Vibrant Summer 2016

Your Connection to Healthy Living

Volume 4, Issue 3 | Summer 2016

FORWARD THINKING

When it comes to joint replacement, preparation is a priority. A dedicated strengthening program before the procedure can get you moving forward faster post-surgery.

Ed Orlosky, 70, did extra workouts in the months before his bilateral knee replacement to ensure recovery before next ski season.

Page 4

3  Cancer answers 6  When to go to the ER 7  Intolerance for incontinence

porterhospital.org :: Spring 2013

1 PHOTO BY ELLEN JASKOL

LIFT YOUR

EYES

As we age, the folds in our upper eyelids can impair vision. In other cases, a puffy “bag” appearance results when the eyelids have excess skin. An eyelid lift surgery called blepharoplasty can help.

Misperceptions about mental illness persist Statistics show that nearly 90 percent of healthy adults believe that treatment can help people with mental illness to lead normal lives.

However, only 25 percent of adults with mental illness believe that people are caring and sympathetic toward the mentally ill.

While stigmas may have improved over the years, clearly those living with mental illness feel that they could be treated with more kindness and understanding.

Why the gap?

‘‘

Mental illness is real.

It’s not just an attitude.”

Claudia Clopton, MD, psychiatric hospitalist at Porter Adventist Hospital, says misperceptions about mental illness and depression persist.

“People confuse mental illness for everyday sadness,” she says, noting that major depression, for example, encompasses so much more than sadness — including sleep problems, energy problems, and difficulty concentrating or making decisions. “Mental illness is outside of most people’s experience. And since there’s no physical test — it’s the patient’s report of their symptoms — other people think it’s something you can change with willpower.”

Functional. “In functional cases, the eyelid can really start to block vision. It affects quality of life. Patients will try to raise their eyebrows to get that skin out of the way,” he says, adding that blepharoplasty is performed through the eyelid crease to remove excess eyelid skin and fat.

Cosmetic. In cosmetic cases, blepharoplasty removes excess eyelid fat that can lead to a puffy or tired appearance — especially under the eyes. “The lower eyelid procedure is considered cosmetic 99 percent of the time,” he says.

For help finding a physician for all your health care needs, call a CenturaConnect expert who will match you with a doctor based on your location and insurance provider. Call toll-free 1-888-776-0414.

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VIBRANT :: Porter Adventist Hospital

Treatments for depression include: Medication. “About 65 percent of people who take an antidepressant will get a response with their first medication,” Clopton says.

Psychotherapy. Also called “talk therapy,” this helps patients understand their illness and develop strategies to manage symptoms.

Electroconvulsive therapy (ECT). Offered at Porter Adventist Hospital, ECT delivers a low dose of electricity that causes a discharge of neurons to stimulate the brain. It is used for major depression that does not respond to traditional medications.

The important thing is to take a step. “Mental illness is real. It’s not just an attitude,” Clopton says. “There are effective treatments that can improve family relationships, quality of life, and ability to work. If one treatment doesn’t work, there are a number of treatments that are effective.”

Learn to bounce back when life brings you down at a FREE resiliency seminar on Aug. 1. See details on back cover.

PHOTO: WOMAN ©GOODLUZ — STOCK.ADOBE.COM; ILLUSTRATION: ©BLOOMUA — STOCK.ADOBE.COM

Chris Thiagarajah, MD, an oculofacial plastic surgeon, performs the surgery at Porter Adventist Hospital. It’s done in two cases.

Clopton urges people to seek treatment if depression or mental illness is suspected. “Often the place people start is with their primary care physician,” she says, noting that primary care physicians today are being trained much more thoroughly on how to detect and treat depression. A referral to a psychiatrist also may be warranted.

CANCER QUESTIONS Six things to ask before starting cancer treatment

Trying to sort through emotions and decisions after a cancer diagnosis is tough enough. But what about when it comes to knowing the questions to actually ask your doctor? Or maybe even harder, the questions to ask yourself?

Help is on the way. Here are six key questions to ask before you start cancer treatment.

Questions to ask your

1

doctor

Questions to ask yourself

What tests need to be done to help determine the extent or stage of my cancer? “There are things in the blood or biopsy itself that might have predictive value as to how well patients might do with their cancer, and also guide treatment,” says Tom Kenney, MD, a board-certified oncologist and hematologist at Cypress Hematology and Oncology at Porter Cancer Care Center.

2

What are my treatment options? Surgery, radiation, and chemotherapy are the standards. But there are new-generation drugs, targeted therapies, immunotherapy, hormone therapy, and clinical trials, too. Ask your doctor about the full range of options available.

3

What is the intent of treatment? “This is a really tough question to ask, but patients need to understand if treatment is designed to cure or control their cancer,” Kenney says. “It’s not always fun to hear, but patients should know the goal of treatment.”

1

Who can I count on to help me through treatment? This is a crucial question, says Jared Ediger, RN, an oncology nurse navigator at Porter Cancer Care Center. “There are people who will offer to help in a general way, but who are the people who will really step up to the plate and help with rides, meals, kids, and daily life when treatment is at its worst?”

?

2

What will motivate me to fight cancer? Is it family? Unreached goals in life? “I help people explore that,” Ediger says. “Helping people establish their reasons for going through treatments helps them maintain focus when things hit their low point.”

3

How much do I want people to know? “It’s smart to establish boundaries,” Ediger says. Do you need to set up a blog? Do you want your phone ringing nonstop? And how do you tell your kids? That’s where Porter Cancer Care Center can help. “We have a Kids Alive program, a support group to help kids sort through the complex feelings they have when their parent has cancer,” Ediger says. Porter Cancer Care Center offers other cancer support groups as well as individual and family counseling.

STEMMING SIDE EFFECTS

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Cancer treatment options often have side effects such as nausea and fatigue. Tom Kenney, MD, offers ideas on how to manage them.

Dr. Tom Kenney

Acupuncture. “Acupuncture has been shown to improve a number of symptoms during treatment, including appetite, fatigue, hot flashes, and pain,” Kenney says.

Antinausea medication.

“I suggest taking antinausea medication proactively, not just reactively. Aggressively treat nausea before it sets in on your worst days of treatment,” he says.

From support groups to nutrition services to individual and family counseling, Porter Adventist Hospital supports cancer patients every step of the way. Visit porterhospital.org/cancer.

Get up and move. Even if you just walk to the mailbox and back, it helps to build physical activity into your day. “In multiple cancer subtypes, studies show that people who are completely sedentary and weaker do worse,” he says.

Porter Cancer Care Center is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas.

porterhospital.org :: Summer 2016

3

Come on

STRONG HEAD INTO KNEE REPLACEMENT SURGERY WITH YOUR BEST FOOT FORWARD

At 70 years old, Breckenridge-area resident Ed Orlosky had absolutely no intentions of slowing down. But his knees? Well, they missed the memo.

“I knew I was headed for a left knee replacement for years,” he says, noting that arthritis had created a painful bone-on-bone situation in his left knee.

“I could ski, but it hurt. I still managed to cycle and kayak and hike in the spring, summer, and fall. But I was getting to the point where it was starting to interfere with what I was doing.”

Then he tore his right meniscus.

With two bum knees and a desire to get back on his feet ASAP, Orlosky decided on bilateral knee replacement. “I figured if I had both knees done at the same time, I would have one hospitalization, one recovery, and the chance to get back to my active life more quickly,” he says.

While he falls into the roughly 8 to 10 percent of knee replacement patients who opt — and qualify — for bilateral knee replacement, Orlosky’s story is also about heading into surgery on the strongest footing possible. His surgeon, Todd M. Miner, MD, an orthopedic surgeon at Colorado Joint Replacement, outlines the reasons this can help.

REHABILITATE BEFORE SURGERY Knee replacement surgery corrects the joint problem in the knee. But strengthening the muscles around the knee can support the new joint after surgery, which can help with recovery.

Research bears this out. A study published in the journal Arthritis Care & Research showed that patients who participated in a six-week exercise program prior to knee replacement showed a 20 percent change in strength preoperatively and were less likely to be discharged to a rehabilitation facility after surgery.

“There’s a real advantage to strengthening the leg muscles prior to surgery.

We call it prehabilitation,” Miner says. “Patients who exercise their quadriceps and hamstrings and work on range-of-motion exercises will not be as stiff following surgery. They definitely will make their rehabilitation easier.”

While it’s not permanent, loss of strength does result from surgery. “The quadriceps muscle gets inhibited, and you lose some strength in the quad from surgery. If you start at diminished strength, you will drop lower. This makes climbing stairs, getting up from a chair, and getting out of bed that much harder,” Miner says.

4

VIBRANT :: Porter Adventist Hospital

Ed Orlosky, 70, doesn’t really have an offseason. Building up his leg strength before bilateral knee replacement meant he was back to hiking and cycling six weeks post-surgery.

PAIN MANAGEMENT Not too long ago, total knee replacement patients stayed in bed for days and relied almost solely on narcotics to control pain.

Orthopedic surgeon Todd M. Miner, MD, says today’s knee patients are up and moving quickly and benefiting from advancing pain management techniques that attack pain from several angles.

“As we look for ways to keep pain managed well before, during, and after surgery, we’re seeing patients get up on their feet within a few hours of surgery and without all the side effects of narcotic pain medications,” he says.

He recommends two questions that knee replacement patients should ask their surgeon prior to surgery:

What pain management strategies do you use during surgery?

“In our practice, we inject a combination of medications into the joint capsule and soft tissues around the knee during surgery. In addition to a spinal block and nerve block in the thigh, this can really help diminish pain in the first 36 hours,” Miner says. That’s a critical time window because the patient will be up and walking — and most likely even discharged — in the 36 hours following surgery. “We don’t want patients to be sedated and having a hard time from the side effects of narcotic pain medication,” Miner says.

PHOTO ©ELLEN JASKOL; WEIGHTS ©TBAEFF — STOCK.ADOBE.COM

What pain management strategies do you use after surgery?

Again, Miner and his colleagues at Colorado Joint Replacement, use a combination of drugs to knock pain down from different directions. “We use anti-inflammatory medication, nerve medication, and non-narcotic pain medication,” he says. “Our research is showing minimized side effects, less nausea, and better results with strength and pain scores early on.”

For his part, Orlosky scheduled extra workouts in the weeks and months leading up to surgery. “I did extra time at the gym working on weights and stretching. I really worked hard. I figured the better condition my body and mind were in, the better my outcome would be.”

He also did his homework ahead of time on where to have the surgery done. He specifically chose Porter Adventist Hospital based on its high volume with surgical knee replacement and the expertise of the staff. “Having a surgeon, physician assistants, and hospital staff that specialize in joint replacements makes for a very positive environment for recovery,” he says.

PULLING DOUBLE DUTY Orlosky’s great conditioning and excellent health status helped him fit the criteria for bilateral knee replacement. “There is a set of criteria patients need to meet in order for it to be safe,” Miner says.

To be considered for bilateral knee replacement, patients must not have:  Signs of heart, pulmonary, or chronic liver disease  Diabetes  A history of blood clotting  Obesity Additionally, Miner says his practice uses a “soft” cutoff age at 70 or 75. The bilateral knee replacement patient also must have good kidney function and must be motivated to take prehabilitation and rehabilitation seriously. “The rehab after two knee replacements is harder. You’re forced to work each knee equally hard. You can’t ‘cheat’ and lean on a non-operated knee,” Miner says.

At the six-week post-surgery mark in April, Orlosky was already back to light hiking and cycling with no restrictions. He looks forward to strapping on the skis this winter. He says active living may be part Dr. Todd M. Miner of the reason his knees wore out — but also part of the reason he recovered so well. “At six weeks I was already doing nearly everything I did before.

People didn’t know I had surgery.”

As for tackling both knees at once like he did?

“Be careful with what people tell you. Some said I was crazy for doing both knees at once. In my case, I felt like that didn’t allow me to favor one leg or the other, so both of them got stronger faster. I would do it again. But everyone has to make that decision on their own,” he says.

If you are considering a knee or hip replacement, learn more at a FREE seminar taught by Dr. Miner on Sept. 22. See back cover for details.

porterhospital.org :: Summer 2016

5

HEAD TO TOE, KNOW WHEN TO GO HEART ATTACKS AND STROKES ARE NOT THE ONLY MEDICAL EMERGENCIES THAT REQUIRE FAST CARE A trip to the ER won’t always be triggered by severe chest pain or loss of consciousness. Sometimes the symptoms are more subtle, but just as serious.

“Common sense can play a big role in whether or not your condition warrants a trip to the ER,” says Ahmed Stowers, MD, medical director at Porter Adventist Hospital Emergency Department.

“When in doubt, go to the ER.”

BODY AREA

SYMPTOMS

POSSIBLE INDICATION OF

Confusion, disorientation

Stroke, concussion, serious infection, cardiac arrest

Inability to be awakened

Stroke, cardiac arrest

Sudden, severe headache

Blood clot, stroke, aneurysm, hemorrhage

Drooping face

Stroke

Slurred or altered speech

Stroke

Loss of vision or blurred vision

Stroke

NECK, JAW

Unusual discomfort/pain

Heart attack

CHEST

Sudden, unusual pain

Heart attack, heart failure

LUNGS

Shortness of breath, difficulty breathing

Heart attack, heart failure, blood clot

ABDOMEN

Sudden, intense, or lingering pain that worsens over time

Appendicitis, ectopic pregnancy, hole in intestine, bowel blockage (Note: Women may experience stomach pain during a heart attack.)

ARMS

Paralysis, numbness, weakness

Stroke

Unusual discomfort/pain

Heart attack

Paralysis, numbness, weakness

Stroke

HEAD

LEGS

7

SIGNS OF SOMETHING

MORE SERIOUS These symptoms also require immediate emergency attention:  Sudden, severe, unusual pain anywhere

throughout your body

 Uncontrollable bleeding  Persistent or severe vomiting or diarrhea  Blood in your vomit or stool  Unmanageable fever  Infectious condition with pain elsewhere

in the body

The Centura Health Trauma System is the region’s leading and most comprehensive network of trauma care and emergency services. It includes six emergency rooms throughout the southern Denver metro area:  Castle Rock Adventist Hospital  Littleton Adventist Hospital  Centura Health Emergency & Urgent Care (opening September 2016)  Parker Adventist Hospital  Porter Adventist Hospital  Southlands ER

 Seizures with no known history of epilepsy

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To find out wait times, go online to southdenverhealth.org.

VIBRANT :: Porter Adventist Hospital

ILLUSTRATION: ©ISTOCKPHOTO.COM/NEYRO2008

Use this head-to-toe guide to assess symptoms of the most common medical emergencies.

HOPE for silent suffering Urogynecology brings full arsenal of treatments for urinary incontinence

!

Yet many women suffer in silence. “It’s a significant quality-of-life issue. Yet only about 10 to 20 percent of patients actually bring it up at a doctor’s visit,” says Robert Hammer, MD, a urogynecologist at Aracea Women’s Care in Cherry Creek.

If incontinence is causing you embarrassment or interrupting your daily life, seeking help from a urogynecologist can help you get your life back. “Incontinence is very treatable,” Hammer says.

Stress Incontinence

Urge Incontinence

Specialist Spotlight

Stress incontinence (SI) occurs when weak pelvic floor muscles and loss of urethral support allow urine to leak while exercising, coughing, sneezing, laughing, or doing other activities that put pressure on the bladder.

Treatments include:

Urge incontinence, which falls under the broader category of overactive bladder (OAB), involves an immediate urge to go to the bathroom. “These are the people who know where all the bathrooms are, who fear feeling a strong urge without a bathroom nearby, who carry a change of clothes wherever they go, and who are, in some cases, afraid to go out of their house,” Hammer says. Treatments include:

Robert Hammer, MD, specializes in urogynecology, the newest subspecialty in obstetrics and gynecology.

He was board-certified in 2013, the first year that urogynecology board certification became available.

> Kegel exercises and/or physical therapy to strengthen pelvic floor muscles. > Inserts to prevent urine leakage, such as pessaries, urethral inserts, or tamponlike disposable bladder support inserts.

ILLUSTRATION: ©BAHRAM7 — STOCK.ADOBE.COM; PHOTO: ©MICHAEL RICHMOND

Urinary incontinence affects up to 18 million women in the U.S. And one of every four women over age 18 experiences episodes of leaking urine involuntarily.

> Surgical placement of a sling to support the urethra. Sling surgeries do involve mesh, but not the mesh that created a media and legal firestorm in 2011. “‘Mesh’ has become a four-letter word. The mesh slings we use for SI remain the gold standard for SI surgical treatment worldwide,” Hammer says. “It is not the transvaginal mesh that the FDA had safety concerns with in 2011.”

> Conservative or behavioral approaches, including Kegel exercises, bladder training, dietary changes, and fluid and diuretic changes. > Medications to calm bladder muscles. “Many studies demonstrate that behavioral changes, physical therapy, and medication can improve urge incontinence,” Hammer says. > Therapies that target nerves and muscles. These include InterStim and percutaneous nerve stimulation, which disrupt abnormal neural reflexes, and Botox, which was recently approved by the FDA for injection directly into the bladder muscle to decrease involuntary contractions.

Just as its name implies, the specialty is a combination of urology and gynecology.

“We take a broad approach to the pelvic floor,” Hammer says, adding that 80 percent of patients who come in with one problem have multiple problems. “We are specialists in these conditions. We don’t miss the association between incontinence, recurrent urinary tract infections, pelvic prolapse, and/or incomplete bladder emptying,” he says.

Hammer spends most of his personal time with his wife, two young boys, and dog Wrigley. His hobbies include climbing Colorado’s fourteeners and painting. “Oil painting is my hobby. Most of the time I paint mountain scenes,” he says.

Learn more about how to keep your bladder healthy at a FREE seminar with Dr. Hammer on Aug. 24. See back cover for details.

porterhospital.org :: Summer 2016

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PRIMARY CARE PRACTICES

Portercare Adventist Health System

CHPG Cornerstar Primary Care

Non-Profit Organization U.S. Postage

CHPG Southlands Primary Care

Denver, CO Permit No. 4773

AURORA

15901 East Briarwood Circle, Suite 200 Aurora, CO 80016 303-269-2626 • cornerstarprimarycare.org 6069 South Southlands Parkway Aurora, CO 80016 303-928-7555 • southlandsprimarycare.org

PAID

2525 South Downing Street Denver, CO 80210

CASTLE ROCK

Ridgeline Family Medicine at the Meadows 2352 Meadows Boulevard, Suite 300 Castle Rock, CO 80109 720-455-3750 • ridgelinefamilymedicine.org

Ridgeline Family Medicine — Castle Pines

250 Max Drive, Suite 102 Castle Rock, CO 80108 303-649-3350 • ridgelinefamilymedicine.org

CENTENNIAL

CHPG Grace Family Practice

6909 South Holly Circle, Centennial, CO 80112 720-528-3559 • gracefamilypractice.org

CHPG Holly Creek

5500 East Peakview Ave., Centennial, CO 80121 303-649-3820

DENVER

FREE CLASSES AND EVENTS RSVP required. Locations and times vary. Visit porterhospital.org/events or call 303-765-3825 for more information.

TOP TIPS ON RESILIENCY

CHPG Clermont Park

2479 South Clermont Street, Denver, CO 80222 303-649-3155 • clermontparkseniorcare.org

Life can be difficult. Learn to bounce back!  Date: Fri, Sep 9  Time: 3-4 p.m.  L ocation: Porter Place, 1001 East Yale Avenue, Denver

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

10 WAYS TO KEEP YOUR BLADDER HEALTHY

CHPG Primary Care Cherry Creek

Dr. Robert Hammer explains better bladder health, including combating incontinence.  Date: Tue, Sep 13  Time: 1-2 p.m.  L ocation: Clermont Park, 2479 South Clermont Street, Denver

GREENWOOD VILLAGE

IS IT TIME FOR A JOINT REPLACEMENT?

CHPG Primary Care Highlands

2490 West 26th Avenue, Suite A120 Denver, CO 80211 303-925-4580 • chpghighlands.org

CHPG Primary Care Porter

950 East Harvard Avenue, Denver, CO 80210 303-649-3200 • porterprimarycare.org 300 South Jackson Street, Denver, CO 80209 303-316-0416 • primarycarecherrycreek.org

If you are considering a knee or hip replacement, this class is a must.  Date: Thu, Sep 22  Time: 2:30-3:30 p.m.  L ocation: Porter Adventist Hospital Conference Center, 2525 South Downing Street, Denver

CHPG at DTC

8200 East Belleview Avenue Greenwood Village, CO 80111 303-770-6500 • dtcfamilymedicine.org

HIGHLANDS RANCH

Highlands Ranch Medical Associates 9135 South Ridgeline Boulevard Highlands Ranch, CO 80129 303-649-3140 highlandsranchmedicalassociates.org

MEDICARE 101

Turning 65? Trying to navigate Medicare? We can help!  Date: Fri, Sep 1  Time: 6-7 p.m.  L ocation: Porter Adventist Hospital Conference Center, 2525 South Downing Street, Denver

LITTLETON

Chatfield Family Medicine

10789 Bradford Road, Littleton, CO 80127 303-738-2714 • chatfieldfamilymedicine.org

Clement Park Family Medicine

6901 South Pierce Street, Littleton, CO 80128 303-932-2121 • clementparkfamilymedicine.org

South Suburban Internal Medicine

7750 South Broadway, Littleton, CO 80122 303-347-9897 southsuburbaninternalmedicine.org

LIVE HEART HEALTHY

Find out how controlling the “Deadly 7” will reduce your risk of heart-related diseases.  Date: Wed, Sep 7  Time: 6-7 p.m.  L ocation: Ross-Cherry Creek Branch Library, 305 Milwaukee Street, Denver

PARKER

5 THINGS TO KNOW ABOUT HEMORRHOIDS

Join Dr. Gavin Sigle to understand more about hemorrhoids and your options.  Date: Tue, Sep 13  Time: 1:30-2:30 p.m.  L ocation: Holly Creek, 5500 East Peakview Avenue, Centennial

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

Centura Health does not discriminate against any person on the basis of race, color, national origin, disability, age, sex, religion, creed, ancestry, sexual orientation, and marital status in admission, treatment, or participation in its programs, services and activities, or in employment. For further information about this policy, contact Centura Health’s Office of the General Counsel at 303-804-8166.

Copyright © Centura Health, 2016.

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Parker Primary Care

10371 Parkglenn Way, Suite 220 Parker, CO 80138 303-649-3100 • parkerprimarycare.org

Timberview Clinic at Parker

9399 Crown Crest Boulevard, Suite 200 Parker, CO 80138 303-269-4410 • timberviewclinic.org

porterhospital.org

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 Health Marketing.