porterhospital.org :: Spring 2013 1PHOTO BY STEVE BIGLEY

Your Connection to Healthy Living

Volume 4, Issue 2 | Spring 2016

FOOD FOR THOUGHTFor patients dealing with digestive distress, treatment options — including

medication and surgery — help bring relief.

2 Helping wounds heal faster

3 Finding a shoulder replacement alternative

6 Catching lung cancer early

GI surgery put an end to acid reflux for Rick Gonzalez. Page 5

2 VIBRANT :: Porter Adventist Hospital

Dr. David Hardin

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Hyperbaric oxygen helps youth return to rugbyFor 17-year-old kicker Adam Leonard, the Friday night rugby game had gone off without a hitch. He couldn’t remember suffering a serious hit. He came home, chowed down, and went to sleep.

“At 2:30 a.m., I woke up and my leg was just in excruciating pain,” Adam says. He was diagnosed with compartment syndrome, a potentially life-threatening condition in which pressure within the muscles builds to dangerous levels. “Adam had swelling of the muscle in the lower leg in an area that is confined within a compartment of fascia. With this type of injury, as the muscles start pushing harder and harder, they start dying. Essentially, his body was crushing itself,” says David M. Hardin, MD, FACS, medical director of the Wound Care and Hyperbaric Medicine Center at Porter Adventist Hospital.

Jason Jennings, MD, an orthopedic surgeon at Colorado Joint Replacement, performed emergency surgery to open Adam’s leg and release pressure on the muscles. Jennings then referred Adam for hyperbaric oxygen

You know that tobacco use increases risk for several cancers. But did you know that when smoking is paired with alcohol use, you may be dealing

a terrible one-two punch to your head and neck?

“All types of tobacco should be avoided to reduce risk of head and neck cancer. While alcohol consumption

alone has less risk for head and neck cancer, in combination with

tobacco, it is a powerful carcinogen,” says Andrew Gaines, MD, an otolaryngologist, with additional expertise in head and neck oncology surgery, at Colorado Head and Neck Specialists.

All in all, researchers estimated that more than 52,000 men and women were diagnosed with head and neck cancer in the U.S. in 2012 — and men outnumbered women almost 2-to-1.

Those who work in certain occupations associated with increased risk of head and neck cancers, such as farming, construction, and industrial metal working, often have a significant history of tobacco use as well, Gaines says. He urges patients with occupational exposure to use personal protective equipment and talk to their physician about quitting smoking.

(HBO) therapy, which had just opened at Porter’s wound care center.

“We used hyperbaric oxygen to not only halt progressive injury, but to help the injury heal,” Hardin says, further explaining how hyperbaric oxygen works. “Oxygen is critical to wound healing. Hyperbaric oxygen therapy supersaturates the blood with oxygen, allowing us to get a large amount of oxygen to tissues throughout the body.”

“It’s just a big, clear tube that your body slides into,” Adam says about the HBO chamber. “You sit there for two hours, and they pump the tube full of pure oxygen. They have little TVs on the outside with audio in the tube, so the time goes fast.”

In his case, so did the healing. Injured at the end of September, he was back as captain of his rugby team by the holidays.

“He has had a complete clinical recovery. I absolutely believe that would not have been the case without hyperbaric oxygen,” Hardin says.

HBO therapy is just one of the wound treatment options at the full-service Wound Care and Hyperbaric Medicine Center at Porter Adventist Hospital. It can be used to treat diabetic ulcers, injuries from cancer-related radiation treatments, and other conditions such as bone infections.

Learn how the Wound Care

and Hyperbaric Medicine

Center at Porter Adventist

Hospital and hyperbaric

oxygen therapy can help you. Call

303-778-5242.

Cut your risk for head and neck cancer

Dr. Andrew Gaines

Adam Leonard was able to return to the rugby pitch after HBO therapy helped him heal quickly.

Porter Adventist Hospital is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas.

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To make an appointment with Dr. Carr or to learn more about biologic resurfacing, call 303-925-4540.

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porterhospital.org :: Spring 2016

SKIPPING Innovative procedure to replace shoulder cartilage helps patients get rid of the pain

No matter which surgery is right for you, Carr urges patients with debilitating shoulder pain to see an orthopedic surgeon specifically trained in shoulder surgery.

SHOULDER REPLACEMENT

While knees and hips tend to take more of a pounding, the shoulder joint can succumb to pain and arthritis, too. In fact, 53,000 people in the U.S. have shoulder replacement surgery each year.

A select group of these patients may be candidates for an alternative to shoulder replacement called biologic resurfacing that replaces worn, arthritic cartilage of the shoulder joint with donor cartilage. In Colorado, it is performed at Porter Adventist Hospital by Ryan Carr, MD, a fellowship-trained orthopedic surgeon with Centura Health Physician Group.

Here’s what you need to know.

Q: WHAT IS BIOLOGIC RESURFACING?A: In a typical shoulder replacement surgery, the damaged, arthritic parts of the shoulder are replaced with artificial components. “You have metal rotating on a

piece of plastic. Over time, the implant can loosen or wear down. If you’re young and have total shoulder replacement, you will likely have a revision surgery in your lifetime,” Carr says.

“Biologic resurfacing is an alternative to total shoulder replacement. It preserves the patient’s normal anatomy, essentially replacing worn, arthritic cartilage of the shoulder joint with cartilage and bone from a deceased donor,” says Carr, who completed fellowship training under the renowned surgeon who developed the procedure. “We go in, cut the arthritis out, and replace that area of worn-away cartilage.”

Q: WHO IS A CANDIDATE?A: For patients who have debilitating shoulder pain uncontrolled by cortisone shots and other conservative treatments such as physical therapy, surgery is the next step. “For most people, it’s total shoulder replacement. For some, it’s biologic resurfacing,” Carr says.

Younger patients in their 40s and 50s with late-stage arthritis who would like to avoid traditional shoulder implants are optimal candidates for biologic resurfacing.

Patients do better if anatomically their ball and socket line up well and if the shoulder socket is well-preserved. “For a lot of patients, even if biologic resurfacing sounds interesting, their anatomy may not make them a great candidate.”

Q: WHAT’S POST-OP LIFE LIKE?A: Biologic resurfacing is typically a same-day outpatient, or one-day inpatient procedure. Patients wear a sling for about six weeks to help immobilize and protect their shoulder. “When we put cadaver bone in there, we want the body to grow bone and incorporate the graft. If a patient gets too aggressive in terms of motion and activities, there’s a chance it can come loose,” Carr explains.

Q: WHAT ARE THE PROS AND CONS?A: Pros: The idea of preserving normal anatomy and avoiding shoulder replacement surgery is an attractive idea to younger patients.

Cons: The procedure is an out-of-pocket expense, not typically covered by insurance. Since it is a newer procedure, there is not a lot of long-term data documenting its effectiveness.

Dr. Ryan Carr

VIBRANT :: Porter Adventist Hospital4

Shining light on

GASTROPARESISNew drug study at Porter Adventist Hospital aims to help patients with a lesser-known condition that results in near-constant nausea, vomiting, bloating, and abdominal pain

Dr. Ashwin Kurian

As medicine advances, sometimes it’s the unheralded developments behind the scenes that end up making a difference in everyday lives and shedding light on lesser-known diseases.

One such study, examining a new medication that holds potential for a little-known digestive disease called gastroparesis, is taking place at Porter Adventist Hospital and other sites across the country. While results cannot

be discussed until the study is published, the study helps draw attention to the disease.

Ashwin Kurian, MD, general surgeon and director of GI services at Porter Adventist Hospital, explains

gastroparesis — as well as how it’s treated and who is at risk.

What is gastroparesis?

Gastroparesis is a condition that prevents the stomach from emptying. Normally, stomach muscles contract to break up food and move it into the small intestine. With gastroparesis, these muscles stop working properly, causing food to move out of the stomach slower than normal.

There are 3 million people with gastroparesis in the U.S. “Still, it’s a fairly undiagnosed and poorly understood disease,” Kurian says.

Signs and symptoms

Hallmarks of gastroparesis include nausea, vomiting, bloating, abdominal pain, and a feeling of fullness after eating a small amount of food.

The tricky thing about gastroparesis is that symptoms mimic a range of conditions, from a very common case of acid reflux to less common disorders. This makes it hard to diagnose.

“It’s usually confused with something else,” Kurian says, noting that a condition called cyclic vomiting syndrome is one of the masqueraders. “With cyclic vomiting syndrome, patients throw up continuously for weeks at a time and then they are better for months. With gastroparesis, patients feel ill all the time and some days are worse than others.”

Another condition that muddies the waters is cannabinoid hyperemesis syndrome, a condition associated with long-term marijuana use that results in hard-to-control nausea and vomiting. “We are seeing more cases in Colorado because of the legalization of marijuana,” Kurian says. “With hyperemesis, patients usually feel better when they have a hot shower or hot bath. If that’s the case, I ask them to stop taking marijuana to see if symptoms improve. Patients may have to stop using marijuana for months before they feel better.”

Gastroparesis can be confirmed if GI endoscopy or a stomach emptying study shows that food is collecting or slow to move out of the stomach.

Treatments

To date, medications have not proven extremely successful in treating gastroparesis. “Some antinausea medications work. Other medications are used that help the stomach empty better by stimulating muscle contractions. Some patients cannot tolerate these medications because of neurological side effects. Another is an antibiotic that unfortunately stops working due to the body getting used to it. Many physicians use a medication that has a small chance of causing serious heart side effects, including sudden death. For this reason, these medications are not FDA-approved and patients are sent to internet pharmacies in Canada to obtain the medication,” Kurian says. “There are not very many good medical options.”

A new medication, under study at Porter Adventist Hospital and other sites, appears in preliminary use to be well-tolerated and effective, Kurian says. The new medication potentially offers a new and exciting medical treatment option for patients who suffer from gastroparesis.

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porterhospital.org :: Spring 2016 5

Meanwhile, Kurian performs three main surgical treatments for gastroparesis:

Gastric pacer. Basically like a cardiac pacemaker, this pacer uses mild electrical impulses to help control nausea and vomiting.

Pyloroplasty. This procedure opens up the valve separating the stomach from the small intestine. “We open it up so food can get into the small intestine more easily,” Kurian says, noting that patients must be carefully selected. Pyloroplasty doesn’t work well in patients who have really advanced gastroparesis or who have very large stomachs or ulcers. “It’s probably the most common procedure I do and for patients who are good candidates, 80 percent of them have a significant improvement in their symptoms.”

Feeding tube insertion. With this approach, nutrition bypasses the stomach directly into the small intestine. “If you can provide nutrition to the gut, it’s better than IV nutrition to the veins,” Kurian says.

In rare cases and when other options have failed, he removes most of the stomach. “We bring the small bowel up, so the food goes from the food pipe into the remaining stomach and into the small bowel, similar to the surgery patients have for gastric bypass for weight loss,” he says.

Surgery for severe reflux solves problem for Pueblo manRick Gonzales went from 175 pounds down to 143 in about six months. It’s not a diet he’d recommend.

“I was losing weight at a rapid pace because I was eating drastically less,” says the 36-year-old Pueblo resident. “I went from zero reflux to off-the-charts reflux for seven months. It seemed like a lifetime.” He got to a point where all he could eat was unseasoned, broiled chicken. He took two doses of Nexium daily, with a daily Pepcid, too. “Nothing I did was touching it,” he says.

As it turns out, Gonzales had acid reflux triggered by hiatal hernia, a condition in which the upper part of the stomach bulges up through the diaphragm into the chest, making it easier for acid to come up.

He was referred to Ashwin Kurian, MD, for a procedure called fundoplication to repair the hernia and stitch the upper part of the stomach around the end of the esophagus.

“I’m getting better every day,” Gonzales says. “I could count on one hand the number of times I’ve had reflux since then.”

Gonzales is not alone. Every year, nearly one-half of adults in the U.S. suffer from some type of digestive or gastrointestinal issue. Denver residents living with stomach, digestive, or GI problems can turn to the GI Lab at Porter Adventist Hospital for help.

Achalasia (severe swallowing problem) Acid reflux or heartburn Barrett’s esophagus Celiac disease Crohn’s disease Constipation Diverticulitis Esophageal cancer Gallstones

Gastroesophageal reflux disease (GERD) Hiatal hernia Incontinence Inflammatory bowel

disease Irritable bowel

syndrome Lactose intolerance Ulcers

Conditions treated at the GI Lab include:

Who gets gastroparesis?

Most cases of the disease are idiopathic. “That is a fancy medical term to say we don’t know what causes the gastroparesis, even after medical tests,” Kurian says.

The most common known cause is diabetes. “When you have diabetes, your nerves get damaged and the nerves to the stomach get damaged,” he says. Hypothyroidism and past stomach surgery can also be causes.

Kurian says that while gastroparesis is rare, occurrences seem to be climbing. “We are seeing more cases, and it’s not certain whether more patients actually have gastroparesis for some unknown reason or if we’re simply recognizing them better.”

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To learn more about the diagnostic and treatment capabilities for gastrointestinal

conditions at Porter Adventist Hospital, visit porterhospital.org/gi or call 303-778-5804.

Eating is enjoyable again after surgery helped Rick Gonzales get acid reflux under control.

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6 VIBRANT :: Porter Adventist Hospital

LOOKING FOR LUNG CANCERLow-dose CT scan catches cancer earlier when it’s more treatableTake a deep breath. Hold it. Exhale. You have just pressed your lungs into active duty, expanding to accommodate the extra-big breath you just took in and acting as command central for oxygen delivery to the body.

Our lungs work without us directing them. You could even say our lungs work silently, behind the scenes. Here’s the scary thing: Lung cancer progresses silently too, often not showing symptoms until it’s no longer curable.

But there is promising news. There is now a low-dose CT scan that may catch cancer early enough to treat it — and beat it. Here’s what you need to know.

No. 1 cancer killer“Lung cancer is the leading cause of cancer death in the U.S. among both men and women. It claims more lives every year than colon, prostate, ovarian, and breast cancers combined,” says Simeon Abramson, MD, medical director of medical imaging at Porter Adventist Hospital.

Does that get your attention? It should — especially if you have a history of smoking.

“Lung cancer is by far the most deadly cancer out there,” Abramson says. “Patients who develop metastatic disease — cancer that has spread beyond the lungs — have a five-year survival rate of 1 to 4 percent. However, when lung cancer is detected at its earliest, most treatable stage, survivorship soars to 50 percent.”

That’s where a low-dose CT scan comes into play.

Who is eligible?The screening is offered to those at highest risk of developing lung cancer. Based on data from the Lung Cancer Screening Trial, a study involving more than 50,000 current or former smokers, the patients mostly likely to benefit from screening are:

Between the ages of 55 and 74

Current smokers, or those who have quit within the past 15 years Heavy smokers — a history of 30 pack years or more (a pack year is an average

of one pack per day per year; for example, one pack per day for 30 years or two packs per day for 15 years)

Abramson says results are promising. “Trial participants who underwent the CT scan had a 20 percent overall less chance of dying of lung cancer than those who just received a chest X-ray,” he says.

Castle Rock Adventist Hospital, Littleton Adventist Hospital, Parker Adventist Hospital, and Porter Adventist Hospital are part of the Centura Health Cancer Network, delivering integrated, advanced cancer

care across Colorado and western Kansas.

Schedule Your ScreeningThese South Denver hospitals

now offer low-dose CT scans to screen for lung cancer for $199.*

Castle Rock Adventist Hospital: 1-855-456-LUNG(5864)

Littleton Adventist Hospital: 303-738-7747

Parker Adventist Hospital: 303-269-4500

Porter Adventist Hospital: 303-778-2415

*Some insurance plans may cover the screening. Check with your plan.

SYMPTOMS not to ignore

While lung cancer often has no early symptoms, if you experience any of these signs, talk with your doctor to evaluate the cause:

A new cough that doesn’t go away Coughing up blood Chest pain that worsens with coughing or deep breathing Shortness of breath and wheezing Recurrent infections, such as bronchitis or pneumonia Swelling of the face Losing weight without trying

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Dr. Simeon Abramson

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porterhospital.org :: Spring 2016 7

Stage an InterventionA medical specialty called interventional radiology uses image guidance to diagnose or treat disease without major surgeryInterventional radiologists treat many conditions that once required major surgeries. “There are new procedures being developed all the time,” says Peter Stratil, MD, MBA, an interventional radiologist at Porter Adventist Hospital.

As a specialty, interventional radiology uses image guidance, such as X-ray and CT, to diagnose problems and perform minimally invasive surgery.

Common interventional radiology (IR) procedures include: Targeted cancer treatment Opening blocked arteries with angioplasty and stents Stopping GI, liver, or kidney bleeding due to trauma or injury Treating vein disease like deep venous thrombosis (DVT),

venous hypertension, and varicose veins Dialysis support work

Peter Stratil, MD, MBAOne of the things that jumps out about Stratil’s title is the MBA he earned concurrently with his MD. “I completed a joint degree program because medicine exists in a business-driven world and to optimally function in that world you need at least a basic understanding of the way the business works. I use this knowledge to work with hospitals and insurance companies to optimize patient care.”

His primary specialties include: Venous disease treatment, including the treatment of acute blood clots in

the legs, pelvis, and lungs as well as the treatment of chronic blood clots, which can cause lifestyle-limiting leg pain and swelling. Oncology treatments. “We can thread a tiny catheter through the arteries that lead to a tumor and inject high-dose

chemotherapy or radiation-emitting beads,” he says. “We can also freeze or burn tumors in the kidneys, liver, lungs, or bones.” Treatment of several gynecological conditions, including the second leading cause of chronic pelvic pain in women

called pelvic congestion syndrome. This condition is underdiagnosed and is characterized by deep pelvic pain that worsens throughout the day.

When off the clock, Stratil enjoys Colorado’s outdoor prerequisites: skiing and golfing. His 2- and 3-year-old kids keep him busy, and he and his wife love to cook together.

Todd Kooy, MDTodd Kooy, MD, is also an interventional radiologist at Porter Adventist Hospital. He specializes in treating patients with cancer as well as patients with liver and kidney disease, and works closely with Porter Adventist Hospital’s liver transplant program.

Cancers that either start in or spread to the liver are one of his main areas of focus. “There are very few treatment options for patients with liver cancer. However, we can target the artery that supplies the tumor, cut off the tumor’s

blood supply, and deliver a concentrated dose of chemotherapy,” he says.

Kooy also specializes in treatment of trauma patients, patients with renal failure requiring hemodialysis, and treatment of venous disease.

When not at work, Kooy enjoys skiing, biking, reading, and traveling. He describes he and his wife as avid, if not obsessive, cyclists, who just returned from a cycling trip to New Zealand. They primarily ride and race mountain bikes, but also enjoy road riding and riding their tandem.

Medical school: University of Chicago Pritzker School of MedicineFellowship: University of WashingtonBoard certification: American Board of Radiology, 2010

Medical school: University of Washington Medical SchoolFellowship: University of WashingtonBoard certification: American Board of Radiology, 2006; Vascular and Interventional Radiology Certificate of Added Qualification, 2008

JOIN Dr. Peter Stratil for

a FREE community seminar on

how to prevent varicose veins

and blood clots in your legs.

See back cover for details.

Non-ProfitOrganizationU.S. Postage

PAIDDenver, CO

Permit No. 47732525 South Downing Street Denver, CO 80210

Portercare Adventist Health System

FREE CLASSES AND EVENTSRSVP required. Locations and times vary. Visit porterhospital.org/events or call 303-765-3825 for more information.

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.

Come for a variety of FREE and low-cost health screenings, and health advice from the experts at Porter Adventist Hospital. Visit 9healthfair.org. Date: Wed, Apr 13 Time: 7 a.m.-Noon

IMPORTANT FACTS ON ORAL CANCERDr. John Campana will share the latest finding on oral cancer risks. Date: Wed, Apr 13 Time: 6-7 p.m.Plus FREE Oral Cancer Screening Date: Sat, Apr 16 Time: 9-11 a.m.

HEART ESSENTIALS 101Get the must-know heart facts from Dr. David Kornhauser. Date: Thu, Apr 14 Time: 1-2 p.m. Location: Highlands Senior Center,

2880 Osceola Street, Denver

BE F.A.S.T. ON STROKE AWARENESSSeconds count; know the signs! Date: Wed, May 4 Time: 6-7 p.m. Location: Ross-Cherry Creek Branch

Library, 305 Milwaukee Street, Denver

ILLUSTRATIONS: HEART ©DOLLARPHOTOCLUB.COM/MARTIN951; POPCORN ©DOLLARPHOTOCLUB.COM/NMARQUES74

porterhospital.org

LADIES NIGHT IN THE BREAST CARE CENTEREnjoy a spot of tea, a massage, and get your mammogram screening done. Most insurance accepted. Call 303-765-6500 to schedule. Date: Fri, May 6 Time: 1-6:30 p.m.

CATCH SOME SHUT-EYETips on how to get enough sleep with Dr. Janice Hartman. Date: Tue, May 17 Time: 1-2 p.m.

STOP STRESSING!Take a moment for yourself and learn how to stop stressing. Date: Tue, May 24 Time: 1-2 p.m.

MOVIE NIGHT — , RATED PGJoin Porter Adventist Hospital and the University of Denver for a family night at the movies. Date: Sat, May 28 Time: 7 p.m.

(approximate start time) Location: Peter Barton

Lacrosse Stadium, 1999 East Jewell Avenue, Denver

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, 2016.

HEALTHY LEGSFind out how to keep blood clots, varicose veins, and more at bay with Dr. Peter Stratil. Date: Wed, Jun 1 Time: 6-7 p.m.

HEART DISEASE Five easy steps to reduce your risk of heart disease. Date: Sun, Jun 5 Time: 2-3 p.m. Location: Schlessman Family Branch

Library, 100 Poplar Street, Denver

ARTHRITIS EDUCATION DAYKeynote Dr. Ryan Carr will focus on shoulder pain and your options. Plus key nutrition facts to avoid flares. FREE screenings available. Date: Fri, Jun 10 Time: 9:30 a.m.-Noon

PRIMARY CARE PRACTICESAURORACHPG Cornerstar Primary Care15901 East Briarwood Circle, Suite 200Aurora, CO 80016303-269-2626 • cornerstarprimarycare.orgCHPG Southlands Primary Care6069 South Southlands ParkwayAurora, CO 80016303-928-7555 • southlandsprimarycare.org

CASTLE ROCKRidgeline Family Medicine at the Meadows2352 Meadows Boulevard, Suite 300Castle Rock, CO 80109720-455-3750 • ridgelinefamilymedicine.orgRidgeline Family Medicine — Castle Pines250 Max Drive, Suite 102Castle Rock, CO 80108303-649-3350 • ridgelinefamilymedicine.org

CENTENNIALCHPG Grace Family Practice6909 South Holly Circle, Centennial, CO 80112720-528-3559 • gracefamilypractice.orgCHPG Holly Creek5500 East Peakview Ave., Centennial, CO 80121303-649-3820

DENVERCHPG Clermont Park2479 South Clermont Street, Denver, CO 80222303-649-3155 • clermontparkseniorcare.orgCHPG Primary Care Porter950 East Harvard Avenue, Denver, CO 80210303-649-3200 • porterprimarycare.comCHPG Primary Care Cherry Creek300 South Jackson Street, Denver, CO 80209303-316-0416 • primarycarecherrycreek.org

GREENWOOD VILLAGECHPG at DTC8200 East Belleview AvenueGreenwood Village, CO 80111303-770-6500 • dtcfamilymedicine.org

HIGHLANDS RANCHHighlands Ranch Medical Associates9135 South Ridgeline BoulevardHighlands Ranch, CO 80129303-649-3140 highlandsranchmedicalassociates.org

LITTLETONChatfield Family Medicine10789 Bradford Road, Littleton, CO 80127303-738-2714 • chatfieldfamilymedicine.orgClement Park Family Medicine6901 South Pierce Street, Littleton, CO 80128303-932-2121 • clementparkfamilymedicine.orgSouth Suburban Internal Medicine7750 South Broadway, Littleton, CO 80122303-347-9897southsuburbaninternalmedicine.org

PARKERParker Primary Care10371 Parkglenn Way, Suite 220Parker, CO 80138303-649-3100 • parkerprimarycare.orgTimberview Clinic at Parker9399 Crown Crest Boulevard, Suite 200Parker, CO 80138303-269-4410 • timberviewclinic.org