Vibrant Spring 2014

porterhospital.org :: Spring 2013 1

Thanks to fast action by a co-worker and advanced stroke care at Porter Adventist Hospital, Kevin Althoff of Centennial continues to enjoy his vibrant life. Read his story on Page 4.

EVERYTHING

2 Ensuring safety for aging drivers

3 Busting the myths of electroconvulsive therapy

7 Making breast cancer treatment simpler

Your Connection to Healthy LivingSpring 2014 | Vol. 2, No. 2

Timing is Acting fast when a stroke hits is

saving lives, and lifestyles. Know the signs and act F.A.S.T.

PHOTO BY ELLEN JASKOL

Approximately one woman dies every minute from heart disease in the U.S. In fact, heart

disease — not breast cancer — is the leading cause of death for

women.

One reason for so many deadly heart attacks is because

women tend to disregard their own health as they care for others. Women, particularly those who smoke or have diabetes, are the most likely to delay

seeking help when experiencing the signs of a heart attack, according to a 2010 Mayo Clinic study.

“Women tend to ignore their symptoms because they think they

don’t have time, or they don’t want to bother anyone,” says Toni Standley, RN, ANP-BC,

cardiac nurse practitioner at Porter Adventist Hospital. “We hear women all the time coming into the ER apologizing.”

Women also may not recognize the symptoms of a heart attack. Rather than having sharp pain in the chest, they more often experience pressure or a fullness. “The feeling that an elephant is sitting on your chest is a common complaint,” Standley says.

Other common symptoms are feeling like you have the flu or unexplained feelings of fatigue, anxiety, or weakness. “The most common symptom we hear is just an overwhelming sense of impending doom,” Standley says. And although diabetes puts a person at increased risk for heart attacks, they are often the people least likely to feel symptoms because of nerve damage.

Is it time to TALK SAFETY with your aging driver?

ELEPHANT on your chestWomen need to act on heart attack symptoms

Porter Adventist Hospital was named one of the nation’s

top 100 hospitals for cardiac surgery in 2014 by Healthgrades, an independent hospital rating organization. The hospital is also the first

and only hospital in Colorado to have earned accreditation and certification for its heart failure program and its atrial

fibrillation care from the Society of Cardiovascular

Patient Care.

If you have an aging parent, spouse, or friend, you might wonder about whether he or she should still be driving. “There’s no specific age after which an aging parent should stop driving, but certain physical, visual, and cognitive limitations can be warning signs for driving safety,” says Rey Erickson, OTR, MS, a staff therapist at Porter Adventist Hospital.

After a stroke, for example, an older adult may have trouble turning the steering wheel or using the brake, or get confused while driving. Complications of diabetes and other neurological problems can lead to problems feeling the wheel or pedals.

Arthritis can limit the ability to get in and out of a car or turn the wheel. Eye conditions like cataracts make it harder to read signs and see colors. Even normal age-related changes, like slower

reflexes and movement, can impact the ability to drive.

Warning signs that it may be time to pull over include: Difficulty reaching or feeling the gas and brake pedals

Getting lost, even on familiar roads Getting honked at a lot Frequent accidents or near misses

If you notice any of these signs, you should suggest a visit to the doctor or a certified driver rehabilitation specialist who can provide an objective opinion, which can help take the emotions out of the situation. Better yet is to discuss potential signs before they occur and agree on a time to start regular evaluations.

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Is your car fit for you?CarFit, a FREE program offered by Porter Adventist Hospital, helps older adults drive safely by ensuring that their cars “fit” them. Some of the items evaluated include seat belt position and the distance to the gas and brake pedals.

DATE: Sat, May 3TIME: 9 a.m.-noonLOCATION: Porter Adventist Hospital parking lotRESERVATION (REQUIRED): 303-765-6549

Spark of HopeAdvancements in ECT make it one of the most effective and often used treatments for depression and other mental health issues

Electroconvulsive therapy (ECT) often helps people with severe depression and other mental illnesses when other treatments don’t work. Unfortunately, media portrayals and how early treatments were performed have given ECT a bad reputation. Many people, for example, remember One Flew Over the Cuckoo’s Nest, where Jack Nicholson played a patient in a mental hospital who was given ECT, without anesthesia, as a punishment for bad behavior.

ECT is a treatment, not a punishment, says Benjamin Alderfer, MD, a psychiatrist at Porter Adventist Hospital, and it’s always done under anesthesia. “How

ECT is performed now is profoundly different than it was in the 1960s. It’s common now for people to wake up after a treatment and ask when they’re going to get their treatment.”

ECT uses a low dose of electricity that triggers a brief seizure that can quickly improve symptoms in people with severe depression (the most common use), bipolar disorder, schizoaffective disorder, and schizophrenia, and in people who are suicidal. A psychiatrist and an anesthesiologist perform the procedure together at Porter Adventist Hospital. Most patients have eight to 15 treatments.

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Learn MoreFind out more about ECT at porterhospital.org/ect.

HERE WE TAKE A LOOK AT COMMON MYTHS ABOUT ECT AND PROVIDE THE FACTS.

MYTH #1 ECT erases memory. “People are often afraid they’ll forget their own name or their husband’s or children’s names. They will not forget things that are well-ingrained,” Alderfer says. It’s common, though, not to remember much about the treatment.

MYTH #2 ECT causes violent and uncontrollable shaking. The word “electroconvulsive” makes people think ECT causes shaking bad enough to break bones and chip teeth. Because a medicine briefly paralyzes the body during an ECT seizure, the patient’s body barely moves at all. The patient is asleep during the whole procedure and doesn’t feel anything because of the anesthesia.

MYTH #3 ECT is a last resort. ECT isn’t just for people who’ve tried everything else first. “It should be used more often,” Alderfer says. “It should be considered once a person with depression has failed a few medications or has had an incomplete treatment response.” Most people feel much better after a few weeks of ECT.

MYTH #4 ECT is dangerous and causes brain damage. The designation of ECT as a special procedure in Colorado makes people think it’s dangerous. “ECT is incredibly safe,” Alderfer says. The risk of death during ECT is one in 240,000. That’s a lot lower than the risk of not effectively treating severe depression.

ECT doesn’t cause brain damage, and it doesn’t increase the risk of having other seizures. It can be performed in nearly all patients.

MYTH #5 ECT is a permanent cure. “While ECT is a highly effective treatment, it’s not a cure,” Alderfer says. Gradually decreasing the number of treatments from three a week to once a month helps keep depression from coming back. But patients still need treatment after ECT. Some patients continue to get ECT treatments once every four to 12 weeks.

Dr. Benjamin Alderfer



When Kevin Althoff suddenly couldn’t remember how to use the phone system at work, the

56-year-old physical therapist thought he was just having a bad day. Althoff had been under too much stress for too long. His responsibilities as a home health care rehabilitation manager had increased greatly after his boss and a co-manager left. Althoff was implementing electronic medical records, preparing for the

periodic state audit, and dealing with several organizational challenges. He was working 60 hours a week.

“A lot of things were piling on top of each other, causing a lot of stress,” the Centennial resident says.

A few minutes after forgetting how to use the phone, Althoff went to talk

to a colleague but couldn’t remember the colleague’s name. Then he felt nauseous. He asked another clinical manager, who was a nurse, for help. She recognized the signs of stroke, and called 911.

FAST ACTIONA stroke happens when blood flow to the brain stops. Brain cells begin to die within minutes. A stroke can cause permanent brain damage, leading to problems such as paralysis on one side of the body or difficulty talking, thinking, or remembering things. It also can be deadly.

“A person having a stroke needs to get to a hospital right away to be treated with state-of-the-art stroke therapies,” says Adam Wolff, MD, medical

director of neurology and the stroke program at Porter Adventist Hospital.

Faster recognition of symptoms and faster access to expert care have helped improve the outcome for stroke victims. In fact, stroke deaths have decreased 30 percent over the past 11 years, according to a recent study published in the journal Stroke.

Getting the proper care fast gives stroke victims the best chance at a full recovery. “Time is brain. The sooner we evaluate the patient, the better,” says Mark Prather, MD, an emergency doctor at Porter Adventist Hospital.

The most effective stroke treatment, a drug called tPA that breaks up the clot to restore blood flow to the brain, must be given within four and a half

Nationally recognized stroke care at Porter Adventist HospitalAs a Certified Advanced Primary Stroke Center, Porter Adventist Hospital meets Joint Commission standards for better outcomes for stroke care. “This means that we take good care of our stroke patients,” Wolff says. “We review our performance on each case and continually try to improve our systems to provide the best stroke care possible.”

Porter Adventist Hospital also received a Get With The Guidelines® — Stroke Gold Quality Achievement Award from the American Heart Association/American Stroke Association. This award recognizes outstanding performance in stroke care based on the use of the latest treatment guidelines. Porter Adventist Hospital is also on the association’s Target: Stroke Honor Roll, for improving stroke care.

Faster recognition of symptoms and specialized care for stroke victims is saving more lives than ever

More than a STROKE F LUCK

911

PHOTOS: STOPWATCH ©ISTOCKPHOTO.COM/BIBIGON; PHONE ©ISTOCKPHOTO.COM/BALAVAN; WALKING ©ISTOCKPHOTO.COM/ASISEEIT

porterhospital.org :: Summer 2013

hours of the start of the stroke. Other treatments also are more effective when done early.

THE RIGHT CALLWhen Althoff’s co-worker called 911, she set into action a plan that provided him with the best chances. Denver Paramedics arrived within minutes and after confirming that he was having a stroke, they notified Porter Adventist Hospital’s ER team who then activated a stroke alert.

A stroke alert at Porter Adventist Hospital notifies a neurologist, a neuroradiologist, and the imaging team that a stroke patient is on the way. An ER doctor and nurse are waiting at the door to meet the patient and get a CT scan. (Porter Adventist Hospital’s ER has a CT scanner in the department, eliminating delays of transporting the patient through the hospital or waiting until the machine is available.) Within minutes, the scan can help doctors determine if the patient has bleeding in the brain, called a hemorrhagic stroke, which would require surgery. An MRI also might be needed, which can help physicians see smaller strokes that might not appear on a CT scan, Wolff says.

In Althoff’s case, an MRI showed a small stroke. An ER doctor and a neurologist worked hand in hand to coordinate his care and determine the best treatment. “It’s good to have two sets of brains and eyes to make the decisions,” Prather says. While tPA was an option, Althoff chose not to get the drug since his symptoms were gone by the time the tests were done. After spending the night in the hospital for observation, he went home.

PREVENTING FUTURE STROKESAlthough strokes are most common in people over the age of 65, many people who are Althoff’s age or younger also are having strokes. So while stroke deaths have decreased, the number of strokes has actually increased. And stroke is still the leading cause of long-term disability.

The key to preventing strokes is controlling risk factors, which include high blood pressure, high cholesterol, smoking, diabetes, and abnormal heart rhythms such as atrial fibrillation (a-fib). Start with knowing if you have one of these risk factors and getting treatment for any of these conditions, experts say.

Althoff learned that he had high cholesterol and blood pressure. He now takes a higher dose of his cholesterol medicine along with aspirin to help prevent blood clots. Reducing his blood pressure is harder, since it only spikes when he’s under stress. While stress isn’t typically linked with stroke, “it can make any underlying risk factor for stroke worse,” Wolff says.

To reduce stress, Althoff resigned from his management job and went back to being a physical therapist, part time.

“The job wasn’t worth dying for. I want to be around for a while,” he says. Althoff is also eating healthier, exercising more, and working on losing weight. Five days a week, he walks in his hilly neighborhood, lifts weights, or uses the treadmill at his gym. Althoff is also spending more time doing things he enjoys, like remodeling the kitchen and grilling. His specialties include the fish he catches himself.

PHOTOS: STOPWATCH ©ISTOCKPHOTO.COM/BIBIGON; PHONE ©ISTOCKPHOTO.COM/BALAVAN; WALKING ©ISTOCKPHOTO.COM/ASISEEIT

Get Help F.A.S.T.If you or someone else is experiencing one of these signs of stroke, call 911 immediately:

FaceDoes one side

of the face droop when

asked to smile?

ArmsCan the

person lift both arms and

hold them?

SpeechIs the person’s speech slurred,

strange, or hesitant?

TimeIf any of these symptoms are

present, call 911.

After surviving a stroke, Kevin Althoff adopted a healthier lifestyle, including fishing and cooking.


PHOTO BY ELLEN JASKOL

Learn MoreIf you are interested in learning more about the types of weight-loss surgery and whether you are a candidate, join Dr. Josh Long, bariatric surgeon, for a FREE community seminar at Porter Adventist Hospital on Wednesday, April 30, at 6 p.m. Complete details on back cover.

STARTING ANEWHow one woman used bariatric surgery as a stepping-stone to begin a more active lifestyle

Less than two years ago, Carol Timm was morbidly obese, had little energy to accomplish more than the minimum tasks of daily life, and was facing a future defined by serious health problems.

“I have a family history of heart disease and my cardiologist told me that if I didn’t do something about my weight, he thought that within three to five years I’d probably have a cardiac arrest,” Timm says.

It was this risk coupled with the regret that she wasn’t able to be active with her four young grandchildren that led Timm to decide on bariatric surgery, and in November 2012 she underwent laparoscopic gastric bypass at Parker Adventist Hospital, a bariatric surgery center of excellence.

Since then, the 64-year-old has shed 159 pounds and counting, changed her eating habits for the better—including giving up the sweets that she used to love — and is a regular exerciser. In December, she competed in her first 5K run with her family.

“I would never have been able to do that before the surgery. I would never have even considered it … but I made it!” she says. “A whole new life has opened up for me.”

Fighting a losing battleWhile many people like Timm struggle for years losing and

regaining weight, there’s solid scientific evidence showing that the hormonal production of fat cells pulls strongly

in the wrong direction for them, says Joshua Long, MD, medical director of bariatrics at Parker Adventist

Hospital. Parker Adventist Hospital and Porter Adventist Hospital are part of Centura Health, the region’s leading health care network.

“They often come in buried in guilt and blaming themselves, but what

they need is something powerful to help level the playing field.”

According to Long, the best candidates for surgery are

individuals with a body mass index (BMI) of 35 or higher

with a health condition related to their obesity, or a BMI of 40 without a related condition.

“The most successful candidates are also committed to the overall process and to using all the tools that we give them,” Long says. “Patients who are highly motivated and really interested in partnering with us to maximize their benefits will get the most out of it.”

“ A whole new life has opened up for me.”

Dr. Joshua Long

Beating diabetes with bariatric surgeryThe evidence that weight-loss surgery can resolve diabetes is mounting. A study published last September in the Annals of Surgery found that the biggest predictors of sustained diabetes remission after bariatric surgery were:

Long-term weight loss

Having diabetes for less than five years before surgery

Having gastric bypass surgery versus gastric banding

Matthew Metz, MD, a bariatric surgeon at Parker Adventist Hospital, helped collect data from his patients for the study. Another procedure not studied in this research offers even greater odds for long-term resolution of diabetes, he says. The duodenal switch calls for removing a large part of the stomach and rerouting food away from much of the small intestine to limit how the body absorbs it.

“We’re seeing as high as a 98.9 percent resolution of diabetes with the duodenal switch,” he says.

Dr. Matthew Metz


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with her grandchildren.

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Streamlining breast cancer treatment In just one day at Porter Adventist Hospital, women who are newly diagnosed with breast cancer can meet with all of their doctors and get a customized treatment plan. At other hospitals, this process can take up to eight weeks, creating anxiety and frustration.

Held every Thursday, the multidisciplinary breast cancer clinic has three parts:

All of the meetings with the woman are held in one comfortable room, with the doctors and members of the support team coming to her. This process allows women to get fast answers and consistent information from everyone who will be treating her.

The multidisciplinary breast cancer clinic is part of Porter Adventist Hospital’s nationally accredited breast cancer treatment program. Accreditation from the National Accreditation Program for Breast Centers recognizes excellence in breast cancer treatment and patient care.

See firsthand the story of a local woman who benefited from Porter Adventist Hospital’s multidisciplinary clinic at porterhospital.org/breastcare.

To make an appointment with Dr. Truong, call 303-765-6380.

Morning The woman and her family meet with a breast surgeon and with the support team, including a licensed social counselor, a genetic counselor, a nutritionist, and a physical therapist, along with the nurse navigator.

NoonWhile the woman and her family are at lunch, the breast cancer treatment team — breast surgeon, medical oncologist, radiation oncologist, nurse navigator, and others — meets to develop a treatment plan.

The treatment plan is customized to the woman’s clinical needs, personal concerns, and lifestyle.

AfternoonThe woman and her family meet with the physicians to discuss the treatment plan.

Schedule your mammogram by textText your name to 303-816-8648 and we’ll call you within two business days to schedule your screening mammogram.

Comforting patients is part of the jobWhen Caitlyn Truong, MD, was growing up, she spent a lot of time in the hospital visiting a cousin who had childhood cancer. “I always found so much comfort whenever the doctor came. I wanted to be that person for others,” she says.

Today, Truong is a breast surgeon whose compassion and expert surgical skills help her patients battle breast cancer. “I will tell them, ‘I haven’t yet met a cancer that I didn’t know what to do with. We have a lot of people working together, and we will come up with a plan,’” says Truong, who is part of the multidisciplinary cancer care team at Porter Adventist Hospital.

Truong decided to focus on cancer surgery while studying medicine in her home state at the University of California, San Diego. She chose breast cancer because this is where she felt she could really make a difference in the lives of her patients — and their families. “Breast cancer strikes women who are otherwise healthy. Usually these women are holding their families together. When breast cancer strikes, it affects the entire family,” she says.

Truong completed her internship and residency at Loma Linda University Medical Center in California. While there, she received the Chief Resident Leadership Award. She completed a fellowship in breast cancer surgery at Stanford University.

Name: Caitlyn Truong, MD Specialty: Breast cancer and benign breast disease surgeon Practice: Centura Health Physician Group

Breast Surgical Care Location: 2555 S. Downing St.


PHOTO BY MICHAEL 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. 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

DANGERS OF PAIN RELIEVERSDr. Philippe Gauthier and Dr. Bipin Raj Bista explain the impact of long-term pain reliever use. Date: Fri, Apr 18 Time: 1-2 p.m.

9 HEALTH FAIRCome for a variety of FREE and low-cost health screenings and FREE health advice. Date: Wed, Apr 23 Time: 7 a.m.-noon

STAYING MOTIVATED — WORKOUT BASICSLearn the basics of getting active at the Porter Athletic Club, with trainer Deb Klafter. Date: Fri, Apr 25 Time: 12:30-1:30 p.m. Location: 950 E. Harvard

Ave., Suite B-40

CARDIAC HEALTHUnderstand the importance of developing good heart health. Date: Tue, Apr 29 Time: 11 a.m.-noon Location: Porter Place,

1001 E. Yale Ave.

WEIGHT-LOSS SURGERYGet the facts on weight- loss surgery and if it is the right option for you with Dr. Josh Long. Date: Wed, Apr 30 Time: 6-7 p.m.

STAYING MOTIVATED — RUNNING CLINICTake your health to the next level. Learn techniques and how to avoid injury at the Porter Athletic Club. Date: Fri, May 2 Time: 6-7 p.m. Location: 950 E. Harvard

Ave., Suite B-40

CARFITFor drivers 65+. Check how well your personal vehicle “fits” you. By appointment only. Call 303-765-6549. Date: Sat, May 3 Time: 9 a.m.-noon Location: Hospital

parking lot

DON’T GET BURNED BY SKIN CANCERDr. John Campana will explain how to prevent, recognize, and treat skin cancer. Date: Thu, May 8 Time: 6-7 p.m.

THINK F.A.S.T. — STROKE AWARENESSReduce your risk and under-stand the impact of a stroke. Date: Thu, May 15 Time: 6-7 p.m.

HEALTH OR HYPE — VITAMINS

Are vitamins a waste? Find out with Dr. Karen Guzzetta. Date: Tue, May 13 Time: 6-7 p.m.

GESUNDHEIT! Seasonal allergies can be miserable. Learn to relieve your symptoms this spring. Date: Tue, May 20 Time: 6-7 p.m.

LIVING WITH CHRONIC ILLNESSLearn coping skills to make living with a lifelong illness less difficult. Date: Thu, May 22 Time: 6-7 p.m.

CAREGIVERSUnderstand how to care for yourself while caring for another. Date: Mon, Jun 2 Time: 2-3 p.m. Location: Clermont Park,

2479 S. Clermont St.

HEART FAILUREDiscover how to avoid heart failure and take control of your health with Dr. Ira Dauber. Date: Tue, Jun 3 Time: 6-7 p.m.

STAYING MOTIVATED – BEGINNING STRENGTH TRAININGLearn the basics of building strength through multiple disciplines at the Porter Athletic Club. Date: Tue, Jun 3 Time: 6-7 p.m. Location: 950 E. Harvard

Ave., Suite B-40

BREAST CANCER AWARENESSReduce your risk and raise your awareness of breast cancer signs and symptoms. Date: Mon, Jun 16 Time: 6-7 p.m.

ARTHRITIS EDUCATION DAYUnderstand the latest research and treatments from experts in the field. Date: Fri, Jun 20 Time: 1-4 p.m.

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Vibrant Spring 2014