Summer 2016 | Volume 8, Issue 3
GAME ON Helping athletes of all ages stay off the sidelines by preventing and treating overuse injuries.
Orthopedic surgeons at Parker Adventist Hospital performed hip surgery on Tara Stilwell so she could get back in the game. See Page 4.
PLUS...
Midlife checkup checklist
Say goodbye to bladder leaks
Solutions for sweet dreams
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PAGE 3
PAGE 7 PHOTO BY ELLEN JASKOL
Take inventory at 50 to boost your health and promote quality of life
EVEN IF YOU FEEL HEALTHY, the mid-century mark is a great time to screen for potential medical problems, gauge your risk for issues down the road, and motivate yourself to pursue a healthier lifestyle. It’s an opportunity “to make new life choices,” says Seth Gursky, MD, a primary care physician at Centura Health Physician Group Cornerstar Primary Care in Aurora. “I discuss the importance of sleep and taking care of one’s self in Dr. Seth Gursky order to lead a successful and healthy life,” he says. “I feel the biggest hurdle for most patients is ‘diet and exercise.’ Whether they are marathon runners or couch potatoes, I never use the word ‘diet’ anymore. A diet is temporary, whereas lifestyle modifications are for a lifetime.” Gursky recommends the following health checkups when you hit 50 and beyond: EXAM/SCREENING
HOW OFTEN
LOOKING FOR
Dental exam
Twice a year
Checkup, cleanings, and an oral cancer exam
Skin exam
Annually, or more often if you have a history of skin cancer
Evaluate changes in moles and any signs of melanomas and basal cell cancers
Eye exam
Every 1-3 years
Check for eyestrain, glaucoma, cataracts, macular degeneration, and other problems
Blood pressure check
Annually, or more regularly if you have a history of hypertension (blood pressure greater than 130/80)
High blood pressure greatly increases your risk of heart disease and stroke
Blood sugar test
Annually
Screen for diabetes
Colonoscopy
Every 10 years, or more often if family history of colon cancer
Check for bowel disease, polyps, and colon cancer
Lung cancer screening
Annually for heavy smokers or former smokers age 50-plus (Talk to your doctor about specific requirements.)
Check for lung cancer (To learn more or schedule a lung screening at Parker Adventist Hospital, call 303-269-4500.)
Vaccinations
Flu shot: annually; Tdap: every 10 years; herpes zoster vaccine: 1 time after age 60
Prevent flu; protect against tetanus-diphtheria and acellular pertussis; prevent shingles
Mammogram (women)
Every 1-2 years
Early detection of breast cancer
Pap smear (women)
Every 5 years
Test for human papillomavirus
PSA or DRE (men)
At age 50, discuss a screening schedule with your doctor
Early detection of prostate cancer
To schedule an appointment with Dr. Seth Gursky at Cornerstar Primary Care, call 303-269-2626 or visit cornerstarprimarycare.org.
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D ’S & D N’TS of calcium supplements
CALCIUM SUPPLEMENTS are a safe and effective way to help prevent osteoporosis, but it’s important to follow these do’s and don’ts: mix your calcium supplement with prescription medications without talking to your doctor, says Vandna Jerath, MD, an OB-GYN at Parker Adventist Dr. Vandna Jerath Hospital. try to get as much calcium as possible through foods such as dairy, dark leafy greens, fortified orange juice, and fortified cereals. get 1,000 milligrams (mg) of calcium a day if you’re a woman under age 50, or a man younger than 70. Women 51-plus and men 71-plus should get 1,200 mg daily. take too much calcium. It can increase your risk of heart attack, stroke, muscle and belly pain, and kidney stones. The National Institutes of Health recommends an upper limit of daily calcium of 2,500 mg for people ages 19 through 50, and 2,000 mg for those 51 and older. take in two doses of 500 to 600 mg in the morning and evening to ensure absorption. Take it with vitamin D (400 to 1,000 IUs), which improves calcium absorption.
To learn more about supplements and meet Dr. Vandna Jerath, OB-GYN, join us at a FREE seminar on Oct. 13 at 11:30 a.m. For details, see back cover.
PHOTOS: TABLET ©SLAVSON — STOCK.ADOBE.COM; LEAF ©SPAXIAX — STOCK.ADOBE.COM; OPPOSITE PAGE: BATHROOM BY TIM GIESEN
Physicals at 50
STRESSED by Incontinence
You don’t have to live with leaks. Work with your physician to find a treatment option that fits your needs.
YOU MIGHT FEEL INCONTINENCE IS AN EMBARRASSING SUBJECT to bring up to your doctor, but I hear about it from patients every day, says Alison Tate, MD, a urogynecologist at Parker Adventist Hospital. “It’s not an embarrassing thing — it’s a common thing,” Tate says. Incontinence, the inability to control the release of urine from the bladder, is a widespread problem affecting an estimated 13 million Americans. It has many causes and possible treatments, so it’s important to discuss with your doctor which kind of incontinence you are experiencing and what therapies — from diet and behavior modification to surgery — might work for you.
Dr. Alison Tate
The two main types of incontinence are: p S TRESS incontinence — involuntary release of urine when pressure within the abdomen suddenly increases, such as with coughing, sneezing, lifting, or running. Childbirth, muscle weakness, and obesity are common contributors. p URGE incontinence — frequent, sudden urge to urinate that often results in leakage, even when your bladder is not necessarily full.
Rule out other causes
Lifestyle treatments
Your physician will examine you and review your health history to determine if pelvic prolapse has occurred and to rule out any other conditions that could be the cause, such as: p Bladder infection p Blockages p Diabetes p Urinary retention p Other chronic diseases that can affect bladder control
Lifestyle changes can be quite effective in alleviating symptoms of incontinence. Your physician might have you try: p Losing weight p Pelvic floor physical therapy (Kegels) p Eliminating caffeinated beverages p Retraining your bladder
Medication treatments ertain medications can C calm an overactive bladder, which can cause urge incontinence p Low-dose topical estrogen applied as a vaginal cream can help firm tissues p Botox injections may help to relax the bladder muscle p
Surgical treatments euromodulation therapy — an N outpatient procedure to implant a device similar to a pacemaker that electrically stimulates the nerves controlling the bladder p Neuromodulation also can be done as an office procedure similar to acupuncture by electrically stimulating the pelvic nerves on a weekly basis for 12 weeks p Sling surgery — strips of a synthetic net material are used to support the urethra or bladder p
Join Dr. Tate for a FREE seminar on Sept. 15 to learn more about incontinence or schedule an appointment with her by calling 303-925-4638. See back cover for seminar details.
9395 Crown Crest Boulevard, 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
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OVER THE TOP Overuse injuries among young athletes and active adults are beginning to stack up, causing short-term injuries and upping the long-term risk of osteoarthritis
S
ince third grade, Tara Stilwell has been in love with the game of volleyball. Now 19 years old and a collegiate player with the Clarkson University Golden Knights, this Centennial teen already has had one hip surgery and is considering another. Stilwell is the face of a trend emerging among active Americans, including young athletes, who are suffering joint injuries — and even osteoarthritis — in their prime. STRIKING EARLY While terms such as hip surgery and arthritis conjure up images of old age, many active adults and even teens are experiencing joint problems because they play so hard.
PHOTO BY ELLEN JASKOL
Hip surgery helped Tara Stilwell, 19, get back on the volleyball court after an overuse injury put her out of play.
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The Centers for Disease Control and Prevention (CDC) recently reported 8.5 million people between the ages of 18 and 44 have been diagnosed with arthritis. Individuals who suffer joint injuries, such as anterior cruciate ligament (ACL) and meniscus injuries of the knee or large rotator cuff tears of the shoulder, are six times more likely to develop osteoarthritis, according to the CDC. Playing one sport or repeatedly engaging in one activity overdevelops certain muscles and ignores others, which can push joints out of alignment. That is why balanced workouts are crucial, says Nate Faulkner, MD, an orthopedic and sports medicine physician at Parker Adventist Hospital who specializes in minimally invasive surgery of the shoulder, hip, and knee. Young athletes in increasing numbers specialize early in one sport and play competitively for many
years before their bodies are fully developed, setting the stage for overuse injuries, says Justin Newman, MD, an orthopedic surgeon at Parker Adventist Dr. Justin Newman Hospital. “I had pain going up stairs, even lying in bed,” says Stilwell. Easing up on her normal activity level wasn’t providing any relief. PLAYING IN PAIN Newman performed hip surgery on her in February. “It feels a lot better,” she says. “I’m glad I got this done now instead of needing a hip replacement at age 40.” Young athletes can be reluctant to take a break from sports and often have a high tolerance to pain, which can delay a diagnosis. Stilwell had been playing in pain for more than a year, she says.
5 COMMON ATHLETIC OVERUSE INJURIES OPTIONS TO TREAT INJURY The good news is that improved surgical techniques and promising new therapies are emerging to repair joints and even cartilage before osteoarthritis has caused irreparable damage. These treatments can provide relief, delaying or even preventing joint replacement, says Faulkner. “There have been big advancements in cartilage restoration.” Still widely used is a 20-year-old surgical technique called microfracture, in which tiny fractures are created in the bone that generate new cartilage as they heal. But microfracture is now being replaced by longer-lasting procedures that can restore — rather than repair — cartilage. Newer options include grafts, implantations, and platelet-rich plasma injections and, though still limited by the FDA, stem cell injections. These new treatments work best on active patients under 50 with small, distinct areas of damage, not those with advanced osteoarthritis. Newman says his career is about restoring joints with minimally invasive surgery, when possible, rather than replacing them. “I’m a joint preserver,” Newman says.
WHAT IT IS
HOW IT HAPPENS
BEST WAYS TO PREVENT IT
BEST WAYS TO TREAT IT
ANKLE SPRAIN
Stretch or tear of weak ligaments
Sudden inward turning of the foot; common in football, basketball, soccer, tennis, running
Strengthen surrounding muscles; improve balance; tape the ankle; stretch before exercise
Elevate and ice for first 48 hours; ibuprofen; stay off it until swelling subsides
SHIN SPLINTS
Pain down front of the leg, along the shinbones
Running, especially long distances or on hard pavement
Run on softer surfaces; wear shoes with adequate support; vary exercise activities
Rest, ice, over-the-counter pain relievers
LOWER BACK PAIN (SCIATICA)
Muscle spasms or pain that often extends down the legs
Cycling, running, golf, tennis, baseball, and using improper form when lifting
Regular stretching, particularly before strenuous activity; strengthen glutes, hamstrings, and core
Ice, rest, over-the-counter pain medications, physical therapy
TENNIS (OR GOLF) ELBOW
Chronic pain, caused by inflammation, on the inside (golf) or outside (tennis) of the elbow
Repetitive, wide, arm-swinging motion, common in tennis, golf, bowling, and gardening
Strengthen forearm muscles through weight training, wrist curls, and squeezing a ball
Ice, rest, and over-the-counter pain medications
KNEE INJURIES
Ligament sprains and tears
Falls; sudden pivoting or twisting while running or playing soccer, football, basketball, tennis
Warm up before exercising; replace worn shoes; exercises to build leg strength
Rest, ice, elevate leg, over-the-counter pain medication; for minor injuries, add strengthening and stretching exercises; many tears require surgical repair
INJURY
To LEARN MORE about joint pain and athletic injuries—including CrossFit risks—join us for a FREE seminar on Sept. 20. For full details, see back cover. PHOTOS FROM STOCK.ADOBE.COM: SHOES ©ALEX_MAC; TENNIS ©FOTOPAK; ICE ©MARCDIETRICH; WEIGHTS ©TBAEFF; PILLS ©BERTFOLSOM; RUNNING ©PUHHHA; SOCCER ©KUNGVERYLUCKY
COMMON OVERUSE INJURY: HIP IMPINGEMENT
By age 18, volleyball athlete Tara Stilwell was hobbled by hip pain caused by an increasingly common injury in teens — hip impingement. This injury is a set of disorders in which deformities of the bone resulting from overuse of the joint interfere with smooth rotation of the hip and limit space for, or pinch, the soft tissue that lines the bones. These bone bumps or irregularities can limit motion, irritate cartilage, and tear tissue.
Along with hip impingement, Stilwell had suffered a torn labrum — the tissue that lines the outer edge of the socket. In February, Justin Newman, MD, orthopedic surgeon, shaved the bony protrusions and reattached the torn labrum in her left hip. By May, Stilwell was feeling well enough that she was ready to be back on the court. grow
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HEAD TO TOE, KNOW WHEN TO GO HEART ATTACKS AND STROKES ARE NOT THE ONLY MEDICAL EMERGENCIES THAT REQUIRE FAST CARE
A
trip to the ER won’t always be triggered by severe chest pain or loss of consciousness. Sometimes the symptoms are more subtle, but just as serious. “Common sense can play a big role in whether or not your condition warrants a trip to the ER,” says Phil Mitchell, MD, medical director at Parker Adventist Hospital Emergency Department. “When in doubt, go to the ER.” Use this head-to-toe guide to assess symptoms of the most common medical emergencies.
HEAD
7
Stroke, concussion, serious infection, cardiac arrest
Inability to be awakened
Stroke, cardiac arrest
Sudden, severe headache
Blood clot, stroke, aneurysm, hemorrhage
Drooping face
Stroke
Slurred or altered speech
Stroke
Loss of vision or blurred vision
Stroke
NECK, JAW
Unusual discomfort/pain
Heart attack
CHEST
Sudden, unusual pain
Heart attack, heart failure
LUNGS
Shortness of breath, difficulty breathing
Heart attack, heart failure, blood clot
ABDOMEN
Sudden, intense, or lingering pain that worsens over time
Appendicitis, ectopic pregnancy, hole in intestine, bowel blockage (Note: Women may experience stomach pain during a heart attack.)
ARMS
Paralysis, numbness, weakness
Stroke
Unusual discomfort/pain
Heart attack
Paralysis, numbness, weakness
Stroke
SIGNS OF SOMETHING MORE SERIOUS
These symptoms also require immediate emergency attention: Sudden, severe, unusual pain anywhere throughout your body Uncontrollable bleeding Persistent or severe vomiting or diarrhea Blood in your vomit or stool Unmanageable fever Infectious condition with pain elsewhere in the body Seizures with no known history of epilepsy 6 ■ Summer 2016 ■
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POSSIBLE INDICATION OF
Confusion, disorientation
LEGS
SYMPTOMS
The Centura Health Trauma System is the region’s leading and most comprehensive network of trauma care and emergency services. It includes six emergency rooms throughout the southern Denver metro area: p Parker Adventist Hospital p Southlands ER p Centura Health Emergency & Urgent Care (opening September 2016) p Castle Rock Adventist Hospital p Littleton Adventist Hospital p Porter Adventist Hospital
To find out wait times, go online to southdenverhealth.org.
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BODY AREA
Dream LIFE DAWN SHEPPARD IS A 64-YEAR-OLD MOTHER who raised six boys while suffering
Surgery can restore sleep, health, and dreams
from a severe form of obstructive sleep apnea and chronic fatigue. She lived with it — too tired to hold a job that she wanted and unable to drive more than a half hour without falling asleep at the wheel. Her husband would lie awake at night, anxiously listening for her next breath. Even when awake, if she laughed too hard for too long, she sometimes passed out. “I thought I could literally die laughing,” Sheppard says. Sleep apnea is a disorder in which breathing stops and starts through the night, or breath is so shallow that not enough oxygen circulates in the blood. “I’ve had it since childhood but wasn’t diagnosed until I was in my 40s,” Sheppard says.
A serious sleep disorder
About 10 percent of Americans have some form of significant obstructive sleep apnea, says Stephen Duntley, MD, a sleep neurologist and medical director of the Sleep Disorders Centers at Parker Adventist Hospital, Littleton Adventist Hospital, Castle Rock Adventist Hospital, and Porter Adventist Hospital. The disorder, characterized by chronic fatigue and loud snoring, can lead to lack of Dr. Stephen Duntley concentration, depression, heart disease, stroke, obesity, diabetes, sexual dysfunction, hypertension, and even sudden death. Obstructive sleep apnea (OSA), the more common form, occurs when throat muscles relax and the airway is obstructed.
PHOTOS: VINES ©KID_A — STOCK.ADOBE.COM; DAWN SHEPPARD BY ERIK JACOBSON
Seeking a solution
Of the 18-25 million Americans who suffer with OSA, one-third to one-half of them use a CPAP (continuous positive airway pressure) machine when they sleep. A CPAP machine increases air pressure in the throat so the airway doesn’t collapse when they breathe in. Sheppard tried a CPAP machine for several months, but it did nothing to provide relief. For those like her with extreme structural issues that restrict the airway, sleep apnea surgery can be a more effective solution, says Randolph Robinson, MD, a plastic surgeon at Parker Adventist Hospital. Reconstructive surgeries can treat the nasal area, back of the throat and palate, and the base of the tongue, which can all contribute to obstructing the airway. One of the most effective surgeries is maxillomandibular advancement (MMA), which expands many different regions of the airway. MMA cures sleep apnea in 85-90 percent of patients, Robinson says.
A dream procedure
“ When I see a patient like Dawn who has suffered so greatly over the years and can’t tolerate the CPAP, I realize how life-changing this procedure is.” — DR. RANDOLPH ROBINSON
Talk to your doctor about a referral to the Sleep Disorders Center at Parker Adventist Hospital, 303-269-4188.
“It’s not a procedure you go into lightly,” says Sheppard, who chose to have MMA surgery. But “what it does for the rest of my life — it’s worth it.” “When I see a patient like Dawn who has suffered so greatly over the years and can’t tolerate the CPAP, I realize how life-changing this procedure is,” Robinson says. “Now she can dream.” He means that literally. She can sleep without interruption long enough to enter into REM sleep, the rapideye-movement phase during which most dreaming occurs. And she can stay awake when she wants. “I was awake the whole 12-hour ride home to Minnesota,” she says. grow
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PRIMARY CARE PRACTICES
Portercare Adventist Health System
CHPG Cornerstar Primary Care
Non-Profit Organization U.S. Postage
CHPG Southlands Primary Care
Denver, CO Permit No. 4773
AURORA
15901 East Briarwood Circle, Suite 200 Aurora, CO 80016 303-269-2626 • cornerstarprimarycare.org 6069 South Southlands Parkway Aurora, CO 80016 303-928-7555 • southlandsprimarycare.org
PAID
9395 Crown Crest Boulevard Parker, CO 80138
CASTLE ROCK
Ridgeline Family Medicine at the Meadows 2352 Meadows Boulevard, Suite 300 Castle Rock, CO 80109 720-455-3750 • ridgelinefamilymedicine.org
Ridgeline Family Medicine — Castle Pines
250 Max Drive, Suite 102 Castle Rock, CO 80108 303-649-3350 • ridgelinefamilymedicine.org
6909 South Holly Circle, Centennial, CO 80112 720-528-3559 • gracefamilypractice.org
CHPG Holly Creek
5500 East Peakview Ave., Centennial, CO 80121 303-649-3820
DENVER
CHPG Clermont Park
2479 South Clermont Street, Denver, CO 80222 303-649-3155 • clermontparkseniorcare.org
CHPG Primary Care Highlands
2490 West 26th Avenue, Suite A120 Denver, CO 80211 303-925-4580 • chpghighlands.org
CHPG Primary Care Porter
950 East Harvard Avenue, Denver, CO 80210 303-649-3200 • porterprimarycare.org
CHPG Primary Care Cherry Creek
300 South Jackson Street, Denver, CO 80209 303-316-0416 • primarycarecherrycreek.org
GREENWOOD VILLAGE
CHPG at DTC
8200 East Belleview Avenue Greenwood Village, CO 80111 303-770-6500 • dtcfamilymedicine.org
HIGHLANDS RANCH
Highlands Ranch Medical Associates 9135 South Ridgeline Boulevard Highlands Ranch, CO 80129 303-649-3140 highlandsranchmedicalassociates.org
LITTLETON
Chatfield Family Medicine
10789 Bradford Road, Littleton, CO 80127 303-738-2714 • chatfieldfamilymedicine.org
Clement Park Family Medicine
6901 South Pierce Street, Littleton, CO 80128 303-932-2121 • clementparkfamilymedicine.org
South Suburban Internal Medicine
7750 South Broadway, Littleton, CO 80122 303-347-9897 southsuburbaninternalmedicine.org
PARKER
Parker Primary Care
free SUMMER Events & Seminars Join Parker Adventist Hospital for a series of FREE events and 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. Register online at parkerhospital.org/seminars.
Community Grand Opening Centura Health Meridian
Advances in Joint Replacement
Sun, Aug 28 | 11:30 a.m.-2:30 p.m. Come celebrate with us as we open our new neighborhood health center, which will include the area’s only 24/7 emergency and urgent care center and more. There will be food and fun for the whole family: 9499 South Oswego Street, Parker, CO 80134 in Meridian.
Tue, Oct 4 | 5:30-7 p.m. Join Dr. Derek Johnson, orthopedic surgeon, to hear about the latest advancements in knee and hip replacement surgery and learn if you may be a candidate.
Joint Pain in Athletic Adults
The Chronic Ear
Thu, Sep 8 | 5:30-7 p.m. Join Dr. Dan Sdrulla, ENT, neurologist, and skull base surgeon, to learn about chronic ear problems such as hearing loss, ear infections, sleep disorders, and balance disorders.
Urinary Incontinence, Overactive Bladder, and Aging in Women
Thu, Sep 15 | 11:30 a.m.-1 p.m. Join our new urogynecologist, Dr. Alison Tate, to learn about common pelvic floor disorders and effective treatment options.
CrossFit Injuries: Preventing Common Injuries and the Mission for Pain-Free Fitness
Tue, Sep 20 | 5:30-7 p.m. Join Dr. Justin Newman, an orthopedic surgeon and sports medicine specialist, and Dan Pope, a North American Strongman National Champion, competitive CrossFit athlete, and doctor of physical therapy, for an interactive session on CrossFit and weightlifting injury education, prevention, and treatment options.
Thu, Oct 6 | 5:30-7 p.m. Join Dr. Nate Faulkner, orthopedic surgeon, for an in-depth look at aging joints, common injuries that occur in older athletes, and how you can stay healthy and active.
What You Need to Know About Supplements
Thu, Oct 13 11:30 a.m.-1 p.m. Meet Dr. Vandna Jerath, OB-GYN, and learn about what supplements are key for maintaining a healthy lifestyle.
10371 Parkglenn Way, Suite 220 Parker, CO 80138 303-649-3100 • parkerprimarycare.org
Timberview Clinic at Parker
9399 Crown Crest Boulevard, Suite 200 Parker, CO 80138 303-269-4410 • timberviewclinic.org
Part of Centura Health, the region’s leading health care network. Centura Health does not discriminate against any person on the basis of race, color, national origin, disability, age, sex, religion, creed, ancestry, sexual orientation, and marital status in admission, treatment, or participation in its programs, services and activities, or in employment. For further information about this policy, contact Centura Health’s Office of the General Counsel at 303-804-8166. Copyright © Centura Health, 2016.
PHOTO: LIFTING ©KJEKOL — STOCK.ADOBE.COM
CENTENNIAL
CHPG Grace Family Practice