Vibrant Summer 2017

Your Connection to Healthy Living

Volume 5, Issue 3 | Summer 2017

Walk in

THE PARK Joint replacement surgery puts an end to pain and lets you get back to what you love.

Get a FREE guide to know when the time is right for joint replacement.

Page 4 When Karen Barrell's pain left her unable to walk, she knew it was time for joint replacement at Porter Adventist Hospital.

3  How to stave off menopause health woes 6  Customize your breast screening schedule 7  Find a better solution for SI joint pain

porterhospital.org :: Spring 2013

1 PHOTO BY ELLEN JASKOL

Be a Good Sport

Colorado summers offer a great mix of activities to enjoy. But they all bring a chance of injury.

To make the most of your summer fun, Steven Kitchen, MD, orthopedic and sports medicine physician at Centura Orthopedics, offers these suggestions:

Activity

Potential Pain Point

Prevention Tip

Running

“For lots of people, when they start running things just start hurting — their knees, heels, ankles,” Kitchen says.

Gradually increase mileage. “Start over each season, even if you maintained your cardio over the winter,” he says.

Change your shoes regularly and run on a good surface.

Trails and treadmills are softer than asphalt.

Trail running

Ankle sprains

Build lower-body and ankle strength and stability. Kitchen recommends single leg dips: Stand on one foot, look at your toes, and do a squat until your knee covers your toes. Try 3 sets of 10 on each side.

Mountain biking

Concussions and broken clavicles (collarbones)

If you’re not ready for higher speeds, start slow and low and take your time to build up your comfort level.

Baseball

Overuse of the shoulder and elbow — especially in kids with open growth plates

Gradually increase your activity and work with coaches on good mechanics. If your technique is good, you will use your legs and lower body — not your shoulder — to generate power, he says.

Porter Adventist Hospital is ranked as one of the nation's Top 50 Orthopedic Programs by U.S. News & World Report. The program offers comprehensive sports medicine services from physical therapy to surgery. Call 720-897-0576 to learn more or schedule an appointment.

Afternoon thunderstorms are routine in the Rockies — and they can come on suddenly. When you’re hiking, protect yourself from lightning strikes with these tips: Try to get below tree line or find the lowest point in an open area Avoid solitary trees and other objects that are taller than the rest of terrain Get rid of any metal objects you’re carrying (trekking poles, backpacks with a metal frame, even jewelry) Stay out of caves and buildings with exposed openings like picnic pavilions Avoid any water and stay out of low spots that might accumulate any rain

15-27% Spike in summer ER visits

THE TOP CULPRITS: heat-related conditions, sunburns, foodborne illnesses, trampoline injuries, lawn mower accidents, and animal bites

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

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Summer

health briefs

SUMMER STORM SAFETY

Midlife Crisis?

Hormonal changes can wreak havoc on women’s lives, but help is available Hot flashes get most of the attention but as a woman ages, changes in hormones affect her body in other unexpected ways. Some women suffer in silence. But for others, symptoms are severe enough to seek treatment, says Jill Goldenberg, MD, an obstetrician/gynecologist at Porter Primary Care in Denver. A checkup with your primary care provider or gynecologist is a good place to start.

“Women may not need a Pap smear every year, but we recommend a visit and pelvic exam annually to make sure what they are experiencing is normal and not something more serious.” Physicians can offer help with:

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BRAIN FOG: There isn’t much evidence that hormone changes cause “brain fog,” Goldenberg says. “But it’s not discounted, because so many patients describe having trouble concentrating, being more forgetful.”

In addition to eating healthily and exercising, some antidepressant medications can improve focus, especially in patients who have experienced mood symptoms before the onset of menopause.

ANXIETY AND DEPRESSION: Many women become depressed and anxious during menopause, Goldenberg says. Disturbed sleep and hormonal changes may play a role. Being physically active can reduce anxiety. But when symptoms are severe, Goldenberg advises women to see a doctor. “I do recommend an individualized approach to these symptoms. Some patients with prior mood symptoms may benefit from medication, while others may benefit from behavioral modifications.”

FITFUL SLEEP: Menopauseinduced hot flashes, night sweats, and anxiety disturb the sleep of about 40 percent of women. While exercise generally promotes good rest, research is mixed on whether it decreases the symptoms’ frequency.

Other strategies beneficial to sleep include limiting alcohol, avoiding evening caffeine, and eating smaller evening meals.

VAGINAL DRYNESS: Drops in estrogen can cause vaginal atrophy, which leads to dryness and, often, painful intercourse.

For many women, waterbased, over-the-counter lubricants help. Others may need prescription vaginal creams, most of which contain very low (but safe) levels of estrogen.

To HRT or not to HRT?

Research linking hormone replacement therapy (HRT) with increased risk of breast cancer, stroke, and venous thromboembolism scared many women and physicians away. But new, larger population-based interpretations of the data have lessened the Stress-reduction concern. “We look at each individual patient and determine the best therapy based ontechniques the severity of symptoms, risks, and likely benefits. When it’s appropriate, we find the lowest dose possible to control symptoms,” Goldenberg says.

Don’t Sweat It It’s summer. Everyone sweats. But people who sweat excessively — especially if localized in the hands, feet, underarms, or face — may have hyperhidrosis. “It’s one of those conditions that affects patients emotionally, physically, socially, and professionally,” notes Sanjay Tripathi, MD, medical director of cardiac and thoracic surgery at Porter Adventist Hospital.

“Unfortunately, a lot of patients go untreated.”

Tripathi offers a microincision surgery that may provide relief to patients who suffer specifically with excessive sweating in Dr. Sanjay Tripathi the hands. “About 90 percent of these patients are extremely satisfied with the results,” he says.

The procedure, called microendoscopic thoracic sympathectomy, or METS, targets the nerve that sends signals to the sweat glands. “We use the latest technology, including a 2.7-millimeter camera, to locate and divide a specific area of the sympathetic nerve. This prevents the nerve from ‘turning on’ the sweat glands,” he says.

The surgery is not for everyone, and is not recommended for sweating of the feet and face. However, Tripathi urges patients not to suffer in silence.

“We have a range of conservative treatments, including prescription antiperspirants and oral medications, that can offer relief.”

If you live with excessive sweating, learn about the treatments available to you by calling 303-778-6527.

To make an appointment at Porter Primary Care, go to porterprimarycare.org or call 303-649-3200. porterhospital.org :: Summer 2017

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Knowing when it’s time for joint replacement can save years of pain

JOINT DECISION Karen Barrell’s knees hurt for years.

It started with the right knee, about the time she first moved to Colorado in 2000.

“I couldn’t walk without pain, but it was bearable.” Even with corticosteroid injections, the pain got worse.

“I knew knee replacement was an option, but I thought I would never do it.” Then her left knee started hurting. Her right leg bowed. Walking became an ordeal. At the grocery store, she needed a shopping cart to lean on.

In 2016, she took a trip to Vail with her daughter and granddaughter. “And, I absolutely couldn’t walk.” That’s when she knew it was time for surgery.

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VIBRANT :: Porter Adventist Hospital

A PERSONAL DECISION Earlier, a family friend, who had seen her hobbling, referred her to Colorado Joint Replacement surgeon Jason Jennings, MD, DPT. Jennings gave her corticosteroid injections, and said she might be a candidate for joint replacement, a notion Barrell resisted. After her Vail trip, her resistance shattered. “I met with Dr. Jennings and immediately felt complete confidence in his ability and expertise,” Barrell says. “He instilled in me the confidence to get through surgery.”

Jennings, who performs both knee and hip replacements, says treatment for osteoarthritis starts with more conservative approaches, and even doing nothing is an option. “I never tell [patients] they have to do anything. It’s not a heart attack.”

For knee pain, first-line treatment can include activity modification, bracing, physical therapy, and injections.

When those treatments no longer work, joint replacement becomes an

Karen Barrell is on the go again with her granddaughter, Eden, now that knee pain is no longer in the picture. option. Jennings says the timing of surgery is a decision he doesn’t nudge patients into. “That’s individualized for each patient. For some, it’s the inability to go to the grocery store. For others, it’s when they can’t go on long hikes. But it’s up to them when they wave the white flag.”

PREPARING THE WAY Some studies suggest that waiting too long can delay recovery from surgery because muscles around the joints weaken from lack of use.

“It’s true that going in stronger is better as far as recovering quickly,” Jennings says. But even patients who can barely walk, let alone exercise, before surgery will experience significant relief and benefit, he says.

When Barrell decided to have her knee replaced, she threw herself into the preparation and was Dr. Jason Jennings amazed at how well her surgery at Porter Adventist Hospital went. “I had surgery on Friday, and went home Saturday afternoon. By Monday I was being driven to physical therapy.”

PHOTOS: FEATURE BY ELLEN JASKOL; TRACK ©ISTOCKPHOTO.COMRA-PHOTOS; PILLS ©KENWNJ–ADOBESTOCK.COM; CLOCK @VVALENTINE–ADOBESTOCK.COM

SPECIALLY DESIGNED CENTER At Porter Adventist Hospital, a special center designed solely for joint replacement patients features specially trained nurses, rehab specialists, and surgical teams. Under the medical guidance of Colorado Joint Replacement, Jenning’s group, the surgical team uses the latest research to improve outcomes. The team, for instance, uses spinal anesthesia rather than general. This means most patients can get out of bed within hours of surgery — an important factor in a speedy and successful recovery.

Get ready, get set Good preparation before surgery can make a world of difference when it comes to recovery.

The Joint Replacement Center at Porter Adventist Hospital helps by offering all patients a pre-surgery class, workbook, and scheduling physical therapy appointments for post-surgery rehab. Good overall health helps, too. Here are a few tips to consider if you are getting ready for joint replacement surgery: ame your blood pressure. If it’s too high, T your surgery might have to be delayed. ention your medications.

M Ibuprofen, and other bloodthinning medications, can increase bleeding risk. Talk to your doctor about all medications you take, even vitamins and supplements. et your diabetes in check.

G Uncontrolled diabetes can increase your healing time and your infection risk. ee your dentist. Get any dental S problems fixed well in advance. If bacteria from dental procedures enters your bloodstream, infections can result. uit smoking. Smokers are at greater risk Q for all kinds of surgical complications.

“At Porter, they got me up and walking so quickly. I was walking up and down stairs, with help, before I left the hospital,” Barrell says.

At two weeks, she stopped taking pain medications.

At three weeks, she was back on the job, for brief shifts, at a baby boutique, and she kept up her physical therapy, with the help and support of an encouraging physical therapist.

“After just three months, I was so thrilled and so relieved that I decided to have the left knee done,” Barrell says. That surgery, done last November at Porter Adventist Hospital, was an equal success.

Is now the time?

Learn the factors you should consider when deciding when to have your joint replaced, then take a quiz to see if you are ready in a FREE guide at coloradojoint.org/right-time.

Colorado Joint leads national research Colorado Joint Replacement surgeons have published more than 400 research studies and have trained surgeons from around the world. Recently, CJR research was on the cover of two issues of the prestigious medical journal, The Journal of Bone and Joint Surgery. One study found that patients who had previous anterior cruciate ligament repairs to their knees were more likely to need follow-up surgeries after total knee replacement. Another study determined how often MRI scans reveal fluid in replaced ceramic-on-polyethylene hips.

To schedule an appointment at Colorado Joint Replacement to assess your knee or hip pain, call 720-372-0935.

porterhospital.org :: Summer 2017

5

In April, Colorado lawmakers joined 29 other states in requiring that a woman be notified when a mammogram reveals she has dense breasts.

— Jennifer Hankinson, MD

SCREENING OUT

CONFUSION Knowing your breast cancer risk helps guide screening decisions

With prominent medical organizations disagreeing about when women should begin getting mammograms and how often they should have them, it’s no wonder women are confused.

Jennifer Hankinson, MD, a diagnostic radiologist and lead imaging physician at Porter Breast Center, says there should be no doubt about when to have that first mammogram.

“We recommend every woman have a baseline mammogram at 40,” Hankinson says. “One of the most important risk factors is breast density. And you don’t know if you have dense breasts until you get a baseline mammogram.”

Dense breasts are not synonymous with large breasts. Density measures the ratio of glandular and fibrous tissue to fatty tissue.

The more glandular and fibrous tissue, the greater the breast density. As breast density increases, so does cancer risk, Hankinson says. She recommends ultrasound with mammograms for women with dense breasts.

Knowing your breast density is important to help you and your doctor calculate your overall breast cancer risk.

Other factors that can impact risk include: • Family history • Childbirth history • Age at first period • Menopause after 55 • Body mass index “If your lifetime risk is over 20 percent, we recommend screening each year, with MRI,” she says.

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VIBRANT :: Porter Adventist Hospital

TAKING BREAST CANCER RISK PERSONALLY We’ve heard the numbers: One in eight women develops breast cancer in her lifetime. But all breast cancer risk is not equal. If your mother had it, your risk may be higher. If you had a child before age 30, it may be lower.

Genetic counselor Josie Kagey and colleagues at Porter Adventist Hospital’s high-risk breast clinic can help you measure your risk, and discuss steps you can take to address it.

Before visiting the clinic, each woman fills out a family history questionnaire, Kagey says. “So, I have their risk determined when they come in. From there we can discuss what the guidelines say is right for them.”

Then, a woman can choose monitoring in the high-risk clinic, or send the information to her primary care doctor, she says.

The clinic also offers testing for genetic mutations that have been linked to breast cancer risk.

For information about genetic testing, call Kagey at 303-765-3923.

SAME-DAY MAMMOGRAMS available at the following Centura Health Breast Care Center locations.

To schedule your mammogram, call: • Porter Adventist Hospital: 303-765-6500 • Castle Rock Adventist Hospital: 720-961-2033 • Centura Health Meridian: 303-269-4150 • Centura Health Southlands: 303-269-4150 • Littleton Adventist Hospital: 1-844-325-5579 • Parker Adventist Hospital: 303-269-4150

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WE RECOMMEND EVERY WOMAN HAVE A BASELINE MAMMOGRAM AT 40.”

BACK PAINRelief Pain plummets with new SI joint fusion

If you’ve ever uttered the phrase, “Oh, my aching back,” you are not alone. “After the common cold, low back pain is the No. 2 health complaint in the U.S.,” says Winston Capel, MD, a neurosurgeon at the Porter Spine Institute.

Up to one in four back patients have pain that stems from arthritis or other problems with the sacroiliac (SI) joint, which is located at the base of the spine. “We now have a minimally invasive, outpatient SI joint fusion that has a success rate of 94 percent. This compares to a 50 percent success with the old procedure, which required an extremely long incision and a lot of muscle trauma,” Capel says.

He says this newer technique, which uses a small incision to place wires and implants that foster a strong, stable fusion, holds great promise for patients who have been told there is “nothing that can be done” for their SI joint pain. “We’ve proven there is successful treatment for SI joint pain,” he says.

In fact, in one study of 40 SI joint fusion patients who opted for this newer technique, pain scores plummeted from 8.7 to less than a score of 1 one year after surgery.

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The Porter Spine Institute is a nationally recognized Center of Excellence. To schedule a personal meeting with our spine nurse navigator and take a tour, visit porterhospital.org/spine.

DUAL FOCUS Patients facing spine surgery usually must choose between a neurosurgeon and an orthopedic surgeon.

Winston Capel, MD, offers the best of both worlds.

“Neurosurgery is focused on taking the pressure off the spinal cord, while orthopedic surgery is focused on reconstruction and correcting deformities,” he says.

“I can focus on both,” he says, noting that he completed a neurosurgery residency and an orthopedic spine fellowship.

When he’s not focused on fixing ailing backs, he’s focused on his wife and four kids, who range in age from 6 to 18.

“We all love to ski and mountain bike. As a family, we love the mountains and love to camp,” he says, noting that the local terrain reminds of him of his native Utah.

Dr. Winston Capel

In fact, the terrain drives one habit in particular that excites him as a physician. “People in Colorado are very health-conscious. Everyone in Colorado is slim and trim.

I drive home past parks that are full of people running, jogging, and playing sports,” he says.

porterhospital.org :: Summer 2017

FUN FACT: Dr. Capel is one of nine kids.

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Mental Health

Portercare Adventist Health System

Non-Profit Organization U.S. Postage

FIRST AID

PAID

We may not realize it, but most of us know someone who struggles with mental illness. Colorado is home to nearly 500,000 people living with a diagnosed mental illness, and the state consistently has one of the nation’s highest suicide rates.

Denver, CO Permit No. 4773

2525 South Downing Street Denver, CO 80210

Yet few of us would know how to respond if a friend, colleague, student, or loved one experienced a mental health emergency.

That’s why Castle Rock Adventist Hospital, Littleton Adventist Hospital, Parker Adventist Hospital, and Porter Adventist Hospital are offering Mental Health First Aid classes. The FREE, eight-hour classes don’t attempt to teach participants to diagnose, or treat, mental illness.

FREE CLASSES & EVENTS Around the Community

Instead, participants learn to recognize symptoms and develop strategies to support someone experiencing mental illness or emotional crisis.

FREE — FAMILY MOVIE NIGHTS

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

To learn more about Centura’s FREE Mental Health First Aid classes, or to register for a class, visit mhfaco.org.

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

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

Visit our website for complete details: porterhospital.org/events.

FINDING DORY

 Date: Sat, Jul 29  Time: Gates open at 6:30 p.m.;

movie begins at 7 p.m.

 Location: Peter Barton Lacrosse PHOTOS FROM LEFT: ©ISTOCKPHOTO.COM/MAROZNC, /LJUPCO, /JACOBWACKERHAUSEN, /MATTHEWENNISPHOTOGRAPHY, /ZINKEVYCH

A separate youth class is offered for teachers, social workers, coaches, and others who work with children and teens. Youth and adult classes offer a five-step action plan to:

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

Stadium, DU Campus

FROZEN

 Date: Sat, Aug 19  Time: Gates open at 6:30 p.m.;

KNEE AND HIP REPLACEMENT

Are you considering joint replacement because your quality of life is impacted by joint damage or pain? Be sure to join Dr. Jason Jennings to learn what you need to know.  Date: Thu, Aug 10  Time: 6-7 p.m.  L ocation: Porter Adventist Hospital Conference Center

MEDICARE 101

Turning 65?

Trying to navigate Medicare?

We can help! D ate: Tue, Aug 29, or Thu, Sep 14 (classes are identical)  Time: 6-7 p.m.  L ocation: Porter Adventist Hospital Conference Center

MAJOR JOINT PAIN TREATMENT

Arthritis and injury to the joints can have lasting painful impacts. Learn what your treatment options are with Dr. Ryan Carr.  Date: Mon, Oct 16  Time: 1:30-2:30 p.m.  L ocation: Clermont Park, 2479 South Clermont Street

movie begins at 7 p.m.  Location: Peter Barton Lacrosse Stadium, DU Campus

AGING AND DEPRESSION

When you just can’t shake the blues, find tools to help.  Date: Tue, Aug 22  Time: 1:30-2:30 p.m.  L ocation: Morning Star — Dayton Place, 1950 South Dayton Street

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).