porterhospital.org :: Spring 2013 1

Tom Smalley shares his courageous battle with pneumonia and multiple organ failure. Page 4.

2 Advanced mammography available

6 New A-fib surgery

7 Easing shoulder arthritis

PHOTO BY ELLEN JASKOL

Your Connection to Healthy Living Volume 3, Issue 4 Fall 2015

A fight for lifeWhen an illness has you clinging to life, a dedicated and

equipped team can help you live, and fulfill your dreams.

2 VIBRANT :: Porter Adventist Hospital

Listen up guys: Head and neck cancers are twice as common among men as they are among women.

In fact, certain head and neck cancers that occur specifically in the tonsils and back of the tongue strike men four times as often as women, says Chris Oliver, MD, an ENT and head and neck specialist at Colorado Head and Neck Specialists.

Oliver outlines five symptoms men should never ignore.1 A lump or mass in the neck2 A sore in the mouth3 Ear pain (due to a shared nerve

from the throat to the ear)4 Hoarseness 5 Difficulty swallowing

New 3-D mammography better at finding small cancer

HEADS UP!

What if a breast screening tool were available that was better than standard mammography at finding cancer while at the same time reducing the number of times women are called back for suspicious findings that turn out to be nothing?

There is. And it’s now offered at Porter Adventist Hospital.

Called 3-D tomosynthesis, the screening tool may also outperform standard mammography at detecting small, more lethal, invasive cancers, according to a study in the Journal of the American Medical Association (JAMA).

Beginning this fall, 3-D tomosynthesis will be available at Porter Adventist Hospital alongside standard 2-D mammography. With 3-D “tomo,” multiple X-ray images are taken from many angles. A computer algorithm then creates a 3-D image of the breast. The scan takes about eight to 10 seconds.

“Tomosynthesis is especially helpful when examining women with dense breast tissue,” says Jennifer Hankinson, MD, lead imaging physician for Porter Breast Center.

Hankinson says these facts are important when considering when, where, and how to be screened for breast cancer: The American Cancer Society

recommends that women age 40 and older should have a mammogram every year. This is true whether you receive standard mammography or tomosynthesis.

Tomosynthesis resulted in a 41 percent increase in detection of invasive breast cancers and a 29 percent increase in detection of all breast cancers, according to a JAMA study.

Tomosynthesis resulted in a 15 percent decrease in women called back for further imaging, according to the same JAMA study.

symptoms men shouldn’t ignore

Dr. Chris Oliver

Dr. Jennifer Hankinson

Porter Adventist Hospital is part of

the Centura Health Cancer Network,

delivering integrated, advanced cancer care across Colorado and

western Kansas.

SCHEDULE your screening mammogram today by calling 303-765-6500. Or text your full name and phone number to 303-872-7469, and we’ll call you to set up an appointment.

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To make an appointment with Dr. Oliver, call 303-778-5658.

Of these, Oliver says a lump or mass in the neck is the major, red flag symptom not to mess around with. “If you see a lump in your neck, you should get to your PCP doctor and get it checked out right way. This can be a lethal cancer,” he says.

When talking about head and neck cancer, it’s important to note that several cancer “sites” are lumped into this category. For example, cancer can strike the salivary glands, oral cavity, pharynx (throat), larynx (voice box), base of the tongue, skin, intranasal sinuses, and the nasal cavity.

JOIN USfor one of our

educational events during Breast

Cancer Awareness Month. See Page 8

for details.

3

symptoms men shouldn’t ignore

What is all the alphabet soup behind my physician’s name? And what does “board-certified” or “fellowship-trained” really mean? Here’s a secret decoder ring to medical credentialing.

MD — Doctor of Medicine.

DO — Doctor of Osteopathic Medicine. Both MDs and DOs are physicians who go through the same types of education and training, but DOs place additional focus on the musculoskeletal system and how it interacts with diseases or injuries.

Board-certified — Think of board certification as an optional next step for a licensed doctor. It is voluntary, and can offer an assurance to patients that the doctor is taking extra steps to polish skills and stay up-to-date through additional study and training. Most certifications must be renewed every six to 10 years.

Fellowship-trained — Fellowship-trained doctors become highly specialized (think of them as “ultra-trained”) in a field (such as shoulder surgery, a subspecialty of orthopedics) by completing one to three years of additional training in that subspecialty.

FACS, FACC, FACOG, etc. — Here, F stands for fellow, which is used to reference a physician’s paid membership with a professional organization. Thus, FACS stands for “Fellow of the American College of Surgeons.” This is very different from fellowship-trained.

Resident — A resident has graduated from medical school, has earned the title of “doctor,” and must complete three to five years of professional training (residency) under a senior physician educator to be licensed.

Licensed — After completing medical school and a residency, both MDs and DOs must pass exams to earn a license in the state or jurisdiction of the U.S. in which they plan to practice.

What does that title mean?

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PORTER PLACE

TURNS 30 A vibrant, relationally warm place to live with nurse support seven days a week, Porter Place is the “Perfect Place.” Celebrating 30 years of caring for seniors in South Denver, Porter Place has always enjoyed this unique distinction: It was built on a foundation of faith. “We are a mission-based community, and that draws people of all faiths, which creates a spiritual richness,” says Charlene Mason, sales representative.

Porter Place services include: Independent living Assisted living A newly renovated, secured memory

care unit On-staff chaplain and multifaith services

Located conveniently near shopping, churches, city parks, golf courses, walking paths, and the University of Denver, the opportunities for an active life are as abundant outside as they are inside, where shared meals, a fitness center, a game room, and many planned activities help residents form a sense of community and belonging.

Whether residents are completely independent or need some assistance, Porter Place caregivers are available 24/7 and are backed up, when needed, with an on-site nurse (16 hours a day, seven days a week). When not on-site, a nurse is always on-call. The location next to Porter Adventist Hospital offers the added security of immediate, expert medical care should the need arise.

TO LEARN MORE or schedule a personalized tour, please call 303-765-6800.

Also be sure to join us on Oct. 22 for a special “Healthy Aging” program. See back cover for details.

FACOGFACS

FACCDO MD

porterhospital.org :: Fall 2015

VIBRANT :: Porter Adventist Hospital4

Dr. Paula Dennen

Porter Adventist Hospital’s participation in National Kidney Registry offers another path to dialysis patients

No ‘Smalley’ FeatThe mid-20s are a time of new careers, friends, and — at least in Colorado — a lot of outdoor sports. Certainly not a time of pneumonia and organ failure. But when a 26-year-old Summit County man faced these trials, he was able to fight his way back to health with the help of multiple teams at Porter Adventist Hospital.

HOW TO HELP A LOVED ONE IN ICUSitting by a loved one’s bedside while in ICU is difficult — but your time need not be idle. Paula Dennen, MD, offers some suggestions on how to support someone you love in the ICU:

PHOTO BY ELLEN JASKOL

SPEAK IN A CALM MANNER and don’t be afraid to hold your loved one’s hand if he or she is unconscious. “On some level, the patient probably knows you are there,” she says.

CREATE AN ATMOSPHERE your loved one would enjoy with favorite music or personal items from home. Read favorite poems, prayers, or stories.

ADJUST YOUR SCHEDULE to be present for physician rounds and discussions involving your loved one’s care.

BE PATIENT. It’s common for patients to feel frustrated, especially if on a

ventilator or feeding tube. Help your loved one communicate with a small white board and offer reassurance that they are making progress.

At age 26, Summit County resident Tom Smalley exuded health and vitality — skiing in the winter, hiking in the summer, and building a life with his girlfriend, Sasha Myers. So, in winter 2013, Smalley didn’t make a big to-do about his chest cold.

“One night, I had a coughing fit that lasted 10 minutes. It just would not let up.” The local hospital diagnosed Smalley with pneumonia and had him air-lifted to Porter Adventist Hospital. The next day, Nov. 18, his heart rate spiked to 180 — a full 80 beats per minute above the top level of normal range — requiring his medical team to use a defibrillator to restore his heart rhythm.

“That’s the last thing I remember. I woke up Dec. 5,” more than two weeks later, he says.

Smalley had a severe case of pneumonia and unfortunately suffered a cascade of organ failures that resulted in aggressive interventions to support his life. He was hospitalized for three months. For perspective, the average length of hospital stay for pneumonia is 5.2 days.

From ICU through outpatient rehab, Porter Adventist Hospital was equipped to handle Smalley’s complex health needs every step of the way. And, as his story reveals, he needed every ounce of expertise offered by the medical specialists at Porter Adventist Hospital.

AGAINST ALL ODDS

In those unconscious, unnerving first few weeks, Paula Dennen, MD, a Porter Adventist Hospital critical care physician who is board-certified in four different specialties, says almost every one of Smalley’s major organs failed at one point or another. She remembers the emotional late night she spent with Smalley’s mom, preparing her for the reality that her son might die. “We shared tears and she told me that, if possible, he would want to be an organ donor. It was so strong of her to be able to go to this place in her heart,” Dennen says.

“His kidneys and liver failed. His bone marrow failed, so he had no platelets.

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After surviving organ failure and paralysis, Tom Smalley is back in the kitchen with

fiancée Sasha Myers.

porterhospital.org :: Fall 2015 5

Intensive Care Unit> Staffed 24/7 with in-house

multi-board-certified critical care physicians who round twice daily

> Multidisciplinary team, including physicians, nurses, dietitians, pharmacists, and social workers who meet daily to discuss each patient

> 25,000-square-foot unit with 36 private rooms

> Latest technology, including continuous hemodialysis, bedside monitoring, and other supportive equipment to aid organ function

Inpatient Rehabilitation> Ranked in top 10 percent of

inpatient rehabilitation facilities for quality care and outcomes by the Uniform Data System for Medical Rehabilitation

> 1:1 therapist-to-patient ratio> Equipped to treat stroke, spinal,

traumatic brain injury, orthopedic, amputee, and multitrauma conditions

> Equipped with a physical therapy gym, transitional living apartment space, and simulation space called “Independence Square,” which includes a mock grocery store, gas station, ATM, car, and full kitchen

Outpatient Rehabilitation > Consistent one-on-one

experience where patients see the same therapist for each treatment

> An emphasis on core stability and the regaining of strength to restore quality of life

> Therapies include manual therapy, dry needling, vestibular therapy, and lymphedema treatment

He suffered severe skin breakdown. His heart was not functioning well. He had an acute lung injury,” she says. “Statistically, if five organs fail, there’s a 90 percent chance of mortality.”

Smalley fought his way into the 10 percent territory.

When he awoke Dec. 5, he remained paralyzed from the neck down — even though the chemical paralysis ICU doctors induced to decrease the body’s oxygen utilization had long been discontinued. He was susceptible to infection. He was tube-fed, and a breathing tube prevented him from talking. He remained on dialysis. “It was one step forward, two steps back sometimes,” says Sasha Myers, Smalley’s girlfriend who never left his side.

Though his muscles atrophied, he had emotional moxie. An audacious question — “Will you marry me?” — had formed in his mind. Paralyzed but not powerless, his singular goal of rehab became to bend down on one knee to ask for Myers’ hand.

A PLAN UNFOLDS

Smalley spent two months in the ICU before being transferred to The Center for Rehabilitation at Porter Adventist Hospital. He ordered an engagement ring and had it delivered to the hospital. “The nurses in rehab knew what the plan was,” he says. Still, he kept the ring and his pending proposal quiet from Myers, determined first to regain function and strength.

“He came to us deconditioned and had lost quite a bit of weight. But he always had his eye down the road,” says Leslie Prodonovich, inpatient rehab manager.

In fact, Smalley had dropped from 130 — which for him was already a low weight — to 98 pounds. He couldn’t eat, walk, or stand.

“They took me from not being able to stand for longer than two or three seconds all the way to walking and cooking,” says Smalley, who had worked as a cook for 10 years.

Unique in the Denver region, Porter Inpatient Rehabilitation has a simulation space called Independence Square. Here, patients can regain skills for everyday activities, like using an ATM machine or cooking in the mock kitchen. “It was a huge thing to prove I could cook again,” Smalley says.

STRONGER EVERY DAY

After being discharged from the hospital, Smalley spent six months in outpatient rehabilitation at Centura Health Center for Therapy at Porter Adventist Hospital. Amy Paton, PT, was his one-on-one physical therapist.

“When he first came in, he had weakness and balance issues. He could walk short distances but was still deconditioned. A lot of times, people aren’t able to recover the way Tom did. But, in a sense, he was his own physical therapist. He did everything on his own that he could to get stronger,” Paton says.

As weeks turned into months, Smalley got stronger. Finally, he was discharged, cleared to drive and cleared to work.

Today, Smalley repairs watches and jewelry at a shop in Denver. “To go from barely being able to put a peg in a pegboard at Porter Rehab to fixing watches is an amazing feat in and of itself. They helped me get my motor skills back. They helped me get my life back.”

He credits everyone at Porter Adventist Hospital — from Dennen and the ICU team to nurses, therapists, and nutritionists — for having a hand in his recovery. “Every single part of that hospital was involved in my care. No one gave up on me,” he says, making a point to include Chaplain Dottie Mann in his accolades. “She was really there for my family and Sasha,” Smalley says.

So it’s only fitting that she will be the one to marry them next summer.

Sure enough, last November — close to the one-year mark of when he fell so ill — Smalley achieved the major goal of his rehabilitation. He bent down on one knee and asked Myers to marry him.

She said yes.

Dennen still gets emotional thinking about Smalley, remembering the medical challenges and ultimately, the relief. “I know his mom, like me, remembers that late night we talked about organ donation,” she says. “Quietly, we are both thankful that was just a conversation.”

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For more than five years, Kay Jensma lived in a constant state of waiting for the other shoe to drop. She had been diagnosed with atrial fibrillation, or A-fib, a heart rhythm problem in which rapid, irregular heartbeats cause the heart’s chambers to beat out of sync. Jensma’s A-fib flared numerous times, triggering listlessness and debilitating, flu-like feelings.

“It’s scary. When you go to bed at night, you hope you wake up the next morning able to just get up and walk,” says the 70-year-old Elizabeth resident.

Today, Jensma and A-fib patients like her have access at Porter Adventist Hospital to a unique one-two treatment approach that tackles persistent A-fib from both the inside and the outside of the heart.

Cardiovascular surgeon Sanjay Tripathi, MD, and cardiologist Sri Sundaram, MD, both with South Denver Cardiology, offer “hybrid ablation,” which has up to an 85 percent success rate in curing A-fib.

Traditional TreatmentsTraditionally, the first-line treatment for A-fib is medication, such as beta-blockers or antiarrhythmic drugs. The next step is catheter-based ablation, a nonsurgical procedure that Sundaram specializes in. The process delivers radiofrequency energy into the heart to destroy tissue that’s triggering irregular rhythms.

Catheter ablation has a 60 to 80 percent success rate in patients without heart abnormalities who have had A-fib for less than two years. Success rates drop if a patient has had A-fib continuously for more than two years.

“If a patient’s A-fib persists after catheter ablation, now, instead of saying, ‘I’m sorry, there’s nothing else I can do for you,’ I have another option,” Sundaram says.

Hybrid AblationThat option is the hybrid surgical/catheter ablation technique now offered at Porter Adventist Hospital. “Myself and Dr. Sundaram are the only physicians in the Denver area offering this particular hybrid procedure,” Tripathi says.

“This is a real breakthrough in how we treat A-fib, especially in patients who are younger, more active, and have symptoms from A-fib that are significantly interfering with their lifestyle,” Tripathi says.

Porter Adventist Hospital is part of the Centura Heart Network, the region’s leading provider of cardiovascular care.

LOOK FOR THIS, NOT THATAlthough heart palpitations or rapid heartbeat are the classic “textbook” symptoms of atrial fibrillation, you should definitely report these common A-fib symptoms to your doctor:

• Fatigue• Shortness of breath• Light-headedness• Overall decreased energy level

Dr. Glenn Bigsby

IN THE RhythmINNOVATIVE “HYBRID ABLATION” TREATS ATRIAL FIBRILLATION FROM THE OUTSIDE IN

Dr. Sri Sundaram Dr. Sanjay Tripathi

What is it? Hybrid ablation involves two procedures separated by six to 12 weeks. First, Tripathi performs ablation on the outside of the heart with a minimally invasive surgical procedure called a thoracoscopic maze. Then, about 12 weeks later, Sundaram performs catheter ablation inside the heart.

Who is it for? Ideal candidates for hybrid ablation are patients who:• Have heart

damage resulting from A-fib lasting longer than two years

• Have failed catheter ablation

What are the advantages?Hybrid ablation treats A-fib from both the outside and the inside of the heart muscle.The modified maze surgery is performed through keyhole incisions made between the ribs on both sides, resulting in less blood loss, shorter recovery time, and lower risk of infection than the traditional, open-heart maze surgery.

Individualized OptionsSometimes, as is the case so far with Jensma, Tripathi’s minimally invasive maze approach may be enough without the need for Sundaram’s follow-up catheter-based ablation.

In fact, Jensma, a serious bowler, is back to throwing her 14-pound bowling ball with wild abandon. This summer she bowled in a national tournament in Reno. “I used to be so weak that the heaviness of the ball was too much.”

And now? “I feel like I’ve got some life left,” she says.

Kay Jensma is finding her rhythm again at the bowling alley.

6 VIBRANT :: Porter Adventist Hospital

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DLEARN MORE about the symptoms and treatment options for A-fib at a FREE community seminar on Oct. 13 with with Dr. Sundaram. See Page 8 for details.

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SHOULDERING THE LOADNew surgeon brings two unique, innovative shoulder surgeries to Denver areaEnjoying a “homecoming” to Colorado, Ryan Carr, MD, an orthopedic surgeon fellowship-trained in shoulder and elbow, began welcoming new patients at Centura Health Physician Group Orthopedics and Sports Medicine Porter on Sept. 1.

While his practice will begin as a general orthopedic and sports medicine practice, he brings fellowship training in shoulder, too. In addition to traditional shoulder and elbow procedures — including minimally invasive rotator cuff repair, total shoulder replacement surgery, and labral repairs (SLAP and Bankart) — Carr offers two unique surgical interventions at Porter Adventist Hospital.

CARTILAGE REPLACEMENT

Carr recently completed fellowship training under a nationally recognized orthopedic surgeon who developed the first minimally invasive cartilage transplant procedure for the shoulder.

“In a younger patient with arthritis in the shoulder joint, a transplant to replace the worn cartilage of the shoulder joint may be a very good option. We go in, cut the arthritis out, and replace that area of worn-away cartilage with donor cartilage,” Carr says. This new procedure is aimed at treating late-stage arthritis without total shoulder replacement surgery.

“There are probably just a handful of people performing this around the world,” Carr says.

RESTORING SHOULDER STABILITY

A procedure designed to restore stability in irreparable rotator cuff tears, superior capsule reconstruction rebuilds the capsule of the shoulder joint. “In layman’s terms,

it helps keep the humeral head, or the top of the arm bone, in place. The hope is that because we are preserving mechanics, shoulder function is

preserved. This may help to ward off or delay arthritis,” he says.

Carr also brings a conservative approach to rehabilitation, preferring to let a patient’s body heal before beginning a formal rehabilitation program. “Anecdotally, I have seen that patients have less pain and have a better recovery and outcome,” he says.

To make an appointment with Dr. Carr, call 303-925-4540.

As an undergraduate at University of Colorado, Ryan Carr, MD, remembers loving, well, everything about the Centennial State.

“I fell in love with not just Colorado being beautiful, but the people as well. Everyone is welcoming, and it’s a terrific environment to live in,” he says.

Carr is originally from the Philadelphia area and after completing medical training in Chicago, he and his wife — a dermatologist — have been trying to get back to Colorado for years. He just completed a shoulder fellowship at University Hospitals in Cleveland and now is glad to be back to the place he considers home.

When not in the office, he loves mountain biking, golfing, and skiing. So, he “gets it” when patients’ active lives are limited by orthopedic pain. “I enjoy getting patients back to their active lifestyles,” he says.

Why the shoulder?

“I enjoy problem solving,” he says, noting that the shoulder is a very complex joint.

7

Dr. Ryan Carr is an identical twin.

“My brother has a bad shoulder from all the ice

hockey he played,” he says. Maybe we can recommend

a fellowship-trained shoulder surgeon

for him.

LEARN MORE at a FREE seminar on shoulder pain on Nov. 12. See Page 8 for details.

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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 303-765-3825.

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, 2015.

Register online at porterhospital.org/events

Porter Adventist Hospital is a regional medical center that provides care for complex health issues. We specialize in complex surgery, cardiovascular care, spine care, joint replacement, liver and kidney transplants, and cancer care. We are part of Centura Health, the region’s leading health care network. Vibrant is published quarterly by Porter Adventist Hospital – Portercare Adventist Health System. The purpose of this publication is to support our mission to improve the health of the residents in 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. Vibrant is produced by Clementine Health Marketing.

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OPEN HOUSEPlease join Porter Adventist Hospital Wound Care for an Open House introducing their new Hyperbaric Medicine Center. Stop by to check out the beautiful new space and the new hyperbaric oxygen treatment. Date: Thu, Oct 8 Time: 5-7:30 p.m. Location: 990 East Harvard Avenue,

Denver

ARTHRITIS EDUCATION DAYArthritis can have a crippling impact on everyday life. Join Dr. Jason Jennings and the Arthritis Foundation to get valuable information for coping with this disease, improving your quality of life, and learning to control your symptoms. Date: Fri, Oct 9 Time: 1-4 p.m.

HEART FLUTTERS OR A-FIB?Join Dr. Sri Sundaram as he explains the most common forms of arrhythmia, symptoms, treatments, and long-term impacts of the disease. Date: Tue, Oct 13 Time: 6-7 p.m.PH

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WOMEN’S NIGHT OUT FOR BREAST CANCER Bring the special women in your life to join us for a ladies’ night out! There will be massages, makeup consultations, and health experts to share what you need to know about breast cancer and breast cancer risk. Date: Wed, Oct 14 Time: 6-7 p.m. Location: Curves Gym, 2553 South Colorado Boulevard, Denver

HEALTHY AGING Healthy aging means living a long, productive, meaningful life, and enjoying a high quality of life. Join Dr. Barbara Morris as she discusses healthy behaviors, including physical activity, nutrition, preventive health services, managing chronic conditions, preventing injury, and how these behaviors can contribute to longer, healthier lives. Date: Thu, Oct 22 Time: 6-7 p.m. Location: Porter Place, 1001 East

Yale Avenue, Denver

GET THE FACTS ABOUT OSTEOPOROSIS Osteoporosis is a bone condition that makes bones thinner and more fragile because of reduced bone density, making individuals at risk for fractures, especially in the hip, spine, and wrist. Join Dr. Lisa Rothgery as she discusses what causes

osteoporosis, signs and symptoms, and treatment and prevention. Date: Thu, Nov 5 Time: 6-7 p.m.

TREATMENT OPTIONS FOR THE PAINFUL SHOULDER Shoulder pain may originate in the joint itself or from any of the surrounding muscles, ligaments, or tendons. Join Dr. Ryan Carr as he explains some of the common causes of shoulder pain as well as new treatment options. Date: Thu, Nov 12 Time: 6-7 p.m.

SIP AND PAINT — PINK NIGHT FOR BREAST

CANCER AWARENESSJoin us for a night of painting and fun, while learning how to reduce your risk

and raise your awareness of breast cancer signs and symptoms. Space is limited; register to reserve your spot today!

Date: Wed, Oct 21 Time: 6-8 p.m.