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Caring for You & Your Growing Family No matter what time in life you decide to start or add to your family, the leading physicians and experienced caregivers at Presbyterian/St. Luke’s Medical Center are here to provide the support you need to have a happy and healthy delivery. As part of our exceptional childbirth services, we also provide a rare partnership between obstetric and pediatric specialists at Rocky Mountain Hospital for Children that does not exist anywhere else in the region. In one convenient location, we care for both mom and baby in all types of births, from the common to the complex, with cutting-edge technology and a compassionate approach to care.
Take a tour at www.pslmc.com/mygrowingfamily Presbyterian/St. Luke’s Medical Center 1719 E 19th Avenue, Denver, CO 80218 720-754-6000 Only hospital in Colorado to fully meet the Leapfrog Group standards in high-risk maternal care.
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Rose Medical Center Find a Rose Doc! 4567 E 9th Ave RoseMed.com Denver, CO 80220 303-320-ROSE (7673)
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DANIEL DONATO, JR, MD, FACOG, FACS Gynecologic Oncology Surgeon Denver - Rose
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Primary Care, Urgent Care, or Emergency Room?
It’s Your Choice. Primary Care
Urgent Care
Choose primary care if you need preventative, routine or non-urgent care for health issues during regular business hours.
If you require attention outside of your primary care provider’s office hours, or have any other non-life threatening illness or injury, choose OnPoint Urgent Care.
• Chronic conditions • Wellness tests • Annual physicals • Flu shots • Vaccines • Earache • Sore throat • Fever • Cold or flu • Sprains and strains • Urinary tract/bladder infections • Confidential testing for STD • Headaches & migraines • Skin conditions • Small cuts & bruises • Mild burns • Minor infections • Muscle & joint pain • Back pain • Sores & blisters
• Health, sports & school screenings • Flu shots & vaccines • Earache or sore throat • Fever, cold & flu • Sprains & strains • Urinary tract/bladder infections • Headaches & migraines • Skin conditions • Small cuts & bruises/burns • Infections • Muscle & joint pain • Back & joint pain • Sores & blisters • Minor broken bones • Migraine requiring IV treatment • Confidential testing for STD • Dehydration & IV therapy • Worker’s compensation injuries • Drug testing/Breath alcohol testing • Pre-employment physicals • DOT physicals/drug screen • Return to work physical
ER Reaction Time Is Critical
Call 911 immediately if you experience the following: • Severe abdominal pain • Seizure • Stroke: Sudden dizziness, numbness or paralysis. Difficulty seeing of speaking, or loss of consciousness. • Heart Attack: Chest pain with pressure sensation or pain radiating into jaw, teeth, shoulder, or back; or palpitations with dizziness, or shortness of breath, sweating, and/or nausea or vomiting. If you have a life-threatening injury, illness, or trauma, choose the emergency room for immediate care. • Chest pain/Severe abdominal pain • Sudden change in vision • Sudden weakness/High fever • Trouble speaking • Difficulty breathing • Uncontrolled bleeding • Loss of limb • Head trauma • Gun shot • Stab wound
If you suspect a life-threatening emergency call 911
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Rose Pediatrics Highlands Ranch 720-310-8539 9137 Ridgeline Blvd Suite 130 rosepediatrics.com Lone Tree Pediatrics Lone Tree 720-526-0012 10099 RidgeGate Pkwy Suite 290 lonetreepediatrics.com Lone Tree Pediatrics Littleton 720-336-3936 7720 S Broadway Suite 540 lonetreepediatrics.com
South Denver OB/GYN & Midwives Castle Rock 720-572-1588 2352 Meadows Blvd Suite 255 southdenverobgyn.com
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CONTENTS FEATURES
24 Surviving Sepsis
26 What to Know Before You Go to the ER
28 Ballet-Inspired Workout Answer for Olympic Skier
38 One-On-One with Colorado’s LÄRABAR Founder
48 Colon Cancer Screening: Alternatives to the Colonoscopy
56 Kids Sports: Specialize or Diversify?
10
12 Break Free from Helicopter Parenting
PUBLISHER & EDITOR
Peter Solveson peter@solvepublications.com
16 Ask the Pediatrician 18 Banish Acid Reflux Naturally
CREATIVE DIRECTOR
Patrick Creyts
22 Midlife Check-In
EDITOR
Andrea Juarez
44 Prostate Health PSA Test Update 46 Cardio Workouts: High-Intensity vs.
FEATURE WRITERS
Sarah Protzman Howlett Andrea Juarez
Steady-State
Joelle Klein
52 7 Foods You’re Not Eating—But Should
Courtney Messenbaugh Maribeth Neelis
54 A Nutritionists’ Guide to Going Vegan
Meghan Rabbitt
58 Teenage Depression and Anxiety:
Kris Scott
What to Know
Morgan Tilton
60 Want Better Sex? Start Talking 62 Brain and Abdominal Aortic Aneurysms
HEALTH PROFILES
Pain-Free Living After Minimally Invasive Spine Surgery
21
Complex Brain Surgery Saves Life
20
32
Transplant Patient Gets Fresh Start
Denver International Spine Center: 3 Patient Stories
35
HEALTH PROFILE WRITERS
PHOTOGRAPHERS
42
Robotics Technology Improves Gynecologic and Urologic Surgeries
Dan Sidor Mark Woolcott
HEALTHWELLNESSCOLORADO.COM COMMITTED TO SUSTAINABLE PRINTING METHODS Publication Printers of Denver prints Health & Wellness magazine. The paper fibers, soy, agri-based inks, and methods used meet or exceed all federal Resource Conservation Recovery Act (RCRA) standards of the U.S. Environmental Protection Agency (EPA).
Copyright 2019 Solve Health Media. All Rights Reserved. Reproduction or use of editorial, data or graphic content is prohibited without written consent from Solve Health Media. Health & Wellness is a biannual publication of Solve Health Media. It is not intended to provide medical advice on individual health matters. Please consult your physician for any health concerns. Subject matter and content of editorial and advertisements do not necessarily reflect the viewpoints of Solve Health Media. Every effort has been made to ensure the accuracy of this publication. Solve Health Media assumes no responsibility for errors or omissions. Please notify Solve Health Media with any changes, additions or complimentary copies.
HEALTH
Andrea Juarez Jeannette Moninger
M E D I A
D E S I G N
Boulder, Colorado
303.484.9001 HealthWellnessColorado.com
SPRING/SUMMER 2019
64
Meet Dr. Wade Smith, Orthopedic Trauma & Limb Reconstruction Surgeon
HEALTH & WELLNESS COMMUNITY EDITION — CALL TODAY FOR DETAILS — Health and Wellness Magazine •
11
How to Break Free from Helicopter Parenting by Sarah Protzman Howlett While few parents aspire to label their parenting style, Dr. Debra Berry, a pediatrician at Lone Tree Pediatrics at Sky Ridge, says she gets more questions about the “right” way to raise kids than she used to. She says parents in the Denver area, like pretty much anywhere else, often fall prey to micromanaging their children’s lives — sometimes referred to as helicopter parenting. The rub? Many parents do not see this as a hindrance, Berry says, but just what attentive, loving moms and dads do. “The thing is, they feel like they are being good parents, when in fact, they are overinvolved,” Berry says. A common example of helicoptering, she says, is parents who are finding out when school assignments are due, and making sure their kids are doing everything on time. “Don’t try to get your kid out of trouble,” she says. 12
Dr. Sheryl Ziegler, a Denver-based therapist and author of Mommy Burnout: How to Reclaim Your Life and Raise Healthier Children in the Process, says parents sometimes joke about being a particular stereotype. She tries to help them see that reality is much more nuanced. “I have moms joking that, ‘Oh, I’m the Tiger Mom,’” she says, “But actually I find they may only be that way around a particular subject and not with everything.” Parents who struggle to let go should remember they are actually “raising adults, not children” — a sentiment that’s gained traction in Utah, says Kerry Stutzman, a licensed marriage and family therapist in Denver.
“Parents of young kids are fighting over what their kids are wearing, but that’s an important part of self-expression.”
Utah’s so-called free-range parenting law took effect in May, permitting parents to decide whether their children are mature enough to bike to school, be home alone or walk to the playground unattended. The idea has appealed to other states as well; New York and Texas are said to be considering similar legislation.
LEGALLY
Here in Colorado, the laws defer to common sense and circumstance, says Dave Kaufman, community services officer with the Boulder Police. Contrary to popular belief, he says, “There is no Colorado law about the minimum age to leave kids alone.” In general, leaving kids in cars applies in the same way, Kaufman says. “There’s no law saying you can’t leave your child in the car while you run in someplace,” he says. “But a car can be mobile.” He says if he came upon a car with a child in it and the door was unlocked, he would be unsettled. In these circumstances, Kaufman says he bases his policing on how the parent responds when confronted. “We don’t want to be the nanny state,” he says. “Education works a lot better, but if the parent is dismissive of what I’m telling them, we can take it the other route and write them a ticket. Then they get to explain to a judge why what they did was safe.”
KIDS SHOULD MAKE DECISIONS TOO
Law and common sense aside, parents can let kids make many of their own choices. Berry says that it should start when they are very young. These practices not only help a parent avoid helicoptering but prime them to skirt arguments later when their kids hit preschool-age. “Let the kids make all the decisions that aren’t important,” Berry says. “Parents of young kids are fighting over what their kids are wearing, but that’s an important part of self-expression.”
Health and Wellness Magazine •
13
‘LET THEM FAIL’
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Stutzman says she believes most kids can be managing their own schoolwork by middle school, and that many parents have a hard time letting go on this particular issue. And while it may be hard to watch, Stutzman says forgetting to turn in schoolwork falls into an important category: the “affordable mistake.” Things like forgetting your lacrosse stick at practice or spilling milk all over the floor are affordable mistakes. “Remember that he is not at risk of harm,” she says. “It just might be inconvenient.” Berry agrees and says, “I’ve heard it said, ‘Fifth grade is the year you’re supposed to let them fail a class.’” Not eating dinner and being hungry? An affordable mistake. Skinning a knee? Also affordable. “In my practice, many parents feel like everything is an unaffordable mistake,” Stutzman says. “Not wearing a helmet, on the other hand, is unaffordable.” Ziegler says it’s OK to have a “helicopter style” and be less flexible around certain non-negotiables, be that an academic standard, sitting down to family dinner a certain number of nights per week or attending religious services on Sundays. “Be clear about your values as a parent,” Ziegler says. “Not everything can rise to that occasion, so maybe you are more agreeable on other things.”
“In my practice, many parents feel like everything is an unaffordable mistake.” ‘BUILD THE CONFIDENCE’
In an effort to give her daughter a sense of achievement, Berry recently let her daughter, a freshman in high school, take the Denver light rail to a writing conference. “I wanted her to buy the tickets and have a good learning experience,” she explains. “A lot of these kids will want to live in a city someday. You build the blocks to help them build the confidence.” Berry says she talks to a lot of parents of teens about the search for identity in late middle school and early high school, where the stakes are higher for parents who continue to helicopter. “It can trigger anxiety and you can stunt their emotional development if you are making all the decisions for them,” she says. Ziegler says what matters most as a parent is to show your child that you do trust him or her by saying yes when you can, while still protecting where you must. “What’s in between helicopter and freerange?” Ziegler says. “Thoughtfulness.”
Health and Wellness Magazine •
15
ASK A PEDIATRICIAN
LOCAL HEALTH CARE PROVIDERS RESPOND TO PATIENT INQUIRIES I think my child may have ADHD. How do I find out for sure?
A child may have attention deficit hyperactivity disorder (ADHD) if there is an issue with a lack of attention, hyperactivity and/or impulse control. A child can have any combination of one, two or three of these problems to have ADHD; however, a lack of attention is central to having ADHD. Children who have attention problems but no hyperactivity or impulsivity will be more difficult to notice because they usually do not cause any problems with the normal flow of the classroom. To have ADHD, the symptoms must cause a problem to the point that it is a disorder: it disorders the normal home, school or extra-curricular activities of life.
A child’s pediatrician is usually equipped with starting and completing an evaluation for ADHD. An in-depth interview with the child and parents, along with using specific forms to collect data from parents and teachers, starts the process. The pediatrician will also look for signs of a possible learning disability since there’s a correlation between the two. Half of children with a learning disability also have ADHD, and a quarter of children with ADHD have a learning disability. Dr. Nicholas Kyriazi Littleton Pediatric Medical Center littletonpeds.com Highlands Ranch
My baby spits up all the time. Is this normal? When should I worry?
Is it true that boys are usually toilet-trained later than girls?
Spitting up is one of the most common concerns for parents. Gastroesophageal reflux is the passage of stomach contents into the esophagus and is a normal physiologic process in healthy infants. Many infants have frequent episodes of spitting up throughout the day, but are otherwise growing and developing well. While frequent spitting up can be stressful for parents, particularly when it appears to be large volumes, we consider babies “happy spitters” as long as the episodes of spitting up are not causing distress to the infant or affecting an infant’s growth. Spitting up can be helped by slowing down feeds, frequent burping and keeping infants upright for 20-30 minutes after feeds. Gastroesophageal reflux disease is the passage of stomach contents into the esophagus that results in bothersome symptoms or complications for an infant. Signs that spitting up may be causing problems that would require medication include poor growth, difficulty feeding, irritability, arching of back and grimacing. If your infant is experiencing any of these symptoms, you should contact your doctor to discuss possible need for treatment.
Before becoming a parent I did not understand the degree of frustration, anxiety and eventual jubilation that accompany toilet-training. Adding to the stress of this rite of passage are the myriad of opinions on when and how to attempt this feat. While there is truth to the idea that boys typically toilet-train later than girls, every child reaches this milestone at his or her own pace. Children are typically daytime toilet-trained between 2-3 years old, with boys training, on average, 2-3 months later than girls. Reasons for this difference are unclear, but may be related to differences in development, methods of training, and socialization factors. Regardless of their gender, toilet-training is most successful when children demonstrate signs they are ready. This is unique to every child. You, as the parent, are the best judge of when your child has achieved the physical, developmental and behavioral skills needed to begin toilet-training. I encourage you to discuss these readiness signs with your pediatrician since we are here to guide you through the mess!
Kelly Newgent, MD Greenwood Pediatrics Southwest greenwoodpediatrics.com Littleton 16
Dr. David Higgins Advanced Pediatric Associates advancedpediatricassociates.com Centennial
When can I give my child peanut butter? What are signs of an allergic reaction?
Some of my friends decided not to get a flu shot this year. Are their reasons any good?
As a pediatrician, my passion is to protect children’s health. One of the very best ways I accomplish this is by administering the flu vaccine. Unfortunately, many people decide against receiving an annual flu shot. Here are a few common reasons patients have told me they decide not to get a flu shot: “The flu shot causes the flu.” The influenza vaccine does not, in fact, cause influenza. It can certainly cause side effects that mimic flu symptoms such as fevers and muscle aches. These side effects are common in other vaccines, too. However, these symptoms tend to be mild and are shorter-lasting than true disease. They also do not lead to serious complications such as pneumonia or brain infections like the real disease of influenza can. “I never received a flu vaccine and have never had the flu. Why should I get one now?” Influenza is a very contagious disease that we are all at risk for catching every year even if we have never caught the flu in the past. If we can protect our bodies against dangers in a safe way, we should do it. Even if you have never been in a serious car accident, wouldn’t you still wear a seat belt? “The flu vaccine does not always work and you can still catch the flu.” No vaccine or medication is perfect. However, deciding not to receive the flu vaccine gives you no protection at all. Also, most patients who receive the flu vaccine and have the misfortune of still catching the flu tend to have a milder course of the disease compared to unvaccinated patients. I encourage you to discuss with your doctor any questions or concerns you have about the flu vaccine. Give it a shot! Dr. William S. C. Payne Advanced Pediatric Associates advancedpediatricassociates.com Centennial/Aurora/Parker
The answer to this question has been debated for the last several decades, and for good reason! By the turn of the millennium, anaphylaxis from peanuts became the number one cause of allergy-related death among children in the United States. Not surprisingly, medical professionals recommended avoiding peanut-containing foods in a child’s diet for the first three years of life, especially in those children at higher risk for developing anaphylaxis. In 2015, however, a landmark study published in the New England Journal of Medicine showed that early introduction and regular consumption of peanutcontaining foods to high-risk infants prevented the development of peanut allergies. New guidelines from the National Institute of Allergy and Infectious Diseases now risk-stratify babies into three groups: • Babies with severe/persistent eczema and/or an immediate allergic reaction to any food are considered “high risk” for developing a peanut allergy. Ideally, peanut-containing foods should be introduced to these babies as early as 4 to 6 months after allergy testing for peanuts is completed by an allergist. • Babies with only mild to moderate eczema should be introduced to peanut-containing foods around 6 months of age with continuation in their diet to prevent a peanut allergy from developing. Allergy testing to peanuts may be completed prior to introduction. • Babies without eczema or other food allergies may start having peanutcontaining products and other highly allergenic foods freely after a few solid foods have already been introduced and tolerated without any signs of allergy. In general, families are encouraged to start solids with a few foods that are of low allergenic risk (e.g. infant cereal and pureed fruits and vegetables). Give your baby one new food at a time, and wait at least three days before starting another. Monitor their reactions: • Signs of an allergic reaction may include rash/hives, diarrhea, and upset tummy. If any of these occur, stop using the new food and consult your child’s pediatrician. • Signs of a life-threating reaction – also known as “anaphylaxis,” may include widespread hives, facial/mouth/throat swelling, wheezing, difficulty breathing, vomiting, flushing, and low blood pressure. As with all infant foods, allergenic foods should be given in age — and developmentallyappropriate safe forms and serving sizes. Dr. Nick Krebs Greenwood Pediatrics greenwoodpediatrics.com Centennial Are there any special surgical techniques for correcting my daughter’s scoliosis?
Two things really matter when treating scoliosis in children: early intervention and straightening the spine without compromising growth. At Rocky Mountain Pediatric OrthoONE at Sky Ridge, we are pioneering a new device and a minimally invasive technique to help young patients with early onset scoliosis. With just one surgical procedure, we implant rods that have an inner magnet along the spine. Several weeks later, we begin routine office visits where we use a magnetic device to very slowly lengthen the rods one millimeter at a time. Kids love growing 3 to 4 millimeters at a time and they don’t feel pain! This minimally invasive technique can help your little one slowly straighten her spine while she continues to grow. Dr. Jaren Riley Rocky Mountain Pediatric OrthoONE at Sky Ridge orthoonedenver.com Lone Tree
Health and Wellness Magazine •
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BANISH
ACID REFLUX — the Natural Way — by Maribeth Neelis More than 60 million Americans experience acid reflux at least once a month, according to the Mayo Clinic. A common medical condition that occurs when stomach acid flows into the esophagus, throat and mouth, acid reflux often causes the symptom known as heartburn. “After digesting a meal, a muscular, valve-like ring located between the stomach and esophagus opens to allow food into the stomach. When this valve does not close properly or loses muscle tone, acid starts to creep up into the esophagus,” says Dr. Diana Milling, a naturopath at Advanced Integrative Medicine in Lone Tree. When heartburn occurs more than twice a week for an extended period of time, you may be suffering from the more serious GERD, says Milling. A chronic form of acid reflux, Gastroesophageal reflux disease, known as GERD, may be treated with medication, or in some cases, surgery. Certain medications, conditions and lifestyle choices can predispose people to the painful, burning sensation often felt in the middle of the chest. But, how can we prevent it?
Diet Do’s and Don’ts
“Diet can be a major trigger for heartburn,” Milling says. “Notably, if there are food intolerances that we are unaware of but consuming on a regular basis.”
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The most common, reflux-producing food sensitivities are eggs, dairy, gluten/gliadin, soy, corn, nuts, sugar, pineapple, bananas, mushrooms and foods high in baker’s or brewer’s yeast. “There are also many foods and drinks that can help to alleviate heartburn,” says Milling. To soothe a case of acid reflux, reach for fermented fare, like kombucha, kimchi or miso; nosh on cabbage or glutenfree oatmeal; sip chamomile or ginger tea with a spoonful of raw honey; season your dishes with fennel or parsley; and use healthy fats, like coconut oil, olive oil or ghee. Natural elixirs can also remedy acid reflux. Milling recommends mixing two tablespoons of slippery elm into a cup of cold water and refrigerating it overnight. In the morning, add raw honey or cinnamon to taste, and take 1 tablespoon every couple of hours. Another easy combination is 1/4 cup of aloe juice mixed into an 8-ounce glass of water; consume daily to help symptoms. Milling also suggests her patients eat smaller, more frequent meals, and always eat at least three hours before bedtime so that food has sufficient time to digest. If it’s less than that, when you lie down, gravity can increase the propensity for acid to travel up towards the esophagus, making acid reflux worse.
Lifestyle Matters
Beyond diet, there are lifestyle changes you can make to reduce acid reflux. Quit smoking, reduce your alcohol intake, and avoid a high-fat diet. Find ways to decrease your stress level. Incorporate deep breathing and yoga into your routine.
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Acid Reflux Producing Foods • Caffeine • Citrus • MSG • Tomatoes • Alcohol and chocolate • Artificial sweeteners • Spicy and fried foods
• Soda and other carbonated beverages • Refined carbohydrates, like cereal or baked goods • Raw onions and garlic • Foods high in histamine— cured meats, soy sauce, olives, and mayonnaise
Source: Dr. Diana Milling, naturopath with Advanced Integrative Medicine
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Dr. Adam Smith explains the removal of a spinal tumor to his patient Scott Collins during a post surgery visit.
M I N I M A L L Y I N VAS I V E S P I N E SURGERY AT SKY RIDGE
A FASTER ROAD TO PAIN-FREE LIVING Salida resident Scott Collins spent 15 years jostling around as a crane operator. Although he now spends his time behind a desk, those earlier years wreaked havoc on Collins’ back. “Chronic back pain kept me awake most nights,” says Collins. “Sometimes, my legs would go numb.” Seeking relief, Collins returned to Dr. Adam P. Smith, the neurological surgeon who performed his neck surgery in 2012 at Sky Ridge Medical Center’s Rocky Mountain Brain & Spine Institute. New imaging scans showed an ependymoma tumor had formed in Collins’ spinal cord. In addition, vertebrae were slipping out of position, a condition known as spondylolisthesis. The standard approach to removing a spinal tumor involves making several 3-inch incisions and cutting muscle and tissue. “Because you have to remove a lot of bone to get to the tumor, a patient may need a fusion (the use of rods and screws) to support the spine,” says Dr. Smith. Fortunately for Collins, Dr. Smith is experienced in a minimally invasive approach that requires one small incision and the use of dilators, or tubes, to access and remove the tumor. During the May 2018 surgery at Sky Ridge, Dr. Smith made small incisions in Collins’ back. Using a series of tubes, he gradually 20
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by Jeannette Moninger
separated the muscles to create a portal to perform the surgery. After the tumor was out, Collins only needed a few stitches and a bandage on the surgical site. “This approach offers many benefits,” notes Dr. Smith. “Because I remove less bone, there’s no need to fuse the spine. Plus, we don’t cut or weaken ligaments and muscles.” As a result, patients typically have a faster recovery with less pain and fewer complications. Collins was walking eight hours after surgery and went home three days later (patients who undergo traditional tumor surgery may spend a week in the hospital). Dr. Smith also performed a minimally invasive spinal fusion surgery to stabilize the spine at the area where vertebrae slipped out of place. Rods and screws keep the spine from shifting. “When I left the hospital, I assumed I had been given a nerve block,” recalls Collins. “I later learned that my lack of pain was due to the minimally invasive nature of the surgeries.” Although the spine tumor wasn’t cancerous, Collins will get regular scans for several years to ensure it doesn’t return. “It’s such a relief to be free of chronic back pain,” says Collins. “I feel fortunate to have received such great care from Dr. Smith and the medical team at Sky Ridge.”
Learn more: skyridgemedcenter.com
COMPLEX BRAIN SURGERY AT SKY RIDGE SAVES LIFE OF CENTENNIAL RESIDENT by Jeannette Moninger
Centennial resident Tomas Martinez went to bed on March 11 with the worst headache he’d ever had in his 36 years. When he woke the next morning, his thoughts were jumbled. “I told him to let his boss know he couldn’t work, and he didn’t recognize her name,” recalls Tomas’ wife, Tatiana. “His comments were scaring me. I knew something was seriously wrong.” By the time the frantic couple reached Sky Ridge Medical Center, Tomas could no longer recall his birthday. Imaging scans revealed that Tomas had a meningioma, a brain tumor that forms on membranes covering the brain and spinal cord. The tumor had hemorrhaged, and blood was irritating and inflaming his brain. In addition, the enlarged tumor blocked the pathway for spinal fluid, leading to a condition known as hydrocephalus, or water on the brain. “People with hydrocephalus can deteriorate quickly due to increased pressure on the brain,” says Dr. Brent Kimball, director of neurooncology at Sky Ridge Medical Center and medical director of CarePoint Neurosurgery. Approximately 48 hours after Tomas entered the hospital, he underwent a five-hour, highly complex brain surgery. “Because the tumor was
located deep inside the brain, the only way to remove it was to make a dime-sized pathway through healthy brain tissue,” says Dr. Kimball, who successfully removed all of the noncancerous tumor. When Tomas awoke after surgery, he had trouble communicating and couldn’t move the right side of his body. “While we try to minimize manipulation of healthy brain tissue, there’s always a risk of post-surgical complications,” says Dr. Kimball. “We expected that Tomas might experience weakness in his right leg and some speech delays. Fortunately, these effects usually go away in a few days.” By the time Tomas moved to a rehabilitation center three weeks later, his speech and movement had significantly improved. After two weeks engaged in intensive therapy designed to improve balance, movement and speech, Tomas regained normal function. “People who undergo brain surgery are eager to return to normal life quickly, which is understandable,” says Dr. Kimball. “I have to remind patients and their loved ones that the brain just went through a major traumatic event. It can take a year or longer to fully recover.” Six months after surgery, Tomas continues therapy to improve his memory and concentration. He bikes daily to build strength and improve motor skills. “It’s frustrating to not be able to do all of the things that once came so easily to me,” says Tomas. “But during my months of recovery, I’ve come to realize how lucky I am that the experts at Sky Ridge were able to save my life, so that I’m still here with my wife and daughter.” Tomas Martinez is back to billiards after the removal of a noncancerous brain tumor and recovery at Sky Ridge Medical Center.
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Living
Life
COACH URGES TAKING STOCK AT MIDLIFE AND CHECKING BACK INTO THE GAME by Maribeth Neelis
Existential angst can strike at any age. But mid-life changes, like health issues, retirement, divorce or an empty nest, often challenge a person’s sense of self and intensify the anxiety. “We have a population of people who have come to see their identity in one way, through their career, their children, their status. Then they wake up one day and realize they have no balance. They don’t exercise or eat well. They’re never in nature,” says Stacey Vicari, life coach and founder of My Ideal Life. The imbalance manifests as guilt, shame, apathy, an inability to have fun, or most commonly, Vicari says, a lack of joy — the abiding internal state of well-being that is not influenced by external factors.
TWO-PART SOLUTION
Vicari’s approach tackles the concrete and abstract aspects of her clients’ imbalance. Practically, she helps people claim boundaries, set limits and delegate responsibilities, so they can refocus their time and energy on relationships, hobbies, exercise, nutrition and personal growth. But it’s also necessary to address the emotional reasons why they have attached so much of their identity to one role, Vicari says. “A lot of what I do is help people look deeply at their sense of value and what means the most to them, so they can begin to recognize they’ve been buying into a story that isn’t working for them, that the person they are being is not who they want to be.”
WRITE IT DOWN
Journaling is one of several tactics Vicari uses with clients to help them make life changes. For instance, Robin LeMastus has found gratitude journaling a powerful tool. Tracking her appreciation for things large and small helps her find harmony
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in hectic days and deal with difficult situations gracefully, says LeMastus, who owns a horse boarding farm. “It’s such a resource for me. After a troubling situation, I write down what about it made me grateful. And surprisingly, there will be something in every situation.” Vicari also suggests asking and answering specific questions, like: What roles do I value most? How much time do I spend doing what I value? What specific steps can I take to spend more time doing what I love? Often, what people value and how they spend their time is incongruous, but they are unaware until putting it on paper, she says.
SET INTENTIONS
Acknowledging there is a limited amount of time with family and friends, Vicari suggests remodeling how that time is spent. Instead of frantically checking tasks off a to-do list, barking orders or zoning out to television, set an intention to spend family time connecting in a meaningful way. Mark Kirchdorfer, a busy CEO, wanted to help his daughters develop confidence. He decided to integrate it into their breakfast routine, asking the girls to say one thing they like about themselves each morning. “At first, it was challenging for them to come up with something,” he says. “But now, they are thinking about what they are going to say the night before. So while they are going to sleep, they are thinking about what they like about themselves.”
MAP IT OUT
Many of Vicari’s clients have trouble envisioning the possibilities. They are dissatisfied with aspects of their lives, but unable to visualize them differently. “Every day, they are stepping into a life that contains so much of what they don’t want,” Vicari says. “A vision map allows them to see what they want and what it will look like, so they can move toward it.” LeMastus, who is practical by nature, says vision mapping encourages her to be imaginative. “I’m not a big dreamer, and this gives me the permission to dream crazily,” she says.
SCHEDULE LIFE
FREE WEIGHT LOSS SEMINARS
For people who have trouble executing their vision, Vicari suggests creating a weekly schedule, something she has done religiously for years. Plan the week, scheduling time to eat, cook, exercise, socialize and be outside. “When you live with that kind of deliberation, what you want will actually happen,” she says. Through her work with Vicari, LeMastus has learned to take guilt-free time for herself rather than letting people and projects dictate her schedule. Creating a plan and maintaining those boundaries has removed the emotional element. “There are no negative emotions involved. Now I have an appointment with you. Then I have an appointment with myself to do yoga,” she says matter-of factly. Vicari says creating your ideal life is simple. Get engaged, plan it out and be contemplative about your actions and how you spend your time. Don’t just let life happen to you. “When we get out of the bleachers and step into the game that is our life and become aware, deliberate and intentional, amazing things start to happen.”
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Surviving One Man’s Fight to Reclaim His Life After A Deadly Infection
by Jeannette Moninger After returning from a European vacation, Mike McKibben initially blamed jetlag for his muscle aches, extreme fatigue and other flu-like symptoms. The 61-year-old Lone Tree resident and his wife, Sue, had a great time in Austria, Switzerland and Germany and even took a cruise on the Rhine River to celebrate their 37th wedding anniversary and Mike’s recent retirement. The couple was looking forward to spending their golden years jet setting around the globe. But on October 2, 2017, just days after his return to Colorado, a high fever and delirium sent Mike and his wife racing to Sky Ridge Medical Center. There, Emergency Department Medical Director Dr. Adam Barkin quickly suspected sepsis. The third leading cause of death in the U.S., sepsis occurs when the body’s immune system becomes overwhelmed with infection. “The body responds by releasing a flood of chemicals to fight germs invading the body,” says Dr. Barkin. “Unfortunately, this response triggers a systemic inflammation that can affect blood flow and damage organs and limbs.” Sepsis affects approximately 1.7 million Americans every year, claiming the lives of 270,000 people. Fast treatment is critical. “Within 30 minutes, the Sky Ridge emergency medical team initiated a sepsis alert protocol,” says Laura Wren, a registered nurse and sepsis coordinator at Sky Ridge. “Mike was given powerful intravenous (IV) antibiotics, as well as IV fluids to help improve blood flow. X-rays and blood and urine samples were taken to determine the cause of the sepsis.” Within a matter of hours, Mike quickly declined and was showing signs of septic shock, the most severe and deadliest form of sepsis. As his heart, lungs, kidneys, liver and pancreas began to fail, the medical team started life-saving measures placing Mike on a ventilator and dialysis. He would remain on life support in the intensive care unit for 10 days. During this time, sepsis ravished his body. 24 24
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“I was told to say my goodbyes on several different occasions.” — Sue McKibben
Sepsis Warning Signs Time is of the essence if you suspect sepsis. For every hour of delayed treatment, the risk of death increases by 8 percent. Watch for these symptoms and call 911 or head to the nearest emergency department. TEMPERATURE: Anything above 100.4 degrees is considered a fever. However, some people with sepsis experience a drop in temperature below 96.8 degrees. INFECTION: Warning signs include fever, fatigue, muscle aches and neck pain. MENTAL DECLINE: The person may seem confused, delirious or sleepy. EXTREMELY ILL: The person may feel like he’s going to die or have severe pain or discomfort. Mike says he felt poisoned.
Battling Infection
Blood cultures showed that Mike had meningococcal bloodstream infection, a rare and dangerous condition caused by the bacteria Neisseria meningitidis. The bacteria spreads through respiratory secretions. An estimated 10 percent of people are carriers, meaning they have the bacteria in their noses and throats, yet never experience health problems. Doctors aren’t sure where Mike was exposed: during his overseas trip or in the U.S. Although Sue felt under-theweather after their vacation, she never got as sick as her husband. As the bacteria and toxins in Mike’s bloodstream rapidly multiplied, his health continued to deteriorate. “I was told to say my goodbyes on several different occasions,” says Sue. The septic shock caused another complication, a condition known as disseminated intravascular coagulation (DIC). “Patients with DIC develop a lot of blood clots and can ultimately experience bleeding when clotting factors are depleted,” says Dr. Barkin. The clots, along with high doses of certain necessary medications, further compromise blood flow to organs and extremities. Soon, Mike’s fingers, toes, nose and ears blackened, a sign of tissue death. To give Mike the best chance at keeping as much of his digits and limbs as possible, Sky Ridge doctors transferred him to the burn intensive care division at Swedish Medical Center. Here, wound care experts provided therapies to minimize tissue damage. Unfortunately, Mike would still lose every finger except for his right thumb, all of his toes and the tip of his nose. By the time Mike awoke six weeks later on November 12, he had lost 40 pounds and his muscles had weakened. He spent the next five months at a rehabilitation center rebuilding his strength and learning how to walk without toes that help you balance and how to dress and eat using hands that no longer had fingers. One year later, Mike still participates in weekly rehabilitation services. Because his kidneys never recovered, he undergoes a fourhour hemodialysis process three times a week and recently was placed on the wait list for a kidney transplant. Throughout his ordeal, Mike has remained upbeat. “I can still do pretty much everything I did before I got sick. The fact that I’m still here and able to do these things is due to the fast actions taken at Sky Ridge,” he says. “I’m thankful to be here and look forward to getting even stronger so I can go on more trips with my wife.”
Mike and Susan McKibben surrounded by some of the Sky Ridge Medical Care Team
Lower Your Risk of Sepsis Certain populations are more at risk for sepsis, including infants and children, adults over 65 and people with impaired immune systems or medical conditions, such as heart disease, diabetes and cancer. Sky Ridge Medical Center sepsis coordinator, Laura Wren, R.N., recommends these steps to lower risk: GET VACCINATED: Vaccines offer protection against meningococcal disease. CDC recommendations include: • Preteens: Meningococcal conjugate vaccine given between ages 11 and 12, with a booster at age 16. • Teens: Serogroup B meningococcal vaccine given between ages 16 and 18. • Adults: Meningococcal conjugate vaccine and serogroup B meningococcal vaccine if you have a damaged or missing spleen, are traveling to a country where the disease is common or have other risk factors. FEND OFF RESPIRATORY INFECTIONS: Infants, children and the elderly who get influenza or pneumonia have a higher risk of sepsis. These vaccines can help: • Flu vaccine: This vaccine is recommended for children ages 6 months and older. Because the immune system weakens with age, a higher-dose flu shot is available for adults over the age of 65. • Pneumonia vaccine: The pneumococcal conjugate vaccine is recommended for all children younger than 2 years old and all adults ages 65 and older. The pneumococcal polysaccharide vaccine is recommended for all adults ages 65 and older, as well as people ages 2 to 64 with certain medical conditions or adults ages 19 to 64 who smoke. PREVENT INFECTIONS: Thoroughly wash all wounds with soap and water, apply antibiotic ointment and cover with a bandage. Watch for signs of infection, such as redness, yellowish discharge, pain and swelling. PRACTICE GOOD HAND HYGIENE: Wash hands thoroughly with soap and warm water for 20 seconds after using the toilet and before eating or preparing food. Sneeze and cough into the crook of your elbow (not hands!) and use hand sanitizer when you’re on the go.
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EMERGENCY ROOM
BASICS
WHEN TO VISIT THE ER AND WHAT TO DO BEFORE YOU GO by Joelle Klein When you or a loved one is in pain or just had an accident, it’s easy to get stressed and confused about what to do. Dr. Adam Barkin, emergency department medical director at Sky Ridge Medical Center, offers expert advice on how to care for common injuries until you get to an emergency room.
PAIN
Barkin says the majority of visits to the ER are because of pain. “Pain is an emergency because no one wants to suffer,” he says. “And there’s always the concern that it could be something serious.” In general, Barkin recommends taking ibuprofen or acetaminophen to help reduce most types of pain including toothaches, muscle sprains, and even burns.
BROKEN BONES
If you think you fractured or broke a bone, or suffered more than a simple sprain, you should seek medical care at an ER. There, they can take x-rays and stabilize it with a splint or cast, if needed, all in one place. But, until you reach the ER, try to elevate it and stabilize it with a makeshift splint, if possible. Icing and minimizing movement as much as possible can help manage the pain.
Pictured left: Dr. Adam Barkin
CUTS AND GASHES
First step: stop the bleeding. To accomplish that, Barkin suggests covering the wound with gauze or some type of dressing and applying gentle, consistent pressure for about five to 10 minutes. Once the bleeding stops, clean it. “Cleaning can be as simple as running it under water to get out the dirt and debris from the cut itself,” says Barkin. Then cover it with a bandage until you can see a medical professional to suture it, if necessary. Ideally, you want to get the wound cleaned up and sutured within six to eight hours after the injury to reduce the risk of infection.
OBJECTS INSIDE THE BODY
“We see foreign objects in basically any hole that someone can put something in,” says Barkin. Whether it’s a fly trapped in someone’s ear or a pencil shoved up a kid’s nose, these may sound a tad humorous at first, but they can be incredibly distressing for people. If you can clearly see the object, you may be able to grasp it with your hands or a set of tweezers. If the item proves too challenging to extract, Barkin says they have several special devices in the ER to safely remove objects without causing harm.
ABDOMINAL PAIN
If you suspect your pain is due to something you ate or drank, try an antacid such as Tums or Maalox. If the distress persists or gets worse, seek medical attention. In the meantime, don’t eat or drink anything until you receive a medical evaluation. “Abdominal pain can be due to a whole host of problems and some of which would require surgery,” Barkin explains. If you end up needing anesthesia for a surgery, having food in your stomach can cause you to vomit.
SNAKEBITE
Rattlesnake bites are fairly common in Colorado, says Barkin. While you may have heard that you should suck out the venom or place a tourniquet above the bite to prevent the venom from spreading, Barkin says, don’t. You should get off the trail as quickly as possible and, once in the car, elevate your leg, ice it if possible, and get to an ER quickly.
BURNS
MORE EXPERT ADVICE It’s important to have someone else drive you to the ER, says Barkin, because your pain or emergency may compromise your driving ability. Similarly, he says he would never discourage anyone from visiting an ER if they have health concerns. “It’s very difficult to tell what’s an emergency and what’s not an emergency before you have some sort of evaluation by a healthcare professional,” Barkin says. “That’s why emergency departments are available and open 24 hours a day.”
Burns can be painful immediately after the incident and up to 24 hours afterward. The first thing you can do to relieve this pain is to apply ice or run the burn under cool water. Next, apply an antibiotic ointment like bacitracin, and cover with gauze. Follow up by applying ice for 20 minutes on and then 20 minutes off. Never apply the ice directly on the skin, Barkin says. Always keep a barrier like a towel or cloth between the ice and the burn.
MARIJUANA-RELATED PROBLEMS
When it comes to marijuana, one of the biggest problems Barkin sees these days is when a kid ingests an edible product. “If you have edibles or any other form of cannabinoids in the house, it’s crucial that you keep them away from anywhere a child could access them,” he warns. Barkin says, if you know your child ingested an edible and is not acting normally, it is best to transport to the ER for observation. There may be other serious causes for this behavior as well, including head injuries, infection or other ingestion.
CHEST PAIN
In the case of chest pain, Barkin suggests not to wait. Seek medical care quickly. Although, statistically, chances are you’re not having a heart attack, it’s very hard to diagnose without diagnostic tests. And because of the serious nature of what chest pain can mean, just go to the ER.
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Get Into Ski Shape with a Barre Workout Ballet-inspired workout helps Olympic skier bounce back by Courtney Messenbaugh
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The 2014 Olympic Games in Sochi, Russia marked the first year that the halfpipe for freestyle skiers was an official Olympic event. The U.S. Olympic Team had four skiers poised to land big finishes in this new event, and one of them was Boulder’s own Lyman Currier, a 19-year-old freestyle pioneer. Unfortunately, for Currier, it was not meant to be. Currier fell during a qualifying round, blew his left ACL and with it, his chances for a bronze, silver or gold. In the years to follow, his ACL problems continued, knocking him out of contention for the 2018 Olympic Games.
Olympic skier Lyman Currier is now a barre-workout regular. He is photographed (left) at The Bar Method in Boulder with owner Amy Chesterton, demonstrating one the many exercises that have had a big impact on his ACL recovery and ski readiness. Lyman Currier (above) performing at the 2016 World Cup finals in Tignes, France. Photo by Andrew Woods
Frustrated, Currier knew something in his training and recovery needed to change. Then, his girlfriend suggested he try a barre class, a ballet-inspired fitness class named after the stationary handrail that’s used extensively in ballet training. “During my first class I quickly realized it was not going to be a breeze,” Currier says, “After struggling through, I almost immediately felt more flexible, but the next day I was more sore than I had ever been, and in places I didn’t even realize I had muscles!” Barre-based workouts have quietly been whipping people into shape for years and are growing in popularity. “I’ve got more stamina, am stronger, and more flexible than I’ve ever been,” Currier says, after becoming a regular at The Bar Method in Boulder. The company has locations from coast to coast.
HOW IT WORKS
“The Bar Method surprises people with how transformative it can be. And, it’s a great place for people with injuries to come and safely rebuild strength and flexibility.”
“The Bar Method surprises people with how transformative it can be,” says Amy Chesterton, owner and instructor at The Bar Method in Boulder. “And, it’s a great place for people with injuries to come and safely rebuild strength and flexibility.” Chesterton describes the one-hour workout as a fat-burning, ballet-inspired conditioning, with light weights and many repetitions of small, isometric movements that lengthen and tone muscles. The barre workout is particularly good for getting in ski shape since skiing is a sport of strength, balance, stamina and flexibility. To be done well, it requires the diligent cooperation of the quadriceps, hamstrings, gluteals, back and core muscles. She says barre fitness classes address all of this in addition to building endurance through the lighter weight and higher repetitions formula. “The key is that you’re building strength and stamina without compromising your joints,” Chesterton says.
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RESULTS FOR WOMEN AND MEN
Usually, barre classes are populated by women, but more men are signing up. The latter are often shocked by how hard they have to work to keep up. Six months after his start, Currier says he’s still challenged by every class he takes and the results are tangible. He visited the Olympic training center in Utah a few months ago and blew the trainers away by scoring higher than he ever had across all of their standard strength tests. Currier says he’s more flexible than he’s ever been, has more stamina to stay on the mountain, and has gained several pounds of muscle mass thanks to the body weight resistance and high repetition, low weight routine at The Bar Method. Even his Olympic trainers have developed a new regimen for him that involves regular barre classes, cardiovascular exercise, and agility training. Currier says he’ll never lift another heavy weight again.
HITTING THE SLOPES
Currier knows there’s a long road still ahead of him, but he’s looking to the 2022 Olympics for redemption. His enthusiasm for The Bar is infectious and he’s encouraging his friends on the USOT to try it as well. Whether you’re male, female, Olympian, or novice, hitting the barre could be a worthwhile effort for anyone looking to level-up their fitness routine and get into ski shape.
FIND A BARRE NEAR YOU
Barre-inspired fitness workouts are available around the metroDenver area, such as at The Bar Method, Pure Barre and barre3.
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INTRODUCTION TO BARRE POSITIONS Are you new to barre or curious about what to expect at your first class? Here are a few moves to help you get acquainted with what a barre workout entails. The Chair strengthens and stretches the quadriceps and works upper and lower back muscles. With a vertical back, activated core muscles, and 90-degree kneeto-ankle alignment, lower and raise seat with small, controlled movements for 90 seconds.
The Legs Together Thigh is good for lower body. Lift heels to recruit the tiny muscles around the knees for stabilization, lift chest, and roll shoulder blades down to encourage good posture. Over the course of two and a half minutes, move up and down, engaging the thighs to build comprehensive lower body strength and overall alignment.
The Waterski Seat is terrific for building muscles used in skiing. Grip and tuck gluteals to do micro leg lifts, one leg at a time. The position engages the full body working the gluteals, hamstrings, and all core muscles for five minutes.
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TRANSPLANT PATIENT GETS A FRESH START by Andrea Juarez
Aurora resident Sal Sandoval underwent a kidney transplant in April 2018 after years of struggling with a rare kidney disease; his new kidney was donated by his wife Nancy.
P/SL Transplant Center Is Top Notch Turning 50 years old can be meaningful to people for many reasons: for some it is a time to be reflective and for others to look forward. For Sal Sandoval, an Aurora resident and recent kidney transplant patient, it’s a bit of both. “This year’s been like a rebirth, like I’ve gotten a new life and get to start fresh again,” says Sal, who turned 50 in April. In 2010, Sal’s life and health took an unexpected turn after attending a health fair screening. He learned he had high blood pressure and was immediately referred to a doctor who, after many tests, determined that he had focal segmental glomerulosclerosis, or FSGS, a rare disease that causes serious kidney damage.
Three years later Sal was diagnosed with stage 2 kidney damage and by 2017 he was at stage 4. By the spring of 2018, his doctors at Presbyterian/St. Luke’s Medical Center (P/SL) recommended he undergo a transplant soon, rather than wait until he had to go on dialysis. With a kidney donated by his wife Nancy, Sal had a transplant at P/SL’s Kidney Transplant Center in April 2018.
P/SL LIVING DONOR CHAMPION PROGRAM
“Before his transplant, I saw his health declining: I saw him struggle to put on his boots, to be tired and cold, to see his frustration with his foggy mind,” says Nancy. “It was a huge weight off my shoulders when I was told I could be his donor.” Most patients in need of a transplant don’t walk in with a living donor like Sal did, says Dr. Vidya Bhandaram, Kidney Transplant Medical Director at P/SL. “It can be an awkward situation to ask a loved one or anyone for an organ,” Bhandaram says. So, P/SL created the Living Donor Champion Program to help. How does it work? Patients identify a friend or family member to be a champion and that champion will learn about organ donation from living donors, as well as ways to spread the word and to make “the ask.” This unique program at P/SL is run by a physician and social worker who provide the medical and resource knowledge to support the patient and champion through the transplant process, including finding a donor and even fundraising. “Had my wife not been a match, we would have been involved with the Living Donor Champion Program,” says Sal. “We appreciated having a plan in place in case it didn’t work with my wife. The program is top notch.” Notably, organ donation from living donors (rather than deceased donors) is preferred. “Donations from live donors have improved results,” says Bhandaram. “Generally, they last twice as long, and have much less risk of complications.”
Dr. Vidya Bhandaram
Dr. Clark Kulig
Dr. Marklyn Jones
“We appreciated having a plan in place in case it didn’t work with my wife. The program is top notch.”
About the P/SL Transplant Center For patients who are deciding where to have a transplant, Sal says the P/SL Transplant Center came highly recommended. It’s an approved United Network for Organ Sharing (UNOS) program and the kidney and liver transplant team has performed more than 2,700 transplant surgeries to date. The Kidney Transplant Center also stands out because it was one of only 53 centers in the U.S., and the only one in Colorado, to receive a 5/5 score by the Scientific Registry of Transplant Recipients (SRTR) in 2017 for outstanding patient and graft survival rates.
Dr. Tom Heffron
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P/SL Excels at Liver Transplants Too Cross Blood Transplants Another service attracting transplant patients to P/SL is its cross-blood transplant program led by Dr. Tom Heffron, Transplant Surgeon and Surgical Director of the Transplant Program. Used primarily with liver transplants, Heffron is one of just a few doctors in the country performing transplants on a routine basis across blood groups for adults and children. Sal and Nancy Sandoval are both doing well after Sal’s kidney transplant was performed at P/SL’s Transplant Center in April 2018. Nancy’s kidney was removed via a minimally-invasive robotic donor nephrectomy surgical procedure. Sal took part in the Steroid-Free Protocol, an after-transplant treatment plan.
RARE SURGICAL TECHNIQUE FOR KIDNEY DONORS
Generally, a recipient receives a transplant from an organ donor with the same blood group or a compatible blood group. But frequently, Heffron says, patients become very sick while waiting for a donor organ with matching blood type.
Many kidney donors and recipients, such as Nancy and Sal, are concerned about the well-being of donors who generously agree to give their kidneys. Fortunately, Dr. Marklyn Jones, Living Donor Surgeon at P/SL, specializes in robotic donor nephrectomies, a minimally invasive procedure in which the kidney is removed using a state-of-the-art robotic surgical system. “The instruments we use allow for complex and intricate dissections,” Jones says. With this surgery, donors experience decreased blood loss, reduced risk of a blood transfusion, a shorter hospital stay, decreased pain and recovery time, and are able to return to work sooner. Nancy went back to work just two and a half weeks after donating her kidney to her husband. Jones says P/SL is the only program in the Rocky Mountain region and one of the few in the nation performing robotic donor nephrectomies.
“To increase a liver patient’s likelihood of receiving an organ, I list for all blood groups,” Heffron says. “People have an excellent survival rate with cross blood transplants.”
STEROID-FREE PROTOCOLS
“Liver disease is sneaky. Many people don’t even know they have hepatitis C since they don’t exhibit any symptoms,” says Dr. Clark Kulig, a Transplant Hepatologist with P/SL. “Our team helps patients manage their medical problems and the reoccurrence of liver disease, since the virus comes back even with a new liver.”
After his transplant, Sal took part in P/SL’s Steroid-Free Protocols (SFP), an after-transplant treatment plan with minimal risk to eligible candidates that minimizes patients’ reliance on prednisone, an immunosuppressant drug used to prevent the body from rejecting an organ transplant. With SFP, Sal was on steroids for just three days after surgery, whereas most transplant patients take prednisone for the rest of their lives, explains Bhandaram. She says they frequently suffer long-term side effects such as weight gain, new onset diabetes, osteoporosis, skin changes, gastritis and hypertension fluid retention, as well as emotional disturbances. “SFP is an important choice we give our patients,” Bhandaram says. “There are only a few places in the country that do this.”
LOOKING FORWARD
“We wake up every day and move forward,” says Nancy. “I know he is going to be in my life and I’m so grateful to help save the person who means the most to me in the world.” Five months after Sal’s kidney transplant, he says all is well for him and Nancy. They are planning their future and getting settled into a new home. “After my transplant I felt so incredibly well. My head was clear, the swelling was gone, and I wasn’t tired,” Sal says. “I think we’re going to really celebrate my next birthday.”
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Hepatitis C Treatment Likewise, P/SL has a team of medical experts that specialize in treating patients with hepatitis C, a viral infection that causes liver damage and frequently liver failure, which requires a liver transplant.
Kulig and his team treat hepatitis C patients at different stages of liver damage before and after a liver transplant. Kulig and the Centers for Disease Control recommend that people born between 1945 and 1965 get screened. A simple blood test can determine whether you have hepatitis C. Through early detection and treatment, liver damage and scarring can be minimized, and in some instances, people can even be cured.
Learn more: www.pslmc.com/transplantcenter | 720-754-2155
SPINE SURGERIES LIFE-CHANGING FOR PEOPLE OF ALL AGES | by Jeannette Moninger
Spinal problems can affect anyone. Some spinal problems are present at birth, others develop gradually over time, and sometimes the pain seems to come out of nowhere. Regardless of the cause, the many board-certified spine specialists at Denver International Spine Center (DISC) at Presbyterian/St. Luke’s Medical Center have the expertise and technology to help. In this article, three doctors and their patients share their stories about tumors, scoliosis, and chronic back and neck pain, and how spine surgery at DISC helped them regain their activities and lives. Health Profile •
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FOR SPINAL TUMORS
Dr.Timothy Kuklo and Joyce Hanson
Joyce Hanson has always been active. The 60-year-old Littleton resident hikes, bikes, skis, and practices yoga and Pilates. But one October morning in 2013, Hanson woke up to excruciating back pain. “I hadn’t done anything out of the ordinary that might have affected my back,” recalls Hanson, who tried (and failed) to make it through the work day. X-rays taken at a nearby hospital indicated degenerative disc disease. For a year, Hanson tried to manage the pain with a combination of massage, steroid shots, Pilates and reflexology. Nothing helped. Seeking relief, Hanson sought the services of DISC co-director and spine surgeon Dr. Timothy Kuklo. An MRI revealed a tumor inside Hanson’s fifth lumbar vertebra. While a biopsy showed that the tumor wasn’t cancerous, it was pressing on nerves and causing Hanson’s pain. Hanson underwent surgery in November 2014. “We had to remove parts of bone from the spinal column in order to reach the tumor. Unfortunately, the spine becomes less stable,” says Dr. Kuklo. To give Hanson’s back more support, Dr. Kuklo performed spinal fusion surgery. This procedure uses rods and screws to create an internal cast that supports the vertebrae. Over time, bone grows around the rods and screws, providing even more spine support. Following the surgery, Hanson’s severe back pain was gone. “I was biking short distances by spring and back on the slopes one year later,” she says. Hanson continues to do exercises to keep her core strong. “I watch my granddaughter, Jane, a few days a week. I have to be able to keep up!” Hanson’s recovery has gone remarkably well, says Dr. Kuklo. “It’s unfortunate that spinal surgery has developed a negative connotation,” he says. “When done for the right reasons and done well, this surgery can be life-changing.”
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“I was biking short distances by spring and back on the slopes one year later. I watch my granddaughter, Jane, a few days a week. I have to be able to keep up!”
Meet DISC, Denver International Spine Center Front row (Left to right): Dr. Timothy Kuklo, Dr. Woosik Chung, Dr. Shay Bess Back row (Left to right): Abby E Leishman, PA-C; Audra Braun, PA-C; Katey Dorweiler, PA-C; Kandice Robinson, PA-C; Jaime Vieira, PA-C; Brittany D’Orio, PA-C
FOR CHRONIC LOWER BACK & NECK PAIN Dr. Woosik Chung and Neale Heywood
Neale Heywood, a guitarist for Fleetwood Mac, first injured his back when he was in his 20s after lifting a heavy piece of equipment. Chronic back pain would plague Heywood for the next 30 years. In 2011, while preparing for a performance at Red Rocks Amphitheater, Heywood’s pain became too much to bear. “I was in agony every time I slung the guitar strap over my head. I had to back out of a European tour,” he says. It was while he was in Colorado that Heywood first heard about Dr. Woosik Chung, a spine surgeon at DISC.
“Dr. Chung saved my ability to play and gave me back the ability to enjoy life.”
FOR SCOLIOSIS
Dr. Shay Bess and the Leong family
Amy and Andy Leong, of Colorado Springs, didn’t plan to adopt two children from China with severe scoliosis, or curvature of the spine. “When we adopted 19-month-old Moriah in 2008, we knew she had some medical issues, but scoliosis wasn’t mentioned in her files,” says Amy.
“As a surgeon, I technically knew how to correct Moriah’s scoliosis, but it was important to make sure that the timing was right for her unique situation.” Once they had a correct diagnosis for Moriah, the family sought help from nationally recognized scoliosis expert and DISC spine surgeon Dr. Shay Bess. “Spinal fusion surgery can correct the curvature, but it stops the spine from growing and can impair lung development in young patients,” says Dr. Bess. “For this reason, we like to hold off on surgery to give a child more time to grow to allow for more lung maturity.” While the Leongs were waiting, the adoption agency contacted them about a 9-year-old boy from China whose scoliosis was so severe (more than 120 degrees) it was affecting his heart and lungs making breathing difficult. “We adopted Josh in March 2012, and Dr. Bess performed spine surgery four months later,” says Amy. It would be another five years before Moriah would have her surgery. “As a surgeon, I technically knew how to correct Moriah’s scoliosis, but it was important to make sure that the timing was right for her unique situation,” says Dr. Bess. Technology involving 3D spine models had advanced greatly since Josh’s surgery. “With Moriah’s surgery, we were able to have a sterilized 3D model of her spine in the operating room to reference,” says Dr. Bess. “These 3D models help the surgical team to better prepare for the procedure and anticipate potential problems. While in the operating room, we can refer to the model to improve and modify our surgical approach.” Today, both kids are standing straighter and participating in many activities. Josh runs track and plays basketball, while Moriah has taken up ballet. “Not every child with scoliosis will need spine surgery,” says Dr. Bess. “But for kids like Josh and Moriah, surgery can greatly improve quality of life.”
Images revealed a severe shifting of vertebrae, a condition known as spondylolisthesis, as well as herniated, or ruptured, discs. “His lower spine had essentially collapsed. As a result, the nerves were severely compressed leading to pain and numbness on the left side of his body,” says Dr. Chung. Heywood underwent spine surgery to repair collapsed discs and free up space for spinal cord nerves. Spine fusion surgery helped to structurally stabilize his spine. Heywood took off a year from playing to focus on recovering, and then he went back on tour. In 2016, Heywood was back at Dr. Chung’s office with complaints about neck pain and stiffness. Herniated discs were yet again to blame. Instead of doing a fusion surgery, Dr. Chung performed cervical disc replacement surgery using artificial discs, a type of mechanical device, to replace the damaged ones. This minimally invasive approach requires no screws or bone fusing, thereby helping to preserve range of motion for the entire spine. The recovery also tends to be easier. Just a few days after surgery, Heywood went hiking in the mountains. “Dr. Chung saved my ability to play and gave me back the ability to enjoy life,” he says. You can catch Heywood in action with Fleetwood Mac at the Pepsi Center on Monday, December 3.
Learn more: discspinesurgery.com | 303.762.3472
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LARA
MERRIKEN Colorado’s LÄRABAR Founder Talks Food, Health & Entrepreneurship Story by Andrea Juarez | Photos by Mark Woolcott
Little did Lara Merriken know that a Cuisinart, a rolling pin and some bags of fruits and nuts, mixed in with some curiosity and “grit” would turn her idea into a multimillion-dollar business. Merriken is the founder of LÄRABAR — the energy bar that was born in a lightbulb moment on a hike in the Rocky Mountains. Minimally processed and made from just a few ingredients, her bars took the market by storm when they were introduced in 2003. Fifteen years later, the company, now owned by General Mills, with Merriken still involved, is going strong. In this one-on-one with Merriken, the Colorado athlete turned social worker turned food entrepreneur talks to Colorado Health & Wellness about her journey and how her health, food, and giving back motivate and keep her on point.
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Tell us about your ties to Colorado.
I was born in California and grew up in Denver in the Congress Park area. I went to Kent Denver for high school. Although I left a few times, I’ve always come back because Denver is such a great place to live. You’ve spoken publicly about your wheat allergy. How did it change you?
In my early 20s, I was getting migraines all the time and I found out I was really allergic to wheat. In the early 90s it was tough but I felt so much better not having it in my diet that I was really motivated to keep it out. I learned about foods that are now normal — like quinoa, kale and chard. I had a very specific diet at the time and I had to cook my own foods and stop eating out. I really wasn’t someone who liked to cook very much but I learned to do it. How did food and nutrition change your career path?
I got so passionate about natural foods that I really wanted to do something in the field. My degree from USC was in psychology. Ironically, I started out as a business major. I stopped because I didn’t like the finance classes. Then, I ended up as a psychology major and I worked as a social worker with at-risk kids; that was my first career. All the kids would always tease me and say, “You eat the weirdest food Lara.” Around my 30th birthday, I wanted to take a leap of faith and go back to school; I thought I’d get into naturopathic medicine, acupuncture and nutrition. I got accepted into a program in Seattle and was three months away from moving there. Then, on a hike, the idea for LÄRABAR came. It was an inspiration and I decided to follow it. Tell us more about that inspiration for LÄRABAR.
(Above) Coloradan Lara Merriken’s diet restrictions ignited a passion for natural foods, which led to the creation of the energy bar company LÄRABAR. This year the company is celebrating 15 years on the market. (At right) Merriken, at her Denver home in July 2018, holds one of her chickens.
I came up with the idea on Memorial Day weekend in 2000 on a hike. I thought to myself: Why hasn’t someone made something really clean and healthy that tastes delicious and indulgent, like my junk food past like cherry pie, apple pie? So, I started blending concoctions like fruit and nuts in my Cuisinart at home, rolling them out and test marketing with my friends. That’s how I made the transition and I just jumped into it. How did you get your bars into stores?
While I was toiling on recipes in my kitchen, I got a job at Whole Foods opening their store in Cherry Creek so I could be around the business and so I could figure out how to make my plan work. I spent three years working there, then one day a key buyer from Austin was in the store. I seized the opportunity and talked to him. I ran home to get my samples that were in a salad bar takeout box. It didn’t look like anything official but he tried them and told me it was one of the most innovative products he tried in a long time and he offered for me to bring them into the Colorado stores when I was ready. That was sure motivation for me. Fast forward nine months, I met the Natural Grocers’ marketing person at a bike event where I was sampling my product. In 2003, when I was ready, I launched at both stores within the same week. What were LÄRABAR’s first flavors on the market?
Cashew Cookie, Cherry Pie, Apple Pie, Banana Cookie, and Chocolate Coconut Chew were my first five flavors and they are still available today.
WHEN DID YOU BECOME SO HEALTH CONSCIOUS? I was a walk-on volleyball player at the University of Southern California, and I played Division I volleyball. My coach had a rule of no sugar and no red meat. That experience at 18 was real education about healthy eating. He did it for performance purposes. I realized I felt better and it began my journey to healthier living and healthier eating. That was where the seed got planted. 40
TELL US ABOUT YOUR INVOLVEMENT WITH DENVER URBAN GARDENS? I’ve had a relationship with them for over 20 years: When I was a social worker I started a community garden at Gray Street and now I’m on their board. Obviously, I’m passionate about food — healthy food — and access to it. Teaching people how to garden and grow their own food is very empowering. I believe in the organization and it’s a natural fit for LÄRABAR to be involved with DUG, supporting the city where its roots are.
What is the LÄRABAR philosophy? If it has one?
We want to offer great healthy options for people. Personally, I wanted to do something to make the world a better place. This is my way of doing that. I can’t solve all the world’s problems but I can contribute in a positive way. That was my vision. That, and to make something anybody would love, not just the extreme health food consumer. I wanted it to be fun, approachable, enjoyable, delicious, satisfying — something that a mainstream consumer would say, “Wow, this is great.” What’s your role in the company now that Small Planet Foods division of General Mills acquired the company in 2008?
I am the founder and creative director advising on strategy and vision of the brand. I’m also still the face of the brand. When I sold to them I didn’t know 10 years later I’d still be working with them since I only had a commitment for a year. General Mills valued and understood what I was about and it’s been a really positive relationship. How has LÄRABAR evolved over the years?
It started as fruit and nuts bars; then we added nuts and seeds, which are crunchy and chewy bars; and recently we’ve added fruit and greens bars, which are lighter and inspired by smoothies. People want variety, different tastes and textures, experiences. We want to offer that to them. Are you still involved in creating flavors?
I have my hand in it very loosely. There’s a team who does that now but I give them my feedback. What’s something you did for yourself after selling the company?
I went to culinary school in Los Angeles after I sold LÄRABAR. I also took professional chef and professional baking programs and later a plantbased course and learned bread baking with spelt and gluten-free flowers. I am still very passionate about food so I cook for fun. I have a culinary group and we cook cuisine from around the world. What are you doing for your physical health these days?
I play a lot of tennis and high intensity strength train, which includes boxing. I also love to hike when possible. I got into tennis a few years ago and I love it. I like the intensity of being an adult, not knowing what you’re doing, and learning. I think it’s good for the brain and it’s active. That’s one of my big passions.
A LOT OF LÄRABAR FLAVORS USE DATES, WHY? I realized early on dates were kind of magical. They are a fruit full of fiber and good things. They kept the bar together and created a lovely sweetness and great balance for flavors like tart cherries in Cherry Pie.
What’s your favorite LÄRABAR?
My all-time favorite is Cashew Cookie and my second favorite is Cherry Pie.
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At Swedish, Robotic Technology Helps Surgeons & Patients BY JEANNETTE MONINGER
The words “robotic surgery” might conjure up images of a Jetsons-era robot operating on a human. The reality, though, is a little less space-age and a lot more sophisticated. Here, Dr. Juan Montoya and Dr. Kevin Davis, surgeons with the Surgical Robotics Institute at Swedish Medical Center, share how they use the latest robotic technology to perform minimally invasive procedures that are safer for patients and lead to faster recoveries.
Dr. Juan Montoya is a urologist and surgeon at Swedish Medical Center who specializes in treating prostate and kidney problems using robotic-devices for improved patient results.
WHAT IS ROBOTIC-ASSISTED SURGERY?
Robotic-assisted surgery enables doctors to perform operations through several small incisions with the aid of robotic tools. The robotic device looks something like a crab with several arms, says Dr. Davis, a board-certified OB-GYN and oncologist with Rocky Mountain Gynecologic Oncology. “A surgeon controls the robotic arms using hand grips and foot pedals from a seated position in front of a computer console,” he says. One of the robotic arms has a very small 3D camera that provides a 360-degree high-definition view of the surgical area inside a patient.
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The other arms contain tiny, dime-sized surgical instruments. “The surgeon is still very much the one controlling the instruments and performing the operation,” says Dr. Davis. “The device enables a surgeon to perform laparoscopic surgery through smaller incisions, which causes less trauma to a body and less blood loss.” Because the operating arms of the robotic device are so much smaller than human hands, surgeons are able to perform highly complex procedures within confined areas of the body without the need for large incisions.
WHAT IS THE SURGICAL ROBOTICS INSTITUTE?
The Surgical Robotics Institute at Swedish Medical Center is comprised of three operating rooms and an inpatient unit dedicated solely to patients undergoing robotic-assisted procedures. Specialized nurse navigators work with these patients and their loved ones throughout the surgical process and recovery. The Institute’s operating rooms feature the latest robotic technology, the da Vinci® Xi Surgical System. Surgeons use this system to treat urological, gynecological and cardiothoracic conditions. The system is also used in general procedures to remove the appendix, gallbladder, spleen and other organs.
TREATING GYNECOLOGIC CONDITIONS
Since 2006, Dr. Davis and his colleagues Dr. Mary Jo Schmitz and Dr. Pamela Stone have successfully performed more than 2,000 gynecologic surgeries using the da Vinci system. “Before this innovation, surgery to remove uterine cancer or noncancerous pelvic masses involved cutting from the navel to the pubic bone,” says Dr. Davis. “Recovery could take six weeks or longer.” Now, women get three to four inch-size incisions that are closed with dissolvable stitches and surgical glue. “Patients typically go home within 24 hours after the procedure and resume normal activities within a week or two.” Doctors Davis, Schmitz and Stone also use the robotic system to perform hysterectomies and to treat endometriosis.
“Patients typically go home within 24 hours after the procedure and resume normal activities within a week or two.” TREATING UROLOGIC CONDITIONS
In 2017, Swedish Medical Center introduced the Center for Advanced Urologic Surgery, which is part of the Surgical Robotics Institute. Here, physicians such as Dr. Montoya, a urologist and surgeon, use robotic technology to treat prostate and kidney problems. Since 2003, Dr. Montoya and his colleagues have performed more than 4,000 robotic-assisted urologic surgeries. “Robotics enable us to remove a man’s prostate through tiny incisions without risk of damaging the neurovascular bundle,” says Dr. Montoya. “This approach lowers a man’s risk of developing urinary incontinence and erectile dysfunction.” The robotic device also helps surgeons remove just the cancerous part of a kidney, leaving most of the kidney intact and functioning. Surgeons also can perform a procedure called pyeloplasty to remove an obstruction that prevents the kidneys from draining properly. “Robotic technology greatly elevates the level of care we can provide patients,” says Dr. Montoya. “Studies show that the surgical outcomes are just as good as traditional surgery, while the benefits of minimally invasive procedures are much greater.”
WE WE WE SWEDISH SWEDISH SWEDISH DENVER DENVER DENVER DENVER HEART HEART HEART HEART IS NOW IS ISNOW IS NOW ON NOW ON THE ON ON THE THE THE SWEDISH SWEDISH SWEDISH SWEDISH MEDICAL MEDICAL MEDICAL MEDICAL CENTER CENTER CENTER CENTER CAMPUS. CAMPUS. CAMPUS. CAMPUS. Denver Denver Denver Denver Heart Denver Heart Heart Heart is aHeart practice is isisaaapractice practice ispractice aof practice established of ofofestablished established established of established Denver-area Denver-area Denver-area Denver-area Denver-area cardiologists, cardiologists, cardiologists, cardiologists, cardiologists, that that that thatthat makemake make make their make their their patients’ their their patients’ patients’ patients’ comprehensive patients’ comprehensive comprehensive comprehensive comprehensive heartheart heart care heart heart care a care care priority. care aaapriority. priority. priority. aDenver priority. Denver Denver Denver Heart Denver Heart Heart Heart Heart offers offers offers offers a wide offers aaawide wide range wide a wide range range range of cardiovascular range of ofofcardiovascular cardiovascular cardiovascular of cardiovascular care,care, care, treating care, care, treating treating treating patients treating patients patients patients with patients with heart with withwith heart heart heart heart disease, disease, disease, disease, congestive disease, congestive congestive congestive congestive heartheart heart failure, heart heart failure, failure, failure, hypertension, failure, hypertension, hypertension, hypertension, hypertension, arrhythmias arrhythmias arrhythmias arrhythmias arrhythmias and other and and andother and other other other heartheart heart and heart heart vascular and and andvascular and vascular vascular conditions. vascular conditions. conditions. conditions. conditions. The practice The The Thepractice The practice practice welcomes practice welcomes welcomes welcomes welcomes new new patients new newnew patients patients patients patients and they and and andthey and they are they proud they are are areproud proud are proud to proud serve to totoserve serve the serve to serve Denver the the theDenver Denver the Denver area Denver area at area area three area at atatthree three locations. three at three locations. locations. locations. locations.
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Learn more: swedishhospital.com
NEW Englewood NEW NEW NEW Englewood Englewood NEW Englewood Office Englewood Office Office Office Office Swedish Swedish Swedish Swedish Medical Swedish Medical Medical Center Medical Medical Center Center Center Center 701 E. Hampden 701 701 701 E. E.E. Hampden 701 Hampden Hampden Ave., E. Hampden Ste. Ave., Ave., Ave., 350 Ste. Ste. Ave., Ste. 350 350 350 Ste. 350 Englewood, Englewood, Englewood, Englewood, CO Englewood, 80113 CO CO CO 80113 80113 80113 CO 80113 303-409-1430 303-409-1430 303-409-1430 303-409-1430 303-409-1430 DenverDenver Denver Office Denver Denver Office Office Office Office Rose Medical Rose Rose Rose Medical Medical Rose Center Medical Medical Center Center Center Center 4545 E4545 4545 9th 4545 Ave., EE4545 E 9th 9th 9th Suite Ave., Ave., EAve., 9th 670 Suite Suite Ave., Suite 670 670 Suite 670 670 Denver, CO 80220 Denver,Denver, CO Denver, 80220 Denver, CO CO 80220 80220 CO 80220 303-331-9121 303-331-9121 303-331-9121 303-331-9121 303-331-9121 Lakewood Office Lakewood Lakewood Lakewood Office Lakewood Office Office Office 3333 S. Wadsworth Blvd., Ste. 217 3333 S.3333 Wadsworth 3333 S. 3333 S. Wadsworth Wadsworth S.Blvd., Wadsworth Ste. Blvd., Blvd., 217Ste. Blvd., Ste. 217 217 Ste. 217 Lakewood, CO 80227 Lakewood, Lakewood, Lakewood, CO Lakewood, 80227 CO CO 80227 80227 CO 80227 303-801-3415 303-801-3415 303-801-3415 303-801-3415 303-801-3415
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Prostate Health:
Should Men Get the PSA Test? Local urologists decode new PSA guidelines by Kris Scott When it comes to men’s prostate health, two common tools have been used to screen for early signs of prostate cancer: the PSA blood test and a digital rectal exam. In recent years, the PSA test has come under scrutiny and medical experts have flip flopped on whether it’s useful, leaving many men confused. Two Colorado urologists weigh in on recent changes in the guidelines for PSA screening and help clarify who and when testing should be done. ABOUT THE PSA & GUIDELINES
The PSA test is a simple blood draw that can signal early-stage prostate cancer by detecting elevated levels of prostatespecific antigens. For years, it was part of the regular male prostate exam. But, in 2012 the United States Preventive Task Force guidelines graded the PSA a “D” and did not recommend the test. In May 2018, the USPTF upgraded the recommendation to a “C” now advising men 55 to 69 years old to consult with their clinician about the prostate specific-antigen test. In 2018, the USPTF also recommended against routine PSA screening for men 70 or older. Urologist Dr. Juan Montoya of The Urology Center of Colorado, disagreed with the 2012 USPTF position, in part, because prostate cancer is the second-leading cause of cancer death in men and early detection is crucial. 44
Dr. Damian Sorce, a urologist with Advanced Urology in Parker, agrees. “[T]ens of thousands of men a year have not been screened,” he says. “We are just starting to see the implications with increasing incidence of metastatic disease and of men dying of prostate cancer.” The 2018 guidelines are an improvement in some respects but Sorce and Montoya stress that the new guidelines aren’t specific enough and are still confusing. In the past, Sorce says there was criticism of the test and its association with over-treatment of low-risk cancers that weren’t likely to become life threatening. He and others emphasize that the problem lies not with the PSA test but with what’s done with the information. For example, an elevated PSA level does not automatically indicate prostate cancer, as higher levels can be caused by other health issues.
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WHEN TO GET THE PSA TEST
To help clarify the confusion for patients, Sorce and Montoya recommend getting a PSA test if:
You are younger than 55 but have a family history of prostate cancer. “Having one family member with prostate cancer
can double the risk,” Sorce says. This is especially true if you have a first-degree relative — a brother, father or son — diagnosed before age 55, or you have two male relatives on the same side of the family with the disease, Montoya says.
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Montoya says this group tends to have higher rates of lethal prostate cancer and be identified with the disease at later stages.
You are African American.
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Sorce says, “Men that have over a 10-year life expectancy should continue to be screened no matter what their age is.”
You are 70 or older and healthy.
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Both doctors agree men should speak with their physician about personal risk factors prior to screening and, if a positive diagnosis is made, have additional conversations about the likelihood the cancer will progress to metastatic status. “The key is finding those men that have dangerous cancers,” Montoya says, and monitoring men with low-risk prostate cancer as opposed to aggressive treatment. “That’s where the greatest utility and benefit of the PSA based screening is.”
The Region’s Leader in Urologic Care TUCC is the largest and most comprehensive urology center in the Rocky Mountain region. With 18 doctors, we provide expert care and treatment for all urologic conditions.
• Leader in Prostate Cancer Diagnosis and Treatment • Same-day or Next-day treatment for Kidney Stones • Vasectomy and Vasectomy Reversals • Female Urology Specialists • Treatment for Male Infertility • Experts in treatment of Urologic Cancers
303.825.TUCC (8822) | www.TUCC.com
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Get the skinny on high-intensity vs. steady-state cardio workouts by Morgan Tilton
Walk the dog, drop off the kids, drive to work, and cook dinner for the family: a typical day is nonstop action — but did you squeeze in exercise? If your free time is tight, high-intensity interval training, or HIIT, is the most efficient training that you can choose for your weekly health routine. Yet, not everyone is able to or should go all in out of the gate. Here, local experts talk about the pros and cons of high and steady cardio workouts. WHY THE HOOPLA OVER HIGH-INTENSITY
HIIT is any workout that alternates between bursts of activity at a maximum effort and brief periods of less-intense activity or rest. To point, a Tabata — one type of HIIT workout — features eight 20-second intervals of intense work, such as sprints, pushups, pull-ups, etc., followed by 10 seconds of rest. “From an efficiency standpoint,” says Dr. Sam Rougas, a cardiologist with Aurora Denver Cardiology Associates at Presbyterian/St. Luke’s Medical Center, “you can get as much bang for your buck doing a 10-minute interval session (20 seconds on, 10 seconds off) as in a 1.5-hour run.” HIIT increases VO2 thresholds (the maximum rate of oxygen consumption) at a greater level and more quickly than standard moderate-intensity exercise, or longer duration training sessions. HIIT also stimulates hormonal changes, reports the Journal of Sports Medicine & Doping Studies. 46
“Human growth hormone also increases, which is responsible for burning fat, so HIIT is a phenomenal way to lose weight,” Rougas says. Furthermore, HIIT increases cardiovascular strength faster than steady-state cardio, improves insulin sensitivity (which causes the body to utilize sugar more efficiently), decreases blood pressure and cholesterol, creates afterburn (the continued burning of calories after exercise), and reduces abdominal fat. The downside: HIIT is painful. “You pay for efficiency in terms of discomfort,” Rougas says. HIIT can also be risky for de-conditioned athletes. Novice HIIT trainees should consider gradually increasing the exercise intensity, working with a physical trainer, and having a heart evaluation before a full HIIT workout.
STEADY-STATE CARDIO
For some folks, HIIT isn’t an option or the best exercise choice due to safety or comfort. Enter: Steady-state cardio workouts, which require moderate efforts for 45 minutes or longer and meet the recommendation of the American Heart Association, as well as the Disease Prevention and Health Promotion’s 2008 Physical Activity Guidelines for Americans. Steady-state training improves cardiovascular endurance sans stress on the cardiovascular system, and improves health by decreasing blood pressure, stress and anxiety. For those with a heart health history, diseases, or injuries, experts also recommend you consult a physician to determine safe exercise guidelines.
COMBINING BOTH
“Neither HIIT or steady-state is the best way to work out,” says Vivian Griggs, personal training coordinator at Greenwood Athletic and Tennis Club. “A comprehensive workout plan should include both and be individualized. Someone’s pace during a steady-state long run might be the maximum pace during another person’s high-level intensity workout.” The best routine is one that sticks. “The key is to make any activity fun, like softball or ballroom dancing,” Rougas says. “Then, you’re much more likely to do it.”
Cardio Breakdown For overall cardiovascular health, the American Heart Association recommends adults perform: 30 minutes of moderate-intensity aerobic activity 5
OR
days per week
25 minutes of
Moderate to
vigorous aerobic
high-intensity
activity 3 days
strength activity
per week
2 days per week
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Su rming up fo Per al Gro ic e Med ractic P
Greenwood Pediatrics offers: • A focus on each family’s relationship with one primary doctor, supplemented by visits with one other physician and one nurse practitioner on the care team
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by Joelle Klein
HARRY CONNICK, JR. AND OTHERS SEEK ALTERNATIVES FOR COLON CANCER SCREENING 48
If you’re 50 years old or around that age, or you’ve been putting off getting a colonoscopy, read on. There are alternative colon cancer screening options that are less-invasive and less-complicated than the colonoscopy.
The colonoscopy has been referred to as the “gold standard” of screenings for colorectal cancer, also known as colon cancer. This common screening method entails drinking a diarrhea inducing liquid to cleanse the bowels and consuming a liquids-only diet the day before the procedure. Then, the procedure involves sedation and taking time off from work. Award-winning singer and actor, Harry Connick, Jr., who turned 50 last year, opted out of the colonoscopy and chose a colon cancer screening alternative. He was in Denver recently to support a public awareness campaign called The New 50 that encourages people to get screened for colon cancer. “I was planning to put it off as long as I could,” he said. “It just wasn’t something I wanted to do.” The campaign was sponsored by Cologuard, a colon cancer screening test approved by the FDA in 2014. It’s one of several colon cancer screening methods available today. “I asked my doctor about Cologuard, and I learned that if you’re 50 and older, and of average risk, Cologuard is an option,” Connick says. “So, I chose it, and I’m happy I did. It was a very easy thing to do.” For Connick, taking advantage of cancer screening tests is important and hits close to home. His wife of 24 years, former model Jill (Goodacre) Connick, was diagnosed with breast cancer in 2012 after a routine mammogram and sonogram led to a diagnosis of early-stage breast cancer. With treatment, she’s been cancer-free for more than five years. “Cancer has always been a big issue for me because I lost my mom to it and Jill has gone through it,” Connick says. “I feel compelled to do what I can to help others, and I don’t have any other capacity to help than to bring awareness, and I feel lucky to be able to do that.”
D I D YOU K N OW ?
Colon cancer is the second leading cause of cancer
death in the U.S. and the third most commonly diagnosed cancer in Colorado. With early detection, it’s also one of the most preventable forms of cancer. Source: Colorado Cancer Coalition.
Health and Wellness Magazine •
49
NON-COLONOSCOPY OPTIONS
The CT colonography, or virtual colonoscopy, uses x-rays to create a 3-dimensional view of the inside of the colon and rectum, allowing the doctor to view polyps or cancer. Then there’s a flexible sigmoidoscopy, a small scope that’s inserted in the anus that allows a doctor to view the inside of the rectum and part of the colon. These visual tests need to be done every five years.
About one-third of eligible adults in the United States have never been screened for colorectal cancer, reports the United States Preventative Services Task Forces. The group recognizes that offering patients different test options increases the chances that they’ll actually get screened. Below is a list of some alternatives to the colonoscopy.
Visual screening tests:
Stool DNA test: For Connick, Cologuard fit the bill. It’s the only FDA-approved stool DNA test on the market. It can be used at home without any prep or time off from work. People can send a stool sample to a lab where it’s tested for blood and certain DNA cell mutations, which are associated with large precancerous polyps or cancer. The Cologuard website says the test should be repeated every three years if results are normal.
Each of these alternative tests has its own set of benefits and drawbacks, and if any come back with a positive result, a diagnostic colonoscopy is required. An important thing to note is that all screening tests, other than colonoscopies, are only recommended for people of average risk. If you have a family history of colon cancer or certain health conditions, such as colitis or Crohn’s disease, you may need to start with a colonoscopy before your 50th birthday and repeat the procedure more frequently.
Other stool-based tests: The fecal immunochemical test (FIT) test, also called an immunochemical fecal occult blood test (iFOBT), detects hidden blood in stool, which can be a sign of larger colorectal polyps or cancers. Then there’s also the guaiac-based fecal occult blood test (gFOBT), that detects hidden blood in the stool through a chemical reaction. Both the FIT and gFOBT can be done at home and should be done every year. Jane Harris, who is with the north region of the American Cancer Society, recommends talking to your doctor because some stool-tests and brands are better than others.
AdvancedPediatricAssociates.com
WHAT ABOUT COST?
Harris says “preventative” cancer screening is covered by most insurance plans and Medicare. There are also free and reduced pricing resources available throughout the metro-Denver area. For example, in Colorado, she says Cologuard has waived the payment for co-pays, which can sometimes be up to $200. Harris encourages people to talk with their doctor and insurance plan provider, especially if price will deter someone from getting screened altogether.
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For his colon cancer screening, Harry Connick, Jr. opted for the Cologuard stool DNA test instead of a colonoscopy.
HAVE THE TALK
The best way to determine which colon cancer screening option is for you is to discuss your wishes, concerns and health issues with your doctor. Harris says the American Cancer Society can also be a resource by calling the Cancer Hotline at (800) 227-2345. Some medical experts, such as Dr. Peter Le, a gastroenterologist with South Denver Gastroenterology, say Cologuard and other screening methods can be effective and appealing to many, but they think a colonoscopy is the best test.
“I think it’s much better and far superior than the others, and that’s why I had one myself,” Le says. For example, a study published in the New England Journal of Medicine found that Cologuard detected 92 percent of colorectal cancers and 42 percent of precancerous polyps that were previously detected by a colonoscopy. While 92 percent means that Cologuard has a high rate of detection, Dr. Le points out that it’s still missing 8 percent of cancers that a colonoscopy catches and does not reliably detect precancerous polyps. Another benefit to the colonoscopy is that the procedure is only performed every 10 years when results are normal. Dr. Edwin Anselmi, family medicine practitioner at Our Lady of Hope Medical Clinic, says he tells his patients who are nearing the appropriate age for screening about all the colon cancer tests. “I give my patients the options,” Anselmi says. “I do tell them the colonoscopy still has slightly better sensitivity and specificity than the other options, but if someone does not want to go through the procedure, then there are definitely alternatives.”
G E T SCREENED Y O U N G E R The American Cancer Society issued new guidelines in
May 2018 recommending that colon cancer screening now begin at age 45 instead of 50 for people of average risk.
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51
7 Foods You’re Not Eating (But Should)
JICAMA. MICROGREENS. CABBAGE. MORE GOOD-FOR-YOU FOODS. by Meghan Rabbitt Let’s face it: Most of us race through the grocery store, checking foods off our go-to lists to make our go-to meals. Even when we have more time — say, we’re strolling around the farmer’s market — it’s not likely we’ll pick up a fruit or veggie we’ve never eaten or cooked before. Yet there’s good reason to be a little more daring when it comes to what we eat, says Jessica Crandall, a registered dietician with Denver Wellness and Nutrition and a national spokesperson for the Academy of Nutrition and Dietetics. “When we eat the same things over and over again, we end up with nutrient deficiencies,” Crandall says. “Eating a variety 52
of foods means we get nutrients from a lot of different sources, which increases our chances of achieving optimal nutrient balance.” Not sure where to start? Here, Crandall and Laura Fry, a registered dietician at Weigh to Wellness in Denver, share their recommendations for the healthiest foods Coloradans aren’t eating enough of — yet.
MICROGREENS
Sometimes confused with sprouts, these are immature greens, harvested less than a month after germination. Why eat them before they mature fully? Well, because some studies suggest microgreens may actually contain higher concentrations of nutrients compared with mature veggies. “Microgreens are such a nutrient powerhouse,” Crandall says. Look for microgreen celery, basil, mustard greens, radish, and watercress — and mix into salads to boost flavor and get more vitamins, minerals, and antioxidants, says Crandall.
TURMERIC
When summer’s over, there’s a good chance you stop adding antioxidantpacked, anti-inflammatory basil, dill, cilantro, and other herbs into your meals. Enter turmeric, which Crandall says is a great (and often overlooked) way to match the antioxidants found in fresh herbs and add a different flavor to meats and veggies. Tip: Crandall likes adding a sprinkle of turmeric on top of roasted cauliflower instead of salt and pepper to give it an Indianinspired flavor.
JICAMA
This root veggie is easy to overlook. After all, it’s not commonly served in this country — and most recipes don’t call for it. However, it’s on this list thanks to its high levels of phytonutrients, including copper, iron, vitamin B6, vitamin C, magnesium, manganese and prebiotic fiber. “These nutrients help strengthen your bones, manage your blood pressure, and boost your immunity,” Fry says. Start adding this sweet-tasting, crisp veggie to your diet. Crandall suggests serving it alongside carrots and celery sticks, adding it to salads, or slicing and serving it with tomatoes and a drizzle of balsamic vinegar.
CHIA SEEDS
These little powerhouse seeds are a great source of calcium, iron, and fiber — something most of us don’t get enough of. “I add chia seeds to yogurt or salad, because just a couple of tablespoons give you a big nutrient boost in a very small serving,” says Crandall. Keep in mind you don’t have to soak them in order to get the benefits. “A lot of people think they’re a lot of work to prepare, but they taste great raw,” says Crandall. “If you soak them, you’ll just notice a texture difference — they’ll be a little softer.”
LENTILS
Too many of us aren’t getting enough potassium, fiber, and magnesium, says Crandall, which can increase our odds of developing cardiovascular disease. Lentils are loaded with all three nutrients, making them a great addition to your diet — particularly as you age. While you might think Indian food or Southwestern dishes when you think of legumes, Crandall recommends they be added to eggs at breakfast, sprinkled on top of a salad for lunch, and even pureed and added to baked goods. Bonus: Lentils are an inexpensive way to add protein to your meals, adds Fry.
CABBAGE
Unless it’s St. Patrick’s Day and you’re pairing it with corned beef, there’s a good chance you don’t eat much cabbage. “It is underutilized in most areas of the United States, but especially in the Colorado area,” says Fry. “That’s a shame, because it is a very low-calorie food — one cup is just 22 calories — and very high in fiber, folate, vitamin C and vitamin B6.” To increase your intake, start adding shreds of cabbage to tacos, salads, and sautéed veggies.
LOCAL HONEY
“When you eat local honey, it helps you build up an immunity to the allergens and tree pollens in your area,” says Fry. Luckily, Colorado is a state with plenty of local honey suppliers. Find one at your farmer’s market or even your local grocery store. While you’ll want to keep your intake in check (honey is still a form of sugar, after all), Fry says the fact that there is little processing from hive to table makes honey one of the best sweetener choices.
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53
THE NUTRITIONISTS’ GUIDE TO
GOING VEGAN THINKING ABOUT GIVING UP ALL ANIMAL PRODUCTS? READ THIS ADVICE FIRST TO AVOID PITFALLS.
You already know eating more whole, plant-based foods is good for your health. Yet if you decide to follow a vegan diet — which means excluding all animal products — it’s important to understand some common pitfalls that can really impact your health, says Laura Fry, a registered dietitian at Weigh to Wellness in Denver. Here, Fry and Jessica Crandall, a registered dietician with Denver Wellness and Nutrition and a national spokesperson for the Academy of Nutrition and Dietetics, share their best advice for overcoming the potential downsides of a vegan diet. PITFALL NO. 1
Consuming too many pre-prepared, highly-processed foods. When you embark on a vegan diet, there’s a good chance you’ll start eating more fruits and vegetables. Yet there will be times when you aren’t able to prep producerich meals from scratch — and as a result, you might reach for the many vegan options of packaged foods that exist these days. (We’re looking at you, vegan mac ‘n cheese and peanut butter cookies). Just because a packaged food says “vegan” doesn’t make it healthy, says Fry. “It’s important to read the labels of the prepared food you buy and be aware of the sugar content,” Fry says. “When you’re vegan, you want to make sure you’re getting ample protein and fat in your diet — and keep your calories from carbohydrates to less than half your calorie intake.” 54
PITFALL NO. 2
Not eating enough protein. When Crandall decided to follow a vegetarian diet, she quickly found out she wasn’t getting enough protein — and ended up anemic. She shares this story to show how tricky it can be to meet your protein requirements when you cut out animal meat — even when you’re a dietitian. “You have to be very strategic about how much protein you consume when you’re following a vegan diet,” she says. “For a lot of people, using a dietitian to help you make sure you’re meeting your nutritional needs can be helpful.” Protein intake requirements depend on how old you are, as well as if you’re male or female. On average, people need 60-80 grams of protein per day. Excellent vegan sources of protein include beans, nuts, and tofu, says Crandall. “You want to make sure you’re consuming some of these protein-rich sources throughout the day in order to get enough,” she adds.
PITFALL NO. 3
Vitamin deficiencies. There are a number of vitamins and minerals that are commonly missing from a vegan diet because they’re found in animal products, says Fry. “The biggies are iron, zinc, calcium, vitamin B12, vitamin D, and omega-3 fatty acids” she says. The good news is that some of these nutrients can be found in vegan foods — you just have to know where to find them, says Fry. Here’s a quick rundown: lentils, soybeans, tofu, tempeh, lima beans, quinoa, fortified cereals, brown rice, oatmeal, pumpkin seeds, pine nuts, pistachios, sunflower seeds, cashews and un-hulled sesame.
Iron:
Zinc: garlic, pumpkin seeds, sesame seeds, dark chocolate, wheat
germ, chickpeas, green peas, baked beans, peanuts, and pecans. Omega-3 fatty acids: brussels sprouts, chia seeds, walnuts, hemp oil and flaxseed oil. “But keep in mind the best sources of omega-3s come from animal products, such as fatty fish and fish oil supplements,” says Fry. “Most plant-based omega-3 sources only have one of the three types of fatty acids we need.” So, opt for vegan products fortified with omega-3s when you can.
the best food sources for these are in animal products, so opt for foods fortified with these nutrients, in addition to taking supplements, to make sure you’re getting enough.
Calcium, vitamin B12, and vitamin D:
PITFALL NO. 4
Having a tough time eating out. Just like anyone following a restricted diet, choosing healthy options when you’re at a restaurant can be challenging, says Crandall. “My advice is to research restaurant menus before you go out so you have time to really think about what you can eat,” she says. Unfortunately, there may be times when there are so few options, you’ll leave a meal feeling hungry. To prevent making bad food choices — like rolling up to the closest drive-through and buying a large order of French fries — Crandall suggests keeping a vegan-friendly protein bar or other snack in your purse or car. “This way when you get into a situation when there’s nothing to eat, you have a meal replacement for yourself.”
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KIDS & SPORTS TOO MUCH TOO SOON Experts Talk About Specialization and Diversifying Play Story by Joelle Klein Photos by Dan Sidor
Hazel Mills was 6 years old when she first enrolled in a recreational gymnastics program. With her small frame and muscular build, she excelled and moved up quickly through competitive programs. As a level 3 gymnast, Hazel started out practicing three days a week for three hours per session. By the time she was just 9 years old, she was a level 5 gymnast, practicing 12 hours during the week plus time on Saturday, when practice was encouraged but not required. “I think that unless you have a kid who wants to take [gymnastics] places, like the Olympics, there’s no reason to train that much,” says Hazel’s mother, Nancy Willerton. When Hazel’s back started hurting her as a level 4 gymnast, she was encouraged by her coach to “power through” her practices and routines, recalls Willerton. After a mediocre season and a 56
personality conflict with the coach, Hazel wanted to leave the team. When her parents learned there would be new management and new coaches in the upcoming season, they encouraged Hazel to stick it out one more season to make sure it was gymnastics she wanted to drop and not the coach.
But, Hazel’s overuse injuries persisted and intensified, and ultimately, she left the team last year. Willerton says her daughter was diagnosed with an inflammation of spinal growth plates. After six weeks of rest and physical therapy, Hazel’s back healed. “I think if she had continued there could have been discomfort later in life from that inflammation,” says Willerton.
THE RISE IN EARLY SPECIALIZATION
Dr. Brooke Pengel, medical director of the Rocky Mountain Pediatric OrthoONE at Sky Ridge Medical Center, says she’s seen an escalating number of overuse injuries. Back injuries, she notes, are among the most common types of injuries she sees in gymnasts. “With the emphasis on winning and success, and the trend of early specialization which goes along with changing kids’ schedules such that they have lengthy practices year-round and lots of competitions, we’re seeing more overuse injuries,” says Pengel. Physical therapist Matt Casseday, with Physical Therapy of the Rockies, says he too is seeing more children, starting at about age 10, with overuse injuries and also reinjuries. He sees young athletes with injuries from every type of sport, such as basketball players with foot and ankle sprains, baseball players with little leaguers’ elbow, and soccer players with knee sprains and ACL tears. Aside from the injuries, both Casseday and Pengel do see the significant benefits of kids playing on sports teams. Some of those benefits include learning teamwork and leadership skills as well as boosting self-esteem and getting them away from electronic devices to do fun physical activities. The problem, though, these days is the push to specialize early, meaning to choose one sport to focus on before the teen years.
“With the emphasis on winning and success, and the trend of early specialization ... we’re seeing more overuse injuries.” SPECIALIZATION DRAWBACKS
“Before 12, kids still have immature bones, open growth plates and they’re just not to the level of an adult in their strength and coordination, which makes them much more susceptible to injury,” Casseday says. The American Academy of Pediatrics (AAP) recommends holding off on focusing on one sport until after puberty. Early specialization does more than just put children at an increased risk for injuries, Pengel says, it can completely disrupt their lives. With practices running late into the evening, family dinners don’t happen, and their social life can be virtually nonexistent outside of training. Furthermore, studies show that early specialization leads to early burnout. The AAP says that by age 13, 70 percent of kids have dropped out of sports. “That’s staggering, right?” says Pengel. “I think that we as a society and also sports organizations need to take that statistic very seriously and know that something is not right if that’s the case.”
BETTER PLAY FOR YOUTH SPORTS
How to do it right? Encourage kids to try multiple sports before dedicating themselves to just one. This not only discourages burnout, says Pengel, but also reduces the risk of injury and produces a more well-rounded, better coordinated, stronger athlete. In fact, the AAP says that delayed specialization and early diversification of sports increases the chances that your young athlete will participate in sports throughout her life — and achieve greater athletic success. Studies of college and professional athletes show that the majority of them participated in multiple sports before specializing. In some sports, early specialization may make sense, says Pengel, because athletes tend to peak younger. These sports include ice skating, gymnastics, swimming and diving.
HAZEL’S WELL-ROUNDED APPROACH
Eleven-year-old Hazel Mills specialized in competitive gymnastics until she had back problems. Now, she is healed and diversifying her play to include basketball, cross-country and soccer.
Eleven-year-old Hazel is now in a year-round club basketball league that practices about three hours a week, a cross-country team at her middle school and is planning to try recreational soccer this fall for the first time. “We may have overcommitted her a little,” says Willerton. “But even with all these different teams, the hours she practices a week are still much less than when she was doing gymnastics.”
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57
T E E N A G E
DEPRESSION & ANXIETY Who, Why and How To Help
by Courtney Messenbaugh
“Teen Suicide Is Soaring.” “More Kids Are Attempting or Thinking About Suicide.” These are a couple of the chilling headlines that appeared in newspapers and magazines in recent months. Anxiety disorders have been steadily increasing in adolescents since 2012 and depression among teens is also on the rise. Suicide is now the second leading cause of death among teenagers 15 to 19 years old. Disturbingly, 80 percent of kids with a diagnosable anxiety disorder and 60 percent of kids with diagnosable depression are not getting treatment, a 2015 Child Mind Institute Children’s Mental Health Report revealed. The data is unsettling; however, the upside is an increasing public awareness. Anxiety disorders and depression are treatable, especially if caught early. 58
Common signs of anxiety disorder: • extreme irritability • obsessive and compulsive behaviors • stomach problems • relationship withdrawal.
NEW UNIVERSAL SCREENING
The American Academy of Pediatrics issued new guidelines in February 2018 that call for universal screening for depression in teens starting at age 12. The screening is a simple two question process that asks whether or not the patient has experienced decreased interest or pleasure in doing things, and whether or not they’ve felt excessively down or hopeless. These questions act as a first-step approach to earlier detection and a catalyst to dig a little deeper if need be.
BEYOND ‘NORMAL’ TEENAGE BEHAVIOR
Anxiety and depression are separate diagnoses, but often go hand in hand. “Eighty percent of teens with depression have anxiety,” says Dr. Ron Morley, medical director at the Colorado Psychiatry Center. “But you can have a kid with just one, with anxiety happening more frequently.” If anxiety goes untreated, it can often lead to depression, says Natalie Vona, licensed psychologist with 5280 Pediatrics. Nearly everyone will experience some anxiety in their lives, but when it becomes urgent and consistent, it should be treated. Review the symptoms of anxiety and depression in the accompanying list. The trouble is that some symptoms look a lot like normal teenage behavior. The Centers for Disease Control explains that normal developmental changes during the early teen years (12-14 years old) include things such as vacillating between high expectations and a lack of confidence, increased moodiness, and feelings of sadness. Anxiety and depression manifest similarly. Vona says many people are often unsure if what they are feeling and thinking is “normal” or if it is something more serious. Because of this, teen depression or anxiety might be dismissed “as being a teen” or not noticed until something more serious — like self-harm or a suicide attempt — happens. The bottom line is that if you notice a pervasive, persistent pattern of some of these symptoms, talk to your child’s pediatrician or make an appointment with a mental health professional to address concerns.
WHY THE RISE?
In a nutshell, a lack of sleep, overwhelmingly busy schedules and hyper-connectivity are likely contributing to this rise in anxiety disorders and depression. Morley points out that causality is always difficult to prove, but this trifecta is certainly not a benign one. Dr. Suzanne Cooper of Greenwood Pediatrics emphasizes the toll that being hyper-connected is taking on today’s teens’ mental health. “It used to be that if you were being bullied, you could escape from it at home,” Cooper says. “Now, the bullying follows you everywhere on your phone.” Morley and Cooper also point out that although teens are hyperconnected, they are missing out on human connections and real emotional bonds. This leaves them feeling isolated — a precarious state for anyone. In addition to detracting from human connection, screens on devices also stimulate the part of the brain that controls sleep cycles, causing greater sleep loss.
HOW TO HELP
Experts agree that one of the most important things you can do to help your teenager is to be present and to talk with him or her on a continual basis. Spend enough time with them that you will notice when things are off. As a catalyst for a more in-depth conversation with your teen, Cooper suggests talking about your own difficult experiences and how you handled them. “If you talk about your own feelings,” she says, “it makes them more comfortable talking about theirs.” As conversations like this unfold, teens may also become more aware of changes within themselves and make them more tuned in to friends who might need help as well. Talking with your children about mental health is just as critical a conversation as talking with them about sexuality and substance use. And, likewise, should be just as ongoing. As Morley put it, there is no need to be paranoid. If your child is depressed or has an anxiety disorder, get them into treatment early. He says, “We are very successful at treating people.”
Common symptoms of depression: • decreased interest in previously favorite activities • social isolation • feelings of worthlessness • major changes in sleep or eating patterns. Source: Psychologist Natalie Vona, 5280 Pediatrics
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HER
SEXUAL HEALTH
W A N T B E T T E R S E X ? S T A R T T A L K I N G | by Morgan Tilton
Something bizarre happened when Emma Murray, now 23, chose a copper IUD for birth control — it’s a tiny intrauterine device that’s inserted by a doctor inside the uterus for long-term protection. Four months post-insertion, the IUD shifted during intercourse, caused a sharp pain, and fell out. Stumped, Murray got a second IUD. A few months after the procedure, Murray was squatting in the woods, and the IUD fell out — again. 60
“I went back to Planned Parenthood and started asking questions,” says Murray. “We found out that my Mooncup formed a light seal around the cervix every time I inserted it.” A Mooncup is a medical-grade silicone cup that’s placed inside the vagina to capture menstrual flow. Murray explains that every time she took out the cup, it caused suction that pulled the IUD down. Murray suspects her experience is probably more common. In the U.S., 4.4 million women from 15 to 44, who have sexual intercourse, use an IUD, reports the Guttmacher Institute. Unfortunately, one significant communication snafu has the potential to cause an unplanned pregnancy. “I had done all of this research on my own,” says Murray. “On the flipside, none of the women’s health care specialists I saw inquired about why the IUD was the best decision for me.”
START THE DIALOGUE
Medical care providers and patients share responsibility when it comes to women’s sexual health. Excellent questions followed by openness, respect, and vulnerability go a long way, say experts, since strong dialogue can empower women’s sexual health. Such conversations, may have made a difference for Murray. “Every week I see women who are self-conscious about the way they [read: their vaginas] look that they aren’t dating…[women] often feel guilty for being vain and live for decades without being empowered,” says Dr. Oscar A. Aguirre, a urogynecologist and founder of Aguirre Specialty Care: Pelvic Surgery and Intimate Aesthetics, The Center for Female Pelvic Medicine and Cosmetic Surgery.
PELVIC PROBLEMS
Pelvic complaints can negatively impact a woman’s intimacy and sexuality. Aguirre, who treats a multitude of aesthetic and functional pelvic issues, says his patients generally fit within three categories: Women ages 15 to 35, sans kids, who want to improve their vaginal appearance or sexual pleasure via procedures such as a labia or clitoral reduction; a second group is mothers with vaginal looseness, prolapse, and pelvic relaxation; and the third is women in their 60s who are experiencing vaginal dryness, painful sex, or incontinence. “All of those women are waiting to be asked the question: How is sex?” says Aguirre. “If you talk to patients, their doctors don’t ask them that question, because they aren’t comfortable talking sexual history and they don’t know how to help those patients.” Aguirre says the question opens an opportunity for solutions that women never knew existed — imagine being 60 years old and reaching a sexual prime. Eighty-percent of his patients choose to combine three treatments: the O-Shot, Geneveve, and CO2. The O-Shot — a PRP (platelet rich plasma) injection in the clitoris and vagina — increases blood flow and nerve sensation, which improves climax, orgasm, and incontinence. The Geneveve — a non-surgical vaginal laxity treatment — utilizes radio frequency to stimulate the body’s collagen formation process, which improves tissue thickness and sensation at the vaginal entrance. And, CO2 laser therapy improves moistness and tightness, says Aguirre.
“It’s not wrong that she wants sex once a month — but it might not be enough for her partner. As a couple, they need to figure out how to close the gap or there’s consequences in the relationship.” “It’s not wrong that she wants sex once a month — but it might not be enough for her partner,” says Cannon. “As a couple, they need to figure out how to close the gap or there’s consequences in the relationship.” To find a solution, Cannon conducts a comprehensive assessment of his patients. Per Cannon’s definition, a low-level or no sex marriage is defined when the couple shares intercourse eight to 12 times per year. If she’s content, that sex frequency could be her own natural state, which might not align with her partner’s needs. A myriad of factors can impact libido, says Cannon, such as medications, bullying or maltreatment from her partner, alcohol use, history of sexual trauma, or a biological issue, which can manifest as pelvic pain. Dr. Shan Shan Jiang, an OB-GYN at Consultants in Obstetrics & Gynecology at Presbyterian/St. Luke’s Medical Center, similarly notes that the most common diagnosis among her patients is hypoactive sexual desire disorder (HSDD), a lack of sexual desire that effects interpersonal relationships. The American Congress of Obstetricians and Gynecologists reports that HSDD affects up to 13.6 percent of women from ages 30 to 70 years old, and the peak incidence is from 40 to 60 years old, according to Jiang, who notes countless potential social, psychiatric, skeletal, or neurological causes. In addition to Cannon’s list, contributing factors of HSDD include stress, psychiatric issues like depression, oral contraceptives, physical conditions caused by surgeries or menopause, muscular overuse due to exercise, or medical conditions like vulvodynia (chronic pain around the vaginal opening). “First and foremost, clinicians need to start the conversation. Even at gynecologist visits, people don’t like to bring up low libido,” says Jiang, who asks patients about their sexual relationships. “Intimacy and sexual desire go hand in hand. ... And, sometimes, someone just needs validation in order to make a change.”
LIBIDO & DESIRE
For Denver-based sex therapist Dr. Neil Cannon, the most common health issue among his patient population is low libido and a desire discrepancy. “A lot of women are pathologized by their spouses in heterosexual relationships when the woman doesn’t want ‘enough’ sex,” explains Cannon. Therein lies the problem, says Cannon, since there is no right level of desire, and everyone’s libido is unique.
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Aneurysms What You Need to Know About Brain and
Abdominal Aortic Aneurysms
by Sarah Protzman Howlett
Thinking about something as life-altering as an aneurysm, can be unsettling, so it’s important to know a thing or two about them. Colorado medical experts explain how they happen, who is at risk and treatment for two common types: cerebral and abdominal aortic aneurysms. 62
Brain Aneurysms A cerebral aneurysm, often called a brain aneurysm, is a localized weakness in an artery wall that can take on various shapes and sizes. The artery balloons out, and like a balloon, it can pop, spilling blood, says Dr. Don Frei, a Denver interventional and neuro-interventional radiologist with Radiology Imaging Associates, who works at Swedish Hospital’s Stroke Center. Curiously, Frei says about 1 percent of the population is walking around with such a weakness in a brain artery, but doesn’t know it because it hasn’t ruptured — and maybe never will. “You could potentially live your whole life and die of some other reason,” Frei says. “We don’t really know why it ruptures when it does,” adding that things like high blood pressure, diabetes and smoking can increase the likelihood of rupture because they put additional stress on artery walls. However, those behaviors and conditions themselves do not ever cause one, he adds. Likewise, an aneurysm’s size does not determine whether it will rupture. Who is at Risk?
People with a family history, such as a parent, sibling or child who have had or have an aneurysm, may be at higher risk, Frei says. He often sees migraine sufferers worry they’re at higher risk but he says there’s not a direct correlation between migraines and brain aneurysms. What are the Symptoms?
“The sudden onset of the worst headache of your life” is how Frei describes the overarching symptom of a brain aneurysm. The pain is caused by blood leaking from an aneurysm. They are clinically silent, meaning there are no warning signs. The annual rate of rupture is approximately 8 to 10 per 100,000 people — or about 30,000 people in the United States — according to the Brain Aneurysm Foundation. Survival, Frei says, is based on how much blood leaks out. Ten percent of people die immediately, and one-third die soon after. Two-thirds do not return to their normal self, having died or been disabled. The average age for a ruptured brain aneurysm is lower than you might think: middle age, or 40s to 50s. Frei has rarely treated children, but plenty of people in their 20s or 30s.
Abdominal Aortic Aneurysms Dr. Omar Mubarak, a vascular surgeon at Presbyterian/ St. Luke’s Medical Center (P/SL), says the most common aneurysm he sees is not in the brain but in the aorta — the largest artery in the body, just below the kidneys. “When a portion of the artery stretches to more than 50 percent of the original diameter, it is called an aneurysm,” he says. In the U.S., ruptured aneurysms are the 10th leading cause of death of men over the age of 50, he says. Like the cerebral aneurysm, there are almost always no symptoms, but a rupture would cause extreme abdominal pain that could cause the affected person to pass out. Who is at Risk?
Mubarak says the most common risk factors for abdominal aortic aneurysms include being over 60, male and a smoker. A family history of abdominal aortic aneurysms also plays a role, especially when a female family member had one. He says males 65 to 75 with a history of smoking should consider an abdominal ultrasound. “Smoking cessation and controlling hypertension can help avoid the formation of aortic aneurysms,” Mubarak says. Treatment
Aortic aneurysms are repaired with endovascular surgery, and Mubarak says survival rates have improved in recent years. They used to say 50 percent would die before reaching the hospital, and 50 percent of that group would die due to complications from repair. Mubarak feels the numbers are no longer so dire in the Denver area, thanks to P/SL’s new Hybrid Operating Room — the largest hybrid OR in the state opened in 2016, and it can accommodate both adult and pediatric patients. “The room gives the surgeons every advantage they need to repair an aneurysm with a stent graft,” Mubarak says, “but still have the capability of open surgery if needed.”
Know the Difference
Get Checked
There are two common exam methods: a magnetic resonance angiography (MRA), which is an MRI that looks at brain arteries, or a computerized tomography angiography (CTA), an angiogram wherein an IV injection of dye gives doctors a clear picture of brain arteries. Patients do not need both procedures, and neither is superior. Notably, the MRA doesn’t require an IV and there’s no radiation exposure. (People who are severely claustrophobic often opt for the MRA; those with pace makers must.) Treatment
Whether people who discover an aneurysm choose surgery, depends on age and other confounding health issues, says Frei who explains the two very successful surgical options: The most invasive procedure involves removing part of the skull and placing a titanium clip across the ballooned artery. The more common surgery is endovascular, where a small incision in the hip allows surgeons to access blood vessels. A coil is then placed into the aneurysm, a method that has been used since about 1995, Frei says.
ANEURSYM A localized enlargement of an artery caused by a weakening of the artery wall. Arteries can be enlarged. STROKE The sudden death of brain cells due to lack of oxygen caused by blockage of blood flow or rupture of an artery to the brain. HEART ATTACK A sudden and sometimes fatal occurrence of coronary thrombosis, typically resulting in the death of part of the heart muscle. —Source: Dr. Omar Mubarak, vascular surgeon, Presbyterian/St. Luke’s Medical Center.
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MEET THE DOCTOR
by Jeannette Moninger
WADE SMITH, MD
Board-certified orthopedic trauma surgeon with Swedish Medical Center Orthopedic Trauma and Limb Reconstruction What attracted you to the field of orthopedic trauma surgery? Smith: Multiple and severe bone breaks can be life
altering. It’s rewarding to be able to truly help someone who is severely injured. We get to help people of all ages and from all walks of life reclaim their lives by restoring function. What types of orthopedic trauma services do you offer? Smith: As a Level 1 trauma center, Swedish treats
the most severely injured patients. I’m fellowship trained in both pediatric and adult orthopedic trauma surgery. My focus is on the care of the severely injured, as well as patients with pelvic fractures or who have complications such as infections or bone breaks that take longer to heal or don’t heal properly. My colleague at OrthoONE, Dr. Steven J. Morgan, and I also specialize in saving limbs – hands, arms, feet and legs – that are damaged due to traumatic injury or illness. We’re the most experienced limb salvage experts in the Rocky Mountain Region. We have many years of experience and a great team to help us. What types of injuries do you commonly see during the winter, and how can a person lower this injury risk? Smith: We see a lot of knee and wrist fractures from
people falling while skiing, snowboarding or from slipping on ice. Our reflexes slow as we age, and we aren’t as physically fit. This deconditioning makes it harder to prevent or stop a fall. I recommend that people engage in activities like tai chi, dance or team sports that promote strength, balance and flexibility. You want to engage those fast-twitch muscle fibers that can help you react more quickly during a fall. Weight training in particular is great, especially as we age.
What is the M60 Mature Fracture Program? Smith: People ages 60 and older have a higher
risk of fractures, often due to falls. As a result, they often experience complications, such as chronic pain, infection, loss of mobility and delirium following surgery. This unique program at Swedish helps older adults recover from fractures while lowering complication risk. We start by administering a nerve block to stop the pain while the patient is in the emergency department. This step reduces the need for narcotics, which can cause confusion in the elderly. We get patients into surgery quickly and perform minimally invasive, often bloodless procedures through very small incisions. Patients are walking within 24 hours. We also have specialists who perform home assessments to lower the risk of falls in the patient’s home.
To learn more, visit orthoonedenver.com or swedishhospital.com
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• Health Profile