Healthyu April 2016

Brought to you by the experts from UCHealth.

April 2016, Vol. 2, Issue 4

Published by: Greeley Publishing Co., publisher of The Greeley Tribune

PG.2

Man takes warning to heart

PG.4

Chili rellenos dish gets a light makeover

PG.3

Service gives provider unique perspective

Behind closed doors

PVH NICU expansion gives families, preemies the environment they need KATI BLOCKER, UCHealth

T Dr. Justin Strote, a UCHealth interventional cardiologist who was part of the multidisciplinary team that conducted the first Watchman procedures at Medical Center of the Rockies in February, holds up the Watchman device that can help prevent clots from forming in patients with atrial fibrillation. Photo by Kelly Tracer, UCHealth.

New device brings new hope

UCHealth first in the state to offer stroke-prevention procedure for patients with atrial fibrillation KATI BLOCKER, UCHealth

M

ae Lewis remembers the first time she thought she was dying. Thinking the end was near, she made more than a dozen legacy quilts for her children and grandchildren.

But doctors soon gave Lewis a reason for her extreme tiredness and racing heart: atrial fibrillation, or AFib, a heart condition in which the upper chambers of the heart beat too fast and with an abnormal rhythm. Although more than 2.7 million Americans live with AFib, it increases their risk for stroke, and Dr. Justin Strote to mitigate that risk, many spend a lifetime on a blood thinner — a medication that comes with its own dangers.

But today, thanks to a new device implanted by UCHealth doctors, Lewis sees a better future ahead.

Heart specialists at UCHealth’s Medical Center of the Rockies and University of Colorado Hospital were the first in the state to implant the Watchman, a device that reduces the risk of strokes for patients like Lewis and may allow them to stop taking powerful blood thinners.

Lewis arrived Feb. 9 to MCR to be UCHealth’s first patient to receive the

Watchman. Three more patients followed that day at MCR, and then two more at UCH on Feb. 19.

“The Watchman has the potential to greatly change how we treat atrial fibrillation, and that is why we are so excited about it,” said Dr. Justin Strote, a UCHealth interventional cardiologist who was part of the multidisciplinary team that conducted the first four Watchman Mae Lewis, 79, of Windsor was UCHealth’s first patient to receive the procedures at MCR. Watchman on Feb. 9 at Medical Center of the Rockies. Photo by Kelly The Watchman is about Tracer, UCHealth. the size of a quarter and looks like a tiny umbrella. body wouldn’t accept warfarin, and It was designed to prevent clots from weekly doctor visits proved that her forming in the left atrial appendage by warfarin levels were all over the chart. sealing off this section of the heart, where The second blood thinner left her so most deadly blood clots form in people dizzy she wasn’t able to drive, and the with atrial fibrillation. third made her vomit.

“To prevent strokes, we have to prevent She finally found one she could blood clots,” Strote said. tolerate, but her age and other factors People with atrial fibrillation are established by the CHADS2 scoring five times more likely to have a stroke tool showed she was at high risk for a than someone without the condition, stroke and a candidate for the Watchman according to the Centers for Disease procedure. These additional criteria Control and Prevention. Many patients include a history of stroke, vascular receive blood thinners, such as warfarin, disease, high blood pressure and diabetes. to ward off the risk of a clot breaking The full eligibility guidelines are set by loose and traveling to the brain. the Centers for Medicare & Medicaid Lewis struggled for years to find a Services, Strote said. CMS not only blood thinner that worked for her. Her determines which patients are eligible, »DEVICE continued on page 2.

he moments after a child’s birth are some of life’s most precious.

When your child weighs only 2 or 3 pounds and is as long as a 1-liter bottle of Pepsi, you need world-class care in a worldclass environment.

Erika Durhot, who delivered her twins on New Year’s Day at Poudre Valley Hospital, knows that in the neonatal intensive care unit, the nurses who cared for her twins became part of her family; Poudre Valley Hospital became an extension of her home.

In the coming weeks, PVH is expanding its NICU, making the home-away-from-home a more comfortable, private and nurturing environment for new life and new parents.

The unit will expand from 9,700 square feet to 22,400 square feet and from 19 beds to 32 private rooms. It will be fully equipped with the latest technology and capabilities, such as high-frequency ventilation, nitric oxide and hypothermia therapy. It will provide families with a private lounge and showers and each room will have a convertible sofa so parents can stay overnight.

“PVH’s NICU provides excellent familycentered care, but it’s time to expand,” said Geraldine Tamborelli, UCHealth’s senior director of women and children services in northern Colorado. “Our expanded NICU (opening April 21) will continue to provide our community with world-class care — we’ll just have a world-class space to do it in.”

PVH’s NICU achieved level III status in 2006, allowing for 19 preemies to be cared for in its open-bay layout and an additional six in its continuing care space. About 450 babies are cared for annually in the PVH NICU, and average census is about 15. »NICU continued on page 2.

David Knighton holds his 1-week-old son, King David Knighton, at Poudre Valley Hospital’s Neonatal Intensive Care Unit. King was born about 11 weeks early and spent nearly two months in the NICU. Photo by Kati Blocker, UCHealth.

THE BABIES CAME JUST IN TIME. Who’s on your team matters. It did for Brittany and Phillip.

The Mastin twins arrived right before Phillip was deployed for active duty. The midwives and OB/Gyns at UCHealth were with Brittany every step of the way through her high-risk pregnancy and delivery, caring for her physically and emotionally as she prepared for a world of change. Learn more about Brittany’s experience and how UCHealth OB/Gyn cares for women for a lifetime. uchealth.org/greeley-ob

970.614.4215

Same day appointments and extended hours available.

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April 2016

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Stern warning may have saved man’s life Doctor says man was a walking candidate for a massive heart attack

Erika Druhot holds daughter, Brielle, at their Loveland home on March 22. Druhot gave birth to twins on New Year’s Day to be the first to deliver in 2016 at Poudre Valley Hospital. After spending almost two months in PVH’s Level III Neonatal Intensive Care Unit, Brielle and her brother, King, were able to go home Feb. 26. Photo by Kati Blocker, UCHealth. »NICU continued from page 1.

Rob Wright works out at Loveland Athletic Club. A stern warning from Wright’s doctor four years ago got him to the gym and back to taking care of himself, which probably saved his life. Photo by Kati Blocker, UCHealth.

ANDREW KENSLEY, for UCHealth

F

our years ago, Rob Wright entered his primary care physician’s office with what he thought was a lingering cold. He left with a plan for a new

life.

“When the doctor saw my blood pressure, he looked like a deer in the headlights,” Wright said. “He wheeled in an EKG machine and told me, ‘We don’t need to talk about colds.’”

Soon afterward, Wright reported to a follow-up appointment at UCHealth’s Heart Center in Loveland, where cardiologist Dr. Tristan Dow wasted no time in giving Wright a dose of reality.

“I told him that his heart problems, the atrial fibrillation (irregular heart rhythm) and cardiomyopathy (enlarged heart muscle), were directly related to being overweight and not taking care of himself,” Dow said.

“He was a walking candidate for a massive heart attack and could die within a year.”

Temporary measures like medications, Dow acknowledged, might have delayed the inevitable. But the only way for Wright to successfully reverse the damage to his heart and avoid debilitating advanced heart failure was to take charge of his body.

“If Dr. Dow hadn’t brought up the words ‘heart attack,’ I don’t know if I would have changed,” Wright said. “I tossed the junk food from the refrigerator and literally walked into the gym the next day.”

An all-around athlete in high school, Wright’s weight had fluctuated like a roller coaster since his 20s. He had heard the message before — eat healthier and drop the pounds. But now he had a very specific

motivation: staying alive for his wife and four children.

For guidance with exercise and nutrition, Wright enlisted the help of friends, including Jeff and Becca Cisneros, owners of Sparta Combat League and Spartan Labs, who Wright works for as the vice president of their Colorado mixed martial arts company. Cliff and Kelly Shuffler put his workouts together and Jay and Terha Watterson of Loveland Athletic Club, along with the support of his family, have helped him faithfully maintain a dedicated workout regimen — two hours of early morning cardio and weight training, five days a week — and a healthy diet consisting mostly of vegetables, lean protein and low-fat options.

Having recently turned 50, Wright also has systematically reduced his medications and the number of required doctor visits. And in April 2015, he underwent a procedure called a cardioversion, basically an electrical shock, to reverse his atrial fibrillation. So far, the procedure has been a success.

“Even after a cardioversion, an arrhythmia can come back if a person is still overweight and not taking care of themselves,” Dow said. “So I made a deal with Rob that until he was thinned down and taking care of himself, I wasn’t going to entertain the option of trying to eliminate his arrhythmia.”

Better physical health (Wright has lost more than 165 pounds) has brought new business opportunities as well as a noticeable improvement in his emotional and spiritual well-being, Wright said.

“When your body gets right, it’s amazing how your mind improves as well. I’m very blessed and very humbled by where this three-year journey has taken

As a level III NICU, clinicians care for the smallest and sickest newborns because it meets the highest standards, including a wide variety of specialists on site such as a neonatologist, neonatal nurse practitioners and neonatal nurses. PVH’s NICU cares for babies as tiny as 2 pounds and as young as 28 weeks (in certain cases, as young as 27 weeks).

“When babies come out early, everything is still developing.

They need the time here to be supported and grow up,” said PVH neonatal registered nurse Kristin Anthony.

As was the case for Durhot and David Knighton’s newborn twins, King David and Brielle Louise Knighton. King weighed just 2 pounds, 12 ounces at birth and Brielle weighed 2 pounds, 8 ounces, and both spent almost two months in the NICU. The NICU’s current layout is an open-bay design that separates babies and their families by curtains. The space is not currently configured to allow parents to stay overnight.

“Because of the setup, there is no room for privacy — it’s the first thing you notice,” Anthony said. “As a nurse, it’s hard to control or provide any isolation.”

The open-bay layout has its advantages, as nurses can easily hear and see when a family or coworker may need their help.

But that same noise and closeness also is a hindrance in a NICU. “We’ve outgrown this space, and our rooms will provide a beautiful, private and quiet environment for parents to spend as much time as they would like,” Tamborelli said. “This will ultimately help these babies grow and develop faster, enabling them to go home even sooner.”

Studies have shown babies respond better to the care provided by their own mothers and fathers, said Barb Peters, nurse manager for PVH’s NICU. “When parents become more involved in the care, they learn more about the baby and are more prepared to take the baby home,” she added.

The new NICU’s design was created by a group of nurses, physicians, pharmacists, respiratory and other therapists, security staff and others, including family members of former NICU patients.

“We have had input in every decision, from floor plans to couch colors, how the room is laid out, furniture, setup, lighting and equipment placement,” Peters said.

King and Brielle are now at home with their parents. Brielle is still on oxygen, but both babies are weighing in around 7 pounds and eating well.

“I’m so thankful for the people at PVH and in the NICU,” Druhot said. “I wouldn’t have known what to do with preemie babies. It was nice that I had full-term experience (Druhot and Knighton also have an almost 2-year-old daughter), but I still had no idea. … These people become like family. I know I’ll continue to stop in here and say hello — and I’ll be excited to see the new space.”

'I tossed the junk food from the refrigerator and literally walked into the gym the next day.'

»WARNING continued on page 3. »DEVICE continued from page 1.

they also set the requirements hospitals must meet to perform the procedure.

While the patient is under general anesthesia, a multidisciplinary team uses ultrasound and X-ray to feed a catheter from the upper leg through the femoral artery and into the heart’s right atrium. They use the catheter to make a small hole in the septum, pass the catheter through it to the left atrial appendage, position the device, and then release it from the end of the catheter. The Watchman opens, sealing the left atrial appendage. Over time, tissue grows over the Watchman and the area is permanently sealed off. The

procedure generally takes one to two hours.

Lewis was out of the hospital and celebrating her 79th birthday with friends the next day.

Lewis and other Watchman patients remain on blood thinners for a period after the procedure, generally 45 days. With careful monitoring, their physicians will decide if they can reduce their use of blood thinners or even stop taking them altogether, Strote said.

“I felt great,” Lewis said. “And I’m thrilled that I’ll soon be off my prescriptions — just thrilled.”

Brielle Knighton followed the birth of her twin brother, King, to be the first babies born in 2016 at Poudre Valley Hospital. The twins weighed just over 2 pounds each and spent almost two months in the NICU. They are now healthy and home. Photo by Kati Blocker, UCHealth.

COMMUNITY OPEN HOUSE WHAT: PVH Neonatal Intensive Care

Unit community open house.

WHEN: 10:30 a.m.-noon April 16.

WHERE: Poudre Valley Hospital’s new neonatal intensive care unit.

The hospital is located at 1024 S. Lemay Ave., Fort Collins. Go through PVH’s main entrance, take the public elevators to the third floor and follow the signs to the open house.

April 2016

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A Red Cross hero Military service gives physician assistant unique perspective when caring for returning soldiers KATI BLOCKER, for UCHealth

C

ol. Victor Palomares, U.S. Army Reserve, has a slightly different perspective than most primary care physician assistants.

“Some people have never been in a vehicle roadside explosion with all of their buddies — the dust, the smell. I’m able to relate. I realize the Fourth of July might not be the most fun holiday to experience,” Palomares said.

Palomares, who will retire in May from the Army Reserve after 30 years of service, has been a physician assistant at UCHealth Family Medicine in north Loveland for the past six years. Before then, Palomares put his medical career on hold for about five years because he was called to multiple tours of duty; his last tour in Iraq ended in 2010.

“When I first got back, I had a readjustment stage to be with family and friends,” he said. “Then I was recognizing that from the soldiers coming back who came in to see me as patients. I understand what they are going through. It makes it easier to communicate with them — to shake their hand or to hold it.”

For his dedication, service and personal sacrifices, Palomares received the Red Cross Armed Forces Award at the American Red Cross Heroes Soiree on Feb. 26.

“Victor exemplifies what the words ‘service’ and ‘sacrifice’ mean — to me he’s a hero,” said Colorado Rep. B.J. Nikkel, who nominated Palomares for the award.

“Because of his sacrifices, it made me much more aware of what many of our National Guardsmen/women sacrifice as they are called to full-time duty overseas in times of war, in service of their nation.”

Palomares said he hopes his recognition encourages others to step forward, help and be available to the next generation — whether as a medical professional, a soldier

Rob Wright went to his doctor for what he thought was a lingering cold, but he left with a plan for a new life.

Wright is now the poster child for lifestyle interventions for treatment of heart problems, according to his doctor.

Photo by Kati Blocker, UCHealth.

Physician assistant Victor Palomares was recently recognized for his dedication and sacrifice as an Army Reserve colonel during the American Red Cross Heroes Soiree on Feb. 26. His military experience helps him help other returning soldiers.

Photo by Steve Peterson, courtesy of American Red Cross.

or both.

“There are a lot of people with more experience than I have,” he said. “To come forward and say, ‘I can share my experience and knowledge with these younger guys.’ That’s what I hope comes from this award.”

Palomares’ careers in both the medical field and the military were built on his desire to give back. He joined the military in 1986 after getting his bachelor’s in biology. He saw it as a way to give back to a country that had given his migrant family an opportunity to leave Mexico and work toward a better life that included education, he said.

After serving active duty as a chemical officer, he returned to his home in Denver, completed his medical training and started his career in the Denver region. But in 2005, he started being activated so often as a reservist — by this time he was a medic — that he put his career on hold. Then

WHO TO CALL To make an appointment with Victor Palomares, call 970.825.0470. in 2010 he joined UCHealth in northern Colorado.

With UCHealth, Palomares continued with his Army Reserve duties as a medical educator, teaching on a monthly basis.

“It’s important that (Army medic) students see what clinical medicine is about and not just learn classroom medicine,” he said. “It takes some of the fear away from what they will see and be exposed to.”

And when his military career ends in a few months, Palomares said he will continue to teach what he knows through opportunities at UCHealth.

“I think I’ll get even more involved in teaching,” he said. “I want to continue that trend and open my door to other physician assistants and nurse practitioners.”

»WARNING continued from page 2.

me,” Wright said.

Patients with advanced heart disease or those who’ve had specialized cardiac or vascular procedures performed at the Heart Center are often sent to consult with exercise or nutrition specialists to help get them started, Dow said. He typically recommends a minimum of 30 minutes of aerobic exercise every day, anything from a treadmill to circuit training, and refers many of his patients to their local gym to meet with a certified personal trainer.

The cardiologist knows how challenging it can be to make hard lifestyle changes.

That’s why he considers Wright in the minority.

“A lot of people expect me to have a pill that will take away their symptoms,” Dow said. “But Rob really took my advice to heart. Rather than getting angry, he’s really shifted things toward a positive outlook, future and prognosis. Rob is a poster child for lifestyle interventions for treatment of heart problems.”

Do you know the

signs of a stroke?

Think F.A.S.T. Know the signs.

Brittany and Phillip Mastin and their boys

THE BABIES CAME JUST IN TIME. Who’s on your team matters.

It did for Brittany and Phillip.

The Mastin twins arrived right before Phillip was deployed for active duty. The midwives and OB/Gyns at UCHealth were with Brittany every step of the way through her high-risk pregnancy and delivery, caring for her physically and emotionally as she prepared for a world of change. Learn more about Brittany’s experience and how UCHealth OB/Gyn cares for women for a lifetime.

Same day appointments and extended hours available.

F A S T

FACE

Ask the person to smile.

Does one side of the face droop?

ARMS

Ask the person to raise both arms.

Does one arm drift downward?

SPEECH

Ask the person to repeat a simple phrase.

Is their speech slurred or strange?

TIME

Act fast.

Every second, brain cells die.

Call 911 if you think you or a loved one is having a stroke.

When it comes to stroke care, UCHealth is the team you want on your side.

MEDICAL CENTER OF THE ROCKIES | POUDRE VALLEY HOSPITAL

uchealth.org/stroke

uchealth.org/greeley-ob | 970.614.4215

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Upcoming events

FEATURE RECIPE

CHILI RELLENOS CASSEROLE

Bright by Three Infant Group, noon-1 p.m.

April 5 at Medical Center of the Rockies, 2500 Rocky Mountain Ave., Loveland. Free class provides parents and caregivers with educational tools, books and games to make the most of the very important developmental years. A free infant packet includes a handbook provided by Bright Beginnings, brochures, and a toy and board book. To register or for more information, call Jennifer Salvador at 970.495.7500.

UCHEALTH HEART CENTER INGREDIENTS

½ lb. ground turkey breast 1 cup chopped onion 2 tsp. cumin 1 ½ tsp. dried oregano ½ tsp. garlic powder ¼ tsp. black pepper 1 ½ cups low-sodium refried beans 2 (4 oz.) cans whole green chilies, drained and cut lengthwise into quarters 1 cup (4 oz.) shredded low-fat Colby-jack cheese, divided 1 cup frozen corn, thawed and drained 1/3 cup all-purpose flour 1 1/3 cups skim milk, divided 1/8 tsp. hot sauce 3 omega-3 eggs, lightly beaten

Take Charge of Your Health: Mindful Eating, 10:30 a.m.-3:15 p.m. April 15 at Medical Center of the Rockies, 2500 Rocky Mountain Ave., Loveland. Symposium will help attendees define ways to be mindful during their daily routine as it relates to managing stress and eating habits. Cost: $25. To register or for more information, call 970.495.7500.

Natural Childbirth, 6-9 p.m. April 14, 21, 28 at Medical Center of the Rockies, 2500 Rocky Mountain Ave., Loveland. This class will teach expectant mothers and their birth partner techniques and coping strategies for a non-medicated childbirth. Techniques will include breathing, massage, relaxation, positioning, visualization, and aromatherapy. Parent preview tour class is included but breastfeeding class needs to be scheduled separately. Cost: $65.

To register or for more information, call 970.495.7500.

More than 130 people attended UCHealth’s March MAN-ness at the Budweiser Event Center on March 7.

Although research shows that mortality rates decline when a person takes an active role in their health, men still don’t visit their doctor. March MAN-ness works to reach these men through a fun and “manly” event that features often ignored topics like prostate exams, colonoscopies, joint replacements, mental health and heart health. Photo by Jody Metzger-Pflieger, UCHealth.

Childbirth Breastfeeding Basics, 6:30-8:30 p.m. April 7 at Medical Center of the Rockies, 2500 Rocky Mountain Ave., Loveland. Learn about the benefits of breastfeeding, establishing and maintaining a good milk supply and solutions to common breastfeeding challenges.

Partners are welcome. Cost: $20. To register or for more information, call 970.495.7500.

Fast Track Childbirth Preparation (two-day), 6-9 p.m. April 8 and 1-5 p.m. April 9 at Medical Center of the Rockies, 2500 Rocky Mountain Ave., Loveland. Class includes overview of labor and delivery, hospital routines, coping techniques, medications, medical interventions and cesarean birth. Please bring a support person, two bed pillows and water bottle. Also, wear loose-fitting, comfortable clothing. Register for hospital tour and Breastfeeding Basics class separately. Cost: $55. To register or for more information, call 970.495.7500.

Fast Track Childbirth Preparation (two-day), 6-9 p.m. April 29 and 1-5 p.m. April 30 at UCHealth OB/GYN in west Greeley, 1715 61st Ave. Class includes overview of labor and delivery, hospital routines, coping techniques, medications, medical interventions and cesarean birth. Please bring a support person, two bed pillows and water bottle. Also, wear loose-fitting, comfortable clothing. Register for hospital tour and Breastfeeding Basics class separately. Cost: $55.

To register or for more information, call 970.495.7500.

Afternoon Tea and Spring Fashion Show, 1:30-3 p.m. April 27 at Chilson Senior Center, 700 E. 4th St., Loveland. This relaxing afternoon for ladies will feature tea, treats, spring fashions provided

by Dress Barn, and fancy hats from Masonville Mercantile. Cost: $5.

To register or for more information, call 970.495.8560.

DIRECTIONS Preheat oven to 350.

Cook turkey and onion in a nonstick skillet over medium-high heat until browned, stirring to crumble. Remove from heat; add cumin and next 4 ingredients (cumin through beans).

Stir well; set aside. Place half of green chilies in the bottom of an 11x7-inch baking dish coated with no-stick cooking spray; top with ½ cup cheese. Spoon turkey mixture onto cheese; spread gently, leaving a ¼-inch border around edge of dish. Top with corn. Arrange remaining green chilies over corn; top with ½ cup cheese. Place flour in a small bowl and add 2 tablespoons milk; blend well until a thick paste forms.

Gradually add remaining milk, hot sauce, and eggs stirring with a whisk until blended. Pour milk mixture over casserole.

Bake at 350 for 1 hour or until set; let stand 5 minutes. Makes 6 servings.

NUTRITION FACTS PER SERVING: 269 calories, 8gm fat, 4gm saturated fat, 22gm protein, 27gm carbohydrate, 297mg sodium, 4gm fiber, 255mg calcium TIP: Using low-fat dairy products in your favorite recipes will lower the total fat and saturated fat content of the recipe by half. When preparing casseroles, lasagna, tacos or burritos, try reduced-fat cheeses made with 2% or skim milk. Also, try to use less cheese than what the recipe calls for.

Do you know the

signs of a HEART ATTACK? Time lost is muscle lost. Know the signs. » Chest discomfort, pressure, squeezing, fullness or actual pain » Discomfort in one or both arms, the back, neck or jaw » Shortness of breath » Sweating » Nausea » Lightheadedness

Call 911 if you think you’re having a heart attack. Minutes matter. Don’t wait.

When you’re having a heart attack, UCHealth Heart Center is the team you want on your side. uchealth.org/heart