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FALL 2013

Your health. Your life.

A New Season of

Health Solutions for women one-step Breast Reconstruction for Cancer Patients

Sound Sleep

Home sleep tests help ID problems


Nearly one-third of supervisors are less likely to promote someone with a cluttered workspace than someone with a tidy workspace, according to a study by CareerBuilder.

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. 7700 S. Broadway Littleton, CO 80122

mylittletonhospital.org

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Less Is More

As the temperatures drop and the holidays draw near, clutter tends to creep into the scene. Papers on your desk or presents scattered around your living room are not the only clutter that can impact your health. Research shows that noise clutter (e.g., phone rings, car honks, music, etc.) contributes to deficits in long-term memory and decreases in levels of perceived quality of life. Clutter can even lead to depression or negative behavior. Environment is the third guiding principle of the CREATION Health lifestyle, an Adventist Health System wellness program that is supported by medical research. To learn more, visit creationhealth.com. Littleton Adventist Hospital infuses music, massage, art, and nature throughout its environment to help nurture the healing journey of our patients. Patients can schedule a bedside musician to come and play therapeutic music, or a certified massage therapist for a hand or foot massage to lower blood pressure, boost their immune system, and improve sleep. A collection of art and sculpture by regional artists and the walking paths in the dedicated outdoor area provide a connection to the surrounding community in addition to the calming effect on the senses for patients and visitors.

Smoking and lung cancer

TIMING YOUR PAP SMEAR

Women smokers are 20 percent more likely to develop lung cancer — the leading cause of cancer-related death for both women and men — than in the past, according to a recent Dr. Lisa Ahrendt study published in the New England Journal of Medicine. Researchers believe that is due to earlier and heavier smoking. But quitting earlier also reaps large rewards, found a second study in the journal. Women who quit by age 34 gain 10 years of life, compared to four years for women ages 55-64. “It typically takes 10-15 years for the damage of smoking to revert,” says Lisa Ahrendt, MD, an oncologist with Mile High Oncology. “While the repair will never reach that of a never-smoker, the sooner smoking cessation occurs, the more there is to gain.”

For women age 30 and over, a Pap smear and HPV test, which can be performed at the same time during a wellness exam, are needed only once every three to five years if results are negative, Dr. Nicole Hoffman according to new cervical cancer and HPV screening guidelines. Nicole Hoffman, DO, a physician at Chatfield Family Medicine, recommends women start testing at age 21 and continue to receive annual testing up through age 30 due to the increased risk of HPV and STDs. “While less testing is becoming the standard, it’s important to get regular testing if your results are positive,” Hoffman says. Women also should continue to get annual physicals and, if over the age of 40, annual screening mammograms. Talk with your physician about what screenings are right for you. If you don’t have a physician, Highlands Ranch Medical Associates is accepting new patients. Call 303-649-3140 or visit highlandsranchmedicalassociates.org for info.

Screening for lung cancer For high-risk candidates, screening for lung cancer, which entails an annual low-dose CT scan for three years, should be part of a regular health routine. Covered by some insurance, those not yet covered may be eligible to participate in Centura’s Healthy Lung Screening Program. More information on high-risk criteria and the program can be found at centura.org/healthylung.

Cover photo: ©IStockphoto.com/neoblues; This Spread counterclockwise: ©IStockphoto.com/JillChen, ©IStockphoto.com/poligonchik, Portraits ©Ellen Jaskol; opposite page: ©IStockphoto.com/yangphoto

IN Good Health


Just as you can thank your parents for the length of your legs and the color of your hair, researchers are quickly finding new genetic links for nearly every disease, from breast cancer to heart disease and Alzheimer’s. Progress in genetic testing is occurring

at much faster rates due to next-generation DNA sequencing methods, which allow for genetic testing to be run on multiple genes at the same time. “The cost of analyzing 10-15 genes is now getting closer to the cost of analyzing one to two genes,” says Lisa Mullineaux, MS, a certified genetic counselor at Littleton Adventist Hospital. “As efficiencies continue, we can gather more genetic data at much faster rates, allowing us to better analyze cases and take proactive measures.” A positive result for one of these tests does not mean you will develop that particular health problem. Rather, it gives you information that will help you make more-informed health decisions, Mullineaux says, such as more frequent screenings or preventive treatments.

“Five to 10 percent of any cancer has an inherited link,” Mullineaux says. “If you see a trend in your family, you should consider genetic testing.”

Genetic counseling and testing is recommended for those with: • A high occurrence of the same disease within a family • Onset of a disease in family members before age 50 • A rare condition present in more than one family member • Family members with multiple primary cancers • Physical changes related to hereditary cancers (e.g., multiple colon polyps) • Family history of cancers that are known to be genetically related

For more information about genetic testing or to schedule a genetic counseling session, visit mylittletonhospital.org/genetic-counseling or call 303-734-3969.

Epilepsy and Depression

Preliminary research positive for antidepressants pilepsy and mood disorders often go hand in hand, with nearly one in three people with epilepsy suffering from depression. Antidepressants are regularly prescribed to treat depression but, until recently, were thought to potentially increase the occurrence of seizures. However, a new but very preliminary study by researchers at Rush University Medical Center in Chicago concludes that antidepressants may not have a negative effect on seizures and may, in fact, improve symptoms

for some patients. “While the study needs to be further validated, the initial findings are positive, indicating that typical treatments for depression, including SSRIs (antidepressants), will not make seizures worse,” says Richard Clemmons, MD, medical director of epilepsy at Littleton Adventist Hospital. The study is a step in the right direction, as addressing mood along with sleep issues and seizures are the three critical components to treating epilepsy, Clemmons says.

Learn More The Epilepsy Monitoring Unit (EMU) at Littleton Adventist Hospital offers patients 17 and older prolonged inpatient video electroencephalogram (EEG) monitoring to diagnose and guide treatment. For more information, visit mylittletonhospital.org/ emu.

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IN BRIEF

Genetic testing can help prevent disease


One and Done | Single surgery for breast cancer

Dr. Lisa Hunsicker, plastic surgeon, Littleton Adventist Hospital

Thanks to an innovative procedure offered at Littleton Adventist Hospital, women can undergo a mastectomy and breast reconstruction in one surgery, reducing time spent in surgery and recovery. Direct-toimplant reconstruction, also known as single-stage or immediate breast reconstruction, takes place during the same surgery as the mastectomy, rather than a series of several procedures like the traditional staged/tissue-expander breast reconstruction techniques. Lisa Hunsicker, MD, a boardcertified plastic surgeon at Littleton Adventist Hospital, has used a direct-to-implant breast reconstruction procedure throughout the past decade.

“As mastectomies have evolved, leaving more breast skin, breast reconstruction needed to keep up the pace,” Hunsicker says. “Tissueexpander procedures are painful and inconvenient, and I wanted to offer my patients an alternative.” Hunsicker works in tandem with the general surgeon to immediately begin reconstruction after the original breast tissue is removed in the mastectomy. This technique reduces the time the patient is under anesthesia and in the operating room from that of traditional procedures. While everyone requires a personalized consultation with a plastic surgeon, most women

Advancing Care

Littleton Adventist Hospital: A Step Ahead in Women’s Health

Portraits ©Ellen Jaskol

Fibroid Facts | Many options can ease symptoms

Dr. Patricia Brown, OB/GYN, Littleton Adventist Hospital

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While more than 40 percent of women will get fibroids at some point in their lives, the good news is that many will never even know they have them. Fibroids are noncancerous growths in the uterus. Most common in women of childbearing age, fibroids often go under the radar, showing no symptoms. “Unless symptomatic, the best option is to leave fibroids alone while monitoring for changes,” says Patricia Brown, MD, an obstetrician and gynecologist with Chatfield Women’s Care, located on Littleton Adventist Hospital’s campus. “Fibroids often

cause no pain or interference and shrink with menopause.” More proactive measures are needed for women who experience symptoms of fibroids — heavy menstrual bleeding, prolonged menstrual bleeding, pelvic pain, frequent urination, constipation, or backaches. For women still wanting to have children, treatment may involve: • Hormone therapy • Uterine artery embolization, which cuts off the blood supply to the fibroids, making them shrink and eventually die but may take up to


Fat-Grafting Procedure Offers Outpatient Solution can undergo direct-to-implant reconstruction if they don’t smoke, have good skin elasticity, and lack severe medical problems. Hunsicker stresses that because the general surgeon and plastic surgeon may have differing philosophies, finding a unified breast team, like the one at Littleton Adventist Hospital, is key to successful direct-to-implant reconstruction. “The breast team I work with at Littleton is second to none,” Hunsicker says. “They do an exceptional job, which allows me to be able to offer direct-to-implant reconstruction to most women.” Recovery from direct-to-implant

reconstruction is typically six weeks, a reason it is growing in popularity among women considering a preventive mastectomy because of a positive breast cancer genetic test or strong family history of breast cancer.

To learn more about breast cancer services at Littleton Adventist Hospital, visit mylittletonhospital.org/ breastcenter.

For many women, misperceptions about breast implants or the thought of extensive recovery postmastectomy overshadow their desire for breast reconstruction. But with fat grafting, also known as autologous fat transfer, these worries are eliminated. Fat grafting uses liposuction to remove fat cells — typically from the abdomen or thighs — and injects them into the breasts in a series of outpatient procedures. While fat grafting can be done immediately after a mastectomy under general anesthesia, it is generally performed on an outpatient basis under IV sedation. “Fat is rich with stem cells that help the body heal after radiation, offering benefits beyond the cosmetic perks and convenience of the procedure,” says Lisa Hunsicker, MD, a board-certified plastic surgeon at Littleton Adventist Hospital. “This makes the benefits of the procedure available to lumpectomy patients, as well as women who have undergone mastectomy.” Fat grafting typically takes two to three hours to perform, and recovery time is generally minimal, with patients back to normal activities within three weeks. Fat grafting will be offered starting this fall at Littleton Adventist Hospital. To find out more, go online to mylittletonhospital.org/breast-reconstruction.

When it comes to your health, you want the best — and you should expect the best. A one-stop shop can be rare, but what if it was right in your backyard? Too good to be true? Think again.

12 months to show improvements in symptoms • Laparoscopic or robotic myomectomy, which entails removing fibroids through small incisions in the abdomen using tiny instruments (laparoscopic) or a da Vinci® surgical robot, which is available at Littleton Adventist Hospital Women with unmanageable symptoms may require endometrial ablation or a hysterectomy. While there is no cure for fibroids, a new study by the National Institute of Environmental Health

Services (NIEHS) found that women with sufficient vitamin D levels were less likely to have fibroids. Specifically, women who spent more than an hour outside each day had a 40 percent reduced risk of fibroids. While more studies are necessary to confirm these findings, obtaining sufficient levels of vitamin D should be part of any woman’s health plan; however, it’s important to limit sun exposure without protection to guard against skin cancer, says Brown.

Chatfield Women’s Care specializes in minimally invasive gynecological surgery, which reduces the size of the incision and recovery time. For more information or to schedule an appointment, call 720-528-0800 or visit chatfieldwomenscare.org/minimallyinvasive-gynecological-surgery.

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Illustration: ©IStockphoto.com/MariaGalybina; Photo: ©IStockphoto.com/jillvhp

Littleton Adventist Hospital was a recipient of the Healthgrades® 2013 Women’s Health Excellence Award™, recognizing the hospital as a top provider of women’s health services, which includes care provided to women for common conditions treated and procedures available at the hospital. Here’s a look at two common women’s health issues and the new, advanced treatment procedures available at Littleton Adventist Hospital.


SlumberSolutions Home Sleep Study

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 6 | FALL 2013 • Create

says. She also recommends 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.

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 Littleton Adventist Hospital Sleep Disorder 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 303-7382570 to learn more about home sleep studies, or go online to mylittletonhospital.org/ sleep, where you can get more information and take a FREE online sleep quiz.

Photo: ©iStockphoto.com/YinYang

Whether it’s your digital habits or a sleep disorder keeping you awake, we’ve got tips to help you get your zzzs

While a sleep study performed in a hospital sleep lab is required in some cases, home sleep studies — like the ones now available through Littleton 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 centers at Porter, Parker, Littleton, and Castle Rock Adventist Hospitals do, they record vital information 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. Home sleep tests are covered by most insurance plans.


Kids-Only ER

Why hand-washing and hydration are necessities

Fingertip Fluid Trick

Good ol’ hand-washing and proper hydration should be part of your arsenal for a healthy winter, particularly when it comes to combating the highly contagious norovirus. The virus spreads

from person-to-person contact or through contaminated food or water and is often accompanied by a fever, muscle aches, headache, and Dehydration is the most gastroenteritis — an inflammation of the stomach and intestines often causing vomiting and diarrhea, which can lead to dehydration. common side effect of “The main characteristics of norovirus are its sudden onset and norovirus. To check for usually much more vomiting and diarrhea than we see with the regular seasonal flu,” says Mark Elliott, MD, medical director at the Littleton dehydration, push on Adventist Hospital emergency department. “One day you can show no the tip of a finger. If the symptoms, and the next you can be extremely ill and dehydrated.” Elliott recommends staying on top of hydration while ill to avoid white spot does not regain more complications. Children should take sips of electrolyte-rich fluids color in a few seconds, like Pedialyte® every few minutes as tolerated between vomiting dehydration likely exists. episodes, consuming one ounce per pound of body weight during a four-hour period, Elliott recommends. The best defense against the virus is hand-washing. Avoid sharing towels and wear a mask and gloves when cleaning up vomit. Also, thoroughly wash foods. Infecting more than 20 million Americans each year, with peaks during the winter months, norovirus can particularly prey on the most vulnerable, including children and older adults, according to the Centers for Disease Control and Prevention. Seek medical attention if your child (or you): Refuses to drink fluids • Can no longer drink • Is lethargic

Dr. Mark Elliott, medical director of emergency services, Littleton Adventist Hospital

Emergency App Littleton Adventist Hospital is making emergency room visits even easier with its new FREE smartphone app, iTriage. With this app, you can check ER wait times or use the “Tell Us You’re Coming” button to alert the emergency room that you’re on your way. Go to centura.org/itriage to download.

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Photo: ©iStockphoto.com/Antagain

Quick-hitting norovirus doubly dreadful

With one in 14 children visiting the ER due to norovirus, and one in six children requiring a doctor’s care due to dehydration caused by the virus, there’s no place better suited to offer treatment than Littleton Adventist Hospital’s Pediatric Emergency Care Center. In affiliation with Rocky Mountain Hospital for Children, it is staffed by boardcertified pediatricians to ensure that children receive the special attention they deserve. While the thought of IVs make many children and parents hesitant to visit the ER, 80 percent of the dehydration cases in children seen at Littleton Adventist Hospital are treated with oral medications and fluids, says Mark Elliott, MD, medical director of emergency services at Littleton Adventist Hospital. Pediatric Emergency Care is located at the hospital’s main ER at Broadway and Mineral Avenue. A boardcertified pediatrician is on staff weekdays from 4 p.m. to midnight and weekends from noon to midnight, but children can be seen at all times. For questions or more information, call 303-795-KIDS.


PorterCare Adventist Health System

FALL 2013

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Denver, CO Permit NO. 4773

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Free health classes

Common Thyroid Disorders Could your recent weight gain, thinning hair, or dry skin be caused by your thyroid? Dr. Julia Rifkin will discuss common thyroid problems, like hyperthyroidism and hypothyroidism, how they’re diagnosed, the difference between them, and the treatment options available.

Centura Health complies with the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973, and no person shall be excluded from participation in, be denied benefits of, or otherwise be subjected to discrimination in the provision of any care or service on the grounds of race, religion, color, sex, national origin, sexual preference, ancestry, age, familial status, disability or handicap. Copyright © Centura Health, 2013.

Date | Thu, Nov 7 Time | 6-7 p.m. Cost | FREE Location | Littleton Adventist Hospital, Conference Room 1 Register | 303-777-6877, option 1

Date | Sat, Nov 9 Time | 2-4:30 p.m. Dates | Thus, Nov 14 or Dec 5 Time | 6:30-8:30 p.m. Cost | $35 per couple (includes a DVD to take home) Location | Littleton Adventist Hospital, Conference Room 1 Register | 303-777-6877, option 1

The ‘Weighting’ Game

Consider knee replacement before pain diminishes your active lifestyle Knee replacement surgery is quite effective at relieving pain, enabling patients to become active once again. For some patients, though, getting back into the exercise routine may be tough. In

fact, one-third of knee replacement patients actually gain 5 percent of their body weight within five years of surgery, according to a recent study published in Arthritis Care & Research. Prolonging knee replacement surgery to the point where you give up activity and take up unhealthy eating are likely culprits, says Robert L. Thomas, MD, a board-certified orthopedic surgeon at the Center for Orthopedics in Littleton. “Too often people look to knee replacements to drastically change their lives, but if someone is already sedentary, more than surgery is needed,” Thomas says. “Exercise is important, but a healthy diet and lifestyle are also critical to reaping the most benefits of knee replacement surgery.” The findings emphasize the importance of proactively addressing knee pain sooner rather than later, Thomas says. When knee pain starts to impact everyday activities, seek treatment to ensure that downtime is minimized and activities are not compromised. To learn more about whether your knee pain is treatable without surgery, or to find out about knee replacement surgery, visit centerfororthopedics.org.

Photo: ©IStockphoto.com/Chalabala

The Happiest Baby on the Block As new parents, we’ve experienced the desperate feeling when our baby cries — especially when it happens in the middle of the night, or when the baby won’t stop no matter what we do. The baby experts at Littleton Adventist Hospital now offer a breakthrough class that can help transform a crying baby into a happy baby. A certified instructor will teach you why a baby cries, the misconceptions about babies, soothing and swaddling techniques, and five steps to trigger your baby’s calming reflex.


Create Fall 2013