Grow Summer 2018

Summer 2018 | Volume 10, Issue 3

Ready for

TAKEOFF

Former U.S. Air Force pilot and Denver International Airport Chief of Operations Eric Hall is prepped for an active retirement after shoulder surgery at Parker Adventist Hospital.

Full speed ahead after reverse total shoulder replacement surgery.

See Page 4.

PLUS...

3 questions to ask before a colonoscopy

Treat sports injuries sooner

Recurrent UTI risks and remedies

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PAGE 7 PHOTO BY ELLEN JASKOL

Dealing With

DIABETES NEW MEDICATION OPTIONS

SCREENING OUT HIDDEN DIABETES

In the past decade, more than 30 million Americans with type 2 diabetes have had a growing list of medication options to treat the disease. Two of the most promising classes of those drugs are: • Sodium-glucose transporter 2 (SGLT2) inhibitors work by preventing the kidneys from releasing excess glucose back into the bloodstream. That means more sugar leaves the body through urine, which helps maintain appropriate blood sugar levels.

• Glucagon-like peptide-1 receptor agonists (GLP-1) are injectable medications that limit how much sugar the liver releases into the blood and slows the rate at which food leaves the stomach. This allows the pancreas to produce more insulin, which lowers blood sugar.

Often people can develop type 2 diabetes without knowing it, because symptoms mimic other conditions, says Christy Beyerly, diabetes program manager at Parker Adventist Hospital.

Common symptoms include: e Unexplained fatigue e Frequent urination e Dry mouth e Extreme thirst e Unexplained weight loss The American Diabetes Association recommends annual screening for everyone starting at age 45. Start earlier if you have risk factors, such as a family history of diabetes; you are overweight or have high blood pressure; you’ve had gestational diabetes; or you are of African-American, Asian, Native Hawaiian, Hispanic, or Latino descent.

Learn More To learn more about diabetes education classes, call Parker Adventist Hospital’s program at 303-269-4500 or Castle Rock Adventist Hospital’s program at 720-455-1111.

Over time, high blood sugar can damage the delicate nerve fibers and weaken the small vessels that carry blood to and from arms, hands, legs, and feet.

The resulting lack of sensation — called neuropathy — carries hidden dangers, says David Hardin, MD, surgeon with the Parker Wound Care & Hyperbaric Center. “Let’s say you’re walking with a rock in your shoe. You would stop and pull it out. But those with diabetes may have no sensation and not realize it’s there.”

People with diabetes are likely to get more wounds.

Those wounds tend to heal more slowly and are prone to infection due to decreased blood flow and oxygen.

That’s where the hyperbaric oxygen (HBO) therapy can help.

“We can use hyperbaric pressure to supersaturate the blood with more oxygen,” to facilitate healing, Hardin says. “Oxygen is the building block for healing.”

Healthy Healing If you are suffering from any type of wound, the wound care experts at Centura Health can help. Our two South Denver wound care centers are: Wound Care Center at Parker Adventist Hospital 9395 Crown Crest Blvd., Parker 303-269-2310 Porter Wound Care & Hyperbaric Center 990 E. Harvard Ave., Denver 303-778-5242

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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PHOTOS: ©ISTOCKPHOTO.COM/VGAJIC; /YELENAYEMCHUK; /SEZERYADIGAR

Summer

HEALTH BRIEFS

HYPERBARIC WOUND HEALING

The BOTTOM Line Three questions to ask your colonoscopy doctor TO DETECT COLON CANCER EARLY when it’s most treatable, doctors recommend that most people get a colonoscopy starting at age 50 (younger for people at higher risk). This procedure doesn’t just detect cancer, it also can prevent cancer by removing polyps before they become tumors.

But not all colonoscopies are the same, says colon and rectal surgeon John Sun, MD, with Centura Colorectal Surgery in Parker.

Who performs the procedure, and how well they do it, matters, Sun says.

There are national standards for colonoscopy quality. Sun recommends that patients who are scheduling a colonoscopy ask the prospective physician (usually a gastroenterologist) the following questions:

What is your adenoma detection rate?

Adenoma is the term gastroenterologists use for polyps. The detection rate should be greater than 25 percent for men and 15 percent for women, Sun says.

The difference is due to the fact that colon cancer is more common in men than women.

“Anything less, and they may be missing things.”

What is your average endoscope withdrawal time?

It should take more than six minutes for the endoscope to be removed, Sun says. “As the withdrawal time decreases, so does detection rate.”

What is your cecal intubation rate?

The cecum is a pouch at the end of the colon that connects it to the small intestine. Successfully entering the cecum with the scope indicates the physician was able to view the colon thoroughly and perform a complete examination. Studies show that less-experienced physicians are less likely to enter the cecum during a colonoscopy.

1 QUESTION TO ASK YOURSELF: Have I done the prep correctly? If not, even the best colonoscopy could overlook small polyps.

PHOTOS: ©ISTOCKPHOTO.COM/JAROON; SUN PHOTO BY ELLEN JASKOL

SCREEN SAVERS Colon cancer screenings can be a lifesaver. While colon and rectal surgeon John Sun, MD, with Centura Colorectal Surgery in Parker, reminds everyone that colonoscopy is the gold standard for testing, a number of less-fuss, no-prep screening options also are available, including: • Fecal immunochemical test (FIT). Using samples collected at home, FIT is a highly sensitive test that looks for blood in stool. Colon tumors often produce bleeding.

• Guaiac-based fecal occult blood tests (gFOBT). This home kit also looks for hidden blood in stool samples.

• Stool DNA tests. This test, sold under the name Cologuard, detects tiny amounts of blood in stool as well as DNA biomarkers that have been found in colorectal cancer and precancerous polyps.

These tests — suggested only for those at average risk for colon cancer — are convenient, but they have drawbacks, Sun says. Red meat, ibuprofen, blood thinners, and other medications can cause bleeding and false-positive results. And, he points out, if you receive a positive result from a home test, the next step is a colonoscopy.

To schedule an appointment with Dr. Sun, call Centura Colorectal Surgery at 303-320-0699 or visit centuracolorectalsurgery.org.

To schedule your colonoscopy, call Centura Gastroenterology – Parker at 303-925-4720 or visit chpggi.org. grow

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BACK IN

Rotation A

fter flying combat missions in Vietnam and a career spent overseeing operations at Denver airports, Eric Hall planned on a retirement filled with leisure time, golf, and racquetball. One thing stood in his way: shoulder pain.

When Hall decided it was time for surgery, he did his research, which led him to Centura Orthopedics & Spine – Meridian surgeon Landon Fine, DO. “Dr. Fine was very straightforward. He didn’t mince words. He told me that with what I had, a normal shoulder replacement wouldn’t work. There was too much deterioration in the joint.”

For Hall, the solution would be a reverse total shoulder replacement. That procedure works well for long-term deterioration due to osteoarthritis, as well as for older patients who have “fractures that are otherwise unrepairable,” says Fine.

STRIKING OUT WITH SHOULDER PAIN Hall traces his rotator cuff damage to hard work raising horses growing up on a family farm and to another classic cause: years of throwing fastballs, sliders, and curves. He pitched in college for Western Michigan University, and was signed by the Kansas City Royals organization when he graduated. But the southpaw’s baseball career was interrupted — permanently as it turned out — by a summons from Uncle Sam. Figuring he’d prefer to see Vietnam from the air rather than the ground, Hall enlisted in the U.S. Air Force, trained as a pilot, and flew 143 combat missions. After nearly seven years of service, he left the Air Force, but not air travel.

On a stopover at Buckley Air Force Base, Hall Dr. Landon Fine spotted a newspaper help-wanted ad: Denver needed an intern at Stapleton International Airport. Hall got the job, and eventually became the airport’s chief of operations, a job he continued to perform at the new Denver International Airport when it opened.

After reverse total shoulder replacement, retirement is a good day on the links for Eric Hall.

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‘REVERSING’ JOINT DAMAGE But his dreams of a racquetball-filled retirement crashed in the reality of shoulder pain. That is, until he discovered he was a perfect candidate for a reverse total shoulder replacement.

“This is the treatment of choice for people over 60 who have arthritis in the shoulder and have rotator cuff tears or deterioration,” Fine says.

Reverse total shoulder replacement repaired a former pitcher’s rotator cuff, and got him back to active retirement

Don’t let shoulder pain disarm you Surgical options can relieve shoulder pain

PHOTOS: GOLF BY ELLEN JASKOL; WOMAN ©ISTOCKPHOTO.COM/WAVEBREAKMEDIA

Reverse total shoulder techniques have been around for years, but have been gaining in popularity, thanks to new technology and excellent outcomes, Fine says. For older people with deteriorated rotator cuffs, the reverse procedure “provides a lot more reliable pain relief and excellent shoulder function, particularly when it comes to range of motion,” he says.

For Hall, all those benefits came with just two days in the hospital, and three days on pain medication. These days, the 73-year-old has traded fastballs for slow tosses to his five grandchildren.

But the racquetball court still beckons.

And, thanks to his surgery, he made his first trip back to the courts just four months after surgery. He’s become a fan of the reverse procedure, and of Fine. “He’s given me back my quality of life,” Hall says.

And he has advice for anyone else whose shoulder pain threatens their quality of life. “If it’s broken, fix it. And, don’t wait too long.”

Learn more about the latest advancements in shoulder surgery at a FREE seminar taught by Dr. Landon Fine on Monday, Sept. 24, from 6-7 p.m. See back cover for details.

After shoulder surgery, you won’t be reaching any high shelves for a while. So, before surgery, take inventory of objects you’re likely to use or need, and move them to a lower, more accessible location.

Don’t let shoulder pain keep you from enjoying life — whether that means throwing a fastball or simply getting a good night’s sleep. Regardless of your age or the cause of your pain, there may be a shoulder repair solution that’s right for you. Centura Orthopedics & Spine – Meridian surgeon Landon Fine, DO, walks through some of the most common surgical options:

Total shoulder replacement In this procedure, the surgeon replaces the damaged or arthritic joint surfaces with a polished metal ball attached to a stem, and a plastic socket.

Who’s a candidate? Patients with osteoarthritis whose rotator cuff tendons are in good shape.

Reverse total shoulder replacement In this procedure, the surgeon turns nature on its head — switching the location of the socket and metal ball. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone, in reverse of the original arrangement. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to move the arm.

Who’s a candidate? Fine says this procedure works well for patients who: Have completely torn rotator cuffs Have fractures that can’t be repaired Are 60 or over and have arthritic shoulders or  rotator cuff tears Had a previous shoulder replacement that failed

Shoulder reconstruction This procedure restores stability to shoulders that are prone to dislocation. The surgery involves repair of the torn or stretched ligaments so that they are better able to hold the shoulder joint in place. The torn labrum is reattached to the shoulder socket with the help of special anchors.

Who’s a candidate? Patients who have suffered a type of labral tear known as a Bankart injury, which is caused by anterior shoulder dislocation.

To make an appointment at Centura Orthopedics & Spine – Meridian, call 303-925-4750 or visit centuraorthopedics.org.

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TIME’S UP

Toughing out a sports injury could lead to bigger problems down the road YOU’VE BABIED YOUR SHOULDER FOR MONTHS, but

it’s still painful during your signature backhand. Or maybe that twinge in your ankle as you jog the High Line Canal just won’t go away.

When a sports injury lays you out flat, it’s easy to know it’s time to see a doctor. But when does more subtle pain need to be seen?

And is it better to go straight to a sports medicine physician or orthopedic surgeon?

“If you’ve tried home remedies and rest for more than two weeks and your pain persists, it’s time to see a doctor or you could be making the situation worse,” says orthopedic surgeon Thomas McDonough, MD, of Centura Orthopedics & Spine – Meridian.

“You can end up making it worse. For example, walking on an ankle with a simple fracture that just needs a cast can cause complications and end up needing surgery,” McDonough says.

“It’s always a good idea to see your doctor if you’ve been injured,” or you’re experiencing long-term joint or tendon pain, he says. “You want to consult with a doctor who deals with these problems all the time.”

CONSERVATIVE APPROACH That’s true even if you don’t need surgery, says McDonough.

“Most injuries and conditions don’t need surgery, and there are many treatments we can try first.”

Those can include: • Nonsteroidal anti-inflammatory pain relievers, such as ibuprofen, or prescription pain relievers • Physical therapy • Cortisone injections

SURGICAL SOLUTIONS If those don’t work, surgery may be necessary, and the results are getting better and better, McDonough says.

Tendon tears, for example, often can be surgically repaired, McDonough says. “I operate on those frequently, with good results.”

Even the dreaded Achilles tear can be successfully repaired with surgery, and usually should be. “Often, if an Achilles rupture is not treated early, it becomes unrepairable,” McDonough says.

When you twist your ankle or wrench your knee, is it heat first, and then ice? Or the other way around? Should you still work out?

First off, early on, ice is always better than heat, says orthopedic surgeon Thomas McDonough, MD, of Centura Orthopedics & Spine – Meridian. The RICE regimen is the best home treatment for minor injuries: Dr. Thomas REST. Take it easy for a few days. It’ll pay off with less chance of McDonough further damage.

ICE. Apply ice (with a light towel between your skin and the ice) for 10 minutes on, 10 minutes off, and then repeat often during the first 48 hours.

COMPRESSION. Wrap the injured area with an elastic medical bandage — snug but not too tight.

ELEVATE. Raise the injured body part above your heart to reduce pain.

Do you ever use heat? When you’re ready to get back in the game is the time for heat.

If muscles are still stiff or sore, heat can help warm them up to avoid reinjury.

To make an appointment with Dr. McDonough, call 303-925-4750.

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PHOTO: ©ISTOCKPHOTO.COM/LARSZAHNER

Sports injury prescription: A regimen of RICE

Slow the GO

Recurrent urinary tract infections don’t have to keep you on the run

MORE THAN HALF OF ALL WOMEN will develop a urinary tract infection (UTI) at some point in their lives.

But when the infections come too often — two or more in six months, or three or more in a year — that is a recurrent urinary tract infection. And while they’re not as well-known, recurrent UTIs are common in women of all ages.

“It is one of the most common referrals I get in my practice as a urogynecologist,” says CHPG Urogynecology Meridian urogynecologist Alison Tate, MD. Bacteria cause UTIs, and most recurrent UTIs are believed to be new Dr. Alison Tate infections, rather than an ongoing infection or one that wasn’t completely eliminated with antibiotics, Tate says.

Risk factors for recurrent UTIs You may be more likely to experience frequent UTIs if you:  Have frequent sexual intercourse  Have a new sexual partner  Use spermicide  Had your first UTI before age 15  Are postmenopausal  Have a family history of frequent UTIs  Are pregnant  Experience fecal incontinence  Cannot completely empty the bladder  Have a shorter urethra or shorter distance from urethra to anus  Have pelvic organ prolapse (a condition that occurs when a pelvic organ such as the bladder drops and pushes against the vaginal wall) When a woman reports blood in the urine or other potentially serious symptoms, Tate says urinary tract imaging or other tests may be needed. But for most women, normal short-term antibiotics, or a six- to 12-month course of low-dose antibiotics, should resolve the recurrent infections.

Special circumstances

PHOTO: ©ISTOCKPHOTO.COM/MANOP1984; /RYOSEI; /PHOTOMARU

For women who’ve gone through menopause, Tate says a topical vaginal estrogen can help prevent recurring urinary tract infections. In older women, UTI symptoms can be slightly different and may include:  Increasing urinary incontinence  Increased need to urinate during the night

UTI

Alternative Treatments Many women, concerned about antibiotic resistance or overuse, turn to alternative treatments. There is little scientific evidence of the effectiveness of these treatments, says CHPG Urogynecology Meridian urogynecologist Alison Tate, MD. But, there is little harm in trying them, she says: Cranberry juice.

Generations of women have sworn by this remedy.

Probiotics. Probiotics, such as lactobacilli found in yogurt, may protect the vagina from bacteria.

High-dose vitamin C. Ascorbic acid may spark bacteria-killing chemical reactions in the urine.

D-Mannose. This natural sugar compound taken as a supplement may have properties that prevent bacteria from sticking to the bladder wall.

To schedule an appointment with Dr. Tate, call 303-925-4638.

When a pregnant woman experiences recurrent UTIs, treatment with pregnancy-safe antibiotics is a must, Tate says, because of the risk of the infection moving to the kidneys.

If that happens, it can increase the risk of preterm birth or delivery of a low birth weight baby.

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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

free SUMMER 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.

Shoulder Surgery Options

CHPG Primary Care Meridian 303-649-3100 meridianprimarycare.org

Mon, Sep 24 | 6-7 p.m.

Join Dr. Landon Fine as he discusses the latest in shoulder surgery and how to know when surgery is right for you. (See related story, page 4.)

CHPG Urogynecology Meridian 303-925-4650 womensurogyn.org Integrated OB/GYN 303-721-1670 integratedobgyn.org Pinnacle Women’s Healthcare 303-840-8780 pinnaclewomenshealthcare.org Timberview Clinic at Parker (on hospital campus) 303-269-4410 timberviewclinic.org

Pathways to Health & Wellness Stop the Bleed

Sat, Jul 28 | 8-9 a.m. or 10-11 a.m.

Parker Adventist Hospital’s Trauma Outreach Program is proud to bring you Stop the Bleed, a national campaign to teach skills to stop life-threatening bleeding. The workshop is FREE and lasts about an hour. Bleeding kits are available for purchase for $25 (cash or check).

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/ community-programs/ creation-health/pathways.

Advancements in Joint Replacement

Tue, Aug 7 | 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.

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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).