2010-03 Northern Colorado Medical & Wellness by Style Media & Design, Inc.

NORTHERN COLORADO

MEDICAL WELLNESS FIVE DOLLARS

MARCH 2010

CHILDHOOD

DIABETES

SYMPTOMS & TREATMENT

MEDICAL

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GET THE FACTS THE

SPINE INSTITUTE

MEET DR. KENNETH PETTINE

A S T Y L E M E D I A A N D D E S I G N , I N C . P U B L I C AT I O N : : E S T. 1 9 8 4

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We're right here with the right care for your heart everyday. Having a healthy heart has such a tremendous impact on your ability to lead an active, fulfilling life. Isn't it comforting to know that the full-time cardiologists and other heart care professionals at the CardioVascular Institute of North Colorado can provide you with a wide range of treatments and procedures? Whether it's an immediate need , a planned procedure, or rehabilitation to get your heart back in shape, our highly-trained experts can provide you with the care you need including , but not limited to: • Emergency assessment and treatment • Diagnosis and treatment of heart conditions

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Northern Colorado Medical & Wellness 2010

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The Mission of Centennial Radiation Oncology, P.C., is to provide safe, effective, and accurate radiation therapy to cancer patients in Northern Colorado, in order to cure, palliate, and/or provide extended quality of life.

Northern Colorado Medical & Wellness 2010

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w w w. s t y l e m a g a z i n e c o l o r a d o . c o m Publisher Lydia Dody Editor Angeline Grenz creative director Scott Prosser Senior Designer Lisa Gould Advertising Sales EXECUTIVES Jon Ainslie (970) 219-9226 Abby Bloedorn (970) 222-8406 Karen Christensen (970) 679-7593 Lydia Dody (970) 227-6400 Saundra Skrove (970) 217-9932 Office Manager Ina Szwec Accounting Manager Karla Vigil Office Assistants Ronda Huser, Trish Milton Contributing Writers Allie Comeau, Jon Geller, DVM, Connie Hein, Kim Lock, Kay Rios, Corey Radman, Graciela Sholander Photographer Warren Diggles Contributing Photographers Marcus Edwards Affiliations Fort Collins Area Chamber of Commerce 2010 Style Magazines January-Loveland/Greeley Medical & Wellness Magazine and Directory February-Style March-Northern Colorado Medical & Wellness April-Style May-Northern Colorado Medical & Wellness June-Style July-Fort Collins Medical & Wellness Magazine and Directories August-Style September-Women’s Health & Breast Cancer October-Northern Colorado Medical & Wellness November/December-Holiday Style Style Media and Design, Inc. magazines are free monthly publications direct-mailed to homes and businesses in Northern Colorado. Elsewhere, a one year subscription is $25/year and a two year subscription is $45/year. Free magazines are available at over 140 locations throughout Northern Colorado. For ad rates, subscription information, change of address, or correspondence, contact: Style Media and Design Inc., 211 W. Myrtle St., Suite 200, Fort Collins, Colorado 80521. Phone (970) 226-6400. Fax (970) 226-6427. E-Mail: ronda@StyleMedia.com ©2010 Style Media and Design Inc. All rights reserved. The entire contents of Style Magazine are copyrighted and may not be reproduced without the expressed written consent of the publisher. Style Media and Design Inc. is not responsible for unsolicited material. All manuscripts, artwork, and photography must be accompanied by a SASE. The views and opinions of any contributing writers are not necessarily those of Style Media & Design Inc.

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Northern Colorado Medical & Wellness 2010

CONTENTS

Northern Colorado Medical & Wellness

M A RCH 2 0 1 0

20 Relief for asthma sufferers

42 combating childhood diabetes

62 perk up for spring

76 Specialty veterinarian care

26 The facts about medical marijuana

58 GLUTEN IT TOGETHER

12 14 16 20 26 34 38 42 51 54 58 62 70 71 72 75 76 79 80

Publisher’s Letter Health News The Spine Institute Tackles Chronic Back Pain Relief for Asthma Sufferers The Facts About Medical Marijuana When the World is Off Balance At the Heart of the Matter Combating Childhood Diabetes Laser-Assisted Techniques Advance Neurosurgery When the Gallbladder Goes Bad Gluten it Together Perk Up for Spring

Improve Fitness with TRX Get Fit, Give Back Calendar

Calcium Score Testing for Your Heart Why Calcium Scores Work Specialty Veterinarian Care Seven Signs of a True Emergency with Your Pet Physician Profile: Doug Kemme, M.D. A Labor of Love

on the cover: Ken Pettine, M.D., with The Spine Institute, restores his patients’ mobility through cutting-edge, innovative disc and facet replacement surgeries.

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

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A New Slant on Surgeons

erhaps you noticed the unusual outfit I’m wearing in my publisher’s photo this month. It doesn’t represent a career change on my part, but an eye-opening experience when photographing our delightful cover physician, Dr. Kenneth Pettine. Over the years, I have admired Dr. Pettine from afar, having heard of his innovative work in designing the Maverick lumbar artificial disc and numerous Spine Institute medical studies. After Style decided to feature him in this issue, I also learned of his many impressive firsts in state-of-the-art spine implant surgery. Not only is Dr. Pettine a successful and focused surgeon, his positive attitude and career passion are admirable. This was evident when we gathered to photograph him for the cover. He brought several shirts and ties - he wanted to look his best. When we talked of photographing at Loveland Surgery Center, he agreed to accommodate us between patients. To be in surgery, our photographer and I had to dress in sterile paper scrubs, hairnets and booties. Then Dr. Pettine suggested I try on his headlight and put on all the rest of the gear he wears when performing surgery for a fun photo op. I jokingly agreed to play dress up. However, through this process, I gained a brand new appreciation and respect for the difficulty and demands of lengthy surgery. Not only were the glasses and magnifying lenses awkward, the headlight confining, the mask hot and uncomfortable, but the added weight of a lead neck shield and lead apron were heavy and cumbersome. “How in the world do you manage to do hours and hours of surgery loaded down with all this gear and not have to rest or use facilities?” I asked. His answer, “I don’t drink anything before surgery and you just get used to all the gear.” My respect and appreciation for all surgeons has grown immensely for their personal sacrifice and commitment. Medicine is very intriguing, but I’m truly still glad that I chose publishing for my career path! It is heartwarming to hear from our readers that the medical articles we write help them learn about a problem they are experiencing or connect them to a healthcare provider. This issue includes important topics that touch many of us. Read “Relief for Asthma Sufferers” to learn about the complexities of this condition and how important it is to determine proper treatment. “Combating Childhood Diabetes” takes a peek at how a family deals with their child’s diabetes diagnosis and management. And “Facts About Medical Marijuana” may bring you more understanding of the challenges of this current local issue. These and many more articles fill the pages of our Northern Colorado Medical & Wellness issue. We hope you enjoy reading it! Wishing you a healthy spring season,

lydia@stylemedia.com

Lydia’s STYLE Magazine

Northern Colorado Medical & Wellness 2010

health news Congratulations Caring Hearts of Northern Colorado Caring Hearts Home Healthcare was the only home healthcare provider in Colorado to be named to HomeCare Elite’s Top 500 Home Health Care Providers. This recognition comes after an analysis of performance in quality outcomes, quality improvement and financial performance. HomeCare Elite is a compilation of the top 25 percent of agencies in the nation. Caring Hearts received the award for the third consecutive year. New Physician Joins Orthopaedic & Spine Center of the Rockies’ Loveland Office Welcome, Dr. Thomas M. Anderson. Dr. Anderson joined the Orthopaedic & Spine Center of the Rockies at their Loveland office as a specialist in primary care sports medicine in January. He joins Orthopaedic & Spine Center after five years in private practice in the area. New Physician Joins Advanced Otolaryngology Welcome, Dr. Natalie Phillips. Dr. Phillips is a board certified doctor of audiology, who joined Advanced Otolaryngology in January. She moved to the Fort Collins practice from Washington.

New Location for Colorado Spine, Pain and Sports Medicine, P.C. Dr. Ricardo Nieves is moving his practice to a new location this month. Colorado Spine, Pain and Sports Medicine’s new address will be 1437 Riverside Avenue, Fort Collins. He is adding Comrades Russian Kettlebell & Kodokan Judo strength training to his practice. Raise Some Hair Join Cancer Center of the Rockies at their 2nd Annual Hair Raiser event. The event helps create wigs for cancer patients. Participate by donating eight or more inches of hair and you will receive a free haircut. Join the Cancer Center and other sponsors on Sunday, April 11, 2010, at Rocky Mountain High School from 1 to 5 p.m. Visit www. raisesomehair.com for all the details. Last year’s event had over 100 hair donors give more than 4,000 inches of hair and helped to create wigs for almost 90 cancer patients.

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Northern Colorado Medical & Wellness 2010

MEDICAL

Spine Innovation

T he S pine I nstitute T ackles

Chronic Back Pain By kay rios

“It’s about staying ahead of the curve and always looking for new and better ways to help patients.”

“

riends don’t let friends get fused.” For Ken Pettine, M.D., that phrase says it all. And because he so strongly supports that idea, he has trademarked the verbiage as the tagline for The Spine Institute, which he co-founded with Jeffrey Donner, M.D.

At The Spine Institute, Dr. Pettine and his cohorts are working hard to prove that fusion may not be the best option for those with spinal injuries and chronic pain. “Spine fusion has a 70 percent clinical success rate. Fusion results in permanent loss of movement which may accelerate degeneration on the disc above and

below the fused area.” Many back issues, aside from trauma, are the result of the natural process of aging. “The enemy is gravity. It wears us all out,” he says. For about half of the population over 40, the process of degenerative disc disease causes symptoms ranging from back pain to nerve root pathology to spinal cord compression. The symptoms stem from worn out discs that don’t function as well as they once did. The gel-like discs act as shock absorbers between each of the bones of the spine and, as they shrink, the space available for the nerve roots and the spinal cord also shrinks. Spinal fusion is the most common form of

– Ken Pettine, M.D., The Spine Institute

surgery for treating degenerative disc disease in the lumbar spine region. In a fusion procedure, the degenerated disc is removed and a bone graft is inserted between the two vertebrae located above and below the removed disc. Metal implants are often then attached to the two vertebrae to stabilize the area until the bone graft fuses to the vertebrae and creates one solid piece of bone.

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“But, if you fuse part of the spine, out the next day. Since then, I’ve run you still have the same forces acting the Bolder Boulder, played softball all on the spine. You just transfer the three seasons, spring, summer and pressure above and below the fused fall. I’ve climbed the third flatiron in area,” Dr. Pettine says. Boulder. I’ve climbed four Fourteeners Dr. Pettine has experienced great and I’m planning on running a half success in relieving his patients’ pain marathon in April.” and, at the same, restoring and preKasten, who is the manager of serving mobility through the use of Justine’s Pizza in Fort Collins, is so disc and facet replacement devices. impressed that she’s waiting for the He is the chief investigator for 13 next opportunity. “His disc is amazing different FDA studies, all using nonand I hope there’s more. I previously fusion technology. In addition, Drs. had a fusion in my neck and I keep Pettine, Donner and Carlton Reckling pushing Dr. Pettine to get one for the are actively involved in research and neck so I’ll have full range of motion constantly exploring new treatments there, too.” in treating spine issues. They are three Cindy Copper, a debt settlement of only a handful of surgeons nationcompany paralegal, was the first wide experienced with implanting patient in the U.S. to have the Disartificial discs and non-fusion spine cover disc implanted. That was in devices. June 2009, and Copper says, “It’s Through their work, the Institute awesome. I had no idea how much has garnered some top-level achievepain I was in until it was gone. Before ments. Dr. Pettine performed the first that, I had constant severe headaches two-level, three-level and four-level 24 hours a day and tingling down NeoDisc™ cervical arthroplasties in both arms.” the world, the first surgery of the Her pain was the result of an injury Hydraflex™ nucleus arthroplasty and Copper’s insurance was pushing system in the U.S., and implanted for a fusion, but she was reluctant. the first two-level Coflex™ device in “A fusion takes months to recover the U.S. In addition, Dr. Pettine’s work from and, as I learned more, I decided at the Institute has accomplished the there was no way I was doing that. first U.S. DSS™ spine stabilization So Dr. Pettine got me into a clinical system procedure, and the first Kinestudy. The recovery was amazing. I flex™ lumbar artificial disc surgery in woke up the next morning, had a the U.S. With offices in Loveland and little bit of a sore throat but I was Cheyenne, Wyo., The Spine Institute eating, drinking and doing everything serves patients regionally, nationally in two days. I was amazed at how and internationally. Surgeries by The quick the recovery was and how full Spine Institute surgeons are performed a recovery I made.” at the Loveland Surgery Center and The success stories and rave reviews are as plentiful as the list of local hospitals. Along with those impressive “firsts” “firsts” in Dr. Pettine’s career. Raised that speak to the accomplishments by in Fort Collins, Dr. Pettine was the doctors at The Spine Institute, many first Head Boy at Blevins Junior High. patients are singing their praises. Tom He graduated from the University of Aurand is one of those. Aurand, in Colorado School of Medicine with October 2009, became the twentiHonors in 1981 and followed that Above: The revolutionary Maverick and Prestige artificial eth patient in the world to receive with a five-year residency at the Mayo replacement discs, based on Dr. Pettine’s own patents. a facet replacement. An electronic Clinic in Rochester, Minn., and a spine engineer in Colorado State Univerfellowship at the Institute for Low sity’s department of Electrical and Back Care in Minneapolis in 1990. Computer Engineering, he says he had long-term That’s when it hit him. “Right in the middle of degenerative injuries. “It was from everything I didn’t want a fusion. He showed me a model of the spine fellowship, I woke up at 3 a.m. with do – skiing, softball and golf – and some genetic the device and my engineering head said ‘this is this idea. That’s really how it started,” he says. degeneration.” really cool’ and I wanted it right away.” That wee hour idea turned into the designs Now, almost six months later, Aurand says, The results were more than he hoped. “All for the Maverick lumbar artificial disc, which “It’s a miracle. I was in-patient overnight and the pain I had – that’s all history. Dr. Pettine Dr. Pettine later patented and which is about then I walked out of the place the next day and saved my life.” to receive formal FDA approval. went to lunch. Recovery time was rather swift Lacy Kasten came to The Spine Institute He says his spine fellowship occurred at the and not terribly unpleasant. I had a little bit of after a car accident. In August 2003, Pettine beginning of the modern era of spine surgery. implanted the Maverick Disc in 31-year-old “Two things happened. First, magnetic resonance slow healing of the surgical site but it was probably my fault for being too active. I felt so good Kasten and, over six years later, she’s still enjoyimaging (MRI) dramatically improved our ability that I was up and around too quickly and that ing the results. “I love this thing. Three months to diagnose spine problems. Second, the first slowed the healing of the exterior wound a bit.” after the replacement, I was back at Copper spine implants improved the results of surgery The wound healed quickly and, after about [Mountain ski resort] snowboarding.” in cervical and lumbar spine. I was fortunate to a month, he was running and in mid-January of It was an easy decision for Kasten as well. be at the right place at the right time.” this year, Aurand and his daughter went skiing. “When I went to him, I said ‘I work out, play Dr. Pettine returned to Colorado and opened He credits Dr. Pettine with his newfound freedom softball, snowboard, climb and I don’t want to Rocky Mountain Associates in Orthopedic Medifrom pain. “He got me into the clinical study. I stop doing those things,’” Kasten says. cine. In 1990, he and Dr. Donner opened The was the first to get this installed by him.” Dr. Pettine told her about the current study Spine Institute and began to grow its reputation Aurand didn’t take much convincing. “I’m on the Maverick and she jumped at the chance. as one of the top spine facilities in the nation not young but am really physically active and I “I was walking 45 minutes after the surgery and and moved into clinical trials. The Spine Institute

Northern Colorado Medical & Wellness 2010

The Spine Institute is credited with more spine research than all the hospitals in the Rocky Mountain region.

is credited with conducting more spine research than all the hospitals in the Rocky Mountain region combined. “The research we’re doing here in terms of FDA clinical trials is more than is being done at the Mayo Clinic or the Cleveland Clinic,” Dr. Pettine says. The FDA clinical trials compare the outcomes of patients who receive an artificial disc or non-fusion implants with those of patients who have a lumbar fusion. The clinical studies are the precursor to FDA approval. Companies who produce the discs interview research centers like The Spine Institute. “To be one of these centers is extremely competitive,” Dr. Pettine says. “Out of probably 500 centers that apply, the company selects twelve.” Dr. Pettine credits his staff and his research coordinator for putting The Spine Institute at the top of the list. “One of the main selection criteria for a company is your research coordinator and his or her experience. Nicole Rittenhouse, our certified clinical research coordinator, is the main reason we are consistently selected,” Dr. Pettine says. “Now that we’ve done enough research over a long period of time, we have a record of success and demonstrated follow-up, so companies are now seeking us out.” The Spine Institute team will be presenting eight research papers at the upcoming American Academy of Neurosurgery’s annual conference. The Institute’s team members have presented 68 papers in the last three years at national and international spine meetings. But Dr. Pettine and group are not standing still or focusing on matters already finished. The Spine Institute is venturing into stem/cartilage research. The research, which began this month, will look at the possibility of adult stem cell therapy for bone fractures and spinal disease and for regeneration of damaged joint cartilage and intervertebral discs. “It’s about staying ahead of the curve and always looking for new and better ways to help patients,” Dr. Pettine says. “This was the vision from the beginning. It’s so exciting, I’ve lost sleep thinking about it.” And, if history repeats itself, those sleepless nights might just lead to another great idea.

Dr. Pettine is the chief investigator for 13 different FDA studies, all using non-fusion technology.

Kay Rios, Ph.D., is a freelance writer in Fort Collins. She writes for a variety of publications and is currently at work on a collection of creative non-fiction and a mystery novel.

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ONE IN THREE WOMEN WILL BE DIAGNOSED WITH CANCER IN HER LIFETIME* AND NEARLY 60% OF WOMEN REGARD HAIR LOSS AS THE SINGLE WORST SIDE EFFECT OF CANCER TREATMENT.** *Cancer Facts & Figures 2007 , American Cancer Society. **Cancer Practice : Journal of the American Cancer Society, November 2001 .

Help the Cancer Center of the Rockies create wigs for cancer patients by participating in the 2nd annual Hair-Raiser event. This event is a contest among all salons in Northern Colorado to see who can collectively cut the most number of inches. The winning salon will receive the coveted "Hair Raiser of the Year" trophy. This traveling trophy will give the top salon bragging rights throughout the next year. Any stylist can participate in the celebration. Participants receive a gift bag and the knowledge that they are helping cancer patients feel beautiful. GREAT CUT FOR A GREAT CAUSE

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Northern Colorado Medical & Wellness 2010

MEDICAL

Asthma

R elief

for

“We don’t know the exact

Asthma Sufferers

By kay rios

he international prevalence and mortality associated with asthma has been sharply increasing over the last 40 years, according to the 2004 report from the Global Initiative for Asthma (GINA). Close to 300 million people worldwide currently have asthma, and that number is increasing by 50 percent every decade, the report says. Asthma numbers are already high in developed countries and rates are increasing in developing regions as they become more Westernized. As the developing world, especially India and China, experiences rapid economic and social changes, it is also seeing increased pollution, migration of population to urban areas and, overall, dramatically changing lifestyles. Asthma is both under-diagnosed and undertreated and the increasing number of hospital admissions for asthma, mostly in young children, reflects an increase in severe asthma, poor

cause [of asthma]. We know there are contributing factors and we think there

disease management and poverty. Worldwide, approximately 180,000 deaths annually are attributed to asthma. Most of those deaths occur in people under 45 years old and are largely preventable. The American Academy of Allergy, Asthma & Immunology (AAAAI) estimates that 20 million Americans (one in 15) suffer from asthma. Nine million of those are children under 18 years of age. Asthma is a chronic inflammatory disease of the airways that causes wheezing, coughing and breathing difficulties. During an asthma attack, airways become narrow as the muscles around them tighten. The airway lining swells and excess mucus is produced, clogging the air passage. Breathing becomes more difficult as air is forced through these narrowing airways, so that a wheezing or whistling sound is created. “We don’t know the exact cause,” says Kristin Wallick, M.D., pulmonary and critical care specialist of Northern Colorado Pulmonary Consultants,

are environmental and genetic influences. We do know that one of the risk factors is gender . . .” – Kristin Wallick, M.D., Northern Colorado Pulmonary Consultants, P.C.

P.C. “We know there are contributing factors and we think there are environmental and genetic influences. We do know that one of the risk factors is gender. In children, males are more apt

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Northern Colorado Pulmonary Consultants, P.C. Pulmonary Disease

Critical Care

Sleep Disorders

Diana Breyer, M.D.

Kirk DePriest, D.O.

Stan Gunstream, M.D.

David Kukafka, M.D.

Rick Milchak, M.D.

James Hoyt, M.D.

Mark Neagle, M.D.

Brent Peters, M.D.

Mark Petrun, M.D.

Eric Stevens, M.D.

Carlos Vassaux, M.D.

Kristin Wallick, M.D.

“Everything that wheezes is not asthma,” says Dr. Wallick. An accurate diagnosis is crucial.

to get asthma, but in puberty women start to catch up. From 20 to 40 years of age, it’s about equal and after 40, women are more prone.” Other factors include airway hyperactivity, allergies, smoking, inhalation exposure or chronic infections, she says. Some risk factors are associated with asthma but even with those factors, asthma is not necessarily the end result. “For example, you can have atopic dermatitis or allergic rhinitis and there is an association of that with asthma but only around 30 percent of people with either of those will develop asthma.” “There is a hygiene hypothesis that has become popular,” says Krishna Murthy, M.D., of Northern Colorado Allergy & Asthma Clinic and clinical associate professor at the University of Colorado Health Science Center in Denver. “It looks at how immune systems are developed in the first few years of life.” Dr. Murthy refers to the relationship between Th1-type and Th2-type. Th1 cytokines produce pro-inflammatory responses responsible for killing virus and bacteria and generating autoimmune responses. Excessive responses can lead to uncontrolled tissue damage, so Th2 is the mechanism to counteract excessive responses. Some researchers regard asthma and allergy as

Northern Colorado Medical & Wellness 2010

LOVELAND 2500 Rocky Mountain Ave., Ste 300 Loveland, CO 80538 970.619.6100

a Th2 weighted imbalance. “The theory is that if, as a child, you get colds, you may be protected down the road because Th1 develops normally. Children who do not get exposed may be more susceptible to a Th2 imbalance. There is the thinking that when families grow up on farms with lots of animals, that exposure protects them more than people living in cities who don’t get that exposure. But,” he cautions, “it is only one theory.” P.K. Vedanthan, M.D., an allergist, associate professor of medicine at University of Colorado Health Sciences in Denver, and founder/chairman of International Asthma Services (IAS), says, “Rural versus urban factors seem to contribute but it is not that simple. Asthma incidence in India is increasing fast. Seventy percent of the population live in rural areas, but there is urbanization of rural areas, as well as a huge population shift into urban areas in search of better paying jobs. Diesel exhaust emissions, an important urban pollutant, are a major cause for increasing cases of allergies and asthma.” New research points to other potential causes, Dr. Wallick says. “There’s new information about the association between obesity and asthma.” The AAAAI’s fall 2007 newsletter reported on research showing that an estimated two-thirds of the U.S. adult population are overweight or obese and this population has been found to have an incidence of asthma 50 percent higher than the remaining population. The article also estimated that overweight or obese children are three times more likely to continue to have persistent wheezing after puberty and two times more likely to have persistent asthma into their teenage years. While the causes are up for debate, the experts all agree on certain “trigger” factors. “Viral infection, exercise, allergies, pollen, molds and animal dander can all be triggers,” Dr. Murthy says. Changes in the weather can also trigger attacks, he says. “Fall and spring tend to be heavier. But in winter, people get viral infections and the rhinovirus (common cold) and flu, which can trigger a response. Stress may have an affect and pollution is a major factor.” Asthma can be developed at any age in life, Dr. Murthy says. “Those affected range from infants to seniors, but there are some differences. For those less than two years of age, viral infection is the number one cause and food allergies are also a factor. For children and young adults who have allergies, we can see induced asthma. People 45 and older can also have asthma but it’s not usually related to allergies if they did not have them as a child.” “Children do have a chance of asthma going away as they age, but there is a huge range of statistics and it’s highly variable,” Dr. Wallick says. “It ranges between 30 and 70 percent and is really vague. But one thing we do know is that, when you get it as an adult, it’s more likely to persist. That doesn’t mean it can’t be controlled or that you only have exacerbations when you are sick. Adults typically have more complex medical issues so we have to be aware of that.” All three stress the importance of having an accurate diagnosis. “Everything that wheezes is not asthma,” Dr. Wallick says. “In adults there are other disease processes that can mimic asthma.”

Dr. Krishna Murthy, of Northern Colorado Allergy & Asthma Clinic and clinical associate professor at the University of Colorado Health Science Center in Denver

Chronic obstructive pulmonary disease (COPD) is one of those, Dr. Vedanthan says. “Because the symptoms overlap – difficulty in breathing, shortness of breath, increased mucous, chest tightness – people think they have asthma. Since the leading cause of COPD in developed countries is smoking, physicians in underdeveloped countries often diagnosis it incorrectly. ‘You don’t smoke, so you couldn’t have COPD. You have asthma, take this medicine.’ But, we are seeing higher rates of COPD in India’s rural areas in the ‘non-smoking’ population and predominately in younger women because of biomass fuel used in homes that have poor ventilation. In January, I did a rural camp in the tribal area of India and we saw 80 patients and 70 percent had COPD. But the general physicians there are not trained to differentiate between asthma and COPD, and then to treat appropriately. In 15 years, COPD and asthma will be the number one killer in India.” Dr. Murthy says proper diagnosis and treatment in the U.S. is available thanks to standardized guidelines and new methods. “At our clinic,

we start with the patient’s history so we can define the severity. We offer a thorough exam and we look for allergic rhinitis. If children have asthma, 80 percent also have allergic rhinitis. In evaluation of the patient, we can do skin tests and determine allergy problems. We also perform a lung function test with a peak flow meter.” Dr. Murthy adds that in the last few years, doctors have been able to identify what happens in the lungs with a test involving fractional concentration of exhaled nitric oxide (FENO). This is a well-validated, noninvasive marker for airway inflammation and can help distinguish asthma from other respiratory conditions. It is also associated with other markers of asthma severity. “With this, we can diagnose and monitor the asthma and personalize patient care.” “It’s important to tailor the treatment based on symptoms and lung function,” Dr. Wallick says. Asthma is caused by airway irritability or hyperreactivity, inflammation and an obstructive lung process. Medication treatments target each of these specific areas with inhaled steroids as

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Northern Colorado Medical & Wellness 2010

Approximately 180,000 deaths worldwide are attributed to asthma each year. Most are preventable. the mainstay of treatment. Asthma medications fall into two categories: First, the relievers or bronchodilators work quickly by relaxing the muscles that surround the airways. The medication is usually inhaled into the lungs from an inhaler or nebulizer. Second, controller medications control or prevent asthma symptoms by reducing airway swelling and the production of mucus. These medications include inhaled or oral corticosteroids, long-term bronchodilators and leukotrien modulators. Inhaled corticosteroids are effective at controlling asthma and preventing permanent airway injury. There are lifestyle changes that can help control asthma, Dr. Wallick says. “The first thing is: don’t smoke. Next, try to control exposure to triggers. In your home, you can control mold in your house by keeping the humidity at less than 50 percent. Use pillow case covers, wash sheets in hot water.” Pets are a big trigger factor, she says. “Cats appear to be worse than dogs because of the scales they shed from their coats and their saliva. If the animals are in the house, on the bed and on the furniture that’s where their allergens will hang out. You can get air cleansers, but they will work better if you don’t have things that harbor a reservoir of dander so minimize carpets and pillows. Consider putting pets outside.” A number of things can be done to reduce the possibility of asthma attacks. “The main thing in asthma care,” Dr. Murthy says, “is regular follow up so that we can adjust the medication as needed and look at potential triggers so that you can lead a normal life.” Kay Rios, Ph.D., is a freelance journalist and grant writer based in Fort Collins. She is currently working with International Asthma Services on a grant to fund the Asthma Educator certification program and the Diploma in Allergy and Asthma program for physicians.

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Northern Colorado Medical & Wellness 2010

MEDICAL

T he

Medicinal Marijuana

F acts

A bout

Medical Marijuana

By angeline grenz

egal, it seems, is a relative term when it comes to medicinal marijuana. Is it legal to use medicinal marijuana? Well, sort of. It is perfectly evident, however, that those who fit under the “legal” parameters for using certainly have their work cut out for them. Who is eligible for legal marijuana use? Where are they protected and where do conflicting laws leave users at risk? What are the doctors saying about marijuana anyway? Also evident is the fact that a plethora of ancillary profiteers plan to benefit from the muddy water surrounding “legal” marijuana use. Amendment 20, passed almost 10 years ago, is currently causing serious debates around physicians, patients, caregivers and dispensaries and their role in legal marijuana use.

Who Can Use?

Who does Amendment 20 cover? When passed

Despite the fact that marijuana use is legal for certificate holders, marijuana is still considered

by voters in 2000, the amendment stated persons with the following chronic conditions, or undergoing treatments that produce one of the following conditions, were eligible for medical marijuana use: cancer, glaucoma, HIV/AIDS, cachexia, severe pain, severe nausea, seizures (including epilepsy) and persistent muscle spasms (including multiple sclerosis patients). Persons with one of these conditions are required to obtain a recommendation for medical marijuana use from their physician before they can request a Medical Marijuana Certificate from the state. The physician must sign a statement certifying that they are “duly licensed in good standing to practice medicine in Colorado,” and that they have “assessed this patient’s medical history and current medical condition.” The recommendation is not a prescription for the use of medical marijuana. Following review by the Colorado Department of Public Health and Environment (CDPHE), those determined eligible are issued a Medical Marijuana Certificate. A certificate holder is then allowed

a Schedule 1 drug under federal law.

to have two ounces and six marijuana plants for personal use. Should they wish, a caregiver can be named to provide the patient with their medicinal marijuana. Patients must renew their certificate every year. Interestingly, according to CDPHE statistics (last updated Sept. 30, 2009), 90 percent of patients reported severe pain as the condition for which they were requesting a medical marijuana certificate. Despite the fact that marijuana use is legal for certificate holders, marijuana is still considered a Schedule 1 drug under federal law (which states it has a “high potential for abuse” and “no current accepted medical use”). Additionally, Amendment 20 prohibits a person from using marijuana in plain

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view or in a place that is open to the general public. Finally, Amendment 20 does not protect a medical marijuana certificate holder from losing their employment from a routine drug test. During a recent seminar presented by Michael Towbin, M.D., family physician and owner of Ultimate Health & Wellness and Connected Care, and Terri Lynn, owner of Natural Alternatives for Health, they explained that medical marijuana users are open to several possible serious legal implications. “You are not protected at your place of employment. Your landlord can evict you,” says Terri Lynn. She also warns that some can even lose their home mortgage due to medical marijuana use, that certificate holders may lose ground in child custody cases, and that currently no test exists for law enforcement to determine if THC (tdelta-9-tetrahydrocannabinol, the active compound in marijuana) present in the body is from recent use. THC can be present in the body for up to six weeks after use. Terri Lynn is a certificate holder and caregiver for between 30 to 35 patients. She calls herself a Cannabis Therapist and advocates for the legal use of medical marijuana because of her own struggle with a chronic illness and an allergy to many narcotics that left her with no way to treat her pain. Terri Lynn’s business is not operated out of a

Northern Colorado Medical & Wellness 2010

store front or building. Rather, she grows in her home and delivers directly to her patients. Terri Lynn does not use her last name in order to protect her family’s privacy. Terri Lynn and Dr. Towbin cautioned attendees at their January 28 seminar, entitled Practicalities of Medical Marijuana Use: Colorado, “to consult your physician and your attorney” before deciding to pursue medical marijuana use. Laws surrounding Amendment 20 are expected to change rapidly in coming months. Currently, two bills that aim to clarify rules for using medical marijuana are making their way through state legislature and local communities have instituted moratoriums on medical marijuana dispensaries while they scramble to create regulations that would restrict where dispensaries are located and how they are operated.

Why Use?

The law, or rather lack of laws, begs the question: why bother? A large portion of the medical community remains unconvinced of medical marijuana’s benefits and unwilling to consider issuing medical marijuana recommendations to their patients. When Style initially contacted one practice, the administrator declined to be interviewed stating, “We have a wide range of opinions regarding this

and we would prefer to avoid making a public statement as a group . . . It would be difficult to speak uniformly for 30 strong differing opinions.” Dr. Towbin states (at a later interview) that his decision to issue recommendations to a number of his patients was natural and logical. “I describe myself as a ‘practicalist.’ If it works, it is safe and it is affordable, then it makes sense for my patients.” Dr. Towbin, who is also an acupuncturist, has a propensity toward natural medicine at his practice, so he felt making medical marijuana recommendations to be in line with his own medical philosophies. Dr. Towbin and Terri Lynn tout the benefits of marijuana in medical applications. They list a number of effects on the body, from positive to neutral to negative, for those considering this option. Dr. Towbin calls marijuana a “serious medication” that can be considered a long-term therapy. He emphasizes that potential benefits do not come in a “one size fits all” package, that organically grown marijuana is important, that pain relief and other benefits cannot be achieved “without some degree of being high,” and that cannabis therapy is of value to many people. Marijuana’s primary active compounds are THC and CBD (cannabidiol). Cannabinoid receptors are found throughout the brain, body and immune

Under the Colorado Medical Marijuana law there is no distinction between caregiver and dispensary. Some, however, try to set themselves apart by offering a variety of wellness services and products, like Abundant Healing (above).

system. THC, according to Dr. Towbin, works well for cancer pain, migraine pain and appetite stimulation. Overall, THC has mainly stimulant properties. CBD, he continues, is recommended for improvement of epilepsy and movement disorders, for stroke and head injury patients, inflammatory disorders and appetite suppression because of its sedative or relaxing type of effect. Most marijuana has a greater presence of THC compounds. However, CBD compounds can be manufactured for specific uses. Marijuana that comes closer to a 50-50 ratio of THC and CBD is thought to be particularly beneficial for MS patients and spinal cord injuries. A wide variety of hybrid plants today enable patients to pick their “designer blend,” specifically engineered to assist with an array of health issues. According to Dr. Towbin, cannabis is relatively safe and would take approximately 1000x the normal dose to be lethal. Alcohol, on the other hand, takes only about 16x the normal dose to be lethal. It can be addictive to some (nine percent of users), says Dr. Towbin, but remains less addictive than both tobacco (32 percent) and alcohol (15 percent). No deaths have been attributed directly to marijuana use. Today’s marijuana is much stronger than marijuana of 30 years ago. The “Mexican schwag,” made up of two to four percent THC potency, which most recreational users purchased off the street decades ago is rarely seen in Northern Colorado today. Instead, new hybrids are more commonly at 10 to 12 percent THC levels, with some as high as 37 percent, according to Dr. Towbin.

There are patients that would not be a candidate for medical marijuana. Dr. Towbin says persons with pre-existing heart conditions, prone to substance abuse or with schizophrenia should not use marijuana, and pediatric use should be limited to only the most strict criteria. Dr. Towbin also recommends proceeding with caution when first using medical marijuana. “The effects are different for different people. Never consider yourself safe the first time you use it.” He has also found a portion of patients who do not like being under the influence of marijuana or cannot tolerate the side effects. Marijuana can be taken in a variety of forms. Terri Lynn recommends her patients purchase a vaporizer. Inhaled marijuana produces a faster, more intense effect. Ingestibles (food products containing marijuana) or pills, salves, tinctures, even suppositories can be taken with varying degrees of how quickly they take effect and how long the effect lasts. Persons with severe, chronic pain may need to use a variety of applications to remain pain-free, says Terri Lynn. Smoking marijuana is never recommended because of its carcinogenic properties. “The requirements of the Amendment [20] are pretty strict,” says Dr. Towbin. “Psychic pain is not on the list, nor are sleeping disorders.” When asked to make a recommendation, Dr. Towbin carefully considers the patient’s medical history. “It is up to each doctor to set their own threshold on who they will make a recommendation for. Some doctors have no threshold whatsoever. I consider mine on the higher end.”

Despite that fact, Dr. Towbin has only refused one patient a recommendation. The patient was 18 years old and had a history of substance abuse. Dr. Towbin does not require his patients to continue with other treatments while using medical marijuana and understands many of his patients desire to discontinue other harsh medications whose side effects can be as debilitating as the medical condition they treat, or to avoid a surgery that has a low prospect of helping their condition. Dr. Towbin finds great appeal in patients’ ability to take control of their own health through the use of medical marijuana. “It is natural and you can grow your medicine yourself. That is phenomenal. You know exactly where your medicine comes from.” Though Dr Towbin stands apart from many of his colleagues in his willingness to make recommendations and openly discuss medical marijuana, he says that many fellow family practitioners respect his viewpoint. “People understand that I take this very seriously. And I know that I would like to have this option later in life, should I happen to need it.” According to The American Cancer Society, studies involving marijuana have been largely mixed or inconclusive as to its benefits and marijuana has yet to be thoroughly tested with regards to medicinal interactions, side effects and other factors. They conclude on their website: “Relying on this type of treatment alone and avoiding or delaying conventional medical care for cancer may have serious health consequences.” The National MS Society has also stated that while studies do indicate some benefit to MS patients from

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While the implication of the law is that a caregiver be involved in the health of a patient, many dispensaries have taken the role of strictly a provider. And while a patient is meant to have only one caregiver at a time, the CDPHE has been inundated with both requests for certificates and changes in caregiver forms and has not been able to keep pace, according to Captain Jerry Schiager, Fort Collins Police Services (FCPS). The variety of dispensaries is apparent: some appeal to popular culture; others have made an attempt to set themselves apart by offering a variety of wellness services. Others, like Terri Lynn, have opted out of an establishment in favor of privacy and a low-key presence in the community. Abundant Healing, in Fort Collins, has the look of a spa, if it were not for the

pungent aroma of marijuana and the alarm systems draped around the necks of the store’s owners (one of which, incidentally, was set off when an owner received a hug from a friend), you might be fooled. Abundant Healing offers a variety of services beyond medical marijuana, with a goal of creating an overall environment of wellness. Massage therapy, apothecary, chiropractic care and Reiki are among their services. Marijuana is kept in a separate room, where the different varieties are measured out for patients. Owners Drew Brown, Dave Schwaab and Joey Simental advise patients who are looking for a caregiver to make an informed, safe decision. “For the first time in the state, people have a legal way to obtain medical marijuana. However, there are sketchy dispensaries

Dr. Michael Towbin of Ultimate Health & Wellness and Connected Care

cannabis treatment, there are “serious uncertainties about the benefits of marijuana relative to its side effects . . .” and “based on the studies to date — and the fact that long-term use of marijuana may be associated with significant, serious side effects — it is the opinion of the National Multiple Sclerosis Society’s Medical Advisory Board that there are currently insufficient data to recommend marijuana or its derivatives as a treatment for MS symptoms.” That statement appeared on their website, last updated Jan. 26, 2010.

Caregivers and Dispensaries

Regardless of the varied opinions, Colorado voters felt strong enough to make medical marijuana an option for a segment of the population. Despite the availability, the loose language surrounding caregivers has created a quagmire. Caregivers are mentioned in the Medical Marijuana law, but there are no rules governing dispensaries. And recent changes on a federal and state level have led to an abundance of dispensaries popping up in municipalities along the Front Range. Technically, there is no legal language for a dispensary. Essentially, they operate the same as a caregiver, but often on a larger scale. A caregiver, according to Amendment 20, is a person with “significant responsibility for the well-being of a patient.” If a patient chooses to use a caregiver, that person is able to grow and handle their marijuana. Terri Lynn manages the growth and production of medical marijuana for approximately 30 people, as much as 180 mature plants. Some dispensaries claim thousands of patients.

Northern Colorado Medical & Wellness 2010

Dave Schwaab, of Abundant Healing, parcels out a dose of medicinal marijuana. Edibles, also shown, are available at many dispensaries.

out there,” says Brown. Schwaab advises patients to look for a caregiver that runs a legitimate business, complete with business license, that charges sales tax and keeps correct business records. “We strongly believe that there is a place for medicinal marijuana and it is our passion to provide top quality product to our clients,” he says. Schwaab declines to reveal how many patients they currently have, saying only that they have a surprisingly diverse clientele of young and old, blue collar and white. “Not the stereotypical clients you see in the newspaper.” Terri Lynn goes further; she recommends finding a caregiver “that will work with you on how to manage your health and have the best quality of life.” Her desire is to one day open up in a medical office complex and operate side-by-side with other healthcare practitioners. “I would like to see caregivers act more like a medical business, not like a retail Starbucks,” she adds. The source of medicinal marijuana should also be given close attention. Grown organically by the caregiver is ideal, according to both Terri Lynn and the owners of Abundant Healing. Both businesses say they do not purchase their product from an outside source and only feel comfortable providing their patients with what they have grown themselves. Shawna Stamm, owner of Green Acres Medicinal, says she not only follows strict guidelines for the operation of her business, but is also selective about who she will take on as a patient. “I will not sell to anyone under 25 years old who is not dismembered,

has MS or a serious brain injury. And my doctor will not issue a recommendation for any patient who is not legitimate.”

The Real Story

All the facts surrounding legal, medicinal use of marijuana, however, are leaving residents, city governments and others with more questions than answers. In an interview with Captain Schiager, he outlined several gray areas to the law that the public is right to be concerned about. The first concern of law enforcement is the number of physicians making recommendations. According to Schiager, of the 700-plus doctors who have issued recommendations to their patients, 15 of those doctors have done 76 percent of the recommendations. And, he adds, not all physicians issuing the recommendations are fully licensed. “Some do not even have their DEA (U.S. Drug Enforcement Administration) registration to prescribe controlled substances.” Many dispensaries have a regular working relationship with a doctor willing to issue recommendations, sometimes to clients who walk in to their “physician clinics.” Often, these are not local doctors they work with on a regular basis. “My medical doctor works out of Boulder,” says Stamm. Caregivers state it can be difficult to find local physicians willing to issue recommendations because of the stigma of marijuana or fear of the changing laws surrounding legal use. Similarly, Abundant Healing provides meeting space to a Boulder physician who meets with patients

interested in becoming certificate holders. However, Schwaab says they have found a local physician who would like to provide a “broad spectrum of healthcare to our patients, including low cost healthcare to people without health insurance.” The question that Schiager and others ask is, if a doctor is willing to issue a recommendation for $200 in cash without a medical history or exam, are they following the intent of the law? The statement that physicians sign on their recommendation says, “I have a bonafide physician-patient relationship with the above-named patient . . . I have assessed this patient’s medical history and current medical condition . . .” Law enforcement is aware of physicians who are making recommendations for people who do not have the legitimate qualifications for medical use, says Schiager. However, because of confidentiality laws, law enforcement’s hands are tied to pursue these “pot docs” who may be abusing Amendment 20. “I am confident these doctors will eventually be dealt with through legislation.” The next concern is that large dispensaries are not meeting the intended meaning of Primary Caregiver. Currently, according to the CDPHE, no statutes or regulations exist in the Colorado Medical Marijuana amendment to govern how they operate. Local municipalities are forced to come up with zoning and other criteria to regulate how dispensaries function on a local level. Schiager enumerates a long list of concerns regarding dispensaries. Just a few: How much marijuana can be grown in a residential home? Where are

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Northern Colorado Medical & Wellness 2010

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dispensaries getting their marijuana? What are they doing with their excess product (keep in mind they can only hold two ounces per patient at one time, but six mature plants can produce much more than that)? Can it be used on the premises? Is an established business able to act as a dispensary simultaneously (i.e. can your local pizza shop sell marijuana in the back room)? Should they be required to indicate that medicinal marijuana is sold on the premises? When you consider the potential profit involved, the propensity for abuse is apparent. Figures compiled by FCPS indicate the current retail price for a quarter ounce (enough for 14 marijuana cigarettes) of medical marijuana is about $120 (street price, says Schiager). A full ounce sells for $480, or $7,680 per pound, and costs only about $400 per pound to grow. Sixty mature plants, according to Schiager, produce about 30 pounds of medical marijuana a month. The questions are endless, says Schiager, and the dangers are real. FCPS has had at least 10 home invasions in recent months where the homeowners were present at the time of the robbery, often tied up and held at gunpoint. “The number of home invasions is very significant – this type of crime just doesn’t happen in Fort Collins.” He continues, “And we feel dispensaries are under-reporting crime because many of them know they are not operating completely under the law.” Conversely, the number one source of complaints about dispensaries comes from other dispensaries, says Schiager. “Some people who get into the [dispensary] businesses don’t understand. They say marijuana is a non-violent drug. However, there is still a lot of money involved and it is one of the most profitable drug trafficking crimes out there.” The availability of marijuana and the stronger strains equal an increase of marijuana sold illegally on the street, he continues. The numbers tell the story. In June 2001, the CDPHE began accepting applications for the Medical Marijuana Registry in Colorado. By November 2004, only 512 patients were listed on the Registry. In 2007, a Denver District Judge overruled a CDPHE guideline limiting the number of patients per caregiver to five. At that time there were 1,350 patients on the Registry. In March 2009, the Obama administration stated they would not use federal resources to prosecute persons who were abiding by the legal use of medical marijuana in states that allowed it. At that time, around 5,000 patients were on the registry.

Since then, the number of certificate requests has exploded. The CDPHE has not been able to keep up with applicants and the latest figures, according to Schiager and based on local media sources, range from 40,000 to 70,000 people who have applied to the Registry, with between 600 and 1,000 new requests daily. Currently, it takes between four and five months for a certificate to be issued by the CDPHE. As the CDPHE struggles to keep up with the paperwork, petitioners can use proof of their application as a provisional certificate. Taking advantage of this provision, the CDPHE is receiving certified letters that are empty or contain “grocery receipts” in lieu of actual paperwork, and law enforcement has no way to verify who is legally using the provisional certificates, says Schiager. Further, patients are naming multiple caregivers and the CDPHE cannot keep up with the requests to change caregivers. This tactic means that many dispensaries have listed, and are growing marijuana for, the same patient. With confidentiality laws to boot, “there is just no way to regulate who is in compliance and who is not.” In November 2006, Colorado voters decided to reject an amendment that would have allowed adults to legally possess one ounce of marijuana. Voters, as Schiager points out, were asked and chose not to legalize marijuana. That leaves him and other law enforcement charged with carrying out the law for legal users. “For law enforcement, this is not a moral crusade. This is a legal mess and we are trying to come up with a way to minimize abuses. Voters voted in legal use, but it is so unenforceable and we are seeing so much illegal activity surrounding this,” concludes Schiager. This turmoil surrounding medical marijuana does little to help the legitimate user and opens up a widespread tendency for abuse. Caregivers, like Terri Lynn and Abundant Healing, are anxious for local regulations to take hold in order to operate under the letter of the law and continue to provide these services. But bottom line, says Terri Lynn, “We need to be able to protect those people that the voters had in mind when they passed Amendment 20.” Angeline Grenz is editor for Style Magazine.

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Northern Colorado Medical & Wellness 2010

MEDICAL

when

Otolaryngology

the

world

off balance

hat do your ears have to do with balance? Plenty. That’s why ear and hearing specialists are first in line when it comes to diagnosing and treating a wide spectrum of balance disorders. The sense of hearing is associated with the ears, of course. But so is the sense of balance. Within the inner ear lies an intricate system that detects changes in head position and relays this information to the brain. Any problem with the balance sensing portion of either ear can translate into annoying, even debilitating, symptoms of dizziness and disequilibrium. “The majority of balance issues break down into one of two categories,” explains Mark Loury, M.D., board certified otolaryngologist at Advanced Otolaryngology, P.C., in Fort Collins. “One is episodic vertigo, where symptoms appear as an attack but the person is fine the rest of the time, and the other is chronic disequilibrium, where the person feels off balance all

By Graciela Sholander

“It is vital that we take a very good medical history of each patient. We look at the onset of dizziness. Was

the time to some degree.” “With regards to symptoms, people will typically come in and say they have some perception of movement, either them moving within their environment or the environment itself moving, most commonly a spinning sensation. They may have other associated symptoms such as plugged ears, ringing or fluctuating hearing,” he continues. Natalie Phillips, Au.D., board certified doctor of audiology at Advanced Otolaryngology, adds the following to the list of balance-related symptoms patients may describe: “Lightheadedness. Loss of balance. Veering off to the right or left. It feels like you are spinning when you are stationary, or as if everything around you is spinning. Vertigo, particularly a whirling vertigo.” Such sensations can seriously disrupt a person’s daily activities and impact quality of life. Some individuals with milder disequilibrium symptoms simply try to put up with them. Others have such severe symptoms that they can’t function normally. In both cases, help is available. It begins with a visit to your family doctor.

it sudden or gradual? We need to know the duration – does it last minutes, hours or days? Is the dizziness constant or does it occur in episodes? Are there accompanying audiological symptoms?” – Natalie Phillips, Au.D., Advanced Otolaryngology, P.C.

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& Wellness 2010

BEFORE "'""'

Outer Ear

Temporal Bone Malleus Incus

Semicircular Canal Vestibular Nerve

be prescribed. Certain patients will benefit from a low-salt diet or other dietary adjustments. Surgery may be needed to correct physical abnormalities associated with particular disorders. Many patients benefit from rehabilitation therapies. A physical therapist certified in vestibular rehabilitation, for example, can teach an individual with balance issues how to retrain the brain to make sense of otherwise confusing signals.

Finding Hope

Ear Canal

Cochiea

Eardrum

(Utricle Saccule) Vestibule

What To Expect Since balance disorders can have one of many possible medical causes, some related but others unrelated to the inner ear, you should consult your general practitioner first. Depending on your symptoms, you may be referred to a neurologist, cardiologist, an allergist or a physical therapist. Most likely, though, you’ll be advised to see an otolaryngologist, more commonly known as an ear, nose and throat (ENT) specialist. Many otolaryngologists work closely with audiologists, medical experts on the auditory (hearing) and vestibular (balance) systems of the ear. “It is vital that we take a comprehensive medical history of each patient,” says Dr. Phillips. “We look at the onset of dizziness. Was it sudden or gradual? We need to know the duration – does it last minutes, hours or days? Is the dizziness constant or does it occur in episodes? Are there accompanying audiological symptoms? Does the patient have any simultaneous cardiac changes? We check the family history. We especially want to know if the patient has a history of migraine or headaches. Were there any recent head traumas or changes in vision? Are there any neurologic symptoms such as tingling or clumsiness of other extremities? We also ask if certain positions aggravate the condition or make it better.” An accurate diagnosis relies on a complete medical history plus a series of tests. If the ear specialist concludes that the symptoms are related to the inner ear, then more diagnostic tests may be done or treatment may begin. But if the patient’s symptoms and history point to a different source, such as the heart or the central nervous system, then a consultation with another specialist, such as an otolaryngologist, a neurologist or a physical therapist, may be necessary.

Possible Causes

Many inner ear-related conditions can throw off a person’s balance, including Meniere’s disease, benign paroxysmal positional vertigo (BPPV) and labyrinthitis, which is an inflammation of the inner ear. Meniere’s is associated with a buildup in fluid pressure inside the inner ear. In addition to vertigo

attacks, Meniere’s is associated with fluctuating levels of hearing loss, tinnitus (ear ringing or roaring) and a sense of fullness in the effected ear. BPPV, a fairly common diagnosis, results when crystals inside the ear become dislodged. “Calcium crystals, normal structures in the inner ear, break loose and float into another part of the ear,” explains Dr. Loury. “This causes a spinning sensation. Each episode is brief, on the order of seconds to less than a minute.” The sense of spinning is usually triggered by movement, such as getting out of bed, into bed, or when lying down and rolling over onto the side.” Rarer conditions include perilymphatic fistula, Ramsay Hunt syndrome, vestibular neuritis (thought to be a viral infection of the balance nerve going from the inner ear into the brainstem) and superior semicircular canal dehiscence syndrome (SSCDS). The fistula is an abnormality between the middle and inner ear, while Ramsay Hunt is shingles of the ear resulting from a herpes virus. SSCDS involves a defect of the bone that overlies the inner ear canal. The proper diagnosis is vital for getting effective treatment. What gives rise to these various conditions? That can be tough to pinpoint. Some balance problems begin with allergies or a bad cold. Others are due to autoimmune disorders. A head injury can trigger episodes of vertigo or disequilibrium. Chronic neck pain or stiffness can cause vertigo or imbalance. In some cases, it’s unclear what, exactly, brought on the condition.

Spectrum of Treatments

Treatment depends on the diagnosis and can range from oral drugs for symptom alleviation to physical therapy for balance retraining to surgical procedures. Treatment for BPPV involves repositioning the dislodged ear crystals. “We do repositioning maneuvers to get the crystals back to where they need to go,” says Dr. Phillips. “It’s a nice, simple treatment where the patient gets pretty immediate results. The tricky thing is that this condition can spontaneously occur, resolve and reoccur. People who try to do these maneuvers at home may actually make it worse.” For some conditions, anti-nausea drugs may

David Johnson, a 27-year-old who works in traffic control for the Colorado Department of Transportation, has been experiencing inner ear balance-related symptoms. “I’d describe it as a disconnected feeling, foggy-headedness, a druglike state and a little pressure in my right ear, on and off for five years now. I don’t have hearing loss, but sometimes loud noises, such as at a concert, will make my ear static sounding, almost robotic.” It began when he was in college. He woke up one day with the sense that something wasn’t quite right. Basically, it was a feeling of disorientation. He’d had a cold a week earlier, but nothing else. Finally doctors made a connection to his inner ear and vestibular neuritis – an inflammation of the inner ear’s vestibular nerve – was suspected. His symptoms cleared up after a month, but they returned again a year later and lasted several months. “It’s hard to cope with,” he says. “I don’t feel that I’m bringing one hundred percent to what I do, at least not every time.” After five years of dealing with these on again, off again symptoms, Johnson decided to once again seek medical attention. A consultation with Dr. Phillips and further tests have opened up a new possibility: fluid buildup in part of the inner ear. With another path for his doctors to explore, Johnson is encouraged. “I’m feeling hopeful now that I have a diagnosis.”

Early Intervention

Pinpointing the source of a balance problem and coming up with an accurate diagnosis involves a good amount of detective work. It requires a thorough analysis of the patient’s medical history, closely evaluating all symptoms, running a number of relevant tests and putting all the pieces together. Occasionally another specialist, such as a neurologist, must be consulted before a definite diagnosis can be given. It can take time and effort, but it’s worth it when you consider the goal: alleviation and, when possible, elimination of dizziness and other symptoms affecting balance. “If you don’t find the answer, seek a second opinion,” recommends Dr. Phillips. “It’s helpful to go to a clinic with the proper equipment and multiple specialties within the same office to be able to collaborate and intervene earlier.” “For people who have some of these balance problems, it is better to intervene earlier than later,” adds Dr. Loury. “The reason being that it’s been shown the sooner you can intervene, the more rapid the recovery will be and the more complete the return to better function will be.”

Graciela Sholander is a Northern Colorado writer and author of Dream It Do It: Inspiring Stories Of Dreams Come True, www.dreamitdoit.net.

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Northern Colorado Medical & Wellness 2010

MEDICAL

Cardiac Health

t h e

h e a rt

of the matter

ardiovascular surgeons register small in numbers but big in demand across the country. Even as cardiovascular disease in the U.S. is increasing as the population grows and ages, the number of active cardiothoracic surgeons has fallen for the first time in 20 years according to the Center for Workforce Studies at the Association of American Medical Colleges.

Their recent study reports that, over the next 15 years, that trend will continue, creating a severe shortage of cardiothoracic surgeons. By 2025, the projection is for a 46 percent increase in the demand for cardiac surgeons and a decrease of 21 percent in the supply, resulting in diminished quality of care and longer delays for people needing heart and lung surgery. The American Medical Association Masterfile currently lists just over 4,700 active

“When I started out, most heart surgeries were in By Kay rios

pediatrics. When I look back at medical school, I remember

cardiothoracic surgeons nationally. But while the rest of the country may be struggling, this area is in good shape, says Michael Stanton, M.D. and cardiothoracic surgeon with the Cardiovascular and Thoracic Group, PLLC He is one of seven cardiothoracic surgeons in Northern Colorado (two are based in Boulder) and, he says, that’s plenty for the time being. “It takes four to 600,000 people to generate enough work for five surgeons in this specialty because the rate of people actually needing heart surgery is currently small.” Cardiothoracic surgeons undergo a longer period of training than any other specialty and, after completing the training, operate on the heart, lungs, all the tissue around the heart and lungs, and on primary blood vessels such as the aorta. As founder of the Cardiovascular and Thoracic Group, he says, “The cardiovascular surgeons at Medical Center of the Rockies perform about 300 heart surgeries per year. We see people from Wyoming, Nebraska, Western

thinking how advanced it was. But we had none of the methods and interventions we do today. And now we operate on patients we would never have thought to operate on years ago, for example, elderly patients in their 70s and 80s.” – Michael Stanton, M.D., Cardiovascular and Thoracic Group, PLLC Lydia’s STYLE Magazine

Kansas and Northeastern Colorado.” Stanton explains, “If you have a blocked artery in the heart, there are three ways to treat it. The first is with drugs that reduce cholesterol, diabetes and blood pressure. The second way is with balloons and stints placed by a cardiologist. If those don’t work, the cardiologist then sends the patient to a surgeon. All our patients come through their primary care physician, a cardiologist or another referring physician. Patients are seen in our Loveland clinic as well as in Fort Morgan” But Stanton is not like the Maytag repairman who sits and waits for calls. In the days just before this interview, Stanton had already completed a coronary bypass on Sunday, fixed an aorta in the chest on Monday, mended a broken vessel in the groin and an aortic aneurysm in the abdomen. And he had put in time in the emergency department at Poudre Valley Hospital. “A year or two ago, I started covering trauma five or six days each month.” Stanton’s true interest is and always has been his specialty. “It’s always been about cardiovascular,” he says. “It’s an exciting field.” His interest began in the late 60s, when he was in medical school at the University of Michigan. “I worked for a blood bank in the evenings and took blood to the operating room. They’d let me stay and watch.” That experience determined his career path. Later, while he was on faculty at Texas Tech University and performing pediatric surgery, he got a call that brought him to Colorado. “My favorite pediatric anesthesiologist had moved here because he liked to ski. He called and said they were opening a cardiac surgical unit.” Stanton took the leap and, in 1984, he came to Greeley and started the heart program at North Colorado Medical Center (NCMC). “It was a race between Poudre Valley Hospital (PVH) and NCMC and we started within a month of each other.” He remained at NCMC for the next 17 years and also started a heart program in Boulder during that time. In 2001, he moved to Fort Collins and opened his current practice. Stanton has changed along with the times. He is trained with the da Vinci Robotic system and proctors other surgeons who are learning to use the da Vinci. Dr. Stanton is currently the only surgeon in Northern Colorado trained to use robotics for cardiac surgeries. He is also currently the only surgeon in Colorado that performs robotically assisted coronary artery bypass grafts and he initiated minimally invasive aneurysm surgery in Northern Colorado. Over the past few years, Stanton has performed over 130 robotically assisted surgeries. He has used robotics for mitral valve repairs, closing holes in the heart, replacing a tricuspid valve and he has accomplished a “lot of lung surgery” using the da Vinci. Stanton continues to develop new surgical techniques to diminish the impact of surgery on patients. He says that while there is less blood loss and less recovery time using robotics, he also says that there are some people for whom robotics are not an option. “You have to be able to collapse the lung away from the chest wall. There are some surgeries where you can’t collapse it.”

Northern Colorado Medical & Wellness 2010

Dr Stanton performs heart and lung procedures with the da Vinci Robotic system.

The training for the da Vinci is extensive, Stanton says. “You start out practicing on inanimate objects then, after several training workshops, you work on animals and human cadavers. When you start out, you start out with simple procedures, then work up to more challenging procedures. Stanton takes pride in keeping up with the latest techniques and changes in the medical field. He’s already seen a number of them, he says. “When I started out, most heart surgeries were in pediatrics. When I look back at what we did in medical school, I remember thinking how advanced it was. But we had none of the methods and interventions we do today. And now we operate on patients we would never have thought to operate on years ago, for example, elderly patients in their 70s and 80s. We used to think that 70 was as old as you could be to have heart surgery.” In the past, some patients would have automatically been eliminated. “We now do complex surgeries that we wouldn’t have done then, such as two or three valves at once or working on a patient whose heart has been damaged by a heart attack. The risks were also too high for patients with coexisting medical issues, for example kidney failure. When I trained, we didn’t have immune suppression medications

Lydia’s STYLE Magazine

so the rejections for a heart transplant were great in the late 70s. There was a high death rate; patients usually lasted only a year or two. But when research developed the appropriate drugs, we started doing high volumes of transplants in the early 80s.” He sees more changes ahead. “We’ll see a continued refinement of diagnostic tools and surgical tools and robots will be used more extensively. The focus is to develop ways of treating people and reducing the trauma.” The biggest change in recent years and the greatest potential, Stanton says, is in the Internet. “It’s already had a huge impact. It’s a good way of keeping abreast of the newest techniques. We’ve always had a lot of information available but we had to go to the library to look it up. Now you can find what you need in a second. We’ll see even more of that kind of opportunity in the future.” For additional information, check the website at www.cvtgrp.com. Kay Rios, Ph.D., is a freelance writer in Fort Collins. She writes for a variety of publications and is currently at work on a collection of creative non-fiction and a mystery novel.

Northern Colorado Medical & Wellness 2010

MEDICAL

Diabetes

combating

Ryan Quaid was diagnosed

childhood diabetes

By kim lock

yan Quaid was just about to start fifth grade in the summer of 2007 when he started to feel dizzy and weak. He was constantly thirsty and woke up several times during the night to use the bathroom.

The sick feeling would come and go, but when he lost 15 pounds his parents became very concerned and took him to the doctor. His blood sugar registered at 900 mg., well above the normal range of between 70 and 150 mg. It was then his parents got the diagnosis they had feared: type I diabetes. “It was shocking, for me a non-medical person, to hear this,” says Ryan’s mother Laura. “The only thing you can do is get past the shock and learn about it and then deal with it, which is what we did.” According to the Centers for Disease Control and Prevention, each year more than 13,000 young people are diagnosed with type I diabetes (formerly referred to as insulin-dependant diabetes or juvenile diabetes). People diagnosed with this type of

with type I diabetes in 2007, just before starting fifth grade. Ryan and his family

diabetes are put on a lifelong regimen of insulin treatments to compensate for their body’s inability to produce insulin. Ryan uses an insulin pump to administer his lifesaving insulin. The pump delivers insulin directly into his body instead of having to use a needle and syringe several times a day. The important thing for people with diabetes to remember is that while type I is a lifelong condition, it is not a death sentence. It is a lifestyle changer, but life goes on. “For me it was a day-by-day, meal-by-meal kind of thing initially and probably for several months,” Laura Quaid says. “And then slowly, just like anything, you work into a routine, and then you get the pump, which changes things, but now I feel like we are in a fairly comfortable routine.”

Type I Diabetes on the Rise for Unknown Reasons

Type I diabetes affects the way the body uses glucose. In patients with type I diabetes, the pancreas

– father Rob (missing from photo), mother Laura, sister Julia and brother Alec – have had to learn how to manage his diabetes and still allow him to participate in all his favorite activities. stops producing insulin, which the body needs to get glucose into the cells. In June 2009, EURODIAB Study Group in Europe performed a study and found that “if present trends continue, doubling of new cases of type I diabetes in European children younger than five

Lydia’s STYLE Magazine

years is predicted between 2005 and 2020, and prevalent cases younger than 15 years will rise by 70 percent.” Previous studies performed in the United States found similar results. The reasons for the increase in type I diabetes in children are unclear, but there appears to be three common causes: genetic factors, a rare autoimmune response to several viruses and environmental influences. “We have seen the onset of type I diabetes at any age and there are a variety of triggers,” says Lisa Harris, registered dietician and diabetes educator with Poudre Valley Health System in Fort Collins. “From an autoimmune reaction to genetic tendency, researchers are currently looking to understand the causes and what things lead to the onset. Nothing specifically has been fully identified yet, especially with an autoimmune reaction. However, stress is often a precipitator and type I can develop with either physical or emotional stress.” Unfortunately, Colorado is not immune from the trend of increasing numbers of type I diabetes diagnoses. According to the Mountain States Genetic Foundation, “Of the 55,000 children born in Colorado every year, an estimated 33 will develop type I diabetes by age six, and 180 will be diagnosed by the age of 20 years. After asthma and mental retardation, type I diabetes ranks as the third most common chronic childhood disease, affecting 1,600 Colorado children and 123,000 in the U.S.” The diagnosis of type I diabetes occurs most commonly like that of Ryan Quaid – a child is brought to the doctor or hospital with extreme thirst, nighttime bedwetting, weight loss and irritability. “The first thing we do is test the child’s urine and, if there is glucose in the urine, we proceed with a blood test to see if their glucose level is above 300,” says John Guenther M.D., pediatrician with the Youth Clinic, P.C., in Fort Collins and Loveland. “The onset of type I diabetes is very dramatic.” Dr. Guenther estimates that his practice sees 10 patients diagnosed with type I diabetes to every type II diagnosis given.

Type II Diabetes Increasing in Children

What seems to be alarming to healthcare officials is that type II diabetes is also on the rise in children under 18. Often a result of obesity, type II diabetes begins when the body develops a resistance to insulin and no longer uses the insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce sufficient amounts of insulin to regulate blood sugar. Childhood obesity, race, activity level and inadequate nutrition are known triggers for type II diabetes. Like type I diabetes, type II is a lifelong condition, but may not require daily insulin injections to maintain proper blood sugar levels. Some children can control their blood sugar levels with proper diet and exercise instead. The onset of type II diabetes is often gradual which makes diagnosing the disease difficult for doctors. Some of the symptoms include those associated with type I diabetes as well as: blurred vision, slowly healing sores and areas of darkened skin. “A lot of times the parents and kids come into the office because someone in the family has diabetes and they have used a blood glucose monitor and tested the child’s blood and found out it was high,” says Amy Driscoll, M.D, pediatrician with the Greeley Medical Clinic, P.C. Dr. Driscoll says she believes the decrease in

Northern Colorado Medical & Wellness 2010

Every year, Ryan (pictured with his insulin pump), his family and 25 friends participate as Ryan’s Riders in the 13-mile Tour de Cure to raise money for diabetes research.

childhood activities and increase in caloric intake is the strongest trigger for type II diabetes. “The leading factor I have seen is an increase in convenience,” she suggests. “We don’t have to be as active as we were even 30 years ago. There is less of a need to walk places because everything is so spread out we just drive.” She also credits the increase in electronic media

usage, i.e. video games, television and computer usage to the increase in a sedentary lifestyle. “Kids are getting the nutrition they need, but they are also getting things they don’t need like an excess of carbs and not enough fruit and fiber,” Dr. Driscoll says. “This tends to be a problem for the whole family – not just the child, but parents and siblings as well.”

Dr. Amy Driscoll, of Greeley Medical Clinic, P.C., examines a young patient. Each year, more than 13,000 children are diagnosed with type I diabetes.

What Can Be Done to Stem the Tide of Diabetes

Colorado has an advantage over other parts of the country when it comes to slowing the pace of diabetes growth. Colorado is officially the “Fittest State in the Nation” according to a June 2009 report by the Trust for America’s Health and the Robert Wood Johnson Foundation. The report found Colorado had the lowest rate of obese adults, at 18.9 percent. Coloradoans lead active lifestyles and enjoy spending time outdoors. This level of activity helps Colorado have the second-lowest diabetes rate at 7.6 percent compared to the national average of 11 percent as found by the Gallup-Healthways Well-Being Index in August 2009. “I do think (the activity level) is a definite positive thing the state has going for it,” says Dr. Driscoll. “People here are more likely to go out and be outdoors even if the weather is not perfectly good. The number of sunny days also helps.” Maintaining an active lifestyle and eating a healthy, balanced diet are key to preventing type II diabetes and controlling it without the use of daily insulin. Ensuring kids eat an appropriate amount of carbohydrates and fats and increase their intake of vegetables, whole grains and fresh fruits is the best way to prevent childhood obesity and decrease the prevalence of type II diabetes.

John Guenther, M.D., of the Youth Clinic

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Northern Colorado Medical & Wellness 2010

Next Step: Education

Once a child has received a diabetes diagnosis, they are often sent to speak with the dieticians with Poudre Valley Heath System. These specialists are trained to help families move from shock to knowledge to acceptance of their child’s diagnosis. “We explain that diabetes can be fully managed,” says Harris, dietician with Poudre Valley Hospital’s Center for Diabetes Services. “It’s normal with a chronic diagnosis for parents and patients to get upset and angry and then deny the diagnosis. It is important to express their feelings and work through them.” To help families with education and

community, the hospital hosts its annual Camp Sweet Pea for two days in June. The camp is only open to children between the ages of five and 10 with diabetes. The camp allows the kids to get to know others with diabetes in the area and gives parents a chance to socialize with others who understand. “For some parents, this is the first time since the child has been diagnosed that the parent has had time to get away,” Harris says. “It is an important activity . . . people come from Denver, Boulder and Greeley to spend this time with others and just be a kid. Everybody is testing (blood sugar) and everybody is getting insulin.”

Lisa Harris, Poudre Valley Health System dietician and diabetes educator

A New Normal For Ryan Quaid, life with diabetes looks different than it did before - he can’t just wake up and hang out on a Saturday morning and do whatever he wants. But on the other hand, life looks remarkably the same. This three-sport athlete still plays football, basketball and runs for the track team; he just has to take the time to check his blood sugar during the activity. Ryan and his parents have also helped other kids with diabetes in his school by requesting the food service employees post the nutritional information for the food served. Simply knowing the carbohydrate count of foods can help diabetics keep their blood sugar under control by knowing the right dosage of insulin to get. “The nice thing is that diabetes hasn’t stopped him from doing anything,” says Laura Quaid. “Two weeks after he was diagnosed he started playing tackle football and I was in a panic. I had to educate his coach, teachers, friends and their parents and babysitters . . . the list just goes on and on. The best thing is he has learned how to deal with it and he has educated other people and can live a totally normal life. Maybe one day he will be on that TV playing college basketball or professional basketball!”

Kim Lock is a freelance writer who enjoys spending time with her husband and three kids in the Colorado outdoors.

Lydia’s STYLE Magazine

Northern Colorado Medical & Wellness 2010

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Risks May Include: Su rgi cal risks include infection or pain at implant site and epidural bleeding. Device risks may requ ire corrective surgery, and may includ e jolting or shocking , loss of effect or lead fracture, m igration or dislodgement. Please talk with your doctor to full y understand the risks and benefits. For a list of adverse effects that have been associated w ith the therapy, please refer to the Important Safety Information at www.tamethepa in.com. Not everyone responds to neurostimu lation therapy in the same way, and your experi ence may vary.

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What You Can Do Don't let pa in define you r life. Effective chron ic pa in rel ief is possible. Talk to a pain management specialist to learn more about Medtron ic neurostimulation therapy. â&#x20AC;˘ You r physician can provide yo u w ith add itiona l information about Medtronic neu rostimulation and work with you to develop an overa ll pain treatment plan.

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References 1. Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132:179-188. 2. Kumar K, Taylor RS, Jacques L, et al. The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery. 2008;63: 762-770. 3. Turner JA, Loseser JD, Deyo RA, Sanders SB. Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications. Pain. 2004;1 08:137-147. 4. Ohnmeiss DO, Rashbaum RF, Bogdanffy GM. Prospective outcome evaluation of spinal cord stimulation in patients with intractable leg pain. Spine. 1996;21 13441350.

Important safety information NEUROSTIMULATION SYSTEMS FOR PAIN THERAPY Brief Summary: ProductTechnical Manuals and Programming Guides must be reviewed prior to use for detailed disclosure. Indication for Use- Chronic, intractable pain of the trunk and/or limbsincluding unilateral or bilateral pain. Contra indications: Diathermy. Warnings: Defibrillation, diathermy, electrocautery, MRI, RF ablation, & therapeutic ultrasound can result in unexpected changes in stimulation, serious patient injury or death. Rupture/piercing of neurostimulator can result in severe burns. Electrical pulses from the neurostimulator may result in an inappropriate response of the cardiac device. Precautions: The safety and effectiveness of this therapy has not been established for: pediatric use, pregnancy, unborn fetus, or delivery. Follow programming guidelines & precautions in product manuals. Avoid activities that stress the implanted neurostimulation system. EM I, postural changes, & other activities may cause shocking/jolting. Adverse Events: Undesirable change in stimulation; hematoma, epidural hemorrhage, paralysis, seroma, CSF leakage, infection, erosion, allergic response, hardware malfunction or migration, pain at implant site, loss of pain relief, chest wall stimulation, & surgical risks. For full prescribing information, please call Medtronic at 1-800-328-0810 and/or consult Medtronic's website at www.medtronic. com. USA Rx Only

Rev 0209

Lydiaâ&#x20AC;&#x2122;s STYLE Magazine

MEDICAL

Neurosurgery

Laser-Assisted Techniques

Advance Neurosurgery

By Allie Comeau

ioneering laser-assisted neurosurgery in Colorado and the surrounding states, Alan Villavicencio, M.D., and his colleagues at Boulder Neurosurgical Associates (BNA), Longmont United Hospital and the Minimally Invasive Spine Institute (MISI) are changing the way spinal and brain disorders are treated along the Front Range.

Dr. Villavicencio and his colleagues at BNA believe laser-assisted surgery to be the future of neurosurgery. “We believe there is a potential for this new CO2 laserassisted technology to improve efficiency in the operating room,” he says. Potentially advantageous over traditional surgery, laser microsurgery in combination with minimally invasive approaches, can result in less operative time, and decreased lengths of hospital stay and recovery time. Also reduced are the risks of perioperative complications such as deep venous thrombosis and pulmonary embolism, hospital acquired pneumonia and wound

Northern Colorado Medical & Wellness 2010

“We believe there is a potential for this new CO2 laser-assisted technology to improve efficiency in the

infections. With reduced blood loss and a lesser risk of complications than traditional surgery, the CO2 laser used by Dr. Villavicencio is working wonders on brain tumors, spinal disorders and herniated discs with minimal side effects and patient inconvenience. “We are fortunate to have the best equipment and most well-trained surgeons in the state,” he says. “We are the pioneers in this area.” Laser-assisted surgery is not a new idea. Lasers have been in use in the military and other industries since the 1970s but innovation for applications in the healthcare industry has been relatively slow. This has changed in recent years as lasers have become smaller, more precise and more efficient. “Lasers in neurosurgery have been around for a while but were always very cumbersome,” says Dr. Villavicencio. “Back then, lasers were big giant machines with huge metal arms and hinges. Trying to use them for delicate, precise operations such as neurosurgery was extremely difficult.” Thanks to new technologies and image guidance systems, however, the use of lasers in medicine has improved drastically. “The OmniGuide is a new flexible

operating room.” – Alan Villavicencio, M.D., Boulder Neurosurgical Associates

catheter laser guidance system that allows for precise use of the CO2 laser,” he adds. “There are several different kinds of lasers. In contrast to other types, the CO2 laser is absorbed very quickly in tissue so that it doesn’t penetrate very far within tissues. This means that it can obliterate tumors, hernias, bone spurs or disc material with minimal thermal spread (hence, less heat transfer into normal tissue and a lower risk of complications).” According to the Boulder Neurosurgical Associates website (www.bnasurg.com) the CO2 laser is especially effective for the treatment of brain, spinal tumors and arteriovenous malformations. A recent innovation of the Massachusetts Institute of Technology (MIT), the

Photo courtesy of Omni Guide

The Omni Guide’s flexible catheter allows doctors to perform no-touch vaporization of disc material and scar tissue.

Photo courtesy of Omni Guide

Omni Guide CO2 laser utilizes a completely new flexible delivery system, which enables no-touch vaporization of disc material and scar tissues. Dr. Villavicencio and his fellow neurosurgeons noticed the difference immediately while performing laser-assisted spine surgeries compared to the surgeries performed with the standard tools. Instead of pulling and tearing, they can now simply dissolve arthritic tissue and other pathologic entities. “With the laser you can achieve a no-touch obliteration of herniated disc or tumors with minimal retraction of surrounding nervous tissue,” says Dr. Villavicencio. “Our results so far are very good.” While the laser has undoubtedly improved the outcomes and recovery time of spinal and brain tumor surgeries, it isn’t a magic bullet. “The laser is not a cureall. It’s just one tool in the armamentarium. You still need to get to the tumor or herniated disc so the laser is only revolutionary in the setting of our combined minimally invasive approaches,” says Dr. Villavicencio. “Basically, we make very small incisions and use tubular retractor systems with endoscopic or microscopic visualization requiring much less muscle dissection and tissue damage. Then once you get there you can use the laser. It’s a combination of everything. You can’t just buy a laser and cure everyone of everything. We still have to make an incision, unless we use the CyberKnife.” CyberKnife is the latest advance in the field of stereotactic surgery, which is often defined, according to Dr. Villavicencio, as “surgery without the surgery.” CyberKnife, the only radiosurgical system that can pinpoint the exact location of a tumor while treating it, allows for targeted radiosurgery with accuracy down to the sub-millimeter. CyberKnife also enables surgeons to use smaller doses of radiation over fewer sessions

The Omni Guide laser has provided Boulder Neurosurgical Associates a new way to perform surgery – precision with a flexible catheter.

than traditional radiation therapy. In addition to limiting radiation, surgery with CyberKnife is virtually pain-free. With CyberKnife, BNA can now treat tumors that were previously thought of as inoperable, either because they were considered too dangerous or were unresponsive to previous treatment. Gone are the days of risky craniotomies, dangerous incisions, long, painful recoveries and even anesthesia for some patients. Perhaps the number one patient benefit of laserassisted neurosurgery at BNA is the fact that many procedures can be performed on an out-patient basis, with most patients able to recover at home within a few hours of surgery. “Most of the minimally invasive spinal surgeries we perform are done as out-patient services,” says Dr. Villavicencio. “At some other places, you’ll go in for a lumbar or cervical fusion and you might be in the hospital for a week. If we do the surgery, you could be home three or four hours later. We sometimes keep people overnight for observation as a precaution, but in most cases patients are home the same day. We can even do many of the surgeries under a local anesthesia, though most people prefer to just go to sleep and wake up when it’s over.” Another tool in BNA’s neurosurgical armamentarium is the N20 Poestar Intra-Operative MRI (iMRI) unit. The iMRI is revolutionizing neurosurgery by providing realtime MRI images during surgery. Thanks to this detailed imagery, Dr. Villavicencio and his colleagues are better able to locate tumors, define lesion borders and make absolutely certain they remove the entire tumor every time prior to the patient leaving the operating room. Without the iMRI, surgeons are sometimes unable to see tumor margins and are forced to err on the side of caution to avoid stroke or paralysis. This means that

Lydia’s STYLE Magazine

sometimes surgery is not 100 percent successful and part of the tumor is left remaining after surgery. With the iMRI, surgeons can confirm during surgery that the entire area has been excised, rather than waiting for post-operative images. According to BNA, the iMRI “helps give a new hope for our patients through a more complete surgical resection of their tumor and a decreased incidence of reoperation, thus allowing for a much faster recovery. The iMRI offers real-time visualization during all stages of brain surgery so that neurosurgeons can plan the path of the surgery at every point. As a result, surgery is more precise with potentially superior results.” Surgeons at BNA also have the benefit of another image guidance system to ensure each minimally invasive surgery goes smoothly: the new O-Arm Image Guidance System, a mobile imaging platform specifically designed for spinal and orthopedic surgery. Displaying three-dimensional, 360-degree, high-resolution images of the patient during surgery in CT Scan quality, the O-Arm System allows surgeons a complete intraoperative view of the body. “It is like driving in the woods at night with a global navigation system. You know exactly where you are and where you are going,” says BNA’s Dr. Lee Nelson. Image guidance is a necessary component in all spinal surgeries, with the standard in most hospitals being fluoroscopy or two-dimensional images of the spine. BNA surgeons benefit from access to threedimensional technology that’s a step above traditional fluoroscopy. Intraoperative isocentric fluoroscopy (Iso-C) technology raises the bar for patient safety by allowing surgeons comprehensive real-time images of the spine during surgery. The Iso-C reduces operative time, radiation exposure to both patients and surgical staff, and results in far fewer surgical complications. BNA research has demonstrated that patients receive 1.5 times less radiation during surgery with the Iso-C compared to surgery with traditional two-dimensional fluoroscopy. While these new techniques are making brain and spinal surgeries more accurate and less invasive, neurosurgeons know that every surgery is different and dynamic. In some cases the laser may not be necessary. “You never know what you’re going to find until you get in there,” says Dr. Villavicencio. “We treat tumors, herniated discs, vascular malformations, structural deformities like scoliosis, all kinds of cervical or neck disorders and degenerative disc disease with the laser,” he says. “But it’s more useful for herniations or tumors that are stuck down to the nerve or would otherwise require retraction and scraping to get out,” he says. “We have the laser at the ready for all surgeries, but it’s not always necessary for more simple procedures or if the tumor or herniated disc pops out during surgery.” Patients at BNA are in good hands. A graduate of Harvard Medical School, Dr. Villavicencio completed a neurosurgical residency at Duke University and an orthopedic spine fellowship at Cedars-Sinai Medical Center. He is one of the few surgeons in the country with dual training in both neurosurgery and orthopedic surgery. Originally from California, Dr. Villavicencio has lived in Niwot for the past eight years on a small farm with 25 cows, 14 pigs and 50 chickens. He’s also a triathlete and is passionate about bicycle commuting. He commutes by bike to and from work every day of the year, rain or shine. “I love living in Colorado. I ride my bike everywhere, about 15,000 miles a year,” he says.

Allie Comeau is a freelance writer living in Denver, Colorado.

Northern Colorado Medical & Wellness 2010

MEDICAL

Gallbladder

when the gallbladder

goes bad

he pain often begins as a bandlike discomfort in the abdomen, becoming constant and building in intensity. Or it may become a sharp, stabbing sensation located in the central abdomen. As the pain intensifies, it can radiate to the shoulder, between the blades and down the back. It is intense enough to cause you to double over, head swarming and stomach sour with the need to vomit. Indigestion? The pain is too severe for that. Heart attack? Though the pain is swift and intense, it is not radiating from the chest. The problem is a gallbladder attack and it is more common than many people realize. “Gallbladder surgery is one of the more common surgeries that we perform,” according to Craig Clear, M.D., with Northern Colorado Surgical Associates, P.C. Dr. Clear estimates that around 20,000 Northern Colorado residents have gallstones, one of the major features that may lead to a gallbladder attack.

Around 20,000 Northern Colorado residents have

By angeline grenz

gallstones. Many of these people, as well as some

These attacks come from obstruction, infection or discoordinated function of the gallbladder. Studies show that gallstones are present in around 15 to 20 percent of people nationwide. Many people never know that they have gallstones, but an unlucky percentage may suffer greatly from a single or repeated attack of gallbladder pain. “I have seen gallbladder stones in all ages, some as young as 11 years old and as old as 96,” adds Dr. Clear. But wait a second; what exactly is the gallbladder? This small robin’s egg blue organ is located just under the liver and works in conjunction with the liver to aid in digestion. The organ is considered non-vital; however, it does have a function in the body, albeit a dispensable one. The gallbladder collects a portion of the bile secreted from the liver and, as it sits in the gallbladder, concentrates the bile. Then hormones from just beyond the stomach signal the gallbladder to release a portion of the bile, generally when digesting high fat or greasy foods, according to Dr. Clear. The bile travels down the bile duct, which runs

without stones, will suffer a gallbladder attack this year. “Gallbladder surgery is one of the more common surgeries that we do.” – Craig Clear, M.D., Northern Colorado Surgical Associates, P.C. from the liver to the duodenum, the first part of the small intestine. Though the gallbladder does aid in digestion, removal of the gallbladder will usually be compensated for by the normal drainage of unconcentrated bile through the bile ducts,

Lydia’s STYLE Magazine

-~-~ -

Thomas G.Chiavetta, MD

Robert R. Quaid, MD

Craig R. Clear, MD

James M. Dickenson, MD

Stefan M. Pettine, MD

Michael D. Roller, MD

Northern Colorado Surgical Associates, P. C. Surgical care since 1956

Providing surgical care using least invasive methods.

Northern Colorado Medical & Wellness 2010

21 2 1 E. Harmony Rd ., Ste. 250, Fort Collins 1970.482.64561888.699.6272 (toll free) I www.ncsurgicaf.net

a backup system fully capable of handling most normal digestion. Gallbladder attacks, and the intense pain they can cause, occur when gallstones form from bile, crystallizing and becoming solid. Sometimes individuals can live with asymptomatic gallstones and never know it. These stones just never produce symptoms. But more frequently, stones move around the gallbladder and irritate the wall of the gallbladder causing inflammation. Some gallstones can become large enough to block the opening from the gallbladder to the bile duct. Or they can move from the gallbladder down into the bile duct and cause an obstruction farther down the duct near the intestine. These instances can often become emergent in nature, especially when the blockage along the bile duct prevents bile from the liver from entering into the intestines. Patients can become jaundiced and experience the intense pain and nausea mentioned at the onset. The blockage can even irritate the pancreas, causing pancreatitis, which needs immediate medical treatment. The pain is not uncommonly confused with heart attack symptoms because it may centralize in the upper abdomen, radiating somewhat to the lower chest just below the heart. In many instances, gallbladder disease is suspected when heart disease has been eliminated as the source of pain in an emergent setting. Gallbladder pain can range from intermittent to constant and can be accompanied by bloating, nausea, upset stomach, fever, heartburn and vomiting. In general, after the initial gallbladder attack, “a person often has more and more attacks,” says Dr. Clear, “and each are fraught with the danger of infection.” Those attacks often lead patients to Dr. Clear, a general surgeon who has performed gallbladder surgery more than 1,500 times. He and his partners from Northern Colorado Surgical Associates collectively perform this operation on average 400 times a year. The path to diagnosis of gallbladder disease usually begins with a patient’s primary physician. After a patient experiences the symptoms mentioned above, a primary physician will order an ultrasound or other test to determine if gallstones are present. “An ultrasound is much better at picking up gallstones than other imaging equipment and is fairly inexpensive,” says Dr. Clear. Occasionally, a primary physician will refer their patient to a gastroenterologist if they suspect that the gallbladder-type pain is part of a larger digestive problem. Sometimes, patients come directly to Dr. Clear from the emergency room, if inflammation is detected or if it is suspected that the bile duct is completely blocked. If gallstones are present, or if there is sufficient evidence to suggest infection, inflammation or gallbladder dysfunction, patients are referred to a surgeon for removal of the gallbladder. The standard for care, according to Dr. Clear, in the case of gallbladder removal is laparoscopic surgery, a procedure first introduced in 1986. Traditional open surgery still has a role in more complex or complicated cases, often requiring more surgery than on the gallbladder alone. However, “surgery has changed a lot in the past 20 years,” says Dr. Clear, who adds that laparoscopic gallbladder surgery is one of his favorite surgeries to perform. “Laparoscopic surgery has revolutionized gall bladder removal,” he adds, “changing surgery from requiring us to create a long incision in the upper

Lydia’s STYLE Magazine

abdomen and a week’s recovery in the hospital to the majority of procedures being done as outpatient surgery.” An uncomplicated gallbladder removal requires an hour or less in the operating room and four small punctures, rather than the opening up of the entire abdominal cavity. After surgery, a patient does not need to make great lifestyle changes. About 10 percent of patients may have some increase in diarrhea when eating fatty or greasy foods. Cutting these foods out of your diet and increasing your consumption of fiber can help. The risks of gallbladder surgery are similar to other surgeries: bleeding, infection, injury to nearby organs and ducts, blood clots in legs, prolonged diarrhea and bile leaks. Gallstones that happen to travel to the lower part of the bile ducts can present a difficult problem with obstruction of the bile flow. In this case, a gastrointestinal specialist may become involved to perform an endoscopic retrograde cholangiopancreatography (ERCP), a small, flexible scope that goes through the mouth and stomach to reach and remove stones from the ducts. An ERCP can be performed as a separate procedure either before or after gallbladder surgery. Though gallbladder attacks can happen to both sexes at any age, gallbladder stones are most common in women, says Dr. Clear. The most common type of stone is caused by cholesterol and bile chemicals present in the gallbladder. “When the right proportion of cholesterol and bile chemicals are present, stones begin to crystallize.” Estrogen can increase the amount of cholesterol present in the bile. Because of this, gallstones are not an uncommon occurrence during some pregnancies. Women who are pregnant and experience gallbladder attacks due to gallstones are encouraged to complete their pregnancy before having the gallbladder removed. However, says Dr. Clear, if the case is severe and the woman has reached the second trimester of her pregnancy, gallbladder surgery can in many cases be safely attempted. Other conditions can lead to the removal of the gallbladder. Sometimes the gallbladder can cease functioning despite the absence of stones. In those cases, a hepatobiliary scan (HIDA) can be used to show if the bile duct is blocked and check gallbladder function. The scan uses a radioactive fluid marker that passes safely through the body and indicates if the gallbladder is functioning correctly. After determining no obstruction is present, gallbladder surgery may be recommended. In some circumstances, the gallbladder will become acutely inflamed, infected or even gangrenous, even in the absence of gallstones. Testing by your doctor will help to evaluate for this problem. In very rare instances, gallbladder cancer is found. This cancer, like pancreatic cancer, is accompanied by a poor prognosis because it is generally very aggressive and spreads quickly, even with radical surgery. The future of gallbladder surgery may include variations of surgery that use a single incision in the navel for the operation or even incision-free surgery, going through mouth, down through the esophagus and operating through a small hole made from inside the stomach. “These procedures are under investigation and even scrutiny,” says Dr. Clear. “Nevertheless, laparoscopic surgery has taken hold, and it is a surgery taking place in the world approximately 700,000 times every year.” Angeline Grenz is editor for Style Magazine.

Northern Colorado Medical & Wellness 2010

wellness

Celiac Disease

g l u te n

t o g et h e r

By corey radman

t is estimated that roughly one percent of the population has celiac disease (CD). With such an array of sometimes confusing symptoms, it can take years for a person to be correctly diagnosed with CD. In the past, it was common for people to suffer symptoms for years or to be misdiagnosed with irritable bowel syndrome or inflammatory bowel disease.

“Gluten-free” is a term you have probably noticed cropping up on the supermarket shelves. Or perhaps you know a person who has started a gluten-free diet, but like many people, you weren’t sure what that really meant or why it would be necessary. Gluten is a group of proteins found in the grains wheat, barley, rye, spelt and kamut. Gluten forms when liquid is added to the grain flour and mixed thoroughly, especially through kneading. The inability to digest wheat varies from person to person and ultimately breaks down into three categories, says Rebecca Dunphy, M.D., of Centers for Gastroenterology in Fort Collins. People can be

Explaining wheat gluten intolerances and celiac disease

intolerant of wheat gluten (they might experience gas or bloating after eating it); they can have an allergy to gluten, which might cause hives, for example; or someone might have the autoimmune disorder celiac disease (CD).

Celiac Disease: Symptoms & Tests

“With celiac disease, there is an antibody reaction to gluten, which damages the small bowel lining, leading to malabsorption of nutrients,” Dr. Dunphy explains. “People misunderstand that you can have gas and bloating from eating wheat without having CD. Wheat intolerance is not a physiologic problem. CD, however, causes damage. Just because you stop eating wheat and your symptoms get better, doesn’t mean you have CD.” Celiac disease is a chronic inflammatory disorder of the small intestine in genetically susceptible individuals. When celiacs eat gluten, the villi in their small intestine flatten and cease to absorb the nutrients from the food. Left untreated, CD increases the risk of developing lymphoma, breast cancer,

osteoporosis and other autoimmune disorders. According to Dr. Dunphy’s colleague, Crystal North, D.O., who practices at Skyline Endoscopy Center and Centers for Gastroenterology, the “classic” symptoms of celiac disease include: recurrent abdominal pain, diarrhea, bloating, excessive gas and weight loss. “Some people have malabsorption of fat, which causes foul-smelling bulky stools or diarrhea.” “The malabsorption of nutrients can cause iron deficiency, neurological problems because of not absorbing B vitamins, and osteopenia/osteoporosis from not absorbing calcium and Vitamin D. Patients with celiac can have other symptoms like depression, anxiety and migraine headaches, although it’s not clear why,” says Dr. North. It is estimated that roughly one percent of the population has CD. With such an array of sometimes confusing symptoms, it can take years for a person to be correctly diagnosed with celiac disease. In the past, it was common for people to suffer symptoms for years or to be misdiagnosed with irritable bowel

Lydia’s STYLE Magazine

Dr. Crystal North of Skyline Endoscopy Center and Centers for Gastroenterology

Many patients, attempting to relieve the discomfort of digestive distress, remove gluten from their diets before undergoing CD tests. This can be a challenge for their doctors, because one’s body has to be reacting to the gluten for the tests to show any evidence of disease. Once someone has achieved relief, they aren’t likely to go back to eating gluten. Thus, says Dr. Dunphy, “If you suspect celiac, ask your primary care physician to run the blood test before you change your diet.” A small percentage of patients, whose blood tests show a negative result, may still have CD. As well, patients who have a high genetic risk for celiac disease need to be tested with an upper endoscopy, says Dr. North. CD is associated with a family history of celiac or with the sometimes overlapping conditions such as Down’s syndrome, Type I diabetes or other autoimmune diseases.

Checking the Pipes

Dr. Rebecca Dunphy of Centers for Gastroenterology

syndrome or inflammatory bowel disease. Newer tests and greater medical knowledge of CD has increased the rate of correct diagnosis. Dr. North explains that the easiest and least invasive way to test for CD is to check a blood test for antibodies against tissue transglutaminase (TTG), or a blood test for endomysial antibody. If the blood tests are positive, an upper endoscopy is performed to take tissue samples of the small bowel. This confirms the CD diagnosis and assesses the severity of the damage to the small bowel. The small bowel biopsy is the gold standard test for CD, according to Drs. Dunphy and North.

Northern Colorado Medical & Wellness 2010

Upper endoscopy, also called EGD (esophagogastroduodensocopy), is an outpatient procedure that employs a flexible camera scope to visually search for damage to the small intestine. Dr. North explains: “The patient is instructed not eat or drink for a few hours before the test. An IV is placed and the patient is given sedation so that they are comfortable. Usually they will not have any memory of the procedure. After they are positioned on their left side and are asleep, a flexible camera scope is passed down the esophagus into the stomach and small bowel. Biopsies are taken with tiny forceps. The whole procedure, after the patient is asleep, takes about five minutes.” The gastroenterologist performing the EGD test is looking for telltale signs that the intestine is damaged. Dr. North continues: “Normally the small intestine has folds and carpet-like mucosa. In celiac, it can still look normal in mild cases, but often has ‘flattened folds,’ or ulcers.”

Adapting to Gluten-Free Eating

“CD is the easiest and hardest disease,” Dr. Dunphy says. “It’s easy because adhering to a gluten-free diet is the cornerstone of treatment [as opposed to a lifelong medicinal regimen]. Once you avoid gluten, the small bowel goes back to normal.” But, she cautions, it requires lifelong attention and radical lifestyle change. Dr. Dunphy recommends networking with a celiac support group like A Fork in the Road (www. glutenfreefork.com) or the Celiac Sprue Association (www.northerncoloradoceliacs.org), where advisors can offer tips and support for the newly diagnosed. Gina Mohr-Callahan is chairperson of the Northern Colorado Chapter of the Celiac Sprue Association as well as co-owner of A Fork in the Road. The newly diagnosed often consult her for guidance. “The most important advice I can impart is: ‘You can do this.’ If you must have an autoimmune disease, this is the one to have, because it is manageable with a gluten-free diet. And the payoff is phenomenal, because the gluten-free path leads to the best gift you can give yourself – better health.” Lasting lifestyle changes are extraordinarily difficult. With that in mind, Mohr-Callahan suggests that ultimate success depends on careful education for you, your family, friends and healthcare providers. Most important, remember that celiac disease is not an allergy, but an autoimmune disease. “Because of this, you cannot cheat on the gluten-free diet. A speck of gluten the size of the period at the end of this sentence is more than enough to cause an immune response,” she says by email. What, then, can you eat on a gluten-free diet? Mohr-Callahan, a gluten-free cooking teacher, assures her students that they can learn to cook delicious, healthy foods for themselves. “Shop the outside aisle at the market,” she advises. Stick to fresh fruits and veggies, lean low-fat meats, fresh eggs, milk and yogurt. They are all naturally

gluten-free, healthy options. Also look for nuts, seeds and sources of good fats and healthy oils. She cautions that many of the new gluten-free products available (more than 1,000 new ones in the last year) are certainly tempting and convenient, but that moderation is required. “Yes, it’s natural to sometimes feel deprived on a gluten-free diet, and it’s easy to go overboard when we discover something that we can have. But many glutenfree products contain lots of fat, sugar, salt and white rice flour – all ingredients most of us should minimize,” she says on her website. It is possible to bake gluten-free foods. They are sometimes even more nutritious and complex than their wheat-based versions. The trick is to blend flours from multiple grains. Mohr-Callahan recommends starting with a “foundation” grain like brown rice then adding other grains to that. Her favorite flour blend calls for 1/2 brown rice flour, 1/4 potato starch, and 1/4 tapioca starch.

Red Snapper Veracruzana Chef Scott Manning: Veracruz was the first city to be developed by the Spanish in Mexico and one of the first things they did was to import the flavors of the Spanish Mediterranean. So today, olives, capers and lemon are traditional to that area of Mexico. I have spun these flavors together with chilies and preparation methods more often found in classical European dishes to share with you:

Eating Out – Is it Out of Question?

Mohr-Callahan encourages gluten-free diners to ask questions and assume nothing about a menu. “Be your own advocate. Be clear with the wait staff about what you cannot eat. Even a ‘little gluten’ is not OK. And,” she adds, “be kind and grateful. If you have a bad experience, try your best to gently educate the wait staff. If you have a good experience, tell the staff and be generous with your praise and your tip.” Many more restaurants are paying attention to patrons with allergies and intolerances. It is possible to find gluten-free offerings on many menus now, and asking the wait staff about gluten-free items will reveal more than you may have anticipated. As well, some cuisines are more naturally geared toward gluten-free cooking, like Latin food, where wheat isn’t the traditional grain. El Monte Grill & Lounge chef, Scott Manning, explains that the Fort Collins restaurant didn’t initially set out to create a nearly gluten-free menu, but once he realized how easy it would be, he took extra steps to ensure that El Monte would be friendly to the wheat intolerant. For instance, Manning uses arrowroot to thicken sauces and soups instead of roux made from fat and flour.

Home cooking

Manning, like Mohr-Callahan, suggests that home cooks need not be intimidated by trying new methods, nor should they settle for bland food. “Think Latin!” he says. “Since wheat was introduced relatively recently to Central and South America, most of the dishes are naturally glutenfree. Just because you are giving up gluten doesn’t mean you have to give up intense flavor.” “Don’t be afraid to experiment!” he says. With that encouragement, Manning released the recipe for a signature El Monte entrée, Red Snapper Veracruzana. The discovery that you can no longer eat wheat must surely come as a shock at first, but the experts all agree that living a wheat-free life is not impossible, it’s actually getting easier and the ultimate good health you will enjoy is entirely worth the effort.

For 2 People 1 lb. r ed (or yo snapper cut in ur fav to 2 orite 1 Tbsp portio f is h) . olive ns, sk in rem o il 2 eac oved h Rom a t o m 1 each atoes f - roas (1/4-in resh Anahe ted, p ch X im eeled chile 1 in and q c h s 4 eac s e t e uarter r d ip ed an s) h jum ed d b c o gree ut int rough o raja n olive choppe s s - pim d 1 tsp. ento r capers emove d, if d 1/4 ea esired ch red , and onion 4 oz. julienn dry w ed hite w 2 oz. ine whole butter - cold Heat a sau té and all ow to pan until ho t, add brown tomat oe on fir st sid olive oil and fish t s, olives an e. Fli place o serv d cape p and ing pla rs, sa it to add o fish in uté f te, de reduce nions, or 2-3 glaze pieces by one raja minute of but half. R pan with w s. Rem s, ter w Seaso h e it m e ove ove w hil n light ly wit e swirling p pan from h ine and allo capers w h a e n a s t, pinc alt an alread h in d pepp and sauce y add thicke er, if salty ns. desire flavor) d (oliv . Enjo es an y! d

Corey Radman is a writer and mother of two, who lives in Fort Collins. Recipe courtesy El Monte Bar & Grill, 1611 South College Ave., Fort Collins, (970) 372-1869. www.elmontegrill.com

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Northern Colorado Medical & Wellness 2010

wellness

P erk

Cosmetic Procedures

U p

For Spring

re you excited that spring is here, looking forward to getting out in the beautiful warm weather the season will bring? Or do you feel sluggish and unmotivated – like you just woke up from a long winter’s nap? (I know what you’re thinking: Nap? When did I get a nap? I don’t have time to nap!) Do you feel like your fuzzy once-white slippers – tired and a little dumpy?

If the description fits you, read on. This is the perfect time of year to take action and do something to perk up your body and refresh your look while preparing for warm weather. Take a little time for you, so that when the summer fun begins, you can throw out the old slippers, get out the flip flops and truly enjoy every moment. Busy women, especially moms, are usually so involved in taking care of everyone else they forget to take care of themselves. Well,

Busy women, especially moms, are usually so By CONNIE HEIN

involved in taking care of everyone else they forget

this is the perfect time to do just that; take care of yourself and treat yourself as lovingly as you do those you love. So what can you do to perk yourself up, you ask? We consulted the experts, gathered the research and have some great suggestions for you.

Refresh Your Look with No Downtime

Let’s start with Dr. Michelle Tollefson at Poudre Valley Health System’s Twenty Three Trees Medical and Wellness Spa. She says for women who want to have procedures done in the relaxed comfort of a spa “with fluffy robes and slippers,” but also want the expertise and experience of medical professionals, this is the place to be. She says their Cynosure Elite Laser Facial is a great procedure for busy women who can’t take time out of their schedules for skin recovery. The laser facial is complete in

to take care of themselves. This is a perfect time of year to do just that; take care of yourself and treat yourself as lovingly as you do those you love. about an hour and a half with no downtime or recovery time at all. As we age, according to Dr. Tollefson, the collagen production in our skin diminishes and the collagen naturally relaxes. The warm soothing heat of the laser works deep in the skin to help stimulate the growth and production of collagen. “The procedure involves no pain,

Lydia’s STYLE Magazine

to get started with good skin health and slow the relaxation of their skin. Healthy is beautiful.” Dr Tollefson says she has seen superior results in patients that also do a microdermabrasion treatment immediately before the laser treatment. “It seems to be the perfect combination for maximum results.”

A Healthy Glow for Skin

Dr. Michelle Tollefson, at Twenty Three Trees Medical and Wellness Spa, uses the Cynosure Elite laser facial to stimulate the production of collagen.

just a warm sensation on your skin that leaves you looking refreshed and improves the overall health of your skin.” Because of the laser’s ability to put heat deep within the skin, it tightens the skin, assists with wrinkle reduction and helps treat sun-damaged skin. “I highly recommend this procedure if you want your skin to look younger, but want a procedure with no

downtime or recovery period.” She says the laser treatment is followed by a facial using products specifically designed to enhance the effects of the treatment. Patients are then educated about products to use to get longer lasting results from the procedure. “This is for patients of any age, from those who want to take care of past damage and refresh their skin to younger patients that want

Dr. Rebecca de la Torre, owner of Allura Skin and Laser Clinic, uses the DOT CO2 laser therapy on her patients to tighten and correct damage to the skin.

Northern Colorado Medical & Wellness 2010

Dr. Rebecca de le Torre at Allura Skin and Laser Clinic agrees this is the perfect time of year for patients to take time to perk up their bodies. “Graduations, weddings and reunions typically happen in the summer months, so these last weeks of cold weather are a great time to spruce up your face so that you look your best for your special events.” She recommends quick fixes that bring great results with minimal downtime. “Patients come in with a range of skin damage, from mild to severe. After consulting with the patient to analyze their skin, we recommend the treatment we feel will be appropriate to restore their skin to a healthy glow.” Dr. de la Torre says their Fotofacial or Fraxel Laser Treatments do a good clean up on the skin, getting rid of red or brown spots, fine lines and wrinkles. “The process gets rid of damaged skin cells and the body replaces them with fresh healthy cells, giving your skin a smoother texture.” She says these laser facials require no physical recovery time, but may require a little social downtime. “Some people may not want to be in public immediately afterward, but any redness can be very easily concealed with makeup.” She says within about a week patients notice an illumination of the skin that makes them look healthier, because the skin truly is healthier. Dr. de la Torre also recommends their new DOT CO2 laser therapy that takes restoration of the skin’s tone and texture to the next level. “This is a more aggressive treatment that induces immediate skin tightening and stimulation of new collagen growth. It is typically used for patients that have severe sun damage, very deep wrinkles, or surgical, acne or trauma scars which are harder to treat.” She says this treatment requires a bit more downtime.

“After having this type of laser treatment you will not only look and feel better, but will have more energy for warm weather activities.” The laser Dr. Schmidt uses is a revolutionary bio stimulation laser that stimulates ATP in the cells – the chemical used by cells as energy. According to Dr. Schmidt, the treatment becomes a weight loss protocol as well as a wellness regimen because it opens the fat cells so they can drain and be used throughout the body for energy or flushed out of the system. Lipolysis is the breakdown of fat stored in fat cells. During this process, free fatty acids are released into the bloodstream and circulate throughout the body. Every organ in the body, including muscle, uses this as their source of energy and the rest is flushed out. This happens naturally in the body when we do very heavy cardio of any kind. The body first uses any carbs in the system, then proteins, and then fat. Dr. Schmidt says the laser tricks the body into thinking that it is getting a tremendous cardio surge so it causes lipolysis. He says the laser is not only used for weight loss, but has been very effective for pain relief. “Every organ, muscle and tissue in the body uses this fluid for energy and will benefit from having it available in the system.” Dr. Schmidt says that in 12 treatments, patients get dramatic results in fat loss and pain reduction. The 12-treatment wellness regimen also includes whole body analysis and treatment with the knowledgeable staff of experts including physical therapists, counselors and homeopathic doctors. For $2,250 you not only get the laser treatments, but also individualized treatments and assistance to address other health issues you are experiencing. “It is not just a weight loss program, but a comprehensive diagnostic and treatment regimen,” he says. “By summer you will have more energy and feel better than ever.” Dr. Jeffery Schmidt, of Xanadu Med Spa, illustrates the Low Level Laser treatment technology.

Permanent Perk-Ups

Sometimes self-esteem and body image are

“Patients often experience some redness and a dry or tight feeling in their skin for a few days.” She says patients need to plan for this procedure farther ahead of any special event coming up in their lives to give the skin time to heal completely from the procedure. Dr. de la Torre says all these treatments result in the patient having new, soft, baby-like skin and a more youthful appearance.

Better Body and More Energy

Dr. Jeffrey Schmidt at Xanadu Medical Spa says he has the perfect procedure to get your body in the best shape possible and ready for the active months of spring and summer. Using the newest technology in Low Level Laser treatments, he can increase the vitality of the body by improving the process through which energy is made and delivered – making every part of the body function better and more efficiently.

Low Level Laser treatments can aid in weight loss by stimulating fat cells to drain, providing energy for the body or flushing out of the system.

Lydia’s STYLE Magazine

Dr. Amy Brewster, owner of Mountain Vista Plastic Surgery

better served by a procedure producing more permanent results, such as a breast reduction and/or tummy tuck procedure. Dr. Amy Brewster, of Mountain Vista Plastic Surgery, says these options may even offer health benefits that you may not have considered. Often people don’t realize what negative affects large breasts can have on their body. Back, neck and shoulder pain are just a few. Dr. Brewster says large breasts can also cause headaches, rashes and other conditions. “Large breasted women often don’t realize how much better a breast reduction could make them feel.” The procedure is an investment in time, but the results are well worth it, says Dr. Brewster. However, it is not something you can plan for a Friday and go back to work on Monday. “Since there is some recovery time required, you must make plans for the children in your life or job responsibilities so that you can take care of yourself.” Dr. Brewster is very passionate about helping patients that need any kind of plastic surgery to improve their lives. “It still amazes me, how much difference a breast reduction or tummy tuck can make in the way a woman feels.” She says while having a breast reduction it is a great time to add on a tummy tuck. Even though insurance will not cover the tummy tuck, it can be done at the same time as the breast reduction, which saves money on many aspects of surgery such as anesthesia, faculty fees, pain medications and recovery time. “Sometimes a healthy diet and exercise just won’t get you where you want to be, so people

Northern Colorado Medical & Wellness 2010

Before photo of Dr. Brewster’s patient, who simultaneously had a breast reduction and tummy tuck.

feel discouraged and stuck,” she says. A tummy tuck can give you motivation to continue a healthy lifestyle without the frustration of seeing no results in flattening the tummy. Dr. Brewster works closely with the patient’s insurance company and their other healthcare providers to make sure all the information is in place and all the billing is coded correctly so there won’t be a problem. “We do that before we ever start a procedure to give the patient one less thing to think about and deal with.” Dr. Brewster, who performs a large variety of procedures at her practice, is there for the patient at every part of the procedure from the consultation to taking out stitches at the end. “I am very hands on and detailed in the operating room, but I also want to know the patient and want to make sure she is prepared for the procedure and is sure about what she wants.” Her patients agree. Paula Weiss had a breast reduction and tummy tuck procedure just weeks ago and says she is happy she decided to do both procedures at the same time. Together, the procedures went smoothly and Dr. Brewster was wonderful and very thorough, she says. “As a healthcare professional myself, I always go to physicians recommended by friends in the medical field,” she said. “Dr. Brewster is who I would recommend to anyone for any kind of plastic surgery.”

Brighten Up Those Eyes

Last but not least in our quest for perk-ups, we come to Dr. Chet Reistad of the Eye Center of Northern Colorado. Do you have droopy eyelids or bags under the eyes? If so, having them perked up can make a big difference in how you look and feel, and possibly in how well you see. Dr. Reistad is one of the few surgeons in the country that specialize in ophthalmic plastic and reconstructive surgery. “The practice of ophthalmic plastic surgery includes cosmetic

Lydia’s STYLE Magazine

Three weeks later, the patient is healing well and happy with her new look.

and reconstructive surgery of the forehead and eyelids, tumor surgery of the eyelids and socket, periocular trauma, tearing problems, eyelid spasms and thyroid eye disease,” says Dr. Reistad. He also performs non-surgical facial wrinkle treatments including Botox, Juvederm injections and Latisse eyelash growth enhancer. With these techniques at his disposal, Dr. Reistad can help patients decide the best course of action, whether it be to help with vision problems due to excess skin over the eye or eyelid fat pad contouring for people who just want a more youthful appearance. “The goal is not to make you look shocked or surprised,” Dr. Reistad says, “just rested and relaxed.” After these procedures, his patients often report that people ask them if they have lost weight, have a new hairstyle or new glasses. “People notice something is different, but often can’t put their finger on it right away.” Dr. Reistad says excess skin on the upper eyelid not only makes you appear older, but can in severe cases interfere with vision. Insurance may cover this procedure if the excess skin is obstructing a patient’s vision, but will not cover the procedure for purely cosmetic reasons. In the lower eyelid area, there can be excess skin or fat pouches that can be contoured or treated to restore a more youthful appearance. “Procedures like these are often not as costly as you might think. They are usually in the same price range as other laser treatments, and can sometimes be the solution in cases when laser treatments are inadequate.” He says for the typical fine lines around the mouth, face and eyes, it is reasonable to try topical treatments or laser. For excess skin and folds, you may be best served with surgery to see improvement. “Operating on the eyelids is not as scary as it sounds,” says Dr. Reistad. He has training in both plastic and reconstructive surgery of the

Northern Colorado Medical & Wellness 2010

Before: Dr. Reistad’s patient had excess skin over the eye that drooped down, imparing her vision.

face and years of experience in ophthalmology as well as mircosurgical training in ophthalmology. The procedures involve bruising for the first few days, but discomfort and swelling can be managed with over-the-counter medications and ice packs. So busy moms – give yourself permission for a little pampering and perk up from head

Lydia’s STYLE Magazine

Dr. Chet Reistad, with Eye Center of Northern Colorado, consults with Joann Duran.

Today, the patient looks younger and more alert after the removal of the excess skin on the upper eyelid.

to toe. With these great options, you can look and feel your best in no time. Then bring on the flip flops and summer celebrations. Connie Hein is a freelance writer living in Windsor who canâ&#x20AC;&#x2122;t wait to perk up and get on the flip flops.

Northern Colorado Medical & Wellness 2010

Improve Fitness with TRX Change can bring a fresh new perspective and outlook to your life. Change in your fitness routine can bring a fresh new attitude to your workout. Katherine Sanford, Personal Fitness Trainer, says changing your workout and shaking things up a bit can not only keep you from becoming bored, but can also work your body in different ways to achieve better overall fitness. She says the new TRX suspension training workout system is a perfect way to do just that. The low impact system consists of two long straps with stirrups that are suspended from a bar. Sanford says it feels much like hanging from a parachute, but you always have some part of your body on the ground. “The system is versatile, functional and portable so it can be easily incorporated into any workout you are already doing, or used on its own.” She says the workout uses a 3-D concept of training that enables movement to be performed at any plane or all planes at once. This makes it possible to work the core while working other parts of the body. “It’s all core all the time,” she says. “Every exercise done on the TRX engages the core to develop balance, flexibility and strength.” The workout can be customized for anyone of any age, any size and any fitness level, according to Sanford. “It’s perfect for athletes who are training to throw a football or have a better golf swing, or people who just want to be strong enough to easily carry bags of groceries or a child around all day.” Sanford offers personal TRX training in Fort Collins at The Other Club and Raintree Athletic

Club and teaches two different types of TRX classes at Raintree. This is a great option “for a fun workout with friends and music,” she adds. Sanford also trains clients on the TRX system in their home using her own straps hooked on a bar or over a door. She says clients can also purchase suspension straps to use at home or when travelling. Be warned, says Sanford, “This system is so fun and different, it’s addicting.”

Horsetooth half marathon course

Start Training Now So you have never done a race before. Or you have done that friendly little 5K and stopped right there. But it is a new season and time to push forward to a new challenge. Make it your goal to start training for this summer’s many 5Ks, 10Ks, half-marathons and marathons. Local races are great motivators and serve a two-fold purpose. Even if you run them recreationally, the goal of completing a race is a great way to get into better shape and push yourself to do something challenging. They also enhance your sense of community (the festivities afterward are almost as much fun as the race itself) and many simultaneously raise funds for local and national non-profit causes. So how do you get started? Many resources are available on the Internet to provide you with a training schedule that meets your needs. Websites we liked: www.coolrunning.com, their Couch-to-5K running plan is great; or www. runningplanet.com, this website has plans for 5K to marathon training. The key to successful training is to start early, at least two months in advance. This allows you to add to your time or distance slowly and steadily, and allows your body to adjust in between harder runs. Pay attention to both rest days and cross-training days. Most workouts will recommend a complete rest day after your longest run of the week. Skip any strenuous exercise this day. On other rest days, you have the ability to cross train in between. Be realistic about your goal. If you have never run before, don’t set your sights on the half-marathon for your first try. Start with a 5K run/walk. Completing the 5K will give you the motivation to continue on from there. Also pay attention to your equipment: good running shoes, comfortable clothing designed to whisk away moisture and a way to carry water if needed. Your local sporting goods store can get you started on the best equipment for your needs. Another option may be to join a local fitness club. With the help of a personal trainer, you can build stamina and personalize your training regimen or ask if the club has a group training class available. Finally, it is time to get mentally prepared. Running a race is not just an activity for the athlete; anyone can train and work up to the race of their choice. And running a race gets you outside to enjoy our beautiful Northern Colorado scenery. Days are getting longer, the weather will get warmer and the sun is calling your name. Get out there and run.

Lydia’s STYLE Magazine

Get Fit, Give Back Calendar Some of these great local events not only require you to get off of your recliner, their proceeds benefit area non-profits.

March

7 – Tortoise & Hare Race Series, 12k, 8 a.m., Fort Collins – 10-mile tune-up for the Horsetooth Half Marathon, www.fortcollinsrunningclub.org

May

1 – Walk MS, 7:30 a.m., Fort Collins, benefitting the National Multiple Sclerosis Society, Colorado Chapter, www.walkms.org 2 – Ram Bicycle Classic 2010, 8 a.m., Fort Collins, benefitting the Global Social & Sustainable Enterprise Program at Colorado State University, www.gsseride.org

13 – Sharin’ O’ The Green 5k, 8:30 a.m., Fort Collins, benefitting Partners Mentoring Youth, www.partnersmentoringyouth.org

8 – Walk MS, 7:30 a.m., Loveland/Centerra – Chapungu Sculpture Park at Centerra, benefitting the National Multiple Sclerosis Society, Colorado Chapter, www.walkms.org

28 – Second Annual JourneyQuest 5k, 9 a.m., Fort Collins, benefitting Shared Journeys Brain Injury Foundation, www.sharedjourneysfoundation.org

9 – Colorado Marathon, Old Town, Fort Collins, bus service to the race begins at 4 a.m., www.thecoloradomarathon.com

April

4 –Tortoise & Hare Race Series, 8 a.m., Fort Collins – 10-mile tune-up for the Horsetooth Half Marathon, www.fortcollinsrunningclub.org 11 – Flying Pig 5k Charity Run/Walk, 9 a.m., Fort Collins, benefitting Foothills Gateway’s Family Support Services program, www.foothillsgateway.org 17 – Fast and the Furriest 5k, 7:30 a.m., Fort Collins, benefitting CSU’s Veterinary Medical Center’s Companion Care Fund 18 – Horsetooth Half Marathon, 8:30 a.m., Fort Collins, finish line party at New Belgium Brewery, www.horsetoothhalfmarathon.com 24 – Sierra’s Race Against Meningitis 5k run/ walk, 9 a.m., Loveland, www.sierraraceagainstmeningitis.com 24 – March of Babies, 8 a.m., Greeley and Fort Collins, benefitting March of Dimes, www.marchofdimes.com/colorado

16 – Community Classic Bike Tour, 6:30 a.m., McKee Medical Center, Loveland, benefitting the Banner Simulation System at McKee 16 – CSU Oval 6 Day Races, consecutive Sundays beginning on May 16 through June 20, 5 to 7 p.m. www.fcgov.com/bicycling/events.php 29 – Pelican Fest Triathlon, 8 a.m., Windsor, www.t2coaching.com

2010 Horsetooth Half Marathon Sunday, April 18, 8:30 a.m. Gear up now for one of Colorado’s oldest running/walking events. The Horsetooth Half Marathon is in its 34th year. The race begins with the scenic Horsetooth Reservoir, runs alongside the Cache La Poudre river and culminates with live music and festivities at New Belgium Brewery.

*Please note: While our calendar is by no means complete, Style is endeavoring to include as many get-healthy activities as possible. If you know of an event, especially those supporting a non-profit cause, please send the information to angie@stylemedia.com. A special thanks to Steve Cathcart, owner of Runners Roost Fort Collins, for providing Style with two entries to the Horestooth Half Marathon and inspiring staff to train for the race.

Horsetooth half marathon course elevation

Northern Colorado Medical & Wellness 2010

wellness

Prevention

C alcium

S C ore

T esting

for your Heart

he American Heart Association recommends that heart attack prevention begin by age 20. This means assessing your risk factors and working to keep them low. For people over 40, or those with multiple risk factors, it is important to calculate the risk of developing cardiovascular disease over the next 10 years.

Peter Koplyay, M.D., radiologist at Harmony Imaging Center (HIC) in Fort Collins, says they have one of the newest screening tools to help with the calculation and prediction of future heart problems. “This new screening scans the heart and gives patients an Agatston score, or calcium score,” he says. “This score is becoming a very valuable new piece of the puzzle when determining your future risk of heart disease and heart attack.” The calcium score shows how much calcium and plaque has built up in the coronary arteries going to the heart. “This can be an important indicator of total coronary artery plaque or build up for the patient,” he says. Physicians can add the calcium score to other risk factors they look at to get an overall picture of a patient’s heart health. These factors include family history, lifestyle, triglyceride and cholesterol scores,

By CONNIE HEIN

A calcium score shows blood pressure numbers, diet and lifestyle. Stephen Treat, M.D., of Heart Center of the Rockies, recommends, “It is good to consider doing this type of test when you have two or more risk factors or a family history. These tests can help us move a person of intermediate risk or unclear risk into a low- or high-risk model and treat accordingly.” The test, according to Dr. Treat, is useful for men and women and different ethnic groups. It is available for any age. However, Dr. Treat says it is best for persons ages 40 to 55 years old. “It is not great for younger people and can lose specificity in older people.” The test, which takes only about 10 minutes, is done using a high-end, multi-detector X-ray-driven CT scanner. During the test, the scanner takes 40 to 50 pictures that look like slices of the heart. The technology that makes the scanner unique is that is only takes pictures when the heart is at rest, or not beating. “Since the X-ray is only used when taking the actual pictures, the patient is exposed to far less radiation than when scanning the entire heart using older technology,” says Dr. Koplyay. Other scanners use X-rays to take pictures of the heart for several minutes and then use only the pictures that were taken when the heart was at rest.

how much calcium and plaque has built up in the coronary arteries going to the heart. “This score is becoming a very valuable new piece of the puzzle when determining your future risk of heart disease and heart attack.” – Peter Koplyay, M.D., Harmony Imaging Center

Lydia’s STYLE Magazine

At Medical Center of the Rockies, cardiologist Brad Oldemeyer and his team want to open the blocked arteries of heart attack patients as quickly as possible. Why? Because faster response times save lives. They are part of a national initiative focu sed on reducing the time it takes from a heart attack patient's arrival at the hospital doors to the moment a balloon catheter clears the blockage. The shorter this "door-to-balloon" time, the more likely the patient will survive and recover. MCR's door-to-balloon time for qualifying patients was nearly half the national standard, as set by the Center for Medicare and Medicaid Services and the Joint Commission . It's comforting to know that doctors like Dr. Oldemeyer have your future at heart.

MEDICAL CENTER OF THE ROCKIES POUDRE VALLEY HEALTH SYSTEM

Heart Center

For more information or to make an appointment, please call (970) 221-1000

OF THE ROCKIES

or (800) 459-4521.

POUDRE VALLE Y HEALT H SYSTEM

heartcenteroftherockies.com Northern Colorado Medical & Wellness 2010

Peter Koplyay, M.D., of Harmony Imaging Center The new technology is much more efficient, with less radiation to the patient. Since this is a fairly new screening, not all insurance companies are covering the cost, says Dr. Koplyay. The technology has only been in use for six or eight years, and has only been used at HIC for two years. However, “research and data are starting to show how valuable the calcium score can be in determining overall heart health and risks,” he says. “Insurance companies realize that screening and prevention saves thousands of dollars in the long run, so many are paying for the screening.” Even if insurance doesn’t cover the cost, says

Stephen Treat, M.D., of Heart Center of the Rockies

Koplyay, it can be one of the most valuable risk assessment tools available, especially when a patient has several of the other heart disease risk factors. The cost for the test is between $200-300, with no need for a doctor referral. He says many first-ever heart attacks are fatal or disabling, so prevention is critical. The sooner you begin comprehensive risk evaluation and reduction, the longer and stronger your heart will beat and the better quality of life you will have. Connie Hein is a freelance writer living in Windsor and grateful to have a healthy heart.

Lydia’s STYLE Magazine

why calcium scores

work

By Roger Ashmore, M.D. Heart Center of the Rockies

he Framingham risk score incorporates a person’s age, sex, cholesterol levels, presence/absence of high blood pressure, diabetes and tobacco use into a model and estimates a person’s 10-year risk of developing clinically active coronary heart disease (heart attack, sudden death or symptoms/ angina requiring therapy). The Framingham risk score, however, only does a mediocre job predicting risk in the individual patient or who is actually going to develop active disease.

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Unfortunately, 50 percent of heart attacks occur in previously asymptomatic patients and a third of these will be fatal. One recent study found that 75 percent of previously asymptomatic patients presenting with a heart attack would not have met criteria for aggressive medical therapy if they had been evaluated in the days before their heart attack. Blood tests such as advanced cholesterol testing and Creactive protein levels (CRP) are now available that help predict who may be at risk but also have limitations. If the actual presence or absence of coronary artery disease could be determined before symptoms develop then therapy could be targeted to those individuals who have documented coronary artery disease and are at highest risk. The amount of coronary calcium present correlates well to the overall amount of coronary artery plaque (atherosclerosis). This is important because coronary artery calcium is detectable in the majority of patients who have a heart attack. Many studies are also showing the higher the amount of coronary artery calcium present, the higher a person’s future risk of heart attack is. The coronary artery calcium score can help the patient and their care provider plan effective preventive strategies. Contributed by Heart Center of the Rockies.

Northern Colorado Medical & Wellness 2010

veterinary

Specialists

specialty

Veterinarian Care By connie hein

ailey, a one-year-old female Labrador retriever, came to Peak Veterinary Specialists with a death sentence. Bailey’s general veterinarian had recommended euthanasia based on a diagnosis of severe kidney failure, but Bailey’s family was not ready to say goodbye. Instead they brought Bailey to see the internists at Peak and left with a whole new outlook. When the specialists looked further into the causes of Bailey’s condition, they discovered Bailey was born with dysfunctional kidneys that caused toxins to build up in her bloodstream, resulting in a loss of appetite and vomiting. She also had a bacterial infection in her kidneys, compounding her problems. Once the infection was treated, Bailey quickly recovered. Although her kidneys will never be normal, she can enjoy life again. Instead of saying goodbye, Bailey and her family have been given eight happy months together (and counting). Ellen Miller, DVM, says this is just one example of

“Our job is to aid veterinarians in helping their four-legged patients with special needs, just as a

what happens often in the offices of Peak Veterinary Specialists (PVS) in Windsor. “Because of our specialized education, we can sometimes give families treatment options they didn’t know were available for their pet.” Dr. Miller says specialists taking care of animals in the veterinary world are just as valuable as specialists taking care of patients in the human world. “Because veterinary specialists have many years of training above and beyond what a general veterinarian typically has, we can be of great service with difficult illnesses, disease and pain control.” A specialist in pet healthcare allows for a broader range of treatment. PVS has vets specializing in internal medicine, dermatology and radiology, as well as surgeons and dentists. “Our job is to aid veterinarians in helping their four-legged patients with special needs, just as a general practitioner would refer patients to a specialist for illnesses and disease they can’t deal with or address,” Dr. Miller says. A board-certified veterinary specialist completes not only undergraduate studies and four years of

general practitioner would refer patients to a specialist for illnesses and disease they can’t diagnose or treat.” – Ellen Miller, DVM, Peak Veterinary Specialists

veterinary school, says Dr. Miller, but also internship and residency in a chosen specialty field (an additional 3-5 years of training). In addition to this extensive training, specialty veterinarians have passed rigorous examinations to achieve board certification in their respective field of study. At PVS, they do not do routine veterinarian care,

Lydia’s STYLE Magazine

See the Difference a Specialist Makes Internal Medicine Ellen Miller, DVM, MS, DACVIM Lauren Prause, DVM, MS, DACVIM Radiology Jennifer Lowry, DVM, MS, DACVR Sandy Van Camp, DVM, DACVR

Dr. Lauren Prause performs a physical exam on a feline patient. She opened the clinic with Dr. Miller in 2004.

Surgery Chad Devitt, DVM, MS, DACVS Brian Van Vechten, DVM Tara Britt, VMD, DACVS Dentistry Clarence Sitzman, DVM, DAVDC

but provide specialized care to both dogs and cats. There is a misconception this kind of specialized care is very costly, especially when the extra training is factored into the equation, but that is not necessarily the case. “In the long run, it can often save money to visit a specialist when necessary.” This is true because their comprehensive knowledge of specific problems, treatments and outcomes often helps them achieve the diagnosis, and ultimately the appropriate treatment, more efficiently. “Since we can often come to a diagnosis more quickly, we can get the animal started on treatment sooner. This can save money, shorten the amount of time your pet experiences discomfort, help them recover faster and can give them a better quality of life.” Dr. Miller cautions people to observe their pets carefully, because dogs and cats may cover up their condition for a long time when they are ill. “For dogs, it is the pack mentality – if I am sick, I will be excluded from the pack. For cats, it is probably similar, but also weak animals become prey if they are not the predator.” “I encourage people to think about what defines their pet’s quality of life, whether it is going for walks,

Northern Colorado Medical & Wellness 2010

Dermatology Linda Messinger, DVM, DACVD Andrea Lam, DVM

SPECIALTY MEDICINE, PERSONAL CARE Please contact your family veterinarian for a referral to Peak Veterinary Specialists Peak Veterinary Specialists 4630 Royal Vista Circle, #11 Windsor, CO 80528 970-674-1775 fax: 970-674-0900 www.peakvetspecialists.com

Radiologist Dr. Sandy Van Camp performs an ultrasound on a patient.

Dr. Chad Devitt performs an orthopedic exam. Dr. Devitt is one of Peak’s three surgeons.

being petted, catching the ball, eating, etc.” She says as pets lose the ability to do these things, it is time to assess what’s best for your pet. Obviously age and arthritis may limit physical activity. “Pets are stoic,” she says. “They tolerate higher levels of pain than humans, so I would encourage people to call their vet even for subtle changes in their pet’s behavior.” If there is a problem, it can be caught early and is more likely to have a better outcome. “If the problem can’t be treated by your general veterinarian, they can refer you to us,” Dr. Miller says. Dr. Miller’s goal is to get the word out to area pet owners and veterinarians that they are here to aid in the healthcare of cats and dogs, adding that some veterinarians don’t even know PVS exists because, in the past, most specialty vets were only in teaching

in 2008. In Windsor, they are joined by radiologists (Drs. Jennifer Lowry and Sandy Van Camp), surgeons (Drs. Brian Van Vechten, Chad Devitt and Tara Britt), dermatologists (Drs. Linda Messinger and Andrea Lam), and a dentist (Dr. Clarence Sitzman). They saw a growing need for specialized care in this area and enjoy collaborating on challenging cases. “We are all very passionate about animals and about what we can do to help make their quality of life better.” As in Bailey’s case, their specialty education and experience not only gave her a better quality of life, but a longer life as well.

Peak Veterinary Specialists’ in-house dentist, Dr. Clarence Sitzman, performs an oral exam on a Cocker Spaniel. universities such as CSU. “In the last 20 years there has been a shift; lots of specialists are now in private practice because we realize the need for our services.” Dr. Miller, along with Dr. Lauren Prause, started their specialty practice in 2004 and moved to Windsor

Connie Hein is a freelance writer living in Windsor, and the author of the Toliver in Time series of children’s books.

Lydia’s STYLE Magazine

Seven Signs of a True E mergency

With Your Pet By Jon geller, dvm

ave you ever wondered what signals a true pet emergency? Or when it is safe to observe strange behaviors before packing up Fido and heading to the vet? The following signs are indicative of a pet in distress and signal that a trip to the veterinarian is necessary. 1. Pale gums: Pull up your pet’s upper lip and check the color of their gums. Normally they should be pink and moist. Pale or white gums could be a sign of internal bleeding.

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2. Difficulty breathing: Increased respiratory effort or breathing rate could be a sign of serious disease. Panting when it is warm is normal for a dog, but is always an emergency in a cat. 3. Unproductive vomiting: Retching or gagging in a large dog can be a sign of a twisted stomach (also called bloat or Gastric Dilation and Volvulus Syndrome), which can be a life-threatening surgical emergency. 4. Difficulty urinating: Straining to urinate could indicate a urinary blockage, which is always an emergency. 5. Seizures: Seizures are brief episodes of unconsciousness, usually accompanied by falling over and paddling, that can lead to more or longer seizures if not treated. 6. Collapse: Collapse can be a sign of heart disease, internal bleeding or a seizure 7. Unexplained bleeding: Bleeding from the nose or any other place that does not stop can signify a life-threatening problem with the ability of the blood to clot. Dr. Geller is an emergency veterinarian at Fort Collins Veterinary Emergency Hospital and Pets Emergency in Greeley, as well as a freelance writer. His work has appeared in Dog Fancy Magazine, Bottom Line Personal and Mother Earth News. In addition, he has a current blog at thebark. com and medhelp.org and answers dog owners’ questions online at Dogchannel.com.

Northern Colorado Medical & Wellness 2010

physician spotlight

Dr. Doug Kemme

Name: Doug Kemme, M.D. Occupation: Oncologist with Greeley Medical Clinic, P.C. In His Downtime: Comedian and Family Photographer

D r . D oug K emme

A Labor of Love By connie hein

r. Doug Kemme, a native of Greeley, has devoted himself to balancing his two great passions: working with his oncology patients and spending time with his family. Sprinkled into his duties to job and family are a lively sense of humor and the drive to give back to the community in which he grew up. As part of the team of doctors at Greeley Medical Clinic (GMC), Dr. Kemme says he is able to help in the care of many more patients through GMC than he could care for in a private practice. He believes being part of setting up and running the GMC group is one of his greatest accomplishments, second only to raising great kids and sustaining a healthy 26-year marriage to his wife Emily. He and Emily were both born and raised in Greeley, so after Dr. Kemme finished medical school and his residency in Denver, and Emily finished law school, they decided Greeley was a perfect place to start

their family. Dr. Kemme says while oncology can be very demanding physically and emotionally, with very long hours, it has given him more time and scheduling freedom than doctors in some other medical fields. “It has been the perfect profession for me to be able to balance giving my patients the best care possible while helping successfully raise our family.” As well as affording him time with family, oncology has given Dr. Kemme time to be active with many community charities, a desire he has passed on to his children. His son Jordan, 18, and daughter Madeleine, 15, are following their parent’s example by volunteering not only in Greeley, but also in other areas of the country. “Our children have become passionate about volunteering,” he says. “We all believe giving back to our community keeps us grounded and involved.” He says Jordan spent his spring break helping in a Katrina Relief program where the students go down and restore a home for a family affected by the hurricane. He is very proud of both of his children

for finding ways of their own to reach out and help others in need. It has been very rewarding to raise consciously aware children who care about the people around them, he adds. He attributes part of their success in raising their children to the decision to basically turn off the television for the past 20 years. “Our children were never allowed to watch television on weeknights because we wanted them to get good grades and find more meaningful, productive things to do with their time.” He allowed them to watch as much television as they wanted on weekends, but never on school nights. Their theory must have worked, because both children have become responsible young people who have done great in school. Jordan is now a champion pole-vaulter in college and Madeleine is in the top of her class in high school. What motivates Dr. Kemme and brings him the most joy in his demanding practice is remembering to keep things light and positive for his patients who are sometimes very ill. He loves to brighten his days as well as his patients with laughter. “I’m always telling dumb doctor jokes to entertain patients and give them a chuckle,” he says. “No matter what the patient is going through, laughter and a positive outlook will help them through the process.” He says he has learned to walk a fine line to keep things positive and be cheerful without giving patients the impression that he is not taking their care seriously. One of his favorite jokes (remember, he did say dumb): “Two doctors decided to go ice fishing for the first time. As they set up their stools and started cutting a large hole in the ice, a deep voice came from above them saying ‘There are no fish down there.’ The doctors looked around and saw no one, but loudly asked. ‘How do you know that?’ The booming voice answered, ‘Because I am the ice rink manager.’” Dr. Kemme says what inspires him to be the best oncologist possible is putting himself in the patient’s shoes and asking himself how he would want to be treated in the same situation. “When the paperwork and other tasks become grueling and I think I can’t do it, I just stop and breathe and remember the patient is someone I care about deeply and the tasks become labors of love.” Besides being a passionate doctor, husband, father, eager volunteer and self-proclaimed comedian, Dr. Kemme is also an avid photographer. He says he loves photography and has great subject matter – his family. Connie Hein is a freelance writer living in Windsor and is also passionate about photographing her beautiful family.

Lydia’s STYLE Magazine

CA) MEDICAL CLINIC AT CENTERRA, PC Part of the

ENT: Arthur Chen, MD Family Practice: Pamela Levine, MD Gastroenterology: Peter Witt, MD General Surgery: Steven Dubs, MD; Lesley Fraser, MD; Michael Peetz, MD; Joseph Livengood, MD Internal Medicine: Grace Alessi, MD; Mark Berntsen, MD; Dana Christiansen, MD; John Ebens, MD; William Lopez, Jr., MD; Michael Randle, MD; Keith Thompson, MD; Daniel Zenk, MD Oncology: Douglas Kemme, MD; Samuel Shelanski, MD; Anne Stroh, MD Orthopedics: Mark Grossnickle, MD; Brett Hunter, MD; Steven Sides, MD; Joshua Snyder, MD Rheumatology: James Levine, DO; Garvin Murray, MD; John Stephen Thompson, MD Additional Services: Imaging, Lab, Rehabilitation Services

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Prostate surgery technology this advanced means less recuperation time and more fishing time.

McKee Medical Center's da Vinci® robotic surgery is minimally invasive and offers men maximum benefits.

For patients who qualify, this robotic surgery allows for smaller incisions, which can mean less pain, scarring, blood loss and risk of infection. You can have a quicker, easier recovery so you can get right back to doing more fishing or other things you love. This leading technology is just one example of the world-class advancements McKee Medical Center has invested in for the people of northern Colorado.

~ ~Banner Health McKee Medical Center www.BannerHealth.com/McKee ·For more information please call (970) 203-2089 2000 N. Boise Ave. • Loveland • Job opportunities: 866-377-5627 (EOE/AA) or www.BannerHealth .com Banner 2010 Health is the leading nonprofit health care provider in northern Colorado. Northern Colorado Medical & Wellness

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