Vibrant Fall 2014

porterhospital.org :: Spring 2013 1

Cindy Anderson had a wedding to plan, and cancer was not going stop that. Read her story on Page 4.

2 Social connections key to senior health

3 Surgery may be best for some herniated discs

7 Multiple ways to relieve pain

Living my Dream

With customized treatment plans at Porter Adventist Hospital, a cancer diagnosis

doesn’t have to alter your life plans.

PHOTO BY ELLEN JASKOL

Your Connection to Healthy LivingFall 2014 | Vol. 2, No. 4

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2 VIBRANT :: Porter Adventist Hospital

UNDER PRESSUREIf you have prehypertension, you can stop trouble before it starts

High blood pressure, called hypertension, is the No. 1 risk factor for stroke. Additionally, seven out of every 10 people having their first heart attack have high blood pressure.

The good news is there’s a warning sign and time to make changes before that ever becomes a problem in your life. About one in three adults has a condition called prehypertension—blood pressure readings that are higher than a normal 120/80 but not high enough to be considered hypertension, which is anything above 140/90.

“Prehypertension is a warning sign that can prompt us to make lifestyle changes,” says Shelby Hashker, RN, BSN, stroke program coordinator at Porter Adventist Hospital. She offers these tips: �Eat healthier. Eliminate high-sodium

foods and added salt from your diet.�Start losing. “By reducing weight,

you’ll put less strain on blood vessels, helping to keep the path open so blood won’t be resistant,” she says.

�Assess your stress. “Living a stress-filled life raises blood pressure,” she says.

�Talk to your doc. Identify ways to rein in blood pressure before it becomes a health risk.

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Friends Make Aging EasierStudies confirm what we’ve long known in our hearts: Social connections help our health. Research shows that our brains may benefit the most, as those who are socially engaged are less likely to develop dementia or other forms of cognitive decline.

Then again, 89-year-old Lila Fehrer could have told you that. “I’m convinced that an active social life improves your health,” says Fehrer, a Porter Place resident who has volunteered at Porter Adventist Hospital since 1992.

Whether “bowling” with friends on a Wii game console, playing Scrabble with fellow residents, or volunteering in the surgery waiting room at Porter Adventist Hospital, Fehrer says her social connections keep her mentally sharp.

Barbara Morris, MD, geriatric medicine specialist with Centura Health Physician Group at Clermont Park, says science is on Fehrer’s side. “Evidence shows you will feel better and have a better quality of life if you are social,” she says.

“I don’t think it can be emphasized enough how important these types of connections — whether religious, cultural, family, or community — are for health, both at the time of illness and for preventing illness to begin with.”

Is it time to move?Although many seniors don’t want to consider leaving their homes, senior living communities can improve quality of life and health, especially if they have become isolated. To learn more about the options available for seniors and the right time to make a move, attend a FREE program for seniors and caregivers at Porter Place on Wednesday, Oct. 22, at 6 p.m. RSVP by calling 303-765-6805.

Another Warning SignA transient ischemic attack (TIA), also called a ministroke, is a warning sign that a true stroke is likely to occur if something isn’t done. Porter Adventist Hospital, an Advanced Primary Stroke Center, offers a

one-day clinic for patients who have experienced a TIA. Tests that can typically take patients weeks to obtain are performed in one day, and the patient knows by the end of the day his or her risk factors for future strokes. Talk to your doctor about this program or call 303-715-7842.

Lila Fehrer credits her social connections at Porter Place for “keeping her going.”

Low Back BluesIf a herniated disc has claimed your quality of life, surgery may be your best betAlthough the majority of back pain patients will never need surgery, there are some cases where that’s just the right treatment. In a recent study published in the journal Spine, a major culprit of low-back pain — the classic herniated disc — was shown to be

better treated with surgery in carefully selected patients.

Woosik Chung, MD, medical director of the Porter Spine Institute, says the key lies in the phrase “carefully selected.”

“Sometimes you have a herniated disc that results in localized back or neck pain. We try our best to treat those nonsurgically,” he says. “The symptom that really concerns us is when we have neurologic involvement — pain radiating down the leg that results in a strength change or sensory change,” he says.

In the Spine study, the surgery group reported pain scores after surgery on a 100-point pain scale that were an average of 11 points below the nonsurgical group.

90/90 RuleWhile surgery can seem scary, living in constant pain drastically alters quality of life. So, how do you decide? Chung gives a “90/90” rule of thumb that may help guide treatment. “Ninety percent of low-back pain patients get better in 90 days,” he says. If 90 days have passed, and radiating pain persists down the leg (or the arm if the herniation is in your neck), it may be time to consider surgery, Chung says.

“The reason we don’t want to wait too long when there is a neurological insult is that those things may become more permanent and progressive,” Chung says.

Surgical OptionsIn the lower back, a procedure called microdiscectomy, which removes the piece of protruding disc, can offer relief for patients who experience radiating nerve pain. Spinal fusion, which joins one segment to another, can reduce pain and improve a patient’s structural stability.

Foraminotomy, a decompression surgery that gives the irritated nerve more space to heal, also may be an option. “We don’t necessarily take out the piece of herniated disc, but sometimes it’s enough to make the nerve happy,” Chung says.

Artificial disc replacement is also catching on as a less invasive treatment option. “This works best for a large herniation at a single level,” Chung says, noting that the biomechanics of the lower back make disc replacement less common than in the neck.

“Not all tools work in all situations,” he says. “The key is to work closely with your medical team to examine your symptoms and the specific treatment options that are best for you.”

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porterhospital.org :: Fall 2014 3

Dr. Woosik Chung

FREE Spine Surgery ClassDo you have a herniated disc? Considering surgery? Get answers to your questions from nurses on the spinal staff at Porter Adventist Hospital.

Dates 1st and 3rd Tuesdays | 9-10:30 a.m.Location Porter Adventist Hospital Conference Center, 2525 S. Downing St. (Free valet parking available.)Registration 303-778-2599 or online at porterhospital.org/spine-surgery-class

Symptoms of herniated discsHerniated discs can cause: Back pain that spreads to the

buttocks, thigh, and calf (or neck pain that spreads to the shoulder and arm) Numbness or tingling Muscle weakness

The pain may be worse: After standing or sitting At night When sneezing, coughing,

or laughing When bending backward

or walking


For Denver resident Cindy Anderson, 2014 has been all about planning her wedding. And fighting cancer.

Her wedding would be unique — an outdoor affair on a fall day in Bryant Park, a lush oasis bordered by midtown Manhattan’s sea of skyscrapers. Her

cancer had its nuances, too. Fed by a protein called HER-2, it was aggressive and stood the chance to double in size within six months.

The race was on.

“My goal was to have treatment complete before my wedding,” Anderson says, noting that she was immediately started on chemotherapy and Herceptin, a drug that targets breast cancer cells that overproduce HER-2, and Pertuzumab, a newly approved drug that has been shown to increase the complete clearance of a tumor.

The chemotherapy shrank the invasive cancer to less than a quarter of its original size and made it noninvasive. “This made for a much less invasive surgery,” Anderson says, noting that lumpectomy was always her preference over mastectomy. She finished radiation Aug. 21, a full five weeks before her wedding date.

Not ‘one size fits all’Today’s breast cancer treatment isn’t your grandmother’s breast cancer treatment.

“In the past, breast cancer patients were all treated almost the same way,” says Nadine Mikhaeel, MD, oncologist and cancer liaison for the Porter Cancer Program. “It’s not ‘one size fits all’ anymore. Today we understand that two patients can have the same size tumor, but it can be a very different cancer.”

When it comes to breast cancer, the stage and grade of the cancer, the hormone

One of a kindPorter Adventist Hospital breast experts treat each cancer — and each patient — with custom care

receptor status, the combination of genes within the cancer, and patient’s age and preferences guide treatment.

Realizing that no two cancers are alike, a panel of experts at Porter Adventist Hospital meets weekly to map out individualized treatment plans. The panel, called a tumor board, is comprised of experts in surgery, medical oncology, radiology, pathology, genetics, nutrition, physical therapy, and nursing. “We talk about every single new cancer diagnosis, and we follow up on current patients,” says breast surgeon Caitlyn Truong, MD.

Getting the pictureCustomized care begins with breast screenings. The Porter Breast Center offers advanced, accredited digital mammography. Some women are candidates for further screening or diagnostic tests, such as diagnostic breast ultrasound or breast MRI.

“The higher a woman’s risk, the more personal and tailored her imaging tests might be,” says Jennifer Hankinson, MD, lead imaging physician at the Porter Breast Center. She adds that genetic factors or family history of breast or ovarian cancer increase risk.

“There are always ways to personalize screening regimens,” Hankinson says. “Once we identify the patients we need to look at more carefully, we tailor additional screening modalities to them.”

Treatment optionsWhen cancer is present, treatments include surgery, chemotherapy, radiation, or hormonal treatment. A patient may need all four treatments, or only one.

IS IT ‘IN THE GENES’?If you have close relatives with breast cancer, you might wonder if you’re at higher genetic risk.

Or, maybe you have breast cancer and want to learn if you had a genetic predisposition — both to guide your own treatment and to help your children understand their risks. “A lot of times, a genetic diagnosis is a family diagnosis,” says Certified Genetic Counselor Josie Kagey, MS.

The Genetic Counseling Clinic at Porter Adventist Hospital can help you understand your risk factors and offer genetic testing, if needed.

For more information about how genetics plays a role in breast health, attend a FREE seminar on Oct. 22 at 6 p.m. See back cover for details.

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“A woman can have a small tumor that is hormone receptor positive that would benefit from hormonal treatment alone,” Mikhaeel says. “Another patient could have a hormone receptor negative type of cancer, and chemotherapy would be the choice for her.”

If a tumor is very large, surgery might be difficult up front. “If we treat with chemo-therapy ahead of time, we may be able to shrink the tumor enough that we can do breast conservation therapy,” she says.

Truong furthers the point. “Now there are many times I can offer lumpectomy over mastectomy,” she says, noting that cancers smaller than 5 centimeters generally can be treated safely with lumpectomy followed by radiation.

Sometimes, lumpectomy or mastectomy are each a viable option. “At that point, it’s important to me to educate my patients and single out what their goals are,” Truong says.

Personal journeysBoulder resident Jennifer Buice was diagnosed with an aggressive cancer at age 39. Like Anderson, her cancer was HER-2 positive. However, her cancer was also estrogen receptor positive and progesterone receptor positive, meaning that these hormones were causing the cancer to grow.

After extensive research and talking through the options with her doctors, Buice also decided to pursue chemotherapy prior to surgery, which in her case, was a double mastectomy performed at the Porter Breast Center. Buice also started Tamoxifen, which blocks the actions of estrogen.

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of a kind “I was young; I had two small children ages 2 and 4. The cancer was super hormone-driven, and I still had a long time to go hormonally. I decided I wasn’t even messing around with it, and mastectomy was the way to go,” she says.

Before being treated at Porter Breast Center, Buice had her initial biopsy and radiation treatments at a larger, university hospital.

“Everything there felt like a cattle call. If I needed anything special, I wanted to be someplace where I’m not one of the masses,” she says. “I called Porter my boutique hospital. I felt like they wanted what was best for me.”

While Anderson’s and Buice’s journeys have similarities, their treatment plans parted ways based on the nature of their cancers, their preferences, and their lifestyles. Porter Breast Center takes those changes to heart every day.

“We get to know our patients by first name,” Truong says. “Here, you’re not only getting excellence in clinical care, but it’s almost like you’re part of our family too.”

As Anderson puts the finishing touches on her wedding preparations, she attests to that firsthand. “The staff at Porter really looked at my breast cancer and my needs rather than saying, ‘This is how we treat breast cancer, and this is what you’ll be going through.’”

To learn more about customized treatment plans at the Porter Breast Center, call 303-778-5815 or visit porterhospital.org/breast.

Schedule by TextIf you are due for your annual screening mammography, simply text your name to 303-816-8648 and the schedulers at the Porter Breast Center will call you within two business days to make your appointment.

Cindy Anderson didn’t let a breast cancer diagnosis slow down her plans to marry Andy Perry.

Jennifer Buice chose to have breast cancer treatment that fit her life with her two sons, Josh (top), 9, and Jacob, 7.

Porter Cancer Care Center is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas.


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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 Hospital. “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.”

Porter Adventist Hospital, an accredited Chest Pain

Center, is part of the Centura Health Trauma System, the region’s largest and most

comprehensive network of trauma care and emergency

services.

Porter Adventist Hospital2525 South Downing Street 303-778-5666

Castle Rock Adventist Hospital 2350 Meadows Boulevard720-455-2500

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

Parker Adventist Hospital9395 Crown Crest Boulevard 303-269-4000

Southlands ER(opening early 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.


The road to rehabRestoring function is the name of the game for physiatrists

If you’re suffering from a back injury or some other type of nerve, muscle, or bone pain that affects how you move, maybe it’s time to see a physiatrist.

Not a psychiatrist — a physiatrist. Physiatrists, also known as physical medicine and rehabilitation doctors, specialize in nonsurgical management of pain and rehabilitation to help restore patient function.

Even though physiatry has been around since the 1930s and broadened in scope during the 1940s when post-World War II vets returned home with disabilities, the vast nature of conditions that physiatrists treat make the specialty less precisely identifiable than, for example, oncology (cancer) or gynecology (women’s health).

“I treat patients with musculoskeletal problems, back and neck injuries, peripheral neuropathy disorders, myofascial pain syndromes, migraines, spasticity, and mobility impairment — you name it,” says Michael R. Moore, MD, who has just opened a physical medicine and rehabilitation practice at Porter Primary Care Harvard Park in Denver.

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For example, physiatrists may treat:

Neck or back pain Carpal tunnel syndrome Sports injuries Herniated discs Pinched nerves Arthritis Fibromyalgia Myofascial pain Neuropathy pain

“A lot of patients nowadays want to pursue conservative approaches before jumping to surgery,” he says, adding that this is where physiatrists excel.

Moore likens himself to a coach, coor-dinating a complex “playbook” to help patients on the road to rehabilitation. “Whether it’s acupuncture, massage, physical therapy, occupational therapy, neuropsych treatments, injection therapies — I use it all. I’m open to any conservative treatment that will help maximize my patients’ function,” he says.

“ We look at the whole person and the whole picture. We don’t focus strictly on imaging.” – Dr. Michael R. Moore

An avid bicyclist and hiker, Michael R. Moore, MD, understands the value of being physically active. That’s why his passion is to help his patients become active again.Moore is the acute rehabilitation medical director at Porter Adventist Hospital and a physical medicine and rehabilitation specialist at Porter Primary Care Harvard Park. He is board-certified in physical medicine and rehabilitation as well as pain management.“I take care of 13 beds here in the hospital, supervising the rehab. I try to maximize the function for patients before they are discharged,” he says.In the clinic setting, he works with patients with ongoing rehabilitation needs. “I’m not a miracle worker, but I’ve had a lot of success stories,” he says, noting that he has helped brain injury, stroke, multitrauma, and complex regional pain syndrome patients regain independence. On his own time, he is very sports-oriented. “I enjoy playing sports, and I’ve had a great time watching and coaching my kids,” he says. He has been married to his wife, Melody, for 23 years and has been in practice for 19 years. Moore completed medical school at Loma Linda University School of Medicine and performed his residency at University of Colorado Health Science Center.

Dr. Moore has hiked several of Colorado’s 14ers. “It’s fun to talk (nay, brag?) about them and give them the old college try,” he says.

Dr. Michael R. Moore practices at Centura Health Physician Group Physical Medicine and Rehabilitation in Denver. He specializes in nonsurgical rehabilitation for pain, including back pain, neuropathy, and migraines. Call 303-649-3855 for an appointment.

PHOTO BY MIKE RICHMOND

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. All programs are FREE and are held in the Porter Adventist Hospital Conference Center unless otherwise indicated. For programs held in the Porter Adventist Hospital Conference Center, there is a free parking garage as well as free valet parking at the hospital’s main entrance. Registration is required for all events; register online at porterhospital.org/events or call 303-765-6549.

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.

Register online at porterhospital.org/events

Porter Adventist Hospital is a regional medical center that provides care for complex health issues. We specialize in complex surgery, cardiovascular care, spine care, joint replacement, liver and kidney transplants, and cancer care. We are part of Centura Health, the region’s leading health care network. Vibrant is published quarterly by Porter Adventist Hospital – Portercare Adventist Health System. 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 [email protected].

porterhospital.org

THE GENETIC FACTOR OF BREAST CANCERFind out what role genetics play in your breast health and if you are at higher risk. Date: Wed, Oct 22 Time: 6-7 p.m. Register: 303-765-6549

BE STILL MY HEART About 5 million people in the U.S. have heart failure. Learn more about the symptoms, causes, and treatments as well as how to reduce your risk. Date: Mon, Nov 3 Time: 1-2 p.m. Location: Porter Place,

1001 E. Yale Ave.

SAD AND YOUR SLEEPHaving trouble sleeping in the winter? Sleeping too much? Seasonal affective disorder may be impacting your sleep. Find out how SAD contributes to sleeping disor-ders and what to do about it. Date: Tue, Nov 4 Time: 6-7 p.m.

SLIPS AND TRIPS! Avoid the common and preventable causes of falls. Learn safety tips and fun exercises to help reduce your risk of falling. Date: Thu, Nov 6 Time: 1-2 p.m.

AVOID THE HOLIDAY BLUESIt’s well-known that the holidays can be a stressful and often lonely time. Dr. Claudia Clopton will discuss tips to lift your spirits and reduce depression. Date: Mon, Nov 10 Time: 6-7 p.m.

TRIM THE FATJoin the Cooking Cardiologist, Dr. Richard E. Collins to learn the impact of a high-fat diet on your cholesterol levels. You’ll also learn to cook (and sample) a dish that helps reduce cholesterol and still tastes great! Date: Tue, Nov 11 Time: 6-7 p.m.

WHEN YOUR SNORE MEANS MORESleep apnea is a potentially serious disease impacting more than just your rest. Dr. Keith Swartz will explain how to identify the symptoms and when you need to seek treatment. Date: Tue, Nov 18 Time: 2-3 p.m. Location: Clermont Park,

2479 S. Clermont St.

WEIGHT LOSS SURGERYTired of taking medicine for high blood pressure, diabetes, and joint pain? The solution may be weight loss surgery. Join Dr. Josh Long to learn about your options. Date: Thu, Jan 8 Time: 6-7 p.m.

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Women’s Care NightsTwo screenings, one appointment, less than 60 minutesRegister today to get your annual mammogram and Pap smear during our Women’s Care Nights! Join Aracea Women’s Care and the Porter Breast Center on Oct. 21, Oct. 28, or Nov. 4 from 4-7 p.m. and get your screenings taken care of in one evening. Convenient and fast, for your busy life. Both exams will take place in private at the Porter Breast Center. Dates: Tues, Oct 21, 28, and Nov 4 Time: 4-7 p.m. Call: 303-778-5815, option 2, to make your appointment

Mammograms and MassagesJoin us on Nov. 11 to get your screening mammogram and a massage. Referrals are not needed if you are over 40. Please check with your insurance to be sure you are covered at Porter Breast Center. Walk-ins welcome or call 303-778-5815, option 2, to schedule. Or text your name to 303-872-7469, and we’ll call you to schedule. Date: Tue, Nov 11 Time: 4-7 p.m.

Vibrant Fall 2014

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