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Northern Colorado Medical & Wellness 2014

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Northern Colorado Medical & Wellness 2014

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w w w. s t y l e m a g a z i n e c o l o r a d o . c o m w w w. m e d i c a l a n d w e l l n e s s . c o m PUBLISHER Lydia Dody | lydia@stylemedia.com MANAGING EDITOR Angeline Grenz angie@stylemedia.com CREATIVE DIRECTOR Scott Prosser SENIOR DESIGNER Lisa Gould DIGITAL DIRECTOR / BUSINESS DEVELOPMENT Austin Lamb | austin@stylemedia.com ADVERTISING SALES EXECUTIVES Jon Ainslie (970) 219-9226 Debra Davis (917) 334-6912 Lydia Dody (970) 227-6400 David Knight (970) 619-9846 Elaine Ryan (970) 541-4915 OFFICE MANAGER/ABOUT TOWN EDITOR Ina Szwec | ina@stylemedia.com ACCOUNTING MANAGER Karla Vigil CIRCULATION MANAGER Trisha Milton PHOTOGRAPHER Marcus Edwards Photography CONTRIBUTING PHOTOGRAPHERS Bridget Eldridge, Ron Pentico CONTRIBUTING WRITERS Malini Bartels, Kyle Eustice, Corey Radman, Kay Rios, Brad Shannon, Elissa J. Tivona, Michelle Venus AFFILIATIONS Fort Collins Area Chamber of Commerce Greeley Chamber of Commerce Loveland Chamber of Commerce 2014 STYLE MAGAZINES January-Northern Colorado Medical & Wellness Magazine and McKee Medical Center & North Colorado Medical Center Medical Directory February-Style March-Northern Colorado Medical & Wellness April-Style May-Style June-Style July-Northern Colorado Medical & Wellness August-Style September-Women’s Health & Breast Cancer October-Northern Colorado Medical & Wellness November-Holiday Style December-Best Of & Winter Activities Style Media and Design, Inc. magazines are free monthly publications direct-mailed to homes and businesses in Northern Colorado. Elsewhere, a one year subscription is $25/year and a two year subscription is $45/year. Free magazines are available at nearly 300 locations throughout Northern Colorado. For ad rates, subscription information, change of address, or correspondence, contact: Style Media and Design Inc., 211 W. Myrtle St., Suite 200, Fort Collins, Colorado 80521. Phone (970) 2266400, ext. 208. Fax (970) 226-6427. E-Mail: ina@StyleMedia.com ©2014 Style Media and Design Inc. All rights reserved. The entire contents of Style Magazine are copyrighted and may not be reproduced without the expressed written consent of the publisher. Style Media and Design Inc. is not responsible for unsolicited material. All manuscripts, artwork, and photography must be accompanied by a SASE. The views and opinions of any contributing writers are not necessarily those of Style Media & Design Inc.

Lydia’s STYLE Magazine

Northern Colorado Medical & Wellness 2014

CONTENTS

Northern Colorado Medical & Wellness

July 2014

20 NEW HOPE FOR EARLY BREAST CANCER DETECTION

WOMEN & HAIR LOSS

24 NEW STEM CELL THERAPY FOR WOUND CARE

FILLERS RESTORE FULLNESS

CONGRATS! YOU’VE BEEN ACCEPTED TO BRACES U

64 DENTAL HYGIENE FOR YOUR DOG

Publisher’s Letter

Screenings 101

New Hope for Early Breast Cancer Detection

New Stem Cell Therapy for Wound Care

Rheumatoid Arthritis Can Strike at Any Age

Labs Evolve to Advance Patient Care

Women & Hair Loss

Combat Summer Adolescent Weight Gain

Fillers Restore Fullness

Fillers on Steroids

You Are My Sunshine, But Not My Skin’s Friend

Congrats! You’ve Been Accepted To Braces U

Senior Law Day 2014

Pets and Pot – A Dangerous Mix

Dental Hygiene for Your Dog

ON THE COVER: Statistically, children have been shown to put on more weight in the summer. Use the 5-2-1-0 principle to keep your kids healthy this summer. Read more on page 40.

The articles in this issue of Northern Colorado Medical & Wellness are presented for your general knowledge and are not a substitute for medical advice or treatment. If you have any questions or concerns about your health, please contact your doctor or healthcare provider.

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Northern Colorado Medical & Wellness 2014

PUBLISHER’S LETTER

Summer

Wellness Wellness. It is a topic we are all interested in, or should be, as healthcare is rightfully trending to emphasize prevention rather then just the cure. That approach extends to our four legged dog pals as well. My little guy, Roo, is my 11-year old buddy who travels to the office everyday and sometimes even out to appointments. He is sporting his summer cut so he looks tiny despite his “big dog” personality. Recently Roo’s breath was so noticeably rank that I took him to my veterinarian, Dr. Maura

Buckner; she immediately told me he needed another dental and that his bad breath was a result of tooth decay. She proceeded to educate me on the hazards of not cleaning my dog’s teeth often enough. I made the appointment immediately. I learned that small dogs are more susceptible to dental problems. Roo had to have several extractions in addition to the cleaning. The bottom line to my story—I learned to pay close attention to my dog’s teeth for his overall health. Be sure to read, “Dental Hygiene For Your Dog” for tips on getting your pooch accustomed to a daily preventative dental regimen. Another pet danger (one I haven’t had but is nonetheless a serious issue) is the occurrence of pets ingesting edible marijuana. This is an extreme hazard to your pet’s health, regardless if it is intentional or accidental. Be sure to read “Pets and Pot, A Dangerous Mix” for the scoop on the seriousness of this issue. When speaking about wellness, we can’t overlook the need to safeguard our skin in the summer. Our cover girl loves the water, as most kids and families do in the summer, but a word of caution is needed. Our intense Colorado sun can be very damaging to our skin. It is imperative to use sunscreen for protection. The statistics are shocking; one in five Americans will get skin cancer in their lifetime. My mother recently had a sore appear on her face and much to everyone’s surprise it turned out to be melanoma. That surgery and recovery was not fun so a word to the wise, prevention is the key. Read, “You Are My Sunshine, But Not My Skin’s Friend,” for very

useful information. You are probably aware that I have a passion for helping women diagnosed with breast cancer through Hope Lives, a local non-profit. A bigger passion is breast cancer prevention and early diagnosis. Early diagnosis is the key to better outcomes, and new developments in technology have made earlier breast cancer detection possible. We are fortunate to have state-of-the-art three-dimensional breast X-ray technology available at North Colorado Medical Center since fall 2013. NCMC is absorbing part of the cost of this diagnostic procedure to ensure women get the best care possible. Be sure to read “New Hope For Early Breast Cancer Detection” for more important details. I am continually amazed at how science is moving ahead to improve our medical care. The need for wound care is a serious issue when it comes as a result of surgery complications, a trauma or a disease process. A new treatment process involving stem cell therapy is improving patient’s healing results and reducing their recovery time at The Wound Care Clinic inside McKee Medical Center. Read how patients are being helped in “New Stem Cell Therapy For Wound Care.” We hope you enjoy browsing this Northern Colorado Medical & Wellness issue. Be sure not to miss the many interesting medical, wellness, beauty and lifestyle articles. Wishing you a healthy summer! lydia@stylemedia.com

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MEDICAL

Screenings

SCREENINGS 101

edical screenings are important. There are certain screenings that every adult should have on their medical to-do list—and some that are not as critical. But how do you, the patient, know which fall into which category? Dr. Jamison Bohl with Kaiser Permanente’s Loveland medical offices has the 411.

lead to potentially extensive (and expensive) follow-up testing based on inaccurate results. Screening tests are done on people who do not exhibit symptoms. For those presenting with symptoms, the doctor will perform diagnostic tests. Now that you have an understanding of those baselines, Dr. Bohl provides an overview of necessary medical screenings—and those that you may be able to pass on.

First, let’s take a look at what every medical screening should have in common. All screenings should demonstrate proven medical benefits of early disease detection and prevention. Screenings should be easily reproducible and standardized in practices throughout the country, reasonably cost effective and should limit the number of false positives that could

Colon Cancer

“This is one of the best screenings for early detection,” states Dr. Bohl. “It reveals colon polyps (small, fleshy clumps of cells that form on the inside surface of the colon) and often, when they are removed, it never goes any further.” For persons of average risk, meaning that no

BY MICHELLE VENUS

immediate family members have a history of colon cancer, colon cancer screenings should start at age 50 and be repeated every 10 years through age 75, unless you are an extremely healthy 75-year-old with a more than 10-year life expectancy ahead of you. There are a few different options for screening. Two of the most common are the colonoscopy, where the physician examines the entire length of the colon, and the sigmoidoscopy, during which only the rectum and lower colon are examined for polyps. With both of these screenings, a thin, flexible, lighted tube with a tiny video camera on the end is gently inserted into the colon, giving the doctor the ability to look at the lining on a monitor. Any polyps that are found can be removed during the screening. Another option is the fecal occult blood test (FIT), which detects microscopic or invisible

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blood in the patient’s stool. This could indicate the presence of polyps or some other digestive distress. If blood is found, the FIT is followed up by a colonoscopy. FITs should be conducted annually.

Breast Cancer

For many years, it was recommended that a woman start breast cancer screening at age 40 with mammograms. According to Dr. Bohl, it is now uniformly accepted that mammograms can wait until a woman is age 50. Younger women tend to have denser breast tissue, which causes mammograms to be less sensitive and could result in increased levels of false-positive results. It is still reasonable to start mammograms at the age of 40, but Dr. Bohl says this should be a shared decision between the provider and patient. “There is not a solid consensus on starting at this age, so a provider and patient should go over the risks and benefits of screening at a younger age. “False-positive results can be harmful,” he continues. “They leave scars—both physical, from a biopsy and emotional, related to the stress and anxiety of the possibility of a cancer diagnosis.” A mammogram is an X-ray picture taken of each breast from two different angles. The breast is placed between two plates and then the image is taken and later examined by a radiologist looking for undetected tumors and microcalcifications (tiny deposits of calcium) that can indicate the presence of breast cancer. Women with a family history of breast cancer may want to be tested for the breast cancer gene but that particular screening is not widely recommended. The school of thought regarding self breast exams and in-office clinical exams is shifting. “The data does not suggest that there are significant benefits (from manual examinations), mainly because a lump often has to be at least one centimeter before it can be felt,” says Dr. Bohl. “There are so many non-cancerous lumps and bumps that occur. A mammogram is the best screening for determining what they are.”

Cervical Cancer

Recommendations regarding cervical cancer screenings have changed drastically over the past five years. Women over age 21 should have Pap smears, a test that detects cell abnormalities of the cervix (the opening to the uterus, located at the top of the vagina). During routine pelvic exams, the cervix is swabbed and the captured cells are later examined for abnormalities. Previously, women were screened annually. Now it is recommended that women from ages 21 to 30 have Paps every two years. Over 30 and that changes to every three to five years, especially if the patient is co-tested for the HPV virus (Human Papillomavirus), the infection that ultimately leads to abnormal Pap smears and, potentially, cancer. Sequential negative test results make it safe to spread those screenings out to every five years, but keep it at three if there is no co-testing.

Northern Colorado Medical & Wellness 2014

Blood Pressure

You should start blood pressure testing at every wellness exam starting at age 18, when risk factors for stroke and heart attack increase. Ideally, blood pressure should be tested at every clinic visit; at a minimum, it should be tested every two years. The test is simple: a cuff is placed on the upper arm and filled with air. It measures the pressure in the arteries as the heart pumps. Blood pressure readings are measured in millimeters of mercury (mmHg) and are given as two numbers. For example: 110 over 70 (written as 110/70). The top number is the systolic blood pressure reading. It represents the maximum pressure exerted when the heart contracts. The bottom number is the diastolic blood pressure reading. It represents the minimum pressure in the arteries when the heart is at rest. A normal BP reading for folks under age 65 tops out at 140/90. Over the age of 65, physicians start looking at treatment when the reading comes in at 150/90. “We’ve seen too many instances of overtreating older patients, so the recommendations have shifted towards higher readings before starting treatment,” Dr. Bohl explains. “With over-treatment, patients run the risk of light-headedness and falling.”

Cholesterol

Cholesterol screenings should be initiated at age 20 for both men and women. Depending on risk factors or initial results, the test should be repeated at age 35 for men and 40 for women. “Unfortunately, men are more predisposed to increased risk from the adverse effects of both high cholesterol and high blood pressure and have greater incidences of stroke and heart attack risk,” Dr.. Bohl states. “That’s why we screen them earlier.” A simple blood test, a complete cholesterol screening—also called a lipid panel or lipid profile—measures the amount of cholesterol and triglycerides in your blood and can help determine your risk of plaque build up in the arteries that can lead to narrowed or blocked arteries (atherosclerosis). Cholesterol screening is important as high cholesterol levels usually don’t cause any signs or symptoms and are often a significant risk factor for heart disease.

Type 2 Diabetes

Diabetes, also known as hyperglycemia, is a chronic disease and occurs when blood glucose (sugar) levels are above normal. Type 2 is the most common form and causes the body to become insulin resistant; it just doesn’t use insulin properly and the pancreas can’t make enough insulin to keep your blood glucose at normal levels. There is no specific age to start the screenings, but doctors look for risk factors that include body habitus (physique), physical activity and family history to determine if you should be tested. The most commonly used screening is the fasting blood sugar test (FBS), which measures blood glucose after not eating for at least

eight hours. This test is often done to check for both prediabetes and diabetes. Another test, the Glycohemoglobin A1c measures the hemoglobin levels in the blood. This test can be used to diagnose diabetes or to show how well your diabetes has been controlled in the last two to three months and whether your medication needs to be changed. The result of your A1c test measures the average blood sugar level, called the estimated average glucose, or eAG. Normal ranges for FSB test results are less than 100 mg/dL (milligrams per deciliter). Prediabetes ranges are from 100 mg/dL to 125 mg/dL, and over 125 mg/dL is considered diabetic. Normal values for the A1c test are 5.6 percent or lower hemoglobin levels; prediabetes levels are 5.7-6.4 percent, and above 6.5 percent indicates diabetes.

Osteoperosis

Osteoporosis is a disease in which bones become fragile and more likely to fracture. Usually the bone loses density, the amount of calcium and minerals in the bone. An initial osteoporosis screening should happen at age 65. “For men, we are not sure if the benefits of screening outweigh risks, but may still be recommended based on your family and medical history,” says Dr. Bohl. Risk factors for both genders are family and medical history and an incidence of low-velocity fractures. “A low-velocity fracture is when you snap a bone in your foot when you’re just walking naturally, or other bone fracture with very minimal force,” Dr. Bohl explains. “It’s not associated with accidents, like a car accident.” The test is a special X-ray test called a DEXA scan that measures bone mineral density and can diagnose bone loss and osteoporosis, predict risk of future bone fractures and determine how well osteoporosis medicine is working. A normal test is not repeated for three to five years if it comes back in the normal range or if mild bone loss (osteopenia) is diagnosed.

Prostate Cancer

Recommendations for prostate cancer screening in men with average risk have changed dramatically over the past five years. In fact, they are the polar opposite of what they once were. “Although we have increased the results for prostate cancer detection by doing screenings, we are not saving the male population years of life lost due to prostate cancer,” Dr. Bohl states. He goes on to explain that prostate cancer develops very slowly—usually over a period of eight to 10 years before it becomes a significant disease. If detected, more harm can come from aggressively treating the disease than any benefits that may be derived. Patients could find they become incontinent or experience erectile dysfunction, thus, routine screening for a man with no symptoms is no longer recommended. Two different tests are used to screen for prostate cancer. The first, the PSA, looks for prostate-specific antigens in the blood, which are produced by the prostate gland. Elevated

Jamison Bohl, M.D. Kaiser Permanente

PSA levels may indicate prostate cancer, a noncancerous condition such as prostatitis, or an enlarged prostate. Most men have PSA levels under four (ng/ mL) and this has traditionally been used as the cutoff for concern about the risk of prostate cancer. Men with prostate cancer often have PSA levels higher than four, although cancer is a possibility at any PSA level. According to published reports, men who have a prostate gland that feels normal on examination and a PSA less than four have a 15 percent chance of having prostate cancer. Those with a PSA between four and 10 have a 25 percent chance of having prostate cancer and if the PSA is higher than 10, the risk increases to 67 percent.

STDs

Once sexual activity starts, everyone should be screened for STDs (sexually transmitted diseases). These include chlamydia, gonorrhea, viral hepatitis, genital herpes, HIV/AIDS, HPV, Pelvic Inflammatory Disease (PID) and syphilis. It is especially important for people who engage in high-risk sexual activity—unprotected sex with multiple partners, or even a single partner who may not be monogamous—to be screened regularly for STDs. Regular medical screenings bring peace of mind, knowing that potentially chronic or even fatal diseases are caught early on and treated appropriately. The information provided should be considered guidelines. Only you and your doctor can determine what is best for you. Michelle Venus is a freelance writer based in Fort Collins.

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MEDICAL

Early Detection

Denise Johnson, radiologic technologist, and Mary Scheid, Breast Health R.N., have been using the Selenia Dimensions System, which provides 3-dimensional breast X-rays, since September 2013 at North Colorado Medical Center.

N E W H O P E F O R E A R LY

BRE A ST CA NCER DETECTI O N

reast cancer remains a big concern for obvious reasons. The numbers tell the story. In 2010, Centers for Disease Control and Prevention (CDC) says that 206,966 women and 2,039 men were diagnosed with breast cancer and 40,996 women and 439 men died from breast cancer in the U.S. Predictions for 2014 from the American Cancer Society estimate that over 230,000 new cases of invasive breast cancer will be diagnosed in women, about 62,000 new cases of carcinoma in-situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer), and another 40,000 women will die from breast cancer. The medical community works hard to keep

BY KAY RIOS

ahead of the curve. Each year, approximately 40 million mammograms are performed in the U.S., according to the Food and Drug Administration (FDA), the majority with 2-D digital mammography. Figures from Performance Benchmarks for Screening Mammography, 2006, reported that approximately 4 million patients are called back for additional examinations, and around 300,000 cancers are detected. With the development of the 3-D breast tomosynthesis, the possibility of earlier breast cancer detection is even better. And it’s now available in Northern Colorado, says Sandy Budde, North Colorado Medical Center Imaging Director for Banner Health. “We started using 3-D mammograms in September 2013.” North Colorado Medical Center operates a full-service Breast Center at Summit View Medical

Commons in Greeley and that’s where the 3-D units are available. “We were the first facility in Northern Colorado to get digital machines in 2006 and we’re currently the only facility to offer 3-D mammograms in Northern Colorado,” Budde says. While 3-D devices have been in use for breast cancer screening in Europe since 2008, it was not until February 2011 that the FDA approved use of the Selenia Dimensions System, the X-ray device that provides three-dimensional (3-D) images of the breast for breast cancer screening and diagnosis. Manufactured by Hologic, Inc., this system allows a screening exam to include both the traditional 2-D mammogram and the new 3-D mammogram. There’s very little difference in exam time or in the time breasts are compressed. Very low X-ray energy is used so the

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Summit View Medical Commons in Greeley houses the new equipment at NCMC’s full-service Breast Center.

radiation exposure is below the FDA limits. The FDA’s approval says that Hologic’s technology is not only safe and effective for breast cancer screening, but clinically superior to conventional 2-D mammography (film or digital) alone. The 3-D tomosynthesis offers significant benefits, Budde adds. “It will reduce callbacks for an additional mammography because it can eliminate the false positive. At our facility, we’ve seen a 20 to 25 percent reduction in callbacks as compared to those prior to using 3-D. Another benefit is the increase of cancer detection. Our radiologists are seeing things they could never have seen with the 2-D images.” Medical professionals agree that early detection is the best defense and, when cancer is found in its earliest stages, chances of survival are improved. Digital mammography has limitations because it only provides a two-dimensional picture of the breast, and the breast itself is three-dimensional object with different structures, such as blood vessels, milk ducts, fat and ligaments. These

Northern Colorado Medical & Wellness 2014

structures can overlap and obstruct view in a two-dimensional, flat image. Nadia Shah, M.D., Advanced Medical Imaging Consultants, will step in to the medical director position of the Breast Center in July of this year. She has worked with 3-D tomosynthesis since May 2013, and she explains how the device works. “There are about 10 extra seconds for the additional tomosynthesis exposure, in which it acquires 15 images,” says Dr. Shah. “Those 15 images are reconstructed by the computer into about 20 to 80 images, depending on the thickness of the breast. This is done for each of the four views.” Overlapping tissue can create an obstruction and is a leading reason why small breast cancers may be missed or normal tissue may appear abnormal. That can lead to unnecessary callbacks. This is an even greater problem for women with denser breast tissue. Dr. Shah says, “The technology separates the tissue layer by layer so radiologists can see smaller or hiding cancers

more clearly. My experience is that it helps detection of cancer by separating overlapping tissue so you can see smaller cancers. That provides better early detection and the possibility of an early treatment.” Reading the expanded images takes more time, Dr. Shah says. “It doubles our time to read them. And currently the FDA requires that you do a standard 2-D in addition to having a 3-D, so we read both.” That also means that, although the radiation dose of the 3-D is lower, with the combination of the two, the dose is slightly higher than with the 2-D alone. “But the combination is still lower than old school film screen mammograms,” she says. “The benefit of the decreased callbacks and the increased cancer detection possibility outweigh any drawbacks.” There is a learning curve with the new technology, Dr. Shah says. “That’s true of any new modalities in radiology. But you are still looking for a mass. We see masses that are breast cancer

on the 2-D, and then with the 3-D, we see subtle distortions in the breast tissue before it is big enough to be a mass.” The use of the 3-D device won’t necessarily eliminate the use of 2-D, she says. “For example, a 2-D look is helpful for determining calcium deposits. They are very common in women but figuring out whether they are benign or not is a challenge and, for that, a 2-D is more helpful.” The Breast Center currently has three radiologists who are trained to use the 3-D tomosynthesis, Budde says. The Breast Center is an accredited American College of Radiology Breast Center of Excellence and a Pink Ribbon Facility and, she says, that patients can receive a diagnosis in a matter of days because the technologies and the breast care specialists are all in a single location. Medicare is not currently reimbursing for the 3-D mammograms, Budde says. “Because of that we provide 3-D mammograms for every patient in every screening at no extra charge. We want to provide the best patient care possible and so we will include that as part of our routine services.” She adds that, in 2015, new billing codes will allow providers to bill Medicare. “We’ve done approximately 6,400 screenings using 3-D mammography since September. It’s well worth the cost of providing it to our clients.”

Three-dimensional images allow doctors to improve breast cancer detection by finding smaller cancers earlier.

Kay Rios, Ph.D. is a freelance writer based in Fort Collins. She is a frequent contributor to Style Media and is at work on two novels and a collection of creative non-fiction essays.

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MEDICAL

Wo u n d C a r e

Dr. Thomas Blomquist, surgeon at Banner Health Clinic in Loveland, examines patient Jim Zalesky’s healing abdominal wound, a wound that healed more rapidly with the use of stem cell therapy.

NEW STEM CELL THERAPY

F OR WOUN D C A RE

e’re all familiar with small wounds like cuts, scrapes or burns. We slap on some ointment and a Band-Aid and carry on, knowing that our body will do the rest. The same is not true for large wounds. Whether they come from a surgery complication or a trauma (like a gunshot or major accident), these wounds just do not heal on their own. Other mitigating factors like heart disease, high blood pressure, smoking or diabetes also impede wound healing.

Left untreated they can cause potentially fatal infections. Until recently there weren’t many highly effective treatment protocols. Luckily, better care through stem cell research has changed this. Thomas Blomquist, M.D., surgeon at Banner Health Clinic, specializing in General Surgery, has been director of the Wound Care Clinic at McKee Medical Center in Loveland since 1998. He says use of stem cell therapy (sometimes called tissue derived tissue stimulant) is a promising new treatment for wound patients. Multiple medical journals, including the

BY COREY RADMAN

Journal of Surgical Case Reports, have found promising results for these types of stem cell stimulators. One 2013 case report notes that it “offers a compelling potential advantage compared with conventional treatments of these large wounds.” The stem cells come as a sheet or in powder form. Manufactured by ACell, this product is sourced from porcine urinary bladder matrix and is FDA approved for the following protocols: trauma and reconstructive surgery, esophageal reconstruction, abdominal wall repair, urology, pelvic floor reconstruction

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and advanced wound care. Dr. Blomquist is very enthusiastic about the results he has seen since bringing the therapy to McKee almost three years ago. “We’re still in the infancy stages of learning how to best use these. I am finding that I can be effective in over 90 percent of the patients I am able to use it on.” He says that the timing of when and on whom they will be most effective has been the most challenging part of this new therapy. Applying them not too soon, but not too late, can achieve remarkable results, “but there’s an art to knowing when the time is just right,” he says.

A Marked Difference

This was certainly the case for Jim Zalesky. His colon surgery in 2009 resulted in an incisional hernia caused by the stitches near his small intestine. When the intestine ruptured in 2012, the necessary surgery left a gaping, dinner-plate sized wound on his abdomen in which surgeons placed drains. Those drains malfunctioned and landed Jim back in the hospital again for a third surgery. That was when they placed a vacuuming device in his wound to try to keep it drained. Upon discharge from the hospital, Jim’s wife, Karen, became the resident wound care expert, monitoring the drain and patching the holes in the covering as the pump struggled to hold suction. She says trips to the hospital for maintenance procedures to keep the vacuum functioning caused her husband horrible pain each time they had to change it out. “We would both be in tears,” she recalls. This hit and miss approach to healing Jim’s wound lasted almost four months with very little new tissue growth before relief arrived. Dr. Blomquist decided to try this newer therapy on Jim’s abdomen in May 2013. As one of the first people at McKee’s Wound Care Clinic to receive the new treatment, Jim says he wasn’t fazed at all by the origin of the tissues that were applied to his stomach. “They come from pig bladders,” he says. “But after having been through so much, I was ready for anything that worked. And this really helped. After the wound vac, I was really thankful for this.” His wife, Karen, says, “We saw remarkable difference once they started ACell.” The Zaleskys report the product looks like thin, wet paper. “Almost like a wafer,” describes Jim. “Papyrus,” corrects Karen. They both agree that it stinks like nothing they’ve ever smelled before. Jim jokes, “They told me at the clinic, the worse it smelled, the better it works!” Based on his results, that may be true. Jim’s wound was fully healed as of November 2013. He recalls that with every visit to the wound clinic, staff measured many millimeters of new scar tissue growth. Plus, his appetite and strength returned upon starting the new therapy. “At the beginning, it [the wound vac] hurt so much. Then, once I started on the stem cells, it was night and day. They made a world of difference.”

Northern Colorado Medical & Wellness 2014

How They Work

Dr. Blomquist has a colorful speech he gives to potential patients who would be good candidates for stem cell therapy. He says: “Think of it this way. There is a battle going on with your skin. There has been a breach in the defenses. It could be a wound, it could be a splinter. The process is the same. A call goes out from the breach with chemical messengers. The body responds by dialing up the blood vessels and sending more cells to the battle through the blood stream. “The bone marrow is where these fighters start their lives. Think of it as boot camp. They say, ‘We need to send more recruits out there to fight.’ The recruits all come out and they know how to do one thing and one thing very well. They know how to kill. That’s the first line of defense. Get the bacteria out of there. Make the pus; kill those invaders. “But that’s all they know how to do, and we humans already know how to kill those invader cells that cause infections. Surgeons can open up an infected wound and flush it out. We can use antibiotics to kill those infecting cells. We don’t need those recruits from the bone marrow to kill anymore. What do we want from them? We want them to build. Lay down scar tissue. Patch the breach. These cells need instructions on what to do, on how to be builders instead of killers. “The stem cells are the new set of orders. Those early bone marrow cells are technically stem cells too. They’re just not fully mature. Everything in your body starts as a stem cell and then grows into a hair cell or bone cell or eyeball cell. The stem cell stimulants act as directors. They give the orders to the recruits from the bone marrow. ‘I want you to build a wall,’ they instruct. And off they go. We give them new orders at the battlefront to build, not kill. So it’s tissue remodeling and regeneration by tricking and reprogramming them.” Dr. Blomquist says he has personally used tissue sheets to cover a wound as big as a standard sheet of paper. He explains that the quality of the new skin is stretchy and has hair follicles, but, “We can never make it perfect. There is always going to be a scar.” Some people scar more than others, but that’s really out of a doctor’s control. “Properly used, we can get the scarring down to a minimum,” he says. Interested patients should contact the Wound Care Clinic inside McKee Medical Center in Loveland at (970) 635-4059.

Corey Radman is a regular contributor to this magazine. Find more of her work at www. fortcollinswriter.com.

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Style 2013Colorado Medical & Wellness 2014 Northern

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MEDICAL

Rheumatoid Arthritis

RH EUMATOI D A RT H R I TIS

C AN STRIK E AT A N Y A GE

heumatoid Arthritis (RA) is an autoimmune disease that results in a chronic, systemic inflammatory disorder that principally wreaks havoc on flexible (synovial) joints, which are the smaller joints in the hands, feet and cervical spine. Other larger joints, such as the shoulder or knee, may be affected, as well. With RA, the joints essentially become inflamed to the point where it’s almost impossible to function normally. RA affects over 1.3 million people in the United States, typically between the ages of 30 to 80, although there have been some cases where the person is in his or her 20’s, which amazes a lot of people. Most of the population believes RA only plagues the elderly, but that is an incorrect assumption. It can happen at any age and women are two to three times

more likely to develop the painful condition than men. Dr. Michael S. Thakor of The Arthritis & Rheumatology Center of Northern Colorado began his practice in Fort Collins over 12 years ago. He has treated hundreds of patients that range in age, gender and race. Sadly, it’s impossible to pinpoint how the condition develops. “We aren’t sure what the causes are, unfortunately,” Dr. Thakor says. “There are some hereditary factors involved that may predispose some people to getting it. In most people that develop RA, there’s no family history they can identify. “The symptoms are fairly typical,” he continues. “People usually notice fairly symmetrical joint symptoms, usually predominating in the smaller joints of the hands and feet with stiffness in the morning. Often it takes them

BY KYLE EUSTICE

several hours to get going. They can have difficulties getting up, getting dressed and squeezing the tube of toothpaste. Usually there’s some degree of swelling in the joints and they may become somewhat warm and red. The symptoms can come on very rapidly. Some people will even sit down to have a meal and try to get up from their chair and they can’t. It can be that sudden. However, more often, the onset is gradual.” RA is much more common in women than men, especially in women who are of child bearing years. Although it can occur for the first time with people in his or her 70’s or 80’s, more typically it’s between young adulthood and middle age that symptoms begin to surface. RA’s unpredictability is further illustrated by the fact that it can almost vanish during a woman’s pregnancy, making the disease even

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Dr. Michael Thackor, with The Arthritis & Rheumatology Center of Northern Colorado, examines an arthritic patient’s range of motion.

more of a mystery. “About 50 percent of pregnant patients will go into remission and we don’t understand exactly why,” Dr. Thakor says. “In the patients whose disease does not go into remission, treatment is still required. There are some patients who have been able to go a few years before it came back. Very often, however, we see flare-ups in the postpartum period. Some women will have trouble holding their babies and changing their diapers so it can be very difficult. Sometimes we have to cut short breastfeeding to start some of the meds back.” While RA is incurable, there are ways to slow down its progression. With today’s medicine, if you develop RA, the prognosis is actually quite good. The key is to diagnose it early and get started on stronger disease modifying arthritis drugs that can not only help the pain synthesis, but can also can stop joint damage, deformity and disability. “It’s really important to get that early diagnosis and don’t just use ibuprofen or naproxen,” he says. “You have to go on to stronger medicines that can slow the symptoms and stop the joint damage.” One of the most frustrating aspects of RA is that there are very few studies indicating what kind of diet would be most beneficial to patients. Healthier eating helps but exercise is also very crucial to keeping the symptoms under control. However, it doesn’t stop the damage. “The difficulty is that there haven’t been those high quality studies with diet that we would like to see,” he says. “People often ask about what to do, diet wise. As doctors, we don’t have the definitive answers. In general, when you look at studies, things that are high in Omega-3 fatty acids like fish oil and flax seed oil seem to help. There are these anti-inflammatory diets that seem to make

Northern Colorado Medical & Wellness 2014

some sense to me, but they don’t have a lot of data behind them. Generally, those are fairly healthy diets where you’re eating less processed foods, more fruits and vegetables and more Omega-3 fatty acids. Some people that cut out gluten seem to do better. It’s not an easy diet to stick with it, but I see where that can be helpful. “There have been a fair number of studies where exercise has been shown to really help, too,” he adds. “Lower impact and mild strengthening exercises like walking, riding a bike, warm water pool exercises, yoga and Pilates all seem to help. The worst thing you can do is to be inactive because you lose muscle tone and range of motion. On the other hand, you can definitely overdo it. You have to be cautious. RA doesn’t signal the end of your life. You can live a very productive life with RA. The treatment makes a massive difference. That’s really the key.” Kyle Eustice recently relocated to Fort Collins with her fiancé Paul and chihuahua Paco from her hometown of Omaha, Nebraska. After spending four years living in Santa Fe, New Mexico, she couldn’t wait to get back to the mountain region. She is a regular contributor to Thrasher Skateboarding Magazine, Wax Poetics, Ghettoblaster, and many others.

Lifestyle changes, such as diet and exercise, may help ease some of the symptoms associated with rheumatoid arthritis, says Dr. Thackor.

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MEDICAL

L a b Te s t i n g

Sue Harkness, McKee Medical Center and Horizon Laboratory director, says new changes in the way labs are done in the Banner System are saving patients time and money by reducing duplication.

LABS EVOLVE TO

ADVANCE PATIENT CARE

o better meet the healthcare needs of Northern Colorado, Banner Health’s regional hospitals, McKee Medical Center and North Colorado Medical Center (NCMC), have made significant upgrades to their testing laboratories and have changed the way they work together. Banner has also added Horizon Laboratory, a regional outreach laboratory that provides reduced-cost, direct-access testing services to the public. This allows Banner’s Northern Colorado labs to operate more efficiently and provide faster, more affordable services to patients. Certain specialized tests are handled at McKee, while

NCMC focuses on others. Sue Harkness, McKee Medical Center and Horizon Laboratory director, notes that in 2012 Banner recognized significant duplication of testing and equipment between McKee and NCMC. That led to the decision to make changes to the two labs themselves, as well as to the way Banner handles testing on a regional basis, to better serve the organization and its customers. Banner undertook a capital project to fund $2.8 million in laboratory renovations at McKee, along with an $11.5 million construction of the NCMC laboratory, for a total investment of $14.3 million. The upgrade at NCMC created a state-of-the-art laboratory, including an automated testing line to support

BY BRAD SHANNON

high-volume sample processing. This update is the first major overhaul to NCMC’s lab in three decades, while McKee’s lab last underwent a significant update in 2007. In consolidating the NCMC and McKee laboratories, McKee is now completing a new microbiology core laboratory that will come on line this fall, making it Banner’s regional hub for this type of testing. There, lab operators will culture organisms like strep and other infectious agents, urinary tract infections, e coli and others to ensure that patients are properly diagnosed and treated. The lab will handle all microbiology testing for McKee, NCMC and other Banner Western Region labs in Wyoming. To improve operational efficiencies, all of

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Matt Hailey, Northern Colorado director of Laboratory Services for Banner Health, shows off the new $11.5 million state-of-the-art lab at North Colorado Medical Center.

the region’s outpatient, outreach lab and routine testing will go to NCMC. McKee’s lab will focus on supporting inpatient testing along with regional microbiological testing. McKee lab’s staff of 33 full-time-equivalent technicians ensure that it operates 24/7, registering patients, drawing blood and performing test procedures. The team supports all of McKee’s inpatient needs, including the emergency room, intensive care unit, obstetrics and surgery departments with quick-turn testing to provide needed results within hours. At NCMC, the new automated testing line will handle the bulk of testing in the region when it becomes operational this month. The lab will test various blood chemistries to assess whether patients are dehydrated or have issues with their thyroid, kidney, liver, muscle, bones, lipids and more. Consolidating this high-volume testing at NCMC will reduce duplication and variation, and improve reliability and consistency.

“The advantage of automating all or part of these testing processes is that we reduce variations associated with human error,” says Matt Hailey, Northern Colorado director of Laboratory Services for Banner Health. “Repetitive, redundant processing functions are among the most fraught with human error. Whenever we can reliably automate a function that involved considerable human intervention before, we see a payoff. We’re not replacing humans, we’re replacing the way certain things get done to make the overall process better.” While trained people must still order the right tests and send results to the proper place, the automated system will ensure specimens are stored and tested properly. “A lot of pieces that previously relied on human intervention will now be automated.” Hailey is particularly excited for the NCMC lab’s open house on July 12. The lab is expected to be fully functioning on July 21. “I’ve seen

a lot of labs, and this is one of the nicest spaces around,” he observes. “We designed it through an interactive process with the architectural team. The work we’ve put into this facility will pay off for years to come.” “Our current lab is 30-plus years old,” he continues. “We’ve outgrown it, and our power and HVAC would have been insufficient soon. Test variety and volume has grown, we have more and bigger equipment, and we’ve been challenging the capacity of the infrastructure and the space. Now we’ll have a new foundation to build on, and room to grow as Banner continues to grow its strategy to serve the people of northern Colorado. We now have space, flexibility and infrastructure for another 30 years.”

Brad Shannon is a freelance writer based in Loveland.

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Testing by the Numbers In 2013, the total number of labs performed by Banner Health labs in Northern Colorado was: •

McKee: 596,316

•

North Colorado Medical Center: 928,596

The top five tests by volume for the Northern Colorado Banner labs over the last few years were:

widely used diagnostic test that physicians are requesting when looking at a wider variety of conditions. Since 2012, Banner has seen nearly a 300 percent increase in this testing. Another trend is the advancement of testing technology. Traditional tests use microbiological culture methods that can take days to culture a specimen, grow out the organism and identify it. Now, molecular testing, or PCR (polymerase chain reaction) amplifies the DNA present in a sample and identifies an organism using it. It is incredibly sensitive and specific, and is much faster. A process that took days can now be done in hours.

1. Complete Blood Count (CBC) 2. Comprehensive Chemistry Panel 3. Basic Chemistry Panel 4. Prothrombin Time (PT) 5. Urinalysis In addition to the need for the direct access testing in the region, which has grown to 10 to 15 percent of Banners test volume regionally, other interesting and important trends are impacting medical testing regionally and nationally. One is an increase in Vitamin D testing. Recent studies have linked Vitamin D deficiencies with a number of disease states, including cancer, childhood asthma and others. Vitamin D testing has become a much more

Northern Colorado Medical & Wellness 2014

Direct Access Testing As the healthcare industry changes, more people are educating themselves to stay informed about their own health. Some are actively monitoring their test results over time, and many are concerned about costs. In response to changing consumer demands and attitudes about healthcare, Banner Health created Horizon Laboratory, an outreach lab offering Direct Access Testing to the public. Today, sites in Greeley, Loveland, Fort Collins and Fort Morgan offer walk-in blood draws each weekday. Samples drawn for testing are couriered to NCMC to be processed. All samples are closely tracked by the Laboratory Information System (LIS) to manage the tests that have been ordered for the patient and how

test results will be given to the patient or their physician. Once delivered, samples are logged and put onto the new NCMC automated chemistry line or routed to one of the other testing areas within the lab. With this low-cost alternative—tests typically cost 40 to 50 percent less than those done at the hospital—there’s no need for an appointment or doctor’s orders. Patients appreciate the lower outof-pocket cost, especially those who are uninsured or have a high deductible. They can also access tests more often than their insurance may cover. Tests can’t be submitted to their insurance, unless they are performed under the direction of a medical doctor. Results can be mailed to the patient, picked up in person or sent to the patient’s physician via fax or email or transferred directly from the LIS to the patient’s Electronic Medical Record (EMR). A variety of test options are offered, from a comprehensive health panel to pregnancy testing to cholesterol and iron testing and much more. Horizon is staffed by six associates in the business office and 12 full-time phlebotomists and specimen processors. With Horizon, Banner focuses on providing convenient locations and hours, low costs and minimal wait times to allow patients to keep tabs on their health. Insurance is not billed, and cash, check or credit card payments are accepted at the time of service. Brad Shannon is a freelance writer based in Loveland.

WELLNESS

Hair Loss

Hairstylist Sally Weiss, owner of Old Town Hair Company, adds extentions to a client‘s thinning hair.

NOT JUST A MEN’S CLUB

FEMALE HAIR LOSS IS RAMPANT BY KYLE EUSTICE

lthough hair loss is often associated with men, a growing number of women suffer the same fate as they age. According to WebMD, as many as 5 percent of women under 30 and 60 percent of those older than 70 are affected. While most women notice it in their 50s or 60s, it can happen at any age for a plethora of reasons, including genetics, poor diet, hormonal changes and medical conditions. While it’s not unusual for people to lose 50 to 100 strands of hair per day, a person shouldn’t lose much more than that. Sudden, patchy hair loss or excessive hair loss when combing or washing your hair can signal an underlying medical

condition and may require medical treatment. Female hair loss takes on many forms. A physical or emotional trauma can cause hair to loosen. Large clumps of hair may come out after only gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches. Some medical treatments, such as chemotherapy for different types of cancer, can result in the loss of hair all over your body, however, it usually grows back after treatment ends. Some people experience smooth bald spots, often about an inch across. This type of hair loss usually affects just the scalp, but it sometimes also occurs in eyebrows. In some cases, skin may become itchy or painful before the hair falls out. Typically, the most common form of hair

loss is a gradual thinning on the top of the head. Women normally retain a line of hair at the forehead, but experience a broadening of the part in their hair. For any woman, this is concerning—and rightfully so. Hair is strongly tied to a woman’s femininity and when it starts to thin or fall out, it takes a massive toll on a woman’s self-esteem. Fort Collins native Sally Weiss, owner of Old Town Hair Company, is all too familiar with this condition. With over 20 years of experience, she has seen it all. Weiss specializes in hair color, color correction, hair design and women’s hair prosthesis, which is particularly vital to her business. Women of all ages come to her in hopes of restoring their hair to a healthier, thicker state. Her special training in human and

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Northern Colorado Medical & Wellness 2014

synthetic hair prosthesis, hair extensions and color correction makes her a valuable asset to any woman’s hair regimen, especially those experiencing hair loss. “Diets can have a lot to do with hair loss,” Weiss says. “A lot of women have autoimmune issues or hormonal issues. Simple aging and genetics have a lot to do with it, as well. Many older gals have that gene kick in and then there’s not a whole lot they can do about it, except treat it with over the counter drugs. If it gets too bad, then you’re usually coming to see us.” While there isn’t much that can be done to correct the hereditary factor, Weiss has several options to minimize the issue, including extensions, wigs, hairpieces and topical solutions. “The only thing I’ve seen over the years that has proven to grow hair back, or at least show some improvement, is a topical solution called minoxidil,” she explains. “Women are supposed to use no more than a 2 percent solution. Men are able to do up to 5 percent of minoxidil. That type of thing usually helps. “Minoxidil isn’t a new treatment,” she adds. “It’s been around for a long time. It was commonly known as Rogaine early on. We carry a product called Bosley. It can help, but it will be up to six months before you see any improvements, if at all. Then a lot of the time, you’ll have to stay on those products for the rest of your life. You’ll lose what you’ve gained if you go off of it.” Old Town Hair Company is also able to

provide cranial prosthetics, integrations, grafting and hair extensions that are individually designed. They offer beauty, comfort and rich, natural color. The designers select only the softest lightweight materials to ensure the ultimate in comfort and natural appearance. All of their prostheses and wigs are made by hand with synthetic or human hair strands to provide the bounce and appearance of natural hair. For some women the problem can be so severe Weiss recommends a dermatologist. They can diagnose more serious conditions like autoimmune deficiencies, thyroid disease, scalp infections and other skin disorders. According to the Mayo Clinic’s website, female hair loss can also be caused by medications used to treat depression, high blood pressure, cancer and arthritis. “Dermatologists will often put women on steroids and stuff of that nature,” Weiss explains. “But I’ve seen it be a losing battle over the years and you’re taking all of these drugs, fighting a gene you can’t beat.” That’s where a good hairstylist like Weiss can come in handy. According to the Old Town Hair Company’s website, over 30 million women in America alone will experience some type of hair loss in their lifetime. “It’s a big problem,” she says. “We have a lot of women who come to us for wigs. A lot of women also have alopecia, which is a genetic condition where you can’t grow any hair at all. We do hair extensions, too, but that doesn’t help the top of your head. We can do

extensions from the horseshoe down and at the top we can do a graft. There are different ways to attach those. I’ve seen women who have a whole head of hair and you would never know it wasn’t their real hair.” For those women who are too embarrassed or ashamed to approach a salon for help, the Old Town Hair Company has a private area where the staff visits with each client due to the sensitive nature of the topic. “It does affect you on a personal level,” she says. “I just did a gal in her 80s and she had hardly any hair on top, but I put her in a top piece and you’d never know. It changed her life. You could visibly see the difference in her facial expressions when we were done. The transformation that took place was amazing. “Of course, it can be an embarrassing thing, but you shouldn’t be embarrassed to come to us because we see it all the time,” she adds. “There are a lot of options out there.”

Kyle Eustice recently relocated to Fort Collins with her fiancé Paul and chihuahua Paco from her hometown of Omaha, Nebraska. After spending four years living in Santa Fe, New Mexico, she couldn’t wait to get back to the mountain region. She is a regular contributor to Thrasher Skateboarding Magazine, Wax Poetics, Ghettoblaster, and many others.

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mind

Northern Colorado Medical & Wellness 2014

body

spirit

mind

body

spirit

WELLNESS

Childhood Obesity

C OM BAT SUM M E R

ADOLESCENT WEIGHT GAIN

BY MICHELLE VENUS

hink back to your summers off from school. Chances are your parents pushed you out the door in the morning with instructions to be home for lunch and dinner. You probably spent a good portion of your time swimming, biking or exploring the surrounding environs. You were fit and healthy and slept like a rock. Today’s trend is different. Independent studies conducted by The Journal of School Health and The American Journal of Public Health came to the same conclusions: Kids gain weight at a more rapid rate during summer vacation than during the school year. In fact, the Journal of School Health research showed that during the school year, a child’s BMI (body mass index) decreases by 1.5 percentile points, whereas it increases by 5.2 percentile points during the summer months. Think of it this way: between August and May, the percentile points go from 95 to 93.5 and in the summer, they go from that same 93.5 at the end of the school year to a much higher 98.7 by the time kiddos head back to the classroom.

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Say what? Michele Gilson, registered dietitian for Kaiser Permanente, says, “Non-structured, non-school time can be a real problem, especially with a kitchen right around the corner.” The problem seems to grow as kids get older. In households where both parents work, younger children are often sent to camps or other structured environments where their activities are coordinated and monitored. Once they’ve reached the age where they can be legally left home alone and become responsible for filling their time on their own, adolescents frequently spend more time in front of computer or television screens. Often, for safety’s sake, they are given instructions not to leave the neighborhood, or even the house. It can result in sedentary behavior and overeating out of boredom. What can parents and their kids do to combat summer weight gain? It can be as simple as 5-2-1-0.

Two

Limit screen time to no more than two hours each day. Here’s another way to get your adolescent involved in choosing how their days plays out: Let them choose how that screen time looks. Will it be television or video games? Will both hours get eaten up in one chunk, or will your child decide to split it into two sessions? When will screen time happen? Children who engage in more than two hours of daily screen time have double the incidence of obesity compared to children who watch less than one hour per day. Additionally, extended television watching has been linked to lower reading scores and attention problems.

One

Five

“Make sure your children are getting five servings of fruits and vegetables every single day,” advises Gilson. And not just at meals: add snacks to that healthy mix. Gilson recommends freezing green beans, grapes and watermelon (or choose your own favorites) as convenient, temperature-cooling, refreshing snacks. Her own young daughters love them. Or make homemade yogurt pops, which can be done easily with paper cups and a popsicle stick. Add chopped up seasonal fruit or berries for one of your fives. Other healthy options include baby carrots with hummus, celery or apples with peanut butter, fruit kabobs, unsweetened applesauce or oven-baked sweet potato fries with pumpkin pie spice sprinkled on top. Make “ice cream sandwiches” from banana slices with a peanut butter-yogurt mix in the middle. Yum. Consider joining a CSA (Community Supported Agriculture) and make a family outing of picking up your share. Northern Colorado has a growing CSA scene, and it’s easy to find one that meets your family’s needs. Plan a family trip to the farmers’ market and let your kids pick out their own fruits and veggies for snacks. The more they are involved with the choice, the more inclined they will be to actually eat what’s in the fridge.

Northern Colorado Medical & Wellness 2014

Make sure your children get one hour of heart-pounding physical activity every day. Gilson asks her younger patients to put their hands over their hearts and feel it beating. Then she instructs them to jump up and down until their hearts start pumping. Hard. “I tell them that’s how I want their hearts to feel for an entire hour,” she explains. “Find an activity that you enjoy. Have fun. This is setting up lifelong habits.” Plan family activities. Take a bike ride together. Go on a power hike. Remember hula-hoops? At the very least, you’ll all enjoy a good laugh. Throw a frisbee. Get everyone involved in that heartpounding activity—even the dog. By doing so, you’re creating good times, memories and healthy lifestyle lessons. If necessary, start gradually and build up to the hour.

Zero

Drink only non-caloric beverages. And it doesn’t have to be plain old water, either. Jazz up a pitcher full of H2O with slices of lemon, lime or oranges. Add a few slices of cucumber and sprigs of mint to a glass of sparkling water. Stay away from sugary drinks. Avoid soda, sports drinks, sweet tea and juice. None of them offer any benefit. When it comes to artificial sweeteners, Gilson recommends parents use their best judgment. “It’s important to keep moderation in mind,” she says. “That being said, caloric drinks should be kept at a minimum.” Kaiser Pemanente has a 5-2-1-0 Action Plan on its website, www.kphealthyme.com, along with healthy snack ideas and other valuable information. In order for an action plan to work, parents need to provide structure to summer vacation. “Sit down with your kids and set up a schedule that you stick to,” suggests Gilson. “Your children should get up the same time every morning. They should eat their meals at approximately the same time and at the table, not in front of a screen or standing up. Plan activities. Ask your kids what they’re going to do that day and when they’re going to do it. The structure they had during the school year should be carried through the summer.” Ready for an activity-filled and healthy summer? 5-2-1-0 blast off!

Michelle Venus is a freelance writer based in Fort Collins

Lydia’s STYLE Magazine

Northern Colorado Medical & Wellness 2014

WELLNESS

Med Spa

Mina Muirhead, R.N. and laser tech, consults with a patient on the benefits of fillers.

FILLERS RESTORE FULLNESS BY ANGELINE GRENZ

oday’s fillers focus on returning the face to the fullness of youth with injectable serums to plump up the cheeks, temples and other areas.

“As we age, we experience bone and fat loss that gives a hollowness to the face,” says Mina Muirhead, R.N. and laser tech at Allura Skin, Laser & Wellness Clinic. “Fillers can lift the face up and restore that nice, natural curve to the cheek area for a more youthful face.” Two new filler products available at Allura focus on the cheek area and creating a fuller look for the face.

Voluma

The first product is an injectable gel designed specifically for the cheek area. “This Hyaluronic

Acid (HA) filler is similar to Juvederm but with a lot more lifting power,” says Muirhead. As women age, the upper part of the face tends to thin and leaves the lower part of the face looking heavier, says Muirhead. Voluma can fill in the cheek area with injections along the cheekbones, and pull the attention back up to the eyes as a focal point. The procedure is a quick 45-minutes and can be done over the lunch hour. Even better, results are immediate, so clients can leave their appointment feeling and looking younger—and the results can last up to two years. Typical side effects are minor bruising and swelling. Muirhead says topical numbing cream before the procedure is generally all that is necessary and the injection does carry a numbing agent as well. Voluma is suitable for women ranging in age

from their mid 30’s through their 60’s. “This procedure is all about instant lift,” says Muirhead. “I love seeing my clients leave thrilled at results they can see immediately.”

Sculptra

Sculptra Aesthetic also creates a fuller, more youthful appearance by helping the body replace lost collagen. Collagen, that key component that keeps skin smooth and youthful looking, decreases naturally as we age. Sculptra replaces that lost collagen over time and gives you gradual, long lasting results. “This product actually stimulates the body to produce more collagen,” says Muirhead, “You can use Sculptra to improve flattened cheeks, facial hollowing and temple indentations and will restore the look of fullness to the face.” Sculptra works gradually. Muirhead

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Voluma patient before and after

recommends to most patients three separate sessions, approximately four weeks apart. Results can last up to two years. Sculptra differs from Voluma in that it can be used all over the face to create fullness and smooth out lines. The procedure generally takes 1 to 1.5 hours per session. There is some immediate fullness to the face from the injectable solution, says Muirhead, but that decreases over time and then the body gradually starts to produce more collagen. She advises that the initial results are seen about a month into the procedure and the full results can be seen after three to four months. Side effects are similar to Voluma; some bruising and a little soreness may be present. However, there is no down time and the treatment is also recommended for women between the ages of late 30’s to late 60’s. Muirhead, a 10-year veteran in the medical cosmetics arena, recommends that anyone interested in facial fillers come in for a free consultation to find which filler might be right for them. “I love helping clients with skin rejuvenation fillers,” she adds. “I get instant gratification seeing my patients leave happy with their results.” Angeline Grenz is managing editor for Northern Colorado Medical & Wellness Magazine.

Northern Colorado Medical & Wellness 2014

WELLNESS

Med Spa

FILLERS ON STEROIDS

kin rejuvenation fillers are a great way to correct the age-related hollowness that happens to the face over time. Who doesn’t want a to turn the clock back to a smoother, fresher looking you? But what if, with a little ingenuity and a whole body approach, the effectiveness of your fillers can be enhanced exponentially? That is the recommendation of Dr. James Howton, medical director of Restore Health Center in Loveland. Dr. Howton outlines a variety of ways to achieve better results by taking a holistic approach to wellness and aesthetics. Dr. Howton advises, “We love fillers such as Juvederm, Voluma, Radiesse or Belotero—but use them not just to fill volume but as building blocks to help restore youthful collagen levels and improve the skin’s elasticity.” He adds that the main ingredient to many fillers, hyaluronic acid, is a precursor to collagen. It gives the body the

foundation but the body still needs the signals to take the filler and use it to build the collagen that will restore youthfulness to the skin. Those signals can come from complementary modalities. This holistic approach to skin health includes a variety of approaches. Dr. Howton says one avenue is to use fillers in conjunction with Photo Activated Platelet-Rich Plasma (PAPRP) injections. These injections contain growth factors and stem cells harvested from the patient’s own blood that signal the body to heal and repair itself. When administering PAPRP at Restore, Dr. Howton utilizes a specially designed light that increases growth factors and activates the stem cells within the plasma. Stem cells can also be harvested from a person’s own fat or bone marrow to address volume loss in the face. At Restore, they inject the stem cells along with the fillers for maximum result. “It is like fillers on steroids,” he says. Another modality that can be used in conjunction with fillers is laser therapies that target the

BY ANGELINE GRENZ

deep dermis of the skin. Lasers stimulate the body to build and repair; Dr. Howton likens it to our body’s response when we work out—we break down muscle, which stimulates our body to build more muscle. “The filler becomes like the extra protein shakes that we ingest after exercise. In this case, we are building more collagen.” Unique radiofrequency treatments like Sublative, require little to no recovery time because they have minimal impact on the surface of the skin. Instead, they rebuild healthy skin from the inside out. When used in conjunction with fillers or PAPRP, rejuvenation results from this treatment are dramatically enhanced. Restore calls this treatment duo ‘Time Machine.’ Dr. Howton advises patients to improve their “internal environment.” Skin ages faster after menopause, he points out. Women achieve much greater results when they address nutritional and hormonal deficiencies in conjunction with facial fillers. Not only does this improve overall health, but it greatly enhances the body’s ability

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Restore Health Center patient who has had Photo Activated PlateletRich Plasma Therapy on the face, neck and chest paired with fillers in the nasal folds and cheekbones.

to heal and repair. Stress is another health factor that greatly affects our overall body health. Oxidative stress is the imbalance between our antioxidant defenses and the presence of free radicals in the body. These free radicals damage our collagen and cause our skin to age. Dr. Howton likes to measure and decrease oxidative stress as part of a holistic approach to beauty. “With high oxidative stress the body just won’t respond as well to treatments and fillers would just mask the real problem.” Dr. Howton says a whole body approach can make all the difference in maintaining our youth for as long as possible. Recapture lost collagen by pairing your filler with another modality to get the absolute best result. “We all have the same tools when it comes to fillers, but what else does your body need to correct collagen loss? In this way fillers become so much more.” To find out more or set an appointment with Dr. Howton or the aesthetics team, visit www. restorehealthcenter.net or call (970) 278-0900.

Angeline Grenz is managing editor for Northern Colorado Medical & Wellness magazine.

Northern Colorado Medical & Wellness 2014

The comforts of home and the feeling of family.

Experiencing the changes in a loved one who has Alzheimer’s disease or a related Dementia can be difficult. Finding a place for your loved one to call home shouldn’t be.

Contact: Shirley Saucedo 720-448-9922 for a tour. w w w. a s h l e y c a r e s . c o m

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Northern Colorado Medical & Wellness 2014

WELLNESS

Skin Care

YOU A RE MY SU NSH I N E,

BU T NOT MY SK I N ’ S FR I E N D

he skin is the largest organ of the human body and a true symbol of beauty. Our intense Colorado sun is both enjoyable and soothing; yet, it can ensue havoc on our skin that can lead to damage beyond repair. It’s a shocking statistic, but approximately one in five Americans will get skin cancer in their lifetime. Colorado’s roughly 300 days of sunshine is a definite culprit, but avoiding the sun and staying indoors is not the answer. Properly protecting yourself from harmful UV radiation while you enjoy the outdoors is the best way to ensure good health and happy skin. The biggest preventable risk factor of sun damage is sun exposure. Dr. Tim Grayson, a dermatologist for Kaiser Permanente in Northern Colorado, states that you should try to avoid

the intense sun in the middle of the day, wear proper clothing during the day and always wear sunscreen. Protecting yourself from ultraviolet radiation prevents skin aging. Considering how much money Americans spend on cosmetic skin products each year, prevention is a practical, economical and healthy option against wrinkles. “Sun protection is one of the most cosmetic interventions you can do,” says Dr. Grayson. “Always use at least 30 SPF sunscreen and make sure it says broad spectrum on the label. That means it protects against UVA and UVB radiation. If you notice any changing spots, immediately seek professional advice. Blistering sunburns are especially dangerous.” It is also recommended that people conduct their own skin self-exams once a month. You can help remind yourself with a smart phone alert or by putting it on your calendar. It is advised that

BY MALINI BARTELS

you use a mirror while doing this to inspect hardto-see areas of your body. Adults can even have a little fun with it and seek the help of a partner. “Tanning is your skin’s response to damage from UV radiation,” stresses Dr. Grayson. “There is no such thing as a good tan. People just shouldn’t do it.” In fact, tanning beds are so dangerous, you increase your risk of skin cancer every single time you use one. While it is certainly true that people with fair skin are at higher risk of skin cancer from UV radiation, nobody is completely protected. Even individuals with dark complexions are susceptible to the sun’s harmful rays. Almost 10,000 Americans will die from melanoma in 2014. Sun protection should be taken seriously, and in Colorado, everyone should know that ultraviolet light is more intense at higher altitudes. It’s equally important to know that

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Tim Grayson, M.D., Dermatologist and Operations Chief, Medical Specialties for Kaiser Permanente Colorado

water, sand and snow reflect UV light; vacationers should protect themselves while having fun. Ever see someone with “ski goggle sunburn?” Not funny once you know how painful and damaging that can be. According to Dr. Grayson, “People tend to not apply enough sunscreen. You can only count on its affect lasting two hours. You must periodically reapply, particularly if you are going in and out of water. Also, there is no such thing as a waterproof sunscreen. There is only water resistant and only for a certain amount of time.” People should also be aware of the two different kinds of ultraviolet (UV) radiation. UVA affects skin aging and can even penetrate through glass. UVB is what causes sunburns. Both are damaging to skin and are the reason why broad spectrum is important to use because of its defense against both UVA and UVB. “There is significant UV exposure in Colorado year round,” mentions Dr. Grayson. UVA rays even go through your car windows. Automotive window tinting with UV protection is a good option for prevention of UVA sun damage, especially if you spend a significant amount of time in your car. Even a cloudy day cannot protect you from sun damage. “Prevention is always the best way to avoid damage,” reminds Dr. Grayson. “We live in Colorado; this is a wonderful place to get outdoors and enjoy life. You just need to do it in a smart way. Don’t let yourself get burned in the first place.” Enjoy our beautiful Colorado summers! Just remember to be smart and pre-emptive about sun damage.

Malini Bartels is a freelance writer, chef, mother, radio host and actress living the good life in Fort Collins.

Northern Colorado Medical & Wellness 2014

SAFEGUARD YOUR SKIN What is ultraviolet light? A form of radia-

tion that is not visible to the human eye. It’s an invisible part of the “electromagnetic spectrum.”

What is melanoma? A tumor of melanin-

producing cells, typically a dangerous and even deadly skin cancer.

What is SPF? Sun Protection Factor is a

Now that you have a sunburn, what should you do? 1.

Give it time—this could take a while.

Moisturize—keep it soft to minimize peeling and itchiness (your mom was right about the soothing properties of aloe vera gel).

Avoid additional sun exposure (don’t make it worse!).

Use over-the-counter pain medication as directed to help with discomfort from burns.

Leave it alone! Avoid blisters and tears that can lead to infection and scarring.

measure of how well a sunscreen will protect skin from ultraviolet rays, the kind of radiation that causes sunburn, damages skin and can contribute to skin cancer.

Some ways to protect your skin from UV radiation damage 1.

Cover up and wear a hat (hey, it’s fashionable!).

Apply sunscreen (Broad Spectrum, SPF 30 or greater) and reapply often.

Don’t forget sensitive and sometimes forgotten areas such as the ears, nose, hands and feet.

Have your car windows tinted with a UV blocking tint—this also helps reduce how much you run your air conditioner in your vehicle.

Avoid the intense midday sun whenever possible.

Now that I have a spot on my skin, what should I do? 1.

Look for lesions and spots that are changing shape, morphing and getting bigger.

Pay attention to bleeding. Bleeding wounds should never be ignored.

Avoid sunbathing and tanning beds.

Continue to avoid additional sun exposure.

Don’t let the weather fool you—clouds are not protection from the sun.

Have your spot or lesion looked at by a family physician or dermatologist.

WELLNESS

Dental Care

Braces U Orthodontics patients can be picked up by the Braces Bus and transported to and from appointments.

CONGRATS! YOU’VE BEEN ACCEPTED TO

BRACES U ! BY MALINI BARTELS

emember the days of hideous headgears and painful jaw expanders? Well, thankfully, they are in the past. Those who are looking for orthodontic treatment to correct a bite problem or obtain cosmetic straightening can relax and enjoy the comforts and innovation of Braces U Orthodontics. In a very tight-niche market, local orthodontist Dr. Cory Coombs decided to explore something different with his practice. In addition to a new

name, the office received a collegiate-themed face-lift at the beginning of this year. “We wanted to bring a more fun and memorable atmosphere to the practice while continuing to offer the very best for patients during their orthodontic journey,” states Dr. Coombs, owner of Braces U Orthodontics. The practice’s original owner, Dr. Robert Lamb, is a well-established orthodontist in the area and the professional associate of Dr. Coombs. Orthodontists such as Drs. Coombs and Lamb are dental professionals who receive two or three additional years of specialized university-based

training after they graduate from dental school as primary care dentists. The specialized training is similar to what distinguishes cardiologists from primary care physicians. Additional training makes orthodontists the most qualified to treat the unique complexities in the alignment of the teeth and jaws. Dana Silk is the general practice manager at Braces U. She says the entire staff is invested in the satisfaction of their patients. “There is a real dedication here to innovation, change and a comfort that comes along with that change,” says Silk. “We are introducing a new way of

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doing things and the entire practice is comfortable with new ideas.” Combined, Drs. Coombs and Lamb have been serving the local community for over 20 years. While their location, doctors and staff remain unchanged, they have added a new service— the Braces Bus, a custom wrapped Toyota Sequoia. With parent permission, the Braces Bus, driven by a staff member, will shuttle kids to and from their school for orthodontic appointments at Braces U Orthodontics. “This minimizes the impact and inconvenience on families,” Coombs explains. “If you can make getting braces more convenient, it’s a lot less painful for everyone.” Starting this fall, the Braces Bus will service the Fort Collins, Loveland and Windsor school areas and will operate mostly during the morning hours. The service will also require an academic release form to go along with the appropriate coordination at the schools. “Traffic is usually a little lighter in the mornings and we want to minimize the impact on schools and kids’ afternoon schedules, particularly in middle and high schools,” says Rebecca Bickham, Braces U Marketing Coordinator. After appointments, parents receive an email documenting how the appointment went and what was accomplished; necessary, since it took place during school hours and the parents were not in attendance. “We use the latest in braces technology allowing us to minimize the total number of appointments, but it can still be a burden for families to get their kids to and from our office without hindering both school and work. That’s why we are introducing a Braces Bus,” says Dr. Coombs. “The Braces Bus sets us apart from other practices. We went the extra mile and discovered what we can do to serve our customers better.” The staff is so excited for their patients when they get their braces off that they throw a party to celebrate their beautiful new smiles! “We host a graduation soiree for all of the kids who are ready to get ‘debonded,’ dedicating a day to celebrating with fun music, a photo booth and indulgent foods, including make-yourown candy mixes, slushees and all the things they love. We want them to feel a part of the

Northern Colorado Medical & Wellness 2014

Braces U journey so when we arrive at the end, we acknowledge a big milestone in their lives with festivities to remember,” says Bickham. “We have created a pressure-free environment where no referral is needed,” adds Dr. Coombs. “The general public doesn’t realize that it’s free to come in and have a professional orthodontist look at your teeth. It’s the best way to prevent problems in the future. And prevention is the key.” Convenience and a progressive nature are recurring themes throughout the practice. With a movie area, iPad and iPod docking stations and the ability for patients to create their own playlist of songs, Braces U has created a hip environment for anyone undergoing orthodontic procedures. They even have a “campus store” full of age appropriate incentives. Of course braces are not just for teenagers. Adults who find they need dental or jaw alignment will relish in the fact that braces technology has made leaps and bounds from their youth. Braces U is located at 4360 Boardwalk Dr., Fort Collins. The practice offers a full range of orthodontic services. For more information, contact Braces U Orthodontics at (970) 226-5505 or find the latest news at www.BracesU.com

Cory Coombs, DDS and owner of Braces U Orthodontics

Malini Bartels is a freelance writer, chef, mother, radio host and actress living the good life in Fort Collins.

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CALENDAR OF EVENTS CONCERT SERIES: July 1, 8, 15, 22, 29 August 5 Noontime Notes Concert Series: An intimate concert series where you can appreciate jazz, rock-n-roll, folk music and other genres while eating your lunch. Located in Oak Street Plaza in Downtown Fort Collins - Tuesdays. 11:30am-1:00pm FREE July 3, 10, 17, 24, 31 August 7 Bohemian Nights presents Thursday Night Live Old Town Square concerts showcasing Colorado music! 7:00-9:00pm Presented by Bohemian Nights, LLC. FREE July 4 Ben & Jerry’s FAC Concert (The last one!) Series Live music in Old Town Square to kick off each weekend! 7:00-9:00pm Presented by Ben & Jerry’s Scoop Shoppe. FREE July 11, 18, 25 August 1, 8 Downtown Summer Sessions Concert Series Old Town Square concerts showcasing Colorado bands, local craft beers and great summer fun! 7:00-10:30pm Presented by The Downtown Fort Collins Business Association. FREE FESTIVALS: July 17, 18, 19, 20 Downtown Summer Sales - Come get the best deals in Downtown shopping! Summer blow out sales for participating Downtown shops will be filling the sidewalks and stores with clearance items, great deals and more. Come with friends and walk around the historic downtown area to enjoy great shopping, grab something to eat on a patio and have some relaxing summer fun while you save money. And on Thursday and Friday enjoy free trolley rides on Downtown’s historic trolley along Mountain Ave, sponsored by Big Al’s Burgers and Dogs. And after discovering some of your favorite shopping spots, finish the evening with dinner at over 45 restaurants, all located a few steps away! GIFT CARDS MAKE PERFECT GIFTS! Over 160 downtown businesses accept Downtown Gift Cards! Tasty restaurants, unique shopping, live entertainment, art galleries, all in a historic setting! These gift cards are available at the Downtown Visitors Center or online at 970-484-6500 www.DowntownFortCollins.com.

Northern Colorado Medical & Wellness 2014

Fostering Our Musical Ingenuity By James Yearling Fort Collins is putting the money where our mouths sing. Music is a vehicle for celebration and resonates as the backbone of our vibrant artistic community. Our beer is best-paired with live music, our events and festivals depend on it and city-wide support rallies around the cause, both applauding and uplifting musicians. Relied upon for entertainment and commemoration, local music rounds out the soundtrack to our lives. Music shapes our sense of place and provides the spice of life. Fort Collins is hailed as a mecca for live music in the Rocky Mountains, with downtown streets morphing into festival grounds, Old Town Square transforming into a classic concert venue, and public spaces that pulse with performers (and even hand-painted pianos). Each note played and every recording released pushes forward our city’s contemporary “hip history” as an incubator for all things music. This musical playground provides authentic opportunities to connect and help each other grow artistically and economically. Non-profit groups dedicated to local musicians “adopt” bands and provide them with professional guidance, business-networking and administrative support; the goal being to curate communications that trigger reciprocal relationships between music industry stakeholders and performers. The city helps send our musicians across the country as ambassadors of the “bikes, beers and bands” culture, and in turn, Fort Collins’ own nationally and critically-acclaimed musicians regularly welcome Grammy-winning and platinum-recording artists to our local stages. These collaborations embolden the grassroots nature of the music community and encourage artists to re-invent the ordinary by joining hands with those who want to

help: local radio stations, world-class recording studios, award-winning photographers, cutting-edge graphic designers and tech experts harmonize with local musicians regularly. This web of support can also empower musicians financially, enabling them to record their next masterpiece or promote their next tour – oftentimes local crowd funding campaigns and fundraisers result in max returns. As Fort Collins works hard to reinvent itself and shift into the future, local music will remain a community-wide point of pride and a jovial reminder to “let the good times roll.” Music is our measure of comparison to “what other places are like” and it is our stamp of approval that Fort Collins values performances, festivals and celebrations. Boasting diverse and talented musicians, uniquely-Colorado music venues and vast community support, it’s clear that Fort Collins’ investment in music is paying huge dividends.

2014 marks two marquee milestones for Bohemian Nights at NewWestFest, a free, threeday community music festival featuring internationally renowned headliners and 70+ Colorado bands. Held on August 15-17, the festival will celebrate the 150th birthday of Fort Collins and the 10th year anniversary of the Bohemian Nights musical line-up. This family-friendly, urban-setting festival also showcases over 250 art, specialty and food booths in addition to the wide variety of musical genres – A Colorado Music Lover’s Dream! Happy Anniversary, Fort Collins!

WELLNESS

Senior Health

SENIOR LAW DAY 2014

ommunity advocates for elders see Senior Law Day (SLD) as an important first step to deal with concerns about the coming age wave—the swell in the U.S. senior population over the next several decades. Consider that in 2011 American families toasted the first “baby boomers” to reach their 65th birthdays. (This generation includes those born between 1946 and 1964.) In 2010, the Federal Interagency Forum on Aging-Related Statistics published demographic predictions. According to their report, “The older population in 2030 is projected to be twice as large

as their counterparts in 2000, growing from 35 million to 72 million and representing nearly 20 percent of the total U.S. population.” Given this forecast, wise families, amid refrains of “happy birthday,” are also reflecting on the social, legal and financial challenges that will accompany the elder years for loved ones and even for themselves. “SLD is not just senior specific. Everybody has aging parents, grandparents or friends. SLD is just a great, inexpensive way for people to come and get accurate information,” says Rikke Liska, Associate Attorney with Procter and Callahan. Workshop sessions scheduled for the August 2 event will provide free legal advice

BY ELISSA J. TIVONA

for people of all ages. She adds, “We target seniors and family members, but quite frankly, it’s People Law Day.” Liska, the 2014 Chair for SLD, which organized annually through Larimer County’s Elder Care Network (ECN), emphasizes that learning about estate planning and knowing about powers of attorney, advanced directives and wills versus trusts pertain to everyone. Fortunately, the Elder Care Network of Larimer County had the foresight to anticipate a rising need for comprehensive, timely and accurate information to help fill gaps in knowledge and reduce anxieties around issues associated with aging. In 2004 an ECN committee, initiated by Kirsten Hartman, a certified

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geriatric care manager and founder of Seniors in Transition, and Elaine Procter, senior partner of Procter and Callahan, began planning the first Senior Law Day in Fort Collins. The local event was modeled after the annual statewide conference held in Denver and sponsored by the Colorado Bar Association. Hartman, who attended one of the early Denver conferences, noted how extremely well attended the event was. She says, “There were 600 people! So I came back to Fort Collins and said why not do the same thing here? We got some attorneys involved, and they got the involvement of the Larimer County Bar Association.” Less than a year later, the first Northern Colorado Senior Law Day was held in September 2005 and hosted about 100 people. This year, organizers expect to quadruple the number of attendees. The event is being held at the Hilton Hotel from 8 a.m. to 3 p.m. on Saturday, August 2. Conference participants must register for the event. (Pre-registration is available online at www.eldercarenet.org/info/sld.) Registrants are encouraged to make a $10 donation to help support the event and other ECN outreach programs. However, no one is turned away for inability to pay. Registration entitles participants to attend two morning sessions and two afternoon sessions, based on interests and selected from a list of 12 topics. All sessions are designed to help seniors and their families with legal

Northern Colorado Medical & Wellness 2014

matters relevant to aging and planning for the future. For example, this year’s topics include: Estate Planning Overview; Real Estate Issues in Estate Planning; Veterans Benefits and Long-Term Care Planning; Tax Consideration for the Modest Estate; Legal Issues of Family Relationships; Who is my Fiduciary and Why Should I Care? Legal Issues of Medical Decision-Making; Medicaid Long-Term Care Benefits; Probate Administration in Colorado; Comparing Wills and Trusts; Legal Considerations for Finances; and Power Against Fraud: Scam Prevention & Remedies. More than 18 attorneys from the community that specialize in elder law and estate planning volunteer their time during Senior Law Day. They offer the educational workshops or make themselves available for consultations through the “Ask-an-Attorney” table. The popular “Ask-an-Attorney” service gives families an opportunity to receive brief one-onone counseling, where they are encouraged to raise issues specific to their situations. Liska notes, “People just don’t know where to start. Or, they’re afraid that if they call an attorney and ask one question, they’re going to receive a bill for a thousand dollars, so they’re afraid to even ask.” Ask-an-Attorney is free legal advice to help families overcome these fears and get them pointed in the right direction. Then, they can make educated decisions about what type of professional services they actually require. Liska also points out that the conference

topics vary every year. Hartman adds, “Often the same people attend the conference year after year and get new information each time.” In addition, all participants receive a copy of The Senior Law Handbook, produced by the Colorado Bar Association and filled with valuable information on relevant topics, supplemented by a Larimer County handbook including notes from all SLD sessions. “I see a lot of people who are looking things up on the Internet or who are just listening to their friends,” says Liska. “Friends are saying, ‘Oh everybody’s got to have a trust; or you have to spend all your money so that you can get on Medicaid.’ And then they are doing things that are not easily reversed. So for those people who need the information, this is a much better way.” Organizers thank platinum sponsors of Senior Law Day, including: Colorado State University Extension; the College of Health and Human Sciences, Department of Human Development and Family Studies; Good Samaritan Society–Communities of Northern Colorado; and Front Range Hospice. Their generosity helps ECN provide morning beverages and lunch for all registrants, along with all the invaluable information throughout Senior Law Day.

Elissa J. Tivona is a freelance writer based in Fort Collins.

VETERINARY

Pet Health

P ETS AND P OT

A DA NGEROUS M I X

tash your stash; guard your ganja. Those phrases have become mantra-like since the legalization of medical marijuana. It’s not about protecting the gold but rather about ensuring safety. A good example for the need for caution is the increased danger to your pets. Pets and pot do not mix, according to veterinary experts. “Marijuana intoxification is the number one toxicity seen in vet emergency rooms,” says Robin Downing, DVM, CVPP, CCRP, Diplomate American Academy of Pain Management, owner of the Downing Center for Animal Pain Management and the Windsor Veterinary

BY KAY RIOS

Clinic. “The increase in these cases has been more dramatic in those states that have legalized medical marijuana. And there will probably be an ongoing increase. Pets are ingesting whatever happens to be around: plants, edibles, tinctures or the smoking stash.” The Veterinary Emergency Hospital in Fort Collins verifies the increase. “We saw a huge spike with the legalization of medical marijuana and the opening of the dispensaries,” says Bonnie Right, DVM. “And the cases have gotten worse,” says Julie Lenoch, DVM, also from the Veterinary Emergency Hospital. “The severity of the symptoms we’re seeing is more highly concentrated because there is more easy access

to the edibles. Butter and oil are the main culprits. We’ve seen two dogs die in our clinic because of the increased potency. Before medical marijuana was legalized, no one died from pot; we had marijuana cases but no deaths.” A study conducted by Wheat Ridge Veterinary Specialists (WRVS) and the Colorado State University (CSU) James L. Voss Veterinary Teaching Hospital between 2005 and 2010 and published in the Journal of Veterinary Emergency and Critical Care found that, as the number of medical marijuana licenses increased in Colorado, so did the number of marijuana toxicity cases among pets. The study reports that the incidence of marijuana toxicosis increased at both hospitals

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Northern Colorado Medical & Wellness 2014

four-fold in those five years, e.g. the number of THC toxicosis cases in all groups at WRVS increased from 1.5 cases per 1,000 visits in 2005 to 4.5 THC toxicosis cases per 1,000 visits in 2010. A significant positive correlation was detected between the increase in known/ suspected marijuana toxicosis in dogs and the increased number of medical marijuana licenses. The two dogs mentioned above that had died ingested butter made with medical grade marijuana. The result of tetrahydrocannabinol (THC) ingestion is, in effect, pot poisoning, according to the research paper. “Toxicosis in dogs can be caused by inhalation of the smoke, direct ingestion of the leaves, seeds, stems and flowers of the plant, ingestion of products laced with marijuana leaves, or ingestion of products made with concentrated THC or hashish oil. Clinical signs may be seen within 30 to 60 minutes after ingestion of marijuana…The most common reported clinical signs of marijuana toxicosis in dogs include CNS depression, ataxia, mydriasis, increased sensitivity to motion or sound, hyperesthesia, ptyalism, tremors and the acute onset of urinary incontinence.” “While death from marijuana overdose is rare, it happens. This isn’t because of the drug itself causing death. It can cause profound sedation and nausea. When animals (or people) pass out and vomit, they can inhale their stomach contents and suffocate,” says Tim Hackett, DVM DACVECC and Director of CSU’s Veterinary Teaching Hospital.

“Animals get profoundly lethargic, vomit, have diarrhea,” adds Dr. Downing. “They have to ingest a huge amount to die but they can get very, very sick on smaller amounts. And unlike other narcotics where there is an antidote that can reverse that reaction, there is no antidote for marijuana intoxification so all we can do is provide care.” That care needs to happen quickly, she says. “They need to seek out a vet as soon as possible. It doesn’t matter if it’s two in the morning or two in the afternoon, that animal needs to go to the hospital immediately. If we get to an animal early enough, we can induce vomiting and then deliver activated charcoal which is a universal antidote for any overdose. It adheres to the molecules and can slow down, reduce or eliminate any additional absorption.” “The vomiting needs to be induced within 30 to 45 minutes before the adverse effects start to kick in,” adds Rainey Corbyn, DVM, and owner of South Mesa Veterinary Hospital. “If the pet owner knows the animal has ingested, then the pet should be brought in immediately. One of the significant effects of marijuana on dogs is sedation so after the effects have set in, it can be dangerous to make them vomit because you run the risk of having them inhale the vomit. So if you see it happen, don’t take two hours to get them to the veterinarian. Treat it like an emergency.” If the owners are unsure, there are several indications. “The major symptoms they’ll see are incoordination, stumbling around, listless

behavior and dilated pupils. Another symptom commonly seen is that they start leaking a lot of urine. The heart rate slows and the body temperature is abnormally low so, often, you’ll have to keep them warm,” Dr. Corbyn says. He adds that, “After treatment, whether vomiting or charcoal, we need to be pretty aggressive with IV fluids to get as much of the drug out of the system as has gotten into the bloodstream.” But, even after any ER treatment, it’s not over, Dr. Corbyn says. “Effects can last for days. The drug is fat soluble, only slowly leaving them over time. Once it gets into their system and gets into fatty tissues, it will have residual longer lasting effects than drugs that are water-soluble. They’re not going to be over it by tomorrow morning. They could be incontinent or have issues for several days. The more that gets into the fat, the longer the period they’ll be effected.” Dr. Downing says there’s another piece to this pot puzzle. “There is a lot of talk now about the role of medical marijuana for use in animals to work with pain. In theory, the use of it for pain relief in animals is grounded since we know animals’ nervous systems have receptors that are appropriate for cannabinoids, the chemical in marijuana that assists with pain and pain management. So, in theory, medical marijuana might have a future in animal medicine but, realistically, we have to ground ourselves in data and in science. We have zero data in animals for the use of

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Northern Colorado Medical & Wellness 2014

marijuana in animals in any case. There are no efficacy studies so we have no idea what the appropriate dose would be if we were going down that path.” Dr. Hackett adds, “Dogs metabolize THC, the active ingredient, differently than people. We don’t know a medical dose in dogs yet. Dosage information for medical marijuana is slim for people and non-existent for animals. Researchers at CSU are beginning the first stages of evaluating medical uses of marijuana in companion animals. It would be irresponsible to recommend its use without more information.” “I am suspicious that part of why there is an increase in intoxification of marijuana products in animals is that people are trying it out on their animals,” Dr. Downing says. “That’s only my suspicion but I wonder if there isn’t some experimentation by people. They may think, ‘Marijuana helps my pain. My dog has pain so I wonder if a little marijuana would make him feel better.’” While Dr. Downing understands the reasoning, she adds, “It is unreasonable to do it without seeking advice from a veterinarian. It’s not like a drug you take that says 10 mg. We don’t even know how much of the active ingredients are contained in marijuana products. So if you or I decide to use medical marijuana to help with pain, we can take enough to get the effect we want. We know when to quit. Animals, on the other hand, can’t tell us how they feel so we’re left with a completely unregulated industry and very little available research.” Caution is the key in any case, they all say. “Marijuana needs to be consumed by the animal to be toxic, so any marijuana or product with marijuana in it has to be kept where pets can’t get it,” Dr. Corbyn says. “Dogs that get food off the counter or table can get it easily if it’s there. If there’s a pan of brownies, they usually eat the whole thing. Dogs are more prone to eating more of anything. Cats are typically finicky eaters compared to most dogs. Dogs will eat anything that hits the floor. But if a cat would ingest it, they could still get ill even though cats aren’t as likely to eat like a whole pan of brownies. The bigger risk is dogs.” Don’t risk leaving these things available where pets can get to them, he says. “Owners in general should be cautious and treat it like a toxic drug. Keep everything out of reach.” “Essentially, this is one of those situations where common sense needs to be our prime directive.” Dr. Downing says. “We should use the same common sense about protecting pets from marijuana products as we would with protecting our children. Storage is most important and really relevant. Where is it going to live: in a medicine cabinet or in a kitchen cabinet? The point is preventing a pet from encounters with these products.”

Kay Rios, Ph.D., is a freelance writer based in Fort Collins.

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Northern Colorado Medical & Wellness 2014

VETERINARY

Canine Dental Health

D ENTA L HYGI ENE

F OR YO UR DOG

og breath.

It’s certainly not something you want said about yourself, but when it’s said about your pooch, it’s time to take a look at his maybe not-so-pearly whites and see if he has dental issues that need addressing. And dog breath is one of the first signs that your pet could be struggling with something much more serious than halitosis. According to the State of Pet Health website (www.stateofpethealth.com), Colorado ranks third out of all 50 states for canine dental disease. “Dental care should start when your dog is a puppy,” says Maura Buckner, DVM with Moore Animal Hospital in Fort Collins. “Start by putting your fingers in the puppy’s mouth—it’s

BY MICHELLE VENUS

not as intimidating as a toothbrush. Use canine toothpaste, which is formulated with enzymes to break down plaque. Never use human toothpaste, which relies on abrasives to clean the teeth and needs to be spit out. Dogs don’t spit.” C.E.T. toothpaste is one brand Dr. Buckner recommends for her patients. It comes in both beef and chicken flavors. Not so appealing to those of us expecting minty freshness after brushing our teeth, but the doggies love it. C.E.T. utilizes a Dual-Enzyme System (glucose oxidase and lactoperoxidase) that provides natural antibacterial action and neutralizes mouth odors. If your pet swallows some of it, there are no ill effects; the product is perfectly safe. Tim Rowe, DVM and owner of Timberline Animal Hospital, suggests establishing a daily

dental routine for your dog. “We brush our teeth everyday,” he points out. “The same should be done for our dogs. Preventative care is very important. Some dogs go for years without any dental care.” Dr. Rowe goes on to explain the problems that can occur when dogs do not receive proper dental care. Bacteria and plaque-forming foods can cause build-up on a dog’s teeth. This can harden into tartar, possibly causing gingivitis, receding gums and tooth loss. But more than that, the bacteria formed in an unclean mouth can enter the animal’s blood stream and spread to other organs like the heart (causing endocarditis, an infection of the inner lining of the heart), kidneys (impacting the kidney’s ability to properly filtrate the blood), and

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possibly the liver. This can lead to more severe and very costly medical problems. Dr. Rowe uses a toothbrush specially designed for a dog’s mouth. While it looks a lot like your own toothbrush, the handle is wider, ensuring that the toothbrush’s head doesn’t poke too far back into the mouth and injure your pet. “You want to brush all the surfaces,” he says. “When training your dog, start on the outside of the top teeth and then move onto the rest of them.” Web MD recommends the following steps to get your dog accustomed to a daily dental regimen: 1.

First get your dog used to the idea of having her teeth brushed. Massage her lips with your finger in a circular motion for 30 to 60 seconds once or twice a day for a few weeks. Then move on to her teeth and gums.

When your pooch seems comfortable being touched this way, put a little bit of dog-formulated toothpaste or a paste of baking soda and water on her lips to get her used to the taste.

Next, introduce a toothbrush designed especially for dogs—it should be smaller than a human toothbrush and have softer bristles. Toothbrushes that you can wear over your finger (or a clean piece of gauze) are also available and allow you to give a nice massage to your dog’s gums.

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Finally, apply the toothpaste to her teeth for a gentle brushing.

A veterinary exam beforehand may be helpful to find out if your dog’s gums are inflamed. If your dog has mild gingivitis, brushing too hard can hurt her gums.

Annual professional cleanings are essential to canine dental health. Both Drs. Rowe and Buckner cannot stress highly enough their importance, especially for smaller breeds that tend to have more dental problems than their larger counterparts. “Non-anesthetic dental cleanings are very trendy right now,” says Dr. Rowe. “Pet owners think they’re doing the right thing by having this procedure done, but it’s actually not recommended by the American Veterinary Medical Association, the American Animal Hospital Association and the American Veterinary Dental College. They all take very strong positions against it.” Why? Cosmetically, non-anesthetic dental cleanings remove the tartar, but it comes back faster than when the teeth are cleaned under general anesthesia because the tooth enamel is often scratched. Cleaning under the gum line and assessing pockets between teeth cannot be done as thoroughly, if at all, as when the dog is fully sedated. Cleaning a dog’s teeth is not unlike the procedure done at your own dentist’s office, except

the pooch is fast asleep. Plaque and tartar are scraped off the surface of the teeth. The veterinarian examines the mouth closely, looking for pockets of debris between teeth, checking for loose teeth and making sure the lips and gums are healthy. Then the teeth are polished and rinsed. “We send dogs home with prophylactic antibiotics,” says Dr. Buckner. “The cleaning releases a lot of bacteria into the body and we want to ward off any infections or other problems.” Now that the teeth are shiny and clean, how can a conscientious pet owner keep them that way? Chew toys that scrape the tartar off are helpful. Avoid chew toys that harder than the teeth; they can actually fracture the dog’s teeth and cause them a lot of pain. Dr. Rowe recommends Nylabones and rawhides. Antlers and other very hard chewies can be very damaging. Products claiming that simply spraying them into the dog’s mouth keeps plaque build up at bay are too good to be true. The only effective way to keep the teeth clean is to brush them. Every day. “We want those doggy kisses,” says Dr. Buckner. “But not when bad breath comes along with them.”

Michelle Venus is a freelance writer, real estate broker and Development Director at KRFC. She is adept at juggling and spinning plates and can be reached at michelle@michellevenus.com

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