Create Winter 2017

Winter 2017 • Volume 5, Issue 1

Your health. Your life.

Resiliency

skills Training for your health, happiness, and life Page 7

a n d ...

DETOXING YOUR HOME Page 2

MANAGING MS Page 3

WHERE TO GO IN AN EMERGENCY Page 8

LAUGHING THROUGH YOUR DELIVERY Page 10

IN Good Health

Environment

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.

50% About half of all homes in Colorado have high radon levels.

Average radon level in Arapahoe County homes.

Safe levels are 0-4.

21,000 Each year, about 21,000 people die from radoncaused lung cancer in the U.S.

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 | Winter 2017 • Create

Home Health Hazards

Your home should be the place you feel safest. But there could be elements in your home

that are harmful to your health.

“I don’t like the term ‘toxicity’ because your home is not toxic,” says Michele R. Kinshella, MS, CIH, an industrial hygienist with Tri-County Health Department. “But there are various elements in the home that have the potential to cause adverse health effects.”

Here are five and what you can do to protect yourself.

Harmful Substance

Why It’s Bad

What to Do

Radon

Radon exposure is the leading cause of lung cancer in nonsmokers. It is especially bad in Colorado (see graphic above).

Get your home tested for radon and, if high, have it remediated.

Mold

Exposure can cause nasal congestion, eye and skin irritation, and wheezing.

Clean spills promptly and run exhaust fans when bathing.

Lead

When exposed to lead from paint or the dust created by deteriorating paint, children can have lowered IQs, behavior disorders, and hearing impairment.

Have lead-based paint removed by a licensed professional. Dust often and don’t allow children to play in contaminated soil.

Combustion Depending on saturation, exposure can cause headaches, carbon monoxide gases poisoning, or even death.

Asbestos

Long-term exposure can lead to lung cancer and mesothelioma, a rare but aggressive form of cancer that forms in the lining of the lungs or abdomen.

Ensure all gas-burning appliances are properly ventilated. And don’t go overboard on weatherizing your home. An air-tight home won’t allow gases to escape.

Hire a licensed contractor to remove asbestos, which is commonly found in popcorn ceilings and old vinyl flooring.

Dr. Jason R. Sims Chatfield Family Medicine 10789 Bradford Road, Suite 150 Littleton, CO 80127 303-738-2714

Surrounded by Stress?

Just as important to your health as your physical environment is your mental environment, says family medicine physician Jason R. Sims, DO. “If somebody is chronically exposed to stressors in the home or at work, that may indirectly cause such things as high blood pressure or stroke,” he says.

Sims recommends making some changes if you’re in a high-stress environment at home or work. But if that’s not possible, at least find ways to deal with the stress. Sims de-stresses by enjoying the outdoors.

“I live up in the mountains so I can be outside much of the time,” he says. “My family loves to hike and snowshoe and go camping to de-stress.”

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6.83 pCi/L

Demystifying

Multiple Sclerosis A diagnosis defined

Multiple sclerosis (MS) is an autoimmune disease in which the body attacks its own central nervous system, including the brain, spinal cord, and optic nerves. Symptoms and their severity vary greatly among patients and range from fatigue and numbness to impaired vision and loss of muscular control.

How to Manage MS

Multiple sclerosis is a chronic and often progressive disease. There is no known cause or cure, but that doesn’t mean there’s no hope.

“If there’s one thing I could tell people about MS, it’s that it’s very treatable,” says Julie Seibert, MD, a neurologist at Colorado Neurodiagnostics, “and that you should treat it early and aggressively to prevent symptoms from worsening.”

The primary course of treatment for MS is to use medications, and there are plenty to choose from.

“It can take some time to find the right medication, as there are a lot of choices,” Seibert says.

“Some new ones have come out recently that may fit better with some patients’ lifestyles. If you’re not tolerating a medication, don’t give up.”

In addition to being vigilant with medication, people who have MS should also: Get plenty of rest

Eighty percent of people with MS report having fatigue. Make sleep a priority.

Hit the pool

Exercise helps with fatigue and also keeps muscles strong. But some with MS notice their symptoms worsen with elevated body temperature.

Swimming is a full-body workout that keeps you cool.

Get outside

Vitamin D, which your body produces when exposed to sunlight, has been found to reduce MS symptoms.

Just relax

Stress can trigger or worsen symptoms of MS, so try coping techniques such as deep breathing, aromatherapy, or soft music.

>40

Years

There has not been a study to determine MS prevalence in the U.S. since 1975.

The National MS Society estimates that about 2.3 million people worldwide are living with MS, but they really don’t know for sure.

Process of Elimination

There’s no blood screen or imaging test for MS. Diagnosis consists of your doctor assessing your symptoms and ruling out other possible causes. Several conditions share similar symptoms with MS, including: • Vitamin B-12 deficiency • Lyme disease • Herniated disc • Syphilis • Brain tumor • Sjögren’s syndrome • Lupus • Lymphoma • Copper deficiency

Julie Seibert, MD, fellowship-trained in treating multiple sclerosis, established the only Multiple Sclerosis Clinic in the south metro area on the campus of Littleton Adventist Hospital, which also serves patients throughout southern Colorado.

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Joe Coggon, who volunteers as the educational coordinator for the Denver Coin Club, recognizes the value of early detection when it comes to lung cancer.

Bringing better outcomes in reach F Littleton Adventist Hospital is using new tools to find — and treat — lung cancer at its earliest stages

or most people, being told a spot on your lung was found during a CT wouldn’t be considered a gift. However, for Joe Coggon, a volunteer Santa, finding the nodule very early was a gift because it means he can get treatment early — when it is most effective — if the nodule starts to grow.

“I lost my dad and two older brothers to cancer,” says Coggon, a former smoker, so he has been conscientious about getting retested every six months. Thus far, Coggon has been lucky. His nodule hasn’t grown, and no further treatment is needed for now.

“I don’t let this little nodule slow me down,” says Coggon, 76, a retired Englewood special education teacher. “But the more you know about your health, the better you can manage it.”

Lung cancer is the leading cause of cancer death in the United States for both men and women. One of the reasons is that it has

been extremely difficult for physicians to tell if a tumor in the lung was cancerous or not.

Thankfully, new tools being used at Littleton Adventist Hospital are making it easier and safer to find and test small lung tumors.

The superDimension™ navigation system, or superD, uses technology similar to GPS to safely reach lung nodules, such as Coggon’s, in the far reaches of the lung’s bronchial branches that in the past had been inaccessible. Then the hospital’s lung nodule team can use endobronchial ultrasound (EBUS) for a more precise biopsy of the lung lymph nodes.

The superD navigation system is “a 21st-century upgrade” to the traditional bronchoscope, says Kelly Greene, MD, a pulmonologist at Littleton Adventist Hospital.

Dr. Kelly Greene

4 | Winter 2017 • Create

“

I don’t let this little nodule slow me down, but the more you know about your health, the better you can manage it.

”

Should you be

screened?

For people with a significant smoking history, national guidelines support annual lung cancer screening with a low-dose chest CT scan.

“Lung cancer is the leading cause of cancer death in both men and women,” says Marla Talmadge, lung cancer nurse navigator at Littleton Adventist Hospital. “Tobacco is one of the main causes of lung cancer.” By the time people come in with a symptom such as a cough, “the cancer has usually already spread, and it’s in an advanced stage when it’s hard to successfully treat,” she explains.“Through screening, we can find lung nodules early, and then we use superD and EBUS to diagnose patients at an earlier stage.”

Lung cancer screening is recommended for:

• Current smokers or those who have quit within the past 15 years • Ages 50 and older • Smoking history of at least 30 “pack years” (a pack a day for 30 years, two packs a day for 15 years, or the equivalent) For more information or to schedule a screening, call 855-456-LUNG (5864).

50% About half of all homes in Colorado have high levels of radon, which is the leading cause of lung cancer in nonsmokers.

Read more on Page 2.

The network of air passages that connect the windpipe to the lungs is called the bronchial tree.

Just like the branches of a tree, the large bronchial tubes divide into smaller and smaller branches to carry air to the far edges of the lungs.

To reach a nodule in the lungs, doctors have traditionally used a thin tube with a light and camera called a bronchoscope. This method, however, can’t reach the tiny passages in the distant parts of the lungs.

In the past, patients with these hard-to-reach tumors could get a needle biopsy, but that procedure — in which a needle is inserted into the lung to collect a small portion of the tumor for testing — carries a risk of collapsing the lung.

In some cases, doctors choose to wait several months to see on follow-up imaging tests if the tumor grows.

The superD system can go further than traditional bronchoscopy because it uses electromagnetic navigation to follow a steerable sensor probe.

Combined with EBUS, it is safer and more accurate than a needle biopsy, Greene says.

Mapping the lungs A high-resolution CT scan of the lung is preloaded into the superD software, acting like a map for the doctor to follow. During the biopsy, patients lie on an electromagnetic pad that makes it possible to track the movement of the magnetic probe on the scope through the lungs.

Once the bronchoscope reaches a spot in the airway that is too narrow for it to enter, a hollow, flexible catheter is extended into the area containing the nodule. “Then the sensor is removed and a tool is inserted through the catheter to collect a small sample of the nodule,” Greene says.

In some cases, the EBUS bronchoscope is used to offer ultrasound guidance to differentiate lymph nodes from other tissue and blood vessels, Greene explains. A lymph node biopsy helps to determine if the nodule is cancerous and if so, the stage of the cancer and whether it has spread.

“A lot of nodules are benign,” says Marla Talmadge, lung care nurse navigator at Littleton Adventist Hospital. But if they do turn out to be cancerous, finding them when they are small makes them easier to treat.

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

Reaching further

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

Aid Could you recognize a mental health emergency?

occurrence in every corner of our communities. But if you witnessed one, would you recognize it? Would you know what to do?

Anytime people are a danger to themselves or others, it’s a mental health emergency that requires immediate attention. This includes someone who:  Is expressing a desire to commit suicide  Shows signs of a psychosis (delusions, paranoia, fear) that impairs functioning  Is extremely agitated, wildly overactive, and unable to calm down

An all-too-common problem Nearly 500,000 Coloradans struggle with diagnosed mental health issues, according to the Colorado Health Foundation. And Colorado has one of the nation’s highest suicide rates.

“We all face mental health issues or know those who could experience a mental health crisis,” says Doug Muir, director of Porter Adventist Hospital’s Behavioral Health Service Line. “Mental health is a huge part of our overall health. People need to know that mental illnesses are often caused by chemical imbalances, which can be alleviated by medication and/or treatment.”

Mental illness emergencies rarely arise suddenly, or in a vacuum. Most people who experience them have some history of mental health problems.

Common kinds of mental illness include anxiety, depression, substance abuse, bipolar disorder, eating disorders, and schizophrenia.

Helping each other “We want to reduce the stigma around mental health and help more people be in a position where they feel comfortable supporting people in a crisis and connecting them to the help they need,” Muir says.

People who have a friend or loved one struggling with mental health issues can and should prepare before a crisis by getting to know the mental health services available in their area, such as mobile crisis teams and walk-in crisis centers. They also should learn some basic tools, which they can get at area classes or from mental health providers, such as: • If someone seems suicidal, ask if the person is thinking of hurting himself. Offer to take the person to a mental health professional, call a suicide hotline, or call 911 — don’t leave him alone.

• If someone around you is threatening violence, call 911, or take the person to the nearest emergency room if you feel safe to do so.

d?

What does our community nee

artments, ver hospitals, local public health dep In 2015, Centura Health South Den tal ent, and other leaders identified men churches, police agencies, governm g the ptin prom ds, nee ity mun as critical com health care and suicide prevention nts icipa part s Clas ses. clas Health First Aid development of a series of Mental and ion mat infor give , nce offer reassura learn how to listen nonjudgmentally, essional help, and help them find it. prof ding nee e encouragement to thos will be held: Mental Health First Aid classes ntist Hospital: Parker Adventist Hospital: Mon, Feb 20 8:30 a.m.-5:30 p.m., Inspiration B Conference Room

6 | Winter 2017 • Create

Adventist Littleton Adventist Hospital: Castle Rock Mar 3 Fri, ital: Hosp Tue, Feb 28 p.m., 5:45 a.m.8:45 p.m., 5 8 a.m.rence Confe land Green 4 Conference Rooms 3 & Room 2

Porter Adve Tue, Mar 14 8 a.m.-5 p.m., Grand Mesa Conference Room

g/register. ster, go to southdenverhealth.or Classes are FREE to attend. To regi

This Page: PHOTO ©Istockphoto.com/KatarzynaBialasiewicz, Illustration ©Istockphoto.com/VICTOR; Opposite Page: ©Istockphoto.com/mihtiander, /DSGpro

First

A mental health emergency is a common

That’s

the Spirit Resiliency affects your health, your happiness, your life , esilience isn’t something usually talked about in a health care setting. Your doctor doesn’t ask how resilient you’re feeling today. There’s no blood test for it and no pill to make you more resilient. And yet, it’s very important to your health and wellbeing.

“Resiliency is how an individual or community copes with the ups and downs of life through tragedy and everyday stress,” says Casey Leno, MDiv, director of mission, ministry, and community health integration at Littleton Adventist Hospital.

“The more resilient you are, the better quality of life you’ll have — the happier you’ll be.”

Resiliency also helps ward off mental health issues like anxiety and depression. It can make it easier to get over relationship problems, financial difficulties, and health issues.

“Anybody who watches TV can do CPR to an extent, but nobody really knows how to help a broken heart,” Leno says. “And that affects our health just as dramatically as cancer and diabetes.”

. Mental Strength Training

Resiliency is a character trait; however, it can be learned, which also means it needs to be taught.

And Littleton Adventist Hospital is doing just that.

“In our community needs assessment, we found that mental health and suicide prevention are our first and second priorities,” Leno says. “We are intentional about our partnerships and the programs we provide to the community to help increase resiliency.”

Currently, Littleton Adventist Hospital is providing free Community Resiliency Training and Mental Health First Aid, an in-person class that trains individuals how to help people with mental illness or in a crisis. (See related story on Page 6.) The hospital also offers a grief and loss program, and community health fairs that incorporate mental health awareness education.

To learn more about resiliency training or register for a class, go online to mylittletonhospital.org/lahclasses.

Help for first responders

First responders are often portrayed as invincible. In reality, EMS providers are twice as likely to die from suicide as in the line of duty.

That’s why Centura Health has partnered with the Colorado Department of Public Health and Environment — Office of Emergency Preparedness and Response to offer First Response Resiliency, a program that teaches skills to EMS providers to help them bounce back from life’s adversities and deal with stress in a healthy way.

First responders can register for the program at co.train.org.

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How to know where to go

Christine Miller, MSN, MS, RN, director of emergency and critical care services at Littleton Adventist Hospital, recommends a hospitalbased ER for serious illnesses or injuries.

Making sense of your health care options — including knowing when you really need a hospital emergency room

W

hen you need medical care in the Denver area,

the good news is, it’s not hard to find. Freestanding emergency rooms, boutique micro-hospitals, and urgent care centers are popping up on every corner à la Starbucks. But the not-so-good news is that they can’t always provide the care you need — especially for a major emergency where time is precious, such as with heart attacks, strokes, and embolisms.

We are part of “Unless you’re pretty well-versed in health care, it can be the Centura Health difficult to know the difference between them and where to Trauma System, the go based on what they offer,” says Christine Miller, MSN, region’s largest and most MS, RN, director of emergency and critical care services comprehensive network at Littleton Adventist Hospital. of trauma care and

If possible, you should always look first to your emergency services. primary care physician. But when your doctor’s office is closed, you can’t get in, or you need emergency care, where should you turn? Here, Miller helps break down the options.

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URGENT CARE There’s definitely a need for urgent care centers in the right circumstances, Miller says. “They can be a good alternative for minor illnesses or injuries when you can’t get in for a same-day appointment with your doctor.” Sprains, minor cuts, ear infections, and the flu, for example, can be easily handled at one of these centers.

PRO: Typically less expensive than a trip to the ER. CON: Potential hidden costs if the services you need aren’t available. “When you walk in, you likely won’t know all of the services you may need, and there are many that they may not be able to provide,” Miller says. Say you need a CT scan. If an urgent care center can’t provide it and you have to go elsewhere, you may end up paying twice.

Why dialing 911 is better than driving If you have a life-threatening condition, did you know that calling 911 is always better than driving to the emergency room — EVEN if you live close by? Here are three reasons why:

2

Care begins sooner. EMS providers arrive quickly and start care en route to the hospital in a controlled environment. “There’s so much they can do on the way, like checking your heart rate; starting oxygen, an IV, and medications for pain; and performing an EKG,” Miller says.

3

Hospital care standing by. Because paramedics can call ahead, hospitals can initiate cardiac or stroke “alerts” that call the needed specialists to the ER, ready to expedite treatment immediately when you arrive.

71%

• Littleton Adventist Hospital Level II Trauma Center and ER, 7700 S. Broadway • Highlands Ranch Emergency & Urgent Care, at the corner of Highlands Ranch Parkway and Broadway • Meridian Emergency & Urgent Care, 9949 S. Oswego Street find out wait ↗Totimes, go online to

southdenverhealth.org.

In a poll of emergency physicians, 71 percent reported that they care for patients on a daily basis who wind up in the ER only after first going to an urgent care center that wasn’t equipped to meet their care needs.

HOSPITAL-BASED ER When you are seriously ill or injured, a hospitalbased emergency room can provide the most comprehensive care. An ER is required to have specialists on call to provide immediate care. “This includes admission capabilities to the hospital,” Miller says. “Littleton Adventist Hospital is a Level II Trauma Center, which means we have surgeons, anesthesiologists, and surgical teams in-house 24/7 for trauma or other urgent surgery needs.”

PRO: Comprehensive care and admitting capabilities.

CON: More expensive — and can be a longer wait — than a trip to urgent care if you only have a minor illness or injury.

MICRO-HOSPITALS Just as their name suggests, micro-hospitals are designed to be smaller versions of traditional hospitals and may have an emergency department, a small number of inpatient beds, and usually also have surgery suites.

PRO: For minor surgery without risk of complications, these facilities can provide close-to-home care.

CON: They can’t treat major trauma and illness, such as a heart attack, stroke, or traumatic injury with internal bleeding. So patients with these conditions will have to be transferred.

COMBO ER & URGENT CARE This new concept developed by Centura Health combines a 24/7 ER and urgent care center that provides patients with the appropriate level of care based on their symptoms.

PRO: Unlike most urgent care centers, these facilities are open 24/7. They are staffed by ER physicians. And you are only billed for the care you receive so you don’t have to pay ER prices if you only need urgent care (unlike freestanding ERs).

CON: Because these centers are not hospital-based, patients have to be transferred if they require surgery. Experts recommend calling 911 if you or a loved one have symptoms of a major injury or illness.

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Photos: ©Ellen Jaskol, ©istockphoto.com/Ridofranz, /MattGush

1

They know what to look for. Emergency medical services (EMS) providers are highly trained in recognizing heart attack and stroke symptoms or concussions, even when you may not see the signs.

Centura Health ER facilities in South Denver

Childbirth: It’s a

Littleton Adventist Hospital now offers nitrous oxide to laboring moms W

hen more and more women said they wanted an alternative to epidurals during labor, Littleton Adventist Hospital listened. It recently became one of only a handful of hospitals in Colorado, and a growing number nationwide, to offer nitrous oxide to laboring women.

“More of the public said they wanted another option for pain management, and our midwives told us their patients were asking for it,” says Stacy Kreil, director of women and children’s services at Littleton Adventist Hospital.

Littleton Adventist Hospital is a leader in labor and delivery innovations, including its Gentle C-Section approach, in which the newborn is quickly examined; then placed on mom skin to skin so neither miss out on that first golden hour of bonding.

|

10 | Winter 2017 • Create

Serious upsides of laughing gas The effects only last as long as the patient continues inhaling.

And that is part of the appeal of nitrous — the gas doesn’t linger in the woman’s body, as it’s exhaled through the lungs. “It has no known effects on the child,” Kreil says.

There are also few side effects.

Some women report mild nausea, and others say they feel unsteady after using it. But unlike some other pain management methods, women using nitrous oxide are free to get up and walk around during labor, Kreil says.

If a woman finds she’s not getting enough pain management, she can switch to an epidural anytime, says Kreil, who expects nitrous oxide use to catch on.

“More and more hospitals are asking us, ‘How does that work?’”

FAST FACT

Using nitrous oxide during labor doesn’t affect breast milk.

The birth concierge at Littleton Adventist Hospital is the go-to helper for expectant parents. To schedule a one-on-one appointment, call 303-738-2757.

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The news on nitrous Best known as the “laughing gas” used to ease pain for patients in the dentist’s chair, nitrous oxide is a colorless, nonflammable gas that produces temporary euphoria when inhaled.

While it’s rare in American delivery rooms, nitrous oxide is widely used in many countries.

In fact, 60 percent of laboring women in the United Kingdom, and half of women in Australia, Canada, and Finland use nitrous oxide during labor.

At Littleton Adventist Hospital, the numbers aren’t that high yet, but they’re growing.

Nitrous oxide is administered through a mask the mom-tobe holds to her face. About 45 seconds before a contraction begins, she inhales. “If she starts inhaling before a contraction, it helps with that contraction,” Kreil says. “Because it’s selfadministered, patients feel like they have control of the pain, and how it’s managed.”

Exercise your right to relief Physical therapy proves you don’t have to live with incontinence and pain Worried that every sneeze or giggle will leave a telltale spot? Experiencing pain during intercourse? Many women think these changes come with middle age, and are just something they have to get used to.

They’re not.

If you’re one of the millions of women experiencing painful intercourse, urinary incontinence, or both, you’re not alone. As many as one in four adult women experiences urinary incontinence. And one-quarter to one-half of women experience painful intercourse after menopause.

But you don’t have to live with either condition.

Pelvic physical therapy Together with traditional medicine, physical therapy can help women take control of their bodies, says physical therapist Kerri Daniels, MPT, CLT, a pelvic health therapist at Littleton Adventist Hospital.

As estrogen levels decline around menopause, resulting dryness and thinning of vaginal tissue can cause pain during intercourse, a condition called dyspareunia. Together with prescription creams, physical therapy can help women enjoy intimacy again at any age, Daniels says.

Meanwhile, childbirth, chronic constipation, and menopause can weaken the muscles that control the bladder, increasing the likelihood of urinary incontinence.

Daniels prescribes physical therapy exercises to help these muscles get stronger and relax, which are both necessary. She uses biofeedback, including ultrasound, to demonstrate muscle contraction and relaxation.

Outpatient relief for pelvic problems

For women struggling with incontinence, pelvic organ prolapse, pelvic floor muscle weakness, pregnancy-related pain, or painful intercourse, Littleton Adventist Hospital’s comprehensive outpatient pelvic floor therapy program offers relief. “Most women see results right away,” says Kerri Daniels, MPT, CLT, a physical therapist who specializes in women’s pelvic health at Littleton Adventist Hospital.

Correcting the Kegel Many women try pelvic floor contractions called Kegel exercises without success. “Unfortunately, about 25 percent of women perform these contractions in a way that makes urinary incontinence worse,” Daniels says.

“Often, women are pushing down instead of lifting up,” she says. “The correct way is to pretend you’re trying to close the openings and lift the pelvic floor.”

Daniels urges women to talk to their doctor about painful intercourse or urinary incontinence. “The earlier, the better. Treatment can be more difficult as the problem worsens. And many times they are not something women have to live with.”

Visit stopincontinence.org to watch an informational video and set up an appointment to speak privately with Kerri Daniels.

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Portercare Adventist Health System

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

Winter

entityhospital.org

entityhospital.org

2017

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