porterhospital.org :: Spring 2013 1

Kevin Bemis, 32, considers his cancer a “project” that he manages while keeping up his active lifestyle. Read his story on Page 4.

CANCER

2 Better treatments for varicose veins

3 Medication checkup reduces problems

7 Female athletes at risk of pelvic problems

Your Connection to Healthy LivingSummer 2014 | Vol. 2, No. 3

Living With

Two out of every three thyroid cancer patients are under 55.

Porter Adventist Hospital is helping them live successfully with this disease.

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2 VIBRANT :: Porter Adventist Hospital

If you have a wound that won’t heal or experience wounds often, the experts at Porter Adventist Hospital’s Wound Care and Hyperbaric Medicine program can help. For more information, call 303-778-5242.

There’s nothing vain about seeking treatment for varicose veins. In fact, whether you have unsightly “spider” veins or bulging, painful veins, treatment can not only improve appearance — it can ease symptoms and prevent more serious complications. Carlos Rueda, MD, vascular surgeon at Porter Adventist Hospital, outlines pros and cons of medical treatments.

When to seek helpVaricose veins, which affect half of adults 50 and older, occur when the one-way valves that keep blood flowing toward your heart become weak or damaged. Rueda urges medical care if these symptoms are present: Swelling or pain in the legs that limits your lifestyle Achy, throbbing, or “heavy” legs Development of ulcers

TREATMENT OPTIONSSclerotherapy injects a liquid chemical to damage the vein, causing it to close and disappear.

PROS: It is less invasive than other medical procedures.CONS: Large varicose veins do not respond well (Rueda recommends this treatment for varicose veins less than 3 mm in size).

Endovenous ablation uses a catheter-guided heat source to close a vein from the inside. “There are two types — radiofrequency and laser. For the most part, they have equal success,” Rueda says.

PROS: It is minimally invasive, safe, and performed while pa-tient is awake. “It is the emerging gold standard,” Rueda says.

CONS: There are rare instances of blood clots or nerve damage.

Ligation and stripping makes incisions over the affected veins, and the veins are then tied off and removed.PROS: Treats severe cases although rarely performed.CONS: Involves numerous incisions and long recovery times.

Get a leg upTreating varicose veins

HAPPY FEETIf you have diabetes, a keen eye can help you put your best foot forward

They say the best defense is a good offense. If you have diabetes, this is especially true when it comes to caring for your feet.

Stay on your toes with these tips from Edward Cetaruk, MD, medical director of the Wound Care and Hyperbaric Medicine program at Porter Adventist Hospital.

Look at your feet daily.Do you see a spot where the skin is breaking down? “If you don’t have good sensation, you may not notice if a pressure point develops,” Cetaruk says.

Keep your feet clean, trim your nails, and invest in good footwear.The point here? Be proactive. A podiatrist can help with footwear or “offloading” shoes to reduce weight-bearing pressure, among other preventive measures.

Keep your diabetes under control.Well-controlled blood glucose can slow the progression of secondary problems such as neuropathy or vascular disease.

If you notice a wound developing, Cetaruk urges patients to see their doctor immediately. “It’s best to seek medical attention early,” he says, adding that most diabetic foot ulcers heal with good wound care, including:

• Reduction of pressure• Debridement, or removal of dead tissue in the wound• Prevention or treatment of infection• Use of wound dressings and products to enhance healing

If wounds do not respond to conventional therapies, hyperbaric oxygen therapy is another option available at Porter Adventist Hospital. This treatment saturates the blood with oxygen, helping stubborn wounds heal faster.

Want to learn more?Register for a FREE class on vascular health taught by Dr. Carlos Rueda.Date: Thu, Aug. 21 • Time: 6-7 p.m.Location: Porter Adventist Hospital

Registration required: 303-765-6549 or porterhospital.org/events

Dr. Carlos Rueda

Stick to the planTaking your medicines is key to preventing hospital readmissions

In the 1960s, oral polio vaccine drops were placed on sugar cubes — a practice said to have inspired the lyrics for the up-tempo “A Spoonful of Sugar” from Mary Poppins.

We’ve been looking for ways to help “the medicine go down” ever since.

In fact, according to the journal Circulation, a whopping 60 percent of heart patients do not take medications as directed. Some patients don’t think they need medication or don’t know why they’re taking them. Still others can’t afford them, don’t like their side effects, or simply forget.

Studies show that anywhere from one-third to two-thirds of hospital readmissions for heart failure patients are due to poor medication adherence. “At Porter Adventist Hospital, in heart failure patients specifically, 24 percent of patients readmit within 30 days. A quarter of those stem from noncompliance to medication,” says Nicole Trouchon, DNP, ANP-BC, heart failure nurse practitioner at Porter Adventist Hospital.

She hits the top reasons head-on.

“I don’t like the side effects.”There is no “one drug fits all.” And yes, there will be an adjustment period. However, lower doses or different classes of medications may limit side effects. “Tell your doctor how the medication makes you act and feel so we can make adjustments,” Trouchon urges.

“I can’t afford it.”If you’re choosing between paying for groceries or medication, bring this burden to your doctor. “We have access to samples, which can help early on when we’re trying to find the right medication. Pharmaceutical companies offer assistance. We can help you find programs or lower-cost prescriptions,” Trouchon says.

“I don’t think it works.”To this point, it takes two to tango. “Providers need to better explain why medications are helping, especially if patients don’t ‘feel’ anything,” Trouchon says. And patients should ask questions, too. “If a patient doesn’t understand a drug’s function, they are at higher risk of just stopping it.”

“I don’t need it.”If you’ve been prescribed a strong medicine, it usually means you’re fighting a strong enemy. “Just because you may not feel high blood pressure or diabetes, it doesn’t mean they are not destroying your body,” Trouchon says.

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porterhospital.org :: Summer 2014 3

Place your heart in

good hands.Porter Adventist

Hospital Heart and Vascular Institute

is the first and only hospital in

Colorado accredited by the Society of Cardiovascular Patient Care for

providing evidence-based care for atrial fibrillation and heart

failure patients.

GET HELP JUGGLING MULTIPLE MEDSConfused about the medicines you’re taking or a loved one is taking? Unsure whether some of your medications are duplicates or interact with one another? Porter Adventist Hospital has received a grant for Medication Therapy Management (MTM) from UnitedHealthcare that may help.

What MTM does: A pharmacist and patient meet one-on-one to discuss dosages, instructions, and problems that may affect adherence. The patient receives a written plan of action.

How the grant helps patients: The grant covers patients’ copays or out-of-pocket expenses.

Who qualifies: This is for patients taking multiple medications, patients taking new medications, or patients taking medications for problems that have serious consequences if medicines are not taken properly.

Get more information or schedule your medication tuneup by calling 303-765-6399.

How healthy is your heart? Take our FREE Cardiac Risk Quiz at porterhospital.org/

heart-quiz.

4 VIBRANT :: Porter Adventist Hospital

The‘GOOD’ CANCER?

Thyroid cancer is skyrocketing, and there’s nothing good about itLooking back, litigation attorney Kevin Bemis had a red flag every time he donned a dress shirt and tie. “I always felt like they were choking me,” he says.

But he never thought he had cancer.

“I never had problems swallowing, and I never felt the slightest bit sick,” says the 32-year-old Lone Tree resident. Bemis joins the growing number of young adults with thyroid cancer.

In fact, thyroid cancer is the most rapidly increasing cancer in the U.S. Andrew

Nemechek, MD, FACS, medical director of Head and Neck Oncology at Porter Adventist Hospital, offers a rundown on statistics and

treatments — as well as a look at the realities of long-term thyroid cancer management.

RISING RISKSToday, the chance of being diagnosed with thyroid cancer is more than twice what it was in 1990. According to the American Cancer Society, two out of every three thyroid cancer patients are younger than 55.

“In my practice, thyroid cancer cases peak in the mid to late 30s. That’s a full decade earlier than when I was training 10 years ago,” Nemechek says. “What has changed? Is it a biologic change in the cancer or a biologic change in the patient? Why is it more common now for me to be evaluating a 20-year-old with multiple lymph node metastases in her neck?”

Researchers, including Nemechek, are scouring possible reasons — including diet, hormonal exposure, radiation ex-posure, and other possibilities for genetic mutations that trigger cancer earlier.

Meanwhile, some of the uptick in thyroid cancer can be attributed to broader use of neck imaging that leads to incidental diagnosis.

Such was the case with 37-year-old Crystal Loveday. In 2009, a severe earache led to a CT scan, which led to a thyroid cancer diagnosis. “My world just spun. My whole world rocked,” says the Loveland homemaker. With a thyroid-ectomy and bilateral neck dissections in her rearview mirror, Loveday still can’t believe she had cancer in the lymph nodes and all over her thyroid, but she didn’t feel a single symptom.

The National Cancer Institute estimates 60,000 cases of thyroid cancer were diagnosed in 2013.Two out of every three cases are in patients younger than 55.

60,000

Kevin Bemis

Crystal Loveday was diagnosed with thyroid cancer after a severe earache. Effective treatment allows her to continue being active with husband James.

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porterhospital.org :: Summer 2013porterhospital.org :: Summer 2014 5

WARNING SIGNSLoveday’s scenario is common, Nemechek says. Very few patients have symptoms such as difficulty swallowing or vocal changes. However, many do have physical signs such as a mass on the neck.

The most common symptoms and signs of thyroid cancer include:

- Discomfort at the base of the neck- A mass on the neck- Difficulty swallowing- Persistent vocal changes- Persistent cough with or

without bleeding

Nemechek urges those with a family history of malignancies — especially breast or other glandular malignances — or patients who have had breast lesions or multiple benign colon polyps to discuss their risk of thyroid cancer with their physicians.

TREATMENTMany thyroid cancer patients are candidates for a three-part treatment.

This treatment may include:- Surgery to remove as much

thyroid tissue as possible- Radioactive iodine ablation (RAI)

to destroy remaining thyroid cells- Thyroid hormone replacement

therapy

“These are the steps for most people. We realize there are real exceptions to this rule, established over the last decade. For example, some patients do not get RAI. Today, therapy is tailored to specific patient and tumor factors, such as stage of tumor,” Nemechek says.

THE ‘GOOD’ CANCER?Most thyroid patients share a word that Nemechek loves: survivorship.

In fact, the cure rates for the two most common types, papillary and follicular, are in the 80 to 90 percent range. But don’t let him hear you characterize thyroid cancer as “good” cancer. “My response to that is, ‘It’s not your neck,’” he says.

During treatment, Loveday heard all the one-liners, including her favorite, “If you have to have cancer, thyroid is the one to pick.”

“Of course no one picks cancer,” she says. “The process I had to go through was just as soul-searching and rigorous as any cancer patient.”

In fact, the journey has unique difficulties. “Your thyroid regulates your metabolism and energy level,” she says. Even though she enjoys bike riding, she tires easily. “Since it’s a

silent disease, people look at you and think, ‘You look fine. What’s wrong with you?’”

Nemechek says Loveday has touched upon

something profound. “Patients with thyroid cancer do so well. The problem is, they do so well. And many live with life interruptions for a very long time. What do you do psychologically while waiting for the other shoe to drop? There’s real angst that goes along with that.”

Bemis remembers the day Nemechek told him he had cancer. “He encouraged me to look at it as a ‘terrible project’ that I needed to work on for awhile.”

It’s advice Bemis has taken to heart. While he continues an active life full of hiking and skiing, he views cancer simply as a roadblock. “It is just a terrible project. That helps me see this as something to get beyond.”

Treating thyroid cancer from all anglesMost thyroid cancers are “well-differentiated.” This means the cells that make up these tumors act like thyroid cells should — they concentrate iodine and make thyroid hormone.

Sometimes, however, a patient’s cancer cells may “look” well-differentiated under a microscope, but they don’t act like those cell types should.

“In our program, we see many patients with complicated tumors,” says Andrew Nemechek, MD, FACS, medical director of Head and Neck Oncology at Porter Adventist Hospital. “All of these patients and their tumor-related information are presented in our weekly multidisciplinary tumor board.”

At Porter Adventist Hospital, specialists from endocrinology, radiation oncology, medical oncology, pathology, neuroradiology, nursing, and speech and language therapy plan care for these patients.

“Is there an opportunity for a clinical trial? Would radiotherapy or targeted therapy help reduce pain? Would the patient benefit from chaplaincy, social services, or our palliative care team? We ask all these questions,” he says.

To schedule an appointment with Nemechek or another specialist at Colorado Head and Neck Specialists, call 303-778-5658.

Share Your StoryThe Aurora-based charity

Catch It In Time is dedicated to sharing inspirational stories

to help prevent cancer. Visit catchitintime.org.

Dr. Andrew Nemechek

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6 VIBRANT :: Porter Adventist Hospital

From food to fitnessWomen’s Health & Wellness Expo offers the latest in health infoAs women, our lives are so busy that we hardly have time to make a doctor’s appointment, much less learn everything we need to stay on top of our health.

Centura Health is here to offer some relief. Join us for four hours and find out the latest in skin care, memory loss, stress reduction, heart health, breast health, and much more. At the second annual Women’s Health & Wellness Expo, women will get all the latest health news through keynote speakers, discussion groups, and an interactive vendor fair. You’ll also be able to sneak in a workout, get free recipes from the nation’s top hospital chef, and much more.

“This year, we have added more options so that there is something for everyone,” says Marti Steger, community outreach coordinator at Porter Adventist Hospital. Porter Adventist Hospital, Castle Rock Adventist Hospital, Parker Adventist Hospital, and Littleton Adventist Hospital are presenters of the Women’s Health & Wellness Expo.

Other hot topics to be covered at the expo include the role of inflammation in women’s health and how to reduce your risk, as well as loads of nutrition information from the latest on gluten intolerance to the best new supplements. The half-day expo is free.

“Centura Health is a network of care that is here to help women not just when they are ill but also in their efforts to stay healthy,” Steger says. “We want to partner with women through every stage of life.”

Balance Your

H E A LT H

Women’s Health & Wellness ExpoDate: Friday, Oct. 3Time: 8 a.m.-noon

Location: Parker Arts, Culture and Events Center (PACE), 20000 Pikes Peak

Ave., Parker, CO 80138 Cost: FREE

Info and Registration: southdenverhealth.org/womens-expo

Supplements are all the rage, but just because you can purchase most everything over the counter does not mean that you should. “There’s no way to tell what supplements you may need without considering your age, diet, lifestyle, and how well you are absorbing minerals and vitamins, which can only be understood with a proper blood test and exam,” says Susan Buckley, RDN, CDE, a member of the health and nutrition team at South Denver Cardiology, which provides cardiology services at Porter Adventist Hospital. Buckley recommends considering these three things when it comes to supplements:

You should discuss all supplements with your doctor or pharmacist to avoid medication interactions.

Start with fruits and vegetables

Fruits and vegetables contain dozens of compounds, while

supplements may focus on only one or two. Aim for five to 10

servings of fruits and vegetables a day. Remember, serving sizes may be smaller than you think (1/2 cup of cooked broccoli or

carrots; 1 cup of lettuce).

Consider drug interactionsCertain medications interfere

with the absorption of vitamins and minerals. For instance, vitamin B12, which helps

prevent anemia and keeps nerve and blood cells healthy, is hindered by proton pump inhibitors. Coenzyme Q10,

which works as an antioxidant and produces energy for cell growth, is depleted with the use of cholesterol-lowering

medications (statins).

Embrace probioticsProbiotics are “good bacteria”

that promote a healthy digestive system. Found in foods like yogurt, miso soup, and kefir,

many people need a higher dose of probiotics than foods alone can provide. Antibiotics

kill natural probiotics. “Roughly 70 percent of our immune

system is in the gut, so if we lack enough good bacteria, we are more susceptible to disease,”

Buckley says.

BEFORE YOUpop pills Three things all women need to know about supplements

FRUITS AND VEGGIES TO GO! Put serving sizes of veggies and fruits in containers that you can grab for a snack, take to work, etc. “Part of eating healthy is making it convenient,” Buckley says.

LEARN MORE about supplements at the

Women’s Health & Wellness Expo presented by Centura

Health on Oct. 3!

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Dr. Johnny Yi practices at Aracea Women’s Care in Cherry Creek North. He specializes in reconstructive gynecological surgery, including hysterectomies, prolapse, and incontinence. To make an appointment with Dr. Yi, call 303-316-6677.

porterhospital.org :: Summer 2014 7

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Triathletes at higher risk to develop prolapseMinimally invasive surgery provides effective treatment for common problem

Exercise, especially endurance or high-impact exercise, can put women at increased risk for pelvic floor disorders, such as pelvic organ prolapse and urinary incontinence, according to Johnny Yi, MD, a specialist in this area who recently joined Aracea Women’s Care in Cherry Creek North.

Prolapse is a condition in which the uterus or another organ slips down into the vaginal cavity, or the top of the vagina collapses.

Symptoms include: Uncomfortable sensation of fullness in the vagina Uncomfortable bulge outside the vagina Urinary or bowel incontinence Difficulty passing urine or having a bowel movement Painful, uncomfortable, or difficult intercourse

Being overweight, aging, and giving birth vaginally are the greatest risk factors for prolapse. But there’s another that most women don’t suspect — exercise.

Triathletes can be affected by prolapse even if they aren’t overweight

or haven’t had a vaginal delivery (although those put them at higher risk), says Yi, a urogynecologist who has conducted specialized research into pelvic floor disorders in triathletes. “We think it is related to the amount of endurance exercise and pressure on the pelvic floor,” he says.

About 11 percent of women who have vaginal prolapse undergo surgery each year in the U.S. While there are several types of surgery, most involve connecting the top of the vagina to strong supporting ligaments to lift it back into the correct position.

Most of these surgeries can now be performed either vaginally with no incisions or laparoscopically through four tiny incisions in the abdomen, Yi says. “There are very few instances where surgery for prolapse or incontinence cannot be done in a minimally invasive manner that results in less time in the hospital, less blood loss, and a faster recovery,” he says.

Johnny Yi, MD, who grew up in Los Angeles and went to college in the Midwest, has had his eye on Denver for some time. Now, after completing three years of fellowship training in minimally invasive and urogynecologic surgery, Yi has finally made his way to the Mile High City.

Yi joins Mandi Beman, MD, at Aracea Women’s Care in the Cherry Creek North area in late July. Yi is married to Paige, a high school science teacher, and they have two young sons, Jack and Ben.

“It is the most desirable place to live where we also have family,” says Yi, whose brother-in-law lives in Boulder. “My family and I like to be out in nature. We love to ski and snowboard, and my wife is an active triathlete looking forward to racing in Colorado. We’re also really looking forward to hiking and camping with our kids.”

Yi completed medical school at the Medical College of Wisconsin. Following an OB/GYN residency in Salt Lake City, Yi completed two years of his specialized fellowship at the Mayo Clinic in Scottsdale and an additional year at Loyola University in Chicago.

FUN FACTDr. Johnny Yi studied

voice and biology during undergraduate studies

at Northwestern University.

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 vibrant@centura.org.

porterhospital.org

STAYING MOTIVATED — OFFICE WORKOUTLearn fun, office-friendly exercises that give you a workout even if you’re chained to your desk. Date: Tue, Aug 19 Time: 1-2 p.m.

THE ABCs OF VEIN HEALTHDr. Carlos Rueda will discuss vein health, from spider veins to pulmonary embolism, and what you need to know to reduce your risks. Date: Thu, Aug 21 Time: 6-7 p.m.

HEART FLUTTER OR A-FIB?Dr. Sri Sundaram explains the most common form of arrhythmia and long-term impacts of the disease. Date: Tue, Aug 26 Time: 6-7 p.m.

VOLUNTEER FOR YOUR HEALTHDid you know volunteering may lower your blood pressure and increase your overall health? Learn more! Date: Tue, Sep 9 Time: 1-2 p.m.

BLOOD SUGAR BLUNDERSLearn how positive food choices can help control blood sugar spikes and pitfalls in this grocery store walk and talk. Date: Wed, Sep 10 Time: 2-3 p.m. Location: University

Hills King Soopers, 2750 S. Colorado Blvd.

MEDICATION SAFETYUnderstand the importance of taking medication properly and avoiding dangerous drug interactions. Date: Thu, Sep 11 Time: 2-3 p.m. Location: Porter Place,

1001 E. Yale Ave.

STAYING MOTIVATED — RUNNING CLINICTake your health to the next level. Learn the proper technique and how to avoid injury at the Porter Athletic Club. Date: Sat, Sep 13 Time: 9-10 a.m. Location: Porter

Athletic Club, 950 E. Harvard Ave., Suite B-40

HEALTH OR HYPE — GLUTENIs going gluten-free really better for you? Find out what you need to know about Celiac disease. Date: Tue, Sep 16 Time: 6-7 p.m.

STAYING MOTIVED — RAISING THE BARREA slower-pace class emphasizes basic alignment and specific muscle actions to balance the body. Date: Thu, Sep 18 Time: 12:30-1:30 p.m. Location: Porter

Athletic Club, 950 E. Harvard Ave., Suite B-40

AN OUNCE OF PREVENTION — HEART DISEASETake control of your heart health and learn to avoid the risk of heart disease. Date: Tue, Sep 23 Time: 2-3 p.m. Location: Clermont Park,

2479 S. Clermont St.

WOMEN’S WELLNESS EXPOHosted jointly by Castle Rock Adventist Hospital, Littleton Adventist Hospital, Parker Adventist Hospital,

and Porter Adventist Hospital. A day dedicated to healthy living, including discussions with experts, a morning workout, and more. FREE parking at the PACE Center. For full details, see Page 6. Date: Fri, Oct 3 Time: 8 a.m.-noon Location: Parker Arts,

Culture and Events Center (PACE), 20000 Pikes Peak Ave.

GET A GRIP ON HAND HEALTHDr. Craig Davis will explore the signs, symptoms, and treatments of common hand problems. Date: Thu, Oct 9 Time: 6-7 p.m.

ARTHRITIS FOUNDATION EDUCATION DAYUnderstand the latest research and treatments from experts in the field. Date: Sat, Oct 18 Time: 8 a.m.-noon

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