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Nobody likes varicose veins. For some people they even cause severe, aching pain. If varicose veins are keeping you from living your life to the fullest, consider scheduling an appointment at North Colorado Medical Center's Vein Clinic. Treating your varicose veins is more than just a cosmetic procedure, and it's important that you have them evaluated and treated by a medical professional.

Schedule a free screening: 970-378-4100

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At the CardioVascular Institute of North Colorado, we have the power to change the course of your life. In fact, we're ranked in the top I% in the nation by Total Benchmark Solutions for heart attack care. Our highly specialized teams use world-class technology, like our 64-slice CT scanner, to provide the clearest possible picture of your overall heart health. In addition, our Cardiac Alert Program, recognized regionally for health care excellence, offers quicker care for emergency heart situations due to outstanding coordination between paramedics, cardiologists and the ER. All of this means there's no reason to go anywhere else for leading heart care.

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Physician information: www.BannerHealth.com or 800-505-6877 Job opportunities: www.BannerHealth.com or 866-377-5627 (EOE) Banner Health is the leading nonprofit health care provider in northern Colorado.

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Specialists in Women’s Health Care The Women’s Clinic has been serving Northern Colorado for over 30 years. We offer a full range of services from gynecological and obstetric care to robotic assisted surgery. SERVICES INCLUDE: UÊ LÀ `Ê,i Û> UÊ1 ÌÀ>Ã Õ `Ê iÜÊÎ ® UÊ > }À>« Þ UÊ iÊ iÀ> Ê i Ã ÌÞ UÊ >L À>Ì ÀÞÊ `Ê À>Ü UÊ i iÌ VÊ Õ Ãi }

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there are many options available Minimally invasive therapy for treatment of acute and chronic pain management. t Epidural Steroid Injections t Facet Blocks t Median Nerve Blocks t Radio Frequency Nerve Ablation Whether you are newly injured or a long-term sufferer, we have many pain management options. We strive to provide diagnostic and therapeutic services with care and compassion to help our patients improve their function and be pain free. Using a team approach, we work closely with: t Family Practice Physicians t Surgeons t Chiropractors t Physical Therapists

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Centennial Radiation Oncolo "Caring for a patient is caring about a person" The mission of Centennial Radiation Oncology, P.C., is to provide safe, effective, and accurate radiation therapy Marie D. Klish, M.D.

to cancer patients in Northern Colorado, in order to cure, palliate, and/ or provide William B. Casey, M.D.

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Providing compassionate cancer care to our community since 1982 Providing Radiation Oncology Services: Poudre Valley Radiation Oncology • 2121 E. Harmony Rd., Ste. 160 • Fort Collins, CO 80528 • (970) 482-3328 North Colorado Cancer Institute • 1801 16th St. • Greeley, CO 80631 • (970) 350-6680 McKee Cancer Center • 2050 B. N. Boise Ave. • Loveland, CO 80538 • (970) 679-8900

Northern Colorado Medical & Wellness

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publisher’s letter

As we visit and interview these exceptional professionals, I continue to be impressed with the quality of care we have in this region. And, it is with a great deal of pride that we expand our medical and wellness issues to include this October issue of Northern Colorado Medical and Wellness.

We at Style have worked hard these past 23 years uplifting our region and responding to the needs of our Colorado Front Range. And, as this area (north of Denver proper) has grown into being a regional healthcare center, we have responded with medical and wellness publications packed full of timely and informative articles with expertise from some of our region’s finest specialists and healthcare providers. As we visit and interview these exceptional professionals, I continue to be impressed with the quality of care we have in this region. And, it is with a great deal of pride that we expand our medical and wellness issues to include this October issue of Northern Colorado Medical and Wellness. This issue spans a wide range of interesting and compelling topics. Get acquainted with Drs. Smolenski and Janssen at the Center for Spinal Disorders who provide highly skilled interventional pain management. Many of us Baby Boomers have back issues that could be mitigated, I am sure, with their expertise. Since I have experienced quite a few surgeries over the years, anesthesia was a topic that interested me. Read up on Dr. Jan Gillespie’s informative overview of this important and interesting aspect of medicine. Early detection is the key to recovery and survival from breast cancer and today the American Cancer Society recommends MRI’s, and breast ultrasound alongside mammograms for high-risk patients. This additional non-invasive procedure complements the standard screening methods and will detect more of the significant disease and also impact treatment decisions. The breast MRI’s enable early

Welcome to this Issue detection when treatment is easier and survival is greatest. Alongside these and many other sound articles that inform and inspire in this issue, we have highlighted several ancient complementary care modalities that are helpful for a wide range of conditions. I don’t happen to believe that what’s new has to necessarily eradicate something older. I believe good things can coexist. Acupuncture, for example, has been used for more than 2,000 years by the Chinese and, as of late, has been enjoying a burgeoning acceptance in the West. In fact, The World Health Organization recommends acupuncture for many respiratory diseases, eye and mouth problems, orthopedic and neurological disorders and gastrointestinal ailments among others. And, it has also shown to relieve nausea and vomiting associated with chemotherapy. Get acquainted with Diana Hermann, Zari Pirasteh, Dianne Batchelder, Lauri Pointer, Melissa Osmun, and Dr. Michael Sutton; all are outstanding holistic healthcare providers whose approach to therapy places a greater emphasis on the relationship of mind, body, and spirit. Thank you for your on-going support of Style. We truly work very hard to bring you interesting and vital magazines with important and informative articles. And we have enjoyed the increasing number of letters, emails, and calls commenting on our issues and suggesting future topics. We love hearing from you. Wishing each of you good health,

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Northern Colorado Medical & Wellness

- Peter Weeks - Owner 9

october 2007

CONTENTS 12 16 22 26 28 30 32 36 38 40 42 46 48

northern colorado medical & wellness

Comprehensive Spine Care

Andrew Smolenski, M.D. is a physiatrist who is new to Center for Spinal Disorders.

Breathing Room

Patients have a variety of holistic modalities from which to choose for health care.

Just What the Doctor Ordered

Poudre Valley Health System’s new facility

Anesthesiology: A Patient’s Guide

Patients have more choices than they know when it comes to anesthesiology.

Breast Health

Breast Health Nurses & MRI Technology

Endodontics

High-tech dentistry with a smile.

Rays of Hope

Comprehensive Spine Care Andrew Smolenski, M.D. is a physiatrist who is new to Center for Spinal Disorders.

breathing room Patients have a variety of holistic modalities from which to choose for health care.

Radiation Therapy delivers doses of radiation to the tumor site.

Head & Neck Cancer

Symptoms of head and neck cancer can be deceptive.

Top Kid Illnesses

When should you go to the doctor?

Sports Medicine

Local physicians and therapists are first line of defense for prevention and treatment.

Sex Therapy

What is sex therapy and how is it approached?

Vein Treatment

EVLT is less invasive treatment for varicose veins.

Anesthesiology: A Patient’s Guide Patients have more choices than they know when it comes to anesthesiology.

rays of hope Radiation Therapy delivers doses of radiation to the tumor site.

Surviving Spinal Injuries

Two inspiring men’s stories of hope.

on the cover Physicians, Michael Janssen, D.O. and Andrew Smolenski, M.D. of Center for Spinal Disorders.

Head & Neck Cancer Symptoms of head and neck cancer can be deceptive.

Cover photo by Dana Milner.

The articles in this issue of Northern Colorado Medical & Wellness are for your general knowledge and not as a substitute for medical advice or treatment. If you have any questions or concerns about your health, please contact your doctor or health care provider.

sports medicine Local physicians and therapists are first line of defense for prevention and treatment.

- - -_

-- .

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interventional pain management

spine care

My role here is to evaluate, collect information and do an exam to target the pain generator. After figuring out the musculoskeletal abnormalities, I try conservative measures first and more invasive procedures as warranted. - Andrew Smolenski, M.D. -

Comprehensive Spine Care by julie estlick

Many patients who walk through the doors of the Center for Spinal Disorders (CSD) simply don’t require surgery – but do need help. Enter Dr. Andrew Smolenski, a specialist trained in Physical Medicine and Rehabilitation (PM&R) and Interventional Pain Management who evaluates patients to find the source of their pain and designs a treatment plan to help them function at their best.

molenski’s position is the latest addition to CSD, the Rocky Mountain Region’s preeminent leader in back, neck and spine care, offering diagnostic, treatment and research facilities in one location. The 50,000-square-foot, state-of-theart medical campus in north Denver (Thornton) includes an ambulatory surgery center and a cutting-edge imaging facility with the latest MRI and CT technology. It also houses the Spine Education

and Research Institute (SERI) and the Musculoskeletal Learning Center (MLC), a non-profit center that provides educational and surgical training to medical specialists from around the world. The Center for Spinal Disorders is a perfect fit for Smolenski, a physiatrist who completed a post-graduate residency in PM&R at the University of Colorado School of Medicine and an additional fellowship in pain management within the Anesthesiology Department. A physiatrist is a medical

doctor who specializes in the non-operative diagnosis and treatment of patients with spinal and sport-related injuries as well as other musculoskeletal problems, and is considered an expert at understanding how muscles work – a crucial skill at a spine center considering 80 percent of back pain is muscle related and doesn’t require surgical intervention. “Pain medicine is about restoring optimal function and quality of life to patients,” Smol-

The single most important thing we try to determine is if the patient’s spinal condition is a true impairment or simply an annoyance in their life. Then it’s essential to tailor their treatment to help them at that moment in their disease. - Michael Janssen, D.O. -

enski says. “My role here is to evaluate, collect information and do an exam to target the pain generator. After figuring out the musculoskeletal abnormalities, I try conservative measures first and more invasive procedures as warranted.” Smolenski recalls an elderly man who came to CSD with horrible pain in his right leg after moving a pool table. He was on heavy-duty pain medicine prescribed by his physician. Smolenski did a thorough review of his medical history and past treatments and conducted a comprehensive physical examination. An MRI revealed lumbar spinal stenosis (a narrowing of the lower back spinal canal). One nerve root was severely affected by this, so Smolenski gave the man an epidural injection of medication along the nerve root to relieve the pain and reduce inflammation. He also coordinated rehabilitation therapy with a physical therapist. Within three weeks, the patient was off his meds and back enjoying his normal routine. “That gentleman’s recovery was unique, but often with

Northern Colorado Medical & Wellness

time and therapy, patients with acute pain get better,” Smolenski says. In taking a multidisciplinary approach to spine care, Smolenski, as the staff’s non-surgical spine specialist, works in coordination with the fellowship-trained orthopaedic spine surgeons at CSD to customize an appropriate treatment plan for each patient. As part of diagnosing a problem, Smolenski may perform electrodiagnostic tests such as an electromyography and nerve conduction study (EMG/NC). This study helps to determine whether a patient may have a nerve or muscular disorder such as lumbar or cervical radiculopathy or Carpal Tunnel Syndrome. Once the pain source is discovered, he may treat patients by prescribing pain medicine, giving epidurals or X-ray guided joint injections or sending them to therapy depending on the issue. In addition to diagnosis and pain treatment, Smolenski is also responsible for referrals and coordination of care with physical and occupational therapists.

“In my job, there is lots of give and take with the therapists, and if someone needs surgery I can conference with some of the best surgeons in the field right in the hallway,” Smolenski says. “At the same time, I have abundant opportunities to practice pain management – I do everything short of surgery.” Over the last two years, CSD founder and internationally acclaimed spine surgeon Dr. Michael Janssen sought to add an interventional pain specialist to his premier staff. Then he found Smolenski, and everything fell into place. “We wanted someone like Dr. Smolenski who had a talent for physical rehab and medicine and the PM&R background with a fellowship in pain management,” Janssen says. “All of his training gives him the full spectrum of knowledge so he is able to run our center and understands all that we can offer to non-surgical patients. He offers great value-added services to our post-operative patients, patients that don’t need surgery right now and he can assist both industry on Work-

interventional pain management

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manâ&#x20AC;&#x2122;s Compensation injuries and primary care physicians to help prevent many of the spinal conditions that occur.â&#x20AC;? Janssen started CSD in 1994 to bridge what he saw as the gaps in care for people with neck and back conditions. He brought together the top spinal surgeons and specialty trained allied health professionals and offered a comprehensive approach to spine care all under one roof. â&#x20AC;&#x153;Over the last decade throughout the Denver Metro area, spine care delivery has been somewhat fragmented between pain doctors, chiropractors, physical therapists and surgeons,â&#x20AC;? he says. â&#x20AC;&#x153;What was missing was the true integration of the spine center of excellence that we now offer with Dr. Smolenskiâ&#x20AC;&#x2122;s expertise. When a patient comes to us, they donâ&#x20AC;&#x2122;t have to go from office A to B, then to C. We tailor health care to the individual rather than lumping all patients together.â&#x20AC;? About half of CSDâ&#x20AC;&#x2122;s patients hail from Northern Colorado and Wyoming, and the average patient is in their mid-40s, according to Janssen. They treat nearly as many people ages 50-75 with degenerative disc problems as those in their 20s40s with work-related injuries. â&#x20AC;&#x153;The single most important thing we try to determine is if the patientâ&#x20AC;&#x2122;s spinal condition is a true impairment or simply an annoyance in their life,â&#x20AC;? Janssen says. â&#x20AC;&#x153;Then itâ&#x20AC;&#x2122;s essential to tailor their treatment to help them at that moment in their disease. Generic programs have failed to meet the needs of most patients, and as we understand the disease and how it is affecting them we can do a customized program for maximum benefit.â&#x20AC;? The physicians of CSD also specialize in treating cervical and thoracic spinal disorders, spinal deformities, fractures and tumors, Degenerative Disc Disease (DDD), herniated discs, spinal trauma, and back and neck pain. CSD is among the

countryâ&#x20AC;&#x2122;s leaders in spine arthoplasty, or artificial disc replacement. Janssen is one of the leading international investigators for many advanced technologies like the Synthes ProDisc TM-L, which replaces a disc with an artificial one similar to a knee or hip replacement. He has performed more disc replacements than anyone in the Western U.S, and CSD is one of only a handful of centers training surgeons to use this cutting-edge technology â&#x20AC;&#x201C; the other sites are in Philadelphia, Los Angeles and Dallas. â&#x20AC;&#x153;A patient that has a disc replacement often experiences dramatically less pain, increased function and a shorter rehabilitation than with traditional fusion operations,â&#x20AC;? Janssen explains. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s a new frontier in spine care that requires a lot of additional training and expertise compared to traditional fusion technology.â&#x20AC;? â&#x20AC;&#x153;When patients truly need surgery, we offer the latest technology and the most experienced surgical hands here at CSD,â&#x20AC;? Janssen says. Physical therapist Annie Fox can attest to that. Fox sends patients from her Thornton practice to CSD on a weekly basis for everything from surgery to spinal evaluations and MRIs. The veteran therapist also frequently attends conferences at the MLC to learn more about spinal conditions. â&#x20AC;&#x153;If I have a patient that isnâ&#x20AC;&#x2122;t benefiting from physical therapy or needs more testing or a surgical consultation, I send them there,â&#x20AC;? Fox says. â&#x20AC;&#x153;I think CSD is one of the best facilities around in terms of quality control in the operating room, professionalism and overall skill level whether someone needs injections or more invasive treatment.â&#x20AC;? Julie Estlick is a freelance writer living in Fort Collins.

EXPERIENCE COMPREHENSIVE

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Using the most advanced technology, treatments and research for the benefit of our patients worldwide.

Our fellowship trained and board certified physicians are recognized leaders in the care, diagnosis and treatment of back, neck and spinal related injuries and disorders.

Chronic Neck or Back Pain Non-Surgical Medical Management Minimally Invasive Spine Surgery Artificial Disc Replacement Spinal Instability or Fractures Cervical and Lumber Spine Fusion Scoliosis and Sciatica Trauma and Tumors Spinal Stenosis Herniated Discs

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centerforspinaldisorders.com Orthopaedic Spine Surgery Artificial Disc Replacement Physical Medicine and Rehabilitation

Interventional Pain Management Electrodiagnostic Medicine Workmanâ&#x20AC;&#x2122;s Compensation

Michael E. Janssen, D.O. Douglas W. Beard, M.D. Hugh D. McPherson, M.D. Monroe I. Levine, M.D. Andrew J. Smolenski, M.D.

introduction to

holistic medicine Zari Pirasteh, Reiki Master

It’s like the universe gives you a hug. - Zari Pirasteh -

breathing room by corey radman

Breathe, in … and out. Lengthen your spine, expand your diaphragm, and breathe. Does it ever seem that everything is coming apart? Like the world is closing in on you?

reathe. It’s what I tell myself when the small things or the occasional catastrophes start to loom on the horizon. It’s the breathing that pushes back the fear or pain. In that space, that breathing room, something a healer said enters my mind. “You must make time for yourself, my dear.” It is that same type of crisis that often brings people to holistic care. Something has broken badly, beyond what they or even their traditional physicians or therapists can repair. Think of an earth-shattering diagnosis, a heart rending family trauma, or the excruciating numbness that comes with chronic pain. These are often the impetuses that compel people to seek another way of feeling better. But, holistic care is by no means only for times of crisis. It is actually what many healers suggest for balance, for spiritual and physical centeredness. Used regularly, they are methods for

gaining that breathing room in your life. Holistic care is a blend of modalities, often from eastern (Japanese or Chinese) traditions that take into consideration the whole being – not just the biomechanical bag of bones that we live in. Its advantages are beneficial to anyone seeking better well-being: physically, emotionally, and spiritually. Breathing of the sort I mentioned above is certainly one part of regaining homeostasis, though the larger resource that many practitioners are tapping into is the energy that is contained within one’s body. Reiki & Healing Touch Zari Pirasteh is the kind woman with the good advice about making time. She has offered Seva (meaning Serving Hands) to Fort Collins clients for 12 years as a Reiki Master and through other modalities.

“You need to make sure you are balanced and centered,” she says. “Reki brings energy to you from the world around.” She explains there are seven main chakras, or spinning wheels of energy within each of us, though overall there are 144,000 in the body. They run down a main meridian in the trunk of the body. She explains that there is a flow of energy through your light body just the same way that there is a flow of blood through your circulatory system. A Reiki Master (or any other energy work practitioner) funnels the energy that is all around us in all living things through their body and into you, sometimes releasing areas of blockage with their focused love. “It’s like the universe gives you a hug,” says Pirasteh. Healing Touch is very similar to Reiki; the main difference is in the philosophy about who administers the touch. Reiki requires that certified masters practice it; Healing Touch’s philosophy is to

Lauri Pointer demonstrates Healing Touch on the author.

Dianne Batchelder, Certified Massage Therapist

share the skill with all people for use in their lives. Pirasteh is quick to say that one is not better than the other. After all, life is a spiritual path. Lauri Pointer, Certified Healing Touch Practitioner and Instructor would agree. She is the owner of Healing Touch & Holistic Wellness private practice. Her path leads toward sharing this skill that she finds so rewarding with many people through classes and workshops. “It is something anyone can do, the skill is innate. Healing Touch is such a practical tool – its founder, Janet Mentgen, dreamed that it would one day be in homes, schools, and hospitals, available to all families.” She notes that the physical body and energy body are closely intertwined. Issues often show up as energy field disturbances before they manifest as symptoms in the physical body- before our physical bodies even feel it. Keeping the energy field open and flowing, which is what a Healing Touch treatment accomplishes, is essential to being fully healed. Healing Touch can also be used to prevent illness and to promote higher level wellness by keeping the energy field - the blue print of our physical body - vibrant and healthy. A story of success: One woman had been having multiple problems with her ankles. After exhausting every option her physicians and physical therapists had to offer, someone thought to recommend Healing Touch. When Pointer did her first session with

Northern Colorado Medical & Wellness

the client, she was exploring the light body with her hands. (She holds her hands just a few inches above the body and feels for the energy from the chakras.) She noted the trauma at the ankles but found “leaks” of energy around the woman’s knees. When asked if there had been knee trouble, the woman remembered that yes, she had forgotten to mention knee surgery on both knees seven years ago. “And when did your ankle trouble begin?” Pointer asked. “About seven years ago,” the woman replied. “Surgeries perforate the light body,” Pointer explains. Healing Touch can both prepare the body before a surgery and repair the leaks afterward, as she did with the woman’s knees. Once the source problem with the knees was resolved, her ankles also felt better. Pointer is understanding of the limitations of language to explain something so powerful. “It sometimes sounds so woo-woo,” she jokes but stresses that the terminology shouldn’t scare skeptics away. Pointer gifted me a session of healing touch, and for one who has never really thought much about auras and never heard of the light body, I was initially doubtful. I can say honestly that I felt her energy connect with mine and I know that something went woosh as she lightly touched my feet. I would go back again. Both Pirasteh and Pointer suggest that when choosing an energy practitioner, you should go to the person you feel most comfortable with be-

cause you will be more receptive with them. They suggest energy work for people who have had surgery or are going to have it. It can also be very beneficial to people experiencing emotional trauma – the healers often get referrals from local psychotherapists because energy work is a safe, no-touch or light-touch way to ease into contact after an assault or other trauma. Massage Therapy Dianne Batchelder, Certified Massage Therapist, calls her business Intuitive Touch for a reason. When asked about massage from a holistic healing viewpoint, she notes that her clients don’t often have to tell her where their pain is, she just knows. That sense, she attributes to her way of working with energy that is similar to Healing Touch but that incorporates massage as well. “Massage, chiropractics, and Healing Touch are complementary. My intention is the same as Healing Touch, to create endorphins and release toxins from the body. I want people to walk out feeling better spiritually and emotionally than when they came. Massage fits into the holistic picture because it gives people a sense of wellbeing, especially when used on a regular basis.” She adds that taking good care of yourself allows you to take care of the other people in your life. Sharon Spoon is a local breast cancer survivor who is still managing a chronic cancer that has spread to her bones. She began using therapeutic

introduction to

holistic medicine

Diana Hermann administers acupuncture on a variety of points. Photos courtesy of Steve Glass

Melissa Osmun in her Bethesda Wellness pharmacy.

massage with her first bout of cancer twelve years ago. “I think massage really helps me manage my stress, which is what they think may have contributed to my cancer’s recurrence. For me it’s about breathing. I watch how I hold my stress and try, every day at work, to take a few minutes to return to that diaphragmatic breathing that I get from all my holistic therapies. You’d be surprised how fast it can rejuvenate you.” Batchelder often treats people experiencing the side effects of cancer treatments. She shares that she too is a cancer survivor and can empathize in a way that others may not be able to. Massage (and many other holistic or “complementary therapies”) are extremely beneficial to people whose bodies are compromised. The pain, the nausea, the soreness can be addressed through a variety of holistic approaches. Massage with a light touch does wonders for cancer patients. A 2007 study in BMC Women’s Health noted that 81.2% of surveyed women with breast cancer used some form of holistic care. This study reported the most commonly used products or practices were herbs, massage therapy, and nutritional counseling (available at a naturopathic doctor or dietician). Spoon says that she used many complementary therapies together. “They all seem to relate. For me it’s about knowing where your focus is.” Batchelder adds that massage really should be a part of a wellness regime. A once or twice a month massage adds the balance and peace that so many seek. “It’s tough for me to see people who think of it only as a luxury, and don’t understand the healing aspect. Spiritual and emotional work can begin with your body. You don’t have to be a student of energy work for it to touch you. I think it’s amazing to work with people and see change in those who weren’t open to it.” Acupuncture Diana Hermann, Licensed Acupuncturist and

owner of Acupuncture of the Rockies, loves to change people’s minds. She’s had numerous success stories including one woman with colitis, who for years was unable to be further than a quick dash from a toilet (not to mention the occasional hospitalizations from blood loss). After a series of treatments, the woman was thrilled to report that she went hiking and camping with her friends, something she had been longing to do. Her colitis symptoms were completely gone. Of all the holistic modalities, acupuncture is becoming accepted by western physicians. The National Institute of Neurologic Disorders and Stroke recommends acupuncture and biofeedback as safe alternatives to medication for pain management. Another recent study from the American College of Chest Physicians recommends acupuncture for pain and nausea relief from the side effects of chemotherapy. Hermann, who has a master’s degree in Acupuncture and Oriental Medicine, reiterates her own experiences, “Doctors are becoming more and more open to acupuncture, and even some insurance companies are beginning to cover it.” An overwhelming amount of research has shown acupuncture to be safe and effective. Yet many people still resist considering it due to an aversion to needles. Hermann explains, “The needles are solid, flexible, and very thin (typically gauge 32 or higher in wire terminology). There is no injection of fluid, so there is no pressure. It really doesn’t hurt.” I can vouch for that. Hermann demonstrated acupuncture on both my hand and foot. It hurts about as much as a mosquito’s bite and after the needles are inserted you don’t feel them at all. Acupuncture comes from Traditional Chinese Medicine. The diagnostic approach is very different between Chinese traditions and western ones. In western medicine, doctors only treat the physical body. Chinese medicine views the bio-energetic

body. It of course considers the physical, but also recognizes that the mechanical functioning of the body is dependent on the energy within. According to an article Hermann wrote (that is shared on her website, www.acupunctureoftherockies.com), Qi (prounced chee) is a form of energy that exists within the body. (This is the same idea as the energy field or light body from Reiki and Healing Touch). Just as blood is carried through a network of blood vessels and electrical impulses travel along nerves, Qi runs along very specific pathways called channels or meridians. These channels are interconnected, to each other and to the organs. They distribute Qi throughout the body and serve as lines of communication between the organs. At various places along the channels that run closest to the surface of the body, there exist tiny portals where the Qi of the system can be accessed. These are the acupuncture points and each one has specific therapeutic functions. Acupuncture stimulates the energy within your body. By poking the energy with a microscopic needle, your brain pays attention and sends a signal to your body to heal the ailment. This is the goal with all holistic modalities – to help the body heal itself. Acupuncture can be used to treat pain, sinus infections, colds, allergies, nausea/vomiting, PMS, anxiety, insomnia, stress and many other ailments. Herbology Hermann is also an herbalist and she explains, “Chinese herbs can also be employed to adjust or balance the Qi and help heal the body of disease or prevent future problems from developing.” Her colleague, Melissa Osmun, is owner of Bethesda Wellness Centers in Windsor and Lakewood. Osmun, also a licensed acupuncturist and herbalist reiterates the message, “The body was designed to heal itself if given the opportunity. A good phy-

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holistic medicine sician must work in concert with that potential.” Herbal medicine works well in concert with acupuncture or can be used by itself. The herbs come from the Chinese medicine tradition and may have been imported from China but all products distributed by Osmun and other reputable herbalists must carry the Good Manufacturing Practice seal of approval. This ensures that the herbal supplements are produced free from toxins or “bonus” ingredients. Osmun elaborates on the herbs’ safety. “Chinese herbs typically have far fewer side effects than Western drugs, including over-the-counter medicines, such as Tylenol (Tylenol is very hard on the liver).” In general people using herbs should share everything they are taking with both their western physicians and their herbalists to avoid potential interactions. Osmun adds, “Interactions are very rare and occur mainly when herbs are abused.” Most of the herbs come to the Bethesda pharmacy in their plant form and are custom ground to powders that are mixed in custom formulas for each client. “My pharmacy consists of about 275 single herbs in concentrated granular powders that the patient can dissolve in water and drink. Herbs can also be taken as a decoction by sim-

Michael Sutton, Naturopathic Doctor

mering the raw ingredients and straining off the liquid to drink like a tea. Some commonly-used formulas come pre-made in pill form.” Herbs can be used to resolve or relieve the symptoms of a number of sicknesses like colds and flu, gynecological issues like fertility, fibroids or endometriosis, arthritis, asthma, and more. Osmun can also use nutritional counseling to help people balance their diet. She often works with diabetics to help maintain their health without medicines. Osmun explains that even people who aren’t

ne sick now, may still have areas of weakness or imbalance in their makeup. A regular supplement can be prescribed to bolster the immune system, as in the case of several school teachers that she helps. “They never get sick, even with all those children around.” Because the herbs are more gentle, they take longer to build up in the system and can take a longer time to work on chronic conditions than western pharmaceudicals. However, that same gentleness is what makes them far less toxic than even over-the-counter drugs most people take. Herbs are often used for children, for these reasons. “There are far fewer side effects. This natural approach gives us time to consider the underlying reason for the illness.” A qualified herbalist can make non-emergency trips to the doctor very rare. Osmun cautions that at least an initial consult with an educated herbalist is very necessary before consumers trek to their local health food store. “Have someone do a quick workup on you. It’s worth the time and money to have a qualified herbalist look for things you might not consider.” Osmun is like many of the holistic practitioners interviewed for this story who envision a health care system that embraces wellness as a goal and supplements traditional healthcare with these modallities to build a better network of care. “I want people to think about Oriental medicine as quickly as they would their regular doctors.” Naturopathy If there is a trunk to this holistic tree, it is Naturopathic medicine. Dr. Michael Sutton is a licensed naturopathic doctor, and owner of Sutton Naturopathic Health Center in Fort Collins. He explains, “Naturopathic medicine encompasses all the therapies with its roots in the healing power of nature. It approaches the whole person and their individual reasons for manifesting problems. Acupuncture, nutrition, herbal supplements all look at non-toxic ways to treat problems.” In Naturopathy, we try to take treatment a step further than you might see in a traditional medical practice. Beyond treating your symptom, I want to know why did it manifest in the first place? How did it start; where did you get off track?” Sutton spends 60 minutes on initial consults with new patients and at least 20-30 minutes at follow-up visits. The idea is to get to know patients and all that is going on in their lives. Knowing that emotional, spiritual, and physical health are all tied together, Sutton includes questions about what is really going on in patients’ lives. For example, patients with cancer often consult Sutton for help with the side effects of western treatment as well as to build their overall vitality to combat the cancer and keep it from returning once it’s gone. Sutton explains his approach to such cases, “Cancer is an abnormal cellular growth. It is the end result of things going wrong, which has often built up over years of negative medical, lifestyle, or environmental influences. I can help deal both with the environmental problems and the side effects of the toxic treatment.” Sutton investigates diet, physical environment, and physical exposures. He treats the known carcontinued on page 25

Northern Colorado Medical & Wellness

poudre valley health system’s

Medical Design Building

Just What the doctorS ordered by melissa katsimpalis

The RX for a strong healthcare environment: best-practice medical services, easy-to-access healthcare, and well-designed facilities that allow healthcare professionals to efficiently serve their patients.

he Redstone Professional Office Building, 2315 E. Harmony Rd., combines those elements. It is a first-class example of how progressive Northern Colorado healthcare professionals working together with an exceptional designbuild firm, can fund and design a building that delivers effective clinical and administrative operations the minute the doors open. Located on the Harmony Campus of the Poudre Valley Health System, the 72,319-square-foot

Randy Everett, M.D., Urology Center of the Rockies

Redstone building was designed by The Neenan Company to support the operations of PVHS’s Corporate Headquarters, Urology Center of the Rockies, Northern Colorado Plastic Surgery PC, Front Range Cancer Specialists, and PVH Laboratory and Surgical Specialists. As Randy Everett, M.D., Urology Center of the Rockies, says, “The collaborative nature of this project, as guided by The Neenan Company, allowed PVHS and each of the medical practices to participate in a step-wise design process. The

Randy Myers The Neenan Company President

Julius Medgyesy Front Range Cancer Specialists CEO

result is a building that provides a custom-design solution for each tenant and helps each of us achieve our goals and our bottom lines while providing central access among three hospitals (Poudre Valley Hospital, Medical Center of the Rockies, and McKee Medical Center). “In the case of our center, Neenan listened to our needs and addressed them as part of the design. For example, the center is structured in four pods around the doctors’ practices. This allows cross-coverage of our nurses and a smooth flow of patients.” The step-wise process to design-build is a specialty The Neenan Company has honed over its 35 years in the building-construction industry. “As the facilitator of a design-build project, we’ll initially look over the financial point of view and all the things involved,” says Neenan President Randy Myers. “We’ll look at the current market and test the viability of construction financing and the ability or interest of the client or, in the case of Redstone, the clients, to get involved. “From hour one, we explain the cost items in detail and issues related to construction loans. We present a reasonable budget to shoot for and then find design solutions to support client needs.” According to Myers, the Neenan goal in designing and building healthcare facilities is to improve patient throughput, reduce healthcare delivery costs, improve staff efficiency and patient care, and address the day-to-day needs of doctors, nurses and patients. “Our philosophy is to become a trusted adviser to our clients. With medical projects, you need to get a good handle on the true issues and needs and where costs could end up. This up-front work cuts a lot of financial risk and demonstrates that responsive design can actually allow more efficient function in less space than what practitioners may originally think.” In the case of the Redstone building, The Neenan Company further reduced the financial risk to the healthcare groups by serving as the project’s developer. Neenan brought together the diverse group of private enterprise, the hospital system and private-practice physicians, developed the property and then sold condominium units to each of the healthcare tenants. The advantage, points out Julius Medgyesy, CEO of Front Range Cancer Specialists, is instead of each healthcare entity separately building a 10,000-square-foot facility, they shared economies of scale, and the physicians saved significant

Steve Ellsworth PVHS Vice President for System Operations

Chris Tsoi, M.D. Northern Colorado Plastic Surgery, PC

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money on the space of their medical centers. “To cooperate and collaborate was really a win-win for everyone.” Steve Ellsworth, PVHS vice president for System Operations, echoes that sentiment. “The Neenan Company initiated the collaboration by understanding that several of the practices now housed in Redstone wanted to locate on the Harmony Campus but individually couldn’t accommodate the size of campus buildings as required under PVHS’s master plan for the Harmony campus.” In the case of FRCS, Medgyesy says, “We have been pleasantly surprised at how much common area we have. We’re not jam packed because FRCS’s design combines better work flow with increased patient-treatment area. The overall effect is a modern, comfortable facility that is patient friendly and tranquil. Our patients are overjoyed.” Another plus, says April Christensen, FRCS’s office manager, is the flexibility of the Neenan design process, which welcomes input from a range of end users. For example, FRCS’s nurses assisted in the design of the clinic’s entire patient treatment area, which features comfortable private rooms in inviting colors, a lab, nurses’ work area and a roomy, cheerful infusion area with large windows providing spectacular views of the mountains. Chris Tsoi, M.D., Northern Colorado Plastic Surgery PC, points out the Redstone building also creates an ease of accessibility to the patients who come there for consultation and care. “In many cases, a patient may need the services of more than one practice located in Redstone. The proximity of the particular medical specialties located here offers our patients a total package, which is better for them and for those of us who care for them.” Another advantage Dr. Tsoi cites is being housed with PVHS, which provides immediate access to patient records via high-speed electronic information transfer. “Neenan understood our needs as physicians to efficiently track our patients’ care whether from clinic to clinic or clinic to hospital. The building was designed to support state-of-the art information transfer.” All Redstone occupants agree with Dr. Everett of the Urology Center: “The Neenan Company’s true value is having vast knowledge of healthcare facilities needs. The company’s ability to coordinate a design and building process works because the Neenan folks spend lots of time listening. They have the ability to negotiate and bring to the table in a very tailored way different players and respond throughout the construction process to our individual needs so there are no delays through the design and construction process.” “All the little extras Neenan offers make the company a standout. Plus, the company’s ability to complete the Redstone building under budget and on time while designing to our needs was just remarkable.” Melissa Katsimpalis, published journalist and poet, and longtime public relations executive strategist, recently opened MUSE Consulting, mkatsimp@frii.com; 970-218-6115.

continued from page 21 cinogens with herbal supplements and looks to partner with the western tradition physicians to help the patient better tolerate the chemotherapy drugs and radiation, which are highly toxic. Some studies have even shown naturopathic remedies actually boost the effectiveness of chemotherapy. “It goes past treating the cancer. I try to cleanse their system. I don’t treat disease, but do treat and educate people in how to get back to a healthy state of being.” Sutton finds that the first time he sees patients they may have one problem they are seeking treatment for but have a host of other issues that haven’t previously been recognized as relating to the main issue. “People have a really intuitive sense about what’s wrong with them but no opportunity to piece it together. I often hear from patients, ‘I knew that but no one would ever listen to me.’” He attributes this confusion to a health system filled with specialists that all treat pieces but no one looks at the whole picture. “People are told that they’re crazy when they really have hormonal or metabolic problems. Because it doesn’t show up on a test, they weren’t listened to.” Sutton belongs to The Colorado Association of Naturopathic Physicians (www.coanp.org), which has a wealth of information on naturopathy, its origins, and methods. Sutton also suggests asking careful questions of any naturopath that you are considering consulting. While many like Sutton are well trained with four-year graduate degrees and residency training, the field is still working toward state-recognized licensure in all 50 states. The Colorado legislature has yet to approve it but has considered multiple bills on the topic. Thus, Sutton holds a license in Vermont, but is working with others to lobby for Colorado to adopt a similar system. Sutton recommends asking where your naturopath schooled, how long was it, was it on-campus (as opposed to a distance program), does he hold a license, is he involved in continuing education? A well qualified, highly recommended naturopath like Sutton can work wonders, as can many of the healers suggested in this article. … And Exhale Every practitioner interviewed for this story stressed that holistic care is a complement to western medicine, not a replacement of it. Each of them would want you to do your research. Learn about different ways to approach your health and wellness. Remember that because a therapy is unfamiliar to you, doesn’t mean it doesn’t work. After all, these methods have been very successful for three thousand years in Asia. All of these modalities really focus on one underlying concept: connecting mind, body, and spirit. The goal of holistic medicine is to achieve maximum well-being, where all of your body’s systems are functioning at their optimum. Think of them as strategies to cope with life’s crises, as ways to gain a little breathing room in your life.

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Northern Colorado Medical & Wellness

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patient education

Anesthesiology

Jan Gillespie M.D., of Northern Colorado Pain Management administers an injection.

physicians and surgeons refer their patients to anesthesiologists frequently, not only for epidurals but also other spinal region injections for back pain control. Patients who do not obtain pain relief from an epidural steroid injection may benefit from the many other types of injections that are now available. Orthopedic surgeons and neurosurgeons frequently refer patients for diagnostic and other types of nerve blocks. If the patient receives adequate pain relief from a steroid injection or nerve block, surgery can often be avoided.

Anesthesiology:

a patient’s guide

by Maryjo Faith Morgan

Pain, it gets your attention. Our body’s warning system effectively produces an instantaneous reaction. Instinct takes over. We jerk away from the source of the pain.

hronic pain, however, is not so easily remedied. As a society, we are increasingly aware of how appropriate pain management can improve the quality of life for those among us living day after day with constant pain. According to Jan Gillespie, MD of Northern Colorado Pain Management and Intermountain Anesthesia Consultants (IMAC), anesthesiologists utilize their expertise to address this long-neglected need. “Pain management is currently one of the highest priorities of modern medicine and

frequently requires a multidisciplinary approach.” She and her colleagues work closely with family practice physicians, surgeons, chiropractors and physical therapists in a team approach to pain management. For the patient, this collaborative effort can bring real solutions. Over the past decade there has been a stronger emphasis on pain management. The accompanying national attention has been a catalyst for more research. Advancements in interventional pain management allow options beyond the classic epidural injection. Primary care

Less risk than ever before in the operating room “Anesthesia is safer today than ever.” The stats Dr. Gillespie shares are pretty impressive. “In 1950, there were 18 deaths per 10,000 anesthetics. Today, only 1 in 200,000 patients die under anesthesia from anesthetic related complications.” She continues, indicating improved monitors and adjusted pre-op instructions as helping to stack the odds in the patient’s favor. “The pulse oximeter and other modern monitors alert us very early when a patient is not doing well, and give us more time to correct the problem.” In the operating room, it is the anesthesiologist who is charged with keeping the patient alive. However, patient comfort and convenience are also important. For example, the old rule requiring a patient to stop the intake of fluids as long as seven hours prior to surgery has been modified for normal weight patients to allow clear fluids (such as water, black coffee, or apple juice) up to two hours prior to surgery. The patient is more comfortable and there are fewer complications due to dehydration. Another detail that does not escape Dr. Gillespie is the fact that under anesthesia, there is not enough lubrication in the eyes. “Tears are not produced during a procedure, and corneas can easily be scratched.” A small amount of sterile Vaseline applied to the eye may cause the patient to be blurry-eyed upon awakening, but it will protect the eyes. Often patients coming out of anesthesia don’t have good eyelid reflexes yet, and the eyes can be unintentionally injured. Although a scratched cornea (the outer surface of the eye) usually resolves without any permanent damage in 24-36 hours, it can cause more pain than the surgical site! Prevention is always best. In the practice of medicine, there are countless procedures and surgeries that ultimately heal, but are painful. Today we face both complex and simple surgical treatments with confidence,

knowing that the anesthesiologist will keep us safe and pain free. We trust these highly skilled specialists to guide us through unpleasant but necessary procedures. Anesthesiologists, physicians who specialize in anesthesiology, typically have earned a college degree, and completed both four years of medical school and a four-year residency in anesthesiology. An anesthesia nurse, also known as a certified registered nurse anesthetist (CRNA), completes two years of additional training in anesthesia and works under a physician’s direct supervision. Use of CRNAs may enable one doctor to rotate through several procedure rooms. During a surgery or procedure, each member of the support team focuses on a particular task. The anesthesiologist is monitoring the patient’s every physical response – by the heartbeat, by the breath – making minute-by-minute decisions about appropriate choices and doses from a whole array of anesthetics, analgesics, and/ or muscle relaxants This use of what is called “balanced anesthesia” keeps the patient pain free and comfortable. It’s all good. Here in this millennium - no clenched jaws, no gnashing of teeth! Communication and Patient Education Patients and anesthesiologists routinely talk ahead of time about patient history, sedation, pain medication and nausea drug preferences prior to the surgery. Moreover, some patients ask the anesthesiologist to call them the evening before surgery for added assurance. According to Gillespie, it is not uncommon for patients who have previously worked with a particular anesthesiologist to request that same doctor for their next surgical procedure. It is encouraging to know that whenever possible, patient requests for a specific anesthesiologist are honored. Northern Colorado is very fortunate to have a large number of board certified anesthesiologists available. The patient education section on the American Society of Anesthesiologists (ASA) website gives comprehensive information and includes a downloadable checklist, “Anesthesia & Me.” This checklist helps patients organize medical/ drug history on one easy cut-out to keep in wallet or purse. The ASA has over 41,000 members and is the largest anesthesiology organization in the world. To find specific ideas on what to ask your doctor, visit: www.asahq.org/patientEducation. htm. Parents, check out the free downloadable Coloring Book designed to demystify the whole anesthesia process for your child: www.asahq. org/patientEducation/MyTrip.pdf. Some Basics An injury sends pain messages through tiny nerves at the injury site which move though to larger nerves and eventually to the spinal column, a direct link to the brain. It is the brain’s job to broadcast a warning. According to how severe

Northern Colorado Medical & Wellness

In 1950, there were 18 deaths per 10,000 anesthetics. Today, only 1 in 200,000 patients die under anesthesia from anesthetic related complications. - Jan Gillespie, M.D. -

the pain is, we react at high alert. Anesthesia blocks pain messages from reaching receptors in the brain, much as turning off the sound would render a klaxon silent. Whether the patient is in a deep controlled sleep or awake, pain does not register because anesthesia stops the sensations from reaching the brain. Tailored Levels There are different levels of anesthesia, which are tailored to the procedure and fine tuned to the individual patient. The depth of anesthesia is on a continuum. Dr. Gillespie warns, “The same dose of drug can produce conscious sedation in one patient and deep sedation or general anesthesia in another. There is a huge variation in the response.” Depending on the drug, it can be administered by inhalation or by intramuscular, subcutaneous or intravenous (IV) injection. For quick reference: Local Anesthetic: applied while patient is awake; drugs are injected near nerves to numb a specific area, which looses feeling. Patients may receive sedation in addition to the local anesthetic injection. Examples of use: dental work and skin procedures, i.e., mole removals or stitches. Sedatives: relieve anxiety, may have amnesia properties so patient will not have recall; can be used for preoperative sedation or in combination with anesthetics. Valium and Versed are among the most recognizable. Note that Versed is very popular because it does not burn going into a vein like Valium does, and it has a short half life, which makes it a good choice for some outpatient procedures. Versed and narcotics decrease a person’s desire to breathe. Therefore, respiration and oxygen saturation must be carefully monitored and the facility must have appropriate equipment and personnel to breathe for the patient if complications arise. Examples of use: in combination with anesthetics and blocks. Conscious Sedation: lightest anesthesia; patient is awake and will respond to painful stimuli, but may not recall the event; sedative medications are administered to cause a semi-

conscious state, also known as “twilight sleep.” Example of use: colonoscopies Regional Anesthesia or Blocks: patient is awake, may be sedated; complete loss of feeling below the site of injection. Examples of use: shoulder surgery (an interscalene block which numbs the shoulder may be added for post operative pain relief in addition to general anesthesia), spinal and epidural blocks are very common for total hips, knees, labor and delivery and C-sections. Deep Sedation: patient is unconscious, but is able to breath without assistance, depth of anesthesia may deepen during procedure and be considered general anesthesia briefly. General Anesthesia: patient is unconscious, needs assistance to breath adequately, receives intravenous medications and is usually given anesthetic gas through a mask or breathing tube, which ensures adequate breathing and clear airway; will not remember event. Example of use: abdominal or chest surgery. It is not uncommon after a general anesthetic for a patient to have a sore throat, if a breathing tube was used during the surgery. Gillespie reports that anesthesiologists today have options to minimize the risk of a sore throat. “I frequently use a small mask - a Laryngeal Mask Airway or LMA - that goes inside the mouth, but not down the throat.” In addition, new drugs we didn’t have just a few years ago treat another formerly common complication from anesthesia, namely nausea and vomiting. An anesthesiologist is a highly accomplished expert, with up to five years additional specialized training beyond medical school. This extensive training and knowledge reduces each patient’s risk, maximizes positive outcomes from surgical experiences, and reduces patient pain and suffering. Maryjo Faith Morgan, a local freelancer, invites visits to her website: www.maryjofaithmorgan.com.

patient education

breast health

We always hear about the latest and the greatest technology in the medical world, but what about the personal touch? How can we get the best care possible while getting technical procedures? One relatively new aspect to women’s healthcare is the Breast Health Nurse. The Breast Health Nurse is there to help women in need of additional testing after a questionable mammogram as well as with answering questions about breast problems and breast cancer.

Breast health nurse by Mary Scheid RN, MSN, OCN

Breast Cancer is still a leading cancer diagnosis for women, with an estimated 200,000 women being diagnosed every year with breast cancer. It is important that women have a good understanding of breast cancer and how it is treated and how they can help prevent it. Thus the Breast Health Nurse role was developed. This Breast Health Nurse will assist woman with a suspicious mammogram and help her through the process of tests and biopsies until the woman has a final diagnosis of a benign breast condition or a breast cancer. If a woman is diagnosed with breast cancer, the Breast Health Nurse will further assist her with appointment needs, education, financial needs and emotional support. The Breast Health Nurse can help guide a woman to the appropriate resources to fulfill her needs. She is there to

lend a helping hand, to listen to her concerns and to help address her problems. If a woman is in need of a Breast Health Nurse due to an abnormal mammogram, the Breast Health Nurse will be there to answer her questions and assist with her procedures. If the woman is in need of a breast biopsy by either mammography guided stereotactic biopsy, ultra sound biopsy or magnetic resonance imaging (MRI) biopsy, the Breast Health Nurse will be there to talk her through the procedure, to answer questions and to hold her hand. The Breast Health Nurse will also be there once the procedure is completed to explain how to care for her biopsy site, to let her know when she can expect her results and to assist her with questions about those results. The Breast Health Nurse is an integral part of a woman’s journey

patient education

breast health

Normal breast MRI

Abnormal breast MRI

Breast MRI

by Cindy Bergmeier

In March, 2007, The American Cancer Society (ACS) issued new guidelines recommending breast MRI in addition to mammograms for certain women considered to be at unusually high risk for breast cancer. As many as 1.4 million women fall into the affected group, according to an American Cancer Society estimate. The breast MRI, in addition to a mammogram and breast ultrasound, will give the high-risk breast cancer patient and her physician additional information that will enable early detection of breast cancer when it is easier to treat and the chance of survival is greatest. The Imaging Center has been providing breast MRI for women since opening for business in late 2000 and has evaluated approximately 1,000 Fort Collins area women. “There has been a notable increase in the number of breast MRIs done and we believe it

is due in part to the recommendation made by the ACS earlier this year,” says Rick Doritty, The Imaging Center’s Executive Director. Breast MRI uses Magnetic Resonance Imaging (MRI) to look specifically at the breast. Each breast MRI produces hundreds of images of the breast, which are then interpreted by a Radiologist. It is a non-invasive procedure that complements the standard screening methods of mammography and physical examination, and diagnostic exams such as breast ultrasound and diagnostic mammography. Breast MRI should be used in conjunction with, but not replace the standard screening and diagnostic methods.

Welcome to regarding breast health issues, helping her to better understand the importance of preventative care and assisting her physically and emotionally, both during and after the procedures, with emotional and educational support. In addition to helping each woman individually, the Breast Health Nurse is also a resource to all women and to her community. The Breast Health Nurse does educational talks for the community, assists at health fairs, run support groups and helps with developing educational materials related to better breast health. We all want the best technology when we have a medical issue, but we also deserve the best possible care and support when using that technology. The Breast Health Nurse is available to help women in getting the best possible overall care not only technically but emotionally and physically. Make sure you are getting the best care possible and check with your mammography center to talk with their Breast Health Nurse. She will be overjoyed to meet you and help you with any concerns you might have about better breast health. Breast Health Nurses are on staff regionally at Summit View Medical Commons in Greeley and at McKee Medical Center in Loveland.

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Mary Scheid RN, MSN, OCN is a Breast Health Nurse at the NCMC Breast Center located at Summit View Medical Commons, 2001 70th Ave. Greeley, CO, (970) 395-2582.

UĂ&#x160; Â&#x153;Â&#x201C;Â&#x201C;Â&#x2C6;Ă&#x152;Ă&#x152;i`Ă&#x160;Ă&#x152;Â&#x153;Ă&#x160;VÂ?Â&#x2C6;iÂ&#x2DC;Ă&#x152;Ă&#x160; satisfaction, high integrity and results! In breast cancer patients, breast MRI may detect additional sites of cancer in the affected breast or cancer in the opposite breast, not detected by mammography or breast ultrasound. â&#x20AC;&#x153;Statistically speaking, MRI detects on average 10-25% more of the significant diseases and changes management in 20% of patients,â&#x20AC;? notes Dr. Richard Pacini. â&#x20AC;&#x153;In addition,â&#x20AC;? states Dr. Deborah Gunderson, â&#x20AC;&#x153;breast MRI is a powerful imaging tool when used to problem-solve challenging breast imaging cases [such as dense breasts], and for breast surveillance and treatment response evaluation following a diagnosis of breast cancer.â&#x20AC;? Dr. Gunderson adds that MRI as a breast cancer screening method for low and medium risk patients could lead to additional costly imaging and unnecessary breast biopsy, since it also detects non-cancerous lesions in the breast. Cindy Bergmeier is Marketing Manager at The Imaging Center. Contributors to the article included Deborah Gunderson, M.D. and Richard Pacini, M.D. of Advanced Medical Imaging Consultants.

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dental specialist

endodontics

Brad LeValley, D.D.S., M.S. works with Tiffany Brunmeier to perform a root canal on a patient.

endodontics high-tech dentistry with a smile

by Julie Estlick

Imagine you’re lying in a chair, massagers working the kinks out of your back as you watch your favorite movie on a flat screen T.V. Now picture yourself in the same relaxing pose while getting digital X-rays and a root canal. At Northern Colorado Endodontics’ (NCE) new state-of-the-art facility, high-tech equipment and the personal touch are integrated in a serene setting to make once-painful dental procedures virtually painless.

orthern Colorado Endodontics has been on the cutting-edge of endodontic treatment, or root canal therapy, for the past 10 years. Partners Dr. Brad LeValley and Dr. Shane Bergo were the first in the region to use digital radiography and microscopes, making procedures shorter and easier to understand for the patient. Nearly all of their patients are referred by area dentists and up to eight a day are emergencies. “Dentists send their patients here because we can get them comfortable and out of pain fast,” LeValley says. “With all the high-tech advances, a root canal is no more painful than having a filling done. Patients arrive at our facility and are pleasantly surprised that they can sit back and listen to

their iPod or watch cable T.V., turn us off and let us do our thing.” When a patient comes in for a root canal, they’re given local anesthesia and a rubber dam is placed over the tooth to isolate it. An opening is made in the crown of the tooth and the canals are cleaned, shaped and filled with a rubber-like material to seal the tooth. Finally, a temporary filling is placed in the opening. Digital X-rays, now the standard in endodontics, provide greater magnification than traditional X-rays and the results are immediate. Patients get a chance to view X-rays before and after their treatment to see what’s been done. The images are then easily communicated to the referring dentist’s office, where the patient will return

within six weeks for a permanent restoration. “Digital X-rays are magnified onto a computer or T.V. screen that is 30 times larger than the X-ray itself and we can manipulate what we see,” LeValley says. “I can adjust the contrast so the dark is absolutely dark and then we see the white of the tooth easier. Or we can manipulate the positive/negative setting so we can pick up the little canals in the teeth.” Digital microscopes, outfitted in six of the seven spacious rooms, magnify 25 times and offer excellent lighting to look right down into the tooth canal. The microscopes are essential in surgery and so are microsurgical instruments which have replaced old-fashioned hand tools. The ultrasonic nickel titanium instruments vibrate with a high frequency and allow for small, precise cutting so less of the tooth structure is removed. “A good portion of the root canal procedure is done with a hand piece which is faster and can follow the anatomy of the root or canal so there is less time in the chair for the patient,” LeValley says. “All of these advances in instruments and equipment allow us to save more natural teeth, which is important for a patient’s overall health.” Although regular dentists are trained in endodontics and most perform some root canals, the many advances in the field have resulted in more difficult cases and, thus, referrals to specialists. Endodontists do additional training to get their Endodontic Certificate and earn a master’s degree in science or dentistry with a focus on endodontics. “We have almost 100 percent referrals,” says LeValley. “With all the complexities in endodontics, dentists prefer to have us do a consultation or the work. We determine whether someone needs a root canal or tooth extraction or maybe the tooth is O.K. and there’s another problem. We do a lot of diagnosing.” The old office space had great views of a pond, but when they outgrew it they sought the expertise of Dr. Michael Unthank, an architect and dentist. Unthank, considered a guru of dental office design, runs a dental design firm in Lincoln, NE, and does between 80-85 dental offices a year. “When planning a dental facility, it needs to reflect the doctor’s personality and where and how they will use their equipment,” Unthank says. “Drs. LeValley and Bergo specifically wanted an attractive office with plenty of privacy for conversations with patients and screening of rooms from other patients. With an existing suite, the challenge was to get all of the equipment and monitors in the right place and size so it all flows without compromise for the doctors, staff or patients. I think their space works really well.” LeValley concurs: “The excellent design and added space gives us much more flexibility, a larger sterilization area and just a better overall layout. Now we can help more patients feel better, faster.” Julie Estlick is a freelance writer living in Fort Collins.

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radiation oncology

radiation therapy Gwen Lisella, M.D. of Poudre Valley Radiation Oncology consults with her staff.

rays of hope by Stephanie Eyster

Marie Curie once said, “Nothing in life is to be feared, it is only to be understood…so that we may fear less.” Curie was fearless in her dedication to understanding and developing the use of x-rays in medicine. In her devotion to the science, Curie endured repeated radiation exposure which may have eventually caused her death from cancer because the beams of radiation were uncontrolled and unfocused.

urie would be in awe of the progress that modern science has made in her field. New technology provides for the shaping, modulation, and guidance of the high-energy radiation beams, greatly improving the treatment options and prognosis for cancer patients. Today, more than two-thirds of all cancer patients in the U.S. receive radiation therapy as part of their treatment plans which may also include surgery and chemotherapy. Karen Hunt, a breast cancer survivor, experienced all three. She underwent a double mastectomy two days after being diagnosed with a tumor in her left breast. She then received chemotherapy for seven months before begin-

ning the final, and most frightening stage of her treatment, radiation. “I was terrified lying on that table and looking up at the x-ray machine,” she says. “What if it moves and hits my heart?” Hunt’s fears were met with understanding and compassion by the radiation therapists at Poudre Valley Radiation Oncology. Hunt recalls, “I went in for my treatment, exposed my chest and then just sobbed. The therapist held my hand until I stopped crying. She said, ‘I can’t imagine going through all of this.’” Hunt’s radiation oncologist, Dr.Gwen Lisella, has been treating cancer patients in Northern Colorado for thirteen years. Lisella explains that radiation therapy is the use of high-energy beams targeted to cancer cells to either kill them or de-

crease their growth. “The most important goal of the therapy,” says Lisella “is to deliver dose to the tumor region while limiting dose to critical structures.” The first step is to clearly identify the tumor location and volume using a variety of scans such as CT or MRI, but with these modalities it is sometimes difficult to see the edges of the tumor. One of the biggest advances in identification involves the use of the PET scan for certain types of tumors which, when merged with the CT, clearly defines the tumor’s exact location. “The PET scan has been great; with it, the tumor lights up like a Christmas tree,” Lisella says. Once the tumor is defined and located, an overall treatment plan must be decided upon.

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Linacs have incorporated the ability to obtain CT scan or other images into the actual delivery system; some can even track a moving target such as a lung tumor which changes position with inspiration and expiration. The patient will usually meet with a surgeon, a medical oncologist, and a radiation oncologist to discuss options. Working together, these specialists will recommend the best treatment for the patient. In the case of cancer, radiation therapy may be used to destroy a tumor that cannot be surgically removed, to kill small amounts of cancer that might remain after surgery, or to control growth in areas when there is a high chance of recurrence. In some cases, the goal is merely to slow down the cancer growth or to reduce the symptoms caused by growing tumors in order to relieve pain and to improve the patient’s quality of life. For maximum effectiveness, radiation beams must be aimed accurately at the same target each time treatment is given. Keeping in mind that the high-energy beams, called photons, do not bend, it is necessary to shape the radiation to the tumor and keep the rays from hitting normal tissue. “Photons are not magical. It is the complexity of the delivery system which allows conformity of dose to be achieved,” Lisella emphasizes, as she describes another of the latest and most important advances in her field: Modern radiation machines have a built-in dynamic blocking system called a multileaf collimator (MLC). This machine, used in combination with advanced software programs, allows for changes in the size, shape, and intensity of the radiation beam to conform to the size, shape, and location of the patient’s tumor. This delivery technique is known as intensity modulated radiation therapy (IMRT). This technology is fantastic, but it requires us to be more careful, now more than ever, in properly locating the tumor. With the IMRT plan we have regions of very high dose adjacent to regions of very low dose. A large dose gradient is created which could be very problematic if there is any motion of the tissues in the treatment region. Both prostate and lung tumors

can change location from day to day. Enter the latest advancement-- IGRT, image guided radiation therapy. This treatment will be guided by imaging technologies such as X-rays, CT scans, or MRIs, not only in the planning stage, but at the time of treatment, helping to assure the accuracy of each treatment procedure. Many of the newly designed radiation machines called Linacs have incorporated the ability to obtain CT scan or other images into the actual delivery system; some can even track a moving target such as a lung tumor which changes position with inspiration and expiration. Lisella is clearly in awe of these newest developments. “The amazing thing about radiation is where the technology is going.” Just like cell phones and iPods, the Linac treatment machines, planning computers, and software programs are continually being upgraded and improved. The rapid advancement in radiation makes it difficult for patients to keep up and, as with other technological advances, there are misunderstandings and misconceptions. Many people fear that external beam radiation treatment will make them radioactive and dangerous to their loved ones. This is not true. The powerful rays hit the cancer cells and then pass through the body. Treatment is painless, lasting only a few minutes, and most often administered as an outpatient service in a radiation facility. Since no hospital stay is required, many cancer patients are able to continue working if their employers are flexible. Treatments need to be given five days a week for two to eight weeks depending on the type of cancer. Some patients worry that the radiation will affect parts of the body that haven’t been treated, but because the high-energy beams are so precisely managed, side effects, other than fatigue, are localized. Stomach cancer patients will become nauseous, throat cancer patients will have difficulty swallowing, and brain tumor patients will lose their hair. After radiation treatment to her breast tissue, what Hunt experienced in terms of a side effect was much like severe sunburn to the skin on her chest and back. “It was the fatigue that was difficult. I would wake up from a long nap or ten hour night and still feel tired.” There is no doubt that fighting cancer requires a tremendous physical and mental effort but the experience is life changing. Hunt says, “Nobody wants to have cancer but the people I’ve met along the way have been incredible; Dr. Lisella, the radiation therapists, and the other survivors are now my friends. I was actually emotional, and a little sad, when my radiation treatments ended. I had seen these providers five days a week for seven weeks and not seeing them every day was going to be an adjustment.” Providing a level of care and compassion that can make a negative situation not only tolerable, but positive, is the goal of Poudre Valley Radiation Oncology. Despite the latest advancements in radiation therapy, it is normal for patients to be scared and anxious. “We try to alleviate their fears and make them feel comfortable, like part of our family,” says Lisella. “It is a very difficult time in the patient’s life and we do everything we can to care for them. I believe in the effectiveness of the treatment I provide and I feel privileged to be involved in my patients’ lives.”

Amy Hulstrom, M.S., PA-C, Kevin E. Bachus, M.D., FACOG, Shari Olson, Ph.D., Bonnie Overholser, PA-C

Stephanie Eyster is a freelance writer who lives in Fort Collins.

Northern Colorado Medical & Wellness

otolaryngology

head & neck

Sarvjit Gill M.D. of Alpine Ear, Nose, and Throat examines a patient.

Head & Neck cancer

by jason Webb

A persistent cough. Difficulty swallowing. A permanent change in your voice. What do these three things have in common? They’re all symptoms of head and neck cancers. But, for many people, these symptoms are just an annoyance – something they assume will eventually just go away. The fact is, however, that they could be pointing to a potentially life-threatening disease.

amily doctors and dentists can usually find the most obvious forms of head and neck cancers, like a sore in the mouth or a lump in the neck. However, there are cavities in the head and neck that cannot be seen without the use of special instruments that allow the physician to see into some of the tougher spots. So, how can someone with concern about an issue find out if they have a problem? First, they could schedule an appointment with an ear, nose, and throat specialist. Often, though, people can’t get off of work or don’t have insurance to cover the office visit. Yet, there is another option. For the ninth straight year, Dr. Sarvjit Gill of Alpine Ear, Nose, and Throat is coordinating a free

head and neck cancer screening in Northern Colorado. This year’s screening will take place November 10 between 8:30 a.m. and 4:30 p.m. in the Loveland office of Alpine Ear, Nose, and Throat, 3820 N. Grant Ave. “It’s a chance to educate the public and detect cancers early in their development,” says Gill. Each year of the screening, doctors and nurses from around the community volunteer their time to participate, and the benefits are not just for the patients. “We all get a lot out of it, and we can help relieve a lot of fear,” says Gill. “It’s also educational for the providers, since they get a review of the proper procedures for checking for head and neck cancers,” says Gill.

Where most general practitioners won’t have all of the necessary tools to do the screening, the offices of Alpine Ear, Nose, and Throat do. With various scopes and mirrors Dr. Gill and his staff will be able to see areas that normal evaluations from the family doctor cannot. Head and neck cancers, according to Gill, often start in spots that are very difficult to check, but he does believe that the family doctor and the dentists can act as an early warning system by being aware of any lesions. Consider the impact of cancer in the head and neck. With all of a person’s senses found in the head and neck, cancer can be devastating, suggests Gill. The American Cancer Society estimates nearly

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1.4 million new cases of cancer will be diagnosed in the United States in 2006. Of those cases, the American Cancer Society estimated 564,830 deaths. The goal of the screening, however, is to catch cancer early before it becomes fatal. â&#x20AC;&#x153;Early detection of head and neck cancers is essential in ensuring a favorable prognosis and optimal functional outcome,â&#x20AC;? says Gill. Gill also says that people who smoke or consume excessive alcohol are at a higher risk for developing head and neck cancers. However, in some cases, like in the tonsils, cancer can be caused by a virus. Gill states that while there is no specific procedure someone can do for a self-exam, there are noticeable signs of which one should take note. The signs and symptoms of head and neck cancer include a lump or mass, voice changes, chronic sore throat, frequent nosebleeds, fluid in the ear, a sore in the mouth, persistent cough, difficulty swallowing, or a skin mole or lesion which is changing in size or color. â&#x20AC;&#x153;Anyone with a concern above their collarbones can come and get checked out,â&#x20AC;? says Gill. Gill stresses that the providers at the screening will try to make sure that anyone who has a concerning lesion will be instructed to follow-up with their own personal healthcare provider. He also says that anyone who does not have a doctor will be referred to one of our community clinics for appropriate care. Contact information and personnel from these clinics will be available at the screening. â&#x20AC;&#x153;Many of the participants will have their fears alleviated,â&#x20AC;? says Gill. According to Gill, since the first Head and Neck Cancer Screening, the doctors and nurses have seen roughly 1,500 people, and each year they find roughly 10 to 15 people with conditions requiring follow-up with a family doctor. Of those people, three to four might have a malignancy. When you consider the exams the providers will perform could cost around $200 for an office visit, Gill estimates that the free screenings has saved people in the community in excess of $300,000. Beyond the screening, Gill says there will also be programs and resources available for people who wish to quit smoking. On the importance of the screening, Gill says, â&#x20AC;&#x153;Every year we find cancer in someone who otherwise may not have sought a medical examination. The bottom line is, every year this screening saves lives.â&#x20AC;?

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Northern Colorado Medical & Wellness

family & pediatric

Medicine

Top kid illnesses When to Go to the Doctor by Lynn M. Dean

“Mommy, I don’t feel so good,” croaks your little one in a raspy voice. You look down and see tired eyes and the crusty evidence of a runny nose smeared across her face. You place the palm of your hand against her forehead. No fever. Then you wonder, Should I just settle her in for a day on the couch, or should I take her to the doctor?

t’s probably too soon to take your child in, say local doctors. “Many viral illnesses will run their course,” says James Seeton, M.D., who practices at Loveland Urgent Care, Mountain View Family Medicine and is the Medical Director of Harmony Urgent Care. “One of the biggest healthcare costs that people have is coming to the doctor with viral illnesses.” Viral and bacterial illnesses flourish in the winter months when our kids spend more time indoors where those nasty germs proliferate. So when should we really take our kids in? Dr. Seeton and Dr. Kirsten Sampera, M.D., FAAP, a pediatrician at the Fort Collins Youth Clinic, review the top common childhood illnesses and give us some rudimentary guidelines to answer that question. Fever: In the first month or two of life any fever over 100.4 degrees should be checked out by your doctor. For older kids, “we look at whether a fever is low grade (101-102 degrees) or high grade (103 or higher),” says Dr. Sampera. “Generally low grade fevers are associated with a viral illness (that will pass on its own) and the higher fevers with a bacterial infection (that may require antibiotics). The important thing is to determine what the cause of the fever is. A high grade fever needs to be evaluated.” The Common Cold (Upper Respiratory Infection): “You don’t need to go to the doctor for routine upper respiratory infections,” says Dr. Seeton. Dr. Sampera agrees. “Parents should know that the typical cold lasts as long as ten days and a cough can persist for up to three weeks after the onset of symptoms. If they have any concern that this is something other than the common cold, we should talk to them, or see the child. For instance, do they think there is an asthma exacerbation, pneumonia or an ear infection?”

Sore Throat: “Generally if the child is coughing, it is not strep throat,” says Dr. Sampera. “The great majority of sore throats are caused by viruses.” She says to suspect strep if there is white pus on the tonsils or tiny dots on the soft palate. If you suspect strep, make an appointment to see the doctor. Croup: “Croup is something we do see a fair amount of,” says Dr. Sampera. “Typically parents tend to bring the children in during the day. But children with croup look and sound worse at night. Cool humidified air helps relieve cough due to croup. Parents should look for signs of distress. Is the child breathing more rapidly? Working hard to breathe? Are the nostrils flaring? Does the child look scared or poorly responsive? Parents need to seek medical care for any signs of respiratory distress.” Stomach Flu (Gastroenteritis): This illness presents with vomiting and/or diarrhea. “Usually if the vomit has blood or bile (bright yellow or green) the child should be evaluated,” says Dr. Sampera. Likewise if there is blood or mucus in the stool, or if there is a concern about dehydration. “Signs of dehydration include not making tears when the child cries, or not urinating normally (decreased urination or dark urine),” she explains. Dr. Seeton agrees. “If kids are getting significantly dehydrated – if they get dizzy when they stand up or they are really lethargic, then they need to come in.” Dr. Seeton says we need to pay attention to our gut (pardon the pun) on this one. “When parents say ‘my child is not himself’ or ‘I’ve never seen him this sick,’ we encourage them to bring the child in.” Ear Infection (Otitis Media): These are painful and leave your child inconsolable. If you suspect an ear infection, you should call your

practice’s phone nurse, or take your child to the doctor. “Because many ear infections resolve on their own, antibiotics are no longer prescribed for every ear infection. However we always want to treat the pain,” says Dr. Sampera. Rash: “Parents should call their doctor if their child has a rash that concerns them,” says Dr. Sampera. Often, the doctor will have you come in to check it out. “ If you suspect the rash is chicken pox, be sure to notify your doctor before going to the office,” she suggests. Abdominal Pain - “Abdominal pain can mean a whole range of scary things for kids, depending upon their age,” says Dr. Sampera. “If the child is in severe pain and is not eating and drinking, he or she should be evaluated.” It’s important to remember that these are just guidelines, and even with them, it may be hard to decide when to take your sick child in to see a doctor, and when to just keep them snug and warm at home. In these instances, Dr. Sampera says it’s better to be safe than sorry. “I would rather see patients unnecessarily, than to have them at home when they really need to be seen. We’re lucky (in our practice) to have a great phone nurse triage system, and we want to hear from parents when they have questions and concerns.” If your doctor’s office doesn’t offer a triage nurse service, or if you have questions after hours, a nurse is on-duty 24/7 at the Poudre Valley Nurse Line. Call 1-800-943-9066.

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

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Northern Colorado Medical & Wellness

exercise and sports

Medicine

Tom Sachtleben, M.D. examines Adam Follett, a running back at Rocky Mountain High School, on the sidelines.

sports medicine by jason webb

Imagine two high school football teams facing off in the third quarter. It’s third and four, and the offense is driving behind a powerful running game. The quarterback breaks huddle, the play called in. Under center, he looks at the defensive formation. He sets. The ball is snapped. The quarterback pitches the ball to a sweeping running back. As the running back passes the line of scrimmage, a linebacker comes free and dives to make the tackle. He hits low; the running back’s foot is securely planted. After the pile-up, the running back grasps his knee as his teammates come over to check on him. Enter the medical staff.

very autumn Friday night across the country, lights illuminate the playing fields. And, on the sidelines are athletic trainers and a well-trained medical staff volunteers who love the sport. Several doctors and athletic trainers cover the football games in Fort Collins, Loveland, and Windsor. All are ready to jump into action the moment a player is injured. It’s their job to make sure the players are taken care of, and the medical staff has to know how to handle a lot of different injuries. One veteran of a football medical staff is Dr. Tom Sachtleben, a family doctor from Associates in Family Practice. Sachtleben has been a doctor in Northern Colorado for three years and, before that, spent seven years in other parts of Colorado.

He provides medical services to the Colorado Eagles and Colorado State University’s volleyball and basketball teams. Locally, he spends time on the sidelines of high school football games. “Most of the high school injuries come from soccer and football,” says Sachtleben, who adds there are also repetitive-use injuries common in baseball. Besides the medical education and training Sachtleben completed to become a family practice doctor, he also participated in a sports medicine fellowship, which gave him specific training on how to identify specific injuries. “I see a lot of knee and ankle injuries and quite a few shoulder injuries in high school athletes,” says Sachtleben.

Some injuries, according to Sachtleben, can be prevented with stretching in warm-ups and proper preseason conditioning. The best way, according to Sachtleben, to help a student avoid injuries is through a conditioning program. “A high school athlete’s body takes time to adapt to the additional stress you get from participating in sports,” says Sachtleben. Another doctor who spends time on the sidelines for Loveland High and Thompson Valley High home football games is Dr. Dale Martin, an orthopedic surgeon from the Orthopaedic Center of the Rockies. Like Sachtleben, he completed a fellowship in sports medicine. Martin, who performs surgery at McKee Medical Center in Loveland, at the OCR Surgery

Center, and the Skyline Surgery Centers, has seen a variety of injuries while volunteering his time as medical staff for high school football. “In contact sports, any manner of things can happen. Common knee injuries are medial collateral ligament injuries and anterior cruciate ligament injuries,” says Martin. With the medial collateral ligament injuries, Martin says no operation is necessary, but it does require around three to six weeks of physical therapy, wearing a brace, and rest. The anterior cruciate ligament, however, is another matter. When a player damages the ACL, the ligament requires surgical reconstruction, and the player’s season is over. According to Martin, the medical staff at football games works to recognize and evaluate an injury quickly. With quick recognition, the player can often return to the field more quickly. And, like Sachtleben, he believes there is one good way students can avoid injuries. “The best way to prevent injuries is a good preseason workout program,” says Martin, who also is a team doctor for the Colorado Eagles and the Colorado Ice. The athletic trainer is a vital piece of the sports medicine team that should be in attendance at every game in every sport. “The important thing is that there is a skilled certified athletic trainer present for initial injury evaluations, as well as for pre-event taping.” Backing up Sachtleben and Martin on the side lines of high school football games is always an ambulance to take student athletes, who may have suffered a serious injury or those requiring immediate medical attention, to emergency care. The final piece in the treatment cycle of an injured student athlete is the physical therapist. Marla Tappy has been a physical therapist for 13 years and is also a Certified Athletic Trainer. She holds a bachelors’ degree in athletic training and a masters’ degree in physical therapy. Her job is to get injured student athletes back to full health. Tappy lists two types of injuries that are common in sports: the acute injuries, like the ACL injuries Martin repairs, and the chronic injuries, which are overuse injuries. And, she agrees with Sachtleben and Martin that the best way to prevent injuries is by proper off-season conditioning. Off-season training should focus on flexibility, balance and reaction activities, strength training, and proper technique. With the initial treatment of acute injuries, Tappy says “It’s important to know the RICE principle: rest, ice, compression and elevation.” In addition, coaches and parents should be well aware that extremely painful injuries and obvious deformities need immediate medical attention. “If the kid is really miserable, or the bone or joint seems deformed, take them to see the doctor,” adds Tappy. With chronic injuries, the best method of treatment is to address the biomechanical cause of the injury. Tappy says that improper technique and poor mechanics are often the reason why athletes develop conditions like tendonitis. Correcting the movement dysfunction will often cause the pain associated with the condition to resolve with little more than ice and a few exercises. Besides learning proper technique and following a good off-season program, Tappy believes there are other ways to help prevent a child from getting injured. She states that it’s important to not challenge kids too early, as it can expose them to risk. Tappy says, “A nine-year-old has no business throwing a curveball or throwing 100 pitches in a game.” There’s a wide variety of growth-related conditions that kids are prone to, and excessive exposure to complex forces can cause problems to occur early. The most important factor for all medical staff working in sports medicine is the safety of the athlete. Tappy says that if there is a chance of long-term damage, she reasons with the athlete to convince him or her not to play. “It’s better to take two weeks now than a lot of time later,” says Tappy. As Tappy notes, coaches are often under a lot of pressure and tend to subtly try to encourage injured athletes to play. Even with young teams, there are expectations that teams will do well or win consistently; that requires availability of key players, even if they are hurt. Plus, the athletes themselves can be quite driven. If they get injured, do they miss games and

Northern Colorado Medical & Wellness

Patient, Carisa Alan, rehabs her knee with Marla Tappy, P.T., after damaging her meniscus.

possibly lose their position, or do they try to keep competing? That’s where the importance of communication comes in. According to Tappy, communication is important when dealing with injured athletes. Coaches, parents, and the medical professionals need to clearly communicate with each other and the athlete in order to keep kids safe and healthy. “Kids have access to great medical resources through the athletic programs at the schools,” says Tappy. She states that it is never recommended to just “suck it up and wear a brace.” The medical professionals that cover high school games are all highly trained. They know how to identify injuries and offer the best treatment for the student athlete. However, if you have concerns about your child getting injured while competing in sports, talk to your child’s school. Information about topics ranging from strength and conditioning programs to on-site sport medical care are readily available through the athletic departments. Finally, don’t forget to speak to your child’s primary care physician. Keeping your athlete healthy should be a team sport.

Jason Webb is a freelance writer who calls Johnstown home.

therapy

mental health

A common question is ‘what will we DO in the sessions?’ We will talk about what the nature of the problem is, is it global, i.e. does it occur all the time or is it situational, occurring only sometimes? - JJ Levy -

Sexual Challenges? Sex Therapy Can Help

by jj levy

The phone rings. It is Jane Smith saying she isn’t sure but she thinks she would like to make an appointment. Maybe it will be just for her, maybe it will also be for her husband, John, but then again, maybe they don’t really need therapy, maybe they can’t really get any benefit, and what do we actually DO in therapy?

can feel all the questions, doubts, fear, and guarded hope that goes into such a call. My heart goes out to her and I want to make it as easy as possible. I approach these situations with warmth, gentleness, and, if possible and appropriate, a sensitive use of humor to ease her anxiety. I ask her if she has privacy at the moment, and, if so, to share with me the nature of the problem, unless she prefers to do so when we meet. I also inquire as to whether she prefers to meet alone at first or to have John join her. I suggest that she consider what would be best for him as well. It would be unwise to meet alone with her if he would feel at a disadvantage to come in

later. Thus, we have already started the process of therapy: exploring what is awry and how to comfortably and effectively address it. Jane wondered if I also offer couples therapy. I assure her that sex therapy is a sub-specialty of couples therapy and we will be attentive to all that occurs of importance to them as there is a synergy between the sexual relationship and a couple’s broader relationship. It is usually stressful to seek psychotherapy. Can you imagine how much more stressful it is to seek sex therapy? A common question is “what will we DO in the sessions?” We will talk about what the nature of the problem is, is it global, i.e. does it occur all the time or is it situational, occurring only sometimes? If it is the former, I always

refer for a medical evaluation to rule out any possible underlying medical problem. I also always evaluate for the sexual side effects of medications that either partner is taking as well as for depression or other emotional factors affecting sexuality. Even when there is a medical condition interfering with sexual functioning, I can assist with the habituated patterns couples develop as a coping mechanism to deal with the sexual problem. These often become entrenched and interfere with change even after the medical issue is resolved. I assure them that they will never do anything of a sexual nature in the sessions. I inform them that it is illegal and unethical for any psychotherapist to allow it. I will also ask the Smiths what steps they have taken to resolve the problem, what has/hasn’t worked in those endeavors and invite them to contemplate the question “What do they think is in the way of having the sexual relationship they desire?” The Smiths may know much more about this than they were aware of. My role, in part, is to facilitate this discussion. I can contribute by helping both partners understand better how their sex role socialization, in other words, how they were raised to be a man or a woman, impacts how they interact sexually. I am interested in knowing how their faith affects their sexual beliefs and whether they had a sex-positive or sex-negative sex education... or none at all. Regardless of the type of sex education they received I will assume that

there are gaps in knowledge and discomfort surrounding the exploration of sexuality that affects the couple. I will help them find ways to respectfully and honestly express what interferes, on the psychological level, with reaching a richer sexual relationship. Then they can make changes that will be mutually rewarding and enduring. Another common question, asked in one guise or another, is, “Am I normal?” Just under the surface of this question resides fear and shame. Thus, the reason that seeking sex therapy can be such a courageous act. Our work together will always be targeting the reduction of fear and shame whether we are talking about these emotions explicitly or not. I remind couples who seeks sex therapy that sex occurs within the context of their broader relationship. Therefore, we

will use both a “wide angle lens” to explore how the rest of their life affects their sexual relationship, and a “zoom lens” to focus more on sexual aspects of their relationship. Some couples are more comfortable discussing the specifics of their sexual expression than are others. The important part is that we discuss the mindset that surrounds their sexual behaviors. For example, the majority of men speak of their sexual “performance.” I speak of their sexual “functioning.” If, for example, John Smith has a problem with sexual functioning, e.g. erectile difficulties, rapid ejaculation, or delayed ejaculation, I will speak of the importance of focusing on pleasure vs. performance. Jane will probably be preoccupied with how John is feeling and John is probably equally preoccupied with how Jane is

feeling. We all know that worry and preoccupation are not aphrodisiacs. Everyone at some point in their lives has a sexual doubt, fear, difficulty with functioning, and a wish to have validation that his or her struggle is common. So do the Smiths. An early concern of the Smiths was that I might not have ever seen anyone with as unusual a problem as they believe theirs to be. They report having what author, Jack Morin, refers to as “troublesome turn ons,” a source of sexual excitement that lies outside one’s sexual value system. Here is shame again with all its attendant agony. This gives us an opportunity to explore Core Erotic Themes (CET), which Morin suggests everyone has. A CET is a theme that tends to be a consistent source of arousal. It can be manifested in a variety of fantasies yet be thematically constant. A partner’s CET may or may not match their partner’s. When the partners understand that this is not personal, it is not a rejection, there is the opportunity to find ways to collaborate on expressing their erotic selves together. The Smiths were fascinated to realize that each person has their favored style of sexual expression, e.g. some are more partner-engaged, some want a trance-like internal focus, and others prefer role-playing in their sexual interactions. John preferred a partner-engaged style, in which he liked to talk, keep his eyes open and experience Jane as very engaged with him during their sexual play. Jane, on the other hand, found this style disruptive to her desire to turn inward and focus on her feelings, eyes closed, and quiet. Neither felt rejected when they realized that these were merely differences that could be intrusive. With this knowledge they became flexible in moving between these styles. I believe that sex therapy must focus on erotic richness in order to have enduring benefit. Erotic richness is that which permits a person to feel most vitally alive, connected to oneself, nature, the universe, and to another. The Smiths were relieved to discover that they could feel better emotionally and sexually with each other without resolving every aspect of their sexual differences. They let go of the argument regarding measurable change, i.e. frequency, type of sexual engagement, etc. when they realized that those debates were less about the sexual activities and more about how loved, wanted, trusted, etc. they were. This helped them let go of the struggles with power, control, and anger that had previously permeated their attempts at improving their sexual as well as the rest of their relationship. This took time and patience. They realized that if they had persisted in their early exclusive focus on their sexual relationship that they would have missed creating the fuller relationship they now enjoy. This is a challenging aspect of effective sex therapy. The Smiths, like most seeking sex therapy, longed for a ready answer that would quickly improve their sex life. They learned something far more useful, that the most rewarding sex comes from some place in the mind that gets translated to the body. Frankly, it was a privilege and a pleasure to work with them. This is the delight of a sex therapist’s work, to see a couple like the Smiths, or any given individual, find peace and satisfaction in their sexual lives. Sex can be a delicious glue in a relationship or the root of its ruin. Sex has the power to be transcendently pleasurable or

profoundly painful. In order to find a trained and experienced sex therapist consult The American Association of Sexuality Educators, Counselors & Therapists (AASECT), the premier credentialing organization for sex therapy. Their website, www.aasect.org, has a listing of all certified and diplomate status sex therapists. When seeking sex therapy, choose someone with this specialized training. JJ Levy, MA, MSW, PC is a psychotherapist in private practice in Ft. Collins. She helps people with anxiety, depression and relationship problems at home and work. She has specialized training and skills in treating compulsive overeating and sexual difficulties.

JJ LEVY, MA, MSW, PC

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$BMM GPS JOGPSNBUJPO JJ Levy, MA, MSW

970.493.8780 jjlevy1@mac.com

In my experience, the majority of women have concerns about their sex life at some point in their life. I feel fortunate to have JJ Levy in our community, as she is qualified to help them. This can be by way of individual counseling as well as through attending her workshops. The Women’s Clinic of Northern Colorado periodically hosts a variety of workshops facilitated by JJ Levy at its Lemay Campus. - Beverly Donnelley, M.D. -

JJ offers a number of workshops and therapy groups. Call (970) 493 8780 Women in Pursuit of Passion Women, Body Image & Food Teens, Body Image & Food Marriage at Mid-Life Divorce “Proofing” Your Relationship Sexual Enrichment Surviving Your Daughter’s Adolescence Anxiety & Compulsions Divorce: Making it a Healthy Transition Stepparenting

Northern Colorado Medical & Wellness

treatment

phlebology Dr. Overton redies patient, Meredith Dody-Hettler, for TMD treatment.

Bob Dupper, M.D. injects sclerosant into a patient’s leg.

EVLT: An Outpatient Procedure to Treat Varicose Veins by lynn M. dean

Your legs look like a roadmap. You can see twisted, swollen veins- perhaps bulging- going every which way up and down your legs. Sometimes you feel a dull ache, burning or heaviness in your legs, especially late in the day. Your feet and ankles swell. Your skin over the protruding vessels itches. You have varicose veins. You are not alone.

ccording to Dr. Bob Dupper, who owns and operates Vein Treatment Specialists in Fort Collins, approximately 40 percent of women and 20 percent of men will suffer from this painful condition. Varicose veins are the result of faulty valves, usually in the leg. As you know, arteries take the blood from the lungs to the extremities and veins return the blood back to the heart. Veins have valves in them to keep the blood flowing upward toward the heart. “When one of those valves is damaged the blood can run back down,” says Dr. Dupper. That blood pools and leads to these rope-like cords in the legs. According to Dr. Dupper, valve failure can be

merely the result of heredity, or it may be the result of added stress on the veins caused by pregnancy and hormonal variations, height, excess weight, or trauma to the area. He says that varicose veins can appear at any age, but are more likely to occur and increase in severity as we get older. While most of us can recognize this unsightly condition, many of us do not realize that varicose veins can lead to more serious medical issues. “Eventually venous disease can lead to scarring and thinning of the skin and venous ulcers that are hard to heal,” explains Dr. Dupper. “The purpose of the blood going back to the heart is so that it can get a new load of oxygen, and get rid of metabolic by-products.” When this doesn’t

occur, the blood is deprived of the oxygen and polluted with the by-products resulting in damage and ulceration. For years, varicose veins were treated by removing the entire vein from the leg– a painful, complicated surgical procedure that required anesthesia. But over the last ten years, new, less invasive therapies have been developed to treat it. One such procedure is EVLT, Endovenus Laser Treatment. “This type of treatment is called endovenus oblation,” explains Dr. Dupper who regularly performs the procedure. “A heat source is used to damage the vein which then scars shut.” Although it sounds like damaging the vein

would lead to more circulatory problems, Dr. Dupper explains that the opposite is true. “You have a deep venous system and a superficial system. The superficial system (where the varicose veins occur) is a collection system. The deep system moves 90 percent of the blood. When you have a diseased vein in the superficial system) the deep system really has to work harder. After the procedure, the leg is still able to get rid of all the blood it needs to.” EVLT doesn’t work for all varicose veins. “You’re limited somewhat to the veins you can treat because they have to be relatively straight,” Dr. Dupper says. “But most of the main problems are in the veins on the inside of the legs.” Dr. Dupper uses a comprehensive approach and multiple therapies to treat varicose veins (and spider veins) including sclerotherapy in which medicine is injected into the vein resulting in damage and scarring. Before performing EVLT, Dr. Dupper maps the veins with the help of ultrasound. “With that, we’re able to identify exactly where the problems are and design a treatment plan. We also use the ultrasound when we do surgery.” EVLT is a relatively quick and painless procedure. “It takes two to three hours from the time you walk in the door until the time you walk out,” says Dr. Dupper. “The most uncomfortable part of the procedure is usually the (administration of) the local anesthetic. We will sedate patients if they want us to. More than 50 percent use sedation.” In EVLT, a needle is put into the vein, generally near the knee, and then a laser fiber is threaded into the vein up to its highest point. The local anesthetic not only deadens the area to be treated, but also insulates the surrounding tissues from the heat of the laser, and increases the pressure around the vein causing it to collapse against the laser fiber. The heated fiber is then removed slowly as Dr. Dupper twists it so as to scar the vein and ensure that it closes down upon itself. After the procedure, the patient dons a compression stocking and walks out the door. He or she can return to work the next day. “Over the next seven to ten days there can be quite a bit of soreness,” adds Dr. Dupper. “But staying active helps with the pain and the healing process.” According to Dr. Dupper, EVLT has a 98 percent success rate. After the procedure, in addition to looking better, patients see an improvement in their symptoms. They have less burning, itching, heaviness and restlessness. Varicose veins are more than just a cosmetic problem. Today’s new treatments address not only how the patient’s leg looks but also how the patient’s leg feels. If you’ve been suffering from the painful and unpleasant side effects of varicose veins, maybe it’s time to make an appointment and talk about an appropriate treatment plan for you. Lynn M. Dean is a freelance writer living in Northern Colorado.

Northern Colorado Medical & Wellness

Say goodbye to varicose veins!

Outpatient Laser Treatment Call for a FREE consultation! We would be happy to check with your health insurance carrier for coverage.

970.776.1600

272 East 29th St. :: Loveland, CO 80538 47

profile

neurological injury

Brett Ledford fishing in his private lake.

Surviving and Thriving After a Spinal Cord Injury by alice ashmore

A spinal injury changes a person completely. People are left with so many questions, not the least of which - how do you survive a crippling injury to your spine? Two Northern Colorado men are living proof there is hope for a full life after separate spinal injuries landed them both in wheelchairs.

rett Ledford of Greeley was searching for a leak under his ‘70s era pickup when life took a tragic turn. “It was the day before Easter. I’d just told my wife to go inside and start the Easter egg dye,” The date was April 15, 1995. “There was no security lock on gear shifts back in the ‘70s. My ratchet got stuck, and when it broke loose, I accidentally pulled the truck into gear.” To Ledford’s horror, he realized a child on a bicycle was watching him work from directly behind the truck. “I was in a sitting position and went down the driveway hanging onto the truck trying to stop it. I was yelling for her to get out of the way.” The girl escaped unharmed.

Ledford was not so lucky. “I felt instantly that my back was broken. One wheel of the truck landed on my head and arm.” His wife Amy arrived in the garage only a few seconds too late to stop the runaway vehicle. Pinned under the truck, he felt his life begin to slip away. “I could have easily died. I felt I was suffocating and I told Amy good-bye.” What followed was a near-death experience. “I closed my eyes, and I saw angels that said everything was going to be okay. I saw my grandfather. ” Ledford says he felt as if he were still outside of his body as the work began to save his life at North Colorado Medical Center. But the 27-year-old Ledford refused to give up. “I had my wife, an eight-month old baby and

a three-year-old.” Ledford also had his small business, Respiratory Care Consultants, in Greeley. He was later transferred to Craig Hospital in Englewood to begin his recovery. “I was a mess. Nothing worked from the waist down. I had a stretched spinal cord and lots of nerve damage.” Incredibly, Ledford is now able to walk. Windsor resident John Jensen was powerboat racing in Saginaw, Michigan when a wrong turn altered the course of his life. “I spun out in a corner and another boat hit me in the back.” The crash was so fierce it ripped his safety belts from their anchors in the fiberglass boat. “His (the other boat’s) spear ripped the back board out of my boat and pushed me and the straps into the steering column,” says Jensen. “It

was a huge impact and something had to give. That ‘something’ was my back.” The impact bent the steering column backwards. “I reached down to try to unbuckle my belts and I couldn’t feel my hands. I knew right away that I was paralyzed.” Although his spinal cord remained intact, it was contused and stretched. Broken ribs also punctured Jensen’s lung. “I remained conscious the whole time.” After initial treatment in Michigan, he returned to Colorado as a paraplegic in a wheelchair and began six weeks of therapy at Craig Hospital. “You take life for granted until something like this happens,” says Jensen. “It changes your whole outlook on life.” The hardest part of his recovery was the emotional roller-coaster he experienced. “It’s pretty shocking – not walking and everything that comes with it.” His three children were foremost in his mind. “I had a one, a four, and nine-year-old at home. It was a devastating blow and I had the idea that my life was over.” Patients in the Craig Hospital rehabilitation program are treated by a team of specialists. “The team includes doctors, therapists and psychologists. My injury was a hard thing for me to accept,” says Jensen. His wife, Aime, was a driving force in his recovery. “My wife had to push me to get up and learn to live again. Craig Hospital has what they call ‘outings’ to get patients out of the hospital. My wife signed me up for every one of them,” says Jensen. “Craig even prepares you for a divorce,” says Ledford. He was shocked when one of the therapists on his team began to discuss the issue of divorce, something not uncommon after a lifealtering injury. “When you are at Craig, eight to five is rehabilitation time; after 5 pm is considered family time.” His voice fills with emotion as he describes his wife’s dedication during his 10 weeks in rehabilitation. “My wife is so strong. She didn’t know the meaning of ‘quit.’ She ran the business and a day care, and then drove from Greeley to Englewood and back every night.” “When my family left I had God to talk to. He must have gotten tired of me.” The hope of walking again entered Ledford’s life during pool therapy session. “The therapist felt a flicker in my right quadriceps. From then on I was out of the bed and on the mat. I just wanted to walk again – I didn’t care how.” He later had his ankles fused to make walking easier and is often mistaken for a polio victim. “I’m what is called an incomplete paraplegic.” Ledford still relies on his wheelchair for most outings, especially those of any distance. “My daughter still wants to ride in my lap even though she is now a teenager,” he says laughing. Although he always appreciated his family, Jensen didn’t realize just how much until after his accident. “I had always hoped I’d be a good father, but this made me realize how important family is. It resets your priorities and puts things in perspective.”

Northern Colorado Medical & Wellness

John Jensen taking time out to hole in on the golf course.

Friends and neighbors extended their help too. The Jensens had just moved into a new home prior to the accident. The lot was barren and in need of landscaping. My wife came home and found the yard completed. “Our friends landscaped the entire yard,” says Jensen. “We’re talking big trees and rocks. These are the kind of things that I used to take for granted.” He adds, “There are so many keys to getting where I am at now – our friends, and we have a lot of giving within our community. When you have that kind of support you are able to dedicate yourself to improving and getting better.” “Your friends give you hope,” says Ledford. Ledford and Jensen met by chance, and have become fast friends. “When I was planning on coming home from Craig Hospital my wife had to go to a medical supply store. She ended up in the store that we now know is Brett’s.” “I’m very lucky to have the friends I do,” Ledford says. “I met John Jensen solely because of this accident.” The men have a strong respect for each other’s accomplishments and determination. In January of 2004, Jensen began to take his first steps. As his endurance grew, the distances became farther. “I’m able to walk well. If you were to see me now, you wouldn’t know I had been injured.” Still a fear haunted him. “For a long time I wouldn’t leave the house without my wheelchair.” Eventually the anxiety was vanquished. “I donated that wheelchair back to Craig Hospital,” he says with satisfaction. Even though he is able to walk Jensen says,

“I’m still considered a paraplegic. It is a lifelong injury and a life-long process.” Those outings from Craig Hospital now include visits to Jensen’s Windsor-based business, Island Lake Marina, during summer months. With the intent to “pay it forward,” both he and Ledford host the events. “We have six to eight people every time,” says Jensen. The outings typically include a cookout, assisting paraplegics in canoeing or fishing on the lake behind Jensen’s business and generous amounts of empathy from men who understand exactly how they feel. “We show newly-injured patients that there are possibilities,” says Jensen. “You get a good feeling.” Ledford says his injury has allowed him to relate on a personal level to the needs of his clientele. “A lot of patients that we see are in wheelchairs. I can now help make them more comfortable.” Although accidents altered their bodies and lives, both men have developed a greater appreciation for living. “I feel very lucky and I realize I have a great life,” says Jensen “At the time I was injured, I was very young and believed in ‘work first, family second.’ Now my family is first and I’ve learned to appreciate all the little things in life,” says Ledford. He is thankful to everyone who worked to save his life that day. “They did a perfect job and I praise them for it.” Alice Ashmore is a freelance writer in Loveland and a regular contributor to Style Magazine.

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