Issuu

FA L L / W I N T E R 2 0 2 3

Art AND

ATHLETICISM Physical Therapy Is On Pointe For JMU Dance Students

PLUS: Family Birthplace Preparing Expectant Mothers Relieve Carpal Tunnel Pain | Highlighting Healthy Hearts

PRESIDENT’S

LETTER

Expanding Our Community’s Access to Care

T Doug Moyer President, Sentara RMH Medical Center

2023 SENTARA RMH BOARD Joseph Funkhouser II | Chair Jerry Benson, PhD | Vice Chair Devon Anders Arthur Dean II Morris Fendley, MD C. Wayne Gates, MD SENTARA RMH ADMINISTRATORS Douglas Moyer President

Gina Yost, MSN, RN, NEA-BC, CLSSBB Vice President, Chief Nursing Officer

Catherine Hughes, MBA, RD Vice President of Operations

Robert Garwood, MD Chief Medical Officer

SENTARA RMH MAGAZINE EDITORS Bob Grebe CONTRIBUTORS Preston Knight Jennifer Stover Lisa Smith

his fall we celebrated the official opening of the Sentara Community Care Center in Harrisonburg. As the fourth Sentara Community Care Center established in Virginia, the facility is part of a new and innovative program that provides direct primary care, medical, mental health and social support services to community members who are facing traditional barriers to care. In partnership with Harrisonburg City Public Schools (HCPS), the center will, in part, be working to reduce long wait times for uninsured students and those on Medicaid who are seeking immunizations and physicals for school entrance requirements—a specific community need identified by HCPS. In addition, to address the root factors that significantly impact health and wellbeing in the communities we serve, Sentara Health and Sentara Health Plans are working to dismantle barriers to healthcare services and provide greater levels of access to vital resources. Toward this end, Sentara Community Care Centers are placed where the greatest gaps in access to care and the widest health disparities exist, utilizing strategically located spaces within or near affordable housing communities. The Harrisonburg center is located at 640 South Main St., offering convenient access to many nearby neighborhoods. In the coming months, we’ll also be adding a Sentara Mobile Care Vehicle that will travel to local neighborhoods to help reduce traditional barriers to care, such as inconvenient appointment times and lack of transportation. Sentara Mobile Care will be present at high-profile community events, and its rotating mobile locations will be selected to maximize convenience and proximity to other essential community organizations and services. Sentara Community Care is focused on treating at-risk, medically underserved and uninsured members of our communities. We will treat any individual who visits a Sentara Community Care Center or Mobile Care unit, regardless of insurance status. And we’re not doing this alone. Sentara Community Care is actively working with community and faith-based leaders to gather feedback that helps us better understand the specific factors unique to each neighborhood and its residents. This is an exciting new model of care for our region that reflects Sentara’s commitment to provide not just health care, but other essential community social support resources, such as food pantries, substance use treatment programs and healthy living classes. We look forward to continuing to build our relationship with the community, so that we may serve in all areas where improved health and well-being are needed. With gratitude,

PHOTOGRAPHY Andrew Shurtleff Tommy Thompson DESIGN Picante Creative

Doug Moyer

President, Sentara RMH Medical Center

CONTENTS FALL/WINTER 2023

Features

Delivering Comfort and Care

In Pursuit of Perfection

Carpal Tunnel Surgery

Family Birthplace

Pushing Through Pain

Hand and Wrist Relief

CONTENTS

Departments

17 Sentara Cares 33 Aging Well

Senior Advantage Program Benefits

36 Health Matters Understanding Concussions and Their Risks

37 La Salud Importa Entender la conmoción cerebral

38 Sentara in the Community Quality Child Care Resources Making an Impact

41 Philanthropy

President’s Letter Inside front cover

3 The Best Medicine 4 New & Noteworthy 6 Physician’s Perspective 9 On-Call Advice 11 Improve Health Every Day

14 Eat Well, Live Well

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BY MICHAEL CORDELL

THE BEST

MEDICINE

Why Your Health Should Be as Important as Your Fish Tank

’m always amazed by people who really know cars. Gearheads, if you will. These individuals describe cars using phrases like: “That sweet ride has a 360 Hemi with a supersized torque and a catalytic wang dang doodle under the lid.” If you know anything about cars, then you can tell from the previous sentence that I don’t. I just like to throw around random tidbits I pick up from “Fast & Furious” movies and sprinkle in words that, if they aren’t actually car terms, should be. Another peculiar species of human, to me, is the gardener. While I admire someone’s commitment to their garden, that’s not something I do, either. Granted, the outside of a gardener’s home often looks like something out of a magazine, whereas mine looks like it’s the set of a zombie movie. With gardening, you reap what you sow. And I don’t sow. And don’t get me started on people who maintain at-home aquariums, some of which are deserving of a cover charge — gorgeous displays of colorful, graceful creatures killing time, gliding through the water as if hypnotized. Obviously, that doesn’t include the occasional “floater” or the partially eaten fish (which was probably the result of introducing a cranky specimen into the tank), but a vigilant owner is quick to hide any evidence that betrays an idyllic aquatic scene. One thing these groups of hobbyists have in common is the time and effort they put into their passions. I have a neighbor who washes and waxes his car hourly. He can tell you exactly how long it will be until the next oil change, and when they bring the air filter out for him to inspect at the service shop, he simply laughs, because he’s already changed that sucker on his own. Actually, he’s already changed his own oil as well, so I’m not sure why he’s even there.

Regardless, he takes immaculate care of his car, and it shows. Likewise, gardeners are constantly outside weeding and fertilizing and pruning. They spread mulch, they water and they perform the other hundred tasks required for a gorgeous display. It’s a constant process that takes effort, which is why I don’t do it. And aquarists are so dedicated to their hobby, they’ve even earned an obscure term like aquarist. Don’t even get them started on water temperature, pH balance, nitrates and oxygen levels. If an aquarist corners you at a cocktail party, you’ll soon be worried about your own oxygen level. There are countless hobbyists and aficionados who spend large amounts of time taking care of whatever it is that means a great deal to them. So, how is it that so many people don’t give their bodies that same consideration? Is an annual physical really that inconvenient when we’re talking about one’s health and livelihood? Shouldn’t we be as particular about the types of things we consume as some people are about the type of oil their car uses, the type of fertilizer they spread in their garden or the quality of the food they give their fish every day? Can’t we respond to an irregularly shaped mole that suddenly appears on our skin the same way we respond to a dent on the car, or a fungus in the garden, or algae forming in the fish tank? We should be our No. 1 hobby — as attentive to our own needs and changes as we are to those other diversions we care about so much. Besides, being in good health helps us keep operating in top form, so we can, in turn, keep partaking in our hobbies. After all, those flower beds aren’t going to mulch themselves. Trust me, I know.

sentara.com

new &

noteworthy Sentara RMH Medical Center is pleased to welcome the following new providers into the hospital community. Sheldon Bradley, NP Emergency Medicine USACS at Sentara RMH (540) 689-1414

Carolyn Murrer, MD Orthopedics Sentara Orthopedics & Sports Medicine (540) 689-5500

Erica Shelburne, DO Pediatrics Mountain Ridge Pediatrics (540) 217-5333

Jordan Burns, DO Urology Blue Ridge Urological (540) 689-5900

Erin Neff, NP Hospitalist Sentara Hospital Medicine Physicians (540) 689-1110

Joey Sorenson, MD Pediatrics UVA Harrisonburg Pediatrics (540) 434-3004

Erica Huffman, NP Family Medicine Sentara Primary Care — Staunton (540) 437-7920

Jamee “Alena” Noel, PA Orthopedics Hess Orthopedics (540) 434-1664

Krystal Trump, DO Orthopedics Sentara Orthopedics & Sports Medicine (540) 689-5500

Robert “Christopher” Kime, PA Orthopedics Hess Orthopedics (540) 434-1664

Mohammed Saad, MD Family/Internal Medicine Sentara Mt. Jackson Health Center (540) 477-3185

Rachel Whitehair, MD Pathology Pathology Associates (540) 689-6670

Christine Fasching Maphis, NP Family Medicine Sentara Community Care (540) 564-5880

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

IWantSentaraMedicalGroup.com 4 |

FALL/WINTER 2023

Sentara RMH Medical Center Named Among the

Nation’s Top Hospitals for Treatment of Heart Attack Patients

Sentara RMH Medical Center was one of 11 personalized to every patient’s needs Hospital Sentara hospitals to receive the American and goals. received two College of Cardiology’s NCDR Chest Pain To receive a Chest Pain - MI Registry national awards - MI Registry Performance Achievement Performance Achievement Award, that recognize high Award and the Get With the Guidelines hospitals must demonstrate sustained performance Mission Lifeline Award for 2023. Both achievement in the Chest Pain - MI and patient awards recognize Sentara’s commitment Registry for at least four consecutive safety to and success in implementing a higher quarters and perform with distinction standard of care for heart attack patients. Each for specific performance measures. Sentara hospital reached an aggressive goal of treating hospitals have continued to be recognized with patients with a standard level of care outlined this performance achievement award for the by the American College of Cardiology and past 12 years. the American Heart Association. The American Heart Association’s Sentara RMH received the NCDR Chest Mission: Lifeline program helps hospitals Pain - MI Registry Platinum award, the and emergency medical services develop highest achievement, which was bestowed systems of care that follow proven upon only 262 hospitals nationwide. standards and procedures for ST-elevation Sentara heart specialists treat more than myocardial infarction (STEMI) patients, helping 2,500 heart attack patients each year and have to ensure that patient care is aligned with the extensive expertise in treating heart attacks and latest evidence- and research-based guidelines. minimizing complications. In addition to emergency The program works by mobilizing teams across care, we offer comprehensive cardiac rehab services, the continuum of care to implement American Ornish Lifestyle Medicine, Pritikin Intensive Cardiac Heart Association/American College of Cardiology Rehabilitation and pulmonary rehab services Foundation clinical treatment guidelines.

All 12 Sentara Hospitals Nationally Recognized for Excellent Stroke Care

All 12 Sentara hospitals recently received the American Heart Association and American Stroke Association’s joint Get With the Guidelines Awards for providing excellent stroke care, ultimately leading to more lives saved and shorter recovery times. Get With the Guidelines recognizes hospitals committed to delivering the most appropriate treatment for stroke patients and meeting certain criteria — including the time it takes to give “clot buster” medication — to achieve the best outcomes. Sentara RMH Medical Center received the Gold Plus Award. According to the American Heart Association and American Stroke Association, stroke is the fifth-leading cause of death and a leading cause of disability in the United States. A stroke occurs when normal blood flow to the brain is interrupted, or a blood vessel ruptures or bleeding occurs in the brain. Within minutes of such events, brain cells start dying, so quick diagnosis and treatment of a stroke are critical in saving as much brain function as possible. One way Sentara meets this high standard is with Telestroke technology, a remote, video-based system that allows immediate access to neurologists. The remote neurologists work with a specially trained team of onsite nurses, physicians and surgeons to deliver rapid, lifesaving care. For additional information, visit SentaraStrokeAwareness.com. sentara.com

PHYSICIAN’S

PERSPECTIVE

Food for Thought:

How Healthy Eating Helps Your Heart By Michael Scholfield, MD, FACC, FASE, DipACLM,

American Board of Lifestyle Medicine certified physician

n an effort to encourage you to eat healthier, perhaps a parent or grandparent said to you at some point, “You are what you eat.” As it turns out, they were right! What we eat plays a significant role in our health — particularly heart health. Nearly 80% of primary care visits are related to lifestyle-borne conditions, such as obesity, metabolic syndrome, high blood pressure, cardiovascular disease, high cholesterol, arthritis, diabetes and osteoporosis. Fortunately, a healthier diet that is rich in whole foods can help improve all these conditions. Are You at Risk for Heart Disease? Heart disease is the No. 1 cause of death in the United States. To gauge your individual 6 |

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risk of heart disease, answer these questions: • Are you within five pounds of your ideal weight? • Do you exercise 30 minutes or more most days of the week? • Do you eat a healthy diet, including five fruits and vegetables, most days? • Do you refrain from using tobacco products? • Do you consume two or fewer alcoholic drinks per day? Although only about 3% of Americans can say “yes” to all those questions, don’t despair if you’re among the 97% who can’t. Tweaks to your overall health can make a huge difference in lowering your risk of heart disease, and much of that depends on what foods you eat. One reason for the unhealthy American diet is our reliance on processed foods. While crackers, chips, pastries and microwave meals are convenient, they simply aren’t good for us. About 63% of the typical U.S. diet consists of processed foods, which contain unhealthy fat and sugar, and grains that have been stripped of their nutritional benefits.

Overall, a diet that is plantbased and rich in whole foods (i.e., food that is not refined) is best for improving your heart health. What About Carbs? Carbs get somewhat of a bad rap these days, but our diet actually benefits from healthy carbohydrates like whole grains, legumes, whole fruits and root vegetables. Troublesome carbs, on the other hand, are found in sweets, salty snacks and starches — these are refined carbs that have been stripped of their nutrients through processing. When a grain is refined, it loses 80-90% of its fiber and 70-80% of its vitamins and minerals. Refined carbs can be found in foods like white bread, pasta, baked goods, white flour, white rice, sweets, sugar-sweetened drinks and many breakfast cereals. What About Fiber? Dietary fiber is only found in plants — it’s the part of a plant your body can’t absorb, which is a good thing when it comes to diet. Fiber also steadies your blood glucose levels and

• Vegetables: Carrots, broccoli, sweet potatoes and Brussels sprouts • Fruit: Berries, pears and apples (berries have the most fiber, most antioxidants and lowest sugar content of any fruit) • Whole grains: Whole-wheat pasta, quinoa and oatmeal

speeds up your metabolic rate, helping you burn calories more efficiently. And since it passes relatively slowly through the body, fiber helps you feel full sooner and for longer, causing you to eat fewer calories and helping to control weight. Some good sources of fiber include: • Legumes: Split peas, black beans, lentils and chickpeas

What About Protein? A component of every cell in the human body, protein helps build and repair cells and body tissue, and is necessary for proper growth and development. Animal proteins, including meat, eggs and dairy, are the primary source of protein in the U.S. diet. Unfortunately, these types of animal protein also contain saturated fats and cholesterol, contain no fiber, and are higher in calories than plant proteins.

Foods high in saturated fat can cause problems with cholesterol levels, increasing your risk of heart disease. With plant protein, on the other hand, you can add fiber, antioxidants, vitamins and minerals to your diet, while avoiding unhealthy fats and cholesterol. Healthy sources of plant protein include: • Red lentils • Edamame • Black beans • Almonds • Peas • Spinach Adjusting your diet will pay dividends, and not just with a healthier heart — it can also help reverse diabetes, lower cholesterol and improve your weight. If you’d like help creating a more hearthealthy diet, talk to your primary care provider or cardiologist about a referral to a nutritionist.

You’re Never Too Old to Get Young

f you get tired easily, feel short of breath doing everyday activities like climbing stairs, and overall have less energy, be assured that this does not have to be an inevitable early sign of aging. In fact, you can take steps — and your healthcare provider can help guide you — to reverse those feelings of fatigue or avoid them for years to come.

With a little effort, we can improve health conditions like heart disease that, rather than old age, may actually be behind feelings of easy fatigue and exhaustion. Heart Disease Risk Factors Overall, heart disease is the leading cause of death in the United States. And sadly, about half of males and more than 60%

By Robert Lancey, MD, MBA,

medical director of cardiothoracic surgery specialists, Sentara RMH Medical Center

of females who die suddenly of heart disease aren’t even aware they have the condition. Of the top five risk factors listed below, all except family history of heart disease can be improved with lifestyle changes: • Diabetes • Family history of heart disease • High blood pressure sentara.com

PHYSICIAN’S PERSPECTIVE

• High dietary cholesterol and fat • Smoking While changing these conditions and quitting smoking aren’t necessarily quick fixes, healthcare providers can work with you to set attainable, measurable goals to begin to improve your overall health. Prevention is Key Many Americans have poor diets and live sedentary lives, avoiding exertion and exercise — even in everyday activities, such as parking close to the mall instead of walking through the parking lot to get there, and taking elevators and escalators instead of stairs. To work toward improving heart disease, consider these ABCs: • Avoid smoking • Be active • Choose the right foods Although those measures might seem a bit daunting at first, primary care providers, cardiologists and dietitians are all here to help guide you in developing and implementing an achievable plan. What is Coronary Artery Disease, and How Do We Treat It? Sometimes, even with our best efforts, we can still develop coronary artery disease, which involves the development of blockages in the vessels that carry oxygen and nutrients to the heart muscle. According to the Centers for Disease Control and Prevention, about one in 20 adults aged 20 and older have coronary artery disease. The 8 |

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leading cause of coronary artery disease, cholesterol is a waxy substance that builds up and forms plaque inside the lining of the coronary arteries, preventing them from delivering enough oxygen-rich blood to the heart. Fortunately, procedures have been developed over the years to treat coronary artery disease medically, depending on its severity. In percutaneous coronary intervention, catheters are passed up into the heart through the arm or leg to open up blockages, and then small metal stents are placed to keep blood vessels from closing down again. Another procedure known as coronary artery bypass surgery involves taking arteries and veins from other locations in the body and using them to bypass the blocked part of a blood vessel, restoring normal blood flow to the heart. Heart Valve Issues Another heart-related condition that can cause progressive fatigue and is often accompanied by shortness of breath occurs when a heart valve becomes leaky or

narrowed (stenotic). For instance, the aortic valve, which is the main valve through which your blood passes from the heart into the blood stream, may become narrowed and need to be replaced. This can be done either through an open-heart surgical operation or by putting a new valve in place using a catheter that is passed up into the heart through the leg. The latter procedure, known as transcatheter aortic valve replacement, is a fairly new and minimally invasive technique available to many patients who would otherwise require open-heart surgery. Overall, when it comes to heart health, the good news is that it’s never too late to take steps to improve! Even those who adopt healthy habits, such as walking and eating sensibly, in their later years show benefits in terms of longer, more productive lives. And if you choose to take steps toward a healthier heart, you won’t be alone in your efforts — your primary care provider and the team at Sentara Cardiothoracic Surgery Specialists will be ready to help you on your journey to better heart health.

ON-CALL

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

Taking Care of

Dad’s Health D

uring November, which is recognized worldwide as Men’s Health Awareness Month, heightened attention is placed on awareness of certain preventable men’s health issues — a time to encourage early screening, detection and treatment of certain conditions and chronic illnesses in men. On average, men die five years earlier than women and are more likely than women to skip their annual physicals. Unfortunately, almost one-quarter of men will die from heart disease and nearly onequarter will die from some type of cancer — and many such deaths can be prevented with lifestyle changes and/or earlier detection and treatment. With that in mind, any time is a good time to remind men to make those important health maintenance appointments! Following is a list of important health tips for the men in your life: At least yearly, or as recommended by your health care provider, assess for cardiovascular disease risks: • Blood cholesterol and triglycerides • Blood pressure • Excess body weight • Smoking At least yearly, or as recommended, assess for prediabetes and diabetes risks: • Fasting blood glucose (should be less than 100) • A1C three-month check (should be 5.6 or less) • Excess body weight

At least yearly, or as recommended, assess for cancer risks: • Alcohol intake • Smoking • Excess weight • Screenings, including colonoscopy and prostate cancer screenings Depression is also an often-overlooked problem for men, so be on the lookout for signs of depression, including sadness, grumpiness, hopelessness and a decrease in energy. Other health reminders for men to help maintain good health include: • getting 7-9 hours of sleep per night • no smoking • moderate (if any) alcohol intake • regular exercise, with at least 150 minutes of moderate-intensity exercise or walking each week • stress management strategies • healthy weight maintenance • healthful food choices (more fruits, vegetables, whole grains, legumes and nuts, and fewer ultraprocessed foods, sweets and processed red meat) Be sure to remind the men in your life to keep up with those regular doctor, dentist and eye appointments, as well as recommended screenings. It’s always better to catch health issues early, before they have progressed. sentara.com

ON-CALL ADVICE

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

Know the Symptoms of

Pancreatic Cancer

n oblong organ located behind the lower part of the stomach, the pancreas produces essential digestive enzymes and hormones to regulate glucose metabolism. According to the American Cancer Society, more than 62,000 people will be diagnosed with pancreatic cancer in the United States this year, with nearly 50,000 are predicted to die from this type of cancer, which causes 7% of all cancer deaths. In fact, the global impact of the disease is so significant that the third Thursday of every November is recognized as World Pancreatic Cancer Day. Although usually there are no symptoms to help catch pancreatic cancer early, there are some signs you should watch out for. If you notice these symptoms, be sure to see your doctor immediately: • Yellowing of the skin and the whites of the eyes • Itchy skin • A low, dull back pain (which could be caused by pressure from a tumor) • Dark-colored urine • Light-colored stool • Low appetite and no interest in eating • Unintentional weight loss from being sick to your stomach • Development of diabetes — 40% of pancreatic cancer patients are diagnosed with diabetes in the months before their cancer diagnosis • Chronic pancreatitis • Smoking — Researchers estimate that 25% of all pancreatic cancer diagnoses are due to smoking • Being overweight or obese and having excess waistline fat • Diabetes that is not well controlled Some risk factors for pancreatic cancer, unfortunately, are not under our control: • Getting older: Most diagnoses occur in people older than 45. The average age at diagnosis is 70. 10 |

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• Gender: Pancreatic cancer is slightly more common in men. • Genetic risk Research into the influence of other lifestyle habits is ongoing, but researchers are not yet certain about their impact on pancreatic cancer risk. These include: • Heavy alcohol intake: This is definitely connected to chronic pancreatitis, a separate risk factor for pancreatic cancer. • Physical inactivity: We know that being active helps with two other known risk factors, developing diabetes and being overweight. • Diet is not a confirmed risk factor, but researchers are looking at intake of red meat, processed meats and sugary drinks as potential factors. More information on pancreatic cancer can be found at www.cancer.org.

IMPROVE HEALTH

EVERY DAY

Pay Heed to Pre-Diabetes,

Pronto!

Since prediabetes affects more than 96 million individuals in the United States, raising awareness of and taking action to reverse the health consequences of this condition is essential to us as individuals and to our overall health as a nation. Study results presented at the Endocrine Society’s 2022 annual meeting reveal that prediabetes needs to be diagnosed as early as possible, since it can lead to significant health issues — even before it progresses into type 2 diabetes. The study looked at 1,794,149 hospitalizations at teaching hospitals from 2016-2018. Patients were in the hospital due to primary or secondary diagnosis of an acute myocardial infarction (MI) or heart attack, and 330,814 of those patients had prediabetes. Researchers found that prediabetes, being stressful on the coronary arteries, was an independent risk factor for having a heart attack or having coronary artery bypass grafting. The American Diabetes Association recommends that the following groups be screened regularly for prediabetes: •

Everyone over age 35 — or earlier, if indicated

•

People with human immunodeficiency virus (HIV)

•

Women with a history of gestational diabetes

•

Adults who are overweight or obese A normal fasting glucose reading is 99 or less. Prediabetes is diagnosed with a fasting glucose of 100-125

or an A1C of 5.7-6.4 (A1C is a reflection of the average of blood glucose over the past three months). Screening for prediabetes and intervening as early as possible are important steps for reversing prediabetes and preventing cardiovascular health issues like MI, since prediabetes impacts the vascular system, leading to inflammation and plaque buildup. If you are diagnosed with prediabetes, be sure to take it seriously and make the lifestyle changes needed to get your blood glucose back into the normal range — and keep it there. Following are some lifestyle tips to help you manage your blood glucose:

•

Diet: Distribute carbohydrate foods evenly across the three daily meals. Eat high-fiber foods at each meal to slow glucose rise after a meal, and drink only sugar-free, carbohydrate-free beverages.

•

Exercise: Engage in modest daily exercise, such as a 30-minute walk.

•

Keep up with health care appointments, so you can stay on top of how your glucose is reacting to lifestyle changes.

More information on prediabetes can be found on the American Diabetes Association website at www.diabetes.org. sentara.com

IMPROVE HEALTH EVERY DAY

Adults Need Vaccines, Too

ften we associate vaccinations with young children, but adults need to keep their vaccinations up to date, too. Not only can immunity from childhood vaccines wear off over time, but some adults are also at risk for different diseases than children. According to the Centers for Disease Control and Prevention (CDC), thousands of American adults get sick each year from diseases that vaccines can prevent. Be sure to speak with your healthcare provider about what vaccines are vital for you. All adults need: • Influenza (flu) vaccine every year • COVID-19 vaccine • Td or Tdap vaccine Older adults may also need vaccinations for: • Pneumonia • Respiratory Syncytial Virus (commonly known as RSV) • Shingles In addition, you may need other vaccines based on your age, health conditions, job, lifestyle or travel habits. Talk to your healthcare provider to find out more about what other vaccines may be recommended for you. Different vaccines work in different ways, but every vaccine helps the body’s immune system learn how to fight germs. It typically takes a few weeks for protection to develop after a vaccination, but that protection can last a lifetime. A few vaccines, such as those for tetanus or seasonal flu, require occasional booster doses to maintain the body’s defenses. “Some patients have concerns about vaccine ingredients or may have heard inaccurate information,” says Steven Pearman, MD, vice president of medical operations with Sentara Health. “I recommend that you speak with your care provider to seek information from a credible source.” Your care provider can also address specific concerns, such as potential allergic reaction to an ingredient in a vaccine, adds Dr. Pearman.

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Vaccines, like medications, can have some side effects — but most people who get vaccinated only have mild side effects, or none at all. The most common side effects include fever, tiredness and body aches, as well as redness, swelling and tenderness where the shot was given. Mild reactions usually go away on their own within a few days. You can obtain safety information for specific vaccines from the CDC website. Vaccine Safety Monitoring The United States currently has the safest vaccine supply in its history, and we have safeguards in place to ensure that vaccines are as safe as possible. For example, the Vaccine Adverse Event Reporting System serves as the nation’s “early warning system” to monitor for potential vaccine safety problems, and is just one component of the country’s comprehensive vaccine safety protocols. How Do Vaccines Prevent Disease? Immunization occurs when the body is exposed to germs that cause a certain disease. The body responds to this exposure by forming specific proteins, called antibodies, to fight those germs. Germs in vaccines are dead or very weak, so they will not make you sick. However, the antibodies your body makes will remain effective for a long time, improving the ability of your immune system to fight the germs in the future. If you get exposed to those germs again, your body may then be able to resist them, because your antibodies can recognize and destroy the germs to prevent illness, or allow your body to experience a milder illness. Keep in Mind Not everyone can be vaccinated. Very young babies, people who are very sick and some older people may not be able to get vaccines. Talk to your caregiver about which vaccines are appropriate for you. By getting immunized, you not only protect yourself, but you also help your family and friends, as well as others who are not able to be vaccinated.

Pay Attention to Signs of Gynecological Cancer A century ago, cervical cancer was the No. 1 cause of cancer deaths for women in the United States. Fortunately, beginning in the 1950s, when doctors began widely using Pap smears to detect cervical cancer, those rates fell drastically. Since the human papillomavirus (HPV) causes most cervical cancers, HPV tests and vaccines are also instrumental in reducing cases of cervical cancer. Early detection of any cancer greatly improves the chances of effective treatment and a successful recovery. According to the American Cancer Society, cervical cancer incidence and mortality rates have decreased by more than 50% over the past three decades, primarily due to improved screening. What About Other Gynecological Cancers? Gynecological cancer is any cancer that starts in a woman’s reproductive organs, including:

IMPROVE HEALTH EVERY DAY

• • • • •

Cervical cancer Ovarian cancer Uterine cancer Vaginal cancer Vulvar cancer Overall, about 100,000 women in the U.S. per year are diagnosed with gynecological cancers, according to the Centers for Disease Control and Prevention (CDC). The most common gynecologic cancer is uterine, and the least common is vaginal. In comparison to overall cancer rates among women, gynecological cancers are relatively uncommon. The three most common cancers in women are breast, lung and colorectal, according to the National Cancer Institute. Are Other Gynecological Cancer Screenings Available? Cervical cancer is the only gynecological cancer that can be identified with routine screenings. That means women should be aware of potential symptoms that could signal cancer. In general, according to the CDC, gynecological symptoms include: • Abnormal vaginal bleeding or discharge (this does not apply to vulvar cancer) • Feeling full too quickly, having trouble eating, experiencing bloating, and having abdominal or back pain are typical signs of ovarian cancer • Pelvic pain or pressure is common for ovarian and uterine cancers • More frequent or urgent need to urinate, as well as constipation, are common for ovarian and vaginal cancers • Itching, burning, pain or tenderness of the vulva, as well as changes in vulva color or skin (such as a rash, sores or warts), are found only in vulvar cancer

When Should I See a Provider, if I’m Concerned? You know your body best. Trust your instincts if you feel something is “off.” Talk to your provider immediately if you have unusual vaginal bleeding, including vaginal bleeding after menopause. According to the CDC, if you have not gone through menopause but notice that your periods are heavier and last longer than typical for you, or if you’re having unusual bleeding between periods, talk to your doctor. For other symptoms, the CDC recommends that women see a doctor if they have warning signs that last for two weeks or longer and are not normal for them. Can I Do Anything About My Risk Factors? You cannot change many risk factors for gynecological cancers, such as age, ethnicity, genetics, and a family history of cancers and menstrual issues. Having children, breastfeeding and using the birth control pill reduce the risk of ovarian and uterine cancer. However, leading a healthier lifestyle can reduce the risk of all cancers. According to the American Cancer Society, about 40% of cancer cases and 45% of cancer deaths in the U.S. could be attributed to risk factors that you can change. For cervical cancer, preventive measures include: • HPV vaccines • Regular Pap tests • Using condoms Of course, for gynecological and all cancers, you can reduce your risk by eating healthy, maintaining a good weight, quitting smoking and exercising regularly. If you have a family history of cancer, your doctor may recommend genetic testing to get additional information and determine ways to mitigate risk factors. sentara.com

EAT WELL,

LIVE WELL

Guide for

Meal Planning

ife these days is busy, so for many people, meals often end up being an afterthought — and as an outpatient dietitian at Sentara RMH Medical Center, I come across this issue frequently with my patients. As a result, I spend much of my time with them brainstorming easy meal prep ideas that can realistically fit into their lives. We typically begin by discussing the main components of a meal: carbohydrates, proteins and nonstarchy vegetables, each of which offers different benefits. The best way to fuel our bodies is by having a balance of all three at meals. • Carbohydrates, which have acquired somewhat of a bad reputation in recent years, are commonly omitted from fad diets and weight loss plans. However, these foods provide necessary energy to fuel our bodies throughout the day, 14 |

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By Leigh Steiniger, MS, RDN, CDCES

and complex carbohydrates can be a major source of beneficial fiber. Complex carbs include foods such as fruits, whole grains (whole-wheat bread, wholewheat pasta, brown rice, etc.), potatoes with the skin, sweet potatoes, corn, peas and beans. Ideally, about one-quarter of each meal should come from complex carbohydrates. When we omit these healthy carbohydrates from meals, we tend to crave less-healthy refined carbohydrates, leading some of us to reach for the sweets later. • Protein is the building block of our bodies, and including protein in all meals and snacks helps us feel full and satisfied. Meals that include just carbs and vegetables, on the other hand, will likely leave you feeling hungry and looking for a snack soon after. Ideally, one-quarter of each meal should come from protein sources like chicken, turkey, lean beef, lean pork, fish, eggs, dairy (milk, yogurt, cheese), nuts and beans.

• Nonstarchy vegetables are great, low-calorie sources of fiber, vitamins and minerals that ideally should make up about half of each meal. All vegetables fall into the nonstarchy category except potatoes, winter squash, corn, peas and beans. Now that we’ve discussed the essential components of a meal, we can brainstorm some ways to include all these nutrients. I’m a big fan of planning and preparing food ahead of time in large batches. If you are able to spend a few hours in the kitchen on the weekend and make several bulk meals in advance, then you can just pull meals from the fridge or freezer during the busy workweek. Below are some ideas that can be made ahead of time. • Crock pot meals are a great option, especially for making soups and chili in the cooler months. They can also be used to make just the protein component of a meal. One option is making a basic seasoned chicken breast in a crock pot and then shredding the meat to use in different ways throughout the week

— it goes great on green salads and can be used for things like chicken salad, tacos or quesadillas. • Sheet pan meals are another easy option for balanced, bulk cooking. These involve putting all the meal components (protein, carbohydrates and nonstarchy vegetables) on one baking sheet and cooking them together. These can be made ahead of time and reheated, or they can be prepped during the weekend (veggies cut, meat marinated) to just throw in the oven during the week. • For many people, breakfast is the most-skipped meal, due to lack of time in the mornings. Unfortunately, though, skipping breakfast usually leads to overconsuming large portions at other meals and more snacking — especially at night. Rather than skipping breakfast or reaching for a sugary cereal, there are some easy options that can be prepped ahead of time. Egg muffin cups are simple to make and refrigerate or freeze for an easy microwave reheat later. Overnight oats also can be prepared ahead of time. Other easy, balanced breakfast ideas include low-sugar Greek yogurt with fruit, hard-boiled eggs and whole-wheat toast, or oatmeal with nuts and chia seeds. • Let’s not forget the snacks! Having healthy snacks prepped and on hand is another way to avoid turning to junk food. An ideal snack includes a carbohydrate or vegetable and a protein. Some easy carbohydrates include wholegrain crackers, air-popped popcorn, whole-wheat toast and fruit. I recommend taking time to prep vegetables for snacking once a week and putting them in little sandwich bags that are easy to grab. Baby carrots, cherry tomatoes and mini bell peppers are tasty vegetable options sentara.com

that require minimal prep. Some healthy proteins for snacks include hard-boiled eggs, string cheese, low-sugar Greek yogurt, nuts and low-sugar peanut butter. It’s not realistic to think that we will be able to prep meals in advance all the time, so I like to discuss some healthy, on-the-fly options for lunch and dinner with my patients as well. Below are just a few ideas for easy items to make in each category, as well as some meal ideas. • Carbohydrates: Whole-wheat or bean-based pasta, canned beans, frozen peas, frozen corn, instant multigrain rice or quinoa cups, and whole-wheat bread. • Proteins: Canned chicken or tuna, premade salmon or veggie burgers, high-protein pasta (made from lentils or chickpeas), and canned beans (rinsed well). • Nonstarchy vegetables: Frozen vegetables are a great option and have less sodium than those that are canned! Keeping salad greens on hand can be the basis for an easy meal as well. Easy Meal Ideas • Meal 1: Bean-based pasta (lentil or chickpea) can serve as both the protein AND the carbohydrate, with a sauce of your choice and a side of frozen broccoli. • Meal 2: Baked salmon or a veggie burger on a whole-wheat bun with a side salad. • Meal 3: Southwest salad with beans, corn and tomato on a bed of lettuce.

Lemon Garlic Chicken and Veggies Sheet Pan Meal Source: eatingbirdfood.com/lemon-garlic-chicken-sheet-pan-meal

Servings: 4

Ingredients 1 pound small potatoes, chopped into bite-sized chunks 1 pound asparagus, trimmed and chopped in half 1½ pounds boneless, skinless chicken breast, chopped into chunks 1 tablespoon olive oil Lemon garlic sauce: juice of 1 lemon 4 cloves garlic, minced 3 tablespoons olive oil 1 tablespoon maple syrup 1½ teaspoons sea salt 1½ teaspoons ground pepper 1 teaspoon dried basil 1 teaspoon dried oregano

Directions 1.

Make the dressing by adding ingredients to a small bowl and whisking until combined.

Preheat the oven to 400°F and spray a large baking sheet with cooking spray, or line with parchment paper. Coat the potatoes with 3 tablespoons of the lemon garlic sauce and an additional 1 tablespoon of olive oil. Roast for 20 minutes.

Meanwhile, let the chicken chunks marinate in the remaining sauce.

Once the potatoes have roasted for 20 minutes, toss and place the chicken with the sauce, along with the asparagus, in the pan. Place the pan back in the oven and roast for 15-25 minutes, or until the chicken is cooked through. Enjoy warm.

As far as store-bought frozen meals go, I advise my patients to be cautious with these. The main concern is that they tend to be very high in sodium. A good guideline is trying to choose an item with less than 600 mg of sodium per serving, if it’s the whole meal. If it’s just a component of a meal, aim for less than 300 mg per serving. It’s also important to choose products with at least 15 grams of protein and 4 grams of fiber per serving. In general, I recommend limiting frozen meals as much as possible and choosing some of the other options presented in this article. 16 |

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SENTARA

CARES

Sentara Health Awards

Nearly $400,000 in Grants to Shenandoah Valley Community Partners

The funds will help advance health equity, improve behavioral health access and address social determinants of health Sentara Health recently announced the allocation of $5.3 million in funding to support 137 partner organizations across Virginia and North Carolina. These investments, along with the more than $10 million awarded in the 2022 grant cycles, represent Sentara’s ongoing commitment to addressing social determinants of health and improving access to care for historically underserved communities. The organization’s efforts are further bolstered by grassroots partnerships with community- and faith-based organizations. More than half of Sentara’s total investment this grant cycle will support community-based health equity programs and initiatives centered around behavioral health and equitable access to health care for underserved communities.

“We believe that by investing in local, communitybased health equity programs and initiatives — particularly in the areas of behavioral health, health care accessibility and affordable housing — we can make a significant impact on improving the well-being of underserved populations,” says Sherry Norquist, MSN-RN, ACM, executive director of community engagement and impact at Sentara. “Together with our community partners, we are dedicated to creating a positive and lasting change in the communities we serve.” In the Shenandoah Valley region — representing Harrisonburg, Staunton and Waynesboro, as well as Augusta, Rockingham and Shenandoah counties — the new Sentara Cares grants provide $394,570 across 13 area programs. “The Sentara Cares grants help us extend our reach outside the hospital and medical office walls

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SENTARA CARES

by providing support to our community partners,” says Doug Moyer, Sentara RMH Medical Center president. “These agencies directly address some of our neighbors’ most urgent needs. The grants strengthen our ability to reach a wider audience and enhance our community’s overall health and wellness on many different levels.” As part of the grants, the United Way of Harrisonburg and Rockingham County (UWHR) received $85,250 for its RockBurg CARES Network program. The initiative will allow UWHR to build relationships with, connect with and support the financial stability of local working households in a group referred to informally as the ALICE population. According to the United Way, ALICE stands for “asset-limited, income-constrained, employed.” These are households that earn more than the federal poverty level but less than the basic cost of living for a given area. Amanda Leech, executive director of UWHR, says that without the Sentara Cares grant, the RockBurg CARES Network would not have the financial support needed to launch. “This program is vital to the community,” says Leech. “We know there are households here that are working hard but still struggling to make ends meet. This program is going to help their families remain stable and help their kids succeed in school. Without Sentara Cares, we would not have been able to make this possible.” The Sentara Cares grant also provided the Harrisonburg-Rockingham Community Services Board (HRCSB) $110,000 for the Harrisonburg Paramedic Program, in coordination with the Harrisonburg City Fire Department. The grant funds case management and peer support positions. “The HRCSB is excited for and appreciative of the opportunity to use the Sentara Cares grant to provide a full-time case management position that will work alongside and in collaboration with the Harrisonburg Community Paramedicine Program,” says Rebekah Brubaker, HRCSB executive director. “This position will work closely with the community paramedic to provide resources and support to individuals who may have mental health- and/or substance use-related needs.” Sentara places a high priority on funding community partners and initiatives that align with its key focus areas: health accessibility, behavioral health, housing,

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workforce training and career development, food security, and social determinants of health. The community partners receiving funding from Sentara encompass the various regions it serves, including Hampton Roads, Central Virginia, Northern Virginia, Southside Virginia, the Shenandoah Valley and Northeast North Carolina, as well as organizations that operate across the commonwealth of Virginia.

Community partners in the Shenandoah Valley include: Blue Ridge CASA for Children — Staunton Community Gear Library — Harrisonburg Elkton Area United Services — Elkton Friends of the Shenandoah Trail — Woodstock Goodwill Industries of the Valleys Inc. — Roanoke Harrisonburg City Schools Family and Community Engagement Department — Harrisonburg Harrisonburg-Rockingham Community Services Board — Harrisonburg Health Equipment Loan Program — Churchville Hope Distributed CDC — Harrisonburg Mental Health America of Augusta — Staunton Ride With Pride — Staunton Rockingham County United Way of Harrisonburg and Rockingham County — Harrisonburg

Delivering Care

Comfort: and

Sentara RMH Medical Center’s Family Birthplace

Anna Bricker wanted to be prepared. Getting ready

to have her first child and lacking any experience with labor and delivery or caring for a newborn, she knew she had much to learn. Thankfully, Sentara RMH Medical Center offers a wide range of classes and educational resources for expectant mothers. sentara.com

“I’m a ‘Type A’ person, and I like to be in control of everything,” says Bricker, 29, of Harrisonburg. “To go into a situation where I don’t necessarily know what’s going to happen or what’s best for me isn’t ideal, so having access to those classes was really reassuring.” Bricker took three of the available courses: Childbirth, Breastfeeding and Family Care. Her first class, Childbirth, covers labor and delivery and includes a tour of the Sentara RMH Family Birthplace. “Being able to walk the building was incredibly helpful,”

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she says. “It gave me confidence in terms of what to expect and knowing what happens during a normal delivery.” “The Breastfeeding course was also very beneficial because I honestly didn’t know what to expect,” she continues. “A lot of women say breastfeeding can be very challenging, and there’s pressure in some circles to breastfeed your baby. It was kind of intimidating because I feel like I should be doing it. But how do I do it?” The Family Care class opened her eyes to some issues about parenting she hadn’t considered.

“The instructor displayed a big chart covering certain conditions a baby might have, like rashes and acne — things you might not realize a newborn could have,” she recalls. “Having prior knowledge of those types of issues helped ease my anxiety and let me know what to expect.” What no one expected, however, was that Anna would start feeling contractions a full month before her due date. “I had learned about Braxton Hicks contractions in the Childbirth class,” she says. “With that knowledge, I wasn’t too worried, but I decided to go into Sentara

RMH anyway, to make sure everything was fine with the baby.” According to the American Pregnancy Association, with Braxton Hicks contractions, which are experienced most commonly during the third trimester, the muscles of the uterus tighten for approximately 30-60 seconds at a time, and sometimes for as long as two minutes. “I thought it was better to be safe and sorry,” Bricker continues. “I knew Sentara encouraged patients to come to the hospital in those types of situations, and I wasn’t stressed because I knew where to go.”

As it turns out, Bricker was not experiencing Braxton Hicks contractions. “I went in there and they told me I was dilating and going into labor,” she remembers. Anna’s due date was August 29, and Jackson Bricker was born July 29 — a healthy baby boy. The knowledge Bricker gained during her prenatal classes really paid off. For instance, she had learned about different positions she could try to make her body as comfortable as possible, and caregivers encour-

aged her to make her own decisions throughout labor and delivery. “I felt going into labor that I knew what my options were,” she notes. “I listened to what my caregivers suggested, and together we came up with a plan that worked best for me. My experience went really well because I put my faith in my Family Birthplace team.”

A Holistic Approach at the Sentara RMH Family Birthplace

The journey to motherhood is a remarkable and transformative experience that requires expert care sentara.com

obstetric hospitalist program, which means board-certified obstetricians and certified nurse midwives are available around the clock for maternity and other OBGYN services. For babies who need special attention following birth, Sentara RMH offers a Level 2 Intermediate Care Nursery that is well-equipped to provide the necessary care. This combination of maternity-specific expertise and facilities ensures the best care during the labor, delivery and postpartum stages. “The Sentara RMH Family Birthplace was named one of the highest-performing maternity units in Virginia by U.S. News and World Report in 2022,” says Shiflett. “We exceed strict healthcare standards in providing top-notch obstetric and and support, and the Sentara RMH Medical Center’s Family Birthplace provides a comprehensive, patient-centered approach to maternity care. The team prioritizes the safety and comfort of both mother and baby, ensuring that every childbirth experience is memorable for the right reasons. “We are like a family and genuinely care deeply for one another,” says Sabrina Shiflett, BSN, RN, NE-BC, director of patient care services. “Our community can count on us to be prepared, and we want every community member to know they will be safe and receive high-quality maternity care at Sentara RMH.” The Family Birthplace includes a trained, dedicated team of pediatricians, neonatologists and maternity nurses. Sentara RMH also recently expanded to include an in-house, 24/7 22 |

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neonatal services, which include exceptional customer service, high-quality care, cutting-edge evidenced-based practices, patient-focused care, and — most importantly — compassionate care that comes from our hearts. We all love what we do and the diverse community we serve.” One of the standout features of Sentara RMH’s labor and delivery services is the hospital’s commitment to personalized care. The medical team understands that every pregnancy journey is unique, and caregivers tailor their approach to suit each mother’s preferences and needs. From pain management options to birthing techniques, the medical staff collaborates closely with each mother to ensure that her birthing experience aligns as closely as possible with her birth plan. For many mothers, choosing the right hospital for labor and delivery is a big decision. “Expectant mothers can choose us for delivery regardless of where they get their prenatal care,” Shiflett adds. “It is your choice, and we welcome you and your family to come to Sentara RMH to receive the best hospital maternity care in our region. We are here for you!” The Family Birthplace offers well-furnished, state-of-the-art facilities, with labor and delivery suites that combine a homelike atmosphere with the latest medical technology. This design ensures that mothers can have a comfortable birthing experience and still receive any needed medical care immediately. “While patient safety is our No. 1 priority, we also care deeply about the individual preferences of our patients,” says Rachel

Bennison, RN, BSN, a Family Birthplace nurse. “We combine the latest evidence-based practices and a collaborative clinical approach among the nurses, midwives and doctors, always keeping in mind the specific desires and wishes of our patients. Our community can be assured that upon entering our doors, they will be met with a highly trained and knowledgeable staff who are also caring and compassionate.” Sentara RMH Medical Center’s Family Birthplace stands as a testament to the power of compassionate and comprehensive maternity care. From its inviting labor and delivery suites to the caregivers’ commitment to education and community building, every aspect of the Family Birthplace experience is designed to nurture and empower expectant mothers. “Our nurses help provide our patients with amazing birth experiences,” says Rebecca McCutcheon, a nurse educator. “They truly care about each and every patient they encounter. They want them not only to have a safe outcome, but an

experience they will remember and cherish forever.” As the journey to parenthood unfolds, Sentara RMH is here to ensure that each mother’s entry into motherhood is marked by comfort, confidence and care.

Education and Empowerment: Prenatal Classes and Resources

Preparation for motherhood begins well before the delivery date, and Sentara RMH Medical Center’s Family Birthplace provides a broad range of resources and classes for expectant mothers, including: •

Childbirth preparation

•

Breastfeeding support

•

Infant CPR

•

Family care

•

Sibling classes for children 3-10 years old

•

Family Birthplace tours

To learn more or schedule a tour of the Family Birthplace, visit www.sentara.com/rmhmaternity.

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Spins, Sprains and

Strains

Navigating Injuries in College Dance Majors From early twirls in preschool recitals to graceful leaps on the university stage, the journey of a college dance major is a testament to dedication, artistry and athleticism. These individuals have invested countless hours refining their craft, often starting as wide-eyed children who were drawn to the magic of movement. 24 |

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To transition from dance-studio beginner classes to the competitive world of a university dance program, one needs not only talent, but unwavering dedication akin to that of an Olympic athlete. This is certainly true for Katelyn Penenburgh and Kourtney Keza, both of whom began their dance journeys at age 3 and are now senior dance majors in the School of Theatre and Dance at James Madison University ( JMU). Behind the flawless performances and breathtaking routines, however, lies a lesser-known reality: the toll that a lifetime of dance can take. “It’s a lot of wear and tear on your body,” says Penenburgh. “We experience a lot of body soreness, as well as a few injuries along the way.” “We have a lot of body aches every day, basically,” Keza adds. “It’s mentally exhausting, too.”

This pursuit of perfection often comes at a cost, as the repetitive strain and rigors of dance can lead to injuries that require special care. Dr. Sarah Gosselin, PT, DPT, CSCS, a physical therapist and strength and conditioning specialist at Sentara RMH Orthopedic Center, works directly with JMU dancers like Penenburgh and Keza, thanks to a partnership between Sentara RMH and the university. Dr. Gosselin has been the driving force behind the collaboration. 26 |

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“Getting athletes in quickly for injury screenings is a big part of what we do to help,” says Dr. Gosselin. “When a student sustains an injury, they reach out to me and I get them set up with an appointment. Since they’re busy students with classes, practices and homework, scheduling can be tricky.” Dr. Gosselin knows firsthand what the dancers go through, having been (almost) literally in their shoes. Growing up interested in dance, she herself graduated from JMU with a Bachelor of Arts degree in dance. She later graduated from Shenandoah University with a doctoral degree in physical therapy. “I think that connection makes a huge difference,” she observes. “The dancers know that I understand what their bodies are going through, as well as the hectic schedule that goes with being a student.” College dance majors often push their bodies to the limits, performing complex routines that demand flexibility, strength and stamina — much like in high-intensity sports. Dancers are, after all, athletes performing art. “The demands placed on their bodies are much the same as for many other types of athletes,” says Dr. Gosselin. “For example, in practice they may need to perform jumps 64 times in a row.” Although dance techniques and training haven’t evolved much since the 1700s, sports science is now being integrated into the arts world, due to partnerships like the one between Sentara RMH and JMU. “What makes dance different from sport is that it’s based so much on aesthetics and how movements should look — regardless of the toll those movements take on the body,” says Dr. Gosselin. Also an adjunct faculty member at JMU, educating students on anatomy, injury prevention and conditioning, Dr. Gosselin provides injury screenings to the university’s first-year students. “I spend a whole evening watching dance students go through different stations, looking at things like their cardiovascular endurance, their strengths, their power and dance-specific movements,” she notes. “I take all that information and create a report that explains what each student should watch out for in the future. Then I give them exercise sentara.com

recommendations and share that information with the dance faculty.” Assessments and educational awareness are key to combating pain — but with the physicality of dance, there’s only so much pain that can be avoided. Repetitive movements, while crucial for mastering techniques, can lead to overuse injuries. And the culture of dance, which often emphasizes pushing through pain, can exacerbate those types of injuries. “Honestly, a lot of the time we don’t talk about our injuries,” Penenburgh says. “We’re asked to do some very strenuous things with our bodies.” “It’s very challenging explaining to people exactly what goes into performances and practices,” adds Keza. “You can’t just go on stage and dance what you have been practicing — you have to practice the emotional part, the artistry behind the physical.” Common injuries dancers face range from sprains and strains to more severe injuries like stress fractures, ligament tears and chronic conditions such as tendinitis. The foot and ankle are particularly vulnerable, given their pivotal roles in dance. Lower back and hip injuries are also 28 |

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prevalent, especially in genres that involve a lot of lifts or backbends. Dr. Gosselin works closely with dancers, customizing exercises and rehabilitation programs to address individual strengths and weaknesses. This might involve targeted stretches to improve flexibility, strength training to support joints, or balance exercises to prevent falls. “Dance comes with a lot of overuse injuries,” says Dr. Gosselin. “Muscles often aren’t quite strong enough, so I look for modifications we can make to enable dancers to continue participating in class and earning their grades. Even modifying just one thing can sometimes help prevent pain from getting worse.” When pain progresses to the point of injury, dance students can’t just miss practice or a performance — they are required to be on the dance floor to pass their classes and earn their degrees. Recently, after Keza had surgery to repair damaged cartilage in her left ankle, she worked with Dr. Gosselin to receive physical therapy at Sentara RMH Orthopedic Center. “I saw Sarah once or twice a week,” says Keza. “We did a lot

of strengthening and manipulation therapy at first to loosen up the ankle joint and calf, which would allow the ankle to move.” The Sentara RMH Orthopedic Center features weights and machines for strength training, tables for stretching and massage, and specialized physical therapy apparatuses to help dancers get back to running and jumping. “It’s nice to have access to stateof-the-art equipment here,” says Dr. Gosselin. “For instance, we have something called the AlterG AntiGravity Treadmill, where you’re put into a big bubble and lifted up — it’s really beneficial during recovery from injuries.” For Keza, the hard work involved with physical therapy has paid off. She is currently scheduled to graduate from JMU in May 2024 and plans to continue her education studying physical therapy. In addition to what she calls “everyday soreness” from back pain and hamstring issues, Penenburgh recently sought physical therapy at Sentara RMH Orthopedic Center after suffering a broken fibula and navicular bone in her right foot. “I don’t know what I would have done,” she says. “I’m very fortunate. Immediately after suffering my injury, Sarah was the first person I wanted to contact.” The role of physical therapists in the lives of these students cannot be overstated — they are the guiding lights that help dancers find their way back to the stage. “I didn’t realize how heavily I would be relying on Sarah and Sentara to help get me back to health,” Penenburgh continues. “I’m still not quite at a hundred percent, but the last four or five months have been dramatically better, thanks to the care I have received at the Sentara RMH Orthopedic Center.”

Release and Relief from

carpal tunnel syndrome

A Quick, Painless Procedure Can Help Patients Move on from Years of Pain and Discomfort

At its core, carpal tunnel syndrome (CTS) is a condition caused by pressure on the median nerve as it travels through the wrist’s carpal tunnel. This pressure can stem from inflammation, repetitive motions or certain medical conditions like rheumatoid arthritis. CTS can lead to a variety of symptoms, including pain, numbness, tingling and weakness in the hand and fingers.

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According to the Centers for Disease Control and Prevention, CTS affects an estimated 3-6% of the adult U.S. population — more than 10 million people. The condition is more commonly diagnosed in women than in men, with individuals between the ages of 40 and 60 at higher risk. Occupations that involve constant, repetitive wrist motions, such as production line workers, mechanics, construction workers and hairdressers, are more prone to developing CTS. Pain and numbness associated with CTS can make even the simplest tasks challenging. That’s certainly the case for patients of Sophia Leung, MD, who come to her seeking relief through surgery. “Carpal tunnel syndrome occurs when you have a pinched nerve in your wrist that makes your hand 30 |

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tingle and go numb,” says Dr. Leung, an orthopedic hand surgeon at Sentara RMH Medical Center who has performed thousands of CTS procedures. “My patients often complain of their hands falling asleep, being unable to sleep at night, having to switch hands while driving, and losing grip strength.” Although a commonly treated condition, the root cause of CTS is still under investigation. “CTS happens to all kinds of people, and there’s not one specific thing that causes it,” Dr. Leung continues. “In the 1990s, experts thought that working in an office and typing at a computer led to a lot of CTS cases, but since then we’ve learned that office jobs aren’t any more likely to cause the condition than other types of work — although repetitive work can certainly be a risk factor. We see a lot of poultry plant workers with CTS, for example.”

Even after a CTS diagnosis, not all patients will be ready to make the leap directly to surgery. Many, like Linda Slota, an occupational therapist and certified hand therapist at Sentara RMH Orthopedic Center, first try more conservative treatments like avoiding problematic activities, or just attempt to deal with the pain. When Slota began experiencing issues working in the garden and painting around her home, she tried stretching and wearing a wrist splint at night — but those measures only did so much to alleviate her discomfort. For individuals whose CTS symptoms fail to improve with conservative treatments, surgical intervention may be necessary. For Slota, the decision wasn’t a hard one to make. “I don’t think anyone wants to have surgery,” she says. “But I was at the point where it was very painful. I knew that if I didn’t have surgery, I might have permanent damage. I had full faith and trust and Dr. Leung. I know her work, and her patients have excellent results.” When patients check in for carpal tunnel surgery at Sentara RMH, many of them will be greeted by Lori Wagner, an administrative assistant. “The procedure is quick and easy,” she tells them. “You’ll be glad you did it.” Wagner also knows firsthand the kind of pain CTS patients endure. She suffered from the condition for about three years before having an operation on her right wrist. “I lived with numbness at night and while driving, and

The procedure is quick and easy. You’ll be glad you did it.”

now there’s none,” she says. “Recovery was very easy — having the surgery was the best decision ever.” In recent years, endoscopic carpal tunnel surgery has emerged as a game-changer in the field. The procedure involves making a small incision in the wrist and using a tiny camera, known as an endoscope, to guide the surgeon in releasing the transverse carpal ligament and alleviating pressure on the

median nerve. This minimally invasive technique offers several advantages over traditional surgery: • Smaller incisions: The

smaller incisions used in endoscopic surgery result in reduced scarring. • Faster recovery: Patients who undergo endoscopic surgery typically experience a quicker return to normal activities, since the procedure requires less soft tissue dissection to the surrounding tissues. •

•

Improved cosmetic outcome: Smaller incisions

and reduced scarring contribute to a more aesthetically pleasing result. Less discomfort: Endoscopic surgery is associated with less postoperative pain and a reduced need for pain medication. sentara.com

Another major advantage of endoscopic CTS surgery is that it only requires local anesthesia. “I’m able to operate on the patient’s hand while they’re awake, without them feeling any pain,” notes Dr. Leung. “Being able to use local anesthesia is nice because they can eat breakfast that morning, and some people who live alone can drive themselves here. And for people who have lots of medical problems, endoscopic surgery is much safer.” The surgery on Wagner’s right wrist went so well that she had her left wrist taken care of three weeks later. In the preop exam room, Dr. Leung injected numbing medicine into Wagner’s left wrist, and within minutes she was led into an operating room. As Dr. Leung entered, she cued up music on her cell phone to help create a relaxed atmosphere, and then began the procedure. With the camera feed transmitted by the endoscope, the entire procedure was displayed on a video monitor.

Understanding Carpal Tunnel Syndrome CTS patients typically report symptoms such as: •

Numbness and tingling in the fingers — especially the thumb, index finger and middle finger.

•

Pain radiating up the arm.

•

Weakness in the hand, leading to difficulty in gripping objects.

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“It’s pretty cool,” Lori replied, watching the monitor as Dr. Leung proceeded with the surgery. “And I feel absolutely no pain — just some pressure.” Dr. Leung explained everything she was doing during the procedure, which took only four minutes to complete. She then addressed the incision with sutures and glue. “The longest part of the surgery,” Dr. Leung joked, “is waiting for the glue to dry.” One of the most significant benefits of endoscopic carpal tunnel surgery is its shorter recovery time, compared to traditional open surgery. Dr. Leung tells her patients they can perform most light duties right away and gradually resume some normal activities after two weeks. Resuming activities requiring heavier lifting can take four to six weeks, and a return of full grip strength can take more than six weeks. Postoperative relief is profound for many CTS surgery

patients. After enduring months or even years of pain, numbness and tingling, life after surgery can feel rejuvenating. Activities that were previously avoided become possible again, helping to restore a sense of normalcy. Now having recovered from carpal tunnel surgery in both wrists, Wagner has advice for others considering the procedure: “Go ahead and get it done. There’s no sense in living with the pain.” Slota agrees. “Carpal tunnel can feel like a hot knife cutting into your palm,” she says. “It is awful, and you shouldn’t have to live with pain like that. It’s only going to get worse over time, and it’s so much better living pain-free.” CTS can significantly impact an individual’s quality of life — particularly if left untreated. If you suffer from pain, numbness and weakness in the hand and fingers, speak with your primary care physician about a referral to Sentara RMH Orthopedic Center.

AGING

WELL

Senior H Advantage Program: Promoting Healthy Aging and Social Engagement

ealth, nutrition and social interaction are vital at every stage of life, but they can become increasingly challenging to prioritize as we age. Proper nutrition and regular physical activity are, of course, essential to every senior’s well-being — but during this stage of life, it’s also important to ensure you stay mentally active, keep in touch with friends and continue to build meaningful relationships. Nearly two decades ago, the Sentara RMH Senior Advantage program was started to help older adults be more involved in their health and healthcare choices. The program focuses on healthy aging and covers all aspects of a person’s life, including social opportunities, health and physical education. Senior Advantage welcomes anyone who is 55 and “better.” Since many members are retired and have fewer demands on their time, the program helps to fill holes in their schedules, while also providing them with friendships and education. sentara.com

AGING WELL

“They’re looking for ways to stay active, socially engaged and involved in their community,” says Susan Ribelin, program coordinator for Sentara RMH Senior Advantage. Embracing Healthy Aging Programs like Senior Advantage help people stay healthy and happy as they get older by focusing on body, mind and relationships. The goal is to have a satisfying and productive life, no matter your age. Whether it’s through educational lectures or simply sharing a meal with newfound friends, Senior Advantage shows that social engagement and mental well-being are as vital to health as physical fitness. Healthy aging programs offer many advantages, including: • Improved quality of life: Seniors often experience enhanced well-being, making life more enjoyable and fulfilling. • Positive health habits: Healthy aging programs motivate seniors to adopt and maintain healthy habits, such as regular exercise and balanced nutrition. • Increased or maintained independence and mobility: Seniors can keep their ability to perform daily tasks and stay active, reducing the need for help. • Lowered risk of disabilities and falls: These programs help prevent disabilities and reduce the likelihood of accidents like falls, promoting long-term health. • Enhanced mental well-being: These programs support mental health, helping to delay cognitive decline and improve symptoms of depression. Of course, a well-lived, healthy life can mean something different for each person. To appeal to a wide variety of people, Senior Advantage offers social activities and a range of seminars, workshops and classes. 34 |

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“They bring their own games and educate the group, or they might share a story. Members are very social at those events.”

impact on their lives. The camaraderie, sense of belonging and shared activities create a strong sense of community among participants, helping to form friendships and encouraging members to stay active and healthy.

Membership benefits also include savings at the Sentara RMH Wellness Center and discounts at the hospital gift shop. Although the COVID-19 pandemic limited the program’s schedule, events and classes have resumed, and attendees are happy to have opportunities to gather again. Recent monthly health education lectures have included topics such as nutrition, fall prevention, Medicare open enrollment and community programs. In addition, physicians and other hospital employees often speak to the group. Senior Advantage has also hosted the Lions Club for vision and hearing screenings. “We really try to listen to what our members want and provide those activities and educational opportunities,” says Ribelin. Members consistently highlight the program’s positive

Embracing Social Opportunities Not surprisingly, social activities are among the most popular Senior Advantage offerings. “This is especially true after COVID,” Ribelin notes. “This is a population that dealt with loneliness and isolation before the rest of the world realized, during the pandemic, how serious the issue could be.” Members especially enjoy game days, where they can learn new games and play old favorites. “We always try to engage the whole group, then break out into smaller groups and let them do the things they really enjoy,” Ribelin says. “They bring their own games and educate the group, or they might share a story. Members are very social at those events.” Another popular activity is the breakfast club that meets at local restaurants or the hospital. “It gives

“We encourage people to try the program and see if it’s for them. Often, they find out that they already know someone in the group, and sometimes they bond with other members right from the start.” members an opportunity to be with other people and enjoy a meal, conversation and fellowship,” Ribelin explains. Verna Rodes joined Senior Advantage after retiring from her job as secretary/treasurer at her family’s roofing business. The program provides her with valuable opportunities for socialization and helps make up for the social interactions she used to have at work. The Bridgewater resident especially enjoys the breakfasts and game days. “I’m a people person and enjoy making new friends,” she says. “I’m just a person that likes to be doing something, especially with other people. The card games are a lot of fun, and there are always new members joining.” Rodes says she plans to bring her canasta cards to the next game day, so she can teach the group how to play. A Positive Impact Senior Advantage is a popular program, including more than 1,000 members and hosting events

that are well attended. Members often encourage friends to join, and couples sometimes join together. “We encourage people to try the program and see if it’s for them,” Ribelin says. “Often, they find out that they already know someone in the group, and sometimes they bond with other members right from the start.” People often discover Senior Advantage through other programs for seniors, like the James Madison University Lifelong Learning Institute or the Valley Program for Aging Services. “The folks who want to remain active, busy and involved tend to seek those groups out and participate in a variety of things,” Ribelin notes. “People enjoy spending time with others their own age and learning new things, whether about family issues or activities available out there.” Many now take part in Sentara RMH Medical Center’s Walk with a Doc program, a free walking and educational program at the hospital. Programs like Senior Advantage can have a positive impact

on people’s overall health, Ribelin notes. “Social determinants of health matter greatly, and what we do in the program definitely helps improve quality of life for our members as they age. People want to live as independently as they possibly can. Taking care of your body through exercise, eating well and getting checkups are all essential, but it’s also important to focus on your mental health — it all feeds together.” Rodes is thankful to have the program and for the difference it has made in her life. “Senior Advantage means so much to me,” she says. “I know it would mean a lot to other people if they would step out and try it. There are so many negative things going on around us — I think we need some good and positive things to fill our hearts and minds with.”

Join Senior Advantage Anyone 55 or older can join for a one-time $10 membership fee. Join today by calling 540-564-7001.

sentara.com

HEALTH

MATTERS

Understanding

concussion

concussion is a type of traumatic brain injury that occurs when the brain gets shaken forcefully enough to collide with the skull. People can go for hours or days after an impact to the head before concussion symptoms appear. Regardless of when symptoms manifest, anyone suspected of having a concussion should be assessed immediately by a medical professional, and a confirmed concussion should always be taken seriously and treated appropriately. Signs and Symptoms Headache is the most commonly reported concussion symptom, followed by “mental fogginess,” or delayed or slowed mental processing. Other common symptoms may include the following: • Confusion • Difficulty tracking a moving object with the eyes • Dizziness • Memory loss • Nausea • Ringing in the ears • Sensitivity to light and/or loud noises Assessing and Treating the Patient Even though no universal standard for initial concussion diagnosis exists, doctors and athletic trainers still try to get some sense, as soon as possible after the impact, of how serious a potential concussion might be. To do so, they may ask patients about any headache symptoms, test their memory by asking them to state their address, or perhaps have them track a pointer or finger with their eyes. However, since concussion symptoms don’t always show up immediately after an impact, proceeding with caution is crucial. Under no circumstance should someone suspected of having a concussion be allowed to return to a sporting event or any other activity involving a risk of reinjuring the brain, before being cleared of symptoms. 36 |

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Repeat concussion injuries—even those occurring years apart—seem to make a person more susceptible to new concussions, which can result in permanent brain damage and take a devastating toll later in life. There is even evidence that repeated concussions may contribute to conditions such as Parkinson’s disease; Alzheimer’s disease; and amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease. Rest is typically the primary mode of treatment for concussions, with other options available based upon a patient’s specific symptoms—for example, wearing sunglasses for sensitivity to light or wearing ear plugs for sensitivity to sound. Sleep is also very important in helping the brain heal. If a person who has suffered concussion has difficulty sleeping, medications can be prescribed to help him or her get the proper amount of rest. Following a concussion, some people experience inner-ear problems that affect their balance, or they may experience problems with vision, including tracking difficulties or issues with peripheral vision. In such situations, physical therapy often can help. If there is the least concern that someone has had a concussion, he or she should be seen by a medical provider as soon as possible.

LA SALUD

IMPORTA

Entender la

conmoción cerebral

na conmoción cerebral es un tipo de lesión cerebral traumática que se produce cuando el cerebro se sacude con la fuerza suficiente para colisionar con el cráneo. Pueden pasar horas o días después de un impacto en la cabeza antes de que aparezcan los síntomas de conmoción cerebral. Independientemente de cuándo se manifiestan los síntomas, toda persona de la que se sospeche que ha tenido una conmoción cerebral, debe ser evaluada de inmediato por un profesional médico, y una conmoción cerebral confirmada siempre se debe tomar en serio y tratar de manera apropiada. Señales y síntomas El dolor de cabeza es el síntoma de conmoción que se informa más comúnmente, seguido de “neblina mental”, o el procesamiento mental retrasado o retardado. Otros síntomas comunes son los siguientes: • Confusión • Dificultad para seguir un objeto en movimiento con los ojos • Mareo • Pérdida de la memoria • Náuseas • Zumbido en los oídos • Sensibilidad a la luz o a los ruidos fuertes

Evaluar y tratar al paciente Aunque no existe un estándar universal para el diagnóstico inicial de conmoción cerebral, los médicos y entrenadores atléticos todavía intentan detectar, lo antes posible después del impacto, cuán grave podría ser una posible conmoción cerebral. Para hacerlo, pueden preguntarle a los pacientes sobre cualquier síntoma de dolor de cabeza, evaluar su memoria pidiéndoles que indiquen su dirección, o quizás hacer que sigan un puntero o dedo con los ojos. Sin embargo, dado que los síntomas de conmoción cerebral no siempre aparecen inmediatamente después de un impacto, es crucial proceder con precaución. Si se sospecha que una persona ha tenido una conmoción cerebral, bajo ninguna circunstancia se le puede permitir que participe de un evento deportivo ni cualquier otra actividad que involucre el riesgo de que el cerebro se vuelva a lesionar, sin haber primero descartado los síntomas. Las lesiones por conmoción cerebral repetidas, incluso las que ocurren luego de pasados algunos años, parecen hacer que una persona sea más susceptible a sufrir nuevas conmociones cerebrales, lo que puede causar daño cerebral permanente y tener un costo devastador más adelante en la

vida. Incluso hay evidencia de que las conmociones cerebrales repetidas pueden contribuir a afecciones como la enfermedad de Parkinson, la enfermedad de Alzheimer y la esclerosis lateral amiotrófica, también conocida como enfermedad de Lou Gehrig. El reposo es típicamente el principal método de tratamiento para las conmociones cerebrales, con otras opciones disponibles en base a los síntomas específicos de un paciente (por ejemplo, usar gafas de sol para la sensibilidad a la luz o usar tapones auditivos para la sensibilidad al sonido). Conciliar el sueño también es muy importante para ayudar a que el cerebro se cure. Si una persona que ha sufrido conmoción cerebral tiene dificultad para dormir, se pueden recetar medicamentos para ayudarle a obtener la cantidad adecuada de reposo. Después de una conmoción cerebral, algunas personas experimentan problemas en el oído interno que afectan su equilibrio o pueden experimentar problemas con la visión, lo que incluye la dificultad para seguir objetos o problemas con la visión periférica. En tales situaciones, la fisioterapia a menudo puede ayudar. Si existe la menor preocupación de que alguien sufrió una conmoción cerebral, esa persona deberá consultar a un proveedor de atención médica cuanto antes. sentara.com

SENTARA

IN THE COMMUNITY

Quality

Child Care

Gets a Big Boost in Virginia 38 |

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Sentara RMH Medical Center has a lead role in ensuring a ‘level playing field’

It is impossible to expect them to realize this now, but for the dozens of children currently attending Shiningstar Daycare in Harrisonburg, they may one day look back fondly on the positive influence the experience had on their lives — an experience on which Sentara RMH Medical Center has had a major influence.

Shiningstar is among the programs that fall under the newly state-mandated Virginia Quality Birth to Five System, or VQB5. This system, which went into effect July 1, 2023, looks to raise the quality of interactions between early childhood educators and the prekindergarten children they serve in publicly funded programming. In essence, the program is an official measure to help ensure that the best interests of families and children are prioritized and carried out by such facilities. “VQB5 really levels out the playing field,” says Natalia Botkins, Shiningstar’s assistant director. “It’s there to make sure lower-income families receive the same type of early childhood education that families with higher income levels might receive. With us being so small and the majority of our children coming from lowerincome families, it has been a great help.” As of fall 2023, all publicly funded birthto-five programs are required to participate in VQB5, with the first quality ratings to be published in fall 2024. The system will include about 3,600 public schools, child care centers and family day home programs, encompassing approximately 12,000

“classrooms,” according to the program’s website. In our area, VQB5 covers 60 private programs from Winchester to Augusta County, providing resources for 174 classrooms. Nine districts deemed “Ready Regions” oversee the program and are responsible for coordinating VQB5 measurement and improvement activities throughout Virginia. The United Way of Greater Charlottesville serves as the lead agency for the Blue Ridge region, covering 21 jurisdictions, including Harrisonburg and Rockingham County. This is where Sentara RMH enters the picture. The United Way subcontracts with the hospital to oversee its local region, which includes nearly 45,000 children under age 5, according to VQB5. “Everything is in place and running,” says Marta Szuba, team leader for grant programs at Sentara RMH.

Sentara’s ‘Commendable’ Role

So, why is a hospital system so involved in an educational program? You could just as easily ask, why not? sentara.com

SENTARA IN THE COMMUNITY

The local connection goes back about two decades, when Rockingham Memorial Hospital recognized the importance of high-quality child care to its own workforce, Szuba says. “It’s essential,” she explains. “Without having a place in our community for early childhood education and care of a certain quality or that adheres to certain licensing, it was harder to bring in new nurses or support staff.” At that time, the hospital applied for and received a grant tied to an initiative that was the precursor to VQB5. Sentara RMH continued its commitment to the cause when the new program mandate came along, preparing over several years for the official launch this past summer. “It’s important for us because our commitment is to the community’s health every day,” Szuba says. “It starts at birth, and part of that commitment comes with education. It comes with communication. This is just a future investment in that commitment to community.” VQB5 sets shared expectations for measuring quality and supporting teachers for all birthto-five programs. According to the program’s website, teachers and leaders receive the feedback and support they need through VQB5 to help young children learn. An important feature of VQB5 is that measurement and improvement are connected and ongoing, so facilities have opportunities to reflect on their progress during the year using a continuous quality-improvement cycle. Szuba acknowledges that it can be surprising to think that Sentara RMH is the organization overseeing such measurements. 40 |

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She herself originally didn’t grasp the hospital’s role in community education. “When I first considered applying for a job at the hospital, I said to myself, ‘I’m not a nurse or doctor — I’m an educator,’” Szuba recalls. “But education is a part of what Sentara RMH does. In the Community Health Department, we have opportunities for families at risk, senior citizens and others. It’s commendable.”

Stars Align

Shiningstar, located on Emerson Lane in Harrisonburg, is familyowned and -operated, providing care to children as young as 1 month old. Employing five teachers, the facility offers infant care, toddler care and preschool, catering to lower-income families in the city. At full capacity, it can accommodate 40 children.

“We have a tough time finding and retaining quality staff,” says Botkins, whose mother, Cassandra Allgood, started Shiningstar in 2007. “Early childhood education as a whole is that way. We especially feel vulnerable being small, minority-owned, and familyowned and -operated.” VQB5 helps guide the facility through staff training and access to classroom supplies. Botkins is highly complimentary of Sentara RMH staff, singling out Sara Barnett, an early childhood education specialist, for always being available to lend assistance. According to Botkins, the goal is to provide the best service possible, and falling short is a missed opportunity that can have long-term consequences on children. “A child’s first few years of development are crucial to future success,” she says. “That foundation is really beneficial for social development. The earlier you get them into a quality program, the better.” Botkins finds her work helping children get a solid start in life to be very rewarding. “Families that have had children graduate from the center frequently trust us to start the process again when they have more children,” Botkins says. “That’s something we’re very proud of.”

PHILANTHROPY

HEALTH CARE

on the

Move Suitcase Clinic works to eliminate obstacles to care for the homeless population Have stethoscope, will travel. When health care is made more accessible, everyone in the community benefits. And by bringing healthcare services to underserved populations in the community, the Suitcase Clinic has proven to be a lifesaver for many in the Shenandoah Valley.

Sentara RMH Medical Center, James Madison University (JMU), and the city of Harrisonburg are lead partners in operating the Suitcase Clinic, which provides 18-20 hours of care each week by volunteers who visit five area homeless shelters. The clinics address healthcare needs for a population that often faces logistical barriers to accessing care, and the mobility of the clinics allows a vulnerable group to seek care in a convenient way. “One of our important objectives is to help people who have no medical home find one,” says Sharon Maiewski, a volunteer physician assistant and associate professor in JMU’s Department of Health Professions. “By helping people establish a relationship with a healthcare provider in the community, we are helping them prioritize their health — and, hopefully, avoid complications of untreated medical conditions, unnecessary emergency department visits and hospitalizations. The result is a healthier community and fewer dollars spent on preventable medical services.” The Suitcase Clinic has more than a decade of documented proof that it is achieving its original goals. supportRMH.org

PHILANTHROPY

Removing Obstacles Nearly 13 years ago, Harrisonburg and Rockingham County formed the Healthcare for the Homeless Coalition as community leaders recognized an increasing problem of unmet needs, including health, for area homeless. A lack of insurance, funds for co-payments and medications, and transportation to the needed services were identified as obstacles to the health of these residents, according to an executive summary for an original grant application. Formed in June 2011, the Suitcase Clinic provides a unique healthcare delivery model, addressing the complex and unconventional health concerns of both sheltered and unsheltered homeless individuals. “Rather than functioning within a permanent clinic setting, supplies can be transported in a suitcase on wheels,” Maiewski says. “The clinic functions in private spaces within the shelter sites.” The Suitcase Clinic provides acute and chronic health care, as well as screening services, referrals for mental health services, foot clinics, health fairs, immunizations, dental referrals, and free over-the-counter and prescription medications. To qualify for services, clients must currently be uninsured, sheltered or street homeless, or have transitioned into housing within the past 90 days. The clinic is staffed by a nurse case manager, a care coordinator and volunteer providers who are either physician assistants, nurse practitioners or physicians. In the past year, the Suitcase Clinic has provided care to more 42 |

FALL/WINTER 2023

“

When I get up in the morning, I can be showered, dressed, fed, caffeinated and in my car headed to work in less than an hour. For a homeless person, those everyday tasks take up most of the morning. That’s why we go to where they are.” than 300 unique homeless clients, with more than 1,000 care encounters, Maiewski says. “Our challenge isn’t finding patients — it’s getting folks to prioritize their health care,” she adds. “For people who are homeless, in terms of importance, health care falls in behind finding safety, food, personal hygiene and shelter.” This is where the clinic shines. While health care is

important to people who are considered homeless, Maiewski explains, addressing it takes a level of dedication they may not have. “They desire good health just like everyone else,” she says. “The problem is that a person without a home has to devote so much of their time and energy addressing daily necessities like working (most homeless people have jobs), finding food and shelter, locating facilities to bathe and clean their clothes, and securing a safe place to sleep at night, that there is little time or energy left for anything else. When I get up in the morning, I can be showered, dressed, fed, caffeinated and in my car headed to work in less than an hour. For a homeless person, those everyday tasks take up most of the morning. That’s why we go to where they are — it removes the barriers of transportation, time, proximity, cost, safety and stigma.”

‘Our People Are Healthier’ The RMH Foundation, the charitable arm of Sentara RMH Medical Center, is among the longtime financial supporters of the Suitcase Clinic. The bulk of the clinic’s funding covers medications, mental health services, dental work and salaries for two staff members. “The RMH Foundation provides funds to pay the nurse case manager and a care coordinator,” Maiewski says. “These two people are essential to the success of the clinic. They are the glue that holds it all together, and their jobs cannot be managed by volunteers.” She says the RMH Foundation has been a “true partner” by

PHILANTHROPY

How to Help You can contribute to the Suitcase Clinic by visiting hhs.jmu.edu/ suitcaseclinic. You can also help by contacting the following shelters in Harrisonburg and offering the gift of your time and talents: Asbury Methodist Church: asburydowntown.org Gemeinschaft Home: gemeinschafthome.org Harrisonburg Salvation Army: harrisonburg. salvationarmypotomac.org Open Doors: valleyopendoors.org Our Community Place: ourcommunityplace.org

offering encouragement, direction advice and leadership in finding ways to sustainably improve the health resources available to the community the clinic serves. “I’ve always worked in clinics where patients had few personal resources,” she adds. “Practicing medicine in environments like the Suitcase Clinic and the free clinic can be quite challenging, but it’s also much more gratifying because we don’t have the limitations and extra costs imposed by insurance companies and healthcare administrators. Of course, that also means we don’t have as many options to offer patients, but we manage pretty well with the basics and a little creativity. And when patients need more than we can provide, we help them access additional medical services.” Some Suitcase Clinic clients have told those providing care

that their lives have been saved thanks to its services. So the clinic can have huge impacts on its clientele. Any improvement to a person’s health, however, is considered a victory. “Our long-standing partnership with the Suitcase Clinic has allowed us to conveniently offer acute care services to our oftenmarginalized population on at least a weekly basis,” says Nate Riddle, executive director of Open Doors, the area’s only low-barrier shelter and support agency. “Not only does the team provide routine clinics, but they meet individuals where they are and assist them with obtaining a primary care provider and/ or specialty care. “Our people are healthier thanks to the Suitcase Clinic.”

Plan for Your Life’s Journey Life is one long road trip, and no matter where you are, we can help you on your journey. We have tools and ideas to save you money, while providing for the people and causes most important to you—causes like the RMH Foundation. Your expression of philanthropy makes a difference to local patients and supports the RMH Foundation’s mission of elevating health care in our community. No matter how far you are into your life’s journey, it is never too late to update your plan. You decide on your destination based on your own values and priorities, and we can help you get there. For more information, please visit https://sentara.giftlegacy.com. We look forward to helping you plan your future!

supportRMH.org

FOUNDATION

friends of the RMH Foundation

Gifts received from May 1 to August 31, 2023

Sentara RMH Medical Center is so grateful to have the support of generous community members. We express this gratitude and recognize the contributions our donors make through the President’s Forum, the William Leake Society, 1910 Cornerstone Club and the White Rose Giving Circle. These exclusive giving circles are our way to honor our most generous partners who show they care about having the best medical services available in our community. Finally, to recognize your loyalty over the years, we are placing the number of consecutive years you have supported the RMH Foundation next to your name. Thank you for your support!

President’s Forum $5,000 - $250,000

William Leake Society

Wayne L. Harrison (1)

$1,000 - $4,999

Diane C. Davis (31)

David O. Banks (1)

Polly Geil (1)

Tena M. Bibb (15)

The Community Foundation

Blue Ridge Bank (8)

of Harrisonburg and Rockingham Cty. (3) RMH Employee Payroll Deductions (1) Harrisonburg Rotary Club (1) James and Frances Mason (4)

Alphonso Price and Emily Brown Boxley (1) Nancy R. Bradfield (15) Helen Breeden (4) Benjamin Craig and Dr. Nicholas Swartz (3)

Everence Foundation, Inc. (1)

Cory and Donielle Davies (15)

Schwab Charitable Fund (1)

Colonel Peter F.and Lydia Dieck (6)

Dr. Charles H. and Mary

Fidelity Charitable Gift Fund (1)

Henderson (18) Ameriprise Financial Services, Inc. (1) Cardinal Dental Specialists (2) David and Emily Larson (4) Robert A. and Janie M. Mullett (1) Wilmer A. Olinger (2) William E. and Heidi B. Strang (1)

Sherrill Glanzer (22) Drs. William and Brooke Goodwin (9)

FALL/WINTER 2023

Rosenberger (1) Kevin H. Roy (1) Shenandoah Automotive Service Center (7) James R. and Mary C. Sherman (11)

Sandra G. Baker (3) Edgar L. Barnard, Jr. (17) James T., Sr. and Barbara R. Begoon (20) Drs. A. Jerry Benson and Martha K. Ross (12)

Barbara B. Stoltzfus (25)

Ralph N. Bergdoll (7)

Doris S. Stone (10)

Steve and Ann Bird (6)

Lynn and Diane Trobaugh (16)

Linda Heatwole Bland (11)

Phillip and Christina Updike (10)

Terry L. Bodkin and Connie

Nancy Hopkins Voorhees (16)

Thompson-Bodkin (8)

Jodie E. Wampler (38)

Dennis P. and Janet E. Boffo (6)

Richard L. and Pamela B. Wilkins (36)

Larry O. and Paula C. Bowman (1) Sherry L. Braithwaite (8) Linda V. Breeden (1)

1910 Cornerstone Club

Donna S. Hahn (17)

$100 - $999

Dr. David C. and Amelia M. Hall (13)

Frank D. and Joyce D. Aigner (1)

Richard and Julie Haushalter (23)

Michael and Violet Allain (4)

Dr. Debra and Mark Horst (1)

Marcus B. Almarode (11)

Estate of Virginia M. Martin (3)

Devon C. and Teresa B. Anders (14)

McDonald’s and Boxley Family (10)

Ervin L. and Ann Noffsinger

Dr. Jason R. and Hilary D. Moore (5)

44 |

E. John, III and Carol H.

Anderson (10)

Drs. David and Heather Morgan (1)

Michael and Vickey Arbogast (1)

Craig A. Orndorff (1)

Jane Armstrong (7)

Janice L. Pence (12)

Artisan Packaging (1)

Thomas B. And Suk Nam Pender (4)

Keith S. and Denise R. Atkins (1)

Dr. Derek and Katherine Robinson (2)

Charles A Baker (1)

Rosemary O. Brenner (13) Bridgewater United Women of Faith (1) Emmett H. and Leola C. Brooks (8) Carol J. Brooks (19) Deborah E. Bullis (27) Jenny and Jared Burden (2) David L. and Elizabeth B. Burkholder (7) J. Michael and Dianne H. Burris (1) Gregory G. and Pollyanna A. Bush (1) Dr. John Canter (1) Bonnie C. Caplinger (5) Dr. Ronald E. and Jo Ellen Capstack (1) William B. Carper, Sr. (41) Patsy Carrier (1)

Dr. Dale A. Carroll and Dr. Merrily

Lelia Lightner Galvin (4)

William A. and Carole H. Kreowski (6)

Richard and Sue Orem (3)

McGowan (1)

Norma J. Gardner (14)

Joseph C. and Carol A. Kudless (11)

Charles V. Oster (27)

Brenda D. Cave (12)

Dr. Robert Garwood (2)

Twilla M. Lambert (8)

Mitchell Palmer (2)

Harry L. and Marlene A. Chandler (1)

Dr. Linford K. and Rebecca L.

Dana Lambert (3)

Park View Federal Credit Union (3)

David J. and Susan J. Lawrence (2)

Joanna Parker (1)

Maryjane and Carroll Chewning (9)

Gehman (4)

Chick-fil-A (1)

Tracey A. Gentry (11)

Elisabeth M. Lawson (8)

David V. and Claudia A. Pascarella (1)

Paul R. and Becky A. Christophel (1)

Walter G. Gerner (9)

Dr. William I. and Lynda D. Lee (17)

Layton E. and Diana L. Payne (2)

Lee E. Clapper, Sr. (11)

Donna Gochenour (8)

Eugene C. and Sherry M. Leffel (3)

Julie A. Pierantoni (5)

LuAnn L. Clark (26)

Chasity H. Godshall (15)

Cathy Jackson Leitner, P.L.C. (10)

Richard G. and Annie L. Pierce (12)

Randy S. Clem (7)

Bobby W. Gooden II (2)

Alice E. Liggett (1)

Reagan Powell (2)

Dr. Bruce Clemons (3)

Brooke and Will Goodwin (1)

Barry L. and Mardia B. Long (1)

W. Marshall and Gloria B. Price (24)

Paul S. and Sherry B. Cline (12)

Marsha Gordan (1)

David M. and Gladys D. Longacre (12)

Lisa C. Price (2)

Janice K. Cobb (1)

Jesse E. Green (1)

William C., III and Beverly M

Edmund and Deborah Price (1)

Julianne Colville (2)

Karen Wood Grizzard (8)

Community Foundation of the

Amanda Gulla (1)

Ruth Lorson (10)

Dr. C. Brad and Carrie M. Rash (6)

Marianne F. Halterman (6)

LPL Financial Foundation (1)

Patrick Connor (1)

Dennis and Mary Jane Rawley (5)

Robert L. and Faye C.

Robert J. Lynch (8)

Cassey Cook (3)

Hansbrough (10)

Thomas D. and Jennifer L. Rea (9)

Laura S. Mapp (30)

Evelyn S. Hedrick (13)

Raymond E. and Naomi W. Ressler (3)

Travis F. and Kara A. Marshall (14)

Nancy and Joey Hepner (1)

Salinda F. Rhodes (5)

Glenn and Leslie Crawford (8)

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