Early therapy yields best results in treating concussion symptoms

By: Suzanne Kim, O.D., Director of the MEDARVA Low Vision Center 


According to the Centers for Disease Control and Prevention, there were approximately 2.8 million traumatic brain injury-related emergency department visits, hospitalizations and deaths in the United States in 2014, the most recent year for which data is available. Changes are, you know someone who has experienced this type of injury.

A traumatic brain injury, or TBI, is described as a direct impact to the head that disrupts the brain’s normal function. Visual problems, including difficulty reading or light sensitivity, are typically some of the first symptoms patients have after suffering a TBI. Other symptoms may include headaches, dizziness, problems with memory or thinking, hearing issues, and changes in mood or personality.

Until recently, treatment for concussions, the mildest form of TBIs, involved resting in a dark room for a week or until concussion-related symptoms disappeared. Current research shows that seeking out a concussion care specialist and starting appropriate therapies within 48 hours of an injury is the best approach to treating concussions and their symptoms.

Take my patient, Mary, a 55-year-old who began having seizures that led to multiple concussions. When I first met her, she couldn’t ride in a car without closing her eyes, couldn’t tolerate any movement without taking anti-nausea medication, and arrived in my office wearing two pairs of sunglasses and a large hat to reduce sensitivity to light. Her symptoms were so severe she initially couldn’t even tolerate therapy. Mary’s concussions had caused damage to the part of her brain involved in eyetracking, visual processing and perception so we began a weekly vision therapy program designed to work in conjunction with physical therapy to reduce her symptoms.

As many as 75% of people with a TBI have visual symptoms. Many people don’t realize that dizziness and balance issues are heavily connected to vision through the vestibular-ocular reflex. Patients who have these symptoms, or others such as difficulty reading or focusing, are often referred to me by health care specialists who recognize the need for more comprehensive vision treatment.

During my initial exam, I look at how a patient’s eyes are working together and determine if any visual processing issues exist. I ask patients if they are having trouble reading, if their vision is worse at the end of the day, have eyestrain or if they are having double vision. Based on my findings, I may recommend a 10-week vision therapy program to help patients process information more clearly. Through weekly visits and follow-up exercises at home, patients reduce or eliminate visual issues with the goal of returning to work or sports or better managing activities of daily living.

After nearly five months of vision therapy, Mary was able to ride in a car without closing her eyes or taking anti-nausea medication. She no longer needed her hat to shield her eyes from bright light, and she even started a support group for TBI patients.

Because visual issues can impact everything from balance to light sensitivity, I recommend seeing a concussion care specialist and receiving a comprehensive eye exam within 48 hours of a TBI. The sooner you begin treatment, the sooner you’ll be able to comfortably return to everyday life.

Dr. Suzanne Kim is Board Certified by the National Board of Examiners in Optometry, as well as being a member of the following professional societies: the American Optometric Association, California Optometric Association, Neuro-Optometry Rehabilitation Association, and College of Optometrists in Vision Development. Dr. Kim was also the recipient of the Low Vision Eschenback Award for clinical excellence in low vision.


TBIs and Your Vision

How Traumatic Brain Injury Impacts Eyesight

It was one of those freak accidents that you hear about. John, a local professional from Richmond, was in a big box store when a steel display sign hanging from the ceiling suddenly broke and came crashing down on his head.

The impact left John lying on the floor, unconscious. He was taken to a local hospital and diagnosed with a concussion after experiencing short-term memory loss, speech issues, nausea, and dizziness with any head movement. 

Traumatic brain injuries – more commonly referred to as TBIs – are described as direct impacts to the head, causing a physiological disruption of the brain function. As a result, the visual system can be affected. 

In John’s case, more than a week after the accident, he had major vision problems that would not go away. He couldn’t drive and couldn’t tolerate riding in a car either. 

We often think about vision as simply what we see; however, vision also includes how the brain makes sense of what we see. A traumatic brain injury can affect vision by damaging parts of the brain involved in visual processing and perception. 

Some common vision complaints after a traumatic brain injury are blurred vision, difficulty reading, double vision, eyestrain, motion and light sensitivity, perceptual deficits, and grainy or wavy vision.

These symptoms may be a result of problems with eye movements, eye teaming issues, weakness or imbalance in the muscles that move the eyes, or other eye muscle problems. These visual anomalies adversely affect the patient’s quality of life and can interfere with activities of daily living, school, and work. 

Freak accidents like John’s that result in TBIs are not uncommon. Out of my patient base treated for TBI, about 20 percent of patients experienced an uncommon or rare accident. The other 80 percent were involved in car accidents.

In terms of treatment options for patients who have experienced vision challenges related to TBI, rehabilitation therapy is an innovative approach. Unique in the region, this therapy offers head trauma patients an option that has traditionally been otherwise unavailable. 

Through specialized neuro-optometric rehabilitation therapy, patients engage in weekly therapeutic treatments and are often able to return to school and work. 

It is a tailored program where a foundation is established to make sure a patient’s vision is corrected and both eyes are seeing equally. Then, we move on to basic eye muscle exercises and other therapy techniques. 

In most cases, patients will start to notice some vision restoration and success in four to six weeks. Other, more serious cases, such as John’s, can take years for complete recovery. 

According to the most recent data available from the Centers for Disease Control and Prevention, in 2013, approximately 2.8 million people came to the emergency department due to a traumatic brain injury. If you or someone you know experiences a concussion or some other type of TBI, don’t hesitate to seek treatment. The sooner the rehabilitation process begins, the sooner you return to everyday life. 

Suzanne Kim, OD, is board-certified by the National Board of Examiners in optometry and serves as the director of the MEDARVA Low Vision Center, where she is committed to providing low vision care to people with visual challenges. Dr. Kim enjoys hiking, yoga, cooking, and traveling the world in her free time.

MEDARVA Delivers ‘Wonderful Experience’ to Out-of- State Patient

Three months ago, Shaun Lilley was living a life of agony. She was always in pain, could barely sleep, dealt with constant swelling and her bad knee had already led to two painful falls. She tried cortisone shots and had multiple MRIs, but nothing seemed to help.

Shaun needed a knee replacement to bring her life back to normal, but after calling her insurance provider, she was told she would be responsible for at least half of the procedure’s sky-high costs. She was running in circles, unable to get an answer as to how much the procedure would set her back.

Unable to foot a bill that could reach as high as six digits, Shaun searched for a more affordable option, but there was no one near her home town of Lake Row, on New York’s Long Island, that provided a low-cost knee replacement.

She was crushed, thinking she would never be able to live a life without pain. That is, until a friend put her in touch with our president and CEO, Bruce P. Kupper, and Chairman Peter Pastore.

After speaking with Shaun, Bruce knew just who to call – Dr. Vivek Sharma of Colonial Orthopaedics – an orthopedic surgeon specializing in knee replacements and part of our network here at MEDARVA.

After consulting with Shaun, Dr. Sharma set her up for an outpatient custom knee replacement – a more in-depth procedure that leads to less pain and a faster recovery. They had a CT scan done on Shaun’s right knee and designed a left knee in its mirrored image. Six weeks later, she would be ready to go.

Shaun had all of her preliminary work done back home in Long Island and set an appointment to have the surgery done on December 6. She made arrangements to stay with a family friend in nearby Urbanna, Virginia and she could hardly wait to put the pain behind her.

That Wednesday, Dr. Sharma installed Shaun’s new custom knee. Following the procedure, she stayed at Stony Point Surgery Center for a couple of hours before moving to The Laurels of Bon Air for rehabilitation, where she spent the following night before going to Urbanna to continue her physical therapy with Amedisys Home Health in Saluda, Virginia. After finishing her final session, Shaun was able to return to New York.

Now, just over a month later, Shaun is back home living pain-free. Her range of motion has increased more than 50 percent since the procedure and her quality of life has increased tenfold.

The procedure, which she paid for entirely out-of-pocket, cost Shaun less than a third of the national average rate for a total knee replacement, even with the tailor-made custom knee. On top of the affordable rate, she said the quality of care she received from everyone at MEDARVA blew her out of the water.

Her experience was so positive that her boyfriend, who is looking into a total knee replacement himself, is thinking of having the procedure done at MEDARVA, despite having an insurance policy that would pay to have the operation done in New York.

Shaun said her original insurance problems turned out to be a blessing in disguise, and it was all thanks to MEDARVA.

“It’s unbelievable. The whole process has just been a really wonderful experience for me,” she said. “I got better care than I would have up here (in New York). In my experience, if I have to have the other knee done, I know where to go.”

These are the kinds of things we love to hear at MEDARVA. Want to know more about how we can help you? Visit our website at www.medarva.com or give us a call at (804) 775-4500.

Dealing with Spring Allergies

The Curse of Spring

Eddie Edwards, Marketing Director
Eddie Edwards is Marketing and PR director for MEDARVA Healthcare

Hay fever, or allergic rhinitis, can make those beautiful Spring days pretty miserable. Here are some of the symptoms:

  • Runny nose
  • Nasal and/or ear congestion
  • Sneezing
  • Red, itchy, watery eyes
  • Sore, scratchy throat
  • Post-nasal drainage
  • Itchy sinuses or ear canals
  • Cough
  • Asthma-like symptoms (wheezing, etc.)

Avoid that yellow dust!

Even though it’s difficult, try to avoid pollen, the main trigger for Spring hay fever symptoms. Here are some tips:

  • Monitor the pollen counts every day so you know what to expect and how to prepare
  • Try to stay indoors on dry, windy, days
  • Plan outdoor activites in the afternoon or evening
  • Have someone help with gardening and other outdoor chores
  • Always wear a mask when working outside
  • Take antihistamines on high pollen-count days
  • Keep windows closed, use HEPA filters, and air conditioning
  • Wash your bedding in hot water every week

Why do I have allergies now?

If you developed allergy symptoms as an adult, you’re not alone. Adult-onset seasonal allergies are common. Typically, these reactions occur when something in your environment has changed. An allergic reaction occurs when your body identifies something as being harmful and then produces antibodies to try to fight that substance. Those antibodies then attach themselves to cells in the body and release a chemical called histamine. Histamine creates inflammation which causes your allergic symptoms.

Many people experience these reactions after a move to a new state where different allergens may be present. When our bodies are exposed to new potential allergens, there is a higher likelihood of having a reaction. If you’re new to Virginia you may be enjoying the different seasons but struggling with allergies this spring.

Allergies can also affect us differently each year. One cause of this is a longer than average winter. If cold temperatures cause a delay in pollination of trees, they pollinate at the same time as many other plants and flowers – increasing the amount of pollen at one time.


Treatment options include prescription and over the counter antihistamines and steroid nasal sprays, and prescription steroid inhalers. In some cases, a deviated septum — the bone and cartilage which separate one side from the other — can make allergy symptoms worse.  A simple surgical procedure can straighten the septum, stop the blockage, and help relieve symptoms.



Protecting Sight of Premature Life

Dr. Matthew Doerr
Dr. Matthew Doerr

A period of time in the Stiles family’s life that was supposed to be filled with joy transformed into one of fear and uncertainty when their baby, Andy, was born at 27 weeks and immediately confined to the Neonatal Intensive Care Unit. While a team of physicians worked day and night to stabilize him, innumerable thoughts flew through his parent’s minds: Was he going to survive? Would he have brain damage? Had his lungs developed properly?  In that overwhelming moment, it did not occur to the new parents, amongst all the possibilities, that their baby may not be able to see.

An infant’s eyes are not fully developed until they are almost full-term. When they enter the world prematurely, especially prior to 30 weeks of gestation, they are at much higher risk for abnormal eye development and blindness if they are not followed closely by an ophthalmologist.

“I just remember seeing him hooked up to all these tubes and alarms,” Jan Stiles said of when their baby, Andy, was in the NICU during his first few months of life. “He was so small and helpless and I couldn’t do anything to help him. His care was in the hands of his doctors and nurses.”

Among the team of doctors tending to Andy was pediatric ophthalmologist, Dr. Matthew Doerr. Dr. Doerr was responsible for performing the weekly eye exams Andy needed to ensure that his eyes developed properly, and if necessary, to perform the medical or surgical interventions that might have been necessary to give little Andy his best chance at normal vision.

“I understood their distress. Parents, who haven’t slept in weeks, and are faced with the complicated and difficult situation of an extremely premature baby just want to hear us say that everything will be fine,” said Dr. Doerr, who has now joined Dr. Edwin Wortham V at VPOS (Virginia Pediatric Ophthalmology Specialists) in Richmond. “As a father myself, I understand a family’s need to hear that.”

“Early intervention in the visual development of a child is critical and sometimes easy to overlook. As anyone who works with children knows, they often won’t complain of a problem, so you have to know what to look for and the right questions to ask,” Dr. Doerr explained. Early intervention and prevention of complications can be the difference between normal vision and profound vision loss.

Part of Dr. Doerr’s specialty is being keenly aware of his young patients and adept at recognizing small nuances and signs in their behavior that when addressed early, can make a huge difference down the road. His own three children have helped him better communicate with his patients and their families. Two of his own children have vision problems, which has helped him relate to what some of his patients and their parents deal with every day.

In his practice, Dr. Doerr sees a wide variety of pediatric eye issues ranging from glasses prescriptions, to routine and complicated ocular misalignment, to even surgical and medical management of congenital cataracts and glaucoma. VPOS, under the expertise of Dr. Edwin Wortham, has been helping children and adults with eye problems since 1992. The practice is located across the street from the Stony Point Surgery Center, where the majority of their procedures take place.

Patients like Andy, and many other premature infants like him, are the types of cases that Dr. Doerr finds most rewarding. “Making a difference in a newborn’s life has a profound impact on everyone involved and I’m thankful for the opportunity,” he said. “I enjoy following these children as they grow and doing everything I can to ensure that they continue to see the world clearly.”

MEDARVA Stony Point Surgery Center Begins Outpatient Hysterectomies

Dr. Keith Berkle
Dr. Keith Berkle

With one of the lowest infection rates in the country, experienced staff, and more availability for surgeries, local physicians are starting to choose MEDARVA Stony Point Surgery Center (SPSC) for one specific new procedure: outpatient hysterectomies.

One of those doctors is Keith Berkle, M.D., a leading OBGYN physician with Virginia Women’s Center in Richmond. Berkle operates at SPSC and has just started doing outpatient hysterectomies at the location. He has already had success with the procedure and is talking more about the benefits of having it at SPSC and why it is a good choice for patients.

“All the assets of SPSC such as very knowledgeable staff, extremely low infection rate, and ease of access are reasons that I wanted to direct patients to the surgery center for this procedure,” Berkle said. “It just makes a lot of sense for the patient and for our surgical team.”

Once regarded as a major surgery with scarring and a slow and painful recovery, laparoscopic hysterectomies now enable patients to go home the same day and return to normal activities much faster than with traditional surgery. There is a minimal negative impact to the patient’s life and lower overall surgical complications. Rather than a large incision, there are approximately three keyhole-sized incisions in the abdomen. As a result, there is a lower risk of bleeding and infection, as well as a lower rate of blood clots caused by inactivity post-surgery.

The most common medical conditions that necessitate hysterectomies are uterine fibroids, endometriosis, severe vaginal bleeding, and chronic pelvic pain. When more conservative treatment methods, such as medicines, do not continue working, surgery may be the only option. By changing the way the surgery is performed, patients are able to regain a healthy lifestyle more quickly than ever before.

Several tips for a fast recovery once the patient returns home are:
• Move around. After the doctor’s go-ahead, get up and walk after your hysterectomy.
• Ease into physical fitness. Building back up to a gym routine is recommended.
• No heavy lifting. Lifting heavy objects can put pressure on abdominal muscles, so it is best to skip these exercises until a month or more after the procedure.

“Stony Point Surgery Center is a great choice right now for patients that need to have this procedure done,” Dr. Berkle said. “I’m excited to be a part of this and lead the effort.”

Berkle has performed minimally invasive hysterectomies since 2008 and is interested in shortening patient recovery time. By sharing the news of the new outpatient hysterectomy option at SPSC, he is hopeful that patients will choose the option and all the benefits that come along with it.

For more information, please contact 804.775.4500 or visit stonypointsc.com.

Keeping hope alive through innovative research

Because of similarities between cells in the human ear and certain jellyfish cells, researchers are able to conduct experiments without risking the hearing of human subjects.

As research funding continues to be squeezed on the national level, the MEDARVA Foundation’s ambition is to initiate new funding models designed to yield quality research, engage partners and connect venture philanthropy with individuals and organizations.


Researchers find human-like cells in an unlikely source 

Dr. Barry Strasnick, M. D., both a professor and chair of Otology/Neurotology at Eastern Virginia Medical School. Dr. Strasnick is a leading researcher examining the effects of gentamicin, an antibiotic used to treat many types of bacterial infections on human hearing. Jellyfish are being grown in Dr. Strasnick’s laboratory to assist in the research to prevent hearing loss in patients who might greatly benefit from certain antibiotics. Jellyfish possess hair cells, “Since we know the hair cells in the human ear are similar in structure to jellyfish cells and react to gentamicin in potentially similar ways, we can experiment with jellyfish hair cells to see how they react to different levels of the antibiotic, without risking the hearing of human subjects,” Dr. Strasnick says. It is important research that will help scientists find ways to protect the hair cells in ears in the human ear when gentamicin or its relatives are required. In the long run, this research will make sure the treatment benefits the patient without any repercussions.


Fueling life-saving medical research in the face of a challenging economic environment 

research-microscope“Federal government cuts in healthcare research, along with decreasing grants from the National Institutes of Health (NIH), have made catalytic grants from organizations such as the MEDARVA Foundation the only way to continue research and keep hope alive,” states Dr. Richard Constanzo, Ph.D., Professor and Director of Research at VCU Department of Otolaryngology. “Two studies would not have been possible without funding from the MEDARVA Foundation, within the current economic climate, we are grateful for the MEDARVA Foundation’s grant to continue this groundbreaking work.”

Physicians from UVA and researchers have utilized the MEDARVA Foundation’s catalytic research funding to take their research to the next level. Both began separate projects through the MEDARVA Foundation’s donated funds, have now been awarded additional funding by the NIH to further their research. MEDARVA Foundation donated funds.

“The MEDARVA Foundation’s research funding keeps research alive, and is clearly picking up a deficit that is not being picked up today.” ~ Dr. Richard Constanzo, Ph.D