Bloom Spring 2013
Learn how to recognize the signs of a stroke, how to seek a second opinion without offending your doctor, and when an elderly driver should think about hanging up the keys in this quarterly magazine nurturing women's health in CO. Written and produced by Clementine LLC of Littleton, CO.
Driving and Dementia | Easing Pelvic Pain | Sandwich Generation Stress Stroke of Beauty New treatments at Penrose help stroke patients to full recovery $12 Cholesterol Test Special offer for bloom readers. Page 7 Spring 2013 Volume 3, Issue 2 healthystart Pulling over the aging driver As a parent grows older, many adult children begin to worry about that person’s ability to drive — particularly if dementia is involved. Yet it’s often one of the last things addressed by families. “The hard thing with driving is that it is so tied to a person’s independence and sense of self,” says Terri Cassidy, a certified driver rehabilitation specialist with Fitness to Drive at Penrose-St. Francis Rehabilitation Services. Fitness to Drive is a program that evaluates a person’s ability to drive safely. Surprisingly, dementia alone is not a reason to take away the keys. In the early stages, some people still have the skills to drive safely. On the other hand, a person without dementia may no longer have the skills, simply due to aging. “The best time to address this issue is early on when the parent is still capable of driving,” Cassidy says. “We encourage families to look at it as a planned retirement from driving. How will we know; what are the signs that we all agree will mean it’s time to stop driving?” It may be time to park the car if the aging driver is showing these signs: Difficulty turning around to see when backing up the car 11 Riding the brake Hitting curbs or improper parking A new program offered by Colorado Sports & Spine is helping women find relief for chronic pelvic pain through physical therapy, relaxation techniques, and biofeedback. “There are a lot of different causes of pelvic pain, such as trauma or recurrent yeast or urinary tract infections,” says Kristina Koch, a physical therapist in the women’s program. “These can cause irritation that causes the pelvic muscles to tighten and spasm, causing pain. It can become a cycle where even the lightest touch becomes unbearable.” This program is designed for women who do not have a treatable medical condition, such as endometriosis, that is causing the pain. Some of the treatment techniques include stretching the pelvic and hip muscles to improve blood flow and using biofeedback or ultrasound to learn how to relax muscles. Scrapes or dents on car For more information about the Penrose Fitness to Drive program or to schedule an evaluation, go online to penrosestfrancis.org/drive or call 719-776-5200. Also, join us on May 11 for CarFit, a FREE event that will review the safety features of an older driver’s car to ensure they are being used properly. bloom is published four times annually by Penrose-St. Francis Health Services. As part of Centura Health, our mission is to nurture the health of the people in our community. The information herein is meant to complement and not replace advice provided by a licensed health care professional. For comments or to unsubscribe to this publication, please email us at email@example.com. bloom is produced by Clementine Words LLC. Executive editor is Jill Woodford. Learn More To learn more about the pelvic pain program, call Colorado Sports & Spine Women’s Health Program at 719-571-8888. 2222 North Nevada Avenue, Colorado Springs, CO 80907 bloom 2 Spring 2013 Penrose-St. Francis Health Services Cover photo: ©iStockphoto.com/mediaphotos; This spread clockwise: ©iStockphoto.com/Giedrius Dagys, ©iStockphoto.com/ Mark Bowden, ©Ellen Jaskol Relieving Pelvic Pain HOW TO SEEK A nd Opinion withou t offe ndin g your doctor A cancer diagnosis can create anxiety, especially about whether you’re getting the right treatment. Often, a second opinion can create peace of mind. “We believe that patients should feel very comfortable with their treatment, and sometimes that means you want a second opinion,” says Dennis Bruens, director of the Penrose Cancer Center. “It happens all the time in cancer care, and it does not upset doctors.” The Penrose Cancer Center recently opened the Second Opinion Clinic. For $99, a patient can submit his or her records to be reviewed by a multidisciplinary team of physicians. The team will then give the patient a report agreeing with the plan of action or recommending that other tests or treatments are considered. To learn more about the Penrose Cancer Center Second Opinion Clinic or to set up an evaluation, please call 719-776-5271. &A Q With Gary Klein, MD Family Medicine Physician at Penrose-St. Francis Primary Care Q: What is a high-level cholesterol test? A: This is the newest type of cholesterol test that not only penrosestfrancis.org provides the standard measures of good and bad cholesterol, but it actually breaks down the various types of cholesterol into particle sizes. Knowing particle sizes within LDL, HDL, and triglycerides are key to better understanding who will develop problematic heart disease. For instance, smaller particles of low-density lipoproteins (LDL, or “bad” cholesterol) are more dangerous because they can more easily penetrate the inner lining of artery cells. So a person could have an acceptable level of total LDL but if it consists primarily of small particles, he or she may be For the man in your life: Heart Murmurs If the man in your life is left short of breath when he sees you, it might be his heart. Not love but a heart murmur. Although a murmur can be harmless, more and more adults are developing dangerous murmurs resulting from valve disease or damage, says Erik Carlson, MD, a cardiologist who specializes in valve disease at Colorado Springs Cardiology, a Centura Health Clinic. Over time, heart valves can become narrowed and inhibit adequate blood flow within the heart. They also can become damaged and begin leaking. These problems can cause shortness of breath, chest pain, and even fainting, and will need to be treated with medications or surgery. A new procedure allows doctors to repair the most dangerous valve problem, aortic valve stenosis, through a nonsurgical catheter procedure. Penrose-St. Francis Health Services is the only hospital in Southern Colorado to offer this technique, called transcatheter aortic valve replacement (TAVR). Heart murmur clinic To learn more about murmurs and valve disease, call the Penrose-St. Francis Murmur Clinic at 719-776-8768 or go online to penrosestfrancis.org/murmur. at increased risk of heart disease. This test also appears to provide early diagnosis of diabetes, metabolic syndrome, and nonalcoholic fatty liver disease. Dr. Klein speaks to physicians nationally about this test on behalf of the test manufacturer. $12 Cholesterol Test Colorado Laboratory Services is offering a standard lipid panel to bloom readers for $12. See Page 7 for details. To obtain the high-level cholesterol test in this article, talk to your primary care doctor for a referral to Penrose-St. Francis Primary Care. If you don’t have a primary care doctor, please call PSFPC directly at 719-776-4646. Spring 2013 3 bloom Different strokes different folks When one woman thought she was having a stroke, she wanted to go to Penrose Hospital When she woke up one morning last September, Elizabeth Dienst noticed her hand was numb. “Maybe I just slept on it wrong,” she thought. She walked to the kitchen for her morning chai tea. She suddenly felt dizzy and accidentally poured her tea all over the counter. “I went to turn on the faucet to wet a rag, and I couldn’t make the faucet work,” she recalls. “I turned around to get some paper towels, and then I fell.” Dienst, a nurse, sat on the floor — and even though she didn’t have any risk factors for stroke, she was certain that’s what was happening. “I grabbed the house phone to dial 911,” she says. “But I couldn’t get my fingers and mind to work together.” Finally, she was able to use her smartphone to call her husband, who manages an ambulance service. When he heard her speaking in gibberish, he knew she was in trouble and brought another paramedic and an ambulance to their house. Dienst wanted to request that she be taken to Penrose Hospital, which is designated as a Primary Stroke Center, but she couldn’t form the words. She pointed to a clipboard in the ambulance, and the paramedic gave her a pen and clipboard. All she could write down was a “P.” “You want to go to Penrose; I already know,” the paramedic said. “That’s where we are headed.” At 45, Elizabeth Dienst was the picture of health. She didn’t think she could be having a stroke. She was wrong. What Is a Stroke? “The typical stroke,” explains Rodney Samuelson, MD, an interventional neurosurgeon at Penrose Hospital, “is one in which a blood clot has formed and travels to the brain and blocks off one of the major blood vessels in the brain.” These strokes are known as ischemic strokes, which account for about 87 percent of all strokes, according to the American Stroke Association. The other category of stroke is hemorrhagic (bleeding). These strokes occur when a weakened blood vessel ruptures. Risk factors for stroke include being older than 55; having high blood pressure, high cholesterol, diabetes, or atrial fibrillation (an abnormal heart Elizabeth Dienst, Colorado Springs stroke patient bloom 4 Spring 2013 Centura Connected Penrose-St. Francis Health Services is part of the Centura Health Stroke Network, Colorado’s largest and most comprehensive network of stroke care. Penrose-St. Francis Health Services Common Signs of Ministroke rhythm); smoking; alcohol use; obesity; physical inactivity; and a family history of strokes. Fast, appropriate treatment can not only save a life, but can result in less cognitive and physical decline. “It only takes a few minutes for the brain cells to become dysfunctional and only a few minutes after that for the brain cells to die,” Samuelson says. “So when a stroke has happened, it’s an absolute emergency.” Advanced Treatment Twenty or 30 years ago, Samuelson says, stroke treatment wasn’t very aggressive, and the outlook for patients was poor. Early trials of thrombolytic agents — drugs designed to dissolve blood clots — had very severe consequences, he says. Then, in 1995, an article was published in the New England Journal of Medicine. This study, called The Pivotal Study, “changed everything in stroke care and neurology,” Samuelson says. “It was that important.” As a result of this study, doctors had a way to evaluate stroke patients and identify those who could receive the anticlotting drug, tissue plasminogen activator (t-PA), safely. Doctors have just three hours from the onset of the stroke to administer the drug. They also must consider the type of stroke as well as a patient’s risk factors and other medical issues when they decide on treatment. Because Dienst was brought to the hospital quickly enough and she was young and otherwise healthy, Samuelson made the decision that t-PA offered Dienst the best chance for survival and recovery. And that’s why Dienst had wanted to go to Penrose Hospital in the first place. “I keep up on what’s new and different in our community,” she says. “I knew Dr. Samuelson was an interventional neurosurgeon — and I could get great care without having to go to Denver. My chances to completely recover were much greater by going to see him.” For patients who don’t qualify for t-PA, there are other options, Samuelson says. “Like cardiologists go into the heart, we can do the same thing in the brain. It’s risky,” he says. “But we have many new technologies, new devices, and new opportunities to … treat patients who wouldn’t qualify for t-PA.” Moving Forward After a series of tests, Dienst learned that she has patent foramen ovale (PFO), which is a hole between the upper two chambers (atria) of the heart, as well as an autoimmune clotting disorder, which combine to put her at risk for a stroke. Thanks to the treatment she received, Dienst was able to quickly recover both physically and cognitively. She went back to work in November and is on blood thinners to help reduce her chances of another stroke. And she has a message for the community: Anyone can have a stroke at any age, even if you don’t have any risk factors. Above all, she says, she feels lucky. “What Dr. Samuelson offers is priceless for Southern Colorado,” she says. “I can never thank him enough for giving me back my quality of life. Drooping of the face Weakness in the arm or leg Difficulty speaking Symptoms of a TIA can come on suddenly and are the same as a major stroke. Confusion Trouble with vision in one or both eyes Loss of balance or coordination A ministroke isn’t a mini-concern. A transient ischemic attack (TIA), known as a ministroke, is a warning sign because it increases your risk for a future stroke, says Heidi Vagts, BSN, stroke coordinator for Penrose-St. Francis Health Services. The symptoms of a TIA and a stroke are the same, she explains. The difference is that a TIA will generally resolve on its own within an hour. But there is no way to know whether your symptoms will be temporary or permanent when they first begin. If someone is experiencing the symptoms of a stroke, there’s no time to waste. Here’s an easy way to remember what you’re looking for: F - Face. A - Arm. Is one side of the face drooping? Does one arm drop? Is there weakness on one side? S - Speech. Is the person’s speech slurred? T - Time. If someone is experiencing these symptoms, call 911. Grocery Spree Register to win a $250 gift card from Whole Foods Market® in Colorado Springs and a visit with one of their Healthy Eating Specialists to find the healthiest options around the store. To register, visit penrosestfrancis.org/giftcard. Deadline to register is June 30. penrosestfrancis.org Spring 2013 5 bloom photoS: ©Ellen Jaskol, ©iStockphoto.com/pagadesign About 795,000 people in the U.S. suffer a stroke each year. And nearly a fourth of those occur in people younger than 65. Detecting Ovarian Cancer Fight like a girl against gynecologic cancers There is no screening test to help catch ovarian cancer early. But asking women three questions can help determine if they should be tested for ovarian cancer, according to a recent study published in the Open Journal of Obstetrics and Gynecology. It starts off small — some spotting, a bloated belly, maybe some pelvic pain, or just pressure. 1 Pain Do you have abdominal and/or pelvic pain? Chances are it’s nothing. But you don’t know that. G 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 and 26,500 women will die this year from gynecologic cancers, according to the Centers for Disease Control and Prevention. The Deadliest 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, says Dirk Pikaart, DO, a gynecologic oncologist at Southern Colorado Gynecology Oncology in Colorado Springs. The key, therefore, is for women to pay attention to symptoms and get them checked early. “Chances are good that it’s not cancer, but you should still get checked,” he says. “If it’s not cancer, it could be something else that can be treated.” Conditions such as endometriosis, fibroids, and even 2 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 perform surgery. The Most Common Endometrial cancer, which occurs in the lining of the uterus, is the most common type of gynecologic cancer and is increasing along with obesity rates, Pikaart says. “The fatty tissue creates estrogen, which constantly stimulates the lining of the uterus,” he explains. “When that lining is continually stimulated, it can develop cancer.” About 80 percent of endometrial cancers can be cured with a hysterectomy, but it must be diagnosed early before it has spread. The most common symptom is abnormal bleeding. “I’ve treated women who have been spotting for three years and didn’t have it checked,” Pikaart says. “The message for women is that bleeding after menopause is cancer until proven otherwise.” Learn More Gynecologic conditions, including cancer, are being more effectively treated through robotic surgery. Using the advanced da Vinci® robot, gynecologic oncologist Dr. Dirk Pikaart can remove even the tiniest cancerous lesions and tumors without injuring organs, arteries, or healthy tissue. Learn more about robotic surgery for gynecologic conditions by calling Southern Colorado Gynecology Oncology at 719-776-6222 or by visiting penrosecancercenter.org/treatment-technologies. bloom 6 Spring 2013 Eating Do you feel full quickly and/or are you unable to eat normally? 3 Size Have you experienced abdominal bloating and/or increased abdomen size? The Penrose Cancer Center is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado. Penrose-St. Francis Health Services The Woman in the Middle Date | May 4 Time | 9-11:30 a.m. Location | Penrose Pavilion, 2312 North Nevada Avenue Cost | FREE Sandwiched between two generations, women between ages 40 and 60 find themselves caring for aging parents while still taking care of their own children. Pulled in many directions, these women are at risk for stress, depression, heart disease, and other health problems. The demographics of our society may make it impossible to avoid being sandwiched, but there are steps women in the middle can take to protect their physical and emotional health. Join Dr. Diane Thompson and Nancy Bader, clinical psychotherapist, who will help you find a healthy balance among parenting, caregiving, and daily activities. You’ll learn how to adjust your perspectives, set boundaries, take care of yourself, and recognize the early signs of stress and depression to help you navigate this stage of life. To register, visit penrosestfrancis.org/middle. Spring Class Calendar Penrose-St. Francis Health Services offers dozens of health classes each quarter. Here is just a sampling of our classes. For a complete list, go to penrosestfrancis.org/wellness. photos: ©iStockphoto.com/Flander, ©iStockphoto.com/laflor May Screening Mammogram Special Date | May 1-31 Location | The Center for Women’s Imaging, 2312 North Nevada Avenue, Suite 220 Cost | $99 In May, in addition to our usual spalike atmosphere, comfy robes, and aromatic hand treatments, enjoy fruity mocktails and receive a FREE gift! Saturday appointments are available. Most insurance plans cover screening mammograms at no charge to the patient — check with your insurance plan for details. Self-pay patients pay only $99 during the month of May. Payment required at time of service. To schedule, call 719-776-8010, option 2. penrosestfrancis.org Low-Cost Lipid Panel Date | Apr 1-May 30 Times | Mon-Fri, 8 a.m.4 p.m.; Sat, 8 a.m.-Noon Location | Penrose Pavilion, 2312 North Nevada Avenue, Suite 110 Cost | $12 Mention you saw this offer in bloom for a special $12 lipid panel that includes total cholesterol as well as a breakdown of triglycerides, and high-density (HDL) and low-density lipoproteins (LDL). No appointment is necessary, but an 8- to 12-hour fast prior to testing is required. Payment due at time of test; insurance cannot be billed. For more information, call 719-667-3141. Oh My Aching Joints Date | Apr 24 Time | 6-8 p.m. Location | NorthCare Building, 6071 East Woodmen Road (on the St. Francis Medical Center campus) Cost | FREE Registration | 719-776-6042 Do you have hip or knee pain that never goes away? Have you been told you have arthritis in your joints? If you answered yes to either of these questions, we invite you to a FREE seminar with Dr. Michael Feign, orthopedic surgeon, to learn how to protect your joints and which treatments can help. Community Skin Cancer Screening Date | May 4 Time | 8-11:30 a.m. Location | Peak Vista Community Health Centers, 225 South Union Boulevard Cost | FREE Registration | 719-444-CARE, option 3 CarFit Date | May 11 Time | 9 a.m. Location | Centura Health Administrative Service Center, 3030 North Cascade Avenue Cost | FREE Registration | 719-776-5200 More than 1 million cases of skin cancer are diagnosed every year. Some are lifethreatening; some cause permanent damage; all are dangerous. We’re offering a FREE skin cancer screening to everyone in the community. For more information or to register, visit penrosecancercenter. org. Trained professionals will lead older drivers through a 12-point checklist with their vehicles, recommend adjustments and adaptations, and offer community resources and activities that could make their cars “fit” better to enhance safety. An occupational therapist will be on hand to provide information on how to maintain and strengthen driving health. Back Pain: Don’t Take It Lying Down Date | Jun 26 Time | 6-8 p.m. Location | NorthCare Building, 6071 East Woodmen Road (on the St. Francis Medical Center campus) Cost | FREE Back pain can stop you in your tracks. Come for a FREE seminar with a physical therapist and Dr. Christopher Malinky, pain management specialist, and find out about some nonsurgical treatments to help with neck and low back pain. For more information, call 719-776-2225. S Spring 2013 7 bloom Catholic Health Initiatives Colorado Non-Profit Org. U.S. Postage PAID Colorado Springs, CO Permit No. 14 2222 North Nevada Avenue Colorado Springs, CO 80907 Centura Health complies with the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973, and no person shall be excluded from participation in, be denied benefits of, or otherwise be subjected to discrimination in the provision of any care or service on the grounds of race, religion, color, sex, national origin, sexual preference, ancestry, age, familial status, disability or handicap. Copyright © Centura Health, 2013. Physician’s Insight Early detection key for women under 50 with breast cancer lthough many women in their 40s don’t think much about breast cancer, they should. More than 25 percent of the breast cancer cases diagnosed last year in El Paso County were in women under the age of 50. And breast cancer in women of this age is typically more aggressive, spreading outside the breast faster. Breast cancer in this age group also tends to be estrogennegative. That means it does not respond to therapies, such as tamoxifen, that help reduce the chances of recurrence. The key to increasing survival and decreasing recurrence rates is early detection, yet many women in this age group skip mammograms and even self breast exams, mistakenly believing that breast cancer only strikes later in life. 25% One out of every four women in El Paso County diagnosed with breast cancer is under 50. Schedule Your Next MamMogram Annual mammograms starting at age 40 are recommended by the American Cancer Society and most physician associations as the best way to catch breast cancer at its earliest and most treatable stage. If detected and treated when the cancer is confined to the breast, women have an 88 percent rate of surviving five years or longer. Don’t panic if called back Women under 50 are more likely to be called back after a screening mammogram for further testing. This does not mean cancer. Here are some common reasons for callbacks: Overlapping tissue: Younger women’s breasts are denser, and tissue can get stacked on top of other tissue during a mammogram. Additional tests spread out this tissue to get a clearer view. Cysts: Fluid-filled sacs, common in women 3550, appear as a mass on a mammogram. These are not cancerous, and most don’t need treatment unless they are painful. Calcifications: These are tiny calcium deposits in the breast that may not be cancerous. Calcifications appear on about half of all mammograms. With Toni GreenCheatwood, DO Medical Director of Breast Oncology at the Penrose-St. Francis Breast Care Center May mammogram special Enjoy fruity mocktails and receive a FREE gift when you get your screening mammogram in May at The Center for Women’s Imaging in the Penrose Pavilion. Saturday appointments are available. Self-pay patients pay only $99 during May. See Page 7 for details or call 719-776-8010, option 2. photo: Ellen jaskol Penrose-St. Francis Health Services has been named one of America’s 50 Best Hospitals by HealthGrades for the sixth year in a row. Learn more at penrosestfrancis.org/healthgrades.