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Hole Health

May 1, 2013

A special supplement to the Jackson Hole News&Guide

Family exercise Playing together is good for more than just health page 12

Outdoor adventure training ...

indoors page 14

Marijuana:

Docs weigh in on its health effects page 18

BRADLY J. BONER / NEWS&GUIDE

The calm waters of String Lake in Grand Teton National Park are a great place for families to spend an afternoon walking, swimming or paddling beneath the towering Teton Range.

St. John’s Community Health Fair • 9 a.m. to 1 p.m. Saturday, May 4 • See story on page 3.


2 - HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013

From the

W

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Creating, enhancing and protecting the smiles of Jackson Hole.

editor

hen you’re charging up peaks, blasting along trails or cruising down the Snake River, it’s easy to forget some of the more mundane aspects of staying fit and keeping healthy. Who wants to think about how to arrange your workplace when getting ready to climb the Grand Teton? Or study the benefits of eating sauerkraut? Or try to decide whether to boil or steam your vegetables for dinner? This year’s Hole Health section takes a look at elements of your health that often go overlooked. There’s a story about getting the entire family outdoors. Another article reviews the benefit of participating in support groups, such as one at St. John’s Medical Center for breast cancer survivors. Other writers take on topics such as the health advantages of fermented foods, protecting your hearing and keeping your brain safe. News&Guide editor Angus M.

Thuermer Jr. rounds up the latest research and analysis of marijuana use, a political issue that’s being hashed out in neighboring Colorado and throughout the country. Ben Graham outlines changes in federal health care reform that could have lasting effects on Teton County residents. And for the more traditional athlete, there’s a story about spring workout routines and one about the new book by famed runner and coach Eric Orton. It’s a section that’s full of useful, practical information about staying safe and healthy in Jackson Hole and getting the most out of your adventures, whether they are indoors or out. And with St. John’s Medical Center’s annual Health Fair just around the corner, it’s a great time to take a minute to check all components of your health, from head to toe, from workplace to backcountry. — Ben Graham and Kevin Huelsmann

Photo by Flo McCall

Special supplement written, produced and printed by the Jackson Hole News&Guide

TETON DENTAL ARTS General Family Dentistry Catherine m. tebay, D.D.s.

Publisher: Kevin Olson Editor: Angus M. Thuermer Jr. Special Sections Editor: Rebecca Walsh Hole Health Section Editor: Ben Graham and Kevin Huelsmann Layout and Design: Kathryn Holloway Photo Editors: Bradly J. Boner, Price Chambers Copy Editors: Molly Absolon, Richard Anderson, Jennifer Dorsey, Mark Huffman Features: Richard Anderson, Emma Breysse, Kevin Huelsmann, Mike Koshmrl, Miller N. Resor, Brielle Schaeffer, Angus M. Thuermer Jr., Rebecca Walsh, Lindsay Wood. Director of Advertising: Adam Meyer Advertising Sales: Karen Brennan, Matt Cardis, Amy Golightly, Tom Hall, Chad Repinski. Advertising Coordinator: Heather Best Advertising Design: Caryn Wooldridge, Jenny Francis, Kara Hanson, Lydia Wanner Pre-press: Jeff Young Press Foreman: Greg Grutzmacher Pressmen: Dale Fjeldsted, Johnathan Leyva, Mike Taylor Office Manager: Kathleen Godines Customer Service: Ben Medina, Lucia Perez Circulation: Kyra Griffin, Pat Brodnik, Hank Smith, Jeff Young Copyright 2013 Jackson Hole News&Guide P.O. Box 7445, 1225 Maple Way Jackson, WY 83002, 307-733-2047 Fax: 307-733-2138, JHNewsAndGuide.com

307-734-5665 Smith’s Plaza 252817

It’s What’s on the Inside That Matters Now accepting new patients Dennis Butcher, MD, Board Certified in Internal Medicine Ellen Meyers, MD, Board Certified in Internal Medicine

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HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013 - 3

PRICE CHAMBERS / NEWS&GUIDE FILE PHOTO

Pediatrician Tom Pockat’s nurse Katie White talks with Amelia Davenport, 7, about her stuffed rabbit’s well-being during the teddy-bear clinic at the 2012 St. John’s Community Health Fair. At this year’s fair on Saturday, people can get tested for vision and hearing problems, high blood pressure, skin cancer and more.

Ounces of prevention Health fair offers free screenings and fitness classes. By Ben Graham

C

lose to 4,000 people had their blood drawn in the weeks and months leading up to the 2013 St. John’s Community Health Fair so they could have their results interpreted for free. That means nearly one-fifth of all Teton County residents are taking advantage of the discounted screenings, making the program one of the most popular at the hospital’s annual fair. The turnout was so strong that St. John’s had to turn people away. But those who missed out will have another chance. St. John’s will host a “procrastinators raffle” at the fair. Attendees can enter their names in a drawing to be able to have the blood work done by appointment at a later date. The majority of those who enter the raffle will win, said Julia Heemstra, wellness coordinator at the hospital. The tests can reveal cholesterol, triglyceride, blood-sugar and enzyme levels that are precursors to diseases like diabetes.

Early detection is key

Such screenings are crucial because they can lead to the early detection of serious health conditions. But that doesn’t mean everybody gets them done. “We all know that they’re important in order to identify if there is a problem that you might need to see a physician for,” Teton County Public Health Nurse Manager Melanie Pearce said. “They’re usually cost-effective, because if you wait, your bill can be higher.” But cost often can be an issue for the uninsured and underinsured, Pearce said. That’s where St. John’s Community Health Fair steps in. One of the goals of the annual

event is to encourage residents to get checked out, such as having their blood analyzed. “It’s the only time I’m aware of that you can meet with physicians and talk with them for free,” Heemstra said. The fair offers a slew of free screenings to those who are interested, and this year is no different. From 9 a.m. to 1 p.m. Saturday at the Snow King Sports and Events Center, residents will be able to get tested for vision and hearing problems, high blood pressure and lingering orthopedic injuries. Children will be able to participate in all of the screenings, too.

Skin checks a big draw

“You have the choice to talk face to face with a provider, rather than just Googling” your symptoms and determining whether you should see a doctor, said Rachel Greene, health fair coordinator. Skin cancer screenings also continue to be one of the most popular. Each year attendees line up to have irregular freckles and moles examined by dermatologists. “We have a higher incidence of skin cancer here in Teton County,” Heemstra said. “I think it’s one of the easiest preventive screens. People are able to have a mole checked out and know within a very short period of time” whether it is a problem. The event also introduces people to the variety of health and wellness services available in the valley, she said. Indeed, more than 100 organizations and health care providers are expected to host booths at the fair. That includes more than 10 departments of St. John’s. But it also involves other corners of the health care community in town, such as the Community Safety Network, which deals with sexual abuse and domestic violence.

St. John’s Community Health Fair schedule When: 9 a.m. to 1 p.m. Saturday Where: Snow King Sports and Events Center Free screenings Hearing Skin cancer Memory screenings Blood pressure Orthopedic injuries Chiropractic muscle/imbalance Dental Free demonstration classes 9 to 9:45 a.m. - Zumba 10 to 10:45 a.m. - Karate, tai chi and qigong 11 to 11:45 a.m. - Mountain fitness Noon to 12:45 p.m. - Kids yoga Sandwiches and pastries will be provided, as well as unlimited coffee. For those favoring super-healthy snacks, the hospital’s Refuge Grill will be serving kale chips. Families will be able to climb aboard an ambulance or fire truck for tours. Weather permitting, one of the biggest differences from last year’s fair will be helicopter tours. The medical air transport company Classic Lifeguard plans to land one from its fleet to give people a close-up look at how trauma patients are flown out of the valley. A storm over Togwotee Pass prevented the helicopter from reaching the fair last year. “They have all the permits in place and plan to land on the ball field,” Heemstra said.


4 - HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013

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Fermentation preserves vegetables and produces pungent flavors. Breads, cheeses, pickles, yogurt and sauerkraut are some of the many foods produced with fermentation.

Tiny helpers in the kitchen

Fermented foods that use microbial life forms have been part of our diets for ages. By Kevin Huelsmann

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assy, partially digested foods are a tough sell. But when people learn that they pack tons of nutritional benefits and that many people eat them daily, attitudes change easily. Fermented foods often are part of people’s daily diets, though they may not realize it. Breads, cheeses, pickles, yogurt, soy sauce, sauerkraut and beer require fermentation to get that pungent bite that keeps eaters coming back for more. “It’s one of the oldest preservation methods that we have,” said Jennifer Jacobsen, an instructor at Central Wyoming College who has worked as a dietician for 15 years. Jacobsen landed at CWC about five years ago. She has been hosting classes on canning, but she also recently started teaching students about fermentation. Last summer her classes on the topic quickly reached their capacity. The popularity of the classes seems to dovetail with the interest in the culinary arts as well as home production, Jacobsen said. “Across the country and in Jackson, people are moving away from the food industry,” she said. “They’re thinking, ‘I can just do this myself.’ ” Eating fermented foods provides people with live cultures that help replenish bacteria in their stomach, similar to taking probiotics. Fermented foods also have sometimes been shown to enhance our ability to absorb certain nutrients, such as vitamins B and C. Additionally, fermented foods are “predigested” by the bacteria they contain. That means they often are

easier to digest and absorb into your system. Beyond health benefits, fermentation is a tradition in many cultures. In Korea, for example, kimchi recipes have been passed down within families or centuries. Many cultures rely on fermentation to preserve fresh vegetables through harsh winters, the process often bringing together neighbors and friends to make large batches of kimchi or sauerkraut. As societies have become more affluent and as technology has advanced, people have strayed from these kinds of traditions. Getting back to these processes re-establishes an important cultural link, said Sandor Katz, author of “The Art of Fermentation.” “Just as the microbial cultures exist only as communities, so too do our broader human cultures,” he writes. “Food is the greatest community builder there is. It invites people to sit and stay awhile, and families to gather together. It welcomes new neighbors and weary travelers and beloved old friends. And it takes a village to produce food. Many hands make light work, and food production often gives rise to specialization and exchange.” Katz’s book came out last summer. It has garnered a significant amount of praise and sparked an even greater interest in fermented foods. He dubbed the tastes produced by the fermentation process as “the flavorful space between fresh and rotten.” “We reject certain food because it is rotten,” Katz said last summer during an interview on NPR. “Certain food we can see is fresh. But there is this creative space between fresh food and rotten food where most of human culture’s See TINY HELPERS on 7

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Learn to run Orton says he wrote his new book for extreme runners and joggers alike.

HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013 - 5

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he Cool Impossible” is not an instructional book or the “Born to Run” how-to. It’s a virtual running “fantasy camp” in Jackson Hole and a read that pulls together “all the elements that create athleticism for runners,” author and Jackson resident Eric Orton said. “We’re bringing the reader — through my voice — to Jackson Hole to train with me for a week,” he said. Orton is the 46-year-old running coach for Christopher McDougall, who wrote the 2009 New York Times bestseller “Born to Run.” He’s a Jackson resident, ultrarunner and entrepreneur, and he has clearly capitalized on the overwhelming success of McDougall’s bestseller. Orton owns a shoe company called B2R, sells leg-strengthening equipment and powdered energy drinks and trains dozens of runners around the world through his website RunningWithEric.com.

“Natural running is ... about the joy of running that we were all naturally born with and can reawaken.” – Eric Orton Running guru

Now he’s author of a book picked up by publishing giant Penguin. “The Cool Impossible,” subtitled “Dreaming beyond fear, and living beyond limits,” is Orton’s first foray into writing. So what is it that creates athleticism in runners? What is the “The Cool Impossible?” The chapters of the 272-page book, Orton said, address strength training, the importance of foot strength, running form, training programs, heart rate monitoring, speed training and nutrition. “Natural running is about so much more than barefoot running,” said a book description posted to Amazon.com. “It’s about the joy of running that we were all naturally born with and can reawaken. Like a favorite running companion, ‘The Cool Impossible’ will be there with

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you, stride for stride and mile for mile, helping you go farther than you ever could have on your own.” As a running coach, Orton has done that for years. Inspired by the Tarahumara — a Native American people of northwestern Mexico — Orton teaches a style of running that emphasizes well-rounded athleticism and resilience to injury as opposed to straightforward running prowess. Orton instructs his clients almost exclusively over the Internet, using custom software and Skype. “I actually train people who live in Jackson that I’ve never even met,” he said. Orton trains and writes for runners of all abilities. “The Cool Impossible” is written to appeal to the veteran runner who is in a rut and isn’t progressing, he said, and also the type of person who read “Born to Run” and perhaps is looking to take the step up from running a half marathon to an ultra race. “Running doesn’t have to be for fitness,” Orton said. “Let that be the byproduct, but create an adventure.” This month Orton will usher in the release of his first book with a tour that will take him to New York City, Connecticut, Oregon, through Colorado’s Front Range and elsewhere. “The Cool Impossible” hits bookshelves in hardcover for $26.95 on Tuesday. It will be available at the Valley Bookstore and online at Amazon.com and BarnesAndNoble.com.

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Survivors of breast cancer meet at Ella’s Room for a St. John’s Medical Center gathering called Steppin’ Out. The gatherings are a time to enjoy oneself and friends, to find support during a time of illness and to take a break from being a cancer patient. “It’s the camaraderie,” Becky Watson said. “It’s good to see other people.”

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group of 12 ladies sipped white wine and mingled among tables covered with piles of candy-colored lingerie. The women admired the dainty, lacy undergarments, debating how to spend the $50 they had been given by the St. John’s Medical Center Oncology Department and Ella’s Room owner Joanna Fishman. A few of them had cropped pixie haircuts from losing hair during chemotherapy; others had been in remission for some time. All of them were survivors. But this shindig at Ella’s Room wasn’t about breast cancer. The St. John’s Steppin’ Out gatherings are a time to enjoy oneself and friends, to find support during a time of illness and to take a break from being a cancer patient. “It’s the camaraderie,” attendee Becky Watson said. “It’s good to see other people, and hopefully, see a familiar face.” Watson, who works in outpatient services at the hospital, heard about the meetings and thought they sounded like fun. She’s a year in remission

from stage one breast cancer. Some window shopping and fellowship seemed like a good deal to Elaine Luton and her friend Rae Doty, too. Luton’s doctor told her about the event, so she and Doty came by the shop “to get out.” The party marked the third meeting of Steppin’ Out. The bunch is still growing. The first meeting of Steppin’ Out was held at the Elk’s Club for an afternoon of bowling and social time. It attracted the most people so far, Taylor said. Their second meeting for coffee at Cafe Boheme was more low key. Steppin’ Out events are scheduled for the third Tuesday each month, although meeting places and times vary. Staffers from the oncology department developed the concept to serve as an offshoot of more traditional cancer support groups, said Carol Taylor, support group facilitator. The traditional support meetings are held at 4 p.m. on the first Tuesday of each month at the hospital’s chapel. This program has been in place for more than 10 years. Not everyone is comfortable with sharing their thoughts and feelings See SHARING on 7

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HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013 - 7

Meeting details

Continued from 6

with other people, Taylor said. Steppin’ Out is a group for people to have informal interactions with other cancer patients and survivors. Taylor explained how some patients tire of “being the face of cancer.” Steppin’ Out gives them the opportunity to be themselves and to have uplifting experiences during treatment. That’s not to discredit the traditional support program. Taylor has seen personal breakthroughs, breakdowns and hard-fought battles during those times of intense sharing in the traditional groups. “It’s our duty to reach out to people that are struggling,” she said. “To know that you’re not alone is really, really important.” Those who are a part of this inner circle hold each other up long after a diagnosis. Taylor asked one patient why he continued attending the meetings after remission. He said it was because “those people were there for me and I need to be there for others.” Living to tell about beating cancer is part of the journey. The group aids those who need a friend or those who want to share a glimmer of hope. “We all know what fear feels like,” Taylor said. “We all know what hopelessness feels like. To have hope is essential.” For others, not having to tell about kicking cancer is the goal. Stories of conquering their illness are kept close. St. John’s oncology has a group for the introspective types, too. Journal writing workshops with Jackson author Tina Welling are held from 3:30 to 4:30 p.m. on the second and fourth Thursdays each month in the classrooms at St. John’s. “Writing brings something from unconscious and pins it down so we can use it,” Welling said. “What we bring to the light we can work with, but what we keep in

Tiny helpers Continued from 4

most prized delicacies and culinary achievements exist.” “While pickles need vinegar to stave off microbial activity, sauerkraut forms its own acidity,” Paul Virant and Kate Leahy write in their book “The Preservation Kitchen.” The trick “hinges on the concentration of salt.” Here are tips to keep in mind during the fermentation process: • Monitor changes in room temperature. • Skim off bubbles and any scum that forms on the surface. • Don’t take funky smells as a bad sign. Most often there are much more subtle and nuanced flavors once you get past the pungent odor. • The brine could turn cloudy. This is not a problem. • It’s OK to scrape off small amounts

The St. John’s Medical Center’s Cancer Support Group meets from 4 to 5 p.m. on the first Tuesday of each month in the hospital chapel. This support group is facilitated by Carol Taylor, who has more than 35 years of social work experience. Patients, family members of patients and friends of patients are encouraged to share their feelings, frustrations and worries in this group. Jackson author Tina Welling’s Journal Writing Workshop is held from 3:30 to 4:30 p.m. in St. John’s Medical Center’s Otter and Eagle classrooms. The free program is designed for patients to journal through their feelings. Welling presents each class with a series of writing prompts. Participants are encouraged to share what they’ve written at the end of each session. the dark works us,” she said. Through a series of writing prompts, participants are able to explore their own thoughts and emotions in the workshop. At the end of the session, those who wish to share what they wrote are encouraged to do so, but Welling welcomes all comfort levels. The goal is to give a voice to the inner self, she said. The oncology department also offers acupuncture referrals, integrative touch therapy, aromatherapy, pet therapy and massage for its patients. For information on the department’s events and support groups call 739-6195. “There are enough choices that there’s something for everyone,” Taylor said. of white mold that might form. However, if mold overtakes the brine, it’s probably a good idea to start over. While sauerkraut and kimchi are becoming staples of fermentation enthusiasts, the options are endless. Virant and Leahy provide recipes for variations on sauerkraut using brussels sprouts, ramps and turnips. Jacobsen said the risks of making your own fermented food are minimal, far less than with canning. Basic taste typically will intervene before anything bad can happen. “If a fermented product you make goes bad, there isn’t a high likelihood you would be able to stomach eating it,” Jacobsen said in a handout she often provides her students. “And even if you did, there aren’t the fatal implications that come along with botulism.” CWC expects to host more fermentation classes this summer or fall. Check CWC.edu for information.

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hen you think about Jackson Hole, you likely think of peace and quiet. But noise loud enough to permanently damage your hearing lurks even in the tranquil Tetons. Power tools at construction sites, hunting rifles and live music in a bar all pose risks, especially over a long period of time. “I think all of us have suffered from decibel overdose,� said drummer Mike Calabrese. “When I play the Coach, I use earplugs. Quite a challenge, because I also sing either lead or harmony ... I’ve tried to ensure that I’ll still be able to sing and play, both guitar and drums, until my last day. That means turning down the volume or wearing ear protection.� Hearing can be compromised by a number of causes like head injuries, childhood infectious diseases and reactions to medications. According to a chart at St. John’s Medical Center’s audiology lab, before the age of 6, 90 percent of children will suffer a middle

ear infection that can cause temporary hearing loss. Presbycusis is a sensorineural, permanent hearing loss associated with aging (the word is formed from two Greek words for “elder� and “hearing�). Noise-induced hearing loss is caused by prolonged or repeated exposure to loud noises, though probably not as loud as you’d think. Eliza Petersen, audiologist for St John’s Medical Center — she holds a master’s degree with a certificate in clinical competency — said the din of a busy manufacturing floor, for example, can exceed 80 decibels, and exposure to that level of sound all day every day can result in permanent hearing loss. Petersen said she has been seeing “rampant� noise-induced hearing loss, and seeing it at younger ages. “It used to be, when I started 23 years ago, World War II vets were where I saw noise-induced loss,� she said. Now she’s seeing it even in teenagers. “It could be hunting without proper hearing protection. It could be iPods See SOUND on 9

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HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013 - 9

Spring & Summer Classes

The power of noise

Continued from 8

with headphones too high for too long.” Such hearing loss is preventable, she said. The human ear has three parts. The outer ear funnels sound down the ear canal to the eardrum. Beyond the ear drum are three tiny bones that transmit vibrations to the cochlea. This oddlooking organ in the inner ear is filled with fluid and lined with tiny hair cells, each of which, more or less, is in charge of converting certain frequencies to neural signals the brain perceives as sound. Loud noises damage these hair cells. The ones that pick up higher frequencies are usually the first to go. “From the time we’re born, we start loosing the highest pitches,” Petersen said, “starting with above 20,000 hertz.” One hertz is one cycle or vibration per second, so 20,000 hertz is 20,000 vibrations per second. The bulk of human speech takes place in the 500 to 6,000 hertz range, so a routine hearing test that Petersen performs in her lab tests a range of 250 to 8,000 hertz. While Petersen was talking, Dr. Martin Trott, St. John’s ear, nose and throat doctor, or otolaryngologist, poked his head into her room to ask if she could squeeze in a patient suffering from ringing in his ears. The man, in his late 50s, had served in the military. She sat him in a sound booth and took her place before her computer. Using a program, she played tones of different frequencies at different decibel levels. Sure enough, his ability to detect the tones began to drop off around 2,500 hertz. At about 6,000 hertz, Petersen had to increase the volume to 70 decibels before he could hear it. A second test involved a recorded voice asking the man to say certain words. “Say the word ‘tough.’ Say the word ‘gap.’” Moon, choice, king, death, love. He got most of them right in one ear, but in his other ear he began to miss some, saying “soft” for “chalk,” “boom” for “moon” and so forth. Petersen said the results were pretty much what she expected; softer sounds, like Vs and Fs, depend on that higher frequency range that the first test showed the man was losing. A hearing aid, she said, would help him a lot. While little about the hearing test has changed since the 1940s — the computer makes it easier to administer and easier to store and pull up the results — hearing aid technology has changed dramatically, even just within the past five years, Petersen said. The models she had on display consisted of a small module, about the size of an almond, that contains a battery, a microphone and a processor that converts sound waves to digital messages. A wire or tube sticks out of it with a loudspeaker smaller than a grain of rice at the end. The module fits behind the ear, the tube wraps up and around the outer ear and speaker is inserted in the ear canal. Once it’s on, you barely feel it, and you’d have to look carefully to notice it on another person. The processor in the module is

The National Institute for Occupational Safety and Health recommends that noise levels for those working 8-hour days should remain below 85 decibels. That’s the level at which hearing protection should be used. As the intensity of a sound increases, the amount of time it takes for hearing damage to occur decreases rapidly. The group says that workers should not be exposed to 100 decibels for more than 15 minutes. Below are the decibel (dB) readings of some common sounds and the maximum amount of time that the NIOSH recommends a worker be exposed to such noises. • Ringing telephone - 30 dB, N/A • Normal conversation - 60 dB, N/A • Lawn mower - 90 dB, two hours and 31 minutes • Chain saw - 110 dB, one minute and 29 seconds • Jackhammer - 110 dB, one minute and 29 seconds • Jet engine takeoff - 140, less than one second • 12-gauge shotgun - 165 dB, N/A

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Source: National Institute for Occupational Safety and Health and the Centers for Disease Control and Prevention. programmable. It can be set to amplify the specific ranges of frequency the wearer is losing. A more sophisticated one offers several pre-programmed settings, one for normal conversation, one for noisy environments such as a bar or restaurant, one for quieter environments and so forth. “It’s like having two mini computers, one in each ear,” Petersen said. As impressive as the technology is, however, most people don’t want to wear hearing aids. And they won’t have to, Petersen said, if they use some common sense and protect their hearing. “I recommend everyone have some form of hearing protection in their pocket before they get to a concert and realize, ‘This is no fun,’” she said. Foam ear plugs work fine, but they need to be put in correctly, she said. Also, they work by simply blocking the ear and so they muffle all sound. That’s fine if you’re firing a gun, for example, but musicians sometimes don’t like the muffled quality. Still, she said, “I see so many musicians getting proactive” about hearing loss. For them, she can make custom plugs that filter sound without distorting the frequencies of the music. As cool as the technology is, the solutions to noise-induced hearing loss are quite simple. “You can have permanent hearing loss, or you can have good hearing,” Petersen said. “It’s your choice.”

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10 - HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013

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espite all of the political debate about the effects of Obamacare, the jury largely is still out. That’s because the most significant portions of the law won’t become effective until 2014, and those are the changes that could have the greatest effects on Teton County, especially on its large population of uninsured people. County residents already have seen some benefits from the law. But state health officials and the Legislature have yet to work out details like Medicaid expansion and creation of a virtual health insurance marketplace. State lawmakers are now debating whether Wyoming should create its own exchange. With an exchange, consumers will be able to compare and shop for coverage packages, sort of like booking a hotel room or airfare online. Because the state missed a deadline in December to decide whether to form its own exchange, Wyoming will become part of the federally run exchange Jan. 1. The Legislature could decide to start its own, but that won’t happen until at least 2015. A select legislative committee is examining whether the state should do that. “It has to be at least two years, because we’re going to study it for a full year,� said Rep. Elaine Harvey, R-Lovell. She is on the committee — dubbed the Select Committee on Health Benefit Exchanges – with five other Republicans. “If we decide to take it over, there will have to be concessions made so that Wyoming citizens can afford to buy insurance,� she said. “So far, it’s one size fits all. That’s where we feel it’s not appropriate.� She noted that Wyoming’s small population means few people would use the exchange. But having many people in the marketplace is part of the plan to drive down costs. “When they expect that thousands of policies will be sold on Oregon’s exchange, we’ll have 20 sold on Wyoming’s,� Harvey said. Regardless of what the committee finds, those without coverage from their employers will be able to use the

State, fed exchanges will provide a market to buy insurance. Oct. 1 • Open enrollment for health insurance exchanges begins. Jan. 1 • Small businesses and individuals will be able to purchase plans through a virtual “Health Insurance Marketplace.â€? • The “individual mandateâ€? begins. Most Americans will be required to purchase health insurance or pay a fee. • Optional Medicaid expansion takes effect, meaning single adults within 133 percent of the federal poverty line will be eligible in states that chose to increase coverage. Wyoming lawmakers voted against this change, so state residents won’t qualify. • Tax credits will be available for those between 100 percent and 400 percent of the poverty line. The credits will be advanceable, meaning they can be used to lower monthly premiums. • Insurers will not be allowed to impose limits on the amount of money spent annually on an insured person’s health care. • Insurers won’t be able to deny someone coverage because of pre-existing conditions. exchange as soon as next year. Some believe that will be a boon for small businesses. “They could be a huge benefit to employers,â€? said Anne Ladd, chief executive of the Wyoming Business Coalition on Health. Businesses with fewer than 50 employees will be able to shop for plans for their employees through the exchange in the first year it is set up. After that, workers will be able to choose their own plans. “The question is, are they going to be done right or not,â€? Ladd said. That is still up for debate. “I don’t think anybody anticipates See INSURANCE on 15

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HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013 - 11

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Some foods are most nutritious raw, but others, including peppers and tomatoes, release extra vitamins and antioxidants when they are cooked.

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early every recommendation about how to cook food comes with a caveat. Typically, raw foods and ingredients that have been cooked only slightly retain the highest amount of nutrients. But there are times when putting food to the fire for a little longer can release an extra boost of vitamins, as is the case with tomatoes, carrots and spinach. Plenty of nutritionists will tell clients to avoid fats, but adding avocado to some dishes can provide more antioxidants. There’s a seemingly endless number of studies and research on the subject, but it’s not always easy to pinpoint exactly how to prepare ingredients so they hang on to the most nutrients possible. Jackson dietitian Therese Metherell relies on a few simple guidelines to make sure the people she’s working with are heading in the right direction, even if they’re not following every minute detail of every new study that’s published. Use a variety of cooking techniques and try to eat an array of

vegetables and fruits, she said. It’s more important to eat these ingredients than it is to get every cooking method exactly right for every single ingredient. “You want to keep it simple,” Metherell said. A good rule of thumb when trying to retain nutrients is to cook for as short a time as possible. Metherell recommends steaming, boiling or even using a microwave. Heat can destroy 15 to 20 percent of some vitamins. While many people know to avoid frying foods, they’re not always sure which other methods to choose. “You want to stay away from blackening or smoking foods,” she said. “That kind of reaction agitates foods and can create free radicals.” For many of her clients, Metherell focuses more on adding healthier options as opposed to trying to eliminate everything someone truly enjoys. For example, people who love eating steak with a nice, caramelized crust should also include on their plate a heap of greens or some beans. Those kinds of choices can help balance a diet, she said. More important, she said, is focusing See GOOD STUFF on 13

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12 - HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013

Getting the kids to work out The exercise is just the start: First you must convince them. By Richard Anderson

T

he family that exercises together … well, you fill in the blank. The benefits are as numerous and as varied as the families of Jackson Hole. Physical activity for parents and children. Teaching the next generation of athletes. Passing along the lessons of good sportsmanship, hunting ethics, taking care of yourself and taking care of your environment. Whatever sport you pursue, pursuing it as a family makes everything better. “We live in a great place where there are lots of opportunities to be outside,” said Katie White, family nurse practitioner with pediatrician Tom Pockat. “When you take the time to exercise as a family, you get all the benefits of physical activity and also all the benefits of being together as a family.” Dr. Travis Riddell, of Jackson Hole Pediatrics, seconded that view. “Parents are really important role models,” he said. “Fit parents inspire kids. “There’s a lot of research about eating,” he said, “about how families that have healthy eating habits translates to less childhood obesity. The same goes for exercise. When a child sees his parents exercise, it becomes something they’re more interested in.” The good habits can start as early as mom and dad want. White encourages new parents — especially new moms — to get out for at least some fresh air as soon as possible. “Putting baby in a sling when they’re real young and getting out is helpful,” she said. But, Riddell cautioned, trying to force a

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youngster can backfire. “We have a lot of parents who are outdoor go-getters,” he said. “They may have a tendency to push a child into activities they aren’t quite ready for, physically and emotionally.” On the other hand, Riddell said, “We see a lot of kids in the 2- to 3-year-old range doing skiing, biking.” Pedal-less “scoot” bikes have revolutionized teaching children how to bike, allowing many to skip the whole training wheels stage. “Many kids are developmentally ready. It depends on the kid.” Of course, safety and preparation should always be paramount — another good value to pass along. Helmets are a must for skiing, biking or skating, Riddell said.

“Even with a kid in a Chariot or a kid on a bike seat,” White added. Staying hydrated also is crucial for good health and good times, as is having plenty of good snacks available, she said. Dress in layers, be prepared for Jackson Hole’s changeable weather (raincoat, extra layers), and make sure babies and young children have a good hat to wear. And don’t forget the sunscreen. The latest research teaches that severe sunburn at an early age can make a person more susceptible to skin cancers later in life. “My family does a lot of boating and camping and swimming in the summer,” White said. “They’re See FAMILY on 13

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HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013 - 13 wildlife.’ … Sometimes just giving it a different name — an animal hunt — Continued from 12 is enough to motivate children to try.” all great activities, but be safe: Use Above all, don’t give up in the face life jackets, and get kids some sort of of kid resistance. swim lessons so they have some expe“Just cause they don’t want to rience and skills.” hike on Saturday,” Riddell said, As any parent knows, motivating a “doesn’t mean they won’t on Sunday. 5- or 6- or 7-year-old (or, sometimes, a It’s mood dependant … day to day, 15-, 16- or 17-year-old) can be half the and year to year.” battle. Also recall the • Zyto Compass Mini Scans “If a kid feels growing body • Simply Health Protein like it’s someof research and thing they’re findings that tell Drink Samples forced to do, they us that simply • Beyond Organic Samples won’t want to do being outdoors is it,” Riddell said. healthy. • Raffle Prizes “Make them “I think that think it’s their a lot of us have 252615 idea. Get peers, known intuitive732-0540 friends, siblings ly that being outM-F 8:30-5:30 involved. You side has a restor1325 S Hwy 89, Smith’s Plaza – Dr. Travis Riddell can spur them ative property to PEEK Babs Melka, PharmD Jackson hole pediatrics it,” Riddell said. with an ‘and then Suzie Ornowski, PharmD IRIDOLOGY Jennifer Hawks, CI when we make “It has a meditait to the lake, we tive quality, can can do this.’” reduce stress, lower blood pressure.” “I’ve been there,” said White, a parEven just having a picnic in a town ent herself. “I live near High School park or playing in the backyard, White Butte, and I’d try to motivate them. said, is important and valuable. My focus was to make it more of a “Unplug,” she said. “Disconnect scavenger hunt: ‘Let’s see how many from the TV and the electronics.” flowers we can hunt, or if we see any Just don’t forget that sunscreen.

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aged at the height of ripeness, meaning they retain their full nuContinued from 11 tritional value. on getting more fruits and vegetaCanned foods typically aren’t as bles into the daily routine. nutritious, as they often rely on “The way you’ll eat them is what fruits and vegetables that couldn’t matters most,” she said. make the cut for the grocery store. A diet consisting exclusively of These items also typically have raw or uncooked foods can provide a higher levels of sodium. lot of health benefits, but researchDrying some ingredients can be ers still aren’t sure whether it’s the beneficial, but this method also best way to go. tends to concentrate calories. For “You end up eating more vitamins, athletes trying to replenish their minerals and bodies after a fiber, with no tough workout, added sugars or this might be fats from cooka plus, but for ing,” Kathryn people trying to Siefel wrote in a watch their caFebruary article loric intake, it’s in Time magaa different story. zine. “But while Juicing also some raw items has become a might be superpopular choice healthy, studies for people tryhave found that to make sure – Therese Metherell ing cooking can acthey get enough Dietitian fruits and vegtually amplify etables in their some nutrients, daily diet. This like lycopene in tomatoes and antioxidants in ca- can be a great way to sneak in more rotenoids such as carrots, spinach, vitamins or use odds and ends in the produce bin. But it also has the sweet potatoes and peppers.” In an environment where it’s not potential of depriving eaters of the always possible to get fresh fruits and most beneficial parts of their ingrevegetables from nearby farms, frozen dients, namely the skin. “The skin has a lot of fiber in foods can be a good alternative. “Sometimes foods have to travel it,” Metherell said. “Juicing conso far,” Metherell said. “Foods and centrates vitamins and nutrients, vitamins are affected by light, air, but it also concentrates calories. It tends to lead to crashes in blood temperature.” Frozen products often are pack- sugar levels.”

“The skin has a lot of fiber in it. Juicing concentrates vitamins and nutrients, but it also concentrates calories.”

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14 - HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013

Training indoors for outdoors Jackson trainers focus on boosting athletic performance By Miller N. Resor

A

new movement in sports fitness is receiving rave reviews from Jackson’s athletic community. Initially introduced to the valley by Mountain Athlete, a gym started by Rob Shaul in 2007, the method focuses on training indoors to perform outdoors. Now gyms across the valley are offering sport specific workouts that focus on building strength and preventing injury while boosting athletic performance. The only class Mountain Athlete offers all year is known as base fitness, but the gym offers a range of seasonal classes. Mountain Athlete’s ski fitness program, which prepares skiers and snowboarders for the winter

PRICE CHAMBERS / NEWS&GUIDE

Kurt Zimmerman and Justin Jelinek work out with Crystal Wright at Wright Training. Open five days a week, the gym offers sport-specific exercises in addition to base fitness classes.

season, put the gym’s style on the map and has inspired similar classes around the valley. The ski fitness program, however, is just one of many sport-specific programs at Mountain Athlete. The gym offers specialized training for kayakers, bikers, hunters, dirt bikers, snowmobilers and mountain athletes. Brenton Reagan, an Exum Mountain Guide and former Marine, has trained at Mountain Athlete year round for the past five years. This spring he completed the gym’s rock climbing program and is currently participating in a program for professional mountain guides. “Rob says he is trying to make us harder to kill,” Reagan said. “It’s pretty amazing. I get older every year, but as long as I train at Mountain Athlete I keep getting stronger.”

Before starting at Mountain Athlete, Reagan worked out on his own. He would include exercises he found in climbing magazines. “On your own you always end up focusing on what you like,” he said. “With the direction that Coach Shaul brings, it makes it easier because you don’t think about it as much. You just have to do it.” Mountain Athlete programs use a technique known as periodization, which maintains athletes cannot be in their best shape all the time. Therefore programs are constructed to target sport-specific muscles at sport-specific times. This summer when Reagan is guiding full time, he will continue with a scaled-down base fitness program that works range of motion and See TRAINING on 15

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HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013 - 15 at Wright Training. Ladd, like Dennison, said she feels like she is in the best shape of her life. “I feel like I have more strength and power,” she said. “It never gets boring. It is always changing.” The workouts do not use traditional weights. Instead canvas sandbags, bell weights and one’s own body are used. Greg Epstein has been training with Wright for three years. He majored in exercise sport physiology and even worked as a personal trainer in the past. Therese Lowe Metherell, RD Although he Peak NutritioN is currently enRegistered Dietitian • Nutrition Consultant INDIVIDUALIZED gaged in the bike NUTRITION fitness class at Brenton Reagan Wright Training, COUNSELING peaknutrition68@gmail.com exum guide he likes to maintain his body year-round. “I’m pretty addicted physically and mentally,” he said. The workouts play to his competitive nature. To find out more about Mountain Athlete and Wright Training visit MountainAthlete.com and JHWrightTraining.com.

Confused about your

core strength only. In the fall he will start working up to peak fitness for ski season. Tracy Dennison, a jammer for the Jackson Hole Juggernauts, a roller derby team that competes at the Snow King Sports and Events Center, started a Mountain Athlete program designed for roller derby athletes a month before the first match to prepare for the season. “I’m feeling like I am in the best shape of my life,” Dennison said. “They are – really good at pushing us.” Professional skier Crystal Wright trained at Mountain Athlete for years before starting her own gym that prescribes some of the same sport-specific techniques. Anne Ladd, who does three-day equestrian eventing, is currently participating in a bike fitness class

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Continued from 10

that these are going to go smooth as silk out the door,” she said. “But if people are patient, over time they will be able to do an apples-to-apples comparison” of insurance plans in the exchange. Another hot-button issue statewide is Medicaid expansion. The U.S. Supreme Court ruled in the summer of 2012 that the federal government could not force states to increase coverage for single adults whose incomes fall below 133 percent of the poverty line. Each state now has the option to do so. Under President Obama’s plan, the federal government will pay nearly all of the cost of the expansion. The Wyoming Legislature decided against it last session, with many lawmakers saying they fear Washington, D.C., wouldn’t hold up its end of the bargain. That decision came in spite of a report from the Wyoming Department of Health that said the state would save $47 million by expanding Medicaid. The state Department of Health and the Joint Labor, Health and Social Services Committee will look into options for expanding Medicaid before the next legislative session, depart-

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16 - HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013

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How to avoid and live with arthritis: • Avoid winter sports injuries by conditioning for six to eight weeks before you hit the slopes. • Once you’re on skis, know your limits. Protect your knees and hips. • Eat a well-balanced diet and exercise to maintain a healthy weight. Extra pounds are hard on the joints. • If you have arthritis, keep joints limber with low-impact workouts like cycling and swimming.

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isdom teeth are the last teeth to erupt within the mouth. When they align properly and the gum tissue is healthy, wisdom teeth do not have to be removed. Removal of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. This is known as impaction and can lead to problems such as infection, decay, bone loss, damage to adjacent teeth and occasionally cysts or tumors may develop. Removal of wisdom teeth should not be taken lightly as there are risks such as nerve damage, openings between the mouth and sinus as well as bleeding and infection. Any dentist may remove wisdom teeth, however an oral surgeon has at least four additional years of hospital based training learning the intricacies of this procedure. Dr. Michael Stern is an oral surgeon and was trained at the Harvard School of Dental Medicine and the University of California, San Francisco. We provide sedation and general anesthesia for patients who would prefer to have little or no recollection of the procedure.

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Osteoarthritis, brought on by a lifetime of movement, is the most common kind of arthritis in Jackson Hole, according to Dr. Gus Goetz.

Goetz said, Jackson’s “bimodal” distribution of arthritis patients makes sense. The injuries associated with such sports — tibia plateau fractures of the shin, anterior cruciate ligament tears in the knee and labral tears in the hip joint — often progress to joint replacement and, later, arthritis. Almost as common as blown knees from a day of powder, Goetz said, are the degenerative labral tears that build up in the hips of bikers, laborers and hockey players. “I do think people walk around with labral tears,” he said. “Untreated labral tears will lead to arthritis.” As a result, Teton County has more than its fair share of hip arthroscopy and replacement surgeries, Goetz said. On the upside, the doctor said, Jackson’s relatively svelte population shows fewer symptoms of the osteoarthritis exacerbated by excess weight that is common in other parts of the country. “It is a little bit of an irony,” he said.

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rthritis is usually a chronic disease of old age or obesity. But in Jackson Hole, with its outdoor lifestyle and elite athletes, arthritis hits much younger. “We see a lot of people in their 40s and 50s,” said Dr. Gus Goetz, an orthopedic surgeon at St. John’s Medical Center. While there are many kinds of arthritis, four are most common. Osteoarthritis results from wear and tear that diminishes the elasticity of cartilage in joints — most often knees and hips. Rheumatoid arthritis is caused by inflammation and is much more common in women than men, with symptoms emerging between the ages of 40 and 60. Infectious arthritis is caused when bacteria, funguses or viruses create an infection in the synovial fluid of a joint. Juvenile rheumatoid arthritis affects children younger than 16 years old. In Teton County, Goetz said, most arthritis patients — about 70 percent of the cases he sees — suffer from the symptoms of osteoarthritis brought on by a lifetime of movement and sitting. But another 30 percent of his patients develop post-traumatic arthritis as a result of sport or repetitive-motion injury. “In this valley, post-traumatic arthritis is by far higher than in the general population,” Goetz said. With all the skiers, cyclists and long-distance runners in town,


HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013 - 17

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Lawyer Elizabeth Moore loves her versatile desk that uses an electric motor to rise or fall to the desired height. Standing — and even dancing — during a long day keeps her pain-free.

When work hurts

By Johanna Love

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or years, after a 10- to 12-hour day working at a desk, Gary Trauner would stand up and stiffly make his way out the door, grimacing all the way. Since switching five months ago to a standing position for much of the work day, the chief operating officer at St. John’s Medical Center is in much less pain. Buying a desk with a hydraulic lift that easily switches from sitting to standing position “has made a huge difference,” Trauner says. Over the years, Trauner sought back-pain relief from across the health care spectrum: orthopedic doctors, chiropractors, massage therapists. “It’s their general consensus that sitting for long stretches at a time is not normal to the human condition,” Trauner said. Ergonomics, the science of fitting the worker to the workplace, is a complex field. When people seek the help of physical therapist Mark Schultheis, his first step is diagnosis: Where is the pain and what is causing it? He routinely sees office workers suffering from cervical headaches, numbness in the arms, carpal tunnel syndrome, shoulder impingements, lower-back pain, neck pain and tennis elbow. Although he works with clients who suffer injuries from improperly lifting heavy objects, “it’s the people

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• Keyboard height or angle • Monitor height, angle, distance from eyes • Chair height, quality • Add a footrest, telephone headset or wrist rest who sit all day that keep me in business,” Schultheis said. Making sure your desk is set up correctly for your body is the first step, Schultheis said. Another important step is making time to get up from your desk and moving around during the day. “The body is meant to move,” Schultheis said. “It’s not meant to sit in place all day and work on deadlines.” Pay attention to your body and note signs of fatigue, Schultheis said, and take a break when needed. Physical therapists like Schultheis spend much of their time talking to people about proper desk setup and even make site visits to analyze clients’ form. From screen position to chair support, mouse distance from

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18 - HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013

Pot pollutes, docs say Research can’t make it a bogeyman but finds ill effects from heavy recreational use. By Angus M. Thuermer Jr.

I

t’s legal next door in Colorado. A Pew Research Center survey published in April shows that a majority of Americans favor legalizing it. In a resort town like Jackson, a subculture — broadly defined by one politician as comprising young athletes — partakes regularly. It’s pot. It’s here. It’s everywhere. Is smoking marijuana harmful? A survey of a few Jackson Hole doctors suggest it might be unhealthy. They’ve got some words for users or would-be users. Why would you voluntarily put smoke in your lungs, one asks. You know it doesn’t belong there. Coughing is a sign of that. Marijuana has been linked to schizophrenia and could accelerate schizophrenic tendencies when used by youth, another says. Pot impairs judgment and fine and gross motor skills, a third declares. It shouldn’t be influencing people treading a thin line in the wilderness or those driving. Marijuana advocates scoff at decades of bogey-

BRADLY J. BONER / NEWS&GUIDE FILE photo

Marijuana has some medicinal effects, but firing up for fun is frowned on by physicians. Smoke in general is bad for lungs, they say, and because pot impairs judgment it’s a particularly bad choice when you’re behind the wheel or in the wilderness.

man attitudes regarding the drug. They point to medicinal properties, now widely recognized, and say one study even suggests pot makes drivers more careful. Researchers also have sought to determine whether the use of cannabinoids, the derivative of marijuana, could be useful in the treatment of dementia. As recently as 2009, no conclusive evidence had been uncovered, but laboratory studies referenced by the Cochrane Dementia and Cognitive Improvement Group indicate they may “regulate some of the processes that lead to neurodegeneration.”

Body as temple

The body is the temple, someone once said. Don’t pollute it. Dr. Jim Little Jr. of St. John’s Family Health and

Urgent Care would agree. He starts from a commonsense observation. “Smoke is generally not good to inhale,” Little said. This is borne out in some studies, where researchers first had to find a method of categorizing the extent of marijuana use. In studying habitual pot smokers, scientists coined the term joint-years. A person would have smoked for a joint-year after consuming a joint a day for a year. Short-term marijuana use was found to make bronchial tubes wider, according to a 2007 review of studies published in the Archives of Internal Medicine. But long-term marijuana smoking reveals symptoms of “obstructive lung disease,” the conclusion stated. In a 2012 study on the effects of pot on pulmonary See POT on 19

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function published in The Journal of the American Medical Association, author Dr. Mark Pletcher and others found no deleterious effects of low or occasional use when pot was employed to control pain, boost appetite, affect mood and manage other chronic symptoms. Heavy use was another matter. “Our findings do suggest an accelerated decline in pulmonary function with heavy use and a resulting need for caution and moderation when marijuana use is considered,” the researchers wrote. A 2006 review of literature, also published in the Archives of Internal Medicine couldn’t find a link between pot smoking and cancer. That didn’t stop authors from sensing a “biological plausibility,” of a connection and urging caution. “Physicians should advise patients regarding potential adverse health outcomes until further rigorous studies are performed that permit definitive conclusions,” they said. Little noted a difference between marijuana joints and cigarettes. “Generally it’s not filtered,” he said of pot, “so you’re getting all of the tar.” Little has another point, one raised years ago when the U.S. sprayed Mexican dope fields with the herbicide paraquat. “You have no idea what pesticides people have treated the plants with,” Little said. “Who knows what the hell is going on pot plants?” With legalization at the state level in places like Colorado, there will be some oversight to that aspect of the marketplace, he said. “At least in that setting, there’s the potential to control,” he said.

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“You have no idea what pesticides people have treated the plants with. Who knows what the hell is going on pot plants?”

Pot affects judgement

Marijuana users would do well to avoid the drug when traveling in the backcountry and certainly when driving, doctors advise. The latter, of course, is illegal. It’s called driving under the influence. Cops and drug recognition experts have methods of determining whether a driver has been smoking marijuana. Symptoms of drug use can be probable cause for a search for pot — either on or in a person. It’s not just about party poopers spoiling a euphoric tour along a scenic highway. “It affects your ability to drive,” Little said of pot. “It affects your judgment.”

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Why do they call it dope? Does pot make you stupid? It’s widely known that marijuana smokers lose their focus and can’t remember things when they’re high. For their study, “Residual cognitive effects of heavy marijuana use in college students,” undertaken by Dr. Harrison Pope and Deborah YrgelunTodd in 1996, the researchers likely had no trouble finding volunteers. Heavy users had smoked a median of 29 of the last 30 days, light users only one. They were tested 19 hours after being admitted to quarantine. “Heavy users displayed significantly greater impairment than light users on attentional/executive functions,” the researchers wrote in The Journal of the American Medical Association, including “reduced learning of word lists.” “Heavy marijuana use is associated with residual neuropsychological effects even after a day of supervised abstinence from the drug,” the two concluded. “However, the question remains open as to whether this impairment is due to a residue of drug in the brain, a withdrawal effect from the drug or a frank neurotoxic effect of the drug.” What are the effects on a marijuana user later in life? At a time when there’s increasing worry about Alzheimer’s, dementia and memory

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HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013 - 19 Many Jackson Hole residents venture into the woods to be where their decisions can have meaning, where they can control their fate and avoid the pitfalls of the wild while experiencing the beauty of raw nature. Being high in such an environment is a bad idea, the medical director for Grand Teton National Park said. Dr. Will Smith also is an emergency medical specialist with ties to St. John’s Medical Center and Teton County Search and Rescue. When high, people aren’t thinking Eden Energy Medicine as clearly as usual and don’t always Therapeutic Massage react normally, he said. Craniosacral Therapy “It might change your decision making, probably for the worse,” he Reiki said. Using marijuana de-tunes fine and gross motor skills and may inLeslie Mackenzie crease risk taking. 207-701-1051 “It’s definitely one of those things leslierobinmac@yahoo.com I’d advise against,” he said. “I’d avoid alcohol or any other drugs when 253987 you’re out in the wilderness as well as driving or any work activities where you rely on decision making.” Having said that, Smith, know of – Jim Little Jr. doesn’t any studies that physician links the use of Providing Comprehensive marijuana to mountain accidents.

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Continued from 19

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loss, some baby boomers are starting to wonder about their drug use as they approach old age. At St. John’s Institute for Cognitive Health, founding director Dr. Martha Stearn said she’s had patients raise questions. “Some of them come in worried,” about all the “recreation drugs,” they might have used in their youth, Stearn said, including pot and LSD. So far, research hasn’t turned up much. “I haven’t seen anything in the literature to suggest that as a risk factor,” Stearn said. But, she added, “you have to wonder.” What is troubling is a growing suspicion that marijuana use among youth susceptible to schizophrenia may promote that malady. Following up on studies, Ann MacDonald, editor of Harvard Health, wrote a column headlined “Teens who smoke pot at risk for later schizophrenia, psychosis.” “Evidence is mounting that regular marijuana use increases the chance that a teenager will develop psychosis, a pattern of unusual thoughts or perceptions, such as believing the television is transmitting secret messages,” she wrote. “It also increases the risk of developing schizophrenia, a disabling brain disorder that not only causes psychosis, but also problems concentrating and loss of emotional expression.” The acceleration of problems has its greatest expression among those predisposed to schizophrenia and similar conditions, and could hasten the onset. “Young people with a parent or

sibling affected by psychosis have a roughly one in 10 chance of developing the condition themselves — even if they never smoke pot,” MacDonald wrote. “Regular marijuana use, however, doubles their risk — to a one in five chance of becoming psychotic.” Among youths who are not at risk, normal chances of psychosis are seven in 1,000, a risk that doubles with regular pot smoking, she said. The brains of teens are in their very, very formative years,” Stearn said. Into the early 20s, when it reaches its maximum weight and growth, there’s a pruning of the brain, a remodeling. “Neurons get discarded along the way,” she said. “Schizophrenia, it’s like a developmental aberration,” Stearn said. “What is contributing to that? Toxic agents like pot?” While pot has beneficial medi– Martha Stearn cal effects in physician some instances, it might also aid in the treatment of dementia, studies suggest. The science so far is young and inconclusive, but researchers urge further study. “Laboratory studies have indicated that cannabinoids may regulate some of the processes that lead to neurodegeneration,” author Sarada Krishnan and others wrote in 2009 for the Cochrane Dementia and Cognitive Improvement Group. “This suggests that cannabinoids could be useful in the treatment of neurodegenerative dementias such as Alzheimer’s disease.” Stearn found the paper intriguing. “It’s being looked at as possible treatment,” she said, “which is surprising to me. I haven’t heard anything about this.

Schizophrenia, it’s like a developmental aberration. What is contributing to that? Toxic agents like pot?”

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Monitoring is key after head injury

HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013 - 21

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on Mobeck received a pass from the left wing in a recreation league hockey game earlier this year and headed toward the net with the puck. Skating forward, prepping for a slap shot, he collided with a defensive player head-on. “As soon as it happened I went down to the ice and took off my helmet,” he said. “My head was pulsating.” He took a break, then skated two more shifts in the game. “I was consciously thinking about the fact that my head wasn’t right,” he said. “I had a horrible headache and felt disoriented.” He decided to quit for the evening. A little while later, with advice from his coach, he headed to the emergency room. After some cognitive and balance assessments, doctors confirmed he had a concussion and he needed to rest. During the next few days, Mobeck felt physically ill. “The sort of sick where you spin around on a merry-go-round and feel like you’re going to throw up,” he said. He had a hard time concentrating, a common symptom of the brain injury. He found he couldn’t perform his duties as the executive director of the Murie Center. Concussions happen frequently in high-speed and high-impact activities, said Dr. James Little Jr. “A concussion basically is a bruised brain,” he said. “It takes time for that bruising to go away. ... It’s not something that you can really rush.” The best thing someone can do if they have had a concussion is to rest and decrease activity until symptoms resolve, Little said. The most common symptoms after a concussion are headaches, amnesia and confusion, according to the Mayo Clinic’s website, but they affect every person in different ways. “Some people seem to rebound from them very quickly,” Little said. “It depends what part of the brain is affected.” Also, the effects of concussions are cumulative. “Over time it can lead to perma-

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High-speed and high-impact activities carry the risk of taking a blow to the head and receiving a concussion. Symptoms can be mild or severe, but every injury should be taken seriously.

nent damage if you have repeat concussions over and over again,” he said. If a recently concussed person receives another blow to the head before he is fully recovered, the effects can be significant, he said. That is called Second Impact Syndrome. “If you re-injure yourself, there’s a chance the repeat injury will be much more severe than initial injury,” he said. At Jackson Hole High School, student athletes are given a baseline test at the beginning of each season to better diagnose concussions. The software is called ImPACT, athletic director Mike Hansen said. “If we suspect someone might have a concussion, we run them through the software again,” he said. “It gives us a score. Depending on the score, we forward it on to health care professionals.” Last year, the high school launched the pilot program with the soccer team. It began testing all student athletes this year, he said. The program also stresses proper technique for each sport, Hansen said. For example, the safest way to tackle in football is to keep your eyes up and to not lead with the helmet, he said. Technique can help minimize the See HEAD INJURY on 22

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Concussion signs

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risk, but it can’t eliminate risk entirely, high school team physical therapist Bo Mosby said. “The challenging part of the concussion is it’s not a physical injury,” Mosby said. “If you sprain your ankle you can see the swelling and the actual injury. A concussion is a silent injury.” Concussions don’t show up on CT scans, he said, so monitoring symptoms is more important to recovery than getting a scan. Red flags such as drowsiness, slurred speech and vision problems mean people should go to the doctor immediately, he said. It took nine weeks for Mobeck to recover from his concussion. He still gets headaches most days. “It won’t keep me from playing hockey,” he said. “It’s a risk that you take.” But now he will be better able to recognize the concussion symptoms and stop playing. “I really didn’t have that understanding until this one,” Mobeck said. Amateur and professional sports are becoming increasingly aware of concussions and are trying to learn more about the long-term effects. “Concussions are one of those things that are very much in the news,” Mosby said. “There is tons of research out there these days that show these retiring [National Football League] players are having earlyonset Alzheimer’s and things like that that are probably attributed to concussions in the past.” Former NFL player Junior Seau’s family filed a wrongful death lawsuit against the league earlier this year for traumatic brain injury and ultimately depression that alledgedly led to his suicide. “We don’t really know what the long-term effects are going to be,” Mosby said. “I’ve tested kids that have had three or four, and I don’t re-

WORK HURTS

We see the reversal

Continued from 17

of disease as well as recovery from the symptoms of aging everyday at our medical center.  Become one of our many success stories. DR JAMES RANIOLO D.O., AOBFP, ABAARM n Board Certified in Family Practice (AOBFP) n Board Certified in Anti-Aging Medicine (ABAARM) n Advanced Fellowship in Functional and Regenerative Medicine (ABAARM) n Masters Degree student in Metabolic and Nutritional Medicine  (USF)  

the keyboard to height of the keyboard, tiny changes can make big differences in how a person feels after work. “You have to figure out what works for each person,” Schultheis said. In 2010, lawyer Elizabeth Moore began working long hours as a clerk for a judge in Cheyenne. Sitting with a computer and book for 14 hours in a row was painful, she said. “I got really nasty backaches,” Moore said. So she began to stand up for part of her workday. At first, that was painful, too, so she alternated between sitting and standing. “The ability to change positions all day makes a big difference,” she said. Now, as a lawyer in Jackson at Moore & Meyers, she stands most of the day. When she’s not dancing, that is.

Signs and symptoms of concussion might include:

a

• Headache or a feeling of pressure in the head • Loss of consciousness • Confusion or feeling as if in a fog • Amnesia surrounding the traumatic event • Dizziness or ‘seeing stars’ • Ringing in the ears • Nausea or vomiting • Slurred speech • Fatigue Symptoms of concussion might be immediate or delayed by hours or even days after injury: • Concentration and memory problems • Irritability and other personality changes • Sensitivity to light and noise • Sleep disturbances • Psychological adjustment problems and depression • Changes in taste and smell Source: The Mayo Clinic ally notice anything.” Of course, the best treatment is prevention, Little said. Some students who have had concussions in soccer, for example, wear padded headbands, Mosby said. “Wear helmets for activities that involve high speed and high impact,” he said. “Even if you’re a very good skier, that just means you’re more likely to be going fast if you hit a tree or you get hit by someone else,” Little said. “If you’re not wearing a helmet, you’re at high risk for a head injury.” “You can leave your Pandora on and dance at your desk,” Moore said. “I boogie at it.” What works for Jamie Storrs, an account manager or “bro-fessional” at Terra PR, is a ball chair. Years of guiding raft trips injured his back, Storrs said, so for about a year he’s been sitting on an exercise ball. He sits, wiggles, rolls and bounces while at his desk, making sure to take time during the day to go walk his dog or stand up. Using exercise balls for chairs is of little benefit, according to a recent study by Jack Callaghan, the Canada Research Chair in Spine Biomechanics and Injury Prevention at the University of Waterloo in Ontario. The research, reported April 12 by The New York Times, found that the balls did not provide a significant core workout or improve posture. Storrs was unfazed by the report. “It seems to work for me,” he said.

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Helping Latinos habla health

HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013 - 23

Many programs available in Teton County.

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n a seasonal job market, health insurance isn’t a guarantee and affordable health care is not always available. Those problems can be compounded when you’re battling a language barrier in a health care system that already is jargon-laden. Getting care often is more of an ideal than a reality. For Teton County’s Latino population, these are the most common obstacles to all kinds of care, from annual physicals to chronic pain. “We have a primarily first-generation adult population here, meaning we have basically the immigrant population and their children,” said Vida Sanchez, executive director of El Puente. “Even if they speak English well enough to navigate through the work environment, they might not speak English well enough to navigate the health care system. It’s a very high register of the language at every step, even when you’re figuring out where to go.” These are problems across Wyoming, according to a survey of health care disparities compiled by the Wyoming Department of Health. Latinos are less likely than whites to get affordable care when they’re pregnant, less likely to live above the poverty level and less likely to be able to afford their health care. In Teton County those factors hold true but are generally considered to be caused by the area’s seasonal economy. Programs have sprung up to help reverse the trends, and many of those who deal directly with the Latino community spend a great deal of their time finding programs that can help a family receive the right care. Where Teton County differs most is in the number of programs set up to help and the number of medical providers who have relationships with such organizations, Sanchez said. Along with El Puente, the Latino Resource Center provides guidance about dealing with the health system as part of an effort to help Latinos assimilate. Even organizations whose primary beneficiaries aren’t Latinos are aware of the issues for that community and often know where to send them. “It’s really very unusual in smalltown U.S.A. to have the awareness and the generosity you do here in Jackson,” she said. “Parts of our medical community are very generous to the uninsured and without that piece, access would definitely suffer.” El Puente provides medical translation and financial guidance to people who aren’t fluent in English. Sanchez estimates that El Puente serves at least two thirds of that group in the county. Some barriers to care are cultural.

Health disparities Statewide, barriers to health care access for Latino families lead to several serious disparities in their health compared with white families. According to the Racial and Ethnic Disparities in Wyoming 2012 Report, Hispanic families in Wyoming are more likely than white families to: •have lower median family incomes •not receive prenatal care in the first trimester •not receive any prenatal care •have children without continuous health insurance •smoke and drink while high school students •smoke as an adult •be overweight or obese •have fair or poor health •not get care due to cost Bonnie Pockat, the maternal and child health coordinator at Teton County Public Health, sees many women who enter the American care system for the first time when they’re pregnant. “A lot of women who came here from Mexico or a South American country, well, their medical systems are different,” she said. “They’re used to just showing up at a clinic. A lot of these women are learning how to navigate our system.” The number of families with children who are U.S. citizens has increased, she said, but parents don’t always know they can get health insurance for their kids through Medicaid. Pockat said her department helps families that don’t realize they could be getting help. Often all that’s needed to connect a family to care is a guide, whether a translator or someone from Pockat’s staff, Sanchez said. While insurance affordability, benefit eligibility and other issues are part of bigger policy and voting decisions, it is the day-to-day work of setting up payment schedules, answering billing questions and dealing with a system that’s Byzantine even to native speakers that helps. “A big piece of being able to improve access is reducing that chaos and confusion,” Pockat said. “I would say in general that our community, for being a small town in Wyoming, does an amazing job at improving health care access for our Latino population, and it’s mostly by paying attention to those areas where we can help.”

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24 - HOLE HEALTH, Jackson Hole News&Guide, Wednesday, May 1, 2013

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