Vibrant Summer 2015

Your Connection to Healthy Living Summer 2015 | Volume 3, Issue 3

When Jerome Peralta (right) needed a kidney, he found his lifesaving connection through family friend Michelle Martin.

Read their story on Page 4. 

lives

CONNECTED

Porter Adventist Hospital’s participation in the National Kidney Registry creates lifesaving ripples for transplant patients across the country.

3  Cancer screening standards 6  Warning signs for women 7  Advanced technology for joint replacement

porterhospital.org :: Spring 2013

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PHOTO BY ELLEN JASKOL

REMOVAL THROUGH THE BELLY BUTTON

More than 25 million Americans have gallstones, with 1 million new cases joining their ranks annually.

If you’re one of them, and you find yourself among the half-million patients needing cholecystectomy (commonly called gallbladder removal), then single-site surgery may be the answer. Single-site cholecystectomy uses the da Vinci® Surgical System robot-assisted platform and specialized technology to work entirely through the belly button.

While gallbladder removals have been performed laparoscopically for years, Porter Adventist Hospital’s team of doctors, David Baer, MD, FACS, and James DeLine, MD, FACS, also offer the Porter Adventist surgery using the da Vinci platform Hospital’s advanced and the single-site technology. robotic surgery program is supported “This gives us a cosmetic advantage

by Centura Centers for with all the advantages of controlling Clinical Innovation, a robot-assisted arm to perform the extending advanced surgery,” says Baer. “The da Vinci health technologies platform offers a magnified 3-D vision across Colorado and and much more precise motion.” western Kansas.

“Nearly all patients are candidates for this type of cholecystectomy,” DeLine says. “Few exceptions, including scarring from previous surgery or obesity, preclude use of the da Vinci single-site platform.”

LEARN MORE about gallbladder removal through the belly button, as well as other robotic-assisted surgeries including hernia repair; spleen and adrenal surgeries; and diseases of the colon, including cancer and diverticulitis, at a FREE class on July 22. See back cover for details.

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SPOTTING BIPOLAR

disorder in young adults According to the National Institute of Mental Health, at least half of all cases of bipolar disorder begin before age 25.

Yet in this age group, it’s tricky to tie signs to the illness.

“There’s so much transition during that time with high school graduation, college, career, an increase in autonomy, possible experimentation with drugs or alcohol, and changing social patterns,” says Steven Mays, MD, medical director of inpatient adult psychiatry at Porter Adventist Hospital. “It can be difficult to identify bipolar disorder. Is it simply adjusting to a season of new expectations? Or is it onset of some kind of mental illness?”

Bipolar disorder, formerly known as manic-depressive illness, involves mood episodes consisting of mania and depression. Mania is the state of being overly joyful or euphoric, while depression is episodes of extreme sadness or hopelessness.

“Depression is easier to spot. Life is harder. They lose interest in doing things they have enjoyed. They are more avoidant and more irritable,” Mays says. Mania, however, can be harder to recognize — especially in college and early career twentysomethings who are transitioning friend bases. “If people don’t have a sense of what you’ve always been like, they may not know that this funny, exuberant friend who is impulsively engaging in risky behaviors — drinking alcohol, doing drugs, having promiscuous sex — actually is someone who has made a pretty big change in judgment,” Mays says.

Key mania symptoms include:

Sleeping little (still with very high energy)

Impulsiveness

Overestimation of one’s abilities Lack of internal realization that behaviors have shifted

Pressured speech or disorganized speech may also come into play.

“This is more than just ‘fast-talking.’ You’re jumping from point A to B to R to Y. For the person telling the story, the quick shift in ideas makes sense,” Mays says.

LEARN MORE at a FREE community seminar on how

to spot and treat bipolar disorder and depression in young adults on Sept. 30 at 6 p.m. See back cover for full details.

VIBRANT :: Porter Adventist Hospital

PHOTOS: BELLYBUTTON ©DOLLARPHOTOCLUB.COM/MARKOS86; TREE ©DOLLARPHOTOCLUB.COM/FRESHIDEA

GALLBLADDER

HOT-TOPIC TESTS

Help deciphering conflicting standards on common cancer screenings

PSA

MAMMOGRAPHY

PAP TESTING

When it comes to cancer screening recommendations, colliding sets of standards make opinions on the matter seem, well, testy. Here are side-by-side standards, plus a physician’s viewpoint on how to sort through it all.

American Cancer Society (ACS): Women should begin pap screenings every three years, starting at age 21. Beginning at 30 and through age 65, the preferred screening is a Pap test combined with a human papillomavirus (HPV) test every five years. Another option is Pap testing alone every three years.

U.S. Preventive Services Task Force (USPSTF): Same recommendation (although the USPSTF does not designate Pap/HPV coscreening as preferred).

Anne Michelle Safley, MD, an internal medicine physician at Porter Primary Care, says better understanding of HPV has shifted the cervical cancer discussion. “We now know that HPV causes almost 100 percent of cervical cancers. Thus, two big changes are in effect: We’re including HPV cotesting in patients 30 to 64 years old with our Pap screening, and we’re immunizing kids and young adults to prevent HPV infection. This is our only cancer vaccine in all of medicine, and it is safe and effective.”

ACS: Women should begin getting annual mammograms at age 40 and should continue to do so as long as they remain in good health.

USPSTF: The USPSTF recommends biennial screening mammography for women ages 50 to 74 years.

When and how often to have a mammogram may be the biggest hot button in breast health — ever. Safley believes thoughtful, one-on-one conversations with patients about risks, family history, and genetics are important. “When talking about screening, we’re throwing at a moving target. Our primary goal is to have honest and thoughtful conversations with our patients. Our hope is to mitigate risk by taking reasonable steps to detect cancer at earlier and more treatable stages.” A bone density or DEXA Scan is also recommended for women over the age of 50 or who are postmenopausal.

ACS: Starting at 50 (or as young as 40, depending on risk), men should make an informed decision with their health care provider about whether to get a PSA test to screen for prostate cancer.

USPSTF: The USPSTF recommends against prostate-specific antigen (PSA)based screening for prostate cancer.

“PSA testing is another test that remains controversial,” Safley says. Part of the dilemma stems from the fact that elevated PSA does not always correlate with cancer. Individual risks, including family history, remain important in determining the benefits of PSA testing.

Porter Adventist Hospital is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas.

Dr. Anne Michelle Safley Internal Medicine Porter Primary Care

Founded in 1930, Porter Adventist Hospital is proud of its 85-year legacy of compassionate, personalized health care for Denver and its surrounding communities. As your partner in good health, we hope you’ll talk to your doctor and mark your calendar with these other top screenings to consider as you age: Cholesterol Blood pressure

COLONOSCOPY

Blood glucose ACS: Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of these screening tests (colonoscopy should be done if results of any of the latter three are positive):  Colonoscopy every 10 years  Flexible sigmoidoscopy every five years  Double-contrast barium enema every five years  CT colonography (virtual colonoscopy) every five years

USPSTF: The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years.

Clinical breast exam Pelvic exam TSH (thyroid) screening Bone density screening

“With colonoscopy, there is an additional benefit. In this procedure, we not only detect precancers, but we also prevent polyps from developing into invasive cancer” by removing them during the procedure, Safley says.

To LEARN MORE about what preventive cancer screenings you should get as you age, come to a FREE seminar on Sept. 15. See back cover for details.

Summer 2015

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Life-Changing G I FT Porter Adventist Hospital’s participation in National Kidney Registry offers another path to dialysis patients Jerome Peralta was part of a chain of 34 people across the country who received lifesaving kidney transplants.

PHOTO BY ELLEN JASKOL

JEROME PERALTA WAS A MAN ON BORROWED TIME. Just 30 years old when his kidneys failed, and 42 years old when a donated kidney from his mom failed him, his weekly routine had become 12 hours on kidney dialysis just to rid his blood of poisons and stay alive.

He felt sluggish every morning and had to rest often. Travel and treatment time cut into his job as a data analyst in the health care industry. Even worse, he had amassed antibodies that would fight off organs from 99 out of every 100 live kidney donors, making the chances of a successful third transplant unlikely.

A sister, cousins, and close colleagues came forward to see if they were potential matches. None were. And that’s when a family friend, a stranger from Virginia, and the National Kidney Registry came in to this remarkable story.

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some point down the road, the other shoe was going to drop.

Kidneys, unfortunately, don’t come with a lifetime warranty.”

Peralta’s physician, Phil Gauthier, MD, an internal medicine specialist and director of transplant medicine at Porter Adventist Hospital, says live donor kidneys typically last 10 to 15 years. “Peralta’s lasted 13. He was in a desperate situation, on dialysis three times a week for four hours, knowing Dr. Phil Gauthier that he was basically looking for one out of 100 donors who would be compatible with him. Life on dialysis is not pretty. Patients are really sick, and one out of every five patients on dialysis dies every year,” Gauthier says.

Peralta muscled through the regimen for nearly three years.

Meanwhile, a chain of events was beginning elsewhere in the U.S. by an anonymous “Good Samaritan” donor who started a process that would give 34 people across the country new kidneys.

But first things first.

THE CLOCK STARTS TICKING

PUTTING THE PUZZLE TOGETHER

Peralta knew when he received a kidney from his mom at age 30, he was destined for a future transplant. “I knew at

Michelle Martin, a 25-year-old U.S. Army Sergeant in the Military Police stationed at Denver Federal Center in

VIBRANT :: Porter Adventist Hospital

Colorado, came forward to donate her kidney to Peralta. A longtime family friend, Martin couldn’t sit idly by. “I was just raised to do the right thing. Jerome needed a kidney. I had two healthy ones,” she says.

The morning of Jan. 8, Peralta’s new kidney “landed” in Denver from Virginia. Transplantation at Porter Adventist Hospital was a success. Immediately he felt better, as his new kidney went to work cleaning out the poisons in his blood.

While her kidneys were a mismatch for Peralta, the pair was approached about tackling the situation a different way.

“The transplant team at Porter Adventist Hospital asked if we would be willing to participate in a donor exchange program,” Peralta says.

Just a week later, Martin underwent robotic-assisted surgery at Porter Transplant Center to remove her left kidney, and her donated organ was immediately flown to a recipient in California. “It never really crossed my mind that my kidney was going to someone else and not Jerome. To be able to help someone in general was an amazing feeling,” she says.

Called the National Kidney Registry (NKR), the program matches donors and recipients from all over the country, putting them together like a puzzle. The switch that starts a “chain” is when a recipient enters the pool with a donor who can be matched with a patient already in the registry. That recipient’s donor is then paired with another recipient from the pool and the chain builds from there.

“It’s a big deal for Porter,” says Bipin Bista, MD, transplant nephrologist who heads up Porter Adventist Hospital’s NKR affiliation. “In Colorado, we are the only transplant center that the NKR utilizes.”

Bista describes the program: “Most of the time, people enrolled in NKR have a donor, but that donor isn’t a match. They are put into a database, and the NKR will assign certain donors who might be a potential match for our recipient,” he says. “It broadens opportunities (to find a match) for patients.”

Joe Sinacore, director of education and development for the NKR, says the process starts with an altruistic donor. “This is someone who is donating a kidney to a stranger. Their gift allows us to start a chain of donors, which helps more than one person. If you can keep the number of pairs cascading forward, we can help find many matches,” he says.

The process not only helps the direct recipients, but also reduces the number of people waiting for a deceased donor kidney. “Every patient who can get matched comes off the deceased donor waiting list. That means other patients who do not have live donors move up on the list,” Sinacore says.

KIDNEY CONNECTIONS For Peralta and Martin, the call came in December 2014 that NKR had put together a potential chain that included them.

Events unfolded quickly.

She absolutely knew she was doing the right thing in the week prior to her surgery when she checked in on Peralta. “The best thing that came out of it was seeing Jerome’s daughters — the look on their faces, the knowledge that their dad was going to be around for a long time,” she says.

‘BACK TO MY ORIGINAL LIFE’ Now, almost 46 years old, Peralta reflects on the selflessness from others that has given him life. He cherishes a letter his Virginia kidney donor sent along with his new kidney, pausing for a moment to gather thoughts and let tears flow. “I’m eternally grateful. This generosity has forever changed my life,” he says.

Bista says the NKR, and Porter Adventist Hospital’s participation in it, offers happy endings all around. “To build up a chain takes a whole lot of effort, but it’s worth it when you see the lifesaving events that ripple throughout the chain.

For donors, they feel so good. They are able to contribute. For the recipient, their quality of life so drastically improves and their expected life span lengthens,” he says.

In fact, for Peralta, the larger issue is holding back from everything he wants to do. “I feel fantastic. I couldn’t be more pleased with the functioning of my new kidney. I feel great.

Today, I’m doing as much as the doctors will allow me to without pushing more than I should,” Peralta says, noting that he’s walking up to 5 miles a day and has started light jogging. “I’m almost back to my original life.”

LEARN MORE at a FREE community seminar with Dr. Gauthier on kidney disease, how to prevent it, and live donation on Aug. 12 at 6 p.m. See back cover for details.

To LEARN MORE about Porter Adventist Hospital’s place as a leading organ transplant center in the region, please visit porterhospital.org/transplant. Or call 303-778-5797 or toll-free 1-855-869-5164. porterhospital.org :: Summer 2015

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Learn m kidney d

SIGNS

CHANCES ARE IT’S NOTHING. BUT YOU DON’T KNOW THAT. THESE COULD BE THE WARNING SIGNS OF A GYNECOLOGIC CANCER, SO PAY HEED.

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ynecologic cancers, including ovarian and uterine, are relatively rare, accounting for less than 3 percent of cancers in women. Still, more than 71,500 women will be diagnosed this year with gynecologic cancers, according to the Centers for Disease Control and Prevention. Survival rates are very high if the cancer is caught early, says Glenn Bigsby, DO, a gynecologic oncologist at Littleton Adventist Hospital and Parker Adventist Hospital. “If detected early, at Stage 1, the five-year survival rate is very high for most types,” says Dr. Glenn Bigsby Bigsby, one of just 1,200 physicians nationwide who specialize in the diagnosis and treatment of these cancers.

The most critical factor is that women pay attention to their bodies and report any changes to their doctor early, he says. Symptoms include abnormal vaginal bleeding (especially after menopause), pelvic pain or pressure, abdominal or back pain, bloating, itching or burning, and changes in bowel movements.

OVARIAN CANCER Next to lung cancer, ovarian cancer is one of the deadliest cancers that can strike women. That’s mostly because there is no screening test that can help diagnose it at an early stage, making it all that much more important to pay attention to symptoms, Bigsby says. Cure rates are 70 to 90 percent if the cancer is found while still confined to the ovary, according to the American Cancer Society.

If it’s not cancer, it could be something else that can be treated. Conditions such as endometriosis, fibroids, and even irritable bowel syndrome can cause the same symptoms. And if a pelvic mass is found, there are now two blood protein tests that can help rule out cancer without having to undergo surgery.

ENDOMETRIAL CANCER The most common type of gynecologic cancer is uterine cancer that occurs in the lining, or endometrium, of the uterus. Endometrial cancer is increasing along with obesity rates, Bigsby says.

Fat tissue creates estrogen, which stimulates the lining of the uterus and spurs the development of cancer, he explains.

About 80 percent of endometrial cancers can be cured with a hysterectomy, but they must be diagnosed early before spreading.

The most common symptom is abnormal bleeding.

Porter Adventist Hospital is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado.

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VIBRANT :: Porter Adventist Hospital

Detecting Ovarian Cancer There is no screening test to help catch ovarian cancer early. But three questions can help determine if a woman should be tested for ovarian cancer, according to a study published in the Open Journal of Obstetrics and Gynecology.

1 DO YOU HAVE ABDOMINAL AND/OR PELVIC PAIN?

2 DO YOU FEEL FULL QUICKLY, AND/OR ARE YOU UNABLE TO EAT NORMALLY?

3 HAVE YOU EXPERIENCED ABDOMINAL BLOATING AND/OR INCREASED ABDOMEN SIZE?

Gynecologic conditions, including cancer, are being more effectively treated through robotic-assisted surgery. Using the advanced da Vinci® robot, gynecologic oncologist Dr. Glenn Bigsby can remove even the tiniest cancerous lesions and tumors without injuring organs, arteries, or healthy tissue.

Learn more about gynecologic cancers and robotic surgery, or make an appointment with Dr. Bigsby by calling 303-955-7574.

PHOTOS: ©ISTOCKPHOTO.COM/SVETIKD, /SANNIE32

WARNING

IT STARTS OFF SMALL — SOME SPOTTING, A BLOATED BELLY, MAYBE SOME PELVIC PAIN, OR JUST PRESSURE.

The Cutting Edge

Joint replacements are helping younger patients stay mobile longer

Hip and knee replacements are among the most successful surgeries performed today. That’s a good thing, since patients seem to be turning to joint replacement at younger ages.

PHOTOS: GOLF ©DOLLARPHOTOCLUB.COM/SAMOTT; DOCTOR BY MICHAEL RICHMOND

“Over the last 20 years, patients who are younger and more active are ending up with arthritis.

Most people used to think joint replacement was an ‘old person’s surgery.’ That’s not true anymore,” says Jason Jennings, MD, DPT, an orthopedic surgeon at Colorado Joint Replacement (CJR).

Today, advancing implant technology and techniques leave experts optimistic that implants will last longer than ever. In fact, implants can last up to 15 or 20 years. “We encourage people to be active,” Jennings says.

As sheer numbers of joint replacement surgeries grow — today, on average, 600,000 knee replacements and 285,000 hip replacements are performed in the U.S. each year — it’s key to find experienced surgeons who specialize in the latest techniques. The orthopedic surgeons at CJR pride themselves in experience and precision, as the practice focuses solely on joint

600K KNEE 285K HIP NUMBER OF REPLACEMENT SURGERIES IN U.S. EACH YEAR

When Jason Jennings, MD, DPT, challenges a total joint replacement patient to get up and walk the same day as surgery, he knows what he’s asking. He spent four years as a physical therapist before starting medical school at age 28.

That was 10 years ago. Today, as the newest physician at Colorado Joint Replacement, he brings a unique perspective.

“I’ve been in the trenches on both sides. I’ve seen what the patients go through following surgery,” he says.

replacement procedures. They perform more than 2,000 joint surgeries each year and train surgeons from all over the world.

And, Jennings says, they are always looking ahead. “We are very passionate about research here,” he says, noting that CJR has research affiliations with the University of Colorado’s physical therapy department and the University of Denver Biomechanics Lab. “We want our patients to know we’re innovative and state-of-the-art.”

LEARN MORE about the causes of hip pain and the treatment options to relieve your pain and restore your mobility at a FREE seminar on July 28. See back cover for details.

Why did he shift gears?

“It was one of those paths in life that you just run into a little later. I thought a medical degree and my experience as a physical therapist could bring everything together for patients,” he says.

Following medical school at the University of South Florida at Tampa, five years of residency at Duke University Medical Center, and a year of fellowship with Colorado Joint Replacement, he officially joined the surgical staff with CJR on June 1.

While he loves returning patients to their feet, front and center of every day is being a dad to his 3-year-old daughter and 5-year-old son. “My wife and I are teaching our kids to ski. We also do a lot of hiking.

We’re outdoors people,” he says, noting that his wife is also a physical therapist in the Denver area.

Dr. Jason Jennings doesn’t have cable. “We have a small TV that the kids can watch movies on, but we try not to sit inside too much,” he says.

To make an appointment with Dr. Jennings, call Colorado Joint Replacement at 720-524-1367.

porterhospital.org :: Summer 2015

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Portercare Adventist Health System

Non-Profit Organization U.S. Postage

PAID

Denver, CO Permit No. 4773

E. Vassar

2525 South Downing Street Denver, CO 80210

S. Downing St.

S. Washington St.

S. Broadway

Porter Adventist Hospital is E. Evans Ave. a regional medical center that provides care for complex health issues. We specialize in complex surgery, E. Harvard Ave. cardiovascular care, spine care, joint replacement, liver and E. Yale Ave. kidney transplants, and cancer care. We are part of Centura Health, the region’s leading health care network. Vibrant is published quarterly by Porter Adventist Hospital – Portercare E. Hampden Ave. Adventist Health System. The purpose of this publication is to support our mission to improve the health of the residents in our co mmunity. 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. Vibrant is produced

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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.

Reg porter ister online a hospit al.org t /even ts Join the health experts at Porter Adventist Hospital to learn ways to stay healthy. All programs are FREE and are held in the Porter Adventist Hospital Conference Center unless otherwise indicated. For programs held in the Porter Adventist Hospital Conference Center, there is a free parking garage as well as free valet parking at the hospital’s main entrance. Registration is required for all events; register online at porterhospital.org/events or call 303-765-6549.

UPCOMING EVENTS GALLBLADDER SURGERY OPTIONS: WHAT’S RIGHT FOR YOU?

Join Dr. David Baer and Dr. James DeLine to learn more about gallbladder removal through the belly button as well as other surgical procedures, including hernia repair, spleen, and adrenal surgeries, to find out what might be right for you.  Date: Wed, Jul 22  Time: 6-7 p.m.

HEALTHY HIPS

PHOTO: ©ISTOCKPHOTO.COM/KIRIN_PHOTO

Hip pain can be the result of fractures, arthritis, osteonecrosis, trochanteric bursitis, tendinitis, strains, sprains, lower back pain, or an infection.

Dr. Jason Jennings will discuss these hip conditions as well as treatments that will help alleviate hip pain and restore mobility.  Date: Tue, Jul 28  Time: 6-7 p.m.

EVERYTHING YOU WANTED TO KNOW ABOUT YOUR KIDNEYS … BUT WERE TOO AFRAID TO ASK

More than half of adults over the age of 30 are likely to develop chronic kidney disease in their lives. Join Dr. Phil Gauthier to learn about chronic kidney disease, why the rate of this disease is increasing, and how to reduce your risk.  Date: Wed, Aug 12  Time: 6-7 p.m.

COMMON CANCER SCREENINGS: HOW TO MAKE SENSE OF IT ALL Confused by what preventive screenings you need and at what age? Join Dr. Anne Michelle Safley as she helps us sort through the standards on common cancer screenings as well as her viewpoint on how to make sense of it all.  Date: Tue, Sep 15  Time: 6-7 p.m.

OPEN HOUSE

Please join Centura Health Physician Group Primary Care Porter for their Open House. Stop by to check out their beautiful new space and bring your family to enjoy a wonderful evening of great food, giveaways, face-painting and even a frozen yogurt truck!  Date: Tue, Sep 29  Time: 4-7 p.m.  L ocation: 950 East Harvard Avenue, Suite 200, Denver

RECOGNIZING AND MANAGING SYMPTOMS OF MAJOR DEPRESSION AND BIPOLAR DISORDER Want to learn how to live a healthy life with a mood disorder? Join us to learn how to recognize symptoms of depression and hypomania/mania, general courses of treatment, and how to identify levels of intervention and treatment.  Date: Wed, Sep 30  Time: 6-7 p.m.