elevate summer 2015

SUMMER 2015 | VOLUME 3, ISSUE 3

Living at the height of wellness

CANCER WARNINGS FOR WOMENPage 6

SURGICAL MESH MYTHSPage 7

FIRST TRIMESTER TIPSPage 8

HERNIATED DISC HELP0

SUNSMARTSFour ways to protect your skin from aging and skin cancer Story on page Page 4

ELEVATE is published four times annually by Castle Rock Adventist Hospital — Portercare Adventist Health System. As part of Centura Health, our mission is to nurture the health of the people in our community. The information herein is meant to complement and not replace advice provided by a licensed health care professional. For comments or to unsubscribe to this publication, please email us at [email protected]. ELEVATE is produced by Clementine Health Marketing. Executive editor is Christine Alexander.

2350 MEADOWS BOULEVARD | CASTLE ROCK, CO 80109

Summer 2015ELEVATE 2

Besides being good for your body, exercise can improve your mind by helping you think more clearly and boosting your mood. So it should come as no surprise that activity is one of the key tenets guiding the CREATION Health lifestyle, a scientifically proven approach upon which Castle Rock Adventist Hospital’s wellness programs are based.

Conversely, a lack of activity in our modern lives has proven to be detrimental to our well-being. “Research has shown that the more you sit, the more hazardous it is for your health,” says Jason Chu, MD, a primary care physician at Ridgeline Family Medicine at Castle Pines. “We all have time constraints, but with so much more daylight during the summer months, it’s easier to fit in a few minutes of activity before and after work or at lunch. You will also find that even small amounts of exercise can increase your productivity the rest of the day.” If you’re not an avid exerciser, it may be time to let go of the excuses that could be keeping you from reaching your fitness goals. Here are some facts to get you motivated.

WARM UP TO STRETCHINGFor years, we were told that

stretching before a workout was critical to prevent injury, but recent

research has proven otherwise. If you want to stretch out, warm up with a

brisk walk or jog first.

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STOP THE SIT-UPS It’s official: You can stop wasting

time on crunches. Recent research shows that moves that work more

of your core, such as planks, deliver bigger results in shorter time than isolation exercises. A 2013 study found that exercises that engage

your distal trunk muscles — those in your shoulders and your behind — are more effective at working your core, which in turn enhances your

stability and strength, increases your endurance, and can even reduce

your risk for injury.

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10 MINUTES AT A TIMELong workouts aren’t always

necessary to achieve positive results. A 2012 Arizona State University

study found that people with early signs of high blood pressure were able to lower it by splitting their

routine into three 10-minute bursts versus a single 30-minute walk.

RUN AWAY FROM PAINRunning has a bad rap for being

tough on your knees, but is that the full story? Maybe not. Recent large-scale research has found that running can significantly reduce your risk for osteoarthritis and hip replacement. Why? Because running is linked to a lower body mass index, and less weight equals less stress on your joints. No more excuses, it’s time

to lace up!

ACTIVEFOR (a better)LIFE

To make an appointment with Dr. Chu, call Ridgeline Family Medicine at 303-649-3350.

Learn more about the CREATION Health lifestyle at Castle Rock Adventist Hospital at castlerockhospital.org/creation-health.

Dr. Jason Chu

Michelle Traver, PA-C, is a certified physician assistant at Ridgeline Family Medicine at Castle Pines. She is passionate about preventive care and helping patients achieve optimal wellness.

A Colorado native, Traver enjoys spending her free time running, skiing, or watching the Broncos with her husband and two young children.

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ELEVATE3Summer 2015

Kid athletes

CONCUSSIONS Wear a helmet, get a medical evaluation if there’s a chance of concussion, and don’t return to play without clearance

SPRAINS AND STRAINS Warm up properly, wear appropriate gear (including supportive shoes), and cross train to build surrounding muscles

OVERUSE INJURIES See “Overdoing It” at right

PREVENTIONINJURY

PREPARE YOUR CHILD FOR AN INJURY-FREE SEASON Nearly 75 percent of American children participate in organized sports. And more than 2.6 million of them get hurt each year, according to the Centers for Disease Control and Prevention. Annual sports physicals assess the ability of the athlete’s body to meet the demands of a sport. Sports physicals are good for one year, so no matter what season your child plays, summer is a great opportunity to get this out of the way.

OVERDOING IT Overuse injuries account for nearly half of all sports injuries among children under the age of 15, according to Until It Hurts: America’s Obsession with Youth Sports and How It Harms Our Kids. Michelle Traver, a certified physician assistant at Ridgeline Family Medicine at Castle Pines, talks about ways to help your child avoid these common sports injuries. “Overuse injuries start gradually, with pain for 10 to 20 minutes after participating in the activity, and then develop into more consistent, chronic pain,” she says. Keep your child off the sidelines with these 1-2-3 tips: • Play on only one team

per season. • Take one to two days

off per week.• Take two to three

months off from each sport every year (it’s OK and even recommended to participate in a different activity during this off time).

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Just over

21 MILLION youth between the ages of

6 and17 play team sports on a regular basis

FAST FACT

Ridgeline Family Medicine has two Castle Rock offices and is currently accepting new patients,

including Medicare patients.

The Meadows720-455-3750

Castle Pines303-649-3350

To make an appointment or learn more, go to ridgelinefamilymedicine.org.

castlerockhospital.org

Michelle Traver

GETTING PHYSICAL


Skin SENSE WITH AGE COMES WISDOM. BUT UNFORTUNATELY, IT ALSO BRINGS UNWELCOME SIDE EFFECTS FOR OUR SKIN. WHILE YOU CAN’T TURN BACK THE CLOCK, YOU CAN SLOW THE EFFECTS OF TIME AND REDUCE YOUR RISK FOR SKIN CANCER IN THE PROCESS. WE SPOKE WITH BOARD-CERTIFIED DERMATOLOGISTS RICHARD G. ASARCH, MD, FAAD, AND ADAM ASARCH, MD, FAAD, WHO RECENTLY OPENED A NEW CLINIC IN CASTLE ROCK, ABOUT FOUR ESSENTIAL THINGS TO ADDRESS WHEN IT COMES TO CARING FOR YOUR SKIN.

ANTI-AGING STRATEGIES TO FIGHT CANCER, WRINKLES, AND BEYOND

TOPICAL SKIN CARE “Topical agents now available can help minimize and, even in some cases, reverse some sun damage,” Dr. Richard Asarch says. “There are surface products to help minimize discoloration and dryness, which is especially problematic in Colorado, as well as agents we use to help the cells in the top layer of skin regenerate and repair itself, and build new collagen.” But because of the way some products are labeled, it’s hard to know exactly what ingredients they contain, and in what amounts. Asarch’s frustration with this dilemma led him to develop his own skin care line, DermaSpaRX. He believes that because each person’s skin is unique, his or her topical skin care should be as well, and recommends working with a dermatologist to find the right balance based on that person’s specific needs.

Dr. Richard Asarch (right) and his son, Dr. Adam Asarch, help Castle Rock residents safely enjoy the mountain sun.

castlerockhospital.org ELEVATE5Summer 2015

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Castle Rock Adventist Hospital is part of the Centura Health Cancer

Network, delivering integrated, advanced cancer care across Colorado and western Kansas.

DID YOU KNOW THAT IF YOU LIVE IN CASTLE ROCK,

YOUR SUN EXPOSURE RISK IS ABOUT

5% HIGHER THAN THAT OF MILE HIGH CITY RESIDENTS, AS CASTLE ROCK SOARS NEARLY 1,000 FEET

ABOVE DENVER?

With our active outdoor lifestyle, plentiful sunshine, and high elevation, skin cancer in Colorado is 15 percent

higher than the national average.

Richard Asarch, MD, introduced Mohs surgery, used for removing skin cancer, to the state of Colorado in 1977, after studying the technique with its inventor, Dr. Frederic Mohs. In the past three decades, he has performed more than 35,000 procedures. Today, he and his son, Dr. Adam Asarch, both perform the surgery, which has come to be recognized as the most effective technique for removing the two most common skin cancers: basal and squamous cell carcinomas.

What’s involved: The procedure removes one thin layer of tissue, which is mapped, color coded, processed, and then examined using a microscope to determine if the margins are free of cancer cells. If no cancer is found, the procedure is complete. If cancer is present, the procedure is repeated until all the margins studied are clear of cancer.

Why it’s so effective: Mohs provides the best therapeutic and cosmetic results, sparing the largest amount of healthy tissue possible while also obliterating cancer cells and removing guesswork. Cure rates are 98 percent, markedly above rates for other accepted procedures.

THE MIRACLE OF MOHS FOR SKIN CANCER REMOVAL

The father-and-son team of Drs. Richard and Adam Asarch recently opened a new clinic in the Alexander Building on the campus of Castle

Rock Adventist Hospital. The Alexander Building houses more than 29 physician practices and specialty health clinics. Learn more at

togetheratcastlerock.com/tenants.

PREVENTIONAs a Colorado resident, you know high altitude can affect your ability to catch your breath. But it also increases the incidence of skin cancer. For every 1,000 feet of elevation, your UV radiation exposure increases about 5 percent. Protect yourself against the sun’s UVA and UVB rays with a sunblock containing an SPF of at least 30, not just when you’re out hiking or skiing, but every day. Why SPF 30? “Studies show people don’t apply adequate amounts, so using a higher-number SPF helps compensate,” says Asarch, who received the 2015 Humanitarian Award from the Melanoma Foundation for his lifetime of work in preventing skin cancer. He recommends using a sunscreen that contains both physical blockers, like zinc or titanium, and chemical ingredients that absorb the sun’s rays, such as avobenzone. “Use a facial moisturizer with sunscreen in it for daily protection, and if you’re going to be outdoors for a longer period of time, switch to the regular sunscreen and reapply every two to three hours,” says Dr. Adam Asarch. In addition, annual skin checks with your dermatologist can help find and diagnose cancer at its earliest stages, which makes treatment easier and more successful.

DIET What you put inside your body eventually shows up on the outside. Studies have shown that sugar can be particularly damaging to your skin, causing inflammation as well as creating wrinkles and sagging. On the flip side, higher intakes of vitamin C and linoleic acid and lower intakes of fats and carbohydrates can improve skin’s appearance. But don’t shun all fats. Healthy fats, like the omega-3 fatty acids found in fish oil, are good for your skin. “Fish oil plays an important role in healing the inflammation that occurs in our skin,” Asarch says. “I do advocate people taking a fish oil supplement, but it’s important that what you get is pure and without other ingredients that might not be beneficial.” He also recommends eating brightly colored fruits and vegetables, and limiting refined carbohydrates.

PROCEDURES There are plenty of surgical and nonsurgical options designed to help with the results of aging skin — everything from loose skin to fine lines and wrinkles and more. And today’s procedures work much quicker than in the past. “What’s happened over the years is that people don’t want a procedure where they have to go hide,” Asarch says. One example is micro-channeling, also called micro-needling. During this procedure, the physician uses a device that doesn’t go deep enough to cause bleeding or pain to infuse ingredients into the skin that help reduce lines and wrinkles and get rid of unwanted pigmentation and discoloration.

Gynecologic cancers, including ovarian and uterine, are relatively rare, accounting for less than 3 percent of cancers in women. Still, more than 71,500 women will be diagnosed this year with gynecologic cancers, according to the Centers for Disease

Control and Prevention. Survival rates are very high if the cancer is caught early, says Glenn Bigsby, DO, a gynecologic oncologist at Littleton Adventist Hospital and Parker Adventist Hospital who treats patients from throughout the region, including Castle Rock. “If detected early, at Stage 1, the five-year survival rate is very high for most types,” says Bigsby, one of just 1,200 physicians nationwide who specialize in the diagnosis and treatment of these cancers. The most critical factor is that women pay attention to their bodies and report any changes to their doctor early, he says. Symptoms include abnormal vaginal bleeding (especially after menopause), pelvic pain or pressure, abdominal or back pain, bloating, itching or burning, and changes in bowel movements.

OVARIAN CANCER

Next to lung cancer, ovarian cancer is one of the deadliest cancers that can strike women. That’s mostly because there is no screening test that can help diagnose it at an early stage, making it all that much more important to pay attention to symptoms, Bigsby says. Cure rates are 70 to 90 percent if the cancer is found while still confined to the ovary, according to the American Cancer Society. If it’s not cancer, it could be something else that can be treated. Conditions such as endometriosis, fibroids, and even irritable bowel syndrome can cause the same symptoms. And if a pelvic mass is found, there are now two blood protein tests that can help rule out cancer without having to undergo surgery.

ENDOMETRIAL CANCER

The most common type of gynecologic cancer is uterine cancer that occurs in the lining, or endometrium, of the uterus. Endometrial cancer is increasing along with obesity rates, Bigsby says. Fat tissue creates estrogen, which stimulates the lining of the uterus and spurs the development of cancer, he explains. About 80 percent of endometrial cancers can be cured with a hysterectomy, but they must be diagnosed early before spreading. The most common symptom is abnormal bleeding.


Castle Rock Adventist Hospital’s advanced robotic surgery program is supported by Centura Centers for Clinical Innovation, extending advanced health technologies across Colorado and western Kansas.

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WARNING SIGNS There is no screening test to

help catch ovarian cancer early. But three questions can help determine if a woman should be tested for ovarian cancer,

according to a study published in the Open Journal of Obstetrics

and Gynecology.

DO YOU HAVE ABDOMINAL AND/OR

PELVIC PAIN?

DO YOU FEEL FULL QUICKLY, AND/OR ARE

YOU UNABLE TO EAT NORMALLY?

HAVE YOU EXPERIENCED ABDOMINAL BLOATING

AND/OR INCREASED ABDOMEN SIZE?

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CancerOvarian

DetectingIT STARTS OFF SMALL — SOME SPOTTING, A BLOATED BELLY, MAYBE SOME PELVIC

PAIN, OR JUST PRESSURE.

CHANCES ARE IT’S NOTHING. BUT YOU DON’T KNOW THAT.

THESE COULD BE THE WARNING SIGNS OF A GYNECOLOGIC CANCER,

SO PAY HEED.

Gynecologic conditions, including cancer, are being

more effectively treated through robotic-assisted

surgery. Using the advanced da Vinci® robot, gynecologic

oncologist Glenn Bigsby, MD, can remove even the tiniest cancerous lesions

and tumors without injuring organs, arteries, or healthy tissue. Learn more about gynecologic cancers and

robotic surgery, or make an appointment with Dr. Bigsby by calling 303-955-7574.

Dr. Glenn Bigsby

ELEVATE7castlerockhospital.org

QUESTIONS WORTH ASKINGIf you’re considering hernia surgery with mesh, ask your surgeon:

1. What is your experience with the mesh you’re using? 2. How many times have you used it? 3. How long has it been on the market? 4. Have there been problems with this type of mesh?

5. What are the pros and cons of using mesh in my particular case? 6. Can I get a copy of patient information, including any warnings?7. What can I expect regarding postoperative pain and recovery time?

BUSTING THE MYTHS ABOUT MESH

Summer 2015

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When some patients hear that mesh will be used in their hernia surgeries, they may not know what this is or they may be concerned. During most hernia surgeries, mesh — a flexible, sterile, woven material — is placed over or under the hernia to support the repair and act as a “scaffolding” to allow your own tissue to grow into place. Most mesh products used for hernia surgery are extremely safe and provide excellent results. Here, David Lundy, MD, a minimally invasive general surgeon at Castle Rock Adventist Hospital, addresses three myths.

MYTH 1: MESH IS UNSAFE.

As with any type of surgical method, the FDA has received reports of complications using mesh for hernia repair. But most of the complications reported were associated with products that are no longer on the market. “We’ve made great advances in the materials we use,” Lundy says. “They cause less inflammation, and we now use meshes that are coated with a special material that inhibits things adhering to the mesh, which has led to fewer complications.” It’s also important to note the distinction between mesh for hernia and for other types of surgeries. “The use of mesh for hernia repair is different than for pelvic surgery, and women should talk to their gynecologist about that kind of mesh,” Lundy says.

WE SEPARATE FACT FROM FICTION WHEN IT COMES TO THE USE OF MESH IN HERNIA SURGERY

Dr. David Lundy1?

23MYTH 2: LIGHTWEIGHT MESH IS ALWAYS BETTER THAN HEAVIER MESH.

The lighter the mesh, the less pain after surgery, and the easier it is for the surgeon to use. But that’s not the only factor in choosing the right mesh. “Patients tend to do well — to a certain point. But the trade-off is that if the mesh is too lightweight, the recurrence rate (of the hernia coming back) goes up,” he says.

MYTH 3: HERNIAS ARE MORE LIKELY TO RECUR AFTER MESH SURGERY.

The case for using mesh in hernia repair is strong, especially for the two most common types of hernias: ventral hernias in the abdominal wall, and inguinal hernias in the inner groin. Data from several studies shows that the rates of hernias recurring after mesh repair are approximately 2.5 percent for ventral hernias, compared with almost 8 percent without it. Data also shows mesh is equally effective at preventing recurrence of inguinal hernias. “Using mesh for groin hernias reduces the risk of recurrence by 50 to 70 percent,” Lundy says. Mesh also results in less postoperative pain and a quicker return to function. “When you’re closing a hernia without

mesh, you’re having to do a lot more work, rearranging tissues and creating more tension,” Lundy explains. Mesh does, however, have a slightly higher infection rate. “The rate was statistically significant but less than a percentage point different than without it, so most surgeons feel that the benefit you get in reducing recurrence is more important,” Lundy says.

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Dr. Lundy’s office is located in the Alexander Building at Castle Rock Adventist Hospital. For a list of practices in the Alexander Building, go to

togetheratcastlerock.com/tenants.


The plus sign is unmistakable — as is the confusion that may follow. The first trimester is critical for giving your baby a healthy start. But if you read all the information out there, your child could be in college before you finish. So, let us help with three key steps to take as you embark on this 40-week journey.

Dr. Anna Lisa Jones

THREE STEPS FOR YOUR FIRST THREE MONTHS OF PREGNANCY

1. DO START PRENATAL CARE NOW.Research has shown that women who receive prenatal care are more likely to have healthy babies. So, if you don’t have an obstetrician or other health care provider, it’s time to find one. In addition to blood work and an ultrasound, your physician also may discuss optional genetic screenings in the first trimester — especially if you’re over age 35 or have genetic abnormalities in your family history, says Anna Lisa Jones, MD, an OB-GYN at RidgeGate OBGYN.

3. DO KNOW WHEN TO SEEK MEDICAL ATTENTION.A wide variety of physical changes are considered “normal” right now, including nausea, increased urination, changes in your breasts, mood swings, swollen ankles, and more. Some things, however, are cause for concern. Call your health care provider or 911 immediately if you experience vaginal bleeding of any kind, severe abdominal pain, or a fever over 100 degrees, Northrup says.

2. DO USE TRUSTED SOURCES.Over the next 40 weeks, you’ll get lots of unsolicited advice. The keys to making it through are simple: Talk to your health care provider about any questions you have, and use reputable online resources such as the American College of Obstetricians and Gynecologists. A few common misperceptions:• Rest as much as possible. True,

sort of. Rest is good, but don’t stop exercising unless your health care provider tells you to, Jones says.

• Don’t eat lunch meat. True, sort of. “We recommend not eating lunch meat at a restaurant or on a tray at a conference,” Jones says. “But if you want to eat lunch meat, just heat it up to steaming first.”

• Drink lots of water. True, sort of. Water is important, but the normal 64 ounces a day is sufficient. “It will help your amniotic fluid develop — and help you avoid preterm labor,” says Jacque Northrup, RN, birth concierge at Castle Rock Adventist Hospital.

To schedule an appointment with Dr. Jones, go to

ridgegateobgyn.org.

FREE CLASS FOR EXPECTING PARENTSLearn more about the first trimester in our FREE class, I’m Pregnant. Now What? A Journey Through the First

Trimester of Pregnancy. Designed for expecting mothers and their support person, this class covers pregnancy-related body changes, nutrition, warning signs, prenatal testing, fetal development, and more. For dates and to

register, go to castlerockhospital.org/register or call Jacque Northrup at 720-455-0355.

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TOXINS TO AVOID

Like food, chemicals can cross the placenta, exposing your unborn baby. The American College of Obstetricians and Gynecologists (ACOG) warns that prenatal exposure to certain chemicals may be harmful and recommends limiting your exposure by:• Using products that are

BPA-free• Not eating fish with high

mercury levels• Avoiding pesticides and

solvents• Always washing fresh

produce Anna Lisa Jones, MD, an OB-GYN at RidgeGate OBGYN in Castle Rock, also recommends avoiding cosmetics with a vitamin A derivative (such as Retin-A), as well as aspirin, ibuprofen, and naproxen (e.g., Aleve).

As birth concierge at Castle Rock Adventist Hospital, Jacque Northrup, RN (facing camera), consults with patients to give their babies a healthy start.

Age and hearing loss go hand in hand, with one in three Americans ages 65 and older suffering from the condition. Yet, hearing loss can occur at any age, says Sabina Scott, AUD, a doctor of audiology at Colorado ENT Specialists. “We treat people of all ages, from infants to the elderly,” Scott says. “While it’s more typical for older people to have problems with hearing, it’s not uncommon for people of any age to experience some degree of hearing loss.” Hearing loss isn’t just about missing out on conversations. It can be linked to a variety of issues, including:• Balance problems• Cognitive decline of up to 40 percent, compared to

those with normal hearing • Increased rates of anxiety, depression, paranoia, social

isolation, and decreased well-being

SOUND ADVICE

“Because of the substantial side effects related to hearing loss, early detection is critical,” Scott says. “If we can catch hearing loss early on, we can work together to minimize its

negative impacts by helping patients address, manage, and protect their hearing in the future.” Adults should have their hearing checked at least once to get a baseline, and those 55 and older should have their hearing tested annually. Newborns should be tested within one month of birth, and children should be tested before starting school. Hearing loss can be caused by a variety of factors, including genetics, exposure to loud noises, earwax buildup, disease, and/or illness, medication, and age.

COMING TO YOUR AID

If the hearing loss cannot be resolved via medical or surgical intervention, then improving hearing through hearing aids could be the best option, Scott says. “Hearing aids today are much more discreet and cosmetically appealing than in the past, and we audiologists digitally program them to be custom fit for the individual’s hearing loss,” Scott says. “While not a cure, hearing aids can greatly improve one’s hearing, communication, and overall quality of life.”

ELEVATE9castlerockhospital.org Summer 2015

MAKE AN APPOINTMENTColorado ENT Specialists provides hearing exams, vestibular/balance assessments, hearing aid consults and custom

fittings, tinnitus consults and management, custom hearing protection and swim molds, and more. To schedule an appointment, call 720-274-2544.

AN (EAR)BUDDING PROBLEM?

Research published in the Journal of the American

Medical Association shows that one in five teens suffers from slight hearing loss, a 30 percent increase from

the late 1990s.

SIGNS OF HEARING LOSS• Consistently feeling like

others are mumbling• Straining to hear or turning

your ear toward sound • Asking people to repeat

themselves• Friends and family comment

on your hearing• Difficulty hearing in groups

and places with background noise

• Hearing people talk but not understanding what they are saying

• Ringing or buzzing in the ear (tinnitus)

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SAY THAT AGAIN?

HEARING LOSS AFFECTS ONE IN FIVE AMERICANS


There are certain ailments in life that seem almost inevitable, and back pain in one form or another is near the top of that list for most of us. In fact, the American

Academy of Orthopaedic Surgeons estimates that 60 to 80 percent of us will experience lower back pain at some point, and for many it will be accompanied by

leg pain due to a herniated disc, often in our 30s and 40s. While most discs will heal on their own (within days, weeks, or sometimes months), there

are times when surgery makes more sense — and when getting it sooner rather than later can make it even more beneficial.

UNDERSTANDING THE PROGRESSION Disc problems are nearly always a

progressive process that starts with back pain, stiffness, tightness, and sometimes

muscle spasms. But within a week or two, it often transitions from back pain into leg pain — or

what is commonly referred to as sciatica, with the pattern of the pain depending upon where the herniation occurs and which nerve

root is involved. But this progression of symptoms isn’t always an indication that it’s time for surgery just yet, says Brad Duhon, MD, a neurosurgeon at Castle Rock Adventist Hospital. “Roughly 80 percent of patients six months out will have little to no problems, so we generally hold off on surgery in the very short term,” he says. “However, there are certain factors that necessitate surgery right away, and the No. 1 factor is whether you have a neurological deficit, like severe weakness or numbness. With that you want to act sooner rather than later.”

A HERNIATED DISCHEALING

WHEN HAVING SURGERY MAKES SENSE — AND WHY WAITING TOO LONG TO HAVE IT MAY NOT

ELEVATE11castlerockhospital.org Summer 2015

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A MIDDLE-AGED MALADY: WHY OLDER PEOPLE DON’T GET HERNIATED DISCS

You don’t see many elderly people with herniated discs, and there’s a biological reason for that. The discs in your spine are composed of a soft, spongy core called a nucleus that hardens with age, and a thick outer covering called an annulus that weakens over time. To cause herniation, the annulus must be sufficiently weakened, but the nucleus must still be soft and spongy enough to be forced out. When you’re in your 30s and 40s, the perfect storm can converge: The annulus has had time to weaken, and the nucleus is still soft enough to extrude. “That’s why herniated discs tend to happen when you’re younger, and other degenerative processes of the spine happen when you’re older,” according to Brad Duhon, MD, a neurosurgeon at Castle Rock Adventist Hospital.

INDICATIONS FOR SURGERY Beyond neurological deficits, there are other criteria that may make someone a better candidate for surgery, according to William Choi, MD, a neurosurgeon at Castle Rock Adventist Hospital. After imaging and a clinical examination, the biggest indicators are: • Size of the herniation: A big herniated disc

will more likely benefit from surgery than from conservative methods, Choi says.

• Location of the herniation: “If it’s located more into the corner where the nerve exits the spine, that tends to be a pretty narrow space anyway,” Choi says. “A hernia in that location will be less likely to respond to conservative treatments.”

• Duration of symptoms: If symptoms persist despite conservative treatments such as anti-inflammatory medications, steroid injections, and physical therapy, patients may benefit from surgery.

• Movement of the disc: “If the disc has ruptured and migrated up or down, it can get lodged against the nerve. The nerve prevents it from moving farther, but now it’s compressing that nerve and causing a lot more pain,” Choi says.

• Prior surgery: Scar tissue from a previous surgery means there’s less room for the nerve to maneuver around the disc, which can result in more symptoms and a greater need for additional surgery.

DELVING INTO MICRODISCECTOMY The gold standard in herniated disc surgery is lumbar microdiscectomy, a minimally invasive procedure that uses a microscope and special retractors working through small incisions to remove the herniated part of the disc, as well as any fragments exerting pressure on the spinal nerve. There are variations on the procedure that are becoming more widely accepted as well, such as tubular microdiscectomy. With a tubular retractor system, the surgeon can work through an even smaller incision based on the size of the tube they use, and they access the disc by going between the muscles as opposed to moving them aside as they would with a typical microdiscectomy. But both techniques offer similar successful results, Duhon says. The procedure itself is quick and (mostly) painless: It takes about 30 to 45 minutes, and patients typically go home the same day.

“Most patients are up and walking just a few hours after, with minimal pain,” Choi says. To prevent re-rupturing the disc, Choi advises patients for the first six weeks to:• Lift no more than 10 pounds• Try not to twist or bend excessively• Avoid activities that put significant impact on the

spine (such as running) But with proper care, the future looks bright for patients after surgery. “Outcomes are very good for microdiscectomies with a very low complication rate, and expectations of 95 percent relief of pain,” says Timothy Kuklo, MD, an orthopedic spine surgeon at Castle Rock Adventist Hospital. “Strength generally also returns in a significant number of patients, but if weakness is present for over six to nine months, then symptoms can become permanent.”

REASONS NOT TO WAITA recent study published in the journal Spine found that individuals with severe back, leg, arm, or neck pain, or numbness or weakness that got progressively worse had better outcomes with surgery than with other nonsurgical treatments. This is likely because the pressure is now (literally) off. “It is my opinion that surgical patients do better because surgery relieves the compression and inflammation around the nerve, giving it time to start healing,” Kuklo says. “This also improves blood flow and nutritional flow to the nerve. In patients who wait a long time (especially with a large herniation), the nerve is actually damaged, setting up a scenario for chronic pain.” Kuklo, Choi, and Duhon all agree that six to a maximum of 12 weeks is a sufficient waiting period, as most patients (not including those with neurological deficits) who will improve without surgery often have by that point. And Choi points out that in this case, the age of your herniated disc often matters more than your chronological age. “If you leave the disc and try to suffer through it without seeking help only to have surgery a year or two down the road, a lot of times a herniated disc could harden and calcify, which becomes harder to retrieve and address surgically,” he says.

2 THINGS YOU CAN DO TO LOWER YOUR RISK OF GETTING A HERNIATED DISCMaintain an ideal body weight. Your discs are the shock absorbers of your spine, and all day long they’re having to bear its entire weight. So if those shocks are bearing too much weight, the discs are facing more

pressure than they were intended to.

Use proper mechanics and form. This goes for everything from the way you throw yourself into your “weekend warrior” activities to how you pick up a pencil off the floor.

2350 Meadows BoulevardCastle Rock, CO 80109

Portercare Adventist Health SystemNON-PROFIT ORG

US POSTAGE

PAIDDENVER, CO

PERMIT NO. 4773

Castle Rock Adventist Hospital is 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, 2015.

NEW 3-D MAMMOGRAPHY IN CASTLE ROCK

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Schedule your screening mammogram today by calling 720-455-1111. Or text your name to 720-644-0880, and we’ll call you!

FREE CYCLECastle Rock Adventist

Hospital’s Free Cycle program is one of the ways we are helping the community live a healthier, happier lifestyle. From May to October, bikes are available for up to four hours FREE to the

community. For more info, or to reserve your bike today, go to

castlerockfreecycle.com

Have you ever tried to read a book without opening the cover? Probably not. But that’s how Jinnah Phillips, MD, director of the Breast Care Center at Castle Rock Adventist Hospital, describes the challenge of reading traditional two-dimensional mammography images. Thanks to the late spring arrival of 3-D tomosynthesis breast screening at Castle Rock Adventist Hospital, those challenges no longer exist. “With 3-D tomosynthesis, we can open up the book and flip through the pages, effectively seeing all the breast tissue,” says Phillips. This is great news, as a lot of women have dense breast tissue and this more detailed view is especially helpful when examining women with dense breasts. Now, with the same number of breast compressions, every patient who comes to the Breast Care Center for mammography screening will have both 2-D and 3-D images taken. With standard mammography, images are taken from two angles of each breast, producing a flat image. In tomosynthesis, multiple X-ray pictures are taken from many angles, moving in an arc around each breast while compressed. A computer algorithm

uses the information collected to create an entire series of 3-D pictures. “With 3-D tomosynthesis, there are 40 percent fewer callbacks to women to come in for additional films,” Phillips says. “Callbacks are a major source of anxiety for a lot of women. Reducing those callbacks is fantastic.” According to Phillips, with traditional mammogram alone, not only are additional films sometimes required, but ultrasound as well. Performing 2-D and 3-D screening at the same time may mean patients move straight to ultrasound without additional films, eliminating, for many women, the discomfort and additional radiation of a callback exam. “These images increase our diagnostic confidence,” Phillips says. “It’s really exciting to be the first site in Castle Rock to offer women this technology.”

WOMEN WITH DENSE BREASTS MAY BE SIX TIMES MORE LIKELY

TO DEVELOP CANCER. DECREASE YOUR RISK BY:

Eating clean (eating whole or unprocessed foods)

Exercising often

Limiting alcohol

Maintaining a healthy weight

Not smoking

Castle Rock Adventist Hospital is part of the Centura Health Cancer

Network, delivering integrated, advanced cancer care across Colorado and western Kansas.

elevate summer 2015

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