Your Connection to Healthy Living
Volume 4, Issue 4 | Fall 2016
SCREENING SCOOP When it comes to beating prostate cancer, the best weapon is early detection. Regular PSA screenings can up your odds for survival.
Mark Koebrich, longtime 9NEWS anchor, knows the value of a strong team. His includes wife Cathy and his physicians at Porter Adventist Hospital. Page 4
3 Free yourself from falls 6 Breast cancer: Navigate the new guidelines 7 Why choose a nurse practitioner?
porterhospital.org :: Spring 2013
1 PHOTO BY ELLEN JASKOL
BURNED by heartburn medication
Dr. Ashwin Kurian
If chronic reflux disrupts your daily life, Kurian suggests talking with your doctor about these treatment options:
The medications include brand names such as Prilosec, Prevacid, and Nexium. “These are very strong medications that, in some cases, people are taking without prescriptions,” says Ashwin Kurian, MD, a general surgeon at Porter Adventist Hospital who specializes in disorders of the esophagus and stomach.
Hiatal hernia repair to correct an anatomical problem when a part of the stomach pushes into the chest
“Most people tolerate PPIs OK in the short term,” Kurian says. “However, there may be more slowly developing problems that come into play with long-term use.”
Fundoplication, which takes tissue from the top of the stomach to create a “collar” around the lower esophagus
One study showed an association between long-term PPI use and chronic kidney disease. Another showed that elderly patients taking a PPI had a nearly 1.5 times higher rate for developing dementia as other patients. Kurian says PPI use also may be associated with heart disease. He urges patients taking PPIs to do so under the supervision of their physician so that kidney and heart function can be monitored. “The good news is there are surgical options. While not without the risk of complications, the side effects of surgical treatments for heartburn are minimal,” Kurian says.
To learn more about the GI tests and treatments available at Porter Adventist Hospital, visit digestivehealthporter.org.
The LINX procedure, which adds a tiny ring of titanium beads around the esophagus Radiofrequency heat to trigger nerve regeneration and cause muscles to work properly
Ins and outs of joint injections Patients living with arthritis often benefit from steroid injections to manage their pain. But how much is too much? “Steroid injections decrease inflammation and swelling, most often in the knee,” says Steve Kitchen, MD, an orthopedic surgeon at Centura Orthopedics. The rule of thumb is to have them no more than every three months. “The cortisone in the shot is combined with other chemicals that bind the cortisone and hold it Dr. Steve Kitchen in place,” he says. Multiple injections can cause those chemicals to build up and harm soft tissue in the knee. Kitchen suggests it’s time to consider surgery when pain inhibits your normal, everyday activities, or when the knee actually starts to adopt an angular, knock-kneed, or bow-legged position. “You can wait so long for surgery that the surgery actually becomes more problematic,” he says. Learn more about how to keep your joints healthy longer and when it may be
VIBRANT :: Porter Adventist Hospital
time for steroid injections at a FREE community seminar with Dr. Steve Kitchen on Wednesday, Nov. 2. See back cover for details.
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If you commonly turn to heartburn medication to keep stomach acid at bay, you may unknowingly be increasing your risk for serious disease. Recent studies suggest that longterm use of certain chronic heartburn medications called proton pump inhibitors, or PPIs, may increase risk of dementia, heart disease, and chronic kidney disease.
FALLING is a real downer Falling and fear of falling are big problems for older adults, but you can start your own customized fall-prevention program with a trip to your doctor. Falls are not only a leading cause of injury, but just worrying about them interferes with living.
Dr. Stephanus Tjan
Strategies to reduce injuries
“The best way to address the problem of falling is to find the cause of falls,” says Stephanus Tjan, MD, a geriatric specialist with an outpatient clinic at Porter Adventist Hospital. “For example, is a medication making you dizzy?”
Don’t Trip Up Take the steps below to identify causes and ways to prevent falls.
Keep a “falling” log: Track when a fall, trip, or near trip happens. What caused it? How were you able to avoid it? List your meds: Your doctor can help wean you off prescription and over-the-counter drugs that greatly increase the likelihood of falling.
Get checked: Eye or ear (equilibrium) disorders increase your risks of falling. Second the motion: Plan, with your doctor, a fitness program of walking, water exercises, tai chi, or other activities to build strength and improve balance, flexibility, and coordination.
Stand up for yourself: Take your time rising from a seated position. Scoot forward off chairs, pushing off both legs placed shoulder-width apart with a stable armrest for support.
Avoid slipups: Use nonslip mats, sturdy seats, and grab bars in showers and baths. Also consider walking sticks or a walker.
Shine a light: Place night-lights in bedrooms, bathrooms, and halls to identify hazards. Keep a flashlight handy for outages.
Put your best foot forward: Wear sturdy, properly fitting shoes. Skip high heels, slippers, flip-flops, and even stocking feet, which contribute to slips.
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Clear the decks: Remove boxes, cords, loose rugs, and any other hazards from your pathways.
Fall Proof A recent Yale University study found that physical activity reduced older men’s risk of seriously injuring themselves in a fall. The study looked at more than 1,600 men and women aged 70 to 89, who were assigned to either a long-term, moderate exercise program or a health education program. The men in the exercise program experienced a 38 percent lower incidence of serious injuries from falls, a 53 percent reduction in bone fractures, and a 59 percent drop in falls requiring hospitalization. Tjan says isometric exercises, which pinpoint specific muscles and act to regain strength, motion, and stability, have helped many older patients after they’ve suffered fractures and degeneration of disks, bones, and joints. Your doctor or physical therapist can identify the right exercises for you.
For information on outpatient physical therapy, call 303-778-5842. A physician referral is required before starting any physical therapy program, so please consult with your physician before scheduling.
porterhospital.org :: Fall 2016
Mark Koebrich and his wife, Cathy, are enjoying retirement and good health.
Former anchorman gets the word out that screening and robotic surgery can provide a speedy recovery and bright outlook for men with prostate cancer
In his long career in broadcast news, Mark Koebrich delivered a lot of messages. But none, he says, have been more important than what he is sharing with men now: Don’t be afraid to get tested for prostate cancer and if you need treatment, don’t be afraid of that, either. “I know all these big, robust guys, and they won’t go because they’re terrified,” Koebrich says. But Koebrich, who recently retired after nearly 40 years on the air at 9NEWS, wasn’t one of them. Regular screening detected his cancer, and robotic-assisted laparoscopic surgery at Porter Adventist Hospital rid him of that cancer. Koebrich will soon celebrate five cancer-free years. For that he credits his primary care physician and the Porter Adventist Hospital team, particularly his surgeon, Marklyn Jones, MD, medical director of Porter Adventist Hospital’s robotic surgery program. “He’s the gold standard for robotic prostatectomy,” Koebrich says of Jones. “He saved my life.” He also has high praise for the Porter Adventist Hospital team. “They take you by the hand and walk you through the whole process. No surgery is fun,” he says. “But I had a great experience.”
180,000 Thanks to surgeon Marklyn Jones, MD (right), Mark Koebrich is celebrating five years cancer free.
VIBRANT :: Porter Adventist Hospital
Prostate cancer is the most common cancer among men, other than skin cancer. This year, 180,000 men will be diagnosed with the disease, according to the American Society of Clinical Oncology. For men whose cancer is treated before it spreads, the five-year survival rate is nearly 100 percent (cancer survival is monitored for five years, after which it is considered gone).
PHOTOS ©ELLEN JASKOL
Surgery that’s second to none To Jones, minimally invasive robotic surgery is the best procedure for prostate removal (prostatectomy). With robotic surgery, the surgeon controls highly precise surgical tools on robotic “arms.” One of the arms controls a high-definition camera, which provides a magnified view of the surgical site. “With robotic laparoscopy, patients have quicker recovery, and usually stay in the hospital a shorter time — typically just overnight,” Jones says. In addition, the robotic procedure carries a lower risk of infection and excessive bleeding. Patients who have the robotic procedure “feel better sooner and get back to normal activities much more quickly,” he says. Koebrich is a walking example of that speedy recovery. For him, the worst thing about the whole procedure was the catheter. “If it weren’t for that, I would have had to remind myself I’d had surgery,” he says. Most men are candidates for robotic-assisted laparoscopic prostate removal, says Jones, who has used the technique for 10 years. Jones says initial concerns that robotic surgery might be less effective than a surgeon’s hands at removing all cancer cells haven’t been borne out. “I tell patients, ‘I’m kidding you if I say I can tell what cancer feels like.’” In Koebrich’s case, surgery removed all the cancer, so radiation wasn’t necessary.
SCREENING DEBATE For years, doctors advised men to get prostate-specific antigen (PSA) blood tests, which measure a protein produced in the prostate gland. That protein is often elevated in men with prostate cancer. But the screening has become controversial over the past five years, with some experts saying some men with elevated PSA levels were undergoing unnecessary cancer treatment. In 2012, the U.S. Preventive Services Task Force advised men not at high risk for prostate cancer to skip the screening. Dr. Marklyn Jones That recommendation alarmed many, including the American Cancer Society and Marklyn Jones, MD, medical director of the robotic surgery group at Porter Adventist Hospital. Jones says he’s seeing more men diagnosed with advanced disease. This summer, a research study documented that trend. The study found that the number of men newly diagnosed with advanced prostate cancer shot up by 72 percent between 2004 and 2013. Researchers say prostate cancer may have become more aggressive. But they suspect that with fewer men being screened, cancer is being detected later. “With screening, we pick up cancer earlier,” Jones says. “We should focus less on the controversy of screening and more on which men need to be treated” for elevated PSA levels, and which can be monitored.
Risk and recovery Because he has an extensive family history of prostate cancer, Koebrich’s primary care doctor had been monitoring the level of prostate-specific antigen (PSA) in his blood closely. Koebrich’s grandfather and great uncle likely died of prostate cancer. And his father, a World War II veteran who didn’t often visit doctors, might have as well, had Koebrich not taken him to a 9Health Fair, where he was screened.
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“His PSA was off the charts. Surgery added more than a decade to his life,” Koebrich says. Eventually, Koebrich’s own PSA levels jumped. Even knowing his history, he said it was hard to believe he had cancer when he felt so good. “I had no symptoms. I didn’t feel bad.”
Learn more about how to lower your risk for prostate cancer at a FREE seminar taught by Dr. Marklyn Jones on Monday, Nov. 7. See back cover for details.
To screen or not? All men should talk to their doctor about whether prostate cancer screening is right for them. The American Cancer Society recommends men in these categories be screened:
>50 at average risk and expected to live at least 10 years
>45 at high risk, including African-American men and those with a close relative who had prostate cancer before age 65
>40 who have more than one first-degree
relative who had prostate cancer at an early age
Porter Adventist Hospital’s advanced robotic surgery program is supported by Centura Centers for Clinical Innovation, extending advanced health technologies across Colorado and western Kansas.
porterhospital.org :: Fall 2016
Breast screening guidelines keep changing, but women don’t need to be confused
It happened again. Another agency, in this case the American
Cancer Society, changed its recommendations on when a woman should get screening mammograms.
Hankinson keeps a close eye on the various recommendations and the research guiding these decisions so she can help women navigate the waters. Dr. Jennifer Given current research, her belief is that women in good health and at average Hankinson risk should start annual mammograms at age 40. This is the recommendation of the American Congress of Obstetricians and Gynecologists as well as the American College of Radiology. Women with a family history of breast cancer should discuss with their doctors how early and how often to undergo screening. In general, a woman with a family history of the disease should have her first mammogram 10 years earlier than the age of the family member when she was diagnosed with breast cancer, Hankinson says.
Our goal is to detect cancer as small as possible, as soon as possible.
About 10 percent of breast cancers are caused by a genetic mutation, so women with a family history also should discuss possible genetic counseling with their physicians. Women should continue to have annual mammograms as long as they are in good health and expect to live 10 years or longer, according to the American Cancer Society.
A New View The latest technology in breast screenings is tomosynthesis, or three-dimensional mammography. Rather than creating just two images of each breast, tomosynthesis uses multiple low-dose X-ray pictures to create a series of 3-D views. “Having so many images means greater accuracy and fewer callbacks due to false positives,” Hankinson says. “Centers like Porter Adventist Hospital’s, using 3-D mammography, are detecting 40 percent more invasive cancers.”
VIBRANT :: Porter Adventist Hospital
To schedule a mammography, call the Centura Health Breast Care Center of your choice. Or text your name to the number shown, and a scheduler will call you to set up your appointment. Porter Adventist Hospital 2555 South Downing Street, First Floor Call: 303-765-6500 Text: 303-872-7469 Castle Rock Adventist Hospital 2350 Meadows Boulevard Call: 720-455-1111 Text: 720-644-0880 Centura Health Meridian 9949 South Oswego Street Call: 303-269-4150 Text: 303-816-8648 Centura Health Southlands 6069 South Southlands Parkway Call: 303-269-4150 Text: 303-816-8648 Littleton Adventist Hospital 7700 South Broadway Call: 303-738-2767 Text: 720-358-5412 Parker Adventist Hospital 9397 Crown Crest Boulevard Call: 303-269-4150 Text: 303-816-8648
“Our goal is to detect cancer as small as possible, as soon as possible. That’s the direct correlation to survival,” says Jennifer Hankinson, MD, breast radiologist at the Breast Care Center at Porter Adventist Hospital. “You want to catch it before you can feel it.”
Choosing a nurse practitioner provides patients with a holistic approach to care Approximately two-thirds of Americans have seen a nurse practitioner (NP) for primary care health needs. In fact, 80 percent of NPs are now specializing in primary care, compared with 14.5 percent of physicians entering primary care residencies. This is good news for patients who seek the holistic approach to primary care that NPs offer. But maybe you’re not entirely sure what an NP does. Or why you may want to choose one for your next appointment. Roanna Ayers, a family practice nurse practitioner at Centura Health Highlands, offers a primer.
What are NPs? A: Ayers says the most common misconception about NPs is that they are “just” nurses. “We are actually advanced practice nurses who diagnose, treat, and prescribe as a physician can,” she says. Requirements and training for an NP include: Master’s or doctoral degree program Advanced clinical training beyond registered nurse preparation National certification and peer review
Why see an NP? A: NPs place a unique emphasis on caring for the whole person, which means they focus on your health and lifestyle and how to help you prevent disease, rather than simply treating symptoms. “We help our patients make smarter health choices, which can help lower medical costs and help them live better, healthier lives,” Ayers says.
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NPs also bring the supportive approach to care they have cultivated as nurses. “Most of us have a background in one-on-one patient care. We end up becoming very personable providers who make connections with our patients and treat them, as well as uncover how we can best support them,” she says.
in your neighborhood The one-stop-shop approach to care at Centura Health Highlands offers family medicine, advanced imaging, orthopedic care, women’s services, and asthma and allergy management, all under one roof at 2490 West 26th Avenue, Suite A120, in Denver.
Nurse practitioner Roanna Ayers focuses on caring for the whole person.
A passionate care provider In describing her career path, Roanna Ayers, FNP, borrows a phrase that often links health care professionals. “I wanted to help people,” she says. She worked as a certified nursing assistant (CNA) while in college. “I thought the nurses were amazing, and so I changed paths to pursue a nursing degree,” she says. While working as a nurse from 2010 to 2015, Ayers realized she wanted the autonomy of having her own practice. “I packed up my ’96 Neon and headed for Regis University, which had an accelerated nurse practitioner program,” she says. “There’s just an amazing feeling you get when you’re doing something that makes you passionate.” Ayers has her own clinical practice at Centura Health Highlands, where she offers: • Primary care • Well-woman exams and Pap tests • Orders for imaging tests, such as colonoscopy and mammography • Joint and trigger point injections • Prescriptions
TO SCHEDULE AN APPOINTMENT with Roanna Ayers or other providers at Centura Health Highlands, call 303-925-4580.
porterhospital.org :: Fall 2016
Portercare Adventist Health System
Non-Profit Organization U.S. Postage
your access Centura Health Virtual Care, powered by MDLIVE, provides virtual access to Centura Health physicians, anytime, from any place.
Denver, CO Permit No. 4773
2525 South Downing Street Denver, CO 80210
Now, there’s an easy way to get care from a board-certified physician, whether it’s in the middle of the night, during the week, or over the weekend. MDLIVE will
Around the Community
RSVP required. Locations and times vary. Visit porterhospital.org/events or call 303-765-3825 for more information.
INS AND OUTS OF JOINT INJECTIONS connect you with a physician via phone or secure video to access care for common health ailments. Physicians are available 24/7 to diagnose, recommend treatment, and prescribe medication when appropriate. There’s no need to wait days for an appointment or to struggle with finding the nearest urgent care — just sign in and talk to a doctor via secure video or phone from your home, office, or on the go. If you have a primary care provider, you may ask MDLIVE to forward a summary of your visit to this provider to keep your provider informed and your medical records together.
TEA AND A TALK AT THE HOUSE OF COMMONS
Join the Breast Care Center for an afternoon of tea. We will have a brief talk about breast health and then enjoy a lovely afternoon tea at the House of Commons. Space is limited, and a reservation is required. Date: Sun, Oct 9 Time: 4-5:30 p.m. Location: House of Commons, 2401 15th Street, Denver, CO 80202
GENETICS OF BREAST HEALTH
Understand the impact of genetics and of aging on your breast health. Date: Wed, Oct 26 Time: 3-4 p.m. Location: Porter Place, 1001 East Yale Avenue, Denver, CO 80210
Go online and visit centura.org/virtual-care to download the MDLIVE app, or call 1-888-905-7502.
Dr. Steve Kitchen will answer your questions on overall joint health and when injections are a reasonable option. Date: Wed, Nov 2 Time: 2-3 p.m. L ocation: Ross-Cherry Creek Branch Library, 305 Milwaukee Street, Denver, CO 80206
R por egiste terh r osp online ital. org/ at eve nts
FIGHT COLDS AND FLU THIS SEASON!
Roanna Ayers, FNP, will give you the top tips to fight germs this cold and flu season. Date: Tue, Nov 15 Time: 6-7 p.m. L ocation: Centura Health Highlands, 2490 West 26th Avenue, Suite A120, Denver, CO 80211
9 TIPS TO PREVENT PROSTATE CANCER
Dr. Marklyn Jones will explain the best ways to avoid risks associated with prostate cancer. Date: Mon, Nov 7 Time: 2-3 p.m. L ocation: Clermont Park, 2479 South Clermont Street, Denver, CO 80222
MEDICATION AND YOUR KIDNEYS—WHAT’S THE IMPACT?
Join Dr. Phil Gauthier as he explains the potential impact of long-term use of various medications on your kidneys. Date: Tue, Nov 15 Time: 2-3 p.m. L ocation: Holly Creek, 5500 East Peakview Avenue, Centennial, CO 80121
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, 2016. PHOTOS FROM STOCK.ADOBE.COM: TEA ©GRESEI; TREE ©GSTUDIOGROUP; KNEE ©DENIX; FLU ©ALEXANDERRATHS
Porter Adventist Hospital is a regional medical center that provides care for complex health issues. We specialize in complex surgery, cardiovascular care, spine care, joint replacement, liver and kidney transplants, and cancer care. We are part of Centura Health, the region’s leading health care network. Vibrant is published quarterly by Porter Adventist Hospital – Portercare Adventist Health System. The purpose of this publication is to support our mission to improve the health of the residents in our community. No information in this publication is meant as a recommendation or to substitute for your physician’s advice. If you would like to comment or unsubscribe to this magazine, please email us at email@example.com. Vibrant is produced by Clementine Healthcare Marketing.
Published on Sep 13, 2016
Learn how early detection is the best weapon to beating prostate cancer, how proton pump inhibitors may increase risk of dementia, heart di...