Spring 2015 • Volume 3, Issue 2
Your health. Your life.
Advancing Stroke
CARE Littleton Adventist Hospital puts local man back on the path to health after stroke
a n d ...
Healthy Outlook Page 2
High-Tech Healthcare Page 3
Controlling Incontinence Page 6
New Epilepsy Treatments Page 7
IN Good Health
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 healthcare 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. 7700 S. Broadway Littleton, CO 80122 mylittletonhospital.org
2 | Spring 2015 • Create
Healthy outlook, healthy body Pour on the health with a glasshalf-full attitude
Stress Relief
A recent study involving hundreds of women found that stressful events were linked to shorter telomeres, which are the protective tips of chromosomes that affect how quickly we age. As telomeres become shorter and they weaken, cells age and die. It’s this cellular aging that is associated with age-related illnesses, such as heart disease, Alzheimer’s, and cancer. “Studies have shown, and I see in my patients every day, that people who have a more positive outlook are better at dealing with stress and along with that comes improved health,” says Rebecca Bub, DO, a family practice physician who helps her patients focus on ways to stay healthy. The good news is that this same study, published last year in the journal Molecular Psychiatry, found that women who maintained active lifestyles, ate healthy, and slept well showed no significant shortening of their telomeres, even under increased stress.
Rev up your immune system People who have a positive attitude have more electrical and metabolic activity on the left side of the brain’s prefrontal lobe, according to researchers at the University of Wisconsin. This is the side of the brain associated with greater numbers of natural killer cells — the ones that help us fight viruses and perhaps even cancer. To learn more about research into the effects of positive outlooks, go online to investigatinghealthyminds.org.
$75,000
People who make more money usually report higher positive emotions — up to a point. Once a person reaches an annual income of $75,000, more money doesn’t necessarily make you any happier, according to a 2014 Gallup study.
Doctor’s
BAG
Dr. Rebecca Bub Family Practice Physician Chatfield Family Medicine 10789 Bradford Road Littleton, CO 80127
Dr. Bub offers comprehensive family medicine to patients of all ages, with a focus on developing lifelong doctorpatient relationships. She has a special interest in preventive medicine, women’s health, outpatient procedures, weight management, and adolescent care. Bub believes in giving back through medical missions and has provided medical care and education to a number of communities throughout the Dominican Republic and Costa Rica. “Every time I’ve done mission work, I get an immediate reset to a positive outlook on life because you see people who have so little being so positive and grateful for even the smallest thing.” To make an appointment with Dr. Bub, call 303-738-2714.
Cover photo: ©Ellen Jaskol;This page clockwise: ©IStockphoto.com/ ryasick, /malerapaso, /Spiritartist
Outlook is the seventh guiding principle of CREAT ION Health, a n Adventist wellness progra m supported by medical research a nd promoted by Littleton Adventist Hospital. To learn more, go to creationhealth.com.
High-Tech Healthcare Cutting-edge technology at Littleton Adventist Hospital helps to improve patient outcomes, reduces surgery and recovery times
Dr. Glenn Bigsby
da Vinci Surgical System
Gynecologists worldwide often use this robotic technology to perform minimally invasive surgeries, such as hysterectomies. At Littleton Adventist Hospital, Glenn Bigsby, DO, a gynecologic oncologist, uses the da Vinci in treating cervical and endometrial cancer. How it works Using the da Vinci allows the surgeon to view magnified, 3-D images, while guiding tiny instruments through a few, small incisions. The surgeon completely controls the instruments, as the da Vinci translates the surgeon’s movements into smaller, and even more precise movements. Benefits • Improved control: The da Vinci instruments rotate 360 degrees, providing the surgeon with more dexterity than the human hand, which allows more precise surgery, Bigsby says. • Enhanced visualization: A screen provides 3-D, highdefinition, magnified views of tissue, allowing better viewing of anatomical structures. • Shorter recovery times: Minimally invasive procedures, including those performed with the da Vinci, result in shorter hospital stays and faster recovery times, compared to traditional surgery.
Dr. David VanSickle
Dr. Ben Guiot
Mazor Robotics Renaissance Guidance System
At Littleton Adventist Hospital, surgeons use the Mazor for deep brain stimulation (DBS) and spine surgery. Neurosurgeon David VanSickle, MD, PhD, uses the Mazor to precisely guide electrodes into brain structures for DBS. Spine surgeons, like Ben Guiot, MD, neurosurgeon, use the Mazor to guide hardware used in various spinal procedures, including scoliosis surgery, spinal fusion, vertebroplasty, minimally invasive spine surgery, and adult reconstructive surgery. How it works The surgeon plans the procedure through Mazor’s 3-D planning software. Once in the operating room, the robot guides the surgeon to the precise, preplanned location where implants are needed. The procedure is performed by the surgeon, with the Mazor serving as a navigational guide to improve accuracy. Benefits • Increased accuracy: “This technology is essentially a GPS that allows a surgeon to place screws with a high degree of confidence and precision,” says Guiot. • Shorter operating times: “With traditional DBS surgery, it takes four to eight hours to place one electrode in the brain. With Mazor, two electrodes can be placed in about two hours,” VanSickle says. • Shorter recovery times: Minimally invasive spine surgeries, including those performed with Mazor’s guidance software, result in faster recovery times, compared to traditional open procedures. • Reduced complications: Clinical studies show use of the Mazor decreases surgical complications, such as blood loss and infection.
Littleton Adventist Hospital’s advanced robotic surgery program is supported by Centura Centers for Clinical Innovation, extending advanced health technologies across Colorado and western Kansas.
Dr. Jodi Wider
GE Invenia — Automated Whole Breast Ultrasound
Primary care physicians, OBGYNs or breast surgeons, like Jodi Widner, MD, may order whole breast ultrasound, in addition to mammography, for women with dense breast tissue or other risk factors of breast cancer. Forty percent of women have dense breast tissue. Since mammography has limited visibility in women with dense breast tissue, screening dense breasts with ultrasound, in addition to mammography, may improve the likelihood of detecting cancer. Ultrasound uses sound waves to create 3-D images rather than radiation. How it works Breast tissue is analyzed through 3-D technology, providing multiple images. Benefits • Improved quality: Whole breast ultrasound is approved by the FDA to help detect tumors that may not appear on a mammogram for women with dense breasts. • Increased comfort: This technique involves minimal compression of breast tissue.
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Just 10 weeks after suffering a stroke, Ken Leaf was completely back to health thanks to Littleton Adventist Hospital’s Primary Stroke Center.
Minimally invasive endovascular procedures provide fast treatment for stroke patients “I was doing some jogging at the recreation center when I felt the onset of what I thought was a migraine headache,” says the 57-year-old Littleton man. “I sat down in the lobby and started to feel slightly better, so I drove myself home. Now I know that was a mistake.” Fortunately, when Leaf got home, his wife, Patti, decided they should go to the hospital. The nearest hospital was Littleton Adventist Hospital, an accredited Primary Stroke Center with advanced capabilities. The stroke team at Littleton Adventist Hospital quickly discovered a blood vessel had burst in Leaf’s brain, causing a hemorrhagic stroke that could have been deadly without timely intervention.
Time is of the essence
You may have seen the phrase, “Time is brain.” And it’s true. During a stroke, the brain is deprived of blood and oxygen, resulting in the death of neurons. Each hour of neuron death causes the brain to age the equivalent of 3.6 years. That’s why it’s so important to get to the hospital quickly, ideally by calling 911 at the onset of strokelike symptoms. Paramedics can start treatment immediately and provide advance notice to the emergency department, which can then be ready to provide immediate care. There are two types of stroke — ischemic and hemorrhagic. The majority of strokes are ischemic strokes, which are caused by a clot in a blood vessel that stops blood from flowing to the brain. The first-line treatment for ischemic strokes is usually a medication called tissue plasminogen activator (tPA). Administered through an IV, tPA helps dissolve the clot and restore blood flow. But tPA must be given within about five hours of the onset of symptoms.
Littleton Adventist Hospital is part of the Centura Health Stroke Network, the region’s leading provider of stroke care. 4 | spring 2015 • Create
Photo: ©Ellen Jaskol
Looking back, Ken Leaf knows he should have called 911 when he was struck by a sudden pain in his temple.
“Intravenous tPA is most effective when we can get it in the patient within the golden hour from onset,” says Mark Murray, MD, PhD, an interventional neurologist at Littleton Adventist Hospital. “That’s why we don’t want patients waiting any longer than they have to before coming in.” Dr. Mark Murray In cases where it’s too late to administer tPA or it’s not effective, it’s best to be at a Stroke Center like Littleton Adventist Hospital. “We have protocols in place to treat patients quickly, which is critical with stroke,” says Janet Carlson, RN, MSN, stroke program coordinator at Littleton Adventist Hospital. “We go beyond what’s required of a Primary Stroke Center and provide advanced treatment options like mechanical clot removal or thrombectomy by interventional neuroradiology. We also have neurologists and neurosurgeons available 24/7.”
Minimally invasive treatment
Interventional neuroradiology (INR) is the practice of using medical imaging to guide and carry out minimally invasive procedures. It provides important treatment options for both ischemic and hemorrhagic strokes. In the case of ischemic stroke, INR can be used to remove a clot. “Basically, we navigate through blood vessels to the clot in the brain, and remove the clot to relieve the vessel blockage by using a tiny specialized device placed from an artery in the groin,” says Perry Ng, MD, an interventional neuroradiologist at Littleton Adventist Hospital. “The success rate of removing clots nowadays is around 80 to 90 percent.” Leaf’s stroke was caused by a ruptured aneurysm, or ballooning of a blood vessel in the brain. Historically, brain surgery was the only treatment for this type of stroke. But today, INR provides nonsurgical treatments that result in less pain and a shorter recovery time. Leaf had a minimally invasive procedure called endovascular coiling, in which a tiny coil was inserted into an artery in his leg and threaded to the ruptured spot in his brain. The coil caused a clot to form, plugging the leak in the vessel and restoring normal blood flow. The procedure involved only a small puncture site in his upper thigh that didn’t even require stitches. “I didn’t have any significant pain from the procedure,” Leaf says. “I had lingering effects of the stroke for about two and a half months — mainly dizziness, headaches, and fatigue. But I have had no disability. And I can’t blame my lack of memory on that, unfortunately.” Leaf’s sense of humor is obviously still intact. He’s also back to his old active self again. “I’m back to walking the dogs and doing some light jogging,” he says. “I look forward to getting back into the outdoors this summer. I’ve recently taken up mountain hiking — I’m talking serious hiking at 14,000 feet.”
Award-Winning Stroke Care Littleton Adventist Hospital is widely recognized for its high level of stroke care. • The American Heart Association®/American Stroke Association® awarded Littleton Adventist Hospital’s Stroke Center the Gold Plus Performance Achievement Award for quality stroke care. They also recognized Littleton Adventist Hospital as the first hospital in Colorado to be named to its Target Stroke Honor Roll-Elite Plus recognizing centers that administer tPA within 60 minutes in more than 75 percent of cases. • The Joint Commission designated Littleton Adventist Hospital a Primary Stroke Center with Advanced Capabilities, one of the first in Colorado. • Healthgrades®, a leading independent healthcare ratings company, named Littleton Adventist Hospital a Five-Star Stroke CenterTM.
Take the FAST test to identify common stroke warnings
F A S T
Face
droops on one side.
Arms
drift downward when raised.
Speech is slurred.
Time
is critical. Call 911 immediately.
Twice As Good Interventional radiology uses radiologic technology, such as CT and MRI scans, to guide treatments that can be performed through one small puncture. Interventional radiology continues to evolve, supplanting major surgery for conditions including stroke, varicose veins, certain cancers, spinal fractures, infertility, kidney failure, and more. Littleton Adventist Hospital is adding a second interventional radiology suite to serve more patients who can benefit from these procedures.
When it comes to stroke, don’t wait If you or a loved one is having a stroke, don’t wait — call 911 right away. Lifesaving treatment begins on the way to the hospital. To learn more about stroke care at Littleton Adventist Hospital, visit mylittletonhospital.org/stroke.
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If you experience incontinence, chances are good that Kegels — if you learn to do them right — can help repair the problem
I
f you’ve given up jumping on the trampoline with your kids or have to clench your core when you sneeze, you’re not alone. It’s estimated that one in four women over the age of 18 experiences some level of incontinence. And if you’re one of these women, you’ve Kerri Daniels probably tried thousands of Kegels without results. Chances are you’ve been doing them incorrectly — and may even be making the problem worse. “Studies show only 50 percent of women are able to do pelvic floor contractions successfully with verbal instruction alone,” says Kerri Daniels, a physical therapist who specializes in women’s pelvic health at Centura Health Center for Therapy at Littleton Adventist Hospital. “Unfortunately, 25 percent perform these contractions in a way that makes urinary incontinence worse.” Stress incontinence occurs when the muscles that control the bladder are weakened, resulting in a loss of urine during activities such as coughing, sneezing, laughing, or exercising. Childbirth, constipation, strenuous exercise, and menopause all can increase a woman’s risk of stress incontinence. “Women have many muscles that form a hammock between the front of the pelvis and the tailbone,” Daniels explains. “For optimum pelvic floor health, these muscles must be strengthened through specialized daily exercises.” The Centura Health Centers for Therapy at Littleton Adventist Hospital, Parker Adventist Hospital, Porter Adventist Hospital, and Castle Rock Adventist Hospital offer a program that teaches women how to strengthen their pelvic floors correctly. Using ultrasound and EMG, therapists can actually show women when they are correctly contracting the right muscles. In addition, physical therapists use manual therapy techniques, functional activity training, and provide a home exercise program so women can maintain the gains they have made in therapy throughout their lifetimes. The majority of patients see a marked decrease in their incontinence after completing the 12- to 16-week program, Daniels says. “This is where women’s health physical therapy can be most beneficial. We’re trained in assessing muscle strength and pelvic floor contractions while teaching women to do them correctly.” The therapy program also helps women who are struggling with pelvic floor weakness, prolapse, pain during and after pregnancy, and pelvic ring pain. 6 | Spring 2015 • Create
Therapy clinics to treat women with incontinence, pelvic floor weakness, prolapse, and pelvic pain are available at four Centura Health hospitals throughout the southern metro area. Call any for more information or to make an appointment. Centura Health Center for Therapy Littleton Adventist Hospital 303-730-5883 Centura Health Center for Therapy Castle Rock Adventist Hospital 720-455-3700
Women have about a 20 percent chance of needing surgery to treat stress incontinence or pelvic organ prolapse in their lifetimes, according to a study published in the June 2014 issue of Obstetrics & Gynecology. Urogynecologist Bruce Dorr, MD, of Littleton OB/GYN, shares the most common types of surgery for urinary incontinence. “The standard of care for surgically correctable stress urinary incontinence — the most common type (of incontinence) — is a midurethral sling,” Dorr says. “A small strip of mesh is used to restore support to the urethra and bladder.” This is an outpatient procedure that allows the woman to go home the same day. There are three approaches to placing the sling: Transvaginal (TVT) The U-shaped sling in TVT results in a tighter sling and a more than 85 percent success rate. Because of the tightness, women have a slightly higher risk of temporary voiding problems right after surgery. Transobturator (TOT) This procedure involves a slightly different placement, resulting in less risk of voiding dysfunction. Postoperative success rates are within 1 to 2 percent of TVT. Mini sling Growing in popularity, the mini sling requires only one incision and less surgery time than the other two approaches. However, Dorr says initial data indicates one- to twoyear postoperative success results are not as high.
Centura Health Center for Therapy Parker Adventist Hospital 303-269-4590 Centura Health Center for Therapy Porter Adventist Hospital 303-778-5842
Dr. Bruce Dorr
Visit mylittletonhospital.org/ stopincontinence to watch a video of me sharing more about surgical options for urinary incontinence.
Photos: ©istockphoto.com/Joey Boylan, ©Lucky Lloyd; opposite page: ©istockphoto.com/Michael Krinke
Take Control
Surgical options for urinary incontinence
Epilepsy Under Control
Cutting-edge care close to home One in every 26 people is diagnosed with epilepsy, a condition that causes seizures. In nearly three-quarters of cases, the cause is unknown. For all patients, the goal is the same — to manage debilitating symptoms. Littleton Adventist Hospital recently opened an Epilepsy Monitoring Unit (EMU) and recruited neurologist and epileptologist Ro Elgavish, MD, PhD, to join Kathryn Polovitz, MD, as co-medical director. Dr. Ro Elgavish “Our goal is to advance the epilepsy care provided in our community, which includes improvements in diagnosis, the latest medications, and development of an epilepsy surgical program right here in Littleton,” Elgavish says. “We expect to apply for a Level IV Epilepsy Center rating, providing the most complex epilepsy care available, within the next two years.” The Littleton Adventist Hospital EMU uses sophisticated technology to diagnose epilepsy and determine which medication, combination of medications, or other treatments will be most effective in controlling patients’ seizures. Located inside the hospital’s intensive care unit, EMU patients are cared for by specially trained nurses, epileptologists, neurodiagnostic techs, and neurosurgeons.
Littleton Adventist Hospital offers: Continuous EEG
University-level medical care
Vagus nerve stimulation
Intensive care unit patients experiencing seizurelike symptoms or altered mental status benefit from continuous electroencephalography (cEEG) to identify seizure activity. “The use of cEEG in the ICU is the standard of care and results in better outcomes for patients,” Elgavish says. “We’ve added technical staff and equipment to increase the availability of this technology to all patients in need.”
At Elgavish’s dedicated epilepsy clinic in Littleton, patients receive the highest level of individualized care without having to travel far from home. “It’s unusual to have a dedicated subspecialty clinic like this in our area. There are only a few in Colorado, typically found in a university setting,” Elgavish says. “We’re proud to offer this highly specialized care to our community.”
Sometimes seizures can’t be controlled by medications, and surgical intervention may be required. Littleton Adventist Hospital neurosurgeons currently offer vagus nerve stimulation, which prevents seizure activity by sending intermittent pulses of electricity to the brain through a device placed on the chest wall that runs to the vagus nerve in the neck.
>>
The future of epilepsy surgery at Littleton Adventist Hospital
Throughout the next two years, Dr. Elgavish will help lead further development of the hospital’s epilepsy surgery offerings. Temporal lobectomy, a procedure that removes an area in the brain that frequently causes seizures, will be offered within the next several months. More complex surgeries, which require placement of electrodes directly on the brain to determine the area where the seizures start, will be available within one to two years.
To learn more, go to mylittletonhospital. org/emu or call our neuroscience nurse practitioner at 720-528-0753.
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Prevention and Early Detection of Ovarian Cancer Dr. Glenn Bigsby, gynecologic oncologist, will discuss signs and symptoms of ovarian cancer, as well as risk factors and prevention tips. Date | Thu, Apr 23 Time | 6-7 p.m. Location | Littleton Adventist Hospital, Conference Room 3 Registration mylittleton.org/ lahclasses or call 303-734-8612
2015 calendar
The Missing Piece of Low Back Pain If you’ve been struggling with low back pain, it may not be your spine that is the problem. It could be your sacroiliac joint (SI). SI joint problems can cause 25 percent of all low back pain, yet are often overlooked. Learn the signs and treatments for SI joint problems with Dr. Ben Guiot, neurosurgeon and spine specialist. Date | Tue, Apr 14 Time | 6-7 p.m. Location | Littleton Adventist Hospital, Conference Room 3 Registration mylittleton.org/ lahclasses or call 303-734-8612
Mammos, Mom, and Me It’s time to take care of yourselves! Bring yourself and your mom or daughter, and join us for mammograms, chair massages, and refreshments. Date | Weds, Apr 29, May 13, May 27, or Jun 24 Time | 4-7 p.m. Location | The Breast Center at Littleton Adventist Hospital Registration (required) 303-738-2767 Incontinence and Pelvic Health Join Kerri Daniels, MPT, CLT, to discuss the symptoms and physical therapy treatments for urinary incontinence and pelvic prolapse. Date | Thu, Apr 30 Time | 6-7 p.m. Location | Littleton Adventist Hospital, Conference Room 1 Registration mylittleton.org/ lahclasses or call 303-734-8612
Non-Profit Org US POSTAGE
PAID
Denver, CO Permit NO. 4773
7700 S. Broadway Littleton, CO 80122
Littleton Adventist Hospital is 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.
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 | Thu, May 14 Time | 6-7 p.m. Location | Littleton Adventist Hospital, Conference Room 1 Registration mylittleton.org/ lahclasses or call 303-734-8612
3rd Annual National Cancer Survivors Day Celebrating survivors, inspiring those who have been recently diagnosed with cancer, and gathering together families who have given their unending support, this event is all about hope. Date | Sun, Jun 7 Time | 10:30 a.m.-1 p.m. Location | Parking lot in between the hospital and surgery center (enter from the Broadway entrance) Info | 303-734-8612
Littleton Hospital Foundation Golf Classic Support the LHF Golf Classic, which provides funds for program development and equipment needs at Littleton Adventist Hospital. Date | Mon, Jul 13 Location | The Country Club at Castle Pines, 6400 Country Club Drive, Castle Rock For information on registration and sponsorships, please call 303-715-7600 or visit littletonhospital foundation.org.
Photo: ©istockphoto.com/fotomirc, /Flander
Spring
Portercare Adventist Health System