Create Summer 2016

SUMMER 2016 • Volume 4, Issue 3

Your health. Your life.

Improve the odds

Knowing the risk factors and how to lower them helps protect against breast cancer

a n d ...

Focus on nutrition Page 2

News for moms-to-be Page 3

Know when to go to the ER Page 6

Neuropsychology: Solving medical puzzles Page 7

IN Good Health Nutrition 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.

1% R ita Sharma, MD, a board-certified family physician,

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 | SUMMER 2016 • Create

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

works with many women between the ages of 30 and 45 who are trying to maintain healthy weights while providing balanced nutrition for their children.

Sometimes while working with women, she discovers factors such as sleep disorders or depression that are affecting their appetite and weight management success.

She finds that taking a nonjudgmental, commonsense approach to changing their lifestyle, rather than trying to overhaul their entire lives, delivers results.

“The success stories we see — what really works for women — is a trusting partnership with her physician who can help develop a personalized plan,” Sharma says.

To schedule an appointment with Dr. Sharma, call 303-770-6500.

Eating during cancer treatment For some people, chemotherapy and radiation can kill their appetite along with their cancer cells. Jane Motler, a nutrition counselor at Littleton Adventist Hospital’s cancer program, offers tips for people who struggle: • Food tastes different: If food tastes too sweet, for example, try adding vinegar, lemon, or other flavorings to make it more palatable. It might also be a good time to try something new.

“Eat a wide variety of foods,” Motler says, because “in cancer, there are no superfoods.”

• You have no appetite: Talk with your physicians about prescription drugs,

such as megestrol acetate (Megace) and dronabinol (Marinol), which can improve appetite and/or tamp down nausea.

“Don’t be a hero, take what medications you need to get rid of symptoms so that you can eat,” Motler says.

• Unable to eat enough: Supplements, such as protein drinks, can help boost your nutrient intake. Multivitamins and minerals are a good idea with a poor appetite. But be careful to choose those with no more than 100 percent of the recommended daily allowance as megadoses of antioxidants, such as vitamins C and E, may interfere with cancer treatment mechanisms.

A drop of just 1 percent in your A1C — the measure of your average blood glucose levels over the past three months — can reduce your risk of developing eye, kidney and nerve disease by 40 percent and reduce the risk of diabetes complications by 30 percent.

Food is a top factor in lowering blood sugar, so summer is a great time to target a lower A1C. Load up on leafy greens and non-starchy vegetables at the farmers’ market.

Diabetes education and nutrition counseling Littleton Adventist Hospital offers classes to help you take charge of your diabetes and learn about nutritional management, medication, blood glucose monitoring and setting personal goals. Individual nutrition counseling sessions also are available with a Littleton Adventist Hospital registered dietitian. Physician referrals are required.

Call 303-738-2654 for more information and schedules.

Cover photo: ©istockphoto.com/laflor; This page clockwise: ©IStockphoto.com/YinYang, /Milenko Bokan, /eurobanks; Opposite Page: ©IStockphoto.com/MelvinDyson, /Anna Omelchenko, /Vasileios Economou

Nutrition

Prep before pregnancy, bounce back afterward

Dr. Rania Khan

Gentle C-sections Until recently, women who delivered a child through cesarean section, or C-section, missed out on the golden hour of bonding — skin on skin — with their newborn. A new approach this year at Littleton Adventist Hospital, called “gentle C-section,” is putting more magic back into the first hour of life.

In a normal vaginal delivery, the newborn is placed on the mother’s chest and perhaps even breastfeeds during that important first hour of bonding. After a C-section, the baby is typically shown to the mother briefly and then whisked off to the nursery while the mother goes to a recovery room, says Stacy Kreil, Littleton Adventist Hospital’s service line director for women and children.

With the gentle C-section birth plan at Littleton Adventist Hospital, the newborn is quickly examined and then placed on the mother, while the surgeon stitches up the incision. Then the baby and mother can go to the recovery room together.

The more regular moderate exercise a woman performs before the delivery of her baby, the more quickly her body will recover.

Moderate exercise isn’t just beneficial to get your pre-baby body back. Working out 30 minutes five days a week can also reduce the incidence of gestational diabetes by 30 percent

to 50 percent.

The best time to get in shape for delivering a baby is really before conceiving the baby, says Rania Khan, DO, an obstetrician/gynecologist at Littleton Adventist Hospital. “It’s best to begin a pregnancy at an appropriate weight and in good physical condition,” she says. Even if you don’t start your pregnancy in great shape, that doesn’t mean you should give up. Just be sure to check with your doctor on how to safely increase physical activity.

Ban the booze before baby Drinking during pregnancy — even in the earliest stage — can cause lifelong problems for a child. More than 3 million American women risk prenatal drinking, according to a recent report by the Centers for Disease Control and Prevention.

The disabilities caused by alcohol, known as fetal alcohol spectrum disorders, are the leading cause of preventable mental disability in children. More than 40,000 U.S. babies are born each year with fetal alcohol spectrum disorders.

Anyone sexually active and not using birth control should stop drinking, the CDC recommends. No known amount of alcohol is safe.

“Before a woman even knows she is pregnant — before a positive pregnancy test can be had — it’s possible the mother’s alcohol consumption could cause physical, behavioral, and mental harm,” says Rania Khan, DO, an obstetrician/ gynecologist at Littleton Adventist Hospital.

However, if you did drink before you knew you were pregnant but stopped right away, chances are good that no harm was done. Just be sure to tell your doctor or midwife.

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Risk Man Knowing your risk factors can improve your odds of surviving breast cancer

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even out of eight women in the United States will never have breast cancer. If you’d like to improve your odds of not being the one out of eight, the first step is understanding your risk factors. If they are lifestyle-related — such as smoking — you can make changes that will reduce your risk. If they are not factors that you can change — such as your age — you can improve your odds of surviving breast cancer by regular screenings.

Here, two breast cancer experts with Littleton Adventist Hospital help women sort through the risk factors.

Age Next to being a woman, age is the single biggest risk factor for developing breast cancer.

The risk of breast cancer goes up with age, with two out of three invasive breast cancers Dr. Jodi Widner found in women 55 or older. But younger women aren’t exempt, says Jodi Widner, MD, surgeon and cofounder of the Breast Care Center at Littleton Adventist Hospital.

“Young women also need to be vigilant and aware of their bodies, watching for any changes,” Widner says. “They often come in for help at a later stage because they think they’re too young for it to happen to them.”

Contrary to popular belief that a mammogram is the only way to detect cancer, women themselves find about 40 percent of diagnosed breast cancers first.

Since you don’t have control over your age, the best action you can take is regular screenings that can detect breast cancer at its earliest stages. If diagnosed early, there is a 93 percent survival rate. Widner recommends: • Age 20: Start breast self-exams monthly • Age 25: Add annual clinical breast exams by a health care provider • Age 40: Add annual screening mammograms (different health care organizations recommend different ages of when to start, so you should discuss this with your physician)

Magic 3 Early detection is key to finding breast cancer when it’s most treatable. There are three ways to schedule a 3-D screening mammogram at Littleton Adventist Hospital:

1 2 3

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Call 1-844-325-5439.

Fill out an online request at mylittletonhospital.org/mammo.

Text your name to 720-358-5412 and our scheduler will call you.

Estrogen Higher levels of estrogen over time increase the risk of breast cancers related to hormone receptors, which account for about 70 percent of all breast cancer cases. Some of the factors that influence estrogen include: • Women who start menstruating under the age of 12, or who go through menopause after age 55, have a higher risk of breast cancer later in life because of longer lifetime exposure to the hormones estrogen and progesterone.

• Pregnancy reduces the number of menstrual cycles in a woman’s life — thus cutting her estrogen exposure — which could be a protective factor, scientists say.

• Breastfeeding, especially for longer than a year, also can reduce cancer risk because it reduces estrogen.

• Being overweight increases your risk of breast cancer because fat cells produce estrogen.

• Hormone replacement therapy that combines estrogen and progesterone increases a women’s risk of breast cancer, especially if used for longer than five years. However, the risk returns to normal three years after stopping.

Family History and Genetics Most women diagnosed with breast cancer have no family history of the disease. Still, family history does increase your risk of developing breast cancer: • Your breast cancer risk doubles if a firstdegree relative (mother, sister, or daughter) has had the disease. Your risk also increases if your father or brother had breast cancer.

• Your risk increases even further if your firstdegree relative had breast cancer before age 40.

• If more than one first-degree relative has had breast cancer, that risk increases as much as fivefold.

Only about 5 percent to 10 percent of breast cancers are caused by a genetic mutation that is passed down from a parent. One of the most common misunderstandings is that genetic

risks for breast cancer are transmitted only through the mother’s side of the family, says Erin Hoffman, a Littleton Adventist Hospital genetic counselor. “The history of breast cancer on your dad’s side is just as important,” she says.

Most inherited cases of breast cancer are linked to mutations in two genes: BRCA1 (BReast CAncer) and BRCA2. These genes repair DNA damage and help keep breast cells growing normally. If they don’t function properly, cancer risk increases. “We now know, however, that there are a multitude of genes that also can cause inherited breast cancer, and women who previously had testing only for BRCA1 and BRCA2 should consider getting updated testing,” Hoffman says.

The likelihood of carrying a genetic mutation that increases your chances of developing breast cancer go up with the following risk factors: • Multiple first-degree relatives — your mother, sister, daughter — have had breast cancer • A more distant relative was diagnosed with breast cancer before age 50 • A man in your family has had breast cancer • You are of Ashkenazi Jewish heritage • Your family has a history of ovarian and breast cancer Although your risk of developing breast cancer is higher if you fit one of these categories, that does not mean you necessarily carry the genetic mutation, Hoffman emphasizes. Genetic counseling can help you understand your risk and determine whether you qualify for genetic testing.

If your family history has you concerned about your breast cancer risk, consider scheduling an appointment with a genetic counselor at Littleton Adventist Hospital.

Call 303-734-3969 or download our Genetic Counseling Referral Form at mylittletonhospital.org/lahgenetic.

Surprising Risk Raisers There are some lifestyle factors beyond smoking, diet, and exercise that can raise your risk for breast cancer. Here’s what to do about some of these surprising risks: • Defend with D: Research shows low levels of vitamin D are linked to higher breast cancer risk, and levels are an easy thing to check and raise with supplements, sunlight, or fortified foods, says Jodi Widner, MD, breast cancer surgeon at Littleton Adventist Hospital.

• Swap out sugar: A 2016 study at the University of Texas MD Anderson Cancer Center found that high amounts of dietary sugar may increase the risk of breast cancer and metastasis to the lungs. “Cancers are sugar-sensitive cells, feeding on sugars,” Widner says.

• Turn out the night-light: Some studies suggest that women who work the night shift — or are exposed to high levels of light at night — have an increased risk for breast cancer.

• Be aware of radiation risk: A littleknown breast cancer risk factor, Widner says, is treatment for another cancer by radiation of the chest. Women irradiated for diseases of the thyroid or for Hodgkin’s disease or non-Hodgkin’s lymphoma are at significantly higher risk of developing breast cancer.

• Limit liquor: Alcoholic consumption increases levels of estrogen and perhaps also damages DNA. As few as three drinks of any kind of alcohol each week raises the risk of breast cancer by 15 percent, research shows. (One drink equals 12 ounces of beer, 5 ounces of wine, and 1.5 ounces of hard liquor.)

• Veg out: In multiple studies, vegetarians have lower rates of cancer. Although the exact linkage has not been determined, Widner recommends reducing meat and other animal-based products while increasing fruits and vegetables.

We are part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas. create | mylittletonhospital.org | 5

Photos: ©istockphoto.com/bymuratdeniz, /YinYang

nagement

Head to toe, know when to go Heart attacks and strokes are not the only medical emergencies that require fast care

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trip to the ER won’t always be triggered by severe chest pain or loss of consciousness.

Sometimes the symptoms are more subtle, but just as serious.

“Common sense can play a big role in whether or not your condition warrants a trip to the ER,” says Ahmed Stowers, MD, medical director at Porter Adventist Hospital Emergency Department. “When in doubt, go to the ER.” Use this head-to-toe guide to assess symptoms of the most common medical emergencies.

Stroke, concussion, serious infection, cardiac arrest

Inability to be awakened

Stroke, cardiac arrest

Sudden, severe headache

Blood clot, stroke, aneurysm, hemorrhage

Drooping face

Stroke

Slurred or altered speech

Stroke

Loss of vision or blurred vision

Stroke

Neck, jaw

Unusual discomfort/pain

Heart attack

Chest

Sudden, unusual pain

Heart attack, heart failure

Lungs

Shortness of breath, difficulty breathing

Heart attack, heart failure, blood clot

Abdomen

Sudden, intense, or lingering pain that worsens over time

Appendicitis, ectopic pregnancy, hole in intestine, bowel blockage (Note: Women may experience stomach pain during a heart attack.)

Arms

Paralysis, numbness, weakness

Stroke

Unusual discomfort/pain

Heart attack

Legs

Paralysis, numbness, weakness

Stroke

signs of something more serious These symptoms also require immediate emergency attention: • Sudden, severe, unusual pain anywhere throughout your body • Uncontrollable bleeding • Persistent or severe vomiting or diarrhea • Blood in your vomit or stool • Unmanageable fever • Infectious condition with pain elsewhere in the body • Seizures with no known history of epilepsy

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Possible indication of

Confusion, disorientation

Head

7

symptoms

The Centura Health Trauma System is the region’s leading and most comprehensive network of trauma care and emergency services. It includes six emergency rooms throughout the southern Denver metro area: • Castle Rock Adventist Hospital • Littleton Adventist Hospital • Centura Health Emergency & Urgent Care (opening September 2016) • Parker Adventist Hospital • Porter Adventist Hospital • Southlands ER

For more info and to see wait times, go to centura.org/urgent-care-and-ers.

This Page: Illustration: ©Istockphoto.com/neyro2008; OPPOSITE Page: ©Michael Richmond

body Area

Mindful Medicine Your aging father is having trouble remembering your child’s name or where he left his car keys or even his car. Is this normal old age or a sign of dementia?

The specialty of neuropsychology helps identify underlying causes of cognitive disorders

Your teenage son who used to be a whiz at math is now struggling. Is it because trigonometry isn’t his thing, or could that head collision last year in soccer be the cause?

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or the longest time, questions like these went unanswered. Now there’s a little-known field of psychology called neuropsychology that helps piece together the puzzle between the physical and cognitive.

Neuropsychology specializes in the assessment and treatment of patients with brain injury or disease accompanied by impairment in behavior, thinking and learning.

“I help with diagnosis and treatments when cognitive problems are involved,” says Ed Cotgageorge, PhD, ABN, a board-certified neuropsychologist at Littleton Adventist Hospital (shown in this photo).

Knowledge Is Power The answers that Cotgageorge finds don’t necessarily lead to a cure, but they often lead to clarity and comfort. A diagnosis of Alzheimer’s disease or another neurocognitive disorder regardless of cause, for instance, would seem to be a devastating blow.

Yet for many patients already suffering the symptoms, the knowledge of what is happening with them is a powerful thing.

“What I hear from patients is: ‘Now I know what’s going on. Now I’ve got something tangible to go on,’” Cotgageorge says. “There is relief. They just want to know. The knowledge returns a little control.”

Expert Consultation Cotgageorge, who joined Centura Health Physician Group last fall, specializes in evaluating a wide range of neurological disorders. To do so, he examines the biological, psychological, and social factors important to health and well-being.

Cotgageorge is part of Centura Health Physician Group Neuroscience Littleton that treats disorders of the brain, spine, and nervous system. Conditions he consults on include:

• Attention deficit hyperactivity disorder • Alzheimer’s disease • Evaluating patients’ suitability for deep brain stimulation • Behavioral pain management • Brain tumors • Workers’ compensation evaluations • Evaluating patients’ mental competency/capacity • Learning deficits • Mild cognitive impairment • Parkinson’s disease • Psychological evaluations for spine surgery and spinal cord stimulations • Seizure • Speech problems • Stroke • Traumatic brain injury The team includes board-certified neurologists, neurosurgeons, neurointerventionalists, and neuropsychologists, such as Cotgageorge. While he frequently works with neurologists and neurosurgeons, Cotgageorge also consults with primary care physicians, therapists, and other health care providers to diagnose and treat patients.

Although neuropsychology has roots back to the late 1800s, it began to get modern-day attention after World War II when doctors needed to treat a large number of veterans with head injuries.

Dr. James “Ed” Cotgageorge Centura Health Physician Group Neuroscience and Spine 7720 S. Broadway, Suite 500 Littleton, CO 80122 303-730-4402 chpgneurospine.org

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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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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.

entityhospital.org Experience the Wonder With Us: Learn About Our OB and High-Risk Pregnancy Care

Every pregnancy deserves expert, compassionate care, and some mothers and soon-to-be moms may need a higher level of specialized attention. Learn from our expert OBGYN physicians about what to expect with a high-risk pregnancy, and what factors are identified to determine if you are considered high-risk.

Date | Thu, Aug 11 Time | 11:30 a.m.-1 p.m.

Location | Centura Health Physician Group Highlands, 2490 West 26th Avenue, #A120, Denver Registration | mylittletonhospital. org/lahclasses OR Date | Tue, Aug 23 Time | 5:30-7 p.m.

Location | Westridge Recreation Center, 9650 Foothills Canyon Blvd., Highlands Ranch Registration | mylittletonhospital. org/lahclasses

2016 calendar

Prevention and Early Detection of Women’s Cancers

Dr. Glenn Bigsby, gynecologic oncologist, treats the five women’s reproductive system cancers; he will discuss the signs and symptoms of those cancers, as well as risk factors and prevention tips.

Date | Tue, Sep 20 Time | 6-7 p.m.

Location | Westridge Recreation Center, 9650 Foothills Canyon Blvd., Highlands Ranch Registration | mylittletonhospital. org/lahclasses

Breathe Easier

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. Karng 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, 7301 South Santa Fe Drive, #180, Littleton Registration | mylittletonhospital. org/lahclasses

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SUMMER

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