Fall 2014 | Volume 6, Issue 4

PHOTO BY ELLEN JASKOL

New Migraine Treatment

PAGE 2

Scarless Hysterectomies

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Preventing Shoulder Injuries

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On the Move

Jeff Bellamy has a new perspective on life after hip replacement surgery at Parker Adventist Hospital.

Overnight joint replacement means getting back to your

life quicker and with less pain.Page 4

NEW Neighborhood

Health Center and ER at Southlands

See story on Page 3.

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Adults at RiskShoulder injuries are not just limited to teens or athletes. Three out of 10 adults will experience some type of shoulder pain in their lives—particularly rotator cuff tears. Join Dr. Micah Worrell, orthopedic surgeon, at a FREE community seminar on Oct. 23 to learn how to protect your shoulders and the treatments available if you suffer an injury. See next page for details.

New treatment for migrainesA NEW HEADBAND-TYPE DEVICE, recently approved by the Food and Drug Administration, might be useful in preventing up to half of migraine headaches in some patients.

The device, called Cefaly, delivers electrical stimulation to the forehead, targeting nerves commonly involved in migraines, says Ravi Shah, MD, stroke medical director for Parker Adventist Hospital. “Cefaly is intended to increase the threshold for headaches so they don’t occur as frequently.”

While medical studies found that the device prevented migraines in some patients, Shah cautions that more research is needed. “Although one small clinical trial showed a significant reduction in migraine days, more research is warranted to establish the efficacy and safety of the device.”

Cefaly, which requires a prescription, costs about $300 and is not typically covered by insurance.

More than the bluesHelp for depression is close at handPERSISTENT LOW MOOD, loss of interest, reduced energy — this is more than a case of the blues. You could be depressed, and your primary care doctor can help.

In fact, a study published in the Journal of Clinical Psychiatry says more than half the cases of depression can be identified and treated in a primary care office.

Josh Solot, DO, family medicine physician at Cornerstar Primary Care, says depressive disorders are common, with major depression affecting 5 percent to 10 percent of patients seen in primary care settings. Other symptoms include changes in sleep, appetite, or ability to concentrate.

Your doctor will most likely recommend a multipronged treatment approach, which could include cognitive therapy, exercise, removal of stressors, and possibly medications, Solot says.

When a patient has not responded to a variety of treatment options, a referral to a mental health specialist may be necessary. “The important thing is to listen to your body and report these changes to your primary care physician,” he says.

the risk of injuryPreventing shoulder injuries in teen athletes

FOOTBALL PLAYERS AND WRESTLERS are the most likely high school athletes to suffer shoulder injuries and are at most risk during games rather than practices, according to a recent study in the medical journal Pediatrics.

The “heat of the moment” mentality during games can lead to altered shoulder mechanics and result in sprains, separations,

or dislocations, says Micah Worrell, DO, an orthopedic surgeon at Parker Adventist Hospital.

“The athlete will do anything to make a play or score a point, thus placing the shoulder in a position for which it has not been trained,” he says. “It is this unpredictable and uncontrollable factor of a game situation that leaves athletes at an increased risk for shoulder injury relative to practice.”

Athletes can reduce the risk of injury by following these tips:> Use proper protective equipment.> Cross-train during the off-season. “This will not only maintain shoulder flexibility and balance, but also help the athlete recognize and recover from periods of overuse,” Worrell says.> Incorporate a routine of shoulder-specific flexibility and strengthening

exercises. “This will decrease the risk of injury and, secondarily, improve performance,” he adds. > Finally, pay meticulous attention to technique with regard to

proper tackling or wrestling maneuvers.

Shouldering

Cornerstar Primary Care, formerly called Access Family Medicine, has moved to 15901 E. Briarwood Circle, Suite 200, Aurora, CO 80016, located at the corner of Parker Road and Arapahoe Road in the Centura Health Building. To make an appointment, call 303-269-2626.

Dr. Micah Worrell

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Fall FREE health seminarsJoin 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. New! Online only registration at parkerhospital.org/seminars.

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Centura Health Southlands 6069 S. Southlands ParkwayOB/GYN 303-840-8780Primary Care 303-928-7555

Southlands ER6159 S. Southlands Parkway

Neighborhood NecessityNew Centura Health Southlands Neighborhood Health Center provides one-stop health care for local residents

RESIDENTS IN SOUTHEAST AURORA AND NEARBY COMMUNITIES now have access to more convenient, comprehensive care with the opening of Centura Health Southlands on Sept. 29. Located near Aurora’s Southlands Shopping Center at E-470 and

Smoky Hill Road, the facility offers primary care, women’s health services, on-site imaging and lab services, mammography, and outpatient rehabilitation.

“Southlands offers full-service, one-stop health care for patients — comprehensive services for residents in their own neighborhood,” says Deb Carpenter, RN, director of ambulatory projects at Centura Health South Denver Group.

Centura Health Southlands is part of the Colorado Health Neighborhoods, an initiative by Centura to provide more local, convenient, and affordable services within communities focused on wellness services as well as treatment. Research showed that the Southlands area was lacking such services for patients.

Southlands’ primary care services will include on-site pediatricians, OB/GYN physicians, and family practice physicians. All services and health care providers at the current Southlands location on Main Street will move to the new facility up the road near Red Lobster.

“We want people to view Southlands as a place where they can get anything they need in one convenient location,” Carpenter says. “If someone comes in for an annual exam and needs a mammogram, she can just go down the hall rather than travel across town.”

Emergency Room Opening Soon

A full-service, free-standing ER is scheduled

to open at Southlands in November. It will be an extension of Parker

Adventist Hospital, and will offer services available at a hospital ER, and use a door-to-

doctor model to deliver the fastest care possible.

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Southlands ER

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Family Fall FestivalJoin your new Southlands neighbors on

Oct. 25 from 11 a.m.-3 p.m. for an afternoon of food, fun, and wellness. Meet the Southlands medical teams while

enjoying fun and healthy activities for all ages.

Ending Back PainTue, Oct 14 | 6:30-8 p.m.Join Dr. Zak Ibrahim, orthopedic spine surgeon, to learn about treatment options for low back pain, including minimally invasive surgery, and how to know when it’s the right time for surgery.

Pain in the NeckTue, Oct 21 | Noon-1:30 p.m.Join orthopedic spine surgeon Dr. Scott Stanley to understand the most common problems causing neck pain and the best proven nonsurgical and surgical treatments.

Shoulder Repair and ReplacementThu, Oct 23 | 6:30-8 p.m.If you’ve been suffering from shoulder pain due to an injury or arthritis, join orthopedic surgeon Dr. Micah Worrell to learn the latest treatment options, from rehab to minimally invasive surgery.

Advancements in Joint ReplacementThu, Nov 6 | 6:30-8 p.m.Join Dr. Derek Johnson, orthopedic surgeon, to learn about the latest in knee and hip replacement surgery.

Scarless SurgeryWed, Nov 19 | 6:30-8 p.m.General surgeon Dr. Christine Rogness will discuss advancements in surgery, including single-site, scarless surgery.

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Overnight Joint ReplacementSurgery patients going home faster thanks to advancements in pain control and physical therapy at Parker Adventist Hospital

You wouldn’t believe it by looking at him, but active 54-year-old Jeff Bellamy’s biggest goal in early 2014 was to be able to tie his left shoe again.

Today, he works out five days a week. But before his hip replacement surgery in February, Bellamy was at the mercy of chronic hip pain from arthritis that had worsened over seven years. When he filled out the presurgical questionnaire about his limitations, it hit him how many of his favorite activities had fallen by the wayside as his pain

became more severe.“It was amazing how many things I’d

forgotten that I enjoyed that I didn’t do anymore,” Bellamy says. “Long walks, playing golf, hiking in the mountains, riding a bike — these are things I naturally gave up over time.”

One-Day SurgeryAfter joint replacement at Parker Adventist Hospital, about 30 percent of hip patients — including Bellamy — and

15 to 20 percent of knee patients are now able to return home after staying just overnight in the hospital.

“The average stay nationwide is still more than three days for both hips and knees,” says Derek Johnson, MD, medical director of orthopedics at Parker Adventist Hospital.

So why try for a shorter stay? “We focus on the healthy patient model, which stresses that joint replacement patients aren’t sick,” Johnson says. “They have a bad hip or knee, but otherwise they’re healthy. So we want to get you up, get you back to your normal function, and get you back to your normal environment as quickly as possible.” Getting back to familiar surroundings and sleeping in your own bed

makes recovery more relaxing.To make it possible for some patients to go home that

quickly, the joint replacement team employs three strategies

Getting back to familiar

surroundings and sleeping in

your own bed makes recovery more relaxing.

21 The number of pounds

Jeff Bellamy dropped after hip

replacement surgery

Dr. Derek Johnson

After suffering from excruciating hip pain for nearly a decade, Jeff Bellamy, 54, can now keep up with his wife, Lori, for a full day of shopping.

LIGHT ON YOUR FEETAbout one-third of knee replacement patients gain weight after surgery, according to a 2013 study published in the journal Arthritis Care & Research. Researchers suspect that one reason is that patients are encouraged to lose weight before surgery but gain it back if they don't become active after surgery. Also, most patients have cut back on activity before surgery due to the pain — a hard habit that must be reversed after the pain is gone.

To pursue post-surgery fitness: Faithfully do the exercises prescribed by your doctor

and physical therapist Once you’re cleared for activity, set aside a half

hour most days of the week for low-impact activities such as:

• Walking • Swimming • Bicycling • Golf • Dancing • Light tennis

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Before and AfterAfter his hip replacement, Bellamy is thrilled to be back to long walks with his wife of 30 years. His weight had crept up a bit as his activity level diminished, but he went from 200 pounds to 179 in the first five months after surgery.

“I’m sad that I waited so long,” he says. With chronic joint pain, “your quality of life is diminished and it doesn’t have to be.”

Before surgery, “I couldn’t even walk the mall with my wife for more than 30 minutes without having to sit down because of the extreme pain,” Bellamy says. Now, “she’s really happy, and so is her shoe collection!”

For hip replacement, the direct anterior surgical approach helps patients recover faster because no muscle tissue is cut. “We work through a window created by separating two muscles out of the way,” Johnson explains.

For knee replacement, Parker Adventist Hospital surgeons spare as much soft tissue and muscle as possible. Also, “we avoid using tourniquets because they can cause muscle damage and postoperative weakness and pain,” Johnson adds.

“We’ve really worked hard at Parker to manage pain while minimizing narcotics and medications that are sedating, and without using long-acting nerve blocks that weaken muscles and prevent people from mobilizing quickly,” Johnson says.

Instead, local anesthetic injections and non-narcotic pain medication manage pain while allowing patients to get up and moving more quickly.

“Dr. Johnson prescribed a couple of different medicines that really worked together to help relieve my pain,” Bellamy says.

One of the most important keys to a successful joint replacement is physical therapy. And the faster patients get that — now within hours after surgery at Parker Adventist Hospital — the quicker and better they recover.

“The physical therapists had me up and walking around that same day without pushing me too hard, which was really nice,” Bellamy says.

Patients sit up on the edge of the bed within the first few hours and are ideally up and walking within four hours. A quick start to rehab helps a patient’s mind as well as his or her body, Johnson says. “There’s a psychological advantage to the patient to show them, ‘This thing works, it doesn’t hurt, and I can use it.’”

to promote swift recovery. These steps also shorten hospital stays across the board, with 90 percent of hip and knee replacement patients at Parker Adventist Hospital leaving within 24 to 30 hours of surgery.

FROM CAN’T TO CANFrom before surgery to after going home from the hospital, rehabilitation is aimed at getting patients back to full function after joint replacement as quickly as possible.

“Our physical therapy process actually starts in pre-op class,” says Lara Palokangas, PT, DPT, coordinator of rehabilitation at Parker Adventist Hospital. Patients learn exercises to do at home that are similar to what they will do after surgery. “They set themselves up for success by getting their muscles used to those exercises ahead of time.”

After surgery, physical therapy begins by measuring a patient’s function and setting goals. “We translate the patient’s desires into clinical goals that can be measured,” says Marty Euwema, PT, DPT, manager of rehabilitation. The therapist may encourage the patient to work toward climbing stairs, for example, and the patient may add the goal of being able to walk the dog. As strength and range of motion improve, therapists help patients remember how far they’ve come — a pick-me-up that also provides motivation to continue working.

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Tissue-sparing surgery

Pain control that preserves mobility

Accelerated rehabilitation

HOME FASTERJoint replacement patients who have surgery at Parker Adventist Hospital return home to recover faster than most.

Get your questions answeredCome to a FREE community seminar on Thursday, Nov. 6, 6:30-8 p.m. with Dr. Derek Johnson, medical director of orthopedics, to learn more about hip and knee joint replacement surgery at Parker Adventist Hospital. See Page 3 for full details.

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90% of knee and hip patients at Parker Hospital return home in 2 days

The national average for knee and hip patients, return to home is more than 3 days &

of knee patients return home in 1 day

of hip patients return home in 1 day30%

15%

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AS THE TEMPERATURES DROP, visits to the ER rise, resulting in 25 percent more ER visits during the winter than the fall, according to the National Health Statistics Reports.

“The colder temperatures and winter weather tend to lead to more injuries,” says Mark Elliott, MD, a board-certified emergency medicine physician with Centura Health South Denver Group, which includes Parker Adventist Hospital, Littleton Adventist Hospital, Porter Adventist Hospital, and Castle Rock Adventist Hospitals. “We also see a spike in ER visits due to participation in winter sports, like skiing and snowboarding.”

Below is a rundown on how to avoid the three most common winter injuries.

Become a

Tips to avoid the

top three winter injuries

FallsFalls account for up to 60 percent of ER visits during winter months. While bumps and bruises are the most common fall-related injuries, one out of three leads to serious head injuries, lacerations, or fractures, according to the Centers for Disease Control and Prevention (CDC).

PREVENTION: �Clear snow and ice from walkways

and driveways (use kitty litter, sand, or deicer on tough areas) �Wear shoes with extra grip or

strap on shoe grips�Walk more cautiously

Winter SportsWinter sports result in half a million injuries annually, with snowboarding accounting for 25 percent of all winter sports-related ER visits, according to the CDC. Common injuries include strains and sprains, head injuries, eye injuries, fractures — and, especially in Colorado, knee injuries. PREVENTION: �Warm up prior to the activity and then stretch

while warm�Wear a helmet when sledding, skiing, or

snowboarding�Wear goggles and sunscreen when out in

the snow“For skiers, I recommend staying forward in your boots, as sitting back in your boots can set you up for ACL injuries in the knees,” Elliott says.

Cold Weather Exposure Exposure to colder temperatures can lead to frostnip (itching and pain to skin), frostbite (tissue damage that often includes blistering, numbness, and pain to the exposed area), and hypothermia (cold exposure that leads to a drop in body temperature resulting in symptoms including shivering, confusion, memory loss, slurred speech, and drowsiness). Risk of hypothermia rises in the elderly and very young and after alcohol use.

PREVENTION: ��Layer clothing and wear water-resistant clothing�Change out of wet clothing as quickly as possible�Avoid lengthy exposure to outdoor temperatures�Hydrate well �Avoid alcohol

“Anyone with a serious head injury, any obvious fractures, hypothermia symptoms, or concerns about head injury or frostbite should go to the ER immediately,” Elliott says. “Most other injuries, including bruises and strains, can be treated with rest and ice.”

Parker Adventist Hospital, a Level III trauma center, is part of the Centura Health Trauma

System, the region’s largest and most comprehensive

network of trauma care and emergency services.

Parker Adventist Hospital9395 Crown Crest Boulevard 303-269-4000

Castle Rock Adventist Hospital 2350 Meadows Boulevard720-455-2500

Littleton Adventist Hospital(featuring separate pediatric ER)7700 South Broadway 303-730-5800

Porter Adventist Hospital2525 South Downing Street 303-778-1955

Southlands ER(opening in November)6159 South Southlands Parkway303-649-3000

Centura Health South Denver Emergency Facilities

Download the FREE iTriage health app to check ER wait times, check

symptoms, and get answers to health questions: itriagehealth.com/mobile.

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Scarless Surgery With virtually scarless single-site surgery, all you’ll remember are the benefits

WHETHER A PRESSED FLOWER from a beautiful hike or a snow globe from a gift shop, a souvenir is tangible evidence of a memorable event.

With FDA-approved single-site surgery for gallbladder removal or hysterectomy, these procedures can be virtually souvenir-free.

“There is nothing nicer than looking down at your abdomen six months later and realizing you can’t find your scar,” says Christine Rogness, MD, a general surgeon who performs single-site procedures at Parker Adventist Hospital. BELLY BUTTON INCISIONGallbladder surgery was one of the first procedures to be performed as a minimally invasive procedure. This type of surgery is called “laparoscopic” because it uses a thin, flexible fiber-optic tube (or laparoscope) and specially designed instruments to work through tiny incisions. Laparoscopy makes a large open incision unnecessary.

Surgeons also can do laparoscopic surgery with the help of robotic instruments they maneuver from a control console. The robotic interface and instruments allow the surgeons better visualization and more precise movements than even traditional laparoscopy.

“The lighting and the camera are so much better with robotic instruments,” Rogness says. “If laparoscopy is like an analog TV, the da Vinci® robot is like HDTV.”

Thanks to the precision of the da Vinci Surgical System, the single-site option lets surgeons reduce the four incisions of traditional laparoscopy down to one incision through the belly button that is less than an inch long.

Benefits of single-site surgery can include: Reduced or no scarring Reduced pain Low blood loss Lower infection risk Faster recovery Short hospital stayWith fewer incisions, “the patient has increased satisfaction,” Rogness says. “People use less

pain medication, and there’s a quicker return to work.”

‘QUICK AND EASY’Wendy Rasmussen, a social work case manager, had her gallbladder removed at Parker Adventist Hospital this past winter.

“I was having trouble with abdominal pain,” Rasmussen says. “I was having increased pain after eating certain things, and increased heartburn.”

When ultrasound showed Rasmussen needed gallbladder surgery, Rogness recommended the single-site procedure. “It was quick and easy,” Rasmussen says. “I’ve had a few surgeries in the past, and this was by far the easiest recovery. I had hardly any post-op pain, and I went home within hours. I was back to work in a week and a half.”

Symptom relief is the only souvenir Rasmussen has from the virtually scarless surgery. “The one incision was right there in the belly button, so you can’t really see the scar,” she says. “You would never even know it was there.”

Is scarless surgery an option for you?Join Dr. Christine Rogness to learn more about scarless surgery and other advancements in surgery on Wednesday, Nov. 19, 6:30-8 p.m. See Page 3 for details.

Dr. Christine Rogness

Wendy Rasmussen describes single-site gallbladder surgery as "quick and easy." She was back to work and enjoying life with her kids in a week and a half.

Specialists in single-site surgery

Eight single-site surgeons operate at Parker Adventist Hospital — the

largest number of single-site surgeons among Colorado facilities, according

to da Vinci Surgical Systems, the manufacturer of single-site surgery

instruments who trains all single-site surgeons. To learn more about this surgery and get a list of surgeons,

go to parkerhospital.org/ single-site-surgery.

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

Non-ProfitOrganizationU.S. Postage

PAIDDenver, CO

Permit No. 47739395 Crown Crest Blvd. Parker, CO 80138

Portercare Adventist Health System

Advanced radiation for breast cancer patients limits riskRADIATION THERAPY is recommended for more than two-thirds of women who get breast cancer. Yet, some women choose to forgo this

treatment out of fear of increased risk of heart disease. Advancements in treatment, however, have all but

eliminated that risk, says Anuj Peddada, MD, medical director of radiation oncology at Parker Cancer Center at Parker Adventist Hospital. Take, for example, a 50-year-old woman who gets radiation for breast cancer this year and has no other risk factors for heart disease. “Her risk of dying from a heart attack 30 years from now is only about 1 percent higher than it would be if she didn’t have

radiation,” Peddada says.

The Parker Cancer Center uses a four-pronged approach to reduce side effects:1. Tailoring each breast cancer treatment plan to the patient’s specific

anatomy using computerized planning based on CT scan images. “There’s no cookie-cutter approach,” Peddada says.

2. Using the TrueBeam linear accelerator to deliver radiation with pinpoint precision to the tumor site while avoiding healthy tissue. “It’s the most advanced linear accelerator in the world, with all the capabilities to do cardiac protection,” he says.

3. Using techniques such as “deep inspiration breath hold” in which a woman holds her breath to push the heart away from the treatment area and reduce radiation exposure.

4. Using internal radiation, called brachytherapy, to place seeds of radiation inside the breast. “If a patient has a really complicated lesion that’s close to the heart, we can treat it with nearly zero exposure to the heart,” Peddada says.

Time for a mammogram?Schedule your annual mammogram at the Trio Breast Center by calling 303-269-4150. Or simply text your name to 303-816-8648 and our schedulers will call you within two business days to make your appointment. We will obtain your previous studies from other locations upon request.

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.

Dr. Anuj Peddada

Cancer care close to homeParker Adventist Hospital’s Cancer Center offers expert radiation therapy near you. To learn more, visit parkerhospital.org/cancer. We are part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across the region.

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9395 Crown Crest Blvd., Parker, CO 80138grow is published quarterly by Parker Adventist Hospital—Portercare Adventist Health System—as part of our mission to nurture the health of the people in our community. To comment or unsubscribe, please email grow2@centura.org. grow is produced by Clementine LLC. of Littleton, Colo.

Executive Editor: Rachel Robinson