Flourish Summer 2011 by Clementine Words

Hormones and weight

Surgery-free fibroid fix

Hydration Hints

flourish Summer 2011

Penrose-St. Francis Health Services

PLUS!

D-Mystifying Vitamin D

Perfectly Precise

Robots revolutionize womenâ&#x20AC;&#x2122;s surgery

healthystart with my little eye…

Gastroenterologists at Penrose-St. Francis Health Services are using a new tool to get an up close look at a patient’s digestive system to check for cancer or other illnesses. Called the SpyGlass® Direct Visualization System, this device allows doctors to examine and biopsy any suspicious findings in the liver, gallbladder, pancreas and bile ducts without the need for scans or surgery. To learn more, go to penrosestfrancis.org/ spyglass

Flourish is published four times annually by Penrose-St. Francis Health Services. 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 flourish@centura.org. Flourish is produced by Clementine Communications of Denver, Colo. Executive Editor is Jill Woodford.

2222 N. Nevada Ave., Colorado Springs, CO 80907

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Summer Sippin’ We typically lose 12 to 16 cups of fluid daily through perspiration, breathing and urination. But on a hot summer day, we can lose up to 8 cups per hour! If you don’t replenish those lost liquids, you can experience fatigue, headaches, dizziness, nausea and confusion.

Forget eight glasses a day. You may need more or less, depending on weight, activity level and health. Laura Tonsits, a registered dietitian with Penrose-St. Francis Health Services, recommends 10 cups a day, or 12 cups or more for those over 200 pounds. Drink more the higher you go. Tonsits suggests an extra glass of water or more each day until you acclimate — even if you’re just going from the Springs to the mountains.

Water is best. However, caffeine- and calorie-free beverages and even fluids from food count. Buy wisely. Bottled waters enhanced with flavors or vitamins are expensive and can be loaded with sugar. But they also can help you get the necessary fluids if you loathe drinking plain water. Just choose carefully.

Brita® water filtration pitchers at penrosestfrancis. org/drinkwater.

For the Man in Your Life Has your partner lost that lovin’ feeling? A new study found that men taking cholesterol-lowering drugs (statins) are twice as likely to have lower levels of testosterone. “The study did not find that statins caused the problem, just that there was a link,” says Chris Simpfendorfer, MD, a cardiologist with Penrose-St. Francis Health Services. “It’s certainly something to be aware of.” If your guy is experiencing unusual fatigue, grumpiness, loss of muscle mass or a declining libido, encourage him to talk to his doctor. Hormone replacement therapy may help.

To find a doctor, go to penrosestfrancis.org/doctor.

Penrose-St. Francis Health Services

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I spy

Lifesaving Moves Visits to the emergency room in Colorado are as much a part of summer as mountain biking and river rafting. Penrose-St. Francis Health Services alone will treat more than 20,000 patients in its two emergency departments during the summer. While you may not be able to avoid a trip to the ER, there are some things you can do to make sure you get the best outcome possible, says Jack Sharon, MD, medical director for Penrose’s emergency services: 1. Carry an up-to-date medical file, including a medication record. A patient with a head injury, for example, is treated very differently if he is taking a blood thinner than someone with the same injury not on that medication. 2. Ask questions while you are still in the ER. Studies prove that the better your understanding, the better your outcome. “Most people have questions but feel silly asking,” Sharon says. “It’s part of our job to make sure you are educated about your care.”

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Maureen Jordan, MD

Obstetrician & Gynecologist, Penrose-St. Francis Health Services

Can hormone replacement therapy help prevent menopause-related weight gain? Weight gain around menopause is a result of not just declining estrogen but also decreased muscle mass and metabolism. While hormone replacement therapy is not a solution to mid-life spread, it can help relieve hot flashes, sleeping problems and fatigue. Alleviating those problems can provide women with the energy and focus they need to exercise more and eat properly, which can help prevent weight gain. A study published in the Journal of the American Medical Association found that women of healthy weight who exercised for one hour five days a week avoided weight gain during menopause.

Support Sisters

Keep up-to-date medical information handy in your car and wallet with a FREE File of Life. Go to penrosestfrancis.org/FOL to order a FREE record.

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A diagnosis of diabetes or heart disease can leave patients feeling both terrified and alienated. Joining a support group may help ease the isolation. “Support groups provide an emotional connection to others who might be experiencing similar situations and emotions,” says Nancy Bader, a licensed clinical social worker with Centura Health-Profile Employee Assistance Program. Bader says support groups also provide participants with the opportunity to exchange educational information. Though research has yet to show a medical benefit from support group participation, some studies have found that breast cancer patients experience an improved quality of life if they belong to a support group. Penrose-St. Francis Health Services offers free support groups for women with heart disease and breast cancer as well as groups for men and women battling other conditions. For information and schedules, please go to penrosestfrancis.org/support. Summer 2011

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UpTime

Simpler hysterectomies easier on women Story by Michele Conklin | Photos by Ellen Jaskol

Penrose Hospital and St. Francis Medical Center are the only hospitals in southern Colorado to offer da Vinci minimally invasive surgery. To learn more, go to penrosestfrancis.org/ davinci.

When you’re the single mother of three children all under the age of 10, the words “down” and “time” aren’t part of your lexicon unless you’re using them as commands. As in: Get DOWN from there this instant and take a TIME out! So when 27-year-old Christa Medina found out that she needed a hysterectomy, she thanked her lucky stars that she happened to work for a gynecologist who performed the surgery in a “minimally invasive” manner that would have her back on her feet in days, not weeks. “Two days after my surgery, I was up walking around and ready to go back to work,” Medina says. “I really feel like I didn’t even have surgery — it was that easy.” Hysterectomies to relieve painful menstrual cycles are common in Medina’s family, but most of those relatives have had traditional hysterectomies that waylaid each woman for weeks. Traditional hysterectomies are done through

large incisions across the abdomen, while minimally invasive surgery is done through small incisions in the vagina wall or the abdomen. It typically takes up to six weeks to recover from an abdominal hysterectomy, compared with less than two weeks for a minimally invasive surgery. “My aunt had just had a hysterectomy and she was in pretty severe pain for three weeks,” Medina says. “She wished she had known about this.” About 600,000 hysterectomies are performed each year in the United States, making it the second most common surgery among reproductive-age women, according to the Centers for Disease Control and Prevention. Despite the availability and effectiveness of minimally invasive surgery, two-thirds of hysterectomies are still performed through traditional abdominal surgery, according to a November 2009 report in the journal Obstetrics and Gynecology. “There are very few patients, less than 10 percent, who require an abdominal hysterectomy,” says Kevin Weary, MD, an obstetrician and gynecologist at St. Francis Medical Center and Medina’s surgeon. “The days of abdominal hysterectomies should be behind us — it’s time to move on in the name of patients.”

Robotic surgery

A hysterectomy didn’t slow down Christa Medina, thanks to da Vinci surgery that had her back playing with daughter Yasmine and her other two children within days.

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There are two types of minimally invasive hysterectomy surgery — vaginal hysterectomy and laparoscopic hysterectomy. Both have been proven to be just as effective as abdominal hysterectomies, with plenty of benefits: • dramatically decreased pain • shorter hospital stay • shorter recovery time • no abdominal scar The newest form of minimally invasive gynecologic surgery is robotic-assisted surgery, sometimes referred to as “da Vinci surgery” Penrose-St. Francis Health Services

SPECIAL REPORT

Questions to ask about hysterectomy If you are considering hysterectomy, the American Association for Gynecologic Laparoscopists recommends asking your doctor:

Vinci, says the robotic system allows her to perform minimally invasive surgery on women who typically might have needed an abdominal hysterectomy due to a severely enlarged uterus. “The beauty of the da Vinci is that it allows surgeons to perform more complex GYN procedures because of the dexterity of the (robotic) hands and the tiny instruments,” Skiles says. “It gives me a lot more control and precision.”

Surgery-free fibroid treatment

Fibroids are the most common reason for hysterectomies in the What is causing my problem? United States, accounting for Some conditions have a number of nearly one-third of all surgercauses. Pelvic pain, for instance, can be ies. But many women who suffer caused by bladder or bowel problems. from fibroids may be able to skip Weighing the Options surgery altogether by opting for Can my condition be treated mediDetermining which surgery is right depends on a procedure known as uterine cally or with a minimally invasive the individual woman. A woman who has given fibroid embolization. surgical technique? birth vaginally and has a normal-size uterus is This procedure involves an There are usually a number of alternatives an ideal candidate for vaginal hysterectomy, interventional radiologist threadfor treating any condition. Be sure you the least invasive of all the surgeries. A woman ing a spaghetti-sized catheter know all of them. who has had a Cesarean section into the uterus through an artery or has abdominal scarring How many procedures like this have in the groin. The physician may be better served by you done? then inserts small “beads” L ear laparoscopic surgery, Your doctor may not have experience with into the uterine arteries to the lat n about est su whereas a woman with newer techniques, such as laparoscopic cut off the blood supply, rgical and n a very large uterus or on-su surgery, and may need to refer you. which kills the fibroids r g treatm ical complicated fibroids e but spares the uterus. n t s Should I get a second opinion? for pelvic might require da “This is a safe alternap A IN Second opinions can confirm the first docVinci surgery or even free sem at a tive to hysterectomy, with tor’s opinion or give you new information. abdominal surgery. inar. (See pa less serious complicage 7 fo “It’s essential to r detail tions, and women generally s.) make sure each woman after the name of the machine. In this procedure, recover from it much more is getting the right surgery surgeons are seated at a console next to the paquickly,” says Jeff Ross, MD, an tient and operate using the da Vinci robotic arms. based on her unique history.” interventional radiologist at Pensays Jody Boydston, MD, a Colorado Using the da Vinci provides the surgeon with a rose-St. Francis Health Services Springs gynecologist. wider field of vision than with traditional laparowho performs this procedure. If a hysterectomy has been recommended, talk scopic tools, plus increased dexterity and precision, The procedure lasts one to two to your doctor about alternatives to surgery as because the robotic arms and wrists can actually hours and is not painful, says well as the different types of surgeries, Boydston reach around corners and rotate 360 degrees, says Ross. However, the patient will Weary, who performs both traditional laparoscopic recommends. Not all gynecologists are trained to experience severe cramping for up perform minimally invasive surgery, so women and da Vinci-assisted surgeries. to 18 hours immediately followmay need to get a second opinion or ask their Trudy Skiles, MD, another Colorado Springs ing surgery, so she will stay in the physician for a referral. obstetrician/gynecologist who also uses the da hospital overnight and be placed on a pain medication pump. “But Days in Resume then she’ll feel well enough to go Surgery Type Description Candidates Hospital Activities home with just some oral pain with GYN cancer, very large uteri or medication and be back at work in Abdominal Traditional surgery requiring a Women complex fibroids. Some women with these Hysterec5-7-inch long incision across 3 days 6 weeks a week,” he says. conditions now qualify for da Vinci laparotomy abdomen scopic surgery. The procedure has less than a 3 percent risk of serious infection Women who have had prior vaginal births Vaginal Performed through the vagina and have relatively small uteri. Particularly 1-2 or other complications, and it reHysterec2 weeks wall good surgery for women who also have days lieves symptoms of uterine fibroids tomy vaginal prolapse. in more than 85 percent of cases. LaparoPerformed through small inci- 90% of women with non-cancer issues. Can scopic and sions in the abdomen either For more information, have enlarged uterus, complex fibroids or 1-2 da Vinci with traditional laparoscopic 1 day call Renee Ward at abdominal scarring from previous surgeries, weeks Hysterec“wands” or using da Vinci 719-776-6034 or ask your including Cesarean sections. tomy robot arms

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doctor for a referral.

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The Great D-bate Weighing the merits of vitamin D

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that some people with type 2 diabetes also have low vitamin D levels. However, there are no studies proving Vitamin D starts its life as a vitamin but is actually that taking vitamin D prevents diabetes. a hormone. Previtamin D Also, because vitamin D is a fat-soluble vitamin, it can hide in fat stores, leading to a low reading of vitamin is formed in sun-exposed skin and converted into D in blood. Obesity then could easily lead someone vitamin D, the type found to believe that low blood levels of vitamin D result in in supplements. That form increased levels of diabetes and heart disease, while is then changed in the liver the total amount of vitamin D in the whole body is not to 25-hydroxyvitamin D, the deficient at all, Koren says. All of this is not to say that vitamin D deficiency is not type measured in a blood test. The kidneys convert a legitimate health concern that needs to be addressed. this form of vitamin D into Based on what is known to date about vitamin D, the the active form—1,25-dihyrecommendations are: droxyvitamin D—or calcitriol. • Most people should be screened for vitamin D levels Vitamin D receptors are if they have or are at risk of any chronic health condipresent on cells throughout tions. Shoot for a level between 30 and 50 nanograms the body, which means that per milliliter, although a recent report from the Instithis “vitamin” has the potentute of Medicine states that levels as low as 20 ng/ml tial to impact every organ are also acceptable. and system — for good or • If you are at risk for vitamin D deficiency and need perhaps bad. to take supplements, some studies show D3 is better. For most people 600-800 IU of vitamin D a day is sufficient to maintain normal levels. If the vitamin D supplement is not already mixed in oil, take it with foods containing some fat. For a list • Don’t take more than what is needed. Do not of sympto ms, visit penrosestf exceed 4,000 units a day if you are an adult, rancis.org /vitaminD. unless prescribed by a physician. Maximal dose is smaller for younger children.

Do you h a vitaminave deficienc D y?

Penrose-St. Francis Health Services

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Vitamin D is shaping up to be this decade’s version of a miracle cure. Part vitamin/part hormone, vitamin D is reported to fix everything from weak bones to depression to cancer. Not so fast, researchers say. Not everything is known about vitamin D, and although hundreds of studies have been done, very few were designed to actually show a cause-and-effect between taking vitamin D and improved health. “Our concern is that beyond vitamin D’s role in bone health, we do not have goodenough understanding of what else it does in the body,” says Michael Koren, MD, an endocrinologist with Advanced Care in Endocrinology & Diabetes in Colorado Springs. “We can expect to discover that vitamin D supplementation results in some good things, but possibly in some unexpected bad outcomes.” It’s clear that vitamin D defiDr. Michael Koren ciency contributes to inadequate bone development in children and later to osteoporosis in seniors (vitamin D is actually required to absorb calcium). But recent claims say that vitamin D can help decrease the risk of breast, colon and prostate cancer, high blood pressure and heart disease, autoimmune disorders, diabetes, depression and arthritis. The problem is these claims lack solid “causation” research, Koren says. For instance, studies have found

Vitamin or Hormone?

calendar Summer Women’s Healthy Back Club Do you have back issues like muscle tightness, aches and spasms, or do you just want to learn how to keep your back healthy? Let our experts help you incorporate fitness into your busy lifestyle, motivate you to stick to an exercise plan, and improve your overall back health. Each session will include a halfhour discussion with a back expert followed by a half-hour of supervised stretches and exercises. Date: 4-week program runs every Tuesday, Aug. 2-23 Time: 5:15-6:15 p.m. Location: Penrose Health Learning Center Gym, 1644 Medical Center Point Cost: $20/person or 2 for $30 Registration Required: 719-776-4852 (Class is limited to 20 participants.) *Note: If you have sharp back or leg pain, this class may not be right for you. Please consult your physician.

Family Focus

ABCs of Car Seats Four out of five car seats are installed incorrectly, used improperly or not correctly fitted — potentially risking your child’s life. Come to this class to learn how to buy, install and use a car seat to protect the children you transport. Date: This one-session class is offered on Saturday, Aug. 13, Sept. 10 or Oct. 8. Time: 1-3:30 p.m. Location: St. Francis Medical Center, 6071 E. Woodmen Road Cost: FREE! Registration required: 719-571-3101 Note: If you already own a car seat, please read your vehicle owner’s manual and car seat instructions before class. Infant/Child CPR If you are a parent, grandparent or babysitter, knowing how to administer CPR to babies and children is a must. Join us for this two-hour class to learn CPR and how to clear an obstructed airway. Dates: Every Tuesday in August Time: 6–8:15 p.m. *This two-hour class also will be offered Aug. 6 and Aug. 20 at 9 a.m. and noon. Location: St. Francis Medical Center, 6071 E. Woodmen Road Cost: $20 per person Registration is required: 719-571-3101 Note: This is the American Heart Association class “CPR for Family and Friends.” A CPR certification is NOT awarded for attending this class. If you have a cold, cold sore or flu, you cannot participate.

Fitness classes Zumba Zumba fuses Latin rhythms and easy-to-follow moves in interval training sessions combining fast and slow rhythms and resistance training. All fitness levels welcome! Date: Session 2 runs six Tuesdays, Aug. 30 – Oct. 4 Time: 4:15-4:55pm Location: Penrose Hospital Wellness Center, 2222 N. Nevada Ave., East Tower, Basement Level Cost: PSF employees: $25; PSF volunteers: $30; Community members: $35 Registration: 719-776-7494

FEATURED PROGRAM

Pelvic Pain Solutions One out of three women suffers from pelvic pain, heavy menstrual flow or severe menstrual cramps. But more than half do not seek care, giving up quality of life and risking other related diseases and increased pain. Join Dr. Kevin Weary and Dr. Roland Baiza to learn more about the causes and treatments — including some simple techniques — for this painful condition. Refreshments provided. Date: Tuesday, Aug. 23 Time: 6 – 8 p.m. Location: Julie Penrose Health Education and Research Center, 6071 E. Woodmen Road Cost: FREE! Registration: 719-776-6558

YogaStretch Move through a series of seated and standing yoga poses to increase flexibility, balance and range of motion. Reduce stress and improve mental clarity with restorative breathing exercises and a relaxation techniques. Chair support is offered. Date: Mondays, Aug. 1 - 22 or Aug. 29 – Sept. 26 (skip Sept. 5) Time: 9 – 10 am Location: Penrose Health Learning Center, 1644 Medical Center Point Cost: $30 for each 4-week session Registration: 719-776-7983

Fun and FUNdraising 71st Annual Pikes Peak or Bust Rodeo Days Wear pink to the “Pikes Peak or Bust” Rodeo Days on July 14 and a donation will be made to PenroseSt. Francis Health Foundation to benefit the Penrose Cancer Center. Visit coloradospringsrodeo.com for details. Date: Thursday, July 14 Time: 7:15 p.m. Tickets: Go to ticketswest.rdln.com and enter discount promo code PEN11 to receive $2 off tickets. Pictures on the Promenade Join us for Penrose-St. Francis Emergency/Trauma night to enjoy the 1980s movie hit Back to the Future, touch a real DeLorean sports car, learn car and bike safety tips, and meet local emergency care responders. Date: Thursday, July 28, 2011 Time: 8:30 p.m. Location: The Promenade Shops at Briargate, 1885 Briargate Parkway Cost: FREE! No registration is needed. Soirée: Behind the Scenes Penrose-St. Francis Health Foundation’s signature fundraising event will take you “Behind the Scenes” for an up-close look at Flight For Life Colorado and give you an opportunity to celebrate our life-saving first responders. Ticket sales benefit Flight For Life Colorado and Penrose-St. Francis Emergency and Trauma Services. Entertainment by Dotsero. Date: Saturday, Aug. 13 Time: 6:30 p.m. Location: St. Francis Medical Center Robert “Bobby” Donner III Hangar Cost: $150 per ticket Information and Tickets: Call 719-776-7760 or visit www.psffound.org

Visit penrosestfrancis.org/wellness for a list of additional health and fitness classes. penrosestfrancis.org

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Fit Beyond

If you’re hitting the half-century mark this year, happy birthday! When you’re done celebrating, consider scheduling a colonoscopy. The big 5-0 marks the start of hormonal shifts and other changes that may increase your risk of disease, says Thomas Bartlett, MD, an internal medicine physician with Penrose-St. Francis Health Services. “It’s important to see your doctor every year after 50 to review necessary screenings for your particular risk factors.”

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Make these tests part of your new routine: ✓ Colorectal cancer screening: Every decade ✓ Hearing test: Every three years ✓ Pap smear: Every three years ✓ Cholesterol and diabetes checks: Annually (an advanced lipid profile may be necessary if at risk of heart disease) ✓ Screening mammogram: Annually* ✓ Osteoporosis: Baseline screening when you hit menopause In addition, if you are beginning a new relationship, you should talk to your doctor about screening for sexually transmitted diseases. “We don’t tend to think about this once we’re out of our 20s, but it’s worthy of a discussion with your doctor,” Bartlett says. *The US Preventive Services Task Force recommends biennial mammograms.

Keep track of your ongoing wellness measures in a wallet-size record. Order your free copy online at penrosestfrancis.org/recordkeeper.

WOMEN’S CARE at Penrose-St. Francis Health Services ranks in the top 5 percent in the nation, according to a study by HealthGrades that reviewed patient results in 16 areas of women’s health. Penrose St. Francis is the only hospital in Colorado to achieve this distinction for the third consecutive year.

Conversations with Women The Heat is On

Free refreshments will be provided.

Symptoms of menopause can greatly diminish your quality of life, but the treatment options are sometimes controversial. Is hormone therapy safe? What are the risks of using bioidentical hormones? In this program, our experts will discuss the latest research into hormone supplements and help you understand how to weigh the risks and benefits based on your individual health profile.

Date: Thursday, Sept. 22, 2011 Time: 6-8 p.m. Location: Julie Penrose Health Education and Research Center (Northcare Building on the St. Francis Medical Center campus) 6071 E. Woodmen Road Cost: FREE For more information and to register, call 719-776-5052. SaveThe Date! Join us on Nov. 15 at our next Conversations With Women to learn how aging impacts your body, brain and beauty — and what you can do about it!

Centura Health complies with the Civil Rights Act of 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.