Sentara Martha Jefferson Summer 2022 Magazine

Sentara Marthamagazıne Jefferson SUMMER 2022

Finding

Happiness Better Health After Weight-Loss Surgery

PLUS: Joint Replacement Surgery Revitalizes Patients Building Relationships and Healthier Lives | Sleep is the Best Medicine

PRESIDENT’S

LETTER

Dedicated to Caring for Our Community Rita Bunch President, Sentara Martha Jefferson Hospital

SENTARA MARTHA JEFFERSON BOARD Carol Hurt | Chair Lillian BeVier Robert Broermann Rita Bunch, President Joshua Fischer, MD Paul Gaden Michael Gentry Samuel Hawley John Ligush, MD Lawrence Martin Douglas Moyer E. Ray Murphy Lou Patalano SENTARA MARTHA JEFFERSON ADMINISTRATORS Rita A. Bunch, MPH, FACHE President Amelia S. Black DNP, RN, NEA-BC Vice President, Chief Operating Officer Johnsa Morris, MHA, MBA, RN, NEA-BC Vice President of Patient Care & Chief Nursing Officer Paul Tesoriere, MD , FHM, FACP Vice President, Chief Medical Officer SENTARA MARTHA JEFFERSON MAGAZINE EDITOR Alyssa Pacheco CONTRIBUTORS Jennifer Stover Preston Knight Lisa Smith PHOTOGRAPHY Luca DiCecco Andrew Shurtleff DESIGN Picante Creative

A

s I write this, I am approaching my six-month anniversary at Sentara Martha Jefferson Hospital. During these past months, I have had the privilege of meeting team members from all areas of our facilities, as well as many of you out in our community. The thing that has struck me most in that time is the commitment I have seen to Sentara Martha Jefferson. I’ve heard from many people how dedicated they are to our hospital and to our team, and how proud they are to be a part of it.

And they have so many reasons to be proud, as evidenced by the accolades Sentara Martha Jefferson has been granted in my short time here. For instance, we recently received a 5-star CMS rating and an A grade in the spring 2022 Leapfrog Hospital Safety Grade. In addition, our Family Birthing Center has been recognized on Newsweek’s 2022 list of America’s Best Maternity Hospitals. Earlier in the year, we also earned certification from DNV GL Healthcare as a Comprehensive Stroke Center, reflecting the highest level of competence for the treatment of serious stroke events. In total, only seven stroke centers in Virginia and approximately 125 across the country hold this top designation.

Of course, none of this would be possible without our team members from every department, and I am grateful to each and every one of them.

While we always appreciate receiving recognition for our hard work from these national organizations, it is even more meaningful to be recognized and appreciated by our community members.

We have truly felt the benefits of your kindness in so many ways. You can read about just one of many such examples on page 44 in our article about the Baby Wall in our Family Birthing Center. Those who have supported the Baby Wall make possible a host of programs serving mothers and babies, including prenatal classes, support groups and additional educational resources for obstetrics nurses— helping to make a real difference for growing families in our community.

You’ll also see firsthand accounts of how two of our surgical specialties have improved quality of life for our patients. On page 19, you’ll read about two of our team members who decided to create lasting change in their lives by undergoing bariatric surgery and achieving long-term health improvements. Further along, on page 29, you’ll hear how our orthopedic experts have helped patients recover from injuries and get back to doing what they love.

On another subject, you may have seen Sentara Healthcare’s 2021 Community Impact Report released in May of this year, which outlines the system’s $254 million investment across Virginia and North Carolina. These dollars are working to care for the uninsured and underinsured, tackle health inequities, and address social determinants of health, and we are grateful to be able to share some of these dollars locally in areas that need it most. As you’ll read on page 24, our Community Health Needs Assessment is a significant determining factor in where these impact dollars go. Sentara Martha Jefferson has always been proud to partner with a wide variety of local organizations to advance health equity, and Sentara’s investment has helped us expand that reach. Be sure to read our Sentara Cares section on page 17, which highlights some of the local partners we work with to create lasting improvements in our community.

As you read this issue, I hope our dedication to the health of our community members comes through. Our commitment to carrying on the Caring Tradition and providing excellent, highly skilled, compassionate health care is strong, and we are dedicated to meeting your family’s and our community’s needs for generations to come.

Best wishes for a safe and healthy summer.

Rita Bunch

President, Sentara Martha Jefferson Hospital

CONTENTS SUMMER

2022

Features

19

Patients Find Happiness, Better Health After Weight-Loss Surgery

24

Collaborative Assessment Seeks to Create Positive Community Changes

28

28

Joint Replacement Surgery Revitalizes Patients New materials, techniques speed up recoveries

CONTENTS

Departments 14

17 Sentara Cares 33 Clinical Excellence

Building Relationships and Healthier Lives

36 Health Matters

Protect Yourself from Ticks

Importa D E P A R 37 T LaMSalud E N T S

Protéjase de las Garrapatas

38 Aging Well

Sleep is the Best Medicine

41 Caring Tradition President’s Letter Inside front cover

3 The Best Medicine 4 New & Noteworthy 6 Physician’s Perspective

11 33 36

9 On-Call Advice 11 Improve Health Every Day 14 Eat Well, Live Well

38

BY MICHAEL CORDELL

THE BEST

MEDICINE

Six Summer Helpful Health Tips (things I learned the hard way, so you don’t have to)

1

The sun is really hot. I don’t just mean “really hot,” as in you don’t need to wear a jacket. I mean really hot, as in its core is 27 million degrees Fahrenheit (I’m not sure what that is in Celsius since, you know, I’m an American, but it’s probably another sizable figure). If you’ve ever baked a chicken, you likely did that for an hour at 350 degrees—which isn’t even close to 27 million degrees—and look how that turned out for the chicken. So don’t lie out in the sun without wearing proper sunscreen. Nobody wants to look like a baked chicken.

2

Stay hydrated, especially if you’re going to be out on a hot day. I’ve heard people say they weren’t worried about the temperature because it was a “dry heat.” You know what else is a dry heat?

My oven. But if you spend a few minutes inside a heated oven, you’re going to wish you had brought along a bottle of water. You’ll also question your decision to crawl into an oven, especially if there’s chicken in there with you, because that means you’ll likely be in there for at least an hour.

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When water skiing for the first time, if you fall, let go of the rope. This may seem like common sense, right? But when I first tried water skiing, I fell face-first and the skis flew off, yet I kept holding on to the rope. After spending longer than one would expect having my face power sanded by the water, I thought to myself: “Here’s an idea—let go of the rope!” I still don’t understand why it took me so long to figure that out. Maybe it was due to the fact that my head felt like it was in one of those paint-mixing machines at the hardware store.

If you decide to play pickleball for the first time— especially as an older adult—don’t be fooled by the cutesy name. The word “pickle” makes it sound fun and simple. A kitten named “Pickles” brings a smile. Being asked, “Would you like pickles with that?” is always a happy question for me (unless, I suppose, I’m ordering ice cream). But pickleball isn’t like hopscotch, especially if you’re playing against an experienced player determined to crush

you and take ownership of your soul. People fall down playing pickleball. They dislocate shoulders. I’d be curious to see if one of the most common reasons for emergency department visits by older people had the word “pickle” in it—and not because they were scratched by Pickles the kitten. I’m not saying you shouldn’t play—I’m just recommending going slow at first.

5

If you go swimming—especially in the ocean—be sure not to wear contact lenses. Not only can your eyes get infected by doing so, but the water might wash out a lens, and then you’ll spend the rest of the day looking for it. You know how hard it can be to find a contact lens dropped in the bathroom at bedtime? Imagine how difficult it would be trying to find one in the ocean. I searched for hours the last time I lost one, and when I finally found it and put it back in my eye, it turns out I had actually found a really tiny baby jellyfish.

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Never put a jellyfish in your eye, regardless of how small it is.

7

So enjoy your summer, but be smart about it.

In other words: Don’t be like me—although that’s probably a good general rule, regardless of the season. sentara.com

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new &

noteworthy

Sentara Martha Jefferson is pleased to welcome the following new providers into the hospital community.

To get connected with one of our providers, or for more information on any caregiver at Sentara Martha Jefferson, please call 1-800-SENTARA.

Christopher T. Bell, MD Anesthesiology Sentara Anesthesia Specialists LLC

James Dillard III, PA-C Emergency Medicine US Acute Care Solutions

Lawrence W. Livengood, PA Orthopedics Sentara Martha Jefferson Orthopedics and Sports Medicine 434-654-5575

Catherine Dabrowski, MD Anesthesiology Sentara Anesthesia Specialists LLC

Neil F. Donovan, PA Gynecology Center for Advanced Gynecology PLLC 434-234-4903

Mary Carolyn C. Vinson, DO Thoracic Surgery Sentara Martha Jefferson Medical & Surgical Associates 434-654-5260

DNV GL Healthcare Recognizes Sentara Martha Jefferson as a Comprehensive Stroke Center Healthcare

Sentara Martha Jefferson Hospital recently earned certification from DNV Accreditation Services GL Healthcare as a Comprehensive Stroke Center, reflecting the highest CERTIFIED level of competence for the treatment of serious stroke events. Only Comprehensive seven stroke centers in Virginia, among approximately 125 stroke centers Stroke Center nationwide, hold this top designation.

“The Sentara Martha Jefferson Hospital Stroke Program is a critical Quality & Patient Safety asset to our community,” says Melanie Winningham, MD, vascular neurologist and stroke medical director at Sentara Martha Jefferson. “Our multidisciplinary team works tirelessly to ensure we offer the personnel, infrastructure and expertise to diagnose, care for and support stroke patients who often require highly intensive medical care, specialized diagnostic testing, and a full complement of neurosurgical and neuroendovascular interventional therapies. We are committed to providing the best care possible to our community, and the emergence of Sentara Martha Jefferson Hospital as a certified Comprehensive Stroke Center is an important step in improving the systems of care for our stroke patients and their families.”

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SUMMER 2022

Recognition for the Sentara Martha Jefferson Women’s Health Team The Sentara Martha Jefferson Family Birthing Center has been recognized as part of Newsweek’s 2022 list of America’s Best Maternity Hospitals. The award, which acknowledges hospitals for high-quality maternal and newborn care—based on service line reputation, clinical performance data and patient satisfaction—highlights the Family Birthing Center’s ongoing commitment to providing the highest-quality maternity care to the patients we serve within our community. Additionally, the International Board of Lactation Consultant Examiners has recognized Sentara Martha Jefferson Hospital as an International Board Certified Lactation Consultant Care Award Facility.

Sentara Martha Jefferson Hospital Recognized with

Top Rating for Hospital Safety Sentara Martha Jefferson Hospital received an A rating for the Spring 2022 Leapfrog Hospital Safety Grade, a national distinction recognizing safety fundamentals in protecting patients from errors, injuries, accidents and infections. An independent national watchdog organization committed to healthcare quality and safety, the Leapfrog Group assigns letter grades of A, B, C, D and F to hospitals nationwide, updating its ratings every six months.

This is the only hospital rating program based

Save the Date!

20th Annual In The Pink Tennis Tournament September 23 & 24, 2022 Mark your calendars, get yourself some pink sportswear and join us in the fight against breast cancer at the 20th annual In The Pink Tennis Tournament! Get ready—this year we're adding pickleball to the fun!

All of the funds raised support Marianne's Room, which provides free wigs and scarves to cancer patients in our community, as well as other patient services. Visit mjhfoundation.org to learn more.

exclusively on hospitals’ prevention of medical errors and other harms to patients in their care.

“I’m deeply proud of the quality of care we provide to our patients and community,” says Rita Bunch, president of Sentara Martha Jefferson Hospital. “Our team strives toward excellence and consistently looks at ways to improve our systems. This recognition highlights the ongoing dedication put forward daily to keep our patients safe, and we are proud to be recognized for the work we have done.”

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PHYSICIAN’S

PERSPECTIVE

The

Mechanical

VENTILATOR A key, lifesaving tool for patients and caregivers

O

n a basic level, the mechanical ventilator is a sophisticated machine that pushes air into the lungs, providing oxygen and forcing out carbon dioxide, essentially simulating human respiration.

Over the years, the Sentara Martha Jefferson Intensive Care Unit (ICU) has grown both in capacity and in the hospital’s ability to care for critically ill patients—and mastery of mechanical ventilation has played a key role in those advancements.

In fact, one of the most common reasons patients are admitted to our ICU is the need for mechanical ventilation.

Often called a “life support machine,” the device is actually used in a number of different clinical situations—including in the operating room, to help keep the patient’s airway functioning properly and support breathing during surgical procedures.

What is Mechanical Ventilation?

Of course, the human body needs to breathe in oxygen and breathe 6 |

SUMMER 2022

out carbon dioxide—both processes are essential to the body’s optimal functioning. For patients with low oxygen levels or elevated carbon dioxide levels, which can result from numerous pathologic processes, mechanical ventilation can help them breathe properly.

Francis B. Ansa, M.D.

Mechanical ventilation is generally split into two general categories: first, invasive ventilation, which requires endotracheal intubation, during which a tube is inserted into the patient’s airway; and second, noninvasive ventilation, which does not require intubation and is used both in the hospital and, in some cases, at home. This article will focus primarily on the invasive variety.

Indications for Mechanical Ventilation The primary indication for mechanical ventilation is to support patients who have developed respiratory failure due to an underlying illness that may be affecting the lungs and respiratory muscles, directly or indirectly.

Other common indications include a patient’s inability to maintain a properly functioning airway, such as after a severe stroke that causes unconsciousness, and upper-airway obstruction resulting from severe throat swelling due to an allergic reaction.

Placing a Patient on Mechanical Ventilation After administering medications to sedate the patient, the endotracheal tube is introduced under direct vision through the mouth—or occasionally through the nose—into the trachea, and then secured in place. Via tubing, the ventilator is then connected to the open end of the endotracheal tube. The ventilator mode and other parameters—such as volume, pressure, rate of air flow, etc.—are then set by the respiratory therapist in collaboration with the supervising practitioner.

What Happens When a Patient is on Ventilation?

Once the initial process of placing the patient on the ventilator is completed, caregivers quickly

turn their focus to maintaining the patient’s comfort. Since the endotracheal tube is inserted between the vocal cords, which is generally uncomfortable for the patient, the nurse typically administers medications such as sedatives, analgesics and paralytic agents. This also helps to prevent adverse effects like dislodgment of the tube, vomiting and aspiration of stomach contents, increased oxygen demand, injury to the lungs, etc.

ICU nurses will then make frequent, ongoing adjustments to medications and ventilator settings to achieve ventilator synchrony, which occurs when the patient’s respiratory requirements appropriately match the level of support being provided by the ventilator.

Taking the Patient Off of the Ventilator When the physician makes the determination to take the patient off of mechanical ventilation, the ventilator is placed in a mode to allow spontaneous (nonmechanical) breathing, a process called the spontaneous breathing trial.

This process helps to determine whether the patient can both oxygenate and ventilate properly, and to assess whether the patient has adequate respiratory muscle strength.

Most, if not all, of the sedation and analgesia medications administered during ventilation are then reduced or discontinued to allow the patient to wake up.

At this point, caregivers must be certain that (1) the patient has a relatively stable mental sentara.com

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PHYSICIAN’S PERSPECTIVE

status; (2) the reason for the need for mechanical ventilation has reversed or improved; and (3) the patient can manage oral secretions, indicating the ability to protect the airway. The few minutes to hours after the endotracheal tube is removed tend to be a critical period, given that approximately 5-20% of patients ultimately will need to be reintubated and placed back on mechanical ventilation.

Benefits of Mechanical Ventilation Mechanical ventilation tends to rest the respiratory muscles, so the patient doesn’t have to work hard to breathe. While the respiratory muscles are being rested, the patient is allowed time to recover gradually—or, hopefully,

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time is provided for the reversal of whatever pathological process caused the patient to be placed on the ventilator.

Ventilation also allows the lungs to be accessed with a bronchoscope, enabling caregivers to obtain samples for laboratory evaluation. In addition, the positive pressure from the ventilator can help to draw unwanted fluid out of the lungs in certain pathologic states.

Risks and Complications of Mechanical Ventilation Since the lungs work in synchrony with the heart, pressure changes in the lungs during ventilation can cause adverse effects on cardiac function, resulting in decreased blood pressure and

other untoward hemodynamic effects. Other potential side effects include ventilator-induced lung injury, diaphragmatic dysfunction and ventilator-associated lung infections. High-pressure injury (barotrauma) and volume injury (volutrauma) are other potential lung complications.

To some, the idea of placing a patient on mechanical ventilation may be frightening and intimidating. However, these machines have saved countless lives over the decades, and advances in medicine and technology have made them safer and more efficient than ever.

At Sentara Martha Jefferson, mechanical ventilation has been and will continue to be an irreplaceable piece of technology in caring for critically ill patients.

ON-CALL

ADVICE Blue Ridge Region physicians of Sentara Martha Jefferson Hospital and Sentara RMH Medical Center answer your health and wellness questions

Why do we

Wrinkle as we age?

Can wrinkles be avoided?

W

rinkling is a natural part of aging that occurs as the skin’s ability to produce natural oils and fats begins to decrease, making the skin dryer and less elastic, and contributing to fine lines and creases that typically become more pronounced with age. Shrinking of natural fat pads under the skin as we age exaggerates these wrinkles.

This natural aging process in the underlying structure of the skin can be made worse by certain external factors, only some of which we can control.

One primary cause of wrinkling is exposure to sunlight. Ultraviolet radiation in the sun’s rays speeds up the wrinkling process by breaking down the elastin and collagen in the skin’s connective tissue, potentially causing the skin to wrinkle and sag prematurely. Smoking also can contribute to wrinkling by interfering with the circulation that supplies blood to the skin.

People who squint or smile a lot may also notice thin lines beginning to form around the eyes and mouth as their skin ages. These are known as dynamic lines, since they come from the repetitive muscle movements of facial expressions, creating creases over time.

While there is no way to avoid the natural process of aging that makes the skin dryer and less elastic, we can take certain steps to slow down premature aging. Avoiding the sun when possible, covering the skin with Ultraviolet Protection Factor (UPF) clothing and wearing sunscreen daily have been shown to decrease sun-induced wrinkles and aging. Not smoking and avoiding secondhand smoke also can help protect the skin from excessive and premature wrinkling. Even people who have smoked heavily for years may notice an improvement in their skin after giving up the habit.

Using creams and moisturizers won’t stop the natural aging process and associated wrinkling, but skin care products can help cover fine lines and creases and keep the skin more supple. Some prescription products actually can trigger collagen production to plump aging skin.

People with deep wrinkles who wish to improve their appearance should talk to a board-certified dermatologist. A number of techniques involving chemical or laser resurfacing procedures, fillers, and neurotoxins like Botox can all reduce wrinkles and improve the appearance of aging skin. sentara.com

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ON-CALL ADVICE

Blue Ridge Region physicians of Sentara Martha Jefferson Hospital and Sentara RMH Medical Center answer your health and wellness questions

What are

bone spurs and how are they treated?

B

one spurs are small segments or portions of extra bone that form along the edges of bones, often in and around the joints or where ligaments or tendons attach to bones.

While they can occur in almost any part of the body, they most often form in the hands, feet, elbows, knees, spine, hips and shoulders.

Experts believe that bone spurs, also called osteophytes, occur with certain changes in the joints brought on by wear and tear. These changes are often associated with osteoarthritis, the inflammation that occurs after the breakdown of the smooth, gliding surfaces of chondral cartilage between bones within the joints. One theory about bone spur formation holds that the body tries to compensate for this increased friction by creating new bony structures along these surfaces, resulting in rough edges that can eventually limit motion in a joint or cause other problems.

Other conditions that can lead to bone spurs include the following: • Plantar fasciitis: chronic inflammation of the thick connective ligament on the sole of the foot that connects to the calcaneus (heel) and supports the foot’s arch • Spondylosis: a general term for various degenerative arthritic conditions of the spine • Spinal stenosis: narrowing of the spaces within the spine, which can irritate the spinal nerves 10 |

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Treatment depends on where the bone spurs are located and the types of problems they may be causing.

Many bone spurs produce no pain or other symptoms and are often found on X-ray images taken for another reason—in such cases, the spurs are typically not treated. If, however, a bone spur rubs against a nerve or another bony surface, it may cause pain and impaired functioning. Spurs associated with osteoarthritis in joints are often treated with nonsteroidal anti-inflammatory drugs and by applying ice.

One complication of bone spurs can occur when the spur breaks off and becomes a “loose body,” which can then move around within the joint. In this situation, the result may be pain or reduced function, and the loose body may even cause the joint to “lock up.” Loose bodies that are causing problems can be removed surgically if other treatments are not effective. Bone spurs themselves typically are not removed surgically, as they will usually just grow back.

If you’re experiencing limited or diminished movement in a joint, talk to your doctor.

IMPROVE HEALTH

EVERY DAY

Choose Your Sunscreen Wisely Statistics show that one in five Americans will eventually develop skin cancer, so wearing an effective sunscreen is vital to help protect against the disease. According to the American Academy of Dermatology, however, not all sunscreens are created equal. For maximum protection, be sure to use a broad-spectrum or multispectrum sunscreen that protects your skin from both UVA and UVB rays, the two types of ultraviolet radiation from the sun that can cause skin damage, including skin cancer.

In addition, choose a sunscreen with a sun protection factor (SPF) of 30 or higher. SPF measures how effective a sunscreen is at blocking harmful UVB rays, and the higher the SPF, the more protection the sunscreen offers.

Finally, choose a water-resistant sunscreen. Apply generously to all exposed areas of skin, according to the directions on the bottle, and reapply at least every two hours—or more frequently, if you are swimming or sweating. One fluid once of sunscreen (about the volume of a full shot glass) is considered the approximate amount needed to cover the exposed areas of the body adequately.

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IMPROVE HEALTH EVERY DAY

KEEP YOUR EYES SAFE In addition to keeping your skin protected from the summer sun, be sure to keep your eyes safe as well. In some circumstances, sun exposure can have both short- and long-term negative effects on your eye health.

Here are some tips to help keep your eyes happy and healthy:

• • •

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Choose appropriate eyewear for outdoor activities. Whether you are in the water, on the beach, mowing the lawn or watching a sporting event, choose the right gear to block out sun rays, dust, water and other particles.

Put on a hat. Head coverings like baseball caps and wide-brimmed hats can help prevent direct eye exposure to sunlight.

Take out your contacts before swimming. Going on a swim with contacts can result in eye infections and severe irritation.

SUMMER 2022

Take the Sting Out of Summer Statistically, it’s reasonably likely that you, a friend or a family member will be stung by a bee this summer. Beyond dealing with the pain caused by the initial sting, it’s essential to know how to remove the stinger properly, should it become lodged in the skin.

While tweezers may seem like a good go-to tool in this situation, squeezing the stinger may actually cause more venom to be released, making the problem even worse.

Instead of tweezers, use a sterilized needle (or your fingernail, if long enough) to scrape away the stinger as quickly as possible. Once the stinger is removed, wash the affected area well. Ice or a cool compress may then be used to relieve any remaining pain or discomfort.

Hydrate, Hydrate, Hydrate According to National Institutes of Health experts, water is essential to countless bodily functions, including helping to flush toxins from the body through urination, perspiration and bowel movements; enhancing circulation and nutrient transport; and regulating body temperature.

When the body doesn’t get sufficient water for its needs, the result is dehydration, signs of which can include dark-colored urine, dizziness, weakness, headache, low blood pressure and confusion.

How much water you need depends on several factors, including the climate and temperature where you live, how much physical activity you’re engaging in, and how much you’re sweating.

Recommendations vary for how much water the average adult needs daily—some sources recommend drinking 30-50 fluid ounces each day, while others suggest 64 fluid ounces per day. If you’re an athlete, are very active, or live in a dry or hot climate, your hydration needs will likely be more significant.

One important note, though: Don’t try to drink a large amount of water at one time to meet your hydration needs. Instead, spread out your fluid intake throughout the day. Here are some tips to help you ensure proper hydration

• • • • • •

Set a daily goal for how much you’d like to drink Don’t wait until you’re thirsty to drink water Carry a water bottle with you throughout the day Set reminders to keep you on track Take sips between bites during meals Consume a full glass of water when you take a pill

Most of your daily hydration needs should be supplied by drinking plain water, but other fluids can contribute, too. However, try not to rely heavily on sugary or caffeinated drinks, since they can act as diuretics, actually causing the body to experience a net loss of water.

Eating foods that contain water, such as watermelon, celery, cantaloupe and cabbage, also contributes to your daily hydration needs.

Use the color of your urine to help you gauge how much water to drink.

Ideally, your urine should be a light yellow color to nearly clear, rather than dark and thick.

By drinking plenty of water each day, your muscles, heart, brain, blood, skin—in fact, your whole body—will function better. You may also think more clearly, have more energy and even feel less hungry, which can result in consuming fewer calories.

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EAT WELL,

LIVE WELL

Thrifty IN THE

KITCHEN

BY RITA SMITH, MS, RD

I

t’s hard to imagine with today’s soaring food prices, but most American families regularly throw away about one-quarter of the food they purchase! For instance, leftovers are often forgotten in the fridge, and fresh produce goes by the wayside—all to the tune of thousands of dollars each year. So it makes sense (and cents) to think a little more carefully through meal planning, purchasing, preparation and food usage to help make the most of household food expenses. And, contrary to popular belief, you can save money without compromising on the quality or nutritional value of the foods you purchase and serve your family.

Let’s review a few tried-and-true tips for keeping more money in your wallet after a trip to the grocery store. Remember: pennies saved during each shopping trip ultimately add up to hundreds of dollars over the long term.

Steps to Take Before You Go to Market • Take a few minutes to complete a food inventory of your kitchen before planning your weekly menus, so you can incorporate what you have on hand in your pantry, freezer and refrigerator.

This reduces unnecessary food purchases while efficiently using what you already have.

• Scope out the weekly grocery store sales to build your meals around discounted items. However, only purchase sale items if you will use them in your current or future menu planning.

• Use coupons anytime, but especially on sale items (for bonus savings).

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• Make a grocery shopping list from your weekly menus and then stick to it when you shop! Impulse buying is often costly and wasteful.

Tips to Save You Money at the Store • Check unit prices on shelf tags to compare costs per ounce, pound or pint of different brands.

• Buy bulk staple foods instead of individual serving portions—assuming you have a use for such larger quantities.

Large bags, cans or boxes of rice, dried beans and peas, pasta and olive oil are great—but only if you will eventually use them up.

• Buy generic or store brands instead of name brands.

• Compare the prices of fresh, frozen and canned fruits and vegetables (fresh produce isn’t always the most budget-friendly option).

• Select cheaper (and consequently often tougher) cuts of meat, but prepare them differently in order to tenderize. Using a slow, moist cooking method, or equipment such as a crockpot, can help you serve delicious, tender dishes.

• Purchase foods closer to their original form. If food has been precut, prewashed, shredded, diced, chopped, seasoned or precooked for you, it will cost more. Instead, buy raw ingredients and prepare them yourself. For example, it’s much cheaper to buy large bags of rice rather than smaller boxes of

preseasoned rice. Old-fashioned rolled oats are less expensive than individual packets of seasoned oatmeal—and, as an added benefit, don’t contain any sodium or sugar! Shred your own block of cheese to save money. Bulk hamburger is cheaper than preformed burgers.

• Buy milk and the occasional 100% fruit juice— but otherwise, don’t pay for prebottled beverages like water, sodas, juices, coffee or tea.

• Keep an eye out for store bargains like day-old bread, which would work well for toast, breadegg strata casserole and homemade croutons.

Tips to Cut Costs on Food Preparation at Home • Make dishes, dressings, sauces and marinades from scratch. Preprepared and “convenience” dishes or items will cost you more.

• Plan meals and dishes with less meat, poultry and fish; fill in with cheaper ingredients such as rice, pasta and beans. (Meat uses up one-quarter of the weekly food budget in most households.)

• Enjoy more meatless meals—for example, veggie chili, lentil soup and pasta with marinara sauce.

• Make your own fresh salads. Premade tossed salads, three-bean salad and coleslaw are much more expensive because the food industry has done the prep work for you.

• Fresh vegetables getting a little less fresh? Dice, toss with olive oil and roast in the oven at 400 degrees.

• Make your own broth in a slow cooker. Store clean, raw vegetable scraps—mushroom stems, outer peels and skins from carrots and potatoes, celery, garlic, herbs, etc.—in a one-gallon bag in the freezer. When the bag is full, add these vegetable contents and ½ teaspoon salt to a large slow cooker, then cover the vegetables with water.

Cook on high for 5-6 hours or on low for 8-10 hours. Strain, discard the vegetables and store the broth in the freezer for up to two months.

• Fresh herbs a bit wilted? Place the herb leaves into an ice cube tray, and fill each section with either water or olive

oil. Freeze until you’re ready to pop a cube or two into soup, stew or casserole.

Get Creative With Leftovers and Aging Produce • Dice or shred leftover or limp vegetables to add to soups, stir-frys, casseroles, meatloaf, meatballs, frittatas, omelets and fajitas. They also can be tossed with pasta or added to fresh vegetable salads.

• Leftover cooked grains and beans can be mixed with seasonings, onions, bread crumbs and a beaten egg to shape into homemade veggie burgers. Grill on a nonstick skillet.

• Slightly soft, peeled fresh vegetables and fruits can be blended into a salad dressing with lemon juice; vinegar; oil; and seasonings like thyme, mint, basil and rosemary. Carrots, zucchini, tomatoes, cucumbers, pears and apples work great in a dressing.

• Limp herbs can be chopped fine in a food processor with olive oil and garlic for homemade pesto, which you can use as a sandwich spread, stirred into soups or tossed with cooked pasta.

• Over-ripe fresh fruits can be diced and sauteed in a smidge of butter-oil blend for a tasty side dish, stirred into pancake or muffin batter, added to a smoothie, or baked into a fruit crisp with oat topping.

Store Fresh Produce Properly to Minimize Waste • Store these in the refrigerator: apples, lemons, oranges, berries, asparagus, bell peppers, broccoli, cabbage, cauliflower, lettuce and other greens, mushrooms, summer squash and zucchini.

• Store these at room temperature: bananas, eggplant, potatoes, onions and winter squash.

• Store these at room temperature until

ripe and then move into the refrigerator:

avocados, kiwis, nectarines, peaches, plums and pears.

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EAT WELL, LIVE WELL

Marvelous Muffins

Prep time: 15 minutes; bake time: 12-15 minutes Makes 12 muffins

Very Veggie Burgers

Ingredients Vegetable cooking spray

Prep time: 15 minutes; cook time: 10 minutes Makes 4-6 burgers

1 cup whole wheat or white wheat flour 1 teaspoon baking powder

Ingredients 2 cups leftover or canned beans (e.g., black, pinto or navy) 3 tablespoons ketchup 1 teaspoon prepared spicy mustard

1/8 teaspoon baking soda

Oh-Boy Bean Soup

¼ teaspoon salt 1 egg or ¼ cup egg substitute or 2 egg whites

½ teaspoon garlic powder

Prep time: 15 minutes; cook time: 30 minutes Makes 6 servings

¼ teaspoon onion powder

Ingredients

¼ cup honey

6 cups cooked or leftover beans, or 3 cans rinsed and drained beans (e.g., black, navy, kidney or pinto)

1 cup berries, mashed banana, diced apples, shredded zucchini, carrots or leftover squash

2 cans (14 ounces each) no-saltadded diced tomatoes

Directions

¼ teaspoon salt

2 tablespoons flour or oat bran ½ cup finely diced cooked or leftover vegetables Vegetable cooking spray Directions 1.

2.

3.

4.

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In a mixing bowl, mash the beans. Use a food processor if a finer texture is preferred.

To the mashed beans add ketchup, mustard, salt, garlic powder, onion powder, flour and vegetables. Mix to combine. Add more flour if too moist.

Preheat a nonstick skillet to medium-high heat. Coat with cooking spray. Using hands, form 4-6 burgers, shaping into patties. Place on hot skillet and pan-fry for 5 minutes. Turn with a spatula and cook an additional 5 minutes. Serve on whole-grain buns.

Topper suggestions include ketchup, relish, mustard, onions, mashed avocado, lettuce and tomato slices.

SUMMER 2022

1-2 cups assorted diced raw or leftover vegetables (e.g., squash, carrots, greens or bell peppers) 1 yellow onion, diced

1/3 cup plain Greek reduced-fat yogurt or 1/3 cup reduced-fat milk 1 tablespoon oil

1.

Coat a 12-cup muffin pan with vegetable cooking spray.

Preheat oven to 375 degrees.

2.

In a large bowl, whisk together the dry ingredients: flour, baking powder, baking soda and salt.

3.

In a small mixing bowl, whisk together egg, Greek yogurt or milk, oil, and honey. Pour into the flour mixture and gently stir. Add berries or other fruit/ vegetable. Gently stir into batter but do not overmix.

4.

Scoop batter by spoonfuls into each muffin cup, dividing batter evenly between the 12 muffin cups. Bake in preheated oven for 12-15 minutes or until lightly browned.

5.

Remove from oven and cool for a few minutes. Remove from muffin cups to cool on rack.

4 cups water or homemade broth ½ cup dried pasta or rice 1 minced garlic clove or ½ teaspoon garlic powder 1-2 teaspoons preferred herbs and spices Directions 1.

Add all ingredients to a stock pot. Stir to combine. Bring to a boil. Reduce heat and simmer for 30 minutes.

2.

For a thicker broth, drain and rinse one can navy or cannellini beans. Mash finely with a fork and stir into the soup.

Serve soup hot with crusty whole-grain bread.

3.

SENTARA

CARES

Making Local Impact and Lasting Change In 2021, Sentara invested $254 Million in Virginia and North Carolina communities, distributing funds in the following ways:

$23M HEALTH AND PREVENTION PROGRAMS

$48M

$167M

TEACHING AND TRAINING OF HEALTHCARE PROFESSIONALS

UNCOMPENSATED PATIENT CARE

$16M COMMUNITY GIVING

WHO WE ARE As an organization, we’re driven to improve health every day. And while we meet that mission through the healthcare services we provide to our patients and the coverage we provide to our health plan members, we know that truly improving health every day requires a much deeper commitment within our communities.

WHAT WE DO Through our grassroots partnerships with organizations throughout Virginia and Eastern North Carolina, we work to: • Ensure greater access to behavioral health services for children, families and adults.

• Secure consistent, equitable access to nutritious food.

• Support targeted training for skilled careers in high-demand fields.

• Develop emergency and scattered housing solutions.

• Eliminate barriers to care and strengthen the cultural fabric of our communities.

In 2021, Sentara and its partners focused on administering lifesaving vaccines, reducing barriers to essential healthcare services and connecting more residents to the resources they need to thrive. sentara.com

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SENTARA CARES

PARTNERING TO ELEVATE EQUITY THROUGH FOOD

PARTNERING TO EXPAND OUR IMPACT CLOSE TO HOME

Targeted access and education help eliminate barriers to nutritious, locally sourced food

Team member and local supplier engagement hit new heights in 2021

As was demonstrated during the COVID-19 pandemic,

members have sacrificed to meet challenge after challenge

too many Americans are just one crisis away from

with the care and compassion our community has come to

food insecurity. After partnering with food banks

expect. In 2021, for example, Sentara team members logged

in 2020 to meet crisis needs through our We Care

1,226 volunteer shifts and donated more than $271,000 to

initiative, in 2021 we turned our attention to making

the H.O.P.E. Fund to help fellow team members in need.

equitable, sustainable access to healthy foods a reality

Since the start of the COVID-19 pandemic, our team

for more communities.

Last year, Sentara also made strides to build resiliency into

In communities surrounding the Jefferson School in

tive Council (SDEC) tasked with broadening and diversify-

Charlottesville, where approximately 94 percent of

ing Sentara’s base of suppliers while emphasizing smaller,

school-enrolled children qualify for free or reduced-

local vendors. “We learned from the pandemic that there

cost lunch, our partnership with the Local Food Hub

are local and regional vendors who can compete on quality,

will allow the organization to expand its “Fresh

price and reliability,” says Jennifer McPherren, vice president

Farmacy” program. This program consists of biweekly

of supply chain and chair of the SDEC. “We want to grow

deliveries of locally sourced food options, along with

those relationships.”

its supply chain by establishing a Supplier Diversity Execu-

farm information, storage tips and easy-to-follow recipes. In addition, this partnership will allow the organization to pilot two “pay what you can” farmer’s PARTNERING TO markets in the Jefferson School parking lot. You can

ELEVATE EQUITY THROUGH FOOD read more about this partnership on page 47.

Targeted access and education help eliminate barriers to healthy, locally sourced food.

To that end, Sentara began offering education sessions to help smaller suppliers navigate the bid process. As a result, Sentara awarded more than $76 million in local contracts in its communities in 2021.

pilot two pay-what-you-can farmers markets in the Jefferson School parking lot.

Employee-Designated Funding

Similarly, in Hampton Roads, As COVID-19 demonstrated, too many Sentarasurvey, is partnering Americans are As only one crisis away from part of our annual engagement teamwith Hampton Roads Urban food insecurity.members While Sentara partnered were asked to select the nonprofit Agriculture (HRUA) to serve with food banks in 2020 to meet crisis organizations they felt best exemplify Sentara’s residents with diabetes, or needs through our We Care initiative, in mission to improve health every day and provide those at risk of developing the 2021 we turned our attention to making the greatest impact in our communities.

Using disease, through vouchers equitable, sustainable access to healthy responses from the survey, a total of $200,000 they can use to shop for fresh, foods a reality for more communities. will be distributed among theorganic, local organizations locally grown produce Getting Mobile — and Local These funds areatpart HRUA’s Markets. Here, listed below. of aMobile $2 million participants will also all Sentara communities. receive instruction In communitiesinvestment surroundingacross the Jefferson on healthy cooking techniques, meal prep School in Charlottesville, where closeBoard to • Jefferson Area of Aging strategies, and even how to grow food.

94 percent of school-enrolled children

Local Food qualify for free•or reduced lunch,Hub Sentara’s Growing Food — and Skills partnership with the Local Food Hub will • Birth Sisters of Charlottesville With its network of 150 partner agencies, allow the organization to expand its • program.

Community Investment Collaborative 19 mobile food pantries, and numerous “Fresh Farmacy” This program access and education programs, the Food consists of bi-weekly deliveriesHousing of locallyAlliance • Piedmont Bank of the Albemarle considers itself sourced food options, along with farm • YMCA – Brooks Family more of a “nutrition bank.” Now, with information, storage tips, and easy-toSentara’s help and in partnership with the follow recipes. In addition, Sentara’s Pasquotank County North Carolina partnership will allow the organization to

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Patients Find Happiness, Better Health After

Weight-Loss Surgery For many people, weight loss presents a persistent challenge—whether the goal is just to shed a few pounds or lose a more significant amount of weight. Even if dieting and exercise manage to yield some progress, maintaining weight loss over the long term can be difficult.

Mike Hall

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W

hen diets and weight-loss tactics fail to produce lasting success, many people begin to face health issues such as diabetes, high cholesterol, high blood pressure, sleep apnea and orthopedic concerns. In addition, an inability to achieve longterm weight loss can lead to a nagging sense of frustration.

That’s when patients turn to the weight-loss (bariatric) surgery team at Sentara Martha Jefferson Hospital for relief, answers and support. More than a hundred people undergo bariatric surgery at Sentara Martha Jefferson each year— and that number continues to grow, according to Timothy Snow, DO, director of bariatric surgery at the hospital.

“For many patients, bariatric surgery is the most effective option to lose a considerable amount of weight, improve overall health and resolve associated medical conditions,” Dr. Snow explains. “Many bariatric patients lose 100 pounds or more. However, the surgery requires strict adherence to a healthy diet in order to serve as a long-term solution.”

Embarking on a Weight-Loss Journey

Most adults can’t imagine being able to fit into the same waist size they wore in their teenage years.

But Mike Hall, 61, of Fluvanna County, is now able to do just that, following successful weight-loss surgery at Sentara Martha Jefferson.

Hall’s transformation began after his primary care physician told him he would need to start taking medication to keep prediabetes from progressing to full-blown diabetes. At the time, Hall weighed 384 pounds.

As soon as Hall got home from his primary care appointment, he cleared his home of unhealthy foods like bread, sweets, soft drinks and “bad” carbs. That soon helped to kickstart some weight loss. Then, Hall, who works as a security officer for Sentara, began to research bariatric surgery options. His daughter and niece, who had previously undergone successful weight-loss surgery at Sentara, also inspired him.

“I was at the point of no return,” explains Hall, who had tried diet plans and exercise but had always gained the weight back. “I was 60 years old.

Mike Hall My health was declining.

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If I didn’t do something, I knew my health would get worse and worse.”

Preparing for Weight-Loss Surgery

After taking classes at Sentara Martha Jefferson to learn about bariatric surgery, which the program requires of all patients, Hall opted for a gastric bypass. Also known as the Roux-en-Y gastric bypass, this surgery involves creating a small pouch from the stomach and connecting the newly created smaller stomach pouch directly to the small intestine.

Before surgery, insurance carriers require that patients meet with a dietitian and a behavioral health counselor to assess the severity and duration of obesity, discuss the patient’s past attempts to lose weight, and understand the behavioral and dietary changes needed for success, Dr. Snow explains.

Surgeons get involved right from the initial consultation to help guide patients’ weight-loss journeys.

Hall lost 62 pounds before surgery by eating healthier, but he knew the discipline required after the procedure would help him continue to lose weight and keep it off over the long term.

“I had considered having a gastric bypass in the past but thought it was just a quick and easy way out,” Hall remembers. “That’s not the way it is. You have to change your way of thinking and eating. The surgery isn’t a cureall. Rather, it’s a tool to help you achieve the weight-loss results you’re striving for—with some disciplined, sustained work on the part of the patient. Is long-term success easy? No!”

Today, Hall is down from 384 pounds to 220 and can wear a size 34 waist. Before beginning his weight-loss journey, he had been up to a size 48.

“Remember, there is hope,” Hall says, encouraging others who may be considering bariatric surgery. “Believe in yourself and believe that you can do it. I would do it again tomorrow, if needed.”

Taking Control of Weight Loss

The epiphany that set Connie Bossieux on a path toward life-changing weight-loss surgery occurred at a department store.

Bossieux, 49, of Troy, Va., who was waiting in a dressing room while her daughter shopped for clothes, was taken aback when she saw her reflection in the mirror.

“For some reason, this was a totally different experience,” remembers Bossieux, a patient care supervisor at Sentara Martha Jefferson. “I immediately made the decision,

Surgery Day and Beyond

Dr. Snow operated on Hall in November 2020, after which he stayed in the hospital for two nights. His daughter and niece took care of him when he returned home.

Hall followed the required liquid diet and then transitioned to a soft-food diet after surgery. Although his weight loss started slowly, he soon began to see results.

“The scale doesn’t tell the whole story,” recalls Hall, who eventually lost more than 100 pounds following the procedure. “Be assured that you are losing weight, and don’t get discouraged if you have a bad day on the scale.”

Connie Bossieux

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Connie Bossieux

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right then and there, that I was going to have surgery to lose the weight.”

Although Bossieux was thin through her young-adult years, losing weight became increasingly difficult after she had her two children. In addition, she had been diagnosed with hypothyroidism and was getting closer to menopause, which were making weight loss even more challenging.

She tried various types of diets, but any progress she made was soon undone.

“When you stop those diets, the weight goes right back on,” Bossieux

explains. “I could see my weight spiraling out of control, and I was afraid I was never going to be able to get a handle on it.”

Deciding to Take Action

Bossieux’s decision to pursue bariatric surgery was inspired in part by encouragement from a good friend and colleague who had successfully gone through weight-loss surgery at Sentara Martha Jefferson.

Bossieux chose the gastric sleeve approach, during which a surgeon removes 75-85% of the stomach,

THE POST-BARIATRIC SURGERY DIET creating a much smaller, tube-shaped “sleeve.”

Shrinking the stomach with this technique prevents consumption of large quantities of food but also allows food to pass through the digestive system normally, since the intestines are left intact.

In addition to being a restrictive procedure, the gastric sleeve is also a metabolic procedure because it changes the way patients process food and beverages, explains Dr. Snow.

“The surgery actually alters the numbers of hormones and receptors in the digestive tract, so people feel full sooner and experience a decreased appetite,” Dr. Snow notes. “The surgery also changes how the body burns calories.”

Dr. Snow performed Bossieux’s surgery in June 2020 at Sentara Martha Jefferson. Her husband, Dean, a firefighter, was ready to care for her at home following her discharge from the hospital two days later.

Quick and Lasting Success

In the weeks after Bossieux’s surgery, her weight dropped rapidly. She eventually went from a size 20 to a size 10, losing a bit more than 100 pounds in 14 months.

“Your results aren’t just a number on a scale, though,” she explains. “Your clothes are falling off you. It does something to your mind. It lifts you up every day as you go down from one size to another.”

Bossieux now walks three to four days a week as part of her exercise routine. She starts most of her days with a protein drink, focusing on proper nutrition at meals by carefully selecting highprotein, low-calorie snacks, such as 100-calorie packs of nuts, mozzarella cheese sticks and yogurt.

Her overall daily intake goal is 800-1,000 calories.

Protein sustains you, making you feel full longer, Bossieux notes. It also helps keep muscles strong as you lose weight.

Bossieux appreciates how attentive the Sentara Martha Jefferson Bariatric Care Center staff was before and after her surgery, patiently answering her questions over the phone and during appointments.

“This surgery has changed my life in every way,” she remarks. “One of the things we say in health care is that we are changing lives, and this surgery is the epitome of that. I feel so much more energetic and confident—like I haven’t felt in years.”

Patients who undergo bariatric surgery must agree to permanently change how they eat, in order for weight to stay off in the long term.

For these patients, doctors recommend:

• • • • •

Balanced meals with small portions Healthy carbs (fruits, vegetables, whole grains) and nonstarchy veggies Healthy snacks between meals Meals low in calories and carbs but high in lean protein, with a daily goal of 60 grams of protein intake Eating small bites at a slow pace, to allow food and liquids to enter the stomach and small intestine at a slower rate

Eating sugary, high-carb foods can cause dumping, a condition that occurs when food moves too quickly through the digestive tract and gets dumped directly from the stomach pouch into the small intestine without being digested, explains Timothy Snow, DO, director of bariatric surgery at Sentara Martha Jefferson. This condition also can occur when a bariatric surgery patient eats too fast or drinks a lot of liquids with solid food, he adds.

Hydration is also a key component going forward after bariatric surgery.

Patients should aim for 64 fluid ounces daily and avoid sugary and carbonated drinks. Fluids are important because they increase the sensation of fullness, help eliminate waste products more effectively and help the heart pump blood more efficiently.

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Collaborative Assessment

Seeks to Create Positive Community Changes The next community health needs assessment from Sentara Martha Jefferson Hospital — called 2022 MAPP2Health — is underway.

As part of the Affordable Care Act, every three years nonprofit hospitals are required to conduct a community health needs assessment and create an implementation strategy to address any identified health issues.

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o conduct the assessments, Sentara Martha Jefferson Hospital partners with the Blue Ridge Health District, UVA Health and the UVA Department of Public Health Sciences, as well as more than 100 area organizations, community members, nonprofits, and local and state officials. Thanks to input from such a wide variety of stakeholders, the assessment is able to inform efforts across the planning district and help to determine priorities for localities and organizations.

Previous needs assessments have identified priorities like promoting healthy eating and active living, improving mental health and substance use services, and addressing health disparities and access to care. Resulting data on health disparities influenced this year’s focus on policies and practices in the built environment, as well as healthcare access—two issues that will be looked at specifically through the lenses of

socioeconomic factors and race, with the goal of advancing health equity. Specific regional barriers identified include: • Transportation: as a challenge to well-being and as a barrier to optimal health • Health access: in terms of numbers of available providers and how convenient it is to make and travel to appointments • Digital access: including broadband access, digital literacy, and access to computers and other technology “We want to identify the policies and practices we, as organizations and policymakers, have in place that are preventing people from being their healthiest,” says Kimberly Skelly, executive director of the Martha Jefferson Hospital Foundation and a member of the community health needs assessment leadership team. “Transportation is an issue across the planning district, whether you live in the city of Charlottesville or in one of our more rural counties. Health access issues encompass the availability of both physical and mental healthcare services. Digital barriers relate to improving access to technology for all community members.”

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As the data indicates, our region’s current health disparities are clear. As an example, Blacks continue to have higher rates of chronic diseases like high blood pressure and diabetes, along with alarming rates of maternal mortality. And even though telemedicine was widely adopted by healthcare providers during the COVID-19 pandemic, the new technology didn’t benefit some patients, since many community members don’t have broadband access or know how to use email, computers or smartphones. And while Jaunt provides excellent regional transportation, the service can be difficult to access for people who are blind, are in wheelchairs or have other impairments. With all this in mind, numerous challenges remain.

Past Successes Needs assessments can inspire real results for the community. For Sentara Martha Jefferson the most significant such outcome has been the Sentara Starr Hill Health Center at the Jefferson School City Center in downtown Charlottesville, which grew out of a community need to address obesity that was identified in the hospital’s 2012 assessment. The Sentara Starr Hill clinic offers free services for people who want a healthier lifestyle, focusing on managing and preventing chronic diseases, including heart disease, diabetes and obesity.

Based on findings from the 2016 assessment which identified a need for more mental health services in our community, the hospital began providing free space at the Sentara Starr Hill Center to The Women’s Initiative, a nonprofit organization that provides women with counseling, social support and education.

The Value of Collaboration This type of collaborative needs assessment process is rare. More commonly, hospitals conduct their assessments in a more self-contained manner that focuses less on seeking input from the wider community.

“The more we can work together and collaborate, the better it is for all of us,” says Skelly. “Involving so many organizations and leaders helps you create a more valuable resource.”

The assessment will examine needs across the entire Blue Ridge Health District, which includes the city of Charlottesville and the counties of Albemarle, Fluvanna, Greene, Louisa and Nelson. More than 80% of the Sentara Martha Jefferson patient population comes from the health 26 |

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district, so the data gathered during the needs assessment is extremely valuable for the hospital.

While past assessments have resulted in the development of beneficial programs, new energy this time around will focus on how to better engage policymakers and government leaders to look at policies and practices that impact healthcare access and outcomes. Once the assessment is complete, Sentara Martha Jefferson staff will draft an implementation plan to address identified needs, which will go to the hospital board for approval.

The needs assessment team is using data collected from the health district, Sentara Martha Jefferson Hospital, and the UVA Equity Center, as well as information gathered through focus groups and photovoice, a research method that empowers participants to share stories about their community and lived experiences through photography.

For the first time, this year’s assessment is virtual, which has made it easier for collaborating groups to participate. The framework for the assessment, developed by the National Association of County and City Health Officials, is the Mobilizing for Action through

Planning and Partnerships (MAPP) tool, a strategic planning process that helps communities prioritize their health needs. Jeanita White Richardson, PhD, a professor in the Department of Public Health Sciences at the UVA School of Medicine, is facilitating the MAPP process with localities and nonprofits and guiding the identification of relevant policies and practices based on local data and input. “By meeting with regional nonprofits and leaders, we can establish grassroots, locally informed priorities that serve as the basis for the creation of actionable policies and practices to address inequities in health,” says Dr. Richardson.

Moving Forward While improving health inequities and access might seem like an overwhelming task, positive results are possible when groups work together on an actionable plan. One decision won’t solve all the issues identified, but change is possible by making small steps and relying on the expertise of individual organizations. A few steps that could positively impact health equity in the region include:

• Installing covers at bus stops, so people are protected from the elements while they wait • Expanding existing programs that help familiarize people with technology, email and digital health care • Hiring community health workers who also speak a second language, to help provide translation services Ultimately, the goal is to get health care to more people and manage chronic diseases proactively, before patients end up in the hospital.

According to Dr. Richardson, our communities are well positioned to address these issues. “We have 400–500 nonprofits in the Charlottesville/Albemarle area, which speaks to the community’s desire to do good,” she says. “We just need to help people channel that desire in ways that yield outcomes.”

Skelly hopes the needs assessment will help community leaders understand which factors create health inequities and motivate them to address those issues. “I’m excited,” she adds. “I really think change happens when you look for opportunities to eliminate barriers and help people live their healthiest lives.” sentara.com

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joint

replacement surgery revitalizes patients New materials and techniques help speed up recoveries As a senior trooper for the Virginia State Police, Troy Johnson places fitness as one of his top priorities. In addition to regularly spending time in the gym working on strength training and cardio, he has been involved in martial arts for nearly 30 years. sentara.com

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So, it’s perhaps not surprising that Johnson’s shoulders eventually began to ache from normal wear and tear over the years.

“I’ve always been active and a ‘gym rat,’” says Johnson, 55, who has been in law enforcement for 12 years. “Over time, both of my shoulders began to hurt due to overuse and exercise.”

To address the issue, Johnson went to see an orthopedic surgeon, who recommended shoulder replacements (see sidebar) to help relieve his pain and keep him in top shape for work and other activities.

Advances in Joint Replacements According to the Agency for Healthcare Research and Quality, about 53,000 people have shoulder replacement surgery each year in the United States, and more than 900,000 Americans undergo knee or hip replacement surgery annually.

Joint replacement surgery also can be performed on the ankles and elbows.

“Over the years, we’ve seen great advancements in materials and techniques for joint replacements,” says Clark Baumbusch, MD, an orthopedic surgeon at Sentara Martha Jefferson Hospital. “We also have more effective anesthetics to control pain. As a result, our patient recovery times have improved.”

Hospital stays following joint replacement have shortened as well, says Dr. Baumbusch. Today, in fact, many patients go home the same day they have surgery.

What Causes Shoulder Pain?

The shoulder is composed of a balland-socket joint, much like the hip.

The muscles and tendons that make up the rotator cuff keep the ball of the upper-arm bone (humerus) in the shoulder socket and also help raise and rotate the arm.

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One major cause of shoulder pain falls under the umbrella of rotator cuff diseases, which include: • Bursitis occurs when the bursae— small, fluid-filled sacs that cushion the bones, tendons and muscles near the joints—become inflamed.

• Tendonitis results due to inflammation of the rotator cuff tendons.

• Rotator cuff tears can develop when tendons in the rotator cuff become physically damaged.

Osteoarthritis, another cause of shoulder pain, occurs when the cartilage that provides cushioning between bones in the joint wears down, causing bone to rub against bone.

“For those with arthritis, symptoms usually progress over months and years, and the resulting pain can become disabling,” Dr. Baumbusch explains. “People frequently report cracking or popping when moving the shoulder—that happens when the smooth surface of the cartilage between the bones disappears.”

Imaging, such as X-rays and CT scans, plus an examination by an orthopedic surgeon, are used to determine the root cause of shoulder pain.

Nonsurgical Solutions Before recommending surgery, physicians look for nonsurgical solutions whenever possible, according to Dr. Baumbusch.

Nonsurgical treatment options include: • Anti-inflammatory medication • Cortisone injections • Modifying activities to reduce pain and let the area heal • Physical therapy (PT) and occupational therapy Physical and occupational therapists can work with patients to stretch and strengthen muscles.

They can also help in other ways— for example, by analyzing a patient’s workplace ergonomics to help improve

sitting posture, or by recommending other activity modifications to minimize strain and pain.

When nonsurgical options aren’t enough, orthopedic surgeons may recommend joint replacement.

Relieving Years of Pain Johnson first experienced pain in his right arm—his dominant side— in 2013.

“It got to the point where I had bone spurs, and my shoulder kept locking up,” he recalls. “There was no way I could move it without a lot of discomfort.”

When the pain became really disruptive, Johnson’s surgeon recommended a partial shoulder replacement.

During this procedure, the surgeon replaces the damaged top section of the humerus bone with a metal ball, and the natural socket is left intact.

Although Johnson had healed from the previous surgery on his right shoulder and was able to resume his activities, he figured it was just a matter of time before the other shoulder wore out.

Sure enough, his left shoulder began to worsen in early 2021.

“Before that, I could move my left shoulder in certain ways without pain,” he recalls. “But eventually it started hurting all the time. The pain went from my shoulder to the tip of my hand and up my neck into my head.”

Johnson also had trouble finding a comfortable position to sleep in, and was no longer able to lift weights during his gym workouts.

He met with Dr. Baumbusch, who recommended a total shoulder replacement on the left side. During this procedure, which is typically a two-hour surgery, the surgeon replaces arthritic joint surfaces in both the ball and socket areas of the shoulder joint.

Johnson’s outpatient surgery took place at Sentara Martha Jefferson in May 2021. sentara.com

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Types of Shoulder Replacement Surgery To help prevent postsurgical pain, the anesthesiologist administered a nerve block around the nerves that enter the neck.

“I had no pain whatsoever,” recalls Johnson. “It was like night and day. When I walked out of the hospital after surgery, it was the last day I had any shoulder pain.”

Postsurgical Recovery While doctors tailor each patient’s recovery individually, Dr. Baumbusch asks patients to follow these general postsurgical instructions: • Keep the affected shoulder in a sling for six weeks. The sling can come off for certain activities, including bathing, getting dressed, eating, typing and watching television.

• Schedule a doctor visit for a week after surgery, at which point the physician likely will take an X-ray and check the wound.

• Start PT about a week after surgery. After that, expect to have PT two to three times a week for two to three months, depending on how quickly mobility and strength return to the affected area.

At about the six-week mark following surgery, the physical therapist will begin to work on strengthening, according to Dr. Baumbusch.

Overall, recovery from shoulder replacement surgery can take three to six months.

“It’s important for people to listen to their therapists,” Johnson advises. “They will decide how quickly to progress—when to push you and when not to push you.”

These days, about a year after surgery, Johnson is still working on adding weights to his exercise routine. Recently he was able to benchpress 225 pounds for a couple of reps.

“Dr. Baumbusch did a heck of a job,” he says. “I am so impressed and amazed.”

Dr. Baumbusch encourages patients with joint pain not to wait to see an orthopedic surgeon, noting that with some injuries, outcomes are better the sooner they are treated, and that joint replacement surgery can offer quick relief to patients who may have been in pain for years.

“People experience relief pretty quickly after surgery because we take out a severely damaged joint and replace it with a nice, new one,” Dr. Baumbusch explains. “The difference can be life-changing.”

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About 53,000 people in the United States have shoulder replacement surgery each year, according to the Agency for Healthcare Research and Quality.

These types of surgeries include: Total Shoulder Replacement: Orthopedic surgeons replace arthritic joint surfaces with a highly polished metal ball attached to the top of the humerus and a plastic socket attached to the scapula. Patients with boneon-bone osteoarthritis and intact rotator cuff tendons are good candidates for conventional total shoulder replacement.

Partial Shoulder Replacement: Also known as a stemmed hemiarthroplasty, the surgeon replaces only the ball with a new metal ball. Sometimes surgeons don’t decide between a total shoulder replacement and a hemiarthroplasty until they’re actually in the operating room, depending on the visible condition of the shoulder.

Resurfacing Hemiarthroplasty: Surgeons replace just the joint surface of the humeral head with a cap-like prosthesis without a stem. This technique preserves bone and offers those with shoulder arthritis an alternative to the standard stemmed shoulder replacement.

Reverse Total Shoulder Replacement: With this procedure, the socket and metal ball are switched. Surgeons attach a metal ball to the shoulder bone, and a plastic socket is attached to the upper arm bone.

This technique allows the patient to lift the arm using the deltoid muscle, which covers the top of the shoulder, instead of using a torn rotator cuff.

Source: https:// orthoinfo. aaos.org/en/ treatment/ shoulder-jointreplacement/

The bones of a healthy shoulder joint.

CLINICAL

EXCELLENCE

Building

Relationships AND

Healthier Lives

Sentara’s Care Management program provides patients with a dedicated advocate

For one group of healthcare professionals at Sentara RMH Medical Group and Sentara Martha Jefferson Medical Group, providing excellent care goes beyond a patient’s visit to the hospital.

As part of Sentara’s Care Management program, these caregivers advocate for patients on a number of levels, helping them to reach and maintain optimal health over the long term.

In care management, which is a team-based approach to care, healthcare providers work together to develop a patient’s plan of care. Rather than just focusing on care during a single visit, Care Management team members work with patients to develop realistic wellness goals, offer health coaching and education, connect patients with available community resources, assist with care following hospital discharge, and provide reminders for ongoing preventive care—all with the ultimate goal of empowering patients to have control over their healthcare needs. There is no cost to patients to participate in the program. sentara.com

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CLINICAL EXCELLENCE

“Health care moves fast, and not all patients understand the process,” says Natalie Bass, BSN, RN, director of Quality Management and Clinical Education for Sentara RMH Medical Group. “Care management nurses are assigned to help engage patients in an ongoing manner.

As a result, patients have an identified partner in their healthcare journey—someone who advocates for them. Patients receive personalized education through this one point of contact and can be connected to critical community resources, as needed.”

One of the program’s major objectives is to help some of the most vulnerable patients—often those who have been diagnosed with two or more chronic diseases—avoid the need for readmittance to the hospital. The Centers for Disease Control and Prevention (CDC) defines chronic diseases generally as those conditions lasting one year or more and requiring ongoing medical attention or limiting activities of daily living, or both. According to the CDC, chronic diseases such as heart disease, cancer and diabetes are the leading causes of death and disability in the United States, and some estimates indicate that nearly half of the U.S. population has at least one chronic disease. This demographic, which is at greater risk of rehospitalization, is a perfect fit for care management, according to Bass.

Bass worked together with Camilla Washington, MSN, RN, Sentara Martha Jefferson’s director of Ambulatory Patient Care Services, to build the Care 34 |

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Management program into its present form.

“Sentara RMH started with its first care manager almost 10 years ago,” says Bass.

“The program has been through many changes over the years, as we’ve grown the team and better identified the population of patients on which we need to focus our efforts. We now have access to more tools and reports to help identify patients who might benefit most from care management services.”

Sentara Martha Jefferson, which had one nurse participating in the program in 2021, had grown its Care Management team to seven nurses by the first quarter of 2022.

Regular Contact Builds Rapport

After a phone call with discharged patients within two business days of leaving the hospital, a care management specialist makes an initial assessment to see what ongoing needs may exist.

Ensuring that a hospital follow-up is scheduled for the patient is one of the program’s earliest tasks.

Then, nurses keep in touch with patients for at least 30 days after discharge, calling at least weekly or meeting in person, as appropriate.

“We don’t want our patients to feel that the only option for care is to return to the emergency room,” says Washington. “For many patients in this population, services continue well beyond the 30-day time period, and navigating health care can be very intimidating—regardless of a patient’s age or disease

After a phone call with discharged patients within two business days of leaving the hospital, a care management specialist makes an initial assessment to see what ongoing needs may exist.

progression. Having an advocate and a liaison they know who can help them is a major benefit of the program.”

While some services provided within the Care Management program may seem simple, overlooking them could be catastrophic for the patient. For instance, medication reviews and appointment reminders help keep patients on top of their care needs.

“During hospitalization, prescribed medications can be added or removed from the patient regimen,” Washington notes. “Care management nurses do a thorough review of medications with patients, including those in the home that may no longer need to be taken.”

Care management nurses also can help with insurance matters, identify services patients may need, and review in-home needs—such as any life-sustaining equipment that may be required.

“Care management nurses do a lot of education and work on social determinants of health,” says Bass. “For instance, they evaluate what might be a patient’s barriers to being successful, and whether the patient might be experiencing food insecurity, lack access to transportation or have financial issues.”

Care management nurses work with an older population, and building trust can take time. A crucial part of the relationship is setting goals, such as developing a proper diet.

“It is often that ongoing dialogue that delivers results,” adds Bass. “For example: ‘What did you eat yesterday?’ ‘What was your weight this morning?’ The nurses are very good at listening and picking up on clues in what a patient says. And if they meet in person, the nurses are very good at observing body language—they have a knack for picking up on the little things a patient might not actually say aloud.”

A ‘Perfect’ Match

At Sentara Martha Jefferson, one patient has called Kristie Gregory, RN, a member of the Care Management team, “one of the best things” associated with any hospital or doctor he’s known.

“She’s super fantastic,” says the 81-year-old patient, who goes by L.P. “I recommend that every doctor—in the hospital or office or whatever—to have someone like Kristie.”

L.P. says he’s recently dealt with “one thing after another,” from a throat infection to chronic allergy problems. Through the Care Management program, he was connected with Gregory, who has helped him get doctor visits scheduled more quickly and prescriptions filled much faster than he’s ever been able to before.

“She really knows her job—she is fantastic,” L.P. says. “Many people my age can get cranky.

You talk to her and feel real comfortable. If you have any problem, you can call her, and she’ll take care of it. It’s been perfect for me.”

Bass says care managers are experienced registered nurses who must complete an accredited credentialing program to ensure they have the skills to manage and coordinate the care of patients with complex medical conditions.

Their doors are always open to help patients in need.

“To many people, the healthcare system can seem incredibly complex,” Bass says. “So many patients can benefit from the type of support the Sentara Care Management program provides.” sentara.com

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HEALTH

MATTERS

Protect Yourself from

TICKS Every summer brings warmer weather, longer days … and ticks!

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n Virginia, the most common health problem caused by ticks is Lyme disease, but you can also get Rocky Mountain spotted fever and ehrlichiosis from tick bites. Deer ticks, also known as black-legged ticks, spread Lyme disease and ehrlichiosis. Dog ticks and lone star ticks spread Rocky Mountain spotted fever (RMSF) and ehrlichiosis. All three tick-borne diseases, which can be treated with antibiotics, cause flu-like symptoms such as aching muscles, fatigue, headache and fever.

Untreated Lyme disease can lead to swollen joints, arthritis, facial paralysis and irregular heart rhythms. Fortunately, few people die from Lyme disease. RMSF and ehrlichiosis, on the other hand, can cause liver and kidney problems, and may be fatal if untreated. Additional complications from RMSF can include brain damage and heart failure, while ehrlichiosis can result in coma.

Given the dire possible consequences, you should take precautions to protect yourself and your family from tick bites.

Avoiding Tick Bites

Ticks are typically most active from April through September. You can protect yourself by following these tips.

• Avoid areas with high grass and thick bushes.

• In areas where ticks are commonly found, wear long pants and long sleeves. Wearing light colors also makes it easier to spot ticks on clothing.

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• On exposed skin, apply insect repellent that contains 20 percent or more of DEET. • On clothing and camping gear, use insect repellent that contains permethrin.

• Check yourself carefully for ticks, using a mirror as needed to examine your entire body.

• Shower or bathe within two hours after being in a tick-infested area, and launder and dry your clothing to kill any ticks you may not have spotted.

• Keep your pets out of tick-infested areas, and check them closely if they go outdoors.

Removing Attached Ticks

It takes 24-48 hours after a tick becomes attached for it to transfer to your blood the bacteria that cause disease. So if you find a tick crawling on you, or even find one attached to you, don’t panic. Instead, do this: • Using tweezers, grasp the tick as close to your skin as you can.

• Pull away from the skin using steady, even pressure. Don’t twist or jerk the tick, or you may cause its mouth to break off and remain embedded in the skin. If this happens, use the tweezers to carefully remove all the mouth parts.

• Wash the area using rubbing alcohol.

• Write down the date and time you removed the tick, and watch the area closely. If you develop a rash, fever or flu-like symptoms within several days or weeks, see your doctor.

LA SALUD

IMPORTA

Protéjase de las

GARRAPATAS Cada verano trae un clima más cálido, días más largos y... ¡garrapatas!

E

n Virginia, el problema de salud causado por las garrapatas más común es la enfermedad de Lyme.

Sin embargo, las picaduras de garrapata también pueden causar fiebre maculosa de las Montañas Rocosas y ehrlichiosis. Las garrapatas de venado, también conocidas como garrapatas de patas negras, propagan la enfermedad de Lyme y la ehrlichiosis, mientras que las garrapatas de perro y las garrapatas estrella solitaria propagan la fiebre maculosa de las Montañas Rocosas (Rocky Mountain spotted fever, RMSF) y la ehrlichiosis. Estas tres enfermedades transmitidas por las garrapatas pueden tratarse con antibióticos y causan síntomas similares a los de la gripe como dolor muscular, cansancio, dolor de cabeza y fiebre.

La falta de tratamiento para la enfermedad de Lyme puede causar inflamación en las articulaciones, artritis, parálisis facial y ritmo cardíaco irregular. Por fortuna, son pocas las personas que mueren a causa de la enfermedad de Lyme. Por otra parte, la RMSF y la ehrlichiosis pueden causar problemas hepáticos y renales, así como pueden ser mortales si no se tratan.

Las complicaciones adicionales de la RMSF pueden incluir daño cerebral e insuficiencia cardíaca, mientras que la erhlichiosis puede llevar a un coma.

En vista de las posibles consecuencias alarmantes, usted debe tomar precauciones para proteger a su familia y a sí mismo de las picaduras de garrapatas.

Evite las picaduras de garrapatas

Por lo general, las garrapatas son más activas entre los meses de abril y septiembre. Puede protegerse siguiendo las siguientes recomendaciones: • Evite las áreas con césped alto y arbustos frondosos.

• Use pantalones y camisas manga larga en áreas donde las garrapatas se encuentren con regularidad. Usar colores claros también facilita la detección de garrapatas sobre la ropa.

• Aplique repelente de insectos que contenga 20 por ciento o más de dietiltoluamida (diethyltoluamide, DEET) sobre la piel expuesta.

• Use repelente de insectos que contenga permetrina para la ropa o el equipo de campamento.

• Revise con cuidado si tiene garrapatas con un espejo según sea conveniente para examinar su cuerpo entero.

• Dúchese o dese un baño no más de dos horas después de estar en un área infestada de garrapatas.

Lave y seque también su ropa para matar cualquier garrapata que no haya podido detectar.

• Mantenga a sus mascotas alejadas de áreas infestadas de garrapatas y revíselas con atención si salen de la casa.

Retire garrapatas incrustadas en la piel

Después de incrustarse en su piel, una garrapata tarda de 24 a 48 horas en transmitir a su sangre las bacterias que producen enfermedades. Así que, si encuentra una garrapata caminando sobre usted o incluso incrustada en su piel, no entre en pánico; mejor haga lo siguiente: • Con la ayuda de una pinza pequeña, agarre la garrapata lo más cerca posible de su piel.

• Hálela para alejarla de su piel al hacer presión firme y uniforme. No tuerza o tire de la garrapata, puede hacer que su boca se desprenda y se quede incrustada en la piel. En caso de que esto suceda, use la pinza para retirar cuidadosamente todas las partes de la boca.

• Lave el área afectada con alcohol isopropílico.

• Anote la fecha y la hora en que retiró la garrapata de su piel y supervise atentamente el área. Acuda a su médico si presenta una erupción, fiebre o síntomas similares a los de la gripe por varios días o semanas. sentara.com

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AGING WELL

Sleep

is the Best Medicine Addressing sleep issues can dramatically boost energy and health

C

onstituting roughly a third of our lives, sleep can have a profound effect on overall quality of life.

Although the link between sleep and health has long been recognized, in recent years this connection has been studied more extensively.

Sleep is a restorative process, according to Fouzia Siddiqui, MD, a sleep medicine specialist at Sentara RMH Medical Center. “It’s that time during the night when your body gets rid of toxins generated throughout the day to help you rejuvenate and get back to normal,” she explains. “And sleep doesn’t just make you feel better—restoration happens at a cellular level, a molecular level. Your blood pressure, your heart rate, your memory and your whole body function improve when you sleep better.”

According to Dr. Siddiqui, good “sleep hygiene” involves establishing a pre-bedtime routine that will allow you to sleep well. “Things like eating a large meal in the evening, watching TV 38 |

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or using your smartphone before bedtime, and not going to bed at the same time each night can all affect your sleep negatively,” she notes. “Creating a quiet, relaxing, distraction-free sleep environment is important.”

William Hammond, MD, a sleep medicine specialist at Sentara Martha Jefferson Sleep Medicine Center, explains that people tend to ignore sleep hygiene until they start experiencing problems.

“That’s when we get back to basics and try to identify problems in a patient’s sleep routines,” he says.

Although the brain’s natural circadian rhythms help us sleep at night and stay awake during the day, Dr. Hammond believes that every organ in the human body—not just the brain—has an internal clock. “There’s a good reason why we recommend not eating a lot before bedtime,” he notes. “Why would you want the clock in your brain to be asleep and the clock in your gut to be up and working?”

Not All Sleep is the Same

Most adults need seven to eight hours of sleep each night. Babies, young children and teenagers require a little more, since the body’s growth hormone is activated during deep sleep. Older adults, on the other hand, tend to need less sleep.

Regardless of age, though, keeping a regular sleep schedule is important. “If you surveyed a group of adults, you would probably find very few of them who attest to getting seven hours of sleep or more consistently,” Dr. Siddiqui says. “Most of us are sleep-deprived.”

That’s not to say, however, that everyone needs the same kind of sleep.

Rapid eye movement (REM) sleep, also known as “dream sleep,” is vital for all age groups, according to experts. REM sleep typically starts about 90 minutes into the sleep cycle. The first REM stage lasts about 10 minutes, with each subsequent stage getting longer. Babies can spend up to 50% of their sleep in REM stages, compared to only about 20% of sleep for adults.

During deep sleep, the body can repair and regrow tissue, build bone and muscle, strengthen the

Jonathan Donahue

immune system, and stimulate areas of the brain associated with learning. However, as people age, they tend to sleep more lightly and get less deep sleep—which isn’t necessarily cause for concern.

According to Dr. Hammond, a common misconception holds that adults need a lot of deep sleep—a false belief fed in part by wearable fitness trackers like Fitbit that monitor the sleep cycle.

“Patients come in and report that they’re not getting enough deep sleep,’” he says. “But deep sleep is mostly for kids and young adults—it’s actually not seen that often in adults and seniors.”

Identifying and Treating Sleep Issues

Jonathan Donahue started having trouble sleeping when he was in high school. By his early 20s, the condition was taking a toll. “I couldn’t stay awake during the day,” he says. “I was falling asleep at work.”

Over the next several years, Donahue’s sleep apnea—a disorder that causes one’s breathing to stop and start repeatedly during sleep—only worsened. “I would keep my wife awake at night,” he recalls. “She practically begged me to get help.”

In March 2021, Dr. Siddiqui suggested that Donahue, now 27, undergo a sleep study.

Sentara’s sleep labs in Harrisonburg and Charlottesville are equipped to analyze patients’ brainwave activity and body movements during the various stages of sleep, to help identify whether they may have a disorder. sentara.com

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AGING WELL

“Going through a sleep study is very easy for the patient,” says Dr. Hammond. “Technicians attach a few monitors, and the patient just sleeps. The machines score and analyze various sleep indicators every 30 seconds.”

After analyzing the results of Donahue’s study at the Sentara sleep lab in Harrisonburg, Dr. Siddiqui recommended that he begin using a BiPAP machine—a ventilator that pushes air into the lungs—to regulate his breathing during sleep. The BiPAP, which features a tube connected to a mask worn over the nose and mouth, also allows for remote monitoring of blood oxygen levels (low blood oxygen levels can indicate ineffective treatment of sleep apnea). Slightly different from the CPAP, another commonly used treatment device, the BiPAP delivers higher air pressure when the patient breathes in, whereas the CPAP delivers a consistent pressure during both inhalation and exhalation.

Donahue, who works as an information technology specialist at the James Madison University Health Center, says his sleep apnea has all but disappeared since he started using the BiPAP. These days he doesn’t wake up more than once a night, and his quality of life has improved dramatically. “It has helped with everything,” he says. “Before using the BiPAP, I wasn’t able to drive at night or on long trips. And now, during the daytime, I’m wide awake and can engage more effectively with people.”

Another Sentara patient dealing with sleep apnea, Ruby Seal, of Crozet, has had the condition for more than 20 years—likely inherited from her father.

One night, while Ruby and her husband were staying overnight in York, Pa., during a trip to an out-of-town car show, Ruby woke up and was having trouble breathing. “It scared the bejesus out of me,” she remembers.

Alarmed and in search of answers, Seal went to see a doctor in Waynesboro. “The first test I underwent didn’t show anything significant in terms of sleep issues,” she says. “Then the doctor’s office called me back in for another test, and the second set of results revealed that I would benefit from a CPAP machine.”

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Now 79, Seal has since come to rely on the CPAP, which she calls her “nasal pillow” and takes with her everywhere. “It really helps my breathing,” she says, noting that she now averages 7.5 hours of sleep each night and wakes up feeling rested.

Better Sleep, Better Health

In addition to sleep apnea, another common sleep disorder is narcolepsy, characterized by overwhelming drowsiness and sudden attacks of sleep during the daytime. However, experts say there are many other reasons why a person might not sleep well, including neck and back pain, anxiety and depression.

“If you’re having problems sleeping, it’s really worthwhile to get it checked out,” Dr. Hammond says. “Sometimes, as specialists, we don’t even conduct a sleep study—the first thing we do is listen to the patient tell us their story. Everyone’s sleep history is different. It’s like a fingerprint.”

Home sleep studies, which are less costly to conduct and can still identify many common sleep problems, are also an option.

“If, after ensuring good sleep hygiene, you’re still having problems falling or staying asleep, aren’t feeling rested during the day, or are even experiencing short-term memory issues, make sure you talk with your primary care physician,” Dr. Siddiqui says. “If you need to be referred to a specialist for a sleep study, or to receive equipment or medications to help improve your sleep, we can definitely help.”

CARING

TRADITION

Welcoming our next

Caring Tradition

Leader Sentara Martha Jefferson Hospital President

Rita A. Bunch

I

n January, Sentara Martha Jefferson Hospital welcomed Rita Bunch, MPH, FACHE, as our new hospital president. An innovative servant leader known for her warm, collaborative style, Rita brings more than two decades of healthcare experience, including her most recent stint as vice president, operations, at Sentara RMH in Harrisonburg.

Raised on a farm in East Tennessee, Rita developed her own passion for service from her mother, who was a lifelong caregiver. Rita has served both community hospitals and large health systems, and her resume includes impressive turnarounds of struggling emergency departments in North Carolina, Ohio and Virginia. Since joining the Sentara Healthcare family in 2016, she has expanded women’s health services in Hampton, secured new orthopedics capacity for Harrisonburg and led a successful financial revitalization of Sentara Careplex Hospitals.

At Sentara Martha Jefferson, she joins a nationally recognized team with elite designations for stroke and cancer care, nursing excellence and patient safety. Last year, the hospital was added to the U.S. News & World Report list of Virginia’s top 10 hospitals. Her challenge is to continue that momentum in clinical excellence, while expanding the tradition of warm, compassionate care for a new era of patients, families, caregivers and community members.

How did you discover your passion for hospital leadership?

Many years ago, I decided I wanted to be a nurse and enrolled in nursing school. One morning I arrived at the hospital where I was doing my training to find one of my patients in a terrible state of care. As I charged off to find the night nurse, my nursing instructor intercepted me and helped me “rethink” my approach. This event caused me to switch my career path from the bedside to hospital administration, as I felt I could make a difference on a larger scale. I made

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CARING TRADITION

a vow to myself that day that no patient in any hospital where I worked would ever receive subpar care, and that’s a promise I’ve held true to my whole career.

What priorities have emerged for the hospital?

We are focusing around three areas. The first is opening up access to more patients. We’re growing and regionalizing some of our strongest services, including neurosurgery, oncology and advanced gastrointestinal services. We’re also exploring how How did you focus your first 100 days at Sento expand our mental health services, recognizing tara Martha Jefferson Hospital? what a deep need that is within our community.

Getting to know our community: supporters, The second area is staff support. Burnout and leaders and, of course, our hospital staff. I like staff shortages are significant issues for us, as they to ask all members of my team to tell me a fun are for all healthcare institutions. The same goes fact about themselves: How long have they for workplace violence. People are often shocked worked here? Why do they keep coming back? to learn that 72% of all workplace violence in the Do they have pets, kids, hobbies? I really pride United States is committed against healthcare myself on getting to know people as individuworkers. We’re committed to caring for our teams, als before learning about what they do. We’re and we have made significant investments this year all people first. My personal motto is, “No through the Martha Jefferson Hospital Foundaone cares what you know until they know how tion’s Staff Wellness and Resiliency Fund in services much you care.” like therapeutic massage, mindful movement, peer I’m committed to knowing all 1,500 support and dedicated respite spaces (see sidebar) members of our team by name—which may to help our teams care for their own physical and seem crazy—but I know I can and will do emotional well-being. it. They are the heart of this hospital. Our We’re also investing $1 million annually leadership team also rounds on all our units, through the Haden Nursing Institute and the listening and learning where we can help. It Clinical Education Center to provide scholarships is important to me that we all stay connected and professional development opportunities for and understand how, together, we can proour nurses and clinical staff. We recently honored vide the best care possible for our community.

42 nurses and clinical leaders who earned associate- through doctoral-level degrees over the past two years, despite COVID. Can you imagine the level of tenacity that requires? Every one of those graduates benefited from scholarship support made possible by gifts from our community to the Foundation.

The third area is workforce development. We’re strengthening our relationship with Piedmont Virginia Community College and UVA Health to build a pipeline and create good-paying jobs in this community. Charlottesville is an expensive place to live, and as a large employer, we’re committed to doing our part to make sure that the people who live and raise their kids here can afford to stay here. Thanks to Sentara’s Tuition Assistance Rita with Sentara Martha Jefferson Hospital Board Chair Carol Hurt (right) and Martha Jefferson Hospital Foundation Chair Meg Holden (left).

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CARING TRADITION

The Women’s Committee of the Martha Jefferson Hospital Foundation recently presented Rita with a check for the proceeds from the 2021 In The Pink Tennis Tournament, Martha’s Market and other fundraising to advance women’s health in our community.

by the Foundation, we can offer opportunities for anyone with a high school degree to get a job and then receive full funding to achieve a two-year, four-year or even master’s degree, entirely funded through scholarship support.

What does the Caring Tradition mean to you?

Martha Jefferson’s culture has always been to care for each other and our community—to treat people as people, not as a disease or a room number. That is our Caring Tradition, and it is a

tradition that should never change. I’m constantly humbled and inspired by our teams, and their compassion keeps me going.

What are you enjoying most about Charlottesville?

I love being nestled in the mountains. It makes me feel like I’m at home in East Tennessee. The beauty of Charlottesville is that small-town feel in a larger-city way. I couldn’t be happier with the way my life’s journey has led me here.

A Healer’s Garden In May, not long after Rita’s arrival, Sentara Martha Jefferson Hospital dedicated the Serenity Garden, a beautiful new respite space for doctors, nurses, clinicians and families, strategically located just outside the Intensive Care and Cardiac units, where critically ill patients are treated.

The garden represents Sentara Martha Jefferson’s commitment to extending the Caring Tradition in unprecedented ways, to help boost the resilience of our heroic frontline caregivers by helping them tend to their own physical and emotional needs through the Intentional Caring Program.

Philanthropic support to the Staff Wellness and Resiliency Fund made possible the new Serenity Garden, which is dedicated to the doctors, nurses and staff of Sentara Martha Jefferson Hospital with gratitude from a grateful community.

Leadership funding from the Joseph and Robert Cornell Memorial Foundation, combined with support from our grateful community through the COVID-19 Emergency Response Fund, made possible the rooftop restoration. Its centerpiece is a lovely statue from the DAISY Foundation, honoring the healers who provide exceptional, compassionate care for patients and families.

“Working on these units is really intense,” says Brianna Battaglia, RN. “You get to where you can’t stop hearing the beeping from all the machines. It’s so awesome to be able to step outside and just get away for a few minutes. We’re all so excited for this space to be open.” mjhfoundation.org |

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CARING

TRADITION “I’m so proud that we were able to make this wall a reality. It perfectly captures the spirit of love and inclusivity that makes our Family Birthing Center such a special place for patients, families and staff.”

—Jennifer Wray, MSN, RN, NE-BC, Clinical Manager, Family Birthing Center

The Journey Through Life Starts Here Community Support Helps New Families

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E

very year, more than 1,200 babies and families begin their journeys together in the Mother-Baby Unit at Sentara Martha Jefferson Hospital. Each of these stories is a miracle, and that was certainly the case with the arrival of Mackenzie de Guzman on March 11, 2021.

Just two days before this healthy baby girl entered the world, her mother, Michelle Moshier, received a frightening diagnosis of breast cancer. Instantly, the future she and her wife, Alexandra de Guzman, had envisioned for their family was turned upside down.

Unsure if the cancer had spread and how bad it might be, Moshier was admitted to the Birthing Center immediately, and Mackenzie was born at 38 weeks. “From the moment we walked in, everyone at the hospital understood what was happening and how stressed we were with other parts of our lives,” Moshier recalls.

“But they didn’t poke and prod—everyone was calm and supportive.”

That attitude helped the couple find their own sense of peace, and Moshier says the six hours of labor and delivery were trauma-free.

“Alex and I made a conscious decision that having a baby was a moment we really needed to enjoy,” she recalls, “and it was not to be overshadowed by cancer.”

A week after Mackenzie’s birth, Moshier began chemotherapy at Sentara Martha Jefferson. Thankfully, today she is cancer-free, and little “Kenzie” is thriving.

Art Celebrating Life

As chance would have it, just as Moshier and her family were navigating the difficult start to their journey together last fall, the Martha Jefferson Hospital Foundation was mounting a permanent art installation celebrating love and family at the entrance to the Mother-Baby Unit.

Curated by obstetrics nurse-turned-photographer Meredith McKown, the installation features portraits of seven families who began their journeys at Sentara Martha Jefferson. Inspired by the power in the story of Michelle and Alex, the Foundation team asked if they would be willing to be included in the exhibition and were thrilled when they graciously agreed.

Alexandra de Guzman (left), Michelle Moshier (right) and baby Mackenzie enjoy a happy moment together.

“It was important to have that image,” Moshier says. “It was a very thoughtful gesture for us, that we were a good candidate for the wall.” In the lovely portrait, her short hair is the only clue that the happy family had recently endured a challenging ordeal.

Their portrait and the others in the installation surround a sea of turtles, inscribed with the names and birthdates of children born at Sentara Martha Jefferson. Families inscribe the turtles by making a gift to help underwrite the hospital’s mother-baby programs and extend the circle of care that binds us as families and as a community.

To reinforce the theme, the word “love” is inscribed in multiple languages, simultaneously celebrating both the diversity and the commonality of Sentara Martha Jefferson’s community, as well as the hospital’s commitment to caring for all who enter its doors.

mmj hj hf of ou un nddaat ti ioonn. .oor rgg

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Nurses celebrate gifts to the Mother Baby Fund and the babies honored on the new “love wall.” The Birthing Center was recently recognized among Newsweek’s 2022 list of America’s Best Maternity Hospitals.

“Just about every mother who enters this unit comes down this hall first,” says McKown, harkening back to her 16 years as a nurse helping babies and families at Sentara Martha Jefferson. “We wanted to show families that all are welcome here.”

Making a Difference for Families in our Community

Support for the baby wall makes possible a suite of programs serving mothers and babies, including rocking chairs, prenatal classes and educational resources for obstetrics nurses. As maternity team coordinator, Laura Salvatierra manages many of the maternity programs, which fall primarily into one of two categories: educational classes and support groups.

The classes include offerings such as childbirth prep, breastfeeding support and family CPR. The support groups are aimed at new mothers and parenting support that is inclusive of both partners.

Salvatierra likes to say that she gets to welcome people to the hospital and make sure that when they walk out the door, they know they can come back for support. “This is a unique role that most hospitals don’t have,” she says, noting the program goes back more than 30 years. “We represent a lot of that community connection that just doesn’t exist in other hospitals—especially for moms and babies.”

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For McKown, the baby wall installation is a gift to her former colleagues on the maternity ward, an homage to the families who begin their journeys at Sentara Martha Jefferson, and a celebration of the intimate and enduring connections between family and community.

“Healthy, loving communities create healthy, loving families,” she says. “And healthy, loving families create healthy, loving communities.”

For their part, Michelle and Alex are proud to have their family’s journey commemorated on the wall, and to share their appreciation with the Sentara Martha Jefferson team members who helped them get through two major life events simultaneously.

“I think about it a lot,” says Moshier. “The fact that there was so much positivity surrounding a potentially negative and traumatizing experience speaks to the care they provide. We are very grateful for the team at Sentara Martha Jefferson.”

Moms and babies at a pre-pandemic support group. Sentara Martha Jefferson’s mother-baby programs benefit directly from the generosity of families who honor a child’s birth by inscribing a turtle on the hospital’s love wall.

Photographer Meredith McKown (pictured, with her own children) credits her own experiences of motherhood with her vision for the wall.

“Turtles represent a journey that's very enduring and lasting, just like our journey with our children,” she says. “And the thing that connects it all is love.”

Welcome your baby with love. To honor a beloved child in your life, please add a turtle to our wall with a gift of $250 or more. Visit mjhfoundation.org or call us at 434-654-8258 for more information.

CARING

TRADITION

Promoting Healthy Eating and Active Living: Local Food Hub For more than a century, Sentara Martha Jefferson Hospital has worked to improve the health of friends and neighbors in our community, providing compassionate care for all who walk through our doors and reaching outward to work for greater health equity in our community.

Every three years, Sentara Martha Jefferson partners with colleagues at UVA Health and the Blue Ridge Health District to create a comprehensive study of the most pressing health issues in our community (see story on page 24). The most recent Community Health Needs Assessment identified four priority areas: • Reduce health disparities and improve access to care.

• Promote healthy eating and active living.

• Address mental health and substance abuse.

• Foster a healthy and connected community for all ages.

Through the support of the Martha Jefferson Hospital Foundation, our Community Benefits team closely collaborates with community healthcare partners to address these urgent needs. This piece is the third in our year-long series highlighting a few of the partners and programs we support and work with to improve the health of our community.

The Local Food Hub creates opportunity for local farmers and more equitable access to nourishing food for the community.

Food with dignity—that is the

vision of the Local Food Hub, a Charlottesville-based organization committed to getting healthy, delicious produce from local and regional farms into the hands of those who need it most.

For more than a decade, the Local Food Hub has brought America’s flourishing local food movement home to Charlottesville, fostering more equitable access to nourishing mjhfoundation.org |

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CARING TRADITION

Some 750 people received bags of healthy food every week during the pandemic thanks to the Local Food Hub.

food, more opportunity for local farmers and more environmental sustainability in our food system.

Their services are urgently needed, given that many as one-third of Charlottesville’s residents live below the poverty line. The cost of fresh produce, coupled with the challenges of “food deserts” in certain neighborhoods and rural communities, puts the ability to secure healthy food at risk. Many of these individuals suffer from diet-related illnesses, such as diabetes, obesity and hypertension, and must make hard choices about how to care for themselves and their families.

“We know that mothers will sacrifice the quality of their own nutrition to help their children and families,” says Anna Fife, Local Food Hub interim executive director. “While this situation isn’t new, the pandemic exposed these gaps and showed us how close so many people are to facing food shortages.”

Compelled by this urgent need, the Sentara Martha Jefferson Hospital Community Health Department partnered with the Local Food Hub in 2015 to launch their Fresh Farmacy: Fruit and Veggie Prescription Program. Based out of the Sentara Starr Hill Health Center, the Community Health team provides personalized wellness support free of charge for community members. By the time the pandemic hit in 2019, the team had plenty of firsthand evidence that the Fresh Farmacy program was filling a crucial gap for their clients and yielding measurable health benefits, from weight loss to reduced need for medication.

In response to the pandemic, the Community Health team joined a coalition of local organizations and funders partnering with the Local Food Hub to help them ramp up quickly. “People were super generous in giving back to our community during the pandemic,” says Fife, noting an outpouring of 48 |

SUMMER 2022

funding, new partnerships and tremendous enthusiasm from small farmers—who wanted to help and were grateful for the market as their other sales outlets dried up. “We came up with a lot of novel, community-oriented solutions to get people quick access to food.”

At the height of the pandemic, the Local Food Hub was delivering bags of food to 750 participants weekly.

Thanks to a partnership with the Yellow Top cab company, many recipients received food deliveries directly to their homes. Safe pickup sites were also established outside the Sentara Starr Hill office in the Jefferson School and at the nearby Crescent Hall senior housing community, where volunteers provided contactless delivery to 75 of their neighbors. Sentara Martha Jefferson Hospital staff also received Local Food Hub deliveries weekly during the summer of 2020 on a “pay what you can” basis, ultimately amounting to 2,000 bags of fresh, healthy food for staff during the height of the pandemic.

Since then, innovations like year-round food deliveries and home drop-offs have endured, as has the spirit of creativity and collaboration. This summer, the Community Health team is partnering with the Local Food Hub on a series of pop-up markets to expand the program and bring fresh produce to children and families in rural Louisa and Greene counties.

“Not everyone feels comfortable going to a farmer’s market, or has the means to do so,” says Seirra Winn, Sentara Martha Jefferson community health worker. “We are taking the food to them and eliminating barriers. Food insecurity is real, and it takes the collaboration of community partners to fill this most basic of needs and help ensure that families in our community stay well.”

Our mission to improve health every day drives everything we do to help keep individuals, families and the community we serve healthy.

We do this by establishing partnerships that create a positive impact in our communities.

Through the support of the Martha Jefferson Hospital Foundation and the Sentara Healthier Community Fund, Sentara Martha Jefferson Hospital provides grant funding to community health partners like the Local Food Hub located in the Blue Ridge Health District and surrounding counties. Find out more at sentaracares.com.

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SENTARA MARTHA JEFFERSON HOSPITAL IS A COMPREHENSIVE STROKE CENTER Sentara Martha Jefferson Hospital is recognized as a Comprehensive Stroke Center

by DNV GL Healthcare. This is the highest level of certification available, and it signifies our ability to provide advanced stroke care 24/7. We are proud to serve Central Virginia with quality stroke care in a warm, caring setting.

For more information, visit www.Sentara.com/Stroke

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