Create Summer 2018

SUMMER 2018 • Volume 6, Issue 3

Your health. Your life.

GREAT

STRIDES

WITH ADVANCED SURGICAL TECHNIQUES AND INNOVATIVE ARTIFICIAL LIMBS, LITTLETON SURGEON HELPS SAVE THE LIVES OF BONE CANCER PATIENTS Page 4

a n d ...

FASTER ABDOMINAL SURGERY THANKS TO ROBOTIC ASSISTANCE Page 3

MANAGING MEDS CAN UP YOUR GAME Page 6

PROMISING PROCEDURES TO STOP SEIZURES Page 7

Dealing With

DIABETES NEW MEDICATION OPTIONS

In the past decade, more than 30 million Americans with type 2 diabetes have had a growing list of medication options to treat their disease. Two of the most promising classes of those drugs are: • Sodium-glucose transporter 2 (SGLT2) inhibitors work by preventing the kidneys from releasing excess glucose back into the bloodstream. That means more sugar leaves the body through urine, which helps maintain appropriate blood sugar levels.

• Glucagon-like peptide-1 receptor agonists (GLP-1) are injectable medications that limit how much sugar the liver releases into the blood and slow the rate at which food leaves the stomach.

That allows the pancreas to produce more insulin, which lowers blood sugar.

SCREENING OUT HIDDEN DIABETES

Often people can develop type 2 diabetes without knowing it, because symptoms mimic other conditions, says Naomi Chawla, BSN, RN, certified diabetes educator at Porter Adventist Hospital. Common symptoms include: g Unexplained fatigue g Frequent urination g Dry mouth g Extreme thirst g Unexplained weight loss The American Diabetes Association recommends annual screening for everyone starting at age 45. Start earlier if you have risk factors such as a family history of diabetes; you are overweight or have high blood pressure; you’ve had gestational diabetes; or you are of African-American, Asian, Native Hawaiian, Hispanic, or Latino descent.

PATHWAYS TO HEALTH & WELLNESS

Need help getting your blood sugar under control. Register for Pathways to Health & Wellness, an 18-session seminar to help you assess your health, lose weight, lower blood sugar and cholesterol, and even reverse type 2 diabetes. Call 303-765-6315 to learn more.

Over time, high blood sugar can damage the delicate nerve fibers and weaken the small vessels that carry blood to and from arms, hands, legs, and feet.

The resulting lack of sensation — called neuropathy — carries hidden dangers, says David Hardin, MD, surgeon with the Porter Wound Care & Hyperbaric Center. “Let’s say you’re walking with a rock in your shoe. You would stop and pull it out. But those with diabetes may have no sensation and not realize it’s there.”

People with diabetes are likely to get more wounds, and those wounds tend to heal more slowly and are prone to infection due to decreased blood flow and oxygen.

That’s where the hyperbaric oxygen therapy (HBO) can help.

“We can use hyperbaric pressure to supersaturate the blood with more oxygen,” to facilitate healing, Hardin says. “Oxygen is the building block for healing.”

HEALTHY HEALING If you are suffering from any type of wound, the wound care experts at Centura Health can help. Our two South Denver wound care centers are: Porter Wound Care & Hyperbaric Center 990 E. Harvard Ave., Denver 303-778-5242 Wound Care Center at Parker Adventist Hospital 9395 Crown Crest Blvd., Parker 303-269-2310

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 produced by Clementine Healthcare Marketing and published four times annually by Littleton Adventist Hospital — Portercare Adventist Health System. 7700 S. Broadway | Littleton, CO 80122 | mylittletonhospital.org 2 | SUMMER 2018 • Create

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Summer

HEALTH BRIEFS

HYPERBARIC WOUND HEALING

A HELPING HAND

I

Robot-assisted surgery means shorter recovery, less pain

t used to be that abdominal surgery meant lots of pain, and potentially a long recovery. But now at Littleton Adventist Hospital, that is changing for many patients, thanks to the da Vinci Xi minimally invasive robotic surgery system.

PATIENT BENEFITS

Dr. Douglas Benson

Douglas Benson, MD, a colon and rectal surgeon at Littleton Adventist Hospital, says the updated system offers many advantages. “I’ve had people who have surgery for rectal cancer or diverticulitis back to work a week after surgery,” he says. Main benefits to patients include:

î Less pain î Less blood loss î Lower infection risk

î Shorter hospital stays î Shorter recovery times î Smaller incision

About 60 percent of his colon cancer surgery patients go home two days after surgery, but “I’ve even sent some home the next day,” Benson says. That compares to the national average of five to six days.

Because the robotic system applies less torque to tissue around the surgery area, bowel function returns sooner, letting patients go home sooner.

In addition, data shows that less movement of tissue means less pain, Benson says. And that reduces the need for narcotics after surgery, which in turn allows patients to be back on their feet — and back to activities — sooner.

No R2-D2 in the OR

ROBOTIC SURGERY CANDIDATES In his practice, Benson most commonly uses robotic technology to treat:

î Colon cancer î Inflammatory bowel disease î Diverticulitis Most patients are candidates for robotic surgery, he says.

The exception may be those who have extensive scar tissue due to previous surgeries.

“Abdominal robotic surgery has taken off in the last five years,” Benson says. “And I think we will see more of it in the future.”

To learn m ore about rob oticassisted su rgery, visit centu ra.org/ robotics.

Despite its name, robotic surgery doesn’t mean a human turns the surgery over to a robot.

A more accurate term is robot-assisted surgery, says Benson.

During the procedure, the surgeon sits at a console and controls the movement of two highly precise instruments that Benson likens to joysticks. “The robot is a tool of a laparoscopic surgeon,” he says.

The robotic technology provides greater precision. “It also reduces tremor. Everyone has a natural tremor. The robot has less, and allows you greater freedom of movement.”

The new da Vinci Xi includes a boom, which hovers over the patient, and can be rotated. “This gives you more mobility than earlier versions, which saves a huge amount of time,” Benson says. “And less time in the operating room is good for the patient.”

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SAVING LIVES, AND LIMBS SPECIAL EXPERTISE HELPS PATIENTS WITH RARE BONE CANCERS LIVE LONGER, AND BETTER

F Dr. Ronald Hugate

or patients with rare bone tumors in their arms or legs, there are few doctors in the entire country who can effectively remove the cancer while saving the limb.

Littleton Adventist Hospital Orthopedic Oncology Medical Director Ronald Hugate, MD, is one of those rare physicians.

Just 30 years ago, patients with bone cancers were all but certain to lose that arm or leg, and probably their battle with cancer. In fact, until the early 1980s, about 80 percent of patients with bone cancers died, and most underwent amputation.

But in the past three decades, the outlook for these patients has brightened considerably, thanks to the small, highly specialized, emerging field of orthopedics known as orthopedic oncology and “limbpreservation surgery” of which Hugate is a part.

“Now, chemotherapy and other treatments are so good that up to 90 percent of patients survive their bone cancers. And since the mid1980s, we have developed advanced surgical techniques to reconstruct bones and joints rather than amputate,” says Hugate, who is one of fewer than 200 trained orthopedic oncologists in the United States.

the patient can maintain function in the affected limb. Then, instead of amputating, orthopedic oncologists construct bone using metal components or harvested bone, Hugate says.

Implanted metal parts can last a lifetime, but some plastic components may need to be replaced every decade or so as they wear out, Hugate says.

Cancers that originate in bone are rare. The National Cancer Institute estimates they make up about 1 percent of all cancers, or about 2,300 cases in the United States each year. Two of the most common types — osteosarcoma and Ewing’s sarcoma — affect mainly children and young adults.

“In the case of pediatric patients, we reconstruct their bones with an expandable implant,” Hugate says. But when the children are fully grown, that expandable implant often is replaced with a permanent one.

“We have developed advanced surgical techniques to reconstruct bones and joints rather than amputate.”

LIMB-SAVING SURGERY

~ Dr. Ronald Hugate

During limb-salvage surgery, the cancerous part of the bone is removed, while nearby tendons, nerves, and blood vessels are preserved so

LIFE-CHANGING RESULTS

That follow-up care gives Hugate the opportunity to stay in touch with pediatric cancer patients as they grow up, and see firsthand how they benefit from life- and limb-preservation surgery. One of those patients, whom he operated on when she was 8 years old, recently invited Hugate to her high school graduation.

“It’s just amazing to see that,” he says. “Ten years ago, she was battling for her life and her limb, and now she walked into my office with both of her legs functioning well and a high school graduation invitation. And she wants to be a doctor. There is no better feeling for me and my team!”

In addition to orthopedic oncology, Dr. Hugate specializes in joint replacement surgery. He has authored a book on that subject: The Handbook of Hip & Knee Replacement Surgery: Through the Eyes of the Patient, Surgeon & Medical Team.

4 | SUMMER 2018 • Create

LITTLETON SURGEON INVENTS IMPROVED PROSTHETICS

As one of only 200 specially trained orthopedic oncologists in the United States, Dr. Hugate is helping find better ways to treat bone cancer so that patients don’t have to undergo amputation.

As a U.S. Army surgeon in Iraq and Afghanistan, then-Lt. Col. Ronald Hugate, MD, treated scores of service members who lost limbs. Watching those active young amputees struggle with clunky, uncomfortable artificial limbs inspired Hugate to pioneer a technology that connects prosthetic limbs directly to the bone and provides greater comfort and mobility. The technology is called osseous integration.

Traditionally, artificial limbs are attached with an outer socket that fits over the residual limb. But those aren’t always comfortable, often don’t fit right, and can cause skin irritation and sores. And heavy perspiration has even been known to cause the limbs to come loose and detach during activities.

With osseous-integrated limbs, an implant that is sized to fit is pressed into the bone canal, and the tissues actually grow into and around the prosthetic, creating a seal much like a deer’s antler has as it enters the skin, Hugate says. This helps prevent infection and make the implant more a part of the patient.

“The integrated prosthetic leg is more functional; there is less pain, and no pressure or irritation from perspiration,” Hugate says. And the integrated leg provides better function and flexibility.

Osseous integration is an emerging technology and isn’t yet an option for everyone. Hugate currently offers the option to patients for whom traditional socket technology has failed, and those who are: • Between the ages of 18 and 50 in good health • Nonsmokers • Nondiabetics • Above-knee amputees (although other amputee types may be considered) • Without history of active infection

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PHOTO: ©MATTHEW STAVER

Army stent leads doctor to seek better solution

PERSONAL BEST Primary care sports medicine physicians can help you reach your peak performance

some primary care doctors also can serve as your personal trainer?

Family practice and internal medicine doctors who have additional training in sports medicine are called primary care sports medicine physicians. These physicians can treat the vast majority of activity-related injuries, using nonsurgical techniques to treat pain and get you back to your game.

Primary care sports medicine physicians also can help develop programs that prevent injuries and enhance your performance, whether you’re a serious athlete or just trying to stay active. They also help patients with chronic conditions, such as asthma, learn how to exercise safely and effectively.

Subbing In | Many patients think that since these specialists are primary care doctors then they have to leave their family doctor. But the title can be misleading — primary care sports medicine doctors are adjuncts to your normal care team.

Dr. Heidi Christensen “You can actually keep your PCP,” says Heidi Christensen, MD, CAQSM, FACEP, primary care sports medicine physician at Ridgeline Family and Sports Medicine at the Meadows.

“We can help with issues like acute and chronic overuse injuries and provide counseling on improving your sports performance and injury prevention.”

While sports injuries are common, approximately 90 percent of them don’t require orthopedic surgery. But they do benefit from the kind of comprehensive, nonsurgical approach to treatment and rehabilitation that primary care sports medicine physicians provide.

And if surgery is needed for an injury, primary care sports medicine physicians team up with orthopedic surgeons to make sure the transition is smooth.

COMMON CONDITIONS TREATED From strains and sprains to chronic injuries, primary care sports medicine physicians have the specialized training and expertise to help you return to your sport or get back to enjoying your favorite recreational activities. Here are a few of the conditions they treat:

★ Ankle sprains ★ Carpal tunnel syndrome ★ Concussion ★ Femoroacetabular impingement ★ Golfer’s elbow 6 | Summer 2018 • Create

★ Growth plate injuries ★ Osteoarthritis in children ★ Patellar tendinitis ★ Iliotibial (IT) band ★ Plantar fasciitis syndrome ★ Rotator cuff syndrome ★ MCL and LCL knee ★ Tennis elbow injuries ★ Trigger finger ★ Neck and back strains

COULD YOUR MEDS BE AFFECTING YOUR PERFORMANCE? Managing chronic diseases can look different for athletes than other people — especially when it comes to medications.

“There are medications that are fine for the general population that would not be good to treat an athlete,” Christensen says.

She and other primary care sports medicine physicians can help with medication modifications. For example, beta-blockers are a common concern.

“People with high blood pressure or chronic headaches are often prescribed betablockers, which slow the heart rate,” Christensen says. They can be problematic because without an appropriate increase in heart rate in response to exercise — or any physical exertion for that matter — vital organs are not able to get appropriate blood flow during exercise. Because of this, people on these medications can have some serious side effects, such as shortness of breath, chest pain, and fainting, Christensen explains.

Make an appointment with Dr. Christensen by calling 720-455-3750.

No referral is needed, and same-day appointments are available for urgent needs.

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You go to themtheforfluyour annual exams and when hits. But did you know that

NEW WEAPONS AGAINST EPILEPSY NEW OPTIONS HELP CONTROL SEIZURES AND GIVE PATIENTS THEIR LIVES BACK Three million people in the United States have epilepsy, and medication fails to control seizures for about one-third of them, says neurosurgeon David VanSickle, MD,

PhD, of Neurosurgery One (formerly South Denver Neurosurgery) ­— A Centura Health Clinic.

For those patients, uncontrolled seizures can disrupt their lives, from driving and dating to holding a job and even taking a shower.

But the last decade has seen enormous advances in treatment, offering those patients new hope. Some of the most promising procedures include: • Laser ablation. A laser fiber is threaded IF AT FIRST through a tiny incision to the source of the seizures.

YOU DON’T Guided by magnetic resonance imaging (MRI), the SUCCEED laser heats and destroys the small area causing the seizures, leaving surrounding tissue unharmed.

If one of the Candidates must have identifiable areas linked three procedures to seizures.

The procedure is highly successful, doesn’t alleviate VanSickle says.

“The patient has a 60 percent chance symptoms, of never having seizures again.” patients can try Dr. David VanSickle

one or more of the other options. Repeat surgeries are typically welltolerated, but talk with your neurosurgeon about the best option for you.

• Responsive neurostimulation (RNS). An implanted device monitors brain waves

and detects and halts seizures. People cannot feel the stimulation once it’s programmed. It doesn’t cause pain or any unusual feelings, VanSickle says.

• Vagus nerve stimulation. A pacemakerlike device is implanted in the chest, and a wire is wrapped around the vagus nerve in the neck. The device sends regular, mild electrical pulses to the brain, preventing seizures.

All three procedures are minimally invasive, and patients go home the day of or the day after the procedure, VanSickle says.

MAKING A MORE PRECISE DIAGNOSIS Usually, people with epilepsy strive to avoid seizures. But when patients check into Littleton Adventist Hospital’s Epilepsy Dr. Katie Polovitz Monitoring Unit (EMU), neurologists actually try to provoke seizures.

In the EMU, patients usually are taken off medications or their medications are reduced, and then carefully monitored for three to five days, using video electroencephalogram (EEG) to study seizures.

There are two goals, says neurologist Katie Polovitz, MD, codirector of the EMU: • Characterizing the seizures. “There are many things that may mimic a seizure,” Polovitz says. By viewing seizures in real time, neurologists can make a definitive diagnosis.

• Locating seizure origins. This helps determine the appropriate next treatment step.

Seizures can be scary, Polovitz says. But the promise of effective treatment inspires patients to experience them. “They are motivated to get better, even if that means purposefully having these events to help in their treatment plan,” she says.

To learn more about Littleton Adventist Hospital’s Epilepsy Monitoring Unit, call 720-528-0823.

To learn more about surgical options to treat epilepsy or make an appointment with Dr. VanSickle, call 720-638-7500.

As a Level 3 epilepsy center, Littleton Adventist Hospital is recognized for its expertise and facilities to provide the highest-level evaluation and treatment for epilepsy, including these latest surgical interventions. create | mylittletonhospital.org | 7

at Littleton Adventist Hospital offers a variety of classes before and after your baby’s birth, as well as education for older kids and grandparents, too! Practical classes taught by skilled instructors help you assume your new responsibilities with knowledge and confidence. Classes are kept small to give you the opportunity to closely interact with our instructors.

• Childbirth Preparation • Comfort Measures • Infant Care • Breastfeeding • Baby Safe • Boot Camp for New Dads • 21st Century Grandparents • Safe Sitter • Girl Talk • and more!

Learn more and register online at mylittletonhospital.org/ lahclasses.

Portercare Adventist Health System NON-PROFIT ORG US POSTAGE

PAID

DENVER, CO PERMIT NO. 3280

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 303-738-7781 (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 SUMMER CALENDAR

TAI CHI FOR HEALTH AND BALANCE

Tai Chi for Health and Balance has been proven to prevent falls, increase balance and movement, and improve quality of life for older adults. We offer a beginner class and an extension class intended for participants who have already completed the beginner class.

Please wear comfortable clothing and bring a water bottle. All events take place at the Littleton Museum, 6028 S. Gallup St., Littleton, CO 80120. Register online at mylittletonhospital.org/ lahclasses.

STOP THE BLEED

Injuries can occur at any time!

Stop the Bleed is a national campaign to bring awareness and teach basic actions to stop life-threatening bleeding. Everyone should be prepared to respond to help prevent deaths caused from blood loss. Join us to learn lifesaving training on how to use bandages and tourniquets.

Registration required. Register online at mylittletonhospital.org/ lahclasses.

Date ǀ Thu, Aug 23; or Wed, Sep 26 Time ǀ 4-6 p.m.

Fall Session Date ǀ Tuesdays, Sep 11-Oct 23 Time ǀ Extension class, 1-2 p.m.; beginner class, 2-3 p.m.

MAMMOS, MOCKTAILS, AND MORE!

You show everyone else love; it’s time to take care of yourself, too.

Join us for mammograms, chair massages, refreshments, and great giveaways! Registration required: 303-738-2767.

Date ǀ Wed, Jul 25; Thu, Aug 2; and Wed, Sep 12 Time ǀ 3-7 p.m.

CAR SEAT SAFETY CHECK

Are you properly protecting your most precious cargo? Ninety percent of car seats are not installed or used correctly. Join us for the FREE Car Seat Safety Check drive-through to receive your complimentary car seat safety check. Our certified child passenger safety technicians will provide a thorough review, offer advice, and provide instruction so you can leave with increased confidence and child passenger safety awareness. Registration not required.

Date ǀ Fri, Sep 21 Time ǀ 10 a.m.-1 p.m.

All events are located at Littleton Adventist Hospital unless otherwise noted.

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FAMILY LIFE EDUCATION