Virginia Magazine asked doctors and nurses from the UVA Health System about the problems they see most often, the medical advances they’re most excited about and the biggest misconceptions about their fields. Their answers might surprise you; they will certainly keep you healthier.
Dr. Chris Holstege founded the clinical toxicology division at UVA in 1999. Patients find themselves under his division’s care due to “everything from drug interactions or abuse, spider or snake bites, industrial exposure to toxins, to kids who eat things that they shouldn’t, to criminal matters like poisoning or terrorism.”
Dr. Holstege says young children often face risks in new environments. “Children get into their grandparent’s medications or cleaning products. Often people don’t think about childproofing when children come to visit,” he says. Adolescents and adults are at risk of poisoning due to drug use. “There are plant-based and synthetic drugs, both legal and illegal, the effects of which haven’t been studied much yet,” says Dr. Holstege. “Lately, we’ve been seeing significant adverse effects, such as seizures, caused by synthetic cannabinoids shipped in from Asia. We report these to the Center for Disease Control; these drugs are increasingly a public health concern.”
In 2004, as part of UVA’s Critical Incident Analysis Group, Dr. Holstege flew to Vienna to consult on the possible poisoning of former Ukrainian President Viktor Yushchenko. “Based on his clinical course, I diagnosed dioxin poisoning, which subsequent lab tests confirmed,” says Dr. Holstege. Criminal poisonings are rare, he says, especially since the early 1900s, when new analytical testing made them easier to diagnose.
“People fixate on perceived dangers that pose exceedingly low risk,” says Dr. Holstege. “A few years ago, people worried about arsenic in a wood preservative used in children’s play sets. Then it was mercury in fish.” Dr. Holstege says that in toxicology the most important factor is dose. “Almost anything can be toxic if we have too much of it. Even water,” he says. The body has natural systems to expel toxins, he says, and exposure to small amounts of a substance usually doesn’t lead to toxicity. “As a member of the American Heart Association, I tell people: Eat fish.”
Dr. Ron Turner consults on pediatric infectious diseases, teaches at the medical school and researches infectious diseases such as the common cold and flu.
“It’s not your imagination that kids get sick more than adults,” says Dr. Turner. “They haven’t yet experienced all these organisms, bacterial and viral, and thus are more susceptible than adults are.” Not only are adult immune systems more developed, but the way adults interact with each other is less likely to spread illness as well. “Kids who are in daycare settings have more illnesses initially,” says Dr. Turner. “But there is a silver lining; later children in daycare get sick less often because they have developed more immunity than children who stay home.” Best advice to prevent infectious diseases? “Everyone should be getting the flu vaccine,” he says. “And hand hygiene, though it may not prevent the flu, is effective for prevention of diarrheal illnesses in both children and adults.”
“Our lab is working to find a vaccine for rhinoviruses—the viruses the cause the common cold,” says Dr. Turner. The research is being led by a Bethesda, Md., biotech firm and funded by the Defense Advanced Research Projects Agency. “We’re doing the virology side of it,” says Dr. Turner.
In the past few years, Dr. Turner’s clinical studies have shown that many popular strategies for the prevention and treatment of cold and flu just don’t work. One study showed that echinacea, popularly believed to bolster the immune system and ward off disease, had no such effect. Another revealed that the use of hand sanitizer did little to inhibit the spread of flu. “Unfortunately, the reality is that you are going to get sick; reconcile yourself to that,” says Dr. Turner. “Some studies show that zinc is helpful, others show that it’s not. If vitamin C has an effect, it’s a very small one. There are an awful lot of claims out there, but there is no data to support those claims.”
The Mental Health Researcher
Irma Mahone (Nurs ’85, Grad ’06) is a research assistant professor at the UVA Nursing School. Her experience working as an advanced practice nurse in psychiatry informs her research about shared decision making in mental health.
In a 12-month period, 26.2 percent of American adults will suffer from a diagnosable mental disorder. “But only 4.8 percent of the adult population will have a mental disorder classified as severe,” Mahone says. A severe mental disorder is one that has a psychotic component or debilitates a person, such as depression. “The most common disorders are thinking disorders and mood disorders,” says Mahone. “Mood disorders such as depression or bipolar disorder affect 9.5 percent of the population, though only 4.3 percent are classified as severe.” Mahone says that the costs of severe mental disorders to individuals and society at large are made clear by life expectancy statistics. “Life expectancy among people who have severe mental disorders is 56 years in contrast with 77.7 years among the general population,” she says.
Mahone has been researching outcomes when mental health care consumers and providers share decision making about treatment. “It’s already been shown that people who are living with diseases that require self-care, like diabetes, have better outcomes when they can fully participate in deciding on their treatment.”
“There’s a very damaging myth that if you’ve suffered from mental illness, your life is ruined. It’s just not true,” says Mahone. “After a psychotic break or hospitalization, many people are able to lead meaningful, productive lives. Recovery is possible.” Mahone says that in the last 10 years, recovery has dominated mental health literature and research. As well, consumers of mental health care have increasingly advocated for the support and treatment they need. “There is a shift of focus to empowering consumers to live the lives they want, rather than to just get rid of symptoms,” says Mahone. Both her research and professional experience have demonstrated the potential for recovery. “When you meet people who have been diagnosed with a mental disorder like schizophrenia who are in recovery, it’s an inspiring and mind-opening experience.”