FALL 2018 • Volume 6, Issue 4
Your health. Your life.
A VAST FIELD OF
OPTIONS INTERVENTIONAL RADIOLOGY PROVIDES MINIMALLY INVASIVE TREATMENT OPTIONS FOR HEALTH ISSUES FROM HEAD TO TOE Page 4
Jessica Mares found relief for decades of pain with a new procedure offered at Littleton Adventist Hospital.
a n d ...
WHAT YOU CAN DO TO FIGHT THE FLU Page 2
DIRECT TO IMPLANT: BREAST RECONSTRUCTION BREAKTHROUGH Page 6
CAN CANCER TREATMENT HARM YOUR HEART? Page 7
IT’S THE ONLY SUREFIRE WAY TO PROTECT YOURSELF THIS SEASON
The flu vaccine
can cut your risk of getting the flu in half, yet many people are still reluctant to get the shot.
“I hear a lot of patients say, ‘I don’t need it. I’ve never gotten the flu,’” says Janice Hartman, MD, of CHPG West Littleton Primary Care. “What I tell them is you haven’t gotten the flu yet.” Here’s what she says you need to know about protecting yourself this season.
BUT IT DIDN’T WORK LAST YEAR!
Scientists formulate a new flu vaccine every year in anticipation of the strain most likely to affect the greatest number of people. But not all flu vaccines are wellmatched with the year’s strain. The 2017-18 flu vaccine was only 36 percent effective, which is lower than the usual effectiveness range of 40 to 60 percent. Still, that’s significant protection. Plus, getting vaccinated lessens the severity and duration of your symptoms if you do end up with the flu.
BOOST YOUR IMMUNE SYSTEM THIS SEASON
Think you can avoid getting the flu by staying away from people who are sick? Think again. Between 20 and 30 percent of people carrying the flu virus display no symptoms.
CAN’T I SKIP THE VACCINE AND GET TAMIFLU INSTEAD?
Say no to sugar > Excess glucose
can reduce white blood cell reactivity (your immune response) by up to 40 percent. A 32-ounce soda can render your immune system useless for four or five hours.
Meditate > A recent review of 20 studies found some early evidence that mindful meditation may have positive effects on the immune system. Eat your mushrooms > One study
found eating cooked shiitake mushrooms can increase the performance of your body’s T cells, which play an essential role in immune response.
A: No. Antivirals like Tamiflu
can reduce symptom severity, reduce complications like pneumonia, and shorten the duration of the flu by about a day; but they won’t cure you. Plus, antivirals must be administered early to be effective — ideally within 48 hours, although they can be effective up to 72 hours after the onset. And getting treated after the fact doesn’t protect vulnerable populations in the community who can’t be vaccinated.
2X
People who get the flu vaccine every year are twice as likely to have less-severe cases when they do contract the virus, as compared with people who haven’t been vaccinated in the previous three seasons.
TAKE A SHOT AT FLU Schedule an appointment with one of our primary care offices by visiting centura.org/locations.
Littleton Adventist Hospital brings specialized care to the people of South Denver in the complex areas of trauma, cancer, neurology, cardiology, orthopedics, women’s services, and more. 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 as a substitution for your physician’s advice. If you would like to comment or unsubscribe to this magazine, please email create@centura.org. Create is produced by Clementine Healthcare Marketing and published four times annually by Littleton Adventist Hospital — Portercare Adventist Health System. 7700 S. Broadway | Littleton, CO 80122 | mylittletonhospital.org 2 | FALL 2018 • Create
COVER PHOTO: ©MATTHEW STAVER; THIS PAGE ILLUSTRATION: ©ISTOCKPHOTO.COM/DIANE LABOMBARBE; PHOTOS: ©ISTOCKPHOTO.COM/DIMA_SIDELNIKOV, /BRAINMASTER, /TASHKA2000, / OLHA_AFANASIEVA; OPPOSITE PAGE PHOTO: ©ISTOCKPHOTO.COM/ARISSTUDIO
HEALTH BRIEFS
Fall
FIGHT OFF THE FLU
MEN’S HEALTH MATTERS
Conditions like breast cancer and bone density are often considered women’s health issues, but they can affect men, too. Learn your risks and recommendations for screening. A MAN’S RISK FOR BREAST CANCER
Breast cancer is extremely rare in men but when it happens, there is often a genetic component. “We know that about 40 percent of male breast cancer has a hereditary component to it,” says Erin Hoffman, MS, CGC, genetic counselor at Littleton Adventist Hospital. Hoffman recommends men with a family history of male breast cancer consider genetic testing. She also recommends that men who develop breast cancer have genetic testing as well. “It can change the way we screen and treat other family members, so that makes it incredibly valuable.”
Men can have osteoporosis, too
Men’s lifetime risk of hip fracture is lower than a woman’s risk, but men are two times as likely to die following a hip fracture. Learning your bone density via screening can help safeguard your bones and your health. According to Jeffry Gerber, MD, who helped develop the calcium Dr. Jeffry Gerber scoring process at Littleton Adventist Hospital, the biggest risks for men — beyond non-modifiable factors like advanced age and being Caucasian — tend to be: • Lifestyle, including factors such as physical inactivity, tobacco, alcohol use, and a poor diet • Chronic diseases of the kidneys, lungs, stomach, and intestine, and diabetes, obesity, and low testosterone • Medications, including an overuse of steroids and heartburn drugs as well as thyroid, pain, and blood pressure medications “While the U.S. Preventive Services Task Force doesn’t provide a bone density screening recommendation for men, those at age 70 with risk factors should get a bone scan,” Gerber says. “And remember, there’s a lot you can do throughout life, including a healthy diet and lifestyle, to prevent future bone loss.”
A SCORE THAT MATTERS If you’re a man over age 40 — even one who’s generally healthy — you’re still at risk for heart disease. That’s why a heart calcium scoring exam can be so important. Calcium in your arteries is a sign of coronary artery disease, and a quick, painless CT scan checks for calcium buildup and provides a score that helps your doctor determine your risk of developing heart disease. Littleton Adventist Hospital offers heart calcium scoring for $99. To schedule a scan and have the results sent to your physician, call 303-738-2767. create | mylittletonhospital.org | 3
KNOW YOUR OPTIONS INTERVENTIONAL RADIOLOGY ALLOWS NONSURGICAL TREATMENT FROM BRAIN ANEURYSMS TO DVT IN THE LEG — AND EVERYTHING IN BETWEEN
I Dr. Brooke Spencer
f you’re not familiar with interventional radiology, don’t feel bad; you’re in good company.
“Only 40 percent of people know an interventional radiologist is a physician, so we have an identity crisis,” says Brooke Spencer, MD, an interventional radiologist at Littleton Adventist Hospital. She wants people to know there are new options for many conditions that can replace traditional surgery. Many interventional radiology procedures can be performed through a pinhole without incisions, and with minimal pain and quick recovery. This infographic looks at some of the most common interventional radiology procedures.
Real stories of IR Go to theii.org/the-docuseries to get an inside glimpse into what interventional radiology can really do by watching “Without a Scalpel,” a patient documentary series featuring Dr. Spencer. The Interventional Initiative is a nonprofit organization started by Dr. Spencer and her colleagues to engage patients in learning about minimally invasive imageguided procedures.
4 | FALL 2018 • Create
BRAIN: Endovascular coiling
Interventional radiologists can treat an aneurysm, an abnormal ballooning of an artery in the brain, through a small incision in the groin. They use imaging guidance to reach the problem artery in the brain and “fill” it with tiny coils to block it from erupting and causing a stroke or death.
SPINE: Kyphoplastyuses X-ray guidance to inject cement through a needle to stabilize a fractured vertebra that isn’t responding to medical therapy.
MEN: Gonadal vein embolization involves
inserting a small catheter via a tiny incision in the neck or groin to reach the gonadal vein with small coils to block it and stop the backflow of blood in a varicocele vein in the scrotum that has become enlarged over time, relieving pain, improving sperm count, and potentially resolving fertility issues.
Prostate artery embolization
“We can perform a prostate artery embolization [to treat benign prostatic hyperplasia, or BPH] by going in through the groin or wrist with a catheter through a sheath and inserting tiny glass beads in the arteries to the prostate to plug the blood supply in that area and shrink the prostate,” says Spencer. “This provides relief without side effects like sexual dysfunction, is less expensive than other surgical options, and is a same-day procedure.”
NECK: Carotid stenting involves inserting a metal cylinder,
or stent, into a clogged artery in the neck to hold it open and restore blood flow to the brain.
WOMEN:
Ovarian vein embolization can be performed to relieve pelvic venous congestion (PVC) by blocking and closing refluxing, dilated veins in the pelvis. “PVC is the pelvic equivalent of varicose veins and can cause debilitating pain,” Spencer says. Read more in Jessica’s story. “Patients often complain of groin pain, pelvic pain, pain with intercourse, back pain, heart racing, and light-headedness, as well as urinary frequency/ urgency. They often have seen many doctors without a diagnosis or relief before they are diagnosed.”
LEG: Wound healing vascular treatments
Wounds that don’t heal could be caused by blocked arteries, blocked veins, or valve damage in veins, and can be fixed in one or two outpatient treatments.
WHOLE BODY: Peripheral arterial disease (PAD) is a narrowing or blocking of peripheral arteries in the legs, stomach, arms, and head. Interventional radiologists can help open the arteries by removing plaque by inflating a balloon via angioplasty or by placing a stent. $99 PAD Screening If you’re at risk for peripheral arterial disease, talk to your doctor about scheduling a $99 screening at Littleton Adventist Hospital.
A minimally invasive procedure helped end years of pelvic pain for Jessica Mares.
PUTTING AN END TO DECADES OF PAIN Jessica Mares has suffered with gynecologic issues her entire adult life, including excruciating pelvic pain. Over the years, the now 40-year-old Littleton resident has had surgery to treat her endometriosis as well as a hysterectomy at age 24 — and still the pain persisted (and got progressively worse) for the next two decades. “You start thinking, ‘Am I crazy?’ Because no one can figure out what’s wrong with you,” Mares says. That’s when her gynecologist determined the pain could be caused by a condition called pelvic venous congestion (PVC). She was referred to Brooke Spencer, MD, an interventional radiologist at Littleton Adventist Hospital, who confirmed this was the case, and that Mares’ iliac vein, located deep within the pelvis, was compressed. The vein is supposed to be open about 14 millimeters; hers was open just 3 millimeters. Spencer was able to treat it by making a tiny nick in Mares’ upper thigh and then guiding a tiny flexible tube to the vein. Once there, she used a stent to open the vein. Two days later, Mares was already out doing yard work. “A lot of people have this condition and don’t even know it, and I was one of them for years,” she says. “But I’m so thankful this is helping me now!”
create | mylittletonhospital.org | 5
ILLUSTRATION: ©ISTOCKPHOTO.COM/SAVARYN; PHOTO: ©MATTHEW STAVER
Uterine fibroid embolization uses small beadlike particles to block the blood supply to fibroid tumors, causing them to shrink and alleviating painful symptoms. This alternative to myomectomy, the surgical removal of fibroids, or hysterectomy, preserves a woman’s uterus, maintains her hormonal cycles, and requires less recovery time. “The American College of Gynecology recognizes that there’s Level A data to support uterine embolization to treat fibroids as an equivalent to myomectomy,” Spencer says.
Breast Reconstruction
Breakthrough Helping women with breast cancer feel like themselves again, quickly and safely Following mastectomy surgery, it can be unsettling to awake from surgery without your breast. But with direct-to-implant surgery, mastectomy and breast reconstruction are performed at the same time, so the patient wakes up with fully reconstructed breasts. “It’s really an external way of moving beyond this breast cancer diagnosis,” says Littleton Adventist Hospital plastic surgeon Lisa Hunsicker, MD, FACS. “It restores their confidence, their femininity, how they see themselves.” Direct-to-implant surgery requires a strong partnership between a skilled oncological surgeon, who performs the mastectomy, and the plastic surgeon, who does the breast reconstruction.
23% Portion of women who understand the full range of breast reconstruction options available to them
CONTROLLING RISK OF INFECTION
DIRECT BENEFITS
This new approach, being performed at Littleton Adventist Hospital and Parker Adventist Hospital has various benefits, including: Very low risk of infection. A study by Hunsicker and her colleagues found that patients who received the new antibiotic irrigation had a 1.9 percent infection rate, compared to 6.4 percent with the standard method. (Nearly) opiate-free pain relief. “We are significantly reducing the amount of narcotics used for surgery, thus reducing opiate dependence and opiate-related complications,” Hunsicker says. “Also, the anesthesia literature shows that there’s an increased recurrence rate of cancer in patients who receive opiates in their anesthetic, so we’re perhaps reducing cancer recurrence.” Speedy recovery. Many direct-to-implant patients are able to go home within 24 hours of surgery and are released from post-op restrictions in as soon as six weeks.
6 | Fall 2018 • Create
Breast cancer patients can certainly benefit from this new protocol, and Hunsicker hopes it will become more widely accepted — potentially by other specialties that implant prosthetics. “I would say it’s epic,” she says. “I think there’s a huge global application to this.”
Celebrate
Yourself
October is National Breast Cancer Awareness Month. Celebrate by putting yourself first and taking time for an annual breast screening with advanced 3-D mammography at: Littleton Adventist Hospital 303-738-2767 Castle Rock Adventist Hospital 720-961-2033 Centura Health Meridian 303-269-4150 Centura Health Southlands 303-269-4150 Parker Adventist Hospital 303-269-4150 Porter Adventist Hospital 303-765-6500
39% Increase in demand for breast reconstruction procedures since 2000
PHOTO: ©ISTOCKPHOTO.COM/KUPICOO; OPPOSITE PAGE ©ELLEN JASKOL
Many surgeons don’t offer direct-to-implant surgery due to concerns about infection rates, which can be up to 30 percent. When a surgeon implants a prosthesis — whether a breast implant or an artificial hip — any infection present may contaminate the prosthesis itself. If that happens, it must be removed. Hunsicker, however, was determined to offer patients direct-to-implant with good pain control and effective infection control. But the local anesthetic being delivered with a pump to numb the implant pocket couldn’t be mixed with antibiotics. Then a new long-acting anesthetic came onto the scene, which didn’t require mixing, Hunsicker says. “That allowed us to pump antibiotic irrigation in and around that pocket for 96 hours after surgery.”
E L B DOU BLE U O R T Cancer treatment can potentially cause heart damage. Learn how one woman is dealing with both — and how Littleton Adventist Hospital is helping safeguard hearts.
When Debbie LeBlanc was diagnosed Dr. Sarah Conlon with stage IV inflammatory breast cancer in 2015, the now 60-yearold wasn’t about to give up. “My tumors responded quickly to treatment and I stayed positive,” she says. “I was not going to let it beat me. I was going to fight.” And fight she has. After completing chemotherapy, she learned she’d need to be on cancer prevention medication for life and have her heart monitored for potential damage. By last spring, LeBlanc had been cancerfree for about a year when another blow landed: Her heart output decreased dramatically after a treatment, putting her at risk for heart attack. But her doctors at Littleton Adventist Hospital took action to help protect her heart.
Help that can harm Cancer treatments including chemotherapy, radiation, and tamoxifen can potentially lead to heart damage. Some types
Debbie LeBlanc hasn’t let breast cancer or heart problems stop her from living the life she wants and spending time with her grandchildren.
of chemotherapy can weaken the heart muscle, while radiation therapy can increase risk for heart attack, heart failure, and arrhythmias. Herceptin, the drug LeBlanc takes to treat her HER2-positive cancer, has been found to cause heart failure in approximately 4 percent of patients. “Cardiac damage is rare, and medical oncologists work in conjunction with cardiologists to help cure women while minimizing these side effects,” says Sarah Conlon, MD, a medical oncologist at Littleton Adventist Hospital. This may include administering a milder dose of medication once per week that can be more easily tolerated than a single powerful dose every three weeks. As for radiation, technologic advances have decreased heart damage risks. “Radiation these days is computer-modeled, so the beams
can be adjusted to come from the side and miss the majority of heart and lungs, and the damage is minimized,” she says.
Defying the odds When LeBlanc’s heart damage occurred, she stopped taking Herceptin for a year only to have her tumor markers jump again. She has since restarted Herceptin with the milder, once-per-week dose. Fortunately, her tumor markers have decreased and her heart continues to be closely monitored. And even more good news: She returned to teaching this fall for the first time since her diagnosis. While she’s been understandably wary of the ups and downs in her care, she’s taking Conlon’s advice to heart. “She told me, ‘Whatever it is, we’re going to deal with it. You just keep living how you want to live,’” LeBlanc says.
HOPE FOR HEART DAMAGE A small study in 2015 found that adding the heart failure medication candesartan to a woman’s breast cancer treatment regimen decreased heart damage in the short term.
UNDERSTANDING YOUR RISK While most heart problems occur during treatment, others can develop years later. Women who may be at a higher risk include those who: Are 65 or over Received higher doses of chemotherapy Were treated for Hodgkin lymphoma during childhood Take medicines like Herceptin and Doxil
Littleton Adventist Hospital is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas. create | mylittletonhospital.org | 7
Portercare Adventist Health System NON-PROFIT ORG US POSTAGE
PAID
DENVER, CO PERMIT NO. 3280
7700 S. Broadway Littleton, CO 80122
MAMMOS, MOCKTAILS, AND MORE!
You show everyone else love; it’s time to take care of yourself, too. Join us for mammograms, chair massages, refreshments, and great giveaways. Date | Wed, Oct 24; Wed, Nov 14 Time | 3-7 p.m.
Registration required 303-738-2767
2018
TO REGISTER, VISIT MYLITTLETONHOSPITAL.ORG/LAHCLASSES We recommend this class as an add-on AFTER completing one of our other Childbirth Preparation classes. This class is focused on comfort measures and strategies for those looking for more practice with labor skills and those planning an unmedicated delivery. As you rotate through “labor stations,” you will have the opportunity to practice labor coping skills that can be used to manage labor more comfortably. This class is primarily practiceoriented and will give you a variety of tools to use during labor, including relaxation, positioning, and breathing, so you can gain additional confidence and skills for your upcoming birth.
Date ǀ Thu, Oct 18; Wed, Nov 14 Time ǀ 6-9 p.m.
SIBLING PREP Help prepare your child or children (ages 3-7) for the arrival of a new baby in the family. Children will learn about newborn characteristics, how they can help with the new baby, as well as learn how to safely touch and hold a baby. A parent is required to attend. A sibling-focused tour of the BirthPlace is included.
Date | Sun, Oct 21; Tue, Nov 13; Sun, Dec 2 Time | 4:30-5:30 p.m.
GIRL TALK This one-time, two-hour class is recommended for mothers and daughters ages 9-13 years old. We will focus on the anatomy, physical changes of puberty, menstruation, and hygiene. Our goal is to create a relaxed atmosphere for preteens and a trusted adult to learn factual information, encourage open communication, and promote young girls’ positive self-esteem. This class is taught by a pediatric nurse practitioner.
Date | Thursdays, Oct 25 or Nov 15 Time | 6-8 p.m.
Events
MA R CA K YO LEN UR DA R!
TAI CHI FOR HEALTH AND BALANCE Tai Chi for Health and Balance has been proven to prevent falls, increase balance and movement, and improve quality of life for older adults. We offer a beginner class and an extension class intended for participants who have already completed the beginner class. Please wear comfortable clothing and bring a water bottle. All events take place at the Littleton Museum, 6028 S. Gallup St., Littleton, CO 80120.
Date | Tuesdays, Oct 30Dec 11 Time | Beginner class 2-3 p.m.; extension class 1-2 p.m. Cost ǀ $35 for 7 classes
PHOTOS: ©ISTOCKPHOTO.COM/STURTI, /MATVEEV_ALEKSANDR, /TATYANA_TOMSICKOVA, /FILISTIMLYANIN
COMFORT MEASURES
FALL
CALENDAR
Littleton Adventist Hospital 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 303-738-7781 (TTY: 711). Copyright © Centura Health, 2018. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 303-738-7781 (TTY: 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 719-776-5370 (TTY: 711).