broadens our perspectives,” said Jennifer Nguyen, a School of Dentistry student who was born in Vietnam. “Especially for healthcare professionals, who interact so closely with patients with such diverse backgrounds, understanding various cultures and traditions will give us an advantage to communicate, connect, and treat patients with better care and respect.” Integrating diversity at WVU happens in three ways: through recruitment, admissions, and retention by boosting the mix of students and faculty members from diverse backgrounds; through the curriculum by incorporating diversity into each course; and through a blanket approach by cultivating a welcoming environment. “Diversity within our class and curriculum will allow us to become well-rounded providers who can establish good relationships with our patients and provide proper care,” said Rebecca Furby, a School of Medicine student from Charles Town, West Virginia. “The better you understand a person, the better avenues of care can be sought. Therefore, diversity will 4
greatly impact how we approach and deliver preventive care for our future patients.” WVU School of Dentistry Associate Dean Shelia Price, DDS, EdD, works with representatives from the other health schools to create an inclusive environment – one that warmly welcomes all students and faculty members, no matter what gender, race, ethnicity, religion, age, sexual orientation, or socioeconomic status. “Fostering inclusive learning communities is an essential step in achieving academic excellence,” Dr. Price said. “Our collaborative effort in creating educational opportunities to engage diverse groups has been an amazingly enriching experience. Promoting respect and mutual understanding despite cultural, economic, linguistic, or other differences in the educational environment is a professional necessity. There is a pressing need to prepare the current and future health workforce to meet the health needs of an increasingly diverse society.” Health Sciences Center students are looking forward to being contributing members of that workforce. “I want to know how to approach those individuals who will one day sit in my chair,” School of Dentistry student Tyler Crowe said. “Coming from a small, rural town in southern West Virginia, I was limited in my knowledge of other cultures. My awareness of diversity during my time at WVU is preparing me to be a better healthcare professional by providing me with experience in treating patients from all
“The better you understand a person, the better avenues of care can be sought. Therefore, diversity will greatly impact how we approach and deliver preventive care for our future patients.” — Rebecca Furby, WVU School of Medicine student Furby
over the map. I have had the opportunity to learn how to handle language barriers, physical limitations, and cultural restrictions.” All of WVU’s health education programs need to address health disparities within minority groups, according to Price. “The burden of numerous diseases and health problems disproportionately impacts minorities. For example, the prevalence of diabetes is higher among African American and Hispanic/Latino adult populations by comparison to their majority counterparts,” Price said. “Diversity and cultural information should be incorporated throughout the curriculum, not as a single course, but in each course.”
To address these obstacles, Price and her colleagues in other disciplines offer presentations and hands-on activities that promote diversity. The programs provide opportunities for students to develop cultural awareness, examine stereotypes, and recognize biases – all with the goal of educating sensitive individuals who will deliver quality healthcare. Ultimately, diversity means looking past differences and seeing commonalities. When that happens, Nguyen said, “We can all connect, unite as one, and grow stronger together.”
While the Health Sciences Center is making strides toward an inclusive environment, the effort is still a work in progress. Raul “Rudy” Sanchez, a School of Medicine student from York, Pennsylvania, has noticed Morgantown doesn’t have the ethnic diversity that a larger city would have. “There are a few students in our class from different backgrounds, but I would like to see more clubs that have a cultural focus,” he said. Nguyen and Crowe both cited various accents as challenges for all students. “Because West Virginia is not as diverse as some other states, people here are not used to the different accents, so communication with people from international backgrounds may be more difficult,” Nguyen said. Crowe said, “Within our class, we have found that some of the people from other countries have a hard time understanding those of us with a southern dialect.” FALL 2013 5
Practice What They Preach Pharmacy, medicine, and dentistry students become their own first patients By Angela Jones-Knopf Photos: Bob Beverly, Angela Jones-Knopf and Autumn Hill Patricia Chase, PhD, the Gates Wigner Dean of the WVU School of Pharmacy, holds a quote often attributed to Gandhi near and dear to her heart: “Be the change you wish to see in the world.” As a healthcare professional and educator, she believes that future providers who want to see people become healthier as a result of their work must accept personal responsibility for their own health. In short, they must first practice what they intend to preach. The WVU Center for Healthy Practitioners is a collaborative effort that allows students to do just that. With the help of a $75,000 grant from the Claude Worthington Benedum Foundation, Dr. Chase worked with WVU Health Sciences Center faculty to design and launch the initiative: Anne Cather, MD, in the School of Medicine, Louise Veselicky, DDS, in the School of Dentistry, Travis White, PharmD, in the School of Pharmacy, and Matthew Gurka, PhD, in the School of Public Health. The WVU Center for Healthy Practitioners builds off of an initiative Chase implemented in the School of Pharmacy in 2008 called My First Patient. Since that time, all first-year students in the School of Pharmacy’s Doctor of Pharmacy program undergo health screenings and counseling aimed at improving their health status. Third-year students conducted screenings in the school’s health education center. Each first-year student identified a goal that he or she wished to achieve, such as losing weight, beginning an exercise plan, or quitting smoking. In doing so, the students became their own first patients. Chase likes to tell the story of six student pharmacists who, after being screened through My First Patient, discovered that they had high cholesterol. They were shocked. As it turned out, they lived in the same fraternity house, where the cook fried many of their meals, including veggie burgers. The students took control of their diets and brought their cholesterol numbers down to normal levels without the use of medication. With the establishment of the WVU Center for Healthy Practitioners, the program now includes first-year medical and dental students, in addition to first-year pharmacy students. 6
“The My First Patient program has uncovered at least seven major health risks experienced by students in the program, including diabetes, high cholesterol, tobacco use, obesity, stress behaviors, and use of alcohol and medications. These mirror the major health problems of the people of West Virginia.” – Patricia Chase, PhD, Dean of the WVU School of Pharmacy All students underwent health screenings and oral health assessments, which were added to the program this year.
prepared me to provide these services. I think my attitude has gone from ‘Wow, I’m really scared’ to ‘OK, I think I can do this.’”
Students choose one health goal, develop an action plan to improve their health in that area, implement the plan and evaluate their progress through a year-end survey. Follow-up surveys are administered during all subsequent years students are in school to determine whether students met their goal in the first year, whether they have maintained the changes made in the first year, and whether the students’ participation in the program affected their attitude toward an interdisciplinary approach to wellness.
Farabaugh said she enjoyed working with students in the other health professions schools because it gave her a first-hand look at what her future job as a pharmacist will be like.
“The My First Patient program has uncovered at least seven major health risks experienced by students in the program, including diabetes, high cholesterol, tobacco use, obesity, stress behaviors, and use of alcohol and medications. These mirror the major health problems of the people of West Virginia,” Chase said. “Students have achieved definite, measurable improvements in their health habits and in their actual health, as measured by follow-up cholesterol testing and other clinical factors.”
“When we get out there and we’re practicing as pharmacists, we’re going to have to work with a lot of other professions and collaborate to help benefit the patients,” she said. “I think this project was a great way to start collaborating with other professions and working together in the future.” Eventually, Chase’s goal is to bring the remaining health professions schools and programs on board so that all students in the Health Sciences Center are participating in My First Patient. “By doing this, we will not only serve our students,” she said, “but we will also serve the many West Virginians for whom they will care throughout their years of practice.”
Nicole Farabaugh, a third-year pharmacy student from Trafford, Pennsylvania, has now experienced My First Patient from both sides. In her first year, she underwent health screenings, and this year, she performed screenings on first-year pharmacy, dental, and medical students. “I think as a first-year student going through this program I was really intimidated, and I was kind of shocked because I just wasn’t familiar with a lot of the technical terms and a lot of the services the third-year pharmacy students were providing to me,” she said. “It’s interesting to see it from this perspective because I understand more now, and I’ve learned a lot the past couple years that has
Top: Dina Tsybina draws blood from the finger of a first-year student during My First Patient. Left: Jacob Kelly (far right) and Keiko Miller (far left) examine Brianna Stalnaker’s teeth. Right: Nicole Farabaugh checks Valerie Elder’s blood pressure.
See video online at youtube.com/watch?v=AbxAxYELQno
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“When you break your bad habits and start eating things that are healthier, you start to like those things.” – Sachin Bendre, MD, PhD, WVU Charleston Division
and Using diet as preventive medicine By Kevin Hamric Photos: Bob Beverly and Autumn Hill The way people think about food could save their lives. Instead of planning a diet only on how it pleases the palate, it’s important to consider how eating the right way can prevent disease and promote good health.
often require a change in lifestyle for the individual. When younger patients need adjustments to their diet, their success can depend heavily on the rest of the family making healthier choices, too.
WVU doctors and dietitians are educating patients on eating habits to help them avoid illness and when needed, how to control and reverse the effects of an unwanted diagnosis.
Sachin Bendre, MD, PhD, a pediatric endocrinologist at WVU’s Charleston Division, said the first thing he explains when talking to parents is that changing eating habits is a family affair.
“When I was officially diagnosed with type 2 diabetes, I wasn’t unfamiliar with the illness because a number of my family members suffer from it,” said WVU Healthcare patient Greg Mundy. “In fact, I expected that I would eventually walk that path myself – I just didn’t expect that it would be at age 35.” Following the diagnosis, Mundy met with Heather Dyson, registered and licensed dietitian and graduate of the WVU Hospitals Dietetic Internship Program, at WVU Cheat Lake Physicians, where they discussed a plan to modify his diet and take control of his health. “I advise my patients to adhere to a whole foods diet, which is rich in plant foods,” Dyson said. “Studies show that diets rich in vegetables, fruit, whole grains, legumes, lean protein, and healthy fats are associated with optimal health and disease prevention.” Dyson also explained that having a diet work as preventive medicine is as much about what people are not eating as what they are. “Eating a diet based on whole foods also involves limiting processed and/or prepared meals. These types of meals are often high in sugar, salt, preservatives, and unhealthy fats,” she said. “Diets high in processed foods are associated with increased risk of chronic disease, such as diabetes, heart disease, hypertension, and others, as well as certain types of cancer.” Knowing what to include in a diet is only part of the battle when it comes to preventing illness. Healthy eating habits 8
“Parents are important role models, and everyone in the family has to be willing to make a lifestyle change,” Dr. Bendre said. “When you break your bad habits and start eating things that are healthier, you start to like those things.” Bendre suggests patients start by restricting their diet to appropriate portion sizes of more nutritious foods with fewer calories, and eventually, healthy eating habits will take hold. “Only eat whole wheat products, cut back completely on refined sugars, and add vegetables to meals any way you can,” Bendre said. “Taste is an acquired thing. Constantly expose yourself to healthier alternatives, and your brain adapts to it.” For Mundy, forming these good eating habits has helped put him in control of his health. “I learned to take pride in the small, daily victories, and since I began dieting and exercising, I’ve dropped my body weight from 245 to 196 lbs.,” Mundy said. “I’ve adopted a low carbohydrate lifestyle and find that I’ve graduated to knowing intuitively what I should and shouldn’t eat.”
Exercise Exercise physiology faculty and students offer specialized wellness programs at the WVU Human Performance Lab
Clockwise from top: Robert Moore stays strong by lifting weights at the WVU Human Performance Lab. The lab provides clinical exercise programs for disease prevention, management, and rehabilitation.
“I’m very impressed by the lab and the staff here. They’re helping me try to be well again,” said WVU Human Performance Lab client Jess Mapstone. After Jess had heart surgery, he and his wife Carole started working out at the lab two to three times a week under the supervision of WVU exercise physiology staff and students.
Jess Mapstone participates in the lab’s cardiac rehab exercise program for people at high risk for heart disease. Exercise physiology major Kent Lemaster assists Jess on a cycling machine.
“We’ve worked with several different student helpers, and they’re all very friendly. It’s like having your own personal health coach at an affordable rate. At a gym, they usually show you the machines, and then you’re on your own. Here, you get much more. You get encouragement from the students and a personalized exercise program that meets your needs,” Carole said.
WVU Department of Neurosurgery’s Robert Nugent, MD, remains limber by working out on a stairclimber and lifting weights at the lab.
At the WVU Human Performance Lab, area residents and WVU employees can improve physical and mental well-being through specialized health programs that are designed to suit each person’s health needs and limitations. Health tests are performed at the lab to create an exercise prescription for each client. Working side by side with clients at the human performance lab, WVU students majoring in exercise physiology gain valuable career-building
Robert Moore finishes up his fitness routine with a good stretch.
Carole Mapstone enjoys the encouragement she receives from WVU exercise physiology students like Kayla Neely when she works out at the lab.
experience. Exercise physiology majors are trained to evaluate people in the areas of cardiovascular fitness, muscular strength and endurance, flexibility, neuromuscular integration, and body composition. The field is one of the largest majors at WVU with more than 800 students currently enrolled. Exercise physiology major Jingting Li said, “Exercise is an appropriate way to help prevent chronic cardiovascular, lung, and other systemic diseases. I like helping people live healthier lives through exercise.”
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Southern West Virginia Lifestyles Project
Neighbors helping neighbors improve community health By Leigh Limerick Photos: Brian Persinger
Michael McCawley, PhD, makes signs and serves food at a SWVL gathering in Mullens.
The town of Mullens, West Virginia, lies nestled along the banks of the scenic Guyandotte River, in the heart of Wyoming County – one of the unhealthiest areas in the United States. On a muggy August evening, WVU School of Public Health associate research professor Michael McCawley, PhD, sits in a gymnasium scrawling out a sign inviting folks to enjoy the barbeque chicken and pork he and his wife, Marge, are heating up in the Mullens Opportunity Center’s kitchen. People of all ages trickle in through the doors, carrying covered dishes for a healthy potluck. Dr. McCawley’s hope is that with a little guidance and a strong community network of neighbors helping neighbors, the citizens of Wyoming County will be the first in their region to spearhead a revolution in reversing discouraging health trends. “What we’d like to see are community volunteers for the programs we want to help people start in this community. The idea that we have is to lay out some simple programs, show people how to start them off, get them started, and let the people here keep them going,” McCawley said. With support from a Claude Worthington Benedum Foundation grant, the Southern West Virginia Lifestyles Project (SWVL, pronounced ‘swivel’) is the result of a collaborative effort by faculty and students representing WVU’s schools of Dentistry, Medicine, Nursing, Pharmacy, and Public Health. The project is expected to be a sustained effort for years to come, and McCawley plans to extend the SWVL program to Boone and McDowell counties in the near future.
SWVL is gaining traction in Mullens due to the outreach efforts of the Wyoming County Ministerial Association – a cooperative assembly of church leaders that’s attempting to recruit community leaders for SWVL from the pulpit. “The reason why I want to do this is that people need to feel supported, and people need to be called to do what’s right,” McCawley said to the crowd gathered at the Mullens Opportunity Center potluck. “Pastors understand what it means to be called, and we want you to start calling on your friends and neighbors to do the right things for themselves and your community.” As the Mullens gathering offered the chance for neighbors to connect and learn how to spread the word about SWVL, health professionals were on hand offering blood glucose screenings and educational resources about diabetes, tobacco cessation resources, and preventing falls. McCawley heartily encouraged attendees to return at a future event to contribute their own recipes for one of SWVL’s first initiatives, Eat Well Wyoming. “We’ll be taking the recipes and having dieticians look at them to see what tweaks could be made,” McCawley said. “The goal is to show how a few simple changes can make our favorite things to eat a lot better for us and have it taste just as good.” The overhauled recipes will become an Eat Well Wyoming cookbook that will make its way into homes throughout the area. SWVL’s success largely depends on finding enthusiastic community leaders who are willing to talk about their health issues and pursuit of lifestyle changes. “When I learned of the new WVU School of Public Health and that Dr. McCawley and others may want to bring their programs in Wyoming County, I knew I had to get involved,” said David “Bugs” Stover, a longtime Mullens resident, schoolteacher, and county circuit clerk. Stover is well-known in Wyoming County. The former high school athlete ran until he was 30, and his weight never climbed past 142 lbs. When he stopped running, his weight ballooned to 273 lbs., and his overall health declined. “After a few years of not running, I started back but have never returned to a good weight,” Stover said. “Just after winning the election for circuit clerk and still coaching the girl’s soccer team at Wyoming East High School, I had a near-heart attack and ended up getting five heart stents just before taking office.”
Since then, Stover has dropped more than 50 lbs., and is determined to keep going. His commitment to hiking, biking, running, and canoeing has combined with his deep sense of activism to complete long distance walks and canoe trips to draw recognition to issues he supports, such as preservation of West Virginia’s coal industry and improvement of highways. In 2012, Stover walked from his home to Mullens Washington, D.C. It was his third time making the trip.
This inspired Stover to suggest to McCawley that SWVL and the Wyoming County Ministerial Association organize a pilgrimage of sorts – a virtual walk from Pineville, West Virginia to Jerusalem. The goal is for participants to make the commitment to walk at least two miles a day toward a cumulative goal of over 6,000 miles – bringing change to the people of Wyoming County physically, mentally, and possibly spiritually. McCawley, Stover, and Wyoming County residents kick off their virtual walk to Jerusalem in October in Pineville, and upon the community’s completion of the 6,000 miles, McCawley plans to travel to complete the last six miles of the trek in Israel. Stover’s hope is that SWVL will be one of several programs in southern West Virginia helping to improve the quality of life – expanding infrastructure, creating jobs, and boosting overall well-being. “We in the southern coalfields have sent a lot of resources to WVU over many decades, not the least of which has been our sons and daughters, and the treasure it takes to get and keep them there. We hope SWVL, this effort from Dr. McCawley and the WVU School of Public Health, will help us create a place where, if they choose, our daughters and sons are able to return home.”
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Dr. Katie Kilcollin screens school children like Allison Hostetter for dental problems at area schools.
‘A Win-Win-Win Situation’ Father and daughter provide one-of-a-kind services to Union By Amy Johns
Photos: Tonia Fullen
In 1974, when Mark Kilcollin, DDS, was fresh out of the WVU School of Dentistry, he decided to set up a practice in rural Union, West Virginia. Monroe County, population 12,000, in the southeastern corner of the state, had not had a dentist for about 10 years and patients had to travel many miles for dental care. So Dr. Kilcollin, a Charleston native, decided it was his way to serve his home state. “I was a single guy, and I thought it would be good for me to give back a little bit, sort of in the spirit of the 60s, and maybe to assuage my misgivings about being given two student deferments from service in Vietnam,” he said. Mark figured he would stay in Union for just a couple of years, then move back to the city where his maternal grandfather had been a dentist. But then he fell in love – with the charms of the countryside and with a beautiful girl who had grown up on a dairy farm in Union. Debbie and Mark were married and settled in Monroe County. His dental practice has grown to include their daughter, Katie Kilcollin, DDS, a 2009 graduate of the WVU School of Dentistry. “It’s been really rewarding for me to see Katie grow in her skills and abilities,” Mark said. “She’s really to the point now where she has surpassed me. I don’t feel like I’m much of a mentor anymore; she’s certainly able to fly on her own.” Both Kilcollins have taken multiple hours of continuing education to expand their skills and keep the practice up to date, offering sedation and surgical placement of implants as well as the basics.
“As the only dentist in Monroe county, the ratio was 1 to 12,000 people. The national average is something like 1 per every 1,800 people, so the disparity is rather large.” – Mark Kilcollin, DDS
“We have cutting-edge technology and techniques. We had completely digital x-rays and patient records in 2005, ahead of 96 percent of the country. Our practice uses the most aesthetic materials and techniques available anywhere.” On a busy day at the clinic, Dr. Katie Kilcollin was performing a root canal on a teenager, and Dr. Mark was filling cavities for adults while a WVU dental hygiene student was cleaning children’s teeth. “It’s a very busy practice. And that’s one of the things that is fairly characteristic of rural practices. There’s a dramatically greater need in rural areas than you would find in the more urban areas,” Mark said.
“You make very close friends with your patients here, and you do see the generations. I’m fortunate to be in practice now in my 39th year, and I’m treating children of children I cared for years ago.” Perhaps the best benefit of working in a rural community is the quality of life. After a busy day at the clinic, Mark makes the three-minute commute through the pretty town, past its historic statue of a Confederate soldier, and turns up a narrow country road. That road leads to his lovely home and farm, where he raises 199 head of beef cattle. His family enjoys tennis, golf,
skiing and entertaining friends. He said his colleagues back in Charleston talk about retiring to the country someday to live on a farm. Mark has been living the dream for nearly 40 years. “I would encourage students to consider practicing in rural areas. You know that on a day-to-day basis that you are helping and impacting people’s lives and are providing a service that without you probably wouldn’t be done.”
Since 1992, Mark has been giving back to WVU and its students by serving as a preceptor for students studying to become dentists and dental hygienists. The students spend several weeks at clinics throughout the state as part of their training. He calls it ‘a win-win-win situation.’ “I enjoy the mentorship with the students, but I also enjoy being able to offer disadvantaged patients the opportunity to have work accomplished at a significant discount. So it helps the students, we’re enriched by working with them, and the community wins as well.” When he first started to practice in Union, far away from any colleagues, Mark said he did feel somewhat isolated. He would frequently call up to experts at WVU for advice and to an oral surgeon friend in Virginia to compare notes. But in the last few years, since the Internet has reached Union, he stays connected online with dentists across the world who are in similar circumstances. And most of them agree with Mark that it’s the patients who provide the greatest rewards. FALL 2013 13
FREE Happier & Healthier Lung cancer screening, tobacco cessation programs help save lives Lung cancer. Despite having a 40-year smoking history, it was still a diagnosis that 61-year-old Larry West wasn’t expecting. “When I first heard I had cancer, I said, ‘Oh wow, this is the lowest point in my life.’ I never thought I’d have it,” he said. After all, it had been four years since Larry touched a cigarette. He quit smoking in 2009 when his wife, Mary, came home and told him that her employer, WVU Healthcare, implemented a tobacco ban. Mary wasn’t happy about the ban at the time but now says it was the impetus for her quitting. “They were taking my smoking breaks away, so we said, ‘Yeah, let’s try it,’” she said. “It was the best decision we could have made.” The couple quit smoking together with help from the West Virginia Tobacco Quitline, a statewide cessation education and phone coaching program. Mary said having her husband on board made it possible, and she thinks that quitting when he did is what saved his life. “We had a healthy competition. It wasn’t mean in any way. We both felt better. It didn’t take long to get used to not smoking,” Mary said. Larry said, “It was a nasty habit. It was nice to kick it after 40 years. I was up to two packs a day, and Mary was up to a pack a day. She figured we were spending about 12-15 bucks a day on cigarettes.”
By Ashley Thomas Photos: Autumn Hill
It was an accident in the kitchen that brought Larry to Ruby Memorial Hospital last summer. He dislocated his shoulder in a fall, and after getting an x-ray, his physician noticed a nodule and sent him to the WVU Healthcare Lung Cancer Screening Program. Larry found out he had cancer. Because it was found before he showed any symptoms, he credits the screening program with helping save his life. “If you smoked as long as I have or if you still smoke, you should get screened. It’s an excellent program,” he said. “I’m retired. My wife is retired. We get to enjoy each other now. I could be in the hospital right now instead of out enjoying life.” Effective screening has played a critical role in catching lung cancer in the early stages. John Parker, MD, WVU pulmonary medicine specialist, said early detection has led to a 20 percent increase in survivability. In July, the U.S. Preventive Services Task Force released its draft recommendation that those at high risk for lung cancer receive annual low-dose CT scans. “This is a good thing. For many years, we’ve had good screening for breast cancer with mammography, for cervical cancer with pap smears, and for the general public for colon cancer. For 30 or 40 years, we have not had an effective screening tool for people at risk for lung cancer. What this new recommendation does is build upon important research done the last five years or so,” Dr. Parker said.
“If you smoked as long as I have or if you still smoke, you should get screened... I could be in the hospital right now instead of out enjoying life.” – Larry West, WVU Healthcare patient
The lung cancer screening program is currently for patients 55 to 74 years old who are active smokers with at least a 30 pack-year history or have quit smoking within the past 15 years. (Pack years are calculated by multiplying the number of packs per day smoked by the number of years smoked.) Patients must be referred by a physician and are charged a $99 fee, but Parker hopes that eventually this cost will not fall on patients. “With this new task force recommendation, I think that Medicare and Medicaid and national private insurance companies are going to probably be forced to have lung cancer screening be a covered benefit,” he said. Still, he said, smokers cannot solely rely on screenings, which is why the screening program also offers a one-time smoking cessation counseling session through the WVU Prevention Research Center. The certified tobacco treatment specialists who provide the counseling also offer longer-term counseling through the WVU Tobacco Cessation Clinic for pulmonary patients. “Statistics and studies have shown that a person’s chances of quitting increase with one-on-one counseling. It’s a lot more effective,” said Jayne Kinney, certified tobacco treatment specialist for the WVU Prevention Research Center. “We have seen more than 60 patients since January and have referred most of them to the West Virginia Tobacco Quitline. If the patient isn’t interested in enrolling in the quit line, physicians can still offer nicotine replacement or prescription medications to help them quit.” Patients interested in the lung screening program or smoking cessation counseling should first contact their primary care physician.
Before they quit smoking, Larry and Mary West could barely walk up stairs without losing their breath. Now, they enjoy taking their dogs, Bentley and Boswell, for long walks together. FALL 2013 15
Why is Black Lung Back? WVU expert says prevention work in mines is crucial
By Danielle Conaway Photos: Bob Beverly and Autumn Hill About 10 years ago, Edward Petsonk, MD, began to examine coal miners’ lung x-rays for the National Institute for Occupational Safety and Health. An occupational lung disease specialist since 1979 and a WVU Pulmonary and Critical Care faculty member, Dr. Petsonk figured there shouldn’t be any more black lung disease because of laws in place for decades to protect coal miners. “It was worse than I thought we would ever see. I almost fell off of my chair. I really was that shocked,” he said. Petsonk found that the number of miners afflicted with black lung disease has been increasing since about the year 2000, when it was at its lowest rate in 30 years. In a clinical review of x-rays and data published in the American Journal of Respiratory and Critical Care Medicine, Petsonk and two other respected lung specialists revealed that young coal miners are getting sicker than older miners, and black lung disease is becoming more deadly.
“Black lung disease is still a big problem. Despite the fact that there are coal mines closing, coal is going to continue to be a big part of West Virginia’s economy, and there’s going to be even more pressure to make coal more competitive,” Petsonk said. “It’s more dangerous for miners now than it was 10-15 years ago. They’re getting sick. They’re getting lung transplants and dying from black lung.” This is all in spite of safety mandates at coal mines that were established in 1969, along with requirements that coal operators offer underground employees periodic chest x-rays and maintain ventilation, dust control systems, and dust regulations in coal mines. Petsonk said, “We have identified clusters or pockets of disease in southern West Virginia, eastern Kentucky, western Virginia and some areas of Pennsylvania. Black lung disease does occur in Illinois, Indiana, Utah, Colorado and other coal mining states, but fewer miners have the disease. In the cluster
areas, black lung disease is both more prevalent and more severe.” If coal miners wore masks and respirators frequently, would cases of black lung disease decrease? Petsonk said it’s unlikely. Masks and respirators can be cumbersome and inhibiting for miners to wear in cramped, dangerous, and noisy underground work areas. “Mine operators must control the dust with types of dust traps, fans, or filters first, and then they can offer masks or respirators if the miners choose to wear them, but masks are not a practical and effective solution to controlling dust – that’s why current rules require mining companies to have controls in place and demonstrate that they are meeting the dust requirements. Certainly, mask issues don’t account for why people are getting black lung,” he said. Larry Mongold, 57, a retired underground coal miner for 19 years, said he received thorough safety and health training at the
One of only 23 programs in the United States and the only program in the Appalachian region, WVU’s occupational medicine residency focuses on the physical, chemical, biological, and social environments of the workplace and requires physicians to complete two years of advanced training beyond their MD degree and internship. “One of the things that is so upsetting to us in occupational medicine is when you are reviewing the lung transplantation records for someone in their 40s or 50s [with black lung] who never smoked, and you know that this disease could have been prevented,” said Chris Martin, MD, director of WVU’s occupational medicine program. “It’s our job to raise awareness about black lung to our medical students and residents.”
Edward Petsonk, MD, examines the PET/CT scan of a patient with black lung disease.
mine he worked at in Keyser, West Virginia. “We had training on wearing respirators and self-oxygen masks. We were well trained, and it was required by law each year to get Mongold refreshed on everything. We wore masks and respirators from time to time. Sometimes, they got in your way or interfered with your work or breathing, and I didn’t wear them,” Mongold said. It was years after Mongold left the mine and was working elsewhere that he began to notice something was wrong. “I was having trouble doing day-to-day things like walking up and down hills on account of not getting enough oxygen. I did a lot of coughing. I still do a lot of coughing,” he said. He began to see WVU pulmonary specialists and had lung function tests to determine
what was going on. The tests confirmed that Mongold had black lung disease – an irreversible, debilitating and potentially fatal condition caused by inhaling coal dust. “It wasn’t really a surprise on account of knowing I was a coal miner. I dearly loved my coal mining job. It was the type of job that you could have and be proud of. If I had it to do over again, I would have worn my respirator more than I had,” he said. Multiple possible explanations abound for the spike in black lung disease, including flaws in existing dust regulations, dust control practices, and dust exposure enforcement of coal mining companies, Petsonk said. Other theories include miners working longer shifts underground because fewer miners are employed today and they’re exposed to more dust, silica, and other toxins. “With these cases of advanced black lung we are seeing, 100 percent of the people who get the disease have too much exposure in a very dusty environment.
No one has ever gotten this type of massive lung scarring from smoking, and black lung disease has never been reported outside of very dusty jobs,” Petsonk said. In an effort to end black lung disease among the nation’s coal miners, the U.S. Mine Safety and Health Administration submitted a draft of tougher rules this fall to the White House Office of Management and Budget for review. “The system still needs to be aware of black lung…It’s the coal dust that you can’t see that gets you,” Mongold said. Petsonk continues to research black lung disease by studying autopsy reports, x-rays, and consulting with the world’s best pathologists for a future clinical review publication. “My job is to get the facts out and give a scientific basis for what’s causing an increase in this disease. I want the world to know about this and help us figure this out.”
FALL 2013 17
BRIEFS SCHOOL OF
DENTISTRY Forty-five dental students received scholarship awards and recognition from the School of Dentistry Scholarship Recognition Program, which acknowledges dental scholarship recipients and donors for their generosity in support of endowments.
Stanley Zaslau, MD, earned subspecialty certification in female pelvic medicine and reconstructive surgery from the American Board of Urology. He is the first physician in West Virginia to receive this subspecialty certification.
The School of Dentistry received a $50,000 grant from the WV Department of Health and Human Resources to help health professionals outside the field of dentistry develop a curriculum that focuses on oral health as a part of overall health.
WVU Behavioral Medicine and Psychology’s telepsychiatry services via web cam have expanded to 27 clinics in 12 rural West Virginia counties. More than 11,000 patients have been seen since the program started in 2009.
During a three-week Governor’s Honors Academy, dental faculty and students educated more than 200 West Virginia high school students on oral health topics in an interactive session called “Dentistry Bits, Bites, and Insights.”
MEDICINE The MD Class of 2017 was selected from an applicant pool that exceeded 3,000, the largest on record. For the second year in a row, the class is gender balanced with a 50/50 female/male ratio. The 2013 Division of Physical Therapy graduates earned a first-time pass rate of 97.5 percent on their licensure exam. Of the 39 graduates, 38 passed the National Physical Therapy Examination. A new degree program was approved by the WVU Board of Governors in immunology and medical microbiology and will allow graduates to better serve the biotechnology industry in West Virginia and worldwide. The American Association of Neuromuscular and Electrodiagnostic Medicine bestowed its highest honor upon Ludwig Gutmann, MD, the Hazel Ruby McQuain Professor of Neurology. He accepts the 2013 Lifetime Achievement Award in October. The Journal of Neuroscience highlighted the work of WVU Center for Neuroscience Director George A. Spirou, PhD, and Paul Holcomb, a neurobiology graduate student in Dr. Spirou’s lab. The journal’s covers featured video stills from the study “Synaptic Inputs Compete During Rapid Formation of the Calyx of Held: a New Model System for Neural Development.”
NURSING Six students in the accelerated baccalaureate nursing program will be awarded scholarships of $10,000 each. To date, the school has been able to award 21 Robert Wood Johnson Foundation New Careers in Nursing Scholarships totaling $310,000. A study by Georgia Narsavage, PhD, RN, and Yea-Jyh Chen, PhD, RN, indicates that a user-friendly, in-home telemonitoring device may help lung cancer patients manage their health from home and decrease hospital admissions. Gail VanVoorhis, MSN, departed for a year in the Republic of Rwanda, where she is working with a government program to build the country’s healthcare education infrastructure and workforce. Follow her on Twitter at https://twitter.com/ WVUglobalhealth Alumna Patricia Chambers Anido created the Anido Family Nursing Scholarship of $50,000 to provide support to undergraduate nursing students.
Alumna Betty Skaggs, PhD, made a $25,000 gift to the school to create the Skaggs Family Dean’s Special Projects Fund to support school activities or needs at the dean’s discretion.
PHARMACY Eighty-four students were welcomed into the class of 2017 during the school’s White Coat Ceremony. Mary Euler, PharmD, joined the school as the associate dean for student services. Dr. Euler is responsible for the development and operation of all aspects of student life. Charles D. Ponte, PharmD, was recognized for his commitment to diabetes education and he was selected as a fellow of the American Association of Diabetes Educators. He is one of nine pharmacists who have been selected since the program was established in 2008. Andrea Armstead, a PhD student in pharmaceutical and pharmacological sciences, was awarded an American Foundation for Pharmaceutical Education fellowship-award renewal to further her education and research on protecting the health of workers in the mining and drilling industries. Allie Karshenas, PhD, has been named the director of clinical operations for the WVU Clinical and Pharmacologic Research Center (CPRC). He will also serve as associate professor in the WVU School of Pharmacy Department of Pharmaceutical Systems and Policy.
PUBLIC HEALTH Kelly Gurka, PhD, leads a team from the WVU Injury Control Research Center and southern WV community partners to study the feasibility of initiating drug overdose programs in three rural high-risk southern WV counties. Deans from the School of Public Health and the WVU College of Business and Economics signed a MPH/MBA Dual-Degree Memorandum of Understanding.
WVU Hospitals has been ranked the No. 1 hospital in West Virginia by “U.S. News & World Report.” The hospital received the same ranking last year.
The Eastern Area Health Education Center and faculty and medical students in the WVU Eastern Division conduct free concussion tests at 10 area high schools and at Shepherd University. A baseline neurological reading is conducted on athletes prior to physical contact. Post injury test results are interpreted by William D. Lewis, MD, and other WVU School of Medicine Eastern Division physicians, who work closely with the high school trainers to determine safe return to athletic activities. The program began in 2005.
CHARLESTON DIVISION The West Virginia Clinical and Translational Science Institute (WVCTSI) awarded a $50,000 pilot grant for a collaborative research project between the WVU Charleston Division and the University of Kentucky with support by CAMC Institute. The collaborative study deals with treatment methods for gallbladder dyskinesia, a disease where the gallbladder does not completely empty causing nausea and pain in the abdomen. John C. Linton, PhD, is the recipient of the 2013 Association of Psychology Postdoctoral and Internship Centers Excellence in Training Award. Dr. Linton is professor and vice chair in the department of behavioral medicine and psychiatry at the WVU School of Medicine in Charleston. Alvita Nathaniel, PhD, has been named WVU School of Nursing’s Interim Chair and Associate Dean for Graduate Practice Programs at the Charleston Division. She succeeds Dr. Cyndi Persily who left in August. The West Virginia Poison Center receives more than 18,000 poison exposure calls and more than 22,000 poison information calls in a given year. Under Director Elizabeth J. Scharman, PharmD, the center provides emergency poison management information to the public and to healthcare professionals 24 hours a day.
The WVU Children’s Dental Program continues to expand under the guidance of Lisa D. Poland, DMD, director of dental health programs for WVU HSC Eastern Division. Last year, the program screened 3,500 children, provided 1,300 fluoride varnish treatments, placed sealants on 2,500 teeth, and referred all of the children to a permanent dental home. The program has screened 10,000 children since its start in 2007. Joy Buck, PhD, principal investigator for the Bridges to Healthy Transitions program recently completed a community health needs assessment in the area served by University Healthcare. Interdisciplinary teams have been created to partner with community groups to address access to care and prevention of chronic illness, cancer, behavioral health/addiction and prenatal/perinatal health. University Obstetrics and Gynecology Associates physician Maria D. Merzouk, DO, received the Outstanding Clinical Faculty of the Year Award for the WVU School of Medicine Eastern Division. This award is voted on by third-year medical students.
WVU School of Nursing instructor Gail VanVoorhis participates in grounds-keeping chores at a rural medical center in Rwanda. This was part of Umuganda, a day when Rwandan people help their communities with projects large and small. The dry season leaves the ground hard and makes the digging difficult. “It was great to get out of the city, and we had a great time working with the local people. There were dancing and speeches after the work,” Van Voorhis said.
FALL 2013 19
BRIEFS JON MICHAEL MOORE TRAUMA CENTER
The Jon Michael Moore Trauma Center, located in Ruby Memorial Hospital, in Morgantown, is the region’s only American College of Surgeons nationallyverified Level 1 trauma center. In addition to caring for the injured, trauma center staff works to promote wellness and injury prevention through education and legislation at the local, state, and federal levels.
NIGHT OF RECOGNITION On October 10, 2013, the fourth annual Jon Michael Moore Trauma Center Night of Recognition honored the hard work and perseverance of the many individuals who comprise the trauma system.
Alison Wilson, MD, director of the Jon Michael Moore Trauma Center, welcomes the crowd to the 2013 Night of Recognition.
Meg Throckmorton, of Waynesburg, Pennsylvania, 2013 Night of Recognition patient honoree, had no idea some of her therapists from the Shepherd Center in Atlanta would be in attendance for the event. Here she is seeing them for the first time.
Don Nakayama, MD, (left) chair of the WVU Department of Surgery, poses with Matthew Loos, MD, assistant professor in the WVU Department of Surgery and WVU Healthcare vice president for medical staff affairs.
(From left to right) Christopher Colenda, MD, MPH, chancellor for WVU Health Sciences; Matthew Wilson, PhD; and Alison Wilson, MD, director of the Jon Michael Moore Trauma Center, pose for a photo with the night’s keynote speaker, former WVU and NFL quarterback Jeff Hostetler and his wife, Vicky.
4 VISIT FROM UKRAINE In collaboration with the World Federation of Ukrainian Medical Associations in the U.S., WVU Healthcare’s Jon Michael Moore Trauma Center educated six Ukrainian trauma surgeons on the American College of Surgeons’ Rural Trauma Team Development Course and Advanced Trauma Life Support (ATLS) program in early October. The visit was intended to facilitate ATLS establishment in Ukraine in timely support of major healthcare transitions there. Plans are currently in the works to bring a second group of Ukrainian surgeons to WVU early next year. Photos: Bob Beverly
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