Vibrant Fall 2017

Your Connection to Healthy Living

Volume 5, Issue 4 | Fall 2017

Bright

DAYS AHEAD Prevention, surgery, and other treatment options to fight skin cancer let you get back to (safe) fun in the sun.

After surgery to remove squamous cell carcinoma, John Kamprath is cancer-free.

3  Choosing the best mental health therapy 6  Advantages of having a primary care doctor 7  Helping hearts pump a bit better

porterhospital.org :: Spring 2013

1 PHOTO BY ELLEN JASKOL

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Women need to know what’s normal and what’s not at this major health milestone

SIGNS YOUR THYROID IS UNDERPERFORMING Hormonal changes in women around 50 often can be attributed to perimenopause, but the chances of developing hypothyroidism (low thyroid hormone) increase during midlife as well. Here are five signs to watch for: 1. You’re cold when others aren’t.

2. You tire more easily.

3. You’re constipated without cause.

4. Your skin is dry.

5. You’re forgetful and depressed.

WHO NEEDS

PAP TESTS?

American Cancer Society guidelines say women with normal Pap test results should continue Pap tests plus HPV screening every five years or a Pap test alone every three years until age 65. The exception: Women who have had a total hysterectomy (removal of ovaries and cervix) can stop testing at their doctor’s recommendation.

HYSTERECTOMIES CAUSE

% 8 7 Women

WHO HAVE HAD THEIR 78 PERCENT OVARIES REMOVED ARE EOPOROSIS. MORE LIKELY TO HAVE OST

SCHEDULE A BONE SCAN Women at average risk for osteoporosis should begin bone density screening at age 65. Screenings require a physician referral and can be scheduled at the following Centura Health South Denver centers: • Porter Adventist Hospital: 1-844-325-5584 • Castle Rock Adventist Hospital: 720-263-4245 • Littleton Adventist Hospital: 1-844-325-5579 • Parker Adventist Hospital: 720-809-8956 • Meridian and Southlands: 720-809-8956

rapid BONE LOSS

Most women today undergoing hysterectomies have their ovaries removed along with their uterus, a procedure called an oophorectomy. While this procedure eliminates the risk of ovarian cancer, it has an often overlooked side effect: Women who have their ovaries removed prior to menopause lose bone mass at twice the rate of women who still have their ovaries, according to a study published in the journal Fertility and Sterility.

If you’ve had your ovaries removed, you should get a bone density test every two years, regardless of your age (young or old), recommends Mandi Beman, MD, a gynecologist with CHPG Women’s Health at Porter Adventist Hospital. If your results are low, talk to your doctor about medication that could slow bone loss. Plus, get adequate calcium and vitamin D, do daily weightbearing exercises, quit smoking, reduce alcohol consumption, and talk to your doctor about medications that can accelerate bone loss — such as antacids and steroids.

NEED ANOTHER REASON TO

KEEP POUNDS OFF? Here’s one: your brain. A recent study of more than 8,000 women ages 65-79 found that with each one-unit increase in body mass index, scores on a measure of cognitive abilities dropped by nearly one point. Keeping pounds off can be a struggle for older women, but maintaining healthy weight may help preserve cognitive abilities, says Mandi Beman, MD, a gynecologist at Porter Adventist Hospital.

Porter Adventist Hospital is a regional medical center that provides care for complex health issues. We specialize in complex surgery, cardiovascular care, spine care, joint replacement, liver and kidney transplants, and cancer care. We are part of Centura Health, the region’s leading health care network. Vibrant is published quarterly by Porter Adventist Hospital — Portercare Adventist Health System. The purpose of this publication is to support our mission to improve the health of the residents in our community. No information in this publication is meant as a recommendation or to substitute for your physician’s advice. If you would like to comment or unsubscribe to this magazine, please email us at vibrant@centura.org. Vibrant is produced by Clementine Healthcare Marketing.

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VIBRANT :: Porter Adventist Hospital

PHOTO: CAKE ©ISTOCKPHOTO.COM/TBD

health briefs

Fall

Turning the big

‘‘TALKING ’’ POINTS

Two types of mental health therapy differ in approach

Whether you or someone you love is living with depression, addiction, or another mental health diagnosis, behavioral therapy is likely to be a recommended treatment. Knowing the difference between two common types can help you get the most out of your care.

In behavioral therapy, sometimes referred to as “talk therapy,” patients meet with a trained therapist to gain new ways of thinking or new coping skills. The two most common types of talk therapy are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). While the names are a mouthful, they share a middle name.

“Behavioral therapy is a proven treatment. The basic idea is to reinforce behaviors you want,” says Jay Ryser, LPC, a behavioral health therapist who specializes in CBT and DBT at The Centre for Behavioral Health at Porter Adventist Hospital. He highlights the two approaches.

CBT

DBT

Focuses on negative thoughts that interfere with everyday life.

Focuses on harmful behaviors that interfere with everyday life.

“We replace our untrue or negative thoughts with something that’s accurate,” Ryser says.

“We replace old coping skills with better ways of getting through painful, overwhelming situations,” Ryser says.

Effective with depression, anxiety disorders, bipolar disorder, eating disorders, and schizophrenia.

Effective with borderline personality disorder, alcohol and drug addiction, and eating disorders.

Suited for patients who are relatively stable emotionally. CBT patients can think clearly through things.

Suited for patients in crisis. Goes into specific skills to help patients lessen destructive behaviors.

Generally spans a 12- to 16-week period.

Generally spans a 6- to 12-month period.

More one-on-one-oriented therapy.

More group-oriented therapy, with some one-on-one components.

PHOTO: HIKE ©ISTOCKPHOTO.COM/PIXDELUXE

FIND A GOOD PROVIDER

Finding a therapist skilled in CBT or DBT can seem like a mountain that you don’t have the energy to climb. Simple legwork can help. Here’s a step-by step guide: 1 Look at your insurance plan’s mental health benefits, and get a list of approved providers.

2 Call providers and preinterview them with questions such as: “How much experience do your therapists have with CBT and DBT? Are they certified?’”

3 Bring a list of questions to your first appointment. An example might be: “This is my situation. Can you tell me what treatment you would recommend?”

Make sure the therapist offers a preliminary plan.

4 S eek someone you feel comfortable with. You may be more likely to open up and return for future appointments.

Coming Soon!

An evening intensive outpatient DBT program is starting this fall at The Centre for Behavioral Health at Porter Adventist Hospital. Learn more by calling 303-778-5774.

porterhospital.org :: Fall 2017

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THE YOU’RE IN

Colorado’s year-round fitness season makes skin protection a top priority

SKIN CANCER KNOWS NO SEASON. In fact, whether mountain biking in summer or hitting the slopes during ski season, Coloradans are exposed to the sun’s damaging ultraviolet rays year-round.

1/3

One in three new cancer cases diagnosed every year is skin cancer.

>80%

About 8-9 out of 10 cases are basal or squamous cell cancers. While the majority of these are benign, they can grow, cause disfiguration, or become cancerous if left untreated.

And the head, neck, and face take the brunt of it:  The lower lip is especially vulnerable to squamous cell cancer

 The nose is the site of more than 30 percent of all facial basal cell cancers  Cancers on the eyelids account for 5 to 10 percent of all skin cancers  Melanoma, the deadliest skin cancer, hits the head, scalp, and neck especially hard Even if a growth on the face, head, or neck is noncancerous, it can still pose a health threat. “Just because something is benign under a microscope doesn’t mean it can’t be locally problematic,” says Andrew Nemechek, MD, with Colorado Head & Neck Specialists at Porter Adventist Hospital. “Benign tumors may grow or become cancerous. A large, growing tumor can change how we look or threaten important facial structures, affecting how we sense things with our eyes, nose, or mouth.”

WHAT TO DO Take prevention seriously. Wear wide-brimmed hats and tightly woven fabrics. Use UV-protective lip balm and sunscreen with SPF 30 or higher and broad-spectrum protection against UV rays — especially in winter, when snow reflects the sun’s rays. Protect your eyes with UV-blocking sunglasses.

Know the three Ps. “If a spot on your skin is persistent, problematic, or in proximity to a crucial facial structure like your eye or nose, you need to have it checked by a dermatologist,” Nemechek says. Other factors such as pain, bleeding, a change in sensation, or a recurrence of a lesion also warrant evaluation.

Dr. Andrew Nemechek

Skin Cancer 101 TYPE

DESCRIPTION

ACCOUNT FOR

OUTLOOK

Basal cell carcinoma

Occurs in basal cells that are in the lowest part of the epidermis. The most common form of skin cancer and typically occurs in locations exposed to sun.

About 7-7.5 in 10 skin cancers

Usually grow slowly, and rarely spread to other parts of the body. However, this can occur if the cancer is left untreated, so early detection and treatment is important.

Squamous cell carcinoma

Occurs in the squamous cells, which are flat cells in the top or outermost part of the epidermis. Also likely to develop in areas exposed to sun.

About 1-1.5 in 10 skin cancers

Usually grow slowly, and rarely spread but more likely than basal cell carcinomas to invade fatty tissue beneath the skin.

Malignant melanoma

Cancer that starts in the melanocytes, specialized cells that make the pigment (called melanin) that gives skin its color.

Melanomas are far less common but far more deadly

Highly curable if caught early, but much more likely than other forms of skin cancer to spread if left untreated.

Malignant tumors of other skin structures

Cancer that derives from the glands, hair, or blood vessels.

Very rare — about 1 to 1.5% of tumors

Pose unique challenges in diagnosis and treatment.

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VIBRANT :: Porter Adventist Hospital

PHOTOS: BACKGROUND ©ISTOCKPHOTO.COM/RAPIDEYE; SKIN ©ISTOCKPHOTO.COM/UTKAMANDARINKA; JOHN BY ELLEN JASKOL; MICROSCOPE ©ISTOCKPHOTO.COM/RUTHYOEL; MOLES BY TIM GIESEN

ABCDEs of Moles After battling— and beating — skin cancer, John Kamprath now takes extra precautions before heading out into the sun.

How can you tell when that mole you’ve had forever — or that new one that just appeared — is something you should view with suspicion? A mole is actually a benign skin tumor, but nearly all moles are harmless. The American Cancer Society offers these basics on when to get a mole or skin spot checked by your doctor: A › Asymmetry: One side or half does not match the other.

TREATMENT For John Kamprath of Estes Park, recurrence was the keyword. “I had a little spot on my head that I always seemed to bump. No sooner would it ‘heal,’ then I’d bump it again,” says the 57-year-old construction worker.

As it turns out, the persistent spot was squamous cell cancer. Many basal and squamous cell cancers can be removed with dermatologic procedures such as Mohs surgery, a technique that removes cancerous tissue a bit at a time until a clear, cancer-free margin has been established. That’s the treatment Kamprath pursued — twice.

“The cancer recurred twice and I was referred to Dr. Nemechek. He performed flap surgery, which removed the cancerous area and then pulled the skin forward and over the area where the cancer was removed.” A recent full-body PET scan shows that Kamprath is cancer-free.

Other treatment options for benign and malignant skin lesions include:  Chemotherapy lotions and creams  Immunologic drugs that use the body’s own immune system to kill cancer cells  Radiation  Systemic chemotherapy Bottom line? If you suspect something’s not quite right, don’t delay getting it checked.

“We want to be timely and deliberate to maximize effectiveness,” Nemechek says.

The science of cancer Our body has amazing self-healing capabilities, such as the “repair machinery” that surveys your skin for DNA damage caused by the sun’s UV rays.

“Our body’s genetic machinery normally allows us to recognize and repair damaged cells. It’s a robust system of surveillance,” says Andrew Nemechek, MD. “But if our surveillance machinery is also damaged, we can’t repair ongoing cellular damage.”

Here’s what happens next: ≥ Damaged cells keep increasing in number. ≥ The cells group together into a tumor, or a growth of like cells. ≥ They grow unchecked. ≥ They can spread to other locations in the body.

Colorado Head & Neck Specialists is a group of highly trained ENT surgeons who specialize in the treatment of head and neck cancers, including advanced skin cancer; HPV-related cancers; and benign and malignant tumors of the thyroid, parathyroid, and salivary glands.

Colorado Head & Neck Specialists offers highly specialized care, including: • Transoral robotic surgery • Laser microsurgery • Skull base surgery • Microvascular reconstruction of the head and neck

To learn more or schedule an appointment, go online to coheadandneck.org.

B › Border: The edges are irregular, ragged, notched, or blurred.

C › Color: The color is not consistent all over the mole. There may be different shades of brown or black or even patches of pink, red, white, or blue.

>6mm

D › Diameter: It is larger than the size of a pencil eraser (about ¼ inch) across.

E › Evolving: The mole is changing in size, shape, or color.

Any new mole that appears later in life should be checked >6mm by your doctor.

Porter Adventist Hospital is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas. porterhospital.org :: Fall 2017

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Primary

6

reasons to have a primary care provider

Dr. Stephen Shepherd

Do you have a regular hairstylist? Dry cleaner? Mechanic? If so, you know the importance of building relationships with people who understand your preferences. And a good primary care physician (PCP) should be on your list as well. A PCP knows your medical history and can look out for your greatest asset — your health.

1 4

You won’t have to wait.

Being an established patient means getting an appointment quicker when you need one because the newpatient paperwork is already on file.

2

You’ll have help interpreting your Google results.

Massive amounts of information — and misinformation — swirls the internet.

Your PCP can help you understand what’s beneficial for you.

Reminder

Appointment in 30 minutes

You won’t have to explain yourself. Primary care physicians keep your personal and family health history in electronic medical records, which means you won’t have to start from scratch at every visit.

What’s a DO? Everyone knows what MD stands for. But an increasing number of physicians are opting for a “DO” after their name. What does it mean?

DO stands for Doctor of Osteopathic Medicine, and it’s equal to MD in level of education. What is different about a DO is their care philosophy.

While MDs focus their training on medication and procedures to heal the body, DOs receive additional musculoskeletal training and tend to rely on methods that encourage the body to heal itself.

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VIBRANT :: Porter Adventist Hospital

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You’ll have access to trusted specialists. When you have an issue that requires a specialist, start with your PCP. “Having a PCP expedites the process of getting a referral,” Shepherd says.

“Your PCP then will act as a point person and coordinate the care between multiple specialists.”

3

Your health will improve.

Having access to primary care improves health and reduces the risk of death from heart disease, cancer, or stroke, according to a review of multiple studies spanning 30 years by the National Institutes of Health.

6

You can get no-hassle prescription refills.

Did you forget you need more asthma inhalers and now you’re leaving town? Your PCP can approve refills of routine medications without an office visit.

Online Scheduling

Having a primary care physician means you’ll be seen quickly. And Centura is making it even quicker by now offering same-day appointments and online appointment scheduling at sameday.centura.org.

Find a Centura primary care doctor online at centura.org/find-a-provider.

PHOTOS: MAGNIFY ©ISTOCKPHOTO.COM/FABRIKACR; WATCH ©ADOBESTCCK – MEHMETALIGRAFIK; ICONS ©ADOBESTCCK – PIXELALEX; PILLS ©ISTOCKPHOTO.COM/SEZERYADIGAR

“Primary care physicians provide a lot more value than the general public knows,” says Stephen Shepherd, DO, a family medicine physician at Centura Health Physician Group Primary Care Highlands. Here are six ways you can benefit from having a PCP.

Temporary

TICKER SUPP

RT

Lifesaving Impella® heart pump keeps blood flowing

Impella heart pump

Sometimes after a heart attack, a heart wants to take it easy and rest for a bit.

But for the patient, a heart that isn’t pumping enough blood to meet the body’s needs can be deadly.

For those patients, Porter Adventist Hospital offers the Impella heart pump, which Steve Friedrich, MD, an interventional cardiologist at South Denver Cardiology Associates, describes as a “bridge,” to temporarily do the heart’s work for it.

When heart attack patients arrive at the hospital, most are rushed to the cardiac catheterization lab. There, an interventional cardiologist locates blockages in arteries and, if necessary, unblocks them and restores blood flow using a stent or a balloon.

In about 80 percent of patients, that procedure, called angioplasty, is enough to get the heart functioning again on its own, Friedrich says.

Rarely, the heart is so weakened or damaged that it doesn’t immediately resume pumping enough blood to meet the body’s needs, a condition known as cardiogenic shock. That’s where the Impella can be a lifesaver.

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

“It helps us keep the heart functioning until it can resume pumping on its own,” Friedrich says. It can also be a temporary solution for patients experiencing heart failure, or those who need blood vessels unblocked through angioplasty but have other conditions that make that procedure risky.

The Impella is inserted through an artery using a minimally invasive procedure, and is powered by an external pump. “Basically, it’s a little tube with a propeller in it that pulls blood out of the ventricle and pumps it into the aorta,” Friedrich says.

ARE YOU HAVING A

HEART ATTACK?

PHOTOS: DOCTOR ©MICHAEL RICHMOND; HEART PUMP COURTESY OF ABIOMED; HEART ©ADOBESTOCCK – SELLINGPIX

It’s essential to get to a hospital immediately when you’re experiencing a heart attack.

According to the American Heart Association, major symptoms of a heart attack are: Chest pain or discomfort Upper body pain or discomfort in the arms, back, neck, jaw, or upper stomach Shortness of breath Nausea, light-headedness, or cold sweats

More than 90 percent of heart attack patients who get to a hospital will survive.

Steve Friedrich, MD, was trained in the practice of fixing hearts without open surgery — a specialty called interventional cardiology — as a resident at Boston’s Massachusetts General Hospital, and in fellowship training at Beth Israel Deaconess Medical Center, also in Boston.

A four-time honoree as one of 5280 Magazine’s Top Docs in cardiology, Friedrich is the father of three grown children. The native of Niles, Mich., gives his own heart a workout playing recreational hockey.

South Denver Cardiology offers a wide range of programs from prevention and screenings to treatment for heart problems. To learn more or make an appointment, go to southdenver.com or call 303-744-1065.

porterhospital.org :: Fall 2017

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CENTURA HEALTH PHYSICIAN GROUP PRIMARY CARE

Portercare Adventist Health System

AURORA

2525 South Downing Street Denver, CO 80210

CHPG Cornerstar Primary Care (Parker and Arapahoe) 303-269-2626 • cornerstarprimarycare.org

Non-Profit Organization U.S. Postage

PAID

Denver, CO Permit No. 4033

CHPG Southlands Primary Care 303-928-7555 • southlandsprimarycare.org

CASTLE ROCK Ridgeline Family Medicine at the Meadows 720-455-3750 • ridgelinefamilymedicine.org Ridgeline Family Medicine — Castle Pines 303-649-3350 • ridgelinefamilymedicine.org

CHPG Grace Family Practice (near Arapahoe and Holly) 720-528-3559 • gracefamilypractice.org

DENVER CHPG Primary Care Highlands (near I-25 and Speer) 303-925-4580 • chpghighlands.org CHPG Primary Care Porter 303-649-3200 • porterprimarycare.org

GREENWOOD VILLAGE CHPG at DTC (Ulster and Belleview) 303-770-6500 • dtcfamilymedicine.org CHPG Primary Care Southmoor (in the DTC) 303-925-4960

HIGHLANDS RANCH Highlands Ranch Medical Associates 303-649-3140 highlandsranchmedicalassociates.org

LITTLETON Chatfield Family Medicine 303-738-2714 • chatfieldfamilymedicine.org Clement Park Family Medicine 303-932-2121 clementparkfamilymedicine.org South Suburban Internal Medicine (at Littleton Adventist Hospital) 303-347-9897 southsuburbaninternalmedicine.org

PARKER CHPG Internal Medicine Parker (on hospital campus) 303-770-0500 • internalmedicineparker.org

FREE CLASSES & EVENTS Around the Community

R por egiste terh r osp online ital. org/ at eve nts

Space is limited. RSVP is required. Locations and times vary.

Visit porterhospital.org/events or call 303-765-3825 for more information.

MY HEART’S A-FLUTTER

Atrial fibrillation, or A-fib, is a quivering or irregular heartbeat.

Join Dr. Sri Sundaram to learn more about this disease, our innovative treatment options, and what you can do to support better heart health.  Date: Thu, Oct 19  Time: 6-7 p.m.  L ocation: South Denver Heart Center, 1000 Southpark Drive

MEDICATION SAFETY

It’s important to understand what medications you are taking and why. Learn more and have the opportunity to ask a pharmacist about your medications.  Date: Mon, Nov 6  Time: 3-4 p.m.  L ocation: Porter Place, 1001 East Yale Avenue

PELVIC DISORDERS

Pelvic disorders, such as urinary or fecal incontinence and pelvic organ prolapse, are not a normal part of aging. Join Dr. John Joyce to learn more and improve your quality of life.  Date: Mon, Nov 6  Time: 6-7 p.m.  L ocation: Porter Adventist Hospital Conference Center

ORNISH™ HEART DISEASE REVERSAL PROGRAM

Dr. Mark Sheehan, cardiologist, will discuss the science behind a program that can actually reverse heart disease and save your life.

Learn more about your eligibility.  Date: Tue, Nov 7  Time: 6-7 p.m.  L ocation: South Denver Heart Center, 1000 Southpark Drive  Registration required: 303-744-1065

MAMMOS AND MOCKTAILS NIGHT

Join us for mammos and mocktails to make getting your mammogram a bit more enjoyable. Bring a friend and join us. This event requires a special RSVP; call 303-765-6500 to register.  Date: Tue, Oct 24  Time: 3-7 p.m.  L ocation: Porter Adventist Hospital — Women’s Wellness Center

HEALTHY AGING — CONTINUUM OF CARE

If you are caring for an ailing loved one, there are many types of care that can make their quality of life better. Join our panel to learn more about at-home care, palliative care, and hospice care.  Date: Thu, Oct 26  Time: 6:30-7:30 p.m.  Location: Parker Adventist Hospital, 9395 Crown Crest Blvd.

CHPG Primary Care Meridian 303-649-3100 • parkerprimarycare.org Timberview Clinic at Parker (on hospital campus) 303-269-4410 • timberviewclinic.org porterhospital.org

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, 2017. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-303-765-3826 (TTY: 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-303-765-3826 (TTY: 711).

PHOTOS: HEART ©ISTOCKPHOTO.COM/ANDIPANTZ; PILLS ©ISTOCKPHOTO.COM/ MA-K AGING ©ISTOCKPHOTO.COM/BOWDENIMAGES; ORNISH LOGO COURTESY OF DEANORNISHMD PELVIC ©ISTOCKPHOTO.COM/GRINVALDS

CENTENNIAL