Create Spring 2018

SPRING 2018 • Volume 6, Issue 2

Your health. Your life.

MAKING

WAVES WITH BREAST SCREENINGS WOMEN WITH DENSE BREASTS MAY BENEFIT FROM SPECIAL ULTRASOUND SCREENING Page 3

a n d ...

EARLY SCREENING AND ADVANCED TREATMENT FOR LUNG CANCER Page 4

ON THE PATH TO KIDNEY STONE PREVENTION Page 6

Laura Moseley has a clearer view of her breast cancer risks, thanks to screening options at Littleton Adventist Hospital.

NEW TECHNOLOGY IMPROVES STROKE ASSESSMENT AND TREATMENT Page 7

A decade-by-decade guide for women’s health screenings

L

et’s face it, ladies, routine health screenings don’t always fit our routine. But it’s

important not to let time, finances, or fear sabotage the discovery of health problems.

Richard Barnett, DO, an internal medicine physician with CHPG South Suburban Internal Medicine in Littleton, offers these screening guidelines for healthy women at average risk for disease.

40s

The 40s are full of questions about mammograms. When to start? How often? Barnett says 40 is not an automatic start age, but it is time to discuss pros and cons with your provider.

Also consider screening for blood pressure annually, cholesterol every five years, diabetes every three years, and vision screening every two to four years.

70s

20s 3

Make time in the jet-setting 20s to begin cholesterol and blood pressure checks every three to five years. Also, schedule a Pap test every three years beginning at 21 and chlamydia screening for sexually active women up to age 25.

50s

Age 50 brings a not-so-nifty rite of passage: colonoscopy. The good news? If there are no signs of colorectal cancer, you can wait a whopping 10 years to repeat. It’s also the only screening test that can actually prevent cancer because nodules that can turn into cancer are removed during the procedure.

At 50, annual mammograms are a must. At 55, if you’re a current or former smoker, begin low-dose CT screening for lung cancer if you smoked the equivalent of a pack a day for 30 years (or two packs for 15 years).

Congratulations on your septuagenarian status and on arriving at another decision about mammography. Some guidelines suggest ceasing mammography at 74.

Barnett recommends discussing the decision with your provider.

s

Thirty-somethings are in the thick of careers and kids. Lucky for you, there’s just one big screening to remember: At 30, begin getting a Pap test with HPV testing. If both results are normal, you don’t need another for five years.

Searching for a primary care or family doctor?

Littleton Adventist Hospital offers six primary care practices throughout the community that are accepting new patients.

To find locations and more information, visit centura.org/locations and enter “Primary Care” and “Littleton” in the search fields.

CHPG OFFICES: Chatfield Family Medicine 303-738-2714 CHPG Clement Park Family Medicine 303-932-2121 CHPG at DTC 303-770-6500 CHPG Grace Family Practice 720-528-3559

60s

By the 60s, your screening schedule — like your body — experiences a few starts and stops. At age 65, start bone density (DXA) screening to check for osteoporosis and stop Paps if your recent test history is normal.

CHPG South Suburban Internal Medicine 303-347-9897 CHPG Women’s Health — Littleton 720-922-6240 Highlands Ranch Medical Associates 303-649-3140

A new definition of high blood pressure means that nearly half of all U.S. adults have hypertension.

And nearly half of these are women.

Birth control pills raise blood pressure risk in some women, as does menopause.

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

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HEALTH BRIEFS

Spring

SCREEN TIME

ARE YOU DENSE? Unpacking breast density risks and recommendations for screening

I

n October 2017, a new Colorado law passed requiring women to be informed when they have dense breasts. It’s a condition that affects 40 to 50 percent of women ages 40 to

74, and it can increase cancer risk in two ways, says Stanley Smazal, MD, FACR, a breast imaging radiologist at Littleton Adventist Hospital.

“First, if your breasts are denser, you have more glandular (versus fatty) tissue, which increases your risks of developing cancer in that particular tissue,” he says. “That’s multiplied by the fact that the density can make general mammography screening more difficult.”

There are four categories for measuring breast density: 1. Almost entirely fatty Dr. Stanley Smazal 2. Scattered areas of fibroglandular density, which is connective tissue, lobules, and milk ducts 3. Heterogeneously dense (indicating some areas of non-dense tissue, but most of the breast tissue is dense) 4. Extremely dense “Categories one and two are fairly simple to read with a mammogram,” Smazal says. “It’s levels three and four — that’s where women should be told what their total risk factors are, and we actually do a calculation to determine what type of screening they should have.”

ULTRASOUND PROVIDES CLEARER PICTURE

Laura Moseley, 57, of Broomfield, had been told she had dense breasts in a previous screening, but it wasn’t until her first 3D mammogram at Littleton Adventist Hospital last September that she learned she was actually in the highest risk category (extremely dense) and more screening would be needed. Fortunately, Littleton Adventist Hospital offers automated whole breast ultrasound (ABUS), which uses sound waves to create 3D images of breast tissue, and Moseley was able to have this additional imaging during the same visit.

“With those two together, they were able to confirm I had no issues. But without the ABUS, they would not have been able to tell,” she says.

Karen Liley, supervisor of the Breast Care Center at Littleton Adventist Hospital, is thankful they can give patients this additional option. “Our patients know that we consider them family, and we want to provide cutting-edge technology to help navigate those times in a woman’s life that you need exceptional care,” she says.

ABUS Benefits

Additional screening options like automated whole breast ultrasound gave Laura Moseley important insights into her breast cancer risks.

These photos show increased breast density from left to right. The two photos on the right are dense breasts. Dense breast tissue appears white in mammograms — and so do breast masses and tumors. Because fatty tissue appears almost black, on a dark background it’s easier to spot a tumor that appears white.

For women with dense breasts, ultrasound screening offers: Schedule a 3D mamm 1. No radiation. ogram or breast u 2. A clearer view. “It can penetrate that Littleton A ltrasound at dventist H ospital by calling breast tissue and give us another 3 Every scre 03-738-2767. en look at what’s underlying there,” personaliz ing includes a ed breast Smazal says. cancer risk assess me genetic co nt, including a That said, screening still begins with unselin of family h g review mammography. “We’re looking for certain istory. things with mammography that we’re not going to be able to see with ultrasound — specifically, abnormal calcifications that sometimes can be an indicator of underlying problems,” he says. create | mylittletonhospital.org | 3

A NEW LOOK AT

LUNG CANCER Dr. Kevin Boyle

It wasn’t too long ago that the words “lung cancer” — the leading cause of cancer deaths in America — were met with dismay. But with earlier

detection and advancing treatments, discussions about lung cancer now include the words “hope” and “options.”

Statistics show that both the number of cases of lung cancer and the deaths from it are declining across both genders and almost all races. And, while Colorado boasts one of the lowest lung cancer death rates in the nation, knowledge can help keep these trends moving in the right direction.

• Super D: This navigation system, short for

CATCHING CANCER EARLY

By the time lung cancer is typically detected, treatment options are limited.

However, new technology is changing this. Using low-dose CT scans, physicians can now identify areas of concern earlier than with typical X-rays without exposing patients to high levels of radiation. Kevin Boyle, MD, a family physician with CHPG Clement Park Family Medicine, refers patients at risk of developing lung cancer for this screening.

“It’s 50-50. Some patients will say, ‘That’s a good idea. I want to do it.’

Others are afraid the test will find something,” he says. “I reassure them that if a lung nodule is there, and if it is cancer, we have a shot at curing it,” he says. Patients who are eligible for the screening: ✖ Are ages 55-77 ✖ Must have a 30-year “pack history” (a pack a day for 30 years, two packs a day for 15 years, or some other equivalent)

✖ Currently smoke or have quit within 15 years ✖ Have no signs and symptoms of lung cancer

EASIER DIAGNOSIS

If screening reveals a suspicious spot on the lung, called a lung nodule or lesion, further tests can reveal whether the spot is cancerous, explains Nitin Gupta, DO, a pulmonary intensivist with Littleton Adventist Hospital. Gupta performs two high-tech, low-risk alternatives to surgical biopsy — both available at Dr. Nitin Gupta Littleton Adventist Hospital: • EBUS: Short for endobronchial ultrasound, EBUS diagnoses lung cancer using ultrasound imaging to guide a fine needle through a patient’s windpipe to take a sample of the lesion.

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superDimension™ Navigation System, gives access to hard-to-reach spots on the edge of the lungs. “If a CT scan detects a lesion, our software program basically plots a road map through the complicated path of airways inside the lungs to get to the lesion,” Gupta says.

“We are finding lung cancers earlier, when we can surgically take them out and perhaps even cure the cancer,” Gupta says.

The vast majority of patients hear good news after these tests. In fact, fewer than 5 percent of all lung nodules are cancerous.

Some nodules are simply scar tissue, the result of past infection, or benign (noncancerous) nodules. Other suspicious nodules may need to be monitored for changes over time. The goal is to find early lung cancers that may be treatable, says Marla Talmadge, oncology and thoracic nurse navigator who follows these patients.

“We want to make sure patients with lung nodules aren’t falling through the cracks,” Talmadge says.

ADVANCES IN DETECTION AND TREATMENT ARE BRINGING HOPE TO THOSE WITH THE DISEASE

LUNG CANCERS NOT ALL THE SAME

While it was once thought that lung cancer was lung cancer was lung cancer, doctors today know that there are many types of genetically different lung cancer tumors. The key to the right treatment is the right diagnosis. The three main types are: Non-small cell lung cancer: About 85 percent of lung cancers. While tobacco smoking is the greatest risk factor, about one in five cases stem from environmental risk factors such as radon, asbestos, and air pollution exposure.

Small cell lung cancer: About 10 to 15 percent of lung cancers.

Smoking and secondhand smoke exposure are the strongest risk factors.

Lung carcinoid tumors: The cause for this slow-growing, rarest form of lung cancer is not well understood. The average age at diagnosis is 60, which is younger than the average age for other lung cancers.

Treatment plans are developed based on the type, stage, and unique traits of the cancer, and may include surgery, radiation therapy, chemotherapy, and targeted therapies. The latter therapy attacks specific components of specific cancers. For example, one targeted therapy might block new blood vessel formation, thus shutting down a tumor’s source of nourishment. A different targeted therapy might disable the signals sent by proteins that “tell” tumor cells to divide and grow.

The bottom line? The earlier a lung cancer is diagnosed, the better.

“Patients just do so much better when we treat cancer sooner. Their quality of life is much improved,” Gupta says.

“We are finding lung cancers earlier, when we can surgically take them out and perhaps even cure the cancer.” ~Dr. Nitin Gupta, Littleton Adventist Hospital

Former smoker Jim Strickler got peace of mind when his low-dose CT scan showed no trace of lung cancer.

Jim Strickler stubbed out his last cigarette six years ago.

After three or four decades of lighting up, he figured it was time. “I’d thought about it on my 40th birthday, on my 50th birthday. But when I hit 60, I said, ‘OK, that’s it.’”

As he piles up years as a former smoker, his risk for heart disease and cancer drops. Still, when his family physician, Kevin Boyle, MD, suggested a lung scan, Strickler didn’t hesitate.

Those smoking years made Strickler a perfect candidate for Littleton Adventist Hospital’s new screening tool, a low-dose CT scan.

The imaging test provides a detailed picture, yet minimizes radiation exposure.

The scan was quick and painless, and revealed clean lungs. That peace of mind, he says, is priceless. “I felt like, whew, I dodged a bullet.”

To learn more about the low-dose CT lung cancer screening or to schedule an appointment, call Littleton Adventist Hospital’s lung cancer screening line at 303-738-7747.

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A QUICK LOOK BRINGS LASTING RELIEF

AND A HARD PLACE The surprising cause of most kidney stones — plus how to prevent them The kidneys are bean-shaped, fist-sized filtering units that send important minerals back into the bloodstream and waste and extra fluid to the bladder as urine.

The most common type of kidney stone (calcium oxalate) forms when there’s too much waste and too little liquid. Often, not drinking enough water is to blame.

The result? The body keeps too much calcium, which crystallizes. “Calcium is not the culprit.

Low urine volume is the culprit,” says Nina F. Casanova, MD, a urologist at Littleton Adventist Dr. Nina F. Casanova Hospital.

Too much salt in the diet makes matters worse. How? “Salt pulls calcium along with it into the urine,” Casanova says.

Downstream from all this activity is the bladder, which is connected to the kidney by a thin tube called the ureter. A stone the size of a tiny pebble can block urine flow.

Blocked urine backs up into the kidney, which swells and triggers five-alarm flank pain. Other symptoms may include blood in the urine, nausea and vomiting, and fever and chills.

WHAT TO DO TREATMENT

See your primary care physician or urologist immediately. Treatments include:  Passing the stone on your own  Ureteroscopy, which uses small instruments to retrieve or obliterate the stone S hock wave lithotripsy, which uses sound waves to blast the stone P ercutaneous stone removal (for large or irregularly shaped stones)

WHAT NOT TO DO  Do not cut back on

STONECOLD STATS

Research out of South Carolina suggests that teenagers are at growing risk for kidney stones. In fact, from 1997 to 2012 teens had the highest rate of increase of kidney stones among all groups in a 150,000-patient study.

What gives? Nina Casanova, MD, says Western diets heavy in soda, caffeine, and salt are likely driving the increase.

calcium. Low dietary calcium increases risk of kidney stones.  Do not try crash diets, especially high-protein weight loss diets, which have been linked to kidney stone formation.

PREVENTION  Drink fluids. Casanova recommends ten 10-ounce glasses of water daily.

Clear urine signals good hydration.  Limit sodium to 1,500 milligrams daily. E at more fruits and vegetables, which may create urine less conducive to stone formation.  L ose weight if you are overweight.

Obesity changes the acid levels in the urine, which causes stones not to dissolve well.

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If you suffer with recurring kidney stones, a urologist can help you find the cause and the right treatment. Visit centura.org and click the “Find a Provider” tab today.

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A ROCK

STROKE

OF GOOD FORTUNE NEW RAPID IMAGING TECHNOLOGY AT LITTLETON ADVENTIST HOSPITAL GIVES STROKE PATIENTS BETTER OUTCOMES

Thanks to quick intervention after she suffered a stroke, Sally Seier is back to enjoying time with her granddaughters.

!

FAST Action An old adage about stroke says that time is brain. To learn warning signs of stroke, remember FAST:

FACE

Face drooping

ARMS

When lifted, does one arm drift downward?

SPEECH Is speech slurred?

TIME

If you see any of these signs, call 911.

For physicians and patients trying to treat and recover from stroke, a challenge has always been the condition’s unknowns: How much damage

was done? Could intervention help? How much recovery is possible?

But when Sally Seier suffered a stroke last August, her care team at Littleton Adventist Hospital knew almost immediately how much damage had occurred, which areas of her brain were affected — and which weren’t. With that information, Perry Ng, MD, was certain she would benefit by removing the blood clot causing her stroke.

Ng is a radiologist with CHPG Neuroscience and Spine who specializes in noninvasive procedures to treat neurological conditions, such as stroke.

Littleton Adventist Hospital uses Rapid processing of Perfusion and Diffusion (RAPID) CT, a new imaging software developed at Stanford University, to provide physicians like Ng with real-time maps of blood flow and circulation in the brain.

“The RAPID CT images provide an estimate of the amount of brain damaged by stroke versus the amount that is potentially salvageable if we remove a blood clot,” Ng says. Generally, the bigger the difference between the two, the more a patient would benefit from removing the clot.

In Seier’s case, the difference was significant, and Ng performed a thrombectomy, or blood-clot removal, in just 27 minutes.

Thrombectomy carries risks, Ng says. So knowing who will benefit, and who won’t, offers a great advantage.

In Seier’s case, RAPID CT gave her doctors information that ultimately helped her recover completely. “I basically came through unscathed.”

Dr. Perry Ng

MORE OPTIONS FOR MORE PATIENTS While fast treatment for stroke is essential, newly released guidelines about the timing for stroke intervention could make a huge difference. Doctors now have up to 24 hours after the onset of stroke symptoms — compared to just six to eight hours as previously thought — to remove the clot surgically. RAPID imaging is helping make it possible by identifying affected areas of the brain. These new guidelines could double or even triple the number of patients who could be eligible for the clot removal procedure.

To learn more about Centura Health’s stroke network, as well as risk factors and prevention, go to centura.org/ stroke.

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Portercare Adventist Health System NON-PROFIT ORG US POSTAGE

PAID

DENVER, CO PERMIT NO. 3280

7700 S. Broadway Littleton, CO 80122

ST-elevation myocardial infarction (STEMI) is a serious heart attack, in which a major artery is blocked. A blocked artery means that oxygen is not reaching vital organs, so fast medical treatment not only saves lives but can prevent major disabilities.

At Littleton Adventist Hospital, new systems assure STEMI patients get lifesaving treatment, fast.

Care starts when paramedics outside the hospital perform a 12lead EKG and identify a STEMI. Paramedics alert Littleton Adventist Hospital’s Level II Trauma Center, which calls a cardiac alert and summons the cardiac team.

When these patients arrive at the hospital, they are whisked directly to the cardiac catheterization lab for treatment.

The protocol has paid off: Patients who are treated at Littleton Adventist Hospital have their arteries opened within 32.5 minutes on average of arrival, far beating the national recommendation of 90 minutes or less.

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 303-738-7781 (TTY: 711). Copyright © Centura Health, 2018. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 303-738-7781 (TTY: 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 719-776-5370 (TTY: 711).

2018 SPRING CALENDAR

COMFORT MEASURES

We recommend this class as an add-on AFTER completing one of our other Childbirth Preparation classes. This class is focused on comfort measures and strategies for those looking for more practice with labor skills and those planning an unmedicated delivery. As you rotate through “labor stations,” you will have the opportunity to practice labor coping skills that can be used to manage labor more comfortably.

This class is primarily practiceoriented and will give you a variety of tools to use during labor, including relaxation, positioning, and breathing, so you can gain additional confidence and skills for your upcoming birth.

Date | Wednesday, Apr 18, 6-9 p.m.; Thursday, May 24, 6-9 p.m.; or Wednesday, Jun 13, 6-9 p.m.

PUMPING & BACK TO WORK

This class will cover techniques and suggestions to maintain milk supply, paced bottle-feeding,

power pumping, and breast milk storage guidelines. Please come with your questions and concerns. As a participant, you are encouraged to bring your pump if you have questions about it. Feel free to attend this class before or after your baby is born.

Date | Saturdays, Apr 21, May 12, or Jun 16 Time ǀ 12:30-1:30 p.m.

GIRL TALK

This one-time, two-hour class is recommended for mothers and daughters ages 9-13 years old.

We will focus on the anatomy, physical changes of puberty, menstruation, and hygiene.

Our goal is to create a relaxed atmosphere for preteens and a trusted adult to learn factual information, encourage open communication, and promote young girls’ positive self-esteem.

This class is taught by a pediatric nurse practitioner.

Date ǀ Thursdays, Apr 26, May 17, or Jun 21 Time ǀ 6-8 p.m.

BIRTH DAY WISHES

Whether it’s your first, second, or third delivery, we recommend scheduling your complimentary, preadmission appointment with our OB birth navigator.

During your private appointment, your medical history will be updated, allowing you to focus on your birth experience once you arrive for delivery. Birth Day Wishes allows you to discuss your labor, delivery, and birth preferences, and get started on your baby’s birth certificate. Plus, it’s a perfect opportunity to have all your questions answered.

If you would like a tour of the BirthPlace and want to save time, a private tour can be included as part of your Birth Day Wishes appointment.

Call 303-734-2186 to schedule an appointment.

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SAVING LIVES BY SAVING TIME