NORTHERN COLORADO
MEDICAL RESOURCE GUIDE 2 01 7- 1 8
TOO SOON TO TELL
With ‘repeal and replace’ starting to take shape, local experts weigh in
FUTURE OF HEALTHCARE IN NORTHERN COLORADO
TOP HEALTH ISSUES FACING COLORADO
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CONTENTS
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TOO SOON TO TELL
With ‘repeal and replace’ starting to take shape, local experts weigh in
08 LETTERS
What’s coming in 2017 at UCHealth, Banner Health and Kaiser Permanente in Northern Colorado
TOP HEALTH ISSUES FACING COLORADO 16 HEART DISEASE 22 DIABETES 28 CANCER 32 RESPIRATORY DISEASE
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NORTHERN COLORADO
MEDICAL RESOURCE GUIDE Published March 2017
President Kathy Jack-Romero kathyjackromero@coloradoan.com Executive Editor Kristin Deily kdeily@coloradoan.com Graphic Designer Erika Moore erikamoore@coloradoan.com Cover Photo Colordoan Library Interim Advertising Director Ryan Young ryoung@coloradoan.com Production Manager Matt Varns mattvarns@coloradoan.com
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1300 Riverside Ave., Fort Collins, CO 80524 Call (970) 493-6397 | Fax (970) 224-7726 ©2017 Coloradoan Media Group. All rights reserved. PLEASE NOTE that the articles contained in this publication are meant to increase reader awareness of developments in the health field. Its contents should not be construed as medical advice or health instruction on individual health matters, which should be obtained directly from a health professional.
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BANNER HEALTH
MARGO KARSTEN, RN, MSN, PHD Chief Executive Officer Banner Health in Northern Colorado
As the White House and our congressional leaders debate the future of the Affordable Care Act, Banner Health remains focused on ensuring our local community’s access to high quality care. I joined Banner Health as chief executive officer for its Northern Colorado hospitals in September 2016. It was a homecoming for me as I previously spent eight years of my career working in executive health care leadership positions in Fort Collins. Having the support of Banner Health, a health care system with more than 50,000 employees, 28 hospitals, a growing medical group and unwavering commitment to the communities we serve, is a huge advantage to us as we steadily increase access to high quality care. Banner opened Banner Fort Collins Medical Center in April 2015, providing area residents with a convenient option for emergency care, in-patient care, surgery and birthing services, as well as access to a wide range of physician specialists. In response to increasing demand, the first expansion of the campus is underway. We are adding 17 exam and procedure rooms, nearly double the existing 18 rooms. In addition, WomanCare, a Fort Collinsbased midwifery practice, is now delivering all of its patients’ babies at Banner Fort Collins Medical Center. Each of Banner’s hospitals in Northern
Colorado, including Banner Fort Collins Medical Center, North Colorado Medical Center in Greeley and McKee Medical Center in Loveland follow consistent clinical practices to ensure a similar patient experience at all three facilities. We’re pleased that our approach continues to result in recognition for quality from respected independent rating agencies like Healthgrades. Banner’s North Colorado Medical Center in Greeley was recently honored by Healthgrades as one of America’s 50 Best Hospitals 2017™ for the third consecutive year. The designation places NCMC among the top 1 percent of more than 4,500 hospitals nationwide for consistent, yearover-year superior clinical performance. NCMC received eight 5-star quality ratings from Healthgrades across five different service lines. McKee was recognized with 5-star quality recognition in five different services lines. We anticipate similar results at Banner Fort Collins once it has been open long enough to qualify. Our specialty services continue to grow throughout the region. In 2016, we opened a new Banner Health Clinic specializing in orthopedics in Loveland,
a new home for a practice that also has patient clinics in Fort Collins and Greeley. Our heart care physicians, the CardioVascular Institute of North Colorado, have opened the Structural Heart and Valve Disease Clinic in Greeley. This clinic headed by Michael Kim, MD, offers heart patients in Northern Colorado and beyond the most advanced diagnostic and treatment services for diseases of the heart valves and heart chambers. We’re excited to offer this expertise to our community and to provide access to our orthopedists, neurosurgeons, oncologists and other specialists locally in Fort Collins, Greeley and Loveland. If you’d like to learn more about Banner Health, the expertise of our Banner Medical Group physicians, our commitment to the community, or health care in general, I am hosting quarterly community conversations at Banner Fort Collins Medical Center. These are informal gatherings with no agenda beyond answering your questions about Banner Health and the health care industry in general. If you would like to attend one of these community conversations, please call Terry Hirsch at 970-8214300. I look forward to seeing you!
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UCHEALTH
2017-18 // Northern Colorado Medical Resource Guide
KEVIN UNGER President and CEO UCHealth’s Medical Center of the Rockies and Poudre Valley Hospital
At UCHealth, we are ushering in a new era that’s going to make the complex and complicated world of health care as simple and convenient as possible. The goal is simple – to improve the patient experience all around. After 18 months of research, exploring exactly what patients would like to experience from their health care providers, we have developed a renewed effort that focuses less on the traditional way of providing health care and more on a modern, personalized experience. We’re moving toward more virtual visits, telehealth, online scheduling and other ways to improve the lives of our patients and their families. We’re also providing personalized customer service and equipping our patients with the information they need to take control of their health. And while a new website, mobile app and newsletter with health information might not seem groundbreaking, there’s much more to come. Combined with all our other efforts, we will transform health care, making it easier to use and more applicable to our patients’ lives. All of this comes at a very exciting time for UCHealth in northern Colorado. After years in the making, we recently opened a new wing at Poudre Valley Hospital in Fort Collins. The three-story, 185,000-square-foot expansion, which officially opened in late February, features an expanded emergency department, a stateof-the-art laboratory, an orthopedics unit, a retail pharmacy and a rooftop helipad. We also recently expanded our Level III Neonatal Intensive Care Unit, which cares for
newborns as young as 28 weeks. The project, which nearly tripled the unit’s space, included 32 new beds in spacious private rooms, staff offices and parent amenities. And there are several other projects under way in northern Colorado that will continue to improve access to advanced, personalized care, close to home: Our long-standing relationships with Colorado State University and Columbine Health Systems continue to grow as we have formed a unique partnership to build a $59 million health and medical center on the CSU campus. There, UCHealth and Associates in Family Medicine will provide services for CSU staff and the public, including a walk-in clinic, imaging and occupational health services. The center, which opens this summer, also features a new Columbine Health Systems Center for Healthy Aging, unlocking a new door of research and outreach program opportunities for the community. Throughout this year, crews will be working on UCHealth’s new hospital and health center in Greeley on approximately 22 acres southeast of U.S. 34 and 71st Avenue. The hospital will provide 53 inpatient beds with room to grow and will include an intensive care unit, emergency department, operating rooms, advanced cardiology services and a birthing center. The campus also will house a separate outpatient health center that will consolidate many of the services UCHealth currently provides in the community. The
services offered at the new health center will include primary care, oncology, cardiology, orthopedics, obstetrics/gynecology, pediatric care and many more specialties in addition to offering the most advanced lab, imaging and pharmacy services. And, late this summer, UCHealth will open the new Longs Peak Hospital on the northwest corner of Colo. 119 and County Line Road in Longmont. It will feature an intensive care unit, a Level III trauma center as well as an emergency department, operating rooms, advanced cardiac services and a surgery center. In addition, UCHealth will be offering several services that are new to the Longmont area, including an enhanced birthing center that will be able to care for babies born at 32 weeks, bariatric surgery, less-invasive sinus surgeries, endoscopic ultrasound to diagnose gastrointestinal and lung diseases, advanced neurological care, advanced orthopedic surgeries, vascular surgery and advanced telehealth services. As you can see, we have a few very busy years ahead of us, and we are excited for what the future has in store. It is an honor to be a part of the hospitals and health system that have been serving Fort Collins and northern Colorado since 1925, and all of us here at UCHealth look forward to providing you and your family with enhanced, personalized care and service for many years to come. Thank you for your continued support.
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KAISER PERMANENTE
EVAN HYATT Executive Director of Operations, Northern Colorado
A little over five years ago, Kaiser Permanente announced plans to expand into Northern Colorado. Now, our footprint in this vibrant community has grown and we are proud to serve more than 40,000 members living in Fort Collins, Loveland, Greeley and surrounding communities. I believe this success can be attributed to the hallmarks of Kaiser Permanente service: convenience, high-quality care, affordability, and community. We understand that physician choice is important. That’s exactly what the Kaiser Permanente network offers in Northern Colorado. Our members can select a physician practicing in one of our medical offices or choose a physician from our network of more than 400 community providers, including Banner Health and other affiliated physicians in Weld and Larimer counties. Hospital care is coordinated at McKee Medical Center in Loveland, North Colorado Medical Center in Greeley, and Banner Fort Collins Medical Center. Kaiser Permanente members can also actively engage in managing their health through My Health Manager™, our personal health record. My Health Manager™ allows users to access their health records securely on our mobile app or online, view lab results, email their Kaiser Permanente physicians, request prescription refills, pay their bill, and make or cancel routine appointments in our medical offices. Kaiser Permanente’s partnership with Banner Health is truly unique. We have linked our electronic medical records together to share information across all levels of treatment and coordinate patient
care accordingly. This collaboration is the first of its kind in northern Colorado, and this technology plays a significant role in our ability to deliver care that is both convenient and high-quality by giving primary and specialty-care providers access to a patient’s medical history. Our integrated care delivery system also allows patient care teams to leverage a robust collection of electronic medical records and deliver the right care at the right time which is more efficient, cost-effective and leads to better health outcomes. For example, Kaiser Permanente members are less likely to suffer heart attacks and strokes because of our success in improving their hypertension (high blood pressure) control rates. Through a system-wide, five-step action plan, Kaiser Permanente has increased Colorado member hypertension control rates from 61 percent to 82.6 percent since 2008 (nationally, blood pressure control rates hover around 50 percent). In Northern Colorado, Kaiser Permanente offers the widest range of affordable commercial coverage plans for employers, families, and individuals.
Larimer and Weld County residents are also eligible to enroll in Kaiser Permanente’s 5-star rated Medicare Advantage plans. The 5-Star ranking is the highest rank awarded by the Centers for Medicare and Medicaid Services. As Colorado’s largest nonprofit health plan, I think it’s important to mention that Kaiser Permanente’s commitment to Northern Colorado extends beyond brick and mortar. We are also dedicated to giving back to the communities we serve. Kaiser Permanente’s Community Relations/Community Benefit programs have contributed more than $3,500,000 to Northern Colorado community programs since opening our Medical Offices in Northern Colorado. Kaiser Permanente is at the forefront of implementing strategies that offer consumers greater convenience, quality care coordination, affordability, and community health and wellness education right here in Northern Colorado. Thank you for your continued support. It is a privilege to have the opportunity to serve Northern Colorado and meet the health care needs of this community.
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2017 HEALTHCARE IN REVIEW
With ‘repeal and replace’ starting to take shape, local experts weigh in
TOO SOON TO TELL BY KELLY K. SERRANO
P Editor’s Note: This story went to print March 8, 2017. All content herein reflects available information at that time.
resident Donald Trump promised to repeal and replace the Affordable Care Act (ACA) if elected. Now, as the new administration moves forward with this plan, many fear he will leave them hanging without health insurance. With hundreds of thousands of Coloradans now covered through individual policies and Medicaid who weren’t covered before the ACA, it’s a valid concern. With the recent release of the outline for the American Health Care Act (AHCA) “replacement” for the ACA, the picture is becoming clearer, but all
fears have not been put to rest. More than 170,000 people currently obtain insurance through Connect for Health, the state’s marketplace/exchange for health insurance, said Gail Snyder, life, health & employee benefits specialist for Snyder Insurance in Loveland. By this June, another estimated 363,000 new enrollees will have signed up for Medicaid since January 2014, when the state expanded eligibility requirements outlined in the ACA, reports the Colorado Health Institute’s “Medicaid Expansion in Colorado:
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An Analysis of Enrollment, Costs and Benefits and How They Exceeded Expectations,” published in May 2016. The newly proposed AHCA could have potentially big impacts in Colorado if it becomes law in its current form. “Everyone’s got an opinion on what might happen, but there’s definitely more questions than answers,” said John Kurath, vice president of the Colorado market for Warner Pacific, a sales and marketing arm for insurance companies that cover individuals and groups with less than 100 people.
“Everyone’s got an opinion on what might happen, but there’s definitely more questions than answers.”
Repealing the ACA requires a supermajority, or 60 Senate votes, which means all 52 Republican members and some of the Democrats must approve it, Kurath said. That is unlikely, in Kurath’s opinion, especially if the legislature can’t agree on an adequate replacement proposal. Instead, the new administration has begun a path of less resistance by defunding some key aspects of the ACA, requiring only 51 Senate votes to pass, Karuth said. While this will effectively hamstring the ACA, the
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“The individual market is really in trouble. If we continue on this path, I don’t see any insurance carriers wanting to do business statewide.”
President Trump, flanked by Vice President Pence and chief of staff Reince Priebus, signs his first executive order on health care on Friday in the Oval Office. Evan Vucci, AP
actual defunding wouldn’t happen for a year or two, giving lawmakers time to come up with a replacement strategy that will win support from both sides of the aisle. “Both parties seem to agree that you cannot repeal it in a way that takes the people who were previously uninsured and make them uninsured again,” he said. Despite some early indicators otherwise, the newly proposed plan will also keep coverage protections regardless of a person’s health condition, pre-existing conditions and pregnancy, he said. And both sides of the political spectrum know addressing costs is critical. “If people think repealing the ACA will lower costs again, their expectations aren’t realistic,” Karuth said. “That’s the bad news. So far none of the proposals really have a solid strategy to address the underlying cost of health care.” “[I]t’s unrealistic to expect costs to go down. The ACA was designed to increase access to
2017-18 // Northern Colorado Medical Resource Guide
health care. What I think people heard five years ago was it was also going to lower costs. But, for anyone in the industry, we knew that was an impossibility: you can’t bring sick people in and lower costs at the same time,” Karuth said. Karuth explained that cost is why many insurance companies no longer serve rural markets, including in Colorado, leaving only one carrier for individuals in many places. The growth of the baby boomer generation is also taking its toll on the government through Medicare. “There are 10,000 baby boomers aging into this system every single day; there are not 10,000 wellemployed teenagers offsetting that cost. Until this is addressed, there will be no stability in our health-care delivery model,” Snyder said. “No one in the industry can claim innocence when it comes to high health-care costs,” Snyder added. “If you put a representative from each of the elements of care delivery in a room and asked who is at fault for high costs and high claims, they
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would all point fingers at another,” Snyder said. She expects the Colorado Legislature will rescind the expensive Medicaid expansion, though the current proposal in the AHCA is to maintain the expansion until 2020. At that point, the program enrollment would be frozen and individuals allowed to phase out. “If this is the case and if the Advance Premium Tax Credits (APTC) remain in place, those folks who would no longer qualify for Medicaid would be paying for their insurance with tremendous tax credits. This would give them affordable premiums,” Snyder said. Until any changes to the ACA actually become law, Karuth advises people to not make decisions based on what they think might happen with the new administration and the proposed plan. “If I were an employer or individual, I would have to make the assumption that, because [the ACA is still] the law, it’s still in effect,” Karuth said.
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HEART DISEASE
WHAT THE HEART WANTS Healthy lifestyle reduces risk of cardio disease, increases chance of longevity
BY KELLY K. SERRANO
T
oday’s busy lifestyle makes eating easy – if not fast – food and spending time in front of a screen a little too common. But the heart can handle only so much of that lifestyle. In fact, it often leads to obesity, which is also is the No. 1 risk factor for heart disease, said Dr. Arnold Pfahnl, an electrophysiologist and site lead for Banner’s CardioVascular Institute of North Colorado.
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LOCAL RESOURCES »» Public health fairs offered by 9News, employers or other community organizations screen for heart disease risk factors including high cholesterol levels and high blood pressure. »» The Health District of Northern Larimer County offers cholesterol screenings and help with smoking cessation. »» UCHealth Heart Center cares for patients at several locations, including the Harmony Campus in Fort Collins, Medical Center of the Rockies in Loveland and Greeley Medical Center. The large medical team works with over 300 clinic specialists to provide patients with a wide range of clinical support, including nutrition, psychological counseling, research and rehabilitation programs. For more information, go to uchealth.org/heart. Call (970) 221-1000. »» In addition to its CardioVascular Institute of North Colorado, Banner Health offers an adult fitness program through its cardiac rehabilitation program, providing trainers and exercise programs as well as nutritionists who tailor diets to patients’ specific needs. Its community wellness courses include healthy eating, open lab blood screenings, yoga and CT Heart Score, which measures the calcium in the heart’s arteries. Call (970) 821-4500, Fort Collins; (970) 820-2120, Loveland; (970) 810-4121, Greeley. »» Banner Health’s Patient Centered Medical Home’s primary care clinicians provide patient navigation services to those with chronic diseases by helping them coordinate their care including appointments, appropriate testing, locating community resources, prescriptions and more. “To be heart healthy, it doesn’t take a lot of physical activity” said Dr. Arnold Pfahnl, “20 minutes most days of the week. A brisk walk has huge health benefits in the long run.” Getty Images/ iStockphoto
»» American Heart Association – Colorado Chapter, (303) 369-5433, (800) 242-8721 or visit www.americanheart.org.
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Northern Colorado Medical Resource Guide // 2017-18
And it’s a risk more people are facing these days. “We’re fortunate to live in a state that’s considered one of the healthiest in the nation, but we still see lots of patients with heart attacks at a very young age,” Pfahnl said. “To be heart healthy, it doesn’t take a lot of physical activity – 20 minutes most days of the week. A brisk walk has huge health benefits in the long run.” Dr. Patrick Green, a UCHealth cardiologist and medical director for Poudre Valley Medical Fitness at Water Valley, said heart failure at a young age – the mid-50s, perhaps – affects longevity and quality of life. “Adopt a healthy lifestyle in order to prevent these chronic diseases or illnesses as long as you can, and maintain a quality of life as you age,” he
compared with a national average of 54 percent, and only two-thirds of adults are physically active. “We spend a lot of screen time, whether it’s TV or computers. It is a risk factor for cardiovascular disease.” And eating more high-fat foods with less nutrition doesn’t help. “We’re only starting to see a change in education of what’s healthy eating with more emphasis on fruits and vegetables, low-carb diets, more fish and seafood” like that recommended in the Mediterranean diet, Pfahnl said. Tobacco dropped to the number two cause of heart disease, but “we’re still seeing a large percentage of patients who smoke, causing heart disease and strokes,” he said. The American Heart Association
“If you have a strong family history of heart disease, it’s all the more important to maintain a heart-healthy diet, get exercise and maintain a healthy body weight.”
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advised. “We can’t live forever, but you want to live well as long as you can.” Women are at as much at risk for developing cardiovascular disease as men, Green noted, but that risk is also higher than that of developing breast cancer “and shouldn’t be ignored.” Despite how much time Coloradans spend doing outdoor activities, cardiovascular disease is the state’s second most common chronic disease behind cancer. It claimed 6,200 lives in 2011 and contributed to 8,500 deaths – or 26 percent of all deaths – total, according to the Colorado Department of Public Health and Environment’s 2014 Colorado Chronic Disease State Plan. “As a society, we seem to be more sedentary,” said Green, noting Colorado’s obesity rate is 56 percent,
reports that 18 percent of adults smoke. “There’s still a lot of room for improvement,” Green said. The onset of Type 2 diabetes in adulthood also plays a major role in heart disease, going hand in hand with the obesity epidemic, Pfahnl said. While the exact link between genetics and heart disease is not clear, “if you have a strong family history of heart disease, it’s all the more important to maintain a hearthealthy diet, get exercise and maintain a healthy body weight,” he said.
Symptoms and screening Patients can exercise regularly and eat a healthy diet, but it’s usually their primary care doctor who checks their blood pressure, cholesterol and blood sugar levels,
Clear View Behavioral Health is a 92-bedstate-of-the-art mental health hospital built specifically with our patients needs in mind and is dedicated to providing quality behavioral health care to promote growth and structure for patients and families throughout the state of Colorado. We treat adolescents, adults and seniors in an inpatient and outpatient setting. Our inviting treatment facility is located in beautiful Johnstown, CO and is centrally located to be a short drive from Fort Collins, Greeley, Boulder, and Denver. Behavioral health challenges can affect safety, independence, relationships, and overall well-being. If you or someone you know may benefit from or need help, contact us today for more information or a free confidential assessment 970-461-5061. We provide a structured, therapeutic and safe environment for those patients who require acute care with psychiatric or behavioral challenges. Our multidisciplinary team’s approach makes use of a highly-trained medical and professional staff to help individuals find the self-acceptance and confidence they need to be successful in their families, communities, workplaces and schools. The goal of our inpatient program is to effectively treat adults, adolescents and seniors suffering from acute psychiatric challenges. We provide assessment, diagnosis and rapid stabilization of acute psychiatric issues with referrals to less intensive, appropriate levels of follow-up care and support. Physician referrals are not required in order to receive an assessment. • Free Assessment 24 hours a day, seven days a week • Inpatient programs incorporating Group, Family & Individual Therapy • Chemical Dependency and Detoxification Programs • Intensive Outpatient Programs
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Stenosis of the left anterior descending coronary artery on angiography (marked by arrow) Getty Images/iStockphoto
and can test to see how much calcium is in the coronary arteries, Green said. “Doing a physical exam and the preventative care they provide is key to preventing heart disease in the future,” Pfahnl said, adding doctors now check patients’ vitamin D levels, too, as they play a role in long-term heart health. People should know the signs indicating trouble before a heart attack, such as the change in ability to do exercise or normal activity; they experience shortness of breath more easily; they feel like their heart is racing; and/or they suffer periods of light headedness they didn’t before, Pfahnl explained. Such symptoms should lead to a visit to their primary care physician. A call to 911 immediately is in order for chest pain or discomfort, especially if it radiates to the neck, jaw or left shoulder and arm, and other symptoms that may include a loss of consciousness, a sudden onset of severe back pain, an elevated heart rate and breaking out in a cold sweat, he said. Green added someone experiencing a heart attack may also have nausea or discomfort in the upper abdomen and feel the need to belch. Women may have unusual fatigue and shortness of breath with activities, and all symptoms are especially concerning if they last for several minutes. If they’ve discussed it with their doctor, they can take an aspirin at the onset of symptoms, “but don’t wait it out at home,” he advised. “We will see them days later when the damage is already done.” Treating the risk factors of heart disease such as high cholesterol, high blood pressure and diabetes are critical in preventing heart disease and cardiac arrest, Green stressed.
From simple to serious, we’re here for your health. In Fort Collins, the experienced physicians at Banner Fort Collins Medical Center and the Banner Health Clinics and Centers can help you with a quick check up and so much more. And, with additional experts nearby in Loveland, Windsor and Greeley, you’re covered no matter where you go in Northern Colorado.
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DIABETES “The biggest fear of diabetes are the complications that go with it and managing it,� said Dr. James Speed. Getty Images/iStockphoto
2017-18 // Northern Colorado Medical Resource Guide
DIABETES An unhealthy affair of the heart & body BY KELLY K. SERRANO
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f the idea of developing diabetes doesn’t strike fear in the heart, it should: heart disease is the No. 1 killer of people with diabetes. “If we can prevent diabetes, we can help prevent heart disease,” said Linda Schoon, a registered dietitian, certified diabetes educator and coordinator of UCHealth’s Diabetes Program in Northern Colorado. “We need to diagnose it early.” Diabetes contributed to nearly 800 Colorado deaths in 2011, or about 2 percent of all deaths, according to the Colorado Department of Public Health and Environment’s 2014 Colorado Chronic Disease State Plan. Preventing Type 2 diabetes means dealing with the epidemic of obesity, its top risk factor, Schoon added. While the onset of Type 2 is usually in adulthood, doctors are diagnosing it more often in children who aren’t getting enough exercise and eating healthy. The Diabetes Prevention Program not only treats patients but also helps them make lifestyle changes, she said. “A lot of what seems to be contributing to the obesity epidemic is lack of family
meals, eating out often, stress, just the busyness, not enough time to exercise,” Schoon said. “To some people it’s related to finances: the fast-food dollar menu is more affordable than getting a chicken breast and vegetables. We’re depending too heavily on processed or convenience food. We need more fruits and vegetables. And portion distortion – that’s a real big one for contributing to obesity.” In Type 2 diabetes, the body resists or can’t use insulin efficiently, so the pancreas goes into overdrive trying to produce it. If the issue isn’t diagnosed and addressed in the pre-diabetes stage, insulin production drops to levels known as insulin deficiency, while blood glucose levels rise and a person has diabetes, Schoon said. “Wherever the blood goes, the sugar goes,” she said, explaining why people with diabetes are at risk for heart disease, too. “If blood has a lot of extra sugar in it, it’s going to damage the tiny vessels, like those in the eyes, kidneys, extremities and nerves, and the large vessels such as those in the heart. Insulin’s job is to take the sugar out of the blood stream and get it
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into the cell to burn for energy. When there’s insulin resistance, it can’t unlock the cell to let the sugar in.” Schoon added, “Weight, particularly around the waist, and inactivity hold cells captive so they can’t do their job efficiently,” which is why those who are overweight are more at risk for diabetes. Dr. James Speed, a Banner Health endocrinologist, said certain ethnic groups including African Americans, Mexican Americans and Asian Americans are predisposed to Type 2 diabetes. And people 40 or older, have a family history of diabetes, are obese, have an unhealthy diet and are less active are most vulnerable to the disease, he said. “The biggest fear of diabetes are the complications that go with it and managing it,” he said. Schoon noted someone with pre-
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»» Banner Health offers patients with diabetes individual nutrition appointments, selfmanagement education and educational appointments for gestational diabetes. https:// www.bannerhealth.com/ services/diabetes »» Banner Health’s Patient Centered Medical Home’s primary care clinicians provide patient navigation services to those with chronic diseases by helping them coordinate their care including appointments, appropriate testing, locating community resources, prescriptions and more. »» UCHealth Center for Diabetes focuses on education, prevention and management. It is based at Poudre Valley Hospital in Fort Collins but also offers services in Greeley and Loveland and the Harmony Campus; (970) 495-8205. UCHealth also has a variety of programs including the Healthy Kids Club, Aspen Club, Living Well/EnhanceWellness and
diabetes can get the disease under control by losing weight, eating healthy and getting regular exercise, but that person will always have a tendency for diabetes. “It’s not a death sentence at all,” she said. “With the right tools – and we believe those tools come from education – we can help people control the diabetes and not have the diabetes control them, and they will avoid long-term complications.” Type 1 diabetes is a largely autoimmune disease in which the body attacks itself, preventing insulin production, Speed said. It had been known as juvenile diabetes until recent years, when doctors have diagnosed it more in adults and the elderly. “It can happen at any age, but most of the people we see are children or young adults,” Schoon said, adding that while genetics may
Healthy Hearts that educate and support people of all ages as they seek to establish healthy lifestyles. »» Northern Colorado Type 1 Diabetes Meetup meets the last Thursday of every month in the basement of Mugs Coffee Lounge, 261 S. College Ave., Fort Collins. E-mail type1noco@ gmail.com. »» Public health fairs offered by 9News, employers or other community organizations screen for heart disease risk factors including high cholesterol levels and high blood pressure. »» The Health District of Northern Larimer County offers cholesterol and blood pressure testing, (970) 224-5209. »» The Colorado State University Kendall Reagan Nutrition Center offers a Dining with Diabetes Program, http://www. nutritioncenter.chhs.colostate. edu/programs-services/diningwith-diabetes.aspx »» www.diabetes.org
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2017-18 // Northern Colorado Medical Resource Guide
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Dr. Craig Seager Crane & Seager Orthodontics 4144 Timberline Rd. Fort Collins, CO Special Focus: Orthodontics Board Certifications: American Board of Orthodontics (ABO) Certified Diplomate of the American Board of Orthodontics Medical School: University of Texas Health Science Center - Doctorate of Dental Surgery degree in 2007, Summa Cum Laude and with a Distinction in Research Residency: residency in orthodontics at the University of Texas Health Science Center in Houston where he earned his Master of Science degree in Dentistry Professional/Medical Memberships: Member of the American Association of Orthodontists, Colorado Dental Association and the Invisalign® Study Club. He serves on the University of Colorado Health Cleft Palate Team. Invisalign Top 1% Provider in 20152017; Invisalign Elite Provider 2011-2014
Orthodontist Dr. Mark D. Crane Crane & Seager Orthodontics 4144 Timberline Rd. Fort Collins, CO Special Focus: : Orthodontics Board Certifications: American Board of Orthodontics (ABO) Certified Diplomate of the American Board of Orthodontics Medical School: UCLA School of Dentistry, Summa Cum Laude with a Doctorate of Dental Surgery in 2000 Residency: residency in orthodontics at Virginia Commonwealth University in conjunction with receiving a Master of Science degree in June of 2002 Professional/Medical Memberships: Member of the American Association of Orthodontists, Colorado Dental Association and the Invisalign® Study Club. He serves on the University of Colorado Health Cleft Palate Team. Invisalign Top 1% Provider in 20152017; Invisalign Elite Provider 2011-2014; 5280 Top Dentists 2008-2016
“Diabetes is a progressive disease,” says Linda Schoon. “Many live in the pre-zone for many years and if we can catch it while they’re in that zone, we can delay the progression to Type 2 and save them from long-term complications like heart and kidney disease.” Getty Images/iStockphoto
influence whether someone has it, researchers have been unsuccessful with finding a cause and, therefore, a cure.
Symptoms and screening The symptoms of Type 1 diabetes include increased urination, causing the person to have to get up at night, as well as rapid weight loss, Speed said. The onset of the disease is fairly dramatic and hard to ignore. Those have a family history of diabetes or are overweight should undergo regular testing, as should those over 45 with high blood pressure and high lipid and triglyceride levels, he noted. “It’s tough because some of those people don’t feel bad,” Speed said. “They have no symptoms and it’s hard to look down the road.” When sugar levels get high enough and symptoms appear, they may include weight loss, blurred vision, increased hunger and neuropathy that causes burning in their feet, he said. They may also feel fatigued, thirsty, urinate frequently, get frequent urinary tract infections or a wound won’t heal, Schoon added. “Diabetes is a progressive disease,” she said. “Many live in the pre-zone for many years and if we can catch it while they’re in that zone, we can delay the progression to Type 2 and save them from long-term complications like heart and kidney disease.” The best way to diagnose diabetes — preferably at the pre-diabetes stage — is having bloodwork done at least annually, depending on the risk level, including a glucose test, she said. An A1C test, which gives a three-month average of blood sugar levels, gives the best indicator whether a person has pre-diabetes or Type 2 diabetes. “One in three people in our nation have pre-diabetes, but only one in 10 of those knows that they have it,” she said. “That’s why I highly recommend the testing. If you’re overweight, you need to be tested for diabetes.”
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Front Range Pain Medicine 3744 S. Timberline Rd. #102 Fort Collins, CO Before embarking on his career in pain medicine in Colorado, Dr. Girardi earned his medical degree from the University of Illinois, College of Medicine. He completed his residency in anesthesiology and critical care at the University of Chicago Hospitals, working as chief resident his final year. Dr. Girardi has been working with patients in Fort Collins, Colorado for nearly 18 years. In that time, he has served as chairman of the Department of Anesthesiology and of Anesthesia Quality Assurance at Poudre Valley Hospital. He joined the medical staff as an anesthesiologist at Poudre Valley Hospital in 1994, and has previously served as medical director at Spring Creek Surgery Center. Dr. Girardi joined Front Range Pain Medicine in 2002. Additionally, Dr. Girardi is faculty for St. Jude Medical. Dr. Girardi specializes in the treatment of back, neck and other pain conditions. He performs interventional management procedures utilizing fluoroscopic guidance and patient sedation, as needed. Dr. Girardi performs nerve blocks, epidural injections, selective nerve root blocks, radiofrequency neural ablation, sympathetic blocks, spinal cord stimulation and discograms. Dr. Girardi holds certifications from the American Board of Anesthesiology and the American Board of Pain Medicine. He is a member of the International Spine Intervention Society, The American Academy of Pain Medicine and The Colorado Medical Society.
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CANCER
CATCHING CANCER Early detection key to improving survival rate BY KELLY K. SERRANO
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t wasn’t too long ago that a “Big C” diagnosis was synonymous with a shortened lifespan. But with modern medicine, a cancer diagnosis usually isn’t a death sentence. “Tremendous advances of modern, state-of-the-art oncology care have resulted in cure rates in all stages of most cancers – much higher cure rates than historically,” said Dr. Jeffrey Albert, radiation oncologist and medical director of Banner Health’s Oncology Program in Northern Colorado. “Many draw on the experience of relatives who went through treatments decades ago” that involved more toxicity with lower cure rates. However, the cancer diagnoses continues to grow: cancer is not only the No. 1 chronic disease in Colorado, but also the No. 1 cause of death, according to the Colorado Department of Public Health and Environment’s 2014 Colorado Chronic Disease State Plan. More than 7,000
Hepatocellular carcinoma (hepatoma) is a malignant tumor often associated with chronic hepatitis B Getty Images/iStockphoto
Coloradans died from cancer in 2011, representing nearly 22 percent of all deaths. The statistics mirror the growing baby boomer population, said Dr. Joshua Petit, medical director of Radiation Oncology at UCHealth’s Poudre Valley Hospital. “The No. 1 risk factor for getting cancer is age,” he explained. “As the population ages, cancer rises at a high rate. “The good news is that Colorado has one of the lowest cancer rates in the United States,” Petit added. “I think that is a reflection of the lifestyle of the people who live in Colorado. It’s nice that people are active and eat well but, when you get down to it, we have one of the lowest smoking rates in the United States.” Because fewer Coloradans smoke, the state’s lung cancer and lungcancer death rates are among the lowest, too, he said. Yet smoking is enough of a problem that lung and another cancer to which it’s linked –
2017-18 // Northern Colorado Medical Resource Guide
colon – are still among the top cancers in Colorado and the nation, along with breast, prostate and skin cancers. Colorado’s rate of skin cancer is higher than the national average, thanks to the altitude and the above-average number of sunny days that entice residents to spend time outside, Petit said. And Albert attributed the prevalence of colorectal or colon cancer to the Western high-fat/low-fiber diet. “The healthier you eat, the less at risk you are for that. A poor diet can lead to obesity and is a risk for a bunch of other cancers including breast and uterine cancer,” he said. People can reduce their overall cancer risk through lifestyle choices: eating a diet with plenty of fruits and vegetables and getting 20 minutes or more of aerobic exercise several days a week, Albert said. People should also avoid the sun – especially the fake kind in tanning beds – and take precautions when outside, Petit added. “You want to make sure you’re covering yourself and wearing
LOCAL RESOURCES »» UCHealth’s cancer care includes a comprehensive Cancer Center on the Harmony Campus in Fort Collins, as well as offices in Loveland and Greeley, with access to clinical trials; massage and healing touch; counseling/oncology social work services; genetic counseling; oncology massage; patient navigation; physical occupational or speech therapy; radiation oncology; nutrition counseling; information about support groups; and more. Visit uchealth.org/cancer or call (970) 237-7700. »» Banner Health Patient Centered Medical Home’s primary care clinicians provide patient navigation services to those undergoing treatment for chronic diseases by helping them coordinate their care including appointments, appropriate testing, locating community resources, prescriptions and more. »» Banner Health’s Cancer Institute at North Colorado Medical Center in Greeley and the Cancer Clinic at McKee Medical Center in Loveland offer both medical and radiation oncology. Services also include a social worker, palliative care, dietitian support, an oncology pharmacist, clinical trials participation for appropriate patients, a pharmacy patient advocate who helps patients locate financial assistance for oral medications, and support services and groups. Loveland, (970) 820-5900; Greeley, (970) 810-3894. »» The Health District of Northern Larimer County offers the Step Free from Tobacco smoking cessation program, (970) 2245209 or quitsmoking@healthdistrict.org. »» America Cancer Society, Greeley Office, (970) 356-9727.
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A person at-risk for lung cancer can undergo a low-dose CT scan (LDCT) to detect it, and mammograms have become part of the annual physical for women of a certain age and even more common for those at risk for breast cancer, Dr. Joshua Petit said.
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sunscreen,” Albert noted. “[The risk of skin cancer] shouldn’t be a deterrent to getting outside and getting active. … Physical exercise can reduce the chances of getting cancer, cardio disease, diabetes, and it’s good for your health in general.”
Symptoms and screening An ongoing relationship with primary care doctors and discussing risk factors including family history, symptoms, available screenings, and l procedures to test for or treat cancer in its earliest stages are key to preventing or successfully treating the disease, Petit said. “Screening has saved lives,” Albert agreed, noting it is available for all of Colorado’s common cancers. “There’s an enormous benefit to detecting the disease early. “As oncologists, we lean toward more screening because we see people who were told they didn’t need screening,” he said. Outside of screenings, people need to see their doctors if they are experiencing unusual changes or symptoms, Petit said. “If it seems abnormal for you, I would get it checked out,” he advised. “If you find cancer when it is early, the treatments are easier, they’re less invasive and they’re more effective. If it’s more advanced,
treatments are more toxic and the success rates are much lower.” Albert noted symptoms of some of Colorado’s most common cancers may include a lump in the breast or armpit; a skin lesion getting larger or darker; blood in the stool or urine; and increased coughing or shortness of breath. “(Any of these) should prompt a call to their primary care physician. Now it’s a diagnostic test, not screening,” he said. A person at-risk for lung cancer can undergo a low-dose CT scan (LDCT) to detect it, and mammograms have become part of the annual physical for women of a certain age and even more common for those at risk for breast cancer, Petit said. He noted that the primary function of colonoscopies is to remove lesions or polyps that can turn into cancer – not to just look for them. Knowing patients’ family history is also a preventative tool, Petit said. If patients have a genetic predisposition to cancer, surgical options are available – such as removal of the breasts or ovaries – or their doctors may do more in-depth screenings and tests to find cancer earlier. “It’s important for patients who are at high risk to see an oncologist” who knows exactly what to look for, he said.
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JUST BREATHE RESPIRATORY DISEASE Battling lower respiratory disease can suck the air out of life BY KELLY K. SERRANO
O
ne of the most common forms of lower-respiratory diseases – asthma – is something most people can’t prevent: once it’s triggered, they have to learn to manage it. The other – Chronic Obstructive Pulmonary Disease (COPD) – is a combination of chronic bronchitis and emphysema, and it’s nearly always avoidable by not smoking.
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Both stick around for life, though that may not be long for those with the latter. Lower respiratory disease ranks as the fourth most common chronic disease among Coloradans, according to the Colorado Department of Public Health and Environment’s 2014 Colorado Chronic Disease State Plan. They contributed to 2,161 deaths in 2011, or 6.6 percent of all deaths.
COPD Dr. James Hoyt, a UCHealth Pulmonology Clinic pulmonologist, said smoking cigarettes causes over 90 percent of COPD cases. “Smoking rates are declining some but, because people are living longer, the incidents of COPD are still on the rise,” he said, noting lung function declines with aging. Dr. William Culver, a Banner Health asthma and allergy care specialist, added, “The best prevention is avoiding cigarette smoke, both personal use and secondhand smoke. If parents or grandparents are smoking in a child’s house, it increases their risk for asthma.” Chronic bronchitis is a mucusproducing “smoker’s cough”; emphysema results in the loss of lung tissue and over-inflation of the lung, Hoyt explained. “One of the keys to COPD is once you have it, it doesn’t go away,” he said. “Only two things prolong survival: stopping smoking, and wearing oxygen if your oxygen saturation is
less than 89 percent when breathing room air.” While many inhaled medications can improve symptoms, none of them have shown to improve the survival of someone with COPD, Hoyt said. The lifespan of people diagnosed with COPD depends on how soon it is diagnosed and if the patient quits smoking, he noted. “If diagnosed early, most patients can live a full life.” But if it’s not diagnosed until advanced stages, it can drastically shorten a person’s lifespan, Hoyt said.
Asthma If nonsmokers have similar symptoms to COPD, they could have asthma, a chronic airway inflammation associated with reversible airflow obstruction, Hoyt said. The inflammation in the lungs may come and go or remain constant, Culver explained. Another major component of asthma is bronchospasm, when smooth muscle contracts into small airways, trapping air in the lung and making it difficult to breathe. Nearly 26 million Americans have asthma, including more than 7 million children, according to the American Lung Association (ALA). “We don’t even know for sure what causes asthma,” Hoyt said. “We know there are hereditary factors, but there are environmental factors like occupational asthma and there are sporadic cases of asthma.” The most common trigger of asthma, Culver said, is a viral infection
“Modern-day treatment of asthma is much more effective. As a matter of fact, with long-term use of these inhaled medicines, you can prevent progression and perhaps long-term lung damage.”
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such as respiratory syncytial virus (RSV), early on in infancy, though exposure to tear gas, air pollution, a toxic spill, chlorine gas and other airborne particles can trigger it, too. Some patients with asthma may have symptoms flair up only when they exercise, with a respiratory infection, air pollution or with allergies, while others will have symptoms all the time. Some women become symptomatic before their menstrual cycle, and some children get better or worse with puberty. “People may say coughs come and go but have ongoing lung inflammation,” he said. “If you have a forest fire, you can put the flames out but leave the embers. The embers are smoldering inflammation in lungs that will always be there and need to be addressed,” Hoyt said. But life is getting easier for those with asthma.
“We don’t even know for sure what causes asthma,” Dr. James Hoyt said. “We know there are hereditary factors, but there are environmental factors like occupational asthma and there are sporadic cases of asthma.” Getty Images/iStockphoto
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2017-18 // Northern Colorado Medical Resource Guide
“Modern-day treatment of asthma is much more effective,” Hoyt said. “As a matter of fact, with long-term use of these inhaled medicines, you can prevent progression and perhaps long-term lung damage.” For more severe cases of asthma, a new treatment called bronchial thermoplasty uses thermal energy to burn the airways and then, as they heal, the diameter of the airways increases and makes asthma easier to control, he added.
Symptoms and screening The symptoms of COPD and asthma include chest tightness, chronic cough, shortness of breath and wheezing, according to the ALA. But those with COPD will cough up excessive phlegm, have frequent respiratory infections and blueness of the lips or fingernail beds. And while the shortness of breath could occur occasionally or frequently for
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»» Banner Health’s Patient Centered Medical Home’s primary care clinicians provide patient navigation services to those with chronic diseases by helping them coordinate their care including appointments, appropriate testing, locating community resources, prescriptions and more. »» McKee Pulmonary Rehabilitation Program offers education and exercise classes for people with COPD. Educational sessions are seven weeks long, meeting 1-3 p.m. Tuesdays. Supervised exercise sessions are at 12:30 and 1:30 p.m. Monday, Wednesday and Thursday. To see Dr. Culver or information about COPD classes, call (970) 820-6606. »» The UCHealth Pulmonology Clinic team provides innovative care for lung diseases, including COPD, asthma, pneumonia and lung cancer, in Fort Collins, Loveland and Greeley. The
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someone with asthma, someone with COPD will struggle with it while doing even regular activities. A spirometry test, which measures how much air a patient inhales, and how much and how fast the patient exhales, can help determine whether patients have a lower-respiratory disease, how severe it is and whether it’s reversible with, Culver said. Hoyt noted when someone has less than 80 percent lung capacity, the patient should see a specialist. Doctors may order a chest X-ray and/ or other tests, such as an arterial blood gas test that measures the oxygen level in the blood and determines how well the lungs are able to move carbon dioxide from the blood, to zero in on a specific disease, according to the ALA. “When symptoms aren’t responding well to whatever the therapy is that’s being offered, it should raise the question whether it’s asthma or COPD,” Culver said.
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