Spring 2013 | Volume 5, Issue 2

Brain surgery for motion disorders.

page 6

Things to do BEFORE getting pregnant.

page 7

Missed endometriosis now revealed.

page 3pLUS...

New gallbladder surgery at Parker Hospital gets patients back in action fast.

Kay Lynn Anderson’s family was happy to have her home and pain-free after gallbladder surgery.

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Breathe EasyCorrect diagnosis key to lung disease treatment

ChROniC OBSTRuCTivE PuLMOnARy diSEASE (COPd) is often mislabeled and even misdiagnosed as asthma. This misdiagnosis can lead to ineffective treatment since COPD is vastly different from asthma.

“It’s easier to think you have asthma, which is mostly genetic, than to admit you have COPD since that is due almost entirely to cigarette smoking,” says Rob Bogin, MD, a critical care and pulmonary medicine specialist at Parker Adventist Hospital. “Because the treatments are different, it’s important to make the right diagnosis so that medications can be tailored properly.”

COPD actually is comprised of two diseases— bronchitis, or damage to the airways, and emphysema, damage to lung tissue. Asthma

affects only the airways. The only true way to get an accurate diagnosis is through a pulmonary function test, which measures the airway’s ability to get air into the lungs as well as the lung tissue’s ability to get oxygen into the bloodstream.

“Testing also tells us which patients will respond to treatment,” Bogin says.

To learn more about pulmonary function testing, go to parkerhospital.org/breathe-easy.

Q&AWith Khoi Pham, MD, Neurologist at Parker Adventist Hospital

What are ministrokes?A: People often mistakenly use the term “ministroke” when referring to a transient ischemic attack, or TIA. During a TIA, blood flow to the brain stops for a brief period of time. Although it is not a stroke, it causes strokelike symptoms.

People who experience a TIA are at high risk of having a stroke within the next month if the underlying causes are not addressed. High blood pressure, poorly controlled diabetes, high cholesterol, smoking, and an irregular heart rate are all risk factors.

The important thing to know about a TIA is that when it starts, you don’t know if it will be a TIA or a true stroke because the symptoms are the same. We have a drug available (called t-PA) that will restore blood flow to the brain during a stroke. But it only works if used within three hours of the onset of symptoms.

Parker Adventist hospital’s Primary Stroke Center is part of the Centura health Stroke network, Colorado’s largest network of stroke care. For more information, go to parkerhospital.org/stroke.

Shaking ShinglesREMEMBER ThE dAyS when moms would expose their children to the chickenpox

virus — intentionally? If you’re old enough to remember that and you were unlucky

enough to have developed chickenpox, you now are at risk of its painful sister —

shingles. “Once you’ve had the chickenpox, it can live in your nerves for years without

a flare,” explains Ozzie Grenardo, MD, a family practice physician at Parker Adventist

Hospital. “Then you can suddenly get shingles due to stress or decreased immunity.”

You also can carry the chickenpox virus without ever having had chickenpox. “It can

lay dormant for years without you even knowing it,” Grenardo says. Like chickenpox,

shingles causes an outbreak of blisters, usually on the torso, although it can spread to

the eyes, mouth, and genitals. Unlike the chickenpox, however, shingles can become

extremely painful. The good news is twofold: There is a vaccine to prevent shingles, and

there is medicine to treat shingles. “Antiviral medications are very common and have good

results when used early,” Grenardo says.

ShingLeS VaccineAdults over 60 (over 50 if you’ve had chickenpox or have a

depressed immune system) should be vaccinated.

To learn more, go to parkerhospital.org/shingles.

Vaccine can protect against painful virus

Women who quit smoking by age 40 almost completely eliminate the excess risk of dying from lung cancer or COPd, found a new study in the New England Journal of Medicine.

Dr. Khoi Pham

Learn more about strokes at a FREE class on April 18. See calendar for details.

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 grow@centura.org. grow is produced by Clementine LLC.

Executive Editor: Rachel Robinson

grow ■ parkerhospital.org ■ 3

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apRiL FREEhealth seminars

Weight-Loss SurgeryWed, Apr 10 | 6:30-8 p.m.Join bariatric surgeon Dr. Josh Long for a look at various surgical weight-loss options. Learn about the LAP-BAND®, gastric bypass, and sleeve surgical procedures, and whether you’re a candidate for surgery.

Stroke preventionThu, Apr 18 | 6:30-8 p.m.Did you know that 80 percent of strokes can be prevented? Join neurologist Dr. Khoi Pham to learn about stroke prevention, the warning signs of a stroke, and treatment.

heart healthTue, Apr 23 | Noon-1:30 p.m.Join cardiologist Dr. Joan Eldridge to find out how the heart changes as you age and steps to protect your heart.

The end to pelvic pain?Thu, Apr 25 | 6:30-8 p.m.Dr. Hope Cassel, OB/GYN, will teach you the causes of pelvic pain and how robotic surgery may help.

Join Parker Adventist Hospital for a series of FREE health seminars. All seminars are held in the Parker 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 by calling 303-777-6877, option 1.

See back cover for May seminars!

New look at endometriosisRobotic system helps doctors reveal hidden problem

SuRgEOnS AT PARKER AdvEnTiST hOSPiTAL are using a new robotic system to treat a type of endometriosis that previously could not be diagnosed.

Until now, surgeons have used laparoscopic surgery to see and remove most endometriosis lesions. But some women develop a type of clear lesion that cannot be seen with traditional laparoscopic surgery. Using the da Vinci® robot, surgeons can now find and remove these lesions.

“These women may have been told they did not have endometriosis, yet their pain continued,” says Hope Cassel, MD, an OB/GYN who performs the robotic surgery at Parker Hospital. “Using the da Vinci robot, I can visualize and remove lesions that would have been missed with the older technology.”

Endometriosis is a condition in which endometrium tissue is found outside the uterus. Because this tissue is reactive to hormones, it builds up and sheds with a woman’s menstrual cycle, causing inflammation and pain. Symptoms include:

> Pelvic cramping or pain, and low back pain that lasts greater than a few days of the month

> Uncomfortable or painful intercourse> Pain with or changes in urinary or bowel patterns during menstruation

If women are experiencing any symptoms — even if they were previously told they did not have endometriosis — they should talk with their physicians about the new procedure, Cassel says.

Learn more about endometriosis at a FREE seminar with dr. Cassel on April 25. See details here.

More than 15 health screenings — including body mass index (BMI) and blood pressure checks—will be offered FREE at this health fair. All screenings are provided on a first-come, first-served basis. For more information, go online to 9healthfair.org.

April 28 7 a.m.-Noon

Parker Hospital

Dr. Hope Cassel

Endometriosis in one of the top three causes of infertility but one of the least treated.

4 ■ Spring 2013 ■ grow

iT uSEd TO BE A diSEASE associated with middle-aged women. But today, gallbladder disease is affecting people of all ages.

“Gallbladder disease is profoundly common,” says Christine Rogness, MD, a general surgeon at Parker Adventist Hospital, who notes that gallbladder removal is consistently one of the two most common surgeries performed at the hospital. “We’re finding it present in all ranges of people — including older adults in their 80s or 90s, and even young adults.”

It’s estimated that about 10 to 15 percent of the population has gallstones, but most don’t have any symptoms and don’t need treatment. In fact, the American College of Surgeons reports that about 80 percent of people who have gallstones go 20 years or more without experiencing any symptoms.

Are you at risk for gallbladder disease?Kay Lynn Anderson, 42, an active wife and mom of two, who exercised and was careful with her diet, had been experiencing pain and discomfort in her upper

abdomen for five weeks before she saw her doctor in January.

“I was convinced it was my gallbladder. Since two of the four women in my family have had their gallbladder removed, I was sure that was the issue,” she says. “My doctor advised me, however, that it was possibly an ulcer. He gave me a prescription and suggested Mylanta, and he was going to schedule an

ultrasound for later in the week.”By later that day, however, Anderson

says, she was absolutely miserable. Her mom took her to the emergency room at Parker

Hospital, where an ultrasound revealed an inflamed gallbladder.

Inflammation of the gallbladder, or cholecystitis, is almost always caused by gallstones, which can prevent the gallbladder from emptying properly. This makes the gallbladder spasm, thus creating pain. Risk for gallbladder inflammation is higher in women than in men, and increases for both genders with age.

The risk for gallstones is also higher among people who are overweight, eat a lot of sugar, and do not exercise regularly, as well as for women who are pregnant or who take estrogen.

Rogness points out that with the rise of diabetes in the U.S., there’s additional concern around

Gallst nesWith robotic surgery, just one small incision is needed to remove gallbladder

What is the gaLLbLaddeR?

The gallbladder is a small, pear-shaped organ. it’s

located near the liver on the right side of the abdomen. When the liver creates bile (a fluid that breaks down fat in food for digestion),

it’s stored in the gallbladder and then released into the

small intestine.

Surgeons at Parker hospital now use robotic surgery to remove gallbladders through an incision the width of a marble. The incision is made through the belly button, leaving no visible scar.

parker adventist hospital is

one of the few hospitals in the area with single-incision robotic technology.

images: marBle ©istoCkPhoto.Com/ aNtimartiNa; Pear ©istoCkPhoto.Com/Caesargfx

gallbladder disease.The high levels of triglycerides that are often found

in people with diabetes can increase the risk of gallstones.

“One of the things that makes gallstones more dangerous is that if you’re diabetic,” she says, “you may have decreased sense of pain, so you may not notice the symptoms as quickly.”

The symptom most people notice is pain in the upper right part of the abdomen or pain extending from the abdomen to the right shoulder or back. You might also experience nausea, vomiting, fever and chills, or bloating.

Once these symptoms appear, surgery to remove the gallbladder is typically recommended. Untreated, gallbladder disease can lead to serious complications, such as serious infection of the gallbladder or inflammation of the pancreas.

Just one incisionThe day after she arrived in Parker Hospital’s emergency room, Anderson had surgery to remove her gallbladder. When Rogness explained the procedure, she knew everything was going to be OK.

“I was very comforted by her and instantly at ease,” Anderson says. “She took the time to truly hear me, and allowed my family and me to ask questions. She explained the procedure to me, and made it such a comfortable situation. Plus, she reassured me that I would finally have pain relief, which alleviated my anxiety.”

Rogness performed single-site surgery using the da Vinci® surgical robot.

The single-site robotic surgical approach requires just one incision through the belly button. With the

increased use of single-site surgery over the past several years, there’s also been more research.

“And in every study looking at single-site surgery, people complain less of abdominal pain,” Rogness notes.

“One of the other benefits to this procedure over a laparoscopic approach is cosmetic,” she adds. “With a laparoscopic approach, you would have three incisions across the upper abdomen plus one at the belly button. You may not want those scars.”

After surgery, patients typically go home the same day or the next morning, and at-home recovery takes about one to two weeks.

Anderson’s surgery was on a Thursday. By Monday, she says, she was able to move slowly and within a week of her surgery, she felt great. With a husband, two active kids, and a full-time job, healing quickly was important.

“I was thrilled it went the way it did; Dr. Rogness and the staff at Parker Adventist were unbelievable,” she says. “Now I feel fantastic.”

Why don’t i need my gallbladder?The gallbladder has an important role — storing bile, which helps with the digestion of fats.

“When you eat something fatty, it goes into the small intestine and sends a message to the gallbladder,” Rogness explains.

So, what happens if you have your gallbladder removed?

“Without the gallbladder, the bile just flows freely into the small intestine,” she says, noting that many people don’t notice.

“It doesn’t alter fat absorption or digestion,” she says. “And it doesn’t make you skinnier or fatter.”

However, one side effect that some people

may experience, she says, is diarrhea, which is the result of an increase in bile salts produced by the liver. When the small intestine can’t absorb the bile salts, they can spill over into the colon, where they appear to have a laxative effect.

But the good news, Rogness says, is this is unusual, and there are medications that can help.

Gallst nesDr. Christine Rogness, General/Breast Surgeon, Parker Hospital

grow ■ parkerhospital.org ■ 5

Kay Lynn Anderson came to Parker Hospital for single-incision robotic surgery to remove her gallbladder.

Learn more about gallbladder disease and the new robotic surgery at Parker hospital. Join dr. Rogness on May 30 for a FREE seminar. See back cover for details.

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A nEW APPROACh for deep brain stimulation (DBS) available at Littleton Adventist Hospital reduces the number of surgeries typically needed and allows patients to now be asleep during the procedure.

Using a new type of portable CT machine called the CereTom®, surgeons obtain precise images of the brain during the surgery. Prior to this, the procedure required separate surgeries

to place markers in the head, implant the generator, and connect the batteries. The new procedure eliminates the first surgery and the need for patient feedback, allowing patients to be asleep during surgery.

“Having to be awake was very stressful and uncomfortable for patients,”

says David VanSickle, MD, PhD, the neurosurgeon performing this new procedure at Littleton Hospital. “The CereTom also enables us to improve the precision of lead placement. This reduces the risk of damage to nearby healthy areas and cuts operating time in half.”

DBS is used for patients with Parkinson’s disease, essential tremor, or dystonia. It involves implanting an electrode in the brain that short-circuits the electrical signals that cause symptoms. It is powered by a small battery pack implanted below the armpit.

Fine-Tuned Adjustments For DBS to work effectively, the generator must be finely tuned and coordinated with a patient’s medications. Typically, that work is done by a neurologist at outpatient appointments that can take weeks or even months to secure.

DBS patients at Littleton Hospital, however, receive this treatment before going home through the Center for Rehabilitation at Porter Adventist Hospital. After the surgery, patients are transferred to this inpatient unit, staying an average of five to seven days while the generator is being adjusted by Mihaela Alexander, MD, an on-staff neurologist.

Porter, Littleton, and Parker Adventist Hospitals are Centura Health hospitals serving DBS patients throughout Colorado and the Rocky Mountain region.

“You might expect that everything becomes normal after the implant, but the reality is that you don’t just flip a switch,” says Gin-Ming Hsu, MD, a physiatrist and medical director of the unit. “Programming is typically done in stages. If this were done as an outpatient, it might take weeks, but we can usually complete it in days.”

Nearly Symptom-Free One patient recently had 95 percent of her symptoms disappear immediately after the surgery. But within a few days, some of her symptoms had returned, so the generator was adjusted along with her medications and she was able to go home nearly symptom-free, Hsu says.

“Had she not been here, it probably would have taken several months to get through the process that took us 10 days,” he says.

Littleton Hospital is opening a similar inpatient rehabilitation unit later this year.

Easier surgery for Parkinson’s patients Littleton Hospital first in state to offer “asleep” DBS

New deep brain

stimulation procedure

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Dr. David VanSickle

6 ■ Spring 2013 ■ grow

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hear about the new “asleep” dBS at a FREE seminar with dr. vanSickle on May 30 at Littleton hospital. go to mylittletonhospital.org/classes-and-events.

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Schedule a preconception counseling appointment. Three months before you plan to start trying to get pregnant, schedule this appointment with your doctor, says Vandna Jerath, MD, an OB/GYN who practices at Parker Hospital. During this appointment, she talks to patients about health issues such as diet and weight as well as any risks for genetic health conditions.

how to choose an obstetricianHere are a few questions to ask yourself to help you choose the right obstetrician.

� Have I asked my primary care physician, friends, and family for recommendations?

� Do I feel comfortable with this doctor?

� Do I have any health conditions that require special care?

� Does this doctor respect my birth plan?

� Does the doctor communicate with me well?

To find an OB/GYN, go to parkerhospital.org/birthplace.

Start taking prenatal vitamins. Folic acid (400 micrograms a day) is recommended to help prevent neural tube defects. “One important fact that most women don’t realize is that they should start at least three months in advance,” says Deb Tozer, MD, an OB/GYN who also practices at Parker Hospital. “Folic acid is important for development in the first trimester, which starts from the moment of conception, before the positive pregnancy test.”

Work toward a healthy weight. Pregnancy is not the time to start a diet. But if you’re overweight, adjusting your diet before conception is a good idea. Just like you, your baby will need plenty of healthy, nutrient-rich foods. Plus, with a healthy weight comes a lower risk of pregnancy-related problems like gestational diabetes, high blood pressure, and miscarriage.

Nix the bad habits. You probably know that smoking and alcohol are no-no’s during pregnancy. Jerath also recommends women cut back on caffeine as well. “Most studies say about 200 milligrams can be considered safe,” she says. “That’s a cup of coffee a day.”

Establish a workout routine. “Women should be in a regular exercise program three to four times a week,” Lee says. “When you’re fit before pregnancy, labor is less painful. Babies tend to be leaner, and labor is quicker.”

Ready for baby?5 tips for getting healthy before you get pregnant

The perfect crib. A beautiful nursery. The sweetest onesies. When you’re thinking about a baby, it’s easy to fast-forward to the day you bring

home your little one. But the first step to a healthy baby is a healthy you. Sue Lee, MD, an OB/GYN on the medical staff at Parker Adventist Hospital,

says the three months before you intend to become pregnant are a critical time. “Starting healthy habits now makes it easier when you do become pregnant,” Lee says.

Here’s a checklist to put you on the path toward a healthy pregnancy.

grow ■ parkerhospital.org ■ 7

Win a WaRdRobeOK, not quite. But you can

win a $100 shopping card from Southlands shopping center. go to parkerhospital.org/ southlands to register and

read entry rules. Parker Adventist hospital is the

exclusive health care sponsor of Southlands.

non-ProfitOrganizationu.S. Postage

PAiddenver, CO

Permit no. 47739395 Crown Crest Blvd.

Parker, CO 80138

Portercare Adventist Health System

Bone UpTips about calcium supplementsiF yOu dRinK A LOT OF MiLK, you’re doing your body good. But if you’re a woman over the age of 50 and you don’t consume at least 1,200 milligrams of calcium daily through dairy products, dark green vegetables, and other calcium-rich foods, you

should be taking a calcium supplement. But things aren’t as easy as popping a couple pills each morning. There are right and wrong ways to take calcium supplements, says Lisa Walker, MD, a family medicine physician at Parker Adventist Hospital. “If you’re taking calcium supplements, you should talk to your doctor or pharmacist or you could be throwing your money away — or worse, harming your health.”

Some things to know about calcium supplements:

May FREE health seminars

Become more body-wise with the experts at Parker Adventist Hospital. All seminars are FREE but require registration by calling 303-777-6877, option 1. Seminars are held in the Parker Hospital Conference Center at the west entrance. A light lunch is served during noon seminars, and light snacks are served during evening programs.

Laparoscopic hernia RepairThu, May 2 | Noon-1:30 p.m.Join Dr. Jessica Evans-Swanson, laparoscopic surgeon, to learn the difference between laparoscopic and traditional open surgery and the benefits of the minimally invasive option.

preventing colon cancerTue, May 7 | Noon-1:30 p.m.Join colorectal surgeon Dr. John Sun to learn if you are at risk for colorectal cancer, how to reduce that risk, and how a colonoscopy can save your life.

advances in Joint ReplacementTue, May 21 | 6:30-8 p.m.Join Dr. Derek Johnson, orthopedic surgeon, to learn about computer-navigated knee replacement, patient specific knee replacement, and minimally invasive anterior hip replacement surgery.

Weight-Loss SurgeryWed, May 22 | 6:30-8 p.m.Join bariatric surgeon Dr. Josh Long for a look at various surgical weight-loss options. Learn about the LAP-BAND®, gastric bypass, and sleeve surgical procedures, and whether you’re a candidate for surgery.

gallstones & gallbladder SurgeryThu, May 30 | 6:30-8 p.m.As many as one out of every 10 people have gallstones, which can lead to gallbladder disease. Learn about the latest, virtually scarless surgery for gallbladder removal with general surgeon Dr. Christine Rogness.

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, 2013.

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Parker Hospital is hiring! If you know any RNs or other skilled clinical professionals with at least two years of experience, we would love to hear from them. our associates earn highly competitive pay and some of the best benefits in the industry. to view all open positions or to apply online, please visit careers.centura.org.

Dr. Lisa Walker

Calcium supplements come in two forms — carbonate and citrate. Carbonate is cheaper of the two and used most frequently. But it must be taken with food, and it should not be taken with medications for gerd (acid reflux) or peptic ulcer disease. Citrate must be taken on an empty stomach.

Calcium supplements should not be taken with thyroid medications, as the absorption of the thyroid supplement may be impacted. other medications also can create interactions.

only 500-600 milligrams of calcium can be absorbed in a single dose. if you need higher doses, break them into morning, noon, and night.

you must have adequate levels of vitamin d in order for calcium to work. But whether and how much vitamin d is needed varies by person. your doctor should test your blood to determine your needs.