Create Winter 2016

Winter 2016 • Volume 4, Issue 1

Your health. Your life.

Take a

Knee A range of treatments can help you and your joints keep moving

a n d ...

Healthy Relationships Page 2

Advances in Spine Surgery Page 3

Screening for colon cancer Page 6

Breast Reconstruction Options Page 7

Interpersonal relationships is one of the eight guiding principles of CREATION Health, an Adventist wellness program supported by medical research and promoted by Littleton Adventist Hospital. To learn more, go to southdenver health.org/ creation-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 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.

7700 S. Broadway Littleton, CO 80122 mylittletonhospital.org

2 | winter 2016 • Create

Interpersonal

Relationships Your REAL social network When it comes to your health, the phrase “social network” doesn’t refer to your Facebook friends. It refers to the people in your life with whom you have deep, meaningful relationships.

Studies show that quality interpersonal relationships actually increase your chances of survival by 50 percent. If that’s not enough reason to nurture your relationships, we don’t know what is! Here’s how: Focus on family. Ever hear of the Blue Zones?

Throughout the world, these are places where populations live the longest and guess what?

Families are a priority.

to

hours

Connect with family members and close friends who bring joy to your life as often as possible.

Forgive and forget.

Forgiveness is a gift for you and the person you’re forgiving. Find ways to get past disagreements to encourage healing and strengthen relationships.

Create traditions. It’s easy to disconnect, thanks to busy schedules and daily to-do’s. Create rituals like a Friday phone call with your mom or a monthly lunch with friends to have something fun to look forward to and help you feel — and stay — socially connected.

Double Benefits

Dr. Pragati Pandey Highlands Ranch Medical Associates 9135 S. Ridgeline Blvd., Suite 190 Highlands Ranch, CO 80129 303-649-3140

6 7

When it comes to increasing social activity, family physician Pragati Pandey, MD, combines two recommendations she knows will benefit her patients: regular exercise in a group setting.

“I’ve seen exercise change patients’ outlooks, decrease stress, and help them feel so much better about themselves,” Pandey says. “I recommend group exercise for the social aspect, but also because when you see others exercise, you want to do it, too.” Over the last year, Pandey has incorporated regular workouts into her own life, reducing stress and increasing her sense of well-being.

In her practice, Pandey has a special interest in women’s health, geriatric and pediatric medicines, and she focuses on preventive medicine with all her patients.

To book an appointment with Dr. Pandey, call 303-649-3140.

That’s how much time Gallup researchers found the happiest people spend socializing each day.

That may seem like a lot but remember, how you socialize matters less than how much — sending a fun email or connecting over the phone counts!

Feeling SAD

If you or someone you love experiences recurrent symptoms of depression, like fatigue, irritability, or trouble sleeping this time of the year, it could be a sign of seasonal affective disorder (SAD). About 5 percent of people in the United States suffer from SAD and another 10 to 20 percent experience a more mild form of the condition.

Many SAD sufferers have success with at-home light therapy, while others find relief from counseling or prescription medication, depending on the severity of symptoms. Friends and family members can help by encouraging anyone experiencing depression symptoms to talk to their physician.

Cover photo: ©Ellen Jaskol;This page clockwise: ©IStockphoto.com/Geber86, /MimaCZ (Illustration), ©Michael Richards; Opposite Page: ©IStockphoto.com/ericsphotography

IN Good Health

Back in Action

Two Littleton Adventist Hospital surgeons share their insights on the latest spine surgery techniques Surgery is commonly the last resort for a number of spine conditions. But take comfort: If you do choose to have surgery, modern advancements are helping surgeons be more precise and less invasive.

And that means you can get back on your feet more quickly. Two surgeons at Littleton Adventist Hospital are employing the latest techniques: robot-guided and minimally invasive spine surgery.

Robot-guided spine surgery When he’s placing rods and screws in the spine to correct a condition, precision is everything. That’s why Dr. Ben Guiot Ben Guiot, MD, a neurosurgeon specializing in the spine, uses the Mazor Robotics Renaissance Guidance System at Littleton Adventist Hospital.

“When we perform a spine surgery, we want to be confident we can place the screws precisely where we want them,” he says.

The Mazor robot relies on a CT scan done before surgery to aid in preoperative planning. Before ever making an incision, Guiot can plan where the screws will be placed and exactly what size he requires.

“That’s something we couldn’t have accomplished with the older system,” he says.

During surgery, the robot then helps guide the surgeon.

“We’re using a fantastic map of the landscape — and the robot is like a GPS,” he explains. “The robot gives us a very clear orientation of where we are going to place our screws.”

That high level of accuracy is everything.

“The more accurate the map that we’re using, the more likely we are to have a successful surgery,” he says.

In fact, one study of 112 patients comparing this technology with freehand surgery showed that using the Mazor robot helped increase implant accuracy, reduce complication rates and reoperations, and shorten the average hospital stay.

Minimally invasive surgery When minimally invasive spine techniques were developed, the goal was to minimize scars. But as Dr. Adam Smith the technique evolved, the incision itself is no longer the focus, says spine surgeon Adam P. Smith, MD. “It’s not called minimally invasive surgery because we make a smaller incision,” he explains. “It’s minimally invasive because of what we do to the tissues. The key is that the disruption to the surrounding tissue is minimized.”

During a traditional surgery, a tool called a retractor can be pulling on and damaging the muscles for hours, disrupting not just the nearby ligaments and joints but potentially unintended areas.

The modest disruption that minimally invasive surgery offers means less muscle injury, less bleeding, lower infection rates, less pain, shorter hospital stays, and quicker recoveries. It also tends to result in a much smaller, more cosmetically appealing scar.

When looking for minimally invasive spine surgery, don’t confuse it with laser surgery, Smith says.

“Laser doesn’t necessarily make the surgery less invasive, and it is not indicated for many spine conditions,” he says. “Insurance tends not to pay for these procedures. If you wish to have a minimally invasive procedure, be sure you’re seeing a boardcertified spine surgeon trained in minimally invasive techniques.”

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.

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Kneed to Know How to take care of your knees so they’ll keep you moving well beyond your 50s

T

urning 50 is a reason to celebrate, not just the chronological milestone but the beginning of a great era of life.

Many people feel a renewed sense of empowerment to take charge and pursue the things that are most important to them.

Then there’s the rub: Aging can take a toll on your knees, which may begin wearing out for a variety of reasons.

The cushioning around the joints wears away, leaving the bones to rub against each other, causing inflammation, pain, and stiffness of arthritis.

But you don’t have to just sit there and take it. Learning what causes knee problems and what you can do to avoid them can help you dance your way through the next stage of your life.

4 | winter 2016 • Create

Mark Barnes, 64, is no longer sitting on the bench after a total knee replacement at Llittleton Adventist Hospital helped him beat arthritis.

What hurts?

What helps?

If your knees are starting to bother you, the sooner you take action, the better the chance that a more conservative treatment — anti-inflammatory medication, supplements, and physical therapy — will be enough. This is a typical path your treatment might take: Anti-inflammatory medication. It’s usually a first step, but Thomas cautions against using it long term because of potential side effects. If a patient isn’t better after about three weeks, he tries another treatment.

Glucosamine and chondroitin supplements. “There’s no known side effects, so I encourage my patients to try it and see if it helps,” Thomas says.

Cortisone injections. They may relieve pain for some people with arthritis. But cortisone can elevate blood sugar levels, so people with diabetes should be aware.

Viscosupplementation. Injections of a gel-like fluid into the knee joint may bring relief for up to one year.

Physical therapy. It can be especially beneficial for people with moderate arthritis, because strengthening the muscles can help stabilize the knee joint. “The Fast Fact stronger you are, the better you’ll do,” Thomas says.

Every pound of weight Knee replacement surgery. If arthritis is isolated in one part of your knee you lose takes 4 joint — which is divided into three compartments — a partial knee replacement pounds of pressure may be the right choice for you. But if the arthritis affects your entire knee joint, a off your knees. complete knee replacement is your best bet.

If surgery turns out to be in the cards for you, Piro recommends physical therapy before the procedure if you’re able, so you can go into the procedure in the best possible condition.

And with appropriate postsurgical physical therapy, most people begin to see significant improvement after six weeks and full recovery after three months. “I replaced both knees in one woman who went on to bike from Seattle to the East Coast,” Thomas says. “Most people are quite pleased with what they can do after surgery.”

For more information on how to keep your joints healthy so you can stay active longer, come to a FREE seminar with Dr. Thomas on Thursday, Mar. 10. See back cover for details.

Mark Barnes is back to playing pickleball at the Sheridan Recreation Center.

Getting back in the game

You’re not likely to find anyone who enjoys physical activity more than Mark Barnes. He’s been a sports enthusiast since he was a kid, playing tennis, basketball, football, and even cycling competitively.

He’s had knee issues since he was 17 and as he got older, knee pain started to slow him down. By the time he was in his late 50s, the now 64-year-old Littleton resident couldn’t even straighten his left knee anymore, the arthritis was so bad. The pain would keep him up at night.

After trying every other therapy, he decided to have a knee replacement in 2010.

“I convinced myself the most important thing was to live a pain-free life,” Barnes says.

He admits the recovery was tough at first, but within a month he was back on the tennis court. He now plays tennis for hours at a time, takes long bike rides, and plays pickleball, just some of his many activities in retirement.

“Being in good shape going into surgery really helps,” Barnes says. “No matter what, you’ve got to keep moving. Like my doctor told me, if you don’t keep moving, you’ll rust.”

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Photos: ©Ellen jaskol

Although acute knee injuries can happen at any age — often leading to arthritis in later years — a lot of knee problems are the direct result of the natural aging process and the way you treat your knees over the decades.

Aging. Osteoarthritis — sometimes called “wear and tear” arthritis — is more Dr. Robert Thomas likely as you age. But it doesn’t have to be that way. “There’s nothing to say that as you get past age 50 that you’re going to acquire arthritis in your knees,” says Alisha Piro, PT, MS, a physical therapist at Littleton Adventist Hospital.

Genes. Even if you take great care of your joints, remember that arthritis can be hereditary, says Robert L. Thomas, MD, an orthopedic surgeon at Littleton Adventist Hospital.

Weight. Being overweight can put additional stress on your weight-bearing joints, including your knees, and usher in arthritis.

Nutrition. Or lack thereof. To help ward off age-related knee issues, give your knees the right nutrition. Plenty of water is key. Also eat a balanced diet with at least 20 percent of your calories from healthy fats, like olive oil, and omega-3 fatty acids found in foods like fish.

Activity. Too much or too little exercise can be tough on your knees. The best way to keep your knees healthy is to stay active, especially because maintaining muscle strength around your joints protects them. But high-impact sports may not be your best bet. Thomas is a fan of stationary biking, as is Piro, who also recommends walking and water-based activities, including swimming and water-walking.

Screenings Two in five Americans not up-to-date on colorectal cancer screening olonoscopy is the only cancer screening test that can actually find precancerous growths and remove them. Yet, a recent study shows that two in five adults ages 50 to 75 are not up-to-date with colorectal cancer screening. Meanwhile, a separate study shows that more than three in five adults with a close relative who had colon cancer are not getting screened early enough.

Colorectal cancer is the No. 2 cancer killer in the United States. Gavin Sigle, MD, colorectal surgeon at Littleton Adventist Hospital and Porter Adventist Hospital, says patients who skip screenings are playing with fire. “If you do not get a screening colonoscopy at age 50 or follow screening recommendations, you’re really at risk of developing a cancer or developing a late-stage cancer that doesn’t allow for surgical intervention,” he says.

Littleton Adventist Hospital He sees the consequences firsthand. is part of the Centura “Once colon cancer has spread beyond the colon, it Health Cancer Network, typically goes to the liver. Then you are really looking at delivering integrated, different options from a surgical standpoint. It’s not as advanced cancer care much of a cure option as it is a prolonging-life option,” he across Colorado and says. western Kansas.

The good news is when colorectal cancer is diagnosed early, before it has spread, nine out of every 10 colorectal cancer patients are still alive five years later.

“The whole point of a colonoscopy is to prevent colon cancer or catch colon cancer at an early stage when it is treatable,” Sigle says.

Ease the Prep

There’s no question that bowel prep is one of the reasons people avoid colonoscopy. But newer bowel preps are lower in volume, they taste better, and they can be taken in separate doses or even mixed with Sprite, or light-colored Crystal Light or Gatorade. Some say drinking the prep solution through a straw helps it go down faster with less bad taste. Other tips are to clear your calendar, have a good book or tablet on hand and, if things get sore, try diaper rash ointment.

Join Dr. Sigle at a FREE community seminar on Thursday, Feb. 18 to learn more about how to prevent colorectal cancer. See back cover for details.

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Get to know

Gavin

Hailing from Evergreen, Gavin Sigle, MD, is a fan of just about every mountain sport. But Sigle, a colon and rectal surgeon at Littleton Adventist Hospital, also has several years of collegiate and professional soccer under his belt, having competed in two pre-Major League Soccer leagues prior to medical school.

His day job is surgery, a specialty he fell in love with early in his training, ultimately choosing colon and rectal surgery for two primary reasons. “Most of my patients are curable. I can make them better right away,” he says. Secondly, he wanted the opportunity to use scopes, specialized instruments used to view and perform laparoscopic, or minimally invasive, surgery.

Sigle has extensive training in laparoscopic and minimally invasive colon and rectal surgery, including complicated pelvic laparoscopy for rectal cancer, ulcerative colitis, and fecal incontinence. He also specializes in sphincter-saving operations for patients with low rectal cancers who want to preserve continence. Make an appointment with Dr. Sigle by calling 303-794-6747.

Photos: ©michael richmond, ©iStockPhoto.com//Tetiana Ryshchenko; Opposite Page: ©Ellen Jaskol

becoming less routine

“I went to surgery looking and feeling like a woman and woke up looking and feeling like a woman.”

— Lana Dale, breast cancer survivor and oncoplasty patient

One-Stop Shop Surgery with reconstruction is redefining breast cancer care at Littleton Adventist Hospital When heading into breast cancer surgery, nearly seven in 10 women do not know all of their breast reconstruction options. Lana Dale shudders Dr. Lisa Hunsicker to think how close she came to being one of them.

The 54-year-old Evergreen resident discovered a lump in her breast in the summer of 2011, had a lumpectomy two months later, and then underwent six rounds of chemotherapy to treat what had been a very aggressive cancer. To be safe, her surgeon recommended mastectomy.

“Traditional mastectomy seemed like a long, painful process, physically and psychologically,” Dale says, remembering how limited she felt her choices were. Then her daughter saw a morning show segment about a Denver-area surgical team performing breast surgery with immediate reconstruction. Called oncoplasty — “onco” for cancer and “plasty” for plastic surgery — the highly tailored approach is offered at Littleton Adventist Hospital by breast surgeon Jodi Widner, MD, and plastic surgeon Lisa Hunsicker, MD.

What is ‘oncoplasty’?

Oncoplasty is the blend of cancer surgery — lumpectomy or mastectomy — and reconstructive intervention. Sometimes oncoplasty happens in a single surgery. With Dale, for example, Widner performed a double mastectomy, removing the breast tissue from both breasts, and Hunsicker immediately followed with placement of implants. “It’s one surgery. I woke up with my implants,” says Dale, a local hospital administrator who went on to join Littleton Adventist Hospital’s staff two years after her surgery.

In other cases, Hunsicker says two separate surgeries are advantageous. For example, in a smaller-breasted woman who has lumpectomy followed by radiation therapy, it’s often best to wait for reconstruction until radiation is over.

“If you put tissue in there — specifically fat grafting — it’s going to die from radiation. It’s better to do lumpectomy, let it heal, do radiation, and then make the breasts symmetrical with reconstructive surgery,” she says.

Who is a candidate?

“If you have breast cancer that will be treated with surgery, you are a candidate to have a discussion with a plastic surgeon,” Hunsicker says. In fact, this is the main message she

hopes patients hear. “Oncoplasty is worth a conversation. You might need us; you might not need us. But the more people know, the more they can direct their own care,” she says.

That said, some patients are better oncoplasty candidates than others.

Hunsicker says large-breasted women considering lumpectomy may address asymmetry concerns with an oncoplastic breast reduction. And, unlike in years past when it wasn’t available, fat grafting for smaller-breasted women also leads to good aesthetic results.

Women who are not optimal oncoplasty candidates include smokers; women who are immune-compromised or morbidly obese; and women with serious heart, pulmonary, or other medical conditions.

For her part, Dale is glad she heard of oncoplasty at Littleton Adventist Hospital.

“Psychologically, having reconstruction and mastectomy in one surgery was so great.”

To learn more about oncoplasty and whether you are a candidate, please call the Littleton Adventist Hospital breast cancer nurse navigator at 303-738-7787.

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Portercare Adventist Health System

In my day, deep brain stimulation meant a game of checkers!

To learn more, visit mylittleton hospital.org/dbs.

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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, 2016.

2016 calendar

FREE classes — All classes are from 6-7 p.m.

RSVP today at mylittletonhospital.org/lahclasses or 303-738-2534.

Stroke Busters: Stroke Prevention Tips Join Dr. Topher Nichols as he shares signs, symptoms, and prevention tips for strokes. Because brains matter.

Date | Thu, Jan 21

Prevention and Early Detection of Gynecologic Cancers

Dr. Glenn Bigsby, gynecologic oncologist, will discuss signs and symptoms of cancer in the female reproductive system, as well as risk factors and prevention tips.

Prevention and Early Detection of Colorectal Cancers

Colorectal cancers can often go unnoticed for years. Join Dr. Gavin Sigle as he shares risk factors and prevention tips.

Date | Thu, Feb 18

New Options in Carpal Tunnel Treatment

Chat with Dr. Carlton Clinkscales, orthopedic and upper extremity surgeon, as he shares how to recognize the signs and symptoms of carpal tunnel syndrome. He will also describe a new, minimally invasive procedure available to treat carpal tunnel.

Date | Tue, Mar 1

Keeping Your Joints Healthy

Meet with Dr. Robert Thomas as he shares tips on how to keep your joints healthy, and keeping you active.

Date | Thu, Mar 10

Is Your Back Pain Really Your SI Joint?

One-quarter of back pain is actually due to an SI joint problem. Join Dr. Ben Guiot for this class on identifying the cause of your pain and new ways of treating it.

Date | Tue, Mar 15

Date | Thu, Feb 4

All classes are held 6-7 p.m. at Littleton Adventist Hospital.

Photo: ©istockphoto.com/farella

WINTER

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