November 2014 Thrive

nc

November 2014

THRiVE » NORTHERN COLORADO WELLNESS

There are many options available — with more on the way — for getting vaccinated this season.

FIGHTING

THE FLU

Page 8.

» INSIDE: MAKE SMART MEDICARE DECISIONS • TEENS FACE STRESSES DAILY • HEALTH EVENTS

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Radiation treatment for early prostate cancer can take 8-9 weeks of appointments.

With high-dose rate brachytherapy, our experts can treat your cancer with pinpoint accuracy, reducing the treatment period to as little as 24 hours. It’s just another way we take care of our own. Talk to your radiation oncologist to find out if this treatment is right for you. For more information or to schedule your appointment, call (970) 350-6680 or visit BannerHealth.com/COCancer.

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NOVEMBER HEALTH EVENTS « Yoga basics classes, 4:30-5:30 p.m. Nov.

3-Dec. 15. Yoga Basics is an introduction to the foundational poses in a beginning yoga practice.

This class will focus on careful physical alignment for the creation of a safe practice. This class is best suited for those with no physical limitations.

NCMC offers yoga classes with Yoga Alliance Certified Teachers. Payment is due at time of registration. Refunds will not be processed once classes have begun. The cost is $48 for six weeks.

« Gentle Yoga, 4:30-5:30 p.m. Wednesdays, Nov.

5-Dec. 17, there will be no class Dec. 26. In Gentle Yoga, the postures are presented in an easy to follow, accessible manner with plenty of time for modifications and focus on breath work. An excellent class for seniors, those with chronic illness or injuries, those newer to yoga or students wanting a gentle practice. The cost is $48 for six weeks.

« Cooking classes, “Healthy Holiday Gifts,” 6-7:30

p.m., Nov. 4 at NCMC in the Cardiac Rehab Kitchen. Treat your family, friends, teachers and neighbors to healthy, homemade gifts this holiday season. We’ll make both sweet and savory gifts so you’ll find something for everyone on your list. Taught by Julie Gormley, R.D. Come and learn a variety of fun and healthy cooking options. These courses are taught by a registered dietitian and are a great way to modify your cooking habits and learn about heart healthy cooking. Recipes and samples are included! All classes are held at North Colorado Medical Center in the Cardiac Rehab Kitchen. The class is $10 per class. Payment due at the time of registration. If you are absent from the class, you will be charged the full amount. Please call (970) 350-6633 to register.

« Body Check... What you need to know: Head

to Toe, Nov. 4 and Nov. 18 at Summit View Medical Commons, 2001 70th Ave. This head-totoe health assessment gives you the tools to put your health first by receiving a comprehensive set of preventive health screenings. Invest in your health today! This screening includes: health fair panel (fasting blood work, please fast 10-12 hours), sleep questionnaire, lung function test, body composition, weight and body mass index, hip and waist measurements, health education with a Wellness Specialist, EKG with results read by a board-certified cardiologist, peripheral arterial disease screening includes: education about peripheral vascular disease, stroke, stroke

prevention and osteoporosis prevention, ankle brachial index, ultrasound of the carotid vessels, ultrasound of the aorta (above four screenings are read by a board–certified radiologist). Upon request: colorectal take-home kit costs, $10 and prostate specific blood antigen screening cost $30, body check with colorectal take-home kit costs $185, body check with PSA costs $205, body check with a colorectal take-home kit and PSA costs $210. All results are sent to your personal physician and to you. The cost is $175 and payment is due at time of service. Please call (970) 350-6070 to schedule an appointment.

Wellness services is not able to bill insurance.

« PAD Screening (Peripheral Vascular Disease),

1-3 p.m. Nov. 4 and Nov. 18, at Summit View Medical Commons. NCMC’s Peripheral Vascular Disease Screening program offers the education and prevention proven to be the best tools for fighting vascular disease and stroke. Patients receive: ankle brachial index: evaluation of leg circulation, carotid artery disease screening: ultrasound of the carotid vessels, abdominal aortic aneurysm screening: ultrasound of the aorta, lipid panel voucher, health education with a wellness specialist, health information packet. The cost is $100 for all four screenings and the payment is due at the time of service. NCMC Wellness Services is not able to bill insurance. Please call (970) 350-6070 to schedule an appointment.

« STAR, 5:30-7:30 p.m. Nov. 6, NCMC Cancer

Institute Conference Room. Come support, touch and reach breast cancer survivors (Breast Cancer Support Group). For further information, please contact Betty Parsons at (970) 339-7137.

« CPR for Health Care Providers (Recertifica-

tion), 3-5:30 p.m. Nov. 10 at NCMC in the Union Colony Room. This class is designed for licensed and non-licensed health care providers who need to re-certify through the American Heart Association. The certification is valid for two years. Please notify us one week in advance if you are unable to attend the class. Your registration will be refunded and there will be a $10 service charge. The cost for the class is $50. If you are absent from the class, you will be charged the full amount. Refunds will not be processed once classes have begun. To register, please call (970) 350-6633.

« Cardiac Education Classes, 3:45-5:30 p.m.

Nov. 10 and 8:45-10:30 a.m. Nov. 12, Cardiac

Rehab Classroom. All classes are free. This class, “give your meals a makeover” will feature the teachings of R.D. Mary Branom. Please call (970) 350-6204 to confirm class times and dates.

« Passport to Health: SPAIN, “Your Adventure

Against Diabetes: What You Can Do NOW,” 6:30 p.m. Nov. 11 in the NCMC auditorium. When it comes to diabetes, you have power! By making some simple changes, you can help prevent diabetes — or if you already have it, you can cut your risk of complications. Our clinical experts will present current information on the many steps you can take to manage your weight, lower diabetes risk and boost your overall health. For complete details visit www.bannerhealth.com/ NCMCspirit or call (970) 392-2222.

« Flu, Pneumonia, Whooping Cough and

Tetanus Clinics in Weld County, 7-8:45 a.m.

Nov. 12 at NCMC via east entrance. The flu can be costly to you and your family because it causes you to feel poorly, miss work or school and be at risk for further complications. Don’t get caught unprepared, make sure you and your family get vaccinated. There are a wide variety of options and locations in Weld County for your convenience. Costs: injectable flu vaccine for $25, nasal mist flu vaccine for $35, pneumonia vaccine for $90, Tdap — tetanus and pertussis (whooping cough) for $55. It’s important to note that Medicare billing is available for flu and pneumonia vaccines. Please bring your Medicare Part B card.

Supplemental insurance such as Humana are not accepted.

« CPR for Health Care Providers Skills Check,

by appointment, in the Wellness Conference Room. This class is designed for licensed and non-licensed health care providers who need to re-certify through the American Heart Association. The certification is valid for two years.

Renew your CPR certification by completing an online CPR module which includes watching a video, reviewing content and an exam. When the online module is complete and a Course Completion Certificate is printed, call Wellness Services to schedule a skills check. Please bring a copy of the Course Completion Certificate with you. The cost is $50 for CPR for health care providers includes skills check with a certified American Heart Association instructor. There is a separate $50 fee for online course, payable online. Payment due at the time of registration. If you are absent from the class, you will be charged the full amount. To

register, please call (970) 350-6633.

« Blood tests, 7-8:45 a.m. Nov. 12 and Nov. 26 at

NCMC via entrance No. 6 or Nov. 19 at Johnstown Family Physicians, 222 Johnstown Center Drive. Wellness Services offers low-cost blood screenings open to community members; some immunizations are also available upon request and availability. To schedule an appointment, call (970) 350-6633. Appointments preferred; please fast 12 hours prior to blood draw. The cost varies and payment is due at time of service.

NCMC Wellness Services will not bill insurance.

« CT heart score, 1-2 p.m., Monday-Friday, NCMC.

CT Heart Score provides a non-invasive test that accurately measures the amount of calcified plaque in the arteries. The procedure begins with a fast, painless computed tomography CT exam.

CT, more commonly known as CAT scanning, uses X-rays and multiple detectors to create interior images of the heart. The Heart Score program includes a 10-minute consultation with a Wellness Specialist, focusing on cardiac risk factor education, identification of non-modifiable and modifiable risks and lifestyle behavior change options. The cost is $199 and payment is due at time of service. NCMC Wellness Services is not able to bill insurance. To schedule an appointment call (970) 350-6070 to schedule an appointment.

« NCMC adult fitness, available to people in the community who are interested in starting an exercise program in a health care setting. The cost per month for an individual $45 or couple, living in the same household, $80. Please call (970) 350-6204 for information.

« Walk with a Doc, Nov. 15 on the west side of Sanborn Park, 2031 28th Ave. This is an international program where interested people meet at a park or public location (usually Saturday mornings) for an informal five-minute health talk and a 30-minute walk (at your own pace). Families are encouraged to attend. There are healthy snacks at the completion of the walk. Free blood pressure checks are available for those interested.

Upcoming walks are posted on the Walk with a Doc website at www.WalkwithaDoc.org.

« Pulmonary Rehabilitation, lung disease

management, education and exercise. Please contact (970) 350-6924 for information and opportunities.

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Expert: Teens face Just in case stresses every day you missed a day...

By Rebecca Wyperd For THRIVEnc

FOR THRIVENC

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skipping school and fighting with his teachers.

Here are some behaviors or events that could be cause for concern: » Change in eating or sleeping habits » Change in friends or activities » Change in mood or behavior like irritability, aggression with others » Change in grades, school performance, or attendance » Missing curfew, running away, or leaving without permission » Isolation from family or friends » Suspected substance use » Suicidal thoughts or mention of suicide » Self-harming behaviors such as cutting » History of any trauma or abuse » Recent family conflict » Recent loss of loved

one close to teen It is never easy being a teen, and it can be hard to watch one you care about struggle with challenges.

When your teenager’s behavior has changed in ways that cause you concern, it can be helpful to seek support for your family. Many counselors or therapists are well versed in helping parents and caregivers discuss teens’ behaviors and what’s “normal.” If your teen is unwilling to go to a counselor, sometimes it is a good idea to seek help for yourself, to learn positive and practical coping and communication strategies.

A good therapist will help you identify your family’s and teen’s strengths and build on those while addressing any concerns. A family who is armed with the right emotional and communication tools is a stronger and happier one.

The Flu Can Be Tough!

And old remedies don’t always work.

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It’s typical to worry when raising a teenager — but it’s important to remember that it’s more stressful being a teenager. Not making the cut for the football team, breaking up with a girlfriend, fighting with friends, bombing a test, moving to a new town, feeling one doesn’t belong or switching schools is stressful for many teenagers.

Because of this, it’s sometimes hard to know when resulting behaviors are typical and when you should seek help. How do you know if your teen’s behavior is “normal?”

First, it is important to note that “normal” is a misleading word. So much of what someone does depends on his or her environment, experiences, family history and beliefs.

What is familiar for one teen and family may not be familiar for the next; it is important to keep that in mind when evaluating how your teenager is responding to stress.

Consider what’s normal for your teen — and then determine whether and how much of a change you see in his or her behavior.

As a caregiver, you may notice that something has changed or seems drastically different: like a once talkative, outgoing teen who suddenly has nothing to say and is hiding out in her room — or a straight-A student who is caught

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October 29, 2014

GREELEY DOCTOR DISCUSSES TREATMENT OF KIDNEY STONES

By Jason Webb For THRIVEnc

S

tatistics from the National Kidney Foundation show that more than half a million Americans visit the emergency department each year because of problems associated with kidney stones. One Banner Health urologist says simple changes in diet can help reduce the risk.

Dr. Jay Paddack, from the Banner Health Clinic

specializing in urology, 5890 13th St. in Greeley, specializes in general urologic conditions and more complex issues men and women may face. Kidney stones are among the conditions he treats.

Paddack describes kidney stones as a solid piece of material formed by an excess of certain minerals in the urine, most commonly calcium.

Stones vary in size and composition and can form anywhere throughout the urinary tract.

“Certain factors can increase the likelihood of forming kidney stones,” Paddack said. “Those include low fluid intake, diet, obesity, age, gender, a personal or family history of stones.”

Additionally, Paddack said certain medications, including acetazolamide and indinavir, and certain medical problems, such as diabetes, Crohn’s disease and others, can increase the risk of kidney stones.

Anyone who has had previous intestinal surgery,

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like gastric bypass, is more susceptible, and any blockage of the urinary tract can lead to stone formation.

While kidney stones have typically affect-

accompanied by chills.

To test for kidney stones, doctors may request a urine sample to analyze and look for an infection. Tests might include a urinalysis and/

“

Testing for kidney stones is typically only done after one goes to the doctor’s office or emergency room with severe, fluctuating pain in the back that radiates to the abdomen and groin.

— DR. JAY PADDACK, Banner Health Clinic

ed men more than 30 years old, the incidence of women and younger people having stones is on the rise, Paddack said.

Diets high in salt, fat and protein and elevated obesity rates has raised the frequency of women and young people developing kidney stones, according to Paddack.

Diet change and an increase in fluid intake can help reduce the risk of developing stones. Paddack recommends people drink two to three liters of water every day, or enough to keep the urine light yellow to a clear shade.

“Testing for kidney stones is typically only done after one goes to the doctor’s office or emergency room with severe, fluctuating pain in the back that radiates to the abdomen and groin,” Paddack said. Additional symptoms may include bloody urine, nausea and vomiting, frequent urination that may be difficult and fever that may also be

or urine culture to look for infection. Blood tests can also identify serious infection and show how well the kidneys are working.

Doctors likely will order some form of imaging study to determine if and where kidney stones are present. The most effective option is a non-contrast computerized tomography scan, or CT scan, which can show the size and location of almost all stones. Other alternative imaging studies include X-rays and ultrasounds which may be less precise.

“Kidney stones can become problematic when they begin to pass through the urinary tract, causing severe pain, urine obstruction and sometimes infection,” Paddack said.

“Although most stones will pass through the urinary tract on their own, sometimes surgical procedures are necessary to remove them.”

Doctors have three primary surgical options

to treat kidney stones. The first is called shockwave lithotripsy, which uses sound waves focused on the stone to break it into small, easily passable fragments.

A second option, called ureteroscopy, uses a small scope inserted into the ureter through the urethra and bladder to visualize the stone. It can then be broken into pieces with a laser and grasped with small instruments.

For large stones in the kidney, doctors may use the third option, percutaneous nephrolithotomy.

With this procedure, the doctor makes a small incision in the back and inserts a scope directly into the kidney. The stone can then be broken up and removed with special instruments.

Additionally, urologists may prescribe medications to minimize stone formation. “These medications alter the levels of certain substances commonly associated with stones that are present in the urine,” Paddack said.

Fortunately, Paddack said not all stones need to be treated. Stones which remain stable in size can just be observed. This can delay the use of surgical procedures until they become large enough to cause problems.

Jason Webb is a public relations specialist for Banner Health.

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THINKING ABOUT HEALTH

GENERIC DRUG FIELD IS FULL OF PRICING TRAPS

By Trudy Lieberman Rural Health News Service

A friend of mine, a diabetic, stumbled on to another booby trap in the pricing of generic drugs. Insurers are pushing a twotiered pricing system on patients. You can choose a non-preferred generic and pay more, maybe a lot more, or a preferred generic and get a price break. That’s the same pricing scheme insurers use for the expensive brand-name drugs.

Consumer groups, doctors, and insurance carriers have encouraged patients to choose generics over the name brands as a way to help lower the nation’s healthcare tab. So for many years my friend has been using a generic drug called gemfibrozil that diabetics often take to lower triglycerides and cholesterol.

It has worked for him.

No nasty drug interactions. No nasty side effects. And the price has been low — $2.71 for 60 pills. In August the price more than doubled to $6.14. He was still OK

» Speak out Rural Health News Service wants to hear your questions and comments about your health care experiences. Tell us about your experiences with generic drugs. Write to Trudy at trudy.lieberman@ gmail.com.

with that.

He was not OK when he got a bill in September from Express Scripts, the pharmacy benefit manager for his Medigap carrier whose plan is offered by his former employer, the City of New York. (PBMs, as they’re called, manage the drug benefits for employers and insurers and supposedly help hold the line on prices.)

Express Scripts wrote his doctor without consulting my friend, the patient, suggesting that for reasons of “safety and efficacy,” he should switch his patient to a different drug, a generic called fenofibric acid. His share of the cost would now be $156.70 for 90 pills. Fenofibric acid costs $1.74 per pill compared to gemfibrozil’s 10 cents a pill resulting in an outof-pocket cost increase of 1,640 percent.

Why the switch? my

friend asked his doctor.

The doctor pointed to the reasons given in the letter about an increased risk of skeletal muscle effects and said maybe it was advisable to try the new drug. He was, however, astounded by the price, but my friend said it was clear the doctor wasn’t going to fight the PBM. My friend spoke to an official at New York City’s employee benefits office who said her office has never heard of a PBM recommending that a more expensive generic drug replace a cheaper one.

I rang up John Rother, former chief lobbyist for AARP and now head of a group called the National Coalition on Health Care.

The Coalition is waging a campaign to educate the public about the exorbitant prices of drugs, particularly the Hepatitis C drug Sovaldi and other specialty drugs in the

pipeline that will carry super high price tags.

“Generic drug prices have been rising steeply, and there doesn’t seem to be an explanation for it,” Rother told me. He said he could only guess that some generic drug makers are leaving the market and the ones remaining will have less competition and the power to increase market share and raise prices.

Maybe there are medical reasons my friend should make the switch, but so far his doctor hasn’t been persuasive.

Has the PBM discovered new side effects for the drug he’s been taking?

Who’s treating the patient — the doctor or the PBM? And how does this big price jump fit in with the PBM’s purported mission: to save money for insurers and employers? Was my friend caught in a tussle between the clinician and the bean counters? How does he know who’s right without doing extensive research himself?

Since individuals can’t negotiate prices with drug companies, and Congress

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has prohibited Medicare from negotiating prices when it passed the prescription drug benefit law in 2003, my friend says, “companies have carte blanche to rip people off.

In situations like this no one ever talks straight, but someone is making a lot more money.” He’s trying to get back on gemfibrozil or a similar generic that’s cheaper than the one the PBM suggested.

Rother looks at the big picture now coming into focus from the sharply rising prices of gener-

ics. “Four years after we passed what we thought was universal health coverage, you can’t get the medicines you need because of the prices. It’s tragic,” he says.

The Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed through the Nebraska Press Association Foundation, the Colorado Press Association, the South Dakota Newspaper Association and the Hoosier (Indiana) State Press Association.

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October 29, 2014

FIGHTING THE F I

By CASEY KELLY ckelly@greeleytribune.com

f you haven’t received your flu shot yet this season, there are myriad options for getting vaccinated against the contagious disease, with even more options on the way soon.

Flu season generally begins in the fall and carries through to March or April, and the best time to receive your flu shot is early in the fall, according to Marilyn Sykes-Johnson, Banner Health’s coordinator for its flu shot program.

“Early November is a good time to get the flu shot,” she said. “During the holidays, many people travel and are seeing family from other areas, so it’s a good idea to get vaccinated before then.”

If someone doesn’t get vaccinated before the holidays, she said, it’s still a good idea to be vaccinated at any point during the flu season because it can reduce the likelihood of catching the flu or, reduce its severity if it is contracted.

People can choose between a trivalent vaccine, which covers three » Want to get flu viruses, vaccinated? or a quadri- North Colorado Medical Center, 1801 16th St., valent vacwill host a clinic from cine, which 7-8:45 a.m. Nov. 12 at covers four. the east entrance of the For those building. who don’t Cost: like nee» Injectible Flu vaccine: $25 dles, many » Nasal mist flu vachospitals cine: $35 and clinics » Pneumonia vaccine: also offer a $90 nasal spray, » Tdap: Tetanus and a trivalent pertussis (whooping higher-dose cough): $55 vaccine, that Sykes-Johnson said is recommended for people over age 65 who may need the extra coverage provided by the higher dose.

“The flu shot is very safe,” she said. “It’s not giving you the flu but it is commanding a response from

» Good health habits to help prevent the flu » Avoid close contact. » Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick, too. » Stay home when you are sick. » If possible, stay home from work, school and errands when you are sick.

You will help prevent others from catching your illness. » Cover your mouth and nose. » Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. » Clean your hands. » Washing your hands with soap and hot water or alcohol hand gel (containing at least 60-percent alcohol) often will help protect you from germs. » Avoid touching your eyes, nose or mouth. » Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose or mouth.

Source: Centers for Disease Control and Prevention

your immune system.”

She said its side effects depend on the vaccinated person’s health, but generally aren’t more severe than slight soreness or inflammation at the site of the vaccination.

North Colorado Medical Center spokesman Gene Haffner said

REGISTERED NURSE LINDA MILLER gives a flu shot to patient during month.

» How to tell If you have the flu

» You will have a sudden headache and dry cough. » You might have a runny nose and a sore throat. » Your muscles will ache. » You will be extremely tired. » You can have a fever of up to 104 degrees. » You most likely will feel better in a couple of days, but the fatigue and cough can la for two weeks or longer.

Source: Centers for Disease Control and Pre

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There are many options available — with more on the way — for getting vaccinated this season » Who should get vaccinated? » Anyone 65 years and older. » People who live in nursing homes and other long-term care facilities. » Women who will be pregnant during the influenza season. » All children 6 to 23 months of age. » Adults and children 6 months and older with chronic heart or lung conditions, including asthma. » Adults and children 6 months and older who needed regular medical care or were in a hospital during the previous year because of: • a metabolic disease (like diabetes).

• chronic kidney disease.

• weakened immune system (including immune system problems caused by medicines or by infection with human immunodeficiency virus (HIV/AIDS). » Children 6 months to 18 years of age who are on long-term aspirin therapy. » People with respiratory problems. » People 50 to 64 years of age. Nearly one-third of people in this age group have medical conditions that place them at increased risk for serious flu complications. » Anyone in close contact with someone in a high-risk group, including all health-care workers, adult and child caregivers.

» Who should not be vaccinated JOSHUA POLSON/jpolson@greeleytribune.com

g a visit to the Evans Recreation Center last

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in addition to the flu shot, people should also consider getting vaccinated against pertussis, also known as whooping cough, because of how many cases have been seen recently in northern Colorado. He said older people should also consider getting a pneumonia vaccine, as they can be more prone to upper-respiratory infections.

There are some people who should not be vaccinated without first consulting a physician. These include: » People who have a severe allergy to chicken eggs. » People who have had a severe reaction to an influenza vaccination in the past. » People who developed syndrome within six weeks of getting a previous influenza vaccine. » Influenza vaccine is not approved for use in children less than 6 months of age. » People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

Source: Centers for Disease Control and Prevention

» New vaccination option on the horizon Golden-based company PharmaJet the vaccine that is able to pierce the has developed a new delivery system skin and get to the depth it needs to. for the flu vaccine that should sound The syringe is ejected and a new tip is appealing to those who want the pro- put on there for the next vaccine.”

Jaskowiak led a 1,250-person study tection without the prick.

The new needleless device to de- on the efficacy of the new device beliver the flu vaccine gained Food and tween October 2012 and January 2013 Drug Administration approval in late at University of Colorado Health’s August this year and should be widely northern Colorado locations. The available for use in next year’s flu sea- study found the new device is at least son, according to Adam Jaskowiak, as effective as traditional vaccines and director of the research department at found local site reactions, like inflamMedical Center of the Rockies.

“Due to the timing of the flu season it isn’t widely available this year, but production is ramping up for next year,” Jaskowiak said.

The device shoots a precise stream of the vaccine straight through the skin without the FOR THRIVENC/PharmaJet use of a needle, THE U.S. FOOD AND Drug Administration which Jaskowiak recently approved the first needle-free flu vaccine said is useful be- delivery system, the PharmaJet Stratis 0.5 mL cause there aren’t Needle-Free Jet Injector, which delivers the vacany sharp objects cine by means of a narrow fluid stream that peneto dispose of and trates the skin in about one-tenth of a second. people with aversions to needles might find the idea of mation, to be comparable between the two methods. a needle-free vaccine more appealing.

“I think this kind of highlights that “It’s a round cylinder, about six inches long and an inch-and-a-half in di- we’re trying to give patients access to ameter. On the end of it is a disposable the latest technological advancements syringe that holds the vaccine,” Jasko- to provide better care in the region,” wiak said. “There aren’t any sharps, Jaskowiak said. “This is one example just small holes. It makes a fine jet of of that.”

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October 29, 2014

RX FOR EXIT: RESEARCH SHOWS PHYSICIAN BURNOUT IS ON THE RISE

By Barbara Sadick Chicago Tribune

The state of our health care system depends, in part, on the state of our health care providers. But research over the last few years has shown that physician burnout is on the rise.

Mark Linzer, director of the division of general internal medicine at Hennepin County Medical Center in Minneapolis, has been studying physician burnout since 1996. Burnout, he says, is a long-term stress reaction that includes emotional exhaustion, a sense of depersonalization, and a lack of a sense of personal accomplishment.

Linzer says burnout occurs in all medical specialties but is highest in physicians who practice on the front lines of medicine.

That includes those in emergency medicine and primary care.

“Burned-out doctors,” he says, “are more likely than other doctors to leave medicine.”

“When doctors become discouraged and leave medicine,” says Doris Gundersen, medical director of the Colorado Physician Health Program, “the problem of the current shortage of physicians is exacerbated.”

With 10,000 baby boomers turning 65 and becoming eligible for Medicare every day, and millions of new patients becoming insured through the Affordable Care Act, access to doctors is becoming increasingly difficult.

Every time a doctor leaves medicine, says Linzer, an interruption in continuity of care is created, and a cost of $250,000 is incurred to replace that physician.

Surveys by the AMA and the RAND Corp., the Mayo Clinic,

TRIBUNE NEWS SERVICE

RESEARCH OVER THE LAST few years has shown that physician burnout is on the rise. the University of Rochester Medical Center, and Stanford University School of Medicine show that the hours and demands of the work, the requirements to interact regularly with insurance companies, the increase in clerical duties, inefficient electronic medical records, a loss of a sense of autonomy, and difficulty maintaining a work-life balance all contribute to the problem.

“Burnout,” says Linzer, “results primarily from challenges within the system.”

When asked in separate studies by the Mayo Clinic and a RAND Corp./AMA collaboration what makes them satisfied in their work, physicians stressed the importance of a sense of autonomy that allows them to

make the best decisions for their patients. As pressure mounts to treat patients quickly, and oversight by the government and insurance companies increases, these decisions can become compromised.

Physician surveys show that doctors report frustration with the pressures of daily practice that make it difficult to establish relationships with patients.

Gundersen says doctors regularly spend hours dealing with insurance companies trying to get treatment approval and dealing with insurance denials and appeals of claims.

The amount of documentation required by insurers and government agencies takes up more staff time and requires too

much physician involvement to resolve complicated billing and recordkeeping issues. Meeting required rules and regulations interferes with the time physicians can spend with patients.

While doctors overwhelmingly say in these ongoing surveys that they appreciate the theoretical usefulness of electronic records, those in use haven’t been properly streamlined. Current systems, says Russell Phillips, director of the Center for Primary Care at Harvard Medical School, are not well-designed for the field and interfere with the face-to-face doctor-patient experience. “Electronic records are burdensome and have made physicians into data entry clerks,” Phillips says.

Surveys also find that physi-

cians cite respect by colleagues, patients and payers as being important to them. But as practices get bigger and workloads get heavier, many are feeling isolated and report a lack of support by the doctors and administrators they work with.

Colin West, a general internist and a lead researcher of physician well-being at the Mayo Clinic, says physician burnout is common and growing. “It’s not the exception,” he says, “but the rule, and the stigma of being burned out has to be eliminated so that we can move forward and create strategies to deal with it.”

On the cutting edge of research into physician burnout, the Mayo Clinic has done surveys and studies and is expected to come out with programs designed to promote physician satisfaction and well-being.

“We need to focus on the entire health care system, because we are all in this together,” says West, adding that first and foremost physicians need to be reminded about the importance and value of what they do.

At the University of Rochester Medical Center, Drs. Michael Krasner and Ronald Epstein have been researching burnout for years. They believe the cure lies in healthy encounters and relationships between health care workers, colleagues and patients. To engage effectively with patients, says Epstein, one has to be present and attentive, and with that in mind, workshops to promote mindfulness meditation and interpersonal communication are offered and have been found to reduce stress, burnout and enhance physician resilience Turn to Burnout on P.11

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MAKE SMART MEDICARE DECISIONS FOR 2015

By Ron Pollack Families USA

As we head into autumn, people with Medicare once again need to consider their options for next year. Even if you like the coverage you have now, you should spend at least a few minutes making sure it will still meet your needs next year. Here are some key questions that people with Medicare should ask.

al Notice of Change (ANOC) and/or an Evidence of Coverage (EOC) notice in September. These notices highlight any changes in the plan’s costs, benefits and rules for the upcoming year. Use these resources to find out whether your plan will cover the same services, drugs, doctors, hospitals, and pharmacies.

Are premiums changing? What about copayments?

Once you know what your current plan will cover next year, you can start making comparisons. To compare your current plan to other plans, go to www.medicare.gov/find-a-plan.

WHEN IS THE ENROLLMENT PERIOD?

Medicare’s open enrollment period runs, as usual until Dec. 7. During this time, you can make changes in your Part D prescription drug plan or Medicare Advantage plan, or, if you don’t have one, you can select one for the first time.

HOW IS THIS DIFFERENT FROM THE OPEN ENROLLMENT PERIOD FOR THE HEALTH INSURANCE MARKETPLACES?

If you have Medicare, the health insurance marketplace is not for you. Medicare coverage and its open enrollment period are completely different from those of the health insurance marketplaces (which are also known as exchanges).

The health insurance marketplace offers coverage and financial assistance for people who do not qualify for Medicare — usually, people under age 65 who do not have permanent disabilities. The marketplace open enrollment period starts and ends later than Medicare’s. But if you have friends or loved ones who need coverage and do not qualify for Medicare, encourage them to check out www. healthcare.gov.

WHAT ARE MY OPTIONS?

During Medicare open enrollment, if you have a Part D prescription drug plan or Medicare Advantage plan, you can change it. You can also join a Part D or Medicare Advantage plan for the first time.

If you currently have original Medicare and a supplemental plan (either a private Medigap plan or a plan with a former employer), be very careful before dropping your supplemental plan. You may not be able to get that plan back later.

HOW SHOULD I PREPARE FOR OPEN ENROLLMENT?

If you have a Part D or Medicare Advantage plan, find out how your plan will be changing for 2015.

Your current plan should have mailed you an Annu-

IF I LIKE MY CURRENT PLAN, DO I NEED TO DO ANYTHING?

Even if you like your current Part D or Medicare Advantage plan, it could still be changing next year.

You should always check to see what your plan will be covering next year and make sure it still fits your needs.

WHAT IF SOMEONE TELLS ME I MUST BUY A PARTICULAR PLAN?

You should never believe any high-pressure sales pitch for a Medicare plan.

Private plans do sometimes decide to drop out of Medicare or change their coverage significantly. If this happens to your plan, take your time to learn about your options and make an informed choice.

You will never be left without coverage — you will always have the option of taking original Medicare.

Burnout from P.10

and are now being taught all over the world.

The Stanford Committee on Professional Satisfaction and Support, co-chaired by Bryan Bohman, an internist and anesthesiologist, says physicians must learn how to take care of themselves.

“Medicine,” he says, “used to revolve around the doctor, but that has changed, and now patients are better educated, more knowledgeable, and unafraid to ask questions.” At the same time, he adds, physicians are being constantly evaluated, scrutinized and pressured.

To take on the battle and explosion of complexity, Stanford is addressing wellness, work-life balance, satisfaction and support across its entire medical culture. Stanford’s satisfaction and wellness pro-

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peer support program has been set up to help the house staff when bad patient outcomes or other critical negative incidents occur.

“In each department,” says Bohman, “the chief resident will be trained to conduct oneon-one conversations to listen and guide their colleagues through the coping process and make suggestions on how residents should take care of themselves during stressful times.”

Other initiatives are also in place at Stanford, and research continues. Bohman says the medical center is hoping to build a center devoted to physician wellness.

“We are completely aware,” he says, “that one of the greatest obstacles to improving patient care is burnout by doctors who practice on the front lines of medicine.”

At Harvard’s Center for Primary Care, another model is

In each department, the chief resident will be trained to conduct one-on-one conversations to listen and guide their colleagues through the coping process and make suggestions on how residents should take care of themselves during stressful times.

— BRYAN BOHMAN, internist and anesthesiologist

HOW CAN I GET MORE INFORMATION?

You can get a lot of information about your options on the Medicare website, www.medicare.gov, or by calling 1-800-MEDICARE. But the best way to get personalized help is to get individual counseling from your local State Health Insurance Assistance Program (SHIP). Every state has a program, and they offer free, unbiased advice.

You can call 1-800-MEDICARE and ask for a referral, or go to www.medicare.gov and click on “Find someone to talk to.”

WHAT IF I NEED FINANCIAL HELP?

If you have limited income and resources, additional financial help is available. For more information, go to the Social Security website www.ssa.gov/ prescriptionhelp , or call 1-800-MEDICARE and ask for a referral to your local SHIP. Ron Pollack is the executive director of Families USA.

grams are geared to medical students, house staff (interns, residents and fellows), and medical staff (attending physicians) and are working at building adequate networks of support not just to prevent their physicians from burning out, but also to promote a high level of professional fulfillment.

Programs at Stanford include student counseling and mentoring. For residents, a 24-hour hotline is available for mental health consultation, and several departments have implemented their own wellness programs to help build resiliency. A resident

at work. About 20 percent of primary care physicians in the university’s hospitals and clinics are now working in teams that include nurses, community health workers, social workers, pharmacists and other professionals who can lend support. Primary care physicians have found that this prevents the burden from falling to just one person, and Phillips says morale has benefited enormously.

As programs to maximize physician well-being are implemented, patients will also be able to feel more confident that they, too, are getting the best care available.

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TRiBUNE MEDiCAL DiRECTORY ACUPUNCTURE

PHYLLIS HAMAR, L.A.C.

Master of Science, Traditional Chinese Medicine NCCAOM Board Certified 710 11th Ave., Ste. 106 Greeley, CO 80631 970-539-0324

WESTLAKE FAMILY PHYSICIANS, PC 5623 W. 19th Street Greeley, CO Phone: (970) 353-9011 Fax: (970) 353-9135 Professionals: Richard Budensiek, DO; Janis McCall, MD; Frank Morgan, MD; Jacqueline Bearden, MD; Angela Mill, MD Website: www.bannerhealth.com

ALLERGY AND ASTHMA

COLORADO ALERGY & ASTHMA CENTERS, P.C. 7251 W. 20th Street, Bldg N, Ste 1 Greeley, CO 80634 Phone: (970) 356-3907

1136 E. Stuart St, Bldg 3, Ste 3200 Ft. Collins, CO 80525 Phone: (970) 221-1681 4700 E. Bromley Ln., Ste 207 Brighton, CO 80601 Phone: (303) 654-1234 www.coloradoallergy.com Professionals: Dr. Daniel Laszlo Dr. John James

NORTHERN COLORADO ALLERGY & ASTHMA

Greeley Phone: (970) 330-5391 Loveland Phone: (970) 663-0144 Ft. Collins Phone: (970) 221-2370 www.NCAAC.com Professionals: Dr. Vel Kailasam, MD Krishna C. Murthy, MD Loran Clement, MD Michael Martucci, MD

ALZHEIMER’S/SKILLED CARE

BONELL GOOD SAMARITAN 708 22nd Street Greeley, CO 80631 Phone: (970)352-6082 Fax: (970)356-7970 Web Site: www.good-sam.com

GRACE POINTE

1919 68th Avenue Greeley, CO 80634 Phone: (970) 304-1919 www.gracepointegreeley.com

MEADOWVIEW OF GREELEY

5300 29th Street Greeley, CO 80634 Phone: (970)353-6800 Web Site: www.meadowviewofgreeley.com

ASSISTED LIVING

BONELL GOOD SAMARITAN 708 22nd Street Greeley, CO 80631 Phone: (970) 352-6082 Fax: (970) 356-7970 www.good-sam.com

COLUMBINE COMMONS

BALANCE

LIFE CARE CENTER OF GREELEY- ASCENT 4800 25th Street Greeley, CO 80634 Phone: (970)330-6400 Professionals: Cozette Seaver, PT; Leslie Vail, PT

CARDIAC VASCULAR SURGERY

1475 Main Street Windsor, CO 80550 Phone: (970) 449-5540 Web Site: www.columbinehealth.com

GRACE POINTE

1919 68th Avenue Greeley, CO 80634 Phone: (970) 304-1919 www.gracepointegreeley.com

HEART FAILURE CLINIC (NCMC) DENTISTRY

5300 29th Street Greeley, CO 80634 Phone: (970)353-6800 Web Site: www.meadowviewofgreeley.com

ASCENT FAMILY DENTAL Scott Williams, DMD 3535 W. 12th Street, Suite B Greeley, CO 80634 Phone: (970)351-6095 www.dentalgreeley.com

THE BRIDGE ASSISTED LIVING 4750 25th Street Greeley, CO 80634 Phone: (970)339-0022

JULIE KAVANAUGH, D.D.S.

AUDIOLOGY 1124 E. Elizabeth Street, #E-101 Fort Collins, CO 80524 Phone: (970)221-3372 Fax: (970)493-9237 3820 N. Grant Avenue Loveland, CO 80538 Phone: (970)461-0225 Fax: (970)593-0670 Web Site: www.allabouthearing.com Professionals: Renita Boesiger, M. A., CCC-A Rachel White, M. A., CCC-A Cheryl Hadlock, M. S., CCC-A

AUDIOLOGY ASSOCIATES

2528 16th Street Greeley, CO Phone: (970)352-2881 Professionals: Robert M. Traynor, Ed. D. F-AAA; Karen Swope, M. A. CCC-A

MIRACLE-EAR

2404 17th Street Greeley, CO 80634 Phone: (970)351-6620 749 S. Lemay Avenue, Suite A1 Fort Collins, CO 80524 (970)221-5225

UNC AUDIOLOGY CLINIC

Gunter Hall, Room 0330 Greeley, CO 80639 Phone: (970)351-2012/TTY Fax: (970)351-1601 Web Site: www.unco.edu/NHS/asls/clinic.htm Professionals: Diane Erdbruegger, Au.D., CCC-A; Erinn Jimmerson, M.A., CCC-A Jennifer Weber, Au.D., CCC-A

1800 15th Street, #310 Greeley, CO 80631 Phone: (970) 392-0900 Professionals: James H. Beckmann, MD; Harold L. Chapel, MD; John Drury, MD; Lin-Wang Dong, MD; Cynthia L. Gryboski, MD; Cecilia Hirsch, MD; Paul G. Hurst, MD; Brian Lyle, MD; Randall C. Marsh, MD; Arnold Pfahnl, MD; James E. Quillen, MD; Gary A. Rath, MD; Shane Rowan, MD; Ahmad Shihabi, MD; Stephen Zumbrun, MD (970) 350-6953 Missy Jensen, FNP-C

MEADOWVIEW OF GREELEY

ALPINE ALL ABOUT HEARING

CARDIOVASCULAR INSTITUTE (NCMC)

CARDIAC, THORACIC & VASCULAR SURGERY (NCMC) 1800 15th Street, Suite 340 Greeley, CO 80631 Phone: (970)378-4593 Fax: (970)378-4391 Professionals: Lyons, Maurice I. Jr. DO Richards, Kenneth M. MD Tullis, Gene E. MD

CARDIOLOGY

3400 W. 16th Street, Suite 8-E Greeley, CO 80634 Phone: (970)351-0400 www.drjuliekav.com

RALPH R. REYNOLDS, D.M.D., M.D. Oral Surgery 7251 W. 20th St. Building H, Suite 2 Greeley, CO 80634 (970) 663-6878 www.reynoldsoralfacial.com

ENDOCRINOLOGY

ENDOCRINOLOGY CLINIC (NCMC) 1801 15th Street, Ste 200 Greeley, CO 80631 Phone: (970)378-4676 Fax: (970)-378-4315 www.bannerhealth.com Professionals: Nirmala Kumar, MD Kimberly Rieniets, MD Corinn Sadler, MD

FAMILY PRACTICE MEDICINE

BANNER HEALTH CLINIC 1300 Main Street Windsor, CO 80550 Phone: 970-686-5646 Fax: 970-686-5118 Providers: Jonathan Kary, M.D. Trina Kessinger, M.D. Anthony Doft, M.D.

BANNER HEALTH CLINIC

100 S. Cherry Ave., Suite 1 Eaton, CO 80615 Phone: (970)454-3838 Professionals: Marianne Lyons, DO Lance Barker, DO, Internal Medicine

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2014 BANNER HEALTH CLINIC

222 Johnstown Center Drive Johnstown, CO 80534 Phone: (970)587-4974 Professionals: Cara Brown, MD J.Matthew Brown, MD Joseph Gregory, MD Courtney Isley, MD Stephen Kalt, MD, Internal Medicine Thomas Kenigsberg, MD

FAMILY PHYSICIANS OF GREELEY, LLP-CENTRAL 2520 W. 16th Street Greeley, CO 80634 (970) 356-2520 Fax: (970) 356-6928 Professionals: Joanna H. Branum, M.D. Angela M. Eussen, PA-C Jennifer D. Dawson , D.O. Douglas A. Magnuson, M.D. Paul D. Lobitz, M.D. Lori A. Ripley, M.D. D.Craig Wilson, M.D.

FAMILY PHYSICIANS OF GREELEY, LLP-COTTONWOOD 2420 W 16th Street Greeley, CO 80634 (970) 353-7668 Fax:970-353-2801 Professionals: Stacey L. Garber, M.D. Amy E. Mattox, M.D. Christopher T. Kennedy, M.D. Daniel P. Pflieger, M.D. Mark D. Young, M.D.

FAMILY PHYSICIANS OF GREELEY, LLP-WEST 6801 W. 20th St., Suite 101 Greeley, CO 80634 (970) 378-8000 Fax: (970) 378-8088 Professionals: Nathan E. Bedosky, PA-C Ann T. Colgan, M.D. Daniel R. Clang, D.O. Tamara S. Clang, D.O. R. Scott Haskins, M.D. Mathew L. Martinez, M.D. Chima C. Nwizu, M.D Michelle K. Paczosa, D.O. Andrew P. Stoddard, M.D. Kyle B. Waugh, M.D. Charles I. Zucker, M.D.

KENNETH M. OLDS

6801 W. 20th Street, Suite 208 Greeley ,CO 80634 Phone: (970)330-9061

WESTLAKE FAMILY PHYSICIANS, PC 5623 W. 19th Street, Greeley, CO Phone: (970) 353-9011 Fax: (970) 353-9135 Professionals: Richard Budensiek, D.O.; Jacqueline Bearden, MD; Tong Jing, MD; Janis McCall, MD; Frank Morgan, MD; David Puls, D.O. www.bannerhealth.com

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TRiBUNE MEDiCAL DiRECTORY DiRECTORY TRiBUNE MEDiCAL FUNERAL SERVICES

ALLNUTT & RESTHAVEN FUNERAL SERVICES

702 13th Street, Greeley, CO Phone: (970) 352-3366 650 W. Drake Road, Ft. Collins, CO Phone: (970) 482-3208 8426 S. College Avenue, Ft. Collins, CO Phone: (970) 667-0202 2100 N. Lincoln, Loveland, CO Phone: (970) 667-1121 1302 Graves Avenue, Estes Park, CO Phone: (970) 586-3101

GASTROENTEROLOGY

HEALTH AND FITNESS

INDEPENDENT ASSISTED LIVING W/SERVICES

MENTAL HEALTH SERVICES

WORK OUT WEST

2010 2014 NEPHROLOGY

GREELEY MEDICAL CLINIC

Health & Recreation Campus 5701 W. 20th Street, Greeley, CO 80634 Phone: 970-330-9691 www.workoutwest.com

1900 16th Street, Greeley, CO 80631 Phone: (970) 350-2438 Professionals: Donal Rademacher, MD

NEUROLOGY

HOME HEALTH CARE

CARING HEARTS HOME HEALTHCARE 6801 W. 20th Street, Suite 207 Greeley, CO 80634 Phone: (970)378-1409

BLOOM AT HOME

1455 Main Street Windsor, CO 80550 Phone: (970) 460-9200 Web Site: www.columbinehealth.com/bloom

COLUMBINE POUDRE HOME CARE 1455 Main Street Windsor, CO 80550 Phone: (970) 460-9200 Web Site: www.columbinehealth.com

REHABILITATION AND VISITING NURSE ASSOCIATION 2105 Clubhouse Drive Greeley, CO 80634 Phone: (970) 330-5655 Fax: (970) 330-7146 Web Site: www.rvna.info Professionals: Crystal Day, CEO

HOSPICE

HOSPICE OF NORTHERN COLORADO

DOWGIN, THOMAS A., MD. CENTERS FOR GASTROENTEROLOGY 7251 W. 20th St., Bldg J, Greeley, CO Phone: (970)207-9773 3702 Timberline, Ft. Collins, CO Phone: (970)207-9773 2555 E. 13th Street, Suite 220, Loveland, CO Phone: (970)669-5432 Website: www.digestive-health.net

NORTH COLORADO GASTROENTEROLOGY (NCMC) 2010 16th Street, Ste. A Greeley, CO 80631 Phone: (970)378-4475 Fax: (970)378-4429 Professionals: Tong Jing, MD Mark Rosenblatt, MD Ahmed M. Sherif, MD Yazan Abu Qwaider, MD

Administration Office 2726 W. 11th Street Road Greeley, CO 80634 Phone: (970)352-8487 Fax: (970)475-0037

PATHWAYS HOSPICE

305 Carpenter Road Ft. Collins, CO 80550 Phone: (970)663-3500 Fax: (970)292-1085 Web Site: www.pathways-care.org Email: info@pathways-care.org

INDEPENDENT ASSISTED LIVING

GRACE POINTE

1919 68th Avenue Greeley, CO 80634 Phone: (970) 304-1919 Website: www.gracepointegreeley.com

MEADOWVIEW OF GREELEY

5300 29th Street Greeley, CO 80634 Phone: (970)353-6800 Website: www.meadowviewofgreeley.com

BONELL GOOD SAMARITAN 708 22nd Street Greeley, CO 80631 Phone: (970)352-6082 Fax: (970)356-7970 Web Site: www.good-sam.com

FOX RUN SENIOR LIVING 1720 60th Avenue Greeley, CO 80634 Phone: (970)353-7773 Fax: (970)330-9708 Web Site: www.good-sam.com

INFECTIOUS DISEASE

BREEN, JOHN F., MD (NCMC) 1801 16th Street Greeley, CO 80631 Phone: (970)350-6071 Fax: (970)350-6702

INTERNAL MEDICINE

BANNER HEALTH CLINIC 2010 16th Street Greeley, CO 80631 Phone: (970)350-5660 www.bannerhealth.com Professionals: Danielle Doro, MD Giovanna Garcia, MD

MEDICAL EQUIPMENT & SUPPLIES

BANNER HOME MEDICAL EQUIPMENT (NCMC) Phone: (970)506-6420

COLUMBINE MEDICAL EQUIPMENT 1455 Main Street Windsor, CO 80550 (970) 460-9205 Web Site: www.columbinehealth.com

NCMC - BEHAVIORAL HEALTH

Dr Patricia Al-Adsani, Child and Adolescent Psychiatry Banner Health Clinic-Internal Medicine 2010 16th Street, Suite C, Greeley, CO 80631 Banner Health Clinic- Windsor 1300 Main Street, Windsor, CO 80550 Shawn Crawford, LPC Banner Health Clinic 222 Johnstown Center Dr., Johnstown, CO 80534 Banner Health Clinic-Internal Medicine 2010 16th Street, Suite C Greeley, CO 80631 Stephanie Carroll, LCSW, CACIII Banner Health Clinic 1300 Main Street, Windsor, CO 80550 Banner Health Clinic Fossil Creek 303 Colland Dr Fort Collins, CO 80525 Elise Pugh, LPC Banner Health Clinic Westlake 5623 W 19th St, Greeley CO 80631 Banner Health Clinic 1300 Main Street Windsor, CO 80550 Susan Goodrich, LCSW Banner Health Clinic-Loveland Pediatrics Loveland Pediatrics, Loveland CO Banner Health Clinic- Windsor 1300 Main Street Windsor CO, 80550 Renee Rogers, LMFT Banner Health Clinic 1300 Main Street, Windsor, CO 80550 Banner Health Clinic 303 Colland Drive, Fossil Creek Fort Collins, CO 80525

CENTENNIAL NEUROLOGY Dr. David Ewing 7251 W. 20th Street, Unit C Greeley, CO 80634 Phone: (970) 356-3876

NEUROLOGY CLINIC (NCMC) 1800 15th Street, Suite 100B Greeley, CO 80631 Phone: (970) 350-5612 Fax: (970) 350-5619 Professionals: Barbara Hager, MD Todd Hayes, DO William Shaffer, MD Christy Young, MD

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TRiBUNE MEDiCAL DiRECTORY NEURO-SURGERY BRAIN & SPINE

BANNER HEALTH NEUROSURGERY CLINIC 1800 15th St., Suite 130 Greeley, CO 80631 Phone: (970)350-5996 Professionals: David Blatt, MD Beth Gibbons, MD

NURSING HOME REHABILITATION

CENTENNIAL HEALTH CARE CENTER 1637 29th Ave. Place Greeley, CO 80634 Phone: (970) 356-8181 Fax: (970) 356-3278

COLUMBINE COMMONS HEALTH & REHAB FACILITY 1475 Main Street Windsor, CO 80550 Phone: (970) 449-5541 Web Site: www.columbinehealth.com

ORTHODONTICS

ORTHODONTIC ASSOCIATES OF GREELEY, PC

Professionals: Bradford N. Edgren, DDS, MS 3400 W. 16thSt., Bldg 4-V Greeley, CO 80634 Phone: (970) 356-5900 Website: www.drbradsmiles.com

ORTHOPEDICS

MOUNTAIN VISTA ORTHOPAEDICS 5890 W. 13th Street, Suite 101 Greeley, CO Phone: (970)348-0020 Fax: (970)348-0044 Web Site: www.bannerhealth.com Professionals: Randy M. Bussey, MD Riley Hale, MD Daniel Heaston, MD Thomas Pazik, MD Kelly R. Sanderford, MD Steven Sides, MD Linda Young, MD

OBSTETRICS & GYNECOLOGY

BANNER HEALTH GYN CONSULTANTS 1800 15th St., Suite 130 Greeley, CO 80631 Phone: (970)353-1335 Professionals: Susan Carter, MD

BANNER HEALTH OB/GYN CLINIC 2410 W. 16th Street Greeley, CO 80634 Phone: (970)352-6353 Professionals: Neil Allen, MD Laurie Berdahl, MD

WESTLAKE FAMILY PHYSICIANS, PC 5623 W. 19th Street Greeley, CO Phone: (970) 353-9011 Fax: (970) 353-9135 Professionals: Jacqueline Bearden, MD; Richard Budensiek, D.O.; Janis McCall, MD; Frank Morgan, MD; David Pols, D.O. www.bannerhealth.com

ONCOLOGY & HEMATOLOGY

CANCER INSTITUTE (NCMC) 1800 15th Street, Greeley, CO 80631 Phone: (970) 350-6680 Toll Free (866) 357-9276 Fax: (970)350-6610 Professionals: Jeffrey Albert, MD Elizabeth Ceilley, MD Brian Fuller, MD Benjamin George, MD Samuel Shelanski, MD Kerry Williams-Wuch, MD Alice Wood, MD Ariel Soriano, MD

PEDIATRICS

BANNER HEALTH CLINIC 6801 W. 20th Street, Suite 201 Greeley, CO 80634 Phone: (970)350-5828 www.bannerhealth.com Professionals: Amanda Harding, MD James Sando, MD

PHYSICAL THERAPY

FRONT RANGE THERAPY

1475 Main Street, Windsor, CO 80550 Phone: (970) 492-6238 Web Site: www.columbinehealth.com

HOPE THERAPY CENTER (Formerly North Colorado Therapy Center) 2780 28th Avenue, Greeley, CO 80634 Phone: (970)339-0011 Website: www.GCIinc.org Professionals: Jeanne Rabe, PT; Jennifer Branson, PT Kryste Haas, OT; Molly Wuethrich, PTA Moni Kohlhoff, PT

NORTHERN COLORADO REHABILITATION HOSPITAL

4401 Union Street, Johnstown, CO 80534 Phone: (970) 619-3400 Website: NCRH@ernesthealth.com

PULMONARY/CRITICAL CARE

NORTH COLORADO PULMONARY (NCMC)

1801 16th Street, Greeley, CO 80631 Phone: (970)392-2026 Professionals: Kelli Janata, DO Robert Janata, DO David Fitzgerlad, DO Michael Shedd, MD Danielle Dial, NP

PEDIATRIC REHABILITATION

BANNER REHABILITATION CENTER 1801 16th Street, Greeley, CO Phone: (970)350-6160 Fax: (970)378-3858

PERSONAL RESPONSE SERVICE

BANNER LIFE LINE (NCMC)

2010 16th Street, Suite C, Greeley, CO 80631 Phone: 1-877-493-8109 (970) 378-4743

PROSTHETICS & ORTHOTICS

CERTIFIED PROSTHETICS & ORTHOTICS, LLC (GREELEY LOCATION)

1620 25th Avenue, Suite A, Greeley, CO 80634 Phone: 970-356-2123 Fax: 970-352-4943

HANGER PROSTHETICS & ORTHOTICS

7251 West 20th Street, Building M, Greeley, CO 80634 Phone: (970)330-9449 Fax: (970)330-4217 2500 Rocky Mountain Avenue, Suite 2100 North Medical Office Building, Loveland CO 80538 Phone: (970) 619-6585 Fax (970) 619-6591 Website: www.hanger.com Professinal: Ben Struzenberg, CPO Michelle West, Mastectomy Fitter

REHABILITATION

ASCENT AT LIFE CARE CENTER 4800 25th Street, Greeley, CO 80634 Phone: (970)330-6400 Website: www.lcca.com Professionals: Annie Bennett Leslie Vail

BANNER REHABILITATION Phone: (970)350-6160

COLUMBINE COMMONS HEALTH & REHAB FACILITY 1475 Main Street Windsor, CO 80550 Phone: (970) 449-5541 Web Site: www.columbinehealth.com

FRONT RANGE THERAPY

1475 Main Street, Windsor, CO 80550 Phone: (970) 492-6238 Web Site: www.columbinehealth.com

NORTHERN COLORADO REHABILITATION HOSPITAL

4401 Union Street, Johnstown, CO 80534 Phone: (970) 619-3400 Website: NCRH@ernesthealth.com

PEAKVIEW MEDICAL CENTER

5881 W. 16th St., Greeley, CO 80634 Phone: (970)313-2775 Fax: (970)313-2777

RESPITE/ADULT DAY CARE

ELDERGARDEN ADULT DAY CARE 910 27th Avenue Greeley, CO 80634 970-353-5003 Website: www.eldergarden.org Sliding scale fee or no fee for Medicaid Enrollment process required

SKILLED CARE/REHAB

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2014 BONELL GOOD SAMARITAN 708 22nd Street, Greeley, CO 80631 Phone: (970)352- 6082 Fax: (970)356-7970 Website: www.good-sam.com

COLUMBINE COMMONS HEALTH & REHAB FACILITY 1475 Main Street Windsor, CO 80550 Phone: (970) 449-5541 Web Site: www.columbinehealth.com

GRACE POINTE

1919 68th Avenue, Greeley, CO 80634 Phone: (970) 304-1919 Website: www.gracepointegreeley.com

SPORTS MEDICINE

MOUNTAIN VISTA ORTHOPAEDICS 5890 W. 13th Street, Suite 101, Greeley, CO Phone: (970)348-0020 Fax: (970)348-0044 Web Site: www.bannerhealth.com Professionals: Randy M. Bussey, MD Riley Hale, MD Daniel Heaston, MD Thomas Pazik, MD Kelly R. Sanderford, MD Steven Sides, MD Linda Young, MD

NORTH COLORADO SPORTS MEDICINE 1801 16th Street, Greeley, CO Phone: (970)392-2496

SPEECH LANGUAGE PATHOLOGY

BANNER REHABILITATION CENTER 1801 16th Street, Greeley, CO Phone: (970)350-6160 Fax: (970)378-3858

NORTHERN COLORADO REHABILITATION HOSPITAL

4401 Union Street, Johnstown, CO 80534 Phone: (970) 619-3400 Website: NCRH@ernesthealth.com

UNC SPEECH LANGUAGE PATHOLOGY CLINIC

Gunter Hall, Room 0330, Greeley, CO 80639 Phone: (970)351-2012/TTY Fax: (970)351-1601 Web Site: www.unco.edu/NHS/asls/clinic.htm Professionals: Lynne Jackowiak, M.S., CCC-SLP Julie Hanks, Ed.D Patty Walton, M.A., CCC-SLP

October 29, 2014

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Education, opportunity help fill rural health ‘pipeline’ For obvious reasons, people around here think “oil and gas” when you say the word “pipeline.” When we use that word at Centennial Area Health Education Center, on the other hand, we’re referring to a major strategy for recruiting a host of different health professionals so desperately needed to serve the citizens of so many of the towns in our northeast Colorado service area.

There do not exist good detailed data documenting the exact extent of health professional shortages. We do know that all but one of the 10 counties in the CAHEC region are officially designated by the feds as medically underserved areas. I’ll bet you can’t guess which one isn’t. It’s Kit Carson County, way out there on the border with Kansas.

According to Kindra Mulch,

Kit Carson County director of health and human services and fellow member of the CAHEC board, the 8,000 residents of the county where she lives and works could use the services of three more laboratory technicians, three radiology technicians, one physical therapist, two Marc physical therapy RANGEL aids, an occupaCAHEC tional therapist and a speech therapist, as well as three more mental health workers, five nurses, a dietician and a pharmacist. I put a lot more faith in Mulch’s intimate knowledge of her community than I do in any statistics collected statewide or nationwide.

The best way to address the lack of health professionals,

especially in rural areas, is to grow your own. I grew up in Chicago. I’m the rare exception, an urbanite who has made the prairie and its small towns my home. In general, rural practices that are not located in a resort area are pretty unlikely to attract and hold the urban-raised folks who make up most of the health workforce.

Small towns sometimes do pretty well at getting nurses.

Everybody knows what nurses do and there are plenty of opportunities to do some of nurse training from home, online.

A lot more rural folk would probably choose other really cool professions, like speech therapist, laboratory technician, or physical therapy aide, if they only knew about them.

That’s where CAHEC comes in. We have put on programs for primary school children.

“Body Shops,” which feature presentations to junior high school kids by various health professionals, have been quite popular. High school students have attended weeklong summer heath career institutes at the Anschutz Health Sciences Campus in Aurora, hosted by the Area Health Education Programs. We’ve held health career fairs at high schools, as well as at University of Northern Colorado and at Front Range Community College. Next summer we’re hoping to expand the career fairs to include more health professions, presented at more sites. CAHEC has provided one-on-one counseling and coaching to students, helping them to choose health career paths and then to complete their school applications.

Our goal is to get kids started along the health career path

TRiBUNE MEDiCAL DiRECTORY SURGERY GENERAL & TRAUMA

BARIATRIC SURGERY (NCMC)

1800 15th Street, Suite 200, Greeley, CO 80631 Phone: (970)378-4433 866-569-5926 Fax: (970)378-4440 Professionals: Michael W. Johnell, MD

SURGERY WESTERN STATES BURN CENTER (NCMC) 1801 16th Street, Greeley, CO 80631 Phone: (970)350-6607 Fax: (970)350-6306 Professionals: Gail Cockrell, MD Cleon W. Goodwin, MD BURN

SURGICAL ASSOCIATES OF GREELEY PC (NCMC)

1800 15th St. Suite 210, Greeley, CO Phone: (970)352-8216 Toll Free: 1-888-842-4141 Professionals: Molly Decker, DO; Michael Harkabus, MD; Jason Ogren, MD; Samuel Saltz, DO; Robert Vickerman, MD

URGENT CARE

SUMMITVIEW URGENT CARE 2001 70th Avenue, Greeley, CO 80634 Phone: (970)378-4155 Fax: (970)378-4151 www.bannerhealth.com Professionals: Susan Beck, MD Thomas Harms, MD Susan Kelly, MD Amy E. Shenkenberg, MD Linda Young, MD

UROLOGY

MOUNTAIN VISTA UROLOGY

5890 W. 13th Street, Suite 106, Greeley, CO 80634 Phone: (970)378-1000 Professionals: Curtis Crylen, MD David Ritsema, MD James Wolach, MD www.bannerhealth.com

VEINS

VEIN CLINIC (NCMC)

1800 15th Street, Suite 340, Greeley, CO 80631 Phone: (970)378-4593 Fax: (970)378-4591 Professionals: Maurice I. Lyons Jr., DO Kenneth M. Richards, MD Gene E. Tullis, MD

as early as possible. It’s sometimes a pretty long pipeline that needs filling. For example, it takes 11 years of post-high school education to become plain vanilla family doctor.

Once students do enroll in health professional school, CAHEC shifts into a higher gear, coordinating training rotations in our service area, including providing housing. Tune in next month to hear more about what we’re doing to support and develop health professional training in northern Colorado one step closer to the end of the pipeline, where the refined “product” is finally delivered directly to the neighborhood service station.

Dr. Marc Rangel is a member of the Centennial Area Health Education Center board of directors.

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reformation was well on its way.

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Did Meniere’s Disease Effect the Protestant Reformation?

Slide #1

Martin Luther is best known as abandoned his college education wealth of evidence exists through Modern physicians have speculatthe Father of Protestantism, as and gave up his plans to study Law reports by his friends. Most of his ed that Luther was suffering from he waswanted the first toto famously and athis age 24 he entered the mondiseases were commonasand Meniere’s disease, which attacks They knowbreak whether faith in Christ remained steadfast hewell approached the end. away from the Catholic Church. A astery of the Augustine friars, and known to 16th century physicians, the inner ear, causing serious equiHis last word, spoken to those questioning his faith, was yes. It them wascorrectly February 18, 1546 andSome the feel that simple German monk of peasant was ordained into the priesthood who interpreted as librium problems. background, Luther as much 1507. bladder stones, chronic constipa- his Meniere’s and hallucinations reformation washadwell on itsinway. influence in shaping our modern tion, and hemorrhoids. were a result of syphilis, which world as almost anyone who has The Reformation The first of his Meniere’s attacks is was rampant in Europe at the ever lived. He was a puzzling, yet While profoundly Catholic, he documented to have occurred on time. Whatever the source of the determined man of extraordinary strongly disagreed with several July 6, 1527, when Luther was 43 difficulties, Martin Luther in 1529 conviction, determination, and practices of the early Church, such years of age. It began with a roar- was not the same Martin Luther of

boldness. Few people in history as immoral behavior, poor educa- ing tinnitus in his left ear, which in- 1519 and earlier. His diseases were Slide #1 have produced as many interesting Slide #2 tion of clerics, and the absence of creased dramatically and seemed taking a toll on his demeanor, writto occupy the left half of his head. ings and speeches. In particular, A state of sickness and collapse followed, but he retained, consciousness throughout the whole period.

After a night’s rest all his symptoms subsided, except the tinnitus, which continued for the rest of his life with varying intensity. Similar Slide 4 attacks, with an increase of the

Bishops from their assigned parSlide 3

stories, both positive and negative, as Martin Luther. He lived to see his teachings put in place by many and inspired Lutheranism, the first of the numerous Protestant faiths that exist today. He was, however, Slide #2 known to be volatile and, especially later in life, a bit irrational.

Could that erratic behavior have been the result of endolyphatic hydrops or Meniere’s disease?

Young Martin Martin Luther, born in 1483, was the eldest son of Hans and Margarethe Luder (later changed to Luther) of Eisleben (now Germany).

A difficult childhood left a permanent mark on young Martin. Hans was ambitious for himself and his family, determined to see Martin, his eldest son, become a lawyer.

He sent young Martin to Latin schools in Mansfield, and then in 1497 to Magdeburg, a school operated by a lay group called the Slide 3 Brethren of the Common Life, and later in Eisenach in 1498. These were difficult years for him and he began to devote himself to religious activities. After nearly dying in a frightening thunderstorm, he resolved to align his life more with God’s teachings. To that end, he

while earlier in his life, Martin Luther defended the Jews as “God’s people whom the Lord will redeem in time”, by 1529, he wrote awful things about the Jews of his day.

He might have been less volatile if there had been treatment for his tinnitus. In 1541, he became deaf, after experiencing bad ear aches and a discharge from his ears. It is difficult to believe that these diseases, particularly the Meniere’s disease did not affect his later writings. He suffered from extremely high blood pressure, which led to angina pectoris, a heart disease causing spasms of pain in the chest. His diseased heart finally failed, and he lost consciousness and died with his friends shouting questions into his deaf ears. They wanted to know whether his faith in Christ remained steadfast as he approached the end. His last word, spoken to those questioning his faith, was yes. It was February 18, 1546 and the reformation was well on its way.

ishes. His anger at the Church of his time would lead eventually to the Protestant Reformation. Be tween 1520 and 1530, Luther developed the basic tenets of his new Slide 4 faith. His beliefs rested on four major articles, which differed greatly from the teachings of the Catholic Church. His major assertions were: • Man is saved by faith alone (“sola fide”).

• The Bible is the sole source of authority in the church (“sola scriptura”).

Miller, a co-researcher at Michigan, that the noise-induced hearing loss prevention concoction could be • The church consists of the entire tinnitus and vertigo as the lead- available within two years. community of Christian leaders. ing symptoms, seized Luther at • All vocations have equal merit, irregular intervals and distressed and every person should serve him extremely. According to one God according to his individual study his was a typical case of calling.

Menière’s disease of the left ear Robert M. Traynor is the CEO and practicing audiologist at Audiology Luther was responsible for bring- manifesting itself more than 330 Associates, Inc., Greeley, Colorado with particular emphasis in ing about both chaos and commu- years before Proper Menière’s amplification and operative monitoring. Dr. Traynor holds degrees In another study funded by the Oklahoma Medical Research Foundation, nity to the masses, as he was the classical observation. Luther felt from the University of Northern Colorado (BA, 1972, MA 1973, Ed.D., researchers Dr. Robert Floyd and retired Army surgeon, Dr. Richard Kopke, M.D., discovered a first to openly challenge the Caththat the devil would whistle and 1975), thebyUniversity of trauma Phoenix combination of two compounds stopped damage to the inner ear caused acute acoustic – (MBA, 2006) as well as Post-Doctoral olic Church. roarlikeinan his ears andAlthough squeeze something IED exploding. they his did not indicate what compounds were they felt (1984). He taught Audiology at the Study at the Northwestern University heart; sometimes the spin was so who holds that,“This is a very exciting finding,” said Dr. Floyd, the Merrick in Aging (1973-1982), University of Arkansas University ofFoundation NorthernChair Colorado at OMRF. research still at awould pre-clinical stage, but we’re hopeful that we soon can begin Luther’s Meniere’s fast in his “The head that isLuther Disease Research for Medical Sciences (1976-77) and Colorado State University (1982testing fall in humans.

Throughout his life, Luther suffered out of his chair. He regarded 1993). Dr. Traynor is a retired Lt. Colonel from the US Army Reserve, from severe constipation, and it is his severe tinnitus as a Satanic Medical Service Corps andofcurrently serves as an Adjunct Professor of More recently, Dr. Kathryn Campbell's work at Southern Illinois University involves the use an a recorded fact that he received infliction and wrote: “When I try antioxidant called D-methionine, a component of fermentedAudiology protein at the University of Florida, the University of Colorado, and his greatest enlightenment--that it to work, my head becomes filled the University of Northern Colorado. For 17 years he was an Audiology is man’s faith and not his achieve- with all sorts of whizzing, buzzing, Consultant to major hearing instrument and equipment manufacturers ments that guarantee his salva- thundering noises.” The condition providing academic and product orientation for their domestic and tion--while he was sitting on the became so severe that he hired a international distributors. A clinician and practice manager for over toilet. His various diseases are body guard to prevent him from 35 years, Dr. Traynor has lectured on most aspects of Audiology in over well documented as he discussed physically hurting anyone during forty countries. them freely in his letters, and a very painful bouts of tinnitus.

Author’s Bio:

Robert M. Traynor, Ed.D., MBA, FAAA

that is found in yogurt and cheese. The antioxidant, in concentrated doses, has been found to improve some forms of hearing loss and even prevent hearing loss before the exposure to noise. "We've been able to show in animal studies that if we give it before and after noise exposure, that we can get pretty full protection from noise-induced hearing loss," Campbell said. According to Campbell and her colleagues will continue their studies by looking at the effects of