Create Spring 2016

SPRING 2016 • Volume 4, Issue 2

Your health. Your life.

Pioneering Treatment for ocd Littleton Adventist Hospital first in state to perform deep brain stimulation to treat obsessive-compulsive disorder Read Sara and Amanda’s story on Page 4.

a n d ...

News for moms-to-be Page 3

CATCHING LUNG CANCER EARLY Page 6

GET CLEAR ON MAMMOGRAM SCREENINGS Page 7

Environment 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.

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 | SPRING 2016 • Create

Environment Spring Training

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s a family physician, Terry Krause, MD, believes the environment, both inside our homes and outdoors, contributes to overall health, and regularly discusses environmental concerns with her patients.

“One thing that comes to mind here in Colorado is how the Dr. Terry Krause environment impacts our exercise and possibly, increases chance for injury,” Krause says. As you gear up for summer activities like hiking and mountain biking, be sure to gear up your body, too, by optimizing leg strength as part of a regular fitness regimen. “And avoid dehydration by carrying a personal hydration pack,” she adds. “A good rule of thumb is three quarts of water per person per day, more in warmer temperatures Dr. Terry Krause or during rigorous activity.” Altitude can be Highlands Ranch Medical Associates a concern as well. Krause advises easing 9135 S. Ridgeline Blvd., Suite 190 into summer mountain activities and seeing Highlands Ranch, CO 80129 a doctor if you experience signs of altitude 303-649-3140 sickness such as nausea, vomiting, headache, or shortness of breath.

Home, Clean Home

Spring cleaning is a great way to free up space, decrease clutter, improve your mood and most importantly, rid your home of allergens or dangers that lurk inconspicuously inside. Keep the following considerations in mind as you move from room to room: • Cooped up? Clear out. Long winters result in cabin fever come springtime.

Boost your mood and prepare for the good weather ahead by scheduling a weekend to declutter and clean out at home.

• Spring cleaning keeps dust mites, a common allergen, at bay. Strengthen your defense by replacing mattress covers with allergen-proof bed covers, damp dusting regularly to reduce

airborne allergens, and replacing air filters in your furnace and air conditioner with high-efficiency media filters with a Minimum Efficiency Reporting Value (MERV) of 11 or 12.

• Identify safety concerns while cleaning. Look for loose rugs, cords, or poorly located furniture to prevent trips and falls. This is especially important when helping aging parents stay healthy and safe at home.

• Once you make space, bring some nature inside. Houseplants boast big benefits ranging from improving oxygen levels and deterring illness by increasing humidity to detoxifying the air inside our homes. Choose varieties like orchids, peace lilies, and spider plants to keep the air feeling fresh even when the windows are closed.

of households spring clean each year according to the American Cleaning Institute.

Sweep Safely

Hantavirus, carried by rodents, can become airborne during a spring sweep and has the potential to progress to hantavirus pulmonary syndrome, which can be fatal. Protect yourself by wearing a mask whenever sweeping the porch, garage, or anywhere rodents may frequent.

Cover photo: ©Ellen Jaskol; This page clockwise: ©IStockphoto.com/freemixer, /terex; Opposite Page: ©IStockphoto.com/jfk_image, /monkeybusinessimages

IN Good Health

Understanding Preeclampsia Preeclampsia is a potentially dangerous pregnancy complication characterized by high blood pressure (BP). It can have serious complications for you and your baby — and it’s more common than you may think. “We see it in about 10 percent of Dr. Jessica Salinas pregnancies in one form or another,” says Jessica Salinas, MD, an OB-GYN at Centura Health Physician Group Women’s Health at Littleton, on the Littleton Adventist Hospital campus.

Causes

While its cause isn’t known for certain, “it’s more common in women pregnant with twins, women with a history of high blood pressure or diabetes, and those pregnant with their first baby,” Salinas says.

Treatment

It depends on severity of disease.

Preeclampsia without severe features: Defined as BP above 140/90 with protein in the urine.

• Ensure BP is well-controlled (under 150/90) • Monitor lab work to make sure you’re not developing severe features • Opt to deliver by 37 weeks Preeclampsia with severe features: Defined as BP above 160/110, with elevated liver function tests and impaired renal function.

• Opt for delivery after 34 weeks

Cure

Delivery: After the baby is born, most symptoms resolve.

High-Risk Help The Perinatal Care Center at Littleton Adventist Hospital specializes in high-risk pregnancies. For more information or to schedule an appointment, including prenatal screenings to determine any risk factors before pregnancy, call 303-730-5862.

Marijuana and Milk The research on the effects of marijuana while breastfeeding is limited, but it is known that traces of THC — the chemical in marijuana that causes you to feel high — can be found in urine of babies whose mothers use marijuana and breastfeed. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists advise against marijuana use. Also, health experts warn that “pumping and dumping” does not work because THC is stored in fat and stays in the system for a long time. To learn more, download a fact sheet from the Colorado Department of Public Health and Education at mylittletonhospital. org/breastfeeding or call the Littleton Adventist Hospital Lactation Department at 303-734-8744.

Midwives make great postpartum partners Midwives aren’t just there for you during pregnancy and delivery. They provide critical postpartum support as well. “Of course we’re there to take care of your physical health, and monitor pain and bleeding, but we provide other support as well,” says midwife Sarah Stone, CNM, at Littleton Adventist Hospital. Two key areas where they excel: • Midwives are trained to help with issues, including breast infections, lab work, and filling prescriptions. The midwives at Littleton Adventist Hospital also can perform a frenotomy, a procedure to release the thin piece of tissue that connects a baby’s tongue to the floor of the mouth, if needed, to help ease breastfeeding.

• Postpartum depression. Midwives work to support new moms through postpartum to help avoid depression. “We’re there to recognize it and help women through it with therapy and medication as needed,” Stone says.

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Breaking Twin women are the first patients in Colorado to have their OCD treated with deep brain stimulation, allowing them to break free from the crippling anxiety that kept them locked inside their house.

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Twins Amanda (left) and Sara Eldritch are feeling lighter and brighter after DBS helped alleviate the OCD symptoms that robbed them of normal lives.

4 | SPRING 2016 • Create

ara and Amanda Eldritch had peculiar habits as toddlers. Wrinkles had to be out of socks, they tucked in their shirts (always), and they washed their hands — a lot.

As they grew into adolescents, it became clear there was something deeper affecting the twin girls. A single hand-washing could take 20 minutes. A shower required hours — and an entire bottle of shampoo.

“It was an anxiety that couldn’t be controlled,” Sara says.

They cleaned their home bathroom two to three times a day. They went through hundreds of latex gloves and bottles upon bottles of rubbing alcohol each month to disinfect anything they touched.

Public restrooms incited panic, severely limiting travel and outings. They painstakingly removed every speck of lint on their clothing. They couldn’t go barefoot in their own home.

To avoid the anxiety surrounding the shower, Sara and Amanda would sometimes go a week or two without bathing. They felt at war with their own existence. And in a desperate cry for help as adolescents, they tried taking their own lives.

Finally, when they were 16, they heard the diagnosis they already knew: obsessive-compulsive disorder (OCD).

Sara and Amanda spent the next 15 years trying various combinations of medications, counseling, and other therapies to escape the desperation and despair they felt daily.

But nothing helped — until they met David VanSickle, MD, PhD, a neurosurgeon at Littleton Adventist Hospital who specializes in deep brain stimulation surgery.

A year after undergoing the surgery (typically used to treat Parkinson’s disease and essential tremor), the twins today are finding hope and joy in simple things like taking a morning walk — something they hadn’t done in more than a decade.

How DBS Works Understanding OCD DBS, VanSickle explains, is an inhibitory surgery: People with OCD are “You’re inhibiting the part of the brain that’s inundated with unwanted overactive.” thoughts they can’t avoid, In those with OCD, the goal is to suppress the called obsessions, which Dr. David VanSickle anxiety, which increases the chances of therapy make them perform repeated being able to address the habits associated with behaviors — compulsions — to ease their the disorder, he says. anxiety. OCD can interfere with a person’s ability DBS requires two separate procedures. to live a normal life, affecting school, work, and During the first procedure, the surgeon places social functions, as multiple hours a day are electrodes on specific areas of the brain. devoted to obsessive thoughts and rituals, such “Traditionally, most of these surgeries are as counting or hand-washing. done while the patient is awake,” VanSickle Because of their OCD and related anxiety and says. “But we can do the surgery while the depression, and the side effects of medications, patient sleeps. Amanda and Sara didn’t the Eldritches, now 31, say they spent think they could get through an their 20s “moping around.” awake surgery.”

Their OCD was so severe and “I’m really Adapting the Mazor resources were so lacking, says excited to Robotics Renaissance® their mother, Kathy Worland, not feel like that she struggled to find Guidance System, a system I’m at war medical professionals who could commonly used for spine with my own help them. surgery, VanSickle is one of existence.”

“Their OCD just got worse and the first surgeons in the world to worse and worse,” she says. “After perform robot-assisted Asleep DBS high school graduation, they retreated surgery, and now performs more of to their beds. They didn’t leave the house until these than any other surgeon in the world.

April of the next year.”

“With the robot, we gain higher levels of They couldn’t hold jobs or attend school or precision,” he says. “And the more accurately even go to a movie. we put the electrodes in the first time, the “We can’t be more than 15 minutes from better.” home because they can’t use a public The electrode wires are placed under the skin restroom,” Kathy adds. “That limits what we can of the head, neck, and shoulder, connecting do. That, in turn, adds to the depression.” with a battery pack (called a neurostimulator), which is implanted in the chest during a second The Promise of DBS procedure about a week later. Then, routine When they were 28, Sara and Amanda programming appointments help ensure the read about deep brain stimulation (DBS), a brain gets the proper amount of stimulation. surgical therapy more commonly used to treat DBS, which was first developed in 1987, has Parkinson’s disease and essential tremor. They come a long way, VanSickle says. contacted a surgeon, who explained that to be “In the last few years, the procedure itself candidates for the surgery, they needed to go has become much better. Outcomes were through certain steps — including making sure always good, but the procedure has become they had tried every other possible treatment. more consistent, faster, much less expensive — They followed the protocol. And two years more mundane, really,” he says. “Yet it’s highly later, they met VanSickle, who agreed they were underutilized as a therapy.” candidates for DBS. Once their battery packs were turned on, “I was pretty convinced this was going to be Sara and Amanda felt different — lighter. their only hope,” VanSickle says.

“We didn’t realize you didn’t have to be In spring 2015, Sara and Amanda were the miserable all the time,” Amanda says. Instead first people with OCD to be treated with DBS in of sleeping all day, they get up in the morning. the state of Colorado.

They go for morning walks. They ride their bikes.

]

They make their meals.

“The day is so much longer and brighter,” Amanda says.

“And prettier,” Sara adds.

Looking Ahead Sara and Amanda continue to see a psychiatrist for their OCD, but they also see hope.

“I feel like I can identify my anxiety,” Sara says.

“I can actually see where it’s coming from. And I feel like I can deal with it.”

Amanda agrees.

“I’m really excited to not feel like I’m at war with my own existence,” she says. “I can be functional enough to go get a job and make a difference. There’s a world out there I want to be a part of.”

Worland saw different people in her daughters almost immediately. They have joy and hope; they laugh.

“Their laughter,” she says. “That was something I hadn’t heard in years.”

Convinced her daughters would’ve ended their own lives, Worland is immensely grateful for VanSickle and Littleton Adventist Hospital.

“This surgery has changed their lives — and saved their lives,” she says.

She’s eager to see who her daughters become. But as a mother, there’s one hope she clings to.

“I haven’t been able to hug my daughters since they were 16. And I know that because of this surgery, I’ll be able to someday,” she says.

“That’s what I live for.”

The FDA has approved DBS therapy for severe cases of OCD under a humanitarian device exemption and is now covered by some insurance plans. Surgeons at Littleton Adventist Hospital currently perform the procedure on a case-by-case basis. For more information, please go online to mylittletonhospital.org/dbs.

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Photo: ©Ellen jaskol

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of U.S. adults have obsessive-compulsive disorder, and half of these cases are considered “severe.”

Looking for lung cancer Take a deep breath. Hold it. Exhale. You have just Dr. Kelly Greene

Dr. Karng Log

pressed your lungs into active duty, expanding to accommodate the extra-big breath you just took in and acting as command central for oxygen delivery to the body.

Our lungs work without us directing them. You could even say our lungs work silently, behind the scenes. Here’s the scary thing: Lung cancer progresses silently too, often not showing symptoms until it’s no longer curable.

But there is promising news. There is now a low-dose CT scan that may catch cancer early enough to treat it — and beat it. Here’s what you need to know.

No. 1 cancer killer

“Lung cancer is the leading cause of cancer death in the U.S. among both men and women. It claims more lives every year than colon, prostate, ovarian, and breast cancers combined,” says Kelly Greene, MD, pulmonologist and medical director of the intensive care unit at Littleton Adventist Hospital.

Does that get your attention? It should — especially if you have a history of smoking.

“Lung cancer is by far the most deadly cancer out there,” says Karng Log, DO, a medical oncologist with Mile High Oncology at Littleton Adventist Hospital. “Patients who develop metastatic disease — cancer that has spread beyond the lungs — have a fiveyear survival rate of 1 percent. However, when lung cancer is detected at its earliest, most treatable stage, survivorship soars to 50 percent.”

That’s where a low-dose CT scan comes into play.

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symptoms not to ignore

While lung cancer often has no early symptoms, if you experience any of these signs, talk with your doctor to evaluate the cause: new cough that doesn’t A go away Coughing up blood hest pain that worsens with C coughing or deep breathing Shortness of breath and wheezing ecurrent infections, such as R bronchitis or pneumonia Swelling of the face Losing weight without trying

Who is eligible?

The screening is offered to those at highest risk of developing lung cancer.

Based on data from the Lung Cancer Screening Trial, a study involving more than 50,000 current or former smokers, the patients mostly likely to benefit from screening are:  Between the ages of 55 and 74  Current smokers, or those who have quit within the past 15 years  Heavy smokers — a history of 30 pack years or more (a pack year is an average of one pack per day per year; for example, one pack per day for 30 years or two packs per day for 15 years) Greene says results are promising. “Trial participants who got the CT scan had a 20 percent overall less chance of dying of lung cancer than those who just got a chest X-ray,” she says.

Castle Rock Adventist Hospital, Littleton Adventist Hospital, Parker Adventist Hospital, and Porter Adventist Hospital are part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas.

6 | spring 2016 • Create

Schedule Your Screening

These South Denver hospitals now offer low-dose CT scans to screen for lung cancer for $199.* Castle Rock Adventist Hospital 1-855-456-LUNG(5864) Littleton Adventist Hospital 303-738-7747 Parker Adventist Hospital 303-269-4500 Porter Adventist Hospital 303-778-2415

*Some insurance plans may cover the screening.

Check with your plan.

This Page: Photo:©dollarphotoclub.com/Cherries, IllustrationS: Lung ©dollarphotoclub.com/annexs2; Group ©dollarphotoclub.com/jacartoon; Oppostie Page: ©ellen jaskol

Low-dose CT scan catches cancer earlier when it’s more treatable

Screening Clarity Changing guidelines have women wondering when to have a mammogram

Ladies, listen up. Experts recommend an annual mammogram beginning at age 40. Oh, but you may have heard other experts say it’s OK to wait until age 50.

Meanwhile … wait for it.

Last summer, the American Cancer Society issued a bombshell update to its mammography screening guidelines, recommending that women begin annual screening mammography at age 45, up from its previously recommended age of 40.

Why are there so many different recommendations? And what’s a woman to do?

Too close to home If Lisa Perry, a 42-year-old mom and full-time deployment superintendent with the Colorado Air National Guard, had languished in indecision about when to start annual mammograms, she would still have cancer.

Perry, who had a clean mammogram at age 40, had no reason to think results would be different at age 42. Yet two suspicious spots picked up on a screening mammogram, followed by an MRI and a biopsy in July of last year, confirmed she had a form of early stage breast cancer called ductal carcinoma in situ, or DCIS. While the cancer was confined to her milk ducts, there was a 30 percent chance that it would spread if not treated.

“If I had waited until age 45 to have my first mammogram, I might be sitting here with a whole different story,” she says.

During her commute home last summer, she tuned in to NPR and heard the news: The ACS updated its screening mammography guidelines from annually beginning at 40 to annually beginning at 45 and biannually starting at 54.

“I couldn’t believe it,” she says. “Where would that have left me?”

Lisa Perry didn’t wait until age 45 to have her first mammogram. That decision could have saved her life.

Talk to your doc Stan Smazal, MD, director of the mammography imaging department at Littleton Adventist Hospital, says women have every right to be confused about breast cancer screening recommendations. “Different groups are using different sets of data. I can’t think of anything more confusing for a woman,” he says.

For his part, Smazal is not confused. He advocates annual mammograms beginning at 40. “Almost 40,000 women in their 40s get breast cancer every year. And it tends to be more aggressive cancer,” he says.

He recommends asking your doctor these questions to determine the screening option right for you: • Do my family history or other risk factors put me at high or intermediate risk for breast cancer?

• Do I have dense breasts and, if so, should I start screening mammography or breast ultrasound earlier?

The bottom line? “You don’t want to mess with this disease. About 17 to 18 percent of all our breast cancers are under the age of 50. That ought to say something,” Smazal says.

Are you a cancer survivor?

Celebrate with us at the fourth annual National Cancer Survivors Day event, June 5, 10:30 a.m. to 1 p.m., at Littleton Adventist Hospital (in the parking lot between the hospital and surgery center, off the Broadway entrance). For more information, go to mylittletonhospital.org/ lahclasses.

Littleton Adventist Hospital is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas.

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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.

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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.

SPRING

entityhospital.org Deep Brain Stimulation for those with Parkinson’s disease

Littleton Adventist Hospital is the only hospital in Colorado offering a new two-step procedure for deep brain stimulation that allows patients to remain asleep during the surgery. Join Dr. David VanSickle to understand this new surgery and why even young Parkinson’s patients should consider surgery sooner rather than later.

Date | Wed, Apr 13 Time | 6-7 p.m.

Location | Littleton Adventist Hospital, Conference Room 3 Registration | mylittletonhospital. org/lahclasses Multiple Sclerosis 101

Affecting the central nervous system, multiple sclerosis interrupts the flow of information throughout the body.

Join Dr. Julie Seibert as she discusses the signs and symptoms of multiple sclerosis and the latest treatment options.

2016 calendar

Date | Wed, Apr 27 Time | 6-7 p.m.

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

21st Century Options for Epilepsy

Seizures can be experienced for many reasons but with epilepsy, there is no apparent cause and they can occur without notice. Join Dr. Rotem Elgavish to learn 21st century diagnosis and treatment options.

Date | Wed, May 11 Time | 6-7 p.m.

Location | Littleton Adventist Hospital, Conference Room 3 Registration | mylittletonhospital. org/lahclasses

National Cancer Survivors Day Date | Sun, Jun 5 Time | 10:30 a.m.-1 p.m.

Location | Littleton Adventist Hospital In the parking lot between the hospital and surgery center, off the Broadway entrance).

For more information, go to mylittletonhospital.org/ lahclasses.

Stroke Busters: Stroke Prevention Tips

As one of the first Primary Stroke Centers with advanced capabilities in Colorado, we focus on the highest level of stroke care. Join Dr. Mark Murray as he shares the signs, symptoms, and prevention tips for strokes. Because brains matter.

Date | Thu, May 19 Time | 6-7 p.m.

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

Photo: ©istockphoto.com/tanuha2001

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