Health Issue 2012

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Here’s the bad news: Nothing is certain but death and taxes. At some point in your lifetime, you’ll likely be affected, either personally or peripherally, by a serious health threat. But here’s the good news: There are a number of health professionals and research scientists in our area fighting against the effects of such conditions, rendering them preventable, detectable or, at the very least, maintainable. This year’s health issue takes a closer look at four of those threats, one for each major stage of your life—childhood obesity, depression, cancer and Alzheimer’s disease—and a few folks in the community working against them. After all, it’s good to have knowledge on your side. Of that, we’re certain.

 

CHILDHOOD OBESITY

Food fight
Yager, Green-Pastors lead local battle against childhood obesity

Long before Michelle Obama unveiled an action plan to tackle what she called “the childhood obesity epidemic” in 2010, Barbara Yager and Joyce Green-Pastors, co-chairs of the Charlottesville-Albemarle Community Action on Obesity taskforce, were ringing alarm bells.

Play with your food! Iman Harrison (left) and Miaia Shortridge whip up a batch of “You’ll-never-know-they’re-lowfat” brownies during a cooking class led by Charlottesville City Schools’ dietitian Alicia Cost. “How do you make kids eat healthy things?” Cost asks. “You make experimenting fun.” (Photo by John Robinson)

A decade later, people are finally listening. Yager and Green-Pastors are the face of a wide-reaching community push to reverse the rise of childhood obesity. Their behind-the-scenes efforts have secured grants, trained teachers, educated families, and built a taskforce that now touts more than 100 community partners, from the Local Food Hub to the Boys & Girls Club of Central Virginia to the University of Virginia School of Medicine.
Though the numbers aren’t conclusive, they indicate that the work has yielded tangible improvement. About 28 percent of Charlottesville and Albemarle third graders and 31 percent of fifth graders were overweight or obese in 2010, down from 34 percent and 35 percent, respectively, in 1996.

“At a time when the national average is still going up, we think it’s pretty remarkable that we have had any movement downward,” Yager said.

Now that childhood obesity and its effects have seeped into the consciousness of area residents, changing habits for the better, the next challenge for Yager and Pastors is keeping it that way.

Convincing the skeptics
The local obesity fight met early indifference.

In 1996, Yager, with colleague Peggy Brown Paviour, worked on a three-year grant from Virginia’s Department of Health as a part of her day job at the Thomas Jefferson Health District. The grant focused on teaching nutrition to fourth- and fifth-graders at Agnor-Hurt Elementary in Albemarle. Yager’s involvement piqued her curiosity in student health, so much she helped craft a survey that gauged how many third-graders in Albemarle and Charlottesville schools were overweight or obese.

The results astounded Yager, but she found that few people shared her astonishment.

Yager remembers a less than receptive audience when she presented obesity figures to local school leaders that showed that as many as 50 percent of city third-graders were overweight or at risk of being overweight.

“They basically told me, ‘This is baloney. It’s just one point in time. Maybe third graders are just chubby,’” she said.

But Yager persisted, and when subsequent surveys of that third-grade class showed that their obesity levels didn’t diminish in fourth or fifth grade, she knew bolder action was needed. In 1999, the Community Action on Obesity (CAO) taskforce was born.

In the group’s early days, Yager won over partners by speaking at school board and PTO meetings and presenting to pediatricians, school nurses, and physical education teachers, sharing her figures and an urgency about the risks of childhood obesity. When children are overweight or obese at age 10, she would say, they are 70 times more likely to be obese as an adult.

Green-Pastors entered the fray in the early 2000s. In her work in internal medicine at UVA Hospital, she was frightened by the spike in diabetes that she was seeing among young people, and she joined CAO to do something about it.

Over the last 10 years, Green-Pastors and Yager convinced community groups that fighting obesity can take many forms; it is much more than persuading children to lay off junk food.

“Obesity is not something that comes on suddenly, nor is it something that goes away suddenly,” Yager said. “There’s not a pill, not one thing that cures it. It takes the commitment of a community.”

WEIGHT UP

In the last 30 years, the prevalence of childhood obesity has more than doubled in children 2-5 years old, has tripled in children 6-11 years old, and has more than tripled in children 12-19 years old.

Source: National Institutes of Health

CAO and its partners have built community gardens and held classes to teach children about maintaining a garden. They have held camps and clinics focusing on fitness and healthy eating. They have worked to improve school lunches, and they have written nutrition standards and manuals for teachers to use.

Through CAO, afterschool cooking classes are now offered at various city schools, funded through grant money acquired by the taskforce. Yager said they opted to focus on cooking because she sees a generation that doesn’t know how to prepare a nutritious meal.

“They know how to open a box and pop it into the microwave, and that’s dinner,” Yager said. “We can advertise fresh food and eating local all we want, but if you don’t know how to prepare it, then that’s a problem.”

One of the cooking teachers, Alicia Cost, who is also the Charlottesville school division’s registered dietician, holds classes at Burnley-Moran Elementary and Walker Upper Elementary every week. Cost regularly sees about 20 budding chefs, and she is careful not to make healthy eating seem like a chore.

“How do you make kids eat healthy things?” Cost asked. “You don’t. You make experimenting fun. It’s just like in education. How do you make kids love trig? You engage them, you challenge them, you get them to become confident.”

CAO actually helped bring Cost to Charlottesville from Michigan in 2002, when it worked with the city schools to create the position that she accepted. Since moving to the area, she has seen how CAO’s work creates a cadre of teachers and community volunteers committed to fighting obesity.

“It’s the only way this can become sustainable,” she said.

Next steps
The partners and programs are in place. Now, CAO is entering a new phase of the fight: sustainability. In the fall, the taskforce organized an advisory board and wrote an ambitious five-year plan that aims to better connect its partners so that services are not duplicated. With such a pool of partners, CAO is shifting its role from galvanizer and chief educator to moderator.

“You can only do so much as a volunteer,” Green-Pastors said. “We are now looking to work with our partners who have a paid staff. They’ll do the interventions, and we’ll provide the curriculum and write the grants and the policies.”

CAO is aiming high. What started as a survey of third graders has grown into a group seeking to curtail obesity in Charlottesville and Albemarle, Greene, Fluvanna, Louisa, and Nelson counties.

“We want to be known and recognized as a healthy community,” Green-Pastors said. “So we don’t just talk about it, but it’s visible everywhere you go.”—Matt Deegan

 

DEPRESSION

Future tense
UVA counselor says uncertainty leads to students’ anxiety, depression

Recent headlines point to a more deeply depressed crop of college students than ever before, a generation tormented with recession-induced career anxiety and alienated by technology.

But Russ Federman, Director of Counseling and Psychological Services within the Department of Student Health at the University of Virginia, cautions against leaping to any grand conclusions about the mental health of today’s young adults.

There’s been a shift in college culture surrounding the treatment of mental health issues, Federman said, not some profound, abrupt shift in students’ mental states.

And student distress in recent years is not solely the product of a shaky economy, but rather a symptom of a more connected world that breeds a feeling of less personal security, he said.

More severely depressed?
A bevy of studies exist to bolster the perception that the mental health issues plaguing college students are becoming more severe.

According to a recent survey by the American College Counseling Association, 44 percent of students who sought counseling have severe psychological disorders, up from 16 percent in 2000, and 24 percent are on psychiatric medication, up from 17 percent a decade ago.

To boot, nearly a third of college students said they were so depressed that it was difficult to function, according to a 2009 survey by the American College Health Association.
Locally, UVA students are also seeking mental health counseling in greater numbers. In the 2010-2011 school year, 9.1 percent of UVA’s student body visited counseling services, up from 8.1 percent in 2000-2001. Also, over the last four years, an average of 329 UVA students were diagnosed with “major depression,” the most serious level of the condition. In the four years before that, only 233 UVA students, on average, received such a diagnosis.

In addition, in 2010-2011, UVA faced 54 student psychiatric hospitalizations, the University’s second-highest count ever. In the most recent fall semester, the school saw 35 hospitalizations, the highest number ever in a single semester.

Federman asserts that the figures reflect more sensitivity to mental health issues within universities in recent years, spurred in large part by the Virginia Tech tragedy in 2006.
“Suddenly, the quiet, sullen, alienated student was a potential killer,” he said. “Whereas prior to that incident, that same student was seen through a different set of lenses.”

After the Tech tragedy, UVA organized a team that now meets regularly to monitor student health issues, and Federman supposes that such a move happened in colleges across the country.

“Most of us working in student affairs are simply much more involved in the issue of student psychological functioning than we were seven years ago,” Federman said. “Are we seeing an increasing trend in the numbers? Probably, but you have people who are more sensitized to mental health issues and are taking a more proactive role in referring students. And because of the increased sensitivity, I think universities are doing a better job of publicizing the help that is available to students. Just because we see increasing numbers doesn’t mean more people, in and of themselves, are depressed. It just means that more students are coming forward and seeking help.”

Shaky foundations
For those students who are distressed, Federman said their anxiety reflects much more than a shaky economy. It points to a world of instant connectivity, which increases its complexity and makes it more difficult to develop strong personal foundations, he said.
“We live in a world of instant connectivity today, so that anything that’s happening on the globe anywhere, we hear about it,” Federman said. “And we don’t just hear about it watching the 6:30 news on TV. We hear about it on Facebook, we hear about it through push notifications on your cell phone. We’re seeing kids grow up in an age where they’re far more aware of the fragility of life or the vulnerability of life. When I was a child, what I knew was what was happening on my block. I was out riding my bike, doing stuff that kids did in the 1950s. I didn’t have much awareness of the broader world, and I think that’s very different than kids today.”

And the technology-fueled barrage of messages that today’s adolescents face is outpacing their ability to understand them, he said.

“When you think of the Information Age and the way in which sexuality is conveyed to kids these days, they have to somehow try to integrate this into their psyche long before they’re ready,” Federman said. “I think it’s one example of what is coming at children or early adolescents when they’re not yet mature enough to integrate it, deal with it and adapt to it.”

And when adolescents are asked to mature faster than they are capable, consequences ensue. Shaky foundations lead to a higher vulnerability to anxiety and depression.
“If we use the analogy of foundations, when you developed in the ’50s and ’60s, the cement simply had more time to set, to settle and become firm. Now, you’re seeing these elaborate structures being built upon people who don’t have very firm foundations, and it’s more challenging for them to maintain these elaborate structures that they’re expected to develop.”

But Federman is quick to point out that he’s not asserting that society used to be better than it is now. It’s just different, he said.

“As long as we have an evolving culture and changing sociocultural norms, you’re always going to be seeing changes in human behavior that go along with them,” he said.

And to adjust to a more connected college student living in a more complicated world, Federman and his colleagues at UVA’s student health department have adapted their focus.
“I’ve been a mental health administrator for about 20 years now,” he said. “When I first began, it had much more of a feel of college counseling, where you’re helping people with the kind of issues that you would think are normally a part of adolescence: identity, career, relationships, academic challenges, economics, sexuality, all of the things that are part and parcel with transitioning from an adolescent to a young adult. Today, when I look at our day-to-day experiences here, this is really more like a community mental health clinic. The range of psychopathology and the acuity of the psychopathology is much broader. The amount of crisis intervention and case management is at an entirely different level than it was 20 years ago.”—Matt Deegan

 

CANCER

The Big C
Sherri Brooks fights the battle against colorectal cancer

In the spring of 2010, Sherri Brooks experienced the first symptoms of the cancer attacking her intestines when she started to throw up. Initially, her doctor diagnosed her with a flu bug that was going around Nelson County, but when the illness persisted, an MRI scan revealed two suspicious spots on her liver. Brooks was then scheduled for a biopsy, and that’s when doctors found a tumor in her upper colon area that was causing a blockage. Worse, it was malignant—the 45-year-old had colorectal cancer.

Sherri Brooks, who was diagnosed with colorectal cancer in 2010, is currently undergoing her seventh round of chemotherapy. On the days she goes to the hospital for treatment, she spends hours waiting for doctors and nurses to take readings, do bloodwork and tests, mix the medicine and begin administering it. (Photo by John Robinson)

Cancer is one of the leading causes of death in America, of course, and there are few people who escape the disease’s touch (my great-uncle died of bladder cancer last year, for instance). And of the 100 different types that ravage the human body, the colorectal variety is among the most frequent, with approximately 150,000 cases detected annually.
Even so, it’s stunning to actually be on the receiving end of a diagnosis like that. “It’s almost like [my physician] was talking to somebody else,” Brooks said now. “He couldn’t be talking to me.” Up to that point, she’d been “very, very healthy,” and always exercised and went for regular check-ups. “I had no medical issues, no high blood pressure, no high cholesterol,” only adding to the surprise. “I just sat there. I didn’t talk. It had to sink in for me.”

Brooks was then referred to the University of Virginia hospital, where she underwent emergency surgery—called a colon resection—to remove the blockage, as well as her ovaries and fallopian tubes (also cancerous). After recuperating, she was scheduled for chemotherapy that was successful in shrinking her liver cancer by 60 percent. Another surgery ensued and in December 2010, half of her liver was removed, plus all of her gall bladder and uterus. After six more rounds of chemo (starting in January of 2011), Brooks was finally declared cancer free.

As a disease, cancer is largely unpredictable, but certain characteristics have been identified over the years. Yet, Brooks’ particular illness defies most accepted thought. For instance, colorectal cancer is generally considered a disease of the elderly, with the median age of diagnosis hovering around the age of 70. At 47, however, Brooks is already a veteran of the disease.

Her relative youth also defies the American Cancer Society’s recommendation for some sort of colon screening for cancer and polyps beginning at the age of 50. A colonoscopy is the most prevalent form—and a procedure both Brooks (who has had two) and the UVA physician in charge of her treatment, Dr. Hanna Sanoff, strongly advocate—but such a screening is urged earlier in life only if there are hereditary reasons to suspect a risk. Brooks had absolutely none.

6 times
That’s how much more likely men age 40-59 are to develop cancer than males age 39 years or younger. Women of that same 40-59 age group are four times more likely to develop cancer than their younger peers.

There is also a common theory about a possible cause of colorectal cancer. “The conventional wisdom is that a diet high in red meat—particularly if it’s really well-cooked red meat—increases your risk of colorectal cancer whereas a diet high in fiber—fruits and veggies—decreases it,” said Sanoff. Brooks admits to not always eating a healthy diet in the past—“We live out in the country, so I eat a country diet,” she said, meaning items like macaroni and cheese and fried potatoes—but said she never consumed much red meat and that as her iron depleted during chemo, Dr. Sanoff actually encouraged her to eat more beef. “I tend to eat more chicken and fish,” she said.

Unfortunately, one way that her disease has conformed is in its reoccurrence. When cancer is not diagnosed until it has already spread through different organs—or is “metastatic” as it was in Brooks—there is a high chance it will return. “I’m going to be at risk for reoccurrence for the rest of my life,” she admitted. “You just learn to live with it.” So when a CT Scan (in October 2011) revealed that the cancer was back, this time in her chest, Brooks was not shocked, but determined to take it on. “It’s incredibly rewarding to spend time with people willing to put in the extra effort to get well,” Sanoff said.

More chemo was ordered and Brooks is currently undergoing treatment every two weeks, a rigorous process that takes almost three days altogether and leaves her fatigued and nauseous. As soon as a round of chemo finishes, she goes on a study drug called Regorafenib—as part of a clinical study helmed by Sanoff and some colleagues at the University of North Carolina—that has shown to be very effective in working with chemotherapy. Not only may it help prolong her life, but if it proves to be successful the drug will aid other patients eventually. “I may be able to help somebody else down the line,” Brooks said. “That’s a wonderful thing.”—Jayson Whitehead

 

ALZHEIMER’S DISEASE

Out of the dark
JABA, UVA working to lessen effects of Alzheimer’s disease

My 82-year-old mother-in-law lives in a small suite of rooms attached to the house I share with my wife and young son. In the early years of her retirement, she rambled fearlessly through the mountains of Highland County, Virginia, an active member of her church and a familiar, beloved presence at civic events and festivals. She earned a Master’s degree from Old Dominion University in her youth, and oversaw a victim’s assistance program that provided safety and comfort for those who had suffered at the hands of criminals.

Nowadays, she often gets lost on the short walk from the kitchen to her own bedroom. She frets about the weather, worries about the news and has difficulty following the plot of “Law & Order,” her favorite television show. She loves to talk, but feels uncomfortable in the company of higher-functioning peers. She’s afraid she will sound stupid when she speaks.

Alzheimer’s patient Curtis Taylor participates in story time with pre-school children at the Jefferson Area Board for Aging’s Adult Care Facility. (Photo by John Robinson)

My mother-in-law suffers from Alzheimer’s disease. Symptoms began to appear a decade ago, and worsened dramatically after her husband died in 2005. She moved in with us in 2007, and we all live in denial and dread of the day she can no longer stay here safely. A paid caregiver stays with her all day, but even that can’t last forever.

The Alzheimer’s Association estimates that 130,000 Virginians aged 65 or older currently suffer from Alzheimer’s disease, enduring moderate to severe cognitive impairment from an illness that is largely untreatable. That number is expected to increase dramatically as the Baby Boom generation ages en masse.

The big question of “what to do?” is best pondered in small chunks. In Charlottesville, the outlook is surprisingly good.

When I visit the Jefferson Area Board for Aging’s Adult Care Center, I see everything I want my mother-in-law to have in her life. Jean Bourbeau, the bubbly, upbeat director of the facility, calls it a social club, and she’s not just blowing sunshine. There are several round tables in the airy common room. At one, a 99-year-old woman makes elaborate collages. Two friends work a jigsaw puzzle at another table. One staffer visits each table in turn, and another plays guitar softly near a row of west-facing windows.

In a nearby art room, the walls are lined with paintings, flowers, and a puppet theater. Effervescent senior Curtis Taylor reads a book to a small mixed group of peers and pre-schoolers, all rapt with attention. The Shining Star Pre-School adjoins the Adult Care facility, and the two populations mix frequently and to great effect. “A lot of parents seek us out,” said Bourbeau, “because their children don’t have grandparents nearby who can be part of their lives. Everyone benefits from the intergenerational interaction.”

Mr. Curtis, as the staff calls him, is a ray of sunshine. He gurgles high in his throat when he’s happy, which seemed to be all the time during my visit, and he doles out hugs and handshakes to anyone who wants one. I want my mother-in-law to meet him, but Jean Bourbeau warns me that more than one lady visitor has fallen for Mr. Curtis’ charms. If his social confidence and simple joy are communicable, it’s a chance I’m willing to take.

The JABA Center provides a valuable middle ground between home care and the wrenching decision to send a loved one into a long-term residential facility. According to Bourbeau, the emotional and physical cost of caring for a relative with Alzheimer’s can be extreme. “About 50 percent of caregivers pre-decease their loved ones,” she said. “You have to take care of yourself before you can take care of someone else.”

JABA offers one-on-one case management in hopes of meeting individual needs in a group setting. Everything—from the nitty-gritty of diet and bathroom scheduling to help with finances and forms—becomes part of the process. The facility has a hair salon and even helps with bathing when needed. “We know that the nursing home is probably inevitable,” says Bourbeau. “But we can really improve the quality of life before that happens.”

That word “inevitable” rankles anyone dealing with the disease. Alzheimer’s is listed by the Centers for Disease Control as the sixth leading cause of death in the United States.

Improvements in care and treatment have led to decreases in fatalities from other top 10 causes like heart disease, stroke and even cancer, but the Alzheimer’s Association reports that deaths from Alzheimer’s rose by 66 percent from 2000-2008.

Is it Alzheimer’s?
The Alzheimer’s Association lists ten warning signs of the disease.

1. Memory loss that disrupts daily life.
2. Challenges in planning or solving problems.
3. Difficulty completing familiar tasks.
4. Confusion with time or place.
5. Trouble understanding visual images and spatial relationships.
6. New problems with spoken or written words.
7. Misplacing things and being unable to retrace steps.
8. Poor judgment and decision-making skills.
9. Withdrawal from work or social activities.
10. Changes in mood and personality.

So where’s the hope? On our doorstep. In April of 2011, the Cure Alzheimer’s Fund awarded a $100,000 research grant to Dr. George Bloom, a professor of Biology and Cell Biology at UVA. Bloom, along with colleagues at other universities around the country, is investigating an exciting new direction in the detection and treatment of the disease. Where previous treatment efforts focused on muting the effects of abnormal structures found in affected brains—called ‘plaques’ and ‘tangles’—Dr. Bloom is part of a new effort that aims to get ahead of the disease.

“None of the drug trials have been successful. Probably because by the time the plaques are abundant, to remove them is moot,” says Dr. Bloom. “The plaques and tangles are, in my opinion, blinking neon lights that identify a brain that has already gone bad. What needs to be done is to detect when the building blocks of plaques and tangles start misbehaving in the first place, and trying to get to them before they do any damage.” To that end, Bloom is investigating amyloid and tau—two proteins found in the brain—to determine how their chemical interactions go awry.

The full impact of Dr. Bloom’s research may be years away, but his lab is working with Dr. John Lazo, a medicinal chemist at UVA, in hopes of finding some immediate applications for the basic science being done along this new avenue. Being able to identify the building blocks of Alzheimer’s may lead to new diagnostic tools that can catch the disease before it is in full swing, and provide a new target for the development of more effective treatment drugs.

“Right now, we know what the overall shape is, but there’s still an awful lot of work to be done before we know the details,” says Dr. Bloom. “We’re just beginning to do that work, and I’m very hopeful that something really good will come out of it.”—Eric Angevine
 

 

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