Hole Health 2022

HOLE Health

February 9, 2022

A special supplement to the

PTs

train young athletes for long haul Physical therapists focus on prevention as well as rehab.

See page 10.

BRADLY J. BONER / NEWS&GUIDE

2 - HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022

Taking your health into your own hands T

CELL PHONES AND CHILDREN: Children Are More Vulnerable.

his year’s Hole Health section is publishing a few months earlier than usual, and we hope it serves as inspiration to double down on some of those New Year’s resolutions by taking your health into your own hands.

Our overarching theme, proactive care, speaks to the importance of responding early rather than waiting for crisis to strike. We saw this theme play out time and time again with the pandemic, though you’ll notice COVID-19 is mostly absent from this lineup of stories. That was an intentional choice to help us refocus on areas that have been overlooked in the midst of such a dominant story.

In two stories on physical therapy we examine how treating an injury early, even if it seems minor, can prevent more lasting damage and shorten your recovery. Better yet,

learning healthy ways to exercise can reduce the risk of injury in the first place.

For your heart, proactive care might mean learning how your habits (and your heredity) impact your health. For a community, surveys help provide that insight and awareness. But being proactive only goes as far as the barriers to entry.

As our story on the uninsured population in Teton County (about 13% of residents) explains, options like Teton Free Clinic are a boon, but they can only go so far.

We also looked at how new models are transforming lives — through better sleep or more accessible athome care.

Hopefully there’s something inspiring in these stories that will help you forge forward into 2022.

— Evan Robinson-Johnson, Hole Health editor

• Children absorb more radiation because they have thinner skulls.

• Their brains are still in development and more sensitive to the effects.

Special supplement written and produced by the Jackson Hole News&Guide

• Cell phone radiation safety standards are twenty-five years old.

Publisher: Kevin Olson Associate Publisher: Adam Meyer Editor in Chief: Johanna Love Managing Editor: Rebecca Huntington Hole Health Editor: Evan Robinson-Johnson Layout and Design: Andy Edwards, Samantha Nock Photographers: Bradly J. Boner, Kathryn Ziesig, Reed Mattison Copy Editors: Jennifer Dorsey, Mark Huffman, Addie Henderson Writers: Will Aldrich, Billy Arnold, Sophia Boyd-Fliegel, Jennifer Dorsey, Mark Huffman, Tibby Plasse, Evan Robinson-Johnson, Whitney Royster, Timothy J. Woods

• Research studies have found memory and brain damage.

• Hundreds of scientists recommend you reduce exposure, especially children.

CELL PHONE SAFETY TIPS FOR ALL:

Advertising Sales: Karen Brennan, Katie Brierly, Tom Hall, Megan LaTorre Advertising Coordinator: Tatum Biciolis Creative Director: Sarah Wilson Advertising Design: Lydia Redzich, Luis F. Ortiz, Chelsea Robinson, Heather Haseltine Production Manager: Chuck Pate Pre-press Supervisor: Lewis Haddock Press Supervisor: Dale Fjedsted Pressmen: Steve Livingston, Nick Hoskins, Robert Heward Customer Service Managers: Lucia Perez, Rudy Perez Circulation Supervisor: Jayann Carlisle 2022 Teton Media Works Jackson Hole News&Guide P.O. Box 7445, 1225 Maple Way. Jackson, WY 83002 Phone: 307-733-2047; Fax: 307-733-2138, Web: JHNewsAndGuide.com

• Cell phones are not toys.

• Use speakerphone.

• Keep the phone away from the head and body.

• Prefer texts, to voice or video calls.

• Avoid carrying your phone against your body like in a pocket, sock, or bra.

• Minimize use in areas of low signal.

• Turn phones off in the car.

• Stream with ethernet, not Wi-Fi.

Dr. Ruth Anne Tomlinson, M.D.

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HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022 - 3

Robust health starts with your heart Lifestyle choices are key; local cardiologists are ready to help.

By Mark Huffman

I

f you’ve lived through the past two years of the COVID-19 pandemic and all of its ramifications, you almost certainly have been exposed to one of the contributing factors that leads to an entirely different health threat.

The factor: stress. It’s vulnerable target: your heart.

Most people know their heart will suffer from a variety of factors but think less about how their heart is affected by mental and physical stress.

“It’s hard to study systematically,” said Dr. Anna Catino, one of two cardiologists at St. John’s Health, “but certainly we have linked high levels of stress hormones and stress to cardiac events.”

A study published in November in the Journal of of American Medical Association followed 918 patients who had stable heart conditions and found that people who were stressed exhibited lowered blood flow to the muscles of their hearts.

One example: If someone close to you dies you’re statistically more likely to have some sort of heart problem soon after.

Stress “can definitely be a factor,” Dr. Catino said.

She and her colleague at St. John’s, Dr. William Mullen, said that while a bit of calming down can be good for your heart, fundamental lifestyle choices also have significant sway. Choices like exercise and smoking, for example, are actionable steps toward (or away from) a healthy heart.

Other factors are more beyond our control: Heredity puts many people at risk, as does the inevitable reality of getting old. It’s also plain to heart docs that high altitude is another ingredient in the mix.

For those looking to proactively care for their heart complications, Catino and Mullen are freshly on the scene. The cardiologist who preceded them was the first full-timer at St. John’s and started only in 2015.

When that doctor left in 2017, Mullen, a Tulane University Medical School grad who now has close to 30 years in practice, first traveled from Palo Alto, California, to see people part time, then moved here to become a full-timer at St. John’s.

Dr. Catino earned her medical degree at the University of Vermont and became a part-time visitor while working at the University of Utah before moving here last summer. They work with cardiology nurse practitioner Stephanie Ferris.

There are also two visiting specialists: an electrophysiologist, who deals with the heart’s electrical activities and comes in monthly, and a pediatric cardiologist who visits every three months.

Though Jackson Hole residents must travel for surgery — only about 40% of U.S. hopsitals do heart surgery of any kind — most other care is available at St. John’s.

“We have a pretty robust general cardiac practice here and can regulate fairly complicated cardiac disease here,” Dr. Catino said. “We have to send people for surgery. ... but we do all the interim and followup care after that.”

Though Jackson’s population remains small — even augmented by patients from outlying areas like Star Valley, Pinedale and Teton Valley, Idaho — Dr. Mullen said there’s been growing demand for cardiology services locally.

“The practice has grown, using any measure,”

BRADLY J. BONER / NEWS&GUIDE FILE

Exercise is a key component of heart health. A lack of it can lead to lead to heart problems down the road. As one cardiologist put it, “Sitting is the new smoking.”

REED MATTISON / NEWS&GUIDE

Whether from stress, hereditary factors, or simply getting old, our hearts take a beating. Fortunately, Dr. Anna Catino and Dr. William Mullen, the only two cardiologists in Jackson, are here to help.

he said, “by several hundred percent over the past five years.”

It’s difficult to quantify the demand, Mullen said, because “we see anyone. ... it might be a onetime visit or ongoing patients.”

Patients come for echocardiograms, nuclear CT scans, electrocardiograms, and stress testing with monitors that they might wear for a day or have implanted for permanent, round-the-clock monitoring. The doctors also supervise patients with pacemakers and defibrillators. Some patients are prescribed drugs and also diet and exercise plans designed to keep them happily ticking.

Despite decades of solid advances in heart health, diseases of the heart remain the country’s No. 1 cause of death.

“No matter where you are in the United States and developed nations, it’s the biggest cause of disease and death,” Catino said.

“More than all cancers combined,” Mullen added.

And while a lot of people in outdoorsy, athletic Jackson Hole think being in a place with a healthy rep confers immunity, they’re wrong, Mullen and Catino said.

“Despite a healthy lifestyle, we do see quite a lot of cardiovascular disease just because of the high prevalence of the disease and the genetic prevalence of cardiovascular problems,” Dr. Catino said.

“People who come here or live in Jackson may hope and believe they’re going to be protected from the usual things,” Dr. Mullen said. “But we still have a lot of people coming to see us because they’ve got a problem. ... We’re surprised by the amount of pathology we have here.”

Mullen and Catino said people who suspect they have a cardiac problem should begin by talking to their own physician. St. John’s Cardiology can be reached by phone at 739-7690.

Contact Mark Huffman at 732-5907 or mark@jhnewsandguide.com.

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4 - HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022

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HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022 - 5

Physician house calls have a new ring Telehealth is bringing doctors back to homes, though Dr. Bruce Hayse still prefers a real visit.

By Evan Robinson-Johnson

O

ne of the last remaining physicians still doing house calls in Jackson, Bruce Hayse has seen his share of changes in the medical industry, and the valley.

“When I first came here ... it was a much more seat of your pants type of medicine. It was fun. But it was also anxiety provoking,” Dr. Hayse said from his museum of a home perched above Cache Creek drainage.

From that vantage he looks down over the town he has served for over 40 years, treating some of its bestknown names — Mardy Murie, Clarene Law, Bert Raynes — and some of its more eccentric characters (Gator, who lived one winter in a lean-to, was a personal favorite).

Often it’s a call in the night from a familiar name. A toolbox med kit tossed in the old Subaru Outback. A comforting hand at the bedside.

Those relationships have opened Hayse’s mind, stoked a connection to his home, and, in a recursive way, tied an entire generation together. Now, as Hayse continues to make house visits to octogenarians, there’s a blossoming approach with a striking similarity to the rural model of old.

Propelled by the pandemic, telehealth and its clinical component, telemedicine, now offer residents care in the comfort of their home. Telehealth’s champions see it as an essential component of the future healthcare landscape.

“Now, instead of opening the front door to their house and a physician walking in, physically, what we’re doing is we’re opening the digital front door,” Dr. Lisa Finkelstein said in a recent interview.

Finkelstein is a former urologist and the current director of telemedicine at St. John’s Health. Through existing partnerships and new grant funding, she’s slowly working to shift the tide of acceptance of virtual visits.

The transition hasn’t been seamless.

Originally insurance companies required patients to travel to rural clinics, where they could video chat with their physician from a controlled setting. Finkelstein and her partner at St. John’s originated sites in Pinedale, Big Piney, Dubois and Star Valley for that purpose.

“Patients would go to these rural clinics so they could get their vital signs and connect to reliable internet,” she explained.

When the pandemic hit the Centers for Medicare and Medicaid Services and private insurance companies pivoted to allow physicians to Zoom directly to patients’ homes (while also paying them for that service).

Still, the model was met with resistance.

“Physicians came on board kicking and screaming,” Finkelstein said. “It depends on the attitude of the providers, and most of us are trained very traditionally.”

That means being present with a patient, in the same room, with the benefit of all five senses. As Hayse puts it: “There’s a feeling you get from people that you can’t get from electronic communication.”

At 73 Hayse hasn’t adopted telehealth as readily as some of his younger See HOUSE CALLS on 14E

REED MATTISON / NEWS&GUIDE

Dr. Bruce Hayse still makes traditional house calls. There is a connection that you can’t get over the phone, he said about a face-to-face meeting. But Dr. Hayse is living through a renaissance of sorts, a time when doctors can provide care in the comfort of your own home via the computer. It’s the modern house call.

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6 - HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022

Lack of insurance squeezes patients Valley residents are more insured than ever, but coverage for the remaining 13% won’t come easily.

By Sophia Boyd-Fliegel

I

t’s Wednesday at the Teton Free Clinic — one of two days a week the nonprofit opens its doors to county residents who don’t have insurance — and both staff members are on hold.

It’s fairly common for Executive Director Amy Gardiner and office manager Josh Braun to spend the entire morning on some large drug company’s answering machine trying to secure medications for their clients. Without their patience, orders wouldn’t be possible.

The Teton Free Clinic serves local residents making under 200% of the federal poverty guideline, which translates to $27,180 a year for an individual or $55,500 for a four-person household. It operates out of donated space from St. John’s Health and is supported almost entirely by local philanthropy, Gardiner said, celebrating a dedicated squad of volunteers who have helped the clinic meet a pandemic uptick in demand.

While her operation fills a crucial service gap in the community, GarREED MATTISON / NEWS&GUIDE diner notes her job’s existence isn’t Teton Free Clinic Executive Director Amy Gardiner waits on hold with a pharmaceutical company waiting to secure necessary medications for a client. entirely good news.

“We would love to be put out of come easily. business by Medicaid expansion or, In 2012, Medicaid expansion was better, more affordable access,” she designed to cover people who don’t TETON COUNTY ADULTS (18 - 64) said. make enough qualify for subsidies The number of insured adults in the federal Marketplace. Particiin Teton County has risen slightly pation in assistance is optional, and Total in recent years: From 2018 to 2021 Wyoming is one of 12 states that has At or below 1,773 Uninsured 138% of the number of people under 65 with yet to opt-in.

Federal health insurance rose from 85% to Expansion supporters say the state Poverty Line 689 39% UNINSURED 87%. That’s up is missing out on from 80% in $275 million that 2013. could cover some 5,817 In recent 34,000 adults Between years Teton 138%-400% statewide.

1,406 24% UNINSURED County has been State legislanamed among tors representthe healthiest, ing Teton County 1000 2000 3000 4000 5000 6000 and the richest have mixed outcounties in the looks.

Sources: US CENSUS SMALL AREA HEALTH INSURANCE ESTIMATES, WYOMING DEPARTMENT OF HEALTH country.

“We [got MedSAMANTHA NOCK / NEWS&GUIDE Yet access to icaid] out of the In 2017, Teton County’s uninsured rate was 15% of the total population. Data collected by US health care is — Amy Gardiner House last year,” Census Small Area Health Insurance Estimates show that the poorer you are, the less likely repeatedly idenTETON FREE CLINIC said Rep. Mike you are to be insured. tified as a leadYin, a Jackson ing community Democrat.

“So “[Federal funds] should be some- tionally conservative long-range vihealth issue in the county’s trien- that’s the furthest it’s ever been. And thing that benefits the generations sion, those working with the uninnial Community Health Needs As- so I think that there could be hope in to come,” he said. “I worry about put- sured in Teton County today say the sessments, with Spanish-language the future.” ting it into programs where it’s sud- “insurance gap” is something to fix and English-language respondents Wyoming Senate President Dan denly spent, and we have to come immediately. in 2021 listing access to care as the Dockstader, a Republican repre- back and ask for more money to re“If I had that magic wand,” said highest priority and second-highest senting Lincoln, Sublette and Teton place it when it’s cut off, and we have Angela Thatcher, who assists Teton priority, respectively. counties, said that on his side of the to continue to ... prop up a program County for the nonprofit Enroll WyoAnd insuring the last 13% of Legislature “I don’t see the votes for that we weren’t propping up before.” ming, “the first thing I would remove adults in Teton County might not Medicaid expansion at this point.”

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HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022 - 7

Anxious? Lonely? Burnt out? Depressed?

Feeling like you have nowhere to turn?

Every day members of our community struggle with anxiety, depression, loneliness and increased alcohol or substance use.

In uncertain times, connection is critical.

However you’re feeling, we’re here to help.

We can connect you with confidential, affordable, high quality mental health and substance use treatment services right here in our community.

The first step is to reach your hand out and ask for help. We are here for you.

LOCAL, CONFIDENTIAL RESOURCES: Jackson Hole Community Counseling Center with 24/7 Crisis Help…..………307.733.2046 Curran Seeley Foundation - Confidential Consults ………………………....…..307.733.3908 Curran Seeley Foundation - 24 Hour Crisis …………………….....………....…..307.739.7149 St. John's Mental Health Resource Line - Call or text……………………………307.203.7880

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8 - HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022

Apnea treatment leads to better nights Implant and electrodes cut snoring and improve breathing while users slumber.

By Evan Robinson-Johnson

J

ackson resident Victoria Ross, 63, first realized she had a sleep problem after her husband had a heart attack.

Unbeknownst to her, Ross was a serious snorer and her life partner, typically a sound sleeper, noticed only after post-surgical medication kept him awake during the night. Ross was diagnosed with obstructive sleep apnea, a common and sometimes serious disorder in which breathing repeatedly stops and starts. Like many folks diagnosed with the disorder, the first step for Ross was to try CPAP, continuous positive airway pressure therapy.

But the treatment didn’t work.

Ross would still grow drowsy on short drives to Alpine, and the machine gave her terrible congestion that she worried co-workers would perceive as COVID-19. Patients fail CPAP all the time, said Dr. Martin Trott, a Jacksonbased ear, nose and throat specialist.

“We call it failing; that’s actually the medical term,” Trott said. “Either they can’t tolerate it or they take it off in the middle of the night. There are many reasons.”

Trott helped Ross — along with 50 other sleep apnea patients in Jackson — find easier sleep through a relatively new procedure that replaces CPAP’s mask and tubing with an implant and electrodes.

Now, when Ross goes to sleep she taps a button on a remote control, and 45 minutes later her tongue gets a series of jolts throughout the night to keep her breathing regular.

“It’s my new BFF,” she said. “Previously I would stop breathing over 40 times an hour. Now it’s down to one incident an hour.”

The intervention, officially known as hypoglossal nerve stimulation, was first approved by the Food and Drug Administration in 2014, but it wasn’t covered by Medicare and other insurance until late 2019.

Not everyone qualifies for the implant, which is produced by Minneapolis-based Inspire Medical Systems Inc. First you have to try, and fail, CPAP. Then, two separate examinations, one under anesthesia, ensure you’re otherwise healthy and no larger intervention is needed.

If the patient checks all the boxes, doctors can install a pacemaker-size transmitter on the patient’s right pectoral, with one other incision under the chin and another to access the See APNEA on 9

KATHRYN ZIESIG / NEWS&GUIDE

After being diagnosed with obstructive sleep apnea, Jackson resident Victoria Ross, 63, sought a solution. Her first step was to try CPAP, continuous positive airway pressure therapy. But the treatment didn’t work. Dr. Martin Trott, a Jackson-based ear, nose and throat specialist, helped Ross with a relatively new procedure that involves an implant and electrodes. Now, Ross said, “I sleep like a baby.”

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HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022 - 9

APNEA

Continued from 8

diaphragm. The outpatient operation typically takes less than an hour, Trott said.

Regular checkups are also part of the process, and the transmitter can be dialed to the most effective zone, similar to deep brain stimulation treatment for Parkinson’s disease.

The Inspire implant might not make for perfect nights — Ross’ husband will still tease her for the occasional snore, but now he knows it’s because she’s dreaming deeply, not struggling to breathe.

“I sleep like a baby now,” she said.

“Previously I would stop breathing over 40 times an hour.

Now it’s down to one incident an hour.”

— Victoria Ross SLEEP APNEA PATIENT KATHRYN ZIESIG / NEWS&GUIDE

Ross has become an ambassador for the procedure, and she’s happy to talk to other patients looking for a CPAP alternative. For most people the starting place is a sleep therapist like St. John’s Shawna Giles, or a doctor like Trott, who can guide them through the process.

“Sleep apnea is grossly underdiagnosed,” the doctor said. “It could be that their bed partners are such sound sleepers, no one recognizes that they’re having pauses.”

It might seem surprising for such a new medical procedure to find a home

Ross squeezes a stress toy model of her Inspire Medical Systems remote that allows her to simply press a button at night to aid with her obstructive sleep apnea. The system gives her tongue a series of jolts throughout the night to keep her breathing regular. “It’s my new BFF,” she said. Ear, nose and throat specialist Dr. Martin Trott said the Inspire system is a good fit for Jackson Hole lifestyles.

in rural Wyoming, but Trott said a unique set of circumstances make Jackson Hole a good fit for Inspire.

For one, sleep apnea is quite common in the community, partially because the disorder is more prevalent at higher altitudes, like Jackson’s base 6,000-foot elevation.

There are also more patients with low body mass index in Jackson, Trott said, which makes folks better candidates for the implant.

Jackson lifestyles may also point to a more convenient solution like Inspire.

“It’s really hard to go camping for three days with your CPAP,” Trott said.

Interestingly, those lifestyles also make for some niche considerations: Like pacemakers, the apnea implants are often positioned with backpack straps in mind. They’re also not recommended for frequent

hunters, Trott said, because of the force of their rifle recoil.

For those who do qualify, the procedure can be life changing. Getting an adequate amount of high-quality sleep is a challenge, Trott said, but it’s a proactive step that sets a baseline for a healthy life.

Contact Evan Robinson-Johnson by calling 732-5901 or emailing ERJ@ jhnewsandguide.com.

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10 - HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022

SHANNON CORSI

Christina Shepherd McGuire rehabs after knee surgery last winter. Before she decided on a knee replacement, pain was making it tough to sleep through the night.

Injuries are fast, but rehab takes time Orthopedic surgery success depends on physical therapy diligence.

Preventing the prevention One way to reduce the risk of that icy lap around the block with your favorite mutt: Get better footwear.

“I have been hanging on for dear life for the right shoes in the right season,” said Skinny Skis coowner and year-round runner Taylor Hall. “There are two dedicated solutions for active winter footwear: You can buy shoes with additional traction, or you can buy aftermarket products that are traction devices.”

Traction devices like Yak Traks, Snow Lines or Kahtoola’s Nanospikes strap onto running soles like ice chains on snow tires.

As for shoes with more traction, Hall said he’s brought in three lines with extra studs — knowing the best way to manage an injury is to prevent one altogether.

By Tibby Plasse

W

ith ice rink-like conditions in parking lots and on sidewalks, walking around in January might be the most dangerous activity there is.

“Everyone thinks it’s only knees during the winter, but there’s a lot of wrists, elbow fractures, twisted ankles,” said local physical therapist Brian Prax. In a particular winter, the injuries match the weather, so he also sees several “tweaks” from daily exertion, not just recreation. “We see a lot of neck and back issues from shoveling, or from snowmobiling, and upper extremities overall,” he said.

Prax sees patients at all stages of their injuries.

Some are straight off the operating table; others call him before calling their physicians.

For Jackson bartender Nick Olmstead, who suffered a freak fall from the Teton chair at Jackson Hole Mountain Resort during the 2020-21 season, the journey to recovery required both.

“By the time I skied back down, I suspected my ankle and thumb were broken — it turned out I also had a broken tibia plateau,” he said. “I have had injuries where you hope it gets better but I was a good candidate to call the doctor.”

Olmstead was in surgery with Teton Orthopedics within the week and spent the winter rehabbing.

“I was diligent about my rehab program in PT and at home. But I am a ‘doctor person,’ so I like to know what’s going on and what to do, whereas I have a friend who injured her knee and did an internet diagnosis and decided to take it easy. I was back on skis by the end of the season last year,” he said. “But carefully.”

Each winter the ER at St. John’s Health is filled with one snow-related injury after another.

“It wasn’t busy until the snow started to fly,” Mary Ponce, one of three chief nursing officers and St. John’s director of critical care, said in January.

But she said not all injuries stem from extreme sports: “We see the gamut: falls in parking lots, at home, businesses and stairs, yes there are extremity injuries but there’s also a lot of falling and hitting one’s head.”

Head injuries can occur in mundane circumstances, and Ponce said people sometimes ignore the significance of the impact.

“Subdural bleeding can present like a headache that will not go away,” she said, “and if you at all lose consciousness or blacked out, that’s a hallmark sign of a real injury.”

For those who do end up in an accident, PT can offer a path back.

Physical therapy serves different roles depending on the trajectory of an accident, Prax said. Some-

COURTESY PHOTO

The author’s own knee the day after a microfracture procedure and plica band removal. Tibby Plasse initially injured her knee making back-to-back butterfly saves in an ice hockey game.

times the damage warrants an ambulance; in other instances an injury presents after days or weeks, and by that point it might seem worth ignoring or simply “working through.” But, as Prax noted, many injuries considered “mild” by the patient can have long-term consequences, and take even longer to heal.

“Tissue changes,” he said. “An injury is different three weeks out versus four or five months out.”

In some instances, facing an old injury can require more than the stretches and healthy habits many PTs and athletes embrace.

For Christina Shepherd McGuire — who recently documented her knee replacement surgery in Teton Family Magazine — coming to terms with her injury meant accepting a higher degree of risk. McGuire’s knee story starts when she was a teenage gymnast.

Her initial surgery is still her biggest scar.

“Back then reconstructive surgery was super primitive,” she said. “My knee continued to go out several times in sports, and by senior year I had the surgery, and I was immobilized for a long time. It’s very different now when you have a meniscus repair.”

Fast forward 30 years to her most recent encounter: revisiting that same knee after years of mountain biking, backpacking and snowboarding. McGuire said she’d tried everything to keep the knee warm and nimble before considering surgery.

“I did hot yoga for breaking up the scar tissue. I

stopped doing big backpacking trips because the descents were brutal. The knee would swell after bike rides even though biking was really the best activity for me,” she said. “But last year I got my knee assessed and it was bone on bone.”

McGuire was once told: “When you can’t sleep through the nights... you’re ready for the surgery.”

Still, she resisted, poring over research to make sure her adventurous lifestyle would still be possible after the procedure. Ultimately she took the leap.

“I liked the preciseness of the robotic surgery,” she said. “It’s a massive recovery, but I feel awesome. I did nine runs on hardpack this weekend and felt no pain.”

Beyond the emotional preparation, McGuire said scheduling her surgery was tricky. A working mother with two active kids, McGuire was hard-pressed to find weeks off for recovery.

“I selfishly scheduled the surgery [in] the season I felt most comfortable missing,” she said.

She didn’t anticipate the level of pain. And even with advancements in surgery tech, McGuire’s return to the slopes required physical therapy and a diligent rehabilitation program.

“I don’t think people realize how much training a physical therapist has in tissue pathology — stretching, massage, and strengthening are only part of it,” Prax explained. “There are evaluative and diagnostic techniques that if made early on in the injury, make rehab much more effective.”

The key there is getting in early. To be “better consumers of health care” Prax recommends folks seek proactive help from as many sources as possible.

Contact Evan Robinson-Johnson at 732-5901 or ERJ@ jhnewsandguide.com.

HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022 - 11

PTs train young athletes for long haul Physical therapists focus on prevention as well as rehab.

By Will Aldrich

M

any youth athletes don’t learn how their most recent injury could have been prevented until they’re sitting in a physical therapy office.

With a number of practices in the valley that work with Jacksonites of all ages, young athletes have the opportunity to remain educated on injury prevention, while staying ahead of accidents that can sideline even the most seasoned competitors.

A quick check-in with a local PT could be the difference between spending your season rehabbing or remaining out on the field in competition.

Enter Brian Prax, owner of Prax Physical Therapy at 185 Powderhorn Lane, who has used the small town setting of Jackson to keep young athletes informed. Prax uses his close ties with coaches and instructors around the valley to arrange seminars with athletic programs, geared toward educating youth athletes on the importance of injury prevention from a young age.

A Minnesota native, Prax spent his early years as a traveling physical therapist, visiting adventure towns across the West for short stints at a time. During his time in Jackson, Prax was particularly struck by local athletes’ growth mentality.

“One of the main reasons I stayed in Jackson was the type of patients I was able to treat here compared to anyone else,” he said. “People here are really motivated to get better.”

While the majority of athletes who seek out his help are in search of a physical remedy to get back on the field, Prax typically saves some time to educate them on how they can prevent injuries from occurring in the first place.

“There’s a little bit of a misconception, especially when you’re looking at youth athletes and physical therapy, because a lot of people blur the line [between] athletic training,” Prax said. “Unfortunately, physical therapy mostly works

KATHRYN ZIESIG / NEWS&GUIDE PHOTOS

Brian Prax of Prax Physical Therapy talks Jackson local Amelia Adams, 24, through resistance band exercises in January to help with her shoulder pain.

Adams first started going to Prax for physical therapy when she was 16 after injuring her knee for the first time. Since those early days the physical therapist has helped her through multiple injuries.

once an injury occurs. We work with the pathology, the injured state, while with high school or middle school and younger athletics, there’s such a big focus on the preventative side of things.

“Our primary role is getting people from the injured state back to the uninjured state so they can play, function and live their life injury free.”

So how can young athletes stay out ahead of an injury? Expressing early discomfort is a key first step, regardless of the severity, Prax said. Adolescents are much more likely to remain quiet about their pains, as they often haven’t experienced that type of discomfort before and are unsure what is usual and what isn’t for their body.

When in doubt it’s important to get checked out to make sure.

When a youth athlete comes to his practice, Prax not only performs a physical evaluation to create a treatment plan but

also examines what happened, how it happened and how the athlete can change his or her routine to ensure a lasting career of athletic pursuits.

“So much of what we do in physical therapy happens not in the clinic,” he said. “If people only came to the clinic and I treated them ... they left and did nothing different in their lifestyle after that, most people wouldn’t get better.

“One of the biggest, most important tools in outpatient orthopedics is having people do the right things and avoid the wrong things for the time that they’re not in the clinic.”

Bones, muscles and tendons continue to develop well into one’s teenage years; it’s important to get out ahead of a nagging injury, so a one-time incident doesn’t create additional problems down the line.

“There’s a lot more potential for some of those injuries in younger athletes to turn into a chronic scenario for the rest of their lives, or something that

Prax uses an ultrasound machine on Adams’ shoulder. Adams, a U14 assistant alpine coach for the Jackson Hole Ski and Snowboard Club, said she continues going to Prax for her “longevity.” Prax has been practicing PT in the valley since 1996, when he moved to the area.

won’t heal entirely,” Prax said.

The PT industry is on the rise too, and the resources available to providers are drastically different from what existed just a handful of years ago. Prax believes the field will continue to grow as new studies are released.

“As a profession we’re still in the phase of growing significantly over time in both the diagnostic tools that we have, as well as the ways in which we can treat things more effectively with the new research that keeps coming out, and the new treatment techniques that we have to ad-

dress the problems.”

“It’s constantly evolving,” he said. “It feels like we’re nowhere near the golden age of physical therapy.”

In a valley full of athletes, there is also a plethora of private physical therapy practices including Excel Physical Therapy, Teton Physical Therapy, All Body Therapy, Four Pines Physical Therapy, Peak Physical Therapy and Medicine Wheel Wellness. There’s also PT at St. John’s Health.

Contact Will Aldrich at 7327065 or sports@jhnewsandguide.com.

Concussion treatment evolves Dark room therapy for concussions is on the way out, and physical therapy is in, Jackson therapists said.

“In the past, that was definitely the gold standard,” said Margaret Blair, a physical therapist and concussion specialist at Teton Physical Therapy and Rehabilitation.

But now, rather than relegating people who hit their heads playing sports or in a fall to sensory deprivation for weeks at a time, therapists are focused on slowly exposing concussion patients to stimuli that engage their brain and help it heal. That’s what therapists call “graded exposure,” which Blair said is analogous to a stoplight. At one end of the spectrum is a red light, activity that causes severe symptoms: dizziness, nausea and vomiting. At the other end is a green light, activity that causes no symptoms at all. In the middle is a yellow light, activity that causes some manageable discomfort, like a light headache.

“What we want to do is flirt between the yellow and green,” Blair said.

What that looks like for individual patients is always different — for some, a light walk might be enough to hover in that go zone. For others, it might be light skiing. Or using a computer at work. And it doesn’t always track with the severity of the concussion.

But Blair said that “graded exposure” therapy generally provides much better outcomes.

“When a patient does sit in the dark room for two weeks and then they come into the clinic, their prognosis is much lower and their time of treatment is considerably extended,” Blair said. “Even if they don’t seem to have too many symptoms, getting them into a licensed PT that specializes in concussion will really just overall improve their quality of life and get them back into the activities that they want to do faster.”

While physical therapists can see patients directly in Wyoming, Blair said the best case scenario is that people showing signs of concussions visit a primary care provider first, ideally within 48 hours of the incident.

The primary care provider can better manage imaging that needs to occur before therapists take over.

— Billy Arnold

12 - HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022

INSURANCE Continued from 6E

in a heartbeat is the minimum income level to qualify for health insurance on the marketplace.”

Thatcher works with Wyoming 2-1-1 to give free and confidential health care advice. Often that means letting people down when they don’t qualify.

“If you make just a little bit under [the federal poverty guideline] you just don’t qualify,” she said.

“And that’s a hard time when you have to tell someone that, especially the narrower that gap becomes.”

The federal poverty line, which depends on household size, is $13,590 a year for a single adult in Wyoming.

Thatcher talks with many people who are self-employed, like independent contractors and individuals approaching retirement who don’t yet qualify for Medicare. But mostly, she’s fielding calls from low income residents looking for a lifeline.

“These are people who are working hard,” Thatcher said, “but they just don’t make enough to afford a quality health insurance plan.”

ness, said she looked at Mountain Health when they came to town, but she didn’t have much luck.

“They claim they’ll be less expensive and more available,” she said.

“They do that for a year, and then it becomes unaffordable.”

Diagnosed with Crohn’s disease as a teenager, Roux had similar difficulty trying to switch to the nowdefunct WINHealth.

“I ended up back on Blue Cross Blue Shield because they’re all that’s left,” she said.

When Roux talked to a private broker about different options she was told: “There’s nobody that’s going to insure you. Stay where you are.”

Roux said she — Lori Roux considered movVIDEO PRODUCER ing across state lines for lower rates. With $1,300 monthly premiums, she can feel her business earnings evaporating.

“I’m not going to be homeless,” she said. “There’s going to be food on the table. [But] is my business going to dissolve? Possibly. All I’m doing is paying out rent and health insurance.”

Her situation is far from unique.

Barriers to health care cause a “huge amount of frustration” for Jackson Hole Mountain Resort employees, said the mountain’s chief administrative officer, Ty Hoath. One of the valley’s top employers, the resort staffs as many as 1,900 people in the winter, but most of those seasonal workers don’t qualify for health insurance.

The U.S. health care system is built on people working 12 months a

“All I’m doing is paying out rent and health insurance.”

Limited coverage options With the nation’s smallest population, Wyoming is dominated by one insurance company: Blue Cross Blue Shield of Wyoming. In 2021, Mountain Health Co-op entered the scene and average rates decreased by 10% statewide.

Lori Roux, a video producer in Jackson who owns her small busi-

See INSURANCE on 13E

REED MATTISON / NEWS&GUIDE

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HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022 - 13

INSURANCE Continued from 12E

year, “which is not how our team is traditionally built,” Hoath said.

The resort’s HR team has looked at work-arounds, including “community-based” approaches like multi-employer welfare agreements

“These are people who are working hard, but they just don’t make enough to afford a quality health insurance plan.”

— Angela Thatcher ENROLL WYOMING

and an association healthcare plan. Hoath describes that idealistic approach as a “co-op opportunity” through a more direct partnership with St. John’s.

“Those conversations are taking place [but] we have yet to crack that nut,” he said.

In internal Jackson Hole Mountain Resort employee surveys, Hoath said, seasonal employees tend to be younger, healthier and prioritize wages above health care.

Gardiner says she sees “people are having to make really hard choices between paying high rent prices and pay-

REED MATTISON / NEWS&GUIDE

As Amy Gardiner sits on hold, Office Manager Josh Braun is in the middle of the same process. When the two aren’t assisting patients they are jumping through the hoops of health care to ensure their community’s needs are met. Often times that looks like hours on hold.

ing a health insurance policy.”

The combination of low coverage incentive and high cost of living all but guarantees a seasonal worker insurance gap.

Local workers, including resort employees, regularly come through the doors, Gardiner said, requiring treatment for everything from broken bones to diabetes. Some of those patients are freshly

off of their parents’ health insurance plans and can’t afford their own plan because of high rent costs, she said. Others lack insurance because their parents didn’t have insurance to begin with, her colleague added.

Then there’s the J-1 students whose typical insurance covers “disasters” but not primary care visits.

Some also have limitations,

like excluding coverage for injuries outside of work or if someone has ingested alcohol or drugs.

Latino residents are overrepresented at the clinic, relative to their percent of the population, Gardiner said.

She has directed the clinic since 2005.

After an hour on hold Wednesday, a voice finally emerged on the line. Gardin-

er answered a few questions about where medication should be sent and asked when to expect it, before she was interrupted again.

“I would love to hold the line,” she replied with her typical cheery patience.

“What’s a few minutes when it’s been an hour and 10?”

Contact Sophia Boyd-Fliegel at county@jhnewsandguide or 307-732-7063.

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14 - HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022

HOUSE CALLS Continued from 5E

RYAN DORGAN / NEWS&GUIDE

Bert Raynes chats with Mary Lohuis and Dr. Bruce Hayse in August 2018 at the Murie Ranch in Moose, where he earned the Spirit of Conservation Award. Hayse and Raynes enjoyed a doctor-patient relationship and friendship. Raynes died in 2021 at age 96.

care for themselves,” Hayse said.

For telehealth’s adopters, the digital systems offer a similar potential.

“We’re in this time period where people — doctors and patients — are trying to figure out the best type of patient situation to do a virtual visit,” Finkelstein said.

Acute, emergency needs, for example, might not make the cut.

But offering advice and accountability — especially for more remote community members — can

be easily streamlined through digital mediums.

And for those clinging to Jackson Hole’s adventure and expansiveness late into their sunset years, meeting a patient where they are can make their final days that much sweeter.

Mardy Murie suffered a host of problems late in her life, Hayse recalled, but she wanted to live out her days on the land she loved most, nestled at her homestead inside Grand Teton National Park.

“People pitched in and said, ‘OK, you can stay out at the Murie Cabin and we’ll take care of you. We’ll do whatever’s necessary,’ ” the doctor said.

Now Hayse finds himself with a similar patient, a well-known Wilson resident, who is 97.

The imperative is simple, he said.

You do “whatever you can do to make their life easier.’”

Contact Evan Robinson-Johnson at 7325901 or ERJ@jhnewsandguide.com.

401276

compatriots. But there’s a deeper value to his approach that’s possible regardless of the medium.

“There has to be a sense of compassion and kindness that you give to people,” Hayse said.

At times in Hayse’s history of holistic care his assistance has looked more like companionship than traditional treatment.

He still has mementos from many of these relationships scattered throughout his home: a totem from “Indian John’s family,” a monkey skull from his time in the Congo, and of course, Kim Schmitz’s tennis shoes on the deck.

“They’ll stay there forever because Kim was a magnificent man,” Hayse said.

As he thinks back to some of the people he’s had the pleasure of treating, Hayse can’t help but see each life for its nuance. Incredible achievement, yes, but also personal histories of emotional trauma that sometimes manifested in bad choices with tragic consequence.

Schmitz, known for his illustrious climbing career, also suffered from drug and alcohol dependencies stemming from some of his more severe accidents in the mountains, Hayse recalled.

In those instances, one of the doctor’s chosen treatments is simply reminding people they aren’t alone in the universe.

“We’re not separate,” he said. “And it’s very easy to lose sight of that.”

Whether it’s a house call or a phone call offering a dose of nonjudgmental comfort and some positive direction, a physician’s influence can point people toward a healthier path.

“When you get to know somebody, you can really have a positive effect on their life and on their ability to

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HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022 - 15

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“My New Year's Resolution is to finish the Boston Marathon in 3:17”

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“Every Day: Get outside, laugh more, be open to new experiences, and express gratitude for this wonderful life!”

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“Give more people an opportunity to experience the open-hearted healing power of animals and nature”

“Laugh,Love,and Live a happy life in Jackson.”

“To keep having fun outside with friends!”

“One of our NY resolutions is to practice music more… we’re forming a family band.”

“Can’t wait to get out of NYC and be back in my favorite spot. Miss all of Jackson has to offer; especially my friends there whom I miss!”

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Men’s Health Fund helps pay for care Hospital foundation aims to raise awareness of this financial resource.

The application states a maximum amount of $500 a year is offered, but Perkins downplayed that, emphasizing that the idea is to make sure men get the care they need,

By Jennifer Dorsey whether it’s a doctor’s appointment for a basic physical or treatment for A not-so-well-known resource at a serious illness.

“We just don’t want financial barthe St. John’s Health Foundation is quietly helping male patients from riers to ever prevent those visits,” around the region access health Perkins said. “The application is the care they might not otherwise be starting point for that conversation.”

The reality, she said, “is every paable to afford.

The Men’s Health Fund provides tient scenario is different, and at the financial support for, among other end of the day we just want to help.

We always look things, wellness for creative ways checkups; prosto help them tate exams and out.” other screenings; The Men’s vasectomies; Health Fund medicine; travel launched in Nofor medical purvember 2018. It poses; and even was created with nonmedical essupport from sentials like child care and grocer— Sheldon Perkins hospital employees and memies while men are ST. JOHN’S HEALTH FOUNDATION bers of the comin treatment. munity who had In 2021 the participated in Men’s Health a national fundFund granted $23,237 in aid, with an average raising effort known as No Shave Noamount of $422 per applicant, accord- vember.

The national effort evolved into ing to the foundation. In all, 62 india local fundraiser called Mustaches viduals received assistance.

“We see men of all ages, all geo- for Men’s Health, which encouraged graphic areas surrounding Teton Teton County guys to sprout a ’stache County, different races and ethnici- to raise awareness of and money for ties and many different health con- men’s preventive health care.

Participants included men from cerns,” said Sheldon Perkins, the foundation’s director of development St. John’s Health, the Teton County and stewardship. “It runs the gamut Sheriff ’s Office, Teton Barber Shop, in terms of the support men need.”

See HEALTH FUND on 17E

“It runs the gamut in terms of the support men need.”

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HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022 - 17

TETON HAND THERAPY

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Parker walks on a treadmill with St. John’s Health cardiopulmonary physical therapist Nola Peacock last year. A fund from the St. John’s Health Foundation provides financial support for a variety of exams and other screenings, and even nonmedical essentials like child care and groceries while men are in treatment.

HEALTH FUND Continued from 16E

Big O Tires, the Teton County School District, Teton Science Schools and the town of Jackson. Their efforts seeded the Men’s Health Fund with $10,000, and in the ensuing years donors have plumped up the kitty.

Since its creation the Men’s Health Fund has flown a little bit under the radar. It’s “relatively nascent compared with some of our other support funds,” Perkins said.

“And it was launched relatively close to when the pandemic started.”

This year the St. John’s Health Foundation plans to make an effort to raise the fund’s profile in the community. Because of COVID-19, in-person community engagement events aren’t in the cards right now, so the foundation will focus on

leveraging digital platforms.

One reason for getting the word out about the Men’s Health Fund is to bolster its use. In 2021 applications averaged a little over five a month.

Another goal is to encourage more people to contribute to the fund.

“We can’t remove these financial barriers without donor support,” Perkins said.

And on that note she stressed that gifts of any size are helpful.

“Some people have preconceived notions of what a good donation is, but, really, any donation makes an impact,” she said.

To support the Men’s Health Fund or find application information, go to StJohnsFoundation.health/menshealth or call 307-739-7512.

307-734-2877 • 310 E Broadway, Jackson • tetonhandtherapy.com

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18 - HOLE HEALTH, JACKSON HOLE NEWS&GUIDE, Wednesday, February 9, 2022

Pandemic increases mental health needs

THANK YOU

Housing and financial gaps compound stress.

By Timothy J. Woods

It’s a work in progress.

Just as Jackson Hole residents, leaders and officials continue to feel their way through the COVID-19 pandemic, multiple recent studies reveal that many in the region are grappling with mental health issues. And there’s a clear correlation between the two.

“At one point or another everyone was struggling at some level,” Deidre Ashley, executive director of the Jackson Hole Community Counseling Center, told the News&Guide in October after the release of Jackson’s first behavioral health needs assessment.

That survey followed the triennial Community Health Needs Assessment, which routinely lists mental health as a top concern, and showed that about 45% of Jacksonites reported their mental health suffered during the COVID-19 pandemic. Of those, about half sought professional care.

A closer look showed people who were younger (ages 18 to 39), low income and white were among the groups whose mental health suffered the most.

And the pandemic appears to be affecting ethnicities differently.

Compared with 28% of Hispanic respondents, 52% of white respondents said their mental health worsened since the beginning of the pandemic.

That survey also revealed more people enduring “poor mental health days.” Compared with a 2018 analysis of county health rankings, residents are experiencing more than twice as much difficulty with such days: The number of poor mental health days in the past 30 days increased from three to seven. Those most affected by poor mental health days were women, nonHispanic people of color, LGBTQ and low-income, according to the community survey.

The study also revealed that the ongoing pandemic isn’t the only cause for mental health concern in the area.

Housing, lack of sufficient income and social safety nets were identified as key causes of stress for residents of

Thanks to generous donors and a challenge grant from the Community Foundation of Jackson Hole, St. John’s Health Foundation has achieved its goal of purchasing an additional 3-D mammography machine.

Introducing the unit to the St. John’s Health Diagnostic Imaging Department later this spring will greatly improve access to screening mammograms in the greater Teton County area.

A healthy hospital is truly the foundation of a healthy community.

Thank you for your support!

stjohnsfoundation.health

401489

the valley.

“While there were some things that were uniquely helpful about being in Teton County during the pandemic, such as access to the outdoors, there were also many ways in which the pandemic was especially challenging for the mental well-being of those living and working in Teton County,” the report states.

“In particular, soaring land and housing prices displaced many people and created new forms of economic insecurity and hardship. Community members saw neighbors and friends leave, and many others questioned whether they could, in fact, continue to call the valley home.”

Despite various programs initiated throughout the town of Jackson and Teton County to provide free mental health services to those struggling with mental health issues, cost was cited in that study as a primary barrier, particularly for those in the Latinx community and low-income residents.

A lack of bilingual counselors only adds to the difficulties of getting care for all who need it.

“Vista Counseling is bilingual and represents [the community] well, but they are chipping away at a mountain,” saud Elizabeth Cheroutes of Jackson Hole Therapy. “We need culturally and linguistically appropriate training available to providers,” A 19-organization steering committee that participated in the FSG study pointed to a number of avenues that would help with residents struggling with mental health, including intentional socialization efforts, youth and parent education, workplace support and establishing a mobile crisis unit.

Providers and elected officials are now using the behavioral health survey in conjunction with the summer’s community health report to guide conversations and future initiatives, such as the reboot of Mental Health JH, which provided free therapy sessions.

The surveys are only a starting place, community leaders acknowledge, but they are also a tangible reference to ensure folks are starting on the same page.

Theresa Lerch Family Practice

Contact Tim Woods at 732-5911 or town@jhnewsandguide.com.

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Lori Bowdler

Theresa Lerch

Woman Owned Local Business FNP-C

FNP-BC

CNM, CFNP

Our aim is to provide exceptional and compassionate patient-centered holistic healthcare for your entire family. As nurse practitioners, we strive to support your wellness goals.

Whether you require preventative wellness, prenatal care, medication management for chronic conditions or a same-day sick visit, we will devote time to listening, assessing and empowering you to reach your highest level of health.

307.733.4585

www.theresalerch.com

320 East Broadway Avenue, Suite 1C Jackson, WY 83001 108 West Center #3 Victor, ID 83455

378189

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Books outline paths to overall wellness

By Whitney Royster Local bookstores shared last year’s health and wellness bestsellers. Find these titles at Jackson Hole Book Trader, Wilson Book Gallery or Valley Bookstore.

“Let’s Talk About Hard Things” by Anna Sale “Breath: The New Science of a Lost Art” by James Nestor “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma” by Bessel van der Kolk “The Prophet” by Kahlil Gibran “One Long River of Song: Notes on Wonder” by Brian Doyle “The Comfort Book” by Matt Haig “Notes on Grief” by Chimamanda Ngozi Adichie “Man’s Search for Meaning” by Viktor E. Frankl “The Untethered Soul: The Journey Beyond Yourself” by Michael A. Singer “Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!” by Robert T. Kiyosaki “Like Streams to the Ocean: Notes on Ego, Love, and the Things That Make Us Who We Are” by Jedidiah Jenkins “Be Here Now” by Ram Dass “Atlas of the Heart: Mapping Meaningful Connection and the Language of Human Experience” and “Braving the Wildernesss by Brené Brown “Rooted: Life at the Crossroads of Science, Nature, and Spirit” by Lyanda Lynn Haupt “Make Your Bed” by William McRaven “This Is Your Mind on Plants” by Michael Pollan “What Happened to You?: Conversations on Trauma, Resilience, and Healing” by Oprah Winfrey and Bruce D. Perry

“The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma” by Bessel Van Der Kolk, M.D.

“How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence” by Michael Pollan “The Book of Hope: A Survival Guide for Trying Times” by Jane Goodall and Douglas Abrams “The Book of Joy: Lasting Happiness in a Changing World” by Dalai Lama, Desmond Tutu and Douglas Carlton Abrams “The Body” by Bill Bryson “Atomic Habits” by James Clear “How Not to Die” by Gene Stone and Michael Greger “Do the F*cking Work” by Brian Buirge “Rules of Aging Well” by Frank Lipman “Anxious For Nothing” by Max Lucado

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Personalized and Precision Medicine | Accepting New Clients Meno Clinic

Center for Functional Medicine

Are Your Hormones in Balance?

Bioidentical Hormone Therapy for Men & Women

Tired of Being Tired?

Low Energy? Hair Loss?

Finally Fix Your Thyroid!

Could it be Your Thyroid or Adrenals?

Low Sex Drive or Mood Swings?

Trouble Losing Weight?

Testosterone Therapy for Men & Women

Certified Weight Loss Program that Works!

Suffering from Allergies

How Healthy is Your Heart?

“No-Shot” Personalized Allergy Program

Advanced Cardiac Testing to Understand Your Risk

Sleep Problems?

Feeling Forgetful?

Programs so You can Feel Rejuvenated Again!

Reversing Memory Loss Program

Internationally Recognized Expert Best Selling Author Heart Solution for Women Dr. Mark Menolascino, MD, MS, ABIHM, ABAARM, IFMCP

5235 HHR Ranch Rd Wilson, WY • (307)732-1039 • www.menoclinic.com • clinic@menoclinic.com

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