Create Fall 2014

FALL 2014 • Volume 2, Issue 4

Your health. Your life.

growing

Upright Pediatric spine surgery close to home helps kids stand tall

a n d ...

High Protein or High Fad Page 2

Football Strike Zone Page 3

stop the Top 3 Winter Injuries Page 6

NEW METHODS OF Breast Surgery Page 7

IN Good Health

Healthy eating through the ages Ditch the fads, embrace moderation

O

Women who eat foods high in animal fat before getting pregnant are more prone to develop gestational diabetes during pregnancy, according to the National Institutes of Health.

“High animal fat can translate into more insulin resistance and weight gain around the abdomen, all factors in gestational diabetes,” Schulz says.

The study found that substituting red meat with poultry significantly reduced the risk of gestational diabetes.

Nutrition is the eighth guiding principle of the CREAT ION Health lifestyle, a n Adventist wellness progra m supported by medical research. Learn more a bout CREAT ION lifestyle principles at creationhealth.com.

80%

of teens don’t consume adequate calcium

Although it may seem like they’re done growing, bones don’t actually reach their peak bone mass until between ages 25 and 30. Teens need to consume at least 1,300 milligrams of calcium daily to support that bone growth. That’s equal to 2 cups of milk, 1 cup of calcium-fortified orange juice, or 1 cup of yogurt.

2 | fall 2014 • Create

Doctor’s

BAG Dr. Andrew Schulz Family Physician Centura Health Physician Group Lone Tree Primary Care 9695 South Yosemite Street, Suite 255A Lone Tree, CO 80124 Dr. Schulz, his wife, and two sons moved to Colorado two years ago to enjoy an active outdoor lifestyle, fitting in hiking, biking, skiing, and hockey as much as possible.

To fuel for their adventures, the Schulz family loves a five-bean creation they call Cinco Bean Bake.

“It has all the essential nutrients we need and tastes delicious,” Schulz says. Get the Schulz family recipe for Cinco Bean Bake online at mylittletonhospital.org/recipe.

To schedule an appointment with Dr. Schulz, call 303-649-3900.

Cover photo: ©IStockphoto.com/Andrew Rich; This page: ©IStockphoto.com/Mauro Matacchione Photography, /MikeyGen73, /eurobanks

Dine right before pregnancy

ne out of seven Americans will try a fad diet this year.

Whether trying to lose weight or looking to improve your nutrition, you are better off adopting a routine focused on moderation and balance, says Andrew Schulz, MD, a boardcertified family physician at Centura Health Physician Group Lone Tree Primary Care, Centura Health’s newest primary care and OB-GYN facility in the south metro area.

“It’s easy to jump on the bandwagon, but without a proper balance of the essential nutrients our body gets from fruits, vegetables, and fiber, you might see quick results but you won’t be better off in the long run,” he says.

A study conducted by the University of Southern California found that high-protein diets in people aged 50-65 increased their rate of death by 74 percent and quadrupled their risk of dying from cancer, compared to those with low-protein diets. However, the study also found that high-protein diets in those ages 65 and older are helpful in preventing frailty and muscle loss, as the body uses insulin differently. A high-protein diet was defined as more than 20 percent of daily calories coming from protein sources.

“I wouldn’t advise anyone to go overboard, with either too much or too little protein,” Schulz says. “Moderation and balance are key. The study shows how our bodies need different things at different ages.”

Shouldering Through Core strength and stretching key to preventing teen shoulder injuries

NEW PAP GUIDELINES

All women ages 21 and over should receive an annual wellness exam that includes a pelvic exam to identify abnormalities in the uterus, ovaries, and vagina, says Jessica McCullough, MD, an OBGYN at Centura Health Physician Group Women’s Health Littleton. However, Pap and HPV tests are now recommended less frequently.  Women 21-29: Pap test every three years. “Nearly all women will get the human papillomavirus (HPV) during their 20s, and we’ve found that their bodies typically fight it off, making excessive testing unnecessary,” McCullough says.  Women 30-65: Pap and HPV tests every five years. “Adding the HPV test to Pap tests increases our ability to detect precancerous lesions, making testing every five years sufficient for most women,” she says.  Women 65+: Can typically stop cervical screening.  Women with a history of abnormal results, dysplasia (precancerous changes), or who have a compromised immune system from HIV or other conditions should discuss testing frequency with their OB-GYN. To make an appointment with Dr. McCullough, call 720-922-6240.

Littleton Adventist Hospital brings specialized care to the people of South Denver in the complex areas of trauma, cancer, neurology, cardiology, orthopedics, women’s services, 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 of 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 or unsubscribe to this magazine, please email create@centura.org. Create is published four times annually by Littleton Adventist Hospital — Portercare Adventist Health System.

Whether tailgating or watching the big game on television, it’s easy to overindulge on salty, fatty foods during football season. And this can quickly increase your risk of stroke, the fourth leading cause of death in the U.S. This fall, try four easy steps to lower your risk of stroke: • Skip the salty seasonings; use onions, herbs, or pepper to flavor.

• Keep the food away from the viewing area — out of sight, out of mind.

• Drink plenty of water to avoid mistaking hunger for thirst.

• Go for a walk at halftime or play catch in the backyard. Being active for 10 minutes three times a day is as effective as exercising for 30 minutes continuously, according to the American Stroke Association.

Recognized for exceptional, efficient treatment of stroke, Littleton Adventist Hospital is a designated Stroke Center by the American Stroke Association.

To learn warning signs of a stroke, go to mylittletonhospital.org/stroke.

7700 S. Broadway | Littleton, CO 80122 | mylittletonhospital.org create | mylittletonhospital.org | 3

photos: ©IStockphoto.com/vizion-photography, /Devonyu

T

een athletes are more likely to suffer shoulder injuries during games rather than practice, with football and wrestling being the riskiest sports, according to a new study published in the medical journal Pediatrics.

“People tend to hit a little harder or run a little faster during games than practice, making these times more predisposed to injuries,” says Kathy Vidlock, MD, who completed a sports medicine fellowship and is a boardcertified family medicine physician at Centura Health Physician Group Highlands Ranch Medical Associates.

While most coaches and teens focus on shoulder strength, that’s not enough, Vidlock says. Be sure to also: • Build core strength. “If your core is stable, the likelihood of any injury — shoulder or otherwise — goes down,” Vidlock says. There is a direct correlation between core strength and fewer injuries, according to numerous studies reviewed in the Strength and Conditioning Journal.

• Incorporate sport-specific dynamic stretching, which activates muscles through movement.

STOP Sports Injuries STOP (Sports Trauma and Overuse Prevention) Sports Injuries, which was created by the American Orthopaedic Society for Sports Medicine (AOSSM), provides online tips and resources to help reduce the risk of sports injuries. Download FREE sport-specific and injury-specific guides for your teen at: stopsportsinjuries.org.

Stroke prevention game plan

Getting straight about scoliosis From kids to adults, world-class spine care available close to home

Elliot Hunter, shown in inset with mom Mary Corbett, has had three surgeries for his scoliosis with Dr. Kumar (shown above), an orthopedic spine surgeon who specializes in pediatric and adult scoliosis.

4 | fall 2014 • Create

When Elliot Hunter was diagnosed at age 1 with congenital scoliosis due to chromosomal abnormalities, his parents thought they might have to travel out of Denver for world-class care.

But their pediatrician referred them to Anant Kumar, MD, in Denver. Kumar, a boardcertified orthopedic surgeon, specializes in pediatric spine surgery at Rocky Mountain Hospital for Children as well as adult degenerative cervical, thoracic, and lumbar spine surgery, and complex spinal deformities at Littleton Adventist Hospital.

“Dr. Kumar has been fabulous during our journey with him throughout the past decade,” says Mary Corbett, Elliot’s mother. “He walked us through every step in the process, showed us X-rays, explained everything thoroughly, and made us feel like Elliot was in the best hands.”

Elliot, now 13, has had three spine surgeries, including a spinal fusion, but his energy and enthusiasm for life remains unaffected, his mother says. Elliott is in the seventh grade at Skinner Middle School and loves to swim, play on the computer, read books, and eat ice cream.

9 million Americans a year. Predominately diagnosed in childhood or early adolescence, scoliosis is an irregular curvature of the spine.

The majority of children with scoliosis can be effectively treated with observation and/or bracing.

“Our goal is never surgery unless it is absolutely necessary,” Kumar says. “However, when surgery is necessary, we take every measure to ensure that the timing aligns with the child’s needs and skeletal maturity.”

Nearly eight out of 10 scoliosis cases are idiopathic, meaning that congenital and neuromuscular causes are not the reason of the condition. Generally diagnosed during puberty through a routine physical exam of the spine, idiopathic scoliosis requires treatment in less than 10 percent of children.

When treatment is required, bracing is most common and is effective in up to 80 percent of cases when the brace is properly worn.

For children like Elliott with congenital scoliosis (when the vertebrae are not properly formed) or neuromuscular scoliosis (associated with trauma or diseases such as cerebral palsy or muscular dystrophy), surgery may be necessary.

The right timing | Elliot, like many children

with congenital scoliosis, has other congenital abnormalities that can make diagnosis and treatment of scoliosis more complicated.

To ensure the most effective treatment, Kumar carefully monitored Elliot during his childhood. In 2010 — at the age of 9 — Elliot underwent his first surgery in which a growth rod was implanted. The rod was fused to

Elliot’s spine above and below the curve to provide stability while avoiding tissue damage and allowing for growth.

And the end of 2011, a second procedure was done to lengthen the growth rod.

“The goal is to keep the spine as straight as possible while allowing for natural growth,” Kumar says.

While the growth rod added more than 5 inches to Elliot’s height, by early 2014, complications from the extreme curve in his spine began to interfere with his quality of life.

“He started having issues breathing, as his lung was becoming compressed,” Corbett says.

Elliot had not grown in six months, which, together with extensive tests, indicated that he had reached his skeletal maturity — the age when additional bone growth is unlikely. So this past summer, Kumar removed the growth rod and performed a spinal fusion at Rocky Mountain Hospital for Children to secure Elliot’s spine in place permanently.

“During this final phase, we were able to completely straighten Elliot’s spine, which will provide him with a better quality of life and function,” Kumar says.

Go-to spine specialist | Whether idiopathic

scoliosis or less common cases like Elliot’s, Kumar’s unique expertise in both pediatric and adult spinal deformities makes him a goto orthopedic spine specialist in Colorado.

“We felt right at home with Dr. Kumar from the beginning,” Corbett says. “His expertise, personal touch, and compassion combined for what we feel like is the best care in the area.

He always goes above and beyond what one would expect of a surgeon today.”

PEDIATRIC PERKS AT LITTLETON ADVENTIST HOSPITAL From surgeries to simple outpatient procedures, children receive the special care and attention they need at the Pediatric Unit at Littleton Adventist Hospital. The Pediatric Unit offers play therapies, including books and toys for patients, patient and family education, an individualized care and monitoring plan, and nutrition services certain to get them back to being kids sooner than later. For complex surgeries, such as spine, Littleton Adventist Hospital partners with Rocky Mountain Hospital for Children to ensure safe, quality care with follow-up back home.

Littleton Adventist Hospital, in affiliation with Rocky Mountain Hospital for Children, also provides Pediatric Emergency Care for kids. Located at the hospital’s main ER at Broadway and Mineral Avenue, the Littleton Adventist Hospital pediatric ER is staffed by board-certified pediatricians and has a kid-friendly environment. Pediatric Emergency Care is open weekdays from 4 p.m. to midnight and weekends from noon to midnight. For questions or more information, call 303-795-KIDS.

Not Just For Kids Scoliosis is often diagnosed during childhood, yet adult scoliosis is prevalent, affecting nearly 2 million adults in America. Adult scoliosis generally derives from one or a combination of the following factors: Childhood scoliosis that was treated surgically Childhood scoliosis that was never diagnosed and/or treated Degenerative scoliosis that forms as a result of wear and age (typically forms in adults 65 years and older) Anant Kumar, MD, an orthopedic surgeon who specializes in adult spine surgery at Littleton Adventist Hospital, performs revision surgery for adult scoliosis patients, or patients with failed spinal fusions.

Up to 13 percent of spinal fusions for scoliosis performed during adolescence requires at least one revision surgery, according to the American Academy of Orthopaedic Surgeons.

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For more information on Littleton Adventist Hospital’s spine program, please contact our spine coordinator at 720-528-0823.

create | mylittletonhospital.org | 5

Photos: ©Ellen Jaskol, ©istockphoto/daniel_wiedemann

A common problem | Scoliosis affects up to

inter arrior

Become a

Littleton Adventist Hospital (featuring separate pediatric ER) 7700 South Broadway 303-730-5800

Tips to avoid the top three winter injuries

As the temperatures drop, visits to the ER rise, resulting in 25 percent more ER visits during the winter than the fall, according to the National Health Statistics Reports.

“The colder temperatures and winter weather tend to lead to more injuries,” says Mark Elliott, MD, a board-certified emergency medicine physician with Centura Health South Denver Group, which includes Castle Rock Adventist Hospital, Littleton Adventist Hospital, Parker Adventist Hospital, and Porter Adventist Hospital. “We also see a spike in ER visits due to participation in winter sports, like skiing and snowboarding.”

Below is a rundown on how to avoid the three most common winter injuries.

Castle Rock Adventist Hospital 2350 Meadows Boulevard 720-455-2500

Cold Weather Exposure

Parker Adventist Hospital 9395 Crown Crest Boulevard 303-269-4000 Porter Adventist Hospital 2525 South Downing Street 303-778-1955 Centura Health at Southlands ER (opening early November) 6159 South Southlands Parkway 303-649-3000

Winter Sports

Falls Falls account for up to 60 percent of ER visits during winter months. While bumps and bruises are the most common fall-related injuries, one out of three leads to serious head injuries, lacerations, or fractures, according to the Centers for Disease Control and Prevention (CDC).

Prevention:

Littleton Adventist Hospital, a Level II Trauma Center, is part of the Centura Health Trauma System, the region’s largest and most comprehensive network of trauma care and emergency services.

 Clear snow and ice from walkways and driveways (use kitty litter, sand, or deicer on tough areas)  Wear shoes with extra grip or strap on shoe grips  Walk more cautiously

Winter sports result in half a million injuries annually, with snowboarding accounting for 25 percent of all winter sports-related ER visits, according to the CDC. Common injuries include strains and sprains, head injuries, eye injuries, fractures — and, especially in Colorado, knee injuries.

Prevention:  Warm up prior to the activity and then stretch while warm  Wear a helmet when sledding, skiing, or snowboarding  Wear goggles and sunscreen when out in the snow “For skiers, I recommend staying forward in your boots, as sitting back in your boots can set you up for ACL injuries in the knees,” Elliott says.

Exposure to colder temperatures can lead to frostnip (itching and pain to skin), frostbite (tissue damage that often includes blistering, numbness, and pain to the exposed area), and hypothermia (cold exposure that leads to a drop in body temperature resulting in symptoms including shivering, confusion, memory loss, slurred speech, and drowsiness). Risk of hypothermia rises in the elderly and very young and after alcohol use.

Prevention:  Layer clothing and wear water resistant clothing  Change out of wet clothing as quickly as possible  Avoid lengthy exposure to outdoor temperatures  Hydrate well  Avoid alcohol “Anyone with a serious head injury, any obvious fractures, hypothermia symptoms, or concerns about head injury or frostbite should go to the ER immediately,” Elliott says. “Most other injuries, including bruises and strains, can be treated with rest and ice.”

 Download the FREE iTriage health app to check ER wait times, check symptoms, and get answers to health questions: itriagehealth.com/mobile.  6 | FALL 2014 • Create

Photos: ©istockphoto.com/tuullaa, /zest_marina, /iofoto

Centura Health South Denver Emergency Facilities

Time for your annual screening mammogram?

Treating breast cancer beautifully Women have more options than ever when it comes to breast cancer surgery thanks to a team approach and advancements in techniques called oncoplastics.

Oncoplasty allows physicians to treat cancer effectively and completely while also considering current and future appearance.

One example is fat grafting, a technique that uses fat from other parts of the body to help reconstruct the breast after lumpectomy or mastectomy. Oncoplasty can be used at the time a woman is being treated but also address issues for women who are months or even years out from their breast cancer treatment.

“We can use small amounts of fat to fill contour irregularities, caused by previous surgery,” says Lisa Hunsicker, MD, a board-certified plastic surgeon at Littleton Adventist Hospital. “This can also help repair previous tissue damage since fat is rich with stem cells that help the body heal.” Most insurance plans will cover the cost of these procedures, even for previous diagnoses.

Oncoplasty options offered now or soon at Littleton Adventist Hospital include: 3 Fat-grafting, which uses fat injected into the breast to improve symmetry or repair defects from previous surgeries 3 Lumpectomy with careful placement of scars and preservation of the breast contour 3 Nipple-sparing mastectomy, which allows the skin and nipple to be preserved while removing all breast tissue 3 Nipple tattooing and nipple reconstruction 3 Single-stage reconstruction to allow women to

undergo mastectomy and reconstruction in one surgery

Lumpectomy is a safe and effective way to treat many breast cancers and has the advantage of preserving most of the breast contour and sensation, says Jodi Widner, MD, a surgeon and Co-Director of the Breast Center at Littleton Adventist Hospital. “A woman can undergo a lumpectomy and wake up with minimal incisions and her breast looking very much like it did before surgery,” Widner says.

For women who require or prefer a mastectomy to treat their cancer, the option of Single-Stage Reconstruction (also known as Direct-to-Implant or Immediate Breast Reconstruction) allows the mastectomy and implant placement to be done in a single, overnight procedure. This technique can decrease downtime, cut patient costs, and offers emotional benefit, as women emerge from surgery with reconstruction completed, rather than facing months without breasts. Worldwide, studies have concluded this procedure is safe and effective, says Hunsicker who has been at the forefront of this technique, both locally and nationally, for more than a decade. Hundreds of patients have benefitted from this approach, allowing them to return to their lives sooner.

Caring for the whole patient and helping them make the decision that is right for them is the focus of the breast team at Littleton Adventist Hospital. Drs. Hunsicker, Widner and Radhika Acharya-Leon, a board-certified medical oncologist, meet with patients and work collaboratively to form a treatment plan that includes cancer treatment, prevention, and nutrition.

“Together, we create a plan that is customized and tailored to each patient,” Hunsicker says.

Women with dense breasts — when more tissue than fat is present — or with a family history of breast cancer now can opt for screening breast ultrasounds at Littleton Adventist Hospital.

“Ultrasound allows us to detect more than what can be detected with a mammogram,” Widner says. “The automated ultrasound machine also eliminates technician error so we can compare images from one year to the next.”

For more information about breast ultrasound or oncoplasty at Littleton Adventist Hospital, call 303-738-7787 or go mylittletonhospital.org/ breast-care. create | mylittletonhospital.org | 7

Photo: ©Ellen Jaskol

Triumphant Trio ~ The breast health team at Littleton Adventist Hospital, including (from left) Drs. Jodi Widner, Lisa Hunsicker, and Radhika Acharya-Leon, join forces to create customized treatment plans for women with breast cancer.

Just text your name to 720-358-5412, and we’ll call you within two business days to schedule your appointment.

And be sure to join Drs. Hunskicker, Widner, and AcharyaLeon, along with other breast care experts, at The Many Faces of Breast Health on Oct. 22 from 6-8 p.m. at the Inn at Hudson Gardens.

Experts will speak on oncoplasty, nutrition, screenings, and the latest advancements in breast health and cancer treatment.

See full details on back cover.

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Get your flu shot today at your neighborhood Walgreens Take Care Clinic! Find locations at walgreens.com.

Littleton Adventist Hospital is 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.

Fall 2014 The Many Faces of Breast Health Dr. Radhika Acharya, Dr. Jodi Widner, Dr. Lisa Hunsicker, and other breast care experts will speak on oncoplasty, nutrition, screenings, and the latest advancements in breast health and cancer treatment.

Date | Wed, Oct 22 Time | 6-8 p.m.

Location | The Inn at Hudson Gardens Register | email laurenbrendel@centura. org or call 303-734-8612

Childbirth Preparation Class Join other expectant parents in a fun and relaxing environment to learn what to expect during childbirth and how to recognize the signs of labor. A reunion for all participants also will be scheduled! This is a four-week class available Sundays, Mondays, and Saturdays.

For a complete list of dates, times, and locations, go to mylittletonhospital.org/ classes-and-events.

Cost | $70 per couple Register | 303-730-5810

Prenatal and Infant Classes The BirthPlace at Littleton Adventist Hospital offers a variety of birth and child care classes, from preparing for childbirth, breastfeeding classes, a bootcamp for new dads, to how to handle emergencies for grandparents and babysitters, or take a tour of The BirthPlace. For a complete list of classes, times, or to register, visit mylittletonhospital.org/ classes-and-events.

Mammos, Mocktails, and More Join us for happy hour! Get your annual mammogram and enjoy mocktails, refreshments, and more! Event is held the last Wednesday of the month.

Date | Wed, Oct 29 Time | 4-7 p.m.

Location | The Breast Center at Littleton Adventist Hospital Registration required | 303-738-2767

New Options in Carpal Tunnel Treatment Join Dr. Carlton Clinkscales, orthopedic surgeon and upper extremity surgeon, as he shares how to recognize the signs and symptoms of carpal tunnel and describes a new, minimally invasive procedure available to treat carpal tunnel syndrome.

Date | Wed, Nov 5 Time | 6-7 p.m.

Location | Littleton Adventist Hospital, Conference Room 1 Register | email laurenbrendel@centura. org or call 303-734-8612

Photo: ©istockphoto.com/Magone

Free health classes