Create Fall 2015

FALL 2015 • Volume 3, Issue 4

Your health. Your life.

An Insider’S

Guide Get the real scoop on how to select the best hospital to deliver your baby

a n d ...

Trust your gut Page 2

Avoid Growth Plate Injuries Page 3

New A-fib Surgery Page 6

A New Look at Back Pain Page 7

IN Good Health

Littleton Adventist Hospital brings specialized care to the people of South Denver in the complex areas of trauma, cancer, neurology, cardiology, orthopedics, women’s services, and more.

We are part of Centura Health, the state’s largest health care network.

The purpose of this publication is to support our mission to improve the health of the residents of our community. No information in this publication is meant as a recommendation or as a substitution for your physician’s advice. If you would like to comment or unsubscribe to this magazine, please email create@centura.org.

Create is published four times annually by Littleton Adventist Hospital — Portercare Adventist Health System.

7700 S. Broadway Littleton, CO 80122 mylittletonhospital.org

2 | fall 2015 • Create

Go With Your Gut

Losing weight is a daunting task that requires organization and meal preparation.

Or does it?

Doctor’s BAG Dr. Rita Sharma Centura Health Physician Group Denver Tech Center 8200 E. Belleview Ave. Greenwood Village, CO 80111 303-770-6500

Several studies over the past decade have shown that intuitive eating may be an effective weight loss tool. It requires no planning whatsoever; all you have to do is trust your body.

It’s simple: The premise is to eat only when you are hungry and to stop eating when you are full.

Research shows that people who eat only to fuel their bodies and not out of emotion have a lower body mass index (BMI) and a higher appreciation of their bodies, compared to other types of eaters.

Trusting your health decisions

Patients who are actively engaged in the decisions about their health and their health care treatment options do better and save money, according to several studies. Patients who received enhanced decision-making support had 12.5 percent fewer hospital admissions and 5.3 percent lower medical costs than those receiving only the usual support, according to a study by Health Dialog.

From Colorado to Nepal

Centura Health takes prides in the quality of gynecologic care it provides to the women of Colorado. Now, the women of Nepal can receive the same quality care.

As part of Global Health Initiatives (GHI), Centura Health is helping women with uterine prolapse get the treatment they need. Muscle strain is one cause of uterine prolapse, a painful condition in which the uterus slips out of place.

It’s common for women in poverty-stricken countries not only to birth and care for children, but also perform demanding physical labor.

Fortunately for Nepali women, Centura Health and other physicians are on hand to perform necessary surgery free of charge to the women who need it. You can also help by supporting the cause at centuraglobalhealth.org.

Rita Sharma, MD, is originally from Canada. She trained in New York and the Caribbean before settling in Colorado with her husband and two children. As a family physician, Sharma understands that trust is a key component when selecting a new primary care provider.

“If you don’t have a good relationship with your physician and there isn’t a level of trust, you’re less likely to follow their advice,” she says. “If you have good, open communication with a physician you trust, you’ll see them more often and have better outcomes with chronic conditions.”

Sharma says you should not be afraid to shop around for a physician you trust.

“The first appointment should establish a care plan and go over medical history,” she says. “That’s a good time to feel each other out. If you don’t feel the relationship is going to work, it’s perfectly acceptable to look for one that will work.”

Cover photo: ©IStockphoto.com/ ;This page clockwise: ©IStockphoto.com/Eurobanks, /iconeer, /sirawit99; Opposite Page: ©IStockphoto.com/xefstock, /FabioFilzi

Trust is one of the eight guiding principles of CREATION Health, an Adventist wellness program supported by medical research and promoted by Littleton Adventist Hospital.

To learn more, go to southdenver health.org/ creation-health.

Trust

Protecting

the Plate

Keeping growth plate fractures in line

With growth plate fractures accounting for 15-30 percent of all fractures in children, it’s important to know the facts to keep your young athlete growing Dr. Michael Fuller strong.

“A growth plate is the area of the bone responsible for bone length,” says Michael Fuller, DO, an orthopedic surgeon at Littleton Adventist Hospital. “While every case is different, most children can heal from growth plate injuries with minimal, if any, long-term issues.”

The growth plate is the area of growing tissue located at each end of long bones. Growth plates are susceptible to fractures because they are the weakest part of a child’s musculoskeletal system and the final area of the bone to harden.

Fewer than 10 percent of growth plate injuries lead to growth deformities, according to the American Academy of Orthopaedic Surgeons. Although rare, growth plate fractures can cause angular or length deformities, bone incongruity, and height or growth restrictions. The key to minimizing the side effects of growth plate fractures is prompt, appropriate treatment, Fuller says.

“Realigning the fracture is critical,” Fuller says.

“Children’s bones heal quicker than adults, which means treatment needs to occur early after injury.”

If you suspect a growth plate fracture, seek immediate medical attention within five days of the initial injury.

“With the right diagnosis and treatment, your child will be up and running, literally, sooner than later,” Fuller says.

Treatment depends on the severity of the fracture and can include manual manipulation and surgery to realign the bone. Once realigned, the bone is kept immobilized and activity is limited to promote healing.

Range-of-motion and strengthening exercises are typically recommended to aid in recovery.

Obese children are more likely than nonobese children to suffer from growth plate fractures, according to research published in Current Orthopedic Practice.

Nothing to jump about

Double the Trouble

Because boys mature later than girls, boys are twice as likely to experience a growth plate fracture, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Trampolines, jump gyms, and high-velocity activities like flag football top the list of activities that can increase your child’s risk of growth plate fractures, says Michael Fuller, DO, an orthopedic surgeon at Littleton Adventist Hospital.

Competitive sports (i.e., baseball, basketball) and recreational activities (i.e., skiing, hiking) account for up to 50 percent of growth plate fractures.

Fuller recommends ensuring that your child eats a healthy diet and takes a multivitamin to promote growth plate and bone strength.

“It’s not always what your child is doing but what he isn’t doing that can make him more vulnerable,” Fuller says.

Signs of a growth plate fracture can include: • Persistent pain and/ or inability to move the limb • Heat, inflammation, or soreness near the end of the bone • Observable abnormality

create | mylittletonhospital.org | 3

An insider’s guide to choosing an obstetrician and birth center

W

hile it’s easy to be lured by fancy décor and on-trend services, the birth center selection you make influences many aspects of your birth experience, such as the care you receive, the options you’ll be given, and the level to which you’ll be able to remain involved with decisions about your care. You also might be selecting a physician and like most moms, you’re probably researching and creating a detailed birth plan. Consider our insider tips to ensure your choices support your wishes every step of the way.

Key In on Expertise | According to The BirthPlace’s Stacy Kreil, director of women’s and children’s services at Littleton Adventist Hospital, the quality of care a birth center’s staff provides is at the heart of a birth experience.

“Our BirthPlace is the one place I’ve worked where the staff truly lives the mission,” she says. “You can just feel it when you walk through the doors.” For patients, this means a memorable birth experience delivered with purpose and passion.

Littleton Adventist Hospital obstetrician Rania Khan, DO, agrees and urges new parents to look beyond room size and physical improvements. “A patient’s comfort in their environment at the time of birth is important,” Khan says.

“However, nursing — the quality and experience of nurses — is the critical component.”

The nurses at Littleton Adventist Hospital average 15 years of service in maternity nursing. Many hold national certifications and are members of professional organizations specific to obstetric and neonatal nursing.

4 | fall 2015 • Create

While most pregnancies, 60 to 80 percent, are considered low risk, the unexpected can occur. Childbirth Connection, a program of the National Partnership for Women & Families, recommends selecting a birth center whose care is “consistent with the best available research about safe and effective care.” As a Level III Maternity Center, The Birth Place at Littleton Adventist Hospital offers subspecialty care for complex maternal, obstetric, and fetal conditions, and has helped safely welcome more than 30,000 bundles of joy over the last 26 years.

Check the Numbers | Safety and success show in birth center

statistics, and Kreil advises that all patients consider the hospital’s outcomes.

“Our amenities are great, and we’re proud to offer them,” Kreil says. “But, as a nurse, I think the most important thing moms need to know is how we perform when it comes to patient outcomes.” Compared to state and national averages on birth experience statistics, The BirthPlace delivers.

For the last eight years, the complimentary Birth Day Wishes program offered to every obstetrics patient at Littleton Adventist Hospital gives parents the opportunity to share, discuss, and document their wishes in advance of baby’s arrival, while also taking care of standard medical questions often asked upon admission.

That means when labor begins, parents can focus on the experience with confidence their wishes and medical history are understood.

Discussing plans for items such as medication, labor comfort measures, and breast-feeding ensures The BirthPlace staff is ready when you deliver. “We encourage all obstetrics patients to take part in the Birth Day Wishes program,” says program coordinator, Cheryl Yanko, RN, BSN, who adds that the program often helps parents think through things they may not yet have considered like vaccinations and preventing newborn illnesses. “Not only does it help us understand the individualized experience the patient is looking for, it helps us and mom plan for baby to arrive.” Yanko says the one-hour appointment includes initial preparation of baby’s birth certificate and is helpful for all births, including adoption and surrogacy arrivals.

Schedule your Birth Day Wishes appointment today by calling 303-734-2186 and selecting prompt No. 2.

Experience Enhancements Many birth centers offer well-thought-out amenities that improve a family’s birth experience. During your facility search, learn about offerings and determine if they fit within your birth preferences.

Dr. Rania Khan, left, and Stacy Kreil are proud to be a part of Littleton Adventist Hospital’s BirthPlace, where exceptional care and experienced nurses provide a memorable birth experience to all patients.

By the Numbers 2014 stats: The BirthPlace at Littleton Adventist Hospital delivers big on healthy outcomes.

Littleton Adventist Hospital’s BirthPlace amenities: • Birth Day Wishes program (see above) • Midwife and doula-friendly environment • Large midwifery practice

• Four Jacuzzi tubs available for laboring • “Parent and me” bonding time • In-room massage • Partner meals

The Right Doctor

Between obstetrics recommendations from friends, insurance lists, and online reviews, you have a lot of info to sift through before selecting your health care provider.

Littleton Adventist Hospital OB/ GYN Rania Khan, DO, advises keeping it simple by focusing on two important considerations: Philosophy. Asking questions about issues important to you is the best way to determine if a doctor supports your philosophy and leads to a strong patient-doctor relationship. “Trust, confidence, and chemistry are crucial for patients and physicians,” Khan says. “It’s vital for patients to know and trust their doctor so when their doctor makes a recommendation, the patient is confident in her rationale and feels like a part of the decision making.”

Chemistry. As you ask questions and share your delivery wishes, you’ll develop a rapport with your physician. “A good doctor-patient relationship means patients feel comfortable discussing both hard and unique situations and asking questions,” Khan says. “The patient should feel she is able to have an open conversation and isn’t being rushed through her appointment.”

BirthPlace

National Average

Elective deliveries < 39 weeks gestation

98.7% compliance rate

The Joint Commission requires 95% compliance

Cesarean section rate

24.7%

2013: 32.7%

Vaginal birth after cesarean (VBAC) success rate

88.1%

2010: 60-80%

Exclusive breast milk feeding rate

85%

Approximately 40% at 6 months of age

create | mylittletonhospital.org | 5

Photos: Opposite Page: ©IStockphoto.com/Lighthousebay, ©Ellen Jaskol; This Page: ©IStockphoto.com/maaram

Birth Day Wishes come true

In the

rhythm

Innovative “hybrid ablation” treats atrial fibrillation from the outside in

Dr. Sanjay Tripathi

Traditional Treatments Traditionally, the first-line treatment for A-fib is medication, such as beta-blockers or antiarrhythmic drugs. The next step is catheter-based ablation, a nonsurgical procedure that Sundaram specializes in. The process delivers radiofrequency energy into the heart to destroy tissue that’s triggering irregular rhythms.

Catheter ablation has a 60 to 80 percent success rate in patients without heart abnormalities who have had A-fib for less than two years. Success rates drop if a patient has had A-fib continuously for more than two years.

“If a patient’s A-fib persists after catheter ablation, now, instead of saying, ‘I’m sorry, there’s nothing else I can do for you,’ I have another option,” Sundaram says.

Hybrid Ablation That option is the hybrid surgical/catheter ablation technique now offered at Porter Adventist Hospital. “Myself and Dr. Sundaram are the only physicians in the Denver area offering this particular hybrid procedure,” Tripathi says.

What is it?

Hybrid ablation involves two procedures separated by six to 12 weeks. First, Tripathi performs ablation on the outside of the heart with a minimally invasive surgical procedure called a thoracoscopic maze.

Then, about 12 weeks later, Sundaram performs catheter ablation inside the heart.

Who is it for?

Ideal candidates for hybrid ablation are patients who: • Have heart damage resulting from A-fib lasting longer than two years • Have failed catheter ablation

What are the advantages?

Hybrid ablation treats A-fib from both the outside and the inside of the heart muscle.

The modified maze surgery is performed through keyhole incisions made between the ribs on both sides, resulting in less blood loss, shorter recovery time, and lower risk of infection than the traditional, open-heart maze surgery.

“This is a real breakthrough in how we treat A-fib, especially in patients who are younger, more active, and have symptoms from A-fib that are significantly interfering with their lifestyle,” Tripathi says.

6 | fall 2015 • Create

Kay Jensma is finding her rhythm again at the bowling alley.

Individualized Options Sometimes, as is the case so far with Jensma, Tripathi’s minimally invasive maze approach may be enough without the need for Sundaram’s follow-up catheter-based ablation.

In fact, Jensma, a serious bowler, is back to throwing her 14-pound bowling ball with wild abandon. This summer she bowled in a national tournament in Reno.

“I used to be so weak that the heaviness of the ball was too much.”

And now?

“I feel like I’ve got some life left,” she says.

Learn more at a FREE community seminar where Dr. Sundaram will explain the most common forms of arrhythmia and the symptoms, treatments, and long-term impacts of A-fib.

Date | Tue, Oct 13 Time | 6-7 p.m.

Location | Porter Adventist Hospital Conference Center Registration required | porterhospital. org/events or call 303-765-3825

Littleton Adventist Hospital is part of the Centura Heart Network, the region’s leading provider of cardiovascular care.

Photo: ©michael richmond; Opposite Page: ©Ellen Jaskol

Dr. Sri Sundaram

For more than five years, Kay Jensma lived in a constant state of waiting for the other shoe to drop. Atrial fibrillation, or A-fib, a heart rhythm problem in which rapid, irregular heartbeats cause the heart’s chambers to beat out of sync, flared numerous times, triggering listlessness and debilitating, flu-like feelings.

“It’s scary. When you go to bed at night, you hope you wake up the next morning able to just get up and walk,” says the 70-year-old Elizabeth resident.

Today, Jensma and A-fib patients like her have access at Porter Adventist Hospital to a unique one-two treatment approach that tackles persistent A-fib from both the outside and the inside of the heart.

Cardiovascular surgeon Sanjay Tripathi, MD, and cardiologist Sri Sundaram, MD, both with South Denver Cardiology, offer “hybrid ablation,” which has up to an 85 percent success rate in curing A-fib.

1 4 in

Teresa Martinez’s lower back pain caused by sacroiliac (SI) joint dysfunction left her in constant pain.

When nonsurgical treatments were not effective, SI joint surgery performed

by Dr. Ben Guiot at Littleton Adventist Hospital allowed Martinez to return to her active lifestyle, pain-free.

Don’t look

back

Surgery for SI joint dysfunction MAY BE THE ANSWER TO LOW BACK PAIN

Teresa Martinez remembers a time when she could get out of bed without pain. She walked 3½ miles a day and even completed a triathlon.

About five years ago, she tried to lift something heavy and hurt her low back. Then before fully healing, she had a bad fall.

After that, walking and lifting even light objects caused pain in her lower back. Martinez, 42, of Grand Junction, learned that her pain was not being caused by a spine issue, but rather by her sacroiliac (SI) joint.

Dr. Ben Guiot

Diagnosing SI joint dysfunction

About 80 percent of adults will experience lower back pain, with up to one-quarter of cases caused by SI joint dysfunction. The sacroiliac joint connects the sacrum (S), a bone at the bottom of the spine, to the ilium (I), the pelvic bone. Unlike most joints, the SI joint is not supposed to move much and when it does, it causes inflammation and pain that often is felt in the lower back, particularly off to the side above the buttocks.

“SI joint dysfunction is an overlooked diagnosis,” says Ben Guiot, MD, a board-certified neurosurgeon specializing in care of the spine. Because the symptoms can mimic other spine problems, such as a herniated disc or sciatica, many doctors focus on treating the lower spine.

To confirm SI joint dysfunction, Guiot conducts a series of functional tests. If SI dysfunction is suspected, he injects the joint with a mix of anesthetics and steroids. If the pain improves initially but then returns, it confirms the diagnosis.

people with lower back pain actually may have SI joint dysfunction.

SI Joint Dysfunction Symptoms • Pain in the lower back, back of the hips, or groin and thighs • Pain when walking, lifting, or climbing stairs • Pain when going from sitting to standing • Leg pain, numbness, tingling, or weakness Risk Factors • Pregnancy, which stretches the ligaments around the joint and allows it to move • Low back spine fusion, which can transfer movement into the SI joint • A fall directly on the tailbone, or other trauma that impacts the joint • Age-related osteoarthritis • Repeated stress on the joint from sports, work, or heavy lifting • Asymmetry, such as scoliosis or having one leg longer than the other

The reward of relief Nonsurgical treatment options are available for SI joint dysfunction, including physical therapy, medications, and joint injections. For most patients, these will be enough.

Martinez had tried physical therapy multiple times and various injection therapies. As the mother of four kids, ages 16 to 24, Martinez wanted to be more active. The pain, she says, “was taking away my life. It was no way to live.”

In June, Martinez, who lives in Grand Junction, underwent SI joint fusion surgery with Guiot at Littleton Adventist Hospital.

“The key is that even a tiny amount of motion in the SI joint can produce enough inflammation to cause pain,” Guiot says. “The goal of the surgery is to eliminate that motion — and therefore, the pain and inflammation.”

Even before she had started physical therapy after surgery, Martinez could once again get out of bed without pain. “Those little things make a big difference,” she says. “If things keep going the way they’re going, I’m thrilled.”

To learn more, go to mylittletonhospital.org/ spine. And be sure to join Dr. Guiot at 6 p.m. on Dec. 2 at Littleton Hospital for a FREE seminar on low back pain.

See details on back cover.

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Portercare Adventist Health System

Non-Profit Org US POSTAGE

PAID

Denver, CO Permit NO. 4773

7700 S. Broadway Littleton, CO 80122

Join us for the FREE event to learn more about women’s health.

Learn from our expert providers about: -breast care -GYN health -genetics -incontinence -heart health

Date | Thu, Oct 8 Time | 5:30-8 p.m.

Location | The Inn at Hudson Gardens, 6115 S. Santa Fe Drive Registration | mylittletonhospital. org/lahclasses

2015 calendar Incontinence and Pelvic Health

Join Kerri Daniels, APT, CLT, to discuss the symptoms and physical therapy treatments for urinary incontinence and pelvic prolapse.

Date | Thu, Oct 15 Time | 6-7 p.m.

Location | Littleton Adventist Hospital, Conference Room 5 Registration | mylittletonhospital.org/ lahclasses Radiation Oncology Open House

Have you scheduled your annual screening mammogram yet?

Well, we’ve made it even easier to schedule. Just text your name to 720-358-5412 and we’ll call you!

Littleton Adventist Hospital 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 303-804-8166. Copyright © Centura Health, 2015.

A little less than a year ago, we broke ground on our brand-new radiation oncology cancer center.

Learn about the services and treatment our cancer team provides, tour the center, and enjoy refreshments. Registration is not required.

Date | Wed, Oct 14 Time | 4-6 p.m.

Location | 7750 S. Broadway, Garden Level

New Options in Carpal Tunnel Treatment

Join Dr. Carlton Clinkscales, orthopedic surgeon and upper extremity surgeon, as he shares how to recognize the signs and symptoms of carpal tunnel syndrome and describes a new, minimally invasive procedure available to treat carpal tunnel.

Date | Thu, Nov 5 Time | 6-7 p.m.

Location | Littleton Adventist Hospital, Conference Room 5 Registration | mylittletonhospital.org/ lahclasses

Prevention and Early Detection of Gynecologic Cancers

Dr. Glenn Bigsby, gynecologic oncologist, will discuss signs and symptoms of cancers of the female reproductive system, as well as risk factors and prevention tips.

Date | Tue, Nov 10 Time | 6-7 p.m.

Location | Littleton Adventist Hospital, Conference Room 1 Registration | mylittletonhospital.org/ lahclasses

Is Your Back Pain Really Your SI Joint?

One-quarter of back pain is actually due to an SI joint problem. Join Dr. Bernard Guiot for a FREE seminar on identifying the cause of your pain and new ways of treating it.

Date | Wed, Dec 2 Time | 6-7 p.m.

Location | Littleton Adventist Hospital, Conference Room 1 Registration | mylittletonhospital. org/lahclasses

Photos: ©istockphoto.com/Christopher Futcher, /kiddy0265

The Many Faces of Women’s Health