Create Winter 2018

WINTER 2018 • Volume 6, Issue 1

Your health. Your life.

SHEDDING

LIGHT

ON BRAIN INJURIES SIMPLE FALLS CAN HAVE SERIOUS CONSEQUENCES

a n d ...

STOPPING THE SHAKING OF ESSENTIAL TREMOR Page 3

Page 4

SOLVING THREE COMMON BACK PROBLEMS Page 6

MAKING JOINT REPLACEMENT MORE EXACT Page 7

CENTURA

Centura Health Heart & Vascular Network is the region’s leading provider of comprehensive heart care, offering advanced heart diagnostics and state-of-theart treatments to: • Open blocked arteries • Repair or replace heart valves • Fix abnormal heart rhythms • Help patients recover after heart attacks • Reduce heart disease risk factors To find a heart program or expert in your neighborhood, go to centura.org/heart.

APP FAILURE

Heart rate apps may be missing a beat or two, according to a study last spring in the European Journal of Preventive Cardiology. “They tested four heart rate applications, and results were all over the place,” says Ajay Yadlapati, MD, a cardiologist with South Denver Cardiology, A Centura Health Clinic. This is partly due to the lack of regulation, he says. Better to stick to apps that motivate like “nutrition apps that track actual calories, or exercise apps that record steps or distance.”

Silent

PRESSURE TEST

TREATMENT

Yes, heart attacks can happen without symptoms. The good news, Yadlapati says, is that there are some signs that signal silent heart attacks. If you’ve been experiencing even mild reflux or heartburn or a general sense of fatigue, especially if they persist despite diet changes and rest, talk to your doctor. Also, diabetes and kidney disease raise your risk for silent heart attack. So don’t shrug off signs.

Pulmonary hypertension — high blood pressure in the lungs — can be tough to diagnose and treat. But a test now available at Littleton Adventist Hospital gives physicians and patients an advantage by identifying those whom treatment is likely to benefit. The test is simple: If inhaling nitric oxide lowers blood pressure in the lungs, the patient is likely to respond to medication, says Dianna Ingraham, RN, MSN, chest pain coordinator and cardiovascular clinical nurse specialist. Talk to your primary care physician about seeing a pulmonologist or cardiologist.

HEART SCAN If you’re a man over age 40 or a woman over age 45, your risk for heart disease is on the rise. A heart calcium scoring exam, a noninvasive scan that checks for calcium buildup in the arteries, can help you assess your risk. To learn more or to schedule a heart calcium scoring exam for $149, call: • Littleton Adventist Hospital (South Denver Cardiology): 303-744-1065 • Parker Adventist Hospital: 303-269-4500 • Porter Adventist Hospital: 1-855-854-3278

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 2018 • Create

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Winter

HEALTH BRIEFS

s You

ESSENTIAL TREATMENT While the cause of essential tremor is not known, a safer, more precise treatment offers hope

E

ssential tremor (ET) is a type of involuntary shaking movement thought to affect 10 million Americans. As those who live with the disorder know, it can be isolating and it can interfere with daily activities, such as eating and writing. Local experts explain essential tremor and how to treat it.

What is essential tremor?

“The first thing patients wonder is, ‘Is this Parkinson’s disease?’” says Luisa Solis-Cohen, MD, a Littleton Adventist Hospital neurologist specializing in movement disorders. The two conditions are often confused, since Dr. Luisa Solis-Cohen their hallmark symptom is tremor.

However, ET is eight times more common.

In general, ET occurs during activity and affects both sides of the body from the onset. With Parkinson’s, tremor occurs during rest and starts on one side, gradually progressing to both sides.

Although the cause of ET is unknown, about 50 percent of cases are hereditary, Solis-Cohen says, adding that researchers are working to identify the responsible gene or genes.

Statistics show an interesting, but unexplained, “bimodal distribution” for age of onset: A big group of patients gets ET in their 40s, and another big group is diagnosed in their 60s and 70s. “While ET is not dangerous, it is often bothersome.

It can interfere with drinking and eating and can limit social activities. ET is not known to shorten life span, but balance and gait instability can occur,” Solis-Cohen says.

Effective treatment Patients who don’t respond to medications and physical therapy are often told there is nothing more to try. This is not so, says David VanSickle, MD, PhD, a neurosurgeon with South Denver Dr. David VanSickle Neurosurgery, A Centura Health Clinic.

In severe cases of ET, a treatment called deep brain stimulation (DBS) calms the overactive brain circuit that leads to tremor. VanSickle likens that circuit to an old stereo turned up so loud it’s creating feedback. “The circuit in the brain that’s overactive creates feedback, too; it’s just a different frequency.” DBS uses electrical signals to fatigue the overactive neurons, thus “turning down” the feedback.

“It has 90 to 95 percent effectiveness in eliminating or mitigating tremor in the arms and legs,” VanSickle says. “You go from a person who can’t write to a person who can.”

DBS, a procedure that guides a wire up through the neck and deep into the brain, has been FDA-approved for ET since 1997. It used to be done while patients were awake.

“Now we do it robotically and while the patient is asleep.

There’s a lower infection rate, it’s far safer, and it’s more precise,” VanSickle says.

DBS has been shown to effectively suppress essential tremor for more than six years after implantation.

Dr. David VanSickle has performed more robotically guided Asleep DBS procedures than any other neurosurgeon in the world.

To find out if DBS might be an option for you, download a FREE guide at southdenverneurosurgery.org/dbs-guide.

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HEAD OVER HEELS

FALLS CAN BE EMBARRASSING OR SERIOUS. KNOWING HOW TO TELL THE DIFFERENCE MIGHT BE LIFESAVING. 4 | WINTER 2018 • Create

<< Shirley Huntington celebrated another holiday season with her granddaughters three years after recovering from bleeding on her brain caused during a serious fall.

very year, slipping on ice, tumbling off a ladder, and countless other activities send people sprawling to the ground — and thousands to the emergency room.

• •

• • • •

Something More Serious

Sometimes, falls can result in more severe injuries.

Shirley Huntington learned that in 2014, when she went outside to change her Christmas-light timer, slipped, and fell. She hit her head and was knocked

SERIOUS CARE FOR SERIOUS INJURIES If you or a loved one suffers a fall or any other injury, you want expert emergency care, fast. Littleton Adventist Hospital is an American College of Surgeons and state-designated Level II Trauma Center, which means it can handle all serious injuries from spinal fractures to traumatic brain injuries 24 hours a day, seven days a week.

FA L L I N G FA C T S

1/5 of falls cause serious injury 1/4

of elderly people fall each year

<50%

of seniors who fall tell their doctor

Tai Chi can prevent falls — and improve balance and movement, and quality of life. To learn more about Tai Chi for health and balance at Littleton Adventist Hospital, call 303-738-2695.

unconscious. She woke up bleeding, walked into the house, and called her daughter. “I said, ‘I think you should take me to the ER. I might need stitches.’”

She walked into Littleton Adventist Hospital, filled out paperwork, and answered questions. “Then, when they were wheeling me back to an exam room, I passed out.”

The fall had caused bleeding on her brain, and Prall operated immediately to stop it. After spending Christmas in intensive care, Huntington was on the road to regaining her strength and brain function.

She now uses a remote control Christmas-light timer. And she has a message for anyone who hits their head: Get checked out, fast.

Rebuilding With Rehabilitation

After brain-injured patients are treated medically, they can move to the Center for Rehabilitation at Littleton Adventist Hospital for Dr. Erasmus Morfe a comprehensive program to get them back to normal activities, says Erasmus Morfe, DO, medical director of the inpatient rehabilitation unit.

For patients like Huntington, that rehabilitation is vital, Morfe says. “When somebody has a brain injury, it can be difficult to do things we take for granted.”

After Huntington’s surgery, the rehab team had her name farm animals. “I could only name about three.

And I grew up on a farm,” she says.

Rehab focuses on three areas: Physical: walking safely and maintaining balance Speech: improving cognition and making sure patients are swallowing properly Occupational: performing daily activities, such as dressing and grooming, and then progressing to more complex tasks Housing the rehabilitation center in the hospital means physicians stay involved and apprised of progress, Morfe says. The center works to involve family members, he says, so they know what to expect when the patient goes home. “Sometimes, recovery is a marathon.”

• • •

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Falls can cause bruises and pain anywhere. But two of the most worrisome injury areas are the back and the head, says J. Adair Prall, MD, a neurosurgeon with Dr. J. Adair Prall South Denver Neurosurgery who treats traumatic head and spine injuries.

Back injuries: In general, take ibuprofen and apply ice to a lower back injury. If pain doesn’t lessen after a few days, call your doctor. You should be seen sooner if: Pain is in the center of the back Pain or tingling radiates down arms or legs Even when pain travels through arms and legs, it most likely will go away on its own. But to be safe, see your physician by the next day, or go to urgent care, Prall says.

Most pain eases in a few days. One notable exception: a bone that has fractured. Bones in the back and neck can fracture in patterns that are sometimes, but not always dangerous. In most cases involving a fracture, pain is immediate and typically worsens over several days, whereas muscle injury usually improves over several days, Prall says. So, if neck or back pain worsens during the days after a fall, rather than improving, see a doctor.

Head injuries: Anytime a fall results in a head injury, closely watch symptoms for several hours.

Consult with your primary care physician or, if it’s after hours, go to the emergency room if a fall causes: Loss of consciousness Confusion Weakness or numbness Vision changes Concussion treatment typically consists of physical and mental rest, Prall says. “Aerobic and cognitive activity and stress can make symptoms linger.”

PUSHING BACK PAIN An estimated eight in 10 people will experience back pain in their lifetime. “Back pain is one of the leading causes of not being able to work

or enjoy recreational activities,” says Ben Guiot, MD, a neurosurgeon who specializes in spine surgery at South Denver Neurosurgery.

Most back pain resolves with anti-inflammatory medications (such as Motrin), rest, and physical therapy. When symptoms persist, however, surgery may relieve pain. And today’s Dr. Ben Guiot spine surgery is not like that of even five years ago. “Hardware is better now, and newer techniques performed through small incisions spare muscles,” Guiot says.

Here, he helps take a look at conditions that often require spine surgery.

SURGICAL TREATMENT:

Spondylolysis/ Spondylolisthesis

Spondylolysis is a fancy name for a crack or stress fracture in a lower back vertebra. Its more serious cousin, spondylolisthesis, occurs when that fractured vertebra slips out of place.

Children and adolescents active in sports such as gymnastics, football, and weight lifting are at greatest risk, as are active adults in their 20s-40s.

Rarely responds to nonsurgical treatment.

Spinal fusion “welds” vertebrae together to stabilize the spine.

Spinal Stenosis

Stenosis is a narrowing of the “tunnel” around your spinal cord. This can place pressure on nerves, leading to numbness, tingling, pain, and leg weakness.

It occurs mainly in adults over 60. Arthritis is the most common cause.

Decompression surgery removes bone and bone spurs that are causing pressure on nerves.

Herniated Disc

A disc is a soft, rubbery pad that serves as a “shock absorber” between vertebrae.

When it herniates, or ruptures, its soft center pushes through the outer edge of the disc, sort of like the jelly seeping out of a doughnut.

Older adults are at risk, as are smokers, those who are overweight, and those who improperly lift or engage in repetitive strenuous activities.

Microdiscectomy, which removes only the protruding portion of the disc, is common for lower back pain. At all levels, disc removal and fusion of the two vertebrae also may be an option. Artificial disc implantation is an alternative to fusion in some neck pain patients.

BACK PAIN NOW RANKS AS THE THIRD MOST BURDENSOME CONDITION ON HEALTH IN 2010, UP FROM SIXTH IN 1990.

6 | WINTER 2018 • Create

WHOM IT AFFECTS:

To make an appointment with Dr. Guiot, call South Denver Neurosurgery at 720-638-7500.

Littleton Adventist Hospital — along with Porter Adventist Hospital, Parker Adventist Hospital, and Castle Rock Adventist Hospital — are part of Centura Health, the region’s leading health care provider. Our spine care program offers specialized neuro spine care, from pain management to surgery.

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WHAT IT IS:

Exact

Replacement ROBOT-ASSISTED TECHNOLOGY PROVIDES PRECISION JOINT REPLACEMENT SURGERY

Dr. Robert Thomas

At Littleton Adventist Hospital, space-age technology is providing an additional layer of precision to joint replacement surgery.

Robert Thomas, MD, and his partner, Tim Lehman, MD, along with other surgeons at Littleton Adventist Hospital now have a new robotic tool, called Mako, that assists surgeons in performing exact, accurate placement of artificial joints. Littleton Adventist Hospital is among the first hospitals in Colorado to offer the technology to surgeons for use in joint replacement of hips, knees, and shoulders.

PRECISION AND PREPLANNING With the Mako system, the procedure begins with a computed tomography (CT) scan, a noninvasive procedure that produces cross-sectional images of the joint. Using the CT images, a computer sizes the implant, and determines exactly how and where to place the new joint. “It essentially allows us to do the procedure before we do the procedure,” Thomas says.

“We can set up the exact positioning and angle of the implant before we do the surgery.” Once those parameters are in place, Thomas says, the robot guides the surgeon. But the surgeon is still in control, Thomas says, and can make a correction if needed.

A new custom-fit knee will let Deb Bewersdorf pedal pain-free.

PAIN-RELIEVING TECHNOLOGY Last summer, Deb Bewersdorf became one of the first patients whose surgery was performed with the Mako robotic technology at Littleton Adventist Hospital. The Parker grandmother had considered gel injections, tried cortisone shots, and even had meniscus repair, but nothing relieved her knee pain. “I said, ‘I want to be done with the pain. Let’s get this fixed,’” Bewersdorf says.

Thomas suggested a partial knee replacement using the robot technology, and she agreed. She’d read about Mako, and knew it was a tool that could help provide a more exact placement of the artificial joint. “Dr. Thomas was excited about it, and we felt it was a good move,” she says.

Because joints are fitted so precisely, the goal of using the Mako system is to provide additional flexibility and better fit, likely reducing wear and tear over the years.

Four weeks after surgery, Bewersdorf was back to playing with her grandsons. By spring she hopes to be back on her bike, pedaling pain-free.

Since the first medical robot was used in an orthopedic surgery in 1983, robotic technology has become a fixture in operating rooms. Robots can help surgeons more precisely navigate around vital organs and make tiny intricate incisions.

Littleton Adventist Hospital is part of the Centura Health Orthopedics Network, the region’s leading provider of orthopedic care.

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Portercare Adventist Health System NON-PROFIT ORG US POSTAGE

PAID

DENVER, CO PERMIT NO. 4773

7700 S. Broadway Littleton, CO 80122

We all want to be healthy. For some, that means overcoming, or preventing, chronic illnesses like diabetes, high cholesterol, or heart disease. For others, it means maintaining a healthy weight. And for still others, it means just feeling great, in body, mind, and spirit.

Whatever your health destination, Centura Health’s 18-session holistic program, Pathways to Health & Wellness, can help you get there.

This three-month program is designed to provide priceless health benefits, including helping you: ✻ Reverse chronic disease ✻ Lose weight ✻ Gain energy ✻ Spend less on food and medications ✻ Enjoy life again

To learn more about Pathways to Health & Wellness, attend a FREE information session at Littleton Adventist Hospital: Sunday, Jan. 28, 2:30-3:30 p.m.

Tuesday, Jan. 30, 6:30-7:30 p.m.

Thursday, Feb. 1, 6:30-7:30 p.m.

Register for an information session at coloradocreationhealth.com.

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 WINTER CALENDAR

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 Littleton Adventist Hospital staff pediatric nurse practitioner.

Visit mylittletonhospital.org/ lahclasses to find upcoming class dates.

MOPS NEW MOMS PROGRAM

The MOPS New Moms support class serves to educate, inform, and create community for moms in their first four months. Each biweekly, 90-minute session is led by a certified MOPS International facilitator and is designed to bring new moms together to share the joys and challenges of parenthood and develop their own confidence. Classes cover

topics like developing a better understanding of your child’s basic needs, breastfeeding, and infant massage, etc. This program is for all moms with babies younger than 4 months. New babies welcome, but no childcare for older children is provided.

Date | Saturdays, Jan 20, Feb 10, Feb 24, Mar 10, Mar 24, and Apr 7 Time | 9 a.m.-Noon Cost | $40 for two participants Location | Littleton Adventist Hospital, 7700 S. Broadway, Littleton Registration mylittletonhospital.org/ lahclasses SAFE SITTER®

Safe Sitter is a medically accurate, up-to-date babysitting course that teaches young teens (11-15 years old) life and safety skills along with basic infant and child CPR and choking relief training. Learn everything you need to know to be a great sitter. Gain the skills and confidence needed to do the job well and earn parents’ trust.

Date | Saturdays, Jan 27, Feb 24, and Sunday, Mar 11

Time | 9 a.m.-3 p.m.

Cost | $80 Location | Littleton Adventist Hospital, 7700 S. Broadway, Littleton Registration mylittletonhospital.org/ lahclasses 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.

Date | Tuesdays, Feb 20Apr 3 Time | Beginner class 2-3 p.m.; extension class 1-2 p.m.

Cost | $35 for 7 classes Location | Littleton Museum, 6028 S. Gallup St., Littleton Registration mylittletonhospital.org/ lahclasses

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THE ROUTE TO GOOD HEALTH