2015 medical directory digital

NOCO HEALTH G

U

I

D

E

Banner Health

CONTENTS

17

4

LETTER FROM RICK SUTTON

6

SLEEP TIGHT

7

ATTACKING ASTHMA

23

CHOOSING THE RIGHT DOCTOR

8

EVERYTHING YOU NEED TO KNOW ABOUT HPV

26

MEET THE DOC

12

DEALING WITH DEMENTIA

32

What's your risk?

14

TIS THE COLD AND FLU SEASON

34

Prioritizing sleep to improve your health

What are the signs of memory-loss and how to proceed if you see them in a loved one.

BANNER FORT COLLINS MEDICAL CENTER

HEREDITARY CANCER AND WHEN TO GET TESTED Fertility:

HOW LATE IS TOO LATE? NoCo Health Guide • 3

Accessing quality health care in Fort Collins is getting a little easier. When Banner Fort Collins Medical Center and the adjoining Banner Health Center for specialty physicians opens April 6, 2015 at the corner of Harmony Road and Lady Moon Drive, it will mark a new era for choice in Fort Collins and the surrounding area.

Banner Fort Collins Medical Center is a full-service, acute-care hospital offering emergency care, orthopedics, general surgery, women’s health, labor and delivery, gastroenterology, urology, pulmonology, intensive care, medical imaging, laboratory services, and other medical and surgical care.

On the same campus, area residents will be able to schedule outpatient appointments with a wide variety of Banner Medical Group specialists including pediatricians, cardiologists, general surgeons, neurosurgeons, urologists, pulmonologists, OB/ Gyns, and gastroenterologists. Banner orthopedic surgeons will be seeing patients at our Banner Health Center on Drake and performing surgeries in the new hospital.

Together with the other Banner Medical Group specialists and primary care physicians already serving patients in Fort Collins, and the independent physicians who partner with Banner Health, we look forward to meeting the health care needs of this community.

So why are we expanding our Fort Collins presence? Simple: The demand for our services in this community is growing.

We know people want to receive care close to where they live and we have invested $86 million into our 28-acre medical campus to ensure we can meet that growing need.

Our new hospital is equipped with a remote telemedicine monitoring technology that transmits vital signs and test results for every patient admitted to the hospital to an offsite operations center. There, expert nurses, and intensive care physicians in the case of our critically ill patients, monitor them 24 hours a day, seven days a week.

This round-the-clock care supports the hospital nurses and physicians working at the bedside to ensure that potential adverse trends are identified and addressed as early as possible. The technology has improved patient outcomes in other Banner Health facilities where it is used and we are excited to provide it in our new Fort Collins facility.

Banner Fort Collins Medical Center is our fifth hospital in Colorado, joining McKee Medical Center in Loveland, North Colorado Medical Center in Greeley, East Morgan County Hospital in Brush and Sterling Regional MedCenter in Sterling.

McKee and NCMC were each named among America’s 100 Best Hospitals™ by Healthgrades in 2014 and this year Healthgrades named NCMC one of America’s 50 Best Hospitals™. Many of the same physicians and staff members who have provided that award-winning care in Greeley and Loveland will be practicing in Fort Collins.

Many of you have used Banner Health for care in the past. We opened our first Fort Collins patient clinic in 2001 at 303 Colland Drive on the south end of town. Over the years, we have added providers and clinics to the community, first at 608 E. Harmony Road, and then on Drake Road, just east of Shields Street.

This is a new era in healthcare for Northern Colorado. Our integrated network of medical providers, hospitals, and insurance providers are working together to deliver the best care possible from diagnosis to discharge in cost-effective ways.

On behalf of the 4,700 Banner Health employees working in Northern Colorado, our independent and Banner-employed physician partners, and our volunteers, thank you for the warm reception to Fort Collins. We are committed to delivering an outstanding patient experience for you, your family and your friends.

I invite you to join us on Saturday, March 28, 2015 when we host a community open house at our new hospital from 9 a.m. to 1 p.m. You will have the opportunity to take tours, and meet many of the caregivers who will be working in the new facility. I hope you can attend.

May God bless you, the United States military and the United States of America.

Sincerely, Rick Sutton Chief Executive Officer Banner Health in Northern Colorado

Rick Sutton

4 • NoCo Health Guide

SLEEP TIGHT

Prioritizing sleep to improve your health

With all of the demands on our time – from family, work, and

wellbeing, as well as making their waking hours more efficient. A

maintaining our homes to making time for hobbies and simple

sleep deprived individual is not going to be able to function at the

relaxation – to say that time is at a premium for most people is a

same level as one who is taking care of their health by getting the

vast understatement. Most people are lucky to have a moment to

sleep their body needs.

catch their breath, let alone a get good night’s sleep.

When you look at the pillars of good health, there are three

What keeps us from sleeping? All kinds of things can keep us from getting a good night’s sleep, but many of them are choices

major important factors: diet, exercise, and sleep. While many

we make around bed time. Our constant use of technology and

people really focus on making sure they are eating well and

communication, particularly the various glowing screens we

getting adequate exercise, sleep can often finish last on this list

look at around bedtime, keeps us awake and alert, delaying the

of priorities. In fact, most adults are only getting on average 6 or

hormones that help us fall asleep. Dr. Kukafka recommends a

7 hours per night. We took some time with We took some time

simple common sense solution of simply turning off your screens

with Dr. David Kukafka, a Banner Health pulmonologist and sleep

and enforcing downtime before bed. Winding down in a non-

specialist practicing in Fort Collins and Loveland, to investigate the

stimulating environment – basically in a quiet, dark place without

importance of sleep and how we can do a better job of getting it.

mentally exciting entertainment – makes it much easier to fall

Sleep is important, but how much sleep do we really

asleep. Enforcing a regular waking time every day will also help

need? Most adults need anywhere from 6-10 hours of sleep a

the body regulate the appropriate time for sleep. Routine is really

night, though it is somewhat variable between individuals. Dr.

the best method of getting to sleep and staying that way.

Kukafka points to lifetime trends and sleep habits to determine how much sleep you actually need in a given night.

Each individual functions differently, and often times

What if you really just can’t sleep? 75% of the population suffers from insomnia at some point, and 25% suffer chronic insomnia that lasts longer than 6 months. Insomnia is usually

circumstances determine how much sleep you need. For

caused by stress, and quickly becomes a cycle that is difficult

example, think about how much sleep your body needed as a

to break. Usually, the initial response is a release of chemicals

child or during periods of low stress and good health. If you have

related to stress, but the problem is quickly reinforced by

always been a night owl and an early riser, your body may only

behavior. The process is not wholly understood, but the cycle,

need 6 or 7 hours to maintain optimal function, but many of us

once established, is difficult to break. Seeking professional

sleep for 8 or 9 hours even as children, indicating that we may

help is a good solution, which Dr. Kukafka describes as a likely

need to prioritize getting more hours in every night.

combination of cognitive behavioral therapy and meditation.

Perhaps even more important is to consider how you are feeling

Biofeedback studies on the patient’s sleep patterns and relaxation

during the day. Fatigue, decrease in concentration, depression,

techniques are usually implemented, with medication added to

and anxiety are signs of not enough hours of quality sleep. The

the solution set when necessary. While other techniques should

most common cause for poor quality sleep is sleep apnea, which if

be tried first, medication is often necessary and appropriate

treated can lead to improved sleep and better daytime effectiveness.

because sleep is essential to health, and should be regarded with

Dr. Kukafka says that many people do not make sleep a priority, instead prioritizing hours of wakefulness and “productivity.” He suggests that people look at sleep as being essential to their

the same importance of other medications.

The bottom line, according to Dr. Kukafka, is that there are three keys to health: diet, exercise, and sleep. Good sleep is just as vital to health as these other factors, and should be taken just as seriously. If you have questions or concerns regarding your own sleep health, please talk to your physician to determine if a sleep study is right for you.

6 • NoCo Health Guide

Attacking asthma Asthma affects about 6.8 million children and 18.7 million adults in the

the more objective tests need to always be

U.S. – 9.3 percent and 8 percent, respectively – according to Centers

considered,” says Dr. Culver By combining

for Disease Control and Prevention. Mind+Body took the opportunity

these three layers of information, medical

this spring season to speak to one of the local experts on allergies and

professionals are able to identify whether

asthma, Dr. William Culver of Banner Health, about the exact effects of this condition that impacts so many people.

Though a reversible and readily treated condition, the signs and symptoms of asthma can be uncomfortable and

they can be avoided or at least properly prepared for.”

Children who have respiratory syncytial

frightening for the sufferer and caregiver

virus (RSV), a cold-like infection, are more

alike. Asthma occurs when the smooth

likely to experience recurrent wheezing.

muscle in the lungs constricts and airways

While this is still cause for some concern,

become inflamed and narrowed. This

it is relatively common.

leads to wheezing, coughing, shortness of

Who has it?

breath, and chest pressure or tightness in

The life course of asthma varies

most patients.

considerably across the population.

What causes it?

While the condition is fairly common in

A relatively common condition, asthma

childhood, some outgrow it, others will

might be caused by a variety of exposures

only experience symptoms intermittently,

and is often associated with other conditions.

and still others seem to re-acquire the

Conditions and exposures that are

condition later in life. There are also adults

regularly found to co-exist with asthma

who never experienced asthma symptoms

include eczema, exposure to cigarette

as children but pick it up at age 35 or

smoke, a personal history of respiratory

older. These individuals might not have

infections, a family history of asthma,

a specific trigger, such as allergies, but

nasal allergies, food allergies, and other

might experience progressively severe and

respiratory conditions.

frequent symptoms.

For many, allergies and respiratory infections trigger acute attacks and

Diagnosing Diagnosing asthma is a largely clinical affair.

symptoms, and a small number of patients

Most are diagnosed based on symptom histo-

face triggers in the workplace. For those

ry, tests of lung function (using a spirometer),

individuals with “occupational asthma,” it

and assessment of subjective experience. “All

is important to identify the specific triggers

three of these factors should be taken into ac-

and how they influence symptoms. Dr.

count, though too much emphasis should not

Culver points out that “it is essential in

be placed on the patient’s subjective experi-

every case to try and identify triggers so

ence. We all experience things differently, so

asthma is the cause of patients’ depleted function or experiences of suffering.

What can we do about it?

Fortunately, although having asthma can be scary and uncomfortable, it is readily treatable. For many, a primary care physician is able to oversee management of the condition, but there are asthma specialists, such as Dr. Culver, who are available as needed.

To ensure effective treatment, the first step is to measure lung function as accurately and as promptly as possible.

Once this is done, early and consistent treatment minimizes the potential for longterm, irreversible damage to the lungs.

For children to receive effective treatment, caregivers must: • Recognize signs (not just wheezing) that a child is having a problem.

• Have an action plan in place.

• Know the physician-prescribed protocols for managing symptoms, such as how to use a nebulizer or inhaler.

With early detection and appropriate treatment to keep symptoms under control, few asthma patients face restrictions on their activities and are able to participate in sports, even at the highest levels of competition.

EVERYTHING YOU NEED TO KNOW ABOUT

HPV Human Papillomavirus

According to the American Cancer Society, 12,000 women are diagnosed with cervical cancer every year in the US. With almost no outward symptoms, this disease used to be a silent killer. But with the widespread implementation of regular gynecological exams for women — particularly the pap smear test — cervical cancer is now often caught in its nascent stages and treated before the cancer progresses.

Banner Health This slow-growing cancer is very treatable, especially when

develop these lesions first. The progression of the disease,

caught early in its development. The extensive screening and

starting with the development of these lesions, is well understood

subsequent monitoring means that there is a great understanding

and generally slow. This slow disease progression allows health

of the mechanisms involved, including a strong causational link

care providers to observe how things are progressing and make

with the very common sexually transmitted disease, Human

decisions based on these observations.

Papillomavirus, or HPV.

Testing for HPV

Mind+Body sat down with Dr. Jennifer Rubatt, gynecological oncologist and new member of the Banner Health team, and Dr. Antonio Barbera, OB/GYN and well-published expert with the family of Banner specialists. Mind+Body asked these two exceptional professionals to tap into their expertise and experience with HPV, cervical cancer, and the recent HPV vaccines.

Human Papillomavirus (HPV) HPV has been shown to cause almost all cases of cervical

The pap smear is the most common test performed for women when they undergo routine gynecological exams. This test screens for many different kinds of diseases and disorders, but does not include an HPV test. Most individuals do not need to be tested for the disease itself, and it is not recommended that routine testing be done until the mid to late 20’s for women, according to Dr. Barbera. A regular pap smear, however, tests for any abnormal cells that may be the result of HPV causing

cancer. There are over 100 different types of HPV, though only

changes on the cervix such as precancerous lesions. Most

about 40 of these strains affect the genitals, and not all of these

people, men and women alike, will clear the virus from their

have been demonstrated to cause cervical cancer. In fact, just 2

systems without any outside aid. This is especially true for women

types of HPV can be linked to 70% of all cervical cancer cases

in their 20’s, who usually clear the disease within a year or so,

in the US, says Dr. Rubatt. There are also only a few strains of

meaning that monitoring by a physician will be an adequate

HPV that cause warts, one of the main outward signs of an HPV

course of action for most cases. Dr. Barbera emphasizes the

infection. Further, these two kinds of HPV appear to be clearly

importance of letting the body clear the virus without interference

separate. In other words, the strains which cause warts do not

whenever safely possible.

cause cervical cancer, and vice versa.

HPV is a highly communicable disease, and is spread primarily

Dr. Barbera and Dr. Rubatt both emphasize the importance of regular pap smears for sexually active women. The monitoring

through skin-to-skin genital contact. It is exceptionally prevalent

of any situation with the potential to become more serious, such

throughout all sexually active adult communities, and it is

as abnormal cells which may become precancerous lesions,

estimated that 75% of adult men and women have HPV, though

should be monitored regularly. The single most important factor

the vast majority of these individuals likely show no symptoms

in the treatment of any of these conditions is the maintenance of

and are not aware that they are carriers of the disease. In men,

physician oversight.

there are no symptoms for any strains of HPV except those which

Cervical Dysplasia

cause warts, but there are strains which cause cancers other than cervical. Men can be affected by other cancers that act on the mucosal organs, such as anal and oral-pharyngal cancers.

Drs. Rubatt and Barbera agree HPV should be taken seriously in both sexes, both because of the “silent carrier” still being able to infect others, and because of the potential for the development of cancers.

While in most cases HPV is a minor virus, both harmless and symptomless, it is noteworthy because it has the potential to cause cervical or other cancers. Human Papillomavirus, in some cases, progresses to cervical dysplasia, which is essentially a precancerous lesion located on the cervix. The severity of these lesions varies, but most women who develop cervical cancer

The actions to combat the disease will follow a course of action based on the severity of the dysplasia observed, and the particular circumstances of the patient. Low grade dysplasia will most likely be left to run its course under close observation.

Dr. Rubatt assures that 70-75% of these cases regress and resolve themselves without any intervention, so often times no action is needed. Both of the Banner doctors we consulted also emphasized the wisdom of doing as little “treatment” as possible in every case, because of the potential for long term side effects and the likelihood of the body resolving any issues on its own.

In all cases, it is critical to remain under the care and observation of a physician, but it is particularly essential when the dysplasia is minor and not being actively treated. If the dysplasia

NoCo Health Guide • 9

Banner Health

does not resolve itself and instead becomes more serious,

lesions) to cervical cancer, according to Dr. Rubatt. The

actions should be taken. The exact course of action is determined

widespread implementation of the pap smear, as well as the

by the individual. Many decisions will be based on whether the

examinations most women undergo as a part of their normal

patient is done with their planned child bearing. More aggressive

annual health checks, have allowed the medical community to

excision will be pursued if the patient is out of child bearing years,

gain a clear understanding of these diseases and how they

while the excision will be more conservative if the patient still

should be treated. Cervical cancer rates have been cut drastically

desires children.

with the implementation of pap smears for women, because these

Regardless, this high grade dysplasia will be excised from the

tests allow for early detection of the disease, as well as effective

cervix and the patient will be monitored for some time to verify

treatment methods based on prevalent study.

the success of the procedure. Dr. Barbera emphasizes the need

Possible Symptoms

for less aggressive treatment for younger women, especially those who have not yet borne children and still have plans to do so. While it is not the case every time, excising lesions from the cervix correlates with the likelihood of complications during pregnancy, particularly with the likelihood of premature birth.

Thus, in younger women, Dr. Barbera usually recommends simply waiting until the next yearly test can be administered before taking any action. Minimally invasive action is always best, according to the most recent research.

The regular implementation of the pap smear has been the true key to understanding both the link between HPV and cervical cancer, and the progression of cervical dysplasia (precancerous 10 • NoCo Health Guide

While in most cases there are no outward symptoms of HPV, or of the progression to cervical dysplasia, there are sometimes signs that should not be ignored. The red flags associated with cervical dysplasia can be subtle, but Dr. Rubatt picked out several signs that should not be ignored when they are present. There is no pain usually associated with any of the symptoms, but bleeding after intercourse, or intermittent bleeding between your usual cycles should be considered unusual and noteworthy. These may be symptoms of cervical dysplasia, another condition, or nothing at all. However, if these signs are present, Dr. Rubatt recommends going to see your doctor to get checked out regardless.

Banner Health

Dr. Rubatt also points out that in most cases there are no outward symptoms of anything being amiss even when there is, in fact, a problem. She emphasizes that the best way to ensure your health is to get regular checkups with your gynecologist, complete with a pap smear to check for any irregularities. This will protect against any number of potential issues. The one additional step to protect against HPV and the possible transition to cervical cancer is to take advantage of the HPV vaccine.

Vaccination Protection The vaccine for HPV, which has been available in the US since 2006, until very recently was available in 2 different forms which protect against several different strains of HPV. The FDA approved a third version of the vaccine in December 2014 that protects against 9 different strains of HPV, as opposed to the two previous vaccines which protected against four and two different strains, respectively. All of these vaccines protect against strains of HPV that cause cervical, oral-pharyngeal, anal, vaginal, penile, and vulvar cancers, and also provides protection against those strains that cause genital warts. The newest vaccine is the most broadly protective, extending to nine different strains, which account for 90% of cervical, vulvar, vaginal, and anal cancers.

The vaccine has been demonstrated through extensive clinical trials to provide good protection against some of the most harmful forms of HPV and the diseases it is a progenitor for.

Who is the vaccine for?

This vaccine has been approved for men and women ages 9-26 by the FDA, though it is still effective if administered at any age.

It is recommended for administration for children and preteens, with the most effective age of vaccination at 10-12 years. This is the ideal age for the vaccine because it is not only when the immune system is at its most active, thus creating the most robust response, but this is an age that it is generally assumed to precedes sexual activity. While sexual activity does not preclude the effectiveness of the vaccine, if the individual is exposed to HPV before the administration of the vaccine, the protection is significantly diminished.

So, why is there a “cutoff” age? While the vaccine is still effective after the age of 26, the likelihood of previous exposure is high by that age. If previous exposure has occurred, the vaccine will still have some effectiveness going forward, says Dr. Rubatt. And while exposure to some forms of HPV may have already occurred, there are only certain strains which have been

any protection possible versus no protection at all.

Further, the vaccine is recommended for both sexes because both sexes are carriers, though there is a much lower risk for HPV to cause any disease in men. In order to eradicate HPV, the vaccine must be administered in both men and women to prevent reinfection in the general population. Dr. Rubatt recommends, therefore, that both boys and girls should be vaccinated in their late childhood or early preteen years.

The bottom line, say Drs. Barbera and Rubatt, is that this is a very effective vaccine. Very strong links between HPV and not only cervical cancer, but with multiple other cancers have been demonstrated as more and more research is performed. Any precaution against contracting the disease should be taken, including safe sex practices, vaccination at an early age for both males and females, and regular gynecological examinations for women beginning at the latest in their early 20’s. With additional emphasis on taking these measures, and continued research into HPV and its relation to certain cancers, the outlook for prevention against both of these diseases remains good.

demonstrated to cause various forms of cancer, and the vaccine will still protect against these strains if they have not already been contracted. Essentially, both Drs. Barbera and Rubatt emphasize NoCo Health Guide • 11

Banner Health

Dealing with dementia What are the signs of memory-loss and how to proceed if you see them in a loved one.

The holidays are the time of year for family. For some of us, it's the one chance of the year to get together, catch up, and spend quality time with our loved ones, some of whom probably live far away and we don’t have an opportunity to see at other times. That said, sometimes a year makes a huge difference in terms of the appearance, life circumstances, and health of these loved ones for better or worse.

This is especially true with children and our elderly relatives. Just a year, or even less time, can mark big changes for our older relatives in terms of their health, mental state, and selfsufficiency. What are the things we should be watching out for with our loved ones? Are there red flags we should be aware of? What are the next steps if we suspect there might be a problem? And how on earth do we talk to our family members about these concerns?

Mind+Body asked two of Banner Health’s experts on aging, dementia, and Alzheimer’s Disease for their perspective on the approach to helping elderly relatives to age gracefully, and how to lend a helping hand where necessary. Dr. Christy Young, neurologist at NCMC in Greeley, who specializes in headache care, stroke prevention, movement disorders, and neuropathies, and Dr. Pierre 12 • NoCo Health Guide

Tariot, director of Banner Alzheimer’s Institute in Phoenix, who specializes in geriatric psychiatry, both agreed to speak with Mind+Body about their areas of expertise.

What is the difference between dementia and Alzheimer’s?

Dr. Young: Dementia is a blanket nonspecific term for memory loss of any kind and may have reversable or non-reversable causes (may be attributed to endocrine issues, head injury, etc.). Alzheimer’s is the most common “dementia” that is a progressive neurodegenerative disease. We are not able to do brain biopsies, which is the real method of diagnosis. The Banner Alzheimer’s Institute program has established that the best way to diagnose and treat is a multi-disciplinary team approach including geriatric psychiatry, neurology, PT/OT/ST evaluations. There are

also better imaging techniques now, with PET scan showing if patient s have the tangles and plaques that can be markers in the brain for Alzheimer’s (however, insurance companies are not typically paying for this test currently here in Colorado).

What are some red flags to look out for during the holiday season?

Dr. Young: Some red flags to look out for are withdrawal from family members over the holidays, particularly during gettogethers, which is possibly due to difficulty with and the associated embarrassment over remembering names. Forgetting simple words on a frequent basis, poor or decreased judgment, repeating questions over and over after they have already been answered, loss of initiative or desire to leave the house, or general changes in personality, depression, or apathy are all possible signs of the onset of dementia or other issues.

Fast changes in memory are not typically Alzheimer’s or dementia, but may be normal pressure hydrocephalus (if gait problems, incontinence, and memory loss are also present), or signs of an infection such as a urinary tract infection (elderly will tend to get very confused with UTIs).

Dr. Tariot: This varies between individuals, but generally having a hard time with the

Banner Health changes in routine during the holidays might indicate the development of a problem with memory. Even changes in family traditions might cause discomfort and resistance, because routine and the same expected things day in and day out is much easier for them to handle. Over stimulation caused by music, parties, decorations, and large groups might wear the older relatives out, so planning for them to opt out of large groups and scheduling rest times are a good idea.

Some general red flags, however, might be repeating questions, not recognizing people, getting lost, trouble finding the right words, change in temperament, a declining ability to function or organize money, mail, meal prep activities, trouble with problem solving/ planning, and in some cases neurological signs like difficulty walking or maintaining balance.

may exacerbate otherwise minimal symptoms.

Once the stress of the holidays is past if there is still a large degree of confusion, then you should seek medical attention promptly. You should see the primary physician first for an evaluation, and they can then help with the next steps, whether it be to simply change some routines at home or to send your family member to a specialist. All cases differ, so there is no real one-size-fits-all answer.

What could be considered a “normal”

What are the options for getting your

level of confusion to be expected in

loved one assistance, if you suspect

older people?

Dr. Young: There isn’t really a normal level of confusion for older people. Many people are quite sharp into their later years.

Some “normal” senile behaviors are mild forgetfulness, which is usually related to heart disease or other chronic conditions.

Dr. Tariot: Some slower processing times when asked questions, not being quite as sharp in recalling names, and being a bit tired or grumpy would probably be considered normal as long as they aren’t affecting the individual to a detrimental degree.

If you suspect there might be an issue, what is the next step?

Dr. Young: Always start with your primary care for evaluation, they will typically do a mini mental status exam (MMSE) and test some basic lab work such as vitamin deficiencies such as vitamin D and B12. They will see if there are underlying cancers, or an underlying thyroid problem that hasn’t been diagnosed.

They will likely do a new depression screening, and typically they will get a CAT scan of the brain to rule out things like a tumor or hydrocephalus or strokes. Many mini-strokes can cause memory problems. If these issues are suspected an MRI might be needed or they will refer you to a neurologist for further testing.

Dr. Tariot: Be on the alert during the holidays, but wait to make any conclusions until after the holidays are over and the stress has been reduced. The over stimulation associated with the busy family get-togethers

When is it appropriate to go to a doctor or seek outside help?

Dr. Young: Any time there is a question or concern over memory it is a good time to start with a primary care physician for evaluation.

Dr. Tariot: If, after the stress of the holidays, the confusion and general concerns have not gone away, it is an appropriate time to go to a primary care physician.

power of attorney needs to be established, living wills need to be done early; they also may look into re-evaluating their insurance and if there is a nursing facility that they would like to have as an option. I have the family remove guns from the home, make sure they don’t have car keys easily found by doors if the patient is sundowning or confused at night; lock doors, and do general safety measures in the home. Additionally, organizing the home, and creating a lot of structure, like putting boards up with the day of the week, time, information about appointments, and planned activities decrease the stress of the patient. Nursing homes are usually something I recommend when the family is not able to care for the loved one, or there are significant behavioral problems, such as wandering, combativeness, or other complications.

However, some families simply wish for the loved ones to be cared for in this way. This

... generally having a hard time with the changes in routine during the holidays might indicate the development of a problem with memory. they cannot manage their lifestyle on their own?

Dr. Young: Every family cares for their elderly differently but there are great memory programs here in northern Colorado and memory nursing facilities that we can recommend depending on the specifics of the patient. This is typically done with your neurologist over time after discussion of medications, labs, imaging, and other patient needs.

Cognitive therapy, computer learning games, and brain games that challenge the patient are extremely important for dementia patients, however with more advanced cases the “new memory” will not be formed and the therapy can be frustrating. We always encourage continued learning, however cognitive therapy would not be useful in advance AD. What are some changes to make at home to help in dealing with the onset

varies among families.

Dr. Tariot: Actions at home to help the patient stay comfortable are all geared towards trying to create simplicity and consistency in routines and communication.

Emphasis on positive events like walking the dog, looking at family memory books, watching tv shows they love, and eating comfort foods are excellent ideas.

Maintaining routines is also very important. If family is visiting for the holidays, they should not stay in the house, and gifts should be simple and geared around evoking positive memories and emotions, like a memory book filled with photos of events they would remember, gifts of their favorite foods or chocolate, or favorite music of their day. Also, the family should remember to keep things simple when visiting, avoiding grudges or topics that will lead to conflict. The family should speak ahead of time and agree on safe topics and things to avoid.

of dementia or Alzheimer’s?

Dr. Young: I always go over in initial assessment that the family needs to get organized as to the patient’s wishes, DNR status, etc. Power of attorney and medical NoCo Health Guide • 13

Banner Health

Coldu & Fl

TIS THE SEASON Tis the season….not just for family, good food,

individuals, should be nothing to worry about. They are a

and holiday cheer, but unfortunately aches,

week or two of feeling generally bad, with sniffles, maybe

pains, colds, and flu. During a time of the year

an intermittent cough, achy joints, and being rundown.

One or two trips to the grocery store to pick up a supply

when there are continuous sniffles, aches,

of tissues, cough drops, and over-the-counter cold meds

and coughs, how do you know when to tough

should resolve the issues. Most of us are very familiar with

it out, and when to seek help? Certainly you shouldn’t trek to the doctor for every sneeze… should you? Do you wave the white flag and resign yourself to chicken noodle soup and a blanket, working from your couch until spring?

Mind+Body asked one of Banner Health’s expert doctors exactly these questions. Dr. Grant Taylor, family medicine physician practicing at Banner Health Center in Fort Collins, agreed to share with us his expertise in surviving cold and flu season.

Cold Season Unfortunately, cold season got its nickname for a very good reason. We all expect a few colds or minor illnesses every year, which is completely normal, according to Dr. Taylor. These illnesses, if we are generally healthy

14 • NoCo Health Guide

this routine, based on annual repetition of similar symptoms, treatments, and outcomes.

Dr. Taylor advises that this is very routine. The best course of action in most cases is to take care of your symptoms at home with over the counter medications to stay comfortable.

For mostly healthy individuals, going to the doctor is probably not necessary for a common cold or the flu. Letting the body deal with the illness and resolve it on its own is the best course of action whenever possible. Exceptions to this will be when there is an elevated fever, if the symptoms last for more than a week or two without signs of improvement, or if there is a progressive or rapid deterioration in condition.

At these points, a physician should be contacted.

To Call Out or Not to Call Out Perhaps the most pressing question for everyone during the winter months in terms of illness is when it is appropriate or necessary to stay home from work, or keep the kids home from school. This question depends a bit

Banner Health

more on the individual, says Dr. Taylor. The major thing to

•• Are you moving around ok?

keep in mind is whether you are feeling good enough to be

•• Are you behaving/feeling mentally ok?

productive, and not a distraction to others. For example,

In general, the threshold of seriousness should be how

he says, if you have a coughing fit every other minute, and

close the sick individual is feeling to “normal.” If they are

have to blow your nose in between each one, it is probably

seriously incapacitated, cannot breathe well, are too weak to

best to just stay home. Not only will you most likely not be

move around, or are confused or mentally compromised, it is

productive in your workplace, you will be exposing everyone

time to take the symptoms seriously and seek medical help.

else to your germs and potentially spreading your cold to your officemates. Once your symptoms are improving, Dr. Taylor advises that it is probably ok to head back to work.

The same general guidelines apply to keeping the kids home from school. If they will be distracting to the other children and prevent effective concentration for themselves and their classmates, they should most likely stay home.

Additionally, Dr. Taylor points out that any time there is a fever present, kids should definitely stay home and rest.

Serious Symptoms While most of the winter colds are minor, and more of an uncomfortable inconvenience than anything, sometimes the symptoms warrant immediate attention in an emergency room. Essentially, these red flag symptoms can be summed up as the following basic wellbeing questions:

The major thing to keep in mind is whether you are feeling good enough to be productive, and not a distraction to others.

The thresholds for the “wait and see” approach outlined above as a general course of action should be reduced for both the very young and the very old, and for those with a history of health problems. These groups tend not to be as robust as mature adults in good health, and should receive professional medical attention sooner since they are more at risk to develop severe symptoms.

•• Are you breathing ok?

•• Are you going to the bathroom ok?

NoCo Health Guide • 15

Banner Health

Fort Collins Medical Center

Banner Health

In 2015, Fort Collins will undergo massive changes in its progress with growth and evolution toward becoming a true metropolitan center. It is no secret that Fort Collins is one of the best places in the country to call home, making appearances on any number of lists naming the top cities to live in over the last decade. In the past few years, the population of the rest of the country has listened, moving en masse to the Northern Colorado region. With this new population comes new housing developments, new retail centers, and a new hospital: Banner Health’s Fort Collins Medical Center.

The facility The brand new, state-of-the-art facility is not only a destination for world class medical care right here in our backyard, it is a beautiful destination on the south end of town for medical needs of the region. This is the 28th hospital in the Banner Health System, and as such it exudes the kind of refined sophistication that comes with extensive experience. Banner Health’s Fort Collins Medical Center benefits

18 • NoCo Health Guide

from every facility that has come before it, accounting for every possible detail and troublesaving measure.

The hospital is a large self-contained facility, though not so large that it would be easy to get lost within confines. The layout is logical, with separate wings dedicated to different areas of care. For example, the emergency services and the regular Banner Health Clinic are located exactly opposite of one another on the ground floor. Part of the beauty of the design is that

Banner Health The main lobby features plenty of Colorado’s natural beauty in the wood and stone accents. Walking in feels like coming home.

it accommodates the emergency and the clinic services equally. The many specialists practicing in the new facility are accessible both quickly and easily. Those requiring the care of multiple doctors do not need to trek across town to different facilities, in most cases. Many specialists are housed within the Fort Collins Medical Center building, providing a convenient solution for patients, especially those requiring extensive and complicated care.

The building itself is beautifully detailed.

Elements of the design are inspired by our Northern Colorado environment, from wooden ceiling panels that resemble stands of aspens, to aspen leaf patterns in the frosted glass, to rock detailing throughout the building. Little pieces of Colorado are incorporated into the facility effortlessly, making it feel truly like a comfortable almost-home. The red rock lining the entryway in the main lobby brings the feeling of the foothills into the halls of the hospital and sets the tone for the facility.

While some measures have been taken to welcome the feeling of the outdoors in, other measures have been taken to keep the outdoors more safe and welcoming for patients and their families. Small details like the heated sidewalks and walkways around the building become major benefits during the long Colorado winter.

Banner Health has taken into account that living in Colorado means that sometimes the weather impacts our ability to get out and about safely. Snow is a reality of life here, but people need access to medical care in all seasons. The heated walkways ensure safety on the way into the hospital, where snow and ice have no chance and the walking areas are clear and dry.

The many floor-to-ceiling windows in the hallways provide lovely views as well as a sense of greenery and natural beauty, courtesy of our ever-present mountain vistas and the gardens full of native plants right outside the windows.

The rooms themselves incorporate lots of NoCo Health Guide • 19

Banner Health

natural light, using big windows whenever possible to create big, airy, welcoming spaces for the patients.

This is especially striking in the labor and delivery rooms, which feel more like rooms in a home than in a hospital.

Emergency and trauma bays are outfitted with the latest high tech life-saving equipment.

One of the details that is easy to miss while visiting the hospital is one of comfort and would be most evident if it was not in practice. The sound system throughout the hospital has been engineered and calibrated to provide a low level of white noise, eliminating the echoing, ambient noise of a hospital facility and replacing it with soft music. The system adjusts itself throughout the day and night, getting louder at peak activity times and softer in the depths of the relatively silent night. This provides a sense of comfort for the patients and visitors, allowing for relaxation without the disturbance of unexpected loud noises.

In the emergency department, there is special attention to serving the patients 20 • NoCo Health Guide

in the most comfortable and care-first manner possible. While every emergency room has a policy of prioritizing the most life-threatening situations, Banner Health has made a commitment across its entire hospital network to 30 minutes from door to doctor. This means that, barring a truly out-of-the-ordinary circumstance, a patient can expect to be seen within 30 minutes of checking in at the emergency department. One of the things that is so remarkable about this emergency department is that when patients are being seen by one of the

Banner Health

medical stafff, they will be in a private ward. The emergency cases are not out in a communal open ward, but each patient is seen within enclosed walls, protecting the safety, security, and privacy of both the patients and their loved ones who may be with them at the hospital.

One detail provided exclusively for the comfort and peace of mind of the families of patients is that each patient is assigned a number upon intake, and this number stays with the patient throughout the duration of their care.

There are monitors in the waiting rooms, the cafeteria, lobbies, and other areas of the hospital. The monitors are tuned to a patient tracking system, which displays the numbers associated with the patients, and where they are located within the hospital. This system allows families the peace of mind to leave the immediate waiting area, which is frequently very stressful, and know that as soon as their loved one is out of surgery, done with a procedure, or has been moved to another

department, they will be notified. It is this collection of small details that really sets the Fort Collins Medical Center apart from any number of other hospitals, both in Northern Colorado and throughout the country.

The labor and delivery suites are full of natural light and have space to accommodate mother, baby and visiting family members comfortably.

The specialties The new Banner Fort Collins Medical Center is not just a hospital with emergency services, it is a diverse medical facility with specialists spanning many different fields. While the emergency services are top notch at the new hospital, the hospital itself offers so much more: •• Emergency care •• Orthopedics •• General surgery •• Women’s health •• Labor and delivery •• Gastroenterology •• Urology •• Pulmonology •• Intensive care •• Other surgical services Meet some of the many new specialists NoCo Health Guide • 21

Banner Health

THE LAYOUT First floor •• 11 emergency department exam rooms and 2 major treatment/ trauma rooms •• Medical imaging: CT, MRI, nuclear medicine, X-Ray, ultrasound •• 4 labor, delivery, recovery, postpartum (LDRP) rooms and a C-section operating room •• Full-service kitchen and dining •• Laboratory providing inpatient and outpatient services 24 hours a day/ 7 days a week •• Attached Banner Health Center with 16 exam rooms Second floor •• 18 inpatient rooms including medical, surgical, pediatrics and intensive care •• 2 operating rooms •• 17 pre-operation and postanesthesia care rooms and 3 procedure rooms

22 • NoCo Health Guide

The new patient rooms feature large windows overlooking the courtyard, beautiful sliding frosted glass doors and the TeleAcute monitoring system.

coming to the new Fort Collins Medical Center in the following pages.

While this is not an exhaustive list, some of Banner Health’s best and brightest shared some of the things that set them amongst the top tier of medical professionals in the country.

TeleAcute Care While many local hospitals include this safety feature in their intensive care units, Banner Fort Collins Medical Center is the only hospital in Northern Colorado to offer this incredible feature for every patient of the hospital. Every room is equipped with this system, which monitors the vital stats, test results, and other patient information.

The information is monitored in real time from a remote location by nurses, whose responsibility is to track the trends in patient statistics, looking for patterns or warning signs of impending trouble. These nurses act as a second layer of defense; a safety net and backup for emergency or

unexpected situations. They are not in place as primary caregivers, and in no way replace the hands-on care of the doctors and nurses on site.

This system is all about patient peace of mind. While the remote monitoring is usually carried out passively, and the patients themselves may never know it is going on, if an emergency situation arises direct contact can be initiated by the remote monitoring center or by the medical staff in the room. Every room is equipped with a screen, speaker, and camera, which allow the remote nurse and the patient to speak face to face.

This allows for an outside consultation at the literal push of a button by the medical staff, and a first-hand look at the patient by the remote staff if they become aware of an adverse trend or other situation that causes alarm. This real-time, round-the-clock tracking is a second layer of defense and takes the care in Banner’s FCMC facility from excellent to truly exceptional.

Banner Health

Choosing the RIGHT doctor Choosing a medical professional to care for you and your family can be a daunting task.

Caregivers impact health directly, can have significant implications on the financial future of patients and their families, and can cause or alleviate incredible amounts of stress in everyday life as well as in the most difficult circumstances most of us will ever face.

Medical professionals don’t just treat our pain and suffering when we need an injury tended or an illness treated. They are the givers of advice, the providers of comfort, the charters of our path toward wellness, and often they are also the first shoulder we cry on and the first hug we receive in the saddest of times.

The importance of a trusting relationship between a medical professional and patient cannot be overstated. Aside from the trust necessary as a patient to simply believe in the medical training and expertise of professionals, there is also a necessary lowering of barriers and sharing of personal and private information in order to facilitate this care.

A medical professional has access to nearly all that a person holds dear to themselves. This is no small responsibility, and it is one that is taken very seriously by professionals in the field.

Whether it is a primary care physician, a pediatrician for your children, an oncologist, or another specialist to treat a specific ailment, choosing a doctor is never easy. While most of us in the modern health care system in our country have our decisions shaped in large part by insurance providers, there is still decision making necessary within one’s network of physicians. Especially in places like Northern Colorado where there are many options for medical care,

“Patients need to trust, which means physicians need to be open, available, honest, and help deliver a positive experience.”

NoCo Health Guide • 23

Banner Health

“Your provider should show natural interest and a curiosity in who you are, and what your ‘story’ reveals to them.” knowing what is important to look for in a physician is very important.

For the sake of argument, assume that all of the necessary prerequisites for choosing a medical professional, like insurance, location, good legal standing, and appropriate licensure, are all taken care of, satisfying the criteria. When it really gets down to the dynamics of the relationship between the physician and the patient, one thing stands out above the rest — the need to ask questions.

Asking questions is probably the most important advice when choosing a doctor, even according tow the doctors themselves. Any good doctor puts the needs and experience of the patient first and foremost. As a patient, being proactive with your health helps doctors and providers make sure you not only get the best care, but also have a positive experience with your doctor. Taking a passive approach – not being invested in your health or educated on your specific needs – makes it difficult for doctors to do the same. Communication, trust, and a collaborative approach to your health should be priorities when choosing the right doctor.

“Patients need to trust, which means physicians need to be open, available, honest, and help deliver a positive experience. This is a shift in paradigm from what many patients may be used to, but it is vitally important for patients and providers to have mutual trust,” says Dr. Jay R. Kurth, a family practice physician with Banner Health. “The trust especially comes into play when we ask for patient histories, and the clear communication on diet, exercise, lifestyle, and drugs. If the patient is not forthcoming with this information, it can have real negative impacts on treatment.”

Dr. Jennifer Main, an internal medicine physician treating patients in Fort Collins’ Colland Drive Banner Health Clinic, makes another vital point. “It is important to patient care that a physician is not only competent, but engaged and invested in you as the patient. Your provider should show natural interest and a curiosity in who you are, and what your ‘story’ reveals to them. They should also listen to your input and opinions, and attempt to include you in their problem solving.

A physician should treat the patient as a vital teammate in pursuit of a shared goal: your health and well-being. This kind of engagement is not only important because it demonstrates to the patient that the physician actually cares, but it is more likely to create a relaxed atmosphere where the patient feels they can share sometimes intimate and uncomfortable details.”

Dr. Antonio Barbera, an obstetrician/ gynecologist practicing out of Banner Health’s new Fort Collins Medical Center, emphasized the trust inherent in his

specialty. “Trust is the most important factor in any good relationship, and that patient/doctor relationship is no different. Open communication based on reciprocal respect is the key to good care. Personalized care is so important, especially in my field. Being able to listen to patients’ needs, and being able to treat every patient with compassion is essential.

Transparent care, where the patient knows why the physician is making the decisions they are making, is one of the biggest factors of gaining that trust. I try to always do my best to put my patients at ease, and to look at them as a whole person, including body and spirit, and not to look at them as a series of stagnant compartmentalized symptoms.”

“When you meet a doctor and you feel you can communicate effectively and easily, and have the doctor understand your needs, care about addressing them, and you feel that in your time with them you have all of his or her attention, this is a doctor you want to keep. He/she will do his/her best for you.”

“I try to always do my best to put my patients at ease, and to look at them as a whole person, including body and spirit, and not to look at them as a series of stagnant compartmentalized symptoms.”

NoCo Health Guide • 25

Banner Health

Meet the Doc...

Antonino “Antonio” Barbera, MD, OB/GYN

David S Kukafka, MD, FCCP, FAASM

How long have you been with Banner?

How long have you been with Banner?

I joined the Banner Health Clinic, specializing in obstetrics and gynecology in Greeley in August 2014. I began practicing in Fort Collins in February 2015 and I am very excited to be involved in the opening of the new Banner Fort Collins Medical Center in April 2015. My office will be at the Banner Health Center on the Banner Fort Collins Medical Center campus.

Since 2012. I have been practicing in Northern Colorado since 1998.

What is your area of expertise/specialty?

What is your area of expertise/ specialty?

Why did you decide to become a doctor?

What is your area of expertise/specialty?

I am an obstetrician/gynecologist.

I am the founder and world leader on the use of transperineal ultrasound in the assessment of fetal head descent in the birth canal during the second stage of labor.

What is the most rewarding part of your job?

I like to be able to place my patients at ease to allow them to always be themselves. I invite them to never apologize for being emotional and to feel free to share their feelings with me. It does not matter if the encounter with my patients is related to a small issue: I try to always connect with the soul of the person in front of me. It is surprising how often small complaints are only the tip of an iceberg that needs deeper attention.

What is your favorite part of living here in Northern Colorado?

I have been in Colorado for a total of 15 years now but the unique geography of this area was new to me. The beauty of this geography is absolutely amazing, from lakes to rivers, from prairies to mountains. I definitely miss the ocean of my motherland Sicily though.

26 • NoCo Health Guide

Sleep medicine, pulmonary diseases and critical care medicine Why did you decide to become a doctor?

No specific reason, just felt right as I was finishing college. Best decision I have ever made.

What is the most rewarding part of your job?

The daily interaction with patients and the ability to make a difference in their lives on a one to one basis.

What is the hardest part of your job?

The physical demands of covering nights and some of the administrative challenges that are part of the job.

What is your favorite part of living here in Northern Colorado?

The ability to live a quality lifestyle in a beautiful environment.

What are your hobbies? What do you do for fun?

Golf, guitar, hiking, exercise and anything involving baseball.

Tell us about your family.

I have a wonderful wife and 5 children and stepchildren, all in various stages of high school and college.

Barbara L. Emerson, MD How long have you been with Banner?

5 years Hospitalist / internal medicine My work philosophy is to find something that you enjoy doing which contributes in a positive way to the world and people around you. I find medicine a fulfilling way to serve and assist others with their precious gift of health.

What is the most rewarding part of your job?

I enjoy connecting with patients and their family members to help with their journey through medical issues. When I can spend time connecting with a patient and they tell me that I helped them, I know my day had value.

What is something you wish patients knew?

Not all medical information reported in the news or on the Internet is accurate.

Additionally, certain things you read or hear from others’ experiences may not apply to your condition.

What is your favorite part of living here in Northern Colorado?

I really enjoy being outside under the beautiful, blue skies on sunny days. The friendliness and neighborly attitudes of people who live here are what make this such a popular and wonderful place.

Banner Health

Beth Gibbons, MD

David Blatt, MD

Lawrence Schoelkopf, MD

How long have you been with Banner?

How long have you been with Banner?

How long have you been with Banner?

I started in August 2013.

What is your area of expertise/specialty?

Neurosurgery Why did you decide to become a doctor?

I was fascinated by the human body, and science, and wanted to be in a career where I could help people.

What is the most rewarding part of your job?

Helping patients get better and be able to do activities that they love and were not able to do before.

What is the hardest part of your job?

Having to give patients and families bad news about a diagnosis, and not being able to help someone to get better.

What is your favorite part of living here in Northern Colorado?

Getting to be active in the mountains, hiking and skiing, and the sunshine!

What are your hobbies? What do you do for fun?

Skiing, hiking, snowshoeing, tennis, cooking, and spending time with my husband.

Tell us about your family.

I am married to my wonderful husband of 10 years. I grew up in Michigan, where my parents still live, and I have an older brother and younger sister.

I have been with Banner since October 2012.

What is your area of expertise/specialty?

I am a neurosurgeon, with an emphasis on minimally invasive surgery of the brain and spine.

Why did you decide to become a doctor?

I decided to become a doctor due to my interests in the life sciences and a desire to make a difference in the lives of others.

What is the most rewarding part of your job?

The most rewarding part is in helping my patients return to the life and activities they enjoy.

What is the hardest part of your job?

The hardest part is having to tell a patient or family bad news such as a malignant or incurable brain tumor or that their loved one has been seriously injured or that there is nothing I can do to help their problem. What is something you wish patients knew?

I have been with Banner for 6 ½ years.

What is your area of expertise/specialty?

General surgery Why did you decide to become a doctor?

I love the science, technology, and relationships that go hand in hand with a career in medicine. I believe that I am called to the service vocation of medicine to help alleviate the anxiety and affliction that affects patients with surgical problems.

What is the most rewarding part of your job?

The most rewarding part of my job is meeting patients and their families, establishing authentic relationships, and providing excellent surgical care so patients can return to their normal lives.

What is something you wish patients knew?

I would like patients and parents of patients to know that my goal with every patient is to treat them like a member of my own family.

I wish patients and their families knew how much I want to be able to help them.

What is your favorite part of living here in Northern Colorado?

What is your favorite part of living here in Northern Colorado?

My favorite part of living here is now being close to two of my children who live in Fort Collins. I do also enjoy the numerous opportunities for shopping, restaurants and activities.

I love the open spaces and outdoor activities available in Northern Colorado.

Tell us about your family.

I have been married for 30 years and we have four sons. My eldest is an Air Force pilot.

NoCo Health Guide • 27

Banner Health

Meet the Doc...

Eric James Gardner, MD

Arnold E. Pfahnl, MD, PhD, FACC, FHRS

Ryan R. McWilliams, MD

I started working for Banner in November of 2014.

How long have you been with Banner?

I have been with Banner Health since July 2014.

What is your area of expertise/specialty?

What is your area of expertise/specialty?

How long have you been with Banner?

I am a board certified orthopedic surgeon.

I did do a sports medicine/arthroscopy fellowship but I enjoy doing general orthopedics. This means that I take care of a variety of orthopedic problems including sports injuries, arthroscopy, ACL surgery, meniscus surgery, rotator cuff repairs, shoulder instability, hand surgery, fracture surgery, and joint replacement of the shoulder, knee, and hip.

Why did you decide to become a doctor?

My father was a physician. Although he always tried to get me to do something else, I first became intrigued with the human body in my high school biology and physiology classes. I was exposed first hand to the job satisfaction that my father enjoyed and wanted something similar.

What is the most rewarding part of your job?

The best, most rewarding part of my job is being able to physically help my patients improve their quality of life and return to physical independence. There is nothing better than feeling and seeing true gratitude from a patient after surgery. That’s what keeps me going to work.

6.6 years Cardiac Electrophysiology Why did you decide to become a cardiologist?

Even before medical school I was fascinated by the mechanical and electrical systems of the heart. I find it fascinating that the systems of the heart are complex but can be understood in a very logical way. Cardiology as a specialty sits on the border between medicine and surgery. In medicine you see patients, make a diagnosis but often are unable to provide a cure. In surgery, on the other hand, you can often fix the problem. In cardiology, rapid technological advances including the ability to perform complex procedures have the ability to significantly improve patients’ lives and sometimes even cure heart problems.

What is the most rewarding part of your job?

I value the one-on-one contact I have with patients. I feel I am a part of my patients’ lives, which is a very special privilege for me.

What is the hardest part of your job?

Sometimes I don’t have an immediate answer to a problem, which means waiting until I have the all information to make the best decision for the patient.

What is something you wish patients parents of patients knew?

I will take the time to listen and provide the best care possible.

28 • NoCo Health Guide

How long have you been with Banner?

What is your area of expertise/specialty?

I specialize in gastroenterology.

Why did you decide to become a doctor?

I first became interested in medicine because I enjoy the science behind it. As part of my development as a physician I became involved in the research of liver disease.

While this intrigued me, I missed being around and caring for patients. Most of all I find solace in being able to reduce the fears patients may have when they are sick and need a compassionate caregiver.

What is the most rewarding part of your job?

The most rewarding part of my job is being able to share in my patients’ stories about their health and then helping them to get on a track to wellness.

What is the hardest part of your job?

The hardest part of my job is breaking bad news in regard to diagnoses that are life changing and affect entire families.

What is your favorite part of living here in Northern Colorado?

I love the laid-back lifestyle, the kindness of the people and being close to the area where I grew up.

Tell us about your family.

Our family moved to Northern Colorado last year. I have three amazing children and a wonderful wife who serve to make every day the greatest.

Banner Health

Jill Hanck, MD

Grant Taylor, D.O.

Christy Young, MD

How long have you been with Banner?

How long have you been with Banner?

How long have you been with Banner?

I joined Banner 4 years ago when TeamHealth began staffing North Colorado Medical Center’s Emergency department.

What is your area of expertise/specialty?

I am an emergency medicine physician.

This means I care for people who choose the Emergency department because they are scared or in pain, as well as people with critical emergencies needing immediate stabilization to prevent loss of life and limb. It is an extraordinary field allowing me the opportunity to care for patients and their families in all stages of life from newborn to elderly.

What is the most rewarding part of your job?

There are so many! Making a connection with patients and their families whether it is during a critical life event or an everyday illness. Working with a fantastic team of physicians, nurses, technicians and EMS professionals who are all focused on patient care. Learning something new every day.

What is something you wish patients, parents of patients knew?

Physicians have responsibilities to the individual patient as well as the community.

For example, physicians protect the community from inappropriate use of antibiotics, by advocating a “wait and re-evaluate” strategy for treating viral sinusitis, viral bronchitis and otitis media, instead of prescribing antibiotics on the first physician visit.

What is your favorite part of living here in northern Colorado?

I am a Fort Collins native and thrilled to be home. It is a treat waking up in sunny, beautiful Colorado near friends and family.

Since 2008 What is your area of expertise/specialty?

Family Medicine Why did you decide to become a doctor?

During college I had several health care related job experiences working as an athletic trainer for Pepperdine University’s sports teams, and working with several friends as a part time in home care giver for a man who was quadriplegic. After college, I worked in a cardiac rehabilitation program. During these experiences I enjoyed interacting with a variety of patients and it was exciting to learn about medicine and science.

What is the hardest part of your job?

Trying to work through or around patient’s social situations are often the hardest parts of the job. Common scenarios such as limited finances, lack of health insurance, inadequate housing, alcohol or drug abuse, and difficult family or work relationships make it very challenging to manage patient’s health care.

What are your hobbies? What do you do for fun?

My 2 best friends are my English Mastiff and German Shepherd. I enjoy playing as much golf as I can with my wife and 2 daughters.

Golf is a great sport that you can spend several hours of quality family time with a spouse or child and there are so many beautiful courses to play in Colorado. My brother lives out of state and we enjoy playing a lot of online video games together to stay in touch.

About 3 years now.

What is your area of expertise/specialty?

I specialize in General Neurology with an emphasis in Stroke, Headache, and Movement Disorders.

Why did you decide to become a doctor?

I was lucky enough to shadow a Neurologist while I was in undergrad and loved the complexities of Neurology. I felt like it would be a field that would evolve and always be interesting.

What is the hardest part of your job?

We do a lot of chronic disease (or diseases that are treatable but not curable) and intervention is not always possible. That is always hard to deal with.

What is something you wish patients or parents of patients knew?

Exercise and diet are much of the battle towards good health. Many simple things can be done in everyday life to prevent stroke risk through foods they choose and lifestyle.

What is your favorite part of living here in northern Colorado?

Fort Collins is a great college town, plus we have both the city and the mountains right near us.

What are your hobbies? What do you do for fun?

I enjoy working out, cooking, sculpture, reading and spending time with my family.

Tell us about your family.

I have 2 sons and a grandson who keep me smiling!

NoCo Health Guide • 29

Banner Health

Meet the Doc...

Gregory Golden, DO

Garrett M. Snyder, MD

How long have you been with Banner?

How long have you been with Banner?

This is my second stint, and it’s just shy of 2 years. I did also work for Banner while in college from 1999-2003 as well.

What is your area of expertise/specialty?

Pulmonary and critical care medicine Why did you decide to become a doctor?

I originally wanted to deliver babies and take care of sick kids. I later found another area of medicine that was a better fit for me.

What is the most rewarding part of your job?

Educating people about how to improve their health What is the hardest part of your job?

Telling people their disease cannot be cured What is something you wish patients or parents of patients knew?

That the decisions you make for your body affect more than just yourself, they affect your loved ones just as much if not more.

What is your favorite part of living here in northern Colorado?

I love being close to my family, which is here.

What are your hobbies? What do you do for fun?

I lost hobbies of my own when I started having children. I enjoy going to my children’s activities.

Tell us about your family.

I have a wonderful wife of 11 years and 3 children ages 7, 4, and 1. We’ll also have a 75 pound Weimaraner.

30 • NoCo Health Guide

3 months What is your area of expertise/ specialty?

Orthopedic Surgery and Sports Medicine. I specialize in treating disorders of the shoulder, knee, fracture care, and joint replacement.

What is the most rewarding part of your job?

The most rewarding part of my job is helping people return to their previous level of function.

What is the hardest part of your job?

The hardest part of my job is when treatments and interventions exhaust the limit of medical knowledge and are still not enough.

What is something you wish patients or parents of patients knew?

I will do everything in my power to help them get better and that I always have their best interests in mind.

What is your favorite part of living here in northern Colorado?

My favorite part of living in Northern Colorado is the accessibility to such a wide variety of outdoor activities.

What are your hobbies?

What do you do for fun? I enjoy skiing, mountain biking, hiking, SCUBA diving, going to sporting events and traveling.

Tell us about your family.

My wife and I have been married for 3 years.

No children yet, but we do have a beagle that we love very much!

What’s Your Risk?

Hereditary cancer and when to get tested T

he holidays are a time we can relax and reflect, and be thankful for

performed to test for genetically linked

health, happiness, and family. Unfortunately, for some of us it is not a

cancers. These include more than one

time without at least some sadness, too. It is a time to remember loved ones who left us too soon, to reminisce about the past, and to plan for the future.

Many of us have family members with cancer and other diseases. There has been a lot in the news recently about

or two family members being diagnosed at a young age, multiple family members diagnosed with the same specific cancer,

indicate a different approach to cancer

or a family member being diagnosed with

screening than for the average person.

a very rare cancer. Family relationships

Some of the most commonly inherited

which may indicate a possible cancer

different cancers with strong hereditary

types of cancers are various kinds of breast

risk can be varied though, and should be

links, and the necessity for evaluating

cancer, ovarian cancer, colorectal cancer,

evaluated on an individual basis.

the risk you may have of inheriting

and some pancreatic, thyroid, and prostate

specific cancers that are considered to be

cancers. A very specific screening process is

to be likely for an individual, the actual

genetically linked. This holiday season,

undertaken to determine if there is any risk

treatment would likely not differ between a

consider having a conversation with family

for a heritable form of cancer. A strong family

hereditary cancer and any other form, aside

members about health history of relatives

history for any of these known heritable

from the level of diagnosis. There have not

to gain insight to your potential risk factors.

cancers is first taken, and if the risk is still

been any differences in outward symptoms

determined to exist, genetic testing may be

or features of the actual disease when it is

demonstrated in all forms of cancer, they

pursued. Specific tests will be determined

genetically linked, and this kind of diagnosis

do exist and are more common than most

according to the specific patient symptoms

doesn’t change outlook or treatment

people might think. The actual role of

and history. However, it is much more likely

options. The main reason to pay attention to

genetics in the heritability of many forms

that an individual will be diagnosed with

the possibility of hereditary cancers is the

of cancer as with many other kinds of

cancer than with the hereditary cancer

ability to improve long term outlook with an

diseases is hard to generalize, since family

syndrome; hereditary cancer diagnoses are

early diagnosis.

history, environment, and lifestyle also play

much rarer than one might think.

While genetic links have not been

a large role in any circumstance. However,

There are some general indications that

a strong family history of the disease may

further evaluation by an expert should be

If a genetically linked cancer is determined

NoCo Health Guide • 31

Banner Health

ANXIETY: TRIGGERS and

TAMERS

Sweaty palms. Shortness of breath. Thundering pulse.

Racing thoughts. A feeling of impending doom.

Though they feel desperate and dire in the moment, these feelings of panic are more common than most people realize. Feelings and the associated symptoms of anxiety are not universal for the adult population, but they are widespread to an almost pandemic level.

Although common, most people don’t realize anxiety is not normal and that it is doing harm to their physical health as well as their psyche. Many people also don’t realize there are techniques for dealing with anxiety, and speaking to your doctor about your symptoms might lead to a life-changing solution.

Mind+Body consulted with Dr. Jennifer Main, internal medicine specialist practicing out of Fort Collins’ Colland Drive Banner Health Clinic, on the issue.

Anxiety is the most common mental health issue, though it often goes undiagnosed and untreated because the symptoms of the condition immobilize the sufferer from seeking the appropriate help. Dr. Main sees this issue as a combination of the stigma surrounding mental health and the symptoms of anxiety.

“Sometimes the hardest part of treating anxiety is getting patients to pursue treatment. Making appointments to see a doctor and following through on those appointments are often a huge block, because this triggers the exact symptoms of anxiety we wish to treat,” says Dr. Main.

Her extensive experience as a primary care physician, the “front line” of patient care, especially in mental health care, has provided her with a wealth of knowledge about treating patients as a whole, including the mind and the body, to achieve wellness.

Anxiety is, in the simplest terms, the body’s stress response operating at an out-of-control level. The human body has certain survival response systems to stress, which normally kick in and provide the means for evading predators or other threats. Basically, this is our fight or flight response, and it is essential for our survival. However, many of the 32 • NoCo Health Guide

Banner Health

everyday experiences we have as modern-day humans excite this stress

integrative therapies,” says Dr. Main.

Dr. Main is a champion of this integrated

performing a mental body scan to return to a physical sense of place and self-control.

response, kicking our bodies into high

approach, which is becoming more

Medication is also a powerful tool in

gear. The problem is that many times we

popular in primary care. “Most people

the arsenal of treatments. Medication is

do not know how to return our bodies

don’t need to see a specialist to deal with

commonly used in conjunction with other

to a neutral, stress-free state. Thus,

their anxiety; they just need a systematic

approaches and is employed to address

we walk through our lives on red alert

approach and a knowledgeable guide to

the paralyzing symptoms of anxiety

at all times, exceptionally sensitive

addressing their symptoms.”

in order to build the other skills that

to stimuli, worried about the possible

“It is important for patients to remember

will allow the sufferer to deal with their

threats to our well-being, and unable

that treating anxiety is a process solution,

to relax. This general elevated level of

not a one-time cure. Continual follow-up

Dr. Main emphasizes the importance

stress is relatively common but is often

is essential to creating a solution to the

of sticking with a treatment plan, as well

anxiety effectively.

“Sometimes the hardest part of treating anxiety is getting patients to pursue treatment. Making appointments to see a doctor and following through on those appointments are often a huge block, because this triggers the exact symptoms of anxiety we wish to treat.” easily treated at the primary care level

issue. But even making an appointment

as the good relationship and effective

with the application of a comprehensive

to see a doctor starts this process and

communication between the patient and

approach to wellness.

has been demonstrated to change the

physician. “Treating anxiety is in large part

neurochemistry of the patient. The

a decision to focus on daily function and

right fit or combination of techniques and

decision to feel better is a huge step

self-care by the patient. Paying attention to

tools for the patient. Most people need

toward actually being better.”

symptoms, seeking professional help, and

“Treating anxiety is all about finding the

a comprehensive approach of therapy,

Some of the techniques to cope with

sticking to the program developed by the

nutrition, sleep, stress management tools,

panic and generalized anxiety include

patient themselves and their doctor are the

and medication. I like to focus on building

meditation or deep breathing; reduction

keys to reducing anxiety and stress, and

healthy pathways through mind/body

of stimuli; and, in acute states of panic,

living a happier lifestyle.”

NoCo Health Guide • 33

Banner Health

How late is too late?

The decision to have children — or the decision not to have children — is one of the most important and impactful decisions that a woman will make in her life.

This is a choice that will not only affect the next 9 months during the actual pregnancy, but all of the months and years afterward.

In short, this is not a decision to be taken lightly. Determining the right time — financially, emotionally, and in terms of career — is a sometimes lengthy decision process, and that right time may not come along until much later than what our parents’ generation would consider a reasonable time to have children.

So the question for many women becomes: When is it too late? When does

Peak fertility For most women, peak fertility occurs

time and biology trump the “right time” and

between the ages of 22-31. While this

force a now or never decision? And at this

is the period of time when women will

more advanced age for childbearing, are

conceive most easily, it does not serve

there possible complications to conception

as a hard and fast rule at all. Individual

that should be expected?

biology, inherited traits, and external

Mind+Body spoke with Dr. Antonio

factors are all contributors to the overall

Barbera, OB/GYN about one of his areas

fecundity of a woman, as well as the ages

of professional passion: female fertility

when she is most likely to conceive. There

and successful conception. Dr. Barbera

are other factors which also contribute to

has moved his practice in Greeley to the

the likelihood of conception, this article will

brand new Banner Fort Collins Medical

focus on the female factors primarily.

Center, where he will continue to serve

Fecundity is the probability of conception

the Northern Colorado community with his

which results in the birth of a baby per

unparalleled expertise.

female reproductive cycle. While this has

34 • NoCo Health Guide

a good degree of variability between individuals, it is a roughly 15-18% chance per month. This percentage is highest during the early to mid-twenties, and reduces somewhat in the late twenties and early thirties, with a rapid depletion in the mid-to late thirties. Thus, while it is possible to become pregnant naturally at a more advanced age, the likelihood of conception without assistance or intervention becomes less likely the older the individual becomes.

When to visit the doc For most women, Dr. Barbera recommends trying for a natural conception for a year before they should really be concerned about their fertility.

There are many factors that influence the ability to conceive, and even in the most ideal circumstances the likelihood of conception is only about 15% in a given month. “Whenever possible I like to tell my patients to relax, be healthy, keep trying, and let nature take its course. Sometimes

Banner Health you have to be patient, but the most

ovaries release one egg per cycle, on

to not only know recent history, but lifetime

natural way we can begin a life the better.”

average, and these eggs will be depleted

gynecological and other health issues, as

Most couples, up to 80-90%, conceive

sometime in middle age, though the exact

well as familial health issues, history, and

within one year of intercourse for the

ages of menarche and menopause varies.

any details known about the ability of the

purpose of pregnancy.

As eggs age within the body, their quality

mother’s ability to conceive. He will rule

Dr. Barbera also emphasizes that a

decreases. This means they become less

out factors one at a time until the cause is

mother should try to be as healthy as

viable and less likely to be able to support

detected. Dr. Barbera uses many different

possible while trying to conceive. While

a successful pregnancy. The quality of

techniques and tools to determine the most

a healthy diet is important to general

the eggs is usually highest in the mid- to

likely cause of the infertility, and most of the

health, as well as your body’s readiness

late-twenties, with a rapid decrease after

steps taken will be dictated by the history

to conceive, there is no “magic diet” or

the mid-thirties. The quality of the eggs

and other known factors about the patient.

vitamin that will guarantee conception.

themselves and the number of eggs in the

While folic acid has been demonstrated

ovarian reserves combine to determine the

attributed to female factors, about 40% are

to help with conception and reduce birth

ongoing fertility of a woman.

attributed to ovarian issues. The remainder

defects, it is by no means a complete solution or guarantee for conception. He

A hormonal test on specific cycle days will help to evaluate the ovarian reserves. The

Within the 35% of the total issues that are

of the female biological factors are cervical, uterine, tubal, or peritoneal in nature. The

recommends, instead, that women who are considering having children think about keeping their bodies constantly “prepared” for pregnancy. This basically means eating well, maintaining healthy weight, and eliminating habits that are destructive to health like smoking in order to keep your body as ready as possible to undergo pregnancy.

For women over 35, Dr. Barbera suggests seeing the doctor after 6 months of unsuccessful attempts to conceive. While some women who are in this more advanced age group for child bearing have no issues conceiving, in general these women have a much more limited window for conception,

“Whenever possible I like to tell my patients to relax, be healthy, keep trying, and let nature take its course. Sometimes you have to be patient, but the most natural way we can begin a life the better.” results of this test is taken into account along

ovarian issues are often a simple case of

with the rest of the patient history and other

low egg quality, especially in women who

factors in order to determine the likelihood of

are of a more advanced age.

the issue with conception originating with the ovaries in the female partner.

understanding of human reproductive

What might be the problem?

systems, there are many options for

Approximately 1 in 6 women experience

and there are many more factors which may

infertility issues, which are classified

be contributing to the difficulty in conceiving.

as inability to conceive after a year

The aging reproductive system

of unprotected intercourse. There

One of the first steps taken when a patient is struggling with infertility will be an evaluation of ovarian reserves. All women are born with a certain number of eggs, which will be released during their monthly cycle throughout their lives.

When his egg reserve has been depleted, the woman no longer has the ability to bear children. Most women are born with several million eggs, but by the time they reach sexual maturity this number is at about a quarter of the original count. The

With modern technology and

are a number of potential issues with conception, which arise from several different sources. Dr. Barbera attributes

treatment in the case of infertility for both male and female issues. Diagnosis of a fertility issue is the beginning of a journey towards successful pregnancy. In upcoming issues, Mind+Body will examine some of the potential options with the help of Banner Health’s experts.

Fertility and female reproductive health are

35% of issues are due to male

overwhelmingly large topics. Mind+Body has partnered

factors, 35% to female factors, 10% to

with Banner Health to examine women’s health and

environmental factors (diet, exercise, medications, etc. attributed to either the male or female partner), 10% are both partners simultaneously, and 10% are unknown factors.

When women come to Dr. Barbera with infertility issues, he starts by taking an extensive history on the patient. He wants

fertility issues in depth in the magazine, in print, and on the Mind+Body website. Look for our future related topics, where we delve into more detail and depth on many women’s health and fertility issues in the coming months. Look for a follow up article on fertility solutions in the July issue of Mind+Body.

THE

S tandard of

HEALTH CARE IS ABOUT TO BE ANYTHI NG BUT YOUR

STANDARD

. e r a C h t l a e H BANNER FORT COLLINS MEDICAL CENTER OPENING APRIL 6

Who wants to settle for standard health care? With the opening of Banner Fort Collins Medical Center and Banner Health Center on the same campus, we’re giving you access to a full spectrum of specialists and working closely with independent physicians to give you the well-coordinated care you need. And with remote patient monitoring, doctors have a second set of eyes to ensure that every inpatient receives the right care at the right time. It’s like nothing you’ve ever seen from health care and everything you should expect.

BannerHealth.com/FortCollins • (970) 229-4000 •

/BannerHealthColorado • Harmony Rd. & Lady Moon Dr.

E