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Fall 2013 | Volume 5, Issue 4
Do you have an
EMERGENCY? common reasons why we head to the ER Tips for knowing if you should go
Dr. Phil Mitchell, medical director of emergency services at Parker Adventist Hospital, helps you navigate your way through illnesses and injuries. Page 4
Low testosterone and depression
Faster recovery from hip replacement
Radiation cancer therapy comes to Parker
PAGE 7 PHOTO BY ELLEN JASKOL
Winter Readiness Preparing your medicine cabinet for winter’s most common illnesses IF YOU’VE GOT A PRESCHOOLER AT HOME, you’re almost guaranteed to face at least one bout of a cold this winter. Same goes for college students, people over age 60, and people who are stressed out. In other words, most of us. And 5 to 20 percent of people will get the flu. More than 40 percent of parents give cough or cold Your best bet at weathering the winter with good health is to medications to children under the age of 4, despite stay rested, eat well, stay hydrated, wash hands frequently, and evidence that these medications don’t work in young get a flu vaccine. But if someone in your family comes down with children and may cause harm, according to a national the cold or flu, there are a few things you’ll want on hand, says poll released earlier this year. Bree Willis, MD, a family physician at Parker Adventist Hospital. Children can experience drowsiness, rapid heartbeat, However, be sure to talk with your doctor about any risks. “Even breathing problems, and seizures after taking cough or over-the-counter medications can be dangerous,” Willis adds. cold medicines. “I tell parents not to use these products Be sure to read labels and with children under 6 because they don’t help, and there follow directions carefully, says can be pretty serious side effects, including oversedation Samantha Glunz, PharmD, director and even death,” says Bree Willis, MD, a family of pharmacy at Parker Adventist medicine physician at Parker Adventist Hospital. Hospital. Acetaminophen and Parents should try propping the child’s head up and ibuprofen, for instance, are t tan es ng using nasal sprays or a cool mist humidifier to loosen co De often contained in cold and flu fen mucus and ease breathing instead, Willis recommends. pro ibu or Acetaminophen medicines, so you shouldn’t take th Cough medicine wi them separately as well. enesin aif gu or n ha orp eth dextrom 6 (only for children over s) ult ad d an Antihistamine Parker Adventist Hospital will provide low-cost flu vaccinations on Nov. 6 and 13 have Bulb syringe (if you from 4-6 p.m. in the hospital’s main lobby. The cost is $25 but is covered by Medicare Part B babies at home) (as primary insurance), UnitedHealthcare Medicare Advantage (formerly Secure Horizons), rinses Nasal saline spray or Aetna, Humana Gold, and Rocky Mountain Health Plan. You must show a valid insurance card. er FluMist®, the nasal spray vaccine, is available for $30 for people ages 2-49 while supplies last. Hot or cold humidifi
Parents continue use of dangerous cold medicines
Low testosterone tied to lower motivation, depression HAS YOUR HUSBAND OR BOYFRIEND LOST HIS GET-UP-AND-GO? Has he lost interest in his favorite activities? Does he seem depressed? He might be suffering from low testosterone levels, even if he’s in his 30s or 40s. “When it comes to low testosterone, everyone thinks about libido. However, one aspect of low testosterone that is overlooked is a lack of motivation,” says Chris West, DO, a family medicine physician at Parker Adventist Hospital. “When we bring it back to normal levels, men are engaged again.” Testosterone levels naturally begin to decline in the late 30s. For most men, it happens gradually and doesn’t cause problems. But for some men, even in their 20s, low testosterone can decrease their quality of life and may even be tied to health problems, such as diabetes. Testosterone levels are easily checked through a simple blood test. There are a number of treatment options, including patches and gels. Blood is checked every three months to adjust the level of testosterone replacement. “In some cases, all the body needs is a little jump start and testosterone will start producing again on its own, and we can lower the dose,” West says. 2 ■ Fall 2013 ■
PHOTOS: TISSUE ©ISTOCKPHOTO.COM/STUARTBUR; SOFA ©ISTOCKPHOTO.COM/ROCKARD
LOW-COST FLU VACCINES
Hipper, Happier HEALTH Anterior hip replacement surgery makes recovery a breeze A NEW TYPE OF HIP REPLACEMENT SURGERY is
JOIN Dr. Johnson to learn more about anterior hip replacement on Oct. 22. This FREE health seminar will be held from 6:30-8 p.m. in the Parker Adventist Hospital Conference Center on the west side of the hospital, with FREE parking immediately outside the center. Registration is required by calling 303-777-6877, option 1.
Three weeks after having her hip replaced at Parker Adventist Hospital, Vicci Williams was back on the golf course.
PHOTO BY ELLEN JASKOL
getting patients back on their feet within hours and back to work in just two weeks. “Seventy percent of our patients are leaving the hospital the day after surgery,” says Derek Johnson, MD, medical director of orthopedics at Parker Adventist Hospital. “With the new approach, recovery is accelerated significantly. It’s also what we’re doing with pain control and physical therapy; some are walking 150-200 feet within four or five hours of surgery.” Traditionally and still most commonly today, surgeons replace the hip joint by making an incision through the buttocks, called the posterior approach. The new method that is rapidly gaining popularity with patients is called the anterior approach. Using this technique, surgeons replace the joint through the front of the hip by moving muscles and tendons aside rather than cutting through them. The result is that patients do not have any restrictions following surgery and immediate recovery is faster, with long-term results equal to the posterior method. Many patients also report less pain after surgery. “I cannot tell you how easy this whole experience was,” says Vicci Williams, 64, who lives in Silverthorne and had both of her hips replaced by Johnson at Parker Adventist Hospital. “After my second (hip replacement), I was playing golf in three weeks. It’s amazing to do it this way. I have a friend who had the other surgery a month before mine, and she’s still having problems.” In hindsight, Williams knows she waited far too long to have her first hip replacement. By the time she gave in, she had given up her beloved golf game and was hobbling through her job as a sales associate at Coach. “I was in extreme pain,” Williams says. “When I went into surgery, the anesthesiologist said, ‘You’re going to wake up feeling better,’and it was the absolute truth. I woke up with minor soreness, maybe a two out of 10.” Williams learned her lesson. At the first twinge of pain in her other hip, she scheduled surgery. Johnson now uses the anterior approach with all of his patients, if possible. Some patients who need revision surgery for a previous hip replacement or patients who have unusual anatomy may still require the posterior approach, he says.
Is It Time? After having both of her hips replaced, Vicci Williams has a piece of advice for other people suffering hip pain: Just do it. “It’s not worth waiting,” she says. Patients, regardless of age or how long they’ve experienced pain, should consider hip replacement when pain is limiting activity or making life unenjoyable, says Derek Johnson, MD, a joint replacement surgeon at Parker Adventist Hospital. “Hip replacement is a wonderful surgery. Ninety-five to 98 percent of people are extremely satisfied,” he says. And putting off surgery can actually have some downsides: Loss of range of motion. As patients cut back activity due to pain, the supporting muscles and tendons can shorten, which can limit range of motion after surgery. Loss of overall fitness. When it hurts to exercise, your heart, lungs, and overall health declines — and your weight can go up. These make surgery and recovery tougher.
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common reasons we head to the ER—and how to know if it’s really an emergency
I Dr. Phil Mitchell, medical director of emergency services at Parker Adventist Hospital
f you’ve only ever seen the inside of an emergency room through the lens of TV medical dramas like ER or Grey’s Anatomy, you might be prone to believing that every visit to the ER is an adrenaline-fueled roller coaster ride. And though physicians, nurses, and other professionals are trained in emergency medicine and do treat a variety of life-threatening illnesses and injuries, they’re often doing a bit of detective work to try and tease out the causes of mysterious symptoms — the kind that appear seemingly out of nowhere, and make it difficult to know where to go for care in the first place. Here, we take a look at six of the most common reasons you’re likely to head to the emergency room, and whether you should actually see your primary care physician or an urgent care center instead.
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According to the Centers for Disease Control and Prevention, the number of ER visits nationally for abdominal pain not caused by an injury increased 31.8 percent between 1999 and 2008. This increase is in line with what Phil Mitchell, MD, medical director of emergency services at Parker Adventist Hospital, and his team see as well. “Abdominal pain is very common and can range from food poisoning or kidney stones to more life-threatening problems,” he says.
ER or elsewhere? “If you’re having fairly mild abdominal symptoms over days to weeks that come and go, it’s probably something more suited to seeing your primary care doctor,” Mitchell says. “But when you have either something severe or just sudden onset that doesn’t let up, then you need to get to the emergency room, as it may require surgery.”
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Just the mention of the words “chest pain” leads most of us to think immediately of two other words: heart attack. But most cases of chest pain seen in the ER aren’t that serious, Mitchell says. “The problem is, it’s really hard for us to tell whether you’re having a serious event or not without seeing you.” ER or elsewhere? When it’s chest pain, don’t take chances. It’s best to start with the emergency room, Mitchell says. “People will often go to their doctor or urgent care first and wind up being sent to the ER for more definitive care,” he says. “If you’re having chest pain, it’s probably not going to be life-threatening, but it certainly could be.”
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PHOTO: AMBULANCE LIGHTS ©ISTOCKPHOTO.COM/YINYANG
PHOTO BY ELLEN JASKOL
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The most common types of back pain are musculoskeletal pain, or nerve irritation and sciatica-type pain. But back pain could also be more serious, like an abdominal aortic aneurysm that’s ruptured, which you’d only feel in your back because the nerves are there, Mitchell says. “We have to be able to rule out the really bad things and know how to effectively treat the much more common ones.”
PHOTOS: BACK ©ISTOCKPHOTO.COM/UGURHAN; HEADACHE ©ISTOCKPHOTO.COM/MAICA; BOY ©ISTOCKPHOTO.COM/HAWRIDGER
ER or elsewhere? If it’s an ongoing issue, it’s often appropriate to follow up with your regular doctor. But for sudden onset or severe back pain, or any type of neurologic symptoms such as tingling or tremors, head to the ER for help. “If the pain is severe enough to get them in, we want to know if it’s something more catastrophic, like epidural abscess or a mass on the spinal cord, which can both lead to paralysis,” he says.
From tension headaches and migraines to intracranial bleeds and tumors, ER physicians see headaches brought on by various culprits — even stroke. “Stroke doesn’t always show up as weakness or not being able to speak. Sometimes it’s just a bad headache and confusion that are the first signs of stroke,” Mitchell says. ER or elsewhere? “The common thread is something that is abnormal for an individual from what they’re used to, with sudden onset or severe intensity,” he says. “You’re likely going to need some type of detailed imaging test (such as a CT scan), and the only place you’re going to get that is in the emergency department.”
Parker Adventist Hospital’s Emergency Room: Level III trauma center 23,000 patients treated annually Top 1 percent nationally for patient satisfaction Average wait time to be assessed under 15 minutes
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RE ASO N 6
FRACTURES AND SPRAINS
While a broken bone or even a simple sprain should receive medical attention, not every strain and sprain needs to wind up in the ER. ER or elsewhere? “If you break a bone and it’s very angulated and deformed, you’ve got to get to the ER right away. But if you think you may have broken a bone in your foot, hand, or ankle, urgent care can sometimes be very appropriate for that,” Mitchell says.
Fever, fussing or nausea, vomiting, and dehydration are the most common reasons parents bring their children to the ER for care, Mitchell says. But how do you know when the ER is appropriate? Stay connected with your doctor. “Get plugged into your pediatrician. They know your child so well, and there’s good data to support their expertise in guiding parents through it,” he says. ER or elsewhere? “Unless something is dramatically abnormal where the child looks acutely ill and you should be calling 911, the first step I’d recommend is calling your regular doctor to see what they say,” Mitchell says.
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Health info at your fingertips Parker Adventist Hospital’s iTriage app puts health care in the palm of your hand. With it, you can:
A ccess ER wait times for Parker Adventist Hospital, and get updates every 15 minutes
R esearch over 300 symptoms, 1,000 diseases, and 350 medical procedures to help you make the best decisions about your health
S earch for pharmacies, doctors’ clinics, or other medical facilities within a 10-, 20-, or 50-mile radius using iTriage’s geolocating capabilities
Get iTriage for your smartphone Visit centura.org/ itriage to learn more about this new feature and download the app.
PHOTO COURTESTY OF ITRIAGE
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Whether it’s your digital habits or a sleep disorder keeping you awake, we’ve got tips to help you get your zzzs
IF YOU REGULARLY read email, scroll through your Facebook page, or play “just one more” game of Fruit Ninja on your digital device as you drift off to dreamland, you’re not alone. But falling asleep by the soft glow of your smartphone, tablet, or laptop could be hurting your health and leaving you feeling sick and tired. In fact, a recent study found that two hours of exposure to those glowing screens at night may reduce melatonin levels by 22 percent. “Light is alerting and suppresses melatonin production, which is a hormone that makes you sleepy,” says Emily Roby, PsyD, a psychologist at the Centre for Behavioral Health at Porter Adventist Hospital. “Suppressing melatonin may disrupt your sleep, and the resulting lost sleep can lead to high blood pressure, diabetes, and other health problems.” So, if your technology has you tossing and turning, it’s time to power down your devices and keep your bedroom a sanctuary for sleep. “If you remove the devices and get in bed and just sleep, it becomes a paired association where the bed actually becomes hypnotic — like it’s its own Ambien,” Roby says. She also recommends
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at least an hour of downtime from devices before bed for both kids and adults.
When bad habits aren’t to blame Poor sleep hygiene isn’t always the culprit keeping you from getting a good night’s rest. A variety of disorders and causes may lead to sleep difficulties, from frequent leg movements and issues with medications to hormone-related problems and bad dreams caused by post-traumatic stress disorder. One of the most common sleep disorders is sleep apnea. “There’s definitely an association between sleep apnea and insomnia,” says Neale Lange, MD, FCCP, FAASM, director of the Sleep Disorders Center at Parker Adventist Hospital. “If people are having difficulty breathing during sleep that’s evidenced by loud snoring, pauses in breathing, or significant daytime sleepiness, they need to get it checked out.” A sleep study can help your doctor get to the bottom of your sleep problems. Studies can be performed in the sleep disorders centers at Porter, Parker, Littleton, and Castle Rock Adventist Hospitals.
While a sleep study performed in a hospital sleep lab is required in some cases, home sleep studies — like the ones now available through Parker Adventist Hospital — also can be effective. “It definitely is an option for some people,” Lange says. “People who are capable of using the equipment and don’t have significant medical disorders may be candidates.” Though home studies don’t capture the full range of data that the accredited Sleep Disorders Center at Parker Adventist Hospital does, they record vital info such as airflow, snoring, blood oxygen levels, and head and neck movements, which can be used to help diagnose problems such as sleep apnea so that further testing or treatment can be provided. Most insurance plans cover home sleep tests.
Take a SLEEP TEST at home If you’ve put off having a sleep test because it’s just too inconvenient, you can now do it at home. The Parker Sleep Disorders Center offers an easy-to-use home sleep test that you take at home and get results from our experts in just one week. Call 303-269-4188 to learn more about home sleep studies, or go online to parkerhospital.org/sleep, where you can get more information and take a FREE online sleep quiz.
PHOTO: WOMAN ©ISTOCKPHOTO.COM/YINYANG
Hope and healing, close to home
With new radiation therapy services, Parker residents have access to a broad spectrum of cancer care without traveling for treatment WHEN YOU’RE FACING CANCER, there are a host of considerations and decisions to make, but what matters most from a medical perspective is the availability of a full spectrum of care and expertise. You want a highly skilled medical oncologist to drive your treatment, a surgeon who is in-tune with the latest oncologic procedures, access to promising new interventions through clinical trials, and a skilled radiation oncologist directing your radiation therapy. With the addition of this final component — a new 10,000-square-foot radiation therapy center opening this fall — Parker Adventist Hospital now offers full-service advanced cancer care close to home for residents of Parker and nearby communities.
Bringing Care Home
Until now, residents of Parker and beyond had to drive 20 minutes or more to receive radiation therapy. Since radiation is often needed daily for four to six weeks, that meant a lot of driving and a lot of stress. For patients who did not have access to transportation, it could have even meant going without. The new radiation therapy center at Parker Adventist Hospital provides a much-needed service for this fast-growing region. “We’re a convenient, comprehensive, multidisciplinary center where physicians have the ability to communicate and work very closely together because we’re all on the same campus,” says radiation oncologist Darlene Bugoci, MD. “This allows patients to get all of their cancer treatments in one location.”
Radiation therapy at Parker Adventist Hospital
ILLUSTRATION: HEART ©ISTOCKPHOTO.COM/CHUWY
Driven by a highly trained and specialized staff — including a board-certified radiation oncologist, therapists, dosimetrists, physicists, nurses, and more — the new radiation therapy services available through Parker Adventist Hospital’s Varian TrueBeam™ linear accelerator can deliver cancer treatments up to two times faster than older models, thanks to dose delivery rates of up to 2,400 monitor units per minute. Here are a few other noteworthy details about this technology: Speed: Intensity Modulated Radiation Therapy (IMRT) treatment — which conforms to a tumor’s size and shape and reduces exposure to healthy tissue — can be completed in less than two minutes. And complex radiosurgery that previously lasted 40 minutes to an hour can now be completed in just five to 20 minutes.
Precision: The Varian TrueBeam is so precise that treatment fields are measured in increments of less than a millimeter.
Accuracy: The TrueBeam checks for accuracy every 10 milliseconds and continually monitors 100,000 data points as treatment is administered, ensuring that radiation is always focused and on-target.
A full range of advanced cancer care treatment options isn’t all you’ll find at Parker Adventist Hospital. Caring here is also about giving hope. “It’s been proven that patients have better outcomes when hope exists— within themselves and in their care environment,” says Connie Wood, director of oncology and medical imaging at Parker Adventist Hospital. “We’re working hard on training staff around hope and the healing arts, including music, massage therapy, and other adjunct offerings to help our patients along this journey.” These extra programs are fully funded by the Parker Hospital Foundation through donations from the community and proceeds from sales in the hospital gift shop.
IS EXTRAORDINARY Parker Adventist Hospital’s cancer program is accredited by the Commission on Cancer (CoC). Parker Adventist Hospital received eight commendations from the CoC — a remarkably rare achievement for a new program. Parker Adventist Hospital is a member of the Centura Health Cancer Network, which delivers integrated, advanced cancer care across Colorado. To learn more, go online to parkerhospital.org/cancer-care.
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Use of common painkillers poses risk of heart and kidney problems
PHOTOS: PILLS ©ISTOCKPHOTO.COM/WWING; RUNNER ©ISTOCKPHOTO.COM/GUSWHU
OVER-THE-COUNTER PAIN MEDICATIONS, such as Motrin® or Advil®, increase the risk of heart attacks and gastrointestinal bleeding, according to a new study published in The Lancet medical journal. That’s on top of earlier studies that show these same drugs also increase the risk of kidney problems, especially when taken with blood pressure medications such as ACE inhibitors. Although the risk is very low, the fact that billions of doses are taken annually in the U.S. makes the actual number of people having complications significant, says Behram Mohmand, MD, a nephrologist at Parker Adventist Hospital. “This is one of the most commonly used medications in the U.S. Over 30 billion doses are sold each year,” Mohmand notes. “And their use is increasing as people are getting older and having more arthritis.” The Lancet study analyzed 754 clinical trials of nonsteroidal antiinflammatory drugs (NSAIDs), including ibuprofen, naproxen, diclofenac, and COX-ll inhibitors. For every 1,000 patients with an average risk of heart disease who take high-dose diclofenac or ibuprofen for a year, about three extra would have an avoidable heart attack, one of which would be fatal, the analysis showed. Separate estimates show that about 40,000 people each year need kidney dialysis as a result of NSAIDs. And despite the evidence of harm, people who are at the highest risk, including those with kidney damage, are continuing to take NSAIDs at the same rate as the general population, according to the Centers for Disease Control and Prevention. “We’re not talking about someone who takes them for an occasional ache or pain,” Mohmand says. “But for people at risk who have chronic kidney disease or low kidney function, even use for a few days can lead to significant problems.”
Athletes at higher risk Athletes routinely take NSAIDs, such as ibuprofen, to relieve muscle soreness. But dehydration, which can occur during sports, increases the health risks of NSAIDs, particularly kidney damage. Athletes should avoid taking NSAIDs when they’re dehydrated, Mohmand says. This is particularly true for those who work out at intense levels for long periods of time, such as marathon runners, long-distance bikers, or triathletes.
Reduce the risk D o not take NSAIDs if you are on other medications, particularly diuretics or blood pressure medicines, without talking with your doctor or pharmacist D o not take NSAIDs if you have heart or kidney disease without talking to your doctor L imit how much you take, follow directions, and stop taking when pain is relieved T ry alternatives such as topical over-the-counter pain relievers, or talk with your doctor about prescription alternatives A void using NSAIDs over a prolonged period of time