Grow Summer 2015

Summer 2015 | Volume 7, Issue 3

The path to

RECOVERY Understanding how to retrain the brain can help stroke patients have better outcomes.

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Marjorie Bystrom is back on her ranch spending time with family and furry friends after treatment at Parker Adventist Hospital helped her recover from a stroke.

PLUS...

Surgery for Parkinson's

Cancer warning signs for women

Next steps for joint surgery

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PAGE 7 PHOTO BY ELLEN JASKOL

How low is too low?

WHEN IT COMES TO DIABETES, plenty of patients focus on blood sugar spikes. But low blood sugar, or hypoglycemia, is just as dangerous, if not more so.

“High blood glucose readings can be life-threatening, but they have more of a cumulative effect,” says Christy Beyerly, registered dietitian, certified diabetes educator, and the diabetes program coordinator at Parker Adventist Hospital. “But one low blood sugar could kill you or someone around you.”

That’s because hypoglycemia — defined as a blood glucose reading under 70 mg/dL — usually comes on quickly and can lead to shakiness, confusion, light-headedness, blurred vision, lack of coordination, seizures, or loss of consciousness.

“If you’re driving, that’s a danger to you and everyone else around you,” Beyerly says.

“You need to know how to treat low blood sugar, and it’s not with a candy bar.”

The American Diabetes Association suggests ingesting 15 grams of one of the following simple carbohydrates to help raise blood sugar. Check your glucose levels again after 15 minutes.

• Glucose tablets (follow package instructions) • 2 tablespoons raisins • ½ cup juice or regular soda • 1 tablespoon sugar, honey, or corn syrup • 8 ounces nonfat or 1 percent milk

Learn to manage highs and lows Recognized by the American Diabetes Association, Parker Adventist Hospital’s diabetes education program has helped countless patients better manage their diabetes. For information on how to obtain a referral to the program, call 303-269-4500 or download the referral form at parkerhospital.org/diabetes.

Classes are typically covered by insurance.

WHILE 3-D MAMMOGRAPHY is no longer considered just an investigational screening method, it’s still not widely used. Even for those who do have access to the FDA-approved technology, it’s typically only used in women with dense breast tissue and those needing a follow-up exam.

Not at Parker Adventist Hospital, though.

Dr. Monique Fox “We can use it for everyone,” says Monique Fox, MD, a radiologist and breast imaging specialist at Parker Adventist Hospital’s Trio Breast Radiologist Center. “Parker [Adventist Hospital] has been phenomenal about it, and our results have been phenomenal.”

The patient experience with 3-D mammography, also called tomosynthesis, is the same as with regular X-ray mammography. Breast compression is still required, and the image scan takes several seconds. But the accuracy is much improved.

“Instead of looking at two images, I’m looking at 50 to 200 for each breast,” Fox says.

“That allows me to see masses more clearly in breast tissue or to see things that aren’t masses. This decreases the callback rate for false positives.”

While you should talk with your doctor about your individual risk factors, the American Cancer Society recommends the following screening schedule for women at average risk: A clinical breast exam every three years in your 20s and 30s, and then To schedule your annually after age 40 screening mammogram, An annual screening mammogram starting at age 40 call 303-269-4150 or TEXT Be familiar with your breasts through self-exams and report any changes your name to 303-816-8648 to your doctor 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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and a scheduler will call you to set your appointment.

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Parker Adventist Hospital offering advanced mammography to all women

Move better, live longer

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Surgery to help manage Parkinson’s symptoms now available at Parker Adventist Hospital APPROXIMATELY 1 MILLION AMERICANS CURRENTLY LIVE WITH PARKINSON’S DISEASE, a progressive disorder that affects the nervous system and causes symptoms such as tremors, rigidity, and slowness of movement. For patients whose symptoms are no longer controlled by medications or who can no longer tolerate the medications, Parker Adventist Hospital now offers an alternative: deep brain stimulation (DBS).

“We wanted to provide a surgery that has proven to be incredibly effective for patients,” says Mariel Szapiel, Dr. Mariel Szapiel MD, a neurosurgeon at Parker Neurosurgeon Adventist Hospital with more than a decade of experience performing DBS for Parkinson’s disease and other movement disorders, including essential tremor.

DBS uses a pacemaker-like device to deliver tiny electrical signals through thin wires, known as leads, Is DBS for me? to one of three areas of the brain that controls movement. Through computer guidance and inDBS may be an option if surgery testing, leads are placed while the patient you meet these criteria: is under local anesthesia and mild sedation. The >H ave a diagnosis of pacemaker device is inserted at a later date under idiopathic (unknown general anesthesia with the patient asleep. cause) Parkinson’s “Patients can experience results the same day as > No dementia or serious surgery,” Szapiel says. “It’s thrilling to see someone, diseases preventing who for many years was unable to write his name, do surgery it while in surgery.” >D isplay some DBS was approved by the Food and Drug improvement in Administration (FDA) for Parkinson’s disease in symptoms with levodopa therapy 2002 and has since become the leading surgery for > Have problems tolerating the disease. A 2013 study found that DBS may be or responding to effective for up to 10 years and significantly improves medications motor symptoms and quality of life for patients, compared to medications alone.

To find out if DBS might be right for you, talk to your neurologist or visit parkerhospital.org/dbs.

September FREE

health seminars Join Parker Adventist Hospital for a series of FREE health seminars. All seminars are held in the Parker Adventist Hospital Conference Center, located on the Garden Level at the west entrance. A light lunch is served during daytime programs, and light snacks are served during evening programs. Registration is required for all seminars. New online registration at parkerhospital.org/seminars.

Weight Loss Surgery Seminars Presented by Dr. Katy Irani: Thu, Sep 3 | Noon-1:30 p.m.

Presented by Dr. Joshua Long: Wed, Sep 9 | 6:30-8 p.m.

Join our bariatric surgeons for a look at various surgical weight loss options, and learn whether youʼre a candidate for surgery.

Hyperbaric Oxygen and Wound Care

Thu, Sep 10 | 5:30-6:30 p.m.

Join Dr. Michael Bertocchi, wound care medical director, for a discussion on hyperbaric medicine and the treatment of difficult wounds. Learn what causes non-healing wounds and how hyperbaric oxygen therapy can help with healing.

Advances in Joint Replacement Thu, Sep 17 | 6:30-8 p.m.

Join Dr. Derek Johnson, orthopedic medical director, to learn about computernavigated knee replacement, patientspecific knee replacement, and minimally invasive anterior hip replacement surgery.

(See story on Page 7.)

Urinary Incontinence in Women Tue, Sep 29 | Noon-1:30 p.m.

Stop the leak! Join Dr. Deborah Tozer, OB/GYN, to learn about new alternatives for urinary stress incontinence in women and finding a less invasive procedure with little downtime for treatment.

WOMEN

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Finding the

WO R D S Advanced understanding of brain connections helps stroke patients make greater improvements

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arjorie Bystrom has always been a woman of words. Whether outscoring opponents on the app “Words With Friends” or conversing with children as a preschool director, Marjorie never lacked for language to connect with and inspire others.

In late 2013, she and her husband, Michael, both retired, made a bucket list dream come true. They bought a ranch near Kiowa, Colo. With their daughter Michaela’s family living right next door, they thought they had ridden off into the sunset.

But then everything changed. Marjorie woke up on Jan. 15 and could no longer find the words.

“I knew something was wrong right away because she normally comes and says hi to me first thing in the morning,” her husband recalls. “When I went to say good morning, she was just speaking gibberish.”

Suspecting a stroke, Michael called daughter Michaela, a registered nurse who lives about 100 yards away. Michaela rushed over and agreed with Michael, so he called 911.

Marjorie was taken to Parker Adventist Hospital, where a stroke alert was called based on her expressive aphasia — her ability to understand but not communicate clearly. A CT scan of her head showed a left middle cerebral artery infarct, a technical term for a type of stroke that results from an obstruction to blood flow to that area of the brain.

GETTING TO THE SOURCE Nearly 90 percent of strokes are ischemic, the type that struck Marjorie.

Since it was not clear if Marjorie’s stroke had occurred within the past three to four and a half hours, tissue plasminogen activator (tPA), the only FDA-approved treatment for ischemic stroke, could not be administered.

“Administering tPA more than four and a half hours after a stroke could have caused more damage,” says Kathryn Polovitz, MD, a board-certified neurologist at Parker Adventist Hospital. “After determining it was a stroke, the next steps were support, treatment, and figuring out the Dr. Kathryn Polovitz cause in someone so young like Marjorie.”

Neurologist Marjorie, just 64, lacked risk factors for stroke, such as high blood pressure; high cholesterol; heart disease; atherosclerosis; obesity; diabetes; and smoking, drug, or excessive alcohol use. However, Polovitz and To learn more about stroke symptoms and recovery, join Dr. Polovitz for a FREE seminar on Oct. 27 from noon-1:30 p.m.

Register online at parkerhospital.org/seminars.

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Act F A S T When it comes to a stroke, think FAST: F A S T

FACE drooping ARM weakness SPEECH difficulty TIME to call 911

Strokes affect people differently, so it’s important to call 911 immediately even if only one symptom is present. When Michael Bystrom suspected his wife, Marjorie, was having a stroke, she only displayed speech difficulty. Michael’s instinct was right and upon arrival at the Parker Adventist Hospital ER, the stroke team there could quickly begin to help.

“Time is brain,” says Kathryn Polovitz, MD, a board-certified neurologist at Parker Adventist Hospital. “The sooner we can treat a stroke, the better the long-term outcomes.”

App Therapy

Specialist-led therapy sessions help stroke survivors like Marjorie Bystrom gain back some of what stroke takes away. Equally important to sessions are hard work and completion of individualized, meaningful exercises at home. “We like to give patients activities that are fun and challenging,” says Susie B. Peterson, MA, CCC-SLP, a certified speech-language pathologist at Parker Adventist Hospital.

A “Words With Friends” expert, Marjorie now uses apps like “Constant Therapy” and “Draw Something” to help rebuild connections in her brain.

“With these apps, Marjorie is accessing different parts of her brain that were not affected by the stroke,” Peterson says. “It’s helping her build new pathways.”

her team did discover Marjorie has atrial fibrillation (AFib), an irregular heartbeat that can cause blood clots. AFib affects 2.7 million Americans — many of whom, like Marjorie, don’t know they have it — and can increase the chance of stroke fivefold if left untreated, according to the American Heart Association.

Marjorie spent a week at Parker Adventist Hospital, where she was put on blood thinners for her AFib and underwent immediate speech, occupational, and physical therapy. She then continued rigorous therapy at Littleton Adventist Hospital’s Inpatient Rehabilitation Unit for a week before returning home on Jan. 30.

“We’ve found that early and aggressive participation in rehabilitation services leads to better outcomes for patients with stroke, concussion, and brain injuries,” Polovitz says.

REBUILDING PATHWAYS IN THE BRAIN Marjorie Bystrom’s goal of reading to her grandchildren the way she used to motivates her to work on her recovery every day.

PHOTO BY ELLEN JASKOL

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Other signs of stroke can include: Dizziness or balance issues Weakness or numbness in the leg, arm, or face Vision issues in one or both eyes Sudden severe headache

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Research in the past two decades has led to a greater understanding of brain neuroplasticity — the brain’s ability to create new pathways and reorganize itself after injury or disease.

“There was a time when the understanding was that stroke patients gained the most from rehab in the first three months, then plateaued,” says Susie B. Peterson, MA, CCC-SLP, a certified speech-language pathologist at the Centura Health Center for Therapy at Parker Adventist Hospital. “But we’re finding that even after a year or more, language and cognition still improve because of the neuroplasticity of the brain.”

As humans age, the brain becomes routine in how it processes information, using the same channels to derive information. “With a stroke, point A to point B might have a disconnection,” Peterson says. “Through therapy, we can retrain the brain to get from point A to point B through alternate routes, say through point C. Therapy can help make new connections and find alternative pathways for the brain.”

DEFINING RECOVERY For Marjorie, therapy has helped her dissect the robust vocabulary that’s in her head into manageable bits to verbally communicate. Today, she often writes a word or draws what she is trying to say, using an alternate way to retrieve the word.

“It’s like a library in my head,” she says. “Everything I want to say is there, I just can’t find it as easily as I used to, so I have to try to get to the words in a new way.”

Marjorie meets with Peterson weekly and diligently practices her homework in between sessions. Marjorie’s mother had a stroke and completely lost her ability to speak and write, something Marjorie is determined to avoid.

“I want to be able to read to my grandkids and communicate like I used to,” says the mother of three and grandmother to four (with another expected to arrive soon). “I’m determined to keep improving.”

With therapy, determination, and the support of her family and friends, there’s no doubt that Marjorie will find her words again. grow

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Parker Adventist Hospital is part of the Centura Health Stroke Network, the region’s leading provider of stroke care.

Parker Adventist Hospital is a Primary Stroke Center that has received The Joint Commission Seal of Approval for exceptional stroke care and received the 2015 American Heart Association/American Stroke Association’s “Get With The Guidelines” Stroke GOLD PLUS award for achieving outstanding stroke treatment for two or more consecutive years.

SIGNS

CHANCES ARE IT’S NOTHING. BUT YOU DON’T KNOW THAT. THESE COULD BE THE WARNING SIGNS OF A GYNECOLOGIC CANCER, SO PAY HEED.

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ynecologic cancers, including ovarian and uterine, are relatively rare, accounting for less than 3 percent of cancers in women. Still, more than 71,500 women will be diagnosed this year with gynecologic cancers, according to the Centers for Disease Control and Prevention. Survival rates are very high if the cancer is caught early, says Glenn Bigsby, DO, a gynecologic oncologist at Littleton and Parker Adventist Hospitals. “If detected early, at Stage 1, the five-year survival rate is very high for most types,” says Bigsby, one of just 1,200 physicians nationwide who specialize in the diagnosis and treatment of these cancers.

The most critical factor is that women pay attention to their bodies and report any changes to their Dr. Glenn Bigsby doctor early, he says. Symptoms include abnormal vaginal bleeding (especially after menopause), pelvic pain or pressure, abdominal or back pain, bloating, itching or burning, and changes in bowel movements.

OVARIAN CANCER Next to lung cancer, ovarian cancer is one of the deadliest cancers that can strike women. That’s mostly because there is no screening test that can help diagnose it at an early stage, making it all that much more important to pay attention to symptoms, Bigsby says. Cure rates are 70 to 90 percent if the cancer is found while still confined to the ovary, according to the American Cancer Society.

If it’s not cancer, it could be something else that can be treated. Conditions such as endometriosis, fibroids, and even irritable bowel syndrome can cause the same symptoms. And if a pelvic mass is found, there are now two blood protein tests that can help rule out cancer without having to undergo surgery.

ENDOMETRIAL CANCER The most common type of gynecologic cancer is uterine cancer that occurs in the lining, or endometrium, of the uterus. Endometrial cancer is increasing along with obesity rates, Bigsby says.

Fat tissue creates estrogen, which stimulates the lining of the uterus and spurs the development of cancer, he explains.

About 80 percent of endometrial cancers can be cured with a hysterectomy, but they must be diagnosed early before spreading.

The most common symptom is abnormal bleeding.

Parker Adventist Hospital’s advanced robotic surgery program is supported by Centura Centers for Clinical Innovation, extending advanced health technologies across Colorado and western Kansas.

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Detecting Ovarian Cancer There is no screening test to help catch ovarian cancer early. But three questions can help determine if a woman should be tested for ovarian cancer, according to a study published in the Open Journal of Obstetrics and Gynecology.

1 DO YOU HAVE ABDOMINAL AND/OR PELVIC PAIN?

2 DO YOU FEEL FULL QUICKLY, AND/OR ARE YOU UNABLE TO EAT NORMALLY?

3 HAVE YOU EXPERIENCED ABDOMINAL BLOATING AND/OR INCREASED ABDOMEN SIZE?

Gynecologic conditions, including cancer, are being more effectively treated through robotic-assisted surgery. Using the advanced da Vinci® robot, gynecologic oncologist Dr. Glenn Bigsby can remove even the tiniest cancerous lesions and tumors without injuring organs, arteries, or healthy tissue.

Learn more about gynecologic cancers and robotic surgery by calling 303-269-4975 or go to parkerhospital.org/cancercare.

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WARNING

IT STARTS OFF SMALL — SOME SPOTTING, A BLOATED BELLY, MAYBE SOME PELVIC PAIN, OR JUST PRESSURE.

Getting a leg up

Advancements in joint replacement include customized knee joints

Dr. Derek Johnson Orthopedic Surgeon

MORE THAN 1 MILLION AMERICANS will have a hip or knee replacement this year, about the same number as cardiac catheterizations and more than double the number of hysterectomies. As joint replacement implants and surgery advance, an increasing number of people — even in their 50s — are opting for surgery to ease debilitating joint pain.

Derek Johnson, MD, orthopedic surgeon and medical director of the joint replacement program at Parker Adventist Hospital, talks about whatʼs new in the field.

Q&A

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What is the biggest advancement in joint replacement surgery?

A: I’d have to say it’s how quickly patients are going home after surgery, particularly here at Parker Adventist Hospital. Typically, about 30 percent of patients go to a skilled nursing facility after joint replacement. Here at Parker Adventist Hospital, 95 percent of patients go home. And nearly every patient goes home within 24 hours of surgery, with nearly half leaving the same day.

How is that possible?

A: Our patients tend to be a bit younger, which helps. About half of our patients are under 65, compared with about 30 percent nationally. But mostly it’s a combination of three things we do in the hospital: using the proper anesthesia, controlling pain appropriately after surgery, and starting physical therapy as soon as possible, sometimes within hours.

What has been the response?

What’s on the horizon that excites you?

A: Patients are happier. They get to sleep in their own beds and not be woken up every two hours. It’s also safer and at the same time, we have not seen the rate of falls increase.

A: Patient-specific knee implants. The No. 1 complaint of knee replacement patients is that the new joint feels stiff and not normal.

We think that’s because the artificial joint is not an exact match to the patient's anatomy. Now we can take a CT (scan) ahead of time and have an implant designed to perfectly match the patient’s native anatomy.

We are hopeful that it will give a much more normal-feeling knee.

When will that become available?

A: It’s available now, but by the end of this year, Parker Adventist Hospital will be one of eight centers in the country conducting a randomized trial to evaluate the functional results.

3 STEPS to easier joint replacement If you are considering joint replacement, you can help improve your outcomes by following some simple steps beforehand: Start a program of low-impact exercise. Although your joint hurts, it’s important to keep it moving to increase the range of motion and make your supporting muscles stronger. This will help you prepare for the rehabilitation you’ll face after surgery.

Attend a presurgery class. Parker Adventist Hospital offers a one-hour class that walks you through everything you can expect and also helps you prepare your home and your life for the fastest, best recovery.

Eliminate narcotics. If you take prescription opioids for your pain, work with your doctor to reduce or eliminate them and use an over-the-counter nonsteroidal antiinflammatory drug, such as Tylenol, instead. “The more narcotics a patient uses before surgery, the harder it is to control pain after surgery because the body has become sensitized to the medicines,” Johnson says.

Learn more about anterior hip replacement, the new customized knee implant, and preparing for joint surgery with Dr. Johnson at a FREE community seminar on Sept. 17 at 6:30 p.m.

See Page 3 for details.

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October

FREE health seminars

Portercare Adventist Health System

Non-Profit Organization U.S. Postage

PAID

9395 Crown Crest Blvd.

Parker, CO 80138

Become more body-wise with the experts at Parker Adventist Hospital. All seminars are FREE but require registration by going online to parkerhospital.org/seminars.

Seminars are held in the Parker Adventist Hospital Conference Center at the west entrance. A light lunch is served during noon seminars, and light snacks are served during evening programs.

Denver, CO Permit No. 4773

Weight Loss Surgery Seminars Presented by Dr. Joshua Long: Wed, Oct 14 | 6:30-8 p.m.

Part of Centura Health, the region’s leading health care network.

Presented by Dr. Katy Irani: Thu, Oct 15 | 6:30-8 p.m.

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, 2015.

Join our bariatric surgeons for a look at various surgical weight loss options, and learn whether youʼre a candidate for surgery.

Don’t let a fall be fatal

Postpartum: A Seminar for New Mothers

Stroke Overview Tue, Oct 27 | 5:30-7 p.m.

Learn about stroke prevention, symptoms, treatment, rehabilitation, and recovery from Dr. Katie Polovitz, neurologist. (See story on Page 4.)

9395 Crown Crest Blvd., 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 Health Marketing of Littleton, Colo.

Executive Editor: Lisa Gates

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Tue, Oct 20 | Noon-1:30 p.m.

Join Dr. Jackie Ziernicki, OB/GYN (and new mom herself!), to learn about the physical and mental changes that new mothers face. Babies welcome.

FALLING IS PART OF LIFE. Toddlers tumble constantly, and comedians even fake falls for a laugh. Most of the time, it’s no big deal. But when an older adult falls, there could be serious — even fatal — consequences.

“Older adults are more frail,” says Mindie Enck, RN, trauma injury prevention coordinator at Parker Adventist Hospital. “So they are more likely to sustain injuries once they fall, and if they’re taking anticoagulants, they are at higher risk of bleeding in the brain, which can be deadly.”

Falls also can affect a person’s quality of life. Between 20 and 30 percent of falls by the elderly lead to an injury, such as hip fracture or head trauma. “Falls can cause serious injuries that can decrease confidence levels, limit activity, and cause functional decline,” Enck says. “Not to mention, the associated hospital stay can be quite costly.”

Falls require medical attention if: > The person who fell takes a blood thinner > Pain medication does not offer relief > There is any deformity > The patient is unable to walk or move the affected limb > There is any loss of consciousness > There is blood in the urine > Instinct tells you to get checked — don’t hesitate!