Nurturing the health of you and your family
Summer 2012 | Volume 4, Issue 3
BRAINS Parker Hospital program helps head injury patients return to full lives
Alec Ottevanger, 19, is back at college after suffering a concussion and losing his ability to read or concentrate.
Adults need annual physicals, too
Surgery to relieve aching backs
Moody teens may be a sign of sleep problem
PAGE 8 Photo by Ellen Jaskol
Back-to-school physicals... for Mom and Dad! Here are general screening guidelines
to pediatricians’ offices around town as parents scurry to get annual physicals and immunizations for their children before school starts. But many parents forget that they, too, need an annual checkup. In fact, only about half of adults get regular checkups and preventive health screenings, according to the Centers for Disease Control and Prevention. “Everyone from babies to adolescents to young people to baby boomers to retirees should have a physical exam every year,” says Maria Archie Villavert, MD, a family medicine physician at Parker Adventist Hospital. Young adults in good health with no family history of health problems at early ages may need only baseline blood tests, while adults over 50 should be getting regular heart, diabetes, and cancer screenings. “Screening guidelines are just that — guidelines,” Villavert emphasizes. “You need to discuss your health history with your doctor to see which ones you need. You may need more or less than what is recommended.” Join Villavert to learn more about staying healthy as you age at a FREE community seminar on Sept. 25. See next page for details.
Age 18 Blood Pressure
Men and women should get a baseline test in their 20s, then get an annual screening starting at age 35.
Men and women with no risk factors should be tested annually beginning at age 45.
Coronary Calcium Scoring
Men should get a baseline scan at age 45. Women should get a baseline scan at age 55.
Women should get an annual mammogram starting at age 40.
Women should be screened every 3 years from age 18-65.
Men and women every 5-10 years (depending on test) starting at age 50.
Osteoporosis (Bone density, DEXA, scan)
Women every 2 years starting at age 65.
For more information, go to cdc.gov/family/checkup.
Schedule a screening by text Need to schedule your mammogram or bone density test? Simply text “SCHEDULE ME” with your name and the name of the screening you’d like to schedule to 303-816-8648, and a Parker Adventist Hospital scheduler will call you within two business days to schedule an appointment that is convenient for you. This text request is to schedule a test only; please call 911 if you have a medical emergency.
Prevent shingles with a simple vaccine
about that virus again, right? WRONG. The virus that causes chickenpox, varicella zoster, stays in your body and can cause shingles, a painful blistering of the skin. “Essentially, anyone who’s had chickenpox carries the virus,” explains Jeffrey Tam Sing, MD, a neurologist at Parker Adventist Hospital. “For whatever reason — be it stress, illness, a medication, or nothing necessarily at all — the virus can be reactivated.” The virus follows nerve paths, he notes, with the rash appearing in patches or bands, commonly along the torso and down the legs. “If you get it on your face, it can be particularly dangerous,” Tam grow
Men and women at least every 2 years.
YOU HAD CHICKENPOX AS A KID, so you never have to worry
2 ■ Summer 2012 ■
Sing warns. “If it gets into your eye, it can cause blindness.” While younger adults can get shingles, the risk increases with age. That’s why adults age 60 and older are advised to get the shingles vaccine. If you notice painful blisters on your skin, Tam Sing says, get to the doctor immediately. “Treatment needs to begin within 72 hours of the rash appearing,” he adds. “Within three days, antiviral medications can be effective.” After that, doctors can treat the pain but not the virus itself, which will have to run its course over a few weeks or a few months.
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AUGUST BRINGS A FLURRY OF ACTIVITY
Driving an end to breast cancer
FREE health seminars
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ONLY ONE OUT OF EVERY TWO WOMEN over the age of 40 is obtaining her annual screening mammogram, despite clear evidence that these screenings detect cancer early and save lives. Parker Adventist Hospital and the Parker Hospital Foundation have joined forces to improve that statistic in the communities they serve. The foundation’s board, made up of community representatives, recently voted to dedicate 100 percent of proceeds from its annual golf tournament for the next two years to breast cancer care in the community. The foundation estimates that it will donate at least $200,000 through the golf tournaments alone to underwrite care for uninsured or underinsured women Special thanks to the 2012 Parker Hospital in the community. Funding also will Foundation Golf Classic Ace Sponsors: be dedicated to provide emotional Critical Care Pulmonary & Sleep Associates and mental support to all women GE Johnson Construction Co. fighting breast cancer. “Insurance often doesn’t support the mental and emotional healing process that is so important to a full recovery,” says Lisa Sandoval, executive director of the Parker Hospital Foundation. “By providing support, we have the opportunity to invest in the lives of the women in our community.” The Parker Hospital Foundation was created when the hospital opened to provide support for programs that are essential to the health of the community but not funded by health insurance. Initiatives funded by the foundation include:
The hospital has provided more than 1,000 FREE equestrian helmets and trained hundreds in horse safety
The foundation purchased this $90,000 “artificial” human that allows care teams to practice critical care skills in high-stress situations
Bedside musicians, massage therapists, rotating art galleries, a sculpture garden, and more are all part of the holistic care provided to patients and their families
All proceeds from the 2012 Parker Hospital Foundation Golf Classic will support breast cancer care in the Parker Hospital community. Sponsorships and openings still available — call 303-715-7600 or go to parkerhospitalfoundation.org for info and registration! Learn More Talk to your primary care physician about getting the shingles vaccine. If you are looking for a doctor, go to parkerhospital.org/doctor.
Family to Family Adoption: This nationally recognized program provides support to birth and adopting families
Join Parker Adventist Hospital for a series of FREE health seminars throughout the fall. All seminars are held in the Inspiration Room of the Parker Hospital Conference Center, located on the hospital’s Garden Level at the west entrance. A light lunch is served during daytime programs, and light snacks are served during evening programs. Registration is required for all seminars by calling 303-777-6877, option 1. Guests are encouraged to park on the west side of the hospital for direct access to the conference center.
The Aging Spine Thu, Sep 6 | noon-1:30 p.m. Join neurosurgeon Bradley Duhon, MD, for an informative discussion about age-related spine conditions and their surgical treatment options.
Bariatric Surgery Wed, Sep 12 | 6:30-8 p.m. Join Matthew Metz, MD, bariatric medical director, to learn about surgical weight-loss options, from gastric bypass to LAP-BAND®, and how these can help improve diabetes and other health conditions.
Health Milestones Tue, Sep 25 | 6:30-8 p.m. Living a longer, healthier life is possible with a complete physical that includes health screenings. Family medicine physician Maria Villavert, MD, discusses important health milestones with you.
Monday, Aug. 27 The Club at Pradera 9 a.m. Shotgun Start
Thu, Sep 27 | 6:30-8 p.m. Join ENT specialist Mark Willis, MD, to discuss chronic sinusitis, causes, and cures, including surgery-free balloon sinuplasty.
See back cover for October seminars!
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 email@example.com. grow is produced by Clementine LLC. Executive Editor: Rachel Robinson
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Retraining Brains T
Learn more about head injuries at a FREE community seminar on Oct. 4. See back cover for details.
4 ■ Summer 2012 ■
he last thing Alec Ottevanger remembers about playing a pickup game of football with his college friends last fall was getting hit — hard. Memories of the rest of that day, and indeed memories from the next four months, are just glimpses. Ottevanger, 19, was a University of Colorado freshman and a member of the school’s elite cycling team when he became one of the growing numbers of teens and adults whose lives are upended by a head injury. Just 10 years ago, little was known — and even less was done — when a kid took a hit to the head. Shake it off was the common advice. “Ten years ago, we likely would have sent kids back into the game,” says Ozzie Grenardo, MD, a family medicine physician at Parker Adventist Hospital who has served as team physician for several local high schools. “We’re now beginning to understand the consequences of concussions, and we’re better able to help limit cognitive damage through physical, occupational, and neurocognitive therapies.” A series of tragedies to both teens and adults — particularly to star athletes — has resulted in a greater understanding of the serious lifelong implications of even mild head injuries. Colorado’s Jake Snakenberg Youth Concussion Act, named after a Grandview High School football player who died in 2004 after a series of concussions, took effect this year, requiring athletes ages 11-18 to be immediately removed from a game if a concussion is suspected. The athlete cannot return to play until he or she is medically cleared by a physician. The problem, however, is that the patient may not know the symptoms to look for, or he or she may discard or intentionally cover up the symptoms in order to obtain medical clearance. “So much of this is in the athlete’s hands or the parent’s hands,” Grenardo says. “They put pressure on themselves to return to the game
when, in reality, it is rare that a professional sports career is on the line. These athletes and parents need to ask themselves how important a game or two is when you may be facing a lifetime of brain injury.”
Lingering Problems In Ottevanger’s case, there was no denying the symptoms. He continued to suffer severe headaches and nausea for weeks after his concussion. When he went to see his doctor, he was referred to the concussion rehabilitation program at Parker Adventist Center for Rehabilitation & Sports Medicine. There, a speech-language pathologist assessed Ottevanger’s ability to concentrate and process information, his memory, and his executive functioning skills (the brain’s ability to successfully carry out daily activities). “In the beginning, I couldn’t read a sentence,” says Ottevanger, who was on academic scholarship but was forced to withdraw from school. “A lot of times, I would have to stop (in the middle of therapy) because I was too tired to go on.” Alec Ottevanger worked with Pamela Panza, a cognitive therapist at Parker Hospital, to recover his ability to concentrate and study after a head injury.
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The cognitive therapy program at Parker Adventist Hospital helps avoid permanent brain impairment that can result from even mild head injuries
The brain is like any other muscle in the body, explains Pamela Panza, the cognitive retraining therapist who worked with Ottevanger. Once injured, it will take rest and often retraining to return to normal. Speech therapists, such as Panza, are the specialists who deal with head injury recovery because processing information involves understanding and processing language, whether that is spoken or written. “Just like you’d train your body on a treadmill by running five minutes, then 10 minutes, we retrain the brain and gradually increase its ability to stay focused,” Panza says. “Once I explained this to Alec, he knew that with every single session, we were making the muscles of his brain stronger.” Gradually, the brain can return to normal or if it still has deficits, the patient can learn coping skills. Some adult patients, for instance, may need to write down phone messages or keep to-do lists when
they never needed that before. “Patients tell me all the time that it feels like ‘the fog has lifted’ once they go through therapy,” Panza says. “Every patient can be helped. If they don’t walk away with complete cognitive improvement, they walk away with strategies to handle their injuries.” Ten months after his head injury, Ottevanger still suffers from occasional headaches. But he has since completed therapy and is now back at the University of Colorado to begin his freshman year again — this time without football. “I once broke my neck playing football, but I guess I didn’t learn my lesson,” he says. “This was definitely a wake-up call.” To learn more about Parker Hospital’s neurosciences program, visit parkerhospital.org/neuro.
The fastest way to recover from a head injury is to let the brain rest, advises Pam Elser, BSN, RN, director of neurosciences at Parker Adventist Hospital. She recommends these tips: > Get plenty of sleep at night and rest during the day. > Avoid bright lights. > Refrain from physical activity. > Avoid using your brain as much as possible. Avoid reading, studying, playing video games, or watching TV. Symptoms of a head injury, such as headaches, should progressively diminish day by day following the injury, Elser says. If symptoms increase or new symptoms appear, the patient should be seen immediately by a health care provider. Photo by Ellen Jaskol
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If these symptoms are still present seven days after a head injury, you should talk with your physician:
Slowness in thinking, acting, speakin g, reading, or reacting Trouble concentrating, organizing daily tasks, or making decisions Get ting lost or easily confused Increased sensitivity to sound, light , distractions Ringing in the ears Loss of balance, feeling light-heade d, or feeling dizzy Blurred or double vision, or eyes that tire easily Neck pain Low-grade headaches that will not go away Change in sleeping patterns, inclu ding insomnia or trouble waking up Changes in mood, including anxiety, sadness, or anger Loss of one or more senses (tas te, smell, hearing) Fatigue
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Getting Help Parker Adventist Hospital can help head injury patients retrain their brains and recover. Speech therapists specializing in cognitive retraining assess patients for symptoms such as forgetfulness, inability to concentrate, irritability, or depression. If the patient exhibits any symptoms, the therapist works with the patient’s physician to design a customized rehabilitation program. To learn more about head injury rehabilitation, call the Parker Adventist Center for Rehabilitation & Sports Medicine at 303-269-4590.
Weight-loss surgery sooner has better chance of reversing type 2 diabetes PATIENTS WITH DIABETES — even those who are not significantly obese — may want to consider bariatric surgery sooner rather than later. A new study released in late June found that patients who had bariatric surgery earlier had a better chance of curing their type 2 diabetes for good. “We might have a surgical cure for type 2 diabetes, which is very exciting,” says Matthew Metz, MD, FACS, medical director Dr. Matthew Metz of The Bariatric & Metabolic Center of Colorado at Parker Adventist Hospital. The study found that 92 percent of patients had their diabetes reversed following Roux-en-Y gastric bypass, the type performed at Parker Hospital. Of those patients, nearly 80 percent were still diabetes-free within three to five years. The patients whose diabetes stayed in remission lost more weight after surgery and maintained their weight loss better. The study was conducted by the Mayo Clinic and presented at the 2012 annual meeting of the Endocrine Society. Patients were more likely to stay in remission if they had undergone surgery within the first five years of the onset of their diabetes. Patients who had type 2 diabetes for more than five years before getting surgery were 3.8 times more likely to have a recurrence of diabetes after surgery. This news comes on the heels of a study released earlier in the year that found the surgery could help patients with lower BMIs than previously thought. Gastric bypass surgery resolved diabetes in 42 percent of patients who were overweight but not considered morbidly obese, with body mass indexes below 35. Sleeve gastrectomy, another type of weight-loss surgery also performed at Parker Hospital, resolved diabetes in 37 percent of patients within one year. “Similar to the Mayo Clinic study, we are seeing over 90 percent resolution of type 2 diabetes after gastric bypass in our patients who have been diabetic for fewer than eight years and are on only oral antidiabetic medications,” Metz says.
Metz recommends that any patient with diabetes should take the following steps: Measure your BMI You can do this online at bariatriccenterco.com/ calculate_BMI. Talk to your primary care physician about weightloss surgery. Although surgery is not covered by insurance for patients with BMIs under 35, you may qualify if you have proven that you cannot lose weight any other way. Prepare for surgery Successful bariatric surgery requires work beforehand. Most patients will need to undergo three to six months of medically supervised weight loss and go through counseling to prepare for the emotional and lifestyle changes that are necessary for success. Parker Hospital’s bariatric program offers comprehensive pre- and post-surgery support, including nutrition and psychological counseling.
Photo by Michael Richmond
Learn more about bariatric surgery at a FREE seminar on Sept. 12 or Oct. 10, 6:30-8 p.m., in the Parker Hospital Conference Center. Register by calling 303-777-6877, option 1. For more information or to schedule a FREE private consultation with a bariatric specialist, go to bariatriccenterco.com. Troy Roberts’ diabetes, high blood pressure, and sleep apnea all were resolved after weight-loss surgery at Parker Hospital helped him lose 110 pounds. 6 ■ Summer 2012 ■
my aging back Surgery can relieve the pain of spine problems
Larry Williams is pain-free after spinal surgery at Parker Hospital.
Photo by Toby Fike
A LITTLE PAIN WASN’T A BIG DEAL. But when the pain got so bad that Larry Williams was in tears and he started losing function in his left leg, the 69-year-old knew it was time to see a doctor. His family physician referred him to Brad Duhon, MD, a neurosurgeon at Parker Adventist Hospital. An MRI scan revealed that Williams had two cysts pressing on the nerves and narrowing the spinal column, a condition known as spinal stenosis. According to Duhon and Scott Stanley, MD, an orthopaedic spine surgeon at Parker Adventist Hospital, surgery is a last resort — after physical therapy, medications, and injections are attempted. Dr. Brad Duhon Dr. Scott Stanley When nonsurgical options didn’t work for Williams, surgery did the trick. “I’m doing absolutely terrific,” he says. “I am having no difficulty walking at all, and I’m not limited on distance. I even mow and trim my son’s yard.”
Here are a few common age-related spine conditions and their surgical treatment options. Spinal Stenosis This narrowing of the spinal canal is a common condition as people age. Someone with stenosis might lean forward a lot, Stanley explains. That’s because “leaning forward opens up the spinal canal and gives them strength to walk.” Surgical Treatment: A laminectomy is a surgical procedure to remove bone or other tissue that is narrowing the spinal canal. A minimally invasive version of this procedure is available.
Osteoporotic Compression Fracture
This condition occurs when a vertebra slips over the one below it.
For older adults who have osteoporosis, compression fractures are common.
Surgical Treatment: A laminectomy can be used to decompress the spine. Spinal fusion surgery also can be used.
Surgical Treatment: Kyphoplasty uses bone cement to support the fractured vertebrae, Duhon says. “In studies, it’s been shown to reduce pain and improve outcomes if done early.”
Finding Dr. Right
Both orthopedic spine surgeons and neurosurgeons are qualified to perform spine surgery. If you’re looking for a spine surgeon, here are some things to keep in mind. ✓ Check for board certification. “Make sure the surgeon is board-certified in neurosurgery or in orthopedic spine surgery,” Stanley says. ✓ Ask for references. “Ask the surgeon about patients who’d be willing to speak on the physician’s behalf,” Duhon advises. ✓ Review his or her bio. “Make sure the surgeon trained at a reputable institution,” Duhon adds. ✓ Have a chat. “When you meet the doctor,” Stanley says, “make sure you’re comfortable with how he or she communicates.”
Join Brad Duhon, MD, on Sept. 6 to talk about the aging spine, how to prevent trouble, and the treatment options available. The program will be held from noon-1:30 p.m. in the Parker Hospital Conference Center. Registration is required by calling 303-777-6877, option 1. grow
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OCTOBER FREE health
Portercare Adventist Health System
Non-Profit Organization U.S. Postage
9395 Crown Crest Blvd. Parker, CO 80138
Become more body-wise with the experts at Parker Adventist Hospital. All seminars are FREE but require registration by calling 303-777-6877, option 1. Seminars are held in the Parker Hospital Conference Center at the west entrance. A light lunch is served during noon seminars, and light snacks are served during evening programs.
Denver, CO Permit No. 4773
Medical Myths & Misconceptions Tue, Oct 2 | noon-1:30 p.m.
As the average life expectancy increases, what does that mean to us? Can we stay active into our 80s? Is it inevitable that we will lose our memory, concentration, and hearing? Internal medicine physician Dmitriy Pales, DO, will be discussing myths and misconceptions associated with aging.
Mild Head Injury Thu, Oct 4 | 6:30-8 p.m.
Learn why it’s important to rest the brain after even a minor injury. Join family medicine physician Oswaldo Grenardo, MD, as he discusses mild head injuries, warning signs, and treatments.
DO YOU HAVE A TEEN WHO HAS PROBLEMS FOCUSING
Bariatric Surgery Wed, Oct 10 | 6:30-8 p.m.
Join Matthew Metz, MD, bariatric medical director, to learn about surgical weight-loss options, from gastric bypass to LAP-BAND®, and how these can help improve diabetes and other health conditions.
Breast Health Experts Tue, Oct 23 | 6:30-8 p.m.
Join breast surgeon Christine Rogness, MD, breast radiologist Monique Fox, MD, and medical oncologist Nadine Mikhael, MD, as they discuss the latest advancements in oncology, surgery, and radiation therapy for breast cancer patients.
Thu, Oct 25 | 6:30-8 p.m.
Orthopaedic surgeon Derek Johnson, MD, will discuss technological advancements that are making knee and hip replacement easier with a shorter recovery time.
See Page 3 for more seminars!
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Knee & Hip Replacement
or controlling his or her moods? Who doesn’t, you might be thinking. But what many consider normal teenage quirks may be the result of sleep problems. “It’s estimated that 30 percent of children with ADHD (attention deficit hyperactivity disorder) have undiagnosed sleep apnea,” says Neale Lange, MD, a pulmonologist and medical director of the Sleep Disorders Center at Parker Adventist Hospital. Teens with any type of obstructive sleep apnea are much more likely to experience problems with attention, hyperactivity, and aggressiveness. They also will have more trouble controlling their moods and managing social situations, according to a report released in June at Sleep, the annual meeting of the Associated Professional Sleep Societies. Sleep apnea not only affects immediate moods, it also can cause developmental changes in the brain that are permanent, Lange says. The greatest risk factor for sleep apnea is obesity, but Lange cautions that even fit teens can suffer. If your teen has these symptoms, you should consider contacting a sleep center for more information: Snoring or stopping breathing for short periods Excessive sleepiness or “nodding off” during the day Problems focusing, moodiness, aggressiveness, or hyperactivity
The Sleep Disorders Center at Parker Hospital treats teens age 14 and above and adults. For a FREE consultation, call 303-269-4188.
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