M.A.X. SUMMER 2016
A man’s guide to maximum health
PLAY LIKE A PRO AGAIN Colorado Springs orthopedic surgeon Dr. Michael Feign guides you down the trail to joint health p3
LISTEN UP
HOT ROD BOD Maintaining your high-performance machine p7
NEW PROCEDURE
treats enlarged prostate without sexual dysfunction p2
PROST ATE
CANCE
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YOU HA VE OPTION S p4
PHOTO BY TOM KIMMELL
G STAYING STRONG
Recognize a Hernia
WHEN TO GET EMERGENCY ATTENTION If a hernia cuts off the blood supply to the intestine, it is a medical emergency. Symptoms include: e Sudden, severe pain e Nausea and vomiting e Fever e Inability to have a bowel movement and pass gas
Is It a Hernia?
If you think you have a hernia, make an appointment to see your primary care physician. Don’t have one? Make an appointment at a Centura Health Physician Group primary care office listed on Page 7.
50% of men will experience enlarged prostate
Get a Lift
NEW TREATMENT FOR ENLARGED PROSTATE INVOLVES NO CUTTING, WHILE REDUCING SEXUAL SIDE EFFECTS About half of men will experience enlarged prostate by the time they reach middle age. Traditional treatments include medications or removal of part or all of the prostate, both of which can cause erectile dysfunction. Now a new minimally invasive procedure called UroLift® is available that doesn’t involve cutting, heating, or removing any prostate tissue. Benjamin Coons, MD, a urologist at Penrose-St. Francis Health Services who performs UroLift, says, “This procedure is so promising because it allows men to return to normal activities in a few days, while minimizing sexual dysfunction.”
RELIEVING THE PRESSURE
Enlarged prostate, also called benign prostatic hyperplasia (or BPH), squeezes the urethra, causing urinary urgency or frequency, a weak or slow urinary stream, and waking at night to urinate. In the UroLift procedure, the urologist places tiny implants to hold the prostate lobes apart. “Instead of a closed channel of [enlarged] prostate lobes, you have an open channel that allows for better bladder emptying,” Coons says. Performed with local numbing and mild sedation, UroLift is an option for about 75 percent of men under age 80 with BPH, Coons says. Men generally resume normal activities in a day or two. “UroLift is a very minimally invasive procedure with a quick recovery that improves men’s quality of life without the need for long-term medications,” Coons says. M
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M.A.X. PENROSE-ST. FRANCIS HEALTH SERVICES
GET RELIEF
If you’re having urinary problems and think your prostate might be to blame, talk to your primary care doctor about a referral to a urologist to discuss treatment options.
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A hernia happens when the inner lining of the abdomen pushes out through a weak spot in the abdominal wall, allowing the intestines or another organ to bulge out. For men, that weak spot often develops near the groin, where natural �uch! openings on either side allow the spermatic cord to come down to the testicle. “Between 25 and 40 percent of men will develop a hernia sometime in their lives,” says Allen H. Tanner II, MD, a general surgeon at Penrose-St. Francis Health Services. Risk factors include a history of heavy lifting, chronic constipation, or a chronic cough. “Once someone notices a bulge or starts having pain, we recommend they see a surgeon,” Tanner says. “It won’t get better on its own.” And luckily the fix is relatively easy. Hernia repair is an outpatient surgery that takes about a half an hour. “Patients are back to regular activity in about a week,” Tanner says. M
Play Like a PRO Again A THREE-POINT PRESCRIPTION FOR JOINT HEALTH
Whether you work out only occasionally or you’re a fitness fanatic, you may notice that your joints don’t respond or recover the way they did in your glory days. To avoid injury and perform your best, follow these three power principles from Michael Feign, DO, an orthopedic surgeon at Front Range Orthopaedics, A Centura Health Clinic.
1 Consistency
Weekend warriors are inviting injury. Regular exercise lays the foundation for the strength, stability, and flexibility that allows you to play hard without getting hurt. “Just like you can’t cram a semester’s worth of information two hours before a final exam, it’s what you did months before that will stop you from getting injured that day,” Feign says.
2 Cross-training
While cardiovascular conditioning is important, strong muscles protect you from injury. Feign says that people tend to ignore two major muscle groups: the abdominals and the small rotator cuff muscles in the shoulder. “Strong abdominals are very important in reducing strain on the low back,” he says. “And people tend to develop the larger pectorals and deltoids, which overpower the rotator cuff muscles.” He recommends very low-weight, high-rep exercises to improve your shoulder strength.
3 Caution
Colorado offers easy access to a lot of extreme activities. But before you dive into a Tough Mudder or run a half marathon, consider your limits. Approach your daily workouts with the same level of caution. Sure, squats are great for building strong glutes, quads, and hamstrings. “But anyone who has anterior knee problems probably shouldn’t be doing lunges or squats,” Feign says. Your orthopedic doctor or personal trainer can steer you toward safer moves.
Finally, when injuries do happen, active guys may resist restricted activity while they recover. But “if you’re going to pay for the appointment, you might as well listen to the recommendation,” Feign jokes. M
Front Range Orthopaedics, A Centura Health Clinic is the official orthopedic provider for:
NEED A NEW KNEE?
If, despite medication and injections, pain from knee arthritis is getting in your way, it could be time to consider total knee replacement surgery. Talk to your doctor if: • Pain is affecting the quality of your daily living • You can’t do the activities you want to do, and you feel like you’re losing your independent lifestyle • You want to learn more about custom-fit implants Advancements in technology are making knee replacement surgery even more effective at getting patients back to activity faster. One such advancement is the development of custom designed artificial joints that reproduce the patient's normal anatomy. “The new custom 3-D knees give patients a better fit, which reduces pain, and better function, so the knee feels more normal,” says Ronald O. Royce, DO, an orthopedic surgeon at Front Range Orthopaedics. M For more information about new custom knee replacements, call Front Range Orthopaedics, A Centura Health Clinic at 719-473-3332.
Local high schools:
Lewis Palmer • Palmer Ridge • Mesa Ridge • Sand Creek
Penrose-St. Francis Total Joint and Spine Center offers FREE monthly hip, knee, and spine seminars. Visit penrosestfrancis.org/ events for upcoming topics.
PENROSESTFRANCIS.ORG
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Prostate cancer is the No. 1 most common cancer in men. But there’s no clear No. 1 best treatment option that fits every man. In fact, a prostate cancer diagnosis means you’re now faced with making a decision about what next steps you’ll take and where you’ll seek treatment. John Watson, a 64-year-old real estate professional from Westcliffe, knows all about it. His journey began with A chance business active surveillance (a “watch and wait” approach). But discussion led when a marker of prostate cancer in his blood called PSA John Watson to spiked, he knew it was time to take action. choose CyberKnife He just didn’t know which one. treatment for his “I had to sift through input that didn’t feel objective,” prostate cancer. he says. In fact, he only learned about the treatment he ultimately decided upon — CyberKnife® — through a chance conversation with a business partner. Now a year after treatment, he shares a bit of his journey.
PHOTO BY STEVE BIGLEY
RESEARCH YOUR OPTIONS
Penrose Cancer Center is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas. 4
M.A.X. PENROSE-ST. FRANCIS HEALTH SERVICES
As it does for many men, Watson’s prostate cancer journey began with elevated PSA numbers. “We watched it over time. It stayed static for a couple of years, but then it took a big jump,” he says, adding that the “velocity” of the PSA led to a biopsy and, later, an appointment with a urologist. “Hormonal treatment and radiation were touched upon, but surgery was really promoted to me as the gold standard,” Watson says. But something didn’t sit right. “I felt surgery was being way oversold. It was like a business deal where you have people competing with only their services,” Watson says. Ultimately, a conversation during a business deal sent Watson on a new fact-finding mission. “It was like a corny TV commercial. I was doing a business deal with a guy I see on a fairly regular basis, and he simply asked, ‘Is everything OK?’” “‘As a matter of fact, I have to go get a biopsy,’ I said.” “Is something going on with your prostate?” his colleague asked, and then followed Watson’s head nod with, “Have you considered CyberKnife?” CyberKnife radiosurgery isn’t actually surgery at all. Instead, it delivers high-dose radiation directly to the prostate while minimizing exposure to surrounding healthy tissue and nerves. It gets its name from the fact that it is so precise and fast. Treatment can often be completed in four or five days. “I began researching, and I became an informed patient,” Watson says, adding that he found his way to Anuj Peddada, MD, at Penrose Cancer Center. After a full workup and discussion about Watson’s goals and preferences, the two settled on CyberKnife. Watson successfully underwent the procedure at Penrose Cancer Center last July. His cancer is gone, he’s had only minimal side effects, and his intimacy with his wife is as good as ever. “I feel great. I’m healthy,” he says.
AVOID ONE-SIZE-FITS-ALL TREATMENT CENTERS
Peddada, medical director of radiation oncology at Penrose Cancer Center, says it’s critical for men to seek treatment at a center that offers a range of treatment options. “I think it’s important to go to a place that provides a comprehensive approach, with a full array of options for cancer treatment — including active surveillance — rather than pushing only the treatments they offer,” Peddada says. In his practice, Peddada starts with confirming the diagnosis. “I review the accuracy of the pathology with a trusted pathology group I have worked with for 16 years,” he says. He also uses multiparametric MRI, a specialized scan that uses several different sequences to image the prostate gland more clearly and accurately than ultrasound or CT. He follows that with a 17-gene assay test, which predicts the cancers that may be more aggressive. “I look at the patient, his goals, and his health. And only then do we put all the information together to determine the best treatment options,” Peddada says. “I’m very open to spending time with men and helping them sort this out.”
KEY QUESTIONS
For a patient sorting through treatment options, where does he start? “It’s really important not to rush. With prostate cancer, even when it’s in its most virulent form, there is time to make a decision,” Peddada says. It’s important that men ask these questions when going over treatment options with a urologist, a radiation oncologist, or a surgeon: Do you have a comprehensive approach that includes everything from a confirmation of diagnosis through a full range of treatment options — including active surveillance? Which treatments do you offer? Which treatments do you actually perform? Which treatments don’t you offer? How many patients do you treat each year with each type of treatment? Do you own this treatment center or have a financial interest in it? Finally, think in twos. “Bring another person with you to appointments so you have a second set of ears. And get a second opinion. Half of this is treatment, but half of it is follow-up. You need to find a doctor you can work with,” Peddada says. M
For more information about CyberKnife or to schedule a consultation with a radiation oncologist, visit penrosecancercenter.org or call 719-776-5282.
While there are many prostate cancer treatment options, this chart outlines some of the most common treatments and the major pros and cons. TREATMENT PROS
CONS
Active surveillance Avoids overtreatment
May leave anxiety or worry
Prostatectomy (surgical May remove all the cancer removal of the prostate)
Possible temporary or permanent incontinence and impotence
External beam radiation Noninvasive, no anesthesia, minimal side effects
Long course of treatment requires Monday-Friday radiation sessions for up to 8 weeks
CyberKnife robotic radiosurgery
No long-term data on effectiveness
Delivers precise doses of radiation while sparing nearby healthy tissue in 4-5 treatments
Possible damage to nearby healthy cells
Hormone therapy
Possible hot flashes, loss of sex drive, growth of breast tissue, or loss of muscle mass
*Penrose Cancer Center also offers high-dose-rate brachytherapy, which delivers focused, high-dose treatments over a 2-day span.
PENROSESTFRANCIS.ORG
When mapping out cancer treatment, terms like Gleason scores and staging and grading can seem overwhelming. But this is your life. And your lifestyle, age, health, and goals should play a huge part in guiding your treatment. Anuj Peddada, MD, urges men to consider a range of factors when sorting through options.
BUSINESS DEMANDS
Businessmen who travel and don’t want to disrupt their lives and jobs with eight weeks of radiation may want to choose short-course treatment options. “Men are not compromising their care by doing this,” Peddada says.
SEXUAL HEALTH
Sexually active men should consider surgical side effects — including possible erectile dysfunction — more heavily than a man who does not have a partner. “CyberKnife or brachytherapy may have the advantage here,” Peddada says.
AGE
Men in their 70s and in excellent shape may choose radiation or surgery, while men with serious health conditions may find that active surveillance is better for them.
HEALTH PREFERENCES
Brachytherapy (radioactive One-time procedure; seeds are placed right convenient, well-studied, into the prostate) excellent control/cure rates* It may shrink cancer, helping other treatments work better
Decisions Are in the Details
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Some men may just want the cancer — and the prostate — out, so surgery may be their top choice even with possible side effects. Other men may choose radiation for its low chance of urinary incontinence. M
7 Steps to Help Your Heart in Minutes Half of men who die suddenly of coronary heart disease did not have a single symptom. But 100 percent of men can be doing something to reduce their risk. Don’t know where to start? Don’t think you have the time? Erik Carlson, MD, a cardiologist at Colorado Springs Cardiology, A Centura Health Clinic and head of noninvasive imaging at Penrose-St. Francis Health Services, outlines seven heart-smart steps that take minutes — but can add years to your life.
Pack a healthy snack for work each day. “Replace potato chips and processed crackers and cheese with heart-healthy foods like almonds, carrots, or sliced apples,” Carlson says.
“Make time to relax, meditate, take deep breaths, or think positive thoughts every day,” Carlson says. Prefer techie over touchy-feely? Join CaféWell, a free interactive online tool provided by Centura Health that offers stress-reduction (and fitness and nutrition) strategies. Visit cafewell.com/code/centuramag.
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Throw out one bad choice 5 minutes weekly
Pick one unhealthy item to remove from the refrigerator or pantry each week — then, replace it with a healthy choice, such as seeds or a new fruit or vegetable. “You don’t have to clean house radically. Just take steps to work toward a healthier diet,” he says.
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Get your numbers checked 10 minutes annually
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15 minutes one time
A heart calcium CT scan checks your arteries for plaque buildup. (See box.)
Take a class
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“You should know your blood pressure and cholesterol numbers like you know your phone number and address,” Carlson says, adding that high blood pressure is one of the largest modifiable risk factors for heart attack and stroke. “For every 20 points your systolic blood pressure (the top number) is greater than 115, you double your risk for stroke.”
Get a coronary calcium score
15 minutes daily
45-60 minutes weekly
Smoking cessation, exercise, or nutrition classes can set your heart health up for success. Find fitness classes at Penrose-St. Francis Health Services by calling 719-776-5776 or visit penrosestfrancis.org/calendar.
Go for a walk
90 minutes weekly
CALCIUM SCORING can identify if your arteries are
blocked or clogged. Penrose-St. Francis Heart and Vascular Center offers calcium scoring screening for $149, and a physician referral is not needed. Call 719-776-8080 for information or to schedule an appointment. M.A.X. PENROSE-ST. FRANCIS HEALTH SERVICES
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“A recent large study followed over 50,000 people during a 15-year period. Walking or jogging for as little as 90 minutes per week resulted in a 35 percent reduction in death and a 50 percent reduction in heart attack, compared with those who did not exercise,” Carlson says. “There’s no pill or test I can give that even comes close to reducing your risk by that number.” M
SIGNS YOUR TICKER IS IN BIG TROUBLE Could you be on the road to a heart attack? Many risk factors — such as high blood pressure, high cholesterol, and undiagnosed diabetes — are “silent.” If you see these heart attack warning signs outlined by the American Heart Association, don’t delay — call 911 immediately. Chest pain (including pressure, squeezing, or fullness) Upper body discomfort (including arms, back, neck, jaw, or stomach) Shortness of breath
Need a cardiologist? Schedule an appointment with Colorado Springs Cardiology, A Centura Health Clinic at 719-776-8500.
Cold sweats, nausea, or lightheadedness
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Take a breath, or two
5 minutes daily
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Bypass processed snacks
YOUR BOD…
AS A HOT ROD? If your car’s engine light goes on, you don’t ignore the problem. You probably keep up with oil changes and brake checks, too. Your body is a lot like your car, but the consequences of running it hard without proper maintenance can be dire. “One in five males dies before the age of 65 because of a medical condition that was entirely preventable,” says Nicholas Piantanida, MD, a family and sports medicine physician at Centura Health Physician Group Primary Care Broadmoor. This five-point inspection can keep you running on all cylinders well into your “classic” years.
1. KEEP YOUR ENGINE RUNNING CLEAN.
Your heart acts as your body’s engine, so it’s important to keep the fuel system running clean. “High cholesterol and hypertension are the two leading causes of stroke, heart attack, and heart failure,” Piantanida says. Checkup: Get your blood pressure and cholesterol checked. If you smoke, live a sedentary lifestyle, or eat a fat-laden diet, talk to your doctor now about lowering your heart disease risk.
2. KNOW THE RIGHT MAINTENANCE SCHEDULE. At 30,000 miles, you may get your fuel filter changed — or not. The same can be true for screenings for prostate cancer, the No. 1 cancer in men. “There are several preferences in terms of how and when to check for it, and when or if to treat it,” Piantanida says. Checkup: Start a discussion about prostate cancer with your primary care provider at age 50.
3. PROTECT YOUR PAINT.
Over time, your car’s finish gets dull. So does your skin. “You may see corrosion. Or is it a bigger problem that might lead to structural damage?” Piantanida says. Checkup: Get an annual skin check, especially if you spend a lot of time in the sun or are at risk of skin cancer. If you notice any changes in moles, get them checked by your doctor immediately. Use broad-spectrum SPF 50 (or greater) sunscreen.
4. CHECK YOUR LINES.
Colorectal cancer is the third most common cancer killer in men. “If you inspect all the lines and find something wrong, you can take out the defective parts. Colonoscopy can remove precancerous polyps,” Piantanida says. Checkup: Schedule a colonoscopy at age 50 (earlier for men with family history).
5. PAY ATTENTION TO SPARK PLUGS.
By age 60, the body’s natural immunity begins to wane. “To give our body’s immune system a boost and some protection, immunizations are important,” Piantanida says. Checkup: Talk to your doctor about these four immunizations: Zostavax® (age 60, for shingles); Prevnar 13® (age 50 and older, for pneumococcal disease); PPSV23 (age 65, for 23 different types of pneumococcal disease); and tetanus, every 10 years. M
NEED A GOOD BODY MECHANIC? SCHEDULE AN APPOINTMENT WITH ONE OF THESE PROVIDERS:
Centura Health Physician Group Primary Care Broadmoor 1263 Lake Plaza Drive, Suite 230 Colorado Springs, CO 80906 719-776-3300
Penrose-St. Francis Primary Care 3027 North Circle Drive Colorado Springs, CO 80909 719-776-4646
Centura Health Physician Group Tri-Lakes Primary Care Tri-Lakes Health Pavilion 17230 Jackson Creek Parkway, Suite 300 Monument, CO 80132 • 719-571-7000
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Penrose-St. Francis Health Services 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, 2016.
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FIVE TIPS TO PREPARE FOR YOUR COLONOSCOPY
Colonoscopy is the best screening tool for colorectal cancer for most patients because it can detect and remove precancerous polyps at the same time. And, if the test is negative, most men only have to do it once every 10 years unless they have other risk factors. Even so, only three in five adults age 50 to 75 are getting screened for colon cancer. Of people at high risk because of family history, only two in five get the recommended screenings. Some people are wary of the prep that’s needed to clean out the colon for a clear view. “It’s not easy, but it’s so critical to do it right,” says Erik Van Os, MD, a gastroenterologist at Penrose-St. Francis Health Services. Here are five tips for making the best of it:
1. Less is more.
You used to have to drink about a gallon of prep solution, but now “we use the smallest amount of volume necessary to get an excellent result,” Van Os says.
2. Take a break. You’ll
need to stay home near a bathroom while the prep is doing its job, so why not have a movie marathon or a Netflix binge?
3. Sweeten the sip. You
can mix the solution with Sprite to make it taste better and drink it through a straw to sneak it down.
4. Follow instructions. “Our ability to see and remove polyps is very much connected to the quality of the preparation,” Van Os says. Research is clear that a split prep works best, with the first dose of the prep solution taken the evening before and the second dose a few hours before the colonoscopy.
5. Remember why. When
colorectal cancer is caught early before it spreads, the five-year survival rate is greater than 90 percent.
Call your gastroenterologist to set up your colonoscopy at the Penrose-St. Francis GI Lab, with fast results from on-site biopsies if needed. Don’t have a GI doctor? Talk to your primary care doctor for a referral or visit penrosestfrancis.org/gidoctors. M.A.X. is published 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. M.A.X. is produced by Clementine Healthcare Marketing. For comments or to unsubscribe to this publication, please email us at max@centura.org. Executive editor is Jill Woodford.