Elevate Fall 2018

Living at the height of wellness FALL 2018 | VOLUME 6, ISSUE 4

A NEW

TWIST ON JOINT RELIEF

Discover advances in ankle replacement surgery Page 5

FIGHT THE

FLU Page 2

STROKES STRIKING EARLIER Page 3

CALMING INFLAMMATION IN YOUR GUT Page 4

HORMONE REPLACEMENT PELLETS Page 7

IT’S THE ONLY SUREFIRE WAY TO PROTECT YOURSELF THIS SEASON

The flu vaccine

can cut your risk of getting the flu in half, yet many people are still reluctant to get the shot.

“I hear a lot of patients say, ‘I don’t need it. I’ve never gotten the flu,’” says Kirstin Rinn, NP, at Ridgeline Family Medicine – Castle Pines. “What I tell them is you haven’t gotten the flu yet.”

Here’s what she says you need to know about protecting yourself this season.

BUT

IT DIDN’T WORK LAST YEAR! Scientists formulate a new flu vaccine every year in anticipation of the strain most likely to affect the greatest number of people.

But not all flu vaccines are wellmatched with the year’s strain.

The 2017-18 flu vaccine was only 36 percent effective, which is lower than the usual effectiveness range of 40 to 60 percent. Still, that’s significant protection. Plus, getting vaccinated lessens the severity and duration of your symptoms if you do end up with the flu.

Think you can avoid getting the flu by staying away from sickos?

Think again. Between 20 and 30 percent of people carrying the flu virus display no symptoms.

CAN’T I SKIP THE VACCINE AND GET TAMIFLU INSTEAD?

BOOST YOUR IMMUNE SYSTEM THIS SEASON

Say no to sugar > Excess glucose can reduce white blood cell reactivity (your immune response) by up to 40 percent. A 32-ounce soda can render your immune system useless for four or five hours.

Meditate > A recent review of 20 studies found some early evidence that mindful meditation may have positive effects on the immune system.

Eat your mushrooms > One study found eating cooked shiitake mushrooms can increase the performance of your body’s T cells, which play an essential role in immune response.

A:

No. Antivirals like Tamiflu can reduce symptom severity, reduce complications like pneumonia, and shorten the duration of the flu by about a day; but they won’t cure you.

Plus, getting treated after the fact doesn’t protect vulnerable populations in the community who can’t be vaccinated.

And antivirals must be administered early to be effective — ideally within 48 hours, although they can be effective up to 72 hours after onset.

2X

People who get the flu vaccine every year are twice as likely to have less-severe cases when they do contract the virus, as compared with people who haven’t been vaccinated in the previous three seasons.

TAKE A SHOT AT FLU Schedule an appointment with one of our primary care practices by calling: Ridgeline Family Medicine at the Meadows: 720-455-3750 Ridgeline Family Medicine – Castle Pines: 303-649-3350

ELEVATE is published four times annually by Castle Rock Adventist Hospital. Executive editor is Christine Alexander. As part of Centura Health, our mission is to nurture the health of the people in our community. The information herein is meant to complement and not replace advice provided by a licensed health care professional. For comments or to unsubscribe to this publication, please email us at elevate@ centura.org.

2350 MEADOWS BOULEVARD | CASTLE ROCK, CO 80109 | 720-455-5000

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Fall 2018

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Fall

HEALTH BRIEFS

FIGHT OFF THE FLU

STROKE INSIGHTS

THE LATEST NEWS AND RESEARCH ON STROKE YOUNG AND AT RISK

W

hile there’s been an overall decrease in strokes across the board, the rate has actually increased in younger people — specifically those ages 15 to 44.

“The jump is being attributed to several factors, including obesity, poor diet, physical inactivity, high blood pressure, and diabetes,” says Whitney Chapman, RN, stroke coordinator at Castle Rock Adventist Hospital.

Fortunately, these risks are ones that can be decreased by adopting healthy lifestyle habits.

A LARGER WINDOW FOR TREATMENT

For stroke patients to receive the clot-busting stroke drug Alteplase, it must be given within 4.5 hours after symptoms first appear. But the stroke treatment window is expanding for some patients. New studies have shown a benefit for about 10 percent of patients, who have a big clot blocking one of the large vessels that provides blood to the brain (called a large vessel occlusion).

“For them, we now have up to 24 hours after symptom onset to potentially be able to go in, remove the clot, and restore blood flow to the brain,” Chapman says.

< Whitney Chapman, RN, is helping Castle Rock residents ward off stroke — especially in young adults. castlerockhospital.org

THINK FAST — AND BEYOND

We’ve learned the “FAST” signs of a stroke: Facial drooping, Arm weakness, Speech difficulties, and Time to call 911. But they aren’t the only signs to watch for.

Besides FAST, you should also watch for sudden: • Loss of vision • Headache • Trouble with walking/ coordination

Castle Rock Adventist Hospital has received The Joint Commission’s Gold Seal of Approval® and the American Heart Association/American Stroke Association’s HeartCheck mark for Advanced Certification for Primary Stroke Centers.

Stroke certification ensures excellence in the care of stroke patients by creating a loyal, cohesive clinical team; establishing a consistent approach to care; reducing variation; and committing to a higher standard of clinical service — all in an effort to improve long-term outcomes.

“In the past year, Castle Rock Adventist Hospital has treated more than 100 patients in the acute phase of stroke, in which we strive to treat eligible patients with Alteplase in less than 60 minutes from arrival into our facility,” Chapman says.

YOU’VE PROBABLY HEARD OF THESE STROKE RISKS: Ones you can change: Ones you can’t change: • Age: Likelihood nearly doubles • High blood pressure • High cholesterol every decade after age 55 • Smoking • Family history • Diabetes • Prior stroke or heart attack • Race: African-Americans have • Being sedentary • Poor diet higher risk • Heavy alcohol use … BUT DID YOU KNOW ABOUT THESE? Gender: More than half of strokes Sleep apnea: “It’s an indirect occur in women. Risk is increased risk factor that can cause heart problems like AFib or coronary by a history of preeclampsia, artery disease that can lead eclampsia, gestational diabetes, to stroke,” especially at high birth control, and hormone altitude, Chapman says. therapy.

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BURNING QUESTIONS

Carlene Chun, MD, PhD, a new gastroenterologist at Castle Rock Adventist Hospital, provides answers about bowel inflammation, from risk factors and causes to treatment — including the latest medications for inflammatory bowel disease

Q

Dr. Carlene Chun

Q

What causes bowel inflammation?

A: It’s important to understand that inflammation is your body’s natural response to toxins and infection, and it is essential for normal healing.

Your immune system is made up of various components that are constantly interacting with the environment to maintain a healthy balance. At the very base level, the GI tract creates a physical barrier between things you ingest, the microbes living in the GI tract, and your immune system. Disruption of that barrier or the communication across it can activate the body’s defense system and cause bowel inflammation. Inflammatory bowel disease (IBD) is a chronic disease caused by a disruption of the healthy balance or homeostasis of the GI tract.

Q Who is at risk for problems?

A: While a specific cause of IBD is unknown, currently the literature suggests IBD is caused by a combination of both genetic and environmental factors.

Disease may develop at any age. However, we’re seeing more severe disease in those who develop it early in life.

Q How is it diagnosed?

A: Typically, a change in bowel habits — described as symptoms of fecal urgency and frequency, sometimes with rectal bleeding — are a signal that something is wrong.

Physicians use an endoscopy to confirm a diagnosis of IBD.

To schedule an appointment with Dr. Chun or another physician at Centura Gastroenterology – Castle Rock, call 720-455-3879.

ELEVATE 4 Fall 2018

SWITCHING THINGS UP

Can it be prevented?

A: There are no clear recommendations for prevention. The key is being aware of symptoms and seeking medical evaluation if you’re concerned about a change in your bowel habits. Early treatment has been shown to limit disease progression and future complications.

Seek care early and work with your doctor to develop the best care plan for you.

Biosimilars are among the latest IBD treatment drugs.

These medications act exactly like brand-name biologics.

They are replaceable with current biologic medications, equally effective, and won’t cause switch-related side effects if changing drugs is necessary because of changes in insurance or availability of the medications.

“Research evaluating the long-term risks of switching back and forth multiple times is ongoing, but the evidence we have now is that they are good replacements,” Chun says.

Q How is IBD treated?

A: IBD is treated using a wide range of medications, including anti-inflammatories, immunosuppressive agents, and biologics like infliximab or vedolizumab that are antibodies that target the immune system. Steroids can be very helpful for short-term treatment while starting a long-term therapy.

ADVANCED ANKLE APPROACH

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SPECIALIZED JOINT REPLACEMENT SURGERY NOW AN OPTION

Creaky knees and achy hips get all the Dr. Courtney Grimsrud attention.

But anyone who has arthritis in the ankle knows how painful and debilitating it can be.

Until recently, patients whose pain wasn’t relieved with medications, injections, or other nonsurgical treatments had few options. Surgery to fuse the ankle bones relieved the pain, but it severely limited motion, permanently. Many had to live in pain.

That is changing.

castlerockhospital.org

ANKLE TECHNOLOGY ADVANCES This fall, Centura Orthopedics & Spine and Castle Rock Adventist Hospital welcomes Courtney Grimsrud, MD, an orthopedic surgeon who is one of the few in the area specializing in total ankle replacement. Grimsrud recently completed a fellowship in foot and ankle surgery at the University of Washington, where she mastered the latest surgical techniques and advanced technology in total ankle replacement.

Back in the 1970s, orthopedic surgeons began performing total ankle replacement, and things didn’t go so well. As a result, total ankle replacement was largely abandoned.

“In the last few years, the technology has gotten much better,” Grimsrud says. That technology includes custom-fit replacement joints, more precise surgical instruments, sharper imaging, and improved surgical approaches.

SUPPORTING THE LONG-TERM RESULTS The result is pain relief and preserved mobility, Grimsrud says.

Ankle replacement is still no walk in the park. In fact, it’s no walking at all without assistance for several weeks.

“It’s a hard area to heal,” Grimsrud says. “It’s the last area of the body to get blood to it.” And, she says, the force of walking concentrates about five times a person’s body weight on the ankle.

Still, she says patients tell her a few weeks of inconvenience is a small price to pay for a future of walking pain-free.

Schedule an appointment with Dr. Grimsrud or another orthopedic physician at Centura Orthopedics & Spine by calling 720-455-3775.

ARE YOU A CANDIDATE FOR TOTAL ANKLE REPLACEMENT? Total ankle replacement surgery is an option for many people with ankle pain caused by osteoarthritis or injury. Those who have structural abnormalities may not be good candidates.

Ideal candidates for the procedure are those who: Are not overweight Don’t participate in high-impact sports or activities Do not have diabetes or other conditions that can impair circulation Are around age 60

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Reconstruction

BREAST

Advances in oncoplastic surgery lead to better health and cosmetic outcomes

Women now, for instance, have the option of combining a lumpectomy that removes only part of the breast with reconstruction versus needing a full mastectomy. This surgery, which occurs at the same time as the surgery to remove the tumor, reshapes or rebuilds the breast to maintain a natural look and feel.

“We’re really able to push the boundaries for breast-conserving surgeries, but it requires a multidisciplinary approach, with the full team of care providers, to accomplish it,” says Clare French, MD, an oncoplastic surgeon and general surgeon who recently joined Castle Rock Adventist Hospital and offers the new surgeries.

Using these new surgical techniques, women have improved cosmetic outcomes after lumpectomy with immediate reconstruction, and may even be able to avoid a mastectomy.

French points to two oncoplastic techniques that help make this possible: mastopexy, or nipple lifts, and mammoplasty, which involves rearranging the breast tissue. If the patient’s nipple can’t be saved, it can now be re-created via 3-D nipple tattoos.

“The goal is to leave the breast as close to a normal shape and appearance after cancer surgery and match the other breast if necessary for the best cosmetic outcome,” French says.

Women considering breast reconstructive surgery should talk to a board-certified surgeon who has extensive experience performing breast reconstruction surgery, French recommends.

BREAST RECONSTRUCTION BREAKTHROUGH

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Following mastectomy surgery to remove breast cancer, it can be unsettling to awake from surgery without your breast. But with directto-implant surgery, available at Littleton and Parker Adventist Hospitals, mastectomy and breast reconstruction are performed at the same time. So, the patient wakes up with fully reconstructed breasts.

“It’s really an external way of moving beyond a breast cancer diagnosis,” says Littleton Adventist Hospital plastic surgeon Lisa Hunsicker, MD, FACS. Benefits of the surgery include: • Very low risk of infection • (Nearly) opiate-free pain relief

• Speedy recovery, with many patients able to go home within 24 hours of surgery and free from post-op restrictions in as soon as six weeks

Celebrate Yourself October is National Breast Cancer Awareness Month.

Celebrate by putting yourself first and taking time for an annual breast screening with advanced 3-D mammography at: Castle Rock Adventist Hospital 720-961-2033 Centura Health Meridian 303-269-4150 Centura Health Southlands 303-269-4150 Littleton Adventist Hospital 303-738-2767 Parker Adventist Hospital 303-269-4150 Porter Adventist Hospital 303-765-6500

Recently relocated to Castle Rock, Dr. Clare French is a long way from home. But that’s nothing new. She grew up riding horses in North Carolina, and then moved across the country to Portland, Ore., to attend Reed College. She graduated with a degree in Chinese Literature and Languages. French then traveled around the world to live and work in China. Returning stateside, French landed in New York, to attend medical school at Columbia University and then worked as a research fellow with the National Institutes of Health studying translational immunology. Then it was back across the country for surgical training at Virginia Mason Medical Center in Seattle, Wash., before heading to Colorado.

To make appointment with Dr. French, call 303-814-8138.

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Recent advances in surgery are providing breast cancer survivors with more options than ever.

A NATURAL ALTERNATIVE ARE BIOIDENTICAL HORMONE PELLETS SAFER OR MORE EFFECTIVE THAN SYNTHETIC HORMONES? LEARN THE BASICS TO MAKE THE BEST CHOICE FOR YOU.

When it comes to hormone replacement therapy (HRT), what’s old is new again. First used in the

1930s, bioidentical hormone therapy is gaining popularity as a more natural hormone replacement therapy option. But is the therapy more effective (or safer) than standard synthetic Dr. Wayne Furr hormone replacement? We’ll explore the potential benefits of pellet therapy with help from Wayne Furr, MD, an OB/GYN on staff at Castle Rock Adventist Hospital.

A NEW OLD REMEDY Bioidentical hormone therapy involves implanting a pellet that’s the size of a grain of rice into subcutaneous tissue to deliver a constant stream of hormones that are identical to the ones your body naturally produces. The hormones are delivered slowly over a course of three to four months.

“This eliminates the need for injections, creams, or pills. And bioidenticals seem to be gaining bona fides not only in their ability to optimize your hormones but also to make you feel better, which is the ultimate goal,” Furr says.

castlerockhospital.org

PARSING THE RESEARCH For many women, hormone replacement conjures worries, including an increased risk of heart attacks, breast cancer, or uterine cancer. That’s one reason pellet therapy may be worth considering, according to Furr.

“The 2002 WHI [Women’s Health Initiative] study that outlined these risks associated with estrogen and progesterone was based on studying synthetic versions of the hormones,” he says. “Natural bioidenticals weren’t included in the study.

Yet from that point on, estrogen and progesterone were wrongly understood to be precancerous.”

Bioidenticals actually act

1 to 2.5 MILLION

The number of women over age 40 in the U.S. using bioidentical hormone therapy.

contrary to the synthetics, he says. Where synthetics were found to increase LDL (bad) and decrease HDL (good) cholesterol, bioidenticals do the opposite. “Natural estrogens can be better options for many women than synthetics because they offer these benefits.”

“Hormone optimization is about bringing a patient who may be within that ‘normal’ range to something that’s actually more optimal for them,” he says.

“Because we want to look at a whole patient and not just her bloodwork.”

DIGGING DEEPER Women are often tested to determine their hormone levels and told they are “within a normal range.” But Furr believes that even women within normal ranges can experience symptoms such as fatigue, memory fog, depression, and low libido; and he tries to find ways to help.

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Portercare Adventist Health System NON-PROFIT ORG US POSTAGE

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DENVER, CO PERMIT NO. 3280

2350 Meadows Boulevard Castle Rock, CO 80109

Castle Rock 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 1-303-673-8166 (TTY: 711). Copyright © Centura Health, 2018. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-720-455-2531 (TTY: 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-720-455-2531 (TTY: 711).

REFLUX RELIEF

EXPERT CARE FOR HEARTBURN SUFFERERS

A new clinic at Castle Rock Adventist Hospital will care for the specific needs of patients with gastroesophageal reflux disease (GERD).

The new reflux clinic is a collaboration between gastroenterology and general surgery at Castle Rock Adventist Hospital, spearheaded by Dr. Maneesh Gupta gastroenterologist Maneesh Gupta, MD, and general surgeon David Lundy, MD. The clinic will offer diagnosis and treatment in one location for patients who experience reflux symptoms three or more times per week.

UNIQUE OFFERINGS

The clinic will provide a combination of medical, surgical, and endoscopic options, including hiatal hernia repair and endoscopies to screen for and prevent Barrett’s esophagus, a precancerous condition sometimes seen in patients with long-term GERD. They also will be one of only a handful of providers in the Denver area to offer a nonsurgical procedure called transoral incisionless fundoplication (TIF). This less-invasive, outpatient endoscopic procedure tightens the lower esophagus to prevent reflux. “It’s a great option for patients with frequent acid reflux that can be controlled with proton-pump inhibitor medications like Nexium and Prilosec because it can help them get off of them and avoid their potential long-term side effects,” Gupta says. “Approximately 85 percent of TIF patients are off their acid medications completely six years out.”

Many patients have been reluctant to have traditional GERD surgery because it results in bloating, gas, and difficulty swallowing. With TIF, patients experience almost none of these side effects.

MORE BENEFITS

Because patients sometimes need multiple procedures, having a gastroenterologist and a general surgeon in one location means procedures like TIF and hernia repair can be performed at the same time, which decreases time in the operating room and recovery time, Gupta says.

To make an appointment at the reflux clinic, call Centura Gastroenterology – Castle Rock at 720-455-3879.

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LEADER IN STROKE CARE Castle Rock Adventist Hospital has earned The Joint Commission's Gold Seal of Approval® for certification as a Primary Stroke Center by demonstrating compliance with The Joint Commission's national standards for health care quality and safety in disease-specific care. This advanced certification award recognizes Castle Rock Adventist Hospital’s exceptional efforts to foster better outcomes for stroke care.