Spring 2017 | Volume 9, Issue 2
What’s the
HOOPLA? When pelvic health problems are meddling with your midsection, Parker Adventist Hospital's new program can help. See Page 4.
PLUS...
Strike out menopause symptoms
Looking for lung cancer
Faster, easier spine surgery
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Spring
health briefs
DIS-ARMING PAIN
Tanya Wright is typing and boxing pain-free after carpal tunnel surgery.
Noninvasive surgery brings carpal tunnel relief FOR YEARS, Tanya Wright lived with severe pain in both of her forearms. She tried ibuprofen, braces, and laser treatment. Nothing worked. “It was just a throbbing, nagging ache that never went away.” When Wright consulted a physician, tests found carpal tunnel in only one arm. She knew that couldn’t be true, and so did Micah Worrell, DO, an extremity-trained orthopedic surgeon at Parker Adventist Hospital. Worrell correctly diagnosed carpal tunnel in both arms, and recommended surgery. Carpal tunnel symptoms vary and can include tingling, numbness, and severe pain, Worrell says. The condition causes pain when compressed arteries cut off blood to the nerves. Worrell advises seeking treatment soon after symptoms start. “Some of the damage can be irreversible if it’s too far along.” Despite long-term symptoms, Dr. Micah Worrell Wright was lucky. She was diagnosed on a Monday, had surgery by Worrell at Parker Adventist Hospital that Friday, and went home the same day. She was back at work — typing — the following Monday. After seven years in pain, she says, “Surgery was so worth it. It is absolutely life-changing.”
1 in 100,000 That’s how many women taking bisphosphonates, a medication that prevents osteoporosis, will experience serious side effects. Bisphosphonates can reduce risk of some osteoporosisrelated fractures by 70 percent. Yet reports of two rare side effects — localized bone deterioration and femur fractures — caused bisphosphonate use to fall by half between 2008 and 2012. The bottom line: Your risk of osteoporosis-related fracture is far greater than your risk of side effects, so talk to your doctor before going without. 2 ■ Spring 2017 ■
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Don’t join ‘em, beat ‘em
Warm up cold shoulders
If you’re trying to get fit, competition beats encouragement. In a recent study, exercisers were divided into groups. Some competed through social media, while others received social media support. A control group had neither. The most faithful exercisers were the competitors. Those in support groups exercised the least — even less than those who had no social media support. Competition raises the stakes and can be a powerful motivator.
It’s time to dust off the golf clubs, head to the tennis court, or get back to work in the garden — all of which can bring shoulder pain. Try these prevention tips: • Ease back into activity • Stretch muscles before and after • If golf or tennis hurts, have a pro analyze your motion and suggest changes • Build muscle strength and flexibility around your shoulder • When pain hits, take time off
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If you're experiencing pain and numbness in your hands and fingers, come to a FREE seminar to learn what may be causing it and how to treat it. See back cover for details.
Midlife Crisis? Hormonal changes can wreak havoc on women’s lives, but help is available HOT FLASHES GET MOST OF THE ATTENTION but as a woman ages, changes in hormones affect her body in other unexpected ways. Some women suffer in silence. But for others, symptoms are severe enough to seek treatment, says Cassandra Ragsdale, MD, an obstetrician/gynecologist at Integrated OB/GYN in Parker. A checkup with your primary care provider or gynecologist is a good place to start. “Women may not need a Pap smear every year, but we recommend a visit and pelvic exam annually to make sure what they are experiencing is normal and not something more serious,” Ragdale says. Physicians can offer help with: BRAIN FOG: There isn’t
much evidence that hormone changes cause “brain fog,” Ragsdale says. “But it’s not discounted, because so many patients describe having trouble concentrating, being more forgetful.” In addition to eating healthy and exercising, some antidepressant medications can improve focus.
ANXIETY AND DEPRESSION:
Many women become depressed and anxious during menopause, Ragsdale says. Disturbed sleep and hormonal changes may play a role. Being physically active can reduce anxiety. But when symptoms are severe, Ragsdale advises women to see a doctor. “I do recommend antianxiety medications in those cases, because I have seen anxiety become severe enough that it is detrimental to women’s lives.”
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FITFUL SLEEP: Menopauseinduced hot flashes, night sweats, and anxiety disturb the sleep of about 40 percent of women. While exercise generally promotes good rest, research is mixed on whether it decreases the symptoms’ frequency. Other strategies beneficial to sleep include limiting alcohol, avoiding evening caffeine, and eating smaller evening meals. VAGINAL DRYNESS:
Drops in estrogen can cause vaginal atrophy, which leads to dryness and, often, painful intercourse. For many women, water-based, over-the-counter lubricants help. Others may need prescription vaginal creams, most of which contain very low (but safe) levels of estrogen.
To HRT or not to HRT? Research linking hormone replacement therapy (HRT) with increased risk of breast cancer scared many women and physicians away. But new interpretations of the data have lessened the concern. “When Dr. Cassandra Ragsdale it’s appropriate, we find the lowest dose possible to control symptoms,” Ragsdale says.
Integrated OB/GYN was rated in the Top 5 OB/GYN practices by Colorado Parent magazine. The practice has three offices that serve patients throughout Parker and southeast Aurora. To learn more or request an appointment, go online to integratedobgyn.org.
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
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Solutions, Not Shame
Parker Adventist Hospital’s new integrated pelvic health program offers relief for once-hidden conditions
W
hen Angela F. woke one morning to intense pelvic pressure and a feeling that her body was “coming out of itself,” she had no idea what was happening — or that one-quarter of women will face similar symptoms in their lifetime. Angela was experiencing pelvic organ prolapse, in which the “hammock” of muscle and tissue that supports organs including the uterus and bladder weaken, causing those organs to fall. In some cases, the organs may bulge into or even out of the vaginal canal. To Angela, the diagnosis “was a complete surprise. I’m 59 years old, and I had never heard anybody talk about this,” she says.
Talk leads to treatment As many as one in four adult women experiences urinary incontinence. One-quarter to one-half of women experience painful intercourse after menopause. And some 200,000 women undergo surgery to repair pelvic organ prolapse each year. Experts predict those numbers will rise as baby boomers age. Not long ago, these conditions were likely to be written off as a natural consequence of getting older, or just part of being a woman. And many women suffered in silence, too embarrassed to even talk with a doctor about symptoms. That’s changing. More and more, women — as well as men who struggle with incontinence — aren’t hiding or settling for the “just live with it” philosophy. And they don’t have to. Parker Adventist Hospital’s new integrated pelvic health program provides treatment, from medications and physical therapy to reconstructive surgery, for those conditions and many others. “It’s not only that the field has been created, but also the fact that these problems are being recognized, addressed, and screened by primary care physicians — and the fact that there is less stigma and embarrassment Dr. Alison Tate in talking about it,” says Alison Tate, MD, a specialist in pelvic floor reconstruction surgery with Women's Health and Urogynecology Meridian. For many, noninvasive treatments such as physical therapy or Botox® injections can alleviate urinary incontinence, and estrogen creams can help relieve vaginal dryness, Tate says.
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After successful treatment for pelvic organ prolapse, Angela wants to make sure other women speak up and get help.
Kegel Clues
Specialized solutions But when aging, pregnancy, giving birth, or having a hysterectomy causes organs and tissue to weaken and fall, or be pushed, surgery can help, says John Sun, MD, a Parker Adventist Hospital surgeon specializing in pelvic and colorectal procedures. In addition, childbirth, along with chronic constipation, can injure nerves in the rectum and damage muscles, both of which can lead to fecal incontinence. Sun sees both men and women with that debilitating condition. Patients with urinary incontinence rely on pads, and continue to lead fairly normal lives. “But if you have fecal incontinence, you’re not going anywhere,” Sun says. He adds that incontinence is one of the main reasons elderly people enter nursing homes. For nerve damage, Sun says implants that stimulate the affected nerves can solve the problem. When muscle has deteriorated, surgery to repair the muscle is the answer. Regardless of the cause, Sun says, the problem is largely treatable.
To help reduce the chances of urinary incontinence, health care providers often recommend maintaining a healthy weight, drinking plenty of non-caffeinated fluids, and doing strengthening exercises called Kegels. Trouble is, a lot of women aren’t shown the proper way to do the exercises, says Parker Adventist Hospital physical therapist Erica Shaw. “Typically people are told to contract muscles as though they’re trying to stop urine,” she says. “A better description is to imagine a string from the pubic bone to the rectum, and imagine pulling that string up from the inside. And most importantly, don’t bear down.” If you’re not certain you’re doing the exercises correctly, talk with your primary care physician during your annual checkup about a physical therapy referral, Shaw says.
BULK UP
To help prevent urinary incontinence and pelvic organ prolapse, maintaining pelvic floor strength with exercise is important, especially after menopause. Another tip: Eat more fiber. Constipation causes you to strain pelvic muscles, which increases your risk for both urinary incontinence and pelvic organ prolapse.
Sharing the secret
JOIN Dr. Tate and Dr. Sun for a FREE seminar on May 4 about treatment options for urinary and fecal incontinence and pelvic prolapse. See back cover for details.
Pelvic Health Program
PHOTO: ANGELA ©ELLEN JASKOL; FERN ©CHRISTINE — STOCKADOBE.COM; PEAS ©ANDERSPHOTO — STOCK.ADOBE.COM
The same is true for female pelvic organ prolapse. In Angela’s case, the discomfort caused by her pelvic organ prolapse was so serious that she opted for surgery. “Dr. Tate gave me options,” she says. “I ended up having a hysterectomy. I just couldn’t see myself living with this forever.” Using the da Vinci® robotic surgery system at Parker Adventist Hospital, Tate performed the hysterectomy through just a few small incisions. She also inserted a vaginal mesh sling at the same time. Angela said her post-surgery pain was minimal, and she went home the third day after surgery. Now physical therapy at Parker Adventist Hospital is helping her regain control of her pelvic muscles. Angela later learned that she knew women who had also suffered with �elvic organ prolapse — and kept it secret. So she’s determined to help educate other women about pelvic floor disorders, so no one else will have to “freak out” as she says she did when her symptoms began. “I want people to know there is help out there. You don’t have to live with this.”
Parker Adventist Hospital’s new program offers a range of treatment options for men and women, including physical therapy, medications, nerve stimulation, and surgery for conditions, including: Urinary incontinence Fecal incontinence Pelvic organ prolapse Pelvic pain Sexual dysfunction Overactive bladder To learn more or schedule an appointment, call 303-925-4638, option 2.
Get Help
If you are suffering with a pelvic floor condition, call today to schedule an appointment with: Alison Tate, MD, urogynecologist, treats female incontinence, pelvic organ prolapse, and other gynecologic issues. 303-925-4650
John Sun, MD, colorectal surgeon, performs all types of colon and rectal surgery, including colonoscopies and treatment for fecal incontinence. 303-720-7463
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SMOKE SCREEN Low-dose CT scans find lung cancer in earlier stages
AT ALMOST AGE 70, Su Dierbeck still remembers the first carton of cigarettes
Peak number for 30-pack-year smokers Dierbeck’s experience is fairly typical. “Smoking in women peaked in the 1960s and ’70s. Lung cancer rates parallel this and follow by about 20 years,” says Mary Elmasri, MD, an interventional pulmonologist at Porter Adventist Hospital. Accordingly, new lung cancer cases peaked for women in 1998 and have declined since. Still, lung cancer remains notoriously difficult to detect and treat. Low-dose CT scans can help those at high risk. This includes those who, like Dierbeck, have a 30-pack-year history (a pack a day for 30 years or two packs a day for 15 years). “It is so important for high-risk candidates to get screened. A 2011 study showed that low-dose CT scans drove the mortality rate down by 20 percent,” Elmasri says. The scan itself is easy — it involves simply lying on a table while a CT scanner uses low doses of radiation to make multiple pictures of the lungs. A lung CT involves one-fourth the radiation exposure of a standard GI X-ray, and the test itself takes less than a minute.
rettes Su Dierbeck has put down the ciga her and picked up the weights, going to k. wee a s core fitness classes six day
Reprieve from risk As for Dierbeck and that nerve-racking matter of her screening results? Statistics say that quitting before the age of 40 — which she did — reduced her risk of dying from smoking-related disease by about 90 percent. “Still, I was terrified between the time I had the screening and the time I got my results,” she says. When they arrived? She exhaled like she had never exhaled. There was no cancer. “It gave me total peace of mind. I plan now to have the screening done every year as recommended,” she says.
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Time to Quit The best way to lower your risk for lung cancer? Quit smoking. “Smoking damages the normal lining of cells,” says Mary Elmasri, MD. “In smokers, you have all these damaged cells — precursors to cancer — proliferating and growing.” The good news? There are more tools to help smokers quit than ever. Elmasri recommends talking to a pulmonologist or calling 1-800-QUIT-NOW for counseling and access to free or discounted samples of FDA-approved cessation medications.
Breathe Easier
Low-dose CT lung cancer screenings are available at Parker Adventist Hospital, Porter Adventist Hospital, Littleton Adventist Hospital, and Castle Rock Adventist Hospital. Call 1-855-456-5864 or visit southdenverhealth.org/ lung-screening to see if you are a candidate. Medicare and most insurance plans cover the cost if you meet the criteria, but be sure to check with your plan.
Parker Adventist Hospital is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas.
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she purchased as a college freshman in 1965. The price was about $5.60 — for the entire 10-pack carton. The cost? That turned out to be much greater. At her peak, Dierbeck smoked three packs a day. Her parents were heavy smokers, and both would ultimately die before age 70 of smoking-related diseases. She recently decided to get a low-dose CT lung cancer screening. She was terrified of what the test might find.
Back in Shape
NEW NONINVASIVE SPINE SURGERY TECHNIQUES MEAN PRECISE REPAIRS AND FASTER RECOVERY
BACK SURGERY. The very words are enough to send a chill down the spine. But that’s changing.
For patients with a degenerative condition called spinal stenosis, an innovative, minimally invasive surgery developed by Parker Adventist Hospital spine surgeon Zak Ibrahim, MD, could be the answer. In spinal stenosis, aging and osteoarthritis can cause the spinal canal to narrow. As a result, the open spaces between the vertebrae shrink, pinching the spinal cord or the nerves around it.
AN UNCOMMON SOLUTION FOR A COMMON PROBLEM Ibrahim says surgery is rarely the first option for a patient experiencing chronic back pain. “We try to exhaust every other treatment option — physical therapy, injections, chiropractic therapy.” When it comes to treatment — and surgery — Ibrahim says, “I’m a big believer that less invasive is better. “We have a different technique for fusion surgery for degenerative processes,” Ibrahim says. “We are the only practice in the Denver area, and one of only a few in the U.S., to offer it.” The technique, for which Ibrahim has received a provisional patent, combines a minimally invasive approach — a 3-inch incision is used — with the Mazor Robotics Renaissance® system, designed specifically for spine surgery, to precisely guide him during the procedure to free up the compressed nerves and stabilize the spine. “We are able to place the instruments within a millimeter of where they need to be, time after time,” Ibrahim says.
Most back pain can be relieved by over-the-counter anti-inflammatory pain relievers. But, Ibrahim says, “If you’ve been having pain for a week or two, let your primary care physician know, and they can prescribe an oral steroid.” For pain that lasts five weeks or more, see a specialist for X-rays or potentially an MRI.
BACK TO LIVING — FASTER The result is that patients are going home — and getting back on their feet — significantly faster. “In a lot of cases, open surgery means a four- or five-day hospital stay. With this minimally invasive approach, the patient is typically up and walking the same day, and frequently leaves the hospital the next day,” Ibrahim says. And, they’re resuming normal activities much more quickly. Many patients even get back to physical activities such as skiing or cycling in about six weeks, Ibrahim says.
PHOTO BY MICHAEL RICHMOND
To learn more about minimally invasive spine surgery techniques, come to a FREE seminar led by Dr. Zak Ibrahim on April 17. See back cover for details.
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PRIMARY CARE PRACTICES AURORA CHPG Cornerstar Primary Care (Parker and Arapahoe) 303-269-2626 • cornerstarprimarycare.org
Portercare Adventist Health System
Non-Profit Organization U.S. Postage
PAID
Denver, CO Permit No. 4773
9395 Crown Crest Boulevard Parker, CO 80138
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 Holly Creek 303-649-3820
DENVER CHPG Clermont Park 303-649-3155 • clermontparkseniorcare.org CHPG Primary Care Cherry Creek 303-316-0416 primarycarecherrycreek.org 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
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 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 SPRING 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.
The Benefits of Minimally Invasive Robotic Spine Surgery
Mon, Apr 17 | 6-7:30 p.m. Join Dr. Zak Ibrahim, orthopedic spine surgeon, to hear about minimally invasive options for robotic spine surgery.
Painful Hands and Numb Fingers: It May Not Just Be Arthritis
Thu, Apr 20 | 5:30-6:30 p.m. Join Dr. Micah Worrell, hand and upper extremity orthopedic surgeon, to learn more about why you might be experiencing pain and numbness in your hands.
Surgical and Nonsurgical Treatments for Pelvic Health
Thu, May 4 | 11:30 a.m.-1 p.m. Join Dr. Alison Tate, urogynecologist, and Dr. John Sun, colorectal surgeon, to hear about surgical and nonsurgical options for treating urinary and fecal incontinence and pelvic organ prolapse.
Advances in Cataract Surgery
Thu, May 18 | 6-7 p.m. Join Dr. Jennifer Grin, ophthalmologist, to find out about the latest innovations in technique, laser-assisted cataract surgery, and premium intraocular lenses, which can restore vision for near, distance, and both!
Sun, Apr 30 | 8 a.m.-Noon More than 15 health screenings — including body mass index (BMI) and blood pressure checks — will be offered FREE or for a low cost at this health fair. The blood chemistry screening is $35 and includes over 23 different blood tests, including cholesterol; $20 blood count; PSA for $30; and new this year is testosterone, male $35, female $45. All screenings are provided on a first-come, first-served basis. For more information, go online to 9healthfair.org.
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, 2017.
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CHPG Grace Family Practice (near Arapahoe and Holly) 720-528-3559 • gracefamilypractice.org