Dee Dee Hallock moved from Florida to Charlottesville to be with her family in Virginia and get help from UVA Medical Center. “I’m a single mom,” she says. “I was an elementary school teacher in Florida for 20 years, I had no help. So the only thing I could do was move up here to have help with my family.” Six days after arriving in Virginia, her son was back in the ICU. Photo by Eze Amos.
Dee Dee Hallock moved to Charlottesville from Florida after her son Nicholas fell ill. He began having issues walking in the fall of 2019. Within six weeks, he was fully in a wheelchair. In January 2020, his oxygen levels dropped and he needed to be admitted to the ICU for two months. That’s when he was diagnosed with an ultra-rare metabolic disorder. Soon he needed a tracheostomy to breathe and a feeding tube to eat.
For a single mother of triplets, this was challenging enough. But since arriving in Virginia, Hallock has had to contend with a new obstacle: limited supplies from the durable medical equipment companies that provide the tubes and ventilators Nicholas needs to live at home.
“I’m only one of many thousands of parents in the state of Virginia who this affects,” says Hallock. “It’s my child’s health, it’s his quality of life.”
An elementary school teacher, Hallock is no longer able to work because Nicholas requires 24-hour care and she has been unable to find a full-time home nurse. She gets her groceries delivered to avoid going out to the store. Getting basic equipment for her son is a challenge, as things like ventilator parts can be delayed for months at a time.
Virginia’s DME companies face multiple problems stemming from the coronavirus pandemic, including supply chain disruptions, backorders, silicon shortages, and inflation. These factors alone have made getting supplies like new feeding tubes difficult for families, but the current Medicaid reimbursement rate has also affected the companies’ ability to attract qualified staff and dispense supplies without operating at a loss. Now, a new budget amendment under consideration in the General Assembly could address the low reimbursement rates that haven’t been able to cover rising costs.
Transitioning a medically fragile child from the hospital to home is expensive, requiring both specialized equipment and expert maintenance. As the ventilator program lead at UVA Children’s Hospital, Michael O’Brien takes care of children who need surgically placed airways in their neck and a machine that breathes for them, and he knows what it costs for parents to take on the task themselves.
“Just in terms of dollars and cents, all of the supplies required for not just the breathing equipment but also the feeding supplies and the actual nutrition is a lot,” says O’Brien. “A monthly bill can range between $10,000 and $12,000 billed to the patient’s insurance.”
While each patient’s insurance covers those exorbitant costs, the actual price of materials and shipping results in the equipment becoming more and more expensive to manufacture. With reimbursement for home health companies unable to meet the changing costs, companies can only supply what keeps them in the black. Parents then have to ration.
“These [supplies] are things that get dirty, because these are things that are always in contact with a patient,” says O’Brien. “And for infection control reasons, we have schedules for routine changing of equipment. My families cannot change those equipment as regularly as we instruct them to because they don’t have the supplies.”
Some families don’t receive the little supplies they’ve been allocated per month, leaving them to buy supplies online.
Michael O’Brien, ventilator program lead at UVA Children’s Hospital, says the cost of a child returning to hospitalization far exceeds the cost of medical supplies. “The incentive for Virginia legislators to increase the reimbursement rate … is to control health care costs in Virginia,” he says. Photo by Eze Amos.
“These surgical airway tubes, these tracheostomy tubes … you might have been able to find one for $50 before the pandemic,” says O’Brien. But if costs rise, there often is no alternative, because only one manufacturer might make a part. “Right now, these surgical airways might be $100, or in some cases several hundred dollars.”
“My institution does not think that changing one tube a month is safe for patients,” he says, which is why they haven’t changed their policy to reflect the supply. “That would be backwards, anyways, letting medical supplies dictate how you practice medicine.”
Last summer, Laura McGrath and her son struggled to get any supplies.
“We went for three months without getting a delivery of food for my son,” says McGrath. “We went for three months without getting the number of tracheostomy tubes that had been ordered for him. They were sending us one a month and saying, ‘Boil it in some water and reuse it.’”
McGrath’s son Finn was diagnosed with cerebral palsy, and requires total care at home. He uses a feeding tube because he has difficulty swallowing, and uses a tracheostomy tube, too, due to neuromuscular issues.
For his meals, Finn receives a pack of food with pre-measured amounts of protein, fat, and carbohydrates. Many children need specific formulas like this.
“When your child has a feeding tube, you kind of go through a formula trial,” says McGrath. “It’s very torturous for both the child and the parent because until you find the medical food that works for your child, your child is going through this period of time, sometimes for months, where they’re gagging and retching and vomiting and not tolerating their food at all, and so they’re not getting fed. It’s extremely stressful.”
When the supply companies can’t provide the right formula, parents have to go through that same difficult process with a substitute. Some parents have resorted to diluting condensed milk as an alternative.
McGrath, like Hallock, is hoping the new budget amendment will defray costs for DME companies and make it easier for parents to care for their children at home. Patroned by Del. Emily Brewer in the House and Sen. Siobhan Dunnavant in the Senate (both Republicans), the amendment would set the reimbursement rate for durable medical equipment to 100 percent of the Medicare rural rate, using $9 million from the general fund and nearly $12 million from non-general funds to support the initiative.
In a statement to CBS 6, Dunnavant said, “Families have not been able to get coverage of items that are necessary to care for their children in the home. … Virginia has made a commitment that the home is the best, most enriching place for children with these extraordinary needs and now we need to be sure they can get the tools they need for care so they can stay at home.”
For Marc Castelo, national director of sales and marketing, HME for Thrive Skilled Pediatric Care, the situation is dire. Thrive transitions medically fragile children home with life-sustaining equipment and services like nursing and physical and speech therapy. He sees the amendment as the only solution that will save his company from pulling out of the commonwealth.
“In Virginia, we are the last pediatric home care company left standing,” says Castelo. “The reason we’re the only ones in the market is that the margins have just become so thin that it’s very difficult to operate.”
Castelo says that even hiring respiratory therapists for the home health care environment has been hard, because RTs get paid more in the hospital. Since it can’t pay a competitive rate, Thrive struggles to attract staff in the state. “Our reimbursement for respiratory therapists is zero,” he says. “There is no reimbursement. So that has to be built into our margin, so that’s another cost.”
“It’s a ticking time bomb waiting to go off.”
On February 25, the General Assembly adjourned without reaching an agreement on the state budget. Republicans and Democrats are in a deadlock, leaving amendments like this one hanging in the balance.
Skooma’s David Treccariche says “out-of-state money has influenced our locally elected officials against the betterment of their constituents.” Photo: Eze Amos.
Since Virginia legalized marijuana in 2021, laws surrounding the drug have been hazy. Though adults 21 and over can legally possess up to one ounce of marijuana and grow up to four plants at home, it will not be legal to sell weed until January 1, 2024. State Democrats unsuccessfully tried to speed up that timeline last year—but now, legislators on both sides of the aisle are pushing to start recreational sales ahead of schedule.
In the House, Republican Del. Keith Hodges has proposed a bill that would allow pharmaceutical and industrial hemp processors to begin selling recreational weed on July 1, but prohibit the state from issuing marijuana licenses to other retailers until July 1, 2024. Democratic state Sen. Adam Ebbin has proposed a bill with the same timeline. While the proposals have drawn support from marijuana advocates pushing for recreational sales to begin before next year, some advocacy groups have criticized them for giving corporations an advantage, and removing social equity provisions included in the monumental 2021 legislation.
Under current law, the Virginia Cannabis Control Authority Board of Directors is required to establish standards and requirements for license applicants who have been convicted of a misdemeanor marijuana crime—or whose parent, child, sibling, or spouse has been convicted of one—as well as applicants who have lived in an area disproportionately policed for marijuana crimes (or an economically distressed area) for at least three of the past five years. People who graduated from a historically Black college or university in the state also qualify for a social equity license.
Hodges’ bill, HB1464, would instead mandate standards and requirements for “any preference in the licensing process for applicants that intend to operate a marijuana establishment in an historically economically disadvantaged community.” Ebbin’s bill, SB1133, would mandate “criteria by which to evaluate and grant license preference to applicants who have resided for at least four of the last five years … [in] a historically economically disadvantaged community.”
By allowing pharmaceutical and industrial hemp processors to sell recreational weed before small businesses, and giving preference to applicants opening dispensaries in economically disadvantaged communities, these bills invite corporations and other outside actors to exploit these areas, and do not guarantee people harmed by the decades-long war on drugs will be prioritized in the licensing process, says Chelsea Higgs Wise, executive director of Marijuana Justice.
“It’s a removal of the focus of the disparate impact of prohibition … and from individuals and families that have been targeted,” says Higgs Wise. “[This] appears to be the compromise across chambers to really encourage the false narrative of urgency to sales.”
The bills introduced by Hodges and Ebbin remove the word “equity” from multiple positions and organizations overseeing the legal marijuana market, and detail provisions for historically economically disadvantaged communities, rather than those specifically impacted by marijuana prohibition. Additionally, HB1464 no longer requires the Cannabis Control Authority to appropriate marijuana tax revenue to pre-kindergarten programs for at-risk children, the Cannabis Equity Reinvestment Fund, substance use disorder prevention and treatment programs, and public health programs. Republican Del. Michael Webert has proposed a bill, HB1750, that would delay retail sales to January 1, 2025, and remove social equity license requirements, too.
Higgs Wise worries about the long-term repercussions of marijuana laws without strong social equity provisions—as more states move toward legalizing marijuana, they could follow the commonwealth’s lead.
“Virginia has got to look across borders … and not only talk to people with the most money and the biggest mouths, which are the pharmaceutical companies,” says Higgs Wise, pointing to social equity issues within other states’ cannabis markets, like California and Illinois.
However, Virginia NORML is in support of the early sales bills, stressing the need for a safe, legal market as soon as possible.
“These bills seek to address some of the most immediate policies for adult use retail sales,” says the organization’s Executive Director JM Pedini. “The priority for the General Assembly this session ought to be public and consumer safety when it comes to retail sales—not who gets to make money first or next off of those consumers.”
The ever-changing proposals surrounding retail sales are confusing people interested in opening dispensaries, says Higgs Wise. Sirak Getachew, who plans to open a CBD dispensary in Richmond this spring, hopes to eventually sell legal weed at his business, but is worried about the social equity requirements.
“It just seems like we are on the sideline with nothing,” he says. “It seems like the war [on drugs] is never over.”
David Treccariche, owner of Charlottesville CBD dispensary Skooma, echoes similar concerns regarding early sales and licensing.
“Out-of-state money has influenced our locally elected officials against the betterment of their constituents,” says Treccariche. “The greatest injustice is to the victims of the state. … Those individuals should be given cannabis licenses and grants as easily as they were given summons and tickets.”
It remains to be seen which of the proposed bills—if any—have a fair chance of passing this legislative session. Gov. Glenn Youngkin has yet to clarify his position on a legalization timeline, which is “creating a hurdle, specifically for House Republicans, on the issue,” says Pedini.
After two-and-a-half years of living with COVID-19, many of us carry a sense of dread when the temperatures drop. Will winter coronavirus, colds, flus, and other infections rise as we gather in smaller spaces for longer periods of time? In a word: Yes.
But fear not. Vaccinations work to keep infection rates lower for many pathogens, and they may also help make diseases less severe and death rates lower. The federal Centers for Disease Control and Prevention puts it bluntly: “The CDC recommends COVID-19 vaccines for everyone ages 6 months and older, and boosters for everyone 5 years and older, if eligible.”
To determine whether you are medically eligible for a COVID shot or any other vaccine, please consult a health-care provider. (Most people can get vaccines without any problems.)
As of October 7, 76.3 percent of the Charlottesville population has had at least one dose. Albemarle County has surpassed that level at an 87.9 percent rate. Ryan McKay, director of policy, planning, and COVID-19 operations for the Blue Ridge Health District, says the district has one of the highest vaccination rates in the state.
The BRHD underestimated how bad last winter’s COVID transmission rate would be—the omicron variant emerged and the vaccine didn’t fight it. This fall, the new bivalent vaccines protect against both the original strain of COVID and the two current omicron variants.
McKay encourages everyone to get the initial two COVID shots or their boosters when they are due, plus the seasonal flu shot—at the same time, if desired. They are given as two shots, not a combined shot.
Patrick Jackson, M.D., an assistant professor in the UVA Division of Infectious Diseases & International Health, says October is a good month to get these two vaccines, so you can “build antibodies before flu starts circulating” and “combination is perfectly fine.”
The strict COVID recommendations of 2020 have softened nationwide and locally. “COVID vaccination is less of a front burner issue now, because of the reduction in the number of transmissions, and the moderated-disease transmission,” says Phil Giaramita, Albemarle County Public Schools strategic communications officer. “We are not in a position to require or collect vaccination data on our employees or among students—student data is blended into the state COVID information registry.” Nonetheless, employees of ACPS have a vaccination rate of more than 90 percent, teachers most of all.
UVA’s COVID health and safety policy, updated for the fall 2022 semester, says, “All students, full-time and part-time UVA faculty and staff, including those working remotely, are strongly encouraged to receive their primary series of COVID-19 vaccine and booster doses when eligible per CDC guidance.”
Despite vaccination progress, the September 30 UVA COVID-19 Modeling Weekly Update predicts another possible surge this December. “It is critical that Virginians get boosted this fall. Models suggest that a bivalent booster campaign could prevent 150,000 cases by March.”
Jackson recommends reviewing your vaccine history with your health-care provider: “Vaccine reviews should be part of your regular health evaluation,” he says.
Besides the COVID vaccine, there is a new vaccine for monkeypox, which can cause a painful though usually not fatal infection. Monkeypox and many vaccines are given throughout the year, as needed, as are booster shots for certain vaccines.
A healthy dose
Before you panic about another possible winter COVID surge, take a look at our guide to vaccines to consider this fall and beyond. Please consult a medical expert with any questions before you get vaccinated.
Monkeypox.Tetanus.
COVID-19 vaccines and boosters
Who should get these? Everyone 6 months and older who is eligible—ask your health-care provider or health department.
How often? The VDH says, “The first two doses of Pfizer-BioNTech or Novavax vaccine should be given at least three weeks (21 days) apart and the first two doses of Moderna vaccine at least four weeks (28 days) apart.” Do not get the second dose earlier than recommended. The Janssen/Johnson & Johnson vaccine is a single first dose only authorized for use now in certain situations.
An extended interval option may work for individuals 6 months of age and older based on an individual’s risks and benefits. A longer (up to eight-week) interval may be optimal for some people, especially for males ages 12 to 39 years. Talk to your health-care or vaccine provider about the timing of the second shot.
According to the U.S. Food and Drug Administration, those 18 years and older can have a single booster of the Moderna bivalent if it has been at least two months since their primary vaccination or if they have received the most recent booster dose with any approved monovalent COVID-19 vaccine (the first booster shot that was available).
For the Pfizer bivalent, those 12 years and older are eligible for a single bivalent booster dose under the same two-month circumstances.
Who should get this? The CDC says everyone over the age of 6 months, to protect as many as possible. Those 65 and older likely will receive the high-dose seasonal flu shot that the CDC recommends.
When? Once a year, about this time of year (October). Flu activity peaks from December to February.
According to the CDC, this annual vaccine is made to protect against the most common strains, year to year. This vaccine can be given along with the updated COVID bivalent vaccine.
Monkeypox vaccine
Who should get this? People who have sex with multiple or anonymous partners are currently at the highest risk for monkeypox. The VDH says that avoiding these activities greatly reduces your chance of catching or spreading monkeypox.
When? Now, if you are at risk or know you have been exposed to someone with the disease.
Anyone can get and spread monkeypox, which is transmitted by close contact with an infected person. Close contact includes sex or intimate contact, hugging, kissing, cuddling, massage, touching skin lesions, bodily fluids, or clothing, towels, and linens that have been in contact with an infected person. Spread can also occur during prolonged face-to-face contact.
Tetanus/DTaP vaccine
Who should get this? Jackson says this is an overlooked vaccine. It is recommended for all ages, and, according to Jackson, pregnant women should also get the shot to help confer immunity in a fetus to fight whooping cough (pertussis). The Mayo Clinic recommends the shot between 27 and 36 weeks of pregnancy.
When? During childhood, and every 10 years thereafter.
The DTaP vaccine works against diphtheria, tetanus, and whooping cough infections. Diphtheria is caused by a poison produced by a bacterium, and it can be deadly. Tetanus is caused by a bacterium usually when a wound is infected by contaminated soil, dust, rust, or animal or human feces. Diphtheria and tetanus are rare in the U.S. because of vaccination. Whooping cough is more common.
Other vaccines
Newer formulations include the Shingrix vaccine for shingles (two doses two to six months apart for those aged 50 and up) and two new pneumonia vaccines: PCV15 (Vaxneuvance) and PCV20 (Prevnar 20) for those older than 65 and younger people at high risk because of a weak immune system or a chronic medical condition.
Keeping abreast
A quick word about women who still need to get an annual mammogram: Don’t let having a recent COVID or seasonal flu vaccine stop you from getting your annual mammogram. In early COVID vaccine days, the guidance was for women to wait about six weeks after a COVID or flu shot because vaccine material was attacked by enlarged lymph nodes. Enlarged lymph nodes, however, are also a possible sign of cancer.
File photo.
“Many women came in shortly after their first vaccinations, and we were seeing higher rates of enlarged lymph nodes,” so the six-week wait time began, said Lisa Vick, team coordinator for mammography at Martha Jefferson Hospital. “We no longer want patients to delay their care.” Vaccination questions are asked and recorded, but vaccines should not postpone mammograms, she says.
As measles make a comeback in pockets of the United States, a resurgence of vaccine-preventable diseases in Charlottesville in recent years has some local health experts worried that messages about the importance of immunization are not sinking in.
In just the first two months of 2019, the U.S. has seen five outbreaks of measles–a highly infectious disease that killed millions of children each year before a vaccine was introduced in the 1960s. It was declared eradicated in this country in 2000, but has been reintroduced as travelers pick up the disease abroad and then spread it among unvaccinated groups here in the U.S. (In Clark County, Washington, which had more than 50 cases this year, one in four kindergartners were unvaccinated before the outbreak.)
So how vulnerable are we here in Charlottesville?
“We have not had any cases of measles yet at UVA, but I’m concerned,” says Dr. Ina Stephens, a pediatrician and specialist in pediatric infectious diseases at UVA Health System. “There are measles outbreaks all over the U.S.”
Stephens calls non-immunization a “huge issue” globally, particularly in Europe, where there were more than 41,000 cases of measles last year. Much closer to home, she notes, “we are seeing other vaccine-preventable diseases cropping up all over the place here in Charlottesville.” That has included outbreaks of pertussis (whooping cough) that have led to hospitalizations and infant deaths; mumps; severe cases of chicken pox with complications and secondary infections; and several cases of Haemophilus influenzae type B meningitis, which is “almost unheard of,” she says. “We haven’t seen that in 20 years.”
Despite available vaccines, she says, “These diseases are coming back.”
Dr. Ina Stephens
“Vaccine hesitancy”—the delay or refusal of available vaccines—was identified by the World Health Organization as one of the top 10 threats to global health in 2019. In the U.S., increasing numbers of parents have been refusing vaccines for their children, although overall vaccination rates remain high.
A strain of anti-vaccine sentiment has run through Charlottesville’s discourse for years: In 2005, The Hook published a cover story suggesting that thimerosal, once an ingredient in the MMR vaccine, caused autism. Andrew Wakefield, the British doctor who fueled the anti-vaxx movement with a paper also linking the MMR vaccine to autism, was later barred from practicing medicine in the UK, and no other researchers were ever able to replicate his findings. In 2008, the medical journal that published Wakefield’s paper retracted it, and the journal’s editor declared it “utterly false.”
Still, in 2016 Wakefield’s anti-vaccine film, Vaxxed, screened in Charlottesville. A member of the Parenting Network of Charlottesville listserve touted the screening, declaring that it revealed a “vast conspiracy at the CDC” and that “millions of people” have been “injured or killed” by vaccines. The forum’s moderators declined to post a response, saying they try to “steer away from contentious subjects.”
Stephens, at UVA, says the spread of misinformation had an effect that can’t be taken back.
“The problem is, this is 10 years in the making of fearing vaccines,” she says. “Once the fear is out there, the fear is out there.”
Marcia Hornberger, the epidemiologist for the Thomas Jefferson Health District, which includes Charlottesville and Albemarle, says the district is always concerned about vaccine-preventable outbreaks, “particularly right now.”
Even in a population with a high vaccination rate, diseases can spread among pockets of unvaccinated people. “The message of not getting vaccinated is prevalent,” Hornberger says,“And that’s certainly concerning.”
The religious exemption loophole
Like most states, Virginia requires children to be adequately immunized to attend school, even private school. Yet parents can get an exemption simply by signing a waiver claiming that immunization conflicts with their child’s “religious tenets or practices.” Few religions expressly prohibit vaccinations, but it’s an easy loophole for parents who don’t want to vaccinate.
It’s difficult to know how many families use the religious exemption to avoid vaccination. Charlottesville public schools report high rates of vaccination, but there is no data available for the area’s preschools and private schools, and rates can vary widely from school to school. In 2011, a student at the Charlottesville Waldorf School contracted measles, and 40 people who were not adequately vaccinated against the disease were quarantined, although it’s unclear how many of those people were CWS students.
Andrea Bostrom, interim administrator at CWS, said in an email that she had “not heard any chatter” among parents regarding the current measles threat, but declined to share information on how many CWS students are unvaccinated or whether exemption rates have gone up.
One Charlottesville preschool director said a “very small number” of families use the religious exemption, and that it is not a concern. Another said the number of families taking the exemption at her school had recently gone up, to five or six families out of a total of less than three dozen.
“We do worry about this,” she wrote in an email. “Although we have not had recent issues at school, in the past we have seen an occasional issue like chicken pox, which puts some of our pregnant moms in possible danger. We have had both children and parents at the school who have actual immune issues, so children who are not vaccinated can be risking the health of others.”
Years ago, she added, a student came down with whooping cough. “It’s a horrible thing to put a child through, with serious complications,” she wrote. “I think anyone who witnesses something like that would not hesitate to get a vaccination for their child.”
The fact that many parents have not witnessed the reality of these diseases may be part of the problem.
“Parents these days are not scared of these preventable diseases because they’ve never seen them…they don’t understand how big of a threat this is,” Dr. Stephens says.
Whooping cough, for example, can be fatal for infants, who typically aren’t vaccinated before age one. There were 18,975 reportable cases of whooping cough in the U.S in 2017, according to the CDC, and the only way to protect infants is to protect older children. Mumps, meanwhile, can cause sterility in older adolescent males, Stephens adds, noting that there was an outbreak of the disease at UVA last year.
In her practice, Dr. Stephens encourages parents to talk to her about their concerns. Then she addresses them one by one. “You want the parents to know that you’re willing to work with them and you want to protect their child the same way they want to protect their child,” she says.
A mother herself, she tells patients she never gives a child a vaccine that she’s not willing to give her own children. “I let them know that I’m with them,” she says. “I understand.”
Mythbuster: the facts on vaccines
Here are some of the questions and concerns Dr. Ina Stephens hears from parents, and her response.
It’s too many vaccines at once! I’m worried it’s more than my child’s immune system can handle
“Each individual vaccine has approximately 10-15 different antigens that the body will make a reaction to, so it will remember it,” Stephens says. A typical virus, like the common cold, carries about 10,000 different antigens. An average child gets about eight or 10 viruses the first year of life—that’s hundreds of thousands of antigens, and nobody’s afraid of that, Stephens says. “[Children’s] bodies are very, very well-equipped to handle making an antibody response to 10-15 antigens.”
Too many needles! I don’t like my child getting so many shots at once.
Many providers will work with parents to space out the shots if that is a concern. “You need to meet the parent where they are,” Stephens says.
Why should we bother? My child is not going to get diphtheria or polio.
Stephens reminds parents of how quickly diseases we thought were eradicated can come back. “I tell them—we didn’t see any measles, and then all of a sudden in 2014 there were 657 reportable cases just in the U.S. alone.” Worldwide, she notes, there were over 173,330 cases of measles in 2017. “That’s crazy, that’s huge.”
How do we know vaccines are safe?
“The public has the right to safe vaccines,” says Stephens, who spent 15 years at the Center for Vaccine Development and Global Health at the University of Maryland. While false information abounds on the internet, parents don’t always have access to the medical research, to actually see the science behind why immunizations are safe and why they are so important. “I also let them know that the vaccine reporting system for adverse events is very active. It’s monitored by the minute, and any adverse effect is looked into.”
Epic flipping adventures await you at Jump trampoline park. Photo: Corbett Smithson
New Year’s resolutions losing steam? (Or maybe you didn’t make any to begin with?) As we come to the end of a long, cold January, it’s not too late to make a fresh start. From ways to be brave to where to find support, here are 25 simple, mostly-local tips to help you look, feel, and be your best—or at least make it through the winter.
By Samantha Baars, Tami Keaveny, Laura Longhine, Erin O’Hare, Lisa Provence, and Susan Sorensen
Be a kid again
A room with wall-to-wall trampolines and a massive foam pit isn’t just your childhood fantasy—it’s a spot that exists in town, called Jump, and you don’t have to wear pigtails or watch cartoons to qualify for admission. And don’t overlook Decades Arcade, where you’ll find dozens of old-school pinball machines with high scores ready to be beaten. The
bevy of board games up for grabs at family-friendly brew houses like Champion and Kardinal Hall aren’t just reserved for the rugrats, either. And although a bit of your childhood died along with Toys ‘R’ Us last year, Shenanigans on
West Main and Alakazam on the Downtown Mall are still full of fun. That’s right, take a moment to feel the unbridled joy of squishing that glittery silly putty on the display table between your full-grown fingers. After all, you deserve it.
Don’t be afraid to hug it out with David Reid when you see him on the Downtown Mall. Photo: Eze Amos
Do something that scares you
When Eleanor Roosevelt said you should do one thing every day that scares you, she wasn’t talking about seeing the latest installment of Halloween or going skydiving. Roosevelt wanted people to get out of their comfort zones and confront their everyday fears. Simple courage, the former first lady knew, takes practice. And with that in mind, here are some suggestions for being brave this year:
Talk to a stranger. Ride a Bird (or a Lime). Speak up at a City Council meeting. Ignore your cell phone. Audition for a play at Live Arts. Throw a block party. Ask for a raise. Start your novel or memoir with a class at WriterHouse. Travel alone. Take dancing lessons at Ix or Carver Rec. And maybe hug that guy on the Downtown Mall.
Rivanna Trail. Photo: Nick Strocchia
Get outside
Need a wilder life? Communing with nature can be uplifting for the senses and the psyche. Luckily, we’re never far from a trail, hike, or nature class.
City dwellers have easy access to the Rivanna Trail’s 20-mile loop, while out in the county it’s possible to climb to a breathtaking view on the Turk Mountain trail in less than an hour. And if you want to drill down on what kinds of wood the woodpeckers in our region are pecking, the Ivy Creek Foundation offers classes on bird-watching and tree identification.
At Monticello, you can join a group to watch the sunrise from one of the estate’s ascending paths, and in Shenandoah National Park, rangers will lead you through fields full of wildflowers in spring, and amateur astronomers will help you identify stars and meteor showers in summer.
For women who prefer to honor themselves and nature while staying in place, the Women’s Initiative combines art and ecotherapy in classes that use wintertime quiet to rejuvenate the heart.
ACAC’s Leanne Higgins says the key to getting fit is to focus on what your body can do—and work on what it cannot. Photo: Amy Jackson Smith
Set a functional fitness goal
New year, new you. Or so the advertisements promise. But when it comes to setting realistic fitness goals, we turned to Leanne Higgins, a personal trainer at ACAC. The key to success, says Higgins, is a “functional goal, something you’d like to do that you cannot do right now.” If you get winded climbing stairs, Higgins suggests short bouts of stair climbing every day, combined with leg exercises, which will “produce a measurable result: climbing stairs with ease.” A lot of people zero in on appearance and weight as measures of success, she says. “But if you focus on what your body can do, and work on what it cannot do, you will find the appearance and weight issues often fall into place.”
Know your neighbors
Sure, you wave to your neighbors from the car, but how well do you really know them? Colette Hall, a former president of the North Downtown Residents Association, says that whenever anyone new moves into her neighborhood, she drops off a note—and a sweet treat—with her and her husband’s contact information. “I only do this when I know they are home, so I can meet them in person,” she says. “This can be time-consuming, but it’s well worth it.”
It’s also worth it to chat with your neighbors while walking your dog or collecting the mail. Invite them to join you the next time you’re downing gin and tonics on the front porch. And if your neighborhood has an association, join it! You just might make your street a better place—and find a new friend or two in the process.
Broaden your horizons
Now that you’ve settled in to 2019, it’s time to bust out of your everyday routine—and getting out of town is one of the best ways to leave your ordinary behind. When you take a trip, you step “into a whole other experience, whether it’s a relaxing getaway that allows for time to think, breathe, and reflect at a slower pace, or an adventure to a foreign land where life might look, sound, smell, and feel entirely different,” says Julie Arbelaez of Peace Frogs Travel/Outfitters.
But it’s not just the adventure itself that’ll shake things up. “The idea of the trip, the planning and anticipation, can create a sense of movement in our lives that creates change,” Arbelaez says, adding that places both near and far can be inspiring.
If hopping on an airplane isn’t in your future, the staff at New Dominion Bookshop reminds you that when you read, you can cross centuries and continents without leaving your living room. “Inhabiting someone else’s life, even if imaginary, exercises the part of your brain that encourages empathy,” says Sarah Crossland, the shop’s marketing director. That “can lead to stronger personal relationships and a compassionate approach to considering new perspectives.”
Plant a tree
Studies have shown that trees, especially in urban areas, can increase your physical and emotional well-being. So take a step against climate change and plant one yourself.
You can find tips on selecting, planting, and caring for your tree at charlottesvilleareatreestewards.org—the organization also offers free classes and guided tree walks.
Find your people
Dr. Seuss famously asked, “Why fit in when you were born to stand out?” But most of us understandably flourish when we find a pack of other weirdos just like us. Are you into English country dancing? There’s a club for that in Charlottesville. Adult anime? There’s a club for that, too. And if you’re tired of knitting alone in your recliner, bring those needles and that ball of yarn to The Women’s Initiative’s semi-regular knitting circle (or to others at the public library and local yarn shops). Where else can you find your people? Let CvilleCalendar.com be your compass.
Eat better
Eating well and eating out tend to be opposite goals, but Jessica Clements, a National Academy of Sports Medicine certified personal trainer and nutrition specialist at Bill Burnett’s Success Studio, says there are ways to do both. Here’s her cheat sheet for local faves—and don’t forget the farmers’ markets!
Bodo’s Bagels: It’s a staple of C’ville, so my tip is to build your own lunch-type sandwich for breakfast. Load it up with turkey and hummus for satiating protein, and add watercress to boost nutrients like vitamin K and antioxidants. It’s guaranteed to keep you full longer than your usual go-to breakfast.
Brazos Tacos: Go for breakfast, where you can get the Flora taco: scrambled eggs, sautéed spinach, black beans, queso fresco, and roasted tomato. A delicious and satisfying start to the day with protein, fiber, and nutrient-rich veggies.
Citizen Burger: Everyone loves a burger, but to cut the saturated fat, try an alternative to beef. Start with the locally made whole wheat bun, add a chicken or turkey burger, lettuce, avocado, tomato, and mustard or a small amount of their garlic aioli or sriracha mayo (you’re saving some calories and fat on the burger so you can spare a few with the sauce). Then choose the side salad instead of fries.
Three Notch’d Brewing Company: You can’t go out on the town in Charlottesville without spending time at one of the local breweries. At Three Notch’d, you can get a wonderful plate of hummus with pita, cucumber, and carrots. It’s a healthy way to snack while partaking in some local libations.
Beer Run: While on the subject of beer, Beer Run is a place in town where you can get pretty much any beer that suits your fancy—and they have great food too. The Verdura Rustica Plate is healthy and delicious. It’s mostly grilled vegetables including eggplant, radicchio, and local squash, mushrooms, tomatoes, and spinach on top of organic brown rice sprinkled with mozzarella and drizzled with basil-parsley olive oil. I’d call that five serving of veggies for the day! Even if you aren’t a practicing vegetarian, this dish is so hearty you won’t miss the meat.
Albemarle Baking Company: No one wants to skip dessert. While it’s never really nutritious for you, moderation is the key. ABC has a ginger molasses cookie that’s scrumptious. The ginger has anti-inflammatory properties, and the molasses is rich in vitamins and minerals. So they’re practically a health food (wink).
Take a deep breath
Feeling stressed? Take a moment to focus on your breath, says Hot Yoga Charlottesville instructor Julia Gilchrist. Slowing the breath, particularly exhales, calms the nervous system and lowers heart rate and blood pressure.
Here’s how: Any time you can steal a moment, “sit in stillness and listen to your breath. Inhale through the nose for a count of four and exhale through the mouth for a count of six. Hold empty for two seconds, then take another round of breath.”
After six to 10 rounds, close your eyes and notice how you feel. Chances are, you’ll feel better.
The technique is a good way to calm yourself down in tough moments, Gilchrist says—whether you’re wigging out over a deadline, having an emotional day, or stressed about locking the keys in the car (again).
Dr. Chris Winter, author of The Sleep Solution: Why your sleep is broken and how to fix it. Photo: Sanjay Suchak
Get enough sleep
For an adult, the sweet spot is somewhere between seven and eight hours a night, according to Dr. Chris Winter, a nationally recognized sleep expert and founder of Charlottesville Neurology and Sleep Medicine. Make sure you’re going to bed at a decent time, and if necessary, set an alarm to remind you that, as fascinating as that Candy Crush game is, it’s 10:30pm and you need to go to bed.
If obeying your bedtime isn’t always an option, or if you had a particularly long night, Winter suggests thinking about your sleep as the need to rack up about 50 hours each week. Have to kick off the covers uber early to meet a deadline at work? No sweat, he says. Take a nap that evening, or use the weekend to catch a few extra Zzzs.
Smile more
Inevitably when you’re in resting-face mode, someone—grandma, a photographer, or a random passerby—will urge you to smile. These cheerleaders may not realize that your clenched lips are masking a cosmetic dental issue. But don’t be afraid to say “Aaah!” because Dr. Jody Yeargan, of Yeargan Family Dental Care, says there are a lot of options.
“Yes, your teeth can be brighter,” says Yeargan. “And I also discuss what orthodontics would do in terms of moving one’s teeth to a more aesthetic position.” He’s been offering the Invisalign brand for years, and says, “it’s my go-to.”As for the mail-order smile equipment, that “may not work as well because the client doesn’t know what to ask for”—talk to your dentist first.
Of course Yeargan’s main focus is maintaining oral health. In addition to having healthier gums, and teeth less prone to tooth decay, he says people with good oral care tend to be a little more successful. And don’t skimp on flossing. “If you’re only brushing your teeth, then you are only cleaning half of them,” says Yeargan.
Work with horses
Delving into your past on a therapist’s couch isn’t the only way to feel better: In equine-assisted therapy, experts connect you with a horse to ride and care for, to improve both your physical and emotional health.
Ride With Pride at Cedar Creek Stables uses innovative programs like Whoa-ga (horse riding and yoga) and cowboy poetry to help a range of clients including traumatized youth, veterans, and people with physical handicaps.
Program Director Kelsey Lasher says “the relationship that naturally develops between the rider and the horse, and the requirement for providing care for the animal, fosters responsibility, independence, self-esteem, and trust.”
Reduce your carbon footprint
You don’t have to be a superhero to save the world. Local environmentalist Anna Bella Korbatov, who chairs the Cville100 Climate Coalition, offers 12 tips for small ways you can make a big difference:
1. Eat a whole-food, plant-based diet with less meat. Korbatov cites a recent study that found that if every American substituted beans for beef, that alone could bring the U.S. close to its goal of a 17 percent greenhouse gas reduction by 2020.
2.Reduce your food waste by freezing fruit and vegetable “odds and ends,” such as strawberry leaves or vegetable peels, to make vegetable stocks or enhance smoothies and salads. Or try composting.
3. Use reusable water bottles, grocery bags, food storage containers, and produce bags.
4. Opt for laptops over desktop computers—they use only a third to a fourth of the energy.
5.Unplug! “Vampire power is a real thing, and it’s scary,” says Korbatov. Plugged in devices suck up electricity even when turned off.
6. Invest in energy-saving light control strategies. New innovations include occupancy/vacancy settings, systems that dim the lights when daylight is available, and plug load controls.
7. Use blinds and curtains to decrease cooling costs in the summer and heating costs in winter.
8. Use sleep settings, built-in timers, and energy-saving modes on appliances.
9. Line dry your clothes.
10. Take showers instead of baths.
11. Wash your clothes with cold water—and while you’re at it, buy fewer of them, and only clean ’em when they’re dirty. Clothes are increasingly being made of plastics such as nylon, acrylic, and polyester, she says, so opt for natural fibers such as cotton, wool, and hemp.
12. Take your car to the shop for regular maintenance, use the eco setting if it has one, make sure your tires are properly inflated.
Take some me time
You cannot pour from an empty vessel.
It may sound cliché, but it’s true, says Debbie Miller, a certified professional life coach with Timbermountain Coaching (and C-VILLE’s CFO). And modern life, with all of the professional, personal, and social stressors we encounter daily, can be a serious drain.
Miller says that self-care is an important part of keeping the vessel—one’s emotional reserves—full. And it can be accomplished in small ways.
It starts with figuring out what feeds you emotionally, she says. Think about an activity, or a place, where you feel emotionally satisfied. Where you feel calm, relaxed, joyful—what is that activity? Where is that place?
Maybe it’s listening (and only listening) to a piece of music every day. Maybe it’s cooking, cuddling on the couch with your dog, or watching two hours of an old-school sci-fi TV show. Maybe (gasp!) you love your job.
If you’re not sure what feeds you, just try something. If it turns out that sitting on a park bench with birdsong in your ears and sun beaming on your face doesn’t feel good to you, try something else. If it does feel good, find a way to do it more (maybe even set a reminder on your iCal).
Miller emphasizes that there’s often a lot of fuel in simple things like taking a walk, savoring a square of chocolate, or inviting a friend over to share a meal.
By taking care of yourself in the ways you know you need (and minimizing your guilt about it), “you’re investing in yourself, so that you can be the best person you can be,” she says, and the benefits of that are many. You’ll be more productive at work, feel more balanced in your life, and perhaps best of all, says Miller, your relationships will be better, because your proverbial vessel will have plenty for pouring.
Photo: Tristan Williams
Skate your troubles away
With free skates, irresistible dance hits, and a relaxed, family-friendly vibe, there’s no better place to find some joy than roller skating at Carver Rec. Skating is free and open to the public on Fridays from 5-7pm, as well as Sunday afternoons from 1-5. Coast around the gym and channel your carefree younger self (bur remember your wrist guards!).
Find the right therapist
Thinking about going to therapy, but not sure where to start? Judith Carlisle, a licensed counselor, trauma specialist, and life coach with Thriveworks Charlottesville, says many practices offer a range of therapists with different backgrounds, specialties, and approaches, and it’s okay to shop around. “Therapists are never hurt if someone comes to see them and doesn’t think it’s a good fit,” she says. She recommends that clients try out a few different practitioners. Look for someone you connect with, where you “feel safe in the room.”
That said, if you’ve tried several therapists and don’t feel a strong connection, choose the one that seems like the best fit, and be patient with yourself. “Connections in life are built over time,” Carlisle notes. But it’s worth the effort, not only for those dealing with trauma, but for anyone who wants to grow: Therapy is a place where you can be safe enough to find your own voice, Carlisle says. “It’s really a luxury.”
Be a mentor
The United Way-Thomas Jefferson Area is volunteer central. Its website—cvillevolunteer.org—lists organizations that need help and Caroline Emerson, VP of community engagement, encourages wannabe mentors to come into the United Way office on East High Street. They know where immediate needs are and can help set you up with organizations, including Book Buddies, Literacy Volunteers, the Adult Learning Center, and many others. “We are very happy to work with people,” says Emerson.
Find a mentor
The United Way can help you with that, too, says Emerson. Agencies known for mentoring adults include Literacy Volunteers and SCORE Central Virginia, which matches entrepreneurs with mentors who can give business advice.
Sit up straight
Hunching over the computer? If you catch yourself in a literal slump, Robin Truxel, certified pilates instructor and owner of TruPILATES, who also holds a master’s degree in physical therapy, suggests this quick move:
Uncross your legs. Feel your feet connecting to the floor, and feel your butt bones connecting to your chair. Visualize the crown of your head reaching up toward the sky, taking your spine with it. (Take care not to perch on the front of your butt bones or thrust your ribcage forward.) Enjoy the feeling for five to 10 full breaths, a few times a day.
Truxel says this should feel good—if it doesn’t (maybe because of rigid hip flexors and/or back muscles) it could be time to visit your doctor or a chiropractor to see what’s up.
Make the most of your library
Everyone knows you can get books, CDs, and DVDs from the public library. But there’s a whole lot more on offer.
Charlottesville’s downtown branch has just introduced “health kits” and “maker kits” that come with both equipment and instructions that you can take home for three weeks at a time. “Getting started with yoga,” for example, includes a yoga mat, block, strap, DVD, and instructional materials. Maker kits include knitting, embroidery, calligraphy, and more. Parents can check out toys, free passes to the Virginia Discovery Museum, or a parking pass good for any Virginia state park, along with a backpack filled with pocket naturalist guides.
Staff at every branch can proctor exams or notarize documents for free, and can provide one-on-one tech training, says reference librarian Abbie Cox. At the downtown branch you can also digitize your photos, negatives, slides, and audio or VHS tapes, all for free by appointment.
From the library’s website, you can download e-books and audiobooks onto your phone, and access databases for language learning, investment news, auto repair, and much more. Use the “What Do I Read Next?” page to get personalized book recommendations based on your reading interests.
Finally, don’t forget all the in-person classes and events at every branch—including books clubs for all ages, crafting groups, movie nights, story times, and special events, from a discussion on homebrewing at the Crozet branch to a stuffed animals sleepover at Gordon Avenue. Pick up a program guide at any branch or go to jmrl.org.
Wear your clothes well
“Fashion you can buy, but style you possess,” American style icon Iris Apfel told Elle in 2013. “The key to style is learning who you are, which takes years. There’s no how-to road map to style. It’s about self-expression and, above all, attitude.” So whatever it is you wear, whether it’s a thrift store dress, a worn T-shirt, a three-piece suit, hospital scrubs, or steel-toed boots, it seems that the secret to wearing your clothes could be, well, you.
Get some (parenting) support
Caring for young children can be exhausting and isolating, especially if you don’t have family around to help. Parent groups can help provide support. The Women’s Initiative offers a free, parent-to-parent discussion group on Tuesday evenings, for parents with children of all ages. There’s also a Monday morning group for moms with babies.
Co-op preschools, where parents are partners in running the school, can be a great way to meet and bond with other parents, and Charlottesville has two: Chancellor Street and Molly Michie.
Downtown favorite Bend Yoga offers support for new moms (like postnatal yoga classes and a free lactation group) as well as parent-child classes. And dads can find each other through groups like Dads with Diaper Bags, on meetup.com. Parenting is tough—don’t do it alone!
Figure out your finances
Pay yourself first, says financial adviser David Marotta. That means putting money into savings, something not enough people do.
Automating makes it easier, and he suggests putting your paycheck into a savings or brokerage account and withdrawing what you need to spend for the month, rather than depositing it into checking where it’s more likely to evaporate. He also suggests increasing contributions if you have a 401(k) with your employer. “While saving is good, saving and investing are what it takes to build wealth.”
Before you can do that, you’ve got to get rid of debt, the bane of financial well-being. Marotta says those who carry credit card debt owe $9,300, on average.
Financial columnist Michelle Singletary advises debtors to list everything they owe and pay off the card with the smallest balance first, because it’s motivation to pay off the rest.
One other tip from Marotta: Cancel a subscription. “Cable just costs too much.”
Photo: Eze Amos
Know your city better
In Charlottesville, City Council meetings have become a spectator sport. Held on the first and third Mondays of the month, they’re mandatory for an engaged and vocal group of regulars, and must-see entertainment for others. The public is welcome to attend the 6:30pm meetings in City Hall, or you can watch from home on Charlottesville TV10, or through the TV10 Facebook page.
Watch councilors who have admitted their dislike and distrust of each other try to do the people’s business. Watch speakers castigate councilors during public comment, and councilors sometimes snap back (ahem, Wes Bellamy). And wonder which of three incumbents—Bellamy, Kathy Galvin and Mike Signer—will skip reelection announcements and say, “I’ve had enough.”
Not that the circus-like atmosphere has discouraged candidates. So far at least six people have declared they’re running, and if you have lived in the city a year, you can, too. It takes 125 signatures to get on the ballot; get started by checking in with the city registrar’s office.
Want to start smaller? Charlottesville has open positions on 14 boards and commissions, and City Council is accepting applications through February 21. The Housing Advisory Committee, Human Rights Commission, and Police Civilian Review Board all are looking for citizens to participate—find out more on the city’s website, charlottesville.org, where you can also learn about and give your feedback on the city budget.
Outside of the city, Albemarle County lists 22 boards with openings. And if you live in the White Hall, Scottsville, or Rivanna districts, there are open seats on the Board of Supervisors. The meetings aren’t as contentious as in the city, and because the supes meet in the afternoon, you’ll be home well before midnight.
If politics isn’t your style, there are plenty of opportunities to learn more about our town. The Albemarle Charlottesville Historical Society hosts lectures, tours, and Third Fridays talks, with upcoming discussions on the history of housing in February and eugenics in April. Monticello and the Jefferson School African American Heritage Center are also places to go to learn more about the area’s not-always-stellar history.
Jordan McNeish started the Jefferson Area Harm Reduction group to help substance abusers in Charlottesville get help without stigma.
Charlottesville resident Jordan McNeish knows the perils of opioid addiction first-hand.
Three years ago, he was on an East Coast road trip with his ex-girlfriend, and the plan was to end up in Maine. But their first stop was Baltimore, to buy heroin. McNeish, 29, says he had gone from using heroin once or twice a year to “more than I would like.”
He bought 10 bags of “Scramble,” “basically a mixture of fentanyl and low-grade heroin cut with god-knows-what,” and shot up in a Burger King parking lot. The next thing he remembers is waking up covered in the orange drinks his ex had spilled while trying to resuscitate him. An EMT had revived him using two doses of naloxone, a drug designed to rapidly reverse an opioid overdose.
“The paramedic that revived me said she thought I was done,” he says.
Naloxone saved his life. Now, he wants to make sure others have the same chance.
Charlottesville has been largely shielded from the opioid crisis, with only six overdose deaths from prescription opioids reported from 2011-2017 (compared to roughly 500 a year, statewide). But the epidemic has still touched local lives, especially as it shifts from prescription opioid abuse to heroin and fentanyl (a synthetic opioid that is often mixed with or sold as heroin, but is 50 times more powerful).
In Virginia, overdose deaths from heroin and/or fentanyl have increased from 153 in 2011 to 938 in 2017, mirroring a nationwide trend.
Charlottesville reported zero heroin deaths in 2011 and 2012, but experienced 13 over the following four years, including four in both 2016 and 2017.
Twenty-five-year-old Betsy Gilbertson was among those who died in 2016. Loved ones said the free-spirited music-lover had been clean for months before her fatal overdose.
McNeish had been friends with Gilbertson when they were teenagers, but had fallen out of touch with her. He found out about her death when he read her obituary in the Daily Progress.
Still, he continued to use. “It is hard to learn a lesson vicariously when it comes to addiction,” he says. “You always have to learn for yourself.”
Eventually McNeish, who had shot heroin the day after his overdose in Baltimore, got serious about quitting.
“I started getting really angry about drug use,” he says. “Started being a fascist about being around drugs, and I would get mad when they were around me.”
He made it a week, a month, two months, and then just kept going. “The longer it had been, the easier it was to continue not using,” McNeish says. He’s now been clean for over a year.
“Some people will hit rock bottom and they’ll just turn around and never use drugs again,” he says. “It just took me three or four tries.”
McNeish funneled his energy during withdrawal into looking for ways to help others who were addicted. He was inspired by the non-judgmental stance of places like Youth on Fire, a drop-in center in Cambridge, Massachusetts, and the New England Users Union, a harm reduction group in which current and recovering substance abusers work to keep each other safe–even if they’re not yet ready to quit.
Along with his girlfriend, Morgan Freegan, McNeish started his own group here in Charlottesville, Jefferson Area Harm Reduction. They distribute naloxone to users who need it, many of whom they know personally. But they are limited by what they can get for free from the Health Department, and by their work schedules and daily lives.
When a public health emergency was declared in response to the epidemic in 2017, the Virginia Department of Health made naloxone available for free to the public. (It can be bought over-the-counter, but even a generic costs $20 to $40 per dose).
“The fact that anybody can get it, that means it’s out in the communities,” says Dr. Denise Bonds, health director for the Thomas Jefferson Health District. She oversees the distribution of naloxone at the Virginia Department of Health in Charlottesville, and says EMTs in the district have been using it for a few years now.
Those interested in acquiring naloxone must attend a one-hour training session, held on the first Wednesday of the month. They can then pick up two doses per week at the Health Department. But McNeish argues that the treatment should be more available and anonymous. “Someone that’s using and still driving around with drugs in their pocket is going to have a hard time going to the Health Department, sitting through a one-hour training, and even doing paperwork,” he says. In December, he asked City Council to consider starting a group similar to his to help distribute naloxone.
In addition, McNeish wants the city to look into a needle exchange program to fight the spread of Hepatitis C and HIV that is prevalent in those using intravenous drugs.
“There’s virtually no place to get clean needles,” says McNeish, who contracted Hep C himself but has since been cured. “I’ve seen people use dirty or broken syringes because they don’t have a clean one.”
Currently, the state has only authorized needle exchange programs in the districts with the highest rates of Hepatitis C and HIV, so our district can’t legally distribute syringes. But Bonds says the community is “fairly well-resourced” when it comes to addiction treatment.
Addiction Recovery Systems, Region Ten, and a handful of other facilities now offer medication-assisted treatment, a proven approach that uses drugs like methadone and buprenorphine to relieve addicts’ withdrawal symptoms and cravings. Region Ten also recently opened the Women’s Center at Moores Creek, which has 12 inpatient suites and offers the opportunity for women to keep their young children (under age 5) with them while they receive treatment.
These options allow substance abusers to regain stability in their lives, advocates say.
It’s support that may be increasingly needed. “It has gotten worse here in the inner circles that I’ve been in,” McNeish says of heroin users. “One out of 10 might die in the next couple of years in that using community.”
Bestselling author Beth Macy's first book, Factory Man, told the story of a small-town Virginia factory owner fighting globalization. In Dopesick, she traces the causes and the cost of the opioid epidemic.
When the opioid crisis began to unfold, Virginia journalist Beth Macy was at its epicenter. As a beat reporter for the Roanoke Times, southwest Virginia’s largest newspaper, Macy focused on social and economic trends and how they affect ordinary people. The paper covered the stories of the addicted and their families, the corrupt doctors that both over-prescribed opioids and dealt with the aftermath, and the cops, judges, and first-responders caught up in the encroaching epidemic.
Now, more than two decades and two books later, Macy has returned to those experiences for her latest bestseller.
In Dopesick: Dealers, Doctors, and The Drug Company That Addicted America, Macy traces how the profit-driven Purdue Pharma, a drug company, began aggressively marketing OxyContin for pain, and how the cycle ultimately led to the abuse of heroin when prescription opioids became harder and harder to come by.
I spoke with Macy about the book, and what it was like to be among the first reporting on—and paying attention to—the opioid epidemic. The interview has been edited for clarity and length.
The title of the book, Dopesick, refers to the nightmarish and extremely painful symptoms a heavy drug-user experiences during withdrawal. Addicted users eventually don’t use drugs to get “high,” but to help ease the debilitating sickness that comes from quitting cold-turkey. Would you describe some of the symptoms you’ve witnessed of someone being dopesick?
Beth Macy: Sure. Almost to a person, everyone I’ve interviewed said it’s like the worst flu times a hundred. Night sweats, diarrhea, vomiting, fever, restless legs; it’s a physical pain that everyone I spoke with would spend [their whole days] avoiding feeling.
I know [Dopesick] is an in-your-face title. If people could just understand that number one, a lot of people weren’t [using] to get high, but because they’d been addicted to this drug, some of them initially through no fault of their own, maybe that would go a long way towards the public understanding and reducing the stigma that prevents some of these people from getting life-saving treatment.
Do you remember your first assignment for the Roanoke Times 20, 30 years ago?
I worked [at the Roanoke Times] for 25 years. I was the family beat reporter. My last big series I did was in 2012, a three-part series about heroin. I was following the travails of these two families whose lives had been upended by heroin. One was a 19-year-old kid who had died of overdose. And the other, the same age, his former classmate [Spencer], was about to go to prison for his role of handing him the heroin that led to his death, and of course he was an addicted user himself.
Not excusing what he did, but they were all at an apartment partying and that happened and Spencer got the blame for it. I was following him around trying to figure out what was happening, because everyone was like “what, wealthy white kids are doing heroin in the suburbs?” Nobody had any idea, myself included.
In some way this was my first experience writing about this. I had read when OxyContin first broke out in the coalfields in central Appalachia in the late ’90s, [but] I didn’t quite put together the connection between all the stories until after the series on heroin. And most people in the country didn’t…The pills are chemical cousins, when the pills get hard to get—if there’s no treatment available for people—they go out to the black market and switch to heroin. That was an important thing to get across.
Not only is it somewhat of a surprise that we see the abuse of these drugs in the middle and upper-middle class, but also how… the opioid epidemic began in a rural environment, here in Appalachia.
Right, so for that reason it was easy for it to happen in “politically unimportant” places. Regional media like the Roanoke Times stopped covering the rural hinterland. Newspapers were dying, and politicians stopped giving a crap about poor people from the mountains, as one of my sources Dr. Van Zee said. He was the first doctor in the country, from rural St. Charles, Virginia, in the heart of central Appalachia, to pick up the phone and call Purdue and say, “This drug has got to be addictive. I’ve got kids I immunized as babies showing up in the ER with overdose.” [This was] in the late ’90s. People he had treated for years, farmers and coal miners, most of them in their 70s, losing everything they had built their lives around because of OxyContin.
Your closeness with your sources, who shared their most private feelings during the darkest times in their lives, is remarkable. Why do you think you were welcomed in such a way?
The last third of the book follows the travails of Tess Henry, this beautiful former honor roll student and basketball star and poet. By the time I met [Tess] it was November 2015, she was three years into her addiction. Her dad is a surgeon, her mom is a hospital nurse, a very educated family. She grew up with a second home. I mean just not what you would expect. Not the kind of person that falls through the cracks typically in our society, and yet over and over and over, [clinic after clinic] denied her treatment. They were so worn out with it.
Unlike a lot of other people who may have said “no we don’t care to be interviewed,” [the Henrys] were like “no, come in, see us all,” and I was just so grateful to them. And similarly with some of the first responders I interviewed, drug court judges, recovery coaches, they had seen these cases for so many years, they were like, “Please. We need somebody to speak for us, we’re too worn out to speak for us.”
Dr. Van Zee, who I talked about in the book, he still works 14-hour days and I think he’s 71 now. Sister Beth Davies is 86. She’s the activist nun that also fought Purdue in the early years, she works 12-hour days. She’s a drug counselor. I mean these are incredible people, and they’re so worn out.
I saw a drug-court judge’s hair turn from salt and pepper to white in the course of about 18 months. I was shocked by the last time I interviewed him how much his hair had changed…People were coming up to him at the grocery, in tiny Lebanon, Virginia, begging him to put their children, their adult children, in drug court—people who don’t even have charges. I think I showed up at the time when they were so worn out they didn’t care about the stigma at this point. I mean, some people still do, but a lot of people are just willing to let me in.
I’m sure you were aware there was a good chance that some of the people you were speaking with weren’t going to make it. Did you prepare for that possibility, that these stories may not necessarily have a good ending?
I did. I spoke with one of my good friends, Roland Lazenby, who has written a lot of sports books, a really excellent writer. He’s been writing books a lot longer than I have.
He said you should focus on the heroes because that’s what the readers will come to identify with and those are the people who are going to help get us out of this crisis. He quoted Mr. Rogers—“find the helpers”—and that really became my lodestar, because I knew I could live in the material a bit better if I focused on the families and the first responders that were fighting back.
You know at no point in the book do I hang out with active users in the middle of their using. I hang out with active users but…I’m not necessarily living in their homeless world or watching them inject heroin into their veins. At no point do I watch anybody use or describe anybody using. That was partly to protect myself. And also so many people in America have no idea how bad this epidemic is. I wanted to write something that would illuminate it and make them care and make them really understand how hard these families and first responders are working to keep their loved ones alive.
At the end, did I know that I was eventually going to get a call that one of my main sources in the book had died? I had [seen] the data. It takes the average user eight years of fortified treatment to get one year of sobriety, I knew [with] fentanyl [emerging], people didn’t have eight years.
Tess Henry had only six. And I knew eventually I would get the call from her mother but didn’t know when and then the day after Christmas. [But] it wasn’t the call that we thought.
[Tess] was dead but she was murdered. She was left to fend for herself in this faraway city where she had relapsed and been kicked out of abstinence-only treatment. It’s another huge telltale sign of how important treatment is, that we allow the narrative that abstinence-only works, and that hurts people with opioid abuse disorder. People continue to fall through the cracks unless they are given easy access to medication-assisted treatment.
Can you elaborate a bit on medication- assisted treatment and why this form of treatment is a big point of a contention between recovery centers, law enforcement, addicts and their families, and the medical community?
Maintenance drugs are basically weak opioids that block the receptors [in the brain that allow you to get high]. Buprenorphine and suboxone…if you’re taking them like you’re supposed to, and then you shoot up heroin, you won’t feel the effects.
Study after study shows, people who take these drugs correctly with counseling are less likely to [commit] crime, less likely to relapse, and less likely to die. They are 50 to 60 percent [less likely to die], compared to abstinence-only models that show only a 6 to 10 percent (success rate). Fifty to 60 percent is pretty good, but that’s still 40 to 50 percent that it doesn’t work for all of the time, and a lot of people have to go through numerous attempts.
There is also a lot of diversion and abuse, which is why law enforcement is against it. But still, if you say your goal is to prevent overdose, there is no question that it is the number one way to do that. It’s the low-hanging fruit.
Is it accurate to say the opioid epidemic has the signs of getting worse before it gets better?
It’s completely accurate. The latest statistics from the Centers for Disease Control show that we lost 72,000 [people to drug overdose] last year, which is up 10 percent from the year before, which are largely due to opioids.
The few states that have MAT widely available, emergency room to MAT programsas a standard, and also have syringe exchanges, and harm-reduction programs in place—there’s three New England states, Massachusetts, Rhode Island, and Vermont—we’re starting to see a slight decline. But overall, epidemiologists and public health experts have shown it’s going to plateau sometime after 2020. That’s unnerving, “sometime after 2020.” These [three New England states] were early passers of Medicaid expansion. In Virginia, we just passed it. It is the number-one way to get people that don’t have insurance into treatment.
This interview was originally published by 100 Days in Appalachia, a digital news publication incubated at the West Virginia University Reed College of Media in collaboration with West Virginia Public Broadcasting and the Daily Yonder.
Victor Taylor woke up in the middle of the night, with “pancake-sized hives.”
Author John Grisham’s ears were “really, really itching.”
“We got in the car,” Grisham told Allergic Living magazine, “and I was so desperate I stripped down, took off all my clothes but my boxer shorts, and I had all the air blowing on me, and you could just see the welts.”
The cause of these mysterious reactions?
Red meat.
UVA physician Dr. Thomas Platts-Mills discovered alpha-gal allergy, commonly known as the “meat allergy,” in 2002. One of the more perplexing human allergies, it occurs when sufferers become sensitized to alpha-gal, a type of sugar present in red meat. Alpha-gal causes a delayed reaction—an affected person may eat meat, then break out in hives hours later, or even have trouble breathing. And because the allergy is believed to be triggered by a tick bite, you can develop it as an adult, even if you’ve been eating meat all your life. While it’s often associated with beef, other meats like pork, lamb, or goat can cause the reactions.
“People think it’s just red meat, but it’s all mammals,” Platts-Mills informed a patient at the UVA Allergy Clinic this fall, in his patrician British accent. “Anything with titties and hair.”
The patient, Greene county resident Frank Morris, had been diagnosed with alpha-gal allergy about a year ago, after a pork barbecue sandwich sent him to the emergency room with a rapidly swelling throat. “It was a really scary thing that night,” he says. “I usually don’t like to go to the doctor…but I couldn’t breathe, I was fighting for air.”
Platts-Mills and his team took him off beef and pork, and Morris says he was doing well. But he was back in the clinic that day after starting to have more allergic reactions, this time to dairy products. Recently, a few sips of a milkshake had made his lips swell up.
“You’re lucky,” Platts-Mills tells him. He says that with alpha-gal, most people don’t get the immediate mouth swelling that provides a heads-up that they are eating something potentially dangerous.
Sure enough, the allergy test confirmed Morris’ new sensitivity to milk, and pricks for beef and pork still produced tell-tale itchy red bumps. He was also tested for chicken, turkey, andfish, all of which came up negative. “You don’t even like fish,” his girlfriend Margie observed. But she was happy the couple at least knew the cause of his symptoms—before his trip to the ER, Morris had spent about six months getting various other diagnoses and medications from his primary care doctor.
That lack of awareness may be starting to change. “It seems like everyone either has it or knows someone who has it,” she says.
Dr. Thomas Platts-Mills, a UVA physician, discovered alpha-gal allergy, commonly known as the “meat allergy,” in 2002. One of the more baffling human allergies, it occurs when sufferers become sensitized to alpha-gal, a type of sugar present in red meat. Photo: Amy Jackson Smith
Discovering the allergy
Platts-Mills, the son of a barrister and a British member of Parliament, is the head of the Division of Asthma, Allergy & Immunology at UVA. His discovery began more than a decade ago, when he was asked to look into severe allergic reactions to a cancer drug, cetuximab. With a team of researchers, he found they were allergic to a particular ingredient in the drug—alpha-gal. Patients had developed antibodies to the sugar.
At the same time, reports of a similar allergy were arising in Platts-Mills’ clinic, independent of the cancer drug. Doing the cancer-drug allergy work, Platts-Mills helped to develop an allergy test (called an assay) for alpha-gal.
“I think the thing that I did, better than anything else, was to say we need to assay everybody in the clinic, anyone who would stand still,” Platts-Mills says. “We wanted to see what this related to.”
Researchers noticed that patients having alpha-gal reactions lived in the same area as a type of tick-borne disease, and wondered if the allergy might be triggered by ticks. (Platts-Mills says a technician on his team, Jake Hosen, was the first to suggest this connection.)
Pursuing that hunch paid off. The Platts-Mills team was able to find blood samples from people taken before and after tick bites, and to show the rise of antibodies to alpha-gal after they were bitten, ate meat, and had a reaction.
Then, Platts-Mills got the allergy himself.
In summer 2007, while this early research was happening, Platts-Mills recalls going fora hike, and having to remove tiny ticks, called seed ticks, from his legs afterwards. He ate meat rarely, but that November, he ate two lamb chops with two glasses of red wine.
“It was four to six hours later that I was covered in hives,” he says.
Ever the researcher, Platts-Mills tracked his alpha-gal antibody levels over time. He had his blood taken every week and watched the level fall as he avoided red meat and rise again after a different tick-bite incident followed by a meat meal. “I’ve done it a few times,” he says.
In March, 2008, Platts-Mills, along with Hosen and others, published a seminal article on the allergy for the New England Journal of Medicine. It has since been cited more than 1,000 times.
Alpha-gall allergy has a unusual delayed response. With a peanut allergy, Dr. Platts-Mills says, if you were exposed at a restaurant you’d know before you left. Whereas with the alpha-gal response, “you could eat a hamburger, sit for hours chatting with friends, wander out,” and still have no idea that you will have a big reaction later.
Dramatically different
Platts-Mills says alpha-gal is dramatically different from other food allergies. For one thing, unlike most allergies, alpha-gal is not species specific. “You can react to meat from a number of species,” he says, adding that some people even have reactions to eating squirrel or some other kinds of roadkill.
The delayed reaction is also not the usual allergic pattern. With a peanut allergy, Platts-Mills says, if you were exposed at a restaurant you’d know before you left. Whereas with the alpha-gal response, “you could eat a hamburger, sit for hours chatting with friends, wander out,” and still have no idea that you will have a big reaction later.
“We had a patient whose symptom was very low blood pressure, who had eaten meats all life long,” Platts-Mills says. “Just recently the symptoms started after eating meat. Three hours later, serious illness set in. You have the enigma of a person who perhaps has been eating meat for 30 or 40 years who flips into this new state.”
While the most common reaction is hives or intense itching, the allergy can also cause stomach pains, trouble breathing, and in some cases even anaphylaxis, a potentially life-threatening condition in which the body goes into shock.
Sensitivity to alpha-gal may also affect the circulatory system. An early-stage UVA study of 118 people found that those with sensitivity to alpha-gal, whether they showed allergic symptoms or not, had about 30 percent more plaque build-up in arteries than those who weren’t sensitive. The researchers also found that more of the plaques had features characteristic of unstable plaques, which are the type more likely to lead to heart attacks.
Study leader Coleen McNamara, a cardiologist who also works in UVA’s Robert M. Berne Cardiovascular Research Center, says that research calls for further clinical studies.
The lone star tick has a distinctive white spot on its back. File photo.
Putting the bite on
In our area, the alpha-gal effect seems to be primarily caused by the lone star tick, which is found on larger mammals like deer and dogs. The larvae of the lone star tick can also bite us. After feasting on our blood, mother ticks can lay 5,000 eggs, which appear as tiny specks that we call seed ticks, Platts-Mills says.
“Some people, slightly wrongly, call them chiggers,” he says. Tiny black dots you may see on your leg are most likely the larvae of the tick, he explains. They are nearly invisible.
When you get these bites, they strongly itch, which can last for a couple of weeks. If the itching reaction persists, Platts-Mills says, you may be more likely to be sensitized to meat.
“We think it is something definitely happening in response to the injected saliva of the tick, which is a complicated substance,” Platts-Mills says. “The injection into the skin causes the trouble.”
Victor Taylor, who lives in Afton, is a frequent hiker and got tick bites in the woods. He remembers one bite that didn’t heal for two weeks. “Once I removed the tick, it itched terribly,” he says. The area of the bite swelled to about the size of a quarter.
An infrequent beef eater, he had a steak a while after the initial tick bite. He awakened at 2 or 3am, and was very itchy, covered with very large hives. He had never had hives before.
“At first, I tried to take a bath to relieve the itching, but I had no idea what was causing it,” he says. The hives returned on another occasion, after he ate spaghetti with meat sauce, and then a third time after pizza with Canadian bacon on it. That’s when he realized it was a meat problem.
“I hadn’t heard anything about a tick-related allergy,” he says. “This was in 2010.” But he was treated by a nurse who had read a paper about how ticks were causing the allergy to meat and to certain cancer drugs.
In other parts of the world, Platts-Mills says, the same alpha-gal effect is happening with other ticks. He is helping a team in Minnesota to study alpha-gal outbreaks there. “It seems to be more the American dog tick in the Midwest, which is rare in Virginia,” he says.
As an aside, he adds that the tick that carries Lyme disease, often called the deer tick, actually is predominantly a mouse tick, a different species. “The bites that transmit Lyme disease generally do not itch. That species’ larvae can’t or don’t bite humans.” Researchers are “about 99 percent sure” that the tick that causes Lyme disease does not cause alpha-gal, he says.
Alpha-gal allergy and other tick-borne illnesses are a growing problem, because ticks are more prevalent in the spaces where we live. (The Centers for Disease Control and Prevention reported that cases of tick-borne illnesses doubled between 2004 and 2016, though it does not yet recognize alpha-gal allergy among these).
This is partly due to climate change, which has vastly increased the population of lone star ticks, which thrive in warm, humid weather. The ticks have expanded their range (all the way up to Maine), and warmer winters mean they’ve been able to stay active longer.
Another factor is the overpopulation of white-tailed deer, which carry the ticks. Deer stroll through many a yard and park in Charlottesville and surrounding counties, especially as increased development has pushed houses further into deer habitat. “We’re living too closely to them,” says Platts-Mills. “This simply was not happening in 1950.”
It’s hard to believe, but Virginia’s deer population was almost non-existent in the early part of the 20th century. The Virginia Game Commission began re-introducing deer to the Blue Ridge in the late 1940s or early ’50s, after commercial hunting had nearly wiped out the population. From a statewide low of about 25,000 in 1930, the deer population grew nearly tenfold by 1970, to about 215,000, according to deer project coordinators with the Izaak Walton League, a conservation society.
Today the deer population in Virginia hovers at about a million. That’s worrying, says Platts-Mills,because it is not unusual for a single deer to have 500 mother ticks busy fattening up, and deer have no way to remove the ticks from their bodies.
Treatment, but no cure
To treat a reaction, Platts-Mills says Benadryl generally works if you’re someone who just gets hives.
While the doctor’s own reactions have been “uniformly non-frightening,” he says scientists still don’t know why some people instead have the very disturbing, severe allergic symptoms (anaphylaxis) that mean they must go to the hospital. He says patients with breathing problems or any other life-threatening symptoms need to seek immediate medical attention. Morris, who has had severe reactions, now carries an EpiPen with him at all times.
While Benadryl can treat the symptoms, scientists have yet to discover a way to eliminate the allergy itself. In some people, the allergy appears to go away on its own—years later, they have no detectable antibodies and can eat red meat again without a problem. In others, the condition seems to go on and on.
Taylor, who says he misses red meat at times, has tried “microdosing” by eating only small amounts of meat—but without success.
Cutting out red meat entirely is the only known cure, says Platts-Mills. The doctor has reached a final conclusion: “I am an adult, and I don’t need red meat, so I have stopped eating it.”
That can be a tough prescription. Morris, who was born and raised on a farm, says he used to eat either beef or pork “almost every night for dinner, or for breakfast. I’ve had to change my diet completely.” The other day, even a chicken casserole had him reaching for his EpiPen (it was made with sour cream and cheese).
At the clinic, his arm still dotted with red welts, Morris asked Platts-Mills what he always asks: “When do you think I can go back to eating meat?”
Platts-Mills answered with a question that was essentially rhetorical: When do you think you’ll be completely free of any exposure to ticks?
In Greene County, that won’t be anytime soon. So Morris’ girlfriend, pondering his test results, looked for a bright side. “Maybe salmon steaks?”
Additional reporting by Laura Longhine.
File photo
Deer control
White-tailed deer, the primary hosts for the lone star tick, are among the most adaptable mammals out there. Without predators, a deer population can grown by a third or more in a season, says Bob Duncan, biologist and executive director of the Virginia Department of Game & Inland Fisheries.
Charlottesville is taking steps toward deer population control. First, it recently allowed residents to participate in the Virginia Urban Archery Season, which allows deer hunting by bow and arrow or crossbow (with the required permit).
Second, this past winter, after much debate, the city hired Blue Ridge Wildlife and Pest Management, LLC, to take out deer in city parks. Sharpshooters were brought in.
The outcome of that effort was 125 deer culled in nine city-owned parks and properties, reports Brian Wheeler, communications director for the city. Seventy-one deer were killed in Pen Park alone. The program yielded a total of 2,850 pounds of venison, which the city donated to the Loaves & Fishes Food Pantry of Charlottesville.
The City of Charlottesville plans to continue the deer-culling initiative in 2019.
Preventing tick bites
One of the best ways to prevent a tick-borne disease is to avoid getting tick bites in the first place. Here are some tips from the Centers for Disease Control and Prevention:
• Use insect repellent. Make sure it has at least 20 percent deet (a repellent chemical, also marketed as Deet brand) or use those with picaridin, IR3535, oil of lemon eucalyptus, para-menthane-diol, or 2-undecanone.
• Hikers, don’t go off trail. Try to avoid brush, tall grass, or tree limbs.
• Use 0.5% permethrin insecticide on clothing and gear. (Some gear comes pretreated with permethrin, but Consumer Reports found that permethrin-treated shirts were not as effective against bites as an ordinary shirt that was sprayed with deet.)
• Shower soon after coming inside, within two hours.
• Treat pets for ticks, especially dogs. Ask a vet about the most safe, effective prevention products
If you do spot a tick on your body,remove it immediately (see tips below). Kill the tick, keep it, and bring it to your doctor if you can. Remember, alpha-gal symptoms may appear hours after a bite.
Here are the CDC’s tips for how to remove a tick safely:
• Use tweezers to grasp the tick near its head or mouth and remove it carefully.
• Do not twist as you pull the tick out. Pull it straight out of your skin. If any part of the tick is still in your skin, remove it.
• Treat the tick as if it’s contaminated; soak it in rubbing alcohol.
• Clean the bite area with an antiseptic, like alcohol or an iodine scrub, or use soap and water.
• Do not crush a tick with your bare fingers (their juices can leak).
• Check daily for ticks on humans and pets when you go outdoors, especially in the following areas: ears, hairline, underarms, groin, bellybutton, paws.
“I don’t care whether a woman has an abortion [or not],” says Amy Hagstrom Miller. “But whatever she decides should be provided with dignity.”
Photo: Amy Jackson Smith
The confirmation of conservative Brett Kavanaugh to the Supreme Court has raised fears that Roe v. Wade could be undercut or even overturned. In fact, abortion access has been under attack for decades by restrictive state laws and regulations (more than a thousand restrictions have been passed since Roe, almost a third of them between 2010 and 2016).
But Charlottesville’s Amy Hagstrom Miller is fighting back. As the lead plaintiff in Whole Woman’s Health v. Hellerstedt, she helped secure a crucial victory against abortion restrictions in Texas, which has since been used in at least 12 other states. Now, she’s challenging similar restrictions in Virginia. Being a plaintiff, she says, serves her broader mission: to eliminate the stigma and shame surrounding abortion. On that front, she says, “I’m a ninja.”
Hagstrom Miller is founder, president, and CEO of Whole Woman’s Health LLC, which operates seven abortion clinics in Texas, Maryland, Illinois, and Missouri as well as its newest clinic in Charlottesville. Most provide comprehensive gynecological care in addition to abortion services. Whole Woman’s Health is “committed to providing holistic care for women,” says its website, and the design of its clinics and offices make that stance clear: Walls are painted a soft lilac, clinic rooms are named for notable women (including Heather Heyer), and empowering quotes from Rosa Parks, Frida Kahlo, Eleanor Roosevelt, and other influential women are stenciled everywhere.
The Charlottesville clinic is on a quiet, tree-lined street; its waiting room has wood floors, a working fireplace, herbal tea, and purple fleece blankets. But outside, the precautions are evident—the signage is small, the parking lot is hidden behind the building, and entry is controlled by intercom.
Hagstrom Miller, 51, is tall, strongly built, and smartly dressed. She looks like the high school athletic champion she was, and like the national entrepreneur she is. Her square black glasses are stylish, her blond hair is streaked, and her lipstick is bright. Her appearance is part of her work, as she sees it, to take on and take down stereotypes. When she went to hearings in front of Texas legislators, she wore business suits and pearls to counter their preconceived ideas about “abortionists.” Now a nationally known advocate, she continues to spend time in her Charlottesville clinic working with patients and staff, making sure that both feel supported.
Midwestern roots
Amy Hagstrom grew up in Minnesota in the 1970s, ina culture she describes as “Democratic farm and labor, committed to being citizens of the community—supporting bike trails, libraries, things like that.” Her upbringing was “traditional, progressive Christian/Presbyterian.” She calls herself part of the Title IX generation, because that landmark support for girls’ athletics gave Hagstrom, the youngest of five children, an outlet her two older sisters didn’t have. Participating in sports—Nordic skiing and both competitive and synchronized swimming—enabled her to recognize her personal strength and competitive drive; both her teams were state champions.
At Macalester College in St. Paul, Hagstrom began as a religious studies major. A semester abroad in India “changed my psyche and affected my behavior,” she says. Her Indian host mother faced discrimination and disapproval, even from other women, because she was a widow. “One time she went to get her beautiful long hair trimmed,” Hagstrom recalls, “and the hairdresser cut it off in a short bob, without her consent, because the hairdresser felt my Indian mother should have shaved her head after her husband died.” Her university-educated host sister’s plan to marry for love was still viewed as unusual.
“I thought so much about the things I had taken for granted and the paths many of these Indian women were still having to forge,” Hagstrom says. Back at college, she added a major in international studies and women’s issues, doing her thesis on arranged marriage and bride-burning.
In 1989, Hagstrom went to Washington, D.C., for the nation’s first national march to support reproductive rights and counter an increasingly violent anti-abortion movement. (The New York Times tallied over 100 clinic bombings and incidents of arson; over 300 invasions; and over 400 incidents of vandalism at abortion clinics between 1978 and 1993.) After graduation, committed to taking a stand on women’s rights, Hagstrom took a job at Planned Parenthood in St. Paul.
She started as a receptionist, handling eight phone lines and the front desk; soon she was involved in every task in the clinic, as well as assisting an outside physician who performed abortions. She began to see an unintended pregnancy as a crisis point at which a woman confronts an intimately personal choice affecting not only her life but, often, the life of her family. “Abortion and other reproductive decisions are not simply medical matters,” she later wrote. “When a woman makes a decision about her pregnancy and her body, she undergoes an intense evaluation of her beliefs, identity, goals, and dreams for the future.”
She witnessed anti-abortion protesters accosting women right up to the clinic door and shouting taunts and threats at patients as well as clinic staff. “The Jesus I was taught about would be holding the hands of the women inside the clinic,” she has said. “He wouldn’t be screaming at them.”
Hagstrom’s experience at Planned Parenthood solidified her conviction that the abortion debate isn’t really about abortion. “I call abortion ‘the hole in the donut,’” she says. “What’s driving the issue is what’s around that hole”—how our society views a woman’s biological and social role and her right to make her own decisions. She sees anti-abortion activists restricting access to abortion without any concerted effort to reduce the need for it, by providing women (or men) with effective sex education, reproductive counseling, and affordable birth control. One example she cites: In 2009, a grant from billionaire Warren Buffett’s family underwrote low-cost or free IUDs in Colorado’s public health clinics, and over the next eight years the teen pregnancy rate dropped by half and the teen abortion rate by almost two-thirds.
A different approach
Hagstrom married her college boyfriend, Karl Miller, and in 1994 the couple moved to New York City. Karl started graduate work in history at NYU, and Amy got a job at an abortion clinic in the city. It was an eye-opening change.
As a counselor in St. Paul, she had often started with a non-judgmental, open question like “How did you come to be here today?” to allow the woman to acknowledge her feelings about the decision facing her. With her New York patients, the same question elicited very different answers, more like “I got here on the subway. Why?”
In New York, a place with more opportunities and more cultural and religious diversity, women saw ending an unplanned pregnancy as a serious decision, but not as a moral failure, she recalled. Her conclusion: ending the stigma about abortion—and the deliberate shaming of women facing that decision—was central to empowering women to pursue their own dreams, goals, and lives.
Soon, Hagstrom Miller moved into clinic management, the business side of abortion services (what she calls “my M.B.A. time”). Even in New York, she found, getting an abortion was too often a demeaning, impersonal, and non-supportive experience. In addition, limited public funding or health insurance coverage hit low-income and poor women—the majority of those seeking abortions—the hardest. “It was sad,” she remembers, “to see women pawning their possessions to pay for a procedure they needed.” Hagstrom Miller wanted to build her own, holistic approach to providing abortion services. When she was recruited to turn around a struggling abortion clinic in Austin, Texas, in 2003, the couple picked up stakes.
Her husband, who had finished his Ph.D., got a job at the University of Texas at Austin. And Hagstrom Miller set to work revamping the Austin clinic, drawing on her counseling and managerial experience from St. Paul and New York City. She also had the support of a group of high-powered and committed professional women working in reproductive health and social justice, who called themselves “the November Gang.” Formed in November, 1989, the group has been meeting twice a year ever since. They provided Hagstrom Miller with advice on clinic administration, staff development, and finance.
Her new company, Whole Woman’s Health, concentrated on patient service—“everything from how we answered the phones to what the waiting room looked like,” Hagstrom Miller says—and on employee support and empowerment. In the process, she tripled revenue. “I found that I could expand access, improve the quality of counseling, and justify the counseling end to the business people, while keeping our focus on that seminal moment [for the individual woman].”
Her success made Hagstrom Miller the go-to person for abortion providers looking to sell or retire. By 2004, she owned three clinics in Texas, and was actively involved with every patient, she says. Next, she bought a clinic in Maryland, where her role was more to train the manager and staff in the Whole Woman’s Health approach. In the process, she was building a national company and developing her business and employee development skills.
Building her own firm was Hagstrom Miller’s graduate education in finance. “I’ve used every form of financing there is,” she says, “because you can’t get a bank loan as a female abortion provider.” She has built her business using angel investors, seller-financing, and now foundation funding through the Whole Woman’s Health Alliance, a non-profit that owns several of her clinics while Whole Woman’s Health LLC manages them. All her clinics accept Medicaid and health insurance, and work to find funding sources so that no woman is turned away because she can’t pay.
While Hagstrom Miller has become a successful entrepreneur—on the table in her corporate office waiting room are fact sheets about abortion, a copy of House & Garden, and an issue of the Harvard Business Review—her goal is not making money: “What we are providing is the supportive experience,” she says. “I don’t care whether a woman has an abortion [or not], but whatever she decides should be provided with dignity.”
Sean Mehl, the clinic director at Whole Woman’s Health in Charlottesville, has worked with Hagstrom Miller for years.
‘I had to litigate’
By 2010, the Hagstrom Miller family’s life was full: Whole Woman’s Health was running six facilities, Karl was making a name for himself as a professor and scholar of American popular music, and the couple had two sons. But at the same time, the Texas legislature was enacting significant restrictions on abortion providers. Clinics around the state were closing. “It became a matter of survival,” Hagstrom Miller says. “I had to litigate.”
Hagstrom Miller’s first lawsuit challenged a Texas law mandating that a woman seeking an abortion undergo an ultrasound first, a requirement with no medical basis. She won in district court in Austin, but lost in the Fifth District circuit court in New Orleans, and decided not to appeal. The experience did, however, open her eyes to how abortion opponents around the country were using state legislatures to undercut Roe. The mandatory ultrasound law she challenged in Texas, for example, was later passed in Virginia and several other states.
In 2013, Hagstrom Miller and pro-bono lawyers from the Center for Reproductive Rights filed Whole Woman’s Health v. Hellerstedt. It challenged Texas law H.B. 2, which required abortion clinics (the majority of which are outpatient facilities) to meet the same regulatory standards as ambulatory surgery centers. The bill’s supporters claimed this was necessary to protect women’s health, but the immediate impact was to force clinics throughout the state to close, including two owned by Whole Woman’s Health. Women were calling in desperation, trying to find a clinic that was still open. In a 2016 interview, Hagstrom Miller recalled, “One woman told us ‘I can’t travel to San Antonio, I have three children, I’m working two jobs—I’m going to tell you what’s in my medicine cabinet and what’s under my sink, can you tell me how to do my own abortion?’ We have many stories like that.”
Sean Mehl, now clinic director at Whole Woman’s Health in Charlottesville, was working at Hagstrom Miller’s clinic in Fort Worth when H.B. 2 went into effect. “Everything was up in the air,” he recalls. “When the law closed us down, we had to call patients to cancel their appointments [for abortion procedures] and we couldn’t reschedule.” When the district court ruled for Whole Woman’s Health and issued an injunction, the clinic re-opened—but no one knew for how long. “We would see as many patients as we could while we could.” Because their San Antonio clinic was attached to an ambulatory surgical center, it could stay open; “we would refer women there, even bring our Fort Worth patients in,” he says. “But Texas is a big state, we couldn’t help everyone.”
Challenging the law had its costs, however. Whole Woman’s Health had to provide the court with more than 10,000 emails and seven years’ worth of clinic documents demonstrating the law’s impact. “The sad thing was that the load of paperwork involved took the best and brightest of my staff off actually helping patients,” Hagstrom Miller says.
Trying to keep clinics open while handling litigation costs left Hagstrom Miller “hugely in debt.” And it made her a public figure, recognized wherever she went. Looking back, she says, “I didn’t know it then, but my husband believed he had to get me out of Texas.”
As an employee at a state university, Karl was also affected by the state’s increasingly conservative government. When the University of Virginia’s McIntire Department of Music recruited Karl in 2014, the family was ready to go. Hagstrom Miller liked Charlottesville’s greenery and changing seasons—“more like Minnesota”—and its university town atmosphere.
For the next two years, while Hagstrom Miller waited on the litigation process, she was living in Charlottesville. “Nobody knew me here—it was surprisingly nice,” she says. “I hadn’t realized how much [the atmosphere in Texas] had affected me. And it was really good for our family.” One day, another mother on a school field trip recognized Hagstrom Miller from the abortion rights documentary Trapped, which the local Planned Parenthood chapter had screened for a fundraiser–without realizing one of the film’s featured advocates was living nearby.
Still fighting
The Whole Woman’s Health decision finally came down on June 27, 2016. The Supreme Court ruled 5-3 that states cannot place restrictions on the delivery of abortion services that create an undue burden on women seeking an abortion. One factor in the decision: Texas’ lawyers maintained the law’s restrictions were intended to protect women’s health, but when questioned could not produce any medical studies or statistics supporting those claims.
Above Hagstrom Miller’s standing desk in her Charlottesville office is a photograph of her on the steps of the Supreme Court that day, beaming against a summer-blue sky. The first thing she did was hold a conference call with her staff and clinic managers in Texas, to tell them of the victory and let them know the clinics would stay open. “It was a very powerful thing, to see my work bear fruit,” she says.
Overturning the Texas law, however, doesn’t automatically wipe away restrictions in other states; each state’s laws have to be challenged in court. “Before, we challenged a law so we could get an injunction to stop it being implemented,” she says. “Now we have the basis to clear out laws based on a new standard.” Whole Woman’s Health has been used to support lawsuits in at least 12 states, including Virginia. Part of Hagstrom Miller’s national strategy is to open clinics in states like Virginia that are classified as “extremely hostile” to abortion rights, so she has standing to bring legal challenges.
In 2016, Hagstrom Miller bought an existing clinic in Charlottesville. Women’s rights groups here and around Virginia were excited. “Virginia women now have an additional option for quality, compassionate, affordable reproductive health care access, and a fierce advocate for women’s dignity and autonomy,” says Anna Scholl, executive director of Earlysville-based Progress Virginia, an advocacy organization promoting progressive policies. While the purchase was part of Hagstrom Miller’s legal strategy, it also allowed her to return at least part-time to clinic services. “I missed the touchstone of working with women,” she says. “And from here, we are within reach for so many underserved women. There’s only one abortion provider south and west of here, in Roanoke; only one in West Virginia; and clinics in North Carolina are closing.”
In June 2018, Whole Woman’s Health and three other abortion providers in Virginia filed a new lawsuit in federal court in Richmond, challenging a range of laws, regulations, and licensing requirements built up over the last 40 years. Tarina Keene, executive director of NARAL Pro-Choice Virginia (not a party to the lawsuit), says, “Having Amy and Whole Woman’s Health in Virginia is really welcome—they are an advocate as well as a provider, and they bring clout.” The lawsuit, Falls Church Medical Center v. Oliver, is set for trial in April 2019.
There are women’s rights advocates and legal strategists who shy away from bringing challenges now that Justice Kavanaugh has been seated. Does Hagstrom Miller have concerns that the Virginia lawsuit, or the ones in Texas and Indiana that Whole Woman’s Health is part of, might provide the Court an opportunity to limit or even overturn Roe?
“Winning at the Supreme Court [with the Texas H.B. 2 challenge] was a long shot,” she points out. “What if we hadn’t brought up our case because we were worried about how [Justice] Kennedy would vote? It’s not just about winning, it’s about the chance to raise the narrative about abortion in this country. Women deserve to be treated with respect and with dignity.”
She recalls the day of the Whole Woman’s Health ruling: “I knew we had won because [Justice] Breyer was reading the decision. And then he kept on reading… and I realized how many states we could help.” And then you see the inner steel of the champion athlete, the social conscience of the Midwestern progressive Christian, the commitment of the woman who came back changed from India: “It’s always the right time,” she says, “to do the right thing.”
The state of abortion laws in Virginia
In 2006, the Guttmacher Institute, a research and policy organization focused on reproductive rights, classified Virginia as one of 19 states “hostile” to abortion rights. The organization identifies states as “supportive/middle-ground/hostile/extremely hostile” based on an analysis of state laws and regulations. At that time, only Ohio and Alabama were classified as “extremely hostile.” By 2016, Virginia had become one of 22 “extremely hostile” states.
The following abortion restrictions are among those on the books in Virginia as of May 2018:
• Health insurance for the state’s public employees covers abortion only in cases of rape, incest, danger to the woman’s life, or fetal impairment.
• Medicaid funding for abortion is only allowed in cases of rape, incest, danger to the woman’s life, or fetal impairment.
• Health plans in the state’s Affordable Care Act health exchange can cover abortion only in cases of rape, incest, or danger to the woman’s life.
• If the woman is a minor (under age 18), her parent must consent and must be notified before the procedure is performed.
• A woman seeking an abortion must be given state-mandated information, including booklets designed to discourage abortion, at least 24 hours (or two hours if she lives more than 100 miles away) before an abortion procedure.
• The “Two-Trip Mandatory Delay Law:” A woman seeking an abortion must undergo an ultrasound at least 24 hours (two hours if she lives more than 100 miles away) before undergoing the procedure; the abortion provider is required to offer her the option to view the ultrasound image.
• Abortions, even those induced by medication, must be performed by a physician, excluding advanced practice clinicians, licensed nurse practitioners, and physician assistants (who are qualified and allowed to perform abortions in many other states).
• Second-trimester abortions must be performed in a facility that meets all the regulatory requirements of a licensed hospital. This law was enacted in 1975, when most second-trimester abortions were performed by inducing premature labor—a procedure now rarely used.
Falls Church Medical Center v. Oliver, scheduled to be heard in April 2019, challenges the last four restrictions cited above.
In addition to these barriers, as of 2014 roughly 92 percent of Virginia counties did not have a single clinic providing abortion services.
Ian Dixon and Sara Stovall, at a Charlottesville for Reasonable Health Insurance meeting in December at Random Row Brewery, have raised more than $17,000 and hired a powerhouse lawyer to question Optima’s tripled health insurance premiums.
Stephen Barling
After Charlottesville earned the dubious distinction of having the most expensive health insurance premiums in the country, some of the area residents who couldn’t afford to pay $3,000 a month formed Charlottesville for Reasonable Health Insurance and retained a lawyer who’s made a career out of keeping insurance companies honest.
Washington, D.C., attorney Jay Angoff was hired to implement the Affordable Care Act in 2010, and before that he was the commissioner of insurance in Missouri. He has worked for Ralph Nader, and he published a landmark study in 2005 that showed how insurance companies artificially inflated malpractice insurance rates for doctors, which in turn increased prices throughout the system.
“He developed a reputation for using the legal system to fight for the little guy against Goliath insurance companies,” says the Washington Post.
And that’s why Sara Stovall and Ian Dixon are happy to have Angoff on their side.
“We’re hoping the name recognition of our attorney and the details our letter has” will get the Bureau of Insurance to take another look at Charlottesville’s rates, says Dixon.
On January 4, Angoff sent a nine-page letter to the Bureau of Insurance detailing ways Optima Health calculated its premiums here that he says are “excessive” and even a violation of federal law.
For example, Charlottesville has a rating factor of 1.579 that far exceeds any other geographic area in the state and that of other carriers, which use 1.07 or lower for this area. Optima executives told Stovall and Dixon that rate was in part because of “the relative health of the population that’s buying.”
Optima spokesperson Kelsea Smith says, “We did not violate the guidelines” and comments the company did “are simply false.”
Angoff also points out that Optima’s own rating factor to insure small groups in Charlottesville is .937, a difference that “would seem to have no rational basis.”
Angoff calls Optima’s 8 percent profit factor in its individual premium rates “unjustifiable” for a nonprofit. And because Optima uses a 5.7 profit for its small group rates, individual policyholders may be subsidizing small group policyholders, says Angoff. He suggests the bureau “may wish to consider whether such a strategy could reasonably be considered unfair discrimination.”
The profit margin “was merely an estimate,” and Optima has lost $32 million over three years on the exchange, says Smith.
Angoff notes that Optima’s ownership of Martha Jefferson Sentara should enable it to negotiate favorable terms for those it insures and to provide leverage with UVA Health System, which Optima has claimed charges higher rates and is more expensive to cover.
That allegation drew a letter to the Post from Richard Shannon, UVA executive vice president for health affairs, who disputes Optima’s assertion that UVA is the reason premiums skyrocketed. He says Optima clients account for fewer than 1 percent of commercially insured patients cared for at UVA, and “Sentara has the opportunity to benefit from these higher premiums while paying itself as a care provider.”
Shannon also takes issue with Optima’s claim that Charlottesville is a high-cost region for health care, and cites a 2015 New York Times article that puts this area 85th lowest among 306 hospitals nationwide for commercially insured beneficiaries.
The challenge could be a first. Dixon says he’s “not aware of a consumer who’s challenged an insurance company on its rates.” And some of the details brought out in Angoff’s letter “are a hard thing for the Bureau of Insurance to dismiss,” he says.
At press time, the Bureau of Insurance had not responded to the letter. “We’re super impatient,” says Stovall. At the same time, she realizes, “We need to give the bureau the space and time to do their investigation.”
In her dream scenario, she hopes “it will motivate the bureau to take immediate action and modify the rates,” she says.
And there’s some urgency for those who lost coverage when their provider pulled out of the area. “Everybody using the Affordable Care Act before qualifies for a special enrollment period until March 2,” says Stovall. “We’re still mad as hell about it and because there’s this special enrollment period, we feel like this is something we can fight for,” says Dixon.
Stovall sees longer-term damage from the tripled health insurance premiums, which could deter someone considering starting a small business and could set a precedent for another insurance company to use the rates as a basis for setting its own.
Says Dixon, “Anyone coming to this area could say this is a very expensive area.”
