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SENTARA RMH Magazine

SPRING 2021

Structural HEART Expanding Heart Care at Sentara RMH

PLUS: Neonatology: Expanding Care for Our Youngest Patients Are the COVID Vaccines Safe? | Treating Vertigo with Physical Therapy

PRESIDENT’S LETTER

2021 SENTARA RMH BOARD Joseph Funkhouser II | Chair

Jerry Benson, PhD | Vice Chair Devon Anders Morris Fendley, MD C. Wayne Gates, MD Arthur Dean II Terrie Edwards Paul Gaden

SENTARA RMH ADMINISTRATORS

Douglas Moyer President

Donna Hahn, DNP, RN, NEA-BC Vice President of Acute Care/CNE

Anthony Bruno, MD, MBA Vice President of Medical Affairs

Rita A. Bunch, MPH, FACHE Vice President of Operations

SENTARA RMH MAGAZINE EDITORS

Jenn Downs Neil Mowbray CONTRIBUTORS

Luanne Austin Charles Culbertson Preston Knight Lisa Smith Jennifer L. Stover PHOTOGRAPHY

A Year of Challenges and Triumphs

he arrival of this magazine will mark roughly a year since we began seeing the first cases of COVID-19 in our state and our community. And what a year it has been! We’ve all been through one of the most challenging and remarkable times in recent history. In many ways, all of us have been waging war against the coronavirus pandemic, not only on the healthcare front in hospitals and nursing homes, but also in our individual lives. With that in mind, it’s understandable that many of us are now suffering from “COVID fatigue.” Despite the challenging and frightening aspects of this pandemic, we’ve also had many opportunities for gratitude and thankfulness. I am deeply thankful for the teams of caregivers throughout our community and region who have stood on the front lines, battling the virus and its effects. I could not be prouder of the Sentara RMH team and the exceptional bravery, dedication and resilience they have shown. I am equally grateful to the many individuals, businesses and organizations throughout our community who have reached out to support Sentara RMH providers. Your well-wishes, prayers and donations have been one of the reasons we have been able to stand firm in the face of such adversity. Another reason we can all be thankful is the rollout of the COVID vaccines. Their availability since December—not even a full year after the virus struck—has been a true marvel of the pharmaceutical industry, and now gives us hope that we may be starting to see some light at the end of this tunnel. I invite those who may have reservations or questions about the COVID vaccines to check out the information on pages 11-13 that specifically addresses the question of vaccine safety. While the vaccine is an exciting milestone in our fight against the virus, we understand and sympathize with the frustrations of many in our community who are eager to get vaccinated, yet have to wait for additional vaccine doses to be made available. Please know that all of us—the Virginia Department of Health and healthcare providers like Sentara—are working to make the vaccine available to as many as we can, as quickly as we can and as supplies allow. Vaccine is being distributed directly to health departments, and we are working in cooperation with the Central Shenandoah Health District to get as many people vaccinated as soon as possible. We thank everyone for their patience and cooperation. While the pandemic has been front and center, the day-to-day successes of our healthcare team have continued. Our cardiology program has been listed among the top 50 cardiovascular programs in the country for a second year by IBM Watson Health (see page 5), and we’ve seen a significant expansion recently of our cardiology services, with the addition of structural interventional cardiologist Dr. Matthew Cauchi (see pages 6-8). In addition, at the end of 2020, our Critical Care Unit was honored to receive the Gold Beacon Award for Excellence from the American Association of Critical Care Nurses (see page 5). Finally, thanks to our local community’s generosity to the RMH Foundation, we have been able to enhance the care we provide COVID patients in the hospital, as well as boost the level of safety for everyone entering the hospital (see page 41). Although our battle against COVID is not over, I’m hopeful for what the future holds, and I look forward to continuing to care for all your healthcare needs in the year to come. Respectfully,

Andrew Shurtleff Tommy Thompson DESIGN

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Doug Moyer President, Sentara RMH Medical Center

Contents SPRING 2021

Advancing Care for Our Youngest Patients Sentara Neonatology Specialists

Weight Loss Surgery for a New Life

Fighting the Pandemic

Bariatric Surgery at Sentara RMH

COVID Vaccine Rollout at Sentara RMH

SPRING 2021

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Contents

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

New & Noteworthy

Physician’s Perspective

Structural Heart Disease

On-Call Advice COVID Corner

Are the COVID-19 Vaccines Safe?

Women’s Health

Benign Breast Conditions

Calendar

Clinical Excellence

Treating Vertigo with Physical Therapy

Health Matters

Keep Watch on Your Blood Pressure

La Salud Importa

Controle la Presión Arterial

Eat Well, Live Well

Calendar

Eating Well to Help Control Chronic Kidney Disease

Philanthropy

THE BEST MEDICINE BY MICHAEL CORDELL

’ve learned from experience recently that when it comes to the news, there is often a dramatic difference between facts and stories. Although both can be true, how I react to news headlines can impact my life—and usually not for the better. For example, I once read a news story about a person taking a shower who saw a snake slither up from his bathtub drain. My immediate takeaway was to no longer take showers, as I had no interest having a snake join me in the tub. Instead, I started spraying myself down outside each morning with the hose. Another news story told of a person who was walking down a sidewalk to get milk when he was killed by a falling tree branch. After reading that story, I came to the obvious conclusion that I needed to start walking down the middle of the street, given that most falling tree branches wouldn’t reach that far. News stories even resulted in my regrettable decision about our family pet. Uncertain about what type of animal to get, I turned on the Google machine and read about a rabid dog that had bitten its owner, a cat that had blinded a woman while playfully clawing at her, and a house that had burned down after an aquarium broke and short-circuited the refrigerator. That’s a long way of explaining why I now own a sloth, which I named Fido. There were no online stories about sloths causing problems—I now realize that’s because no one has been dumb enough to have a sloth as a family pet. So after getting hypothermia from hosing myself outside in the winter, constantly dodging honking cars while walking in the street, and standing on a tabletop screaming while a hostile Fido snarled at me (sloths have fangs!), I decided to rethink my strategy of basing life decisions on news stories.

It turns out that stories often make the news because they are unusual. Newspapers don’t sell a lot of copies with headlines like “Man Walks to Store for Milk, Chooses 2%” or “Local Resident Takes Shower, Fails to Rinse and Repeat.” So while all of those stories I read technically may have been true, they weren’t the best basis for decision-making. Another problem with getting information online is that you can generally find whatever kind of story you want to find. If you don’t want to eat your vegetables, the Daily Mail has an article proclaiming “Eating Vegetables Can Seriously Damage Your Health.” If you’d rather eat candy, Candy Club’s website offers a piece titled “The Surprising Health Benefits of Candy.” But finding the answer you want is different from finding the best answer. My point—to the degree my prattling ever has a point—is now that COVID-19 vaccines are becoming available, I’ll be turning off the Google machine and consulting with my doctor for the best medical advice. I’m doing so because my doctor is smart, is someone I trust, and keeps current on facts-based news (not stories). When I ask him whether or not I should take the vaccine, he’s won’t say, “Well, I read this story about this one person in Alaska who … .” Instead, we’ll talk about what’s best for me. I’m also willing to wager that my doctor has never owned a sloth (see above: my doctor is smart). Although my experience with one would probably make a good story.

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All the News That Fits

new& noteworthy Sentara RMH Medical Center 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 RMH, please call 1-800-SENTARA.

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Clinton J. Adams, PA-C Allied Health Sentara Pulmonary & Critical Care Specialists 540-689-5600

C. Buckley Gillock, MD Urology Blue Ridge Urological 540-689-5900

Simeon A. Melaku, DO Family Medicine Sentara Mount Jackson Health Center 540-477-3185

Mark R. Anderson, MD Urology Blue Ridge Urological 540-689-5900

Rebecca A. Haggan, PA-C Hospital Medicine Sentara Hospital Medicine Physicians

Bree R. Moses, CNM Allied Health Harrisonburg OB/GYN Associates 540-434-3831

Noeen Arshad, DDS Dentistry All Smiles Harrisonburg 540-432-1300

William R. Jones III, MD Urology Blue Ridge Urological 540-689-5900

Kelsey L. Murray, SLP Allied Health Sentara Voice & Swallowing Services 540-689-1000

M. Courtney Capstack, PA-C Allied Health Sentara Gastroenterology Specialists 540-564-5800

Kimberly Kelstone, CNM Allied Health Harrisonburg OB/GYN Associates 540-434-3831

Brian C. Stisser, MD Urology Blue Ridge Urological 540-689-5900

Kimberly J. Daly, CRNA Allied Health Sentara Medical Group Anesthesiology Specialists 540-879-2583

Jordan C. Leonard, MD Pediatric-Neonatology Pediatrix Medical Group 804-323-8893

Anne S. Wong, FNP-C Allied Health Blue Ridge Urological 540-689-5900

Kyle P. Faulkner, PA-C Allied Health Hess Orthopaedic Center & Sports Medicine 540-434-1664

Matar G. Matar, MD Hospital Medicine Sentara Hospital Medicine Physicians

Ambi Zeller, ACNP-BC Allied Health Sentara Cardiology Specialists 540-689-7400

Sentara RMH Named Among the Top 50 Cardiovascular Hospitals for a Second Year

Critical Care Unit Achieves Gold Beacon Award for Excellent Patient Care The American Association of Critical Care Nurses (AACN) has conferred a gold-level Beacon Award for Excellence on the Sentara RMH Critical Care Unit (CCU). The Beacon Award for Excellence recognizes unit caregivers for successfully improving patient outcomes and aligning their practices with the AACN’s six Healthy Work Environment Standards. The Sentara RMH CCU earned a gold award—the highest level— by meeting evidence-based Beacon Award for Excellence criteria.

Fortune and IBM® Watson Health® have named Sentara RMH as one of the nation’s top-performing hospitals in cardiology. The announcement was made in late 2020 with the release of the annual Fortune/IBM 50 Top Cardiovascular Hospitals study, which spotlights leading shortterm, acute-care, nonfederal U.S. hospitals that treat a broad spectrum of cardiology patients. This is the second consecutive year Sentara RMH has received the 50 Top Cardiovascular Hospitals award. Hospitals do not apply to be included in the Fortune/IBM Watson Health study, nor do they pay to participate. Learn more at www.ibm.com/ watson-health/services/ 100-top-hospitals.

Vaccinating the Community Against COVID-19 In early February, Sentara RMH Medical Center partnered with the Central Shenandoah Health District (CSHD) to provide a COVID-19 vaccination event at the county fairgrounds. The clinic was by appointment only, and eligible participants were contacted directly by CSHD to schedule an appointment. Vaccine recipients included those on the CSHD’s waitlist and members of local minority populations. Sentara RMH provided the vaccines, as well as staff members to help administer the 1,000 doses that were given. Medical interpreters were also available onsite to assist those with limited English capability. “As healthcare providers, we recognize the importance of getting vaccines to the community as quickly and efficiently as we can,” says Doug Moyer, president of Sentara RMH. “We are working as quickly as we can, given the limited amounts of vaccine available, and we thank community members for their patience.”

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Staying at the Forefront of Treating

Structural Heart Disease

the body, structures and childhood, smaller and more subtle tissues are interwoven to defects can lead to progressive symptoms provide specific functions, and changes within the heart that go contributing to a coordiunnoticed for many years. Unfortunately, nated symphony of activity that supports many of these changes ultimately reach a life. In the cardiovascular system, this critical point at which they require timely coordination is especially important, attention and treatment. allowing for the synchronous and harAt Sentara RMH, our structural heart By Matthew Cauchi, DO monious movement of blood among the team is a distinct subspecialty within heart’s chambers, through different doors (valves), our Cardiology division and includes physicians, and ultimately to the lungs and the rest of the body. advanced care practitioners, nurses and support Any abnormality in these organs or their tissues can staff who are committed to providing expertise in result in a chain reaction of imbalances, altering the management of patients with structural heart the size, shape, functionality and pressures within disease. The team focuses on the multispecialty the heart, contributing to a decline in function and evaluation and treatment of patients with heart quality of life. failure, advanced coronary artery disease, valvular Structural heart disease encompasses a broad heart disease and a variety of other conditions. As range of cardiovascular conditions that affect all part of this evaluation, caregivers consider which components of the heart, including the tissues, patients may be candidates for minimally invasive, valves and support structures. While some of these catheter-based procedures that have become availconditions are congenital (present from birth), able over the past decade, providing options to many develop over time as the result of genetics, those patients deemed too high-risk for open-heart habits and lifestyle choices, and due to the general surgery. This “team approach” is crucial to the “wear and tear” that occurs with aging. patient-centered care that is so important to our Most structural heart problems result from the culture and environment at Sentara RMH. process of aging and its effects on the heart. Generally, these conditions manifest in persons between Correcting Valve Problems and the ages of 50 and 90, but for some individuals with Congenital Heart Defects known cardiovascular comorbidities such as diabeThe most common structural heart conditions tes, obesity, high blood pressure or high cholesterol, we treat are valve problems, mainly of the aortic these problems can occur earlier in life. This type and mitral valves. These conditions can include of issue is different from congenital heart defects, both stenotic (narrowed) and regurgitant (leakwhich arise during fetal development. While most ing) valves. Both conditions can lead to elevated severe congenital heart defects are detected in

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PHYS ICIAN’S PERSPEC TIVE

pressures within the heart and symptoms of heart failure such as fatigue, shortness of breath, swelling in the legs and weight gain, but each condition requires its own unique evaluation and treatment approach. Typically, this evaluation seeks to determine why the valve has failed, the toll it has taken on the patient’s body, and the appropriate timing for intervention to avoid further complications or functional decline. The second-most common type of condition we treat includes select congenital defects, such atrial septal defects, patent foramen ovale (PFO) or ductus arteriosus, aortic coarctation, and pulmonic valve stenosis. Many of these defects are the result of the failure of certain fetal structures to close or develop at some point during

early development, or shortly after birth. Given their delayed presentations into adulthood, these issues are typically not as severe, but over time they can result in significant derangements in the structure and function of the heart, requiring more rapid attention once detected. These conditions are classically managed with minimally invasive, catheter-based techniques but may require surgery, depending on the type and extent of the defect.

Reducing Risk of Stroke An individualized approach to reducing the risk of stroke for specific patients is another focus of the structural heart specialists at Sentara RMH. The two main strategies for reducing this risk are identifying individuals at risk with heart rhythm abnormalities

(mainly atrial fibrillation), and identifying those with unique risk related to a PFO. Characterized by a small hole between the top chambers of the heart, PFO is a very common finding during an echocardiogram and is seen in approximately 25% of the population. However, certain individuals with this finding are at high risk for stroke and should be further evaluated for catheter-based closure in order to reduce the risk of stroke. Atrial fibrillation, another common heart condition, is characterized by an irregular cardiac rhythm and has the potential to cause the formation of clots within certain structures of the heart. This condition significantly increases a patient’s stroke risk and typically requires “blood thinner” medications like warfarin. However, some patients are not candidates for these medications, due to prior

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PHYS ICIA N ’ S PERSPEC T IV E

collaborative and individualized care plan.

Diagnosing Structural Heart Conditions

bleeding or individual risk of falling. In those cases, a careful evaluation by our structural heart and electrophysiology teams is needed to identify potential candidates for certain procedures or implantable devices, in an effort to reduce the risk of stroke while avoiding long-term anticoagulation medications.

Managing Heart Failure Heart failure is a complex, challenging cardiac condition with a variety of causes. From a structural heart perspective, management of heart failure can be augmented though implantation of a small sensor known as CardioMEMS within the arteries of the lungs. This sensor provides daily readings to help a patient’s primary cardiologist understand and identify impending episodes weeks before the development of symptoms. Later this year, Sentara RMH will begin offering CardioMEMS to appropriate heart failure patients as an adjunct to medication, further engaging heart failure patients into a more

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Many structural heart conditions present with symptoms similar to those of other heart problems, which can make diagnosis somewhat challenging and require a multidisciplinary approach centered on advanced imaging techniques. Symptoms vary depending on the patient, condition and severity of disease. They include, but are not limited to, the following: • Shortness of breath • Chest pain or tightness • Stroke or ministroke • High blood pressure (hypertension) • Leg swelling • Fluid buildup in the lungs (pulmonary edema) • Extreme tiredness or fatigue • Rapid weight gain • Poor concentration or memory lapses Many of these symptoms are also similar to those of pulmonary diseases like asthma or chronic obstructive pulmonary disease, which often makes it difficult to make a diagnosis based on symptoms or physical examination alone. Additional testing or procedures may be necessary to make a definitive diagnosis. The diagnosis of all structural heart conditions requires some form of imaging, the most common being a screening echocardiogram. This imaging modality gives a real-time look at the chambers of the heart, as well as the structure and function of the valves. It also provides insight into the pressures within the heart that may be the cause of a patient’s symptoms.

Basic screening tests are typically followed by more advanced imaging, which may be noninvasive (stress testing, CT scan or cardiac MRI) or invasive (transesophageal or intracardiac echocardiogram, heart catheterization), depending on the conditions suspected. All of this testing can be performed locally at Sentara RMH in collaboration with our teams, including the Advanced Cardiac Imaging and Radiology departments. The ultimate goal of this additional testing is to ensure the correct diagnosis for a patient’s symptoms and the development of an individualized treatment approach for the patient.

Benefits of a Structural Heart Program Developing a structural heart program as a complement to our Cardiology and Cardiothoracic Surgery departments ensures that Sentara RMH patients receive the most up-to-date recommendations when it comes to managing a variety of different conditions. Our program runs parallel to the well-established, award-winning cardiology service line at our hospital, and helps ensure that our community has access to the most advanced technologies, procedures and medical devices. Investing in the structural heart program at Sentara RMH once again demonstrates our commitment to remain on the leading edge of advanced cardiac care and provide access to specialized care, close to home, for our community members.

To learn more about Sentara RMH Cardiology and Cardiothoracic Surgery services, visit Sentara.com.

ON-CALL ADVICE

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

What is an underactive thyroid, what causes it and how is it treated?

Early symptoms of hypothyroidism like fatigue are often overlooked, but as the patient’s metabolism continues to slow, additional symptoms may appear, including sluggishness; increased sensitivity to cold; constipation; pale, dry skin and brittle nails; hoarse voice; elevated cholesterol levels; unexplained weight gain; muscle aches, tenderness and stiffness; heavier-than-normal periods; and depression. Untreated hypothyroidism can lead to joint pain, obesity, infertility and heart disease. Various conditions may result in hypothyroidism. In some cases, certain autoimmune diseases may cause the immune system to produce antibodies that attack the thyroid. More rarely, a disorder of the pituitary gland—often the result of a benign brain tumor—can cause the condition. Also, some people are born with thyroid disease. Certain medications also may cause hypothyroidism—for example, lithium, which is used in treating psychiatric disorders, and amiodarone, which is used to treat irregular heart rhythms. Other potential causes include radiation therapy, thyroid surgery, pituitary gland disorder, pregnancy, iodine deficiency, and having a parent or grandparent with autoimmune disease. Hypothyroidism affects people of all ages, but women over age 50 are most commonly affected. The condition is diagnosed by measuring thyroid hormone levels in the blood.

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underactive thyroid, also known as hypothyroidism, is a condition in which the thyroid gland does not produce enough thyroid hormones. The thyroid, which lies below the voice box on the trachea (the “windpipe”), produces hormones that help regulate the body’s metabolism.

Doctors recommend that middle-aged women be screened for hypothyroidism during routine physicals. Some doctors also recommend testing pregnant women or women who are thinking of becoming pregnant. Men are more likely to develop hypothyroidism after age 60, so men in that age group should be screened regularly. Although there is no cure for hypothyroidism, typically the condition is treated with hormone replacement therapy, using the synthetic thyroid hormone levothyroxine. This is an oral medication that must be taken for the rest of a person’s life. However, with proper management under a physician’s care, hypothyroidism generally does not interfere with the ability to enjoy a happy, fulfilling lifestyle. sentara.com

ON- C ALL A DVICE

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

What is shingles, and why do some people continue to have pain after shingles goes away?

After a person has had chickenpox, the varicella-zoster virus lies inactive in certain nerves close to the spinal cord. For some unknown reason, this virus can reactivate later in life in the form of shingles. Shingles can occur at any age, but it’s more common in elderly people and in those with weakened immune systems. When a person gets shingles, a red rash generally appears first, followed by small, itching blisters that burst, ooze and then crust over. The primary symptom of shingles is pain, which may begin even before the rash appears, and may be accompanied by sensations of burning, itching, tingling or numbness. Symptoms are usually confined to a small area and are virtually always located only on one side of the body. Shingles usually goes away by itself in two to three weeks, but prompt treatment with antiviral medications can reduce the severity and duration of symptoms. If pain and burning continue after the rash and blisters have gone away, this condition is called postherpetic neuralgia (the word neuralgia means “nerve pain”). This neuralgia, which results from nerve damage caused by the outbreak of shingles, has symptoms resembling those of shingles and may include pain, itching, numbness and weakness.

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hingles is a painful, blistering skin rash caused by the varicellazoster virus, the same virus that causes chickenpox. Unfortunately, after the rash and blisters of shingles have gone away, the associated nerve pain sometimes continues.

There is no cure for postherpetic neuralgia, and the pain may last months or years. Use of certain prescription medications, however, may help provide temporary relief. People who think they may be developing shingles—that is, they experience pain or burning with a rash or small blisters on one side of the body—should see their physician right away. Starting antiviral medication within 72 hours of developing shingles helps reduce the severity of shingles symptoms and lessens the risk of developing postherpetic neuralgia. People who are 50 and older should ask their doctor about whether Shingrix, the shingles vaccine, is appropriate for them.

COVID CORNER

Are the COVID-19 Vaccines Safe? In spite of the many rumors, unfounded claims and myths you may have heard or read, the COVID-19 vaccines are indeed safe. The U.S. Food and Drug Administration (FDA) has rigorous standards and procedures in place to ensure the safety of any vaccine, and clinical trials must show COVID-19 vaccines are safe and effective before they are used. People of different ages, races and ethnicities, as well as those with different medical conditions, have participated in these large-scale trials. The Pfizer and Moderna vaccines were studied in placebo-controlled trails in nearly 90,000 patients to establish their safety and efficacy. Thousands of healthcare workers have been vaccinated in the weeks since these vaccines were launched, and there have been few adverse effects. The FDA and the Centers for Disease Control and Prevention (CDC) continue to monitor the safety of all COVID-19 vaccines.

How are the Vaccines Administered? Both the Pfizer and Moderna COVID-19 vaccines are delivered via injection into the arm, just like a flu shot. Both vaccines require two doses: an initial dose and then a repeat vaccination 3-4 weeks later.

Are There Side Effects? Some people may experience mild symptoms, including muscle pain at the injection site, fever, headache or fatigue. These symptoms, which actually signal that your immune system is responding properly to the vaccines, usually go away on their own within a few days. Very few serious side effects have been reported. sentara.com

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Concern has been raised about how quickly the COVID-19 vaccines were developed. The COVID-19 vaccines are based on messenger RNA (mRNA) vaccine technology, which has been studied for more than a decade. Although this technology was perfected with the SARS-1 and MERS virus outbreaks starting in the early 2000s, those coronaviruses were short-lived and had limited spread, so there was no opportunity to test or implement the associated vaccines. Since then, pharmaceutical companies have had the vaccine technology ready to apply to any new virus outbreaks, such as COVID-19. Although profitability and financial risk are often deterrents for pharmaceutical companies to developing new vaccines, those factors weren’t relevant in the case of the COVID-19 vaccines. In 2020, the U.S. government actually prepaid multiple pharmaceutical companies to manufacture potential COVID-19 vaccine candidates, removing any financial risk to the companies and accelerating the development process.

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Too Quick?

COVID CORNER

Myths vs. Facts: MYTH: “I don’t have to wear a mask if I get the vaccine.” FACT: You must still wear a mask. It is still not clear if one can carry the virus and spread it to others, even if vaccinated.

MYTH: “There is a microchip in the vaccine.” FACT: There is no “tagging” or any metal in the vaccine—a microchip is too large to be embedded in the vaccine.

MYTH: “My DNA will be changed.” FACT: The mRNA vaccines from Pfizer and Moderna have no impact on human DNA.

MYTH: “I will contract COVID-19 if I get the vaccine.” FACT: These vaccines are not made from live or attenuated virus.

Instead, they “teach” the immune system to find and destroy the virus “spike protein,” which is how the virus attaches to human cells and infects the host. The mRNA is rapidly destroyed by the cell, leaving no permanent trace.

MYTH: “The vaccine uses fetal tissue.” FACT: The mRNA COVID-19 vaccines produced by Pfizer and Moderna do not require the use of any fetal cell cultures as part of the manufacturing process.

MYTH: “The virus has mutated, so what is the point of getting the vaccine?” santima.studio/ stock.adobe.com

FACT: Most viruses mutate over time. Even with mutations, the spike protein used to attach to human cells is the same. Scientists are confident that the COVID-19 vaccines will be effective against virus mutations.

MYTH: “I already had COVID, so I don’t need the vaccine.” FACT: It is unclear how long your natural immunity will last after

having COVID-19, so you still need to receive the vaccine to prevent future infection.

MYTH: “Once I get the vaccine, I’ll have lifelong immunity.” FACT: It’s too early in the use and study of the COVID-19 vaccines to know how long they will be effective.

MYTH: “The vaccine will give me Bell’s palsy.” FACT: Four patients who received the vaccine in clinical trials

developed Bell’s palsy. There is no evidence this was related to the vaccine, and because the trials were so large, the occurrence rate was similar to what would be expected in the general population.

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Can I get the vaccine if I’m pregnant or want to become pregnant, or if I’m breastfeeding? A now-blocked Facebook post that went viral claimed the coronavirus vaccine could cause infertility, incorrectly suggesting that the vaccine teaches the body to attack a protein involved in placental development. In reality, the protein the vaccine spurs the body to make and attack bears little resemblance to the one in the placenta. Both American College of Gynecology and Society for Maternal Fetal Medicine recommend the mRNA vaccine during pregnancy, after a discussion between the doctor and the patient on its benefits. Researchers believe there is minimal risk to a fetus, or to a breastfeeding infant.

Should I Get the Vaccine? Experts believe getting a COVID-19 vaccine may keep you from getting seriously ill, even if you do get COVID-19. Vaccinations protect you by creating an antibody response without your having to experience illness. The vaccine also may protect people around you— particularly those at increased risk for severe illness from COVID-19. Only you can decide if you should get the COVID-19 vaccine. If you have concerns or questions, talk to your healthcare provider. You can also review the vaccine information provided at Sentara.com.

This information was compiled by Sentara clinical experts through a thorough review of trusted medical sources, including the New England Journal of Medicine, the Society of Maternal Fetal Medicine, the National Center for Biotechnology Information, the CDC and others.

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WOMEN’S HEALTH

BENIGN

BREAST

CONDITIONS At some point in their lives, many women will experience a benign breast condition, a category that includes unusual growths or other changes in breast tissue. As the name implies, benign breast conditions are noncancerous. However, any change in the breasts could be a sign of cancer, so it’s important to see a doctor if you notice a difference in your breasts.

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condition, according to Emily Turzanski, DO, a breast surgeon with Sentara Breast Surgery Specialists in Harrisonburg, include the following: • Unusual growths or lumps • Pain or swelling • Thick, dry or red skin • Fluid discharge • Itchy or warm skin Many of these conditions don’t require treatment, and it's normal to experience one or more of them over the course of your life, says Lynn Dengel, MD, MSc, a surgical oncologist at Virginia Breast Care in Charlottesville. However, if you experience discomfort or pain, or simply want a benign lump or cyst removed, a breast surgeon can help.

Types of Benign Breast Conditions Some of the most common types of benign breast conditions include the following. Cysts

Breast cysts, which are fluid-filled sacs typically found in women of childbearing age or in the years leading up to menopause, may feel round and rubbery. They often appear suddenly and may go away on their own. Although cysts may not require any treatment, a doctor may use a thin needle to drain (aspirate) a cyst if it is large or painful. Fibroadenomas

Fibroadenomas of the breast are round, rubberyfeeling lumps. They can occur at any age but are most common in women in their 20s and 30s. Hormonal changes, including those that occur during pregnancy, can cause fibroadenomas to grow over time—or they may shrink or disappear completely. A breast surgeon may recommend a watch-andwait approach with fibroadenomas that don’t cause pain or produce uncomfortable symptoms. If a fibroadenoma increases in size or is painful, a breast surgeon may recommend a procedure to remove the affected breast tissue. Clogged milk ducts

Breastfeeding mothers can get clogged or plugged milk ducts that prevent the flow of breast milk. Clogged ducts present as hard, often painful lumps. Women approaching menopause may also develop a form of clogged ducts called duct ecta-

sia. Treatment typically involves the use of warm compresses or antibiotics. If symptoms don’t improve, in some cases a breast surgeon may remove the affected duct. Mastitis

Mastitis is an inflammation of the breast tissue that primarily affects breastfeeding women. Symptoms include swelling, pain, warmth and redness. Mastitis also can result in an infection, accompanied by fever and chills. The condition is typically treated with antibiotics, pain relievers, massage and cool compresses. If an abscess forms, it can be drained as an outpatient procedure. Lactation consultants also can help provide support and techniques for mothers who are struggling with breastfeeding while coping with mastitis. Mastitis also can affect menopausal women who aren’t breastfeeding—especially those who smoke or have diabetes. Compresses, good hydration and antibiotics may be used to treat mastitis at this stage of life.

Diagnosing and Treating Benign Breast Conditions Many women discover benign breast conditions while examining their own breasts, notes Dr. Turzanski. “Women may find a lump or change in their breasts, or their primary care doctor or OB/ GYN may find a lump during an annual exam,” she says. “Cysts, fibroadenomas and clogged milk ducts can all feel like a lump in the breast.” Breast surgeons can diagnose benign breast conditions with a core needle biopsy, adds Dr. Dengel. During this procedure, the doctor uses ultrasound imaging to guide the placement of a hollow tube that is used to extract a sample of breast tissue for evaluation. Due to the advancement of breast care in recent years, many diagnostics and treatments now can be performed in a doctor’s office. “We can perform many more tests in our office today, without a trip to the operating room,” says Dr. Dengel. “If I feel a mass, I can put my ultrasound probe right on the mass and evaluate it.”

Seeing a Breast Surgeon Breast surgeons like Dr. Turzanski and Dr. Dengel specialize in treating noncancerous

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he most common signs of a benign breast

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W O M E N’S HEA LT H

When to See a Doctor Normal hormone fluctuations affect breast tissue and can cause breast tenderness, pain and other changes, but a doctor should look at any differences that last longer than two weeks—some signs of a benign breast condition are also similar to signs of breast cancer. See your family doctor or OB/GYN if you notice a lump that: • Lasts longer than two weeks • Doesn’t go away after your menstrual cycle • Is accompanied by a fever or infection

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Screening Mammogram versus Breast Ultrasound A mammogram is an X-ray of your entire breast. All women over the age of 40 should get an annual screening mammogram to look for signs of breast cancer. A breast ultrasound uses sound waves to examine a specific part of the breast. A breast ultrasound is typically used either to evaluate findings from a mammogram or assess a symptom such as discomfort or a lump.

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“Plenty of people will have a benign breast lump removed for a number of reasons, including anxiety or a family history of breast cancer,” she says. “Some people may want a breast lump removed so it doesn’t mask other findings on a mammogram or breast exam.”

Know Your Breasts Both physicians emphasize the need for women to be aware of any changes in their breasts. The best way to do this is by performing regular monthly breast self-examinations at home. Regular examinations will help you notice changes in your breasts. In addition, all women should get an annual breast exam from their primary care provider or OB/GYN. These exams should start once a woman reaches puberty and continue throughout her life. Sentara Breast Surgeons “Although we’re talking in Charlottesville and here about noncancerous Harrisonburg breast conditions, starting Virginia Breast Care around age 40 most women 595 Martha Jefferson Drive, also should have an annual Suite 320 mammogram to screen for Charlottesville, VA 22911 cancer,” concludes Dr. Tur434-984-6121 zanski. “Younger women with Sentara Breast Surgery risk factors for breast cancer Specialists should talk to their physician 2275 Health Campus Drive about when they should begin Harrisonburg, VA 22801 having mammograms.” 540-689-4800

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breast conditions, as well as breast cancer. Primary care providers and OB/ GYNs manage many breast conditions in their offices, but they may refer certain patients to a breast surgeon for additional assessment or treatment. Patients over age 40 who receive regular mammograms may see a breast surgeon if they require a second opinion or need a breast ultrasound. Younger patients not receiving regular mammograms due to their age may see a breast specialist for ultrasound imaging and diagnosis. Patients also may see a breast surgeon if they’re experiencing anxiety about their symptoms or want a second opinion. “These benign conditions still can provoke anxiety for many women,” says Dr. Dengel. “They may want reassurance or want us to remove the lump or aspirate it to make it go away.” Each patient’s case is unique, notes Dr. Turzanski.

calendar Unless otherwise noted, call 1-800-SENTARA for more information and to register. Classes are also listed on Sentara.com. We have coded our classes and events as follows: AR Advance registration required NR No advance registration required FREE No fee

Behavioral Health Life Recovery Intensive Outpatient Program A program for those with alcohol or substance abuse issues. Sessions will focus on education about substance abuse, relapse prevention and strategies for managing difficult emotions that accompany substance abuse. Meets Mondays, Tuesdays and Thursdays, 4-7 p.m. For more information, call 540-564-5100. Cancer Sentara RMH Hahn Cancer Center offers a number of classes and support groups—many of them free of charge—for cancer patients, cancer survivors and caregivers. To learn more, visit Sentara.com or call 540-689-7065. Chronic Pain Chronic Pain Self-Management Classes Learn techniques for how to cope with chronic pain and how to communicate with healthcare professionals, family and friends, as well as appropriate exercise and nutrition information. Call 540-820-8567 to learn more. FREE

Diabetes Caring for Your Diabetes Class Series Covers medications, monitoring, reducing risks, staying active, healthy eating and more. Medicare and most insurance plans cover a portion of the cost. Virtual and in-person class options available. To register, call 1-800-SENTARA. AR Grief and Loss Grief: 1 to 1 Grief can follow death, marriage breakup, chronic illness, job change or retirement. Talk with someone trained to help you understand how your grief can affect you. For an appointment, call 540-564-5118. Seniors Sentara RMH Senior Advantage Affordable, fun educational and social events for adults 55 and “better.” Call 540-564-7001 or visit Sentara.com to learn more. Support Groups A variety of support groups—most of them free of charge—are provided by Sentara RMH or affiliated groups in the community. Among them are the following: • Bariatric Support Group • Breastfeeding Support Group • Cardiac Device Support Group • Hand-in-Hand Resource Mothers Teen Pregnancy Support Group (virtual group) • New Moms Ask a Nurse—Partnering with Postpartum Support Virginia (Zoom meeting) This is a partial listing. To learn more about these and other support groups offered in the Sentara RMH service area, visit Sentara.com.

Sentara RMH Medical Center offers a variety of classes and seminars throughout the year. For a complete list and more details, visit Sentara.com. Many events meet virtually. COVID-19 safety precautions are in place at all in-person events and appointments. sentara.com

calendar

Vascular Screening For people 50 and older with known cardiovascular disease or risk factors (high blood pressure, diabetes, smoking or high cholesterol), Sentara RMH Heart and Vascular Center’s vascular screening checks for vascular disease that can lead to stroke, abdominal aortic aneurysm (AAA) and peripheral artery disease. Appointments are available on Monday mornings: 8:15 and 9 a.m.; advanced registration is required. To learn more, go to Sentara.com. To register, call 1-800-SENTARA. A physician referral is not required. Women’s Services Mammography Van Schedule Call 540-689-6000 or 800-277-1021 to schedule your mammogram at the following locations: March 19—South River Medical Clinic, Grottoes March 23, May 20, June 14, July 26—Walmart, Luray March 24, May 14, July 12—Walmart, Timberville March 26, April 23, July 2—Carilion Family Medicine, Weyers Cave March 30, April 9, May 10, May 25, June 17, July 7, Aug. 6—Sentara East Rockingham Health Center, Elkton March 31, April 13—Eastern Mennonite University (across from The Commons) April 7, April 22, May 27, June 15, June 30, July 30—Sentara Timber Way Health Center, Broadway April 14—Riverbend Elementary School, Elkton April 15, July 14—Grottoes Food Lion April 19, July 19—Healthy Communities Health Center, Elkton

April 20, July 9, July 27—Highland Medical Center, Monterey April 21, May 18, June 18, July 21—Bridgewater Health Center April 26—Mamma Mia Italian Restaurant, Shenandoah April 27, July 6—Harrisonburg Community Health Center April 28—Harrisonburg Parks & Recreation April 29—Pleasant Valley Elementary School, Harrisonburg May 5—Broadway High School May 12—Wilbur S. Pence Middle School, Dayton May 19, July 22—Sentara Mount Jackson Health Center June 22, July 29—Elkton Area Community Center July 8—Lantz Construction, Broadway July 16—New Market Community Center Aug. 5—South River Medical Clinic, Grottoes

Sentara RMH Wellness Center 2500 Wellness Dr., Harrisonburg So much more than a gym, we’re the perfect fit for your lifestyle, with classes and activities for all ages and life stages. Find your perfect fit with group fitness classes, including yoga, aqua, fitness, indoor cycling, Bodypump, a dedicated Pilates equipment studio, a functional training and recovery area, two indoor pools, indoor track, and child care for our youngest members! Stop in for a visit and experience for yourself why you should become a member of the Sentara RMH Wellness Center, or call 540-564-5685 for more information. Lifeguard Certification Classes For ages 16 and older. Call 540-564-5698.

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Advancing Care

Youngest FOR OUR

PATIENTS Neonatologists Expand Services for Newborns and Their Families at Sentara RMH

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fter 26 hours of labor, Elizabeth Fink and her husband, Kevin, found themselves prepping for a cesarean section for the delivery of their first baby. Elizabeth’s labor had stalled, and together with their obstetrician, the couple decided a C-section was the best plan. At about 7:30 p.m. on Aug. 4, Layne Michael arrived in the Family Birthplace at Sentara RMH Medical Center. Immediately, Elizabeth knew her new baby was struggling. “I could hear his cry, and I knew it wasn’t a normal cry,” recalls Elizabeth, 28, of Singers

Elizabeth Fink with baby Layne

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Glen. “After my husband cut the cord, a nurse put an oxygen mask on the baby. He was having trouble breathing. Before I could even see him, Layne was taken to the neonatal unit to find out what was wrong.” Fortunately for baby Layne and his parents, a Sentara RMH neonatologist was on hand and ready to jump into action. Medical experts in providing the most up-to-date care for newborns, neonatologists specialize in treating the littlest, sickest, most vulnerable new babies. They also assist with providing care for healthy newborns, when needed.

Specialized Care for Newborns In August 2020, four neonatologists officially joined the staff of the Sentara RMH Family Birthplace, which delivers about 1,800 babies a year, according to Sabrina Shiflett, BSN, RN, NE-BC, director of patient care services at Sentara RMH. The arrival of these specialists was part of a long-term Sentara RMH goal to offer expanded services for parents and their babies. For many years, hospital-based pediatricians at Sentara RMH known as pediatric hospitalists have been treating healthy newborns and those with minor medical issues, as well as providing 24/7 care for hospitalized children of all ages. The addition of neonatologists to the medical staff brings a whole new level of care, says Ann Heerens, MD, interim medical director for Sentara Neonatology Specialists. Sentara RMH partnered with Pediatrix Medical Group, the nation's leading provider of maternal-fetal, newborn and pediatric subspecialty services, to provide neonatology services locally. Their expertise and training provide them the skills to care for newborns in high-risk situations. “Neonatologists become involved whenever a baby is sick—for example, when a baby is having trouble breathing,” Dr. Heerens explains. “We also work with obstetricians (OBs) to counsel women who have a high-risk premature baby or a baby who is expected to be sick at birth with a known congenital problem.” Sentara RMH neonatologists coordinate with parents and OBs to create a plan to deliver these higher-risk babies safely. They also help hospitals plan for deliveries involving multiple births.

Helping More Newborns and Families Sentara RMH currently offers Level 2 neonatal care, an intermediate level of care indicating that the hospital can treat babies with minor health concerns. When the neonatologists came on staff last August, the hospital became eligible to apply for status as a Level 3 neonatal intensive care unit (NICU). Previously, premature babies and newborns with breathing problems, genetic abnormalities or sentara.com

Kevin and Elizabeth Fink with Layne

other complications were either referred prior to birth to another hospital, or were transferred after birth to another hospital with a higher level of care. In either case, this kind of disruption can result in additional stress for families. “After a mom delivers, she and her partner need time to bond with their baby and time to recover,” Shiflett says. “If a baby is born or transferred to a hospital to receive a higher level of care, the parents may have to travel an hour or more to see their new baby—which can create many challenges and stressors for families.” Besides being apart from their babies, new parents having to leave town to see their baby may be separated from their support system. They may have to arrange care for other siblings, keep up with day-to-day household demands while traveling, and cover the expense and hassle of lodging and meals. Some new parents also may need help with transportation, Shiflett explains. “This all can be taxing and exhausting for new moms, dads and the entire family,” she adds. Baby Layne and his parents were one of the first families to benefit from the addition of neonatologists at Sentara RMH. In fact, Layne was born just three days after the new specialists came on board. Without the intervention of a neonatologist, Layne likely would have been transferred to another hospital, explains Terri Horst, clinical manager of the Family Birthplace. Instead, a Sentara RMH neonatologist

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What is a Certificate of Public Need? performed a needle aspiration to remove air from baby Layne’s chest cavity to expand his lung and help him breathe. “My family greatly benefited by being able to stay together,” says Elizabeth, who also experienced complications and developed a fever after her C-section, resulting in a six-day stay at Sentara RMH. “My husband was very instrumental in my recovery. If he had left to follow the baby to another hospital, I wouldn’t have had anyone with me during my recovery.” Higher-Level Nursery Care As part of its long-term maternity care plans, Sentara RMH started the process to become a Level 3 NICU by filing a certificate of public need (COPN) with the state in late 2019 (see sidebar). “Currently, as a Level 2 facility, we can keep babies born at 32-34 weeks, depending on their respiratory status, and babies who need to stay extra hospital days but do not require a subspecialist, such as a cardiologist or pulmonologist,” explains Dr. Heerens. By expanding to a Level 3 NICU, the Family Birthplace team will be able to keep babies born as early as 28 weeks, babies who require a ventilator and babies who need longer-term hospital stays. The hospital hired Dr. Heerens to develop a neonatal program at Sentara RMH. She served as interim medical director of the program until Jordan Leonard, MD, joined the medical staff in February 2021. Even with a Level 3 NICU, babies who need subspecialty care or surgery would need to be transferred to a hospital with

an even higher level of care, Dr. Heerens notes. Making Room for More Babies Developing a plan for advanced nursery care also requires support from other areas of the hospital, Shiflett adds. With that in mind, she has been coordinating plans with Sentara RMH departments such as Respiratory Therapy, Imaging Services, Pharmacy, Physical Therapy, Laboratory, Occupational Therapy, and Heart and Vascular, as well as hospital dietitians. All these departments will provide care to newborns in the NICU. In addition, Shiflett has been gathering information and advice from the three other Sentara Healthcare NICUs at Sentara Princess Anne, Sentara Northern Virginia Medical Center and Sentara Norfolk General Hospital. If Sentara RMH is granted the COPN, it would take 6-12 months for the hospital to offer Level 3 NICU services, Shiflett says. In preparation for these advancements, the hospital has been working with an architec-

Sentara RMH Family Birthplace at a Glance: • 2 operating rooms • 5 labor-and-delivery triage rooms • 6 intermediate-care nursery beds (this could expand to 11 beds under Level 3 NICU care) • 10 labor-and-delivery rooms • 20 mother-and-baby rooms for after delivery • Well-baby nursery

In Virginia, when a hospital wants to offer a major new service, it must show that the community needs the service and that it will be economically viable. To do this, the hospital files a certificate of public need (COPN) with the Virginia Department of Public Health, which regulates the COPN application program. In 2019, Sentara RMH began the process to increase its newborn nursery care from Level 2 intermediate neonatal care to Level 3 specialty neonatal care. The application required hundreds of pages of documentation, statements from key stakeholders, documentation of community support, design and floor plans, lists of equipment needs, plans for additional staffing, and financial information, says Sabrina Shiflett, director of patient care services at Sentara RMH, who has helped spearhead the request. The next step in the process is a public hearing to collect testimony from community members about the need for a neonatal intensive care unit. After the hearing takes place, all documentation will be submitted to the state, and a decision will be made either to grant or deny Sentara RMH’s COPN request. In 2020, Sentara RMH transferred 60 high-risk pregnant moms to other hospitals to deliver. The hospital also transferred 53 babies born at Sentara RMH who needed specialty care.

tural firm to reconfigure and renovate the nursery, which must be completed before the Level 3 NICU can open. “Our Family Birthplace team is highly skilled and experienced, going above and beyond for our patients every day,” Shiflett says. “They are a very strong, compassionate and extremely dedicated healthcare team. By offering a higher level of neonatal care as close to home as possible, in the near future we hope to be able to help more babies and families in our community.” sentara.com

Weight-Loss

SURGERY

for a New Lease

on Life

hile the need for improved health and a slimmer appearance lead many overweight people to look into weight-loss surgery (also known as bariatric surgery), other factors—such as a yearning to spend more quality time with family—also can come into play. Wayne Shifflett, who once tipped the scales at 400 pounds and was borderline diabetic, recalls that appearance and health issues were only part of the reason he decided to contact the Sentara RMH Weight Loss Surgery team. The biggest motivator, he says, was the stillborn birth of his granddaughter in 2015. As a way to honor his granddaughter, Shifflett entered the Sadie Rose Foundation annual fundraiser 5K race in May 2016. A nonprofit based in Dayton, Va., the Sadie Rose Foundation offers one-on-one and peer-led group support for those who have lost a loved one. “My heart was willing to run the race, but my body was not,” says Shifflett, of Port Republic, Va. “I did three-quarters of a mile and couldn’t go any farther. They had to come get me, and I felt so defeated. That was when I decided to go on a weight-loss journey.” Although one source of inspiration for Shifflett was to “go back and finish that race,” he had other reasons, too. “I had two kids, seven grandkids and my wife, and I wanted to be around for a whole lot longer than my body was going to allow me to be,” he says. “I had my physical goals as well, but my ‘heart goal’ was to be here for my family.”

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Wayne Shifflett

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The Bariatric Solution The first thing Shifflett says he learned when he contacted Sentara RMH was that bariatric surgery is not a “magic bullet.” However, when coupled with lifestyle and nutritional changes, it’s a tool that can truly transform lives. “Bariatric surgery isn’t a quick fix,” says Robert Garwood, MD, medical director of general and bariatric surgery at Sentara RMH. “Having the surgery is the easiest part of the whole deal—it’s just an aid that requires commitment from the patient to make it all work.” Dr. Garwood recommended that Shifflett have a sleeve gastrectomy, a nonreversible procedure in which about two-thirds of the stomach is removed laparoscopically. The remaining stomach takes the shape of a “sleeve” that limits the amount of food that can be eaten. Sleeve gastrectomy is the procedure Dr. Garwood performs most frequently, although other techniques are available as well. Between the day Shifflett made his commitment to the day he was rolled into the operating room—a period of several months—he had to complete a psychological evaluation, attend a weight-loss seminar, keep appointments with Dr. Garwood, have regular counseling sessions with a nurse practitioner and a dietitian, and learn about the lifestyle and nutritional changes that would help make the surgery successful in the long run. He also learned that weightloss surgery patients at Sentara RMH must go on a liquid diet for two weeks before and two weeks after the surgery. Shifflett

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complied with all the requirements, and by February 2019 he had lost about 50 pounds and was on track to have his procedure.

A Commitment Realized Shifflett initially was a bit nervous about having the surgery, but that anxiety soon dissipated. “The entire surgical team was so professional that they put my mind at ease,” he says. “They all introduced themselves and told me what their roles would be during the procedure. I realized these people really cared about me as an individual.” When he awoke after surgery, the team told him that the sooner he could walk, the more it would help alleviate any pain. Shifflett says he initially struggled to sit up in bed, but he was determined to get moving. “They asked me what I was doing,” he recalls. “I said I was going for a walk down the hall. And I did. I started walking shortly after I came off the operating table, and I’ve been walking regularly ever since.” Shifflett had his surgery on Feb. 4, 2019. Just three months later, on May 4, he again entered the Sadie Rose Foundation 5K race. This time he finished—and has kept

BARIATRIC SURGERY CAN BE A GAME-CHANGER Sentara RMH bariatric surgeon Robert Garwood, MD, says prognoses are generally excellent for people who decide to have bariatric surgery and commit to making the needed lifestyle changes. “Most patients will lose 70-75% of their excess body weight and see a marked improvement in their overall health and mobility,” he notes. Such improvements include enhanced blood sugar control among diabetes patients, a reduction in sleep apnea (to the point where many people are able to get off their CPAP machines), a reduced need for blood pressure medication, and significant improvements in individuals with gastroesophageal reflux disease. Losing weight through bariatric surgery also can help women who want to get pregnant, since excess weight can negatively affect menstrual cycles and fertility. Cancer patients, too, may experience improvements from weight-loss following a bariatric procedure. In addition, patients with orthopedic issues can see significant benefits. “We see a lot of patients who need joint replacements but aren’t eligible due to obesity,” Dr. Garwood adds. “After weight loss, orthopedic outcomes are generally far better for them.” Perhaps the greatest benefit of bariatric surgery, though, is increased enjoyment of life. “People look better, they’re more outgoing with others, and they’re more active with their friends and families,” he says. “Simply put, they enjoy life more.” Dr. Garwood is medical director of general and bariatric surgery at Sentara RMH Medical Center, as well as Sentara RMH’s chief of surgery and the division medical officer for group surgical services for the Sentara Blue Ridge region.

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Shifflett had his surgery on Feb. 4, 2019. Just three months later, on May 4, he again entered the Sadie Rose Foundation 5K race.

going since. In 2019 he completed 10 5Ks and also was able to return to hiking, a longtime passion. On Sept. 21, 2020, he hiked to Old Rag Mountain in Madison, Va.—the state’s “gold standard” for hiking—finishing in five hours, 45 minutes. Reflecting on his surgery, Shifflett says he would “do it again in a heartbeat.”

After beginning his weight-loss journey at 360 pounds, today he weighs 198 pounds and has gone from a size 50 trouser waist down to size 32. As part of his long-term commitment to weight loss, he keeps a careful watch on his diet. “It’s all about portion control,” he says, “and avoiding those things you know are trouble, like carbs.” The result is precisely what he wanted: a healthy lifestyle and an extended, active life with his family. “My grandkids are ages 2 to 9,” he says, “and I can chase every one of them now.”

TO LEARN MORE

Call Sentara Surgical Specialists at 540-689-5800, or visit Sentara.com. 28 |

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COVID

vaccine Rollout

How Sentara RMH Delivered This Precious Cargo to Help Fight the Pandemic

As some of the first COVID-19 vaccines began to reach people

around the world, Sentara Healthcare took an early leadership role to distribute some of the first doses to healthcare workers, hospital staff and community members in Virginia. Months before the first vaccines were delivered to Sentara Norfolk General Hospital, a systemwide coronavirus task force at Sentara developed intricate plans to transport the extremely temperature-sensitive Pfizer vaccine to hospitals across the healthcare system. The first shipment of Pfizer vaccines arrived in Norfolk just before Christmas. The Pfizer and Moderna vaccines—the first COVID vaccines approved for use in the United States—have been revolutionary, both in terms of how quickly they were developed and in their use of “messenger RNA” technology to enable the body’s immune system to recognize and fight the coronavirus. “Having these vaccines delivered in less than a year is a remarkable achievement of modern science and the result of a great

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deal of scientific research,” says Mark Nesbit, MD, an Emergency Department physician at Sentara RMH Medical Center who was the first person to receive the vaccine at the hospital. “The time frame for vaccine development is usually measured in decades, not months.”

Planning for the Vaccines’ Arrival

For Sentara team members, the vaccines represent hope and progress during a pandemic that has changed so much about our way of life. “I’ve had loved ones who have been affected by the virus, and I wanted to do my part to help stop the spread,” explains Sharon Peale, a frontline employee in the Sentara RMH gift shop who received the vaccine early this year. “I hear the daily reports of the virus, and I see the effects it’s having on people.”

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Besides implementing a “hub and spoke” shipping plan across the healthcare system, the Sentara coronavirus task force also worked with hospitals to ensure they had the right equipment to store the highly sensitive Pfizer vaccine, which must be kept between -112 degrees Fahrenheit and -76 degrees F. The Moderna vaccine also must stay frozen, between -13 degrees F and 5 degrees F. Since a medical-grade freezer can accommodate that range, the Moderna vaccines are shipped directly to hospitals, explains Jamin Engel, PharmD, regional director of pharmacy for the Sentara Western Region. If packed in dry ice, the Pfizer vaccine can be stored temporarily in its shipping container—but the preferred option is to keep it in an ultracold freezer. Regardless of the storage method or the brand of vaccine

received, each vaccine requires extensive monitoring of storage temperatures. The Pfizer shipping container, for example, contains a GPS-monitored, wireless-connected device for temperature recording. “Whichever vaccine came first, we were going to be ready for it,” says Engel. “At times like these, it’s good to be part of a healthcare system—we put our heads together, looked at what equipment was out there and figured out how to distribute the vaccine safely.” Engel and Laura Adkins, Sentara RMH pharmacy manager, helped create the pipeline to ship the vaccine to Sentara hospitals in the Blue Ridge Region. Shipments traveled from Norfolk to Sentara Martha Jefferson, which was established as the regional storage hub. From there, vaccines were sent to Sentara RMH, Sentara Halifax Regional Medical Center and Sentara Northern Virginia Medical Center. To assist in community vaccination efforts, Engel also helped coordinate shipments of some of Sentara’s supply to various Virginia Department of Health clinics.

“Planning has been complex, and other patients of course also need our attention and treatment, but these vaccines are a light at the end of the tunnel,” Engel says. “It’s been exciting to be a part of the rollout, and it’s been a complete team effort.”

Setting Up Vaccine Clinics Employee Health teams worked on the logistics of setting up vaccine clinics at Sentara hospitals. The first vaccines arrived at Sentara RMH on Dec. 17. “We were administering the Pfizer vaccine within a couple of days of receiving it, which is quite remarkable,” says Kim Stanchfield, RN, team coordinator for employee health at Sentara RMH. “Being a part of the vaccine distribution has been one of the most gratifying experiences of my 46 years at Sentara RMH.” Stanchfield’s department educated hospital employees about the vaccines—which are voluntary, not mandatory. She also coordinated a complicated vaccine clinic schedule that had to take into consideration different shifts and workdays, as well as the shelf life of the Pfizer vaccine once it leaves the ultracold freezer.

“Once you take it out of the freezer and put it into a refrigerator, you can’t return it to the freezer, and you have five days to use the vaccine,” Adkins explains. “We have to be good stewards of the vaccine, which requires careful coordination with employee health vaccination appointments—and even finding eligible employees to help fill canceled appointments, to minimize the risk of wasting vaccines.” In addition to the five-day time frame, the clinic has six hours once a vial is diluted with saline and the vaccine is pulled into syringes, whether they are at room temperature or in a refrigerator. These time constraints require an extraordinarily efficient, well-run clinic staffed with a minimum of 10 team members, including a nurse, pharmacists to prepare the vaccines and staff to administer the vaccines.

“We get people registered in five minutes, and then they get the vaccine,” Stanchfield says. “After that, they move to an observation room for 15 minutes to be monitored for any side effects.” Engel notes that resourceful pharmacy staff at Sentara and across the country quickly discovered that they could use a specialty syringe to extract six doses out of each Pfizer vial, rather than the five doses initially anticipated by the manufacturer. This allows providers to get the most out of each vial and enables more people to be vaccinated with a limited supply.

Among the First to Get the Vaccine When Dr. Nesbit received an email informing him that he could sign up for vaccination, he didn’t hesitate. In fact, just by chance, he ended up being the first one to receive the vaccine at Sentara RMH.

Getting Vaccines to Clinic To get Pfizer vaccines from the pharmacy on the second floor to the vaccine clinic on the first floor at Sentara RMH, employee health and pharmacy personnel orchestrated a complex, carefully scripted plan. According to the manufacturer’s instructions, such a plan involves freezing water bottles and then thawing them to a specific temperature. The bottles are layered and packed with the vaccines in a Styrofoam container for the trip to the vaccine clinic, and pharmacy staff then moves the vaccines into the clinic refrigerator. sentara.com

“I signed up for 6:30 a.m. on Dec. 17, so I would still have time to walk upstairs for my shift at 7 a.m.,” he says. “When I got the shot, I realized I was the first.” Dr. Nesbit has been evaluating and treating COVID-19 patients in the Sentara RMH Emergency Department since March 2020. In the meantime, he says, healthcare experts have learned a great deal about the spread of the virus, its symptoms and effective treatments. As a patient care supervisor at Sentara RMH, Cynthia Davis, RN, has worked directly with COVID patients and their families since the pandemic began. Even with all the cases she has seen, Davis wasn’t immediately sure that she would opt to get the vaccine, out of concern about potential side effects. She reconsidered her decision, however, as she saw the drastic increase in COVID-19 cases within the community after Thanksgiving. “It was definitely a reality check that the virus wasn’t going away soon,” Davis notes. “I decided to receive the vaccine not only for my own benefit, but for the benefit of my family, the community and the patients I come into contact with daily.” As reported in the clinical trials, some initial recipients of the COVID vaccine have reported mild side effects. After the first dose of the vaccine, many people report soreness at the injection site. After the second dose, some people experience fatigue, headache, muscle pain, chills, joint pain and fever, according to the U.S. Food and Drug Administration (FDA). “Those side effects are signs that your body is building an immune response,” Stanchfield explains.

Building Herd Immunity As the FDA approves more vaccines and a higher percentage of the population is immunized, the country will inch closer to herd immunity, according to the Centers for Disease Control and Prevention. Once that threshold is reached, the disease won’t be able to spread as easily from person to person, due to the high numbers who will have been vaccinated or already will have had the disease. At the current time, since herd immunity varies by disease, experts do not know what threshold is needed to control COVID-19. In the meantime, health experts advise everyone to continue wearing masks, observing social distancing and practicing good hand hygiene. New treatments likely also will emerge to combat the virus. “However, it’s best that you never get this disease, especially if you can develop an immunity without getting infected,” Dr. Nesbit says. “Our treatments will never be better than the protection of a good vaccine. We don’t expect to manage smallpox, polio or tetanus with medicine—these, like many other diseases, are controlled with vaccines. The path forward in managing COVID-19 is through vaccination.” To learn more about COVID-19 vaccine safety, see the article that begins on page 11.

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How Does the COVID-19 Vaccine Work? Most vaccines trigger an immune response by using a weakened or inactivated version of a given virus, which imitates an infection. With this method, the next time the body runs into that virus, it knows how to fight it. Unlike traditional vaccines, the coronavirus vaccines do not use a weakened or inactive virus to spark an immune response. Instead, they use messenger RNA (mRNA) to target the “spike proteins” that enable the coronavirus to latch onto and infect healthy cells. The mRNA technology instructs our cells to make a piece of the spike protein that is unique to the COVID-19 virus. Since only part of the protein is made, it triggers an immune response without harming the vaccinated person, according to the Centers for Disease Control and Prevention (CDC). With this method, the body views the spike proteins as invaders and builds antibodies against them. Later, if a vaccinated person encounters the actual virus, the body will recognize the spike proteins and respond accordingly to destroy them. Both the Pfizer and Moderna vaccines, which require two doses each, are about 95 percent effective in fighting the COVID-19 virus, according to Dr. Mark Nesbit, Sentara RMH emergency physician. Although both vaccines appear to provide limited (and potentially only short-term) protection after the first dose, a second dose is required to achieve the maximum benefit. After the second dose, you may not have optimal protection from the virus for a week or two, according to the CDC. Other pharmaceutical companies are manufacturing additional types of vaccines—some requiring only one dose— to join in the fight against COVID.

CLINICAL EXCELLENCE

TREATING

Not long ago, a man in his mid-80s came to the Physical, Occupational and Speech Therapy Outpatient Clinic at Sentara Martha Jefferson Hospital complaining of dizziness. He walked slowly, hesitantly.

VERTIGO WITH PHYSICAL THERAPY

“Normally, he was a pretty functional, strong guy,” says Anne Knox, PT, MSPT, GCS, a physical therapist who specializes in vestibular and balance disorders. “He would help his church with building projects and did a lot of woodworking and yard work. But then he had a sudden onset of vertigo, with nausea and other problems.” After checking him over, Knox diagnosed the man with benign paroxysmal positional vertigo (BPPV), one of the most common types of vertigo.

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C LIN ICA L E XC E L LEN CE

Those who suffer from vertigo experience a spinning sensation and feel as if their visual field is moving. The condition also may come with lightheadedness, dizziness, nausea and a loss of balance. Episodes are brought on by changes in head position, such as bending over, looking up or down, and turning the head quickly in any direction. Fortunately, once diagnosed, BPPV and most other forms of vertigo are highly treatable. Most inner ear disorders are grouped together under the general category of dizziness by those who are not trained in vestibular therapy. As such, they often go undiagnosed. “What’s interesting about vertigo is that, although it’s so common, it’s poorly understood by healthcare practitioners,” Knox says.

A Problem of the Inner Ear BPPV is a disorder of the body’s vestibular system, which is part of the inner ear. “The vestibular system is responsible for our sense of hearing, and for providing our brain with information about motion, head position and space,” says Jeb Brittle, MPT, a physical therapist at Sentara RMH. This information allows us to keep our balance, stabilize our head and body during movement, and maintain posture. “When you have trouble with your vestibular system, you can have difficulty with balance, dizziness and walking,” Brittle says. The two main causes of vertigo that Knox and Brittle see in their clinics are BPPV and vestibular neuritis, which is an inflammation in the inner ear. BPPV occurs when debris has collected within a part of the inner ear. This debris,

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formally known as otoconia and sometimes referred to as “ear rocks,” is made up of small crystals of calcium carbonate. With head movement, the displaced otoconia shift, sending false signals to the brain and causing the eyes to move in a specific pattern known as nystagmus. This eye twitching makes it seem like the room is spinning, Knox explains. In addition to dizziness, symptoms of BPPV include lightheadedness, nausea, vomiting and blurred vision. Episodes of BPPV symptoms tend to last about 10-60 seconds. Vestibular neuritis can be caused by an infection or inflammation in the inner ear, says Brittle. Its symptoms can be mild or severe, ranging from subtle dizziness to a violent spinning sensation (vertigo), as well as nausea, vomiting, unsteadiness and imbalance, difficulty with vision, impaired concentration, and severe disorientation. Symptoms of vestibular neuritis usually come on suddenly, with severe dizziness starting abruptly during routine daily activities. In some people, the symptoms are present upon awakening in the morning. This sudden onset can be frightening. “The symptoms can last for two to three days,” Brittle says. “They may be so severe that they affect a person’s ability to stand up or walk.”

As for medications, the most common one prescribed for dizziness is meclizine. However, explains Knox, meclizine actually suppresses the vestibular system, when the ideal solution is to get the system to work better. “In the acute phase of vertigo, meclizine can help,” says Knox. “But when you’re trying to recover, you want the vestibular system working.”

Who Gets Vertigo and Why

Treating Vertigo When patients come for physical therapy for vestibular disorders, they’re often stressed— not only by their condition, but by the effort it often takes to get the condition diagnosed and treated. “Physical therapy is really highly effective at treating vertigo, with 80-90% success,” says Brittle. During treatment for BPPV and vestibular neuritis, a physical therapist guides the patient through certain exercises. The most common therapy for BPPV is known as the Epley maneuver. “With that maneuver, we’re trying to get those crystals back into the part of the ear where they belong,” Brittle says. “Typically, in just one or two visits, patients with vertigo are cured.” When physical therapists can’t figure out where a patient’s symptoms are coming from, they still can try to find ways to help them adapt. “We look at the big picture,” Knox says. “We can make recommendations that will make the person’s life better. They really appreciate that.”

Dizziness is the second-most common complaint heard in doctors’ offices, according to the National Institutes of Health. For individuals over age 70, dizziness is actually the No. 1 medical complaint. Although very common, acute or chronic problems with equilibrium can limit a person’s everyday living. So it’s crucial for elderly persons with a vestibular balance disorder to be treated, says Brittle. “When the elderly lose their sense of balance, they often become scared they will fall and break a hip—so instead, they just sit,” he adds. “And when they do get up, they go real slow, take a step and stop.” That lack of movement can cause older individuals to deteriorate and lose muscle strength, which in turn further contributes to their lack of balance. “It’s kind of a snowball effect for the elderly,” Brittle says. “Generally, if someone in their 30s or 40s gets vertigo, they make the best of it and get back to work because they can’t afford to be off. They really just retrain themselves to adjust to a new sense of balance.” Knox notes that treating older people can sometimes be multilayered. Her patient mentioned above—the man in his mid-80s with BPPV—also had arthritis in his neck, so he wasn’t able to do the therapy exercise Knox prescribed. To work around that problem, she used a special table that moved the man’s whole body to accomplish the maneuver. Although the BPPV quickly cleared up, the man still had a balance problem. “COVID restrictions had made him less fit,” she says. “His quality of life had changed.” So Knox worked with him on his gait. “Gait speed is very important,” says Need physical Knox. “Faster walking is correlated with therapy to treat good health.” vertigo? Talk to In addition, the man had cervicogenic your doctor (a dizziness—another type of vertigo—so he referral is needed), got dizzy whenever he looked up. Knox then call: advised him to stay off ladders. The patient In Charlottesville: was more than happy with his therapy, 434-654-8333 which had restored his quality of life. In Harrisonburg: 540-689-4999 “By the time he left,” Knox says, “he was feeling like Superman.” sentara.com

HEALTH MATTERS

Keep Watch on

igh blood pressure, also known as hypertension, is sometimes called “the silent killer” because it usually causes no noticeable symptoms, and many people don’t realize they have hypertension until it results in other health problems. Left untreated, high blood pressure can lead to heart attack, heart failure, stroke, kidney failure and eye damage. The best way to know if you have high blood pressure is to have your pressure checked regularly by your healthcare provider. You also can regularly check your blood pressure yourself, either at a pharmacy equipped with a blood pressure machine or using a home blood pressure monitor.

What the Numbers Mean Two numbers are used to record blood pressure. Systolic pressure, the higher of the two numbers, indicates the pressure your blood exerts in your arteries with each heartbeat. Diastolic pressure, the lower number, indicates the pressure your blood exerts between heartbeats. Here is what the numbers mean, according to the American Heart Association:

Upper Number (Systolic Pressure)

Normal Elevated High Blood Pressure/Stage 1 High Blood Pressure/Stage 2 Hypertensive Crisis (Consult your doctor immediately)

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Less than 120 120–129 130–139 140 or higher Higher than 180

and and or or and/or

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Your Blood Pressure Who is at Risk? Risk factors for hypertension include the following: • Age: You’re more likely to have hypertension as you age. • Race: Blacks tend to get hypertension at an earlier age. • Family history: Hypertension tends to run in families. Other risks for hypertension include being overweight or obese, having a sedentary lifestyle, stress, smoking, excessive alcohol consumption, and having too much sodium (salt) in your diet. In addition, nearly 60 percent of people with diabetes have hypertension.

How Do I Keep My Levels Normal? The easiest way to keep your blood pressure normal is to get regular exercise, reduce stress, maintain a healthy weight and eat a healthy, low-sodium diet. Don’t smoke, and don’t drink alcohol in excess.

What if I Find Out that I Have High Blood Pressure? A slightly elevated blood pressure reading may simply require a lifestyle change, such as losing weight, reducing stress, changing diet or increasing your physical activity. If Lower Number your pressure gets too high, how(Diastolic Pressure) ever, your doctor may recommend blood pressure medication in addiLess than 80 tion to lifestyle changes. Less than 80 If you have high blood pres80–89 sure, be sure to see your doctor for regular checkups. 90 or higher

Higher than 120

LA SALUD IMPORTA

Controle la

presión arterial

Si no se trata, la presión arterial alta puede provocar ataques cardíacos, insuficiencias cardíacas, accidentes cerebrovasculares, insuficiencias renales y daños oculares. La mejor manera de saber si usted tiene presión arterial alta es que su proveedor de atención médica le controle la presión de manera regular. También puede controlar la presión arterial usted mismo regularmente: la mayoría de las farmacias ofrecen una máquina que puede controlar la presión arterial con precisión y también tienen dispositivos de control domésticos.

El significado de los valores Se utilizan dos valores para registrar la presión arterial. La presión sistólica es el valor más alto de los dos e indica la presión que ejerce la sangre en las arterias con cada latido del corazón. La presión diastólica es el valor más bajo e indica la presión que ejerce la sangre entre los latidos del corazón. A continuación, presentamos el significado de los valores según la Asociación Estadounidense del Corazón:

Valor superior (Presión sistólica)

Normal Elevada Presión arterial alta/etapa 1 Presión arterial alta/etapa 2 Crisis hipertensiva

Menos de 120 120-129 130-139 140 o más Más de 180

y y o o o

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a presión arterial alta, también conocida como hipertensión, a veces se denomina factor de muerte silencioso porque normalmente no presenta síntomas visibles, y muchas personas no saben que la tienen hasta que causa otros problemas de salud.

¿Quiénes están en riesgo? Los factores de riesgo incluyen los siguientes: • Edad: Es más probable que padezca hipertensión a medida que envejece. • Raza: Las personas de color suelen tener hipertensión a una edad más temprana. • Antecedentes familiares: La hipertensión suele ser hereditaria. Otros riesgos relacionados con la hipertensión incluyen el sobrepeso o la obesidad, el sedentarismo, el estrés, el tabaquismo, el consumo excesivo de alcohol y el exceso de sodio (sal) en la dieta. Además, casi el 60 por ciento de las personas con diabetes tienen hipertensión.

¿Cómo mantengo los niveles normales? La manera más sencilla de mantener la presión arterial en un nivel normal es hacer ejercicio con regularidad, reducir el estrés, mantener un peso saludable y tener una dieta saludable y baja en sodio. No fume y no beba alcohol en exceso.

¿Qué sucede si descubro que tengo presión arterial alta? Una medición de la presión arterial ligeramente elevada puede simplemente requerir un cambio en el estilo de vida, por ejemplo, perder peso, reducir el estrés, cambiar la dieta o Valor inferior aumentar la actividad física. Sin em(Presión diastólica) bargo, si la presión es demasiado alta, el médico puede recomendarle mediMenos de 80 cación para la presión arterial además Menos de 80 de los cambios en el estilo de vida. 80-89 Si tiene presión arterial alta, asegúrese de realizarse controles médi90 o más cos regulares. Más de 120

(Consulte con el médico de inmediato).

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Eating Well to

By Patricia Tyndale, RD Sentara Martha Jefferson Hospital

Help Control

Chronic Kidney Disease

ur kidneys serve several vital roles in the body, including eliminating waste, filtering the blood and helping to maintain fluid balance in the body. When kidney function is compromised, chronic kidney disease (CKD) can develop, often due to chronic conditions like diabetes and hypertension (high blood pressure). 38 |

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Based on my experience, CKD seems to be one of the least understood chronic conditions among patients. For starters, many patients have little awareness of the different stages of the disease or what recommendations they should follow. If you receive a CKD diagnosis, your healthcare provider may

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EAT WELL , LIVE WELL

Apple Cranberry Walnut Salad Ingredients 2 cups red seedless grapes, each grape sliced in half 21/3 cups walnut halves, chopped into pea-size pieces 1¼ cups (6-ounce package) Ocean Spray Craisins® Pomegranate Juice Infused Dried Cranberries

recommend that you consult with a dietitian to help you gain a better understanding of the role nutrition plays in preventing the progression of CKD. By following a healthy lifestyle, including a diet that includes plenty of fruits and vegetables and few processed foods, you can slow the progression of CKD and improve your outcome. Here are a few factors to consider regarding nutrition and CKD.

4 stalks celery, chopped into ¼-inch pieces 7 medium-sized Gala apples, skin on 1 bottle (8 fluid ounces) Maple Grove Farms Fat-Free Cranberry Balsamic Dressing

Directions 1. Rinse the cluster of red grapes and separate from the stem. Use a paring knife to slice each grape in half. Place sliced grapes in an extra large mixing bowl.

Sodium Excessive sodium (salt) intake can lead to serious outcomes for people with compromised kidney function. Since sodium contributes to fluid retention, it also can raise blood pressure, which can further reduce kidney function in those with CKD. Typically, sodium is present in high quantities in many restaurant foods and in most processed and packaged items in grocery stores. In fact, a single restaurant dish may contain 3,000 milligrams of sodium or more, while the U.S. Food and Drug Administration’s recommended sodium intake for an entire day is less than 2,300 mg. When eating out, you can reduce your sodium intake by checking nutrition information beforehand; asking for sauces, dressings and other condiments to be served on the side; consuming smaller portions; and sharing meals. A better option, though, is to eat out less frequently and make more meals at home—using fresh ingredients, rather than packaged, frozen or prepared items. Substitute the high-sodium foods you usually consume with reduced-salt or salt-free products. And instead of seasoned salts, use garlic, onions and herbs to flavor meals. Together, these steps can help reduce your sodium intake to 500 mg or less for a single meal. You can also reduce your sodium intake by buying frozen vegetables without sodium, as well as not having the saltshaker present at the table during mealtimes.

Chop the walnuts into pea-sized pieces. Add the chopped nuts to the bowl with the grapes.

Add the bag of dried cranberries to the mixture.

Rinse, clean and chop the celery into ¼-inch pieces, and add to the mixture.

Rinse the apples, slice them in half vertically and core them. Slice into wedges, and then chop the wedges into bite-sized pieces. Add the chopped apple pieces to the mixture.

Pour the bottle of cranberry dressing over the entire mixture. Stir the ingredients, making sure the dressing is incorporated and covers all of the ingredients. Chill and serve.

Plant-based diets have been a focus in the media recently for their ability to prevent certain cancers, as well as heart disease, diabetes and other conditions. As with many healthy-eating recommendations, eating more fruits and vegetables also is beneficial for kidney health. Fruits, vegetables and foods from other plant sources are packed with vital nutrients, and may even be effective in delaying the progression of CKD.

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Plant-Based Eating

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E AT WE LL , LIVE WEL L

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If you are among the millions of adults who suffer from CKD, or if you have a loved one who has CKD, you can learn more about how to maintain kidney health by consulting with a registered dietitian, in addition to your other healthcare providers. Other helpful resources include the National Kidney Foundation (www.kidney.org) and the American Kidney Fund (www.kidneyfund.org).

One very effective way to prevent development of CKD and other health conditions is to manage your weight. In addition to helping prevent diabetes, heart disease, high blood pressure and many cancers, maintaining a healthy weight also can help prevent worsening kidney function. Simple strategies for better weight management include focusing on more nutrientdense foods, such as fiber-rich grains and lean proteins. These foods create a feeling of satiety (fullness) that can help with portion control. Engaging in regular physical activity also can be beneficial for weight management.

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Weight Management

Chicken Fajitas Ingredients 2 chicken breasts (about 12 ounces) 6 tablespoons grated 2% Mexican cheese blend ½ teaspoon onion powder

Potassium and Phosphorous Levels

1 teaspoon garlic powder

Following a low-sodium diet is a standard recommendation for CKD, even in its earlier stages, but what about other dietary modifications? Potassium and phosphorus are two minerals that build up in the blood when the kidneys can no longer excrete them in adequate amounts. For many CKD patients, elevated phosphorus levels (known as hyperphosphatemia) in later stages can be controlled with a phosphorus binder. CKD patients with elevated potassium levels (known as hyperkalemia) should follow a low-potassium diet. Regular visits with your nephrologist will help to monitor these levels.

1 teaspoon ground black pepper

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½ yellow onion, sliced and cut into strips 1 bell pepper, cut into strips 6 small corn tortillas

Directions 1.

Cook chicken until 165°F. Let cool, then cut.

Cook onion until translucent, and cook bell pepper until browned.

Toss chicken and vegetables with onion powder, garlic powder and black pepper.

Add chicken and cooked vegetables to tortilla.

Top with shredded cheese.

PHILANTHROPY

RMH Foundation

BOARD MEMBER #Dedicated to Giving Back lthough neither a physician nor a professional social media influencer, Paul Riner has managed to find ways to connect the two fields to provide valuable support for healthcare services in the Harrisonburg area— all via the simple hashtag. There’s no act too small if it means supporting your local hospital, says Riner, 39, a Rockingham County resident and board member of the RMH Foundation, the fundraising arm of Sentara RMH Medical Center. It’s with this mindset that he and the company he owns, Riner Rentals of Harrisonburg, achieved a pair of notable successes in the past year, thanks to the savvy use of social media hashtagging. Through two community-minded social media campaigns in 2020, Riner helped raise funds for the Foundation’s Crisis Response Fund—funds that were then used to purchase critical resources to help Sentara RMH frontline healthcare workers respond more effectively to the COVID-19 pandemic. “If I have learned anything over the last year, it’s that we are all in this together,” says Cory Davies, the Foundation’s executive director. “Generous support from Riner Rentals and others throughout the community has been vital to helping ensure that all our neighbors and friends have access to the critical, highquality healthcare they need.” “Throughout the pandemic, we have seen in such a stark way how heroic our frontline caregivers truly are, for the sacrifices they have made and the excellent

care they have provided,” adds Davies. “But our donors are healthcare heroes, too, for the support they provide, which helps bring care to patients in need.”

Inspired to Help Having been actively involved as an RMH Foundation Board member for about two years, Riner is dedicated to supporting the hospital’s mission. But his relationship with Sentara RMH developed long before he volunteered to serve. While his mother, Sandy, was battling cancer, Riner witnessed firsthand the care she received through the Hahn Cancer Center, which provided outstanding treatment in a convenient, local setting. “She was always so thankful that she didn’t have to drive to Charlottesville to get treatment,” Riner recalls. “The nurses, the pharmacists—everyone was so great. Always attentive, always involved.” Riner’s wardrobe has grown exponentially pinker over the years, as part of his active efforts to raise awareness of breast cancer, after his mother passed away in 2014. In 2020, as COVID-19 brought additional challenges to Sentara RMH and its frontline workforce, Riner says he and his company wanted to get involved. w w w.S uppor tRMH.org

been no gallery openings, no shows in recent months. It was cool seeing the arts community come together for their frontline healthcare employees, and also to help artists in some small way.” The #artfeltTHANKS campaign, which closed at the end of August 2020, raised more than $6,000 overall.

Digital Campaign, Real-World Benefits

“We were looking for ways to support the folks at the hospital who were on the front lines dealing with all of this,” he says. “The COVID-19 crisis brought us an opportunity to help.” Taking place on May 5, 2020, #GivingTuesdayNow was a dedicated, worldwide social media effort to help those challenged most by the pandemic. As part of that campaign, Riner Rentals and Sentara RMH spread the word over social media in search of financial support, which led to a $5,000 matching gift from the company to the Crisis Response Fund. A few months later, Riner was at it again with another social media fundraising drive. The #artfeltTHANKS campaign was a collaboration among Riner Rentals, the Arts Council of the Valley, and the Rockingham Fine Arts Association in which 20 artists teamed up to create a series of yard signs thanking frontline healthcare workers. The signs sold for $25 apiece, with proceeds split between the artists and the Crisis Response Fund. “We had wondered if there was something we could do to benefit local artists who were out of work,” Riner says. “COVID has had a lot of negative impact on them—there have

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Through funds raised from the social media campaigns, two significant purchases were made to support Sentara RMH: pulse oximeters, which are used to monitor oxygen levels in patients diagnosed with COVID-19, and thermal scanners, which enable caregivers to screen hospital visitors and others quickly and efficiently, via temperature readings, for potential signs of COVID-19 infection. The pulse oximeters have had a major positive impact on patient care during the pandemic. “Previously, we had the capacity to measure blood oxygen levels only in a limited number of patients—in beds equipped with pulse oximeters,” Davies says. “The new pulse oximeters, by contrast, are integrated with the hospital’s telemetry system—which enables caregivers to monitor patient vital signs remotely—greatly expanding our capacity to provide excellent care for COVID-19 patients.” In one case, says Davies, a patient who was on supplemental oxygen kept inadvertently removing the oxygen tubes to his nose, causing his blood oxygen levels to drop—a situation that can have serious consequences for COVID-19 patients. “With the new capability to monitor his blood oxygen in real time through telemetry, our nurses were able to intervene quickly, replace the tubes promptly and help the patient stay on a quicker path to recovery,” he notes. Likewise, the newly purchased thermal scanners have yielded significant benefits by helping to ensure a safe environment for patients and employees through an accurate, efficient COVID-19 screening process.

“The scanners have enabled us to quickly screen employees and visitors at entrances, without requiring extra staff to take temperatures manually—and more slowly— with traditional thermometers,” he adds. “That added efficiency allowed us to deploy staff to other hospital areas where they were needed.” Improved accuracy is another major advantage of the new thermal scanners. “Some manual thermometers have greater variability in temperature readings, which is less than ideal,” Davies says. “These thermal scanners, on the other hand, have militarygrade precision.” By helping to keep people with possible COVID-19 infection from entering the hospital, the new scanners helped Sentara RMH reopen safely to visitors amid the pandemic.

Mission (Not Yet) Accomplished Riner takes pride in knowing that #GivingTuesdayNow and #artfeltTHANKS produced tangible benefits for frontline workers and patients at Sentara RMH. He notes, however, that the need to support these healthcare heroes is far from over. “They’ve been dealing with COVID-19 since early 2020, and they’ll probably be

dealing with it for another 10-12 months,” he says. That continued need makes the Crisis Response Fund a vital ongoing resource—not only for the hospital, but for the Shenandoah Valley overall. “There’s always some way to get involved,” Riner says. “It doesn’t have to be a gigantic project. Just find something that resonates with you or something you feel you can do to make a difference.” If you can’t afford to donate directly to support the cause, that’s OK. Sometimes helping can be as simple as sharing a hashtag on social media. “If you have received good care at Sentara RMH, try to make a donation,” he continues. “Contact Cory and ask him how you can make a gift. But there are also ways to get involved beyond donations. Supporting our hospital should be an important cause for everyone in our area, because Sentara RMH is our local provider. We’d be a whole lot worse off if they weren’t here to help the community get through times like these.” To donate or help support Sentara RMH in other ways, contact the RMH Foundation at 540-689-8545 or visit supportrmh.org.

An Estate Planning Quiz Are you certain that your current estate plan is up to date? Take this brief quiz to see where you stand. 1. Do you have a will or living trust to direct the distribution of your property? Yes n No n 2. Is the makeup of your family the same as when you last reviewed your plans? Yes n No n 3. Do you live in the same state as when you last updated your will or other plans? Yes n No n 4. Is the person you have named to settle your affairs still able and willing to serve? Yes n No n 5. Has the value of your assets remained the same since you last reviewed your plans? Yes n No n 6. Are all the people and charities important to you mentioned in your plans? Yes n No n

Your score 1. If you answered No to any of the above questions, you may need to review your plans. Professional advisors and attorneys who specialize in such matters can offer advice and help to coordinate various parts of your plan. thodonal/stock.adobe.com

To receive the FREE brochure “37 Things People ‘Know’ About Wills That Aren’t Really So,” please contact Sarah Orem at seorem@sentara.com w wor w .540-689-8549. S u p p o r t R M H . o r g | 43

friends of the

RMH Foundation Gifts received from Aug. 1 to Dec. 31, 2020 entara RMH Medical Center is grateful to have the support of generous community members. We express this gratitude and recognize the contributions our donors make through the President’s Forum, the William Leake Society, the 1910 Cornerstone Club and the White Rose Giving Circle. These exclusive giving circles are our way to honor our most generous partners who show they care about having the best medical services available in our community. Finally, to recognize your loyalty over the years, we are placing next to your name the number of consecutive years you have supported the RMH Foundation. Thank you for your support! Totals represent cumulative amounts given in 2020. President’s Forum $100,000 and above Colonel and Mrs. Peter F. Dieck (3) The Fred O. Funkhouser Charitable Foundation Inc. (24) Mary Louise Leake (12) E. John III and Carol H. Rosenberger (7) John and Faye Sellers (15) Phillip and Christina Updike (7)

$25,000–$99,999 Diane C. Davis Richard R. J. Morin (15) Rebecca W. Morris (31) Thomas W. and Tassie L. Pippert (9) James B. Richardson Jr. (12) Schwab Charitable Fund (3) Earl L. Shirkey Jr. Trust (1) The Community Foundation of Harrisonburg and Rockingham County (18) Lynn and Diane Trobaugh (13)

$5,000–$24,999 Devon C. and Teresa B. Anders (11) Bank of the James (5) Books-A-Million, Valley Mall (1) Robert L. Branner Estate (1) Charles Schwab (1) Paul S. and Sherry B. Cline (9) Eddie R. and Catherine Coffey (23) Crosslink Community Church (1) Everence Foundation Inc. (4) Joseph K. II and Sallie Funkhouser (15) Dr. David C. and Amelia M. Hall (10) Orden L. and Reba R. Harman (13) Elizabeth Harnsberger Trust (9) Richard and Julie Haushalter (21) Ollie Heatwole Trust (1) Dr. Charles H. and Mary Henderson (38) LaCroix Sparkling Water (1) David and Emily Larson and the Spark Adoption Grant of The Community Foundation of Harrisonburg and Rockingham County (1) Dr. William I. and Lynda D. Lee (14) Earle A. and Glenna B. MacKenzie (6) Beverly T. MacLeod (7) Travis and Kara Marshall (11) Kathy Moran and Marcie Harris (11) Drs. David and Heather Morgan (4) Douglas J. and Lori B. Moyer (4) Calvin R. Nichols Jr., Charitable Fund, a Donor Advised Fund of the U.S. Charitable Gift Trust (4) Charles V. Oster (25) Bonnie L. Paul Estate (4) Dennis and Mary Jane Rawley (3) Douglas M. and Vickie K. Rawley (4) Rockingham Insurance (3)

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RunSignUp (6) Select Aerospace Industries Inc. (4) Twila and Larry Showalter Cancer Fund of The Community Foundation of Harrisonburg and Rockingham County (3) Barbara B. Stoltzfus (22) William G. and Hope Shank Stoner (15) The US Charitable Gift Trust (4) Truist Bank, Harrisonburg (1)

William Leake Society $1,000–$4,999 Mary L. Addy (3) Dr. Donna Amenta (9) Judy Anderson (1) Arts Council of the Valley (1) David O. Banks (3) Drs. A. Jerry Benson and Martha K. Ross (9) Auburn A. and Ruth D. Boyers (39) Nancy R. Bradfield (12) Steve and Christine Bradshaw (2) Rosemary O. Brenner (1) Mary Elizabeth Brown (1) Dr. Anthony and Tracy Bruno (1) Amy E. Burke (22) Dr. William F. and Susan Cale (7) Ruby J. Callahan (12) Thomas G. Camp, Jr. (2) Cardinal Dental Specialists (6) William B. Carper Sr. (39) Dr. Henry H. Chang (18) Maryjane Chewning (6) Sandra Clatterbuck (4) CommonWealth One Federal Credit Union (2) Thomas F. Constable Jr. (21) Louise Dolly Cook (4) Bettye C. Davis (5) Brian and Angie Davis (1) Dick Myers Chrysler, Dodge, Jeep, Ram, Fiat (1) Rosemary and David Eyeler (1) Fidelity Charitable Gift Fund (10) Sherrill Glanzer (19) Drs. William and Brooke Goodwin (6) Dr. Eugene J. Harper, MD (2) John R. and Mary Ann Heatwole (2) George and Cary Hevener (16) James and Connie Hillyard (5) Dr. Debra Horst and Mr. Mark Horst (2) Robert P. and Eloise B. Hostetler (8) IDM Trucking Inc. (15) Integrity Insurance Group (1) Tedd H. and Lora W. Jett (31) Richard C. and Mona D. Johnson (32) Dr. Charles E. and Dawn F. Kern (5) David and Kitty Krogh (1) Elisabeth M. Lawson (5) LD&B Insurance Agency (2) Cathy Jackson Leitner, PLC (7)

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RMH Foundation John M. and Martha S. Watkins (3) Grace B. Watt (21) Lyn Simmons Weaver (1) Wallace W. and Mary Alice Weaver (9) Charles Winston and Jo Ann C. Wenger (1) Wayne B. and Mary Sue Wenger (20) Homer and Janice Whetzel (4) Jon D. and Karen S. Whetzel (1) Peggy White (4) Jo Ann Widener (16) Roberta (Robbie) and Robert K. Wilkins (13) Kathleen M. Williar (5) Nell C. Wright (8) Richard S. and Margaret M. Wurst (5) Fredd Wynn (7) Jeff and Martha Reed and Bill and Lorraine Yake (1) Matilda M. Yoder (12) Miriam G. Yoder (18) Richard L. and Jeanelle G. Yoder (26) Robbie Jean Zirkle (13) Warren and Barbara Zirkle (1)

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Memory Gifts Catherine Abel Frank Abel Betty Allen Challace and Mary Lou McMillin Gregory William Allman Irvin C. and Patricia P. Allman Dr. Roddy Amenta Jeffrey J. and Linda B. Reisner Susan Moore Arey Margie L. Moore Amber Rae Armentrout C. Dennis Armentrout Our Father, Melvin L. Armentrout Timothy R. and Phyllis C. Armentrout Amanda Armstrong Eldon W. and Sandra P. Armstrong Marty Baer James E. and Carole S. Hively Dr. Frank and Nancy W. Steller Garfield E. Banks Sr. Edith J. Banks Ann Lootsma Barr John G. Barr Juanita Hopkins Beadles Nancy Hopkins Voorhees Dick Beazell William C. and Lena T. McClure Madeline Miller Beck Jerry R. and Kathleen L. Andes Audrey Beery Norwood I. Beery My Mother, Bette Berg, and Mother-in-Law, Thelma Holloway Becky J. Conner Jennifer Barbour Biller Mary E. Barns Choices Council on Domestic Violence for Page County Inc. Thomas F. Constable Jr. Peter R. and Carol A. Hughes New Market Veterinary Clinic Roxanne Rhodes Sean Dudley and Edward Jones Region 275 Team James and Merda Mae Blauch Craig M. and Lois Blanch Miller Bernard L. Bolt Mary S. Bolt Alleyne B. and Leonard R. Boyer Sheri Lee Childs Ira B. and Ethel G. Boyers Pamela Boyers Arbogast Bernice Breeden Teresa R. Atkins Steven J. and Pamela C. Flora Troy Clinton Breeden Tena M. Bibb Leroy S. Bremerman Jr. Patricia A. Brunk Connie K. Brown Larry E. Brown Ray Brownfield Richard H. Torovsky Jr. Melvin Browning Richard L. and Pamela B. Wilkins Don W. Brunk Patricia A. Brunk L. Ronald and Bonnie V. Smith Judith Paige Bunt Joseph H. Meyerhoeffer John Marshall Burner Christine W. Burner Glenn, Terri, Wes and Jake Smith

Harry Lee Byers Margaret T. Byers Jane Alane Byrd Flora H. Byrd Dr. Donald M. Callahan Ruby J. Callahan Rena Cavicchi Dr. Michael J. and Virginia M. Galgano Rena Cavicchi Lennis Echterling and Mary Lou Wylie Loretta Clapper Lee E. Clapper Sr. Edward. S. Clark Norma Clark Dean Suter Clatterbuck Sandra Clatterbuck Jim and Caroll Douglas James Daryl Cline Jane Cline Lough James A. Clutteur, Sr. Arletta M. Clutteur Charles D. Coakley Daneen A. Coakley Eugene Coakley Nelson and Linda Simmons Linda L. Cocking Marilou M. and George C. Johnson Terry and Judy LePera Peggy Coffey Tommy and Betsy Heatwole Glendye Dr. F. Edward Comer Tommy and Betsy Heatwole Glendye Janice Simmers Rhodes Louis Jack Comer Pearl A. Comer Carroll Comer and Elwood Walton Wylie E. and Diane Walton June W. Craun Samuel E. and Donna Kay Ritchie Michelle Ilene Crites Ilene N. Smith Connie Curro Russell A. Curro George Curro Russell A. Curro D’Earcy Davis Victor J. II and Cheryl B. Smith Debra D. Thompson Our Deceased Family Members Orlando A. and Eloise E. Pinneri J. Brisco Dellinger R. Calvin and Susan Dove Anderson Lee Dofflemyer Pamley D. Rhodes Pat Dotson Anne M. Dellinger Mary Katherine Dove R. Calvin and Susan Dove Anderson Gladys and Browniie Driver Sharson S. and David R. Kisamore Karen Duval Katherine K. Byers Hilda S. Earhart Darwin C. and Kathryn E. Simmons Kermit and Jean Early H. Paul and Betty Jo Obaugh Eldor, beloved Sentara RMH therapy dog Daniel R. Lynn and Rosemary P. Mitchell Clarence and Jane Ewing Ann Ewing Homan Leo Falconieri William B. and Margaret A. Zeh Ray Farmer Anne G. Farmer Norval E. D. Fishel Arletta M. Clutteur Frances Flora Lillie Ann Flora Hampton W. Foley Mabel Anna Foley Ben and Betty Ann Fordney Richard A. and Cathy D. Baugh Kenneth Frantz and Steve Starick Loretta G. Frantz

Ron French Christine and Adam Anderson Carroll E. and Billie M. Bushong Glenn and Leslie Crawford David Krajewski Brett Layman Athena G. K. Pearson Steven D. and Varina L. Tavenner Ronnie Carlton French Staunton Professional Fire Fighters Local 3468 Maisie Maxine Furr Laura K. Howard Mahlyn V. and Pauline S. Knott Ruby Angeline Gallalee Edward R. and Nancy K. Gallalee Boyd and Ada Garber Anne G. Farmer Derwood and Ruby Garber Anne G. Farmer Dr. Harry M. Gardner Norma J. Gardner Clara Eugenia Alvarez De Garibay Martha Guadalupe G. Alvarez Jill Hedrick Garrison F. L. Proctor Jr. Sandy Gehr Derek G. and Karen S. Brownsword Wayne and Maurine Geisert Gregory W. and Margaret S. Geisert Barbara Gerner Walter G. Gerner Janet Glendye Tommy and Betsy Heatwole Glendye Sherry H. Gordon R. Jay and Cynthia C. Veenis Brenda Newman Hall Elizabeth Hall Joyce Hall Robert P. Hall Barbara Ann Hansbrough James P. Hansbrough Vivian Z.Harrison Steve and Christine Bradshaw Cathy Fulk Dwight and Ellen Hartman Calvin Wall Redekop Carol Heatwole Sandy Wampole Charles L. Heatwole Doris B. Heatwole George Heavner Louise Dolly Cook Barbara J. Henry, RMH School of Nursing Class of 1951 Lillan B. Hilbert John Steven Hensley Sr. Jo Anne Dean Rick Hernandez Mill Creek Church of the Brethren Bethany Class Elaine Hershey Arlena Rogers Charles E. Hill Mark A. Shifflett and Rebecca R. Hill-Shifflett Phyllis N. Himelright William E. “Ike” Himelright Harold Hinegardner William R. and Barbara H. Hite Jack Hinegardner William R. and Barbara H. Hite James F. Hoak Delores H. Hoak Mr. and Mrs. Ray H. Holsinger Margaret A. Alexander Ellwood and Ernestine Hoover Anne G. Farmer H. C. Hoover Anne G. Farmer Warren Hopkins Leila P. Hopkins Jo Ann Hottinger Dannie Samuel Hottinger Dr. Vida S. Huber Harold E. Huber Russell Edward “R.E.” Huffman Jr. Lillian C. Huffman

Mary Rimel Hulvey Clara Jean Comer Peggy Koiner Hylton Edward C. and Charlotte K. Hopkins Agustin Garibay Izqvierro Martha Guadalupe G. Alvarez Gerald “Gerry” Ernest Jacques Eddie Ney and Margee Greenfield-Ney Dr. Frank and Nancy W. Steller Joseph Yagloski William E. Jameson Polly A. Jamison Donald C. Jenkins Shelvy M. Jenkins Mary Doris Joecks Judith A. Miller Lynn and Diane Trobaugh Reverend Samuel P. Jones Jr. Sue Ludington Jones James B. Joyner Sr. Catherine W. Joyner Gary A. Judd Charles O. and Jacqueline P. Flick Lloyd C. Kern Frank H. and Tara M. Vetting Wilma Kern Dr. Bary and Ruth Berger Johnnie M. Kibler H. L. Jr. and Mildred R. Maiden Robert Knicely Brenda S. Knicely Sharon Ann Koontz John H. Koontz Carolyn Jean Landes Patricia L. Sayre J. Steven Landes Frances E. Ritchie Goldie Landis Dawn E. Evans Dr. George Lewis Lawson Elisabeth M. Lawson Margaret Deputy Lehman Edwin M. and Dianna R. Lehman Darla Faye Craft LePera Thomas C. and Doreen D. DeVore Terry and Judy LePera Allen G. and Kaethe J. Schick Linda Light J. Douglas Light James W. Liskey Jo Ann S. Liskey Mary Smith Liskey Belinda “Dawn” Cooper Lillian C. Huffman Diane M. Lepkowski Iona S. Pitts Debbey G. Roadcap David Stainaker Donald R. Litten Madeline W. Litten Ann Payne Long Dale D. Kipps Janet L. Long Carolyn Long Dickenson Leonard and Virginia Long George E. and Betty L. Painter Bennie Lough Bobbie K. and Joyce C. Lough Anne Lowery Nancy R. Bradfield William B. MacLeod Beverly T. MacLeod Jane Marshall James and Connie Hillyard Pauline Z. Martin R. Larry Martin George William Bill Martz Rosalee L. Martz Dallas E. Meadows Donna F. Meadows

Jim Messner Drs. A. Jerry Benson and Martha K. Ross Otho A. Boyers Mensel and Linda Dean Joseph K. II and Sallie Funkhouser Dr. Charles E. and Dawn F. Kern William K. and Lynette G. Latham Dr. William I. and Lynda D. Lee Donald R. and Nancy M. Myers Dr. Frank and Nancy W. Steller Debra D. Thompson Lynn and Diane Trobaugh Merv and Marlene Webb Joyce S. Michael Charles W. Michael Harlen Miller Shirley Allen Frederic and Martha Hoerr Ron and Linda Pope Gerald and Caroline White Ken Miller Rose M. Miller John Minnis Jr. Steven B. and Nancy C. Jones Thomas F. and Nancy D. Kilby Michael K. and Barbara L. McCall Frank Moore Vernon M. Jr. and Glenna Dale Payne Thomas Lewis Frank Moore Darrell B. and Vickie Moss Hulver Margene Moore George and Cary Hevener Phyllis J. Morin and Brenda Morin Bazinet Richard R. J. Morin Sam Morris Betty D. Morris Mother Charles and Janet Batten Virginia “Jenny Anne” Mowbray Jonathan and Melissa Rawley and Family Betty Myers John L. and Faye A. Lokey Marion E. Newkirk Sheryl L. Newkirk Barbara Ann Newman Carey K. Sr. and Gertrude L. Newman Richard L. Newman Shirley Osborne Arnold L. Osborne Holly Padgett John Christian Dorrance, John Charles Dorrance Jr., and Janine Ferretti, Jennifer Dorrance and Sean Furmage, David Dorrance and Tammy Dorrance, Mary Lou Dorrance, Kristie Siverts Dorrance, Lynn Siverts and Brett Sloan, Louise Engwer and Scott Engwer Donna Faye Parady Ashley Huyard Lewis Parady Richard L. Parker Jane Parker David O. Pauley John R. and Tina D. DeLapp Ashley Middlekauff Payne Tommy and Betsy Heatwole Glendye Hallie Bowman Pence Carolyn B. Pence and the Fred Pence Family Doris W. Petefish Jerry E. Petefish Norman Pirkey Michael and Brandon Theimer Jo Ann Pool John E. Pool Jr. Kimberly Harrison Prater Susan Diane Harrison Dorothy V. Price and Evelyn V. Stultz Rodney and Ruth Stultz Page and Ann Price, William and Wilda Houff Edmund and Deborah Price Carrie L. Prophet Bobby E. Prophet Etha Mae Propst Leila P. Hopkins Karen Puckett Robert and Deborah A. Ryder Harry and Rick Rawley Dennis and Mary Jane Rawley

w w w.S uppor tRMH.org

friends of the

RMH Foundation Phoebe Jo Reamer Reed Keith S. and Denise R. Atkins Christine Reeves Richard M. Reeves Harold E. Reid Rita Reid Marvin B. Rexrode Michael B. Rexrode Mr. and Mrs. Russel S. Rhodes Dr. Richard T. and Carolyn F. Wilfong Warren and Mattie Rhodes Jimmy J. Sr. and Carolyn R. Sheffer Elda “Jean” Ringgold William W. II and Barbara G. Williams Maurice F. Ritchie Frances E. Ritchie Phyllis R. Roberts and Gary L. Higgs Frances E. Ritchie Geraldine Rush Amy L. Rush Dorothy Saum, RMH School of Nursing Class of 1948 Lillan B. Hilbert Scotty Scafidi Debra D. Thompson Thomas Daniel Scanlon Martha G. Beddingfield Lyman and Rosemary Seese Lyman G. Seese Jr. William R. Seymour Lucy J. Seymour Janice Shanholtzer Skyline Chapter Model A Club Jo Ellen Shifflett Charles Randall Shifflett Lynwood S. Shifflett Rebecca A. Wood James E. Shirron Shriley A. Shirron Kay P. Showalter Goldie T. Showalter Delmas Siever Superior Concrete Inc. Arlie E. Smith Detra Shell Smith Ray V. Sonner Phyllis H. Sonner Terry and Glenda Spitzer Patricia A. Spitzer Linda Baer Sprinkel Mill Creek Church of the Brethren Bethany Class Captain Robert J. Stevens, USN Florence G. Stevens Karl Stoltzfus Jr. Dr. Charles E. and Dawn F. Kern Ronald Wade Stover Joseph and Sharon Buckner Tommy and Betsy Heatwole Glendye Terry D. and Linda M. Looney Virginia Council on Economic Education Wayne A. Strawderman Esther J. Strawderman Thelma Stroop Kenneth R. and Ruth A. Getz Suzan M. Stuart Luther G. Stuart Jr. Owen Guy and Eileen Dove Stultz Jon D. and Karen S. Whetzel Diana Cline Summers Frank M. Summers Andrew Surchek Mary L. Surchek Dr. G. G. Tanner Don A. and Carole T. Landes Phillip Taylor Peggy B. Cook Terry Raye Taylor D. Kevin and Laura Meadows Ruby D. Thacker Jon D. and Sandra H. Ritenour Herbert Theimer Michael and Brandon Theimer Florence A. Trelawney Gilbert S. Trelawny

48 |

SPRING 2021

Wayne and Betty Turner Phillip W. and Joanna T. Thompson Winston F. Turner Mary Miller Turner Mary V. Tusing Raymond W. Tusing Jane Van Ryan David O. Banks Fred VanPelt Dr. James and Julianne Colville Tony VanPelt Daisy H. VanPelt Fred and Freida Vetting Frank H. and Tara M. Vetting Daniel C. Voorhees Nancy Hopkins Voorhees Doug Wager Louis F. and Elizabeth D. Skillman Charles Winston and Jo Ann C. Wenger Jean Ann Wall Stephanie Ayoub Jean Ann Wall Elaine Barnes Flora H. Byrd Ann Ess Mayor and City Council - Greenville, North Carolina Julia and Mike Miller Leslie C. Moritz Mike and Linda Potter The Rochlis Family Jeff and Martha Reed and Bill and Lorraine Yake Warren and Barbara Zirkle Phyllis Dove Wampler Mr. Jodie E. Wampler Oscar and Ruth Warren Richard G. and Annie L Pierce Norris Elwood Weaver Lyn Simmons Weaver Walter C. Whitmore Tim Land John Widener Jr. Tommy and Betsy Heatwole Glendye Judy Wildman Carl E. Bradley and Beverly H. Scanlan Diane Downey Charles E. and Deborah A. French Charles I. and Mary E. Griffith Cynthia C. Hutchins Michael A. Kelley Cathy McCully Mary E. Modolo Suzanne Montgomery Glen E. and Linda C. Nielsen Pamela Scott C. F. and Janet L. Wagniere Riggin Waugh George E. and Jacqueline B. Zimmerman Mr. and Mrs. Everett E. Wilfong Dr. Richard T. and Carolyn F. Wilfong Golda V. Wimer Thomas E. Wimer Jr. Ruth Winchester James B. and Jean M. Hammond Maxine Wine Calvin B. Alger John “Yogi” Wolfe Jay L. Campbell Bill Woody Gary W. and Linda D. Hodge Nelson C. Wright Lyman G. Seese Jr. Frances E. Wyant (Mother) Evelyn S. Hedrick John and Joyce Zigler Randolph G. and Beverley Z. Nelson Blair Zirkle Maxine W. Zirkle

Honor Gifts Ibrahim Altin Helen Altin Any Cancer Patient James T. Sr. and Barbara R. Begoon R. Samuel Arthur, MD Martha Guadalupe G. Alvarez Ludmila I. Bird Heather Moneymaker James Brady Barbara D. Brady Ted and Cindy Bryan Darlene L. Newman Jennifer Bryant John J. Jr. and Linda W. Myers Sarah Cameron 2020 Services Charlotte L. Stover Camila Jessica W. Christopher, ED Nurse Donald L. and Ginger B. Usry Lawrence Conell, MD Martha Guadalupe G. Alvarez Joyce Davis Donald L. and Ginger B. Usry Delta Dean Carroll J. and Delta M. Dean My Wife, Lydia L. Dieck Colonel Peter F. Dieck Jim and Betty Dovel Donald L. and Ginger B. Usry Hampton W. Foley Mabel Anna Foley Sara Gosselin 2019 Services Charlotte L. Stover Sentara RMH Hahn Cancer Center Robbie Jean Zirkle Sentara RMH Hahn Cancer Center Nurses Donald L. and Ginger B. Usry Sentara RMH Hahn Cancer Center Nursing Staff Family of Mary Katherine Dove Dr. G. William and Dorothy Harper Robert and Sarah Rees Dr. Ann Reed Held Mae B. Guthrie Kathryn Haddiy Hill Mark A. Shifflett and Rebecca R. Hill-Shifflett Wanda Hollen, ER Nurse, Retired Terri Lynn Denton Ann E. C. Homan (Sister) James O. and Geralene C. Pryor Lindsay Kisamore Horst Richard L. and Joyce K. Strawderman Hospice Volunteers Horace E. Jr. and Sara G. Jones Elizabeth Kaestner Janice K. Miller Kennedy Family Donald L. and Ginger B. Usry Robert M. Kyger, MD Foelke D. Nair Donald Lemish Denise A. Whitman Nancy Lemish Birthday September 22 Denise A. Whitman Nancy Mandeville Chuck and Dawn Kern Karen Moyers Robert S. and Patricia M. Scott Judith S. Strickler John B. Mansfield, MD Martha Guadalupe G. Alvarez Kristopher Maul and Natalie Hensley Anna-Christy Carson Lewis F. Moore Keith A. and Luanne K. Higgs In honor and in memory of my loved ones you have cared for Mona C. Ageon Men and Women who contributed to the recovery of My wife, Karin Mars David A. Mars All Nurses - All are Wonderful Roger and Judy von Seldeneck

Allyson, Haylee and Sophia Papp, My Great Granddaughters Juanita M. Taylor Deborah Powers James R. and Mary C. Sherman Patra H. Reed Lyle C. and Georgianne M. Hull Barbara Ritchie Tommy and Betsy Heatwole Glendye Cathy Roadcap Donald L. and Ginger B. Usry Brian E. Robinson, MD Amy E. Burke Delores H. Hoak John and Cindy Reeves Kathleen M. Williar Nell C. Wright Emily Ryan Robert P. Hall Carolyne Schuckman Susan L. Schuckman Sentara RMH Medical Staff and Volunteers Douglas M. and Vickie K. Rawley Amber and Conner Smith Donald L. and Ginger B. Usry Johnson Smith Granville L. and Betty L. Richards Joyce Smith Robert L. and Patricia A. Taylor David E. Solomon David E. and Marilyn S. Solomon John Sponaugle Shirley M. Beale Anna Hartbarger Bob and Carrie Talbott Beatrice Stidley Bonnie Lee Stidley Karen Thayer Adam and Caitlin Berkey Hugo A. Tholen David V. and Claudia A. Pascarella Ann Trobaugh Betty Diehl Diane E.Trobaugh’s 75th Birthday Denise A. Whitman LeDhu Tynes Carroll T. Lisle Christine M. Urbanski, MD Family of Mary Katherine Dove Roberta (Robbie) and Robert K. Wilkins John Walsh, MD Martha Guadalupe G. Alvarez Janice Weiderman Donald L. and Ginger B. Usry John Wenger, MD Martha Guadalupe G. Alvarez All West Virginia Patients who depend on RMH Robert E. and Ruby D. Phares Krista L. Whetzel, Nurse At Sentara RMH Brenda W. Fawley June White Tommy and Betsy Heatwole Glendye Mary Helen Witt, MD Karen Sue Sponaugle Kennneth Lee Thomas Jr. and J. Faye Hoover-Thomas Nurses in Wound Care Bonnie Lee Stidley Dr. Paul Yoder Daryl D. Gum Karen Zirk Roy E. Jr. and Carolyn M. Zirk

S E N TA R A S LE E P CE N T E R

HAS SLEEP BECOME A NIGHTMARE? One out of three Americans may have a sleep disorder. The nationally-accredited Sentara Sleep Center provides evaluation, diagnosis and treatment of disorders that occur during sleep, as well as disorders that affect alertness.

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