health!St. Joseph

Franciscan Health System • FALL 2011

FROM ST. JOSEPH MEDICAL CEnTER AND THE OTHER SERVICES OF FRAnCISCAn HEALTH SYSTEM

See page 15 for our

Calendar of Events

Making a difference: The Carol Milgard Breast Center

HEART DISEASE: Spot the clues

Keep your bones strongSee page 10

Maternal care

4 Franciscan Health System | Fall 2011

Your baby, your wayVaginal birth after cesarean could be an option for you

Your last delivery may have been by cesarean, but that doesn’t mean your next birth must be. At St. Joseph Medical Center, many women with previous cesareans are encouraged to consider trying for a vaginal birth

after cesarean, or VBAC, for future babies.

Advantages of VBACGail Venuto, MD, FACOG, an obstetrician at St. Joseph Women’s Clinic, says, “At their very first visit, we ask these women, ‘How would you like to have your baby?’ Many women don’t even realize they have a choice.”

Dr. Venuto explains, “Compared to a repeat cesarean delivery, a VBAC offers many advantages, especially if a woman has children at home.” She cites a shorter recovery and hospital stay, a lower infection rate and a reduced need for blood transfusions.

Are you a candidate?Not every woman with a previous cesarean should have a VBAC. According to Dr. Venuto, some women are advised to plan a repeat cesarean. They include:• women with a vertical

incision on their uterus instead of the much more common low, horizontal scar

• women with scars from pre-vious surgery on the upper part of the uterus, perhaps to remove fibroid tumors

• women who have had a previous uterine rupture

• women with several previous cesareans

• many women with diabetes or obesity

Safety firstMost women eligible to try for a VBAC can deliver vaginally. But VBAC candi-dates must understand that any labor could still end up with a cesarean for a variety of reasons. The baby might be coming out breech, or bottom first. Mom may fail to dilate, or the baby suddenly suffers distress.

Hospitals that offer VBACs should have an obstetrician ready to perform an emergency cesarean, if necessary. Not every hospital can offer this, but St. Joseph OB hospitalists ensure an obstetrician is always present.

Family-centered maternity careRegardless of how your baby is born, the St. Joseph family-centered birthing unit is geared toward meeting its patients’ needs. In addition to obstetricians like Dr. Venuto, the staff includes maternal-fetal medicine and family practice doctors, certified nurse-midwives, and experienced nurses.

“We ask each patient to develop a birth plan to consider what kind of

birth she wants, and we try to help her achieve it,” Dr. Venuto says. “That’s the case whether it’s a water birth or a birth with family members present, a VBAC or a scheduled cesarean.”

Gail Venuto, MD, FACOG

Learn more about all the choices our Family Birth Centers offer. Call 888-825-3227 or go to www.FHShealth.org/fbc.

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You never forget the day you discover you have cancer. India Furman, the mother of three children and grandmother of a young grandson, remembers it clearly.  She felt a pain in her left breast and discovered a hard mass the size of a golf ball. When she saw her doctor the next day, he was very concerned and told her to make an appointment immediately at the Carol Milgard Breast Center in Tacoma. Thankfully she was able to get in the next day.

After a quick succession of mammograms, ultrasounds and biopsies, her worst fears were confi rmed—she had cancer. Her diagnosis was invasive ductal carcinoma—a fast growing cancer that needed immediate attention.  The recommended treatment, a double radical mastectomy, was performed, and then the process of healing began.

“It’s been a painful, exhausting ordeal,” she recalls. But now, more than a year later, she smiles broadly and says that her health has defi nitely improved. “Things are getting better every day.”

She credits the Carol Milgard Breast Center’s technology and nurturing care with her good health. “I love Carol Milgard (Breast Center), and I love everyone I’ve met there,” says India. “I feel like I’m fi nally on the right track.”

Mammography

Making a difference: The Carol Milgard Breast Center One in eight women will be diagnosed with breast cancer in her lifetime

New medical building to be health care destination center

To learn more about mammography options available at Franciscan Health System, go to www.FHShealth.org/mammograms.

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India and grandson, Harvey Blue, enjoy a blustery day outdoors.

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Taking care of your health is going to be easier when St. Joseph’s new Franciscan Medical Building is completed. The patient-centered health care destination will offer seamless care in orthopedics, family medicine, women’s care and neurosciences.

The 120,000-square-foot building will accommodate four specialized outpatient “destination centers,” fostering collabora-tion among specialists, effi ciencies of care and cost, and promote convenience and an improved experience.

Located on South J Street, across from the St. Joseph Outpatient Center, the Franciscan Medical Building will include: • fi ve fl oors of physician practices• a skybridge across South J Street,

connecting to the Outpatient Center’s 2nd fl oor

• a 770-stall parking garage

The building’s contractor is Aldrich & Associates, Bothell; and has been developed by Frauenshuh, Tacoma.

If you’re like a lot of people, you may not think twice about everyday activities like combing your hair or walking to the mailbox. But for people who have rheumatoid arthritis (RA), such tasks can seem overwhelming.

RA is a chronic disease that causes pain, swelling, stiffness and a loss of function in the joints. It occurs when the body’s

immune system, which normally fights off bacteria and disease, turns on itself and attacks healthy joint tissue.

Arrested developmentThe good news is that, with proper treatment, RA can be controlled, says Dina Titova, MD, PhD, a rheumatolo-gist with Franciscan Medical Group’s ROAD (Rheumatology, Osteoporosis and Arthritic Disease) Clinic, which has a location in Tacoma.

“The earlier the disease is diagnosed, the better the outcome,” Dr. Titova says. “Starting aggressive drug treatment as soon as possible can prevent permanent joint damage.”

First, people need to recognize the early signs of RA. All too often, Dr. Titova explains, patients dismiss their symptoms as a normal part of aging. Also, it can be hard to know if you have RA because some symptoms, like joint pain and stiffness, can occur with other diseases. “That’s why it’s so important to have a proper evaluation by your doctor to get an accurate diagnosis.”

RA’s warning signsSee your primary care doctor if you experience any of these early RA warning signs:• pain, redness and swelling in the wrists and the small joints

in the hands and feet• joint pain in a symmetrical pattern (on both sides of

the body)• morning stiffness lasting more than an hour• joint pain accompanied by fatigue• joint pain and stiffness that improve with physical activity

Improving quality of life“There’s no way to reverse joint damage from rheumatoid arthritis once it’s occurred,” Dr. Titova says. “And there’s no way to prevent RA, although there is clear evidence that smoking does trigger RA in people who are genetically predisposed to developing the disease. The focus is on preventing joint damage with early, aggressive drug therapy that can slow the progression of the disease and even put some patients in remission.

“At the ROAD Clinic, we have so many more therapeutic options we can offer patients now to improve their quality of life.”

Stop rheumatoid arthritis in its tracksEarly diagnosis is key to better outcomes

ARE YOU AT RISK?Schedule an appointment with your internal medicine provider. Don’t have one? Call 888-825-3227 and get connected with a Franciscan Medical Group doctor today.

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Dina Titova, MD, PhD

8 Franciscan Health System | Fall 2011

Rheumatoid arthritis

Fight inflammation—and help ward off disease

Inflammation

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There is growing concern about the debilitating impact of chronic inflammation—now thought to be the root cause of degenerative disorders like arthritis, obesity, heart disease and cancer. But what exactly is inflammation and why is it so devastating?

Normally, inflammation is our body’s protection system. When we have an injury or exposure to a foreign microor-ganism, our body responds to the threat with inflammation and destroys the alien cells and then returns to normal.

Chronic inflammation takes place when the inflammation doesn’t turn off, and instead of protecting our bodies, continues to attack.

Scientists think chronic inflammation inside the body could play a role in the development of conditions like heart disease, diabetes, obesity, arthritis and cancer.

Why inflammation mattersStudies have shown that cancer often arises at sites of inflammation in the body.

A study in the Archives of Internal Medicine found that women with higher white blood cell counts—a sign of inflammation—had a greater risk of developing cancer of the breast, colon, lung and uterine lining.

Inflammation goes hand-in-hand with heart disease, also, notes Franciscan Heart & Vascular Associates cardiologist William Bilnoski, MD. “Inflammation, essentially, is coronary artery disease,” he explains. “Cholesterol attaches to the walls of the arteries and causes an inflammatory response, which can then

result in symptoms up to heart attacks that are caused by blood vessel blockages.”

Diabetes is also impacted by inflammation and must be carefully

monitored if chronic inflammation is present—especially if the patient is taking glucocorticoids, a form of steroid, says Endocrine Consultants Northwest endocrinologist Zhiyu Wang, MD. “Diabetic patients should talk to their physician about possibly adjusting their diabetes control plan, if inflammation-related problems are identified.”

Tracking inflammationOne way to check for inflammation is with a blood test to gauge C-reactive protein, or CRP, a protein made by the liver. With inflammation, CRP levels rise. Doctors may order CRP tests to check if some inflammation-related diseases, such as rheumatoid arthritis or lupus, are progressing.

People with high CRP levels also tend to do worse after heart attacks than those with more normal levels, notes Dr. Bilnoski. “I use the test only after I’ve done a thorough heart disease risk assessment,” he says. “It can help us determine how aggressively to treat heart disease, and may guide dietary and medication recommendations.”

How can you reduce inflammation?Some experts think that what you eat can reduce inflammation in your body. “De-creasing risk factors for many diseases cover the same strategies,” says family medicine physician Kavitha Krishnamani, MD, Franciscan Family Medicine, in Tacoma. “Watching your diet is critical.” She recommends eating more:• fiber-rich foods such as

pears, peas and prunes• fish• nuts• foods with magnesium,

such as soy, beans and leafy greens

Some foods to avoid because they might add to inflammation are:• red and processed meats• full-fat dairy products• white bread and white rice

These strategies tend to help control heart disease and diabetes.

Other strategies that Dr. Krishnamani recommends include:• exercise for at least 30 minutes three

times per week• don’t smoke• don’t drink to excess

These smart moves also target other risk factors for disease, such as artery-clogging cholesterol, which raises heart risks.

Zhiyu Wang, MD

Our health care experts have the answers. Call a Franciscan doctor today at 888-825-3227. 

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Kavitha Krishnamani, MD

William Bilnoski, MD

“Decreasing risk factors for many diseases cover the same strategies. Watching your diet is critical.” –Dr. Krishnamani

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 Orthopaedic 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 underweight, drinking excessive alcohol or coffee, and smoking.

Primary care physicians start testing an otherwise healthy woman for osteoporosis 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 in an effort to decrease long-term fracture risk.  

The real and present danger of fractures“Fragility fractures usually occur in the hip or spine, though wrists and shoulders 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.”

With the rise in osteoporosis rates, hip fractures are becoming more common, averaging more than 500,000 each year. That number is projected to increase to 750,000 in 10 years.

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.

Start—or keep—exercising“Walk for 30 minutes at least three times weekly. This kind of weight-bearing exercise is critical to increasing bone mass,” says Dr. Bargren. “Other beneficial activities include hiking, jogging, dancing and aerobics—anything that pits your bones against the force of gravity.”

Bone up at mealtimeThe 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, with Franciscan Orthopedic & Sports Medicine Associates in 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 obvious 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 ages 65 years and older in the United States. However, studies show that patients in their 80s and 90s who exercise regularly have improved balance, resulting in fewer falls.

If your balance isn’t what it used to be, start slowly. Stand near a support structure, such as a wall or a table so you can catch yourself if necessary. Stand on one leg for 5 seconds and then do the same with the other leg every day. After a week, repeat

Orthopedic care

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

10 Franciscan Health System | Fall 2011

Patrick Vaughan, MD

John Bargren, MD

Joshua Johnston, MD

the exercises but try to increase the time to 10 seconds. Ultimately you should set a goal of 15 or 20 seconds each day. It may not seem like much, but you’ll feel steadier and better able to adapt to a sudden incline or decline while walking.  

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 pain, osteoporosis and results in longer recovery time to heal after injuries,” says Dr. Vaughan. For fractures, longer recoveries can mean more time off your feet, which negatively impacts long-term mobility, heart health and increases the risk of infection. 

Get screened  As noted, most primary care physicians start screening for osteoporosis between the ages of 60 to 65. However, family medicine physician Brendon Hutchinson, MD, of St. Joseph Medical Clinic, explains you may be screened as early as 50 if you have any of the following:

• family or personal history of osteoporotic fractures

• loss of height, which can indicate spine strength issues

• history of steroid or injectable birth control use

• smoke or drink excessive alcohol or coffee

According to Dr. Hutchinson, “If you are female, white and underweight, and fall into any of the risk factors, early screening is extremely important. White women have a

greater osteoporotic fracture risk than women of other races or ethnicities.”

Understand treatment risks“No medication therapy is without risks,” says Dr. Hutchinson. “In the past, we used estrogen therapy to help prevent bone loss which may still be an option for some women. However, this does slightly increase the risk of breast cancer,” he notes.

“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 may also increase the risk of fractures in some women, however, further research is needed to confirm and understand why.” 

Take medications as directed “Even with risks, medication is important for many women—especially older women who are at greatest risk for fracture because of thin bones and poor balance,” says Dr. Hutchinson.

The most important thing to do to avoid gastrointestinal issues is to take the medications as directed, sitting up with a glass of water when you first wake up (before eating). You should remain sitting up straight for at least half an hour after taking the medicine and don’t eat for at least an hour. The reason it is important to remain upright after taking the pill is because this type of pill can get stuck in the esophagus and cause irritation.

www.FHShealth.org 11

Brendon Hutchinson, MD

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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Ankle replacement

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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 of years. “Walking was very painful, and I had a continual limp,” he says. “It certainly slowed me down.”

WD was referred to Byron Hutchinson, DPM, who specializes in reconstruc-tive foot and ankle surgery at his clinic, Franciscan Foot & Ankle Specialists. What had begun with an ankle fracture had developed into end-stage osteoar-thritis. 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 thought it was the best option for him. “Ankle replacements have been around for over 40 years, but this is a new technique using new technology,” 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. “Total ankle replacement surgery gives the ankle near normal motion,” says Peter Krumins, MD, orthopedic surgeon at Tacoma Orthopaedic Surgeons. “And because it places less stress on other joints, it reduces the risk of those joints becoming arthritic in the future.”

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 EXPERTS Dr. Hutchinson and Dr. Krumins are two 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 or Tacoma Orthopaedic Surgeons at 253-756-0888.

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Peter Krumins, MD

health!Franciscan

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. Joseph Medical Center Syd BersanteManaging 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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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. 2

Where: Tollefson Plaza in Tacoma, corner of Pacifi c Avenue and South 17th Street

Hours: 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

Brought to you by Franciscan Health System, Tacoma Art Museum and other local sponsors. www.polarplaza.org