Vibrant Winter 2015

Your Connection to Healthy Living Winter 2015 | Vol. 3, No. 1

MAN ON THE

RUN

New heart devices at Porter Adventist Hospital giving patients a new lease on life.

Chad Stoltzfus has maintained his active lifestyle, thanks to a new leadless pacemaker.

Read his story on Page 5. 

2 3 7

What

to ask before a prostatectomy

Avoiding

medication emergencies

Customized treatment for sleep problems porterhospital.org :: Spring 2013

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PHOTO BY STEVE BIGLEY

KNEES

Preventing ACL surgery now can save athletes from knee replacement later Young athletes who have anterior cruciate ligament (ACL) repair are more likely to have degenerative arthritis later in life, according to a growing body of research. And that often means knee replacement surgery.

Todd Miner, MD, adult reconstructive specialist at Colorado Joint Replacement, offers several preventive strategies:  Keep muscles limber and balanced with

strength training and stretching. “Often young athletes will do squats and leg presses to strengthen quads and gluteal muscles, but the most critical protection for ACL injuries is strong hamstrings,” he says, recommending leg curls and cycling.

 Try a “jump training” program to help

learn correct landing techniques, such as landing with the knees slightly bent.

 Check gear — especially when downhill

skiing. “If your bindings aren’t adjusted correctly or the release mechanism is set too tight, that increases risk for ACL injuries,” Miner says.

 Don’t rush back after injury. “Work with

an athletic trainer or physical therapist to make sure muscles and hamstrings have been rehabilitated after injury.”

Female athletes are at higher risk, so prevention strategies are especially important for them.

Protect Your Knees Learn preventive strategies to reduce the risk for ACL injury at a FREE community seminar on Feb. 25. See back cover for full details.

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VIBRANT :: Porter Adventist Hospital

Ask these four questions first

If you’re on the road to radical prostatectomy, Mark Jones, MD, a urologist at Porter Adventist Hospital, urges you to ask your surgeon these four questions:

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Do I really need surgery, and would molecular testing help me decide?

“The No. 1 thing I would tell patients is to find out if they are a candidate for active surveillance. Prostate cancer may not always be a deadly disease. Sometimes we can Dr. Mark Jones follow it over time,” Jones says.

Molecular testing, meanwhile, is a new frontier in prostate cancer. While it is not standard — and possibly not covered by insurance — it may help assess how aggressive the prostate cancer is. This can help guide treatment.

2

Should I have an open prostatectomy or a robotic prostatectomy?

3

How experienced are you in open and robotic prostatectomy?

“This is still a little bit controversial, but for the most part we’re on our way to saying robotic prostatectomy is the way to go,” Jones says.

“Evidence shows both are equally effective as far as side effects, but the robotic approach may enhance precision, spare blood loss, shorten hospital stay, and expedite recovery.”

“A typical urologist does about 10-15 prostatectomies a year. It’s hard to be excellent at it with that number,” Jones says, urging patients not to shy away from asking their surgeons how many prostatectomies they perform each year (he recommends 30-50) and what their results are both for cancer treatment and side effects, such as incontinence and erectile dysfunction (ED).

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What can I expect after surgery?

Realistic expectations about side effects limit surprises and help motivate patients to do the work needed to get the best possible outcome.

“In our practice, for example, we have patients meet with a physical therapist before surgery to learn pelvic floor exercises. This improves chances of regaining continence quickly after surgery,” he says.

FREE Seminar Learn how to keep your prostate healthy, the signs and symptoms of prostate cancer, and whether you should be screened at a FREE seminar on Jan. 27. See back cover for details.

PHOTO: JUMP ©DOLLARPHOTOCLUB.COM/VJ

KNOW YOUR

Facing Prostatectomy?

Medication information not always up to date

A new study suggests that Internet encyclopedia Wikipedia may not be your best bet for current information on prescription medications.

Specifically, researchers looked at how quickly Wikipedia entries on 22 prescription medications were updated following drug safety warnings issued by the Food and Drug Administration. Nearly a quarter took an average of 42 days to be updated, while more than one-third of the entries remained unchanged a full year or more after the FDA warning was issued.

In an emergency, make sure you’re in the right hands. Porter Adventist Hospital was just certified as a Level III Trauma Center.

Find out more at porterhospital.org/ porterER.

Dr. Ahmed Stowers

Given the number of emergency department (ED) visits triggered by medication errors, Ahmed Stowers, MD, medical director of emergency medicine at Porter Adventist Hospital, calls the study alarming but not surprising. “With so many adverse reactions, it’s important to know how to take medications and be able to access reliable information about them,” Stowers says.

“On a typical shift where I see 20 patients, I can almost guarantee that five of those will be medication-related,” he says.

His best advice? Talk to your physician and pharmacist to understand the following: > The correct way to take the medication > Interactions with other prescriptions, over-the-counter drugs, supplements, or foods > Side effects to watch for and what to do in case of problems > Credible websites, such as fda.gov, where you can learn more and get updates

Hail to the chiefs of history At Porter Place, a senior living community near the University of Denver and Observatory Park, the halls are filled with dynamic personalities that have helped shape our world.

Take Don Hoover, a distant relative of 31st President Herbert Hoover. He made a name in his own right working with Mercury 7, the first class of U.S. astronauts to fly in space.

“I personally calibrated the 10g (gravitational force) accelerometer used on Project Mercury,” Hoover says, noting that the instrument measured g-force on Friendship 7, the spacecraft piloted by John Glenn that orbited Earth three times in 1962. “He measured out at 7.15g on that mission,” Hoover says, recalling the excitement of the Cold War competition for supremacy in space.

“We were in a space race with the Russians. It was a terrible rat race for the engineers, but a very exciting time,” Hoover says, recalling the time the Mercury 7 astronauts visited his underground General Dynamics/Astronautics lab. “When he was leaving, John Glenn turned to us and said, ‘Do good work.’

We did and they did, and it all worked out pretty well,” Hoover quips.

CELEBRATE PRESIDENTS DAY

PHOTO BY MIKE RICHMOND

PHOTOS: HAND ©DOLLARPHOTOCLUB.COM/LOBANOV; PILLS ©DOLLARPHOTOCLUB.COM/BAHRIALTAY; SIREN ©DOLLARPHOTOCLUB.COM/KULOS

Wiki…not so picky?

Porter Place residents Don Hoover and Lucy Casagranda share presidential lineage (Casagranda is a descendant of 12th President Zachary Taylor).

As a tip of the cap to them and to celebrate Presidents Day, Porter Place is giving away a gift basket valued at $100, featuring a one-year membership to the Denver Botanic Gardens and red, white, and blue goodies.

Tour Porter Place Feb. 16-20 to be entered to win.

To learn more or register, call 303-765-6800.

porterhospital.org :: Winter 2015

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Upbeat Possibilities For patients whose hearts have a hard time keeping the beat, two new devices being tested at Porter Adventist Hospital may hold hope.

As left tackle on the New York Jets offensive line, Winston Hill spent his entire career protecting Joe Namath’s blind side.

Now someone needs to protect his.

Hill’s “blind side” is on the inside. Congestive heart failure (CHF) has rendered his heart muscle too weak to pump effectively. Fatigued by everyday life and unable to exercise, this 73-yearold former football ironman — incredibly, he only missed one game in 15 pro seasons — found himself sidelined by CHF and hospitalized for several days each month.

This was true until last February, when Hill enrolled in a clinical trial for an investigational device called the CardioFit®.

It’s one of two exciting clinical trials at Porter Adventist Hospital that hold the potential to change the lives of patients living with heart disease.

INOVATE-HF device for congestive heart failure

Like Hill, more than 23 million people worldwide suffer from CHF. When a person has CHF, the brain revs up the body’s “fight-or-flight” response. This sympathetic nervous system response floods the body with adrenalin and cortisol, which spikes blood pressure and heart rate.

At the same time, CHF causes the brain to underutilize the parasympathetic nervous system, which instructs the vagus nerve to calm the heart.

“Among the many ways the body tries to compensate for a weakened heart muscle is that the brain stimulates the sympathetic nervous

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VIBRANT :: Porter Adventist Hospital

system — and it overdoes it. The parasympathetic nervous system gets left behind,” explains Ira Dauber, MD, principal investigator for the Porter INOVATE-HF trial and a cardiologist at South Denver Cardiology.

This response puts the heart under constant stress, causing a person to feel short of breath and fatigued — even when doing simple activities like taking a walk.

Dr. Ira Dauber

CHF is generally treated with drugs that decrease the sympathetic nerve response but don’t address the parasympathetic nervous system. CardioFit is designed to do just that by sending gentle electrical pulses to the vagus nerve to calm the heart.

Because CardioFit treats CHF from an entirely different approach than current therapies, it holds promise to help a variety of patients, Dauber says. “A significant percentage of CHF patients fail to respond to currently available therapies.

If approved, this could fit a broad population of people.”

The results for Hill have been remarkable.

“I have not been hospitalized since the implant. I have not had a single episode with my defibrillator — and believe me, when that thing goes off it feels like getting kicked in the chest. I try to exercise every morning, and that’s something new. I wasn’t able to do that before,” says Hill, who stresses that he didn’t have special access to the INOVATE-HF clinical trial because of his pro football résumé.

More than 80 research centers worldwide are participating in the INOVATE-HF clinical trials to measure the safety and efficacy of the investigational device. Once the clinical trials are completed, BioControl Medical, the manufacturer of CardioFit, will have to apply for approval from the Food and Drug Administration before the device can become available outside of the trial.

PHOTOS: JERSEY ©DOLLARPHOTOCLUB.COM/ROB; FOOTBALL ©DOLLARPHOTOCLUB.COM/RAZIHUSIN

HILL

Wireless pacemaker trial

On another front, 36-year-old Chad Stoltzfus works at the military hospital at Fort Carson as an EKG technician, a fitting profession for someone who has had so many of these heart tests.

Born with a hole between his right and left ventricles, Stoltzfus had two heart catheterizations by age 4, followed by surgery to remove a growth near his pulmonary valve. At age 17, he was implanted with a pacemaker to help regulate “pauses” in his heartbeat that lasted up to eight seconds long.

PHOTO BY STEVE BIGLEY

Last November, at age 35, Stoltzfus developed an infection around one of his pacemaker’s leads, the wires that go from the pacemaker just under the skin to the heart. His pacemaker would have to be removed.

Chad Stoltzfus hits the trails with his new wireless pacemaker being tested at Porter Adventist Hospital.

Clinical Trials at

PHOTOS BY ELLEN JASKOL

Porter Adventist Hospital

Cardiologists at Porter Adventist Hospital are participating in patient trials to test devices that help improve the way the heart pumps: BioControl Medical CardioFit® — a device used in patients with congestive heart failure that stimulates the vagus nerve to help calm the heart and make it beat more efficiently St. Jude Medical Nanostim™ Pacemaker — the world’s first leadless pacemaker that is implanted directly into the heart through a catheter (small tube) to help regulate a person’s heartbeat LEARN ABOUT ENROLLMENT STATUS and eligibility criteria for these trials by visiting clinicaltrials.gov and entering “INOVATE-HF” or “Leadless II IDE” into the search field.

Leads are the weakest part of any pacemaker, says Sri Sundaram, MD, a cardiologist and electrophysiologist at South Denver Cardiology. They can dislodge, break down, or become Dr. Sri Sundaram infected, especially when implanted in patients at a young age. “Leads aren’t designed to have so much wear and tear over the years,” Sundaram says.

Stoltzfus knew this would be a possibility. “Because I was so young at implantation and the leads had been in there almost 20 years, a calcification process occurred around them, making them extremely difficult to extract,” he says. Doctors got the leads out, but the two major veins to his heart collapsed.

This meant it would be nearly impossible — and highly risky — to get to his heart with a traditional pacemaker again.

In July 2014, Stoltzfus became the first patient implanted at Porter Adventist

Hospital with the investigational St. Jude Medical Nanostim™ leadless pacemaker.

Rather than being implanted under the skin with leads that connect to the heart, this device is implanted directly into the heart. “It has all the upside of helping the heart fire if needed without the downside of having leads in there,” Stoltzfus says.

Sundaram, Porter Adventist Hospital’s site investigator for the leadless pacemaker clinical trial, says Stoltzfus’ new pacemaker weighs about 2 grams, compared with 23 grams for traditional pacemakers.

WHEN WEIGHT DOES MATTER

Traditional pacemaker

23g

2g

Stoltzfus’ pacemaker

While traditional pacemakers are implanted surgically, the Nanostim is placed in the heart through a tiny tube called a catheter that is run through the femoral vein from the groin. If it gains FDA approval, Sundaram predicts it could be a game changer, especially for young patients, kidney patients who need their veins for dialysis, and older patients for whom wound healing is a concern.

“We’re talking about transforming something from a surgical device to a nonsurgical device at about a tenth of the size,” Sundaram says.

For Stoltzfus, the leadless pacemaker has eliminated his fear of passing out due to long pauses in his heartbeat.

“Having no leads is a pretty big deal for me,” he says, noting that recovery time after implantation was quick.

“Five days after, I could walk briskly with no discomfort. After a week, I could walk and jog,” he says, adding that he is now training to run the Pikes Peak Marathon in 2015.

porterhospital.org :: Winter 2015

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ON TARGET More precise radiation therapy means fewer side effects for people with cancer

How Radiation Works Radiation targets quickly growing cancer cells and damages their DNA so they can’t grow and divide. Normal cells can repair themselves in a way that cancer cells can’t.

Chances are likely that you might be sitting in a driverless car in the next decade. In addition to being safe, you’re sure to be hoping that the car will get you exactly where you want to go.

Thankfully, these types of advancements have already occurred in radiation oncology. Today’s sophisticated multimillion dollar radiation therapy machines — coupled with highly trained cancer experts — can now deliver exactly the right amount of radiation directly pinpointed at cancerous cells with very little damage to surrounding tissue.

A PRESCRIPTION FOR PRECISION

Just as medications have improved to reduce side effects, so has radiation therapy. The machine itself, called a linear accelerator, is the focus of improved treatment and decreased side effects. The Porter Cancer Care Center at Porter Adventist Hospital and Parker Cancer Center offer the most advanced type of linear accelerator called the Varian TrueBeam.

This machine offers several technological advancements that allow more precise dosing and placement of the radiation, including:

CUSTOM CONTOURING

INTEGRATED IMAGING

360-DEGREE ACCESS

The TrueBeam accelerator has what’s called a high-definition multileaf collimator. That’s a fancy term that basically means that the radiation beam can be shaped to match the cancer tumor and avoid healthy tissue.

“By contouring the dose into the areas that we actually want to treat, that allows us to limit the side effects in a way we were not able to do before,” says Jeremy Land, manager of radiation oncology at Porter Cancer Care Center.

The linear accelerator has a built-in imaging system that can visualize the tumor during treatment.

In the past, radiation oncologists had to plan a wide safety margin around the treatment area to account for the patient’s breathing and any changes in position from day to day.

“Now, with image guidance, we can be much more confident in delivering the radiation to where we need it, so we can be more sparing,” Peddada says.

To treat a tumor from multiple angles previously required stopping and starting the treatment. TrueBeam rotates around the patient to deliver radiation from nearly any angle, reducing treatment time.

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VIBRANT :: Porter Adventist Hospital

DITCH THE TRAVEL Porter Adventist Hospital is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas. We provide radiation therapy in three South Denver locations to allow you to receive treatment close to home.

Radiation Oncology at Porter Adventist Hospital The Cancer Center 2555 S. Downing St. Denver, CO 80210 303-778-5714 Radiation Oncology at Parker Adventist Hospital The Cancer Center 9395 Crown Crest Blvd.

Parker, CO 80138 303-269-4975 Opening Fall 2015 Radiation Oncology at Littleton Adventist Hospital Cancer Care Center 7700 S. Broadway Littleton, CO 80122 303-734-8740

ILLUSTRATIONS: DARTS ©ISTOCK.COM/LEVKING, /WALRUSMAIL

“The word ‘radiation’ can scare us,” says Anuj Peddada, MD, medical director of radiation oncology at Parker Adventist Hospital’s Cancer Center. “I tell my patients to think of radiation as medicine. If you don’t need it, we don’t prescribe it. If you need it, it can be lifesaving.”

1-2 PUNCH Dr. Keith Swartz brings expertise in ENT and sleep medicine to help patients get their 40 winks Prior to the housing collapse, a trend in homebuilding hinted at the seriousness of sleeplessness in America.

“Dual master suites were one of the most common requests in homes before the real estate bubble burst. That was a huge red flag for us ENT and sleep medicine specialists,” says Keith Swartz, MD, who recently joined Associates of Otolaryngology at Porter Adventist Hospital.

Husbands and wives kept up by the partners’ snoring, tossing and turning, or insomnia began heading for a different room to get some shut-eye.

“But no one wanted to give up the luxury of the master suite,” he says.

While separate bedrooms may help the partner without the sleep problem, the problem is far from solved. Snoring, erratic breathing, restless legs, and other sleep disturbances can take a heavy toll on a person’s health. Sleep apnea, a common cause of irregular breathing during sleep, increases the risk of heart disease, diabetes, depression, and other health problems. “People often don’t breathe well when they sleep. We call it sleep-disordered breathing. That’s my forte,” Swartz says.

Swartz is the only physician in Colorado with medical board certification in both ear, nose, and throat (ENT) medicine and sleep medicine.

This dual specialty allows him to provide a more thorough analysis of a patient’s sleep problem.

“What really separates me from everyone else is that I do a detailed airway analysis with my sleep medicine hat on too.” Swartz uses a technique called sleep endoscopy, in which a patient is anesthetized and a fiber optic scope is inserted into the airway. The scope allows Swartz to see in real time whether the obstruction causing the sleep problem is at the back of the throat, back of the tongue, or some other level. He also examines whether nasal obstruction or limb movement may be interrupting sleep.

{ please }

Do Not Disturb

The result is a customized treatment plan rather than a standardized prescription for CPAP, or continuous positive airway pressure machine commonly prescribed for sleep apnea patients.

“We tailor therapy to every patient,” he says.

To make an appointment with the Porter Sleep Disorder Center, call 303-778-5781.

A HAPPY HOMECOMING

Keith Swartz, MD, looks to science when he is diagnosing sleep and ENT issues in his patients, but it’s poetry that moved him to Colorado.

After 16 years of active duty in the U.S. Air Force, Swartz and his wife, Melinda, and their three kids, 7-year-old Clementine, 9-year-old Calvin, and 11-year-old Henley, had settled in California. But when his homeowners association began considering a rule to ban kids from riding bikes in the streets, he knew it was time to head back to Colorado where he had grown up. “That was a flashing red light for us. We needed to find a place where our souls would be happy again,” he says.

PHOTO BY ELLEN JASKOL

Dr. Swartz always imagined he’d be a dentist like his dad. But medical school beckoned. “And, wouldn’t you know it? I ended up gravitating to the medical specialty most like dentistry,” he quips.

Dr. Keith Swartz enjoying the Colorado outdoors with his older of two sons, Henley. porterhospital.org :: Winter 2015

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Portercare Adventist Health System

Non-Profit Organization U.S. Postage

PAID

Denver, CO Permit No. 4773

2525 South Downing Street Denver, CO 80210

S. Downing St.

S. Washington St.

S. Broadway

Porter Adventist Hospital is E. Evans Ave. a regional medical center that provides care for complex health issues. We specialize in complex surgery, E. Harvard Ave. E. Vassar cardiovascular care, spine care, joint replacement, liver E. Yale Ave. and kidney transplants, and cancer care. We are part of Centura Health, the region’s leading healthcare network.

Vibrant is published quarterly

by Porter Adventist Hospital 285 E. Hampden Ave. – Portercare Adventist Health System. The purpose of this publication is to support our mission to improve the health of the residents of 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. porterhospital.org

Part of Centura Health, the region’s leading healthcare 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, 2015.

Reg porter ister online a hospit al.org t /even ts Join the health experts at Porter Adventist Hospital to learn ways to stay healthy. All programs are FREE and are held in the Porter Adventist Hospital Conference Center unless otherwise indicated. For programs held in the Porter Adventist Hospital Conference Center, there is a free parking garage as well as free valet parking at the hospital’s main entrance. Registration is required for all events; register online at porterhospital.org/events or call 303-765-6549.

UPCOMING EVENTS WEIGHT LOSS SURGERY

Tired of taking medicine for high blood pressure, diabetes, and joint pain? The solution may be weight loss surgery. Join bariatric surgeon Dr. Josh Long to hear the latest research on the positive impact of bariatric surgery on obesity-related health conditions.  Date: Thu, Jan 8  Time: 6-7 p.m.  L ocation: Porter Adventist Hospital Conference Center

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PROSTATE HEALTH — WHAT EVERY MAN SHOULD KNOW

Prostate cancer is the second most common cancer in American men.

Dr. Mark Jones will discuss prostate health, the effects of aging, and how it may impact the body. Find out the age you should begin prostate screenings, the signs and symptoms of prostate cancer, and what to do if you are diagnosed.  Date: Tue, Jan 27  Time: 6-7 p.m.  L ocation: Porter Adventist Hospital Conference Center

SHOP SMART FOR A HEALTHY HEART

During this grocery store walk-andtalk, you will learn which foods are better for lowering cholesterol and blood pressure. You will also find out how to read nutrition labels in order to become more skilled at choosing foods that promote heart health and avoiding foods that contribute to heart disease. Registration is required for this walk-and-talk. Space is limited to 15 people; register today!  Date: Mon, Feb 2  Time: 2-3 p.m.  L ocation: University Hills King Soopers, 2750 S. Colorado Blvd.

THE SKINNY ON DIETS

The new year is beginning, and weight loss is often at the top of everyone’s to-do list. Before you begin the latest fad diet, join Betsy Bosley, certified nutritionist, to find out which diets work long term and which are just hype.  Date: Tue, Feb 3  Time: 6-7 p.m.  L ocation: Porter Adventist Hospital Conference Center

HEART DISEASE IN WOMEN — GET THE FACTS

The risk of heart disease in women is higher than for men. Frequently, women don’t even know the signs of heart disease or that they aren’t the same as those for men. Come learn to spot the symptoms, dispel the myths, and reduce your risk. It might be easier than you think to put an end to heart disease.  Date: Tue, Feb 10  Time: 6-7 p.m.  L ocation: Porter Adventist Hospital Conference Center

Looking to live a healthier and happier life? Learn about this unique, whole-person health philosophy.

By consistently practicing the eight principles of CREATION Health — Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships,

KNOW YOUR KNEES

Anterior cruciate ligament (ACL) injuries can have a long-term impact on your knee health. Learn to protect your knees and reduce the risk factors for an ACL injury through important preventive strategies. Should an injury cause long-term effects, learn to spot the signs, when to seek treatment, and what the treatment options are.  Date: Wed, Feb 25  Time: 6-7 p.m.  L ocation: Porter Adventist Hospital Conference Center

Outlook, and Nutrition — you will begin to experience a balanced and healthy approach to life. In this discussion, you will learn how to begin to incorporate these principles into your life and live life to its fullest.  Date: Wed, Mar 4  Time: 6-7 p.m.  L ocation: Porter Adventist Hospital Conference Center