Fall 2015 | Volume 7, Issue 4
Living
PROOF
Breast cancer cases are expected to increase in women over 70. Annual screenings are still the best defense.
A lifesaving screening caught Ann Ryan's cancer early. After treament, the 71-year-old is back to cutting a rug.
PLUS...
Safe Weight Loss Surgery
Healthy Warnings
New A-fib Surgery
PAGE 2
PAGE 3
PAGE 6 PHOTO BY ELLEN JASKOL
Still growing and growing!
Welcome, Sam Huenergardt
IF YOU’VE VISITED PARKER ADVENTIST HOSPITAL in the past few months, you probably noticed how much easier it is to find parking. That’s because we opened our new parking deck in June, adding 175 new spaces! And that’s not all. Construction on campus continues as we prepare to open our new neurosciences, spine, and orthopedic patient unit just after the first of next year. The dedicated unit has been specifically designed with neuro, spine, and orthopedic patients in mind. In addition to the 24 new inpatient beds, the unit will feature a conference room for patient education classes, as well as a rehab gym for patients to rebuild strength following surgery. We’re also adding four operating rooms with space to house two more at a later date and six new preoperative beds. “And this,” says Leanne Hartford, chief operating officer (COO), “is just Phase 1 of our updated master plan to prepare ourselves for the growth of our community. Stay tuned for more!”
PARKER ADVENTIST HOSPITAL welcomed Sam Huenergardt as president and CEO on July 27. Huenergardt comes to Colorado from Texas, where he was president and CEO of Central Texas Medical Center. But he’s no stranger to the Adventist Health System family. Prior to his most recent position, Huenergardt served as COO for Gordon Hospital, an Adventist Sam Huenergardt Health System facility in Calhoun, Ga. And before that, he was controller at Shawnee Mission Medical Center, an Adventist Health System hospital, in Shawnee Mission, Kan. Parker Adventist Hospital is part of the Adventist Health System. “My family and I are so excited to be here, and I am thrilled to be part of the Centura team,” Huenergardt says. “Parker Adventist Hospital has done a tremendous job of serving this community, and I am so grateful to have the opportunity to help extend Centura’s mission here.”
Worried about weight loss? Gastric bypass is safer than you might think
2 ■ Fall 2015 ■
grow
Are you a candidate?
If you’ve been struggling to lose weight or keep it off, it might be time to consider weight loss surgery. You may be a candidate if: You have a body mass index (BMI) of 40 or higher or 35 or higher with weight-related medical problems, such as type 2 diabetes, hypertension, sleep apnea, or heart disease. You don’t smoke, or you are able to quit before surgery. “Smoking increases risk for complications,” says Katy Irani, MD, also a bariatric surgeon at Parker Adventist Hospital. “Quitting before surgery will help the healing process.” You are 17 or older. “In adolescence, the body is going through rapid growth changes, so we prefer not to operate on anyone under 17,” Irani says. You are realistic and committed. “Patients can expect to lose about 80 percent of excess body weight,” Irani says. “How much you lose is really determined by how well you use your bypass. If you stick with the dietary changes, you will be successful.”
Join Drs. Joshua Long and Katy Irani for monthly community seminars on the newest procedures in weight loss surgery and what it takes to qualify for surgery. See Pages 3 and 8 for details.
PHOTOS: PARKING BY ELLEN JASKOL; WOMAN ©DOLLARPHOTOCLUB.COM/HARTPHOTOGRAPHY
GASTRIC BYPASS was once believed to be a high-risk surgery. But is it? Cleveland Clinic researchers recently reviewed more than 66,000 procedures and found that laparoscopic gastric bypass — one of the most common weight loss surgeries — is as safe as routine minor procedures such as gallbladder removal, appendectomy, and hysterectomy. In fact, not having surgery may even be riskier as obesity significantly increases a person’s risk of dying early, says Joshua Long, MD, medical director of bariatric surgery at Parker Adventist Hospital. “Surgery actually reduces this risk by 89 percent in the first five years after your procedure, leading to a longer, healthier, and more fulfilling life,” he says. For instance, the national cure rate for type 2 diabetes following gastric bypass is nearly 84 percent, according to a study published in the journal Diabetes Care — and perhaps even higher when surgery is combined with other nonsurgical tools.
Heed the Warnings
Prediabetes and prehypertension are reversible — if you act now THERE ARE PLENTY OF TIMES IN LIFE when you don’t get a
warning of what’s about to happen. But type 2 diabetes and high blood pressure (hypertension) often do come with warnings: prediabetes and prehypertension. “These conditions are definitely reversible as long as you take them seriously,” says Andrew Schulz, MD, a family physician at Parker Primary Care. “You can stop them from becoming life-altering.”
Dr. Andrew Schulz
PUT THE BRAKES ON DIABETES With prediabetes, your blood glucose level is higher than normal but not high enough to be considered diabetes. Using an A1C test, which determines your blood glucose over the past two to three months, prediabetes is diagnosed with an A1C of 5.7 to 6.4; over 6.4 is considered diabetes. To prevent prediabetes from turning into type 2 diabetes:
October FREE
health seminars Join Parker Adventist Hospital for a series of FREE health seminars. All seminars are held in the Parker Adventist Hospital Conference Center, located on the Garden Level at the west entrance. A light lunch is served during daytime programs, and light snacks are served during evening programs. Registration is required for all seminars. New online registration at parkerhospital.org/seminars.
The Breast Care Center — October Extended Hours In honor of Breast Cancer Awareness Month, we are extending our screening mammogram hours on Mondays to 6:30 a.m.-6:30 p.m.
Weight Loss Surgery Seminars Presented by Dr. Joshua Long: Wed, Oct 14 | 6:30-8 p.m.
Presented by Dr. Katy Irani:
Lose weight. Reaching your ideal body weight may be daunting, but losing just 10 or 15 pounds can help prevent diabetes, according to the American Diabetes Association.
Eat the meat first. The order in which you eat a meal can affect blood sugar levels, according to a study published in the journal Diabetes Care. Eat meat, vegetables, and fat before carbs and you could reduce your blood sugar by 37 percent. “Also limit carbohydrates to one-quarter of your plate,” Schulz says.
Hoof it for a half hour. Walking is great exercise. For the most benefit, keep your pace between 3 and 4 miles per hour. Repeat for 30 minutes five times a week.
PHOTOS: FROM LEFT ©DOLLARPHOTOCLUB.COM/SEDLACEK; /KARANDAEV; /PANCHENKO
Keep high blood pressure at bay
Prehypertension is elevated blood pressure that’s not yet high enough to be classified as hypertension: 120 to 139 mm Hg for the top (systolic) number or 80 to 89 mm Hg for the bottom (diastolic) number. To keep blood pressure in check: Limit libations. More than two drinks per day for men or one drink for women increases blood pressure. Study your sleep. Sleep apnea, a condition in which sleep is interrupted by pauses in breathing, puts you at greater risk for high blood pressure. If you have daytime fatigue, talk to your doctor about a sleep study. Skip salt for six weeks. Salt is an acquired taste. To unlearn it, avoid adding salt for six to eight weeks.
Want to learn more about how to prevent diabetes, high blood pressure, and high cholesterol? Parker Adventist Hospital's expert educators offer a low-cost class full of helpful tips. Call 303-269-4859 for more information.
Thu, Oct 15 | 6:30-8 p.m. Join our bariatric surgeons for a look at various surgical weight loss options, and learn whether youʼre a candidate for surgery.
Postpartum: A Seminar for New Mothers
Tue, Oct 20 | Noon-1:30 p.m. Join Dr. Jackie Ziernicki, OB-GYN (and new mom herself!), to learn about the physical and mental changes that new mothers face. Babies welcome.
Common Causes and Treatment of Elbow, Wrist, and Hand Pain Tue, Oct 20 | 5:30-7 p.m. Do you golf, play tennis, or use a keyboard frequently? If you’re experiencing any elbow, wrist, or hand pain, we can help. Join Dr. Micah Worrell, orthopedic surgeon, and Kelly Martin, OTR, CHT, occupational therapist, for a discussion about what causes the pain, how therapy can help, and when surgery might be an option.
Stroke Overview
Tue, Oct 27 | 5:30-7 p.m. Learn about stroke prevention, symptoms, treatment, rehabilitation, and recovery from Dr. Katie Polovitz, neurologist.
grow
■ parkerhospital.org ■ 3
Ageless wisdom
about breast cancer
Breast cancer is expected to rise in women over 70. Learn what you need to know to protect your health — and the women you love.
A
s women get older, they expect to encounter certain health obstacles, like menopause and bone loss. But at a certain age, they might think they’ve dodged a bullet on other health concerns — and breast cancer is a prime example. In fact, some women stop having mammograms at 70 because they believe they’re too old to get breast cancer or too old to be treated. In truth, breast cancer cases in women over 70 are expected to increase markedly during the next 15 years, according to research from the U.S. National Cancer Institute. So, why is this number going up, and what can be done about it? We’ll explore what’s behind these numbers and the argument for annual mammography screenings as you age.
Unpacking the numbers
4 ■ Fall 2015 ■
grow
The case for annual screening According to Rogness, much of the disagreement over the age at which women should start screening has centered on concerns regarding the potential overtreatment of ductal carcinoma in situ (DCIS), a noninvasive form of breast cancer that can be a precursor to more invasive forms. “The risk of going from DCIS to invasive cancer is somewhere between 40 and 60 percent, but no one can tell you if you’re going to be in the group that doesn’t go on to develop invasive breast cancer,” she says. “So, if you could detect DCIS before you develop invasive breast cancer, then that’s the best time to be treated. And you need annual mammography screening to get these subtle findings.” This goes for women in their 70s, too. The good news is, if cancer is found at an older age, it’s likely to be less aggressive and easier to treat, Rogness says. “But we want to help you find it early so that it can be a speed bump and not a life-changing event.”
ILLUSTRATION: ©ISTOCKPHOTO.COM/ALEXBELOMLINSKY
While breast cancer risk tends to decline after age 80, one recent large-scale study found that women over 80 benefit from regular mammograms in two big ways: They’re more likely to be diagnosed with the disease early on, and more likely to be living five years after a diagnosis.
“We’re going to see more numbers because women are living longer,” says Christine Rogness, MD, a general surgeon and medical director of the breast care program at Parker Adventist Hospital. The National Cancer Institute’s study predicts that roughly 441,000 U.S. women will be diagnosed with breast cancer in 2030, up from 283,000 in 2011. Women 70 and older will account for 35 percent of those cases. While the number of cases is going up, the actual rate is not Dr. Christine Rogness increasing, Rogness stresses. “The life expectancy for U.S. women is now 81 years and climbing, and we’re seeing more cases because of that.” That’s right: Hitting the big 7-0 doesn’t automatically eliminate your risk of developing breast cancer. “The risk continues to rise until you get to about 75 or 80, and then it actually goes down again,” Rogness says. In fact, younger women are actually at lower risk for breast cancer, which rises slightly during each decade of life. In recent years, recommendations about when women should get mammograms have grown more confusing. But Rogness and Parker Adventist Hospital follow the guidelines advocated by the American College of Surgeons and the American Cancer Society: “Until you are within 10 years of the age of your presumed death, you should get annual screenings, starting at age 40,” she says.
The earlier, the better Ann Ryan is living proof that continuing regular breast cancer screening into your 70s can be lifesaving. Last fall, when the 71-year-old’s annual mammogram showed a possible abnormality, she wasn’t taking chances. Twenty years ago, the Centennial resident and Colorado native had colon cancer, so she understood the importance of early detection from personal experience. When a needle biopsy came back negative but her care providers still thought they saw something atypical, Ryan was fully on board with further testing. She was then referred
for a surgical biopsy at Parker Adventist Hospital for an even closer look. The bad news: Cancer was detected. Luckily it was so small — because it had been caught so early — that it was removed at that time, turning the biopsy into a lumpectomy. A second surgery the following week to check for cancer in her lymph nodes came back negative. She’s now taking antihormones, the standard breast cancer follow-up treatment, for the next five years. But even after two cancer diagnoses, Ryan counts her blessings. In her work with
Rocky Mountain Cancer Assistance, where she serves on their board and processes applications for assistance, Ryan sees cases like hers all the time. “I know how common it is, and I also know that people normally need to have radiation and chemo, but I didn’t. I was lucky,” she says. “This has been pretty much a piece of cake, all things considered.” Needless to say, Ryan remains an advocate for annual mammograms. “People use all kinds of excuses, but I wouldn’t just tell them to go, I’d drive them there,” she says.
Revealing your genetic risk
PHOTO: DANCING BY ELLEN JASKOL
Concerned about your genetic risk for breast cancer? Genetic counseling can help you learn your risks for specific conditions based on your family history and determine if you’re eligible for genetic testing or any specific screening. Melissa Gilstrap, MS, CGC, a board-certified genetic counselor at Parker Adventist Hospital, can help you begin to uncover your genetic risk factors. Melissa Gilstrap “It’s my job to help individuals put together their family history and genetic information in order to get plugged into the appropriate providers as well as screening and prevention options,” Gilstrap says. If you are eligible for cancer-related genetic testing and decide to proceed, it’s important to understand what it can and can’t tell you.
It CAN tell you:
It CAN'T tell you:
• If a specific gene mutation runs in your family • If you carry a mutation, what cancers you are at risk for, your risk for developing them, and what screening and prevention options would be available to you
• Whether you’ll definitely get cancer, how your cancer might progress, or how severe your illness might be. “Cancer risks are rarely 100 percent. Genetic testing is not a crystal ball to predict the absolute future. It is a heads-up on what could happen, so you can prevent it or find it early,” Gilstrap says. • Your risk for other health problems. Because the test looks only at selected genes, it won’t tell you your risk for other health conditions, such as Alzheimer’s disease.
Genetic counseling and testing are typically covered by insurance when people meet medical necessity criteria, and it’s not just for breast and ovarian cancer. “There’s also genetic testing for other types of cancer that may run in your family — especially colon cancer,” Gilstrap says. If you have a personal or family history of breast, ovarian, colon, or other cancers that you are concerned about, call 303-269-4975 to schedule a consultation with Gilstrap.
Parker Adventist Hospital is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas.
Two-time cancer survivor Ann Ry an is back in step with her dance group, thanks to a lifesaving brea cancer screenin st g at Parker's Br east Care Center .
New Name The Trio Breast Center has changed its name to The Breast Care Center at Parker Adventist Hospital.
Don't skip your screening To schedule your 3-D mammogram at The Breast Care Center at Parker Adventist Hospital, call 303-269-4150 or text your name to 303-816-8648 and someone will call you within two business days to schedule your mammogram.
grow
■ parkerhospital.org ■ 5
IN THE Dr. Glenn B igsby
Rhythm
INNOVATIVE “HYBRID ABLATION” TREATS ATRIAL FIBRILLATION FROM THE OUTSIDE IN
Kay Jensma is finding her rhythm again at the bowling alley.
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. 6 ■ Fall 2015 ■
grow
PHOTO BY MICHAEL RICHMOND
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 Dr. Sri Sundaram Dr. Sanjay Tripathi 85 percent success rate in effectively treating A-fib.
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.
Parker Adventist Hospital recently received full Chest Pain Center with Primary PCI Accreditation from the Society of Cardiovascular Patient Care (SCPC) by demonstrating expertise in: Assessing, diagnosing, and effectively
treating chest pain patients quickly
Designing services to promote optimal
patient care
Ensuring ongoing training of chest
pain staff
Continually seeking to improve processes
and procedures
Integrating its ER with local EMS Educating the community about signs
of a heart attack
Virtually Scarless Hysterectomy Belly button surgery gets women back on their feet quicker and with less pain ROUGHLY ONE IN THREE WOMEN will undergo a hysterectomy by age 60. One of the most common surgeries among women of childbearing age, hysterectomy is a procedure that removes the uterus due to excessive bleeding, cancer, fibroids, endometriosis, adenomyosis, or other medical issues. In its effort to offer leading-edge treatments that benefit patients and minimize side effects, Parker Adventist Hospital now offers minimally invasive single-site robotic hysterectomy surgery. This procedure requires only one incision near the belly button. “The surgery works really well for women whose uterus is not too large and who do not have large ovarian cysts,” says Michael Gavigan, MD, an OB-GYN physician at Parker Adventist Hospital.
Simpler surgery, bigger benefits Using the da Vinci® Single-Site® robotic guidance system, Gavigan utilizes 5 mm instrumentation and a 3-D camera to navigate through a single 1-inch incision near the belly button. Once the uterus is properly detached, it is removed through either the small incision or the patient’s vagina, depending on the situation. “The single-site surgery offers many benefits, including quicker recovery times, less blood loss, and less pain following surgery, which leads to less need for narcotic pain medicine,” Gavigan says. Other benefits of the single-site hysterectomy surgery, when compared to traditional open hysterectomies and other minimally invasive procedures, include: > Shorter hospital stay > Fewer complications > Shorter recovery
Eligibility and options
PHOTO: ©DOLLARPHTOCLUB.COM/BILLIONPHOTOS
Candidates for single-site hysterectomies include women with noncancerous issues and normal pathology, including the absence of large fibroid tumors, no
Nearly one out of five hysterectomies are performed as same-day outpatient procedures, according to the American Congress of Obstetricians and Gynecologists. large ovarian cysts, and a regular-sized uterus. Women with gynecologic cancer are typically referred to an OBGYN oncologist and evaluated on a case-by-case basis. As the procedure becomes more commonplace, Gavigan anticipates it will be available to more women. “As with most surgical procedures, the more experience we have, the wider range of patients we can perform the procedure on,” he says. For some women, another minimally invasive procedure may be the best option. Dr. Michael Gavigan Using the da Vinci Si HD Surgical System, Gavigan performs minimally invasive da Vinci hysterectomies on women who are not eligible for the single-site procedure. Da Vinci hysterectomies use three to four small incisions in the abdomen to separate the uterus and remove it through the vagina.
For more information about minimally invasive gynecologic procedures, visit parkerhospital.org/ womens-gynecology
grow
■ parkerhospital.org ■ 7
November FREE health seminars
Portercare Adventist Health System
Non-Profit Organization U.S. Postage
PAID
Denver, CO Permit No. 4773
9395 Crown Crest Blvd. Parker, CO 80138
Become more body-wise with the experts at Parker Adventist Hospital. All seminars are FREE but require registration by going online to parkerhospital.org/seminars. Seminars are held in the Parker Adventist Hospital Conference Center at the west entrance. A light lunch is served during noon seminars, and light snacks are served during evening programs.
Weight Loss Surgery Seminars Presented by Dr. Katy Irani: Thu, Nov 5 | Noon-1:30 p.m. Thu, Nov 19 | 6:30-8 p.m. Thu, Dec 3 | Noon-1:30 p.m.
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.
Presented by Dr. Joshua Long: Wed, Nov 11 | 6:30-8 p.m. Wed, Dec 9 | 6:30-8 p.m. Join our bariatric surgeons for a look at various surgical weight loss options, and learn whether youʼre a candidate for surgery.
Handy Advice from Micah Worrell, DO, hand and upper extremity surgeon at Parker Adventist Hospital
Back in Control: Advantages of Minimally Invasive Robotic Surgery
With a network of 27 bones and associated structures, including nerves, tendons, and ligaments, the hand and wrist are at risk for a variety of painful conditions. We sat down with Parker Adventist Hospital hand and upper extremity surgeon, Micah Worrell, DO, to discuss common causes of pain and available treatment options.
9395 Crown Crest Blvd., Parker, CO 80138 grow is published quarterly by Parker Adventist Hospital— Portercare Adventist Health System—as part of our mission to nurture the health of the people in our community. To comment or unsubscribe, please email grow2@centura.org. grow is produced by Clementine Health Marketing of Littleton, Colo. Executive Editor: Lisa Gates
PHOTOS HAND ©DOLLARPHOTOCLUB.COM/AFRICASTUDIO; BACK ©DOLLARPHOTOCLUB.COM/KASPARSGRINVALDS
Tue, Nov 10 | 5:30-7 p.m. Learn about the latest technology in robotic spine surgery and when it might be a good idea for you.
Q. What are the most common causes of hand and wrist pain? A. Finger and thumb pain or clicking (trigger finger); hand/finger pain and numbness (carpal tunnel syndrome); and arthritis of the thumb, finger, and wrist. I also see quite a bit of tendon irritation of the wrist and elbow, related to overuse issues.
Q. What are the best ways to manage symptoms? A. When dealing with degenerative changes (those that occur over time) or arthritis, nonoperative measures to alleviate pain include splinting or bracing, antiinflammatory medications, ice, adjusting the work environment, and patient education. An educated hand therapist can play a substantial role in treating hand and wrist pain using massage, stretching, and modalities such as iontophoresis (electrical stimulation) and dry needling. Alternative treatments, like acupuncture, may be helpful as well.
Join Dr. Worrell to learn more about the causes and treatment of hand and wrist pain at a FREE community seminar on Oct. 20 from 5:30-7 p.m. See Page 3 for details.
Q. When should patients seek medical care? A. I often ask my patients what they do for fun. When pain interferes with a favorite activity, an evaluation is certainly a good option. For conditions such as carpal tunnel syndrome and trigger finger, an earlier evaluation is preferred, as these conditions may worsen or become irreversible if not addressed early. In addition, any time the pain is the result of an injury, patients should seek medical attention to rule out more serious issues.