UVA Health System Blog

Stories about the patients, staff and services of UVA


Babies, The Heimlich and Celiac Disease: January 2015 Roundup [VIDEO]

On February 6, 2015 | At 9:21 am
Lentils are a gluten-free alternative for people with celiac disease.

Have celiac disease? Lentils are gluten-free and add texture and protein to your meals.

These three things don’t sound related, but we wrote about all of them in January 2015, and then some.

For celiac disease sufferers, avoiding gluten is essential. One writer shared her personal story, tips for managing celiac disease and why most people shouldn’t eliminate gluten.

Kenneth Liu, MD, decided to become a neurosurgeon after watching a PBS show when he was eight — and he loves his job. He answered our 7 Quick Questions.

Did you know physical and occupational therapy is a major part of our Neonatal Intensive Care Unit? Meet two therapists who work with premature babies.

One of our nurse practitioners performed the Heimlich maneuver on a man who was choking. Read her story and learn how to perform this lifesaving technique.

We spent Martin Luther King, Jr. Day discussing diversity in healthcare and teaching local students about careers in medicine. View the photos from our events.

Finally, we continued our weekly podcasts:

The Health System in Charlottesville News

Becker’s Hospital Review named the Medical Center to its list of “100 hospitals with great women’s health programs.”

Quitting smoking is extremely difficult, even after a cancer diagnosis. Cancer Center employee Lindsay Hauser helps cancer patients give up cigarettes for good.

Thanks to a holiday book drive, the Ronald McDonald House is getting 10,000 new books. The house provides lodging for families while their kids get treatment at the Children’s Hospital.

George Hoke, MD, explained what a hospitalist is and why he loves his job.

Brad Haws, CEO of the UVA Physicians Group, lost 120 pounds by changing his diet and exercise habits. He and other locals and doctors share tips for living healthy at any age.


Healthy Holiday Tips and More: December Roundup [VIDEO]

On January 2, 2015 | At 9:47 am

In December the blog featured posts about the holiday season with healthy tips, recipes and more. We hope you had a wonderful holiday season, and we wish you a very happy and healthy 2015!

Our healthy holiday tips featured many delicious recipes that were both healthy and satisfying and can be used throughout the year for parties or healthy options for your meals at home. We also included helpful tips for managing stress and arthritis.

The annual Lights of Love celebration kicked off the holiday season at UVA Children’s Hospital. Check out the video for the highlights as one of our young patients helped to light the tree!

The holidays can be a tough time if you, or a family member, are receiving treatment for cancer. UVA Cancer Center offered these 12 tips for remaining healthy and positive. UVA Cancer Center offers counseling, nutritional guidance, educational support resources and many other programs and tools for patients and caregivers year-round.

We caught up with Dr. Craig Portell who treats cancer patients at the Emily Couric Clinical Cancer Center. Find out who inspires him and the one thing that must always be stocked in his fridge.

Finally, we reviewed a heart-healthy recipe for gingerbread cookies.

The Health System In the News

Mason’s Toy Box honors the legacy of Mason Thomas by collecting and donating toys to UVA Children’s Hospital and other Virginia hospitals every year for the holidays. (Daily Progress)

Sharing your health history with family members may mean more years of holidays together. Matthew Thomas, certified genetic counselor for the UVA Cardiovascular Genetics Clinic, examines inherited versus non-inherited conditions and how to determine if you’re a candidate for genetic testing. (Daily Progress)

UVA Medical Center is partnering with engineering students from Guatemala to develop software that will help deaf children learn the English language. (Newsplex)

Researchers at the University of Virginia School of Medicine are launching a major clinical trial to determine the best medication to save people from potentially deadly seizures.

Work co-authored by University of Virginia School of Medicine researcher Wladek Minor, PhD, has been named as one of the most cited scientific papers of all time.

A federal survey ranked UVA Medical Center in the top 5 percent of hospitals nationally for its support of breastfeeding.

Chris A. Ghaemmaghami, MD, has been named chief medical officer (CMO) for the University of Virginia Medical Center after serving as the interim CMO since February.


Recipe Review Thursday: Gluten-Free Gingerbread Cookies

On December 4, 2014 | At 10:05 am

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

Gingerbread Men Cookies


A holiday staple for many households, commonly found in the shape of a house or miniature “people.” For me, making gingerbread is more of a craft. I enjoy decorating the people in various outfits or icing the house with candy-covered roofs. But eating it? Well, that’s a different story.

Although adorable and fun to make, I’m not much of a gingerbread fan. I find many recipes are either too spicy, or they’re too hard and crunchy after baking. A little bit of chew and more sweetness than spice is perfect for me.

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Main dishes

I was surprised to see applesauce as an ingredient and questioned the consistency of the finished product. I also made a slight change to the recipe and used gluten-free flour instead of regular flour. After the dough’s refrigerated chilling period, I immediately noticed a difference.

Usually, gingerbread dough is denser and easier to manipulate. Even after extending the chilling period to six hours, the gluten-free flour proved to not hold as well. I kept pouring flour onto the rolling pin and cutting board, but the dough kept sticking with no avail. Getting the cookies from the cutter to the baking sheet in one piece posed a bit of a challenge, and I was left with a few limbless gingerbread people! I have had similar experiences with other gluten-free recipes, so this may not be an issue for those using regular flour.

Naturally, I was skeptical about the taste, but they came out perfectly. They had a very sweet, almost buttery taste with a soft consistency. The applesauce was slightly noticeable, but it was a nice enhancement. I was pleasantly surprised with the outcome and of course, I enjoyed the decorating process.

Stars: 4 out of 5

Filed under : Healthy Living,Nutrition,Recipes | By
Comments : 0 |

Recipe Makeovers, De-Stressing Tips: Your Guide to Healthy and Happy Holidays [VIDEO]

On December 1, 2014 | At 10:36 am

It’s your year to host the family holiday gathering. Your sister has called twice to remind you she’s now vegan and avoiding carbohydrates. You’re not sure how to accommodate your aunt’s celiac disease. And your son’s older cousin just told him that Santa doesn’t exist.
Breathe deeply and exhale. Our holiday guide is here to help. Keep reading for tips on staying healthy this holiday season.

Avoiding Holiday Weight Gain: Recipes and Nutrition

How Much Weight Do We Really Gain Over the Holidays?

Cardiologist Brandy Patterson answers this question and offers tips for staying active [VIDEO].

Healthy Holiday Menu Swaps

Are frozen quiche appetizers or canned cranberry sauce among your staples? Dietitian Katherine Basbaum offers easy homemade swaps with less sugar, fewer calories and no unpronounceable ingredients.

Diabetic-Friendly Meals

Meals loaded with carbs, sugar and fat are especially problematic for people with diabetes. If some of your holiday guests have this disease, check out these tips for diabetic-friendly meals, such as baked sweet potatoes with cinnamon instead of marshmallows and butter.

Other Healthy Holiday Recipes


Make these in advance!

Main Dishes

Side Dishes/Vegetables


Holiday Health

Managing Holiday Stress

Financial concerns, extra obligations, family disagreements — all of these contribute to stress over the holidays. Check out these quick tips.

Fighting Arthritis Symptoms

Cold winter weather and increased activity over the holidays can lead to flare-ups of arthritis and other autoimmune diseases. Combat symptoms with these tips.

What’s Your Holiday Health Tip?

Did you re-invent your family’s favorite recipe, or do you have a tip for combating stress? Tell us in the comments below.

Filed under : Healthy Living,Recipes,Rheumatology | By
Comments :1 |

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


Recipe Review Thursday: Spinach, Roasted Red Pepper and Goat Cheese Frittata with Fresh Herbs

On November 6, 2014 | At 8:30 am

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

Spinach, Roasted Red Pepper and Goat Cheese Frittata with Fresh Herbs

Club Red Spinach, Roasted Red Pepper and Goat Cheese Frittata with Fresh HerbsI’m always on the lookout for quick and easy meals for my twin toddlers, who’ve decided they’re basically vegetarians. They love eggs and omelets, so this recipe seemed to fit the bill. This is an easy recipe to execute, though it takes a little planning ahead to roast the red peppers. You could always buy a jar of roasted red peppers if you don’t have the time to do that step yourself.

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My frittata took longer to set than the instructions call for. I left it on the stove top for about 8 minutes and broiled it about 10 minutes. I had to turn the broiler down to low halfway through so the top didn’t burn.

I was a little worried about the flavor of a dish that uses so many eggs but no salt, but it wasn’t a problem. There’s plenty of veggies and cheese in every mouthful. And the all-important toddler verdict? One of my guys loved it. He ate two servings! The other turned it down. You can’t win them all!

Stars: 5 out of 5

Toddler Stars: 1 out of 2

Filed under : Healthy Living,Heart,Recipes | By
Comments : 0 |

Virginia Film Festival: A Menu of Healthy Movies

On November 5, 2014 | At 9:00 am

As always, this year’s Virginia Film Festival, which runs November 6-9, offers a slew of movies from the edgy and new to the historical and classic, covering a diverse range of topics and interests.

Alive inside movie

Alive Inside reveals what happens when patients with dementia and Alzheimer’s disease are treated with music. Image courtesy Bond/360.

These include films with themes on health and wellness that we just couldn’t pass up. Go and watch, and come back and tell us what you thought!

Our Film Festival Picks 

Alive Inside

The story of musical interventions into the lives of people suffering from dementia and Alzheimer’s disease.

The health connection: Music as medicine!

The UVA connection: Sponsored by the UVA Health System, Carol Manning, MD, will lead a discussion after the film.

Why we like it: We love uplifting research, and the previews look delightful.

Go see it: 6:15 pm, Friday, Nov 7
See a preview of Alive Inside


Landscapes of Longevity

An investigation into what makes a “Blue Zone” — places around the world where people live longer, healthier lives.

The health connection:  Aging — we all do it. Longevity — we all want it.

The UVA connection: Directed by graduate researchers from UVA’s Department of Landscape Architecture and Urban Planning.

Why we like it: It’s encouraging to watch happy people feeling vital in their golden years, and it’s fascinating to think that where and how we live can affect our health so profoundly.

Go see it: 1:00 pm, Sunday, Nov 9
See a preview of Landscapes of Longevity


Fed Up

Childhood obesity re-examined, this film looks at this health crisis and the role played by the food industry.

The health connection: The health repercussions of obesity are startling.

The UVA connection: Executive producer Katie Couric will be on hand for a post-film discussion.

Why we like it: The preview suggests the reporting in this film will reveal connections between food and health relevant to all of us.

Go see it: 2:00 pm, Saturday, Nov 8
See a preview of Fed Up


The Wizard of Oz

This classic continues to entertain the imagination of children and adults alike.

The health connection: Don’t overlook the mind-body connection. Also, walking is a great way to stay fit, even when you’re being pursued by flying monkeys.

The UVA connection: Sponsored by UVA Children’s Hospital.

Why we like it: It’s impossible not to.

Go see it: 10:00 am, Saturday, Nov 8
See a preview of The Wizard of Oz




The Detective Work of Autoimmune Disease

On October 31, 2014 | At 8:25 am

Angela Crowley, MD, is up-front about it. Accurately diagnosing an autoimmune disease can be tricky.

UVA rheumatologist Angela Crowley finds autoimmune diseases fascinating.

UVA rheumatologist Angela Crowley, MD, finds autoimmune diseases fascinating.

“People on average see six doctors over a period of 4 years before they get a diagnosis.”

This is because, in general, autoimmune diseases tend to arrive unpredictably, disguised as other conditions, offering only confusing clues as to what they are.

Why Are Autoimmune Diseases So Mysterious?

One reason is that the list of what’s considered to be autoimmune is long and ranges from the very common to the extremely rare.

Did you know? The following are all autoimmune diseases:

  • Celiac disease
  • Diabetes type 1
  • Multiple sclerosis (MS)
  • Psoriasis
  • Inflammatory bowel disease

While very different, all these disorders have one thing in common: They occur when a person’s immune system decides to attack healthy body cells. Instead of fighting infection with antibodies, the body produces autoantibodies. The body is essentially fighting itself.

Where and how this self-attack occurs determines the disease and its symptoms. But the occurrence of these symptoms is not simple, clear or predictable. Other situations make diagnosis problematic:

Asymptomatic or Delayed Symptoms. You can have osteoporosis, for example, and have no symptoms at all — only getting diagnosed after a bone fracture. Or with ankylosing spondylitis, the average diagnosis timeframe is 10 years — about how long it takes for the condition to be visible on an X-ray.

Common symptoms. Or you could have severe joint pain as a result of any number of autoimmune diseases, but lack any other symptoms to help doctors determine exactly which one you have. Vasculitis, for instance, is systemic, which means, along with causing inflammation of blood vessels, it can cause pain anywhere and everywhere in your body.

Co-Conditions. Your celiac disease or Grave’s disease could lead to or just show up with rheumatoid arthritis; having both means one condition can mask the other.

Misconceptions. You might be in pain and avoid seeing a doctor. “People ignore their pain, thinking they are too young to have arthritis, which isn’t true,” says Dr. Crowley. “It can happen to kids. Rheumatoid arthritis and osteoarthritis are two different things.”

Mimics. Dozens of diseases can look like MS, for instance, from lupus to other neurological conditions. And it takes time to rule out.

Uniqueness. Lupus in one person can show up with a set of symptoms completely different than the ones that show up in another person. Doctors can’t rely on symptoms alone to determine the nature of the affecting disease.

Diagnosing Autoimmune Disease

Varied, numerous and inherently elusive, the diagnosis of autoimmune disease can be tough detective work.

But what might seem daunting to others is precisely why Crowley became a rheumatologist. “I find it to be fascinating. Everyone is different, so I’m surprised and challenged daily. It’s really rewarding to be able to identify a rare disease and to be finally able to give a patient an answer to symptoms and something that can help them. Or to find a rare presentation of a common disease.”

So how does one diagnose if you can’t count on symptoms entirely?

Myth vs. Fact: Celiac Disease

The proliferation of gluten-free options at restaurants and grocery stores might look like just another trend. But celiac disease is a serious autoimmune disease. And though sometimes treated as such, it is not an allergy one can grow out of or ignore. If a person with celiac disease ingests gluten, she can trigger a number of symptoms, not all stomach-related; over time, eating gluten can give rise to more autoimmune diseases.

Diagnostic tests include, but are not limited to:

  • Antinuclear antibody (ANA) test—the presence of autoantibodies does not automatically mean you have an autoimmune disease, but a high level can indicate lupus, scleroderma, juvenile arthritis, others
  • Comprehensive metabolic panel
  • Tests associated with inflammation and arthritis
  • Urinalysis

Rheumatoid arthritis I can usually diagnose in the first visit; it’s normally straightforward.” Which is good, since it’s very important to be diagnosed early. “The earlier we can treat it, the more likely it is that it will be easier to treat later on and you won’t need as much medication.”

Which is why Crowley is excited about the advances being made in the field.

The latest? “We have a new imaging technique, a new type of CT scan, to diagnose gout. We’ve never been able to do it with imaging before. I’ve had patients who didn’t know it was gout until we used this technique. To diagnose gout you have to look at joint fluid and see gout crystals, but there’s not always a big collection of joint fluid to examine. Or you can look at uric acid, but some people have high levels of uric acid and no gout. You might suspect, from the symptoms and the blood tests, that the person has rheumatoid arthritis. Which is a problem, as rheumatoid arthritis and gout require very different treatments.”

But with the dual-energy 3D CT scan, diagnosis is straightforward. “The gout crystals look green. Fun pictures,” adds Crowley.

Flares & Triggers: Autoimmune Disease

While an ultimate cause for autoimmune disease remains unknown, research has shown that:

  • People can have a genetic propensity for an autoimmune disease
  • A trigger can activate or turn on the gene
  • Suspected triggers include environmental, chemical, sunlight, stress, drugs and infection factors
  • These triggers can cause a disease to “flare” up
  • These disorders can appear at any and all ages, making it difficult to pinpoint exact causes

Another thing is clear to Crowley and others in the field. “In the last two decades, we’ve seen a significant increase in autoimmune diseases, and a lot of experts think it’s the environment.”

Specific research has shown that tobacco use can turn on these genes, and gum disease can turn on rheumatoid arthritis genes.

But as with most aspects of autoimmune disease, these are hints, not answers. “We suspect it’s not just one thing, not one sole cause.”

No Quick Fixes: Treatments and Hope

There are no known cures for autoimmune diseases. Rheumatologists look to medications, supplements and physical therapy for the relief of symptoms and suppression of the immune system.

Crowley says that’s no reason to lose hope. “There is a lot of good research going. We have a lot of great treatment options. One hot topic in research is trying to predict the right treatment for each person. We have to do trial and error to see what can put someone in remission, but with more knowledge about disease features and genetics, we can narrow down the options and go straight to the most appropriate medicine right away.”

Stress and Self-Care

Along with medication, Crowley advises her patients to practice good self-care. She knows living with an autoimmune disease can be stressful. “People break down into tears in my office at least once a day,” she says.

But stress can make symptoms worse. “People get flared up when stressed, so I tell people we can’t fix the situations, but we can control the response. Good sleep and exercise are things we can work on. Tai chi and yoga are good for the body and mind (and there’s free videos for these on YouTube),” and can help manage symptoms. She also checks patients’ vitamin D levels, which are important for bones and the immune system.

Open for Business: UVA Rheumatology on Pantops

You can visit Crowley at her office on Pantops, where there’s plenty of free parking and friendly staff. View clinic directions, hours, contact info.

And while there aren’t published studies showing that diet benefits autoimmune diseases, she does see that diets can affect individuals, some of whom find that removing gluten, dairy, meat, sugars, fats and artificial ingredients help.

Even without a cure, Crowley finds her work rewarding. “We can put someone in remission and take them from not being able to do much of anything to being able to return to work and play ball with their kids. I get to develop relationships with people. It’s a team approach between us and our patients.”

And because an autoimmune disease can affect various parts of the body, Crowley also teams up with doctors in other fields. She doesn’t just treat one thing, she says. “We treat the person as a whole.”

Do You Have an Autoimmune Disease?

It’s hard to know without the care of a specialist like Crowley. If you have inflammation, joint pain or other vague symptoms, see your primary care physician for a referral. You can even schedule an appointment with Crowley herself!


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.


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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