Vibrant Summer 2018

Your Connection to Healthy Living

Volume 6, Issue 3 | Summer 2018

TARGETING CANCER Customized drugs attack cancer at a cellular level Page 4

3  Summer safety for kids 6  Medication impact on sports performance 7  Colonoscopy results giving more details

porterhospital.org :: Spring 2013

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PHOTO: ISTOCKPHOTO.COM/WILDPIXEL

Dealing With

DIABETES NEW MEDICATION OPTIONS

SCREENING OUT HIDDEN DIABETES

In the past decade, the more than 30 million Americans with type 2 diabetes have had a growing list of medication options for treating their disease. Two of the most promising classes of those drugs are:

Often people can develop type 2 diabetes without knowing it, because symptoms mimic other conditions, says Naomi Chawla, BSN, RN, certified diabetes educator at Porter Adventist Hospital. Common symptoms include:

• 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 slow the rate at which food leaves the stomach. That allows the pancreas to produce more insulin, which lowers blood sugar.

Unexplained fatigue Frequent urination e Dry mouth e Extreme thirst e Unexplained weight loss e e

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 the Porter Diabetes Education Center at 303-765-6431.

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 Porter 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, and 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: Porter Wound Care & Hyperbaric Center, 990 E. Harvard Ave., Denver 303-778-5242 Wound Care Center at Parker Adventist Hospital, 9395 Crown Crest Blvd., Parker 303-269-2310

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

HYPERBARIC WOUND HEALING

summer STAY SAFE THIS

Whether you’re caring for children or just feel like a kid, play it safe with these tips

KNOW WHEN TO GO Making a decision about whether to go to the emergency department is one tough task in the heat of the moment. Porter Adventist Hospital’s trauma medical director, Crea Fusco, MD, offers this go-to list of absolute emergency situations: eart attack symptoms, such as chest pain; pain H extending to neck, jaw, or arms; shortness of breath; light-headedness; nausea; or cold sweats

Dr. Crea Fusco

S troke symptoms, such as drooping face, arm weakness, or speech difficulty Difficulty breathing arge amounts of blood in the stool or urine, especially if accompanied L by fever, rash, fatigue, pain, or evidence of blockage Any sudden, intense, or unrelenting pain ny sudden or intense headache, especially with fever, neck pain, A stiffness, or rash

WATCH YOUR KIDS AROUND WATER More children ages 1 to 4 die from drowning than any other cause except birth defects, according to the Centers for Disease Control and Prevention.

“Supervise kids around water. This needs to be done with no distractions like playing cards or talking on the phone,” Fusco says.

Additional helps? Enroll kids in swimming lessons and enroll yourself in a CPR class.

Any deep cut, especially if muscle, tendon, or bone is visible ever if accompanied by lethargy, altered mental status, or symptoms F of infection

PHOTOS: ©ISTOCKPHOTO.COM/NERTHUZ; /DEBENPORT; /ZINKEVYCH; /AZURE-DRAGON

Any fall in which you hit your head While concussions in young athletes have been the focus of scrutiny lately, that last bullet point is especially critical for seniors, too. The number of Americans ages 75 and older who suffered brain injuries skyrocketed 76 percent from 2007 to 2013. Fusco advises that any elderly patient — especially if taking a blood thinner — should be taken to the ER in the event of a fall or blow to the head.

PLAY IT SAFE ON THE PLAYGROUND Kids will be kids, and that means a lot of injuries. These strategies can keep the “play” in playground. e

Supervise kids closely.

Be aware of your child’s abilities. “They are going to climb, and they will challenge themselves,” Fusco says. Know when to “spot” them.

e

If a child falls and shows any signs that concern you, seek medical attention. “If a child has any change in mental status or confusion or blurry vision, bring them to the ER,” Fusco says.

Porter LOVES Kids

Did you know that the emergency room at Porter Adventist Hospital provides care for kids? Indeed, it does, and often much quicker than other Denver ERs. If you or a loved one of any age needs emergency care, visit us at 2525 South Downing Street (just south of Evans Avenue in Platte Park). porterhospital.org :: Summer 2018

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Tailor-Made

CANCER

TREATMENT As medical researchers understand increasingly intricate details about cancer cell behavior, they are developing treatments that are more precise and customized to the individual patient. Breakthrough drugs, called targeted therapies, are being used to attack specific mechanisms of cancer cells with less toxicity than standard chemotherapy.

Other new drugs, called immunotherapies, focus less on attacking the cancer and more on boosting the body’s own defenses to fight it.

“We are growing in our understanding of the processes going on in cancer cells that cause them to behave so badly,” says Thomas Kenney, MD, hematologist/oncologist at CHPG Cypress Hematology and Oncology. Kenney and his colleagues provide this customized care at Porter Cancer Center.

Dr. Thomas Kenney

The result? Today’s cancer drugs hold promise to help patients live better and longer. Here are two exciting types of treatments that are changing the game.

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New cancer drugs customized at a cellular level offer precise and personalized treatment

Taking aim at cancer cells

For some types of cancer, the one-size-fits-all approach of chemotherapy is becoming a thing of the past. “Chemotherapy drugs basically interfere with the process of cell division,” Kenney says, noting that this very broad, systemic treatment harms healthy cells as well as cancer cells.

Targeted drugs, also called precision medicine, leave healthy cells alone and go straight for cancer cells — attacking the genetic molecules (usually proteins) that allow them to survive, multiply, and spread.

“In the past 15 years, especially in the last five, there has been an explosion of new targeted agents,” Kenney says. “Take a person with cancer who has a mutation in a particular gene. Was it exposure to something that caused the mutation? Was it dumb luck? We don’t know. What we do know is that if a gene becomes mutated, it then makes a mutated protein, which causes trouble.

Proteins carry out the marching orders of genes. If proteins get the wrong marching orders, they can tell cancer cells to grow.”

Kenney says a groundswell of recent research has led to better understanding of the structure of genes. And precision medicine targets cancer in many ways, including: • By blocking bad proteins, as in the scenario above • By turning off the chemical signals that allow cancer cells to grow and divide • By preventing blood vessels from feeding cancer cells, causing them to die But not all of the new drugs are right for all cancers, or even variations of one type of cancer, or even in two patients with the same type of cancer. Targeted therapies are made to work on specific molecules, so patients must be tested to see if and how many of these molecules are present in their body. Customized treatment plans are then developed for the patient and the molecular traits of his or her cancer.

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VIBRANT :: Porter Adventist Hospital

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While these treatments hold tremendous promise — especially for kidney cancer and some lung cancers — Kenney offers a word of caution. “When talking about

Precision Medicine Explained

›

›

Targeted therapies are drugs that treat a specific genetic mutation causing cancer cells to grow. Patients must be tested to see if their cancer contains this mutation. If so, they are candidates for the treatment.

chemotherapy vs. targeted treatments, most targeted drugs are not as harsh on the body as chemotherapy drugs. Still, we’re often trading one set of side effects for another.”

Chemotherapy commonly causes hair loss, drops in white blood cell and platelet counts, and nausea. Targeted treatments may trigger other issues such as an uncomfortable rash or digestive problems.

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Hide-and-seek with immunotherapy

Cancer cells thrive and multiply, in part, because they are able to hide from the immune system or they are able to kill off immune system cells. A promising treatment called immunotherapy fights cancer not by attacking the cancer cells but by boosting the body’s own defense system.

Immunotherapy drugs do this by either helping the immune system to find elusive cancer cells or by blocking the cancer’s ability to kill immune cells.

“You would think that the immune system should recognize an abnormally growing cancer cell as foreign, but cancer cells have developed ways to evade the immune system,” Kenney says. “This is partly because the cancer cell is the body’s own cell, as opposed to bacteria, which is clearly foreign.”

Early immunotherapy drugs, which Kenney calls the “first volley” in the immunotherapy story, show promise. “Most immunotherapy drugs right now work on the premise that cancer cells produce proteins that tell immune cells to die. Immunotherapy blocks that process. You’re not attacking the cancer cells; you’re simply assisting your own immune system,” he says.

Malignant melanoma is by far the most responsive to immunotherapy, Kenney says, noting that immunotherapy is also approved for kidney, lung, bladder, and other cancers.

PHOTO: ©ISTOCKPHOTO.COM/AMIAK

While immunotherapy may not cure cancer, it shows promise in other ways, especially when combined with other therapies. “One of the tantalizing things about immunotherapy — and former President Carter is an example of this — is that some patients may experience a better quality of life and prolonged life. Immunotherapy keeps cancer under its thumb even when the cancer is very advanced,” he says, adding that melanoma patients treated with immunotherapy have seen survival rates jump from six months to as much as three years or more.

Got Questions?

In the face of a cancer diagnosis, it can be tough to know what to ask your doctor about your treatment options.

The National Cancer Institute offers these questions: What immunotherapies or targeted therapies have been approved for my specific cancer type?

How are these different than chemotherapy?

What are the benefits and risks of each type of treatment?

What do you recommend, and why do you think it’s best for me?

How do I find out about clinical trials for my type and stage of cancer? Would you recommend a specific study?

Do I need any additional genetic testing to determine the best treatment for me?

Could I benefit from a combination of immunotherapy and targeted therapy, or in combination with chemotherapy?

What are the possible side effects?

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

If you have a family history of cancer, schedule a cancer risk assessment with our certified genetic counselor at the Genetic Counseling Clinic at Porter Adventist Hospital by calling 303-778-1955.

An estimated 25,570 new cases of cancer will be diagnosed in Colorado in 2018. porterhospital.org :: Summer 2018

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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 family medicine physician David Kornhauser, DO, at CHPG Primary Care — Highlands.

“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,” Kornhauser 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 Kornhauser. “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, Kornhauser says.

Tendon tears, for example, often can be surgically repaired, Kornhauser says.

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,” Kornhauser says.

Sports injury prescription: A regimen of

RICE

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 family medicine physician David Kornhauser, DO, at CHPG Primary Care - Highlands. The RICE regimen is the best home treatment for minor injuries: REST. Take it easy for a few days. It’ll pay off with less chance of 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 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. Kornhauser, call 720-893-8220.

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VIBRANT :: Porter Adventist Hospital

PHOTO: ©ISTOCKPHOTO.COM/LARSZAHNERPHOTOGRAPHY

but not too tight.

Closer look at

COLONOSC

PIES

Size, shape, and location of polyps impact risk of colon cancer Not long ago, interpreting colonoscopy results was fairly simple. If no small growths, called polyps, were found, your gastroenterologist would probably tell you to come back in 10 years. If polyps were detected, you might need another screening in five to seven years.

Recently, researchers have learned that not all polyps are created equal. When it comes to potential risk for colorectal cancer, the size, shape, and location of polyps matter, says Madhan Iyengar, MD, with Centura Gastroenterology Porter. All those details can help determine your follow-up care.

Types of colon polyps

Screening recommendations

While the majority of polyps never develop into cancer, some types appear more likely to than others, says Iyengar, who is board-certified in internal medicine as well as gastroenterology. Additionally, tumors that originate on the right side of the colon develop differently, and respond differently to treatment, than those that form on the left.

Although researchers are still looking at the differences in polyps, there are some preliminary recommendations.

The main types of polyps found in the colon are: • Hyperplastic polyps. The most common type that are relatively small, are usually found on the left side, and rarely develop into cancer.

• Serrated polyps, or adenomas. These polyps, which have a sawtooth appearance under a microscope, occur in two types: traditional serrated adenoma and sessile serrated adenoma (SSA).

Of the two, SSAs generally are flatter and harder to detect, Iyengar says.

They also have a higher risk of becoming cancerous. Research suggests that among colon cancers that develop in the decade between colonoscopy screenings, most are SSAs.

PHOTOS: ©ISTOCKPHOTO.COM/KYOSHINO; DOCTOR BY ELLEN JASKOL

Madhan Iyengar, MD As a board-certified internal medicine specialist, Madhan Iyengar, MD, is trained to diagnose, prevent, and treat all types of conditions. He’s also a gastroenterologist, which means he’s certified and fellowship-trained in treating conditions of the digestive system, including irritable bowel syndrome, inflammatory bowel disease, and acid reflux.

For large SSAs, most doctors recommend a follow-up colonoscopy in one to three years, Iyengar says.

For smaller growths, five to 10 years usually will do.

While learnings about colon cancer are evolving, one thing hasn’t changed: Colonoscopy remains the only screening test that can actually prevent cancer because polyps can be removed before they grow into tumors.

4/10

Nearly 40 percent of patients who develop colon cancer are diagnosed when the cancer is still localized in the colon, giving them a greater than 90 percent chance of survival.

Regular colon cancer screenings are the key to early detection.

Denver native Dr. Madhan Iyengar is back to enjoying Colorado's active outdoor lifestyle.

Before attending medical school at the University of Kansas and completing training at the University of Southern California and the University of California, Irvine Medical Center, Iyengar was a South Denver kid. The Highlands Ranch High School graduate says he’s delighted to be back home.

To make an appointment with Dr. Iyengar or schedule a colonoscopy, call Centura Gastroenterology Porter at 303-260-2740.

porterhospital.org :: Summer 2018

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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. 3280

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

CENTENNIAL 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 Denver Tech Center (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

Your closest Centura Health Emergency Department is at Porter Adventist Hospital — 2525 South Downing Street. Visit porterhospital.org for wait times.

SUMMER 2018 CALENDAR

We’ll be out in the community throughout the summer. Be sure to join us for these fun events! See our Facebook page for more information.

FREE FAMILY MOVIE NIGHTS AT DU Coco

 Date: Sat, Jul 21  Time: Gates open at

6:30 p.m.; movie begins at 7 p.m.

 Location: University of Denver’s

Barton Lacrosse Field

YOGA ON THE ROCKS

 June-August Experience a yoga workout at the most awe-inspiring venue in the world – Red Rocks.

Wonder Woman

 Date: Fri, Aug 10  Time: Gates open at 7:30 p.m.;

movie begins at 8 p.m.  Location: University of Denver’s Barton Lacrosse Field

DENVER BOTANIC GARDENS SUMMER CONCERT SERIES  Date: Wed, Aug 1 — Amos Lee  Date: Wed, Aug 8 — Bruce Hornsby

FILM ON THE ROCKS

 June-August It’s the 19th season to enjoy live entertainment and films at Red Rocks.

SN❄W FIT

 September-October Ski fitness training for all ages at Red Rocks.

PHOTOS: ©ISTOCKPHOTO.COM/CLICKNIQUE; /NATTANAPONG

CHPG Primary Care Meridian 303-649-3100 • meridianprimarycare.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, 2018. 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).