Grow Fall 2012

Fall 2012 | Volume 4, Issue 4

growNurturing the health of you and your family

The link between headaches and sleep.

page 3

Breast cancer strikes under 40.

page 6

Menopause symptoms you shouldn’t ignore.

page 2pLUS...

RidingHigH

Shoulder replacement at Parker Hospital returns equestrian

to the saddle

Karen Grant of Denver sought out a Parker Hospital specialist for surgery to relieve the arthritis in her shoulder.

Photo by Ellen Jaskol

2 ■ Fall 2012 ■ grow

What’s NOT Menopause

Dr. Tara Wiebe

As woMen PAss THrouGH MenoPAuse, many will experience a host of health symptoms that are caused by changing hormones. Most of these eventually will pass.

But women shouldn’t chalk up everything to menopause. “Women tend to attribute everything to aging, and they either hope it will go away or think they can live with it,” says Tara Wiebe, MD, an OB/GYN at Parker Adventist Hospital.

THese syMPToMs sHoulD Be cHecKeD By A DocTor: Menstrual bleeding: Irregular, heavy, or frequent menstruation is one of the most

common symptoms of menopause, but it could be due to something more serious. “This is a common time for endometrial hyperplasia and cancer,” Wiebe says. “It also could be polyps or fibroids that can be treated and make life a lot better.”

Breast tenderness: Starting at age 40, women should get annual clinical breast exams and screening mammograms. If breasts are tender and it’s not around the time of your period, see your doctor right away.

Chest pain, heart palpitations, dizziness: These could be signs of heart disease or heart arrhythmias.

Sadness: “This is probably the biggest thing to hit women in their late 40s or early 50s,” Wiebe says. “They think mood changes, weight gain, and difficulty sleeping are normal. But there can be a depression component to it.”

Thyroid disease: This can cause the same symptoms as menopause. Every woman should have her thyroid checked if she’s experiencing weight gain, mood changes, and/or fatigue.

FIND a DOCTORFor many women, the last time they saw a doctor was when they gave birth. If you’re in your 40s, now’s the time to make sure you’re seeing a doctor at least once a year. To find a doctor, go to parkerhospital.org/doctor.

Health Watchcommunity members needed for long-term study

THe AMerIcAn cAncer socIeTy is kicking off a community health study that will look at how lifestyle, genetics, and the environment affect the development of cancer. The Cancer Prevention Study-3, or CPS-3, is recruiting volunteers from communities across the country, including Parker.

Enrollment will take place on Nov. 13-17 at 14 sites throughout the metro area, including Parker Adventist Hospital.

The study is open to anyone ages 30-65 who has never been diagnosed with cancer, with the exception of basal or squamous cell skin cancer. Participants will be asked to:

complete a lifestyle surveyGive a small blood sampleProvide physical measurements, such as waist size

Participants must be willing to commit to the study long term, which requires completing periodic surveys at home for the next 20-30 years. They will receive newsletters and information related to the study.

participate in this study by registering at cps3colorado.org. Then come to Parker Hospital on the following days to complete your personal information:

Tue, Nov. 13, 5-8 p.m.Thu, Nov. 15, 8 a.m.-noonSat, Nov. 17, 9 a.m.-1 p.m.

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9395 Crown Crest Blvd., Parker, CO 80138grow is published quarterly by Parker Adventist Hospital as part of our mission to nurture the health of the people in our community. To comment or unsubscribe, please email [email protected]. grow is produced by Clementine LLC.

Executive Editor: Rachel Robinson

SPECIAL Health OffersLow-cost

Flu VaccinesParker Adventist Hospital will offer flu vaccines on Nov. 7 and 14 from 3-6 p.m. in the hospital’s main lobby. The cost is $25 but is covered by Medicare Part B (as primary insurance), UnitedHealthcare Medicare Advantage (formerly Secure Horizons), Aetna, Humana Gold, and Rocky Mountain Health Plan. You must show a valid insurance card. FluMist®, the nasal spray vaccine, is available for $30 for people ages 2-49 while supplies last.

$99Heart ScanIf you have one or more risk factors for heart disease and are over 50, you may want to consider a coronary calcium scan. This noninvasive test measures the level of calcification in the heart. Calcium is a marker of heart disease. Normally $333, Parker Adventist Hospital is offering this scan for $99 from Oct. 29-Nov. 30. A physician’s referral is not required, but test results must be sent to a doctor. To schedule a scan, call 303-269-4500.

What’s NOT Menopause

grow ■ parkerhospital.org ■ 3

Women now will be eligible for eight additional preventive care services, including annual physicals and contraception, without a co-pay or deductible, through the Affordable Care Act. Coverage takes effect on the next policy renewal after Aug. 1, 2012, for the following benefits:

1. Well-woman exams2. Gestational diabetes screening3. Breast-feeding support, supplies, and counseling4. FDA-approved contraception, education, and counseling5. HPV DNA testing for women 30 and older6. HIV screening and counseling7. Sexually transmitted infections counseling8. Domestic violence screening and counseling

For a complete list of preventive services now covered at no cost to the patient, go to healthcare.gov/prevention.

Q&Aby Katie Polovitz, MDNeurologist Parker Adventist Hospital

Why do I wake up with a headache?If you routinely get headaches in the morning, you may not be breathing properly while you are sleeping. If this happens, carbon dioxide levels in your body can rise and cause a headache. This can be caused by a condition known as obstructive sleep apnea, which is diagnosed with a sleep study.

There is also a strong link between sleep and migraines. Migraine sufferers often can’t sleep due to pain, but the lack of sleep causes increased frequency and intensity of headaches. Without enough sleep, patients also tend to skip exercise and drink more caffeine — two additional risk factors for migraines.

Medications for headaches in some individuals may be acting like a Band-Aid. The real cure is to help the patient restore a harmonious balance in the body by practicing good sleep hygiene. The brain responds well to routine. If you create a routine for sleep, your body will respond. I suggest:

> Don’t read or watch TV in the bedroom. These habits can stop the body from producing melatonin, the hormone that causes sleep.

> Don’t go into your bedroom until 30 minutes before sleep. > Don’t have loud or stimulating noises in the bedroom.> Use white noise, such as a fan. Brain studies show that white noise prevents

recurrent thoughts by distracting the brain. > Don’t turn on the TV or read if you wake up during the night because it

reactivates the brain.

SLeep QUIZIf you have difficulty sleeping, find yourself tired despite a full night’s sleep, or have recurring headaches, you may have a sleep disorder. Find out more and take a FREE sleep quiz at parkerhospital.org/sleep. Be sure to discuss your concerns with your doctor.

WOMeN’S BeNeFITSexpanded

Dr. Katie Polovitz

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THe BAD news? One in five adults has arthritis, with shoulders being one of the most commonly affected areas. THe GooD news? Shoulder replacement surgery is relatively easy and relieves all the pain in most patients.

“Shoulder replacement is a less impactful recovery than knee or hip replacement since the shoulder is not a weight-bearing joint,” says Todd Alijani, MD, an orthopaedic surgeon at Parker Adventist Hospital. “Plus there is no need for a blood transfusion. And patients typically never go to a rehab hospital, which can happen with hip surgery. The results are excellent.”

Karen Grant echoes that sentiment. Just a month after Alijani replaced her left shoulder at Parker Hospital, Grant was sleeping through the night without pain and looking forward

to riding her five horses again, a hobby that her shoulder pain had forced her to abandon.

“I work in an office and by the end of the day, I was in so much pain it was unbelievable,” says 63-year-old Grant, who lives in Denver but came to Parker because of Alijani’s specialization in shoulders. “For the past six months, I couldn’t even sleep.”

Grant returned home the day after her surgery and began physical therapy at the Parker Adventist Center for Rehabilitation & Sports Medicine. She says she is making fast progress. “What am I hoping to do? Everything!” she says.

Shoulder SolaceJoint replacement surgery can relieve severe shoulder arthritis pain quickly


Thanks to successful shoulder surgery at Parker Hospital, Karen Grant can once again tend to her five horses with her granddaughter.

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Is it time for shoulder replacement?The decision to have shoulder replacement surgery is an individualized choice, says Todd Alijani, MD, an orthopaedic surgeon at Parker Hospital.“The timing is different for each patient, mainly due to pain tolerance and lifestyle,” says Alijani, who specializes in shoulder problems. “If the patient is very active, then we don’t want to wait until they’ve lost a great deal of range of motion because it’s difficult to get that back after surgery.”

It may be time to consider shoulder replacement surgery if you have: Pain that interferes or impedes necessary daily movements, such as getting dressed or using the bathroom Pain that wakes you up at night Loss of range of motion or weakness in the shoulder No improvement with other treatments, such as cortisone injections “I don’t recommend shoulder replacement until the patient says I can’t live with this any longer,” Alijani says. The American Academy of Orthopaedic Surgeons reports that 75 percent of shoulder replacement surgeries are performed by orthopaedic surgeons who do only one or two procedures annually. The organization recommends that patients seek an orthopaedic surgeon who specializes in shoulder repair and who performs more than two shoulder replacements annually to reduce the risk of complications.

FRee SHOULDeR SeMINaRJoin Todd Alijani, MD, orthopaedic surgeon, to learn the most common shoulder injuries and how to prevent them. Then join lisa larson, shoulder physical therapist at the Parker Adventist center for rehabilitation & sports Medicine, as she leads you in some easy exercises that strengthen the shoulder and help prevent rotator cuff tears.

DaTE: wed, Dec. 12 TIME: noon-1:30 p.m. (light lunch will be provided) LOCaTION: Inspiration conference room at Parker Adventist

Hospital (west entrance) COST: FREE

REgISTRaTION: required; call 303-777-6877, option 1


Pain ReliefToday, about 53,000 people in the U.S. have shoulder replacement surgery each year, according to the Agency for Healthcare Research and Quality. This compares to more than 900,000 Americans a year who have knee and hip replacement surgery.

The most common reason for needing a shoulder replacement is arthritis. Arthritis gradually wears away the cartilage that lies between the top of the arm bone, the humerus, and the shoulder socket, the glenoid. Arthritis causes the cartilage to crack and eventually go away, leaving the bones to rub against each other.

“The bone underneath is like sandpaper,” Alijani explains. “Bone on bone causes friction and pain.”

Shoulder replacement typically requires just a night or two in the hospital. And thanks to improvements in medications, patients now can receive an anesthetic block that reduces pain while reducing the need for narcotics.

“I needed very little pain medication when I went home,” Grant says. However, she added that physical therapy has been painful at times. “I’m getting there. It’s still a little painful, but I’m now able to sleep through the night.”

Surgery OptionsIn addition to traditional shoulder arthroscopy that replaces both the ball and joint, two other types of joint replacement surgery are available. With a procedure known as resurfacing hemiarthroplasty, the surgeon places a protective cap on the top of the humerus (the “ball” of the joint). This procedure is used with younger, athletic patients, as it prolongs the natural joint as long as possible.

Reverse shoulder replacement is the newest type of surgery available, performed by just a handful of orthopaedic surgeons in the Denver metro area. With this surgery, the artificial joint is flipped upside down so that the cup is on bottom and the ball on top. It is particularly useful for older patients whose rotator cuff has been injured.

“We employ this technique when the patient’s rotator cuff can no longer be employed to lift the arm,” Alijani says. “This procedure has a higher complication rate than traditional surgery, but the results are phenomenal.”

Screening ConfusionConflicting recommendations leading women to forgo mammograms

one-THIrD oF BreAsT cAncers detected at Parker Adventist Hospital over the past year were in women under the age of 50, when breast cancer is its most aggressive and deadly. Yet over the

past two years, the number of women in their 40s getting mammograms has declined precipitously, says Monique Fox, MD, a board-certified breast radiologist at The Trio Breast Center at Parker Adventist Hospital.

“I think there is a misconcep-tion that mammograms don’t work on younger patients,” says Fox. She believes this misconcep-tion grew out of the controver-sial recommendations made in late 2009 by the U.S. Preventive Services Task Force. The USPSTF recommended that women not get mammograms before age 50 unless they were at high risk of getting breast cancer.

The recommendation was not made because mammograms are ineffective in women under age 50. In fact, the USPSTF specifically found that the detection rate in women under 50 was the same as in women 50-59. Instead, the task force made this recommendation based on the finding that fewer cancers are found per 1,000 screenings in women under 50.

“I think physicians and patients should know that the test is not flawed for younger patients, but rather that it is a game of

statistics and cost benefit that the task force is playing,” Fox says. “I may be biased because I am seeing the individuals that have breast cancer in their 40s. But in our population, 31 women were diagnosed under age 50 out of 129. This is significant, especially in Parker where our population is younger. I think these individuals matter, and sometimes you have to look through the forest to see the trees.”

Many primary care physicians are adopting the USPSTF recommendation, according to a study conducted last year by the University of Colorado School of Medicine. But most breast cancer experts, along with the American College of Surgeons and the American Cancer Society, still recommend that women begin annual screening mammograms at age 40.

“Breast cancer that occurs between ages 40 and 50 tends to be more aggressive and has a higher chance of spreading to the lymph nodes and metastasizing,” Fox says. “We see individuals here, and these are young healthy women who are getting breast cancer.”


‘‘IN OUR pOpULaTION, 31 WOMeN WeRe DIagNOSeD UNDeR age 50 OUT OF 129. THIS IS SIgNIFICaNT...”

SCHeDULe YOUR MaMMOgRaM BY TeXTIs your to-do list a mile long with a reminder somewhere on there to schedule your annual screening mammogram? Make your life a bit simpler by sending a quick text to The Trio Breast center at Parker Adventist Hospital to schedule your screening! Just text the words “Schedule Me” and your name to 303-816-8648. we’ll call you during business hours within two business days and find a time that’s convenient for you to get your screening.

Schedule Me !‘‘‘‘

Dr. Monique Fox,board-certified breast radiologist

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Dense breasts increase cancer riskWomen with dense breasts are four to six times more likely to get breast cancer, according to recent studies. “It’s a greater risk factor than having a mother or sister with the disease,” says Monique Fox, MD, a board-certified breast radiologist at Parker Adventist Hospital.

Not only are these women more likely to develop cancer, but screening mammograms are less effective at detecting cancer in dense breasts. Many experts, including Fox, recommend that these women obtain breast ultrasounds in addition to mammograms.

Studies have found that ultrasound finds three to four additional cancers for every 1,000 women with dense breasts that mammograms miss. Four states — but not yet Colorado — require radiologists to inform women they have dense breasts.

Whether or not you have dense breasts can be determined only by an imaging study, such as a mammogram, and not through a clinical exam by your physician. Dense breasts occur most often in younger women because breasts get more fatty with age.

MammographyFaQWhen should I get one?Breast cancer experts recommend beginning annual screening mammograms at age 40 for most women — younger if your doctor recommends it based on personal or family health history.

Can I go anywhere?Most women can choose where to go for a mammogram as long as it is covered by their insurance company. Women can schedule a mammogram directly without a physician’s referral.

Can I change facilities?Yes. You are never locked into getting your mammogram at the same location. What’s important, however, is that the radiologist compares the results of your current screening to past mammograms. At The Trio Breast Center, we will obtain those records for you.

Are all facilities equal?No. Some things you should look for to ensure the highest quality are accreditation by the American College of Radiology; the availability of digital mammography, breast ultrasound, and MRI; and board-certified breast radiologists who read every mammogram. The Trio Breast Center meets all of these criteria. In addition, Trio is accredited by the National Accreditation Program for Breast Centers and offers a breast nurse navigator who helps women manage any needed follow-up appointments or treatment.

Do I need to worry about radiation?All people should limit the number of medical X-rays and scans they receive over their lifetime to reduce the chance of cancer. However, you should never avoid medical scans at the risk of your health. The benefits of getting annual screening mammograms starting at age 40 that detect cancer at its earliest and most treatable stages far outweigh the risks of exposure to radiation. Today’s digital mammography machines use half the radiation dose of the older analog machines.

What if I don’t have insurance?The Parker Adventist Hospital Foundation sponsors a program called Get-One-Give-One that provides FREE screening mammograms to uninsured women in Parker and the surrounding communities. To find out if you qualify or to make a donation to help other women, go to parkerhospitalfoundation.org/get-one-give-one.

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risk for breast cancer, call The Trio Breast center at Parker Adventist Hospital at 303-269-4150. parkerhospital.org/mammogram

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Parker, CO 80138

Portercare Adventist Health System

Parker adventist Hospital invites the community to its sixth annual Concert of ThanksCaring. This year’s program has been expanded to add performances and activities for children.

“The concert has always been our gift to the community, but now we want to use it to connect with our community and engage them in our healing mission,” says Morre Dean, CEO and president of Parker Hospital.

The concert will feature the sounds of local children’s choirs as well as the Denver Brass and Celtic Colorado. New this year will be a performance by the Celtic Dancers as well as a special presentation by Dylan’s Down with the Arts, a local boy with Down Syndrome.

An art exhibit titled “What Gives You Life?” by Legend High School students will be on display. Art honor students at Legend also will help children create art that will be delivered to hospital patients.

The Concert of ThanksCaring is part of the Parker Hospital Healing Arts program that incorporates visual and musical art into the healing process. The Healing Arts program is funded entirely by the Parker Adventist Hospital Foundation through community donations and hospital gift shop proceeds.

For a full list of activities at this year’s concert, please go to parkerhospitalfoundation.org/concert.

Parker Arts, Culture and Events Center (PACE)20000 Pikes Peak Ave., Parker, CO 80138

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Safe TravelsHelp holiday visitors combat altitude sicknessone ouT oF every Four PeoPle who travel from sea level to altitude will experience some form of altitude sickness. Altitude sickness can range from a simple headache to a full-blown medical emergency. “Particularly at the holidays, we treat a number of out-of-towners for altitude sickness,” says Phil Mitchell, MD, medical director of emergency services at Parker Adventist Hospital.

Symptoms include headache, nausea, fatigue, and difficulty sleeping. More extreme cases can result in difficulty breathing, fainting, and rapid heart rates. “The elderly are particularly at risk, especially if they already have a breathing or heart condition,” Mitchell says.

Mitchell suggests these tips:✓ Remind visitors to be well hydrated before traveling to Colorado, and

then drink an extra four to eight glasses of water daily while visiting✓ Limit alcohol, tobacco, and salt ✓ Hold off on activity for one to two days✓ If they have difficulty with altitude, ask their doctor at home for

Diamox, which can curtail altitude sickness

Mitchell also reminds visitors to continue taking their prescription medications, especially diuretics. “Many elderly will stop these medicines for fear of making too many trips to the restroom while traveling, but stopping can cause heart failure,” he says.

If you are traveling during the holidays or you’ll be hosting guests, make sure everyone has an up-to-date medication record with them. This form can save critical minutes in an emergency. Download a FREE printable record at parkerhospital.org/medrecord.

a CONCeRT OFTHaNKSCaRINgNOV. 11, noon-1:30 p.m. | FRee

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Grow Fall 2012