Bloom Spring 2018

MANAGE YOUR MIGRAINES | METABOLISM BOOSTERS | INCONTINENCE SOLUTIONS

Penrose-St. Francis Health Services

Nurturing women’s health in Colorado Springs

PERSONALLY

TAILORED CANCER CARE New advances in treatments give women customized choices

ADVANCE

DIRECTIVES Put a plan in place Page 9

SPRING 2018 Volume 8, Issue 2

HealthyStart

GONE IN A FLASH

WHEN ESTROGEN STARTS TO DIMINISH, A HOST OF SYMPTOMS CAN APPEAR

Dr. Meredith Cassidy

GET IT CHECKED:

If you are experiencing excessive or frequent bleeding — at any age — talk to your doctor. It is not a normal symptom of perimenopause and can signal something serious, such as a thyroid issue, fibroids, or cancer.

Perimenopause is a pretty-sounding name for the time, usually in her mid-40s, when a woman’s estrogen production slows as menopause approaches. Perimenopause can produce some notso-pretty symptoms. St. Francis Medical Center OB/GYN Meredith Cassidy, MD, reviews some common symptoms and treatments.

Night sweats and hot flashes. “Nobody knows what triggers them,” Cassidy says. Certain foods, like cheese and red wine, can exacerbate them. There is no hot flash cure, but Cassidy recommends: • Ice packs • Lowering bedroom temperature • Exercise • Fans • Antidepression medication Some women swear by natural remedies, like black cohosh and ginseng. Cassidy cautions that no studies confirm this, and no studies have determined if they are safe long term.

Weight gain. Hormonal changes may expand your abdomen and hips. To fight it, move more, eat less, and limit alcohol and sweets.

Vaginal dryness. If you’re not comfortable with hormone replacement therapy, Cassidy suggests vaginal estrogen creams, which don’t put as much estrogen into the bloodstream.

Mood swings, depression. Sleep disturbances are partly to blame, but greater stress, or negative feelings about aging, play a role. “It’s complex,” Cassidy says. She suggests plenty of sleep and exercise. Antidepression medications can help, if needed.

Fatigue. A hormone roller coaster can be exhausting. The best solution, Cassidy says, is sleep.

Estrogen therapy relieves many symptoms but carries risks, including increased risk of breast cancer and stroke, and many women aren’t comfortable taking hormones. Bottom line, Cassidy says: Discuss concerns and symptoms with your doctor.

High blood pressure and high cholesterol are leading causes Dr. Paul Sherry of heart attacks in women. After menopause, blood pressure, bad cholesterol (LDL), and triglycerides usually increase, while good cholesterol (HDL) may decrease or stay the same.

“These changes put women at higher risk of heart attacks.

It’s important to see your doctor regularly and have your blood pressure and cholesterol checked,” says Paul Sherry, MD, a cardiologist with Colorado Springs Cardiology, A Centura Health Clinic. Sherry recommends having your blood pressure checked every year and starting at age 40, having your cholesterol checked every three years.

Doctors think a drop in estrogen contributes to changes in blood pressure and cholesterol after menopause. Weight gain also may contribute to these changes. Some types of hormone therapy may increase blood pressure.

To locate an OB/GYN near you, visit penrosestfrancis.org and click on “Find A Provider.”

bloom is published four times annually by Penrose-St. Francis Health Services. Executive editor is Jill Woodford. As part of Centura Health, our mission is to nurture the health of the people in our community. The information herein is meant to complement and not replace advice provided by a licensed health care professional. For comments or to unsubscribe to this publication, please email us at bloom@centura.org. bloom is produced by Clementine Healthcare Marketing.

A heart calcium scan can help you prevent a heart attack. Learn more at penrosestfrancis.org/heart or call 719-776-8010 to schedule a $149 heart scan.

2222 North Nevada Avenue, Colorado Springs, CO 80907

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HOW BAD IS IT ...

NOT TO CHECK YOUR BLOOD PRESSURE AND CHOLESTEROL AFTER MENOPAUSE?

FOR THE MAN IN YOUR LIFE

NEW TECHNIQUES OFFER WORRYFREE PAIN RELIEF

I

KNOW YOUR TYPE: Colorado recently passed a law requiring doctors to inform women after a mammogram if they have dense

breasts. But what does it mean to have dense breasts — and what type of screening should you have? Here’s how radiologists classify breast density and potential next steps: Category

% of women affected

Screening type

1. Almost entirely fatty

10%

Mammogram

2. Scattered areas of fibroglandular density

40%

Mammogram

3. Heterogeneously dense

40%

Mammogram; breast MRI

4. Extremely dense

10%

Mammogram; breast MRI

A mammogram is likely all you’ll need for the first two categories, says Toni GreenCheatwood, DO, a breast surgeon and director of breast oncology at the Penrose Cancer Center.

“The best way to assess dense breast tissue is to look at the person’s total risk,” she says. “I recommend having a conversation with your care provider to discuss other risk factors that, when added to the density factor, may mean additional imaging would be Dr. Toni Green-Cheatwood recommended.” Other factors could include family history and personal menstruation and birth history.

Dense breasts, which have nothing to do with size, only can be diagnosed by a physician. About half of all women over age 40 have dense breasts.

Schedule your screening mammogram at the Center for Women’s Imaging by calling 719-776-8010. Plus, you may qualify to participate in an important breast cancer screening study called TMIST. Learn more at penrosestfrancis.org/breastcare.

WALK YOUR WAY TO A GOOD MOOD

Dr. Meagan Jones

penrosestfrancis.org

Did you know that walking is good for your mood, as well as your body?

“Walking increases endorphins, feel-good chemicals in the brain. It gives your mind a break, and helps you release stress and sleep better,” says Meagan Jones, DO, a primary care doctor at CHPG Penrose-St. Francis Primary Care. Jones recommends walking 15 to 30 minutes every day. Walking in a park or any other natural setting is most relaxing, but walking on city streets or indoors works, too.

f the man in your life is looking at a joint replacement sometime in his future, there are now options to avoid using opioids. Centura Dr. Michael Feign Orthopedics surgeon Michael Feign, DO, utilizes techniques to provide alternatives to using habit-forming pain medications.

“One of the biggest changes in my practice is how we work with anesthesia,” Feign says. He and his surgery team combine general anesthesia with analgesic pain blocks that minimize numbing during surgery. The combination allows patients to walk sooner, and that promotes faster healing, he says.

In addition, the surgical team inserts a catheter containing nerve-blocking medication, which patients use the first days after surgery, when pain usually is most severe. When the catheter is removed, the pain has lessened, and with it, the need for opioids, Feign says.

“If we can get patients through the first bad pain, they won’t have to rely on opioids as much.”

To schedule an appointment with Centura Orthopedics, call 719-776-7846.

Walk outside when the sun is shining for an extra mood boost.

Walk with a Doc: Join CHPG Primary Care physicians for a morning walk and a chance to ask health questions. See Page 11 for upcoming dates and times or visit penrosestfrancis.org/events.

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ONE SIZE DOES NOT FIT ALL

CANCER CARE MORE WOMEN WITH BREAST, LUNG, OR COLORECTAL CANCER ARE LIVING LONGER, THANKS TO CUSTOMIZED CARE

“One size fits all” used to be the approach to treating most breast, lung, and colorectal cancers in women. Today, a better understanding of these cancers and new technology enable doctors to provide more personalized, more effective, and less toxic treatment.

MORE ACCURATE CANCER STAGING Doctors use the cancer’s stage — how much cancer there is and whether it has spread to other parts of the body — to plan the best treatment. In the past, staging was based on the anatomy, or structure, of the tumor. Under new staging Dr. M. Carmen Matei guidelines from the American Joint Committee on Cancer, doctors now also consider the chance of recovery or recurrence (the prognosis).

This information comes from genetic and tumor tests, including tumor profiling, done using blood and biopsy samples.

The new guidelines are especially important in breast cancer, says M. Carmen Matei, MD, a medical oncologist/hematologist at Rocky Mountain Cancer Centers. “We’ll be able to treat breast cancer more effectively, often with less toxicity,” she says.

PERSONALIZED TREATMENT WORKS BETTER Personalized or precision medicine uses genetic and tumor information to customize treatment for each patient. “We use a multipronged approach to determine what’s going to Dr. Maurice Markus be the most appropriate treatment plan for each patient,” says Maurice Markus, MD, PhD, a medical oncologist/ hematologist also at Rocky Mountain Cancer Centers.

Genetic and tumor information guides doctors in using two newer types of cancer treatment: • Targeted therapy attacks specific genes or proteins to stop cancer from growing and spreading.

• Immunotherapy boosts the body’s natural defenses to fight cancer.

Many targeted therapy and immunotherapy drugs are available. Dozens more are being developed, and combinations of targeted therapy and immunotherapy also are being tested. “Early results from clinical studies show that combining targeted therapy and immunotherapy works better than using either alone, without excessive toxicity,” Markus says.

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GETS PERSONAL TOP

4 WAYS TO PREVENT CANCER

Be overweing obese ight or twice a causes s cancer many women s in as men. in

About four out of every 10 cancers and deaths from cancer can be prevented, says a 2017 study by the American Cancer Society. Excess body weight, drinking alcohol, and physical inactivity topped the list of lifestyle choices that contribute to breast, colorectal, and other cancers. All of these lifestyle choices are modifiable risk factors that were more common in women than in men. For lung cancer, smoking was the leading modifiable risk factor.

penrosestfrancis.org

CANCERS LINKED TO LIFESTYLE CHOICES (PERCENT OF CANCERS ATTRIBUTED TO LIFESTYLE FACTOR)

Excess body weight

Drinking alcohol

Physical inactivity

Smoking

BREAST CANCER (WOMEN ONLY)

LUNG CANCER

COLORECTAL CANCER

11.3%

0%

(women and men)

6.4%

0%

8.1%

3.9%

0% 16.3%

0%

5.2%

(women)

(women and men)

Nearly

82%

0% Spring 2018

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Here are three examples of how these treatments are being used: • Immunotherapy for breast cancer: Two out of three breast cancers are classified as hormone receptor-positive. These cancer cells have receptors that attach to estrogen or progesterone to fuel cancer cell growth.

In women with hormone receptor-positive breast cancer that has spread to other parts of the body, a type of immunotherapy called CDK4/6 inhibitors increases the effectiveness of hormone therapy like tamoxifen. “This is a huge advance that slows the progression of metastatic cancer,” Matei says.

• Targeted therapy for breast cancer: One in five breast cancers are a type called HER2positive. HER2 is a growth-promoting protein on the outside of all breast cells.

HER2-positive cancer cells have higherthan-normal levels of this protein, which leads these cancers to grow and spread faster. Doctors now can use drugs that attach to the HER2, blocking the cancer cells’ ability to receive growth signals.

• Immunotherapy for lung and colorectal cancers: Some types of lung and colorectal cancers are made up of cells that have an overabundance of a molecule called PD-1 or PD-L1. These molecules disguise cancer cells so that the immune system doesn’t recognize and destroy them. Immunotherapy drugs can block the mechanism these cells use to hide, allowing the immune system to go to work. Immunotherapy drugs like these are being used for stage 3 lung cancer tumors that can’t be removed surgically and for colorectal cancers that continue to grow after chemotherapy.

Continued from Page 5

SCREENING GUIDELINES FROM THE AMERICAN CANCER SOCIETY

30+ 40+ 50+ WOMEN AGE

WOMEN AGE

WOMEN AT HIGH RISK OF BREAST CANCER Start annual mammogram and MRI

BREAST CANCER

COLORECTAL CANCER

AGE 40-44 Annual mammogram is optional AGE 45+ Annual mammogram

If you’re at increased risk, talk to your doctor about when to start screening

WOMEN AGE

GET SCREENED

AGE 50-54 Annual mammogram

Screening Mammogram Center for Women’s Imaging, 2312 North Nevada Avenue Appointment scheduling: 719-776-8010, option 2.

Ask about our $99 mammography special May 1-31.

AGE 55+ Mammogram every 1 or 2 years Colonoscopy every 10 years OR Virtual colonoscopy (CT scan) every 5 years OR Blood tests using the stool (if you won’t have colonoscopy), usually every year SMOKERS AND PAST SMOKERS AGE 55+ Annual low-dose CT lung scan

LUNG CANCER

5

CANCER IN WOMEN BY THE NUMBERS BREAST CANCER

LUNG CANCER

COLORECTAL CANCER

#1

#2

#3

most common*

most common

most common

#2

#1

#3

most deadly

most deadly

most deadly

Average age at diagnosis

Average age at diagnosis

Average age at diagnosis

62

70

72

Oral, Head, and Neck Cancer Screening A FREE painless and noninvasive 5- to 10-minute exam of the mouth, head, and neck area. Limited appointments available. Wednesday, April 25, 4-6 p.m. at the Penrose Cancer Center. To register, call 719-776-5548 or visit tinyurl.com/ pccheadandneckscreening.

Skin Cancer Screening A FREE screening of skin areas of concern with a referral to your primary care provider if needed.

Saturday, May 5, 8-10:30 a.m.

To register, call 719-444-CARE, option 3, or visit tinyurl.com/ skincancerscreening.

Penrose Cancer Center offers classes and support groups regardless of where you receive cancer care. For info on classes and dates, go to penrosestfrancis.org/ events.

* After skin cancer

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& QA BENJAMIN COLE, MD Family Medicine Physician CHPG Primary Care Powers 6080 North Carefree Circle Colorado Springs, CO 80922 719-571-1088

Q: WHO GETS MIGRAINES? A: Up to 25 percent of women and men will

have migraines at some point in their lives, but migraines are three times more common in women. We don’t know why. Women can get migraines anytime from before puberty to after menopause.

Q: HOW ARE MIGRAINES

DIFFERENT FROM REGULAR HEADACHES?

A: Migraines are intense headaches that cause pounding, throbbing pain, and last four to 72 hours. Most people need to lie down in a dark room during a migraine, which increases sensitivity to light and sound. About one-third of people with migraines experience an aura first: visual abnormalities, or changes in taste, touch, or smell. Irritability and fatigue are also pre-migraine symptoms.

Q: CAN I PREVENT MIGRAINES? A: Some migraines can be prevented. The key

is to identify and control your triggers, which differ for each person. Triggers include stress, caffeine, red wine and other types of alcohol,

Mana Migra ge ines

r e fo Col oc on . r n D a D ge Joi with ee Pa ils.

S lk ta Wa ril 14. re de o p A or m f 11

some foods, certain medications, and some medical conditions. Keep a migraine journal and record what you did and ate, any medications you took, and anything else that was different the day of a migraine. You and your doctor will be able to connect the dots and find your triggers.

Reducing stress, a common trigger, helps prevent migraines. Exercise, meditation, deep breathing exercises, and hobbies that are pleasurable and not frustrating all reduce stress.

Q: WHAT SHOULD I DO IF I HAVE MIGRAINES?

A: First, try over-the-counter migraine

medications, which work well for some people. Sleep helps, too. If over-the-counter medications don’t help, see your doctor.

Medications to treat and prevent migraines can be prescribed if over-the-counter medications don’t work or if you have many migraines each month that interfere with your life. Taking a migraine medication within the first 10 minutes of the migraine stops or significantly decreases symptoms, allowing you to get on with life. Preventive medications are taken regularly to prevent or reduce migraines.

BENJAMIN COLE, MD Born and raised in Florida, Benjamin Cole, MD, enjoys living in Colorado, where he can ski and snowboard with his wife, Colleen, and his two children, Alexander (age 8) and Victoria (age 6).

When not partnering with his patients to help them live healthier lives, he also enjoys mountain biking, hiking, and outdoor photography. Cole has special training in wilderness medicine.

Dr. Cole likes to develop long-term, cooperative relationships with patients.

To make an appointment with Dr. Cole, call 719-571-1088.

penrosestfrancis.org

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INDEPENDENCEHIGHWAY DON’T LET INCONTINENCE KEEP YOU FROM HITTING THE ROAD

Your kids make fun of you because you know where all the bathrooms are this side of the I-25, and your husband knows better than to try and drive anywhere “straight through.” Still, you have yet to talk to your doctor about your urinary incontinence because you think

your only options for treatment will be Kegels or diapers. Not true, says James A. Simon, MD, a urologist with Penrose-St. Francis Health Services.

“We have lots of very good options now for treating incontinence,” he says.

Once your physician determines what type of incontinence you’re dealing with — and it could be multiple types (see yellow box ) — he or she may recommend one or more treatment options.

urge incontinence Techniques such as bladder training, double voiding, and scheduled urination can help your body learn to control its urine. Your doctor also may recommend dietary changes, such as cutting back on caffeine and acidic foods.

MEDICATION ➤ GOOD FOR: stress,

3 TYPES OF INCONTINENCE

urge incontinence Prescription drugs can calm overactive bladders, and topical estrogen creams or collagen can help strengthen the urethra.

Overflow incontinence occurs when the bladder doesn’t empty completely, leading to frequent dribbling of urine.

Stress incontinence is when sneezing, coughing, laughing, lifting, or exercise causes leakage. It’s actually caused by two different issues: intrinsic sphincter deficiency, which occurs when the sphincter is weak, and urethral mobility, where the urethra drops below the pelvic floor muscles.

Urge incontinence is characterized by the frequent and sudden need to urinate even when the bladder isn’t full. It’s also referred to as “overactive bladder.”

MEDICAL DEVICES ➤ GOOD FOR: overflow,

stress incontinence A device inserted into the urethra can prevent leakage during physical activity. Pessaries can be worn all day in the vagina to help with leakage caused by bladder prolapse.

Women are twice as likely to have urinary incontinence as men, according to the Office on Women’s Health. Why? Pregnancy, childbirth, and menopause.

PELVIC FLOOR STRENGTHENING ➤ GOOD FOR: stress, urge incontinence

Kegel exercises or electrical stimulation can help strengthen the pelvic floor muscles so they’re better able to hold in urine. And even though you may think you know how to do Kegels, ask about a referral to physical therapy just to be sure — nearly half of all women do them incorrectly, which can actually worsen the situation.

SURGERY ➤ GOOD FOR: stress, urge (rarely) incontinence

If other treatments fail, your doctor may recommend surgery.

One technique involves placing a sling under the urethra, helping to keep it closed when it needs to be.

“The procedure has revolutionized female urology,” Simon says.

“I was in the room for the first sling surgery, and I’ve done over a thousand of them since.”

Colorado Sports and Spine Centers provide pelvic floor muscle training.

Talk to your doctor for a referral or call 719-571-8888.

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BEHAVIORAL TECHNIQUES ➤ GOOD FOR: overflow,

PLANNING

AHEAD

ADVANCE DIRECTIVES TAKE THE GUESSWORK OUT OF TOUGH HEALTH DECISIONS 3 THINGS TO KNOW

In Colorado, the three advance directives recognized by state law are:

✹

Medical durable power of attorney Names your health care agent, the person who will make decisions if you are unable

✹

CPR directive An indicator of your desire not to be resuscitated should your heart stop beating or you stop breathing

✹

Living will Specifies your wishes regarding artificial life support

penrosestfrancis.org

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f you’ve ever been in the hospital, you might have been asked if you had advance directives in place. Maybe you mumbled something about needing to get them done. Maybe you thought they seemed confusing, or were something that you’d one day get around to.

Rev. Roger Butts, staff chaplain for Penrose-St. Francis Health Services answers three common questions about advance directives.

Q: WHAT ARE ADVANCE DIRECTIVES? A: Advance directives assist your health care providers with medical decisions if you are

unable to make these decisions yourself. I think about them as an act of love. They make your wishes crystal clear, which alleviates the possibility of what I call “moral injury” to your loved ones. They remove the deep burden of guilt during a time of anguish and stress by giving loved ones clarity about your wishes.

Q: WHO NEEDS TO THINK ABOUT THEM AND WHEN? A: No one wants to think about end-of-life medical decisions, but everyone should. I

encourage adults of all ages to put advance directives in place.

Most people plan to wait until they are older or until “something happens.” The tricky thing about that is none of us knows what the next day will bring. We see plenty of people in the ER who never would have imagined they’d need a decision maker.

Q: WHO SHOULD BE IN ON THE DISCUSSION? A: Your loved ones — including parents, spouse, children, and close friends — should know

what your wishes are and who you have designated to make health decisions for you if you are unable to. Make sure to send copies to your primary care physician.

Colorado is a “proxy state.” This means that unless you specify a health care agent to make health decisions on your behalf, a proxy must be selected by a panel of the interested parties in your life, including family, friends, or close advisers. If they can’t agree, it goes to the courts.

To learn more, visit centura.org and search “advance directives.”

Or, attend a FREE workshop on advance directives (see Page 11).

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calendar

Spring

2018

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PROBIOTICS:

MYTHS VS. FACTS

Date | (select one) Tue, Apr 24, 4-5 p.m., CHPG Primary Care Broadmoor, 1263 Lake Plaza Drive; OR Wed, Apr 25, 11:15 a.m.-12:15 p.m., Tri-Lakes YMCA Community Room, 17230 Jackson Creek Parkway; OR Thu, Apr 26, 4-5 p.m., Penrose-St. Francis Primary Care, 3027 North Circle Drive Cost | FREE Registration | penrosestfrancis.org/events

W

hat is a probiotic? How is it different from a prebiotic? How do I add this to my diet? Learn to separate myths from facts regarding probiotic use.

BRAIN INJURY SUPPORT GROUP Date | Third Thursday of the month Time | 5:30-7 p.m.

Location | Penrose Pavilion, 2312 North Nevada Avenue, 2nd Floor Cost | FREE Registration | penrosestfrancis.org/events Education, emotional support, and opportunities for socialization and peer support to brain injury survivors, caregivers, family, and friends.

SENIOR LIVING TRANSITIONS AND STROKE RECOVERY 3RD ANNUAL STROKE AND THE ART OF LIVING: A COMMUNITY CONFERENCE FOR STROKE AND BRAIN INJURY Date | Sat, May 5 Time | 8 a.m.-12:45 p.m. (7-8 a.m. breakfast/registration) Location | Penrose Cancer Center, 2222 North Nevada Avenue, Cancer Center Conference Rooms A-C Cost | FREE Registration | penrosestfrancis.org/events or 719-776-5731 A day of professional talks on post-stroke and brain injuryrelated issues that survivors and their caregivers face. Topics this year are ALL NEW and chosen based on last year’s attendees’ feedback. Topics and activities include: how to prevent another stroke, cooking demonstration and food sampling, a tai chi segment, transforming difficult lifestyle changes into reality, and a panel discussion with community resource contacts.

Continental breakfast and snacks provided. Limited to 55 people.

SENIOR RESOURCE COUNCIL’S GOLDEN GUIDANCE SERIES Date | Saturdays, Jun 9, 16, 23, and 30 Time | 9 a.m.-1 p.m.

Location | Kaiser Permanente, 4105 Briargate Parkway Cost | FREE A four-part educational series for seniors and their caregivers on all things related to living well and enjoying the golden years. Each Saturday will focus on a different topic, such as health and wellness, senior housing options, legal/financial/insurance resources, and home care options. Informational booths, seminars, and activities provided.

Sponsored by Penrose-St. Francis Primary Care for Seniors. Learn more at srccos.org/2018golden-guidance-series.html.

Penrose-St. Francis Health Services

STEPPING ON Date | (choose one) Fridays, May 4Jun 15, 10 a.m.-Noon; OR Jun 29Aug 10, 10 a.m.-Noon Location | Penrose Pavilion, 2312 North Nevada Avenue, Conference Room B Cost | FREE Registration | Call Angela Kedroutek at 719-776-5924 or Heather Ditzler at 719-776-5098 Stepping On empowers older adults to carry out healthy behaviors that reduce the risks of falls. In a small group setting, older adults learn balance exercises and develop specific knowledge and skills to prevent falls. Older adults who should attend are those who are at risk for falling, have a fear of falling, or who have fallen one or more times. Limited to 15 participants.

ADVANCE MEDICAL PLANNING: HAVING THE CONVERSATION Date | Thu, May 10 Time | 11:30 a.m.-1 p.m.

Location | Penrose-St. Francis Primary Care for Seniors, 3027 North Circle STOP THE BLEED Date | Fri, Apr 20, 1:30-2:30 p.m. OR Drive Cost | FREE 3-4 p.m.; OR Fri, Jun 15, 1:30-2:30 Registration | Register by May 3 at p.m. OR 3-4 p.m.

Location | Penrose Pavilion, 2312 North penrosestfrancis.org/events or 719-776-5813 Nevada Avenue, Conference Rooms The best time to make decisions A&B about medical care is BEFORE you Cost | FREE or your family has a medical crisis.

Registration | Call Angela Kedroutek Advance Medical Planning allows you at 719-776-5924 or email to determine who can make medical angelakedroutek@centura.org Everyone should be prepared to respond decisions for you in the event you are not able to make them yourself. We’ll to help prevent deaths caused from blood loss. Stop the Bleed teaches basic help you understand the requirements actions to stop life-threatening bleeding. and nuances, guide you through the various advance directive forms, and Participants will learn how to use bandages, tourniquets, and pack wounds answer questions. Lunch provided with registration. to stop life-threatening bleeding.

Limited to 30 people.

PENROSE-ST. FRANCIS PRIMARY CARE FOR SENIORS PRESENTATION Date | Tuesdays, Apr 24, 10-11 a.m.; May 8, 5-6 p.m.; Jun 12, 10-11 a.m.; and Jul 10, 5-6 p.m.

Location | Penrose-St. Francis Primary Care for Seniors, 3027 North Circle Drive Cost | FREE Registration | 719-776-4650 Are you about to turn 65 and join Medicare? Learn how we are redefining senior health care. A UnitedHealthcare salesperson will be present with information and applications. For accommodations of persons with special needs at sales meetings, call 719-331-9126 (TTY: 711). Visit chpgprimarycare.org/penrose-seniors for clinic details. penrosestfrancis.org

FROM COVERAGE TO CARE: HOW TO ACCESS THE RIGHT HEALTH CARE AT THE RIGHT TIME Date | Thu, May 17 Time | 11:30 a.m.-1 p.m.

Location | Penrose-St. Francis Primary Care for Seniors, 3027 North Circle Drive Cost | FREE Registration | Register by May 10 at penrosestfrancis.org/events or 719-776-5813 When you are not feeling well, there are an increasing number of options (primary care, urgent care, freestanding emergency rooms, hospital EDs) that are available to you. They may or may NOT be your best option. This workshop will help you determine what is your best option and how you can manage your experience to get the best and safest care possible. Lunch provided with registration.

MEN’S PROSTATE HEALTH Date | Mon, Jun 18 Time | 11:30 a.m.-12:30 p.m.

Location | Tri-Lakes YMCA Community Room, 17230 Jackson Creek Parkway Cost | FREE Registration | 719-571-7039 All men, regardless of age, should be concerned about their prostate health. Find out what the men in your life need to do to promote a healthy prostate and prevent prostate problems. Open to men and women.

DIABETES EDUCATION CLASSES Date | Group classes starting monthly Location | Penrose-St. Francis Health Learning Center, 3207 North Academy Boulevard Cost | Covered by private insurance/ Medicare/Medicaid; physician referral required Information and Registration Call Jean 719-776-3611 or Judy 719-776-3634 If you have diabetes, education can help you optimize your health through a customized diet, exercise, and medication management plan.

Individual appointments and group classes are available. For information regarding the National Diabetes Prevention Program (NDPP), contact Mike at 719-776-4685.

CULTIVATING RECOVERY A FREE drug and alcohol relapse prevention group facilitated by a therapist, designed to continue accountability and treatment for those who have successfully completed a primary treatment program (inpatient or intensive outpatient). Topics are based on the needs of participants and may include self-care, support systems and relationships, coping skills, boundaries, spirituality, grief, assertiveness, communication, anger and resentment, developing joy, as well as moving forward in wellness on your recovery road. For more information, call 719-776-6850.

SILVERSNEAKERS® Location | 3030 North Circle Drive, Suite 217 Cost | FREE Eligibility | 719-776-4650 People who are 65+ and have insurance through AARP, Aetna, Anthem BlueCross/Blue Shield (HMO and HMO SNP), Humana, Kaiser Permanente, and UnitedHealthcare Information | penrosestfrancis.org/events and click on “Fitness Schedules” or call 719-776-4880 SilverSneakers is the nation’s leading fitness program designed exclusively for older active adults. Get fit the way you want, at your convenience. With this innovative program, you can take part in our strength training or SilverSneakers Classic Fit classes. Plus, we have treadmills, recumbent bikes, NuStep machines, arm ergometers, resistance bands, dumbbells, and stability balls. Paperwork and orientation required before participating.

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WALK WITH A DOC Date | Saturdays, Apr 14, CHPG Primary Care Powers, 6080 North Carefree Circle; and May 12, Fox Run Regional Park, 2110 Stella Drive (meet at the trailhead parking lot off Roller Coaster Road, just south of Baptist Road) Time | 9-10 a.m.

Cost | FREE Information I penrosestfrancis.org/ events. For weather cancellations, call 719-776-5000.

Walking is the single best thing we can do to live a long, high-quality life.

Stay active and learn something new from a Centura Health Physician Group primary care doctor during this one-hour, beginner-level walk. Wear comfortable walking shoes. Dogs must be on a leash. Look for Walk with a Doc signage.

Don’t wait until you have a heart attack.

Know your score.

NON-PROFIT ORG US POSTAGE

PAID

DENVER, CO PERMIT NO. 3280

2222 North Nevada Avenue Colorado Springs, CO 80907

Heart Scan · $149 719-776-8010 Learn more at penrosestfrancis.org/ heart.

Penrose-St. Francis Health Services is part of Centura Health, the region’s leading health care network. Centura Health does not discriminate against any person on the basis of race, color, national origin, disability, age, sex, religion, creed, ancestry, sexual orientation, and marital status in admission, treatment, or participation in its programs, services and activities, or in employment. For further information about this policy, contact Centura Health’s Office of the General Counsel at 1-303-673-8166 (TTY: 711). Copyright © Centura Health, 2018.

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-719-776-5370 (TTY: 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-719-776-5370 (TTY: 711).

TURN UP YOUR METABOLISM With Melaina Bjorklund, MS, RD, clinical dietitian at Penrose-St. Francis Health Services

friend who can eat whatever she wants and not gain weight. “I have a high metabolism,” she says. And it’s true. Some people are fortunate enough to be born that way. But what about the rest of us? Good news: We can alter our metabolism with a few simple habits.

PICK PROTEIN

It’s called the thermal effect of food — the amount of energy it takes for your body to digest the food you eat. Eat foods that are more difficult to digest, and your body will expend more calories doing it. It won’t account for more than 10 percent of your daily burn, but opting for protein, which is more complex, is better for your metabolism than simple carbohydrates like sugar.

ADD JALAPEÑOS

Spicy foods raise your body’s core temperature — and your metabolism along with it. Again, it’s not a huge difference, but turning up the spice level of a meal will raise your metabolism short term.

Plus, spicy foods can help with satiety.

EAT ALMONDS BEFORE BED

Skipping meals is never a good idea, as it slows your metabolism. When food isn’t coming in, your body is smart enough to downregulate its metabolism to preserve the energy it has. Eat three light meals and two to three snacks per day, including a small snack before bed. Ten to 12 almonds will do it.

Warm weather naturally increases metabolism because the body has to work harder to stay cool.

CHANGE IT UP AT THE GYM

The most significant way to rev up your metabolism is to exercise. But don’t think your evening walk around the block is going to cut it long term. Your body needs variety. Mix up your exercise routine, well, routinely, to keep your metabolism on its toes.

The Penrose-St. Francis Wellness Center offers a variety of low- and high-impact fitness classes. Learn more at penrosestfrancis. org/events.

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We all have that one