Spring 2013 | Vol. 1, No. 2
Your Connection to Healthy Living
A Hipper Lifestyle New hip replacement surgery returns patients to activity faster
Helen Haughey is always on the go after anterior hip replacement surgery. Read her story on Page 4.
Inside this Issue
2 3 7
Do you have a thyroid problem? Ministrokes pass without notice but spell trouble ahead Parents’ stress showing up in kids
porterhospitallorg :: Spring 2013
1
Photo by Ellen Jaskol
Skin Sense
Most common form of cancer striking hard in Colorado When it comes to skin cancer in Colorado, John Campana, MD, doesn’t beat around the bush: “It’s underfeared and undertreated,” he warns.
Most people receive 80 percent of their lifetime sun exposure by age 18. Campana, medical director of the oncology program at Porter Adventist Hospital, sees the results firsthand. He and his partners at Colorado Head & Neck Specialists are often called upon to construct new noses or ears, two of the most common spots for skin cancer, resulting from often-ignored lesions. Reconstruction usually takes hours and requires skin grafts from other parts of the body. “Skin cancer rates are exploding, especially here in Colorado,” Campana says. “People are not afraid enough.” There are more than a million new skin cancers diagnosed in the U.S. every year. The vast majority of these will be basal cell malignancies, which are generally not life-threatening and do not spread to other organs. Most of these are
easily managed by dermatologists. But just because it’s not melanoma doesn’t mean it isn’t dangerous. Left untreated, basal cell cancer can spread and cause large sores and protrusions that are not only unsightly but can permanently damage the eyes, ears, nose, lips, and bones of the face. “People get lulled into thinking that because most skin cancers are basal cell that they don’t need to worry,” Campana says. “I tell patients and doctors alike the same thing: biopsy early and biopsy often if you even have a suspicion that it might be cancer.”
Skin Safety Learn about skin cancer in Colorado: how to prevent it, how to spot it early, and how to treat it. Attend a FREE seminar on May 8 with Dr. Campana. See back cover for details.
Sorting out thyroid problems Small, but mighty — the thyroid gland regulates hormones affecting nearly every metabolic function in your body. Ever since Oprah Winfrey blamed her thyroid for her weight problem, many women think the same about their extra pounds. But in most cases, poor diet and lack of exercise are the culprits, says Julia Rifkin, MD, an internal medicine physician and endocrinologist at Porter Adventist Hospital. Dr. Julia Rifkin
2525 South Downing Street Denver, CO 80210 303-778-1955
2
“Even if there is a problem and we correct it, a woman may experience five to 10 pounds of weight loss once the thyroid levels are normalized,” Rifkin says. Hypothyroidism can cause fatigue, constipation, depression, or an inability to concentrate. However, symptoms such as dry skin or thinning hair can be a result of Colorado’s climate, so testing is needed to root out the cause, Rifkin says.
VIBRANT :: Porter Adventist Hospital
About 20 percent of people over 60 develop hypothyroidism, and about 5 percent of younger people do. The greatest risk factors are: Being female Being over age 60 Having diabetes or an autoimmune disease Having a family history
An autoimmune disorder that attacks the thyroid is the primary cause of hypothyroidism. But certain types of radiation therapy to treat cancer can also cause it in a very small percentage of patients. It is diagnosed through a blood test, and treatment typically is medication that begins relieving symptoms in four to six weeks, Rifkin says.
Learn More Concerned you might have thyroid problems? Attend a FREE seminar on April 11 with Dr. Rifkin. See back cover for details.
Photos: CHILD ©iStockphoto.com/Maica; SKY ©iStockphoto.com/erdavid; Doctor: Ellen JASCOL
Porter Adventist Hospital is a regional medical center that provides care for complex health issues. We specialize in general and robotic surgery, cardiovascular care, spine care, joint replacement, liver and kidney transplants, and cancer care. We are part of Centura Health, the state’s largest health care network. The purpose of this publication is to support our mission to improve the health of the residents of our community. No information in this publication is meant as a recommendation or to substitute for your physician’s advice. If you would like to comment or unsubscribe to this magazine, please email us at vibrant@centura.org.
Warning Sign
Ministrokes last less than five minutes but warn of danger ahead You’ve just pulled a 10-hour day and when you stand up to leave the office, your left leg feels weak and numb.
Same-day Diagnosis
You chalk it up to spending too many hours sitting at your desk and since the problem disappears by the time you reach your car, you don’t give it a second thought. But you should. You may have just had a “ministroke,” known as a transient ischemic attack or TIA. TIAs occur when a blockage temporarily prevents blood from getting to the brain. Symptoms typically disappear within 24 hours, with most going away in less than an hour. If you’ve had a TIA, there’s a one in three chance that you will have a major stroke within a year, according to the American Stroke Association. “TIAs are really warning strokes,” says Kryssy Kimminau, RN, program coordinator of Porter Adventist Hospital’s Advanced Primary Stroke Center. “Once you recognize that you’ve had one, you need to know what caused it and then manage those risk factors to avoid having one that could cause permanent disability.”
Porter Adventist Hospital is one of very few hospitals in the country and the first in Colorado to offer an outpatient clinic that assesses and diagnoses TIA patients in the same day. Diagnosing the underlying causes of a TIA and getting treatment are critical since 10 percent of TIA patients have a major stroke within a week of their attack.
FAST Action Needed The signs of a TIA, or ministroke, are the same as a regular stroke, but symptoms usually last less than five minutes.
F A S T
Face drooping Arm weakness Slurred speech Time to call 911
Risk factors include: ✓ High blood pressure ✓ Diabetes ✓ Cigarette Smoking ✓ Alcohol Consumption ✓ High cholesterol, specifically high LDL “Other stroke risk factors are inactivity and obesity,” Kimminau says. “People who are inactive due to recent illness or surgery are at risk of forming blood clots that can dislodge and travel to the brain, causing a stroke.”
Photo: MAN ©iStockphoto.com/laflor
Stroke Class Learn how to recognize the signs of a ministroke and how to reduce your risk in a FREE seminar on April 9. See back cover for details.
“What can take up to 28 days outside of our center, we get done in one day,” says Kryssy Kimminau, RN, stroke program coordinator at Porter Hospital.
Here’s a look at the day: 8 a.m. Patient arrives at valet parking and is personally greeted and taken through registration. 9 a.m. A customized plan is formed and testing takes place throughout the morning. Standard tests include blood tests, an MRI, EKG, and heart ECHO. 1 p.m. Patient meets with a
neurologist who goes over all test results and the recommended treatment plan.
3 p.m. Patient heads home
with a diagnosis and treatment plan to be implemented with the patient’s primary care doctor.
For more information about the TIA Clinic at Porter Adventist Hospital, please call 303-715-7842. Porter Hospital is part of the Centura Health Stroke Network, Colorado’s leading provider of stroke care.
porterhospital.org :: Spring 2013
3
Hip Hip
y a r o o H New anterior hip replacement surgery gets patients back on their feet faster
Helen Haughey isn’t a woman to sit around. After moving her household
from Kansas City to Denver last December, she turned around a week later to head to Hawaii and was barely back in Denver before boarding another plane to San Diego. So when this 51-year-old go-getter needed hip replacement surgery last fall, she looked into a new technique that was touted to result in a faster recovery. The procedure, called the anterior approach, is performed through the front of the hip rather than through the buttocks. And it is in hot demand by patients. “I was kind of in trouble with the doctor and physical therapist when I came in two weeks after my surgery because I was supposed to be using a walker, and I wasn’t,” Haughey says. “I just felt so strong so quickly.”
Helen Haughey quickly adopted an active outdoor life in Colorado after her anterior hip replacement.
Anterior hip replacement produces faster recoveries because it allows surgeons to replace the hip by moving muscles and tendons rather than cutting through them, says Charlie Yang, MD, an orthopedic surgeon with Colorado Joint Replacement at Porter Adventist Hospital who performed Haughey’s surgery. The surgery also removes short-term restrictions such as not crossing your legs or bending over to tie your shoes. “The long-term results of the traditional posterior approach and this approach are the same, but the benefit is in the first four to six weeks,” Yang explains. “Because tendons and muscles are not cut, most patients experience less pain and they are able to return to full function faster. They can do just about anything they want immediately.”
Waiting Game
Picking the right time for hip replacement Choosing the right time to have a joint replaced can be a bit tricky. You should never opt for a major surgery before you really need it, but you can wait too long, says Todd Miner, MD, an orthopedic surgeon who specializes in primary and revision joint replacement surgery with Colorado Joint Replacement at Porter Adventist Hospital. “We used to worry about whether an implant would last, so we tended to put off surgery,” Miner says. “But that’s really not an issue with the new implants.”
And that’s just what John Beaupre did. Ten days after getting anterior hip replacement surgery, also by Yang, the 71-yearPhoto by Ellen Jaskol
4
VIBRANT :: Porter Adventist Hospital
old Steamboat Springs resident hiked a 5½-mile trail. Five weeks later, he biked 350 miles across Mongolia.
“Once I saw that my patients were doing significantly better, I made a full commitment to this approach,” he says.
“I never looked back,” says Beaupre, who posted his second-best time ever running the seven-mile Atalaya Peak in Santa Fe four months after surgery. “I’m better than new as far as I’m concerned.”
Nearly anyone who needs a hip replacement qualifies for the anterior approach. The only limitations are patients who have irregular hip anatomy, either due to genetics or trauma, or who have had past hip surgery. In those cases, surgeons need the wider view provided by the posterior approach, Yang says.
Hip osteoarthritis can be difficult to diagnose because pain often appears in areas that seem unrelated to the hip. Pain can be a dull ache or sudden and sharp and can show up as: > Lower back pain > Groin-area pain > Knee pain Although anterior hip replacement has been around for 20 years, not many surgeons offer it because the posterior approach is so effective and because the anterior approach is difficult to learn. “You have to reorient your brain,” Yang says. “It’s like looking at the car engine from the top rather than the bottom.” Yang began researching the anterior approach three years ago, largely due to patient demand. After training in 10 hands-on seminars, called labs, he began performing the procedure. Since then, he has performed more than 250 anterior hip replacements and now does 80 percent of his cases this way. He expects to perform between 300 and 400 cases this year.
In most patients, the surgery can be performed through an incision just four to five inches long. By moving the muscles and tendons rather than cutting through them, the anterior approach provides more stability to the artificial hip and results in less chance of dislocation, which is a slight risk with the posterior approach. Physicians also believe that the anterior approach may provide slightly better accuracy in aligning the new hip due to the ability to obtain X-rays of the hip during the surgery. Even one millimeter of improved accuracy is meaningful because the hip wears better and lasts longer over decades of use. “I just feel so good that it’s an affirmation that our move to Colorado was the right thing,” Haughey says.
Some problems that can occur by waiting too long include: Loss of range of motion. As the hip stiffens, you tend to not use it as much, which leads the supporting muscles and tendons to shorten. The loss of range of motion can make regaining motion after surgery more difficult for the patient and therapist. Loss of overall fitness. When your joints hurt, it’s hard to exercise. When it’s hard to exercise, your heart, lungs, and overall health declines — and your weight can go up. These make surgery and recovery tougher and more risky.
Learn More Join Dr. Yang on April 20 to learn more about anterior hip replacement and how it can get you back to a full life faster than ever. You’ll also have the chance to learn more about the latest treatments and research into arthritis. See back cover for details.
Dependence on narcotics. If joint pain is severe, patients may need narcotic painkillers, but this makes pain control during and after surgery more difficult. It’s best to avoid narcotics, if possible, or work with your doctor to wean them down prior to surgery.
APRIL
20
IMAGES: STRETCH ©iStockphoto.com/Jan-Otto; WORKOUT ©iStockphoto.com/Feverpitched; PILLS ©iStockphoto.com/FotografiaBasica; CALENDAR ©iStockphoto.com/MrPlumo
porterhospital.org :: Spring 2013
5
Easier surgery for Parkinson’s patients Littleton Hospital first in state to offer “asleep” DBS
Using a new type of portable CT machine called the CereTom®, surgeons obtain precise images of the brain during the surgery. Prior to this, the procedure required separate surgeries to place markers in the head, implant the generator, and connect the batteries. The new procedure eliminates the first surgery and the need for patient feedback, allowing patients to be asleep during surgery. “Having to be awake was very stressful and uncomfortable for patients,” says David VanSickle, MD, PhD, the neurosurgeon performing this new procedure at Littleton Hospital. “The CereTom also enables us to improve the precision of lead placement. This reduces the risk of damage to nearby healthy areas and cuts operating time in half.”
Dr. David VanSickle
DBS is used for patients with Parkinson’s disease, essential tremor, or dystonia. It involves implanting an electrode in the brain that shortcircuits the electrical signals that cause symptoms. It is powered by a small battery pack implanted below the armpit.
Learn More Hear about the new “asleep” DBS at a FREE seminar with Dr. VanSickle on Thu, May 30, from 6-7 p.m. at Littleton Hospital. Go to mylittletonhospital.org/ classes-and-events.
Fine-tuned Adjustments For DBS to work effectively, the generator must be finely tuned and coordinated with a patient’s medications. Typically, that work is done by a neurologist at outpatient appointments that can take weeks or even months to secure.
DBS patients at Littleton Hospital, however, receive this treatment before going home through the Center for Rehabilitation at Porter Adventist Hospital. After the surgery, patients are transferred to this inpatient unit, staying an average of five to seven days while the generator is being adjusted by Mihaela Alexander, MD, an on-staff neurologist. Porter, Littleton, and Parker Adventist Hospitals are Centura Health hospitals serving DBS patients throughout Colorado and the Rocky Mountain region. “You might expect that everything becomes normal after the implant, but the reality is that you don’t just flip a switch,” says Gin-Ming Hsu, MD, a physiatrist and medical director of the unit. “Programming is typically done in stages. If this were done as an outpatient, it might take weeks, but we can usually complete it in days.” Nearly Symptom-free One patient recently had 95 percent of her symptoms disappear immediately after the surgery. But within a few days, some of her symptoms had returned, so the generator was adjusted along with her medications and she was able to go home nearly symptom-free, Hsu says.
“Had she not been here, it probably would have taken several months to get through the process that took us 10 days,” he says. Littleton Hospital is opening a similar inpatient rehabilitation unit later this year.
6
VIBRANT :: Porter Adventist Hospital
New deep brain stimulation procedure allows patients to remain asleep during surgery.
Photo: BRAIN ©iStockphoto.com/Firstsignal
A new approach for deep brain stimulation (DBS) available at Littleton Adventist Hospital reduces the number of surgeries and allows patients to now be asleep during the procedure.
Stressed Out From blurred vision to trouble breathing, worry and anxiety take families down No one really comes into Lori Leopold’s family medicine practice complaining of stress, but it’s the top health concern she’s seeing these days. “It shows up in a lot of ways,” says Lori Leopold, DO, an osteopathic medicine physician affiliated with Porter Adventist Hospital. “I see a lot of women who tell me they can’t focus or concentrate.” Whether it’s one time or ongoing, stress causes the body to release adrenaline and cortisol. Among other effects, these hormones depress the immune system while increasing blood pressure and glucose. The result can be headaches, body aches, insomnia, concentration problems, and weight gain — just to name a few.
To help unwind without causing financial stress, Dr. Leopold recommends taking advantage of the many family events throughout Denver, such as summer movies in the park. Her current favorite stress-free zone is the Denver Zoo’s Toyota Elephant Passage.
“Anxiety and depression are very common symptoms,” Leopold says. Chronic stress eventually can lead to high blood pressure, heart disease, and diabetes. Leopold works with her patients to measure and reduce stress. The first steps are ruling out other causes for health problems and teaching patients about the effects of stress. The motivation to get stress under control, however, often comes from realizing the nonphysical impact of stress. “Parents who are stressed are teaching their children how to respond to pressure, and I’m seeing more and more anxiety and depression in children, teens, and college-age kids,” Leopold says.
Warm Bedside Manner Having Lori Leopold, DO, as your doctor must be a lot like having a good friend, a really interesting good friend. Her warmth and laid-back style are a perfect fit for the Denver families who come to see this family practice physician. But it belies the interesting path she traveled before settling down in her Cherry Creek office.
Despite — or maybe because of — her travels, Leopold is very settled in Denver. Married with a 3-year-old son, she enjoys working with entire families, from children to grandparents. “It’s fun to see multigenerational families,” she says. “Plus it gives me better insight into a patient’s health when I know their entire family.” Name Lori Leopold, DO Practice Creekside Family Medicine Address 300 South Jackson Street, Suite 340, Denver, CO 80209
Photo by Michael Richmond
Photos: STRESSED WOMAN ©iStockphoto.com/miszaqq; ELEPHANT Courtesy of Denver Zoo
After growing up in Western Massachusetts, Leopold attended the prestigious Barnard College and Columbia University before participating in pancreatic cancer research at Memorial Sloan-Kettering Cancer Center in New York. Her work there led her to medical school in Arizona and residency at Virginia Commonwealth University before she headed out to serve as a primary care physician with first the Chickasaw Nation in Oklahoma and then the Apaches in Arizona.
Creekside Family Medicine is operated by the Centura Health Physician Group.
porterhospital.org :: Spring 2013
7
To make an appointment with Dr. Leopold, call 303-316-0416.
Portercare Adventist Health System
Non-Profit Organization U.S. Postage
Paid
Denver, CO Permit No. 4773
2525 South Downing Street Denver, CO 80210
Porter Adventist Hospital is part of Centura Health, Colorado’s largest health care network. 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. Copyright © Centura Health, 2013.
Re porte gister onli ne at rhosp ital.o rg/ev ents
Upcoming Events
Join the health experts at Porter Adventist Hospital to learn ways to stay healthy as well as new treatments for health problems. All programs are FREE but require registration by calling 303-777-6877. All programs, except where noted, are held in the Porter Hospital Conference Center with programs beginning promptly at 6 p.m. Arrive early for good seats and free light refreshments. Free valet parking at the hospital’s main entrance or plentiful free parking in the Porter Hospital parking garage is available.
APRIL
Is it your thyroid?
Arthritis Education Day
MAY
No Time for Stroke
Are your thinning hair, dry skin, and feeling like you’re constantly cold due to the Colorado climate, or is it your thyroid? Hypothyroidism and hyperthyroidism can happen at any age. Dr. Julia Rifkin will teach you the difference between them, how they’re diagnosed, and what treatment options you have. Date: Thu, Apr 11 Time: 6-7 p.m.
Learn the latest research and treatment for osteoarthritis. Experts specializing in knee and hip arthritis along with professionals who focus on pain management, rehabilitation, and exercise will be on hand. Orthopedic surgeons, Dr. Charlie Yang and Dr. Todd Miner, will be discussing the new anterior hip replacement surgery. Date: Sat, Apr 20 Time: Noon-4:30 p.m. Registration: 303-756-8622, extension 251
Healthy Journeys
For every eight minutes without oxygen, a pea-sized portion of the brain dies. With a stroke, time is critical. Join Porter Stroke Coordinator Kryssy Kimminau to learn how to recognize symptoms, identify risk factors, and decrease your risk. Date: Tue, Apr 9 Time: 6-7 p.m.
PhotoS: VACCINE ©iStockphoto.com/sjlocke; BLOOD PRESSURE ©DREAMSTIME/Eugene Sim Junying; SUNBURN ©iStockphoto.com/jcarillet
Get Vaccinated ! Find out how your immune system changes with age and what vaccines you need at what ages with Mistie Nguyen, Porter Hospital pharmacy outpatient coordinator. Date: Wed, Apr 10 Time: 2:30-3:30 p.m. L ocation: Porter Place Retirement Living, 1001 E. Yale Ave.
Back on Track Get past the pain and on with your life! Learn how to ease your back pain, when to seek a doctor’s care, why surgery might or might not help, and more with Porter Hospital physical therapist David LaValley. Date: Tue, Apr 16 Time: 6-7 p.m.
Aching Legs ? If your legs ache, especially when you walk, you could have peripheral artery disease. This dangerous disease slows down the flow of blood to your extremities. Join Dr. Carlos Rueda, Porter vascular surgeon, to learn the warning signs and risk factors. Date: Wed, Apr 17 Time: 6-7 p.m.
A survival guide to keep you healthy during your travels. Mistie Nguyen, Porter Hospital pharmacy outpatient coordinator, will talk about health precautions before you go and how to prevent illness while on the road. Date: Thu, May 2 Time: 6-7 p.m.
Dangers of Skin Cancer Come for a variety of FREE and low-cost health screenings, and free health advice from the experts at Porter Hospital. Date: Wed, Apr 24 Time: 7 a.m.-noon
More than 1 million cases of skin cancer are diagnosed every year. Some are life-threatening; some cause permanent damage; all are dangerous. Meet Dr. John Campana, medical director of oncology at Porter Hospital, and learn how to prevent, recognize, and treat this dangerous disease. Date: Wed, May 8 Time: 6-7 p.m.