Elevate Winter 2017

Living at the height of wellness Winter 2017 | VOLUME 5, ISSUE 1

Slope Safety

Get prepped for injury-free winter fun with proper sport-specific conditioning Page 8

Castle Rock Adventist Hospital Earns an A for Safety See back cover

Pain Management Options Page 3

Dissolving stents for your heart Page 4

stress AND digestive distress Page 7

Partial knee replacement Page 9

activit y

How to (really) keep an open mind It’s easy to say that you’re openminded — or even that you want to be. But what can you actively do to make it happen?

Research shows these three things encourage an open mind.

1. Slow down. If you want to seriously consider an opposing viewpoint, give it some time.

2. Consider the decision critically. Evaluate the pros and cons.

3. Force yourself to supply reasonable arguments that go against your personal leanings.

This kind of positive mental activity can expand our minds — and our outlook.

Active lively

body,

mind

Staying active is one habit that’s good for both mind and body.

And activity is also one of the most important guiding principles of CREATION Health, a scientifically proven approach that Castle Rock Adventist Hospital’s wellness programs are based on. Physical activity increases blood flow throughout the body — including the brain. It gives us more physical and mental energy, and even helps us sleep better, says Eric Shadle, MD, group manager of Community & CREATION Health, South Denver Operating Group, Centura Health.

“Some people — endurance athletes, for example — actually find activity to be a spiritual experience,” Shadle says. “Any activity that pushes us to the limit expands the mind and taps into that spiritual side of our brain, and that’s good for our total health.”

Move at the MAC Spending too much time cooped up at home this winter?

Plan an active afternoon the whole family can enjoy at the MAC (Miller Activity Complex): • Jump for joy on their 16 trampolines • Swim laps in the indoor pool • Take a swing in the batting cages or golf simulator • Relax in the vortex whirlpool Call 720-733-2222 to learn more.

Could ‘spring forward’ be deadly?

Daylight saving time was established to conserve energy during World War I, but springing forward may have created an accident hazard due to disrupted sleep. Multiple studies have shown a small but significant increase in traffic accidents and deaths the day after the spring time change. It’s a great reminder of the importance of staying mentally alert — especially when you’re behind the wheel.

ELEVATE is published four times annually by Castle Rock Adventist Hospital — Portercare Adventist Health System. 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. ELEVATE is produced by Clementine Healthcare Marketing.

2350 Meadows Boulevard | Castle Rock, CO 80109

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CREATION Health is a wellness program designed to support whole-person health.

Pain management from

head to toe Back pain is one of the most common complaints of Americans. In fact, eight out of 10 Americans will experience back pain at some point during their lifetimes — sometimes crippling pain that limits activity, work, and enjoyment. That’s where Katarzyna Kocol, DO, comes in. As a physiatrist specializing in interventional spine and pain management at Castle Rock Adventist Hospital, Kocol treats a variety of pain problems using a range of treatments, from simple in-office procedures to more invasive nonsurgical procedures performed in a hospital environment. Here we highlight some of the most common treatments.

Trigger point injections ease muscle pain Trigger point injections are an in-office procedure that can relieve spine pain by injecting medication into trigger points or knots that form when muscles don’t relax. It’s commonly used to treat myofascial pain of the lower back and neck, but also can provide longlasting pain relief for gluteal or leg pain.

Epidural injections offer a shot of relief Epidural injections work by delivering a powerful combination of steroids and anesthetic directly into the space outside of the sac of fluid around your spinal cord. “We use X-ray guidance to ensure we’re reaching the spine at the right spot,” Kocol says. The procedure takes about five to 10 minutes, is performed in a hospital or surgical center, and may provide permanent or temporary pain relief.

Waves of relief with radiofrequency ablation Radiofrequency ablation uses an electrical current produced by a radio wave to heat up a small area of nerve tissue and decrease pain signals from the area.

It’s often used to treat low back and neck pain, as well as inoperable hip and knee osteoarthritis, with a goal of reducing pain by at least 50 percent for a year or more. The procedure is performed in a hospital or surgical center.

Fighting migraines with Botox®

Dr. Katarzyna Kocol offers a variety of treatment options to help put an end to pain.

castlerockhospital.org

Individuals who’ve experienced chronic migraines for six months or longer and haven’t had successful results with other conservative treatments may benefit from Botox therapy. It involves multiple injections on both sides of your body, from the muscles around your shoulders to the base of your neck, above your earlobe, and in your forehead. “It can be a very successful treatment option for migraines,” Kocol says. “Botox is done every three months with a goal of reducing migraines by 50 percent, but some patients experience complete resolution of their migraines.”

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New stents to open blocked arteries offer multiple benefits

When blood flow to the heart is restricted due to narrowed arteries, cardiologists often will insert a tiny mesh cylinder that helps reopen the passage. These cylinders, called stents, often come coated in a drug that is slowly released into the blood to help prevent the artery from becoming blocked again.

Now, a new type of stent being used at Castle Rock Adventist Hospital is offering multiple benefits — particularly to younger patients. The SYNERGY stent is thinner, making it easier and quicker to place — and the drug coating dissolves quicker, reducing risk of inflammation.

“The SYNERGY stent platform we’re using at Castle Rock Adventist Hospital is the latest generation,” says Russell Royer, RCES, EMT-P, CVT, MBA, cardiovascular and interventional radiology program manager. “It’s the thinnest stent on the market right now, and the polymerbased drug coating fully dissolves within 90 days.”

How They Work One downside of drug-eluting stents is that the polymer used to adhere the drug could last well after the drug has dissolved. Longterm exposure to the polymer can lead to inflammation, which has been associated with complications such as vessel renarrowing and blood clots.

With the SYNERGY stent, the polymer coating dissolves along with the drug.

“With previous generations of stents, we’ve seen the polymer last a lot longer than they intended — a lot longer than the drug itself,” Royer says.

The new stents also reduce the length of time patients need to take blood thinners.

“Typically a patient is on dual antiplatelet therapy for a minimum of a year after receiving

a stent,” Royer says. “The new stents have the potential to reduce the amount of time the patient is on blood thinners to three months.”

Easier Placement Stents with a bioabsorbable polymer are approved for use in anyone requiring stent placement. And they come with no new risks to patients when compared with previous drugeluting stents.

Even insertion is the same, if not slightly improved.

“The new stent, being the thinnest available, is far, far more deliverable,” Royer says. “It’s easier to get it to go where it needs to go. It may not be super evident to the patient, but easier deployment means less procedure time, which is always a positive.”

Castle Rock Adventist Hospital is part of the Centura Heart Network, the region’s leading provider of cardiovascular care.

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The bioabsorbable polymer coating on SYNERGY stents is microns thick.

4

A human hair is microns thick.

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Invisible Advantage

Studying up on the

female

heart

Now that heart research must include women, scientists are making some interesting discoveries

F

or decades, women were excluded from heart disease research. In

fact, it wasn’t until 1993 that the National Institutes of Health said women and minorities needed to be included in government-funded studies.

“Researchers for a long time didn’t think heart disease affected women,” says Amanda Bolton, board-certified family nurse practitioner with Ridgeline Family Medicine. “Of course, we now know that’s not true at all.”

Today, plenty of studies are looking at heart disease in women. Here we look at some recent discoveries.

Women worse off after heart attack One study found that a year after a heart attack, women were more likely than men to have poorer physical and mental functioning, more chest pain, and worse physical limitations. The study suggests that not recognizing heart symptoms — and therefore, not getting treated early — was one reason for the difference.

Another recent study found that as many as one in five women under age 55 experience a heart attack without any chest pain at all.

Take away: Be aware of all symptoms of heart attack — chest pain; pain or discomfort in one or both arms, the back, neck, jaw, or stomach; shortness of breath; breaking out in a cold sweat; nausea; light-headedness — and get care right away. Many women report an overwhelming feeling of impending doom or something not “feeling right.”

Insomnia increases stroke risk Insomnia raises your risk of stroke by a whopping 54 percent, and women are more likely than men to have insomnia, according to a study in the American Heart Association journal Stroke. While researchers are unclear about the connection, evidence suggests insomnia increases inflammation and blood pressure and also impairs glucose tolerance.

Take away: If you’re having trouble sleeping, talk to your doctor about solutions

and ensure your blood pressure and glucose levels are under control.

Call 911

If you or a loved one is experiencing symptoms of a heart attack, call 911 — even if you think driving yourself would be faster.

Early responders can start lifesaving care immediately and call in a “cardiac alert” to Castle Rock Adventist Hospital’s emergency department so that cardiac specialists are at the door when you arrive.

castlerockhospital.org

Gestational diabetes increases risk of heart disease It’s well-known that having diabetes increases your risk for heart disease, but now researchers have found that having temporary diabetes during pregnancy raises your risk, too. A 20-year study showed that women who had gestational diabetes were more likely to have clogged arteries and early heart disease than women who never had gestational diabetes.

Take away: If you had gestational diabetes, talk to your doctor about a heart

disease screening schedule and ways to reduce your risk for atherosclerosis.

Need a family physician? You can schedule an appointment with Amanda Bolton or another provider at Ridgeline Family Medicine at The Meadows by calling 720-455-3750.

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Aid Could you recognize a mental health emergency?

An all-toocommon 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.

ed?

What does our community ne

churches, hospitals, local public health departments, In 2015, Centura Health South Denver de suici and care h leaders identified mental healt police agencies, government, and other tal Health Men of s serie a of ent lopm prompting the deve prevention as critical community needs, urance, give how to listen nonjudgmentally, offer reass First Aid classes. Class participants learn find it. them e needing professional help, and help information and encouragement to thos held: Mental Health First Aid classes will be r Adventist Hospital: Parker Adventist Hospital: Mon, Feb 20 8:30 a.m.-5:30 p.m., Inspiration B Conference Room

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

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

go to southdenverhealth.org/register.

Classes are FREE to attend. To register,

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First

A mental health emergency is a common 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

Gut Check How does stress really affect your digestive tract? Learn the facts.

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Dr. Prashant Krishnan

Ever experienced “butterflies” in your stomach before a big event? Or a stomachache when you’re anxious? Then you probably won’t be surprised to learn that our digestive tract is second only to our brain and spinal cord in the number of neurons it contains.

So, how does stress impact your gut, and what can you do about it? Here are three facts to keep in mind: Stress is an agitator — not a creator — of GI stress.

Stress generally doesn’t cause GI issues, but it can exacerbate underlying conditions, such as Crohn’s disease, ulcerative colitis, and IBS, says Prashant Krishnan, MD, a gastroenterologist at Castle Rock Gastroenterology.

“Because the nervous system deals with stress and is so wellconnected to the GI tract, you can end up with GI symptoms,” he says. “That’s why when people are stressed, they can feel queasy and nauseated, because they are so well-connected.”

You can’t give yourself an ulcer.

“There’s this misconception that stress causes ulcers, but it’s not emotional stress that causes them. It’s physiological stress,” Krishnan says. In fact, about 90 percent of peptic ulcers and 80 percent of gastric ulcers are caused by an infection of H. pylori, a bacterium found in the lining of the stomach.

Exercise is key to dealing with stress — digestive and otherwise.

“Exercise increases the endorphins and neurotransmitters that make our minds feel better, and they also make the rest of our body function better — including the digestive tract,” Krishnan says. He also recommends focusing on breathing to help relieve stress and its symptoms.

90%

of your serotonin, the body’s “feel good” hormone, is made in your digestive tract.

The Probiotics Puzzle While extensive research is still being conducted on gut bacteria and its role in our health, Americans have rushed to add probiotics to their diet.

But are they effective? The truth is, we don’t really know yet.

“With billions of different types of bacteria in our gut, we don’t understand what all exists in there yet; there’s simply too much,” Krishnan says. That said, those probiotics you’re taking aren’t likely to do any harm, and some early studies have shown they may help with mild forms of ulcerative colitis, Crohn’s disease, and possibly with IBS.

To schedule an appointment with Dr. Krishnan, call Castle Rock Gastroenterology at 720-455-3879. castlerockhospital.org

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Winter

sports

are beckoning

When the snow flies, ski slopes call.

And that means your joints and muscles will be tested in ways unlike any other season’s activities.

“You often hear people say they’ll ‘ski themselves into shape,’ but that’s the worst thing you can do,” says Scott Bartel, DPT, SCS, a Castle Rock Adventist Hospital sports-certified physical therapist. “Skiing is a unique form of continuous motion at high altitude.”

balance and more prone to limb and back injuries,” Bartel says.

He recommends, if you’re healthy, checking out the conditioning programs for skiing and snowboarding offered by many local gyms.

Even if you’re regularly hitting the slopes, he says, it’s important to work a maintenance program of 30 to 60 minutes two to three times during the week, rather than being a weekend warrior.

Ideal conditioning It’s inviting an injury to press the quads, hamstrings, glutes, and knees into service — absorbing the dynamic up-and-down motion of skiing on uneven mountain terrain — without sport-specific conditioning. When it comes to preventing injuries, strong core musculature is key.

“Without it, you are more likely to lose

Après ski injury Skiers or boarders who experience a significant sprain or strain are likely good candidates for physical therapy to return them to top form and prevent further injury.

While many injuries will improve to some degree on their own, you can overlook the finer points a therapist is trained to observe, Bartel says. A good therapist will help you

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improve your balance and increase the strength and agility needed for specific sports.

“Going back to skiing or other activities without going through a return-to-sport program can set you up for another injury,” Bartel says. “After injury, motion can be more tentative and less intuitive. A therapy program will help you regain baseline strength and range of motion.”

Castle Rock Adventist Hospital offers ‘Return to Sport’ Therapy.

Call your physician for a referral or call us to answer your questions at 720-455-3700.

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Avoid a painful reckoning

KNEE SURGERY OPTIONS

When less is more

Considering knee surgery? Learn why going with a partial

(versus total) replacement can be a better option.

Dr. Ed Szuszczewicz

If you’re facing knee surgery, you may not realize there are options beyond a total knee replacement. But a partial knee replacement can be a much better choice. With help from Ed Szuszczewicz, MD, a fellowship-trained orthopedic surgeon specializing in joint replacement at Centura Orthopedics, we’ll show you why — and the potential benefits of partial knee replacement.

Replacing what’s broken Your knee is divided into three basic compartments: the inside (medial), the outside (lateral), and the kneecap (patella). So, if you have arthritis in only one of those three parts, you may be a candidate for one of the two types of partial replacement: unicompartmental knee arthroplasty (or “uni”) for the inside or outside of the knee, or patellofemoral arthroplasty to replace the kneecap. Here are a few reasons worth considering partial knee replacement: Hospital stay: Patients with kneecap replacements typically spend one night in the hospital; uni patients typically go home the same day, versus three or four days for a total knee replacement.

Recovery time: Partial knee replacement generally results in less pain and less intensive physical therapy and faster recovery than total knee. That’s because patients regain their range of motion sooner, allowing them to start outpatient

physical therapy right away. Typically, with total replacement, patients receive physical therapy at home before progressing to an outpatient setting, he says.

Joint feel: “Both types of partial knee replacements feel more like your own knee than with a total knee replacement, which many patients say feels more artificial,” he says.

Revisions: If a partial knee replacement eventually fails, converting to a complete knee replacement is akin to having a total knee replacement for the first time, Szuszczewicz says.

Outcomes: Ten years out, the success rates for partial and total knee replacements are virtually identical — 90 to 95 percent. “The partial knee replacements of 20 to 30 years ago didn’t do as well, and they got a bad rap. But the reality is, the 10-year results are now the same — so they’ve come a long way.”

$

A Better Bargain Opting for a partial knee replacement might also save you money, according to a 2015 Cornell study, which found that the procedure is a better value than total replacement for people over 65 because they’re less likely to have surgical complications and need less physical therapy.

To schedule an appointment, call Centura Orthopedics Castle Rock or Centura Orthopedics Lone Tree at 303-790-7181. castlerockhospital.org

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Effective natural remedies for common pregnancy symptoms

T

he excitement you feel at the beginning of your pregnancy can quickly be overshadowed by uncomfortable (and sometimes painful) symptoms. Still, you’re committed to using natural remedies that won’t harm you or your baby. The problem is, it can be hard to determine not only what’s safe to take, but which natural remedies actually work.

Jen Holcomb, FNP, a certified nurse midwife who practices at Castle Rock Adventist Hospital, shares this overall rule of thumb: “In general, therapies offered by a practitioner — such as chiropractic, acupuncture, and massage — are safe,” she says. “It’s when you get into self-prescribing with over-the-counter remedies that there are more hazards to watch for.” Holcomb shares these safe, effective natural remedies you may want to try for yourself. concern

Remedy

Morning sickness

• Chew on fresh ginger or peppermint leaf, get a whiff of peppermint or ginger oil, or drink real ginger ale • Acupressure uses finger pressure to stimulate trigger points and relieve nausea

Heartburn

• Papaya enzyme capsules • Apple cider vinegar diluted with water

Leg cramps

• Magnesium capsules

Back or pelvic girdle pain

• Chiropractic care • Acupuncture (it can also help induce labor)

Headache

• Remedies can vary based on the cause, but hot or cold compresses often help

Constipation

• Aloe vera juice • Increased water intake • A “constipation cocktail” containing equal parts applesauce, flaxseed, and prune juice; store in the fridge and take a tablespoon per day

Hemorrhoids

• Witch hazel pads

For more information about the midwife services at Castle Rock Adventist Hospital, call the BirthPlace concierge at 720-709-1986.

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Prepping for labor with … herbs?

Did you know that certain herbs can help you prepare for labor?

For example:

Red raspberry leaf When brewed as a tea, it acts as a uterine tonic that tones and helps improve the functioning of the uterine muscles.

EVENING primrose oil “It can help soften and ready the cervix for labor, so it should be used only after 36-37 weeks,” Holcomb says.

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Ginger is just one of the natural remedies that certified nurse midwife Jen Holcomb recommends for morning sickness.

Peaked Pregnancy

Heads

Up

Testing Readiness

Comprehensive concussion management helps athletes safely return to play It used to be known as “getting dinged” or “having your bell rung,” but current research shows that even what seems like a minor head injury can have lasting effects, especially if it’s not treated properly. Heidi Christensen, MD, CAQSM, a board-certified primary care sports physician who specializes in treating concussions in her clinic at Castle Rock Adventist Hospital, explains what to expect if your child is diagnosed with a concussion and when it’s safe to get back in the game.

What a concussion looks like A concussion is a brain injury that can be caused by a jolt or blow to the head or anywhere else on the body, which then causes short-term disruption in brain function. Most concussions occur without the individual losing consciousness and symptoms can be physical, mental, and emotional, including headache, lethargy, irritability, depression, and insomnia.

What treatment looks like Because the way each person experiences a concussion is unique, Christensen and her team individualize concussion management based on each person’s needs, in conjunction with standard protocols. Patients are evaluated in the clinic, where they undergo a neurologic exam, monitoring of symptoms, and possibly ImPACT® (Immediate Post-Concussion Assessment and Cognitive Testing).

When patients are symptom-free, the graduated return-to-play protocol begins, allowing athletes to increase physical activity incrementally. “Most of us are athletes and we understand the desire to return to sports, but we want to make sure it’s safe.” castlerockhospital.org

ImPACT testing is an important piece of the return-to-play protocol, especially for an athlete who undergoes strenuous physical activity and makes important split-second decisions during games.

“The test helps gauge things like reaction time, verbal memory, and visual motor speed, which is difficult to assess on a physical exam,” she says. “ImPACT is great at objectively identifying subtle effects of concussion on the brain.”

Missing the Signs

While nearly 500,000 children are seen in the ER for concussions each year, a June 2016 study in the Journal of Pediatrics found that the actual number of concussions among children is estimated to be between 1.1 and 1.9 million annually.

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Portercare Adventist Health System Non-Profit Org US POSTAGE

PAID

Denver, CO Permit NO. 4773

elevate your winter

Castle Rock Adventist Hospital has received the highest rating possible for hospital safety by The Leapfrog Group. The hospital scored an A in the annual survey for meeting or exceeding measures that keep its patients safe from errors, injuries, accidents, and infections.

Learn more at hospitalsafetygrade.org.

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 303-804-8166. Copyright © Centura Health, 2017.

COMMIT TO KAIZEN this year

T

he new year is a great time to commit to a new, healthier you. But rather than making one big resolution, this year commit yourself to the art of kaizen — the Japanese term for small, continuous steps that result in effective long-term change. Michelle Traver, a certified physician assistant with Ridgeline Family Medicine at Castle Pines, offers these tips: • Fill your calendar. Make a standing date once a week with your spouse or friends to converse, stroll, take a class, or cook a healthy meal.

• Stay present. Rather than fixating on what it will take to achieve your goal or even the goal itself, focus on the present, like how you feel after going to bed early or taking a walk.

• Hang in there. It takes about three to six weeks to form a new habit. Once you do, good habits are as hard to break as bad ones.

• Put it in writing. Write yourself “commitment cards” and stick them on your mirror, in your purse, or by the TV to keep your goals top of mind.

Book a Physical Annual checkups can spot health problems early on when they are easiest to fix. To book an appointment with Traver or another provider at Ridgeline Family Medicine, call 303-649-3350 (Castle Pines office) or 720-455-3750 (The Meadows office).

Add Time Want to add more time to your day? Volunteer.

According to a study published in the Harvard Business Review, people who volunteer their time feel like they have more of it.

For volunteer opportunities at Castle Rock Adventist Hospital, call 720-455-0450 or go online to castlerockhospital.org/ volunteering.

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A FOR SAFETY