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Choosing wisely from the many options for treating back pain

PHOTO BY ELLEN JASKOL

Rosalie Holen chose surgery at Porter Adventist Hospital to relieve her debilitating back pain.

Read her story on Page 4.

Back to HEALTH

2 Stress, depression, or just the wintertime blues?

6 New at-home sleep study can help detect problems

7 New treatments for migraines

INSIDE THIS ISSUE

Your Connection to Healthy Living

Fall 2013 | Vol. 1, No. 4

2 VIBRANT :: Porter Adventist Hospital

Porter Adventist Hospital is a regional medical center that provides care for complex health issues. We specialize in general and robotic surgery, cardiovascular care, spine care, joint replacement, liver and kidney transplants, and cancer care. We are part of Centura Health, the state’s largest health care network. The purpose of this publication is to support our mission to improve the health of the residents of our community. No information in this publication is meant as a recommendation or to substitute for your physician’s advice. If you would like to comment or unsubscribe to this magazine, please email us at vibrant@centura.org.

2525 South Downing Street • Denver, CO 80210303-778-1955

Learn MoreJoin psychiatrist Dr. Claudia Clopton for a FREE seminar on recognizing the difference between stress and depression, along with tips for decreasing your stress. See back cover for details.

Between holiday stress, winter weather, and everyday priorities, the “happiest time of year” can stir up a flurry of negative feelings. For most people, these feelings are short-lived and vanish when life gets back to normal.

But for one in every four Americans, negative feelings could be a sign of a mental illness.

“Differentiating stress from a treatable mental illness can be difficult for many people,” says Steven Mays, MD, an in-patient psychiatrist at Porter Adventist Hospital. “I encourage people to think about what they have not been doing that they normally do, or what they have been doing that requires an inordinate amount of time and/or effort.”

Major life events, even positive ones such as the birth of a baby, a new job, or holiday celebrations, do not always evoke positive emotions and actions. Negative or “blah” feelings are not unusual, but they typically subside within a few weeks. When these feelings persist and impact daily activities or result in thoughts of self-harm, an underlying mental illness may be at the root of the problem.

Mood disorders, such as depression, bipolar disorders, and seasonal affective disorder (SAD), affect nearly 10 percent of the U.S. population. These disorders are marked by sadness, worthlessness,

‘Tis the season for stress, depression, and much more Give yourself a proactive present: Understand common mental health issues

Warning for Women Women are nearly 70 percent

more likely than men to

experience depression, according

to the National Institute of

Mental Health.

SAD Reality Seasonal changes can wreak havoc on mental health. While light therapy helps some, the best thing for seasonal affective disorder (SAD) — a depressive state usually occurring during the winter months, when less sunlight is present — is getting outside. “Be mindful of proactively engaging in activities outside of the house,” Mays says.

irritability, or erratic behavior that lasts for months or even years. Anxiety disorders, characterized by overwhelming fear or panic coupled with uncontrollable obsessive thoughts, affect roughly another 40 million adults annually.

“It’s important to remember that you are not alone and that help is available,” Mays says.

According to a study published in June 2013, discrimination against people with mental illnesses increases self-stigmatization and negatively impacts treatment of the disorders. “It’s not uncommon to blame or punish ourselves for needing help, which can make it harder to seek help,” Mays says. “When thoughts of self-harm arise or daily routines are significantly impacted, seek medical help.”

MENTAL BOOST 101

Stay connected: Create a plan and take baby steps toward being more social and active — resist jumping in all at once.

Set realistic expectations: Treatment and recovery take time. Resist the temptation to think, “It’s always been this way; it will always be this way,” and embrace the process.

Create a mood journal: At the same time of day, document feelings, energy level, mood, quality of sleep, and thoughts of harm. This daily routine helps identify patterns, triggers, and progress.

Read: Embrace the plethora of self-help books available; find one that’s right for you.

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REALITY BUMPSMammograms reveal more than breast cancer

While mammography is typically synonymous with breast cancer screening, the reality is that benign (noncancerous) breast diseases are more commonly detected during the low-energy X-ray procedure.

“Benign breast changes underlie the wide spectrum of imaging findings that we see in the breast,” says Jennifer Hankinson, MD, a radiologist at Porter Adventist Hospital. “In fact, benign processes, and not cancer, are commonly identified on imaging performed after an abnormal screening mammogram.”

In many cases, a combination of diagnostic mammography, ultrasound, and/or biopsy are necessary to make a diagnosis. According to Hankinson, some of the most common benign breast conditions are fibrocystic changes and fibroadenomas, neither of which typically leads to breast cancer.

Fibrocystic changes usually entail thickened tissue, dilated ducts, and the formation of fluid-filled sacs called cysts. In most cases, no treatment is needed unless discomfort arises. Fibrocystic changes are most common in premenopausal women and women on postmenopausal hormone replacement therapy.

Fibroadenomas are solid tumors that normally occur in women in their 20s and 30s. In certain patients, these tumors can be managed conservatively with imaging surveillance. For others, biopsy may be necessary.

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WARNING SIGNS While over-the-counter medications are effective for many people, seek medical attention when these more severe symptoms occur: Black stools Heartburn more than twice a week Pain when swallowing Vomiting Severe chest pain Weight loss

If experiencing these symptoms and gastroesophageal reflux disease (GERD), further medical attention is necessary to rule out cancer, esophageal stricture, and other conditions.

No need to panic Roughly one in 10 screening mammograms requires further imaging with mammography and/or ultrasound. Of those, only 10 percent will be referred for biopsy, and 70 percent of biopsies yield a benign (noncancerous) result.

Schedule your mammogram by textThe Porter Breast Center is making it easier than ever to schedule your annual screening mammogram. Just text your name to 303-872-7469 and one of our schedulers will call you within two business days during business hours to schedule a time that works for you. We’ll also retrieve past results from other facilities. Early morning appointments are available.

Antacids may offer more than relief for heartburn sufferers — the over-the-counter remedy has been linked to reducing cancers of the throat and vocal cord, according to a recent study conducted at Brown University and published in Cancer Epidemiology, Biomarkers & Prevention. The study also identified frequent gastric reflux, a cause of regular heartburn, as a risk factor for developing cancer.

While the study is preliminary and requires more research, the concerns of frequent heartburn and the positive effects of antacids are nothing new, says Hanna Kraus, MD, a gastroenterologist at Porter Adventist Hospital.

“It’s not uncommon for people to get total relief and be able to control their heartburn with products like Tums®, Zantac®, or proton pump inhibitors,” Kraus says. “If further research validates antacids as reducing the risk of cancer, then all the better.”

A burning sensation resulting from stomach acids backing up into the esophagus, heartburn affects nearly 44 percent of Americans at least once a month, according to the International Foundation for Functional Gastrointestinal Disorders. Frequent or uncontrollable heartburn is cause for concern, as it can lead to damage of the esophagus, larynx, and throat — and can infrequently result in cancer, says Kraus.

Beat the Burn Frequent heartburn may increase cancer risk

4 VIBRANT :: Porter Adventist Hospital4 VIBRANT :: Porter Adventist Hospital

Back to HEALTHWhen Rosalie Holen’s son called to say he and

her two grandsons wanted to take her to a movie and birthday dinner, she couldn’t

refuse. Even though she was in horrible pain, she didn’t want to disappoint her boys.

She’d been in pain for days. She didn’t have full control of her legs and feet. She had numbing in her arms as well, and the pain was so bad it had affected her sleep. She also was losing control of her bladder and bowels. Worse still, her primary care doctor and other

physicians were stumped.

“No one could come up with a possible reason,” she says.

The night of her birthday dinner, her son, an emergency physician who works out of state, observed her difficulty walking.

“He wanted to go right to the ER,” Holen, 74, says. “I didn’t want to. I refused. … The little boys wanted to take me to dinner.”

After more questions from her son, Holen lost the battle. In the emergency department of Porter Adventist Hospital that night, the emergency physician agreed and called Timothy Kuklo, MD, an orthopedic surgeon at Porter Adventist Hospital.

“I had several tests done,” Holen recalls. “It was just as my son thought.”

A vertebral bone in the middle of her back was broken, causing nerve damage. That night Kuklo performed surgery — a laminectomy and vertebral column resection to relieve the pressure on the spinal cord.

Holen felt the relief right away. “He did a beautiful job,” she says.

Before surgery is neededBecause Holen’s condition was affecting the nerves so severely, emergency surgery was necessary. But the good news is that most people with back problems don’t end up needing surgery.

Back pain will affect most of us some day. Here’s what you need to know about your treatment options.

Rosalie Holen’s surgery has helped her get back to her normal life where even household chores are a joy.

Understanding Spinal FusionA spinal fusion surgery is used to treat instability in the spine or an abnormality such as a curvature.

This surgery permanently joins two or more of the bones in the spine.

The number of spinal fusion surgeries performed in the U.S. has increased at a higher rate than other inpatient surgeries, but studies show this complex, aggressive

surgery may not always be necessary.

“Some people end up having a procedure that they shouldn’t have had,” says Timothy Kuklo, MD, an orthopedic surgeon at Porter Adventist Hospital.

“There are less invasive surgeries that are possible.”

And sometimes, he says, surgery isn’t needed at all. So, before undergoing spinal fusion — or any spine

surgery — consider getting a second opinion to make sure it’s the best option for your condition.

According to the National

Institutes of Health,

Americans spend approximately

$50 billion a year treating low back pain. It’s also the

most common reason for job-

related disability.

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Back pain is so common that 80 percent of us will experience it at some point in our lives. And, according to Michael Wayne Madsen, MD, an orthopedic surgeon also at Porter Adventist Hospital, the most common reason is an overuse injury — a sprain or strain. Another set of causes relates to the worsening of degenerative conditions in the spine such as a disk herniation (when the soft center of a spinal disk pushes out through the exterior), spinal stenosis (a narrowing of the spinal canal), or spondylolisthesis (slippage of one vertebra onto another).

When they are referred to a spine surgeon, a lot of people worry that they’ll need surgery, Kuklo says. “But well over 90 percent don’t need surgery even after they come to our office,” he says.

For people with sprains and strains, rest and ice — and maybe nonsteroidal anti-inflammatory drugs like ibuprofen — are all that is typically needed.

For people with degenerative spine conditions, surgery is considered a last resort, Madsen says.

Weight loss and improving your physical fitness is a good place to start to repair the spine, Kuklo explains. He recommends a walking program, yoga, and Pilates. And when patients go to physical therapy, they can work one-on-one with a therapist to develop a strength-training and stretching regimen to target their particular issue. Physical therapy also can help patients learn good posture and how to properly lift heavy items to prevent future injury.

If physical therapy and anti-inflammatory medications don’t work, some patients find that epidural steroid injections are helpful. And both Kuklo and Madsen encourage patients to try acupuncture, massage, or chiropractic care as well.

“The medical evidence (for alternative treatments) is lacking somewhat,” Madsen says. “But my take is that if it’s working, I’m delighted.”

Surgical considerationsEvery person’s situation is different, Kuklo and Madsen say. But if a spine condition is limiting your ability to live a high quality of life — and these nonsurgical treatments have failed — it may be time to consider surgery.

For some people, it’s because the pain is too severe. For others, a spine condition might prevent them from being able to walk more than 50 steps without needing to sit — something that lessens quality of life and affects cardiovascular health, Madsen notes.

The time frame for making that decision, he adds, varies. For some people, it might be six months. For others, it could be years before they decide it’s time to consider surgical intervention.

Kuklo adds that it’s also important for patients to be motivated to get better. Following surgery, a patient is

expected to start being active and go to physical therapy.

“We want people up and out of bed,” he says. “They have to be motivated to get up and get moving. The people who do well are those who are the most active and follow the physical therapy protocols.”

Up and movingHolen remembers the nurses and physical therapists at Porter Adventist Hospital asking her to stand and start to walk after her surgery. When she was able to move, she realized that not everyone is as lucky.

“I feel very, very fortunate,” she says, adding that her entire experience was a good one. “When I was at Porter, I don’t know of a time I had so many doctors, nurses, and therapists who were so kind to me.”

Today, three years after the surgery, Holen feels great and tries to walk a little every day.

“I walk outside with a cane — just to alert people so they don’t bump into me,” she says. “It’s not for my own benefit.”

If you’re experiencing back pain, Kuklo says, consider your spine surgeon a resource to figure out the cause of your pain and find the right treatment. It’s nothing to fear, he says.

“The vast majority of people who have significant back pain won’t need surgery,” Madsen adds. “They’ll do just fine.”

Back to HEALTH

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Back pain: What are your options?Experiencing back pain? Dr. Michael Madsen, orthopedic surgeon at Porter Adventist Hospital, will provide tips for nutrition and fitness, as well as offer insights on the nonsurgical therapies for back pain.

Date: Monday, Nov. 11Time: 6-7 p.m.Location: Porter Adventist Hospital

Conference CenterCost: FREERegistration (required): 303-777-6877

6 VIBRANT :: Porter Adventist Hospital

If you regularly read email, scroll through your Facebook page, or play “just one more” game of Fruit Ninja on your digital device as you drift off to dreamland, you’re not alone. But falling asleep by the soft glow of your smartphone, tablet, or laptop could be hurting your health and leaving you feeling sick and tired. In fact, a recent study found that two hours of exposure to those glowing screens at night may reduce melatonin levels by 22 percent.

“Light is alerting and suppresses melatonin production, which is a hormone that makes you sleepy,” says Emily Roby, PsyD, a psychologist at the Centre for Behavioral Health at Porter Adventist Hospital. “Suppressing melatonin may disrupt your sleep, and the resulting lost sleep can lead to high blood pressure, diabetes, and other health problems.”

So, if your technology has you tossing and turning, it’s time to power down your devices and keep your bedroom a sanctuary for sleep.

“If you remove the devices and get in bed and just sleep, it becomes a paired association where the bed actually becomes hypnotic — like it’s its own Ambien,” Roby

says. She also recommends at least an hour of downtime from devices before bed for both kids and adults.

When bad habits aren’t to blamePoor sleep hygiene isn’t always the culprit keeping you from getting a good night’s rest. A variety of disorders and causes may lead to sleep difficulties, from frequent leg movements and issues with medications to hormone-related problems and bad dreams caused by post-traumatic stress disorder. One of the most common sleep disorders is sleep apnea.

“There’s definitely an association between sleep apnea and insomnia,” says Neale Lange, MD, FCCP, FAASM, director of the Sleep Disorders Center at Parker Adventist Hospital. “If people are having difficulty breathing during sleep that’s evidenced by loud snoring, pauses in breathing, or significant daytime sleepiness, they need to get it checked out.”

A sleep study can help your doctor get to the bottom of your sleep problems. Studies can be performed in the sleep disorders centers at Porter, Parker, Littleton, and Castle Rock Adventist Hospitals.

SlumberSolutionsWhether it’s your digital habits or a sleep disorder keeping you awake, we’ve got tips to help you get your zzzs

Home StudyWhile a sleep study performed in a hospital sleep lab is required in some cases, home sleep studies — like the ones now available through Porter Adventist Hospital — also can be effective.

“It definitely is an option for some people,” Lange says. “People who are capable of using the equipment and don’t have significant medical disorders may be candidates.”

Though home studies don’t capture the full range of data that the accredited sleep disorders centers at Porter, Parker, Littleton, and Castle Rock Adventist Hospitals do, they record vital info such as airflow, snoring, blood oxygen levels, and head and neck movements, which can be used to help diagnose problems such as sleep apnea so that further testing or treatment can be provided.

Home sleep studies are covered by most insurance plans.

Take a sleep test at homeIf you’ve put off having a sleep test because it’s just too inconvenient, you can now do it at home. The Porter Sleep Disorder Center offers an easy-to-use home sleep test that you take at home and get results from our experts in just one week. Call 303-778-2401 to learn more about home sleep studies, or go online to porterhospital.org/sleep, where you can get more information and take a FREE online sleep quiz.

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Mojo for Migraines New treatments for ‘sick headaches’ More than one out of 10 Americans suffer from migraines, with women three times more likely than men. Characterized by a variety of symptoms, migraines typically include a headache with nausea, vomiting, and/or sensitivity to light, sound, or smell.

“Think of a migraine as a ‘sick headache,’ meaning an ill or debilitated feeling with a headache,” says Justin S. Moon, MD, a neurologist at Porter Adventist Hospital.

New forms of abortive medications, which treat migraines after they occur, now offer more options than ever to sufferers. As an alternative to oral medication, the slow-release sumatriptan (brand name Imitrex®) patch was approved by the Food and Drug Administration (FDA) in early 2013. Another option, the sumatriptan needle-free injection, provides relief in as little as 10 minutes for some patients.

For those unable to tolerate sumatriptan, a new inhaler that delivers dihydroergotamine (DHE) offers hope. DHE, a veteran abortive migraine medication, is traditionally administered intravenously or as a nasal spray.

To prevent migraines in some patients, Moon uses BOTOX®, which was FDA-approved in 2010 for chronic migraines.

“The core of the therapies we use have been around for a long time,” Moon says. “We are just using them in new ways, offering patients more relief.”

Minimize migrainesStart with a daily routine — sleeping at the same time for at least eight hours, exercising, staying properly hydrated, and not skipping meals. While a consistent routine is not always possible, for many migraine sufferers, it can minimize their occurrences without the need for medication.

Meet Dr. Justin Moon – Headache SpecialistAs a child, while most of his friends were focused on scoring touchdowns or stopping opponents, Justin S. Moon, MD, wondered about concussion prevention and treatment. Today, it’s no surprise that he specializes in head trauma, headaches, facial pain, and neurology for professional athletes and children alike.

A native of Phoenix, Ariz., Moon started his medical career at the University of Arizona, where he received both a master’s degree in public health and a medical doctorate degree. He then completed his neurology residency at the Medical College of Wisconsin (Marquette School of Medicine) before embarking on a headache and facial pain fellowship at the Mayo Clinic in Rochester, Minn. “Headache is an underserved area in medicine,” Moon says. “In addition to my interest in head trauma and neurology, I focused on where I could help people who were not getting their needs met.”

Moon, his wife, and their four children moved to Denver five years ago. Whether he is treating a professional hockey player for a concussion or a mother suffering from migraines, Moon tackles neurology head-on — it’s one of the reasons U.S. News & World Report recently named him a Top Colorado Neurologist.

Dr. Justin S. Moon

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Join Dr. Justin Moon, one of Denver’s top headache experts, as he explores the signs, symptoms, and treatment options for migraine headaches at a FREE community seminar on Nov. 7. See back cover for details.

Non-ProfitOrganizationU.S. Postage

PAIDDenver, CO

Permit No. 47732525 South Downing Street

Denver, CO 80210

Portercare Adventist Health System

Upcoming EventsJoin the health experts at Porter Adventist Hospital to learn ways to stay healthy as well as new treatments for health problems. All programs are FREE. For programs held at the Porter Adventist Hospital Conference Center, free valet parking at the hospital’s main entrance or plentiful free parking in the Porter Adventist Hospital parking garage is available. Registration is required for all events; register online at porterhospital.org/events or call 303-777-6877.

Porter Adventist Hospital is part of Centura Health, the region’s leading health care network.Centura Health complies with the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973, and no person shall be excluded from participation in, be denied benefits of, or otherwise be subjected to discrimination in the provision of any care or service on the grounds of race, religion, color, sex, national origin, sexual preference, ancestry, age, familial status, disability or handicap. Copyright © Centura Health, 2013.

Register online at porterhospital.org/events

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AVOIDING FALLS AND INJURYFalls are the most common causes of hospitalization and long-term care for the elderly. Join Porter Adventist Hospital physical therapist David LaValley to learn the common — and preventable — causes of falls. You’ll learn safety tips and exercises that will help you reduce the risk of falling. DATE: Tue, Oct 22 TIME: 1-2 p.m. LOCATION: Porter Adventist

Hospital Conference Center

GETTING A BETTER NIGHT’S SLEEPSleep problems affect your daily life and your long-term health. The good news is most sleep disorders can be prevented. Join sleep specialists Dr. Emily Roby and Bret Svoboda, BS, LPN, RPSGT, to learn how you can improve your sleep. DATE: Thu, Oct 24 TIME: 6-7 p.m. LOCATION: Porter Adventist

Hospital Conference Center

COOLING HEARTBURN AND MANAGING GERDHeartburn and GERD are more than just nuisances, they can increase the risk of cancers of the throat and vocal cords. Porter Adventist Hospital expert Dr. Hanna Kraus offers advice about common treatments, medications, and lifestyle changes to help cool heartburn and manage GERD. DATE: Tue, Oct 29 TIME: 6-7 p.m. LOCATION: Porter Adventist

Hospital Conference Center

HEALTHY EATING FOR THE HOLIDAYSDo you dread another holiday season centered on food and over-indulgence? Join Amber Thomas, RD, CSO, at Whole Foods in Cherry Creek as she discusses ways to modify traditional holiday meals and avoid common dietary pitfalls. DATE: Mon, Nov 4 TIME: 6-7 p.m. LOCATION: Whole Foods

Market, 2375 E. 1st Ave., Denver

HEADACHE OR MIGRAINE? Join Dr. Justin Moon, one of Denver’s top headache experts, as he explores the signs, symptoms, and treatment options for migraine headaches. Learn the differences between regular headaches and migraines and tips on preventing both. DATE: Thu, Nov 7 TIME: 6-7 p.m. LOCATION: Porter

Adventist Hospital Conference Center

BACK PAIN: WHAT ARE YOUR OPTIONS?Millions of Americans experience back pain every year, and it is the No. 1 reason for visiting a doctor. Dr. Michael Madsen of the Porter Spine Institute offers advice on when surgery may be an option and when other treatment options should be considered. DATE: Mon, Nov 11 TIME: 6-7 p.m. LOCATION: Porter Adventist

Hospital Conference Center

STRESSED OR DEPRESSED?Join Dr. Claudia Clopton to learn the differences, symptoms, and therapy options for various types of mood disorders, including stress, depression, seasonal affective disorder (SAD), anxiety, and others. DATE: Tue, Nov 19 TIME: 6-7 p.m. LOCATION: Porter Adventist

Hospital Conference Center

Porter Adventist Hospital is committed to quality and patient safety as evidenced by our recent honors, which include: The highest rating for surgery by

Consumer Reports

Named one of the top three hospitals in the state by U.S. News and World Report

An “A” from The Leapfrog Group for overall performance in keeping patients safe from preventable harm and medical errors

The Healthgrades 2013 Patient Safety Excellence Award™