health! - St. Francis Hospital, Fall '11

health!St. Francis

Franciscan Health System • FALL 2011

FROM St. FRAnCiS HoSPitAL AND THE OTHER SERVICES OF FRAnCiSCAn HeALtH SYSteM

See page 15 for our

Calendar of Events

Shed pounds with Healthy Solutions®!

HeARt diSeASe: Spot the clues

Close to home! Special care for high-risk pregnancies

2 Franciscan Health System | Fall 2011

Sign up for free health talks›› Interested in attending? Get more information or register by visiting the Franciscan website at www.FHShealth.org/classes or calling

888-825-3227 toll-free.

Know your health risks!›› When it comes to health conditions and diseases, early detection is key. Get insight into your health risks at www.knowmyhealthrisk.org. The assessments are simple, quick—and may just keep you healthy!

3 MEDICALCREDENTIALSMD, DO, PA, RN, CNM... Do you know the differences?

6 HIGH-RISKPREGNANCIESGet special care in the South Sound

7 HEARTDISEASESpot the clues before it’s too late

12 ASTHMARELIEFInnovative procedure can permanently open tight airways

14 COLONCANCERGetting screened isn’t so hard— and it just might save your life

Find your new health care professional today!

Capsules

Health! online ›› WWW.FHSHEALTH.ORG

Find us on Facebook, Twitter and YouTube!›› Get news and information about health events and more at:

www.facebook.com/FranciscanHealth

www.twitter.com/FHShealth

www.youtube.com (Search for FranciscanHealth System.)

Check us out!

LiSSA BROd, Md›› Franciscan Neurology Associates253-985-27221802 S. Yakima Ave., Suite 208Tacoma

SuE diLLOn, dO›› Franciscan Prompt Care253-539-420015214 Canyon Road E.Puyallup

LyLE CALCAMuGGiO, MdKAREn ROBinSOn, Md›› Franciscan Women’s Health253-944-695034709 Ninth Ave. S., Suite B-500Federal Way

THOMAS POuLTOn, Md›› Franciscan Urology Associates 253-272-84411624 S. I St., Suite 204Tacoma

yu Jin KiM, dO›› The Lakewood Clinic253-985-668811311 Bridgeport Way S.W., Suite 100Lakewood

FERdiJACKSOn “JAKE” RAMiRO, Md›› Federal Way Medical Center253-945-815430809 First Ave. S., Federal Way

Today’s health care teamMaking sense of credentials

The majority of people receive much of their health care from their “personal” doctors. These days, however, they’re likely to see a host of other medical professionals with titles they might not recognize.

While you may be used to getting treatment from a physician with a medical doctor degree, many studies show quali-fi ed, certifi ed, and licensed nurses and medical assistants provide a continuum of care in many settings.

Primary careA primary care provider is the medical professional you see fi rst for checkups and many of your health care needs. Depending on your preferences and health care plan, you may see the following:• Doctor. Most people’s primary care

providers are medical doctors (MDs) or doctors of osteopathic medicine (DOs) who specialize in internal medicine, family practice or pediatrics.

• OB/GYN. These doctors specialize in obstetrics, gynecology and wom-en’s health care. Many women see these doctors for their primary care.

• Nurse practitioner (ARNP). These nurses have graduate degrees in nursing and can serve as primary care provid-ers in many practices that serve adults, children and older patients.

• Physician assistant (PA). These professionals work with MDs and DOs to provide many services. PAs perform many of the same services as doctors. They may do physical exams and diagnose and manage diseases.

nursing careNurses communicate between patients and doctors, off er advice and support to patients and families, administer medi-cine and help perform diagnostic tests. Nurses make up the greatest number of health care workers in the US.

• Registered nurses (RNs) and licensed practical nurses (LPNs) both care directly for patients in hospitals and clinics. The RN is an advanced degree requiring more years of training and testing.

• Certified nurse midwife (CNM). These providers are trained to diagnose, treat and perform gynecological care for women as well as deliver and care for newborns.

No matter who you choose to provide your medical care, be sure to do your part by becoming an informed and involved patient to help ensure your chance of getting the right treatment.

www.FHShealth.org 3

For your information

Find your doctor at Franciscan Medical Group. Call 888-825-3227 or go to www.SouthSounddoctors.org.

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Make magical memories with your family this holiday season! Come and enjoy art, ice skating and more at the Franciscan Polar Plaza. See page 15 for more details.

When: Nov. 25 – Jan. 2Where: Tollefson Plaza in Tacoma, corner of Pacifi c Avenue

and South 17th StreetHours: 4 – 10 p.m. Mon – Fri; 10 a.m. – 10 p.m. Sat;

10 a.m. – 8 p.m. Sun When Tacoma School District is out for winter break,

hours will be extended to: 10 a.m. – 10 p.m. Mon – Sat; 10 a.m. – 8 p.m. Sun

Cost: Admission $8, skate rental $2

Weight management

Lose weight with Healthy Solutions® Last November when Denise Stahl reached the heaviest weight of her life she knew that she needed to make changes or face a future with health problems. She turned to Healthy Solutions® at St. Francis Center for Weight Management and has been dropping dress sizes ever since.

Weight loss made simpleCreated by Health Management Resources (HMR), the program is designed to help people who want to lose between 20 and 200 pounds. It features 14 shelf-stable microwavable meal replacement entrees, as well as chocolate and vanilla shakes. “The food is delicious, fast and convenient,” says DJ Gray, RN, manager of the Center.

During the weight loss phase of the program you attend weekly classes and eat HMR meals and shakes along with fi ve servings of your own fruits and vegetables. “The classes are very positive and encouraging. You get to know each other, too, which is fun,” says Denise. Women typically lose 1 to 3 pounds per week and men lose 2 to 4 pounds per week.

If you can’t make it in for the weekly classes, you can still join the program by doing the home-based version. Your food order is shipped to your house every two weeks, along with the support materials you need to be successful. It’s the same great program, done in the privacy of your home.

Maintenance that makes senseOnce you lose the weight, the Healthy Solutions® mainte-nance program helps you incorporate regular food back into your diet. By attending classes at least twice per month you learn how to troubleshoot diffi cult food situations, such as eating out. This phase lasts 18 months.

“The maintenance program reinforces healthy behavior, like keeping your exercise up and eating enough fruits and veggies,” says DJ.

Getting startedFor Denise, getting started was the hardest

part. But once she replaced her old habits with newer healthy ones, the weight

started to come off and she felt better than ever.

She’s now lost 50 pounds and gone from a size 22 to a size 10. “I feel a lot better. I’m more alert, more awake, more energetic and get a lot more done,” says Denise.

Denise wants to lose another 30 pounds. She’s not worried. “The program is easy to follow. Anyone can do it once they make the decision,”

she says.


To learn more about Healthy Solutions® call 253-944-6544 or 800-823-6525 to sign up for a free informational session.


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www.FHShealth.org 5

Ouch! If you’ve experi-enced kidney stone pain, you never want to again. Most people agree that kidney stones are extremely painful. Fortunately, with com-passionate treatment at

Franciscan Health System and smart prevention, you may never have to experience them yourself.

Kidney stones, also called renal stones, are crystalline “pebbles” that form from normal body chemicals. Men are slightly more at risk. But one in fi ve of us will develop at least one kidney stone.

How the pain startsKidney stones become problematic when they pass out of the kidneys and get stuck. Pain typically starts in the back and radiates to the abdomen, becoming quite intense, says family practitioner James Morgan, MD, with Franciscan Family Medicine.

“If a urinalysis tests positive for blood, a limited CT scan is ordered,” Dr. Morgan explains. Stone size and location determined from this internal view guides treatment.

A variety of treatment optionsA stone smaller than fi ve millimeters that is not completely blocking urine fl ow will usually pass on its own. Fluids, and sometimes medication to help empty the bladder and control pain, are prescribed.

But if the stone is large; the kidney appears infected, swollen, or blocked; or the patient has fever, chills, nausea, or vomiting, “that’s a medical emergency,” Dr. Morgan says.

A Franciscan urologist like Richard Zobell, MD, with Franciscan Urology Associ-ates, has the skill and advanced technology to treat larger stones. “We may use lithotripsy, an external sound wave, or lasers to break up stones so they can pass.”

Depending on severity, surgery may also be required. But today, “that typically

means a minimally invasive procedure using a scope,” he says. “Open procedures are rare.”

Water may ward off kidney stones“Some things are known to prevent stone formation, including fl uids, citrate (lemon juice) and magnesium, while other factors may cause stones to form such as a high-protein diet, salt in the diet and oxylate,” says Dr. Zobell. So if you’re a repeat off ender, dietary change

may be in order. Upon analysis, a majority of stones are calcium-oxylate-based. That means ditching spinach, beets, peanuts, chocolate, parsley, tea and coff ee. “But don’t cut out calcium,” Dr. Zobell notes. “It can actually help prevent recurrence.”

Avoiding the extreme pain of kidney stonesExtrememaybegreatforsports—butit’sbadforpain.

Kidney health

James Morgan, MD

Franciscan Medical Group urologists in your community

Christopher Arroyo, MD253-858-9192

John Bak, MD253-985-6134

Scott Bildsten, DO360-874-7300

John Hedges, MD, FACS360-874-7300

Keith Schultze, MD360-874-7300

Thomas Poulton, MD253-426-6180

Richard Zobell, MD, PhD253-426-6180

Gig Harbor Lakewood Port Orchard Tacoma

Are you or a family member suffering from kidney stones? Get in touch with one of our urologists today! Call 888-825-3227.


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For many women, pregnancy is a time of great excitement and joy. However, for some women it can also be a time of worry and concern, especially if you have a high-risk pregnancy.

“A woman with a high-risk pregnancy often requires a level of care and

monitoring above and beyond what’s needed for a typical pregnancy,” says Peter Robilio, MD, a Franciscan Medical Group perinatologist with Pacific Northwest Maternal-Fetal Medicine.

A woman may have a high-risk pregnancy because of a chronic medical problem that becomes more compli-cated with pregnancy, such as:• diabetes• heart disease• high blood pressure• seizure disorders• multiple sclerosis• asthma • thyroid problems• blood clotting disorders

The pregnancy may also be at risk because of an issue with the fetus, including:• malformation• growth problems• chromosomal abnormalities • neural tube defects like spina bifida

In addition, she may require additional care because she’s pregnant with multiples, has a history of complications during pregnancy or develops an issue during pregnancy that she didn’t have before, such as gestational diabetes.

Quality care close to home “At Pacific Northwest Maternal-Fetal Medicine, the physicians, nurses and staff provide comprehensive care for women with high-risk pregnancies from preconception consultations to prenatal diagnosis, through pregnancy, labor and delivery,” Dr. Robilio says. “We are able to play many different roles in a wom-an’s care depending on her unique needs.” Physicians use state-of-the-art technology, such as a level II ultrasound, to get the most detailed picture possible

of a baby’s anatomy and can better see how blood flows through the heart.

A significant number of women who are referred to Pacific Northwest Maternal-Fetal Medicine’s clinics have diabetes. “Hormones produced by the placenta during pregnancy can raise blood sugar levels, which can make diabetes worse or cause the disease,” says Therese Burke-Hale, RNC, patient care coordinator at Pacific Northwest Maternal-Fetal Medicine’s Federal Way clinic. “Diabetes can cause complications for both the mother and baby, but we work closely with women to teach them what they can do to control their blood sugar and reduce the risks.”

‘A safe and supportive experience’Women who come to Pacific Northwest Maternal-Fetal Medicine’s clinics can rest assured that they are receiving the best care possible. “Our perinatologists are fellowship trained and have extensive experience treating the full spectrum of complications associated with pregnancy,” Dr. Robilio says.

Patients also receive the care they need when they need it. “All of the doctors and I carry a pager 24 hours a day and are always available for our patients,” says Julie Deutsch, RNC, perinatology coordinator at the clinic’s Tacoma location. “We know that pregnancy can be a challenging time, especially for women with high-risk pregnancies. We do everything we can to ensure a safe and supportive experience for patients and their families.”

Special care for high-risk pregnanciesyou don’t have to drive to Seattle to get the best care for you and your baby

High-risk pregnancy

To learn more about all the prenatal and childbirth options at Franciscan, call 888-825-3227 or go to www.FHShealth.org/familybirthcenters.


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Pacific Northwest Maternal-Fetal Medicine

Peter Robilio, MD, perinatologist, Federal Way and Tacoma clinics

John Read, MD, perinatologist, Tacoma clinic

Kerry McMahon, MD, perinatologist, Federal Way and Tacoma clinics

www.FHShealth.org 7

especially if you have chest pain at rest, which could signal that a heart attack is occurring,” says Dr. Lau.

• Shortness of breath – This possible heart-attack symptom can also warn of heart failure, in which the heart fails to pump enough blood to the body. If you’re unusually breathless during physical activity, while at rest, or in combination with chest pain, call 911.

• Arrhythmia – If you regularly have skipped or quickened heartbeats or a fluttering feeling in your chest, you may have arrhythmia, or an irregular heartbeat. Talk with your doctor.

“Something besides heart disease could cause these symptoms, so it is a good idea to have them evaluated by a physician to rule out dangerous heart conditions,” says Dr. Lau. And it’s important to remember that even without any symptoms, you could be at risk for heart trouble.

Are you at risk?Certain heart disease risk factors are with you no matter what you do. These include advancing age, male gender, a family history of heart disease and ethnicity (for example, being African-American). But you can make changes that help you avoid lifestyle risks such as smoking, physical inactivity, and being overweight.

“A medical checkup can fi nd hidden risk factors such as high blood cholesterol, high blood pressure, or diabetes, which is strongly linked to heart disease,” Dr. Lau says.

When in doubt, it is important to talk with your doctor. “You don’t want a heart attack to be your fi rst sign of heart disease,” Dr. Lau says. If you have a hunch something might be wrong, he adds, don’t second-guess yourself—get prompt medical care.

Heart and vascular

When a heart attack happens, don’t wait!Quick medical help can greatly increase your chance for survival after a heart attack. Sadly, people who notice symptoms wait fi ve hours on average before they reach an emergency room. About half of those who suffer a heart attack die before they reach the hospital. If you think you may be having a heart attack, call 911 immediately. It’s better to learn you aren’t having a heart attack than wait until it’s too late!

HAVe YoU HAd A HeARt CHeCKUP LAteLY? To set up an appointment with a cardiologist, call 888-825-3227.


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Spot the clues to heart disease

Our hearts keep us going. And because we can’t see them, as long as they seem to be working, we usually don’t give them a second thought.

The scary fact is that you could go for years

without realizing you have clogged arteries that leave you just a heartbeat away from a heart attack.

“In the early stages of heart disease, as artery-clogging plaque is building, you may not have any symptoms. They may be absent, or easily missed,” says cardiologist Theodore Lau, MD, Franciscan Heart & Vascular Associates.

Even a full-blown heart attack may not have the sudden, severe chest pain you see in the movies. “Some heart attacks cause symptoms so mild people mistake them for indigestion—but the damage they can cause is still very real,” Dr. Lau says.

Could it be heart disease? Symptoms of chronic heart disease may include:• Angina – This discomfort usually

signals that the heart isn’t getting enough blood to meet increased demand, often caused by physical exertion, stress or digestion. You may feel pressure or squeezing pain in the chest, sometimes radiating to the arms, shoulders, neck, jaw or back. The discomfort may be aching, heavy, exhausting, sharp or burning. It may come and go. “See a doctor immediately,

Theodore Lau, MD, FACC

When it comes to breast health issues, breast cancer gets all of the attention. However, there are a variety of other breast conditions that women can develop during their lifetime. These breast issues

can cause lumps, pain and discomfort, among many other symptoms. In fact, women are more likely to visit a breast surgeon due to benign breast conditions than breast cancer, says Richard R. Gould, MD, a board-certified general surgeon with Auburn/Federal Way Surgeons and the St. Francis Breast Clinic, both of which are part of Franciscan Medical Group.

Women’s care

Maintain healthy breasts for life

Richard R. Gould, MD, FACS

The Women’s Health and Breast Center at St. Francis Hospital is a national leader in providing breast health services. Don’t delay! Make your appointment today! Call 888-825-3227 or go to FHShealth.org/mammography.


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Symptoms to know Some of the most common non- cancerous breast diseases that women may experience include:• Fibroadenoma – a solid, rubbery,

but usually painless lump• Fibrocystic breast changes –

lumps, bumps and pain in the breast that worsen before each menstrual cycle

• Mastitis – a breast infection that causes pain, redness and swelling in part of the breast

• Breast abscess – an infection of the breast due to a blocked milk duct that causes inflammation and pain

• Cysts – round or oval-shaped fluid-filled sacs within the breast that move when you touch them

• Nipple discharge – leakage that is clear, milky, yellowish or bloody

Why you shouldn’t waitIf you notice any of the symptoms above or any change with your breasts, be sure to see your physician and have it checked out, Dr. Gould says. “The symptoms of benign breast conditions can be very similar to breast cancer, so it’s important to have a doctor perform the necessary tests to rule out cancer.” Those tests may include a physical exam and health history followed by imaging such as mammogram or ultrasound—and a breast MRI if needed. Finally, a biopsy is usually performed to provide a definitive diagnosis.

“Seeing your health care provider can also help you feel better. Some of these conditions are treatable with lifestyle changes, medications, or in-office procedures such as fine needle aspiration to drain a cyst or abscess,” says Dr. Gould. “In some cases, such as a fibroadenoma that grows rapidly, surgery may be necessary to remove it.”

Whether a lump or other kind of breast abnormality is due to one of these conditions or something more serious like cancer, it’s important to get it checked out as soon as possible, Dr. Gould says. “There’s nothing better than early detection for treating any kind of breast disease.”


Keep the body in balance andhelpwardoffdisease

Inflammation

www.FHShealth.org 9

Scientists think chronic inflammation inside the body—a reaction of the body’s disease-fighting immune system—could play a role in developing conditions like heart disease, diabetes and cancer.

Nawang Sherpa, MD, a family practitioner with Federal Way Medical Center, doesn’t disagree. However, when it comes to curbing risk for these potentially life-threat-ening conditions, he prefers to consider the problem one of balance in the body.

“I have worked with many different types of people,” Dr. Sherpa explains. “While inflammation is still being researched, a large part of promoting health is balancing food and activity levels. If something’s not in balance, we get into trouble.”

Case in pointDr. Sherpa grew up at 12,000 feet in the foothills of Mt. Everest in Nepal.

“In the 70s and 80s, tourism became popular. I saw people in my town transition from carrying mountain climbers’ gear up Mt. Everest to running hotels. They went from being very active to very sedentary,” Dr. Sherpa says.

When their diet did not change with their activity level, they gained weight, Dr. Sherpa notes. “Even young men died of heart attack and stroke. Now people are more concerned about their lifestyle. Someone

working in an office cannot eat steak like a cowboy working on a ranch.”

Honesty is critical Shedding pounds has been shown to reduce inflammation and cardiovascular disease risk. So to help control weight, honesty with your doctor is the best policy.

“Your doctor should not judge you for what you eat or do. He or she should help

you come up with health maintenance strategies that match your lifestyle to reduce disease risk,” Dr. Sherpa says.

Healthy lifestyle ideasA healthy start for reducing inflammation and disease risk is to eat whole foods you prepare yourself. “Processed foods contain too much salt,” Dr. Sherpa says. Other foods to avoid because they tend to worsen inflammation include: red and processed meats, full-fat dairy products, and white bread and white rice.

Dr. Sherpa also recommends getting enough exercise and if you smoke, quitting.

Nawang Sherpa, MD

Cool the flame, control diAbeteSWhile inflammation as a cause for diabetes seems new, this relationship was noted by physicians more than 100 years ago, says endocrinologist Jayalakshmi Udayasankar, MD, with Franciscan Endocrine Clinic, who goes by “Dr. Jaya.”

Findings today mirror those historic observations, Dr. Jaya adds. Increasing prevalence of obesity is causing an increase in diabetes. “Inflammation is a common denominator for obesity and diabetes.”

Diabetes-promoting inflammation occurs in fat tissue. “Visceral fat, in the abdomen, and in organs such as the liver and muscles,” explains Dr. Jaya. “This inflammation increases insulin resistance and contributes to the development of type 2 diabetes.”

A little TLC is your best betYour best bet for reducing inflammation, decreasing insulin resistance and preventing diabetes is therapeutic lifestyle changes—also known as TLC—which promote weight loss through healthy eating and exercise, Dr. Jaya notes. Surgical weight loss shows similar improvements in inflammatory markers in the blood as measured by high-sensitivity C-reactive protein.

If you are overweight, “aim to lose at least 7 to 10 percent of your body weight to help get inflammation and diabetes under control.”

Jayalakshmi Udayasankar, MD

Call a Franciscan Medical Group doctor today at 888-825-3227 to get help making these important lifestyle changes.


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You may view fragility fractures—when bones break because they cannot withstand body weight during a normal daily activity—as a later-life concern. Not so, says orthopedic surgeon Patrick Vaughan, MD, with Tacoma Orthopaedic Surgeons.

“Fractures have their roots in weakened bones, known as osteoporosis. And since bone mass peaks in your 20s, if you’re 35 or older, it’s time to start thinking about preventing this potentially debilitating condition,” Dr. Vaughan explains.

Fortunately, with smart prevention and the help of Franciscan Medical Group physicians, you can stay one step ahead of fractures and live a more active, healthier life, whether you’re 29 or 90.

Are you at high risk for osteoporosis?“Osteoporosis means ‘bones with holes,’ and it is reaching epidemic proportions among American women,” says orthopedic surgeon John Bargren, MD, who practices at The Ortho-paedic Center in Tacoma.

Being female and older increases your risk of developing osteoporosis—though men can develop it, too. Other risks include being Caucasian, being under-weight, drinking excessive alcohol or coffee, and smoking.

Primary care physicians start testing an otherwise healthy woman for osteopo-rosis between ages 60 and 65 using the DEXA scan. This painless imaging test compares the density of bones in a

woman’s hip and lower spine against composite scores of healthy women in their 20s—the lower the score, the more likely it is that a physician will recommend both lifestyle change and some form of medication therapy.

the danger of fractures“Fragility factures usually occur in the hip or spine, though wrists and shoul-ders can also sustain these troubling injuries,” states Dr. Bargren. “Spine fractures may contribute to height loss and spine rounding. Hip fractures require rehabilitation and are more likely to result in loss of independence.”

Both men and women have a one in five chance of sustaining fragility fractures before age 65. However, after 65, the risk for women increases to a one in two chance. The reason for this change? Menopause. Once estrogen production falls, bone density decreases dramatically. Fortunately, there are preventive measures you can take to help protect your bones.

exercise is key!“Walk for 30 minutes at least three

times weekly. This kind of weight-bear-ing exercise is critical to increasing bone mass,” says Dr. Bargren. “Other benefi-cial activities include hiking, jogging, dancing and aerobics—anything that pits your bones against the force of gravity,” he adds.

bone up at mealtime“The Institute of Medicine recommends supplementing with calcium (1,000 mg for premenopausal women and 1,200-1,500 for postmenopausal women) and vitamin D (400-800 international units,

or IUs, daily). Taking vitamin D is extremely important in the Pacific Northwest, where sunshine is at a premium,” notes orthopedic surgeon Joshua Johnston, MD, from Franciscan Orthopedic & Sports Medicine Associates, Lakewood.

A healthy diet can also help your body get the minor minerals it needs for bone-building such as magnesium, manganese and iron. Many physicians recommend leafy green vegetables and other plant-based foods in addition to calcium sources like milk and yogurt.

Practice balanceAccording to the Centers for Disease Control and Prevention (CDC), injuries from home-related falls result in an average of 21 million medical visits and 20,000 deaths each year. They are the leading cause of injury among adults 65 years and older in the US. However, studies show that patients in their 80s and 90s who exercise regularly have improved balance and fewer falls.

If your balance isn’t what it used to be, try this exercise: Stand near a wall or a table so you can catch yourself if necessary. Balance on one leg for five seconds and then on the other leg every day. After a week, try to increase the balancing time to 10 seconds. Ultimately, you should set a goal of 15 or 20 seconds each day.

Quit smoking“Many patients in their 30s think the only risk to smoking is lung cancer. They are surprised to learn that smoking leads to greater risk for back

Orthopedic care

Fend off fragility fractures Understand your osteoporosis risk to maintain health and quality of life


Patrick Vaughan, MD

John Bargren, MD

Joshua Johnston, MD

pain, osteoporosis and longer recovery times after injuries,” says Dr. Vaughan.

Get screened Most primary care physicians start screen-ing for osteoporosis between the ages of 60 to 65. If your family has a history of fragility fractures, or you have lost height (a possible spine strength issue), your doctor might recommend screening as early as 50.

Understand treatment risksNo medication therapy is without risks. In the past, estrogen therapy was used to help prevent bone loss. This may still be an option for some women, but there is a slight increase in the risk for breast cancer. Other therapies include medications in a class called bisphosphonates. While they can increase bone mass, they do carry a

risk of gastrointestinal problems. Prolonged use of bisphosphonates have been found to increase the risk of fractures in some women. Your physician will recommend the best course of treatment for you.

take as directed Even with the associated risks, medication is important—especially for older women who are at greatest risk for fracture because of thin bones and poor balance.

“The most important thing to do to avoid gastrointestinal issues is to take the medications as directed,” notes family medicine physician Hong Nguyen, MD, with Federal Way Medical Center. “Take the medication sitting up with a glass of

water when you first wake up (before eating). Stay sitting up straight for at least half an hour after taking the medicine and don’t eat for at least an hour,” she adds.

“Taking medication with at least eight ounces of fluid is critical because this particular type of pill can get stuck in the esophagus and cause irritation,” explains family practitioner Kevin McKeighen, DO, with Enumclaw Medical Center. “You shouldn’t just take it with a sip of water like many other pills,” he says. “IV medications and nasal sprays are new options for patients who can’t tolerate the pills,” adds Dr. McKeighen. “However, prevention remains the best protection against osteoporosis.”

www.FHShealth.org 11

Hong Nguyen, MD

Kevin McKeighen, DO

Got QUeStionS? Attend one of our free orthopedic health talks. Find one near you by calling 888-825-3227 or go to www.FHShealth.org/classes.


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If you have severe asthma and are seeking better relief, St. Joseph Medical Center in Tacoma is among the first hospitals in Washington to offer the first nondrug treatment, called bronchial

thermoplasty. This innovative procedure can permanently open tight airways in the lungs, providing symptom relief that standard medication may not.

Hope for a better life“This is a very promising treatment for individuals who have been taking all the right medications as prescribed by their doctor, but whose symptoms are not completely under control,” says interven-tional pulmonologist Navdeep Rai, MD, who performed the initial bronchial thermoplasty on June 21 at the Advanced Endoscopy Center at St. Joseph. “The procedure will help many patients reduce their use of rescue inhalers, lead more active

lives and feel better physically.”The procedure is available to patients

who are at least 18 years old and experience severe, persistent asthma; and who are not already receiving relief from standard treatments such as inhalers or long-acting beta agonists (LABAs).

People with persistent asthma often develop a thickening of the smooth muscle lining the airway, which narrows the airways in the lung, causing coughing, wheezing and shortness of breath. Bron-chial thermoplasty reduces the size of that muscle, which decreases the ability of the airways to constrict. As a result, it helps reduce asthma attacks.

How it worksDuring this minimally invasive procedure, the patient is under moderate sedation or light anesthesia. An interventional pulmonologist, such as Dr. Rai, guides a flexible tube through the nose or mouth into the lungs. The tip of a small catheter is

expanded to contact the airway walls, then thermal energy is directed at the walls to permanently shrink the enlarged smooth muscle that has caused airway constriction.

The procedure is performed in three outpatient visits, scheduled about three weeks apart.

Navdeep Rai, MD

New treatment offers better relief for asthmaLiving with asthma isn’t always easy. While some cases are mild, others can be life-threatening.

Medical specialties

People with chronic severe asthma should talk to their doctor about a referral for this bronchial thermoplasty procedure.


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ACTnowFocused radiation therapy—delivering a large dose of radiation to a specific target in the brain without damaging surrounding healthy tissue—has long been the gold standard for treating patients with brain disorders without surgery. Now, next-generation technology available at St. Joseph Medical Center is enabling doctors to offer this revolutionary approach to more patients while shortening treatment times.

The updated technology, known as Gamma Knife Perfexion, is even more accurate and allows doctors to treat tumors that had been unreachable with the previous system, says Daniel Nehls, MD, FACS, a neurosurgeon with Franciscan Medical Group, who practices at Neurosurgery

Northwest in Tacoma. “In addition to brain disorders, we can now treat tumors at the skull base and upper cervical spine. The new system can also safely treat multiple metastatic tumors in a single session.”

Patients who can benefit from Gamma Knife include those with:• benign and malignant brain tumors• metastatic tumors• vascular malformations• trigeminal neuralgia• essential tremor

Despite its name, Gamma Knife treatment doesn’t involve any incisions, and patients experience minimal side effects. Because Gamma Knife is focused and precise,

patients receive the full dose of radiation in one session, compared to multiple sessions for conventional radiation therapy. The new system reduces treatment times significantly, enhanc-ing patient comfort.

“Gamma Knife Perfexion takes targeted radiation therapy for brain disorders to the next level,” Dr. Nehls says. “That means more people have more options for a good quality of life.”

Want to learn more about this life-saving service? Go to FHShealth.org/ssgk or call 888-825-3227.

Daniel Nehls, MD, FACS

Gamma Knife® PerfexionTM: A new level in radiation therapy


Ankle replacement


WD Page’s total ankle replacement was a success!

Ankle replacement

Most people know someone who has had a knee or hip replaced—but an ankle? Thanks to advanced technology, total ankle replacement (TAR) has become an appealing alternative to traditional ankle fusion surgery. For active senior WD Page, it was exactly the surgery he needed to keep him moving pain-free.

A full-time missionary known to the Russian orphans he ministers as “Grandpa Dub,” WD had been experiencing ankle pain for a couple years. “Walking was very painful, and I had a

continual limp. It certainly slowed me down.”WD was referred to Byron Hutchinson, DPM, who specializes in reconstructive

foot and ankle surgery at his clinic, Franciscan Foot & Ankle Specialists. What had begun with an ankle fracture had developed into end-stage osteoarthritis. Such severe arthritis is the result of progressive wearing down of the cartilage cushion that lines the ankle joint, ultimately resulting in bone-on-bone grinding, pain, and loss of function and mobility. While a fairly common condition, Dr. Hutchinson thought an uncommon solution might work best.

new hope for arthritic anklesUpon examination, WD was deemed a good candidate for TAR surgery. And since TAR’s average recovery time is two to two-and-a-half months compared to a staggering four to nine months for ankle fusion surgery, WD agreed it was the best option for him. “Ankle replacements have been around for over 40 years,” says Dr. Hutchinson. “What we’ve learned about biomechanics from hip and knee replacements has revolutionized this generation of ankle replacement.”

The procedure involves replacing the arthritic ankle with an implant composed of two or three parts that glide easily against each other. The ankle is therefore able to retain its natural movement painlessly.

One of the other benefi ts of TAR is that it places a smaller amount of stress upon the surrounding joints, reducing the risk for future arthritis. Fusion surgery is still recommended for younger patients with osteoarthritis, those with severe deformity of the leg, and diabetic patients.

After surgery, WD spent just four days at St. Francis Hospital, and began to move his ankle six days later. “The hardest part was waiting for the doctor to tell me I could put weight on my foot again,” he remembers. But after eight weeks, he was up and walking.

“That ankle is absolutely performing the way it’s supposed to and doesn’t cause any problems whatsoever,” says WD, happy to be back to his missionary work. “The pain is gone, and I’m back at full speed again.”

Walking on airGet active again with total ankle replacement surgery

Byron Hutchinson, DPM

tRUSt tHe eXPeRtSByron Hutchinson, DPM, is one of only a few surgeons in the South Sound regularly performing total ankle replacement surgery. To learn more, call Franciscan Foot & Ankle Specialists at 206-242-6553.


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If you were told you could prevent a potentially fatal cancer by getting one test every 10 years, would you do it? A colonoscopy screening, which is used to identify and remove abnormal growths in the colon before they can develop into cancer, does just that. But when it comes to this gold-standard screening for colon cancer, many of us procrastinate.

“If everyone at age 50 had a baseline colonoscopy screening, the death rate from colon cancer would drop signifi cantly,” explains Tricia Sinek, RD, CD, community cancer program manager for Franciscan Health System. “Colon cancer is probably the most preventable type of cancer. But it takes the initiative of individuals to get screened.”

A colonoscopy involves viewing the entire colon using a long fl exible lighted scope. If abnormal growths called polyps are found, they can usually be removed during the test. This eliminates the opportunity for these polyps to develop into cancer.

easier than you thinkA colonoscopy isn’t as bad as you might think. You have the option to be sedated before the test so you are very relaxed, and people don’t remember a thing. It’s not painful, and the procedure only takes about 15 to 20 minutes.

“Many people build up the idea of a colonoscopy to something bigger than it is. It’s really very simple. Once you have the screening, you don’t have to worry about it again for a long time. It’s peace of mind,” says Theresa Terem, MD, FACS, a Franciscan colon and rectal surgeon with Mt. Ranier Surgical Associates.

When to start testingThe Centers for Disease Control and Prevention (CDC) recom-mends beginning regular screening for colon cancer at age 50. However, you may need to get tested at an earlier age if you have:• a previous history of polyps or colon cancer• a family history of polyps or colon cancer• inflammatory bowel disease

If polyps are found during a colonoscopy, you may need to be screened more frequently. However, most people only require testing for this slow-growing cancer every 10 years.

“If you haven’t had a colonoscopy, go and check it off your list. It’s the easiest thing you can do to prevent cancer,” advises Sinek.


Have you been screened for colon cancer?

Colon cancer

AuBuRn/FEdERAL WAyH. James Yamashita, MD, FACSAuburn/Federal Way Surgeons253-927-1800

FEdERAL WAyRichard Gould, MD, FACSCarolina Salcedo-Wasicek, MD, FACSAuburn/Federal Way Surgeons253-927-1800

GiG HARBORDonald George, MD, FACSLinda Pai, MD, FACSFranciscan Surgical Associates253-530-2940

LAKEWOOdSteven Duras, MD, FACSFranciscan Surgical Associates253-985-2733

TACOMAEugene Cho, MD, FACSTheresa Terem, MD, FACSWendy Weeks, MDMt. Rainier Surgical Associates253-552-1200

Expert care, Close to homeMeet the Franciscan Medical Group specialists in your area who make up the fi nest team of colon and rectal surgeons in the South Sound.

Tricia Sinek, RD, CD

Theresa Terem, MD, FACS


UPCoMinG eVent

BeginaholidaytraditionthiswinterwhentheFranciscanPolarPlazacomestoTollefsonPlazaindowntownTacoma.AtTacoma’scoveredopen-airicerink,FranciscanPolarPlazagivesthecommunityanopportunitytocometogetherandmakememoriestolastalifetime.FranciscanHealthSystem,TacomaArtMuseumandotherlocalsponsorshavepartneredtomakeTacomaafestive,familyfriendlydestinationthisholidayseason.Visitwww.PolarPlaza.org.When: Nov. 25 – Jan. 2Hours: 4 – 10 p.m. Mon - Fri; 10 a.m. – 10 p.m. Sat; 10 a.m. – 8 p.m. SunWhen Tacoma School District is out for winter break, hours will be extended to 10 a.m. – 10 p.m. Mon – Sat; 10 a.m. – 8 p.m. SunCost: Admission $8, skate rental $2

HeALtH tALKS›› Healthy is delicious—Mediterranean diet to Reduce Cancer RiskLearnwhycertainfoodscanimproveyourhealth.EnjoyalivecookingdemowithacheffromtheSt.AnthonyCafé.Costis$10/personandincludesappetizersanddessert.Visit www.FHShealth.org/StAnthonyHealthTalks or call 888-825-3227 to register. Thur, Nov 10 • 5:30-7:30 p.m.GIG HARBOR Smalling Family Education Center, St. Anthony Hospital

›› Have the ultimate Birth ExperienceAreyoupregnant?Thinkingabouthavingyourfirstbabyoraddingtoyourfamily?TanyaWilke,MD,explainspregnancy

planning,includingprenatalexams.EnjoydessertandatouroftheFamilyBirthCenter.Visit www.FHShealth.org/classes or call 888-825-3227 to register.Tues, Nov 15 • 6-7:30 p.m.ENUMCLAW St. Elizabeth Hospital, Rainier Room

›› Healthy is delicious—Keep the Taste, Lose the WaistLearnhoweatinghealthytrulycanbedeliciousbyusingREALingredientsthatarefresh,locallysourcedandsustainable.Visit www.FHShealth.org/classes or call 888-825-3227 to register (required).Thur, Dec 1 • 5:30-7:30 p.m.LAKEWOOD St. Clare Hospital, Resource Center, 4908 112th St. SW

›› Women’s Health Tips for Boomers and BeyondFamilymedicinephysicianJanisFegley,DO,givesafreehealthtalkforwomenafter40.Visit www.FHShealth.org/classes or call 888-825-3227 to register.Thur, Nov 10 • 6-7:30 p.m.PUYALLUP Franciscan Medical Pavilion—Canyon Road, 15214 Canyon Road E

›› Successful Living with Heart FailurePresentedbyRosemaryPeterson,MDCall 888-825-3227 to register (required).Tues, Nov 16 • 6:30-8 p.m.FIRCREST Fircrest Golf Club, 1500 Regents Blvd

›› understanding Heart Valve issuesPresentedbyScottWerden,DO,FACC,andCraigHampton,MD.Call 888-825-3227 to register (required).Tues, Nov 29 • 6:30-8 p.m.FIRCREST Fircrest Golf Club, 1500 Regents Blvd

oRtHoPediC HeALtH tALKSRegister online at www.FHShealth.org/ortho or call 888-825-3227.

›› Best Joints in TownPresentedbyJohnBargren,MDMon, Nov 14 • 6-7 p.m.TACOMA LaQuinta Inn, 1425 East 27th St

›› Advancements in Joint ReplacementPresentedbyDavidBishop,MDWed, Nov 2 • 6:30-8 p.m.ENUMCLAW St. Elizabeth Hospital, Rainier Room

›› Help for your Aching KneesPresentedbyDeniseWells,MDWed, Nov 30 • 6-7 p.m.FEDERAL WAY St. Francis Medical Office Building

LiVinG betteR›› Living Well with Kidney diseaseSt.JosephNephrologyServicesisofferingclassestohelppeopleunderstandtreatmentsandhowtopreservekidneyfunction.Call 888-825-3227 to register (required).Wed, Nov 2 • 3–5 p.m. and Wed, Nov 16 • 3–5 p.m.TACOMA SJMC, Room will be noted at registration

›› Heart Healthy nutrition SeriesJoinusforafour-weekseriesprovidinghearthealthydieteducation.Registrationisrequired.Call toll-free 888-825-3227. SeriesstartthefollowingWednesdaysfrom9:30–10:30am:Nov 2, Dec 7, and Jan 4TACOMA St. Joseph Heart & Vascular Center Education Room

Support GroupsPleasevisitwww.FHShealth.org/support.

ST. JOSEPH MEDICAL CENTER1717 S. J St

Tacoma • 253-426-4101

ST. FRANCIS HOSPITAL34515 Ninth Ave S

Federal Way • 253-944-8100

ST. CLARE HOSPITAL11315 Bridgeport Way S.W. Lakewood • 253-985-1711

ST. ELIZABETH HOSPITAL1455 Battersby Ave

Enumclaw • 360-802-8800

ST. ANTHONY HOSPITAL11567 Canterwood Blvd N.W. Gig Harbor • 253-530-2000

Health Resources & EventsFRAnCiSCAn HEALTH SySTEM

Most programs and classes are free, but many require registration. For more information, call the number listed. Fall 2011

Franciscan Health is now on Facebook, YouTube and Twitter! ›› Search for “Franciscan Health System.”

health!St. Francis

A publication of Franciscan Health System

St. Francis Hospital 34515 Ninth Ave S, Federal Way, WA 98003St. Joseph Medical Center 1717 South J St, Tacoma, WA 98405St. Clare Hospital 11315 Bridgeport Way SW, Lakewood, WA 98499St. Elizabeth Hospital 1455 Battersby Ave, Enumclaw, WA 98022St. Anthony Hospital 11567 Canterwood Blvd NW, Gig Harbor, WA 98332Franciscan Medical Group 1313 Broadway Plaza, Suite 200, Tacoma, WA 98402

CEO, Franciscan Health System Joe WilczekPresident, St. Francis Hospital Tony McLeanManaging Editor Joan B. Artman

Franciscan Health System is part of Catholic Health Initiatives, which has health care facili-ties throughout the United States. ©2011, Franciscan Health System. All rights reserved.

For questions or comments, or if you’d like to be removed from the health! mailing list, please contact us at 253-382-3850, (fax) 253-382-3877, www.FHShealth.org or write to: Editor, Franciscan health!, Franciscan Health System, Marketing & Communications, PO Box 2197, Tacoma, WA 98401-2197.

FRANCISCAN HEALTH SYSTEM1717 South J StreetTacoma, WA 98405

ST. FRANCIS HOSPITAL • ST. JOSEPH MEDICAL CENTER • ST. CLARE HOSPITAL • ST. ELIZABETH HOSPITAL • ST. ANTHONY HOSPITAL • FRANCISCAN MEDICAL GROUP

ABOuT FRAnCiSCAn HEALTH SySTEM

OuR MiSSiOn To create healthier communities OuR ViSiOn To be the South Sound's first choice for healing of mind, body and spirit OuR VALuES Reverence, integrity, Compassion, Excellence››

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F RANC ISCAN ORTHOPED ICS – WE KEE P THE SOUTH SOUND MOV ING

Presented by denise Wells, MdRegister online at FHShealth.org/ortho or call 888-825-3227

Wednesday, November 30 • 6–7 p.m.FEDERAL WAY, St. Francis Medical Offi ce Building

Knee replacement can reduce pain and improve your quality of life. Come hear leading Franciscan orthopedic surgeon

Denise Wells, MD, give a free health talk titled, “Advancements in Joint Replacement - Help for Your Aching Knees.”

don’t suffer any longer!Advancements in Joint Replacement – Help for your Aching Knees

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health! - St. Francis Hospital, Fall '11