El Paso County Edition
Graceful Dance your way to improved health
A Pet Lover
Pet therapy enhances patient experience at Memorial Hospital Cover Story Page 24
I AM NOT
Back Pain 13 Tips for a healthy spine Page 12
INSIDE UTE VALLEY PARK CANCER SCREENING DEFYING DEPRESSION MEDICAL MARIJUANA
I AM a Person NOT a disease KNOWLEDGE SHOULD BE FREE - SO IS THIS MAGAZINE - TAKE ONE
SeeDisclaimer Disclaimeron onPage Page38 //// See
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Welcome from our Chairman
elcome to the second issue of Doctors Quarterly. The feedback we received from the first issue was overwhelmingly positive and brought value to people’s lives and their journey of healthful living. I hope you find this issue just as valuable and informative as the first.
In the spirit of the holiday season it is worth remembering that in spite of our differences we are, in the end, all in this together. “In this” can mean many things. We are all in this together when it comes to living and making our way in our community and our country. We are all in this together when it comes to caring about our friends and families. And we are all in this together when it comes to health care in which the health care provider and the patient share a common bond and responsibility which includes education and communication on healthcare topics for the best possible outcome for the patient. Combining these two overarching goals of promoting education and communication is the core mission of Doctors Quarterly. In this issue we have educational articles written by local practitioners on a variety of topics, another journey to one of the many magnificent locations in this beautiful area in which we live, and a nod to our four legged friends that bring so much joy and even provide therapy to so many of us. We also highlight the annual Top Doc event which brings together the physicians voted by their peers as being the Top Docs in their specialty. The main purpose of the Top Doc event is to promote collegiality and communication between the Top Docs for the betterment of patient care.
WE WANT TO HEAR FROM YOU
Medical science is a wondrous thing. We’ve come such a long way toward better understanding of diseases and trauma and how best to prevent or treat them – and we have such a long way to go. But there is something more fundamental and more profound than can be had in a clinic or hospital and that is the power of compassion, human connection, and thoughtful communication. I want to share a thought that a number of people who I greatly respect try to live by. Before they speak, write, or even have an internal dialog, they ask themselves: Is it kind? Is it necessary? Is it true? Wishing you and yours a happy, healthy and peaceful holiday season. To Your Health,
(719) 445-9435 www.DoctorsQuarterly.com Editor@DoctorsQuarterly.com
Reagan Anderson, DO Chairman of the Board Co-Founder, Doctors Quarterly
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Winter 2017 Edition
PHOTOS BY MARK REIS
Learn more about the amazing pet therapy dogs enhancing the patient experience at Memorial Hospital.
IN THIS ISSUE OBSTRUCTIVE SLEEP APNEA Alternative Treatments Page 10
RETIREMENT Honoring Dr Keith Bodrero Page 21
DANCE Your Way to Improved Health Page 37
BACK PAIN 13 Tips for a Healthy Spine Page 12
SCREENING For Colorectal Cancer and Polyps Page 22
PEAK VISTA Family Medicine Residency Program Page 39
MISSING TEETH Modern replacement implants Page 14
HUMANE SOCIETY Happy Tails. Happy Hearts Page 26
CONCUSSIONS Proper Recognition and Treatment Page 44
DRY SKIN Winter products and practices Page 16
SHOULD YOU BUY Building Ownership and Financing Page 28
MYTHS About Accidental Bowel Leakage Page 46
ALLERGIES AND ASHTMA Stay Health this Winter Season Page 18
DEFYING DEPRESSION 16.1 Million Americans Experience it Page 31
RETIREMENT MONEY How Much Do I Need Page 48
TRAIL CALLS Ute Valley Park Page 20
MEDICAL MARIJUANA How Medical Is It? Page 34 Page 50
The Tricare West contract is currently transitioning from UnitedHealthcare Military & Veterans to HealthNet Federal Services. Given your past experience with the Tricare system in our community, how are you able to help providers and beneficiaries? With over 172,000 Tricare beneficiaries in the Pikes Peak region, I’m very sensitive to the challenges and potentially devastating healthcare impacts that arise during the transition between contractors. The 2013 contract transition from TriWest to UnitedHealthcare M&V was extremely challenging. Providers experienced severe delays in medical reimbursements that put enormous financial burdens on practices of all sizes. We nearly lost a local autism center as a result. The complicated referral process caused extended delays for patients who required critical care or timely specialty services. As a senior member of the House Armed Services Committee, I brought the Assistant Secretary of Defense for Health to Colorado Springs to engage directly with local providers and individual beneficiaries. Soon after, we began to see dramatic improvements in all problem areas. Currently, I’m proactively working with HealthNet to ensure a smooth transition and prevent any reoccurrence of those same issues. I will continue to partner with the regional medical community to ensure care for our service members, veterans, and their families remains the best in the nation.
with Rep. Lamborn Congressman to the Fifth Congressional District Contact Information Congressman Doug Lamborn 1125 Kelly Johnson Blvd., Suite 330 Colorado Springs, CO 80920 (719) 520-0055 Learn more at: www.lamborn.house.gov
Do you have any concerns with the increased consolidation in health care? Consolidation of health care providers and networks is a significant issue. You don’t always hear about it on the news, but it’s happening. Sometimes mergers are good and necessary for increasing quality health care. But often concentration of power does more harm than good. I’m a big proponent of increasing competition in the health care marketplace. This keeps health care entities from becoming monopolies, it enhances patient care, and ultimately drives down costs for those seeking care in our community. I’ve also seen that as consolidation increases, provider networks shrink. People lose access to their doctors and are placed in a tough situation while they’re forced to look elsewhere for their care. I want robust competition and robust networks so that my constituents can have access to the highest quality care available. That’s what I’m fighting for on Capitol Hill.
! CALL TO ACTION
Contact Congressman Lamborn’s office if you are a patient or a provider who has issues with the upcoming rollout of the Healthnet Federal Services Tricare contract.
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TOP DOCS 2017
Once a year Colorado Springs Style magazine asks physicians to vote on which local physicians exemplify excellence in their specialty. For the past three years, these “Top Docs” from our community have come together for an evening of collegiality, making connections with other physicians, entertainment, and dinner in what has become the annual Top Doc Event. This year, Congressman Lamborn attended and spoke about healthcare reform. Also attending were Mr. Joel Yuhas, President and CEO of Memorial Hospital, and representatives from the offices of Senators Michael Bennett and Cory Gardner. Doctors Quarterly ® was also introduced to the Top Docs so that they would know of another method of educating the community on health topics. We at Doctors Quarterly ® think that these efforts to increase communication among medical practitioners and the community will benefit patient care and will go a long way to helping make our community more healthful, joyful, and vibrant.
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Disclaimer The “Content” (including all advertisements, articles, concepts, formulas, graphics, ideas, images, systems, testimonials, trademarks, and all other forms of data or material) contained in Doctors Quarterly (including printed journal/online formats/podcasts/other sources) is INFORMATIONAL only and is the property of Doctors Quarterly. The Content, whether expressed or implied, does not contain ANY medical advice, is not intended to replace the advice of your licensed Healthcare Provider, is not to be used to diagnose or treat anything, is not to be used to delay diagnosis or treatment by a licensed Healthcare Provider, and does not establish a Healthcare Provider-Patient relationship in any way. Even if information in Doctors Quarterly is authored by your Healthcare Provider, you must consult with that Provider to make sure the information contained in Doctors Quarterly is appropriate for you. Doctors Quarterly (to include its associates, employees, owners, Publisher, or suppliers of content) does not endorse or recommend any specific business, Healthcare Provider, opinion, procedure, product, service, test, treatment, or any other form of Content. Any information or Content used from Doctors Quarterly is solely at your own risk. Doctors Quarterly makes no claim as to the medical Standard of Care. Any copying, forwarding, recreation, redistribution, transmission, or use of Content is prohibited unless prior written permission is obtained from Doctors Quarterly. If you do not agree to the above Disclaimer, do not use Doctors Quarterly.
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Food Allergy | Insect Allergy | Pet Allergy | Pollen Allergy Breathing Infections | Insect Allergy | Pet Allergy | Pollen Allergy Food Allergy | Insect Allergy | Pet Allergy | Pollen Allergy Assessment | Chronic Food Allergy Breathing Assessment | Chronic Infections Breathing Assessment | Chronic InfectionsExzema | Hives | Other Skin Conditions Exzema | Hives | Other Skin Conditions Exzema | Hives | Other Skin Conditions
Food Allergy | Insect Breathing Asse Exzema | Hiv
Call us today at 719-260-1022 to schedule your appointment at either our Briargate or Woodland Park location. Call us today at 719-260-1022 to schedule your appointment at either our Briargate or Woodland Park location. Pikes Peak Regional Hospital Nathanael S. Brady, D.O. 595 Chapel Hills Drive, Suite 102 16222 West Highway 24, Suite 210 Board Certified Allergy & Immunology Board Allergy & Immunology Briargate Medical Center PikesCertified Peak Regional Hospital Briargate Medical Center Pikes Peak Regional Hospital Nathanael S. Brady, D.O. 595 Chapel Hills Drive, Suite 102 16222 West Highway 24, Suite 210 Board Certified Allergy 595 Chapel Hills Drive, Suite 102 16222 West Highway 24, Suite 210& Immunology
Call us today at 719-2
at either our Bri
Call us today at 719-260-1022 to schedule your appointment
DR. CHAD ABERCROMBIE Chiropractic Sports Physician. Biomedical Acupuncture and Dry Needling
ANGELA ANDERSON Owner of Be the Change Health, Wellness and Fitness. Independent Beachbody Coach
at either our Briargate or Woodland Park location. Briargate Medical Center
Nathanael S. Brady, D.O.
DR. REAGAN ANDERSON Clinical Professor of Dermatology and a Dermatology Residency Program Director at RVU
MARIO ARAGON PA-C Physician Assistant Family Medicine and Urgent Care
Nathanael S. Brady, D.O.
Board Certified Allergy & Immunology
| Insect | PetAllergy | Insect | Pollen Allergy Food AllergyFood Allergy Allergy| |Pet Pollen Allergy Allergy Allergy | Chronic Infections | Chronic Infections Breathing Assessment Breathing Assessment | Other | Hives Exzema | Hives Skin| Conditions Exzema Other Skin Conditions
Briargate Medical Center 595 Chapel Hills Drive, Suite 10
DR. NATHANAEL BRADY Nathanael S. Bra Allergy, Asthma and Immunology Physician and Owner of Pike Peak Allergy & Asthma
Board Certified Allergy &
Call us today atC719-260-1022 schedule your all us today atto 719-260-1022 toappointment schedule your appointment at either our Briargate Woodland location. Park location. at eitherorour BriargatePark or Woodland Briargate Center Medical Center Briargate Nathanael S. Nathanael Brady, D.O.S. Brady, D.O. Medical
Pikes Peak Regional Pikes Hospital Peak Regional Hospital
595 Chapel Hills595 Drive, Suite 102Drive, Suite 102 16222 West Highway Suite 210 24, Suite 210 Chapel Hills 1622224, West Highway Board Certified Allergy Immunology Board&Certified Allergy & Immunology
Food Allergy | Insect All Breathing Assess Exzema | Hives
Call us today at 719-260
at either our Briarg
Nathanael S. Brady, D.O.
DR. ALEX CONSTANTINIDES Family Practice, Osteopathic Manipulation and Certified Ringside Physician
DR. KENNETH FINN Physical Medicine and Rehabilitation, Pain Medicine and Pain Management
VLADIMIR ISHCHENKO Champion Dancer, Choreographer and Dance Trainer
DR. LUKASZ KOWALCZYK Physician and Partner at Peak Gastroenterology Associates
Board Certified Allergy & Immunology
Briargate Medical Center 595 Chapel Hills Drive, Suite 102
DR. MARC LABOVICH Anatomical, Clinical Pathology and Gastrointestinal Pathology
Food Allergy Page 37 | Insect Allergy | Pet Allergy | Pollen Allergy Page 46
Breathing Assessment | Chronic Infections Exzema | Hives | Other Skin Conditions
Call us today at 719-260-1022 to schedule your appointment at either our Briargate or Woodland Park location.
Nathanael S. Brady, D.O.
Board Certified Allergy & Immunology
Briargate Medical Center 595 Chapel Hills Drive, Suite 102
Pikes Peak Regional Hospital 16222 West Highway 24, Suite 210
Food Allergy | Insect Allergy | Pet Allergy | Pollen Allergy Breathing Assessment | Chronic Infections Exzema | Hives | Other Skin Conditions Call us today at 719-260-1022 to schedule your appointment at either our Briargate or Woodland Park location.
TONY LeVEQUE Executive Vice President Central Bancorp
DR. CAMERON PERIGO Esthetic Family Dentistry
DR. SCOTT ROBINSON Family Medicine Residency Program Director at Peak Vista
Nathanael S. Brady, D.O.
SUSAN STRASBAUGH Owner and CEO of Strasbaugh Financial Advisory, Inc.
Board Certified Allergy & Immunology
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Briargate Medical Center 595 Chapel Hills Drive, Suite 102
Pikes Peak Regional Hospital
16222 West Highway 24, Suite 210 DR. RON D THOMAN
Private Practice Oral and Maxillofacial Surgeon
by Ron D. Thoman, D.D.S.
Obstructive Sleep Apnea Alternative Treatment with Oral Maxillofacial Surgery
bstructive sleep apnea has been written about and highlighted by many authors in recent years.
This is for good reason. Obstructive sleep apnea (OSA) is a severe disease that affects many individuals in our community. If left untreated, sleep apnea can lead to numerous other disorders such as hypertension, irregular heartbeat, changes in mental abilities, strokes, diabetes, and premature death. Obstructive sleep apnea is a complex disorder that has multiple causes and can present with different levels of severity. Because of this, there are multiple individuals involved in diagnosing and treating obstructive sleep apnea. Essentially, OSA is a condition that leads to the cessation of breathing usually caused by some sort of obstruction in the airway. Structures that lead to obstruction can be in the upper airway, such as nasal obstruction or elongated soft palate. More frequently, obstructions are in the lower airway caused by the tongue moving posterior, obstructing the airway. The lateral walls of the airway can collapse contributing to this obstruction. There are other unusual causes related to the central nervous system. One of the most common measurements of the severity of sleep apnea is the Apnea-Hypopnea Index (AHI). Mild AHI is 5-15 events per hour, moderate is 15-30 events per hour, and severe is greater than 30.
Proper diagnosis should be performed using a sleep study coordinated with a certified sleep physician. Once a diagnosis of OSA is made, then a team of physicians and dentists steps in to assist with various treatment modalities. Certain treatments are directed toward controlling the disease. Others may lessen or even cure OSA. Individuals typically involved in treating OSA are sleep physicians, general dentists, otolaryngologists, neurologists, and oral maxillofacial surgeons. Treatment modalities that control OSA are CPAP and dental repositioning splints. CPAP (full mask with positive pressure) is by far the most successful at controlling OSA. Jaw repositioning splints provided by a dentist can be successful in mild-to-moderate sleep apnea. Modalities that help decrease the severity or may even cure OSA are weight loss, nasal and/or septal surgery, UPPP (surgery on the soft palate and throat), or jaw repositioning surgery. Nasal surgery or UPPP is usually provided by an otolaryngologist and helps address obstruction involving the area of the upper airway. These are successful in 30-35% of patients. For the remaining patients, the obstruction is either of a central cause or involves the lower or lateral airways.
Jaw repositioning surgery is provided by oral maxillofacial surgeons. This treatment is geared to alter not only the upper airway but also the lower airway. This can also indirectly improve the lateral wall support. Jaw repositioning surgery moves the upper and lower jaws forward. This, in turn, pulls the soft tissue of the palate and tongue forward, opening up the upper and lower airways. This soft tissue movement can also tighten the lateral walls of the airway, reducing their tendency to collapse. The larger the movement of the upper and lower jaws, the higher probability of successful treatment of OSA. This surgery is performed in a hospital setting with use of general anesthesia. The patient is usually able to recover and resume normal activity and diet within about 6 weeks. These surgeries are indicated in patients who have difficulty tolerating CPAP or already have pre-existing jaw disorders which can be improved by jaw surgery. There are different combinations of jaw surgery. Sometimes it may involve only the maxilla or upper jaw. Other times it may involve only the mandible or lower jaw. These may also include advancement of the chin. The success increases with the number of jaws included in the advancement and the amount that each is moved. Complications can include temporary or permanent
Posterior Airway before Correction
numbness of areas of the face, alteration in appearance, dysfunction of the temporomandibular joint, changes in bite, or some relapse of the facial bones. A recent study showed OSA was reduced from AHI of 117.9 to 16.1 with jaw surgery.1 A meta-analysis study, which reviewed all known legitimate articles on OSA, found that jaw advancement was a viable alternative to help decrease or cure OSA.2
Posterior Airway enlarged after advancement of upper and lower jaws
Jaw surgery does take a commitment of time and requires a surgical procedure, but it is certainly a viable option for treatment of obstructive sleep apnea patients. If you have questions, please contact an oral maxillofacial surgeon treating these conditions. 1. Journal of Oral Maxillofacial Surgery, Goodday 2016, 74(3):583-589 2. JAMA Otolaryngology-Head and Neck Surgery 2016, 142(1):58-66
ABOUT THE AUTHOR Dr. Ron D. Thoman is a Private Practice Oral and Maxillofacial Surgeon. He is a Member of the Cleft Lip and Palate team Childrens Hospital. Dr. Thoman is Affiliated with University Health Memorial and St. Francis/Penrose Hospitals. Dr. Thoman specializes in the removal of wisdom teeth, placement of dental implants, orthogathic surgery, along with treatment of head and neck pathology, cleft lip and palate, trauma and sleep apnea.
Q: What type of index is used to assess the severity of sleep apnea?
Oral and Maxillofacial Surgery Specialists, P.C. 8580 Scarborough Drive #240 Colorado Springs, CO 80920 719-590-1500 www.Jaws-1.com
Q: Surgical specialists who performs nasal surgery are called _____.
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by Chad Abercrombie, DC
Back Pain Treatment and Prevention EXPERTS ESTIMATE THAT AS MUCH AS 80% OF THE POPULATION WILL EXPERIENCE BACK PAIN AT SOME TIME IN THEIR LIVES.
Back pain is a fact of life for many people. Back pain is one of the most common reasons for missed work and is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections. Low back pain costs Americans at least $50 billion in health care costs each year. With lost wages and decreased productivity, that figure easily rises to more than $100 billion.
A Closer Look at Back Pain The back is a complicated structure of bones, joints, ligaments, and muscles. Back pain can be caused by sprained ligaments, strained muscles, ruptured disks, and irritated joints. While auto and work accidents or sports injuries can cause back pain, sometimes the simplest of movements – for example, picking up a paper clip from the floor – can have painful consequences. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Sometimes back pain is sharp and intense and heals in a few days or weeks. Others experience back pain as a chronic condition, seriously altering their ability to work and enjoy family time and other leisure activities and can lead in some cases to depression. A recent 12
survey of health conditions identified back pain as the single leading cause of disability worldwide.
Preventing Back Pain Spinal health is an important factor in preventing back pain, as well as maintaining overall health and wellbeing. The American Chiropractic Association (ACA) encourages people to take steps to improve their spinal health and avoid injury. Approaches such as better nutrition, exercise, ergonomic workspaces and proper lifting and movement techniques can go a long way in helping people to strengthen their spines and potentially avoid serious injury and chronic pain.
Conservative Treatment Treatment for back pain has evolved over the years. Research now supports first trying drug-free, conservative options for pain management while remaining as active as possible during recuperation. While medication may be necessary for some patients, often a conservative approach may alleviate pain and even lessen or eliminate the need for prescription painkillers.
CALL TO ACTION
Take steps to prevent injuries and low back pain Try conservative care options such as chiropractic when self-care is not enough.
13 • •
Maintain a healthy diet and weight. Exercise, ergonomic workspaces, and proper lifting are a few things that can help you avoid serious injury. • Avoid prolonged inactivity or bed rest. • Warm up or stretch before exercising or other physical activities. • Maintain proper posture. • When standing, keep one foot in front of the other, with your knees slightly bent. This position helps to take the pressure off your lower back. • Sleeping on your back or stomach puts excessive pressure on your spine. Choose a side position instead. • Avoid twisting while lifting. Twisting is one of the most dangerous movements for your spine, especially with added weight. • If an item is too heavy to lift, pushing it is easier on your back than pulling it. Whenever possible, use your legs, not your back or upper body, to push the item. • Do NOT bend over at the waist to pick up items from the floor or a table. Bend at the knees. • When sitting, keep your knees higher than your hips with your head up/back straight. Don’t slouch. Try to maintain the natural curve in your low back. • When texting, bring your arms up in front of your eyes so that you don’t need to look down at the screen, putting unnecessary pressure on neck and spine. • Quit smoking. Smoking impairs blood flow, resulting in oxygen and nutrient deprivation to spinal tissues.
Beyond the risks of overuse and addiction, prescription drugs that numb pain may also convince a patient that a musculoskeletal condition such as back pain is less severe than it is, or that it has healed. That misunderstanding can lead to over-exertion and a delay in the healing process or even lead to permanent impairment. Spinal manipulation, one of the main methods of treatment used by chiropractors, is widely recognized as one of the safest drug-free, non-invasive therapies available for the treatment of back pain and other musculoskeletal complaints. It was also found to be a cost-effective option when used either alone or combined with other therapies in a 2012 study. In 2017 the American College of Physicians (ACP) updated its guidelines for the treatment of back pain, citing heat therapy, massage, acupuncture, and spinal manipulation as recommended options. Chiropractic care for back pain incorporates therapeutic modalities and rehabilitative exercises to help stabilize and prevent reoccurrence.
ABOUT THE AUTHOR Dr. Chad Abercrombie has centered his practice in the areas of workers compensation, auto accident, and sports injuries. He is a certified chiropractic sports practitioner with extensive training in head, neck and back pain, chiropractic rehabilitation, and certification in biomedical acupuncture and dry needling.
TIPS FOR A HEALTHY SPINE
Alliance Health Partners 155 Printers Parkway, Suite 200A Colorado Springs, CO 80910 (719) 632-4754 www.alliancehealthpartners.com
Q: What spinal chiropractic treatment is widely recognized as one of the safest, non-drug therapies for back pain?
Q: What movement should be avoided while lifting?
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Q: What sleeping position puts excessive pressure on your spine?
by Cameron L. Perigo, D.D.S, PC
Modern Replacement of Missing Teeth • Multiple missing teeth and early bone loss • Replacement of upper molar with single tooth dental implant • Modern titanium dental implant • Conventional removable partial denture
re you, a loved one, or a friend missing one or multiple teeth? If so, you are not alone. According to the American College of Prosthodontists, 120 million Americans are missing at least one tooth. Of those, 36 million are edentulous or missing all teeth. Based on projections, over 200 million Americans will be missing one or more teeth within the next 15 years. Although most teeth are lost due to dental caries (decay) or periodontal (gum) disease, there are other causes. Trauma to the face can lead to loss of teeth and the surrounding bone, which most commonly affects the upper front teeth. In addition, tumors of the jaws, vertical fractures, and severe wear contribute to partial loss of the dentition. These conditions can occur at any age and are quite common. The obvious consequences of missing teeth are decreased ability to chew and, potentially, poor esthetics. However, many patients are unaware of the progressive changes that occur
when a tooth is lost. Our teeth are housed in a special part of each jaw referred to as the alveolar bone. Like bones elsewhere in the body, lack of use can lead to atrophy or alveolar bone loss. When a tooth is removed or lost, approximately 25% of the surrounding bone is lost in the first year. In the absence of treatment, the alveolar bone loss is progressive until this part of the jaw is gone. Other concerns are shifting of the opposing tooth or adjacent teeth, nutritional deficits, and less confidence in social interactions. We typically divide replacement of missing teeth into two main categories, removable and fixed prostheses. As the name implies, fixed prostheses are not removable at home, while removable prostheses are taken out of the mouth daily for cleaning. Although every situation is unique, most patients prefer a fixed prosthesis. When a single tooth is missing, a dental implant is an excellent fixed replacement option. Modern implants are precisely fabricated titanium fixtures that are placed into the alveolar bone at the position of the lost tooth root. During healing, the adjacent bone integrates with the implant to form a permanent “root”. When the implant is ready, a post and crown are placed on the implant. The result is a tooth that cannot decay, yet can be flossed, and functions like your natural tooth. If multiple teeth have been lost, we are often able to place multiple implants in the alveolar bone. After healing, individual crowns can be placed on implants or a bridge can be utilized. With a bridge, implants are not placed for each individual lost root, but rather at selected sites with adequate bone. Finally, a single “bridge” of crowns
! CALL TO ACTION Missing teeth for extended periods of time can lead to bone loss, irreversible changes in the bite, reduced ability to chew, and loss of confidence. Your dentist can help you decide which replacement option is right for you and a reasonable timetable for treatment.
Patient with mulitple missing teeth
Implant restoration replacing a missing upper first molar
spans the space between implants to complete the restoration. Most edentulous (missing all teeth) patients have removable dentures. Many of us have a friend or family member with existing non-implant dentures that they tolerate but detest. The good news is that modern implant dentistry can dramatically improve the stability, bite force, and comfort of many existing complete or partial dentures. Our clients often describe implantstabilized dentures as life-changing. They consistently experience increased confidence and are once again able to eat the foods they love without denture adhesives. For edentulous patients that prefer a fixed prosthesis, multiple implants are placed in the upper and lower jaws. After healing, a hybrid denture is attached to the implants. This type of prosthesis is very stable and well-tolerated. One of the biggest advantages of implants is the efficient transfer of biting forces to the alveolar bone. This force stimulates the bone, allowing maintenance of the existing bone mass, effectively halting the progressive bone loss mentioned earlier. If the teeth have been missing for an extended period, bone replacement grafting is often an option to replace the lost bone.
Q: What is the bone called that houses the teeth?
Traditional removable partial denture
Modern dental implant
If you or a loved-one has missing teeth, schedule a consultation with your dentist. At this appointment, he or she will likely perform X-rays and complete a thorough clinical examination. They will also discuss your treatment goals and any functional or esthetic deficits you have noticed due to the missing teeth. Your dentist can help you sort through the options discussed above and develop a treatment plan that will help you optimize your oral health and smile.
ABOUT THE AUTHOR
Dr. Cameron Perigo has been practicing with Esthetic Family Dentistry since 2014. He completed an Advanced Education in General Dentistry Residency at the Air Force Academy followed by eight years of active duty in the US Air Force. Dr. Perigo enjoys providing comprehensive dentistry, including restorative care, surgical treatment, root canals, cosmetic procedures, and IV sedation. Cameron L. Perigo, D.D.S, PC Esthetic Family Dentistry, LLC 8580 Scarborough Drive, Suite 105 Colorado Springs, CO 80920 (719) 528-5577 www.outstandingsmile.com
Q: How do dentists refer to an appliance that cannot be removed at home?
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Q: Modern dental implants made of ______.
by Dr. Reagan Anderson
Dry Skin in Winter
inter is approaching and with the cold weather comes dry air and dry skin. One of the most common conditions dermatologists will see during this season is itchy skin. As you age your body starts to lose the ability to produce as many natural moisturizing factors as it did when you were younger. Fortunately, there are products you can use that will replenish your skin with the substances that we are no longer making in sufficient quantities to keep your skin as well hydrated as it once was.
Good Bathing Practices • Shower at least twice a week. The more active you are, the more often you will need to shower. But the more you shower, the more problems you will have with dry and irritable skin.
• Showers should be 5-10 minutes long instead of 20 minutes long. The longer the shower, the drier and
irritable your skin will be. I often recommend getting in the shower and getting wet. Then, turn off the water and apply your shampoos and cleansers. Turn the water back on and rinse off. It is not only a “green” and responsible way to consume water, but it will also help your skin.
• Pat dry your skin. Rubbing your skin only causes problems. People often do it to “exfoliate” but, your skin naturally exfoliates and the more you try to force it to exfoliate by bad products or bad practices, the more problems you will have.
• After you bathe, apply lotion from the neck down while skin is still slightly damp. This helps “seal in” the moisture and often times makes all the difference in your routine. If your skin is still dry, apply lotion more often.
CALL TO ACTION Prevent dry irritable skin this winter by stocking up on good over-the-counter products and changing your bathing patterns.
Bathing Mistakes • Do not make the water hot while showering. Hot
water just rips the moisture out of your skin. You do not need to have the water so cold that you shiver during your shower. But, if the water is so hot that your bathroom mirror is fogged over, that the paint is coming off the walls from the steam, and your skin is so red you look like a lobster, then the water is way too hot and you are damaging your skin.
• Don’t use soaps as they can be too irritating to the skin. Use good cleansers in the shower instead.
Recommended Products The following products can be purchased without a prescription online or at your local drug store: For cleansers, I recommend using Dove Sensitive Skin Body Bar, Cetaphil® Restoraderm® Body Wash, CeraVe® Cleanser, or Vanicream™ Cleansing Bar. For moisturizers, my recommendation will depend on if you mind the “feel” of a moisturizer” on your skin. For those who do not like to “feel” the moisturizer, I recommend CeraVe® Lotion or Vanicream™ Lite Skin Care Lotion. Since these are not as “heavy” feeling, you will probably need to use them more often than the “thicker” ones that have more of a “feel” to them. For those who do not mind the “feel” of a moisturizer, I recommend Cetaphil® Restoraderm® Moisturizer or Vanicream™ Moisturizing Skin Cream. The above tips should keep your skin moist and happy this winter. If they do not solve your dry and irritable skin issues within 2 weeks, please see your doctor.
• Do not apply your cleanser with a washcloth,
a loofah or a sponge. These products are too abrasive, are breeding grounds for mold and bacteria, and cause damage to the skin. Put your cleanser on with your hands. Do not scrub it into your skin. Let it rest on your skin for a minute and then rinse it off. Again, unless you have a select few medical conditions that need medical intervention to help your skin exfoliate, you should not be manually exfoliating your skin.
• Do not overdo how often or how long you are in
a hot tub. Most people should be able to handle going into the hot tub for 5-10 minutes once or twice a week. If you are in the hot tub for one hour every day, your skin will have problems. Rinse off after getting out of the hot tub and apply your lotion.
ABOUT THE AUTHOR Dr. Anderson is aBoard Certified Dermatologist and Mohs Micrographic Surgeon. He serves as a Clinical Professor of Dermatology and a Dermatology Residency Director at Rocky Vista University and is actively involved in patient and healthcare provider education on dermatology conditions and treatment. Colorado Dermatology Institute 8580 Scarborough Drive / 1220 Lake Plaza Drive Colorado Springs, Co www.coderm.com 719-531-5400
Q: You should not use soaps to cleanse your skin. Instead, please use a gentle _______.
Q: What should you use to gently apply a cleanser to the skin?
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by Dr. Nathanael Brady
Navigating Winter with Allergies and Asthma How to Stay Healthy and Enjoy the Winter Season
aby, itâ&#x20AC;&#x2122;s cold outside. Winter in Colorado is a great time to enjoy staying inside with a cup of cocoa and a book or venturing outside to ski or hike. Whatever your plans, use the following guide to enjoy this winter and holiday season with allergies and asthma under control! Cold weather is a welcome change for seasonal pollen allergy sufferers, but it may not bring relief for all with allergies and asthma. With more time spent indoors to escape the cold temperatures, a host of other allergy and asthma triggers can cause problems. Animal dander, molds, cockroaches, and dust mites are common triggers inside the home and exposure to illnesses from family members, classmates and coworkers increases. When the furnace is turned on, irritants like dust, dirt, dander, and bacteria are circulated around the home. Symptoms that may indicate indoor allergy issues are the same as outdoor allergies. You may have upper airway symptoms like congestion, runny nose, sneezing, postnasal drainage, sore throat or sinus headaches, itchy, watery, irritated eyes, or lower airway issues like a cough, wheezing, or difficulty breathing. Skin issues can manifest as flares of dry, itchy, red rash (eczema) or hives.
Tips to Decrease Indoor Allergens 1
Remove carpeting, when possible.
Remove pets from the bedroom.
Regularly wash pets.
Clean up after pet exposure.
Set indoor humidity below 50%.
Wash bedding weekly.
Use dust mite covers on mattresses and pillows.
Avoid feather pillows and down comforters.
Clean the home regularly.
The holiday season can bring additional challenges for allergy and asthma sufferers. Respiratory illnesses are in full swing during the winter. Holiday gatherings with family and friends in the home mean increased exposure from hugs, handshakes, and gathering by the fireplace. Traveling brings tight quarters on the airplane or in the car on the way to grandma’s house. If you are ill, try to minimize close contact with others and consider skipping out on the office party or other social function. Assure you are frequently washing hands or using hand sanitizer and be sure to use your sleeve to catch that cough or sneeze instead of your hands. Airborne irritants can cause havoc for asthma and allergy sufferers. Try to avoid the smoke from Greatuncle Frank and Aunt Bethany’s potent perfume. Cold air is often an issue for sensitive upper and lower airways. When going out to cut down the Christmas tree or carol, bundle up and try to breathe through your nose to heat and humidify the air that is breathed in. When kids are out playing in the snow or sledding, use scarves to cover up their nose and mouth.
! CALL TO ACTION Simple steps can help identify and minimize allergy exposure and decrease symptoms.
any food allergies. Always ask about ingredients if you are not absolutely sure it is safe to consume. If in doubt, skip the dish in question. Nothing can wreck a celebration like an unscheduled emergency room visit! To assure you have something safe to eat, you can volunteer to bring a dish or two. Most importantly, have your emergency medications on hand at all times including antihistamines and an epinephrine auto-injector. If you are giving a gift to someone with allergies or asthma, but be sure that you inquire about any issues with fragrances or foods. Decorating is a great way to get in the holiday mood. While getting out the boxes, be careful of irritating dust as well as allergy and asthma flares from molds, mites, and rodent droppings. Keep decorations in places where moisture is minimal,
to prevent mold growth. Wash your hands frequently to avoid transferring allergens and dust to your face. You may be concerned with a Christmas tree allergy, but the issue is most often molds that can live in the tree or the water reservoir. Chemicals applied to the tree after harvest can also be an irritant trigger. With the busyness of the holidays, be sure to listen to your body and rest when needed. Assure you maintain your medication regimen, bringing all medications when traveling away from home, including asthma inhalers if prescribed. Don’t allow your allergies or asthma to prevent you from enjoying an active winter and memorable holidays!
Food Allergy | Insect Allergy | Pet Allergy | Pollen Allergy Breathing Assessment | Chronic Infections
| OtherAUTHOR Exzema | Hives Skin Conditions ABOUT THE Call us today at 719-260-1022 to schedule your appointment at either our Briargate or Woodland Park location.
Dr. Nathanael Brady is a board-certified allergy, Nathanael S. Brady, D.O. asthma, and immunology physician and is the owner of Pike Peak Allergy and Asthma. He is originally from Michigan, training at Michigan State University, Ohio State University, and Case Western University. When not seeing patients, he spends his time wrangling his three young children with his wife Jennifer. Board Certified Allergy & Immunology
Food allergies are a daily battle but can be especially difficult during the holiday gift-giving and gatherings. It is best to let hosts, teachers, and co-workers know in advance about
Briargate Medical Center 595 Chapel Hills Drive, Suite 102
Pikes Peak Regional Hospital 16222 West Highway 24, Suite 210
Q: What is a common indoor allergen?
Pikes Peak Allergy and Asthma 595 Chapel Hills Drive, Suite 102 Colorado Springs, CO 80920 (719) 260-1022 www.peakbreathing.com
Q: What do dust mites use as a water source?
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“In every walk with nature, one receives far more than one seeks.”
Ute Valley Park Trail Call
From the Vindicator Drive park entrance, follow Ute Valley Park Trail (either end) for a 3.5 mile easy to moderate loop. Trail etiquette
Keep your ears perked for mountain bikers passing by, as visibility may be limited on narrower trails with winding turns. Bikers please remember that hikers ALWAYS have the right of way. park Hours
May 1 – October 31: 5am-11pm / November 1 – April 30: 5am-9pm Features
Mountain Biking, Hiking, Trail Running, On-Leash Dog Walking
Have you ever driven past “Ute Valley Park” on Vindicator Drive and thought, “I should check that out sometime,”? If so, I am here to tell you to get exploring ASAP! This is not one to be missed. Nestled in-between old Colorado Springs neighborhoods and right where you would least expect, this park boasts 540 acres of trails and landscapes that will make you feel like you have been transported out of the suburbs and into a remote outdoor retreat. The landscape brilliantly moves from sand and scrub oak to sandstone formations, to ponderosa pine forests and floral meadows. The park is vast and you can get lost if not following a map or selected trails, so be sure to track your route accordingly. About: Hats off to the City of Colorado Springs for purchasing 203 acres of the park from Hewlett Packard. This portion of land along the eastern border was platted for residential and commercial real estate development – but $7.5 million was enough to keep the land undeveloped and accessible for the city’s priceless outdoor enjoyment. If you are interested in learning more about volunteer opportunities to help maintain this magnificent park, visit www.friendsofutevalleypark.com/volunteer/
Q: What type of rock can be seen throughout Ute Valley Park?
Q: What is a predominant tree in Ute Valley Park?
Picture by Angela Anderson
by Angela Anderson Be the Change HWF, LLC
Honoring Dr. Keith Bodrero Upon Retirement What I have learned: Everyone deserves to be listened to. Everyone deserves compassion. Love is the great healer, it heals ourselves and others. God is our ultimate healer. Listen to Him and seek His assistance.
I opened my practice, Powers Medical, in 1994 after finishing my family practice residency here in Colorado Springs. Powers Medical developed into an integrative family practice where I treated many patients with chronic illnesses such chronic fatigue syndrome, fibromyalgia, Lyme disease, endocrine problems, and other chronic health problems. I never wanted to have to say to a patient that there was nothing else I could do for them. We used nutrition, aromatherapy, bioequivalent hormonal therapy, osteopathic manipulative therapy, microcurrent therapy, and intentional healing. In February 2017, we merged our practice with Centuraâ&#x20AC;&#x2122;s Colorado Health Physicians Group (CHPG). In October 2017, I left CHPG and retired from routine family practice medicine.
Service is the life blood of happiness, go do some good for the world. Health is a do-it-yourself endeavor, but we all benefit from good advice and assistance. View healing as a participatory sport. Building health is easier and more rewarding than fighting disease. You can heal yourself. Intention is powerful. Energy heals.
I am leaving a wonderful group of patients that I will miss serving. I am very grateful for the things I have learned in my practice of medicine and especially for all the things that my patients have taught me. I also thank the physician community at large for all the support and mutual care provided to me and my patients. Thanks also to my many employees and their hard work. Especially, I thank my wonderful wife for her unending support. I have accepted a position to teach osteopathic manipulative therapy at Rocky Vista Universityâ&#x20AC;&#x2122;s new branch campus at Ivins, Utah near St. George, Utah. The side effect of living in Ivins is a much shorter trip to see our grandkids.
Your expressions of gratitude make it all worthwhile.
Keith Bodrero, DO 2017
Thank you for teaching us and allowing us to be of service to you.
Good office staff makes it all work well. I am totally grateful to Sandra, my wife, who has supported me and assisted me in so many ways.
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by Dr. Marc H. Labovich
Screening for Colorectal Cancer and Colon Polyps
o you followed doctor’s orders and got a colonoscopy at the age of 50 and you now have your results. If no polyps or other abnormalities are found, congratulations! You will likely be told to come back in 10 years for a follow-up exam. Keep following your current healthy lifestyle by eating plenty of vegetables and salads, minimize your red meat intake, and keep exercising. However, if you have been diagnosed with colon polyps, what do these results mean? The colonoscopy procedure is performed by looking at the inner walls of the colon (also called the large intestine) through a fiberoptic camera. During the procedure, your doctor will remove any polyps or other abnormal areas and send this tissue to a pathologist for microscopic inspection and definitive diagnosis. The pathologic diagnosis is then used to determine what kind of follow-up you require to minimize the chances of developing colorectal cancer. This risk is determined based on any family history of
polyps or colorectal cancer as well as the number, type, and size of the polyps found.
Common Types of Colon Polyps The most common type of colon polyp is the hyperplastic polyp. This type of polyp has no real chance of progressing to cancer. The adenoma is the next most common type of colon polyp and is divided into various subtypes. All adenomas are considered precancerous. The World Health Organization has divided adenomas into two general pre-cancerous risk categories - those with low-grade dysplasia and those with high-grade dysplasia. The term ‘dysplasia’ refers to abnormal growth of cells (from the Greek dys- ‘bad’ + plasis ‘formation’). The vast majority of adenomas fall into the low-grade category and have a low risk of progression to cancer. However, any diagnosis of high-grade dysplasia in an adenoma increases your risk for colorectal cancer and requires more frequent clinical surveillance. You may need to have additional studies or even surgery performed if you are diagnosed with high-grade dysplasia in a colon polyp, depending on the extent of dysplasia, the polyp size, and other factors.
! CALL TO ACTION
The U. S. Preventative Services Task Force recommends colorectal cancer screening beginning at age 50 in men and women who have an average risk for development of colorectal cancer. Average risk is defined as no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease (Crohnâ&#x20AC;&#x2122;s Disease and Ulcerative Colitis); and no family history of colorectal cancer or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer. The USPSTF is an independent, volunteer panel of national experts in preventative and evidence-based medicine. Colorectal cancer is the second leading cause of cancer deaths in the United States; thus, if you are 50 or older, please talk to your physician about screening. Colorectal cancer incidence rates continue to decline in people 50 and older and have dropped by 32% just since 2000. This trend is thought to be largely a result of screening which can prevent colorectal cancer by detecting and removing precancerous polyps.
Tubular Adenoma 2X
Tubular Adenoma 10X
Sessile serrated polyps are another type of fairly common colon polyp. They look similar microscopically to hyperplastic polyps, but have an increased chance of progressing to colorectal cancer, especially with increasing size. Some serrated polyps have low- or high-grade dysplasia in them. These carry an even higher risk of colorectal cancer.
Less Common Types of Colon Polyps Inflammatory/post-inflammatory-type polyps are almost always benign and likely just a local reaction to tissue damage. There may be one or multiple of these polyps, depending on their underlying cause.
Juvenile polyps may be single or multiple, inherited or sporadic. They may be associated with an inherited syndrome called Juvenile Polyposis and the polyps may contain areas of precancerous (dysplastic) change.
Peutz-Jeghers polyps have a distinctive appearance under the microscope with a core that looks like the branches of a tree. Other types of sporadic polyps can be found at any age. There are other less common and unusual types of polyps, but those discussed above cover the vast majority of what will be found endoscopically.
ABOUT THE AUTHOR Dr. Marc Labovich is certified by the American Board of Pathology in Anatomic and Clinical Pathology and is also subspecialty trained in the discipline of Gastrointestinal Pathology. Dr. Labovich works at Colorado Springs Pathology Associates, a local, independently-owned pathology services company owned by Dr. Karen Anthony.
Q: What is another name for the large intestine?
2838 Janitell Road Colorado Springs, Colorado 80906 719-368-7247 www.coloradosprigspathology.com
Q: At what age should you get screened for colorectal cancer?
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Joel Yuhas President & CEO of Memorial Hosptial with his dogs
t UCHealth Memorial Hospital Central, everyone knows Xena the Warrior Princess. She’s a 22-pound French Bulldog, and she is fond of green beans, ice cream and visiting patients at Memorial Hospital. She has a calm and reassuring bedside manner. She’s known to put her paw on top of a patient’s hand to let them know that everything is going to be all right. “Everyone knows her,’’ said Sonji Martin, her owner who volunteers weekly with Xena. “She makes people smile. Patients, nurses, the staff, they’re always happy to see her.’’ Xena is one of 19 dogs in Memorial’s pet therapy program, which is designed to help patients focus on something that reminds them of home – and not the hospital.
Pet therapy enhances patient experience at Memorial Hospital By Erin Emery and Cary Vogrin
“There are numerous published studies demonstrating the positive impact of a pet therapy program on hospitalized patients,’’ said Memorial Hospital CEO Joel Yuhas. “Those hospitalized often have very little choice in what happens to them in a hospital. A National Institutes of Health study found that patients reported decreased pain, reduced stress, more relaxed respiration, improved mood and increased perception of energy.’’
Each therapy dog at Memorial is certified by an agency that evaluates dogs for personality and behavior. All of the dogs have had obedience training and are tested to ensure they react appropriately in a variety of situations. The dogs have a clean bill of health from their veterinarian. “Pet therapy dogs are rigorously trained to respond to touch, and it is part of their job to help our patients find warmth and friendliness in our hospitals,’’ Yuhas said. “Hospitals are increasingly turning to the growing field of animal-assisted therapy, using dogs or other animals to help people recover from or better cope with health problems, such as heart disease, cancer and mental health disorders.” Xena comes to Memorial once a week. Like any princess, Xena has her own chariot – a doll stroller – that Martin uses to wheel her through the halls of the hospital so she won’t tire out. Xena has 450 followers on Instagram. Her hobbies include sleeping and eating. Rebekah Grexia Dunlap, a registered nurse at Memorial, said Xena helps comfort staff, as she did recently after a traumatic situation with a patient.
Xena the Warrior Princess
hospital by yourself and walking in with a dog. The joy a dog brings is incredible,” McCants said. “People stop to interact with dogs. Sometimes it takes me 30 minutes to get up on the floor because there are so many people who want to see the dog.” Murphy spends most of his time in pediatrics, but he also visits other units and the emergency department. McCants recalled a time a doctor asked for Murphy to come to the emergency department to help calm a 3-year-old child who was upset about having a procedure. “Murphy put his paws up on the bed and the child just melted,” McCants recalled. The dogs “bring a sense of peace with them and many of the patients miss their animals at home. Some of the families in pediatrics, along with the staff, just need that warm, fuzzy feeling.” McCants said Murphy knows when he’s going to work and he’s all business when he arrives. “He’s very calm. When he goes to work, he knows he needs to follow the protocol: No barking, no jumping. He knows he’s there for the patients. After a two-hour session with multiple patients, he comes home and sleeps.” “He’s exhausted, but he loves it.”
“Afterwards, Xena and Sonji showed up, and everyone starting sitting on the floor so they could pet her,’’ Dunlap said. Larry McCants, a volunteer, frequently brings Murphy, a 5-year-old goldendoodle, to the hospital. His presence at Memorial brings joy to the faces of patients, staff and visitors. “There is a huge difference between walking into the See Disclaimer Disclaimer on on Page Page 88 //// www.DoctorsQuarterly.com See
olorado Springs was named one of the friendliest cities for dogs based on a number of amenities, from dog parks to pet friendly restaurants. In the spirit of that recognition, Humane Society of the Pikes Peak Region wants to make sure homeless pets in our community – dogs and cats alike – receive a second chance. More than 17,000 animals pass through HSPPR’s doors every year, and thanks to volunteers, donors and adopters, they are saving more lives than ever before. If you’ve visited HSPPR recently, you’ve probably noticed some big changes. Thanks to incredible support from the community, a 16,000-foot expansion and renovation is providing much-needed space for pets in need. Spacious and sunny cat condos in the new adoption center allow for more room to roam and adopter interaction. Separate dog and cat intake waiting areas help calm anxiety for animals (and their humans) coming into the shelter. Special isolation rooms for the sick prevent the spread of disease while they receive treatment from HSPPR’s accredited veterinary hospital. Designated disaster rooms give staff more capacity to care for dozens of animals
pulled from hoarding situations or natural disasters. Driving past HSPPR on I-25, you can now see their wonderful volunteers walking dogs in the new dog park – every dog, every day, that’s their motto. The new dog park provides a secure area for the team to play with the dogs, get them out of their kennels and into the fresh air. And the new livestock barn was already home to several goats and a 700-pound stray boar! How animals are treated is a reflection on our community, and HSPPR’s compassionate staff and volunteers work to provide the best care possible. The organization is filled with passionate and dedicated individuals like you who, together, work to save the lives of animals in need. HSPPR is proud to serve as the only open admission shelter in the region – no animal is ever turned away – and they continue to make great strides in accomplishing their mission: a compassionate community where animals and people are cared for and valued. But they can’t do it without you. Adopt, volunteer or donate today to help create a brighter future for the animals in our community.
Did You Know? All HSPPR adoption packages include a spay/neuter, vaccinations, a voucher for a free veterinary exam, 30 days of pet health insurance, and a microchip. And of course, you’re saving the life of an animal in need! You may notice some adoption fees are higher than others. That’s because HSPPR’s variable pricing system, used by many shelters across the U.S., helps them recover the costs of putting so many young animals through foster care, not to mention helps pay for medical procedures and lower adoption fees on older animals. By charging more for puppies and other popular breeds of dogs, they are leaving a legacy for other animals in desperate need of care. Visit www.hsppr. org/adopt to find your happy tail!
Volunteers are at the heart of making a difference for homeless and abused pets at HSPPR. Volunteers work side-by-side with shelter staff and provide manpower for programs that improve the quality of life for shelter animals. They volunteered more than 105,000 hours last year alone! HSPPR volunteers must be at least 18 years of age to work independently and are asked to commit to 2-3 hours per week for at least 6 months. Before joining the HSPPR volunteer team, you must attend an information session to learn about the organization’s mission and policies. Visit www. hsppr.org/volunteer for more information on joining the HSPPR volunteer team.
HSPPR relies on donations and grants to continue their important work. A Charity Navigator Four Star Charity (the highest ranking), HSPPR is a local, independent nonprofit not affiliated with national organizations such as ASPCA or Humane Society of the United States. As little as $25 provides antibiotics for a sick kitten; $75 provides blood tests for a senior dog waiting for adoption. But there are other ways to help, too. Consider donating your vehicle, hosting a fundraiser at your business, or attending HSPPR’s annual Fur Ball and Pawtoberfest events benefiting the homeless animals of the Pikes Peak Region. Visit www.hsppr.org/donate for more ways to give.
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by Tony LeVeque, Executive Vice President
For Your Financial Health
8 things professionals need to know about building ownership and financing.
hether you’re a physician-owner or an administrator, you may find that it’s time to buy a building for your practice. You may be tired of writing rent checks every month. Or, you may want to take advantage of the tax benefits and rising property values associated with ownership. But is ownership right for you? Here are 8 things you should know about buying your own office space and finding the right building loan financing for you:
1. Ownership gives you flexibility and control Commercial real estate ownership gives you the flexibility to grow and expand, or shrink and downsize to meet the ever-changing needs of your business. For example, you might need to downsize your practice and rent out part of the space to another business owner. On the other hand, business may be booming, and you may be ready to expand into a larger unit. Owning your own building allows you to scale your practice up or down, in good times or bad. As a building owner, you can tailor the construction and building design to fit your individual needs and budget. You can design an office layout that’s most productive for your practice, rather than having to work within the constraints of a rented space. You have the freedom to design a building that reflects the desired appearance of your practice. You can make long-term investments in creating an environment and adding features to benefit your employees and patients.
2. Ownership provides an opportunity to create a stream of passive rental income Passive rental income can be used to supplement retirement, pay down debts, increase cash flow, reinvest to grow the business, or prepare for additional real estate projects. Tenants are usually subject to periodic rent increases so your cash flow will grow over time. Ownership locks in many of the expenses and limits future cost increases.
3. When considering financing for a building, consider a local community bank and surround yourself with local professionals Most commercial real estate projects require financing. There are many reasons why you should consider financing the property through a local lender. Community bankers are generally more knowledgeable about the local market and familiar with the individuals involved in the transaction process, such as the builder, engineer, contractor, and architect. Large national chains generally can’t offer the same amount of expertise and help for your project. An experienced local banker will understand the different financing options for commercial real estate and guide you through each step of the transaction process.
Local experts will be aware of common mistakes and make the process more productive and efficient. Don’t let the project take over your time and distract from your responsibilities. Let the professionals manage the project. A quality lender will act as a quarterback and help facilitate the process.
4. Location, location, location:
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"Central Bank & Trust understands business, and they help you come up with a funding solution that works. On top of that, they make the loan processs straightforward and easy."
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The type of structure and location of the structure are important factors to consider when purchasing commercial property. Before constructing or buying a building, here are a few key things to consider: • Is the location close and convenient for your patient base? • Does the facility have easy access? Is there adequate parking? • How much space do you need now? In three years? In five years? • What is the trajectory of the surrounding neighborhood? Will it accommodate your plans for the future?
5. Base decisions on value, not just price You will make many financial decisions during the process of acquiring or building commercial real estate, including different buildings, financing options, builders, architects, and consultants. Making price the primary decision factor in those choices generally leads to problems down the road and likely ends up costing more in the long run. When choosing the right lender for your owner-occupied financing, it’s easy to focus only on rate (aka price). But it’s important to base your decision on the overall value of the loan and lender offers, not just the rate. A less professional lender may attempt to focus on rate alone, but the process may lead to more costs, fees, and delays that create lost revenue or added expenses. A quality lender will work with you to understand your short-term and long-term plans and will structure financing that best suits your situation. Always consider the value (including non-monetary value like knowledge and experience) versus nominal cost when considering financing options.
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6. Factor in the risks associated with building ownership and construction Before signing a commercial loan, make sure to factor in the risks associated with building ownership. Common responsibilities include: • Routine and emergency maintenance • Unexpected expenses • Cost overruns during construction • Vacancy issues if tenants are sharing your space
7. Consider the common loan options A Small Business Administration (SBA) loan is one of the best products on the market for owner-occupied commercial real estate. With an SBA loan, you are able to obtain more favorable financing terms. Key features of SBA loans are: • Low down payment – as little as 10% • Long-term loan – as long as 25 years, fully amortizing • Flexibility to finance the entire project • Favorable interest rate options • Little or no loan covenants • Must be at least 51% owner-occupied for existing properties and 60% for new construction An experienced local SBA lender should be able to make the process as easy as most other commercial loans and will eliminate the need to work directly with the SBA or an entity that works in conjunction with the SBA.
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There is also a Conventional Commercial Loan where the borrower works with a lender like Central Bank & Trust and says, “I want to buy a commercial building for my practice,” and we create the loan. Key features of a Conventional Commercial Loan include: • • • • •
Down payment – typically 20-25% Loan Term – 20-25-year amortization with a balloon payment every 5-10 years Low upfront fees – generally paid out of pocket in addition to the down payment Loan covenants are customary Flexibility with occupancy percentage (less than 51% is acceptable)
8. Get pre-qualified When choosing a commercial loan, it’s important to get pre-qualified first. With a pre-qualification, the rest of the loan process runs more smoothly and you will be able to evaluate and act upon opportunities more quickly. Pre-qualification should only take two or three days after completion of the initial application.
Interested in getting pre-qualified for a commercial real estate loan? Contact Tony LeVeque at Central Bank & Trust to get started today.
ABOUT THE AUTHOR Tony Leveque, Executive Vice President, Central Bank and Trust, SBA and Commercial Real Estate Lending Expert. Central Bancorp 1 South Nevada Avenue, Suite 100 Colorado Springs, CO 80903 (719) 228-1100 https://centralbancorp.com/
by Mario Aragon PA-C
DEFYING DEPRESSION H aving a hard time finding the drive to push those covers off yourself in the morning? Do your hobbies, interests, and friends feel more like burdens than enjoyment? Has your appetite diminished or do you eat more to drown the sadness? Do you find yourself lying in bed for hours feeling anxious with endless thoughts consuming your mind? Do you lack energy and focus throughout the day? Have you asked yourself, “Would life be better for me and everyone if I just wasn’t around anymore?” If you can answer “yes” to most of these questions, you may be dealing with the “demon” of depression! In 2015 the National Institute of Health released data that 16.1 million Americans experienced a major depressive episode in the past year. The number is
imaginably much higher than that as many people do not seek care for this issue. Depression is a real experience and disease for some. Too often, suicides are the first we learn that an individual had been suffering with depression. On average there are 121 suicides per day in the United States. To some degree, most of us have experienced sadness, despair, and hopelessness entering our lives at one point or another. Sometimes there’s a reason or cause for these feelings, and other times you may have no clue why you feel the way you do. Often times depression can stem from life events such as the loss of a family member or a close friend, illness, problems in a marriage, post-child birth, alcoholism, loss of employment, or finances,
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CALL TO ACTION Depression should be viewed and managed from multiple angles. Nourish the spiritual, physical, and emotional aspects of your life. When needed, seek professional assistance along the path leading to peace of mind and body.
to name just a few. How does one explain feelings of depression they may experience when there is no apparent reason or cause for such feelings? Well, the answer is probably more complex than a “chemical imbalance” or deficient hormones. Although still not completely understood, research is pointing towards intertwined causes of depression. The amygdala, hippocampus, and thalamus are thought to be areas in our brains where we experience depression. Genetics, stress, medical conditions, and even some medications also can play a significant role in developing depression.
16.1 MILLION Americans experienced a major depressive episode in the past year.
Our brain is a complex network of connections which is constantly transmitting and receiving signals back and forth to perform specific functions. Emotions and mood are also delivered through this massive web of neurons (nerves). There is an intricate set of steps in line to transmit and receive a message from one nerve to its neighboring nerve. Messengers called neurotransmitters, act as the couriers to send messages back and forth in between nerves. Serotonin, norepinephrine, glutamate, and dopamine are some of the major messengers of the nervous system. There must be receptors at each nerve ending to accept the neurotransmitter to its side. There are channels along the nerve endings which allow for 32
neurotransmitters to move in and out of the nerves. Any deviation, deficiency, malfunction, or break in the system can cause a communication disaster and increase chances of developing depression. Stress can be a positive response to help us when we are in danger. Constant stress can increase risk for heart attack, weaken the immune system, increase blood pressure, and lead to depression. It is thought that stress inhibits nerve cell connections and growth particularly in the areas of the brain known to deal with emotions and feelings. This process can lead towards a break in the system and missed connections of neurotransmitters keeping one’s mood and feelings stable. So what? What do we do with all the fancy science? Just knowing about how the brain works and how nerves “talk” does not make depression go away! Where do you start? You cannot fix a problem until you realize that there is a problem. Sometimes, we can see clearly for ourselves that we are struggling emotionally and psychologically, where other times it may take a close friend, family member, coworker, or doctor to help us realize we are struggling. Be honest with yourself! Seek help if you or someone else suspects you may be dealing with depression. Does it mean that you are going to be given a “happy pill” and sent on your way? Although medication can have an important role in treating depression, it is not the only part of the solution nor should it be. Have a meeting with a trusted medical professional to sit down and discuss where you have been, where you are at, and where you would like to end up. It is important that your doctor hears your perspective of why you might be feeling certain emotions. It may be necessary to have laboratory work performed to look for other underlying causes of depression to include, hypothyroidism, low testosterone, or menopause.
Depression treatment may be as close as a “hop, skip, and jump away!” A recent study showed aerobic exercise can significantly help elevate mood. Research from this study showed that the very first exercise session that the participants engaged in was a great predictor of whether or not exercise in itself would help to improve depressive symptoms. Weight loss can be extremely encouraging to a person who is overweight and may be depressed from a poor body self-image. Other benefits from exercise include increased energy, restful sleep, and opportunities to meet other people and socialize. It is recommended to engage in thirty minutes of exercise a day with workouts to include jogging, running, swimming, bicycling, lifting, and spinning, to name a few. Do not try to prepare for the Boston Marathon! Just start somewhere, such as walking. Sometimes depression can be one of the multitudes of symptoms for someone who has high blood sugar levels. Eating a low carbohydrate and low cholesterol diet can also be beneficial to keep your body’s metabolism in check.
Depression should be treated through multiple avenues and directions. Counseling and cognitive behavioral therapy, a type
of talk therapy, have been extremely beneficial in helping to take incorrect thinking and negative thoughts into a positive direction, resulting in behavioral change. Professional counselors, psychologists, and psychiatrists are trained to help guide the process of change. Spiritual health may be the paramount “food for our souls” when it comes to depression. There are a variety of different belief systems, forms of meditation, religions, and understanding of the greater purpose of who we are and what one’s ultimate potential might be. Who, what, and how you believe can be power motivating factors in your life for inner peace and development. Focusing on your core beliefs,
prayer, and meditation can move one to change both mind and body. Spiritual struggles can be the cause of despair at times. Speaking and meeting with an ecclesiastical leader can also help guide one in steps to be taken towards spiritual healing if necessary. Let’s bring everything back together. Depression is a real and common condition which most everyone will experience in their lifetime. For some, it is a lifetime struggle and others, episodic. It is important to understand what depression is, know our limits, find root causes, if possible, or understand there may be no cause for that matter. Seek help from family, close friends, professionals, and spiritual outlets. Forgive yourself and others. Do not carry unnecessary burdens you cannot impact or do anything about. Accept that you may be experiencing depression, but do not let it label who you are. Take one step at a time and build up to a better and more complete you!
ABOUT THE AUTHOR Mario Aragon is a Physician Assistant and former paramedic practicing in Family Medicine and Urgent Care for the past seven years.
Q: What is the name of a neurotransmitter which helps elevate mood?
Alliance Urgent Care and Family Practice 9320 Grand Cordera Parkway, Suite 100 Colorado Springs, CO 80924 (719) 282-6337 www.amedicalpractice.com
Q: What can help minimize depression the first time engaging in it?
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by Dr. Kenneth Finn
HOW MEDICAL IS MEDICAL MARIJUANA?
Marijuana has been used for thousands of years for a variety of things. It has been documented in ancient China and Egypt for example. There is, however, some disagreement and controversy as to what it may or may not be used for. Colorado has had a medical marijuana program since 2000 and at that time it was very difficult for patients to obtain recommendations to use marijuana for their condition for a variety of reasons. Doctors were somewhat reluctant to recommend due to fear of legal recourse, and patients did not have the capacity to obtain their marijuana due to the lack of a place to go. Dispensaries simply did not exist 17 years ago. In 2009, after a series of legal maneuvers at the state level, Colorado experienced de facto legalization and dispensaries appeared across the state. It has reached a point where there are more medical marijuana dispensaries in Colorado than the number of Starbucks and McDonalds combined. The total
number of medical marijuana dispensaries rivals the total number of licensed pharmacies, where every other legal medication is dispensed in a controlled manner, supervised by a licensed pharmacist. Licensed pharmacists are required to have a college bachelorâ&#x20AC;&#x2122;s degree, which typically takes four years to complete, followed by completion of a rigorous four-year Doctor of Pharmacology degree program. They are monitored by the stateâ&#x20AC;&#x2122;s Department of Regulatory Agencies and have to have documented continuing education in order to continue to practice and maintain their license. On the other hand, anyone working in a medical marijuana dispensary needs to be 21 years of age, does not have to have
any high school, college, or other higher education, and they don’t necessarily require knowledge of the pharmacology of one substance, compared to that of a licensed pharmacist. In Colorado, a patient can obtain a recommendation for marijuana if they are certified by a licensed physician as having a “disabling medical condition.” Those conditions include pain, spasms, nausea, cancer, seizure, glaucoma, weight loss, and most recently PTSD. It is unfortunate that physicians who may not have the expertise for any of those conditions have the capacity to make recommendations for those conditions. For example, a radiologist can make a medical marijuana recommendation for a cancer patient under Colorado law. It would be improper for a general gynecologist to manage a patient’s chemotherapy regimen. In some instances, that would be considered malpractice. Also, under Colorado law, a bonafide patient-physician relationship is required and the physician is required to maintain medical records. In my experience, patients who have medical marijuana cards never know the name of the recommending physician and my office can never obtain medical records.
El Paso County has the largest percentage of medical marijuana patients in the state. Over 20% of the states medical marijuana patients live there.
! CALL TO ACTION
It is important that state and federal government agencies work together to allow critically necessary medical research be performed to prove what components of the marijuana plant can be used to treat specific medical conditions.
Regarding the chemistry of marijuana, there are components of the plant which may have medical use. The most common and well-known component is THC or tetrahydrocannabinol. It is also the component of the plant that gets you high. The other component of the plant which may have medical use is CBD, or cannabidiol, and does not get you high. The chemical system in the human body, called the endocannabinoid system, is where the components of the plant may work. The receptors where THC act are called the CB1 and CB2 receptors. CB1 receptors are mostly located in the central nervous system and CB2 receptors are mostly located on tissues which are involved in inflammation. THC works on these receptors primarily and it is important to understand that this is a substance that works primarily on the brain. How CBD works is less well understood but may work in patients with seizures, among other conditions.
The most common reason patients use marijuana is for pain. See Disclaimer on Page 8 //
Pain is a broad diagnosis and can originate from a variety of sources and different types of pain will respond to different medications differently. In patients who go to the doctor, the most common pain conditions are back pain, joint pain, and abdominal pain. Unfortunately, the medical literature is completely absent in demonstrating benefit in these more common pain conditions. Most of the literature may show benefit in less common pain conditions, which include nerverelated and cancer pain. In these conditions, most of the studies used products which are purified, not available in the United States, or with synthetic products which mimic THC. It is also important to understand that dispensary cannabis is a generic substance and very different from cannabinoids which are purified products, absent of any contaminants. A recent article from the respected medical journal, Annals of Internal Medicine, August 2017, reviewed the available medical literature and concluded that limited evidence suggests that cannabis may alleviate nerve-related pain in www.DoctorsQuarterly.com
some patients, but insufficient evidence exists for other types of chronic pain. Another concern is the available products vary in potency and delivery systems. It can be smoked, vaped, ingested, rubbed, and some of the more potent products, dabbed, where a highly concentrated product is heated with a blow torch and the gases inhaled. There is no available literature on any of these variable and potent products and their medical benefits. CBD is a product of the plant that will not get you high. How it works is not completely understood and is showing some promise in the management of pediatric seizures, which is very uncommon. The University of Alabama, Birmingham, is currently looking at potential benefit with the purified CBD product, Epidiolex. In Colorado, homemade preparations of this plant component run the risk of contaminants which include pesticides, fungicides, rodenticides, as well as particulate matter. At the University of Colorado, the pediatric seizure specialists have had to admit children using these homemade products who present with an increase in
seizure, developmental regression, and in a few cases, the patient had to be placed in a coma to stop the seizures. In summary, there is potential medical benefit from the components of the marijuana plant. There are currently many other plant-based medications used on a regular basis that have met the rigor of scientific study through the FDA, as patient safety is important. Marijuana has not met that rigor at this time. Per the American Pain Society’s position on the matter, there should be increased federal funding for: pain-related cannabis research; broadened pain conditions being studied; eased regulatory restrictions impeding appropriate research; improved access to high-quality plant cannabis for research; and states should be encouraged to collect and track data on patients receiving medical marijuana. If physicians can be provided a plant-based medication that has met the rigor of scientific research, that data is widely available, and that product is proven in particular medical conditions, they would be satisfied. Marijuana has not yet met the definition of a medication, and science, not public opinion, should determine what is medicine.
Q: What is the common component of marijuana which causes you to get “high?” 36
ABOUT THE AUTHOR Dr. Kenneth Finn has been practicing medicine in Colorado Springs for 24 years, specializing in Pain Medicine. He is Board Certified in Physical Medicine and Rehabilitation, Pain Medicine, and Pain Management. He served on the Governor’s Task Force on Amendment 64, which legalized marijuana for recreational use, Consumer Safety, and Social Issues Work Group. He also serves on the Colorado Medical Marijuana Scientific Advisory Council. Other activities include serving on the American Board of Pain Medicine’s Executive Board, Exam Council, and Appeals Committee. He has participated in providing primary care services on medical mission trips to Iquitos, Peru, and Muganero, Rwanda. He is an avid mountain biker and telemark skier, spending as much time in the Colorado mountains as possible, and has called Colorado Springs home for 24 years. Springs Rehabilitation, PC 6005 Delmonico Drive, Suite 130 Colorado Springs, CO 80919 (719) 634-7246 www.springsrehab.net
Q: What is the most common reason people may use marijuana for medical purposes?
Q: What county has the most number of medical marijuana patients in the state?
by Vladimir Ishchenko
Your Way to Improved Health! One Activity DANCE Yields Many Health Benefits.
ealth-conscious people of all ages seek a better, more enjoyable quality of life through improved physicality. They strive for improved cardiovascular health, muscle strength, endurance, aerobic fitness, weight management, strong bones, reduced risk of osteoporosis, slowed aging, less risk of falling, and more sheer happiness. There is a daunting abundance of expert advice, food products, supplements, sports activities, and exercise equipment to help fitness seekers achieve their goals. Who knew that one activity, DANCE, offers all of these health benefits and FUN as well?! Health professionals and exercise physiologists from a variety of prestigious institutions, such as the National Academy of Sports Medicine, the New England Journal of Medicine, and Berkeley Wellness, found that DANCE is enormously beneficial to body and brain health, as well as emotional/ relational well-being.
five areas. He concluded that various exercises had a few improvements, but only DANCE could claim improvements in all five. In addition, DANCE resulted in improved balance, agility, and coordination. Comana concluded, “What I like about DANCE is DANCE is free flowing. It’s less traumatic on the body than an aerobic class.” The New England Journal of Medicine noted that especially for seniors, dancing can improve balance, ultimately reducing dangerous falls. Berkeley Wellness added that DANCE also improved “gait, walking speed, reaction time, and cognitive and fine motor performance.” What about weight control? The Centers for Disease Control and Prevention found that 40% of American adults and almost 20% of adolescents are obese - the highest rates ever recorded. Again, DANCE is an answer. Berkeley Wellness reported, “On average, a 150 pound person burns about 240 calories” per hour dancing.
Physical Benefits of DANCE Fabio Comana, an exercise physiologist and education team member of the National Academy of Sports Medicine, researched five components of fitness - cardiovascular endurance, flexibility, muscular endurance, body composition, and muscular strength - comparing how a variety of exercises resulted in improvements in these
CALL TO ACTION
So go for it! Sign up for a DANCE class. Mention this article when you text 719-244-4288 and receive a discount on your first dance class!
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“There are shortcuts to happiness and DANCE is one of them.” Vicki Baum “DANCE is the most honest form of communication I know.” Nathan Bala “DANCE lessons are an easy, low-pressure way to meet people.” Fred Astaire
Fictions and Facts
Lydia, 86, praised her late husband’s wisdom. “When we had three little children, my husband traveled five days a week. By Friday when he returned home, I was tired, angry, and ready to pick a fight. He would say, ‘Honey, put on a pretty dress. I am taking you for dinner and DANCE. We will fight when we get home.’ When we got home, I couldn’t remember why I had been angry!”
I have two left feet. FACT: “Teach the brain what to do and the body follows.” Dieter Kast FICTION:
I’m shy. “Dancing lessons are an easy, low-pressure way to meet people.” Fred Astaire FICTION: FACT:
Personal Testimonials: Sasha, 33, was born crippled with a crooked spine and weak legs. His mother enrolled him in DANCE classes at age three; by the age of six, he won his first DANCE competition and became his country’s national champion dancer for the next eight years. Ann, 72, danced for years before needing a major surgery. Her surgeon predicted she would fare well because of her high level of physical fitness. Indeed, she returned to DANCE in half the normal recovery time.
2003, researchers at the Albert Einstein College of Medicine determined that DANCE can decidedly improve brain health. Researchers studied the effects of 11 different physical activities including cycling, gulf, swimming, and tennis, but found that only DANCE lowered participants’ risk of dementia. In fact, DANCE done on a regular basis showed a 76% reduction in dementia risk.
The Journal of the American Medical Association recently stated, “The number of older people with dementia is expected to triple by 2050 in the U.S. because of the growth of the older population.” In
Berkeley Wellness reported, “Dancing is good for your mood. It has been shown to reduce depression, anxiety and stress, boost self-esteem, body image, coping ability, and overall sense of well-being.” The authors of a meta-analysis of 27 studies published in “Arts in Psychotherapy” encouraged DANCE as treatment for depression and anxiety.
I’m too stressed. “Life isn’t about waiting for the storm to pass. It’s about learning to DANCE in the rain!” Vivian Greene FICTION: FACT:
ABOUT THE AUTHOR For 30 plus years, Vladimir Ishchenko has been a champion dancer, choreographer, and dance trainer. Originally trained in dance in the Ukraine and Germany as well as receiving a Master’s Degree in Physics at Simferopol State University, he taught dance in Europe and now teaches at Springs Rhythm Dance Studio in Colorado Springs. Springs Rhythm has won several Top Studio awards at the annual Colorado Star Ball and is a vibrant studio where teachers, students, and dance fans have fun within a friendly dance community.
Q: What is one activity which can produce multiple health benefits? 38
I’m too busy now. “Life is short and there will always be dirty dishes, so let’s DANCE!” Jesse Howe Fiction: I’m too old. Fact: “One should dance while one still can.” Marty Rubin FICTION:
Emotional/Relational Benefits of DANCE
Mental Benefits of DANCE
It’s difficult. FACT: No, it’s FUN. “Dance is the hidden language of the soul, of the body.” Martha Graham FICTION:
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Springs Rhythm 1414 Kelly Johnson Blvd. Colorado Springs, CO 80920 719-244-4288 www.springsrhythm.com
Q: Besides increased body health, what other part of the body can achieve improved health through DANCE?
by Dr. Scott Robinson
Peak Vistaâ&#x20AC;&#x2122;s Family Medicine Residency Program in Colorado Springs
n early 2013, Peak Vista Community Health Centersâ&#x20AC;&#x2122; (Peak Vista) leadership recognized several trends that were affecting our local medical community. These trends included an increased shortage of primary care physicians (PCP), in particular Family Medicine, and longer recruiting times for all specialties. These trends are well documented in national general news and population based studies, as well as in the medical literature. The national data is sobering: If the PCP to population ratio is kept constant, more than 44,000 PCPs will be needed by 2035.
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At current training production rates, the nation will be short 33,000 PCPs by 2035. “To eliminate projected shortages in 2035, primary care residency programs must increase by 21% compared to current production.” With the shortage of PCPs, especially family physicians, Peak Vista began to explore the possibility of building and financially supporting a Family Medicine Residency (FMR) in Colorado Springs. At the time, Colorado Springs was the largest city in the country without a primary care training residency. An excellent, longestablished pathology residency exists at Penrose-St. Francis Health Services and a privately sponsored dermatology residency exists under the management of Dr. Reagan Anderson. Unfortunately, there was a lack of Pediatrics, Internal Medicine, or Family Medicine training sites in Colorado Springs at that time. After extensive cost/benefit analyses, and projections of workforce recruitment and retention, Peak Vista’s Board of Directors voted to move forward with the ambitious goal of starting and maintaining a FMR in Colorado Springs. Dr. Scott Robinson assumed the role as Program Director in February of 2015, after working in a similar role for many years out of state. An aggressive timeline of 18 months began to find internal and external funding to support the program, apply for initial
American Osteopathic Association (AOA) accreditation, join and pay for the numerous systems necessary to match, manage and track residency work, set up the roughly 22 specialty rotations and hospital affiliations, hire core faculty and support staff, build facilities to accommodate the family medicine continuity clinic, and select and recruit its first class. All these tasks were completed on time; Peak Vista welcomed the first class of residents in July 2016.
Traditionally starting a new program takes between 2-3 years; however, Peak Vista accomplished it in only 16 months due to outstanding institutional support. Due to the efforts of Peak Vista’s Family Medicine Residency Program Director, faculty, external partners
and internal resources, its first class of eight residents matriculated from medical school July 2016, and began their rotations. The inpatient rotations occur at PenroseSt. Francis Health Services, UCHealth University of Colorado Memorial hospitals, and Children’s Hospital of Colorado – Highlands Ranch. Outpatient and mixed inpatient/outpatient rotations occur with numerous private and group practices throughout Colorado Springs. Many of these groups devote an enormous amount of resources to arrange the rotations and assign supervisory adjunct faculty physicians to train the resident physicians. For this commitment to medical education, the community and Peak Vista are grateful. It is truly the highest aspiration to train another physician as a future colleague, and
to realize that each welltrained physician will attend to thousands upon thousands of patients in their forty to fiftyyear career. During the process of establishing the FMR program, the AOA and Accreditation Counsel of Graduate Medical Education (ACGME) announced its merger, to be finalized by 2020. To the Peak Vista FMR program, already AOA accredited from 2014 on, this meant a large secondary body of work had to be accomplished quickly, from documentation and design of some systems, to redesigns of others, from re-organization of some rotations, to altering our resident log and tracking systems. Nationwide, only 52% of FM residencies are successful in obtaining initial accreditation through the ACGME. Peak Vista’s Family Medicine Residency was successful in obtaining ACGME initial
accreditation, effective June 2017, adding to its ongoing accreditation from AOA. This allows the FMR program to accept MD medical school graduates, as well as DO graduate colleagues starting July 2018. ACGME accreditation also guarantees the program will be an active and vibrant part of the medical community in Colorado Springs after 2020 – and beyond – and will add family physicians to the local workforce after its first-class graduates in 2019, and every year thereafter. These accomplishments are something to celebrate for the city, as it means that as Colorado Springs grows, the community will have excellent Family Physicians to support good health, share care with specialty physician colleagues, and assume patient care from older established community physicians as they retire in the future.
“I am grateful for the opportunity to lead this Peak Vista program and for the patients and communities we serve.” —Dr. Scott Robinson
REFERENCE -Annals of Family Medicine March 2015 vol. 13, no 2, 107-114
ABOUT THE AUTHOR Dr. Scott Robinson is the Family Medicine Residency Program Director at Peak Vista. Appointed as program director in February 2015, Dr. Robinson brings a wealth of experience, education, and knowledge of family medicine in clinical environments ranging from private practice and residency programs to geriatric primary care and provides valuable care to the underserved and uninsured. Dr. Robinson served as the program director of the Bay Area Family Medicine Residency in Corpus Christi, Texas from 1999 to 2005. Afterward, he continued working as a family physician in Texas for a number of years and then joined Peak Vista in 2010. Most recently, he served as vice president of medical services, overseeing six of Peak Vista’s 25 health centers. Dr. Robinson holds a medical degree from Texas College of Osteopathic Medicine; and a Master’s degree in clinical gerontology and Bachelor’s in biology from Baylor University.
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by Dr. Alex Constantinides
Concussions PROPER RECOGNITION AND TREATMENT
f you or your children play sports or participate in outdoor recreation (biking, horseback riding, etc), you may be at risk for a concussion injury. Concussions are mild traumatic brain injuries that occur with direct blows to the head, or by rapid acceleration/deceleration (whiplash) of the head. The Centers for Disease Control has estimated that there are between 1.6-3.8 million concussion per year in the United States from sports and recreational activities. The changes that occur in the brain during a concussion happen at a cellular level and cannot be seen on standard medical imaging such as CT Scans or MRIs. These changes are thought to include a rapid depolarization (electrical reset) of the brain, which may cause patients to feel “dazed” or even be severe enough to make them briefly lose consciousness. This electrical activity is followed by changes in the brain’s blood flow and pressure regulation, electrolyte transport, and decreased glucose delivery as the brain monitors itself for injury and tries to repair the damage. These blood flow and metabolic changes typically last for 7-10 days and account for many of the “postconcussion” symptoms that patients may feel.
Common symptoms patients may feel during a concussion include a mild headache, lightheadedness, poor balance, fatigue, light sensitivity, mild nausea, or decreased appetite. Common signs that you may observe in a patient who has sustained a concussion include vacant stares, slowed verbal responses, confusion or disorientation, memory problems, and emotional responses that seem inappropriate or out of proportion for the individual’s normal behavior. 80% of people with a concussion will have complete resolution of these signs or symptoms within 7-10 days. Signs and symptoms that are concerning and should prompt immediate medical attention at your local physician or ER include prolonged loss of consciousness, focal weakness of a single area of the body, prolonged vision changes, drainage from the ear, severe headache, vomiting, prolonged symptoms beyond 7-10 days, or any symptom that continues to worsen after the initial injury. There are no medications which have been shown to aid in healing concussions. If the patient is having
CALL TO ACTION Get plenty of rest after a concussion. Return to your sport gradually. Seek immediate medical help if any concerning or prolonged symptoms occur.
minor headaches or body aches they may take acetaminophen (Tylenol) but should avoid aspirin, ibuprofen (Motrin), and Naprosyn (Aleve) as these medications can affect how platelet cells form clots, therefore increasing the risk of bleeding in the brain. It is very important to let the brain rest during the concussionhealing phase. Important things to remember during this time are: • • • • • •
Get plenty of rest. Do not exercise. Stay hydrated. Eat at regular intervals (do not skip meals). Avoid alcohol. Avoid playing video games or watching action/intense movies or TV.
During the healing phase of a concussion, the brain is very susceptible to injury in the event of another concussive blow. This is referred to as “Second Impact Syndrome” and can lead to severe injury or death even from a relatively minor blow. Most documented cases of second impact syndrome occur in the 7-10 days after a concussion. Therefore, until patients have recovered from their initial
injuries, they should avoid sports and activities that could lead to a second concussion until they are completely recovered from their initial injury. In Colorado, all school athletes must be evaluated by a licensed practitioner (MD, DO, NP or PA) and have a written release prior to returning to sports. It is also important that the patient returns to normal activity gradually. In the sports medicine programs with which I work, we use standard Return to Play protocols. These involve waiting until the athlete is completely symptom-free from their initial concussion and has fully resumed all academic activities. Patients can then gradually start with mild aerobic activities such as riding a stationary bike. If the athlete is able to do this without any symptoms returning, we will progress through stages of sport
specific exercise (dribbling a basketball, shooting a puck etc), non-contact practice/drills, full-contact practice, return to full gameplay. If at any time the athlete becomes symptomatic, they are returned to the previous asymptomatic stage of the protocol. All school coaches in Colorado are required to complete annual concussion education and training. Many sports and outdoor recreational activities are associated with some inherent risk of concussion. However, rather than avoid activities that bring us health and happiness, we should be aware of and take precautions that will reduce the risk of injury. This may include wearing proper wellfitting activity appropriate protective gear (helmets, mouth guards, etc) and participate in sports under the supervision of educated/trained coaching staffs. When concussions occur, it is important that patients get enough rest and take time to let their bodies heal. Following a gradual return-to-activity protocol will ensure that patients return to optimal levels of health and can continue to enjoy athletics and life in the Colorado outdoors.
ABOUT THE AUTHOR Dr. Alex Constantinides is Board Certified in Family Practice and Osteopathic Manipulation. He is also a Certified Ringside Physician with the American College of Sports Medicine and works as the ringside doctor for the majority of boxing and mixed martial arts events with the Colorado Combative Sports Commission, including many TV appearances with the Ultimate Fighting Championship. He volunteers as Team Physician for Doherty High School and UCCS.
Q: A minor concussion that can cause major injury while the brain is still healing is called _____ _____ syndrome. See Disclaimer on Page 8 //
UCHealth Medical Group Primary Care at Academy Office 5265 N Academy Blvd, Suite 1800 Colorado Springs, CO 80918 (719) 599-0444 www.uchealth.org
Q: Which over the counter medication is safe after a concussion? www.DoctorsQuarterly.com
by Dr. Lukasz Kowalczyk
MYTH # 2: ABL occurs as part of aging and is “normal.”
ABOUT ACCIDENTAL BOWEL LEAKAGE (ABL)
FACT: ABL does increase with age, but it is NOT normal. Many underlying disease states lead to ABL and should be excluded. The most common diseases include:
RECLAIMING CONFIDENCE AND INDEPENDENCE
• • • •
MYTH # 1: ABL is uncommon and only affects a small number of people. FACT: ABL is defined as the involuntary loss of liquid or solid stool. It affects an estimated 46 million adults in the U.S. This is over 10% of the population. In people over the age of 65, it is even more common, occurring in 1 out of 5 individuals. This is a very common problem but one that is not discussed openly. There are many reasons for this, including embarrassment, lack of good treatment options, and a lack of health care provider comfort on how to discuss and manage ABL.
Hemorrhoids Pelvic floor muscle weakness Obstetrical injury from childbirth Inflammatory bowel disease and other diarrhea-causing diseases • Nerve injury related to back injuries and diabetes • Neurological conditions such as Parkinson’s and Alzheimer’s • Rectal tumors
MYTH # 3: If none of the above diseases are discovered, then patients must either live with their ABL or undergo major surgery as the only treatment options. FACT: Many times, none of the above diseases are found. In fact, most ABL’s are related to weak nerve signals which control the muscles of the rectum and allow proper sensation of stool in the rectum. The nerve is called “S3” and is the 3rd nerve of the sacrum. Stimulation of this nerve can lead to improved or completely resolved ABL. There is a simple device called Interstim, which helps to stimulate the S3 nerve. Interstim is the TOP rated treatment for ABL. As you can see from the picture, Interstim does NOT go anywhere near the spine, as the S3 nerve is a PERIPHERAL nerve, so the procedure is very safe.
MYTH # 4: Having the device placed is painful and is a major surgery. FACT: Having the device placed is a simple outpatient procedure. The device is slightly larger than a quarter and sits below the fat pad of either hip. There are no restrictions of activity once the device is implanted.
MYTH # 5: Doctors do not like to be bothered with patient complaints of ABL. FACT: ABL is a difficult and challenging problem to tackle. The good news is that there are physicians who have the necessary experience to deal with this problem and offer the best therapies for it.
! CALL TO ACTION
Speaking up and letting your doctor know that you have this problem and that solutions exist is the first and most important in taking control over ABL. There are physicians that are compassionate and able to help you conquer ABL!
A board-certified Gastroenterologist can provide a complete workup to exclude the conditions listed. Additionally, some GI physicians have chosen to specialize the helping patients suffering from ABL. They have been certified in evaluating patients for devices such as Interstim. They also have access
to other specialized diagnostic tools and specialists such as a pelvic floor physical therapist who can provide additional complementary therapies. It is important to find a Gastroenterologist who is passionate and experienced in treating patients with ABL.
ABOUT THE AUTHOR Dr. Lukasz Kowalczyk, â&#x20AC;&#x153;Dr. K,â&#x20AC;? is a physician and partner at Peak Gastroenterology Associates, a current GI Center of Excellence for Interstim. He is a national trainer for the Interstim device. He is dedicated to helping patients regain their independence and confidence by alleviating ABL.
Peak Gastroenterology Associates 2920 North Cascade Avenue, Suite 300 Colorado Springs, CO 80907 W: (719) 636-1201 F: (719) 636-1326 www.peakgastro.com
Q: Stimulation of what nerve is the most effective interventional therapy for ABL?
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Q: How many people over the age of 65 are affected by ABL?
by Susan Strasbaugh, CFP®, EA, AIF®
For Your Financial Health
How Much Money Do I Need to Retire? MAKE SURE THE NUMBERS ADD UP “Can I afford to retire?” It’s a simple question, but it has enormous implications. Planning for retirement is like completing a vast jigsaw puzzle. Your big-picture goals may be simple enough but you must fit many pieces together to get there.
Perhaps the most critical component in retirement planning is assessing your current financial situation. Over the years, you’ve amassed an array of assets and future income streams from myriad sources: investments, retirement/401(k) plans, government or company pensions, executive compensation programs, insurance policies, family trusts, rental property, Social Security and more.
START BY EVALUATING YOUR INVESTMENTS It is important to look at the following factors when reviewing an investment strategy that supports your retirement goals: Costs and Performance – What are your current investments costing you and what have they actually returned? Has it been a fair trade-off? The average equity mutual fund has expenses in excess of 1% per year, without providing
additional return over a similar index fund with much lower expenses. RISKS – Can you minimize the investment risks you’re taking, without sacrificing the returns you want or need to achieve? Is a well-diversified portfolio part of that plan? TAX-EFFICIENCY – Are your assets positioned optimally for current and future tax planning? Asset location, or positioning your investments in the proper tax “buckets,” can dramatically improve your after-tax return. Be sure to consider the many ways that your well-managed portfolio might play out under various scenarios. For example, what if … You retire sooner or later than age 65? You will need to plan for how to pay for health insurance until you qualify for Medicare.
Do you have to pay for large medical expenses? A Fidelity study estimated the cost of healthcare in retirement years will be $220,000 for a couple, both aged 65, retiring in 2017. (Source: Fidelity Viewpoints, Sept. 6, 2017). You take your Social Security benefits earlier, later, or in staggered amounts? Taking Social Security early can dramatically impact your income in later years. In fact, for most baby boomers, delaying your benefits to age 70 rather than age 66 results in an 8% increase in benefits for each year you wait. You’ll want to prepare a retirement cash-flow plan to fund 30 to 40 years (or more) of expected spending. Begin by listing your expected expenses and income sources, for example:
Annual Household Cash Flow: Expected Annual Income Social Security _______ Pension Sources (you and your spouse) +_______ Social Security (you and your spouse) +_______ Other Sources +_______ =_______
Total Annual Income Expected Annual Expenses Fixed costs Mortgage, utilities, insurance, food etc. Variable costs Capital costs (i.e. vehicles, vacations, travel, major home repairs) Out-of-pocket healthcare
+_______ +_______ +_______
Total Annual Expenses
Surplus or Shortfall
Once you have clarified your income sources and annual expenses, subtract the expenses from the income to see where you stand. If you have a surplus, congratulations! You will be able to maintain your lifestyle without tapping into your investments. If instead, you find yourself with a shortfall, this is where withdrawals from your investment portfolio can make up the difference. With a well-managed, diversified portfolio, the general rule of thumb is to start with a 4% annual withdrawal rate from your investments. This should allow you to continue inflation-adjusted withdrawals for a 30-year retirement. So, for example, if you have a shortfall of $40,0000, you likely need an investment portfolio of $1,000,000 ($1,000,000 x 4% = $40,000) to fill the gap. How did the numbers add up? The answer to the question -- “How much money do I need to retire?” -- is a very individual one, based on your lifestyle expenses and other sources of income. Hopefully, you now have a better handle on what that number is for you.
ABOUT THE AUTHOR
Q: How much does the average worker in his or her 50’s have saved for retirement? A: Surveys have found an average retirement savings balance of approx. $125,000 for those age 50-55 group.
Q: What do you need to have saved by age 55? A: Around 7 times your average earnings, assuming you want to retire at age 65. So, if you and your spouse earn $100,000 per year, you are aiming for a balance of $700,000 (or more if you are an over-achiever!) by age 55.
Susan Hodges Strasbaugh, CFP®, EA, AIF® is owner and CEO of Strasbaugh Financial Advisory, Inc. and has provided fee-only financial planning, investment management, and tax advice since 1998. Her practice focuses on retirement planning for professionals within ten years of retirement. Strasbaugh Financial Advisory, Inc. 8580 Scarborough Drive, Suite 145 Colorado Springs, CO 80920 (719) 265-4600 www.strasbaughfinancial.com Disclosure: Past performance may not be indicative of future results. Different investments involve varying degrees of risk; future performance of specific investments, investment strategy, or product including the investments and/ or investment strategies recommended or undertaken by Strasbaugh Financial Advisory, Inc. are not guaranteed. See Disclaimer on Page 8 //
Winter 2017 Puzzle Edited by Dr. Regan Anderson
1. What type of index is used to assess the severity of sleep apnea?
4. At what age should you get screened for colorectal cancer?
2. Over the counter medication that is safe after a concussion is ______.
5. This sleeping position puts excessive pressure on your spine.
3. What is a predominant tree in Ute Valley Park?
8. What is the component of marijuana which causes you to get â&#x20AC;&#x153;highâ&#x20AC;??
6. You should not use soaps to cleanse your skin. Instead, please use a gentle _______.
11. What is the bone called that houses the teeth?
7. What can help minimize depression the first time engaging in it?
12. What should you use to gently apply a cleanser to the skin?
9. What is another name for the large intestine?
14. Stimulation of what nerve is the most effective interventional therapy for ABL?
10. What county has the most number of medical marijuana patients in the state?
16. Modern dental implants are made of ________.
12. What do dust mites use as a water source? 13. A minor concussion that can cause major injury while the brain is still healing is called _____ _____ syndrome. 14. What is the name of a neurotransmitter which helps elevate mood? 15. What is a common indoor allergen?
17. What type of rock can be seen throughout Ute Valley Park? 18. How do dentists refer to an appliance that cannot be removed at home? 19. What is one activity which can produce multiple health benefits? 21. What spinal chiropractic treatment is widely recognized as one of the safest, non-drug therapies for back pain?
16. What movement should be avoided while lifting?
22. Besides increased body health, what other part of the body can achieve improved health through dance?
20. What is the most common reason people may use marijuana for medical purposes?
23. Surgical specialist who performs nasal surgery are called _____.
See Disclaimer on Page 8 //
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