Elevate Fall 2013

Living at the height of wellness FALL 2013 | Volume 1, Issue 2

Bountiful Health

Tips to keep you and your family healthy through the fall and beyond

Measuring Up

Breast cancer treatment making huge strides forward

Food & Mood Page 2

Vitamin D Pros & Cons Page 3

At-Home Sleep Test Page 6

PREGNANCY HEALTH Page 7

Go Mediterranean

to cut your risk Mood & Food Just as poor eating habits can wear down your body, they also can affect your mental health. But nutrients like omega-3 fatty acids found in wild salmon and walnuts, and magnesium from leafy green vegetables, nuts, and avocados boost emotional and physical wellness. Dine out healthy tonight at Manna Restaurant at Castle Rock Adventist Hospital.

See the current menu at castlerockhospital.org/manna.

You already know that eating a healthy, balanced diet is good for your overall health. But a recent study found that eating a Mediterranean-style diet high in fruits, vegetables, lean protein, olive oil, nuts, and whole grains may reduce the risk of heart attack, stroke, and heart Dr. Jane Ruger disease deaths by 30 percent in high-risk individuals.

“Nutrition is a powerful tool in the battle against heart disease, and the power of a healthy eating plan like the Mediterranean diet cannot be overstated,” says Jane Ruger, MD, a physician at Ridgeline Family Medicine in Castle Rock. For more information, visit ridgelinefamilymedicine.org.

CREATION Health Challenge Go veggie! Try to commit one day a week to eating a vegetarian diet. Like us on Facebook and we will post vegetarian recipes to inspire you!

Just Sprouting Up Microgreens — those tiny herbs and leaves you’re used to seeing in fancy restaurant salads — are making their way to your local grocery store and farmers’ market, and with good reason. A recent study found microgreens may contain between four and 40 times more nutrients than mature plants.

Squash Game ‘Tis the season to start enjoying winter squash, from acorn and delicata to spaghetti and pumpkin.

So, how long will it stay fresh?

Butternut squash stays fresh for up to three months when stored in a cool spot (around 55 to 60 degrees).

ELEVATE is published four times annually by Castle Rock Adventist Hospital. As part of Centura Health, our mission is to nurture the health of the people in our community. The information herein is meant to complement and not replace advice provided by a licensed health care professional. For comments or to unsubscribe to this publication, please email us at elevate@centura.org.

ELEVATE is produced by Clementine Words LLC. Executive editor is Christine Alexander.

2350 Meadows Boulevard | Castle Rock, CO 80109

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Cover photo: ©shutterstock.com/AlekseiPotov; This page: Clockwise: ©IStockphoto.com/ValentynVolkov, ©IStockphoto.com/jgroup, ©IStockphoto.com/brown54486, Portrait ©Ellen Jaskol, ©IStockphoto.com/woodstock

Nutrition Side Ache It may only be considered a “side,” but an average order of fries contains around 600 calories, which would take nearly two hours to walk off. Stuck at a fast-food joint? Skip the fries and opt for a garden salad.

Conquering Winter Ailments The latest info and expert recommendations to help you and your family stay well all season

INFLUENZA

NOROVIRUS

The main difference

A respiratory illness

The numbers

Up to 1 in 5 Americans get the flu each year

A stomach virus 1 in 15 Americans become infected with a norovirus illness annually

Symptoms Vaccine

Medications/treatment

Prevention

Sudden onset of fever and a cough with severe fatigue or body aches; may also experience congestion, sore throat, chills Recommended for everyone 6 months and older Antiviral drugs are available to treat the flu, but they must be administered within 72 hours of onset of symptoms; if given in time, they can shorten the course of illness by up to 4 days Vaccine is the best prevention; frequent hand-washing and sneezing into your elbow help prevent spreading of the virus

Nausea, vomiting, and diarrhea None Rest and fluids to prevent dehydration Thorough hand-washing— especially after using the toilet and before preparing or eating food

Q. Do I really need to take a vitamin D supplement?

A. A variety of contradictory recommendations have been offered up in recent years regarding the need for daily vitamin D supplements — some suggest large doses while Dr. Raewyn Shell others question the effectiveness of taking supplements at all. But because living in the northern U.S. means you can’t take in as much vitamin D from sunlight in fall and winter, you may naturally be more prone to deficiency, which can increase your risk for a range of health problems, from osteoporosis and heart disease to the flu.

Raewyn Shell, MD, with Ridgeline Family Medicine in Castle Rock, recommends talking to your doctor about the need for vitamin D supplements — especially if you fear you could be at risk for deficiency.

“I think we just have to look at it on an individual basis based on what their risk is, what health problems they have, and their current vitamin D levels, and treat accordingly,” she says.

Individuals at risk of low vitamin D levels may include breastfed babies; elderly people who don’t get much sun exposure; people with darker skin; and individuals with a malabsorption condition, such as Crohn’s or bowel disease; as well as people who’ve had bariatric surgery or are obese, Shell says.

Ridgeline Family Medicine in Castle Rock provides care to all members of the family, from infants to grandparents. Call 720-455-3750 for information or to make an appointment.

castlerockhospital.org

Too young for cold meds

Despite warnings from doctors and the Food and Drug Administration, a recent study found that nearly half of parents still give young children cold medicine. Donald Traver, MD, a pediatrician at Castle Rock Adventist Hospital breaks down the guidelines and offers treatment alternatives.

Guidelines: “We follow FDA guidelines, which say kids under the age of 2 should not use any overthe-counter cough and cold meds.

And there’s been no indication even for kids under the age of 6 that these medicines are beneficial, and may be harmful,” Traver says.

Treatment: Traver recommends treating symptoms with fluids and rest, using a cold mist humidifier, and suctioning your child’s nose out. “For younger kids, parents can keep them in an upright position to help things drain, and use nasal saline irrigation and nasal sprays for older kids.”

Using cold meds for children over 6: Though the efficacy of over-the-counter medications hasn’t been proven, parents who do decide to use them should choose a single agent that’s geared toward the worst symptom. “The more medications you use, the more risk for a reaction to them,” Traver says.

Did you know?

A recent study found that the influenza vaccine is not linked to increased risk of Guillian-Barré syndrome, a nerve-degenerating disorder, and only individuals who’ve had GBS in the past should avoid it.

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Photos: ©Shutterstock.com/megapixel, Portrait ©Ellen Jaskol

What’s the Difference?

Norovirus and influenza are different illnesses, and knowing how to tell them apart in the early stages can help ensure you get the right treatment when you need it most.

3 things to ask your doctor about treatment

1

Tumor characteristics Size, lymph node set, grade and stage, hormone receptors, HER2 status, whether it’s a high- or lowrisk tumor.

2

Treatment options From breast conservation surgery to mastectomy with immediate reconstruction. Is chemotherapy and/or radiation needed?

3

General risk Do you have genetic markers for the disease? Most women don’t, but the risk is high for those who do, so they need to be identified.

Let’s Measure How Far We’ve Come Advances in breast cancer treatment are improving outcomes — and giving women more reason to hope. Here, we take a closer look at the progress.

Breast cancer treatment was once a one-size-fits-all proposition. But as researchers and physicians learn more about breast cancer — and diagnostics and treatments continue to progress — treatment has become more and more customized to each patient’s unique needs. We spoke to three women — a medical oncologist, a breast surgeon, and a breast radiologist — at the forefront of breast cancer care about the varying breast cancer treatment journey for women.

In recent years, medical oncology for breast cancer has taken a more multidisciplinary approach, with a group of physicians working together to determine how best to deliver the care. And the care itself has become a more individualized process.

“Nowadays each individual tumor is determining the type of treatment the patient gets, not just one treatment for everybody,” says Nadine Mikhaeel, MD, a medical oncologist at Castle Rock Adventist Hospital.

The development of targeted therapies have made it possible to attack the cancer cell without affecting normal cells. For example, Herceptin® is an antibody that specifically targets the cells that exhibit overexpression of the HER2 receptor, a particularly aggressive form of breast cancer. The drug is very effective and has minimal side effects. “It has changed the natural history of the disease and changed a very bad outcome to a successful one. The majority of those patients now do better than everybody else,” Mikhaeel says.

Progress also is being made in the ability to predict breast cancer recurrence.

Medical Oncology

Terrific Trio: Drs. Jinnah Phillips (left), Nadine Mikhaeel, and Christine Rogness team up to bring the latest in breast cancer treatment to women in Castle Rock.

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Now, more than ever, women facing breast cancer have choices when it comes to their treatment—including their surgical options.

“The range of surgical options has expanded, and I think that we’re much better at acknowledging a woman’s personal preference regarding how she wants to be cared for,” says Christine Rogness, MD, a breast surgeon at Castle Rock Adventist Hospital. She and her colleagues help educate women so they feel safe about their choices. For instance, a lumpectomy—a partial removal of the breast—is just as effective as a mastectomy in some cases, but may need radiation follow-up. Other women may be more comfortable choosing mastectomy with or without immediate reconstruction, particularly women who cannot undergo lumpectomy with an appropriate cosmetic result.

Besides more surgical choices, the process of looking to see if cancer has spread has become less invasive in the last 20 years. Axillary lymph node sampling has progressed to sentinel lymph node biopsy, which removes less lymph nodes from the armpit or axilla. This reduces the risk of long-term consequences, such as swelling and pain in the arm.

“That’s been a huge advance for surgical care,” Rogness says.

To Rogness, the most important part of her job is empowering women to understand their cancer as well as their surgical options and possible cosmetic and functional outcomes so they can make the best, and most informed, decision.

“I want them to wake up six months after it is all over and be happy about the decisions they made. I don’t want them to feel like they were railroaded into a decision they weren’t prepared for or didn’t ultimately want.”

Breast Surgery

Just as with surgery and oncology, radiation therapy is also evolving to become more targeted. Advancements in technology allow radiation to be delivered with pinpoint accuracy at very high doses, minimizing any damage to healthy tissue.

And thanks to the advent of accelerated partial breast radiation, some women can receive treatment over the course of about a week, instead of the usual six to eight weeks of therapy. A balloon catheter is placed in the breast, and the treatment is focused only on the tumor bed itself and a small rim of the surrounding breast tissue versus whole-breast radiation.

Radiation Therapy

The American Cancer Society recommends that all women get annual screening mammograms starting at age

40

To schedule your mammogram at Castle Rock Adventist Hospital, call 720-455-1111.

castlerockhospital.org

Schedule your annual screening mammogram on Tuesday, Oct. 22, or Wednesday, Oct. 30, 4-7 P.M. and receive a FREE massage afterward!

Call 720-455-1111 to schedule an appointment.

Jinnah Phillips, MD, is a board-certified breast radiologist at Castle Rock Adventist Hospital. She completed her medical training at the University of Utah Medical School and an internship and residency at University of Pittsburgh Medical School.

Nadine Mikhaeel, MD, is a medical oncologist at Castle Rock, Porter, and Parker Adventist Hospitals.

She is board-certified in internal medicine, oncology, and hematology.

She holds an appointment as clinical assistant professor at the University of Colorado School of Medicine.

Christine Rogness, MD, is a board-certified surgeon at Castle Rock Adventist Hospital as well as a member of the hospital’s community board of directors. She also is medical director of the Trio Breast Cancer Program at Parker Adventist Hospital.

She completed her medical training, internship, and residency at University of Colorado Health Sciences Center.

Finding cancer earlier — with fewer callbacks

Treatment isn’t the only area where strides are being made against breast cancer. Advanced diagnostic capabilities now enable breast cancer to be found at an earlier, more treatable stage. Yet with these early detection capabilities, many women fear being called back more frequently if abnormalities are found.

While much is made of these recall rates, women shouldn’t let their fears keep them from getting screenings, says Jinnah Phillips, MD, a board-certified breast radiologist at Castle Rock Adventist Hospital, which features a digital mammography center.

“A good screening program shouldn’t have more than 10 percent recalls at the most. And I’ve seen so many cancers detected in women in their 40s that would not have been detected but for the fact that they got those mammograms,” Phillips says.

If you are called back in after your screening mammogram, don’t panic, Phillips says. Only 10 percent of callbacks result in a biopsy, and nearly three-quarters of those biopsies turn out to be noncancerous.

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Photos: ©IStockphoto.com/indigolotos, Portraits ©Ellen Jaskol

“An oncotype test is a simple lab test performed on the removed cancer cells that can predict if a woman’s specific cancer has a higher tendency to recur in the future. It’s usually performed at diagnosis and can be very helpful in making future treatment decisions” to help ward off recurrence, Mikhaeel says.

Whether it’s your digital habits or a sleep disorder keeping you awake, we’ve got tips to help you get your zzzs

If you regularly read email, scroll through your Facebook page, or play “just one more” game of Fruit Ninja on your digital device as you drift off to dreamland, you’re not alone. But falling asleep by the soft glow of your

smartphone, tablet, or laptop could be hurting your health and leaving you feeling sick and tired. In fact, a recent study found that two hours of exposure to those glowing screens at night may reduce melatonin levels by 22 percent.

“Light is alerting and suppresses melatonin production, which is a hormone that makes you sleepy,” says Emily Roby, PsyD, a psychologist at the Centre for Behavioral Health at Porter Adventist Hospital. “Suppressing melatonin may disrupt your sleep, and the resulting lost sleep can lead to high blood pressure, diabetes, and other health problems.”

So, if your technology has you tossing and turning, it’s time to power down your devices and keep your bedroom a sanctuary for sleep.

“If you remove the devices and get in bed and just sleep, it becomes a paired association where the bed actually becomes hypnotic — like it’s its own Ambien,”

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Roby says. She also recommends at least an hour of downtime from devices before bed for both kids and adults.

When bad habits aren’t to blame Poor sleep hygiene isn’t always the culprit keeping you from getting a good night’s rest. A variety of disorders and causes may lead to sleep difficulties, from frequent leg movements and issues with medications to hormone-related problems and bad dreams caused by post-traumatic stress disorder. One of the most common sleep disorders is sleep apnea.

“There’s definitely an association between sleep apnea and insomnia,” says Neale Lange, MD, FCCP, FAASM, director of the Sleep Disorders Center at Parker Adventist Hospital. “If people are having difficulty breathing during sleep that’s evidenced by loud snoring, pauses in breathing, or significant daytime sleepiness, they need to get it checked out.”

A sleep study can help your doctor get to the bottom of your sleep problems. Studies can be performed in the sleep disorders centers at Porter, Parker, Littleton, and Castle Rock Adventist Hospitals.

Home Sleep Study While a sleep study performed in a hospital sleep lab is required in some cases, home sleep studies — like the ones now available through Castle Rock Adventist Hospital — also can be effective.

“It definitely is an option for some people,” Lange says.

“People who are capable of using the equipment and don’t have significant medical disorders may be candidates.”

Though home studies don’t capture the full range of data that the accredited sleep disorders centers at Porter, Parker, Littleton, and Castle Rock Adventist Hospitals do, they record vital information such as airflow, snoring, blood oxygen levels, and head and neck movements, which can be used to help diagnose problems such as sleep apnea so that further testing or treatment can be provided.

Home sleep tests are covered by most insurance plans.

Take a SLEEP TEST at Home

If you’ve put off having a sleep test because it’s just too inconvenient, you can now do it at home. The Castle Rock Sleep Disorder Center offers an easy-to-use home sleep test that you take at home and get results from our experts in just one week. Call 303-455-3740 to learn more about home sleep studies, or go online to castlerockhospital.org/sleep, where you can get more information and take a FREE online sleep quiz.

Photo: ©iStockphoto.com/YinYang

Slumber Solutions

Proceed

with CARE Planning for and managing your pregnancy with a chronic condition

It’s a Boy! Meet Alexander Mark Palermo, the first baby born at The BirthPlace at Castle Rock Adventist Hospital. He arrived on Aug. 1, weighing in at 7 pounds, 7 ounces, and measuring 20.5 inches long.

His mom, Kathryn Palermo, RN, an acute care nurse at Castle Rock Adventist Hospital, was hoping to hold out until Aug. 1 — the opening of The BirthPlace — so that Alexander could be born here. She made it just in time: Palermo arrived at the hospital at 7 a.m., and Alexander was born at 10:57 a.m.

“I have to praise the labor and delivery nurses — especially my delivery nurse, Jenessa, and the baby’s nurse, Kate,” Palermo says. “They were awesome, and it wouldn’t have been the same experience without them.”

castlerockhospital.org

A lot to learn From childbirth and baby care to breastfeeding, Castle Rock Adventist Hospital offers an array of FREE classes to get you prepped for delivery and what comes next! Scan the QR code below on your smartphone to get a list of class dates and times, or go online to castlerockhospital.org/prenatal-classes.

Photos: Clockwise: ©iStockphoto.com/Astroid, ©iStockphoto.com/DawnPoland, FAMILY PORTRAIT ©Ellen Jaskol

If you’ve longed to become a mother but are concerned about pregnancy because of a chronic health condition, you should know that it doesn’t have to hinder your dreams of motherhood. But participating in preconception counseling and getting your condition under control before pregnancy is key to your health and the health of your unborn child, says Juliet Leman, DO, an obstetrician at Castle Rock Adventist Hospital.

“If you have a long-standing chronic condition, it’s better to come in and meet with your obstetrician prior to getting pregnant so that we can have you on the right cocktail of medications that we know is safe for pregnancy, and get you in a nice, stable place before conception,” she says.

Leman offers a snapshot of the health goals for women with chronic conditions both before and during pregnancy below.

Diabetes. “You want to go into the pregnancy having your blood sugar under control, not bouncing around and bottoming out and then getting pregnant. Your chance of a miscarriage is so much higher,” Leman says.

Thyroid conditions. Many women are concerned about taking their thyroid medication during pregnancy, but it’s safe, Leman says. “We want you on your medication; we want your thyroid under control.”

Hypertension. Close observation is necessary to ensure blood pressure stays in check, and you may need to switch medications. “We don’t recommend the classes of medications known as ACEs and ARBs during pregnancy, as well as a lot of diuretics,” Leman says. “Typically, we use beta-blockers as needed, but there is still an elevated chance for getting preeclampsia, so it is something you want to be aware of.”

Obesity. Achieving a healthy weight prior to pregnancy is optimum for mother and baby. Your obstetrician will work with you to address any weight issues, as obesity increases the risk of gestational diabetes and hypertension.

Multiple sclerosis. “Women with multiple sclerosis may still have flares or other complications during pregnancy, but we can help treat them,” Leman says. Your obstetrician will work with you and your neurologist or other care coordinator to come up with a plan that works best for your specific needs.

Childbirth Class — Learn the tools and techniques of Lamaze and the options for delivery so that you can make the best decision for the birth of your baby.

Baby Care Class — The first few days at home with your new baby are both exciting and challenging! Learn how to care for your baby with techniques in swaddling, bathing, diapering, and more.

Breastfeeding Class — Learn tips and techniques to make breastfeeding your new baby an effortless and rewarding experience for you both.

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Portercare Adventist Health System

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2350 Meadows Boulevard Castle Rock, CO 80109

Castle Rock Adventist Hospital is part of Centura Health, the region’s largest health care network. Centura Health complies with the Civil Rights Act of

Castle Rock Adventist Hospital Phone List Main Hospital.......................................................720-455-5000 Emergency Room...............................................720-455-1000 Birth Concierge/Lactation Support/ Prenatal Education..............................................720-455-0355 Medical Records..................................................720-455-0430

Don’t mind the weather

Mammography/Imaging/Cardiology/ Pulmonology Scheduling...................................720-455-1111

How to stay moving after a winter joint replacement

Physical Therapy (Outpatient Clinic)..............720-455-3700 Sleep Lab (Scheduling).......................................720-455-3740

Recovering from hip or knee replacement requires regular activity, so you might not think that winter would be a good time for surgery. But thankfully, Colorado’s winter comes with plenty of dry, sunny days that allow you to keep moving outdoors. You also can keep up your routine at your local health club or on a treadmill at home. But what about individuals who want to resume favorite winter activities like skiing?

“You can’t run or play contact sports like hockey, but you can downhill ski at the level you were at before, as well as cross-country ski, snowshoe, and do most indoor sports,” says John S. Xenos, MD, an orthopedic surgeon fellowship trained in adult reconstruction surgery who practices at Castle Rock Adventist Hospital.

Gift Shop...............................................................720-455-0460 Manna Restaurant...............................................720-455-3664 Volunteer Office.................................................720-455-0450 Spiritual Care (Chaplain)....................................720-455-0630 Wellness Coordinator.........................................720-455-2510 Centura Virtual Resource Center (class registration)................................................303-777-6877

Anterior hip replacement — is it for you?

Join Dr. John Xenos, orthopedic surgeon, for a FREE seminar about the newest technique in hip replacement.

Date: Tue, Oct. 29. Time: 6-8 p.m. with light dinner followed by program. Castle Rock Adventist Hospital Conference Center RSVP required | 303-777-6877, option 1

A better recovery with physical therapy The power of working with a physical therapist during your recovery has been proven. A 2012 study of people with hip arthritis found that those who exercised with physical therapists six to eight times over eight weeks had much better function and range of motion than those who did not exercise.

Xenos also recommends preoperative therapy for those who can tolerate it. “If you’re in better condition before surgery, then you’re going to recover better afterward,” he says.

For more information about physical therapy programs, go online to castlerockhospital.org/rehab.

Photo: ©iStockphoto.com/mkallstrom

elevate your Fall

1964 and Section 504 of the Rehabilitation Act of 1973, and no person shall be excluded from participation in, be denied benefits of, or otherwise be subjected to discrimination in the provision of any care or service on the grounds of race, religion, color, sex, national origin, sexual preference, ancestry, age, familial status, disability or handicap. Copyright © Centura Health, 2013.