Elevate Fall 2015 by Clementine Words

Living at the height of wellness FALL 2015 | Volume 3, Issue 4

Step

Ahead

No need to put off joint replacement if pain is limiting your life

Sleep Easy Page 3

New A-fib Surgery Page 6

3-D Mammography Page 7

Picking a Midwife Page 12

Vitamin C gives vegetarians a boost You already know that vitamin C can enhance your immune system — and may even minimize the duration of cold symptoms by up to 1.5 days. But did you know it can also be a powerful ally for vegetarians? Vitamin C works to help your body do a better job of absorbing iron from plant sources like spinach, beans, and nuts. But here’s the trick: You’ll need to eat foods rich in this type of iron (known as non-heme iron) in combination with vitamin C. A spinach salad with grapefruit, or black beans tossed with colorful yellow peppers and tomatoes, will easily fill the bill.

Falling for Carbs As days grow shorter, serotonin levels drop. And lower levels of this feelgood hormone can provoke cravings for comforting carbs. Instead of resisting, feed your cravings with healthy carbs like sweet potato, pumpkin, and squash that are at their peak during this season.

Season’s

Eating

Eating for comfort, for pleasure, out of boredom. More and more, our eating habits seem to be drifting away from food’s primary purpose: to fuel our bodies, sustaining us not just physically but also mentally. “The foods we eat can affect our mood, just as our mood affects our food choice,” says Margo Hahn, registered dietitian and nutritionist at Castle Rock Adventist Hospital and Parker Adventist Hospital. “That’s why the nutritional content of the foods we choose is so important.” And it’s also why Nutrition is a focus area that helps guide the CREATION Health lifestyle, a scientifically proven approach that Castle Rock Adventist Hospital’s wellness programs are based on. Here are a few ways to eat healthfully — and happily — especially as the air turns crisper. Learn more about the CREATION Health lifestyle at Castle Rock Adventist Hospital at castlerockhospital.org/creation-health.

ELEVATE is published four times annually by Castle Rock Adventist Hospital — Portercare Adventist Health System. 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

ELEVATE

Fall 2015

Get a lift from B1 Does your mood start to dip as the days grow shorter? You may be low in thiamin (also known as vitamin B1). Four double-blind studies found that higher thiamin levels were linked to improved mood. Perk your mood up through foods such as fortified grain cereals, eggs, legumes, and nuts and seeds.

To hydrate dry skin, go fish Struggling with dry skin, thanks to Colorado’s climate? Instead of heading to the beauty aisle for a remedy, you might look in the grocery section. Research has shown that a deficiency in omega-3 fatty acids can be a cause of dry skin. So load up your fall diet with salmon, walnuts, and flaxseeds to maintain your supple complexion.

Cover photo: ©Istockphoto.com/; This Page, clockwise: ©Istockphoto.com/Cecilia Bajic, /Kaan Ates, /maggeee, /LilliDay; opposite page: ©istockphoto.com/jaroon, /Tuomas Kujansuu

Nutrition

Fall back into better sleep Making more room for sleep (studies)

The response to the initial opening of a sleep lab at Castle Rock Adventist Hospital was overwhelming. During the lab’s first six months, it was open three nights per week and often had a wait list to get in. But starting later this fall, the hospital’s sleep lab will have a new home with expanded features and availability. The newly constructed center features dedicated rooms in a quiet location that has easy access from the second floor lobby. Each room will have a private bath with a shower and a full-size bed. With the addition of the new dedicated rooms, a complete range of sleep services and testing for adults and children (ages 5 and up) will be offered four to six nights a week. Call 720-455-3740 for more information or go online to castlerockhospital. org/sleep.

5 signs you might need a sleep study

FAST FACT

Oversleeping

raises

stroke risk

You’ve heard about the dangers of not getting enough sleep, but getting too much can also harm your health. According to a February 2015 study in the journal Neurology, sleeping more than eight hours a night may put you at a higher risk for stroke than individuals who get six to eight hours of shut-eye.

castlerockhospital.org

If any of these scenarios sound familiar, you might be a candidate for a sleep study. You feel excessively tired 1 during the day, despite sleeping six to eight hours or more. You act out your dreams, 2 sleepwalk, or have been injured or nearly injured someone else while asleep. You have loud, 3 interrupted periods of snoring, or wake up gasping during the night. You snore and either 4 wake with headaches frequently, or snore and take even ONE medication for high blood pressure. Your child snores and is 5 either having behavioral or learning difficulties, or is smaller or larger than your pediatrician advises for his or her age.

ZZZZZZ Got the snooze blues? Turn off your tech!

America’s bedrooms glow bright blue most evenings, lit by digital screens of all types. Because our bodies respond to light and dark, any bright light — especially with a blue tint — stimulates brain centers that regulate alertness and sleep cycles. This delays and decreases the amount of sleep-promoting hormone melatonin produced in the brain. The result: a harder time falling asleep and a shifting of drowsiness to later and later each night, depending on the duration of the light exposure. To safeguard your sleep, turn off tech one hour before bed. If you must use a phone or tablet at night, download a blue blocker app (like f.lux for iPhone or Twilight for Android) to reduce the sleep-stealing hue.

To schedule an appointment for a sleep study at Castle Rock Adventist Hospital, call 720-455-3740.

Fall 2015

3 ELEVATE

Unbroken A lifesaving lesson for everyone about how a potentially deadly condition can be misdiagnosed and how a Larkspur man is back to protecting wild mustangs, thanks to finally finding the right answer.

pulmonary embolism is serious business — but it can also be seriously difficult to spot. In March, Michael Golembeski learned that the hard way. The 65-year-old Larkspur resident was taken to the emergency room on a Tuesday with pain and coughing like he’d never experienced. After an X-ray, he was told he had pneumonia and given medication. By Friday, he wasn’t improving but was given the same diagnosis at another facility. Fortunately for Golembeski, his third trip to the emergency room — this time at Castle Rock Adventist Hospital — yielded the correct diagnosis. “The doctor in the ER who examined me knew right away it wasn’t pneumonia. I had six to eight blood clots in both lungs,” Golembeski says. The clots had formed a blockage known as a pulmonary embolism (PE). It’s commonly caused by deep vein thrombosis (DVT), a blood clot that forms deep in the body — most often in the leg — then works its way to the lung. That’s how doctors believe Golembeski’s formed, though its cause is still unclear. And, although PEs are typically caused by blood clots, they also can be caused by tumors, air, and even fat, says Stefen Ammon, MD, medical director of emergency services at Castle Rock Adventist Hospital.

Castle Rock Adventist Hospital helped Michael Golembeski return to his passion of protecting wild mustangs, after a pulmonary embolism sent him to the emergency room earlier this year. ELEVATE 4 Fall 2015

Closer. Faster. Always open. Having Castle Rock Adventist Hospital’s ER nearby means you don’t need to battle traffic on I-25 to get the care you need. The ER is staffed with board-certified emergency physicians and specialtytrained emergency nurses with years of experience. Our ER also is equipped with on-site imaging that includes MRI, CT, ultrasound, X-ray, and digital mammography as well as on-site lab services. Castle Rock Adventist Hospital is also part of Colorado’s largest trauma network, Centura Health, and offers a helipad for air transport if needed.

Pondering the odds While PE can be difficult to diagnose, there are certain factors that put people at an increased risk for blood clots in the lungs or legs. Immobilization is at the top of the list, which is why PE is more common among hospitalized patients, as well as individuals who have been on a long flight or road trip without the ability to get up and move around to keep the blood flowing in their lower extremities. Someone who has just had surgery — especially hip or knee joint surgery — or been injured in a car accident is also at greater risk for PE. Other risk factors can include smoking, obesity, a genetic predisposition to blood clots,

and taking hormones, like the ones found in birth control pills. Pregnant women also have an increased risk of formation of blood clots, Ammon says, as do people with cancer. “People with cancer may develop a blood clot that goes to their lungs. This is actually sometimes how cancer is diagnosed or caught, through an initial diagnosis of pulmonary embolism,” he says. Testing tells the tale While it may seem odd, the good news is that diagnosis of PE is on the rise — not necessarily because it’s happening more frequently, but because better testing methods are making it easier to spot, and physicians are testing for it more frequently, Ammon says. Patients with risk factors and symptoms are scored based on those symptoms. But there’s also a screening blood test called the D-dimer, which can reveal which patients are at higher risk for developing a clot. A CT scan of the chest, which looks specifically at the blood vessels of the lungs, is also needed. “It’s worth mentioning that you really can’t diagnose [PE] definitively with a chest X-ray, and you can’t diagnose it based on a physical exam alone,” Ammon says. “It’s not something I’m going to hear in my stethoscope or see on an EKG. You’re going to need an imaging test,” such as a CT. Sauntering on Fortunately for Golembeski, his symptoms were caught in time and he continues to recover. He’s on a regular routine of blood thinners, the typical protocol for a PE diagnosis, designed to prevent clots from spreading and help the body break them down. He will be tested every six months to check for clots, but he says he’s feeling good again and realizes how fortunate he is. “That second day in the hospital, the doctor told me most people don’t survive that many clots,” he says. “Nobody wants to go to the hospital, but going to that one saved my life.” And his swift recovery has allowed him to get back to his own lifesaving work: protecting wild mustangs and burros through his WindDancer Foundation (wind-dancer.org). Golembeski is now in the process of planning a large-scale photo and painting exhibit with a horse theme, featuring the works of local, national, and international artists, at Denver International Airport from October through March to raise awareness about the animals.

Help your vessels roam free While pulmonary embolism cannot always be prevented, there are modifiable risk factors associated with PE that can be addressed. • Stop smoking. Stefen Ammon, MD, says this is especially critical for women taking birth control pills because it adds two different risk factors to the equation.

castlerockhospital.org

• Move around during long road trips or flights. “Get up and move if you can. And pump your ankles and point your toes multiple times while you’re resting every half hour to an hour,” Ammon says. • Consider compression stockings if you’re prone to clots.

Trailblazers in emergency care Castle Rock Adventist Hospital’s ER is staffed by physicians from Emergency Physicians of Porter Hospital (EPPH), who’ve been caring for patients in Centura Health’s South Denver hospitals for decades. EPPH was founded in 1987 by six emergency physicians practicing in the Porter Adventist Hospital emergency department. The six were among the first formally trained emergency physicians in the U.S., training at Denver Health Medical Center, one of the first emergency medicine residencies in the country. In the years since, EPPH has grown to staff the emergency departments of Littleton Adventist Hospital, Parker Adventist Hospital, Castle Rock Adventist Hospital, and the Southlands Adventist Health Campus. The group also oversees the South Denver Emergency Services Team, which provides medical direction to the area’s extensive EMS provider network. Jointly, EPPH’s 40-plus board-certified emergency physicians provide care for more than 100,000 patient visits in the South Denver suburban region annually.

Fall 2015

5 ELEVATE

Photos: Opposite page: ©Ellen Jaskol; This page: ©istockphoto.com/ppart

Hard to nail down Pulmonary embolism is actually more common than people may realize, and can be deadly. In fact, among cases of sudden death, pulmonary embolism is second only to sudden cardiac death, Dr. Stefen Ammon and it’s the most common preventable cause of hospital-related death, Ammon says. But PE can be challenging to diagnose, as symptoms can vary widely. “The symptoms caused by pulmonary embolism are typically related to the effects of the blood clots becoming lodged in the blood vessels of the lungs,” Ammon says. The majority of people with PE complain of shortness of breath and pleuritic chest pain, the kind that feels like a stabbing, localized pinpoint pain that’s worse when you take a deep breath. Other symptoms may include coughing — sometimes with blood in the sputum — as well as an abnormal heart rhythm or palpitations, and fainting. “In a worst-case scenario, the blood clots can be so large that they can completely obstruct blood flow from the heart, causing cardiac arrest,” Ammon says. And, to make diagnosis even trickier as we head into winter, PE can resemble pneumonia, as it did in Golembeski’s case. “Patients who suffer from chronic obstructive pulmonary disease [COPD] may suffer from bronchitis or pneumonia, which can be associated with chest pain, shortness of breath, and a cough productive of bloody sputum — symptoms also seen with PE,” Ammon says. “In that setting, it’s really easy to attribute the symptoms to their COPD rather than pulmonary embolism.” To further complicate diagnosis, up to 50 percent of people with DVT, the complication that can lead to pulmonary embolism, may have no symptoms.

In the

rhythm

Innovative “hybrid ablation” treats atrial fibrillation from the outside in

Dr. Sanjay Tripathi

Traditional Treatments Traditionally, the first-line treatment for A-fib is medication, such as beta-blockers or antiarrhythmic drugs. The next step is catheter-based ablation, a nonsurgical procedure that Sundaram specializes in. The process delivers radiofrequency energy into the heart to destroy tissue that’s triggering irregular rhythms. Catheter ablation has a 60 to 80 percent success rate in patients without heart abnormalities who have had A-fib for less than two years. Success rates drop if a patient has had A-fib continuously for more than two years. “If a patient’s A-fib persists after catheter ablation, now, instead of saying, ‘I’m sorry, there’s nothing else I can do for you,’ I have another option,” Sundaram says. Hybrid Ablation That option is the hybrid surgical/catheter ablation technique now offered at Porter Adventist Hospital. “Myself and Dr. Sundaram are the only physicians in the Denver area offering this particular hybrid procedure,” Tripathi says. What is it? Hybrid ablation involves two procedures separated by six to 12 weeks. First, Tripathi performs ablation on the outside of the heart with a minimally invasive surgical procedure called a thoracoscopic maze. Then, about 12 weeks later, Sundaram performs catheter ablation inside the heart.

Who is it for? Ideal candidates for hybrid ablation are patients who: • Have heart damage resulting from A-fib lasting longer than two years • Have failed catheter ablation

What are the advantages? Hybrid ablation treats A-fib from both the outside and the inside of the heart muscle. The modified maze surgery is performed through keyhole incisions made between the ribs on both sides, resulting in less blood loss, shorter recovery time, and lower risk of infection than the traditional, open-heart maze surgery.

“This is a real breakthrough in how we treat A-fib, especially in patients who are younger, more active, and have symptoms from A-fib that are significantly interfering with their lifestyle,” Tripathi says. ELEVATE

Fall 2015

Kay Jensma is finding her rhythm again at the bowling alley.

Individualized Options Sometimes, as is the case so far with Jensma, Tripathi’s minimally invasive maze approach may be enough without the need for Sundaram’s follow-up catheterbased ablation. In fact, Jensma, a serious bowler, is back to throwing her 14-pound bowling ball with wild abandon. This summer she bowled in a national tournament in Reno. “I used to be so weak that the heaviness of the ball was too much.” And now? “I feel like I’ve got some life left,” she says.

Look for this, not that Although heart palpitations or rapid heartbeat are the classic “textbook” symptoms of atrial fibrillation, you should definitely report these common A-fib symptoms to your doctor: • Fatigue • Shortness of breath • Light-headedness • Overall decreased energy level

Castle Rock Adventist Hospital is part of the Centura Heart Network, the region’s leading provider of cardiovascular care.

Photos: This Page: ©michael richmond; Opposite Page: ©istockphoto.com/Susan Chiang

Dr. Sri Sundaram

For more than five years, Kay Jensma lived in a constant state of waiting for the other shoe to drop. Atrial fibrillation, or A-fib, a heart rhythm problem in which rapid, irregular heartbeats cause the heart’s chambers to beat out of sync, flared numerous times, triggering listlessness and debilitating, flu-like feelings. “It’s scary. When you go to bed at night, you hope you wake up the next morning able to just get up and walk,” says the 70-year-old Elizabeth resident. Today, Jensma and A-fib patients like her have access at Porter Adventist Hospital to a unique one-two treatment approach that tackles persistent A-fib from both the outside and the inside of the heart. Cardiovascular surgeon Sanjay Tripathi, MD, and cardiologist Sri Sundaram, MD, both with South Denver Cardiology, offer “hybrid ablation,” which has up to an 85 percent success rate in curing A-fib.

Good

Call

New 3-D mammography now available in Castle Rock detects cancer earlier and reduces unnecessary callbacks

3-D mammography resulted in a 15 percent decrease in women called back for further imaging, according to a study published in the Journal of the American Medical Association.

For the vast majority of women who get annual mammograms, they give it little thought and Dr. Jinnah Phillips just pop in for the 10-minute screening and go back to their busy lives. However, about 10 percent of these women will get a phone call asking them to come back in because something “suspicious” was spotted. But, according to the American Cancer Society, fewer than one in 10 women who are called back actually have cancer, and that leaves the other nine worrying needlessly. “Any screening having to do with the breast is going to be very emotional to begin with,” says Jinnah Phillips, MD, a breast radiologist at Castle Rock Adventist Hospital’s Women’s Imaging Center. “And when a woman gets a callback, her mind immediately goes to ‘I might have breast cancer.’ It raises a lot of anxiety in patients.” More images means less uncertainty A new type of mammography technology, now available at Castle Rock Adventist Hospital, is helping to decrease the number of women who will have to face that needless anxiety. Breast tomosynthesis, commonly called 3-D mammography, allows radiologists to see more from the very beginning, as compared with traditional 2-D mammography. And that reduces the need to call women back for additional testing. Rather than taking a single X-ray straight down on the breast, 3-D mammography takes multiple X-rays and then a computer program arranges them to produce a 3-D image of the breast. “Reading a 2-D mammogram is a little bit like trying to read a book with the cover closed,” Phillips says. “With 3-D mammography, we can now open the book and look through all the pages. It gives us a better understanding and a higher level of confidence when we’re reading the mammogram.” This reduces the callbacks attributed to asymmetry and overlapping breast tissue. The technology is still relatively new and not available everywhere. But early research suggests about 8.78 percent of women get callbacks with 3-D mammography, as opposed to 10.4 percent with 2-D mammography, according to breastcancer.org. That equates to a 15.6 percent lower rate of false positives for 3-D mammography. castlerockhospital.org

Higher detection rates, too If you’re wondering if lower callback rates mean radiologists are missing out on detecting early cancers, don’t worry. 3-D mammography also has a higher detection rate than 2-D mammography. One study by the University of Pennsylvania Medical Center found that 3-D mammography catches 5.24 cancers per 1,000 women, whereas 2-D mammography finds 4.28 cancers per 1,000 women. “We’re very fortunate to have this technology at Castle Rock Adventist Hospital,” Phillips says. “Anything that helps reduce anxiety and encourages women to keep coming in for their mammograms is a wonderful thing.”

Text to schedule your 3-D mammogram! We’re making it easier than ever to schedule your annual screening mammogram. Simply text your name and preferred appointment time to 720-644-0880, and one of our schedulers will call you. Or you can call us directly at 720-455-1111.

Fall 2015

7 ELEVATE

Ready for

Replacement

rthritic joint pain can be a vicious cycle that leads to progressive loss of physical well-being and quality of life. First, the discomfort keeps you from being active, which causes a loss of conditioning and often an increase in weight. Over time, your arthritis worsens, leading to further loss of conditioning. And the pain can then interfere with even normal daily activities. Years ago, this type of pain simply had to be managed and lived with until you were old enough to be a suitable candidate for hip or knee replacement surgery. But advanced surgical techniques like the types available at Castle Rock Adventist Hospital are making replacement a viable option for younger adults in our active community who want to stay on the move.

Young and hip: The replacement trend that’s here to stay Hip replacement surgery has grown in popularity in the past few decades due to its ability to relieve pain and improve mobility, allowing people to get back to their pre-pain activities. And while around 285,000 replacements are performed annually, until recently it was a procedure for older patients. “Back in the ’60s, ’70s, and ’80s, we didn’t have good long-term results, so we tended to only offer it to older patients,” says Ed Szuszczewicz, MD, an orthopedic surgeon at Castle Rock Adventist Hospital. “Now we’re getting excellent results in younger patients, so it makes more sense.”

Dr. Ed Szuszczewicz performs hip replacement through one 2- to 4-inch incision.

ELEVATE

Fall 2015

Smaller incision, bigger benefits Szuszczewicz (pronounced sha-shevitz) touts long-term hip replacement success rates of 95 percent at 10 years, 85 percent at 15 years, and 75 percent at 20 years. This means three out of four hip replacements that are done today will still be functioning well 20 years from now, which makes hip replacement surgery one of the most successful procedures of all medical operations. Anterior minimally invasive hip replacement techniques are making the procedure even more enticing. Instead of the single, 10- to 12-inch-long incision needed with traditional hip replacement, minimally invasive techniques require just one

shorter 2- to 4-inch incision that reduces pain and expedites recovery. The long-term results of anterior minimally invasive hip replacement surgery appear to be equivalent to the old standard approach, but short-term results offer significant improvements over conventional surgery. “What the anterior minimally invasive approach does is it offers better short-term results, including shorter hospital stays, less pain, and a significantly faster recovery. Patients just feel better faster,” Szuszczewicz says. “Of my patients, about 87 percent go home the same day, and they’re off all pain medications at around two weeks post-op.” The complication rates for this procedure are also low. “The risk of infection for surgeries I’ve performed is 0.3 percent, and risk of dislocating is one in 500,” says Szuszczewicz, who’s been performing the procedure for nearly 12 years. Ready to return to action And there’s another reason for the uptick in younger adults opting for surgery: We’re more active now. This means joint problems like arthritis of the hips affect adults at a younger age, but it also means we’re more likely to want to do something about it to preserve our health and mobility. “We’ve got people in their 60s running

up and down the incline in Colorado Springs, training for marathons, and hiking and biking much later in life. So the arthritis is affecting their quality of life, and they want to do something about it,” he says. And Szuszczewicz says there’s very little his patients aren’t able to do after replacement. “If they’re advanced skiers, they can go back to skiing. And some of them jog or play tennis or basketball,” he says. And in more good news, the reasons a person can’t have surgery are few: Individuals who’ve had previous hip surgery (and have the hardware and scar tissue that go with it) or who are morbidly obese are typically not eligible, but “virtually everyone else is a candidate,” Szuszczewicz says.

From 2000 to 2010, the national average length of a hospital stay for total hip replacement for patients age 45 and older decreased from nearly five days to just under four days. Today, many patients at Castle Rock Adventist Hospital who have an anterior minimally invasive hip replacement may spend just one day in the hospital.

Not waiting for knee surgery Just as with hip replacement, today’s artificial knee joints are lasting longer, and people are opting for surgery at an earlier age than ever. So, if you’d rather rock on than rest in a rocking chair, knee replacement can help you do it. But before you proceed, there are a few factors you may want to consider. Your Lifestyle Knee pain from arthritis was once accepted as a part of aging, but our attitudes about being active are changing, according to Todd Wente, MD, an orthopedic surgeon at Castle Rock Adventist Hospital. “Individuals are no longer willing to sacrifice their activities and mobility. They want to remain active, and they want to address arthritis pain at an earlier age in order to do so,” he says. And now, one factor that led individuals to postpone surgery in the past has been improved, as implants today are lasting longer. In fact, some studies suggest that today’s knee implants may have an 80 percent chance of lasting more than 20 years.

FAST FACT

Psychological Benefits Sure, the physical benefits of knee replacement, including improved mobility and decreased pain, are obvious. But Wente is quick to point out the psychological health benefits that go along with staying active. “Those benefits are something to consider and probably do not get discussed enough. Having to give up the activities that we enjoy can take a tremendous mental and emotional toll, and may very well decrease our overall health,” he says. Recovery Time Minimally invasive surgical techniques for knee replacement are allowing a faster return to many activities. Full recovery, however, varies based on a variety of factors, such as age, overall health, and desired goals. For example, if you work at a desk job, you’re likely to be back at work within just a couple of weeks. If you’re trying to return to a more physically rigorous job, it may take a few months. And the same is true for your leisure expectations.

“Today we are replacing knees in patients who just want to walk a few blocks for fresh air as well as in those who expect to return to skiing, tennis, hiking, etc.,” Wente says. “Recovery time will obviously be quite different for patients based on the goals they have.”

More than 90 percent of people experience a substantial reduction in their knee pain and significant gains in mobility and functioning in their daily lives following knee replacement.

Joint Maintenance While joint replacements are lasting longer, doing what you can to help your new knee last as long as possible is still imperative. That starts with maintaining a healthy weight and getting regular exercise — and don’t forget to include strength training in your routine. “Muscle strength is vital for artificial joints, and many patients are incompletely rehabilitated following joint replacement surgery. Maintaining muscle strength and conditioning should be a lifelong commitment,” Wente says. He also recommends discussing appropriate goals and activities with your surgeon, as some activities may increase the risk of component failure.

The ‘just right’ timing of joint replacement

The right time for joint replacement used to be when you were in your late 60s or 70s and when the pain had become so bad that you couldn’t continue the most basic daily activities. But surgical advances and more active lifestyles have rewritten the rule book. Today, the optimal time for surgery is a more individualized decision, and may be recommended at a much earlier age. Szuszczewicz and Wente walk us through treatment approaches you should consider first, and offer their take on when it may be time to consider replacement. KNEE

Approaches to consider first

• Anti-inflammatories like ibuprofen or naproxen sodium • Physical therapy • Hip joint injections • Ambulatory aids like canes or walkers

• Medications, including both over-the-counter and prescription anti-inflammatories • Physical therapy • Injections, such as cortisone, hyaluronic acid, platelet-rich plasma, and stem cell • Bracing may be an option for some

When to consider replacement

“I basically tell people, if it’s affecting their quality of life — if it’s keeping them from doing what they want to do or it’s more pain than they want to deal with on a regular basis and they’re not getting adequate relief with the nonoperative treatment, then it’s probably time to talk about surgery. And it doesn’t matter whether they’re 29 or 89,” Szuszczewicz says.

“Once patients have tried some or all of these nonoperative approaches and are still making lifestyle decisions based on their knee pain, it’s time to consider surgery,” Wente says. “There is no specific age. It is an individualized approach based on your health, activity levels, and goals, and it should be an individual decision between you and your orthopedic surgeon. I encourage patients to start those discussions early.”

castlerockhospital.org

Dr. Todd Wente is performing knee replacement on all ages of adults who want to maintain an active lifestyle.

Fall 2015

PhotoS: ©Ellen Jaskol

HIP

9 ELEVATE

More than

skin deep

A look at four common lumps and bumps that form just under the skin’s surface, and what to do about them

LIPOMAS

ELEVATE

EPIDERMAL CYSTS

LYMPH NODES

Check it out: The only way to know if a skin mass is cancerous is to perform a biopsy.

SARCOMAS

What are they?

Benign (noncancerous), fatty, fleshy tumors that can show up just about anywhere on the body.

Small (almost always noncancerous) lumps of skin cells.

Organized centers of immune cells that help fight infection and even cancer. Usually benign, they become enlarged when they’re defending the body from infection.

Relatively rare, cancerous tumors that come from bone, muscle, fat, cartilage, and other soft tissue. They are more common in people with a family history of cancer or exposure to radiation.

What do they look and feel like?

Usually small and fleshcolored, they typically feel soft and mobile. Sometimes they cause mild pain or discomfort.

Usually firm — a bit like a marble — and located anywhere, but most commonly on the face, scalp, neck, or trunk. They can become infected, tender, and red, and may have some discharge.

Soft or firm, usually appearing in a string on the neck, armpit, or groin.

Usually more fixed, firm, and fast-growing than benign lumps and bumps.

When should you see a doctor?

If they grow rapidly or become fixed, or if they’re located on the neck, breast, or genitalia.

If they become infected — especially if they’re red or painful.

If they’re noticeable enough for you to feel them, especially if they’re accompanied by symptoms like weight loss, night sweats, or other signs of systemic illness.

As soon as you notice one, especially if it’s growing quickly.

What’s the treatment?

Many times, watchful waiting. Lipomas may be removed surgically, often right in the doctor’s office.

Oral antibiotics may be prescribed if they’re infected. Watchful waiting is one option, but the definitive treatment is removal.

Your doctor may perform a biopsy using a needle or by removing a lymph node that is sent to a lab for testing.

The tumor and surrounding tissue are removed. Sometimes, chemotherapy and/or radiation are necessary, too.

10 Fall 2015

Skin eruptions happen to everyone at some point, and they can be as simple as a bug bite or as serious as skin cancer. But what about lumps and bumps that crop up just below the skin’s surface? They’re quite common, says David Lundy, MD, a general surgeon at Castle Rock Adventist Hospital. “Many of them aren’t anything serious, but any new or changing lump or bump should be evaluated Dr. David Lundy by your primary care physician,” he says. From there, you may be referred to a specialist. Here are four common lumps and bumps to be on the lookout for and what to do about them. And any mass that’s painful, uncomfortable, or growing rapidly should be looked at sooner rather than later, especially if you have a personal or family history of cancer, Lundy says.

Diverticular disease:

It’s more common 40% than you think

Diverticular disease is identified in more than

of colonoscopies.

Diverticular disease, also called diverticulosis, is a condition where small pockets of tissue (diverticula) pooch outward from the colon. It is typically symptom-free, harmless, and it becomes more common as you age. But what it can lead to is not so benign. It is a precursor to diverticulitis, a painful infection that can lead to Dr. Vanessa Lee hospitalization, serious complications, and even surgery. Because the two conditions can be tricky to keep straight, Castle Rock Adventist Hospital gastroenterologist Vanessa Lee, MD, is here to help untangle the confusion.

Warding off recurrence Let’s start with the good news. Diverticulosis — the painless condition — is the one that is most common, with age as its major risk factor. At least 60 percent of people have diverticulosis by the time they are 60, Lee says. The condition is most commonly diagnosed during a routine colonoscopy. And while diverticulosis is a precursor to diverticulitis, an infection of the diverticula, only about 15 percent of patients with diverticulosis advance to that disease. “Diverticulitis is tricky; we don’t know why some patients get it, and we can’t determine if it will happen again,” Lee says. “We follow these patients very closely, as these infections can be severe, spread to other organs, and recur.” About one in three patients who have diverticulitis will go on to have a recurrence of the condition. Lee works closely with patients who have diverticulitis to manage recurrence. Although some research questions whether a high-fiber diet can contribute to castlerockhospital.org

[dahy-ver-tik-yuh-loh-sis] [dahy-ver-tik-yuh-lahy-tis] All in a name

Diverticulosis and diverticulitis have the same origins but very different endings. The first typically causes no symptoms, while the latter is very painful and may require surgery.

diverticulitis for some patients, she says the limited studies don’t support decreasing fiber intake. “There are just as many studies that show a high-fiber diet wards off the disease,” she says. “And there are so many other great reasons to eat a high-fiber diet, like reducing your risk for colon cancer.” Gaining good GI health For patients with diverticulitis, Lee recommends increased fiber, highquality probiotic supplementation and, in some cases, consultation with a surgeon. Diverticulitis patients also should have a postinfection colonoscopy to ensure diverticulitis wasn’t triggered by a colon polyp. So what can you do to avoid diverticulosis and, in turn, diverticulitis? Not much, according to Lee. “There’s an old wives’ tale that says to avoid nuts and seeds,” she says. “But there’s absolutely no evidence that nuts and seeds cause diverticulitis.” Having a diet rich in fruits and vegetables and following your doctor’s recommendations for colonoscopy screening are the best ways to ensure good GI health, she says.

Fall 2015

ELEVATE

Portercare Adventist Health System

Non-Profit Org US POSTAGE

PAID

Denver, CO Permit NO. 4773

2350 Meadows Boulevard Castle Rock, CO 80109

Castle Rock 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, 2015.

By Your Side

Tools to ease labor

elevate your Fall

Midwives give support from prenatal through postpartum Along with a woman’s partner, her childbirth provider is a key factor in a healthy pregnancy and smooth delivery. At Castle Rock Adventist Hospital, both obstetricians and certified nurse-midwives (CNMs) play that role at The BirthPlace. For women with no risk factors for a complicated pregnancy or delivery who also want a full-time labor and delivery coach or a birth without pain medication, a midwife is a great option. CNMs provide prenatal care and attend births of women with low-risk pregnancies. For women with moderate to high-risk pregnancies or those who develop complications as their pregnancy progresses, obstetricians are the more likely choice, and also offer natural childbirth options. A Personal Partnership In routine pregnancies, midwives are able to spend time addressing the well-being of the woman and her family as they prepare to welcome a new baby. After

Women who choose a drug-free labor often use a variety of tools to help make labor more comfortable. Castle Rock Adventist Hospital offers: • Labor slings to support standing positions • Birthing balls for women to sit on • Birthing stools to support an upright squat in labor, especially while pushing • Squat bars for labor beds • Wireless, waterproof, portable fetal monitors so that women in labor can continue to move • Jetted tubs (available in some labor rooms)

addressing questions and concerns in prenatal appointments, “we focus on patient education and building a personal relationship,” says Sarah Stone, a nursemidwife who practices at Castle Rock Adventist Hospital. During labor, “we suggest position changes, explain what’s going on, and coach them through it,” says Stone, who is director of midwifery at South Denver OB/GYN, a practice where obstetricians and midwives work together. After the mom and baby head home, midwives are a resource for postnatal questions and concerns and can offer sound advice on home care practices.

Should I get a doula? Some women choose to hire a professional birth attendant, or doula, in addition to having a midwife or obstetrician. A doula provides continual support, even if a partner needs a bathroom break or the provider has another patient to check on. And if medical issues arise, the doula can continue comfort measures while the midwife or obstetrician focuses on managing the medical care.

Preplan and personalize your birth experience at Castle Rock Adventist Hospital by scheduling an appointment with our birth concierge. Call Jacque at 720-455-0355.

Welcome Dr. Danielle Henkel to South Denver Cardiology! Born in Duluth, Minn., Dr. Henkel has been a general cardiologist since 2012, following her work as a research collaborator and assistant professor of medicine. It was at the Mayo Clinic in Rochester that she completed medical school, an internal medicine residency, and a cardiology fellowship, where she focused on clinical applications of multimodality cardiac imaging.