It’s not often that the Roanoke Valley is a national harbinger. But when it comes to the job market, we’re already where experts say the country is headed, with 25,000 workers – 17 percent of the entire workforce – employed in medical-related jobs.

Carilion Roanoke Memorial Hospital (Photo by David Hungate.)

James Lesniak’s careening career path embodies the evolution of Roanoke’s economy: from a dinosaur of steely underpinnings to curative colossus of hospitals, clinics and emergency helicopters flying high above the worst of the recession’s woes.

The 43-year-old Lesniak, scheduled to graduate as a newly minted physician assistant from Jefferson College of Health Sciences in December 2011, has come a long way from his days working in a steel mill in Santa Barbara, Calif., in the 1980s.

“That was a pretty good job back then,” at $17 an hour, when Lesniak was seeking a liberal arts bachelors degree, he says.

During that same decade, Roanoke received a wake-up call about its future, when then-leading employer Norfolk Southern Railroad packed up its coveted headquarters and moved to its East Coast namesake city in 1982.

Now, Lesniak, the ex-steel worker, and Roanoke, the former railroad town where he moved in 1990, are partners in a new era. The largest employer hereabout today is the Carilion Clinic empire, which includes Jefferson College, and is among several hospitals and other facilities in the area that have physician assistant jobs available at pay that typically ranges from about $70,000 for new graduates to a mean income of more than $93,000. The jobs typically come with prescription-writing authority and the responsibility of interviewing patients and passing on the findings as essentially advisors to primary doctors.

Health-care jobs are the new employment frontier in Roanoke, where Carilion boasts 13,000 workers, more than twice the number at which Norfolk Southern peaked. In fact, the area’s second-largest medical payroll, HCA-owned LewisGale Regional Health System, has about 1,800 workers, slightly outnumbering Norfolk Southern’s roughly 1,700.

If economists and academic leaders are right, Lesniak is among the millions of Americans – thousands of them in the Roanoke area – who are right to pursue a career in health care as a path to job security and relatively good wages.

The Virginia Employment Commission predicts that five of the 25 job categories expected to grow fastest in the commonwealth by 2018 will be health related. They will include a wide range of education and training requirements – from a few weeks for nursing assistants to masters degrees for physical therapists and a decade to produce new MDs.

James Lefniak: The former steel worker is now a physician assistant, having graduated from the Jefferson College of Health Sciences. (Photo by Brett Winter Lemon.)

To be sure, pay scales vary greatly too, from below $10 an hour for hospital laundry workers and about twice that for home health aides who assist patients with eating, bathing and toileting, to doctors earning well into six figures annually. At the bottom of the pay pyramid, where no college is required, there’s little hope of advancement or significant pay increases.

What’s more, there’s some uncertainty about what impact President Barack Obama’s health reform law will have on medical jobs. But an estimated 32 million Americans are expected to acquire health insurance as a result of that legislation, so the federal program seems to mean that the market for care providers will keep growing, perhaps at a faster rate.

Meanwhile, the Roanoke area is already a microcosm of where experts say the national job market is headed. Health care is by far the largest segment of the labor market here, accounting for about 25,000 employees – or 17 percent of the entire workforce.

The abundance of health-care jobs has helped keep the Roanoke area’s unemployment rate at about 6.8 percent, far below the nation’s overall 9.1 percent. Still, despite those employment opportunities, Roanoke’s per-capita income languishes at $33,700, 15 percent below the U.S. average.

Roanoke’s employment base is nearing where Washington labor experts predict the entire country will be by 2018, when, they say, 22 percent of all workers may be in jobs related to health care.

What’s more, health care currently leads other Roanoke area economic segments in hiring needs. A recent list of job openings in Roanoke county by state employment officials found Carilion at No. 1 with 194 jobs. Others among the Top 20 employers with slots to fill, LewisGale with 62 and Emeritus Assisted Living at 21.

“Health care employees are highly skilled and extremely valued throughout the country, as well as the Roanoke Valley,” says R.J. Redstrom, vice president of human resources at LewisGale, which has hired about 200 new workers this year in the Roanoke Valley.

Those new jobs keep coming despite this area’s modest population growth. That’s because another demographic is in health-care opportunity’s favor.

“The aging baby boomers are becoming more prevalent as health-care consumers, and Southwest Virginia’s aging population is one of the fastest growing in the state,” says Redstrom.

Shelby Benois of the Salem V.A. hospital, says the facility will continue to recruit physician assistants, registered nurses and licensed practical nurses. (Photo by Robert West.)

The Department of Veterans Affairs Salem V.A. Medical Center has increased its employment by 198 since 2007 and now has 1,958 full-time employees. Shelby Benois, a spokeswoman for the facility, says management expects the need to recruit about 100 new workers in the fiscal year ending Sept. 30, 2012.

“We expect to continue to recruit for our hard-to-fill positions over the next few years,” says Benois, who adds that those jobs include physician assistants, registered nurses and licensed practical nurses.

Educators are rushing to keep up with demand. Virginia Western Community College is adding new space for classes in medical fields with the 68,000-square-foot Center for Science and Health Professionals, scheduled to open by the time this edition is published. The center will accommodate 1,400 students in such majors as dental hygiene and practical nursing, compared with a previous capacity of 900.

Margaret Andrews, head of Virginia Western’s practical nursing program, says that enrollment in her curriculm rose nearly 50 percent to 59 students last fall. Many of those new students are refugees from other segments of the economy, she says.

“Several have come from manufacturing places, including furniture. And we have a couple of people who were in banking.”

Andrews says the new health-care education building will underscore the direction of both the economy and her school. “There are jobs for practical nurses right now,” she says. They typically pay $19 to $21 an hour for graduates of the two-year associates degree program.

Andrews says she has heard of only one graduate from Virginia Western nursing class of May 2011 who hadn’t found a job within four months. “But it’s not because she couldn’t get hired, it’s because she didn’t like the job description”: working in a nursing home.

“Some of them don’t want to work in a nursing home. They want to be in a clinic or doctor’s office where they see a variety of patients,” Andrews explains.

The limit on job opportunities for practical nurses illustrate a reality in the health care employment market: Career prospects aren’t created equal and those who aspire to certain fields would do well to research them.

Job opportunities for registered nurses, who typically have four-year bachelors degrees, and whose median annual wage nationally is $63,000, are plentiful in Virginia. Barbara Brown, an RN and vice president of the Virginia Hospital & Healthcare Association, says, the commonwealth’s current demand for 3,600 new nurses annually may rise in 2014, when the Obama health plan becomes fully effective.

Is Virginia producing enough new graduates to offset a shortage? Brown says, “A recession brings folks back into the workforce and that has happened with the nursing supply overall in the last few years.” But many experienced nurses are nearing retirement age, and she wonders, “What happens in five to 10 years when the 50-year-old nurses who came back into the market decide to retire and permanently leave the workplace?”

Michael Geres, clinical manager of Eye Care & Surgery in Roanoke County: “There just aren’t enough qualified people to work in an office like this.” (Photo by Brett Winter Lemon.)

Some fields are relatively wide open for those who possess the right skills. Consider that Michael Geres, clinical manager of Eye Care & Surgery in Southwest Roanoke County, was recently planning to hire an ophthalmologist’s assistant even though the practice he runs didn’t have an opening.

The candidate, he says, “fits our mold and even though we don’t have an opening we’ll probably hire her because our practice is growing” and eye-care technicians are in short supply, Geres says. “The technical community is understaffed, meaning there just aren’t enough qualified people to work in an office like this.”

Eye-care technicians, who typically handle about 40 patients a day, check their eyes with a variety of equipment and ready them for further examination by optometrists and ophthalmologists. Such jobs pay in the range of $11 to $24 per hour to candidates whose training may vary from a one-year certificate program at a community college to a bachelors degree. There’s no education program of either sort in the Roanoke area, says Geres, who is in discussions with both Virginia Western and National College in Salem to help start one.

At the top of the medical jobs food chain, of course, are MDs, and the new Virginia Tech Carilion School of Medicine is attracting students such as Matt Joy, who came to Roanoke from California to start classes in August 2010.

Like Lesniak, the physician assistant student at Jefferson College, and similar to Roanoke’s economy in general over the last few generations, Joy is reinventing himself. In undergraduate school at the University of Southern California, he majored in, of all things, music – specializing in guitar.

“I was trying to do the music business thing in Los Angeles and it really wasn’t panning out to provide the lifestyle I wanted,” says Joy, now 29.

So in 2007 Joy returned to USC for a post-bachelor program that offered pre-med courses.

“I went right back to Biology 101 and that sort of thing,” he says. In 2009 Joy started researching and applying to medical schools. He noticed the fledgling VTC institution in Roanoke, paying special attention because his wife, now a teacher at Community High School, is from Winston-Salem, N.C. “We thought it would be nice to have family in the area,” he says.

The couple embodies the genre of young professionals that economic development officials around the country are wooing in the belief they’ll find job security and expand their spending by raising families. Sure enough, the Joys are expecting their first child.

Renting a home here while they try to sell a house in California, the couple has discovered that the Roanoke lifestyle appeals enough to consider staying in the Star City after four years of medical school.

“After years in Southern California, we were ready for a change of pace,” he says. “In terms of amenities, Roanoke is pretty nice. We’re happy with the arts, and some of the eateries have been pretty great. We’ve made friends and set in some preliminary roots here.”

Joy, who aspires to become a general surgeon, has even found a venue to play his guitar for a small audience. “I’ve gone to the open mike night a couple of times at the Village Grill in Grandin Village and brought some friends along,” he says.

Matt Joy, now a student at the Virginia Tech Carilion School of Medicine: “The music business thing in Los Angeles wasn’t really panning out.” (Photo by Brett Winter Lemon.)

Lifestyle is also important to Lesniak, whose wife is an administrator at Hollins University; the couple has a 13-year-old daughter. He had been trying to prepare for uncertain economic events even before focusing on the medical field. While working in a series of contract jobs for a variety of nonprofit community development groups and social service nonprofit agencies, he obtained a masters degree of arts and liberal studies from Hollins in 2003.

But by 2008, he had seen the pay level of his contracts gradually diminish. “I was at a point where the nonprofit market was becoming more difficult and finding funding” from grants and donations that have come under pressure during the recession “is getting harder,” Lesniak says.

So he applied for acceptance in Jefferson College’s physician assistant curriculum: “I’m looking for more pay and job security. I decided this was the right time, the beginning of a period of economic challenges for the country.”

He’s almost assured of landing a lucrative physcian assistant position in the Roanoke area early in 2012, after he graduates and passes the Virginia licensing exam for his profession.

Mark Lambert, spokesman for the Jefferson College of Health Sciences, says Carilion Clinic hires more than 90 percent of the school’s graduates.

The new job will probably solidify Lesniak’s family finances, but he isn’t expecting much of a change in spending habits. “I’m not going to buy a boat or start going on fancy vacations.”

Still, as with Roanoke’s economy in general, he expects health care will provide “more financial stability than I have ever had in my life.”

For one thing, he hopes his new employer will almost certainly provide a benefit he hasn’t enjoyed while working in his last few temporary jobs in the nonprofit sector.

“We’ve always had to rely on my wife’s health insurance. Now, I think I can have my own.”

Chronic or acute. Physical or emotional. No matter the form or severity, pain is often unbearable. Pain specialists in the valley offer techniques and procedures to control the aches, and can even help patients become pain free after years of hurt.

“Pain in the neck” is a common figure of speech. But when used literally, it can indicate a serious issue. In fact, pain on any part of the body – or even felt emotionally – is not to be ignored.

Physiatrists, chiropractors, physical therapists and psychiatrists all work daily with patients to help ease pain. Here, Roanoke Valley physicians in several disciplines break down the various types of pain and how to get the best treatment possible.

The Physiatry Approach

Doctor/patient cooperation is a key factor in relieving pain.

Before pain can be treated, says Dr. Murray Joiner, a physiatrist of physical medicine in Roanoke, the doctor and patient must spend time together to get to the root of where and when the pain began.

“Often, the problem started somewhere besides where a patient thought it did,” he adds. “I get a detailed history, review tests (such as x-rays, CT scans and nerve tests) and perform a physical exam to come up with an appropriate diagnosis and treatment plan.”

Joiner also asks specific questions about the pain: “How severe? What makes it feel better? Is it sharp, dull, achy, sore, etc.?

“Each question is specific to a nerve or other parts of the body,” he explains. “The patient’s answer helps pinpoint the actual problem.”

Joiner treats two basic types of pain, nociceptive and neuropathic. Examples of nociceptive pain include broken bones, herniated disks, arthritis or inflammation. Treatments may involve the use of heat, water, exercise or traction. Interventional techniques, such as the burning or freezing of nerves, or implanting devices into the spine to cover up the pain, are also used when necessary.

“In our specialty, we are willing to consider anything not off the wall to get you better,” Joiner says.

Neuropathic pain, often difficult to treat, refers to pain generated from the nerve itself, such as fibromyalgia, irritable bowel syndrome or peripheral neuropathy (widespread nerve damage). Medications such as Cymbalta or Lyrica may be prescribed, or Joiner may use therapeutic modalities or electrical devices to treat the pain.

It is important for a patient to cooperate with the doctor in order to reap the most benefits from treatment.

“You can’t start out with the premonition that you’re not going to get better, you have to want to be fixed,” Joiner says. “We’re going to figure out what to do to make you better. To have you as a patient for life, we’ve failed.”

Most people experience relief once treatment begins, Joiner says. And patients can further manage their pain at home via hot or cold packs or lukewarm baths.

“This is a challenging specialty, and I love every day of it,” says Joiner. “When I see people leave with no more pain, it’s a great feeling.”

Chiropractic Care

Pain management starts with locating the cause of discomfort.

Whether a patient visits a chiropractor in addition to or in lieu of a pain management specialist, Dr. Craig Camidge with Tuck Chiropractic Clinic wants to build the knowledge in patients that chiropractic care is a “gentle treatment.”

“The drawbacks to what we do are minimal,” Camidge says. “People are often interested in trying this before something more invasive,” such as surgery, injections or long-term medicinal therapy.

When meeting with a patient, Camidge first analyzes the severity of the pain. Those who just experienced an injury or recently began feeling pain are diagnosed with acute pain. If a patient has been in pain for a long time and may have tried numerous options for relief, the pain is considered chronic.

Camidge says low back pain, sciatica, severe headaches and neck pain can all be chronic by nature. Treatment options include electric stimulation therapy to reduce inflammation, a variety of exercises and stretches to relieve pain and stabilize the injured area, or manipulation of bones and joints by hand to get them moving again. He also teaches patients exercises they can do at home.

“I have patients that get better right away,” he says. “Others with more chronic pain need nine to 12 treatments before significant progress is made. We may take care of them longer than that if it will continue to help them.”
According to Camidge, there are two keys to successful treatment of pain.

“Cooperation among the patient’s doctors – which can include a pain management physician, primary care doctor, surgeon and chiropractor,” he explains. “And the patient has to own their injury and put forth the effort to get better. That’s when we get our best results.

“When patients decide to take ownership of their condition and do whatever they can to cure or manage it, we can really make powerful changes.”

The Benefits of Counseling

Counseling can provide positive ways to control emotional pain.

Dr. Maurice Fisher with Comprehensive Counseling Services knows pain is not just a physical feeling.

“Everyone that comes to us is dealing with some sort of emotional pain, such as depression, anxiety or the inability to deal with certain stresses in life,” he says. “And physical problems can often merge with psychological pain.”

He also acknowledges that substance abuse sometimes reflects the use of drugs to kill pain. Other patients experience social pain, whether it stems from the loss of a job or difficulty with family matters.

“When it comes to physical, social and emotional pain (combined), we try to figure out which came first,” Fisher says. “Did the physical pain someone is describing come from a medical problem or did an emotional pain trigger it?”

Upon meeting a patient for the first time, Fisher gets to know his or her background to determine the cause of pain, which he says is seldom just one issue.

“It’s usually a culmination of things that get someone here,” he says. “Once we determine the cause, we find out if the pain is controllable or not. Many folks deal with a lack of healthy adaptive skills, such as mood management, stress management or the ability to adapt to changing environments.”

Fisher says some clients know they are in pain, but do not know the cause until they talk about their life with him and the challenges they are facing. He typically meets with clients for six to eight sessions to help “give them fundamentals for how to manage or tolerate their pain differently.”

“Most people can learn how to deal with problems without the use of medication,” Fisher adds, but he is not anti-drug if the need arises. “And the door remains open for people that need to come back. If life throws a curveball and they have trouble handling the situation, we welcome them to come back.”

Physical Therapy Perks

Resistance exercises are a form of physical therapy.

Physical therapy is helpful for pain management, says Mary Beth Brown, a physical therapist with Lucas Therapies, because exercise in general can decrease pain and increase endorphins.

When a patient comes in, Brown performs an evaluation, learning medical history as well as the type of pain and what makes the pain increase or decrease.

“Once we get a measure of their range of motion and strength, we can start on an exercise program and see how they respond to different movements,” Brown says. “Some patients also benefit from modalities such as a TENS unit that excites the nerves.” TENS – or transcutaneous electrical nerve stimulation – refers to the use of electric current for therapeutic purposes.

From head to toe, Brown says physical therapists have pain relief covered, offering a “handful of exercises” per each body part. They also treat patients experiencing pain from fibromyalgia, arthritis or chronic pain syndrome.

“I don’t know our success rate, but if nothing else is working for someone, they can benefit from trying physical therapy,” Brown suggests. “We can help with muscle endurance, strength and flexibility. We’ve never turned anyone away, and everyone has seen some positive results.”

Patients are treated for a span of two to three weeks or four to six weeks. If the treatment is helping alleviate pain, Brown says they may continue for another four to six weeks after discussing the progress with a primary care physician.

In addition to exercises with weights, bands, stability balls and other equipment that promotes particular movements – such as pushing, pulling and gripping – Brown says aquatic therapy is a great option. And every patient receives a print-out of his or her specific program in order to also exercise at home.

“Every patient is different,” Brown explains. “We tailor each program to what the patient needs to function in their everyday life or job,” whether it is a mom experiencing pain from lifting her child, or a construction worker having difficulty operating machinery due to arm or back pain.

After treatment ends, patients are encouraged to stay active and maintain strength to prevent or lessen further aches and pains.

The advantage with elective surgery is that you have time to think, prepare and get your body ready for the procedure – whether it’s cosmetic or health-crucial.

What a misnomer! The term elective surgery sounds like an operation a patient chooses rather than being medically necessary, which is often not the case – as anyone who has undergone a scheduled angioplasty will testify.

Basically, any surgery that can be planned in advance falls into the elective-surgery category. That includes cosmetic procedures like face-lifts and tummy tucks, as well as surgeries most folks wouldn’t consider optional. Think non-acute cholecystectomies (gallbladder removal). Think masectomies. Think hip replacement.

Unlike the patient who shows up at the emergency room with a perforated appendix, elective-surgery candidates are often afforded time to do homework and make decisions. They can pick out surgeons, select the optimal dates for the operations, and get their bodies and minds in the best possible shape.

“It allows you to get your ducks in a row,” says Dr. Charles Daniel, a urologist with Jefferson Surgical Clinic.

Selecting a surgeon
The best place to find your surgeon may be at the office water cooler.

“The way it works for most patients, and I find in Roanoke this is very true, is that it’s really by word of mouth,” says Dr. James Farmer, an orthopedist with LewisGale Medical Center. “You talk to your friends.”

After gathering recommendations, patients will still want to study the doctors’ resumes, paying careful attention to whether or not they have been certified through the American Board of Medical Specialties, according to plastic surgeon Dr. Enrique Silberblatt.

“Whenever you’re having any service performed you want to pick a provider who’s trained to provide that service,” says Silberblatt. “If you want some electrical work done in your home, you’re not going to call the plumber.”

Younger surgeons may have less experience performing a specific operation, but they shouldn’t be dismissed out of hand.

“Oftentimes they’re more up to date on the newer and more advanced procedures,” says Dr. Patrice Weiss, chair of obstetrics and gynecology at Carilion Clinic.

Patients will want to steer clear of physicians who seem too eager to perform a surgery on a patient who hasn’t yet undergone less invasive treatments, advises Dr. Paul Lenkowski Jr., an ear, nose and throat doctor with Jefferson Surgical Clinic.

“If someone offers you surgery for your sinuses the first time they see you, you may want to go after another opinion,” he says.

“Your surgeon is somebody that gives you information. Not a salesman,” Silberblatt agrees. “If you go in and they’re a little too anxious to get you on the books and they start suggesting procedures that never crossed your mind then the little red flags should go up.”

Setting a date

Since by definition elective surgeries are not urgent, life-or-death situations, how does a patient decide when to go under the knife?

Often, they listen to their bodies.

For instance, people who love to read or people who frequently drive at night may be ready for cataract surgery sooner than their counterparts who don’t rely on their eyesight as heavily. “It has a lot to do with what your activities are and what you want your daily functioning to be,” says Dr. David Kinsler, an ophthalmologist with Vistar Eye Center.

Farmer engages candidates for orthopedic surgeries into discussions about how long they’ve suffered from the injury, the intensity of their pain and the attempts they’ve made at getting better.

“Once we get to that point, the picture is really clear and you very rarely need to convince somebody,” he says.

Patients also need to take their mental health into account when scheduling surgery. Women going through divorces often come in for consultations with Silberblatt in the hopes of freshening up their appearance. Silberblatt explains that they’d be better suited to wait to have surgery when they’re at a happier place.

“Surgery is a stress in life,” Silberblatt says. “You want to do it at a point where you don’t have any other associated stressors.”

Once patients decide to go through with surgery, they have to set a date. More than one web site offers astrological charts designed to assist in selecting the optimal time for surgery, but none of the doctors interviewed for this story was aware of any patients consulting with celestial bodies. Rather, says Daniel, they tend to time the procedures so that they fit with work, school and vacation schedules.

That’s why Daniel performs the majority of vasectomies on Fridays. “A lot of guys will knock off work an hour early, come over here 3:30 or 4 p.m., get a vasectomy, go home, take it easy over the weekend and then return to life,” Daniel says.

Getting Ready

Dr. Steven Goldstein, a cardiologist with LewisGale Medical Center, says a regimen of exercise and eating well in the days prior to an angioplasty isn’t likely to make the operation go any more smoothly.

“I think it’s more of a long-term plan of eating well and exercising,” he says. “I mean you don’t want to eat badly or anything.”

For elective surgeries that can be postponed weeks or months, though, patients may have more time to make improvements to their lifestyles, which, according to Weiss, can reduce their risk of acquiring nasty things like post-op blood clots and pneumonia.

“Major changes within a couple of weeks are usually hard,” Weiss says. “But we know that patients who smoke, patients who are obese, patients who are diabetic, patients who are malnourished do not recover and heal as well as their counterparts who are nonsmokers, nonobese, not diabetic.”

Some doctors stress getting unrelated medical conditions like high blood pressure under control before undergoing some elective surgeries like repairing a torn ACL. For other operations, that’s less crucial. Kinsler only asks patients with a multitude of health problems to pay a visit to their internist before undergoing cataract surgery.

“For your everyday person who has hypertension or diabetes, that’s not necessary,” he says.

Farmer’s patients frequently work with physical therapists to strengthen muscles and improve joint function before undergoing surgery.

“All that really helps them get better on the back end faster,” he says.

Patients might also be well served to work on improving their attitudes before an operation. Sunny dispositions can help patients to heal more quickly, Weiss and Farmer agree.

“The more positive your outlook and the more active you are to begin with usually you do better post operatively,” Farmer says.

A Head-to-Toe Look at Elective Surgeries

Cataract Surgery: As we age, areas of our eyes’ lenses turn cloudy. Cataract surgery replaces that opaque natural lens for a clear artificial one. In the past, people used to talk about cataracts as being at various stages of ‘ripeness’ by how cloudy the lens had become.

Dr. David Kinsler, an ophthalmologist with Vistar Eye Center, regards this notion as old-fashioned. “You’re not a watermelon or a cantaloupe,” he says.

Instead, Kinsler stresses that patients know it’s time for cataract surgery when “they can’t see well enough to do the things they want to do.”

LASIK Eye Surgery: During this operation, ophthalmologists change the shape of a patients corneas in hopes of eliminating the patients’ need for glasses. Kinsler says he performs fewer LASIK procedures these days due to the lackluster economy.

“This is all out of pocket,” he says of LASIK. “It’s like going out and buying a new car or a TV or something.”

Rhinoplasty: Nose jobs ranked as the sixth most popular cosmetic surgical procedure in 2010 according to the American Society for Aesthetic Plastic Surgery. While the operation can make a dramatic change in a person’s appearance (think Jennifer Grey from “Dirty Dancing”), Roanoke plastic surgeon Dr. Enrique Silberblatt cautions that it takes a year for minimal residual swelling in the nose to disappear completely.

“That doesn’t mean you’re running around looking like Bozo for a year,” he says. “Most of the big swelling goes away in three or four weeks.”

Balloon Sinuplasty: In this relatively new operation that’s akin to angioplasty, doctors place a balloon into the nose. It’s gradually inflated to open the blocked nasal passage.

“You’re not really removing stuff,” explains Dr. Paul Lenkowski, Jr., an ear, nose and throat doctor with Jefferson Surgical Clinic. “You’re just making things bigger and making them function better.”

Here’s something you probably didn’t know: doctors sometimes use cocaine to relieve nasal congestion and as an anesthetic before this surgery. “It’s a really good decongestant and then afterward it helps to control the pain,” says Lenkowski, Jr.

Tonsillectomies: In the first half of the 20th century, most kids had their tonsils surgically removed as a measure to ward off recurrent strep throats. Today, tonsillectomies continue to be the second most common surgery performed on children. In January, the American Academy of Otolaryngology issued new tonsillectomy guidelines recommending that doctors perform the operation only when children have recurrent sore throats (more than seven in a year) or sleep apnea. The new guidelines delight Dr. Tu Tran, an ear, nose and throat doctor for LewisGale Medical Center.

Before, Tran would sometimes face parents of a child with a sore throat who insisted that the child’s tonsils be removed. Tran would refuse, and the parents would take the child to another doctor, who might have a different criteria for removing tonsils.

Tran says that tonsillectomies can improve life for kids who meet the guidelines, but he’s not one for sugar coating.

“It is a big deal operation,” he says. “The reason is that it’s very painful. No matter what. It’s very painful.”

Ear Tubes: In this most common pediatric operation, doctors insert tiny tubes designed to drain fluid in the ears of kids who get recurrent ear infections. Without this surgery, Dr. Vivian Mao, an ear, nose and throat doctor for Carilion Clinic, worries she’d have to prescribe more antibiotics to clear up ear infections. That, in turn, will lead to antibiotic-resistant bacteria. “Luckily, ear tubes are pretty simple solutions,” Mao says.

Angioplasty: Doctors use a balloon to widen clogged heart arteries in this common procedure. While non-urgent angioplasty is considered elective surgery, patients don’t face it casually, according to Dr. Steven Goldstein, a cardiologist with Lewis-Gale Medical Center.

“I think people do have an understanding of how serious it is and how risky it is,” Goldstein says. “Anything that involves the heart, they kind of get their tail up.”

The operation has a success rate of over 95 percent, with less than one percent of patients dying during surgery, according to Goldstein. “It’s under one percent, but it’s a hundred percent for those people,” he says.

Liposuction: The second most popular cosmetic surgical procedure involves a doctor removing fat from specific areas of the body. Silberblatt warns that patients shouldn’t see this procedure as a substitution for weight loss. At most, he will remove 10 pounds of fat. What the procedure can do, however, is to remove fat from specific areas.

“You should be at the weight you’re going to be at,” Silberblatt says. “Then you can recontour at that weight.”

Bariatric Surgery: About 220,000 morbidly obese people in the U.S. had surgeries designed to limit their food intake in 2009, according to the American Society for the Metabolic and Bariatric Surgery. Carilion Clinic currently averages about two dozen bariatric surgeries each month, according to Dr. T.A. Lucktong, medical director of bariatric surgery at the facility.

Lucktong has found that his patients on average manage to keep off between 40 and 60 percent of the weight they initially lose following the operation.

“Some patients can regain the weight lost,” he says. “Most patients who regain weight regain a small portion of the weight loss. Some patients do not regain weight and continue to maintain initial weight loss long term.”

Hysterectomy: Removing a woman’s uterus is still one of the most common gynecological surgeries, according to Dr. Patrice Weiss, chair of obstetrics and gynecology at Carilion Clinic.

“However, there appears to be fewer performed nationally,” she says, “because there are newer and less invasive procedures which may be able to correct the problem before a woman requires a hysterectomy.”

One of those newer procedures is an endometrial ablation, a procedure that destroys the lining of the uterus. “It is a procedure much less invasive than a hysterectomy, designed to treat women with abnormal uterine bleeding,” says Weiss.

Women who do eventually decide to have a hysterectomy will find that the surgery can now be performed laparoscopically. “Women can wake up and have three or four band-aids and go home the next day, as opposed to several years ago where people were having big skin incisions and had a much prolonged healing course,” Weiss explains.

Carpal Tunnel Surgery: Carpal tunnel syndrome occurs when patients compress nerves in their wrists, usually by engaging in repetitive motions, whether that’s typing numbers into a spreadsheet or dealing out tarot cards. Patients usually come to see Dr. James Farmer,  an orthopedist with LewisGale Medical Center when symptoms of  numbness, tingling and pain keep them from sleeping at night.

Doctors may complete carpal tunnel surgery using traditional surgery, a mini-open approach that involves a smaller, one-inch incision or endoscopy. “There are lots of ways to skin a cat,” explains Farmer,  an orthopedist with LewisGale Medical Center.

No matter the surgical approach, though, the end result is the same: the carpal ligament is cut. “It’s like opening a can of biscuits to relieve the pressure,” he says.

Hip Bursectomy: A bursa is a fluid-filled pouch that serves as a cushion between a bone and a muscle or a tendon. When the bursa get inflamed it’s called bursitis and it really hurts. Usually the pain can be eased through less invasive methods like cortisone injections or anti-inflammatory medications, but severe cases may require surgery. The procedure involves making two to three small incisions and inserting a camera to use as a guide. Then, Farmer says, “we get in there and clean out the bursa.”

Patients undergoing hip bursectomies tend to be in their fifth decade of life or older, according to Farmer. “It’s a degenerative thing,” he says.

ACL Reconstruction: This surgery repairs a tear in the anterior cruciate ligament in the knee. Farmer has a particular affection toward this surgery because many of the patients who need the operation are athletic and want to continue being active.

“You fix the mechanical problem and nine times out of 10 they’re going to return to the same level of activity they were at before,” he says. “That isn’t the case with a lot of other surgeries.”

Bunionectomy: The name pretty much explains this one. Doctors use this procedure to exorcise a bunion, an often painful enlargement of bone or tissues at the base of the big toe which are frequently caused by wearing shoes that are too tight and narrow. Doctors go in through a small incision with a (gulp) saw to remove the bump. Sometimes doctors will also realign the bones in the big toe using pins to keep things in place. –BJ

Can we live forever? Well, no. But with the introduction of so many improvements in medical technology and treatments, the possibilities of at least extending our life expectancy are increasing.
Local healthcare providers are excited to share the many new and improved ways they care for patients. From head to toe, they’ve got you covered:

1. Premium Intraocular Lens (IOL) Implant – For cataract patients, surgery is necessary, but the traditional IOL only offered vision for one distance – far, intermediate or near. The Premium IOL, says Beth Kolnok, director of marketing for Vistar Eye Center, is multifocal, giving cataract patients the possibility to see well at more than one distance.

“As many active baby boomers are reaching the age of 60, more of them will be affected by cataracts,” she says. Premium IOLs provide “a major improvement in overall satisfaction with cataract surgery.”

2. Lucentis – A prescription medicine that is injected into the eye, Lucentis treats patients with Age-Related Macular Degeneration. AMD, Kolnok says, is a chronic condition that occurs in two forms, wet and dry, and “steals” vision. Traditional treatment options slow or stop vision loss. With Lucentis, used for wet AMD, patients have seen an improvement in vision.

3. Cirrus HD OCT – This new technology helps doctors identify signs of glaucoma and other retinal diseases, and is also used to monitor the patient’s condition and effectiveness of treatment. It is a more advanced imaging tool than most options because it uses high-definition technology to take millions of images of the back of the eye.

“This new technology takes the diagnosis and treatment of eye diseases to a new level,” says Richard Johnson, M.D., Ophthalmologist, LewisGale Physicians. “By combining this technology with a thorough eye exam, we are able to detect problems sooner and help the patient avoid vision loss.”

Lewis Gale Physicians use the Cirrus HD OCT.

4. Lenstar LS900 – Using light instead of sound waves to determine the length and anatomy of the eye, Lenstar LS900 helps doctors determine the best fitting implant to be used during cataract surgery.

“In less than 30 seconds with a single scan, this technology can calculate eye measurements,” says Joy Sutton, marketing communications manager for LewisGale. “During cataract surgery, the cloudy natural lens is replaced with the implant. Choosing the right implant is important because it gives the patient a better chance of not needing glasses following surgery.”

5. Lyric – The world’s first 100 percent invisible extended-wear hearing device, Lyric is placed deep in the ear canal – no surgery or anesthesia required – and can be used everyday for up to four months at a time. According to Allison Buth, media relations specialist with Carilion Clinic, Lyric uses the ear’s anatomy to provide exceptional sound quality.

“Carilion Clinic is proud to be one of the select healthcare organizations in the United States (and the only provider in the region) to offer the Lyric hearing device to its patients,” Buth says.

6. Concussion Protocols – A team of orthopaedic surgeons, neuropsychologists and emergency room physicians with Carilion Clinic has developed new protocols for treating concussions, which include cognitive rest and increased recovery time. Based on guidelines issued by the American Academy of Pediatrics, says Buth, these protocols are designed to educate athletic trainers, coaches and parents to ensure athletes receive proper care.

7. Laser Assisted New Attachment Procedure (LANAP) – Currently the only FDA-approved laser protocol for the treatment of periodontal disease, LANAP is less painful, has a higher success rate and offers a faster recovery time than traditional treatments. Traditional treatments involve use of a scalpel to grind away bone and teeth.

“This is quite a step forward in the dental community, says Josh Nelson, vice president and general manager of Harvey Dentistry & Blue Ridge Dental Group. “Several of our doctors have this technology at their disposal and are well trained.”

8. CEREC & Digital Impressions – Patients needing a crowned tooth can have a new crown in a matter of hours instead of weeks thanks to CEREC. The dentist, Nelson explains, can design the new tooth on a computer with CAD/CAM technology. Using a digital impression, the dentist shows a patient how the new tooth will look with surrounding teeth. The design is then sent to the in-office milling unit, where a new tooth is milled out of a porcelain block.

9. CI Photon Camera – New technology for imaging the heart with a small camera has emerged at LewisGale Medical Center. The equipment features a chair design that allows for ease of patient exchange and a comfortable scanning position. Its cardiac imaging positioning ensures minimum heart-to-detector distance with no possibility of detector pinch. Plus, explains Sutton, the upright sitting position minimizes patient movement while they are scanned.

10. Cardiac Catheterization – A new approach to cardiac catheterization at both LewisGale and Carilion involves insertion through the wrist instead of the groin area to conduct angiograms, which detect blockages in the heart.

According to Sutton, this technique offers patients a decreased risk of bleeding and discomfort following the procedure.

11. Hypothermia Therapy – When a person goes into cardiac arrest, the brain and other organs compete for the diminishing supply of oxygen, which can lead to brain damage. According to Buth, Carilion Clinic recently introduced hypothermia therapy to cool the body, which slows metabolism and reduces the brain’s need for oxygen. This gives rescue workers and doctors more time to treat the cardiac arrest and prevent or reduce brain damage.

Hypothermia therapy allows doctors and rescue workers more time to treat cardiac arrest and prevent or reduce brain damage.

12. Lead Extraction – Thanks to a minimally invasive technique, Carilion Clinic doctors can extract lead from inside the heart of a patient with a pacemaker. Instead of major surgery, a laser is used to remove the lead through the same incision in which a pacemaker was inserted. Lead must be removed when it is damaged, large amounts of scar tissue surround it, infection occurs, or there is blockage of the vein by a clot or tissue.

13. Interventional Pulmonology – Patients with lung cancer and airway diseases no longer have to travel out of town for treatment. The interventional pulmonology program at Carilion Clinic offers laser therapy to treat difficult airway cases and has expanded the availability of cryotherapy, rigid bronchoscopy and airway stenting.

“Endobronchial ultrasound procedures have facilitated the diagnosis and staging of lung cancer and other pathology, avoiding the need for more invasive surgical procedures,” says Buth. “Due to this success, the clinic is adding another endobronchial ultrasound system.”

14. Hyperbaric Oxygen Therapy (HBOT) – The Advanced Wound Center at LewisGale Medical Center has two new hyperbaric oxygen chambers offering the latest technology for accelerated wound healing. HBOT, says Sutton, delivers pure oxygen under pressure, which promotes the healing of damaged tissue. Patients suffering from certain diabetic wounds that are healing slowly or not at all, tissue damage from radiation therapy, a skin graft with inadequate blood supply or certain infections of the bone and/or skin, can benefit from HBOT

“More than 7 million people in the U.S. will suffer from chronic, non-healing wounds this year, and that number is growing 10 percent every year,” says Michael Walton, program director. “We are excited that the Advanced Wound Center at LewisGale has the medical expertise, technology, and state-of-the-art therapies to accelerate the healing rates of our patients.”

HBOT also is available at Carilion.

15. Molecular Imaging Equipment – LewisGale offers a new PET/CT machine with upgrades for patient comfort and decreased scan times, allowing doctors to stage and monitor cancer patients. The machine also is used to perform a unique heart study to look for areas of the heart that can be fixed after a heart attack.

The state-of-the-art molecular imaging equipment also is utilized for traditional oncology and Na-F PET bone imaging.

16. Endoscopic Ultrasound (EUS) – Another treatment brought to the area by Carilion, EUS evaluates and treats diseases of the esophagus, stomach, liver, pancreas, colon and rectum. EUS allows for screening both cancerous and non-cancerous diseases, says Buth. It is diagnostic in nature and identifies if something is cancerous or not, and helps in staging cancers, which determines the treatment plan.

17. Minimally Invasive Total Disc Replacement – This spine surgery technique – performed at LewisGale and Carilion – involves removing the diseased disc and replacing it with an artificial version. Benefits include smaller incisions, less surgical blood loss, shorter hospital stays, less pain and medication post-operatively and faster return to daily activities.

“These techniques allow for far less post-operative pain and discomfort, while allowing the surgeon to perform the same surgery in an improved, and more advanced manner,” says James Leipzig, M.D., Orthopaedic Surgeon at LewisGale.

18. Transforaminal Lumbar Interbody Fusion (TLIF) – Dr. Gregory Riebel with Virginia Orthopaedic offers TLIF, which combines the benefits of comprehensive open surgery with the benefits of minimally invasive technology. It also is available at LewisGale and Carilion. According to Sutton, the procedure involves joining two or more vertebrae together by inserting a bone graft or bone graft substitute between the vertebrae in order to fuse them together and create a more stable spine.

“Major spinal procedures can be done through very small incisions with specially engineered spinal retraction systems, with visualization of the spine through state-of-the-art radiologic and microscopic assisted devices,” says Dr. Riebel. “Patients benefit through rapid recovery, due to smaller incisions, much lower blood loss, less pain and less tissue trauma.”

19. Anterior Hip Replacement – Performed by making a four- to five-inch incision in the front of the hip instead of the typical 10- to 12-inch incision in the side or back of the hip, anterior hip replacement is available locally at Carilion Clinic. This method allows surgeons to work through a natural interval among the muscles surronding the hip, sparing tissue from trauma and a lengthy healing process, says Buth. Other benefits include reduced blood loss, reduced tissue healing and a patient’s ability to avoid the pain of sitting on the incision.

20. Genetic Services – Carilion Clinic offers comprehensive genetic counseling services for children, adults and prospective parents. Plus, Carilion houses the only prenatal genetic counselors in the region.

At LewisGale, clinical genetics counseling options offered to high risk patients include increased cancer screening, chemoprevention and risk-reducing surgery, such as a total hysterectomy. Genetic counseling is available for a variety of cancers, including breast, ovarian, uterine, pancreatic, colon and melanoma.

“The Department of Clinical Genetics will soon provide maternal-fetal counseling as well for common genetic disorders including Down syndrome, sickle cell disease, cystic fibrosis and spina bifida,” says Kara Bui, a certified genetics counselor who heads up the new Department of Clinical Genetics for LewisGale.

21. Bioness Technology – A new wireless medical technology, Bioness Ness L300 Foot Drop System at LewisGale assists patients affected by central nervous system injuries and disorders – such as stroke, multiple sclerosis, traumatic brain injury and spinal cord injuries – to regain the ability to walk.

“Foot drop results from an injury or illness that paralyzes or weakens foot and ankle muscles, making walking difficult,” Sutton says. “Three unobtrusive components that patients wear under their clothing enable the system to help restore their natural movement when walking. When the patient lifts the heel, these components communicate with each other wirelessly and send low-level electrical impulses that cause the nerves to contract muscles responsible for lifting the foot during walking.”

22. Functional Electrical Stimulation (FES) Cycle – Using electrical stimulation to exercise muscles and improve mobility, the FES Cycle (a wired stationary bicycle) is ideal for patients following a spinal cord injury or stroke. It’s also appropriate for patients with multiple sclerosis. The cycle helps build muscle, strength and circulation. FES is available at LewisGale and Carilion.

23. da Vinci Robotic System – According to Buth, the da Vinci robotic system at Carilion increases dexterity in minimally invasive surgery that typically is unavailable with routine laparoscopy. It allows for more complex surgery, traditionally done by a laparotomy, to be done laparoscopically. The system provides better treatment options and can now be used for laparoscopic hysterectomies, myomectomies, adnexal surgery, severe endometriosis, pelvic adhesive disease, sacralcolpopexies, oncologic staging of uterine and ovarian cancer, radical hysterectomies and tumor debulking.

24. Melanoma Clinical Trial – LewisGale Regional Cancer Center in Salem is serving as the clinical site for a melanoma study that could lead to a new treatment. Conducted by Blue Ridge Cancer Care, the study involves using a modified version of the herpes simplex virus called OncoVEX.
“OncoVEX is designed to grow only inside cancer cells and not healthy tissue,” explains Sutton. “When it’s injected into the tumor, OncoVEX draws immune cells into the tumor where it programs them to go out into the body and attack other cancer cells.”

Trial results will be submitted to the Food and Drug Administration for approval of OncoVEX as a new treatment option.

25. Interventional Radiology Procedures – Carilion Clinic has introduced new techniques for interventional radiology-related treatment. These include bronchial artery embolization for hemoptysis, fibroid embolization, intracranial vascular procedures, percutaneous transhepatic cholangiography, percutaneous nephrostomy drainage catheter placement, placement of internal nephroureteral stent catheters, pulmonary angiography, radiofrequency tumor ablation, transjugular intrahepatic portosystemic stent and tumor chemoembolizations.

Click on the image below to view a special section from our July/August 2011 “Top Docs” issue

Quick Links:

Vistar Eye Center:  www.vistareye.com

Enrique A. Silberblatt, M.D., FACS: www.silberblatt.com

Asthma & Allergy Center: www.asthmaandallergycenter.net

Blue Ridge Dental Group of Harvey Dentistry: www.blueridgedentalgroup.com

Virginia Orthopaedic: www.vaortho.com

Roanoke Plastic Surgery: www.roanokeplasticsurgery.com

Walter Chiropractic Clinic: www.walterchiropracticclinic.com

Lucas Therapies, PC: www.lucastherapies.com

Here are links to some of the wonderful businesses that supported our July/August “Top Docs” issue. We encourage you to visit their websites soon – and tell them you saw them in The Roanoker!

Allstate Insurance

Asthma & Allergy Center

Allstate Insurance

Asthma & Allergy Center

Blue Ridge Travel

Bluefield Graduate and Professional Studies-Roanoke

Bobby’s Occasions

Bruce E. Mayer

Chalaine’s Embroidery

Community School

Cundiff Drug Store

Cyndi’s Fashions

Doggie Doos Grooming Salon

Dogwood Restaurant

Dominion Electronics

Dr. Murray Joiner & Associates

Earthworks Pottery

Farmer’s Insurance

Field of Dreams

Friendship Retirement Community

Grand Rental Station

Grand Storage of Vinton

I Don’t Know Restaurant & Catering (IDK)

Jefferson College of Health Sciences

Lancerlot Fitness Center

Lewis Gale Medical Center

Lucas Therapies, P.C.

Marie Flippen, Caldwell Banker Townside Realtors

McDonald’s

Miller-Motte Technical College

Neely’s Accounting Services, Inc

Radford University College of Graduate and Professional Studies

Ribble & Francisco Accounting, Inc.

Richard Brogan Plumbing

Roanoke United Methodist Home

The Barbeque Grill

V.R.P. c/o Eliane Niemann, N.D.

Vinton Appliance Center

Vinton Baptist Church

Vinton COC

Vinton Veterinary Hospital

Virginia Orthopaedic

Virginia Western Community College

Walter Chiropractic Clinic

With the daily recommended amount of sodium at no more than 1,500 milligrams (a teaspoon of salt contains 2,235; two oz. of pretzels 800, a cup of tomato juice 650) many of us are exceeding the recommendation by a factor of two or three. And with processed foods as a primary culprit, recommendations for reduction include eating fresh meats, fruits and vegetables, comparing food labels and being aware of portion size both at home and when dining out. More health tips

1. And here’s another reason to watch the salt. A study of women by the Women’s Health Initiative reveals that hypertension among older women increases the risk for brain lesions and thus dementia, as well as increasing stroke risk.

2. Cold season and exercise season. According to the UC Berkeley Wellness Letter, the severity and duration of colds has no relationship to continued exercise or rest. The recommendation is to start slowly, see how you feel and proceed accordingly. Presence of more severe infection – fever, fatigue, swollen glands, diarrhea – should be a sign to stop exercising until you’re fully well.

3. Pretend you’re hunting? A Penn State study finds that those with positive feelings about movement and exercise are indeed more physically active. Suggestions for taking on that perspective include a nod to our ancestors’ tendency toward activity as a survival advantage– still true today if in a different context.

4. And act like a lion is after you now and again. Interval training –getting your heart rate up to 80-90 percent of max (to find your maximum, subtract your age from 220), for periods of one to four minutes within an otherwise less-intense workout – has been shown to improve endurance, lower blood pressure and increase “good” cholesterol.

5. POM: Pretty good, but not a miracle. The leading marketer of pomegranate juice has been slapped on the wrist by the FDA for making medical-benefit claims; fruits and juices are good, nutritious food, but cannot be touted as producing direct disease reduction.

1. Fitness guru Artie Levin in March, 1981 on a balanced life based on an hour-long workout, six days a week: “If you’re in good shape physically, you’ll be in good shape emotionally. You’ll also be more mentally alert. Life has to be equally balanced on four sides, like a square – physically, spiritually, mentally, socially.”

2. World top-20 triathlete Pat Bateman in July 1990, soon after his retirement from competition to become a personal fi tness consultant: “There’s nothing greater than setting a goal and working toward it. That’s as true for a middle-aged businessperson who completes a four-mile footrace as it is for a world-class bicyclist who completes the Tour de France.”

3. Ophthalmologist/triathlete Dr. Junius Crowgey, then 61, in November 1985 on the weather and sustaining his bicycling and running: “There are all kinds of fabrics now to keep people going through the cold months. Roanoke’s weather isn’t all that bad. With a good polypropelene suit you can keep going in about any weather.” And Crowgey’s perspective from not far south of age 65: “At 65 and after you can be young one year and old the next.” But also this: “Artie Levin’s an amazing guy – he has 4,500 miles on his bike already this year and he’s seventy-damn-two years old!”

4. Crowgey, nearly a dozen years later, in August/ September 1996: “Churchill told his troops before the invasion of Normandy to concern themselves with solutions, and that the problems would take care of themselves. With exercise it’s this way: Concern yourself with doing, and the off days will take care of themselves.”

5. RAC exercise development director Glenn Englebert in April 1987 on the best exercise machine: “The cross country ski simulator is considered the best aerobic exercise in the whole wide world.”

6. Cardiologist Dr. Marta Sayers in July 1984 on a factor beyond weight control, monitoring of blood pressure and blood sugar and not smoking on women’s heart health: “Where men tend to store discontent and not say anything, women tend to speak up and say what’s bothering them. That’s important because it affects you less.”

7. Phys-ed teacher Jerry Anderson in March,1990 on nutrition monitoring: “My wife and I went to the grocery store and read the labels. It takes hours at first, but you find the hidden fat sources.”

8. Attorney Larry Davis in March 1984 on his regimen of every-other-day free weights and a half hour of hard sprints every evening: “I’m out there to sweat – just trying to stay in shape and keep myself together. My view is if it doesn’t hurt, you’re not getting it done.”

9. Orthopaedic doctors Thomas Miller and William Mirenda, writing in June 1988 on the aging athlete: “Only a maximally trained athlete is obliged to see a dip in his or her performance with age. That means the rest of us can still hope to improve our tennis forehand, cure our golf slice, and in some cases, even improve our times in foot or bike races.”

10. Psychologist Dr. Paul Woods in July 1984 on stress management: “I haven’t been angry for over a year. I’ve been productive, but I’ve given up that everything must go right all the time.”

11. Registered dietician Lee Ann Matthews in July/August 1997 on diets: “Instead of thinking of yourself as being on a diet or getting ready for a class reunion, start considering what you’re doing as habit changes that will last forever. The same changes you’re making to lose weight are the changes that will keep the weight off and make the improvement last.”

12. Psychiatrist Dr. Jitendra Desai in July/August 1997 on managing stress: “Find something you can get joyfully lost in. It doesn’t matter what it is – hobbies or involvement with a group. For me it’s playing Indian drums.”

13. Therapist Jane Hundley in May/June 1998 on contact with others: “It’s important to connect with someone or something else each day, because emotional isolation is oft en an underpinning that leads to depression.”

14. Dr. Wayne Harris in January/February 2010 on remaining true to an exercise regimen: “You have to start by saying ‘I have but one body and it’s my responsibility to take care of it.’”

15. Oncologist Dr. William Fintel in July/August 2003 on dealing with cancers: “Cancer therapy is getting better and easier, but if you can avoid a late diagnosis of cancer you may never have to hear the word ‘chemotherapy.’ Catch it small and get it all.”

Carilion is a large part of why the valley ranks sixth in health care out of 402 North American metropolitan areas in the most recent "Cities Ranked and Rated."

In the realm of desirable living situations, Roanoke Valley’s health care is right at the top of the heap.

For a population of just over 299,000, the valley has grabbed some big-time honors: notably the #6 ranking for health care performance out of 402 North American metropolitan areas. And, according to, 2007’s Cities Rated and Ranked, there’s more:

Such life-enhancing factors as below-national-averages cancer mortality and stress rates. Higher per capita numbers of physicians and hospital beds. And growing national recognition. In all, an impressive 93.9 rating out of a possible 100.

What’s behind all these happy accomplishments?

Two all-star achievers: Carilion Clinic and HCA Lewis-Gale.

If there are identical truths about Carilion and Lewis-Gale, they’re these:  Both are rock-solid 100-year-old institutions in the Roanoke Valley. Both have leapt into the 21st century with eyes focused on growth, revolutionary technology and patient care.

Carilion Clinic is the biggest employer sector in the region, encompassing not just the Roanoke Valley but the surrounding area. It owns seven hospitals – including Roanoke Memorial, Roanoke Community and Franklin Memorial – and co-owns an eighth with Centra Health. In addition, it operates more than 100 physician offices and out-patient facilities, employs 12,000 people, and has a total of more than 600 physicians on staff.

But Carilion’s reach doesn’t stop there.

In 2009, the system launched the Westlake Center for Smith Mountain Lake with Urgent Care and other services. During the same calendar year, it opened 3 Riverside, its newest outpatient facility, located in Roanoke’s Riverside Center at the corner of Jefferson Street and Reserve Avenue. Both are small pieces in the Carilion growth spurt that has paid off with such patient-centered refinements as two LifeGuard emergency helicopters, an entire fleet of EMT-staffed ambulances and the area’s only Level-1 trauma center with the highest level an emergency facility can achieve.

Now being reorganized along the lines of the Mayo Clinic with more doctors in a wide number of specialties, Carilion has earned the 18th spot on the list of top integrated health networks published by SDI Health.

As Carilion grows into a major force in today’s medical world, however, nothing has piqued the community’s interest and pride more acutely than the joint Virginia Tech Carilion School of Medicine and Research Institute, whch will welcome its first class in the fall. With more than 1,400 applicants and only 42 slots to fill, the four-year school is designed to answer the need for “research-competent physicians who can translate research from the bench to the bedside and into the community.” In addition, it will help relieve the shortage of physicians, a priority with the American Association of Medical Colleges and the American Medical Association.

Also a source of public confidence, Consultants in Cardiology is the largest cardiology practice in Southwest Virginia and joined Carilion Clinic in January 2009. Purpose of the switch: to develop a Congestive Heart Failure Clinic with the Department of Medicine, an atrial fibrillation treatment center, expanded imaging services, health screenings and an expanded regional heart alert program. 266-6000; carilionclinic.org.

HCA Virginia Health System

Headed by Salem’s 521-bed Lewis-Gale Medical Center, HCA’s comprehensive healthcare network serves thousands of patients annually through such valley facilities as Lewis-Gale Imaging Center, Blue Ridge Surgery Center and the Lewis-Gale Breast Center.

Marking its 100th anniversary in 2009, Lewis-Gale acts as a regional referral center for specialized procedures and like the system’s three other regional hospitals, consistently ranks in Virginia’s top 10 in Anthem’s Quality-In-Sights® Program, based on patient safety, health outcomes and member satisfaction. In addition, the facilities also score in the top 10 percent of all U.S. hospitals in four core measures established by the Centers for Medicare and Medicaid Services:  heart attack care, heart failure, pneumonia and surgical infection prevention.

Lewis-Gale's Chest Pain Center is one of only 128 to receive national accreditation.

Providing diagnostic and surgical outpatient care and committed to a quality hospital experience and clinical outcome, Lewis-Gale is the first valley facility to offer patients a fully accredited Chest Pain Center. Its services include a complete range of cardiac care, including diagnostic and interventional procedures such as Prime ECG used to detect pending heart attacks, angioplasty and the region’s only cryoablation and radiofrequency treatment for atrial fibrillation, a common type of irregular heartbeat that can cause heart attacks and strokes.

A regional cancer center, Lewis-Gale serves individuals with intensity modulated radiation therapy that can deliver treatment with pinpoint accuracy; Synergy S, the advanced linear accelerator with radio-surgery capabilities for inoperable tumors; and clinical trials. The center also is equipped with the new PET/CT Scanner used for diagnostic imaging to determine cancer staging and cardiac abnormalities; the region’s first digital mammography, and the only HDx3.0T MRI system, one of the latest high-definition systems available.

Besides Lewis-Gale, HCA also operates Alleghany Regional Hospital, Low Moor; Montgomery Regional Hospital, Blacksburg, and Pulaski Community Hospital, Pulaski; Women’s and Children’s Center at Alleghany, and the Imaging Center at Montgomery Regional. 776-4000; lewis-gale.com

Catawba Hospital, Catawba, Va.

Observing its centennial year of service and set on an idyllic 850-acre campus 10 miles from Salem and 17 miles from Roanoke, Catawba Hospital is part of the Commonwealth of Virginia’s public mental health system, specializing in adult care.  Once a facility for the treatment of tuberculosis, Catawba was reorganized as a mental health center serving persons with severe mental illnesses in 1974, and today accommodates 110 beds – 60 geriatric and 50 adult – offering both short-term acute care units and dedicated geriatric units in private and semi-private rooms.

Affiliated with the University of Virginia School of Medicine, Catawba offers specialized referred care for the region, serving citizens of the Roanoke Valley and surrounding regions in psychiatry, psychology, social work, music therapy, recreation therapy, specialized psychiatric nursing and other disciplines. Also a focus for which Catawba is recognized is its work in suicide, aggression-risk assessment and risk reduction, work that has been presented nationally.

The facility also has presented nationally on its psychosocial programming, which focuses on its recovery services. These services support people returning to the community in meaningful and safe ways. A public safety net for the community’s mental health system, Catawba works in partnership with the private sector partners and community service boards. A portion of its work also attends forensic patients who are adjudicated not guilty by reason of insanity or are transferred from jail.  375-4200; catawba.dmhmrsas.virginia.gov

Veterans Affairs Medical Center, Salem, Va.

The Veterans Affairs Medical Center is a 298-bed operation that provides psychiatric care to all Virginia veterans, as well as medical, surgical and primary care to those in Southwest Virginia. Classified as a Clinical Referral Level I Facility, this teaching hospital offers a full range of patient care with state-of-the-art technology, education and research. Areas of care include medicine, surgery, psychiatry, physical medicine and rehabilitation, neurology, oncology, dentistry, geriatrics and extended care.

Affiliated with the University of Virginia School of Medicine, the center trains more than 200 University residents, interns, and students annually, as well as students from the Edward Via Virginia College of Osteopathic Medicine and nursing students from many programs. In addition, 29 associated health-training programs are offered in affiliation with 44 colleges and universities, and a formalized sharing agreement is maintained for radiation therapy, allergy, gynecology, dermatology, oncology, ophthalmology, teleradiology and mammography.

Authorized beds include 182 general medical, surgical and psychiatry; 90 at the Extended Care Rehabilitation Center; 26 in the Substance Abuse Residential Rehabilitation Treatment Program, and 10 in long-term Substance Abuse. The center’s Extended Care program is based at the Community Living Center.

Specialty programs cover a wide range of concerns, from geriatric evaluation management and women’s health to sleep disorder evaluation, memory disorders, smoking cessation and amputation care and treatment. The facility is recognized as a National Center for Excellence for treatment of post-traumatic stress disorders. The center also has Community Based Outpatient Clinics in Danville and Tazewell. 982-2463; salem.va.gov

Virginia Veterans Care Center

Located next door to the Veteran Affairs Medical Center, VVCC opened on Veterans Day 1992 as a state-of-the-art model for long-term health care. The state home for Virginia veterans, the 240-bed facility is set on handsome grounds surrounded by the Blue Ridge mountains and is intended to provide affordable, comprehensive nursing and resident care to state residents admitted there, as well as the aged, infirm and honorably discharged armed forces veterans.

It offers assisted living, rehabilitation, skilled nursing, Alzheimer’s and dementia care, and provides comprehensive care with on-site x-rays, physical therapy, podiatry care, and other services.

Besides health care, patients can take advantage of wheelchair-accessible nature trails. deck, library, chapel, barber shop and billiard room. They can also enjoy the fully enclosed wander garden for safe inside and outside walks. 982-2860; dvs.virginia.gov

Blue Ridge Cancer Care

A private group of oncologists and hematologists practicing in Southwest Virginia, with primary locations at Carilion Medical Center, Lewis-Gale Medical Center and the New River Valley, BRCC was originally founded in 1976 by Dr. Steve Rosenoff. Today, it boasts 18 physicians and five mid-level practitioners.

Services and treatments include medical oncology, radiation oncology, hematology, diagnostic testing and clinical research. Through its affiliation with U.S. Oncology, a national network of cancer professionals, and the region’s two medical schools, BRCC conducts the largest research trial program in the area, and patients are thereby offered the latest treatments in the comfort of their own communities. In addition to education and community support, the group recognizes the need for full family support and care in the treatment of all cancer patients.

Other offices are located in Rocky Mount, Low Moor, Bedford, Christiansburg and Wytheville. 1-800-543-5660; 982-0237; blueridgecancercare.com

Mount Regis Center

A 25-bed inpatient treatment center, Mount Regis specializes in the treatment of substance abuse and chemical dependency. In operation since 1947, the facility provides 24-hour nursing care, inpatient medical detox, inpatient rehab, day treatment/partial hospitalization and an intensive outpatient program. The center’s work has been recognized as a National Center of Excellence for quality alcohol and drug dependency treatment programs.  389-4761;  mtregis.com

Blue Ridge Behavioral Healthcare

One of 40 Code of Virginia local community services boards, this organization supplies Roanoke and Salem cities, as well as Roanoke,  Craig and Botetourt counties, with care for individuals who are seriously mentally ill, have substance abuse problems or an intellectual disability.

With multiple program at a variety of locations throughout the valley, it employs 400 individuals who provide support or services via state and local government funding, federal and private grants, reimbursement from federal agencies, client insurers and private payment. Emergency service is available 24 hours a day; however, assessment is generally required prior to admittance to any program. Services include counseling, psychiatric and emergency services, sexual assault response and awareness, medication monitoring and other life skill help. 345-9841; brbh.org.

Alternatives

In addition to professionally trained healthcare physicians, specialists, psychologists, nurses and social workers, the valley offers a wide variety of other medical disciplines, including chiropractors, massage therapists, acupuncturists and yoga and pilates instructors. To contact, please check phone listings.

A Passion for Healing

Scott Hansen doesn’t sound like a man with piety on the brain.

In fact, the New Jersey native comes across as a down-to-earth physician who thoroughly understands his job: heal the sick and do it with the big dose of compassion.

That credo has so impressed his peers that Hansen, a model of modesty, keeps garnering tributes: Last year’s Doctor of the Year citation from the Bradley Free Clinic plus Teacher of the Year honors from the Psychiatry Residency Program at Catawba Hospital, where he’s ministered to body and soul of the hospital’s mentally ill since  2006.

“A lot of the way I work goes back to medical school,” he says. “In my fourth year, I had to do two community rotations – one in an urban setting, North Philadelphia, a very rough neighborhood, and the other a rural setting in Colorado. That was frontier medicine. They crystallized everything.

“I became a National Health Service Corps scholar. Essentially, it’s a program for students who want to do primary care in under-served areas. It paid for everything for the two years I had it. In return, I owed the government two years, so I went from my residency to Bland County, where I even made house calls. It was very challenging but very rewarding.”

Other “service” positions followed, including six years as a staff physician and medical director of the Kuumba Community Health and Wellness Center (now New Horizons), a federally qualified center where approximately 50 percent of patients were uninsured.

Finally, Hansen joined the private sector. He lasted only 15 months.

“The commercial influence,” he says, “just left me cold.”

Not so with the Catawba position.

“The appeal is of continuing to work with a group of people who have limited access to medical care,” he explains, “people who frequently slip through the cracks. Often these patients not only require a mental diagnosis but also physical diagnosis, and sometimes it’s difficult to tell where psychiatry begins and medicine begins and vice versa.”

Tough or not, Hansen sees his work as an honor.

“Being a physician – even when you hear doctors complain about today as opposed to 30 years ago – it’s a very privileged position. “I feel I have a responsibility to give back to society.”

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Dr. Dane McBride, a board-certified asthma and allergy specialist at the Asthma and Allergy Center on Franklin Road, tells this story:

A teenager came to him with asthma so severe he couldn’t play sports. Since his asthma was often triggered by allergies, McBride injected him every few weeks with a relatively new treatment, Xolair, that temporarily blocks the antibodies triggering allergic reactions. The teen, now in his twenties, is currently attending college on a partial sports scholarship.

Such is the power of the right allergy treatment at the right time.

Spring is one of two seasons (the other is early fall) when allergies get the best of people who are susceptible. In early March, allergies to tree pollens begin and continue for several months; by the first of May, grass pollens are added to the mix.

To make matters worse, we live in a valley, which according to McBride, may be the worst possible scenario for allergies. The mountains on either side create a kind of inverted bowl effect, whereby allergens and pollution get trapped and linger longer than they would otherwise.

There are three ways of handling allergies: (1) You can avoid the allergen that triggers them (e.g., avoid pets to avoid pet dander – but good luck avoiding trees and grass); (2) You can use over-the-counter or prescription medicines to block the allergy’s effects (more effective for some people than for others); or (3) You can reduce allergies through allergy immunotherapy, which uses progressively larger doses of allergens to immunize you against the allergens’ effects.

If the first two aren’t producing the relief you need, you may be ready to tackle the third.

Standard Immunotherapy

To anyone who’s struggled with allergies for years, the idea of wiping out the misery with immunotherapy scarcely seems possible. The standard version of this therapy, allergy shots, has been around for decades. But in the first 11/2 years of treatment, visits to the doctor’s office can be frequent. And although the shots confer immunity benefits after just a few months, it takes five years of them to consolidate the changes so that they will last for many years after the shots stop.

Even then, there’s no guarantee allergies are gone for good.

Nevertheless, the shots “have come a long way, baby” since their earliest years, says McBride. If you took allergy shots years ago and found them less than fully effective, know that doctors now use higher concentrations of allergen extract than they used initially.

“We found lower doses, though safer, don’t work or not for long,” McBride says. Typically doctors now push the concentration to the highest strength patients can tolerate safely: “We turn the volume down on the [allergies], and sometimes we turn the whole thing off.”

Are You in a Rush?

Yet even those for whom immunotherapy might be a good idea can’t always leave work twice a week for the first 16 weeks, or shoulder the cost if their insurance co-pays for each injection are high.

For such people, allergists consider administering what’s called “rush” immunotherapy. It still takes five years to build up lasting immunity, but the initial visits to the doctor’s office are fewer. Rather than building up to your target (maintenance) dose with shots once or twice a week for the first few months, you literally build up to the desired level in a few days.

McBride says his practice also offers a middle-ground approach called “modified rush” immunotherapy.

As you can imagine, accelerating the process this way creates a slightly higher risk of having a severe reaction to the allergens, so before the injections patients take steroids and antihistamines to forestall problems. Those who are highly reactive to allergens in the first place, or have heart disease or severe asthma, are not good candidates for an accelerated approach.

Antibody Antidote

Finally, for some folks there are injections of the aforementioned Xolair, which “knocks out the allergic antibodies” in the system, McBride says. The down side is that the treatment has to be repeated every two to four weeks ad infinitum, since within that time frame the body regenerates the offending antibodies. Not everyone is a candidate for such treatment, and not everyone would want it. But for those whose lives are being held hostage to severe allergies and/or allergic asthma, the inconvenience might seem like a fair tradeoff.

What Are Allergies?

Here’s how allergies work: When your immune system comes into contact with a substance to which it’s susceptible, such as grass pollen, it overreacts, treats the substance like an “enemy,” and releases antibodies to fight the invader.

The unnecessary antibodies then cause the immune cells to release chemicals, including histamines, that set off allergy symptoms: sneezing; watery eyes; runny nose; hives; headaches; itchy eyes, nose or throat, etc.

Your body can be allergic to many different substances, including pollen, animal dander, dust mites, certain foods, insect bites and drugs. An allergist can test to find out which allergens are triggering your symptoms.

Today we know how bad smoking is for us, but it's still hard to quit. Here's some help.

Smoking is a deadly habit – if you need proof just consider the following facts from the American Cancer Society:

• Nearly half of all Americans who continue to smoke will die because of it.

• 438,000 people in the U.S. die from tobacco use each year.

• Nearly one out of every five deaths is related to smoking.

• Cigarettes kill more Americans than alcohol, car accidents, suicide, AIDS, homicide and illegal drugs combined.

But it doesn’t have to be this way. Today we know how devastating smoking can be to our bodies, and if you are looking to quit there is more help available now than ever before. Smoking cessation programs, medications, nicotine patches and gum, support groups and more are all tools that are out there to help you kick the habit, but the first step is acknowledging you are ready to quit and planning for success.

“You have to be really ready to quit,” says Edythe Naughton, registered nurse and health educator with Carilion Clinic. “Until a person is ready, you can offer help, guidance, understanding, incentives, but until a person reaches that point in their life where they’re really ready to quit, it’s going to be very difficult to quit.”

However, even if you think you’re ready, don’t get discouraged if you can’t stop right away. According to Naughton the average smoker attempts to quit seven times before he or she finally snuffs out the habit for good.

“People should not get discouraged if they fall off the wagon, that’s really common, and they just need to keep trying, because eventually they’ll be successful,” she says, adding that every time you start smoking again you have another opportunity to recognize the triggers and stumbling blocks that caused you to fail the last time. “Recognizing those is a good thing, because the next time you try you’re even more prepared.”

Here are a few more tips to help you stop smoking:

1. Pick a date to quit, and when it arrives, just stop smoking – don’t try to wean yourself off or it will be harder.

2. Start getting ready before you quit by paying attention to how often you smoke and by trying to recognize the triggers that cause you to smoke so you can avoid them when you do quit.

3. Let the people around you know you’re quitting to gather support and to make yourself accountable.

4. If you can, get a buddy to quit smoking with you. Nobody can understand like a fellow smoker. However, if you can’t find a buddy don’t let that prevent you from quitting, your other friends, even nonsmokers, can also provide support.

5. Have alternatives to smoking ready to go, such as snacks, gum and time for exercise.

6. Plan for some free time. When you do quit, you will find the time you used to spend smoking really adds up. Have activities planned to keep you busy during that time.

7. Eliminate temptation by throwing out your cigarettes and cleaning out your car.

8. Consider consulting your physician to see if a prescription medication is right for you. Drugs such as Zyban or Wellbutrin are anti-depressants that may help you deal with the cravings.

From joint and bone health to mental health, heart health to cancer prevention, we’ve tried to bring you the best advice available on every topic we’ve addressed in our year-long wellness series. Now it’s time to bring it all together. Here are the keys to good health.

Exercise And You:Why Working Out Works Out

Exercise works. Whether it’s cancer prevention or joint health, mental and emotional health or heart health, on every topic we addressed over the past year, exercise came up at one point or another as one of the best ways you can help take care of yourself.

FACT: Exercise helps keep your weight under control.

“You don’t have to be a tri-athlete or a marathon runner to achieve what most of us need to achieve,” says Dr. Clifford Nottingham, a family practice doctor with Carilion Family Medicine and the top doctor in this category in our most-recent Top Docs feature (July/August 2005). “You need to get your heart rate up, sweat a little bit and get some reasonable improvement in your cardiovascular tone.”

More tips:
• First, if you’re overweight, don’t feel like you have to lose it all at once. Even a small weight loss of five to 10 percent can significantly decreases the risk of both heart disease and diabetes.

“There’s nobody who can’t do something,” Nottingham says. “The truth is, if you’re starting at ground zero, there’s always something that you can do, and
the trick is to find what works for you. Try to find something that makes you feel good, try to find something that you actually enjoy.”

• Second, if you’re having trouble getting started, Nottingham says he often advises his patients to consult a personal trainer. You may not need the regular services of a trainer, but an initial consultation with these experts can go a long way towards starting you on the road to a more fit you.

• Finally, especially if you’re prone to putting it off or skipping sessions, consider finding a workout buddy. The accountability factor will rise if you’ve got someone else depending on you, and it usually helps make exercise more fun too.

“It really helps to have a partner,” Nottingham says. “It really keeps you going.”

FACT: Exercise keeps your joints healthy

Exercise keeps your joint muscles strong, which will ultimately help support those joints and prevent and delay the onset of osteoarthritis. The key to remember here is that amount and kind of exercise have to be taken into consideration.

“Mobility remains very important, and it’s a matter of trying to get exercise to the right degree,” Nottingham says. “If you overdo it, you may have to pay the price of a lot of discomfort, and if you don’t do things you’re definitely going to have some discomfort and lack of mobility.”

Some ideas for balancing your routine include mixing in weight-bearing exercise with water exercise and other exercises that are not high impact. Make sure to avoid repetitive activities, especially if they can result in repetitive injuries to your joints. Extension and muscle-building exercises can also help increase stability and balance, which reduces the risk of falls that can cause bone breaks and helps your posture as vertebrae collapse during osteoporosis.

FACT: Exercise keeps your bones strong

Weight-bearing activities like running and jogging help prevent osteoporosis by increasing bone density. The counter argument here is that these same kinds of exercise can be hard on the joints, so again, a proper balance is essential.

“Unfortunately swimming and biking, which are two wonderful exercises otherwise, don’t tend to help with osteoporosis,” Nottingham says. “Something in which you bear weight is critical, and walking is something that, for the average individual, is very easy to do for osteoporosis prevention.”

FACT: Not all exercise is blood, sweat and tears

For example, yoga and tai chi are both non-aerobic exercise options, and these and other similar activities help with flexibility and mobility and are also often great sources of stress relief. Stretching programs are also beneficial.

“If you look at your dog, when your dog gets up from a nap, what’s the first thing he does? He stretches,” Nottingham says. “We really need to be doing the same thing. Particularly as we get older, we need to work on stretching and flexibility. … Yoga and Tai Chi are two [forms of exercise] that I often encourage folks to take a look at, but even just a home stretching program can help.”

FACT: Exercise helps you de-stress

Yes, exercise actually might help hold the blues at bay. 30 minutes of regular exercise three to five times a week may help ward off depression, and it is proven that exercise releases endorphins and raises dopamine levels, which increases the feeling of pleasure.

Exercise also increases oxygen consumption, which is good for brain function, and if you’re stressed you’re likely to eat more, so keeping stress-free helps keep your weight under control.

“Exercise seems to enhance our emotional status and emotional health,” Nottingham says. “Almost always, if I prescribe an anti-depressant, I prescribe exercise to go with that, with the advice that it’s going to make the medicine work better and hopefully you’re going to come off the medicine.”

Sleeping your way to a healthier you. Exercise can help make you tired in a healthy way, and a good night’s sleep can make a world of difference to your health.

 FACT: Exercise can help you get a better night’s sleep

And a good night’s sleep goes a long way toward keeping you from being stressed, helping keep your heart in tip-top shape and helping keep your memory sharp and your brain healthy.

“Exercise helps you to get tired in a healthy way,” Nottingham says. “It’s also certainly important to try to be consistent with your sleep cycle and get to sleep at the same time.”

One word of caution – try not to exercise right before bed. A four-hour window between exercise and sleep is ideal since exercise can jazz you up and make it harder to sleep in the short-term.

FACT: Exercise improves your heart health

As mentioned, being overweight is not good for the heart, but exercise not only helps keep weight down, it also keeps the heart muscles strong and keeps blood pressure low and cholesterol levels where they need to be (it increases good HDL and lowers bad LDL).

“The other element is, if your body doesn’t have any excess weight to take around, it takes a lot of burden off the heart, lungs the kidneys and the other internal organs that have to support your body, not to mention the joints,” Nottingham says.

FACT: If you smoke, exercise can be a great distraction when trying to quit

If you’re trying to quit smoking, adding exercise to help occupy your newfound free time will not only help keep your mind off your cravings, it will further benefit your body in all of the ways mentioned above – talk about two (or in this case a whole lot more) birds with one stone!

Diets Work Too!
How Healthy Eating Helps Keep You Fit

Everywhere you look there are bits of nutritional information that contradict one another. One day carbohydrates are the root of all weight gain, and the next day the complex carbohydrates can protect you from a myriad of diseases. The diet world pendulum has swung from no fat to lowfat to healthy fat diets over the past decade. A person attempting to get their dietary house in order may find all of the information a little intimidating. We’ve waded through the current research to help clarify a few dietary issues and to separate fat from fiction.

FACT: Carbohydrates do not make you gain weight.

If you eat more calories than you burn, weight gain will occur no matter if the excess is consumed in the form of carbohydrates, protein or fat.

“It’s obvious that calories matter when it comes to weight loss regardless of the ratio of carbs, protein and fat in the diet,” says Monica Burgoon, a local licensed dietician. “I prefer to focus on the quality of foods in the diet and how this relates to poor health instead of counting calories and arguing about the ideal ratio of protein/carbs/fat for weight loss.”

Additionally, complex carbohydrates are a nutritionally good way to spend what calories you take in due to fiber content. Fiber helps the body stay healthy in a variety of ways, including lowering cholesterol and keeping the digestive system healthy, according to the American Heart Association (AHA).

Carbohydrates can also assist in the production of serotonin, a feel-good chemical that attaches itself to receptors in the brain. Examples of good carbohydrates that help release serotonin include whole grains and other complex carbohydrates. These kinds of carbohydrates provide a long, steady boost in serotonin levels, as opposed to the short spikes caused by simple carbohydrates such as sugar and caffeine.

Protein, carbohydrate and fat ratios aside, in the end it’s all about one number – the calorie.

“It’s a little old mathematical equation tweaked by what your body’s rate of metabolism is,” Nottingham says. “Short of that, it’s basically calories in and calories out.”

FACT: Not all dietary fats are bad.

The low-fat diet revolution that gripped the nation in the ’90s led by the likes of Susan Powter scared dieters away from all fats – even those that help protect the heart.

According to the AHA, Omega-3 fatty acids, “benefit the heart of healthy people, and those at high risk of – or who have – cardiovascular disease.”

Any additional cardiovascular protection is welcome, and omega fatty acids can be found in fatty fish like lake trout, mackerel, salmon, herring and sardines, according to the AHA. Omega fatty acid complex supplements are also available and can help people that don’t enjoy the taste of fish.

“This is a good way to stack the cholesterol numbers in your favor,” Nottingham says.

The superheroes – omega fatty acids – should be part of a well-rounded diet, but villainous saturated fats should be avoided as they do not contribute positive health benefits and can even be harmful. The AHA reports that eating too much saturated fat and cholesterol will raise blood cholesterol, and high blood cholesterol is a major risk factor for developing other types of heart disease.

Sources of saturated fat and cholesterol include foods that are favorites for many including whole fat dairy, fatty red meats, and fried foods.

“Unfortunately, living in the South [saturated fats are] pretty common,” Nottingham says. “If someone accidentally picks up Southern Living, people are going to get recipes with them in there.”

All is not lost though. Food can be enjoyable without added unhealthy fats. Try skim milk and low fat cheeses. While avoiding saturated fat, you still need to make sure to get enough calcium and vitamin D into your diet to protect bone health.

“The other thing I would suggest is that people at risk for osteoporosis shouldn’t restrict dairy too much or calcium intake and get plenty of Vitamin D,” Nottingham says.

FACT: All calories are not created equal.

Empty calories in the form of sugar and simple carbohydrates can take up a significant allotment of your daily calorie budget without offering nutrients or even filling you up for long.

“One of the hugest offenders are soft drinks,” says Nottingham. “If you look at the number of folks that eat reasonably healthy but go through a half or even a whole two liter of soda, that is a huge amount of yucky, empty calories that is more than your system can burn up.”

FACT: Eating water-dense foods can allow for weight loss.

Vegetables and fruits are water-dense, allowing you to eat more of them and feel more satisfied without as many calories. Soups can also be considered water-dense, but only if they are non-creamy.

Eating ourselves to death. Portion control and a well-rounded diet is key to maintaining a healthy weight. PHOTO BY DOUGLAS MILLER

One cup of chopped, raw broccoli has 31 calories and one-third of a gram of fat. An equal amount of lobster bisque weighs in at over ten times the caloric value at 360 with 29 total grams of fat – almost half the daily allowance.

In addition to filling up without many calories, vegetables offer nutrients that we simply don’t get enough of.

“The powerhouse foods are mostly plant-based so that they will be part of the diet if more vegetables and more of a variety of vegetables are eaten,” Burgoon says. “They include onions, garlic, crucifers (broccoli/kale/cauliflower), berries – especially blueberries, flax and sunflower seeds, raw chocolate, and herbs used for tea like nettle, rose hip, ginger.”

The bottom line according to Burgoon:

“If calories are being restricted for weight loss, it is very important that the foods that are eaten be nutrient dense and that vitamin and mineral supplements are taken to avoid deficiencies and maintain optimum levels of nutrients. For the diet, this means emphasizing a variety of non-starchy vegetables, some whole fruit, good quality protein foods and some good quality fats, and limited whole grains but not as flour products. Food intolerances and medications need to be considered because they may be associated with weight retention and other problems with metabolism.”

When Nothing Else Works
Facts You Need to Know About Weight-Loss Medications and Surgeries

If it’s not clear by now, losing weight is usually no easy task. Although we cannot stress enough the importance of diet and exercise, sometimes getting results requires more drastic measures.

Fortunately there are aids out there in the form of medications and surgeries that can help you get the results you need to maintain your overall wellness. However, both of these measures should be taken with a grain of salt – no matter how effective, lifestyle factors, at least for the time being, still seem to be the best way to drop weight, and even with the application of these procedures and medications, exercise and diet are still going to be a large part of the puzzle.

Weight loss medications

“Whenever considering medications for this type of situation, it’s always important for people to know that it’s only going to be part of the program,” Nottingham says. “They have to be committed to the nutritional and physical exercise component of what they need to do.”Currently there are two long-term prescription weight-loss drugs approved by the FDA, Xenical and Meridia. While Nottingham says both of these drugs are effective, they are by no means miracle pills, and they can be expensive and cause some unwanted side effects.

“Those are sort of the two drugs that most doctors would say are safest, the unfortunate fact is that they are not super powerful, they’re not super effective,” he says. “One of the major issues is that most insurance agencies won’t pay for them. Xenical also has some unwanted side effects, primarily with diarrhea.”

The reason for these side effects is that Xenical works much like the ingredient Olestra that is used in some low-fat foods by binding to fat cells in order to keep them from being absorbed. This also has the effect of decreasing the absorption of some fat-soluble vitamins and beta-carotene. The makers of the drug recommend users also take a multi-vitamin that contains D, E, K and beta-carotene to compensate.

Meridia, on the other hand, is an appetite suppressant and actually affects certain chemicals in the brain to make people feel full without eating as much. The main concern with Meridia regards patients with heart complications since this drug can cause mild increases in blood pressure and heart rate and substantial increases in some patients. Other more common side effects include dry mouth, constipation and insomnia, and sometimes headaches and increased sweating.

“These drugs are things that hopefully can be used to help jump start somebody while they are learning about the nutritional aspects and exercise part,” Nottingham says. “If we can help them psychologically to get started and drop some pounds, hopefully these other programs will kick in and they’ll begin to derive the same benefits from other lifestyle changes instead.”

Doctors like Nottingham are hopeful that the future will bring better and safer medications with fewer side effects, and Nottingham notes that there are already promising new medications on the horizon.

“The closest thing to the miracle pill are some of the agents being used to treat diabetes,” he says. “Byetta is this neat new agent that has a protein in it that has the effect of suppressing your appetite. It’s injected, but it has a very powerful reduction in appetite side effect. It’s actually the first diabetic medicine that has caused people to drop weight instead of gain weight. So there’s a lot of interest in taking it or some of the other drugs like it and using them for some new pharmacological weight-loss agents.”

Surgeries

The bariatric (weight loss) surgery, gastric bypass, reroutes the digestive system to reduce the amount of food a person can consume or process, resulting in weight loss. However, the procedure isn’t for everyone.

“There are some people that it just seems that nothing else works,” Nottingham says. “Their overall health is so compromised that this might be the best option for them.”

People with a body mass index (BMI) of over 40, or those with a BMI of 35 to 39.9 with related health problems, can be considered for gastric bypass according to the Mayo Clinic. A BMI of 35 to 39.9 means that the person is obese, where a BMI of over 40 indicates extreme obesity.

“Folks who have significant cardiovascular, endocrine or orthopedic types of problems may be having the issues because of the excess weight their body is forced to carry,” Nottingham says.

Since the amount of food that can be eaten and digested is severely limited after surgery, weight loss can be rapid. However, this is not an instant or effortless solution to obesity. Lasting results come from being continually conscious of your diet and exercising.

“I always tell people looking at this that it is not a quick fix,” Nottingham says. “It is going to change the pattern of your eating for the rest of your life, but you have to be in control of the foods you eat.”

As with any surgery, there are risks, but they can be mitigated by carefully selecting an experienced, knowledgeable surgeon.

“One of the things I tell folks selecting surgeons [is that] you are selecting them for their talents and to know when to operate and when not to operate,” Nottingham says.

Donna Springer:
“Your Body Is Like A Trophy.”

Donna Springer; then and now: 30 years later and she's still got it.

 Long-time readers of The Roanoker may know Donna Springer as the cover model of our September/October 1976 issue. She was 40 then, and model-trim.

Today she’s just as dedicated to fitness, and many know her as the energetic woman riding next to you on an exercise bike at the Roanoke Athletic Club.

“Your body is like a trophy, you must work out or you will lose it,” she says.

For many, exercise is seen as a chore, but for Springer exercising is something she looks forward to.

“I exercise with a partner and afterwards we go out to eat,” she says.

Springer’s upbeat attitude about working out has helped her stay active for many years, but this grandmother of four also knows the value of not overdoing it with a heavy daily workout.

“You do what your body tells you to do,” she says. “My grandchildren swim, but I don’t. I use exercise equipment and do sit-ups, and avoid high-impact workouts.”

For those afraid to get back in the gym because they are not certain how to get things started, Springer offers some tips.

“Keep your heart rate up, get a membership to a gym, because if you pay for it you will use it, and having a friend go with you is always good,” she suggests. “As you get older, watch what you eat, it will affect your weight and cholesterol.”

Springer also stresses the importance of making exercising a job; the reward is better health and a longer, more fulfilling life.

Today Springer lives in Southwest Roanoke and has been employed as a sales associate at Safeguard Business Solutions for the past 25 years.

—David Lint

Mary Fowler. She's gone on to lose nearly 10 more pounds since we last checked in.

Wellness Volunteer Update: Mary Fowler is Still On Track

Last time we checked in with Mary Fowler in our July/August issue of the Wellness Series, she’d lowered her cholesterol, blood pressure and lost five-and-a-half pounds. Fowler achieved her results with help from Beth Anderson, a registered dietician with The Nutrition Resource.

Fowler took Anderson’s lessons regarding watching portion sizes and getting enough daily activity to heart. She has lost another 9.5 pounds and is fitting into her clothing more easily. As cold weather arrived, she donned a pair of pants from last winter expecting them to be tight but found the opposite.

“It used to be that when I put my jeans on [after the summer] I thought someone had come into my house and washed them with hot water and dried them on high heat because they were tight,” Fowler says. “It was nice this time to put them on and have them zip up without a hitch.”

Swimming and walking are still Fowler’s exercises of choice to help in her mission to improve her fitness and overall health.

“I have continued to walk more each month,” she says. “The first time I went walking, it was hard on my knees, but after the summer and the swimming, the walking has gotten a little easier.”

—AC

Peggy Overstreet. Her success with Jenny Craig includes a loss of 24 pounds.

Wellness Volunteer Update: Peggy Overstreet
Reaches Her Goal Weight With Jenny Craig

When we last checked in with Peggy Overstreet in our July/August issue, she had lost more than 24 pounds and 17 inches through the Jenny Craig diet.

Her success continues, and as this issue goes to press in October, Overstreet has reached her goal weight by continuing to lose 7.6 more pounds for a total of 32 (43 if you count the nine pounds we recently learned she had already dropped before we even signed her up as a wellness series volunteer!)

Better still is the fact that Overstreet is no longer dependent on the Jenny Craig food alone to keep herself in tip top shape.

“I’m pretty much on my own now,” she says. “When I do [eat the Jenny Craig food], it’s more for convenience.”

Overstreet, who has continued to exercise every day throughout her weight-loss program, has made it look easy every step of the way and says keeping the weight off has not been as difficult as she expected.

“It’s been a little easier than I thought in the maintenance stage,” she says. “I was concerned once I leveled off it would be hard to maintain. I think the key there is the exercise.”
She says she is now enjoying her new body, and she doesn’t mind spending some extra money to treat herself for her success.

“I am trying to buy new clothes,” she says. “I have a trip planned with a girlfriend to go shopping.”

—JKW

Click to Lose: Links to Weight Loss

A basic search of the World Wide Web will yield over a million results for “weight loss.” Here are a handful of websites to get you on your way:

• The non-profit group Calorie Control Council offers free information regarding calorie content of everyday foods, a printable food diary and exercise and BMI calculators. www.caloriecontrol.org.

• The publishers of the book “The CalorieKing Calorie, Fat & Carbohydrate Counter 2006 Edition,” offer online information at www.calorieking.com. Free information includes a large searchable database of nutritional information on food, articles and recipes. Enhanced features such as menu plans, online diary and weight tracking are available for a fee.

• The Mayo Clinic provides free information on their website regarding weight loss with a calorie calculator and articles with basic advice on exercise, portion control and more. Visit www.mayoclinic.com, select “healthy living” on their homepage and then
“weight loss.”

• The free government website, www.mypyramid.com offers a customizable version of the food pyramid. You enter your age, gender and level of daily activity to get basic recommendations on how much of your daily intake of food should come from each of the food groups.

• On www.fitday.com, you can create a free account that allows you to track calorie intake, exercise, set goals and see nutritional information on
your foods.

• At www.nutradiary.com, a free online diary helps you track meals, set goals and view your progress over time. They also post links to articles about weight loss and fitness.

These are just a few of the thousands of websites that can help in your battle of the bulge. Just remember to check with your doctor before setting out on a low calorie diet or extreme exercise routine to make sure you’re good to go.

—AC

Janette Saviano's target area is measured by Dr. Greg Alouf before her mesotherapy procedure. PHOTO BY ANDREA CLARK

Janette Saviano, a petite 35-year-old, could exercise and never lose the little pooch below her belly button. She wanted something that would take off a few stubborn extra pounds in that area, so she decided mesotherapy was worth a try since the treatment is often used for spot reduction.

Mesotherapy was developed in France in 1952 and is said to be an alternative to liposuction. The procedure involves hundreds of injections with a tiny needle and a cocktail that is injected into the middle layer of the skin enabling patients to lose weight by excreting fat in waste. The cocktail Saviano received at Dr. Greg Alouf’s office of Alouf Aesthetics was designed to help her lose weight five times faster.

Alouf says the procedure can be used to treat cellulite, burn fat and even as a treatment for skin pain. Mesotherapy can even be used on the face. The facial procedure, called mesoglow, uses the same idea and injects what Alouf calls a “vitamin cocktail” which plumps up and heals the skin while also helping to regain elasticity lost with age.

Saviano wants to lose a few stubborn pounds on her lower abdomen, just below her belly button. PHOTO BY ANDREA CLARK

Alouf’s office uses a very precise way of injecting the cocktail during mesotherapy, he says. When training for the mesotherapy in Ft. Lauderdale and Miami, he had the procedure done with the gun tool and by hand on his own body to test it out. The outcome, he says, was obvious. “The gun was less painful.”

Although it may sound scary, the mesotherapy gun has never scared any patients, Alouf says. Alouf’s top-of-the-line model cost around $4,500, and patients, he says, are impressed with the technology.

“When I use the gun, it increases my accuracy,” he says.

Alouf uses this type of gun to perform the injections on Saviano’s target area, her lower abdomen. The gun works like a nail gun, except with a needle, Saviano says, adding that the procedure was a little painful for her.

“He had to tell me funny stories to distract me,” says Saviano. Ice was used to numb the area before the injections, and Saviano said the procedure was bearable.

With the procedure, Alouf offers a complimentary treatment using a Triactive Cellulite Laser which would normally cost $150, but with mesotherapy, it’s free. Saviano’s favorite part of the treatment is this special massage.

“It feels like a real massage,” she says.

After the area is numbed with ice, Alouf uses a mesotherapy gun to perform the injections. PHOTO BY ANDREA CLARK

The massage on her belly is designed to help her excrete the fat she wants to lose. The Italian laser is said to reduce 27 percent of cellulite.

Although warned about the bruising after the procedure, the soreness took Saviano a little by surprise.

“I didn’t expect to have this much,” she says. “I’m so puffed up I can’t even touch my belly,” she said soon after her mesotherapy. Her first treatment was Aug. 22 and three weeks later in September, she’s still a little sensitive to the touch.

But, there’s no gain without a little pain, and Saviano has lost five pounds since the first treatment. She admits her eating habits haven’t exactly been helpful and has discontinued the procedure at this time until she decides to change those eating habits.

“I was just spinning the wheels overeating and then going for the meso,” Saviano says. But, even without healthy eating habits and exercise, her size 7 pants have still become a little looser.

Three moles were gone in less than three minutes. It took one treatment to remove Tuesday Moriarty’s three moles on her face using an Erbium Laser by Dr. Greg Alouf of Alouf Aesthetics.

Tuesday Moriarty wanted to get rid of three prominent moles on her face. PHOTO BY ANDREA CLARK

This laser is “such a precise tool,” Alouf says. The laser targets water and basically burns off the tissue, he says. “It’s so clean and precise.”

The Erbium Laser, a resurfacing laser, produces less scaring, generally speaking, than the CO2 laser, according to Alouf. “This is another type of laser that not many people have,” he says.
Dr. Greg Alouf uses the Erbium Laser to take off the moles. This laser targets water, essentially burning off the mole in a precise way.

Dr. Greg Alouf uses the Erbium Laser to take off the moles. This laser targets water, essentially burning off the mole in a precise way. PHOTO BY ANDREA CLARK

Alouf describes the way he cuts the moles on Moriarty’s face slightly below the surface of the skin to a pond, which will fill up over time, making it level. Moriarty’s face, with the tiny indented area where the mole once was, will fill up, just like a pond, producing even skin and not a raised area or bump.

“He cuts them deep, to even up,” says Moriarty.

Like an artist, Alouf can “artistically carve off the mole after the numbing,” he says.

And after the numbing, Moriarty says, “The procedure was not anywhere near intolerable. [It] stung a little, but really wasn’t that bad.” It took less than a minute for each mole to be removed.

After Shot. The remains of the three moles have almost completely vanished from Moriarty's face. PHOTO BY MIKEL CHAVERS

Moriarty’s face has healed, although not to 100 percent, she says adding there’s a little bit of an indention still. The healing really started to accelerate, however, when Moriarty quit smoking. After four days without cigarettes, her face has started to look even better, she says.

Moriarty discovered that smoking can really affect your healing time after experience with another procedure in which the doctor told her to stop smoking. “Not smoking makes that much of a difference,” she says.

Before: Hidden tooth crouching canine. Photo: Virginia Watson

I’ve got an entirely new smile as I write this. Just a few short months ago I had teeth that made me feel self-conscious when I smiled, laughed or talked. However, I stubbornly refused orthodontics for years. I know that braces are a wonderful solution for many people and have evolved from the heavy mouth metal and headgear. I’m far too impatient for what seemed to be minuscule changes that occur over the span of a year or so.

Enter Dr. Robert Branham and his plan. As we reported in the May/June issue, I had a lot of work done that culminated in the placement of temporary veneers and bridges, which instantly improved my smile.

Since then my gums healed to Dr. Branham’s satisfaction. We made an appointment to replace the temporaries with the permanent porcelain, but truth-be-told, I wasn’t in any big hurry to change anything. The temporaries were such a large improvement over my old, oddly spaced teeth that I felt pretty good about leaving things as they were. The compliments alone had me beaming like crazy at everyone and anyone.

After: Andrea Clark says she could not be more pleased and feels free to smile big and often.Photo: Douglas Miller

But eventually, I forfeited the temporaries I’d come to love, and sat in Dr. Branham’s chair. He and his patient assistant, Lisa Lane, carefully prepped and placed the final dental beauties in my mouth. They removed the temporaries and any remaining bonding material, placed the new materials without bonding them and handed me a mirror so I could see the new pearly whites before they were cemented to my teeth forever.

I was stunned that the new ones looked even brighter and more realistic than the attractive transitory teeth. With my seal of approval they carefully set upon

marrying my old teeth to my new porcelain whites. Nearly four hours later my bite had been adjusted to the point it felt better than it had since the trouble with my teeth began 14 years ago, and I had new, whiter teeth – permanently.

The texture of the porcelain was almost as amazing to me as the new look. I kept running my tongue over the veneers, marveling in how much they felt like smooth, just-dentist-cleaned teeth.

Dr. B & Andrea C. Dr. Branham's gentle, kind way kept this patient calm and happy throughout the entire treatment process. Photo: Karen Patterson

While I’ve basked happily in the compliments and loved new slick texture of the teeth, I am most changed by the fact that I can laugh heartily without covering my mouth or forcing my lips together before smiling for a photograph. I feel better about myself and I guess that’s the real point of all of the cosmetic procedures – not the just restoration of appearance but of self-confidence.

Contact: Dr. Branham – 774-0061
Cost: $8,000-$9,000