2007-07 Northern Colorado Medical & Wellness Magazine and PVHS Physician Directory

& MEDICAL WELLNESS FORT

M A G A Z I N E

A N D

D I R E C T O R I E S

VOLUME IX

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COLLINS

2007 | 2008

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Fort Collins Medical Magazine & Directories 2007 2008

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Fort Collins Medical Magazine & Directories 2007 2008

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Fort Collins Medical Magazine & Directories 2007 2008

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If yours are not, give us a call.

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2007 Style Magazines January-Loveland/Greeley Medical & Wellness Magazine and Directory February-Building & Remodeling March-Family, Community & Philanthropy March-Northern Colorado Medical & Wellness April-Business of Northern Colorado May-Home & Garden June-Business to Business June-Building & Remodeling July-Fort Collins Medical & Wellness Magazine and Directories August-Women & Business September-Home Interiors & Entertainment October-Women’s Lifestyle Health & Beauty October-Northern Colorado Medical & Wellness November-Holiday December-Winter/Wedding December-Northern Colorado Social Registry Magazine and Directory Style Media and Design, Inc. magazines are free monthly publications direct-mailed to homes and businesses in Northern Colorado. Elsewhere, subscriptions for 16 issues cost $24/year free magazines are available in stands at 75 locations throughout Northern Colorado.

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For ad rates, subscription information, change of address, or correspondence, contact: Style Media and Design Inc., 211 W. Myrtle, Fort Collins, Colorado 80521. Phone (970) 226-6400.

E-Mail: editor@StyleMedia.com ©2007 Style Media and Design Inc. All rights reserved. The entire contents of Style Magazine is copyrighted and may not be reproduced without the expressed written consent of the publisher. Style Media and Design Inc. is not responsible for unsolicited material. All manuscripts, artwork, and photography must be accompanied by a SASE. The views and opinions of any contributing writers are not necessarily those of Style Media & Design Inc.

The NCMC Inc. Board of Directors, the NCMC Foundation and Banner Health congratulate North Colorado Medical Center for achieving MagnetTM recognition status from the American Nurses Credentialing Center. Receiving this distinction for providing the highest quality of nursing practice and patient care is a rare honor. Less than 2 50 hospitals nationwide have received this status. We're pleased to recognize all of the people who made this happen. But we'd like to

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Fort Collins Medical Magazine & Directories 2007 2008

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World-Class Healthcare It is with a great deal of enthusiasm that we publish this 9th annual Fort Collins Medical & Wellness Magazine and Directories for it gives us the opportunity to revisit the brilliant management team of the Poudre Valley Health System (PVHS) and be brought up to date on some of the exceptional treatments our physicians and healthcare providers offer the people of our region. We are so fortunate to have the exceptional visionary leadership of Rulon Stacey, Kevin Unger, George Hayes and their teams along with the committed and caring physicians that serve our region.

The outstanding facilities, latest technology and equipment along with excellent care, position PVHS among the best in the industry. This synergy and mind-set on providing World-Class care, once again, has earned Poudre Valley Hospital (PVH) national recognition; the impressive Magnet Award and Solucient 100 Top Hospital Award have once again been awarded to PVH. PVH was the first hospital in Northern Colorado to make available robotic assisted surgery technology for heart disease, prostate cancer, and gynecologic issues. Read up on the latest techniques and outcomes in Precision and Less Pain Robotic Prostatectomy.

Advances in research and treatment, and recent emphasis on the importance of prevention has advanced the Woman’s Heart program at Heart Center of the Rockies. Read Heart Health at Any Age and be sure to attend the notable Dr. Christiane Northrup’s event, October 11, 2007, at the Hilton Fort Collins.

In addition, read about another important spine procedure that has brought health and hope to those suffering back issues in Intra-Operative Imaging and Image Guidance Spine Surgery.

Medical research in health and wellness continues to improve treatment options and outcomes for patients. Read about the importance of diagnostic procedures and treatment by way of Radiologic Diagnostic Imaging. And, learn about improving quality of life for seniors through new state-of-the-art The Gift of Sight Cataract Surgery. Also, enjoy reading about area seniors who maintain their strength, balance and fitness in Exercise Keeps Seniors Young. The importance of quality sleep and treatments for Pediatric Sleep Disorders is fascinating and eye opening. And, learn about a new quick procedure reducing the time commitment needed in building crowns, in On-Site Crowns.

This Fort Collins Medical & Wellness issue is full of useful and interesting information and includes a convenient Physician’s Directory. We enjoy providing this issue to you and hope you keep it as a resource guide to help manage and maintain your health throughout the year.

Wishing each of you good health,

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severity zones to help reduce waiting. Plus our highly skilled physicians and nurses work together during the initial consultation so patients don't have to restate their medical condition. It's this kind of teamwork, dedicated to healing the whole person, that's been our trademark for the past 30 years and for years to come. McKee Medical

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Fort Collins Medical Magazine & Directories 2007 2008

& MEDICAL WELLNESS FORT

M A G A Z I N E

COLLINS

A N D

D I R E C T O R I E S

VOLUME IX

2007 | 2008

T AB L E

O F

C O N T E N T S

Medical Magazine & Directory

Wellness Magazine & Directory

10

Publisher’s Letter

14

PVHS Salutes Employees of 2007

17

Introduction Letter

84 Exercise Keeps Seniors Young 87 10 Things That Age You & How to Fight Back 90 On-Site Crowns 92 Eating Disorders The Silent Killer 96 Wellness Directory

Rulon F. Stacey, President and CEO, Poudre Valley Health System

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PVHS Building on Success

24 Raising the Bar PVH in Top 100 Hospitals Nationally

26

Style Magazine offers these editorials for your general knowledge and not as a subsititue for medical advice or treatment. If you have any questions or concerns about your health, please contact your doctor or healthcare provider.

PVH Nursing Excellence

28 Radiologic Diagnostic Imaging t8

Physician’s & Surgeon’s Directory

41

Introduction Letter Kevin Unger, President and CEO, Poudre Valley Hospital and George Hayes, President and CEO, Medical Center of the Rockies

55 Robotic Prostatectomy 60

Spinal Surgery

68

Firefly Medical

18

84

28

106

70 Heart Health at Any Age 76

In the Palm of a Hand

99

My Doctor An Endangered Phrase

102 106

Pediatric Sleep Disorders Gift of Site Cataract Surgery 12

BOARD

M.D., PH.D., F.A.C.S. CERTIFIED GENERAL SURGEON

Get caught with a great pair of legs!

Fort Collins Medical Magazine & Directories 2007 2008

medical

PVHS

PVHS Salutes the

Cover photo by Dana Milner Photography

employees of 2007 The cover photograph for this year’s issue of the Fort Collins Medical & Wellness Magazine and Directories features Kevin Unger, the president and CEO of Poudre Valley Hospital, and four PVHS employees of the year.

Each year Poudre Valley Health System—PVH and the Medical Center of the Rockies are part of the health system—selects 26 employees of the year. The selection is based on recommendations by staff members, physicians and patients.

The employees of the year offer outstanding care and excellent service. They stay abreast of the latest developments in the healthcare profession. They have outstanding reputations for integrity, compassion, patient confidentiality, and other work skills and personal traits that make them the best of the best. Enjoy getting acquainted with Kevin Unger and our featured employees of the year.

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Kevin Unger, PVH’s president and CEO, is respected and well-liked by his staff for his professionalism; dedication to PVH, the staff and physicians; and his enjoyable sense of humor.

(PVHS administrators, by the way, are eligible to be nominated as employees of the year.) His boss—Rulon Stacey, PVHS president and CEO— offers this assessment: “Kevin sets the standard for the world-class healthcare that we strive to provide in our community. He is the role model that America’s healthcare leaders should fashion themselves after.”

Peggy Bradley, employment manager for the human resources department, was nominated by colleagues in her department who are impressed by her many outstanding traits and qualities, as well as her creativity, positive attitude, teamwork, and the excellence she provides in interacting with other staff members. “Peggy has the highest level of integrity,” stated a peer.

“She does the right thing because it is the right thing to do.”

Tracy McGuire, registered nurse and clinical educator in the hospital’s birthing center, was nominated by all of the staff members in her department. They wholeheartedly agreed that she has an infectiously positive attitude and possesses natural charisma, strength and creative innovation. She works diligently to improve methods through which staff members learn and patients benefit the most. One colleague said, “Tracy faces every situation with a ‘we can-do-it’ attitude.”

Dr. David Marchant, medical director of PVH’s Family Medicine Center, leads by example and is an excellent role model. His excitement for improvement is contagious and he always remains positive and has a great sense of humor.

“He makes patients feel really listened to and he takes the time to give them great quality care,” pointed out staff members at the center.

Herb Brady, manager of PVH’s ambulance services, was nominated by colleagues in his department. They applauded him for being an efficient leader who stimulates enthusiasm among the staff members. He respects the opinions of others, is proactive and teamoriented, and communicates effectively. “He sets the standard,” a co-worker wrote.

Fort Collins Medical Magazine & Directories 2007 2008

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We’re here for you.

When you need medical care, the professionals at Poudre Valley Health System are here for you.

PVHS is Most Wired The journal of the

Whether you need inpatient care at Poudre

American Hospital

Valley Hospital or Medical Center of the Rockies,

Association has named

or you need outpatient services at one of our many clinics and diagnostic or surgery centers, our exceptional physicians and staff are standing by.

Compassionate care is what you deserve and what we take pride in delivering. We’re here for you.

Poudre Valley Health System one of the nation’s top 101 hospitals and health systems making use of electronic technology to improve patient care and safety.

www.pvhs.org

P O U D R E VA L L E Y H E A L T H S Y S T E M P O U D R E VA L L E Y H O S P I TA L

|

MEDICAL CENTER OF THE ROCKIES

Dear Medical & Wellness Reader: We’re living in exciting times for healthcare in Fort Collins and the region.

On Valentine’s Day of 2007, Poudre Valley Health System opened the Medical Center of the Rockies in northern Colorado. MCR is the region’s premier hospital for cardiology, cardiac surgery and trauma care, and associated medical services.

MCR brings together an expert staff and world-class technology in a healing, family-centered environment. All patient rooms are private and comfortably homelike. The medical technology—robotic surgery and other surgical and support services—is at the forefront of medicine.

Meanwhile, a major improvement project for Poudre Valley Hospital in Fort Collins was launched in 2007.

The project is a $35-million upgrade of the hospital that will take place over the next four years. In addition, another $6 million will be spent to retrofit the hospital with state-of-the-art information technology.

By the time the upgrade is completed, PVH will have these new features: improved emergency room facilities; larger operating rooms to accommodate new surgical technology; a medical office building for local physicians; a parking garage that will solve the hospital’s chronic parking shortage; more modernized, larger patient care areas for such key services as orthopedics, neurology, women and family care, bariatric surgery, robotic-assisted surgery, and oncology; and information technology that is among the best in the medical industry.

We’ve moved ahead with the PVH improvement project as part of our ongoing effort to keep PVH as one of the nation’s best hospitals.

In 2007—for the fourth year in a row—Solucient, the nation’s leading independent company that tracks hospital performance, named PVH as one of the nation’s 100 top hospitals for superior clinical outcomes, patient safety, and operational and financial performance. PVH was the only hospital in Colorado, Wyoming, Utah, New Mexico, Montana, Kansas, and western Nebraska named to the 100 Top Hospital list.

Solucient points out that the 100 Top Hospitals set the national standards for clinical outcomes, patient safety, financial performance, efficiency, and growth in patient volume. The 100 hospitals are selected through an extensive study that Solucient conducts of 3,000 non-federal acute care hospitals.

This honor and the many awards from other regional and national organizations that we’ve received over the last few years result from the high quality of our employees and members of the medical community in Fort Collins and northern Colorado.

On behalf of PVHS, I want you to know that we’re here for you and we’ll continue to provide you with world-class healthcare.

P O U D R E VA L L E Y H E A LT H S Y S T E M

Rulon F. Stacey, Ph.D., FACHE President/Chief Executive Officer Poudre Valley Health System

Fort Collins Medical Magazine & Directories 2007 2008

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medical

PVHS

Poudre Valley Health System:

Building on Success

by JC Clarke

18

Anyone who has driven the stretch of I-25 just east of Loveland lately has seen what is perhaps the most visible and impressive landmark of the Poudre Valley Health System’s growth and success. But actually, the opening of the Medical Center of the Rockies is just one part of a continuing odyssey of expansion as PVHS has grown from a single hospital in 1996 to a thriving multi-facility system in 2007.

Fort Collins Medical Magazine & Directories 2007 2008

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As the population of northern Colorado continues to grow, the need for quality healthcare has grown with it, and PVHS has always been one step ahead of the game in anticipating the region’s needs and finding ways to meet them.

Under the guidance of Rulon Stacey, President and Chief Executive Officer of the Poudre Valley Health System, PVHS has repeatedly expanded in order to ensure that it can continue to provide top-quality care at the lowest possible cost to the people of northern Colorado.

Poudre Valley Hospital recently joined an exclusive list of only six hospitals nationwide that have been placed on the Thomson 100 Top Hospitals list each of the last four years in a row. The designation is awarded based on many factors, including both the high quality and the low cost of services. The award represents a major achievement for the entire staff of PVH. “I don’t know if people understand what an incredible resource PVH is for this area,” remarks Stacey. “PVH provides the highest quality care with the lowest charges in the region. Our board of directors made a commitment to quality ten years ago, and our people have really made the difference.”

The newest, and probably most visible, part of the Poudre Valley Health System is the Medical Center of the Rockies, which has patterned its business model on the success of PVH. “All of our policies and procedures, and all of our financial and operating systems are the same,” says George Hayes, President and CEO of MCR. He believes that this is a huge part of the success that MCR has already enjoyed.

“Things have gone exceptionally well,” says Hayes. “The continuity has been essential—all of the key elements were in place prior to the opening.” About half of the staff at the Medical Center of the Rockies came from Poudre Valley Hospital (about 300 employees), which made

20

bringing the tradition of excellence from PVH to MCR much easier, and the results have been seen from day one. “It definitely made for an easier transition,” says Hayes. “We brought a solid and stable staff from PVH.” Indicators that MCR is on pace to match PVH’s incredible track record can already be seen in the numbers. “We’re about 2-3% ahead of our budget projections,” says Hayes. “You really never know what to expect, so it’s been great to exceed those expectations.”

Hayes is also quick to point out that the hospital opened, as scheduled, on February 14 exactly. “About five or six months beforehand we

Indicators that MCR is on pace to match PVH’s incredible track record can already be seen in the numbers. “We’re about 2-3% ahead of our budget projections.

- George Hayes President and CEO, MCR

settled on February 14 as the date, and through a lot of hard work from a lot of different people we were in fact able to open on the day we planned,” he says.

The impact of the opening of the Medical Center of the Rockies on other healthcare facilities in the region like McKee Medical Center in Loveland and the North Colorado Medical Center (NCMC) in Greeley has not been as dramatic as some people expected, says Kevin Unger, President and CEO of Poudre Valley Hospital. “Everyone’s still busy. McKee is holding steady, and here at PVH we’re actually above our projections. There was a need for more patient beds in this area and MCR seems to have come along at exactly the right time to meet that need.”

“We took a lot of grief about potentially taking away from McKee and NCMC,” adds Stacey. “But it doesn’t look like either one has been negatively impacted. We made projections four years ago and I’m very proud of how accurate those projections were. We knew that the area would continue to grow, which means that everybody in the region can continue to be productive.”

Far from finding itself short of patients to serve, Poudre Valley Hospital is moving forward with a $35-million expansion that broke ground in June. This expansion includes the remodeling of the emergency department and the cafeteria, and the remodeling and expansion of the operating rooms at the existing location. There is also another $6-million project underway to enhance information technology at the hospital.

Part of the expansion project is focused on the west side of Lemay Avenue, across the street from the existing hospital. Projected expansions include a 700-space parking garage and a medical/ administrative office building. “In the next year or two you’ll see a lot of changes which will keep us on the cutting edge of the healthcare industry,” says Unger.

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Fort Collins Medical Magazine & Directories 2007 2008

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PVH EXPANSION aerial view.

PVH EXPANSION looking north. Sky bridge over Lemay Avenue.

“These expansions will really change the face of PVH,” remarks Stacey. “We’re really thrilled and proud of our progress.”

PVHS is also expanding its Harmony Campus, with the 72,000 square foot two-story “Redstone Building” set to be completed in September of this year. That project is being developed in conjunction with Neenan Company, the developer, builder, and part owner of the building along with physicians and PVHS. PVHS also recently announced plans to build a new cancer center at its Harmony Campus projected for 2010, focusing on prevention, treatment, research and survivorship.

All things considered, the Poudre Valley Health System is an enormous asset to the economy of the entire northern Colorado region. “The Denver Post recently listed the top non-profits in the state and we were number six,” says Stacey. “We’re the largest locally-owned non-profit company in the state. That means that we don’t have to send our money to an out-of-state national corporate structure—we’re able to keep all of that money here in the region.”

In addition to its economic contribution to the area, PVHS is also a leader in green development, keeping the long-term environmental health of the region in mind as it plans and executes its expansion. The new Medical Center of the Rockies is a green building, built to meet the standards set out by the Green Building Council for Leadership in Energy and Environmental Design (LEED).

LEED certification focuses on five areas of human and environmental health: Sustainable site development, water savings, energy efficiency, materials selection, and indoor environment quality. Now that the building is operational, the process of certification is nearly complete.

“We’ve nearly completed our LEED certification,” says Hayes. “Within the next month or so we should be ready to submit our application to the Green Building Council. There’s a lot of work involved in the process of becoming certified, but we’re pretty much done and plan to have it finished up by next month.”

The Poudre Valley Health System has seen a period of impressively managed expansion, yet it hasn’t lost its focus on total quality and patient satisfaction since Rulon Stacey took the reigns in 1996. While its local ownership and leadership benefits the regional economy, it has also taken steps to protect the area’s future through sustainable development and green building practices. The current success is sure to continue as the entire system moves forward with a proven business model and an experienced, dedicated staff, enabling it to provide top-quality service to the growing number of people who call northern Colorado home.

JC Clarke is a freelance writer and novelist who lives in Fort Collins with his wife Victoria and their two children.

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It's not just an imaging center. It's a choice.

Since 2000, Harmony Imaging Center has provided the most comprehensive, highest quality medical imaging in the Fort Collins area. Now we are able to bring this same high standard to our new location next to Medical Center of the Rockies, in Loveland.

With a new location comes a new name. Harmony Imaging Center is now the Imaging Center at Harmony while the new Loveland facility is the Imaging Center at Centerra. Both are equipped with the latest technology and staffed by the same excellent technologists and radiologists you've come to trust.

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Fort Collins Medical Magazine & Directories 2007 2008

23

medical

Top 100

raising the bar

PVH in top 100 hospitals nationally

by JC Clarke

In a far-reaching and independent study of more than 3,000 hospitals nationwide, The Thomson Corporation recently named Poudre Valley Hospital one of the Top 100 Hospitals in the nation based on nine standards of excellence. PVH was the only hospital in the state of Colorado to receive this recognition.

We’re now seeing the results of a longterm investment that started back in 1996.

The Board made a commitment to quality, and that is what has really made the difference.

- Rulon Stacey CEO, Poudre Valley Health System

24

Earlier this year The Thomson Corporation acquired Solucient, the company that has conducted the landmark hospital study for the last fourteen years. The standards that were used to measure the survey are risk-adjusted mortality, risk-adjusted complications, patient safety, core measures average, growth in patient volume, severity-adjusted average length of stay, expense per adjusted discharge, profit from operations, and cash to debt ratio.

“We’re thrilled and honored,” says Kevin Unger, Chief Executive Officer of Poudre Valley Hospital. “This is the fourth consecutive year, and the fifth time that we’ve achieved this status.”

When asked why the hospital performs so well, Unger gives the credit to the people of PVH. “The turnover rate here is among the lowest in the nation,” he says. “Our staff is dedicated and committed to excellence.”

Rulon Stacey, CEO of Poudre Valley Health System, the six-hospital system that in addition to PVH includes the new Medical Center of the Rockies and the Harmony Campus in south Fort Collins, also points to the people who work at Poudre Valley Hospital as key to the hospital’s success. “We’re able to reward the people who work here,” says Stacey. “So our employees stick around.”

Craig Luzinski, PVH’s chief nursing officer agrees that it is teamwork across the organization that has produced such impressive patient outcomes while maintaining low costs.

“Our physicians, nurses, and other employees work together constantly to measure, review and improve performance to make PVH a great place to receive healthcare,” he says.

Unger feels that Stacey’s leadership since he arrived in 1996 has also been instrumental to the hospital’s success. “Performance excellence is the overriding management philosophy,” he says. “We’re able to achieve a good balance of

cost and quality.” He points to the adoption of the Malcolm Baldrige National Quality Program in 1998, which was spearheaded by Stacey, as an important step in bringing the hospital to the top of the healthcare industry. “It’s an overall quality and business model,” he says.

“It’s a good foundation from which to build success.”

Better quality care is less costly care. This is the fifth consecutive year that we have been the lowest-cost healthcare provider in the state, but we’re also one of the best in terms of quality.

- Rulon Stacey CEO, Poudre Valley Health System

Stacey feels that the Board of Directors of the Poudre Valley Health System set the stage for success as well. “We’re now seeing the results of a long-term investment that started back in 1996,” he says. “The Board made a commitment to quality, and that is what has really made the difference.”

The benefits of having a high-performing hospital are many and varied, but a recent

issue of Modern Healthcare magazine points out that if all hospitals performed like the benchmark hospitals identified in the Top 100 Hospital study, more than 100,000 additional patients could survive each year, and an additional 114,000 could avoid complications.

Seemingly paradoxically, the top hospitals not only provide better care, but they do it at a lower cost than other hospitals. On average, the 100 Top Hospitals spent 12 percent less per discharge than the industry average.

“Better quality care is less costly care,” says Stacey. “This is the fifth consecutive year that we have been the lowest-cost healthcare provider in the state, but we’re also one of the best in terms of quality.”

Not only is PVH the only hospital in the state to be named to this year’s list, it’s also one of just a handful of hospitals nationwide that have been able to repeat the honor four years running. “PVH is one of only six hospitals nationwide that has managed to make the list for four consecutive years,” says Stacey, putting this monumental achievement into perspective.

The changes we’ll see in the next two years will make a difference for the patients at PVH. The additional parking and remodeling will definitely add to overall patient satisfaction and keep us on the cutting edge of the healthcare industry.

- Kevin Unger CEO, Poudre Valley Hospitol

Performance excellence is the overriding management philosophy. We’re able to achieve a good balance of cost and quality.

Stacey points out that the success of PVH will have an impact on the entire region as the same business model and focus on quality are applied at the new regional trauma center, the Medical Center of the Rockies. “We’ll use the same structure at MCR,” he says. “We’re a locally-owned healthcare company, and we’ll continue to be committed to excellence across the board.”

As PVH moves forward with plans for expansion, including a $35 million initiative to expand and remodel its operating rooms, emergency department and cafeteria and to build a new medical office building and parking garage across Lemay from the existing hospital, it seems clear that it will continue to be a premier healthcare facility for years to come.

“The changes we’ll see in the next two years will make a difference for the patients at PVH,” says Unger. “The additional parking and remodeling will definitely add to overall patient satisfaction and keep us on the cutting edge of the healthcare industry.”

JC Clarke is a novelist and freelance writer who lives in Fort Collins with his wife, Victoria and their two children.

Rulon Stacey named to national healthcare executive board Rulon Stacey, president and CEO of Poudre Valley Health System, has been elected to serve on the 16-member governing board of the American College of Healthcare Executives (ACHE), an international professional society of more than 30,000 health care executive who lead hospitals, health systems and other health care organizations.

Stacey was elected to the voluntary 3-year board position March 17 during the Council of Regent’s Meeting at the 50th Annual ACHE Congress on Healthcare Leadership in New Orleans.

“We look forward to the contributions that Rulon will bring to the board of governors,” said Thomas C. Dolan, ACHE president and CEO. “As a national health care leader, Rulon brings real knowledge and insight to the board.”

Stacey, who is board certified in healthcare management and an ACHE Fellow, was Colorado’s ACHE regent from 2003-2007. He has also held the PVHS top executive position since 1996, and was instrumental in a major increase of healthcare opportunities over the last decade for people living in northern Colorado, Wyoming and southwestern Nebraska.

His leadership has included developing and shepherding along efforts that resulted in the construction of the PVHS Harmony Campus, completed in 2003; and, among other successes, the recent opening of the 136-bed Medical Center of the Rockies.

Stacey has served on the board of trustees of the American Hospital Association, as the vice chair of the board of directors of VHA Mountain States, on the board of directors of the Fort Collins Chamber of Commerce, and as president of the board of directors of Colorado State University’s Booster Club.

He received the 2006 HOPE Award from the Northern Colorado Multiple Sclerosis Society, was named the Northern Colorado Business Leader of the Year in 2005 by the Fort Collins Coloradoan, received ACHE’s 1999 Robert S. Hudgens Award for young healthcare executive of the year, and is a past recipient of Modern Healthcare’s Up-and-Comer Award.

Stacey earned his doctoral degree in health policy from the University of Colorado at Denver and his master’s degree in finance and bachelor’s degree in rural economics from Brigham Young University.

- Kevin Unger CEO, Poudre Valley Hospitol

Fort Collins Medical Magazine & Directories 2007 2008

25

medical

Magnet award

PVH nursing excellence

by Lynn M. Dean

Craig Luzinski, PVH Chief Nursing Officer with Pam Brock, VP of Marketing and PR for PVHS.

Nurses. They’re the bedrock of patient care. When I delivered each of my babies at Poudre Valley Hospital, it was a nurse who talked me through my breathing and, with the physician, encouraged me to push. It was an nurse who taught me how to feed my first little one. And it was a nurse I turned to whenever I had a seemingly-silly-but-important-to-me new mom question. Later, when I miscarried during my third pregnancy, it was a nurse who held my hand for two hours until the doctor could confirm that I had indeed lost the baby.

When my sister was hospitalized last summer, it was a nurse who sent me home to rest, assuring me that he would call should her condition worsen.

And, when she went into septic shock and was transferred to ICU, he kept his word and called me back to the hospital at midnight. Another nurse taught me to read the ICU monitors and explained the thresholds below which we really needed to be concerned, even though the alarms were going off every few minutes.

Nurses are at the heart of patient care. It doesn’t matter what kind of medical procedure we have done, inpatient or outpatient, a nurse is most likely the one who’ll be coordinating our care, surrounded and supported by a team of doctors and other clinicians.

Poudre Valley Hospital (PVH) has always striven to attract and retain the best nurses available in order to provide optimum patient care and has actively taken steps to ensure that the PVH is one of the best places for nurses to work.

They believe that nurses who are supported and offered leadership and growth opportunities will give their best back to PVH, its patients and the community at large. Part of this effort recognizes nursing excellence.

“Back in 1997, Poudre Valley Hospital made a nursing goal to obtain the designation of Magnet Hospital for Nursing Excellence, presented by the American Nurses Credentialing Center,” explains PVH’s Clinical Director Donna Poduska, RN. “At that time there was little written about Magnet, but nursing leaders at PVH felt that the nursing staff was meeting all the criteria and wanted to have that designation to reward them for the excellence in nursing they had been practicing and continued to practice.”

In order to achieve the Magnet designation, PVH had to demonstrate that the hospital and its

26

nursing staff met the criteria established under the 14 “Forces of Magnetism.” (See sidebar) “Each criteria is research based,” explains Craig Luzinski, PVH’s Chief Nursing Officer.

“There are sub-categories and criteria under each of the 14 larger categories. Back in the 80s researchers set out to identify the qualities of those organizations that were able to attract and retain nurses.”

“That research continues to this day,” adds Poduska. “The criteria are re-evaluated over time.”

Magnet Institutions are held up as role models for others. In 2000, PVH received its Magnet designation making it the first hospital in the Rocky Mountain region and only the 18th hospital in the nation to do so. PVH was re-designated in 2004, at that time one of only 14 other hospitals to be re-designated.

“Our nurses and our patients have experienced many far-reaching benefits from the achievement of Magnet designation,” explains Poduska. “Magnet is more than just a designation. It demonstrates a culture of teamwork, empowerment, respect, integrity, and caring within the nursing staff and between different disciplines.”

According to Poduska that translates to higher retention rates and better patient care because of “how we operate our nursing service and collaborate with all of the other non-nursing clinicians. It’s proven that relationships are better.

Nurse to physician relationships are better, and there’s more accountability in clinical decision making.”

“Our management style is one of active participation, visibility, and decentralization of decision-making,” agrees Luzinski. “The staff, nursing leadership and I actively work together to make decisions as a team. That’s a really key

component.”

The positive working environment and the Forces of Magnetism- forces that attract quality nurses- help PVH recruit and retain the best of the best. “Forty-five percent of our nurses identified PVH’s Magnet designation as one of the reasons they selected to apply for a position,” says Poduska. She explains that with the current nursing shortage, these nurses have their pick of institutions, and consistently choose PVH. “They know this is going to be a good place to work based on demonstrable criteria.”

The community at large benefits, too, and not just because of the availability of quality medical care. “Our nurses are very involved in the community and participate in many PVH and community sponsored events,” shares Poduska.

“They’re involved in churches, schools, and nonprofits. They have that sense of belonging to the community.

PVH will be up for re-designation next year.

“We’re re-designated every four years,” explains Poduska. “We’re always raising the bar. A good description of a Magnet facility is that constant improvement.”

The Medical Center of the Rockies, another Poudre Valley Health System hospital, is currently in the process of developing the infrastructure based on the Forces of Magnetism, but it takes time to build the data that demonstrates they meet all the criteria. “They are on the journey,” says Poduska.

The bottom line. “I get to lead a group of people who are really proud of what they do,” says Luzinski. “We focus on quality and we have the data to prove it.”

Lynn M. Dean is a freelance writer living in Northern Colorado.

The Forces of Magnetism The Forces of Magnetism, forces that attract nursing excellence, are research based criteria developed by the American Nurses Credentialing Center. In order to earn a Magnet designation, institutions must meet or exceed over 120 specific criteria in the following 14 broad categories:

Quality

Force 1: Quality of Leadership

Force 2: Organizational Structure Force 3: Management Style Force 4: Personnel Policies and Programs Force 5: Professional Models of Care

Care

Force 6: Quality of Care

Force 7: Quality Improvement

Resources

Force 8: Consultation and Resources Force 9: Autonomy

Force 10: Community and the Hospital Force 11: Nurses as Teachers

Image

Force 12: Image of Nursing

Force 13: Interdisciplinary Relationships Force 14: Professional Development

Fort Collins Medical Magazine & Directories 2007 2008

27

medical

radiology

Winfield Craven, M.D., Medical Director, Department of Radiology, Medical Center of the Rockies, stands in front of angiographic equipment, which uses imaging to diagnose and treat medical conditions.

XXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXX XXXXXXXXXXXXXXX

radiologic

Winfield Craven, M.D., Medical Director, Department of Radiology, Medical Center of the Rockies, stands in front of angiographic equipment, which uses imaging to diagnose and treat medical conditions.

diagnostic imaging

by Court Klinck & PVHS Radiology Staff

Among the many benefits of living in Northern Colorado is the availability of world-class healthcare. A prime example is the Radiology Department of Poudre Valley Health System (PVHS). These departments offer state-of-the-art radiologic imaging services to approximately 9,500 patients each month. The department’s outstanding staff of Board-Certified and Fellowship-Trained Radiologists, Radiologic Technologists, Radiology Nurses and support staff coupled with excellent facilities and the finest imaging equipment have resulted in its being among the very best radiologic imaging centers in the United States.

28

Radiology encompasses diagnostic and treatment imaging techniques that use x-rays, computed tomography (CT), ultrasound, magnetic resonance imaging (MRI), positron emission tomography (PET) and other advancing technologies to image areas of the body.

Services and treatments are provided at the following locations: Poudre Valley Hospital (PVH) in Fort Collins, the new Medical Center of the Rockies (MCR) in Loveland, the Breast Diagnostic Center (BDC) at the Harmony Campus in Fort Collins, and the Windsor Imaging Center.

The Imaging Center at Harmony, The Imaging Center at Centerra and PET Imaging of Northern Colorado provide outpatient medical imaging services. The multiple locations function as a seamless, single entity allowing them to share staff and equipment, use common practices and procedures, coordinate personnel at various facilities, and create a network of computers and image archiving - Picture Archive Communication System (PACS) - that stores, shares and displays digital diagnostic images.

Input for this article was provided by four key members of the PVHS Radiology Department team: Liz Fegley, Administrative Director of Radiology at PVH, Jack Retzlaff, Administrative Director of Radiology at MCR, Dr. Deborah Gunderson, Medical Director of Radiology at PVH, and Dr. Winfield Craven, Medical Director of Radiology at MCR. These individuals are proud of the professional caliber of the department’s staff, the world-class facilities and equipment, and the high quality of diagnostic imaging services and overall patient care. Liz Fegley comments, “Patient care and safety are our top priorities. We’re here for our patients. It’s very gratifying to receive letters from patients and physicians thanking us for providing life-saving services.” Jack Retzlaff emphasizes, “Our operations are all either accredited, or in the process of becoming accredited, by the American College of Radiology (ACR). The ACR program for accreditation is a voluntary program, except in the case of mammography where it is mandatory.

Because of the high standards the ACR sets for staff, equipment, ongoing training and quality control, we feel it is very important we follow these guidelines. In addition, our Radiologists are very highly trained, and the best in the industry.

Any one of them would be considered a top addition to any teaching hospital in the country.”

The key to the PVHS Radiology Department’s elite national ranking and top-quality services is its outstanding staff of Radiologists, Radiology Nurses, Radiologic Technologists and Support Services personnel. Radiologists are in charge of all patient diagnostic imaging services at PVHS. A Radiologist is an M.D. who, in addition to graduating medical school and serving an internship, has at least four

Deborah Gunderson, M.D., Medical Director, Department of Radiology, Poudre Valley Hospital, stands in front of a PACS (Picture Archiving and Communication System), which she uses to interpret medical images including MRI, CT, ultrasound, nuclear medicine, and plain film x-ray. These images are available immediately to referring physicians in the PVHS system.

years of advanced study and training in medical imaging techniques, interpretation of images, and medical image-guided procedures. All PVHS radiologists also have an additional one or two years of fellowship training in a specific area of radiology. Dr. Gunderson indicates, “Radiologists tend to specialize in particular imaging services.

An advantage to our program is that we rotate among the various Radiology Department locations. It used to be that radiologists had fewer off-hour responsibilities than other doctors.

That’s definitely no longer true due to emphasis on medical imaging for diagnosis.” It is important to note that PVHS has both 24/7 Radiologist presence and 24/7 transcriptionist service to take

care of patient needs quickly.

There is an expanding role for the interventional radiologist who uses medical imaging for biopsies, drainages and medical therapies. With the use of needles and catheters, these minimally invasive procedures can give patients an alternative to surgical procedures. This can reduce cost and time away from home and work. Some examples include: Kyphoplasty: Cement is introduced via a needle to support a spinal fracture.

Angioplasty: Narrowings of arteries or veins are opened using a balloon catheter.

Uterine Fibroid Embolization: Fibroids (benign masses in the uterus muscular wall) is reduced

Patient care and safety are our top priorities. We’re here for our patients. It’s very gratifying to receive letters from patients and physicians thanking us for providing life-saving services.

- Jack Retzlaff Administrative Direcor of Radiology, MCR

Fort Collins Medical Magazine & Directories 2007 2008

Liz Fegley, Administrative Director of Radiology, Poudre Valley Hospital, stands in front of a diagnostic digital radiography equipment, which is used for routine x-rays i.e. chest, arms, and legs. in size by occluding the blood flow to the mass using a catheter.

Radiology Nurses are registered nurses and are required to have certifications in Advanced Cardio Life Support (ACLS), Pediatric Advanced Life Support (PALS), Cardio Pulmonary Resuscitation (CPR) and Conscious Sedation. These nurses play an important role in providing patient care before, during and after Interventional Radiology procedures.

Radiologic Technologists operate the various types of equipment used in diagnostic imaging.

In order to practice at PVHS, all Technologists must be registered with the American Registry of Radiologic Technologists (ARRT). This registration requires completion of a two-year program at an accredited school or hospital, followed by the passing of the national registry examination.

All of the technologists working in the specialty areas (CT, MRI, Ultrasound, Nuclear Medicine,

30

Interventional Radiologic team includes Amy S. Hayes, M.D., Shelly O’Leary, and Kristin Hicklin

Interventional Radiology, Mammography) carry (or are in the process of acquiring) advanced certifications for their specialty areas.

The equipment and systems used at the PVHS locations are, like the caliber of the staff, very impressive. Much of the department’s diagnostic equipment represents the very latest in medical imaging technology. Examples of this include Digital Radiography (DR). With DR’s improved technology, the PVHS Radiology Departments are able to be faster when doing procedures, which also result in improved radiologist reading turnaround time and faster diagnosis. Plus DR potentially lowers the radiation exposure for the patient.

Among the members of PVHS Radiology, the Poudre Valley Hospital Breast Diagnostic Center (BDC) is a full-service breast health and breast imaging facility. In addition to screening and diagnostic mammography the BDC offers

breast ultrasound, ultrasound-guided breast biopsies, and stereotactic breast biopsies as well as ultrasound-guided cyst aspirations. The BDC also works closely with The Imaging Center at Harmony to provide Breast MRI and Breast MRI biopsies. The BDC is very excited to be remodeling and adding digital mammography early in 2008.

After completing an examination on the diagnostic imaging system, images are sent to the PACS computerized image archive where, using secure, Web-based software, they become immediately available for viewing from various locations. These locations include physicians’ offices and homes. The PVHS Radiology Department operates almost completely without traditional radiology film. Nearly all images are stored and viewed on the PACS system, enabling physicians and others to access patient information in a timely manner. Jack Retzlaff points out, “In the past decade, the time between

For much of the past, radiology was viewed as a ‘behind the scenes’ adjunct function of medicine.

That’s definitely no longer the case – we’re now a central part of the medical diagnosis and treatment process.

As I like to say, ‘Radiology is out of the darkroom.’

- Liz Fegley Administrative Direcor of Radiology, PVH the patient’s initial assessment and final diagnosis has been substantially reduced – often resulting in life saving or quality of life improvements for the patient. The new digital imaging systems and PACS are playing a major role in this process.”

According to Retzlaff, “Radiology is changing at a dramatic rate - paralleling with the remarkable advances in computer technology. A lot of equipment becomes obsolete in three to five years.

While new equipment is expensive, it translates to improvement in quality of patient care and overall productivity (often reducing the cost of imaging services to patients).” Dr. Craven adds, “PVHS is a private, not-for-profit organization. Consequently, we are able to reinvest locally in the necessary equipment and facilities to maintain the highest quality of service while keeping patient costs at the lower end of the scale. For example, PVH is ranked in the top 100 hospitals in the country and historically we have provided the lowest cost healthcare in the state on most procedures.”

The PVHS Radiology Department’s mission statement is “To provide high-quality imaging procedures and world-class care to each and every patient in a comfortable and safe environment.”

It certainly appears that the department is accomplishing its mission. In order to continue fulfilling the mission, ongoing improvements in the quality of services and patient care continue.

Liz Fegley concludes, “For much of the past, radiology was viewed as a ‘behind the scenes’ adjunct function of medicine. That’s definitely no longer the case – we’re now a central part of the medical diagnosis and treatment process. As I like to say, ‘Radiology is out of the darkroom.’”

Court Klinck is a freelance writer living in Eaton.

Fort Collins Medical Magazine & Directories 2007 2008

31

PVHS Radiology Department Imaging services and treatments: Digital radiograph showing fractured humerus

Cardiac CT showing coronary arteries

Computed Tomography (CT Scanning or CAT Scanning). Uses special X-ray equipment to produce images of internal organs, soft tissue, bone and blood vessels, and a computer to arrange the images into cross-sectional views.

Radiography (General X-ray). Uses x-radiation that passes through the body. The x-rays are then captured by the digital receptor generating a digital image of the area of interest.

Maximum Intensity Projection (MIP) showing increased activity in the liver.

Knee MRI showing cartilage (small black triangles)

Magnetic Resonance Imaging (MRI Scanning).

Uses a strong magnetic field and radio waves to produce the images. The patient lies inside a cylindrically shaped magnet. With the patient inside a strong magnetic field, radio waves are transmitted into the body. Each organ or tissue resonates at a different frequency that is received by the scanner. The MRI computer converts these signals into an image.

Fetal 3-D Ultrasound Breast scan showing breast tumor in red

Mammography. Uses low-dose X-ray systems to image the breast and assist in the diagnosis of breast diseases in women.

32

Nuclear Medicine. A very small quantity of a radioisotope is injected into the patient becoming concentrated in specific organs or tissues. The patient is then scanned with nuclear medicine cameras and images are produced demonstrating the specific anatomy of the scanned area.

Ultrasound. Uses high-frequency sound waves.

Tissues reflect sound waves differently and the ultrasound equipment, using computers and reconstruction software, turns this information into real-time images.

Lateral Spine radiographs showing compression fracture and kyphoplasty

Interventional Radiology. Involves a variety of minimally invasive surgical treatments and procedures whereby the Interventional Radiologist uses different imaging devices (e.g. CT Scanning, Ultrasound, X-ray) to diagnose and treat disease.

Fort Collins Medical Magazine & Directories 2007 2008

33

If you’re having a baby, we’re here for you.

If you’re expecting a baby, the team of physicians and birthing center professionals at PVHS are here to ensure that you and your baby have a safe, comfortable delivery.

Take a Tour!

State-of-the-art birthing centers are located at both Poudre Valley Health System hospitals — at Poudre Valley Hospital in Fort Collins and Medical Center of the Rockies in Loveland.

Call for a schedule of upcoming tour dates.

We look forward to being part of your special day.

Come take a tour of our state-of-the-art birthing centers.

Poudre Valley Hospital 970-495-7000 Medical Center of the Rockies 970-624-2500

www.pvhs.org

P O U D R E VA L L E Y H E A L T H S Y S T E M P O U D R E VA L L E Y H O S P I TA L

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For many types of procedures, we use a special operative scope - a laparoscope - that allows us to make smaller surgical incisions. Laparoscopic (or minimally invasiv e) surgery means patients are likely to have less pain for a shorter length of time and w ill recover more quickly.

The extensive use of laparoscopic surgery in northern Colorado and Wyoming is unique to us. We also perform the traditional open f orms of surgery when necessary.

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Fort Collins Medical Magazine & Directories 2007 2008

Richard W. Lindeberg, D.D.S., M.S. David Clark Johnson, D.D.S., M.S. www.periofortcollins.com

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If you suffer an orthopedic trauma, we’re here for you.

Robert Baer, MD Orthopedic Trauma Surgeon

Mark McFerran, MD Orthopedic Trauma Surgeon Amy Kennedy, PA-C Michael Quirk, PA-C Orthopaedic Center of the Rockies

If you’re seriously injured, our orthopedic trauma team is on standby 24/7 to provide the most comprehensive care in the region.

On-call coverage at the new Trauma Center of the Rockies — part of Medical Center of the Rockies in Loveland — includes world-class facilities and staff, the only fellowship-trained orthopedic trauma surgeons in Northern Colorado and the best options available for treatment and recovery of orthopedic injuries.

Education, top-notch technologies and the compassionate care you expect and deserve as our patient. We’re here for you!

www.pvhs.org

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We’re here for you.

When you need medical care, the exceptional

Watch for what’s new!

caregivers at Poudre Valley Hospital are here

Exciting changes are

for you.

underway at PVH.

In its 82 years, Poudre Valley Hospital has

Watch for our new

quietly built a reputation as one of the best

parking garage,

hospitals in the country. Today we are a

medical office building,

full-service hospital specializing in women and

operating rooms and

family care, oncology, orthopedics

other upgrades that are

and bariatric and robotic surgery.

part of our $41 million remodel and expansion.

Then, now and always, we’re here for you.

www.pvhs.org

P O U D R E VA L L E Y H O S P I T A L P O U D R E V A L L E Y H E A LT H S Y S T E M

Dear Medical & Wellness Reader:

Kevin Unger President and CEO Poudre Valley Hospital

George Hayes President and CEO Medical Center of the Rockies

P O U D R E VA L L E Y H E A LT H S Y S T E M

We’re here for you, and our goal is to provide you with world-class healthcare.

That’s the philosophy of the Medical Center of the Rockies and Poudre Valley Hospital, the two major regional hospitals in northern Colorado.

As presidents and CEOs of these two fine organizations, we want you to know that the care you receive is provided by some of the nation’s best and most dedicated health-care professionals, and medical technology that is among the best found anywhere.

Some local residents have wondered since MCR opened on Valentine’s Day 2007 how the two hospitals coordinate care. As part of Poudre Valley Health System, the hospitals work closely together through a seamless arrangement that allows for inter-facility sharing of patient records and information. In addition, many physicians who are members of the MCR medical staff are also on the PVH medical staff.

Two of MCR’s major clinical services focus on heart and trauma care. The Heart Center of the Rockies and the Trauma Center of the Rockies are located at MCR, as are intensive care units, emergency services, a birthing center and well-baby nursery, medical and surgical nursing units, and full-service radiology and laboratory services. Surgical services include general, cardiothoracic, orthopedic trauma, and neurological trauma. As with PVH, robotic-assisted surgery plays a prominent role in MCR’s surgical technology.

PVH provides a full range of medical services, including inpatient care at the hospital on Lemay Avenue, outpatient services at the Harmony Campus, psychiatric services at Mountain Crest Behavioral Healthcare Center, and family practice medical services at the Family Medicine Center.

We’ve also heard community members ask about what they should do if they have a medical emergency—a heart attack, for example. Which hospital do you hurry to? First of all—and this is important for you to remember—go directly to the nearest hospital. MCR and PVH each have excellent emergency medical services. However, if you have a scheduled cardiac surgical procedure, you would have that performed at MCR rather than PVH. Both MCR and PVH provide services not only for Fort Collins and Loveland but also for the region of northern Colorado, Wyoming and southwestern Nebraska. The need for healthcare in our region continues to increase at a phenomenal rate, matching the growth in our region’s population.

We’re proud to say that our hospitals are providing outstanding clinical care and customer service, and we are committed to providing you with the medical services and care that you and your family may need over the years to come. We hope that you and your family remain healthy and well, but if you do need medical attention, MCR and PVH are here for you.

Kevin Unger President and CEO Poudre Valley Hospital

George Hayes President and CEO Medical Center of the Rockies

41

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Culver, William G., MD 2001 S. Shields St., Bldg. H .....................498.9226 Gondalia, Lakham L., MD 2121 E. Harmony Rd., Ste 350......1.800.437.5443 James, John M., MD 1136 E. Stuart St., Bldg. 3-#200............221.1681 Kailasam, Velusamy, MD 2121 E. Harmony Rd., Ste. 350 ... 221.2370 See ad this page

ANESTHESIOLOGY

Alessi, Richard D., MD 1236 E. Elizabeth St., Ste. 3 ...... 224.2985 See ad on back cover Bobo, Russell W., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Carline, Marylida, MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Cochran, Thomas S., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985

Laszlo, Daniel J., MD 2001 S. Shields St., Bldg. H .....................498.9226

Deringer, Michael A., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985

Murthy, Krishna C., MD 2121 E. Harmony Rd., Ste. 350 ... 221.2370 See ad this page

Derrisaw, James, MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985

Seeley, Janet K., MD 2001 S. Shields St., Bldg. H .....................498.9226 Vedanthan, P.K., MD (Lakewood)...............................................303.238.0471

ALLERGY/IMMUNOLOGY

Lanting, William A., MD 2121 E. Harmony Rd., Ste. 350 ... 221.2370 See ad this page

Dunn, Duane L., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Ford, Troy A., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Fuller, Andrea J., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Girardi, George E., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985

Harrison, William L., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Hodges, Kathleen A., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Horne, Stephen G., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Kirsch, Timothy E., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Koepp, Jeffrey, MD 1236 E. Elizabeth St. Ste. 3......................224.2985 Krohn, Douglas, MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Lichon, Amy, DO 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Marks, Sandy C., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Martinez, Alice, MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Miller, Justin D., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Moss, William E., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Neff, William A., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Perschau, Erik R., DO 1236 E. Elizabeth St., Ste. 3 ....................224.2985

Velasco, Stephen E., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Wagner, Jan Gillespie, MD 1629 Blue Spruce Dr. #208 ....................495.0300 Weiner, Kelli L., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Williams, Daniel K., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Williams, Wendy M.H., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985

CARDIOLOGY

Ashmore, Roger C., MD 2121 E. Harmony Rd., Ste. 100 ... 221.1000 See ad on page 53 Beckmann, James H., MD 1800 15th St.,Ste. 310, (Greeley).....392.0900 See ad on page 105 Chapel, Harold L., MD 1800 15th St., Ste. 310, (Greeley)....392.0900 See ad on page 105 Cullinane, David, MD 2121 E. Harmony Rd., Ste. 100 ... 221.1000 See ad on page 53

Raymond, Jeffrey MD 1236 E. Elizabeth St., Ste. 3.....................224.2985

Doing, Anthony H., MD 2121 E. Harmony Rd., Ste. 100 ... 221.1000 See ad on page 53

Rechnitz, Gary D., MD 1236 E. Elizabeth St., Ste. 3 ...... 224.2985 See ad on back cover Reed, Jay A., MD 3800 N. Grant Ave.....................................622.0608 Richardson, Emily C., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Salimbeni, Julio C., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985

Downes, Thomas R., MD 2121 E. Harmony Rd., Ste. 100 ... 221.1000 See ad on page 53

Serell, Sean M., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Stenbakken, Gelerie D., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985 Thomas, Christopher D., DO 1236 E. Elizabeth St., Ste. 3 ....................224.2985

42

Thornton, Margaret N., MD 1236 E. Elizabeth St., Ste. 3 ....................224.2985

Green, C. Patrick, MD 2121 E. Harmony Rd., Ste. 100 ... 221.1000 See ad on page 53 Johnson, C. Timothy, MD 2121 E. Harmony Rd., Ste. 100 ... 221.1000 See ad on page 53 Larson, Dennis G., MD 2121 E. Harmony Rd., Ste. 100 ... 221.1000 See ad on page 53 Luckasen, Gary J., MD 2121 E. Harmony Rd., Ste. 100 ... 221.1000 See ad on page 53

Miller, William E., MD 2121 E. Harmony Rd., Ste. 100.... 221.1000 See ad on page 53 Myers, Gerald I., MD 2121 E. Harmony Rd., Ste. 100.... 221.1000 See ad on page 53 Oldemeyer, John Bradley, MD 2121 E. Harmony Rd., Ste. 100.... 221.1000 See ad on page 53 Purvis, Matthew T., MD 2121 E. Harmony Rd., Ste. 100.... 221.1000 See ad on page 53 Rath, Gary A., MD 1800 15th St.,Ste. 310, (Greeley).....392.0900 See ad on page 105 Shihabi, Ahmad H., MD Fort Morgan...................................... 970.867.7900 Stoltz, Chad Lynn, MD 2121 E. Harmony Rd., Ste. 100 ... 221.1000 See ad on page 53 Treat, Stephen A., MD 2121 E. Harmony Rd., Ste. 100.... 221.1000 See ad on page 53 Voyles, Wyatt F., MD 2121 E. Harmony Rd., Ste. 100.... 221.1000 See ad on page 53 Whitsitt, Todd B., MD 2121 E. Harmony Rd., Ste. 100.... 221.1000 See ad on page 53

DENTISTRY/GENERAL

Hargleroad, Jennifer K., DDS 1025 Garfield St....................................... 493.2254 Pixley, Thomas R., DDS 2170 W. Drake Bldg. 1..............................221.5115

DENTISTRY/PEDIATRIC

Evans, Gregory D., DDS 1220 Oak Park Dr.....................................223.8687

EAR, NOSE & THROAT

Chand, Maria S., MD 1120 E. Elizabeth St., F-101....... 221.1177 See ad page 44 & on back cover Conlon, William Sean, MD 1032 Luke St.............................................484.8686 Eriksen, Christopher M., MD, FACS 1120 E. Elizabeth St., F-101....... 221.1177 See ad page 44 & on back cover

Van Tassell, Keith A., DDS 2001 S. Shields, Bldg. A .......................... 484.4104

Gill, Sarvjit “Sarge,” MD 3820 N. Grant Ave. (Loveland).... 593.1177 See ad page 44

DENTISTRY/PERIODONTICS

Gupta, Sanjay K., MD 5881 W. 16th St. (Greeley)................ 970.313.2740

Lindeberg, Richard W., DDS, MS 1120 E. Elizabeth, G4................ 221.5050 See ad page 37

DERMATOLOGY

Baack, Brad, MD 1120 E. Elizabeth St., Bldg. G2.................484.6303 Hultsch, Anne Lise, MD 3726 S. Timberline Rd., Ste. 101..............221.5795 Kornfeld, Bruce W., MD 1006 Centre Ave.......................................482.9001 Sayers, Clinton P., MD 1120 E. Elizabeth St., Bldg. G2.................484.6303 West, B. Lynn, MD 3726 S. Timberline Rd., Ste. 101..............221.5795

Fort Collins Medical Magazine & Directories 2007 2008

Loury, Mark C., MD, FACS 2001 S. Shields St., Bldg. E-101.. 493.5334 See ad this page & on the back cover Robertson, Matthew L., MD 1120 E. Elizabeth F-101............. 221.1177 See ad page 44 Runyan, Brad, MD 2121 E. Harmony Rd., Ste. 350.... 212.0169 See ad on back cover Schaffer, Stephen B., MD 2001 S. Shields St., Bldg. E-101.. 493.5334 See ad this page & on the back cover Smith, Bruce M., MD 2121 E. Harmony Rd., Ste. 350.... 484.6373 See ad on back cover Zacheis, David H., MD 1120 E. Elizabeth St., F-101....... 221.1177 See ad page 44

EMERGENCY MEDICINE

Apostle, Michael J., MD 1024 S. Lemay Ave...................................495.8006 Dellota, Kriss, MD 1024 S. Lemay Ave...................................495.8006 Farstad, David J., MD 1024 S. Lemay Ave...................................495.8006 Green, Jason T., DO 1024 S. Lemay Ave...................................495.8006 Hallahan, Tara A. DO 1024 S. Lemay Ave...................................495.8006 Johar, Jasjot S., MD 1024 S. Lemay Ave...................................495.8006 Johnston, P. Scott, MD 1024 S. Lemay Ave...................................495.8006 Litel, Alexa L., MD 1024 S. Lemay Ave...................................495.8006 Luttrell, Matthew, MD 1024 S. Lemay Ave...................................495.8006 Olsen, Eric B., MD 1024 S. Lemay Ave.................... 495.8006 See ad page 111 Patrick, Kenneth M., DO 1024 S. Lemay Ave...................................495.8006 Repert, William B., MD 1024 S. Lemay Ave...................................495.8006 Snodderley, Paul L., MD 1024 S. Lemay Ave...................................495.8006 Solley, Matthew C., MD 1024 S. Lemay Ave...................................495.8006

43

Springfield, Tracy J., MD 1024 S. Lemay Ave...................................495.8006 Teumer, James K., DO 1024 S. Lemay Ave...................................495.8006

ENDOCRINOLOGY

Izon, Meriam P., MD 2121 E. Harmony Rd., Ste. 380.... 295.0010 See ad this page

Turner, Daniel T., MD 1024 S. Lemay Ave...................................495.8006

Widom, Barbara, MD 2001 S. Shields St., Bldg. H......................498.9226

Updegraff, Jeffrey G., MD 1024 S. Lemay Ave...................................495.8006

FAMILY PRACTICE

Weil, Lawrence J., MD 1024 S. Lemay Ave...................................495.8006

Abrahamson, Bradley S., MD 1221 E. Elizabeth St., Ste. 4....... 484.1757 See ad on page 101

Wood, Ian O., DO 1024 S. Lemay Ave...................................495.8006

Abrahamson, Lara, MD 1635 Blue Spruce Dr.................................494.4040 Adamson, Theran B., MD 2021-D Battlecreek Dr..............................206.0851 Anderson, Robert Scott, MD 2127 E. Harmony Rd. Ste. 140................ 297.6250 Askew, Crystal D., MD 1918 S. Lemay Ave., Ste. A.......................494.4531 Bailey, Austin G., MD 1025 Pennock Pl.......................................495.8800 Bakanauskas, Egle A., MD 1300 Main St., (Windsor)......................... 686.5646 Basow, William M., MD 1025 Pennock Pl. ....................................495.8885

44

Bender, John L., MD 4674 Snow Mesa Dr., Ste. 140.................482.0213

Cranor, J. David, MD 1124 E. Elizabeth St., Bldg. C...................484.0798

Bermingham, Roger P., MD 1025 Pennock Pl.......................................495.8800

Davies, Ann T., MD 1025 Pennock Pl.......................................495.8800

Bethards, Kelby F., MD 1017 Robertson St....................................472.5000

de la Torre, Rebecca A., MD 1212 E. Elizabeth St..................................482.2791

Birnbaum, Bernard J., MD 1025 Pennock Pl. ....................................495.8800

Dean, Laura B, MD 2127 E. Harmony Rd. #140....................297.6250

Brewington, Flora Ho, MD 1136 E. Stuart St. ....................................224.0754

DeYoung, Douglas B., DO 1212 E. Elizabeth St..................................482.2791

Brickl, Ian D., MD 1635 Blue Spruce Dr.................................494.4040

Duran, Christine B., MD 1212 E. Elizabeth St..................................482.2791

Broman, Steven D., MD 1221 E. Elizabeth St., Ste. 4....... 484.1757 See ad on page 101

Duran, Matthew G., MD 1212 E. Elizabeth St..................................482.2791

Burnham, Linda A., MD 1918 S. Lemay Ave., Ste. A.......................494.4531 Bursten, Marian S., MD Casper, WY......................................... 307.265.8300 Carroll, Cory D., MD 1040 E. Elizabeth, Ste. 102......................221.5858 Carson, Frank R., MD 2121 E. Harmony Rd., Ste. 370................221.2290

Bell, Sarah J., MD 1635 Blue Spruce Dr............................... 490.4040

Coburn, Thomas C., MD 1455 Main St., Ste.150, (Wiindsor)686.0124 See ad on page 101

Bender, Edward L., MD 1212 E. Elizabeth St..................................482.2791

Connally, Patricia A., DO 2629 Redwing Rd. #310.........................223.5479

Duvall, Kirby J., MD 1000 Drake Rd..........................................498.3104 Ferguson, David R., MD 3000 S. College Ave..................................266.8822 Fields, Jacqueline C., MD 315 Canyon Ave., Ste. 1............................472.6789 Flanagan, John P., MD 3519 Richmond Dr..................... 204.0300 See ad on page 101 Fritzler, Stace, MD 2121 E. Harmony Rd., Ste. 370................221.2290 Glazner, Cherie, MD 1025 Pennock Pl.......................................495.8800 Gould, Jacquelynn M., MD 1025 Pennock Pl.......................................495.8800

Gray, April K., MD 1918 S. Lemay Ave., Ste. A ......................494.4531

Lesage, Margaret R., MD 1025 Pennock Pl. .....................................495.8800

McClellan, Danielle, MD 1025 Pennock Pl. .....................................495.8800

Rodriguez, Juan B., DO 4674 Snow Mesa Dr., Ste. 140.................482.0213

Hawley, Laura K., MD 1025 Pennock Pl ......................................495.8800

Levine, Pamela L, MD Denver................................................303.607.6500

McCreery, Colleen R., DO 3519 Richmond Dr. ................... 204.0300 See ad on page 101

Roller, Jennifer A., MD 3519 Richmond Dr. ................... 204.0300 See ad on page 101

Merkel, Lawrence A., MD 2121 E. Harmony Rd., Ste. 370 ...............221.2290

Rotman, Mark F., MD 2001 S. Shields St., Bldg. I ........ 221.5255 See ad on page 101

Helgeson, Heidi E., MD 1025 Pennock Pl. .....................................495.8800

Lockwood, Stephanie R., MD 1025 Pennock Pl. .....................................495.8800

Henderson, Sandra E., MD 2025 Bighorn Dr......................... 229.980 See ad on page 101

Lopez, Joseph M., MD 1136 E. Stuart St., Bldg. 4-202 ...............221.5925

Monaco, Julie A., MD 1635 Blue Spruce Dr. ...............................494.4040

Hoenig, Mark W., MD Julesburg...................................................474.3376

Lundeen, Anna C., MD 1025 Pennock Pl. .....................................495.8800

Hopkins, Jan H., MD 1120 E. Elizabeth St., Bldg. G1 ................493.2776

Lowther, Kelly H, MD 3000 S. College Ave., Ste. 210.................266.8822

Murphy, Lawrence E., MD 1113 Oakridge Dr. .................... 225.0040 See ad on page 101

Hornung, Diana L., MD 1635 Blue Spruce Dr. ...............................494.4040 Jinich, Daniel B., MD 2001 S. Shields St., Bldg. E-201 ..............221.9991 Kaleta, Andrea D., MD 2025 Bighorn Dr....................... 229.9800 See ad on page 101 Kauffman, Jeffrey N., MD 1124 E. Elizabeth St., Bldg. C ..................484.0798 Klinger, Susan K., MD 2025 Bighorn Dr....................... 229.9800 See ad on page 101 Kuroiwa, Christina L., MD 315 Canyon Ave., Ste. 1........................... 472.6789 Lembitz, Deanne D., MD 4630 Royal Vista Dr. #7 (Windsor) . 530.0575 See ad on page 8

MacDonald, Nola A., DO 315 Canyon Ave., Ste. 3 ...........................472.8008 Maes, Elizabeth J., MD 1025 Pennock Pl. .....................................495.8800 Mallory, Patrick, DO 3850 Grant Ave., Ste. C (Loveland) .........669.9245 Marchant, David R., MD 1025 Pennock Pl. .....................................495.8800 Mason, R. Anthony, MD 4630 Royal Vista Dr. #7 (Windsor) . 530.0575 See ad on page 8 McCarthy, Victoria A., MD 2001 S. Shields St., Bldg. I ........ 221.5255 See ad on page 101

Fort Collins Medical Magazine & Directories 2007 2008

Nevrivy, Thomas E., MD 3519 Richmond Dr. ................... 204.0300 See ad on page 101 Orozco-Peterson, Marilu, MD 811 E. Elizabeth St. .................................224.1596 Ottolenghi, David R., MD 2121 E. Harmony Rd., Ste. 310 ...............221.3855 Palagi, Patricia C., MD 3000 S. College Ave., Ste. 210 ................266.8822 Paulsen, Mark M., MD 1221 E. Elizabeth St., Ste. 4 ...... 484.1757 See ad on page 101 Podhajsky, Tim P., MD 2025 Bighorn Dr....................... 229.9800 See ad on page 101 Reichert, Bryan K., MD 1025 Pennock Pl. .....................................495.8800

Rubright, Jon S., MD 2001 S. Shields St., Bldg. I ........ 221.5255 See ad on page 101 Sachtleben, Thomas R., MD 3519 Richmond Dr. ................... 204.0300 See ad on page 101 Samuelson, Scott, MD 1124 E. Elizabeth St., Bldg. C ..................484.0798 Sands, Arthur C., MD 1021 Robertson St...................................482.0666 Schmidt, David S., MD 2001 S. Shields St., Bldg. I ........ 221.5255 See ad on page 101 Seeton, James F., MD 2121 E. Harmony Rd., Ste. 310 ...............221.3855 Serrano-Toy, Monica T., MD 2121 E. Harmony Rd. Ste. 370 ............... 221.2290 Smith, Jerome I., MD 2025 Bighorn Dr....................... 229.9800 See ad on page 101

45

Stephens, Floyd V., MD 1113 Oakridge Dr. .................... 225.0040 See ad on page 101 Stoddard, Andrew P., MD 1124 E. Elizabeth St., Bldg. C ..................484.0798 Sullivan, Donna L., MD, FAAFP 1025 Pennock Pl. .....................................495.8800 Sunthankar, Shivalini M., MD 1014 Centre Ave. .....................................482.8881 Thieman, William J., MD 1217 E. Elizabeth St., Bldg. 1 ..................484.7245 Thorson, Steven J., MD 1212 E. Elizabeth St.................................482.2791 Tippin, Steven B., MD 2025 Bighorn Dr....................... 229.9800 See ad on page 101 Towbin, Michael M., MD 1217 Riverside Ave.................................. 482.7800 Unger, Mark S., MD 1113 Oakridge Dr. .................... 225.0040 See ad on page 101 Valley, George E., MD 3000 S. College Ave., Ste. 210 ................266.8822 Van Farowe, Cynthia K., MD 1014 Centre Ave. .....................................482.2201 Webber, Pamela, S., MD 1025 Pennock Pl. .....................................495.8800 Weiskittel, Deborah A., MD 1113 Oakridge Dr. .................... 225.0040 See ad on page 101

Witt, Peter C., MD 1900 16th St. (Greeley)............................350.2440

HEMATOLOGY/ONCOLOGY

Brown, Regina, MD 2121 E. Harmony Rd., Ste. 150 ... 493.6337 See ad on page 45

Scott, Miho Toi, MD 2121 E. Harmony Rd., Ste. 150 ... 493.6337 See ad on page 45 Shelanski, Samuel A., MD 1900 16th St. (Greeley)............................667.7870 Stone, Michael D., MD 1900 16th St. (Greeley)............................378.4170

Fangman, Michael P., MD P.O. Box 27140 .........................................217.5160 Kanard, Anne Margaret, MD 2121 E. Harmony Rd., Ste. 150 ... 493.6337 See ad on page 45 Kemme, Douglas J., MD 1900 16th St. (Greeley)...........................353.3722 Lininger, Thomas R., MD 1900 15th St. (Greeley)...........................378.4170 Medgyesy, Diana C., MD 1501 S. Lemay Ave............................... 212.7600 Merrill, Clinton F., MD Laramie............................................. 307.742.7586

INFECTIOUS DISEASES

Cobb, David K., MD, FACP 2121 E. Harmony Rd., Ste. 380 ... 224.0429 See ad on page 47 Johnson-Baack, Tamara Sue, MD 2127 E. Harmony Rd., Ste. 380 ... 224.0429 See ad on page 47 Liao Ong, Jacob C., MD 2121 E. Harmony Rd., Ste. 380 ... 224.0429 See ad on page 47 Peskind, Robert L., MD 2121 E. Harmony Rd., Ste. 380 ... 224.0429 See ad on page 47

Minkoff, Monica, MD 1501 S. Lemay Ave.................................. 212.7600 Moore, James C., MD 1501 S. Lemay Ave...................................212.7600 Romero, Paolo, MD 2121 E. Harmony Rd., Ste. 150 ... 493.6337 See ad on page 45

Alessi, Grace, MD 4674 Snow Mesa Dr., Ste.100..................482.3712 Allen, David K., MD 305 Carpenter Rd. ...................................292.0179 Asadi, S. Daniel, DO 1021 Robertsono St.................................482.0666 Austin, William B., DO 2121 E. Harmony Rd., Ste. 300 ...............207.9958 Berntsen, Mark F., MD 1900 16th St. (Greeley)...........................350.2438 Bush, James F., MD ................................. Fort Collins Cash, Robert L, MD 1900 16th St. (Greeley)............................350.2438 Clipsham, Victoria A., MD 2121 E. Harmony Rd., Ste. 300 ...............207.9958 Ebens, John B, MD 1900 16th St. (Greeley)............................350.2438 Gaines, Jennifer L., MD 2121 E. Harmony Rd., Ste. 300 ...............207.9958 Griffin, Daniel, MD 1006 Robertson St...................................482.3820 Hendrick, James D., MD 4674 Snow Mesa Dr., Ste. 100.................482.3712

INTERNAL MEDICINE

Abbey, David M., MD 1100 Poudre River Dr...............................224.9508 Adamson, Carrie L., MD 2021 Battlecreek Dr. ................................206.0851

Hendrick, Jennifer M., MD 4674 Snow Mesa Dr., Ste. 100.................482.3712 Homburg, Robert C., MD 1100 Poudre River Dr...............................224.9508 Johnson, Richard W., MD 1006 Robertson St., Ste. 104..................484.9027

Weixelman, Janice M., DO 8025 First St., Unit B (Wellington) ...........568.7800

Johnston, Christine G., MD 2121 E. Harmony Rd., Ste. 300................224.9102

Williams, David C., MD 1025 Pennock Pl. .....................................495.8800

Juhala, Robert J., MD 4674 Snow Mesa Dr., Ste. 100.................482.3712

Wilson, Fiona A., MD 1221 E. Elizabeth St., Ste. 4 ...... 484.1757 See ad on page 101

Khera, Sukhjinder K., MD 1006 Robertson St...................................482.3820

Wozniak, Janell R., MD 1025 Pennock Pl. .....................................495.8800

GASTROENTEROLOGY

Compton, Rand F., MD 3702 Timberline Dr., Bldg. A ................... 207.9773 Dowgin, Thomas A., MD 3702 Timberline Dr., Bldg. A ....................207.9773 Dunphy, Rebecca C., MD 3702 Timberline Dr., Bldg. A ....................207.9773 Durkan, Mark N., MD 3702 Timberline Dr., Bldg. A ....................207.9773 Holland, Rod R., MD 3702 Timberline Dr., Bldg. A ....................207.9773

Knepper, Katherine L., MD 4674 Snow Mesa Dr., Ste. 100.................482.3712 Kopel, Charles S., MD 2121 E. Harmony Rd., Ste. 300 ...............207.9958 Loecke, Steven, MD 1900 16th St. (Greeley)............................350.2438 Lopez, William, MD 1006 Robertson St...................................482.3820 LumLung, Christine M., MD 2121 E. Harmony Rd., Ste. 300 ...............207.9958 Lynch, Michael J., DO 1101 Oakridge Dr., Ste. B.........................223.1199 Orton, Lambert C., MD Steamboat ........................................ 970.879.3327 Ow, Cathy L., MD 4674 Snow Mesa Dr., Ste. 100.................482.3712

Jenkins, Joseph X., MD 3702 Timberline Dr., Bldg. A ....................207.9773

Reghitto, Charmaine, MD 2121 E. Harmony Rd., Ste. 300 ...............207.9958

McElwee, Hugh P., MD 3702 Timberline Dr., Bldg. A ....................207.9773

Spannring, Mary M., MD 2121 E. Harmony Rd., Ste. 300 ...............207.9958

Simmons, Robert A., MD 3702 Timberline Dr., Bldg. A ....................207.9773

Stafford, Neil K., MD 1100 Poudre River Dr...............................224.9508

46

Simmons, Mark S., MD 4674 Snow Mesa Dr., Ste. 120.................266.3650

Muelken, Kevin D., MD 1600 Specht Point Dr., Ste. I....... 493.7733 See ad on page 46 Rademacher, Donald R., MD 1900 16th St. (Greeley) ...........................350.2438

NEONATOLOGY

Barry, James S., MD Denver .............................................. 303.861.6868 Hall, Daniel M., MD Denver .............................................. 303.861.6868 Hernandez, Jacinto A., MD Denver .............................................. 303.861.6868 MacRitchie, Amy N., MD PVH, 1024 S. Lemay Ave..........................495.8280 Thompson, Keith S., MD 1900 16th St. (Greeley)............................350.2438 Tryggestad, David I., MD 1900 16th St. (Greeley)............................350.2438 Yoder, Elizabeth A., MD 2121 E. Harmony Rd., Ste. 300 ...............207.9958 Zenk, Daniel R., MD 1900 16th St. (Greeley)............................350.2438

Lang, Christina, MD 4674 Snow Mesa Dr., Ste. 120.................266.3650

Singer, James R., MD 1600 Specht Point Dr., Ste. I....... 493.7733 See ad on page 46 Teruel, Mark A., MD 1600 Specht Point Dr., Ste. I....... 493.7733 See ad on page 46

Paisley, Jan E., MD PVH, 1024 S. Lemay Ave..........................495.8282 Rosenberg, Adam A., MD Denver .............................................. 303.861.6868 Satterwhite, Daniel J., MD PVH, 1024 S. Lemay Ave..........................495.8280

NEUROLOGY

Allen, Timothy J., MD 2121 E. Harmony Rd., Ste. 270 ... 221.1993 See ad on page 47

Nash, Jerry D., MD 2121 E. Harmony Rd., Ste. 180 ...............226.6111 Tolge, Celina F., MD 5890 W. 13th St., Ste. 112 (Greeley).....353.2255

OBSTETRICS/GYNECOLOGY

Cloyd, David G., MD 1136 E. Stuart St. Bldg. 2-100 ................493.5904 Donnelley, Beverly E., MD 1106 E. Prospect Rd. ................ 493.7442 See ad on page 36, page 39 & on the back cover Eisenhauer, Darla E., MD 2695 Rocky Mountain Ave. (Loveland)493.7442 See ad on page 39 Galan, Henry L., MD Denver ................................................... 303.372.6695

Thilo, Elizabeth H., MD Denver. .............................................. 303.861.6868

Curiel, Michael P., MD 2121 E. Harmony Rd., Ste. 270 ... 221.1993 See ad on page 47

Wilkening, Randall B., MD Denver .............................................. 303.861.6868

Friedman, Sheri J., MD 1221 E. Elizabeth St., Ste.3 .....................482.4373

Hayes, Kimberly W., MD 1136 E. Stuart St., Bldg. 2-100 ...............493.5904

Mazowiecki, Michael C., MD 7251 W. 20th St., Bldg. C (Greeley)..........356.3876

Hoffman, Mark F., MD 1136 E. Stuart St., Bldg. 2-100 ...............493.5904

INTERNAL MEDICINE/PEDIATRICS

Drysdale, Christopher R., MD 4674 Snow Mesa Dr., Ste. 120.................266.3650

Simmons, Richard E., MD 1600 Specht Point Dr., Ste. I....... 493.7733 See ad on page 46

Miller, Tamara A., MD 2121 E. Harmony Rd., Ste. 180 ...............226.6111

NEPHROLOGY

Merritt, Jason L., MD 1600 Specht Point Dr., Ste. I....... 493.7733 See ad on page 46

Fort Collins Medical Magazine & Directories 2007 2008

McIntosh, Gerald C., MD 1221 E. Elizabeth St., Ste. 3 ....................482.4373 Meredith, Lawrence A., MD 310 E. 5th St. (Loveland).........................667.7664

Hayes, Karen E., DO 1224 E. Elizabeth St.................................221.4977

James, Warren K., MD 1106 E. Prospect Rd. ................ 493.7442 See ad on page 36, page 39 & on the back cover

47

Jeffrey, Ransy L., MD 1106 E. Prospect Rd. ................ 493.7442 See ad on page 39 & on the back cover

Crews, Kent R., MD 1725 E. Prospect Rd. ................ 221.2222 See ad on page 4 & on page 107

Kieft, Larry D., MD 1136 E. Stuart St., Bldg. 2-100...............493.5904

Foster, Gary J., MD 1725 E. Prospect Rd ................. 484.5322 See ad on page 4 & on page 107

King, Angela, MD 1106 E. Prospect Rd. ................ 493.7442 See ad on page 36 & on back cover Kozak, Susan H., MD 1106 E. Prospect Rd. ................ 493.7442 See ad on page 36, page 39 & on the back cover

Olsen, Karl Erik, MD 1725 E. Prospect Rd ................. 221.2222 See ad on page 4 & on page 107

Ludwin, Gary A., MD 1106 E. Prospect Rd. ................ 493.7442 See ad on page 39 & on the back cover

Reistad, Chet Erik, MD 1725 E. Prospect Rd. ................ 221.2222 See ad on page 4, page 86 and on page 107

Micetich, Kara L., MD 1106 E. Prospect Rd. ................ 493.7442 See ad on page 36, page 39 & on the back cover

Robinson, Matthew J., MD 1725 E. Prospect Rd. ................ 221.2222 See ad on page 4 & on page 107

Priebe Philip N., MD 4674 Snow Mesa Dr .................. 493.7442 See ad on page 36 & page 39

Shachtman, William A., MD 1725 E. Prospect Rd. ................ 221.2222 See ad on page 4 & on page 107

Serniak, Elizabeth K., MD 1106 E. Prospect Rd. ................ 493.7442 See ad on page 36, page 39 & on the back cover

Smith, Randall W., MD 1725 E. Prospect Rd. ................ 484.5322 See ad on page 4 & on page 107

Stauffer, Christine F., MD 1006 Luke St. ...........................................419.1111

Stevens, William W., MD 1725 E. Prospect Rd. ................ 221.2222 See ad on page 4 & on page 107

Tollefson, Michelle L., MD 1106 E. Prospect Rd. ................ 493.7442 See ad on page 39 Tool, Audrey L., MD 1106 E. Prospect Rd. ................ 493.7442 See ad on page 36, page 39 & on the back cover Tool, Kevin J., MD 1106 E. Prospect Rd. ................ 493.7442 See ad on page 36, page 39 & on the back cover Vance, Maude M., MD 1136 E. Stuart St., Bldg. 2-100 ...............493.5904

OBSTETRICS/GYNECOLOGY/ INFERTILITY

ORAL/MAXILLOFACIAL

Biggs, Donald R., DDS 1032 Luke St.............................................4821156 Felton, Rickey E., DDS 1008 Centre Ave., Ste. B ..........................221.4633 Orr, Mark F., MD 2014 Caribou Dr., Ste. 100 ..................... 225.9555 Reynolds, Ralph R., DMD 2992 Ginnala Dr. (Loveland)....... 663.6878 See ad on 63 Thurgood, David B., DDS 2001 S. Shields St. J3.............................. 498.0196

Bachus, Kevin E., MD 1080 E. Elizabeth St. ................ 493.6353 See ad on this page, page 75 & on the back cover

Troxell, James B., DDS 1120 E. Elizabeth St., Bldg. B, Ste.3........482.6811

OCCUPATIONAL MEDICINE

Baer, Robert M., MD 2500 E. Prospect Rd. ................ 493.0112 See ad on page 38 & on page 49

Mercer, Jeanette Y., MD 1330 Oakridge Dr. ....................................674.0899

Beard, Douglas W., MD Thornton...........................303.287.2800 See ad on page 6

Holthouser, Michael G., MD 1330 Oakridge Dr. ....................................495.8450

Scherr, Frederick P., MD 1025 Pennock Pl., Ste. 121....................495.8450 Yanagi, Ann K., MD 1380 Oakridge Dr.. ...................................495.8400

OPTHALMOLOGY

48

Norris, Andrew M., MD 2121 E. Harmony Rd., Ste. 190 ...............224.2020

ORTHOPEDICS

Beard, David A., MD 2500 E. Prospect Rd. ................ 493.0112 See ad on page 49 Benz, Robert J., MD 2500 E. Prospect Rd. ................ 493.0112 See ad on page 23 & page 49

Arnold, Patrick D., MD 1725 E. Prospect Rd. ................ 221.2222 See ad on page 4 & on page 107

Biggs, William D., MD 2500 E. Prospect Rd. ................ 493.0112 See ad on page 23 & page 49

Bashford, Kent P., DO 1725 E. Prospect Rd. .............. 221.2222 See ad on page 4 & on page 107

Brackett, Bess, MD PO Box 336694 (Greeley)........................330.5400

Bussey, Randy M., MD 5890 W. 13th St. (Greeley)........................348.0020 Chamberlain, Satoru T., MD 2500 E. Prospect Rd.................. 493.0112 See ad this page Dhupar, Scott K., MD 3810 N. Grant Ave. (Loveland).................669.8881 Donner, E. Jeffrey, MD 3810 N. Grant Ave. (Loveland).... 669.8881 See ad on page 31 Duncan, Kenneth H., MD 2500 E. Prospect Rd.................. 493.0112 See ad this page

Sanderford, Kelly R., MD 5890 W. 13th St., Ste. 101 (Greeley)........348.0020 Sides, Steven D., MD 5890 W. 13th St., Ste. 101 (Greeley)........348.0020 Sobel, Roger M., MD 2500 E. Prospect Rd.................. 493.0112 See ad this page Trumper, Rocci V., MD 2500 E. Prospect Rd.................. 493.0112 See ad this page

Durbin, Mark B., MD 2500 E. Prospect Rd. ................ 493.0112 See ad this page

Young, Eric E., MD 3810 N. Grant Ave. (Loveland).................669.8881

Gordon, A. Lee, MD 2121 E. Harmony Rd., Ste. 260................221.2827

PAIN MANAGEMENT

Grant, Michael P., MD 3810 N. Grant Ave. (Loveland).................669.8881 Grant, Lee B., MD 2500 E. Prospect Rd.................. 493.0112 See ad this page Grey, Sean G., MD 2500 E. Prospect Rd................. 493.0112 See ad this page Grossnickle, Mark D., MD 1900 16th St. (Greeley)............................350.2427 Houghton, Michael J., MD 2500 E. Prospect Rd. ................ 493.0112 See ad this page Hunter, Brett P., MD 1900 16th St. (Greeley)...........................350.2427 Jackson, Wesley P., MD 2500 E. Prospect Rd.................. 493.0112 See ad this page Kindsfater, Kirk A., MD 2500 E. Prospect Rd.................. 493.0112 See ad this page Knauer, Sally A., MD 2121 E. Harmony Rd., Ste. 290................224.9890 Magsamen, Benedict F., MD 3805 S. Centennial Dr...............................226.4465 Martin, Dale R., MD 2500 E. Prospect Rd.................. 493.0112 See ad this page McFerran, Mark A., MD 2923 Ginnala Dr. (Loveland)........ 663.3975 See ad on this page & page 38 McNair, Patrick J., MD Golden................................................ 303.233.1223 Nelson, Garth C., MD 1020 Luke St.............................................493.2102 Pazik, Thomas J., MD 6801 W. 20th St., Ste. 201 (Greeley).............330.1090 Pettine, Kenneth A., MD 3810 N. Grant Ave. (Loveland).... 669.8881 See ad on page 31 Reckling, W. Carlton, MD Cheyenne................................................ 307.632.6637

get back to what you love

Watkins, John J., MD 1900 16th St. (Greeley)............................350.2427

Trauma and Fractures Spine Hand and Upper Extremity Foot and Ankle Knee Shoulder Sports Medicine Joint Replacement/ Arthritis Pediatrics

Boylan, Thomas, DO 3744 S. Timberline Rd., Ste. 102..............495.0506 Hompland, Scott J., DO 1330 Oakridge Dr......................................377.9555 Sisson, Charles B., MD 1136 E. Stuart St., Bldg. 4-104................221.9451

PATHOLOGY

Singer, Donald A., MD 1024 S. Lemay Ave...................................495.8740 Staszak, Christopher, MD 1024 S. Lemay Ave...................................495.8740 Williams, James Elmer, MD 1024 S. Lemay Ave...................................495.8740

PEDIATRICS

Anderson, Carole M., DO 1200 E. Elizabeth St..................................267.9510 Archer, Deborah, MD 1635 Blue Spruce Dr.................................494.4040 Ballard, Elizabeth A., MD 1200 E. Elizabeth St..................................267.9510 Booth, Richard R., M 2001 S. Shields St., Bldg. G.......................484.4871 Brockway, Julie M., MD 1200 E. Elizabeth St..................................267.9510 Crawford, Deborah D., MD 1635 Blue Spruce Dr.................................494.4040

specialists in the medicine of motion Fort Collins: 2500 E Prospect Rd / Fort Collins, CO 80525 970-493-0112 / Toll-Free: 800-722-7441 www.orthohealth.com

O’Leary, Sean Timothy, MD 1200 E. Elizabeth St..................................267.9510 O’Leary, Sonja C., MD 1635 Blue Spruce Dr.................................494.4040 Schaffer, Michael S., MD Denver............................................... 303.861.6820 Seidman, Marc H., MD 1635 Blue Spruce Dr.................................494.4040 Sullivan, William J., MD 1200 E. Elizabeth St..................................267.9510 Whitman, Douglas W., MD 1635 Blue Spruce Dr.................................494.4040

PHYSICAL MEDICINE & REHABILITIATION

Loveland: 2923 Ginnala Dr / Loveland, CO 80538 970-663-3975 / Toll-Free: 888-663-3975

PODIATRY

Anderson, James C., DPM 1355 Riverside Ave., Ste. C......... 484.4620 See ad on page 27 Burns, Michael J., DPM 2001 S. Shields St., Bldg. F.......................493.4660 Hatch, Daniel J., DPM 1931 65th Ave., Ste. A (Greeley). 351.0900 See ad on page 108 Hecker, Thomas M., DPM 2500 E. Prospect Rd.................. 493.0112 See ad this page Knutsen, Chad M., DPM 2001 S. Shields St., Bldg. F.......................493.4660 Moore, Harold Randall, DPM 1217 E. Elizabeth St., Ste. 11...................472.8700

Elliott, Max A., MD 1200 E. Elizabeth St..................................267.9510

Adamson, Carrie L., MD 2021 Battlecreek Dr..................................206.0851

Guenther, John P., MD 1200 E. Elizabeth St..................................267.9510

Bender, John D., DO 1330 Oakridge Dr., Ste. 130.....................377.9555

Hanson, Vaughn W., MD 1200 E. Elizabeth St..................................267.9510

Jacob, Joseph P., MD 4401 Union St. (Loveland). ........................619.3400

Hull, Lori J., MD 1200 E. Elizabeth St..................................482.2515

Lockwood, Bruce A., MD 1300 Oakridge Dr., Ste. 130.....................377.9555

Markley, Jennifer L., MD 2001 S. Shields St., Bldg. G.......................484.4871

Reichhardt, Gregory, MD 2001 70th Ave., #205 (Greeley).............392.2490

Vaardahl, Michael D., DPM 1931 65th Ave., Ste. A (Greeley). 351.0900 See ad on page 108

McGinnis, James G., MD 1200 E. Elizabeth St..................................267.9510

Wunder, Jeffrey A., MD Wheat Ridge....................................... 303.423.8334

Webb, Emily Huang, DPM 1927 Wilmington Dr., #102......................416.9009

O’Brien, Barry G., MD 2001 S. Shields St., Bldg. G.......................484.4871

Zimmerman, Fredric D., DO Wheat Ridge....................................... 303.423.8334

Fort Collins Medical Magazine & Directories 2007 2008

O’Halloran, William D., DPM 1301 Riverside Ave...................................482.3668 Schulte, Robert C., DPM 2001 S. Shields St., Bldg. F.......................493.4660 Thomas, Michael I., DPM 1355 Riverside Ave., Ste. C......... 484.4620 See ad on page 27

49

PSYCHIATRY

Northern Colorado Pulmonary Consultants, P.C. Pulmonary Disease

Critical Care

Sleep Disorders

Gottfried, Joseph M., MD 4601 Corbett Dr........................................207.4800 Heacock, Craig R., MD 4601 Corbett Dr........................................207.4800 Moreno, Hermann A., MD 4601 Corbett Dr........................................207.4800 Nagel, John K., MD 4601 Corbett Dr........................................207.4800 Oddy, Richard A., MD 120 Bristlecone Dr....................................224.5209 Pearson, Glenn E., MD

4601 Corbett Dr........................................207.4800 Rennick, John H., MD 525 W. Oak St............................................494.4300 Udupa, Usha R., MD 4601 Corbett Dr........................................207.4800 Watanabe, Kenneth S., MD 4601 Corbett Dr........................................207.4800 Woodard, Timothy W., MD 4601 Corbett Dr........................................207.4800

Diana Breyer, M.D.

Stan Gunstream, M.D.

James Hoyt, M.D. PULMONOLOGY

Breyer, Diana M., MD 2121 E. Harmony Rd., Ste. 300 ...........224.9102 See ad this page Gunstream, Stanley R., MD 2121 E. Harmony Rd., Ste. 300 ...........224.9102 See ad this page Hoyt, James D., MD 2121 E. Harmony Rd., Ste. 300 ...........224.9102 See ad this page Kukafka, David S., MD 2500 Rocky Mnt Ave. Ste.300 .... 619.6100 See ad this page & page 56

David Kukafka, M.D.

Rick Milchak, M.D.

Mark Neagle, M.D.

Milchak, Richard J., MD 2500 Rocky Mnt Ave. Ste.300 .... 619.6100 See ad this page Neagle, Mark B., MD 2121 E. Harmony Rd., Ste. 300 ...........224.9102 See ad this page & page 56 Petrun, Mark D., MD, FCCP 2121 E. Harmony Rd., Ste. 300 ...........224.9102 See ad this page & page 56 Stevens, Eric E., MD 2121 E. Harmony Rd., Ste. 300 ...........224.9102 See ad this page

Mark Petrun, M.D.

Eric Stevens, M.D.

Kristin Wallick, M.D.

Pulmonary Disease | Asthma | Emphysema COPD | Hypoxia | Critical Care | Sleep Disorders | Pulmonary & Exercise Testing FORT COLLINS 2121 E. Harmony Rd., Ste 300 Fort Collins, CO 80528 970.224.9102 50

LOVELAND 2500 Rocky Mountain Ave., Ste 300 Loveland, CO 80538 970.461.9124

Wallick, Kristin A., MD 2121 E. Harmony Rd., Ste. 300 ...........224.9102 See ad this page

RADIATION ONCOLOGY

Klish, Marie D., MD 2121 E. Harmony Rd., Ste. 160 ...........482.3328 See ad on page 51 Lim, Meng Lai, MD 2121 E. Harmony Rd., Ste. 160 ...........482.3328 See ad on page 51 Lisella, Gwen H., MD 2121 E. Harmony Rd., Ste. 160 ...........482.3328 See ad on page 51

Simpson, C. Kelley, MD 2121 E. Harmony Rd., Ste. 160............482.3328 See ad below

Geraghty, Micahel J., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Casey, William B., MD 2121 E. Harmony Rd., Ste. 160............482.3328 See ad below

Gunderson, Deborah Z., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

RADIOLOGY

Hayes, Amy S., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Reese, Mark F., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7 Singer, Charles J., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7 Stears, Robert L., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Berkowitz, Bruce Andrew, MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Howshar, Mark Edward, MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Weinstein, Stanley W., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Bodenhamer, John R., MD 2008 Caribou Dr. ...................... 377.0270 See ad on page 7

Jess, Sarah J., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Weissmann, Jeffrey R., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Craven, Winfield M., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7 & page 8

Klingelheber, Bob F., DO 2008 Caribou Dr........................ 377.0270 See ad on page 7

RHEUMATOLOGY

Dunphy, Thomas R., MD 2008 Caribou Dr....................... 377.0270 See ad on page 7

Koplyay, Peter D., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Fleener, Christopher M., MD 2008 Caribou Dr....................... 377.0270 See ad on page 7

Luttenegger, Thomas J., MD, FACR 2008 Caribou Dr........................ 377.0270 See ad on page 7

Florant, Tracy H., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Markel, Curtis L., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Fuller, Samuel E., MD 2008 Caribou Dr....................... 377.0270 See ad on page 7

Pacini, Richard J., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Geis, J. Raymond, MD 2008 Caribou Dr........................ 377.0270 See ad on page 7

Peck, Steven H., MD 2008 Caribou Dr........................ 377.0270 See ad on page 7 & page 8

Fort Collins Medical Magazine & Directories 2007 2008

Levine, James W., DO 1900 16th St. (Greeley)............................350.2433 Meyer, Fred H., MD Cheyenne, WY............................................482.3966 Thakor, Michael S., MD 2121 E. Harmony Rd., Ste. 361............... 267.9799 Murray, Garvin C., MD 239 W. 67th Ct. (Loveland).......................461.1880

Trumper, Rocci V., MD 2500 E. Prospect Rd.................. 493.0112 See ad on page 49 Yemm, Stephen J., MD 2500 E. Prospect....................... 419.7009 See ad on page 49

SURGERY CENTERS

Harmony Ambulatory Surgery Center, LLC 2127 E. Harmony Rd., Ste 200..... 297.6300 Surgery Center of Fort Collins 1100 E. Prospect Rd.................. 494.4800 See ad on back cover

SURGERY/ASSIST

Conlon, Robert M., MD 1032 Luke St.............................................484.8686 Connally, Patricia A., DO 2500 E. Prospect Rd.................. 493.0112 See ad on page 49 Janasek, Mitchell J., MD 2121 E. Harmony Rd., Ste. 310................221.3855 Johnson, Robert V., MD 2500 E. Prospect Rd.................. 493.0112 See ad on page 49

Thompson, John Stephen, MD 239 W. 67th Court (Loveland)...................461.1880

Kaiser, Dale C., MD 2500 E. Prospect Rd................. 493.0112 See ad on page 49

SPORTS MEDICINE

Kesler, Kelvin F., MD 1106 E. Prospect Rd.................. 493.7442 See ad on page 39

Servi, Jane T., MD 2121 E. Harmony Rd., Ste. 290................224.9890

51

Tutt, George O., MD ................................ Fort Collins Van Den Hoven, Raymond P., MD 2500 E. Prospect Rd. ............... 493.0112 See ad on page 49

SURGERY/CARDIOVASCULAR

Guadagnoli, Mark, MD 2121 E. Harmony Rd., Ste. 100 .. 221.1000 See ad on page 53 Lamounier, Fernando N., MD 2121 E. Harmony Rd. Ste. 100 .... 221.1000 See ad on page 53 Stanton, Michael, MD 1148 E. Elizabeth St................................ 221.5870

SURGERY/GENERAL

Bauling, Paulus C., MD 1148 E. Elizabeth St.................................221.5878

Dickinson, James M., MD 2121 E. Harmony Rd., Ste. 250 ... 482.6456 See ad on page 37 Dubs, Steven, MD 1900 16th St. (Greeley)............................350.2426 Fraser, Lesley A., MD 1900 16th St. (Greeley)..........................350.2426 Kaufman, Steven L., MD 1136 E. Stuart St., Bldg. 4 #102 ............498.8346 Lee, James S., MD 1500 16th Ave. Ct. (Greeley) ...................350.0948 Ogren, Jason W., MD 1800 15th St., Bldg. 210 (Greeley) .........352.8216 Parsons, Sally A., MD 1148 E. Elizabeth St.................................221.5878 Peetz, Michael E., MD 1900 16th St. (Greeley) ...........................350.2426

Blomquist, Thomas M., MD 1900 N. Boise, #420 (Loveland).............669.3212

Pettine, Stefan, MD 2121 E. Harmony Rd., Ste. 250 ... 482.6456 See ad on page 37

Chiavetta, Thomas G., MD 2121 E. Harmony Rd., Ste. 250 ... 482.6456 See ad on page 37

Quaid, Robert R., MD 2121 E. Harmony Rd., Ste. 250 ... 482.6456 See ad on page 8 & page 37

Clear, Craig R., MD 2121 E. Harmony Rd., Ste. 250 ... 482.6456 See ad on page 37

Roller, Michael D., MD 2121 E. Harmony Rd., Ste. 250 ... 482.6456 See ad on page 8 & page 37

Collins, John A., MD 1148 E. Elizabeth St.................................221.5878

Rubinson, Samuel M., MD Colorado Springs .............................................. 719.520.1411

Cribari, Chris MD 1148 E. Elizabeth St. ................ 221.5878 See ad on back cover

Smith, Sara, MD 1148 E. Elizabeth St.................................221.5878

52

Woodard, Scott, MD 555 Prospect Ave. (Estes Park) ..............586.2200

SURGERY/OPHTHALMIC/ PLASTIC/RECONSTRUCTIVE

Reistad, Chet, MD 1725 E. Prospect Rd. ................ 221.2222 See ad on page 4, page 86 & page 107

SURGERY/PLASTIC/ RECONSTRUCTIVE

Viola, John J., MD 1313 Riverside Ave................... 493.1292 See ad this page & page 61 Wirt, Timothy C., MD 1313 Riverside Ave................... 493.1292 See ad this page, page 61 & back cover

UROLOGY

Brutscher, Stephen P., DO 1500 S. Lemay Ave. .................. 484.6700 See ad on page 57

Chand, Maria, MD 1120 E. Elizabeth St., F-101 ...... 221.1177 See ad on page 44 & back cover

Eddy, Michael J., MD 1647 E. 18th St. (Loveland) ....... 669.9100 See ad on page 57

Chapman, Jeffrey K., MD 1217 E. Elizabeth St., Bldg. 7..... 493.8800 See ad on back cover

Everett, Randy W., MD 1500 S. Lemay Ave. .................. 484.6700 See ad on page 57

Duncan, Diane, MD 1701 E. Prospect Rd. ...............................493.7445

Goodman, Gary R., MD 1900 16th St. (Greeley) ...........................350.2491

Gonyon, Denis L., MD 5881 W. 16th St. (Greeley).......................313.2760

Lee, Michael R., DO 1500 S. Lemay Ave. .................. 484.6700 See ad on page 57

Tsoi, Christopher M., MD 1217 E. Elizabeth St., Bldg. 7..... 493.8800 See ad on back cover

Nasseri, Kevin K., MD 1500 S. Lemay Ave. .................. 484.6700 See ad on page 57

SURGERY/NEURO

Nemeth, Clifford J., MD 1647 E. 18th St. (Loveland) ....... 669.9100 See ad on page 57

Coester, Hans C., MD 1313 Riverside Ave. ................. 493.1292 See ad this page, page 61 & back cover Turner, Donn M., MD 1313 Riverside Ave................... 493.1292 See ad this page, page 61 & back cover

Phillips, George H., MD 1647 E. 18th St. (Loveland) ....... 669.9100 See ad on page 57 Soper, Timothy H., MD 1500 S. Lemay Ave. .................. 484.6700 See ad on page 57

If you need cardiac care, I’m here for you.

If you need advanced cardiac care or surgery, Dr. Thomas Downes and his colleagues at Heart Center of the Rockies are here for you.

Heart Center of the Rockies at Medical Center of the Rockies is a cardiac hospital-within-a-hospital, staffed by cardiac surgeons, cardiologists, nurse practitioners, specialist nurses and technicians to handle your most immediate needs with compassion and expertise. Equipped with the latest cardiovascular technology, Heart Center of the Rockies is here for you.

Heart Center OF THE ROCKIES

P O U D R E V A L L E Y H E A LT H S Y S T E M

Heart Center of the Rockies provides cardiac care at Medical Center of the Rockies and Poudre Valley Hospital.

www.pvhs.org

MEDICAL CENTER OF THE ROCKIES P O U D R E V A L L E Y H E A LT H S Y S T E M

500 robotic procedures and counting... we’re here for you.

The robotic surgical team at Poudre Valley Hospital is here for you.

Surgeons and staff at Poudre Valley Hospital and now also Medical Center of the Rockies perform minimally invasive, robotic surgeries for: • • • •

prostate removal valve repair and other heart surgeries hysterectomy other complex procedures

The benefit for you, the patient? Less pain and a much faster recovery.

For more information, visit www.robotics.pvhs.org.

Celebrating

We’ve just completed our

500th surgery with the da Vinci® robotic-assisted surgical system at PVH. Thank you to our surgeons and robotics nursing team for your dedication and commitment to excellence.

P O U D R E VA L L E Y H O S P I T A L P O U D R E V A L L E Y H E A LT H S Y S T E M

54

500

medical

robotic surgery

precision and less pain robotic prostatectomy

by Kay Rios

Stephen Brutscher, D.O. of Urology Center of the Rockies is one of three surgeons who pioneered the robotic program at PVH.

Fort Collins Medical Magazine & Directories 2007 2008

In the battle against prostate cancer, robots have marched into the lead by offering a more precise means to remove tumors and provide more effective reconstruction. “Just two years ago, 90% of our prostatectomies were being done with open surgery and now 90% are being done robotically,� says Dr. Michael Lee of the Urology Center of the Rockies (UCR).

55

A Good Nights Sleep...

You deserve it more than once in a blue moon.

TWO CONVENIENT FRONT RANGE OFFICE LOCATIONS: In Fort Collins at the Harmony/Timberline Medical Campus In Loveland at the Medical Center of the Rockies

LOCAL: 970.663.3377 TOLL FREE: 888.R.SLEEP.N (888.775.3376)

Mark Petrun

David Kukafka

Mark Neagle

MD FCCP DABSM

MD FCCP DABSM

MD FCCP DABSM

56

“There’s a reason,” adds Dr. Stephen Brutscher, also from UCR. “It offers benefits to both the patient and the doctor.” Brutscher, who was one of three surgeons who pioneered the robotic program at PVH, says he has personally performed nearly 75 prostatectomies and, he says, he’ll be doing more. Prostate cancer is, after all, a fairly common occurrence among males.

Prostate cancer, in fact, is the second most common cancer in American males. Based on diagnostic numbers analyzed by the American Cancer Society, it’s been estimated that one in six men will be diagnosed with prostate cancer during his lifetime. Regular urologic exams, early detection and diagnosis, and treatment have a dramatic impact on mortality rates. The good news is that 90% of prostate cancers diagnosed in the U.S. are detected in an early stage and have an excellent chance of being cured.

While the exact cause of prostate cancer remains unknown, certain risk factors are recognized. Age is the most common with twothirds of prostate cancer being diagnosed in males over 65 years of age.

Brutscher says, “If you live until you are 90 there’s a 70% chance that you will get it. The risk is greater with each decade after 70. But if you get it in your 80s and 90s, you are more likely to die with the cancer than from it.”

“Race is also a contributing factor,” Lee adds.

“African-American males are 60% more likely to be diagnosed and they are more likely to have a later stage of the disease at the time of diagnosis and, usually, a worse prognosis,” he says.

Family history, too, plays an important role.

Having a father or brother with prostate cancer significantly increases a man’s risk of developing the disease. Diet ranks right in there with red meat and high fat diets being linked to higher occurrence rates. “Prostate cancer is actually higher in developed countries,” Brutscher says.

“As with most cancers, the poorer the diet, the more susceptible you are. A healthy diet means a lot. Regular exercise has also been associated with lower incidence rates.”

Since many patients are diagnosed in early stages of the disease, Brutscher says they are candidates for treatments. Several treatment options exist. Two radiation-based approaches include brachytherapy and external beam radiation. Brutscher explains that, brachytherapy, also known as “seeds,” involves surgical implantation of multiple small radioactive rods directly into the prostate. Low-dose radioactive seeds or pellets are permanently implanted into the prostate. Recent long-term data shows that this can be an excellent treatment option for a select group of patients. With external beam radiation, a highly focused beam of radiation delivers the same total dose of radiation to the prostate but must be administered over the course of several months.

A treatment still be investigated involves cryotherapy. In this process, lethal ice is used to freeze the cancer. “Several thin needles are placed in the prostate and cycles of freezing and thawing are used to destroy the cancer.” Brutscher says he remains skeptical about that process and this treatment should only be recommended in a highly select group of patients.

Surgical options are also available but, in the past, the location of the prostate has created a big challenge for surgeons. The prostate gland,

an accessory male sex organ primarily functioning to support and promote male insemination and fertility, is situated between the base of the bladder and the external striated urethral sphincter. Its broad base lies against the bladder neck and its apex narrows to join the urethra and the sphincter. In other words, it’s in a tough spot.

The two surgical treatments include open radical prostatectomy or robotic radical prostatectomy.

In open surgery, the prostate is removed through a lengthy vertical incision made in the lower abdomen. Reconstruction of the bladder to the urethra follows prostate removal, a procedure that can be difficult particularly in a deep pelvis.

Although open prostatectomy had been accepted as the “gold standard” treatment for prostate cancer, the possibility of erectile dysfunction and incontinence concerned patients. As a means of addressing erectile dysfunction, a “nerve-sparing” technique was developed over a decade ago and remains a common practice to preserve sexual potency.

The other surgical form uses the daVinci Robotic System to remove the diseased prostate.

Lee says, “In a nutshell, it is a replication of a once very technically challenging laparoscopic prostatectomy. The steps are identical. The major difference is that we now have robotic technology which has truly revolutionized what was, previously, a very difficult operation into one that doesn’t necessarily require extensive laparoscopic training.”

Although the entire prostate is removed similar to open surgery, there are key differences.

One key distinction is that, instead of operating through a 5 to 7 inch length incision, the entire operation is done from outside of the body. Five to six laparoscopic ports are placed in the lower abdomen by making incisions that range from one-quarter inch to an inch and a half. Carbon dioxide is used to inflate the abdomen, creating a working space. Through these ports, laparoscopic instruments perform a number of surgical tasks including cutting, cauterizing and sewing. For this technique, the surgeon operates at a console about 10 feet from the patient, and looks at the organ through a magnified, three-dimensional view. “The amount of light and magnification provides a better view during robotic surgery than I’ve ever seen during open surgery,” Lee says.

The Poudre Valley Health System currently has three daVinci robotic surgical systems for a variety of surgeries. PVH, only one of 11 health-

Fort Collins Medical Magazine & Directories 2007 2008

57

As with most cancers, the poorer the diet, the more susceptible you are.

A healthy diet means a lot. Regular exercise has also been associated with lower incidence rates.

- Stephen Brutscher, D.O. Urology Center of the Rockies

care organizations in the nation to use three or more robots, reached a milestone in June when the 500th robotic-assisted surgery was performed at the hospital. That record surgery was a prostatectomy performed by Lee. Lee says the urologists at UCR provide an enormous amount of counseling and information about treatment options so the patient can make a well-informed decision. “I find the counseling to be a such a critical part of the treatment plan.”

Prostate cancer, in fact, is the second most common cancer in American males.

Based on diagnostic numbers analyzed by the American Cancer Society, it’s been estimated that one in six men will be diagnosed with prostate cancer during his lifetime.

Aside from surgical options, prostate cancer patients can also opt for hormone therapy, chemotherapy or simply waiting and watching.

“I’m very honest with my patients,” says Brutscher. “ Please explore radiation; ask about cryo. Ultimately, a patient has to come to the decision themselves. If they opt to do nothing, I would probably arm wrestle them but if they choose something other than surgery, that’s fine as long as they are educated about all of their options. The patient has to be comfortable with the choice.”

Still, Brutscher’s preference is the robotic approach because of the benefits. Offering advantages over both open surgery and traditional laparoscopic procedures, the daVinci robotic system has an “Endowrist” that allows the surgeon to recreate exactly the same motions with the laparoscopic instrument that he creates with his own hands and wrists. Because of that, the surgeon can cut and sew with much

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We used to say you had to do 30 to 40 laproscopic prostatectomies to be proficient but now we’re seeing that same proficiency level within four to five robotic cases.

- Michael Lee, D.O. Urology Center of the Rockies

greater precision. In addition, unlike a standard laparoscopic camera, the daVinci has two cameras mounted side by side, providing a magnified, three-dimensional view of the prostate and its neighboring organs. The main benefits of the robotic approach are less blood loss, less postsurgical pain, shorter hospitalization and faster recover. And recent advances in nerve-sparing using the robot also offer a faster return of erections and a higher rate of potency following surgery. “The continence rate is good,” says Brutscher. “It’s easier with a robot to preserve the nerve.”

The good news is that 90% of prostate cancers diagnosed in the U.S. are detected in an early stage and have an excellent chance of being cured.

Robotic surgery is not for every patient, Lee says. “There are certain criteria that make this operation more difficult: obesity, large prostate gland, and certain anatomic configurations or abnormalities. But,” he adds, “these rules are being broken every day. These patients I turned away a year ago, we are now taking.”

The use of robotics has really mitigated the learning curve, Lee says. “We used to say you had to do 30 to 40 laproscopic prostatectomies to be proficient but now we’re seeing that same proficiency level within four to five robotic cases.”

With robotic technology, Lee says, “We’re starting to see a migration to much more challenging reconstructive prostate, bladder and kidney surgeries once deemed only possible with open surgery. We’re literally just seeing the tip of the iceberg.”

Kay Rios is a freelance writer based in Fort Collins. She is currently a doctoral candidate in Educational Leadership at Colorado State University.

Fort Collins Medical Magazine & Directories 2007 2008

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medical

Neuro surgery

intra-operative imaging and image guidance

Spinal Surgery

by Court Klinck

A sixteen-year-old girl is involved in a car accident.

She has sustained a broken bone in her spine, is barely able to move, and is in great pain. CAT Scan and MRI reveal that the bone has compressed and bruised her spinal cord. Surgery is required.

Neurosurgeon Dr. Hans Coester, of Front Range Center for Brain & Spine Surgery, is called to operate.

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Neurosurgeon, Hans Coester, M.D. of Front Range Center for Brain & Spine Surgery, P.C.

Fortunately for the young patient, the surgery is performed at the Medical Center of the Rockies (MCR), using O-arm® System (“O-arm”) and StealthStation® Treon® Plus Treatment Guidance System (“StealthStation”) intra-operative imaging and image guidance equipment from Medtronic Navigation. Dr. Coester uses the O-arm to obtain 3D pictures of the patient on the operating table at the start of surgery, transfers these images to the StealthStation, and uses the StealthStation to precisely guide his instruments and insert screws during surgery. He also views additional images from the O-arm at the conclusion of surgery to make sure that the operation has been successful. The result in this case: the young girl’s bone is returned to the normal position and secured, and she walks out of the hospital in days with no neurological difficulties.

MCR purchased the O-arm equipment when the hospital opened in February 2007.

At that time, MCR was only the 11th hospital in the world to acquire an O-arm system.

Karen Martin, MCR’s Director of Peri-Operative Services, states, “We are proud to be one of the first hospitals to purchase the O-arm.

The system’s capabilities are very impressive.

It provides the surgeons and our patients with one of the best intra-operative imaging capabilities available anywhere. Medtronic provides technical support from its major service facility close by in Louisville, Colorado.”

As of this writing, MCR is one of only two Front Range medical facilities that offer the O-arm.

Since its initial operational use at MCR, the O-arm has been used in 42 surgical cases - 34 spinal cases, four pelvic cases, and four facial cases. It was used in the second surgery on the first day that MCR was open. The surgical procedure involved treatment of a fractured acetabulum (hip joint). According to Director Martin, it was the world’s first surgery using O-arm technology on this particular type of fracture.

The O-arm reflects recent advancements in intra-operative radiological (X-ray) image technology. It is a large, mobile piece of medical equipment used during surgery that produces live images, selects and saves individual images as desired, and, where image guidance is used, transfers images to image guidance equipment such as the StealthStation. The O-arm system includes a large ring (similar to CAT Scan equipment) that encircles the patient during surgery, and a digital flat-panel screen for displaying images. The equipment operates in three distinct imaging modes: traditional fluoroscopy, multi-planer fluoroscopy, and 3D volumetric imaging. Availability of the O-arm’s advanced imaging capability is of significant benefit to patients receiving surgical treatment in Operating Rooms, Emergency Departments, ICUs, Procedure Rooms and Trauma Areas.

In addition to its current applications, other applications for the O-arm are under development.

Improving on current 2D C-arm™ technology, the O-arm provides the following additional capabilities:

OARM Equipment. O-arm® System is used to obtain 3-D pictures of patients’ spines before and after surgery.

• Real-time 3D image capability covering a full 360 degrees around the patient • Higher image resolution • Use of precision robotics to acquire different image views • Ability, at the end of surgery, to view the results while the patient is still on the operating table (precluding the need for post-operative CAT Scan to ensure that surgical procedures have been done successfully.)

The O-arm provides spine surgeons with real-time 3D pictures, including a critical axial view of anatomy. Spine surgery, in particular,

is axially based, as are other advanced and minimally invasive surgical procedures.

Earlier 2D systems made it difficult for surgeons to determine the placement of their instrumentation relative to the axial plane. The O-arm is about the same size as the 2D C-arm system. However, a section of the O-arm opens (telescopes back into itself) to create a “C” shape while the patient is being positioned on the operating table. Once the patient is positioned, the telescoped section is closed to, again, form an “O” shape and imaging begins.

Continued on page 66

Spinal cord.

Improving on current 2D C-arm™ technology, the O-arm provides the following additional capabilities: • Real-time 3D image capability covering a full 360 degrees around the patient • Higher image resolution • Use of precision robotics to acquire different image views • Ability, at the end of surgery, to view the results while the patient is still on the operating table (precluding the need for post-operative CAT Scan to ensure that surgical procedures have been done successfully.)

Spinal Injury

Fractured bone compressing spinal cord.

Contusion in spinal cord.

When the hospital opened in February 2007. At that time, MCR was only the 11th hospital in the world to acquire an O-arm system. We are proud to be one of the first hospitals to purchase the O-arm. The system’s capabilities are very impressive.

It provides the surgeons and our patients with one of the best intraoperative imaging capabilities available anywhere.

Medtronic provides technical support from its major service facility close by in Louisville, Colorado. MCR is one of only two Front Range medical facilities that offer the O-arm.

- Karen Martin Director of Peri-Operative Services, MCR

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BEFORE

Fort Collins Medical Magazine & Directories 2007 2008

AFTER

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X-rays of completed fusion. Views from the side and the back. Photos courtesy of Front Range Center for Brain & Spine Surgery.

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If you suffer a brain or spine trauma, we’re here for you.

If you’re seriously injured, the experts at Medical Center of the Rockies’ trauma center are here to provide the most comprehensive, highest quality trauma care in the region.

Neurosurgeons — Dr. Hans Coester, Dr. John Viola, Dr. Tim Wirt and Dr. Donn Turner — are on standby 24/7 to provide fast, effective assessment and treatment of brain and spine injuries, ensuring the best possible outcomes for you, our patients.

Neurosurgeons Dr. Hans Coester and Dr. John Viola, Front Range Center for Brain and Spine Surgery

Trauma Center of the Rockies, a part of the new Medical Center of the Rockies in Loveland, is equipped with the latest life-saving technology for brain and spinal care.

www.pvhs.org

TRAUMA CENTER OF THE ROCKIES MEDICAL CENTER OF THE ROCKIES

Fort Collins Medical Magazine & Directories 2007 2008

65

Continued from page 61

John James, M.D.

FORT COLLINS

1136 E. Stuart St., Bldg. 3, Suite 3200 Ft. Collins, CO 80525 (970) 221-1681

GREELEY

7251 W. 20th St., Bldg. N, Suite 1 Greeley, CO 80634 (970) 356-3907

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Images used by StealthStation were obtained before surgery from CAT Scan or MRI equipment.

This potentially posed a problem for surgeons in that the CAT Scan and MRI images - typically taken with the patient lying on his or her back - often did not accurately reflect the position of bones and tissue when the patient was on the operating table, lying on his or her stomach.

The O-arm, as differentiated from the 2D C-arm that uses manual reorientation, employs multi-axis precision robotics to switch from anterior-posterior, to a lateral or oblique view.

The O-arm is able to store images of these various views and the surgeon can quickly and easily scroll through the various images and recall a specific image with the touch of a button. A digital flat-panel X-ray detector provides improved dynamic range and spatial resolution, and also eliminates the distortions associated with C-arms.

While the StealthStation has been in use for years on a stand-alone basis for intra-operative image guidance, prior to the advent of intraoperative imaging technologies, including O-arm, images used by StealthStation were obtained before surgery from CAT Scan or MRI equipment. This potentially posed a problem for surgeons in that the CAT Scan and MRI images - typically taken with the patient lying on his or her back - often did not accurately reflect the position of bones and tissue when the patient was on the operating table, lying

66

MCR has stepped up to the plate and made a major financial investment in the Medtronic equipment. It’s great news for surgeons and for our patients.

guidance equipment. They have also enhanced StealthStation with updated software to make screw placement more precise. MCR has stepped up to the plate and made a major financial investment in the Medtronic equipment. It’s great news for surgeons and for our patients.�

For further information contact:

Front Range Center for Brain & Spine Surgery Fort Collins, Loveland, Greeley (970) 493-1292, (800) 458-0306 www.brain-spine.com Medical Center of the Rockies Loveland (970) 624-2500, (800) 252-5784 www.pvhs.org Medtronic Navigation Louisville (720) 890-3200, (888) 580-8860 www.medtronicnavigation.com

Court Klinck is a freelance writer living in Eaton.

- Dr. Hans Coester, Neurosurgeon Front Range Center for Brain & Spine Surgery

on his or her stomach. In addition, the patient’s condition may have changed between the CAT Scan/MRI and the time of surgery (e.g. such as a fast-growing tumor). Obtaining real-time, 3D images from the O-arm during surgery solves this problem and makes the combination of O-arm and StealthStation an excellent intraoperative imaging and image guidance solution for spinal surgery.

The type, complexity and location of a particular injury or problem, and the surgeon’s preference, determine whether or not the O-arm and StealthStation are used. Either system is capable of being employed on a stand-alone basis, or they can be used in combination. Dr. Coester indicates, “I use intra-operative imaging and image guidance in about 10% of my spinal surgeries. These are the complex cases - whether minimally invasive or open - where additional image inputs are required and/or where instruments and “hardware� (screws and rods) are in close proximity to neural or vascular structures. In these cases, most of the time I use the O-arm and StealthStation in combination.�

When the surgeon elects to use the StealthStation in addition to the O-arm, the StealthStation provides the surgeon with image-guided surgery (IGS) navigation.

Utilizing the O-arm in conjunction with the StealthStation provides a seamless, completely interfaced imaging/IGS navigation solution.

The O-arm, with its high-precision robotics, is well suited for use with IGS systems such as the StealthStation, as it eliminates the two drawbacks of IGS systems, i.e. images being pre-operative, and registration requiring some level of manual intervention.

Dr. Coester has enthusiastic praise for Medtronic and MCR for providing the Front Range community with the best available intra-operative imaging and image guidance capability. “Medtronic has introduced the O-arm to provide real-time, 3D imaging and an interface to the StealthStation image

Fort Collins Medical Magazine & Directories 2007 2008

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medical

invention

Firefly Medical

Intelligent Care by Design In the last 30 years, the environment in medicine has dramatically changed. Demands are higher and expectations are greater. Many products, which were originally designed with an ad hoc, “this will work” approach, are now decades-old dinosaurs.

Today’s popular industry themes are to “improve the patient care experience” and “prevent falls.” Aging baby boomers are fueling demand for better products, care, and results.

Outdated equipment that may once have been cutting edge now barely cuts it at all.

Fort Collins-based Firefly Medical appears poised to create a major design revolution in a hospital product that is used every day, the archaic IV pole.

The Company’s debut product, the IMS (Infusion Management System) is a brilliant new product category that offers sleek features and innovative functions. The IMS will dramatically improve patient and caregiver safety. State-ofthe-art design provides easier ambulation and cutting edge engineering gives the versatile IMS three storage options. Bold form and beautiful coloration come together in a branded device that looks like nothing in the market to date.

Firefly Medical has engaged in rigorous evaluation of the IMS with detailed input from patient safety experts, hospital executives, RNs,

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and many others. This has amounted to a nearunanimous applause for the product and its specific design. Over time the product is bound to replace the traditional IV pole.

Firefly Medical has assembled an incredible team that is ideally suited to successfully launch this product. Their serial entrepreneur and Founder, Steve Schmutzer, spent ten years as an RN dealing with the problems of medical equipment firsthand. Startup veterans, Chris Pullen and Robin Slaton, combine for many years and accomplishments in product design, manufacturing, operations, and marketing. Terry White, CEO, co-founded Centura Health Systems in Colorado and possesses deep healthcare and executive experience. Lucas Weidner, a talented mechanical engineer, has joined the team. A former Baxter executive has written Firefly’s comprehensive Sales and Marketing plan and is positioned to formally lead that charge when it is time to go to market.

Though Firefly Medical is currently focused on building the prototype for the IMS, the Company has actually received a number of Purchase Orders for the product. Interest in Firefly Medical is high from Angels and VC companies.

For more information about Firefly Medical and their IMS, please see their website: www. fireflymedical.com.

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Fort Collins Medical Magazine & Directories 2007 2008

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medical

Cardiology

heart health

at any age

by Lynn M. Dean

“The weirdest thing happened to me this morning,” my sister told me a few weeks ago. “I was pulling weeds in the back yard and my chest got all tight. I started sweating, I got nauseous and then dizzy. I had to go inside and sit down and catch my breath.”

Stephen Treat, MD, FACC, a cardiologist with an interest in women's heart health and prevention teams up with Lynn Kincanon, CCA, advocate for women's heart health and Kerry Rayder, RN, BSN, clinical cardiology nurse who does risk assessment for A Woman's Heart at Heart Center of the Rockies.

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“I think you should call the doctor and have it checked out,� I said. “It could be your heart.� “It’s not my heart. I’m only 45,� my sister said firmly. “It was probably just the heat. I was probably dehydrated.�

It had been hot, and dehydration would make her dizzy, I reasoned. On the other hand... “Just to be safe, I think you should call the doctor.� “I think you’re over-reacting,� my sister insisted. “I’ll tell you what,� I acquiesced. “Why don’t you call the triage nurse at the doctor’s office. If she thinks it’s nothing, I’ll defer to her opinion.�

A few days, an EKG, stress test and several blood panels later we were sitting in the doctor’s office to hear the results. “Everything looks good,� said Dr. Chad L. Stoltz, MD, FACC, a cardiologist at the Heart Center of the Rockies. “Your heart looks perfectly normal.� “See!� my sister directed toward me using an “I told you so� tone. “I made her come in,� I explained. “You did exactly the right thing,� the doctor assured her. “I can’t tell you how many patients I see who ignore symptoms just like yours and come in months or years later with congestive heart failure and irreparable damage to the heart muscle.�

Unfortunately, cardiovascular disease is the number one killer of American women. According to the Heart Center of the Rockies, it kills more women than the next seven leading causes of death combined. “Heart disease far outstrips the number it kills versus the various forms of cancer,� stresses the Heart Center’s Kerry Rayder, RN. “One out of 2.5 women will die of heart disease or stroke. They’re also the number one causes of disability in the United States.�

These statistics sound dismal, but the news isn’t all bad. According to Lynn Kincanon, a Heart Center Nurse Practitioner, if we start early, 82 percent of heart disease can be warded off. And while it is never too early to think about heart disease prevention, if you, like me and my sister, are approaching menopause, time is of the essence, because that’s when the clock really starts ticking faster. “I can’t say enough about prevention when it comes to fighting heart disease,� says Steve Treat, MD, a cardiologist at the Heart Center of the Rockies. “It is important for all women to have a discussion with their physician or healthcare provider about their individual risk. This is especially important for women as they approach menopause, a time when statistically a woman’s risk begins to rise.�

Nationally recognized women’s healthcare expert Dr. Christiane Northrup agrees. In her book, The Wisdom of Menopause, she points out that the years around menopause are the time when a woman’s risk for heart disease, high blood pressure and stroke begins to rise. But women can empower themselves by taking good care of their hearts, she says. “The main thing to keep in mind about menopause is that it’s a completely normal process,� she writes, “not a disease to be treated.

Our hormones are giving us the opportunity to see, once and for all, what we need to change in order to live honestly, fully, joyfully and healthfully in the second half of our lives.�

There is even better news – prevention is not

that hard. And, “all the things we do to stay heart healthy are also key in preventing other diseases as well,� says Rayder.

We have to take steps to prevent heart disease now. “Women are living so long that if you don’t take care of your body- the whole spectrum- then you’re going to live a great portion of your life with co-morbidities of heart disease and stroke which is incredibly expensive and limiting and takes a lot out of your life,� adds Kincanon.

First, we need to know our BMI (Body Mass Index) and strive to stay as close to our ideal body weight as possible through good nutrition and exercise. The more over-weight we are relative to our height, the greater our risk of heart disease. “For every increase in your BMI, your risk of diabetes and hypertension increases,� explains Kincanon. If your BMI is over 25, you’re overweight,

over 30 and you’re obese.�

We also need to know our numbers. “Women have to become their own health advocates,� says Rayder. “It’s a very important piece of the puzzle.� In addition to our BMI, we need to pay attention to our cholesterol levels, our blood pressure, and our blood sugar levels. “Know your lipid panels- in other words, your cholesterol levels,� stresses Rayder. “Ask about your test results. What is your HDL (the good cholesterol)? Ask, ‘What do those numbers mean?’�

We also need to ask about our blood pressure.

High blood pressure, or hypertension, makes our hearts work harder and can damage our arteries.

Normal blood pressure is less than 120/80, but, according to the Heart Center, if our pressure creeps up into the danger zone, between 120/80 and 130/89 (prehypertension) we need to be es-

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Fort Collins Medical Magazine & Directories 2007 2008

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Creating your best smile that’s the overton difference

You did exactly the right thing,” the doctor assured her.

“I can’t tell you how many patients I see who ignore symptoms just like yours and come in months or years later with congestive heart failure and irreparable damage to the heart muscle.

- Dr. Chad L. Stoltz, MD, FACC, Cardiologist Heart Center of the Rockies

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pecially vigilant and step up our prevention efforts “It’s bound to go up,” warns Kincanon.

We also have to pay attention to our blood sugar levels. According to the Heart Center, “among diabetics, 60 percent die of some form of cardiovascular disease, and diabetes is a more powerful heart disease risk in women than in men.”

That’s yet another reason we need to carefully watch our weight. “People who have been overweight their whole lives are in danger of developing Type II diabetes due to the stress on the pancreas,” explains Kincanon. “They develop insulin resistance.”

To address all of these issues, we need to get active. Exercise lowers our blood pressure and increases good cholesterol. It’s also a good way to maintain our weight. “We recommend thirty minutes of exercise most days,” says Rayder. And every little bit counts. “Take as many steps as you can in a day.”

Finally we need to eliminate as much stress as possible from our lives. According to the Heart Center. “Ongoing feelings of stress and anger have been shown to contribute to heart disease risk.”

Lynn M. Dean is a freelance writer living in Northern Colorado.

Christiane Northrup, M.D.

Menopause and Beyond: Embracing the Vast Possibilities of Midlife Thursday, October 11th, 2007 6:30 pm - 8:00 pm Hilton Fort Collins 425 W. Prospect, Fort Collins, CO The second half of your life is designed to provide you with more pleasure, prosperity and fulfillment than you ever dreamed possible. In this upbeat and eye-opening lecture, Dr. Christiane Northrup will share her cutting-edge ideas and reveal the latest research on topics such as hormone replacement and sex.

She will also explain how expressing your emotions fully, engaging in uplifting relationships and cultivating joy can positively affect your heart health.

Don't miss your opportunity to see Dr. Christiane Northrup, author of two New York Times best-selling books, Women's Bodies, Women's Wisdom and The Wisdom of Menopause, who will provide you with a blueprint for making sure that your menopause years, and the 5-10 years preceding menopause are the happiest and most vibrantly healthy years of your life.

Tickets are $25.00 and can be purchased at all King Soopers on the Front Range and a select number of City Markets in the mountains and western slope. Tickets are also available online at www.ticketswest.com.

Fort Collins Medical Magazine & Directories 2007 2008

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Food Choices for a Healthy Heart

foods to Choose more often • 100% whole grain versions of: breads, English muffins, bagels, dinner rolls, tortillas, pita bread, pasta, frozen waffles, low-sodium crackers (Triscuits or Ak-Mak) • Oatmeal • Any whole grain lowsugar cereal that provides 5gm fiber per serving • Brown or wild rice • Popcorn with no butter or salt • Any fresh or frozen fruit • Canned fruit in light syrup or fruit juice • Dried fruit without added sugar • Up to 8oz 100% fruit juice per day • Any fresh vegetable • Low-sodium canned vegetables • Frozen vegetables without sauces • Salads with low-fat, lowsodium dressings • Low-sodium vegetable or tomato juice • Eggs high in omega-3 (Gold Circle Farms, Eggland’s Best) • Egg whites or egg substitutes • Hard boiled, poached, scrambled or eggs cooked with olive or canola oil • Beef – 93-96% lean hamburger, lean roast, tenderloin, flank • Wild Game – deer, elk, bison, antelope • Pork – tenderloin • Lamb – leg and loin • Poultry – chicken and turkey breast without skin, lean ground turkey breast, lowsodium turkey and chicken lunch meats • Fish – (at least two times a week) any fresh or frozen fish or shellfish that isn’t breaded and deep fried, tuna or salmon packed in water, sardines • Soy – tofu, tempeh, silken tofu, soy nut butter, unsalted soy nuts • Beans – any cooked, dried beans, fat-free refried beans, split peas, lentils • 1% or Skim milk • Soy or calcium fortified rice milk • Low-fat buttermilk • Evaporated skim milk • Fat-free, low-sugar creamers • Low-fat or fat-free cheeses, soy cheese • Mozzarella cheese sticks • Fat-free cottage cheese or ricotta cheese • Low-fat plain yogurt, lowsugar flavored yogurt or soy yogurt • Olive oil, canola oil, peanut oil • Reduced-fat margarines/spreads without trans fats (low-fat versions of Smart Balance or Benecol), spray margarine • Fat-free salad dressings, mayo, cream cheese or sour cream

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Food Choices for a Healthy Heart

foods to Choose more often • 100% whole grain versions of: breads, English muffins, bagels, dinner rolls, tortillas, pita bread, pasta, frozen waffles, low-sodium crackers (Triscuits or Ak-Mak) • Oatmeal • Any whole grain lowsugar cereal that provides 5gm fiber per serving • Brown or wild rice • Popcorn with no butter or salt • Any fresh or frozen fruit • Canned fruit in light syrup or fruit juice • Dried fruit without added sugar • Up to 8oz 100% fruit juice per day • Any fresh vegetable • Low-sodium canned vegetables • Frozen vegetables without sauces • Salads with low-fat, lowsodium dressings • Low-sodium vegetable or tomato juice • Eggs high in omega-3 (Gold Circle Farms, Eggland’s Best) • Egg whites or egg substitutes • Hard boiled, poached, scrambled or eggs cooked with olive or canola oil • Beef – 93-96% lean hamburger, lean roast, tenderloin, flank • Wild Game – deer, elk, bison, antelope • Pork – tenderloin • Lamb – leg and loin • Poultry – chicken and turkey breast without skin, lean ground turkey breast, lowsodium turkey and chicken lunch meats • Fish – (at least two times a week) any fresh or frozen fish or shellfish that isn’t breaded and deep fried, tuna or salmon packed in water, sardines • Soy – tofu, tempeh, silken tofu, soy nut butter, unsalted soy nuts • Beans – any cooked, dried beans, fat-free refried beans, split peas, lentils • 1% or Skim milk • Soy or calcium fortified rice milk • Low-fat buttermilk • Evaporated skim milk • Fat-free, low-sugar creamers • Low-fat or fat-free cheeses, soy cheese • Mozzarella cheese sticks • Fat-free cottage cheese or ricotta cheese • Low-fat plain yogurt, lowsugar flavored yogurt or soy yogurt • Olive oil, canola oil, peanut oil • Reduced-fat margarines/spreads without trans fats (low-fat versions of Smart Balance or Benecol), spray margarine • Fat-free salad dressings, mayo, cream cheese or sour cream

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foods to Choose less often • Croissants, pastries, sweet rolls, cinnamon rolls, donuts, cupcakes, large muffins, biscuits • Snack crackers (saltines, club crackers, Ritz crackers) or cracker mixes (Chex Mix), cheese flavored crackers • Sugar sweetened cereals • Potato, rice or pasta box dinners, stuffing mix • Fruit canned in heavy syrup • Dried fruit with added sugar • Fruit juices with added sugar or high fructose corn syrup • Deep fried vegetables • Vegetables with cream, butter or cheese sauces • Canned vegetables and vegetable juices with more than 140 mg sodium per serving • Eggs fried in bacon grease, butter or margarine • Beef – 73% hamburger, short ribs, corned beef, brisket, T-bone, porterhouse, prime rib, bologna, salami, pastrami, beef hot dogs, corn dogs • Pork – ribs, sausage, bacon, brats • Lamb – ribs, chops • Poultry – chicken or turkey skin, buffalo wings, fried chicken, duck, goose, canned chicken • Fish – canned tuna or salmon packed in oil, breaded and fried fresh or frozen fish, shellfish served with butter or cream sauces • Organ Meats – all • Nuts – salted, oil roasted nuts, peanut butter made with trans fats • Whole milk • Sweetened condensed milk or evaporated whole milk • Cream, half and half, and non-dairy creamers made from oils • Whole milk, processed, American, and Velveeta cheeses; cheese sauces, cheese whiz • Whole milk yogurt, cottage cheese or ricotta cheese • Full-fat ice cream • Butter, lard, chicken skin, shortening, bacon grease, coconut, palm, palm kernel oil • Full-fat margarine, salad dressing, mayo, cream cheese or sour cream • Hollandaise, cream, butter, or cheese sauces, gravy

Fort Collins Medical Magazine & Directories 2007 2008

75

medical

NICU

Winfield Craven, M.D., Medical Director, Department of Radiology, Medical Center of the Rockies, stands in front of angiographic equipment, which uses imaging to diagnose and treat medical conditions.

in the palm

of a hand

by Corey Radman

Sometimes, however, babies are born much earlier. This was the case with Ella Newcomer.

When she was born at 28 weeks and 2 days her parents were terrified that her health would suffer from the pre-term C-section due to a complication of her mother’s eclampsia. With Ella fitting in the palm of an adult hand and weighing only 860 grams (1 lb., 14oz), it is easy to understand why they worried.

When an emergency prompts an early delivery like Ella’s, the Neonatal Intensive Care Unit (NICU) at Poudre Valley Hospital is the safety net that expectant parents rely on. In the last five years, the NICU has steadily been increasing the level of care that it as been able to provide for these, youngest babies. Five years ago, the NICU was known as the Special Care Nursery and was certified as a Level IIa nursery, which meant that they could

76

NICU team members include: Michelle Walker, RN, Clinical Educator; Carol Wallman, RN, Neonatal Nurse Practitioner; Krista Albert, RN, Patient Care Coordinator; Jan Paisley, MD, Neonatologist; Greg Perry, Pharmacy Clinical Coordinator; Vaughn Hanson, MD, Pediatrician; Brian Omundson, Respiratory Therapy.

10 months. That’s about 40 weeks – the time a full term pregnancy takes to gestate. Over those 10 months, babies develop rapidly and parents wait expectantly – tracking every flutter and hiccup from the growing child within. care for babies born at 32 weeks. Through much dedication from the hospital administration and leadership from Neonatologist Jan Paisley, MD and Sharon Glass, Neonatal Nurse Practitioner (NNP), the NICU is now classified as a Level IIIa nursery, caring for babies born as early as 28 weeks.

PVH’s journey to IIIa results from an innovative partnership with Denver Children’s Hospital.

Expert staff from Children’s joined the PVH team of experts to create a level of infant care that is unparalleled in northern Colorado. Glass and Paisley worked through much of the advanced planning and delivered the additional education for the PVH nursing staff. The evolution included the addition of two more neonatologists: Drs. Dan Satterwhite and Amy MacRitchie (both from Primary Children’s Hospital in Salt Lake City). The staff also boasts Carol Wallman, NNP, the 2007

National Association of Neonatal Nursing (NANN) award winner for distinguished service. Wallman serves as NANN’s representative for all NNP’s with the American Academy of Pediatrics. The accomplishments of any one of these impressive professionals would fill a book but all are actively involved in clinical research and education both regionally and nationally. This team is actively advancing the field of neonatal medicine. Northern Colorado patients are the lucky beneficiaries of their cutting edge work.

Though the neonatologists and NNPs are truly a gift to the region, the foundation of any outstanding medical department begins with the nurses. Barb Peters, Clinical Care Coordinator is enthusiastic about the quality of care they provide.

“In 31 years in the nursing field, these are the best nurses I’ve ever worked with. They care deeply

about what they do and about the families. They are excellent clinically and awesome with people.” The goal of giving babies and their families the best start wouldn’t be possible without the nurses. Michelle Walker, RN and Clinical Educator for the unit explains that the unit really embraces evidence based practice, “We strive for change based on what evidence shows – not doing what we’ve always done because we’ve always done it that way.” Walker explains one big change in the shift to caring for 28 week pre-term infants was the ability to take the NICU to the delivery room.

This meant the purchase of new equipment like warmers and respirators that were mobile. It also meant preparing all the staff from nurses to radiology technicians to work with much smaller and more fragile babies.

For example, even though Ella was in relatively good condition at birth, she required the kind of care that only a Level IIIa nursery could provide. Glass explains that the NICU staff was present in the delivery room for her first tentative breath – an approach that was key in her fantastic progress. They used a specialized air mask, a CPAP, to provide breathing assistance that helped her lungs fully expand and ultimately learn to breathe easier. By day two of her life, Ella no longer required breathing assistance and switched to a nasal cannula (the little tube in the photo) that feeds pressurized air. She was treated with phototherapy for jaundice. Additionally, Ella still has occasional episodes of bradycardia and apnea (slowing of heart rate, pressure drops, and she forgets to breathe), for which they treat her with

small amounts of caffeine.

Asked about the advantages of having this type of nursery here, Glass explains, “The biggest issue for Ella and her parents was that they were able to stay here in Fort Collins. Had she been transferred to Denver, she would have been that much farther away from her parents. Studies have shown that pre-term infants who have more contact with their parents calm more easily, sleep, grow, and eat better.”

Ella’s parents, Kim and Todd Newcomer, cannot say enough kind words about the NICU staff.

“Every day we thank God that we were here in Fort Collins when this happened. We just moved here and think the healthcare in Fort Collins is amazing. The doctors are awesome and the nurses… well they’ve become our friends,” she says after a heartfelt pause. “They are all so patient and understanding of what it is like to be a parent in this situation.” Kim explains that the NICU staff makes every effort to include parents in the care of their baby, even down to setting a predictable schedule for changing diapers and taking temperatures so that they can be there to do the job.

Ella is getting stronger every day and just now learning to suck, which means breastfeeding isn’t long away. “We were lucky that Ella was born here. The NICU has done everything possible to make it easy for us all to bond.”

The incredible responsibility of these precious little lives rests in the hands of the cohesive and talented staff of the PVH NICU. Their true team approach, the larger web of support from the hospital staff and the local pediatricians, and the

Fort Collins Medical Magazine & Directories 2007 2008

true spirit of giving the best to every patient make all the difference in the world.

Corey Radman is Assistant Editor at Style Magazine.

The happy family: Todd, Kim, and Ella Newcomer.

77

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If your baby is early, we’re here for you.

If your baby is born prematurely, the neonatal intensive care team at Poudre Valley Hospital is here for you.

Staffed by neonatal specialist physicians, nurses and therapists, and equipped with the latest technology, the PVH neonatal intensive care nursery (NICU) provides the highest level of care for sick and premature babies in Northern Colorado.

Breathe easy. We’re here for you.

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Fort Collins Medical Magazine & Directories 2007 2008

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Wellness

Senior Fitness

Hillary Beck-Gifford assists Marjorie Halvorson with the extended side angle yoga pose.

Bill Cook includes the Cable Row with 60 lbs. of weight during his work out with Hillary Beck-Gifford.

Exercise Keeps Seniors Young

by Alice Ashmore & Lydia Dody

As we age, muscle tissue and strength dwindles. Regular exercise, together with weight training, can reverse this process, as well as improve heart health, help prevent and treat diabetes, hypertension, stroke, obesity, and even malignancies such as colon cancer and breast cancer. Exercise eases stiffness from arthritis and improves mobility and core strength thus reducing the risk of falls.

Bill Cook’s hearty voice and body strength project a vigor that one would expect from a much younger man. What makes Cook remarkable is that his energy belies his 89 years of age. He states, “I work out religiously, rigorously and happily.”

Cook is one of a growing number of seniors who make working out at The Other Club in Fort Collins a regular part of their fitness schedule. “As I get older, I figure I need to do this routinely,” Cook says. He retired as Dean of Natural Sciences from Colorado State University in 1983, a position he held for 17 years.

In part he is motivated to keep up with his younger wife. “Bobbie being 16 years younger has kept me young.” he says. “I feel about the same physically as I did ten or 15 years ago.” His neuropathy (loss of feeling

84

in the feet and legs) also benefits from an active lifestyle. The couple travels frequently and recently returned from a three week trip to Europe.

Bud Phillips, 58, opened The Other Club 12 years ago, and has nearly 30 years experience in helping others care for their bodies as a personal trainer. “I worked previously for HealthWorks before opening my own club.”

The Other Club specializes in personal training but is also open to members who work out on their own. We specialize in one-on-one attention.” He adds, “We’re a limited membership club with only 250 memberships therefore we are never crowded.

The Club is known for its comfortable atmosphere. Although it has its share of

“hard bodies,” Phillips calls it accessible and non-intimidating. “Seniors feel comfortable here, and that is a great advantage. If you are not comfortable, you won’t come back.”

He adds, “The average age of our members is fifty-five and we have many professionals working out here.”

The fitness boom has often overlooked the fastest growing segments of our society – baby boomers and their parents “Fitness is essential for seniors. As you age, you lose muscle mass. Resistance training is the only thing you can do to reverse this process,” says Phillips.

Both Bill and Bobbie Cook recommend someone work with a personal trainer when beginning an exercise program. They work with Hillary Beck-Gifford, a Certified Personal Trainer at The Other Club. “One

Fitness is essential for seniors. As you age, you lose muscle mass.

Resistance training is the only thing you can do to reverse this process.

- Bud Phillips Owner, The Other Club

of the reasons we like Hillary is that she has kept Bill from overdoing and hurting himself,” adds Bobbie.

In addition to his gym work outs, Cook practices a stretching routine every morning and plays nine holes of golf a week. “I’ve had very little illness in my life besides neuropathy in my legs. I take no medications at all.”

Bobbie also stays fit, but has her own schedule. “I go (to the gym) at a different time, but we do try to walk together in the evening.” Her routine also includes yoga several times a week offered by The Other Club.

Phillips says about 40 percent of his clientele are over the age of sixty-five. “Our trainers are experienced in working with an older population.” Phillips notes that despite their enthusiasm, a young or inexperienced trainer can pose problems for mature clients. “A new, young trainer’s knowledge base is typically applicable to their own age group.”

He recommends a diverse program composed of cardio, stretching, weights, balance and correcting posture through the Egoscue Method. “We’re all about having a balanced approach to fitness. All of our trainers design their programs to improve their clients’ activities of daily life. As people age, and if they do not have an exercise program, they develop muscle weakness and imbalance resulting in poor posture,” explains Phillips. In addition, “Balance

Bill Cook uses the Lateral Pulldown with 80 lbs. to stay strong.

training is important because it helps reduce the risk of falls in older adults and in women with low bone mass.”

A large staff of personal trainers, physical therapist Valerie Potter and Certified Massage Therapist Lawrence Lay work on-site at The Other Club. “We have nine trainers,” says Phillips. “All of our trainers are mature. I’m the eldest at 58, and the youngest ones are in their thirties.

Exercise for seniors can include some special concerns. “We do a lot of joint mobility and range of movement.” Phillips says unconditioned seniors tend to become very immobile and often get caught in a vicious cycle of balance and strength issues.

“Typically loss of balance is caused by a lack of strength, and the tendency becomes to do nothing and then lose more strength.

With commitment and consistency though,” Phillips says, “the work literally reconnects the body and mind.”

The facility also features a warm water therapy pool kept at a comfortable 90 degrees for aerobic water exercise and physical therapy exercises. The therapy pool is especially effective for patrons with arthritis, chronic pain or those recovering from injuries. “All of the movements are supported by the water.” The club is housed in the original Orthopedic Center of the Rockies therapy building at 1227 Riverside Avenue, Fort Collins.

The Cooks frequently see Curt and Marjorie Halvorson at The Other Club. Curt exercises daily. “I do cardio two times a week.

Once a week I work out with Keith Beyerle, Certified Personal Trainer, for strength training and then do my routine on my own the other days.” You might wonder what inspires such devotion. His answer: “To be able to hunt big game.”

“I retired from the U. S. Department of Fish and Wildlife in 1992 at age 62, and I had a dream of hunting.” His career as a wildlife biologist kept Halvorson accustomed to a rigorous life in the field. “I’ve been active all of my life, but the last few years of my job were very sedentary.” A jogger since age 40, Halvorson eventually had to stop running to preserve his knees.

Exercise is a “quality of life” choice for 77 year-old Curt. “If I was not exercising, I’d still be hunting, but I would not be enjoying

Fort Collins Medical Magazine & Directories 2007 2008

Bud Phillips owner of The Other Club personally trains and designs work out programs for nearly 40 clients.

it nearly as much.” His last trip included twelve days of backpacking through the Canada’s Northwest Territory in pursuit of Dall Sheep.

“Curt’s routines are much more strenuous,” says Marjorie, 74. “I work with a trainer on Monday and then repeat that routine on Wednesday and Friday. I also do yoga three times a week.” She began exercising regularly about eight years ago when long days on her feet working as a teacher and medical specialist began to take a toll.

Besides the physical benefits, Marjorie points to the positive mental benefits of regular exercise. “I’m much more positive.

I skip the negative stuff and appreciate the small things.” Curt adds, “It’s a time when you are doing something as an individual for yourself. It is your own private time.”

Dr. Ben Magsamen, 74, an orthopedic surgeon and Founder of The Longevity Clinic in Fort Collins also works out at The Other Club. He says, “Anyone over forty is not as vigorous. Our lung function is diminishing by one percent a year.” He notes as humans

85

Work Balance into Everyday Life It may be easier than you think to fit balance training into your daily routine. Try some of the following activities: • Stand on one leg whenever you’re waiting in line at the theater, bank, or grocery store.

• Stand on one leg while brushing your teeth; one minute on one leg while brushing the upper teeth, and another minute on the other leg while brushing the lower teeth.

• Ask someone to toss you a Frisbee or beach ball while you balance on one leg and then on the other.

• Practice sitting down and getting up from a chair without using your hands.

• Practice walking heel to toe-that is, like a tightrope walker, placing the heel of one foot just in front of the toes of the opposite foot each time you take a step.

Courtesy of Harvard Health Publications, Harvard Medical School

Marjorie Halvorson works out on the treadmill several times a week to stay fit.

Curt Halvorson does two 90 minute cardio work-outs weekly to stay fit.

Continued on page 88

86

Ten things that age you and

how to fight back

Cosmetic surgery might be the quickest way to reclaim a young, healthy look, but it’s not the only way. If you focus on correcting the behaviors that add years and harm your health, you can turn back the clock. Here, the 10 unhealthy behaviors mentioned most often by anti-aging experts—and how to reform yourself.

Feeling overwhelmed by stress • Excess Stress - Can lower our immunity, boost the risk of heart disease and generally makes us feel crummy.

- However, now Elissa S. Epel, PhD, a professor of psychiatry at the University of California at San Francisco, has cell-level proof that too much stress triggers premature aging of the immune system.

• Signs of Stress - You might feel your heart racing, or you might feel sweaty.

• Ways to unwind - A short-term fix for relieving stress is simply to do deep breathing, also known as diaphragmatic breathing.

- A longer-term fix for relieving stress is to plan time into your schedule that allows you to do things that are relaxing and reduce stress.

Drinking too much alcohol—or drinking too little • Benefits of consuming alcohol - According to a study in the American Journal of Epidemiology, one or two drinks a day can lower the risk of dying from heart disease by a third or so.

- Women should limit their alcoholic intake to one a day, and men to two.

• Health risks of consuming alcohol - Indulging in more than the advised amount of alcohol intake for women and men can lead to increased health risks, such as strokes and cancers of the liver, throat, and breast.

Moving too little • Reasons to be active - Even a little bit of activity can help extend our life, reduce the chances of being overweight, reduce stress, and maybe even ward off Alzheimer’s disease.

• Making the effort - Simple decisions, such as parking further away than usual or taking the stairs instead of the elevator, are a healthy start to living a more active lifestyle.

- A healthy exercise level recommended by the Centers for Disease Control and Prevention is

a moderate-intensity activity such as walking for 30 minutes or more, five or more days a week.

Eating too much saturated fat • The drawbacks - Saturated fats, found in meats, poultry, milk and butter, can boost “bad” and total cholesterol and send you down the path of heart disease.

• A better choice - A healthier option would be to try a Mediterranean-style diet, which incorporates monounsaturated fats found in canola, olive and peanut oil and polyunsaturated fats found in safflower, corn and flaxseed oil.

Smoking cigarettes • Risks - Although it has become widely known that smoking cigarettes is harmful for your health and is related to increased risks of cancer and early wrinkling, more than one-fifth of U.S. adults, or 46 million people, still smoke, according to the Centers for Disease Control and Prevention.

• Getting Help - In a review of 123 studies published in 2004, nicotine gum and other replacement treatments, such as the patch, upped the odds of quitting by two times compared to relying on willpower alone.

Breathing Polluted Air • Effects and Solutions - Outdoor pollution can cause coughing and burning eyes and is linked to asthma attacks and respiratory disease.

- Although it is easier said than done, staying indoors when pollution levels are high can help alleviate these symptoms.

- Every person has the opportunity to make a small difference in their own immediate environment.

- Drive Smart: Consider walking or biking, or carpooling even one day a week instead of driving.

- Be aware of the products you use around the house. Choose water based products

Fort Collins Medical Magazine & Directories 2007 2008

or ones that have low amounts of volatile organic compounds (VOCs).

Getting too much sun • Consequences - Every year, more than a million people in the U.S. find out they have skin cancer—and another 55,000 find out they have the most deadly form, melanoma.

• Prevention - Limiting sun exposure and wearing a sunscreen with an SPF of at least 15 cut the risk of skin cancer as well as wrinkles.

Getting too little sleep • Sleep deprivation is harmful - Lack of sleep has been linked to obesity, diabetes, high blood pressure and memory problems, even in young adults.

• Tips for a better night’s rest - Having a clean, dark room are key ingredients for a sleeper’s paradise. It is also helpful to keep distractions, such as TVs, out of the room.

Being overweight • Health risks - Excess weight is linked to increase chances of heart disease, diabetes and even cancer; however, an astounding 64 percent of adult Americans still weigh too much.

• Diets - The key to being successful when dieting is to choose one that best fits your lifestyle and to stick with it.

Eating too much sugar • Where it leads - Consuming excess amounts sugar can lead to weight gain and possibly heart disease.

• Appropriate amount - It is considered unhealthy when more than 12 teaspoons of ‘added sugars’ in snacks and cookies are consumed in a day on a 2,200calorie diet.

- When cravings arise, a wise choice would be to snack on fruits and sweet vegetables.

87

Continued from page 86

We’re all about having a balanced approach to fitness.

All of our trainers design their programs to improve their clients’ activities of daily life. Balance training is important because it helps reduce the risk of falls in older adults and in women with low bone mass.

Nutrition in Mind striving for balance

Leah Barrett, MS, MSW, LCSW NUTRITIONIST/PSYCHOTHERAPIST

1200 South College Ave, Suite 201 Fort Collins, CO 80524

970.484.9906

leahbarrett@comcast.net

- Bud Phillips Owner, The Other Club

age we also lose muscle mass, a process called sarcopenia. The term is much less familiar to the general public than concerns about osteopenia (bone loss.)

“There is no magic pill that will allow you to sit in your Lazy Boy and maintain your muscle strength. We have become a society of convenience and ease.” He views this societal trend as strongly reinforcing a sedentary lifestyle and poor nutrition.

Phillips is baffled by the number of people, especially those over 50, who avoid regular exercise and miss out on the quality of life it provides. “I can’t figure out why, given all the benefits, someone wouldn’t do it!”

“It’s never too late to start,” says Curt Halvorson. “If you want to enjoy the rest of your life, find an exercise club and have a trainer design a program for you. Talk to your doctor and trainer and develop a plan. You sure don’t have to be put out to pasture!”

Alice Ashmore is a regular contributing writer living in Loveland.

Lydia Dody is the Publisher of Style Magazine.

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89

Wellness

dentistry

crowns

on-site

by Julie Estlick

Like most of us, Randy Briggs needs an occasional filling despite taking good care of his teeth. Dental work doesn’t scare him, but the announcement that he needed a crown would send shivers up his spine. That is, until he discovered the wonders of the CEREC 3D procedure at Johnston & Johnston Family Dentistry.

Briggs, who has two old-fashioned crowns (dental restorations that fully cup over the tooth above the gum line), jumped at the chance to see how the latest technology works when Dr. Ron Johnston found another tooth requiring attention last summer. Chairside Economical Restoration of Esthetic Ceramics (CEREC) is a system used to create a crown on-site at the dentist’s office in one visit, eliminating the need for a temporary crown and a follow-up appointment.

Here’s how it works: Johnston uses a small infra-red scanner to take digital pictures of the tooth before and after the decay and any old fillings are removed. The pictures are then converted into a 3-dimensional model on the computer screen. He uses software to design the restoration - a crown or filling that “restores” the function of a decaying tooth – in just a few minutes and with the click of a mouse sends the data to a separate milling machine. A white ceramic block that matches the shade of your tooth is placed in the milling machine and in 10-20 minutes the crown is ready to go. Johnston makes sure the restoration has the proper fit and bite inside the mouth, then polishes it up and bonds it into place on the tooth.

“The big advantage to me is that I can get a

Gina Horgen consults with Ron Johnston, DDS of Johnston & Johnston about the benefits of a new Cerec crown.

crown in one visit – that’s the beauty of it,” Briggs says. “One shot to plug up the tooth, repair it and you’re done. The whole thing took about an hour.

In the past, I’ve had to take time off work on two different days – that’s significant.”

The CEREC system, which utilizes Computer Aided Design/Computer Aided Manufacture (CAD/CAM), has been on the market since the mid-1980s, but advances in software and milling materials that make the restorations look natural and bond better have won over many skeptics.

Currently, about 4 percent of all dentists in the country use CEREC and most agree it is the wave of the future.

“When a tooth breaks we can get the patient fixed up so they don’t have to wait 2-3 weeks with a temporary and they can get on with their lives,” says Johnston, who co-owns the practice with his wife, Dr. Samantha Johnston. “The key is people don’t like to come to the dentist, so if they only have to come once it’s much better. It really does work!”

Right now it takes the Johnstons on average 90 minutes to put on a crown, but software advances are simplifying the design process and making it faster so the patient spends less time in the office. Just last month the couple attended a

software update training in Scottsdale, AZ. Since Johnston & Johnston Dentistry installed the CEREC 3D system 16 months ago, people have driven four hours just to get a crown put on in a single visit and referrals keep rolling in.

Samantha’s mother and father have both done it and several people have returned for additional restorations. “Everyone that gets a crown with this procedure at our office has been 100 percent pleased,” Samantha says.

Traditionally, if you needed a crown your dentist would make an impression of your tooth and send it to a lab to design the crown. In the meantime, a temporary crown would be put on the tooth until your next visit when it would be chinked away and replaced with the permanent crown. Aside from the fun of multiple mouthnumbing injections, more of the tooth structure is often removed when using a temporary, Samantha notes.

“Personally, I think this procedure is much less traumatic for our patients’ teeth because the tooth is prepared and the crown is bonded in one visit,” Samantha says. “This eliminates the need for a temporary crown, which can leak, come off prematurely and cause sensitivity.”

Both dentists noticed that patients have less Continued on page 112

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970.493.5120

2001 South Shields

Fort Collins Medical Magazine & Directories 2007 2008

Bldg. E

Suite 200

Fort Collins

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Wellness

mental health

eating disorders the silent killer

by Alexandria Dody-Hettler and Meredith Dody-Hettler

How do you imagine perfection? What does perfect look like to you?

Perfection is often defined as “without a flaw or defect.” For many people, though, perfection has to do with the body.

The picture of perfection is a thinner, possibly more toned figure. (Did you just imagine yourself minus 30 pounds?)

Or, you may ask yourself, what if I just looked like one of those famous Victoria Secret Angels, or one of those flawless Desperate Housewives? But this is not solely a feminine matter. For guys, Matthew McConaughey, perhaps?

Is he “perfect”? Or how about super soccer star David Beckham?

We Americans have an insatiable appetite for physical perfection. Celebrity gossip magazines exalt those who have overcome the battle of the bulge. Many of us are ready and willing to jump at the chance to try yet another touted weightloss program regardless of the price. Who do we have to thank? The $50-billion diet industry has created this illusory belief that a short-cut for weight-loss exists. Despite the low percentage of people who experience long-term dieting success, we continue to search for this dietary fountainof-youth for quick and easy weight loss. We seek ways to lose weight, while, unfortunately, we lose sight and ignore the commonsense means for achieving a healthy weight.

And what’s all of this brought to many Americans? Eating disorders. We’ve all heard about eating disorders—bulimia nervosa and anorexia nervosa are the two most common eating disorders—and some are so severe that death can occur.

Most who suffer do so in silence, too often too embarrassed to let others know. The underlying causes are complicated. A person may be too self-critical and have negative thoughts and feelings about body weight and food. Eating habits disrupt normal body function and everyday life, and suddenly all of this is transformed into an eating disorder.

A quick online search of eating disorders can demonstrate how prevalent the problem is in our society. Consider these revealing stats from the

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National Centre of Eating Disorders: • 60 percent of women in our nation consider weight to be the most dis liked facet of their body.

• Two out of five teenagers are on a diet.

• Up to 10 million teens develop an eating disorder or abnormal attitudes and behaviors with food.

• Two out of five women are unhappy with their overall appearance.

• Only 15 percent of women are happy with every part of their body.

“Our culture has been so clear that if you are thin, you are also good, beautiful and successful,” points out Susan MacQuiddy, a local psychologist specializing in the treatment of people with eating disorders. MacQuiddy, who has treated eating disorders for the last 25 years, emphasizes that a complex interplay exists among the biological, social and psychological factors of individuals faced with eating disorders.

“One third of all dieters progress to pathological dieting and one quarter of those people end up with partial or full blown eating disorders,” MacQuiddy says. This means that eight to nine percent of all dieters eventually end up with serious issues around eating.

One of the major challenges with conquering

eating disorders is the simple fact that there is no common cause. Researchers are investigating biological factors that may predispose individuals to develop an eating disorder. Studies, for instance, have compared the rates of bulimia nervosa in identical and fraternal twins. The studies indicate that if an identical twin develops an eating disorder, the sister is more likely to develop a similar problem than would be the case with fraternal twins. On the other hand, it may be that genetic differences also impact our hunger and satiety signals, making some people more vulnerable to eating issues. And, of course, society plays a huge role, as does the media who constantly bombards us with images of thin and thinner. “This message can be subtle or explicit, but we are all impacted by the media,” MacQuiddy emphasizes.

To the average person without an eating disorder, someone with an eating disorder may be the type of person who frequently stares into the mirror, constantly comments on how fat he or she looks, skip meals, or makes excuses to go to the bathroom following meals, where purging of the just-eaten food can take place.

All of these—and more—may, in fact, be true for people suffering from an eating disorder disease, but what most of us don’t know is the answer to a universal question: Why? “It is not uncommon,” offers MacQuiddy, “for an individual who develops an eating disorder to have perfectionist tendencies, to feel hyper responsible for themselves and everyone

else around them, and to have experienced some trauma in their life (divorce of parents, sexual assault, abuse, among others). Some of those who develop eating problems were also teased about their body or size as children.”

In some cases, the problem transforms into anorexia nervosa. The National Institute of Mental Health estimates that 0.5 - 3.7 percent of females suffer from anorexia nervosa at some point in their lives. People with the disorder see themselves as overweight even if they are extremely thin. Like all eating disorders, the process of eating becomes an obsession. Unusual eating habits develop such as avoiding meals, picking specific foods, weighing and counting food, obsessive behavior with weighing themselves, excessive exercise, purging, and as a result most girls with anorexia experience delayed onsets or irregularities in menses.

In comparison, the other most common eating disorder is bulimia nervosa, which 1.1- 4.2 percent of American females will face in their lifetimes, according to the National Institute of Mental Health. Bulimia nervosa is usually considered the most secretive eating disorder because the person suffering from it is usually just slightly overweight. However, as with individuals suffering from anorexia, they fear gaining weight. They strongly desire to lose weight and feel dissatisfied with their bodies. Individuals with bulimia perform recurrent episodes of binge eating, which are characterized as eating excessive amounts of food within a discrete period of time and accompanied by a lack of control over eating during the episode.

To compensate for the binge, individuals will purge, using methods like vomiting, laxatives, diuretics, enemas, other medications, fasting, or excessive exercise. “Binging and purging bring relief and pleasure,” says Craig Heacock, a psychiatrist with Mountain Crest Behavioral Healthcare Center. “Binging is their way of exercising control if their life is out of control. Purging is how they deal with the guilt and shame.

“That is why, unlike most illnesses, patients often don’t want to get better. They often drop out of treatment. Families need to know that. I rarely see these patients for more than two sessions. It is a long recovery process. The first step is building trust with the therapist. Patients know they need help but are very conflicted about recovering.”

MacQuiddy believes patients with eating disorders respond best to a multidisciplinary approach where the treatment team includes a physician, nutritionist and psychologist with other

specialists added as needed. Whether inpatient or outpatient treatment is needed, a patient is usually stuck in a devastating, self-destructive pattern and a team approach for treatment is best. “The treatment team works to create a supportive environment where much needed changes can occur,” MacQuiddy says. “By first breaking through habitual patterns, the treatment team provides structure, guidance and focus for the patient to look more in depth at their own thought patterns and how they may lead to self destructive behaviors.”

MacQuiddy feels that everyone could benefit from a more normalized approach to eating.

“When we pay attention to our hunger and fullness cues, we tend to eat a variety of foods. Rather than restricting foods we like, it’s sometimes helpful to think about adding foods like fruits and

vegetables that might be lacking.”

And perhaps, in the final analysis of what a person with an eating disorder may want to consider, is the knowledge—as difficult as it can be— that there is no such thing as perfection when it comes to our body. There is no perfect body, no perfectly toned figure. Humans are, regardless of what we may so desperately desire, imperfect, and it’s living with the imperfection that makes all of us perfect.

Alexandria Dody-Hettler enjoys writing and will be a sophmore at the University of Denver.

Meredith Dody-Hettler graduated from CSU and plans to attend medical school.

The Warning Signs • Frequent weighing.

• Looking frequently in the mirror or avoiding mirrors altogether.

• Compulsive behavior.

• Wearing baggy clothes to hide the body.

• Going to the bathroom right after meals.

• Asking for frequent reassurance about appearance.

• Distinct rancid breath odor if bulimia is present.

Craig Heacock, MD, psychiatrist, Mountain Crest Behavioral Healthcare Center

Fort Collins Medical Magazine & Directories 2007 2008

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History of perfection, or is it really imperfection?

by Alexandria Dody-Hettler

All through history women have been plagued by body image, beauty issues, and striving for perfection. According to John Nagel, MD, PVH Mountain Crest Medical Director and Assistant Clinical Professor of Psychiatry at the University of Colorado School of Medicine, “Although the feminist movement has made great headway in women’s equality, it lags behind in how women are judged. No matter how intelligent and accomplished a woman is, she is still judged by her physical appearance. This prays on a woman’s confidence and it is no wonder that in colleges across the country one in four young women experiment with eating disorder behavior. It is a tyranny that is perpetuated by the fashion and cosmetic industries, by health clubs and by plastic surgeons.

According to the media, a woman must apply a lot of make-up, look young, work out and be thin to be beautiful and worthy. As a society it is imperative that we dispel this beauty myth for the health of our future generation of women.”

Portrait of Lillian Russell, American actress and vocalist; nla.pican22921192; National Library of Australia

1900s

60s

Today

Mid to late 19th century: Women wearing corsets risked their physical health in order to squeeze their waists to achieve looking their absolute smallest.

1960s: There was a dramatic turn with the arrival of the famous model Twiggy. Weighing a scant 91 pounds, she transformed the fashion industry into creating shapeless female jeans that looked like they should be worn by prepubescent boys.

20th century: Society’s opinion transformed, wanting dimpled flesh (today’s cellulite), which was thought to reflect bountiful wealth, energy, and health. The thin people of the 20th century were considered sickly and poor. Slenderness made its way back into the spotlight, however, as the standard thin woman would be considered too fat by today’s standards.

1980s: The slim image remained, yet became influenced by a more toned and muscular look. Women could no longer just diet to become the correct size. This era required a new pressure to exercise to achieve the right muscular look.

1920s: The Victorian hourglass shape became extremely popular thanks to the sexy flapper trend. Women showed their curves, yet kept a slender profile which looked so good doing the Charleston dance.

1950s: Marilyn Monroe came onto the scene, creating new standards for women, while simultaneously bringing back the popularity of women’s beautiful curves.

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1990s: The very slim image carried on, but the large breasted woman was also flaunted, a dual image almost impossible to achieve.

Today: As Jade Deanne of the National Centre for Eating Disorders stated in an article, Body Image In Our Time From a Feminist Perspective, “Today the ideal combines such opposite traits as erotic sophistication with naïve innocence, and delicate grace with muscularity, maturity with youth.” As Hollywood and media icons show us, today’s ideal body is very slim, and is often bordering on emaciated.

Larimer County Eating Disorder Resource Guide

Announcing Bas Bleu's 2007-2008 Season!

The Lion in Winter September 8 – October 14, 2007

Mountain Crest Behavioral Healthcare Center 800.523.1213 or 970.207.4800

The 1940s Radio Christmas Carol A World Premier November 10 – December 30, 2007

Fort Collins • Judy Abplanalp, PhD 970.223.7365

Someone Who’ll Watch Over Me January 26 – March 2, 2008

Professional dietary guidance

Wings March 29 – May 4, 2008

• Jennifer Amaral-Kunze, MED 970.402.8543 Specializes in disordered eating & obesity

• Leah Barrett, MS, MSW, LCSW 970.484.9906 Nutritionist and psychotherapist

• Janice Goldblatt, PsyD 970.224.9799

Bernice/Butterfly: A Two Part Invention May 31 – June 29, 2008 0INE 3T /LD 4OWN &ORT #OLLINS s OR WWW BASBLEU ORG

Marriage & family counseling, eating disorder information & treatment centers

• Fern Lawler, PhD 970.224.1500 Licensed psychologist

• Susan MacQuiddy, PhD 970.491.6496 Licensed psychologist. Specializes in eating disorders, relationship concerns, family issues

• Dorinna Ruh, LCSW, CACIII 970.227.1439 Provides individual, family, or group counseling for persons with eating disorders

• Jane Welzel, LPC 970.221.1099 Mental health services, therapy for eating disorders

Loveland • Chris Book, Registered Dietician, CDE 970.622.9997 Insurance: Aetna, EAS, sliding fee scale

Greeley • M. Sean O’Halloran, PhD 970.351.1640 Psychologist. Specializes in eating disorders

Fort Collins Medical Magazine & Directories 2007 2008

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FORT COLLINS

WELLNESS 2007

ACUPUNCTURE ::

211 West Myrtle Fort Collins, CO 80521 970.226.6400 | Fax: 970.226.6427 www.stylemedia.com

DENTISTRY/ORTHODONTICS ::

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Bethesda Wellness Center, LLC (Windsor) 8010 Larimer County Rd 5...............970.556.3876 www.bethesdawellnesscenters.com See ad on page 89

Burdett R. Edgren, DDS, MS (Greeley) 3400 W. 16th Street., Bldg. 4-V.......970.356.5900 www.dredgren.com See ad on page 95

DENTISTRY/COSMETIC :: Overton Center for Dental Arts - Thomas F. Overton, DDS

DENTISTRY/PERIODONTICS ::

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David Clark Johnson, DDS, MS 1120 E. Elizabeth St., G4 . ..............970.221.5050 2996 Ginnala Dr., Ste. 101 (Loveland) .970.221.5050 See ad on page 37

DENTISTRY/ENDODONTICS ::

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Anthony F. Girardi, DDS 1331 E. Prospect Rd., Bldg. B-1......970.482.4916 2996 Ginnala Dr., Ste. 101 (Loveland).970.461.1994 See ad on page 80 David M. Jones, DDS 1331 E. Prospect Rd., Bldg. B-1......970.482.4916 2996 Ginnala Dr., Ste. 101 (Loveland).970.461.1994 See ad on page 80 Kelly B. Jones, DDS, MS 1331 E. Prospect Rd., Bldg. B-1......970.482.4916 2996 Ginnala Dr., Ste. 101 (Loveland).970.461.1994 See ad on page 80 Jason E. Maines, DDS, MS 1331 E. Prospect Rd., Bldg. B-1......970.482.4916 2996 Ginnala Dr., Ste. 101 (Loveland).970.461.1994 See ad on page 80

directory

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MASSAGE THERAPY ::

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Intuitive Touch Massage-Dianne Batchelder, CMT 420 S. Howes St., Ste.100...............970.222.3128 See ad on page 89

INDEPENDENT LIVING ::

NUTRITION ::

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Nutrition in Mind-Leah Barrett 1200 S. College Ave., Ste. 201 .......970.484.9906 See ad on page 88

PHYSICAL THERAPY :: Harmony Hand & Physical Therapy Center, Inc. 3744 Timberline Rd., Ste.103..........970.204.4263 9299 Eastman Park Dr. (Windsor).......970.674.9675 See ad on page 64

SALON & SPA :: Bliss MedSpa 5250 Hahns Peak Dr., Ste.140 (Loveland).970.278.0111

HEALING TOUCH

::

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www.ultrabliss.com See ad on page 63 Reflections Medspa 4060 S. Timberline Rd., Ste.120 ....970.372.0307 www.reflectionsmedspa.com See ad on page 71

HEALTH CARE :: Columbine Health Systems www.columbinehealth.com.............1.800.718.2224 See ad on page 2 and this page

SENIOR HEALTH CARE :: Fort Colllins Good Samaritan Village 508 W. Trilby Rd................................970.226.4909 See ad on page 64

HEALTH CLUB :: DENTISTRY/FAMILY :: Johnston & Johnston-Ron & Samantha Johnston, DDS 2001 S. Shields., Bldg E-#200........970.493.5120 See ad on page 91 Steven Koehler, DMD 4745 Boardwalk Dr., Ste. D-102......970.223.6101 www.smilefortcollins.com See ad on page93

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The Other Club Fitness Center 1227 Riverside Ave..........................970.221.4348 See ad on page 89

HOME/DURABLE MEDICAL EQUIPMENT (DME) :: Mobility & More 1447 N. Denver Ave. (Loveland)..........970.461.8400 www.mymobility.biz See ad on page 80

SKIN CARE :: Greeley Quick Care 2928 W. 10th St.(Greeley).................970.351.8181 See ad on page 10

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B A R I AT R I C C E N T E R O F T H E R O C K I E S P O U D R E VA L L E Y H O S P I TA L

MEDICAL

primary care

“my doctor”

an endangered phrase

by Corey Radman

My pregnancy with my daughter was a doozy. It seemed that the entire first trimester was spent within a two-second dash of the bathroom. The hourly vomiting confined me to bed or bathroom for all of one October and left me with the sunken eyes and bony protrusions of a death camp survivor. Without the help of a doctor with whom I had established a long-term relationship, I would have struggled even more.

Corey Radman and her primary care physician, Dr. Stephen Broman, of Associates in Family Medicine.

Through use of carefully considered medications and after three weeks of non-stop vomiting, I found relief through anti-nausea meds. Eight months later my daughter, Elizabeth, was delivered by that same family doctor, Stephen Broman.

The journey to her birth was life changing for my husband and me. We were both so grateful for our doctor’s guidance and reassurance through scary times.

Dr. Broman has been my doctor for 11 years.

Because he had provided family care for me long before the pregnancy, a relationship of trust had been built. I knew Dr. Broman and he knew both me and my husband and our general medical preferences. Elizabeth is now three and very much looks forward to visiting “Docah Bwoman” and have him look in her ears “to see if there are any monkeys.” And it is a delight for me, a proud mommy, to have him as an extension of our family to share the joy in watching her grow.

Dr. Stephen Broman is one of 24 board certified family practitioners at Associates in Family Medicine. With 6 clinics in Fort Collins and Windsor, they offer the kind of cradle to grave care that is becoming jeopardized. From obstetrics to geriatrics, they can provide all of the care a family needs. They also offer an Urgent Care Center, which is open on Saturdays and Sundays (3519 Richmond Drive, Fort Collins). Dr. Broman explains why he loves working for the practice, “We are large enough to well serve the needs of patients but still a manageable size to maintain the best quality of care I’ve ever seen. I wouldn’t hesitate to send any of my family members to any of my partners.”

Recent reports have related that this type of quality, relationship-based family care is increasingly more difficult to find. Family care clinics around the country are closing their doors be-

cause they simply cannot afford to stay in business. Reimbursements from third party payers are being cut back, especially for care provided through government assistance like Medicare and Medicaid. Thus patients using assistance programs find it difficult to be seen as a new patient at many clinics. Primary care providers, including family physicians, general internists, or general pediatricians, are becoming a threatened breed.

The crisis in our medical system is one that will ultimately affect us all.

Dr. James Sprowell, Executive Director of Associates in Family, P.C. explains his perspective on the growing problem in family care. “I see three big reasons for the huge shift in health care: increasingly expensive technology; a shortage of medical students choosing primary care as a specialty; and an aging population that will stress an already burdened system.” Sprowell elaborates that the number of national dollars available to spend on healthcare are limited. Increasingly expensive tests and treatments siphon away many of those precious dollars. For example, you visit your physician for a recurring headache and a comprehensive history and physical exam is performed and then an MRI is ordered. The insurance company might reimburse $140 for the comprehensive office visit but the MRI costs $2000. Although the MRI can exclude rare serious causes for headaches, in most cases the MRI will fail to determine the actual cause of the headache. The high cost of such technology drains the overall pool of money available for healthcare provision at an alarming rate. Your insurance company spent $2000 and you still don’t know why your head hurts. If enough MRI studies are ordered, then the money available to reward the physician for his or her time, clinical judgment, and wisdom becomes threatened.

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Family doctors can provide the kind of integrated care for which no other specialty is capable.

A doctor with a generalist background that sees patients for all types of issues from an annual Pap smear to winter colds enables a physician to see the whole picture.

Dr. James Sprowell consults with another Associates in Family Medicine physician, Dr. Bradley Abrahamson.

A report in the New England Journal of Medicine confirms Sprowell’s second suspicion. The problem of physician supply lies in the proportionate distribution of generalists versus specialists, i.e. there are fewer and fewer students choosing the less lucrative specialty of family medicine over subspecialties like cardiology. According to the American Academy of Family Physicians, in 2006 there were 20,072 medical residencies to fill. Of those residents, only 15%, or 3,032 chose primary family care programs. Larry S. Fields, MD, president of the AAFP notes, “The trend toward specialization, which is likely driven by increasing student loan debt and income expectations, could result in an increasingly fragmented, over-specialized and inefficient system.”

The increasing numbers of baby boomers needing more and more medical care has been no secret for some time. Making this worse is the additional difficulty, that Medicare does not reimburse clinics for services at the same rate of most insurance companies (they will pay for the $2000 MRI but the reimbursement for the office visits to a family physician, internist or neurologist is limited). This means that clinics have an extremely difficult time covering the actual cost of the care for this sub-group of patients. At Associates in Family Medicine, they are not turning away Medicare or established Medicaid patients, though Sprowell admits that if the majority of their patients used it, they wouldn’t be able to make ends meet.

Dr. Broman reiterates the point. “There is a huge fragmentation of care [without a primary provider]. There is no patient advocate when insurance companies actually encourage patients to self-refer to specialists.” He prefers that fam-

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ily care providers take a “gatekeeper” role to keep costs down overall. After all, he says, “Every cough is not a pulmonary cause.”

Broman and the other providers at Associates in Family Medicine strive to provide the kind of care that patients value. Family doctors can provide the kind of integrated care for which no other specialty is capable. A doctor with a generalist background that sees patients for all types of issues from an annual Pap smear to winter colds enables a physician to see the whole picture. This is especially true where a doctor sees an entire family and has the opportunity to see his patient from many perspectives. Asked why they continue providing this kind of care, even in the face of mountains of paperwork and insurance bureaucracy, they both respond that the patient relationships are so rewarding.

Family doctors get the unique opportunity to know their patients well and to dramatically impact their lives. Dr. Sprowell relates this story as an example of the ideal relationship with a primary care doctor. “I had a patient who was a woman in her 70s, a salt of the earth person and rather stoic, who had been in my care for 10 years and with the clinic for about 20. We both love to garden and would always talk about that when she came in for check ups. One year she just seemed down. We talked for 10 minutes about her health and she said nothing about any specific problems.

When I said, ‘How’s your yard?’ she kind of sighed and replied that she just wasn’t doing that anymore. This, from a woman who lived to garden, was significant to me. After probing a bit, she explained that she was too tired and out of breath even to push the lawn mower one pass over the

yard. This was clearly very abnormal for her usual physical activity level, so I scheduled a stress test that was dramatically abnormal within 10 seconds. Further tests showed that she had a critical blockage of one of her main arteries. She underwent an angioplasty and in later office visits was visibly much happier and was back to gardening.

I am convinced that our long-term relationship allowed that critical history to be recognized and ultimately lead her to a life saving intervention.

This is the kind of care that all patients should have and doctors like the ones at Associates in Family Medicine strive for: care that begins with connectedness. Doctor Broman sums it up as he describes participating in another family’s birth (but he could have been talking about my daughter’s), “To deliver a baby for a couple that is so prepared and so ready to have a child is incredibly rewarding. And then I get to be there as the child and her family grows. I love that stuff!”

The future of primary care in the US is definitely changing. According to many studies and both doctors interviewed for this story, probable solutions will likely have to include governmental oversight. The path to a universal health care coverage system will be long and likely arduous.

However it is crucial that these types of patient/ doctor relationships be retained. Dr. Sprowell sums it up when he says, “Everyone should be able to have someone they call, ‘My doctor.’”

Corey Radman is the Assistant Editor for Style Magazine.

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Medical

Sleep Disorders

pediatric

sleep disorders

by Maryjo Faith Morgan

Sleep can be very exciting, according to Dr. Timothy Ryschon, of the Colorado SleepCenter of the Rockies. In fact, good restful sleep for everyone is his goal. He approaches diagnosing and treating sleeping disorders with the enthusiasm and confidence of one who has seen dramatic results.

Pictured with a Finger Oximeter Monitor, Matthew Lewis, age 5, prepares for a night sleep study at the Colorado SleepCenter of the Rockies.

“Everybody takes sleep for granted. People don’t consider how incredibly important the quantity and quality of sleep are for the rest of their lives … I’m excited about the impact we will have on people’s waking moments, those times of memories, relationships and daily living. Sleep, or the lack of it greatly affects the conscious state.”

Diagnosing pediatric sleep disorders differs from determining them in adults. Adults with undiagnosed sleep disorders present with prominent symptoms such as insomnia, restless legs syndrome, sleep apnea and/or snoring. In children and adolescents, the clues are often in their daily living. But even dead giveaways are over looked because we are not aware of the connection. Infant/childhood apnea, sleep terrors/nightmares, bedwetting, and rhythmic disorders, are all related in some way to sleep; either through regulation of sleep and wakefulness, disruption of sleep, or being a consequence of disordered sleep.

The case for treating sleep disorders in the young is stronger than many may think. “Fifty percent of adolescents surveyed responded that they have significant sleep issues or problems with daytime alertness,” shares Dr. Ryschon. “This is giant-sized! There is not another epidemic of this magnitude in the American population. Fifty percent of the population does not have heart disease. Fifty percent of the population does not have cancer. But fifty percent of our adolescent population is [sleep] impaired. These are the peo-

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ple who need to be learning and developing their brains – and we are leaving them in a semi-rested state.”

Dr. Ryschon explains that the dynamic state of neurological development and physical growth in children influences the type of sleep disorders they experience. This influence of disordered sleep and problems with wakefulness are of particular concern in children because they disrupt learning and academic performance. In some cases, sleep disorders create daytime problematic behaviors that are difficult to distinguish from other conditions such as attention deficit hyperactivity disorder (ADHD) and Attention Deficit Disorder (ADD).

This makes accurate diagnosis critically important in order to avoid frustrations and long term disillusionment with treatment.

Dr. Terry Himes, a founding partner of Colorado SleepCenter of the Rockies along with Dennis Himes, general manager, says a relatively high proportion of children diagnosed with ADD and ADHD have a sleep disorder as well. Immerging medicine is confirming far more prevalence than realized. “These children present as irritative and having a lack of attention.”

Although there is still speculation as to why children with ADHD respond to treatment with stimulant medications, about 70% do experience an increase in focus and an ability to control their own behavior. However, these same kids may experience excessive daytime sleepiness, a sleep

disorder indicator, but remain on stimulants; they might benefit from looking into sleep disorders.

Another considerable factor in children can be weight. As a self-described “preventionist,” Dr. Ryschon seeks to derail the harmful trajectories of obesity in youth.

“Frequently our goal will be to simply slow the rate of fat accumulation until growth ‘catches up,’ normalizing the weight risk. In other cases, where weight has accumulated to an extent that will never be safe at any normally achievable height, weight reduction becomes the goal. Our interventions focus on reducing high-risk eating behaviors and modifying leisure-time physical activity levels.

We are ever vigilant for serious co-morbidities like high blood pressure, high cholesterol, obstructive sleep apnea, and pre-diabetes and follow these conditions very closely. We are always prepared to resort to technological or pharmacologic interventions if needed. Excess weight is not the only condition associated with serious sleep disturbances, it is just increasingly common.”

Dr. Ryschon shares his recent experience with a teenaged patient. “Ted” is an example of an older sleep disordered youth in a diagnostic dilemma. His ADD (Attention Deficit Disorder) was being treated with stimulants and “Ted” was also dangerously overweight, a condition that caused sleep apnea and significantly lowered his quantity and quality of restful sleep.

It seemed stimulants were the wrong answer

Kevin Unger, PVH’s president and CEO, is respected and well-liked by his staff for his professionalism; dedication to PVH, the staff and physicians; and his enjoyable sense of humor.

(PVHS administrators, by the way, are eligible to be nominated as employees of the year.) His boss—Rulon Stacey, PVHS president and CEO— offers this assessment: “Kevin sets the standard for the world-class healthcare that we strive to provide in our community. He is the role model that America’s healthcare leaders should fashion themselves after.”

Peggy Bradley, employment manager for the human resources department, was nominated by colleagues in her department who are impressed by her many outstanding traits and quality, as well as her creativity, positive attitude, teamwork, and the excellence she provides in interacting with other staff members. “Peggy has the highest level of integrity,” stated a peer.

“She does the right thing because it is the right thing to do.”

Tracy McGuire, registered nurse and clinical educator in the hospital’s birthing center, was nominated by all of the staff members in her department. They wholeheartedly agreed that she has an infectiously positive attitude and possesses natural charisma, strength and creative innovation. She works diligently to improve methods through which staff members learn and patients benefit the most. One colleague said, “Tracy faces every situation with a ‘we can-do-it’ attitude.”

Dr. David Marchant, medical director of PVH’s Family Medicine Center, leads by example and is an excellent role model. His excitement for improvement is contagious and he always remains positive and has a great sense of humor.

“He makes patients feel really listened to and he takes the time to give them great quality care,” pointed out staff members at the center.

Herb Brady, manager of PVH’s ambulance services, was nominated by colleagues in his department. They applauded him for being an efficient leader who stimulates enthusiasm among the staff members. He respects the opinions of others, is proactive and teamoriented, and communicates effectively. “He sets the standard,” a co-worker wrote.

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in “Ted’s” case since his obstructive sleep apnea was related to his weight. In many situations breathing apparatuses such as C-PAP (Continuous Positive Airway Pressure) or BiPAP (Bi-level Positive Airway Pressure) decrease the work of breathing for those with sleep apnea, help get more air into the lungs, and restore restful sleep.

However, “Ted” chose to implement the suggested modification program and was remarkably successful. (Integrated childhood weight management programs are designed to lower the chances of children developing sleep apnea from being overweight as adults. Programs address a range of health conditions that are related to being overweight, including problems with cholesterol, blood pressure, and asthma.) He became significantly more physically active, experienced a reduction in body mass by 40-50 pounds, and his disrupted sleep pattern disappeared. He became a different person.

Dr. Ryschon maintains that we simply do not appreciate how widespread the problem is for children. We all hear parents talk about sleep problems and consign those difficulties as some right of passage; kids are just that way. Everyone’s tired. We never think of sleep disturbances as being correctable medical conditions.

As a society we may not yet be immediately aware of sleep disorders in terms of recognition, management and prevention of sleep disorders.

Many sleep problems do not require formal sleep studies and can be managed through phone consultation between the primary care provider and sleep specialists, and many medical plans now cover evaluation, diagnosis and treatment. Full service sleep labs like Colorado SleepCenter of the Rockies of the Rockies are offering a combination of treatment with consistent education of parents, children, and our community.

Awareness and education are the keys to good and restful sleep for all.

Maryjo Faith Morgan is a Loveland freelance writer and a member of Colorado Authors’ League (www.coloradoauthors.org).

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American Sleep Apnea Association at www.sleepapnea.org American Academy of Sleep Medicine at www.asda.org National Sleep Foundation at www.sleepfoundation.org American Stroke Association at www.strokeassociation.org National Stroke Association (US) at www.stroke.org Heart and Stroke Foundation of Canada at www.heartandstroke.ca Talk About Sleep at www.talkaboutsleep.com

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medical

opthalmology

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the gift of sight

Refractive and Cataract Surgeon, Karl Olsen, M.D. and Harriet Skyes before cataract surgery at Eye Center of Northern Colorado Surgery Center.

cataract surgery

by Court Klinck

71-year-old Harriet Sykes has had problems with her vision since the third grade. For many years she wore glasses, then switched to contact lenses. Beginning five years ago, she noticed a significant deterioration in her vision. Three years ago, she was diagnosed with cataracts in both eyes. Over the past year, Harriet’s vision degraded to the point where, based on tests performed in late January, her insurance company authorized coverage for cataract surgery. In March, she had two surgeries separated by three weeks - one for each eye. The surgeries were performed by Dr. Karl Olsen, specialist in general ophthalmology and cataract and refractive surgery, at Eye Center of Northern Colorado in Fort Collins.

106

Through her experience under Dr. Olsen’s care, Harriet has learned a great deal about cataracts and the latest advancements in cataract treatment. A cataract is clouding of the clear lens that focuses light onto the retina. The lens consists of proteins and water combined so as to allow light through with minimum distortion. With age, the proteins can clump together, allowing less light to pass through and causing blurred vision. Early cataract surgery was complicated and risky. For this reason, ophthalmologists usually postponed surgery until the patient’s vision was severely limited. Today, cataract surgery is one of the safest and most common surgeries performed in the United States. People with cataracts are now able to have surgery as soon as cataractrelated vision problems interfere with their normal activities. However, medical insurance policies typically stipulate the extent of vision impairment required before surgery is covered.

Cataracts brought on by age start small and usually occur in the center of the lens. At first, there are no symptoms. Over time, however, symptoms such as blurred vision, glare, double vision, dull color vision, poor night vision, and worsening nearsightedness present themselves, affecting a person’s ability to read clearly and making it dangerous for them to drive. At age 65, there is a 50-50 chance that a person has started to develop a cataract. Someone who regularly takes corticosteroids or the anti-cancer drug tamoxifen may also be at increased risk for cataracts.

Smokers develop cataracts earlier and even those who quit are at greater risk than average. Longterm exposure to sunlight can increase the risk for cataracts. There is some evidence that a wellbalanced, low-fat diet rich in fruits and vegetables may help reduce cataract risk.

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Two types of cataract surgery are currently performed: • The most common is phacoemulsification or small incision surgery. In this procedure, the surgeon makes a 1/8-inch incision in the side of the cornea and inserts a slender probe. The probe sends ultrasound waves to break up the central part of the lens – then vacuums up the lens. A replacement lens is folded to fit inside the probe and is inserted into the lens capsule where it unfolds. The probe is removed and the surgeon closes the incision or, optionally, allows it to heal by itself. Recovery occurs in a few days.

• Conventional extracapsular cataract extraction or large incision surgery (practiced commonly in the past) is more invasive involving a 3/8-inch to 1/2-inch incision under the upper eyelid. The replacement lens is inserted and the incision is stitched. Recovery takes six weeks to four months. If your ophthalmologist recommends this procedure, ask why. It might be necessary because you have a weak lens capsule or particularly hard cataract. However, if your doctor simply is not trained in the newer small incision procedure, you might want to seek another opinion.

The type of replacement lens one chooses is of great importance in determining the effectiveness of cataract surgery. There are four primary lens types: • Monofocal lenses restore clear vision at a set distance. If you have been wearing glasses or contacts for distance vision, your

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distance vision without glasses after surgery may be significantly improved. However, separate glasses will be needed for reading and intermediate activities such as using a computer. Optionally, the surgeon can use a distance lens in one eye and a close-up lens in the other. This may eliminate the need for glasses, but not everyone adjusts well to this approach, especially if depth perception is an important consideration. Insurance companies generally provide coverage for monofocal lenses.

• Multifocal lenses, in a manner similar to bifocals and progressive glasses, help with presbyopia, the age-related difficulty in shifting focus from far to near. Lenses such as ReZoom and ReSTOR® provide, in most cases, a full range of vision without glasses, except for the finest print. After surgery, vision improves over the first few months as the patient’s brain adjusts to seeing at various distances. Based on trial results, multifocal lenses typically provide similar distance vision performance to monofocal lenses, with better

At Harriet’s examination a week after the second surgery, Dr. Olsen indicated that her right eye was in the healing stage and that she should use her eyes as much as possible without glasses. reading performance. However, people with multifocal lenses are more likely to be bothered by halos around lights. They may also have difficulty seeing in low light. (ReZoom has two extra focusing zones to provide clearer vision in low light.) Multifocal lenses may not work well for those with severe astigmatism and certain other eye conditions. These lenses are comparatively expensive - approximately $2,000 each - and most medical insurance plans cover only the amount equivalent to monofocal lenses.

• Accommodative lenses are hinged and move in response to the eye’s focusing muscles. They address distance and intermediate vision, but are not as effective for reading vision.

• Toric lenses correct astigmatism and reduce the need for distance vision glasses. Some astigmatism may remain after surgery. This can usually be

108

Dr. Olsen making the initial incision.

Fragmentation and removal of cataract during the surgery as shown on the operating room monitor. (View is the same as Dr. Olsen’s through microscope.)

Fort Collins Medical Magazine & Directories 2007 2008

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corrected with limbal relaxing incisions (LRIs).

In treating Harriet’s condition, Dr. Olsen utilized small incision surgery and a multifocal ReZoom lens. The results clearly demonstrate the effectiveness of current cataract surgical techniques and lens technology. One week after surgery on her first eye, the left, Harriet’s distance vision was very good. She was also able to read better than before surgery, although she required reading glasses for very fine print. Harriet’s postsurgery care was simple. After morning surgery, gauze was applied over her eye and a clear plastic eye shield placed over the gauze. Approximately 20 minutes after surgery, Harriet was cleared to go home, with a friend driving. At 5:00 p.m. on the day of surgery, Harriet removed the shield and gauze and put three different types of drops in her

eye. She continued taking the drops four times a day for seven days after surgery, then tapered them to conclusion over the next three weeks. She was only required to use the plastic eye shield the day of surgery and, thereafter, only at night for seven nights. After two days - the day of surgery and the following day - Harriet was back at work and resuming her normal daily activities.

Harriet’s second surgery, on her right eye, was similar to the first, with some adjustments to her eye drop regimen. The morning after surgery, she was able to read the paper unassisted. Later that day, during the post-surgery checkup in Dr. Olsen’s office, her right eye vision was tested and determined to be “excellent” – 20/20 for distance and reading. That evening, Harriet was able to work three hours on her taxes without reading

Jody (Surgical Scrub Nurse) prepares the intraocular lens for implantation.

Harriet Sykes immediately after surgery with eye bandage that stays on for three hours.

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Today, most people with cataracts can look forward to achieving dramatically improved vision through new lens technology and advances in surgical techniques.

Anatomy of the Eye Your eye lets light inside through the pupil in the center of your iris.

The pupil is actually a hole, behind which sits the lens.

The lens works much like a camera’s lens, focusing light onto the retina at the back of the eye. It also adjusts the eye’s focus, letting us see things clearly both up close and far away.

The lens is mostly made of water and protein. But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.

- Dr. Karl Olsen Eye Center of Northern Colorado in Fort Collins glasses. At the one-month post-surgery exam, Dr. Olsen determined that the surgeries had both been successful in terms of fixing Harriet’s cataract problems. He pointed out, however, that in 5% of cataract surgeries, additional correction of refractive error could be required to achieve the best possible unaided visual acuity. Dr. Olsen will be examining Harriet later in the year to determine whether additional correction will be needed in her case.

Harriet considers her cataract surgeries to have been very successful. “I can say that I’m delighted with the results, and I would highly recommend the surgery to others. I can see better at a distance than I have been able to for years.

Not only was the surgery successful in terms of removing my cataracts and significantly improving my vision, it was a relatively easy and painless experience. The only slight pain was the insertion of an IV for administration of the anesthetic.”

Dr. Olsen offers the following concluding thoughts: “Today, most people with cataracts can look forward to achieving dramatically improved vision through new lens technology and advances in surgical techniques. Since each person has his or her own set of vision problems and postsurgery vision requirements, and because there are a number of different medical procedures and lenses available, it is essential that those considering cataract surgery thoroughly discuss available options with their ophthalmologist prior to deciding on a specific treatment approach.”

A considerable amount of information in this article was obtained from material published by Harvard Women’s Health Watch, March 2007.

Trademarks, trade names and brand names are the property of their respective products’ manufacturers and/or owners.

Court Klinck is a freelance writer living in Greeley.

Fort Collins Medical Magazine & Directories 2007 2008

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Continued from page 90

Cosmetic dentists and partners, Ron and Samantha Johnston, DDS, ready Gina Horgen for a Cerec crown.

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Before and after a series of new, Cerec crowns. sensitivity to hot and cold after getting a crown now because the fit is better. The CEREC highresolution images and computer model allow for a more exact impression of the area that needs filled or crowned. That’s important because dental crowns effectively become the tooth’s new outer surface so the more natural the feel the better. “We can duplicate the shape of the tooth better so it’s a real familiar shape when you bite down,� Samantha says. Briggs concurs: “My crown didn’t need any adjustment or drill shaping when it came off the milling machine. You don’t get the feeling that the tooth is up too far when you’re chewing food.�

In case you’re wondering, CEREC crowns are covered under most dental insurance plans and can cost less because certain procedures are eliminated with the one-step process. Anyone interested in learning more about the CEREC system can make an appointment for a free consultation at Johnston & Johnston Dentistry, (970) 493-5120, 2001 S. Shields, Bldg. E, Suite 200, Fort Collins, CO 80526. “It’s a great time to be a patient and a dentist because of the technology available,� Ron concludes.

Julie Estlick is a freelance writer and copyeditor living in Fort Collins.

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