UVA Health System Blog

Stories about the patients, staff and services of UVA


Recipe Review Thursday: Gluten-Free Brownies

On September 18, 2014 | At 9:56 am

We’re trying new heart-healthy recipes and will share the results with you. All recipes are from Club Red, UVA’s heart health club for women.

Gluten-Free Brownies

Gluten-free brownies made with honey and almond butter

These gluten-free brownies still have the right texture and plenty of chocolate taste.

I have strict requirements for brownies. They need to be:

  • Dense and moist
  • Rich and chocolaty
  • Easy to make. Bonus points if I don’t have to do a lot of dishes afterward.

This recipe easily satisfied the third requirement, as it only took me 10 minutes to mix up the ingredients in one large bowl. I just used a spoon, not the suggested hand blender, to mix.

But I was skeptical when I saw the recipe didn’t use familiar ingredients like oil as well as flour, left out to make the brownies edible for people with gluten restrictions. I don’t have a medical reason to avoid gluten, and I don’t usually eat gluten-free.

I was even more skeptical when I saw, “The batter rises substantially during baking.” They didn’t sound likely to produce the texture I needed to satisfy my brownie craving.

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The batter does rise considerably; the brownies tend to fall a bit when they’re cooling. But this meant they did keep the dense, chewy texture I desired. They were moist and had the same texture and appearance as any other brownies. They weren’t quite as chocolaty as I’m used to, but every time I thought maybe they needed more chocolate, I bit into a mostly-melted chocolate chip.

I shared these with several people, one of whom has celiac disease. She loved the brownies; another friend ate about five in one sitting.

I’m not sure I’ll make these again unless I need a gluten-free option. They’re more expensive than traditional brownie recipes (the almond butter will set you back at least $7). If you can eat gluten, these aren’t much healthier than traditional brownies; they might have more protein per serving, but they also have more calories. But the taste and texture are almost indistinguishable, and they were a hit amongst my friends. This is worth adding to your gluten-free recipe library.

Stars: 4 out of 5

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Podcast Tuesday: How to Determine the Best Knee Replacement Option [AUDIO]

On September 16, 2014 | At 9:30 am

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The Charlottesville Women’s Four Miler: More than Just Another Race

On September 12, 2014 | At 9:52 am

The words glared from my computer monitor, mocking me: “This week should be EASY. Your training for the Four Miler is complete.”

The 2014 Women's Four Miler, a breast cancer fundraiser in Charlottesville, VA

With my mom after the 2014 Charlottesville Women’s Four Miler

The well-intended advice from the UVA Runner’s Clinic, emailed two days before the Charlottesville Women’s Four Miler, was a painful reminder that I hadn’t exactly started my training — at least not the way I had envisioned it. My runs this summer were few and far between, and I had never actually reached the four-mile mark. I also hadn’t gotten up to the 10-minute miles I’d envisioned.

I’m close to at least two breast cancer survivors. One has battled various types of cancer 10 times. Cancer, in its many forms, has taken more of my loved ones than any other diseases combined. I wanted to run the Four Miler to raise money for breast cancer research at UVA, my employer. But I’d be lying if I said I didn’t care about how fast I ran the race.

I even shut out my own mom. We walked the Four Miler together two years ago. I told her we could both do the race, but she’d have to walk by herself.

Why We Really Run

I had knots in my stomach as I bid my mom farewell and joined a pace group of other runners expecting to do 10-minute miles. I re-tied my shoes twice and walked toward the starting line, a little sad as I looked at all the families running together: moms, daughters, sisters, aunts, some bearing the names of loved ones who had won or lost their breast cancer battles. But I focused more on my pace once we started running.

Mile One: Hey, this is pretty easy.

Mile Two: I’m not making the pace I wanted to. I need to pass more people. Hey, look, there’s my mom on the other side of the road!

Mile Three: Wow, this hill is hard.

Then I began seeing the Motivational Mile posters, which are along the last mile of the course and display the names of people affected by cancer. I recognized easily a dozen of the names. A few were acquaintances who I didn’t know were cancer survivors.

It was a much-needed reminder that yes, this race, like any other, is about fitness and personal goals. But the real reason we race is for the women who can’t. 3,500 women get up early to participate in the race because, together, they raised $370,000 for the UVA Breast Care Program last year. My mom and I are far from being top fundraisers, but in our own small way, we’ll be a part of that big dollar amount this year.

After I finished, I stood by the finish line and cheered for friends and colleagues as they finished, and finally, my mom, who finished her walk in almost exactly an hour. My time wasn’t the personal record I’d hoped for, but I didn’t really care anymore. I ran the four miles, longer than I’d ever ran before. More importantly, I was a small part of a big effort to win the battle against breast care.

Donate to the Cause

The Women’s Four Miler is accepting donations until September 22 and hopes to raise $400,000 for the Breast Care Program. So far, they’ve raised 70 percent of their goal. Help them get to $400,000.


Podcast Tuesday: Preventing and Treating PCOS [AUDIO]

On September 9, 2014 | At 10:45 am


Monthly Roundup: August 2014

On September 8, 2014 | At 11:23 am

From the nationwide spread of the Ice Bucket Challenge to the heartbreak of Robin Williams’ death, we featured some hard-hitting stories this past month.

UVA Department of Neurology ALS Ice Bucket Challenge

UVA neurologists take the ALS Ice Bucket Challenge.

UVA In the News

Stories that made the news this month:


Podcast Tuesday: Brain Tumor Symptoms But No Tumor [AUDIO]

On September 2, 2014 | At 10:16 am

Lynchburg resident Devon Hendricks missed two weeks of work as she struggled to find a diagnosis for her headaches and vision loss. Read her story.

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‘A Terrible Disease’: Why We’re Taking the ALS Ice Bucket Challenge [VIDEO]

On August 27, 2014 | At 10:24 am

My dad doesn’t know the difference between texting and tweeting. So when I told him I had just taken the ALS Ice Bucket Challenge, I expected I’d have to explain just what that was. Instead he said, “Oh, that’s really cool!”

UVA Department of Neurology takes the ALS ice bucket challenge.

UVA neurologists take the ALS Ice Bucket Challenge.

That’s when I knew this thing was everywhere.

What is ALS?

As many as 30,000 Americans have ALS (also known as Lou Gehrig’s disease) right now, according to the ALS Association, but neurologist Ted Burns, MD, works with patients who didn’t know what ALS was until they were diagnosed with it.

“It’s a terrible disease,” he says.

Essentially, ALS causes the neurons that control muscle activity to degenerate and die, so they can no longer signal the muscles. The onset of muscle weakness can begin just about anywhere. Patients may initially develop weakness in the arms, legs and neck, and eventually they lose their ability to speak, swallow and breathe. Others first note trouble speaking, swallowing or breathing.

They may die within 3-5 years of developing symptoms, although Burns has patients who have had it for 20 years or longer. Why some people deteriorate faster than others is one of the many unknowns of ALS.

Where the Money Goes for ALS

There is no cure for ALS, and the one FDA-approved treatment, a drug called riluzole, only slows progression by a few months on average. Donations to the ALS Assocation fund clinical trials to find better treatments and a cure.

Researchers and doctors are also working to understand why some patients develop ALS when they have no clear genetic predisposition and what exactly ALS does to motor neurons and the cells around them.

“The money will be put to good use, but we need to keep raising money,” Burns says.

At UVA, researchers are looking at the quality of life of patients and collaborating with other ALS centers to share important clinical data to better understand the disease.

ALS Care in Charlottesville

UVA’s Richard R. Dart ALS Clinic offers physical, occupational and speech therapy, along with support from a team that also includes neurologists, nurse coordinators, social workers and nutritionists.

The clinic has about 90 patients, and Burns says the group of employees has been consistent over the last 10 to 15 years. “Very dedicated, experienced care providers,” he says.  

Watch UVA Employees Take the Ice Bucket Challenge

We’ll add more videos as more employees take the challenge. Check back or follow us on Twitter to see them!

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Podcast Tuesday: When to Consider a Hip Replacement [AUDIO]

On August 26, 2014 | At 10:09 am

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Podcast Tuesday: Treating External Iliac Arteriopathy in Avid Bicyclists [AUDIO]

On August 19, 2014 | At 10:29 am

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Q&A: Robin Williams and What You Should Know About Depression and Suicide

On August 18, 2014 | At 10:35 am

The sudden death of actor Robin Williams has put mental illness and Parkinson’s disease in the spotlight. Kim Penberthy, PhD, works with patients who have severe depression and talks about the stigmas, myths and what you can do to help.

Kim Penberthy, PhD, answers FAQs about depression and bipolar disorder after the death of Robin Williams.

Kim Penberthy, PhD

Are there any common myths about depression and suicide you want to address?

I think that the biggest myth may be that depression and suicide are indicators of immorality and weakness in a person. Depression is an illness. People who suffer from mental illness may be drawn to suicide because they feel that they have no other option to deal with the pain and suffering of severe chronic depression.

Does depression always have a physical cause, such as a chemical imbalance?

Depression and bipolar do seem to run in families, and there does seem to be a genetic component to many mental illnesses. But even when you find a genetic component, it still only accounts for a very small percentage of the likelihood of developing the disorder.

We are all also impacted by environmental factors, which include your development history or the way you were raised, the culture in which you live, and your current environment. In my field, we assume it’s a combination of biological, psychological and social factors.

Not being Robin Williams’ doctor, it’s hard to say what happened. I will say he is part of a demographic that is increasingly attempting and completing suicide — white middle-aged men. It used to be the highest rates of suicide occurred in the elderly and teenagers, but that has changed recently and we don’t really know why. There might be something unique about the stress of being a white middle-aged male in our society at this time that is driving that rate to increase.

Men are more likely to commit suicide than women. The data indicate that for every women who kills herself, 3.6 men commit suicide. Men also use more lethal means, like hanging themselves or shooting themselves.

Robin Williams made us laugh, so it’s easy to assume he was a happy person. But people often make jokes to avoid discussing serious topics. Is there a link between this and depression?

Yes, some people use humor to avoid discussing, but it’s hard to make generalized statements about depressed people using humor to cope with or avoid dealing with their depression. For example, many of the severely depressed individuals that I treat are so lethargic and sad that they have no energy or interest in making jokes. They may be barely able get out of bed and get dressed, so they certainly don’t have the energy to make a joke.

I think it really depends on the severity of the depression that we’re talking about. But I think we also have to realize that actors are acting a lot of their lives. He was a very talented actor, and I don’t think any of us have a full understanding of his private life.

What are some of the treatments for depression and bipolar disorder?

There is a difference diagnostically between chronic and episodic depressive disorders. It sounds like from what I read that Robin Williams may have had a chronic illness, and these kind of persistent disorders respond best to treatments designed specifically for them.

Cognitive Behavioral Therapy (CBT) and antidepressant medications and/or mood stabilizers are typically the most common and most effective treatment for depression and bipolar disorders and can be very effective in alleviating symptoms in these disorders.  We have found, however that chronic or persistent depression may require an augmented treatment approach.

Something called Cognitive Behavioral Analysis System of Psychotherapy or CBASP is the only proven effective psychotherapy treatment for chronic or persistent depression when combined with effective antidepressant medications. A challenge is that many of these very sophisticated treatments that take a lot of training to learn are not available to many people, and we need to change that.

Patients often need to be on medication and therapy, and some research does show that both are more effective combined than alone.

What can you do to help a friend or family member? How should you react if the person blows it off with a joke or seems to snap out of it?

Sometimes it really helps to let the person know they have people in their life who care about them, but often with persistently depressed individuals, they may not believe this or acknowledge it. If a loved one is suffering from depression or bipolar disorder and has not been seen for treatment, I would recommend talking with them in a supportive and loving way about getting treatment. I recommend you ask them, if they really feel like they don’t want to get treatment for themselves, could they do it for the people they love.

If someone is actively suicidal, you need to call 911.

Why is there a stigma around mental illness?

I really don’t know. That’s a really good question. I used to think it was because mental illness is not always physically visible in the person who has it  — it is more evident in our moods and thoughts — and it seems somehow different than other diseases and illnesses such as diabetes or cancer. Because of this, there may be a sense that we can control it and because of this we may think if a person is sad and cannot snap out of it they are weak or not trying. We equate it with our own emotions: ”I remember when I was sad that my cat died, and I got over it, so why can’t you get over this?”

If anything good comes out of it this tragic event, it may be an increased awareness that this could happen to anyone. Anyone can be depressed or bipolar, just like anyone can have diabetes or cancer. It’s got nothing to do with your morality or character. I hope additional conversations continue about implementation of early detection, assessment and effective treatments for depression, bipolar illness, and other mental disorders.

What are some of the warning signs of suicide?

The warning signs can be variable or non-existent. Obviously, people suffering from depression and bipolar disorder are at higher risk, and people who endorse wanting to kill themselves are at very high risk. Some people will let you know that they are feeling overwhelmed and thinking of killing themselves while others may go about discussing it in non-direct ways like saying, “I can’t go on like this.” Often, people may make plans for their death by suicide, such as giving items away or planning for their pets to be cared for.  So when you see someone preparing to not be there, when they’re not going on vacation or going on a trip, that can be a warning sign.

Additionally, anyone using drugs or alcohol, may be at increased risk for suicide due to the disinhibiting qualities of such substances.

Often increased hopelessness is associated with increased risk of suicidality.  It is thought that this may happen because the depressed individual does not see any possibility of change. The pain is too bad, the pain is too intense, and they don’t have any hope of change – they can see no other way out

When pain from the depression is intense and hope is low or nonexistent, that’s when depressed individuals may be at highest risk for suicide.

What about someone who has just experienced a tragedy like the death of a child? Is that person more likely to become suicidal?

My understanding is that this may not be a common factor in increasing the likelihood of suicide. Suicide is usually associated with a severe mental illness, something like bipolar disorder or depression, but certainly may be exacerbated by situations in the person’s environment.

How can you help a friend or family member who has lost someone to suicide?

Listening and being there for that person are going to be the most important things you can do. If you think they’re suffering so much that they need treatment, you may wish to gently suggest such. It may be an overwhelming, confusing time for a person who has lost a loved one to suicide and often the people who remain are experiencing a wide range of emotions. They may be angry, confused, they may be frustrated — deeply hurt and sad. That’s OK, don’t take it personally, just be there for them.

If you or a loved one is having symptoms of depression, start by talking to your primary care doctor. Don’t have a PCP? Find one and make an appointment online.

If you think someone may be suicidal, contact the National Suicide Prevention Lifeline at 1.800.273.TALK (8255).

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