October 2014 Thrive

nc

October 2014

THRiVE » NORTHERN COLORADO WELLNESS

FOR THE

RECORD Electronic medical records provide better organization, patient care and cost benefits. Page 8.

» INSIDE: STUDENTS BACK ON ROADS • STAY CONNECTED WITH TECHNOLOGY • HEALTH EVENTS

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September 24, 2014

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ydo I Where turn when it comes

My family’s health? is that

to my health?

I’VE NEVER even heard of that Is it

DISEASE.

medication

safe?

treatable?

What’s the latest

technology?

Who doI TALK TO

y

I have been suffering from constant neck and arm pain. What might be the cause?

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2

about this?

What are my OPTIONS

now?

Neck and arm pain is very common and can be caused by different problems.

Fortunately, there are many treatment options available as well.

A ruptured or herniated disc is a common cause of neck and arm pain, although there are many other factors. Symptoms may include dull or sharp pain in the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers, or numbness or tingling in the shoulder or arm.

Ask the

Expert

Neck and arm pain can also be caused by poor posture, lack of exercise, an injury, or the natural process of aging.

Treatment options include cold/heat therapy, pain medications, physical therapy, massage and lifestyle modifications like losing weight, quitting smoking and improving posture, especially when working on a computer.

If pain persists, surgery may be suggested. Most procedures can be done using minimally-invasive techniques.

If you are living with chronic neck and arm pain, contact a Banner Health neurosurgeon today.

Banner Health Clinic- Neurosurgery, Brain & Spine 1800 15th St., Suite 130, Greeley 2923 Ginnala Dr., Loveland

Beth Gibbons, M.D. Neurosurgery

David Blatt, M.D. Neurosurgery

Kai Stobbe, PA-C Neurosurgery

Appointments: (970) 350-5996 www.BannerHealth.com/BMG-CONeuroBrainSpine Accepting Kaiser Permanente Members

September 24, 2014

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THINKING ABOUT HEALTH

Medicare Advantage plans are no advantage

By Trudy Lieberman Rural Health News Service

Evidence continues to pile up that Medicare Advantage plans are no advantage for taxpayers.

MA plans, as they are called, are one alternative for seniors to receive their Medicare benefits.

But in this case, the benefits come from government payments to private insurance carriers, not directly from the federal government.

Medicare Advantage plans took off in 2006 when overpayments from the government allowed insurance sellers to offer these arrangements as an alternative to traditional Medicare benefits and Medigap policies.

In a move to encourage beneficiaries to use managed care — on the theory it would save money — the government began to pay insurers to provide the same benefits to seniors and disabled people eligible for Medicare that would be available in the regular fee-forservice program.

Payments from Washington have been very generous — a

kind of subsidy for insurers that has made it possible for them to entice seniors with low or no monthly premiums for their coverage and extra goodies like chiropractic care, gym memberships, and eye glasses.

There was a catch, though, that seniors would learn about only if they got sick. Some of these no-premium MA plans came with high copayments and coinsurance required for many services.

Still, they’ve become so popular that 30 percent of all Medicare beneficiaries now have them, and most beneficiaries eagerly sign up for them during fall open enrollment with little thought to potentially high out-of-pocket costs down the road.

Studies by health policy researchers in and out of government have found that Medicare has paid insurance companies as much as 12 percent or 13 percent more than it costs to provide identical benefits for the same services under the traditional program thanks to quirks in the payment formulas, as well as overbilling by

insurance companies.

The most recent study has come from Medicare’s own researchers, who quietly posted their results in late July on an online research site of the Centers for Medicare and Medicaid Services (CMS), which runs the Medicare program. They found many MA plans routinely overbill the government for treating elderly patients and have done so for years.

Researchers said that many MA plans exaggerate how sick their patients are and how much they cost to treat them, a practice called upcoding, which my journalistic colleague Fred Schulte at the Center for Public Integrity has written about extensively.

Schulte told me, “the study can appear to be an inside baseball thing but it’s hugely important since it exposes tons and tons of misspent taxpayer money.”

For example, CMS researchers found that beneficiaries in some MA plans appeared to have rates of some diseases like depression and complications from diabetes that were higher

than those in traditional Medicare. Yet they concluded that people who join MA plans are healthier than those who stay in traditional Medicare.

They concluded it’s “unlikely” that the higher payments insurers receive for these more complicated conditions are related to improvements to seniors’ health provided by the plans, as the insurance industry claims.

The fact the study has gotten so little attention is puzzling considering the MA program will cost the government some $160 billion this year. But then maybe it’s not so puzzling given what’s happened to past efforts to reduce excess payments to the plans.

President Barack Obama came to the White House vowing to cut the overpayments, a promise he made often on the campaign stump. But each time CMS proposed cuts, the insurance industry’s lobbying, its slick advertising and TV campaigns, and ultimately pressure from members of Congress, both Democrats and Republicans, turned the proposed cuts into payment

increases.

Medicare Advantage is good business for the carriers. Last year a journalist for the now defunct Medicare News Group estimated no cuts would add some $11 billion to insurers’ bottom lines.

In 2013, the agency proposed a 2.2 percent cut that turned into a 3 percent rate hike. Same story this year.

A proposed 2 percent rate reduction resulted in a small increase in payments. And, in 2012, CMS decided to forgive more than $32 billion in overpayments the government had given the insurers from 2008 through 2010.

Schulte thinks the recent study may be the program’s “Achilles heel.”

I’m not so optimistic.

CMS has not released the names of the insurance companies doing the most overcharging. If the agency would spotlight individual companies, then we consumers would have a chance to see what’s really happening.

Maybe that would finally effect change.

Women have reconstruction options after mastectomy

By Molly Decker For The Tribune

UESTION — I was recently diagnosed Qwith breast cancer and a total mastecto-

my has been recommended. Can you please explain what options are available for breast reconstruction after mastectomy?

A

NSWER — Despite the massive efforts

that have been made to raise awareness of breast cancer, it appears we still need to

do a better job of discussing breast reconstruction for women who undergo a mastectomy. Just 23 percent of women are aware of the wide range of breast reconstruction options that are available, according to the American Society of Plastic Surgeons and The Plastic Surgery Foundation.

In honor of National Breast Reconstruction Awareness Day on Oct. 15, and to answer your question, here’s a brief discussion of breast reconstruction options: Though a number of techniques and

strategies are used, there are two main categories of mastectomies: partial mastectomy and total mastectomy.

For total mastectomies, women have several reconstructive options, which include: » Two-stage reconstruction, which involves implanting temporary expanders at the time of the mastectomy and then following up with permanent implants after the expanders have reached the desired size. » Immediate reconstruction (during the mastectomy) with silicone or saline

implants. » Delayed reconstruction (post mastectomy) with implants. » Reconstruction using the patient’s own muscle to replace the removed tissue. » Fat transplantation where the patient’s abdominal fat is re-implanted as “breast” tissue.

For partial mastectomies, options include: Turn to Mastectomy on P.10

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BEWARE YOUNG DRIVERS BACK IN SCHOOL IN WELD COUNTY

By Kelly Campbell For The Tribune

As millions of teens head back to school, many will be driving to and from classes every day.

Teens are at a greater risk than any other age group to be involved in a crash, due largely to lack of experience. Many of those crashes could be avoided with proper education, said DRIVE SMART Weld County Coalition member Sue Helfrich of Allstate Insurance.

Helfrich said common mistakes by new drivers include tailgating, speeding and poor judgment, especially when making lefthand turns across oncoming traffic.

Some, despite warnings and laws, ignore the dangers of drinking and driving.

Crash statistics from the National Highway Traffic Safety Administration indicate 31 percent of teens involved in fatal crashes had been drinking.

Distraction is a major hazard for teen drivers. In addition to talking on cell phones and texting, other distractions that take a driver’s attention from the road include talking with passengers in the car, tuning the radio or iPod, or reaching for coffee or a water bottle.

“Driving requires our full attention,” Helfrich said.

Drowsy driving is another risky behavior common

among young drivers. The National Highway Traffic Safety Administration estimates that more than 100,000 crashes every year are due to driver fatigue, resulting in more than 1,500 deaths and 71,000 injuries.

Several signs warn a driver to stop and rest. A driver who experiences any of these should pull over at the next exit or a safe rest area and take a break or a 20-minute nap. Have a cup of coffee or caffeinated snacks and allow 30 minutes for the caffeine to enter the bloodstream.

Don’t drink alcohol or take medication.

“Drowsy driving poses a real risk to everyone on the road,” Helfrich said. She cited a recent study that showed nearly one-third of all drivers have dozed at the wheel. “At highway speeds, dozing off for even three or four seconds can send you off the road and into a tree or out of your lane into oncoming traffic. Drowsy driving is, in our opinion, as dangerous as drunk driving.”

See how you can make a difference at www.noys.org (National Organizations for Youth Safety). More information on DRIVE SMART Weld County can be found at www.drivesmartweldcounty.com.

Kelly Campbell is the DRIVE SMART Weld County coordinator.

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LINK FOUND BETWEEN DRUGS USED FOR SLEEP, ANXIETY AND ALZHEIMER’S DISEASE

By Melissa Healy Los Angeles Times

Older people who have relied on a class of drugs called benzodiazepines to reduce anxiety or induce sleep are at higher risk of going on to develop Alzheimer’s disease, new research finds, with those whose use of the medications is most intensive almost twice as likely to develop the mind-robbing disorder.

Benzodiazepines — marketed under such names as Xanax, Valium, Ativan and Klonopin — are widely used to treat insomnia, agitation and anxiety, all of which can be early signs of impending Alzheimer’s disease in the elderly.

But the current study sought to disentangle benzodiazepines’ use in treating early dementia symptoms, probing instead the possibility that heavy use of the medications may permit, cause or hasten the onset of Alzheimer’s dementia.

The study compared the pattern of benzodiazepine use in 1,796 elderly people diagnosed with Alzheimer’s with that of 7,184 similar people who had no such diagnosis.

Such a study design, conducted by French and Canadian researchers and published in the journal BMJ, cannot by itself establish that more intensive use of the medications causes Alzheimer’s disease.

But it does strengthen such suspicions.

Among the study participants over 66 who were living independently in the Canadian province of Quebec, those who took low-dose benzodiazepine medication, or who took higher doses but very briefly or infrequently, did not see their Alzheimer’s risk go up five years after they were first prescribed such a medication.

But the picture was more worrisome for those who frequently took long-acting benzodiazepines, who frequently took high doses, or who took any such drugs regularly over several months.

The benzodiazepines specifically considered by the researchers were the short-acting anti-anxiety medications alprazolam (Xanax), lorazepam (Ativan), oxazepam (Seresta) and diazepam (Valium), and the longer-acting anti-seizure and “hypnotic” drugs frequently used to treat insomnia: clonazepam (Klo-

nopin), flurazepam (Dalmane), midazolam (Versed), nitrazepam (Mogadon), temazepam (Restoril) and triazolam (Halcion).

The widely prescribed medicines marketed as Ambien, Lunesta and Sonata (generically named zolpidem, eszopiclone and zaleplon) are “atypical benzodiazepines” and were not included in the analysis.

The authors of the study created an index that gauged the intensity of a participant’s benzodiazepine use and found that at the end of a five-year period following an initial prescription, Alzheimer’s risk mounted steadily.

Those who took the cumulative equivalent of daily doses for three to six months over a five-year period were roughly 32 percent more likely than those who took none to develop Alzheimer’s. Those who took the cumulative equivalent of a full daily dose for more than six months were 84 percent more likely to do so.

There’s already strong research evidence that frequent or regular benzodiazepine use degrades memory and mental performance in humans and animals. And some research suggests that with regular use of this class of drugs, the receptors to which they bind in the brain become less active. And lower activity of those receptors has been linked to cognitive decline.

“In view of the evidence, it is now crucial to encourage physicians to carefully balance the risks and benefits when initiating or renewing a treatment with benzodiazepines and related products in older patients,” the authors wrote.

International medical guidelines recommend the use of benzodiazepines as treatment for anxiety disorders and transcient insomnia, but caution that they are not meant for long-term use, and should not be taken steadily for more than three months.

But many patients continue to take these drugs for years.

In addition to their cognitive effects, benzodiazepines are widely implicated in the national epidemic of opioid pain medication overdoses and fatalities that result from mixing them with alcohol and opioid drugs.

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OCTOBER HEALTH EVENTS « Community Wellness Clin- « CT Heart Score, 1-2 p.m. ics, 10 a.m.-noon Oct. 1 at the Windsor Recreation Center; 7-11 a.m. Oct. 3, 50+ Health and Job Fair; 10 a.m.-noon Oct. 10, Platteville Town Hall; 10:30 a.m.-noon Oct. 13 and Oct. 29 at the Greeley Senior Center; 4-6:30 p.m. Oct. 14 at the Eaton Town Hall; 9-11 a.m.

Oct. 14 at Evans Recreation Center and 7-8:45 a.m. Oct. 15, wellness blood draws and walk-in flu, Banner Health in Johnstown; 10 a.m.-noon Oct. 23 at the Kersey Senior Center. The clinic will include: flu, $25; nasal flu mist, $35; pneumonia, $90; Tdap, $55.

We accept Medicare Part B for the flu and pneumonia vaccines. Please bring your Medicare Part B card with you to the clinic. Sorry, we do not bill insurance; we do accept cash, credit card or check. Flu shots available for ages 4-17 with parent present.

Monday-Friday at North Colorado Medical Center.

Heart Score provides a non-invasive test that accurately measures the amount of calcified plaque in the arteries. The procedure begins with a fast, painless computed tomography CT exam. CT, more commonly known as CAT scanning, uses X-rays and multiple detectors to create interior images of the heart. The Heart Score program includes a 10-minute consultation with a wellness specialist, focusing on cardiac risk factor education, identification of non-modifiable and modifiable risks and lifestyle behavior change options. The cost is $199 and payment is due at the time of service.

Wellness Services is not able to bill insurance. Call (970) 350-6070 to schedule an appointment.

Are all hospices the same?

-NM OQNiS @MC ENQ OQNiS GNROHBDR @QD CHEEDQDMS MNM OQNiS TRDR @KK QDRNTQBDR SN B@QD ENQ O@SHDMSR @MC OQNUHCD RTOONQS SN B@QDFHUDQR @MC HR MNS BNMBDQMDC VHSG BQD@SHMF RG@QDGNKCDQ U@KTD Pathways Hospice … @ KNB@K MNM OQNiS NEEDQHMF educational and support OQNFQ@LR ADMDiSSHMF SGD DMSHQD BNLLTMHSX @S little or no cost.

Upcoming Support Groups Newly Bereaved: Sept 16 & 23, 6-7:30pm Living with Loss: Sept 23, 5:30-7:30pm Call for fee and registration information.

www.pathways-care.org 305 Carpenter Rd, Fort Collins • (970) 663-3500 1455 Main St, #140, Windsor • (970) 674-9988

« STAR, 5:30-7 p.m. Oct. 2, NCMC

Cancer Institute Conference Room. Support, touch and reach breast cancer survivors (Breast Cancer Support Group). For further information please contact Betty Parsons at (970) 339-7137.

« PAD Screening (Peripheral

Vascular Disease), 1-3 p.m.

Oct. 7 and Oct. 21 at Summit View Medical Commons.

NCMC’s Peripheral Vascular Disease Screening program offers the education and prevention proven to be the best tools for fighting vascular disease and stroke. Patients receive: ankle brachial index: evaluation of leg circulation, carotid artery disease screening: ultrasound of the carotid vessels, abdominal aortic aneurysm screening: ultrasound of the aorta, lipid panel voucher, health education with a wellness specialist, health

information packet. The cost is a $100 and payment is due at time of service. To schedule an appointment call (970) 3506070. NCMC Wellness Services is not able to bill insurance.

« Cooking Classes, “Ethnic

Foods Made Lighter,” 6-7:30 p.m. Oct. 8, North Colorado Medical Center in the Cardiac Rehab Kitchen. Take your taste buds on a trip with some international dishes you’ll love! Taught by Mary Branom, R.D. Come and learn a variety of fun and healthy cooking options. These courses are taught by a registered dietitian and are a great way to modify your cooking habits and learn about heart healthy cooking.

Recipes and samples are included! Payment due at the time of registration. If you are absent from the class, you will be charged the full amount.

Please call (970) 350-6633 to

register.

« Blood tests, 7-8:45 a.m.

Oct. 8 and Oct. 22 at NCMC via entrance 6 and Oct. 15 at Johnstown Family Physicians, 222 Johnstown Center Drive.

Wellness Services offers low-cost blood screenings open to community members; some immunizations are also available upon request and availability. Now also offered in Johnstown on the 3rd Wednesday of every month at Johnstown Family Physicians, 222 Johnstown Center Drive.

Appointments preferred; please fast 12 hours prior to blood draw. To schedule an appointment, call (970) 350-6633.

« Body Check... What you

need to know: Head to Toe, Oct. 2 and Oct. 16 at Summit View Medical Commons, 2001 70th Ave. This head-to-toe health assessment gives you the tools to put your health first by receiving a comprehensive set of preventive health screenings. Invest in your health today! This screening includes: Health Fair Panel (fasting blood work-please fast 10-12 hours), sleep questionnaire, lung function test, body composition, weight and body mass index, hip and waist measurements, health education with a wellness specialist, EKG with results read by a board-certified cardiologist, peripheral arterial disease screening includes: Education about peripheral vascular disease, stroke, stroke prevention and osteoporosis prevention, ankle brachial index, ultrasound of the carotid vessels, ultrasound of the aorta (above four screenings are read by a board-certified

radiologist), upon request: colorectal take-home kit, $10; prostate specific blood antigen screening, $30. The cost is $175 and the payment is due at the time of service. Wellness Services is not able to bill insurance. Call (970) 350-6070 to schedule an appointment.

« Prostate Cancer Support

Group, 5:30-7 p.m. Oct. 16, NCMC Cancer Institute Conference Room. For further information, please contact Julianne Fritz at (970) 350-6567.

« Walk with a Doc (WWAD),

Oct. 18 at Sanborn Park, 2031 28th Ave., on west side of the park. WWAD is an international program where interested people meet at a park or public location (usually Saturday mornings) for an informal five-minute health talk and a 30-minute walk (at your own pace). Families are encouraged to attend. There are healthy snacks at the completion of the walk. Free blood pressure checks are available for those interested. Upcoming walks are posted on the Walk with Doc website, WalkwithaDoc. org.

« NCMC Adult Fitness,

individual cost is $45 and for a couple (living in the same household) $80. The Adult Fitness Program is available to people in the community who are interested in starting an exercise program in a health care setting. For more information call (970) 350-6204.

« Pulmonary Rehabilitation, lung disease management, education and exercise.

For more information and opportunities contact (970) 350-6924.

September 24, 2014

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Hookah smoking a hot trend for young adults but clouded by health concerns

By Lizzie Johnson The Dallas Morning News

D

ALLAS —

Clouds of sickly sweet blackberry smoke are billowing out of Isaac Doss’ mouth. He takes a long draw from the bubbling hookah and passes the pipe to Kara Brick.

They are sprawled on cushioned wicker chairs on the patio at Kush, a hookah bar on Greenville Avenue in Dallas. It’s a muggy Thursday and the two are celebrating the return of Kara’s sister, Savannah Brick, from an au pair job in Europe.

“This is kind of cheating,” Kara Brick, 28, says. “We are all ex-smokers. With cigarettes, you really have to push through smoking it the first time. They taste terrible and smell terrible. Hookah is actually enjoyable. This has a social feel and is something we can do together.”

Hookah bars are a relaxed gathering place for customers to socialize as they smoke tobacco through water pipes. It’s a hot trend among young adults. Nearly one in five U.S. students smoked hookah in the last year, according to a study published in the journal Pediatrics. About 10 businesses sell hookah within a fivemile radius of the University of Texas at Dallas.

But hookah, which comes with few warning labels or health notices, can be more dangerous than smoking cigarettes. A study funded

MCCLATCHY NEWSPAPERS

FRIENDS HANG OUT AT Kush Mediterranean Grill & Hookah Lounge in Dallas in June. Some studies show hookah smoking is no healthier than cigarettes. by the National Institutes of Health notes that a single hookah session delivers 1.7 times the nicotine, 6.5 times the carbon monoxide and 46.4 times the tar of a single cigarette.

“There is no reason to believe that a water pipe is less dangerous than a cigarette,” says Dr. Thomas Eissenberg, a Virginia Commonwealth University professor who has conducted numerous

studies on water pipe smoking. “In fact, depending on some of the toxins, there is reason to believe it is more dangerous.”

Doss, 25, smoked hookah regularly at the University of the Ozarks in Clarksville, Ark., without realizing the health risks.

“I was 18 the first time I smoked,” he says. “I smoked every weekend. I never considered how bad it would be

for me. Now I smoke occasionally enough that it really can’t affect me. It’s something I consider before I go to the hookah bar.”

State law prohibits the sale and smoking of hookahs to anyone younger than 18.

Kevin Perlich, a spokesman at the Richardson, Tex., Police Department, says that anyone caught smoking under 18 will be issued a citation for the use of tobacco,

a Class C misdemeanor similar to a speeding ticket.

Richardson has adopted ordinances that ban the use of tobacco products, including water pipes, in most public places. But the law does not restrict young patrons from entering the lounge, so teenagers are legally able to be in the environment.

“Hookah seems like it is on the upswing,” says Dr. Gary Weinstein, a pulmon-

ologist at Texas Health Presbyterian Dallas. “There are hookah bars in many young areas, and it’s a cool thing to do. It seems cooler than smoking a cigarette.”

Data from the University of Michigan’s Monitoring the Future survey suggests hookah usage among high school seniors in the past year rose 21 percent.

Turn to Hookah on P.10

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September 24, 2014

FOR THE REC

Electronic medical records provide better organization, patien

H

By Casey Kelly ckelly@greeleytribune.com

ospital patients have better access to their health records and their doctors’ ears than ever before thanks to the implementation of electronic health record systems.

Instead of a new mother forgetting to ask her doctor a question in her appointment and having to wait until her next meeting to ask it, she can get an email response from her doctor within 24 hours.

“I’m a pediatrician, and especially for new moms who haven’t had a baby before, they have a thousand questions, and it’s hard to think of them all while they’re in the room with me,” said Amanda Hill, a pediatric and adolescent medicine physician at Kaiser Permanente’s Greeley Medical Offices at 2429 35th Ave. “It’s way easier for them to send me a message than to call the call center, make an appointment or wait until their next one to ask the question.”

Kaiser Permanente began moving to electronic medical records in 2004 with the launch of its HealthConnect system and launched its patient portal — My Health Manager — in 2007.

As of the end of the first quarter of 2014, 66 percent of Kaiser’s eligible member population had registered for My Health Manager, Kaiser Permanente Advertising and Marketing Consultant Pamela Tauman said.

My Health Manager offers Kaiser Permanente patients the ability to schedule appointments, send messages to their doctor, refill prescriptions or have them sent to their home, as well as see the details of their medical records, like lab results and growth charts. Kaiser offers the service through its website at www.KP.org, as well as it’s mobile application.

“We just find that so many people like doing this on their phones,” said Amy Whited, manager of public relations and digital media. “The

whole world is moving toward mobile and I think we’re seeing that on KP.org, too.”

Hill said she worked with paper records at an early job in her career when she was working at a hospital in Montana.

“For kids, especially kids with chronic illness, they would have volumes of charts, not just one chart,” Hill said. “If you’re trying to find out, for instance, when their last kidney ultrasound was, that’s 30 minutes of flipping through the patient’s charts to find what you need.”

The implementation of the electronic medical records system has helped Kaiser delivery care more efficiently, Whited said.

According to Kaiser’s data, diabetes patients visited the emergency room 29 fewer times per 1,000 patients and were hospitalized 13 fewer times per 1,000 patients annually after Kaiser implemented its HealthConnect system.

The growing database of patient

PAYTON SCHELLER, 5 MONTHS, loses interest in the medical records during a check-up w Greeley. information and outcomes also provides doctors with better information about how their treatments are working from a bird’s-eye view.

“It really does promote evidence-based medicine because you can see what really works,” Whited said.

At the University of Colorado Health Internal Medicine at 1900

16th St. in Greeley — formerly known as the Greeley Medical Clinic — the clinic began phasing in electronic medical records in June 2007 and implemented the system across the board in 2008. Since then, the clinic has used the Epic Electronic Health Record software to keep track of its patients’ information.

“The first part of the move was

getting all the data transferred from paper to electronic charts,” internal medicine physician Mark Berntsen said. “It was easy to do it the way we phased it in. First was the problem lists, then medication lists and the last thing was notes. With that, our paper records went away.”

Berntsen said the switch has made it easier for doctors to see data

September 24, 2014

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JOSHUA POLSON/jpolson@greeleytribune.com

with Dr. Amanda Hill on Tuesday in

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on their patients, and also for patients — who use the patient portal My Health Connection — to see their own data and even get in touch with their doctor electronically.

“It’s definitely helpful and easier to find data,” he said. “If someone shows up to see the cardiologist, I can see that. I can see lab results as soon as they come off the machine.

We also have an easier time getting in touch with patients. They can send me questions about what a certain lab result means and I can get back to them without having to make a new appointment if it isn’t necessary.”

Berntsen said the new system gives both doctors and patients better data, which in turn leads to providing better, more efficient care.

He said instead of playing phone tag with patients, they can have a question answered quickly through email. He also said patients tell him they enjoy seeing the results of their tests, instead of simply being told what they are during their next appointment.

Steve Hess, chief information officer for University of Colorado Health, said the hospital system has more than 75,000 patients enrolled with My Health Connection, with more than 3,700 new patients enrolling each month. He said the most common features patients use are reviewing results, scheduling appointments and securely messaging the clinic.

“As far as cost savings, the most obvious one of implementing Epic is the reduction in transcription costs of over $3.6 million annually,” Hess said. “The other benefits of the integrated electronic health records are more difficult to financially quantify, but we have seen a decrease in patient safety issues and better, more complete handoffs of information across care settings.”

University of Colorado Health implemented the program in their last remaining clinic serving Northern Colorado and Southern Wyoming on Sept. 23, Hess said.

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Obesity rates have stabilized, but waistlines are still growing Los Angeles Times

Americans may have stopped putting on pounds, but their waistlines are still expanding, according to a new analysis from the Centers for Disease Control and Prevention.

The average waist circumference of U.S. adults has increased by about 3 percent since the end of the last century. In 1999 and 2000, the waists of Americans who were at least 20 years old measured 37.6 inches (or 95.5 centimeters) around. By 2011 and 2012, that figure had grown to about 38.8 inches (98.5 cm), CDC researchers report in Wednesday’s edition of the Journal of the American Medical Association.

Those figures are age-adjusted averages, but the trend applies to pretty much all demographic groups, the report says. Men and women both saw “significant increases” in waist circumference, as did “non-Hispanic whites, non-Hispanic blacks and Mexican Americans.”

Waistlines of Asian Americans may have grown too, but the CDC didn’t start collecting data on them as a group until 2011, the researchers note.

The study calls attention to five groups that experienced “particularly large increases” in waist circumference during the study period: » African-American women in their 30s saw their average waist size grow by nearly 4.6 inches. » Mexican American women who had passed their 70th birthday expanded their waists by 4.4 inches, on average. » Mexican American men in their 20s added an average of 3.4 inches to their waists. » Black men in their 30s grew their waists by about 3.2 inches, on average. » White women in their 40s added an aver-

age of 2.6 inches to their waists.

Overall, the proportion of Americans suffering from abdominal obesity rose from 46.4 percent in 1999-2000 to 54.2 percent in 20112012, according to the study. (These figures were adjusted for age as well.)

The data on bigger waists come from the National Heath and Nutrition Examination Survey, an ongoing study that combines physical examinations with in-depth interviews.

Interestingly, NHANES data were cited in February by another group of CDC researchers who declared that American obesity rates have experienced “no significant changes” between 2003-2004 and 2011-2012. That study, which was also published in JAMA, focused on body mass index.

“At a time when the prevalence of obesity may have reached a plateau, the waistlines of U.S. adults continue to expand,” the new report concludes.

While BMI is used to assess whether a person has enough excess body fat to be considered overweight or obese, the waist circumference measurement can help doctors predict whether that extra weight translates into serious health problems.

“If most of your fat is around your waist rather than at your hips, you’re at a higher risk for heart disease and Type 2 diabetes,” according to the National Heart, Lung and Blood Institute, part of the National Institutes of Health. Those risks kick in for women with a waist size above 35 inches and men with a waist size above 40 inches.

To get an accurate measurement your own waist circumference, stand up, breathe out and place a tape measure snugly around your bare abdomen, just above the top of your hip bones.

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Mastectomy

Be role model for kids in own eating habits

» Bilateral breast lift or breast reduction to create symmetry of the breasts at the time of the mastectomy. » Partial mastectomy followed one year later by the injection of the patient’s body fat into the area where breast tissue was removed.

A combination of options could also be used.

Of course, other factors play a role in determining which option is the most appropriate, such as the size of the patient’s breasts, prior abdominal surgeries and the amount of subcutaneous abdominal tissue a woman possesses.

The good news is that most women make good candidates for some form of breast reconstruction (unless there are other major medical problems present that would make prolonged anesthesia or additional surgery too risky).

The numbers of options for mastectomies and breast reconstruction can feel overwhelming for patients, especially under the already significant emotional stress from a breast cancer diagnosis.

However, the benefit of having so many options is that we can usually find a good fit for each individual patient that allows for optimal removal of the cancer, as well as a desirable cosmetic outcome.

Please do not hesitate to ask your surgeon if you are a candidate for reconstructive options at any time during the process of diagnosis, treatment and recovery.

By Barbara Quinn

from P.3

Molly Decker, DO, is a general surgeon at the Banner Health Clinic specializing in general surgery in Greeley. Dr. Decker performs minimally invasive and advanced laparoscopic surgeries as well as general procedures. She is a member of the American Society of Breast Surgeons.

The Monterey County Herald

Now that school has started, what’s the latest on how to encourage good eating habits in our young ones?

Be a good role model, say experts. Like it or not, parents are the most important influence in our children’s lives. And even if we are not perfect, it’s our responsibility to demonstrate healthy behaviors to our kids. That’s how they learn.

Want to see how well you are doing? Here are some questions to ask yourself, adapted from nutrition experts at the National Dairy Council: » Do you regularly skip breakfast? » Do you drink sodas rather than water or milk with your meals?

» Do you frequently go on diets to lose weight? » Do you indicate a fear of or frequently talk about “bad” food to your child? » Do you have frequent snacks throughout the day rather than regular meals? » Do you eat in front of the TV? » Do you eat when you are bored or under stress?

Be honest. If your answer to several of these questions is “yes,” you are likely sending unhealthy nutrition messages to your child.

OK, so what can we do about it? Start, say experts, by realizing that we can encourage healthy behaviors in our kids by modeling healthful actions ourselves. Here are some ways we can start: Eat meals at regular times, especially breakfast.

Demonstrate to your child —

Hookah from P.7

Eissenberg says this is an issue because many young people do not realize they are inhaling tobacco, charcoal smoke and other carcinogens with each breath.

“The problem is, if you go into a water pipe bar and look at the pipe you are being served, there is nothing on that pipe or on the tobacco or in that charcoal that tells you it’s dangerous,” Eissenberg says. “I have gotten this outlook from kids: ‘It doesn’t say it’s dangerous, so it must be safe.’”

When smoking a cigarette, the user lights the tobacco with a fire and inhales the smoke.

With hookah, the smoke passes from a head containing tobacco and charcoal, through a water bowl and into a hose for inhalation.

The tobacco comes in many flavors, ranging from chocolate to fruit to alcoholic varieties.

Hookah smoke is known to contain higher levels of lead, nickel and arsenic, 36 times more tar and 15 times more carbon monoxide than cigarettes, research in the Journal of Cancer Epidemiology, Biomarkers & Prevention shows.

This is because smoking a hookah requires

through your own actions — what a moderate portion looks like.

Example: I might choose to eat a couple slices of pizza with a large salad instead of a large pizza with a couple sprigs of salad.

Limit the amount of high sugar, high fat foods you bring into your home. Our goal: a light but not depriving food environment.

Focus on beverages such as water and milk instead of soda and fruit drinks.

Find ways to include your children in the preparation of food and meals. Again, that’s how they learn.

Teach kiddos to recognize a “balanced” meal — one that includes at least three of the following nutrient groups: protein (fish, poultry, lean meats, nut butters, eggs), vegetables, fruit, whole grains or beans, and high calcium

taking harder and longer drags, increasing the levels of inhaled carcinogens and nicotine in the lungs.

“When they take a puff, the smoke is very cool and the draw resistance is very low, so it is easy to inhale and it tastes good,” Eissenberg says. “They take dramatically larger puffs, about 500 milliliters per puff. We are talking about an entire cigarette’s worth of smoke in a single puff.”

The longer the hookah session, the more nicotine and toxins a person takes in.

A 45- to 60-minute hookah session can expose the smoker to about the same amount of nicotine and tar as one pack of cigarettes, Eissenberg says.

“If you aren’t a cigarette smoker because you know cigarettes are dangerous and lethal, then there is absolutely no reason to be smoking a water pipe and every reason to avoid it for the same reason,” he says. “Water pipe smoking will kill you also.”

Dr. Mark Millard, a medical director at Baylor Martha Foster Lung Care Center, has practiced medicine in the Middle East, an area where water pipe smoking has been prevalent for more than 400 years. On one trip, he treated a woman from Saudi Arabia

foods (low fat milk, yogurt, cheese or calcium fortified milk substitutes).

Serve desserts that add nutrients. Fruit and yogurt, for example.

Pack school lunches with your child’s preferences as well as nutritional needs in mind. Add extra veggies to sandwiches. Use a variety of whole grain breads, crackers or “wraps.” Vary protein sources such as deli meats, nut butters, hummus or other bean spreads, eggs, and cheese. Always include a fruit or a vegetable. Pack after-school snacks such as high protein cereal bars or trail mix, especially if your student has sports practice.

And don’t forget, Mom and Dad, good habits are caught more than taught. Let the role modeling begin.

with a hacking cough.

“She was smoking every night for an hour,” he says. “That is quite a lot of inhalants. I told her to get rid of her hubbly bubbly (hookah).

It’s nicotine that is the addictive factor. It makes people want to come back for more.

People can get addicted to hookahs, and it does affect your health.”

Five years ago, Farhad Ata opened Kush Hookah Lounge.

Ata has smoked hookah his entire life.

He says he likes the nicotine buzz and the chill environment. He knows smoking is not healthy, but he has accepted the risks. It’s something he says he hopes clients are aware of, too.

“I don’t really sit down and talk with them about the health risks,” Ata says. “I think some people are already schooled, and they just accept it. Other people don’t care. It is still tobacco, no matter what, even if it is flavored. Your lungs are meant for air. Any type of smoke is not good for you, whether it’s cigarettes or hookah.”

Eissenberg says: Know the risks.

“As a package deal, it’s a dangerous thing to do,” he says. “Educate yourself. Then make the decision.”

September 24, 2014

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Technology helps health education center to stay connected At the last meeting of the Centennial Area Health Education Center (CAHEC) Board of Directors we tried something new. Well, not that new. You’ve got to remember that the sort of people who are far enough in our careers to have the time to volunteer for the boards of organizations like AHEC are generally Marc too old to be naturals at RINGEL information technology.

For The Tribune Thanks to the efforts of a clever young staff person, two board members — one from Burlington and the other from Haxtun — were able to attend the meeting via interactive video, using the communications program

GoToMeeting.

Remote users saw every document and slide that we saw at the home office. They got everything but the sandwiches while we got glimpses of their faces projected onto a movie screen.

Overall, it felt like the people who participated in the meeting from over 100 miles away were more engaged than they’d been at meetings where we only heard their voices over a speaker set in the middle of the conference room table. The video system and Internet connection did help us feel more tightly bound.

When I first became involved with CAHEC in 1996, our mission (besides seeing

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Just in case you missed a day...

The Flu Can Be Tough!

And old remedies don’t always work.

Turn to CAHEC on P.15

Come Stay & Play!

Call Us & Skip The Waiting Room!

Come Experience the difference!

Open 7 Days A Week; Extended Hours

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TRiBUNE MEDiCAL DiRECTORY ACUPUNCTURE

PHYLLIS HAMAR, L.A.C.

Master of Science, Traditional Chinese Medicine NCCAOM Board Certified 710 11th Ave., Ste. 106 Greeley, CO 80631 970-539-0324

WESTLAKE FAMILY PHYSICIANS, PC 5623 W. 19th Street Greeley, CO Phone: (970) 353-9011 Fax: (970) 353-9135 Professionals: Richard Budensiek, DO; Janis McCall, MD; Frank Morgan, MD; Jacqueline Bearden, MD; Angela Mill, MD Website: www.bannerhealth.com

ALLERGY AND ASTHMA

COLORADO ALERGY & ASTHMA CENTERS, P.C. 7251 W. 20th Street, Bldg N, Ste 1 Greeley, CO 80634 Phone: (970) 356-3907

1136 E. Stuart St, Bldg 3, Ste 3200 Ft. Collins, CO 80525 Phone: (970) 221-1681 4700 E. Bromley Ln., Ste 207 Brighton, CO 80601 Phone: (303) 654-1234 www.coloradoallergy.com Professionals: Dr. Daniel Laszlo Dr. John James

NORTHERN COLORADO ALLERGY & ASTHMA

Greeley Phone: (970) 330-5391 Loveland Phone: (970) 663-0144 Ft. Collins Phone: (970) 221-2370 www.NCAAC.com Professionals: Dr. Vel Kailasam, MD Krishna C. Murthy, MD Loran Clement, MD Michael Martucci, MD

ALZHEIMER’S/SKILLED CARE

BONELL GOOD SAMARITAN 708 22nd Street Greeley, CO 80631 Phone: (970)352-6082 Fax: (970)356-7970 Web Site: www.good-sam.com

GRACE POINTE

1919 68th Avenue Greeley, CO 80634 Phone: (970) 304-1919 www.gracepointegreeley.com

MEADOWVIEW OF GREELEY

5300 29th Street Greeley, CO 80634 Phone: (970)353-6800 Web Site: www.meadowviewofgreeley.com

ASSISTED LIVING

BONELL GOOD SAMARITAN 708 22nd Street Greeley, CO 80631 Phone: (970) 352-6082 Fax: (970) 356-7970 www.good-sam.com

COLUMBINE COMMONS

BALANCE

LIFE CARE CENTER OF GREELEY- ASCENT 4800 25th Street Greeley, CO 80634 Phone: (970)330-6400 Professionals: Cozette Seaver, PT; Leslie Vail, PT

CARDIAC VASCULAR SURGERY

1475 Main Street Windsor, CO 80550 Phone: (970) 449-5540 Web Site: www.columbinehealth.com

GRACE POINTE

1919 68th Avenue Greeley, CO 80634 Phone: (970) 304-1919 www.gracepointegreeley.com

HEART FAILURE CLINIC (NCMC) DENTISTRY

5300 29th Street Greeley, CO 80634 Phone: (970)353-6800 Web Site: www.meadowviewofgreeley.com

ASCENT FAMILY DENTAL Scott Williams, DMD 3535 W. 12th Street, Suite B Greeley, CO 80634 Phone: (970)351-6095 www.dentalgreeley.com

THE BRIDGE ASSISTED LIVING 4750 25th Street Greeley, CO 80634 Phone: (970)339-0022

JULIE KAVANAUGH, D.D.S.

AUDIOLOGY 1124 E. Elizabeth Street, #E-101 Fort Collins, CO 80524 Phone: (970)221-3372 Fax: (970)493-9237 3820 N. Grant Avenue Loveland, CO 80538 Phone: (970)461-0225 Fax: (970)593-0670 Web Site: www.allabouthearing.com Professionals: Renita Boesiger, M. A., CCC-A Rachel White, M. A., CCC-A Cheryl Hadlock, M. S., CCC-A

AUDIOLOGY ASSOCIATES

2528 16th Street Greeley, CO Phone: (970)352-2881 Professionals: Robert M. Traynor, Ed. D. F-AAA; Karen Swope, M. A. CCC-A

MIRACLE-EAR

2404 17th Street Greeley, CO 80634 Phone: (970)351-6620 749 S. Lemay Avenue, Suite A1 Fort Collins, CO 80524 (970)221-5225

UNC AUDIOLOGY CLINIC

Gunter Hall, Room 0330 Greeley, CO 80639 Phone: (970)351-2012/TTY Fax: (970)351-1601 Web Site: www.unco.edu/NHS/asls/clinic.htm Professionals: Diane Erdbruegger, Au.D., CCC-A; Erinn Jimmerson, M.A., CCC-A Jennifer Weber, Au.D., CCC-A

1800 15th Street, #310 Greeley, CO 80631 Phone: (970) 392-0900 Professionals: James H. Beckmann, MD; Harold L. Chapel, MD; John Drury, MD; Lin-Wang Dong, MD; Cynthia L. Gryboski, MD; Cecilia Hirsch, MD; Paul G. Hurst, MD; Brian Lyle, MD; Randall C. Marsh, MD; Arnold Pfahnl, MD; James E. Quillen, MD; Gary A. Rath, MD; Shane Rowan, MD; Ahmad Shihabi, MD; Stephen Zumbrun, MD (970) 350-6953 Missy Jensen, FNP-C

MEADOWVIEW OF GREELEY

ALPINE ALL ABOUT HEARING

CARDIOVASCULAR INSTITUTE (NCMC)

CARDIAC, THORACIC & VASCULAR SURGERY (NCMC) 1800 15th Street, Suite 340 Greeley, CO 80631 Phone: (970)378-4593 Fax: (970)378-4391 Professionals: Lyons, Maurice I. Jr. DO Richards, Kenneth M. MD Tullis, Gene E. MD

CARDIOLOGY

3400 W. 16th Street, Suite 8-E Greeley, CO 80634 Phone: (970)351-0400 www.drjuliekav.com

RALPH R. REYNOLDS, D.M.D., M.D. Oral Surgery 7251 W. 20th St. Building H, Suite 2 Greeley, CO 80634 (970) 663-6878 www.reynoldsoralfacial.com

ENDOCRINOLOGY

ENDOCRINOLOGY CLINIC (NCMC) 1801 15th Street, Ste 200 Greeley, CO 80631 Phone: (970)378-4676 Fax: (970)-378-4315 www.bannerhealth.com Professionals: Nirmala Kumar, MD Kimberly Rieniets, MD Corinn Sadler, MD

FAMILY PRACTICE MEDICINE

BANNER HEALTH CLINIC 1300 Main Street Windsor, CO 80550 Phone: 970-686-5646 Fax: 970-686-5118 Providers: Jonathan Kary, M.D. Trina Kessinger, M.D. Anthony Doft, M.D.

BANNER HEALTH CLINIC

100 S. Cherry Ave., Suite 1 Eaton, CO 80615 Phone: (970)454-3838 Professionals: Marianne Lyons, DO Lance Barker, DO, Internal Medicine

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September 24, 2014

2014 BANNER HEALTH CLINIC

222 Johnstown Center Drive Johnstown, CO 80534 Phone: (970)587-4974 Professionals: Cara Brown, MD J.Matthew Brown, MD Joseph Gregory, MD Courtney Isley, MD Stephen Kalt, MD, Internal Medicine Thomas Kenigsberg, MD

FAMILY PHYSICIANS OF GREELEY, LLP-CENTRAL 2520 W. 16th Street Greeley, CO 80634 (970) 356-2520 Fax: (970) 356-6928 Professionals: Joanna H. Branum, M.D. Angela M. Eussen, PA-C Jennifer D. Dawson , D.O. Douglas A. Magnuson, M.D. Paul D. Lobitz, M.D. Lori A. Ripley, M.D. D.Craig Wilson, M.D.

FAMILY PHYSICIANS OF GREELEY, LLP-COTTONWOOD 2420 W 16th Street Greeley, CO 80634 (970) 353-7668 Fax:970-353-2801 Professionals: Stacey L. Garber, M.D. Amy E. Mattox, M.D. Christopher T. Kennedy, M.D. Daniel P. Pflieger, M.D. Mark D. Young, M.D.

FAMILY PHYSICIANS OF GREELEY, LLP-WEST 6801 W. 20th St., Suite 101 Greeley, CO 80634 (970) 378-8000 Fax: (970) 378-8088 Professionals: Nathan E. Bedosky, PA-C Ann T. Colgan, M.D. Daniel R. Clang, D.O. Tamara S. Clang, D.O. R. Scott Haskins, M.D. Mathew L. Martinez, M.D. Chima C. Nwizu, M.D Michelle K. Paczosa, D.O. Andrew P. Stoddard, M.D. Kyle B. Waugh, M.D. Charles I. Zucker, M.D.

KENNETH M. OLDS

6801 W. 20th Street, Suite 208 Greeley ,CO 80634 Phone: (970)330-9061

WESTLAKE FAMILY PHYSICIANS, PC 5623 W. 19th Street, Greeley, CO Phone: (970) 353-9011 Fax: (970) 353-9135 Professionals: Richard Budensiek, D.O.; Jacqueline Bearden, MD; Tong Jing, MD; Janis McCall, MD; Frank Morgan, MD; David Puls, D.O. www.bannerhealth.com

September 24, 2014

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TRiBUNE MEDiCAL DiRECTORY DiRECTORY TRiBUNE MEDiCAL FUNERAL SERVICES

ALLNUTT & RESTHAVEN FUNERAL SERVICES

702 13th Street, Greeley, CO Phone: (970) 352-3366 650 W. Drake Road, Ft. Collins, CO Phone: (970) 482-3208 8426 S. College Avenue, Ft. Collins, CO Phone: (970) 667-0202 2100 N. Lincoln, Loveland, CO Phone: (970) 667-1121 1302 Graves Avenue, Estes Park, CO Phone: (970) 586-3101

GASTROENTEROLOGY

HEALTH AND FITNESS

INDEPENDENT ASSISTED LIVING W/SERVICES

WORK OUT WEST

NCMC - BEHAVIORAL HEALTH

Health & Recreation Campus 5701 W. 20th Street, Greeley, CO 80634 Phone: 970-330-9691 www.workoutwest.com

Dr Patricia Al-Adsani, Child and Adolescent Psychiatry Banner Health Clinic-Internal Medicine 2010 16th Street, Suite C, Greeley, CO 80631 Banner Health Clinic- Windsor 1300 Main Street, Windsor, CO 80550

HOME HEALTH CARE

Shawn Crawford, LPC Banner Health Clinic 222 Johnstown Center Dr., Johnstown, CO 80534 Banner Health Clinic-Internal Medicine 2010 16th Street, Suite C Greeley, CO 80631

CARING HEARTS HOME HEALTHCARE 6801 W. 20th Street, Suite 207 Greeley, CO 80634 Phone: (970)378-1409

BLOOM AT HOME

COLUMBINE POUDRE HOME CARE

Stephanie Carroll, LCSW, CACIII Banner Health Clinic 1300 Main Street, Windsor, CO 80550 Banner Health Clinic Fossil Creek 303 Colland Dr Fort Collins, CO 80525

REHABILITATION AND VISITING NURSE ASSOCIATION

BONELL GOOD SAMARITAN

Elise Pugh, LPC Banner Health Clinic Westlake 5623 W 19th St, Greeley CO 80631 Banner Health Clinic 1300 Main Street Windsor, CO 80550

FOX RUN SENIOR LIVING

Susan Goodrich, LCSW Banner Health Clinic-Loveland Pediatrics Loveland Pediatrics, Loveland CO Banner Health Clinic- Windsor 1300 Main Street Windsor CO, 80550

1455 Main Street Windsor, CO 80550 Phone: (970) 460-9200 Web Site: www.columbinehealth.com/bloom 1455 Main Street Windsor, CO 80550 Phone: (970) 460-9200 Web Site: www.columbinehealth.com

2105 Clubhouse Drive Greeley, CO 80634 Phone: (970) 330-5655 Fax: (970) 330-7146 Web Site: www.rvna.info Professionals: Crystal Day, CEO

HOSPICE

HOSPICE OF NORTHERN COLORADO

DOWGIN, THOMAS A., MD. CENTERS FOR GASTROENTEROLOGY 7251 W. 20th St., Bldg J, Greeley, CO Phone: (970)207-9773 3702 Timberline, Ft. Collins, CO Phone: (970)207-9773 2555 E. 13th Street, Suite 220, Loveland, CO Phone: (970)669-5432 Website: www.digestive-health.net

NORTH COLORADO GASTROENTEROLOGY (NCMC) 2010 16th Street, Ste. A Greeley, CO 80631 Phone: (970)378-4475 Fax: (970)378-4429 Professionals: Tong Jing, MD Mark Rosenblatt, MD Ahmed M. Sherif, MD Yazan Abu Qwaider, MD

MENTAL HEALTH SERVICES

Administration Office 2726 W. 11th Street Road Greeley, CO 80634 Phone: (970)352-8487 Fax: (970)475-0037

PATHWAYS HOSPICE

305 Carpenter Road Ft. Collins, CO 80550 Phone: (970)663-3500 Fax: (970)292-1085 Web Site: www.pathways-care.org Email: info@pathways-care.org

INDEPENDENT ASSISTED LIVING

GRACE POINTE

1919 68th Avenue Greeley, CO 80634 Phone: (970) 304-1919 Website: www.gracepointegreeley.com

MEADOWVIEW OF GREELEY

5300 29th Street Greeley, CO 80634 Phone: (970)353-6800 Website: www.meadowviewofgreeley.com

708 22nd Street Greeley, CO 80631 Phone: (970)352-6082 Fax: (970)356-7970 Web Site: www.good-sam.com 1720 60th Avenue Greeley, CO 80634 Phone: (970)353-7773 Fax: (970)330-9708 Web Site: www.good-sam.com

INFECTIOUS DISEASE

BREEN, JOHN F., MD (NCMC) 1801 16th Street Greeley, CO 80631 Phone: (970)350-6071 Fax: (970)350-6702

INTERNAL MEDICINE

BANNER HEALTH CLINIC 2010 16th Street Greeley, CO 80631 Phone: (970)350-5660 www.bannerhealth.com Professionals: Danielle Doro, MD Giovanna Garcia, MD

MEDICAL EQUIPMENT & SUPPLIES

BANNER HOME MEDICAL EQUIPMENT (NCMC) Phone: (970)506-6420

COLUMBINE MEDICAL EQUIPMENT 1455 Main Street Windsor, CO 80550 (970) 460-9205 Web Site: www.columbinehealth.com

Renee Rogers, LMFT Banner Health Clinic 1300 Main Street, Windsor, CO 80550 Banner Health Clinic 303 Colland Drive, Fossil Creek Fort Collins, CO 80525

NORTH RANGE BEHAVIORAL HEALTH Adult Mental Health & Addictions Services 1260 H Street; 1306 11th Avenue; 1309 10th Avenue Greeley, CO 80631 970.347.2120 Child, Youth, & Family Mental Health & Addiction Services 1300 N. 17th Avenue, Greeley, CO 80631 970.347.2120 Counseling Center at West Greeley Children, Adult, & Family Counseling 7251 W. 20th Street, Building C, Greeley, CO 80634 970.347.2123 Crisis Stabilization Services Crisis & Detox Services 1140 M Street, Greeley, CO 80631 970.347.2120 South County Program Adult, Children, & Family Mental Health & Addiction Services 145 1st Street, Fort Lupton, CO 80621 303.857.2723 Suicide Education & Support Services (SESS) Prevention, Education & Grief Support 2350 3rd Street Road, Greeley, CO 80631 970.347.2120 or 970.313.1089

2010 2014 NEPHROLOGY

GREELEY MEDICAL CLINIC

1900 16th Street, Greeley, CO 80631 Phone: (970) 350-2438 Professionals: Donal Rademacher, MD

NEUROLOGY

CENTENNIAL NEUROLOGY Dr. David Ewing 7251 W. 20th Street, Unit C Greeley, CO 80634 Phone: (970) 356-3876

NEUROLOGY CLINIC (NCMC) 1800 15th Street, Suite 100B Greeley, CO 80631 Phone: (970) 350-5612 Fax: (970) 350-5619 Professionals: Barbara Hager, MD Todd Hayes, DO William Shaffer, MD Christy Young, MD

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TRiBUNE MEDiCAL DiRECTORY NEURO-SURGERY BRAIN & SPINE

BANNER HEALTH NEUROSURGERY CLINIC 1800 15th St., Suite 130 Greeley, CO 80631 Phone: (970)350-5996 Professionals: David Blatt, MD Beth Gibbons, MD

NURSING HOME REHABILITATION

CENTENNIAL HEALTH CARE CENTER 1637 29th Ave. Place Greeley, CO 80634 Phone: (970) 356-8181 Fax: (970) 356-3278

COLUMBINE COMMONS HEALTH & REHAB FACILITY 1475 Main Street Windsor, CO 80550 Phone: (970) 449-5541 Web Site: www.columbinehealth.com

ORTHODONTICS

ORTHODONTIC ASSOCIATES OF GREELEY, PC

Professionals: Bradford N. Edgren, DDS, MS 3400 W. 16thSt., Bldg 4-V Greeley, CO 80634 Phone: (970) 356-5900 Website: www.drbradsmiles.com

ORTHOPEDICS

MOUNTAIN VISTA ORTHOPAEDICS 5890 W. 13th Street, Suite 101 Greeley, CO Phone: (970)348-0020 Fax: (970)348-0044 Web Site: www.bannerhealth.com Professionals: Randy M. Bussey, MD Riley Hale, MD Daniel Heaston, MD Thomas Pazik, MD Kelly R. Sanderford, MD Steven Sides, MD Linda Young, MD

OBSTETRICS & GYNECOLOGY

BANNER HEALTH GYN CONSULTANTS 1800 15th St., Suite 130 Greeley, CO 80631 Phone: (970)353-1335 Professionals: Susan Carter, MD

BANNER HEALTH OB/GYN CLINIC 2410 W. 16th Street Greeley, CO 80634 Phone: (970)352-6353 Professionals: Neil Allen, MD Laurie Berdahl, MD

WESTLAKE FAMILY PHYSICIANS, PC 5623 W. 19th Street Greeley, CO Phone: (970) 353-9011 Fax: (970) 353-9135 Professionals: Jacqueline Bearden, MD; Richard Budensiek, D.O.; Janis McCall, MD; Frank Morgan, MD; David Pols, D.O. www.bannerhealth.com

ONCOLOGY & HEMATOLOGY

CANCER INSTITUTE (NCMC) 1800 15th Street, Greeley, CO 80631 Phone: (970) 350-6680 Toll Free (866) 357-9276 Fax: (970)350-6610 Professionals: Jeffrey Albert, MD Elizabeth Ceilley, MD Brian Fuller, MD Benjamin George, MD Samuel Shelanski, MD Kerry Williams-Wuch, MD Alice Wood, MD Ariel Soriano, MD

PEDIATRICS

BANNER HEALTH CLINIC 6801 W. 20th Street, Suite 201 Greeley, CO 80634 Phone: (970)350-5828 www.bannerhealth.com Professionals: Amanda Harding, MD James Sando, MD

PHYSICAL THERAPY

FRONT RANGE THERAPY

1475 Main Street, Windsor, CO 80550 Phone: (970) 492-6238 Web Site: www.columbinehealth.com

HOPE THERAPY CENTER (Formerly North Colorado Therapy Center) 2780 28th Avenue, Greeley, CO 80634 Phone: (970)339-0011 Website: www.GCIinc.org Professionals: Jeanne Rabe, PT; Jennifer Branson, PT Kryste Haas, OT; Molly Wuethrich, PTA Moni Kohlhoff, PT

NORTHERN COLORADO REHABILITATION HOSPITAL

4401 Union Street, Johnstown, CO 80534 Phone: (970) 619-3400 Website: NCRH@ernesthealth.com

PULMONARY/CRITICAL CARE

NORTH COLORADO PULMONARY (NCMC)

1801 16th Street, Greeley, CO 80631 Phone: (970)392-2026 Professionals: Kelli Janata, DO Robert Janata, DO David Fitzgerlad, DO Michael Shedd, MD Danielle Dial, NP

PEDIATRIC REHABILITATION

BANNER REHABILITATION CENTER 1801 16th Street, Greeley, CO Phone: (970)350-6160 Fax: (970)378-3858

PERSONAL RESPONSE SERVICE

BANNER LIFE LINE (NCMC)

2010 16th Street, Suite C, Greeley, CO 80631 Phone: 1-877-493-8109 (970) 378-4743

PROSTHETICS & ORTHOTICS

CERTIFIED PROSTHETICS & ORTHOTICS, LLC (GREELEY LOCATION)

1620 25th Avenue, Suite A, Greeley, CO 80634 Phone: 970-356-2123 Fax: 970-352-4943

HANGER PROSTHETICS & ORTHOTICS

7251 West 20th Street, Building M, Greeley, CO 80634 Phone: (970)330-9449 Fax: (970)330-4217 2500 Rocky Mountain Avenue, Suite 2100 North Medical Office Building, Loveland CO 80538 Phone: (970) 619-6585 Fax (970) 619-6591 Website: www.hanger.com Professinal: Ben Struzenberg, CPO Michelle West, Mastectomy Fitter

REHABILITATION

ASCENT AT LIFE CARE CENTER 4800 25th Street, Greeley, CO 80634 Phone: (970)330-6400 Website: www.lcca.com Professionals: Annie Bennett Leslie Vail

BANNER REHABILITATION Phone: (970)350-6160

COLUMBINE COMMONS HEALTH & REHAB FACILITY 1475 Main Street Windsor, CO 80550 Phone: (970) 449-5541 Web Site: www.columbinehealth.com

FRONT RANGE THERAPY

1475 Main Street, Windsor, CO 80550 Phone: (970) 492-6238 Web Site: www.columbinehealth.com

NORTHERN COLORADO REHABILITATION HOSPITAL

4401 Union Street, Johnstown, CO 80534 Phone: (970) 619-3400 Website: NCRH@ernesthealth.com

PEAKVIEW MEDICAL CENTER

5881 W. 16th St., Greeley, CO 80634 Phone: (970)313-2775 Fax: (970)313-2777

RESPITE/ADULT DAY CARE

ELDERGARDEN ADULT DAY CARE 910 27th Avenue Greeley, CO 80634 970-353-5003 Website: www.eldergarden.org Sliding scale fee or no fee for Medicaid Enrollment process required

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2014 BONELL GOOD SAMARITAN 708 22nd Street, Greeley, CO 80631 Phone: (970)352- 6082 Fax: (970)356-7970 Website: www.good-sam.com

COLUMBINE COMMONS HEALTH & REHAB FACILITY 1475 Main Street Windsor, CO 80550 Phone: (970) 449-5541 Web Site: www.columbinehealth.com

GRACE POINTE

1919 68th Avenue, Greeley, CO 80634 Phone: (970) 304-1919 Website: www.gracepointegreeley.com

SPORTS MEDICINE

MOUNTAIN VISTA ORTHOPAEDICS 5890 W. 13th Street, Suite 101, Greeley, CO Phone: (970)348-0020 Fax: (970)348-0044 Web Site: www.bannerhealth.com Professionals: Randy M. Bussey, MD Riley Hale, MD Daniel Heaston, MD Thomas Pazik, MD Kelly R. Sanderford, MD Steven Sides, MD Linda Young, MD

NORTH COLORADO SPORTS MEDICINE 1801 16th Street, Greeley, CO Phone: (970)392-2496

SPEECH LANGUAGE PATHOLOGY

BANNER REHABILITATION CENTER 1801 16th Street, Greeley, CO Phone: (970)350-6160 Fax: (970)378-3858

NORTHERN COLORADO REHABILITATION HOSPITAL

4401 Union Street, Johnstown, CO 80534 Phone: (970) 619-3400 Website: NCRH@ernesthealth.com

UNC SPEECH LANGUAGE PATHOLOGY CLINIC

Gunter Hall, Room 0330, Greeley, CO 80639 Phone: (970)351-2012/TTY Fax: (970)351-1601 Web Site: www.unco.edu/NHS/asls/clinic.htm Professionals: Lynne Jackowiak, M.S., CCC-SLP Julie Hanks, Ed.D Patty Walton, M.A., CCC-SLP

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CAHEC from P.11

to it that health sciences students doing rotations in our region didn’t have to sleep under bridges) was to put on conferences.

Among other courses, we brought Advanced Cardiac Life Support and Advanced Trauma Life Support to the provinces.

And we provided programs, usually set in Greeley, on anything people might want to attend, including on professional burnout and dream interpretation.

That’s how we earned our keep.

CAHEC even built our own office building, containing a lovely, large class/ conference room in which to hold our multitudinous offerings. Today that facility, still the envy of the other Colorado AHEC districts, is underutilized. If you or your organization would like to use our nice, inexpensive meeting space in Greeley, please call us.

Electronic communications is the reason for the decline in face-to-face programs. Today’s professionals can find online most everything they need to know,

FOR THE TRIBUNE

whether nearly instantaneously in the course of caring for a patient or, for more extensive education, in the form of an online course. These days not many learning experiences require teacher and learner to be in the same location.

For those things that do require hands-on experience, health care has been catching up with the aviation industry in

developing all sorts of simulators that provide professionals with the opportunity to practice critical medical skills without endangering human beings.

Several portable and fixed site simulation labs serve the territory, teaching everything from management of the gravely ill patient to routine colonoscopy.

So, what’s the role of a regional orga-

BARIATRIC SURGERY (NCMC)

1800 15th Street, Suite 200, Greeley, CO 80631 Phone: (970)378-4433 866-569-5926 Fax: (970)378-4440 Professionals: Michael W. Johnell, MD

SURGERY WESTERN STATES BURN CENTER (NCMC) 1801 16th Street, Greeley, CO 80631 Phone: (970)350-6607 Fax: (970)350-6306 Professionals: Gail Cockrell, MD Cleon W. Goodwin, MD BURN

SURGICAL ASSOCIATES OF GREELEY PC (NCMC)

1800 15th St. Suite 210, Greeley, CO Phone: (970)352-8216 Toll Free: 1-888-842-4141 Professionals: Molly Decker, DO; Michael Harkabus, MD; Jason Ogren, MD; Samuel Saltz, DO; Robert Vickerman, MD

URGENT CARE

SUMMITVIEW URGENT CARE 2001 70th Avenue, Greeley, CO 80634 Phone: (970)378-4155 Fax: (970)378-4151 www.bannerhealth.com Professionals: Susan Beck, MD Thomas Harms, MD Susan Kelly, MD Amy E. Shenkenberg, MD Linda Young, MD

Dr. Marc Ringel is a board member for the Centennial Area Health Education Center.

UROLOGY

MOUNTAIN VISTA UROLOGY

5890 W. 13th Street, Suite 106, Greeley, CO 80634 Phone: (970)378-1000 Professionals: Curtis Crylen, MD David Ritsema, MD James Wolach, MD www.bannerhealth.com

VEINS

VEIN CLINIC (NCMC)

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nization like CAHEC in this brave new world of online education and simulation?

I hearken to a cartoon I love. Two dogs, sniffing each other’s butts, are held on leashes by a mistress and a master. One of the humans says to the other, “There are some things you just cannot learn on the Internet.”

CAHEC staff and board are locals ourselves. We seek to provide that human connection to everybody who lives or trains in our service area, whether they are a health professional, are studying to be one, or might be one when they grow up.

We work with people in professional schools, local school systems, colleges, nursing homes, pharmacies, hospitals and health departments. In keeping with our mission to train and support health professionals and, ultimately, to improve the health of our constituents, we strive to connect everybody to everybody both within our region and to a wide array of outside resources…in any way we can, face-to-face, by Internet or video.

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1800 15th Street, Suite 340, Greeley, CO 80631 Phone: (970)378-4593 Fax: (970)378-4591 Professionals: Maurice I. Lyons Jr., DO Kenneth M. Richards, MD Gene E. Tullis, MD

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September 24, 2014

Hearing Aids Will Not Cure Dementia

By Robert M. Traynor, Ed.D.

Lately, there has been a lot of “hype” about the use of amplification and Dementia. At least in the US, the ads hocking hearing instruments from many of the manufacturer-owned, hearing aid sales operations lead patients to believe that if they purchase hearing instruments they will cure dementia, and even Alzheimer’s Disease. Too bad that this is not true as it would be an easy treatment option to cure this terrible disease. While the cause of this dreaded disease has been attributed to everything from Teflon-coated pans to genetics, there is no specific cause of the disorder. Physicians and audiologists have hypothesized for quite some time that hearing impairment probably contributes to the everyday cognitive difficulty encountered by dementia patients and their families. If hearing impairment does contribute to cognitive dysfunction, a higher prevalence of hearing impairment in people with dementia than people without should be measured. In addition, the worse the dementia the more hearing impairment should be noted as well.

Although previous studies of hearing and cognition in older adults have consistently demonstrated these conditions to be associated, the associations have not always been statistically significant. These studies have sometimes been criticized for low statistical power, imprecise diagnostic criteria and instrumentation, and failure to control for potentially confounding variables such as age and de-

pression. Evidence is mounting, however, that hearing loss in older patients is not just a relatively benign condition that, at worst, leads to frustrated family members who can’t make themselves heard.

Recent research by at least two independent groups has shown a strong association between hearing loss and cognitive decline. The results are troubling enough to cause one investigator to call for an “all-hands-on-deck” push to make age-related hearing loss a public health priority.

and 80 years of age. At baseline, none of the participants had any evidence of cognitive impairment, although some had hearing loss.

During a median follow-up of 11.9 years, 58 cases of incident allcause dementia were diagnosed, of which 37 were considered to be Alzheimer’s disease. The risk for participants developing dementia “increased linearly with the severity of hearing loss,” Dr. Lin said.

Compared with normal hearing, the hazard ratio (risk) for dementia was 1.89 (1.00–3.58) for mild hearing loss, 3.00 (1.43–6.30) for moderate hearing loss and 4.94 (1.09–22.40) for severe hearing loss. These results were supported by a subsequent study of nearly 2,000 patients by Lin et al. (2013) and further supported by Gallagher et al (2012) in another study by an independent group in the U.K.

Hearing Aids and Dementia?

So, the jury is now in …… the literature that suggests dementia and Alzheimer’s patients should be screened and/or evaluated for hearing impairment. Good NIH studies now indicate that these patients might be better connected to friends and family if they have amplification to assist them with their everyday communication needs. This is, however, not a purchase that should be taken lightly. While hearing instruments are probably beneficial to these patients, families need to insure that they do not simply make a hearing aid purchase and hope to cure the disorder. The introduction of amplification will not be a cure for the disorder as is suggested in may hearing aid ads. The prudent approach is to coordinate the use of amplification as one component of an active treatment program for dementia and Alzheimer’s patients, not merely a purchase. A careful discussion with your physician is

the correct beginning, then upon referral to an appropriate audiologist hearing should be evaluated and, in cooperation with your physician, amplification considered if appropriate.

References: Lin F.R, Metter, E.J., O’Brien, R.J., Resnick, S.M, Zonderman, A.B., & Ferrucci, L. (2011), Hearing loss and incident dementia, Arch Neurol. Feb; 68(2): 214–220.

Lin, F.R.,Yaffe, K., Xia, C., Xue, Q., Harris, T.,Purchase-Helzner, E., Satterfield, S., Avonavon, H.N.,Ferrucci, L., and Simonsick, E, Hearing loss and cognitive decline in older adults, JAMA Intern Med. 2013; 173(4):293-299.

Pichora-Fuller, K., (2014). Cognition and hearing healthcare, ENT and Audiology News, July/August, Vol 23, No 2, p. 81.

One of the studies funded by the National Institutes of Health conducted by Lin et al. (2013) at Johns Hopkins, suggested that about 50% of their hearing-impaired older patients had dementia when compared to their “normal hearing” older adult control subjects. Recently, in the ENT and AudiMiller, a co-researcher at Michigan, that the noise-induced hearing loss prevention concoction could be ology News, a noted Canadian Frank R. Lin, MD, PhD, an assistant available within two years. researcher, Dr. Kathleen Pichoprofessor in the division of otology, neurotology and skull base ra-Fuller, stated that “we must surgery at Johns Hopkins School go beyond simply testing hearing of Medicine, assistant professor in and amplifying sound if progress the division of geriatric medicine in is to be made in helping those the Johns Hopkins Center on Aging who are hard of hearing remain Robert M. Traynor is the CEO and practicing audiologist at Audiology and Health and assistant profes- actively engaged in communicaAssociates, Inc., Greeley, Colorado with particular emphasis in tionstudy andfunded social interaction.

The Research Foundation, sor in the departments of epideIn another by the Oklahoma Medical amplification and operative monitoring. Dr. Traynor holds degrees researchers Floyd androle retired surgeon, Dr. Richard Kopke, M.D., discovered a needDr.toRobert assess the ofArmy cognimiology and mental health at the from University of Northern combination of two compounds stopped damage to the inner ear the caused by acute acoustic trauma – Colorado (BA, 1972, MA 1973, Ed.D., Johns Hopkins Bloomberg School tion in more realistic listening sit1975),what thethe University of Phoenix something like an IED exploding.

Although they did not indicate compounds were they felt (MBA, 2006) as well as Post-Doctoral of Public Health in Baltimore, said, uations using new behavioral and Study Northwestern University that,“This is a very exciting finding,” said Dr. Floyd, who holds theat Merrick Foundation Chair in Aging (1984). He taught Audiology at the “My collaborators at the National physiological approaches.” Dr. University Northern (1973-1982), University of Arkansas Research at OMRF. “The research is still at a pre-clinical stage, but we’reof hopeful that weColorado soon can begin Pichora-Fuller further observes Institute on Aging (NIA) were very testing in humans. for Medical Sciences (1976-77) and Colorado State University (1982surprised at the strength of the as- that the connection between 1993). Dr. Traynor is a retired Lt. Colonel from the US Army Reserve, hearing cognition has gained sociation.”

More recently, Dr.and Kathryn Campbell's work at Southern Illinois University involves theand use of an Medical Service Corps currently serves as an Adjunct Professor of newcalled importance recently as literantioxidant D-methionine, a component of fermented protein Audiology at the University of Florida, the University of Colorado, and The study in the NIH-sponsored ature does now show some indithe University of Northern Colorado. For 17 years he was an Audiology Baltimore Longitudinal Study of cation that older adults who are Consultant to major hearing instrument and equipment manufacturers Aging was one of Dr. Lin’s first to hard of hearing are at greater risk providing academic and product orientation for their domestic and show such a strong link between than their normally hearing peers international distributors. A clinician and practice manager for over hearing loss and dementia. The for clinically significant cognitive 35 years, Dr. Traynor has lectured on most aspects of Audiology in over study included 639 participants, decline. forty countries. most of whom were between 60

Author’s Bio:

Robert M. Traynor, Ed.D., MBA, FAAA

that is found in yogurt and cheese. The antioxidant, in concentrated doses, has been found to improve some forms of hearing loss and even prevent hearing loss before the exposure to noise. "We've been able to show in animal studies that if we give it before and after noise exposure, that we can get pretty full protection from noise-induced hearing loss," Campbell said. According to Campbell and her colleagues will continue their studies by looking at the effects of