Read Now - Sentara

Meet Harrisonburg’s First
Endocrinologist
Be Alert to Signs of Concussion
Preste atención a las señales de contusión
Understanding Genetic
Counseling
PAGE 20
PAGE 24 /PÁGINA 25
PAGE 32
healthQuest
FA L L 2 0 1 4
Artist,
Interrupted
COVER
STORY
THE LESSER-KNOWN SYMPTOMS OF HEART ATTACK
PAGE 40
president’s message
A
nyone who reads or listens to the news knows that the pace of change in health care is at an all-time high.
Every day, it seems, the news is full of articles about health care reform, the Affordable Care
Act, Medicaid and Medicare funding reductions and shortfalls, and hospital workforce reductions
through layoffs.
Insurance providers are increasing the burden on patients for out-of-pocket costs, making it
more difficult for patients to get the care they need.
Many—in fact, most—of these pressures are starting to hit closer and closer to home.
Yet, amidst all this turmoil, Sentara RMH is adapting and adjusting. We continue to move forward with
performance improvement initiatives that help us reduce costs while ensuring safe, high-quality care. We
are growing services and programs like orthopedics, cardiac care and women’s services, to better meet our
community’s needs. We are implementing new initiatives like patient-centered medical homes and chronic
disease management programs to help manage specific populations of patients.
We are mindful that the primary reason we are able to move successfully forward
is that we are part of a system that continues to grow and thrive. Through our relationships with our sister Sentara hospitals, we are able to share best practices and prepare for
changes as they come.
One of our ongoing goals is to help improve access to care. To that end, our planning continues for construction of primary care facilities in the northern region of Rockingham County. And we are discussing with the town of Bridgewater how to better meet
that community’s needs. Also, if you’ve visited our health campus recently, you may have
noticed a steel frame starting to reveal the shape of the new orthopedics and advanced
imaging building that will improve access to these services. The building is slated to open
late next year.
Improving access also means giving you an easy way to access your own personal
health information. In this issue of HealthQuest you will read about the recently
Jim Krauss
launched My RMH Medical Record patient portal, a secure online resource for accessPresident,
ing your personal Sentara RMH health information. If you haven’t enrolled, take an
RMH Healthcare
opportunity to do so soon.
Corporate Vice President,
Also in this issue you’ll find articles on several special services we have brought to
Sentara Healthcare
the community recently, including genetic counseling, wound healing and specialized
treatment for chronic pain. You’ll also read about 12 talented new physicians who have
recently joined the Sentara RMH medical staff.
What I know for certain is that no hospital, including Sentara RMH, will be able to remain untouched
by regulatory reforms and marketplace changes. However, the strength of the Sentara system; the dedication
of our staff, volunteers and physicians; and the ongoing support of our community will sustain us as we move
forward with confidence.
As always, we remain grateful to be your community hospital and to have the opportunity to serve your
health care needs in support of our mission to improve health every day.
Sincerely,
Jim Krauss
President, RMH Healthcare
contents
FALL 2014
32
14
features
8
Clinical Pharmacists
On the Front Lines of
Patient Care
12
My RMH Medical
Record
Fingertip Access to Your
Personal Health Information
14
Finding Freedom
From Pain
Complex Regional Pain
Syndrome
29
20
32
29
40
When It’s
Complicated, an
Endocrinologist
Can Help
Relieving the Pain
of Frontal Sinus
Blockage
Unraveling Family
Medical Mysteries
Through Genetic
Counseling
Artist, Interrupted
The Lesser-Known Symptoms
of Heart Attack
44
New Center Hastens
Wound Healing
40
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
President | Jim Krauss
12
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, Sentara Blue Ridge Region | J. Michael Burris
departments
3 Ask the Doctor
Mumps, iron deficiency,
labyrinthitis
6 Physician’s Perspective
Clinical Trials: Staying on the
Leading Edge of Cancer
Treatment
19 Community Health
In the Loop Walking Program
23 Cancer Awareness
Understanding Prostate Cancer
24 For Your Health
Be Alert to Signs of Concussion
Senior Vice President, Operations | Richard Haushalter
52 Sentara News
54 Medical Staff Update
Sentara RMH Welcomes New
Health Care Professionals
Local Race Helps Local Women
Get Free Mammograms
59 Friends of the RMH
Foundation
Gifts Received Jan. 1–May 31, 2014
64 Jim Bishop
A Blanket Statement on Security
50 Sentara RMH News
Ann 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
Distribution | Karen Giron
CONTRIBUTING WRITERS
Luanne Austin | Jim Bishop | Karen Doss Bowman |
Vanessa Heatwole | Christina Kunkle |
Heather Morgan, MD | Neil Mowbray | Debra Thompson
Turn Over a New Belief
Sentara RMH Employees Donate
More Than $98,000
BOARD OF DIRECTORS
Contributing Designer | Marc Borzelleca
36 Living With Synergy
49 Employee Gifts
Vice President, Information Services | Michael J. Rozmus
Cover Photo/Contributing Photographer | Tommy Thompson
26 Nutrition
Not All Fats are Created Equal
48 Board Members
Sentara RMH Board Welcomes
Three New Local Members
Vice President, Human Resources,
Sentara Blue Ridge Region | Mark Zimmerman
Design and Production | Picante Creative
Preste atención a las señales de
contusión
Managing Anger
Vice President, Business Development,
Sentara Blue Ridge Region | Ronald J. Cottrell
57 RMH Foundation
25 Sobre Su Salud
38 Behavioral Health
Vice President, Acute Care Services;
Chief Nurse Executive | Donna Hahn
26
24
© 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
[email protected] or call 540-564-7205.
Q
Q:
ask the doctor healthQuest
What is mumps, and is it
dangerous? Why do we hear
about outbreaks of mumps?
M
umps is a viral
infection that
typically affects
the parotid glands, a pair of
saliva-producing glands located in front of and slightly
below the ears. Mumps may
cause these glands to swell,
a characteristic sign of the
infection that can make it
difficult for the infected per- Hillary G. Whonder-Genus, MD
son to chew or swallow.
Other common symptoms of mumps include
fever, headache, fatigue, general weakness and loss of
appetite. However, some people with mumps show
very mild or no signs and symptoms. In children,
mumps is usually a fairly mild disease with few if any
complications. Adults with mumps are more likely to
experience complications.
MUMPS IS INFECTIOUS AND SPREADS These include, in males,
testicular inflammation
RAPIDLY AMONG SUSCEPTIBLE
with possible atrophy of
the testicles (sterility is
PERSONS LIVING OR WORKING IN
very rare) and, in females,
CLOSE PROXIMITY.”
inflammation of the ovaries
or breasts. Only rarely does mumps lead to deafness,
viral meningitis (inflammation of the membranes
surrounding the brain and spinal cord), or encephalitis (swelling of the brain).
Mumps is infectious and spreads rapidly among
susceptible persons living or working in close proximity. Transmission is from person to person through
contact with infected saliva—either directly through
inhalation of airborne droplets produced when an infected person coughs, sneezes or speaks, or indirectly
when an infected person touches an item or surface
with unwashed hands and then another person
touches the same surface and transmits the virus to
his or her nose or mouth. Mumps can also be spread
through sharing cups or utensils with an infected
person, often unknowingly.
After someone is exposed to the mumps virus
and subsequently infected, it typically takes 14 to
18 days for symptoms to show up (the incubation
period). A person with mumps is contagious (infectious) during the incubation period from several
days before until five days following the onset of
symptoms, with the peak period of contagion about
three days prior to the appearance of swollen glands.
Infants less than one year rarely get infected because
of the passage of maternal antibodies.
There is no cure for mumps. Treatment involves
supportive care, including rest, drinking plenty of
fluids and reducing fever, if present. During the infectious phase, mumps patients should avoid contact
with others who may lack immunity to the virus.
The MMR (measles, mumps and rubella) vaccine is
available to protect susceptible persons from future
mumps virus disease (a preventive measure) but will
not cure a person who is already infected.
According to the Centers for Disease Control
and Prevention (CDC), before widespread immunization against mumps began in 1967, more than
180,000 new cases of mumps were reported annu-
RMHonline.com
3
[IRON
DEFICIENCY]
IS THE MOST
COMMON
NUTRITIONAL
DEFICIENCY
IN THE UNITED
STATES.”
ally in the United States. Since that
time, the incidence of mumps
has decreased by more than 99
percent. But outbreaks of mumps
still occur, even with widespread
immunization. In the first half of
2014, according to the CDC, two
outbreaks at U.S. universities were
widely reported in the news. When
looking at outbreaks, it’s important to
note that the attack rate is much higher in
unvaccinated people than in those who have been
completely vaccinated.
Because of the outbreaks reported worldwide,
the revised ACIP (Advisory Committee of Immunization Practices) recommendation remains as one
dose at 12 to 15 months and a second dose at four
to six years. Adults born before 1957 are considered
immune; therefore, persons born after 1957 should
have documented evidence of immunity, either from
disease or complete immunization. In fact, many universities are now requiring entering students to have
proof of immunity from mumps.
Even though the MMR vaccine is very effective
in protecting against mumps, that protection is not
absolute—one dose of MMR is about 78 percent
effective; two doses are about 88 percent effective. Wherever people associate regularly in close
or crowded conditions, such as in dormitories, in
classrooms, in camps or on sporting teams, the CDC
notes, there is still a possibility of outbreaks, raising concerns regarding waning immunity over time.
Whether a third dose is needed in late adolescence
or the timing of the second dose needs to be adjusted
for complete immunity is yet to be determined. But
consistent widespread use of the MMR vaccine will
continue to limit the size, severity and scope of any
outbreaks that may occur.
Hillary G. Whonder-Genus, MD, is a pediatrician
in practice and the chief medical officer at Harrisonburg Community Health Center. She joined the
Sentara RMH medical staff in 2007.
Q | What can you tell me
about iron deficiency? How
common is it, and what
problems can low iron cause?
Iron deficiency typically is caused by blood loss, poor
diet or an inability to absorb enough iron. Studies
conducted in April 2012 by the Centers for Disease
Control and Prevention found that 6.7 percent of
4
healthQuest | Fall 2014
Americans had iron deficiency.
It is the most common nutritional deficiency in the United
States.
People at higher risk for
iron deficiency include premature and low-birth-weight
infants, children who have been
exposed to lead, underweight
teens, women with heavy
menstrual bleeding, pregnant
Rosa King, MD
women, and adults with internal bleeding. Also at risk are kidney dialysis patients,
people who have undergone gastric bypass surgery,
vegetarians, and those who follow a low-fat or highfiber diet.
Symptoms of iron deficiency include fatigue,
decreased performance at work or in school, slow
cognitive and social development during childhood,
difficulty maintaining body temperature, decreased
immune function, brittle nails, cracks in the skin along
the sides of the mouth, an enlarged spleen and inflammation of the tongue.
Many people with iron deficiency also develop
iron deficiency anemia. Anemia occurs when the red
blood cell count is low or when red blood cells do
not contain enough hemoglobin, an iron-rich protein
that carries oxygen from the lungs to the rest of the
body. Symptoms of iron deficiency anemia include
the symptoms of iron deficiency listed above, plus
shortness of breath, dizziness, headache, coldness in
the hands and feet, pale skin, and chest pain. A lack of
sufficient hemoglobin-carrying red blood cells can also
lead to heart problems, including irregular heartbeats
(arrhythmias), heart murmurs, an enlarged heart or
even heart failure.
Because people with mild cases of iron deficiency
and iron deficiency anemia may not show symptoms, a
simple blood test is needed to check for iron deficiency. Doctors use this blood test, combined with a physical exam and review of the patient’s medical history, to
diagnose cases of iron deficiency anemia.
In addition to the immediate symptoms, iron
deficiency can lead to weakened immune function over time. Iron deficiency anemia is especially
problematic in infants and young children because
it can lead to long-term problems with neurodevelopment, including poorer cognitive, motor and
social-emotional function.
Preventing iron deficiency and iron deficiency
anemia can be as simple as eating a balanced diet
filled with iron-rich foods, including red meat, egg
yolks, leafy greens, dried fruit, beans, liver and artichokes. Including plenty of vitamin C in your diet
can improve iron absorption. If you develop iron
deficiency or iron deficiency anemia, you should
also ask your doctor about supplements and other
treatments.
Family medicine physician Rosa King, MD, is on
staff with Sentara RMH East Rockingham Health
Center in Elkton. She joined the Sentara RMH
medical staff in 2012.
Q | What is labyrinthitis?
Labyrinthitis is an inner
ear disorder. The condition gets its name from
the labyrinth, the portion
of the inner ear responsible for balance and
hearing.
The labyrinth consists of fluid-filled structures—three semicircular
canals and two sacs—that
Danny Neal, MD
regulate our balance, and
the cochlea, a snail-shaped structure filled with
fluid and nerve endings that enable us to hear. The
two-branched vestibulo-cochlear nerve carries messages from the labyrinth to the brain. Nerve signals
involving balance travel along the vestibular branch,
and sound signals along the cochlear branch.
Labyrinthitis occurs when the vestibular and
cochlear branches of the nerve become inflamed. The
inflammation usually results from a viral infection
like the common cold or flu. Less commonly the
cause may be bacterial, such as the bacteria that
cause Lyme disease or a bacterial infection
of the middle ear. Allergies and certain
medications can also cause labyrinthitis.
The inflammation interferes with
the transmission of nerve signals
to the brain. Resulting symptoms include ringing in the ear
(tinnitus); temporary hearing
loss; dizziness; loss of balance;
involuntary eye movements;
and inability to focus the eyes,
particularly on moving objects. Vertigo, a feeling of
whirling or spinning even when the person is standing still, is a common symptom of labyrinthitis. In
some people, the vertigo or loss of balance may cause
nausea and vomiting. Hearing loss associated with
labyrinthitis is very rarely permanent.
Symptoms usually start suddenly and may be
fairly severe at first. In most cases, symptoms go away
within several days or a few weeks, with complete
recovery in a month or two. Sudden head movements often can trigger a feeling of vertigo for weeks
after diagnosis.
There is no known way to prevent labyrinthitis. Because dizziness and vertigo are symptoms of
many other disorders, it may be difficult to diagnose
labyrinthitis. Hearing tests, MRIs and CTs can help
differentiate labyrinthitis among disorders with
similar symptoms.
Risk factors for labyrinthitis include recent viral,
upper-respiratory or ear infection, excessive alcohol
consumption, smoking, a history of allergies, fatigue,
stress, and the taking of certain medications that may
affect the inner ear.
Treatment typically involves control of symptoms. Your doctor may prescribe an antibiotic,
antihistamines, sedatives or antinausea medication to
treat the symptoms.
Patients with labyrinthitis should avoid bright
lights, remain fairly still and move slowly. If they experience vertigo or dizziness, they should also avoid
driving.
VERTIGO, A
FEELING OF
WHIRLING
OR SPINNING
EVEN WHEN
THE PERSON IS
STANDING STILL,
IS A COMMON
SYMPTOM OF
LABYRINTHITIS.”
Danny Neal, MD, is in private practice at Harrisonburg ENT. He joined the Sentara RMH medical
staff in 1989. ■
RMHonline.com
5
physician’s perspective
Clinical Trials:
Staying on the Leading Edge of Cancer Treatment
Oncology, the branch of medicine that deals with the study and treatment of malignant tumors,
is a rapidly changing field. In the past two decades alone, oncology has become more and more
complex. New chemotherapies and new methods of radiation treatment delivery seem to be
constantly emerging, allowing us to personalize cancer care like never before.
P
hysicians have become
increasingly reliant on
well-designed clinical trials
to provide us with evidence
of the safety and efficacy of these new
treatments. However, clinical trials
require the participation of patients, and
acquiring adequate numbers of appropriate patients for trials can be a challenge. In fact, some trials have closed
early due to lack of patient participation,
which is a waste of resources and causes
further delays in making new treatments
available to patients.
Accredited cancer treatment centers, such as the Sentara RMH Hahn
Cancer Center, are required by our
accrediting body, the American College
of Surgeons’ Commission on Cancer
(CoC), to enroll a certain proportion of
6
healthQuest | Fall 2014
our patients into clinical trials. As a way
to motivate cancer centers to put more
emphasis on clinical trials, the CoC
recently raised the bar for clinical trial
enrollment requirements. Beginning
in 2012, our center’s requirement for
enrollment increased from 2 percent to
4 percent of all of our patients.
At first glance, this may not seem
like a large number of patients. However, patients must initially meet the
selection criteria of a clinical trial. In
addition, patients must be willing to be
enrolled and possibly “randomized” to
one treatment or another. This often involves giving up a sense of control, much
of which has already been lost with the
diagnosis of cancer. These issues, as well
as a number of other challenges to enrolling patients in a study, has prompted
By Heather Morgan, MD,
Radiation Oncologist,
Sentara RMH Hahn
Cancer Center
the Hahn Cancer Center to find a number
of ways to meet our clinical trial accrual
requirements.
Increasing Trial Participation at
the Hahn Cancer Center
One way to increase the number of patients
enrolled in trials was to make more trials
available at our cancer center. The most
well-designed clinical trials are developed
by academic oncologists and surgeons who
specialize in certain types of cancer. These
physicians are typically members of one of
the national cancer clinical trial organizations, and they meet to discuss the development of new studies.
The Sentara RMH Hahn Cancer
Center has been a member of the Radiation Therapy Oncology Group (RTOG),
which has enabled us to offer access to
“
clinical trials to determine if it is equally
effective as the longer regimen, which
treats the whole breast for five weeks.
The Hahn Cancer Center developed
a study based on the national trial in
terms of treatment techniques, and we
will be keeping track of our patients’
outcomes until the results of the national trial are available.
Benefits to Patients
By enrolling in clinical trials, patients
may benefit by having an opportunity
to try new and potentially more effective or less toxic treatments. There is no
guarantee that the patient will be able
to receive the experimental treatment,
as most well-designed clinical trials
are randomized, meaning a “flip of the
coin” determines if a patient receives
the standard treatment or an experimental treatment.
these initial studies prior to moving on
to the large phase III trials, which cost
a lot more to implement. Despite this,
patients chosen for the experimental
treatment may experience unexpected
side effects, and there is still a slight
chance that the treatment will be less effective than the standard treatment. It is
important to note, however, that patients
are never forced into clinical trials and
can drop out of a trial anytime if side
effects are too severe.
Sentara RMH Medical Center
also requires that any clinical trial be
approved by the hospital’s institutional
review board. Both medical and nonmedical professionals from the hospital
and community, respectively, volunteer
their time to review newly proposed
studies and to monitor ongoing studies
to make sure that they are ethical and as
safe as possible for our patients.
“
some of the RTOG trials for certain
patients receiving radiation for breast,
prostate, lung, or head and neck cancer.
We will soon gain access through the
Sentara network to a wider variety
of clinical trials sponsored by other
national research groups.
For less common cancers, we can
also refer patients to larger academic
centers for clinical trials. The National
Cancer Institute (NCI) maintains a
database of ongoing approved clinical
trials for cancer, and it can be searched
by type of cancer and by region of the
country. In order to participate in any
clinical trial, however, the patient must
meet specific selection criteria. The trial
protocol will contain a list of things that
will qualify or disqualify a patient for
enrollment into a study. This list helps to
ensure that the group of patients being
studied will have similar characteristics.
Physicians have become increasingly reliant on well-designed clinical trials to provide us with evidence of the
safety and efficacy of these new treatments. However, clinical trials require the participation of patients, and
— Heather Morgan, MD
acquiring adequate numbers of appropriate patients for trials can be a challenge.
Some patients have cancers or situations
that are so rare that a clinical trial may
not be available for them.
Clinical Studies Based at the
Hahn Cancer Center
Our cancer center has also developed internal studies in which we are
enrolling certain patients. One study
developed in conjunction with breast
surgeon Dr. Heidi Rafferty, of Sentara
RMH Breast Care, involves the use
of accelerated partial breast irradiation (APBI) for early breast cancer.
This is a new treatment that enables
us to shorten the course of radiation
therapy for patients after a lumpectomy (removal of a small tumor from
the breast) from five or more weeks
to about one week by treating only a
small amount of breast tissue where the
cancer was located.
The treatment is becoming more
and more common for certain breast
cancer patients but is still being tested in
One of our patients who enrolled
in a study testing a shorter wholebreast radiation treatment felt lucky
to be randomized to the experimental
three-week regimen versus the standard
six-week regimen. She lived in Luray,
and this helped reduce the number
of trips to the cancer center by half.
Regardless, both the standard and
experimental groups receive treatment
designed by the foremost experts in the
field who have written the specifics of
the study’s protocol.
Limiting Risks for Patients
There are some potential risks to
patients when enrolling in trials. Our
center tries to limit these risks by
opening only phase III trials, which
test a new treatment compared to a
current standard treatment. Phase I
and phase II trials are the initial steps
in determining a new treatment’s
safety and efficacy.
New treatments must do well in
The treatment of cancer has made
great strides in the past few decades due
to this type of well-coordinated research.
While there is typically no monetary
benefit to physicians for enrolling
patients into these NCI-sponsored
clinical trials, it benefits the profession
by answering an important question
about cancer care. We oncologists are
continually striving to make cancer
treatments both more effective and less
toxic, thereby
improving
the cure rates
and quality
of life for our
patients. ■
■ Heather
Morgan, MD, is
a radiation oncologist at Sen-tara RMH Hahn
Cancer Center.
She joined the
medical staff in
2006.
RMHonline.com
7
Oncology Pharmacy
Specialist John Moore
chats with Omar Eby as
Eby begins a chemotherapy treatment.
CLINICAL
PHARMACISTS:
On the Front Lines of Patient Care
When Megan Ellmers, PharmD, tells
people she’s a pharmacist, they automatically assume she’s behind a counter filling
prescriptions. But Ellmers’ job is not to
dispense medicine, and she doesn’t even
stand behind a counter.
By Luanne Austin
8
healthQuest | Fall 2014
Ellmers works on the “front lines” of health care
as an ambulatory care clinical pharmacist at Sentara
RMH South Main Health Center in Harrisonburg.
She consults one-on-one with patients who are seeing their primary care physician within a few days
after being discharged from the hospital.
“I provide patients with transitional care from
hospital to home,” she explains.
Before meeting with a patient, Ellmers reviews
Clinical pharmacist
Megan Ellmers works with
physician assistant
Paul Johnston to help
patients manage their
high blood pressure.
the patient’s list of medications. She looks at the
drugs the patient was taking before being admitted
to the hospital, the drugs that were stopped during
the hospital stay and the drugs that were started during the stay. She checks for redundancies. She checks
the patient’s insurance status to be sure the medications are affordable.
“It doesn’t matter what the doctor prescribes if
the patient can’t afford the medications,” she explains. “Often patients are reluctant to admit they
can’t pay; they just don’t take the medicine.”
Thirty minutes before patients’ appointments
with their physicians, Ellmers meets with them to
discuss their medications. She goes over the list
with them, making sure they’ve stopped taking the
ones they were supposed to stop and are taking their
current medications correctly. She checks to see if
they’re having uncomfortable side effects.
“It’s a safety measure,” says Ellmers. “Often,
the hospital physician doesn’t see them again once
they’re discharged, so this review provides continuity
of care regarding their medication regimen.”
What’s a Clinical Pharmacist?
Ellmers is one of several “front line” clinical pharmacists who work for Sentara RMH Medical Center.
Clinical pharmacists differ from behind-thecounter pharmacists in that, rather than working di-
Emergency Department
nurse Aryn Knight, RN,
asks Clinical Pharmacist
Saumil Vaghela about a
patient’s medications.
rectly with medications, they are out on the nursing
units, in departments and in medical offices working
directly with physicians, other health professionals
and patients. Their job is to ensure that medications
contribute to a patient’s best overall health.
“The hospital pharmacy impacts every patient
who comes through the door,” says John Lubkowski,
pharmacy operations manager. “Pharmacists evaluate
all drug orders for each patient, asking things like, ‘Are
there allergies? Should there be an adjustment of dosage or strength? Is the patient’s kidney function able
to handle the drug?’ We still need pharmacists filling
the traditional role, but clinical pharmacists allow us
to provide outreach, to be where the patients are.”
Clinical pharmacists evaluate medication safety,
cost and effectiveness. Getting it right the first time
reduces the chance that a medication could harm
the patient; it also reduces cost and can shorten a
patient’s hospital stay.
“For example, if the first antibiotic a patient is
sent home on isn’t effective and the patient has to
return, that drives up the cost for the patient and the
hospital,” says Laura Adkins, clinical pharmacy manager. “Part of our job is to be sure the drug is doing
what it’s supposed to do. If it’s not, the physician may
need to change the drug or dosage.”
On the Hospital Nursing Unit
In the hospital, a clinical pharmacist is assigned
to one patient care floor. Upon arrival, he (or she)
gets a report of all the patients on the floor, including their lab reports, medications, dosages and side
effects. He makes rounds with a physician. Together
RMHonline.com
9
they may identify medication-related issues and resolve
them on the spot. The clinical pharmacist also responds
to emergency “codes”—for instance, if a patient goes
into respiratory arrest—where there may be a need to
administer or adjust a medication.
A clinical pharmacist may consult with an inpatient
for myriad reasons.
“If patients are seeing multiple doctors and they
come to the hospital for an acute situation, their medications need to be overseen by someone to check for
correct dosing and drug interactions,” says Betsy Early,
Sentara Blue Ridge region pharmacy director.
Because many patients, especially the elderly, take
multiple medications, patients are sometimes admitted
to the hospital because of a “medication event,” such as
incorrect dosage or a medication interaction that causes
negative reactions. The clinical pharmacist works with
the patient’s physician in the hospital to make appropriate adjustments.
“As medications are helping people to live longer,
their drug regimens are becoming more complex,” says
Adkins.
Jeremy Rose,
infectious
disease clinical
pharmacist,
right, works
closely with
Dr. Parag Patel,
the new infectious disease
physician at
Sentara RMH.
10
In the Medical Office
Ambulatory care clinical pharmacy is new for Sentara
RMH and is a collaboration between the hospital and
its outpatient clinics. Ellmers’ position at Sentara RMH
South Main Health Center began in January 2014.
Research has shown that when medication assessment and reconciliation are done by clinical pharmacists
such as Ellmers, three to seven days after a hospital
discharge, readmissions and costs decrease.
“Older people in particular may be confused about
what to take and what to stop taking,” Early says.
healthQuest | Fall 2014
Ellmers says some patients take notes while she
talks with them about things like which medications to
take with food or without food, or separately from other
medications.
“A lot of patients are going through medication
changes, and they have questions,” Ellmers says. “They
want to know, ‘Why am I stopping a medication I took
for years?’ So just going through their list with them and
giving explanations, you see the light bulb go on.”
Ellmers also works with patients who are taking
chronic care medications like insulin for diabetes, and
anticoagulation medications like Coumadin.
Adkins says Sentara RMH hopes to expand the
ambulatory care pharmacy program to its other clinics.
“This has been so effective and so helpful to the patients
that we want to be able to offer it at our other health
centers throughout the community,” she says.
In the Cancer Center
At the Sentara RMH Hahn Cancer Center, Clinical
Oncology Pharmacy Specialist John Moore, PharmD,
oversees the ordering, mixing and dispensing of all
chemotherapy drugs and other medications. With a
“satellite pharmacy” in the cancer center, the pharmacy
staff is able to mix chemotherapy drugs and provide
medications to the patients sooner, he says.
Moore also meets with patients in the cancer
center, counseling them about potential drug side effects,
discussing product safety and offering support. He considers providing patient care the best part of his job.
“From the patient’s standpoint, cancer treatment
is a tough time, a daunting diagnosis,” Moore says. He
talks with patients when they are starting new medication, and he checks with patients on return visits to
assess how they are doing with their medication. “From
an emotional standpoint, it helps patients with anxiety,”
he adds.
Moore acknowledges that chemotherapy drugs can
be “hazardous medications.” Chemotherapy regimens
are often complex and high-risk, so he stays abreast of
the latest information in the field.
“There is no room for error,” he states. “Chemotherapy drugs must be mixed in the right amounts, in
the right fluids, in the right time frames.”
He reviews physician orders and, if necessary,
goes to the physician with suggestions to improve the
medication regimen. Sometimes a physician or nurse
asks him to speak with a patient about drug side effects
or other concerns.
“I’m the source for drug information for the
doctors, nurses and patients,” he says. “I’m grateful to
be part of a dedicated team of physicians, nurses and
pharmacy technicians who provide high-quality care for
our patients.”
Dealing With
Infectious Disease
With antibiotic resistance rates continually rising at health care institutions, and new antibiotic-resistant
organisms being identified, Jeremy
Rose, PharmD, infectious disease
(ID) clinical pharmacist, has his work
cut out for him.
“It’s lower here than in bigger
cities, but it’s coming here too,” says
Rose. “Our decisions for treatment
must be prudent.”
The role of the ID clinical pharmacist is to monitor the use of antibiotics to be sure there’s no overuse
and that, in each case, the appropriate
antibiotic is being used for the organism being treated.
While many people are allergic
to common antibiotics like penicillin and sulfa drugs,
other problems such as liver and kidney ailments can
also dictate the need for an alternate drug. Plus, there
are many areas of specialty knowledge in antibiotic
therapy, such as for pneumonia and urinary tract
infections.
“There is seldom a one-size-fits-all solution,” Rose
says. “What works for one patient may not work for
someone else.”
He also checks the patient’s lab work for changes
and response as antibiotics are being administered.
“At the 72-hour point, we can tell if the patient is
doing better or worse,” Rose says. “If he’s better, we may
trim back on the antibiotic a bit in hopes that it helps
the outcome and avoids problems. Or if the patient is
worse, we may change our strategy.”
In the Emergency Department
Emergency Department (ED) patients present a unique
challenge for the clinical pharmacist.
The ED treats patients in acute health situations,
such as an injury, breathing problems or chest pain.
Because they usually arrive at the hospital without
preparation, patients don’t always bring their medication lists, so the ED staff interviews each patient and
reviews the patient’s hospital history, past medications
and past charts.
“We focus on the emergent problems, and the
drugs we use must treat the acute illness,” says Saumil
Vaghela, PharmD, Emergency Department clinical
pharmacist.
Vaghela is constantly reviewing physicians’ orders
to be sure the medications are up to date, do not interact
with patients’ current medications, and are not related
to medications to which the patients are allergic.
“The way we treat disease is constantly changing,”
he says.
He also checks in on patients to see that they’re
responding appropriately to the medications. If patients
are not responding appropriately, Vaghela works with
the physicians and nurses to increase dosing or find
more effective medications. With more critical patients
who will be admitted or transported to another facility,
he sees to their IVs or other medications.
“I focus on the sickest patients to make sure they
get the medications they need in the ED before they’re
admitted to the hospital or transferred out,” he says.
For patients who are being discharged to go
home and who have questions about their prescriptions, Vaghela goes over their medications with them.
“In the ED, we treat all kinds of medical problems and are prepared to expect the unexpected,”
he says.
Clinical
Pharmacist
Laura Deavers,
who works
in the nursing units, and
Hospitalist
John Anderson,
DO, review a
patient’s medications at the
bedside.
Safe, Effective Patient Care
is the Goal
Wherever in the health care system the clinical
pharmacist encounters the patient, the goal is the
same: to make sure medicine is doing what it should
to improve the patient’s health.
Notes Adkins, “Our pharmacists work directly
with doctors, other health care providers and patients
to improve medication use, enhance patient safety
and contribute to the best possible health outcomes
for patients every day.” ■
RMHonline.com
11
My RMH
atients of Sentara RMH Medical
Center now have a convenient online
resource for accessing their personal
health information: My RMH Medical Record.
My RMH Medical Record is a secure web portal where you can view your hospital visit history back to January 2012, including medications you’ve received; vital signs taken; procedures
performed; and lab, imaging and other reports.
You can manage your personal health information,
review scheduled appointments, and download or
share your health information with others.
Medical Record:
Fingertip Access to Your Personal
Health Information
12
healthQuest | Fall 2014
Why should you use the patient portal?
Sentara RMH Medical Center offers this portal
to provide patients and their families access to
valuable health information online. You can
■
View, download or share your health
information in multiple formats
■
See details for scheduled visits
■
Review laboratory results, radiology and
other reports
■
View allergies and medical conditions
■
Review current medications
■
Reference visit history, including discharge
instructions
■
Manage your family’s health information
within your own account
Are you enrolled in the Sentara RMH Medical
Group portal? This one’s different.
The Sentara RMH Medical Group also has a portal, but it is separate from the portal used by Sentara
RMH Medical Center. While they’re both called
“My RMH Medical Record,” they require separate
accounts and provide different information. The Medical Group’s portal is designed for you to communicate
with your primary care provider or specialist, while
the hospital’s portal is where you will find information
related to your hospital visit.
How do you set up enrollment? Patients have
several options.
■
If you haven’t already enrolled in My RMH
Medical Record, that will occur as part of the
admitting process when you register at the
hospital during your next visit.
■
Go to RMHOnline.com and click on the “My
RMH Medical Record” portal page. Complete
and return the form from the Forms menu,
following the instructions provided.
How can you share access with others?
■
Once you have enrolled in the portal, you can give
others access to your health information, if you would
like. For example, if you’re an older adult and would
like to give access to your adult child, you may do so.
There is information within the portal to help you in
this process.
Stop by the Sentara RMH Health Information
Management Department, located at 3320
Emmaus Road, Harrisonburg. The office is
open Monday–Friday, 8 a.m.–4:30 p.m.
■
Stop by the Release of Information (ROI) desk
located in the main lobby of Sentara RMH
Medical Center.
What is custodial patient access?
Under normal circumstances, an individual must be
18 years or older to request a portal account. Parents
and legal guardians may request portal access to their
children’s health information. When the child reaches
age 14, this access automatically ends due to state and
federal requirements. See additional information at
RMHOnline.com.
Who can enroll?
If you’ve been an inpatient, outpatient or Emergency
Department patient of Sentara RMH Medical Center
since January 2012, you are eligible to enroll in My
RMH Patient Portal.
Upon enrollment by a registration or Health
Information Management staff member, you will
receive an email or printed instructions with everything you need to access the portal. You will need to
consent to terms and conditions electronically upon
registration, and then you’re all set.
Questions or concerns?
For more information, including help and FAQs, a
user guide, terms and conditions, and forms, go to
RMHOnline.com and click on the “My RMH Medical
Record” hospital portal page.
You can also email us at [email protected],
or call Sentara RMH Healthsource at 540-564-7200. ■
RMHonline.com
13
Finding
Freedom
From Pain
The Mystery
of Complex
Regional Pain
Syndrome
More than two years ago, Michelle
Bowers of Franklin, W.Va., went to
kick a drawer closed. Instead, her
foot hit the wall.
“I hit the wall with a lot of
force,” says Bowers, age 30. “That
started it.”
From the pain she felt, Bowers thought she had sprained her
ankle. Her primary care physician
agreed. But when the pain continued and worsened, Bowers ended up
in the Emergency Department (ED)
at Sentara RMH Medical Center. She
was referred to a physician who treated
her pain aggressively with medications.
Meanwhile, Bowers, unable to stand
on the foot or to walk for more than a
few minutes, had to quit her job as a
patient care technician in the ED. She
stopped her daily walks and cut back on
things she loved doing: gardening, cooking, baking and volunteering at the fire
department. She could not go hunting
and fishing with her husband, Ronnie.
“I had to give up everything,” Bow-
14
healthQuest | Fall 2014
BY LUANNE AUSTIN
ers says. “I had to totally reconfigure my
life around this injury.”
Bowers began reading and
crocheting to occupy her time.
Bowers’ husband pitched in to
help with household tasks. A
police officer at Sugar Grove
Naval Base, he became the sole
supporter of the family.
When the pain medications
stopped helping two years after the
initial incident, Bowers was referred
to Christopher Joel Hess, MD, a
physiatrist and pain specialist with
Sentara RMH Orthopedics and Sports
Medicine.
And finally, she got a diagnosis—and
hope.
A Rare Condition
Involving Severe Pain
Dr. Hess diagnosed Bowers with complex
regional pain syndrome (CRPS). CRPS is a
chronic pain condition most often affecting one of the limbs (arms, legs, hands
or feet), usually after an injury or
trauma to that limb. CRPS, also referred to as reflex
sympathetic dystrophy, is believed to be caused by
damage to, or malfunction of, the peripheral and
central nervous systems.
“The nervous system gets ramped up and out of
control, resulting in severe pain and disability,” says
Dr. Hess.
According to the National Institute of Neurological Disorders and Stroke (NINDS), anyone can
get CRPS. It can strike at any age and affects both
men and women, but it is much more common in
women. The average age of affected individuals is
around 40. Children do not get it before age 5 and
only very rarely before age 10, according to
the NINDS, but it is not uncommon in
teenagers.
Dr. Hess had seen many cases of
CRPS while completing a pain management fellowship at the University of
Virginia School of Medicine. In the year that
he’s worked at Sentara RMH, he has seen 30
referrals for suspected CRPS, but has confirmed
just 10 cases.
“It’s a very rare condition involving severe
pain that is out of proportion with the injury,” says Dr. Hess. “It
gets missed a lot.”
“The average
time to a CRPS
diagnosis is 30
months after the
initial injury,” he
adds.
Other symptoms of CRPS include changes in
skin color, temperature and swelling in the affected
area, as well as abnormal sweating and extreme
tenderness to touch. Even with such clear
symptoms, the disease is a “diagnosis of
exclusion,” says Dr. Hess.
To be sure it’s not another disease,
he usually orders lab work, imaging and
sometimes a referral to another
specialist.
Once diagnosed, CRPS can be managed by several treatment options, including
medications; physical, occupational and psychological therapies; sympathetic nerve block;
and spinal cord stimulation.
Patient education is another aspect of
treatment, in which the physician and
patient look at the course of the disease and chart a
plan of action.
“The earlier a diagnosis is made, and the earlier
treatments are initiated, the better the outcome,” says
Dr. Hess. “In mild cases, individuals may recover
gradually with time. In more severe cases, however,
individuals may end up with a long-term disability.”
Spinal Cord Stimulation
May Deter the Pain
Since medications had stopped working for Michelle
Bowers, Dr. Hess tried a nerve block, which involves
injecting an anesthetic next to the spine to directly
block the nerve activity and improve blood flow in
the affected limb.
“But that didn’t work for me,” says Bowers.
The next step was a spinal cord stimulation trial.
This outpatient procedure involves temporary placement of electrodes along the back of the spinal cord.
The electrodes are externally attached to a battery
pack the patient wears around the waist. When
activated, the electrodes cause a numbing or
tingling sensation that replaces
the pain in the affected limb.
The patient wears it home for
one week to see if it’s effective before it’s permanently
implanted.
“The goals are to increase function of the affected
limb, decrease the use of pain
medication and decrease the
pain by at least 50 percent,”
Dr. Hess says. If the trial meets
these goals, the device is surgically implanted. After it heals and
scars into place, the patient can return to
regular activities.
The trial worked so well for Bowers that she scheduled surgery soon
thereafter. In June, Mark E. Coggins,
MD, an orthopedic spine surgeon,
performed the implant operation
at Sentara RMH.
“It’s working!”
Bowers says. “I
have 70 percent
more mobility and less
pain. I’m very
RMHonline.com
15
C. Joel Hess, MD, sees
Sara Davis, 16, in his office.
She was diagnosed with CRPS
when she was 12, but had
suffered with symptoms since
a foot injury at age 10. The
spots on her leg are part of
the condition.
16
healthQuest | Fall 2014
pleased with it. Dr. Hess has been amazing. All the
doctors have. I’m so happy with them.”
Quick Diagnosis May Lead to
Quicker Recovery
Rebecca Huffman Pegram of Timberville began her
journey with CRPS in February. It started with an
abscess near her armpit. Her primary care physician
noticed it and referred her for surgery. The surgeon,
John Mansfield, MD, drained it and took a culture.
Then one day in March, after a long and stressful telephone conversation, Pegram suddenly felt
severe pain. Her pinky and ring fingers were curled
into her palm, and her arm was very tender to the
touch.
“I had to hold my arm close to my body,” says
Pegram, 49. “The pain was so bad I could have
screamed.”
The pain started at the right side of her neck
and ran down her shoulder to her elbow and half of
her middle finger. She was not able to use her arm
to get dressed, do household chores or enjoy her
photography hobby.
Dr. Mansfield “took X-rays and MRIs,” she
says, then told her to see Dr. Hess right away.
“Her exam showed classic CRPS,” says Dr.
Hess.
“He was a very kind young man,” Pegram says.
“He said, ‘This is what I believe you have.’ He talked
me through everything they were going to do. He
listens to you.”
Since Pegram was already taking medications
for fibromyalgia—the same ones used for CRPS—
Dr. Hess recommended physical therapy, which
uses desensitization techniques. He also gave her
an ultrasound-guided nerve block injection into her
neck. She experienced 80 percent relief with the first
shot, and with each subsequent shot—four, over the
course of four weeks—she had significant relief.
Now, she says, the pain is 100 percent gone and
she’s regained total mobility of her arm.
“She has a good prognosis because we found
it within a couple of months,” Dr. Hess says. “She
responded well.”
Pegram says, “For anyone who has this, Dr.
Hess is the one to go to.”
“
It’s been
really
helpful
for Sara
to see
other
young
people
like
herself
learning to
overcome
CRPS and
achieve
their
goals,”
Legg says.
with the side of her foot, twisting her ankle. Within
a short time, Davis began experiencing severe pain at
the injury site. Davis’ physician believed the injury was
a sprain, and it took several months to identify two
hairline fractures in her foot.
For two years, Davis had physical therapy and
medication to control the pain, but everything, including pool therapy, proved ineffective. Since she was so
young, physicians were reluctant to increase the medication dosage very much. Finally, her pool therapist
at Sentara RMH Rehab suggested the possibility of
CRPS. She recommended asking Sara’s orthopedic
foot specialist at UVa if this was a possibility. That’s
when Davis got the diagnosis of CRPS. Her physician said she was a “textbook case” of CRPS, but it was
overlooked due to her age. She was 12 at that time.
“From the knee down, her right leg was half the
size of her left,” says Davis’ mother, Cindy Legg. “It
turned paper-white, got blotchy and swollen, and was
ice cold most of the time. All of that, and extreme
pain, too.”
Dr. Hess was completing his pain fellowship at
UVa at the time, so he was one of the physicians to
treat Davis. He says she received a series of nerve block
injections in her back, which gave her temporary relief.
In the meantime, Davis was having a hard time at
school. She had no trouble with grades, in spite of her
Rebecca Huffman
Pegram of Timberville
was diagnosed with
complex regional pain
syndrome, or CRPS,
earlier this year.
For Younger Patients, Trauma
in Multiple Ways
Perhaps the most poignant cases of CRPS are those
of children. Pediatric cases are even scarcer than
adult cases, so they easily get overlooked.
When she was 10, Sara Davis of Bridgewater
was playing soccer barefoot and kicked the ball
RMHonline.com
17
Sentara RMH Physical
Therapist Trey Haskell
works with Davis to help
her with pain management
and mobility.
frequent absences, because she asked her teachers for
help. The problem was her classmates.
“Nobody at school believed that I was in real
pain,” says Davis, now 17. She needed crutches to walk
and often had her foot in a walking boot. “I got called
‘fake’ so many times—it takes a toll on you.”
Some days, Davis did not want to get out of bed
or go to school. Plus, she had lost the ability to play
sports—soccer, basketball and volleyball—and had to
quit her hip-hop dance class.
Learning New Ways to Manage
the Pain—and Regain Life
Then, last summer, Davis spent three weeks at Boston
Children’s Hospital in its Pediatric Pain Rehabilitation
Center. Dr. Hess calls it “a premier place” for CRPS
treatment. There, Davis had physical, occupational and
psychological therapy, alongside other youths learning
to endure and live with the pain.
“I learned to push myself, even when I’m in pain,
and find things to do to get my mind off it,” Davis says.
Now she stays active even during flare-ups, which has
reduced their intensity and duration.
Before Boston, Davis suffered with the psychological aspects of CRPS, which affected her self-image,
close relationships and social life.
“I was down all the time, from all the stress of
everything,” Davis says. “There’s pain there, but people
can’t see it.”
She spends time with family members—her
sisters and, especially, two nephews she’s fond of—and
18
healthQuest | Fall 2014
Next
spring,
Davis will
graduate
from high
school.
Now she
has hope
that she
can actually go to
college
to pursue
her goal of
becoming
an elementary school
teacher.
with close friends. In Boston, she made friends
with two other teens with CRPS with whom
she keeps in touch. Legg says the support is
good for her daughter.
“It’s been really helpful for Sara to see
other young people like herself learning to overcome CRPS and achieve their goals,” Legg says.
While Davis accepts the limitations
imposed by CRPS, she no longer feels defined
by them.
“I’ve got to be the one to step up and say,
‘I’m the one who must deal with it,’” she says.
Davis and her mother were delighted
to find that Dr. Hess had started working at
Sentara RMH.
“He remembered me from UVa,” Davis
says. “He’s so understanding.”
“Now we know where to go when we need someone,” says Legg. “Having Dr. Hess, and appropriate
therapy, available so close to home has been a real relief
for us. The time spent in Boston was invaluable, but
we’ve also been blessed with the medical support we’ve
found right at home, at Sentara RMH.”
Dr. Hess had suggested that as Davis approached
adult age, she could consider a spinal cord stimulation trial. Spinal cord stimulation in pediatric patients
remains controversial, according to Dr. Hess. At this
time, Davis feels she’s too young for that and wants to
continue to manage her condition with therapy and
medication.
Next spring, Davis will graduate from high school.
Now she has hope that she can actually go to college
to pursue her goal of becoming an elementary school
teacher.
“Many become maladjusted after years of pain, but
she’s very well adjusted,” says Dr. Hess. “She takes control
of her care.”
Legg is excited to see her daughter flourishing and
credits the team at Sentara RMH with helping her get
her life back. “As a parent, seeing your child live in pain
day after day is devastating,” she says. “I’m especially
grateful to Trey and the team at Sentara RMH Rehab
Services for all they’ve done for Sara. And of course, Dr.
Hess. He’s been a true godsend for us.”
You can find more information about CRPS at
http://www.rsdhope.org/crps.html or at the National Institute of Neurological Disorders and Stroke or U.S. National
Library of Medicine websites. ■
community health
In the Loop:
WALKING PROGRAM SPEEDS RECOVERY FOR
HIP REPLACEMENT PATIENT
On Thursday mornings, you’ll usually see Sheila Douglas of Harrisonburg and her faithful four-legged
friend, Bodie, strolling the one-mile loop around the hospital on the Sentara RMH health campus.
BY DEBRA
THOMPSON
S
heila and Bodie are “regulars” with the
“In the Loop” weekly walking program,
sponsored by Sentara RMH Community
Health, since its launch in August 2012.
Just a month earlier, in July 2012, she’d had
right hip replacement surgery performed by Dr. Bill
Lennen of Sentara RMH Orthopedics and Sports
Medicine.
“Someone mentioned it would be good if I
got into a routine of walking every day,” she recalls.
“Then I saw this program advertised. I joined the
group and started walking. It helped me to recover
from my hip surgery faster.”
Sheila Douglas and
her friend, Bodie,
take a break during
a recent Thursday
morning walk at
Sentara RMH.
“In the Loop” is a walking group for adults of
any age. It is coordinated by staff from the Sentara
RMH Senior Advantage program but is open to
everyone from new moms pushing baby strollers to
great-grandparents—singles, couples or even trios of
friends. Participants sign up and walk every Thursday morning on the Sentara RMH Medical Center
health campus.
“The one-mile paved loop around the hospital
provides a safe place for folks to walk, and there’s beautiful scenery to enjoy while they’re doing it,” says Susan
Ribelin, coordinator of the Sentara RMH Senior
Advantage program, which is a part of Sentara RMH
Community Health. “There are also benches placed
along the way, so if someone wants to take a quick rest
or just sit and take in the view, they can do so.”
On the last Thursday of each month, participants gather in the Hahn Medical Offices Building
conference room after their walk for refreshments,
prizes and fellowship.
“In the Loop inspires folks to come walk together
and encourage each other,” Ribelin says. “We have been
averaging about 15 walkers each Thursday. The group
provides added motivation, whether someone is trying
to be more active, to lose weight, to recover from or
prepare for surgery, or just to make new friends.”
Douglas tries to walk every Thursday, often
accompanied by Bodie, who was her late husband’s
dog. In 2013 she had left hip replacement surgery,
again performed by Dr. Lennen, and within weeks
had rejoined In the Loop.
The walking program has been a strong catalyst
for her recovery, although she also swims and works
out at the Sentara RMH Wellness Center.
“I think having a group to join makes you get
out there and do it,” says Douglas, who turned 74 in
July. “The exercise is great. If you can join something
like a walking group after your surgery, it can help,
believe me!”
It’s easy to join both In the Loop and Senior
Advantage. For more information, call 540-4334231 or visit RMHOnline.com/SeniorAdvantage. ■
RMHonline.com
19
When It’s Complicated, an
Endocrinologist
Can Help
W
By Luanne Austin
hen Glenda Davis moved in late spring from Chicago to Harrisonburg, her diabetes was
out of control. She was always tired, had problems sleeping and suffered with swollen feet.
She needed to find a physician in the community to help her get back on track.
Fortunately for Davis, Sentara RMH had just
brought to Harrisonburg its first endocrinologist, Nabeel Babar, MD. Davis learned of Dr. Babar by checking the physician locator on the hospital’s website.
“He gave me a thorough examination,” says Davis,
67. “Then he sat down and talked extensively with me
and developed a plan of care.”
In addition to adjusting Davis’s insulin dosage, Dr.
Babar discontinued one of the
medications Davis had been
taking for years. It’s no longer
recommended for diabetic
patients, he told Davis, and
he prescribed a newer, more
effective oral medication to
control her diabetes.
“I had never even heard
of it before,” says Davis, a retired registered nurse. “He’s an
excellent doctor—so knowl-
Glenda Davis, a retired registered nurse,
was able to get her diabetes under
control by following Dr. Babar’s
very detailed recommendations.
20
healthQuest | Fall 2014
edgeable, and he treats patients holistically. Although
he’s very busy, he’s never hurried. He gives you the time
you need and answers all your questions. On my initial
visit, I felt an immediate trust and confidence in him.”
She began feeling better after only a few days on
the new medication, and her swollen feet went back to
normal. “It turns out it was the discontinued medication that had caused this problem,” Davis says.
A Look at All Body Systems
and Functions
Dr. Babar joined the Sentara RMH
medical staff in March 2014. His office
is located at the South Main Health
Center, and he already has a busy
practice.
Endocrinologists specialize in
hormone-related diseases, such as
diabetes, thyroid problems, metabolic disorders and hypertension. The
hormone-producing glands can affect
all other body systems.
“I love endocrinology because it
involves complex processes of body
function and how different organ
systems interact with one another,” says
Nabeel Babar,
MD, is Sentara
RMH Medical
Center’s first
endocrinologist.
He joined the
medical staff in
March 2014.
Dr. Babar. “Rather than focusing on any one particular
organ system, like a cardiologist (heart specialist), I
look at the person as a whole.”
Dr. Babar was born in New Jersey and lived there
until age 11, when his parents decided to move back to
their country of origin, Pakistan. After graduating high
school, he studied at Allama Iqbal Medical College,
then returned to the United States for his internship
and residency at Beth Israel Medical Center in New
York. He completed his fellowship in endocrinology
at the National Institutes of Health in Bethesda, Md.
Before coming to Harrisonburg, Dr. Babar worked for
the University of Virginia for four years at its multispecialty clinic in Culpeper.
A quest for a “peaceful environment” in which to
raise their four children is what brought Dr. Babar and
his wife, Sharmila, to Harrisonburg. “I have experienced life in New York and the D.C. metro area, and
although there is so much to do, you miss the connection with nature,” he says. “We value the blessings of
clean air, fresh locally grown food and the outdoors.”
Not One-Size-Fits-All Medicine
More than 50 percent of Dr. Babar’s patients are
people with diabetes.
“I enjoy caring for patients with diabetes,” he
says. “I have to love it, because it’s time consuming
and requires a huge amount of patience. A lot of
times patients don’t follow instructions or their diets,
and that can be challenging.”
Most diabetes patients are treated by primary
care physicians (PCPs). That works for people with
early-stage or “routine” diabetes. But if a patient’s
diabetes gets out of control and his or her PCP is
no longer able to help, they now have the option of
seeing Dr. Babar.
“I tend to see patients with diabetes who have
progressed to a more advanced stage,” Dr. Babar says.
RMHonline.com
21
Dr. Babar, he felt a nodule in her thyroid gland.
“I was greatly alarmed because both of my parents
died from lung cancer,” she says. “My mother also had
her thyroid removed at an early age. Dr. Babar sent me
for a biopsy, and the results showed it was benign, I’m
happy to say.”
A Thorough Approach and
Caring Bedside Manner
Greg Yost
saw Dr. Babar
shortly after
his wife, Gina,
told him an
endocrinologist had joined
the Sentara
RMH medical
staff. Today,
Yost’s blood
sugar levels
are normal.
“Many are already having diabetic complications such
as eye, kidney or nerve disease by the time they see me.
Helping patients regulate their blood sugars can prevent these complications from worsening and affecting
their quality of life. ”
Diabetes care, says Dr. Babar, is not a one-sizefits-all approach, but is multidisciplinary and involves
many players, including physicians, nurses, diabetes
educators, nutritionists and exercise physiologists. Diet,
lifestyle, exercise, medical management and behavioral
counseling all come into play.
He referred Davis to meet with a diabetic educator, who recommended she enroll in the Pro-Ex (Pro-
Greg Yost’s blood sugar had been out of control for
years. When his wife, Gina, told him Sentara RMH
had hired an endocrinologist, he made an appointment.
“I have always received excellent care from my
primary care physician and was doing all the right
things—taking the standard medications, watching
my diet, trying to exercise—but it wasn’t working,” says
Yost, 53, of Broadway. Yost has owned his own faithbased driver education business for almost 20 years.
Training new drivers requires an extra level of alertness
that Yost wanted to be sure he would never lack due to
elevated blood sugar levels.
After his examination by Dr. Babar, Yost received
a prescription for an alternative medication. Within a
week, for the first time in years, his blood sugar levels
were normal.
Yost was impressed with Dr. Babar’s expertise and
personality.
“As a wellness-fitness consultant myself, and
“Helping patients regulate their blood sugars can prevent …
complications from worsening and affecting their quality of life.”
gressive Exercise) program at the Sentara RMH Wellness Center. Pro-Ex is a two-month fitness program
for people with medical problems. Davis met with a
personal trainer and signed a contract to “stick with it,”
she says. So far, she’s been extremely impressed with
the program, and she says she’s determined to follow
Dr. Babar’s plan of care to improve her health.
About one-third of Dr. Babar’s patients have thyroid disease: hypothyroidism, hyperthyroidism, thyroid
nodules, goiter or thyroid cancer. The thyroid gland,
located in the neck, regulates energy metabolism, body
temperature, neurological development and general
functioning, Dr. Babar says.
Most of his thyroid patients are referred by their
primary care physicians or the hospital. Often, when
patients get imaging or examinations for another condition, a thyroid problem may be detected.
In fact, during Davis’ initial physical exam with
22
healthQuest | Fall 2014
someone who appreciates real customer service when I
see it, I especially appreciated how well-read Dr. Babar
is and how passionate he is in keeping up with the latest research in his field,” Yost says. “Although I feel my
family physician took good care of me overall, Dr. Babar took it to the next level. But the main thing I like
about him is his unique and amazing bedside manner.
He’s interested in his patients’ health and takes the time
needed to both listen to and work with patients to get
a game plan for total health. My success was obviously
very important to him, and he spoke to me in a way
I could understand and act upon. I was so impressed
with him that I couldn’t wait to tell my friends.”
Glenda Davis echoes the same experience.
“He spent time with me and answered all my
questions, unhurriedly,” she says.
Adds Yost, “In this day of ever-changing health
care, Dr. Babar is a breath of fresh air.” ■
Cancer Awareness
Understanding
Prostate Cancer
The prostate is a small, walnut-shaped gland located below the bladder and in front of the
rectum. It’s the part of the male reproductive system that produces seminal fluid.
In some cases in older men, it may not require treatment. But some prostate cancers
grow aggressively and spread to other parts of the body.
Signs and Symptoms
In the early stages, prostate cancer may
not produce any symptoms. But the signs
and symptoms of more advanced cancer
include the following:
• Difficulty urinating
• Blood in the urine or semen
• Lack of force in the urine stream
• Erectile dysfunction
• Pelvic discomfort
• Pain in the lower back, thighs or hips
September is
National Prostate
Cancer Awareness
Month
Risk Factors
•
Age—typically most cases of prostate cancer
occur in men over age 65.
•
African-American ethnicity—black men are more
likely to develop prostate cancer than are men of
other races or ethnicities, and it’s also more likely
to be aggressive in black men. The reason for this
is unknown.
•
Obesity—men with serious weight issues are more
likely to develop aggressive prostate cancer.
•
Family history—men who have a history of other
family members with prostate cancer, or a history
of women with breast cancer, may be at greater risk
for developing prostate cancer themselves.
Complications
The three primary complications with prostate cancer
are metastasis, or spreading of the cancer to other
parts of the body; erectile dysfunction (ED); and
urinary incontinence. Both ED and incontinence can
result from either the prostate cancer or its treatment.
Screening, Diagnosis and
Treatment
The two ways men are screened for prostate
cancer are by digital rectal exam (DRE) and
the prostate-specific antigen (PSA) test. DRE
provides information about the size, texture
and shape of the prostate. PSA is a protein
produced by cells in the prostate. It’s natural to
have a small level of PSA in the blood. Elevated
levels may indicate an enlarged prostate or the
presence of inflammation, infection or cancer.
Diagnosis is generally made by ultrasound studies that provide images of the prostate, or by biopsies
(samples) of prostate tissue that are analyzed in a medical laboratory for the presence of cancer cells.
After a diagnosis of prostate cancer is made, tests
are performed to see how advanced the cancer is within
the prostate and if the cancer has spread to other parts
of the body (a process called staging). Depending upon
the stage of the cancer, treatment may include any of the
following options:
• Surgery
• Radiation therapy
• Chemotherapy
• Hormone therapy
Most men diagnosed with prostate cancer do not die
from it. Depending upon the stage and type of prostate
cancer a man has, as well as other factors, the oncologist
may decide simply to watch the cancer to see if it starts to
spread or develop into a more advanced stage.
If you have any of the risk factors or signs and symptoms of prostate cancer, talk to your doctor. Early detection of prostate cancer is the best way to ensure a positive
outcome. ■
RMHonline.com
23
for your health
Be Alert to Signs
of Concussion
A concussion is a traumatic brain injury that can occur whenever a person
falls, suffers a blow to the head or body, or undergoes any shaking or jarring
movement strong enough to cause the brain to collide with the skull.
Most concussions are fairly mild, and people often don’t
know they have a concussion. But even mild concussions
injure the brain, and severe concussions may cause a loss
of consciousness. Contrary to popular opinion, however,
not all concussions cause a person to lose consciousness.
result in more serious or lasting damage. The best way to
recover from a concussion is to rest. Most people, if they
take it easy, will recover completely.
Signs and Symptoms
The American Academy of Pediatrics recommends seeing
a doctor right away if a child suffers anything more than a
slight blow to the head.
Adults or children with head injury should see the
doctor if any of the following occur:
• Headache that gets worse or won’t go away
• Lasting or recurring dizziness
• Loss of consciousness, particularly if lasting more than
30 seconds
• Behavioral changes, irritability or uncharacteristic
moodiness
• Frequent vomiting
• Seizures
• Vision problems, dilated pupils or pupils of different
sizes
• Lasting disorientation or confusion
• Slurred speech or other speech
changes ■
The symptoms of concussion can last for hours, days, weeks
or longer. Physical symptoms of concussion include:
• Headache
• Nausea and vomiting
• Dizziness
• Blurred vision
• Problems with balance and coordination
• Sensitivity to light and noise
Psychological or cognitive symptoms include:
• Confusion
• Problems with concentration
• Memory loss, which may or may not follow loss of
consciousness
• Irritability and personality changes
Head Injuries—Common in Children
It can be difficult to know if young children have suffered
a concussion. In addition to the symptoms listed above,
watch for these signs:
• Changes in behavior and the way they play
• Sudden lack of interest in their favorite toys or activities
• Increased irritability and more frequent temper tantrums
• Inability to pay attention
• Loss of newly acquired skills (toilet training, dressing
themselves)
Take It Easy
When people have had a concussion, even a
mild one, they need to give the brain time to
heal. In particular, athletes suspected of having a
concussion should not engage in further activity until cleared by their physician. Reinjuring the
brain before a concussion has had time to heal can
24
healthQuest | Fall 2014
When to See a Doctor
sobre su salud
Preste atención a las
señales de contusión
Una contusión es una lesión traumática del cerebro que puede ocurrir
cuando una persona se cae, sufre un golpe en la cabeza o el cuerpo o ha sido
sometido a alguna sacudida o impacto lo suficientemente fuerte para causar
una colisión entre cerebro y el cráneo.
La mayoría de las contusiones son leves, y con frecuencia
las personas no saben que tienen una contusión; incluso
las contusiones leves pueden lesionar el cerebro, y las
graves pueden ocasionar pérdida de la conciencia. Sin
embargo, a diferencia de la opinión popular, no todas
las contusiones causan pérdida de la conciencia en una
persona.
Signos y síntomas
Los síntomas físicos de una contusión incluyen:
• Dolor de cabeza
• Náuseas y vómitos
• Mareos
• Visión borrosa
• Problemas con el equilibrio y la coordinación
• Sensibilidad a la luz y al ruido
Los síntomas psicológicos o cognitivos incluyen:
• Confusión
• Problemas con la concentración
• Pérdida de la memoria, que puede o no llevar a la pérdida del conocimiento
• Irritabilidad y cambios en la personalidad
Lesiones en la cabeza (común en niños)
• Puede ser difícil saber si los niños pequeños han sufrido
•
•
•
•
•
una contusión. Además de los síntomas descritos anteriormente, preste atención a estas señales:
Cambios en el comportamiento y la forma en que
juegan
Repentina falta de interés en sus juguetes o actividades
favoritos
Aumento de irritabilidad y rabietas más frecuentes
Incapacidad para poner atención
Pérdida de habilidades adquiridas recientemente (ir al
baño, vestirse solos)
Tómelo con calma
Cuando las personas han sufrido una contusión, incluso
una contusión leve, necesitan darle tiempo al cerebro
para recuperarse. Particularmente, los atletas de quienes
se sospecha tener una contusión, no deberían participar
más en sus actividades hasta que lo autorice su médico.
Volver a lastimar al cerebro antes de que haya pasado
el tiempo necesario para recuperarse de una contusión,
puede provocar daños más graves o duraderos. La mejor
manera de recuperarse de una contusión es descansar. La
mayoría de las personas, si lo toman calma, se recuperarán
por completo.
Cuándo consultar a un médico
La Academia Estadounidense de Pediatría recomienda
consultar al médico de inmediato si un niño sufre más que
un golpe leve en la cabeza.
Los adultos o niños con lesiones en la cabeza deben
ver al médico si sufren alguna de las siguientes situaciones:
• Dolor de cabeza que empeora o no desaparece
• Mareos duraderos o recurrentes
• Pérdida del conocimiento, particularmente si dura más
de 30 segundos
• Cambios en el comportamiento, irritabilidad o melancolía inusual al carácter
• Vómitos frecuentes
• Convulsiones
• Problemas de la vista, dilatación de las pupilas o pupilas
de diferentes tamaños
• Desorientación duradera o confusión
• Trastornos del habla u otros cambios del habla ■
RMHonline.com
25
nutrition
Not All Fats
are Created Equal
Concerned about fat in your diet? Confused by all the nonfat
and low-fat options in stores?
T
o be healthy, you don’t have to eliminate all
fat from your diet. In fact, it would be very
hard to do so. Most foods contain several
kinds of fat, and you need a certain amount
of fat in your diet to maintain good health. But not all
fats are equal, and some are better for you than others.
Why does the body need fat?
• Fats help our bodies absorb fat-soluble vitamins
By Vanessa
Heatwole, RD,
Sentara RMH
Medical Center
like vitamins A, D, K and E.
• Fats are essential for the maintenance and normal
activity of healthy cells, and they help the body
maintain appropriate hormone levels.
• Fat insulates nerve fibers and aids in the transmission of nerve impulses.
• Unused calories from dietary fats, carbohydrates
and protein are converted into fat, which is deposited in our adipose tissue (fat cells), where it helps
insulate the body from cold and heat and provides
protection for our internal organs. But too much
adipose tissue can lead to diabetes, heart disease
and other health problems related to obesity.
• Fats are calorie-dense, rich sources of energy. When
the body uses up the calories from carbohydrates,
which usually occurs after about 20 minutes of
exercise, it begins to burn calories from fat.
Good fats are unsaturated.
FUN
FACT
The human
brain is made
of about 60
percent fat.
26
These fats are considered “good” because research
suggests they can possibly lower LDL (low-density
lipoprotein, or “bad” cholesterol). However, there are
still differences between monounsaturated fatty acids
(MUFAs) and polyunsaturated fatty acids (PUFAs).
MUFAs are known to lower LDL while raising HDL (high-density lipoprotein, or “good”
cholesterol). Low LDL and high HDL levels
help prevent heart disease. Therefore, a diet high
in MUFAs can be beneficial in preventing heart
disease. MUFAs may also contribute to better
control of blood sugar and insulin levels in people
•
healthQuest | Fall 2014
with Type 2 diabetes, and they’re generally high in
vitamin E, a powerful antioxidant.
•
•
PUFAs are known to lower LDL but they also
lower HDL, which is not desirable since having a
high HDL number is considered heart-protective.
Still, PUFAs benefit us because they can help
keep overall cholesterol levels down and decrease
cholesterol deposits on artery walls.
Omega-3 fatty acids are a type of PUFA; they’re
also essential fatty acids (EFAs), meaning the
body cannot make them on its own. To maintain
health, therefore, we have to get them from our
diet. Omega-3 fatty acids provide many benefits:
✓ They’re the starting point for production of
hormones that regulate blood clotting.
✓ They assist in the contraction and relaxation of
artery walls.
✓ They help prevent inflammation.
✓ They help slightly lower blood pressure while
improving blood vessel function and reducing
plaque formation in arteries.
✓ They may help control lupus, eczema and rheumatoid arthritis.
✓ They may play a protective role in cancer and
other conditions due to their anti-inflammatory
properties.
Sources of MUFAs: Olive oil, peanut oil, canola oil,
sunflower oil, sesame oil, olives, avocados, peanut butter,
other nut butters, and many nuts and seeds.
Sources of PUFAs: Soybean oil, corn oil, safflower oil,
salmon, mackerel, herring and trout.
Sources of omega-3 fatty acids: Tuna fish, walnuts,
flaxseed and flaxseed oil, chia seeds, canola oil, salmon,
mackerel, herring, sardines, rainbow trout, tofu and other
soybean products.
Questionable fats are the saturated fats.
Saturated fats are now called “questionable” fats
because of conflicting medical evidence about their
effect on cholesterol and the risk for heart disease.
They’re considered unhealthy because they increase
LDL levels in the blood, which significantly increases the risk for heart disease. However, saturated
fats also increase HDL levels, which is known to be
protective against heart disease.
Experts still recommend reducing total saturated
fat intake to substantially reduce the risk of heart
disease. The American Heart Association recommends keeping total intake of saturated fats to less
than 7 percent of your daily calories. Saturated fats
can usually be found in most animal products and
most processed foods.
Sources of saturated fats: Cheese, butter, whole milk and
cream, ice cream, beef, pork, eggs, coconut oil, palm and
palm kernel oils, chocolate, most fried foods including
chicken, and most processed foods.
Bad fats are the trans fats.
Trans fats, or trans fatty acids, are oils that have been
turned into solid fats through an industrial process
that adds hydrogen to vegetable oils to prolong their
shelf life and enhance their flavor and texture. Trans
fats are found mainly in packaged and processed
foods, although negligible amounts of trans fat occur
in nature. But the trans fats in processed foods are
more harmful than those found in trace amounts in
meats and dairy products.
Trans fats are worse than saturated fats because
they increase bad LDL cholesterol AND decrease
good HDL cholesterol—a “double whammy” that’s
exactly the opposite of what’s healthy for your heart.
Trans fats also help contribute to inflammation in
the body.
What are fats … and lipids,
triglycerides and fatty acids?
F
ats are one of the three main food types, along
with proteins and carbohydrates. Like carbohydrates, fats are made up of carbon, hydrogen
and oxygen atoms. But compared to carbs, fats contain much less oxygen and have higher concentrations
of carbon and hydrogen. This makes fats insoluble
in water and higher in energy (calorie)
content than carbohydrates.
Fats belong to a group of
substances called lipids. Along
with carbohydrates and proteins, lipids are one of the main
components of animal and
plant cells. (Other lipids include
cholesterol, steroids and phospholipids.)
Triglycerides are the most
common form of fat we digest.
About 95 percent of the lipids in
our bodies and in the foods we eat are
triglycerides. Triglycerides are made up of three fatty
acids (tri-) attached to a glycerol molecule (-glyceride).
Glycerol is a water-soluble carbohydrate molecule that
the body can convert to glucose.
High triglyceride levels in the blood are a risk
factor for atherosclerosis (hardening of the arteries),
heart disease and stroke. Normal triglyceride levels
are less than 150 milligrams per deciliter (mg/dL) of
blood. The test to determine your triglyceride level
(the amount of fat in your blood) is called a lipid panel.
RMHonline.com
27
“TRANS-FAT-FREE FOODS” AND
FOOD LABELS
Food manufacturers can advertise
a product as
having “no trans
fat” so long as
it contains less
than a half-gram
of trans fat PER
SERVING. So
when eating these foods, be sure to note the serving
size and watch your portions; otherwise, you could be
eating more trans fat than you intended.
Another name for trans fat is “partially hydrogenated oils” or “shortening.” If you see these words on
nutrition labels, the food contains trans fat.
The 2010 Dietary Guidelines for Americans
recommend eliminating consumption of trans fats
from processed foods completely, or limiting them to
less than 1 percent of your total calories. A 2 percent
increase in trans fats is associated with a 23 percent
increase in cardiovascular risk.
Sources of trans fats: Commercially baked goods including many
pie and pizza crusts, crackers, cookies, and biscuits; fried foods
like French fries and doughnuts; and many shortenings and stick
margarines.
How much fat in a diet is healthy?
For healthy adults, the American Heart Association recommends that 25 percent to 35 percent of total daily calories
come from healthy fats like those found in fish, nuts and
vegetable oils. If you’re eating 2,000 calories per day, ideally
you should eat no more than 55 grams to 75 grams of fat
per day. However, this is very individual and is best determined by your registered dietitian.
Diets can still be healthy even if they contain fats like
MUFAs and PUFAs. Just don’t overindulge, especially if
your goal is weight loss. Fats—healthy or unhealthy—
provide more calories per gram
than either carbs or protein. And
the more calories you consume, the
more likely you are to gain weight,
especially if you’re not exercising
regularly. ■
■ Vanessa Heatwole, RD, is a registered dietitian on staff with Sentara
RMH Food and Nutrition Services.
Recipe Modifications to Lower Saturated and Trans Fats
28
Ingredients:
Possible substitutes:
1 whole egg
¼ cup egg substitute; 1 egg white + 1 tsp oil; 2 egg whites
1 Tbsp butter
1 Tbsp trans-fat-free margarine; 2 tsp preferred vegetable oil
1 cup hydrogenated shortening (or lard)
2⁄3 cup preferred oil; 1 cup + 3 Tbsp trans-fat-free margarine
½ cup butter/margarine
¼ cup applesauce + ¼ cup trans-fat-free margarine
1 oz bacon (2 slices)
Canadian bacon, turkey or soy bacon
1 cup light cream
3 Tbsp oil + skim milk equal to 1 cup;1 cup evaporated skim milk
1 cup heavy cream
2⁄3 cup milk + 1⁄3 cup oil
1 cup sour cream
¾ cup buttermilk + ¼ cup oil; 1 cup plain low-fat yogurt;
1 cup blenderized low-fat cottage cheese
1 oz hardened cheese (Cheddar, Colby, Muenster)
1 oz skim milk mozzarella cheese; 2 Tbsp ricotta cheese;
2 Tbsp 1% cottage cheese
1 oz (1 square) chocolate
3 Tbsp powdered cocoa + 1 Tbsp oil (for chocolate frosting or
sauces); ¼ cup cocoa (for cakes or cookies)
healthQuest | Fall 2014
W
UNDER
PRESSURE:
RELIEVING
THE PAIN OF
FRONTAL
SINUS
BLOCKAGE
W
hen Staunton resident
Ted (Theodore) Maddox saw Harrisonburg
otolaryngologist/head
and neck surgeon Michael
Alexiou, MD, in late 2012,
Maddox had suffered with
sinus headaches and pain for
the better part of 18 years. He
also had an enormous puffy bulge
over his left eye, one of the largest
Dr. Alexiou had ever seen.
“He looked like someone had implanted a baseball in his
forehead,” Dr. Alexiou says. “The tumor had gotten so big that
the pressure of it had eroded away the skull bone beneath it.
There was no bone at all from the skin of his forehead back to
his brain.”
This type of tumor, Dr. Alexiou explains, is called a Potts
puffy tumor, but it is not cancer. It’s the result of built-up
infection stemming from severe sinusitis along with complete
blockage of Maddox’s left frontal sinus.
Maddox, who was 77 at the time, was experiencing terrible headaches on the left side of his head, the result of the
pressure in his blocked sinus. He had sought treatment for
the sinusitis several times before he saw Dr. Alexiou. In 1995,
Maddox had the first of three sinus surgeries to treat the problem. A fourth sinus surgery was scheduled in 2001 or 2002, he
says, but he decided not to have it because it seemed pointless.
“Each time, it would help for a while, but every few years
I would have to go back and have it done again,” he says.
Maddox continued to live with the sinusitis and blocked
By Neil Mowbray
frontal sinus for about 10 years. When the tumor on his
forehead began to increase significantly in size, he decided he
needed to seek help. He had heard about Dr. Alexiou, he says,
and decided to make an appointment.
“Dr. Alexiou ordered all kinds of X-rays of my head,
which were taken at the hospital,” he says. “When he got
back to me with the results, I was really pleased with what he
told me.”
A Newer Surgery to Fix Frontal Sinus Blockage:
the Modified Lothrop Procedure
Dr. Alexiou explained to Maddox that the pressure, and the
tumor caused by it, was coming from the blocked outflow tract
of his left frontal sinus. The blockage was the result of scar
tissue that had formed as a complication following each of his
earlier sinus surgeries. The buildup of pressure in the sinus and
the lack of sinus drainage had caused the bone to erode away
completely.
The traditional surgical repair for this type of problem
is called frontal sinus obliteration. To perform this operation,
the ear, nose and throat surgeon makes an incision along the
forehead and removes the bone from the front of the sinus to
open it up. He or she then packs the sinus full of fat to permanently close up the sinus and make the sinusitis go away.
The fat, Dr. Alexiou notes, is taken from another part of the
patient’s body, which involves additional incisions.
The other surgical option for performing frontal sinus
obliteration is to make an incision along the patient’s hairline, pull back the skin and then remove the bone to open
and pack the sinus. The bone and skin are then replaced.
RMHonline.com
29
Theodore Maddox, right,
poses with his surgeon,
Dr. Michael Alexiou, in front
of a CT image of Maddox’s
head taken two years ago.
The arrow (circled in red)
on the CT points to the
large Potts puffy tumor that
Maddox had on his forehead, caused by a blocked
and severely infected left
frontal sinus.
But Dr. Alexiou told Maddox that
he was a good candidate for a newer
type of sinus surgery that does not
have the risks, scarring and other possible complications of the traditional
obliteration surgery. The newer procedure, called modified Lothrop sinus
surgery, is a drill-out procedure that
reopens the sinus without the need for
a large external incision.
The modified Lothrop procedure
is a type of minimally invasive surgery.
Dr. Alexiou uses an endoscope, a thin
tube fitted with a light on the end
that he introduces into one side of the
patient’s nose. He uses different angles
to visualize and remove a portion of the
bony wall at the top-center section of
the nose, and then opens the blocked
frontal sinus by drilling through the
bone in the middle of the forehead.
The other instruments that are used are
placed in separately and controlled by
the other hand. In this way, one hand
operates the viewing scope, and the
other hand holds and uses the instruments that do the work.
Dr. Alexiou performs the procedure in the hospital’s operating room
(OR), where he can enlist the aid of the
30
healthQuest | Fall 2014
hospital’s fusion system.
“This is a computerized program
that uses CT imaging to develop a 3-D
model of the patient’s head,” he explains.
“We affix a navigator device to the
patient’s forehead and, using a kind of
triangulation method, the fusion system
can show us in three-dimensional space
exactly where we are inside the patient’s
head.”
Theodore Maddox and his good
friend, Barbara Carter
The modified Lothrop procedure
takes about two hours to perform.
“Both of the traditional obliteration procedures are difficult; they involve
cutting the skin of the face or head, so
there’s scarring; and they can involve
significant risk of complications,” says
Dr. Alexiou. “So this Lothrop procedure
was developed to help avoid those kinds
of issues.”
Although the complications are
fewer, the surgery is more delicate, Dr.
Alexiou explains. “When performing
the modified Lothrop procedure, you’re
working very close to the eye and brain,
so there is no room for error,” he says.
Despite the delicacy of the surgery,
Maddox says he had no fear of undergoing the procedure. The sinus problem
had bothered him for years, and he’d had
no lasting success with his prior surgeries. He was willing to take a chance.
“I’m just turning it over to God and
you,” he recalls telling Dr. Alexiou.
Maddox says the surgery “went
great.” He adds that Dr. Alexiou and the
Sentara RMH OR team were “wonderful.” He says he thinks he remembers
the OR nurses singing to him just
before he went under anesthesia.
“Before and after the surgery, they were all top
notch,” he says. “They made me feel at home, which is
a good way to feel when you’re going into surgery.”
Maddox was kept overnight in the hospital for
observation. He was given an antibiotic, since one of
the greatest risks is infection, and told to take it easy
for several weeks to allow healing. He saw Dr. Alexiou
about a week after his surgery and was told he was
doing well.
That was in November 2012. Since that time,
Maddox says, he has had no further sinus problems. The
baseball-sized puffy tumor on his forehead is history.
“When I drained his tumor during surgery,” Dr.
Alexiou says, “I literally could have put my finger there
and touched his brain. But after three to six months, all
of that bone that had eroded away had formed again.”
Not for All Sinus Surgery Patients
Dr. Alexiou says the modified Lothrop procedure
provides impressive patient outcomes but is not for all
sinus surgery patients. It was designed specifically to
address only the kind of severe frontal sinus problems
Maddox was having.
The procedure is indicated, Dr. Alexiou notes,
only if someone has developed scarring over the frontal
sinus opening that results in severe sinus infection.
It’s also for someone who develops a puffy tumor, as
Maddox did, or meningitis (infection of the lining of
the brain), another complication that can result if the
infection and pressure from a blocked frontal sinus
extend back into the head, instead of protruding on the
forehead.
“Sinus problems are fairly common in our
community, and this procedure is very specialized,”
Dr. Alexiou says. “It’s good for people to know this
surgery is something I do here locally—that they can
come to Sentara RMH to have it done, rather than
having to leave the area.” ■
SINUSES AND SINUSITIS
O
ur sinuses are a connected system of small,
hollow, air-filled cavities that occur in pairs in
the bones on either side of the nose. They’re
named for the bones in which they are located:
•
•
•
•
Frontal sinuses are located in the central part of the
forehead in the frontal bone, just above the eyes.
Sphenoid sinuses occur in two pairs within the
sphenoid bone, located near the optic nerve and
pituitary gland.
Ethmoid sinuses are not like the other sinuses
because they’re not single cavities; instead, they
occur as a series of smaller cavities arranged in front,
middle and rear groupings within the ethmoid bone,
the bone located at the top of the nose and between
the eyes. Ethmoid sinuses have their own direct
openings into the nasal passage.
Maxillary sinuses are located in the cheekbones;
they’re the largest sinuses we have.
The nose is divided in the center by a thin wall
called the septum. Most of the sinuses drain into the
nose through a small channel or drainage pathway
called the middle meatus.
Why do we have sinuses?
“That’s a good question,” says Harrisonburg ortolaryngologist Michael Alexiou, MD. “We know that our skulls
would be very heavy if we didn’t have them, and we
would need much bigger muscles to support the skull
if it was solid bone. So that’s one purpose our sinuses
serve. We know, too, that the cheek sinuses produce
nitrous oxide, which lowers blood pressure. But we’re not
sure if that’s a ‘reason’ why we have maxillary sinuses. Apart
from those things, we really don’t know.”
Just like the nasal cavity, the sinuses are all lined with
a thin layer of tissue called mucosa. The mucus produced
in the sinuses drains into the nose and eventually into the
throat and stomach. Sinusitis refers to inflammation of the
mucosal lining in the sinuses.
“Almost anything can cause inflammation of the sinuses,” says Dr. Alexiou. “Viruses, bacteria, chemical irritants,
allergies, trauma—they’re all possible causes. Inflammation
simply refers to any swelling of those sinus linings.”
RMHonline.com
31
Unraveling Family Medical Mysteries Through
GENETIC
oan Horst of Harrisonburg wasn’t completely surprised
to be diagnosed with thyroid cancer in 2008. Her father
had died of an incurable form of thyroid cancer more
than three decades earlier, and her father’s mother and
two sisters had their thyroid glands removed because
of benign growths. One of her maternal aunts survived
thyroid cancer as well.
Horst, 68, beat thyroid cancer, but she was diagnosed with breast
cancer in March. Her breast cancer was caught early, so she was treated
with radiation and is now being treated successfully with hormone therapy.
But because her maternal grandmother had a mastectomy due to breast cancer, she
was eager to learn more about her family’s cancer risks. Breast surgeon Heidi Rafferty, MD, of Sentara RMH Breast Care and medical director for the Sentara RMH
Funkhouser Women’s Center, recommended genetic counseling for Horst to explore
possible explanations for the cancerous and noncancerous conditions that had
affected so many of her relatives.
By Karen Doss Bowman
32
healthQuest | Fall 2014
COUNSELING
“Knowledge is power, and when people have information about their genetic vulnerabilities, they have
the power to do or not do something about it,” says
Dr. Rafferty. “Genetic testing is not appropriate for
everyone. But I’ve seen lives saved and certainly lives
extended because an appropriate person, or a relative of
that person, was tested and found to be a carrier, and
then that person or the person’s relative had planned
preventive surgery and a small cancer was found.”
Dr. Rafferty adds that she has seen this scenario
unfold many times. “It’s almost breathtaking when it
happens,” she says.
Unraveling Family Mysteries
for a mutation in the PTEN gene, then Horst would
have been diagnosed with Cowden syndrome. That
means her children and other family members could
also have been tested for the known mutation.
“If we had been able to identify a nonworking
PTEN gene in Mrs. Horst, each of her children
would have had a 50 percent chance of having it as
well,” Thomas says.
Joan Horst enjoys
quilting in her
spare time.
“The fact that there was thyroid cancer on both sides
of my family makes me concerned about my children, as well as my brothers and their children,” says
Horst. “It’s not that I want this information to scare
anyone in my family. I simply believe it can help us
all make educated decisions about our health care.”
Horst met with Martha Thomas, MS, CGC, a
certified genetic counselor who sees patients at the
Sentara RMH Funkhouser Women’s Center and the
Sentara RMH Hahn Cancer Center. After evaluating Horst’s personal and family medical history,
Thomas suspected that Horst had Cowden syndrome, an inherited condition caused by a mutation,
or change, in the PTEN gene.
When functioning normally, Thomas explains,
the PTEN gene “tells” the body to produce a tumorsuppressing protein that helps prevent cells from
growing and dividing too rapidly. A mutation in the
gene may interfere with that function, allowing cells
to divide uncontrollably. That may increase a person’s
risk for developing benign or malignant tumors of
the breasts, thyroid, uterus, colon, kidneys and skin.
Because Thomas identified Horst as a likely candidate for Cowden syndrome, Medicare would cover
her genetic testing. The test was simple: Horst provided a saliva sample that Thomas sent to a lab for
analysis. She recently received the results: the genetic
test was negative. If the test result had been positive
RMHonline.com
33
Horst consults with
Sentara RMH
Genetics Counselor
Martha Thomas.
Even though Horst’s genetic testing results were
negative for a mutation of the PTEN gene, Thomas
says she wouldn’t rule out a genetic cause for the cancer
and benign growths that are prevalent in her family.
“A negative genetic test result doesn’t mean a
decreased risk of cancer—it could simply mean that
we don’t know what to look for in a genetic sense,” says
Thomas. “We still have to take Mrs. Horst’s family and
medical histories into consideration. And based on
that history, I’d recommend close monitoring and early
screenings for her and her relatives, no matter what the
results of her test reveal.”
Genetics Breakthroughs May Hold
Promising Health Benefits
Genetic testing examines a person’s DNA to determine
if he or she has inherited a certain gene, genetic mutation or other marker that can indicate a greater risk of
developing certain forms of cancer, including breast,
colon, ovarian, uterine and thyroid cancer, as well as
some types of heart problems and other diseases.
“If we can identify people with genetic predispositions to cancer, there are things we can do to decrease
their risks of ever developing cancer in the first place,”
Thomas says. “It also helps us catch cancers when
they’re in the early stages and more manageable.”
Thomas counsels people who have known genetic
syndromes or who are at risk for one, or people with
a group of clinical features that may have underlying
genetic causes. She divides her time between the Hahn
34
healthQuest | Fall 2014
Cancer Center on Mondays and the Funkhouser
Women’s Center on Thursdays; the other days of the
week she provides genetic counseling services at Martha Jefferson Hospital in Charlottesville. She requires a
referral from a physician or nurse practitioner.
“Many people find it reassuring to know if they
have a genetic predisposition to diseases so they can
make informed decisions about prevention and care,
and can encourage their loved ones to do the same,”
says Janet Macarthur, director of oncology and palliative care at Sentara RMH Medical Center. “I believe
more and more people will seek genetic counseling and
testing—especially as they see public figures coming
out with their own results. We’re glad we can offer this
service in our community.”
During consultation, Thomas gathers information
to paint a thorough picture of the patient’s personal
and family medical history. Next, she gives patients
an overview of basic genetics and helps them understand how some cancers and other conditions may be
passed down through families. For patients who are
candidates for genetic testing, she discusses what’s
involved—the tests she offers are saliva analyses—and
what it means to have a positive or a negative result.
She also helps patients understand what their insurance will or will not cover.
“I don’t send out genetic testing on all the
patients I see because it’s either not appropriate for
their circumstances or their insurance won’t cover it,”
says Thomas. She draws her guidelines for managing a
patient’s risk of cancer or other genetic disorders from
various sources, including the National Cancer Comprehensive Network, the National Society of Genetic
Counselors and the American Cancer Society. “If a
patient with a strong family history of cancer doesn’t
have genetic testing done, I still make recommendations for managing their risk of developing cancer. I
hope that patients leave my office with a better understanding of hereditary cancer in general and a plan for
managing their cancer risk based on their family and
medical history.
She adds that no referral for genetic counseling
is a bad referral. “If someone is worried about a family
history of disease, it may be helpful to sit down with
me and talk about it,” she says. “I can look at the bigger
picture and reassure them, or encourage them to monitor their risks more closely.”
Finding Answers
One of the genetic tests Thomas frequently offers is
for uncovering mutations of the BRCA1 and BRCA2
genes, which are linked to a higher-than-average risk
for breast and ovarian cancers.
Thomas notes that these genetic mutations seem
to receive the most publicity, especially since 2013
when actress Angelina Jolie made public her decision
to have a preventive double mastectomy, or surgical removal of both breasts, after testing positive for a faulty
BRCA1 gene. But Thomas points out BRCA1 and
BRCA2 are just two potential genes linked to breast
I hope that
patients
leave my
office with
a better
understanding of
hereditary
cancer in
general and
a plan for
managing
their cancer
risk based on
their family
and medical
history.
Martha Thomas, MS,
is a certified genetic
counselor who sees
patients at the Sentara RMH Funkhouser
Women’s Center and
the Sentara RMH Hahn
Cancer Center. She
also sees patients at
Martha Jefferson Hospital in Charlottesville.
cancer. That means a negative test result for these
two mutations does not eliminate the possibility
that a patient has other genetic factors that could
heighten the risk of breast cancer.
“The biggest misunderstanding is that BRCA1
and BRCA2 are the only breast cancer genes,” says
Thomas. “They’re a factor in up to 40 percent of
breast cancers of genetic origin, but that means that
the remaining 60 percent or so of hereditary breast
cancer cases are caused by other genetic factors. In
fact, most breast cancers are not caused by inherited
syndromes, and hereditary breast cancers account
for just 5–10 percent of all breast cancers. That’s
what I show patients, and they’re typically blown
away by that information.”
Thomas emphasizes that genetic testing is
completely voluntary, even in cases where it would
be appropriate for a patient’s circumstances. Some
people aren’t ready for the emotional implications
of knowing their test results for a genetic syndrome, whether positive or negative.
“We can’t change a person’s DNA at this
point, so I encourage patients to think about
whether they’re emotionally prepared if genetic
testing reveals a predisposition for certain conditions,” she says. “Are they prepared for the results,
and what will they do with the results once they
get them? Some people are worriers; some feel guilt
if they have a potential of passing on a hereditary
disease to their children. I try to make people fully
aware of what they’re getting into and explore the
emotions beforehand.”
Teresa Boshart Yoder, RN, MSN, director of
women’s services at the Funkhouser Women’s Center, believes that offering genetic testing services
can help save lives.
“If people know they’re at high risk for breast
cancer, or any other type of cancer, then they may
be able to take proactive measures that may prevent
their developing cancer, or that allow us to catch it
early,” says Yoder, a breast cancer survivor.
Joan Horst is grateful for the opportunity to
delve deeper into her family’s medical history and to
offer her children, siblings, nieces and nephews information that ultimately could save someone’s life.
“I think it’s important to make educated decisions about my health,” Horst says. “When you’re
part of a family that has had several incidents of
cancer, the ability to test other family members for
a potential genetic link can either increase alertness
about possible cancers or relieve anxiety.”
For more information about genetic testing at
Sentara RMH, visit RMHOnline.com and follow
this path: Services > Women’s Center > Sentara RMH
Breast Care. ■
RMHonline.com
35
living with synergy
TURN OVER A NEW BELIEF
Grow Better Beliefs and
Watch Your
Life Blossom!
Have you ever felt blocked or sabotaged when striving for a goal?
Do you experience the same struggles over and over? If so, you may
have certain limiting childhood beliefs holding you back.
E
veryone falls into the “negativity
trap” at one time or another—
that place where we’re overly
self-critical or judgmental of others.
Whatever the cause, whether physical
exhaustion, overwhelming emotions,
work pressures or family stressors, when
we become aware of strong negative
thoughts it’s essential to call a timeout
to flip them to positive before they grow
into damaging beliefs.
Napoleon Hill, a Virginia native
and business consultant, once said, “Our
mind is a fertile garden spot in which
weeds will grow in abundance if the
seeds of more desirable crops are not
sown there. Don’t let negativity find its
way into the rich garden of the mind.”
Author Bill Meyer reinforces
this sentiment when he writes, “Be
intentional! Every thought is a seed. If
you plant crab apples, don’t count on
harvesting Golden Delicious.”
Beliefs are thoughts we have over
and over until we believe them to be true.
Empowering beliefs such as “I am happy,
healthy and strong” bring out our best
and help grow a positive mindset. Limiting beliefs such as “I’m fat, stupid and not
good enough” undermine our confidence,
creating shame and self-doubt.
We have the power to choose by
design what we believe. We’re free to
change our minds and, as we change our
minds, we inch steadily toward achieving our goals.
So how can you grow better beliefs
by design? Begin by using the follow-
36
healthQuest | Fall 2014
ing tips to intentionally plant better
beliefs—those that grow your ability to
rebound quickly with grace and ease.
Take a Timeout
You can’t give to others if you’re running on empty! So step out of the fast
lane, grab a pen and paper, and clear
your mind. Take a long, deep breath and
ask for guidance. Slow down and look
within for inspiration and wisdom. Be
honest and take responsibility for where
you are by giving your feelings a voice.
Seeing your thoughts on paper
provides fresh perspective and renewed
clarity. Without regularly connecting
to what’s most important, you’ll find
yourself tired, depleted and serving
everyone’s needs except your own.
Now think about your beliefs. Try
to identify any that are working against
you. Which are keeping you from reaching your full potential? Your goal will be
to start eliminating these, one by one,
from your belief system.
Accept and Love Yourself
Exactly as You Are
Don’t beat yourself up. Instead, celebrate
the awareness that you can do better.
Focus on progress, not perfection. As
poet Leonard Cohen says,
“Forget your perfect offering. There
is a crack, a crack in everything. That’s
how the light gets in. I am asking you
to love your pockmarks, your scars, your
size, your inability to be articulate, your
awkwardness and all your imperfec-
By Christina Kunkle, RN,
CTA Certified Life and
Wellness Coach
tions. Do not run from these very welts
that are a part of you. Stop, turn and
embrace your humanness, ALL OF IT.
Nurture yourself. Get used to loving
who you are right now, with no excuses,
no conditions.”
Stay Positive
It’s tempting to jump head-first into
a busy day, yet that’s the fast track to
negativity. It’s more empowering to
start heart-first, setting a clear intention
about who you want to be and how you
want to feel, no matter what’s going on
around you. This determines whether
you respond or react to circumstances as
they unfold. Every thought, feeling and
action will either take you closer to or
farther away from who you want to be.
Belief is the key to your success. You’ll
need grit and courage to master your
mindset, so get tough!
“Keep your thoughts positive, because
your thoughts become your words.
Keep your words positive, because your
words become your behaviors.
Keep your behaviors positive, because
your behaviors become your habits.
Keep your habits positive, because your
habits become your values.
Keep your values positive, because your
values become your destiny.”
— Gandhi
Counter Negativity
Formulate a positive affirmation that
counters your negative belief and reaffirm it daily. Write your affirmation in
Keep Taking Action
Choose to be Happy!
your diary, on your bathroom mirror,
next to your computer—anyplace where
you will see it often and can say it out
loud as often as possible. You will be
happily surprised by the results!
Affirmations are most powerful
when we:
• Say them in the present tense
• Write them down
• Feel them strongly
Say your affirmations every day, first
thing in the morning and last thing at
night. This daily practice gives attention
to what you want more of, promotes
healthy self-talk and bolsters self-esteem.
Here are a few examples:
• I choose foods to keep my mind
focused and energy steady.
• I commit to being happy, fit and
strong.
• I am relaxed, productive and
centered.
• I find a way to let better beliefs
grow strong.
To stay happy, focus on your blessings.
Cherish each morning and give thanks
for each evening. Close your eyes and
call to mind something to be grateful
for, paying particular attention to your
feelings. What are you grateful for?
What are 10 things you can choose to
be grateful for right now?
I’m reminded of a story in Marci
Shimoff ’s book, “Happy for No Reason,” in which a Cherokee elder told
his grandson about the battle that goes
on inside people. “My son, the battle is
between the two ‘wolves’ that live inside
us all,” he said. “One is Unhappiness.
It is fear, worry, anger, jealousy, sorrow,
self-pity, resentment and inferiority. The
other is Happiness. It is joy, love, hope,
serenity, kindness, generosity, truth and
compassion.”
The grandson thought about it for
a minute, then asked his grandfather,
“Which wolf wins?”
The old Cherokee simply replied,
“The one you feed.”
Which wolf are you feeding?
Yes, even on days when you don’t feel like
it, even when you feel you’re not making
progress, know that by taking action, you
are moving forward. Have faith in yourself
and stay empowered. Big changes come
with small choices.
So, if you haven’t taken a look at the
beliefs you are holding, DO IT! Take small,
frequent steps forward in keeping your
mind clutter-free.
Cultivating new beliefs will bless your
life from this time onward. Take action today toward helping your better beliefs grow
stronger, and watch your life blossom! ■
■ Christina Kunkle, RN, is a CTA Certified Life and Wellness Coach, founder of
Synergy Life and Wellness Coaching, and
creator of the “Synergy Success Circle.”
She helps busy women prevent burnout by
promoting bounceback resilience to
stay focused, positive
and excited about the
challenges of work
and life. For more
information, visit
her website, www.
synergylifeandwellnesscoaching.com, or
call 540-746-5206.
RMHonline.com
37
behavioral health
FOR BETTER HEALTH AND RELATIONSHIPS,
Learn to Manage
Your Anger
In itself, there’s nothing wrong with anger. It’s normal to have feelings of
anger arise because of life’s general annoyances and inconveniences. For most
of us, most of the time, these feelings are mild and short-lived. But if our
anger frequently escalates to a higher or prolonged level, or expresses itself
in inappropriate or destructive ways, our feelings of anger can have serious
consequences for ourselves and our relationships.
Anger Can Manifest Itself in Physical,
Emotional and Behavioral Ways
Physical—that is, physiological—manifestations
of anger include headaches, increased heart rate
and blood pressure, shaking or trembling, clenched
jaw, elevated temperature, sweating, and adrenaline
rushes.
On an emotional level, anger may call forth
other feelings like irritation, guilt, resentment, anxiety, sadness and cynicism.
In terms of behavior, angry people may be
abrasive or abusive to others, losing their sense of
humor or becoming sarcastic. They may yell, cry or
engage in unhealthy behaviors like excessive drinking. Or they may internalize the anger and become
withdrawn and demoralized.
Any of these possible manifestations can mean
real trouble in terms of our health and relationships.
They’re indicators that we should take appropriate
action to better manage our anger.
We can’t always avoid unpleasant experiences,
but we can learn to control our emotional responses
to them. The goal of anger management is to reduce
the impact anger has on us, and there are many ways
to do this.
38
healthQuest | Fall 2014
Recognize It
The first step in managing anger is to recognize your
anger. Reflect on the following:
• How do you know when you’re angry?
• Which situations or interactions make you angry?
• How do you react when you’re angry?
• How does your anger affect you and others?
You may find it helps to record your experiences
with anger in a journal. Reviewing this information can
help you identify patterns and triggers so you understand
the things that seem to intensify your anger. Reviewing
can also help you recognize any links between your anger
episodes and other experiences, and help you assess the
consequences and productiveness of your responses.
The more clearly you understand your anger, the
more likely you will be to address it effectively.
Get Rational
When you’re angry, your emotions often cloud your
logic. If you allow it, your thoughts can quickly become
exaggerated and your perceptions can become distorted. You may engage in “worst-case scenario” thinking
and entertain irrational assumptions. Such thinking
does little to calm you and, in many cases, serves only
to justify and escalate your anger.
concerns to others—respectfully but directly. When
you speak assertively, you let others know what you
find troubling, but you do so in a nonconfrontational,
nonaggressive way.
A good method is the classic “count to 10” approach, where you take a moment to collect your
thoughts and intentionally think about what would be
most productive to say in the situation. You can then
express yourself effectively by speaking from your own
position (using “I statements”), avoiding emotionally
charged words and focusing on expressing your desire,
rather than extending blame. This helps the other
person understand what’s angering you, and it prevents
you from saying something you may later regret.
Chill Out or Work Out
Try to remain objective and rational in the midst
of a heated situation by paying attention to your
thoughts. Replace dramatic internal messages with
more realistic ones. Instead of entertaining thoughts
that place blame, replace them with thoughts that
extend the benefit of the doubt. For example, replace:
“She’s not returning my call just to make me wait”
with: “She must be tied up at the moment and unable
to call.” Redirect fatalistic thoughts such as: “This is going to mess everything up” to: “Let me focus on what’s
currently happening.”
Taking on a more rational mindset can help
you think of possible solutions or alternatives to the
situation or issue that’s angering you. It shifts your
focus from your discomfort to your options. It can also
remind you of reasons why it’s beneficial to keep your
anger under control, such as: “I need to remain calm
so I won’t do anything to jeopardize my job.” You may
even want to be proactive by preparing a few statements like that, which you can reflect upon and repeat
to yourself when anger strikes.
Be Assertive
Often you can alleviate the anger you feel by assertively addressing it. That means stating your needs or
Your breathing rate and heart rate both increase when
you become emotionally provoked. You can learn to
reverse these increases by deliberately doing things to
calm yourself and allow the angry feelings to subside.
Techniques like deep breathing, progressive muscle
relaxation, prayer, meditation, visualization, using calming music or mantras, and journaling can all help calm
angry feelings.
In contrast to relaxing, exercise can also help.
Physical activity can provide an outlet for angry emotions, especially if you feel you’re likely to erupt. When
anger escalates, consider tension-relieving exercise like
yoga or Tai Chi, or energy-burning exercise like a brisk
walk, run, or another favorite physical activity.
Take a Timeout
Similar to the “count to 10” method, a “timeout” may
be just the thing that keeps your anger from getting
the best of you. Sometimes the simple act of removing yourself from the situation that’s angering you
can defuse the emotion. A different environment can
sometimes prompt different emotions and help to
change your emotional perspective. When you feel anger starting to rise, excuse yourself from the situation.
Doing so interrupts the emotional escalation and can
provide an opportunity to practice some of the other
anger management techniques shared above.
Anger Does Not Have to Control Us
There are many things we can do to take control of
anger. Take time to find out which anger management
techniques work best for you. If you feel you need
additional support managing your anger, talk to your
doctor or local mental health professionals.
The information in this article is provided courtesy of
Optima Health. ■
RMHonline.com
39
Artist,
Interrupted
BY N E I L M O W B R AY
The Lesser-Known Symptoms
of Heart Attack
On Dec. 31, 2013, artist Ken Schuler of Linville had an appointment with his primary care physician for a presurgical physical. He was scheduled to have shoulder
surgery in early 2014 to repair a torn rotator cuff.
A
presurgery physical is required for all
surgery patients at Sentara RMH Medical
Center to ensure a safe, optimal surgical outcome. Surgery patients are assessed and tested
before surgery, as deemed appropriate by their care
team, to detect anything that might cause a problem.
Schuler, 62, admitted to his doctor that he
hadn’t been feeling the best for a few days. As part
of the presurgical physical, his doctor performed an
electrocardiogram (EKG), a heart rhythm test, that
appeared normal, but he also found that Schuler’s
heartbeat was slow. He ordered blood work and sent
Schuler home, telling him to take it easy until his
office called with the results.
Early the next morning, New Year’s Day 2014,
the doctor’s office called with surprising news:
Schuler had suffered a heart attack.
“That was the first thing I heard on New Year’s
morning, and it was kind of shocking,” Schuler says.
“I can’t say the news scared me, but it definitely set
me back for a second. Anytime you hear you’ve had a
heart attack, it’s like a slap in the face.”
As the doctor’s office instructed, Schuler had his
wife, Bettie, drive him immediately to the Sentara
RMH Emergency Department.
40
healthQuest | Fall 2014
Subtle Signs
The news was particularly surprising, Schuler adds, because he has no personal or family history of heart disease,
and he had experienced none of the obvious symptoms
that he would have associated with his heart.
However, he had experienced some annoying jaw and
neck pain several days earlier.
On Saturday evening, Dec. 28, the Schulers were
entertaining friends. As they were eating dinner, Schuler
suddenly felt like someone had slugged him in the jaw.
“I didn’t know what it was,” he says. “I had no chest
pain, no arm pain, no shortness of breath, so I didn’t associate it with my heart. I went to the living room and sat
on the couch; it was hurting pretty bad.”
After their friends left, he put ice packs on his jaw. The
pain eventually subsided, and he went to sleep. The next
morning he got up and drove to Luray with a friend, then
came home and sighted a rifle, all with no more jaw pain.
“I didn’t feel the best, but I didn’t feel that bad either,”
he says.
A Swarm of Activity
When Ken and Bettie arrived at the Emergency
Department, it was like they had “stepped in a yellow
jackets’ nest—except, these were good yellow jackets,” he
Recipe for a
Healthy Heart
Eat a healthy diet low in saturated
• fat
and high in fruits, vegetables,
fiber and whole grains.
least 30 minutes of exercise
• aGetday,at most
days of the week.
Control your cholesterol and
• blood
pressure.
excess weight and maintain
• aLose
healthy weight.
Stop smoking and avoid second• hand
smoke.
Get plenty of rest and control
• stress.
See your doctor regularly and
• follow
his or her instructions.
Local artist Ken
Schuler and the
emblem of his
trade, a large pencil
in his front yard.
RMHonline.com
41
“My doctors and
nurses, the cardiac
rehab folks, the respiratory people and the
pharmacist—they all
treated me very well,”
Schuler says of his
experience. “And I feel
better than I’ve felt in
a long time; I feel like
my old self.”
The artist at work
jokes. “They were buzzing around me, pulling clothes
off and sticking things into me. There was definitely
a swarm of activity when I got there.”
The Emergency Department physician who assessed Schuler contacted the cardiologist on call, Dr.
Brad Rash of Harrisonburg Medical Associates. Dr.
Rash admitted Schuler to the hospital, telling him
they needed to find out what had happened and how
much damage had been done to his heart.
The symptoms Schuler had experienced several
days earlier—the jaw and neck pain with no arm pain,
no chest pressure and no shortness of breath—were
not the most typical heart attack symptoms, nor were
they rare, according to Dr. Rash. “That’s certainly not
the most common symptom of a heart attack, but it’s
not particularly uncommon, either,” he says. “Whenever a person complains of jaw pain that’s not related
to dental problems, the heart is typically on the list of
things we consider.”
42
healthQuest | Fall 2014
The blood test that alerted Schuler’s physician
to the heart attack is called a troponin test. Troponin,
Dr. Rash explains, is a protein that’s released from the
heart during a heart attack or whenever the heart is
under severe stress.
“The only organ in the body that secretes troponin
is the heart, so if we see an elevated troponin level in
the blood, that implies some level of myocardial infarction, meaning death of the heart cells.”
Dr. Rash ordered additional tests, including an
echocardiogram, an ultrasound of his heart. Schuler’s
echocardiogram showed he had normal heart wall
motion. “That indicates he really didn’t have enough
damage to detect it on the echo study,” Dr. Rash says.
Schuler was then taken to the catheterization
lab in the Sentara RMH Heart and Vascular Center,
where Dr. Rash performed a cardiac catheterization
that revealed an 80 percent blockage in Schuler’s right
coronary artery. Interventional cardiologist David
McLaughlin, MD, of Harrisonburg Medical Associates, was called in to open the partially blocked artery
and insert a stent, a thin metal tube, to keep the artery
open. The procedure went fine.
Afterward, Dr. Rash told Schuler to take aspirin regularly as a preventive measure. The aspirin, he
explained, would thin Schuler’s blood and help prevent
clot formation within the stent that Dr. McLaughlin
had just placed in his coronary artery.
There was just one problem: Schuler has a severe
allergy to aspirin.
“The few times that I’ve accidentally taken something with aspirin in it, the rescue squad had to take
me to the emergency room,” Schuler says. “My eyes
swelled shut, and I’d go into anaphylactic shock.”
Dr. Rash was aware of the allergy, and he told
Schuler they were going to try to desensitize him to
aspirin.
Fooling the Body’s Immune System
The desensitization process required that Schuler stay
in the hospital several additional days. He was taken to
Is It a Heart
Attack?
Not everyone having a heart attack
experiences the “classic” symptoms
of tightness, pressure or pain in the
chest, along with pain in the arms
or neck, sweating, and shortness
of breath. So what should you do if
you’re not sure whether that strange
or worrying symptom is coming from
your heart?
“First, you should call your primary doctor,” says cardiologist Brad
Rash, MD, of Harrisonburg Medical
Associates. “Second, if you’re having
symptoms that get worse with exertion and better with rest, it’s more
likely to be a coronary blockage. If
symptoms persist, then call 911.”
And if you’re pretty certain you
are having a heart attack, Dr. Rash
recommends calling 911 and then
taking aspirin. “I would recommend
four baby chewables, or a full adult
dose of aspirin,” he says.
the Critical Care Unit (CCU) for close monitoring.
“We have strict protocols that we follow when we
desensitize patients to various medications, and the
entire process requires significant coordination of care,”
says Rick Villiard, PharmD, clinical pharmacist for
Sentara RMH Pharmacy. Villiard worked with Schuler
during the desensitization process.
“We place the patient in the CCU as a precaution,
and we have emergency medications at the bedside
in case the patient would have a reaction,” Villiard
explains. “The patient receives one-on-one nursing
care, and a critical care physician is available should the
need arise. A respiratory therapist performs frequent
pulmonary function tests as part of the desensitization
protocols.”
He explains that if the patient is found to be exhaling less air than normal, that’s an indication the patient
may be starting to have an asthma-like reaction.
Villiard prepared an aspirin-containing solution
that was administered to Schuler.
“We started him with a very tiny dose, about 5
milligrams, and observed him for 60 minutes,” says
Villiard. “His dose was increased each hour, and after
about eight hours he was able to tolerate a therapeutic
dose of aspirin. We essentially fooled Ken’s immune
system into tolerating aspirin.”
By the end of that day, Schuler took two fullstrength adult aspirin tablets with no allergic reaction.
When he first went home, he took two baby aspirin
tablets each day for a month, and now he takes one
baby aspirin a day.
“They told me not to stop taking it,” Schuler says,
“because if I miss several doses, I could revert back to
being allergic again.”
Dr. Rash also recommended Schuler take Plavix®,
another blood-thinning medication, and a statin to help
control cholesterol.
Back to the Drawing Board
Schuler was released from the hospital on Saturday, Jan.
4, with no restrictions on his activities. At Dr. Rash’s
suggestion, he went through nine sessions of the cardiac
rehab program at the Sentara RMH Heart and Vascular
Center to build up his cardiopulmonary system and his
muscle strength.
“My doctors and nurses, the cardiac rehab folks, the
respiratory people and the pharmacist—they all treated
me very well,” Schuler says of his experience. “And I feel
better than I’ve felt in a long time; I feel like my old self.”
In early summer, Schuler’s physicians finally gave
the green light for him to have the shoulder surgery
that had been planned for January. That was good
news for the artist. He’s already back at the drawing
board. ■
RMHonline.com
43
New Center
Hastens
Wound Healing
BY KAREN DOSS BOWMAN
As a registered nurse employed in assisted living at Bridgewater Retirement
Community, Janet Flaten spends a lot of time on her feet. In January she developed open
sores on each of her big toes, but they weren’t healing well because of all the walking her
job requires. She also has diabetes, a condition that often slows the healing process.
“I wasn’t in a lot of pain, but because I walk so
community,” says Michele Kibler, MHA, program
much—and the shoes I wore weren’t helping—the
director for the center. “Previously there was nowhere
wounds just wouldn’t heal,” says Flaten, 60, of Bridgenearby for patients with chronic, nonhealing wounds
water. “I had tried a number of treatment options that
to go to receive comprehensive wound care under the
brought some improvement, but it was slow-going.”
direction of a physician. Before we opened, there were
Fortunately for Flaten, Sentara RMH Medimany people in the community who suffered with their
cal Center opened the Wound Healing Center on
wounds for months and years. We strive to heal those
Oct. 8. This is a multidisciplinary center that provides
wounds and improve each patient’s quality of life.”
comprehensive care for chronic wounds; those
The center treats a wide variety of wounds,
not healing or not expected to heal within
including diabetic ulcers, venous ulcers,
30 days; or recurring sores resulting
arterial ulcers and pressure ulcers; osteofrom diabetes, trauma or other health
myelitis (infection of the bone); and
problems.
traumatic injuries. Already the center
The center is the first of its
is showing great results: During the
kind in the local community,
first three months of operation, 97
bringing together the expertise
percent of patients were discharged
of a diverse group of specialists,
as healed. Referrals aren’t required,
including vascular surgeons, podiaso patients may call the center ditrists, general surgeons and plastic
rectly to make an appointment.
surgeons. Specially trained wound care
“Harrisonburg and its surrounding
nurses serve as case managers, ensurcommunities were in dire need of a place
ing that each patient receives personalized
like the Wound Healing Center, where the
Hyperbaric oxygen
treatment.
medical team is specially trained and skilled
therapy provided
The center is one of 500 nationwide
at treating chronic wounds,” says Jarrod
at the Sentara RMH
in partnership with Healogics, the nation’s
Day, MD, medical director of the Wound
Wound Healing Center
leading wound care management company,
Healing Center and a vascular surgeon in
was just the treatment
and one of only a handful of such centers
practice with Valley Vascular Associates in
Janet Flaten needed
across Virginia.
Harrisonburg. “We are equipped to deal
for the nonhealing
“This center is a great thing for the
with the most severe wounds and can offer
44
healthQuest | Fall 2014
wounds on each of
her feet.
patients superb care right here, close to home. Our
team of doctors works closely together with the goal of
healing wounds before they reach the level of severity
where more drastic measures are required.”
Hyperbaric Oxygen Therapy Can Speed Healing
The Wound Healing Center offers the most advanced
treatment options for nonhealing wounds, including
hyperbaric oxygen therapy.
Hyperbaric oxygen therapy is delivered in an
enclosed, see-through pressurized chamber. The patient
lies in the chamber and relaxes while breathing pure
oxygen. The higher air pressure inside the chamber
allows the patient’s lungs to take in more oxygen than
is possible at normal air pressure. The blood carries the
oxygen throughout the body, stimulating improved
circulation, fighting bacteria and promoting healing.
Hyperbaric oxygen therapy is available to patients
whose wounds have failed to heal using more conservative therapies, but it also may be used for patients
who have undergone skin grafts or flap surgeries (such
as those in a mastectomy) or experienced postradiation
tissue damage, or to treat scuba diving (decompression) sickness. Patients with untreated pneumothorax,
those who are pregnant in nonlife-threatening circumstances, or patients on a high dosage of Amiodrane (above 400 mg) may not be candidates for this
therapy, Kibler notes.
Podiatrist Orlando
Cedeno Jr., DPM,
explains to a patient
inside the hyperbaric
chamber how he can
use the phone to
communicate with
the patient once the
chamber is closed.
RMHonline.com
45
Among the physicians
who frequently see
patients in the Wound
Healing Center are
vascular surgeons, from
left, Tara Balint, MD, and
John Mansfield, MD, and
medical director of the
center, Jarrod Day, MD.
Flaten’s medical team, led by general and vascular surgeon John Mansfield, MD, believed that in
addition to extensive wound care, she would benefit
from hyperbaric oxygen therapy. She had 30 hyperbaric treatment sessions, each lasting 90 minutes,
with outstanding results.
“I was able to get into the chamber and just
relax,” Flaten says. “The nurse would turn my TV
on, and I pretty much closed my eyes and relaxed
throughout the treatment. My ears kept popping,
but it wasn’t painful. I just continually swallowed or
yawned to keep them pressurized.”
Diabetes and Nonhealing Wounds
Like Flaten, the majority of patients who receive
care at the Sentara RMH Wound Healing Center
have diabetes. The disease is prevalent throughout the
community, mirroring national statistics: About 25.8
million children and adults (or 8 percent of the total
population) have been diagnosed with diabetes, according to the American Diabetes Association. In addition,
more than 25 percent of the population over 65 years
old (10.9 million) has been diagnosed with the disease,
while millions more have it but remain undiagnosed.
Diabetes, which is caused by too much glucose
(sugar) in the blood, may lead to nerve damage, resulting in neuropathy, or loss of feeling, in the feet, says Dr.
46
healthQuest | Fall 2014
Day. A person with neuropathy may step on a sharp
object and cut his foot, or walk with a pebble in her
shoe that causes a sore, and not notice the wound until
it becomes infected. The nerve damage also can change
the shape of the foot, creating new pressure points that
are susceptible to injury.
In addition, elevated levels of sugar in the blood
allow bacteria to thrive, weakening the body’s immune
system and ability to fight infection. This also impedes
healing.
Smoking interferes with wound healing by reducing the amount of oxygen that reaches the body’s
organs. It can speed up plaque formation, causing
blood vessels to become narrower, diminishing the flow
of blood the body needs to repair itself. That makes the
heart work harder to pump blood throughout the body.
“Smoking hurts everything, and it especially hurts
the arteries,” Dr. Day says. “It keeps the white blood
cells from working efficiently and from doing their job
of fighting infection.”
Diabetes is the leading cause of lower limb amputations not resulting from accident or injury, according to
the U.S. Centers for Disease Control and Prevention.
The Wound Healing Center’s medical team strives to
save limbs and takes on even the most complicated cases.
James King, of Elkton, is a diabetic patient with
vascular disease who has had numerous amputations,
Control Diabetes to
Prevent Problems
with
including his right leg and a left toe. After his four
remaining toes were amputated in January, the wound
wouldn’t heal. Vascular surgeon Greg Montgomery,
MD, first tried a skin graft using King’s own skin. But
the graft didn’t take, so King was prescribed hyperbaric
oxygen therapy. Within the first few weeks, the wound
was 80 percent healed, King says.
“There’s really nothing to it, and when you come
out, you feel great,” says King, 59. “I’d recommend the
treatment to anyone else with a nonhealing wound. It
will heal you up, and you’ll be on your way.”
A Full Array of Wound Healing Treatments
In addition to hyperbaric oxygen therapy, the Wound
Healing Center offers a wide range of other treatments for chronic wounds. These include antibiotics
and topical medications, silver dressings, compression therapy and bioengineered skin grafts, some of
which are created from human cells and are used to
promote healing. The center offers pressure-reducing
casts, such as the total contact cast, designed to take
pressure off the feet and allow wounds to heal.
The Wound Healing Center also offers transcutaneous oxygen monitoring to measure the amount
of oxygen in the tissue surrounding a wound. This
monitoring is helpful in determining if a patient might
benefit from hyperbaric oxygen therapy. In cases of
severe wounds, transcutaneous oxygen monitoring can
help the doctor determine the best location for amputation that would offer the greatest chance of healing.
“People who have had these wounds
for months and months—maybe even for
a year or longer—have a poor quality of
life,” says Dana Lambert, RN, clinical
nurse manager at the Wound Healing Center. “They have to change the
dressings on their wounds frequently, and
they’re always concerned about drainage. The wounds are painful and may cause
further complications. For many of them, the
next alternative is amputation. By offering the best
techniques and treatments available, we hope to save
their limbs and ultimately improve their quality of life.”
Dr. Mansfield says the Center’s patients especially
benefit from the multidisciplinary approach to care.
“The Wound Healing Center is focused totally
on wound care, and patients have access to doctors
from multiple specialties,” says Dr. Mansfield. “You
have the whole gamut of specialists who can look at
the problem and give different perspectives for the
best way to help the patient heal. It’s a very collaborative approach, and that brings positive outcomes.”
Dr. Day adds: “Research shows that bringing
W
Healing
hile diabetes can increase a patient’s risk for
serious complications such as foot ulcers and
poor blood flow to the lower extremities, RMH
Diabetes Nurse Educator Julie Pierantoni says
certain lifestyle changes may help prevent or delay
the onset of these problems.
“The higher blood sugar level slows down the
white blood cells and paralyzes them. These are the
cells that fight infection,” Pierantoni says. “When
you give the bacteria more food, you’re setting up
this huge cascade of events, such as damage to
nerves and blood vessels, that will not promote
healing. Our goal as diabetes nurse educators is to
help patients keep their diabetes under control so
they can reduce the chances that they’ll get these
wounds that resist healing.”
Pierantoni recommends that patients take the
following steps to reduce their risk factors:
■ Closely monitor blood sugar levels.
■ Eat a balanced diet with plenty of fruits and
vegetables, and minimize added sugars and
carbohydrates, which turn into sugar during
digestion.
■ Get plenty of exercise, and move the feet
and legs frequently while sitting at work or
watching television.
■ Examine the feet daily to detect sores before
they become serious. Seek treatment early
for wounds.
■ Stop smoking.
■ Maintain a healthy weight.
together a team of specialists to treat chronic wounds
can improve limb salvage rates, which translates to
more people healing their wounds without major
amputations. Through the Wound Healing Center,
we are able to provide seamless, coordinated care for
wounds and also to educate patients about preventing wounds in the first place.”
King says he enjoyed getting to know the doctors, nurses and staff at the Wound Healing Center.
He felt confident in their medical expertise.
“The doctors, nurses and the whole team there
are hard to beat,” King says. “They’ve been upfront
with me, and I think the world of them. I’d recommend anyone with nonhealing foot problems to ask
their doctor about hyperbaric oxygen therapy. It’s
worked miracles for me.” ■
RMHonline.com
47
board members
Sentara RMH Board of Directors
Welcomes Three New Local Members
Three Long-Term Members Retire From Board
T
he Sentara RMH Board of
Directors recently welcomed
three new local members and
bid farewell to those leaving the board
after having fulfilled their terms.
The new board members are Devon
Anders, James Hartman and Martha
Shifflett. Retiring from the board are
Mensel Dean, Allon Lefever and James
Messner.
Devon Anders is president of InterChange Group Inc. in Harrisonburg.
He graduated magna cum laude from
Eastern Mennonite University with
a bachelor’s degree in accounting and
business administration. He is a certified
public accountant (CPA).
He is also a partner and director
in two other local companies, Classic
Distribution Inc. and A&J Development and Excavation Inc. He is a past
president of the Rockingham Education Foundation Inc. and serves on the
boards of Friendship Industries Inc. and
the Southeast Warehouse Association.
He has also served on the RMH Foundation Board. He currently serves on
the stewardship committee for Lindale
Mennonite Church.
“I believe quality health care is vital
to our community, and I am honored to
48
healthQuest | Fall 2014
have been asked to serve on the board of
our community’s hospital,” he says. “As a
CPA and entrepreneur, I can’t move too
far from the financials of an organization, and I enjoy understanding what
makes businesses and organizations successful. As a Christian, I have a passion
and duty to give back to my church and
the community as the Lord has blessed
our family.”
He and his wife, Teresa, have two
daughters and a son.
Jim Hartman is chairman of Truck
Enterprises in Harrisonburg.
A lifelong resident of the community, Hartman graduated from Eastern
Mennonite High School. He holds a
bachelor’s degree in business administration from James Madison University.
He is a board member for the
American Truck Dealer Association and
the Virginia Trucking Association as
well as a National Dealer Council member for Kenworth Truck Company.
Hartman is a past member of the
James Madison University Board of Visitors and served as board rector from 2010
to 2012. He also served on the Park View
Mennonite Church finance committee
from 2002 to 2012. He has served on
numerous fundraising committees.
“As a lifelong resident of the
Harrisonburg-Rockingham community,
I have seen the growth and development
of Rockingham Memorial Hospital
along with our city and county,” he says.
“My employees depend on Sentara
RMH and our local medical community for health, wellness and medical
needs. Sentara RMH is a vital resource
for our community in providing needed
medical services, education, information,
disease prevention and partnerships with
companies and organizations. I appreciate the invitation to serve on the Sentara
RMH Board of Directors.”
He and his wife, Carolyn, have three
children.
Martha Shifflett is president of United
Bank, Southern Shenandoah Valley.
Shifflett has four decades of banking experience, beginning just after her
graduation from Mary Baldwin College
cum laude, with a degree in economics.
She also graduated with honors from
the University of Virginia School of
Bank Management.
She currently serves on the boards
of the Harrisonburg-Rockingham Free
Clinic and the Harrisonburg Electric
Commission. She also is a member of
the Rotary Club of Harrisonburg.
She served on the RMH Foundation board and as its chairman from
2007 to 2009. She also served on the
boards of the United Way of Harrisonburg & Rockingham County, the James
Madison University Duke Club, and
the Arts Council of Harrisonburg and
Rockingham County (vice chair, 2009).
In addition, she was 2008 chair
of the Bridgewater College Business
Community Campaign and an elder
of Harrisonburg First Presbyterian
Church from 2008 to 2010.
“Since we relocated to the
Shenandoah Valley approximately 10
years ago, no organization has had
more influence on me and my family
than Rockingham Memorial Hospital,” she says. “Serving on the RMH
Foundation Board heightened my
awareness of and interest in the hospital’s influence upon our local economy
and upon virtually every business
and family in the area with regard to
providing access to high-quality medical care. It would be my hope that my
skills and experience in organizational
leadership and financial management
would enable me to have a positive
impact.”
Shifflett and her husband, Ray,
live in Harrisonburg. They have two
children and five grandchildren.
Sentara RMH Employees Give More Than
$98,000 to 2014 Employee Gifts Campaign
E
mployees of the Sentara
RMH Medical Center believe that “Giving Makes
You Happy!” and proved it as they
gave more than $98,000 to the
2014 Employee Gifts Campaign.
“The campaign raised $98,386,
which is 116 percent of this year’s
goal of $85,000,” says Janet Wendelken, development officer for the
RMH Foundation. Wendelken
directs the Foundation’s annual
fund, which includes the Employee
Gifts Campaign.
A total of 741 Sentara RMH
employees made gifts to the
campaign, which ran from May 21
through June 30.
“This generosity shows that
our Sentara RMH employees care about their patients,
their co-workers, their work and this hospital,” says Sentara
RMH President Jim Krauss. “These funds will go a long
way toward fulfilling our mission to improve health every
day. Our team truly understands that giving will make our
hospital better for our community.”
The campaign was led by five employees who served
as volunteer co-chairs: Deanna Lam, Funkhouser Women’s
Center; Janet Macarthur, Oncology Services and Hahn
Cancer Center; Neil Mowbray, Corporate Communications;
Meg Robinson, Sentara RMH Wellness Center; and Rusty
Tusing, Facilities Management.
“Giving Makes You Happy” was this year’s campaign
theme. To celebrate the campaign’s success, many employees
took part July 10 in a dance celebration choreographed
by Sentara RMH Wellness Center Zumba instructor
Sara Forde Allen and held on the hospital’s café patio
to the song “Happy” by Pharrell Williams. The song was
featured in the computer-animated movie “Despicable
Me 2.”
The annual Employee Gifts Campaign was launched
in 1975. This year employees could focus their donations
to support the hospital equipment and program fund or
the Employee Relief Fund, or to support their own or
another department. The Employee Relief Fund is a fund
set up by the hospital to assist employees who are facing
a financial crisis due to a serious illness or unfortunate
personal situation.
RMHonline.com
49
Sentara RMH news
Nicely Named Director, Sentara
RMH Imaging Services
B
ecky Nicely, RRT, has been named
Nicely received a degree in radiologic
director of Sentara RMH Imaging
technology from the University of Virginia
Services. Nicely has 15 years of
School of Health Sciences and a bachelor’s
experience in imaging services managedegree in radiologic health sciences from
ment. She has been employed with Sentara
Adventist University of Health Sciences.
RMH since 2008, serving as diagnostic
She is a registered radiologic technologist
imaging manager until being named
and a registered mammography technolointerim director of Imaging Services in
gist. She is currently completing a master’s
June 2013.
degree in management.
From 1999 to 2008, she worked with
“As interim director, Becky maintained
Shenandoah Shared Hospital Services and
a strong working relationship with the
was responsible for CT and MRI services
radiologists and did a great job leading
at Sentara RMH and Augusta Health.
this important service,” says Richard
“I am excited about this new leadership
Haushalter, Sentara RMH senior vice
BECKY NICELY, RRT
opportunity,” she says. “I knew at an early age
president and chief operating officer.
that helping others is what I wanted to do.
“Becky’s participation in Sentara’s LeaderThrough my leadership role, I can continue to fulfill
ship Advance program helped her further develop into
my passion of helping others by serving and equipping
this leadership role. She will be an outstanding leader,
staff with the skills needed to do their jobs well as we
taking us into a new era of imaging services at Sentara
strive to provide exceptional service to our patients.”
RMH. ”
Hackett Named Executive Director
for Sentara RMH Medical Group
P
hilip Hackett has been named executive director of the Sentara RMH
Medical Group. Established in January 2010, Sentara RMH Medical Group
is a subsidiary of Sentara RMH Medical
Center. Its team of 106 providers includes
78 physicians, 28 advanced practice clinicians and a support staff of 355. It operates
25 primary care and specialty clinics across
Rockingham, Page and Augusta counties.
Hackett is a native of Indiana but a 25year resident of Virginia. He has 20 years of
experience in health care, holding positions
of progressively increased responsibility in
physician practice management and operations. More than half of his experience has
been with Carilion Health System in southwestern
Virginia. He most recently served as a director of the
Southern & Western Group for Health Management Associates in Naples, Fla., with more than 500
employed physicians.
50
healthQuest | Fall 2014
“Phil is a seasoned and versatile senior
health care executive with extensive financial
and operational management experience,
particularly in the physician practice setting,” says John McGowan, MD, president,
Sentara RMH Medical Group. “His wealth
of experience in medical group management
will greatly benefit Sentara RMH Medical Group as we focus on providing quality, compassionate care and maturing our
population health management capabilities
through optimum electronic medical record
utilization, patient-centered care, evidencedriven performance and service excellence.”
PHILIP HACKETT
Hackett holds a bachelor’s degree
in business administration and accounting from Anderson University in Anderson, Ind. He
completed graduate coursework in higher education
administration from Virginia Tech in Blacksburg, Va.
He also is a certified public accountant.
“I am extremely excited to join the Sentara RMH
Medical Group team and become part of the Harrisonburg-Rockingham County community,” Hackett
says. “The mission, vision and culture of Sentara
RMH align with my personal focus on partnering
with physicians to improve quality, safety and cus-
tomer service. Our industry is in an exciting period
of change. I look forward to helping continue a
tradition of excellence as we partner with our physicians to meet the medical needs of our community
and address the challenges ahead of us. ”
Sentara RMH Conducts Its First MRI Scan
on a Patient With an Implanted Pacemaker
S
entara RMH Medical Center staff
recently performed the hospital’s
first magnetic resonance imaging (MRI) scan on a patient fitted with
a pacemaker system designed, tested
and FDA-approved for use in the MRI
environment.
Implanted pacemakers help regulate
heart rhythms, explains Robert VerNooy,
MD, a cardiologist and electrophysiologist
with Harrisonburg Medical Associates
and the Sentara RMH Heart and Vascular
Center. Dr. VerNooy and his colleagues
perform pacemaker implants as well as
other procedures to treat abnormal heart
rhythms. They began implanting MRIcompatible pacemakers at Sentara RMH
in 2013.
Magnetic resonance imaging is one
of the fastest-growing areas of diagnostic imaging and often is the standard
of care for imaging soft tissue. MRI is
often preferred by physicians because
it provides a level of detail and clarity
not offered by other soft-tissue imaging
modalities.
“Before this type of device was
invented, patients with implanted pacemakers were prohibited routinely from
getting an MRI scan over the lifetime of
their implanted device because it was
unsafe,” Dr. VerNooy says.
During an MRI procedure, patients
with non-MRI-safe pacemakers could
face serious complications, such as
interference with pacemaker operation,
damage to system components, lead or
pacemaker dislodgement, or change in
pacing function, he explains.
continued on page 52
RMHonline.com
51
Sentara news
Sentara RMH
news
continued from page 51
More than 200,000 patients
annually in the United States must
forego an MRI scan because they
have a pacemaker. It has been
estimated that a patient with an
implanted cardiac device has a
50–75 percent chance of being referred for an MRI over the lifetime
of the device.
“It’s satisfying, as a physician
who implants these devices, to
know that a clinically beneficial
pacemaker system for a given
patient does not limit the future
quality of care for that patient,
such as advanced MRI imaging
that might become necessary,” Dr.
VerNooy adds.
The FDA-approved MRIcompatible pacemaker systems are
Medtronic‘s first-generation Revo
MRI™ Surescan® and the improved
second-generation Advisa® dualchamber pacemaker systems, he
says. The system implanted in the
patient who underwent an MRI at
Sentara RMH was the latest Advisa
system.
Sentara RMH performs more
than 11,000 MRI scans each year,
according to Becky Nicely, director,
Sentara RMH Imaging Services.
“MRI scans in pacemaker patients will become much more routine and safe, which will improve
the overall clinical care of these
patients, especially for MRI imaging of neurologic and orthopedic
problems,” Dr. VerNooy says.
52
healthQuest | Fall 2014
Sentara and East
Virginia Medical
School Launch
Sentara • EVMS
Fetal Care Center
NORFOLK, Va. – Crystal Springer,
27, was pregnant with twins when
she learned one of them was killing
the other. They were diagnosed with
a rare condition called twin-to-twin
transfusion syndrome (TTTS), in
which one of the fetuses was giving
up most of its blood and nutrients to
the other through communicating
blood vessels on the placenta. TTTS
affects about 15 percent of twins in
the womb.
Crystal and her husband, Nick,
a sailor on the USS Eisenhower, were
stunned when a routine sonogram
at her doctor’s office 22 weeks into
her pregnancy led to a same-day visit
with Jena Miller, MD, an EVMS
maternal-fetal medicine specialist. Dr.
Miller recommended a laser procedure performed in utero to separate
the blood vessels. It would be the
first of its kind for the new Sentara •
EVMS Fetal Care Center at Sentara
Norfolk General Hospital.
“Every day, you live in fear,” says
Springer, who adds that Dr. Miller
was upfront and honest about the
risks. “We could lose one or both of
them during the procedure,” Springer
recalls. “They could have still been
premature, and there were concerns about brain damage and heart
problems as a result of the condition.”
Doing nothing meant one or both of
the twins would likely die.
Dr. Miller performed the first
TTTS procedure at Sentara Norfolk
General Hospital on Dec. 9, 2013.
Though she had performed the procedure many times, this was her first
with EVMS, but Springer trusted her
Sentara Norfolk General Hospital
knowledge, skill and compassion.
“We got really lucky,” says Springer.
Identical twin sisters Ella and Anna
were born prematurely at 32 weeks of
gestation on Feb. 21, 2014, one minute,
one pound and one inch apart. They
spent six weeks in the Special Care
Nursery at Sentara Norfolk General
Hospital, growing stronger each day as
EVMS physicians and the hospital care
team monitored their progress. Both
have gone home and are expected to
develop normally.
Center combines assets
of Sentara and EVMS
“This collaboration brings important
services to the Hampton Roads region
and to Virginia,” says Alfred Abuhamad, MD, chair of EVMS Obstetrics
and Gynecology. “Combining EVMS’
maternal-fetal medicine expertise and
Sentara’s world-class facilities and care
team means that women with complicated pregnancies have access to
outstanding care.”
The center, located on the Eastern
Virginia Medical Center campus
in Norfolk, provides in utero treatment for many fetal conditions once
considered life threatening or treatable
only after birth. It is the only site of
care in Virginia, and one of few on the
East Coast, offering laser therapy for
TTTS. The next-nearest sites performing TTTS procedures are in Baltimore
and Charlotte.
“Our partnership provides the
opportunity to capitalize on the unique
strengths of Sentara and EVMS, to
offer an unparalleled level of care in our
region,” says Kurt Hofelich, president of
Sentara Norfolk General Hospital.
“EVMS is proud to build on
our strong relationship with Sentara
Healthcare, to bring a new level of care
to families in Hampton Roads and
beyond,” says Richard Homan, MD,
president and provost of EVMS and
dean of the School of Medicine.
U.S. News & World
Report Ranks
Sentara Norfolk
General No. 1 in
Virginia
Two surgical specialties ranked among the
top 50 in the nation
S
entara Norfolk General
Hospital has been ranked the
No. 1 hospital in Virginia and in
Hampton Roads by U.S. News &
World Report. In the 2014-2015
“Best Hospitals” edition, the
hospital was also recognized with
two “top 50” specialty programs.
Cardiology and Heart
Surgery are ranked 44th, which
marks the 14th consecutive year
among the nation’s elite programs
in the U.S. News national survey.
For the first time, the Ear, Nose
and Throat program is also among
the nation’s top 50 programs, at
No. 41. This national ranking is due,
in part, to innovative procedures used
by surgeons associated with Eastern
Virginia Medical School for patients
with head and neck cancers.
“Our community-based
surgeons and EVMS partners are
actively engaged as part of our care
team, which elevates our programs,”
says Kurt Hofelich, president of
Sentara Norfolk General Hospital.
“This No. 1 ranking in Virginia is
a testament to the work our entire
team does every day of the year.”
Sentara Norfolk General Hospital is one of just five voluntary Level
I trauma centers in Virginia and
home to the Nightingale Regional
Air Ambulance, which serves community hospitals and EMS partners
in a 125-mile radius as part of the
Sentara not-for-profit mission. The
hospital is a tertiary referral center
for complex cases and home to
unique services, including:
• Heart, kidney and pancreas
transplantation
• Total artificial heart and ventricular assist device programs
• Catheter-based heart valve
replacement
• Burn trauma program
• Neuromuscular & Autonomic
Center with sweat chamber
diagnostics
• Sentara “Music & Medicine”
program
• Sentara/EVMS Fetal Care Center
• CyberKnife® Robotic
Radiosurgery
• Sentara Cardiovascular Research
Institute
“It’s great to be part of a system
like Sentara with such an enduring
commitment to quality,” says Jim
Krauss, president of Sentara RMH
Medical Center in Harrisonburg,
which is ranked 15th in Virginia by
U.S. News for 2014. “That attention
to safety and quality extends to all
Sentara hospitals, and our patients
and communities benefit from our
combined commitment.” ■
RMHonline.com
53
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.
Daniel L. Cardwell, PA-C
Adam W. Hamidi, DO
Allied Health
Emergency Medicine
Sentara RMH Cardiothoracic Surgery
Harrisonburg Emergency Physicians
Graduate School: Western University of
Health Sciences, Pomona, Calif.
Medical School: Lake Erie College of
Osteopathic Medicine, Bradenton, Fla.
Certification: Physician Assistant
Residency: Northeast Ohio Osteopathic
Medicine Residency, South Pointe Hospital,
Warrensville Heights, Ohio
Member: Association of Physician Assistants in Cardiovascular Surgery
Clinical Interests: Cardiology, oncology
Personal Interests: Travel, hiking, history
Justin D. Deaton, DO
OB/GYN
Shenandoah Women’s HealthCare,
Harrisonburg
Medical School: Pikeville College School
of Osteopathic Medicine, Dayton, Ohio
Internship: Mercy Health Partners,
Muskegon, Mich.
Residency: Mercy Health Partners,
Muskegon, Mich.
Member: American Osteopathic Association, American College of Obstetricians &
Gynecologists, American College of Osteopathic Obstetricians & Gynecologists,
American Urogynecological Society
Clinical Interests: Pelvic organ prolapse,
urinary incontinence
Personal Interests: History, running,
basketball
54
healthQuest | Fall 2014
Member: American College of Emergency
Physicians, American College of Osteopathic Emergency Physicians, American
Osteopathic Association
Clinical Interests: Pediatrics, geriatrics
Personal Interests: Travel, tennis and BBQ
Nazim U. A. Khan, MD
Bryan D. Maxwell, DO
Interventional Cardiology
OB/GYN
Harrisonburg Medical Associates
Harrisonburg OB/GYN Associates
Medical School: Khyber Medical College,
University of Peshawar, Pakistan
Medical School: Kansas City University of
Medicine & Biosciences, Kansas City, Mo.
Internship: University of Connecticut
Health Center, Farmington, Conn.
Internship: Carilion Clinic (University of
Virginia affiliate), Roanoke, Va.
Residency: University of Connecticut
Health Center, Farmington, Conn.
(Internal Medicine)
Residency: Carilion Clinic (University of
Virginia affiliate), Roanoke, Va.
Fellowships: East Carolina University
Brody School of Medicine, Greenville, N.C.
(Cardiovascular Disease); East Carolina
University School of Medicine (Interventional Cardiology)
Memberships: Fellow, American College
of Cardiology; Fellow, Society of Cardiovascular Angiography and Interventions
Board Certification: Cardiovascular
Disease, Interventional Cardiology, Nuclear
Cardiology and Echocardiography
Clinical Interests: Coronary artery
disease, heart failure, hypertension,
interventional cardiology
Member: American College of Obstetrics
and Gynecology, Medical Society
of Virginia
Board Certification: Obstetrics and
Gynecology
Clinical Interests: Minimally invasive
surgery, urogynecology, robotic surgery
Personal Interests: Swimming, cycling,
triathlon, outdoor activities
Parag G. Patel, MD
Infectious Disease
Sentara RMH Infectious Disease
Medical School: M. P. Shah Medical College, Saurastra University, India
Amanda M. Loucks, MD
Family Medicine
Harrisonburg Family Practice
Medical School: Eastern Virginia Medical
School, Norfolk
Residency: University of Virginia,
Charlottesville
Board Certification: Family Medicine
Member: American Academy of Family
Physicians
Clinical Interests: Pediatrics, well woman
care, preventive medicine
Personal Interests: Fusing glass, crafts,
spending time with family
Residency: Forest Hills Hospital, North
Shore LIJ Health System, Forest Hills, N.Y.
(Internal Medicine)
Fellowship: Carilion Clinic, Virginia Tech
School of Medicine Program, Roanoke, Va.
(Infectious Disease)
Member: Infectious Diseases Society of
America, American College of Physicians
Board Certification: Internal Medicine,
Infectious Diseases
Clinical Interests: General infectious disease, HIV/AIDS, immunocompromised host
Personal Interests: Drawing, cricket
Sridevi Mannem, MD
Internal Medicine
Sentara RMH Hospitalists
Medical School: J. J. M. Medical College,
Davangere, India
Residency: Mercy Catholic Medical
Center, Darby, Pa.
Member: American College of Physicians
Clinical Interests: Hematology
Personal Interests: Cooking
RMHonline.com
55
medical staff update
Emily Z. Ritchie, MD
Radiology
Rockingham Radiologists Ltd.,
Harrisonburg
Medical School: Louisiana State University School of Medicine, New Orleans
Internship: Trident Family Medicine,
Charleston, S.C.
Member: American Psychiatric
Association
Board Certification: Psychiatry
Clinical Interests: Mood and anxiety
disorders
Personal Interests: Endurance sports,
Bible study
Residency: Medical University of South
Carolina, Charleston
Rachel S. Stevenson, PA-C
Fellowship: University of California–
Davis, Sacramento (Women’s Imaging)
Allied Health
Sentara RMH Hospitalists
Member: American Association of
Women Radiologists, American College of
Radiology, Radiological Society of North
America, American Roentgen Ray Society
Graduate School: James Madison
University, Harrisonburg, Va.
Board Certification: Diagnostic Radiology
Personal Interests: Cooking, running,
LSU football, and spending time with her
husband and their dog and cats
Derek J. Robinson, MD
Certification: Physician Assistant
Member: American Academy of Physician
Assistants, Virginia Academy of Physician
Assistants
Clinical Interests: Undeserved populations, health-related lifestyle improvements and management
Personal Interests: Hiking, reading and
cooking
ENT/Otolaryngology
Meadowcrest ENT & Facial Cosmetic,
Harrisonburg
Medical School: University of Iowa
Carver College of Medicine, Iowa City
Residency: University of Virginia,
Charlottesville
Member: American Academy of
Otolaryngology—Head and Neck Surgery
Clinical Interests: General otolaryngology
—adult and pediatric ENT, head and neck
disorders, sinus and ear disease
Personal Interests: Outdoor activities,
hunting, fishing, hiking, biking, kayaking
Joseph F. Smith, MD
Psychiatry
Sentara RMH Valley Behavioral
Medicine, Harrisonburg
Medical School: University of Virginia
School of Medicine, Charlottesville
Internship: University of Virginia
Residency: University of Virginia Medical
Center, Charlottesville
56
healthQuest | Fall 2014
Thomas L. Wigginton, MD
Radiology
Rockingham Radiologists Ltd.,
Harrisonburg
Medical School: Drexel University
College of Medicine, Philadelphia, Pa.
Internship: Sentara Norfolk General
Hospital/Eastern Virginia Medical School,
Norfolk
Residency: Baystate Medical Center,
Springfield, Mass.
Fellowship: University of Virginia,
Charlottesville (Diagnostic Radiology)
Member: American College of Radiology,
Radiological Society of North America,
American Roentgen Ray Society, American Society of Neuroradiology, Medical
Society of Virginia
Board Certification: Diagnostic
Radiology
Clinical Interests: General radiology
and neuroradiology
Personal Interests: Spending time
with family
RMH foundation
People of all
ages take part in
the annual Race
to Beat Breast
Cancer 5K Run/
Walk event
each October.
Local Race Helps Local
Women Get Free Mammograms
Mammograms are important screening tools for detecting breast cancer in its earliest stages
in hopes of saving lives. Thanks to the generous fundraising efforts of Harrisonburg Parks and
Recreation and Panera Bread, more than 100 women from Harrisonburg and surrounding communities received free mammograms at the Sentara RMH Funkhouser Women’s Center last year.
S
ince 2002, Harrisonburg Parks and Recreation,
This year’s race will take place on Saturday, Oct. 25, at
By
with support from Panera Bread in recent years, Karen Doss Westover Park in Harrisonburg.
has hosted the annual Race to Beat Breast
“We strive to give back to the community and are
Bowman
Cancer 5K Run/Walk in support of National Breast
proud that the proceeds stay here locally to support
Cancer Awareness Month in October. The event has raised tens
women in need of breast cancer screenings and treatments,”
of thousands of dollars to provide breast cancer screenings and
says Erik Dart, athletic program supervisor at Harrisonburg
treatments to women without health insurance or those who
Parks and Recreation. “It means a lot more to the participants
cannot afford these services.
when the money goes to a local cause, rather than a national
“Without these donated funds, many women in our
charity. People know that their family, friends and neighbors
community wouldn’t be able to have a screening mammogram,
may benefit from the services provided by these funds.”
which we know can save lives,” says Teresa Boshart Yoder,
Panera Bread, a lead sponsor for the 5K, contributed
RN, MSN, director of Women’s Services at the Funkhouser
an additional $5,800 through sales of pink silicone rings
Women’s Center. “We expect to have about 150 women come
and pink ribbon bagels, which Marketing Coordinator Allie
through this year who need financial assistance. This wonderMunsey describes as “one of our most popular items.” The
ful support enables us to reach out into the community to help
bakery encourages cashiers to boost sales of these items by
people in need, and it helps us raise awareness about the imporoffering fun contests for those who raise the most money.
tance of mammograms for keeping women healthy.”
All employees are invited to be part of the check presentaLast year, about 530 people participated in the 3.1-mile
tion to the RMH Foundation. Doing so helps them underrace and raised more than $15,000 for the Women’s Center.
stand the impact of the gifts.
RMHonline.com
57
Cory Davies
of the RMH
Foundation, far
right, receives
a presentation
check from
employees
of Panera
Bread in
Harrisonburg.
“When our employees hear about how the money is
used to help patients, and they meet people from the community who are breast cancer patients or survivors, it helps
them connect the dots,” Munsey says. “They realize, ‘This
could be my wife or my daughter or my mother or sister,’
and seeing Panera’s commitment to supporting mammograms and breast care treatment for women in the community makes them feel good about the company they work
for. We strive to be a true community partner, and we truly
care about the people in our community—whether they are
our customers or not.”
A Grateful Patient
Breast cancer is the most common form of cancer among
U.S. women after skin cancer, and it’s the second-leading
cause of cancer death among women. The American Cancer Society estimates that one in eight women will develop
breast cancer in their lifetime. A new study published in
BMJ (formerly British Medical Journal) concludes that
routine screening mammograms may reduce breast cancer
deaths by 28 percent.
A recent patient, who asked to remain anonymous, was
grateful for the free mammogram she received last year after losing her health insurance in January 2013. Having had
a loved one die from breast cancer, she was worried about
how she could afford her annual mammogram.
“I am so grateful. God bless the people who set up this
fund,” she wrote in a letter to the RMH Foundation. “I was
so scared not to have my annual mammogram [because] I
watched my sister-in-law die from breast cancer. If I had
not been put in touch with the program, I would have had
to delay my mammogram for I don’t know how long. May
all involved in this be deeply blessed.”
A 5K for All Fitness Levels
You don’t have to be a diehard runner to participate in the
annual Race to Beat Breast Cancer. Walkers are also welcome, Dart says. While some participants sign up because
58
healthQuest | Fall 2014
they enjoy running, others join simply to honor a
loved one affected by breast cancer.
“When people hear about a 5K, they get intimidated by the distance, but it’s OK to walk the course,”
says Dart, who encourages people to sign up in groups
of at least five family members or friends to get a
$5-per-person discount on the fee. “We try to keep it
as smooth and low-key as possible. We encourage anyone who wants to come out and participate in honor
or memory of an individual, or to promote awareness
about breast cancer—or just to have a good time.
Whatever the reason, it’s in support of a good cause.”
Dart has enjoyed hearing the stories survivors
share before the race begins. Over the past 12 years,
he’s met a lot of survivors who tell stories about their
experiences, and he remembers some who have lost
their battle with breast cancer.
“It allows everyone to put a face with the experience, and it’s really powerful—some of the stories are
gut-wrenching,” Dart says. “It’s helped me to form
closer ties with so many of our participants who have
been affected by breast cancer. We see so many people
come back year after year, and it’s good to see how
they’ve progressed.”
Cory Davies, executive director of the RMH
Foundation, is appreciative of Harrisonburg Parks and
Recreation and Panera Bread—as well as other organizations and businesses in the community—for their
generous support of this special health care need.
“We’re grateful that they help us provide a muchneeded service in our community,” Davies says. “Their
support allows us to assist women who would not
be able to afford a mammogram, and that makes a
significant impact in our community.”
Yoder adds that the funds also help provide educational materials about breast cancer for patients.
“Because we’re able to provide free mammograms,
we hope to be able to catch suspicious spots or lumps
early, when there’s still a good chance of full recovery,”
she says. “I’m sure that the generosity of partners like
Harrisonburg Parks and Recreation and Panera Bread
has saved the lives of many women in our community.
For that, we are grateful.” ■
The 12th Annual Race to Beat
Breast Cancer 5K Run/Walk
Saturday, October 25, 2014, Westover Park, Harrisonburg
• 9a.m.:IntroductionandCancerSurvivorTestimonials
• 9:30a.m.:Run/WalkBegins
Sponsored by Harrisonburg Parks and Recreation and
Panera Bread. For more information or to register, visit
http://www.harrisonburgva.gov/beat-breast-cancer-race.
friends
OF THE RMH FOUNDATION
Gifts Received Jan. 1–May 31, 2014
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 2014.
President’s
Forum
$100,000 and above
RMH Volunteer Auxiliary
$25,000–$99,999
Aubrey R. Liskey Estate
$5,000–$24,999
Jerry R. and Kathleen L. Andes
Bill and Gerry Bedall
Harrisonburg Emergency Physicians,
PLC
Mary Doris Joecks and Family
McDonald’s of Harrisonburg and Boxley
Family
Peggy Robinson Miley
William Leake
Society
$1,000–$4,999
Drs. A. Jerry Benson and Martha K.
Ross
Chase Investment Counsel Corporation
Eddie R. and Catherine Coffey
Cross Keys Mill Creek Ruritan Club
Cory R. and Donielle Davies
Dr. Christopher D. and Sandra S.
DiPasquale
Kermit and Jean Early
Eula R. Eppard
Dr. C. Wayne and Donna Gates
Hurt & Proffit Inc.
Richard and Mona Johnson
Mary Louise Leake
Elizabeth M. Lynch
Dr. and Mrs. John A. McGowan
The Merck Foundation
Merck Partnership for Giving
Edward A. Morris
James E. and Mary B. Nolan
Organogenesis Inc.
Panera Bread—Blue Ridge Bread Inc.
Dr. David H. and Janet T. Wendelken
John J. and Naomi V. Wenger Charitable
Account
Darrell R. Wyant
1910
Cornerstone
Club
$100–$999
James B. and Kay F. Acker
Frank R. and Linda N. Adams
Mary L. Addy
Mazin Baker Adil Al Alawi
Laura E. Adkins
Isobel B. Ailles
Clarence C. and Helen M. Allen
Donald V. Allen
Paul A. Antone
JoAnn Daggy Arey
C. Dennis Armentrout
Weldon O. and T. Gail Armentrout
Robert C. and Mary B. Atkins
Sandra G. Baker
Hope N. Barb
Edgar L. Barnard Jr.
James H. Barnhart
Richard A. Baugh
Dr. Joseph W. and Elaine F. Behl
Charles F. Bell
Benevity Community Impact Fund
Tena M. Bibb
Roger L. and Sonja A. Bible
Linda Heatwole Bland
William E. and Allene R. Blessing
Blue Ridge Insurance Service Inc.
Colonel Charles J., USAF-Ret., and
Alice O. Bonner
Jeanine Botkin
John F. and Elsie L. Bowers
Matthew B. and Whitney L. Bowles
Larry O. and Paula C. Bowman
Chester L. and Nancy B. Bradfield
Bridgewater Ruritan Club
Tami L. Brown
Brunk and Hylton Engineering Inc.
William H. Bryant
Louise R. Burtner
Margaret T. Byers
Tammy M. Byrd
Charles T. Campbell
Eleanor M. Campbell
Franklin R. and Shirley D. Campbell
Jay L. Campbell
Diana Canning
William B. Sr. and Phyllis W. Carper
Robert P. and Marilyn R. Carroll
Dr. and Mrs. G. Edward Chappell Jr.
R. Bradley and Mary Ellen Chewning
LuAnn L. Clark
Susan E. Clark
Alfred R. and Melba Cline
Paul and Sherry Cline
Roberta B. Cline
Daneen A. Coakley
Mary M. Coleman
Commonwealth Building Materials Inc.
Thomas F. Constable Jr.
Lesley A. Cook
Dewitt R. and Janet A. Cooley
Patricia S. Costie
Jerry L. and Phyllis Y. Coulter
Mary J. Cross
Deborah J. Cubbage
Timothy E. and Jenifer D. Cupp
Carl Davis
Diane C. Davis
Irene Morris Davis
John R. and Tina D. DeLapp
J. Brisco and Janet Dellinger
Terri Lynn Denton
Denton Family Charitable Foundation
Ltd.
L. D. Jr. and Patricia C. DeRamus
Raymond C. Diehl
Lynn and Dave Diveley
Dominion Foundation
Norman R. Downey Jr.
Jeanie Dunham
Martin Z. Eby
Janet S. Einstein
Everence
Beverly S. Eye
Fidelity Charitable Gift Fund
Audrey G. Fitzwater
Norman V. and Patsy M. Fitzwater
Larry A. and Linda J. Fogle
Lois S. Foley
James K. and Faith W. Forkovitch
Daniel F. and Debra W. Fraser
Donald O. and Polly B. Fravel
RMHonline.com
59
friends
OF THE RMH FOUNDATION
Forrest L. and Freddie F. Frazier
Charles J. Frye
Tammy Fulk
Funkhouser and Associates Inc.
Ruth A. Geiser
Sherrill and Jim Glanzer
Jack W. Glover
Kenneth H. and Joyce C. Goad
Michael C. Gochenour
Edwin L. and Esther B. Good
James L. and Patricia B. Grandstaff
Dorothy P. Gray
Ruth Griffin
John E. and Kristin M. Grimes
Daryl D. Gum
Mae B. Guthrie
Josh P. and Chassidy S. Hale
Jean S. Hamill
Hanon Pediatrics, PLC
Harrisonburg Community Health
Center Inc.
Harrisonburg Pediatrics, PC
Darrell Haslacker
Jennifer L. Hayden
Robert A. and Marlene A. Hazzard
Dr. J. T. Hearn and Phyllis Weaver
Hearn
Dr. Charles H. and Mary Henderson
Farrel B. Hendricks
Michelle Hendrix
John E. and Judith N. Henneberger
Barbara J. Henry
Joyce Herndon, Brenda & John
Bosserman, Karen & Jeff Gwaltney
and John & Michelle Herndon
Cary and George Hevener
Glenn and Sandra Hodge
Brent and Karen Holl
William S. Holland
Christopher A. Hollis
Jeffry M. and Kathryn A. Hollis
Joseph E. Hollis
Tracy A. Hollis
David B. and Gay M. Holmes
Jeffrey L. and Susan H. Holsinger
John and Lou Holsten
George and Ann Homan
Brenda B. Hoops
Deborah D. Hoover
Evelyn B. Hosaflook
Dr. Alden L. and Louise Otto Hostetter
Maria K. and Steven E. Hostetter
Geri A. Howdyshell
Thomas C. and Karen S. Huffman
Brenda J. Hull
David L. and Regina G. Ingram
James J. Iverson
James Madison University Hospitality
Management
James Madison University MBA
Class—Noble Notes
Leanne M. Jenkins
Tedd and Lora Jett
Sarah F. Jones
Alice M. Julias
Flora L. Kagey
Marie W. Kauffman
60
healthQuest | Fall 2014
Deborah B. Kile
Dr. Rosa L. King
Gleen D. and Lena R. Kite
Orrin M. Jr. and Jane C. Kline
Martha S. Knicely
Julie F. Kramer
Jim and Vicki Krauss
Frederick H. Kruck
Billy and Betty Kuykendall
L D & B Insurance Agency
Gary and Sheila Lam
C. Stephen and Cynthia H. Lamb
Rebecca S. Lanhardt
Milton and Mary S. Laughland
Eldon F. and Susan B. Layman
Michael L. and Susan B. Layman
Anna S. Leakey
Dr. William I. and Lynda D. Lee
Eugene C. and Sherry M. Leffel
Terry A. and Judy LePera
Jean L. LeRoy
Doug and Linda Light
Alvin M. and Lorraine C. Lineweaver
Carissa Link
Jo Ann Liskey
Lillie M. Lohr
Omer L. Jr. and Margie Long
Wilbur J. and Ann S. Long
Charlotte R. Lucas
Beverly T. MacLeod
Laura S. Mapp
Janet E. Marshman
Peter F. Jr. and Elizabeth S. Martens
Elizabeth Maxfield
Philip H. Maxwell
Celia M. McClinton
Matthew C. McCoy
Ronald T. and Louise M. McCoy
Lenny and Elaine McDorman
McGaheysville Ruritan Club
Colonel Richard K. McNealy
Donna F. Meadows
Craig M. and Lois B. Miller
Edgar L. and Carmen Strite Miller
Ginny Miller
Linda R. Miller
Margaret (Peggy) M. Miller
Nathan Miller
Sara G. Miller
Sylvia S. Moore
Kathy Moran and Marcie Harris
Lawrence F. Jr. and Nancy L. Moran
Jerry and Becky Morris
Edward W. and Mindy J. Morrison
Carroll A. and Lois S. Moyers
Lawrence G. and Linda C. Mullen
Jane C. Mundy
Douglas J. and Yvette M. Munnikhuysen
Sterling E. and Foelke D. Nair
John N. and Linda E. Neff
Steve A. Nelson
New York Life Insurance Company
Dan and Gail O’Donnell
Charles V. and Lois M. Oster
Randall S. and Renee A. Ours
Michael Overby
Ann Pace
Austin F. Pacher Sr.
Edward C. and Carol L. Parks
Anneliese Patterson
William D. and Cynthia Lee Patzig
Clement C. III and Carolyn S. Pearce
Clarence E. and Rhoda W. Peifer
Charles W. and Anna Mae Pellman
Dr. R. Steven and Stephanie M. Pence
Dr. Keith E. and Dorothy J. Peterson
Philips Lifeline
Julie A. Pierantoni
Richard G. and Annie L Pierce
William B. and Barbara B. Pond
Mrs. Raymelle W. Pope
Johnny Propst
Dr. Heidi D. Rafferty
Dr. Harold F. III and Donna S. Reilly
Louise K. Reynolds
James W. Rhine
Ethel G. Rhodes
Rebecca E. Richards
Melissa L. Riley
M. Hope Ritchie
Beth Robbie
Jesse D. and Wilma K. Robertson
Grace D. Robinette
Meg Robinson
Beatrice R. Rolon
Thomas R. and Laura R. Rosazza
Bernard T. and Virginia L. Rote
Bryan W. and Peggy S. Sandridge
Kathryn L. Schmidt
Joyce M. Schumacher
Frank J. and Carol A. Scibek
Ralph L. and Ann W. Sebrell
Cathy Link Sedwick
See-Mor Truck Tops & Customs Inc.
Dennis W. and Peggy A. Sellers
John H. and Faye T. Sellers
Sentara RMH Wellness Center
Members and Staff
Mary C. and James R. Sherman
Corie B. Shifflett
Charles C. Shiflet Jr.
June B. Harrison-Short
Jeanette M. Showalter
Audrey L. Shreckhise
Mary Elizabeth Skinner
Mr. and Mrs. Marvin T. Slabaugh
Ilene N. Smith
William C. Smith
Bradley A. Snyder
Karen A. Sodikoff
Charles (Bud) and Barbara R. Somers
Kim H. Stanchfield
Julia D. Alderfer-Stauffer
Kenneth L. and Virginia J. Steeber
Barbara K. Stickley
Karl D. and Barbara B. Stoltzfus
Dr. John M. and Doris S. Stone
William G. and Hope Shank Stoner
Esther J. Strawderman
Rodney and Ruth Stultz
Fred G. Sutherland
George H. and Elaine R. Sylvester
TASC Corporation
Linda L. Taylor
John Teague
Clayton N. and Jacqueline D. Towers
Gregory S. and Ann B. Trobaugh
Lynn and Diane Trobaugh
Sallye Trobaugh
Truck and Equipment Corporation
Donald, Florence and Todd Turner
Rusty A. Tusing
Sandy and Sherwin Tusing
Samuel G. and Sandra J. Underhill
United Way of Greater Augusta Inc.
Phillip and Christina Updike
Nancy Hopkins Voorhees
Pamela S. Waggy
Charles W. Jr. and Dorothy Wampler
Fred F. and Dorris M. Wampler
Rick and Joyce Wampler
Valerie S. Weaver
Wallace W. and Mary Alice Weaver
Merv and Marlene Webb
Henry G. Jr. and Ferne M. Wenger
Janet E. Whetzel
Roberta (Robbie) and Robert K. Wilkins
George and Carrie Willetts
Dr. Paul R. Jr. and Carol D. Yoder
Ronald and Shirley B. Yoder
Teresa Boshart Yoder
Helen C. Young
Robbie J. Zirkle
Annual
Support
$25–$99
Active Network
Sandra V. Adams
Phyllis Albrite
Anthony N. Allred
Daniel A. Amberg
Rebecca J. Ambrose
Garland R. Jr. and Carol D. Anderson
Sharon H. Arbogast
Stanley T. Barbour
Tamela J. Bare
Joseph M. Beahm
Daniel H. and Ora M. Bender
Dan R. and Florence M. Benner
Amy F. Bennett
Ernest F. Jr. and Emmy R. Bernhardi
Holly G. Berry
Dr. Thomas and Faythe E. Bertsch
Beta Xi Chapter—The Delta Kappa
Gamma Society
Chris and Hilda Bewall
Susan L. Blaine
Byron Bland Jr.
Doris A. Bomberger
David H. and Wendy P. Bowman
Norma C. Bowman
Catherine E. Boyd
Addison D. Brainard
Brittany A. Breeden
Victoria E. Breen
Bridgewater Church of the Brethren
Friendship Circle
George B. and Edatha V. Brockington
Patricia A. Brunk
Henry F. and Catherine S. Buhl
Deborah E. Bullis
Hascal Buracker
David B. and Elizabeth B. Burkholder
Shirley Bussard
Susan D. Cabell
Colonel and Mrs. Joseph J. Callahan
Theodore and Anna B. Campbell
Joseph P. and Akiko Carniglia
Chanda J. Carrier
Noelle S. Carroll
Lewis E. Casey
Harry W. Cash
Jillene K. Cavallo
Robert W. Clatterbuck
Dallas N. and Peggy H. Claytor
C. Douglas and Gloria A. Cliborne
Penny C. Cline
Matthew J. Cline-Taskey
Pamela F. Collins
Jackson P. Comer
Sondra K. Comer
Debra A. Craddock
Jean and Paul Craig
Judy A. Craun
Frances W. Crider
Ashley L. Cromer
Perry Crowder
Paul D. and Corinne E. Crumley
Dennis A. and Martha C. Cummins
Michael W. and Debra I. Davis
Barbara Dean
Desiree S. Dean
Karen E. Dean
Weldon D. and Shirley B. Dean
Robin L. DeLaughter
Samantha L. DePoy
Virginia Derstine
Dorothy H. Dickerson
Donald B. Dillon
Ruth Dod
Jean M. Dove
Frank S. Earman Jr.
Richard T. and Terri L. Elms
Theresa T. Enfiejian
Miranda N. Eppard
Lenard I. and Barbara J. Eppley
Reagan B. Eshleman
Barbara Estep
Esther R. Eye
Whitney B. Eye
Lee Anna Farrall
Fred A. and Deborah J. Faught
Ronald L. and Barbara B. Ferguson
Jane Ferguson-Clamp
Krista R. Fetterman
Robert G. Fint
Fischer Family Trust, Ardeth and
Richard Fischer, Co-Trustees
Betty Jo Fleisher
J. C. Jr. and Betty B. Foltz
Mary Y. Funkhouser
Rebecca G. Gant
Sarah N. Garrison
Alberta P. Gearhart
Michael W. Gentry
Dana L. Gibson
Portia B. Gibson
Cecil F. Gilkerson
Bonnie C. and J. W. Good III
Michael A. and Deborah W. Good
Robert P. Good
April N. Gooden
Evelyn W. Guyer
Richard A. and Linda C. Halpern
Robert L. and Faye C. Hansbrough
Greg E. and Kim P. Harper
Jay P. and Josette M. Harris
Lora A. Harvell
Carolyn A. Haslacker
Haslacker A.C. and Heating
Richard W. Hatch
Julia H. Hawse
Jack and Mary Hayes
Dolores S. Haynes
Marlene A. Hedrick
Wilma F. Hedrick
Ralph C. Heishman
Judith Heneeberger
Pharis V. Hensley
Charlotte L. Higgins
Natalie Hiner
Michelle L. Hogle
Brent and Karen Holl
George G. and Doris A. Hoolahan
Bobbi S. Hottinger
Martha F. Hounchell
William D. and Kathryn L. Hughes
Byron E. and Julie A. Hukee
Richard A. and Linda J. Humbert
Buddy G. Hutchens
Indian American Cafe
John M. Jr. and Nancy Lu Irvine
Robert N. and Barbara H. Jackson
John D. and Ernestine S. Jenkins
Shelvy M. Jenkins
Joe and Sharon Jerlinski
Ronald P. and Julianne Jilinski
George L. and Betty A. Jones
Cheryl K. Karns
Thomas Kauffman
William R. and Evelyn F. Keller
Wayne and Kay Frances Kelley
Iva H. Kenney
Megan D. Khamphavong
Lakisha N. Kilby
Janet E. Kimble
Ronald Kirk
Joseph R. Kisamore
Mary Ann Kiser
Tammy S. Kitta
Amos D. and Anna G. Knicely
Katie C. Knicely
Sabrina H. Knight
Barbra J. Knupp
Victoria A. Krauss
Emil and Louise Kreider
Elizabeth L. Kyger
Mary H. Kyger
Anna S. Labrousse
Deanna D. Lam
Nancy L. Lam
Raymond L. and Myron O. Lam
Krystle D. Landes
Jay B. and Peggy H. Landis
Jerry O. and Daisy D. Leake
Sandra L. Leap
Donna E. Lear
Ashley A. Lehman
David J. and Lavonne W. Lehman
Michael L. and Sharon A. Lehman
Lidia Machado Lemus
Tommy M. Lilly
Wayne A. and Brenda W. Lilly
Josellin R. Lindo
Junior L. Lineweaver
Jean G. Link
Charles R. and Tamara C. Lockard
Barbara L. Long
Cristy L. Long
Harry E. and Virginia L. Long
Jeanette G. Long
Robert and Dorothy Long
Hattie H. Lovegrove
Annmarie Ludlow
Jennifer E. Lussier
Aimee B. Lyle
David M. and E. Grace Lynch
Norman R. and Marilyn Mailhot
Neil D. Marrin
Christine M. Marshall
Gerald E. and Sophia B. Martin
John R. and Marian S. Martin
Kathryn Mason
Norma J. Maupin
Joyce E. Maust
Robert L. McCracken
Pamela S. McDaniels
Paul A. McEnderfer
Elizabeth McGirr
Patsy Meadows
Colonel and Mrs. William P. Menefee
MGM Resorts Foundation
Heather L. Miller
Mabel V. Miller
Martha B. Miller
Richard R. and Joyce D. Miller
Wayne S. and Betty See Miller
Diane O. Mincey
Kristal R. Mitchell
Carole J. Mongold
Leslie Morris
Rebecca Morris
Sherrie L. Morris
Stacey R. Morris
Jay A. and Wanda R. Moyer
Merideth L. Moyers
Judith R. Nafziger
Thomas A. Nardi
Robert E. and Delores M. Nash
Anne W. Nielsen
Susan E. Ober
Anne T. Oberndorfer
Joseph T. O’Byrne
Phoebe M. Orebaugh
Richard and Barbara Owen
Meghan C. Painter
Arthur E. Parente
Elmo and Ella Massey Pascale
Kristin H. Payne
Jane Peck
Tammy D. Pence
Janet M. Peterson
Eileen B. Phillips
Eunice H. Pitsenbarger
Leroy W. and Nora P. Plaugher
Tracey J. Poe
Fonda D. Prichard
Ira H. and Ruby C. Propst
Nathan R. and Linda R. Propst
Wilbert E. Raines
Saranna T. Rankin
Eleanor S. Rexrode
Charles E. and Marie E. Rhodes
Donald L. and Lydia S. Rhodes
Nancy Riggs
Natalie S. Rinaca
Elizabeth N. Ritchie
RMH School of Nursing Alumni
Association
Brian A. Roach
Mendy D. Roadcap
Patricia B. Robbins
Lori A. Roberts
Helen C. Rohrbaugh
Ronald W. and Mary Ellen Rohrbaugh
Harold W. and Carolyn M. Roller
Beulah B. Roman
Matthew D. Rotteli
Margaret O. Roy
Monica L. Rutledge
Rexford J. Schroyer
Kathryn K. Scripture
Kristin R. Seith
Connie J. Seligson
Bernard J. and Thelma L. Shamblin
Raymond W. and Gladys Shank
Janice Shanholtzer
Jeffrey K. and Janet S. Sheffer
Jimmy J. Sr. and Carolyn R. Sheffer
Jean M. Shenk
Joy L. Sherman
Cheryl Wynne Shifflett
Alton K. and Helen W. Shipe
Debbie L. Shipe
Mary K. Shipe
Nancy J. Shomo
E. C. and Ruth C. Showalter
Lottie Jane Showalter
Melvin E. Showalter
Margaret S. Shrewsbury
Dr. Beverly P. Silver
April M. Simmons
Sara E. Sipe
Charles Slott
Kara B. Smoker
Mary Y. Southerly
Caroline M. Spiers
Bonnie K. Spitzer
Mr. and Mrs. John H. Sponaugle
James A. and Barbara J. Stader
Debbie H. Stewart
Dwynn M. Stoval
Leonard S. and LaVonna C. Strickler
Leslie A. Sullivan
Marta E. Szuba
Annie P. Taylor
Rodney L. and Frances L. Teets
Fred C. and Doris H. Thompson
Jamie L. Thompson
Wendy V. Thompson
Erik D. and Faye H. Topp
Elisa Torres
Garnett R. and Lena A. Turner
Wayne A. and Betty H. Turner
Raymond W. and Mary V. Tusing
Deborah E. Tysinger
Loring H. Vance Jr.
Dr. Ben F. and Janice W. Wade
Naomi Waggy
Timothy L. Walker
William R. and Susan M. Walls
Buddy R. and Myrtle C. Walton
J. Conway and Patricia W. Waters
Michael W. and Laura A. Watson
Harold H. and Karen L. Weber
Patrick H. and Joem C. Webster
Janet M. Westfall
Gwendolyn M. Whetzel
Louise A. White
Kelly M. Whitlock
Edgar and Shirley Wilkerson
Richard L. and Pamela B. Wilkins
Louie Z. Will
Amanda L. Williams
Garland J. and Shelvy Williams
Leesa T. Williams
Karen Wimer
Michael L. and Brenda P. Witt
Melissa K. Wolfe
RMHonline.com
61
friends
OF THE RMH FOUNDATION
LTC Charles V., USA (RET) and
Stephanie S. Wollerton
Marijo Wood
Sherry T. Wood
Tracie L. Wray
Carissa Wyant
James R. Yager
Karla Young
Heidi A. Zander
Richard K. Zimmerman
Susan F. Zirkle
Memorial
Gifts
Marion Allen
Donald V. Allen
Dr. Roddy Amenta
Robert C. and Mary B. Atkins
Pamela Darlene Arbogast
Donald L. and Judith M. Smith
Betty J. Arehart
Larry A. and Angela M. Caplinger
Margaret F. Dillon
Patsy Reich
Dennis W. and Peggy A. Sellers
Superior Concrete Inc.
Amber Rae Armentrout
C. Dennis Armentrout
Weldon O. and T. Gail Armentrout
Dewitt R. and Janet A. Cooley
Linda A. Davis
Casey R. and Alice H. Ruliffson
Cheryl Wynne Shifflett
Truck and Equipment Corporation
Audrey Barnhart
James H. Barnhart
Anna Hendrika Boudina Barr
Kathleen M. Williar
Mattie W. Barranco
Stephen S. and Mattie W. Barranco
Tammy Blizzard
Julia D. Alderfer-Stauffer
William Kent Bowers
James K. and Faith W. Forkovitch
Dr. L. Daniel Burtner
Louise R. Burtner
Brenda B. Hoops
Harry Lee Byers
Margaret T. Byers
John D. Snyder
Nancy J. D. Campbell
Charles T. Campbell
Nida K. Caplinger
Friendship Industries Inc.
Mary Alice “Toots” Carr
Richard P. and Myrna Conner
Charles D. Coakley
Daneen A. Coakley
Carmen M. Dagostino
Yolanda Nieves
David Denman
Jim and Pat Messner
Carroll E. Dennison
Raymond C. Diehl
Viola Dickerson
Edwin and Dianna Lehman
Carlos Victor Diehl Jr.
Christine W. Burner
Ed and Debbie Price
Nanette B. Ritchie
Melissa and Pete Shawger
Charles C. Shiflet Jr.
Glenn, Terri, Wes and Jake Smith
Gregory S. and Ann B. Trobaugh
Leo L. Jr. and Patricia W. Walton
Janet L. Wayland
Lorriane Diehl
Raymond C. Diehl
Naomi Eppard Diehl
Eula R. Eppard
LeRoy Henry Fega
Richard C. and Cheryl L. Tharp
Frances Wilson Flora
Brent and Karen Holl
James G. Bowman Sr.
John R. and Esther C. Gordon
Doris L. Flynn
Blue Ridge Insurance Service Inc.
Betty H. Campbell
Edward C. Bridges
Janice S. Bridges
Conrad Frazier
Forrest L. and Freddie F. Frazier
Gerri Brown
Dan and Gail O’Donnell
Dr. Harry M. Gardner
Betty S. Gentry-Metzler
Anneliese Patterson
Alfred and Verda Brenneman
Charles W. and Anna Mae Pellman
William E. Foley
Lois S. Foley
Ernest L. Brown
Catharine M. Brown
Warren Tack Garber
Judith J. Spahr
Colonel Albert Ray Brownfield III
Colonel Charles J., USAF-Ret. and
Alice O. Bonner
Thomas F. Constable Jr.
Mary Ann Crabbs
John E. and Kristin M. Grimes
Bob and Brenda Lovan
62
M & R Vineyard, LLC
Elizabeth Maxfield
Douglas J. and Yvette M. Munnikhuysen
Michael Overby
Kay E. Payne
Colonel Ovidio E. and Norma I. Perez
George H. and Elaine R. Sylvester
TASC Corporation
The Shenandoah Valley Wine Growers
Association
Nicholas B. and Wendy Yarnold
healthQuest | Fall 2014
Dr. Joseph E. Gardner
William B. and Barbara B. Pond
Richard T. Getz
David E. and Nancy L. Lockwood
John D. Rossheim
Joan Rae Thursby Giuliano
Arthur S. Giuliano
Elizabeth Betty Glick
Frederick W. and Dorothy J. Custer
Joseph “Joe” S. Glick
Jeffrey D. and Faye B. Curl
Frederick W. and Dorothy J. Custer
Larry S. and Mandy D. Pence
Charles C. Shiflet Jr.
Michael L. and Julie A. Shiflet
My Son, Greg Good, and My Daughter,
Teresa Good
Josephine L. Good
William C. Gray
Mary S. Gray
Loretta Grunewald
Carson Hensley
Mildred S. Harper
Tammy Fulk
L D & B Insurance Agency
F. Harrison from Broadway, Virginia
Robert and Kathryn Manley
Orville Hepner
Betty Lou Hepner
Rachel M. Hollis
Christopher A. Hollis
Jeffry M. and Kathryn A. Hollis
Joseph E. Hollis
Tracy A. Hollis
Maxine C. Holsinger
Bernard T. and Erma R. May
Jerald S. “Jerry” Howdyshell
Carissa Link
Cathy Link Sedwick
Wanda Anne Hudson
Brenda and John Bosserman
Karen and Jeff Gwaltney
Joyce Herndon
Michelle and John Herndon
Gordon L. Huffer and Earl D. Huffer
Peggy H. Huffer
Charles Kelsie Hughes Jr.
TelecomPioneers—Old Dominion
Chapter #43
Kenneth Humphries
Donald O. and Polly B. Fravel
E. Wayne Hussey
Pete T. and Alexandra Karageorge
Ronnie and Lorraine Losh
Fred F. and Dorris M. Wampler
Mickey Hutton
Bernice D. Hutton
Peggy K. Hylton
John C. and Mary E. Albert
Augusta County Service Authority
Augusta Health Care Inc.
Lee K. and Brenda Branner
Brunk and Hylton Engineering Inc.
Daneen A. Coakley
Fred L. Jr. and Jacqueline Collier
Diane C. Davis
Phil and Debbie Douglas
EGS & Associates Inc.
Anne G. Farmer
Roger F. and Cheryl Flint
Glass & Metals Inc.
Jonathan D. and Gwyndolyn E.
Harrison
Edward C. and Charlotte K. Hopkins
Debra S. Huffman
David L. and Regina G. Ingram
Marian C. Jameson
L D & B Insurance Agency
Jason L. and Mary Beth Landes
Dewey E. and Brenda F. Lawson
Dr. William I. and Lynda D. Lee
Timothy K. and Christy L. Long
Eddie M. and Patricia M. Lynn
Martin’s Native Lumber Inc.
McDaniel Contractor Services
Shirley M. Miller
John N. and Linda E. Neff
Nielsen Builders Inc.
Ronnie L. and Gloria S. Raynes
David C. and Judy M. Rees
Richard E. and Patsy G. Richard
Kathleen S. Risser
Thomas W. and Judy S. Rowland
Casey R. and Alice H. Ruliffson
Robert S. and Johanna R. Runion
William D. and Joan B. Sanger
Charles C. Shiflet Jr.
Skyline Chapter Model A Club
William C. Smith
Charles (Bud) and Barbara R. Somers
Dr. Asa R. and Jean F. Talbot
Valley Church of Chirst
Janet E. Whetzel
Dr. Harold S. Jenkins
Jim and Pat Messner
Lois Elizabeth Jenson
Jerry A. and Beverly L. McGowan
Doris Johnson
Rollins R. Johnson
Thomas Keenan
John T. and Deborah K. Keenan
Brenda B. Keyes
Ishmal W. II and Judy M. Baugher
Funkhouser and Associates Inc.
Michael C. Gochenour
Joseph K. and Angela J. Grogg
Kay E. Hensley
Paul E. and Shirley K. Judd
H. L., Jr. and Mildred R. Maiden
Karen M. Necsary
Lynda Krobath
Thomas F. Constable Jr.
Gayle Gaston
Pamela Holland
Lantz Construction Company
Paul Jr. and Beatrice Menges
Robert E. and Barbara A. Menges
Jane Frances Kruck
Frederick H. Kruck
Leroy B. Layman
Dale W. and Sharon L. Reeves
Darla Faye Craft LePera
Terry A. and Judy LePera
Margaret Lockard
Charles Lockard
Barbara L. Long
Georgie E. Long
Juanita Loud
Franklin R. and Shirley D. Campbell
Mary Lumsden
Isobel B. Ailles
Jean C. Madren
Beta Xi Chapter—The Delta Kappa
Gamma Society
Marie K. Frey
Charles C. Shiflet Jr.
J. Mark Martin
Virginia M. Martin
David Mattichak
Henry C. III and Jane M. Bowers
Ruth W. Bryant
Richard P. and Clara Doerle
Madeline Halkovich
Milton and Mary S. Laughland
Dolores Mattichak
Gordon and Anne Mattichak
William D. and Cynthia Lee Patzig
Dr. and Mrs. Richard H. Smith Jr.
Jeff and Dot Weaver
Sandy McAfferty
Anne W. Nielsen
Dotty McDonald
Kenneth L. and Virginia J. Steeber
Dallas E. Meadows
Donna F. Meadows
Normand R. Meny
Susan D. Meny
Merlin Miller
Mildred Miller
Paulette Mills
Robert E. and Mary E. Rhan
William Kaylor Monger
Michael L. and Susan B. Layman
Nancy Marie Painter
Southeast Baptist Church
Southeast Baptist Church Hope Bible
Class Members
Elsworth and Ethel Paris
Berlin and Paula Paris Zirk
David O. Pauley
John R. and Tina D. DeLapp
Ruth E. Pequignot
Wynne Jane Jacoby
Jesse and Dorothy Price
Rodney and Ruth Stultz
Darrell W. Pruitt
Deborah K. Pruitt
Pauline S. Pullin
Dorothy B. Ashby
Virginia Clara Reed
Linda H. Higgins
Beulah G. Hill
Gerald J. and Patty K. Jablonowski
Jesse A. and Edith Meadows
Naomi S. Meadows
Kimberly Watrous
Carey and Wanda Young
Beatrice Reedy
Dick and Ginny Holsinger
Clifford and Jennifer Huffman
See-Mor Truck Tops & Customs Inc.
E. Virginia Reilly
Louise K. Reynolds
Patricia R. Reynolds
Richard A. Baugh
Ralph T. and Carolyn E. Dameron
David B. and Gay M. Holmes
Anne S. McFarland
Richard L. and Etha Jane Parker
Jacquelyn L. Pugh
John Teague
Jeff and Dot Weaver
Mary Frey Ritchie
Mary Ellen Brown
Jay and Elizabeth McKell
Ethel L. Rowe
Doris Jean R. Stimpson
Virginia B. Ryan
Phoebe T. Bowman
Lanny L. and Phyllis B. Branner
Lee K. and Brenda Branner
Robert L. and Anna Lee Branner
Wanda, Robert, Sue Coffman &
Rosemary White
Donald E. and Kathie W. Dellinger
Eugene C. and Sherry M. Leffell
Derwood L. and Nancy R. Runion
Virginia B. Ryan
Seniors Crossing Inc. DBA Timberville
& Journey’s Crossing
Helen H. Thomas
Blenda Schultz
Cynthia G. Carpenter
Janet Allen, Janice Toman and Susan
Collins
Randall Nutter
Rossevelt and Mary Rowe
Gloria Short
June B. Harrison-Short
James M. Shreckhise
Audrey L. Shreckhise
Patsy A. Shull
Peggy H. Huffer
Billy G. Sigler
Beatrice S. Richcreek
Bonnie Swartz Skelton
Robert B. Jr. and Jeanne S. Minnich
Terry Spitzer
Patricia A. Spitzer
Frank Steeber
Kenneth L. and Virginia J. Steeber
James O. Stepp
Janet S. Stepp
Dan Stickley
Barbara K. Stickley
Wayne A. Strawderman
Esther J. Strawderman
Edward L. Strickler
Lynn D. Boyter
Bob and Karen Martin
Robert and Evelyn Stultz
Rodney and Ruth Stultz
Ardath Sutherland
Fred G. Sutherland
Sue and Willie Swadley
Pamela S. Waggy
Robert Richard Taylor
Cerner Corporation, Quantitative
Research and Biostatistics
Emma Tibbals, mother
Virginia Wamsley
Charles Trexler
Mary V. Trexler
Donald Turner
George W. and Kathryn Land
Irvin W. Tusing
Wilta Tusing Reedy
Anne H. Vance
William P. and Suzanne N. Vance
Willis Whetzel
Janet E. Whetzel
Earnest B. Whitelaw
Ruby Hartman Whitelaw
Edwin E. Will
Anna Mae Will
Juanita F. Wilkins
Linda M. Crist
John “Yogi” Wolfe Jr.
Jay L. Campbell
Janice Simmers Rhodes
Marie S. Yancey
Donald A. and Eva W. Good
Betty M. Hedrick
Charles E. and Donna D. Hores
Timberville Church of the Brethren
Melvin C. Yoder
Douglas H. and Martha B. Shank
Kenneth H. Zeh
Kenneth L. and Virginia J. Steeber
Honor Gifts
All the Nurses and Doctors on 3 West
Sterling E. and Foelke D. Nair
Erma Allen, my Mom
John S. and Jo Anne Hensley
Teresa B. Anders
Keith VanBenschoten
C. Dennis Armentrout
Dewitt R. and Janet A. Cooley
Dr. Robert J. Audet Jr. of Balint Pain
Management Center
Leonard J. and Carol J. Kosup
Sherry Jo Boyer
Polly Frye
Joseph Brisco Dellinger
J. Brisco and Janet Dellinger
Charles “Chuck” Eayres
Barbara J. Lester
Laura Q. Ferdinand
Joan Quass
Lorna Fusano, mother-in-law
Virginia Wamsley
Kay Harrison and Grant Bodkin Wedding
Cynthia Mohr
Susi Underhill
George and Carrie Willetts
Leona K. Hill and Beverly Rader
C. David Hill
James B. Hoover
Chase Investment Counsel Corporation
Debbie Kimble
George W. and Kathryn Land
Leroy and Juanita Kiser 50th Wedding
Anniversary
William G. and Hope Shank Stoner
Dr. Shawn M. Lepley
Susan Jane Berry
Dr. David P. McLaughlin
Sterling E. and Foelke D. Nair
Linda Myers
Phyllis A. Showalter
Dr. Thomas R. Oates
Mr. and Mrs. William L. Heavner
Everett Parks, our first grandson
Edward C. and Carol L. Parks
Dr. Stewart G. Pollock
Thomas C. and Karen S. Huffman
Dr. Heidi D. Rafferty
Regina A. King
Erma Swearingen, sister
Virginia Wamsley
Catherine B. Thomas
William F. and Rebecca T. May
Dr. Christine M. Urbanski
Roberta (Robbie) and Robert K. Wilkins
Dr. Duane S. White
Mary J. Purdie
Dr. Paul R. Yoder Jr.
Daryl D. Gum
Karen Zirk
Roy E. Jr. and Carolyn M. Zirk
Jodi Marie Gooden
Bobby W. Gooden II
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
63
Jim Bishop
A BLANKET STATEMENT ON
A
s a toddler, I often carried
around a sprig of evergreen. I
don’t know why; neither did
my parents. But it’s even documented
in a scratchy 8-millimeter home movie.
Both our daughters, Jenny and
Sara, had their cherished chattels as
youngsters. Jenny extracted threads
from a knitted coverlet on her bed and
routinely applied a “fuzzy” ring around
her pacifier to aid in going to sleep.
Sounds delectable, doesn’t it?
Sara clung to a small quilt similar
to the ratty, shredded blanket of Linus
of Peanuts comic book fame. These
objects, carried everywhere, helped
provide a sense of security, whether in
surroundings perceived as friendly or
hostile.
The need for security blankets
doesn’t appear to lessen as we move
through various life stages. We all
desire them, collect them and cling to
Security
them, items both concrete and abstract.
They help keep us from becoming
unraveled, especially if we sense our
lives becoming stretched unduly or
becoming threadbare.
There’s nothing wrong with adults
clinging to a “blankie,” I believe, unless
it becomes a way of avoiding our
responsibilities or something to hide
behind.
What are my security blankets?
Keeping a regular schedule, even
three years into retirement, that still
allows for flexibility and serendipitous
moments; hearing the clock radio
come on at 6:30 a.m. and air personalities Jim, Karl, Frank and Jennifer serving up the news and weather reports
interspersed with lighthearted banter;
imbibing that first cup of steaming hot
coffee while perusing the local newspaper; slipping on headphones and
getting lost in my music collection;
receiving words of affirmation; having
a few dollars tucked away for that
“emergency” situation; and receiving
love and support from immediate and
extended families.
Are there security blankets that
ultimately make us less secure? For
starters, how about materialism, militarism and nuclear proliferation? To
what extent do I wrap myself in these?
And when did I last rid myself of
a security blanket that largely served to
keep others from seeing who I really am?
The best security blankets are
those that I’m able to share with those
around me: words of encouragement
and comfort, a helping hand, maybe a
financial gift to someone facing unexpected expenses, a Scripture or inspirational reading that gives personal
insight into a problem or issue.
And rising above all else—and
making these other efforts possible—is
steadfast faith in my Creator God,
who promised, “Never will I leave you,
never will I forsake you” (Heb. 13:5,
NIV).
Whatever our age and circumstance, let’s wrap ourselves in security
blankets that warm us up to contribute
to the making of better, more caring
communities, locally and globally.
That about covers it. ■
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 [email protected].
●
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