Cheers Fall 2014 by Clementine Words

St. Mary-Corwin Medical Center

CELEBRATING YOUR HEALTH

Fall 2014 • Volume 4, Number 4

A Girl’s Best Plan Building a customized breast health plan starts with knowing your risk. Story on page 3

Finding lung cancer earlier PAGE 4

Less painful surgery PAGE 6

30-minute cancer prevention PAGE 7

PHOTO BY STEVE BIGLEY

elcome to Cheers, the health magazine specially created for the families of Pueblo and our surrounding areas by St. Mary-Corwin Medical Center and its clinical experts. For the past several years, Cheers has run as an insert in the Pueblo Chieftain. But with this issue, we made the decision to begin mailing to homes to make it more convenient to get the health tips and information we are providing. Making health care more convenient is a major theme at our hospital and throughout the Centura Health system. We know that if health care can be delivered close to home at convenient locations, people are much more likely to access preventive health care or care in the earliest stages of disease. That, in turn, makes for healthier communities—the top goal of the changing health care system. In this issue, you’ll read about several ways we are helping to advance care in our community—everything from a new way to detect lung cancer at its earliest stages to Saturday appointments for colonoscopies, the only cancer screening that can actually prevent cancer. We’ve also opened new health care clinics in our community, and expanded services and hours at our Pueblo West clinic. We hope that you will find the information in Cheers — and the changes we are making in this community — to be useful in improving the health of your family. Cheers,

Brian Moore President and CEO St. Mary-Corwin Medical Center

cheers | St. Mary-Corwin Medical Center

10 YEARS

of Flight For Life in Pueblo

4,000+ calls and counting

hen seconds count, the Flight For Life® team stationed at St. MaryCorwin Medical Center answers the call — more than 4,000 since 2004, to be exact. The crew is on-duty 24 hours a day to transfer critically ill and injured patients via Lifeguard 4, the helicopter based at the hospital. “We have had tremendous support from the community, which has allowed us to treat and transport thousands of patients over the past 10 years,” says J.C. Taylor, RN, assistant nurse manager with Flight For Life at St. Mary-Corwin Medical Center. Flight For Life operates as a not-for-profit ng organization funded by community support and the eri sw an t no n Whe St. Mary-Corwin Health Foundation. Ability to pay is 0 40 n more tha never taken into account during urgent transports. r pe lls emergency ca “We take pride in the fact that a lot of lps he year, Lifeguard 4 communities view us as their 911 emergency t with search and assis responders,” Taylor says. “We are truly the only efforts, community critical care transport organization in southeastern education, and Colorado.” fire and avalanche Operating within a 120-mile radius of the watches. hospital, Lifeguard 4 responds to calls for a variety of emergencies, from heart attacks and traumatic injuries to high-risk pregnancies and pediatric cases. The onboard Lifeguard 4 crew includes a pilot, flight nurse, and flight paramedic who are specially trained to provide emergency care in an airborne environment. St. Mary-Corwin Medical Center’s program was launched in November 2004. Lifeguard 4 is one of five helicopters in the Flight For Life Colorado fleet, which also includes several fixed-wing aircraft and ground ambulances.

My Life Flight “Without Flight For Life, I probably would not be here today. After wrecking my motorcycle, they kept me alert and transported me to St. Mary-Corwin and then on to St. Anthony. Today, when I see a Flight For Life helicopter, I pray for the crew and those receiving treatment and thank the Lord that they were there for me.” – Adrienne Herrera, Flight For Life patient in 2011

PHOTOS: HELICOPTER COURTESY OF FLIGHT FOR LIFE COLORADO; MOORE BY STEVE BIGLEY; HERRERA BY STEVE BIGLEY

Dear Neighbors,

Risky Business

12%

An average woman’s chance of developing breast cancer in her lifetime

Not knowing your chances for developing breast cancer can be detrimental to your health

ou’re already familiar with the pink ribbons, T-shirts, kitchen appliance — pink everything! — associated with Breast Cancer Awareness Month. You may have even supported the cause by making a donation or joining a walk. But do you know your personal risk for breast cancer? The average woman has about a 12 percent chance of developing breast cancer in her lifetime. Certain lifestyle factors, including smoking, obesity, poor diet, and being sedentary can raise your risk. These factors are modifiable, meaning you can take steps to lower your risk. Some women have additional risk factors they don’t have control over, such as a personal or family history of breast cancer. But that doesn’t mean they should be ignored.

Is breast cancer in your genes?

Women with a strong family history of breast cancer may want to find out if they have a gene mutation that puts them at high risk for breast and ovarian cancer. The lifetime risk of breast cancer in women with one of the gene mutations for breast cancer is somewhere between 45 and 80 percent.

A woman may have a gene mutation associated with breast cancer if:

PHOTOS: SCARF ©DOLLARPHOTOCLUB.COM/AFRICASTUDIO; SCARF ©DOLLARPHOTOCLUB.COM/SYDA; WOMEN BY STEVE BIGLEY

 Several women in her family have had breast or ovarian cancer, particularly before age 50  Women in her family have had cancer in both breasts  Men in her family have had breast cancer  She is of Ashkenazi (Eastern European) Jewish descent

 ARE YOU AT

HIGH RISK? t. Mary-Corwin offers S genetic counseling for women who think they may be at high risk for breast cancer. Call 719-557-5701 or visit stmarycorwin. org/genetic-counseling to learn more. To schedule an appointment at the high-risk breast care clinic, call 719-557-5931, option 3. 

“In the San Luis Valley, there is a higher incidence of breast cancer because of the gene mutation,” says Wendy Richmond, MD, a family medicine physician who treats high-risk breast cancer patients at the Dorcy Cancer Center at St. Mary-Corwin. This is because the valley has a high population of people of Ashkenazi Jewish descent, even though many may not know it, explains Richmond.

The high-risk clinic

St. Mary-Corwin recently opened a high-risk breast care clinic to help women understand their risks and preventive options. “We’ll be seeing anyone who thinks they may be at high risk for breast cancer or who is experiencing nebulous (unidentified) breast pain,” Richmond says. “We’ll also be following up with breast cancer patients once they’re done with treatment to prevent or catch any recurrences.” If you believe you may be at risk or you’d like to get more information, talk to your doctor or call the clinic directly at 719-557-5931, option 3, to schedule an appointment.

Heather Hull, Sandy Stein, Cora Zaletel, and Janelle Hall (from left) have all made a commitment to get annual screening mammograms at St. Mary-Corwin Medical Center. Screening mammograms can help detect breast cancer at its earliest and most treatable stages.

stmarycorwin.org | cheers

GPS for finding

lung cancer SuperD making lung tumor screening super easy and super safe

LUNG CANCER is the leading cause of cancer death in the United States for both men and women. One of the reasons for that, historically, has been that it was extremely difficult for physicians to tell if a tumor in the lung was cancerous or not. A new tool, referred to as the superD (no, it’s not a slalom course — that’s a super G), is making it easier and safer to test small lung tumors. By catching the cancer in its early stages, it is more successfully treated. Since spring of 2014, St. Mary-Corwin Medical Center has been using the superDimension™ navigation system, or “superD,” to biopsy hard-to-reach lung tumors in the tiny outer branches of the airways. “It’s completely changing the way we look at lung cancer,” says Joshiah Gordon, DO, MSc, a pulmonologist at St. Mary-Corwin Medical Center.

Setting the stage for earlier diagnosis

Lung cancer symptoms typically don’t appear until the disease is in an advanced and non-curable stage. “You often don’t have symptoms until it starts to spread,” Gordon says. And once symptoms do appear, patients may attribute them to other problems or just not report them to their doctor until they have been going on for a long time. At that point, the cancer is generally in an advanced stage. The stage of a cancer measures how much cancer is in a person’s body and how far it has spread. The lower the stage, the earlier the cancer has been detected, which generally makes it more treatable. “Before superDimension, most lung cancers were diagnosed as a stage III or IV,” Gordon says. In those cases, doctors can only slow down the progress of the cancer. But at some centers using superD, up to 70 percent of lung cancers are being diagnosed at stage I or II, when cancer is more curable. “We’re really talking about changing the demographics of cancer in southern Colorado,” Gordon says.

Should I get screened? Lung cancer screening guidelines The best way to prevent lung cancer is not to smoke or to stop smoking. Men who smoke are about 23 times more likely to get lung cancer, and women are about 13 times more likely. If you have been a heavy smoker for a long time, your doctor may recommend an annual low-dose CT scan to screen for lung cancer. A screening test looks for cancer before you have any symptoms. National guidelines support lung cancer screening if all three of these apply to you:

1. You are a current or former smoker. 2. You are 55 to 74 years old. 3. You have a smoking history of at least

30 “pack years” — for example, a pack a day for 30 years or two packs a day for 15 years.

The network of air passages that connect the windpipe to the lungs is called the bronchial tree. Just like the branches of a tree, the large bronchial tubes divide into smaller and smaller branches to carry air to the far edges of the lungs. To reach a tumor in the lungs, doctors use a thin tube with a light and camera called a bronchoscope (“broncho” for the lung passages ‘You Have Arrived’ plus “scope” for the tool that looks inside the lungs). Traditional For a safer, more accurate bronchoscopy can’t visualize the tiny passages in the distant parts lung biopsy, the superD of the lungs. As the passages divide and narrow, “the standard system acts like a GPS to bronchoscope can only get to maybe the third or fourth segment,” or let the doctor know exactly less than half of the lung, Gordon says. where the tumor is located. In the past, patients with these hard-to-reach tumors could

cheers | St. Mary-Corwin Medical Center

PHOTOS: COURTESY OF SUPERDIMENSION, LTD.

Reaching further

5-YEAR SURVIVAL RATES for people with lung cancer

Stage 1A

Stage IV

49% 1%

Source: American Cancer Society

Cancer centers using superDimension systems find up to 70% of lung cancers at stage I or II when they’re more treatable.

get a needle biopsy, but that procedure — in which a needle is inserted into the lung to collect a small portion of the tumor for testing — carries a risk of collapsing the lung. In some cases, doctors choose to wait several months to see on follow-up imaging tests if the tumor grows. The superD system can go further than traditional bronchoscopy because it uses electromagnetic navigation to follow a steerable sensor probe. It is safer and even more accurate than a needle biopsy, Gordon says.

ILLUSTRATIONS: MAP ©DOLLARPHOTOCLUB.COM/GIORGOS245, LUNG ©DOLLARPHOTOCLUB.COM/PALAU83

Mapping the lungs

Using superD to map the lungs, doctors start with a high-resolution CT scan. A CT scan uses multiple X-ray beams to take pictures of cross sections of the body that combine to show a three-dimensional picture. This image functions like the map in a GPS system in a car or phone. Then, the superD software lets doctors plan ahead of time the route they will take with the scope to reach the tumor in the lungs. Just like you might plan more than one route on your GPS if you’re going to a new destination, “I find the nodule on the image and give myself two or three ways to get there,” Gordon says. When patients come in for Dr. Joshiah Gordon the biopsy, they lie on a special electromagnetic pad that allows the superD system to track the movement of the magnetic probe on the scope through the lungs in real time. The doctor can follow the preplanned route through the branches of the lungs and see when the scope, which is inserted into the lungs through an airway in the mouth, has reached the tumor to take a sample for biopsy.

Landmarks for treatment

With the biopsy mapped out ahead of time, the physician also can plan where to place special markers called fiducials to pinpoint tumor location and guide future treatment. “In addition to making a route to the tumor, I mark three or four spots where I would place fiducial markers, which are little metal coils,” Gordon says. During the biopsy, rapid on-site evaluation (ROSE) is used to immediately send tissue samples to pathology for testing. “Usually, I get a phone call after about 10 minutes to tell me whether it’s cancer,” Gordon says. At that point, the physician can place the fiducial markers while the biopsy is still under way. “Then the patient is completely ready, whether they go for surgery or radiation.” To plan the best treatment option for each patient, the Dorcy Cancer Center at St. Mary-Corwin Medical Center holds weekly tumor conferences, where cancer specialists, primary care physicians, pathologists, radiologists, and surgeons review each case. “Everybody’s in the same room to discuss the best treatment option,” Gordon says. Radiation therapy is one option to treat lung cancer. Since a patient’s breathing makes the lungs a moving target, the fiducial markers pinpoint the tumor so the radiation beam can focus on the cancer cells without harming surrounding tissue. At the Dorcy Cancer Center, radiation oncologists use advanced technology, called 4-D computed tomography respiratory gating, that allows them to deliver a precise dose of radiation to the lungs and other parts of the body that move with breathing. If the patient gets surgery instead, the markers are still useful because the surgeon can see and feel them to confirm the tumor location.

 JOIN US The Dorcy Cancer

Center at St. MaryCorwin Medical Center offers a support group for people who are being treated or have survived lung cancer and their families. The group meets at 5:30 p.m. the first Wednesday of the month. For more information or to RSVP, call 719-557-5989. 

stmarycorwin.org | cheers

Less Is M

Robot-assisted surgery offers a less invasive option with more benefits for patients

urgery used to mean a large open incision that gave the surgeon access to see and work on the part of the body that needed attention. When laparoscopic surgery came along, some surgeries could be done with special instruments through several small incisions. But there were some limits to how well surgeons could see and maneuver with laparoscopy. Now, robotassisted surgery with the da Vinci® Surgical System at St. Mary-Corwin Medical Center is making it possible for more patients to have minimally invasive surgery.

Small surgery, big benefits

Just like traditional laparoscopy, robotic surgery uses several small incisions to allow access for specialized surgical tools and a camera. The da Vinci system lets the surgeon work at a bedside control console, where his or her movements control the robotic arms. “You’re operating at the end of a straight stick laparoscopically,” explains Gary Lane, MD, a general surgeon at St. Mary-Corwin Medical Center, “whereas the robotic arm has a wrist and you can turn Dr. Gary Lane it in all directions.” This range of motion makes robotic surgery an option for more complicated procedures that traditional laparoscopy can’t handle. The three-dimensional, magnified

image available with the da Vinci also gives the surgeon a superior view of the surgical field. For patients, minimally invasive surgery offers: > Less pain > Less blood loss > Shorter hospital stay > Quicker return to work and normal activities

Is robotic surgery for you?

Gallbladder surgery, hiatal and inguinal hernia repair, and colon resections are three of the most common robotically assisted surgeries. “If you’re a candidate for laparoscopic surgery, then you’re probably a candidate to have it done robotically,” Lane says, as long as your surgeon has experience using the robot for your procedure. Just because the robot is the newest surgical tool available, however, doesn’t mean it’s appropriate for every surgery, Lane says. The robot takes extra time to set up, so simple procedures such as removing an appendix can be done more quickly with traditional laparoscopy. Also, the robot works best in a small, defined area of the body. More extensive colon surgery, for example, may be done better with an open incision. “Just because you can do something robotically doesn’t mean you necessarily always should,” Lane says. “I use it when I think it will really benefit the patient.”

First and Only

St. Mary-Corwin Medical Center is the first and only hospital in the Pueblo area to offer robotic-assisted surgery. For more info, visit stmarycorwin.org/robotic.

Gallbladder surgery is one of the most common procedures performed minimally invasively with the help of the da Vinci robotic surgery system. The gallbladder stores bile made by the liver to digest fat, but you can live without it. If the bile in the gallbladder hardens into gallstones, it can block the tube that lets bile travel into the small intestine. A gallbladder attack can cause these symptoms: Steady pain in the upper right side Pain that increases quickly and lasts Pain between your Pain under your of your stomach 30 minutes to several hours shoulder blades right shoulder Gallstones affect women twice as often as men. If you have gallbladder disease, your doctor may recommend surgery to remove your gallbladder.

cheers | St. Mary-Corwin Medical Center

ROBOTIC PHOTO COURTESY OF INTUITIVE SURGICAL

Understanding Gallbladder Disease

Debunking

COLONOSCOPY Fears

You can prevent colon cancer in just 30 minutes!

olorectal cancer — which includes cancers of the colon, rectal, and bowel — is the second most common cancer diagnosed in the United States and the third most deadly cancer. One in every 20 Americans will be diagnosed with colorectal cancer in their lifetime, according to the American Cancer Society. And yet there’s one surefire way of lowering your odds of getting colorectal cancer — colonoscopies. According to research published in the New England Journal of Medicine, the occurrence of colorectal cancer is nearly half for patients who undergo routine colonoscopies. “Colonoscopy has reduced the rate of colon cancer by roughly 35 percent in the past 10 years,” says Joseph Edelson, MD, a board-certified gastroenterologist with St. Mary-Corwin Physician Partners — Gastroenterology, part of the Centura Health Physician Group. A colonoscopy is the only cancer screening tool that can actually decrease the risk of getting a cancer. That’s because most cases of colorectal cancer start as precancerous polyps in the colon, which can be detected and removed during a colonoscopy before they ever become cancerous. “The statistics are astoundingly in favor of screening, particularly a routine colonoscopy,” Edelson says.

A Simple Procedure

To perform a colonoscopy, a trained physician uses a thin, flexible tube with a camera to examine the entire colon and a portion of the small intestine. Polyps — precancerous growths — can be removed during the procedure. Colonoscopy is recommended once every 10 years for people ages 50-75 who have no other risk

factors. The procedure takes 30 minutes, on average. If you’re still unsure about getting a colonoscopy, here are four insights that might ease your mind:

EASIER PREP — You may have heard that the prep is gruesome. But patients today only need to consume roughly half of the bowel-clearing drink as before, and the preparation can be tailored to the patient, Edelson says. LITTLE DISCOMFORT — Imagining the test is actually more uncomfortable than the test itself. Colonoscopies are performed under uniform standards in a private room, and patients are under sedation. Some patients even describe the experience as a “good nap.” NO COST — Under the Affordable Care Act, most insurance plans must cover the full cost of screening colonoscopies; Medicare and Medicaid in Colorado also pay for screening colonoscopies. (If a polyp is found, however, the patient may have some costs — talk with your insurance company prior to your screening.) EASY REFERRAL — If your physician hasn’t yet recommended a colonoscopy, be sure to ask. “I encourage people to be proactive with their health,” Edelson says. “In today’s world, patients can easily access health information, so rather than wait for a doctor’s recommendation, take the initiative, particularly with screenings.” In most cases, patients do not need a referral, he adds. “The best example I can give patients is what I practice for myself and my family — we are all up-todate with our colonoscopies,” he says.

 NO EXCUSES! If you’ve put off getting your colonoscopy because you can’t take time off work, St. MaryCorwin has now put that excuse to bed by offering colonoscopies one Saturday each month in addition to normal weekday hours. To find out dates and schedule an appointment, call 719-557-3660. St. Mary-Corwin is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas. stmarycorwin.org | cheers

St. Mary-Corwin Medical Center brings specialized care in the complex areas of cancer care, robotic surgery, joint replacement surgery, sports medicine, pediatrics, women’s services, cardiology, and more. We are part of Centura Health, the state’s largest health care network. 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 as a substitution for your physician’s advice. If you would like to comment on this magazine, please email cheers@centura.org. Cheers is produced by Clementine Words LLC of Denver, Colo. Executive editor is Rochelle Kelly Wristen.

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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, 2014.

The CANCER Conversation A guide for talking to children about your cancer diagnosis hen Nancy Leins, 64, felt a lump in her breast, she had no second thoughts about telling the children that she and her husband care for full time. She was open with them from the beginning — even the two youngest who were just 2 and 8 years old at the time. “We tried to make it easy for them and something they could relate to,” Leins says. “I really believe that cancer is a whole-family thing, and so we were real open with them.” Brenda Galassini, MSW, oncology program manager at the Dorcy Cancer Center at St. Mary-Corwin Medical Center, applauds Leins’ approach. “Talking to your children is very important,” she says. “It allows them the opportunity to provide you with insight into what they’re thinking and feeling so that you may help them cope in healthy ways.”

Talk the Talk

Telling your children you have cancer is never easy, but there are ways to ensure a successful dialogue.  TAILOR

YOUR MESSAGE. Use plain English and ageappropriate details. Depending on age and maturity level, you may want to talk with children separately.

 O FFER

REASSURANCE. Make sure children understand that cancer is not contagious and that they won’t catch it. Also assure them that they had nothing to do with the reason you have it.

 T ELL

THEM WHAT TO EXPECT. Your family’s routine is bound to change while you’re in treatment. Explain how children’s schedules will be affected, but that no matter what, they will be cared for.

 D ON’T

OVERPROMISE. Let children know that your doctors are doing everything they can to help you feel better. But don’t tell them you’ll be fine. It will only confuse them in the event your health deteriorates.

 R EPEAT. The cancer conversation isn’t a one-time thing.

Keep the lines of communication open throughout treatment and beyond.

Let your kids CLIMB The Dorcy Cancer Center offers a program specifically for children 6-11 who have a parent with cancer. During the six-week program, children share their feelings and bond with other kids in similar situations, and do crafts to help them express themselves. To learn more or to enroll a child in the next session, call Brenda Galassini at 719-557-4548.

Nancy Leins, a Pueblo breast cancer survivor, never hesitated about sharing her diagnosis with her family, a practice experts recommend as a way to help children cope.

Need Support?

The Dorcy Cancer Center offers a wide variety of cancer support programs, plus events and screenings. If you would like to be notified of these, sign up at stmarycorwin.org/calendar.