UVA Health System Blog

Donna Markey, RN, MSN, ACNP-CS, is a nurse practitioner at UVA’s Hope Cancer Care Augusta in Fishersville, where she teaches patients about the chemotherapy process, tests and other aspects of their condition, writes prescriptions and helps patients manage side effects and symptoms. She enjoys the opportunity the job gives her to spend time with her patients and explain often-difficult topics.

“It meant the world to me to have them take care of me,” UVA nurse practitioner Donna Markey says of her coworkers. (Photo courtesy of Karen Pape)

But on April 18, 2012, Markey became a patient herself when she felt a lump under her right arm. “I knew immediately I was in trouble,” she says. She went to work and told her coworkers. She had an ultrasound and a biopsy that day, and two days later was diagnosed with stage 2 breast cancer. Chemotherapy started about a week later.

Markey’s oncologist was Maya Ghaemmaghami, MD, who works with her. “It was natural for me to get care from the people I know best and who I know and trust,” says Markey, who’s worked at Hope Augusta since 2009. “It was natural for me to seek their guidance and support and go where I was the most comfortable.”

And she didn’t really have a choice. “They would’ve been mad at me if I went somewhere else,” she laughs.

Breast Cancer Treatment

Over the nine months following her diagnosis, Markey’s cancer was treated with chemotherapy, surgery and radiation.

Chemotherapy

The first step was chemotherapy: Six treatments, three weeks apart, each for 6 ½ hours. Markey took off the Fridays she had chemotherapy and came to work late the following Mondays. A flexible work schedule allowed her the time to recover from the chemo. “They were happy to adjust my hours for me. I was tired. By the end of 18 weeks, you’re exhausted.”

Markey chose to get chemotherapy at Hope Cancer Care Charlottesville. “I didn’t have to get chemotherapy sitting next to one of my own patients or with the staff who I work with every day.

“I just figured it was stressful enough for them. When I was first diagnosed and I went around telling everybody, they were devastated. I love them and they love me and I just knew how hard that was going to be for them potentially if I had a problem or I got sick.” She still got her blood work and other tests at work.

Mastectomies, Breast Reconstruction

Markey had surgery in October 2012 — bilateral mastectomies with immediate breast reconstruction. While she thought she only had cancer in one breast, doctors discovered it in both breasts during surgery (her type of cancer, lobular, doesn’t show up well on a mammogram). One month later, she had lymph node surgery.

Radiation Treatment

After the surgeries, Markey went back to work in early December and started 5½ weeks of radiation therapy the following week. Her radiation treatments were five days a week at the Moser Radiation Therapy Center in Ivy and lasted about 15 minutes each.

Side Effects of Cancer Treatment

Cancer treatment takes its toll on a patient’s body and Markey was no different. Toward the end of her chemotherapy treatment, she experienced nausea, hair loss, digestive problems and swollen feet. “It was August. It was hot and my feet were swollen. By the end of the day I could barely stand to walk on them anymore.”

The chemo also left her with sore feet, which was tough because she spends a lot of time on her feet at work. Radiation therapy came with its own side effects. Seven days after it was over, her skin blistered and peeled and she had second-degree burns under her arm. “That was pretty painful,” she admits.

Continuing to work while experiencing those symptoms couldn’t have been easy, but, as Markey herself says: “I am pretty tough.”

And today, thankfully, most of her symptoms are gone.

“I feel good. I have stiffness and there’s a lot of scar tissue [from surgery]. You constantly have to stretch to keep things loose and keep being able to move. But my skin has healed from the radiation already and my energy is good.”

Donna Markey, RN, MSN, ACNP-CS, is a nurse practitioner at UVA’s Hope Cancer Care Augusta. In April 2012, she became a patient when she felt a lump under her right arm. (Photo courtesy of Karen Pape)

Cancer Free

The surgery removed Markey’s cancer, and the radiation and chemotherapy treatments were intended to prevent a future occurrence. She’s cancer free now. “And we hope that I stay that way,” she says.

Taking Control with Alternative Therapies

While it’s clear that Markey is naturally a tough woman, she also credits part of her ability to withstand her cancer treatment and those side effects to complementary and alternative therapies she says helped give her good energy and support her immune system.

“I think that’s why I’ve done as well as I’ve done. People look at me and they can’t believe I’ve been through the last nine months. I think that had a big part.”

Dietary Changes

Markey changed her diet significantly, changes she intends to stick with:

• She stopped eating most dairy, except yogurt.
• She gave up sugar.
• She limited animal protein and fat.

She also ate a lot of fruits and vegetables and juiced when she couldn’t eat solid foods due to nausea.

Exercise

Markey did Pilates before her diagnosis and continued to do so during her treatment. She’s also incorporated yoga into her exercise regime.

Acupuncture

Markey also used acupuncture to help deal with nausea and give herself more energy.

Massage

Her husband, Kevin, had a massage therapist come to their Crozet home the night before each chemotherapy appointment for a full-body massage. “That was amazing and it just helped me relax and be calm and peaceful about the whole thing.”

Markey encourages her patients to try these alternative therapies. “If they don’t think of it, I recommend it. More and more patients ask about those kinds of things, and they’re all very interested in my experience.”

Caring Coworkers

In addition to the flexible work schedule Markey had during her illness, her coworkers helped in other ways. “Everybody picked up the slack for me.” Markey notes that the other nurse practitioner in her office, Kathleen Haden, RN, MSN, ANP-C, took on a lot of her work, as did doctors at the practice. “They just made it happen.”

And her coworkers helped her outside the office, too. They offered to cook for her, but she didn’t want that because of her dietary changes, so she mentioned she’d like to have someone weed her garden. “In one afternoon, they completely weeded and mulched my entire yard. It was amazing,” she says, tears welling in her eyes.

And when she arrived home from the hospital after her surgery, she was greeted by a lovely surprise. “They had decorated my front porch for Halloween with pumpkins and mums. Just really sweet things. I have awesome coworkers.”

Connecting with Her Patients, Facing Cancer

Markey’s experience has given her a new perspective when it comes to working with her patients, many of whom have sent her cards or letters.

“I don’t think I had a problem with credibility before, but when they understand that you understand what they’ve been through, they listen to you differently. It has a different impact on them.”

She hopes to work on survivorship issues, especially looking at how to best help patients after their treatment is complete. “You are on a treadmill for nine months. When the treadmill stops, you say, ‘What now?’ Obviously I have a lot of insight into that, but the general patient doesn’t. My hope for the future is to be able to continue to share that information and help patients as they face their cancer.”

Do you know a cancer survivor with a story to tell? We’d love to hear it! Share with us below.

Every July, the UVA volunteers who spend 30 hours providing free healthcare in southwest Virginia leave with many stories, some tragic, some uplifting. Emergency room nurse Tim Cunningham has turned those stories into a powerful one-man play.

Cunningham, according to a University of Virginia story, “conducted intimate, anonymous, one-on-one interviews with more than 30 patients” at the 2009 Remote Area Medical (RAM) clinic in Wise County. He used those interviews to create 11 characters that he portrays in his play, “Out of Their Way.”

I’ve volunteered at RAM for three years and saw Cunningham’s play just before last year’s clinic. It was often poignant, sometimes funny, and I don’t think I was the only one tearing up at the end. This is well worth the 85 minutes out of your day.

Want to go?

The play is Thursday, April 19 at 4 p.m. in McLeod Hall Auditorium. (Driving? You can park in the Central Grounds Parking Garage or at the Corner; the McLeod garage is permit-only until 5 p.m.) It’s free and open to everyone.

Read More about the Remote Area Medical Clinic

We’ve got photos, volunteer stories and more from the 2011 clinic.

When Rebecca Lewis began her nursing career in the 1960s, intensive care units were long and narrow, with curtains between beds. “More ward-like,” she says.

Hospitals have come a long way since then.

Our 72 new private patient rooms have large windows to let in lots of light. The green, blue and umber shades of the walls reflect nature themes.

Lewis, who is now a facilities planning administrator and clinical liaison at UVA, says the new rooms and units are designed to:

• Accommodate family members
• Promote privacy
• Reduce noise
• Prevent and stop infections

All these features ultimately promote faster healing and help our staff do their jobs.

Quiet Environments for Patients and Staff

Monitors beep. Phones ring. Staff scurry back and forth. People talk. Patients need rest, but hospitals aren’t always the quietest places.

A University of Chicago study found that noise in hospital rooms was higher than World Health Organization recommendations and could sometimes spike to twice the recommended level. (more…)

After a year filled with personal bests, Louise Knudson didn’t have a great race at the Olympic Trials Marathon Saturday.

Olympic Trials Marathon Runner Louise Knudson

Knudson, an RN who works with patients recovering from heart and lung surgery, placed 114 out of the 152 runners who completed the marathon in Houston. Her time was 2 hours and 49 minutes, 14 minutes slower than the personal best she hoped to achieve.

Knudson said she started strong but never fell into a good rhythm, partly because she came down with stomach cramps a few miles into the race. “It just turned out to not be my day,” she said.

Still, she had a great time in Houston and enjoyed running with the country’s top female athletes. “I was really glad to be a part of the trials,” she says. “It was something I wasn’t expecting.”

Knudson, 26, started running seriously only a few years ago. She plans to take some time to recover from this marathon and then begin focusing on track racing and her short distance times.

She has something else to look forward to: she was accepted into Virginia Commonwealth University’s nurse anesthesia graduate program. She’ll start in the fall and work towards a master’s degree in nurse anesthesia practice.

And she hopes to be back at the Trials in four years.

“I try to set my goals high,” she says. “This time it didn’t work out, but I’ll have to try again.”

We’re proud of Knudson and wish her the best of luck!

Read More

Did you miss our two previous posts about Knudson and UVA’s Center for Endurance Sport? Get the background story:

• UVA Nurse, Marathoner Has a Shot at the Olympics
• UVA’s Running Resources Helped Olympic Trials Contender

At this point, there’s not much Louise Knudson can do besides stretch and rest.

Olympic Trials Marathon Runner Louise Knudson

Knudson, a 26-year-old UVA nurse, is running in the U.S. Olympic Trials marathon Saturday in Houston. We shared her story last year, after she qualified for the trials at the Boston Marathon.

Knudson is competing against 196 other women Saturday. She’ll have to finish in the top three to make the U.S. Olympic team.

When we talked to Louise in July, she wanted to increase her training mileage from 85 to 100 miles per week. She hoped to get her marathon time down from 2 hours and 42 minutes to a more competitive 2:30, a time she hoped would give her a good shot at competing with the country’s top female runners.

Now, she realizes that was too ambitious.

“My plan was to build my mileage up higher than it had ever been and do some shorter races to see how it goes,” she says. “Well, I got my mileage up to 100. The week after that, I sprained my foot.”

That was in early August. In a way, it was good timing. She’d planned to take a month off running beginning in September. Instead, she cross-trained for five weeks by running in the pool, which reduces stress on the joints and feet. After that, she rested for three weeks.

“It always drives you crazy to rest, but in every case I’ve seen, people who rest after an injury gain their fitness back very easily,” she says. (more…)

Darcy Alimenti spent much of her teen years watching her mother and brother fight cancer.

Darcy Alimenti (left) helps a visitor during her volunteer shift in UVA's emergency room.

First, her older brother was diagnosed with leukemia during her freshman year of high school.

She visited him when he stayed overnight at UVA Children’s Hospital, accompanied him on clinic visits, watched him get spinal taps and learned to change his dressings at home.

While he was still undergoing treatment, her mother developed leiomyosarcoma, a rare soft tissue cancer.

A Passion for Nursing

While Alimenti’s brother was getting cancer treatment, a nurse mentioned UVA’s junior volunteer summer program. Alimenti signed up.

Junior volunteers work in UVA’s gift shop, escort guests to their destinations, deliver flowers and mail and ensure patients are comfortable. They’re required to volunteer weekly, but Alimenti went in twice a week, eventually racking up 350 hours over three summers.

“I absolutely loved it,” she recalls. “I loved being with patients, being able to give back to this hospital that had been keeping my brother alive.”

She realized she enjoyed interacting with patients more than anything.

“I definitely developed this passion for nursing.”

Standout Applicant

UVA Cancer Center volunteer Sara Templeman worked with Alimenti once and was impressed. “Darcy just knew the whole thing,” she says. “She saw what was needed and would take care of it without any direction. She was also very good with the patients, stopping to talk with them.”

Templeman is a member of the Hospital Auxiliary, a group of employees and volunteers. The auxiliary awards its annual Dawson Junior Volunteer Scholarship to an exceptional junior volunteer who has been accepted or is enrolled in a health care degree program.

During the 2009-2010 school year, Alimenti’s senior year at Monticello High School, she was accepted into the UVA School of Nursing and applied for the scholarship.

Her many hours of hospital volunteering stood out, but so did her high grades and contributions to other organizations. Alimenti also volunteered for the American Red Cross and at a local family health provider and helped organize fundraisers for cancer research.

The long list of accomplishments made Alimenti the obvious choice for the $2,500 scholarship.

More surprising, though, is that she got it again in 2011, after continuing her hospital volunteer work and being named to UVA’s Dean’s List.

“It’s certainly unusual to give the scholarship two years in a row, but Darcy really stood out,” Templeman says. “She’s volunteered all over the hospital, practically every area you can think of. She’s done it all cheerfully and with a smile on her face.”

Alimenti now volunteers weekly through Madison House, UVA’s student volunteer organization. She’s currently volunteering in the emergency room, helping patients and their families. That work is more stressful, she says, but she’s never forgotten how it felt to be there with a patient.

Want to Volunteer?

Hospital volunteers can work directly with patients or help behind the scenes. Learn more about the Junior Volunteers program and other volunteer opportunities at the hospital.

240 UVA employees, nursing and medical students are volunteering at the Remote Area Medical clinic in Wise, Va., this week. We’re talking to some of them and sharing their stories. Betty Jenkins is a registered nurse in the operating room at Culpeper Regional Hospital, UVA’s partner hospital.

What have you been doing today?

I’ve worked in the dental area taking care of patients. I make sure that their blood pressures and blood sugars are in a good range before they have oral surgery, mostly extractions.

What treatments can dental patients get at RAM?

Many patients are getting cleanings and fillings or restorations. This area is extractions and oral surgery.

I think the patients have gotten really good care, even though the event is all run by volunteers. Every practitioner that’s here really wants to be here, and I think they get a lot of fulfillment out of it. They strive to give really good care.

Do you have any patient stories you can share?

I was really touched by this lady who took the time to tell me how much she appreciated this service and the volunteers. She wasn’t the only person, but she took her time to stop in the midst of things and say how much she appreciated it. It was very touching.

240 UVA employees, nursing and medical students are volunteering at the Remote Area Medical clinic in Wise, Va., this week. We’re talking to some of them and sharing their stories. Ellen Shields is a registered nurse at UVA. We caught up with her around 1 p.m. today.

What is your job at RAM?

I’m the leader of the blue team. We see endocrinology patients, including people with diabetes, and other people with high cholesterol and hypertension. We have a diabetes coordinator, patient educator and a social worker. There are 20, maybe 22 of us altogether, between the medical students and the nursing students, all the helpers.

What’s your job like as the leader?

Part of my role is keeping the flow going. I make sure every patient that comes in gets assigned a doctor or medical student. We put them into a room and make them comfortable. I’m making sure that the flow continues, and we keep moving because we have so many patients.

How’s today been going so far?

We’ve been busy. Really busy.

Were there any patients who stood out to you?

We already sent two patients to the emergency tent as they came in. Their symptoms required that. And there are just a lot of really nice people here who are trying to get some assistance.

Knudson running in the 2011 Boston Marathon, where she qualified for the Olympic Trials.

In the final stretch of the 2011 Boston Marathon, Louise Knudson thought she must be reading the clock wrong.

She had to run the 26.2 miles in 2 hours and 46 minutes to qualify for the Olympic trials, and the clock seemed to show that her time was 2:42. But her personal best was 2:47, and the season had been rough so far.

“I thought, maybe it actually says 2:47,” the 25-year-old recalls. “But as I got closer, I saw that it was 2:42. I just couldn’t believe it. It was the greatest day ever.”

Knudson’s success in the Boston Marathon means that she’ll go to the Olympic Trials in Houston in January for a shot on the 2012 U.S. Olympic team.

Only three people will make the team, so her odds are slim. But she’s beaten the odds before.

Learning from the Best

Knudson ran cross country for two years in high school but quit after graduation because she didn’t think she could make her college team. But she continued running on her own and entered two marathons.

“I just love running,” she said. “I started running in high school because it made me feel good. I was dealing with a lot of emotional stress and it was my relief. It was the one thing I could do for me, that was mine.”

Even though she had no coach and knew nothing about training, her time improved. And she wanted to keep running marathons. (more…)

Jacque Griffin, RN

A 51-year-old man boards a plane with his wife for a well-deserved vacation. One hour later, his wife is yelling for a doctor. Miraculously, a trained nurse comes to the rescue and resuscitates the man to the cheers of passengers.

Sounds perfect for the big screen or a soap opera, right?

Only this time, it’s not made for the movies. It’s real, and Jacque Griffin, RN, director of Clinical Operations at UVA’s Transitional Care Hospital, is the humble heroine.

“I did what anyone else would do, and I am so grateful that I was there,” she said.

“I have to say, the experience really is nothing like what you would think it’s like. The space is very small. No one knows how to help you. It was hard. It was really hard,” said Griffin.

(more…)