Southwest Va.'s Mortality Mystery

Jody Hershey, director of the New River Health District, said several factors that the study suggests for the drop in longevity come down to lifestyle choices. But in an area struggling economically, where the day's gas prices might determine whether it's worth a drive to the doctor's office, it's not always easy to push preventive measures, he said.

"If you are struggling to put food on the table, you don't have time to think about prevention," Hershey said, adding that lack of health insurance is a significant problem in southwest Virginia.

On Main Street in the town of Pulaski, economic distress is clear. "For Sale" signs hang on several storefronts, and even at lunchtime, few people stroll the streets. It wasn't always like this, business owner David Allen said.

"This place was elbows to elbows walking down Main Street," he said. "This was where everybody came to shop."

That was before popular stores left and major manufacturers, such as Pulaski Furniture, where many residents worked, closed. Now everyone talks about expected layoffs at Volvo, a major employer.

"It's going downhill," John Stevens said. "We even lost a Wal-Mart here. Who loses a Wal-Mart?"

He and his brother Skip Stevens are the fourth generation to run the funeral home. They have seen a rise in requests for cremations, another sign of financial strain, they said. Cremation runs about $2,000, burial four times that.

The life expectancy study, published Tuesday in PLoS Medicine, an open-access journal of the Public Library of Science, found that the drop was not limited to any race or ethnicity but that it was more common in rural and low-income areas. Radford, population 16,000, is viewed as less of a blue-collar community than Pulaski County, population 35,000. But the two localities face many of the same health issues, officials said.

"Across the board, the lifestyles here are relatively unhealthy," said Stuart Goldstein, a local general surgeon. "People are born and raised on fast food." He said it's not unusual to see parents smoking in the car with their children and the windows rolled up.

Goldstein said that he sees many cases involving cancer of the throat, head and neck and that the number of gallbladder disease cases -- influenced by factors known as the "five F's": female, forty, fertile, fair and fat -- "is unreal."

Lynne Metzler, who overseas diabetes treatment for Carilion New River Valley Medical Center in Radford, said many patients expect to get diabetes because their mothers and grandmothers had it. She said that for many, the surprise comes not with the diagnosis but with the realization that they "don't have to lose a leg" or "go on dialysis."

Health-care providers said it is not unusual to find that women, who handle most of household health-care decisions, tend to put their health problems last.

Judy Opincar, 48, unemployed and on disability, said she knows she should have started taking care of herself sooner. She has high blood pressure, high cholesterol and diabetes, but it took her mother's death in December, at 69, to spur her to diet.

"That was the wake-up call," Opincar, who weighs 250 pounds and hopes to qualify for gastric bypass surgery, said. "I'm built exactly like her, and I don't want that to happen to me."

When her twin sons were little, she said, she cooked every night. But now, with only herself to care for, she said she either turns to the microwave or finds herself at one of many fast-food options on "Hamburger Row" near a bridge that divides Radford and Pulaski.

She met her friend Carol Agee at Wendy's on Wednesday for dinner. Both struggle with their weight and are helping each other make changes, if only incremental. Opincar passed on the fries with her spicy chicken sandwich, and Agee said she has limited her eating out to about five times a week.

"You're doing better," Opincar told her.

"That's pretty bad when that's better," Agee said.

Officials in both localities point to initiatives to improve health. A state-of-the-art recreation center in Radford is free to residents, said Mayor Thomas L. Starnes, who frequents the city's five miles of trails. Pulaski County Administrator Peter M. Huber pointed to the area's two state parks, a speedway, a fairgrounds and many ballfields.

Esther Britt, described at her funeral as a "spitfire," worked as a nurse at one point. But it was clear that by the time she died, she had taken better care of others than herself. She smoked a pack and a half of cigarettes a day and ate as much as she wanted, Mary Britt said.

Her sister's illnesses and ailments were many: gallbladder disease, a degenerative disc in her back, bursitis in one shoulder, arthritis in the other, carpal tunnel syndrome, a hiatal hernia and diabetes. Recently, a tracheal tube was inserted to help her breathe. Her family traces the beginning of her decline to a car accident in her late 20s that shattered her ankle and eventually led to the amputation of her lower left leg.

"She's had every type of surgery you can think of," Britt said. "And each time she'd get a little down and then pick right back up again."

A day after the funeral, Britt stood at her sister's flower-laden grave and pointed to two untouched patches of green nearby. One is where she will be buried, next to her sister, and the other is where their mother will lie.