Grow Fall 2018

Fall 2018 | Volume 10, Issue 4

Gary McElroy and his wife, Liz, are enjoying life in the country again after his successful treatment for breast cancer.

Guided Toward

RECOVERY Radiation therapy precisely kills cancer cells without harming healthy tissue.

See Page 4.

PLUS...

Fight the Flu

Speedy Joint Replacement

Moving Beyond Breast Cancer

Tackle Tummy Troubles

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PAGE 7 PHOTO BY ELLEN JASKOL

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 Rachel Rabazzi, DO, of CHPG Primary Care Meridian. “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 well-matched 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.

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.

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?

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 offices. To find one near you, see back cover.

9395 Crown Crest Boulevard, Parker, CO 80138 grow is published quarterly by Parker Adventist Hospital—Portercare Adventist Health System—as part of our mission to nurture the health of the people in our community. To comment or unsubscribe, please email grow2@centura.org. grow is produced by Clementine Healthcare Marketing.

Executive Editor: Abel Del Valle

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ILLUSTRATION: ©ISTOCKPHOTO.COM/DIANE LABOMBARBE; PHOTOS: ©ISTOCKPHOTO.COM/DIMA_SIDELNIKOV, /BRAINMASTER, /PEOPLEIMAGES, / OLHA_AFANASIEVA

HEALTH BRIEFS

Fall

FIGHT OFF THE FLU

Welcome, Baby A little planning can help everyone adjust when a newborn comes home

A BABY CHANGES EVERYTHING. To make the adjustment as smooth as possible, Shannon Ingwersen, MD, of CHPG Integrated OB/GYN at Parker Adventist Hospital, offers tips for preparing every member of the household.

Dads-to-Be • After baby comes home, take steps to help dad feel part of things. “Try to make a habit of bonding time for dad at night, maybe with that skin-to-skin contact that mom gets,” Ingwersen says.

Siblings • Explain what to expect with an ageappropriate book. Let siblings help prepare the nursery and buy baby a gift, Ingwersen says. An infant-like doll lets them practice holding the baby — preferably while sitting down.

Take your child to the hospital to meet baby, and make sure mom gives siblings plenty of attention and cuddles during the visit.

Protect your newborn from illnesses. Make sure everyone who’ll have close contact with baby has an up-to-date Tdap vaccine.

Pets • Months before delivery, create behavior expectations, and reward your pooch for respecting them. A professional trainer may help.

“Have someone bring home an article of the baby’s clothing or blanket to let your dog smell before baby comes home,” Ingwersen says.

PHOTOS: ©ISTOCKPHOTO.COM/TATYANA_TOMSICKOVA; /DECADE3D

To learn more about Parker Adventist Hospital’s Women’s & Babies services, find birth classes, or view videos of our obstetricians and schedule an appointment online, go to parkerhospital.org/birthplace.

JOINT SUCCESS

Advancements in technique and pain control IF ACHY HIPS AND KNEES are slowing you down, but you dread the long hospital stay and painful recovery of joint replacement, here’s some good news: The procedures performed at Parker Adventist Hospital don’t require either.

“There have been tremendous advancements in just a few years,” says orthopedic surgeon Derek Johnson, MD, medical director of the hospital’s Joint Replacement Program. “We have better surgical techniques and better pain management protocols” that are making hospital stays shorter and recovery quicker.

Two of the most notable technical advancements, according to Johnson: Anterior hip replacement. Custom knee replacement.

Accessing the hip joint Fitting a new knee specifically from the front spares to each patient often allows muscle and speeds patients to resume activities recovery. more quickly.

Plus, a new pain management approach allows patients to be up and around — and go home — more quickly.

The technique starts with an anesthetic injection that numbs the joint and provides pain relief up to 36 hours, reducing the need for narcotics, Johnson says.

Of the 600-plus patients who Dr. Derek Johnson have hip or knee replacement surgery each year at Parker Adventist Hospital, 90 percent are home within a day, with most patients bypassing the once-common lengthy stays in rehab facilities, Johnson says.

Knee replacement still means rehab, Johnson says. “But physical therapists have noticed patients are doing better sooner.”

To learn more about advancements in knee and hip replacement surgery, join Dr. Johnson for a FREE seminar on Tuesday, Nov. 20. See back cover for details.

To schedule an appointment with Dr. Johnson at Centura Orthopedics & Spine – Meridian, call 303-925-4750. grow

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PRECISI

Cancer Fighting

Advanced radiation technology kills cancer cells but spares surrounding organs

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The surface guided radiation therapy (SGRT) killing Gary McElroy’s breast cancer cells takes about five minutes, at most, to do its work. If

you count positioning time and preparation, it adds up to about 10 or 15 minutes that the 63-year-old spends lying on the treatment table at the Parker Adventist Hospital Cancer Center before getting on with his day.

When the beam attacks his cancer, he feels nothing. There are few sounds, other than the click of a mouse and the voice of the technician.

“If it wasn’t for having to breathe when they tell you, you could go to sleep,” McElroy says.

He may not sleep through treatment, but McElroy can rest easy knowing that the 25 SGRT treatments he received are as precise as they are effective in destroying his cancer.

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Precise radiation therapy with SGRT meant that Gary McElroy, 63, didn't miss a day on the job during his 25 treatments for breast cancer.

Breast cancer strikes men, too!

What is SGRT? SGRT is a highly advanced system for precisely delivering radiation to a tumor, while sparing surrounding tissue and organs. SGRT uses three high-definition cameras to compare the patient’s body surface in real time to three-dimensional CT scan images of the tumor and patient, says Andrew Tanner, MD, medical director of radiation oncology at Parker Adventist Hospital.

The Cancer Center at Parker Adventist Hospital uses the system for cancers of the head Dr. Andrew Tanner and neck, abdomen, prostate, and breast. Parker Adventist Hospital technicians are so expert that they now routinely help train colleagues from other cancer centers around the world in using SGRT.

Gary McElroy credits a television news story with helping save his life.

In December 2017, 9News reported on the death of Roland “Fatty” Taylor, a retired basketball player who spent his last season with the Denver Nuggets. McElroy was struck by the fact that Taylor, a man and a retired athlete, died of breast cancer.

McElroy, who works out and stays in shape — he’s completed an Ironman triathlon — said the story hit home. “I never thought I’d get cancer. I’m athletic; I eat right. But I realized, if a professional athlete can get it, then I can, too.”

The story inspired McElroy to do something he never had before: a self-exam. “I found a lump,” McElroy says.

McElroy had a double mastectomy and four months of chemotherapy before beginning surface guided radiation therapy (SGRT) at Parker Adventist Hospital.

He also had genetic testing.

“It turns out I have mutations on both BRCA-1 and BRCA-2 genes,” he says.

Mutations on either of those genes are linked to greater risk of several types of cancer, including breast, ovarian, and prostate. And those mutations are inherited.

So, his chance viewing of that news item on male breast cancer may have saved McElroy’s life, but it may also lead his five children to important knowledge of their own genetic makeup and cancer risk as well.

In the meantime, McElroy is determined to spread the word that male breast cancer is real. “I tell people if it can happen to me, it can happen to anybody.”

Greater precision, fewer side effects

Know the Signs Symptoms of male breast cancer are similar to the disease in women, and include: Lump

Nipple pain or discharge

Inverted nipple

Enlarged lymph nodes under the arm

What’s the Risk?

For men, the chances of getting breast cancer are small: about one in 1,000.

But some factors that increase a man’s odds are:  Age: The average age a man is diagnosed with breast cancer is 68  Higher-than-average estrogen levels, which can be caused by: • Taking hormonal medications • Exposure to hormones in the environment • Being overweight or obese  Genetic mutations, such as BRCA-1 and BRCA-2  Strong family history of breast cancer  History of excessive alcohol consumption  Liver disease

PHOTO BY ELLEN JASKOL

Radiation therapy, in which radiation beams are directed at cancer cells to kill or shrink them, is an effective cancer-fighting agent. But in the past, there has been risk of radiation damage to surrounding organs. That’s especially a concern among breast cancer patients like McElroy, and particularly those whose cancer is on the left side, near the heart.

But SGRT allows precise delivery of radiation directly to a tumor. A green light alerts the technician when everything is aligned properly. And if it’s not, the software automatically halts the treatment, Tanner says.

“With older equipment, we couldn’t tell if patients were holding their breath in the best way during delivery of the radiation. With this system, you can tell when everything is lined up perfectly,” Tanner says.

At Parker Adventist Hospital, radiation technicians pair the precision technology of SGRT with a technique called deep inspiration breath hold (DIBH), which uses the body’s natural rhythm while breathing in to move the heart down and away from the treatment area. The result is a significantly reduced risk of the heart being unnecessarily exposed to radiation during treatment for left-side breast cancer, Tanner says. And, because a smaller area is treated, side effects are minimal.

McElroy, an inspector for the Colorado Department of Agriculture, never missed a day of work after his SGRT treatments, which he completed in June. The area around the location of the treatments has gotten a bit red, but otherwise, “I haven’t had any side effects at all.”

To learn more about the Cancer Center at Parker Adventist Hospital, call 303-269-4975 or go to parkerhospital.org/ cancercare.

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

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Breast Reconstruction

Breakthrough

Women can now opt for breast reconstruction at same time as breast cancer surgery

Controlling risk of infection

In the past, surgeons were not able to offer direct-to-implant surgery due to concerns about infection rates, which could run as high as 30 percent. But a new anesthesia that allows mixing with an antibiotic dramatically lowers that risk and makes the two-in-one surgery possible.

The new anesthetic, called EXPAREL, is long-acting, Rogness says. “That allows us to pump antibiotic irrigation in and around that pocket for 96 hours after surgery.”

Direct benefits

Direct-to-implant surgery being performed at Parker Adventist Hospital and Littleton Adventist Hospital, has various benefits, including: Low risk of infection. A study published in PRS Global Open found that patients who received the new antibiotic irrigation had a 1.9 percent infection rate, compared to 6.4 percent with the standard method.

Nearly opiate-free pain relief. “With EXPAREL, we are significantly reducing the amount of narcotics used for surgery, thus reducing opiate dependence and opiate-related complications,” Rogness says.

Speedy recovery. Many direct-toimplant patients are able to go home within 24 hours of surgery and are released from post-op restrictions in as soon as six weeks.

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23% Portion of women who understand the full range of breast reconstruction options available to them*

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: Parker Adventist Hospital: 303-269-4150 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 Porter Adventist Hospital: 303-765-6500

Increase in demand for breast reconstruction procedures since 2000* * American Society of Plastic Surgeons

PHOTO: ©ISTOCKPHOTO.COM/KUPICOO

FOLLOWING MASTECTOMY SURGERY, it can be unsettling to awake from surgery without your breast. But with direct-to-implant surgery, 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 this breast cancer diagnosis,” says Christine Rogness, MD, a breast surgeon at Parker Adventist Hospital. “It restores their Dr. Christine Rogness confidence, their femininity, how they see themselves.”

Direct-to-implant surgery requires a strong partnership between a skilled oncological surgeon, who performs the mastectomy, and the plastic surgeon, who does the breast reconstruction.

GUT CHECK When tummy troubles persist, diagnostic tests can pinpoint the cause

Dr. Poorna Ramachandran

WHETHER IT’S FROM THAT EXTRA SLICE of pepperoni pizza, a heaping helping of stress, or a bug a child brings home from school, we all get tummy troubles.

Usually symptoms go away on their own. But when they last more than a few days, it may be time to see a specialist, says Poorna Ramachandran, DO, gastroenterologist at Centura Gastroenterology – Parker.

“There are a wide variety of issues that can be causing abdominal pain,” she says.

TUMMY TESTS To narrow it down and to pinpoint the exact cause of tummy troubles, gastroenterologists rely on a growing variety of diagnostic tests.

The tests Ramachandran recommends depend on a patient’s age as well as symptoms. “Depending on the patient population, we evaluate for H. pylori infection, celiac disease, ulcers, reflux, and narrowing of the esophagus, in addition to other rarer causes.”

Diagnostic tests include:

Breath or stool tests detect the bacteria H. pylori, which can cause stomach pains, nausea and vomiting, and lead to ulcers.

Upper endoscopy uses a tiny camera on the end of a long, flexible tube, which is inserted through the throat to visually examine the upper digestive system. The patient is under conscious sedation during the brief procedure.

REFLUX REDUCTI

Blood tests can reveal celiac disease, which is an immune reaction to gluten.

KNOW WHEN TO GO Stomach pain or upset stomach symptoms usually go away on their own in a few days. But Ramachandran says, always get checked out when:  Stomach pain or indigestion lasts three or four weeks  You’ve lost weight without trying to  There is blood in your vomit or your stool

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Gastroesophageal reflux disease (GERD), also known as acid reflux or heartburn, is a common cause of gastro upset. What you eat — as well as when and how much — can affect acid reflux, says Ramachandran. To cool the burn, she suggests cutting back on: Midnight munching. Digestion takes several hours. When you’re vertical, gravity helps, but if you’re lying down, stomach acid may leak and flow back into the esophagus. Try to avoid eating for at least two to three hours prior to when you lie down for the night.

PHOTO: ©ISTOCKPHOTO.COM/DIY13

Caffeine. Caffeinated drinks are high in acid.

Spicy foods. These can be tough to digest, and lead to indigestion.

Portion size. Eating small meals throughout the day eases symptoms.

Stress. The connection between the gut and the head is well-documented.

To schedule an appointment with Dr. Ramachandran, call 303-925-4720 or visit chpggi.org.

Your weight. “Extra weight can put pressure on the esophagus, causing reflux,” Ramachandran says.

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Portercare Adventist Health System

CENTURA HEALTH PHYSICIAN GROUP PRIMARY CARE & OB/GYN PRACTICES

Non-Profit Organization U.S. Postage

PAID

Denver, CO Permit No. 3280

9395 Crown Crest Boulevard Parker, CO 80138

AURORA CHPG Cornerstar Primary Care (Parker and Arapahoe) 303-269-2626 cornerstarprimarycare.org CHPG Cornerstar Women’s Health (Parker and Arapahoe) 720-851-8230 cornerstarwomens.org CHPG Southlands Primary Care 303-928-7555 southlandsprimarycare.org CHPG Southlands Women’s Health 303-649-3090 southlandswomenshealth.org

PARKER CHPG Internal Medicine Parker (on hospital campus) 303-770-0500 internalmedicineparker.org CHPG Primary Care Meridian 303-649-3100 meridianprimarycare.org CHPG Urogynecology Meridian 303-925-4650 womensurogyn.org

free FALL Seminars & Events Join Parker Adventist Hospital for a series of FREE events and seminars. All seminars are held in the Inspiration A and B conference rooms in the Parker Adventist Hospital Conference Center, located on the Garden Level at the west entrance, unless otherwise noted. A light lunch is served during daytime programs, and light snacks are served during evening programs. Registration is required for all seminars.

Register online at parkerhospital.org/events.

Advancements in Joint Replacement Tue, Nov 20 | 6-7 p.m.

Join Dr. Derek Johnson, orthopedic surgeon, to hear about the latest advancements in knee and hip replacement surgery and learn if you may be a candidate.

Integrated OB/GYN 303-721-1670 integratedobgyn.org

Mental Health First Aid Colorado

Participants learn to recognize symptoms and develop strategies to support someone experiencing mental illness or emotional crisis. A separate youth class is offered for teachers, social workers, coaches, and others who work with children and teens. Youth and adult classes offer a five-step action plan to:

 Assess risk of suicide or harm  Listen nonjudgmentally  Give reassurance and information  Encourage appropriate professional help  Encourage self-help and other support

Pinnacle Women’s Healthcare 303-840-8780 pinnaclewomenshealthcare.org

For more information and to find a class near you, go to mhfaco.org/findclass.

Timberview Clinic at Parker (on hospital campus) 303-269-4410 timberviewclinic.org

Making Strides Against Breast Cancer Pathways to Health & Wellness

An 18-session seminar presented over three months, designed to help you choose and attain the health goals you have set for yourself. No two individuals are alike, which is why this program has the flexibility to adapt to each individual for maximum success. The course is offered at a variety of locations near you.

For more information, go to centura.org/communityprograms/creation-health/pathways.

Centura Health will be participating in the American Cancer Society Making Strides Against Breast Cancer walk on Sunday, Oct. 28. Proceeds from the event go to breast cancer research, prevention, and early detection. Help us support this incredible cause by donating to makingstrideswalk.org/centurahealth.

PHOTOS: ©ISTOCKPHOTO.COM/TETMC; /SDOMINICK; /GIGA

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 1-303-269-4053 (TTY: 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-303-269-4053 (TTY: 711).