Sentara RMH Summer 2022 Magazine

SENTARA RMH SUMMER 2022

Magazine

Heart Failure Clinic Leads to

SUCCESS PLUS: New Joints Reduce Pain, Let Patients Return to Activities Building Relationships and Healthier Lives | Sleep is the Best Medicine

PRESIDENT’S

LETTER

Working Every Day to Serve Our Community Doug Moyer President, Sentara RMH Medical Center

2022 SENTARA RMH BOARD Joseph Funkhouser II | Chair Jerry Benson, PhD | Vice Chair Devon Anders Rita Bunch Arthur Dean II Morris Fendley, MD Paul Gaden C. Wayne Gates, MD Michael Gentry SENTARA RMH ADMINISTRATORS Douglas Moyer President

Donna Hahn, DNP, RN, NEA-BC

Vice President, Chief Nursing Officer

Catherine Hughes, MBA, RD Vice President of Operations

Robert Garwood, MD Chief Medical Officer

SENTARA RMH MAGAZINE EDITOR Alyssa Pacheco CONTRIBUTORS Luanne Austin Preston Knight Lisa Smith Jennifer L. Stover PHOTOGRAPHY Andrew Shurtleff Tommy Thompson DESIGN Picante Creative

S

ummer has arrived in the Shenandoah Valley, bringing a heightened sense of optimism and gratitude, and I’d like to open this letter by thanking our entire Sentara RMH Medical Center team. Being that no part of health care has remained unaffected by COVID, every member of our team has had to adapt and make significant changes to continue to serve our patients and community throughout the pandemic. I couldn’t be more proud of and thankful for this team.

Even during this challenging time, our team has continued to focus on the needs of our community, launching new programs and services. For instance, on page 23, you will read about three patients who have been set up for success through our new Heart Failure Clinic, established in 2021. All inpatients with a diagnosis of heart failure are now automatically referred to this outpatient program for follow-up, management and care, and the results so far have been impressive. Even in its early stages, this clinic is proving to have a meaningful impact in preventing heart failure patients from needing to be readmitted to the hospital.

You’ll also find firsthand accounts of how two of our programs have greatly improved quality of life for some of our patients. On page 19, you’ll read about two individuals who have found empowerment and better health by getting their diabetes under control through the Sentara RMH Diabetes Self-Management Education and Support program. Furthermore, on page 28, you will see how our orthopedic experts have helped their patients recover from injuries and return to their favorite activities.

On a more somber topic, Sentara RMH has been helping our community cope with several recent tragedies in our area. In response to these events, our behavioral health teams have been at the forefront, offering their services, comfort

and guidance to those in need. While we don’t have all the answers to this country’s current mental health crisis, Sentara RMH is prioritizing mental health services and is committed to working with our community to find and implement lasting solutions. On page 6, you’ll hear from one of our nurse practitioners about a number of valuable resources to help patients and families overcome and remove the stigma often associated with mental health issues.

Finally, in May Sentara Healthcare made its 2021 Community Impact announcement, which outlines the system’s investment across Virginia and North Carolina. The overall impact of community grants, uncompensated care and unfunded teaching costs supported by Sentara amounts to more than $35 million here in our community—resources that are invested to care for the uninsured and underinsured, tackle health inequities, and address social determinants of health. Be sure to read our Sentara Cares section on page 17, which highlights some of the local partners we work with to create lasting change in our community. Sentara RMH Medical Center has always been proud to partner with a wide variety of community organizations to help advance health equity, and Sentara’s investment has helped us expand that reach.

We are honored and truly fortunate to serve such an incredible community, and we are grateful for your continued support.

In health,

Doug Moyer

President, Sentara RMH Medical Center

CONTENTS SUMMER

2022

Features

19

Empowering and Improving Quality of Life for People with Diabetes

23

Heart Failure Clinic Leads to Success

28 28

Joint Replacement Surgery New joints reduce pain, let patients return to activities

CONTENTS

Departments 14

17 Sentara Cares 33 Clinical Excellence

Building Relationships and Healthier Lives

36 Health Matters

Protect Yourself from Ticks

37 La Salud Importa

Protéjase de las Garrapatas

38 Aging Well

Sleep is the Best Medicine

41 Philanthropy President’s Letter Inside front cover

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

11 33 36

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

38

BY MICHAEL CORDELL

THE BEST

MEDICINE

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

1

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

2

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

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

3

4

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

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

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

5

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

6

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

7

So enjoy your summer, but be smart about it.

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

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new &

noteworthy

Sentara RMH Medical Center is pleased to welcome the following new providers into the hospital community.

Paul A. Burke, PA-C Emergency Medicine US Acute Care Solutions

Rachel H. Kaplan, CRNA Anesthesia Sentara Anesthesiology Specialists 757-363-6230

Carrie E. Schlabach, NP-C Wound Care Sentara Wound Healing Center 540-689-2100

Molly Anadale, PA-C Gastroenterology Sentara Gastroenterology Specialists 540-564-5800

Earl D. King, MD Pulmonary Medicine Sentara Pulmonary & Critical Care Specialists 540-689-5600

Jennifer J. Sicking, CRNA Anesthesia Sentara Anesthesiology Specialists 757-363-6230

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

David Okolica, MD General Surgery/ Bariatric Surgery Sentara Surgery Specialists 540-689-5800

Betty L. Strawhorn, NP-C Palliative Care Sentara Palliative Care Specialists 540-564-5600

Zhijie Gao, MD Oncology Sentara Medical Oncology Specialists 540-689-7000

Cori T. Pflugradt, PA-C Gastroenterology Sentara Gastroenterology Specialists 540-564-5800

Misha Suresh, PA-C Cardiothoracic Surgery Sentara Cardiothoracic Surgery Specialists 540-689-5555

Brittany N. Gay, NP-C Gastroenterology Sentara Gastroenterology Specialists 540-564-5800

Aaron D. Reed, MD Radiation Oncology Shenandoah Valley Radiation Oncology Associates 540-689-7036

Pamela S. Wong, PA-C Orthopedics Hess Orthopaedics & Sports Medicine 540-434-1664

Paul Guarino, MD Gastroenterology Sentara Gastroenterology Specialists 540-564-5800

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

SUMMER 2022

Tracy D. Wulff, PA-C Psychiatry Sentara Behavioral Health Specialists 540-564-5100

Sentara RMH Honored with the Community Builder Award This year, the United Way of Harrisonburg and Rockingham County honored the Sentara RMH team with the Charlie Wampler Jr. Community Builder Award for our care of the community throughout the pandemic. The team greatly appreciated receiving the award, which was created to honor organizations exemplifying the same level of commitment to our community that Charlie consistently demonstrated.

2022 Golden Stethoscope Award Congratulations to Robert C. Li, MD, recipient of the 2022 Golden Stethoscope Award. This award recognizes outstanding physicians on the Sentara RMH medical staff who demonstrate excellence in patient care, customer service, communication and teamwork.

The Sentara Therapy Center in Elkton Has Moved!

VHHA Appreciation Tour The Virginia Hospital and Healthcare Association (VHHA) stopped on campus during its recent Hospital Appreciation Tour to share the organization’s gratitude and appreciation for our team. As part of the tour stop, VHHA team members brought a large digital billboard truck with screens to share special messages—as well as snacks—with the Sentara RMH team.

The Sentara Therapy Center in Elkton has moved down the road to a new, larger location at 14171 Spotswood Trail, Elkton, VA 22827. The new facility, which includes more gym equipment, will enable us to care for a wider audience of patients.

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PHYSICIAN’S

PERSPECTIVE

Overcoming and Removing the Stigma on

Mental Health

ISSUES

M

ental illness is estimated to affect at least 20% of Americans—more than 60 million people in the United States—each year, according to the National Association for Behavioral Healthcare. Up to 50% of Americans likely will need mental health treatment at some point, and chronic mental health diagnoses currently rank among the leading causes of premature death and disability in the U.S. Since early 2020, the COVID-19 pandemic has exacerbated the situation, leading to increased incidents of mental health crises and an unprecedented need for mental health services. Unfortunately, the mental healthcare system in general is also currently experiencing significant provider shortages—predicted to continue through 2025—throughout most of the 6 |

SUMMER 2022

Malinda Whitfield, APRN Family/Psychiatric Mental Health Nurse Practitioner

United States. So, as a nation, we are facing daunting challenges in this area of the healthcare system.

A diagnosis of serious mental illness can include bipolar disorder, schizophrenia, psychotic disorders, recurrent major depressive disorder or post-traumatic stress disorder (PTSD). These diagnoses often result in chronic and debilitating physical and mental health conditions, especially if left untreated or inadequately addressed.

Statistically, individuals with insufficient mental health treatment have higher rates of emergency department visits, inpatient psychiatric admissions, chronic illness and poor physical health outcomes.

In addition, the prevalence of co-occurring physical health conditions contributes to significantly higher healthcare spending for these individuals—more

than twice as high, according to estimates, as healthcare spending for those without a diagnosed mental health disorder.

Unfortunately, those suffering from depression, anxiety and other forms of mental illness often fail to seek treatment or maintain adequate treatment for their symptoms. Although numerous factors are involved, a leading cause of such gaps in mental healthcare can be attributed to the stigma associated with mental illness.

Defined as knowledge (ignorance or misinformation), attitudes (prejudices), and behaviors (discrimination) toward a person or group that often results in the unfair treatment of others, stigma surrounding mental health issues contributes to healthcare disparities and often leads to social injustice and inequality. Stigma can exist on many levels and frequently results in significant public health concerns—especially as related to mental health and mental illness—due to negative effects on patient engagement in seeking and maintaining treatment. Stigma can either be real or perceived, and for those suffering with mental illness, such stigma can actually seem worse than the illness itself.

According to the National Alliance on Mental Illness (NAMI), one in five Americans suffering from mental health conditions experiences harm as a result of stigma. These individuals often will avoid seeking help due to feelings of shame and fear, and subsequently remain silent about their diagnoses. NAMI offers a StigmaFreeQuiz that allows individuals to self-assess for misconceptions or negative stereotypes about mental illness.

Harmful effects of mental health stigma include: • Internalization of negative beliefs, including beliefs that the individual will never succeed at certain challenges, or that their situation will not improve • Reluctance or avoidance in seeking treatment • Lack of understanding by family, friends, co-workers, etc.

• Fewer opportunities for work, school or social activities • Homelessness • Bullying, physical violence or harassment • Lack of adequate health insurance to cover mental illness treatment How to overcome mental health stigma: • Provider education: NAMI Provider is a 15-hour program of in-service training taught by a team consisting of an adult with a mental

•

•

•

health condition, a family member, and a mental health professional who is also a family member or has a mental health condition.

Public Education: Mental Health Education, is a program offered by NAMI that

provides education classes, presentations, outreach, advocacy and wellness for the families, friends and loved ones of people with mental health conditions. Additional education specific to military service members and veterans with mental health conditions is also offered. NAMI Homefront is a program designed to provide resources to families, friends and loved ones to help strengthen support for and better understand the challenges faced by service members and veterans.

Engage actively in treatment: Among other benefits, treatment can help identify the sources of mental health issues and reduce symptoms that may be interfering with work and personal life.

Serve as an advocate for those with mental illness: Consider expressing opinions at

events and writing letters to media sources, community leaders and elected officials. Get involved in local, state and national organizations to support and promote access to care for individuals suffering with mental illness.

NAMI offers the following suggestions about what individuals can do to help reduce the stigma of mental illness: • Talk openly about mental health.

• Educate yourself and others: Respond to misperceptions and negative comments by sharing facts and experiences.

• Be conscious of language: Remind people that words matter.

• Encourage equality between physical and mental illness: For example, draw comparisons to how someone might treat someone with cancer or diabetes.

• Show compassion for those with mental illness.

• Be honest about treatment: Normalize mental health treatment, just like other healthcare treatment.

• Inform the media when they are using stigmatizing language in presenting stories of mental illness.

• Choose empowerment over shame. sentara.com

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PHYSICIAN’S PERSPECTIVE

Don’t Say: • “It could be worse.”

• “Just deal with it.”

• “Snap out of it.”

• “Everyone feels that way sometimes.”

• “You may have brought this on yourself.”

• “We’ve all been there.”

• “You’ve got to pull yourself together.”

• “Maybe try thinking happier thoughts.”

Employers who are leading efforts to address stigma offer some suggestions: • Tailor programs/approaches to company culture and existing strengths.

• Publicize measures being taken to lead a healthy workplace environment, including commitments to the overall culture of health, attracting and retaining the best talent, valuing employees, etc.

• Train leaders to identify emotional distress, respond promptly and constructively to behavioral performance concerns, and make referrals as indicated.

• Be welcoming of any need for accommodations. Train managers to respond appropriately.

Employee Assistance Programs (EAP) are generally offered by employers to help employees deal with a variety of concerns, including work-life stressors, mental and emotional well-being, family or financial worries, and relationship problems. According to the Center for Workplace Mental Health, these services are significantly underutilized, with only an estimated 3-5% of employees using available EAP assistance.

How Do We Stop Stigma?

Do Say: • “Thanks for opening up to me.”

• “Is there anything I can do to help?”

• “I’m sorry to hear that. It must be tough.”

• “I’m here for you when you need me.”

• “I can’t imagine what you’re going through.”

• “Can I drive you to an appointment?”

• “How are you feeling today?”

• “I love you.”

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SUMMER 2022

Organizations and Campaigns Numerous organizations and campaigns focus on addressing the issues of mental health stigma and discrimination. Some of these include: Bring Change to Mind: A nonprofit organization

focused on encouraging dialogue about mental health and raising awareness, understanding and empathy.

Co-founded by actress and activist Glenn Close in 2010 after her sister and nephew were diagnosed with mental illnesses, the organization offers learning resources and tools for taking action to help reduce mental health stigma.

Stamp Out Stigma: An initiative spearheaded by the

Association for Behavioral Health and Wellness to reduce stigma surrounding mental illness and substance use disorders. The campaign encourages people to start conversations and talk openly about mental illness and substance use.

Make It OK: A campaign to reduce the stigma of mental

illnesses that offers personal stories, tips on what to say when talking about mental health and resources to help fight stigma in the community.

This Is My Brave: A storytelling theater show in which

community members share their stories of living successful lives despite mental illness. Since 2014, This Is My Brave has inspired nearly 800 storytellers to share true, personal stories on overcoming depression, anxiety, bipolar disorder, PTSD and other illnesses. In spring 2020, organizers developed BraveTV to bring stories of hope online during the COVID-19 pandemic.

Healthy Minds with Dr. Jeffrey Borenstein: A PBS series

produced by the Brain & Behavior Research Foundation that focuses on common psychiatric conditions through inspiring personal stories and expert, cuttingedge information, including new approaches and next-generation therapies in diagnostics, treatment and research.

ON-CALL

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

Why do we

Wrinkle as we age?

Can wrinkles be avoided?

W

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

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

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

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

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

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

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

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ON-CALL ADVICE

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

What are

bone spurs and how are they treated?

B

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

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

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

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

SUMMER 2022

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

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

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

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

IMPROVE HEALTH

EVERY DAY

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

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

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

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IMPROVE HEALTH EVERY DAY

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

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

• • •

12 |

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

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

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

SUMMER 2022

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

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

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

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

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

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

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

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

• • • • • •

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

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

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

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

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

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

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EAT WELL,

LIVE WELL

Thrifty IN THE

KITCHEN

BY RITA SMITH, MS, RD

I

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

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

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

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

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

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

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SUMMER 2022

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

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

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

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

• Buy generic or store brands instead of name brands.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• Store these at room temperature until

ripe and then move into the refrigerator:

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

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EAT WELL, LIVE WELL

Marvelous Muffins

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

Very Veggie Burgers

Ingredients Vegetable cooking spray

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

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

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

1/8 teaspoon baking soda

Oh-Boy Bean Soup

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

½ teaspoon garlic powder

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

¼ teaspoon onion powder

Ingredients

¼ cup honey

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

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

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

Directions

¼ teaspoon salt

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

2.

3.

4.

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

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

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

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

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

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

1.

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

Preheat oven to 375 degrees.

2.

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

3.

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

4.

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

5.

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

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

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

2.

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

Serve soup hot with crusty whole-grain bread.

3.

SENTARA

CARES

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

$23M HEALTH AND PREVENTION PROGRAMS

$48M

$167M

TEACHING AND TRAINING OF HEALTHCARE PROFESSIONALS

UNCOMPENSATED PATIENT CARE

$16M COMMUNITY GIVING

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

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

• Secure consistent, equitable access to nutritious food.

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

• Develop emergency and scattered housing solutions.

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

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

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SENTARA CARES

PARTNERING TO EXPAND OUR IMPACT CLOSE TO HOME

SUPPORTING FUTURE HEALTHCARE PROFESSIONALS

Team member and local supplier engagement hit new heights in 2021

We partner with local secondary and postsecondary institutions in our communities to support students who have a passion and desire to pursue health careers. In 2021, the RMH Foundation continued a 30-year partnership with Blue Ridge Community College (BRCC) with a $100,000 commitment to fund BRCC’s healthcare education programming.

This initiative will help to ensure a pipeline of homegrown providers in the Shenandoah Valley for years to come.

Since the start of the COVID-19 pandemic, our team members have sacrificed to meet challenge after challenge with the care and compassion our community has come to expect. In 2021, for example, Sentara team members logged 1,226 volunteer shifts and donated more than $271,000 to the H.O.P.E. Fund to help fellow team members in need.

Last year, Sentara also made strides to build resiliency into its supply chain by establishing a Supplier Diversity Executive Council (SDEC) tasked with broadening and diversifying Sentara’s base of suppliers while emphasizing smaller, local vendors.

“We learned from the pandemic that there are local and regional vendors who can compete on quality, price and reliability,” says Jennifer McPherren, vice president of supply chain and chair of the SDEC. “We want to grow those relationships.”

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

OOD

t-you-can farmers fferson School

ton Roads, ing with Urban A) to serve betes, or veloping the vouchers op for fresh, own produce Markets. Here, so receive instruction g techniques, meal prep en how to grow food.

and Skills

f 150 partner agencies, ntries, and numerous tion programs, the Food marle considers itself on bank.” Now, with d in partnership with the ty North Carolina

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SUMMER 2022

In addition to scholarships for community members and educational programming, Sentara also provides host sites for students engaging in hands-on practicum training in a variety of fields at nearby colleges and universities.

PARTNERING TO ENSURE CONNECTIONS TO CARE Reducing access barriers hinges on increasing points of contact and providing navigational services As healthcare providers privileged to serve diverse communities throughout Virginia and Eastern North Carolina, we know the term “access” can mean different things, depending on the neighborhood. However, increased presence and personalized support remain at the heart of our efforts to help ensure that all community members have equitable access to care and services.

Employee-Designated Funding As part of our annual engagement survey, team members were asked to select the nonprofit organizations they felt best exemplify Sentara’s mission to improve health every day and provide the greatest impact in our communities. Using responses from the survey, a total of $200,000 will be distributed among the local organizations listed below. These funds are part of a $2 million investment across all Sentara communities.

• • • • • •

Blue Ridge Area Food Bank Blue Ridge Free Clinic First Step Boys and Girls Club of Harrisonburg Open Doors Valley Program for Aging

Empowering and Improving Quality of Life for People

with Diabetes By the time a new diagnosis of type 2 diabetes is made, that patient likely will already have lost about 60% of the functionality in their insulinproducing cells. However, those changes aren’t necessarily permanent.

By taking prompt measures, including making adjustments to eating habits and increasing physical activity, it’s possible for patients to regain some of that functionality and minimize long-term complications.

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MM

any such patients aren’t sure where to start, though, and that’s where the Sentara RMH Diabetes SelfManagement Education and Support (DSMES) program can help. Certified by the Association of Diabetes Care and Education Specialists, the program offers much-needed assistance to help people learn more about managing medications and insulin, making healthy choices, and even reducing out-of-pocket costs.

Unlike in many other diabetes education initiatives, patients in the DSMES program receive care at doctors’ offices across the local area, rather than just at a central hospital. In addition, primary care providers throughout the Harrisonburg community—not just those connected with Sentara—may refer patients to the program.

Sentara RMH-certified diabetes specialists in the DSMES program, all of whom are registered nurses, teach patients how to use insulin and review their medications in consultation with patients’ primary care providers, who make diagnoses and any needed prescription adjustments.

In addition, a community health worker on the program team assists patients who may need additional services,

Top Misconceptions About Diabetes “I must go on a diet.”—Focus on making healthy changes to your diet, rather than cutting out whole food groups. Eat more fresh fruits and veggies, whole grains, and lean proteins, and cut out sugary drinks and processed foods.

“I need to start a serious exercise regimen.”— Although it’s important to move your body every day, that doesn’t mean you need to run a marathon or even work up a serious sweat. If exercise is difficult for you, try a rocking chair, armchair exercises, or walking to your mailbox and back twice.

“Having to take insulin or medicine for diabetes means I’ve failed.”—Actually, it means there’s a problem with your pancreas! Your pancreas may need some help, but that doesn’t mean there’s anything wrong with you.

“Once I start insulin, I can never stop.”—This isn’t necessarily true. If you get your blood sugar under control, you may be able to reduce the amount of insulin you take or discontinue it altogether.

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such as home visits, transportation and food assistance. Diabetes education services are also provided, as needed, to patients admitted to Sentara RMH Medical Center.

“We work diabetes care into patients’ lives, all while addressing any existing barriers and helping them access insurance benefits,” says Julie Pierantoni, MSN, RN, CDCES, a certified diabetes care and education specialist and the DSMES program’s diabetes services quality coordinator. The program’s other diabetes care and education specialists include Susan Clark, BSN, RN; Eugene Dovis, BSN, RN; Holly Huffman, BSN, RN; and Laura Williamson, BSN, RN. To assist patients financially, diabetes specialists help them locate lower-cost, insurance-approved insulin. For example, Pierantoni recently helped a patient lower her costs by switching from a local pharmacy to a mail-order prescription provider. These services make it easier for patients to control their blood sugar and focus on getting the daily movement and healthy foods their bodies need.

Small Changes Can Make a Big Difference Quinton Johnson knows how important it is to stay active in order to help control his diabetes and improve his overall health. To keep moving, Johnson, 75, likes to hunt, walk his dog and do landscaping work for his children, who live near his Timberville home. “If my kids don’t have something for me to do, I’ll find something for myself to do,” he says. “I try to stay outside when I can.”

A retired truck driver, Johnson was diagnosed with type 2 diabetes 20 years ago. To help manage blood sugar levels before entering the DSMES program, he was taking oral metformin and giving himself insulin injections.

Still, his diabetes wasn’t well controlled.

To help solve the problem and deal with his hypoglycemia (low blood sugar)—which can be particularly dangerous for seniors— Johnson’s primary care provider referred him to the program. Pierantoni adjusted Johnson’s medicines with input from his doctor, and since then his blood sugar has been well controlled.

Johnson enjoys the program’s convenience, since he is able to go for his regular check-

ins every three months at the Sentara South Main Health Center, where his primary care doctor is located.

Losing weight also has had a positive impact on Johnson. In addition to giving up drinking beer, cutting back on meat and incorporating more vegetables into his diet, he now chooses smaller portions of the “comfort” foods he enjoys, like pizza and mashed potatoes. “I might eat one slice of pizza and then wait a day or two before having another slice—and I don’t make a habit of it,” he says. “I don’t need to make a hog of myself when I sit down to eat. Smaller portions can be just fine.”

“Americans in general eat too much,” observes Pierantoni, “so just cutting back can have an impact.” And in fact, those small changes produced big results for Johnson, who went from taking 40 units to 10 units of insulin a day and cut his metformin from four pills to two pills a day.

“That’s a big difference right there,” Johnson says. “I just kept working at it until I got it. Julie has been excellent and has really been helping me. I put my head to it and did what she said.”

Getting Diabetes Under Control Although Barbara Payne had uncontrolled type 2 diabetes for more than 20 years, she didn’t want to take insulin.

After retiring and moving to Dayton, Payne’s primary care doctor referred her to the DSMES program at Sentara South Main Health Center.

After some consultation, Pierantoni persuaded Payne to try insulin as the best solution for controlling her blood sugar.

Barbara Payne

“I told her she could take it once a day at whatever time worked best for her,” recalls Pierantoni.

“She decided to take it in the morning with her coffee.”

By using a continuous glucose monitor, Payne, 70, automatically tracks her blood sugar without needle sticks and gets alerts if her numbers go too high or too low.

Although she gets a little nervous when she hears the monitor’s alarm go off, she recognizes that it’s an important tool for managing her blood sugar levels.

Thanks to the monitor, she knows how much insulin she needs and when to take it. “Julie taught me how to use the monitor the right

Free Diabetes Prevention Program Sentara RMH also offers a no-cost group diabetes prevention program, where you can learn good health habits and get support. The program is free for anyone with prediabetes or who is at high risk of developing diabetes due to any of these criteria: • Overweight • Over 45 • Inactive • Having a family history of diabetes • Having high blood pressure or high cholesterol Register for the free program by calling 540-689-1001.

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way,” says Payne, who self-adjusts her insulin if she’s having a treat or a bigger meal. “For the best results, she told me to check it before I eat, rather than after.”

Payne also appreciates that the program has taught her about foods like bread that cause blood sugar to spike. “I learned about the triggers, which helps me decide which foods I should focus on,” she notes. “I’m on the right track now, and it isn’t as hard as I thought it would be.”

Payne and Johnson are both on Medicare, which covers four diabetes program visits per year. Many commercial insurance plans also provide coverage, and Sentara RMH offers scholarships and financial assistance for those without insurance.

“Use those benefits,” says Pierantoni, “You may have had diabetes education in the past, but things have changed. There are some amazing medicines out there, and we can help you make decisions about which medicine is the best solution for you and your finances.”

People with diabetes should consider trying the DSMES program, Payne says. “If you have blood sugar challenges, it provides some great tools. I was way up there when I first went to Julie, and she has helped so much.”

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Sentara RMH Diabetes Program Recognized as a 2021 Health Quality Innovator of the Year Sentara RMH was recognized as a Health Quality Innovator of the Year in the Population Health category in 2021. The award recognizes the efforts of the Sentara RMH Diabetes Self-Management Education and Support program to improve quality of life, reduce mortality rate and decrease hospital admissions for people in the Harrisonburg area.

When data revealed a significant increase in uncontrolled diabetes and high blood pressure in the community, Sentara RMH shifted most diabetes education and support services from the hospital setting to area primary care practices. Making it easier for people to access care, that change helped to triple patient participation in the program.

The Health Quality Innovator Awards are given annually by Health Quality Innovators to recognize and celebrate healthcare organizations using successful, evidence-based approaches to quality improvement.

Heart

Failure CLINIC

Leads toSuccess “Sometimes you don’t notice the things you can’t do until can start doing them again,” says David Gutschow of Harrisonburg.

Gutschow, age 53, didn’t realize he was headed toward congestive

heart failure. He just knew he no longer had the capacity to teach or participate in karate classes, and he no longer had the stamina to go on walks with his wife.

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“If we wanted to go somewhere,

I had to figure out how long I could last,” says Gutschow, a senior implementation engineer for an information technology company. “My ability to stay active got steadily worse over a couple of years. I was doing less and less.”

Gutschow had been experiencing heart problems since suffering a minor heart attack in 2011. Then, in November 2020, he underwent a lengthy open-heart surgery.

Around the time of his surgery, Sentara RMH Medical Center was planning to open a Heart Failure Clinic in its Cardiology Department. The clinic, which was due to begin seeing patients in March 2021, was designed to help people with heart failure improve their outcomes and keep from being readmitted to the hospital.

“Before we were ready for patients, I got a call that Mr. Gutschow was not doing well and needed to be seen,” says Ambi Zeller, ACNP-BC, AACC, a cardiology nurse practitioner and team lead of the Heart Failure Clinic. “My initial response was, ‘We’re not even open yet!’”

Nonetheless, Zeller was able to get Gutschow into the clinic quickly and intervene to help improve his condition.

“The focus of the clinic is to help patients with heart failure improve outcomes and quality of life—without having to be readmitted,” Zeller says.

Under the guidance of Brad Rash, MD, FACC, medical director for Sentara Cardiology Specialists, the clinic has already been successful at reducing readmissions.

When the Heart Failure Clinic opened in March 2021, the rate of readmission for heart failure patients was about 13%, according to Zeller. In January 2022, that rate was down to just 1.8%.

“And in February 2022, our readmission rate for these patients was actually zero,” Zeller notes, “which is unheard of.”

Setting Up Patients for Success The Heart Failure Clinic at Sentara RMH was designed to monitor patients during a period of 30-90 days following a heart failure hospitalization.

“For some patients, the monitoring period is 30 days; for others, it’s 90 days,” Zeller explains. “The duration depends on how well they’re doing.”

Patients are referred to the clinic by cardiologists at Sentara RMH. To be eligible, a candidate must have been diagnosed with heart failure, been hospitalized for heart failure in the past 12 months and be a patient of the hospital’s cardiology team.

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David Gutschow

During an initial visit to the clinic, staff members assess the patient’s status to learn what the patient understands about heart failure, their prescribed medications and the impact of diet on health, as well as the patient’s activity level.

Clinic team members also evaluate the patient’s medicines, as well as trends in blood pressure, heart rates and weight, to determine the appropriate plan of action.

“Every single patient’s body is different, so you can’t just create a cookie-cutter set of ideals and impose that on every patient,” Zeller says. “That first visit is all about learning where they are in the disease process and how we can help them going forward.”

As part of the clinic’s treatment plan, patients initially return every one to two weeks to get their medicines just right, and then every three to four weeks for regular check-ins.

“We tend to be very hands-on during the initial treatment period,” Zeller observes.

“We ask patients to be sure to let us know if their weight changes or if they experience any symptoms.”

In addition to Zeller, the clinic staff consists of four nurses: Tina McDonaldson, LPN; Clarissa Hottinger, LPN; Megan Henry, RN, BSN; and Elaine Clancey, NP. Team members stay in touch with patients, calling them regularly, and also can intervene with a patient’s pharmacy, if needed, to avoid disruptions in medication regimens— another important factor in helping to prevent readmission.

The staff can help with other challenges, too.

“Sometimes challenges with getting patients to take their medications has to do with affordability,” Zeller says. “It may be that patients aren’t forgetting or choosing not to take them—they just can’t afford the medicines they’re on.”

Likewise, if a patient has no transportation to doctor or clinic visits, they may miss appointments due to circumstances beyond their control.

“We really dig down to see what’s going on with these patients and help them follow their treatment plans,” Zeller adds, “so they can be the healthiest they can be.”

Getting Back to Life Granville “Dick” Leecy of Penn Laird was hospitalized for congestive heart failure shortly after the Sentara RMH Heart Failure Clinic opened in March 2021.

At age 75, Leecy had been an active outdoors person all his life, having worked at Lakeview Golf Club in Harrisonburg for many years, as well as staying busy hunting, gardening and camping.

Until a few weeks before his hospitalization, he had felt fine. But in February 2021, he began to experience coughing and shortness of breath. When the problem became severe, he went to Sentara RMH.

Dick Leecy and wife

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“My heart wasn’t pumping properly,” he says.

A week after his release from the hospital, he went to his first appointment at the Heart Failure Clinic.

“Ambi was very friendly and outgoing, and she made my wife and me feel at ease,” Leecy recalls.

“She discussed my heart condition and told me what I need to do to maintain my heart health.”

Leecy learned that in order to live well, he needed to make some lifestyle changes.

“I had to quit smoking, quit drinking alcohol and quit drinking coffee—I used to drink eight to nine cups a day,” says Leecy. “And I had to go on a low-sodium diet.”

What it came down to for Leecy was the desire to continue doing the things he loved doing.

“As a couple, we decided we were going to listen to Ambi and follow her recommendations,” he recalls.

By quitting smoking, taking his medications, and being faithful with his diet and exercise, Leecy began to feel much better. He had lots of support from his family, church friends and the clinic staff.

By the end of 2021, Leecy was out in the woods hunting again. The couple also went camping and took a vacation at the beach.

“If it hadn’t been for Ambi and the team at the Heart Failure Clinic, I don’t know where I’d be now,” says Leecy. “I’ve found that I can do everything I used to do before—except that now I do it in moderation. I have to listen to my body.”

Getting Back on Their Feet Guy Rawley of Mount Solon had been expe-

riencing heart issues since 1994, during which time he had undergone numerous catheterizations, had an angioplasty and received four stents. In spite of all these procedures, the cabinetmaker continued to have heart and chest problems.

Last year, when he started experiencing severe weakness and shortness of breath, his cardiologist referred him to the Heart Failure Clinic.

“I’m glad I went—that’s where I got the help I needed,” says Rawley, age 86. “Ambi was dedicated to finding what my problem was.”

According to Rawley, his main issue was the medicine he had been taking.

“She put me on a new medication that got rid of a lot of fluid,” he says. “After that, I lost 35 pounds!”

Rawley is thankful that the clinic staff was so diligent in finding ways to help him.

“I credit them with getting me back on my feet,” he says. “When I first went there, I was run down and tied to using a walker. Now I’m out working in the garden regularly.”

These days Gutschow is feeling much better, too, and is back to a full schedule of karate classes.

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clinic, he and his wife would frequently eat out at restaurants—which can be counterproductive for patients with cardiovascular issues.

“Working with Ambi and her team, we made changes in the way we eat,” Gutschow says. “We started gardening last year, and now we even can and preserve our own foods.”

By six months after the surgery, Gutschow had dropped 100 pounds.

“I feel healthier now than I have in years,” he says.

According to Zeller, getting and keeping heart failure patients healthy is all about figuring out what leads to readmission, then treating

those issues as quickly as possible. Part of solving that puzzle, she believes, lies in looking beyond just an isolated condition.

“As a nurse practitioner, I see the patient as a whole human,” she explains. “I think sometimes as providers we can get stuck on treating a single condition. I’ve found that it’s much more helpful to look at all of a patient’s issues and work to treat the entire individual from a holistic perspective.”

“I honestly think my job is about treating the sum of mind, body and spirit,” she adds. “It takes looking at everything together to care for a human properly.”

Guy Rawley

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Gwyneth Mellinger

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M

uch like a car that has been driven for thousands of miles, our bodies can begin to show signs of wear and tear after a while—especially in our joints. With all the stress and force they absorb and all the twisting, bending and lifting they endure, it’s no surprise that injuries and conditions like arthritis can break down our joints and eventually lead to debilitating pain.

Joint replacement surgery can reduce pain and empower patients to return to activities

For some of us, joint pain impacts everyday activities, such as the ability to walk upstairs, get out of a car, run errands, clean the house or work in the yard. Unfortunately, joint pain also can sideline us from activities that enhance our lives, like exercising, hiking, playing sports and gardening.

Thankfully, orthopedic surgeons can replace worn-out joints and enable patients to return to normal activities without pain.

Hip and knee replacements are the most commonly performed joint replacements, according to the American Academy of Orthopaedic Surgeons. However, replacement surgery also can be performed on other joints, including the ankles, shoulders and elbows.

“Joint replacement techniques and materials have evolved tremendously over the years,” explains Mark Williams, DO, an orthopedic surgeon at Sentara RMH Medical Center who specializes in adult reconstruction. “Now, hospitalization following joint replacement has been reduced to less than a day in many cases. Even just a couple of decades ago, similar surgeries used to require stays of up to two weeks in the hospital.”

Worsening Hip Pain When Gwyneth Mellinger and her husband, Mike Auchard, moved to Harrisonburg from Cincinnati six years ago, the potential for outdoor adventures in the area’s rich landscape really appealed to them.

When Mellinger, 65, developed pain in her left hip a few years ago, she was forced to stop participating in those activities.

Mobility

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“We were very attracted to Harrisonburg for a number of reasons, and proximity to the mountains was definitely a plus,” recalls Mellinger, who works as a professor, as well as director of the School of Media Arts and Design at James Madison University (JMU). “My husband has been involved with a hiking group through JMU, but I haven’t been able to join them, in part because of my physical limitations.”

Throughout Mellinger’s adult life, other healthcare providers had been addressing what they thought was back pain. She had tried chiropractic treatments, acupuncture, physical therapy and yoga, focusing on her back as the source of her condition.

Shortly after she moved here, Mellinger’s doctor at Sentara RMH determined that arthritis in her left hip was actually behind much of her pain. Although she was able to put off surgical replacement of the hip for a few years, eventually the procedure became necessary.

“I went from having arthritis with some cartilage in my hip joint to being bone on bone,” says Mellinger, who had total hip replacement surgery in September 2020.

Osteoarthritis, the most common type of arthritis, occurs when the cartilage that cushions the surfaces between bones wears away. When bone rubs against bone, people experience pain, swelling and stiffness.

During a total hip replacement, surgeons replace the damaged ball-and-socket joint with a metal ball-and-socket joint. A plastic or ceramic spacer, which is inserted between the new ball and socket, creates a smoother gliding surface.

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the surgeon removes and replaces the ball part of the hip joint. Patients with hip arthritis, however, typically require a total hip replacement, since arthritis usually affects both the ball and the socket portions of the hip.

Debilitating Knee Pain Kenny Presgraves, 67, spent decades on his feet work-

ing in construction, in roofing, for the city of Newport News Engineering Department and as a consultant with the Virginia Department of Transportation. Presgraves also participated in football and baseball in high school.

“Throughout the years, I did a lot of walking and climbing,” recalls Presgraves, of Stanley, Va. “I climbed ladders, paved, poured new asphalt and built bridges.”

Not surprisingly, after a long career of heavy activity, he began to develop pain in his left knee in the fall of 2021.

“It got to the point where it would pop or feel like it was going to give out,” he says. “My wife and I enjoy walking, and my knee made it so I couldn’t really go out on walks with her anymore.”

After viewing X-rays of the problematic knee, Dr. Williams determined that a knee replacement would be the best option for Presgraves, who was accompanied by Shelia, his wife of 40 years.

“I think a lot of Dr. Williams,” Presgraves adds.

“He sat down with us and took time to answer all our questions and explain everything thoroughly.”

Surgical Solutions Presgraves underwent a total knee replacement, also known as total knee arthroplasty, at Sentara RMH

in December 2021. He stayed overnight at the hospital before being released.

“We remove damaged cartilage and bone during a total knee replacement surgery,” explains Dr. Williams. “Once that’s done, we replace the entire joint with artificial surfaces. Sometimes a patient only needs a partial knee replacement. In that case, we only repair the part of the knee that is worn out.”

While Mellinger experienced a great deal of relief after her left hip replacement, her physical therapy (PT) was interrupted by pain in her right hip. After looking at X-rays, Dr. Williams discovered that she had bone spurs in her right hip, and recommended a total hip replacement on her right side as well.

During Mellinger’s presurgical appointment, Dr. Williams addressed her concerns about potentially leaving the hospital too soon, due to prior episodes of low blood pressure she had experienced.

“Dr. Williams really listened to me and understood my concerns,” Mellinger says. “He understood what I wanted for my outcomes, so I had absolute confidence that he was the right person to perform my surgery.”

Mellinger also appreciated how Dr. Williams and his team were able to fit her surgery in around her school schedule. Her procedure ultimately took place at the beginning of December 2021, leaving her with up to eight weeks of family medical leave assistance to tap into during the semester break.

Mellinger’s surgical team used the anterior approach for both hip replacements. During this procedure, the incision is made through the front rather than through the side or back of the thigh. With this approach, surgeons

Kenny Presgraves

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can avoid cutting through muscles, which in turn speeds up recovery time.

Working Hard to Recover Physical therapy is a major key to successful recovery after joint replacement surgery, and physical therapists usually begin to work with these patients even before discharge from the hospital. Often, patients will undergo a few weeks of home PT before transitioning to an outpatient facility for continued therapy.

“The goal of physical therapy is to gradually regain strength and function in the joint that was replaced,” Dr. Williams says. “PT also helps to restore range of motion to the joint, to assist with daily activities.”

Physical therapists work to improve strength, flexibility and balance. They also use various methods to control pain and decrease swelling during the recovery process.

Presgraves had PT both inside and outside the home. Shelia, having undergone surgeries and PT herself, was determined to help her husband get back to his old self and played an integral role in his recovery.

“We worked together every day, and most days we did two therapy sessions,” Shelia recalls. “We both feel that once the doctor does his part, it’s up to the patient to make sure the joints work properly.”

They started with stretching and short walks with a walker or cane, eventually working up to doing squats 32 |

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while holding on to their kitchen counter, as well as doing lunges with the help of a step stool.

“It’s pretty hard work,” Shelia adds, “but it can be done with the right therapy—and the will to do it!”

The couple’s perseverance paid off with glowing reports from Dr. Williams at Presgraves’ follow-up appointments.

For her part, Mellinger progressed quickly with PT following her hip replacement surgery. She also asked for more PT sessions to work on her left hip, since she’d had to stop PT prematurely due to the arthritis in her right hip.

“My recovery went smoother than I had imagined,” she notes. “I would advise other patients facing joint replacement surgery to make sure to do the physical therapy and follow doctors’ orders. It’s important to set goals during your recovery and then follow through.”

Enjoying Life Pain-Free Gardening is one of the activities Mellinger has most been looking forward to taking up again. After easing into it during the spring, she’s back working in her garden full speed now.

“I’ve been able to be out there for two hours at a time without experiencing pain afterward,” she says. “That’s kind of amazing.”

For Presgraves, his new knee has enabled him to get back outdoors and take walks with his wife, as well as return to hunting, fishing and other outdoor activities.

He also started a part-time job in Luray at the Page Coop Farm Bureau, which sells farming supplies and home improvement tools.

“The surgery has allowed me to get back to my activities without the pain, swelling and occasional lockups my knee used to cause,” he remarks. “I’ve even been able to climb a ladder to trim a tree limb. Getting my knee replaced has really changed my life for the better.”

CLINICAL

EXCELLENCE

Building

Relationships AND

Healthier Lives

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

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

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

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

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CLINICAL EXCELLENCE

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

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

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

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

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Management program into its present form.

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

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

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

Regular Contact Builds Rapport

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

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

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

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

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

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

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

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

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

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

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

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

A ‘Perfect’ Match

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

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

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

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

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

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

Their doors are always open to help patients in need.

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

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HEALTH

MATTERS

Protect Yourself from

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

I

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

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

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

Avoiding Tick Bites

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

• Avoid areas with high grass and thick bushes.

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

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

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

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

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

Removing Attached Ticks

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

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

• Wash the area using rubbing alcohol.

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

LA SALUD

IMPORTA

Protéjase de las

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

E

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

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

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

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

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

Evite las picaduras de garrapatas

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

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

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

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

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

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

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

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

Retire garrapatas incrustadas en la piel

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

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

• Lave el área afectada con alcohol isopropílico.

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

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AGING WELL

Sleep

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

C

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

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

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

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

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

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

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

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

Not All Sleep is the Same

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

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

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

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

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

Jonathan Donahue

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

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

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

Identifying and Treating Sleep Issues

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

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

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

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

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AGING WELL

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

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

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

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

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

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

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

Better Sleep, Better Health

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

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

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

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

PHILANTHROPY

Breast Cancer Imaging at Your Convenience

Donation brings new mobile mammography van for continued early detection

L

ong before it became normal for speedy, on-demand delivery services to bring virtually any meal or product conceivable to your doorstep, Sentara RMH had already perfected the art of healthcare convenience with its mobile mammography van.

Operated by Sentara RMH’s Funkhouser Women’s Center, the mobile van service turns 25 this year—a silver anniversary that just happens to coincide with the arrival of a new and improved vehicle. Through the generosity of a donor’s gift to the RMH Foundation, the new van is fully funded

and now in motion, possibly soon coming to a business or community location near you.

“Bringing care to where women live and work can be one of the best solutions to detecting cancer early and getting patients on a path to health and full recovery,” says Cory Davies, RMH Foundation executive director.

While the new van is actually four feet shorter than its predecessor, it offers the same core amenities as the old unit, as well as the same 3D imaging software capabilities available at the Funkhouser Women’s Center. The interior of supportRMH.org

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PHILANTHROPY

the van also features soothing colors, with scenic photos placed throughout the registration area and mammography suite.

Having that sense of comfort is crucial, considering that a screening exam can lead to a bit of anxiety for some women.

“With the van, we offer the same quality imaging, highly trained and experienced mammography technologists, and local radiologists,” says Tami Eppard, who oversees operations of the van as manager of mammography for the women’s center. “Most images are analyzed the next day.

The mammography service offered with the van is the exact same service as offered at the Funkhouser Women’s Center.”

‘Top-Flight Care’ on Wheels The new van was made possible through the kindness of the Fred O. Funkhouser Charitable Foundation Board, with a contribution that enabled the RMH Foundation to address a critical need in the operations of the women’s center. The generator in the previous mammography van was at the end of its life, so a whole new van was greatly needed.

“Ensuring that women throughout the Shenandoah Valley have access to top-flight care is something we can all get behind,” says Jan Scaglione, president of the Fred O. Funkhouser Charitable Foundation. Scaglione, who now resides in Florida, 42 |

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grew up in Harrisonburg and maintains a passion for caring for community members in the Sentara RMH service area.

“The board is honored to play a part in such an important project, and we are grateful for the good work of the staff of the Funkhouser Women’s Center to make great care available,” she adds. “I think my philanthropist father, Fred Funkhouser, and my mother, Virginia Funkhouser, formerly a registered nurse at RMH, would be so pleased.”

The importance of the early detection of breast cancer cannot be overstated, given that one out of every eight women in the United States is diagnosed with breast cancer at some point.

Early detection, which is encouraged for women 40 and older, results in better outcomes—so women should be mindful not to put off their annual mammograms.

Unfortunately, according to Eppard, during the past two years of the COVID-19 pandemic, many women skipped getting routine screenings at the women’s center.

Fortunately, though, while many other types of services were scrambling to meet the changing needs of consumers during the pandemic, the mammography van was already set up to bring care to its customers.

“The goal of screening mammography is to detect breast cancer in its earliest stages, when it is easier to treat,” Eppard says. “For the past two years, even as the pandemic was causing some women to be more hesitant about coming in for screenings, the mobile van has continued to offer mammography services at convenient locations throughout the community. One nice feature of the van is that only one patient is able to be inside at a time—providing both privacy and social distancing.

Mobile mammography patients aren’t required to sit in a waiting room with other people.”

Willing to Go Almost Anywhere In 2021, the mobile mammography unit provided screenings for a bit more than 2,000 women—a significant increase from 1,600 the year prior.

PHILANTHROPY

Eppard says about 2,600 screenings were conducted in 2019, the last “normal” year of operations, prior to the pandemic.

The van regularly travels to dozens of sites throughout the Valley, all upon request, from Highland to Page counties and almost anywhere in between.

“We go pretty much everywhere, so the van gets quite a bit of use,” Eppard says. “That’s why we needed a new generator.”

The mobile van concept began in 1997, with the idea of bringing services to people who did not have easy access to the potentially life-saving screenings. The van was first used through Shenandoah Shared Hospital Services.

Area poultry plants were popular spots for the van to visit in its early years. It was much more convenient for employees to hop on the van, get screened and go right back to work, instead of having to take time off to drive to the women’s center in Harrisonburg.

“Screening mammography is a simple procedure that takes about 20 minutes,” Eppard says.

“With the van, you don’t need to take a half-day off for a 20-minute procedure.”

Over time, cancer center officials have found a greater need for mammography services among a

wider population of women. Community centers and schools, for example, have become frequently requested places for the van to visit each year.

Eppard notes that Sentara RMH works with uninsured patients who may need financial assistance to cover the cost of screening mammography, with the assistance of two different organizations: the RMH Foundation and the Virginia Department of Health’s Every Woman’s Life program.

“Financial barriers shouldn’t be a reason to skip your annual screening mammogram,” Eppard adds.

Davies shares an important observation about the mobile mammography service from Sentara RMH surgeon Emily Turzanski, DO. “As she puts it,” he begins, “‘Every time we have a new breast cancer patient, we trace back to determine how we diagnosed the case. In so many cases, the mobile van is the answer. I can’t begin to think of the cases we would miss—and the consequent lives we would lose—if this service weren’t available.’ Now that the new van is up and running, the mobile mammography service will only continue to improve and expand.”

If you’re interested in scheduling the van for your community or workplace, please call 540-689-6815.

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

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FOUNDATION

friends of the RMH Foundation

Gifts received from Jan. 1 to April 30, 2022

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, the 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!

Totals represent cumulative amounts given in 2022.

President’s Forum $1,000,000 and above Dr. Garner H. Downey and Mae Frances Downey Pass Through of the Community Foundation of Harrisonburg and Rockingham Cty. (1)

$100,000-$999,999 Richard Argenbright Charitable Remainder Unitrust (1) Linda L. Rinaca (1) The Community Foundation of Harrisonburg and Rockingham Cty. (20)

$25,000-$99,999 Diane C. Davis (30) Howard N., Jr. and Zanette S. Hahn (9) Sentara RMH Volunteer Auxiliary (41)

Wilmer A. Olinger (1) The Robert H. Strickler and Lorraine W. Strickler Foundation (10)

Ameriprise Financial Services, Inc. (4) DuPont Community Credit Union (5) David and Emily Larson and the Spark Adoption Grant of The Community Foundation of Harrisonburg and Rockingham Cty. (3)

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Richard C. and Mona D. Johnson (34)

Theta Iota Chapter of Alpha Phi James Madison University (6)

Kathy Moran Wealth Group (1)

Jodie Wampler, in memory of Phyllis (37)

Rennie Mitchell McAllister (1)

Demitri and Heather Wilson, Kennedy’s Angel Gowns (1)

William Leake Society $1,000-$4,999 Anonymous Fund given through The Community Foundation of Harrisonburg and Rockingham Cty. (1) Linda Heatwole Bland (10) Blue Ridge Bank (7) Chris Bradshaw (4) Helen Breeden (3)

$5,000-$24,999

John R. and Mary Ann Heatwole (4)

Coldwell Banker Premier Harrisonburg (1)

Estate of Virginia M. Martin (3)

1910 Cornerstone Club $100-$999 Kebats Abraha (1) Robert L. and Karma C. Adams (15)

Thomas B. And Suk Nam Pender (3)

Ruth K. Alger (3)

Helen and David Penrod (3)

Ervin L. and Ann Noffsinger Anderson (9)

Laura R. Remington (1) Katie and Derek Robinson and the Robinson Family Fund, a Donor Advised Fund of US Charitable Gift Trust (1) Schwab Charitable Fund (3) Shenandoah Automotive Service Center (6) Barbara B. Stoltzfus (24) The U.S. Charitable Gift Trust (6) Lynn and Diane Trobaugh (15) Phillip and Christina Updike (9) Whetzel Family Irrevocable Trust (2)

Robert E. and Linda L. Alley (5)

John E. and Betty L. Anderson (1) Diane E. Anthony (1) Suzanne Arthur (1) Davy Balderson (1) Edith J. Banks (8) Edgar L. Barnard, Jr. (16) Jerry and Pamela Basch (1) Sam L. Batton (7) Ralph N. Bergdoll (6) Adam and Christy Blagg (8) William E. and Allene R. Blessing (9)

Edward Jones Investments (7)

Dennis P. and Janet E. Boffo (5)

Fidelity Charitable Gift Fund (15)

John F. and Elsie L. Bowers (6)

First Presbyterian Church (1)

Lawrence D., Jr. and Linda K. Bowers (3)

Drs. William and Brooke Goodwin (8) Harrisonburg Kiwanis Club, Inc. (3)

Chester L. and Nancy B. Bradfield Pass-Through Fund of the Community Foundation & Rockingham Cty. (31)

Martha F. Bradfield (5) Delma J. Brenneman (6) David and Teresa Bruce (7) Henry F. and Catherine S. Buhl (11) Ernest P. Burger (2)

Dominion Energy Charitable Foundation (10)

Karen Wood Grizzard (7)

Flora L. Kagey (15)

Dave D. and Patricia H. Dungan (7)

Mae B. Guthrie (15) Richard and Sally Halterman (1)

Bruce J. and Sandra D. Kertcher (1)

Robert L. and Faye C. Hansbrough (9)

Sharon L. Kiracofe (16) Dorothy Kreider (2)

Evelyn S. Hedrick (12)

Walter L. and Maria B. Landis (1)

Sherrel J. Hissong (14)

Eugene C. and Sherry M. Leffel (2)

Dr. J. Robert and Rosalie Hartman Eshleman (6)

Melvin and Edith Burger (1)

Dr. James D. and Sheila D. Evans (3)

David L. and Elizabeth B. Burkholder (6)

Kenneth and Gay Fawley (1)

James E. and Carole S. Hively (1)

Hal C. and Saundra Sue Ferguson (1)

Thomas J., III and Virginia C. Holden (5)

Brenda D. Cave (11)

John W. and Betty Jo Fleisher (1)

Stan and Joni Holland (32)

Lee E. Clapper, Sr. (10)

Jane S. Hopson (1)

Clark and Bradshaw, P.C. (1)

Stephen A. and Jacqueline R. Flossic (1)

Randy S. Clem (6)

Larry A. and Linda J. Fogle (15)

Robert P. and Eloise B. Hostetler (10)

Julianne Colville (1)

Forrest L. Frazier (20)

William R. Hudelson (13)

Community Foundation Central Blue Ridge (1)

Charles J. Frye (4)

Thomas C. and Karen S. Huffman (5)

Glenn and Leslie Crawford (7)

Joseph K., II and Sallie Funkhouser (17)

William B. Carper, Sr. (41)

Dennis A. and Martha C. Cummins (9) Dale L. and Sandra S. Cupp (4) Sam and Judy D’Andelet (1) Alice B. Davis (1) Terri Lynn Denton (13) Denton Family Charitable Foundation (5) Carolyn Long Dickenson (5)

Richard E. and Patsy G. Fulk (1)

Susan S. Gallaher (1) Edward R. and Nancy K. Gallalee (1) Dr. Linford K. and Rebecca L. Gehman (3) Ronald W. and Velda J. Gilkeson (3) Henry B. and Dorice M. Graham (1)

Douglas Hughes (1) Buddy G. Hutchens (3) Richard E. and Linda H. Jacobs (3) Pam Jeffers (1) Shelvy M. Jenkins (32) JMU Phi Sigma Sigma Iota Chi Community Service Project (1) Dr. Robert F. Jochen V.M.D. (7) J. Robert and Patricia C. Johnson (4)

Rich and Micheline Lehman (5) Robert J. and Carolyn J. Leiston (15) Donal E. Loker (5) James Lovaas (1) Karen Lovaas and O. Erich Hunt (1) Magnolia’s Tacos and Tequila Bar (1) H. L., Jr. and Mildred R. Maiden (5) Laura S. Mapp (29) Harold C. and Brenda H. Marshall (7) R. Larry Martin (5) Donna and Rob Martin, Blue Ridge Trailers (1) Philip H. Maxwell (35) Mary Sue McDonald (1) Mr. James McHone and Mr. Noland McHone (1)

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friends of the RMH Foundation

Kyle L. Miller (4) Mr. and Mrs. Brian Mills (1) Diane O. Mincey (13) Frances Moran (1) Dr. A. Glenn and Linda M. Morrison (1) Donald L. and Marie I. Moyer (3) Douglas J. and Yvette M. Munnikhuysen (10)

Charles W. and Patsy C. Rodeffer (4)

Talbott Family (1)

Violet Allain (3)

Bernard T. and Virginia L. Rote (1)

Juanita M. Taylor (40)

Teresa B. Anders (13)

Robert W. and Jeanne C. Taylor (1)

Ann J. Bird (5)

Tena, Becky, Lesley, Brandy, Jenay, Katherine and Others (1)

Nancy B. Bradfield (31)

Wayne and Joan Ruck (5) Laurence and Evelyn Sauder (17) Al P. and Phyllis S. Saufley (8) Garland R. and Denise L. Sawyer (3)

Linda Heatwole Bland (10) Sherry B. Cline (25)

Frank H. and Tara M. Vetting (4)

Jennifer Matthaei Cottrell (1)

Jerry M. and Janet S. Wampler (1)

Phyllis Yarrow Coulter (11) Lou Dellinger (3)

Diane C. Davis (30)

Steven J. and Jinni Williams Newing (1)

Frank J. and Carol A. Scibek (1) Ralph L. and Ann W. Sebrell (12)

Helen and Jennifer Wanger (1)

George D. and Elizabeth A. Ojalehto (2)

Ron and Sarah Seiger Family, Ron and Linda, Steve, Sharon and Bob Tinko, Greg and Jen (1)

Karen L. Weimer (1)

Linda Denton ((1)

Henry G., Jr. and Ferne M. Wenger (15)

Lynn Diveley (15)

Lucy J. Seymour (13)

Cathy Wheeler and Bev Sears (1)

Charles V. Oster (26) Park View Federal Credit Union (3) Layton E. and Diana L. Payne (1) Peak View Elementary School (2) Pershing - Pro Equities, Inc. (2)

David W. Shaffer, Jr. (6) Frank B. and Shirley S. Shakespeare (13) Hazel K. Shirk (2)

Robert E. and Ruby D. Phares (4)

Ilene N. Smith (40)

A. Kenneth and Mildred L. Ranck (7)

John D. Smith (4) Carol L. Sommer (1)

Thomas D. and Jennifer L. Rea (8)

St. Jacob’s Lutheran Church (1)

David and Elizabeth P. Reedy (3) Raymond E. and Naomi W. Ressler (2) Eleanor S. Rexrode (22) Ridgeway Mennonite Church (1) Mark E. and Barbara C. Roberts (3)

William G. and Hope Shank Stoner (17)

Thomas Wetsel (1) Jo Ann Widener (18) Richard L. and Pamela B. Wilkins (35) Roberta (Robbie) and Robert K. Wilkins (15)

Thomas M. and Linda L. Stumph (1) T. Rowe Price Program for Charitable Giving (1)

Sallie E. Funkhouser (17) Sherrill Glanzer (21) Brooke D. Goodwin (8) Zanette S. Hahn (9) Amelia M. Hall (12) Mary Henderson (40)

Garland J. and Shelvy Williams (12)

Ann E. C. Homan (21)

LTC Charles D. Young, US Army Retired (5)

Mona D. Johnson (34)

William and Natalie Zink (1)

Esther J. Strawderman (15) Richard L. and Joyce K. Strawderman (15)

Gayle H. Driver (7)

White Rose Giving Circle $500 Eight Anonymous

Louise Otto Hostetter (15) Dawn F. Kern (7) Vicki Krauss (23) Carol A. Kudless (10) Twilla M. Lambert (7) Susan J. Lawrence (1) Elizabeth M. Lawson (7) Cathy Jackson Leitner, P.L.C. (9) Kara A. Marshall (13) Sharon Menefee (4) Margaret (Peggy) M. Miller (24) Edgar L. Miller in memory of Carmen S. Miller (16) Rebecca W. Morris (33) Debra L. Mowery (4) Lori B. Moyer (6) Gloria B. Price (23) Carrie M. Rash (5) Martha K. Ross (11) Shirley M. Shimp (7) Patricia N. Shoemaker (8) Ilene N. Smith (40) Elayne Smith (2) Barbara B. Stoltzfus (24) Hope Shank Stoner (17) Debra D. Thompson (33) Diane E. Trobaugh (15) Sallye Trobaugh (9)

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SUMMER 2022

Christina Updike (9) Velleda M. VerNooy (2) Nancy Hopkins Voorhees (15) Valerie S. Weaver (10) Denise A. Whitman (19) Dr. Karen Wigginton (5)

Annual Support $25-$99 Richard S. and Alice H. Alley (1)

George H. and Carol A. Glading (1)

Eddie Ney and Margee Greenfield-Ney (3)

Memorial Gifts

Michael A. and Deborah W. Good (17)

Edward C. and Carol L. Parks (14)

Douglas Arthur Suzanne Arthur

Evangeline Michael Griffith (1)

Charleen C. Pinnell (5)

A. V. and Cynthia Hanagud (1)

Saranna T. Rankin (1)

Martin T. Hartman (2) Nancy Hernandez (2)

Reformation Lutheran Church (1)

Delmas C. and Gloria H. Hinkle (1)

Fred A. and Elaine K. Rohrer (1) Martha J. Rohrer (1)

Peggy Hufford-Bohannon (1)

Phillip M., Jr. and Betty J. Secrist (1)

Roy C. Anderson (3)

Richard A. and Linda J. Humbert (14)

Edward K. Bachschmid (1)

Shirley F. Hupp (5)

James H. and Catherine I. Beachy (1)

Khadijeh Hussain (1)

Vyacheslav Bondarev (1)

Ronald P. and Julianne Jilinski (15)

John F., Jr. and Brenda H. Bosserman (1)

Peggy James (1)

R. Fleming and Sharon W. Jones (4)

William N. Shawger, Jr. (7) E. Wayne and Linda H. Sheffer (1) Keith W. Sheffer (1) Teresa Shenk-Stuart (4) James R. and Mary C. Sherman (10)

Lorraine L. Kimble (5)

Harvey E. and Joan F. Shifflett (3)

Larry W. and Janice L. Knicely (3)

Suzanne Shifflett (1) Larry and Kay Shiflett (3)

Richard A. and Barbra J. Knupp (8)

Alton K. and Helen W. Shipe (10)

Andrew I. Kohen (3)

Harry L. Shoemaker (13)

William A. and Carole H. Kreowski (5)

Paul F. and Wanda L. Showalter (7)

Jerry O. and Daisy D. Leake (14)

Pavel and Tatyana Shulgan (1)

Richard G. and Claudia J. Childs (7)

Sandra L. Leap (4)

Anatolly Kuzmich Shumeyko (1)

Chester D. and Shelby J. Click (1)

Carroll T. Lisle (3)

Lynn and Audrey Slaven (1)

J. Steve and Dianne Little (1)

Linda D. Smiley (1)

Vunly Luangrarj (7)

L. Ronald and Bonnie V. Smith (4)

Rodney A. and Patricia D. Branson (9) Patricia A. Brunk (15) Jim Burnette (1) Padi Burtner (1) Thomas L., Jr. and Carroll P. Buskirk (5) Cynthia Cartee (1) George F., III and Lucretia A. Carter (1)

Daneen A. Coakley (1) John L. and Ruth M. Collins (1) Jackson P. Comer (2) Community Mennonite Church (1) Judy Ann Craun (3) Timothy J. Creegan (1) Carroll L. and Dianna L. Cubbage (6) Courtney D. and Joyce A. Dofflemyer (1)

Allison M. Lucas (1) Ralph C., Jr. and Alice A. MacPhail (1)

Victor J., II and Cheryl B. Smith (14)

Larry W. and Mary Grace Mallow (1)

SRMH Hospice Refund (2) Edna W. Stoner (3)

Robert and Kathryn Manley (11)

Dwynn M. Stovall (14)

Jeanette Marston (1)

Summit Church of the Brethren Church (1)

James and Barbara Martz (1) Patricia L. May (1) Roger L. and Juanita K. May (2)

Juanita A. Durrett (15)

Mable S. McCullough (3)

David C. Edwards (1)

Karen K. McInteer (2)

B. Earl and Cheryl K. Eshbach (10)

Frances A. Meadows (1)

George W. and Catherine Ann Fiel (1)

Elmer W. and Violet J. Metzler (4)

Dora Ann Fulk (1)

Garry W. and Peggy R. Miller (4)

Lelia Lightner Galvin (3)

Helen O. Nash (1)

Diane A. Gasper (8)

Marie Menard (3)

Stanley H. and Norma H. Suter (1) Violet Thompson (1) Jacqueline G. Towers (33) Janette R. Tusing (7) VIP Recognition, LLC (1) Derek and Tipavan Watana (1) Anna B. Wimer (8) Bennie W. and Sharon E. Wratchford (1)

Garfield E. Banks, Sr. Edith J. Banks William Blosser, Jr. Debra Jackson V. Stephen Bradshaw Chris Bradshaw Clark and Bradshaw, P.C. Kenneth and Gay Fawley John W. and Betty Jo Fleisher Richard E. and Patsy G. Fulk Sherrill Glanzer Noland and Barbara McHone Mr. James McHone and Mr. Noland McHone Steven J. and Jinni Williams Neºwing Christie Osborne William and Natalie Zink Viola Stultz Branner Mildred F. Branner Loretta Clapper Lee E. Clapper, Sr. Eugene Coakley Nelson and Linda Simmons Mike Cullers Patricia Thomale Les Curry Davy Balderson Richard Davis Diane C. Davis Jeff T. Dellinger Shirley L. Dellinger Gail Emswiler Kenneth and Gay Fawley Ruby Angeline Gallalee Edward R. and Nancy K. Gallalee Donald Harpine D. D. Coffman Joyce E. Horst A. Kenneth and Mildred L. Ranck Donnie Shelton Huffman Helen and Jennifer Wanger

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friends of the RMH Foundation

William John Hussey Bettye J. Hussey W. E. Jamison Polly A. Jamison Gerry Lee Jeffers Pam Jeffers Larry Franklin Kertcher Thom Bailey Stephen A. and Jacqueline R. Flossic Paula Gaherty W. R. and Carolyn S. Good Bruce J. and Sandra D. Kertcher Friends of Bruce Kertcher, brother of Larry Elliot Lieberman and Rachel Edds James Lovaas Karen Lovaas and O. Erich Hunt Frank A., Jr. and Janice F. Marcella Massanutten Women’s Club David L., Sr. and Diane M. O’Brien Charles F. Thompson Shirley Dellinger Leake Kaye F. Leake Elaine Frye Liskey Thomas Wetsel Ray M. and Ann H. Wine Thomas Lee Martin Thom Bailey Sam and Judy D’Andelet Mr. and Mrs. Brian Mills

Robert Douglas McCall Dawn Powell Ault Covenant Alianza David M. and Andrea H. Eshbaugh Cathy Wheeler and Bev Sears Daniel McCormick Joyce M. Ham Virginia “Ginny” L. McNett Walter P. McNett Joyce S. Michael Charles W. Michael Lucille Minnich Robert B., Jr. and Jeanne S. Minnich Stanley and Naomie Moyer Lareth L. May Bobby L. Myers Fay B. Myers Sterling E. Nair Foelke D. Nair Lois M. Oster Charles V. Oster Louise S. Phillips Mary Sue McDonald Talbott Family Robert Rhan Mary E. Rhan Ina Blosser Richards Ernest L., Jr. and Barbara B. Mongold

Michael Eugene Ruckman, Jr. Joseph K., II and Sallie Funkhouser Richard and Sally Halterman Ron and Sarah Seiger Family, Ron and Linda, Steve, Sharon and Bob Tinko, Greg and Jen

Frances E. Wyant (Mother) Evelyn S. Hedrick

Todd Rupp Joe D. and Elaine M. Nofzinger

Honor Gifts

Daniel Sanger Karen L. Weimer

Cancer Doctors Roberta (Robbie) and Robert K. Wilkins

Gilbert and Carolyne Schuckman Susan L. Schuckman

Robbie Jean Zirkle Laura S. Mapp Carol L. Sommer

Dr. James Colville Julianne Colville

Mom and Dad’s Birthday, Tim and Zena Shifflett Ethel S. Smith

Punkaj K. Dua, MD Karen Wood Grizzard

Wayne A. Strawderman Esther J. Strawderman

Laurie R. Dye William G. and Hope Shank Stoner

Phyllis Lee Zimmerman Wampler M. Wayne and Mary Ann Angleberger Larry W. and Jan S. Hoover Fred R. and Elizabeth W. Stone Phyllis Dove Wampler Mr. Jodie E. Wampler Richard L. Williams Donna D. Williams Kennedy Milan Wilson and all babies gone too soon!

Demitri and Heather Wilson, Kennedy’s Angel Gowns

Dr. Christopher J. Eller Anita H. Brechtel Megan A. Grizzard Gladding, FNP Karen Wood Grizzard Donna Hahn Buddy G. Hutchens Tena, Becky, Lesley, Brandy, Jenay, Katherine and Others Naomi Heishman Wayne E. and Carolyn H. Miller Dr. and Mrs. Don Hopson and Family Jane S. Hopson Jodi Housh Bobby W. Gooden II Barbara Lam Flora L. Kagey David Lucas Ruby Mae Breeden James McHone Terri Lynn Denton Dr. T. Keith Vest Howard E., Sr. and Elizabeth F. Beall Dr. Yuriy Zhukov Kyle L. Miller Lulubelle Ziegler Sangerville United Methodist Church

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SUMMER 2022

LET’S BE HEALTHY

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