UVA Health System Blog

Stories about the patients, staff and services of UVA


Podcast Tuesday: Minimally Invasive Heart Valve Surgery [AUDIO]

On November 25, 2014 | At 10:21 am

Filed under : Heart,Podcast Tuesday,Surgery | By
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Lung Cancer in Women: Time to Face the Facts and Get Screened

On November 24, 2014 | At 10:30 am

Which cancer do you think kills the most women? Chances are, you guessed breast cancer. Incorrect! Believe it or not, lung cancer is the leading cause of cancer death among women. In a recent study by the American Lung Association to measure awareness of lung cancer risk, only 1 percent of women surveyed selected lung, compared to 87 percent who selected breast.

Lung cancer surpasses pancreatic, ovarian and other types of aggressive cancer as the leading cause of cancer deaths in both women and men. Although smoking is a major risk factor of the disease, approximately 20 percent of patients diagnosed with lung cancer have never smoked. Of this 20 percent, most are women.

Richard Hall, MD, UVA Cancer Center

Richard Hall, MD is a medical oncologist at UVA Cancer Center who specializes in lung cancer.

“When looking at lung cancer across the board in the United States, the number of patients who are diagnosed with the disease is almost the same in both men and women. However, when I look at my practice and consider patients who were never smokers, almost all of my patients happen to be female,” says UVA medical oncologist Richard Hall, MD.

The Myth of the Smoker’s Disease

Hall adds that in other parts of the world, the majority of women who develop lung cancer never smoked. That’s especially true in East Asian countries such as:

  • Japan
  • South Korea
  • China
  • Taiwan

Lung Cancer: The Leading Cause of Cancer Deaths

Because the incidence of lung cancer in non-smoking women is higher than in non-smoking men, organizations such as the American Lung Association (ALA) are trying to raise women’s awareness of the disease. The ALA surveyed 1,000 women to measure awareness, knowledge and perceptions about lung cancer and found:

  • Only 1 percent selected lung cancer as a leading cause of cancer death among women, compared to 87 percent who selected breast cancer.
  • Only 1 in 5 women knew that less than half of all women diagnosed with lung cancer would live a full year after diagnosis.

Lung cancer has one of the lowest 5-year survival rates of all cancers, with only 18 percent of patients surviving at least 5 years, as reported by the ALA.

According to Hall, women who have never picked up a cigarette are shocked upon diagnosis of lung cancer. “Naturally it raises questions of other environmental exposures that contribute to their diagnosis, and unfortunately, there is still a lot we don’t yet understand.”

The first step to improving the statistics surrounding lung cancer is educating the public about the disease. Although we have a lot to learn about what causes lung cancer, there are critical steps you can take to prevent the disease: Quit smoking and get screened.

Quit smoking

Quitting smoking is the #1 way to reduce your chances of developing cancer.

Smoking cessation is the single most important thing someone can do to reduce their risk of developing lung cancer. It also helps them save money. Screening is the second most important action to take, especially for patients with a history of smoking,” says Hall.

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) approved CT screening for patients who qualify based on age and smoking history. The United States Preventative Services Task Force recommended the CMS approve lung screening after the results of the National Lung Screening Trial showed that people who underwent CT chest screening lived longer than those who underwent annual chest x-rays.

UVA offers a comprehensive Low-Dose CT Lung Screening Program and encourages those at high-risk to get screened.

Treating Lung Cancer

Without screening, lung cancer is generally diagnosed at later stages, making it more difficult to treat.

However, certain lung cancers can be treated by targeting the genetic changes in lung tumors, stopping the growth and survival signals of cancer cells at the molecular level.

While UVA provides these treatments, Hall and his team are also conducting clinical trials to identify additional therapies for patients at all stages of disease.

If you…

  • Are concerned about lung cancer symptoms
  • Are high risk and would like to be screened
  • Want a consultation with the lung cancer team at the UVA Cancer Center

Call 434.924.4246 to make an appointment.

Related Podcast: Lung Cancer: Myths vs. Facts

Filed under : Cancer,Pulmonary,Women's Health | By
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Winter Vim & Vigor: Sanjay Gupta, Stopping Seizures

On November 21, 2014 | At 10:47 am

Are your stomachaches acid reflux or could they be symptoms of celiac disease or gluten sensitivity? This winter’s issue of our family health magazine, Vim & Vigor, is all about food and nutrition. Sanjay Gupta shares five reasons why food is the best medicine.

Drew Thomas gets dialysis for chronic kidney disease.

Health System accountant Drew Thomas lives with chronic kidney disease. Read his story in Vim & Vigor.

Also, we’ve got stories about:

  • A woman who went to law school after surgery eliminated her devastating epileptic seizures
  • A West Virginia resident whose fatigue led to a referral to the UVA Heart & Vascular Center, where he found treatment for chronic total occlusion and coronary artery disease
  • A UVA clinical trial that uses non-invasive focused ultrasound to destroy painful uterine fibroids
  • Who should be screened for lung cancer and what this procedure involves

Read the Winter Vim & Vigor.


Why Would I Want to Go to Teaching Hospital? AMC Myths Dispelled

On November 19, 2014 | At 9:10 am

An interview with Dr. Susan Kirk, co-director of UVA’s High Risk Medical Obstetrical Clinic and Associate Dean for Graduate Medical Education.

Many Virginians have to travel long distances to access medical care, but I am fortunate to live in a town with two hospitals. One is a community hospital and the other is an academic medical center (AMC). I sometimes hear people ask questions about the differences between the way the two operate, wondering if each offers equal care. I’ve heard people express hesitation about what they perceive to be the inconveniences of a teaching hospital — things like, “I don’t want to be practiced on by students!”

Susan Kirk, MD, has written about the important role AMCs play in our healthcare system.

uva hospital

In an effort to get to the facts about an AMC, I asked Kirk some questions of my own.

Myth #1: It’s not a big deal that we have an AMC here in Charlottesville. Aren’t they everywhere?

Actually, no. There are only about 400 teaching hospitals in the country, making up only six percent of all hospitals. The number of major academic medical center is even less, around 120.

We are very lucky here in Charlottesville to have one.

Myth #2: UVA is “rich”; it has a lot of money, more than a regular hospital.

When it comes to money, an AMC may receive different types of funding that, added together, may seem like a lot. But it’s important to know that AMCs, often considered “safety-net hospitals,” receive funds to care for the poor, the uninsured and underinsured. Unlike other hospitals, AMCs:

  • Take patients without insurance that other places may turn away
  • See patients on Medicaid and Medicare
  • Spend a lot of money training residents
  • Need money for research

Myth #3: If I go to a teaching hospital, doctors and students will experiment on me for training purposes.

It is false to believe any experimentation occurs at a teaching hospital. Compared to a community hospital, Kirk says, “The medical care and surgeries are the same. We might be more cutting edge, but our patients receive treatments that are tried and true, not experimental. We do offer many opportunities for any person who wishes to participate in a clinical trial, where the newest treatments are investigated, but this is strictly voluntary.”

And according to safety data, teaching hospitals have better quality scores than nonteaching hospitals.

Who Sees You at a Teaching Hospital?

A few definitions:

Attending doctor
Part of the faculty, has completed all training and is board-certified.

Has graduated from medical school, is licensed, but hasn’t completed the hands-on training, called a residency, needed to become an MD.

Has completed basic residency training, but needs subspecialty training to become board-certified in a specialty area.

Medical Students
Not yet graduated from medical school, these students spend most of their time as observers or learning how to take a basic history or perform a physical exam.

Myth #4: Getting taken care of by residents and students means I’ll get sub-par treatment.

Kirk believes the opposite, that being a role model and teacher to medical students holds her to a higher standard of performance.

“I would say that one of the real joys and benefits about being around learners is that they’re always asking questions, so they force you to stay on top of the latest developments in medicine. You have to self-educate constantly,” she says.

“People ARE learning on the job — that part is true. But unless we don’t want to have any physicians in twenty years, there will always be the need for training sites.” For Kirk, it is an honor to hold the role of an educator and help mold her students. “You want the next generation of doctors to not only be skilled at providing care but to learn how to deliver care that is compassionate and professional as well.”

Myth #5: A doctor who is also a teacher has less time for me, the patient.

For Kirk, teaching takes time on her end, not for the patient. Students come to her with a spectrum of experience. She explains, “With the newest or least-experienced learners, it’s more time-consuming, allowing them to go through the motions themselves, and then going through it with them. But once you can trust them to do things right, they make you more efficient; they’re an extra pair of hands.”

And for patients, doctors-in-training can actually translate to more time and attention about their health. “Rather than the high volume, too-busy private practice doctor, our patients get more time to talk with a resident, delivering a more enriched experience for them.”

Myth #6: Going to a teaching hospital means I’ll have no privacy.  

Kirk finds this concern rare. “Most patients take pride in helping to educate the next generation of doctors. I always encourage patients to allow residents to work with them, because that is our mission. But speaking for myself, if someone were very uncomfortable being seen by a learner, I would honor that.”

Myth #7: Why should I care whether or not my hospital conducts research?

Here are three reasons to care:

  • It helps the doctors and staff to be better educated about newly available treatments for your condition.
  • You could be in a study that benefits you personally and contributes to the discovery of a cure.
  • Knowing your hospital is trying to improve the health of our country is a very positive thing. We’re not just in it to make a buck but to improve the health of people in general.

Myth #8: No one chooses an AMC over a community hospital for standard care.

On the contrary, many patients prefer an AMC for primary and standard care, knowing that “the full breadth of services are available” if and when specialty services are needed. “We have everything from molecular genetics to specialists in thyroid disease,” Kirk adds. “An AMC attracts people who have a very highly specialized piece of knowledge that might not necessarily seen in a community hospital, although we also have some of the best primary care physicians in the commonwealth.” And for some people, having access to the latest and the best means they don’t have to worry that they are missing out on something.

Your Turn

Do you have concerns or questions about academic medical centers?

Let us know in the comments below and we’ll find the answers.

Filed under : Primary Care | By
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Podcast Tuesday: Enterovirus in Children [AUDIO]

On November 18, 2014 | At 8:57 am


Copperhead Bites: “It’s Been Pretty Busy”

On November 14, 2014 | At 9:30 am

I have never seen a copperhead near my house in Albemarle County, but it seems I’ve just been unlucky. (I like snakes.) In September, many of my friends were reporting sightings of this distinctive-looking venomous snake.

copperhead snake

This copperhead was spotted on the Rivanna Trail in Charlottesville in September. Photo courtesy Bob Gibson.

Toxicologist Chris Holstege, MD, co-director of the Blue Ridge Poison Center, says this isn’t a coincidence. “It’s been pretty busy,” he says. “It was a bumper year” for copperhead bites.

This year the Center has treated 129 copperhead bites, up from 112 in 2013 and 92 in 2012.

Why? The snakes become immobile during extremely hot weather, Holstege says, and you’re less likely to encounter one. July and August were cooler than average this year, according to CBS19.

“We should be coming to an end,” he says. But be careful if you’re out on an unusually warm winter day. The Poison Center has seen bites in December.

Learn More: The Poison Center offers tips for preventing and treating snakebites.

However, in the grand scheme of things, you’re much more likely to get the flu than be bitten by a snake — and as Holstege reminded us yesterday, ticks cause a lot more problems than venomous snakes or spiders.

Filed under : Family Health and Safety | By
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Myth vs. Fact: Was That Spider Really a Brown Recluse?

On November 13, 2014 | At 8:52 am

The story flooded my Facebook feed: A house in Missouri was infested with 5,000 brown recluse spiders. More than one of my friends said they’d just burn that house down if it was theirs.

Wolf spider and brown recluse

The brown recluse (bottom) isn’t established in Virginia but is often confused with the wolf spider (top).

Brown recluses have long been a source of terror and urban legend. Mention them to a group, and chances are someone will claim to know someone who’s been bitten, maybe lost a hand or maybe even died.

I’m not immune to the hype: I scrutinize the small spiders that come into my house every fall with the same fervor as someone hoping to prove the existence of Bigfoot.

But they never appear venomous. When I tried to identify the small brown spider I saw the other day, a Google Image search revealed that it was, most likely, a wolf spider.

It turns out I was lucky I hadn’t been bitten. “They certainly hurt,” says toxicologist Christopher Holstege, MD.  He suspects some rumored brown recluse bites actually came from the wolf spider. Those bites cause a lot of pain, but they won’t lead to serious problems.

Brown Recluses in Virginia

A lot of people claim they’ve seen brown recluses in Virginia, although the spiders aren’t common here. They’re “more common in the popular press than in real life,” the Virginia Tech Department of Entomology notes. Penn State College of Agriculture says the recluse is established in 15 states; Virginia isn’t one of them.

That doesn’t mean they’re not here: They’re established in neighboring Tennessee, and they can end up in moving boxes and suitcases.

However, Holstege is the co-medical director of UVA’s Blue Ridge Poison Center, which serves a large portion of Virginia, including the southwest tip along the Tennessee border. A large chunk of the Poison Center’s calls are medication mistakes and exposure to household toxins; their doctors have never seen a brown recluse bite. Some people suspect a bite when they develop lesions, Holstege says, but the true cause is always something else.

What do we have in Virginia? Deer ticks. Virginia had 925 confirmed cases of Lyme disease in 2013. As Holstege points out, “Spiders help control the tick population.” So if he sees a spider in his house? “My kids capture it and put it outside.”

What About Black Widows?

The Poison Center does treat bites from the black widow, which is the only venomous spider established in Virginia. “For how prevalent they are, we don’t really see many bites from them, either,” Holstege says.

All about black widows: Check out our spider FAQs

The spiders’ goal is to keep themselves and their webs safe, not to bite you. Brown recluses “are called recluse for a reason,” Holstege says. If you get bitten by any spider, Holstege’s advice is to “stay calm; see how it progresses. If you start having more pain in the extremity or if you get spasms, you might want to seek medical attention. Black widow bites aren’t like snakebites, where the earlier you get the antivenin, the better. You can come in anytime.” If you’re unsure about a spider bite, you can call your local poison center at 1.800.222.1222.

Watch Out for Snakes, Too

How many copperhead bites has the Blue Ridge Poison Center seen this year? Check back tomorrow or subscribe to the blog to find out!

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7 Quick Questions: Meet Dr. Jonathan Swanson

On November 12, 2014 | At 10:00 am

Ever wonder what your doctor or health provider does outside the exam room? Our 7 Quick Questions series gives you a personal glimpse into the people of UVA.

Jonathan R. Swanson, MD, is the medical director for the Neonatal Intensive Care Unit and an assistant professor of pediatrics.

1. What did you want to be when you were little?

From what I remember, I wanted to be a 747 pilot, a race car driver (I thought it was safer than playing sports) and a farmer (you can’t get fired). But in the end, being a professional baseball player eventually took over all other dreams.

Dr. Jonathan Swanson

2. What’s your favorite place to travel?

Right now, my family is kind of stuck in Disney mode. However, the most beautiful places we have been include the Fjords of Norway and the Na Pali coast on the island of Kauai. I also enjoy touring the continental United States – I have a goal to visit all 50 states with five to go.

3. What’s one thing you always have in your fridge?

With three kids between the ages of two and seven, one can never have enough ketchup in the house.

4. What’s the most unhealthy thing you eat?

Donuts. Let’s just say it is a good thing that Spudnuts is not on my commute.

5. What’s the most exciting thing/research happening in your field right now?

In our NICU currently, I am very excited about how the team has come together to use our Be Safe problem-solving methodology. In particular, the team that has spearheaded our examination of unplanned extubations has done tremendous work.

Personally, I am fortunate to be working with a number of individuals outside of UVA evaluating how we diagnose and treat necrotizing enterocolitis (the death of intestinal tissue), a gastrointestinal disease that affects our smallest patients.

6. Why pediatrics?

I knew I wanted to work with kids after coaching a basketball team of 3rd and 4th grade girls as a high school senior. They definitely taught me more than I taught them. During medical school, pediatrics just felt like home, which made it an easy decision.

7. Who’s your inspiration/hero?

I have had a number of mentors along my career path, but clinically, I try to pattern my bedside manner and teaching style after Dr. Robert Boyle (recently retired). He exuded calmness in a busy intensive care unit and really instilled in me that there are many different ways of getting the desired end result. I am also inspired by so many of the families that I have come in contact with over the years. When we have patients who stay with us for several months, we really get to know the families and it is inspiring to see their growth in caring for their infant.

On a personal level, my wife continues to inspire me. She makes me a better person every day and she is the glue of our family all while juggling her own medical career.


Podcast Tuesday: Lung Cancer Myths and Facts [AUDIO]

On November 11, 2014 | At 9:40 am

Filed under : Cancer,Podcast Tuesday,Pulmonary | By
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Q&A: Helping Your Kids Stay Healthy During Flu Season

On November 10, 2014 | At 8:44 am

Ina Stephens, MD, gave us this update on the flu vaccine. She specializes in pediatric infectious diseases and sees patients at By Your Side Pediatrics and Northridge Pediatrics.

flu vaccine info

Do parents need to get the flu vaccine to help protect their child?

Yes! Parents absolutely carry viruses and unknowingly pass them along to their kids.  In fact, parents, who are adults with likely some immunity/partial immunity to many viruses, may become “infected” with a virus and have little or no symptoms (a slight runny nose for instance), pass it on to their young child who has minimal immunity, and the child can exhibit many more symptoms of the virus.

So to answer your question, absolutely yes — parents should receive their flu vaccines! It’s especially important for parents with infants under 6 months of age, as these infants are too young to receive the influenza vaccine themselves.

What about enterovirus D68 (EV-D68)? The CDC says these infections will taper off at the end of fall. Why are viruses seasonal?

The answer to this question is largely unknown. No one really knows why the enteroviruses peak in late summer/fall and then fade away. There is certainly the known entity of “viral competition,” so when another virus starts to “peak,” like the influenza virus in the winter, they compete within the host environment, and the other “summer/fall” viruses fade. But why? No one knows. One interesting fact, though: In equatorial countries, influenza occurs throughout the year, but is highest in the monsoon or rainy season.

Does the flu shot prevent or affect D68?

The influenza vaccine will not prevent enterovirus D68. However, if you get the flu, especially if you have reactive airway disease or asthma, which can be triggered by influenza, then you’ll be more susceptible to a severe enteroviral infection if you also become infected with it.

How can you tell a difference between the flu and D68? The symptoms sound similar.

Clinically, it may be difficult to tell. Both viruses usually are accompanied by fever. Enterovirus D68 usually causes mild to severe respiratory problems as well as a runny nose, sneezing, cough and body aches. Severe symptoms may include difficulty breathing, especially in those who are prone (asthmatics).

Influenza usually comes on faster and is accompanied by chills, sore throat, fatigue, headaches and body aches. The only definitive way to distinguish is by viral testing.

With so many viruses and infections running around, not to mention the Ebola scare, what steps can we take and teach our kids to help avoid infections?

Yes, many viruses running around! Vaccination against the flu is most important to prevent infection. There is no vaccine to prevent enterovirus D68 infections. However, you can protect yourself if you:

  1. Wash hands often with soap and water for 20 seconds, especially after changing diapers or using the toilet. Enterovirus is found in stool, and good hand hygiene is important for anyone.
  2. Don’t rely on hand sanitizer. It’s not effective against enteroviruses.
  3. Avoid touching your eyes, nose and mouth with unwashed hands.
  4. Use good respiratory hygiene—coughing and sneezing into a tissue or elbow and properly disposing of tissues.
  5. Avoid kissing, hugging and sharing cups or eating utensils with people who are sick.
  6. Clean and disinfect frequently touched surfaces, such as toys, doorknobs and computer keyboards, especially if someone is sick.
  7. Stay home when feeling sick and consult your doctor.
  8. Take your medicine as directed if you have asthma or other respiratory illness.
  9. Stay up to date with your immunizations, especially for the flu. This can protect against other common infections and lessen the risk of having a more severe illness if you are infected with enterovirus D68 at the same time as influenza.

What is the critical symptom for when you take your child to the doctor?

There is no “critical symptom,” but if your child has a high fever, significant cough, lethargy or any signs of respiratory distress, she should be evaluated by her doctor.

When is the best time to get it? How long does it last?

The best time to get it is late fall (October/November). The vaccine gives protection then during the likely flu season, which is usually late October until April. Sometimes doctors see cases as late as May.

Why have children died from the EV-D68 virus? What do you say to parents worried about that?

Any enterovirus can cause infection of the nervous system (i.e. meningitis, encephalitis, spinal cord inflammation, etc.).  It is a very rare infection/complication of any enterovirus, but it certainly occurs. There is no way to prevent this from occurring. If a child is experiencing neurological illness, they should be seen by their doctor.

Take a Deeper Dive: The CDC has more details for parents.

Do You or Your Kids Need a Flu Shot?

Our primary care physicians have plenty of vaccine for anyone 3 years and older.

Call us beforehand to ask about vaccine availability for patients under 3 before coming in.

Find a clinic to make an appointment