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Sentara Marthamagazıne Jefferson FA L L 2 0 2 0

Keep Moving! JOINT SURGERY HELPS RESTORE MOBILITY

PLUS: Seasonal Flu or COVID-19? Manage Diabetes and Live Better | Help for Varicose Veins and Spider Veins

PRESIDENT’S LETTER

2020 SENTARA MARTHA JEFFERSON BOARD Carol Hurt | Chair

Bill Achenbach Lillian BeVier John Ligush, MD Lawrence Martin E. Ray Murphy Bernie Boone Michael Gentry Douglas Moyer

SENTARA MARTHA JEFFERSON ADMINISTRATORS

Jonathan S. Davis, MPH, FACHE President

Amy Black, DNP, RN, NEA-BC Vice President, Chief Operations Officer

Johnsa Morris, MHA, MBA, RN, NEA-BC Vice President, Chief Nurse Executive

Paul Tesoriere, MD Vice President of Medical Affairs

SENTARA MARTHA JEFFERSON MAGAZINE EDITORS

Jenn Downs Neil Mowbray CONTRIBUTORS

Luanne Austin Karen Doss Bowman Lisa Smith Jennifer L. Stover

Despite Difficult Times, We Have Much for Which to be Thankful

eflecting on the past nine months, it’s amazing to see how far we’ve come. While in some ways March seems like it was yesterday, in other ways it seems like an eternity ago. Regardless, 2020 has not been “normal” by any means. There’s not a person in our organization, or our community, who hasn’t had their typical routine disrupted due to COVID-19. In addition, to be honest, it’s been tough. Like you, I look forward to closing out 2020. That said, I have seen many silver linings and blessings, for which I’m truly grateful, come out of this year. Here at Sentara Martha Jefferson, it has been amazing to see our team come together and respond to the pandemic-related needs of our patients, families and community. Every member of our team has done an amazing job planning ahead to ensure that we provide the best care to our patients. I’ve mentioned on numerous occasions during this prolonged crisis that we’re in a marathon rather than a sprint, and I’m so proud of the professionalism our staff members have consistently shown, losing neither momentum nor resilience in the process. Outside of work, it has been heartwarming to see immediate families spending more time together, slowing down and eliminating activities that once took calendars captive. Personally, I’ve enjoyed getting outside more with my own family. We have been able to discuss, process and further understand this historic time for our country, which one day they will look back on in their history books—or maybe their online history lessons! All that said, it’s clear that we are not out of this yet. Moreover, while 2020 will come to an end in a few short weeks, 2021 certainly will bring its own set of challenges. From my viewpoint, one of the most important things we can do to close out the year strong is to make sure we’re taking care of ourselves. Just because it’s been a difficult year doesn’t mean we get a pass on our annual doctor’s appointments or screenings (many of which can be lifesaving). I turned 50 this year and recently had my first colonoscopy. Although clearly not the way I hoped to spend a morning, it was an important action for me to take for my health, and to demonstrate that the pandemic can’t stop me from caring for myself and prioritizing what’s important. Along those lines, on page 33 you can read more about 3D mammography and the benefits it brings for early detection of breast cancer. And for those of you struggling with sleep during these difficult times, learn more on page 6 about how to determine whether you may be a candidate for a sleep study, which can help diagnose what may be causing you a lack of recuperative rest. Although I know some of you may be hesitant to enter a healthcare setting, I want to assure you that at Sentara Martha Jefferson Hospital we are taking extra precautions to ensure your safety and well-being—ever our No. 1 priority—and that we are always prepared to provide safe, compassionate, high-quality care. You can read more about those precautions on page 19. In closing, I am extremely grateful to the entire community for the support you have shown me personally, as well as to the Sentara Martha Jefferson team, as we have ventured through these uncharted waters. You have provided prayers, kind words, and donations of supplies and funds. In addition, our physicians, nurses, clinicians and support staff have gone above and beyond to keep our hospital operational and safe for all who turn to us for care. I wish you each a wonderful holiday season, and here’s to finding more silver linings, as well as encouragement for a strong ending to the year and a great 2021 to come. Warm regards,

PHOTOGRAPHY

Luca DiCecco Andrew Shurtleff DESIGN

Picante Creative

Jonathan S. Davis, MPH, FACHE President, Sentara Martha Jefferson Hospital

Contents FA L L 2 0 2 0

Seasonal Flu or COVID-19?

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Preparing for Both Illnesses

Learning to Manage Diabetes and Live Better

Keep Moving!

Sentara Martha Jefferson Diabetes Management Program

Joint Surgery Helps Restore Mobility

Contents

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D E P A R T M E N T S President’s Letter Inside front cover The Best Medicine

New & Noteworthy

Physician’s Perspective

Testing for Obstructive Sleep Apnea

On-Call Advice

Improve Health Every Day Women’s Health

Varicose Veins and Spider Veins

Calendar

Clinical Excellence

3D Mammography

Health Matters

Practice the Basics of Infection Prevention

La Salud Importa

Adopte las Medidas Básicas para la Prevención de Infecciones

Calendar

COVID Corner

Philanthropy

Coping and Even Thriving During COVID-19

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THE BEST MEDICIN E BY MICHAEL CORDELL

Lessons Learned from

a Year in the House

K, 2020. You’ve got some explainin’ to do. Entering this year, I assumed it would be a great one, simply because the number 2020 had a numerical symmetry that connoted terrific things. And yes, most of my decisions are based on logic like that (but don’t act like you didn’t think the same thing). Instead, for me 2020 turned out to be the Year of the House. I went out for takeout food on March 17, and I’m not sure I’ve left my house since, with the exception of walking up to my mailbox. Obviously that’s a bit of an exaggeration—after all, who gets mail anymore? Each January, my wife and I create a photo book to memorialize the previous year. These photo books are normally filled with pictures of various trips, concerts, hikes, great dinners out, gatherings of family and friends, and all of the enjoyable things that fill our lives. It’s now looking like our 2020 photo book will be about two pages long, and most of our “memories” from this year will be pictures of our dog, Trolley. Although I basically never changed out of my “2020 Happy New Year” sweatshirt, I nevertheless learned a number of important things this year, despite the lack of photographic evidence to document it. • Healthcare workers truly are wondrous individuals. Most every healthcare worker—regardless of his or her role—has raised the bar in response to the pandemic. In 2020, healthcare workers have been much like firefighters who fearlessly rush into burning buildings, with one important difference: for healthcare workers, bravely venturing into perilous circumstances has been a daily event this year. They have been truly heroic on a regular and repeating basis. • Human interaction shouldn’t be taken for granted, even between total strangers. Once all of this has passed—and it will pass—I’m going to take a different view of the people who serve in restaurants, provide customer service in stores and assist me with my healthcare needs, among many others.

I actually miss these complete strangers, and once I’m back in a crowded restaurant and the waitperson comes to our table, I sense our relationship will feel different. I’ll likely even want to give them an unprovoked hug, although that’s probably illegal in most states. Perhaps just a knowing nod will be more appropriate. And a sizable tip. • My mother was right after all: Wash your hands. • Don’t take the truly important things for granted. That’s a lesson we’re often given the opportunity to learn, and it usually doesn’t stick. But if any year has provided us with an extended period of time to step back and appreciate the things we have—and that we perhaps take for granted—it was this one. And by “truly important things,” I mean things like people, not toilet paper. • At the same time, I also learned not to underestimate the value of having an ample supply of toilet paper. So bring on 2021. I like that number! I like its sequential nature. I’ve got a good feeling about next year. I feel optimistic.

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new& noteworthy Sentara Martha Jefferson is pleased to welcome the following new providers into the hospital community. To get connected with one of our providers, or for more information on any caregiver at Sentara Martha Jefferson Hospital, please call 1-800-SENTARA. More information can also be found at Sentara.com.

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Paul A. Burke, PA-C Emergency Medicine US Acute Care Solutions 434-654-7150

Jenna M. Kim, MD Ophthalmology Charlottesville Eye Associates 434-977-5160

Morgan R. Newsome, DO Pediatrics Pediatric Associates of Charlottesville 434-296-9161

Lauren M. Fry, PA-C Hospital Medicine Sentara Martha Jefferson Inpatient Services 434-654-7580

David S. Lancaster II, MD Emergency Medicine US Acute Care Solutions 434-654-7150

Ryan M. Pivovar, DPM Podiatric Foot and Ankle Surgery Virginia Foot & Ankle Surgical Associates 434-977-8040

Kevin M. Fussell, MD Pulmonary/Critical Care Sentara Martha Jefferson Medical & Surgical Associates 434-654-5260

William J. Maloney, MD Internal Medicine Downtown Family Health Care Inc. 434-817-1818

Mohammad H. Shakhatreh, MD Gastroenterology Sentara Martha Jefferson Medical & Surgical Associates 434-654-5260

Lori T. Hage, MD Hospital Medicine Sentara Martha Jefferson Inpatient Services 434-654-7580

Erin McLoughlin, MD Hematology/Oncology Sentara Martha Jefferson Hematology & Medical Oncology Associates 434-654-8390

Cynthia A. Thompson, CRNA Anesthesiology Sentara Anesthesiology Specialists

William J. Hightower, MD Anesthesiology Sentara Anesthesiology Specialists

Sharlene M. McNeish, CRNA Anesthesiology Sentara Anesthesiology Specialists

Stephanie R. Wilhelm, CRNP Emergency Medicine US Acute Care Solutions 434-654-7150

Leslie S. Hilding, MD Hospital Medicine Sentara Martha Jefferson Inpatient Services 434-654-7580

Mario E. Montalvo, DO Hospital Medicine Sentara Martha Jefferson Inpatient Services 434-654-7580

Rhett N. Willis Jr., MD Plastic Surgery Charlottesville Plastic Surgery 434-227-5333

Sentara Hospitals Recognized as Leaders in LGBTQ Healthcare Equality

Sentara Martha Jefferson Hospital Receives Honors for High-Quality Stroke and Diabetes Care Sentara Martha Jefferson has received the American Heart Association/American Stroke Association’s Get With the Guidelines®– Stroke Gold Plus Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring that stroke patients receive the most appropriate treatment according to nationally recognized, researchbased guidelines established on the latest scientific evidence. Sentara Martha Jefferson also received two additional recognitions—the Target: Stroke Elite Plus Award and the Advance Therapy Award—for meeting quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-busting medication tPA (tissue plasminogen activator). The recognitions honor Sentara Martha Jefferson for achieving door-to-device times in at least 50% of applicable patients within 90 minutes for direct arrivals and within 60 minutes for transfers. The hospital received a third recognition—the Target: Type 2 Diabetes Honor Roll Award— for meeting quality measures for providing appropriate care to stroke patients with diabetes, with more than 90% compliance for 12 consecutive months.

All 12 Sentara hospitals have earned Leader in LGBTQ Healthcare Equality status in the 2020 Healthcare Equality Index (HEI), a national LGBTQ benchmarking tool from the Human Rights Campaign. Leader status is HEI’s highest designation and can be attained only by earning a top score of 100 in the 2020 HEI survey. Sentara's hospital top scores place them in an exclusive group in Virginia—only four other facilities in the commonwealth hold Leader status. Sentara Albemarle Medical Center, located in Elizabeth City, N.C., joins 20 other facilities in North Carolina with Leader status. “Sentara is a community leader, and everyone who enters a Sentara facility—whether for work, care or just to visit—should know they are welcome, safe and valued, and will receive the highest quality of care,” says Dana Beckton, chief diversity officer for Sentara Healthcare.

Follow Us on Facebook Be in the know and stay up to date with Sentara Martha Jefferson Hospital by following us on Facebook. Hear from our experts and learn tips and information to help keep you and your family healthy.

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PHYSICI AN’S PERSPEC TIVE

Testing for Suspected

Obstructive

bstructive sleep apnea (OSA) occurs when the upper airway collapses during sleep and blocks normal airflow. This collapse occurs when the muscles supporting the soft tissue in the throat relax, temporarily constricting the airway (often, bed partners or other family members will notice the stoppages in breathing). The obstruction of a person’s breathing during sleep can result in frequent arousals, reduced sleep time and less deep sleep, and may also significantly lower blood oxygen levels during sleep. Those effects can, in turn, contribute to feelings of not having slept well,

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Sleep Apnea

daytime fatigue and tiredness, low energy levels, and possibly severe daytime sleepiness. Loud snoring, morning dry mouth and headaches also may be present in people with OSA. A lack of quality sleep By David A. Calhoun, MD attributable to untreated OSA Sleep Medicine also can have negative effects on concentration, memory, and job and school performance, and can increase a person’s risk of accidents—including motor vehicle accidents. Studies indicate that long-term OSA, particularly

if moderate or severe, increases a person’s risk of developing hypertension, heart disease, atrial fibrillation and stroke.

A Common Problem

Recent studies suggest that up to 50% of men and up to 25% of women may have OSA. The risk of having the disorder increases with age and is especially high in overweight and obese individuals. More men than women have OSA, and risk of OSA is higher in people with other medical conditions such as hypertension, heart disease, diabetes, congestive heart failure and chronic kidney disease.

Diagnosing OSA and Other Sleep Disorders in the Sleep Lab

Definitive diagnosis of OSA requires a sleep study to document significant reductions in airflow, accompanied by awakenings and/or decreases in blood oxygen levels. The gold-standard test is a monitored sleep study performed in a certified sleep lab. This is most often done overnight, although daytime assessments can be carried out if the patient normally sleeps during the day. The in-lab study provides the most comprehensive assessment of sleep, including, at a minimum, measurement of brain wave activity with an electroencephalogram (EEG), as well as monitoring of eye movements. These measurements allow the sleep physician to confirm the onset of sleep and its duration, and to monitor the patient’s stage of sleep, allowing the physician to distinguish deep sleep from lighter stages of sleep. In-lab studies also provide measurements of airflow, respiratory

effort, blood oxygen levels, heart rate and rhythm, body position, assessment of arm and leg movements during sleep, and video monitoring. This extensive observation allows not only for a definitive diagnosis of OSA, but also for recognition of other unrelated sleep disorders that may be present, including grinding or clenching the teeth, leg kicking, sleep-related seizures, the inappropriate acting out of dreams, and other less common sleep disorders. OSA is diagnosed and its severity is determined based on the number of times the patient’s breathing is obstructed per hour of sleep. Obstructive breathing events are classified either as apneas (a complete absence of airflow for at least 10 seconds) or hypopneas (a reduction in airflow for at least 10 seconds, accompanied by a significant drop in blood oxygen level and/ or an arousal from sleep).

Diagnosing OSA with a Home Sleep Study

Home sleep studies offer an alternative to in-lab studies for diagnosing OSA. Typically less comprehensive than an in-lab study, a home study is limited to testing for the presence or absence of significant OSA. Although the number of parameters measured does vary among different home monitoring systems, most units are limited to measuring airflow, respiratory

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effort, blood oxygen levels and heart rate. Some home testing systems do include channels for measuring body position and estimating the degree of snoring. However, home testing typically does not provide for recording the patient’s EEG, which precludes being able to determine sleep onset and stage of sleep. In addition, home testing typically provides no assessment of the patient’s limb movements— especially leg kicking.

Comparing Lab-Based and Home Sleep Studies

With its greater diagnostic capability, in-lab sleep monitoring is more expensive than home sleep studies, as well as less convenient, since patients are required to spend the night in a sleep lab. In-lab studies also are more cumbersome, since many more electrodes are attached to the patient’s body, and potentially less comfortable for patients who may have trouble sleeping in a strange bed away from home. In addition to being less costly, home sleep testing enables physicians to assess patients in their normal sleeping environment, which sentara.com

Treating OSA

may allow for a more typical night of sleep. Home testing is also more convenient for patients who may have trouble leaving their home. However, compared to in-lab assessments, home testing is limited to evaluation for OSA. If testing for other sleep disorders is required, a home study will not suffice. During in-lab studies, a sleep technician monitors the sleep study and can recognize and correct problems with data collection during the test. Since home testing is not monitored by a sleep technician, it comes with a higher incidence of unsuccessful data collection, causing the need for home studies to be repeated more frequently than in-lab studies. An important limitation of home sleep testing is its inability to document when the patient is experiencing true sleep. This is important because the severity of a patient’s OSA is based on the number of obstructive respiratory events occurring per hour. If the patient is awake during some of the testing period, the study will underestimate the severity of OSA, since people typically do not have obstructive

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respiratory events when they are awake. Consequently, home sleep assessments do not identify mild cases of OSA as reliably as in-lab assessments. Given this limitation, home testing for OSA is most appropriate for those patients who have conspicuous symptoms of OSA. This distinction also means that if a home study is negative for OSA, but a high level of suspicion of OSA persists, it is possible that the home study results were inaccurate. In those cases, the study will have to be repeated, or an in-lab study will be required to know with certainty whether OSA is present or not.

Signs and Symptoms of Obstructive Sleep Apnea Loud snoring Frequent awakenings Episodes of breathing stoppage Fatigue/lack of energy Daytime sleepiness Morning dry mouth and/or headaches

Patients diagnosed with OSA are most often treated with continuous positive airway pressure (CPAP) therapy. The CPAP machine increases air pressure in the patient’s upper airway, preventing it from collapsing during sleep. Often CPAP can be started at home, but some patients may need an in-lab study to ensure that the CPAP equipment is effective and properly adjusted to provide maximum benefit. An in-lab study also may be needed if there are concerns about complicating conditions such as congestive heart failure, lung disease (especially chronic obstructive lung disease) and/or risk of hypoventilation. At Sentara Martha Jefferson Hospital, if a home sleep study is recommended, the patient will be scheduled to come by the sleep lab to pick up the monitor and receive instructions on its proper use. The unit should be returned to the sleep lab the next day so the data can be downloaded and reviewed. A follow-up visit with the sleep clinician is usually scheduled one to two weeks after the patient returns the sleep monitor. During this visit, the clinician will review the test results with the patient and discuss treatment options, as appropriate. The good news for patients with OSA is that it is highly responsive to treatment with CPAP, and patients can have good outcomes if they follow the recommended treatment plan. If you think you may need a sleep study, talk to your healthcare provider or call 434-654-5280.

ON-CALL ADVICE

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

Are heartburn and acid indigestion the same thing?

lthough both conditions involve discomfort and feature symptoms that tend to overlap, leading many people to use the terms interchangeably, heartburn and acid indigestion occur in distinct areas of the body. Acid indigestion usually describes feelings of discomfort in the stomach or abdomen that can occur with eating. Sometimes called sour or upset stomach, symptoms may include burning stomach pain, belching, bloating, abdominal fullness, nausea or vomiting. This condition typically occurs when the stomach is stimulated to produce acid, or when the mucous lining of the stomach fails to protect it from acid or other irritating substances, such as aspirin or ibuprofen. Symptoms also may result from eating too much or too quickly, from eating highfat foods, or from eating during high-stress situations. Unlike acid indigestion, heartburn refers to burning sensations or feelings of pressure in the upper abdomen and chest. And although heartburn can be a symptom of acid indigestion, it occurs when stomach acid leaks into the lower esophagus and burns the esophageal lining— often brought on by bending over or lying down, or by eating

certain spicy or acidic foods. As a side note, while this pain can feel like one of the classic symptoms of heart disease, heartburn actually doesn’t have anything to do with the heart. Occasional episodes of acid indigestion and heartburn usu-

ally are relieved by self-treatment with over-the-counter medications. Avoiding alcohol and carbonated beverages and refraining from smoking also may help to relieve symptoms. However, acid indigestion and heartburn may be signs of a more serious problem like a stomach ulcer or gastroesophageal reflux disease (GERD)—particularly if symptoms last longer than two weeks. If you experience acid indigestion or heartburn fairly often, see your healthcare provider.

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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

aryngitis is an inflammation of the larynx, the “voice box” that contains the vocal cords. It can be either acute (of short duration), or chronic (of long duration). Laryngitis typically results in a change of vocal quality, often described as hoarseness or a weak voice. Associated symptoms can include dry throat, cough, a tickling sensation that leads to repeated clearing of the throat, and/ or a sore throat.

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What is laryngitis, and what causes it? What treatments are recommended?

Acute laryngitis can result from viral or bacterial infection, such as the common cold, flu, bronchitis or pneumonia. Chronic laryngitis may result from continuous irritation of the larynx brought on by heavy smoking, excessive alcohol consumption or gastrointestinal issues like acid reflux. People who constantly use their voice also can irritate their vocal cords and experience laryngitis. Voice changes also may be caused by benign or malignant growths on the a7880ss/stock.adobe.com vocal cords. Frequently effective self-treatment measures for acute laryngitis include the following: • Rest your voice and avoid talking as much as possible to give the inflammation a chance to subside. • Avoid smoking or drinking alcohol or caffeine, since those agents can dry out and irritate the vocal cords.

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• Drink plenty of water and use a humidifier to maintain moisture and lubrication in the throat. • Cover your mouth with a scarf or mask when going out in extremely cold weather. • Moisten your throat by sucking on lozenges or gargling with saltwater. A healthcare provider should be seen in cases where there is difficulty swallowing or breathing, or if you develop a high fever with laryngitis. Voice change that persists for longer than 3 weeks should be evaluated by a physician to determine the underlying cause.

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IMPROVE HEALTH EVERY DAY

FLU SHOTS

Are Even More Important This Year With the COVID-19 pandemic still among us, and given the medical complexities the disease can produce, getting your flu shot early this year is crucial. Since many flu symptoms are similar to those of COVID-19, getting a flu vaccination could help prevent potential confusion about any symptoms you may experience in the coming months. Also, preventing flu will help save lives and preserve precious healthcare resources. People can get the flu and COVID-19 at the same time, according to the Centers for Disease Control and Prevention, and both illnesses can quickly become life threatening. Research shows that flu vaccines reduce the risk of having a more serious case of flu, and also result in fewer hospitalizations and deaths. So, getting the flu vaccination this fall is more important than ever. If you haven’t yet had your flu shot, talk to your healthcare provider.

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I MPROVE HEALTH EVE RY DAY

TEMPERATURES

RISING:

Understanding

FEVER

Tips for a Great

Night’s Sleep

Getting enough sleep is essential for your good health and wellbeing. Adults usually need about seven to nine hours of sleep each night, and people over 65 need seven to eight hours per night. Babies, young children and teens, however, need even more sleep to enable proper growth and development. Continual sleep deprivation can weaken your immune system, reduce your mental sharpness, affect your performance in school or on the job, and make you more susceptible to accidents. If you have trouble getting a good night’s sleep, consider these tips: • Avoid eating heavy meals and drinking alcohol or caffeine for at least two to three hours before bedtime. • Avoid sleeping with the TV, radio or other electronic devices on in your room. • Limit naps to 10-15 minutes in the early afternoon, and avoid napping too close to bedtime. • Get regular physical activity for at least 30 minutes per day most days of the week—but not right before going to bed. • Maintain a regular sleep schedule by going to bed and getting up around the same time. • Keep your bedroom dark and cool while you are sleeping. • Make sure your mattress and pillow are comfortable and conducive to restful sleep. • Before going to bed, practice meditation, prayer or deep breathing; take a relaxing bath or shower; or engage in some other relaxation technique to help you calm down from the day’s activities.

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Is a temperature of 99.9 degrees a fever? When does a baby’s temperature reach the danger point? Fevers are the body’s way of fighting off infection. Just as we heat water to sterilize it, the body heats up to kill germs. The average body temperature in adults ranges from 97-99 degrees. Clinically, a temperature is considered a fever when it reaches 100.4 degrees or above in adults and children. In babies three months old and younger, a temperature of more than 100.4 degrees should be treated as a medical emergency because it could indicate the presence of sepsis, a severe, potentially lifethreatening infection. In otherwise healthy adults and older children, you can try treating a fever with

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Consider Gentle Exercise to

Help Relieve Chronic Stiffness and Pain

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home remedies first. Take medications like acetaminophen and ibuprofen, or try other remedies like cool compresses or a cool bath. If the fever does not go away within 48-72 hours, or if it keeps rising within that time to above 103 degrees, seek medical help. Adults and older children should see their medical provider if they have a fever with a serious underlying medical condition, a new rash, pain with urination, a surgical procedure in the last 14 days or a weakened immune system. Also see the doctor if your fever comes and goes for up to a week or more, even if the temperature is not high. Any time a temperature is of concern—particularly in infants and younger children—see your physician. During the COVID-19 pandemic, a temperature of 100.4 degrees or higher may be a sign of coronavirus infection. If you think you may have been exposed to the COVID-19 virus, or if you have other respiratory symptoms or a loss of taste with your fever, call your healthcare provider for advice about the need for testing.

Gentle stretching is one of the most beneficial types of exercise to help relieve chronic pain. Stretching also can improve your blood circulation and improve your flexibility and range of motion. Arthritic joints often feel better when they undergo regular movement, so engaging in gentle exercises can help keep you from stiffening up. While sitting in a chair, try bending and straightening your legs for 20 repetitions, three times per day or more. Gentle strength training with weight machines, dumbbells or even just your own body weight improves circulation, muscle tone and strength. Regular strength training also boosts your metabolism, helping you burn calories more efficiently for better Syda Productions/stock.adobe.com weight management. Weight loss can help relieve the stress on joints and possibly help ease joint pain. Cardiovascular exercise is beneficial for a strong heart and lungs. If you fear that running or jogging might be too strenuous or painful, try walking or swimming—both are gentler on the joints. Besides the many physical benefits regular exercise provides, such as improved circulation, enhanced muscle tone and greater strength, it also helps improve your mood, thanks to the release of natural endorphins—those “feel-good hormones”—into your bloodstream. Physical therapy can be another good way to reduce chronic pain and stiffness. For guidance on the best gentle exercises for your needs, talk to your physician or a physical therapist. sentara.com

WOMEN’S HEALTH

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VEINS

Vexing You? What You Can Do about Varicose and Spider Veins Varicose veins and spider veins—those red, purple and blue lines and webs visible just below the surface of the skin—can be an unsightly nuisance. Or worse. While the biggest threat posed by most such veins is cosmetic, varicose veins can potentially turn into an issue that requires medical treatment. Lewis V. Owens, MD, a vascular surgeon at Sentara Martha Jefferson Hospital, explains why veins can develop problems. “Arteries take blood away from the heart, while veins return blood to the heart,” he says. “Arteries are usually more efficient because they have a robust pump: the heart. Veins don’t have that powerful pump and have to work against the force of gravity, so they can become dilated, weak and inflamed.” Veins also have valves, he adds, which can become a source of problems. Similar in appearance to varicose veins, spider veins carry less potential for harm. Somewhat hereditary in nature, according to Dr. Owens, spider veins

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develop due to inadequacies in the elastic tissue of the small valves that primarily function in veins to keep blood moving back toward the heart. “The valves go up the legs like a stepladder,” says Dr. Owens. “But if the valves get leaky or incompetent, veins can get bumpy and inflamed.” Spider veins are common, affecting about 25 percent of the adult population.

What Causes These Problems?

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“There are many theories about causes,” says Christine Ou, MD, a vascular surgeon at Sentara RMH Medical Center. “Previously we thought females more frequently developed varicose veins, but now we know that men get them quite often, too.” Dr. Owens notes that although men are just as prone to varicose veins as women, more women come in for treatment. “They’re more of a cosmetic problem than anything else,” Dr. Owens adds, “so we treat them for aesthetic purposes. Women, in particular, often don’t like the way spider veins look.” People at risk for varicose veins include those who are overweight or pregnant, and people like teachers, hair stylists and nurses whose professions require them to stand for prolonged periods of time, according to Dr. Ou.

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Age can be another factor contributing to weakening of the veins, as can hormones and sitting for long periods of time. Varicose veins may start off looking similar to spider veins, but worsen over time. They can start to itch, burn and swell, and may cause sensations of heaviness in the legs. As varicose veins worsen, bumps and bulges may emerge under the skin and lead to additional problems. In some cases, the skin may break down, allowing damaged or weak veins to erupt into a venous ulcer that looks like a wound. Bulging veins also may result in thrombosis (blood clotting) in surface veins. Another condition that can arise is phlebitis, in which the veins become inflamed and may block blood flow.

To Treat or Not to Treat? While many problems with varicose veins probably don’t need to be treated, the condition can become a nuisance when veins become uncomfortable, itchy or swollen. There are three general approaches to addressing varicose veins, according to Dr. Owens. “First, you can do nothing—but the condition will progress,” he says. “Second, you can take some conservative measures, including exercising, losing weight, wearing compression stockings and elevating the legs.” Weight loss and exercise may help relieve varicose veins by improving blood circulation, he explains. Compression stockings can help by assisting the pumping action of the veins in the calf muscles. Elevating the legs can facilitate blood flow upward from the ankles. “The veins work against gravity,” says Dr. Owens, “so elevating the legs and exercising help augment the pumping action in the calf muscles.” “I’m pretty conservative in treating varicose veins because all that most patients need is compression and elevation,” Dr. Ou says. “However, for a number of reasons, sentara.com

W O MEN’S HEALTH

some people can’t tolerate those measures.” Elderly people, for instance, often have difficulty in getting compression stockings on and off, so Dr. Ou often explores other conservative options with them. Doing nothing or taking conservative measures is appropriate for most patients. However, for those who experience significant discomfort, bleeding, open sores or superficial thrombosis, Dr. Owens says medical treatment—the third option—may be necessary.

Treating Spider and Varicose Veins To treat spider veins, cosmetic sclerotherapy is usually the most effective option. During this outpatient procedure, a special sclerosing solution is injected into the spider vein. The needles used are extremely thin—the size of a human hair—so the injection is well tolerated by nearly all patients. The solution causes the vein to collapse, and the body starts absorbing the vein until it eventually disappears. The blood is then redirected to healthy veins, leading to improved circulation. “It’s not the ‘fountain of youth,’ but sclerotherapy does a good job with spider veins,” says Dr. Owens. Topical laser treatments are another option for spider veins, but that technique is much more expensive. As for varicose veins, about 25 percent of patients require treatment, according to Dr. Ou. Since patients differ in terms of symptoms, expectations and goals, there’s no one “right” way to treat everyone, and there are

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many treatment options, Dr. Ou adds. Fortunately, since surface veins are not as important to blood flow as deep veins, procedures generally do not affect circulation. Before undergoing more aggressive treatment, patients with varicose veins will have a physiologic ultrasound to assess valve function for leaking or incompetent valves. Then patients will be asked to wear compression socks for several months. If this conservative approach fails, other options will be considered. Endovenous (“inside the vein”) laser treatment is a widely used procedure that offers excellent outcomes with a low complication rate, says Dr. Ou. During this procedure, which takes about 60 minutes and is performed in a clinical setting under local anesthesia, the physician heats the inside of the valve-incompetent vein, which causes it to seal shut and gradually disappear. Another treatment for varicose veins is transilluminated powered phlebectomy, a minimally invasive technique in which the vascular surgeon

uses two small tubes called cannulas. The tubes are inserted through a minimal number of tiny puncture sites to localize and directly visualize varicosities (the areas of bulging) and assist in their complete removal. This is a useful technique for patients who are not candidates for endovenous catheter therapies. Although these and other treatments can be very effective, people with a genetic predisposition to valve insufficiency can expect to have recurring problems, says Dr. Owens. “If you’re born with valve problems, you can never take care of it 100 percent,” he cautions. “There will likely be ongoing issues.” For this reason, most patients who undergo surgery for varicose veins return for further treatment within two to five years. “Thankfully, however, these vein conditions are rarely life threatening,” points out Dr. Ou. “Whether through conservative measures or more advanced techniques, patients with these issues can achieve reduced symptoms, improved cosmetic appearance and enhanced quality of life.”

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Sentara Martha Jefferson Hospital is pleased to provide a variety of health education opportunities to community members. Highlights of the fall 2020 offerings are listed below. A full list of classes, support groups and seminars can be found by visiting Sentara.com or calling 1-800-SENTARA (1-800-736-8272). About Bariatric Surgery: An Information Session for Those Seeking Lifelong Weight Management Nov. 19, 1-3 p.m. This free seminar discusses specific types of bariatric surgery and whether those options might be right for you. A free online seminar is also available at Sentara.com/weightlosssurgery.

Joint Camp: A Complete Guide to Preparing for Knee and Hip Surgery Details on Sentara.com. Call Connie Summy, BSN, RN, ONC, at 434-654-8338 to obtain the Sentara Martha Jefferson Joint Camp video link.

Preparation for Childbirth: Virtual Class * Call 1-800-SENTARA or visit SentaraMJHMaternity.com for dates and times. Classes are conducted by a certified childbirth instructor, and topics include understanding and managing the different stages of labor through relaxation, labor positions and breathing techniques; medication options; and Caesarean birth. Early registration is encouraged!

Advance Care Planning Assistance Class meets on the first Thursday at 10 a.m. and the fourth Thursday at 3 p.m., Phillips Cancer Center Conference Room, 3rd floor of Sentara Martha Jefferson Hospital Telephone or Zoom consultations available upon request. As part of routine health care, we encourage everyone over the age of 18 to complete an advance directive. An advance directive designates who will make health decisions for you if you cannot speak for yourself. It informs your care team of your choices for future medical care. During our class, we will answer your questions about advance care planning, will assist you with completing an advance directive, and will file your completed advance directive with the U.S. Living Will Registry. We will also submit it to medical records to be included in your electronic medical record so your care team will have access to the document. Please register by calling Tammy James at 434-654-5597.

Out of the Blues—A Virtual Postpartum Support Group Meets the second and fourth Thursdays of each month, 10:30 a.m.-noon. Even if this is not your first baby, sometimes the work of caring for your family can be overwhelming and bring unexpected stress, worry and sadness. If you need a place to talk, we are here for you. Feel free to bring your baby and connect with others who may be experiencing similar challenges. For more information or to be added to the email list to receive a link to join, call 434-654-4415.

Registration for all classes is required unless otherwise noted. To register, call 1-800-SENTARA.

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Empty Arms, Full Hearts Support Group Held the third Thursday of each month, 7-8:30 p.m. For parents of deceased infants; find space and time to share with other parents who are going through the same experiences. Currently meeting by Zoom. To request the meeting link, please contact Tammy James at 434-654-5597.

Cancer Support Groups Various online cancer support groups are offered. Please contact Tammy James at 434-654-5597 to explore which group best fits your needs.

Sentara Star Hill Health Center

Sentara Martha Jefferson offers a variety of other classes and seminars, including the following: Basics in Baby Care Breastfeeding Calming the Chaos Heart to Heart Support Group

A Free Wellness Center Focused on Chronic Disease Prevention and Management located at the Jefferson School City Center, 233 4th St. NW, second floor, Charlottesville

Sibling Tours

Currently, because of the COVID-19 pandemic, we are not holding our drop-in sessions, but we are seeing patients and offering the community the opportunity to schedule appointments to have their blood pressure, blood sugar and weight checked. Also conducting virtual group sessions and virtual cooking classes, and connecting community members to resources and services that provide mental and physical wellness. All services are free and open to the public. For information or to schedule an appointment, call 434-984-6220.

Welcome to Motherhood Support Group

Taking Control (stress management)

Welcome to Parenthood Support Group Most classes are free. For a complete list of classes, support groups and seminars at Sentara Martha Jefferson Hospital, please visit www.sentara.com.

Registration for all classes is required unless otherwise noted. To register, call 1-800-SENTARA (1-800-736-8272).

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Seasonal Flu or COVID-19? Sentara Martha Jefferson Infectious Disease Team Prepares for Both Illnesses When the COVID-19 pandemic took root in March, Sentara Martha Jefferson Hospital, much like hospitals all across the world, worked tirelessly to understand the new strain of coronavirus and plan for the impact it would have on patients, healthcare workers, the hospital and surrounding communities. sentara.com

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This fall and winter, Sentara Martha Jefferson will face yet another challenge: treating coronavirus and seasonal flu cases at the same time. Since both are respiratory viruses with similar symptoms, distinguishing between the two could be challenging for both patients and caregivers. Depending on the diagnosis, treatment likely will take different paths. With more than six months of experience and data from treating COVID-19 patients, infectious disease experts at the hospital are confident in their strategies for handling both the flu and coronavirus effectively—especially since information on treating COVID-19 cases is updated continually. “Studies are released daily around the world,” says Keri Hall, MD, a Sentara Martha Jefferson infectious disease specialist. “One of the major challenges as an infectious disease doctor is finding the time to keep up with the unprecedented pace of new medical information. Some days it feels like drinking from a firehose, to use a common analogy, but all of this research helps to improve patient care.” Notable Differences Flu season typically peaks each year in January or February. So when doctors first started diagnosing patients with COVID-19 at Sentara Martha Jefferson in early 2020, they were still treating a few flu cases, says Andrea Chapman, infection preventionist at Sentara Martha Jefferson. Fever, body aches, cough, sore throat, headache, and runny or stuffy nose are all symptoms shared by the two viruses, as well as by the common cold. One of the most significant differences between COVID-19 and the flu, however, is how quickly flu symptoms appear. “If you’ve been exposed to the flu, you’re more likely to feel sick quicker than if you have been exposed to COVID-19,” Chapman points out. “So if, for example, you had a known exposure to a family member with the flu and then a day or two later you start to feel

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feverish with a sore throat, it’s probably going to be the flu.” With a COVID-19 infection, patients tend to feel symptomatic more gradually. Other differences between COVID-19 and the flu include: • Incubation period: Symptoms usually appear one to two days after exposure to the flu virus. With COVID-19, the average time for symptoms to appear after exposure is five days, but it can range from two to 14 days. People can also spread COVID-19 to more people and for a longer period than is the case with the flu.

• Taste/smell: Many people diagnosed with COVID-19 experience a loss of taste or smell. In fact, loss of taste and smell was the leading indicator of COVID-19 in a U.S. and British study involving 2.6 million people who reported symptoms on a smartphone app.

“We do see flu outbreaks in congregate living facilities,” Chapman says. “But the flu doesn’t produce the same type of ‘superspreader’ events like we’ve seen with COVID in church choirs, a scientific conference in Boston, and other parties or events where it spreads to a large number of people.”

• Populations affected: Severe cases of COVID-19 have primarily developed in the elderly, those with compromised immune systems and those with other underlying health conditions. Although young children can get COVID-19, their likelihood of developing serious illness from the virus is much lower than it is for the flu.

How Do These Viruses Spread? Both the seasonal flu and the coronavirus are spread due to person-to-person contact, rather than through food, blood or vectors such as insects. Both viruses spread primarily through large droplets that get expelled into the air when infected people cough, sneeze and even talk, depending on how close people are in proximity to others. With the flu, researchers know for sure that people also can become infected by physical contact with another person, as when shaking hands. Infection also can occur when a person touches an object or surface that someone has just sneezed or coughed

• Superspreading: Although flu is a contagious illness, it doesn’t have the same “superspreader” tendencies as the coronavirus.

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• Asymptomatic cases: As many as 80% of patients diagnosed with COVID-19 have a mild case, or do not experience symptoms at all. With the flu, most patients experience the telltale signs. Although asymptomatic infections can occur with the flu, they’re not as common.

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on, and then touches his or her own nose, mouth or eyes. Experts believe COVID-19 can be transmitted via objects as well, but person-to-person contact is the primary method of transmission, according to the Centers for Disease Control and Prevention. Duration of contagiousness is another significant difference between COVID-19 and the flu. People are contagious with the flu for a shorter period of time—up to one day before the onset of symptoms through the first three to four days of the able to fend it off. But COVID is completely new, so illness. The window is longer for the coronaour immune systems are more vulnerable.” virus. Someone with COVID-19 can be infecLiving in a “hot spot” area with a relatively high tious up to two days before symptoms appear infection rate increases a person’s odds of contractand remain contagious for much longer. ing the coronavirus. “With COVID, even if you’re asymptomatic, you can remain contagious for at least Slowing the Spread of Both Viruses 10 days after testing positive,” Chapman The good news is that the precautions people are says. “We’re seeing that sometimes people taking to slow the spread of COVID-19—such as continue to test positive for weeks or months wearing a covering over the nose and mouth, pracafter that. We are still learning more about ticing social distancing, avoiding large crowds, and how long patients with COVID can transfrequently washing hands with soap and water—also mit the virus to others. This period varies, can limit the flu from spreading. depending on the severity of illness and the People have become more knowledgeable on patient’s immune status—people who are sehow to wash hands properly, and to wash or sanitize verely immunocompromised or have severe them often, Chapman says. In addition, for many of disease can be infectious for longer us, our mindset has shifted to staying home periods of time.” when we feel sick. COVID-19 is also more “If people stay home when they deadly for certain patient aren’t feeling well, that will prevent populations, in part because opportunities for disease to circulate, with a new virus, people which will be helpful with the flu as have no built-up immuniwell as COVID,” Chapman points out. ties to fight it. The virus can Unlike during the H1N1 “swine cause inflammation in the flu” outbreak in 2009, today people lungs that, in severe cases, can more easily avoid crowded places may require a patient to go on like stores and workplaces, thanks to a ventilator. increased options for online shopping, “Most of us have an immune curbside pickup and working from home. xtock/stock.adobe.com system that’s encountered flu in the past, and many of us receive an annual Flu Vaccine Key to Staying Healthy vaccine that boosts our immune response Of course, the No. 1 defense against flu is the anagainst flu—so we have some protection or nual flu vaccine. immunity,” Chapman explains. “When our “Even if the vaccine doesn’t totally prevent a perbody encounters a similar virus, we’re more son from contracting flu, the flu shot will help reduce

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How Sentara Martha Jefferson Hospital is Keeping You Safe

the severity of symptoms and prevent many hospitalizations,” Chapman notes. During the 2019-2020 flu season, the flu infected 11,964 people in Virginia, according to the Virginia Department of Health. Each flu season, the vaccination is modified to combat the strains of the virus researchers predict will be in circulation. After receiving the flu vaccine, it takes about two weeks for antibodies to develop in the body to fight a flu infection. That’s why doctors recommend getting vaccinated well before the virus is active in your area. Flu patients also can benefit from antiviral medications like Tamiflu that can shorten the duration of illness or even prevent a person from getting the flu. Similar medicines for coronavirus are still under development. COVID Care While researchers are working around the clock to develop a vaccine for COVID-19, Dr. Hall says healthcare teams now are much more prepared to care for patients than they were in March. At the beginning of the pandemic, screening policies, instructions for isolating patients and guidelines for treating patients changed every few days as hospitals made adjustments. Now they have standard procedures in place that have been developed and tested over time. “For example, at the beginning of the pandemic, it was recommended that patients be placed on mechanical breathing machines, known as ventilators, as soon as they showed signs of deterioration,” Dr. Hall recalls. “To improve patient outcomes, that practice has been adjusted, with a focus on not putting patients on ventilators until absolutely necessary.” Medications used to treat COVID-19 patients also have evolved as the pandemic has progressed. For example, the use of steroids was discouraged early during the outbreak, but data now shows steroids— which are commonly available and inexpensive—actually should be used in many cases, Dr. Hall explains.

Everyone entering the hospital—staff, patients and visitors—is screened for COVID-19 and required to wear a mask. In the Emergency Department, patients suspected of having COVID-19 are immediately separated from other patients. If you have a surgery scheduled, you’ll likely be required to take a COVID-19 screening test prior to surgery. Fewer chairs are available in waiting rooms, and magazines have been removed to avoid transmission via high-touch objects. Housekeeping uses enhanced cleaning protocols recommended by the Centers for Disease Control and Prevention for sanitizing high-touch surfaces in patient rooms and common areas. Besides using disinfectant products, the hospital also employs ultraviolet light disinfectant technology. To reduce congregating traffic in the cafeteria, fewer tables are now open for seating, and more grab-and-go food options are available.

“Physicians and scientists around the world have been working tirelessly to learn how to prevent the spread of the coronavirus infection and how to treat it,” Dr. Hall adds. “The scale and rapidity of the research is unprecedented and should be celebrated as an example of what human beings can do when they unite around a common goal.” sentara.com

Learning to Manage

DIABETES—

Live Better AND

A chronic condition that affects many of the body’s organs, diabetes can be challenging to control, requiring regular monitoring and careful control of carbohydrate intake. Although numerous medication options exist to help manage diabetes, finding the right one can take time. Proper medical treatment is essential, however, since untreated diabetes can lead to many severe and lifethreatening complications, including heart disease; poor circulation, possibly resulting in amputation of toes, feet or lower limbs; and damage to kidneys, eyes and nerves.

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Sentara Martha Jefferson Hospital’s diabetes management program offers a holistic, practical approach to treating this complicated condition, giving people the skills they need to manage the condition and prevent complications.

Taking Control of Diabetes There are three primary pathways for controlling diabetes: • Diet: Meal planning and healthy food choices are an essential part of life for people with diabetes. • Lifestyle: Exercise and weight control or weight loss can improve blood sugar levels and heart health. • Medication: Oral and injectable medications lower blood sugar when diet and lifestyle changes alone aren’t enough. Many people with diabetes can benefit from specialized care like Sentara Martha Jefferson’s diabetes management program, says Elizabeth Driscoll, MSN, PhD, FNP, BC-ADM, one of the providers on the program team. The program helps people find the right treatment plan, which could include prescription medications, pumps or glucose monitors, as well as education, nutrition support and physical therapy. Under the right circumstances, treatment could even involve reducing the number and/or frequency of medications a patient is taking to control his or her condition.

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Ready for a Change Michael Grant’s doctor suggested that he participate in a diabetes management program to help control rising blood sugar levels caused by his type 2 diabetes. Grant, 61, chose Sentara Martha Jefferson, where he also sees Erika Struble, MD, for kidney cancer treatment. “I told my primary doctor I wanted to go to Sentara Martha Jefferson,” Grant says. “Everybody’s so friendly, and the doctors are great.” sentara.com

Michael Grant

A motorcycle officer with the Culpeper Police Department, Grant was ready to make a change. His late wife, Donna, lost several toes due to diabetes. “I saw what she went through,” he says. “I knew that if I didn’t start doing something, I would end up going down that road, too.” Grant started seeing Driscoll for virtual telehealth visits in March 2020. She recommended he use a continuous glucose monitor (CGM), which includes a sensor to test his blood 24/7 without a fingerstick. CGMs allow people to see how food and exercise affect their blood sugar. Driscoll, who does not have diabetes, even tried using a CGM herself, just out of curiosity. She found that although her blood sugar remained level after she ate

Contact the Diabetes Management Program: Your primary care provider can refer you to our program. Phone: 434-654-5260

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fudge on an empty stomach, it spiked after she ate a bagel. “The CGM is really useful and helps people make effective dietary changes,” she notes. The CGM helped Grant figure out what foods weren’t working for him. “I can eat something and then check the monitor,” he explains. “If my blood sugar spikes, I know I shouldn’t be eating that.” Driscoll also changed Grant’s diabetes medication. While many older diabetes medications can cause weight gain, newer medications can actually help people lose weight. Since March, Grant has lost 50 pounds, and he’s lowered his blood pressure and cholesterol as well. His hemoglobin A1C also dropped from 11 to 7. The A1C test, which measures a person’s average blood sugar level over the previous three months, gives more information about a patient’s diabetes control than a simple blood sugar test, and results are available at the clinic in about five minutes. “Changing my medicine seemed to help a great deal,” says Grant, who actually had to get new work uniforms due to his substantial weight loss. “He really responded,” says Driscoll. “We set up effective changes, including switching his medication regimen, which is easier for him to manage now and has helped him lose weight. His blood sugars are great.” Grant appreciates the time Driscoll spent with him. “She took the time to see what was going on,” he says. “She really helped me turn things around and made my life so much easier.”

What is Diabetes?

If you have diabetes, your body doesn’t make enough insulin, or it doesn’t use insulin well. This causes sugar to build up in your blood, which leads to higher-than-normal blood sugar levels. Untreated high blood sugar can lead to serious health complications. There are two main types of diabetes: • Type 1 diabetes is less common, often caused by genetic, autoimmune or environmental factors. • Type 2 diabetes makes up 90 percent of all diabetes cases. Risk factors include age, obesity, family history and physical activity.

What About Prediabetes? Prediabetes is indicated by a higherthan-normal blood sugar level that doesn’t meet the criteria for type 2 diabetes. A normal blood sugar reading is 4–5.7, while prediabetes is in the range of 5.8–6.4. Your primary care provider or a diabetes management program can make a prediabetes diagnosis. Learning you have prediabetes is a great opportunity, through weight loss and increased activity levels, to prevent the onset of full diabetes. You should get screened every year for prediabetes if you: • Have a family history of diabetes • Live a sedentary lifestyle • Had gestational diabetes when you were pregnant

Nutrition and Exercise: Key Components of Diabetes Treatment The diabetes management program also includes: • A nutritionist, who helps create meal plans and teaches people which foods are beneficial and which ones aren’t. A nutritionist also can help you learn how to read food labels and figure out healthy ways to enjoy food. • A diabetes educator, who teaches people how to use CGMs, as well as other diabetes equipment and medication. • Referrals to physical therapy. Many insurance plans cover several appointments with a physical therapist, who will design a realistic and achievable home exercise plan. Physical therapists also modify exercises for people who have breathing issues or heart or kidney disease.

Positive Change For Driscoll, it’s gratifying to see how much people like Grant benefit from the program. Her daughter was diagnosed with type 1 diabetes as a child, and now she puts her knowledge to work helping others. “I really empathize with the struggles of people with diabetes,” she says. “We live a diabetes-friendly lifestyle in my house. Although I don’t have diabetes myself, I know what it’s like to limit things and focus on healthy foods.” Grant also credits Driscoll and the diabetes management program for his success.

“Everyone at the hospital is always so professional, kind and willing to help,” he says. “They treated my wife like gold. Even if they don’t know you, they will stop and help you.”

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Our bodies turn the food we eat into glucose, or sugar, which we use for energy. The pancreas makes a hormone called insulin, which helps glucose get into our cells.

Gestational Diabetes: Be Aware If you’re pregnant, part of your regular prenatal care likely will include a glucose tolerance test, which screens for gestational diabetes. High blood sugar levels can affect you and your baby, so be sure to follow your doctor’s instructions for treatment. If you have gestational diabetes, your blood sugar should return to normal soon after delivery. However, women who have had gestational diabetes while pregnant are more likely to develop type 2 diabetes later in life. Driscoll recommends an annual test to make sure your blood sugar stays in the healthy range.

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Joint pain

—whether caused by arthritis, natural wear and tear, or injury—can interfere with even the most ordinary pleasures of life: gardening, hiking, playing with grandchildren, volunteering at church or taking family vacations. But patients can find relief at Sentara Martha Jefferson Hospital, a leader in hip, knee and shoulder replacement and resurfacing procedures. The hospital’s highly trained and experienced doctors, nurses, and physical and occupational therapists work closely with each patient to deliver personalized care that reduces pain and decreases the risk of future injuries.

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Hip Action For Deborah Wishart and her family, Walt Disney World is a favorite vacation spot. They’ve been four times since 2013, but it’s not easy to enjoy the “magic” when hip pain makes walking difficult. During Wishart’s second and third trips to Disney with her husband, Len, along with their 13-year-old twins, Leonard and Claire, she experienced pain that made it difficult to get around the expansive parks and participate in the fun. To complicate matters, she has Charcot-Marie-Tooth disease (CMT), a hereditary neuromuscular condition that damages the nerves in the arms and legs, causing muscle weakness and atrophy. After returning from the family’s 2017 trip, Wishart consulted Megan Swanson, MD, at Sentara Martha Jefferson Orthopedics. Imaging tests

revealed that bone was rubbing against bone in Wishart’s left hip. The top of the left femur, normally shaped like a ball, had worn down and flattened like a hockey puck. To correct the issue, Dr. Swanson performed a direct anterior hip replacement procedure on Wishart’s left hip. “Direct anterior hip replacement surgery affords the

patient the benefits of a hip replacement with less risk of limp and pain, as the posterior muscles and the pelvic stabilizing muscles are not extensively cut during the procedure—as they would be in a posterior or lateral surgical approach,” Dr. Swanson says. “This is even more important in a patient like Mrs. Wishart, with a neuromuscular disorder that causes severe weakness in her lower legs, leading her to use her pelvis and hip muscles to compensate.” After making a remarkable recovery from the surgery, Wishart had Dr. Swanson perform her right hip replacement in January 2020—again through a direct anterior approach. “It’s amazing how much better I feel,” says Wishart, 54, of Lake Monticello. “I have no pain in either hip now. Dr. Swanson has been amazing through this process. She made me feel so at ease. She’s just very easygoing and super smart, and really a great person.” For Wishart, the Caring Tradition at Sentara Martha Jefferson was evident in the acts of kindness shown to her by doctors, nurses and other team sentara.com

All in the Family

members. She recalls Dr. Swanson praying with her before surgery, and the anesthesiologist asking questions to learn more about her CMT—an extra step to help ensure her safety during the procedure. “Mrs. Wishart is close to my heart because we both love our kids and our dogs and want to be active moms,” says Dr. Swanson. “As happenstance, I saw her out in the community one day before her surgery, walking with a painful limp at the dog park, and it deeply touched me. She has overcome so much in her lifetime dealing with CMT. I am so thankful I was able to be a part of her team and get her back to doing the things she loves.” Wishart, who gave birth to her twins at Sentara Martha Jefferson, adds: “It’s just amazing that everyone at the hospital is so friendly and so helpful. Despite being busy with all of their responsibilities, my caregivers never hesitated to come when I needed them. It’s such a warm and homey atmosphere, and I’m grateful to Dr. Swanson for taking good care of me. I can’t get around as fast as my family because of my CMT, but my hips are completely pain free now. That means I can get out with them at Disney, at soccer games and on family beach trips and be a part of their lives.”

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For Curtis and Ruby Hedgeman of Scottsville, knee replacement surgeries were a family affair. Both suffered for years with arthritis in the knees, making it difficult to do the things they enjoyed, such as gardening, yard work, hunting and volunteering in the churches Curtis pastored. “I’m a very energetic person, and I like to be busy doing housework, working out in the yard and going shopping,” says Ruby, 80. “My pain got to the point where I couldn’t do those things.” By 2013, Curtis’ pain was causing him to have trouble sleeping at night. That’s when he knew it was time to consider knee replacement surgery. John Edwards, MD, at Sentara Martha Jefferson Orthopedics, had treated the couple for years, using conservative treatments such as anti-inflammatory drugs and, later, cortisone injections.

Although those measures were effective for many years, their arthritis progressed with age. “It got to the point where I just couldn’t rest at night,” says Curtis, 81, now retired. “That just makes it difficult to do anything, which is very discouraging.” Curtis had his right knee replaced in June 2013, and Ruby had her right knee replaced in 2015. Later, in 2017, Curtis and Ruby each underwent a left knee replacement. After each procedure, the Hedgemans recuperated at home. “I was in a lot of pain all the time, whether standing, walking or even lying down,” Ruby recalls. “It got to the point where I couldn’t do anything without experiencing pain.” Although medications and injections can be effective initially in many cases, the time may come for some patients to consider the potential benefits of surgery. “Knee replacement surgery is not a life-saving procedure—it’s more of a lifestylesaving operation,” Dr. Edwards says. “I don’t typically push patients to have these procedures, but when they tell me their knee pain is interfering with life, that’s when they typically decide to have surgery.” Curtis and Ruby are grateful that they no longer have pain in their knees. Although retired now, they stay busy with church work, yard work and day trips. Curtis still likes to go

deer hunting, and Dr. Edwards has on occasion received venison sausage from these grateful patients. “We think a lot of Dr. Edwards—he’s so calm and down-to-earth,” says Ruby, adding that she did so well during recovery that Dr. Edwards presented her with a medal to mark her achievement. “His bedside manner is really wonderful, and we really love him. I would recommend Sentara Martha Jefferson to anyone.”

A Positive Outlook Speeds Recovery Sally Murphy likes to keep busy. Whether volunteering in the community, baking bread, walking, bicycling, crocheting or hosting her five grandchildren for an annual “No Parents Week” at Bethany Beach, Del., she always seems to have something scheduled. When she and her husband, Ken, retired in 2008, they moved to the Charlottesville area to be closer to their two sons and their families. Eventually, osteoarthritis in her shoulders began to cause pain and limit her range of motion, interfering with the activities she enjoyed. She even had difficulty lifting her youngest grandchild, who was a toddler at the time. In 2014, Murphy consulted with Stephen Gunther, MD, at Sentara Martha Jefferson Orthopedics. He repaired her right rotator cuff, the group of muscles and tendons that hold the shoulder in place. Four months later, he performed a total joint replacement on the left shoulder. sentara.com

incredible with his patients. He exudes confidence, respect and empathy, and he has a wonderful ability to make you feel like you’re the only person on his radar screen. Plus, I love his sense of humor!” For his part, Dr. Gunther enjoys establishing long-term relationships with patients like Murphy. Her dedication and follow-through with physical therapy have been key to her recovery, he says. “Sally is a pleasure to care for because she has such a wonderful, positive attitude,” Dr. Gunther says. “That positive, engaging outlook and attitude makes a big difference in healing and postoperative recovery. Patients like her often do have much better outcomes. It’s a joy for me to take care of patients and see them get back to their lives.” “I was in pretty bad shape, and Dr. Gunther gave me my life back,” says Murphy, 73, who also has had knee and hip replacement procedures. In the six years since those shoulder procedures, the wear and tear in Murphy’s right shoulder progressed. This past June, Dr. Gunther performed a reverse ball-and-socket shoulder arthroplasty, which reverses the normal balland-socket structure. Instead of attaching the artificial ball to the top of the arm bone, where it normally would be placed, the surgeon attaches the artificial ball to the shoulder blade. The artificial socket is attached to the top of the arm bone. With this arrangement, the deltoid muscle covering the shoulder allows the patient to raise the arm over the head without the normal rotator cuff function. “This procedure is a shoulder replacement for people with an unrepairable rotator cuff tear—especially if it’s coupled with arthritis,” Dr. Gunther explains. “It provides functionality in cases where other solutions would not.” Murphy feels great and is pleased with her results. “Dr. Gunther is the ‘shoulder guru,’” Murphy says. “Not only is he a renowned surgeon in his field, but he is

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CLINICAL EXCELLENCE

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MAMMOGRAPHY Leading-Edge Breast Cancer Screening Technology Saves Lives

If you haven’t heard about threedimensional (3D) mammography yet, read on! Also known as tomosynthesis, 3D breast imaging is the most upto-date breast screening technology available to women today. “Tomosynthesis takes multiple images of each breast,” says Emily Ritchie, MD, a radiologist and women’s imaging specialist with Sentara RMH Medical Center. “As a result, it provides a more accurate study than traditional imaging techniques.”

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CLINICAL EXCELLENCE

That greater accuracy means patients don’t need to be called back for additional imaging— and possibly biopsies—as often as with two-dimensional (2D) imaging. “That’s a huge advantage when it comes to patients’ time and anxiety levels,” Dr. Ritchie adds. Multiple studies have demonstrated the superiority of tomosynthesis over 2D mammography. One study showed a 38% drop in recall rates and an 11% drop in biopsy rates. Cancer detection is also better with 3D mammography. In addition to seeing cancer more easily, 3D mammograms also allow radiologists to spot tumors sooner than ever before. Early detection, of course, is especially effective in treating breast cancer. “There’s about a 20-30% relative increase in accurate cancer detection,” says C. Scott Pease, MD, a radiologist at Sentara Martha Jefferson Hospital. “So 3D mammography offers fewer false positive exams and seems better at finding cancers than 2D imaging alone.” In fact, 3D tomosynthesis has been one of the most significant advances in the field since mammography was first used to screen women for breast cancer in 1969.

How Tomosynthesis Works A standard 2D mammogram consists of flat X-ray pictures of each breast taken at two different positions, yielding two images for each breast. Digital 3D breast tomosynthesis, on the other hand, provides hundreds of additional images, giving radiologists 3D views into the breast tissues that aren’t possible with a 2D mammogram. During a tomosynthesis exam, lowdose X-ray exposures are taken during a brief compression of the breast, as the X-ray source moves incrementally around the breast. “The technique produces scans that almost look like a short movie,” says Dr. Pease. “Viewing breast tissue in this way reduces ‘artifacts’ caused by normal tissue overlap, which helps reduce recall rates and false alarms.” The 3D exam also allows radiologists to better detect certain early tissue changes associated with breast cancer—particularly architectural distortions of the breast tissue. From the patient’s perspective, the 3D and 2D procedures are actually very similar, except that during

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tomosynthesis the machine moves to capture more images, and the procedure takes one to two seconds longer. A tomosynthesis scan also requires more time for a radiologist to review, Dr. Pease notes. Sentara Martha Jefferson has offered tomography since 2014, and Sentara RMH has had the technology since the winter of 2015. Approximately 70-80% of Sentara RMH patients opt for 3D mammography, according to Dr. Ritchie, and most women opt for it at Sentara Martha Jefferson, too. When it was first introduced, 3D mammography wasn’t accepted by some insurance companies, and it was only partially covered by others. “Now, almost all insurance companies are on board,” says Dr. Ritchie. Medicare and many insurance providers cover the full cost of 3D mammography; other insurance providers cover most of the cost but leave a portion for the patient to pay, she adds.

Who Benefits from 3D Mammography? “All women can benefit from having a tomosynthesis exam,” says Dr. Ritchie. “We strongly recommend it for women who have previously had breast cancer.” Tomosynthesis may be particularly beneficial for women who are at high risk of developing

breast cancer, including those with dense breast tissue or a family history of breast cancer. Being high-risk means that a woman’s chance of developing breast cancer is greater than average, but it does not mean she will definitely get cancer, Dr. Pease notes. When a woman knows she is at high risk, she can make more informed decisions about her health care, including screenings and prevention methods. Both Sentara RMH and Sentara Martha Jefferson offer high-risk breast programs aimed at giving women the tools they need to make these important decisions. Depending on a woman’s particular needs, these tools may include more frequent examinations and adding other imaging technologies, such as MRI or ultrasound.

Why Choose Sentara? For women who opt to get their mammograms done at Sentara RMH or Sentara Martha Jefferson, there are many advantages. “Our compassionate mammography technologists really strive to perform the best imaging,” says Dr. Pease. “I’m always impressed by our staff’s professionalism—their desire to do their best and adapt to new technologies.” Quality audits at Sentara Martha Jefferson have bested published national data by the Breast Cancer Surveillance Consortium and compare well to those of published academic papers, he adds. Both Sentara hospitals use current Hologic tomosynthesis equipment that features radiation dose-reduction techniques. The staff and equipment comply with quality measures established by the American College of Radiology and the U.S. Food and Drug Administration. Getting mammograms done at the same location, year after year, adds consistency, says Dr. Ritchie, enabling radiology teams to compare mammograms with ultrasound or MRI images to look for correlations. If callback imaging or biopsies are needed, scheduling can be done quickly and easily. “When outside imaging centers do the mammograms, Sentara radiologists must request the previous images and reports to review, which can add time to the process,” she explains. Another advantage is having the patient’s entire breast care team in one place, allowing radiologists, breast surgeons and nurse practitioners to consult together easily about the best treatment options. At Sentara RMH, both 2D and 3D digital mammography services are available at the Funkhouser Women’s Center and on the Mobile Health Services Van. At Sentara Martha Jefferson, the same mammography services are available at the Outpatient Centers at Proffitt Road and Pantops, and at the Health Services Center at Spring Creek.

Mammogram Screening is Safe—Even During the Pandemic dima_oris/stock.adobe.com

With all of the COVID-19 safety protocols in place at Sentara RMH Medical Center and Sentara Martha Jefferson Hospital, there is no reason to postpone, procrastinate or delay when it comes to getting your annual mammogram. “We always put our patients’ safety first,” says Emily Ritchie, MD, a radiologist at Sentara RMH. “Our team strongly believes that part of patient safety is making sure everyone has access to health care, even in a pandemic.” The protocols being practiced at both hospitals meet or exceed the guidelines for COVID-19 in healthcare settings, including those recommended by the Centers for Disease Control and Prevention, the World Health Organization, and the U.S. Food and Drug Administration. Patients are prescreened for COVID-19 before their appointments—and, in fact, anyone entering the hospital or clinic is screened with a no-touch thermometer for possible COVID-19 symptoms. Physical distance is required in the waiting rooms, and the number of patients in the office at any one time is limited. Hand sanitizer and masks are provided to all patients and guests. All staff members wear masks and other necessary protective equipment. Imaging technicians wear masks, sterile gloves and other protective equipment. All surfaces and equipment are wiped down between patients. Common areas are also cleaned regularly between each use, with a focus on high-touch surfaces such as chair armrests, doorknobs, hand scanners and pens. Both hospitals provide their staff members with detailed checklists of cleaning requirements so that nothing is overlooked. “Breast cancer can be a deadly disease, but it’s usually curable when caught early by a screening mammogram,” says Dr. Ritchie. “So ensuring that our patients have safe access to our life-saving services during the pandemic is our top priority.” sentara.com

Practice the Basics of

Infection Prevention

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HEALTH MATTERS

nfectious diseases spread through a variety of means. Respiratory diseases like COVID-19, influenza (flu) and the common cold spread via droplets of saliva or mucus that contain germs. An infected person expels the droplets into the air by sneezing, coughing or talking. If someone else is in close contact with the infected person and inhales these droplets, he or she also can become infected.

Germs, including respiratory viruses and gastrointestinal bacteria, can be spread by contact as well. Hands can become contaminated by touching an infected person’s skin or body fluids, or by touching a surface that contains the germs. The germs can then enter the body through the mouth, eyes or nose via contact with unwashed hands. Many infectious diseases also can spread through contaminated food or water. However, COVID-19, influenza and other respiratory diseases cannot spread this way.

• Rinse thoroughly under running water. Use a clean towel or paper towel to dry your hands. Use the towel—not your freshly washed hands—to turn off the faucet. Wash your hands frequently, especially at these times: • After using the bathroom • After blowing your nose, sneezing or coughing • After handling pets or cleaning up after them • Before preparing food or eating • Before and after visiting or caring for a sick person • Whenever your hands are visibly soiled When soap and water are not readily available, or when your hands are not visibly soiled, you can use alcohol-based sanitizer. Make sure the sanitizer gets between your fingers, around your nails and on the backs of your hands.

Appropriate Hand-Washing

Other Infection Prevention Practices

One of the most effective ways to stop the spread of germs is frequent, thorough hand-washing. Multiple times a day, our hands touch surfaces and objects that are also touched by many other people. Each touch is an opportunity to pick up germs and spread them to yourself and others.

• Clean frequently touched surfaces with a disinfecting product that kills bacteria and viruses. • Cover your cough or sneeze using a tissue. If one is not available, sneeze or cough into your bent elbow. • When you are sick, stay home. • Practice social distancing as recommended by the Centers for Disease Control and Prevention, as well as other public health officials. • Thoroughly clean surfaces and utensils that come in contact with raw meat or raw fruit or vegetables.

To wash your hands effectively, do this: • Wet your hands thoroughly with warm or cold water and apply soap. • Rub your hands together to create a good lather. Scrub the palms and backs of your hands, between your fingers, around your nails, and on your wrists. Continue scrubbing for 20 seconds (you can sing or hum “Happy Birthday” twice or count slowly to 20).

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Although we don’t need to live in fear of the germs that surround us, it does pay to remember and regularly practice these tips for simple infection prevention and control.

LA SALUD IMPORTA

Adopte las medidas básicas para la

prevención de infecciones

as enfermedades infecciosas se propagan a través de diversos medios. Las enfermedades respiratorias, como la COVID-19, la gripe y el resfriado común, se propagan a través de las gotas de saliva o del moco que contienen gérmenes. Una persona infectada expulsa gotas al aire al estornudar, toser o hablar. Si otra persona está en contacto estrecho con la persona infectada e inhala esas gotas, también puede infectarse. Los gérmenes, incluidos los virus respiratorios y las bacterias gastrointestinales, también pueden propagarse por contacto. Las manos pueden contaminarse al tocar la piel o los líquidos corporales de una persona infectada, o al tocar una superficie que contiene gérmenes. Luego, dichos gérmenes pueden ingresar al cuerpo a través de la boca, los ojos o la nariz cuando nos tocamos estas zonas del cuerpo con las manos sucias. Muchas enfermedades infecciosas también pueden propagarse a través de alimentos o agua contaminados. Sin embargo, la COVID-19, la gripe y otras enfermedades respiratorias no pueden propagarse de esta manera.

Lavado adecuado de manos Una de las formas más eficaces de detener la propagación de gérmenes es el lavado de manos frecuente y minucioso. Varias veces al día, las manos tocan superficies y objetos que muchas otras personas también tocan. Cada vez que se toca algo se corre el riesgo de recoger gérmenes y propagarlos a usted mismo y a los demás. Para lavarse las manos eficazmente, haga lo siguiente: • Mójese bien las manos con agua cálida o fría, y aplique jabón. • Frótese las manos hasta que se forme buena espuma. Frote las palmas y los dorsos de las manos, entre los dedos, alrededor de las uñas y las muñecas. Continúe frotándose las manos durante 20 segundos (puede cantar o tararear el “Feliz Cumpleaños” dos veces o contar lentamente hasta 20).

• Enjuáguese bien las manos con agua corriente. Use una toalla limpia de tela o de papel para secarse las manos. Use la toalla, no las manos recién lavadas, para cerrar el grifo. Lávese las manos de manera frecuente, en particular, en los siguientes momentos: • Después de ir al baño • Después de sonarse la nariz, toser o estornudar • Después de tocar mascotas o de limpiar lo que ensuciaron • Antes de preparar alimentos o de comer • Antes y después de visitar o de cuidar a una persona enferma • Siempre que las manos estén visiblemente sucias Cuando no haya agua y jabón disponibles, o cuando las manos no estén visiblemente sucias, puede usar un desinfectante a base de alcohol. Asegúrese de colocarse desinfectante entre los dedos, alrededor de las uñas y en los dorsos de las manos.

Otras medidas para la prevención de infecciones • Limpie las superficies de mucho contacto con un producto desinfectante que mate bacterias y virus. • Al toser o estornudar, cúbrase con un pañuelo de papel. Si no tiene uno a mano, estornude o vectorfusionart/stock.adobe.com tosa en el pliegue del codo. • Quédese en casa cuando esté enfermo. • Ponga en práctica el distanciamiento físico según lo recomendado por los Centros para el Control y la Prevención de Enfermedades, así como por otros funcionarios de salud pública. • Limpie a fondo las superficies y los utensilios que entran en contacto con carne, frutas o verduras crudas. Aunque no tenemos que vivir con miedo a los gérmenes que nos rodean, vale la pena recordar y poner en práctica regularmente estos consejos para la prevención y el control de infecciones.

sentara.com

COVID CORNER

Coping

AND

EVEN

Thriving DURING

COVID-19

Since arriving in the United States in early 2020, the COVID-19 pandemic truly has turned our world upside down. Many thousands have lost their lives, while countless others have lost their livelihoods. In light of this new reality, experiencing feelings of grief, anger, fear, anxiety, weariness and cynicism is quite understandable and normal. Even if you haven’t been directly affected by the virus, you’ve likely felt its impact on your life. The ways we move about, educate our kids and do our jobs have changed rapidly, and now even something as mundane as a trip to the grocery store can be a cause for anxiety and stress. “Adapting to a global pandemic can be unsettling and challenging, since none of us has been through anything like this before,” says Luanne Bender Long, PhD, LPC, LMFT, clinical manager at Sentara RMH Behavioral Health. “COVID-19 has resulted

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Get Reliable Information Since COVID-19 is a new disease, the medical community is learning more about it on a continual basis—which, in turn, means information about the pandemic in the media has changed frequently. As a result, you may find a lot of confusing and conflicting news out there. When evaluating such information, ask yourself what facts a story states and what biases the media outlet or reporter may have, and make sure you get information about COVID-19 from reliable sources, says Tammy James, RN, MDiv, chaplain at Sentara Martha Jefferson Hospital. She suggests these websites for the latest information about testing, safety and more: • Centers for Disease Control and Prevention (CDC): https://www.cdc.gov

•

World Health Organization (WHO): https://www.who.int

Get Regular Exercise and Eat a Healthy Diet

tasty treat, turning to “comfort food” in times of stress isn’t healthy in the long run.

Stay Connected

Although many of us are hunkering down at home these days in order to stay safe, getting out of the house regularly—done in a safe manner—can have real benefits. In fact, something as simple as going for a 30-minute walk each day can boost your mood and improve your health. Be sure to drink enough water while exercising, though, since dehydration can lead to headaches and irritability. Also, try to resist the urge to overeat when you’re feeling stressed or anxious. Similar to alcohol and drug use, “emotional eating” is often used as a form of self medication, according to Bender Long. Although you may feel comforted while you’re eating a liukovmaksym/stock.adobe.com

in the loss of our sense of predictability, control and justice, and has seriously challenged the belief that we can protect ourselves and our families.” And although we can’t wish COVID-19 away, we can take some steps to make our lives a little better during this stressful and unusual time.

It’s okay to acknowledge your sadness over the loss of human connection. Cry when you need to, lament your losses and then move forward. Also, you’ll likely feel less isolated if you stay in touch with friends and family. Try to connect with loved ones through social media, video chat meetings, texts and phone calls. “You can even mail letters and cards to loved ones,” says James. “It’s a great way to stay in touch, and it’s fun to get ‘real’ mail back. Get your kids or grandkids involved in the letter writing!”

Be Kind to Yourself Find healthy ways to lower your stress level and relax: • Read or listen to a podcast • Find a new hobby or pick up an old one again • Plant a garden • Practice yoga • Foster or adopt a pet And if social media causes you to feel stress, scroll past negative posts and comments, or avoid social media altogether. sentara.com

Practice Gratitude

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Reflect upon the positive things that have come out of this time, and try to appreciate the growth in resiliency you may have experienced. Consider keeping a gratitude journal, writing down what you’re thankful for and your successes each day. Looking back through the journal at a later time can be inspiring and encouraging. “Ask yourself what you’ve gone through and succeeded at in the past,” says Bender Long. “Use that as a guide to say, ‘I can do this.’”

Take Time for Yourself

Don’t Forget: We’re All in This Together

With many schools and offices closed, families and loved ones are spending a lot more time together at home these days, Bender Long notes. “That can be challenging, even if there’s a lot of love,” she says. Set boundaries and take regular time to be alone, if you need it. “It’s not selfish to take time for yourself—it’s actually good for your mental well-being,” Bender Long adds. “Time to yourself could mean taking a bath with the door locked, going for a drive or simply spending some time alone in your bedroom.”

Even when you’re feeling alone, know that many others are feeling very much the same these days. “One would hope that this pandemic will draw us together in our shared humanity,” says James. “We are all in this together and need one another to get through this. If we stop to hear each other and stop making assumptions about each other, we can see the hearts of our fellow citizens and truly know them.” We will get through this together, says Bender Long. “We need each other to do this, knowing that on the other side, we’re still going to be a community and family,” she concludes. “We can do this.”

Your spiritual beliefs can give you a sense of inner peace and help you worry less about external issues. Prayer and meditation can help decrease anxiety and fear and lead to a greater sense of well-being. “When people meditate, they become centered in the present moment,” explains James. “Meditation helps keep the mind from worrying or obsessing about things beyond one’s control.” If your place of worship isn’t open or you’re staying home for safety reasons, consider attending virtual worship services. If your church, synagogue or mosque doesn’t offer virtual services, there are plenty that do. James also suggests attending virtual services of other faith traditions to broaden your horizons.

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Gain Strength from Spiritual Beliefs

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EAT WELL , LIVE W ELL

NEED HELP? Get help if you or someone you love is struggling or abusing alcohol or drugs. Call or visit online: • Sentara RMH Behavioral Health Specialists: 540-564-5104 • Region Ten mental health services: 434-972-1800 • National Suicide Prevention Hotline: 800-273-8255 • Move2Health Equity: move2healthequity.org/ covid19 • Local resources, podcasts and updates to help decrease stress and promote healthy living

HOLIDAY TRADITIONS Thanksgiving, Hanukkah, Christmas and Kwanzaa all may look different this year. Family gatherings may be smaller or even canceled, and many of us may need to avoid traveling. Get creative with your holidays, says Luanne Bender Long, PhD, LPC, LMFT, clinical manager at Sentara RMH Behavioral Health. That may mean connecting with loved ones via Zoom, FaceTime or another video chat platform. It could involve wearing masks and practicing social distancing at gatherings. Try creating new traditions if the old ones won’t work this year. Smaller gatherings of 6–8 people may be safer, but be sure to check the number of COVID-19 cases in your area before making any plans.

PHILANTHROPY

Home-Grown

Nurses

Supporting Professional Development within the Sentara Martha Jefferson Hospital Community

former operating room (OR) nurse, Brenda Hathaway speaks passionately about her nursing career: working alongside surgeons, prepping patients, gathering instruments and learning about human anatomy. These days, she is passionate about boosting the careers of aspiring nurses—especially current or future OR nurses—as well as those who want to advance to the next professional level. This enthusiasm inspired Brenda and her husband, Curtis, founder and owner of Hathaway Paper Inc., to designate their gifts to Sentara Martha Jefferson Hospital to raise awareness among the hospital’s nurses and OR technicians about nursing careers in the operating room. When Brenda earned her nursing diploma from C&O Railroad Hospital in Clifton Forge, Va., in 1960, nursing students were able to experience the many available potential nursing disciplines and career paths. That’s how Brenda became “hooked” on OR nursing, opting for a second clinical rotation in the OR—an experience she may not have had in current associate’s or bachelor’s nursing degree programs. “I did not gravitate to bedside nursing,” says

Brenda, who took a break from her nursing career in 1974 to manage Mrs. Rowe’s Restaurant and Bakery, the successful Staunton establishment her mother started in the 1950s. “I loved the operating room. As an OR nurse, I saw the patient come in, helped them prepare for surgery and saw their problem resolved. The patient moved on to the next level of care. I just loved the whole process.” After graduating and passing the Virginia State Nursing Boards, Brenda returned to the OR at UVA Hospital, working wherever needed among the various surgical specialties until she became head

Brenda Hathaway with nurse manager Jenny Hughes and NCP Constance Barbour (top photo, from left); with David Coy, physical therapist (bottom left); and with Allison Crawford, Tee Coyer, Kait Young and Donna Freeman of the OR nursing team (bottom right, left to right)

mjhfoundation.org

The Brenda D. and Curtis H. Hathaway Endowment Fund for the Advancement of Operating Room Nursing at Sentara Martha Jefferson Hospital In addition to their many years of generous annual support of nursing at Sentara Martha Jefferson Hospital, Brenda and Curtis Hathaway are establishing an endowment fund for the perpetual support of Operating Room (OR) nursing at Sentara Martha Jefferson. The Hathaway Endowment will provide permanently restricted annual support for academic scholarships, professional development awards and simulation/training aides for OR nurses, as well as nurses and OR techs pursuing careers in OR nursing at Sentara Martha Jefferson. Through the Hathaways’ passionate and generous gifts, Sentara Martha Jefferson OR nurses can be even more confident of committed support for education and training, as opportunities develop to acquire new knowledge and skills that can enhance the delivery of safe and highly reliable nursing care in the surgical environment. They also will have support to advance professionally as nurses; pursue additional specialty certifications in the field of surgical nursing; and enhance their roles as respected partners and advocates for safety, best practices and the best outcomes for surgical patients. “We thank Brenda for her many years of service and dedication to OR nursing,” adds Allison Crawford, MSN, RN, CRNI, director of surgical services at Sentara Martha Jefferson. “OR nurses often are among the unsung heroes in health care, and we are so grateful to Brenda and Curtis for their generosity, and for Brenda’s passion to promote OR nursing among new and experienced nurses,” shares Crawford. “Knowing that this support is something we can count on now and in the future helps us plan and prioritize our educational needs, and to recognize our outstanding nurses for the care they deliver every day.” For information about how to establish an endowment at Sentara Martha Jefferson Hospital, contact Kimberly Skelly, executive director (kpskelly@sentara.com), or Cathy Sedwick, director of philanthropy (clsedwic@sentara.com), at the Martha Jefferson Hospital Foundation.

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nurse for orthopedics. Whether working as a “scrub nurse” or “first assist,” Brenda recalls how much she enjoyed working with the surgeons and staff in the OR, being able to anticipate what came next and which instrument would be needed— everyone working together to make the surgery go smoothly and safely. In recent years, Brenda and Curtis have supported nursing education, simulation training and professional development for Sentara Martha Jefferson’s OR nurses. Tee Goyer, MSN, RN, CNOR, clinical manager for the operating room—herself a beneficiary of nursing scholarship support at Sentara Martha Jefferson—gratefully acknowledges Brenda’s insights and experience as an OR nurse. “It is so encouraging to know our community appreciates and supports what we do, and that people like Brenda and her husband direct their own charitable giving in such a meaningful and purposeful way.” In July, Brenda underwent hip replacement surgery at Sentara Martha Jefferson. The procedure went very well, and Brenda credits Dr. Megan Swanson for her excellent outcome. As Brenda recovered postoperatively, she met Constance Barbour, nursing care partner (NCP). “Constance had a special way about her in the way she (and the entire nursing team) provided patient care,” recalls Brenda. During Brenda’s hospitalization, Barbour spent a lot of time with Brenda and impressed the Hathaways so much that they wanted to express their appreciation through philanthropy.

Following Brenda’s discharge from her joint replacement surgery, she reached out to the Martha Jefferson Hospital Foundation, expressing a desire to expand their philanthropic investment in the hospital’s nursing programs and provide support for Barbour and other NCPs to help further their nursing careers. Barbour already has plans to pursue a Licensed Practical Nurse certification at Piedmont Virginia Community College. The hope that community support provided by the Hathaways and others can help with the cost of education while working at Sentara Martha Jefferson has inspired her to set her sights even higher. She now can see the potential to pursue an associate’s degree in nursing—and maybe more. “Their support just means everything to me,” says Barbour, who joined the Sentara Martha Jefferson team in January. “I was just doing my job. I sat with Mrs. Hathaway to comfort and care for her. This is the way I treat every patient I work with—the way I would want a family member or myself to be treated. Their expression of gratitude in this way is such a blessing.” Jenny Hughes, nurse manager for the Orthopedics Medical/ Surgical Unit at Sentara Martha Jefferson, says donors like the Hathaways who support nursing education and professional development help to build a stronger hospital community. “For someone like Constance, who is starting her nursing education at the ground level by taking program prerequisite courses, it's going to help her climb the ladder and fulfill her dream,” Hughes says. “I see her going really far. She will continue to grow in her career as a nurse, and I see her becoming a leader in this hospital.”

PHILANTHROPY

Priorities

SENTARA MARTHA JEFFERSON HOSPITAL

Philanthropic

ince its founding in 1903, Sentara Martha Jefferson Hospital has been providing exceptional care for our community, rising above unforeseen challenges to maintain its world-class status. Supported through the generosity of our community, the mission of the Martha Jefferson Hospital Foundation is to help Sentara Martha Jefferson remain at the forefront of high-quality health care while retaining our personalized Martha Jefferson Caring Tradition. The generosity and partnership of our community helps make this a reality, and we are grateful for your dedication and support. The modern-day challenges of COVID-19 underscore the critical role of philanthropic giving in supporting the unmet needs of our front-line healthcare workers, our patients and their families, and those most at risk in our community. Here are just a few examples of the ways in which contributed support continues to make a difference for the health and well-being of our community.

to Strengthen Our Margin of Excellence

Cancer Screening, Survivorship and Treatment Approximately 1,000 women are identified each year at Sentara Martha Jefferson as being at increased risk for developing breast cancer. As an integral component of our nationally accredited Comprehensive Breast Care Program, with community support the hospital has established the High-Risk Breast Cancer Program to go beyond what insurance providers will cover and provide genetic counseling, testing and education, exercise and nutritional counseling, and personal follow-up with a nurse navigator for those identified with increased risk. Philanthropic support also is instrumental to our Cancer Survivorship Program, which helps patients transition into a new phase of life after cancer care. This program provides a network of services and support, including group and individual counseling, rehabilitation programs to aid patients with physical and mobility issues, and mindfulness-based cancer recovery workshops. “I feel fortunate to have such a wonderful [program] right in our neighborhood. During all of my interactions with caregivers at Sentara Martha Jefferson, I always feel like I come first— and that helps motivate me to take care of myself.” —Tina LaRoche, patient

Educational and Professional Advancement for Nurses and Clinical Staff Quality patient care is defined by the quality of our healthcare delivery team, which is why since 2013 the Martha Jefferson Hospital Foundation has funded educational scholarships through the Haden Nursing Institute. To date, more than 185 nurses have received scholarships, enabling them to return to school and earn advanced degrees. Evidence demonstrating the close correlation between advanced education, improved patient outcomes and reduced mortality is strong. Thanks to the community’s continuing support, Sentara Martha Jefferson is well on the way to realizing the goal of having at least 80% of our registered nurses attain at least a baccalaureate mjhfoundation.org

degree in nursing. We continue to seek community support to achieve this goal. In 2017, the Foundation extended comparable educational opportunities to our non-nursing professionals through the establishment of the Clinical Education Center. Philanthropic gifts to this program advance the careers of clinical professionals, including respiratory, occupational and physical therapists, as well as medical technicians in the laboratory, pharmacy and operating room (see Hathaway story on page 41). “The Sentara Martha Jefferson respiratory therapy team saved my life in 2017, inspiring me to establish the Marshall Make A Difference Fund to provide educational awards to members of the respiratory team. During the COVID pandemic, the respiratory therapists are truly on the front line and deserve our support more than ever.”—Lindsay Marshall, grateful patient and Martha Jefferson Hospital Foundation Board member

Programs for Patients and Families Living with Serious Illness To support the medical, emotional and spiritual wellbeing of our patients and families, community gifts fund the Palliative Care Program and the Caregiver Center through the Martha Jefferson Hospital

Foundation, offering a lifeline to patients and their loved ones as they navigate the complex and unfamiliar world of health care. Palliative care is a medical subspecialty that excels in symptom management and improving quality of life for patients with complex or serious illness. While the majority of palliative care patients seen in the outpatient clinic are receiving cancer care, the team also sees inpatients being treated for neurological, cardiac and pulmonary conditions, and, most recently, for complications arising from COVID-19. Philanthropic support is essential in providing palliative care and decisionmaking assistance to patients and their families throughout the progression of an illness, as well as at end of life. Similarly, the new Caregiver Center provides a unique resource for families. Frequently ill-prepared for overwhelming circumstances, caregivers can be at a loss in navigating the healthcare system, coordinating and caring for loved ones, and balancing their own lives. Fully funded with private support, the Caregiver Center provides a lifeline of emotional support, assistance and guidance. Centrally located near the Phillips Cancer Center, the Caregiver Center offers an oasis for spouses, parents, children, siblings and friends as they support their loved ones.

Caring Acts of Kindness The Martha Jefferson Caring Tradition is a culture of compassion, respect and kindness

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that defines Sentara Martha Jefferson Hospital. Through the Caring Tradition Fund, the Martha Jefferson Hospital Foundation supports thoughtful, personal touches that help reduce anxiety, lend comfort, and create better experiences and outcomes for patients and their families. Every nursing unit and program at Sentara Martha Jefferson is touched by the Caring Tradition Fund, which is truly a flexible source of philanthropic support to help wherever the need is greatest. From the Acts of Kindness Program that enables staff to provide a small gift for a patient needing a little extra encouragement or support, to massage therapy for cancer patients, to the purchase of glider chairs for “Thank you and your team for the compassion that is not learned and for kindness that goes far above and beyond.” —Jaimie Bachmayer, patient

parents comforting children, to pet therapy programs for patients and staff, the Caring Tradition Fund makes possible large and small programs that, together, result in an unmatched margin of excellence. Please consider a year-end gift to the Martha Jefferson Hospital Foundation. As always, 100% of your gift will go to programs and initiatives in our local community. Visit mjhfoundation.org or call us at 434-654-8258.

PHILANTHROPY

Community Generosity

Expands The Caring Tradition

While Sentara Martha Jefferson Hospital has long embraced the Caring Tradition, the greater Charlottesville community and beyond also has shown enduring, heartfelt compassion for patients and their families through their generous support of the Martha Jefferson Hospital Foundation. Despite the challenges presented by COVID-19, the hospital and foundation have pressed forward with the creation of two beautiful new spaces within the hospital: the Haney Volunteer Center and the Caregiver Center.

The Haney Volunteer Center Welcomes Volunteers Back As a longtime volunteer at the Phillips Cancer Center, Helen Landel has spent many days making sure patients get what they need: a warm blanket, a pillow, a drink or a snack—and, before COVID-19, even a hug. Among team members and patients, however, Landel is known best as “the Cookie Lady.” Every Thursday, she brings in about eight dozen homemade cookies to share. “It's a free-for-all,” says Landel, who has volunteered at the hospital for 48 years. “I hear people say, ‘the Cookie Lady is here,’ and I put out tins with different types of cookies. Some take more than one, wrapping them in a napkin to take with them.” Volunteers like Landel are vital to the hospital’s work, even though several volunteer programs have been paused temporarily out of safety concerns during the COVID-19 pandemic. As they return, the new Haney Volunteer Center is ready to provide these dedicated people with a welcoming and well-equipped home base. In 2019, more than 400 volunteers contributed in excess of 53,000 service hours across more than 70 departments. “Our volunteers are so important to the core operations of the hospital, and we value all they contribute to the enhancement of services and care, the patient and visitor experience, and their unique personal warmth and compassion,” says Renee Dinwiddie, manager for volunteer and guest services. “Having

Volunteer Sandy Derr

a prominent space for our volunteers speaks volumes about how the hospital values them and their contributions.” The Haney Volunteer Center, named in memory of Melton T. and A. Muriel Haney, is prominently located in the main lobby. With four computer workstations and a large work surface, the center provides space for the hospital’s volunteers to gather, have computer access, and complete continuing education and training. “It is truly a work hub,” Dinwiddie says. “Our volunteers are essential, and we have missed them during the pandemic. They enhance our operations and our customer service by contributing to the hospital’s long-standing Caring Tradition culture.” mjhfoundation.org

Concierge volunteers like John Roberson and Andy Anderson, who team up at the Phillips Cancer Center on Fridays, greet patients and families, answer their questions, provide information, give directions and offer more services as needed. In some cases, they also may escort patients to their appointments. “In the Cancer Center, we see many of the same people who come in regularly for treatment, and we form connections with them,” Anderson says. “I’ve met some really nice people doing this work. It’s an enjoyable and meaningful experience.” At 92, Nancy Maine has been a hospital volunteer for more than 60 years. These days, she also covers the front desk at the Cancer Center and loves greeting people as they come in for treatments. “I enjoy interacting with other people, and it’s a joy working with the patients who come to the Cancer Center,” she says. “Sentara Martha Jefferson is a caring community, and I really enjoy my hospital family.”

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Program coordinator Katy Kreienbaum, left, with caregiver

Celebrating the Opening of the Caregiver Center When patients are hospitalized, recovering, or learning to live with a chronic disease, there is often a caregiver by their side. Caregivers are most often our spouses, parents, children, siblings, and friends. While the medical staff’s primary focus is rightly on the patient, we cannot underestimate or ignore the physical and emotional needs of family caregivers as they grapple with the life-altering effects of a loved one’s illness or injury. To support the needs of caregivers and improve outcomes for patients, Sentara Martha Jefferson has built a new Caregiver Center, which opened this summer. Providing a lifeline of emotional support, assistance and connection with resources for caregivers, the Caregiver Center is a program fully funded with philanthropic support through the Martha Jefferson Hospital Foundation. This free hospital program offers help from trained staff and volunteers in supporting the needs of caregivers in a compassionate and nonjudgmental way. “This is a very special place for the caregivers of our community. This Center provides a dedicated space where they can come for support for themselves, to receive support and have a place to recharge,” says Katy Kreienbaum, Caregiver Center Program Coordinator. The new Caregiver Center allows Sentara Martha Jefferson to extend holistic care to family members, as well as professional medical caregivers who are welcome to stop in for a time of meditation and respite. Centrally located between the Phillips Cancer Center and Gift Shop, yet far enough removed to provide a quiet place to rest, the Center has a relaxing reception area featuring a stone fireplace and expansive windows that let in abundant natural light. The space also includes a business hub with a computer and phone charging station, a private meeting room with a tranquil water element ideal for relaxation and meditation, and a second private room for completely alone time. The first of its kind within the Sentara system, the Center is another example of how our community’s philanthropic support makes possible an unmatched margin of excellence here at Sentara Martha Jefferson Hospital. “While our number one priority is taking great care of the patients, often right beside that patient is a caregiver who is under tremendous stress,” Kreienbaum says. “Anyone who has been a caregiver can appreciate that reality. Our goal is to provide a safe haven for caregivers to take time to “fill their own cup” so they can return to their loved one with a boost to their own resiliency.”

PHILANTHROPY

The Power of

Women with a

Purpose

hen 16 women came together in 1993 to raise awareness and philanthropic funds for breast health programs at Martha Jefferson Hospital, they could not have anticipated what a profound impact their efforts would have nearly three decades later. The seed that small group planted has blossomed ever since, and is continuing to thrive here at Sentara Martha Jefferson Hospital. Today, The Women’s Committee (TWC) has nearly 300 tenured and active members. In partnership with the Martha Jefferson Hospital Foundation, the group raises a net average of $200,000 each year, providing funds for a host of hospital programs. “It’s pretty amazing that the work these women began has carried through for so long and contributed such a significant amount of work and philanthropic support over the years,” says Amy Nolasco, TWC chair. “To be successful, we need the support

of our community, and that’s one thing that remains consistent. That makes Charlottesville a pretty special place.” One of TWC’s first fundraisers was Martha’s Market, an event that brings together hundreds of vendors and shoppers seeking unique treasures and an opportunity to support cancer care and other women’s health initiatives at Sentara Martha Jefferson. This year, due to the coronavirus pandemic, Martha’s Market will take place primarily online, November 13-15, for the first time in the event’s 27-year history. Wells Fargo Bank is generously supporting the event as this year’s presenting sponsor. “We’re excited about making this a virtual event,” says Nolasco, who also is chair of Martha’s Market. “While it’s going to be different, we have a lot of support from the community. Buyers can shop from the comfort and safety of their homes or shop in person at participating local merchants. And now that we’ve worked out the logistics of offering the shopping experience online, we can continue to do a mix of in-person and online shopping in years to come.” Through the tremendous success of Martha’s Market and related annual fundraisers such as the In The Pink Tennis Tournament, TWC has raised more than $6 million over the years. These event proceeds have supported impactful programs like free Breast Health Screening Days, providing free mammograms and health screenings each year for approximately 100 women in our community. TWC also established Marianne’s Room, a special resource room for women diagnosed with cancer, providing wigs, scarves, special “Chemo Caps,” soft postoperative prostheses and camisoles to breast cancer patients after a mastectomy, at no cost to the patient. Embracing the philosophy that promoting an overall sense of well-being is an integral part of care and healing, mjhfoundation.org

TWC funding also provides services such as massage therapy, yoga, exercise classes and support groups. Their support of blanket warmers and chairs in the Infusion Center keeps patients as comfortable as possible while undergoing oftenlengthy treatments. Their 2020 support renewed their funding for these initiatives and provided critical funding to the Caregiver Center, the Mother and Baby Fund, the High-Risk Breast Program, the Cancer Survivorship Program, and the Palliative Care Program. “As a community cancer center, we are focused on the medical care provided and on the holistic care of each individual,” says Laura Kavanagh, regional oncology director at Sentara Martha Jefferson’s Phillips Cancer Center. “Body image, mental health, community and survivorship are really important to us as a comprehensive cancer program. Services and programs like these inspire patients to seek us out for their care—they know these personalized services can help them through their treatments and support them through survivorship. We’re so grateful for

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the generosity of our community and The Women’s Committee.” Crystal Chu, Blue Ridge Cancer Program Sentara Martha Jefferson team coordinator, adds Programs and Services Funded that many of these from 2019 TWC Community programs and services Support have continued, even amidst the coronavirus • Cancer Resource Center/ crisis. The support Marianne’s Room groups are particularly important, she • Breast Health Screening Days says, and the Sentara • High-Risk Breast Cancer Program Martha Jefferson team • Cancer Survivorship Programs has found creative ways to keep women • Caregiver Center engaged and support• Palliative Care ing one another. • Cancer Care Center Staff Education “The efforts of • Special Care Nursery Bottle Warmers The Women’s Committee really show • Cancer Center: Patient Massage, that our community Aromatherapy and Patient comes together to Special Needs offer everything our • Caring Embrace Yarn patients need beyond treatments,” Chu says. “It’s really a full community effort that involves so many volunteers and donors—many of whom have friends and loved ones battling cancer—who share a piece of this journey. We wouldn’t be able to offer this comprehensive program without their support.” For Nolasco, whose mother was treated for breast cancer at Sentara Martha Jefferson, serving on TWC is personal. It allows her the opportunity to give back to a community that rallied around her loved ones as they battled the illness. “It’s really rewarding for me to be able to give something back to the community hospital that was super supportive of my mom during her cancer diagnosis and treatment,” says Nolasco. “As a family, I just felt like we were being extremely well cared for while my mom went through her treatments. I never felt like we were a number or that we were just trying to be moved quickly through the process. It’s been wonderful to see how the team at ‘Martha Jeff’ shares that Caring Tradition.” For more information, or to become a member of The Women’s Committee, please visit mjhfoundation. org or contact the Martha Jefferson Hospital Foundation Office at 434-654-8258.

Gifts from our Community Supporting our Community Our 100% Promise to You!

Make a gift for today to support

In the face of great challenges, community is

Educational scholarships for nurses and clinical staff to advance their careers and improve patient outcomes,

Free breast cancer screenings clinics for community members,

Emotional support and guidance for family members coping with a loved one’s illness, and

Acts of Kindness such as providing iPads on every nurse unit to facilitate “virtual” visits for patients in isolation or far away from loved ones

our greatest strength. At Sentara Martha Jefferson Hospital, we know and believe this, which is why our first 100% promise to you is that our doctors, staff, and nurses are here for you and your family when you need us. Our second 100% promise is that 100% of your generous philanthropic support to the Martha Jefferson Hospital Foundation will be used locally in support of patients in this community. Please a gift to help us continue the Martha Jefferson Caring Tradition.

Make a gift for tomorrow Estate gifts to Martha Jefferson Hospital Foundation through a will, trust, retirement account, or life insurance policy help strengthen programs like the Haden Nursing Institute and the Phillips Cancer Center, while also providing lasting opportunities for donors to create a named fund in honor of a loved one or family.

“It is our aim to make this institution a blessing to this community.” —Dr. J. Hamilton Browning, 1906, a Martha Jeﬀerson Hospital Founder

For more information about making a gift to the Martha Jefferson Hospital Foundation, contact us:

Call: 434-654-8258 or email: mjh_foundation@sentara.com or visit our website: mjhfoundation.org

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Limiting Visitors

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In times of uncertainty, trust that Sentara is here to keep our community safe. We are following strict guidelines and have implemented extra safety measures to ensure you are safe while receiving the care you need. When it comes to your health, don’t wait to seek care. You’re safe at Sentara.

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