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NORTHERN COLORADO

MEDICAL WELLNESS FIVE DOLLARS

VOLUME III 2008

SLEEP

DISORDERS LINKED TO WOMEN’S HEART DISEASE

INFERTILITY

WHAT NEXT?

ROCKY MOUNTAIN CENTER FOR REPRODUCTIVE MEDICINE

VEIN

SUCCESS

VEIN & LASER CENTER OF NORTHERN COLORADO

BODY CONTOURING AMY BREWSTER, MD PLASTIC SURGERY CHANGES LIVES

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Accounting Manager Karla Vigil Office Assistant Ronda Huser Contributing Writers Alice Ashmore, Kevin Bachus, Laura Lee Carter, Allie Comeau, Caroline Creager, Lynn M. Dean, Lydia Dody, Angie Grenz, Connie Hein, Deborah Huth Price, Corey Radman, Kay Rios, Jason Webb

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Copy editor Laura Lee Carter Contributing photographers Dave Arns, Lydia Dody, Shaun Hudson, Todd Newcomer Affiliations Downtown Business Association Fort Collins Area Chamber of Commerce Loveland Chamber of Commerce Greeley Chamber of Commerce Windsor Chamber of Commerce 2008 Style Magazines January-Loveland/Greeley Medical & Wellness Magazine and Directory February-Building & Remodeling March-Northern Colorado Medical & Wellness March-Family, Community & Philanthropy April-Business of Northern Colorado May-Building & Remodeling - Home & Garden May-Northern Colorado Medical & Wellness June-Business & Building July-Fort Collins Medical & Wellness Magazine and Directories August-Women In Business September-Building & Remodeling Home Interiors & Entertainment October-Women Health & Breast Cancer October-Northern Colorado Medical & Wellness November-Holiday December-Winter/Wedding Style Media and Design, Inc. magazines are free monthly publications direct-mailed to homes and businesses in Northern Colorado. Elsewhere, subscriptions for 16 issues cost $24/year. Free magazines are available in stands at 75 locations throughout Northern Colorado. For ad rates, subscription information, change of address, or correspondence, contact: Style Media and Design Inc., 211 W. Myrtle St., Suite 200, Fort Collins, Colorado 80521. Phone (970) 226-6400. E-Mail: rhonda@StyleMedia.com

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©2008 Style Media and Design Inc. All rights reserved. The entire contents of Style Magazine is copyrighted and may not be reproduced without the expressed written consent of the publisher. Style Media and Design Inc. is not responsible for unsolicited material. All manuscripts, artwork, and photography must be accompanied by a SASE. The views and opinions of any contributing writers are not necessarily those of Style Media & Design Inc.

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Lydia's STYLE Magazine


publisher’s letter Sometimes You Have to Ask for Help Following the excellent work of Dr. Amy Brewster with three people who made the difficult commitment to change their lives, has been inspirational. Thank you Amy, for your dedication to your field and to your patients! Enjoy reading about Body Contouring, Infertility options, and Vein Surgery Success and more! This month the focus of this letter will be a very personal one. Over the years I have shared my life with my readers. My happy moments and the challenges of being a mother of two daughters; the blessings of my family and friends; the progress of Style and the great staff that helps me create the magazines we produce and more. But nothing has put me in as vulnerable position as sharing my devastating breast cancer diagnosis that turned my life upside down in November 2000. I shared my hardships, my emotional trauma and fear, and my spiritual awakening and healing. I did it to show women that they aren’t alone in the diagnosis and that there is HOPE. Quotes and inspirational sayings cover the wall above my desk and I read them often, especially the one from Mother Theresa. “I know God will not give me anything I can’t handle. I just wish that He didn’t trust me so much.” My plate is so full right now it is overflowing so, though it is scary to ask, I decided I would ask for help – publically. Many of you know that in 2001 while undergoing my chemotherapy and

the patient

This new, interesting and informative issue of Northern Colorado Medical & Wellness has been especially inspiring to me.

hospitalizations for breast cancer, I had a vision to turn my nasty experience into something positive to help other women who would be diagnosed with breast cancer. For a year I worked on creating a non-profit and in January 2002 the Lydia Dody Breast Cancer Foundation started providing free services for women fighting the battle. With the generous and kind help of many sponsors, donors, providers and volunteers the foundation has provided free services for hundreds of women for the past six years. Recently we changed the name to Hope Lives but all the same services have continued. We have helped with child care the day of a woman’s chemo; we have moved families; we have conducted support groups; we have cleaned women’s houses; we have provided acupuncture for pain management; we have provided therapeutic massage, healing touch, and counseling; we have provided wigs, transportation and more. We have been a center focused on providing women and their families emotional, psychological and physical support and empowering women through education, mentoring, and free complementary services. The numbers continue to increase and manpower and funding isn’t keeping up. We need your help. We have a small office and we keep our expenses low. We raise money by conducting events but that heavily burdens the very small

staff. We don’t want to turn women away. We need volunteers to help us with office coverage, volunteers to help with our upcoming big fund-raising gala in October, volunteers who understand the importance of our purpose and to take a leadership position in being on our board of directors. Hope Lives Breast Cancer Support Center’s sole purpose if to help women and their families right here in our communities. We need your help as financial partners/sponsors and we need your donations. We deeply appreciate everyone who has dedicated time, talents, and financial donations in the past in support of this very worthwhile cause. Please help us continue providing these essential services to support healing until a cure is found. Your efforts have and will continue to make a difference in our community. Hope Lives Breast Cancer Support Center 2729 Redwing Rd, Suite 260 Fort Collins, CO 80526 970-225-6200 www.hopelives.org, staff@hopelives.org Thank you with all my heart,

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May 2008

CONTENTS 14 18 20 24 26 30 32 34 36 37 38 40 44 46 50

northern colorado medical & wellness

Body Contouring Plastic Surgery

Sleep Disorders

Linked to Women’s Heart Disease.

Vein Surgery Success

The Vein and Laser Center of Northern Colorado

Evolution of Reflections Medspa Maria Chand, MD joins the team.

Infertility. What Next? Rocky Mountain Center for Reproductive Medicine

Kidney Stones Are No Joke!

James Wolach, MD explains causes & cures.

Leaky Bladder and Bulging Abdomen Myth vs. Fact

14

Body Contouring Plastic Surgery

20

Vein Surgery Success The Vein and Laser Center of Northern Colorado

ADHD Kids Find Help Diagnosis and treatment.

Summer Camp Adventure

The Learning Camp helps kids with ADHD.

Married Vets

Share Profession & Life

A Chance At Nine Lives

Fort Collins Cat Rescue saves lives.

Pulse Fitness Center

Health Club celebrates 28th anniversary.

Wellness When Traveling Abroad Don’t Let a Nasty Health Scare Ruin Your Next Trip Abroad

Playing It Safe

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Infertility. What Next? Rocky Mountain Center for Reproductive Medicine

37

Married vets

Share Profession & Life

Summer safety for kids.

Thomas Chiavetta, MD Striking a Balance

Amy H. Brewster, MD, of Mountain Vista Plastic Surgery, is Board Certified, American Board of Plastic Surgery.

on the cover

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pulse Celebrates 28th year Health Club celebrates 28th anniversary.

Her smart Joseph Ribkoff ensemble of jacket, culottes, and shell is accented by Yolanda black onyx jewelry, all courtesy of Designs, Fort Collins. Hair design by Vanessa Jacquot, make-up by Kim Shore of Mane Door Salon, Fort Collins. On location at Harmony Campus, PVHS. Cover photo by Hudson Photography

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

50

Thomas Chiavetta, MD Striking a Balance


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Plastic Surgery

Body Contouring I intentionally keep the volume of my practice small so that I have more oneon-one time with each of my patients. - Amy Brewster, MD, Mountain Vista Plastic Surgery

Body Contouring: The Final Phase

by Lydia Dody

“I have great compassion for people who have taken off a substantial amount of weight and then, as a result, have lots of loose hanging skin. After all of their hard work, this is a constant memory of the fact that they were once overweight. Eventually many choose to complete the process with the final body contouring phase. Surgery can also help those that are stuck in the weight loss process and need help reaching their next goal. ”

A

my Brewster, MD is a University of Kansas graduate, which was where she developed a passion for this specialty. Her education included a Cranialfacial Fellowship and Plastic Surgery residency training under internationally renowned body contouring specialist, the late Ted Lockwood. She is Board Certified with the American Board of Plastic Surgery. Practicing since 1996, Brewster keeps her Mountain Vista Plastic Surgery office small and patient focused. “I intentionally keep the volume of my practice small so that I have more one-onone time with each of my patients,” she explains. “A large part of my practice has always been breast augmentation, reduction, and reconstruction, but as weight reduction surgery and weight loss have grown in popularity, the need for complete lower body lifts, breast lifts, tummy tucks, arm lifts, thigh lifts, and spot lipo suction have evolved for a more normal appearance to the body.” She explains that after weight reduction surgery, a

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substantial amount of weight loss, or post baby weight loss often the skin and tissues lack the elasticity necessary to conform to the new smaller body size. The skin can be severely stretched with the abdominal area having a muffin-like overhang. The upper arms may sag, the breasts flatten and hang with nipples pointed down, and thighs and buttocks can sag with hanging skin. Body contouring surgery addresses these issues in stages. It improves the shape and tone of the body by removing the excess sagging fat and skin and tightening the underlying muscle when indicated. This results in a more normal appearance and is the final phase of the weight loss process. Brewster and her team, Yvette Brewer, Aesthetics Coordinator, and Christy Vance, Practice Administrator, spend a lot of time with their patients educating and explaining. “This surgery is a huge commitment not to be taken lightly - emotionally, financially, physically, and having enough time away from work – are all factors that need to be considered,” says Brewster.

“It is important that a patient’s weight is stabilized and they are on a nutritionally sound diet for maximum results and optimal healing. They must also realize that enhancing body contouring is a wonderful and lasting finale to weight reduction but it does result in scars, which do however, diminish over time.” Brewster explains that she does not like to do all areas at one time for safety, for optimal pain management and the best recovery. “I typically combine several areas such as tummy and legs, tummy and breasts, or arms and breasts. Surgery can take as little as one hour but I try not to exceed eight hours for the best patient comfort and recovery.” When asked about recovery, Brewster explains that a minimum of one week at home with a caretaker is critical she explains. “Typically a patient is 90% healed after six weeks.” It is obvious that Dr. Brewster is passionate about her field and the difference she can make in the lives of her patients. “Our patients become our friends as we go through this process together.


My husband says, I have my swagger back now!... I wouldn’t have had the determination to continue without Amy. - Stacey Shepard, patient

It is so rewarding to see them blossom with a new found self-confidence. We are grateful to be a part of this inspirational commitment to health and improved quality of life.” Michael Chellson is a medical device regulatory attorney who was featured in Style’s March 2008 Northern Colorado Medical & Wellness issue. Just a few years ago he weighed in at 450 pounds and was plagued with numerous health problems. Today, after his impressive personal dedication to creating his own weight loss program, commitment to exercise, and good health, Chellson is a trim 168 pound elite athlete involved in competitive motorcycle racing. Chellson’s quick wit comes through when he explained that after his dramatic 282 pound weight loss, “You just can’t lose that much weight without looking like a guy in a baggy suit.” He continued that his decision to have surgery came after an intense and sweaty eight hour day attending a motocross school where his massive skin folds contributed to a serious infection. He knew about the procedure and was impressed with Dr. Brewster’s knowledge in the field. His respect is clear, “She is in the profession for the right reasons. She chooses to be a mom and take family time and her practice is not profit oriented but patient oriented.” Chellson’s surgery took a total of 15 hours and he has 65 inches of incisions. He talked about the fact that the surgery was painful. For the first two weeks, he required a caretaker and it took nearly 2 months for complete healing. Advice he shared, “Make sure you make the decision for the right reasons, don’t expect perfection, have a post surgical support system in place. Surgery is not a replacement for diet and exercise.” “I feel pretty good about myself. Now I see a typical sized person in the mirror. It is a huge improvement in self-image and it has improved all aspects of my life. Yes, it was a good thing and it was an absolute joy working with Amy!”

Northern Colorado Medical & Wellness

Amy Brewster, MD shows patient Stacey Shepard before and after photos of breast augmentation.

Before

After

Before

After

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Plastic Surgery

Body Contouring Michael Chellson today

Before

You just can’t lose that much weight without looking like a guy in a baggy suit. - Michael Chellson

After Scott Baker today

Before

Stacey Shepard, a mother of two young children, Ruby 3, and Miller 5, decided to have surgery for different reasons. A petite 5’3” 35-year-old woman, Shepard gained weight with every child, and at 220 pounds decided to change her life. She wanted to be healthy and have energy to keep up with her active young children. She began by working out and watching her food intake and got down to 180 pounds. As a result, her skin was loose and droopy and she felt self-conscious. In January 2007 she chose to have one big surgery addressing a tummy tuck, breast lift, back lift and liposuction on her legs. She decided to do everything at once to have only one big recovery. The surgery took over 9 hours and she spent two days in the hospital. It took a full month to recover but now she has a flat tummy, smaller thighs, and improved breasts. “I had to wait six weeks to start working

I am very happy with the surgery. Why carry that discomfort around if you have an option? - Scott Baker After

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out, but since surgery I have taken off another 25 pounds after working with a trainer and nutritionist. I am at 160 pounds now but want to take off another 20 pounds. I ran a 9K. I work out three days a week and jog the other two. My husband says, I have my swagger back now!” Shepard is working on losing her last 20 pounds. “Maybe I will need more surgery and possible breast augmentation. I’ll wait to see. I wouldn’t have had the determination to continue without Amy. Scott Baker, Vice President, and Wealth Management Advisor for 10 years with Merrill Lynch has had issues with weight over the years. He would lose weight and then re-gain more - the typical yoyo syndrome. In 2000, at his top weight of 290 pounds, Baker had sleep apnea and learned that sleep is affected by weight. At that weight, his golf game and his scuba activities were being impeded and he decided that at 49 years old, it was “now or never.” He decided to embark on Bariatric surgery with James Dickinson, MD. “It worked really well and I lost weight quickly. Nine months later I have stabilized at 192 to 202. It wasn’t easy. I had to eat drastically differently; five small meals a day. Traveling and business meetings were challenging and I often ordered off the children’s menu.” Luckily, Baker was young enough that his skin had elasticity. “As I lost weight, my skin tightened up everywhere except around my belly. The first three years I didn’t care and it didn’t bother me. But as I got a little older, I had more extra skin on one side. This caused me rashes in the summer that itched and got irritated.” In the summer of 2007 Baker was diagnosed with a hernia that needed surgical attention. He counseled with Dr. Brewster and they decided that this would be a good time to do the body contouring at the same time. “The surgery took over five hours with Dr. Amy Brewster following the hernia surgery. It was a big surgery and luckily I scheduled the recovery over the holidays so I didn’t lose much work time,” shared Baker. “I am very happy with the surgery. Why carry that discomfort around if you have an option? I can now buy clothes off the rack that still fit when I sit down. I have already noticed an improvement in my golf game and I am more comfortable in my wet suit. And, the cosmetic improvement is significant and I feel better about myself. The results are worth it.” Baker spoke highly of Dr. Brewster and her staff. “She is a great surgeon, down to earth, and great at explaining everything. I got excellent care. She is a good person and a good surgeon. She goes above and beyond. She came to our Christmas Open House and brought instruments to take out my stitches on Christmas Eve. Now that’s going beyond the call of duty!” For more information, contact Dr. Amy Brewster, Mountain Vista Plastic Surgery, 2121 E. Harmony Road, Suite 360, Fort Collins, 970-266-0456. Lydia Dody is the Publisher of Style Magazine and is still working on losing that last pesky 15 pounds just like Amy Brewster who has 10 to go.

Northern Colorado Medical & Wellness

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Sleep Disorders

Women’s Heart Health

Studies are showing that, because of what sleep deprivation does to hunger hormones, sleep deprived individuals tend to eat more. - Cindy Crosby, RPsgT, Northern Colorado Pulmonary Consultants’ Sleep Disorders Center of the Rockies Kerry Rayder, RN, Heart Center of the Rockies, assesses her patient’s blood pressure.

Sleep Disorders Linked to Women’s Heart Disease

by Connie Hein

We are all aware through television, radio, and in print, from the American Heart Association, that the greatest risk factors for heart disease in women are smoking, diabetes, high cholesterol, hypertension, and being even moderately overweight.

B

ut researchers have discovered what is believed to be a link between sleep disorders and women’s heart disease. In a recent study at Duke University, researchers found that even when the sleep quality ratings of men and women were similar, women had dramatically higher cardiac risk profiles. Lead researcher, Edward Suarez says in a statement to Brain, Behavior, and Immunity Journal, “For women, poor sleep is strongly associated with high levels of psychological distress and greater feelings of hostility, depression and anger. They had higher levels of all the biomarker tests

18

that have been associated with increased risk of heart disease and higher levels of insulin. Women who reported taking a half an hour or more to fall asleep showed the worst risk profile.” According to the Harvard Gazette, in a study conducted at Harvard-affiliated Brigham and Women’s Hospital (BWH) and published in the January 27, 2008 issue of the Archives of Internal Medicine, researchers found that both long and short sleep durations may be independently associated with an increased risk of heart disease in women. Najib Ayas of BWH and an instructor in medicine at Harvard Medical School is quoted

as saying, “Our research is one of the first to hypothesize that sustained reduced sleep duration as well as an excess, could negatively impact a woman’s cardiovascular health. Our data reflect that short and long sleepers may be at a higher risk of coronary heart disease (CHD).” Ayas and his team found that sleeping five hours or less per night was associated with a 30 percent increase in risk of CHD, and sleeping six hours per night was associated with an 18 percent greater risk. Women who slept eight hours per night had the lowest recorded rate of CHD. Kerry Rayder, registered clinical cardiology nurse, and part of “A Woman’s Heart” Program at the Heart Center of the Rockies, at the Medical Center of the Rockies in Loveland, made these comments about the Duke study, “Though I do not believe that this particular study reveals direct evidence of sleep issues as a cause of heart disease in women, I do think it can be viewed as a factor that affects overall health and heart health. Many studies have shown women do in fact have more sleep issues than men.” Rayder says that in the past most of the sleep research and studies have been done on men, but with this new information the researchers are starting to do more women’s sleep research as it relates to heart disease. Future studies will tell us more about sleep disorders in relation to women’s heart health.


Rayder believes that when either men or women have not had the necessary hours of quality sleep, they are less likely to make good decisions about diet and exercise during the day. “It is less likely a person will take the stairs instead of an elevator when they are sleepy. And we tend to reach for caffeine or candy instead of healthier choices when we are tired or sleepy.” Even though these are little things in our lives, they can add up to major factors in heart health, especially for women. Cindy Crosby, is a registered polysomnographic technologist (RPsgT) and the Sleep Operations Coordinator for Northern Colorado Pulmonary Consultants’ Sleep Disorders Center of the Rockies, which operates both PVH Sleep Disorders Center in Ft. Collins and McKee’s Sleep Disorders Center of Northern Colorado in Loveland. She says, “Studies are showing that, because of what sleep deprivation does to hunger hormones, sleep deprived individuals tend to eat more. Extra weight can put someone at an increased risk for sleep apnea, a syndrome where people stop breathing or have reduced breathing while sleeping. The lack of breathing causes a lack of oxygen to the body which causes the heart to work harder, thus the link to hypertension and cardiovascular disease. Also, because the patient’s oxygen deprived brain will send signals to the sleeping patient to wake up and take refresher breathes, sleep is fragmented and non-restorative and completes what can be a nasty cycle of weight gain/poor sleep and sleep apnea/poor heart health if allowed to go unchecked.” On March 7, during National Sleep Awareness Week, several members of the newly formed National Sleep Awareness Roundtable (NSART) met with Department of Health and Human Services Secretary Michael Leavitt to discuss how to raise national awareness of the importance of quality sleep and the signs and symptoms of sleep disorders. At the meeting, Secretary Leavitt expressed interest in working with NSART on several fronts to see that federal agencies and other public health officials learn more about how disrupted sleep impacts current national public health priorities such as hypertension, heart disease, stroke, depression, diabetes, obesity and at-risk behaviors such as alcohol and drug abuse. These preliminary research findings have already shown good reasons for women to pay special attention to problems like insomnia. All the experts agree that poor sleep habits are a definite factor in a woman’s overall health, and should not be ignored. Hopefully there will be future research studies to tell us more about any links between women’s heart disease and sleep disorders. For more information on the treatment of sleep disorders contact the PVH Sleep Disorders Center at Mountain Crest in Ft. Collins at (970) 663-3377. For more information on women’s heart health contact the Heart Center of the Rockies in Loveland at (970) 221-1000.

A Good Nights Sleep... You deserve it more than once in a blue moon.

TWO CONVENIENT FRONT RANGE OFFICE LOCATIONS: In Fort Collins at the Harmony/Timberline Medical Campus In Loveland at the Medical Center of the Rockies

LOCAL: 970.663.3377 TOLL FREE: 888.R.SLEEP.N (888.775.3376) Northern Colorado Pulmonary Consultants, P.C. Pulmonary Disease

Connie Hein is a freelance writer in Windsor, and author of the Toliver in Time series of children’s books.

Northern Colorado Medical & Wellness

Critical Care

Sleep Disorders

Mark Petrun

David Kukafka

Mark Neagle

Anna Negrõn

MD FCCP DABSM

MD FCCP DABSM

MD FCCP BE

MD

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Vein Treatment

EndoVenus Laser Therapy Holly Trumble and Charmaine Pankewicz enjoy the shorts weather at Benson Sculpture Park in Loveland.

Vein Surgery Success by Lynn M. Dean

When Holly Trumble took her grandkids to the pool each summer, children would stare and ask her about the bulging, twisting “snake” on her legs. It was something she was used to. She had suffered from varicose veins for more than 30 years, ever since the birth of her first child.

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t just got worse and worse,” she says. “It started at my knee and went up and up. It was bumpy and bulgy. It got so tired of it. It was so repulsive that I would never wear shorts until I was totally tanned.” For Charmaine Pankewicz, her varicose veins were not only ugly, but also extremely painful. As an operating room nurse, she spent almost her entire workday on her feet. “I would come home after a day of work and have swollen, tired, and achy legs,” she explains. Even when she went to

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bed at night, Charmaine couldn’t find relief. “My legs were restless.” Holly and Charmaine are not alone. According to The Vein and Laser Center of Northern Colorado, 25 % of all women and 15 % of men have varicose veins. “They are more common in women,” says Stephen Peck, MD, an interventional radiologist with the Center. “Pregnancy and hormone levels are probably, in part, the cause. But we treat a fair number of men, too. Roughly one in five of our patients are men.” And while many women like Holly and

Holly Trumble before and after surgery.


Charmaine develop varicose veins during or after pregnancy, according to Dr. Peck, the problem can show up at any time. “I’ve treated women in their early 20s and early 80s and any age in between.” In addition to pregnancy, which increases blood flow throughout a woman’s body, genetics play a huge role in whether a woman, or a man, will develop varicose veins. “If your mother had them, or your grandmother had them, you are more likely to develop them,” explains Dr. Peck. Both Holly and Charmaine had relatives with varicose veins. Other common causes include excessive body weight and prolonged standing. And while both she and Holly are normal weight, Charmaine works on her feet for almost her entire operating room shift each day. Holly and Charmaine both hated the way their legs looked. But varicose veins are more than just unattractive. They can lead to serious health problems. When valves in the leg veins fail, gravity pulls the blood backward toward the feet (reflux) and blood pools in the lower extremities. As pressure in these veins increases, varicose veins develop. “Under pressure, the veins burst and bleed,” says Dr. Peck. “In addition to pain, it can lead to significant skin changes including hardening of the skin, swelling, discoloration, and ulceration.” “It causes stagnation, which can lead to vascular changes, dermatitis and ulcers,” agrees Michael Roller, MD FACS, one of Dr. Peck’s partners and a surgeon with The Vein and Laser Center of Northern Colorado. “Although there is a portion of our patients who come for cosmetic reasons, most of our patients come in for painful varicosities. A small percentage of our patients with varicose veins, develop skin changes and ulcers. Unfortunately, without treating the source of their problems, their ulcers won’t heal.” “Ulceration can lead to destruction of an entire extremity if not treated,” adds Dr. Peck. “We get a lot of our referrals from the Wound Clinic.” The veins that cause most of the problems, the greater saphenous and lesser saphenous, are near the surface of the skin and, ironically, typically carry the least amount of blood back to the heart. In a way, they are superfluous. Yet these same veins are the pipelines which feed varicose veins. Although patients may treat the symptoms of varicose veins by wearing supportive stockings and avoiding prolonged periods of standing, these solutions are not always practical and do not address the source of the problem. To do that, doctors must remove or destroy the pipeline that feeds the bulging vein. “Eighty to 85 % of varicose veins are due to reflux in one of the greater complexes,” explains Dr. Roller. “Because we have a duplicated system, (a deep network of vessels and another network near the surface), we can remove that vein.” In the past, standard treatment included vein stripping, a surgical procedure in which the problem vein was literally pulled out. Often this was an inpatient hospital procedure which

Northern Colorado Medical & Wellness

Our group offers the whole spectrum of venus procedures. We decided to combine with the radiologists so that we could provide some of the services that they normally do along with the procedures that we do. - Michael Roller, MD FACS, The Vein and Laser Center of Northern Colorado

Ulceration can lead to destruction of an entire extremity if not treated. We get a lot of our referrals from the Wound Clinic. - Stephen Peck, MD, The Vein and Laser Center of Northern Colorado

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Goodnight? Good luck.

A good night’s sleep can be elusive for some. Try these tips for a more restful night without the use of drugs: • Keep the bedroom for sleep and sex only. • Prepare the bedroom for sleeping. The room should be dark, cool, and quiet.

• Go to bed and wake up at the same time everyday.

sleep, get up and do something relaxing for 10 minutes before trying again.

• Restrict caffeine use to the morning.

• If your mind is racing, try jotting down your thoughts in a note pad kept on your nightstand.

• Exercise regularly, but not too close to bedtime. Try to exercise at least 4 hours before bedtime. • Establish a pre-bedtime routine. A warm bath 2-3 hours before bed time initiates a drop in body temperature, mimicking a natural process that promotes and triggers sleepiness. • Don’t toss and turn. If you find that after 20 minutes you are unable to sleep or return to

M A K E YO U R L E G S YO U N G A G A I N

TO D AY please visit

www.ColoradoVeinAndLaser.com for all the information

ADVANCED LASER TECHNOLOGY TO TREAT:

Varicose Veins • Spider Veins • Leg Ulcers • Other Vein Problems

Free Vein Screening with Ultrasound (Limited ultrasound. See clinic for details)

970.267.2661

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• Avoid alcohol too close to bedtime. It may help you fall asleep faster, BUT it also leads to more and earlier awakenings. Courtesy Cindy Crosby, Sleep Disorders Center of the Rockies

Continued from page 21 required anesthesia and a long recovery period. But today, new medical procedures like EndoVenus Laser Therapy (EVLT), are available. EVLT uses lasers to damage the vein walls, shrinking them to prevent blood flow. It is a minimally invasive procedure done in the doctor’s office under local anesthesia. “Once you laser the greater or lesser saphenous– the source of the problem-- the chances of the varicose veins coming back are greatly reduced,” says Dr. Peck. “If you don’t do that, they will come back.” With this new therapy, came opportunities for collaboration among local doctors and a new practice. The Vein and Laser Center of Northern Colorado combines the services of two surgeons and two interventional radiologists in one convenient office. “Our group offers the whole spectrum of venus procedures,” explains Dr. Roller, one of the surgeons in the group. “We decided to combine with the radiologists so that we could provide some of the services that they normally do along with the procedures that we do. We’ve been working here together for about a year and a half now.” “We have a lot of experience with wires and catheters,” adds Dr. Peck. “The techniques of this new therapy lend themselves to being performed by interventional radiologists.” The Center’s patients typically see good results. After EVLT, patients can often return to work or resume their daily activities right away. Sometimes, as was the case with Holly, EVLT is combined with more traditional techniques to ensure the best results for each patient. Both Holly and Charmaine are happy with their results. “The recovery period was so easy,” says Holly. “I could do everything I normally did with very little pain. I have no more aching in my legs and they look fabulous.” “It has increased my self-esteem,” says Charmaine, “And medically I feel unbelievable. I don’t go home with swollen legs anymore. They don’t ache and I don’t feel like I have to sit down at work.” Lynn M. Dean is a freelance writer living in Northern Colorado.


WORLD CLASS CARE IN YOUR HOMETOWN!

UCR has been providing urologic care to patients in Northern Colorado since 1970. We currently have offices that are staffed full-time in Loveland and Fort Collins. We serve McKee Medical Center, Medical Center of the Rockies, Poudre Valley Hospital, Skyline Surgery Center and Harmony Surgery Center. Our physicians treat all urologic disorders and perform scalpel-less vasectomies.

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Northern Colorado Medical & Wellness

970-484-6700

2315 E. Harmony Rd., Ste. 140 Fort Collins, CO 80528

UCR has the most experienced Robotic and Laparoscopic Team in Northern Colorado. Newest Technology to include UROPLASTY for urgency and urge incontinence.

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Beauty

Plastic Surgery

Reflections Medspa by Connie Hein

I joined the great team at Reflections because I wanted to provide quality medical care in an elegant setting with convenient evening and weekend hours to cater to our patients.

When you enter the enchanting facility at Reflections Medspa, warmth and elegance surround you. You are swept away on a peaceful mini-vacation.

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eflections is a successful two-yearold spa owned and operated by physicians and nurses. The staff provides many cosmetic procedures such as photo skin rejuvenation, hair removal, vein and tattoo removal, massage services, botox and soft tissue fillers such as Restylane and Juvederm. When asked what makes Reflections unique in the Northern Colorado area, Todd Kerr, one of the co-owners says, “The great advantage at Reflections is not just the quality of the procedures, but also the affordability.” Because most of the procedures can be done in the office, the cost is far less for their clients. As of March 1st Reflections Medspa entered a new phase in their evolution as the premier medspa in the Front Range area. Reflections, in partnership with About Face – Facial Plastic Surgery, PLLC is excited to now offer facial cosmetic surgery. Maria Chand MD, FACS joined Reflections Medspa to provide a variety of facial rejuvenation procedures including facelifts, neck liposculpture and neck lifts, blepharoplasty (eyelid lift), chin, ear, and nasal cosmetic surgery. Eric Olsen, MD and Medical Director at Reflections, is excited to have Dr. Chand join the Reflections staff. He says, “She’s an amazing surgeon, and we feel lucky to have the opportunity to pair up with her and About Face – Facial Plastic Surgery.” Dr. Chand has performed over one hundredfifty facelift and blepharoplasty procedures in the

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Denver area in the past year alone, and now brings her specialized experience to Northern Colorado. Dr. Chand is dual board certified in Otolaryngology Head & Neck Surgery and Facial Plastic and Reconstructive Surgery. Dr. Chand says, “I joined the great team at Reflections because I wanted to provide quality medical care in an elegant setting with convenient evening and weekend hours to cater to our patients.” Jennifer Poore, one of Dr. Chand’s thrilled patients had an eyelid lift procedure done two years ago. She says, “Maria Chand has the kind of skill and compassion that one has to be born with. That is something that can’t just be learned.” Poore believes the procedure was one of the best things she has ever done for herself and highly recommends Dr. Chand. She adds, “Dr. Chand cares deeply about the welfare of each of her patients.” Chand has a calm, caring, confident attitude that makes one feel at ease immediately. She says the initial consultation between doctor and patient is one of the most important parts of the entire process. During the consultation, Dr. Chand seeks to understand not only the expectations of the patient, but also determines whether the patient is an appropriate candidate for elective surgery. There is no hard-sell between doctor and patient, but instead an open dialogue concerning the reasons the patient is requesting this type of surgery. Are they doing this for an upcoming

- Maria Chand MD, FACS, Reflections Medspa

event or special occasion? And if so, will there realistically be enough healing time before the event? Are they doing it for the right reasons? Is it something they want for themselves, and not in an effort to please someone else? Are they healthy enough to tolerate surgery? Dr. Chand suggests that a patient take some time to think about these questions before deciding whether or not to have any elective surgery. “If the patient knows what they want when they come in, it makes the consultation time more efficient and beneficial for both patient and doctor. We want our patients to be thrilled, from consult to result, with their experience at Reflections, not just satisfied.” Kim Brunkhardt, RN and another co-owner at Reflections believes that adding the facial plastic cosmetic surgery procedures was a perfect fit for Reflections. “As far as I know, there is not another medspa of this kind with so many services in the area.” From the education at the beginning, to the “goodie bags” sent home at the end, Dr. Chand and the staff at Reflections Medspa have thought of everything to make the experience satisfying. For more information on any of these facial procedures call 970-372-0307. Connie Hein is a freelance writer in Windsor, and the author of the Toliver in Time children’s book series.


‌there is not another medspa of this kind with so many services in the area. - Kim Brunkhardt, RN, Co-owner, Reflections Medspa

The great advantage at Reflections is not just the quality of the procedures, but also the affordability. Todd Kerr, Co-owner, Reflections Medspa

Northern Colorado Medical & Wellness

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Reproductive Medicine

Fertility Treatments Kevin Bachus, MD, Rocky Mountain Center for Reproductive Medicine, PC

Infertility. What Next?

by Kevin Bachus, MD, Rocky Mountain Center for Reproductive Medicine, PC

Nothing is more frustrating for couples than having difficulty conceiving the family that they desire. Sometimes this occurs when attempting to conceive the first child, but the frustration can be just as real when having difficulty with subsequent pregnancies.

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ompounding the problem is a misguided public perception that pregnancy is natural and therefore occurs with ease. Estimates are that one in six couples will have difficulty with conception, which is defined as a lack of pregnancy after twelve months of attempt. The perception that infertility is more common now than in the past may have some truth. Infertility itself has not really changed, but there

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have been some changes in the societal norms, which contribute to the problem. Specifically, couples are getting married later in life, and dual career families have also had an effect in deferring child bearing until a later age. Unfortunately, these trends have an undesired effect, as increasing age has a very detrimental effect on the ability to conceive. Peak reproductive age is in the mid twenties. Fortunately, conception rates for many couples

remain reasonably high into the early thirties, but it is at this age where infertility rates begin to increase. This decline in fertility with age is poorly understood by most couples. When people see public figures conceive well into their forties, it gives them the impression that they can conceive at any age. As the accompanying figure illustrates, conception rates decline dramatically after the woman passes her mid thirties. Often when conception does occur in the later reproductive


Birth rates by age

Age

The perception that infertility is more common now than in the past may have some truth. Infertility itself has not really changed, but there have been some changes in the societal norms, which contribute to the problem. - Kevin Bachus, MD, Rocky Mountain Center for Reproductive Medicine

Diagnostic hysterosalpingogram (HSG) showing no irregularities/ abnormalities within the uterus and no evidence of tubal obstruction. Northern Colorado Medical & Wellness

years, it is with great delays, difficulties and with some assistive reproductive technologies. It is very crucial that a thorough medical history be taken to identify any predisposing factors that might lead to infertility. Examples of these factors include a history of appendicitis or pelvic pain in the woman. Both of these can increase the probability of pelvic scar tissue causing increased difficulty in the transfer of the egg from the ovary to the fallopian tube. Without this transfer, conception cannot occur normally. Further history important in both partners includes smoking and in the male, a history of groin trauma, or certain medications. Once a history is completed, the general infertility evaluation begins. First it makes the most sense to determine if ovulation is occurring. Many women chart their daily temperature to improve their chances of conception, looking for an increase of one degree fahrenheit typically seen with ovulation. This effect is due to the hormone progesterone, which is the dominant hormone after ovulation. Unfortunately, this is not a foolproof method for determining ovulation as so many other things can affect this temperature shift. Simply charting the interval between periods combined with a single blood test are better determinants of ovulation. A lack of ovulation is estimated to occur in approximately 20% of women and irregular menstrual intervals are the biggest clue to this possibility. A semen analysis is another test done early in the fertility evaluation as approximately 20% of all couples are found to have the exclusive problem of male infertility. Up to 50% of couples will have at least some difficulty attributable to male infertility. Unfortunately, lifestyle issues such as hot tub exposure, have little effect on sperm counts. Generally speaking, neither do medications or surgery. Given the fact that a simple thing such as a fever associated with the flu, can temporarily affect sperm count, a repeat analysis is generally performed when the first assessment is abnormal. Determination of a normal uterus and fallopian tubes is performed by radiographic imaging via ultrasound and a hysterosalpingogram (HSG). Ultrasound is a painless method to ascertain if uterine tumors are present which can impact conception or increase the chance of miscarriage. The HSG is one method to determine if tubal patency exists. If, for example, an appendicitis or endometriosis resulted in scarring of the fallopian tube, the HSG is well suited to detect this problem. Other types of tubal blockage are more subtle, and are amenable to the HSG procedure correcting this blockage. This so-called “flush effect� has been offered as the explanation for increased pregnancy rates following an HSG. Treatment for infertility is dependent on what abnormalities are found following testing. When sperm counts are low, inseminations are an effective method to increase the number of sperm that are then able to access the fallopian tubes where fertilization occurs. This technique involves

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INFERTILITY FACTOR

Amy Hulstrom, M.S., PA-C, Kevin E. Bachus, M.D., FACOG, Shari Olson, Ph.D., Bonnie Overholser, PA-C

 t   w w w. d r b a c h u s. co m 28

COUPLES AFFECTED

Endometriosis

25%

Semen

20%

Ovulation

20%

Tubal

15%

Unexplained

15%

Other

5%

placing suitably washed sperm into a thin flexible catheter that is inserted past the cervix into the uterus with normally little discomfort. Typically, though, this works better if the female partner is given medication to gently stimulate the ovaries into producing a modest increase in the number of eggs, yet at the same time being mindful to limit this stimulation in order to limit the incidence of multiple pregnancies. Simple ovulatory disorders usually respond to a medication called ClomidŽ (clomiphene citrate). This is convenient to take, and is a less involved treatment than inseminations. Occasionally, however, this problem can be difficult to treat and may require extensive monitoring and more potent medications. The most aggressive technology for infertility treatment is called in vitro fertilization (IVF). It is effective for nearly any type of abnormality found. IVF requires extensive ultrasound monitoring, a minor surgical procedure to retrieve the eggs, and, occasionally, a delicate microscopic procedure called “ICSI� (intracytoplasmic sperm injection) to assure fertilization occurs. Over the years, this technique has increased in success, in particular for younger individuals. It is not uncommon to have conception rates in excess of 60% per attempt, which is several times higher than inseminations. Due to these increased success rates, care must be taken to limit the number of embryos transferred to the uterus in an effort to limit multiple pregnancies. Cost is always a consideration for any medical treatment. In the past, insurance companies have generally avoided any coverage for testing or treatment. Today, an increasing number of companies have seen the wisdom of providing for at least some coverage (i.e. diagnostic testing) as the importance of this issue in the lives of many couples has been recognized. At the Rocky Mountain Center for Reproductive Medicine, an important philosophy is to be as unobtrusive, safe, and cost effective as possible. This ultimately leads to an effort to customize care to meet the needs of each particular couple. Kevin Bachus, MD, is the only board certified infertility and reproductive endocrinology specialist serving the tri state area of Northern Colorado, Wyoming, and Nebraska for over 12 years.


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Urology

Renal Calculi Katy Willey, RTR examines the machinery with James Wolach, MD, North Colorado Urology, PC.

Kidney Stones Are No Joke!

by Laura Lee Carter

Do you need motivation to drink enough water every day? How’s this for incentive? Drinking more could help you avoid the excruciating pain of kidney stones. According to James Wolach, MD, a urologist at North Colorado Urology in Greeley, our semi-arid Colorado climate increases our chances of developing this painful condition. So drink up!

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idney stones, one of the most painful of urologic disorders, have distressed human beings for centuries. Evidence of kidney stones has been found as early as 7,000 years ago in Egyptian mummies. Unfortunately, kidney stones also are one of the most common urinary tract disorders. Each year, Americans make almost 3 million visits to healthcare providers and over half a million trips to the emergency room for kidney stone problems. Most kidney stones pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Also, research advances have led to a better understanding of the many factors that promote stone formation and thus better treatments for preventing stones. There are multiple reasons why kidney stones occur, but Dr. Wolach estimates that 60% of his patients have developed this ailment because of

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simple dehydration. Other common causes are consuming too much salt in the diet, too much calcium, or a general genetic predisposition to the stones. For unknown reasons, the number of people in the United States with kidney stones has increased over the past 30 years. In the late 1970s, less than 4% of the population had stone-forming disease. By the early 1990s, the portion of the population with the disease had increased to more than 5%. Stones occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s. Once a person gets more than one stone, other stones are likely to develop. It is estimated that adults have a one-in-ten lifetime chance of developing serious kidney stones. Adults are also more likely to pass their stones with only medical management for pain. The occurrence of kidney stones has been increas-

ing in children, although they are still much more common in adults. Experts at Johns Hopkins Hospital say children get kidney stones about 1% as often as adults. Dr. Wolach has noticed over the years, how younger and younger patients are arriving at his practice. He notes a slight increase in his pre-teen population, with an even greater increase among teenagers. Dr. Wolach reports, “Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves into the urinary tract and blocks the flow of urine. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur.� If the stone is too large to pass easily, the pain will continue, and blood may be released into the urine, turning it pink. Until 20 years ago, open surgery with large incisions was necessary to remove a stone, and surgery required a recovery period of 4 to 6


gotta go? WE CAN HELP!

Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves into the urinary tract and blocks the flow of urine. James Wolach, MD, North Colorado Urology, PC

Ou r p ractice ca n tre a t a l l you r u rolog ic a l co n d i ti o n s

5890 W. 13th Street, Suite 106 | Greeley CO 80634 [970] 378.1000 or 1.800.281.1964 ncupc@aol.com | www.ncupc.com

Dr. James W. Wolach

weeks. Today, treatment for these stones is greatly improved, and most options do not require major surgery, and can be performed in an outpatient setting. Dr. Wolach says “It has been many years since physicians found it necessary to resort to open surgery for kidney stones. Various non-invasive methods are now available to break up the stones with minimal collateral damage.” Extracorporeal shock wave lithotripsy (ESWL), introduced in 1983, is the medical procedure most frequently used for the non-invasive treatment of small kidney stones. This procedure requires a lithotriptor. North Colorado Medical Center in Greeley is the only hospital in Northern Colorado that possesses such a machine. According to Dr. Wolach, “Our lithotriptor was acquired three years ago. The advantage to having one of these devices available Monday through Friday, rather than having to wait for a traveling unit, is fully understood by those who have experienced the extreme pain of a kidney stone as it migrates from the kidney into the urinary tract. Immediate treatment is much more desirable.” It is estimated that more than one million patients are treated annually with ESWL in the United States alone. Here’s how the lithotriptor works. The sedated or anesthesized patient lies down in the apparatus’ bed, with his back supported by a waterfilled coupling device placed at the level of the kidneys. An x-ray or ultrasound imaging system is used to pinpoint the stone and aim the machine. The lithotriptor then uses a focused, highintensity acoustic pulse to send shock waves that are created outside the body, into the skin and

Northern Colorado Medical & Wellness

31


body tissues. The goal is to hit the denser kidney stones, breaking them down into small particles that can then be easily passed through the urinary tract and out of the body. Dr. Wolach says, “The procedure takes 45 minutes to an hour, and the patient is under general anesthesia.” In most cases, ESWL may be done on an outpatient basis. Recovery time is relatively short, and most people can resume normal activities within a few days. Dr. Wolach reports, “In the majority of cases, my patients return to work the next day.” Complications may occur with ESWL. Some patients have blood in their urine for a few days after treatment. Bruising and minor discomfort in the back or abdomen from the shock waves can occur. To reduce the risk of complications, doc-

tors usually tell patients to avoid taking aspirin and other medicines that affect blood clotting for several weeks before treatment. Now that you know so much about kidney stones and their treatment, you can see why you may want to start drinking more water and avoid too much salt in your diet. Start paying more attention to the salt content in the foods you consume and start hydrating! Laura Lee Carter is a Fort Collins freelance writer and copy editor. For more information see her website at: www.lauraleecarter.com

Leaky Bladder & Bulging Abdomen

Myth vs. Fact

By Caroline C. Creager, PT

Myth: Incontinence is a normal outcome of aging. Fact: Although incontinence is very prevalent it is never normal – at any age. Myth: A leaky bladder, caused by a sneeze or cough, is no big deal. Fact: Stress incontinence is often caused by weak pelvic floor muscles. The longer you wait to strengthen the pelvic floor muscles, the more likely your bladder will leak more frequently. Myth: You can’t develop further complications from incontinence. Fact: A variety of medical, emotional and social problems accompany incontinence, such as, sleep disturbances, loss of self-esteem, depression, urinary tract infections, and restricted social, athletic, and sexual activity. Myth: You can’t do anything about a leaky bladder. Fact: The Agency for Health Care Policy and Research, 1996, reports that 80% of urinary incontinence can be helped by non-invasive techniques - regardless of age. Strengthening the pelvic floor muscles with exercise, biofeedback, bladder retraining, and electrical stimulation are non-invasive techniques taught to class participants of the Abdominal & Pelvic Floor Boot Camp, to eliminate or improve incontinence. Myth: Sit-ups will strengthen my pelvic floor and flatten my bulging abdomen. Fact: Sit-ups can cause pelvic floor muscles to ‘bear down’ and abdominal muscles to ‘pooch’ out – making a leaky bladder and a bulging abdomen worse – not better. One of the secrets to preventing your bladder from leaking and flattening the notorious bulging abdomen is to spend 8 minutes a day strengthening the pelvic floor and abdominal muscles – from the inner to the outermost layers. Perform the following simple, yet amazingly successful, exercise to attain and maintain a sleek abdomen and strong pelvic floor.

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Caroline C. Creager, PT, is an awardwinning author of health and fitness books and the owner of the Berthoud Athletic Club, Executive Physical Therapy, Inc., in Berthoud, Colorado. Caroline is also the lead instructor for the innovative Abdominal and Pelvic Floor Boot Camp for Women. Call Caroline, 970-532-2582 (CLUB), visit her website at www.bacinfo. com or email her at Caroline@ CarolineCreager.com.

Creager demonstrates the recommended abdominal exercise.

Abdominal and Pelvic Floor Strengthener Target Areas: Deep abdominal muscles located on the side and front of the abdomen, pelvic floor and deep lower back muscles. Benefits: After having a baby, gaining weight, or turning 40, corset-like muscles of the abdomen (transverse abdominis), become very weak predisposing you to a bulging abdomen, weak pelvic floor muscles, poor posture, and back pain. This exercise improves posture, abdominal, and pelvic floor strength, a leaky bladder, and helps stabilize the spine. It also promotes the working relationship between the abdominal, back, and pelvic floor muscles. Instruction: Kneel. Lean forward and place hands on floor. Align shoulders and hands, then hips and knees. Maintain head alignment with body, and a neutral spine position. Take a relaxed breath in and out. Now without breathing in, slowly and gently draw the lower abdomen in towards the spine. Hold, breathe lightly. Relax the abdomen gradually. Hold: 5 – 20 seconds Repeat: 10 times Frequency: 2 – 3 times per day, everyday, or every time the phone rings! If you perform this exercise as recommended, you will be amazed at the positive results!

Northern Colorado Medical & Wellness

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Behavioral Health

Pediatric Learning Disorders

ADHD Kids Find Help

by Kay Rios

Having a child diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) can be devastating. “I felt like I’d been hit by a truck,” says Ann Cathcart, whose son, Tucker, was diagnosed with Attention Deficit Disorder (ADD) in first grade. “I was hearing that something was wrong with my little guy. It was a scary time.”

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he’s not alone. ADHD affects approximately two million children in the United States, according to the National Institute of Mental Health (NIMH). That means that, in a classroom with 30 students, at least one will most likely have ADHD. A child with ADHD faces difficulties both in learning and in life, but the situation is not hopeless. With appropriate treatment and support, many obstacles can be overcome. Cathcart, who is the founder of The Learning Camp in the Vail Valley (see accompanying story), has witnessed that. Seventeen years after his diagnosis, Tucker is an English major at Mesa State and doing quite

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well. The first step in finding the right kind of help is proper diagnosis. The principal symptoms of ADHD are inattention, hyperactivity, and impulsivity. There are also three subtypes of ADHD recognized by professionals, according to Kathy Sigda, PhD and child psychologist at Mountain Crest Regional Behavioral Healthcare Center: “First, there’s a combination of hyperactivity, impulsivity, and inattention, second a predominately hyperactive-impulsive type and, third, a predominately inattentive type (also known as ADD).” But every child exhibiting those symptoms does not necessarily have ADHD, Sigda cautions.

The key is identifying symptoms above and beyond those that are indicative of a child’s age. “It’s important to know what is normal for that age.” Sigda recommends consulting a professional. “The best place to start is with a pediatrician. Ask what is normal to expect for that age. For example, a three-year-old is typically impulsive and hyperactive.” Symptoms have to be exhibited for six months and in different settings, i.e. home and school, Sigda says. And data needs to be collected. “We use quantitative rating scales that teachers and parents complete and then we interview parents and observe the child. The observation is less reliable because, typically, a child one-on-one will not show those symptoms so we really rely on teacher and parent reports.” Other conditions can be mistaken for ADHD, she says. “It might be a learning disability where they can’t stay focused or it could be anxiety. With a learning disability, a particular area of learning is affected but you will still see a level of potential, for example, a child of average intelligence not learning math – that’s an inability to learn. It’s very different than a child with ADHD who is distracted and unfocused, and not ready for learning.” It’s important to remember that ADHD is, by definition, a developmental condition, says Aaron Skalicky, PhD, and clinic director for NeuroDevelopment. “That’s often overlooked when ADHD is discussed. It is not the result of something that has just changed in that child’s life. It is a neurologically based condition.” There are several lines of thinking, he says, but the links are not clear at this time. “There is a genetic possibility,” he says. “Genetic research is starting to show that children with ADHD may have genetic similarities particularly related to genes that synthesize dopamine. The theory is that their brain is not producing dopamine in the normal way. Brain systems that are very dependent on that system – the frontal lobes – may be off because of the way dopamine is regulated.” The frontal lobes of the cerebrum allow us to solve problems, plan ahead, understand the behavior of others, and restrain our impulses, he says. Understanding the cause can help determine future treatments. “We currently have treatments for ADHD but not the cure,” Sigda says. “So it’s truly about having to live with ADHD rather than taking a pill and being cured.” For parents and their children trying to cope, different approaches are available. “There’s research that says for a child with a true diagnosis, you need a three pronged approach: medication, therapy, and educational intervention.” Sigda says. “The first line of medication is a stimulant. That may seem counter productive for someone hyperactive but we are stimulating a portion of the brain that controls impulses, which helps us organize and plan.” She acknowledges the controversy over medication. “Some children can not tolerate these meds. And they are very serious medications. You have side effects, which is certainly a real problem. And the other piece is that medications don’t fix the problem.”


ADHD is, by definition, a developmental condition. “That’s often overlooked when ADHD is discussed. It is not the result of something that has just changed in that child’s life. It is a neurologically based condition... Genetic research is starting to show that children with ADHD may have genetic similarities particularly related to genes that synthesize dopamine.

Aaron Skalicky, PhD, Clinic Director, NeuroDevelopment

Skalicky’s approach focuses primarily on cognitive behavior therapy. “There is a research base showing that in over 50% of those diagnosed, if you prescribe a stimulant, the symptoms will subside. But we don’t have a solid understanding of the long-term side effects. And a stimulant is an immediate response to the symptom. What medication doesn’t do is help a child develop compensation skills they will need to function long term. There are a lot of behavioral interventions that have a solid basis in research. The options are really quite wide for parents that want their child to learn behavioral skills.” Parental involvement is essential, Skalicky maintains. “We focus on family involvement because parents play a huge role in how quickly kids improve.” It is, in fact, a team effort, “We also collaborate with the school. The school benefits from the foundation we create and we can help the teacher incorporate the behavioral plans we develop into the classroom environment.” That cooperation is essential, “It gets the parents, the school team, and the clinic all on the same page.” Teams get results, Cathcart has learned. She worked with the family pediatrician and a special education teacher at her son’s elementary school.

- Aaron Skalicky, PhD, Clinic Director, NeuroDevelopment

“We set up an Individualized Education Plan (IEP) and it made a huge difference. It helped him get the support he needed to level the playing field. I can’t recommend it highly enough. And the school was a great resource.” Laura Richardson, director of Poudre School District (PSD) Integrated Services (formerly Special Education) also emphasizes the team approach. “We work with the parents, with outside counselors, and with physicians if the child is on meds. We all have to work together. Our efforts won’t have an impact if we operate in isolation.” By working with a team, a more individualized plan can be developed. “With ADHD, one size does not fit all,” Richardson says. “As a multidisciplinary team, we can look at what will work for that individual. The intervention and strategies we develop in the IEP considers what is the least restrictive environment that will help that student. What kinds of support can be provided in that setting? Sometimes we use co-teaching with a general education teacher and a special ed teacher. If that doesn’t meet their needs, there may be something outside the classroom, maybe small groups or some pre-teaching techniques.” PSD has adopted the Response to Intervention (RTI) process. “We start from the first sign of

difficulties either behaviorally or academically. We put interventions in place, collect data, and monitor the process. We want to catch students as soon as possible before the gap gets too large. We don’t use the ‘Wait to Fail’ model.” With a team of professionals on their side, kids with ADHD have more chance at success in school and in life. Those skills learned early on may help carry them through later years as well. “Children who are more on the hyperactive end of the continuum tend to outgrow the symptoms as they get older,” Sigda says. “But attention issues can still stay with them. Most adults can cope with that effectively if they develop strategies that compensate.” Skalicky adds: “These are really critical life skills. Once you leave school, you still need to know when to put the brakes on and how to control your impulses. You still need to know how to structure your day, how to jot down a note in a systematic way. Those are all skills that translate into life long situations.” Kay Rios is a freelance writer based in Fort Collins. She is currently a doctoral candidate in Educational Leadership at Colorado State University.

The best place to start is with a pediatrician. Ask what is normal to expect for that age. For example, a three-year-old is typically impulsive and hyperactive. - Kathy Sigda, PhD, Child Psychologist, Mountain Crest Regional Behavioral Healthcare Center

Kathy Sigda, PhD, Child Psychologist, Mountain Crest Regional Behavioral Healthcare Center Northern Colorado Medical & Wellness

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Behavioral Health

Recreation and Learning Support

Ann Cathcart, Owner, The Learning Camp

Summer camp adventure

by Kay Rios

The Learning Camp grew out of a personal need. It all began seventeen years ago when Ann Cathcart’s son, Tucker was diagnosed with Attention Deficit Disorder (ADD).

“I

knew I had to change my life and help Tucker. I was running the Better Business Bureau in Fort Collins at the time and I saw my son struggling so badly in school. I knew he needed a full time mom. I resigned my position and moved to the Vail Valley where I had gone to school. It was a situation where he could walk to school and I could be more available to him. My whole life changed completely to accommodate his needs.” While the change was positive, there were still struggles. “I was not prepared for how difficult school would be and how difficult his social life would be. He was picked on and every year we had to adjust academically. Kids like Tucker look normal but they can’t keep up in school and they

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are struggling with friends. When you’re failing at both of those, you can’t keep up self-esteem.” She thought that summer camp might be an answer but she couldn’t find one that fit the bill. “A friend said, ‘you live in a beautiful place, why don’t you start a camp yourself?’” Cathcart took her friend’s advice, and in 1996, opened a day camp in the Vail Valley. “All the children begged for an overnight adventure. So, after that first summer, I went to my bank. My banker believed in me and gave me a line of credit on my home. I found land to lease for 5 years to see if there was a need. And we were full every summer.” That was the beginning of a beautiful relationship between The Learning Camp and special needs students looking for a rewarding

experience. The Camp caters to kids with learning disabilities including ADHD and dyslexia. Offering a traditional summer camp adventure for boys and girls age seven to fourteen, the focus is on helping kids build self-esteem, independence and academic success. Cathcart and her co-director and husband, Tom Macht, run the camp. “We hire professionals who want to work with kids who struggle with these things,” she says, “because it’s a very small program, it’s very nurturing. We run it like a large family. The kids are surrounded by adults who understand them and can give them the support they need, not only academically but socially.” The program has an academic component, she says, but there is also a heavy focus on self-esteem building. “To me, that is the most important ingredient. Our children need to be motivated to go to school and learn every day. If a child loses self-esteem, they also lose motivation to become educated. We work hard to renew their motivation: ‘so what if I have ADHD, I can still learn.’ I think building self-esteem is what we do best.” It’s certainly worked for Cathcart’s son. “I credit the camp staff and the luck I had with the school staff. Tucker is so healthy and so happy and I really think it took a whole community to get there.” For programs, schedules, and contact information, go to: www.learningcamp.com or (970) 524-2706. Kay Rios is a freelance writer based in Fort Collins. She is currently a doctoral candidate in Educational Leadership at Colorado State University.


Veterinary Medicine

Family Profile

Power Couple Shares Passion by Alice Ashmore

Some might call them a power couple of Northern Colorado’s veterinary world. Randy Fitch, DVM, MS, can turn a dog’s badly deformed leg and paw into a usable limb. Holly Hamilton, DVM, MS, can save an animal from blindness. These married veterinarians may have separate practices, but they share a combined passion for their profession and their family.

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r. Fitch says veterinarian couples are not uncommon. “We met in vet school in Madison, Wisconsin,” adds Dr. Hamilton. “Vet students don’t get out much,” she adds with a laugh. And there are advantages to the couple’s partnership as each has an understanding of the other’s profession. “It’s nice to be able to talk about cases,” she says. The Fort Collins pair work in adjacent specialty practices in north Loveland. Dr. Hamilton practices at the Animal Eye Center at 215 West 67th Court, while Dr. Fitch practices with VCA Veterinary Specialists of Northern Colorado at 201 West 67th Court. Although they work in close proximity, they often don’t catch up with each other until the end of the day. “We occasionally consult with each other,” she says. The couple was drawn to Northern Colorado by Colorado State University, where Dr. Fitch taught for four years. The university is on the forefront of veterinary research. He cites an example: “There are more limb spares at CSU than anywhere in the world.” A “limb spare” is the saving of a limb that would otherwise require amputation. A snapshot of the veterinary statistics in the Northern Colorado region is surprising. “The area is home to the greatest density of veterinary specialists and the highest number of veterinarians per capita in the country,” says Dr. Fitch. Are You Board Certified? Both Dr. Hamilton and Dr. Fitch are board certified in their specialties. “There is a general lack of understanding that there are veterinary specialists,” Dr. Hamilton says. She often hears the

Northern Colorado Medical & Wellness

exclamation, “I didn’t know there were veterinary ophthalmologists!” Board certification requires very specific training and four additional years of study. Dr. Fitch is a Diplomate of the American College of Veterinary Surgeons, with specialties in orthopedics and neurosurgery. Dr. Hamilton is a Diplomate of the American College of Veterinary Ophthalmologists. Both Dr. Hamilton and Dr. Fitch routinely see referrals from a wider area, including pets from Wyoming and Nebraska. In his practice, Dr. Fitch has treated dogs from as far away as Arizona. “I have the easiest patients possible. I mostly work with Labradors and Golden Retrievers.” (These are the most common canines in the area.) The majority of his work is dedicated to improving comfort, mobility and pain management. “We’ve had some pretty incredible results.” Those results often transfer into the realm of human health. “We benefit from the human world and they benefit from us.” He cites joint replacement as an example. Replacement techniques were originally tested and perfected in animals, before being tried on humans. Managing a Busy Family Dr. Hamilton says the couple uses the “divide and conquer” strategy to keep up with the demands of an active professional and family life. The couple has two young boys, Chase who is seven and Nathan, who is five years old. For fun, the entire family practices martial arts. “We all do karate together,” says Dr. Hamilton. Dr. Fitch notes that besides fun and fitness, karate teaches the kids the importance of focus and

discipline. They also enjoy family bike rides. “We definitely make time to do things as a family.” Both vets take Mondays off to create additional family time, and they plan to combine Dr. Fitch’s veterinary lecture trips into a family vacation. Pets are Family Here in Colorado Coloradoans generally see their pets as family members. Dr. Fitch says the cost of caring for a dog over its lifetime averages $23,000. “It is not uncommon to see people take a second job to take care of their dog’s medical needs.” Both vets are strong proponents of pet insurance. He adds, “It’s sad to be unable to treat a pet because the owner cannot afford it, especially when the pet has a curable problem. People often have to make difficult financial decisions. Pet insurance definitely saves dogs lives.” For those without pet health insurance, a program called Care Credit can help a cashstrapped pet owner. The program offers a six month loan interest-free, and competitive rates if payments extend beyond sixth months. “Pet insurance makes a wonderful gift,” says Dr. Hamilton. One of Dr. Fitch’s favorite quotations reflects the attitude of compassion seen in this couple’s unique partnership: “How wonderful it is that nobody needs to wait a moment before starting to improve the world.” – Anne Frank Alice Ashmore is a freelance writer from Loveland, Colorado.

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Veterinary Medicine

Feline Rescue

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Fort Collins Cat Rescue staff: Sarah Swanty, Director; Anna Neubauer, President; and Thomas Welsh, DVM.

A Chance At nine lives

by Deborah Huth Price

Toulouse, a large black and white cat, lounges on a table at Fort Collins Cat Rescue, insisting on being the center of attention. He purrs and encourages pats on the head from anyone within reach. He is obviously adored by the staff and volunteers, and generously returns the affection. Toulouse doesn’t know how lucky he is.

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f it weren’t for Cat Rescue, Toulouse would probably be sick, lost, abused, or dead. Toulouse did not do well when placed with a family, according to Sarah Swanty, shelter director. It seems he preferred the shelter’s social structure and his cat and people buddies. While Toulouse is a permanent resident, most of the remaining cats at the shelter do need a home. This no-kill shelter began with the dream of two veterinary technicians, Sarah Swanty and Anna Neubauer. “We always wanted to do rescue work,” says Swanty, “and to do cat rescue, you really have to know cats.” This came as a surprise to Swanty, who thought she was a dog person. “There are a lot more homeless cats because they reproduce faster,” says Swanty, and now her loyalty to kitties is strong. “Cats are so smart—they are the most perfect animal.” While holding other full time jobs, the two women began the shelter in June 2006 with 17 cats from another shelter that couldn’t keep them. By January 2007 they were able to quit their jobs and devote full attention to their dreamturned-reality. Taking care of homeless kitties may seem like a noble thing to do, but the task can be daunting. Their current location on Mulberry, near Interstate 25, is their third in just two years. The shelter is always full with 35-40 cats, and an additional 40 kittens, and special needs cats in foster homes. Swanty, who now directs the shelter, says, “I had no idea how many homeless cats were in the community. We have 5-15 on the waiting list to get in on a daily basis.” “We’re not just helping animals, we’re also helping people,” says Swanty. She recalls families and students who had to move to new apartments and were not able to take their cats with them. “They feel better knowing that we can help them find a home for their pet.” Swanty also stresses the importance of education and directing people to resources. “It’s always better to find a way to keep your pet than having to surrender it.” A few months after Swanty and Neubauer started the shelter, Thomas Welsh, DVM, a retired Fort Collins veterinarian, offered his services to spay and neuter pets. Fort Collins Spay/Neuter clinic was born March 1, 2007 and by midApril 2008, the clinic had performed over 3,700 operations. The spay clinic is directed by Neubauer. She says, it helps keep the dog and cat overpopulation down, and is a great resource for those who cannot otherwise afford the service. The clinic offers basic services like spay/neuter surgeries, vaccinations, and micro-chipping to low-income families, the elderly, and students at a reduced rate. Welsh adds that animal rescues from Colorado, Nebraska, and Wyoming also send animals to the clinic to be spayed or neutered. “Our goal is not to compete with other practices,” notes Welsh. The clinic does not do follow-ups, or offer x-ray, ultrasound, or boarding, but instead refers pet owners to clinics in town. The clinic also teams up with the Larimer Humane Society on certain projects. A current example is a free spay voucher offered by the


[Spaying or neutering] decreases certain health risks, the pet has a longer life span, they are less likely to roam, and are a better companion. - Anna Neubauer, Fort Collins Cat Rescue and Fort Collins Spay/Neuter clinic to those who surrender an unwanted litter of pets to the Humane Society. Sometimes convincing people to spay or neuter their pet can be a challenge. “Everybody thinks they have the best dog that ever lived and wants them to have puppies,” says Welsh. According to the Humane Society of the United States, “Between six and eight million dogs and cats enter U.S. shelters each year, and three to four million of these animals are euthanized because there are not enough homes for them.” “We have made a difference nationally,” adds Welsh. “In the 1970s, 20 million pets were killed in shelters each year.” There are other reasons to have a pet spayed

Northern Colorado Medical & Wellness

or neutered. Neubauer says, “It decreases certain health risks, the pet has a longer life span, they are less likely to roam, and are a better companion.” In addition, Welsh mentions that there is an economic savings in tax dollars used each year, cutting down on costs to euthanize and care for unwanted animals. The dream of Swanty and Neubauer has come a long way in two years, and the cats keep coming in. “I would love to see a day when everyone spays and neuters their pets and there are no homeless animals,” wishes Neubauer. Toulouse and his friends would then have a chance to live out all nine of their lives. That’s a kitty paw high-five.

Fort Collins Cat Rescue is located at 2321 E. Mulberry, unit 1. Fort Collins Spay/Neuter is at the same address, unit #9. To find out how to support the work of Fort Collins Cat Rescue and Fort Collins Spay/Neuter, go to the web site: www.fortcollinscatrescue.org or call 484-8516. Deborah Huth Price works for the City of Fort Collins as an environmental educator at Bobcat Ridge Natural Area, and also serves as education coordinator at Discovery Science Center in Fort Collins.

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Wellness

Local Fitness Solution Dave Huber has been a local fitness expert since the opening of his first Fort Collins center, Club Nautilus in 1980… … And 28 years later, he remains at the heart of health in town.

Pulse Fitness Center Maintains its Place At the Heart of Fort Collins Health

by Corey Radman

Dave Huber advocates fitness for everyone. As the owner of Pulse Fitness Center, he talks to people in the community about their workouts constantly.

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or instance, Dave was talking to a family friend who hadn’t exercised regularly since high school, and who in his 50s had suffered two heart attacks. “How can I possibly work out? What would I do?” he asked Dave, who replied, “Well you can walk can’t you?” That random conversation convinced Pete Johnson to join Pulse and start walking the track, which led to working out with bicycles and weights, which led to a regular workout regime. Years later, Pete still exercises regularly.

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Dave, the Owner and General Manager of Pulse Fitness Center, has been encouraging people to exercise for 34 years, 28 of those at Pulse. He built his first club when he was 18 in his hometown, State College, Pennsylvania. You could call his enthusiasm a lifelong passion for people and fitness. Dave opened his first Fort Collins fitness center in 1980, Club Nautilus, on Elizabeth Street. Within four years, the club was bursting at the seams and required a move across the street to a larger facility where aerobics were added. The new building

and services needed a new name, thus Club Nautilus became The Fort Collins Pulse Aerobic and Fitness Center. Within four years the Pulse, then 2,000 members strong, had once again outgrown its facility. In 1988, the Pulse moved to its current location at 2555 South Shields. With 50,000 square feet and a multitude of programs, classes, and services, it has maintained its reputation as a local’s place to work out. A part of that local appeal is Dave himself. He knows most of the current 7,000 Pulse members by sight and many by name. “Customer service is


Arnold Schwarzenegger visited Dave Huber’s first club opening in Pennsylvania, 1978.

We consider our staff and members our Pulse Family. - Dave Huber, Owner and General Manager, Pulse Fitness Center

my number one priority. I know everybody here and many of them come [to Pulse] because of that.” Since some members have been coming to Pulse for 20 years, it’s like seeing old friends. Dave is also proud to give credit for the high usage rate to his instructors and trainers. “We get 30,000 visits per month and average 1,000 people through the door each day,” he says. With numbers like that, it’s clear to see that they are doing something right. Another draw for members is Pulse’s very competitive, all-inclusive membership rate. One month costs only $57, or $44 for seniors. For that fee, you get access to the entire facility, the equipment, the pool, and all classes, which include the trademarked LesMills Group Fitness workouts. On most days of the week you can join in sessions like: BodyPump™, BodyJam™, Tai Chi, aquatic aerobics, and many others. Dave explains that all of the programs and changes Pulse has added through the years have been through member requests and feedback. “It’s the members who dictate what we do for them.” A good example of member driven change came through Dave’s wife, Amber Huber. Though Amber is employed full time as a Realtor through

Northern Colorado Medical & Wellness

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Re-Max, she is often in the club and jokingly calls herself the Quality Assurance Manager. “I always have an opinion and Dave and I brainstorm together,” she laughs. It was Amber who had been talking to members using the yoga classes and found that there was much room for improvement. In 2002, the yoga classes were jammed into a room that seemed to be a bit of an afterthought. With racquetball courts just on the other side of the wall, the ping, ping, ping noise wasn’t conducive to concentration and relaxation. Amber noticed that Pulse had an extensive storage area that was essentially wasted space. “So I grabbed Dave and convinced him that we could do this better,” she says. The new Yoga Center at Pulse has been open since 2003. With its own exterior entrance, yin and yang inspired entry tile, and completely natural products on the floor and walls, it has been a great success. Amber, who refers to the Yoga Center as her first baby explains her vision. “Everything is planned with feng shui in mind. We wanted to address the needs of members who are healing through a naturopathic or homeopathic process and be sure that the materials we used were in harmony with positive energy needed.” Like Dave, Amber loves to make friends with the members at Pulse. She once asked Pulse member, Michele Campana, why she looked so refreshed and beautiful. “Because I come here,” Michelle replied. Pulse childcare watched Michelle’s four children when they were small, allowing this busy mom time for herself every day. Michele is enthusiastic in her praise for Pulse: “The child care is awesome. You can bring your kids to a safe environment while you have a break and get some exercise. Stephanie, the childcare director, is amazing. My little ones learned their ABCs there.” Though her kids are in school now, Michelle, a member for 15 years, still uses Pulse for swimming as a part of her triathlon training. She says, “The trainers and teachers we have used have all been very helpful. My kids all learned to swim at Pulse and we loved the teachers. It has definitely made my life a lot easier.” Pulse consistently strives to make life easier for its members, which is why they also offer a separate workout area for women only called, Express for Women. With weight machines designed for the female frame and a more secluded feel, women who don’t want to exercise in front of a group of people, can find fitness on their own terms. With Express for Women, The Yoga Center, and the standard Pulse Fitness offerings,

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Everything [about the Yoga Center at Pulse] is planned with feng shui in mind. We wanted to address the needs of members who are healing through a naturopathic or homeopathic process and be sure that the materials we used were in harmony with positive energy needed. - Amber Huber, Pulse Fitness Center

Greeley Medical Clinic’s newest location

Medical Clinic at Centerra, P.C. Open Monday through Friday 8 am to 5 pm. Located in the South Medical Office Building at Medical Center of the Rockies.

Dave & Amber Huber stand outside the Yoga Center at Pulse Fitness Center.

Soon to be in our new Medical Office Building – December 2008 a membership to Pulse is like having three clubs in one. Because of the extensive range of services offered, the diversity of Pulse’s membership base is broad. Having been locally owned for so many years, it breaks the health club stereotype of appealing only to the young and the hard-core. Many of Pulse’s members are over 40. The services and classes are designed to appeal to many ages. “Our mix includes CSU students, young professionals, working adults, and we have a very active seniors group with class offerings at convenient times for them,” Dave says. It is no wonder that Pulse has been the Coloradoan’s Best Fitness Club for 16 of the last 17 years. Dave and Amber Huber, as well as the 120 Pulse instructors, trainers, managers, and staff, strive to create a positive environment for all their members. Dave adds, “We consider our staff and members our Pulse Family.” Tammy Hansen, Business Office Manager says, “We really do appreciate our members as people! We always try to do business with members first and support hundreds of charity events each year.” Pulse has always supported community causes and recently started the “Pulse Cares That’s Why Pulse Shares” program. Each month Pulse highlights a local charity, encourages member support, and donates a percentage of sales to the cause. The 28 years in Fort Collins have been successful for Dave Huber. Community members often ask him why he has not expanded into other locations. He says, “I wouldn’t want to jeopardize the integrity of the service to the members by losing focus. I keep doing what I do because I want people to achieve their fitness goals, whatever they are.” Corey Radman is the Editor of Style Magazine.

Northern Colorado Medical & Wellness

2500 Rocky Mountain Avenue, Suites 340 & 350 Loveland, Colorado 80538 For appointments call

(970) 619-6030

As the largest multi-specialty care medical group in Northern Colorado, we can help coordinate total care for you at these locations: Greeley Medical Clinic, PC (Main Campus): 1900 16th St., Greeley, CO 80631

970-353-1551

Clinic Pharmacy: 1900 16th St., Greeley, CO 80631

970-350-2413

Urgent Care: 1900 16th St., Greeley, CO 80631

970-350-2425

Peakview Medical Center: 5881 W. 16th St., Greeley, CO 80634

970-313-2700

Urgent Care West: 2001 70th Ave., Greeley, CO 80634

970-378-4155

Arthritis Center of the Rockies: 239 W. 67th Ct., Loveland, CO 80538

970-461-1880

Loveland Hematology/Oncology Associates: 2050 N. Boise Ave., Loveland, CO 80538

970-667-7870

Cancer Institute-Oncology: 1800 15th St., Greeley, CO 80631

970-378-4170

Medical Clinic at Centerra, PC: 2500 Rocky Mtn. Ave., Stes. 340 & 350, Loveland, CO 80538

970-619-6030

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Travel

Infectious Disease

Don’t Let a Nasty Health Scare Ruin Your Next Trip Abroad by Angeline Grenz

More important than comfortable walking shoes on your next trip abroad, may be what the doctor sends with you--the proper immunizations and health precautions.

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eople are traveling more than ever, with studies showing upwards of 840 million international travelers in 2006. Taking proper precautions can prevent your dream vacation from becoming a disaster with potentially life-threatening consequences. The standard trips to Mexico and Europe will no longer suffice. Travel trends show an increasing interest in exotic locations. Many are traveling to countries off the beaten path. Some countries

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are courting tourists for the first time, according to travel consultant Ann James-Griffith with Aggie Travel Points in Fort Collins. Africa, the Middle East, Tibet, Cambodia, Vietnam, and China are the short list of countries sought out by the adventurous tourist. With this new trend in travel, comes a greater need to be aware of the many health risks involved. The first step in planning your vacation should be a visit to your family physician. The more exotic your trip, the earlier you should be-

gin the process. Some vaccines, such as hepatitis A, are administered in a series with as much as six months required between shots. “Many don’t think about getting vaccines before they travel, and certainly not six months in advance,” according to Robert Peskind, MD with Rocky Mountain Infectious Diseases Consultants in Fort Collins. Unsure if your destination requires a visit to the doctor? Visit the Center for Disease Control’s website, www.cdc.gov, which provides up-todate information on countries and their health


Many don’t think about getting vaccines before they travel, and certainly not six months in advance. - Robert Peskind, MD, Rocky Mountain Infectious Diseases Consultants

risks. The general rule of thumb, says Dr. Peskind, is any travel to a third world country means a trip to your doctor for inoculations. The cautious traveler can get the most specific and up-to-date information from clinics such as the Rocky Mountain Infectious Diseases Consultants. Through a program called Travax, Dr. Peskind prints out a customized report on each destination, containing information on needed vaccinations, health precautions, and any recent outbreaks. Information is tailored to the areas you are traveling to, activities you will be participating in, and what precautions to take if you are traveling with children or others with special needs. This comprehensive report can help you focus in on which immunizations are necessary and which are optional, saving the traveler not only the expense of needless immunizations, but also the possible side effects involved. For instance, some remote areas in India pose a risk of Japanese encephalitis, but if travel is limited to major cities this risk is eliminated. Immunizations can have side effects ranging from nausea to anaphylaxis. Certain immunizations are also not appropriate for children or pregnant women. Hepatitis A and typhoid are the most common vaccinations administered to persons traveling to third world countries. Africa poses the highest risk from a health standpoint, according to Dr. Peskind, especially West Africa. Along Africa’s Ivory Coast, infectious diseases such as yellow fever,

Common infectious diseases when traveling abroad Infectious diseases vary by region and country. The following are infectious diseases that pose the highest risk to travelers, according to the World Health Organization’s 2008 International Travel and Health.

Dengue Fever Transmission method: Mosquitoes. Contaminated Regions: Tropical and subtropical regions of central and south America, south and south-east Asia, and Africa. Vaccination: No vaccine exists. Take precautions against being bitten by mosquitoes.

Hepatitis A, B, and C Transmission method: Hepatitis A - direct contact with infected persons or contaminated food and water. Hepatitis B - contact with infected body fluids. Hepatitis C - person to person. Contaminated Regions: Greatest risk exists in countries with poor sanitary conditions or regions where there is a prevalence. Vaccination: Vaccines, which require a series of shots six months apart, are available for both Hepatitis A and B. No vaccination is available for Hepatitis C.

Malaria Transmission method: Mosquitoes. Non-immune travelers are at high risk. Contaminated Regions: Tropical and subtropical areas, especially Africa, South America, and India. Malaria is less present in urban areas, except in urban areas of Africa and India. Tourist destinations in Southeast Asia, Latin America, and the Caribbean pose no risk. Vaccination: No vaccine exists. Anti-malarial medication can be taken and should be started before entry into areas where malaria is endemic.

Typhoid Transmission method: Consumption of contaminated food or water. Contaminated Regions: North and West Africa, South Asia and Peru. Vaccination: Vaccinations are available.

Yellow Fever Transmission method: Mosquitoes. Contaminated Regions: Some tropical areas of Africa, Central and South America. Vaccination: Vaccination is available. Vaccination may be mandatory for entry into certain countries.

Many other health risks and diseases exist. Research the specific areas you plan to travel to by visiting your family doctor or a clinic such as Rocky Mountain Infectious Diseases Consultants. Additional information can be found at the World Health Organization’s website, www.who.org.

continued on page 48

Northern Colorado Medical & Wellness

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Prevention

Pediatric Health If your child cannot swim, make sure they are wellsupervised, and if they can swim, don’t assume they are safe. - Jan Hopkins, MD, Caring for the Family

Playing it safe by jason webb

When my daughter was born a year-and-a-half ago, my mother reminded me of all the crazy things I used to do as a kid, warning of the things I should look out for as my daughter grew up. I was one of those kids who had no fear of running through the woods, climbing trees, or jumping off of the jungle gym. Cuts, scrapes, and the occasional concussion were all too common.

I

f my daughter turns out like me, I’m going to need to know the location of every urgent care center in Northern Colorado, and memorize her doctor’s phone number. A first aid kit would probably be a good investment, too. As the summer approaches, children head outside to play more. They ride their bicycles, go camping, and participate in summer sports. These are prime activities for an unprepared or unsupervised child to get hurt. Jim Seeton, MD, with Loveland Urgent Care Center, sees plenty of children with injuries during the summer. “Sports-related injuries, some lacerations, scrapes, and bruises, and diving accidents are more common.” It only makes sense that injuries increase as children become more active. “Kids tend to run into things, fall down and get hurt,” says Jan Hopkins, MD, a physician with Caring for the Family in Fort Collins. “We see a lot of scrapes and a few broken wrists as kids try to stop their

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fall off a bicycle.” “Good supervision of activities is important,” says Dr. Seeton, and for children participating in summer sports, being prepared to play should be a top priority. “Children should exercise and warm up before playing a sport.” Also, water safety should never be overlooked, according to both Seeton and Hopkins. “If your child cannot swim, make sure they are well-supervised, and if they can swim, don’t assume they are safe,” says Dr. Hopkins. Most importantly, if the child is out in open water, he or she needs to wear a life preserver. Knowing basic preventative measures can protect your child from injuries and illness. “Whenever a child is riding a bike, they have to wear a helmet,” says Dr. Hopkins. “They may not like it, but they really should.” Knee, elbow, and wrist guards are also important for children who are skating. However, injuries are just one health worry

for parents. Illnesses continue, even in the warm months. “During the summer time, there are fewer cases of respiratory illnesses, however we do see an increase in the number of illnesses coming from insect bites such as mosquito and tick related illnesses [like West Nile Virus],” says Dr. Seeton. “Always be sure to check your children for ticks following time in the woods or after a hike. Parents should keep in mind that children are most likely to be bitten by mosquitoes while playing at dusk and near standing water. Of course summertime also brings more stings from bees and wasps.” Those pesky bees and wasps not only can cause a child a lot of pain, but also some kids may have allergic reactions to the stings. There are several ways to combat what bugs you. First, of course, is insect repellant. “Using an insect repellant with 20% DEET and also wearing long sleeves can protect against bug bites,” says Dr. Hopkins. Dr. Seeton notes, “Less body surface ex-


To DEET or not To DEET?

Always be sure to check your children for ticks following time in the woods or after a hike. Parents should keep in mind that children are most likely to be bitten by mosquitoes while playing at dusk and near standing water… - Jim Seeton, MD, Loveland Urgent Care Center

posure is best.” When hiking with children, know what poison ivy looks like and teach your child to avoid it. “Children touch the poison ivy, and the oil is transferred and spreads,” says Dr. Hopkins, which causes more itchy rashes. Ouch. “Trailheads will often tell you if you’ll come across it on the hike.” Consult the Internet for poison ivy or poison oak pictures before heading out. In the event that your child touches poison ivy, it is recommended to wash the affected area with soap and water. An ubiquitous problem, especially under Colorado skies, is sunburn. “Sunburns are very common on the nose, face, ears, and shoulders,” says Dr. Hopkins who has seen her share of children with severe sunburns. She recommends SPF 30 or 45. “Sunscreen is a must and should be at least SPF 15,” says Dr. Seeton. However, putting it on in the morning before the child goes outside isn’t enough. Both doctors say parents have to follow the sunscreen’s directions and reapply as needed.

Northern Colorado Medical & Wellness

Still, sunscreen may not be the best choice for the fair skinned. “Some parents might want to put their child in loose-fitting long-sleeved tees to help protect their skin,” says Dr. Hopkins. What it boils down to is having everything you need on hand before the kids head outside to play. Putting together a summer first aid kit is a simple and important way to keep your child protected. According to Seeton and Hopkins, important pieces to include are: sunscreen, bug spray, antibiotic ointments, band aids, some Benadryl, and a topical steroid like Cortaid. “Another good thing to have, that many parents forget about, are baby wipes since they stay wet and can be used to clean cuts and scrapes,” notes Dr. Hopkins. Of course, if the injury or illness is severe, it’s best to take the child to a doctor. Jason Webb is a freelance writer who lives in Johnstown.

West Nile Virus has been a real problem in Colorado in recent years. Symptoms like fever, headache, tiredness, and body aches, or in severe cases tremors, convulsions, even death are a real concern for parents with young children. The prevention question is: to DEET or not to DEET? Concerns about DEET’s toxicity have had moms and dads in a bind. However, studies have shown that DEET is harmless when used correctly. Jim Seeton, MD of Loveland Urgent Care Center notes that there are few reported cases of problems and even fewer fatalities. “The problems really come from people who have ingested [large amounts] of the chemical.” Young children who put their hands in their mouth have not been found to be at risk for problems. The Environmental Protection Agency states the use of DEET-based repellants is safe on children two months and older in concentrations between 10 to 30%. Alternatives to DEET do exist for parents who are still concerned about its long-term use. “Citronella is a nice option,” says Jan Hopkins, MD of Caring for the Family. “It must be applied every 30 to 60 minutes to remain effective.” Citronella or plant based repellents like oil of lemon eucalyptus are available in sprays or lotions at natural food stores. When compared to the recommended concentrations of DEET, they have not been found to work as well but do seem to repel mosquitoes, biting flies, and gnats. Caution should be exercised; some natural products can cause skin reactions.


continued from page 45

Spend the money on travel insurance. It may prove lifesaving if you experience a medical emergency. - Ann James-Griffith, Aggie Travel Points, Fort Collins malaria, and typhoid are present, but the yellow fever vaccination is the only one required in order to enter a country. Without proper vaccines, travelers can be refused entry or may be given the vaccine by a local government official, which can be quite a scary proposition, when you have no idea if the needle being used is sterile. Africa has the highest population of persons infected with HIV/AIDs, but other destinations, like Saint Kitts Island in the Caribbean, also have a prevalence of this disease, says James-Griffith. When advising travelers about these types of destinations, she recommends taking extra precautions like refraining from visits to the local barber. Fear of HIV/AIDs should not hinder travelers, because “HIV is difficult to get,” according to Dr. Peskind. The most common physical ailment when traveling abroad is traveler’s diarrhea. This affliction is caused by food or water contaminated by escherichia coli (E. coli). According to Dr. Peskind, it is impossible to completely avoid this annoying travel companion. The best precaution is to avoid raw meats, seafood, or dairy; eating only fruits and vegetables that can be peeled; and avoiding food from street vendors. Avoid salads and drink only bottled or boiled water, sodas, beers, or other pre-packaged liquids. If you find it too difficult to resist the local cuisine of street vendors, choose those vendors who cook the food right in front of you. If you find yourself battling a case of traveler’s diarrhea, treatment is generally simple. Over-thecounter medications, such as Pepto Bismal, often do the trick after repeated doses. For more serious cases, antibiotics may be needed to clear up symptoms. If you are traveling with children, be advised they can become dehydrated easily after a bout of diarrhea. Discuss with your family doc-

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tor health concerns specific to children before traveling out of the country. Here are a few final precautions to buy you some extra travel peace of mind. Have your prescriptions refilled before traveling, and travel with them in their original packaging to avoid complications when going through customs. Carry plenty of first aid products, bug spray, sunscreen, and aspirin or Tylenol if your travels take you to a locale where these products are not readily available. Finally, spend the money on travel insurance, says James-Griffith. It may prove life-saving if you experience a medical emergency. Dr. Peskind recommends having a contingency plan. If the unthinkable happens and you must seek medical attention, have a plan ready that will get you out of the country and home for major medical procedures. As a part of that plan, ensure that your health insurance covers care in other countries. Health concerns need not scare you away from travel to exotic destinations. The incidence of infectious diseases are known for each country and precautions are in place. Some countries, such as Cambodia and Vietnam, have recently opened their doors to international tourists for the first time. “The world is small. People are traveling. It is amazing to see where they are going today,� declares James-Griffith. With proper planning, your adventures will only be limited by your imagination. Angeline Grenz is freelance writer living in Fort Collins.

Northern Colorado Medical & Wellness

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Medical Profile

Laparoscopic Surgeon Thomas Chiavetta, MD, Northern Colorado Surgical Associates

Striking a Balance by Allie Comeau

Albert Einstein once said, “Life is like riding a bicycle. To keep your balance you have to keep moving.” Thomas Chiavetta, MD a pioneering laparoscopic surgeon with Northern Colorado Surgical Associates, would most certainly agree.

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hiavetta is one busy man. Between his family, successful surgical practice, and the sports he enjoys, he’s always on the move. He strives daily to achieve balance between work, family, and play. While he would love to be able to devote more time to each, he knows that all three passions make him the person he is, and contribute to his overall happiness. Chiavetta knew he wanted to be a doctor from the time he was sixteen years old. Inspired by Michael E. DeBakey, a famous cardiac surgeon, and Marcus Welby, a TV doctor, he discovered his passion for medicine at an early age. His interests in biology, physiology, and medicine, combined

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with his desire to help people in a meaningful way, left him no other option. “I used to try and come up with a back-up plan, something I could do if I didn’t get into medical school,” he says. “But I could never figure one out. I was afraid if I focused on an alternate plan, that’s what I’d end up doing, and I wouldn’t achieve my real goal of being a doctor. So I went for it with everything I had, and fortunately, I made it.” While it’s doubtful that fortune had much to do with his success, it’s obvious he feels lucky to have found a career he’s passionate about. Dr. Chiavetta loves helping people and performing surgery. “My favorite part is taking care of patients and doing surgery,” he says. “That’s what I like

most about medicine. It’s a way to directly help people in a hands-on way, and hopefully see them get better.” Dr. Chiavetta is also passionate about teaching the next generation of doctors and surgeons. He feels this is yet another way to help people. “There are only so many patients you can take care of directly,” he says, “but you can also help people by teaching other physicians, medical students, and surgeons.” Even more important than his love of medicine is his family, whom he speaks adoringly of. His wife, Cathy, and his seventeen-year old triplets Lauren, David, and Joey, occupy his time when he’s not in surgery. “The triplets have always kept us busy,” he says. Striking a balance between work and home is something he strives towards, but continues to be challenging. “There isn’t a lot of free time in this profession, but it’s important to have interests outside of medicine,” he says. “I want to spend as much time with my family as possible, so they are really my focus.” Luckily, the family enjoys similar activities and has made it a priority to enjoy them together. “My son, Joey, and I really like to ski and ride our bikes, and Lauren and David are competitive figure skaters, so we spend a lot of time supporting them and enjoying what they do. They’re really good.” Sometimes getting out of town is the best way to ensure the pressures of work don’t infringe upon a family weekend. “If I’m in town, there’s always work that could be done,” he says. Family vacations have been a great way for the Chiavettas to spend uninterrupted time together. “We used to go to Mexico every spring break and just hang out on the beach,” he says. “We also like to be up in the mountains. We own a place in Steamboat Springs now, and try to escape there as much as we can.” It remains to be seen if these trips have prepared Dr. Chiavetta and his wife for their big trip to Italy this summer. They’ve signed on as chaperones for the triplets’ school trip. “We’re excited, it should be really fun. Now I’m just trying to learn a little Italian.” You might wonder how he has time for anything else, let alone time to learn Italian, but somehow he also manages to fit skiing and cycling into his schedule. “Luckily, my hobbies have the added benefit of keeping me in shape and relieving stress. If I find time for myself, I’m on my bike or skis,” he says. “I rarely work out at the gym.” Living in Colorado for the past 27 years has definitely helped foster his love of both sports. Last summer, Dr. Chiavetta and his son rode the Bicycle Tour of Colorado, which took them through the mountains and ended in Steamboat Springs. “I’ve actually seen more of Colorado by bike than any other way,” he says. That seems to be the way he’s experienced life in general – always on the move. Like riding a bicycle, Dr. Chiavetta maintains balance by moving… between work, home, and play. Allie Comeau is a freelance writer and copywriter living in Fort Collins, CO. See her blog on active lifestyles at http://blog.sierratradingpost.com

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2008-05 Northern Colorado Medical & Wellness Magazine  

May - Northern Colorado Medical & Wellness Pediatrics & Family A popular regionally focused issue featuring topics of health, prevention, a...