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Nurturing the health of you and your family

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Summer 2011 | Volume 3, Issue 3

World

Parker woman cruises to Iceland with new custom knee

Grow Healthy!

screenings Free health and classes See page 3

INSIDE Breast Cancer Choices

| Surgery to Cure Diabetes | Disc Replacement Dilemma


Multiple Choice Aggressive breast cancer surgery not always needed

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Mammos and More Kick off Breast Cancer Awareness Month on Monday, Oct. 3, with the Trio Breast Center at Parker Adventist Hospital. Trio will offer screening mammograms and bone density exams between 7 a.m. and 5 p.m. While you’re there, enjoy delightful gourmet treats from our award-winning chef, free customized risk assessments with a certified genetic counselor and breast self-exam education with our certified breast care nurse. Take home a special gift bag filled with a manicure set and other gifts. Appointments are required; call 303-269-4150. Please have insurance information available. If you have had previous mammograms at other facilities, we are happy to retrieve the prior images for you. 2 ■ Summer 2011 ■

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The Trio Breast Center at Parker Adventist Hospital holds the highest level of certification by the National Accreditation Program for Breast Centers.

Navigating Your Options There is no one-size-fits-all when it comes to breast cancer treatment. Choosing the right option is a complex decision that depends on many factors and requires the insight of many medical specialists. At The Trio Breast Center at Parker Adventist Hospital, a nurse specially trained in breast cancer can help women facing that journey. Jane Jachowicz, RN, is one of only 12 breast patient navigators in Colorado certified in both breast imaging and cancer oncology. Her services are available free to any patient at Parker Hospital. Jachowicz offers these tips to women facing a diagnosis of breast cancer:  Don’t feel rushed. Most women have time to research and weigh their options before making a treatment decision.  Meet with multiple specialists prior to making your decision.  Be honest and forthright about your concerns and opinions.  Seek support from other survivors but don’t compare your cancer or journey to theirs.

Photo: WOMAN: ©iStockphoto.com/joste_dj

acing a diagnosis of breast cancer, women today often are choosing the most aggressive forms of surgery in hopes of improving their odds of survival. However, less radical surgery can be equally effective and may be easier on a woman, says Christine Rogness, MD, breast surgeon and medical director of the breast program at Parker Adventist Hospital. Indeed, a long-term study by the National Cancer Institute has shown that survival rates are equal whether a woman chooses to remove just the cancerous portion of her breast or her entire breast. (For more information on this study, go online to http://www.nsabp.pitt.edu/B-06.asp) “It’s difficult to get your mind wrapped around the idea that you can do less and have the same chance of survival,” Rogness says. “But choosing radical surgery doesn’t necessarily improve your chances because your chances are so good in the first place.” Ninety percent of women with breast cancer have equal long-term survival rates regardless of whether they choose a total mastectomy or lumpectomy with radiation, Rogness says. The “right” choice, then, comes down to each woman’s particular tumor, receptor type, health history, lifestyle and personal preferences. A woman’s decision may be influenced by the type of physician she sees first after diagnosis—a surgeon or a medical oncologist. Ideally, women should consult with both types of cancer specialists, and possibly a medical geneticist, before making a decision. At Parker Hospital’s Trio Breast Center, a nurse specially trained in breast cancer care, called a breast patient navigator, contacts women immediately if breast cancer is diagnosed. The navigator helps coordinate rapid appointments with the various specialists, often on the same day. The navigator is available to attend appointments with patients to assist them in weighing their options. “We try to provide each woman with the best education and research and then help them choose what is going to work best in their life with their health history and genetics,” says Jane Jachowicz, RN, certified breast patient navigator.


Q&A

Reversing diabetes Can weight loss surgery cure my diabetes?

ANSWER: Recent studies show

some very promising results for significantly improving or even curing diabetes with weight loss surgery. But not all bariatric surgeries are equal when it comes to this issue. For patients who meet the criteria for weight loss surgery, gastric bypass surgery, also known as Roux-en-Y bypass, is highly successful at improving Type 2 diabetes. (Type 1 diabetes, the genetic form, typically is not helped by bariatric surgery.) More than 75 percent of diabetic patients who received gastric bypass surgery were either cured or able to cut their medications by half, according to research by the University of

California San Francisco released earlier this year. Gastric bypass seems to be more effective than other types of weight loss surgery at helping insulin-dependent patients because it bypasses part of the small intestine. This creates a biological change in the body that reverses insulin resistance and restores some pancreatic function. If your diabetes has not progressed to being insulin-dependent and is managed with oral medications alone, weight loss from any type of surgery may be enough to improve your condition. In cases where patients are non-insulin resistant and have a lower

body mass index, LAP-BAND surgery may be appropriate. In fact, the U.S. Food and Drug Administration recently expanded use of LAP-BAND to include individuals with a BMI of 30–34 who have a medical condition related to their obesity, such as diabetes. This means, in effect, that a 5-foot-5-inch woman with diabetes who weighs 180 pounds or more would now qualify for surgery. Matthew Metz, MD, FACS Medical Director The Bariatric & Metabolic Center of Colorado 303-269-4370

To see if you qualify for bariatric surgery or to attend a free weight-loss seminar, visit bariatriccenterco.com. Next seminar: Sept. 14.

inars m se h lt a e h E E R F r e b Septem

out the fall. All health seminars through spital for a series of FREE nference Center, Co tal spi Ho r Join Parker Adventist Ho n Room of the Parke atio pir Ins the ved during in d hel seminars are rance. A light lunch is ser level at the new west ent den gar l’s pita hos the on located programs. t snacks during evening d daytime programs and ligh . 1. Guests are encourage call 303-777-6877, ext rs; ina sem all for ed center. Registration is requir access to the conference of the hospital for direct to park on the west side

Weight Loss Surgery

Photo: WOMAN: ©iStockphoto.com/ flashon

>> 6:30-8 p.m. Wednesday, Sept. 14 , medical director of MD tz, Join Matthew Me latest in weight loss bariatrics, to learn the surgical options treatments. Learn about -band and how lap to from gastric bypass diabetes and other e rov imp p hel surgery can health conditions.

cement Custom Knee Repla 0-8 p.m.

>> 6:3 Wednesday, Sept. 21 knee replacements, in Hear about the latest computer-navigated including custom joints, e for surgery, with surgery and the best tim of joint replacement, r Parker’s medical directo Dr. Derek Johnson.

Kidney Disease

Noon-1:30 p.m. Thursday, Sept. 22 >> m Mohmand, MD, Join nephrologist Behra od test can help blo to learn how a simple of chronic kidney risk r you d you understan vent this “silent” killer. disease and how to pre

Community Health Fair :: Sept. 17 Southeast Christian Church invites the community to participate in more than 15 free and low-cost health screening stations, including cholesterol, diabetes and blood pressure checks. The fair will be held on Saturday, Sept. 17, from 7 a.m. to noon at the church, 9650 Jordan Road in Parker. Parker Adventist Hospital is a proud health partner of this community wellness event. For a complete list of screenings and safety demonstrations, go to www.sechristian.org.

ery Back and Neck Surg -1:30 p.m. Noon Thursday, Sept. 29 >> Learn about k? nec or k bac g hin Ac ion the pros and cons of fus new the sus surgery ver y disc replacement surger y, with Dr. Sean Marke medical director of neurosurgery.

9395 Crown Crest Blvd., Parker, CO 80138 grow is published quarterly by Parker Adventist Hospital as part of our mission to nurture the health of the people in our community. To comment or unsubscribe, please email grow@centura.org.

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Measure of Success New custom joints promise longer relief

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oint replacement surgeon Derek Johnson, MD, measures success in degrees. Every time Johnson replaces a patient’s knee, his goal is to restore perfect alignment in the patient’s leg from hip to ankle. Landing within 3 degrees of straight has proven to be critical to long-term success.

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Photo by Michael Richmond

Photo: MAP: ©iStockphoto.com/

“We know from years of data that poor alignment after knee replacement increases the chances significantly that the patient will need revision surgery,” says Johnson, medical director of the joint replacement program at Parker Adventist Hospital. Now Johnson is using a new joint replacement technique that experts believe will help surgeons achieve alignment in more patients, ultimately reducing the number of revision surgeries and helping artificial knees last 10 or even 15 years longer before needing replacement.


achieves alignment within 3 degrees of straight in about 75 percent of patients. This new technique achieves it in more than 90 percent of patients, Johnson says. Down the road, that could save 15 out of every 100 patients from needing revision surgery due to the complications associated with malalignment of more than 3 degrees. Proponents also are hopeful that it could help artificial knees last up to 10 years longer. “Even a degree or two of malalignment puts extra wear on the knee,” Johnson says. “The thought is that reducing the percent of patients who have more than 3 degrees of malalignment will result in longer function for artificial knees.” Pree doesn’t think much about how her knee might feel in 15 or so years. She’s too busy going to Zumba classes, walking her new puppy, babysitting her grand-niece, and, of course, getting packed for the next cruise. “I came down steps one at a time for 30 years,” Pree says. “Now I can run up and down steps if I want to. It amazes me.”

L ea rn a bo ut C us to m k ne e r ep la ce m en t

Learn more about custom knee rep lacement at a FREE seminar with Derek Johnso n, MD, medical director of joint replacement services at Parker Adventist Hospital. The program will be held Wednesday, Sept. 21, from 6:30-8 p.m. in the hospital’s conference center on the garden level. Refreshments will be served. Reserv ations are required; call 303-777-6877, ext . 1. Guests should park on the west side of the hospital for direct access to the conference cen ter.

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Photo: COMPASS: ©iStockphoto.com/scanrail

The new technique, often referred to as patient specific or custom joint replacement, uses a CT scan of each patient’s anatomy to design customized cutting guides that help the surgeon achieve accuracy in positioning the knee. Judy Pree got her custom knee last November and she’s also measuring its success in degrees — degrees of longitude and latitude, that is. Pree, 62, set off in July on a 30-day cruise from New York to Iceland. Along the way, she planned to try out her new knee on hikes through the countryside of Denmark, Norway and other ports of call. “My knee had not been out of pain for a day until I had this replacement,” says Pree, who injured her knee 35 years ago playing racquetball. “Now I’m 100 percent pain-free. It doesn’t matter what I do, I’m pain-free.” To get an idea of how a knee should work, think of hanging a plumb line from the center of the hip to the center of the ankle. The thigh bone, the knee and the shin bone all should Judy Pree revels in her pain-free run straight up and down life after getting a that line. But after cartilage new “custom joint in the knee is damaged replacement” for through either an accident her right knee. or a long-term disease such as arthritis, the knee falls out of alignment and the leg becomes bowed. When the knee is replaced, the leg bones should align along that plumb line once again. Because every patient’s anatomy is different, surgeons must adjust how they position the artificial knee to get within 3 degrees of straight. “Six weeks after surgery, we take an X-ray and actually measure whether we’ve hit it perfectly or how many degrees off we are,” Johnson explains. “The more precise we can make that alignment, the less wear and tear on the artificial knee, which helps it last longer.” Traditional knee replacement surgery

Photo by Michael Richmond

New custom joint replacement helps bring a patient’s knee back into perfect alignment, reducing the need for additional surgery, says Dr. Derek Johnson.


Special delivery Coordinated care plan spells success for high-risk pregnancy

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Photo by Ellen Jaskol

t had all the makings of an episode of “Grey’s Anatomy”: a high-risk pregnancy so complex it took 15 specialists at Parker Adventist Hospital working together to assure a successful outcome. The result: Aspen Marie Schreiber. Born June 1, 6 pounds, 4 ounces, at Parker Hospital’s BirthPlace. Aspen’s mother, Sarah Schreiber, credits the efforts of Vandna Jerath, MD, an obstetrician at Parker Hospital, who orchestrated the plan for her complex care. “This was one of the top-five mostcomplicated cases of my career,” Jerath says. “I don’t think I’ve had a patient with that many consultants ever.” Among them were specialists in perinatology, Sarah Schreiber and pulmonology, cardiology, daughter Aspen interventional cardiology, urology, interventional radiology, gastroenterology, rheumatology, genetics, hematology, psychiatry, labor and delivery, physical therapy, and anesthesia. Schreiber had multiple health problems, including shortness of breath, hypoxia requiring oxygen, and heart palpitations. Doctors discovered she had a hole in her heart, which could lead to blood without oxygen and blood clots being circulated through her body. “These are life-threatening conditions,” Jerath says.

Take a BirthPlace tour

“She was at risk for having a stroke, mini-strokes or blood clots in her lungs and legs.” The BirthPla ce at Parker To deal with Schreiber’s Hospital offe rs moms-to-b many conditions and risky e an advanced ca re team made up of delivery, Jerath organized leading specia lists in obstet rics, perinatology a coordinated-care and nursing ca re. With a Level IIIA N conference with all 15 ICU and arou nd-theclock neonat consulting physicians as al specialists, you ca n rest easy kn well as labor and delivery owing that yo ur sp ec ial delivery is nurses. They laid out a our priority. parkerhospita l.org/birthplace written plan outlining every . condition, potential problems and a delivery plan. Jerath worked closely on the plan with Henry Galan, MD, a perinatologist at Parker Hospital and chief of maternal and fetal medicine at the University of Colorado Health Sciences Center. Neal Lange, MD, a pulmonologist, and Mike Wahl, MD, an interventional cardiologist, also were instrumental in Schreiber’s care. “At some of the facilities where I have previously worked, it would be highly unlikely this type of patient could have delivered there,” Jerath says. “I think it says a lot about Parker Hospital that the doctors here can care for such a high-risk patient.” With doctors standing by, Schreiber was ready to be induced. After nearly 38 weeks of sometimes daily doctor appointments and always daily worry, the delivery came off without a hitch. And just one day after being born, Baby Aspen was on her way home to meet her big brother Dylan. Today, mom and daughter are doing fine. “The genuine care and concern I received from everyone was excellent,” Schreiber says.

Register Me to Win a $100 Babies”R”Us® Gift Certificate Name Email Phone Due Date (if pregnant) Obstetrician Date of Tour

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*This information will be used only for the gift certificate drawing and will not be used for marketing purposes.

Photo: BOOTIES: ©iStockphoto.com/ ideabug

To learn more about the deluxe accommodations and expert care available at Parker Adventist Hospital, take a FREE tour before Oct. 31 and register to win a $100 Babies”R”Us® gift card. To schedule your tour, please call 303-777-6877, ext. 1, and bring this coupon with you to your tour.


Disc Debate Weighing the pros and cons of spinal disc replacement

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Photo: BACKPAIN: ©iStockphoto.com/ peepopeepo ILLUSTRATION: SPINE: ©iStockphoto.com/ alex-mit

ith the success of joint replacement surgery for hips, knees and shoulders, it’s no surprise that an increasing number of patients are looking at artificial discs to relieve pain in their necks and lower backs. Replacing a disc in the spine with an artificial disc, known as arthroplasty, was approved in the last decade as an alternative to traditional fusion surgery. The draw of the new surgery is the belief that using an artificial disc to preserve motion in the spine will prevent further deterioration of adjacent discs. But this theory has not yet panned out. “It makes sense logically, but there’s some compelling research that shows degenerative disc disease may have an inheritable component,” says Sean Markey, MD, a neurosurgeon who performs spine surgery at Parker Adventist Hospital. “If that’s the case, no matter what surgery you do, you may have degenerative changes (in subsequent discs) anyway.” That’s not to say that patients should count out disc replacement. Results with this Dr. Sean Markey surgery are equal to the outcomes with fusion surgery, and there are some definite advantages. Disc replacement surgery is less traumatic and patients can resume normal activities within two weeks, compared with up to eight weeks with fusion surgery. Disc replacement also results in less muscle damage. “Good candidates for arthroplasty are active patients

between the ages of 20 and 60,” says Markey, medical director of neurosurgery at Parker Hospital. “Because we attach the artificial disc to the natural joint, the patient can’t have joint disease

if it goes wrong. An artificial disc can be removed, but it requires a second surgery through the front of the body, where the original surgery was performed. Performing surgery in the same

Good candidates for disc replacement are active patients between the ages of 20 and 60

like arthritis or spinal disorders that create instability.” Disc replacement is a relatively new surgery, so long-term results are largely unknown. The U.S. Food and Drug Administration approved artificial discs for use in the lumbar (lower back) region in 2004 and for the cervical (neck) region in 2007. Another concern is whether the artificial disc will eventually wear out and need replacement, Markey says. “The thought is that artificial discs will help avoid surgery on transitional (adjacent) levels, but if the disc eventually needs replacing, then you may be replacing one type of surgery for another,” he says. While arthroplasty and fusion have about the same success rate of 90 percent or greater, arthroplasty is more difficult to fix

place can be complicated and risks vessel damage, Markey says. Fusion surgery, on the other hand, is typically performed through the back of the body. If a revision surgery is needed, it can be done through the front of the body. “The percent of patients with problems from either surgery is very low, but the revisions for fusion surgery are much safer and easier to do,” he says.

Learn More Hear the pros and cons of fusion vs. disc replacement at a FREE lunch seminar with Sean Markey, MD, neurosurgeon, on Thursday, Sept. 29, from noon to 1:30 p.m. See full details on page 3.

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October Health Seminars Make an appointment with the experts at Parker Adventist Hospital to become more body-wise. All seminars are FREE but require registration by calling 303-777-6877, ext. 1. Seminars are held in the Parker Hospital Conference Center, located on the garden level at the west entrance. A light lunch is served during noon seminars and light snacks during evening programs. Guests are encouraged to park on the west side of the hospital for direct access to the conference center.

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9395 Crown Crest Blvd. Parker, CO 80138

Weight Loss Surgery Wednesday, Oct. 12 :: 6:30-8 p.m. Join Matthew Metz, MD, medical director of bariatrics, to learn about the latest in weight-loss surgeries and what it takes to qualify.

Many Faces of Breast Cancer Wednesday, Oct. 19 :: 6:30-8 p.m. Join three experts to learn about the latest research into the many types of breast cancer, the latest treatments and how to reduce your risk. Dr. Monique Fox, breast radiologist; Dr. Christine Rogness, breast surgeon; and Dr. Nadine Mikhaeel, medical oncologist, also will discuss new screening guidelines.

Men’s Health 101 Thursday, Oct. 20 :: Noon-1:30 p.m. Dr. Christian Whittington, a family practice physician, discusses the critical screenings every man needs, including the latest on prostate cancer screenings.

strength

compassion

Oh, My Aching Joints Thursday, Oct. 27 :: Noon-1:30 p.m. Join rheumatologist Dr. Elena Weinstein for a discussion on the latest developments in rheumatoid arthritis and osteoarthritis.

hope

innovation

expertise

Kidney Check > Hidden disease merits close watch GFR, which the National Kidney Foundation considers the easiest way of estimating kidney function. A GFR below 60 (normal is more than 90) means a patient could be in trouble and merits further evaluation, Mohmand says. “Adults at risk of CKD or those with an abnormal GFR should talk with their doctor to understand their situation and see if further evaluation is warranted,” he says. People are at increased risk of CKD if they are diabetic or have high blood pressure. African Americans, Native Americans, Hispanics and patients with a family history of CKD also are at higher risk.

Learn more about kidney disease at a FREE luncheon on Sept. 22 with Dr. Mohmand. See page 3 for details.

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.

Photo: MAN: ©iStockphoto.com/ sjlocke

Twenty-six million Americans suffer from a disease that they often don’t feel until damage has been done. Chronic kidney disease, or CKD, not only leads to kidney dialysis in many cases but also is related to significantly higher early death rates—even in its earliest stages. “Unfortunately, by the time you have symptoms of kidney disease, you may have irreparable damage or severe kidney disease,” says Behram Behram Mohmand, MD Mohmand, MD, a nephrologist with Parker Adventist Hospital. “If addressed early, the progression can be slowed and complications avoided.” CKD is easily checked with routine blood work at most annual physicals. These blood tests typically include a measure called glomerular filtration rate, or


Grow Summer 2011