Vibrant Winter 2014

Winter 2014 | Vol. 2, No. 1

new year, NEW STYLE

Your Connection to Healthy Living

Run down and out of breath?

Know when your symptoms spell heart trouble and what can be done.

Sherí Edwards, one of 7 million Americans who has atrial fibrillation, had her heart fixed at Porter Adventist Hospital.

Read her story on Page 4. 

INSIDE THIS ISSUE

2 3 6

 Don’t blame aging for your health woes  Breaking the silence about problems “down there”  3 things to know about finding a physician

under health reform porterhospitallorg :: Spring 2013

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PHOTO BY ELLEN JASKOL

Most negative health symptoms have an underlying cause So you or your husband (or both) have hit 50 or beyond, and you’re starting to feel the years. Less energy, not as happy as you used to be, or maybe you’re not as intimate as often as you once were. It’s just a fact of getting older, right?

Wrong, says Michael Metros, MD, a physician at Apollo Internal Medicine in Denver, which is part of the Centura Health Physician Group.

“Even people in their 50s and 60s blame symptoms on aging, but there’s always an underlying cause to those symptoms,” Metros says. “You can be in your 80s and 90s and still have an amazing quality of life.”

Metros recommends to first focus on the basics. Are you getting regular exercise, having good sleep habits, and eating a healthy diet that limits carbohydrates, processed food, corn syrup, and saturated fats?

“People forget to look at the simple things,” Metros says.

If you’re eating healthy and exercising, there are a number of common problems that could be causing symptoms such as fatigue, weight gain, soreness, lowered sex drive, and even cognitive decline. These include:

If you think sinus headaches are the ones you get when a winter cold hits, you’re right. But sinus headaches don’t only happen when you’re congested.

Sinus headaches often plague sufferers year-round, despite a variety of tests and treatments.

“I see patients who have gone years and years without a diagnosis,” says Ed Hepworth, MD, an otolaryngologist (ear, nose, and throat expert) and co-medical director of the Colorado Center for Craniofacial and Skull Base Disorders at Porter Adventist Hospital.

One in eight Americans suffers from sinus headaches each year, accounting for 12.6 million trips to a doctor’s office, according to the U.S. Centers Dr. Ed Hepworth for Disease Control and Prevention.

Often, these headaches are misdiagnosed as migraines or tension headaches.

“Migraines are overdiagnosed and overtreated,” Hepworth says. “In my experience, less than 10 percent of headaches with facial pain are migraines.”

The most common five or six sinus infections cannot be seen by looking inside the nose but instead require endoscopy or a CT or MRI scan, Hepworth says.

People also may be reluctant to seek out a doctor’s advice because they think it will be time-consuming and expensive.

But most problems can be sorted out in a couple of visits with some inexpensive lab tests, Metros says.

Sinus headaches are typically dull and achy headaches that don’t come and go. They are generally worse in the morning or after lying down. One type, called barosinusitis, comes on with changes in weather or altitude. And headaches can last even after the sinus problem is resolved. “The insulation around the nerves is eroded by infection, causing persistent pain after the infection is gone,” Hepworth says.

“Taking a good patient history during the first office visit quickly leads the physician down a decision tree, so it is usually not difficult to determine the cause of the symptoms,” he says.

Finding the right specialist – there’s an app for that!

> Sleep apnea > Diabetes > Low testosterone

> Depression > Hypothyroidism > Medications

Health or Hype?

Are probiotics really necessary or a waste of money?

Find out if the claims about probiotic dietary supplements are more fiction than fact at a FREE class on Tuesday, March 4. See back cover for details. 

VIBRANT :: Porter Adventist Hospital

Looking for a doctor who focuses on a specific field of medicine? Porter Adventist Hospital is home to some of the region’s top medical specialists, and now you can browse our directory of physicians on your smartphone or tablet with our FREE app. Go to porterhospital.org/doc-app.

PHOTOS: COUPLE ©ISTOCKPHOTO.COM/MEDIAPHOTOS; HAND TABLET ©ISTOCKPHOTO.COM/LIGHTMAX

AGINGgracefully

Sorting out sinus headaches

Let’s Talk

Two common health issues women rarely discuss — incontinence and prolapse — are also among the most treatable Women who suffer with pelvic floor disorders like urinary incontinence or prolapse certainly aren’t alone.

But it’s hard to determine how many actually do for one simple reason: Women don’t talk about it.

What’s worse, many don’t know that help is available through both nonsurgical and surgical options.

Let’s start the conversation with a look at the causes, testing, and treatments available for both.

TYPES:

PRIMARY CAUSES: DIAGNOSIS:

PHOTOS: BABY ©ISTOCKPHOTO.COM/LSOPHOTO; SMOKING ©ISTOCKPHOTO.COM/EWG3D; MASK ©ISTOCKPHOTO.COM/DESIGN56; WOMEN ©ISTOCKPHOTO.COM/DIGITALSKILLET

NONSURGICAL TREATMENTS:

SURGICAL TREATMENTS:

PHOTO BY MICHAEL RICHMOND

“The estimate is that as many as 40 to 50 percent of women suffer from both. But it’s very hard to ascertain how common they are because women are uncomfortable discussing it and don’t seek out treatment,” says Mandi Beman, MD, a gynecologist at Aracea Women’s Care in Cherry Creek.

Dr. Mandi Beman

INCONTINENCE

PROLAPSE

Stress: occurs when you cough, sneeze, laugh, or lift something heavy Urge: bladder muscles contracting involuntarily, causing urine to leak Mixed: a combination of stress and urge incontinence

When pelvic muscles and tissues are stretched or weakened, the bladder (most common), uterus, or rectum can sag through them and into the vagina

Childbearing is the biggest factor, followed by obesity and age

Childbearing and obesity

Stress incontinence: patient history and physical exam, where you cough or sneeze with a full bladder Urge incontinence: patient history and physical exam Urodynamics testing: uses a variety of methods to measure how long and how much urine can be held

Pelvic exam, where you bear down and push

 Weight loss  Kegel exercises to strengthen pelvic floor muscles  Stopping smoking  Cutting out dietary bladder irritants, including alcohol, caffeine, and highly acidic foods like citrus juices and tomatoes  Bladder training — going to the bathroom every two hours so that if you do cough or sneeze it’s not with a full bladder  Medications (for urge incontinence; there are none available for stress incontinence)

 Weight loss  Kegel exercises to strengthen pelvic floor muscles  Stopping smoking  Eating a fiber-rich diet to prevent straining and constipation  Pessary — a device worn in your vagina that can support a prolapsed uterus, vagina, bladder, or rectum

Minimally invasive outpatient surgery; takes about 20 minutes and is about 85 percent effective

Minimally invasive vaginal surgeries; may require no incisions and can be up to 97 percent effective

“A bladder sling is placed underneath the urethra, and when it heals it supports the urethra so that when you cough and sneeze it has a backstop to close against,” Beman says.

Women in the know Learn more about pelvic floor disorders and available treatments at araceawomenscare.org.

“The success rate really depends on a variety of factors, including what has prolapsed? Was it the uterus? The bladder?

That makes a difference,” Beman says.

4 WAYS

to support your pelvic floor:

1. Keep your weight in check.

2. Eat a healthy, fiber-rich diet.

3. Don’t smoke.

4. Do your Kegel exercises. porterhospital.org :: Winter 2014

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Be still

my beating Denver mom, hairstylist, business owner finds cure for condition that forced her heart to beat 200 beats per minute Looking back, Sherí Edwards thinks she probably had her heart condition for years. But it wasn’t until November of 2012 that her symptoms were severe enough to get her attention.

“I landed in the Porter (Adventist Hospital) ER because my heart rate was up to 200” beats per minute, says Edwards, now 47. “I had waited a while because I thought it was anxiety or hypoglycemia. Now I look back and think I had it for years and didn’t know it. I wouldn’t eat enough, I couldn’t breathe, and I felt weak. Turns out it was a-fib.”

Leading cause of stroke

Atrial fibrillation, or a-fib, is a condition in which the pulmonary veins, which carry oxygenated blood from the lungs into the heart, beat extremely fast, causing the heart to beat fast. It’s estimated that 7 million Americans have this condition. People with a-fib are five to seven times more likely to have a stroke. In fact, a-fib is the leading cause of stroke.

The tricky part about a-fib, however, is that many people do not experience any symptoms. Or, like Edwards, they chalk up their feelings of fatigue and weakness to something else.

“Unfortunately, the most common symptoms of a-fib are no symptoms at all,” says Sri Sundaram, MD, a cardiologist at South Denver Cardiology who specializes in heart pacing issues.

NORMAL

Left atrium Sinoatrial node (pacemaker) Right atrium Atrioventricular node

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Porter Adventist Hospital testing new technology to treat atrial fibrillation Porter Adventist Hospital is one of just a dozen sites in the nation testing new technology that may help improve the success of ablations in curing atrial fibrillation, or a-fib.

During an ablation, an electrophysiologist (a cardiologist who specializes in heart pacing) directs a small, flexible tube (called a catheter) with a laser on the tip into the left atrium of the heart. Once there, the doctor must push up against the wall of the heart with the laser to burn it so that it will form scar tissue that blocks the erratic signals from getting into the heart.

ILLUSTRATION: HEART ©123RF.COM/ALILA

VIBRANT :: Porter Adventist Hospital

PHOTO BY ELLEN JASKOL

Porter Adventist Hospital is part of the Centura Heart Network, the region’s leading provider of cardiovascular care.

Sundaram began treating Edwards’ a-fib with antiarrythmic medications, the first line of treatment for the condition. But these drugs work in only 30 to 60 percent of patients.

When medications are not effective, Sundaram recommends a minimally invasive procedure called an ablation that blocks the signals from the pulmonary veins. To do this, the physician sends a tiny tube through the artery in the groin up into the left atrium of the heart. He then uses a laser to form scar tissue on the wall of the heart to prevent the rapid signals from getting to the heart.

“The scar tissue acts like a water dam to create a barrier that the a-fib can’t cross,” explains Sundaram, who performs more than 100 ablations annually at Porter Adventist Hospital.

Sherí Edwards is back at work and play after an ablation at Porter Adventist Hospital.

Once inside Edwards’ heart, Sundaram saw quickly the reason why medications were ineffective. Her pulmonary veins were beating 450 beat per minute. “That’s the fastest I’ve ever seen.

The cardiologist, however, has no way of telling how hard he is pushing. “If you push too hard, you can poke a hole and damage the heart, so we err on the side of not pushing hard enough, which makes it more likely to get a recurrence of a-fib,” explains Sri Sundaram, MD, an electrophysiologist at South Denver Cardiology. Currently, about 70 percent of ablations are successful on the first try.

The new technology being tested at Porter Adventist Hospital senses the force the doctor is using and signals whether that is too much or too little. The hope is that this feedback will increase the success rate of ablations.

It was a very difficult ablation. When the heart is beating that fast, you worry about really bad things happening.”

A surgical cure

Ablation cures the problem in about 70 percent of patients, and new research shows that it extends a patient’s life as much as seven years. Plus it eliminates the need — and cost — of medications.

Edwards has had only three short recurrences of a-fib in the year following her ablation.

“After I had the attack in November (which landed Edwards in the ER), I pretty much stayed in a-fib all the time. I would go to work then stay in bed the rest of the time. I couldn’t breathe; I couldn’t move. It was definitely not a life, that’s for sure,” says Edwards, who is a hairstylist, owner of a health and wellness company, wife, and mom.

“I’m a thousand times better. Now I work out really hard; I have a life again. I can’t say enough good about Dr. Sundaram, and Porter (Adventist) Hospital was great.”

Are you at risk?

Take this quiz to see if you might be at risk for developing atrial fibr illation, and then discuss the results with your doctor. If you are experiencing any sympto ms of heart problems, call your doctor right aw ay.

Are you over the age of 60?

(Age is the No. 1 cause of atrial fibrillation.)

Do you have any of the following: Uncontrolled high blood pressure Heart valve problems Coronary artery disease Sleep apnea Thyroid disorder Are you obese?

Do you have more tha n 12 alcoholic drinks per week (wom en) or 15 drinks per week (m en)?

Do you experience an y of the following: Fatigue or exercise into lerance Light-headedness or diz ziness Chest pain Heart flutters or palpitatio ns

Hearts A-flutter Join Dr. Sundaram for a FREE community seminar on Feb. 25 to learn more about how the heart generates electricity and what happens when it goes awry. He’ll talk about the signs and symptoms of common heart pacing problems, including how to treat hearts that beat too slow and hearts that beat too fast. Bring your questions for the Q&A session!

Date: Tuesday, Feb. 25 Time: 6-7 p.m.

Location: P orter Adventist Hospital Conference Center Cost: FREE Registration: 303-777-6877

See back cover for more FREE classes, including a special Valentine’s class with The Cooking Cardiologist on the health benefits of chocolate.

porterhospital.org :: Summer porterhospital.org :: Winter 2013 2014

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3 questions to consider when choosing your family physician

A primary care physician, PCP, commonly falls under one of three specialties: a family physician (treating patients of all ages), a pediatrician (specializing in children from birth to adolescence), or a general internist (for patients 18 and over).

Sometimes women also use gynecologists as their PCP. “Your primary care doctor should be your home for medical care,” explains Marija Dubrick, MD, a family physician at Porter Primary Care, a member of the Centura Health Physician Group.

With the evolution of technology and the advent of the Affordable Care Act, choosing your family doctor shouldn’t be just a matter of who is in the neighborhood or who is on your health plan (although those are important). Adding these three questions to your selection process can make the job easier:

Does the doctor use an electronic medical record (EMR)?

Is your doctor part of a medical home?

How long is the initial visit for a new patient?

An EMR is a digital file of a patient’s medical history. Not only does this improve quality and convenience of patient care but because all doctors involved in the patient’s care can access the patient’s medical record, it allows for better diagnosis, treatment, and coordination of care.

A patient-centered medical home, PCMH, is a new model of health care, promoted through the Affordable Care Act. In this model, your PCP becomes the quarterback, taking the lead in providing preventive and primary care that keeps you healthy while also coordinating specialty care when needed. The goals are to improve health status, improve quality of health care services provided, and reduce costs.

You’re not looking to save time when it comes to you and your family’s health. Check with the doctor’s office to make sure that the doctor plans to spend at least 30 minutes with you on your initial visit to obtain a complete health history.

Looking for a primary care physician?

Join us for an open house on Wednesday, March 12, from 4-7 p.m. at Porter Primary Care at Cherry Creek, 300 S. Jackson St., Suite 340. Meet the doctors from Porter Primary Care and Aracea Women’s Care and enjoy FREE refreshments and appetizers.

FREE parking is available across the street from the office.

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VIBRANT :: Porter Adventist Hospital

The Centura Health Physician Group has doctors in your neighborhood whose offices can serve as medical homes, helping to ensure patients get the most appropriate and costeffective health care.

Aracea Womens Care Specializing in Womens Care Mandi Beman, MD 300 S. Jackson St., Suite 320 Denver, CO 80209 303-316-6677 araceawomenscare.org Clermont Park Specializing in Senior Care Barbara Morris, MD 2479 S. Clermont St. Denver, CO 80222 303-649-3155 Mountain View Family Physicians Specializing in Family Medicine Arlis Adolf, MD Anna Wegleitner, MD 2020 S. Oneida St., Suite 100 Denver, CO 80224 303-759-4800 mountainviewfamilyphysicians.org Porter Primary Care at Cherry Creek Specializing in Family Medicine Marija Dubrick, MD Lisa Rothgery, MD 300 S. Jackson St., Suite 340 Denver, CO 80209 303-316-0416 porterprimarycare.org Porter Primary Care at Harvard Park Specializing in Family Medicine Locke Keney, MD Pragati Pandey, MD Stacia Sams, MD 950 E. Harvard Ave., Suite 660 Denver, CO 80210 303-649-3200 porterprimarycare.org PHOTO: FAMILY ©ISTOCKPHOTO.COM/MEDIAPHOTOS

The ABCs of finding a PCP

Find a Doctor

BUILDING A BETTER KNEE

Step out of joint pain

Porter Adventist Hospital joint researchers study knee motion to help develop better artificial joints Most people think of the knee as a fairly simple joint. But in reality, the knee is complex and gets its ability to move through its unique shape and ligament attachments, says Raymond Kim, MD, an orthopedic joint replacement surgeon and researcher at Colorado Joint Replacement.

“It’s not a simple hinge,” Kim explains. “There are many subtle motions that are involved, so it’s difficult for an artificial joint to re-create the same movement, especially because the ACL has been removed.”

Kim is leading research that uses special X-ray technology to image the knee joint as it moves. The machine, called bi-planar fluoroscopy, was built at the University of Denver, Colorado Joint Replacement’s partner in this research. By studying how the knee moves, Kim’s hope is that a new type of artificial knee joint that optimizes real-life movement can be designed.

“This could change the face of implant design,” he says. “Right now, lots of surgeons are performing custom-fit joint replacements. Those customize the fit of the implant on the patient’s bones, but what’s more critical is the way it behaves in the midst of its soft tissue envelope.”

Learn more about how the knee works, how to protect it throughout your life, and tips to ease JAN joint pain at a 23 FREE community seminar on Jan. 23.

See back cover for details. 

Dr. Raymond Kim performs more than 500 joint replacements annually at Porter Adventist Hospital (most orthopedic surgeons average less than 25 each year). He also has served with medical missions in Panama, Ethiopia, Kenya, and North Korea.

Change of Direction

PHOTO BY MICHAEL RICHMOND

Name: Raymond Kim, MD

Specialty: Hip and knee joint replacement

Practice: Colorado Joint Replacement

To make an appointment with Dr. Kim, call 720-524-1367 or go online to coloradojoint.org.

Location: 2535 S. Downing St., Suite 100 (adjoining Porter Adventist Hospital)

Colorado Joint Replacement is operated by the Centura Health Physician Group.

porterhospital.org :: Winter 2014

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PHOTO BY MICHAEL RICHMOND

When God shuts one door, he opens another.

Raymond Kim, MD, is living proof of that aphorism. After graduating from Johns Hopkins University with bachelor’s degrees in electrical engineering and biomedical engineering, he couldn’t find a job. While he looked, he took a job as a high school teacher.

“It was actually one of the most rewarding jobs I’ve ever had,” Kim says. “But I made only about $10,000 that year … it wasn’t really a sustainable occupation to support a family.”

So he and his wife, Melissa (who also attended Johns Hopkins), decided they would both go to medical school. They returned to her home state and attended Marshall University School of Medicine in West Virginia. The original plan was that Melissa would go on to train in general surgery while Kim stayed at home with their first child.

But when their daughter was born 12 weeks premature weighing only 2 pounds, the tables turned and Kim was off to a residency.

“I went on to pursue an orthopedic surgery residency,” says Kim, who now specializes in hip and knee replacement surgery at Colorado Joint Replacement. “It’s very engineering-related, so it was something close to my heart — and hands.”

After five years of residency at the Mayo Clinic in Rochester, Minn., Kim moved to New York, N.Y., where he completed a fellowship in joint reconstruction at the Insall Scott Kelly® Institute for Orthopaedics and Sports Medicine. In 2012, Kim was awarded the prestigious John Insall Award for research on total knee replacements and was named one of the top 26 knee surgeons in the U.S. by Orthopedics This Week.

Portercare Adventist Health System Porter Adventist Hospital is a regional medical center that provides care for complex health issues. We specialize in general and robotic surgery, cardiovascular care, spine care, joint replacement, liver and kidney transplants, and cancer care. We are part of Centura Health, the state’s largest health care network. Vibrant is published quarterly by Porter Adventist Hospital.

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 to substitute for your physician’s advice. If you would like to comment or unsubscribe to this magazine, please email us at vibrant@centura.org.

2525 South Downing Street Denver, CO 80210 303-778-1955

Non-Profit Organization U.S. Postage

PAID

Denver, CO Permit No. 4773

2525 South Downing Street Denver, CO 80210

Porter Adventist Hospital is part of Centura Health, the region’s leading health care network.

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, 2014.

Re porte gister onli ne at rhosp ital.o rg/ev ents

Upcoming Events

Join the health experts at Porter Adventist Hospital to learn ways to stay healthy as well as new treatments for health problems.

All programs are FREE and are held in the Porter Adventist Hospital Conference Center unless otherwise indicated. For programs held in the Porter Adventist Hospital Conference Center, free valet parking at the hospital’s main entrance or plentiful free parking in the Porter Adventist Hospital parking garage is available. Registration is required for all events; register online at porterhospital.org/events or call 303-777-6877.

HEALTH OR HYPE: SUPERFOODS

A PATIENT PREPARES: TALKING TO YOUR DOCTOR

STAYING MOTIVATED: WHOLE-PERSON WELLNESS

Oncology nutrition specialist Amber Thomas explains the benefits of superfoods.  DATE: Tue, Jan 14  TIME: 6-7 p.m.

Learn to make the most of your doctor visit.  DATE: Tue, Feb 4  TIME: 1-2 p.m.  LOCATION: Clermont Park, 2479 S. Clermont St.

Explore the mental, physical, and spiritual aspects of whole-person wellness.  DATE: Thu, Mar 6  TIME: 6-7 p.m.

PHOTOS: CHOCOLATE ©ISTOCKPHOTO.COM/PLAINVIEW; STRETCH ©ISTOCKPHOTO.COM/PAFE; MASSAGE ©ISTOCKPHOTO.COM/SIMSPIX

STEP OUT OF JOINT PAIN Dr. Charlie Yang will discuss what you need to know about joint pain and replacement.  DATE: Thu, Jan 23  TIME: 6-7 p.m.

BLOOD SUGAR BLUNDERS Grocery walk and talk to learn wise food choices to prevent and control diabetes.  DATE: Tue, Jan 28  TIME: 2-3 p.m. L OCATION: University Hills King Soopers, 2750 S. Colorado Blvd.

STAYING MOTIVATED: RESOLUTIONS Tips on how to create and keep a resolution while avoiding personal and physical land mines.  DATE: Thu, Jan 30  TIME: 6-7 p.m.

STAYING MOTIVATED: COUCH TO 5K Keep your resolution going and learn what it takes to walk or run a 5K.  DATE: Tue, Feb 4  TIME: 6-7 p.m.

HEALTH OR HYPE: CHOCOLATE! Cooking Cardiologist Dr. Richard Collins gives you the tasty tidbits on the benefits of chocolate.  DATE: Tue, Feb 18  TIME: 6-7 p.m.

HEART FLUTTERS OR A-FIB? Dr. Sri Sundaram covers the impact of a-fib and its connection to stroke.  DATE: Tue, Feb 25  TIME: 6-7 p.m.

HEALTHY BACK, HEALTHY BODY Dr. Jonathan Clapp reviews the importance of spine care and speaking up about symptoms.  DATE: Thu, Feb 27  TIME: 11 a.m.-noon  L OCATION: Porter Place, 1001 E. Yale Ave.

HEALTH OR HYPE: PROBIOTICS Discuss the pros and cons of probiotics with Dr. Hanna Kraus.  DATE: Tue, Mar 4  TIME: 6-7 p.m.

BREAST HEALTH: WHAT YOU NEED TO KNOW Learn preventive self-care to reduce your risk of breast cancer.  DATE: Tue, Mar 18  TIME: 6-7 p.m.

MORE THAN A MIGRAINE It’s not just in your mind. Dr. Justin Moon discusses the cause and effect of migraines.  DATE: Thu, Mar 20  TIME: 6-7 p.m.

Monday Mammograms and Massages

Get your screening mammogram and massage. Referrals not needed if you are over 40. Please check with your insurance to be sure you are covered at Porter Breast Center.

DATE: Mons, Jan 27, Feb 24, Mar 31 TIME: 3-7 p.m.

LOCATION: Porter Breast Center, 2555 S. Downing St., Suite 140 COST: Massages are FREE, and mammograms will be billed to your insurance.

REGISTRATION: W alk-ins welcome, or call 303-778-5815, option 2, to schedule, or text your name to 303-872-7469 and we’ll call you.