Fall 2017 | Volume 9, Issue 4
Bountiful
SEASONS Fresh techniques are giving patients an alternative to surgery. See Page 4.
Frank Tammen enjoys a plentiful harvest, thanks to a lifesaving procedure at Parker Adventist Hospital that helped him avoid surgery.
PLUS...
Hysterectomy and osteoporosis link
Easier access to health care
Prepping for joint surgery
PAGE 2
PAGE 6
PAGE 7 PHOTO BY ELLEN JASKOL
-
Women need to know what’s normal and what’s not at this major health milestone
SIGNS YOUR THYROID IS UNDERPERFORMING
Hormonal changes in women around 50 often can be attributed to perimenopause, but the chances of developing hypothyroidism (low thyroid hormone) increase during midlife as well. Here are five signs to watch for: 1. You’re cold when others aren’t. 2. You tire more easily. 3. You’re constipated without cause. 4. Your skin is dry. 5. You’re forgetful and depressed.
% 8 7 Women
WHO HAVE HAD THEIR
78 PERCENT OVARIES REMOVED ARE EOPOROSIS. OST E HAV MORE LIKELY TO
SCHEDULE A BONE SCAN
Women at average risk for osteoporosis should begin bone density screening at age 65. Screenings require a physician referral and can be scheduled at the following Centura Health South Denver centers: • Parker Adventist Hospital: 720-809-8956 • Castle Rock Adventist Hospital: 720-263-4245 • Littleton Adventist Hospital: 1-844-325-5579 • Porter Adventist Hospital: 1-844-325-5584 • Meridian and Southlands: 720-809-8956
WHO NEEDS
PAP TESTS? American Cancer Society guidelines say women with normal Pap test results should continue Pap tests plus HPV screenings every five years or a Pap test alone every three years until age 65. The exception: Women who have had a total hysterectomy (removal of ovaries and cervix) can stop testing at their doctor’s recommendation.
NEED ANOTHER REASON TO KEEP POUNDS OFF? Here’s one: Your brain. A recent study of more than 8,000 women ages 65-79 found that with each one-unit increase in body mass index (BMI), scores on a measure of cognitive abilities dropped by nearly one point. Keeping pounds off can be a struggle for older women, but maintaining healthy weight may help preserve cognitive abilities, says Chutaporn Charnsangavej, MD, board-certified OB/GYN at Pinnacle Women’s Healthcare.
HYSTERECTOMIES CAUSE
rapid BONE LOSS
Most women today undergoing hysterectomies have their ovaries removed along with their uterus, a procedure called an oophorectomy. While this procedure eliminates the risk of ovarian cancer, it has an often overlooked side effect: Women who have their ovaries removed prior to menopause lose bone mass at twice the rate of women who still have their ovaries, according to a study published in the journal Fertility and Sterility. If you’ve had your ovaries removed, you should get a bone density test every two years, regardless of your age (young or old). If your results are low, talk to your doctor about medication that could slow bone loss. Plus, get adequate calcium and vitamin D, do daily weight-bearing exercises, quit smoking, reduce alcohol consumption, and talk to your doctor about medications that can accelerate bone loss — such as antacids and steroids.
9395 Crown Crest Boulevard, Parker, CO 80138 grow is published quarterly by Parker Adventist Hospital—Portercare Adventist Health System—as part of our mission to nurture the health of the people in our community. To comment or unsubscribe, please email grow2@centura.org. grow is produced by Clementine Healthcare Marketing. Executive Editor: Rebecca McLuskey
2 ■ Fall 2017 ■
grow
PHOTOS: CAKE ©ISTOCKPHOTO.COM/TBD; CELLS ©ISTOCKPHOTO.COM/ARCYTO
health briefs
Fall
Turning the big
Wisdom of the ages Year-by-year tips for giving your child a healthy, happy childhood CENTURA HEALTH PHYSICIAN GROUP SOUTHLANDS Primary Care pediatrician Olukemi Akinrinola, MD, offers a few tips to help you keep your child healthy and happy, from birth through the teen years:
PHOTOS: BOY ©ADOBESTOCK.COM — BRIANJACKSON; LEAF ©ISTOCKPHOTO.COM/DE-KAY; SYRINGE ©ADOBESTOCK.COM — HAPPYVECTOR071
Infants
Infants need a separate sleeping space of their own, free of blankets, toys, and other choking hazards. Having baby in your room is fine; in your bed, is not, Akinrinola says. “It’s a hazard.” It’s too easy to roll over onto baby, she says. “You can’t control how you sleep, especially because new parents tend to be exhausted.”
TODDLERS
Little ones this age put everything in their mouths, Akinrinola says. Your job: Keep small toys and other choking hazards, cleaning chemicals, and other poisons out of reach of little hands. Despite precautions, accidents happen, Akinrinola says. “So always have the number for poison control on the fridge.” And be sure other homes where your child visits regularly, like Grandma’s house, are secure, too.
Preschool and kindergarten
Kids this age still need about 12 hours — or more — of sleep every night. “When they’re tired, they’re more likely to melt down,” Akinrinola says. Routine is crucial for children. “Find a schedule that works for your family.”
Tween and teen shots
Elementary school
Injuries are common at this age, so make sure your child can swim, knows what to do in a thunderstorm, and knows his address, phone number, and parents’ names, Akinrinola says.
Dr. Olukemi Akinrinola
Tweens
It’s a good idea for kids this age to have a phone to contact parents. But that doesn’t have to — and shouldn’t — mean unlimited internet access and screen time, Akinrinola says. “We encourage apps that let parents monitor kids’ online activities.”
Teens
We all need privacy, Akinrinola says. Teens especially crave — or demand — it. “They’re working out who they are.” For parents, that means finding balance between keeping an eye on kids, and granting the space they need. The best approach: Keep talking to them, and encourage them to talk to you, she says.
Olukemi Akinrinola, MD, who has practiced in countries where vaccine-preventable diseases remain a threat, reminds parents that immunizations don’t end with infancy. Here is a list of later vaccines every child needs, by age: 11-12 Tdap (tetanus, diphtheria, pertussis) round 2 11-12 HPV; girls and boys both need the human papillomavirus vaccine 11-12 Meningococcal vaccine 16 Meningococcal round 2 Every 16-18 Meningococcal B fall: FLU SHOT
For more information, please contact Dr. Akinrinola’s office, CHPG Southlands Primary Care at 303-928-7555.
Whatever your child’s age, don’t hesitate to call your pediatrician with questions, Akinrinola says. “There are no stupid or silly questions.”
grow
■ parkerhospital.org ■ 3
Healthy
HARVEST Lifesaving procedure prevents deadly bleeding while avoiding surgery
W
hen Frank Tammen was hospitalized after a fall, he found out that his life was in danger, not from the fall, but from an abdominal aortic aneurysm (AAA). An AAA is a bulge in the aorta, the main blood vessel that supplies blood to the body and runs from the heart through the chest and abdomen. The Castle Rock resident had known about the AAA for about 10 years. Since it was small and like most people, Tammen didn’t have symptoms, doctors monitored him to make sure the AAA wasn’t growing. But by the time the 75-year-old man was hospitalized from his fall in July 2016, the AAA had grown to 5.7 centimeters (cm), or 2.24 inches.
REDUCING RISK WITH A MINIMALLY INVASIVE REPAIR
Frank Tammen was back in the fields with his wife, Sharon, thanks to a nonsurgical procedure that fixed a bulging aorta that could have led to deadly bleeding.
“When an AAA grows over 5 cm, it’s at higher risk to rupture,” says Richard F. Grzybowski, DO, an interventional radiologist at Parker Adventist Hospital. This causes bleeding that’s usually deadly. To prevent a rupture, Grzybowski and interventional radiologist Dietrich Schultze, MD, repaired Dr. Richard F. Tammen’s AAA at Grzybowski Parker Adventist Hospital without surgery, using a thin, flexible catheter — a tube the size of a spaghetti noodle. Called endovascular repair, the procedure involved making
PHOTO BY ELLEN JASKOL
4 ■ Fall 2017 ■
grow
two small puncture wounds in the groin, and using X-rays to guide a stent graft — a small, metal “scaffold” — through an artery in Tammen’s leg up to the AAA. Expanding the graft at the bulge reinforced the aorta, preventing it from tearing or bursting.
MAKING A QUICK RECOVERY Tammen went home the day after his procedure. Within a few weeks, he was back working in his vegetable garden. “I felt fine afterward,” says Tammen, who hadn’t wanted traditional open surgery, the other way to repair an AAA. “Recovery is a lot easier after endovascular repair than after open surgery,” says Grzybowski. Patients with AAAs can usually have endovascular repair, unless the AAA extends into certain parts of the aorta that require open surgery.
Endovascular Repair vs. Traditional Surgery
ENDOVASCULAR REPAIR
OPEN SURGERY
Incision
2 cuts, each about ¼ inch
About 8 inches
Hospital stay
Overnight
5-9 days
Return to normal activities
1 week
4-6 weeks
In addition, the risk of infection and bleeding along with pain are greatly reduced with endovascular repair.
For more information, please contact Parker Adventist Hospital’s imaging department by calling 303-269-4500.
SHARPER IMAGE
PHOTOS: VEGETABLES ©ISTOCKPHOTO.COM/LEOCRAFTS; X-RAY ©ALAMY.COM/OJOIMAGESLTD
Advancing technology makes less-invasive procedures available to more patients INTERVENTIONAL RADIOLOGY is a field that increasingly offers patients an alternative to traditional surgery. Using highly detailed, real-time imaging such as X-ray, physicians thread tiny catheters through arteries to the problem area. Once there, they are able to perform a variety of procedures, including opening clogged arteries, cutting off blood flow to stop a tumor from growing, or even fixing a fractured spine. “Thanks to advances in the imaging technology fields of ultrasound, CAT scan, and real-time X-ray, using guidewires and various other tools, we can do many procedures in a minimally invasive way, without large incisions,” says Richard F. Grzybowski, DO, an interventional radiologist at Parker Adventist Hospital. Conditions that can now be treated through interventional radiology include: > S pinal fractures. An interventional radiologist uses continuous X-ray to guide a needle into the fractured vertebra, and then injects a special bonding compound. >P eripheral artery disease. When arteries are damaged, through clots or calcium blockage, interventional radiologists can repair or unblock the arteries using a variety of techniques and procedures that are all done through catheters (tiny tubes) that run through arteries to the problem area. The techniques include implanting stents, or small metal tubes, to hold open narrowed arteries, and angioplasty, a procedure in which inflatable devices, called balloons, open narrowed arteries.
> Uterine fibroid tumors. Through a small incision, the doctor threads a catheter inside an artery. Using imaging, the doctor guides the catheter to the tumor’s blood supply and releases small particles that block the blood vessels, cutting off the supply of nutrients the tumor needs to live. In nine out of 10 patients, the tumor shrinks significantly, relieving symptoms. Interventional radiology, also called IR, may be an option for treating certain types of cancer, prostate enlargement, kidney and liver disease, and infertility as well. IR can offer several advantages over open surgery, Grzybowski says, including: • Faster recovery • Less risk of infection • Shorter hospital stays
grow
■ parkerhospital.org ■ 5
Primary
6
reasons to have a primary care provider
Dr. Rachel Rabazzi
1 4
You won’t have to wait. Being an established patient means getting an appointment quicker when you need one because the newpatient paperwork is already on file.
You won’t have to explain yourself. Primary care physicians keep your personal and family health history in electronic medical records, which means you won’t have to start from scratch at every visit.
2
You’ll have help interpreting your Google results. Massive amounts of information — and misinformation — swirls the internet. Your PCP can help you understand what’s beneficial for you.
Reminder
Appointment in 30 minutes
What’s a DO? Everyone knows what MD stands for. But an increasing number of physicians are opting for a “DO” after their name. What does it mean? DO stands for Doctor of Osteopathic Medicine, and it’s equal to MD in level of education. What is different is their care philosophy. While MDs focus their training on medication and procedures to heal the body, DOs receive additional musculoskeletal training and tend to rely on methods that encourage the body to heal itself. 6 ■ Fall 2017 ■
grow
5
You’ll have access to trusted specialists. When you have an issue that requires a specialist, start with your PCP. “Having a PCP expedites the process of getting a referral,” Rabazzi says. “Your PCP then will act as a point person and coordinate the care between multiple specialists.”
3
Your health will improve. Having access to primary care improves health and reduces the risk of death from heart disease, cancer, or stroke, according to a review of multiple studies spanning 30 years by the National Institutes of Health.
6
You can get no-hassle prescription refills. Did you forget you need more asthma inhalers and now you’re leaving town? Your PCP can approve refills of routine medications without an office visit.
Online Scheduling Having a primary care physician means you’ll be seen quickly, and Centura is making it even quicker by now offering same-day appointments and online appointment scheduling at sameday.centura.org. Find a Centura primary care doctor online at centura.org/find-a-provider.
PHOTOS: MAGNIFY ©ISTOCKPHOTO.COM/FABRIKACR; WATCH ©ADOBESTCCK – MEHMETALIGRAFIK; ICONS ©ADOBESTCCK – PIXELALEX; PILLS ©ISTOCKPHOTO.COM/SEZERYADIGAR PHOTOS OPPOSITE PAGE: CALENDAR ©ISTOCKPHOTO.COM/FABRIKACR; DENTAL ©ISTOCKPHOTO.COM/PASHAIGNATOV; SHOES ©ISTOCKPHOTO.COM/CHICTYPE
Do you have a regular hairstylist? Dry cleaner? Mechanic? If so, you know the importance of building relationships with people who understand your preferences. And a good primary care physician (PCP) should be on your list as well. A PCP knows your health history and can look out for your greatest asset — your health. “Primary care physicians provide a lot more value than the general public knows,” says Rachel Rabazzi, DO, a family medicine physician at Centura Health’s Primary Care Meridian. Here are six ways you can benefit from having a PCP.
Joint Effort
Knowing what to expect and plan for can speed joint replacement recovery
IF JOINT REPLACEMENT SURGERY IS IN YOUR FUTURE, you have some work ahead.
“We’re going to do amazing surgery. But you have jobs to do, too,” says Susan Barnett, MSN, RN, ONC, joint replacement program clinical manager at Parker Adventist Hospital. Barnett and her colleagues offer a mandatory presurgery class, and a surgery preparation plan for all patients who are facing joint replacement surgery. While everyone’s surgery experience is different, highlights of Barnett’s basic timeline include: 2 MONTHS BEFORE SURGERY
3 WEEKS BEFORE SURGERY
See your dentist. Your mouth is a bastion of bacteria. To prevent bacteria from traveling to the surgery site, “We recommend no dental procedures, including cleanings, six weeks before or after surgery,” Barnett says. Attend surgery prep class. It’s required at Parker Adventist Hospital, Barnett says, but even so, you should want to come because it will improve your recovery. It will also give staff the opportunity to get acquainted and support your journey. Schedule therapy. New joints need therapy; much of that is done independently in your home following our instructions. Don’t wait until after surgery to schedule physical therapy or other outpatient therapy your doctor orders. Pile on the protein. Protein builds muscle and helps wound healing, so increase intake before and after surgery. Go shopping. Check with your surgeon, but you might want to stock up on: • A front-wheeled walker • Pillows • Protein snacks • Comfortable shorts and T-shirts • Supportive footwear • Books or movies Check your diabetes. A high A1C could mean postponing surgery. “If blood sugar is high, that’s just asking for infection,” Barnett says. Create a care plan. Line up your post-surgery caregivers, including those who will walk your pets for the first week or so. Plan meals. Cooking won’t be on your menu for a while, so prepare and freeze a few meals.
SURGERY WEEK
Clean and clear. Fall-proof your home. Pick up throw rugs, clear a path for a walker, and move kitchen and bathroom supplies to a convenient height. Infection control. Shower with antibacterial soap for five consecutive days. The day before surgery — put clean sheets on your bed; get clean towels ready.
SURGERY DAY
Check in to Parker Adventist Hospital’s dedicated orthopedic surgery unit. “Our care teams know the protocols and safety procedures. They know how to get you up and moving,” Barnett says. And they will, because the goal is to get you home as soon as it’s safe, which may be the same day as surgery. “You’ll recover better in your home, with your family and friends,” Barnett says.
AFTER SURGERY
Learn the Latest To learn the latest news in joint replacement surgery — including techniques that send you home within 24 hours — attend a FREE class on Nov. 30. See back cover for details.
Get moving. You’ll need to take it easy for several weeks, but walking and doing exercises as instructed will speed your recovery. Get into therapy. Knee replacement patients start physical therapy within days of surgery, and typically continue therapy for several weeks. Hip replacement patients continue therapy in their home, using instructions provided by their surgery team. Cheer up. Barnett’s best recovery advice: “Put a happy spot into your day, every day.” grow
■ parkerhospital.org ■ 7
CENTURA HEALTH PHYSICIAN GROUP PRIMARY CARE PRACTICES
Portercare Adventist Health System
Non-Profit Organization U.S. Postage
PAID
Denver, CO Permit No. 4033
9395 Crown Crest Boulevard Parker, CO 80138
AURORA CHPG Cornerstar Primary Care (Parker and Arapahoe) 303-269-2626 • cornerstarprimarycare.org CHPG Southlands Primary Care 303-928-7555 • southlandsprimarycare.org
CASTLE ROCK Ridgeline Family Medicine at the Meadows 720-455-3750 • ridgelinefamilymedicine.org Ridgeline Family Medicine — Castle Pines 303-649-3350 • ridgelinefamilymedicine.org
CENTENNIAL CHPG Grace Family Practice (near Arapahoe and Holly) 720-528-3559 • gracefamilypractice.org
DENVER CHPG Primary Care Highlands (near I-25 and Speer) 303-925-4580 • chpghighlands.org CHPG Primary Care Porter 303-649-3200 • porterprimarycare.org
GREENWOOD VILLAGE CHPG at DTC (Ulster and Belleview) 303-770-6500 • dtcfamilymedicine.org CHPG Primary Care Southmoor (in the DTC) 303-925-4960
HIGHLANDS RANCH Highlands Ranch Medical Associates 303-649-3140 highlandsranchmedicalassociates.org
LITTLETON Chatfield Family Medicine 303-738-2714 • chatfieldfamilymedicine.org Clement Park Family Medicine 303-932-2121 clementparkfamilymedicine.org South Suburban Internal Medicine (at Littleton Adventist Hospital) 303-347-9897 southsuburbaninternalmedicine.org
PARKER CHPG Internal Medicine Parker (on hospital campus) 303-770-0500 • internalmedicineparker.org CHPG Primary Care Meridian 303-649-3100 • parkerprimarycare.org Timberview Clinic at Parker (on hospital campus) 303-269-4410 • timberviewclinic.org
free FALL Seminars & Events Join Parker Adventist Hospital for a series of FREE events and seminars. All seminars are held in the Inspiration A and B conference rooms in the Parker Adventist Hospital Conference Center, located on the Garden Level at the west entrance, unless otherwise noted. A light lunch is served during daytime programs, and light snacks are served during evening programs. Registration is required for all seminars. Register online at parkerhospital.org/seminars.
Non-Narcotic Joint Replacement Tue, Oct 10 | 5:30-6:30 p.m. Join Dr. Presley Swann to learn more about his method for non-narcotic joint replacement surgery.
Learn the Basics of Insurance
Tue, Oct 17 | 5:30-6:30 p.m. Join our team of experts to learn more about basic insurance terms such as deductible, out-of-pocket max, and copay. This is not an in-depth look at each insurance plan offered in the market, and there will be no insurance salespeople at this community lecture.
My Heart’s A-Flutter
Thu, Oct 19 | 6-7 p.m. Location: South Denver Heart Center, 1000 Southpark Drive Atrial fibrillation, or A-fib, is a quivering or irregular heartbeat. Join Dr. Sri Sundaram to learn more about this disease, our innovative treatment options, and what you can do to support better heart health.
Healthy Aging: Continuum of Care
Thu, Oct 26 | 6-7 p.m. As we age or care for a loved one, we need guidance and support. Join our panel discussion to learn more about at-home care, palliative care, and hospice care. Our experts will be on hand to answer your questions and support your needs.
Stories in My Genes: The Value of Discovering Family Health History Thu, Nov 9 | 5:30-6:30 p.m. Join experts from the Colorado Genealogical Society and Melissa Gilstrap, MS, CGC, genetic counselor at Parker Adventist Hospital, to learn more.
Advances in Joint Replacement Thu, Nov 30 | 6-7 p.m. Join Dr. Derek Johnson to hear about the latest techniques for joint replacement surgery, including how to reduce pain and even go home in one day.
PHOTOS CLOCKWISE: ©ISTOCKPHOTO.COM/JACOBLUND; /JEZPERKLAUZEN; /TEFIM; /DANILOVI
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 1-303-673-8166 (TTY: 711). Copyright © Centura Health, 2017. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-303-269-4053 (TTY: 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-303-269-4053 (TTY: 711).