Read Now - Sentara

Reverse Total Shoulder Replacement
Restores Function Sooner
CT Scan for Lung Cancer Screening/
Examen de detección de cáncer de pulmón
Sentara RMH Recognizes
2014 Safety Champions
PAGE 14
PAGE 18 /PÁGINA 19
PAGE 34
healthQuest
SPRING 2014
Stroke Can Occur
at Any Age
Quick Treatment is Key
to Full Recovery
PAGE 20
COVER STORY
Caring for Our Youngest Patients
Pediatric Hospitalists Provide 24/7
Care to Kids at Sentara RMH
PAGE 8
president’s message
T
his May marks the third anniversary of the merger between RMH and Sentara Healthcare.
Our board of directors made the decision in 2010 to choose a merger partner to enable RMH to not
just survive in the turbulent new world of healthcare, but to thrive in it. Our partnership was finalized in
May of 2011. And, as expected, much has changed in the state and national healthcare landscapes since
that time.
The Affordable Care Act has been passed and the national health exchanges have launched. Healthcare
reimbursement is moving from a “fee for service” model to a “pay for value” model, where payment is based
not on how many patients are seen, but on the outcomes for those patients. Healthcare providers currently
straddle the old and new healthcare realities, and more changes loom ahead as we continue to transition to a totally new era in care delivery.
Our merger with Sentara has positioned us well to navigate these tempestuous waters. As a system of community hospitals, we are always looking ahead at ways to provide
efficient and effective care, delivered with a compassionate touch. Product standardization, volume purchasing and shared technology are helping us to improve safety and
quality and appropriately adjust our costs at a time when the government is reducing its
reimbursements even more.
At a time when many hospitals and health systems are taking drastic measures in
reaction to increased costs and decreased payments, Sentara stands firm on its commitment to remain strong for its patients, its employees and the communities it serves.
We’ve come to accept that change in healthcare is constant . . . but so is the Sentara
RMH commitment to improving health every day. With the power of the Sentara
system, we can continue to grow and develop programs and services that best meet the
Jim Krauss
needs of our community. You’ll read in this issue of HealthQuest about some of those
President,
programs and services, including the following:
RMH Healthcare
• Ourpediatrichospitalistprogram,whichensuresaround-the-clockcareforour
Corporate Vice President,
youngest patients as well as continuity of care from the Emergency Department to
Sentara Healthcare
inpatient care and home again;
• TheVITEK® mass spectrometry system, a new lab technology that allows us to
identify disease-causing germs faster so that patients can be treated more quickly;
• Reverse total shoulder replacement surgery, offered by Sentara RMH Orthopedics and Sports Medicine, an innovative new procedure that can help some people who are not candidates for traditional
shoulder surgery;
• The introduction of Xofigo® at the Sentara RMH Hahn Cancer Center to treat advanced prostate cancer that has metastasized to the bones; and
• The initiative to transition several of our health centers to “patient-centered medical homes,” a move
that helps us provide care in the most appropriate way for patients in a new era of healthcare delivery.
There’s lots more to read about, including a “music and medicine” collaboration between Sentara RMH
Hahn Cancer Center patients and JMU music students, recognition of our employee patient safety champions, and an update on our exceptional volunteer services program. You will also read the inspiring story
of Daryl Brubaker of Broadway, a husband and a father of two young children, who suffered a stroke at age
32—and survived it, thanks to quick intervention in the Sentara RMH Emergency Department.
IhopeyouenjoythisissueofHealthQuestandthat,asyouread,youunderstandmoreaboutthe
mission of Sentara RMH to improve the health of those we serve. We are grateful to be your community
hospital and to continue receiving your support.
Sincerely,
JimKrauss
President, RMH Healthcare
contents
SPRING 2014
20
14
31
features
8
Pediatric
Hospitalists: 24/7
Care to Kids at
Sentara RMH
14
Reverse Total
Shoulder
Replacement
20
Stroke Can Occur
at Any Age
25
The Skin You’re In:
Protect It, So It Can
Protect You
31
Mass Spectrometry
System
34
Sentara RMH
Recognizes 2014
Safety Champions
38
Sentara RMH
Volunteers:
Ambassadors of
Compassion
43
Students and
Patients Bond
Over Music
44
Xofigo® for Advanced
Prostate Cancer
44
healthQuest
A health lifestyle publication by Sentara RMH Medical Center
2010 Health Campus Drive, Harrisonburg, VA 22801
RMHOnline.com
A D M I N I S T R AT I O N
35
President | Jim Krauss
Senior Vice President, Sentara RMH Medical Center,
President, Sentara RMH Medical Group | John A. McGowan, MD
Senior Vice President, Clinical Effectiveness | Dale Carroll, MD, MPH
Chief Financial Officer | J. Michael Burris
departments
3 Ask the Doctor
Diabetic eye disease, skin tags,
e-cigarettes.
6 Physician’s Perspective
Screening mammography does
save lives
13 Transformation of Care
Sentara RMH Medical Group
gains approval for first medical
homes in area
18 For Your Health
Lungcancerscreening:CTscan
for early detection
19 Sobre Su Salud
Senior Vice President, Operations | Richard Haushalter
51 Medical Staff Update
Sentara RMH welcomes new
professionals to the hospital and
community
54 RMH Foundation
The White Rose Giving Circle:
the power of compassionate
women united
56 Friends of the RMH
Foundation
Gifts received Sept. 19-Dec. 31,
2013
64 Jim Bishop
Going out on a limb for wellness
Tomografíacomputada(TC)
para la detección temprana de
cáncer de pulmón
Vice President, Human Resources Development and
Support Services | Mark Zimmerman
Vice President, Information Services | Michael J. Rozmus
BOARD OF DIRECTORS
Anne E. C. Homan, Chair | Howard P. Kern, President and COO,
Sentara, Vice Chair | Alden L. Hostetter, MD, Secretary |
Devon C. Anders | A. Jerry Benson, PhD |
David L. Bernd, CEO, Sentara | Joseph D. Funkhouser II |
Terry M. Gilliland, MD, Senior Vice President and CMO, Sentara |
James E. Hartman | Martha D. Shifflett
Executive Editor | Debra Thompson
Managing Editor | Neil Mowbray
Design and Production | Picante Creative
Cover Photo/Contributing Photographer | Tommy Thompson
Distribution | Karen Giron
CONTRIBUTING WRITERS
Luanne Austin | Jim Bishop | Karen Doss Bowman |
Thomas Bundrick, MD | Jeanette Kulju | Christina Kunkle |
Linda Morrison | Neil Mowbray | Alicia Wotring Sisk |
Robert Sisk | Whitney Thomas | Debra Thompson
Are we eating too much sugar?
Cut added sugar for better health.
36 Living With Synergy
Vice President, Business Development | Kay Harrison
Contributing Designer | Marc Borzelleca
28 Nutrition
35 Advance Care Planning
Peace of mind for you and
your family
Vice President, Acute Care Services and
Chief Nurse Executive | Donna Hahn
28
What to do in the meantime:
cultivate serenity in the midst
of uncertainty
© Copyright 2014 by Sentara RMH Medical Center. No part of this publication
may be reproduced or transmitted in any form or by any means without written
permission from Sentara RMH Medical Center. Articles in this publication are
written by professional journalists who strive to present reliable, up-to-date
health information. However, personal decisions regarding health, finance,
exercise and other matters should be made only after consultation with the
reader’s physician or professional adviser. All editorial rights reserved. Opinions
expressed herein are not necessarily those of Sentara RMH Medical Center.
Models are used for illustrative purposes only.
Please email comments or questions to
rmh_rmhhealthquest@sentara.com or call 540-564-7205.
47 Sentara RMH News
Announcing new practices opening, staff member promotions, a
new Board member
47
Q
Q:
ask the doctor healthQuest
What is diabetic eye disease?
D
iabetic eye disease
refers to a variety of
problems that people
with diabetes can face. The
main problems are
• Cataracts—a clouding of
the lens in the eye causing
decreased vision
• DiabeticMacular
Edema—swelling of part
of the retina responsible
Robert S. McCormick, MD
for the best vision
• ProliferativeRetinopathy—abnormal blood
vessels that form in the front of the eye causing
increased eye pressure or, more commonly, form
in the back of the eye and bleed.
Left untreated, diabetic eye disease can cause
severe vision loss or even loss of the eye. With early
treatment, however, diabetic eye disease can usually
be effectively treated.
People with diabetes often develop cataracts at
an earlier age than people without diabetes. Cataracts
can usually be treated with surgery. Diabetics are at
increased risk for some complications from cataract
surgery, but the majority of them do quite well.
Diabetic retinopathy is a major cause of decreased
vision and blindness among adult Americans. Elevated blood sugar from diabetes damages the small
blood vessels in the retina, the membrane that lines
the back of the eye and is responsible for creating the
vision signal. Early on, this results in micro-aneurysms, which are tiny ruptures of the blood vessels.
This leads to leakage of fluid and localized areas of
swelling.Atthisstagenotreatmentisneeded.Ifthis
gets worse, it can lead to significant swelling in the
macula(macularedema).Themaculaisthepartofthe
retina responsible for detailed vision like reading and
recognizing faces.
Macular edema is usually treated by a series of injections of medication directly into the back of the eye.
The medication helps stop the leakage from the blood
vessels. Sometimes laser surgery is needed to help
stop the leakage. The main goal of treatment is to help
prevent further damage to the retina, not necessarily
to improve vision. Often the vision merely remains the
same and does not deteriorate further.
Proliferative retinopathy occurs when severe
damage to the blood vessels causes the inside of the
eyetonotgetenoughoxygen.Inresponsetothis,
newbloodvesselsbegintogrow.Ifthisoccursonthe
iris, the colored part of the eye, it causes increased
pressure in the eye, which can cause blindness. This
usually requires laser surgery or, in the most severe
cases,invasivesurgery.Iftheretinaisaffected,the
new vessels grow up off the retina into the vitreous
gel that fills the back of the eye. They tend to be very
fragile and will often break and bleed. When this
happens, the back of the eye fills with blood that can
severelyimpairvision.Iftheabnormalbloodvessels
are discovered before they bleed, laser surgery can be
performed to help get rid of the vessels. Once bleeding occurs, it may require surgery to clear the blood
from the back of the eye.
People with diabetes should have an eye exam
that includes having their pupils dilated at least once
a year, and more frequently if needed. The longer a
person has diabetes, the greater the risk of developing diabetic eye disease. Early intervention for diabetic retinopathy can significantly reduce a person’s
risk of severe visual loss. However, once damage is
done, it cannot be undone, so prevention is the best
RMHonline.com
3
option. The best way to prevent these problems is to
keep the blood sugar under good control, not smoke,
and control blood pressure and cholesterol.
Ophthalmologist Robert S. McCormick, MD,
is in private practice in Harrisonburg. He joined
the Sentara RMH medical staff in 2001.
Q | What are skin tags?
What causes them, and are
they something I should be
concerned about?
Skin tags, also known as skin
barnacles or acrochordons,
are benign skin growths that
project or hang down from
surrounding skin. They’re
typically 1-10 mm in size,
and they grow from the
surrounding skin by a small
stalk. They’re usually the
same color as the surrounding skin or slightly darker.
Jerri A. Alexiou, MD
They are very common
and usually harmless. Generally, they do not cause a
problem unless they become irritated from rubbing
against clothing or another body part.
Skin tags can occur almost anywhere on the
body, but the most common areas are the base of the
neck and the armpits. Other common places include
the eyelids, the folds of the buttocks or groin, and
under the breasts, especially in women with larger
breasts or women whose bras rub them under the
breasts.
No one knows what causes skin tags, but they
seem to occur in areas where there is friction or rubbing on the skin. Overweight people seem especially
prone to developing skin tags, but more than half of
the general population develops them at some point
in their lives. They’re most common in the middleaged, especially up to about age 60, but children
and toddlers also develop skin tags, especially in the
underarm area and on the neck.
Skin tags do not usually have to be treated unless friction causes them to become painful. People
may choose, however, to get rid of them for cosmetic
reasons. Skin tags are removed by minor surgery, by
freezing them with liquid nitrogen or by clipping
them off. All three removal methods are performed
inaphysician’soffice.Ingeneral,peopleshouldnot
remove skin tags at home because of the risk of
infection or heavy bleeding.
4
healthQuest | Spring 2014
Sometimes dermatologists will
choose to do a biopsy on a skin tag
once it is removed, especially if it
is large or of a different color than
the surrounding skin. The reason
for doing the biopsy is to verify
that the skin tag is not malignant
(skincancer).
Skin tags can come back after being taken off, but there is no truth to the belief that
removing them will cause more to appear. Often,
women will shave them off when shaving their armpits. This is common and should not be a cause for
concern because the skin tags are generally very small.
Skin tags also can fall off on their own if the blood
supply through the stalk is cut off for some reason.
Inthatcase,theskintaggenerallyturnsdarkredor
purple and may become painful before it drops off.
Jerri A. Alexiou, MD, is in private practice at
Harrisonburg Dermatology. She joined the Sentara
RMH medical staff in 2001.
Q | What are e-cigarettes?
Are they safe? Can they help
someone quit smoking regular cigarettes?
Electronic cigarettes, also known as electronic nicotine delivery devices, personalvaporizers(PVs)orvapes,
are battery-powered devices
resembling conventional
cigarettes. All e-cigarettes
contain a microcircuit which
is activated when a person
draws on the mouthpiece,
similar to taking a puff on a
cigarette. They also contain
a cartridge filled with liquid
Aklilu M. Degene, MD
nicotine plus humectant, a
substance that attracts and absorbs water molecules.
With each puff, a small amount of the solution in the
cartridge is vaporized, creating a visible mist without
smoke or flame. Many e-cigarettes also have an LED
at the end that lights up with each puff to simulate
the burning end of a real cigarette.
E-cigarettes were patented in 2004 and introduced into the U.S. market in 2007. Currently, there
are more than two million users nationwide, and
e-cigarettes constitute an industry of more than
$2billionannually.Todate,themanufactureof
e-cigarettes has not been regulated.
Electronic Cigarette
LED lights up when
the smoker takes a puff
Battery
Microprocessor controls
heat & light at the tip
Sensor detects when
smoker takes a puff
IntheUnitedStates,e-cigarettesarebeing
marketed aggressively as “lifestyle choice consumables.” They’re also promoted as a safe way to
help people quit smoking because they deliver a
lower concentration of nicotine while allowing
the user to experience the physical sensations and
mimic the behavioral aspects of cigarette smoking. Studies show that e-cigarettes deliver between
0.025milligrams(mg)and0.77mgofnicotine,
whereas tobacco cigarettes deliver between 1.54 mg
and2mg.(Inthiscomparison,15puffsonan
e-cigarette are assumed to be equivalent to smokingaconventionalcigarette.)
However, the use, safety, chemical contents
and general efficacy of e-cigarettes for smoking
cessation are subjects of considerable debate in the
scientificcommunity.Toxiccompoundsandcarcinogens identified in some brands of e-cigarettes
bytheU.S.FoodandDrugAdministration(FDA)
and Health New Zealand include diethylene glycol
and N-nitrosamine. Diethylene glycol is a toxic
substance that can cause leukemia, and nitrosamines are the same carcinogens found in tobacco
cigarettes.
Thus, e-cigarettes pose a challenge to clinicians whose patients have chosen to use them as a
replacement for cigarettes, to reduce the number of
cigarettes they smoke or for smoking cessation.
Health experts, policymakers and many
consumers have significant concerns about these
products, including the following:
• There is little information about the safety,
abuse potential and efficacy of e-cigarettes
(Nature,Sept.26,2013,v.501,p.473).
• E-cigarettes pose a serious danger of renormalizing smoking, of making it socially acceptable to smoke. Children, who often cannot
Heat vaporizes propylene
glycol & nicotine
Cartomizer (flavor cartridge) and disposable mouth piece.
It stores the nicotine & glycol mixture.
differentiate between regular and electronic
cigarettes, are getting the message that smoking
issociallyacceptable(LancetOncology,Vol.14,
Oct.2013).
• Nicotine is a highly addictive drug, and many
teens who start with e-cigarettes may be condemning themselves to a lifelong struggle with
addiction to nicotine and conventional cigarettes
(TexasDentalJournal,May2013,pp.442ff ).
• E-cigarettes may even delay a smoker’s decisiontoquitsmoking(NewEnglandJournalof
Medicine2011,Vol.368,pp.193-95).Arelated
concern is that e-cigarettes may result in dual
smoking, in which users continue smoking regular cigarettes in addition to the electronic ones.
The FDA and the World Health Organization
have warned against the widespread use of e-cigarettes as a smoking cessation product. And healthcare professionals point out that there have been no
clinical studies of the long-term effects of e-cigarette
use on health.
It’sbesttoerronthesideofcaution:protect
your lungs by avoiding both e-cigarettes and conventional tobacco cigarettes.
THERE IS
LITTLE
INFORMATION
ABOUT THE
SAFETY, ABUSE
POTENTIAL AND
EFFICACY OF
E-CIGARETTES.”
Aklilu M. Degene, MD, is on staff with Sentara
RMH Pulmonary Associates in Harrisonburg. He
joined the Sentara RMH medical staff in 2005. ■
RMHonline.com
5
physician’s perspective
RESPONDING TO THE REPORT ON THE CANADIAN STUDY:
Screening
Mammography
By Thomas Bundrick, MD
Does Save Lives
On Feb. 11, 2014, The New York Times ran an article with the title, “Vast Study Casts Doubts on Value of Mammograms.”
The article was based on the 25-year follow-up of a Canadian study published in the British Medical Journal. Both the
original research and the New York Times article challenge the medical community on its assumptions and recommendations regarding breast health. In particular, the article claims the Canadian study casts “powerful new doubts” about
the value of regular screening mammograms “in women of any age.”
I
welcome challenges like the
Canadian study and the New York
TimesarticlebecauseIbelieve
it’s good to “rock the boat” once
in a while. Maybe we don’t know what
we think we know. Broadly speaking,
the article claims that after followingmorethan89,000womenforup
to 25 years—who all began the study
between the ages of 45 and 59—it was
found that screening mammography
did not save lives but, in fact, led to
overdiagnosis and overtreatment.
First, let me applaud some of
thestudy’sconclusions.Idobelieve
screening mammography finds breast
cancers that will probably never become
clinically significant during the woman’s
lifetime.Ialsoagreethatscreeningwill
notsaveeveryone’slife.AndIfurther
agree that current treatment by our
oncologists and surgeons has greatly
improved the mortality rates of women
diagnosedwithbreastcancer.Icaneven
6
healthQuest | Spring 2014
agree that in some instances the medical
costs to the patient and community may
have outpaced the benefits of the medical workup and treatment.
ButwhataboutthenegativesI see
in the Canadian study? First, this is old
research with an extended follow-up.
Whenoriginallypublishedinthe1980s,
the study was severely criticized for the
poor technique and quality of the mammograms upon which the research was
based.Icannotpersonallyaddressthat
issue,butIwouldliketo pointoutthat
during the initial screening period, 524
cancers were found in the control group
on physical exam, with an average size
massof2.10centimeters(cm).Atthe
same time, 666 cancers were found by
screening mammography, with an average
masssizeof1.98cm.Ofthese,68percent
werepalpable(abletobefeltonbreast
self-exam)atthetimeofmammography.
The latter results do not correspond
with my experience as a clinician. As a
diagnosticradiologist,Ihavebeeninvolvedwithmammographysince1986,
andsince1994Ihavereviewedevery
breast cancer case at Sentara RMH.
Veryfewofthecancersdiscoveredby
screening mammography have been
palpable at the time of diagnosis.
In2013atSentaraRMH,wefound
43 invasive cancers with screening mammography. Of these cancers, 25 were less
than 1 cm, 15 of them were 1–1.5 cm, and
five tumors were larger than 1.5 cm. Also
in 2013, nine of these invasive cancers
were grade 3, the most aggressive type of
breast cancer. Yet, seven of these nine were
less than 1.5 cm, which, based on size, still
hadagoodprognosis.Tellthesepatients
that screening mammography did not
make a clinical difference!
The Canadian study reports that
26.7 percent of their screening cancers
were found as interval cancers; that is,
cancers that were found between yearly
mammograms. But our experience of
Dr. Bundrick reads a
screening mammography
study at the Sentara RMH
Funkhouser Women’s
Center. He has been
reading mammography
studies since 1986, and
since 1994 has reviewed
every breast cancer case
at Sentara RMH Medical
Center. Based on his
clinical experience, he
believes that screening
mammograms do save
lives.
interval cancers at Sentara RMH is
lessthan10percent.Inaddition,inthe
Canadian study, 30.6 percent of their
screening mammography patients were
node positive. This means that the breast
tumor has metastasized, or spread, to the
axillary(armpit)lymphnodes,asituation
that can often result in a worse prognosis
for the patient. But at Sentara RMH in
2013, nearly half of the Canadian number, or 16.3 percent, were node positive.
The New York Times article also
points out the more controversial issue
ofDCIS(ductalcarcinomainsitu),
the most common type of noninvasive
breastcancer.DCISiscancerthat
has started in the milk ducts but has
notspreadbeyondtheducts.Initself,
DCISisnotconsideredlife-threatening.BecauseDCISiscontainedwithin
the duct and is not life-threatening,
many physicians and researchers do not
evenidentifyDCISascancer.Now,
if we include atypical ductal hyperplasia(ADH)andlobularcarcinoma
insitu(LCIS),Icertainlyagreethat
we need a new paradigm to guide our
management of these lesions that are
notconsideredcancer.(NeitherADH
norLCISisbreastcancer.ADHisa
condition of abnormal cellular growth
inthebreastducts,whereasLCIS
is characterized by a proliferation of
abnormal cells in the milk glands.
Though benign, both types of lesions
increase a person’s risk of developing
invasivebreastcancer.)
Of course, it is screening mammography that finds these lesions, since
they are not palpable and generally produce no symptoms. But we should not
blame the modality for our lack of judgment in how to handle these pathologic
diagnoses. The medical community,
including oncologists and surgeons, as
well as patients, needs to re-evaluate its
response to these diagnoses. Watchful
waiting may be the paradigm for most
of these lesions.
Let me leave you with these
thoughts. There is strong research available that contradicts the Canadian study.
One such study is the 29-year follow-up
oftheSwedishTwo-CountyTrial,which
began in late 1977 and followed 133,000
women. The study’s first results, publishedin1985,showeda30percentdecrease in breast cancer mortality because
of screening mammography. Subsequent
follow-up has shown similar results.
TheSwedishTwo-CountyTrialhas
consistently claimed that this 30 percent
decrease in breast mortality is because of
screening mammography.
Interestedreaderswhohavethe
time and are so inclined may want to
review both the Canadian and Swedish studies to see what they think. After
studyingthisresearchmyself,Iwould
advise clinicians and their patients to
await word from our various national
societies, such as the American Cancer
Society or the American College of
Radiology, for guidance.
Inthemeantime,it’simportantfor
physicians and the general public to realize that mammography is like life—it’s
not simply a matter of black and white.
AtthistimeIpersonallybelieve
screening mammography does save lives
and we should stay the course. Current
guidelines based on the best available
research recommend annual screening
mammography beginning at age 40. As
a radiologist who has been actively involved with screening mammography for
nearly three decades and has reviewed
hundredsofbreastcancercases,Istand
bythoseguidelines.Ithinkthethousands of women whose lives have been
saved by early detection with screening
mammography would agree. ■
■ Thomas Bundrick, MD, is in practice
with Rockingham Radiologists, Ltd. He
joined the Sentara RMH medical staff
in 1986.
RMHonline.com
7
Pediatric
Hospitalists
Provide 24/7 Care to Kids at Sentara RMH
I
n January, a 12-year-old girl was brought
to the Sentara RMH Emergency
Department(ED)complainingabouta
problem with her throat. When David
Moyer-Diener, MD, examined her, he suspected it was a vocal chord dysfunction.
“ButitwasaconditionI’dneverseen
before,” says Dr. Moyer-Diener. So he called
one of the hospital’s pediatric hospitalists, who
recognized the problem right away. The pediatrician recommended an exercise to the child
and referred her to a specialist. Her relieved
parents were then able to take her home.
“Itwasalearningexperienceforme,”says
Dr. Moyer-Diener, “and the child received the
appropriate care.”
A New Way of Caring for the
Hospital’s Youngest Patients
The pediatric hospitalist program is new to
Sentara RMH, providing a valuable aroundthe-clock service to pediatric patients and their
families.Toofferthis24/7coverage,Sentara
RMH has hired four pediatric hospitalists. The
first came in April 2013 and the remaining
three came on board in summer 2013. They
work in 12-hour shifts every other week, so
one of them is always on the health campus or
on call.
Pediatric hospitalists, as defined by the
American Academy of Pediatrics, are pediatricians who work primarily or exclusively in
hospitals. They care for children in many areas
of the hospital, including the pediatric unit;
labor and delivery; the newborn nursery; the
8
healthQuest | Spring 2014
B Y L UA N N E AU S T I N
emergency department; and, in hospitals that
have these units, the neonatal intensive care
unit and the pediatric intensive care unit.
Pediatric hospitalists work with a child’s
regular pediatrician and other physicians and
providersinvolvedinthechild’scare.Ifthere
is a significant change in a child’s condition,
a pediatric hospitalist will update the child’s
pediatrician. When a child leaves the hospital, a pediatric hospitalist will give his or her
pediatrician an overview of the child’s hospital
stay and instructions for any further care, if
necessary.
“You see pediatric hospitalists in larger
hospitals, but this is new for smaller hospitals,”
says Joseph P. Sorenson, MD, the first pediatrician Sentara RMH hired as an inpatient
hospitalist. “The way healthcare is going, it will
grow.I’mexcitedtobeapartofitherefromits
beginning.”
Pediatric Care, Always There
Before coming to Sentara RMH, Dr. Sorenson was part of a private practice in Georgia.
Between seeing patients in the clinic and in the
hospital, he says, his work was demanding.
“So many pediatricians are overworked,”
he says.
He notes that “many pediatricians experience challenges balancing their practice, their
hospital patients and unassigned patients.”
Unassigned patients, he explains, are those
who either do not already have a primary care
physician or may be visiting from out of town
when they become ill.
The Care
They
Provide
The pediatric hospitalists at
Sentara RMH Medical Center
care for children with illnesses
and medical needs that
require hospital care.
The American Academy of
Pediatrics lists these:
•
•
•
•
•
•
Infectious conditions of
the blood, skin, lungs and
kidneys
Respiratory illnesses, such
as pneumonia and croup
Problems with chronic
illnesses, such as diabetes
and asthma
Common pediatric illnesses, such as influenza
and dehydration
Recovery from injuries
or surgeries
Care of newborns
In addition, pediatric
hospitalists often assist other
pediatricians, family practitioners, general surgeons
and specialists in caring for
children.
“We make rounds often
and are available for consultation with the family,” says pediatric hospitalist Dr. Joseph
Sorenson.
Providing care for the youngest patients at Sentara RMH Medical Center are, from
left, Jeannie Zigler, DO; Erika Shelburne, DO; Joseph Sorenson, MD; and Scott Cole,
MD. As hospitalists, they see pediatric patients only in the hospital.
RMHonline.com
9
Emergency physician David Moyer-Diener, MD,
consults with Dr. Erika Shelburne in one of
the ED’s four rooms specially decorated and
equipped for children.
Quality Care for Kids,
Closer to Home
One immediate benefit of the new pediatric hospitalist
program is the ability to keep children in the community
rather than sending them to other health facilities.
“In the past, some children have had to leave the
community because we didn’t have a pediatrician in
house all the time or we weren’t able to provide a certain
service,” says Sabrina Shiflett, director of Sentara RMH
Family Birthplace and Pediatrics.
Over time, however, Sentara RMH will be able to offer
more services to pediatric patients.
“Our pediatric hospitalists will provide assistance in
the care of children with medically complex problems;
children who need postoperative care; and those with
cardiac, gastrointestinal and pulmonary problems,” says
Jenay Mason, inpatient care manager.
Pediatric hospitalist Dr. Joseph Sorenson describes
these patients as “moderately to severely ill—the patients
who need more one-on-one care than clinical pediatricians have time to give because of their practice.”
This does not include the critically ill, who are still
transferred to other facilities as appropriate.
10
healthQuest | Spring 2014
Inthepast,ifachildwasadmittedtoSentaraRMH,
he would be seen by his regular pediatrician. This is still
allowed, of course, and a few pediatric practices still prefer
to care for their own patients in the hospital. But most
pediatricians are happy to collaborate with the pediatric
hospitalistsincaringfortheirpatients.It’sanadvantageto
them and their patients to have a pediatrician at the hospital
or on call 24 hours a day.
“A pediatric hospitalist program, aligned with community pediatricians, strengthens the continuity and quality
of pediatric hospital care provided at Sentara RMH,” says
Jenay Mason, the hospital’s inpatient care manager. “The
program also allows for more children to see their pediatrician for acute and well-child visits at their physician’s office.”
As Mason points out, evidence indicates that hospitals with a pediatric hospitalist model of care have shorter
lengths of stay, lower readmission rates and higher patient
satisfaction among child patients and their parents.
Sentara RMH generally admits 130 to 140 pediatric
patients, including newborns, per month. Like much of the
rest of the hospital, pediatrics is busier at certain times of
the year. During flu season—October through April—kids
come in with stomach bugs, dehydration issues and asthma
problems.RSV(respiratorysyncytialvirus)isanot-uncommon complaint. This is an asthma-like condition to which
babies and young children are particularly susceptible.
The good news, says Dr. Sorenson, is that “doctors in
theValleyarefindingouttheycansendthesepatientsto
us at Sentara RMH, which helps keep them close to their
families.”
In the Nursery: Checking Up on
the Littlest Patients
First thing in the morning, Erika Shelburne, DO, visits
the Family Birthplace. With nearly 1,750 births at Sentara
RMH per year, the nursery generally has between six and
20 newborns at any time.
Dr. Shelburne, a pediatric hospitalist who joined the
Sentara RMH staff in July 2013, examines and evaluates the
babies and talks with their mothers. She’s also available for
at-risk deliveries—for instance, premature births or when
there may be complications.
“Ifthebaby’sintroubleorthemotherisgettingtired,
we pediatricians can be there to help the baby,” Dr. Shelburne says.
Sabrina Shiflett, Family Birthplace and Pediatrics
director, says her departments have always had community
pediatricians on call for the nursery or high-risk deliveries.
Whathaschangedishavingpediatriciansin-house24/7.
“The way healthcare is going, [the pediatric
hospitalist program] will grow. I’m excited
to be a part of it here from its beginning.”
— Dr. Joey Sorenson
they feel comfortable and safe bringing their children here,
close to home.”
In Case of Emergency: The Doctor is In
says.
“It’sveryconvenienttohavethislevelofaccess,”Shiflett
Families seem to appreciate the hospitalists, too.
“Inthenursery,newparentscanaskquestions,say,about
circumcision,andI’mheretoanswer,ratherthanhavingthem
wait for their pediatrician to come in,” Dr. Sorenson says.
The goal of the Family Birthplace and Pediatrics is to offer
their patients up-to-date, evidence-based pediatric care. Not
only do they want to provide better care, but more services.
“We’regrowingourpediatricservices,”Shiflettsays.“It’sa
win-win for the community—the children, the
families and the pediatric offices.”
The ability to offer new services doesn’t
happen instantly, however. The pediatricians
are in place, but the hospital staff must also
be educated. For instance, the pediatric nurses
are getting additional training on caring for
children with diabetes. Dr. Shelburne says
childrenwithType1diabetessometimesdevelopDKA,diabeticketoacidosis,whichmay
require hospitalization and “very individualized treatments.”
“We’re training everyone on the healthcare team so we can care for those children
rather than send them to other facilities where
they may not have the family and community
supporttheydohere,”Dr.Shelburnesays.“I
hope parents feel a peace of mind that we have
professionals here at their local hospital; that
Dr. Scott Cole and staff nurse Anne Lowery,
RN, take care of a newborn in the nursery.
The pediatric hospitalist program was already in place when
Dr. David Moyer-Diener began working in the Sentara RMH
Emergency Department in summer 2013. He can attest to the
success of the collaboration, noting the program has helped
the ED improve care for its pediatric patients with the newest
and best evidence-based treatments.
“We don’t want to subject children to unnecessary testing, radiation or antibiotics,” says Dr. Moyer-Diener, the ED
liaison with the Pediatrics Committee. “We want them to get
maximum benefits and expose them to minimum risks.”
Even before the pediatric hospitalist program was
launched, community pediatricians had asked Sentara RMH
to make the ED more child-friendly, says Carlissa Lam, CNS,
clinical educator and a member of the Pediatrics Committee.
The changes made in the ED range from cartoon-character
bandages to child-appropriate equipment and a “pod” of four
cheerfully painted, kid-friendly exam rooms.
“We’re trying to make the ‘front door’ a little friendlier for
pediatric patients and their families,” says Sarah Birx, RN, an
ED nurse with extensive pediatric training.
In2013,theSentaraRMHEDsaw12,000patients
under the age of 17, so having a pediatric hospitalist on call
around the clock has been a real help to the physicians there.
Dr. Moyer-Diener figures he and the other ED physicians
“I like being in the hospital, getting to know
the families, being a part of letting the kids
heal. This is where my heart is.”
— Dr. Erika Shelburne
get assistance from a pediatric hospitalist at least once
a day.
“We call them with questions and concerns,” he
says. “They evaluate the patients and admit them if
necessary, or recommend a treatment.”
A small percentage of the pediatric patients seen
in the ED are admitted to the hospital, and even fewer
are transported to another health facility. Still, the ED
has the same goal as the Family Birthplace and Pediatrics departments: to offer more services to patients so
they can stay closer to home.
“The vast majority of ED pediatric patients are
treated and sent home,” says Marcus Almarode, RN,
director of the ED. “The ability to get a pediatric
consult at virtually any time is invaluable to our staff as
well as the patients and their families.”
A Heart for Helping Children
All of the new pediatric hospitalists are friendly and
easy to work with, Shiflett says. And they do not wear
lab coats.
“Kidsarescaredofwhitecoats,”Dr.Sorensonsays.
Other aspects of the hospital are also scary to
children,likegettinganIVintheirarmorhavingan
oxygen mask placed over their face. Dr. Shelburne says
the specially trained pediatric nurses are great at helping kids feel at ease.
Dr. Sorenson, a father of four, says he realizes that
parents are used to their child’s pediatrician and that it
may take time to learn to trust someone new. But he
wants the community to know that Sentara RMH has
board-certified pediatricians on staff.
SaysDr.Shelburne,“Ilikebeinginthehospital,
getting to know the families, being a part of letting the
kids heal. This is where my heart is.” ■
Sentara RMH Pediatric Hospitalists
Scott C. Cole, MD
Medical School: Uniformed Services University of Health Sciences
Internship: Wright State University
School of Medicine
Residency: Wright State University
School of Medicine
Board Certification: Pediatrics
12
healthQuest | Spring 2014
Erika L. Shelburne, DO
Medical School: Virginia College of
Osteopathic Medicine
Internship: Arnold Palmer Hospital
for Children/Orlando Health
Residency: Arnold Palmer Hospital
for Children/Orlando Health
Joseph P. Sorenson, MD
Medical School: University of
Miami School of Medicine
Internship: East Carolina University
Residency: East Carolina University
Board Certification: Pediatrics
Jeannie Zigler, DO
Medical School: Lake Erie College
of Osteopathic Medicine
Residency: Virginia Commonwealth University Medical Center
Board Certification: Pediatrics
Sentara RMH Medical Group:
Seeking to Establish Patient-Centered
Medical Homes in the Community
South Main
Health Center
S
entaraRMHMedicalGrouphasreceivedapprovalfromthe
NationalCommitteeforQualityAssurance(NCQA)tomove
aheadwiththeprocessofhavingthreeofitsprimarycare
clinicsrecognizedaspatient-centeredmedicalhomes.
According to the NCQA website,
the patient-centered medical home
is a way of organizing primary care
that emphasizes care coordination and
communication to transform primary
care into “what patients want it to be.”
NCQA notes that medical homes can
lead to higher quality and lower costs,
and can improve patients’ and providers’
experience of care.
The Sentara RMH health centers
seeking this recognition are East Rockingham Health Center near Elkton, and
the South Main Health Center and the
practiceofDr.RobinKollmaninHarrisonburg.
“Sentara RMH Medical Group is
excited about achieving this milestone in
care management,” says John McGowan,
MD, president, Sentara RMH Medical
Group. “We look forward to establishing
patient-centered care in our primary care
clinics. The patient-centered medical
home model will further enhance the
careourpatientsreceive.Italsowillbuild
stronger relationships between patients
and their caregivers. Thus, we can hope
to achieve better continuity of care,
higher quality and enhanced safety for
our patients.”
Sentara RMH Medical Group
began the recognition process more than
a year ago, according to Lisa Bricker,
RN, BS, director, Primary Care Services,
SentaraRMHMedicalGroup.To
achieve certification, she explained, the
clinics initially had to assess and redesign their patient care services to comply
with NCQA certification requirements.
Some aspects of the redesign were coordination of care, efficient transitions of
care, broad access to care and engaging
patients to actively participate in comanaging their health.
“This change process required
a tremendous group effort on the
part of the primary care providers,
practice managers and their clinical
team members,” Bricker says. “These
individuals worked to redesign care
delivery operations to ensure that they
are patient-centered, based on a team
approach, focused on expanded access
to care and driven toward improved
care outcomes.”
As part of the medical home model,
Bricker says the clinics each added
a number of additional patient and
provider team resources. These resources
included patient care coordinators,
East Rockingham
Health Center
behavioral health specialists, group
education meetings, chronic disease
management protocols and electronic
patient portals for patients to access
their electronic medical records.
“These initiatives have already
resulted in a rise in the clinics’ quality
metrics and a reduction in readmissions
and ED visits,” Bricker says. “The better
we can coordinate the patient’s care
outside of the hospital, the less they will
require such acute interventions.”
As the next step in the process,
Sentara RMH Medical Group will
submit clinic applications to NCQA
to determine the level of recognition
granted to these three clinics. Using its
quality metrics, NCQA will assign each
clinic a level of recognition based on
the degree to which it meets the high
standards of performance established
by NCQA Patient-Centered Medical
Home recognition.
“Level 3 is the highest level, and it
is within reach for each of these clinics,”
Bricker says. “We are really pleased that
we are to be able to offer this higher
level of care to all the patients we serve
in these clinics. We hope to expand the
model to other Sentara RMH clinics
over time.”
NCQA is a private, not-for-profit
organization founded in 1990 for the
purpose of improving the quality of
healthcare nationally. Learn more at
www.ncqa.org. ■
RMHonline.com
13
Reverse Total
Shoulder
Replacement
R
Helps Patients
Regain Shoulder
Function Sooner
BY LUANNE AUSTIN
ay Shifflett’s shoulder had been hurting for 15 years.
For a long time, he kept the pain at bay with physical
therapy and anti-inflammatory medicines like ibuprofen and acetaminophen. But in the past year, the pain
became unbearable.
Following reverse
total shoulder
surgery in January, Ray Shifflett
can now perform
his regular daily
activities free
of pain, including taking care
of his prize 1957
Chevrolet.
14
healthQuest | Spring 2014
“Icouldn’tsleep,Iwasinsomuchpain,”saysShif“I
flett,
flett,73,ofElkton.“Icouldn’tgetanyrelief.”
When simple activities like tilling the soil
in his garden, washing his car and doing tasks
around the house became too difficult, Shifflett
went to see his primary care physician at Sentara
East Rockingham Health Center.
An X-ray showed severe arthritis with associated changes in the shoulder that indicated
a severe rotator cuff tear. Shifflett, now retired,
blames the damage to his shoulder on the heavy
lifting he did for 10 years as part of his job.
He was referred to Chad Muxlow, DO, at
Medi
Sentara RMH Orthopedics and Sports Medicine, who determined that Shifflett was a perfect
candidate for reverse total shoulder replacement
surgery.
“I’dneverheardofitbefore,”saysShifflett.
Not Your Typical Shoulder
Replacement Surgery
Dr. Muxlow joined the staff of Sentara RMH in August 2013,
bringing unique skills as an orthopedic and sports medicine surgeon,
including the ability to perform reverse total shoulder replacement.
“It’snotacommonprocedure,”hesays.“It’sforashoulderwith
arthritis, in addition to a severe rotator cuff tear, that gets so bad,
nothing else can be done.”
Each year, thousands of people with shoulder arthritis undergo conventional total shoulder replacements, according to the
American Academy of Orthopedic Surgeons. However, this type of
surgery does not help patients, like Shifflett, with large rotator
cuff tears who have developed a complex type of shoulder
arthritis called “cuff tear arthropathy.” For these patients,
reverse total shoulder replacement may be the only
viable alternative.
“It’saprocedureforwhenthereareno
other options for the patient,” Dr. Muxlow
says. Candidates for the surgery are typically in their late 60s and older.
A conventional shoulder replacement device mimics the normal
anatomy of the shoulder: a plastic
“cup” is fitted into the shoulder
socket, and a metal “ball” is
attached to the top of the
upper arm bone, the humerus.
Inareversetotalshoulder
replacement, the socket and
metal ball are switched. The
metal ball is fixed to the
socket and the plastic cup
is fixed to the upper end
of the humerus.
“Itcreatesamechanical advantage by allowing the other muscles of
the shoulder to elevate
the arm without the
rotator cuff,” Dr.
Muxlow explains.
Inahealthy
shoulder, he
notes, the
RMHonline.com
15
Mary Russell is so
pleased with the
outcome of her
reverse total shoulder
replacement surgery,
performed by Dr. Chad
Muxlow in December,
that she hopes to have
the same procedure
performed on her
right shoulder. Her
husband, Willie, was
her primary caregiver
during recovery, she
says.
surgery, including blood loss and infection. Complications specific to a total joint replacement include
wear, loosening or dislocation of the components.
Quicker Return to
Shoulder Function
Shifflett was impressed with his surgery experience,
whichtookplaceinJanuary2014.Ittookabouttwo
hours. After the procedure, he spent one night in
the hospital. He returned home with his arm in a
sling and had physical therapy three times a week for
several weeks to work on his range of motion. His
physical therapy ended in March.
With reverse total shoulder replacement, the
rotator cuff muscles help shoulder function returns much sooner than with
position and power the
conventional shoulder surgery, says Dr. Muxlow.
arm during range of
“With rotator cuff surgery, the tendon must heal
motion. A conventional replacement device also uses
to the bone,” he says. “But with the reverse shoulder
the rotator cuff muscles to function properly. But in
replacement surgery, there’s no tendon repair to actua patient with a large rotator cuff tear and cuff tear
ally heal, just the surgical scar and tissues.”
arthropathy, these muscles no longer function. The
Mary Russell of Elkton says the only pain she
reverse total shoulder replacement relies instead on the felt after her reverse total shoulder replacement was
deltoid muscle to power and position the arm.
soreness from the surgery. Russell, 74, has suffered
“The surgery is technically demanding,” says Dr. with arthritis for many years. She had two successful
Muxlow. “Getting the stability and function is diffihip replacements in 2012. At the time, her orthocult to achieve because you’re changing the mechanpedic surgeon recommended the reverse shoulder
ics of how the shoulder functions.”
surgery, but she did not want to travel to CharlottesThe reverse total shoulder replacement has
ville for the procedure.
beendoneinEuropesincethe1980s;theU.S.Food
Russell continued to lose the use of her left
and Drug Administration approved its use in the
shoulder, even giving up her hobby of basket weavUnitedStatesin2003.Itcarriesthesamerisksasany ing. Then, in the summer of 2013, while stringing
The reverse total shoulder
replacement is so named
because the surgical
procedure reverses the
natural anatomy of the
glenohumeral joint in the
shoulder. The glenohumeral
joint (left) is a ball-andsocket joint, with the
“ball” of the upper arm
bone (humerus) fitting
into the cuplike socket
of the scapula (glenoid
fossa). Following reverse
total shoulder replacement
(right), the positions of
the ball and socket are
reversed. (Images courtesy of
Biomet Orthopedics)
16
healthQuest | Spring 2014
“Recovery from the reverse
shoulder surgery takes
about six to eight weeks. “
Ambition to be an Orthopedic
and Sports Medicine Surgeon
Dr. Muxlow knew as a teenager that he wanted to
be an orthopedic surgeon. As a high school athlete,
— Dr. Chad Muxlow
he injured his knee and needed surgery. A friend’s
father, an orthopedic surgeon, performed the procedure. Dr. Muxlow was impressed.
beans from her family garden, she experienced
“Ialwayslikedsportsandthemechanicalnature
extreme pain when reaching for beans from the
of the body,” he says. “So orthopedic sports medicine
basket.
wasaperfectfitforwhatIliketodo.”
“Iknewitwastime,”shesays.
After graduating from Michigan State UniverBy that time, Dr. Muxlow had joined the staff
sity(MSU)CollegeofOsteopathicMedicine,Dr.
of Sentara Orthopedics and Sports Medicine, so
Muxlow completed his orthopedic surgery residency
she was able to schedule the surgery at Sentara
at McLaren Orthopedic Hospital and Sparrow HosRMH.
pital through MSU. He completed his fellowship
“IwasthrilledIwasn’tgoingtohavetogo
in arthroscopy and sports medicine at Orthopedic
across the mountain or that my family wouldn’t
ResearchofVirginiainRichmond.
have to go across the mountain to visit or bring
Learning the reverse shoulder surgery “was just
me back and forth,” Russell says.
partofmytraining,”Dr.Muxlowsays.“It’ssomeShe had the surgery in December 2013. She
thingIcanoffertothecommunitythatnooneelse
was surprised at how well it went.
“I’mrealpleased,”Russellsays.“We’reblessed does.”
Shifflett is glad Muxlow brought his talents
to have Dr. Muxlow at Sentara RMH. He’s a very
to Sentara RMH. He says he’s had no pain in his
good surgeon.”
shoulder since the surgery.
She hopes to have the same procedure done
“It’sremarkable,”hesays.Nowhe’sabletodress
on her other shoulder.
himself, tie his shoes and slip on his coat with no
Recovery from the reverse shoulder surgery
pain.
takes about six to eight weeks, until the shoulder
“Irecommendthistoanyonewithshoulder
becomesstable,Dr.Muxlowsays.Inthemeanpain,” Shifflett says. “Go see Dr. Muxlow.” ■
time, no lifting, he adds.
Dr. Chad Muxlow,
of Sentara RMH
Orthopedics and
Sports Medicine,
is currently the
only orthopedic
surgeon in
the area who
performs reverse
total shoulder
replacement. The
surgery, he says,
is for a shoulder
with arthritis
and a severe
rotator cuff tear
that gets so bad
nothing else
can be done
for it. The X-ray
images show the
placement of
the prosthetic
devices after
surgery.
RMHonline.com
17
for your health sobre su salud
Lung Cancer Screening:
CT SCAN FOR EARLY DETECTION
Lung cancer is the number-one cause of cancer-related death in the
United States and is responsible for more deaths annually than breast,
prostate and colorectal cancers combined.
Why screen for lung cancer?
A landmark national study, the National Lung
ScreeningTrial(NLST),sponsoredbytheNational
CancerInstitute,hasindicatedthatscreeningwith
low-doseCTscanscanhelpfindthesecancersearly,
leading to a higher cure rate.
What is a lung cancer screening?
TheLungCancerScreeningisalow-doseCT(computedtomography)scan,whichisatypeofimaging. The scan covers the entire chest and provides a
more detailed look than a standard chest X-ray. The
screening exam takes about 15 minutes in total, with
the actual scan time lasting only five to 10 seconds.
What does the screening cost? Is it covered by
insurance?
Most insurers do not cover this type of screening.
Itisapersonaldecisionandaninvestmentinyour
health and peace of mind. The total cost is $250,
which you will pay at the time of service.
What happens after the screening?
You and your primary care physician will be informed of your screening results within five business
days.Iftheresultsareabnormal,yourphysicianswill
coordinate the appropriate follow-up appointments
and care.
Who should have this screening?
This exam is for patients who are at high risk for
lung cancer.
18
healthQuest | Spring 2014
What are the requirements to have the lung
cancer screening?
•
•
•
Age55-80andmusthavesmokedapackaday
for30years(orsmokedtwopacksadayfor15
years)
A current smoker OR a previous smoker who
quit in the last 15 years
No current symptoms related to lung cancer
(spittingupblood,unintentionalweightloss
of 15 pounds—if either of these symptoms are
happening,callyourdoctorimmediately)
OR:
• Age 50 or older and smoked a pack a day for 20
years(ortwopacksadayfor10years),plusone
of the following risk factors:
- Family history of lung cancer
- Personal history of any type of cancer
- Chronic obstructive pulmonary disease
(COPD)orpulmonaryfibrosis
- Exposure to radon, silica, cadmium, asbestos,
arsenic, beryllium, chromium, diesel fumes
or nickel
How do I schedule a lung cancer
screening?
Call 1-844-EARLYDX (1-844-327-5939). Our lung
screening coordinator will review your risk criteria
with you and will determine if you are eligible for
screening. If so, the scheduler will help you make
your appointment. ■
Examen de detección
de cáncer de pulmón:
Tomografía Computada (TC) para la detección temprana
El cáncer de pulmón es la causa número uno de muerte relacionada con
el cáncer en los Estados Unidos y es responsable por más muertes cada año
que el cáncer de seno, próstata y de colon y recto juntos.
¿Por qué realizarse exámenes de detección de
cáncer de pulmón?
¿Cuáles son los requisitos para el examen de
detección de cáncer de pulmón?
Un estudio nacional de punto de referencia, el Ensayo
NacionaldeExamendeDetecciónPulmonar(NLST,por
sussiglaseninglés)patrocinadoporelInstitutoNacionaldel
Cáncer, ha indicado que puédelos exámenes de detección con
TCdedosisbajapuedenayudaraencontrarestostiposde
cáncer temprano, lo que provoca una mayor tasa de curación.
•
¿Qué es un examen de detección de cáncer de pulmón?
ElexamendedeteccióndecáncerdepulmónesunaTC
dedosisbaja(tomografíacomputarizada)queesuntipode
diagnóstico por imágenes. El escáner cubre todo el pecho y
proporcionaunavisiónmásdetalladaqueunaradiografíadel
pecho estándar. El examen de detección toma aproximadamente15minutosentotal,yeltiempodelatomografíadura
sólo 5 a 10 segundos.
¿Cuánto cuesta el examen de detección?
¿Está cubierto por el seguro?
Lamayoríadelascompañíasdesegurosnocubrenestetipo
de exámenes de detección. Es una decisión personal y una
inversión en su salud y tranquilidad. El costo total es de
$250, que usted pagará en el momento del servicio.
•
•
Tenerunaedadentre55y80añosyhaberfumadoun
paquetedecigarrillospordíadurante30años(ohaber
fumadodospaquetesaldíadurante15años)
Un fumador actual O un ex-fumador que dejó de
fumarenlosúltimos15años
Notenersíntomasactualesrelacionadosconelcáncer
depulmón(escupirsangre, pérdidadepesoinvoluntaria de 15 libras—si ya tiene cualquiera de estos
síntomas,llameasumédicodeinmediato)
O:
• Tener50omásañosdeedadyhaberfumadoun
paquetepordíadurante20años(odospaquetesal
díadurante10años),ademásdeunodelossiguientes
factores de riesgo:
- Historial familiar de cáncer de pulmón
- Antecedentes personales de cualquier tipo de
cáncer
- Enfermedad pulmonar obstructiva crónica
(EPOC)ofibrosispulmonar
- Exposiciónalradón,sílice,cadmio,asbestos,arsénico,berilio,cromo,vaporesdieseloníquel
¿Qué sucede después del examen de detección?
A usted y su médico de atención primaria se le informará
de los resultados de su examen de detección dentro de los
siguientes5díaslaborables.Silosresultadossonanormales,
su médico coordinará la atención y las citas de seguimiento
apropiadas.
¿Quiénes deberían someterse a este examen
de detección?
Este examen es para pacientes que se encuentran en alto
riesgo de padecer cáncer de pulmón.
¿Cómo programo un examen de detección
de cáncer de pulmón?
Llame al 1-844-EARLYDX (1-844-327-5939).
Nuestro coordinador de evaluación pulmonar
revisará los criterios de su riesgo con usted y
determinará si usted es elegible para el examen
de detección. De ser así, el encargado de programar las citas le ayudará a programar una. ■
RMHonline.com
19
As Daryl Brubaker of Timberville did morning exercises at home
on Oct. 2, 2013, he began to feel lightheaded. Thinking he had
overexerted himself, he decided to slow down a bit and stretch.
Stroke
That’s when he realized that his right arm was numb.
C
B Y K A R E N D O S S B OW M A N
oncerned, Brubaker tried to tell his wife, Rebekah,
that something was wrong. But the right words just
wouldn’t come out of his mouth.
“It was weird—different words came out of my
mouth than the words I wanted to say,” says Brubaker, who is
just 32 years old. “That freaked us both out a bit. Neither of us
said it to the other, but we both suspected that I was having a
stroke. We still thought, ‘No way.’ I thought I was too young to
have a stroke, and there were no signs leading up to it.”
The couple bundled up their children, dropped them off with
relatives and drove to Sentara RMH. Brubaker walked into the
Emergency Department (ED) about an hour and a half after first
noticing his symptoms. He was assessed by a triage nurse, then
quickly taken to a room for evaluation by the stroke team. This
team, which includes an ED physician, a neurologist and several
nurses, confirmed that he was indeed having a stroke.
20
healthQuest | Spring 2014
CAN OCCUR AT ANY AGE
Daryl Brubaker was exercising
when he began experiencing
stroke symptoms, and he
maintains an active lifestyle
following his brush with
stroke. His doctors believe
his stroke may have been the
result of a genetic clotting
disorder, so he is taking medication to prevent another
occurrence. His advice to
anyone, regardless of age,
who thinks he or she is having
a stroke? “Call 911. Getting
to the hospital quickly is
the best way to ensure a full
recovery.”
RMHonline.com
21
Think FAST
Recognizethesignsandsymptomsofstroke
To learn and remember the signs of stroke, the American Stroke
Association urges the public to think FAST:
AfteraCTscanshowednobleedinginhis
brain, Brubaker was cleared to intravenously receive a clot-busting drug called tissue plasminogen activator, or tPA. This drug is considered
the gold standard for treating ischemic strokes,
which are caused by a blockage within a blood
vessel that supplies oxygen to the brain.
“The stroke team at Sentara RMH did an
amazing job,” says Brubaker, a branch manager
attheHarmonySquareofficeofParkView
FederalCreditUnion.“FromtheminuteIgot
there, they knew what was going on, and they
took it very seriously. A couple of nurses stayed
with me the whole time. They explained to me
everything that was happening and kept my
wifeinformedaswell.Iwashappywiththecare
Ireceivedandthewayeverythingwashandled.”
Time is Brain: Act Quickly
When a Stroke Attacks
Additionalsignsofstrokeincludethefollowing:
• Suddennumbnessorweaknessoftheface,armorleg
• Suddenconfusionortroubleunderstanding
• Suddentroubleseeinginoneorbotheyes
• Suddentroublewalking,dizziness,orlossofbalanceor
coordination
• Suddensevereheadachewithnoknowncause
Time is Brain: Call 911
22
It’s extremely urgent to seek immediate medical attention if you
or a loved one has symptoms of a stroke.
Bob Hume, advanced emergency medical technician (EMT)
with the Elkton Emergency Squad, provides a lot of stroke awareness education in the community. He urges people not to drive
themselves to the hospital. Instead, he says, call 911 and let the
rescue squad transport you there. They’ll get you there faster
and more safely.
“We can get to the patient quickly, and if the signs point to
a stroke, we can alert the hospital so that the medical team is
waiting for the patient upon arrival,” Hume says. “EMTs do not
diagnose, but we try to recognize what’s going on and do interventions if possible. Time is of the essence, and our goal is to get
patients to the hospital safely and as quickly as possible to give
them the best chance of a positive outcome.”
Janet Marshman, coordinator of the Sentara RMH Stroke
Program, acknowledges the important role EMTs play in positive
outcomes for stroke patients. “By calling brain attacks in as they
bring stroke patients to the hospital,” she says, “our Emergency
Medical Service providers are the foundation of our success with
our improved door-to-tPA administration.”
healthQuest | Spring 2014
A stroke, also known as a “brain attack,” is
a very serious medical emergency. The most
common type is the ischemic stroke, caused
by a blood clot that interrupts blood flow to
the brain. When brain cells are deprived of an
oxygen-rich blood supply, they die. That results
in permanent damage that may leave a patient
disabledorresultindeath.Infact,strokeisthe
fourth-leading cause of death in the United
States and a leading cause of disability, according to the American Stroke Association. And
anyone, no matter what age, race or gender, can
have a stroke.
Every second counts when a stroke occurs.
The countdown begins at the onset of the first
symptoms, which may include sudden weakness
or numbness on one side of the body, slurred
speech or language problems, dizziness, vision
problems, or headache. The first three hours are
the critical window during which a patient may
receive tPA, although, in certain limited cases,
the time can be extended. The tPA dissolves the
blood clot blocking the vessel and restores blood
flow to the brain.
“With stroke, time is brain,” says Dan
Chehebar, DO, a Sentara RMH neurologist
and medical director of the hospital’s stroke
program. “About 2 million neurons die each
minute during a stroke. With current treatment
therapies, you usually have up to three hours
to give the clot-busting drugs that may reduce
brain damage. We also know, however, that
the sooner people get the drug, the better their
chances are of making a good recovery. As time
goes on, more damage is going to occur. We want to
treat patients as quickly as possible to give them the
best chance of a full recovery.”
As an Advanced Primary Stroke Center—a
certification bestowed in 2012 by the Joint Commission, and later again that year by Det Norske
Veritas,bothindependentnationalhospitalaccrediting organizations—Sentara RMH has proven
its commitment to following nationally recognized
best practices for stroke care. The hospital meets a
number of quality measures, including delivery of
personalized treatment for stroke and coordinated
care among providers.
Members of the Sentara RMH stroke team are
specially trained and prepared to give stroke patients
fast and effective care. Janet Marshman, coordinator
of the stroke program, points out that the majority
of Sentara RMH stroke patients who qualify for tPA
receive the drug within the three-hour window from
the time they are “last known well,” or from the onset
of symptoms.
“Our goal is to give the tPA in less than 60
minutes from the time the patient arrives in the ED,”
Marshman says.
The drug cannot be used for patients suffering
from a hemorrhagic stroke—another common type
of stroke resulting from the rupture of a weakened
blood vessel in the brain. Even so, prompt treatment
isessentialforthesepatientsaswell.Incaseswhere
tPA is not an appropriate treatment option or neurosurgery may be needed, Sentara RMH works closely
with medical centers that provide comprehensive
stroke care to ensure that these patients have the best
possible outcomes.
Partnering with local emergency medical service
(EMS)providershasbeenakeyfactorinthesuccess
of the Sentara RMH stroke program, says Marshman. EMS providers help to prepare the patient
for arrival at the hospital by taking steps such as
performing the initial stroke symptom assessment,
making sure the patient is stable, and starting an
IV(intravenous)lineorconductinganEKG
(electrocardiogram)tocheckthe
heart’s electrical activity. They also
call the hospital en route to
activate the stroke team.
“We offer a continuum
of care for stroke patients
that begins with local
EMS and extends to our
Emergency Department,
the Critical Care Unit and
our designated Stroke Unit,”
Marshman says. “We’ve taken on
collaborative efforts to make sure EMS providers are able to identify symptoms of stroke and to
call the hospital as they transport the patient. As
soon as we know the patient is coming, we issue
a brain attack alert to mobilize the stroke team.
We are able to offer personalized care as soon as
the patient arrives at the hospital, and it continues
until they go home.”
Community Education
A critical component of Sentara
RMH’s stroke center certification is a commitment to
educating the community
about stroke symptoms
and the importance of
seeking medical help
quickly. Sentara RMH
offers stroke education
throughout the community—particularly during
Stroke Awareness Month in
Daryl and Rebekah
Brubaker found it
hard to admit to
themselves that he
was having a stroke
when the 32-year-old
began experiencing
stroke symptoms at
home last October.
Their quick response
meant Daryl received
the treatment he
needed for a full
recovery.
RMHonline.com
23
Reduce Your
Risk of Stroke
Certain medical conditions may increase
your risk of stroke, including high blood
pressure (hypertension), high cholesterol, heart disease, diabetes and obesity.
However, the National Stroke Association
says about 80 percent of strokes could
be prevented by making certain lifestyle
changes. These include:
■ Eatingahealthydietthatincludes
plentyoffruitsandvegetables.
Choosefoodsthatarelowinsaturated
fatsandcholesterolandhighinfiber
andantioxidants.
■ Maintainingahealthyweight.
■ Stayingactive.Aimforatleast30
minutesofphysicalactivitymostdays
oftheweek.
■ Quittingsmoking,andavoiding
secondhandsmoke.
■ Drinkingalcoholinmoderation.
■ Monitoringyourbloodpressureand
cholesterol.
■ Managingyourdiabetesbykeeping
yourbloodsugarlevelsundercontrol.
May—at venues such as the Rockingham County
Fair,theGreenValleyBookFair,andHarrisonburg
and Rockingham County public schools. The hospitalalsopartnerswiththeGreaterShenandoahValley
BrainInjurySupportGroup.
“Sentara RMH has been an invaluable resource
forourgroup,”saysKarenArnold,thesupport
group’s president. “A lot of people don’t associate
stroke with brain injury, so the hospital has done a
good job of helping people to understand how stroke
impacts the brain. They do a good job reaching out
to the community and making people aware of the
symptoms of stroke and how to prevent it.”
“Our focus is helping people understand that
stroke is as serious as a heart attack,” Marshman
adds. “We want people to take stroke seriously and
understand the importance of seeking medical attention right away if they or a loved one experience
symptoms of stroke.”
24
healthQuest | Spring 2014
A Positive Outcome
Brubaker recovered quickly from his stroke and is
grateful for the care he received at Sentara RMH.
Doctors believe his stroke may have been the result
of a genetic clotting disorder. He currently is under
the care of a hematologist who has prescribed a
blood thinner to help prevent another stroke.
“My takeaway from this experience is, if you
think you’re having a stroke, call 911,” Brubaker says.
“The rescue squad can call ahead to the hospital so
that the stroke team is ready to meet you at the door.
IrealizeIwasfortunatetohavearrivedatthehospitalintimetoreceivetheclot-bustingdrug,butItell
people not to mess around. Getting to the hospital
quickly is the best way to ensure a full recovery.” ■
To Learn More
Visit the National Stroke Association
online at www.stroke.org and the
American Stroke Association at
www.strokeassociation.org.
For information about the
Greater Shenandoah Valley Brain
Injury Support Group, visit www.
gsvbisg.com, or call 540-421-5610. The
group meets on the third Wednesday
of each month at the Harrisonburg
Rescue Squad. Meetings are free and
registration is not required.
Skin
YOU’RE
In:
THE
Protect It, So It
Can Protect You
I
t’sthepartofyourbodythatletsyoufeelandtouch.Itwrapsaround
youandprotectsyou.It’swhatyoushowtheworld.Handsdown,your
skin is an important and vital part of your health.
“Keepingyourskinhealthyhelpskeepthebodyhealthy,”says
Jerri Alexiou, MD, of Harrisonburg Dermatology.
Your skin is your body’s largest organ, and it affects multiple systems
withinyourbody,accordingtotheNationalInstitutesofHealth.Yourskin
keeps harmful bacteria and other germs out, helping you avoid infection.
Italsohelpsregulateyourbodytemperature,andcreatesvitaminDfrom
sunlight, which strengthens your bones.
So how should you care for this multitasking organ? Here are a few
basics.
1
Wear your sunscreen—always!
“The single best thing people can get in the habit of doing every day is
putting sunscreen on whatever is not covered by hair and clothing,” says Dr.
Alexiou.
Most people know to protect themselves from the sun: Wear sunscreen
when you’re outside and avoid the peak hours of 10 a.m.–2 p.m.
But you may be exposed to the sun more than you think. People who
spend a lot of time driving—truck drivers, for instance, or salespeople or
delivery drivers—may experience more sun damage, particularly on their left
side.That’sbecauseultravioletA(UVA)rayscanpenetrateglassunlessitis
very heavily tinted.
Sunscreen Q&A
IS HIGHER BETTER?
Dermatologists recommend wearing
sunscreen with a sun protection factor
(SPF) of at least 30. But are sunscreens
with SPF numbers higher than 30 even
better for our skin?
Not really, says Dr. Alexiou. “The
difference in protection between SPF
30 and higher numbers is very small,”
she notes. “If you plot a graph of UV
protection against sun protection, it
levels off at 30.”
WHAT ABOUT VITAMIN D?
Our skin makes vitamin D from
sunlight, and we need vitamin D for
strong bones, muscular movement
and transmission of nerve impulses.
But does the SPF interfere with that,
or can vitamin D still be made from
sunscreen-protected skin?
“Most folks who wear daily sunscreen still make enough vitamin D,”
says Dr. Alexiou. “But the active form
of vitamin D—the form that doesn’t
need sunlight for activation because
it’s already active—can be taken in
the form of a vitamin supplement. It’s
called vitamin D3.”
BY ALICIA WOT RING S IS K
RMHonline.com
25
The best protective strategy, says Dr. Alexiou, is
to apply sunscreen every day, rain or shine. Protect
your hands, arms, neck, face, and any other exposed
skin. Apply your sunscreen every morning and every
few hours throughout the day.
“It’sasimplethingtodo,butitmakesabigdifference,” she says.
When choosing a sunscreen, find one with an
SPF(sunprotectionfactor)ofatleast30,sheadvises.
It’sbesttochoosebroad-spectrumprotection,which
protectsagainstthesun’sUVAandUVBrays.An
overexposure to either type of ultraviolet radiation
can increase your skin cancer risk. There’s a wide
variety of sunscreens available, including powdered
ones that make it easy to re-apply over makeup.
Protecting your skin from the sun means you’re
also fighting the signs of aging, like wrinkles and
brown spots.
“Ifyou’reinthatdailysunscreenhabit,you’ll
be doing a lot of the antiaging work already,” Dr.
Alexiou says.
2
Get to know your own skin
When you’re comfortable with your skin, you’re more
likely to know when something is amiss.
People should check their own bodies about
once a month for anything unusual, Dr. Alexiou
advises. A quick look in the mirror before you get in
the shower will suffice.
“We always want people looking out for what
we call the ugly duckling sign,” she says. “We want
people to get to know what their moles look like, and
if they ever notice a mole that stands out—the ugly
duckling—then we would definitely want them to
come in and have it checked.”
3
See your doctor for screenings
Unlike many other health screenings, there are
no universally accepted guidelines for skin cancer
screenings, Dr. Alexiou says. The one exception is if
youhaveafamilyhistoryofmelanoma.Inthatcase,
doctors say you should be screened regularly starting
in your 20s. Otherwise, she generally recommends
people see a dermatologist every year or so to be
checked out.
Skin cancer screenings involve a simple look over
your skin by a professional—there’s no blood work or
biopsy unless your doctor finds something suspicious.
And skin cancer, if detected early, has a high cure rate,
according to the American Academy of Dermatology
(AAD).Basalcellcarcinomaandsquamouscellcarcinoma have a 95 percent cure rate, the AAD website
says. And melanoma has a near-100 percent cure
rate if spotted early. However, if it’s not caught early,
melanoma can be deadly.
4
Stay healthy inside and out
The relationship between your health and your skin
is a two-way street. Your skin can be a window into
the body, Dr. Alexiou says. For example, if your skin
is dry and itchy all over, it might be a symptom of
Know Your ABCs . . .
and D’s and E’s!
When you’re examining your skin for moles,
the American Academy of Dermatology
recommends looking for the ABCDEs:
Asymmetry — If you drew a line in the middle,
are the two sides different?
Borders — Are the borders uneven or undefined?
Color — Is the mole multicolored?
Diameter — Is the mole more than ¼-inch wide
(about the width of a pencil eraser)?
Evolving — Is the mole changing or getting
bigger?
If you find something suspect or odd looking,
call your doctor.
26
healthQuest | Spring 2014
a more serious health problem like thyroid disease.
And cuts or sores on your skin can lead to a greater
risk for infection. That’s why it’s important to keep
your whole body healthy.
Eating a nutritious, balanced diet and drinking
plenty of water isn’t just good for the rest of your
body, it also helps keep your skin in top shape.
“Eat a wide variety of fruits and vegetables,
especially ones that are high in antioxidants that can
help both the appearance and the function of your
skin,” Dr. Alexiou says.
There’s no multivitamin that can give you the
same well-rounded benefit as a mix of beneficial
foods, she notes. Since so much of your skin is made
of water, it’s important to stay well hydrated.
Caring for your skin at every age
Over time, your skin changes, and damaging effects
from the sun set in. Pores get larger, and wrinkles get
deeper. Your skin can lose its elasticity and become
drier and thinner. But there are safe and proven ways,
in addition to sunscreen, to improve the health of
your skin as you age, says Dr. Alexiou.
A few over-the-counter options include glycolic
acid and alpha hydroxy acid, which are relatively
inexpensive ways to help rejuvenate skin. These
measures are appropriate at any age, but you can start
them as early as your 20s or 30s.
“By the time people are in their 40s and 50s,
they’re ready to go to something more aggressive,”
she says.
At that time, doctors may prescribe a topical retinoid, an antiwrinkle and antiaging skin rejuvenating
cream. For those who can’t tolerate the prescriptionstrength cream, the over-the-counter form, retinol,
can still benefit the skin’s health.
And the cream does more than simply improve
howtheskinlooks,Dr.Alexiouexplains.Itcanactually prevent skin cancer changes.
At 60 or 70, the skin becomes drier, and may
need a creamier sunscreen or moisturizer. For extremely dry skin, she recommends petroleum jelly.
Skin fragility—where the skin tears easily—may
also become an issue for people in their 60s or 70s.
But skin fragility is an effect of sun damage, and
once fragility becomes a problem, it can’t be reversed,
Dr. Alexiou notes.
“Iwishyoungpeopleandevenpeopleintheir
40s understood how much of that skin fragility
comes from the sun,” she says.
Dr. Alexiou adds that she’s seen farmers who,
after years of daily sun exposure on their arms and
hands, have skin that bruises and tears very easily.
SINCE SO MUCH OF YOUR
SKIN IS MADE OF WATER,
IT’S IMPORTANT TO STAY
WELL HYDRATED.
“Once that fragility is there, the only thing you
can do is wear long-sleeve shirts or thicker clothing
to help prevent the damage,” she says. “You just have
to baby your skin more.”
That’s why ultimately wearing sunscreen is the
best thing you can do to protect your skin’s health
throughout your life. Though women tend to be
more concerned about their appearance as they age,
men should also protect themselves from sun damage
by using sunscreen.
“Iputitonmyfaceandneckeveryday,nomatterwhattheweather,nomatterhowlongI’mgoing
tobeoutside,”Dr.Alexiousays.“It’sagreatthingto
start in your teens or 20s.” ■
RMHonline.com
27
nutrition
Are We Eating
Too Much Sugar?
CUTTING ADDED SUGAR CAN LEAD
TO BETTER HEALTH
Who really wants to forego having a piece of their son’s birthday cake,
enjoying some of Grandma’s special cookies at Christmas, or sipping
delicious sweet tea on a hot summer’s day?
By Linda
Morrison, MS,
RD, CDE, and
Whitney Thomas,
RD, CDE
U
nfortunately, it’s not just these occasional
treats that add sugar in our diets; sugar
iseverywhere.It’shiddeninscoresof
foods where we would least expect to find it—in “heart-healthy” cereals,
for example, and in low-fat foods, yogurt,
whole wheat bread, peanut butter, salad
dressings, protein bars, pasta sauce and
crackers. And that’s just to name a few;
the list goes on and on.
TodaytheaverageAmerican
consumes22–28teaspoonsofadded
sugar a day. That’s more than three
times the roughly six teaspoons per day
maximum recommended by the American
Heart Association 1.
What exactly is sugar, and what are
“added sugars”?
“Sugar” is a general term for simple carbohydrates—
chemical substances that consist of carbon, hydrogen
and oxygen atoms. Sugars are found primarily in
plants. They come in many molecular forms, depending on the arrangement of the atoms, and from a
variety of sources. Each form of sugar has a different
name.
Most of these names end in –ose: glucose, sucrose,
fructose, lactose, maltose and so forth. Glucose, also
known as dextrose, is found widely in plants and is
the form of sugar that our body’s cells use for energy.
Fructose, or fruit sugar, is found primarily in fruits,
flowers and berries. Maltose is found primarily in
barley.
28
healthQuest | Spring 2014
Many of these simple sugars have a sweet taste
and are used for food. Common table sugar, the white
stuffinthesugarbowl,issucrose.Itismadeupofhalf
fructose and half glucose. Brown sugar is simply table
sugar with molasses added.
Fruit contains a mixture of fructose, sucrose and
glucose. High fructose corn syrup, a manufactured
substance not found in nature, is generally 55 percent
fructose and 45 percent glucose.
Milk sugar, or lactose, contains half glucose and
half galactose. Maltose, a component in the process of
brewing beer, is simply two glucose molecules bonded
together.
Starches like grains, legumes and starchy vegetables consist of many glucose molecules bonded
together.
The term “added sugar” refers to any sugar, natural
or manufactured, that you use in your own cooking or
add at the table, as well as sugar that’s been added to
the prepackaged and processed foods and beverages
we consume. Added sugar does not include artificial
sweeteners like SPLENDA®, Sweet‘N Low® and
Equal®.
Knowingthenamesofthevariousformsofsugar
will help you spot added sugars listed on food labels.
What happens inside the body when we
eat sugar?
When a person consumes sugar, the various parts are
metabolized(brokendownandabsorbed)differently.
Glucose and galactose enter the blood stream from
the small intestine and are absorbed by all body cells.
This triggers a blood sugar spike and the release of
insulin, which counteracts the spike.
Fructose is metabolized primarily by the liver.
When consumed in excess, fructose triggers the liver
to convert the excess to fat. This fat is stored in the
liver or released into the blood stream and is referred
toastriglycerides.Ifthefructoseweconsumeisin
liquid form like soda, sports and energy drinks or
juice, it enters the liver more quickly than if the sugar
is in a food that contains fiber, which slows the body’s
absorptionofthesugar.(Thesweetenersusedinmany
drinks today—sucrose or high fructose corn syrup—
bothhavefructoseinthem.)
Researchers around the globe now suspect that
fructose makes up roughly half of most sugars consumed by humans and is more likely to land on your
belly than somewhere else. Eating too many calories from any source—sugary drinks, alcohol, fatty
burgers and fries—can expand a person’s waistline.
However, calories from excess fructose may be more
likely than other types of sugar to end up around
your midsection.
Since2009,researchbyKimberStanhope2 at the
University of California at Davis, as well as research
at the University of Minnesota3, in Denmark4 and
in Switzerland5, shows the same trend when human
subjects are given beverages sweetened with different
sugars. When the research participants consumed as
few as one to two cans of soda containing either fructose or sucrose daily for three weeks, they experienced
an increase in visceral fat, also known as deep belly
fat. This did not happen with glucose.
Stanhope also saw another disturbing trend: an
increase in small, dense LDLs with greater fructose intake. Small, dense LDLs are the cholesterol
particles that are more damaging to arteries than the
fluffy, large LDLs.
What’s the big deal with belly fat?
A person with visceral or deep belly fat is generally
at higher risk of heart disease and diabetes than
someone with fat on the hips or fat just below the
skin. Any significant increase in the levels of these
liver-produced fats often results in insulin resistance
or metabolic syndrome.
Insulinisahormoneproducedinthepancreas
that allows glucose from the blood to enter the
cells, where it is used as energy. When our body’s
cells become resistant to insulin, the body tries to
compensate by producing more and more insulin
until eventually the pancreas may become exhausted.
Without enough insulin, levels of blood glucose rise
and diabetes can develop.
The term “metabolic syndrome” refers to the
condition of a person who has insulin resistance
combined with a high triglyceride level, low levels of
HDLcholesterol(thegoodcholesterol),andalarge
waist compared to one’s hips.
So how much sugar is safe to consume?
Robert Lustig, MD, is a professor of pediatrics in
the Division of Endocrinology at the University of
California, San Francisco. He is also an expert in
childhood obesity, and he frequently lectures about
how excess sugar in the diet acts as a toxin or poison.
Dr. Lustig recommends that Americans begin by
decreasing their consumption of added sugars from
our current average of 25 teaspoons to about 12
teaspoons, or about 200 calories daily 6.
In2009,theAmericanHeartAssociation
suggested a limit for women of no more than 100
calories from sugar per day, and for men of no more
than 150 calories from sugar7. This would be less
than one can of soda, about six fluid ounces of fruit
juice, or two regular Oreos.
Top 10 Foods
Where You
Would Least
Expect to
Find Added
Sugar
1 Sports drinks
(like Gatorade)
2 Some “whole
grain” cereals
(like Kashi Go
Lean Crunch,
Raisin Bran)
3 Salad dressing
4 Dried fruit
5 Flavored
oatmeal
packets
6 Sauces
(spaghetti,
marinades,
ketchup, BBQ)
7 Fruit juice
8 Flavored
yogurt
9 Energy bars/
sports bars
10 Fruit
smoothies
How can I begin cutting back on added
sugar in my diet?
Don’t try to cut drastic amounts of sugar out of
your diet all at once. Doing so can often result in
frustration and failure as you begin to feel deprived
ofsomethingyougenuinelycrave.Instead,follow
these tips to reduce the amount of added sugar in
your diet.
• Weanyourselfoffsugargradually.Ifyouscale
back slowly, you may be pleasantly surprised to
findthatyoursugarcravingsdecrease.Ifyou’re
used to drinking regular sweet tea, try adding
one-third unsweetened. Then eventually add
RMHonline.com
29
Does Sugar
“Feed Cancer”?
✮ By Robin Atwood, MS, RD, CSO,
clinical dietitian at the Sentara RMH
Hahn Cancer Center
A few studies have proposed that
sugar elevates risk of certain cancers, but this has not been proven.
The problem may not be the sugar,
but the insulin we produce when
we eat lots of simple sugar. Chronically elevated insulin levels increase
inflammation in our bodies and
create an environment that may
promote growth of certain cancers.
Sugar consumption also promotes
obesity, which does raise cancer risk.
In addition, those who consume
large amounts of sugar typically eat
fewer cancer-protective fruits and
vegetables and more fatty meats,
which may account for an increase in
cancer risk.
To date, research has not shown
that sugar “feeds” cancer cells any
more than sugar feeds all cells in
our body. Our bodies need glucose
(simple sugar) for energy. Our bodies
break down carbohydrates, such as
bread, cereal, pasta, fruit and starchy
vegetables, into glucose. If you cut
every bit of carbohydrate out of your
diet, your body will make glucose
for fuel from other sources such as
protein and fat.
It is important to note that sugar
increases caloric intake without
providing any of the nutrients that
reduce cancer risk. Because sugar
and refined carbohydrates contain
“empty calories” lacking nutritional
value, it is wise to eliminate these
non-nutritional carbohydrates and
sugars like desserts, and refined
starches like white bread, and focus
on including cancer-protective plant
foods, such as whole grains, whole
fruits and vegetables, as energy
sources.
30
healthQuest | Spring 2014
•
•
•
one-half unsweetened, and eventually two-thirds unsweetened. Your
taste buds will adjust over time.
Don’t drink your sugar. Sweetened
beverages such as regular sodas,
juices and caramel macchiatos are
abigsourceofsugar.Ifyou’retrying to drop weight, nixing sugary
drinks can easily help you slash
500 calories a day, or more, from
your diet.
Curb your sugar cravings with fruit.
Fruit contains natural sugars along
with fiber that slows your body’s
absorption of sugar and can help
prevent sugar highs and lows.
Everything in moderation. On
those special occasions when you
do allow yourself to indulge your
sweet tooth, do so “just a bit.” Eat
just a thin slice of your son’s birthday cake, or have just one or two
of Grandma’s Christmas cookies
instead of eating six or seven, or
■ Linda Morrison, left, and Whitney
Thomas are both registered dietitians
and certified diabetes educators (CDEs)
with Sentara RMH Medical Center. For
information about scheduling nutrition
consultations with the Sentara RMH
clinical dietitians, call 540-689-6339.
more. An occasional indulgence
should not be an excuse to binge on
sugar. ■
References
1
Liebman, B., Sugar Belly. How much sugar is too
much sugar? Nutrition Action Healthletter. Center for
Science in the Public Interest. April 2012.
2
Stanhope, S., Journal of Clinical Investigation 119:
1322, 2009.
3
Odegaard, A., Obesity20:689,2011.
4
American Journal of Clinical Nutrition 95:283,2012.
5
American Journal of Clinical Nutrition 94: 479, 2011.
6
Taubes,G.,Is Sugar Toxic? The New York Times,
April 13, 2011.
7
American Heart Association, Circulation 120: 1011,
2009.
MASS
SPECTROMETRY
SYSTEM
Faster Identification of Disease-Causing Germs
Means Quicker Treatment for Patients
By Neil Mowbray
A new leading-edge
diagnostic tool in the
Sentara RMH Laboratory
can help doctors begin
effective treatment of
patient infections sooner
than would be possible
with conventional
diagnostic procedures.
TheVITEK®massspectrometry(MS)
unit is a new automated diagnostic system
that identifies 193 different disease-causing
microorganisms, according to manufacturer
bioMérieuxInc.ofDurham,N.C.Itdoes
this by performing 192 different automated
tests. Each test takes about a minute. »
Bacteria and yeast appear on
microbiology plates after an
incubation time of 18 to 24
hours. The red surface is the
growth medium that nourishes
and supports the microorganisms as they are growing.
RMHonline.com
31
“Human disease can be caused by hundreds of
different organisms, including viruses, bacteria, yeast,
prions, fungi and mycobacteria,” says Sentara RMH
pathologist Diana Padgett, MD. “Both the need for
therapy and the type of therapy are often dependent
on correct identification of the organisms. Much of
this organism identification is the responsibility of
themicrobiologylaboratory.ThebioMérieuxVITEK
mass spec provides a rapid, inexpensive way of identifying bacteria and yeasts by analysis of their protein
components.”
According to a statement released by bioMérieux following U.S. Food and Drug Administration
(FDA)approvallastAugust,theClevelandClinic
hascalledtheVITEKMS“oneoftheTopTen
BreakthroughMedicalTechnologiesof2013.”
SentaraRMHwasthefirsthospitalinVirginia
to acquire the technology, Dr. Padgett notes.
Medical technologist Connie
Zangus places the slides
containing bacteria and yeast
for identification into the
bioMérieux VITEK unit.
Laser technology identifies
disease-causing agents
In the foreground is the
bioMérieux VITEK Mass
Spectrometry unit. In the background, medical technologists
in the Sentara RMH Medical
Laboratory’s microbiology
department culture, or grow,
bacteria on growth plates. Any
bacterial or yeast growth they
obtain from patient specimens
can be identified by the “mass
spec” unit in less than an hour.
32
healthQuest | Spring 2014
TheVITEKMSuseslasertechnologytoidentifythe
type of disease-causing agents present in a particular
lab specimen, such as a urine sample, a blood sample
or a sputum sample, collected from a patient with an
infection. The laser breaks apart any bacteria or yeast in
the sample, and the resulting protein particles create a
patternthat’suniquetoeachmicroorganism.Tomake
theidentification,theVITEKMScomparesthesepatterns, known as spectra, to those of clinically significant
microorganisms stored in the instrument’s database.
The database contains spectra for most of the bacterial
and fungal infections that cause disease in humans,
according to bioMérieux.
Toobtainthebacteriaoryeastforthetest,medical
technologists working in the lab must first culture, or
grow, them on plates containing a growth medium, a
liquid or gel that supports the growth of the infectious
agents.
“When we get a specimen to culture, it has to
incubate overnight,” explains medical technologist
“Sentara RMH was selected as one of the clinical testing and validation sites for the VITEK MS
bioMérieux platform, and we were the first clinical site in Virginia to have this technology.”
— Dr. Diana Padgett
Jennifer Clevinger. “The minimum for growth is about
18to24hours.Aslongaswehaveonegoodisolated
colony of bacteria or yeast, we can identify the organismwithinaboutanhourusingtheVITEKMS.”
Testingcanbeginalmostassoon asgrowthis
visible on the plate, Clevinger states. The technologist
places a small bit of the growth in a tiny circle on a
special glass slide, adds a chemical solution to it and
placestheslideintheVITEKMS.
Each slide contains 64 small circles, and each
circle can hold a different sample of bacterial or yeast
growth,Clevingersays.IttakestheVITEKMSabout
a minute to analyze each circle.
“We can have all of the samples on the slide identified in about an hour,” Clevinger says.
By contrast, using the older method of identification required abundant organism growth that could
takeuptofivedays.Iftherewasn’tenoughgrowth,or
if there were no isolated colonies of bacteria or yeast on
the plate, a new culture would have to be grown from
the specimen, which added additional time before the
identification could be made.
“As far as turnaround times, with the old method
it could take up to three or even five days, depending
on circumstances, before we got the identification,”
says Renee Ours, Microbiology and Core Laboratory manager. “Now it’s a much shorter time, which is
important for our patients.”
Quicker identification, quicker treatment
TheVITEKMSallowsformorerapididentification
of disease-causing microorganisms, frequently almost a
day sooner, according to Dr. Padgett.
“This gives treating physicians a significant
advantage when designing their treatment protocols,”
Dr.Padgettsays.“Italsotypicallymeanslessexpensive
identification of organisms. As a result patients can save
money on testing, and possibly reduce the length of a
hospital stay, or avoid exposure to more broad-spectrum
antibiotics, which is both a health and cost advantage.”
ThecomputersystemthatworkswiththeVITEK
MS quickly provides physicians with information about
the sensitivity of bacteria to antibiotics. Before SentaraRMHbeganusingtheVITEKMS,thehospital
Pharmacy provided clinicians with an annual report,
called an antibiogram, on the susceptibility of bacteria
to antibiotics. The antibiogram allows physicians to
see which strains of bacteria are becoming resistant to
certain antibiotics so they can prescribe other antibiotics
for more effective treatment.
“Now, instead of waiting a year to find out what
those susceptibility patterns are, the computer system
will allow us to collect and provide that data more
real-time,” says Clevinger. “We’ll be able to see sooner
what our susceptibility patterns are for certain strains of
bacteria and treat patients better and faster.”
Sentara RMH first in Virginia
to use VITEK technology
A small amount of
bacteria or yeast that
has been cultured on
the plates is placed
within a small circle on
a special slide that then
goes into the VITEK MS
unit for analysis.
WhentheFDAapprovedmarketingoftheVITEK
MS in August 2013, the Sentara RMH Medical
LaboratoryhadalreadybeenworkingwiththeVITEKMSforalmostayear.
“Sentara RMH was selected as one of the clinicaltestingandvalidationsitesfortheVITEKMS
bioMérieux platform, and we were the first clinical site
inVirginiatohavethistechnology,”saysDr.Padgett.
“We are pleased to be able to offer this leading-edge
technology to physicians and their patients at Sentara
RMH. Faster diagnosis and treatment of infections
means we can provide even better care, and this supports our mission to improve health every day.” ■
RMHonline.com
33
Sentara RMH Recognizes
2014 Safety Champions
INAUGURAL VICTORIA MORRIS PATIENT SAFETY AWARD PRESENTED
S
entara RMH recently recognized five team
members as 2014 Safety Champions for
their dedication to strengthening the culture
of patient safety at the hospital. A sixth team member was selected as the recipient of the inaugural
VictoriaMorrisPatientSafetyAward.
The 2014 Safety Champions are:
• CarrieBynaker, safety specialty coordinator,
Operating Room
• AnneSnow,RN, Cath Lab
• MarthaSchneider,DNP,MSN,RN; director,
CCU, PCU and 5 West
• TroyEppard,RN,InpatientBehavioralHealth
• GraysonSless, Human Resources Development
The recipient of the
inauguralVictoriaMorris Patient Safety Award
is DebraSmith,RN,
perioperative coordinator,PerioperativePre-/
Post-Care. See sidebar
for details on this award.
“The recipients of
this recognition shape
the culture of safety
at Sentara RMH on a
Grayson Sless
The 2014 Safety Champions are, second from left, Martha Schneider,
Troy Eppard, Debra Smith (recipient of the Victoria Morris Patient Safety
Award), Carrie Bynaker, Anne Snow and, inset, Grayson Sless. Presenting
the awards at the March 5 ceremony were Rebecca Jessie, director of
quality improvement and patient safety, far left, and Dr. Dale Carroll,
senior vice president of clinical effectiveness and chief medical officer
(far right). This is the fourth year that Sentara RMH Medical Center has
honored Safety Champions.
The Victoria Morris Patient Safety Award
Tori Morris was an RMH employee for 27 years,
and served as patient safety officer and patient
safety coordinator for five years before her
untimely death last summer.
“Tori was dedicated to providing highquality, safe care to patients,” says Rebecca
Jessie, director of quality improvement and
patient safety. “She helped analyze RMH safety
events throughout 2009, which led to the development of our Patient Safety First toolbox.
She was instrumental in developing our safety
training program, and she taught more than
200 hours of safety training in 2011 and 2012.”
Tori became ill at the end of 2012, and
she passed away July 28, 2013. After her death,
her husband, Ed, requested that donations in her
memory be made to the RMH Foundation. The donated funds helped to provide crystal awards that
were presented to all of the 2014 Safety Champions.
The funds also make possible the presentation of
the inaugural Victoria Morris Patient Safety Award,
which will provide recipient Debra Smith, RN, with
an opportunity to attend a national patient safety
conference with all expenses paid.
In future years, Sentara RMH staff will have
the opportunity to donate to this fund through the
Employee Gifts Campaign.
“Sentara RMH Medical Center thanks Ed Morris
and his family for their thoughtful and generous
support,” says Jessie.
Ed and Tori Morris, July 2013
34
healthQuest | Spring 2014
advance care planning
daily basis by applying our safety
tools and behaviors in their daily
practice,” says Dale Carroll, MD,
senior vice president of clinical
effectiveness and chief medical
officer. “They hold others accountable for safe practices and
ensure that we first ‘do no harm.’”
The annual RMH Safety
Champion recognition, launched
in 2011, emphasizes the Sentara
RMH commitment to patient
safety, notes Rebecca Jessie,
director of quality improvement
and patient safety. Candidates
were nominated by Sentara
RMH staff and physicians for
their outstanding contributions
to patient safety. Criteria for
nominees included the following:
• Consistently exemplifies
patient safety in all aspects of
his/herwork
• UsesSafetyFIRSTtools
consistently and exhibits the
safety “standards of behavior”
• Isalwaysa mentor for safety
Members of Sentara RMH’s
Patient Safety Committee
evaluated the entries, which were
submitted by Sentara RMH staff,
and selected the winners.
“All of us at Sentara RMH
are passionate about keeping our
patients safe by ensuring we first
do no harm,” Jessie says. “Sentara
RMH Safety Champions make
this statement their personal
mission and move our organization forward through exemplary
teamwork.” ■
Advance Care Planning
PEACE OF MIND FOR YOU
AND YOUR FAMILY
I
t may not be a pleasant topic to think about: what our healthcare wishes
would be if we become too sick or incapacitated to speak for ourselves. But
often families are faced with having to make such decisions—along with
possible disagreements, confusion and even guilt—when a loved one is faced
with a dire, life-threatening medical emergency or terminal illness.
Advancecareplanningcanbeagiftyougiveyourselfandyourfamily.It
means that the treatment you receive in the event you’re unable to speak for yourself matches your healthcare wishes and preferences.
“Making healthcare decisions for ourselves is difficult even in the best
circumstances; making a decision for someone else is even more complicated,”
saysNatalieRinaca,SentaraRMHpatientrelationscoordinator.“It’simportant
to provide a guide that our loved ones and healthcare providers can follow in the
event that we cannot speak for ourselves. Advance care plans give you the power
to document what you do and do not want, and to name someone to speak for
you if you are unable.”
Advance care planning differs from the traditional advance directive conversations because it places more emphasis on looking at one’s values and personal
definition of quality of life, Rinaca explains.
“Advance care planning isn’t just for older people; at any age, a medical crisis
could leave a person too ill to make his or her own healthcare decisions,” she says.
“Even if you aren’t sick now, making healthcare plans for the future is an important step toward making sure you get the medical care you would want, even
when doctors and family members are making the decisions for you.”
Rinaca notes that an advance care plan is easy to create, no lawyer is needed
and it’s free.
For a free booklet, and the state-approved advance care planning form, call
Sentara RMH Healthsource at 540-564-7200 or stop by the main lobby registration
desk at Sentara RMH Medical Center. ■
RMHonline.com
35
living with synergy
What
to
Do
in the Meantime
“
I am still determined to be
cheerful and happy, in whatever
situation I may be; for I have also
learned from experience that the
greater part of our happiness
or misery depends upon our
dispositions, and not upon
our circumstances.
”
CULTIVATE SERENITY IN THE MIDST
OF UNCERTAINTY
T
here are times when the
clock seems to stop abruptly,
reminding us that we’re on
God’s divine schedule. Many
life scenarios throw us into an uncertain
“meantime” where things are happening
that we can’t control, explain or understand—the meantime between losing a
job and finding another, between having
a breast biopsy and receiving the results,
the positive pregnancy test and a fullterm delivery, a high-risk surgery and
the improved quality of life a loved one
is seeking.
— Martha Washington
It’sanaturaltendencytoavoid
discomfort and insecurity. So when our
supporting walls in life threaten to fall
in on us—or fall apart altogether—we
can retreat by default into helplessness,
or react out of panic. We distract. We
eat.Wesmoke.Wedrinkaglass(or
three)ofwinebeforedinner.Wewatch
hoursofstuffonTVthatmeansnothing to us.
But when we escape into numbing behaviors, we miss out on how the
experience can grow us. Luckily, there’s
a third alternative, which is to respond by
design with a serene disposition.
The meantime can be a rich opportunity to grow personally and professionally if we replace fear with faith,
and worry with action. These resilient
perspectives will help transform the
period of in-between into a positive
experience, using uncertainty to your
advantage:
CHOOSE: Serenity means “a
disposition free from stress or negative
emotion.” While you may not have a
choice about the circumstance you’re
in, no matter what happens you can
always control two things—your
breathing and your perspective.
When you feel out of control
and confused, the
By Christina Kunkle, RN, CTA Certified Life and Wellness Coach
36
healthQuest | Spring 2014
fight-or-flight reaction is easily triggered, causing a
cascade of stress hormones like cortisol and adrenaline
thatsendyouintoabreathlesspanic.Tobypassthis,
pause to focus on breathing deeply and slowly for a
few minutes while mentally repeating a word such
as“peace”oneachinhale,andaphrasesuchas“Iam
calm” on each exhale. This promotes relaxation in your
mindandbody.Ifpossible,stepoutsideinthefreshair.
APPRECIATE: Genuinely look for the good
in your life, exactly as it is here and now. An attitude
of gratitude fosters optimism and keeps your heart
open. Yesterday is gone and tomorrow isn’t here yet, so
have positive expectation that a favorable outcome will
unfold. Yes, you’ll need to adapt as circumstances arise,
but the best investment of your time and energy is to
be grateful for what you do have going for you instead
of being anxious because of what you don’t have.
Cultivate a reassuring stance for yourself and others
byvoicing,“Ican’twaittoseewhatgoodcomesfrom
this!” Allow the joy that creates to feed your faith.
QUESTION: Ask “how” instead of “why.” Let
go of the struggle to understand why things happen as
they do. Saying “poor me, why is this happening to me,
whydoIdeservethis?”willonlykeepyoufeelinglike
avictim,whichissuretokeepyoustuck.Instead,say
withanairofcuriosity,“HowcanIfindthepositivein
this and get back into taking inspired action?” You see,
“Actionistheantidotetodespair”( JoanBaez).
Thechoiceisyours,butI’vefoundthattheway
forward with the least amount of suffering is to accept
the reality of what is, and to keep asking to be shown
howIcanbenefitfromeachnewsituation.Ourbrains
are programmed to answer questions. You’ll receive
answers if you stay attentive. Answers may come to you
through a flash of insight, your intuition or a hunch,
something that is said to you, or through a person you
meet. When you catch yourself asking “why,” flip it
to “how” and do your best to move forward with the
answers you receive.
TRUST: Believe that things happen for you,
not to you. When you realize everything that happens
is for your highest good and holds a gift, it serves to
deepen your faith and keep you focused. Even if you
can’t see them right away, stay open to the lessons your
life experiences are teaching you. This resilient point
of view reminds you that you’re seeing just a snapshot,
but in time you’ll see the bigger picture. At unexpected
moments, things often happen to reveal why you
needed to experience the hard times.
The following poem reminds us there’s a higher
purpose in the things we encounter. And although a
certain outcome may not be what we asked for, our
best interests are always being considered.
I asked for strength and God gave me difficulties to make
me strong.
I asked for wisdom and God gave me problems to solve.
I asked for prosperity and God gave me a brain and
willingness to work hard.
I asked for courage and God gave me dangers to
overcome.
I asked for love and God gave me troubled people to help.
I asked for favors and God gave me opportunities.
I received nothing I wanted.
I received everything I needed.
My prayer has been answered.
~Author unknown
NURTURE: Takecareofyourselfphysically,
spiritually, mentally and emotionally so the best version
of you can rise to the occasion with more grace and
grit.Indulgeinrestorativedistractionslikeexercising,
spending quality time with friends and family, reading
inspirational books, listening to soulful music, enjoying
nourishing food, watching amusing movies, napping,
taking nature walks, or otherwise enjoying your favorite meaningful hobbies.
TEACH: Give friends, family and colleagues a
priceless gift by being a brilliant example of what it
takes to persevere through uncertainty with dogged
determinationandwell-balancedpoise.It’snot
whetherwewillfacehardchallengesinlife.It’samatter of which ones we will be called to face, and when.
Trialswillalwayscome,testingourspirit.Thequestion
is whether we will give up when meeting the unknown,
or resolve to grow stronger.
Of course there will be days where you know you
could have done better. When this happens, remember
this inspiring comment of author Mary Anne Radmacher: “Courage does not always roar, Sometimes
courage is the quiet voice at the end of the day saying
‘Iwilltryagaintomorrow.’” ■
■ Christina Kunkle, RN and CTA Certified Life and Wellness Coach, is founder of
Synergy Life and Wellness Coaching LLC
and creator of the “Synergy Success Circle”
and “SOAR,” a heart-centered leadership
development program. She helps busy
professionals prevent burnout by promoting bounce-back resilience to stay focused,
positive and excited about the challenges of
work and life. To learn more, visit her website at www.synergylifeandwellnesscoaching.com or call 540-746-5206.
RMHonline.com
37
Volunteer Pat Messner helps out
in the Sentara RMH Hahn Cancer
Center. Messner has been a regular
volunteer in the Cancer Center
since it opened in 1990.
38
healthQuest | Spring 2014
SENTARA RMH
VOLUNTEERS:
Ambassadors of Compassion
W
hen visitors and patients arrive at the front door of
Sentara RMH Medical Center, the smiling face of a
volunteer welcomes them.
Volunteers at Sentara RMH fill a variety of roles at the hospital
to help patients, families and staff. Volunteer Services Director
Melinda Noland describes Sentara RMH volunteers as ambassadors
of compassion.
“Compassion is something that, as a hospital, we need to have
in abundance,” she says. “And that’s something that I see from every
volunteer. They want to give something of themselves to this hospital
and its patients.”
Three decades of service
In1983,PatMessner,79,cametoSentaraRMHforsurgery.Duringherstayshewasimpressed by not only the doctors and nurses, but the volunteers who helped her along the way.
She decided she wanted to become a volunteer and return the kindness to other patients. For
31 years, she has been a familiar figure at Sentara RMH.
One of Messner’s first jobs was to help launch the volunteer patient discharge service.
“AfterIbeganworkinghere,anothervolunteerandIstartedthepatientdischarge
service,” Messner says. “When a patient was ready to go home, the nursing unit called and
we would take a wheelchair up to the unit, get the patient and bring the patient with their
BY ROBERT SISK
RMHonline.com
39
belongings down to the waiting car. That allowed
staff members to stay on the unit and help patients
who still needed care.”
In1990,theRMHRegionalCancerCenter
(nowcalledtheSentaraRMHHahnCancerCenter)
opened at Sentara RMH. The new cancer center provided an opportunity for patients to stay close to home
and receive care. Before it opened, volunteers were
sought to help assist cancer patients coming in for
various treatments. Messner was the first to sign up.
“This was so new to everyone,” she says. “We
went through an orientation and learned how to
workwithcancerpatients.I’vebeenworkingin
theCancerCentereveryTuesdaymorningsinceit
opened,andI’vemissedveryfewdays.Inalotofservice areas, you don’t have hands-on interaction with
thepatients,butyoudointheCancerCenter.It’s
interesting because a lot of patients will ask me where
mycancerwas.Itellthem,‘Ihaven’thadcancer.I
volunteerherebecauseIliketohelppeople.’”
EveryTuesday,MessnerarrivesattheCancer
Centerbefore8a.m.andpicksupalistofpatients
scheduled for treatment that day. Before the patients
arrive, she makes sure the rooms are prepared and
then goes to the lobby to wait for patients to arrive.
“I’llgetawarmblanketoragownandmake
them comfortable,” she says. “You have to be compassionate, you have to be friendly and you have to smile.
A smile is part of our garment. Some patients like
youtohangontothemandtouchthem.Igetalot
of hugs.”
Janet Macarthur, RN, director of the Hahn Cancer Center, says the volunteers make all the difference
to patients who are at their most vulnerable.
“They do so much for our patients,” she says.
“We have volunteers in the chemotherapy lounge;
they get lunches for patients and clean up the chairs
after someone leaves. They do untold numbers of
things for us that would take our staff away from
patient care.”
Staying busy
When Evelyn Showalter, 59, retired as a small business owner, she wasn’t ready to stop working. While
she was in high school, she had volunteered with
Sentara RMH, delivering flowers to patients. She
says she always wanted to come back so, after retiring,
she felt she had the time to volunteer.
40
healthQuest | Spring 2014
Jack Smith prepares to transport a patient
in the Sentara RMH Emergency Department,
where he has volunteered since shortly after
retiring in 2012. He says hardly a day goes
by that he is not thanked by a staff member
for his volunteer work.
“IwaslookingforsomethingIenjoyedand
wantedtodo,”shesays.“WhenIthoughtabout
whereIwantedtovolunteer,IknewIwantedto
comebacktoSentaraRMH.Itdoesn’tfeellike
work; it’s different than work. You don’t always want
to go to work, but you always want to volunteer.”
Showalter volunteers in the inpatient surgery
waiting area, assisting Sentara RMH staff members
with patients coming in for pre-surgery interviews.
“We also help family members who are waiting
for their loved ones during surgery,” she says.
Showalter says she loves her job because she
loves meeting new people. Being a volunteer at Sentara RMH, she adds, has given her the opportunity
to meet people she might not have met otherwise.
“I’vemadefriendsthatIwouldneverhavemet
ifIwasn’tavolunteer,”shesays.
Noland notes that Showalter’s assignment was
the perfect fit for her personality. She says there are
volunteer opportunities that will fit almost anyone’s
comfort level.
“There are so many needs in the hospital,”
Nolandsays.“Ifyouarewilling,wehavesomething that will fit your schedule and personality.
Not all of our opportunities involve interacting
with patients. We have volunteers who stuff envelopes or help in offices. RMH Gifts and Floral is
staffed and run full time by a dedicated group of
volunteers. All the money we raise in the gift shop
is gifted back to the RMH Foundation for patient
needs. There’s a place for you here.”
Who Can Volunteer?
Sentara RMH is actively seeking to add volunteers,
says Volunteer Services Director Melinda Noland.
Prospective volunteers should fill out an application,
which can be found on RMHonline.com or requested
by calling Volunteer Services at 540-689-6400. Volunteers must pass a background check and have a
simple health screening for communicable diseases
like tuberculosis (TB).
The most important attribute for new volunteers is a willingness to contribute, Noland says.
“Anybody who has an interest in volunteering
should apply,” she says. “If you have a giving heart
and the time to be part of an organization that
wants to be here for the community, we want you
here! We can put you to work.”
Service volunteers must be more than 18 years
old, but Sentara RMH also has a group of junior volunteers, ages 14-18. For more information about the
Junior Volunteer Program, visit RMHonline.com.
Evelyn Showalter
volunteers in the inpatient
surgery area. She says she
loves her job because of
all the people she has met
and the new friends
she has made.
A new adventure
Jack Smith retired, but he never slowed down. He’s the
head scorekeeper for James Madison University’s men’s
and women’s basketball, and he operates the scoreboard
for the JMU Dukes during football season. He was a
teacher and administrator for the Harrisonburg Public
Schools for 39 years before retirement in 2012.
“Ittook meaboutsixmonthstogetbored,soI
came to volunteer,” he says. “A friend of mine, Earl
Shirkey, was a volunteer for 17 years here and worked
13,000 hours before he had to stop for health reasons.
Healwaystalkedabouthowmuchheenjoyedit,soI
thoughtthiswaswhereIwantedtogo.”
Twiceaweekforthepastyear,Smithhasworked
a shift in the Sentara RMH Emergency Department
(ED),helpingvisitorsregisterandshowingthemto
their rooms. He says he does almost anything to help.
“IassistthestaffinanywayIcan,aslongasit’s
not medical,” he says. ”When patients get called back
totheexaminationarea,Iescortthemtotheroom.
RMHonline.com
41
Noland Named Director of
Sentara RMH Volunteer Services
MelindaSwisherNolandis the new director of volunteer services at Sentara RMH
Medical Center.
Noland has been with Sentara RMH
since January 2005. She most recently
served as director of the Sentara RMH Wellness Center, a position she had held since
November 2008.
“As Volunteer Services director, my
goal is to lead an impactful and engaged volunteer team to provide
every patient and family an exceptional and compassionate experience,”
Noland says.
Noland holds a bachelor of science in health sciences, healthcare
administration, from James Madison University. She joined Sentara RMH
in January 2005 as Investigational Review Board (IRB) coordinator. She
established an IRB program for the hospital to comply with national
regulations. She developed and initiated IRB policies and procedures
for the protection of human subject research and created, implemented
and managed the IRB tracking system.
In October 2005 she became health lifestyles coordinator for the
Sentara RMH Wellness Center. In February 2006 she was promoted to
program coordinator, responsible for increasing the quantity and quality of programs offered by the Wellness Center as well as membership.
In February 2007 she was promoted to operations coordinator and in
November 2008 became Wellness Center director.
“I enjoyed leading the Wellness Center team and I am proud of
our record specifically related to increasing our brand and community
profile, employee satisfaction and loyalty, delivering high-quality customer service, and developing innovative programs to retain and grow
membership,” she says.
Noland also currently serves as leader of the hospital’s Outpatient
Customer Service Team and as chair of the hospital’s Patient and Family
Advisory Council.
“My experience with these teams has exposed my passion for
service and heightened my desire to support patient-centered care,”
Noland says.
In her new role, Noland manages the overall function and operations of the Volunteer Services department. She ensures effective
volunteer recruiting, education and retention, and a customer-friendly
focus. She implements volunteer programs and services and acts as a
liaison with the RMH Auxiliary, which plans and coordinates numerous
fundraising activities for Sentara RMH. She also manages the ongoing
Junior Volunteer Program to facilitate youth involvement and exposure
to the healthcare environment.
“We are thrilled to have Melinda join us in this capacity,” says Cory
Davis, executive director, RMH Foundation, which provides oversight
for volunteer operations. “She has a deep appreciation for the service
our volunteers provide and she is incredibly passionate about the role
they play in helping Sentara RMH carry out its mission. Her background
in customer service and building successful teams will help propel our
Volunteer Services department to new heights as we continue to build an
engaged volunteer corps.”
42
healthQuest | Spring 2014
“There are so many
needs in the hospital.
If you are willing [ to
volunteer], we have
something that will
fit your schedule and
personality.”
— Melinda Noland
Igettheroomreadyforthemandshow
them where everything is and will get
themawarmblanketiftheyneedit.I
doallthelittlethings.Idootherthings
whenit’sbusy,likedeliverlabwork.Ido
whatever needs to be done.”
InadditiontohelpingcareforED
patients, Smith says he really enjoys
working with the ED staff and physicians.“I’mparticularlyimpressedwith
their professionalism and skill, and how
they perform their duties,” he says.
ED director Marcus Almarode
says volunteers like Smith make a real
difference for his busy staff.
“We really appreciate the time
and contributions of our volunteers,”
Almarode says. “They’re a huge asset
and a valuable part of our caregiving
team—somuchso,thatI’mworking
with Melinda [Noland] on expanding their role and coverage within our
department. We truly appreciate all
they do, and we’re looking for ways to
engage their talents even more.”
What strikes Smith the most, he
says, is the staff ’s appreciation for what
he does.
“Icantellyou,notadaygoesbyI
don’t get thanked by at least one staff
member,”hesays.“Volunteersreally
do make a contribution and help make
the staff ’s job of taking care of patients
easier.” ■
Students
and Patients
Bond Over
Music
ByJeanetteKulju, PR Coordinator, JMU College of Visual
and Performing Arts, Forbes Center for the Performing Arts
James Madison University (JMU) students and oncology patients
at the Sentara RMH Hahn Cancer Center are coming together
thanks to a new “iPad music as therapy” program established
as part of the JMU-RMH Collaborative.
T
he program, funded by the RMH
Foundation, is the brainchild of
JMU School of Music faculty
member Dr. David Stringham, whose
chance meeting with former music
therapist Paul Ackerman resulted in the
creation of a Music and Human Services
course at JMU.
Offered for the second time as
an experimental course in Fall 2013,
MUS498allowsstudentstoselectan
off-site practicum for music outreach.
Sophomore John Riley and senior Mark
Thress “wanted to do the Sentara RMH
practicum very badly,” says Ackerman.
Riley is a music education major
who desires to teach in a public school
one day. He thought he could make
chemotherapy treatment “a bit better
for some patients” because several close
family members had been affected by
cancer.Inaddition,hewasinterested
in the ways music could be expressed
beyond traditional performance. “The
iPad provides the perfect avenue for
performance, creativity and entertainment,” says Riley.
According to Thress, a senior
majoring in vocal performance and
minoring in communication sciences
and disorders, he and Riley program the
iPads so that patients “have all the music
they like to listen to, the games that they
like to play, and the videos they like to
watch.” Both students find the sessions
extremely gratifying. Riley claims it is
one of the most rewarding experiences
he has been a part of, and Thress admits
that seeing the effect that music has on
the patients is unlike anything he has
experienced before.
Through a special arrangement
with Sentara RMH, JMU’s public
relationsofficeintheCollegeofVisual
and Performing Arts had the opportunity to sit in on an iPad therapy session
with Thress and longtime patient Dick
Phillippi. Phillippi has been undergoing
chemotherapy at Sentara RMH for 11
years for leukemia contracted 40 years
ago after exposure to Agent Orange in
theVietnamWar.Despitemorethan
100 treatments over the years, Phillippi
says he “wouldn’t change the experience
for anything in the world.”
During the session, Thress showed
PhillippihowtouseTunePad,Soundrop and GarageBand for the iPad
in addition to engaging Phillippi in
conversation about his interests and
past. Phillippi shared details about his
childhood, when he played the steel
JMUseniorMarkThress
showsSentaraRMHHahn
CancerCenterpatientDick
Philippihowtoaccessmusic
andgamesonaniPad.
guitar, and his love
for woodcutting
Photo courtesy of JMU, taken by
Lexie Thrash.
caricatures, animals
and walking sticks.
He says he made walking or “story” sticks
for “every one of my children for graduation,” depicting 20-25 activities they
had been involved with in their lives.
Phillippi also teaches a woodcutting class
at Bridgewater Retirement Community, where he worked as a maintenance
supervisor. Doctors say that Phillippi can
continue classes—and woodcutting—so
long as his platelet count is not low.
As for the iPad therapy session,
Phillippi called it “neat” and appeared to
enjoy the distraction during his treatment, which lasted several hours.
Janet Macarthur, director of Oncology and Palliative Care at Sentara RMH,
speakspositivelyabouttheprogram.“It
really helps our patients entertain themselves when they’re in the chair for a long
time,” she says. “We’d love to see it grow
and continue.”
Infact,itseemstheprogramwill
continue. Riley and Thress will both
return in spring 2014 to work with patients, and Riley is applying for a scholarship in hopes of conducting research on
the impact of iPad music as therapy on
patients.
Stringham would like to take the
researchonestepfurther.“I’dliketo
explore what it’s like at 19 to sit next to
someonewhois64(likePhillippi)who
has a life-threatening illness and bond
over music,” he says. ■
RMHonline.com
43
New Drug Therapy for
Advanced Prostate Cancer
Can Relieve Pain, Prolong Life
BY DEBRA
THOMPSON
For almost 10 years, Tom McGinn, 61, of Harrisonburg, has lived with and
battled prostate cancer.
Tom was diagnosed in October 2004, at age 51, after his urologist found
a mass in his prostate during a routine annual exam. The cancer was stage 3
at diagnosis, and his doctors considered it to be aggressive. Tom, who had
no direct family history of cancer, had a radical prostatectomy—
removal of the prostate—in early 2005, followed by radiation therapy of the
pelvic bed in June 2005.
A
fterarecurrencein2008,heunderwent chemotherapy and hormone
therapy as well as other treatments for
the cancer.
AlthoughTomandPat,hiswife
of34years,hadlivedinHarrisonburgsince1989,
TomhadbeencommutingtoworkinWashington,
D.C., since 1999. He was employed by the National
Geographic Society as vice president of global sourcing, overseeing total procurement, inventory control
and travel services. Because of the amount of time
he spent in the D.C. area, he had chosen doctors
innorthernVirginiaformedicalcare,includinghis
cancer treatment.
“Iwasuptherealot,soitwasmoreconvenientto
havemydoctorsaroundnorthernVirginia,”hesays.
He had been in remission for two years when an
elevatedPSA(prostate-specificantigen)testindicated
that the cancer had returned and had spread to his
bones. “That’s when they told me they could treat it, but
couldn’t cure it,” he says. “That was hard to take at first.”
When prostate cancer metastasizes to the bones,
itcancauseconstantachingandterriblepain.In
Tom and Pat McGinn, of Harrisonburg, shown here with their dog,
Hidy, are glad he was able to find compassionate, state-of-the-art
treatment for his metastatic prostate cancer at the Sentara RMH
Hahn Cancer Center, close to their home. In 2013, Tom began
receiving radiation treatments with Xofigo, a drug newly approved
by the U.S. FDA that targets cancer in bone, leaving healthier bone
and other organs intact. The treatments have provided Tom a better quality of life than would have been possible without them.
44
healthQuest | Spring 2014
additiontoanunceasinglevelofpain,Tomwasexperiencing
flare-up pain—excruciating pain that comes with no warning.
Tomknewhewasinforwhathecallsa“HailMary”round
of chemotherapy, and he didn’t want to face the commute to
northernVirginiafortreatments.Healsofeltitwastimeto
retire and focus on the most important things in his life.
“We had reached a point where the
treatments weren’t going as well and my
life expectancy was decreasing,” he says.
“IdecidedtoretiresoIcouldspendthe
timeIhaveleftwithmyfamily.Ididn’t
want to drive back and forth [to northern
Virginia]fortreatment,soIresearcheda
number of cancer treatment centers in the
region.IfoundthattheSentaraRMH
Hahn Cancer Center gets high marks in
themarketplace.ThefactthatIwasliving
300 yards from a hospital with a great
reputation made my decision easy.”
InAugust2010hestartedtreatments at the Hahn Cancer Center under
the care of Dr. Mary Helen Witt. He
began to undergo chemotherapy for a second time to shrink
the cancer and, he hoped, reduce the pain and improve his
quality of life.
However, after six weeks of chemo, the results were not
positive.OneofTom’sradiationoncologists,HeatherMorgan, MD, had recently read about a new radiotherapy drug
for treatment of advanced prostate cancer. The drug, called
Xofigo®, was undergoing accelerated U.S. Food and Drug
Administration(FDA)approval.
New Treatment is a More
Targeted Approach
Xofigo(radium-223dichloride)isaradiationtreatment
injected into the vein that targets cancer in bone, leaving
healthier bone and other organs intact.
“Xofigo binds with minerals in the bone to deliver radiation directly to bone tumors, limiting the damage to the surrounding normal tissues,” explains Jana Miller, Sentara RMH
specialty imaging manager and radiation safety officer. “Xofigo
is a special form of radiation that emits alpha particles. Alpha
particles don’t penetrate very deeply, and the radium gets taken
up in the bones only. Where there’s change in the bone, as is
the case with prostate bone metastases, the radiation goes right
to where the cancer is.”
Xofigo is for metastatic prostate cancer that has spread
to bone, when cure is not an option and hormonal therapy
isnolongereffective.Itdoesn’ttreatdiseaseinorgans
or lymph nodes. A treatment takes only 10-15 minutes,
and a patient typically has a series of six treatments one
month apart.
Inadditiontorelievingthebonepain,Xofigohasbeen
shown to extend a patient’s life by three to four months.
“Our main goal, when cancer is not curable, is to
preserve a patient’s quality of life,” says Dr. Morgan.
“Anything that can improve quality of life, relieve pain
and extend life is a welcome, worthwhile advance. Xofigo
preserves the patient’s ability to live as normal a life as
possible with reduced need for narcotic pain medicine.”
Xofigo was approved by the FDA
fortreatingadvanced(metastatic)
prostatecancerinMay2013.InAugust 2013, Sentara RMH became the
fourthhospitalinVirginia,andthe
third in the Sentara Health System, to
start treating patients with it.
However, last summer there
were only two hospitals in the MidAtlantic region within reasonable
driving distance of Harrisonburg for
TomtogoforXofigotreatment.One
was Sentara CarePlex in Hampton,
Va.,whichwasthefirsthospitalin
the state to treat a patient with the drug. The other hospital was Georgetown University Medical Center.
“Iremembercallingaroundforhimbecausewedid
not have it yet,” Dr. Morgan recalls. “We referred him to
Georgetown for his first dose; they had just received it.
Then within weeks, we received it, too.”
TomreceivedhisfirsttreatmentatGeorgetownin
July 2013. Then, in August, Sentara RMH was approved
touseXofigo,andTomwasabletohavehisfinalfive
treatments close to home, at Sentara RMH.
Adding Quality to Life
Tom’sgoalwastoenjoyhislifeasmuchaspossibleand
to focus on building and strengthening relationships,
especially those with his wife, his three children and three
grandchildren. But the pain he was experiencing had begun
to get in the way of what he wanted to do with his life.
AfterreceivingtheXofigotreatments,Tomsayshebegan
to notice a significant reduction in his everyday pain.
“Itwastremendous,”Tomsays.“Mybenchmarkis
that the pain is more manageable now than it was before.
Istillhaveflare-ups,butmyneedforpainmedicationhas
significantlydecreased.Ithasloweredmystressleveland
allowed me to focus on what’s really important. My wife
recently retired and we’ve been spending so much time
RMHonline.com
45
Pat calls her husband
“a very positive person”
with a great sense of
humor. “He is a brave
warrior,” she says.
togethernow.Ican’timaginewhat
the pain would be without the Xofigo
treatments.”
TomandPattravelasmuchashe
is able. He loves to spend time with his
grandchildren—Jacob, 17; Christina,
15; and Caroline, 10 months—and
his brother and sister-in-law, Bob and
Judy.“Itrytogetasmuchtimewith
them, my wife and mother as possible,”
hesays.“I’vealsospenttimewithold
friends.I’vereignitedsomerelationships
Ithoughthaddiedmanyyearsago.”
Tomacknowledgesthat,although
the Xofigo did make a significant difference in the short term, by the end
of the six-month treatments he was
starting to have breakout pain. He is
on strong pain medications to help
control breakout pain and lower back
issues, but says the pain is still not as
bad as it was last year.
What is a PSA Test?
PSA stands for prostate-specific antigen,
which is a substance made in the prostate. A PSA test measures the level of PSA
in the blood. A “normal” PSA range is 1.0
to 4.0. As a rule, the higher the PSA level
in the blood, the more likely a prostate
problem is present.
But many factors, such as age and
race, can affect PSA levels. The PSA test
can be abnormal with benign enlargement and infection of the prostate gland.
It also can be elevated with other conditions that irritate the prostate gland,
such as certain medications or medical
procedures.
Because many factors can affect PSA
levels, your doctor is the best person to
interpret your PSA test.
46
healthQuest | Spring 2014
“Iamdoingasmuchasmybody
will allow me to do,” he says.
AddsPat,“Tom’salwaysbeena
very positive person, and he has a great
sense of humor. He is a brave warrior.”
Together,TomandPatremain
focused on the positives. “As a family
we have talked about it enough to know
the process and the facts of dealing with
it,” he says matter-of-factly. “Of course,
the emotions come up, but we all have
aprettygoodfaithwalk.Igetalotof
thoughts and prayers sent my way, and
they make the journey a lot easier!”
A Therapy Well
Tolerated by Most
Patients
Since it began offering Xofigo last August, the Sentara RMH Hahn Cancer
Center has treated at least a half-dozen
patients with the new drug therapy.
“Patients tolerate the treatment
very well, with very few side effects,”
says Dr. Morgan. “There is less bone
marrow toxicity, which was a bigtime limitation previously, but we still
monitor blood counts.”
Ifthedrugaffectsthebonemarrow, which manufactures red and white
blood cells and platelets, the patient
may need blood transfusions, she explains. Blood counts are always checked
the week before a treatment.
Because Xofigo is excreted through
the gastrointestinal tract, not the urinary tract, she says, some patients may
experience nausea and diarrhea early in
thetherapy.Ifbloodcountsareaffected,
patients can experience generalized
weakness. Still, she notes, its effects on
the body are typically less severe than
chemotherapy and some of the older
radioactive isotopes to treat cancer in
the bone.
“As more research has been done
on certain cancers, new treatment
options have been created that greatly
improve patient outcomes and quality
of life,” Dr. Morgan says. “Our goal in
treating an incurable cancer is avoiding a situation in which the toxicity
outweighs the benefits.”
Compassionate,
Leading-Edge
Treatment Close
to Home
Tomwashappytofindcompassionate,
leading-edge treatment at a state-of-theart cancer center in his own backyard.
“The staff are great,” he says. “They
know what they are doing and have been
able to answer all my questions. The staff
here are comparable to the staff that
administered my treatment at Georgetown; they are every bit as capable, but
more important is how friendly they are to
the patients with whom they have longterm relationships. The staff have made the
whole experience much more comfortable.
You couldn’t ask for better people!”
For Dr. Morgan, the reward of the
newtreatmentisknowingTomhasnot
only added days to his life, but quality to
his days. “He is an incredibly nice man
who makes intelligent, informed decisions,” she says. “He knows the outlook.
We all have wonderful things to live for,
andIfeelfortunatetobeabletohelp
him with that. My fellow staff members
feel the same; it is our honor to be a part
of our patients’ lives.” ■
Tom decided to retire so he could spend his
remaining time with family and friends. ”I am
doing as much as my body will allow me to
do,” he says.
Sentara RMH news
Drumm Named Interim
Director, Sentara RMH
Orthopedics, Sports Medicine
and Rehab Services
A
damDrummhas been
named interim director, Sentara RMH
Orthopedics, Sports Medicine and Rehab Services.
“Adam’s experience,
enthusiasm and vision make
him an excellent choice to
lead our growing and vibrant
orthopedics, spine and sports
medicine programs,” says
John McGowan, MD, president, Sentara RMH Medical
Group. “His commitment to teamwork, quality and customer
service will foster growth and continued success.”
Drumm joined Sentara RMH as a physical therapist in
May 2009. Since June 2012, he has served as sports medicine
program manager.
“Iamexcitedtohavebeengiventhisopportunity,”says
Drumm. “We have assembled an exceptional team of physicians, advanced practice clinicians, nurses, therapists and
support staff at Sentara RMH to provide orthopedics, sports
medicineandrehabservices.Ilookforwardtocontinuing
to expand the excellent quality and compassionate care that
Sentara RMH Orthopedics and Rehab Services provides.”
Drumm holds a bachelor’s degree in athletic training
and a doctorate in physical therapy from the University of
South Florida.
Gilliland Joins Sentara RMH
Board of Directors
T
erryGilliland,MD,
senior vice president
and chief medical
officer for Sentara Healthcare, has joined the Sentara
RMH Board of Directors.
Dr. Gilliland joined
Sentara Healthcare in 2013.
He is responsible for clinical effectiveness programs;
patient safety and quality;
and physician integration
for Sentara Healthcare’s 11
hospitals, 453,000-member
Optima health plan, 600 employed physicians and more than
2,000 network physicians.
“IlookforwardtoservingtheHarrisonburg/Rockingham community and ensuring that Sentara RMH continues
toimprovehealtheveryday,”saysDr.Gilliland.“I’vereally
been impressed with the people, processes and quality at
Sentara RMH. They’re well positioned to adapt to the new
healthcare delivery environment as part of a really excellent
healthcare system.
“Having lived and worked for a number of years in a
similarcommunity,Iunderstandthechallengesofproviding healthcare in a more rural setting,” he continued. “As a
physician,Ibringauniqueperspectiveontheopportunities
we have to improve effectiveness and efficiency and ensure
we are delivering the right care in the right place at the right
time to the right patient.”
Before joining Sentara Healthcare, Dr. Gilliland spent
17yearswithKaiserPermanenteandthePermanenteMedical Group. Most recently, he served as an associate medical
director for the Mid-Atlantic Permanente Medical Group,
with 1,000 physicians across 30 medical locations providing care to 500,000 members with affiliations with several
hospitals in the Mid-Atlantic region.
Dr.GillilandisanativeofIdahoFalls,Idaho.Hecompleted his medical education at UCLA and general surgery
internshipandresidencyatVirginiaMasonMedicalCenter
inSeattle,Wash.HepracticedinMountainView,Calif.,
before joining the Colorado Permanente Medical Group.
He was a Sloan Fellow and received a master of science in
management from the Stanford Graduate School of Businessin2008.
Dr. Gilliland is a fellow of the American College of
Surgeons, is a member of the Western Surgical Society, and
serves on the board for Sentara Quality Care Network and
Optima Health Plan.
Dr.Gillilandandhiswife,Jill,liveinVirginiaBeach.
They have three grown sons.
Hahn, Schneider Earn
Nursing Doctorate Degrees
T
wo Sentara RMH Medical Center nursing leaders
haveearnedtheirdoctorateofnursingpractice(DNP)
degreesfromtheUniversityofVirginia.
Chief Nurse Executive DonnaHahn,DNP,RN,NEABC, and Critical Care Unit Director MarthaSchneider,
DNP,RN,NEA-BC,both earned their doctorate degrees in
December 2013. They are the first Sentara RMH nursing
leaders to achieve a DNP degree.
According to Hahn, while similar course work is
required, a DNP degree focuses on clinical education and
improving outcomes for patients, whereas a doctor of philosophy, or PhD, degree in nursing focuses on preparation for
RMHonline.com
47
Sentara RMH news
Reed Honored as a March of Dimes
Virginia Nurse of the Year
T
heVirginiaMarch
of Dimes has named
PatraReed,MSN,RN,
CNML,asoneofVirginia’s
Nurses of the Year.
Reed serves as director
of clinical excellence and
patient transitions for
Sentara RMH.
TheVirginiaNurseof
the Year Awards are given
annually in 20 categories.
Reed was selected Nurse of
the Year in the Performance
&RiskManagement/QualityImprovementcategory.
She received the award in early November at the annual
Nurse of the Year Awards Gala in Richmond.
“Receivingthisawardisanhonor,”Reedsays.“Tobe
recognizedbyyourpeersreallymeansalot.Iamnotonefor
self-recognition,butIcouldn’tbehappiertoreceivethisaward.”
Morethan500nurseswerenominatedinVirginia.
All nominations were blinded and then reviewed by a
distinguished selection committee comprised of healthcare
professionals and nursing leaders from across the commonwealth. The committee members scored each applicant
according to established awards criteria.
“Patra has brought a wealth of experience, passion
and knowledge to Sentara RMH,” says Donna Hahn, vice
president,acutecareservices/chiefnurseexecutive.“Sheisa
driving force behind our continued commitment to clinical
excellence and is helping Sentara RMH navigate through
theever-changinghealthcareenvironment.Itisnosurprise
that she was given this award.”
Inaddition,TenaBibb,RN,nursemanager,InpatientBehavioral Health, was a finalist in the Nurse of the Year Behavioral
Health category. Each category had three to five finalists.
Reed, who joined Sentara RMH in August, has 20 years
of experience in the acute healthcare setting, including 13
yearsinnursingleadership.ShehasexperienceasanICU
staff nurse, nursing case manager, clinical systems support
coordinator and nursing director. She also has served on
the clinical nursing faculty and advisory board of the James
Madison University Department of Nursing.
Reed holds a bachelor’s degree in nursing from James
Madison University and a master’s degree in nursing from
theUniversityofVirginia.Sheisacertifiednursemanager
and leader through the American Organization of Nurse
Executives Credentialing Center. She will begin studies at
James Madison University in January toward a doctorate in
nursing practice.
48
healthQuest | Spring 2014
conducting research regarding
clinical outcomes.
“Iwasattractedtopursuing a DNP degree because it
focuses on, and can directly
impact, the care we provide our
patients every day,” Hahn says.
“My degree work focused on issues nurses face on a daily basis
in the patient care setting and
on ways to improve the patient
Donna Hahn, DNP, RN, NEA-BC
care experience.”
Hahn notes that the
InstituteofMedicineandthe
Robert Wood Johnson Foundation published a report titled
“The Future of Nursing: Leading Change, Advancing Health”
in 2010 in which they encouraged nurses to pursue lifelong
learningopportunities.“Iwould
hope other nurses would see
the benefits of returning to
school to further their formal
Martha Schneider, DNP, RN, NEA-BC
education as a contribution to
patients,” she says.
Hahn joined Sentara RMH in 2007 and has 36 years of
nursing experience with more than 26 years in nursing leadership. Schneider joined Sentara RMH in 2009. She has spent
15 years in nursing and has 30 years of leadership experience.
“As nurses we have a responsibility to our patients to
continue learning and growing in our profession,” Schneider
says. “Within the Sentara system there is a commitment to
continuallypursuingadvancednursingeducation.WhenI
startedmycareer,Ihadanassociate’sdegree.Throughoutmy
careerIhaveworkedtoimprovemynursingknowledgeand
myprofessionalismthrougheducationsothatIcanbetter
support my staff and improve the patient experience.”
Sentara RMH offers a variety of support to nurses
who decide to pursue advanced education, including tuition
reimbursementandscholarships,notesHahn.Inaddition,
Sentara has its own nursing school for nurses to pursue a
bachelor’sdegreeinnursing(BSN).
“Nurses within the Sentara system, including Sentara
RMH, who have the desire and commitment to move to the
next level can get the support they need,” she says.
Sentara is currently encouraging all associate’s degreelevel nurses to achieve at least BSNs. “Nursing research has
shown that patient outcomes improve with the more BSNlevel nurses a hospital system has,” Hahn says. “Our goal is
tohave80percentofSentaraRMHnursesachieveaBSN
by 2020.”
Currently, she says, almost 60 percent of Sentara
RMH nurses have BSNs, which is above the national
average.
Sentara RMH Medical Center Accepting Applications
for New Histotechnology School
I
n response to a national shortage of certified histotechnologists, Sentara RMH Medical Center has launched a
newSchoolofHistotechnology(HTL).
Histology is the science that studies the structure of
cells and their formation into tissues and organs. A histotechnologist prepares and stains tissue to allow detection of
abnormalitiesanddisease,saysSueLawton,HTLSchool
program director.
“There is a severe shortage of certified histotechnologists
in the United States,” Lawton says. “We hope by launchinganHTLSchoolwecanhelpaddressthisshortagein
our community and others. Histotechnologists are in such
demand that most of the students will have jobs waiting for
them before graduation.”
LawtonsaystheHTLSchoolwillparallelthestructure of the Sentara RMH School of Medical Laboratory
Science(MLS).Shenotes
that the MLS School has had a 100 percent pass rate on
national certification exams for the past 14 years.
StudentsenteringtheHTLSchoolmusthaveafouryear college degree, preferably in biology or chemistry. LawtonsaystheHTLSchoolwillprovideayearofstudyleading
to the histotechnologist certification exam.
“We hope our students will choose to remain with
Sentara after graduation, but there are many opportunities for
certified histotechnologists,” she says. “Graduates can work
with hospitals, veterinary pathologists, marine biologists or
forensic pathologists.”
The new school will be located at the Sentara RMH
Burgess Avenue building. The first class will enter in June
2014. Applications can be found at rmhonline.com.
For more information, contact Lawton at 540-564-7232.
Sentara RMH Medical Center Receives
Crystal Award for Sustainability
S
entara RMH Medical
Center received the
Crystal Award in Sustainability for Healthcare at
the second annual Energy
and Sustainability Conference, held Feb. 11–12 at the
Greater Richmond Convention Center.
PaulKetron, director,
Facilities Management, for
Sentara RMH, received the
award and also presented at
the conference, which was
hostedbyVirginiaCommonwealth University and
theVirginiaChamberof
Commerce.
More than 500 business and industry leaders
attended to learn how
sustainability is changing
some organizations and
how others are adapting and
leveraging sustainability to
enhance business results.
They also shared their
experiences.
The Crystal Awards
in Sustainability recog-
nizeVirginiacompanies
and institutions for their
environmental sustainability
achievements. Winners
were selected in the fields of
government, higher education, commercial real estate,
K–12schools,healthcare
and manufacturing.
“Itisanhonortobe
recognized by statewide colleagues and be included in
the select group of awardees,”saysKetron.“AtSentara RMH, we have an outstanding team of committed
facilities management staff
who work diligently to
maximize our resources to
not just maintain the status
quo, but to press to higher
levels of achievement. This
award is a validation of their
work.”
Sentara RMH Medical
Center was awarded Gold
LEED(Leadershipin
Energy and Environment
Design)certificationforits
new facility, which opened
inJune2010.Itwasthefirst
healthcare facility of its size
to receive LEED certificationinthestateofVirginia.
Ketronsaysthatthe
new hospital’s Central
Energy Plant was measured
recently and found to be operating at an efficiency level
of 0.6, significantly better
than the national average of
1.0. This number is based on
tons of cooling produced by
number of kilowatts used,
he explains.
“With the continuous
drive to use energy efficiently and lower operating costs,
we have taken the benefits
of the new hospital design
and built upon them,” says
Ketron.“Wehavereduced
the hospital’s utility expense
by over $2.00 per square
foot from our previous facility on Cantrell Avenue [in
Harrisonburg].”
Ketronaddedthatthe
hospital captures heat off
the boiler exhausts to heat
Paul Ketron, director of facilities
management, receives the Crystal
Award in Sustainability for
Sentara RMH in February.
water for the Central Energy Plant as well as a large
section of the lower level
of the hospital. The hospital also leverages its well
water to offset some Central
Energy Plant processes, and
it uses landfill gas to fuel
boilers for hot water and
steam production.
RMHonline.com
49
Sentara RMH news
Willetts Named Vice
President of Operations at
Sentara CarePlex Hospital
in Hampton
C
arrieE.Willetts,
director of Sentara RMH orthopedics, spine and sports
medicine services,
has been named vice
president of operations
at Sentara CarePlex
Hospital.
Sentara CarePlex
Hospital, opened in
December 2002, is
an acute care facility
located in Hampton,
Va.,withthelatest
technology in the industry, including one of
the area’s first “smart”
operating rooms and a campus-wide fiber optic backbone
to support transfer of filmless, digital diagnostic images.
“Carrie is an exceptional leader who led the successful development and implementation of a comprehensive
spine program and promoted the continued growth of our
premier sports medicine services,” says Dr. John McGowan, president, Sentara RMH Medical Group. “She
also fostered the implementation and success of our joint
services program, which provides seamless, coordinated
care for patients undergoing joint replacement. We will
miss her greatly, but she will be a huge asset to CarePlex.”
Willetts joined Sentara RMH in 2006 as assistant
director of business services for physician practice management.In2008shewasnameddirector,marketdevelopment, and in 2011 she became director of orthopedics,
spine and sports medicine.
She earned a bachelor’s degree in health services
administration from James Madison University and a
master’s degree in health services administration from
VirginiaCommonwealthUniversity.
50
healthQuest | Spring 2014
Sentara RMH Welcomes First
Endocrinologist, Opens Endocrinology
Practice in Harrisonburg
S
entara RMH recently welcomed NabeelBabar,MD,
the first endocrinologist to
join the Sentara RMH medical staff. Dr. Babar began seeing
patientsage18andolderinlate
February.
Endocrinology is the medical
specialty that deals with diagnosis
and treatment of diseases related
to hormones and the hormoneproducing glands of the body.
Endocrinology covers such human
functions as the coordination of
energy metabolism, growth and reproduction.
ConditionsthatanendocrinologisttreatsincludeType1and
Type2diabetes,gestationaldiabetes,thyroiddisorders,parathyroidglanddisorders(hypercalcemia),pituitarydisorders,adrenal
glanddisorders,osteoporosis,hypertension,cholesterol(lipid)
disorders,hypertriglyceridemia(hightriglyceridelevelsinthe
blood),polycysticovarysyndrome,infertility,lackofgrowth,and
cancers of the endocrine glands.
“We are pleased to be bringing this much-needed and indemand specialty to the Harrisonburg community as part of our
mission to improve health every day,” says John McGowan, MD,
president of the Sentara RMH Medical Group.
Dr.BabargraduatedfromAllamaIqbalMedicalCollege
in Lahore, Pakistan. He completed his internship and internal
medicineresidencyatBethIsraelMedicalCenterinNewYork,
N.Y.,andanendocrinologyfellowshipattheNationalInstitutes
of Health in Bethesda, Md. He is board-certified in internal
medicine and in endocrinology, diabetes and metabolism.
Before joining Sentara RMH, Dr. Babar served as clinical
endocrinologist at National Naval Medical Center in Bethesda
and,morerecently,ranabusyendocrinologypracticeattheUVa
SpecialtyCareClinicinCulpeper,Va.Duringthistimehealso
served on faculty as clinical assistant professor of medicine at the
UniversityofVirginia,Charlottesville.
“I’mveryexcitedaboutstartingtheSentaraRMHendocrinology practice here in Harrisonburg. The demand for endocrine
services here is tremendous and the community has been extremely welcoming,” says Dr. Babar. “For too long, patients have
had to travel long distances to see an endocrinologist. With the
establishment of the clinic here, we aim to provide patients with
the quality care they need closer to home. ”
The Sentara RMH Endocrinology practice is located at the
Sentara RMH South Main Health Center, 1661 South Main
StreetinHarrisonburg.Theclinicisopen8a.m.–5p.m.andcan
bereachedat540-689-4300. ■
medical staff update
The following professionals have recently joined the Sentara RMH medical staff.
We welcome them to Sentara RMH and the community.
Do you need a physician referral or need to contact a physician? Call our free contact
center, Sentara RMH Healthsource, at 540-564-7200, or call toll free, 855-564-7200.
Rupen S. Amin, MD, MBA
Family Medicine
Belay S. Birhan, MD
Sentara RMH Internal Medicine
(Hospitalists)
Sentara RMH Internal Medicine
(Hospitalists)
MedicalSchool: Ross University School
of Medicine, Edison, N.J.
MedicalSchool:School of Medicine,
Jimma University, Ethiopia
Residency: Virginia Commonwealth
University—St. Francis Family
Medicine Residency, Midlothian, Va.
Residency: Addis Ababa University,
Ethiopia (Pediatrics); Kingsbrook Jewish
Medical Center, Brooklyn, N.Y. (Internal
Medicine)
BoardCertification: Family Medicine
AdditionalEducation: MBA, University
of Tennessee Physician Executive MBA
Program, Knoxville, Tenn.
Member: American Academy of Family
Physicians, Medical Society of Virginia
Internal Medicine
Member: American College of Physicians
PersonalInterests: Watching movies,
biking and reading novels
AlsoServes: Board of Directors, Virginia
Academy of Family Physicians
Ryan T. Chico, PA-C
PersonalInterests: Skiing, mountain
biking, golfing, watching movies and
trying new recipes
Sentara RMH Orthopedics and Sports
Medicine
Nabeel I. Babar, MD
Endocrinology
Sentara RMH Endocrinology,
Harrisonburg
MedicalSchool:Allama Iqbal Medical
College, Lahore, Pakistan
Internship: Beth Israel Medical Center,
New York, N.Y.
Residency:Beth Israel Medical
Center, New York, N.Y. (Internal Medicine)
Fellowship: Endocrinology, Diabetes
and Metabolism—National Institutes of
Health, Bethesda, Md.
Allied Health
GraduateSchool:James Madison
University, Harrisonburg, Va.
Certification:National Commission on
Certification of Physician Assistants
Member:American Academy of Physician
Assistants, Virginia Academy of Physician
Assistants
ClinicalInterests: Sports medicine, joint
replacement surgery, fracture management, ACL reconstruction, arthroscopic
shoulder surgery
PersonalInterests:Outdoor activities,
running, golf, soccer, hunting, spending
time with family, photography, and
theology and religion
BoardCertifications: Internal Medicine;
Endocrinology, Diabetes and Metabolism
Julie M. Diehl, PA-C
Member:American Association of Clinical Endocrinologists, American Thyroid
Association, The Endocrine Society
Harrisonburg Emergency
Physicians
Physician Assistant
ClinicalInterests: Type 2 diabetes, metabolic syndrome, thyroid disorders
GraduateSchool:James Madison
University
PersonalInterests:Hiking and other
outdoor activities
Certification: Physician Assistant
PersonalInterests: Cooking and
spending time with family
RMHonline.com
51
medical staff update
Daryl E. Kurz, MD
Ophthalmology
Retina of Virginia, PLC,
Harrisonburg
MedicalSchool:Ohio State University
College of Medicine, Columbus, Ohio.
Internship:Pittsburgh Mercy
Hospital, Pittsburgh, Pa.
Residency:University of Virginia,
Charlottesville, Va.
Fellowships:Ophthalmic molecular
genetics: University of Iowa, Iowa City;
Retina—vitreous: Indiana University,
Indianapolis; Uveitis and genetics:
Oregon Health Sciences University’s
Casey Eye Institute, Portland
BoardCertification: Ophthalmology
Member: American Academy of Ophthalmology, American Society of Retina
Specialists, American Uveitis Society
AlsoServes:Clinical Assistant
Professor, Indiana University
PersonalInterests:Outdoor and fitness
activities
James M. Lovelace, MD
Orthopedic Surgery
Hess Orthopaedics & Sports Medicine,
Harrisonburg
MedicalSchool:University of Texas
Medical School, San Antonio, Texas
Residency:University of Texas Health
Science Center, San Antonio, Texas
BoardCertification:Orthopedic Surgery
Member:American Academy of Orthopaedic Surgeons, American Medical
Association
PersonalInterests:Distance running and
engaging in outdoor activities with his
family
Fellowship:Cardiothoracic
Anesthesiology: Washington University
School of Medicine, St. Louis, Mo.
BoardCertifications: Anesthesiology,
Perioperative Transesophageal Echocardiography
Member:American Society of Anesthesiology, International Anesthesia Research
Society, Society of Cardiovascular
Anesthesia, America College of Physician
Executives
AlsoServed:Vice President of Medical
Affairs, St. Joseph’s Medical Center,
Stockton, Calif. (2010 –13)
PersonalInterests:Boating, travel and
skiing
Jeanne R. Parrish, NP
Nurse Practitioner
Harrisonburg Emergency
Physicians
GraduateSchool:Frontier Nursing
University, Hyden, Ky.
Certification:Family Nurse
Practitioner
Member:International Association
of Forensic Nurses, American
Association of Nurse Practitioners, Virginia
Nurses Association
PersonalInterests:Watching her children’s activities, traveling and tending her
exotic animal collection
Carrie E. Rountrey, MEd
Allied Health
Sentara RMH Voice and
Swallowing Services
GraduateSchool: University of Virginia,
Charlottesville, Va.
Anesthesiology/Transesophageal
Echocardiography
AdditionalEducation: Completing
PhD in Communication Sciences and
Disorders, James Madison University
Sentara RMH Cardiothoracic Surgery;
Director, Sentara RMH Department of
Organizational Excellence
Certification:American SpeechLanguage Hearing Association Certificate
of Clinical Competence
MedicalSchool:University of Pennsylvania School of Medicine, Philadelphia, Pa.
Member:American SpeechLanguage Hearing Association,
Virginia Board of Audiology and SpeechLanguage Pathology
Susan B. McDonald, MD
Internship:Virginia Mason Medical
Center, Seattle, Wash.
52
Residency:Virginia Mason Medical
Center, Seattle, Wash.
healthQuest | Spring 2014
ClinicalInterests:Voice disorders,
dysphagia, neurogenic/neurodevelopmental communication disorders,
Parkinson’s disease and treatment,
outcomes measurement
PersonalInterests: Travel
Crystl D. Willison, MD
Consultative Neurosurgery
Private Practice, Harrisonburg
MedicalSchool:West Virginia School of
Medicine, Morgantown, W.Va.
Internship:George Washington
University, Washington, D.C.
Physician Assistant
Residency:West Virginia School of
Medicine, Morgantown, W.Va.
Hess Orthopaedics & Sports Medicine,
Harrisonburg
BoardCertification:Neurological
Surgery
GraduateSchool:Miami Dade College,
Miami, Fla.
Certification:Physician Assistant
Member: American Association of
Neurological Surgeons, American Medical
Association, Medical Society of Virginia
Member:American Academy of Physician
Assistants
ClinicalInterests: Back pain, spine
consultation and patient education
PersonalInterests:Scuba,
motorcycle riding, cycling
PersonalInterests:Football, running and
gardening
Pamela A. Thomas, PA-C
RMHonline.com
53
RMH foundation
The White
Rose Giving Circle:
The Power of Compassionate
Women United
By Alicia Wotring Sisk
A $500 gift to Sentara RMH Medical Center is
no small matter, but imagine what you could do
if you multiplied that gift by 50.
T
hat’s what the White Rose Giving Circle,
a group of local philanthropic women, does
every year to benefit the hospital. Their individual gifts, united, add up to a big difference. Since
thegroupwasfoundedin2008,ithasgivenmore
than $100,000 to benefit the hospital and, by extension, the community.
The White Rose
The White Rose Giving Circle is an all-woman philanthropic group that meets three times a year. Each
member contributes at least $500 annually and each
one gets to vote on how the total amount is used.
“We provide things that are not in the budget of
the hospital,” explains Nancy Bradfield of Bridgewater, a founding member of the group. “For example, if
there’s a department that perhaps submitted a budget
item and didn’t get their request, or something that’s
a minor purchase that would make their work a lot
easier.”
Each department is invited to submit a proposal,
and a committee narrows the number of proposals down to a select few for consideration by the full
membership. The finalists are invited to give a short
presentation on what they are asking for and why, and
then the women vote.
“We spend almost every penny,” Bradfield says.
What’s in a Name?
WhytheWhiteRoseGivingCircle?Isthereany
significanceinthename?
“Not really,” says Nancy Bradfield, one of the group’s
co-founders. “We had about 10 suggestions for the
name, and White Rose Giving Circle was one of them.
The members voted and selected it. They wanted a
name that is simple and elegant.”
Making a Difference in the Hospital and
Community
Initsfirstfiveyears,thegrouphasgivenalotofequipment to benefit the hospital.
One item was a GlideScope for the Labor and
Delivery unit. This device allows for quick intubation, the
insertion of tubes into the body for giving or removing
fluids. The hospital had two GlideScopes in the operating
rooms, but none specifically for use during C-sections.
Purchasing one for Labor and Delivery meant medical
staff could respond much faster in an emergency.
Another White Rose gift funded software, a printer
and a fax machine for the Medical Assistance Program,
which helps patients get low-cost or free medication from
pharmaceutical companies, Bradfield says.
Oneofthegroup’s2013giftswasanAccuVeinsystem for the Emergency Department. Sentara RMH had
justoneAccuVeinsystemforusethroughouttheentire
hospital. But, according to the proposal submitted to the
White Rose, venipuncture is the most frequently performed invasive procedure in the Emergency Department,
so it made sense to have one specifically for use there.
The device uses infrared technology to show on the
skin’s surface the location of veins underneath. The device
benefits patients, the nursing staff and the hospital, says
Paula Neher, a registered nurse in the Emergency Department who submitted the proposal.
“It’sbetterforboththepatientandthestaffifwe
cangetourIVsonthefirsttry,”Neherexplains.“Every
additionaltimewehavetoattempteitheranIVoralab
stick, we’re risking infection; it’s obviously more painful
and stressful for the patient; and it uses supplies, so it costs
more money every time we do it.”
TheAccuVeinprovidesatrainingbenefit,too.The
Emergency Department tends to attract young, energetic nurses, Neher says, but that also means they have
lessexperiencewithstartingIVsanddrawingblood.
UsingtheAccuVeinsystem,whichletsnursesseewhere
veins are located, they can get better accustomed to feeling for a vein.
“It’sonewayweimprovetheirefficiency,”Nehersays.
She adds that she’s grateful to the White Rose Giving
Circle for making the device available to the ED.
“Ihadnoideathisgroupexisted,buttheseladies
arewonderful,”shesays.“Ilovetheideathattheypull
it together to make big things happen.”
Creative, Compassionate Women
The White Rose Giving Circle is a unique way to
make a contribution, says Sherrill Glanzer, development officer for the RMH Foundation.
“A lot of people can make a $500 gift, and that’s a
significant amount of money, but when many of these
gifts are combined, all at once you have a really significant gift that’s going to make a significant difference at
Sentara RMH,” she says.
The fact that it’s all women is another part of what
makes the group unique and appealing, says Bradfield.
Bradfield’s husband, Chester, served for years as treasurer on the RMH Board of Directors, and Bradfield
liked the idea of making a contribution in her own way.
“Itwasintriguingbecauseitwasagroupofladies
doing something special,” Bradfield says. “And it didn’t
require a lot of meetings. Women can be very efficient.”
The effectiveness of the White Rose Giving Circle
shows that you don’t have to spend a lot of time or
money to make a big difference, Glanzer says. And
the group appeals to women’s interest in collaboration,
creativity and compassion.
“You have philanthropic women who are really
passionate, really bright and who really want to make
a difference,” Glanzer says. “You put all that together
and the White Rose becomes a really important and
significant group that benefits RMH.”
For more information about the White Rose Giving
Circle and how to join, call 540-564-7221. ■
Among the
members of
the White Rose
Giving Circle are,
from left, Nancy
Bradfield, Sherrill Glanzer, Lou
McCoy, Mona
Johnson, Esther
Good, Donna
Reilly, Sally
Funkhouser and
Mary Sease.
Have you ever wished you could support Sentara RMH and improve
your financial security at the same time? Well, you can. At Sentara
RMH, we call it Creative Giving. By taking advantage of incentives
the IRS provides, we can craft a gift that delivers exactly the benefits to us, and to you, that you have been looking for.
The RMH Foundation offers, free and without obligation, a 14-page
booklet, “Reflecting on Tomorrow,” that outlines nine options for
how to create this real-life win-win. To receive your copy, please
complete and return the form below:
Name: ___________________________________________________________
Address: _________________________________________________________
_________________________________________________________________
City: _____________________________________________________________
State: __________________________ Zip: _____________________________
Mail to: Cory Davies, Executive Director, RMH Foundation
2010 Health Campus Drive, Harrisonburg, VA 22801
540-564-7225
RMHonline.com
55
friends
OF THE RMH FOUNDATION
Gifts received Sept. 19–Dec. 31, 2013
Sentara 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 and the 1910 Cornerstone Club. 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. Thank you for your support!
Totals represent the cumulative amount given in 2013.
President’s
Forum
$100,000 and above
Carolyn Henry Joseph
CharitableTrust
Aubrey R. Liskey Estate
Ethel Strite Estate
$25,000–$99,999
Donna Amenta
Everence
Fidelity Charitable Gift Fund
Harrisonburg Electric
Commission
Harrisonburg Emergency Physicians,
PLC
Peggy Miley
KathyMoranandMarcieHarris
Jerry and Becky Morris
SelectAerospaceIndustriesInc.
KarlD.andBarbaraB.Stoltzfus
Judith S. Strickler
$5,000–$24,999
JerryR.andKathleenL.Andes
Mary Ann Clark
Ralph W. Cline
ClineEnergyIncorporated
DynamicAviationGroupInc.
Dr.FrankW.IIIandJeanGearing
Orden L. and Reba Harman
ElizabethHarnsbergerTrust
Dr. Charles H. and Mary Henderson
Dr. Alden L. and Louise O. Hostetter
56
healthQuest | Spring 2014
Dwight and Carolyn Houff
JimandVickiKrauss
Dr.WilliamI.andLyndaD.Lee
Ann Pace
PaneraBread-BlueRidgeBreadInc.
Rockingham Cooperative
William G. and Hope Shank Stoner
Robert Hopkins and Lorraine Warren
Strickler
The Community Foundation of
Harrisonburg and Rockingham
County
LynnandDianeTrobaugh
United Bank
William Leake
Society
$1,000–$4,999
Active Network
Mary L. Addy
Dr. Santhosh Ambika
DevonandTeresaAnders
Dr. Alexander Baer
Dr. Frank J. and Dr. Jean-Marie P. Barch
Gerald W. and Carolyn L. Beam
Larry and Natalie Beiler
Blackwell Engineering, PLC
Auburn A. and Ruth D. Boyers
Dr. Gene and Mary Ann Branum
Dr.andMrs.DouglasT.Brown
Ruby J. Callahan
William B. Sr. and Phyllis W. Carper
Dr. Henry H. Chang
Dr. G. Edward Jr. and Elizabeth S.
Chappell
ClassicKitchensInc.
Eddie R. and Catherine Coffey
Joseph Jr. and Julianne Craig
Diane C. Davis
Nancy H. Davis
Mensel and Linda Dean
Brownie M. Driver
Gladys A. Driver
EddieEdwardsSignsInc.
FirstBankandTrustCompany
Foilz Hair Stuido, LLC
Thelma B. Good
David C. and Amelia M. Hall
KatherineA.Harrison
Harrisonburg Construction Company
Inc.
Harrisonburg Department of Parks and
Recreation
Martin F. and Elizabeth L. Hayduk
OllieHeatwoleTrust
Glenn and Sandra Hodge
Dr. Wallace and Jean Holthaus
GeorgeW.IIandAnnE.C.Homan
IDMTruckingInc.
Joe Bowman Auto Plaza
Dr.ElmerE.andMarianneKennel
EstateofMaryElizabethKite
Lantz Construction Company
David and Emily Larson
Larson Family Fund of The Community
Foundation of Harrisonburg and
Rockingham County
TravisF.andKaraA.Marshall
Dr. and Mrs. John A. McGowan
T.CarterJr.andConnieG.Melton
Dr. Marcus N. and Jodi G. Morra
Edward A. Morris
N2 Hair Salon
KeithNash
Dr. Jim and Rebecca Newcity
Garry R. and Nancy B. Nichols
NielsenBuildersInc.
Dr.BurlF.andCynthiaT.Norris
Dr.TerryL.andJoyceOverby
Packaging Corporation of America
(PCA)
Bonnie L. Paul
Fred B. and Carolyn B. Pence
Janice L. Pence
Dr. R. Steven and Stephanie M. Pence
Drs.ZackT.andJudithS.Perdue
Frances Plecker
Plecker Family Fund of The Community
Foundation of Harrisonburg and
Rockingham County
LindaK.Queen
Heidi D. Rafferty, MD
Harry L. and Reba S. Rawley
Robert and Sarah Rees
Rocco Building Supplies, LLC
Rockingham Group
Rocktown Sports Performance, LLC
Bob and Mary Sease and Family
Sease Family Fund of The Community
Foundation of Harrisonburg and
Rockingham County
JohnH.andFayeT.Sellers
Helen W. Shickel
Shickel Corporation
Audrey L. Smith
DorisS.Trumbo
Union First Market Bank
Walmart
Merv and Marlene Webb
Dale E. and Waneta R. Wegner
Wayne and Joyce Wright
1910
Cornerstone
Club
$100–$999
RobertL.andKarmaC.Adams
AFP/NPD
IsobelB.Ailles
Clarence C. and Helen M. Allen
DonaldV.Allen
H G. and Peggy Allen
Franklin L. Allman Jr.
James R. Alpine
Dr. Steven G. and Patricia A. Alvis
George W. and Mary Anderson
Harold L. and Jeanette Arbogast
Gary A. Arehart
JoAnn Daggy Arey
C. Dennis Armentrout
KeithS.andDeniseR.Atkins
Arthur F. Baker
Sandra G. Baker
Wanda D. Baker
Cynthia M. Banks
John G. Barr
Russell M. and Lydia M. Baylor
Sue E. Baylor
Walstene A. Bazzle
JamesT.Sr.andBarbaraR.Begoon
George W. Bell
KennethG.andLindaR.Berry
Dr. Thomas and Faythe E. Bertsch
Beta Alpha Psi - James Madison
University
Chris and Hilda Bewall
Hilary McCabe Bierly
William C. Bigelow
Barry and Naomi Blay
TerryL.BodkinandConnieLee
Thompson-Bodkin
Charles H. Boggs Jr.
Clifford L. Bowman
JamesO.andSylviaK.Bowman
Linden R. and Nona L. Bowman
Steve and Chris Bradshaw
Addison D. Brainard
Lanny L. and Phyllis B. Branner
Robert N. Branson
Rosemary O. Brenner
JohnJ.andMaryT.Broaddus
Carol J. Brooks
Barry Browder
Donald R. and Jean C. Brown
Robert E. Sr. and Susan R. Brown
Brown, Edwards & Company, LLP
NellieV.Brubaker
Patricia A. Brunk
RichardC.andKathrynC.Bump
Wendelin M. Burnett
Colonel Norman S. Burzynski, USAF
(Ret.)
Gregory G. and Pollyanna A. Bush
Charles C. and Frances Ann Byers
MargaretT.Byers
Nancy E. Camp
Barry A. and Cynthia C. Campbell
Franklin R. and Shirley D. Campbell
A. Fontaine and Martha J. Canada
Eleanor F. Canter
John Canter
KarlaE.Carickhoff
Thomas F. and Janice R. Carroll
R. Bradley and Mary Ellen Chewning
Paul R. and Becky A.
Christophel
Lee E. Clapper Sr.
Clark and Bradshaw, PC
Richard H. Collins
Barbara Fielding Colson
ConnersSalesGroupInc.
Thomas F. Constable Jr.
Jerry L. and Phyllis Y. Coulter
Eugene A. and June S. Counts
Dr. Diane Cowger and Dr. Marc A.
Hudson
CharltonK.andSarahJ.Crider
KathleenF.Cross
AlbertL.andNeviaT.Crow
Dale L. and Sandra S. Cupp
Russell A. Curro
Carl Davis
MichaelW.andDebraI.Davis
Sharon D. Davis
Ben and Betty DeGraff
Sandra A. Delawder
J. Brisco and Janet Dellinger
Dr. and Mrs. Byard S. Deputy
Raymond C. Diehl
Lynn and Dave Diveley
Norman R. Downey Jr.
Paul S. C. and Nancy A. Driver
TomandKathyDunham
Lisa A. Ellison
Episcopal Campus Ministry
Dr. J. Robert and Rosalie Hartman
Eshleman
Harold C. Eskey
Dr. James D. and Sheila D. Evans
L.KathrynEvans
LeightonD.andKathrynR.Evans
Donald M. and Joyce Y. Evers
Anne G. Farmer
Anna Lee Fega
Hal and Sue Ferguson
Carl E. and Janice G. Fifer
GarlandV.andCarolynK.Fifer
Elwood and Madge Fisher
NormanV.andPatsyM.Fitzwater
Dr. William P. and Nancy R. Fletcher
Edgar A. Flora
William M. and Grace A. Florence
Theodore W. and Mary Beth M. Flory
Larry A. and Linda J. Fogle
VirginiaR.Foltz
Ben Fordney
Richard H. Forman
RickandLauraK.Fox
Haywood G. France
Loretta G. Frantz
Forrest L. and Freddie F. Frazier
MarieK.Frey
John and Patricia Froehlich
Charles J. Frye
David and Rachel Frye
Sally F. Fulton
Curtis W. Funkhouser Sr.
Thomas N. and Susan S. Gallaher
Dr.LinfordK.andRebeccaL.Gehman
Everett E. Gibson
Glass&MetalsInc.
Dr. David A. Glazer, DC
TommyandBetsyHeatwoleGlendye
GlennGlassIncorporated
KennethH.andJoyceC.Goad
Gregory and Carolyn Gochenour
James M. Sr. and Jean M. Godman
Joseph W. Good
Mary Martha Good
Nina M. Goodridge
Steve H. Gordon
JoniK.Grady
Grand Home Furnishings
Julia Nelle Grandle
Mr. and Mrs. Peter M. Green
Dr. Joseph M. Jr. and Sandra Greene
Benjamin W. Greider
John F. and Joann Grubbs
Daryl D. Gum
Eric and Patricia Hagerty
Herman W. and Rosemary G. Hale
Josh P. and Chassidy S. Hale
Alma C. Hale-Cooper
HaleyBuildersInc.
Jean S. Hamill
Bruce D. Hamilton
Robert H. Hammond
Helen S. Harman
Jack and Sammie Harner
Carolyn J. Harrison
VivianHarrison
HarrisonburgVirginiaAssociates
Nancy Harrold
Carol and Heidi Hartman
IvanL.andEdithHartman
Collier S. and Betty Ann Harvey
Dr.J.T.HearnandPhyllisWeaver
Hearn
John R. and Mary Ann Heatwole
KathrynS.Heatwole
Leo E. and Ruthanne J. Heatwole
W.MichaelIIIandKellyO.
Heatwole
Farrel B. Hendricks
John E. and Judith N. Henneberger
Barbara J. Henry
MaxK.Hepner
Robert W. and Shirley A. Hibarger
Christine C. Mast Hill
Judge Marvin C. Jr. and Grace W.
Hillsman
James H. and Lois Hinegardner
RonaldLeeandDellaIreneHinkle
ShelvyK.Hinkle
DanielK.HiteJr.
William R. and Barbara H. Hite
James F. and Delores H. Hoak
Donald L. Hobbs
Joseph E. and Rachel M. Hollis
John and Lou Holsten
Elizabeth A. Homan
Linda S. Hoover, CFP
Robert E. and Betty W. Hoover
Robert S. and Marilyn J. Hospodar
Dr.JeromeJ.HotchkissJr.andKimberly
Haines
Jean R. Houff
James G. L. Howard
Larry R. and Susan D. Huffman
David M. Hughes
Brenda J. Hull
BillyM.HulveyII
Delores D. Hulvey
GlenC.andVirginiaAnnHulvey
Rita Hunter
Robert W. and Ann G. Hurley
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friends
OF THE RMH FOUNDATION
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63
Jim Bishop
GOING OUT ON A LIMB FOR
O
n an unseasonably mild afternoon in early November, a
friendly game of soccer broke
out on our front lawn. The players were
my8-year-oldtwingrandkidsGrant
andMegan,mywifeAnna(69)and
yourstruly(68),withthetwins’then
14-month-old brother Lane trying his
best to get in on the action.
Everyone was having a ball, trying
to intercept the rubber orb, reverse the
direction of play and take shots on the
makeshift goals. The action intensified,
kids and adults alike caught up in the
moment, when suddenly, this primordial
player lunged for the ball, lost his footing and hit the ground running—hard.
AsIlaytheremotionless,appendages sprawled in various directions, the
entourage helpfully responded to the
mishap by laughing uproariously. Then,
tomyutmostsurpriseanddisbelief,I
triedgettingup,butcouldn’t.Iremained
at the point of impact, dazed and confused, and the raucous laughter quickly
dissipated. Anxiety and concern swept
over Grant’s and Megan’s young faces.
NeverbeforehadIfeltphysically
Wellness
incapacitatedlikethis.Ihadentered
unfamiliar, rather daunting territory.
My dear spouse helped me get up,
slowly.Icouldmove,evencautiously
stand erect on my right leg, but the left
felt like gelatin. Megan pulled a pair of
crutchesfromstorageandIinchedmy
way inside to the living room sofa.
After daughter Sara came to pick
up the grandkids, Anna took me to
thedoctor,whereIwasplacedina
wheelchair for the first time in my life,
then interviewed and examined by two
empathetic healthcare professionals.
IfeltrelievedbytheassurancethatI
had pulled, but not torn, the hamstring
muscle in my left leg. But it still hurt
like crazy.
After wrapping my throbbing leg
in a large athletic bandage, the attending
physician wrote prescriptions for a pain
medication and muscle relaxer, which
Igotfilledbeforewereturnedhome.
Insteadofgoingtolinedanceclassthat
evening,Iwaslaiduponthesofa,waiting for the medications to kick in.
Inthedaysahead,Igotaroundon
crutches and with a little help from the
painmedicationIwastaking.
Ittooknearlyamonthtorecover
from the accident. The whole ordeal
proved a learning experience for this
athleticallychallengedsenior.Itwasa
sober reminder to act my age and to
exercisemorecareinwhatIchooseto
do,whatIshoulddoandhowIprepare
to do it.
Exercise is so important to staying
fitasoneages.I’mfinding,two-and-ahalf years into retirement, how difficult
it is to keep the pounds off with easy access to our well-stocked refrigerator, my
wife cooking more than when both of us
worked full time, and eating out regularlywithfamilyandfriends.Itakemy
cholesterol and blood pressure tablets
and a multivitamin supplement daily.
While acknowledging that my
generally robust condition could change
inaheartbeat(again,literally)atthiscapriciousseniorstageoflife,Igivethanks
for my loving, supportive family, many
friends and church small group, and
more than enough extracurricular activities to keep me inspired and motivated.
Thebottomline:Ifyouhavereasonable physical, mental and spiritual health,
you are rich beyond measure. Like the
Beatles declared many years ago, “Money
can’t buy you love,” but striving to stay
fit, whatever your age, and having access
to quality healthcare can combine to
provide a richer quality
of life, happiness and
well-being. ■
Jim Bishop is retired
after 40 years as public
information officer at
Eastern Mennonite
University. He continues
his freelance writing and
photography interests
and is a regular donor to Virginia Blood
Services. He can be contacted at jimanna.
bishop@gmail.com.
●
64
healthQuest | Spring 2014
Heart Surgery
to the Next Level:
Minimally Invasive
Cardiothoracic Surgeon Jerome McDonald, MD
brings minimally invasive cardiac and thoracic
procedures to our community.
“The opportunity to have world-class care involving
almost every discipline of cardiac and thoracic
surgery in the local community is a big advantage.
The heart team at Sentara RMH Heart and
Vascular Center is truly exceptional.”
—Dr. McDonald
Minimally invasive cardiothoracic surgery is not an option for every patient.
RMHOnline.com
Rockingham Memorial Hospital
2010 Health Campus Drive
Harrisonburg, Virginia 22801
NON-PROFIT
U.S. POSTAGE
PAID
PERMIT NO. 19
BURLINGTON, VT
RMHOnline.com
Change service requested
Extraordinary Surgical Care
In the Smallest Way Possible.
At Sentara RMH Medical Center, our expert surgical team provides
a wide array of advanced procedures that include minimally
invasive and laparoscopic surgical techniques.
These types of procedures mean a quicker recovery for you.
Talk to your doctor today to see if minimally invasive
surgery is an option for you.
RMHOnline.com