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winter 2014

Your health. Your life.

Breathing

Easier

New asthma procedure reduces ER visits and medication use

a n d ...

Better Resolutions Page 2

New Heart Tests Page 3

Parkinson’s Surgery Page 7

FREE Health Classes Page 8


IN Good Health

Conquer Your Resolutions

Lose weight, quit smoking, eat healthier … Nearly half of all Americans choose to make New Year’s resolutions, and nearly half of those will still be on track in six months. Want to make your odds of success even higher? Setting specific goals nearly doubles success rates, studies show. Instead of resolving to lose weight, set a goal of losing one pound per week. Even better is setting a goal around something you can control, such as resolving to eat seven servings of fruits and vegetables per day. Choosing a healthy lifestyle is the first guiding principle of the CREATION Health lifestyle, an Adventist wellness program supported by medical research.

High-intensity exercise reduces risk of chronic disease

Women who engage in high-intensity exercise — such as running, swimming laps, and playing basketball — can cut their risk of chronic disease to just 11 percent, compared to 20 percent in women who don’t exercise regularly or at high intensity, according to a recent study in the Archives of Internal Medicine. Likewise, men can cut their risk to 16 percent from 28 percent. “High-intensity exercise, coupled with proper nutrition, can play a major role in combating diseases and, for those with chronic illnesses, improve your quality of life,” says Kathy Vidlock, MD, a boardcertified family medicine physician at Highlands Ranch Medical Associates, who has also completed a sports medicine fellowship. High-intensity exercise leaves a person breathing hard and fast with an elevated heart rate. When engaged in this level of activity, most people can speak only a few words at a time. People who engage in vigorousintensity exercise need only

one hour and 15 minutes

weekly, while people who engage in moderate-intensity exercise need double that, according to the Centers for Disease Control and Prevention. 2 | winter 2014 • Create

New Y ear’s resolvers are 10 times more likely to accomplish their goals tha n non-resolvers who have the sa me goals, according to a study pu blished in the Journal of Clinical Psycholog y.

600

international units

the amount of vitamin D needed daily by women ages 51-70. Women over the age of 70 need 800 international units daily.

Vitamin D Shortage

Doctor’s

BAG Dr. Kathy Vidlock

Highlands Ranch Medical Associates

Dr. Ryan Myers

Chatfield Family Medicine

When it comes to osteoporosis, women tend to know about the need for calcium. But equally important is an adequate level of vitamin D, which is necessary for the body to absorb calcium, says Ryan Myers, MD, a board-certified family medicine physician at Chatfield Family Medicine. Vitamin D is present in very few foods, mainly the skin of fatty fish, such as salmon and tuna. You also can get vitamin D through exposure to sunlight; however, with the use of sunscreen (a good thing), sunlight exposure may not be enough. Most women don’t get enough vitamin D naturally and should be tested for deficiencies, which is done with a simple blood test, Myers says. If levels are inadequate, the woman should talk with her doctor about supplements. “The reality is that vitamin D deficiencies can lead to osteoporosis, particularly as women age,” Myers says. To schedule an appointment with Dr. Myers, call 303-738-2714 or visit chatfieldfamilymedicine.org.

Cover photo: ©IStockphoto.com/IsaacLKoval, This page: ©IStockphoto.com/Talaj, ©IStockphoto.com/eurobanks, ©IStockphoto.com/AlexRaths

Go to mylittletonhospital.org/vision to learn how to create a vision board that can help you achieve your 2014 goals.


Advanced heart tests score better treatments

1. Expanded lipid test: This blood test measures LDL (bad cholesterol) and HDL (good cholesterol) and assesses the size of cholesterol particles. LDL and HDL particles transport fats in the bloodstream; small, dense LDL can nearly triple the likelihood of a heart attack, studies show.

2. Genetic test: Done via a blood sample or cheek swab, genetic testing can lead to patient specific treatment plans, including specific diets. For instance, chromosome 9p21 is associated with early heart disease, but eating a diet rich in fruits and vegetables can counteract its effects.

3. Carotid Intima Media Thickness (CIMT) test: Using ultrasound, this test detects vascular disease, provides a measure of true vascular age, and helps determine whether treatment is necessary.

4. CT calcium score: This computed technology (CT) scan tests for the presence, location, and amount of calcified plaque in the coronary arteries.

Heart disea

se ris

k factors • High choleste rol or blood pres sure • Obesity • Personal or fa mily history of ca rdiac event befo • Diabetes and re age 55 prediabetes • Smoking • Unhealthy diet • Lack of phys ical activity • Stress

Join us for a nutrition

lecture and heart-healthy cooking demonstration on Wednesdays, from 11 a.m. to 12:30 p.m. at South Denver Cardiology. RSVP online for an upcoming class at southdenver.com/calendar-ofevents. You can also schedule a $99 calcium heart scan by calling 303-744-1065, option 2.

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.

Fighting From Within Doctors are continuing to find success with a treatment that delivers radiation directly into inoperable liver cancer tumors. Intra-arterial

yttrium-90, or Y-90 radioembolization, is an outpatient procedure that uses a catheter inserted into the groin to deliver radioactive particles (Y-90) into the liver artery feeding the tumor. The procedure allows for highdose therapy directly into the tumor with minimal side effects, leaving healthy tissue unharmed. “Radioembolization attacks the tumor from the inside out and is performed as a same-day procedure with little or no pain,” says Brooke Spencer, MD, a board-certified interventional radiologist at Littleton Adventist Hospital. Research has shown that Y-90 can be tolerated at levels that successfully shrink or halt progression of the tumor without jeopardizing quality of life for patients. The percentage of Americans getting liver cancer has been increasing over the past several decades due to an increase in the cases of hepatitis and obesity, which along with alcoholism are the primary causes of liver cancer. Littleton Adventist Hospital offers this, along with many other types of nonsurgical cancer treatments. For more information, visit mylittletonhospital.org.

7700 S. Broadway | Littleton, CO 80122 | mylittletonhospital.org create | mylittletonhospital.org | 3

photo: ©IStockphoto.com/monkeybusinessimages, ©IStockphoto.com/jeridu

Cholesterol, blood pressure, and waist size are three important factors that can help predict heart disease. But for people who have a known risk factor of heart disease, advanced screenings help clarify the likelihood of problems and define better treatment. “The more detailed information we have, the better we can treat patients,” says Richard Collins, MD, a board-certified cardiologist at South Denver Cardiology. Advanced cardiac screenings include:


Breath of relief for severe asthma sufferers New, innovative procedure reduces frequency of asthma attacks

Dr. Kelly Greene, Pulmonologist, Littleton Adventist Hospital

Dr. Evan Stepp, Pulmonologist, Littleton Adventist Hospital

People who suffer from severe, persistent asthma may soon be able to breathe a sigh of relief, literally, thanks to a new nondrug outpatient procedure now available at Littleton Adventist Hospital. Known as bronchial thermoplasty (BT), the new procedure uses a bronchoscope and radiofrequency energy to reduce the excessive smooth muscle tissue in the airway. The reduction of muscle tissue decreases the ability of the airway to narrow and constrict in response to triggers. As a result, the frequency of asthma attacks is lessened and, in many cases, medication usage is reduced. “Bronchial thermoplasty is incredibly exciting,” says Kelly Greene, MD, a board-certified pulmonologist and intensive care co-director at Littleton Adventist Hospital. “We haven’t had anything new in the area of asthma specifically for people who suffer from severe asthma.” Asthma is a chronic respiratory condition marked by difficulty breathing. It is caused by an inflammation of the airways, which results in the narrowing of the airways. Asthma can be triggered by a variety of sources unique to the sufferer, ranging from allergies to cold air to infections. BT is recommended for asthma sufferers over the age of 18 whose asthma is not well-controlled with medications. BT may not be for everyone; it’s important to consult your physician or pulmonologist to determine if BT is for you.

3-Step Treatment

4 | winter 2014 • Create

BT consists of three outpatient procedures spaced three weeks apart. Each time, the physician inserts a bronchoscope — a long tube with a camera on one end — through the mouth or nose and into the lungs. The physician then applies radiofrequency energy to the airways to reduce excessive smooth muscle.


78%

drop in emergency room visits as compared to before the procedure

Nearly one-third of patients who underwent BT experienced a reduction in inhaled corticosteroid usage by more than

50%

“The new procedure is essentially taking the bronchoscopy, a common procedure that we do frequently, and adding a twist to it,” says Evan Stepp, MD, a board-certified pulmonologist at Littleton Adventist Hospital. Each procedure typically takes less than an hour, with the patient under moderate sedation. The first session targets the airways in the right lower lobe of the lungs, the second focuses on the left lower lobe airways, and the third session treats the airways in the upper lobes of the lungs. Breaking the process up into three procedures allows for thorough attention to each area and appropriate recovery time. Generally, patients remain at the hospital for a few hours after the procedure to let the anesthesia wear off. “Recovery from the sedation required for bronchial thermoplasty is typical for any outpatient procedure, much like recovery from a colonoscopy,” Stepp says. Asthma attacks account for more than 2 million visits to the emergency room each year. BT works in tandem with asthma medications to reduce the frequency and severity of attacks. A recent study published in the Journal of Allergy and Clinical Immunology found that patients who underwent BT experienced a 78 percent drop in emergency room visits as compared to before the procedure. The same study found that BT is effective for up to five years, and that nearly one-third of patients experienced a reduction in inhaled corticosteroid usage by more than 50 percent. “We know that inflammation of the airways drives asthma,” Greene says. “Some of the medications used presently for asthma, particularly prednisone, carry risks. BT has shown remarkable success in a recent fiveyear study, leading to reduced medications and relief for severe asthma sufferers.” Asthma has grown in prevalence by nearly 15 percent in the last decade and affects nearly one in 12 Americans, according to the Centers for Disease Control and Prevention’s National Asthma Control Program. BT is an exciting advancement for asthma sufferers who haven’t been able to find relief with medications or who are taking excessive amounts of medications, says Greene. A potential candidate for BT, according to Greene and Stepp, is someone 18 and older who has: • Difficult-to-control asthma • Frequent asthma exacerbations • Frequent use of steroids “Controlled asthma should not include more than one flare up a year that requires steroids or a hospital visit,” Stepp says.

FREE BT Seminar Find out if bronchial thermoplasty (BT) may be right for you by attending a FREE seminar on Saturday, Feb. 8, at 10 a.m. at Littleton Adventist Hospital. To register, visit mylittletonhospital.org/bt or call 303-777-6877, option 1.

Winter Warrior

While everyone with asthma reacts differently to triggers, colder temperatures often wreak havoc on many asthma sufferers. To combat colder temperatures this winter, try these tips: • Use short-acting bronchodilators 15-30 minutes prior to exposure to the cold air • Wear a scarf, mask, or something over the mouth to warm the air • Try breathing through your nose rather than your mouth • Be aware of sensitivities to smoke from fireplaces and avoid if a trigger • Practice good personal hygiene and hand-washing to reduce respiratory infections • Avoid exercising outdoors if cold air is a strong trigger

Exercise-induced asthma:

Warning signs

Exercise-induced asthma (EIA) is triggered during physical activity when the heart rate increases. While upward of 90 percent of people with asthma experience symptoms while exercising, people without asthma also can experience EIA. Some statistics show that as many as one in five Americans suffers from EIA. Kim Hegemann, registered respiratory therapist at Littleton Adventist Hospital, recommends that parents and children know common signs of EIA, which include: • Coughing or wheezing during or after exercising • Chest tightness and/or inability to take a deep breath Symptoms of EIA typically occur within five to 10 minutes after starting, during, or after exercise. “The best remedy is to use short-acting bronchodilators (like albuterol) 15-30 minutes prior to exercise and to check with your doctor to see if routine use of controller medications, like Flovent®, would be helpful, as they keep inflammation down,” Hegemann says. If you suspect you or your child has EIA, consult a physician. A study found that nearly one out of four U.S. athletes competed in the 1998 Winter Olympics with exercise-induced asthma.

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Photos: ©IStockphoto.com/AleksandarNakic

Patients who underwent BT experienced a


3 questions to consider when choosing your family physician

A primary care physician, PCP, commonly falls under one of three specialties: a family physician (treating patients of all ages), a pediatrician (specializing in children from birth to adolescence), or a general internist (for patients 18 and over). Sometimes women also use gynecologists as their PCP. “Your primary care doctor should work with you to understand your health concerns and build healthy goals to work toward together,” explains Terry Krause, MD, a family physician at Highlands Ranch Medical Associates, a member of the Centura Health Physician Group. With the evolution of technology and the advent of the Affordable Care Act, choosing your family doctor shouldn’t be just a matter of who is in the neighborhood or who is on your health plan (although those are important). Adding these three questions to your selection process can make the job easier:

Does the doctor use an electronic medical record (EMR)?

An EMR is a digital file of a patient’s medical history. Not only does this improve quality and convenience of patient care but because all doctors involved in the patient’s care can access the patient’s medical record, it allows for better diagnosis, treatment, and coordination of care.

Is your doctor part of a medical home?

A patient-centered medical home, PCMH, is a new model of health care, promoted through the Affordable Care Act. In this model, your PCP becomes the quarterback, taking the lead in providing preventive and primary care that keeps you healthy while also coordinating specialty care when needed. The goals are to improve health status, improve quality of health care services provided, and reduce costs.

How long is the initial visit for a new patient?

You’re not looking to save time when it comes to you and your family’s health. Check with the doctor’s office to make sure that the doctor plans to spend at least 30 minutes with you on your initial visit to obtain a complete health history.

According to a 2011 Consumer Reports study, 76 percent of doctors surveyed reported that forming a long-term relationship with a PCP is the most important thing a patient can do to obtain better medical care.

6 | winter 2014 • Create

The Centura Health Physician Group has doctors in your neighborhood whose offices can serve as medical homes, helping to ensure patients get the most appropriate and cost-effective health care. Centura Health Physician Group at Denver Tech Center (formerly South Quebec Family Medicine) Megan Haldy, DO Timothy Judd, DO Rita Sharma, MD 8200 E. Belleview, Suite 100* Greenwood Village, CO 80111 303-770-6500 *New address as of February 3, 2014 Chatfield Family Medicine Kelli Glaser, DO Nicole Hoffman, DO Ryan Myers, MD Laurie Patton, MD 10789 Bradford Road, Suite 150 Littleton, CO 80127 303-738-2714 Clement Park Family Medicine Kevin Boyle, MD Maria Hopp, MD 6901 S. Pierce St., Suite 110 Littleton, CO 80128 303-932-2121 Highlands Ranch Medical Associates Terry Krause, MD Kent Lofley, DO Kathy Vidlock, MD 9135 S. Ridgeline Road, Suite 190 Highlands Ranch, CO 80129 303-649-3140

Call the location nearest you to schedule an appointment today!

Photo: ©iStockphoto.com/mediaphotos

The ABCs of finding a PCP

Find a Doctor


John Bauer, 65, reduced his Parkinson’s disease symptoms with deep brain stimulation.

DBS How It Works

A new type of deep brain stimulation (DBS) that allows patients to remain asleep during surgery is now available at Littleton Adventist Hospital, one of only a few hospitals nationwide to provide this advanced surgical procedure. Often called “asleep” DBS, this new

procedure can be completed in two surgeries, rather than three. It also offers more precise results, compared to traditional DBS surgery, says David VanSickle, MD, PhD, a neurosurgeon at Littleton Adventist Hospital who helped advance this procedure. VanSickle is one of just a few neurosurgeons nationwide to perform both traditional and asleep DBS. “The results for asleep DBS are comparable to awake DBS, giving patients an option in procedures that best suits them,” VanSickle says. “New studies released last year show that DBS is effective in early stages of Parkinson’s disease and may even prolong life.” About two-thirds of VanSickle’s patients are now choosing asleep DBS, he says. Last summer, John Bauer, 65, was one of those. Diagnosed with Parkinson’s disease in 2003, Bauer’s disease had progressed to the point where it was causing extreme episodes of muscle freezing and stiffness. “I was going downhill quickly last winter,” says Bauer, a computer programmer who lives in Englewood. “DBS was a ‘no-brainer’ for me.” While not a cure, DBS has been shown to improve symptoms and reduce medication use for Parkinson’s disease patients by up to 50 percent. “My energy level has greatly improved, and my symptoms have lessened,” Bauer says. Bauer also notes that his medication usage has gone down each week since the procedure. k • Is lethargic

Learn More

at a FREE seminar about asleep deep brain stimulation (DBS) with Dr. VanSickle on Wednesday, Jan. 29. See details on back cover. You also can go online to view a video about the procedure at mylittletonhospital.org/dbs.

Benefits of asleep deep brain stimulation • Eliminates one of three surgeries • Allows patient to be asleep during surgeries • MRI/CT performed during the first surgery, eliminating a presurgery hospital visit • Electrode placement takes half the time as traditional DBS and is typically within 1 millimeter of target as compared to 1-2 millimeters

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portrait: ©Michael Richmond

No-Brainer

Parkinson’s patients can sleep through new two-step deep brain stimulation surgery

DBS works similar to a cardiac pacemaker, delivering tiny electrical signals to the brain to disrupt the connections that cause tremors and rigidity. A small device, called a generator, is implanted near the collarbone. This generator sends the electrical signals via small wires, called leads, to one of three target areas of the brain that control movement. Unlike the traditional awake DBS procedure, asleep DBS eliminates the need for a presurgery MRI and reduces the number of surgeries from three to two. In the first surgery, a portable CT machine (CereTom®) provides intraoperative images that can be overlaid on an earlier MRI, which allows for lead planning and placement during the same procedure while the patient is under general anesthesia (asleep). The surgeon places the generator in the second surgery. Electrode placement during asleep DBS takes roughly half the time as awake DBS, and placement is within 1 millimeter of the target as compared to 1-2 millimeters with traditional DBS. “I was most interested in the precision of the lead placement that the asleep procedure offers,” says Bauer, who has been able to return to his hobbies of photography and chess with more vigor and enjoyment than in the past. “I really waited three years too long,” Bauer says. “I just wish I would have done this sooner.” DBS is currently available for people with Parkinson’s disease, essential tremor, and dystonia.


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PAID

Denver, CO Permit NO. 4773

7700 S. Broadway Littleton, CO 80122

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, 2014.

The Diabetes Education Center at Littleton Adventist Hospital offers classes and individual consultations with a registered nurse and registered dietitian/certified diabetes educator to help you manage your diabetes. Topics covered include nutrition, physical activity, medications, monitoring, prevention and treatment of complications, goal setting, and problem solving. Medicare and most other insurances include diabetes self-management education and training as a covered benefit. A physician’s referral is required for the class and individual appointments. For more information or to register, call 303-738-2654.

Winter 2014 Deep Brain Stimulation for Parkinson’s Littleton Adventist Hospital is the only hospital in Colorado offering a new two-step procedure for deep brain stimulation that allows patients to remain asleep during the surgery. (See Page 7.) Join Dr. David VanSickle, neurosurgeon, at a FREE seminar to understand this new surgery and why even young Parkinson’s patients should consider surgery sooner rather than later. Light refreshments will be served. Date | Wed, Jan 29 Time | 6-7 p.m. Location | Littleton Adventist Hospital, Conference Room 3 Date | Wed, Feb 19 Time | 6:30-8 p.m. Location | Parker Adventist Hospital, Conference Room Inspiration B Date | Wed, Feb 26 Time | 6-7 p.m. Location | St. Anthony Hospital, Auditorium A & B Registration (required) | Online at mylittletonhospital.org/dbs or call 303-777-6877, option 1

Mammos, Massage, and Mochas! Join us for mammograms, chair massages, mochas, and chocolate fondue, as well as personalized skin consultations and bra fittings. Plus, register today for a chance to win a microdermabrasion facial! Date | Tue, Feb 11 Time | 4-8 p.m. Information and Registration 303-738-2767

Free health classes

innovative Asthma Treatment Adult patients who suffer from severe, persistent asthma are invited to a FREE seminar on bronchial thermoplasty. BT is a new long-lasting, nondrug procedure that delivers controlled energy to the lungs and decreases the muscle’s ability to constrict the airways, resulting in fewer asthma attacks. A light breakfast will be served. Date | Sat, Feb 8 Time |10-11 a.m. Location | Littleton Adventist Hospital, Conference Room 3 Registration (required) Online at mylittletonhospital. org/bt or call 303-777-6877, option 1 EAT YOUR WAY TO LOWER CHOLESTEROL Join The Cooking Cardiologist, Dr. Richard Collins, on Wednesday for a cooking class on how to nourish a healthier heart. Date | Wednesdays Time | 11 a.m.-12:30 p.m. Information and Registration southdenver.com/calendarof-events

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Diabetes Education Classes


Create Winter 2014