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OCTOBER 2012

Annual

Seniors Edition

Advances in Colon Cancer Diagnosis & Treatment

Elite

Senior Athletes

Living with

Parkinson’s w Colorado w w . m Medical e d i c &a Wellness landw ellness.com Northern 2012

| www.stylemagazinecolorado.com

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The Voice of Northern Colorado for

28 Years.

s t y le me d ia a n d d e s i g n , i n c .

| 970.226.6400 |

w w w. s t y l e m a g a z i n e c o l o r a d o . c o m w w w. m e d i c a l a n d w e l l n e s s . c o m Publisher Lydia Dody | lydia@stylemedia.com Managing Editor Angeline Grenz angie@stylemedia.com creative director Scott Prosser Senior Designer Lisa Gould digital director Austin Lamb | austin@stylemedia.com Digital/Editorial Assistant Logan Martinez Advertising Sales EXECUTIVES Jon Ainslie (970) 219-9226 Lydia Dody (970) 227-6400 David Knight (970) 619-9846 Saundra Skrove (970) 217-9932 Office Manager/About Town Editor Ina Szwec | ina@stylemedia.com Accounting Manager Karla Vigil Circulation manager Trisha Milton Copy editor Corey Radman Contributing Writers Laura Dowling, Heidi Kerr-Schlaefer, Marty Metzger, Corey Radman, Kay Rios, Laura Sebastian, Carl Simmons, Tracee Sioux, Elissa Tivona, Michelle Venus PhotographerS Marcus Edwards, Don Hajicek Contributing PhotographerS Bill Cotton Affiliations Fort Collins Area Chamber of Commerce Loveland Chamber of Commerce & Visitors Center 2012 Style Magazines January-Northern Colorado Medical & Wellness Magazine and McKee Medical Center & North Colorado Medical Center Physician Directory February-Style March-Northern Colorado Medical & Wellness April-Style May-Northern Colorado Medical & Wellness June-Style July-Northern Colorado Medical & Wellness Magazine and University of Colorado Health Physician Directory August-Style September-Women’s Health & Breast Cancer October-Northern Colorado Medical & Wellness November/December-Holiday Style Style Media and Design, Inc. magazines are free monthly publications direct-mailed to homes and businesses in Northern Colorado. Elsewhere, a one year subscription is $25/year and a two year subscription is $45/year. Free magazines are available at over 236 locations throughout Northern Colorado. For ad rates, subscription information, change of address, or correspondence, contact: Style Media and Design Inc., 211 W. Myrtle St., Suite 200, Fort Collins, Colorado 80521. Phone (970) 2266400, ext. 208. Fax (970) 226-6427. E-Mail: ina@StyleMedia.com ©2012 Style Media and Design Inc. All rights reserved. The entire contents of Style Magazine are copyrighted and may not be reproduced without the expressed written consent of the publisher. Style Media and Design Inc. is not responsible for unsolicited material. All manuscripts, artwork, and photography must be accompanied by a SASE. The views and opinions of any contributing writers are not necessarily those of Style Media & Design Inc.

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Bohemian Nights Success

Dear Lydia, On behalf of the Bohemian Nights at NewWestFest staff, I would like to thank you for the August edition featuring the women who run the show at Bohemian Nights at NewWestFest. Angie, David and Heidi were so supportive and accessible, which made the process fun and stress-free! The ladies had so much fun at the photo shoot and interview; the excellent article and photos are a reflection of the professionalism and personality you and your staff bring to the table.   We have received positive feedback on the feature from many people via our website, blog, social media and in-person. Thank you for all your hard work and for the opportunity to be featured in such a high-quality magazine.    Mary Timby  Communications Coordinator, Bohemian Nights

Lydia, Being a model for the annual breast cancer awareness issue (September 2012) has been more than fun. I have seen confidence emerge and sometimes hidden parts of personalities come to the forefront. One thing we all have in common, not one of us is going to give in to cancer. Some may have had dark moments and we each have had a different path, but we are all determined fighters, whether or not we may have known it prior to diagnosis. Don’t tell us no! This has been an opportunity to gain 30 new friends. When we get together, we don’t always talk about cancer; we discuss our lives! And that’s the focus – we are living and thriving. Cancer is no longer a death sentence; however, early detection is the key. Unfortunately, it is striking younger and younger women. We must find the cause and/ or the cure. Thank you, Lydia, for your dedication, and the continuing efforts toward breast cancer awareness and the help that is provided to patients.

Love Olivia

Lydia, We all loved reading your recent Style Magazine at the office (September 2012), especially the piece on Olivia Newton-John… what an inspiration! We were also oohing and aaahing over the necklace she was wearing on the front cover – is this something we can find locally or a personal piece of jewelry? Thank you for your fine work and awesome magazine!   Debbie and the Gals at Hensel Phelps, Greeley

Linda Norman Hiser, Fort Collins

Dear Ladies of Hensel Phelps: Thank you for your kind words. Unfortunately, the necklace is from her own collection. We loved having her appear on our cover and look forward to seeing her perform at Union Colony Civic Center in October! – Lydia

Christy Grosboll Sugar Mill Productions, Loveland

Thank You

Angie, I just wanted to thank you so much for all your dedication and hard work on the article (“Modern Day Teen Superheroes,” September 2012). I couldn’t be happier with the way you wrote it. So well done. Rockstar! Again, thank you so much.

The Breast Cancer Fight

Lydia, I just want to take a minute to thank you for your courtesy and thoughtfulness for this year’s Celebrating Life issue (September 2012). First of all, the whole magazine is beautiful, the women are fabulous, and we are grateful to have a Grand Dame (you) as such a powerful friend to us all in curing this bad boy. I am proud to be part of your team! Abby Charpentier Vogue Laser Clinic, Loveland

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Lydia presents the new cover look to cover model Liz Barnez.

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CONTENTS

Northern Colorado Medical & Wellness

October 2012

18 Living Well with Parkinson’s

30 Independent Medical Practices Stand Strong

26 Heal with Your Own Stem Cells

42 elite senior athletes

8 12 14 18 22 26 28 30 36 38 42 47 48 50

From the Readers Publisher’s Letter Colon Cancer Outcomes Improve Living Well with Parkinson’s Hip Replacements – Regain Your Life Heal with Your Own Stem Cells Safeguarding Seniors Independent Medical Practices Stand Strong Let’s Get Topical: Compounding Your Pain Relief The Silver Tsunami Elite Senior Athletes Trust Your Gut Senior Product Spread Get Fit, Give Back Calendar Hearing Device Worn in Mouth Weight Gain Despite Exercise Vegetable of the Moment: Pumpkin

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Ensuring Nine Happy Lives

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Teaching the Fundamentals – of Football and Life New Medical Courses for Greeley Students

Teaching the Fundamentals – Of Football and Life

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Family Focus

60 62 64 66

Kid Friendly Events in Northern Colorado Urgent Care Option for Pets Ensuring Nine Happy Lives Princess, The Paralyzed Pekinese Physician Spotlight: Stace Fritzler, M.D. Helping the Community She Loves

on the cover: Seniors today are healthier and living longer. Find out how healthcare and other industries anticipate changes in services as more baby boomers reach age 65. Read “The Silver Tsunami” on page 38.

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

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Publisher’s Letter

Stay Healthy as You Age This issue of Northern Colorado Medical & Wellness has a special focus on senior health and lifestyle. Although I might qualify in age as a senior, I still think of myself as being much younger. I believe this is true for many active seniors today. In the article, “Elite Senior Athletes,” meet two seniors who continue to train and compete in their sports. George Thornton plans to tackle swimming the English Channel in 2013, and if he accomplishes that grueling feat, he will be the oldest person to swim the Channel. Libby James, now 76 years young, has broken numerous running records in her age group and she continues to train and compete. We might not all be elite athletes but numerous studies have shown that regular physical activity is one of the most important preventatives of disease as we age. I have always admired Libby’s athleticism; she was also one of my favorite contributing writers for Style Magazine for many years. As we think about our enormous wave of Baby Boomers and their impact on our communities, read “The Silver Tsunami.” Experts estimate an additional 52,000 seniors will be living in Larimer County by 2040. This growing population will have many social and economic impacts on our region. Seniors have an improved quality of life today because of many new innovations, medical breakthroughs and aids to maintaining good health. Read “Colon Cancer Outcomes Improve” to learn about new advances in diagnosis and treatment. In “Living Well with Parkinson’s” meet two well-known locals who are thriving with this chronic condition. We are lucky to live where medical care is plentiful and exceptional. We have two major health systems serving our region, and an excess of 300 independent physicians who have taken care of their patients throughout the decades. I found it eye-opening to learn about the many practices that have served our region since the ‘50s. Read “Independent Medical Practices Stand Strong” to appreciate this group’s commitment to their profession and to their patients. This issue is loaded with great information to help you stay informed about health and wellness topics for the family. I hope you enjoy reading the many interesting articles that relate to staying healthy and keeping a high quality of life as we age. In good health,

lydia@stylemedia.com

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MEDICAL

Colon Cancer

Dr. Andrew Mills, radiologist with The Imaging Center, prepares a patient for a virtual colonoscopy.

C olo n C a n cer

Ou tco m e s I mp ro v e

C

olon cancer is the second leading cause of cancer death in both men and women, but advances in screening technology, surgery and medicine make the diagnosis less dire than in the past. The bowel is divided into three segments: the stomach, small intestine and large intestine. The latter is the colon. The work of digestion is complete once material reaches the colon. The stomach has broken down the food particles and the small intestine has absorbed the nutrients. The materials in the 3 1/2 feet of colon represent left over nutrients the body was unable to absorb, solid waste and a significant amount of fluid. “The large bowel is really a repository so the body has the opportunity to reabsorb the fluid that comes out of the small intestine,” says Stefan M. Pettine, M.D., of Northern Colorado Surgical Associates in Fort Collins. Colon cancer is common, but symptoms tend

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to occur only after a tumor has grown large enough to cause complications such as blocking the intestine or causing bleeding. Colon cancers occur in the inner lining of the large intestine, not in the muscular wall or outer part of the colon. The tumors arise from premalignant polyps that are a transformation of the lining that has undergone a malignant change and has become cancerous. There is a two-fold purpose to screening for colon cancer. The first is to look for cancer, but also to find and remove polyps that could be premalignant. “We think there’s a natural lifecycle to the formation of polyps, to their growth and to their malignant transformation, that may be in the order of anywhere from four to 10 years, and that’s why we recommend colonoscopy at 10 year intervals beginning at age 50,” says Dr. Pettine. If a person is showing symptoms such as chronic anemia from blood loss, chronic abdominal pain or changes in their bowel habits,

By Heidi Kerr-Schlaefer

constipations or blood in the stool, he or she is a candidate for colon cancer screening no matter their age. Patients younger than 50 who have a family heredity factor or those who are predisposed to forming polyps should also get colon cancer screenings.

What is a Virtual Colonoscopy?

A colonoscopy is a test that allows a doctor to look at the inner lining of the colon through a thin, flexible tube called a colonscope. During a traditional colonoscopy, tissue samples can be collected and abnormal growths, such as polyps, can be removed. Colonoscopies are often used as a screening test to check for cancer or precancerous growths in the colon or rectum. During the procedure a patient is under heavy sedation. A traditional colonoscopy is done in a surgery center, but a virtual colonoscopy is performed in a radiology department such as The Imaging Center at Harmony in Fort Collins. A virtual colonoscopy uses a CT machine to get a three-dimensional

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image on a computer screen. The radiologist can then “fly through” the colon virtually on a computer. “Virtual colonoscopy is one of the newest things when it comes to colon screening,” says Willy Hammon, executive director for The Imaging Center at Harmony. “It’s been out at least 10 years and it has been growing in acceptance in the insurance world. In the past it’s usually been something a patient has had to pay for out of pocket.” The prep is the same for both a standard and virtual colonoscopy because in both exams the colon must be emptied. Prep starts two days in advance, and patients receive a packet outlining what they must do to clean out their colon for the test. Once the patient arrives and changes into a gown, the virtual colonoscopy takes a total of 10 minutes. A tip is inserted into the rectum and the colon is inflated, which can be slightly uncomfortable. The patient is then scanned once while lying on their stomach and once on their back. After the procedure, the patient can go home and return to their normal lifestyle. The radiologist then reads the scans by doing a virtual fly through of the colon. They can stop at any point and they have multiple views they can look at to determine whether the person needs a biopsy or if there is no further action necessary. It is important to note that while virtual colonoscopy is becoming more widely accepted by insurance companies, the majority still do not cover the procedure, preferring instead to cover the much more expensive traditional colonoscopy. It is a good idea to check with your provider before scheduling a virtual colonoscopy.

Laparoscopic Surgery

In the unfortunate circumstance that cancer is discovered, advances have been made in both surgical procedures and chemotherapy treatments for colon cancer. In the past, surgery for colon cancer involved a large incision from breastbone to pelvic bone. It also meant a long hospital stay and having to live with a colostomy bag for a period of time. Today, laparoscopic surgery is drastically changing the way these surgeries are performed, resulting in better outcomes for patients. Laparoscopic camera-assisted surgery is a much less invasive way to remove a tumor from the colon. Three to four small incisions are made in the abdomen, and the surgery is done via these ports. The benefits to doing laparoscopic colon surgery are vast, and new benefits are still being discovered. The shock to the colon is lessened because there is no hands-on manipulation, which means recovery times are faster, and hospital stays have been cut to three to five days instead of the standard five to seven. The other big advantage to laparoscopic surgery is smaller wounds, reducing the chance of infection, which is a real issue when dealing with the colon, a place where billions of bacteria reside. Laparoscopic colon surgery and open colon surgery have equivalent survival outcomes, however, studies have shown a slight improvement

Northern Colorado Medical & Wellness 2012

clinical study looks at

bacteria in colon By Heidi Kerr-Schlaefer

Stefan M. Pettine, M.D., at Northern Colorado Surgical Associates in Fort Collins, and his team are currently involved in some fascinating colon cancer research being conducted at the College of Veterinary Medicine & Biomedical Sciences at Colorado State University. Colon cancer is almost exclusively a human disease; it rarely occurs in animals. As scientists at CSU research why this might be, Dr. Pettine is helping with a pilot study analyzing the types of bacteria that grow in the micro environment of the lining of the colon. “There are bacteria that live inside the bowel, but, along the inner microlayer of the mucus that lines the bowel, there is also a microenvironment there that harbors certain bacteria,” explains Dr. Pettine. The types of bacteria living in the microenvironment created in the colon probably play a big role in what chemicals are being produced there and some of those chemicals may be carcinogenic. “When we look at impacts of diet, the impact may not be that red meat

causes colon cancer. The impact may be that red meat in our diet leads to increased nutrients of various sorts in the colon that are undigested and those nutrients get acted upon by bacteria that convert them into actual carcinogens,” says Dr. Pettine. The point is that it may not be as simple as saying there are carcinogens or cancer-causing agents in our food, because they may not be there until the material gets to the colon and begins to interact with those specific bacteria. The data from the study has demonstrated that there are differences in the bacteria living in the microenvironment of patients that do have colon cancer and patients that don’t have colon cancer. The next stage will be to see if these bacteria can be altered by changing the patient’s food intake. Eventually these findings could influence which patients are screened for colon cancer more aggressively in the future and, with diet intervention for at risk patients, doctors may be able to change the bacteria present in the colon and actually prevent colon cancers. 15


Dr. Stefan Pettine, M.D., Northern Colorado Surgical Associates

in long-term survival in colon cancer with laparoscopic surgery, and this survival advantage seems to be due to improvements in patients with stage three cancer, when cancer has spread to local lymph nodes. This could be because the former causes less insult to the immune system, but whatever the reason, it is good news. “The expectation is that probably half of colon surgery will be done laparoscopically within the next five years, and within the next decade it will probably be similar to gall bladder surgery or appendix surgery where the vast majority are done laparoscopically,” says Dr. Pettine.

Medicine

Once a cancer has spread, surgery is performed to remove the tumor, and chemotherapy is then prescribed. Dr. Pettine notes real advances have been made in these medicines that treat the disease beyond the bowel. In patients with stage one tumor cancer in a polyp or cancer that has just begun to invade the inner lining of the colon, 90 to 95 percent will be disease free in five years. In stage three, when a tumor is removed surgically and not accompanied by chemotherapy treatments, 65 percent of patients will survive. With good chemotherapy treatment upwards of 85 percent of stage three patients will be disease free in five years. Even in stage 4 patients, survival at five years can be at 40 percent with surgery and chemotherapy.

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The Future Looks Bright

The next stage in surgical advances sounds like science fiction, but it has been successfully attempted in Canada and Minnesota. Already, robotic surgery allows the surgeon performing the operation to be thousands of miles away. In the future, a skilled surgeon at a large center could be paired with a surgeon in a rural area to perform a surgical procedure at a distance. “I think one of the biggest hurdles we have in medicine is how do we equalize care between our bigger, affluent communities and our rural communities,” says Dr. Pettine. “It’s exciting – the idea that we can take a physician’s expertise and move it beyond the boundaries of his hospital and his operating room.” The future for patients with colon cancer is bright. There is promising research being conducted at Colorado State University, with the help of Dr. Pettine and his team, that could potentially lead to a better understanding of colon cancer and, in turn, more efficient screening and possibly even prevention. “There’s a lot going on in terms of prevention, and I think that’s exciting. Early detection is very exciting, especially when paired with a simpler surgery that people recover from quickly,” says Dr. Pettine. Heidi Kerr-Schlaefer is a journalist and freelance writer from Northern Colorado. She is also the Mayor of HeidiTown.com, a blog about festivals & destinations around Colorado.

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MEDICAL

P a r k i n s o n ’s D i s e a s e

Jim Murray has been living with Parkinson’s disease for eight years and refuses to let his disease destroy his quality of life.

Living well with parkinson’s By Michelle Venus

I

t comes on slowly. Perhaps a tremor of the hand. Or the arms and legs start feeling stiff and rigid. Losing balance and difficulty walking are additional symptoms.

Parkinson’s Disease (PD) is a brain disorder that affects nearly 60,000 people each year. For some reason, the brain doesn’t produce enough of a chemical called dopamine, which acts as a medium of sorts to transmit the signals that control motor functions. Without sufficient dopamine, nerve cells called neurons malfunction and ultimately die. Oftentimes significant damage to neurons has occurred before the disease is even diagnosed. Although PD can attack any part of the brain, it is primarily found in the substantia nigra (which literally means black substance) of the midbrain.

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“I prefer to call it Parkinson’s condition,” says Jim Murray, a real estate agent with The Group Inc. “I don’t really consider it a disease. It’s not something you can give to someone. You don’t normally die from Parkinson’s, and you can learn to live with it.” Murray was diagnosed with PD eight years ago. But his symptoms started two years prior, when he was 50. “I had a tremor in the little finger of my left hand,” he holds up his hand and demonstrated the shaking. “And joint stiffness, rigidity, things like that.” PD is a progressive disorder and progresses at different rates for different individuals. For instance, Murray knows people who have been diagnosed for just a few years and are now in wheelchairs. But he continues to work full-time at The Group and leads an active life. Every morning

he starts his day with stretching exercises. Murray also lifts weights and monitors his diet – he limits caffeine intake, no more coffee. Instead, he drinks green tea. Every day. His vitamin regimen has grown to include supplements like CoQ10 and glucosamine. A 2002 study conducted by Dr. Clifford Shults of the University of California at San Diego found that 1200 milligrams per day reduced progression of the disease by 44 percent. Phase III of the study was concluded in 2011. CoQ10 seems to improve the function of the mitochondria; known as “cellular power plants,” they produce the energy that generates fuel for cell activity. Glucosamine is a natural compound found in healthy cartilage. It keeps joints moving smoothly. There are medications that help control PD through different approaches. Some help to

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Nancy Quick, PT, Ph.D., with Berkana Rehabilitation Institute, works with a patient on a tricycle. Bicycling has been shown to improve symptoms in Parkinson’s patients.

slow the loss of dopamine, helping to keep the neurons healthy and functioning for as long as possible and others work to improve the symptoms. Murray takes a “cocktail” of three different meds, including one that must be administered every two hours. The fine-tuning of PD cocktails takes time to get just right, as each patient responds differently. Too little, and the patient still experiences debilitating symptoms. Too much and dyskinesia – involuntary movements such as tics or a lack of coordination – becomes a problem. Think of actor Michael J. Fox, who put his PD in front of the public in 1998, seven years after diagnosis. He exhibits signs of dyskinesia with some upper body swaying and facial tics. What causes Parkinson’s Disease? No one knows. “When someone figures that out, they’ll probably win a Nobel Prize,” states Fort Collins Neurology’s Timothy J. Allen, M.D. “There’s no cure and no way to reverse Parkinson’s.” Stem cell research shows promise. It helps to replace cells that are not able to produce dopamine. Research and autopsies have confirmed the location of dead or dying cells through brain

Northern Colorado Medical & Wellness 2012

mapping. A new therapy is being successfully tested on patients, where a hole is drilled through the skull and stem cells are literally “squirted” into the brain. When all goes right, increased amounts of dopamine, which Dr. Allen calls “the grease of the brain,” are produced. Deep brain stimulation (DBS) is a recent development in PD treatment. With DBS, nearly-hairthin electrodes, or leads, are inserted through small openings made in the skull and implanted into the PD-damaged sections of the brain. These leads then travel under the skin of the scalp, neck and shoulder and attach to the neurotransmitter, a small battery-operated device that is surgically implanted under the skin near the patient’s collarbone. The neurotransmitter sends electrical impulses deep into the brain via the electrodes. These impulses interfere with and block the electrical signals that cause PD symptoms. The neurotransmitter controls the amount of stimulation that the brain receives, and like medication, it requires some tweaking and tuning to get it just right. Once the perfect balance has been achieved,

patients can drastically reduce the amount of medication required to keep symptoms at bay. Jim Murray is familiar with this procedure. He will be undergoing DBS surgery this fall. “It’s scary and exciting,” he says. “Scary, because it’s brain surgery. Exciting, because it has the potential to change my life in a very good way.” But what if stem cell treatment or DBS aren’t the answers? What can a patient do to enhance his or her quality of life? “Physical therapy,” says Nancy Quick, PT, Ph.D. and President/CEO of the Berkana Rehabilitation Institute. For over 20 years, Quick has practiced, taught and researched physical therapy with a focus on recovery of function for both neurological and orthopedic patients. At her Fort Collins clinic, she sees patients who are striving to live healthy and robust lives even though they struggle with disorders such as PD, Multiple Sclerosis, stroke and traumatic brain injury. “I look at PT as a holistic approach that helps people engage in life. I ask them what they loved to do before Parkinson’s, what gave them joy, then we focus on what we can do through

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physical therapy to help them stay involved with those activities,” Quick declares. “If somebody loves gardening, what can we do to keep them in the garden?” She designs therapy programs with traditional and some not-so-traditional equipment to help improve balance, strength, coordination and flexibility. Quick uses a body weight system to help patients with balance issues. A ceiling-track allows her to move patients to various parts of the clinic and do different exercises while in the harness. One track is over a treadmill. Another is in the center of the room. Pointing at a television, she talks about using the Nintendo Wii to help improve balance and coordination with her patients. Quick describes some “really exciting research coming out of the Cleveland Clinic” showing that bicycling at 70-90 rpm can improve symptoms. A researcher from the Cleveland Clinic discovered this when he rode a tandem bike in a seven-day bicycle ride across Iowa with a friend whose PD symptoms had virtually disappeared when she got off the bike. With that in mind, Quick gets her PD patients on an adult-sized tricycle. Starting in the gym, she gets them used to being in the saddle and maneuvering the bike in a safe environment. Once they’ve mastered riding inside, she moves them to the parking lot to get used to surface changes and curbs and then ultimately in a nearby park or trail. “What I like about the bike is that it requires them to really use motor control in ways they

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Murray and his wife, Beth, are pictured with actor Michael J. Fox, whose own battle with Parkinson’s has been widely publicized. The Murrays have worked locally with the Michael J. Fox Foundation for Parkinson’s Research.

don’t on a stationary bike,” says Quick. She is not aware of any other physical therapists in the country using this type of program in clinical practice. She plans to bring her own research programs, which focus on treating peripheral nerve injuries and developing technology that enhances movement recovery for disorders such as PD, MS and stroke, to the clinic in the future. One of Quick’s patients, Clifford Shaw, has actually gotten his own trike and rides it every day. At 82, Shaw has had PD for several years, and it is fairly advanced. “With this,” she places her hand on the bike, “he feels successful. He can do this on his own. He can go out with his wife or his grandkids on the bicycle. And that’s what I love about this. It’s an avenue that really helps my patients engage in life.” Shaw states that riding the bike has “made me a lot more free to move.” That engagement in life makes a huge difference to Quick’s patients. Parkinson’s can be a devastating diagnosis and depression is not uncommon among patients. Therapies that help to alleviate symptoms and maintain independence are important to overall health. Jim Murray can attest to that. “There are four factors that I focus on,” he says. “Diet, exercise, meds and attitude. And I can’t stress enough how important a positive attitude is when dealing with Parkinson’s.” Michelle Venus is a writer living in Fort Collins.

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MEDICAL

Orthopedics

H i p R e p lace m e n t s –

re g a in y o u r l i fe

I

f hip pain from arthritis is keeping you from enjoying life, you’re a good candidate and it’s time to talk to your doctor about a hip replacement, says Riley Hale, M.D., orthopedic surgeon at Banner Mountain Vista Orthopedics in Greeley. Many people are opting for hip replacement according to statistics gathered by the Center for

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By Kay Rios

Disease Control and Prevention (CDC). According to 2009 records, 327,000 hip replacements were performed in the U.S. The American Academy of Orthopaedic Surgeons (AAOS) says that total hip replacements have doubled in the past 14 years. While there is no age limit for hip replacement and the need can arise at any age, a projection on increases of replacements is based on the growing numbers of an aging population.

The hip is one of the body’s largest joints. The socket is formed by the acetabulum, part of the large pelvic bone, and the ball is the femoral head at the upper end of the thighbone. In a total hip replacement, damaged bone and cartilage is removed and replaced with prosthetic components. Recommendations for surgery are based on a patient’s pain and disability, not age. Most are

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Kirk Kindsfater, M.D. Orthopaedic and Spine Center of the Rockies

Riley Hale, M.D. Banner Mountain Vista Orthopedics

age 50 to 80 but even young teenagers with juvenile arthritis have undergone surgery. The good news is that patients are benefiting from improvements, says Kirk Kindsfater, M.D., orthopedic surgeon at Orthopaedic and Spine Center of the Rockies in Fort Collins. “Materials have changed. There’s new technology with old articulating surfaces being replaced with ceramic and very durable plastic. The prosthesis bearing surface has changed and has improved a lot. Changes in surgical techniques allow for less operating time and we’re better at getting patients out of the hospital and rehabilitated.” In decades past when joint replacement was new, different factors determined how long the replacement would last. Some early implants

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A view of a recent total hip replacement performed at Orthopaedic and Spine Center of the Rockies.

failed because the metals and plastic used were susceptible to breakage. But with improvements in the prosthesis and implants, the wear and tear factor was prolonged. Dr. Hale says that polyethylene durability has been improved through “crosslinking,” a process in which polyethylene molecules are bonded together, resulting in a stronger material which can substantially improve wear resistance. Additionally, today’s ceramic implants generally resist chipping and breaking more so than earlier versions. “You have to depend on your surgeon to tell you what is best,” Dr. Kindsfater says. Improvements in technique and surgical instruments now allow surgeons to insert prosthetic joints using shorter skin incisions. This results in less surgical trauma, faster hospital release and improved rehabilitation. Most recent trends in hip replacement surgery have focused on improved rehabilitation and pain management that will shorten post-surgery recovery.

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Another change is in the use of anesthesia, Dr. Kindsfater adds. “Most surgeries are done with a regional, spinal anesthesia rather than a general anesthesia so the patient stays awake during the procedure. It’s better for your lungs and there is less risk of blood clots.” The approach to the surgery can also vary from anterior to posterior. “The most common is a posterior approach,” Dr. Hale says. “It requires cutting a few small hip muscles and patients do well. Another approach is the direct anterior. It’s not new but it’s come back into favor because of different instruments and special operating tables. The new tables allow the hip to extend and rotate. One advantage of this application is there are no muscles cut.” Dr. Kindsfater says he prefers the posterior approach and adds that, “there is no good, hard data that says the anterior approach is better. But the approach is the surgeon’s choice. If you have a skilled surgeon and you do what you’re told in terms of rehabilitation, you’ll have a successful operation.” One thing that has not changed is the fact that hip replacements are finite. “If you are 40, you will have to have that redone at some point,” Dr. Kindsfater says. “But, even in that case, they should last 25 to 30 years.” Even with new materials and techniques, Dr. Hale says, “It’s hard to say how long they’ll last. Even with the old style, 80 percent are still functioning at 20 years. With new surfaces and not using cement, they may go beyond 20 years. So far, the lab tests are encouraging but only time will tell. There is still the possibility of a redo after 20 years. I feel uncomfortable guaranteeing anything else.” That discussion is always held with patients, both doctors say, along with all of the additional information about approach and materials to be used. After the pre-op appointments and lab work, patients know what to expect. “In skilled hands, surgery usually takes an hour or so,” Dr. Kindsfater says. “For some of the younger patients, we get them up the night of surgery. Older ones may not get up until the next day when the physical therapist can work with them. There are some bending restrictions for six weeks.” Dr. Hale adds, “Most people can expect to be fully weight bearing the day after. In general, most people do very well in six weeks with a full recovery in several months.” “We are definitely better at getting people on their feet and getting them home,” Dr. Kindsfater says. “At three months, I say you can do anything you want except running. No high impact but it’s okay to golf, bike or play tennis. A hip replacement is our best joint replacement because it’s the most reliable and gives the most pain relief. It’s that good.” The bottom line, he says, is the patient’s benefit. “You give them a good hip, you give them their life back.”

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

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MEDICAL

Stem Cell Therapy

Atari Bigby, currently a safety for the San Diego Chargers, underwent surgery to utilize his own stem cells to heal torn cartilage in his ankle and stave off severe arthritis in the future.

Heal with your own stem cells

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NFL Super Bowl champ fearing arthritis, an ailing 37-year-old firefighter and an 18-yearold with severe back pain are among many who have turned to a simple, 30-minute outpatient procedure that uses a person’s own stem cells to address specific injuries. Kenneth Pettine, M.D., of the Orthopedic Stem Cell Institute in Colorado, uses stem cell therapy instead of, and sometimes in addition to, surgery to treat orthopedic injuries and conditions due to aging and joint degeneration in knees, hips, shoulders, feet and ankles, as well as degenerative discs in the back or neck. This minimally invasive procedure may help patients heal faster and regain pain-free motion, and has been the treatment of choice for people with a variety of painful and debilitating ailments. During a simple and safe 30-minute procedure, Dr. Pettine extracts stem cells from a patient’s pelvic bone. Dr. Pettine then uses a system to isolate and concentrate the stem cells before re-injecting the cells into injured parts of a patient’s body. The body naturally uses these concentrated stem cells to immediately begin the healing process. Hard-hitting NFL player Atari Bigby turned to Dr. Pettine in July 2012 to undergo the treatment “as an investment in my future.” His goal: to thwart

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By Laura Dowling

potential arthritis in his left ankle in coming years. Bigby, an eight-year NFL veteran and Super Bowl champion now playing for the San Diego Chargers, experienced a torn cartilage in his left ankle in 2008. He underwent surgery at that time and again in 2010. Bigby says he has seen many retired NFL players suffer from severe arthritis as a result of injuries during their professional careers. With an eye on his post-NFL days, he turned to Dr. Pettine. “I’m in my prime,” he says. “The stem cell treatment is something I can do now to address the future. When I’m old and retired from this game, I still want to be active with my kids.” Veteran firefighter Travis Garretson, 37, of Casper, Wyo., suffered from excruciating ruptured and bulging spinal discs for three years. Endless chiropractic sessions, massage, physical therapy, steroid injections and even nutrition didn’t alleviate the agony, and forced Garretson to miss four months of work in just one year. Garretson came to Dr. Pettine in 2011 hoping for a treatment that would alleviate even some of his pain. Garretson underwent the stem cell procedure in January 2012. Since receiving the therapy, he hasn’t missed a single day of work and is back to his high fitness level of running, lifting weights and easily passing the annual firefighter fitness test, accomplishments that only months prior seemed unlikely.

“Before the procedure, I just laid around because of the pain in my back, down my leg and the numbness,” he recalls. “My job is so physically demanding. We get medical calls four to five times a day, which can mean lifting people onto a gurney and into an ambulance. Now I can do pretty much whatever I want.” For two years, Casey Henry, an 18-year-old nationally recognized high school football champion and baseball first baseman from Sterling, Colo., couldn’t ride in a car for an hour or get out without help. The athletic teen was suffering from two herniated spinal discs. “In baseball, I couldn’t bend over and get a ground ball,” Henry recalls. “I had to go all the way to my knees.” He just “gritted it” and figured his adrenaline kicked in to alleviate pain during sports. But the pain became too much for him to handle. “I had three options: fuse the discs through surgery, which probably shouldn’t be done until I’m 30 or 40, get regular cortisone injections or go with the stem cell treatment. I chose using my own stem cells,” he says. At the end of baseball season in April, Dr. Pettine injected Henry’s two discs with the teen’s own stem cells. “It was a good choice because it definitely helped,” Henry says. Three months after treatment, Henry achieved the biggest accomplishment

Lydia’s STYLE Magazine


in his sports career: winning the national football championship at a stadium 18 hours from home. He was also named Player of the Year. “Without using my stem cells for treatment, I never could have made that long trip and accomplished victory,” Henry says.

Your body’s on-the-spot repairmen

This procedure is called autologous stem cell treatment, so named since the donor and recipient are the same person. The procedure has nothing to do with embryonic stem cell treatment where the stem cells come from embryos. There are no ethical issues with using our own stem cells. For the autologous stem cell treatment, Dr. Pettine pulls stem cells from a patient’s own bone marrow residing in the pelvic bone (or fat tissue, in the near future) where high levels of the cells reside. This is done with IV sedation so the patient generally remembers nothing about the procedure. The primary role of these stem cells is to maintain and repair the tissue in which they are found. When an injury occurs, the cells move to the inflamed site, release proteins to regulate the inflammation, release other proteins to stimulate new cell growth and then begin to change into the same type of cell that was damaged. By injecting adult stem cells into an injured part of the body, the stem cells may create healthy tissue to repair damaged tissue and potentially help the body heal itself. For example, these stem cells, when injected into an area with a damaged joint or disc, turn into cartilage cells to aid the body in healing the damage. Dr. Pettine is one of the first orthopedic surgeons in the country offering a method of adult stem cell regenerative medicine. His approach allows a remarkable 95 percent of a person’s removed adult stem cells to remain viable after being separated from other bone marrow material, which helps bring about the significant improvement in patients like Garretson and Henry. Dr. Pettine is such a strong believer in the treatment that he has performed the procedure on himself. “I’ve had eight ankle surgeries and two hip replacements,” he says. ”I know what it’s like to live every day with chronic pain. About a year ago, I injected my own ankle joints with adult stem cells, and I feel significantly better.” Dr. Pettine is Principal Investigator for 15 FDA clinical studies. He is currently conducting research under an IRB approved protocol. The study evaluates the treatment of discogenic low back pain with intradiscal injection of autologous bonemarrow derived cells. Early analysis of the research data suggests its potential clinical efficacy in the treatment of moderate to severe degenerative disc disease. Dr. Pettine believes the adult stem cell treatment could significantly alter the practice of orthopedic and spine surgery in the U.S. However, Dr. Pettine is realistic about the downsides to the treatment, one of which is the cost, $4,500 for a single level injection and $6,500 for multiple levels (up to four levels). Another major set-back is the lack of insurance coverage. But Dr. Pettine is encouraged by the early clinical results. He hopes with long-term follow up of Class I data the autologous adult stem cell treatment will be added to the list of covered benefits with leading health insurance providers.

Northern Colorado Medical & Wellness 2012

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MEDICAL

Medication Management

Safe g u ar d i n g Se n i or s

I

n April 2008, the Institute of Medicine (IoM), a non-governmental agency under the National Academy of Sciences, sounded an alarm. “The nation faces an impending healthcare crisis as the number of older patients with more complex health needs increasingly outpaces the number of healthcare providers with the knowledge and skills to adequately care for them.” Their 2008 report, Retooling for an Aging America: Building the Healthcare Workforce, challenged healthcare professionals to prepare for the coming age wave: the flood of baby boomers who would begin turning 65 years old in 2011. By 2030, demographers predict the number of adults over age 65 will comprise 20 percent of the total population. This means at least one in five Americans will require a healthcare workforce trained to address unprecedented and more costly geriatric issues than ever before. Among many challenges authors discussed increased longevity. Given longer life

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spans, older adults are subject to multiple chronic conditions. Today, professional training stresses treatment of single, mainly acute, diseases. Early on, the American Society of Consultant Pharmacists (ASCP) recognized the potential for harm without changes to this status quo. In 1997 they established an independent, nonprofit Commission for Certification in Geriatric Pharmacy (CCGP) to develop professional credentialing for licensed pharmacists to specialize in the needs of geriatric patients. Tobi Snyder is one of a growing number of CGPs in Colorado. She received her Doctor of Pharmacy from Drake University. She says, “We are experts at looking at people over the age of 65. Elderly people often have multiple diseases and conditions. Also, as people get older their physiology changes. For example they could have decreased kidney function, changes in protein binding, increased body fat, changes in pH levels altering the ability to absorb medication… All of these changes can affect the medications we take as well as how the medications affect

By Elissa Tivona

disease outcomes.” Because of physiological changes associated with aging compounded by drug interactions, the risk for medication-related problems is highest among older adults. Snyder offers an example of a typical geriatric profile: The patient can present with congestive heart failure, high blood pressure, diabetes, hypothyroidism, pain, arthritis, and depression or anxiety. “A high percentage of people may have all these. A CGP looks at all those diseases and all the medication, and evaluates and monitors all of them. They make recommendations based on patient-specific parameters.” The ultimate goal is effective Medical Therapy Management (MTM), which gives elders and caregivers control over healthcare decision-making and rising treatment costs. On the advice of a CGP, individuals can discuss medication regimens and doses with doctors. In some settings, a CGP intervenes directly with doctors to discuss medication management and possible adjustments. Snyder explains, “Once you hit five or more medications you’re basically guaranteed to have

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Tobi Snyder is one of only a handful of specially trained geriatric pharmacists in Colorado. drug interactions or drug/disease interactions. It’s not unusual for a typical geriatric patient to be on 17 or more medications.” Occasionally, symptoms ascribed to old age or another disease can be the result of medical side effects or unrecognized drug interactions. According to the CCGP website, “Certain medicines may increase the risk of falls or may cause memory problems that can be mistaken for Alzheimer’s disease or dementia…. The geriatric pharmacist knows that the elderly are subject to conditions, such as falls, delirium and cognitive impairment that are not usually a concern in younger adults. Drug therapy must be evaluated with respect to the potential for medications to cause or worsen these ‘geriatric syndromes.’’’ Proper MTM can help patients avoid common pitfalls due to numerous prescriptions from multiple specialists treating the same person. A trained CGP monitors kidney and liver function to determine the build up of drugs in the body. This build up can lead to more frequent and more severe negative side effects. “Everything is compounded exponentially in the geriatric population,” explains Snyder. However, she also emphasizes that cascades of illnesses, multiple medicines and negative interactions in the elderly can be avoided, or even better, prevented altogether. For some conditions, such as insomnia, professionals now consider non-pharmacological interventions as alternatives to prescriptions. Snyder also counsels awareness of healthy habits, which reduce later morbidity and escalating costs due to preventable conditions. Starting now to lessen the odds of obesity, diabetes, decreasing bone density and other chronic conditions can help America avert an impending healthcare crisis. “Walking 15 minutes a day in your 40s will help you in your 80s,” says Snyder. “Anything we can do to keep people as healthy as possible and prevent these diseases from developing in the first place, the better off people will be.” Snyder welcomes questions that caregivers and seniors may have for her. She can be contacted at Tobi.Snyder@yahoo.com. Elissa Tivona is a writer and international educator in Fort Collins. She resides online and in social media as the Peace Correspondent at www. thepeacecorrespondent.com.

Northern Colorado Medical & Wellness 2012

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MEDICAL

Independent Practices

Dr. Maude Vance, with The Women’s Clinic of Northern Colorado, examines a patient.

I n d e p e n d e n t Me d i cal Pract i ce s

Sta n d Stro n g

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hough much attention has been given to the increasing number of private practices being bought up and shuffled under the umbrellas of local health systems, doctorowned practices are still alive and well in Northern Colorado. In fact, the amount of local private physicians still outnumbers healthsystem employed physicians by 2 to 1. This is good news for the patients who enjoy the individual, hands-on contact they receive from their family practioners and specialty clinics. But healthcare reform and looming changes have made these practices wary of what the future might hold for them and their ability to survive without the deep pockets available to larger health systems.

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By Angeline Grenz

Among the challenges for private practices are changes mandating costly electronic medical record systems, smaller Medicare reimbursements and making do with less (already a small practice mantra). Add in the dynamic of new HMO-type insurance products with limited physician panels, often referred to as closed-system insurance, entering the Northern Colorado market and private practices can sometimes feel they are treading deep waters.

The Benefits of Being Small

“A perception exists in the community that hospitals own and operate most of the clinics in and around the Fort Collins/Loveland area. This leads consumers to believe that there is no perceivable difference in the quality of care or service

that a patient could expect to receive,” says Larry Mortensen, practice administrator for The Youth Clinic. Nothing is further from the truth, says the administrators and physicians who run these private practices. Mortensen and several administrators from local private practices have created an informal group that meets together semi-regularly to discuss challenges and solutions to operating under coming healthcare reform legislation and changes in health insurance systems. The group, which includes The Youth Clinic, Associates in Family Medicine (AFM), Rocky Mountain Family Physicians, Front Range Center for Brain & Spine Surgery, Northern Colorado Surgical Associates, Eye Center of Northern Colorado and The Women’s Clinic of Northern Colorado, underscore the importance of their

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relationships to the region – both as healthcare providers and as small businesses. There are roughly 150 health-system employed physicians in Northern Colorado and more than 300 independently-employed physicians in the region, estimates Nancy Timmons, practice administrator for Front Range Center for Brain & Spine Surgery. The number is telling: despite the press announcing practices who are joining health systems, the bulk of family practitioners and specialty clinics are still operating independently – and they provide an immense amount of support to local hospitals. “Independent physicians are credentialed with many local health systems and hospitals,” says Timmons. “Many independent physicians work in multiple systems instead of being employed and only working in one health system… they are happy to work within whatever hospital or facility setting will be best for their patients.” Independent practices are vital to the operations of local hospitals. Most of the independent practices mentioned in this article have doctors who see patients at Poudre Valley Hospital and Medical Center of the Rockies. Others have privileges at North Colorado Medical Center in Greeley or McKee Medical Center in Loveland. Many specialty

relationship with patients and two to three generations of their families. “Most patients spend very little time in an inpatient facility,” says Dr. Sprowell. “But many spend a lifetime managing chronic conditions with a primary care physician and specialty physician.” “One of the biggest advantages to being an independent practice,” adds Mortensen, “is the focus our business places on establishing personal relationships with families.” In addition to nurturing these close relationships, the cost of care can often be less for patients at independent practices. “The cost of medicine in a community goes up when the physicians are employed by the hospital,” says Scott Kenyon, practice administrator for The Women’s Clinic. “The tests and procedures cost more as the hospital is able to charge more for the same services that can be provided by an independent provider.” The cost, he adds, can sometimes be double in a hospital setting. Physicians can refer patients to other locations for lab tests, images, etc., where a health system must generally have those services done in the hospital setting or at a health system-run facility. “There are instances where care from an employed

A perception exists in the community that hospitals own and operate most of the clinics in and around the Fort Collins/Loveland area. This leads consumers to believe that there is no perceivable difference in the quality of care or service that a patient could expect to receive. Larry Mortensen, practice administrator for The Youth Clinic clinics have doctors from their practices on call with local ERs to cover emergencies that require their particular medical specialty. The difficulty when hospital systems purchase independent practices most often centers around specialty practices, such as heart centers or cancer centers. “The challenges are the ones that have been absorbed are monopolistic [as specialists], and once one gets absorbed, there is no other independent option,” according to David Schmidt, M.D., president and medical director for AFM. But many practices are clinging to the independence they enjoy as small, privately owned clinics. There is just no other business model that works for them. “Physicians give up a significant amount of autonomy when they become employed by health systems,” according to Dr. James Sprowell, executive director of AFM. Drs. Sprowell and Schmidt boast that AFM still maintains patients from Dr. Wells, who began the practice in 1962. “Corporate medicine is impersonal,” says Mac McMullen, administrator for Rocky Mountain Family Physicians. “We have a little over 28 years [in business], and we have had a very personalized patient-physician relationship.” Though AFM and other practices have been approached about the possibility of joining health systems, they hesitate. After all, many of these practices have been running independently for several decades, and they enjoy having a close

Northern Colorado Medical & Wellness 2012

hospital system provider costs more because procedures, lab work and tests are not necessarily directed to the most efficient and cost effective place of services,” says Carol Wittmer, administrator for the Eye Center of Northern Colorado. “Another distinct advantage of being independent is the maneuverability of our organization,” continues Mortensen. “Larger organizations have to work through numerous committees and boards… This puts them at a disadvantage when trying to respond quickly to a trend or best practice. Independent owners have a much better sense of their entire organization and are able to quickly change direction if necessary.” But despite the numerous compelling reasons for private practices to remain independent, hurdles exist and other practices have had to join to survive changes, particularly due to healthcare reform and the insurance industry’s response to these changes.

The High Cost of Reform

One inescapable cost of reform is the mandated electronic health medical record systems (EMRs) that are required by Medicare to be in place by 2015. The systems create a more seamless way for physicians in multiple locations, and between multiple practices, to quickly and accurately share patient information, and they cut down on the number of needless repeat tests or X-rays. These systems, while practical from an operations standpoint,

Fort Collins 1107 South Lemay Avenue, Suite 200 (970) 484-1757 3519 Richmond Drive, (970) 204-0300 1113 Oakridge Drive, (970) 225-0040 2025 Bighorn Drive, (9700 229-9800 2001 South Shields Street, Bldg. I (970) 221-5255 Urgent Care 3519 Richmond Drive, Fort Collins (970) 204-0300 Windsor Office 1455 Main Street, Windsor, (970) 686-0124 Mammography Center 3519 Richmond Drive, Fort Collins (970) 204-0300 www.afmfc.com Date Established: 1962 Starting Physician: Dr. Don Wells Number of Physicians: 40 providers (31 docs and 9 mid-level) Names of Physicians: Brad Abrahamson, M.D., Lara Abrahamson, M.D., Robert Anderson, M.D., Ian Brickl, M.D., Steven D. Broman, M.D., John C. Cawley, M.D., Cynthia Van Farowe, M.D., Jessica Guiroy, M.D., S. Elizabeth Henderson, M.D., James M. Kesler, M.D., Susan K. Klingner, M.D., Margaret Lesage, M.D., Stephanie Lockwood, M.D., Elizabeth Maes, M.D., Victoria A. McCarthy, M.D., Colleen R. McCreery, D.O., Lawrence E. Murphy, M.D., Thomas E. Nevrivy, M.D., Timothy P. Podhajsky, M.D., Anne Robinson, M.D., Mark F. Rotman, M.D., Jon S. Rubright, M.D., David S. Schmidt, M.D., Anne Siple, M.D., Floyd Stephens, M.D., Steven B. Tippin, M.D., Mark Unger, M.D., Deborah A. Weiskittel, M.D., JD Wideman, D.O., Fiona A. Wilson, M.D. Number of Employees: 150 including physicians Sub-specialties: Family Practice Health System Affiliations: University of Colorado Health System Poudre Valley Hospital and Medical Center of the Rockies

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A lot of employees just don’t understand the nature of closed [insurance] networks until they can’t go to the physician or health system they used to. David Schmidt, M.D. Associates in Family Medicine Dr. David Schmidt, president and medical director for Associates in Family Medicine, enjoys the ability to develop close relationships with patients at his independent practice.

are anything but from a cost standpoint to small practices. “Compliance with many of the aspects of healthcare reform can’t be done without an electronic medical record and practice management software system,” says Kenyon. “A smaller 3 to 5 provider medical office currently on paper charts could spend almost $300,000 to convert those charts to an EMR in the first year. The costs for having a high quality medical practice management software system never go away.” The cost has been crippling for some. Those independent practices that have absorbed it successfully began the process early on – prior to healthcare reform’s mandate. Many practices who could not afford the transition have been absorbed into local health systems. AFM is one independently owned family practice that was on the leading edge of instituting an EMR, but they were able to do so with the assistance of a local health system. “There is a misconception that integration is the same as ownership,” says Dr. Sprowell. “You can create an integrated system without all the parties being under the same employer. That is what we have done with PVHS [now University of Colorado Health (UCH)].” UCH was instrumental in assisting AFM to institute an electronic medical health record system that is integrated with UCH’s EMR system. “We have been working on that relationship for over 10 years,” adds Dr. Schmidt. Most private practices already run on the lean side. With reductions in Medicare reimbursements, they will trim what’s left of the fat. “A major challenge is controlling the costs of the healthcare physicians deliver while coping with the ever-decreasing reimbursement they receive from Medicare and commercial insurance companies,” says Timmons. “Smaller practices do not have the economies of scale that a larger organization does.” Mortensen adds, “Organizations such as

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Medicare and Medicaid are piloting bundled payment models that pay a single rate to a healthcare organization for the coordination of a patient’s care. This has led to a feeding frenzy of practice acquisitions by large health organizations to capture and control reimbursement. Independent practices are then forced to compete with the very hospitals their physicians helped support and build.” McMullen adds, “Starting in January 2013, a 28 percent decrease in Medicare is earmarked to go into effect. Under that, all the other insurance carriers use Medicare’s fee schedule as a baseline.” The outcome? All carriers will reduce reimbursements, putting further strain on doctors. Some small practices could go broke, says McMullen. But a small practice’s maneuverability may be its saving grace. As costs continue to become a bigger factor in healthcare decision-making, Dr. Sprowell says local, independent family physicians will actually be better situated to manage some of these costs. “Independent practices are in a good position because we have no obligation to send patients to any particular facility,” he says. “We are really helping to facilitate minimizing those costs to patients,” adds Dr. Schmidt. “A lot of the challenges of healthcare reform are going to fall on the health systems. They have to become more cost effective, especially for outpatient treatment,” says Dr. Sprowell.

Closed-System Insurance

The closed system healthcare insurance model is developing a greater presence in Northern Colorado. These models mandate that members must receive care from a closed network of providers, often associated with a health system or hospital, or pay costly additional fees. The up side to closed system insurance models is that they often offer cheaper health insurance rates. “One positive thing I have seen,” Kenyon says, is that closed insurance models have “started

to drive down the costs of health insurance as other carriers are worried about losing market share.” But the cost savings doesn’t always add up for those patients who change insurance, then call their doctor of 20 years and find out they are not on the list. Or who may have to go outside of their community for doctor and hospital visits. This is because many closed-system insurance companies employ their own doctors and only work with certain hospital systems, so independent practices may not be on the list of approved providers, though this fact is not always clearly evident to individuals and employers who are shopping for cheaper insurance premiums. “My first concern is… this will cause the patients to unwittingly choose to lose access to their current doctors and hospitals,” continues Kenyon. “It is a major inconvenience for the patient, especially if that patient is pregnant and has already established her delivery protocol.” “This disrupts the patient continuity of care,” adds McMullen. “Then you have to deal with physicians and specialists you are not familiar with.” Many independent practices accept a wide range of insurance providers. While private practices don’t anticipate losing a large number of patients to closed systems, they do hope to encourage the community to carefully weigh decisions, and ask pointed questions, before entering into a commitment with a new insurance company. “A lot of employees just don’t understand the nature of the closed networks until they can’t go to the physician or health system they used to,” says Dr. Schmidt.

Still Surviving as a Local Business

“Independent practices face the same challenges that anyone running a small business faces,” says Timmons. Dr. Sprowell adds, “Independent medical groups also tend to benefit the local business community. Local physician offices utilize local

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Fort Collins 1313 Riverside Avenue (970) 493-1292 Loveland 2500 Rocky Mountain Avenue, Suite 350 (970) 669-0470 www.brain-spine.com                Date Established: 1978 Starting Physician: James S. Warson, M.D.           Number of Physicians: 3 Names of Physicians: Douglas W. Beard, M.D., Donn M. Turner, M.D., Timothy C. Wirt, M.D. Number of Employees: 14 FT, 5 PT Sub-specialties: Neurosurgery and Orthopaedic Spine Health System Affiliations: University of Colorado Health and Banner Health: Poudre Valley Hospital, North Colorado Medical Center, Medical Center of the Rockies, Surgery Center of Fort Collins

Fort Collins 1725 East Prospect Road (970) 221-2222 Loveland 6125 Skypond Drive, (970) 663-3262 2555 East 13th Street, #225 (970) 679-0000 www.eyecenternoco.com Date Established: 1961 Number of Physicians: 14 PROSPECT RD

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SHIELDS ST

Names of Physicians: Patrick Arnold, M.D., Kent Bashford, D.O., Michelle Chaney, O.D., Kent Crews, M.D., Gary Foster, M.D., Arthur Korotkin, M.D., Benjamin Marske, O.D., Karl Olsen, M.D., Chet Reistad, M.D., Matthew Robinson, M.D., Natalie Santelli, O.D., William Shachtman, M.D., Randall Smith, M.D., William Stevens, M.D. Number of Employees: 137 Sub-specialties: Pediatric Ophthalmology, Retina, Glaucoma, Cornea and Oculoplastics Health System Affiliations: University of Colorado Health: Poudre Valley Hospital, Medical Center of the Rockies

Northern Colorado Medical & Wellness 2012

DRAKE RD

LocationFollow us on social media! Find us at the northeast corner of Centre and Shields. 1024 Centre Ave., Bldg E, Suite 100 Fort Collins, Colorado 80526

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1024 Centre Ave., Bldg E, Suite 100 Fort Collins, Colorado 80526 (970) 797-2431 | www.berkanarehab.com

Contact Information Give us a call today to schedule an appointment or to visit the facility. Phone: (970) 797-2431 Fax: (970) 797-2509

Achieve.

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resources such as marketing companies, accountants, attorneys, insurance companies and medical supply companies.” As healthcare reform continues to bring changes, some private practices may fold, or be forced to join a health system for survival. “I suspect the financial requirements as healthcare margins are further tightened will cause some smaller independent practices to be forced out of the business of medicine,” says Kenyon. Yet, while survival might be tougher for private practices, the long-standing clinics in Northern Colorado have ridden the rollercoaster of healthcare changes before. As with any smaller business, much depends on a good infrastructure to be successful. “If you know how to run a private practice, and if you do it well, you can survive in any up or down,” says Dr. Schmidt. And what goes around may come around, according to Mortensen. “I think larger organizations and health systems will inevitably try to emulate independent practices by focusing on the patient/physician relationship. I think in the future, independent practices will have an opportunity to teach larger health systems how to deliver personalized quality healthcare to their patients in a cost efficient manner.” For McMullen, while healthcare waits out reform, he feels private practices need to collaborate together for their collective survival. “It will never be the same that it was… but hopefully we will still be here.”

Fort Collins 2121 East Harmony Road, Suite 250 (970) 482-6456 www.ncsurgical.net Date Established: 1956; the first surgical specialty practice in Fort Collins Starting Surgeon: Stanley Henson, M.D. Number of Physicians: 6 Names of Physicians: Thomas G. Chiavetta, M.D., Craig R. Clear, M.D., James M. Dickinson, M.D., Stefan M. Pettine, M.D., Robert R. Quaid, M.D., Michael D. Roller, M.D. Number of Employees: 18

Fort Collins 1124 East Elizabeth Street, (970) 484-0798 www.rmfamilyphys.com  Date Established: 1992  Number of Physicians: 4 Physicians, 3 Physicians Assistants  Names of Physicians: Flora Brewington, M.D., John David Cranor, M.D., Jeff Kauffman, M.D., Scott Samuelson, M.D. Number of Employees:  22  Health System Affiliations:  University of Colorado Health: Poudre Valley Hospital and Medical Center of the Rockies

Sub-specialties: Bariatric Surgery, Cancer Surgery, Colon Surgery, Advanced Laparoscopic Surgery Health System Affiliations: University of Colorado Health: Poudre Valley Hospital, Medical Center of the Rockies

Fort Collins 2500 East Prospect Road (970) 493-0112 Loveland 3470 East 15th Street (970) 663-3975

Angeline Grenz is editor for Style Magazine.

www.orthohealth.com Date Established:1969 Starting Physicians: Drs. Ben Magsamen, Charles Collopy, Robert Johnson and Doug Murray Fort Collins 1107 South Lemay Avenue, Suite 300 Loveland 2500 Rocky Mountain Avenue, North Medical Office Building, Suite 150

Loveland 2695 Rocky Mountain Avenue, Suite 260

(970) 493-7442

(970) 267-9510

www.fcwc.com

www.youthclinic.com

Date Established: 1965

Date Established: 1964

Starting Physician: Nelson Bachus

Number of Physicians: 9 Physicians, 8 MidLevel Providers, 1 Child Psychologist, 1 Speech Therapist, 1 Nutritionist, 1 OT/PT

Number of Physicians: 15 Names of Physicians: Kaea Beresford, M.D., Robert Burke, M.D., Beverly Donnelley, M.D., Warren James, M.D., Angela King, M.D., Susan Kozak, M.D., Kara Micetich, M.D., Philip Priebe, M.D., Jennifer Reeve, M.D., Nicole Roberson, M.D., Elizabeth Serniak, M.D., Bradley Stern, M.D., Kevin Tool, M.D., Maude Vance, M.D., Eric Yeh, M.D.

Names of Physicians: Carole Anderson, D.O., Amy Bailey, M.D., Elizabeth Ballard, M.D., Julie Brockway, M.D., John Guenther, M.D., Vaughn Hanson, M.D., James McGinnis, M.D., Barry O’Brien, M.D., Kirsten Sampera, M.D., Brian Mesinger, Ph.D. Number of Employees: 65

Number of Employees: 85

Sub-specialties: Pediatrics

Sub-specialties: Obstetrics, Gynecology

Health System Affiliations: University of Colorado Health: Poudre Valley Hospital, Medical Center Of The Rockies

Health System Affiliations: University of Colorado Health: Poudre Valley Hospital, Medical Center of the Rockies

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Fort Collins 1214 Oakpark Drive & 1200 East Elizabeth Street

Number of Physicians: 25 Names of Physicians: Thomas Anderson, D.O, Robert Baer, M.D., David Beard, M.D., Robert Benz, M.D., Bill Biggs, M.D., Satoru Chamberlain, M.D., C. Dana Clark, M.D., Kenneth Duncan, M.D., Mark Durbin, M.D., Sean Grey, M.D., Ryan Hartman, M.D., Thomas Hecker, D.P.M., Michael Houghton, M.D., Nathan Hunt, D.P.M., Wesley Jackson, M.D., Kirk Kindsfater, M.D., Dale Martin, M.D., Mark McFerran, M.D., Bret Peterson, M.D., Vincent “Skip” Ross, M.D., Michael Rusnak, M.D., Thomas Sachtleben, M.D., Steven Seiler, M.D., Rocci Trumper, M.D., Stephen Yemm, M.D. Number of Employees: 260 Sub-specialties: Hand/Upper Extremity Surgery, Trauma/Fracture Surgery, Joint Replacement Surgery, Sports Medicine Disorders & Surgery, Athletic & Reconstructive Surgery of the Foot & Ankle Surgery, Adult and Pediatric Spine Disorders & Surgery, Pediatric Orthopedics, Podiatric Medicine & Surgery, and Diabetic Foot & Wound Care Health System Affiliations: University of Colorado Health & Banner Health System

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Northern Colorado Medical & Wellness 2012

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MEDICAL

Pain Relief

L et ’ s Get T o p i cal :

Compounding Your Pain Relief By Carl Simmons

W

hen it comes to topical pain medications, most people don’t look any further than that tube of Bengay. However, the options patients have for pain relief today are almost endless – and often a lot more effective and customized than reaching for a pill. “The topical application of pain medication is becoming more common,” says Nancy Lamb, R.Ph., consulting pharmacist for Good

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Day Pharmacy in Loveland. “The fact that it’s become more popular in veterinary medicine has helped people become more aware of its benefits to them as well. With topicals you not only treat the location that hurts, but the corresponding nerves in the spinal cord. Medications, their strength and the delivery method can all be customized. Instead of people taking three different pills, medications can all be put in a topical form, so people don’t have to take a pill at all.” The process by which this is accomplished

is known as prescription compounding. Pharmacists can mix the needed medication (or medications) into a topical form, such as a cream or ointment, which can be applied directly to the point of pain. Because of this, Lamb says, “You can take a lot less medication topically. You can put 50 milligrams of ibuprofen on your knee, and it’s more effective than taking 400 milligrams orally, because it’s going directly to the site of pain.” Lamb talks about a patient who had been in a car accident, and was suffering from

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severe neck pain. “She was a wreck; she was in tears nearly every day. In addition, after being on oral pain medications for months, she was experiencing a lot of muscle stiffness. I worked with her to come up with the right combination of topical pain medication, so that we could treat the actual areas of pain. She still has chronic pain from the accident, but she’s managing that pain far better today.” “People have a hard time waking up, and functioning, when they’re on oral pain medications. They don’t function well, or feel well,” Lamb adds. “Topical pain medications offer better pain relief and less side effects, and as a result you’re better able to participate in rehabilitation – and in life. There’s less missed work; you’re more in control and have more energy.” The fact that topical pain medications are applied directly has additional benefits. “Topical pain medications don’t affect other organs, such as your liver or kidneys, to the same degree that oral medications do. It’s going directly to the point of pain, rather than through your entire system,” Lamb says. “Especially when you’re older, it’s not good to be on a variety of oral medications – it increases the risk of complications, as well as the probability of falling because of disorientation. “Also, people are becoming more sensitive to the effects of oral medication, so they’re taking other medications to offset the effects, such as stomach medications. It creates a cascade of other problems – for instance, less bone density and your system doesn’t absorb vitamins as well.” The one negative to using topical medications, Lamb explains, is that they’re not always covered by insurance, as most prescription programs have a pre-set list that cover pills only. However, she adds, “By the time you’ve missed work, and with increasing co-pays on medication, it might be cheaper to use a topical medication anyway.” Lamb also noted that workers’ compensation programs are more likely to cover topical pain prescriptions than are regular insurance companies. Despite the insurance issue, topicals are becoming more accepted and prescribed. “We’ve had physicians’ offices ask us to come and present this information to them, and they’re very receptive when they hear this message,” Lamb says. “It’s a little more difficult to prescribe, because you’re often combining medications into one topical treatment, but patients want what’s actually going to work for them.” Lamb continues, “People need to know, especially seniors, that it’s OK to ask your doctor about the effects of the medications they’re taking and whether there’s a way to treat it topically. If we know what the problem is, we can put together a compounded prescription that can be effective.”

Carl Simmons is a freelance writer living in Loveland.

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wellness

Seniors

T h e S i lv e r T s u n a m i

N

orthern Colorado is preparing for what’s being called the Silver Tsunami, referring to the enormous wave of Baby Boomers entering their senior years as they turn 65. Seniors are expected to bring a host of new opportunities and challenges with an additional 52,000 seniors living in Larimer County by 2040. According to the Colorado Demographer’s Report on Aging, Larimer County’s over 65 set is predicted to increase by 62 percent from 2010 to 2020, followed by a 34 percent growth between 2020 and 2030, and a further 14 percent growth in the next decade to 2040. In 2010, Larimer County had 35,541 residents over 65, which is expected to reach 87,730 by 2040. According to Elizabeth Garner, the state demographer, Colorado typically gets an influx of 25- to 35-year-olds emigrating here from other states. The first big migration of this age

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group was in the 1970s with the Baby Boomers; these people are now coming of age. The Larimer County Office on Aging is expecting to see Coloradans from other cities and out-of-state immigrants moving to Northern Colorado also. Baby Boomers, a generation born in the years following World War II, with birthdays between 1946 and 1964, have transformed every aspect of American life. It is expected that they will inevitably redefine what it means to be a “senior citizen,” as 10,000 Americans now celebrate their 65th birthday daily. Many industries including healthcare, aging services, transportation and housing are preparing now to provide the level of service this generation has become accustomed to.

NoCo Senior Squall

The Fort Collins Senior Center has been holding a series of community meetings titled Silver Tsunami as Golden Opportunity to examine the economic impact and opportunities that the

By Tracee Sioux

aging of the Baby Boom population is expected to bring. “Fort Collins has been identified as a leading retirement community,” says Barbara Schoenberger, recreation supervisor at the Fort Collins Senior Center. “We wanted to look at what’s positive about our community. What support is there for aging adults? What resources do we need to attract retirement-aged people? How can we increase the support we currently offer to meet the growing senior population?” Many aging service organizations such as the Aspen Club, Fort Collins Senior Center and the Larimer County Office on Aging have already been offering their services to this population for a number of years, because their agency funding allows them to serve the senior population. It is expected, however, that up to 50,000 more people will be using these same resources now through 2040. Jill Taylor, senior services supervisor at Aspen Club of University of Colorado Health (formerly

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Northern Colorado Medical & Wellness 2012

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Brenda Carns shares lunch with girlfriends at the Senior Center.

Poudre Valley Health System), which provides low-cost health screenings and wellness programs to adults over 50, says “if any community can pull together and create a wonderful community to get older in, it’s Northern Colorado.”

Not Your Grandma’s Golden Years Anymore

Historically, seniors have needed a lot of extra care, medical and otherwise. They are thought to be inactive members of society, a drain on resources even. No one is expecting that of this generation of seniors. Baby boomers are projected to work into their 70s, not needing additional care until they are in their mid- to late-70s. They will contribute significantly to the economy, providing help to their grandchildren and children, purchasing luxury items, transforming senior living communities, supporting the healthcare industry and contributing greatly to charities with both money and man-hours, says Schoenberger. Picture Grandma: fit and forever brunette, in designer jeans, running her part-time business from her iPad while Facebook messaging her grandkids and making a donation to her pet charity online. That’s how Baby Boomers are expected to do retirement.

Aged Longer

While many agree that Baby Boomers are unlikely to check out of society, there will be other challenges. People who live much longer may need additional care much longer, notes Mike Maguire, owner of Home Instead Senior Care, which provides at-home, non-nursing care. It’s the Catch-22 of exceptional medical care. Even if they can’t cure a disease, they can extend life, which also extends aging. Patients with dementia, Alzheimer’s, chronic diseases and even cancer may live a decade or even two with their disease. The emotional toll on family members providing prolonged care can be tremendous. The cost of long-term care

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can be crippling. Many seniors, and those who work with seniors, fear that they will outlive their retirement funds.

Working Out

Baby Boomers currently make up 37 percent of the local workforce and in Colorado over the next 20 years 1 million people are expected to “age out” of the workforce. There are concerns about having enough skilled caregivers and healthcare workers. Some say Northern Colorado is experiencing a shortage of geriatric or cardiology physicians and elder care specialists already. While enough available jobs seem as difficult to find as $100 bill hidden in the couch cushions, the Colorado Demographer’s Report on Aging predicts that between 2015 and 2025 so many people will have left the workforce that Colorado will need to attract one new worker from outside the state for every new job created. There will be an increased need for labor in any industry where seniors are spending their money, from housing to transportation. It is estimated that four senior people support one job in Northern Colorado. By 2030, one health services industry job will be supported by 10 people over 65, according to the Report on Aging. However, many agencies and private companies who serve the aging community see the benefit of employing the same generation that they serve. McGuire’s typical employee is over 50 and one of his best workers is 84. Schoenberger expects retirees to contribute significantly to the workforce, while demanding flex-time, job sharing and part-time opportunities.

How They Roll

Transportation is one of the largest concerns for the Northern Colorado community and its aging population. Eventually, due to slower reflexes or poor eyesight, many seniors stop driving their own cars.

All of the aging service agencies said they are hoping that local cities and counties will address the need for increased public transportation services. Easy access to transportation encourages economic activity from seniors and allows them to live independently for longer. The Larimer County Office on Aging (LCOA) currently has four transportation programs for adults in the 60 plus category. Transportation services range from volunteers who drive seniors to doctor appointments, to shuttles run by assisted living facilities, to city bus service. The City of Fort Collins has a comprehensive transportation master plan, which takes into account all abilities, including those of seniors. Fort Collins’ plan isn’t restricted to bus service, but incorporates the city’s walking trails, availability and accessibility of bus stops, bike lanes and specialized bus services. Fort Collins is particularly pro-active about cycling as a mode of transportation and their FC Bikes program offers bicycling classes for a variety of abilities. Alongside regular bus services, the Dial-ARide program is available to seniors and those with disabilities. Users can call Dial-A-Ride and schedule a round trip visit to a doctor’s office or other appointment. “As the demand grows – obviously as the baby boomer bubble gets bigger – I wouldn’t be surprised that more people will be demanding an expansion of our paratransit service,” says Aaron Iverson, transportation planner for the City of Fort Collins. There are currently plans for growing regional bus service, like the current FLEX, a single bus route that runs to Longmont. An expansion of regional transportation will allow seniors the ability to move more easily along the Front Range, perhaps all the way to Denver.

In Conclusion

The Larimer County Office on Aging, Aspen Club, Fort Collins Senior Center and other programs do not require income vetting for seniors to benefit from their services. Obviously, the fact that Colorado’s senior population is expected to grow 150 percent by 2030 means there will be additional stress on community services. Because no increased government funding is expected, some agencies wonder how long it will be before they have to restrict services to a lower income demographic. “There are going to be a lot of needs in the future, but one thing about our community is that we rally together to pool resources and collaborate,” states Taylor proudly. “We have some great programs, we’re so rich in services and rich in professionals who work with older adults. It’s a very creative county. As funding decreases I’m sure there will be greater collaboration between organizations. It’s a wonderful community to get older in, it truly is.” Tracee Sioux is a Northern Colorado writer and author of Love Distortion: Belle, Battered Codependent and Other Love Stories. She can be found at www.twitter.com/traceesioux and www.thegirlrevolution.com.

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ACTIVE SENIORS • HEALTH • ACTIVITIES • RECREATION • WELLNESS • SERVICES

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el i te se ni or at h letes By KAY RIOS

A

s we age, physical activity is one of the most important efforts we can make for our health. It can help prevent age-related health issues and keep muscles stronger so day-to-day activities can be accomplished without dependence on others. Research also documents how activity keeps healthcare costs down. A study funded by the Centers for Disease Control and Prevention (CDC) found that regular use of Medicare-sponsored health club benefits was associated with lower long-term healthcare costs. The CDC says that older adults need at least 2 1/2 hours of moderate-intensity aerobic activity such as brisk walking every week and musclestrengthening activities that work all major muscle groups two or more days a week. Activity can be spread out over the week or broken up into small time chunks during the day. The main thing is to get moving and keep moving. An increasing number of seniors realize the importance. And a handful have taken it even further; they show up in marathons, they ski, they swim and they live life to its fullest, regardless of the decade in which they find themselves. Two local senior athletes are receiving national recognition for their dedication to their chosen sport; read their stories and be inspired.

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Libby James, 76, was recently inducted into the Colorado Running Hall of Fame.

Libby James

Libby James started running 40 years ago and, at 76, she doesn’t intend to stop any time soon. Why should she? She’s still setting records. She set national records in the 5K (in both 70-74 and 75-79 age groups) as well as the 10K (75-79 age group) and the 10-mile (75-79 age group). In the Bolder Boulder in 2009, James ran 48:54 in her age group, displacing the previous national 10K record at 50:43. She set an age group world record in the 2011 Aetna Park to Park 10-miler with a chip time of 1:19:22. James is also the 2011 Running Times Master Runner of the Year in age groups 70-74 and 75-79. This past April, she was inducted into the Colorado Running Hall of Fame. She had been interested in running for a long time and, when she finally started, she had four teenagers in the house. “So I’d get up, run a mile in the neighborhood, come back and make breakfast.” When she turned 40 in 1976, she entered a local 10K race and clocked 44 minutes. “I had a little success,” she says. “There was a marathon rage then. I thought 26 miles sounded impossible but I ran my first marathon in Denver in 1978.” She took first in 1979 in the Denver Marathon in the women 40 to 49 age group. “I decided I wanted to do the Boston Marathon. I had to qualify and run a marathon in 3 hours and 20 minutes and I didn’t have the time down.” Not one to be easily discouraged, she wrote a note to the race director: “What do you have against old ladies?” He wrote back, saying, “It’s just before Thanksgiving and I’m feeling good. So if you can do one in 3 hours 30 minutes, you can run.” So she ran one in Denver in 3 hours 29 minutes

Northern Colorado Medical & Wellness 2012

and 47 seconds. “He said, ‘Send the money.’” The cost was $5 (now it’s $150 for U.S. residents). “It was a great experience,” James says. James did quite a few marathons in those early days and she has run the Bolder Boulder annual 10K race around 30 times, winning her age group 22 times. “It’s one of my favorite races. I used to live in Boulder and all my kids were born in Boulder.” James says that running is part of her daily routine. “There may be days you want to sleep in and that’s what I call the annoyance barrier. You can’t listen to it; you just have to run.” She usually runs four miles a day and longer on weekends, rain or shine. She also does Pilates as part of her regimen. For mature adults just starting out, she says, “When you start to run, figure out a mile course and start walking or jog until you are out of breath but complete the mile. Then you can increase it. When I trained for my first marathon, I was told never add more than 5 miles per week. Run until it’s uncomfortable. I read an article that said the first 100 miles are the hardest,” James says. James was drawn to running because, she says, “I think it’s a good sport for an introvert. It’s also very simple. All you need is a pair of shoes. Most of my running I do alone; I sort out my thoughts.” But she also says her greatest joy has been training and running with family and friends. “I’m pleased that three of my kids and nine or 10 of my grandkids run.” She recently ran the Tokyo Marathon with her son who lives in Japan. James admits that the accolades are nice but says, “That blows over fast but while it’s happening it’s fun. It’s icing on the cake. The races are fun and they’re a good way to interact with other runners but running itself is the draw. It’s a good day when I get to run.”

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Photo courtesy of Bill Cotton, Colorado State University

George Thornton, 72, has the goal of swimming the English Channel.

George Thornton

George Thornton, age 72, has always been active. “My wife, Louise, and I want to stay fit and we get a sense of satisfaction out of the achievement.” His record speaks for itself. Over the past 20 years, he has participated in 90 plus triathlons including 12 Ironman Triathlons and two Hawaii World Triathlon Championships. Thornton has also completed the Horsetooth 10K Swim each year since 2000. “I was a swimmer up through college. I didn’t swim competitively for about 20 years until I got back into masters swimming at age 45,” he says. His regimen includes a work out five days a week with the Fort Collins Area Swim Team (FAST) Masters. “For years, I’ve been going to a strength coach once a week doing kettle bells and lots of core work with a medicine ball. When I was training for triathlons, I rode with a couple of guys better than I was so I had to work hard.” His latest goal changed that routine. “Two years ago, I set the challenge of swimming the English

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Channel. I didn’t have any aspirations until I saw my friend, Joe Bakel, do it. I was on his support boat and I got pumped.” He began a rigorous regimen. “I swam three days a week with the team, one day strength training and one day-long swim in Lindenmeier Lake when the weather permitted to build up the distance.” He would spend 10 straight hours swimming during those times. The channel is 21 miles so distance is an issue but another consideration is the temperature of the water. “It’s 57 to 58 degrees. You have to train for cold water so I swam Lindenmeier until November,” Thornton says. Nutrition is also a factor. The swimmer doesn’t stop to fuel but drinks a slow release, long lasting complex carb drink every 30 minutes out of a bottle while in the water. “You have to learn what you can take in and the salt water can give you a stomach ache if you swallow it.” Swimming the Channel is only possible between June and the middle of September.

“There are several eight-day periods of neap tides [the point where the difference between high tide and low tide is at a minimum] when currents are weakest. And you don’t swim a straight course. Because of the current, you can end up swimming 25 to 30 miles.” Thornton didn’t get his shot this year. “We sat there for two weeks but the weather wouldn’t permit it.” The pilot makes the call. “They’re authorized to take you across and are very experienced,” Thornton says. During the eight-day neap tide period, the pilot tries to get four swimmers across. In this case, none of the four (Thornton was number three) got to go. Why did he want to do it? “If you ask that question, you wouldn’t understand the answer,” he says with a smile. He admits, however, “Some of it’s the notoriety. I would have been the oldest person to do it.” As for being active, Thornton says, “In a broader sense, Louise and I continue this lifestyle because of our 10 grandkids. We ski with them and do

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Northern Colorado Medical & Wellness 2012

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Thornton had his prostate removed in August and attributes his quick recovery to his athletic lifestyle.

fun things with them.” He encourages older adults to get active. His advice? “Start slow and do it with companions. Older athletes should also get coaching so they don’t do things wrong. We need to be concerned with injury prevention in older age. So make sure you stretch, do strength work and cross train. Pay attention to nutrition.” He also suggests setting goals that are specific and measurable. “And chart your progress,” he adds. His progress toward the English Channel continues although it might not be next year. He was diagnosed with prostate cancer in March of this year. “The doctor had agreed to wait until after I swam the Channel but then I needed to make a decision.” He had the prostate removed this past August and is currently working on recovery, which he says is going well. He attributes that to being fit. Thornton is walking and swimming again but a bit easier for now. “I’ll have PSA tests each month for a year and we’ll see what happens.” Before he left the Channel, his pilot said he’d see him next year. “I told him it might take longer and he was very empathetic because he had his removed five years prior so he knew what that meant. He still has my money and he expects me back.” As for the Channel, “It’s a dream that has not quit,” he says. Kay Rios is a freelance writer based in Fort Collins. She is a world class tribathlete and prepares for tribathelons with a regular routine of soak, steam and shower.

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T ru st y o ur gut

By COREY RADMAN

Raw Food Can Balance and Regulate Health

I

t may seem out there, culinarily speaking, but raw food diets are a growing trend on the coasts that are working their way inward in the U.S.

working hard to digest the donut you grabbed at breakfast, it can shunt that focus to recovery from disease or optimal function.

Raw food is just that, uncooked. Raw foodists believe that the human body is better adapted to eating vegetables, fruits, seeds, nuts and sprouted, unprocessed whole grains. It is usually a vegan diet with no or low heat, and no alcohol or caffeine either. Depending on whom you talk to, this lifestyle is either the answer to optimal health or a potential road to nutritional deficiency. According to the raw foodist philosophy, enzymes are the key to better health. Enzymes originate in your food and function best at low temperatures, below 118 degrees Fahrenheit, they say. By eating live foods with the enzymes in tact, a body doesn’t have to work harder to use its own enzymes. Thus leaving energy to focus on healing or optimal health. Seventy-five percent of a raw vegan diet is organic fruits and vegetables. (There are a smaller group of raw dairy and meat eaters, but most raw foodists are raw vegans.) Many raw foodists come to the diet because they have hit a wall with their health and are seeking a natural path to wellness. Raw philosophy says eating this way provides more energy, better resistance to disease, detoxification and weight loss. The idea being that because your body isn’t

No crinkly packaging. No grab and go from the drive through. What in the world do raw foodists eat? Salad? And more salad? “Yes, salads play a big role, but there is so much more,” says Loretta Jones one of the organizers of the NoCo Raw Meetup group. She and co-chair, Kim Harris, gather local vegan and raw food enthusiasts once a month for a rawluck, in Greeley or Loveland. Jones explains that a salad laced with yummy dressing, nuts, seeds and avocado is a full and balanced meal. But, she adds, smoothies are one of the most accessible raw choices for the newly initiated. “I like to make a really big green smoothie for breakfast and then there is some leftover to eat with lunch or a snack later,” she says. Harris explains that smoothies enable people to ingest a large amount of greens every day. Blended ingredients are usually whatever is around but often include fruits or sweeter vegetable like carrots plus spinach, kale or wheatgrass. “This time of year,” she smiles, “I blend half a bunch of kale and a dozen peaches. It’s like drinking fruit punch.” Harris says most new raw foodists can get

So you eat... um salad?

started with a good knife, a food processor and a blender. Add an inexpensive dehydrator and it is possible to create a number of inventive entrees that go far beyond salads and smoothies. Using soaked or sprouted grains and chopped veggies, raw foodists come up with veggie burgers, pizza, crackers with dips, cold soups, even lasagna (made with thin-sliced zucchini “noodles,” nut cheeses and uncooked marinara sauces which blend raw and dried tomatoes). Recipes are available at www.rawfoods.com. Eating raw does involve preparation techniques that are unfamiliar, but takes about the same amount of time as any other scratch cooking would.

Nutrient Caution

Probably the most common question people have about raw food is that of nutrient deficiency, particularly protein. RawFoods.com notes that the human body needs only 25 to 35 grams of protein each day. By eating leafy greens (which are excellent protein sources) as well as other fruits, nuts and seeds, vegans and raw foodists are getting, on average, 50 grams per day of protein, more than enough to support optimum well-being. Jones says the reason many people don’t think of greens as a solid protein source is because they don’t eat enough of them to add up. To be extra cautious, we also asked a physician. CONTINUED TO PAGE 59

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Hearing Device Worn in Mouth

Eating in a noisy restaurant and straining to hear the person sitting across from you is typical, but for patients with single-sided deafness (SSD) the task in nearly impossible. Advanced Otalaryngology and Audiology in Fort Collins is the only clinic in Northern

Vegetable of the Moment: Pumpkin Taking that trip to the pumpkin patch with the kids and grandkids is tradition, but pumpkin offers more than just front porch jack-o’-lantern fun. The word “pumpkin” is derived from the Greek word for “large melon,” which is “pepon,” then changed through the French to “pompon” and the English to “pumpion,” before the American translation was named “pumpkin.” According to Self Magazine’s Nutritional Data website, pumpkin is low in saturated fats and very low in cholesterol and sodium. Also, it is a good source of vitamin E, Thiamin, Niacin, vitamin B6, folate, iron, magnesium and phosphorus, along with being a very good source of dietary fiber, vitamin A, vitamin C, riboflavin, potassium, copper and manganese. In Central America, when the seeds harvested from the pumpkin’s hollow cavity are hulled and roasted, they are called pepita. These seeds offer several healthy benefits within the pumpkin seed oil. The seeds are packed with fiber, vitamin E, manganese, potassium, calcium, iron, magnesium, zinc and selenium. When storing whole pumpkins, find a cool, dry, well-ventilated area at a temperature of 50 to 55 degrees. Do not store them near apples, pears or other ripening fruit, as their release of ethylene gas will shorten your pumpkin’s life span.

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Colorado that currently offers the SoundBite Hearing System to those patients as an alternative prosthetic hearing device, placed in the mouth rather than the ear. “The SoundBite Hearing System is designed for patients with moderately-severe to severe hearing loss in one ear, otherwise known as single-sided deafness, as well as for conductive hearing loss,” Natalie Phillips, Au.D., at Advanced Otolaryngology, says. “It is the world’s first non-surgical and removable hearing solution that imperceptibly transmits sound via the teeth.” Unlike other hearing device options that require surgery or are worn on both ears, SoundBite consists of two components, an easy to insert and remove in-the-mouth (ITM) hearing device, which is custom made to fit around the upper, left or right, back teeth, and a small behind-the-ear (BTE) microphone unit worn on the impaired ear. The microphone collects and channels sound from the environment through the ear canal. The sound is then transmitted through a wireless chip to the

By Logan martinez

ITM device which converts them into sound vibrations that travel through the teeth and bone into the cochlea within the inner ear. “SoundBite Hearing System works by making innovative use of this well-established, natural principle that we call bone conduction to deliver clear, natural, high quality sound,” Dr. Phillips says. “You hear many sounds through bone conduction already, for example when you chatter your teeth, crunch on potato chips or scratch your scalp.” The FDA has cleared the system to currently treat SSD, with intended future indications including the treatment of conductive and mixed hearing loss. Dr. Phillips continues, “It is designed for people age 18 years and over. A SoundBite trained hearing professional must assess hearing loss, medical conditions and lifestyle to determine if SoundBite is the right choice.” Dr. Phillips says, “I think it gives patients, who fit the criteria, an excellent option to hear better and to make their lives easier by improving their listening situations.”

Pumpkin Orzo with Sage Enjoy your pumpkin in a savory treat this fall, like a serving of Pumpkin Orzo with Sage from www.seriouseats.com.

Pumpkin Purée Note: If you’re starting with a fresh pumpkin, slice in half and place cut side down on a lightly oiled baking sheet. Bake at 350 degrees for 30 minutes or until tender. Allow to cool and scoop out with a spoon. Puree in a food processor until smooth.

8 ounces orzo

3 cups vegetable or chicken stock

3 cups water

1 1/2 cups pumpkin purée

1 1/2 cups vegetable or chicken stock

1/2 cup whole milk

30 sage leaves, cut into ribbons

1 shallot, diced

1 tablespoon butter

3/4 teaspoon salt

20 grinds fresh black pepper

3 tablespoons Parmesan cheese

In a large saucepan, bring 3 cups of broth and 3 cups of water to boil over high heat. Add orzo. Return to a boil and cook for nine minutes or until pasta is al dente. Drain and set aside. Meanwhile, sauté shallots and sage in butter for five minutes over medium heat. Add 3/4 cup of broth and 1/2 cup of milk. Allow to simmer for five minutes or so. Add pumpkin puree to simmering broth and stir well. Add salt, pepper, and remaining 3/4 cup of broth. Reduce heat and simmer on medium low for 10 to 12 minutes, or until sauce reaches desired consistency. Stir in Parmesan cheese. Toss with orzo and serve hot. Approximately 315 calories and 7 grams of fat per serving.

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Get F i t, G i v e B ac k C ale n d ar CSU Triathlon Halloween 5K The Colorado State University Triathlon Team is hosting their 3rd Annual Halloween 5K on October 27 at 7:30 a.m. and invites all to join in the fun. The event, at the Colorado State University Oval, will include a costume contest, giveaways, free post-race snacks, awards for age divisions, a $50 cash prize for top male and female finishers and allows dogs if they are leashed. A portion of the proceeds will go to Athletes in Tandem, Inc. and benefit CSU’s Triathlon Team. They will also be collecting old and unused running shoes to give to Runner’s Roost. Runner’s Roost recycles the shoes by donating them or recycling them via programs like Nike’s Reuse-A-Shoe Program. For more information, visit www.csutri.com.

Get involved in giving back and being active! Many of these great events donate their proceeds to nonprofit organizations. October 13 – 2012 TREK Breast Cancer Awareness Ride, 10 a.m., Trek Bicycle Store, Loveland, www.treklove.com 19 – The Harvest Night 2 Mile Run/Walk & Kids’ Fun Run, 6 p.m., North Lake Park, Loveland, www.facebook.com/events/155561707870522 27 – 2012 Phantom 4-Miler, 9 a.m., Embassy Suites, Loveland, benefitting Larimer County Humane Society, Animal House and Denkai Animal Sanctuary, www.phantom4miler.com 27 – 3rd Annual CSU Triathlon Halloween 5K, Colorado State University, Fort Collins, benefitting the CSU Triathlon team, www.csutri.com

Weight Gain Despite Exercise By Logan Martinez

Exercise, diet, weight loss supplements. The list goes on for ways to lose weight, but if you have tried it all, maybe there are some other reasons that are holding you back from that figure you want to see in the mirror. 1. The “If I exercise, then I can eat what I want” Mentality The New York Times reported that a study performed by anthropologists in Tanzania determined that while regular exercise by a huntergatherer nation called the Hadza walked between three and seven miles a day, their metabolic rate was the same as an average Joe’s. The scientists’ conclusion was that “active, ‘traditional’ lifestyles may not protect against obesity if diet changes

Northern Colorado Medical & Wellness 2012

27 – Dash the Dead, Eastman Park, Windsor, www.facebook.com/DashtheDead

November 3 – Heart Center of the Rockies Half Marathon/10K/5K, 8:30 a.m., Boyd Lake State Park – County Road 11c, Loveland, www. lovelandhalfmarathon.com 10 – Veteran’s Day 5K, 9 a.m., Colorado State University Campus, Fort Collins, www.veterans. colostate.edu 11 – World Run Day 2012, all Colorado cities, all day long beginning at 9 a.m., www.runday. com 22 – Loveland Turkey Trot, 8:30 a.m., McKee Medical Center, Loveland, benefitting The Breast Cancer Research Foundation, www. bannerhealth.com/Giving+Back 22 – Fort Collins Club Thanksgiving Day Run 4M, 9 a.m., The Beach House Grill, Fort Collins,

to promote increased caloric consumption.” In other words, exercise does not always allow you to eat more. Therefore, even with regular exercise, eating unhealthy or eating more cannot be justified. According to an article by Audrey Lynn on www. Livestrong.com, you have to make sure you are eating the right kinds of food. She suggests eating several smaller meals throughout the day instead of three larger meals. “A nutritious plan, whether for weight-loss or health maintenance, should be heavy on vegetables, fruits and grains and light on meat,” Lynn reports. 2. Lacking Aerobic Exercise While going to the gym and lifting weights builds muscle, you still have to have a portion of the workout that includes some aerobic exercise to enhance calorie burning. Make sure to mix in calorie-burning exercises with your workout schedule such as biking, climbing, brisk walking or jogging. 3. Exercise Increases Appetite Increased exercise causes your body to need more energy to burn fat and stay active. In some

benefitting Larimer County Food Bank 24 - 25 – The Goruck Challenge – Team Event, 1 a.m. and 10 p.m., Location released one week before challenge, Fort Collins, benefitting the Green Beret Foundation, www.goruck.com

December 1 – 2012 Jingle Bell Run/Walk Northern Colorado, 8 a.m., Colorado State University Campus on Oval Drive, Fort Collins, benefitting the Arthritis Foundation, www.jinglebellrunnortherncolorado.kintera.org 9 – t2coaching Indoor Triathlon, 7:30 a.m., Fort Collins Club, Fort Collins, www.t2coaching.com 23 – 6th Annual Sleigh Riders Motorcycle Toy Run, 10 a.m., John Elway Dealership, Greeley, benefitting Santa Cops of Weld and Larimer County, www.k99.com/sleigh-riders-motorcycle-toy-run-announce-date-for-christmasevent/

cases, this causes your body to tell you it needs more food. Instead of eating an energy bar or sports drink that can be loaded with calories, keep a healthy food regimen. Try reading labels on food choices and choose low fat, low calorie, nutritious foods that are high in fiber and lean proteins. 4. Sleep Deprivation Despite a regular diet and exercise, lack of sleep can cause physiological stress. This, according to an article by Kathleen Zelman, RD, on WebMD, biochemically causes the body to store more fat. “When you’re tired, you also don’t handle stress as well, so you reach for food as a coping mechanism,” reports Zelman. Sleep deprivation symptoms include fatigue, low energy levels, nodding off easily and feeling irritable. Though, if you continue a regular exercise regimen, it should help you get more sleep. Other reasons you are not losing weight despite exercise and a healthy diet could include medical conditions or hormone imbalances, in which case, a physician should be consulted for weight loss instruction.

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family f o cu s

Teaching the Fundamentals -

of Football and Life By Carl simmons

For John Howell, president and director of coaching for the Northern Colorado Pop Warner Association (NoCo Pop Warner), the fundamentals go way beyond what happens on a football field. “Some of it is X’s and O’s,” Howell says, “but most of it is our philosophy – not just technique, but from a discipline and lifeskills perspective. It’s about using your platform as coach, and using the sport of football to teach core values that will help kids succeed in life, and contribute to society as the men and women they’re going to become.” NoCo Pop Warner is part of the statewide Rocky Mountain Pop Warner League, and serves the Fort Collins/Greeley area, as far east as Ault. “Loveland has its own program, so it’s basically Loveland north,” Howell explains. “And if a Loveland team is full, they can come play for

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us; the reverse is true as well. We have a great relationship with the Loveland association.” The association offers football and cheer programs to boys and girls ages 5 through 11. While the national Pop Warner program goes up to age 14, “we don’t want to pull kids out of the junior-high program,” Howell says. “We just want to give them a good foundation.” Age divisions run 5 to 7 (Tiny Mites), 7 to 9 (Mighty Mites), 8 to 10 (Junior Pee Wee), and 10 to 11 (Pee Wee). Howell, along with wife Laura, started NoCo Pop Warner in 2010. In its first season, the football program had 45 kids; now, in its third season, more than 200 kids participate in the program. The cheer squad is also enjoying its share of success. “In fact, two of our cheerleading squads were (state) league champions last year (Tiny Mites and Junior Pee Wee),” Howell points out.

Football gets Howell excited – as well it should, given he played safety for five years for Colorado State University, prior to a six-year career in the NFL which included backing up John Lynch on the Super Bowl XXXVII champion Tampa Bay Buccaneers. And it was Howell’s background that fueled his desire to start NoCo Pop Warner. “I grew up in a small town of Nebraska, and played eight-man football. I didn’t play 11-man football until I was a walk-on at CSU. I knew that when I retired from football, I’d come back to this area. As my boys got older, I saw there was no tackle football in Fort Collins before age 9. There was an eight-man league (Fort Collins Junior All-American); but when I came to CSU, I was competing against kids who had been playing tackle football since they were 5 years old. I tried to pretend they didn’t have an advantage, but they clearly had more knowledge of the game.”

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Howell continues, “I thought: Why can’t they play football at that age like they do at Texas, Oklahoma, Kansas? I understood that in a town of 500 where I grew up, but I couldn’t understand that in this area. I just wanted there to be the same opportunities here. I wanted it for my boys, for their buddies, and for their buddies’ buddies.” However, Howell is quick to add, “The reason that we’re growing isn’t just because we have 11-man football; it’s everything else we offer. We also have an extensive off-season program for all coaches. We have classroom clinics, onthe-field clinics and online courses that they have to attend and pass in order to coach in our association. “We also try to keep our player-to-coach ratio as low as we can – one coach to every four or five players. There aren’t tryouts in Pop Warner; everyone is eligible. We try to develop each player individually. We’re not going to leave kids behind because they’re less skilled or less experienced. Winning games is a by-product of that philosophy, not the goal.” In terms of the program’s growing success, Howell says, “It’s really about the people behind the scenes – board members, coaches, volunteers, parents, members of the community… It’s about all the people who sacrifice a lot of their time. I can’t begin to tell you how much it takes to run this program.” Howell says, “I look at all the coaches who’ve helped me during my lifetime – Sonny Lubick, Tony Dungy, John Gruden, Mike Holmgren… And yet, the coach who did the most for me was my wrestling coach in Mullen, Neb., between the ages of 4 to 12. And that’s the message I give our coaches: Don’t underestimate the value of what you do for these kids.” NoCo Pop Warner 1001A E. Harmony Road, Ste. 146 Fort Collins, 80525 www.nocopopwarner.com Carl Simmons is a freelance writer living in Loveland.

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family f o cu s

New Medical Courses

for Greeley Students By Logan Martinez

Students walking into Greeley Central High School (GCHS) can have a brand new educational experience this year, learning earlier how to become doctors, nurses and medical practitioners. NCMC, Inc. (a nonprofit board that oversees management of North Colorado Medical Center in Greeley) and Banner Health have committed a total of $300,000 to fund the renovation of space at GCHS for an expansion of the Health Science Academy. The ribbon cutting ceremony for the academy was on Aug. 8, giving students access to the facility just in time for the new school year. The academy will give high school students, grades 9 through 12, the skills, knowledge and certification needed to enter a variety of healthcare jobs or pursue further medical training in college.

“NCMC, Inc. and Banner Health believe that innovative, quality educational programs and school districts are integral to the overall quality of life in communities we serve. We felt that support of this program would enhance the school system and provide expanded opportunities for students,” says Gene Haffner, director of public relations for NCMC. The Health Science Academy program will fully develop over the next three years, offering the ability for up to 220 students to explore medical career pathways and be better prepared to enter the healthcare workforce while they are still in secondary school. The expansion provides access to medical terminology, health sciences and human anatomy and provides new state-of-the-art lab facilities. The lab facility will offer lessons delivered in a simulated clinical environment, using hospital beds, medical mannequins and other diagnostic and therapeutic equipment and supplies.

“The program facility and content expansion will provide a more comprehensive curriculum related to health career fields and give students opportunities for more interactive and ‘hands-on’ experiences in learning skills necessary to succeed in health careers,” Haffner says. The Academy generates a relationship with Aims Community College and the University of Northern Colorado, which could lead to internships and job shadowing with local professionals. “Ultimately, this means giving increased educational opportunities for young men and women to explore multiple healthcare options. We believe that providing this avenue to obtain the needed training is important to ensure that we have highly trained, committed people in the future Northern Colorado healthcare workforce,” Haffner says. “Physicians and staff members will serve as guest speakers and guest instructors on different topic areas in the classroom. I’m sure that the instructor will also be providing opportunities for the students to be involved with the ambulance service as well as the medical programs at Aims Community College and the University of Northern Colorado,” Haffner says. According to a news release on RMParent. com, student interest and enrollment is already above expectations. “For the 2012-13 school year, 90 9th- and 10th-grade students are enrolled in the academy’s Introduction to Health Science class. Another 26 11th- and 12-grade students are enrolled in the Health Science Technology Education class. Additionally, there are 19 seniors in the Pharmacy Technician Certification program.” GCHS students are a part of the future Northern Colorado healthcare system and this program is aiding in giving them a jump-start on the career field of tomorrow.

Try something new with these family-friendly activities in Northern Colorado.

events in northern colorado october 3 -6, 10 -14 & 17 - 21 – Pumpkin Patch, 10 a.m., The Farm at Lee Martinez Park, Fort Collins, www.fcgov.com/events

13 - 14 & 20 - 21 – Hay Rides, 1:30 p.m., The Farm at Lee Martinez Park, Fort Collins, www.fcgov.com/events

19 – Starry Night Astronomy: Moon Magic, 6:15 p.m., off CR 27, South of Masonville, Bobcat Ridge Natural Area, free, www.fcgov.com/recreation/calendar

13 - 14 & 19 - 20 – Nancy Drew: Detective, 1 p.m. or 7 p.m., Lincoln Center Magnolia Theatre, Fort Collins, $7, www.fcgov.com/lctix

19 & 20– Sundance Family Festival, see website for times, Senior Center, Fort Collins, www. fcgov.com/recreation/calendar

19 - 20 – Haunted Wagon Ride, 5:30 to 8 p.m., Aspen Lodge, Estes Park, $15/child under 11, $30/ adult, www.estesparkcvb.com

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kids • play • fun • health • activities

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19 - 20 – Humans vs. Zombies, 6 p.m., Northside Aztlan Community Center, Fort Collins, $20, Oct. 19 for 6-8 graders, Oct. 20 for 9-12 graders, www.fcgov.com/recreation/ calendar 25 – Youth Night, 6 p.m., Northside Aztlan Community Center, Fort Collins, free, ages 8 -18, www.fcgov.com/recreation/calendar 26 - 27 – Haunted Wagon Ride, 5:30 to 8 p.m., Aspen Lodge, Estes Park, $15/child under 11, $30/adult, www.estesparkcvb.com 26 - 27 - 28 – Treatsylvania, 6 p.m., The Farm at Lee Martinez Park, Fort Collins, $5/ trick or treater, must be accompanied by an adult, purchase tickets in advance at The Farm, Northside Aztlan Community Center or EPIC, www.fcgov.com/recreation/calendar 27 – Halloween Enchanted Garden, 10 a.m., Gardens on Spring Creek, Fort Collins, amusement for young children, $3/child, www.fcgov. com/recreation/calendar 27 – Halloween Family Fun Festival, 10 a.m. to 2 p.m., Loveland Museum/Gallery - Peters Park, Loveland, free, www.ci.loveland.co.us 27 – BowWowvania, 12 p.m., The Farm at Lee Martinez Park, Fort Collins, bring your costumed dog, $5/dog, humans/free, all ages welcome, must be accompanied by an adult, purchase tickets at The Farm, www.fcgov. com/recreation/calendar 27 – Hogwarts Halloween, 5 p.m., Northside Aztlan Community Center, Fort Collins, K-8 grade, $15/child, $5/adult, children under 10 must be accompanied by an adult, www.fcgov. com/recreation/calendar 27 - 28 – Howl-O-Ween Twilight Trick or Treat, 4 p.m. to 8 p.m., Centennial Village Museum, $2/adults, $1/child, free/students or children under 2, www.greeleygov.com/CPRD 28 – Night Walk for Families, 5:45 p.m., off CR 27, south of Masonville, Bobcat Ridge Natural Area, free, no registration required, www.fcgov.com/recreation/calendar 31 – Tiny Tot Halloween, Old Town Square, Fort Collins, 10 a.m. to 1 p.m., www.downtownfortcollins.com 31 – Community Halloween Party, 6 p.m. to 8 p.m., Community Recreation Center, Windsor, free, www.windsorgov.com

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november 1 – Youth Night, 6 p.m., Northside Aztlan Community Center, Fort Collins, free, ages 8-18, www.fcgov.com/recreation/calendar 6 – Noontime Nature, Public Library - Erion Room, Loveland, free, 12 p.m., www. ci.loveland.co.us 9 – Family Fun Night, 6:30 p.m., Gardens on Spring Creek, Fort Collins, $5/family, www. fcgov.com/recreation/calendar 23 – 2012 Festival of Trees, 9 a.m., Monfort Concert Hall, Union Civic Center, Greeley, week long extravaganza of decorated trees, $2/adults, $1/children or seniors, www. ucstars.com 23 – Catch the Glow, noon, Downtown Estes Park, free, Santa visits, hay rides, Catch the Glow Parade at dusk, www.estesparkcvb.com 24 – Christmas with the King, 7:30 p.m., Monfort Concert Hall, Union Civic Center, Greeley, 16-member Elvis experience band play a Christmas show, $16-$45, www. ucstars.com 24 – Holiday House Christmas Bazaar, 9 a.m. to 3 p.m., Estes Park Conference Center, Estes Park, $1 at door, www.estesparkcvb. com 29 – Miracle on 34th Street, 7 p.m., Monfort Concert Hall, Union Civic Center, Greeley, a musical production about Christmas miracles, $33-$42, www.ucstars.com 30 - Dec. 1 – Gifts from the Garden, 5 p.m. to 8 p.m., Gardens on Spring Creek, Fort Collins, www.fcgov.com/gardens 30 - Dec. 31 – Garden of Lights, 5 p.m. to 9 p.m., Gardens on Spring Creek, Fort Collins, www.fcgov.com/gardens

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december 1 – Windsor Wonderland, all day, Main Street, Windsor, enjoy hot chocolate, horse drawn carriages and visiting Santa, for more details visit www.windsorgov.com 4 – A Crossroads Christmas IV, 5 p.m. to 8 p.m., Cultural Arts Council Fine Arts Gallery, Estes Park, free, donations for Crossroads Ministry accepted, www.estesparkcvb.com 6, 7, 8 & 9 – Canyon Concert Ballet: The Nutcracker, 7 p.m. or 2 p.m. on Dec. 8, Lincoln Center Performance Hall, Fort Collins, $20 or $24 senior/student/child, $25 or $30 adult, www.fcgov.com/lctix 14 – Craig Morgan & Phil Vassar: Acoustic Christmas Tour, 7:30 p.m., Monfort Concert Hall, Union Civic Center, Greeley, down-home country style Christmas music, $28-$75, www. ucstars.com 14 - 15 – Gift of the Magi, Dec. 14 at 7:30 p.m. or Dec. 15 at 2 p.m., UCA Griffin Concert Hall, Fort Collins, $40/adult, $20/student, $10/ children 12 & under, www.fcgov.com/lctix 15 – Sounds of Christmas, 2 p.m. to 4 p.m., Rialto Theater Center, Loveland, $16/person, www.ci.loveland.co.us

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CONTINUED FROM PAGE 47 Fort Collins Naturopathic Doctor, Lorraine Caron cautions people to reach out to an expert before embarking on drastic dietary changes, especially if the goal is healing. She says, “With a long-term raw foods diet, it will be a challenge to get enough protein and fats for most people. Cooking actually makes certain nutrients more bio-available, or removes problem chemicals... In my practice, I have to consider the person in front of me. The vast majority of Americans could do with more raw food or at least more veggies in their diet, that’s indisputable. But one diet does not fit all people at all points in their lives.” Dr. Caron suggests a mix of raw and lightly cooked foods. “I’m not a big fan of going to extremes. There is a time and a place for raw food, but I don’t think 100 percent raw is appropriate for all people.” Medical journal studies on raw foodism are scant. The results from completed studies have been mixed. The Journal of Nutrition reported in a 2005 study that 201 adherents to a raw foods diet did lower their total overall cholesterol levels, but they were also vitamin B12 deficient. Vitamin B12 derives from animal sources and is present in some nutritional yeast products and fortified cereals.

Happy Mediums

Jones readily admits that she does not eat 100 percent raw. And that works for her. “I usually eat raw at breakfast, sometimes at lunch and a cooked dinner,” which is still 25 to 50 percent raw. Thus, she and many others like her are getting about half of their daily calories from these pristine, easily-accessible sources. They “lean into raw.” Harris cycles from vegan with some cooked food to 100 percent raw over time depending on where she is in her life and what her needs are. “When I am 100 percent raw, I notice huge differences in my energy levels and blood sugar.” However, she notes that for people coming from standard American diet, even a small increase of raw food in their diet will make a noticeable difference. To compensate for missing B12, some raw foodists will take supplements, but many abstain because supplements are rarely vegan. Those folks make fermented foods like sauerkraut or fermented drinks to find that vitamin. Bottom line, eating 100 percent raw food requires much more attention and care to balanced nutrient content than most people pay. It’s not an impossible task, but does require time, effort and careful consideration. The benefits of higher energy levels and better resistance to disease are anecdotal, but hard to discount when you talk to people who have done it.

Resources for those interested in trying a raw diet: therawfoodcoach.com purejeevan.com thegardendiet.com rawfoods.com

Corey Radman is a Fort Collins-based freelance writer. A version of this article originally appeared at www.whisperingtree.net.

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veterinary

Urgent Care

Bobby Cawthron, DVM with Aspen Grove Veterinary Care, examines an urgent care patient.

urgent care option for Pets By Laura Sebastian

I

t’s every pet parent’s nightmare: a sudden illness or injury that occurs when your regular vet isn’t available or equipped to handle the situation. What do you do? Where do you go? Though there are excellent full-service emergency care facilities in Fort Collins, such as those at Colorado State University’s Veterinary Teaching Hospital, now there is a new alternative. On May 1, 2012, Aspen Grove Veterinary Care introduced its urgent care services, which have already become a thriving addition to its regular veterinary, boarding and daycare services. “We’re now open until 10:30 p.m. Monday through Friday and take on any and all dog and cat cases that come in the door,” says Bobby Cawthron, DVM, lead veterinarian and owner of Aspen Grove since 2006. “There are

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urgent issues, as well as issues that need to be addressed promptly but may not be immediately life-threatening – that often don’t require the care of a specialist at a larger emergency hospital. Here, you won’t need to spend specialist fees for something that a general practitioner can handle.” With on-site services that include X-ray, pharmacy, blood work, EKG, fluid therapy, laser surgery and pain management, Aspen Grove offers much of what you’ll find at other emergency hospitals, but in a smaller environment that is not only less stressful for your wallet, but also for you and your pet. Walk-in exam fees for emergencies are $79, $65 if you call ahead for an appointment, which is recommended but not required. The urgent care services are handled by Lauren Abrahamsen, DVM, who also practices general

vet care. Dr. Abrahamsen is a graduate of CSU’s vet school and joined the practice on May 1, 2012, after working previously at an emergency clinic in Calgary, Canada. “I really enjoy the fast-paced nature of urgent care; never knowing what might walk through the door keeps me on my toes and no two days at work are ever the same,” Dr. Abrahamsen says. “I like that we are able to provide an affordable alternative for minor emergencies and illnesses besides visiting an emergency referral hospital.” So how do you know when your pet needs one of the larger, all-night emergency facilities? “Cases better suited to those hospitals are patients who need on-going oxygen, constant fluid or ICU care,” Dr. Cawthron says. “Though even if it turns out your pet does need more extensive, overnight care, you can still get things started here in a more cost effective way. In those

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cases, we can stabilize your pet and help you transfer them if needed.” Another problem pet owners face is simply not knowing when their animal needs immediate care, as the signs of illness and even injury can be difficult to recognize. “Any time your pet is hit by a car, even if they seem fine and are walking, get immediate care. They could have internal bleeding but initially seem okay,” Dr. Cawthron says. “And always pay attention if your pet is not looking normal to you. The less than obvious things are if they hide, appear depressed or are not as responsive as usual. Other red flags include straining to urinate or defecate or having a distended belly, especially in dogs. If your male cat strains to urinate or urinates frequently, it can mean a blockage, which is very serious and needs immediate care. Other serious issues include difficulty breathing, eye injuries, back legs that are unstable or unusable.” But your pet’s needs don’t have to be urgent in order for you to take advantage of Aspen Grove’s extended office hours. For a $42 exam fee, you can schedule basic preventative care such as wellness checks or getting your pet’s shots. You can even dash in after work to get your pet a late-night nail trim (which doesn’t require an exam fee). “I feel like Aspen Grove provides the perfect environment for both myself as a doctor and for my patients and their owners,” Dr. Abrahamsen says. “I am able to provide a continuum of care and see my patients through everything from their first vaccines to late night emergencies.” And just as you would with your human children, have a plan in place for emergencies. Know the location of your chosen hospital, have a list of the medications your pet is taking, any past issues or conditions your pet may have, even a copy of his or her medical records. If you do go for emergency care, have your dog on a leash and your cat in a carrier. “Animals can bite or try and get away when they’re frightened or injured,” Dr. Cawthron says. “And we want you both to get here safely.”

When to Use Urgent Pet Care (from aspengrovevet.com):

• • • • • • • • • • • • • • •

Vomiting/diarrhea Bleeding Straining to urinate/defecate Allergic reactions Abdominal distension Trauma Shock Respiratory distress Seizures Hyperthermia or hypothermia Fainting Eye injuries Toxin/poison Fractures/dislocations Paralysis

Laura Sebastian is a writer living in Fort Collins.

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veterinary

Pet Care

E n s u r ing N i ne Hap p y L i ve s

F

elines’ fabled nine lives bestow a mixed blessing. People do indeed sometimes witness cats’ amazing four-paw landings from dizzying heights or inexplicable, spontaneous recoveries from dire illnesses. But perhaps such accounts sadly relegate veterinary care for the ordinary 99 percent of felines to the very bottom of their owners’ To-Do lists, if at all. Robin Downing, DVM, CVPP, DAAPM, is owner of Windsor Veterinary Clinic and The Downing Center for Animal Pain Management. Dr. Downing advises that, although there are 10 million more cats than dogs in the U.S., feline visits to the vet are far more infrequent. She mentions several health issues that particularly endanger these animals’ welfare. Cats are stoic, even in illness. Without routine vet visits, well-hidden symptoms of undiagnosed problems can worsen exponentially. Many felines, especially inactive ones, become overweight or obese. Excess poundage causes a host of hazardous maladies, including diabetes mellitus, pancreatitis, kidney disease, hyperthyroidism and an eightfold increased risk for cancers, says Dr. Downing. Frightening as a diagnosis can be to a cat owner, early detection and intervention can prolong their pet’s life expectancy, which presently is as long as the early 20s. Over-population has been well-touted by animal

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By Marty Metzger

welfare groups and media as the primary cause of euthanasia at shelters. Intact, breeding felines produce a mind-boggling number of offspring in a relatively short time, according to statistics. While accurate, a perhaps less well-known peril is the high incidence of spread of contagious diseases among roaming romantics. Dr. Downing also notes a dramatic decrease of breast cancers in spayed females. Spay or neuter surgery can be performed on felines as young as 8 weeks, reports Dr. Downing, basing that age on a study by Paul Gambardella of the Massachusetts Society for the Prevention of Cruelty to Animals. Additional concerns challenge the nine lives myth. Katrina Morgan, DVM, of VCA Loveland Animal Hospital, points to periodontal disease as a major culprit in infections and heart disease. Many cats, some genetically predisposed, exhibit dental disease by age three. Prevention includes proactive oral care. “I love to get kitten owners brushing those little ones’ teeth early on,” she says. Age-related disorders run the gamut. Dr. Morgan sees infectious upper respiratory infections and parasites more frequently in younger patients. Hyperthyroidism, kidney failure and cancers are more prevalent in geriatric cats. The problem of pudgy cats is no bulging, fridgeraiding Garfield joke. Dr. Morgan’s suggestions for feline weight management are regular exercise (perhaps initiated by an owner-operated laser pointer)

and portion control. She recommends feeding a combination of moist and dry feeds. Free-choice grazing might be great for goats, but for a beloved house cat, bigger is definitely not better. Both Drs. Downing and Morgan disagree with the premise that cats don’t require regular veterinary care. “Cats are complex creatures,” asserts Dr. Downing. “For example, it’s a common belief that nothing can be done for one suffering from a chronic disease. That’s false. Today’s sophisticated medical care can definitely offer hope.” The two veterinarians debunk more incorrect notions about felines: •

De-clawing – Contrary to usual opinions, cats with all toes intact can be trained to scratch solely on owner-acceptable surfaces, says Dr. Downing. Removing claws, and therefore joints, is unnecessary.

Training – Not just Fido can retrieve, sit or come when called. Dr. Morgan declares that Fluffy can also perform those and other learned behaviors. (However, Splash Cats will probably never become as ubiquitous a competitive sport as is Splash Dogs!)

Cat Colonies – Although feral cats amiably coexist in familial groups, Dr. Downing advises that forcing domesticated cats to

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live in close proximity to ‘foreign’ felines creates a stress phenomenon. •

Heartworm – Cats, like dogs, are at risk for this potentially fatal infestation. Preventive treatments also thwart roundworms and hookworms, says Dr. Morgan.

She also mentions litter box issues – a physical problem, not misbehavior, may be to blame. Another misconception is that cows’ milk is a nutritious treat for kitty. In fact, warns Dr. Morgan, it’s actually bad for felines, many of which are intolerant of cow milk. Dr. Downing addresses important differences between feline and canine needs. While acknowledging some overlap, she counsels that, for example, cats metabolize medications differently. Dosing requirements must be speciesand weight-adjusted. Nutritional requirements vary, so are likewise best outlined by each cat’s veterinarian, adds Dr. Downing. Because cats are so incredibly adept at hiding illness, disease processes manifest differently in cats than in dogs, says Dr. Morgan. Therefore, both she and Dr. Downing adamantly advise owners to bring cats in for routine visits at least once or twice annually. But many owners dread (and hence skip) the ordeal. Haunting visions of shrieking, bug-eyed, claw-wielding protests send some cat parents into panic attacks. Be of good courage. Cat-friendly veterinary practices are out there to offer hope. In fact, a new, specific designation of CatFriendly is now assigned by the American Association of Feline Practitioners. Dr. Downing explains that the credentialing process began in early 2012 to change cat owners’ perceptions. It addresses the quirks and nuances of felines per se and individuals in particular. The Cat-Friendly Program strives to reduce fear and pain for the cat and make each visit a happy one. Gold or Silver designations are conferred upon qualifying practices. A committee conducts a comprehensive review of the veterinary candidate, including an online, virtual visit. Ten different practice areas from team training to proper imaging techniques are examined, says Dr. Downing. She proudly reports that both of her practices have been granted the coveted Gold level designation. There are only two other Cat-Friendly designated practices in Colorado, one in Denver and the other in Colorado Springs. These two are the lesser Silver level. For meeting vigorous guidelines of care, VCA Loveland Animal Hospital is American Animal Hospital Association accredited. Dr. Morgan is a member of the American Association of Feline Practitioners, veterinary professionals dedicated to the health of feline patients. Dr. Downing praises the association’s website, www.catvets.com, as an excellent source of guidelines for owners. The association’s goal is to make the veterinary environment a happy one for cats. After all, one healthy life is far preferable to nine tenuous ones.

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Mon-Fri 9:00 AM to 6:00PM Sat 9:00 AM to Noon Cremation & Burials Caskets • Markers • Urns

preciousmemoriespetcemetery.com

Marty Metzger is a writer living in Fort Collins.

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veterinary

Pet Tails

Princess The Paral y z e d Pe k i n e s e By Michelle Venus

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nce upon a time, there was Princess. She was a beautiful Princess with a sparkling personality that made everyone love her the moment they met her. Unfortunately, Princess suffered a spine injury that left her paralyzed. She longed to run and play as she had when she was younger, but alas, she was unable to do so. Princess is a Pekinese. She was found in a parking lot one evening in November 2011, abandoned by her owner. And she was paralyzed. Princess could not move her back legs at all. In order to get from one place to another, she had to pull herself along with her front legs, dragging her useless limbs behind her. This resulted in her spine twisting (the back legs fell to either side of her body) while her shoulders and upper back strained to do all the work. The poor girl was in a lot of pain. Enter Robin Downing, DVM. Owner of The Downing Center for Animal Pain Management, Dr. Downing has been helping pets with spinal injuries throughout her career. She teaches paralyzed dogs and cats how to walk again. It’s not a miracle: it’s called spinal or reflexive walking. Let’s start with a physiology lesson first. When an animal loses its ability to walk due to a spinal cord injury, there is still some integrity in the spinal cord. The autonomic, or unconscious part of the nervous system still works. This is why a heart can beat or lungs can expand

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without having to think about making these organs function. These automatic functions happen deep within the spinal cord. Conscious movement and muscle feeling are more superficial; located closer to the surface of the spinal cord and these are what are impaired when a lesion causes pressure. That injury is akin to a dam in a river. The signals from the brain can go as far as the dam and no further. South of the injury, though, there is still intact spinal cord and nervous system activity. Part of that activity are reflexes called segmental reflexes – the reflexes in that segment of the spinal cord still feed the functions of the areas where those systems happen to live. Understanding how these reflexes work is the key to the principle of spinal walking. The reflex is engaged when the bottom of the foot is stimulated. The stimulated leg withdraws and moves closer to the body while the opposing leg straightens out. The straight leg touches the ground, the foot is stimulated and the reflex repeats itself. Princess was taken to The Downing Center in Windsor, where she became Dr. Downing’s pet project. She actually lived with the doctor while she was undergoing treatment, not only for paralysis but for other ailments as well, including her back pain and a raging bladder infection. As it turns out, bladder infections are not uncommon for paralyzed animals; they lose their ability to completely eliminate urine and stool. Once these problems were under

control, walking lessons began. First it was necessary to get Princess into a spine neutral position. This was accomplished by building strength in her front legs by exercising on an underwater treadmill. Normally an initial step is to put the animal in a walking wheelchair that supports the back legs, but Princess progressed so quickly, she jumped over this step completely. Her nervous system actually rerouted itself through collateral intervention, where the signals utilize the nerves that still work to maintain functions. This rerouting helps Princess to urinate on her own. With her intense therapeutic regimen, Princess became adoptable just one month later. For other animals, it can take more than six months to become proficient with spinal walking. It’s very dependent on the extent of the injury, the pet’s body type and how much time an owner can devote to training. Princess’ owner, Diana Palluck of Greeley, describes Princess as having a wonderful spirit, “She doesn’t know she’s disabled. She just plays with the other dogs and thinks she’s the boss.” Princess undergoes a pain management program and takes daily cranberry extract for bladder health. The rest of Diana’s dogs – rescue animals all – don’t realize she’s disabled either. She’s just one of the crew. Now that is a miracle.

Michelle Venus is a writer living in Fort Collins.

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Physician spotlight

Stace A. Fritzler, M.D.

h el p i n g t h e

community she loves By Heidi Kerr-Schlaefer

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rowing up in rural Montana, Stace A. Fritzler, M.D., didn’t have any female doctors as role models. However, when she was just 6 years old, she found out that girls could become doctors and she made the decision that medicine would be her future profession. In Montana, family practice physicians were the most common type of doctor, and Dr. Fritzler always sensed that it would be her specialty. After attending Carroll College in Helena, where she obtained an undergraduate degree in biology with a minor in chemistry, Dr. Fritzler went on to medical school at the University of Washington in Seattle.

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“When I started doing my clinical clerkships, I liked everything. I liked surgery, I liked delivering babies, I enjoyed seeing kids and adults, so I decided family practice was where I could get a little bit of everything,” says Dr. Fritzler. Today, Dr. Fritzler is a general practitioner with Fort Collins Family Physicians, where she’s been for 13 years. Dr. Lawrence Merkel founded the practice more than 35 years ago. There are three physicians and two physician assistants in the office located at University of Colorado Health’s Harmony campus. The variety of patients and ailments at a family practice is still what Dr. Fritzler enjoys the most about her work. Based on her age and gender, Dr. Fritzler has a lot of female patients and also does a lot of pediatrics and

preventive medicine. “I get to see babies from the time they’re born, and as they are growing,” says Dr. Fritzler. “But I love the diversity. One minute I am seeing an infant and the next minute a 95-year-old. It’s not the same thing every day.” Dr. Fritzler spent her first year of residency in Idaho, and then after a friend told her about an opening at Poudre Valley Hospital, she applied and was accepted. She finished up her residency and was hired by Fort Collins Family Physicians. She married a Colorado native, and they have two daughter, ages 3 and 5. “I love Fort Collins,” says Dr. Fritzler. “It’s home.” Recently, Dr. Fritzler had an opportunity to help the community she loves by assisting in the opening of a new medical clinic at Crossroads Safehouse. For 32 years, Crossroads has been serving abused men, women and children in Northern Colorado. They provide free safehousing, advocacy, legal assistance, transitional housing and education. Now, they also provide general medical services. The medical clinic at Crossroads provides a safe place to seek medical help. Victims of domestic violence often don’t have access to medical care for a variety of reasons. Sometimes it’s financial, but often an abusive partner won’t let the victim get medical care either for control reasons or out of fear of someone finding out about the abuse. The stigma surrounding domestic violence can also prevent an individual from seeking medical attention. “Dr. Fritzler was instrumental in getting us started,” says Laura Williams, volunteer coordinator and public relations director at Crossroads. “She’s amazing and so supportive. She’s open to answering any questions, even when I email her in the middle of the day. She’s also been networking, raising awareness and finding physicians to volunteer with us.” The Crossroads Safehouse medical clinic opened in February 2012, and has been well received. There are 12 physicians volunteering their time, with Dr. Fritzler among them. Patients come for basic medical issues like sore throats, colds and wellness checks. “A lot of time it’s just listening. We try to listen and reassure,” says Dr. Fritzler. “It’s also a lot about education.” Dr. Fritzler explains to patients that it’s important for a woman to get an annual pap smear and for children to receive the proper vaccinations. “It helps a lot to know we’re helping them back on their feet,” she says. When she’s not seeing patients at Fort Collins Family Physicians or at Crossroads, Dr. Fritzler enjoys spending time with her family. She also loves sports and tries to run and play softball when she finds the time.

Heidi Kerr-Schlaefer is a freelance writer and journalist. She is also the Mayor of HeidiTown. com, a blog about events, festivals & destination in Colorado.

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2012-10 Northern Colorado Medical & Wellness Magazine  

October - Northern Colorado Medical & Wellness Senior Living A regionally focused issue featuring health, healing, health maintenance and p...

2012-10 Northern Colorado Medical & Wellness Magazine  

October - Northern Colorado Medical & Wellness Senior Living A regionally focused issue featuring health, healing, health maintenance and p...

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