Spring 2014 | Volume 6, Issue 2
TEAMING UP Optimism, hope and good friends make facing a critical illness easier Page 4 After surgery to remove a brain tumor, Kristen Robley (left) and Kim Roth, RN, one of her ICU nurses, formed a lasting friendship.
Diabetes after breast cancer
Thyroid cancer on the rise
Success with weight-loss surgery
PAGE 6 PHOTO BY ELLEN JASKOL
Take the pressure off
High blood pressure doesn’t have to stop you from getting pregnant have high blood pressure when they conceive or they develop it in the first 20 weeks, a condition known as chronic high blood pressure. Although it is safe for these women to be pregnant, some extra steps need to be taken up front to ensure a healthy mom and baby, says Henry Galan, MD, a perinatologist at Parker Adventist Hospital who specializes in caring for pregnant women with health risks. “It’s important to see their primary care doctor or, if possible, get preconception counseling with an OB/GYN or a maternal-fetal medicine specialist,” he says, noting that chronic hypertension is different than preeclampsia, a condition characterized by high blood pressure that occurs after 20 weeks of pregnancy. High blood pressure is defined as a systolic (top number) greater than 140 millimeters of mercury over a diastolic (lower number) greater than 90 — or 140/90 or higher. If left untreated, high blood pressure may harm the mother’s heart, lungs, liver, kidneys, platelet counts, and even cause seizures and stroke. It also can restrict the baby’s growth and result in preterm delivery, Galan says.
Galan offers this prepregnancy checklist to women with high blood pressure: • S ee a physician prior to conception for an overall physical checkup, with testing of the heart, liver, and kidneys. •O ptimize blood pressure and review blood pressure medications with a physician. ACE inhibitors and similar blood pressure medications can affect fetal renal development or cause cardiac abnormalities, so women on those medications will need to switch with the counsel of their doctors. Women should not stop taking medications on their own, Galan warns. • S tart an aerobic exercise program of 30 minutes three to four days per week well before conceiving, which helps control blood pressure.
Mothers-to-Be Month If you’re thinking about starting a family or are already pregnant, tour The BirthPlace at Parker Adventist Hospital. To schedule your tour, call 303-777-6877. Or to find an OB/GYN, visit parkerhospital.org/doctor.
Diabetes higher among breast cancer survivors WHILE EVERYONE 45 and older should undergo diabetes screenings, female breast cancer survivors have an even greater need. New research published in Diabetologia suggests that female breast cancer survivors may be more prone to developing type 2 diabetes, which occurs when the body improperly uses Dr. Ramona insulin. Rodriguez “While the correlation between breast cancer and diabetes has yet to be fully understood, I recommend that all women who have had breast cancer and anyone with high risk factors be screened regularly for diabetes earlier
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than age 45,” says Ramona Rodriguez, MD, a board-certified internal medicine physician at Timberview Clinic at Parker. Others at high risk of developing type 2 diabetes include those with a BMI greater than 25 with one of the following risk factors: • Family history of diabetes • Lack of physical activity • Diabetes while pregnant • High blood pressure The most common and effective diabetes screenings are hemoglobin A1c, fasting plasma glucose, and two-hour oral glucose tolerance tests, all of which are simple blood tests, says Rodriguez. The fasting
plasma glucose test requires fasting for at least eight hours, while the oral glucose tolerance test requires drinking a glucose liquid at set intervals with subsequent blood testing after consumption. To schedule an appointment with Dr. Rodrigquez, call 303-269-4410.
Special Extended M ammo
Hours Join us as we celebr ate spring and moms with a spec ial mammo event on May 12 and June 23 from 7 a.m.7 p.m. at The Trio Breast Center. Enjoy light refresh ments and convenient hours. Call 303-269-4150 to make your mam mogram appointment toda y.
PHOTO: PREGNANT ©ISTOCKPHOTO.COM/M_A_Y_A
ABOUT 3 PERCENT OF WOMEN who get pregnant each year
Thy-rocketing Risk With cases of thyroid cancer on the rise, catching it early is key WHILE MANY CANCER RATES are declining, thyroid cancer is trending up.
“Thyroid cancer incidence has been on the rise. It’s one of the fastestrising malignancies, particularly in women,” says Sharmini Long, MD, a boardcertified endocrinologist at Parker Adventist Hospital. Today, the chance of being diagnosed with thyroid cancer is more than twice what it was in 1990, according to the American Cancer Society. Although this may be partially due to earlier detection, the incidence of large malignancies also has been rising. The good news? “If you catch it early, there’s a 97 percent fiveyear survival rate,” says Mark Willis, MD, an otolaryngologist and Dr. Sharmini Long head and neck surgeon at Parker Adventist Hospital.
Some thyroid cancers are found when patients see their doctors because of a lump in the neck. Difficulty swallowing also can be a sign. Often, there are no symptoms. “That’s a little bit nerveracking for patients. You’d think if you have cancer you should feel something,” Long says. Her best advice: See your doctor once a year to get your neck Dr. Mark Willis checked, especially if you are a woman between the ages of 40 and 50. “You may have nodules that you can’t feel, but your physician is trained to find,” she says.
The National Cancer Institute estimates 60,000 cases of thyroid cancer were diagnosed in 2013. Women outnumber men three to one. WORKING TOGETHER
At Parker Adventist Hospital, patients with thyroid cancer have more than statistics on their side. Willis and Long work closely together to map out treatment for many thyroid patients. “You want your patient to have the right surgery the first time. We work together to try to achieve this,” Long says.
ILLUSTRATION: ROCKET ©ISTOCKPHOTO.COM/RACING-LEGENDS
Genetic research may further improve the prognosis for thyroid cancer patients. “Researchers are identifying genes involved with cancer development. If we know someone has a gene mutation that is aggressive, we’ll be more aggressive with treatment,” Long says.
Learn more about thyroid cancer Find out more about the risks of developing thyroid cancer and how to treat it at a FREE community seminar with Dr. Mark Willis and Dr. Sharmini Long on Thursday, May 1. See back cover for details. If you would like to schedule an appointment with Dr. Long, call 303-649-3115. Or call 303-269-2677 for an appointment with Dr. Willis.
Join Parker Adventist Hospital for a series of FREE health seminars. All seminars are held in the Parker Adventist Hospital Conference Center, located on the 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.
Wed, Apr 9 | 6:30-8 p.m. Join bariatric surgeon Dr. Joshua Long for a look at the surgical and medical approaches to weight loss. Learn the options, including gastric bypass and LAP-BAND® surgeries, and whether you may be a good candidate.
Thu, Apr 10 | 6:30-8 p.m. Join orthopedic surgeon Dr. Harold Hunt and learn the latest in hip replacement surgery with the anterior approach that helps speed recovery.
Colon Cancer: From Prevention to Treatment
Tue, Apr 15 | Noon-1:30 p.m. Colorectal cancer is the second leading cause of cancer-related deaths, yet among the most treatable of all cancers. Join gastroenterologist Dr. Erik Pieramici to learn how colonoscopies are getting easier. All participants will receive a FREE screening toolkit to take home.
Early Signs of a Heart Attack
Thu, Apr 17 | 6:30-8 p.m. Join cardiologist Dr. George Pachello to learn the early warning signs of heart attacks and how to act fast to reduce damage.
Women’s Health After 40
Tue, Apr 22 | Noon-1:30 p.m. Join OB/GYN Dr. Vandna Jerath for an insightful discussion on the latest research, news, and screening guidelines for women’s health, including infertility, sexual health, PMS, incontinence, and cancer.
Scarless Gallbladder Surgery
Tue, Apr 29 | Noon-1:30 p.m. As many as one out of every 10 people have gallstones, which can lead to gallbladder disease. Learn about the latest, virtually scarless surgery for gallbladder removal with general surgeon Dr. Christine Rogness. grow
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with expertise, technology, Kristen Robley’s life was close to perfect — until the day she was diagnosed with a brain tumor at the age of 34. She had moved to
A life-altering diagnosis
“It was plain as day that I had a baseballsized tumor in the left side of my head,” says Robley, after seeing the MRI. Robley was taken to the ICU and given steroids to reduce the swelling in the brain caused by the tumor, which was very likely to be lifethreatening and fast-growing. Neurosurgeon Sean Markey, MD, recommended surgery to remove as much of the tumor as possible, followed by chemotherapy and radiation therapy to stop the growth of any remaining tumor cells. “I didn’t feel overwhelmed, but I had a lot of questions,” says Robley. That is often the case when receiving a diagnosis of a
major health issue or a chronic disease, says Markey. He suggested to Robley and for his other patients that they talk with their families and write down every question they can think of, and then meet again with their doctor. Robley’s tumor was in the frontal lobe of the brain, which controls movement, intelligence, reasoning, behavior, memory, personality, planning, decision making, judgment, initiative, inhibition, and mood. Fortunately, its location within the frontal lobe made removal possible without extensive brain damage. But surgery wasn’t without risk. It could affect Robley’s ability to think, reason, and process information (cognitive functioning), and to remember things.
Nearly 175,000 people will be diagnosed with primary brain tumors this year, according to the American Brain Tumor Association. About one-third of those are malignant (cancerous). They occur most frequently in children and older adults, but young adults are not immune. Brain tumors are the second leading cause of cancer deaths in men ages 20-39 and the fifth leading cause of cancer deaths in women of that age group.
MORE PRECISE BRAIN SURGERY Neurosurgeons at Parker Adventist Hospital recently began using a special CT scanner to operate more precisely on the brain and spine. Called BodyTom®, the portable, full-body, 32-slice scanner gives neurosurgeons high-quality images of soft tissue and bone as surgery is occurring. This is especially important when operating on brain tumors, where the brain shifts as the tumor is removed. “BodyTom is really enhancing our surgical navigation system for brain tumors, allowing safer and more complete resections,” says Sean Markey, MD, a neurosurgeon at Parker Adventist Hospital.
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PHOTOS: BRAIN ©ISTOCKPHOTO.COM/FIRSTSIGNAL; BODYTOM COURTESY OF NEUROLOGICA CORP.
Kristen Robley never doubted she would survive her brain tumor after surgery at Parker Adventist Hospital
Aurora from Pennsylvania and married her best friend, Philip. She was teaching special education students at Arapahoe High School, and she and her husband were making plans to start a family. Then the headaches she had been getting on and off for a few years started getting worse. Robley also began having trouble hearing out of her right ear, along with problems with her balance, peripheral vision, and thinking clearly. In July 2011, she went to the emergency room at Parker Adventist Hospital for help.
BRAIN TUMORS and
Four days after coming into the ER, the swelling in Robley’s brain had gone down enough for surgery. Markey, who has treated hundreds of patients with brain tumors, was able to remove the entire tumor. Removing brain tumors is a challenging surgery. “The tumor looks just like the brain,” Markey says. “You have to come up with Dr. Sean Markey a way to tell the difference between the tumor and the brain.” Markey did that by creating a threedimensional picture of Robley’s brain, based on an MRI taken shortly before the surgery, in an image-guided surgical navigation system. But once he started removing the tumor, the brain began to move and the MRI was no longer accurate. Markey’s extensive experience with brain tumors, and the use of a surgical microscope, enabled him to distinguish the tumor from the brain. New technology now allows real-time CT scans of the brain during surgery to assist surgeons during this process (see accompanying box).
Robley came out of the surgery fully functional, just with less energy than before. “I was very fortunate,” she says. Going into the surgery without cognitive impairment was one reason Robley did so well, Markey says. The expertise of Markey and other members of the treatment team is another reason. “We have good outcomes because of our team,” says Markey, who works closely with a neuroradiologist, a neuropsychologist (who assesses the patient’s functioning before and after surgery), an oncologist, and a radiation oncologist — all of whom are available at the Parker Adventist Cancer Care Center. Together they plan and deliver customized treatment for each patient. “We try to relate to our patients and understand them as people,” Markey says. This attitude was clear to Robley, who calls Markey “an excellent doctor and a really good person.” ICU doctors and nurses are also part of the team. During her ICU stay, Robley and one of her nurses, Kim Roth, discovered that they were both married on the same day and at the same place. This was the beginning of a close friendship.
The power of a positive attitude
Although Robley’s tumor turned out to be Grade 3 (out of four, which is the worst), where the average survival time is seven years, she continues to be optimistic. “Being negative doesn’t get you better,” she says. That positive attitude has aided Robley’s recovery and her quality of life, Markey says. “Kristen is a very impressive woman. She is very tough.” Even though an MRI done after surgery showed no signs of the tumor, it’s impossible to remove every tumor cell, Markey says. So Robley also had chemotherapy and then radiation therapy, completing her treatment in spring 2013.
PHOTO BY ELLEN JASKOL
For most primary brain tumors, the cause is unknown, although age (younger and older adults) and gender (men are more likely to have brain tumors than women) play a role. Symptoms are very similar to a stroke: a sudden, severe or long-lasting headache, slurred speech or decline in other senses, balance problems, and loss of awareness or memory. People with brain tumors also may experience nausea and fatigue. Metastatic brain tumors, caused by the spread of cancer to the brain, are more common than primary tumors. Lung and breast cancer are the most common cancers that spread to the brain and cause tumors.
Kristen Robley shares hope with patients in the ICU at Parker Adventist Hospital, where she once recovered.
Robley doesn’t have enough energy to go back to work, but she keeps busy reading, cooking, volunteering at Parker Adventist Hospital, and traveling with her husband. Two days a week, she volunteers in the intensive care unit where she was once a patient. “It’s a good way for me to say thank you to the hospital, and to give visitors the feeling that everything is going to be OK,” she says.
Understanding a Diagnosis When a patient is diagnosed with a life-threatening condition or chronic disease, it’s overwhelming and often confusing. But getting clear answers is essential. Join Dr. Sean Markey, neurosurgeon, May 15 to learn how to ask better questions of your physician and how to conduct research on the Internet that helps you understand your options better. See back cover for details.
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How one woman used bariatric surgery as a stepping-stone to begin a more active lifestyle
LESS THAN TWO YEARS AGO, Carol Timm was morbidly obese, had little energy to accomplish more than the minimum tasks of daily life, and was facing a future defined by serious health problems. “I have a family history of heart disease and my cardiologist told me that if I didn’t do something about my weight, he thought that within three to five years I’d probably have a cardiac arrest,” Timm says. It was this risk coupled with the regret that she wasn’t able to be active with her four young grandchildren that led Timm to decide on bariatric surgery, and in November 2012 she underwent laparoscopic gastric bypass at Parker Adventist Hospital, a bariatric surgery center of excellence. Since then, the 64-year-old has shed 159 pounds and counting, changed her eating habits for the better—including giving up the sweets that she used to love—and is a regular exerciser. In December, she competed in her first 5K run with her family. “I would never have been able to do that before the surgery. I would never have even considered it … but I made it!” she says. “A whole new life has opened up for me.”
“A whole new life has opened up for me.”
FIGHTING A LOSING BATTLE
While many people like Timm struggle for years losing and regaining weight, there’s solid scientific evidence showing that the hormonal production of fat cells pulls strongly in the wrong direction for them, says Joshua Long, MD, medical director of Parker Adventist Hospital’s bariatric program. Dr. Joshua Long “They often come in buried in guilt and blaming themselves, but what they need is something powerful to help level the playing field.” According to Long, the best candidates for surgery are individuals with a body mass index (BMI) of 35 or higher with a health condition related to their obesity, or a BMI of 40 without a related condition. “The most successful candidates are also committed to the overall process and to using all the tools that we give them,” Long says. “Patients who are highly motivated and really interested in partnering with us to maximize their benefits will get the After bariatric surgery and losing most out of it.” 159 pounds, Carol Timm is now running 5k races and playing with her grandchildren. 6 ■ Spring 2014 ■
The evidence that weight-loss surgery can resolve diabetes is mounting. A study published last September in the Annals of Surgery found that the biggest predictors of sustained diabetes remission after bariatric surgery were:
Long-term weight loss Having diabetes for less than five years before surgery
Having gastric bypass surgery versus gastric banding
Matthew Metz, MD, a bariatric surgeon at Parker Adventist Hospital, helped collect data from his patients for the study. Another procedure Dr. Matthew Metz not studied in this research offers even greater odds for long-term resolution of diabetes, he says. The duodenal switch calls for removing a large part of the stomach and rerouting food away from much of the small intestine to limit how the body absorbs it. “We’re seeing as high as a 98.9 percent resolution of diabetes with the duodenal switch,” he says.
FREE Weight-Loss Seminar If you are interested in learning more about the types of weight-loss surgery and whether you are a candidate, join Dr. Joshua Long, bariatric surgeon, for a FREE community seminar at Parker Adventist Hospital on Wednesday, April 9, or Wednesday, May 14, at 6:30 p.m. See Pages 3 and 8 for complete details.
PHOTO OF PATIENT BY ELLEN JASKOL
Beating diabetes with bariatric surgery
With Harold Hunt, MD Orthopedic Surgeon Parker Adventist Hospital
Preserving your natural hips Approximately one in four people will develop hip arthritis during their lifetime, but that’s no cause to throw in the towel. We spoke with Harold Hunt, MD, an orthopedic surgeon at Parker Adventist Hospital, about steps you can take to preserve your natural hips.
What are the essentials when it comes to preserving your hips? Maintaining a normal weight and an active lifestyle are probably the two paramount issues with preserving your hips. As part of that, Dr. Harold Hunt you’ll want to be doing some sort of exercise. The Arthritis Foundation recommends at least 30 minutes of aerobic exercise three times per week. And of course, load-bearing exercise is good for maintaining bone density as well.
PHOTO: EXERCISE ©ISTOCKPHOTO.COM/LEEZSNOW; ILLUSTRATIONS: CALENDARS ©ISTOCKPHOTO.COM/LUSHIK
Does exercise need to be low impact? If you have a propensity for joint pain, low-impact activities like walking, using an elliptical trainer, cycling, and doing water aerobics may be preferred. But there have been no studies that show highimpact activities increase your risk of arthritis, so most people just need to choose something that they enjoy so they will stick with it. What about the factors you can’t control? Some hip problems are uncontrollable. A common cause of early hip arthritis is related to congenital abnormalities resulting in abnormal shape or anatomy of the hip. For people in their mid-40s or 50s with hip arthritis, this is the most common form of early hip arthritis. Also, if you have a strong family history of arthritis, you are more likely to develop hip problems. Is there any evidence that joint supplements actually help? The American Academy of Orthopaedic Surgeons did look at this, and they found no Level 1 studies that showed that supplements like glucosamine or chondroitin made a significant difference in people’s joint pain, so they don’t recommend them. However, anecdotally, I have had patients who have tried them and felt the benefits. So I generally tell patients to try them for about six weeks and if they feel like it makes a difference for them, I think it’s reasonable to continue. If they don’t notice any difference during this time, I typically have them discontinue use.
Preparing for hip replacement ONCE YOU AND YOUR SURGEON
decide that hip replacement is right for you, there’s much to be done to prepare for your procedure. Derek Johnson, MD, an orthopedic surgeon and medical director of Parker Adventist Hospital’s joint replacement program, takes us through a few of the highlights.
Dr. Derek Johnson
Several Weeks Out Preoperative joint class. This class is imperative, covering everything you’ll need to think about before surgery and following surgery to make the process easier. Exercises. “Work to strengthen the stabilizing muscles around the hip that you’ll be relying on after surgery,” Johnson says. “That gets you off of your walking aids more quickly.”
1-2 Weeks Out Prepare your home. Move things you’ll need following surgery to the first floor of your home, prepare and freeze meals in advance, and remove rugs and other items that are trip hazards. “You’ll also want to arrange for transportation, as you won’t be driving that first week or so,” Johnson says. Medication use. Your doctor may advise you to stop taking certain medications prior to your procedure.
24 Hours Before Pack your bag. Prepare your hospital bag with all of your medical information, including an up-to-date medication list and your insurance information, as well as comfortable, loose-fitting clothing for going home. Scrub up. Showering or bathing the night before surgery can help reduce the risk of infection.
FREE joint replacement seminar Join Dr. Derek Johnson, orthopedic medical director, to learn how to reduce your pain and recover quicker after surgery at a FREE community seminar on Thursday, May 22. See back cover for complete details.
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MAY FREE health seminars
Portercare Adventist Health System
Non-Profit Organization U.S. Postage
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 Adventist Hospital Conference Center at the west entrance. A light lunch is served during noon seminars, and light snacks are served during evening programs.
9395 Crown Crest Blvd. Parker, CO 80138
Denver, CO Permit No. 4773
Thyroid Cancer Facts and Symptoms Thu, May 1 | Noon-1:30 p.m. Women are twice as likely today to be diagnosed with thyroid cancer than 25 years ago. Learn the risk factors and symptoms with ENT Dr. Mark Willis and endocrinologist Dr. Sharmini Long.
Skin Cancer 101 Tue, May 6 | Noon-1:30 p.m. Join dermatologist Dr. Leslie Capin to learn how to screen your body to find skin cancer at its earliest and most treatable stage. Participants will receive a voucher for a FREE skin cancer screening.
Weight-Loss Surgery Wed, May 14 | 6:30-8 p.m. Join bariatric surgeon Dr. Joshua Long for a look at the surgical and medical approaches to weight loss and how these techniques can improve your health, including reversing diabetes.
Ask Your Doctor the Right Questions Thu, May 15 | 6:30-8 p.m. Join Dr. Sean Markey, neurosurgeon, to learn what questions you need to ask your physician and how to conduct research on the Internet that helps you understand your options better.
Outpatient Joint Replacement Surgery Thu, May 22 | 6:30-8 p.m. Join orthopedic surgeon and medical director Dr. Derek Johnson to learn about hip and knee replacement and our cutting-edge pain management and rehab techniques that allow patients to return home the day of surgery.
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 firstname.lastname@example.org. grow is produced by Clementine LLC. Executive Editor: Rachel Robinson
Part of Centura Health, the region’s leading health care network. Centura Health does not discriminate against any person on the basis of race, color, national origin, disability, age, sex, religion, creed, ancestry, sexual orientation, and marital status in admission, treatment, or participation in its programs, services and activities, or in employment. For further information about this policy contact Centura Health’s Office of the General Counsel at (303)804-8166. Copyright © Centura Health, 2014.
Women should opt for colonoscopies Detection of early stage colon cancer results in over 90 percent survival rate
Colon cancer risk factors • History of colon polyps, inflammatory bowel disease, or specific cancers • Family history of polyps or colorectal cancer • Inherited diseases like Lynch syndrome • African-American • Obese, physically inactive, a smoker, or a heavy drinker
ALTHOUGH THERE ARE THREE TESTS to screen for colon cancer, women should opt for colonoscopies, says Erik Pieramici, MD a gastroenterologist at Parker Adventist Hospital. “Women are more likely than men to develop cancer on the right side of the colon, an area which is not evaluated by flexible sigmoidoscopy,” a screening that looks at only a portion of the colon, Pieramici says. In addition, polyps in women are frequently flat and hard to detect on X-ray. During a colonoscopy, a physician uses a camera to examine the entire colon. If a lesion, known as a polyp, is spotted, it is removed and biopsied for precancerous and cancerous changes. All colon cancers start as polyps so if they are found and removed prior to becoming cancerous, cancer can be prevented. And if cancer is detected, survival rates soar if found early. “If we find lesions or cancer early, the survival rate can be over 90 percent, compared to approximately 50 percent for patients who come to us with symptoms,” Pieramici says. Colon cancer is the second leading cause of cancer deaths in Americans. Everyone should get a colon cancer screening starting at age 50, but only about two-thirds of Americans do so, according to the Centers for Disease Control and Prevention (CDC). In addition to colonoscopies, screenings include a fecal occult blood test (which looks for blood in the stool) and flexible sigmoidoscopy cer (which examines the rectum and can on col t ou ab Learn more lower one-third of the colon). Join us at a FREE community seminar Women and those who have a risk n more presented by Dr. Erik Pieramici to lear factor for colon cancer should get it on about colon cancer and how to prevent colonoscopies.
. April 15 at noon. See Page 3 for details