Create Fall 2016

FALL 2016 • Volume 4, Issue 4

Your health. Your life.

Baby Steps

Advances in medicine are making pregnancy possible for more women with chronic health conditions

Stroke survivor Kim Maloney welcomed Colin last October after a healthy pregnancy and delivery closely monitored by her physicians at Littleton Adventist Hospital.

Page 4

a n d ...

Wise Health Choices Page 2

Keeping Kids Healthy Page 3

Breast Cancer: Navigate the New Guidelines Page 6

A Closer Look at Epilepsy Page 7

IN Good Health

Choice

Raise a fork to healthier choices

It’s easy to put down the fork or the cigarette, or to head to the gym ...

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 2016 • Create

once in a while. But positive, lasting change requires a conscious effort: making a choice and then repeating it over and over again until it becomes second nature.

Dr. Sarah Crowley Choice is also one of the focus areas that helps guide the CREATION Health lifestyle, a scientifically proven approach upon which Littleton Adventist Hospital’s wellness programs are based. When it comes to talking with her patients about making healthy choices, instead of suggesting a laundry list of changes, Sarah Crowley, DO, a physician at Littleton Adventist Hospital, zeros in on their own wants and goals.

“When you try to figure out where they’re starting from and what is most important to them, you get better buy-in,” she says.

And she’s quick to emphasize the need for patients to have a choice about their care at every stage of life, especially the elderly.

“That’s a big, important piece for me as a physician. I can tell them what I recommend, but I always want them to feel empowered to make decisions for themselves,” she says.

Sure, we still love food that comes from a drivethrough window and a plastic wrapper more than we should, but Americans are making progress on the healthy-eating front.

According to a USDA study, we’re choosing to eat healthier foods, including eating more fiber and fewer calories from fat, saturated fat, and cholesterol.

The brain’s frontal lobe enables creatures great and small to reason and make choices. For the sake of comparison, here’s a look at how much that area takes up.

Cats

3.5%

Dogs

7%

Chimps

17%

Humans

35-40%

Go ahead and grin

According to a study from the University of Michigan, choosing to smile can actually help you improve your mood and feel more engaged at work — but only if you mean it.

That’s what happened with study participants who used positive thoughts — like a vacation or any other happy event — when they smiled. Those who painted on a fake smile had the opposite experience, and were also less productive.

Waist-ing away on diet soda

If you switched to diet soda as a healthier choice to save calories, recent research shows it may be time to give it up entirely.

A nine-year study by the University of Texas Health Science Center at San Antonio found that participants who drank diet soda tended to expand their waistlines faster than those who skipped out on the bubbly beverage.

Cover photo: ©Ellen Jaskol; This page clockwise: ©IStockphoto.com/Steve Debenport, /adventtr, /esolla, /sdominick ; Opposite Page: ©IStockphoto.com/???, /BanksPhotos, /anksPhotos

Choosing a healthy path

Choice 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.

Tummy Troubles What’s your plan for food allergy emergencies?

One in 13 U.S. children — approximately two per classroom — has a food allergy, yet most of their parents don’t have a food allergy emergency plan in place.

Dr. Leslie Tourangeau Leslie Tourangeau, MD, a boardcertified pediatrician in the emergency department at Littleton Adventist Hospital, works to educate parents on the need for one, and cites fear and uncertainty as hurdles to be overcome.

“The most difficult part in treating food allergies is making that critical decision: Do you give antihistamines and watch them, or do you jump to epinephrine and call 911?” she says. “That decision can paralyze parents sometimes.”

But having a well-researched, documented plan that helps take the guesswork away and allows parents to follow a consistent process instead can be lifesaving.

Tourangeau suggests using a template from a trusted source, such as the Food Allergy & Anaphylaxis Emergency

Care Plan from Food Allergy Research & Education (FARE), as it categorizes symptoms and provides clear direction.

“For mild symptoms, you give antihistamines and watch; for severe symptoms, you give epinephrine and call 911,” she says. “The doses of all their medications are included (on the plan) along with a physician’s signature, as schools often require that.”

And your plan should be front and center at home, too.

“Keep it on the fridge and make sure that anyone who’s going to care for your child not only understands but is comfortable administering the medicine, or they can’t be left alone with them,” she says.

$

Concerned about the rising price of EpiPens? Ask your pediatrician for a prescription for a generic epinephrine autoinjector or generic Adrenaclick. Both contain the same dosage of epinephrine as an EpiPen at a fraction of the cost.

Be sure to talk with your pharmacist about correct usage.

Kids in (GI) Distress

Kids end up in urgent care or the ER with all types of GI distress, such as GERD or IBS. But the GI issue they’re most frequently seen for typically has an easy fix.

“The most common thing we see that causes abdominal pain that results in an ER visit is constipation, hands down,” says Leslie Tourangeau, MD, a board-certified pediatrician in the emergency department at Littleton Adventist Hospital. And there are times of the year when the GI issue tends to spike, including:

Back to school: “At the beginning of the school year, kids are nervous about finding the bathroom and nervous in general,” she says.

Vacations: “Kids don’t eat as well and often don’t want to use unfamiliar toilets.”

Holidays: “Halloween, Thanksgiving, Christmas — anytime where you binge on food you normally don’t eat a lot of, we see the problem,” she says. “It’s just about making sure kids are eating a pretty healthy diet: fruits, veggies, water, repeat!”

So, what are the signs that you should seek treatment for GI distress?

• Appetite loss that’s causing weight loss or changes in activity level • Unrelenting pain — especially if accompanied by fever or vomiting — likely indicates emergency care is needed Bottom line? Trust your gut. “It’s easy for us to quickly rule out something like appendicitis, but everything sounds terrible in the middle of the night when your child is hysterical and you’re exhausted,” she says. “You’ve seen your kids sick, healthy, and everything in between. If you’re really concerned, it’s probably worth at least a visit or a phone call.”

Pediatric Emergency Care at Littleton Adventist Hospital is open weekdays from 4 p.m. to midnight, and weekends from noon to midnight. Patients of any age may always been seen in the emergency department, 24/7. For more information, call 303-795-KIDS.

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Making

Pregnancy Possible Modern medicine means even women with chronic health conditions can conceive

P

Despite a heart defect and a stroke at age 16, Kim Maloney was able to get pregnant and bring Colin into the world safely.

4 | FALL 2016 • Create

regnancy is tough on the body, even in the healthiest of women. Add in a chronic condition such as hypertension or diabetes in the mother, and you create a lot of stress being placed on her body.

Such pregnancies are considered highrisk, and Kim Maloney is all too familiar.

The 28-year-old had a stroke at age 16 and has been dealing with the side effects ever since.

“I had a type of heart defect that makes you susceptible to blood clots,” Maloney says. “I had a stroke in 2004. The doctors rated it an 8.5 out of 10 in severity.”

After spending a week in intensive care and months in rehabilitation, Maloney began to rebuild strength, even though some doctors told her she might never walk again. She had left-side paralysis and developed spasticity, or muscle cramping and tightness.

Uncharted Territory

Upping the Odds

Lennon isn’t surprised Maloney was able to conceive Because strokes aren’t particularly common in young and deliver a healthy baby with her health history. women, there aren’t a lot of documented cases of “Twenty-first century science is pretty amazing,” pregnancy in women with baclofen pumps.

Lennon says. “It’s been incredible for helping women “There are only a handful of patients worldwide conceive and has improved outcomes for pregnancy who’ve been in her situation, so we just didn’t have a tremendously, even in high-risk cases.” lot of data about how baclofen delivered directly

Four factors determine whether a to cerebrospinal fluid would affect the baby pregnancy is considered high-risk: age, or whether pregnancy could cause “Twenty-first century lifestyle, pregnancy conditions (such mechanical pump complications that science has been as multiples), and pre-existing health would affect the mother,” Alexander incredible for conditions. Those health conditions says. “With the abdomen increasing helping women conceive include high blood pressure, in size, it could put pressure on her and has improved stroke, diabetes, polycystic spine; the catheter could become outcomes for pregnancy ovary syndrome, kidney disease, dislodged; and she could lose tremendously, even autoimmune disease, thyroid the drug, which could cause her in high-risk disease, obesity, and HIV/AIDS. to have life-threatening withdrawals cases.”

“Diabetes, in particular, is one with seizures and serious cardiac and condition that used to make it tremendously respiratory complications.” difficult to conceive and then carry a pregnancy,” Fortunately, Maloney had no difficulties Lennon says. “Same with hypertension.” conceiving and had a healthy full-term pregnancy.

Fortunately, modern medicine makes pregnancy “I actually had a very easy pregnancy,” she says. possible. Now, the key is disease management.

“We had to increase the dose of baclofen a bit in my “As long as mom is managing her chronic condition third trimester because I started having more spasticity. well and is otherwise healthy, baby shouldn’t be But I had no issues at all with the pump itself.” affected,” Lennon says.

With the help of Lennon, Maloney delivered a healthy But it helps to have the support of a well-equipped baby boy in October 2015 at The BirthPlace at Littleton hospital and skilled staff.

Adventist Hospital and named him Colin.

“Littleton (Adventist Hospital) is unique in that for 20 Alexander was there, too. years now, it’s had a Level 3 nursery,” Lennon says.

“That was by my request,” Maloney says. “When “It’s a great hospital for high-risk obstetrics, and highI had my stroke in 2004, she was the first doctor on risk pregnancies are well-managed here.” scene. She knows my full medical history, and I just Alexander suggests women who have chronic wanted to make sure I had someone in there in case conditions and want to get pregnant talk to their anything went wrong. But nothing did. I delivered after doctors about their situation. “People can do a lot of a very easy five hours of labor.” things — more than they might think,” she says. “They Alexander was more than happy to be present at just need to be told that they can.”

Colin’s birth. “She has been my patient since age 16, and I care a great deal about this girl,” she says. “I have not seen a baby being born for many years, and it was very special that she asked me to be there.”

About

Stroke Symptoms Don’t ignore the signs of stroke, even if you think someone is too young to be having one. Call 911 right away if you observe the following symptoms: • Sudden numbness or weakness of the face, arm, or leg, particularly if on one side of the body only • Sudden confusion, difficulty speaking, or difficulty understanding • Sudden difficulty seeing out of one or both eyes • Sudden difficulty walking, dizziness, or loss of coordination • Sudden severe headache

Schedule a tour today Are you pregnant or planning to become pregnant? Call 303-730-5810 or visit mylittletonhospital.org/ birthplace to schedule a tour of Littleton Adventist Hospital’s BirthPlace.

6-8% percent of pregnant women have high blood pressure, according to the National Heart, Lung, and Blood Institute. create | mylittletonhospital.org | 5

Photos: ©Ellen Jaskol, ©istockphoto.com/Sohl

In 2005, Maloney had a pump surgically implanted to deliver a medication called baclofen through a catheter that enters the spine directly into the spinal fluid, to reduce spasticity. It worked great.

Dr. Mihaela Alexander “My stroke-related spasticity was pretty well-controlled with the pump,” Maloney says. But when she and her husband decided to plan a pregnancy, she met with her OB-GYN, Kelly M. Lennon, MD, and her neurologist, Mihaela Alexander, MD, both at Littleton Adventist Hospital.

“I researched pregnancy and baclofen pumps extensively and didn’t see any reason why she couldn’t have a healthy baby. But I told her we would need to watch very carefully,” Alexander says.

Moving

Target

Breast screening guidelines keep changing, but women don’t need to be confused

It happened again.

A New View The latest technology in breast screenings is tomosynthesis, or three-dimensional mammography. Rather than creating just two images of each breast, tomosynthesis uses multiple low-dose X-ray pictures to create a series of 3-D views. “Having so many images means greater accuracy and fewer callbacks due to false positives,” Acharya says.

6 | FALL 2016 • Create

To schedule a mammography, call the Centura Health Breast Care Center of your choice. Or text your name to the number shown, and a scheduler will call you to set up your appointment.

Littleton Adventist Hospital 7700 S. Broadway Call: 303-738-2767 Text: 720-358-5412 Castle Rock Adventist Hospital 2350 Meadows Blvd.

Suite 100 Call: 720-455-1111 Text: 720-644-0880 Centura Health Meridian 9949 S. Oswego St. Call: 303-269-4150 Text: 303-816-8648 Centura Health Southlands 6069 S. Southlands Parkway Call: 303-269-4150 Text: 303-816-8648 Parker Adventist Hospital 9397 Crown Crest Blvd.

Call: 303-269-4150 Text: 303-816-8648 Porter Adventist Hospital 2555 S. Downing St. First Floor Call: 303-765-6500 Text: 303-872-7469

This Page: PHOTO: ©Istockphoto.com/Neustockimages; opposite page: ©Ellen Jaskol

Another agency, in this case the American Cancer Society, changed its recommendations on when a woman should get screening mammograms.

No one would blame women for being confused and frustrated, but it’s not an option to ignore this issue and we must continue to be proactive, says Radhika Acharya, DO, a medical oncologist with Mile High Oncology who treats patients at the Breast Care Center at Littleton Adventist Hospital.

“Our goal is to detect cancer as small as possible, as soon as possible.

That’s the direct correlation to survival,” Acharya says. “You want to catch it before you can feel it.”

Dr. Radhika Acharya keeps a close eye on the various recommendations and the research Acharya guiding these decisions so she can help women navigate the waters. Given current research, her belief is that women in good health and at average risk should start annual mammograms at age 40. This is the recommendation of the American Congress of Obstetricians and Gynecologists as well as the American College of Radiology.

Women with a family history of breast cancer should discuss with their doctors how early and how often to undergo screening. In general, a woman with a family history of the disease should have her first mammogram 10 years earlier than the age of the family member when she was diagnosed with breast cancer, Acharya says.

Our goal is to About 10 percent of breast cancers are caused by a detect cancer as genetic mutation, so women with a family history also should discuss possible genetic counseling with their physicians. small as possible, Women should continue to have annual mammograms as as soon as long as they are in good health and expect to live 10 years or possible. longer, according to the American Cancer Society.

In the EMU, Ro Elgavish, MD, PhD, medical co-director of the Epilepsy Program at Littleton Adventist Hospital, helps diagnose seizure types.

Seizure Safety Guide See someone having a seizure? Forget what you’ve seen on the big screen.

Here’s what to do and what not to do: • DO make sure the person is out of harm’s way • DON’T put anything in the person’s mouth • DO call 911 if you don’t know the person’s medical history, or if the seizure is different from or lasts longer than previous episodes • DON’T hold the person down • DO take note of how long the seizure lasts

Everything Epilepsy Monitoring unit helps patients with seizure disorders get the answers and treatment they need

P

icture someone having an epileptic seizure.

Did you envision a person lying on the ground, shaking uncontrollably?

That’s one type of seizure, but there are lots of different types. And they’re not all easily diagnosed.

“Seizure types can vary from focal, where a patient might just stare blankly or have a strange sensation, all the way to a convulsion, which is what most people think of when they hear ‘seizure,’” explains Ro Elgavish, MD, PhD, a neurologist/epileptologist and medical co-director of the Epilepsy Program at Littleton Adventist Hospital. Conversely, there are many conditions that look like seizures but aren’t.

“For example, certain heart problems, or episodes associated with a psychological illness, can look a lot like seizures. But they have nothing to do with epilepsy,” Elgavish says.

Getting the right diagnosis Fortunately for South Denver residents, Littleton Adventist Hospital has an Epilepsy Monitoring Unit (EMU) where doctors can diagnose seizures and categorize their type.

“The EMU is a monitoring unit for making sure the diagnosis is correct,” Elgavish says. “We also determine what type of seizure a patient is having. That’s important because the type of seizure affects how it should best be treated.”

There are dozens of antiseizure medications on the market today. But not all of them work the same for everyone. And it’s difficult for doctors to know which ones will work best for their patients. Again, the EMU comes in handy.

“In the unit, we can more safely make complex changes to the patient’s medications, which is something that may be dangerous to do at home or may take significantly longer,” Elgavish says.

The EMU team also evaluates patients for surgery.

“For about a third of patients, medications don’t stop their seizures — and they may require surgery,” he says.

Epilepsy can happen to anybody Epilepsy affects nearly 65 million people worldwide, according to the Epilepsy Foundation. It’s a chronic neurological disorder that can develop at any age, but it is most common in young children and the elderly. The disorder is sometimes attributed to genetics, brain injury, or a congenital defect. But many cases of epilepsy have no known cause.

Because seizures can be present in a variety of ways, it’s important to tell your doctor about any recurring changes in behavior. Take note of any unusual experiences in which you feel detached from your body; have periods of forgetfulness; experience indescribable feelings; feel numbness or tingling; experience unexplained sleepiness or weakness; or have jerking movements in the arms, legs, or face.

If you think you could benefit from our EMU service, contact your neurologist, epileptologist, or primary care physician for a referral. For more information about services at the Littleton Adventist Hospital EMU, call 720-528-0823.

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Portercare Adventist Health System

In my day, deep brain stimulation meant a game of checkers!

To learn more, visit mylittletonhospital.org/dbs.

PAID

Denver, CO Permit NO. 4773

7700 S. Broadway Littleton, CO 80122

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, 2016.

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CLASSES

FALL

Breathe Easier

2016 calendar

Did you know that lung cancer is the leading cause of cancer-related death for men and women? Arapahoe County has the third-highest number of annual lung cancer diagnoses within Colorado and as a result, Littleton Adventist Hospital diagnoses more lung cancer patients than any hospital in South Denver. Learn from Dr. Karn Log as he shares the prevention tips and risk factors for lung cancer, and breathe easier!

Date | Tue, Oct 18 Time | Registration begins at 7:30 a.m.; the program begins at 8 a.m.

Location | The Bistro at Aspen Grove Registration | bit.ly/2bjo0Lk

Mammos, Mocktails and More!

Join us for happy hour! Get your annual mammogram and enjoy mocktails, refreshments, and more!

Date | Wed, Oct 19 Time | 4-7 p.m.

Location | The Breast Care Center at Littleton Adventist Hospital Registration required 303-738-2767

Centura Health Virtual Care, powered by MDLIVE, provides virtual access to Centura Health physicians, anytime, from any place.

Now, there’s an easy way to get care from a board-certified physician, whether it’s in the middle of the night, during the week, or over the weekend.

Our virtual care program, powered

by MDLIVE, will connect you with a physician via phone or secure video to access care for common health ailments. Physicians are available 24/7 to diagnose, recommend treatment and prescribe medication when appropriate.

There’s no need to wait days for an appointment or to struggle finding the nearest urgent care – just sign in and talk to a doctor via secure video or phone from your home, office or on the go. If you have a primary care provider, you may ask MDLIVE to forward a summary of your visit to this provider to keep your provider informed and your medical records together.

Go online and visit Centura.org/ virtual-care, download the MDLIVE app or call 1-888-905-7502.

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