2011-07 Northern Colorado Medical & Wellness Magazine and PVHS Physician Directory by Style Media & Design, Inc.

2011 | 2012

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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 w w w. m e d i c a l a n d w e l l n e s s . c o m Publisher Lydia Dody | lydia@stylemedia.com Editor Angeline Grenz | angie@stylemedia.com creative director Scott Prosser Senior Designer Lisa Gould digital director Austin Lamb | austin@stylemedia.com Advertising Sales EXECUTIVES Jon Ainslie (970) 219-9226 Lydia Dody (970) 227-6400 David Knight (970) 619-9846 Saundra Skrove (970) 217-9932 Office Manager/About Town Editor Ina Szwec | ina@stylemedia.com Accounting Manager Karla Vigil Office Assistant Trisha Milton Contributing Writers Connie Hein, Heidi Kerr-Schlaefer, Marty Metzger, Erica Pauly, Corey Radman, Kay Rios, Heather Schichtel, Graciela Sholander, Carl Simmons, Tracee Sioux, Audrey Springer PhotographerS Marcus Edwards, Brent Yoder Contributing photographers Rod Pentico, Mari Wolf Affiliations Fort Collins Area Chamber of Commerce Loveland Chamber of Commerce & Visitors Center 2011 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-Northern Colorado Medical & Wellness Magazine and Poudre Valley Health System Physician Directory August-Style September-Womenâ&#x20AC;&#x2122;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 150 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) 2266400. Fax (970) 226-6427. E-Mail: ina@StyleMedia.com ÂŠ2011 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.

2011 | 2012

Annual

POUDRE VALLEY HEALTH SYSTEM

Magazine

T A B L E On the cover: New mother Marci Carlson and nurse Pamela Smoot, RN, watch over young Wyatt in Poudre Valley Hospital’s Women’s Care Unit. Photography by Brent Yoder

Medical Magazine & Directory

Physician

O F

Directory

C O N T E N T S

Wellness Magazine & Directory 74

Chronic Disease Management Class

Conditioning Programs Aid Lifestyle Changes

Publisher’s Letter

Quit Until You Succeed

Introduction Letter

Rules Made to be Broken

Improve Your Run

Get Fit/Give Back Calendar

Cosmetic Dentistry of the Rockies

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

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

Expanding Quality as PVHS Grows

Wellness Directory

Rulon Stacey Publishes First Book

Prosthetic Innovations Enhance Independence

Nursing Awards Showcase Quality

Injury Prevention

Pediatrics at PVH

Stroke: Fast Actions Save Lives

Physician Directory

Introduction Letter

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

Dr. William A. Neff, Chief Medical Officer, Poudre Valley Health System

Healthy Heartbeats

Poudre Valley Medical Group: Today’s Healthcare

Benefits of Robotic Hysterectomies

Robotic Thoracic Surgeries: The Next Frontier 8

Publisher’s Letter

Leading Edge of Health Reform It is with a great deal of enthusiasm that we publish our 13th annual medical magazine with its focus on Poudre Valley Health System (PVHS), including the annual Physician Directory. Since PVHS has expanded beyond Fort Collins, we have renamed the issue Northern Colorado Medical & Wellness to better represent the region they serve. This issue gives us the opportunity to revisit the PVHS legacy of promoting, preserving and celebrating health and wellness. This year has been an exceptionally expansive one for PVHS. Not only has the system embraced a large number of physician providers and now counts more than 100 physician clinics under its umbrella, but it has also undertaken signifi-

cant steps for a joint partnership with the University of Colorado Hospital at the Anschutz Medical Campus in Aurora. The driving force behind this strategy is upcoming healthcare reform with its projected shortage of medical professionals and the need to continually improve the quality of healthcare in a cost-effective manner. Rulon Stacey, president/CEO of PVHS, is once again at the forefront of anticipating the needed requirements to deliver exceptional healthcare to the residents of Northern Colorado. Delivering world-class care as a result of Stacey’s leadership and employee commitment continues to be recognized through the many awards PVHS has received. In 2008, the System received the prestigious Malcolm Baldrige National Quality Award. In 2011, the Medical Center of the Rockies was selected as a recipient of the Overall Best Performer Award by Avatar International, which tracks patient satisfaction at hospitals throughout the nation. This year the American Nurses Association also announced that Poudre Valley Hospital (PVH) and MCR were among five U. S. hospitals to receive a national award for nursing quality. Read about this significant achievement in “Nursing Awards Showcase Quality.” At Poudre Valley Hospital, providing the best care for children and their families is their wholehearted commitment. We visited PVH recently when we photographed precious baby Wyatt, parents Marci and Dave Carlson, and Pamela Smoot, RN, for our cover and feature article. Thank you to the family for sharing their sweet new baby with our readers. Read “Pediatrics at PVH” to learn of the pediatric specialists on staff and appreciate their dedication to excellent medical care for the youngest members of our communities. I must say that I am a fan of robotic surgery, hav-

ing had Dr. Beverly Donnelley perform my hysterectomy a few years ago. Friends warned me that this procedure would take a long recovery with no lifting and lots of rest. After deciding to have the procedure done robotically, I had a much easier recovery time – a cakewalk by comparison and I highly recommend it when possible. Read “Benefits of Robotic Hysterectomies” for more insight into this amazing medical technology. In the wellness section of this issue, read about 10-year-old Spencer Hawk and how his family is dedicated to helping him lead an independent and active life through the help of prosthetic technology. And read Eric Gundlach’s inspiring story of perseverance and courage in “Prosthetic Innovations Enhance Independence.” We hope you enjoy reading the interesting and informative articles about health, wellness and the progressive healthcare we have available in our area. This issue is a useful reference and includes the easy-to-access Physician Directory which is divided by specialty and physician name. An additional bonus to this issue is that it is available 24/7 on our website, www.medicalandwellness.com, along with past medical issue archives. We encourage you to keep this issue as a reference or pass it along to someone who might benefit from it. My hope is that this issue will support you in taking good care of your health and the health of your loved ones. In good health,

lydia@stylemedia.com

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

Dear Medical & Wellness Magazine Reader:

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

You have probably heard a lot about national healthcare reform and how it will change the landscape of the business of providing medical services. As with many healthcare organizations in the United States, Poudre Valley Health System has prepared for national reform by encouraging providers in the region to work closely together. As I write this letter to you, 24 physician clinics in Fort Collins, Loveland and Greeley have already joined the PVHS family or been started by our health system with the goals of consolidating services and enhancing quality. Those last two words—“enhancing quality”—are the critical drivers in what we are doing. Our goal isn’t to become a bigger organization just for the sake of becoming bigger. By far, our overriding goal is for everyone to join together to enhance quality. We can doing this by making a seamless health system where patient care information is easily and securely exchanged among providers who need to know it; by honing processes so they reflect the best practices in care and service; and, among other benefits, expanding education and other opportunities that will improve the health of our communities. As part of this effort, PVHS and the University of Colorado Hospital in Aurora announced in June that we are pursuing a joint partnership that will create a new health system. This is a huge step forward in healthcare in our region. It will create the state’s largest health system that is owned and operated by a Colorado nonprofit company. The reach of the new system will cover at least as far and wide as our two organizations’ current service areas in Colorado and the Rocky Mountain and High Plains regions. The partnership joins together our two outstanding organizations that have national reputations for high-quality healthcare. Each organization is a great complement to the other. UCH brings its highly successful medical research capabilities and nationally respected academic training through the University School of Medicine. PVHS will enter the partnership with an incredibly strong track record and national reputation for providing community-based healthcare with patient outcomes that meet or exceed national benchmarks. National healthcare reform, the increasing complexity and cost of treating patients and a projected shortage of medical professionals were all determining factors in our decision to create the new health system. Most importantly, we kept the needs of our patients at the forefront of our decision-making. Colorado’s changing population patterns—particularly in the geographic areas served by PVHS and UCH—will better benefit from a unified health system. Here are a few of the many advantages: • The partnership will strengthen both PVHS and UCH, resulting in more opportunities for more medical services and remaining abreast of the latest medical technology and patient care techniques. • The combination of our academic-based and community-focused medicine will bring further innovation and leading-edge care to patients. Among other benefits, this will translate into more research and clinical trials for patients in Northern Colorado. • Top quality training for the next generation of healthcare professionals will meet the needs of diverse populations of patients living in our region. • Many more opportunities—cancer care, cardiac services, neurological services, to name just three—will be available through the new health system. During the last decade, PVHS has taken many significant steps forward, all of which have created one of the nation’s highest quality health systems. Now, we are taking yet another huge step in our evolution to ensure that our patients have access to the highest quality healthcare in the world. For updates on the PVHS-UCH partnership and to learn more about other PVHS developments, please go to our website (pvhs.org) or visit my blog at visionary.pvhs.org.

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

Northern Colorado Medical & Wellness 2011

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

Dear Medical & Wellness Magazine Reader:

George Hayes President and CEO Medical Center of the Rockies

We take great pride in knowing that the 4,686 physicians and employees of Poudre Valley Health System, as well as the more than 700 community residents who do volunteer work at Poudre Valley Hospital and Medical Center of the Rockies, offer our community the best in service that can be found anywhere. Here’s an example of how great care translates into saving lives. In the year prior to March 2011—these are the latest figures currently available— PVH and MCR were both in the top 10 percent of hospitals nationwide in saving lives, according to Thomson-Reuters, a private company that monitors patient outcomes in the healthcare industry. In other words, thanks to the outstanding care given the physicians and staffs of the two hospitals, 71 patients were saved who otherwise would likely have died from their illnesses had they been treated elsewhere. It’s little wonder that other organizations in healthcare often recognize PVHS for its high-quality service and care. In 2008, the health system received the Malcolm Baldrige National Quality Award, an honor created by Congress to recognize the nation’s top-performing organizations. PVHS was one of three organizations and the only healthcare provider to receive the award that year. In 2011, MCR was selected as a recipient of the Overall Best Performer Award by Avatar International, a private company that that tracks patient satisfaction at hospitals throughout the nation. The award is presented to the top facilities in Avatar’s national database with the highest overall combined score for inpatient, outpatient, emergency department, and ambulatory services. That puts MCR in the top 5 percent of Avatar’s database. This was the fourth consecutive year that MCR was a recipient of the award. Also in 2011 the American Nurses Association announced that PVH and MCR were among five U.S. hospitals to receive a national award for achieving and sustaining outstanding nursing quality that improves patient care and safety. ANA said the five award-winners demonstrated superior results and sustained improvement in patient outcomes and high nurse job satisfaction. Hospitalacquired pressure ulcers, patient falls with injury, infections acquired as a result of hospitalization and nurse turnover were among indicators tracked. “The common traits of the award-winning hospitals are strong leadership, teamwork, commitment to ongoing improvement in patient care quality, continuous staff education and efficient use of resources,” said ANA President Karen A. Daley. What do these accolades mean for you and all of us living in this region? They are measures of great success. They mean, quite simply, that we have easy access to world-class care, a benefit that few other communities can boast. We ask that you feel the pride that we do when we hear about Poudre Valley Health System. The physicians, the staff and the volunteers are there for all of us!

George Hayes President and CEO Medical Center of the Rockies

Kevin Unger President and CEO Poudre Valley Hospital

Northern Colorado Medical & Wellness 2011

Kevin Unger President and CEO Poudre Valley Hospital

medical

PVHS

Rulon Stacey, President and CEO, and Grace Taylor, Chief Strategy Officer

Expanding Quality as

PVHS Grows

by Angeline Grenz

You can’t talk about the future of a health system without talking about healthcare reform. Reform looms mightily – coloring processes, shaping growth and altering traditional courses. Poudre Valley Health System knows this as well as any – possibly better – as they move forward to ride out a wave of change while still maintaining the quality of service that their patients demand. “The healthcare industry of the future is going to pay us to keep them better, not just fix them when they are sick,” according to Rulon Stacey, president and CEO of Poudre Valley Health System (PVHS). “It is the right thing to do, but it is completely different than the incentives in the industry for the past 100 years.” The challenge is for healthcare systems to outline processes that work under the current system and that will work under the new system, “so that the transition will be smoother,” says Stacey.

What is involved in those processes? Information, standardization and integration, according to Stacey. But those changes and challenges must meld with the everyday operations of a stellar health system, making strategic planning ever more important as PVHS grows into the future. That growth has prompted PVHS to form a partnership with University of Colorado Hospital in Denver. The two entities signed a letter of intent last month to form a joint operating agreement.

Today’s Successes PVHS continues to receive accolades and awards and push their employees to provide the highest quality healthcare available, as evidenced with Poudre Valley Hospital’s recurring Magnet designations and Medical Center of the Rockies’ designation, received for the first time this year. Both hospitals were also awarded prestigious nursing awards – two of the five hospitals recognized for the award out of more than 6,000 hospitals nationally. (For more information, read “Nursing Awards Showcase Quality” on

page 20 of this magazine.) At the same time, Stacey is positioning PVHS to lead the way during healthcare reform changes. For the past several years, PVHS has been bringing in wellness and lifestyle programs to support the health of patients outside a hospital setting. Developing information systems, such as electronic medical records, is a large part of those changes, but PVHS is looking to take it a step farther. Likening it to the reminders your dentist may send you for a teeth cleaning, Stacey foresees a new, more proactive method to keeping patients healthy. “We would like to be able to say ‘You have diabetes, it is time to come for your blood test’ or ‘we recommend you come in for a diet counseling session,’” explains Stacey. “We mine the patient data, and share it with the primary physician and the specialist involved. We think if we get really good at that and have a broad enough base of providers, we will be able to make a difference in the lives of people.” Integrative medicine services also represent part of the philosophy shift, and PVHS has been making organizational changes for the past couple years, particularly noticeable with the creation of the Poudre Valley Medical Group in 2009, which has brought many specialty clinics in Northern Colorado, southern Wyoming and Nebraska under one umbrella. Just short of two years old, PVMG has grown to over 100 providers and 130 doctors, and is growing. (For a more detailed overview read “Poudre Valley Medical Group – Today’s Healthcare” on page 55 of this magazine.) To facilitate this, PVHS has developed a strategy that is designed to engage physicians and encourage a collaborative partnership. “We want to make sure we find ways to work with our physicians, gauge their satisfaction and utilize what they bring,” says Stacey. The program has been successful. “It has resulted in the highest physician satisfaction in the top 10 percent in the country for the physicians who work here.” He adds that physician integration into PVHS is one of the most important strategies currently in place. “We want to expand our services geographically,” says Stacey, “and partner with people we have not partnered with in the past.” The hospital in Sidney, Nebraska is one of the most recent to join the PVHS organization. “We want this to be the premiere group in Northern Colorado,” says Grace Taylor, PVHS’ chief strategy officer. “But at the same time we also need to find beneficial ways to work with independent physicians in our community that aren’t a part of PVMG and that is an equal priority.” Part of that partnership, says Taylor, may be assisting these independent physicians with the development of their electronic medical records programs. Currently, PVHS is working with Longmont United Hospital to develop the Indian Peaks Medical Center in Frederick. Phase one is an urgent care facility. “The facility will be able to grow over time and develop into whatever services the region needs,” says Stacey. That could be another hospital or perhaps a surgery center, he says. They expect to be under construction in the next 12 months, he adds. “We are excited to have this 50-50 partnership with Longmont United,” adds Taylor. Taylor’s position is a new job at PVHS. Taylor oversees business development and outreach activities, marketing activities and strategic planning, with department

Northern Colorado Medical & Wellness 2011

directors reporting to Taylor as they organize and plan for the future. Joint Venture Planned “You can expect PVHS to expand into even new geographic locations,” says Stacey. In fact, their recent announcement of intent to form a joint operating agreement with University of Colorado Hospital means they are not just driving north, but south as well. The letter of intent is the result of talks initiated between the two health systems at the end of 2010. They cite health insurance reform, the increasing costs of treating patients and a projected shortfall of medical professionals as the impetus for the agreement. “This is an opportunity to prepare for the changes we expect as a result of healthcare and health insurance reforms,” said Bruce Schroffel, president and CEO of University of Colorado Hospital, at a press conference last month. “While these changes are still largely undefined, the need to build strategic partnerships, such as this one, will only grow more pressing as time goes by. In the coming years, we will face monumental changes that will affect the delivery and expectations of healthcare throughout the Rocky Mountain region and beyond, but we will be ready.” He describes it as a “perfect, synergistic partnership.” The new partnership will create “one of the largest not-for-profit systems in the state of Colorado,” Stacey said at the conference, “and the only system that is both owned and operated in the state.” Stacey adds that both organizations are fiscally healthy and the “joined systems will be greater than the sum of its parts” in financial stability, continued growth, improved medical outcomes and quality patient care. Stacey underscored that the joint operating agreement between the two systems is neither a merger nor a takeover. Both systems will keep their current CEOs and continue to own their individual properties. The agreement will create a new nonprofit healthcare system with its own board that will lead decision making for the new system. “We will work together to create a future vision that ensures that each entity is positioned to provide the quality of care that our patients have come to expect and deserve,” said Stacey. An agreement is expected to be finalized this fall, according to PVHS public relations staff. Stacey Leads Change PVHS’ success at navigating the complexities of change under reform and providing continued excellence in care is largely due to its dedicated leader, Rulon Stacey. He came to PVHS in 1996 and under his direction, the system has been the recipient of multiple impressive recognitions, the Malcolm Baldrige National Quality Award being one of the foremost. This year, Stacey is serving as Chair of the board of the international professional association, the American College of Healthcare Executives. The position is particularly prestigious for Stacey, because his peers elected him. “It is a huge honor that will stick with me for the rest of my career.” Stacey, chair-elect last year, will pass on the helm to another in 2012. In this position, he travels periodically to other health organizations to speak to healthcare executives, generally on subjects such as PVHS’ 2008 Malcolm Baldridge award and, frequently, on

healthcare reform. He is passionate about taking this opportunity to inspire his colleagues. “I think there are things as healthcare executives that we have to keep in mind. We have to remember that we are healthcare providers. If I am effective at my job and I change a process that impacts patients – I can impact 10,000 patients a year, a 100,000 patients a year. As healthcare providers, we have to understand that.” Moving Forward Big changes organizationally have revolved around strategy. Physician integration is the first change, but other changes are looming. Standardization will be key. “There are fifty different ways to do one type of surgery. By definition one of those is the best. We have to find out which is the best way and make every one do it that way,” says Stacey. Healthcare’s future will be tied to managing its rising costs, says Stacey. “I am relatively certain there is nobody in Washington, D.C. or in Denver that is trying to figure out ways to pay healthcare providers more for the services they provide.” That leaves PVHS the challenge to drive more costs out of the system without compromising quality. Standardization is one of those ways, says Stacey, and that requires good leadership. “One of the benefits [of healthcare reform] is that it is forcing us to find the best practice and replicate that practice across the country and that will provide value for the patient – higher quality and lower cost.” Along with standardization will come new services for their patients: “We are now developing more of a payor strategy,” says Stacey. The addition of insurance products is a logical next step for the health system, and one that is becoming standard among health systems. “It is part of the integration. Insurance companies believe that they have to be able to provide care now and providers of care think they have to offer some insurance products. So everybody is crossing the line in some way to offer that integrated service.” Growth of the health system also means important additions and changes to services at existing locations. The Cancer Center of the Rocky’s addition of a new linear accelerator, located at the Harmony Campus, is exciting news. The Poudre Valley Health Services Foundation supported its purchase and the accelerator, a cutting-edge tool that will be the first in Colorado, signifies a continuing dedication to cancer treatment at PVHS and will “clearly differentiate this organization from others from a cancer treatment perspective,” says Stacey. Construction is currently underway at the Cancer Center to accommodate the new machine, and it will be installed in September. While the Poudre Valley Hospital (PVH) facility will remain the same this year, changes to the structure are looming in years ahead. “The emergency room at PVH is completely saturated,” says Stacey. Even with the Urgent Care Center at the Harmony Campus and the addition of Medical Center of the Rockies (MCR), PVH’s ER is still bursting at the seams, seeing around 65,000 patients a year – and well over 100,000 patients total at the three locations. “We can expect sometime in the next year or two we will have a major renovation and expansion of the facility,” he says. Taylor adds that because of the building’s many re-designs over the years, an expansion of the ER will cause a “domino effect”

Rulon Stacey

Publishes First Book by Angeline Grenz

Stacey explores the long term consequences of healthcare reform. Rulon Stacey has produce on his mind. Apples, potatoes, you name it. But Stacey, Poudre Valley Health System president and CEO, isn’t concerned so much about the price of a pound of cherries as he is with what this produce represents. In this case, it is part of his analogy about the history of healthcare in the U.S. and the challenge of healthcare reform in his recently released book: Over Our Heads: An Analogy of Healthcare, Good Intentions and Unforeseen Consequences. Stacey published the book in May as a way to better explain a topic about which he is questioned regularly. The book was a product of a frequently told analogy he uses to explain how healthcare got where it is today to other professionals in his industry. “I had many people ask me about why healthcare costs are so expensive and it is a long story,” he says. “I started telling the story and somebody said to me ‘you should write a book’

and I thought ‘that’s a good idea; I think I will.’” The book has been years in the making. “I have been formulating the idea for a long time,” says Stacey. “However, two years ago I hired someone to take my thoughts and write them down because I didn’t have time myself. The process was complete last fall, which is when I found a publisher for the book.” Fire Starter Publishing, who provides intellectual resources for healthcare professionals, is the publisher of Stacey’s book. Stacey’s book centers on Andy Johnston, fictional owner of Johnston’s Corner Market in the fictional town Capital Springs. Johnston is Stacey’s “Joe the Plumber;” his character’s experience a metaphor for the crumbling U.S. healthcare system. The book follows Johnston and the fate of his business as city government attempts to help the Capital Springs’ impoverished by creating a food distribution program. The well-intentioned, imperfect food voucher program creates an imbalance that leads to higher prices and an uneven distribution, an allegory for where healthcare is today, says Stacey, and its dire future under current policy. Stacey’s analogy provides a relatable way to explore the very complex and oft-misunderstood topic of healthcare in the U.S. “My goal in writing the book is to simply get the other side of the story out there,” says Stacey. “I have been so frustrated as people point the finger at hospitals and hospital executives as the cause of the healthcare crisis that this became a bit of a personal agenda for me. I am happy now, when I speak, to be able to reference the book in order to answer that question.” The book is Stacey’s first foray into publishing, but plans are in the works for a second book. Fire Starter Publishing has already accepted Stacey’s next topic on leadership. The book will be “designed to help leaders know the specifics of how to get an organization to perform at top levels,” says Stacey. The book will focus on specific tactics that executives can employ to move their organization to function at an optimal level. Under Stacey’s leadership PVHS received the prestigious Malcolm Baldrige National Quality Award in 2008. Currently, he is facilitating negotiations with University of Colorado Hospital to form a joint operating agreement that would create a joint nonprofit healthcare system. Stacey is also serving as chair of the board for the American College of Healthcare Executives this year. It is a position that he was voted into by a body of his peers, and he is regularly asked to speak in front of his colleagues nationally and internationally since being named chairelect last year. When Stacey is not involved in the complex world of healthcare, he is active in his church, Church of Jesus Christ of Latter-day Saints, and looks forward to “two goals: quiet dinner with my wife periodically and fly fishing (in that order!).” Stacey and his wife, Linda, have four daughters. Stacey’s book is available for purchase at www.firestarterpublishing.com or on www. Amazon.com.  Angeline Grenz is the editor of Northern Colorado Medical and Wellness Magazine.

“The healthcare industry of the future is going to pay us to keep them better, not just fix them when they are sick.” – Rulon Stacey, president and CEO of Poudre Valley Health System that may impact and relocate other services currently at PVH. Expansion at the hospital may look north towards property owned by PVHS on Doctor’s Lane. MCR still holds the capacity for growth, says Taylor, but aside from some small build outs, no major plans are in works for the space. In Greeley, PVHS is opening a new oncology infusion center next to the Greeley Medical Clinic. It is slated to open early fall 2011. Poudre Valley Medical Fitness opened at Water Valley in Windsor earlier this year, and last month a satellite of Twenty Three Trees Medical & Wellness Spa opened at Water Valley as well. A physician shortage is expected in the future, according to Taylor. This shortage has influenced the way PVHS grows, and their coming joint venture with University Hospital in Denver. But with Baldridge Awards and international attention for the quality of their healthcare, PVHS is receiving notice from top physicians from all over the nation. “The pool is small,” says Taylor, “But we are lucky to live in a beautiful place and our recognitions have set us apart. But we still have to focus on good communication and fair market offers” to draw in the best candidates. Bottom line, PVHS will continue to focus on providing value to our patients, says Taylor. Treating a health problem is no longer enough, she adds, providing education and mechanisms to help treat patients in out patient settings is of increasing importance. But they are poised to meet these challenges. “We are a strong organization and I think the future is bright for Poudre Valley Health System – and there is more to come,” Taylor concludes.  Angeline Grenz is the editor of Northern Colorado Medical and Wellness Magazine.

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medical

PVHS

Nursing Awards

Showcase Quality by Angeline Grenz

What happens when you take the “best of the best” in hospitals and then single out the top five for recognition? Evidently you get Poudre Valley Health System (PVHS). Both Poudre Valley Hospital (PVH) and Medical Center of the Rockies (MCR) were chosen as two of only five hospitals in the country to be recognized for outstanding nursing quality that improves patient care and safety.

The top five were chosen out of 1,700 hospitals nationwide that report to the American Nurses Association’s National Database of Nursing Quality Indicators (NDNQI). NDNQI is the industry’s comparative database to measure nursing services and patient care. PVH received the award for the fourth time in January 2011. Notably, they were the first hospital to ever receive the award, created in 2008. During that year, PVH’s nursing staff was deemed so impressive

Proudly displaying their recent nursing award is Medical Center of the Rockies’ nursing leadership team: Clinical Director of Resource Services Barbara Ochsner, Chief Nursing Officer Kay Miller, and Critical Care Clinical Nurse Specialist Melanie Roberts.

according to NDNQI data that they were the only hospital chosen for the award. MCR takes the honor of achieving both Magnet designation status and the NDNQI nursing quality award almost immediately after being eligible. The Magnet designation is from the American Nurses Credentialing Center and is considered by the industry to signify the gold standard in nursing care. The Magnet designation represents the top 6 percent out of more than 6,000 hospitals nationwide. PVH received their initial Magnet designation in 2000 and have received the designation every year they have been eligible (hospitals must accumulate two years of data between application submissions). The quality standards that are inherent in the Magnet designation process have long been part of the PVHS culture, tried and true at PVH for many years. Naturally, those standards became the cornerstone on which MCR was built. “You really are being benchmarked against the best of the nation. We were very, very honored,” says MCR Chief Nursing Officer Kay Miller. But the award is no accident. “We really had the opportunity, since before MCR opened, to set the direction and seek out people who have a passion for excellence

and engage them in the direction we are heading.” Standardizing Care But recognitions aside, the dedication to quality at both PVH and MCR must be found at the most basic level of care – the interaction between nurse and patient. So how does a fast growing health system with almost 1,500 nursing professionals foster an environment of dedicated patient care and nurse engagement? Key, says Miller, is to “make sure that the staff providing the care really has decision-making and input into what is the best way to deliver this care.” “Our staff was so committed to quality, from day one,” says Barbara Ochsner, Clinical Director of Resource Services at MCR. “It is a culture of quality and safety and it is lived by every nurse here. How they are doing is important to them as individuals and as a unit.” “When you give staff the opportunity and challenge, telling them ‘we want you to provide the best care you can for the patient and family,’ they come up with the best ideas. It becomes a source of professional pride for them,” says Melanie Roberts, Critical Care Clinical Nurse Specialist at MCR.

“Our staff,” she continues, “asks every day ‘Am I doing the best right thing?’” Donna Poduska, PVH interim chief nursing officer, explains the structure: “In our nursing model, we have committees – such as a nursing quality committee – that are staff-run. They monitor quality through our nursing dashboard.” The committees outline best processes and areas of improvement and institute changes, standardizing them throughout the healthcare system. The standardization is an important component, but it works at PVH and MCR because nurses are the motivators. “We get nurses engaged because they are making the decisions,” says Poduska. Understanding the Patient “You must standardize, but still keep in mind the individual patient,” says Miller. Nurses must connect on a deeper level with their patients, understanding their needs, cultural and religious beliefs, support system at home, resources, and how much the individual is committed to following through with their own care. “Even in the in-patient setting, it is tremendously helpful if you connect on that level as that will enable the patient to successfully transition to home,” says Miller. Oftentimes, the patient is more open with their nurses than with their doctors, often without realizing it. “The nurse has a conversation with the family member or patient and they will tell them something, just in conversation, that they didn’t think was important to tell the doctor or anyone else,” says Roberts. “It happens very nonchalantly while they are developing a relationship with the family and the patient. You have to get to know them to know what they really need.” Sometimes this requires an understanding of what a patient’s needs might be after they are away from the hospital setting. In providing a continuum of care, nurses must begin accessing the particular resources a patient may need when they return to their home. Playing Detective for Better Patient Care “Nurses are like detectives,” says Roberts. When they look at making improvements in areas – such as the number of falls or pressure ulcers – sometimes the problem isn’t clear-cut, but that doesn’t mean solutions can’t be relatively simple. Take, for instance, red socks on patients that represent a high fall risk. When a nurse or doctor sees the red socks, they know that the patient needs to be monitored more closely. In 2008, nurses were challenged to reduce the number of pressure ulcers on patients in the intensive care unit. Nurses were baffled by the problem, having examined the clinical literature and their own experiences, and came up empty as to a cause. Nurses had state-of-the-art beds for the patients, but found that the pressure ulcers were still occurring. The department then did a little detective work: nurses took turns lying in the beds, acting out the part of patient. After a process of elimination, the nurses found that patients, if not positioned correctly on the bed, were experiencing discomfort. At the same time, they changed the types of pillow, the skin care regimen and the way they made the beds and found the combination of factors reduced the number of pressure ulcers. Once the problem was outlined and remedied with a new bundle of care, the number of pressure ulcers was reduced by 70 percent and a new standard for care was created

Northern Colorado Medical & Wellness 2011

Charmaine Pankewicz, operating room nurse at Medical Center of the Rockies, proudly testifies to the fact that the nursing staff is dedicated to quality care every day.

Donna Poduska, interim chief nursing officer at Poudre Valley Hospital

within the health system. The nurses named the new process the “Butt Bundle,” and it became an organization-wide approach. “They were given the opportunity to find a solution that worked, and then they were charged with educating their peers and role-modeling the practice change,” says Roberts. This education component is another important factor in success. “Once we have processes in place, then we must educate everyone on that change,” says Poduska.

Staffing ratios are also in the 90th percentile of hospitals in the entire Magnet staffing database – a boon that allows nurses to take the time to provide that quality of care to patients. “It makes all the difference in the world,” says Miller. Pankewicz agrees, “They do everything possible to make you the best nurse in the world and this be the best job ever. This place is unbelievable.” She cites the additional education she has gained since coming to MCR four years ago as proof positive of the investment they have made in her personally.

High Standards Part of Culture The nursing quality committee reviews quarterly reports from each nursing unit within PVHS. Their goal is to continually outperform the mean (they use a ‘stoplight’ system). If they fall below the mean (a red), that unit must develop an action plan that is monitored through the committee. If they simply match the average (a yellow), then after three months of no improvement an action plan must be formulated. There is no status quo for PVHS nurses. This is also part of the Magnet designation – in order to receive re-designation after the initial, you must out perform the previous two years. “There is a monitoring system built into the designation,” says Poduska. “You can’t just get Magnet and then forget about it, because you won’t get it again.” It is an ongoing, challenging process. Continual improvement is a constant goal in the PVHS culture. The delivery of care at PVHS is patient-family centered. This is a model of care that is grounded in the understanding that family plays a vital role in the well being of the patient and the model promotes collaboration, participation and communication between healthcare providers, family and patient. To that end, community members and volunteers are invited to sit on committees and focus groups to provide input on new programs or policies, according to Poduska. This input is vital, she adds. “When you

get down to it, it is about the patient. We might be so used to doing something that we may not be able to see the trees for the forest. Having them be involved in what is happening in their care is very important to us.” It is a model of care that the nursing staff believes in profoundly, according to Charmaine Pankewicz, operating room nurse and self-proclaimed “cheerleader” for MCR and their recent award. “They [the hospital] really buy into patient-family centered care and I am really focused on this type of care. I am a patient advocate and I know if I have concerns, they will take care of them. I, and the other nurses, live what Magnet is.” NDNQI evaluated several areas of criteria for the award, including patient falls, nursing hours per patient days (staffing), nurse satisfaction, pressure ulcers and other data. NDNQI reviews each hospital’s information from the previous year. The five NDNQI awards were based on hospital classifications: PVH’s award was among teaching hospitals; MCR’s award was for community hospitals. Psychiatric, academic and rehab hospitals were the other categories. Notably, Craig Hospital in Englewood received the NDNQI award in the rehabilitation area – further pointing to the quality healthcare available in the state of Colorado. Nurse satisfaction and retention levels are high at PVHS – and Poduska underscores that this is due to nurse-physician collegial communication. “There is a great respect and trust for what each one brings to the table,” she says. “It is a dynamic process, but on the whole we have very good relationships with each other.” “It takes everyone always working in harmony, with the nursing staff being the pivotal point on the team, that differentiates PVHS,” adds Miller. “And we have an openness and willingness to look at where we can do better and work as an organization to achieve that. It is a team that is committed to excellence every single day.”

Looking Toward the Future Where do they go from here? “The pressure is on,” says Poduska. They will continue to strive for re-designation with Magnet, but also gear for changes that are coming from healthcare reform. “We don’t really know the rules yet of healthcare reform,” adds Poduska. “We must continuously strive to improve,” says Miller. One challenge will be the charge to deliver exceptional patient care with fewer resources. Monitoring the continuum of care, more care on the outpatient side, and a high emphasis on preventative care will be the commission nurses take forward under reform. “Systemwide, PVHS is looking at the Lean process, which is a process geared to standardize work and maintain high quality by minimizing waste,” says Miller. Poduska adds the nurse practitioner will be given an even more important role in healthcare under reform, and nurses in general will be encouraged to have baccalaureate degrees, be certified in their specialties and attain the highest education levels they can at PVHS. Despite the challenges, “it is an exciting time in nursing,” says Poduska.  Angeline Grenz is the editor of Northern Colorado Medical and Wellness Magazine.

medical

pediatric medicine

Pediatrics

at PVH

by Corey Radman

By far, one of the scariest things a parent will ever see is their own child in a hospital bed. It belies the premise of being their sole protector. By some parental accounts, handing a child over to a team of white-coated professionals feels like a betrayal, an admission of defeat.

Marci and Dave Carlson, who recently delivered a healthy baby boy at Poudre Valley Hospital, enjoy a family moment. They well know the comfort and confidence provided by a hospital system that makes healthy babies a priority.

The only salve for a parent’s wounded heart when they reach that stage is faith that their child’s team is the best. At Poudre Valley Hospital (PVH), providing the best care for children and their families is not just a goal. It’s a higher purpose. “People who go into peds… there’s just something about them. They get it,” says Amy Lichon, D.O. and pediatric anesthesiologist with Northern Colorado Anesthesia Professional Consultants. And she’s right. Pediatric care takes more time and more careful consideration of not just the patient, but also the patient’s entire family. It takes a team of highly specialized professionals: some hold a scalpel, some are magic with an IV, some render a two pound neonate unconscious and then reverse the process safely. So many of these heroes are seen by families only briefly, but their hands are crucial when milliseconds count. Pat Bohling-Smith, R.N. and clinical director of the Women and Family Care Department at PVH, ensures that all those professionals – and their hands – have what they need to do their job: “Our goal [at PVH] has always been to provide as

Northern Colorado Medical & Wellness 2011

full a spectrum as we can within our community so patients and families (and their physicians) don’t feel like they have to go to Denver. They can stay home and receive the care they need.” PVH President and CEO Kevin Unger says the pediatric service line has his full support. “We are proud of our pediatric program and are continually looking at ways to meet our patients’ needs. Our goal is to continue to provide services that will allow pediatric patients and their families to receive world-class care here in Northern Colorado.” Most pediatric services provided at the hospital converge at the Pediatrics Plus Unit on the third floor of the hospital. With 17 beds, children from birth to age 17 receive their pre- and postoperative care here when they are admitted to the hospital. While Bohling-Smith says there really is no typical patient, many of the kids seen here are admitted for respiratory problems (especially in the winter months) as well as for surgeries like appendectomies or cleft lip or palate repairs. As admissions to the Peds Plus Unit are heaviest

during the winter months, the unit provides care to other patients as well as children. According to Cynde Donley, R.N., nurse manager of the unit, women who have undergone gynecologic surgeries and new mothers/babies are also cared for on the unit. The staff has received training to provide the same excellent level of care to these patients/families as well as children. That’s the Plus in Peds Plus. Several of the specialists interviewed for this article have multi-dimensional practices but the majority of them report that their time spent working for the benefit of children is some of the most rewarding. Why? Because kids heal completely and quickly, because helping a child makes such a huge impact in their life, and because each of these doctors is passionate about providing excellent medical care to our smallest community members. There are many skilled hands that weave the safety net of protection for Northern Colorado children. Here are a few of their specialties from A to Z:

Amy Lichon, D.O., is a pediatric anesthesiologist. Her special training allows her a greater level of skill when putting a child to sleep, especially in complicated neonatal and craniofacial surgeries.

Anesthesia “Roughly 80 percent of the surgeries performed every day on children are routine,” says Tim Kirsch, M.D. He and Dr. Amy Lichon are both fellowship trained in pediatric anesthesiology, which means that they both spent an extra year after residency training in children’s hospitals. The results of routine surgeries like tonsillectomies, ear tubes or appendectomies are all fairly predictable and positive. The bigger risk, the one that makes parents nervous, is the anesthesia required. “Most parents understand that putting a child to sleep is inherently risky,” says Dr. Kirsch. That is why PVH has made the commitment to making pediatric anesthesiology available 24/7. Drs. Kirsch and Lichon are available almost all the time and when they aren’t, their other colleagues with pediatric training step in. For those dicey, complicated cases like neonatal surgery or craniofacial surgery, these specialists make sure they are available. Dr. Kirsch explains how he quells the fears of parents: “I say, ‘My job is to watch over your child. I make them comfortable – from a nice gentle induction through the procedure, the reversal, and I stay until he or she is fully awake. My full

attention is on your child through the whole procedure: heart rate, blood pressure and oxygen levels. I take care of everything outside of the surgical field.’” Because these specialists are on call at the hospital so much of the time, they have been able to provide back up for the medical staff on procedures like central lines or intubations, and they have established treatment protocols that enhance overall care. For example, it is now the standard (unless otherwise requested by family) to administer oral anti-anxiety medications with an amnesia component to all children under age 8 when going into surgery. “I don’t want being wheeled away from everyone they know and love to be the last thing that that child will remember before surgery,” says Dr. Kirsch. Dr. Lichon thinks the integration of pediatric service providers is better now than ever before at PVH. “Because Tim and I are at the hospital full time we have more interaction with the other doctors and they feel comfortable calling on us, even for non-surgical services. It feels more like a team with everybody working for the best outcome for that little patient.”

Tim Kirsch, M.D., pediatric anesthesiologist, Northern Colorado Anesthesia Professional Consultants

Mark Boustred, M.D., Northern Colorado Plastic and Hand Surgery, and member of the PVH Cleft Clinic team

Cleft Clinic Mark Boustred, M.D. with Northern Colorado Plastic and Hand Surgery, specializes in smiles. He’s an internationally known plastic surgeon from South Africa who has performed cleft lip and palate surgery all over the world; however he chooses to call Fort Collins home. Dr. Boustred is the go-to surgeon for craniofacial problems in the region. He is humble about his accomplishments, but his results tell the story for him. Many of his patients come to him with incredible deformities and ultimately look and function normally. His outcomes are the best available anywhere, according to Bohling-Smith. Dr. Boustred, along with his colleague Dr. Chris Tsoi, works with the Cleft Clinic, a service through the Children’s Therapy Services, which unites all providers needed under one roof. He explains: “A lot of these kids need several specialists to take care of them. Thus, coordinated multi-discipline clinics are the best solution.” Dr. Boustred and his colleagues provide plastic surgery, ear/nose/ throat surgery (ENT), specialized nursing, audiologists, feeding specialists, dental care and ongoing occupational and physical therapy. According to Dr. Boustred, approximately one in every 800 babies born will have a cleft lip or palate. On any given cleft lip or palate surgery there are two to three surgeons, including Dr. Boustred and Matt Robertson, M.D. – one of the ENT surgeons – several nurses, as well as the pediatric anesthesiologist. Dr. Boustred appreciates the way the team meshes well together. “We have world-class care here,” he says. “I feel very comfortable working with the pediatric anesthesiologists and Dr. Robertson. Really, we have everything we need at PVH for most of the deformities that occur in children.”

Northern Colorado Medical & Wellness 2011

Matt Robertson, M.D., Alpine Ear, Nose and Throat, and member of the PVH Cleft Clinic team

ENT A frequent colleague of Dr. Boustred’s is Dr. Robertson of Alpine Ear, Nose and Throat. He doesn’t do pediatrics exclusively, but does care for most of his practice’s small patients. He says he likes helping kids, partly because he is a father of three (soon to be four) young children himself, and also because children are such resilient healers. “It’s amazing how quickly kids bounce back. For a tonsillectomy, kids look normal again in four days, where adults will still be in pain two weeks later.” The Vice Chair of Surgery for PVH, Dr. Robertson interacts quite a bit with the other doctors at the hospital. In his estimation the kind of care possible at PVH is “equal or better than what you could receive at the Children’s Hospital [in Denver].” Granted, he says, there are surgeries that will never be required often enough here to staff the requisite specialists – cases like burns, transplants or pediatric neurosurgery. “There is not enough of a population base to justify those kinds of specialists here. Overwhelmingly, for the majority of pediatric problems, I think the pediatric service lines we offer in Northern Colorado are equal or better than what can be received at a tertiary care center.” Speaking as a surgeon and a father, Dr. Robertson adds that parents who are considering elective surgery (like for ear tubes) should know that at PVH, the doctor who shakes your hand at the consult will be the same pair of hands working on your child in the surgery suite. “I think it’s a comfort to the parents of my patients to know that I have done thousands of ear tube surgeries in my career,” he says.

Beth Ballard, M.D., with Fort Collins Youth Clinic, serves as a pediatric hospitalist at Poudre Valley Hospital.

Hospitalist Program The pediatric hospitalist program was formed in early 2010 to remedy the problem of noncontiguous care for the hospital’s smallest patients. “It used to be that patients who entered the hospital without a doctor got whoever was on call that day. Every day was a different doctor,” explains Beth Ballard, M.D. and pediatrician with the Fort Collins Youth Clinic. Now, Youth Clinic doctors like Dr. Ballard take rotations at the hospital providing care for those who have no regular doctors or for practices in town who ask for back up at the hospital. “That consistency has made a huge difference,” she says. “Now the ER knows who to call [when admitting a patient], the hospitalists are there in the hospital and have the time to attend to patients when problems occur, and local kids who didn’t before have an established relationship with a doctor leave with a provider.” She continues: “We [hospitalists] help with pain management, fluids, nutrition and general pediatric conditions.” This is in contrast to the older model, where a general practitioner or surgeon would

round on their patients at the hospital first thing in the morning, then go to their clinics and be slammed until the end of the day when they could get back to the hospital. Having a hospitalist on staff fills that gap. “Families have more opportunity to ask us questions and understand what is happening with their children.” Dr. Ballard, who has worked at the Youth Clinic since 2000, has observed a steady path toward excellence at PVH. “The hospital can now care for more patients and sicker patients.” One informal benefit to the new program is the collegial atmosphere that is building among the doctors who now have the opportunity to see one another outside treatment areas. “Because I’m there, the other doctors know me and how I can be helpful to their patients,” Dr. Ballard says. The physicians, in part because they see each other more often, can now consult more regularly about the children in their care and lean on each other for expertise.

Northern Colorado Medical & Wellness 2011

AFTER

Travis R. Willey, D.D.S.

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NICU The hospital’s smallest patients, newborns, usually room with their mothers after they are born in the Women’s Care Unit. That’s the ideal scenario. Occasionally, these wee ones need more medical attention, either because they were born prematurely or have complications at birth; it is for them that the NICU exists. Recently awarded Level IIIB status from the Colorado Perinatal Care Council, PVH has one of the top Neonatal Intensive Care Units (NICU) in the region. Their new designation allows the hospital to care for babies younger than 28 weeks and smaller than 1,000 grams (just over two pounds). Under the guidance of neonatologists Dr. Daniel Satterwhite, Dr. Amy MacRitchie and Dr. Jan Paisley, the NICU can now care for babies who were born between 26-36 weeks gestation as well as for those who have respiratory problems, infections, low blood sugar or jaundice. This unit has the ability to transport babies from the

Poudre Valley Hospital’s sickest infants are cared for in the Neonatal Intensive Care Unit.

delivery room to the unit and keep them there until they are well enough to go home. Drs. Satterwhite, MacRitchie and Paisley are fulltime faculty members in the Department of Pediatrics at the University of Colorado School of Medicine, and their main practice sites are at Poudre Valley Health System and Children’s Hospital Colorado. This affiliation with the University of Colorado and Children’s has enabled a higher level of expertise and care at the PVH NICU. Barb Peters, R.N., is the nurse manager of the NICU. She attributes the phenomenal success of the unit to the entire team that works in the NICU. “Teamwork is vital to allow us to achieve our mission. Frequently, many things are happening at the same time, and teamwork is essential to get them all done. Especially when we have a critical baby, many hands are needed to accomplish everything that needs to be done at the same time. Teamwork makes that CONTINUED ON PAGE 102

Northern Colorado Medical & Wellness 2011

medical

Stroke

Poudre Valley Hospital’s Stroke Center team: Stroke Program Director Pam Boehm, Stroke Program Coordinator Kathi Patterson, Stroke Medical Director Dr. Gerald McIntosh, and Dr. Michael Apostle, with Emergency Medicine

Stroke: Fast Actions

Save Lives

by Graciela Sholander

Sixty-one-year-old Jane was working in her garden alongside her husband, Steve. The pair was reminiscing about their most recent camping trip when Jane suddenly felt strange; she couldn’t remember what they’d just been talking about, and she felt dizzy and disoriented. Steve immediately noticed something was wrong with his wife because her speech became slurred and her words turned incoherent. Recognizing these symptoms as signs of stroke, he dialed 911 on his cell, and an ambulance was soon there. 32

On the way to the hospital, paramedics began working on Jane right away. At the hospital’s advanced stroke center, an expert multidisciplinary team made up of neurologists, emergency room doctors and nurses, and other specialists diagnosed and treated her quickly. Within the hour, she showed significant improvement, and was moved out of the ER and checked into a hospital bed. She remained hospitalized for several days, receiving treatment to prevent another stroke as well as rehabilitation to begin addressing her stroke-related speech difficulties. After checking out of the hospital, Jane continued with rehab. Although she faced challenges ahead, doctors gave her a favorable long-term prognosis, for which she and her husband were extremely thankful.

Gold Seal for PVH Stroke Center That’s the type of scenario that the specialists at Poudre Valley Hospital’s (PVH) award winning stroke center deal with on a regular basis. The center’s medical professionals are trained to act quickly, and this fast response can make a world of difference in stroke patients. Think of a stroke as a “brain attack” where blood flow is interrupted to part of the brain. A speedy, accurate diagnosis and immediate treatment can save the patient’s life. It can also prevent further damage to the affected part of the brain, minimizing the degree of resulting disability. Last year, after earning the Gold Seal of Approval Award for certification as a primary stroke center, PVH became Colorado’s only advanced stroke center north of Denver. This award was given by The Joint Commission, which is the nation’s top accreditation and certification organization in the healthcare arena. Having such an advanced center in our midst is good news for Northern Colorado and surrounding areas, including southern Wyoming and western Nebraska. It means that our extended community has access to some of the best-trained doctors and most advanced treatments available for stroke patients. On average, every 40 seconds someone in the United States experiences a stroke, and stroke is a leading cause of serious, long-term disability. In the face of these statistics, it becomes clear that we’re fortunate to have a state-of-the-art stroke center nearby. “Our diagnosis and treatment starts with our amazing EMTs who are trained to evaluate possible stroke victims in the field,” explains Sheri Friedman, M.D., a neurologist with Poudre Valley Health System. “They begin communicating with our emergency room physicians and nurses, who then prepare to rapidly evaluate the patient on arrival to the hospital. The oncall neurologist is notified of a potential stroke patient before they arrive. From the moment the patient arrives they are rapidly assessed, information about their health history and symptoms are taken, and then they get a CT scan of the brain. This all occurs within a matter of minutes. “It generally takes less than 30 minutes to determine if this person is a candidate for intravenous tPA, the ‘clot-busting’ drug,” she continues. “Our stroke team consists of the EMTs, emergency room physicians and nurses, specially trained technicians and nurses who initially evaluate the patient, radiologists, hospitalist physicians and neurologists. All have received special training in evaluating and treating the stroke patient.”

Time is of the Essence This comprehensive approach is crucial because with stroke patients, time truly is of the essence. The faster patients receive specialized medical treatment, the better their chances of surviving the stroke, preventing another stroke and minimizing long-term effects. As Mike Apostle, M.D., emergency physician at PVH, aptly points out, “When it comes to stroke, time lost is brain lost. So, if you have any symptoms of a stroke, don’t delay getting your symptoms evaluated.” “The faster a person can get to a

Watch for These Symptoms – Act F.A.S.T.

Face

One of the keys to getting a stroke patient to the hospital quickly is knowing what symptoms to watch for. The acronym FAST can help you figure out if someone is having a stroke:

Does the face look uneven? Ask them to smile.

Does one arm drift down? Ask them to raise both arms.

Bof fri fleu. Does their speech sound strange? Ask them to repeat a phrase.

911

Call 9-1-1 at any sign of a stroke. Every second, brain cells die.

Arm Speech Time

Suddenness is another clue that the person is experiencing a stroke. Unexpected changes such as sudden weakness on one side of the body, sudden confusion, sudden severe headache, or sudden trouble seeing are also symptoms of stroke.

CONTINUED ON PAGE 100

Northern Colorado Medical & Wellness 2011

PHYSICIAN D

SURGEON T

Northern Colorado Medical & Wellness 2011

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

Dear Medical & Wellness Magazine Reader: You may have heard that Poudre Valley Health System has been expanding its services during the last two years by starting or purchasing physician clinics throughout the community and Northern Colorado. We began moving along this path in late 2008 when we created Poudre Valley Medical Group (PVMG) as the physician arm of PVHS. PVMG is physician-led, which means its board of directors is comprised primarily of physicians. The idea is that doctors, in collaboration with PVHS administrators, are instrumental in making medical and strategic decisions. These clinics have become part of the PVHS family: • • • • • •

William A. Neff, M.D. Chief Medical Officer Poudre Valley Health System

• • • • • • • • • • • • • • • • • •

PVMG Brain and Spine Surgery in Fort Collins, Loveland and Greeley Cancer Center of the Rockies, Fort Collins Endocrinology Consultants of Northern Colorado, Fort Collins Family Health Care of the Rockies, Fort Collins PVMG Family Medicine, Fort Collins Foxtrail Family Medicine, Loveland (joint partnership with Associates of Family Medicine) Greeley Medical Clinic, Greeley Heart Center of the Rockies, Fort Collins, Loveland and Greeley PVMG Internal Medicine, Fort Collins Drs. Kieft, Cloyd, Hoffmann and Hayes, Fort Collins Loveland Family Practice Loveland Oncology and Hematology, Loveland Loveland Urgent Care Medical Clinic at Centerra, Loveland Neurology Associates of Northern Colorado, Fort Collins and Loveland Peakview Medical Center, Greeley Pediatric Surgery, Fort Collins and Greeley PVMG Physical Medicine and Rehabilitation Poudre Valley Internists, Fort Collins PVMG Primary Care, South, Loveland PVMG Primary Care, Sterling Radiation Oncology, Fort Collins Surgical Specialists of the Rockies, Fort Collins, Loveland and Greeley Windsor Medical Clinic

Heart Center of the Rockies has medical offices in Fort Collins, Loveland and Greeley; and holds clinics and offers services in Craig, Estes Park, Fort Morgan, Kremmling, Steamboat Springs, Sterling, Yuma, and Walden in Colorado; and Alliance, Oshkosh, Scottsbluff, and Sidney in Nebraska; and Laramie in Wyoming. PVHS embarked on the effort to align with physicians because—by all of us working together—we are better able to coordinate patient care and enhance quality. In addition, this coordination of medical professionals helps prepare us for looming changes that will be brought about by national healthcare reform. Many healthcare organizations and physician groups around the nation are following the same tactic: joining together to create larger organizations where care can be better coordinated and the quality of care can be enhanced. At PVHS, we’ve moved ahead like this with the goal of maintaining the world-class care that we offer our patients. Thanks to the great quality of services provided by our staff of physicians, employees and volunteers, our patients are the ones who benefit.

Dr. William A. Neff Chief Medical Officer Poudre Valley Health System

Northern Colorado Medical & Wellness 2011

poudre valley health system *Physician and surgeon list provided by PVHS. This list is current as of 6/24/2011. Address locations are in Fort Collins unless otherwise indicated.

ALLERGY/IMMUNOLOGY Culver, William G., MD 608 E. Harmony Rd., Ste. 101 ........498.9226 Gogate, Shaila U., MD 2121 E. Harmony Rd., Ste. 350 ..........221.2370 See ad on page 19 Gondalia, Lakhman L., MD Cheyenne, WY .......................307.778.2015 James, John M., MD 1136 E. Stuart St., Bldg. 3-200 ......221.1681 See ad on page 65 Kailasam, Velusamy, MD 2121 E. Harmony Rd., Ste. 350 .....221.2370 See ad on page 19 Kujawska, Anna, MD 608 E. Harmony Rd., Ste. 101 ........498.9226 Lanting, William A., MD 1029 Robertson St ........................227.4611 Laszlo, Daniel J., MD 608 E. Harmony Rd., Ste. 101 ........498.9226

PHYSICIAN 2011 | 2012 &SURGEON directory*

Murthy, Krishna C., MD 2121 E. Harmony Rd., Ste. 350 .....221.2370 See ad on page 19

Carline, Marylida, MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page

Lichon, Amy, DO 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page

Pace, R. Scott, MD 6801 W. 20th Street, Ste. 206 (Greeley) ......................................353.0155

Cochran, Thomas S., Jr. MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page

Marks, Sandy C., III, MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page

Vedanthan, P. K., MD Lakewood, CO .......................303.238.0471

Deringer, Michael A., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page

ANESTHESIOLOGY Adams, Ryan S., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Alessi, Richard D., Jr. MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page, page 107 and page 108 Bindseil, Richard, DO 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Bobo, Russell W., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page

Derrisaw, James, MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Dunn, Duane L., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Eisenmenger, Michael J., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Fife, Jason D., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Ford, Troy A., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Fortner, Corwyn, MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Harrison, William L., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Hodges, Kathleen A., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Horne, Stephen G., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Keate, Tyler L., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Kirsch, Timothy E., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page

Markus, Jennifer L., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Martinez, Alice, MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Miller, Justin D., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Moss, William E., DO 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Muncy, Travis R., DO 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Neff, William A., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad on this page Olsen, Kimberlee J. MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Perschau, Erik R., DO 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Raymond, Jeffrey D. MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Richardson, Emily C., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Ryan, Kathleen D., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Salimbeni, Julio C., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page Serell, Sean M., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page

Koepp, Jeffrey, MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page

Soma, Thomas D., MD 1236 E. Elizabeth St., Ste.1.........224.2985 See ad this page

Krohn, Douglas D., MD 1236 E. Elizabeth St., Ste.1 ...........224.2985 See ad this page

Stenbakken, Gelerie D., MD 1236 E. Elizabeth St., Ste.1 .........224.2985 See ad this page

Velasco, Stephen E., MD 1236 E. Elizabeth St., Ste.1 .........224.2985 See ad on page 40

Luckasen, Gary J., MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53

Vizena, Annette D., MD 1236 E. Elizabeth St., Ste.1 .........224.2985 See ad on page 40

Miller, William E., MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53

Wagner, Jan Gillespie, MD 1175 58th Avenue, Ste. 202 (Greeley) .....................................495.0300

Myers, Gerald I., MD 940 Central Park Dr., Ste. 290 Steamboat Springs ..............970.870.1035 See ad on page 12 and on page 53

Watrous, Dwain D., MD 1236 E. Elizabeth St., Ste.1 .........224.2985 See ad on page 40 Weiner, Kelli L., MD 1236 E. Elizabeth St., Ste.1 .........224.2985 See ad on page 40 Williams, Daniel K., MD 1236 E. Elizabeth St., Ste.1 .........224.2985 See ad on page 40 Williams, Wendy M. H., MD 1236 E. Elizabeth St., Ste.1 .........224.2985 See ad on page 40

CARDIOLOGY Ashmore, Roger C., MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53 Austin, Wendy J., MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53 Baker, William B., MD 940 Central Park Dr., Ste. 290 Steamboat Springs ..............970.870.1035 See ad on page 12 and on page 53 Doing, Anthony H., MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53 Dow, Tristan J., MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53 Downes, Thomas R., MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53 Green, C. Patrick, MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53

Oldemeyer, John Bradley, MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53 Purvis, Matthew T., MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53 Stoltz, Chad Lynn, MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53 Strote, Justin A., MD 2121 E. Harmony Rd., Ste. 100 ..221.1000 See ad on page 12 and on page 53 Treat, Stephen A., MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53 Whitsitt, Todd B., MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53

Conlon, William Sean, MD 1032 Luke St. .............................484.8686

Hermstad, Erik L., MD 1024 S. Lemay Ave. .....................495.7000

Dellota, Maria S., MD 1006 Centre Ave. ........................482.9001

Johnston, P. Scott, MD 1024 S. Lemay Ave. .....................495.7000

Eriksen, Christopher M., MD, FACS 1120 E. Elizabeth St., F-101 ........221.1177 See ad on page 42, on page 107 and on page 108

Langstaff, Shawna L., MD 1024 S. Lemay Ave. .....................495.7000

Gill, Sarvjit “Sarge”, MD, FACS 3820 N. Grant Ave. (Loveland) ....593.1177 See ad on page 42 Gupta, Sanjay K., MD, FACS 6500 29th Street, Ste.106 (Greeley) .....................................330.5555 See ad on page 75 Loury, Mark C., MD, FACS 2001 S. Shields St., Bldg. E-101 ..493.5334 See ad on page 37, on page 107 and on page 108 Robertson, Matthew L., MD 1120 E. Elizabeth St., F-101 ........221.1177 See ad on page 42 Runyan, Brad, MD 2121 E. Harmony Rd., Ste. 350 ...212.0169 See ad on page 107 and on page 108 Sabour, Sarmad, MD 6500 29th Street, Ste.106 (Greeley) .....................................330.5555 See ad on page 75

Luttrell, Matthew, MD 1024 S. Lemay Ave. .....................495.7000 Mosiman, Robert J., MD 1024 S. Lemay Ave. .....................495.7000 Olsen, Eric B., MD 1024 S. Lemay Ave. .....................495.7000 Patrick, Kenneth M., DO 1024 S. Lemay Ave. .....................495.7000 Philbeck, G. Ken, MD 1024 S. Lemay Ave. .....................495.7000 Repert, William B., MD 1024 S. Lemay Ave. .....................495.7000 Solley, Matthew C., MD 1024 S. Lemay Ave. .....................495.7000 Springfield, Tracy J., MD 1024 S. Lemay Ave. .....................495.7000 Teumer, James K., DO 1024 S. Lemay Ave. .....................495.7000 Tremblay, Darren E., DO 1024 S. Lemay Ave. .....................495.7000

DERMATOLOGY

Smith, Bruce M., MD 2121 E. Harmony Rd., Ste. 350 ...484.6373 See ad on page 107 and on page 108

Baack, Brad, MD 1120 E. Elizabeth St., Bldg. G2 ....484.6303

Wold, Stephen M., MD 1120 E. Elizabeth St., F-101 ........221.1177 See ad on page 42

Blattner, Mary A., MD 5881 W. 16th Street (Greeley) ....313.2734 See ad on page 12

Zacheis, David H., MD, FACS 3820 N. Grant Ave. (Loveland) ....593.1177 See ad on page 42

Hultsch, Anne-Lise, MD 3726 S. Timberline Rd., Ste. 101 ..221.5795

EMERGENCY MEDICINE

Wood, Ian O., DO 1024 S. Lemay Ave. .....................495.7000

Kalajian, Andrew H., MD 1120 E. Elizabeth St., Bldg. G2 ....484.6303

Apostle, Michael J., MD 1024 S. Lemay Ave. .....................495.7000

Yanagi, Ann K., MD 4674 Snow Mesa Dr., Ste. 200 ....495.8450

Kornfeld, Bruce W., MD 1006 Centre Ave. ........................482.9001

Arguelles, Carlos A., MD 1024 S. Lemay Ave. .....................495.7000

ENDOCRINOLOGY

Sayers, Clinton P., MD 1120 E. Elizabeth St., Bldg. G2 ....484.6303

Dellota, Kriss, MD 1024 S. Lemay Ave. .....................495.7000

Johnson, C. Timothy, MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53

West, B. Lynn, MD 3726 S. Timberline Rd., Ste. 101 ..221.5795

Kiser, Robert H., MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53

EAR, NOSE & THROAT (OTOLARYNGOLOGY)

Larson, Dennis G., MD 2121 E. Harmony Rd., Ste. 100 ...221.1000 See ad on page 12 and on page 53

Chen, Arthur F., MD 5881 W. 16th Street (Greeley). ...313.2740 See ad on page 12

Northern Colorado Medical & Wellness 2011

Farstad, David J., MD 1024 S. Lemay Ave. .....................495.7000 Green, Gabriel E., DO 1024 S. Lemay Ave. .....................495.7000 Green, Jason T., DO 1024 S. Lemay Ave. .....................495.7000 Hallahan, Tara A. DO 1024 S. Lemay Ave. .....................495.7000

Turner, Daniel T., MD 1024 S. Lemay Ave. .....................495.7000 Updegraff, Jeffrey G., MD 1024 S. Lemay Ave. .....................495.7000 Weil, Lawrence J., MD 1024 S. Lemay Ave. .....................495.7000 Wideman, Eric W., DO 1024 S. Lemay Ave. .....................495.7000

Izon, Meriam P., MD 2121 E. Harmony Rd., Ste. 300 ...295.0010 Widom, Barbara, MD 1040 E. Elizabeth St. Ste.101......224.3636 See ad on page 12

FAMILY MEDICINE Abrahamson, Bradley S., MD 1107 S. Lemay Ave. Ste. 200 .......484.1757 See ad on page 45

Abrahamson, Lara, MD 1113 Oakridge Dr. ........................225.0040 See ad on page 45 Adamson, Theran B., MD 2021 Battlecreek Dr., Unit D .........206.0851 Ahern, Caitlin M., MD 2127 E. Harmony Rd. ....................297.6250 Anderson, R. Scott, MD 3519 Richmond Dr. .......................204.0300 See ad on page 45 Askew, Crystal D., MD 1918 S. Lemay Ave., Ste. A ............494.4531 Bailey, Austin G., Jr., MD 1025 Pennock Pl. .........................495.8800 Bakanauskas, Egle A., MD 1455 Main St., Ste.100 (Windsor) ......................................686.3950 See ad on page 12 Bender, Edward L., MD 1212 E. Elizabeth St. .....................482.2791 Bender, John Lumir, MD 4674 Snow Mesa Dr., Ste. 140 ......482.0213 Bermingham, Roger P., MD 1025 Pennock Pl. .........................495.8800 Bethards, Kelby F., MD 1001 E. Johnson St. (Holyoke) ...............................970.854.2500

Birnbaum, Bernard J., MD 1025 Pennock Pl. .........................495.8800 Bradley, Robert C., III, MD 1455 Main St., Ste.100 (Windsor) ......................................686.3950 See ad on page 12 Brewington, Flora Ho, MD 1124 E. Elizabeth St., Bldg. C ........484.0798

Coburn, Thomas C., MD 1455 Main St., Ste.150 (Windsor) ......................................686.0124 See ad on page 45 Corona, Joseph A., MD 5881 W. 16th Street (Greeley) .......................................313.2700 See ad on page 12

Ferguson, David R., MD 3000 S. College Ave. Ste. 210 .......266.8822 See ad on page 12 Fields, Jacqueline C., MD 315 Canyon Ave., Ste. 1 ................472.6789 Fox, Judith B., MD 3850 N. Grant Ave., Ste. 100 (Loveland) .....................................624.5150 See ad on page 12

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

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

Broman, Steven D., MD 1107 S. Lemay Ave. Ste. 200 .........484.1757 See ad on page 45

Davies, Ann T., MD 1625 Foxtrail Dr. (Loveland) .........619.6900 See ad on page 12 & on page 45

Burnham, Linda A., MD 4674 Snow Mesa Dr., Ste. 140 ......482.0213

de la Torre, Rebecca A., MD 2032 Lowe St., Ste.103 .................223.0193

Glazner, J. Cherie, MD 1025 Pennock Pl. .........................495.8800

Butler, Lisa R., DO 1212 E. Elizabeth St. .....................482.2791

DeYoung, Douglas B., DO 1024 Centre Ave., Bldg. E-100A ...484.0774

Goacher, C. Lee, MD 3820 N. Grant Ave., Ste.100 (Loveland) .....................................624.5150 See ad on page 12

Carey, Michael V., MD 1455 Main St., Ste.100 (Windsor) ......................................686.3950 See ad on page 12 Carroll, Cory D., MD 1040 E. Elizabeth St., Ste.102 .......221.5858 Charnecki, Sara E., MD 620 Iris Dr. (Sterling) .............970.522.7266 See ad on page 12

Duran, Christine B., MD 1212 E. Elizabeth St. .....................482.2791 Duran, Matthew G., MD 1212 E. Elizabeth St. .....................482.2791 Felix, Kevin A., DO 3850 N. Grant Ave., Ste. 100 (Loveland) .....................................624.5170 See ad on page 12

Fritzler, Stace A., MD 2121 E. Harmony Rd., Ste. 370 .....221.2290 Geppert, Margo J., MD 2127 E. Harmony Rd. ....................297.6250

Grauerholz, Brent D., MD 1900 16th Street (Greeley) .........350.2454 See ad on page 12 Gray, April K., MD 1918 S. Lemay Ave., Ste. A ..........494.4531 Grossman, Daniel R., MD 2121 E. Harmony Rd., Ste. 370 ...221.2290

Guiroy, Jessica A., MD 1113 Oakridge Dr. .......................225.0040 See ad on page 45 Henderson, Sandra E., MD 2025 Bighorn Dr. .........................229.9800 See ad on page 45 Hoenig, Mark W., MD 2362 E. Prospect Rd., Ste. A ........495.0999 Jinich, Daniel B., MD 2001 S. Shields St., Bldg. E-201 ..221.9991

Marchant, David R., MD 1025 Pennock Pl. ........................495.8800 Mason, R. Anthony, MD 4630 Royal Vista Cir., Ste. 7 (Windsor) ...................................530.0575 Mayer, Paul T., MD 1025 Pennock Pl., Ste. 121 .........495.8980 McCarthy, Victoria A., MD 2001 S. Shields St., Bldg. I ...........221.5255

Johns, Stacie L., MD 1635 Blue Spruce Dr. ..................494.4040

McCreery, Colleen R., DO 3519 Richmond Dr. ......................204.0300 See ad on page 45

Kauffman, Jeffrey N., MD 1124 E. Elizabeth St., Bldg. C ......484.0798

McLaughlin, Keith C., MD 1025 Pennock Pl., Ste. 121 .........495.8980

Kesler, James M., MD 3519 Richmond Dr. ......................204.0300 See ad on page 45

Mercer, Jeannette Y., MD 2555 E. 13th Street, Ste.110 (Loveland) ..................................461.6140

Klingner, Susan K., MD 2025 Bighorn Dr. .........................229.9800 See ad on page 45

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

Lembitz, Deanne D., MD 4630 Royal Vista Cir., Ste.7 (Windsor) ...................................530.0575 Lesage, Margaret R., MD 1455 Main St., Ste. 150 (Windsor) ....................................686.0124 See ad on page 45 Levine, Pamela R., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ..........203.7180 See ad on page 12 Ley, James W., MD 5881 W. 16th Street (Greeley) ....313.2700 See ad on page 12

Miller, Laurie A., MD 1635 Blue Spruce Dr. ..................494.4040 Murphy, Lawrence E., MD 1113 Oakridge Dr. .......................225.0040 See ad on page 45 Nevrivy, Thomas E., MD 3519 Richmond Dr. ......................204.0300 See ad on page 45 Noordewier, Edwin R., MD 1900 16th Street (Greeley) .........350.2454 See ad on page 12 Nystrom, Robert R., DO 1900 16th Street (Greeley) .........350.2471 See ad on page 12

Robinson, Anne L., MD 1107 S. Lemay Ave. Ste. 200 .......484.1757 See ad on page 45

Unger, Mark S., MD 1113 Oakridge Dr. .......................225.0040 See ad on page 45

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

Van Farowe, Cynthia K., MD 3519 Richmond Dr. ......................204.0300 See ad on page 45

Rotman, Mark F., MD 2001 S. Shields St., Bldg. I ..........221.5255 See ad on page 45

Webber, Pamela, S., MD 1025 Pennock Pl. ........................495.8800

Rubright, Jon S., MD 3519 Richmond Dr. ......................204.0300 See ad on page 45

Weiskittel, Deborah A., MD 1113 Oakridge Dr. .......................225.0040 See ad on page 45

Samuelson, Scott J., MD 1124 E. Elizabeth St., Bldg. C ......484.0798

Weixelman, Janice M., DO 8017 First Street, Ste. C (Wellington) ................................568.4800

Sands, Arthur C., MD 1021 Robertson St. .....................482.0666 Schmalhorst, Brian K., MD 5881 W. 16th Street (Greeley). ...313.2700 See ad on page 12 Schmidt, David S., MD 2001 S. Shields St., Bldg. I ..........221.5255 See ad on page 45 Seeton, James F., MD 2211 S. College Ave., Ste. 300 ....237.6339 Serrano-Toy, Monica T., MD 2121 E. Harmony Rd. Ste. 370 ....221.2290

Wideman, JD, DO 2001 S. Shields St., Bldg. I ..........221.5255 See ad on page 45 Wilson, Fiona A., MD 1107 S. Lemay Ave. Ste. 200 .......484.1757 See ad on page 45 Wozniak, Janell R., MD 1025 Pennock Pl. ........................495.8800

FAMILY MEDICINE/SPORTS MEDICINE

Siple, Anne I., MD 2025 Bighorn Dr .........................229.9800 See ad on page 45

Ross, Vincent J., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11

Smith, Jerome I., MD 2025 Bighorn Dr. .........................229.9800 See ad on page 45

Sachtleben, Thomas R., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11

Stephens, Floyd V., Jr. MD 3519 Richmond Dr. ......................204.0300 See ad on page 45

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

Litel, Alexa L., MD 2127 E. Harmony Rd. ..................297.6250

Oligmueller, William J., MD 5881 W. 16th Street (Greeley). ...313.2700 See ad on page 12

Stoddard, Andrew P., MD 2520 W. 16th Street (Greeley) .....356.2520

Yemm, Stephen J., MD 2500 E. Prospect Rd....................493.0112 See ad on page 11

Lockwood, Stephanie R., MD 3519 Richmond Dr. ......................204.0300 See ad on page 45

Orozco-Peterson, Marilu, MD 811 E. Elizabeth St. ....................224.1596

Sullivan, Donna L., MD 1025 Pennock Pl. ........................495.8800

GASTROENTEROLOGY

Ottolenghi, David R., MD 2121 E. Harmony Rd., Ste. 310 ...221.3855

Taliaferro, Peyton, MD 1327 Eagle Dr. (Loveland) ...........619.6450 See ad on page 12

Compton, Rand F., MD 3702 S. Timberline Dr., Bldg. A ....207.9773

Taylor, Grant M., DO 608 E. Harmony Rd., Ste. 101 .....204.9069

Dowgin, Thomas A., MD 7251 W. 20th Street, Bldg. J (Greeley) .....................................378.1414

Loeb, Mark H., MD 2127 E. Harmony Rd. ..................297.6250 Lopez, Joseph M., MD 1136 E. Stuart St., Ste. 4202 .......221.5925 Lowther, Kelly H., MD 4674 Snow Mesa Dr., Ste. 140 ....482.0213 Loy, Brienne J., MD 1106 E. Prospect Rd., Ste. 100 ....495.8470 See ad on page 12 MacDonald, Nola A., DO 315 Canyon Ave., Ste. 3 ..............472.8008 Mallory, Patrick, DO 1548 N. Boise Ave. (Loveland) .....669.9245

Palagi, Patricia C., MD 3000 S. College Ave., Ste. 210 ....266.8822 See ad on page 12 Podhajsky, Tim P., MD 2025 Bighorn Dr. .........................229.9800 See ad on page 45 Ptaszkiewicz, Matt MD 3000 S. College Ave., Ste. 210 ....266.8822 See ad on page 12 Rangel, Keith A., MD 1455 Main St., Ste.100 (Windsor) ....................................686.3950 See ad on page 12

Northern Colorado Medical & Wellness 2011

Thieman, William J., MD 2127 E. Harmony Rd. ..................297.6250 Thorson, Steven J., MD 1212 E. Elizabeth St. ...................482.2791

Dunphy, Rebecca C., MD 3702 S. Timberline Dr., Bldg. A ....207.9773 Durkan, Mark N., MD 3702 S. Timberline Dr., Bldg. A ....207.9773

Tippin, Steven B., MD 2025 Bighorn Dr. .........................229.9800 See ad on page 45

Holland, Rodney R., MD 3702 S. Timberline Dr., Bldg. A ....207.9773

Towbin, Michael M., MD 1217 Riverside Ave. .....................482.7800

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

Kading, Steven O., MD 1900 16th Street (Greeley) ..........350.2740 See ad on page 12 Langer, Daniel A., MD 2555 E.13th Street, Ste. 220 (Loveland) ....................................669.5432 McElwee, Hugh P., MD 3702 S. Timberline Dr., Bldg. A ......207.9773 North, Crystal M., DO 2555 E.13th Street, Ste. 220 (Loveland) ....................................669.5432 Sears, Stephen R., MD 2555 E.13th Street, Ste. 220 (Loveland) ....................................669.5432 Simmons, Robert A., MD 3702 S. Timberline Dr., Bldg. A ......207.9773 Strong, Lewis R., MD 2555 E.13th Street, Ste. 220 (Loveland) ....................................669.5432 Witt, Peter C., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ............203.7010 See ad on page 12

HEMATOLOGY/ONCOLOGY Brown, Regina J., MD 2121 E. Harmony Rd., Ste. 150 .....493.6337 See ad on page 12 Fangman, Michael P., MD P.O. Box 271040 ...........................217.5160 Kemme, Douglas J., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) .....................................203.7080 See ad on page 12 Lininger, Thomas R., MD 1800 15th Street, Ste. C (Greeley) .......................................378.4170 See ad on page 12

Shelanski, Samuel A., MD 2975 Ginnala Dr., Ste. 120 (Loveland) .....................................667.7870 See ad on page 12

Copple, Sheila A., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ............203.7050 See ad on page 12

Sorensen, Matthew D., MD 2121 E. Harmony Rd., Ste. 150 .....493.6337 See ad on page 12

Demacopoulos, Nicola D., MD 1900 16th Street (Greeley) ...........350.2438 See ad on page 12

Stone, Michael D., MD 1800 15th Street, Ste. C (Greeley) .......................................378.4170 See ad on page 12

Ebens, John B, MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ............203.7050 See ad on page 12

Stroh, Ann L., DO 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ............203.7080 See ad on page 12

Ellis, Robert H., MD 1024 S. Lemay Ave. .......................495.7000 Hendrick, James D., MD 1939 Wilmington Dr., Ste. 102 ......980.6024

Zenk, Daniel R., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ............203.7050 See ad on page 12

HOSPICE & PALLIATIVE CARE

Hendrick, Jennifer M., MD 4674 Snow Mesa Dr., Ste. 100 ......482.3712 See ad on page 12

INTERNAL MEDICINE/ HOSPITALISTS

Allen, David K., MD 305 Carpenter Rd. .......................292.0179 See ad on page 101

Herrera, Xavier, MD 1100 Poudre River Dr. ...................224.9508

INFECTIOUS DISEASES

Homburg, Robert C., MD 1100 Poudre River Dr. ...................224.9508

Cobb, David K., MD, FACP 2121 E. Harmony Rd., Ste. 380 .....224.0429

Juhala, Robert J., MD 4674 Snow Mesa Dr., Ste. 100 ......482.3712 See ad on page 12

LiaoOng, Jacob C., MD 2121 E. Harmony Rd., Ste. 380 .....224.0429 Peskind, Robert L., MD 2121 E. Harmony Rd., Ste. 380 .....224.0429

INTERNAL MEDICINE Abbey, David M., MD 1100 Poudre River Dr. ...................224.9508 Agrama, Susan D., MD 1327 Eagle Dr. (Loveland) ............619.6450 See ad on page 12

Khera, Sukhjinder K., MD 1106 E. Prospect Rd., Ste. 100 ......495.7410 See ad on page 12 Lamb, Richard C., MD 620 Iris Dr. (Sterling) .............970.522.7266 See ad on page 12 Lopez, William, Jr. MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ............203.7050 See ad on page 12 Lund, Amanda M., DO 4674 Snow Mesa Dr., Ste. 100 ......482.3712 See ad on page 12

Marschke, Robert F. Jr., MD 2315 E. Harmony Rd., Ste. 110. ....212.7600

Alessi, Grace, MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ............203.7050 See ad on page 12

McFarland, Ross W., MD 2315 E. Harmony Rd., Ste. 110. ....212.7600

Asadi, S. Daniel, DO 4401A Union St. (Johnstown) .......619.3656

Nowak, Bonnie, MD 1106 E. Prospect Rd., Ste. 100 ......495.7410 See ad on page 12

Medgyesy, Diana C., MD 2315 E. Harmony Rd., Ste. 110. ....212.7600

Berntsen, Mark F., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ............203.7050 See ad on page 12

Ow, Cathy L., MD 4674 Snow Mesa Dr., Ste. 100 ......482.3712 See ad on page 12

Romero, Paolo, MD 2121 E. Harmony Rd., Ste. 150 .....493.6337 See ad on page 12

Cash, Robert L., MD 1900 16th Street (Greeley) ...........350.2438 See ad on page 12

Randle, Michael T., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ............203.7050 See ad on page 12

Scott, Miho Toi, MD 2121 E. Harmony Rd., Ste. 150 .....493.6337 See ad on page 12

Christiansen, Dana L., MD 1900 16th Street (Greeley) ...........350.2438 See ad on page 12

Reimer, Christina M., MD 4674 Snow Mesa Dr., Ste.100 ......482.3712 See ad on page 12

Moore, James C., MD 2315 E. Harmony Rd., Ste. 110. ....212.7600

Lynch, Michael J., DO 1101 Oakridge Dr., Ste. B ................223.1199

Stafford, Neil K., MD 1100 Poudre River Dr. ...................224.9508 Sunderman, Steve R., MD 607 Castle Ridge Ct. .....................223.8922 Thompson, Keith S., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ............203.7050 See ad on page 12 Tryggestad, David I., MD 1900 16th Street (Greeley) ...........350.2438 See ad on page 12

Austin, William Bennett, DO 2121 E. Harmony Rd., Ste. 300 .....224.9102 Clipsham, Victoria A., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Filipowski, Piotr J., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Gaines, Jennifer L., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Johnston, Christine G., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Jones, Christopher E., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Kilzer, Helen M., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Knepper, Katherine L., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 LumLung, Christine M., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Mack, Adam G., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Maller, Nancy T., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Mills, Angela M., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Reghitto, Charmaine, MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Spannring, Mary M., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Yoder, Elizabeth Anne, MD 2121 E. Harmony Rd., Ste. 300 .....224.9102

Simmons, Richard E., MD 1600 Specht Point Rd., Ste127 ...493.7733 Singer, James R., MD 1600 Specht Point Rd., Ste.127 ...493.7733 Teruel, Mark A., MD 1600 Specht Point Rd., Ste.127 ...493.7733

NEUROLOGY Allen, Timothy J., MD 2121 E. Harmony Rd., Ste. 270 ...221.1993 See ad on page 67 Curiel, Michael P., MD 2121 E. Harmony Rd., Ste. 270 ...221.1993 See ad on page 67 Friedman, Sheri J., MD 1106 E. Prospect Rd., Ste. 100 ....482.4373 See ad on page 12 Himes, Terry M., DO 2500 Rocky Mountain Ave., S. Medical Office Building, Ste. 310 (Loveland) ..................................619.6000 Jacobs, Marianne B., DO 295 E. 29th Street, Ste. 240 (Loveland) ..................................669.2668 Kaur, Paramjit, MD 1106 E. Prospect Rd., Ste. 100 ....482.4373 See ad on page 12

INTERNAL MEDICINE/PEDIATRICS

Hall, Daniel M., MD Aurora, CO ..........................303.724.2840

Capes, Geoffrey G., MD 4674 Snow Mesa Dr., Ste. 120 ....266.3650

Kinsella, John P., MD Aurora, CO ..........................303.724.2840

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

MacRitchie, Amy N., MD PVH, 1024 S. Lemay Ave. ............495.8280

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

Paisley, Jan E., MD PVH, 1024 S. Lemay Ave. ............495.8280

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

Satterwhite, Daniel J., MD PVH, 1024 S. Lemay Ave. ............495.8280

MATERNAL & FETAL MEDICINE Heyborne, Kent D., MD Denver, CO ..........................303.860.9990 Porreco, Richard P., MD Denver, CO ..........................303.860.9990 Stettler, R. William, MD Denver, CO ..........................303.860.9990

NEONATOLOGY Delaney, Cassidy A., MD Aurora, CO ..........................303.724.2840

Thilo, Elizabeth H., MD Aurora, CO ..........................303.724.2840 Wilkening, Randall B., MD Aurora, CO ..........................303.724.2840

NEPHROLOGY Merritt, Jason L., MD 1600 Specht Point Rd., Ste.127 ...493.7733

McIntosh, Gerald C., MD 1106 E. Prospect Rd., Ste. 100 ....482.4373 See ad on page 12 Meredith, Lawrence A., MD 2500 Rocky Mountain Ave., N. Medical Office Building, Ste. 310 (Loveland) ...................................667.7664 See ad on page 12 Miller, Tamara A., MD 2121 E. Harmony Rd., Ste. 180 ...226.6111 Nash, Jerry D., MD 2121 E. Harmony Rd., Ste. 180 ...226.6111

OBSTETRICS/GYNECOLOGY Beresford, Kaea N., MD 1107 S. Lemay Ave. Ste. 300 .......493.7442 Burket, Charles R., MD 1900 16th Street (Greeley) .........350.2403 See ad on page 12

Muelken, Kevin D., MD 1600 Specht Point Rd., Ste.127 ...493.7733

Carter, Susan D., MD 1800 15th Street, Ste. 220 (Greeley) .....................................353.1335

Rademacher, Donald R., MD 1900 16th Street (Greeley) . .......350.2438 See ad on page 12

Cloyd, David G., MD 1136 E. Stuart St., Ste. 2100 .......493.5904 See ad on page 12 and on page 38

Northern Colorado Medical & Wellness 2011

Colberg, Craig S., MD 1900 16th Street (Greeley) .........350.2403 See ad on page 12 Donnelley, Beverly E., MD 1107 S. Lemay Ave. Ste. 300 .......493.7442 See ad on page 107 and on page 108 Geraghty, Kyra L., MD 1025 Pennock Pl. ........................495.8800 Hayes, Karen E., DO 1224 E. Elizabeth St. ...................221.4977 Hayes, Kimberly W., MD 1136 E. Stuart St., Ste. 2100 .......493.5904 See ad on page 12 and on page 38 Hoffman, Mark F., MD 1136 E. Stuart St., Ste. 2100 .......493.5904 See ad on page 12 and on page 38 James, Warren K., MD 1107 S. Lemay Ave. Ste. 300 .......493.7442 See ad on page 107 and on page 108 Jeffrey, R. Lee, MD 1107 S. Lemay Ave. Ste. 300 .......493.7442 Kieft, Larry D., MD 1136 E. Stuart St., Ste. 2100 .......493.5904 See ad on page 12 and on page 38 King, Angela, MD 1107 S. Lemay Ave. Ste. 300 .......493.7442 See ad on page 107 and on page 108 Kiser, Rick E., MD 1900 16th Street (Greeley) ..........350.2403 Burket, Charles R., MD 1900 16th Street (Greeley) .........350.2403 See ad on page 12 Kozak, Susan H., MD 1107 S. Lemay Ave. Ste. 300 .......493.7442 See ad on page 107 and on page 108 Micetich, Kara L., MD 1107 S. Lemay Ave. Ste. 300 .......493.7442 See ad on page 107 and on page 108 Priebe, Philip N., MD 1107 S. Lemay Ave. Ste. 300 .......493.7442 See ad on page 107 and on page 108 Roberson, Nicole M., MD 1107 S. Lemay Ave. Ste. 300 .......493.7442 Serniak, Elizabeth K., MD 1107 S. Lemay Ave. Ste. 300 .......493.7442 See ad on page 107 and on page 108 Skorberg, Christine F., MD 1006 Luke St. .............................419.1111 Stern, J. Bradley, MD 1107 S. Lemay Ave. Ste. 300 .......493.7442 See ad on page 107 and on page 108 Tollefson, Michelle L., MD 1107 S. Lemay Ave. .....................495.8400

Tool, Kevin J., MD 1107 S. Lemay Ave. Ste. 300 .......493.7442

Holthouser, Michael G., MD 4674 Snow Mesa Dr., Ste. 200 ......495.8450

Vance, Maude M., MD 1107 S. Lemay Ave. Ste. 300 .........493.7442 See ad on page 107 and on page 108

Milliken, William J., MD 8010 S. County Rd 5, Ste. 101 (Windsor) .....................................377.1300

Worford, Cherie L., MD 1006 Luke St. ...............................419.1111 Yeh, Eric M., MD 1107 S. Lemay Ave. Ste. 300 .........493.7442

Oâ&#x20AC;&#x2122;Toole, Kevin J., DO 4674 Snow Mesa Dr., Ste. 200 ......495.8450 Scherr, Frederick P., MD 2500 Rocky Mountain Ave., S. Medical Office Building, Ste. 330 (Loveland) ....................................495.8450 Yanagi, Ann K., MD 4674 Snow Mesa Dr., Ste. 200 ......495.8450

OBSTETRICS/GYNECOLOGY/ INFERTILITY Bachus, Kevin E., MD 1080 E. Elizabeth St. .....................493.6353 See ad on page 107 & 108

OCCUPATIONAL MEDICINE Basow, William M., MD 2500 Rocky Mountain Ave., S. Medical Office Building, Ste. 330 (Loveland) ....................................495.8450

Korotkin, Arthur, MD 1725 E. Prospect Rd .....................221.2222 See ad below

Nicholas, Kenton C., DDS 1900 16th Street (Greeley) ...........350.2458 See ad on page 12

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

Orr, Mark F., DDS, MD 2014 Caribou Dr., Ste. 100 ............225.9555

Olsen, Karl E., MD 1725 E. Prospect Rd ......................221.2222 See ad below

Reynolds, Ralph R., DMD, MD 3520 E. 15th Street, Ste. 102 (Loveland) ....................................663.6878

Reistad, Chet Erik, MD 1725 E. Prospect Rd. .....................221.2222 See ad below

Thurgood, David B., DDS 4609 S. Timberline Rd., Ste. 104B..498.0196

OPHTHALMOLOGY

Robinson, Matthew J., MD 1725 E. Prospect Rd. .....................221.2222 See ad below

Arnold, Patrick D., MD 1725 E. Prospect Rd. .....................221.2222 See ad below

Smith, Randall W., MD 1725 E. Prospect Rd. .....................221.2222 See ad below

Bashford, Kent P., DO 1725 E. Prospect Rd. .....................221.2222 See ad below

ORAL/MAXILLOFACIAL

Crews, Kent R., MD 1725 E. Prospect Rd. .....................221.2222 See ad below

Bley, Justin C., DMD 1707 61st Avenue, Ste. 102 (Greeley) ......................................506.0350

Foster, Gary J., MD 1725 E. Prospect Rd ......................221.2222 See ad below

Felton, Rickey E., DDS 1008 Centre Ave., Ste. B ...............221.4633

Troxell, James B., DDS 1120 E. Elizabeth St., Ste. G3 ........482.6811

ORTHOPEDICS Baer, Robert M., MD 2500 E. Prospect Rd. .....................493.0112 See ad on page 11 Beard, David A., MD 2500 E. Prospect Rd. .....................493.0112 See ad on page 11 Beard, Douglas W., MD 1313 Riverside Ave. ......................493.1292 See ad on page 36, on page 107 and on page 108

Benz, Robert J., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11

Martin, Dale R., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11

Dunn, Cory D., MD 5802 Wright Dr. (Loveland) .........353.5136 See ad on page 19

Biggs, William D., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11

McFerran, Mark A., MD 3470 E. 15th Street (Loveland) ....663.3975

Halbert, Richard E., MD 5802 Wright Dr. (Loveland) .........353.5136 See ad on page 19

Chamberlain, Satoru T., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11 Clark, C. Dana, MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11 Dhupar, Scott K., MD 1624 17th Avenue (Greeley) .......353.5959 Donner, E. Jeffrey, MD 3810 N. Grant Ave. (Loveland) ....669.8881 Duncan, Kenneth H., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11 Durbin, Mark B., MD 2500 E. Prospect Rd. ..................493.0112 See ad on page 11

Nelson, Garth C., MD 1020 Luke St. .............................493.2102 Pettine, Kenneth A., MD 3810 N. Grant Ave. (Loveland) ....669.8881 Reckling, W. Carlton, MD Cheyenne, WY .....................307.632.6637

Libby, Arlene L., MD 5802 Wright Dr. (Loveland) .........353.5136 See ad on page 19

Rusnak, Michael P., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11

Mattoch, Ingerlisa W., MD 5802 Wright Dr. (Loveland) .........353.5136 See ad on page 19

Seiler, Steven J., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11

Neuhauser, Thomas S., MD 5802 Wright Dr. (Loveland) .........353.5136 See ad on page 19

Sides, Steven D., MD 5890 W. 13th Street, Ste. 101 (Greeley) .....................................348.0020

Walts, Michael J., MD 5802 Wright Dr. (Loveland) .........353.5136 See ad on page 19

Grant, Michael P., MD 3810 N. Grant Ave. (Loveland) ....669.8881

Snyder, Joshua T., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ..........203.7100 See ad on page 12

Grey, Sean G., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11

Sobel, Roger M., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11

Grossnickle, Mark D., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ..........203.7100 See ad on page 12

Young, Eric E., MD 3830 N. Grant Rd. (Loveland) ......776.3222

Hartman, Ryan L., MD 2500 E. Prospect Rd. ..................493.0112 See ad on page 11 Houghton, Michael J., MD 2500 E. Prospect Rd. ..................493.0112 See ad on page 11 Hunter, Brett P., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ..........203.7100 See ad on page 12 Jackson, Wesley P., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11 Javernick, Matthew A., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11 Kindsfater, Kirk A., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11

Hamner, H. Wentzell, MD 5802 Wright Dr. (Loveland) .........353.5136 See ad on page 19

ORTHOPEDICS/SPORTS MEDICINE Trumper, Rocci V., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11

PAIN MANAGEMENT Columbus, David J., DO 3744 S. Timberline Rd., Ste. 102 ..495.0506 See ad on page 49 Girardi, George E., MD 3744 S. Timberline Rd., Ste. 102 .495.0506 See ad on page 49 Sisson, Charles B., MD 2809 E. Harmony Rd., Ste. 100 ...221.9451

PATHOLOGY

Knauer, Sally A., MD 2121 E. Harmony Rd., Ste. 290 ...224.9890

Bee, Christopher S., MD 5802 Wright Dr. (Loveland) .........353.5136 See ad on page 19

Mahon, John H., MD 2121 E. Harmony Rd., Ste. 260 ...221.2827

Carney, Heather M., MD 5802 Wright Dr. (Loveland) .........353.5136

Northern Colorado Medical & Wellness 2011

PEDIATRICS Anderson, Carole M., DO 1200 E. Elizabeth St ....................267.9510 See ad on page 90 Archer, Deborah, MD 1635 Blue Spruce Dr. ..................494.4040 Bailey, Amy C., MD 1200 E. Elizabeth St ....................267.9510 See ad on page 90

Hull, Lori J., MD 2001 S. Shields St., Bldg. G .........484.4871 Kolanz, M. Meshelle, MD 5881 W. 16th Street (Greeley) ....313.2700 See ad on page 12 Markley, Jennifer L., MD 2001 S. Shields St., Bldg. G .........484.4871 McGinnis, James G., MD 1200 E. Elizabeth St. ...................267.9510 See ad on page 90 Moore, Christopher P., MD 5881 W. 16th Street (Greeley) ....313.2700 See ad on page 12 Oâ&#x20AC;&#x2122;Brien, Barry G., MD 1200 E. Elizabeth St. ...................267.9510 See ad on page 90 Pedersen, Robert L., MD 5881 W. 16th Street (Greeley) ....313.2700 See ad on page 12 Ryan, Joseph P., MD 5881 W. 16th Street (Greeley) ....313.2700 See ad on page 12 Sampera, Kirsten M., MD 1200 E. Elizabeth St. ...................267.9510 See ad on page 90 Schaffer, Michael S., MD Aurora, CO ..........................720.777.2942 Seidman, Marc H., MD 1635 Blue Spruce Dr. ..................494.4040 Whitman, Douglas W., MD 1635 Blue Spruce Dr. ..................494.4040

Ballard, Elizabeth A., MD 1200 E. Elizabeth St. ...................267.9510 See ad on page 90

PEDIATRIC/DENTISTRY

Booth, Richard R., MD 2001 S. Shields St., Bldg. G .........484.4871

Evans, Gregory D., DDS 3221 Eastbrook Dr. .....................407.1020

Brockway, Julie M., MD 1200 E. Elizabeth St. ...................267.9510 See ad on page 90

Galm, Katherine S., DDS 2800 Madison Sq. Dr., Ste.1 (Loveland) ..................................669.7711

Crawford, Deborah D., MD 1635 Blue Spruce Dr. ..................494.4040

Guido, Joseph A., DDS 3600 Mitchell Dr. ........................224.3600

Driscoll, Amy B., MD 5881 W. 16th Street (Greeley) ....313.2700 See ad on page 12

Hargleroad, Jennifer K., DDS 2105 Bighorn Rd., Ste. 202 .........493.2254

Elliott, Max A., MD 1200 E. Elizabeth St. ...................267.9510 See ad on page 90 Guenther, John P., MD 1200 E. Elizabeth St. ...................267.9510 See ad on page 90 Hanson, Vaughn W., MD 1200 E. Elizabeth St. ...................267.9510 See ad on page 90

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

PHYSICAL MEDICINE & REHABILITATION Adamson, Carrie L., MD 2021 Battlecreek Dr., Unit D .......206.0851 Bender, John D., DO 1300 Oakridge Dr., Ste. 130 ........377.9555

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

Thomas, Michael I., DPM 1355 Riverside Ave., Ste. C ...........484.4620 See ad on page 103

Laney, Samuel K., MD 1106 E. Prospect Rd., Ste. 100 ....482.4373 See ad on page 12

Vaardahl, Michael D., DPM 1931 65th Ave., Ste. A (Greeley) ...351.0900

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

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

Martin, Rebekah L., MD 2032 Lowe St., Ste. 101 ................221.1919

PSYCHIATRY

Nieves, Ricardo A., MD 1437 Riverside Ave. .....................692.5550

Gottfried, Joseph M., MD 4601 Corbett Dr. ..........................207.4857

Primack, Scott J., DO Greenwood Village ................720.875.0551

Heacock, Craig R., MD 4601 Corbett Dr. ..........................207.4857

Wilson, Daniel R., MD 1106 E. Prospect Rd., Ste. 100 .....482.4373 See ad on page 12

Moreno, Hermann A., MD 4601 Corbett Dr. ..........................207.4857

Wunder, Jeffrey A., MD 7251 W. 20th Street (Greeley) ......356.4066

PODIATRY Anderson, James C., DPM 1355 Riverside Ave., Ste. C ...........484.4620 See ad on page 103 Atherton, Stacy M., DPM 1305 Summer St., Ste. 200 (Longmont) ...........................303.772.3232 Bogin, Staci E., DPM 1927 Wilmington Dr., Ste. 102 ......416.9009 Burns, Michael J., DPM 2001 S. Shields St., Bldg. F ...........493.4660 See ad on page 27 Hatch, Daniel J., DPM 1931 65th Ave., Ste. A (Greeley) ...351.0900 Hecker, Thomas M., DPM 2500 E. Prospect Rd. .....................493.0112 See ad on page 11 Hunt, Nathan A., DPM 2500 E. Prospect Rd. .....................493.0112 See ad on page 11 Knutsen, Chad M., DPM 2001 S. Shields St., Bldg. F ...........493.4660 See ad on page 27 Oâ&#x20AC;&#x2122;Halloran, William D., DPM 1301 Riverside Ave. ......................482.3668 Overman, Jared L., DPM 1355 Riverside Ave., Ste. C ...........484.4620 See ad on page 103 Schulte, Robert C., DPM 2001 S. Shields St., Bldg. F ...........493.4660 See ad on page 27 Schultz, Peter D., DPM 1440 N. Boise Ave. (Loveland) .......278.1440

Nagel, John K., MD 4601 Corbett Dr. ..........................207.4857

Neagle, Mark B., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Peters, Brent T., MD 2500 Rocky Mountain Ave., S. Medical Office Building, Ste. 300 (Loveland) ....................................619.6100 Petrun, Mark D., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Saliman, Joshua A., MD 2500 Rocky Mountain Ave., S. Medical Office Building, Ste. 300 (Loveland) ....................................619.6100 Stevens, Eric E., MD 2500 Rocky Mountain Ave., S. Medical Office Building, Ste. 300 (Loveland) ....................................619.6100 Vassaux, Carlos R., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102

Fuller, Samuel E., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59 Geis, J. Raymond, MD 2008 Caribou Dr ...........................484.4757 See ad on page 23 and on page 59 Geraghty, Michael J., MD 2008 Caribou Dr ...........................484.4757 See ad on page 23 and on page 59 Gunderson, Deborah Z., MD 2008 Caribou Dr. ...........................484.475 See ad on page 23 and on page 59 Hayes, Amy S., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59 Jess, Sarah J., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59

Wallick, Kristin A., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102

Koplyay, Peter D., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59

Pearson, Glenn E., MD 4601 Corbett Dr. ..........................207.4857

RADIATION ONCOLOGY

Sehr, David S., MD 120 Bristlecone Dr.. .......................224.5209

Lisella, Gwen H., MD 1024 S. Lemay Ave. .......................495.7000

Luttenegger, Thomas J., MD, FACR 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59

Straumanis, Eric J., MD 1762 Hoffman Dr. (Loveland) ........663.3030

Petit, Joshua Henry, MD 2121 E. Harmony Rd., Ste. 160 .....482.3328 See ad on page 12

Oddy, Richard A., MD 2627 Redwing Rd., Ste. 220. ........622.0588

Udupa, Usha R., MD 4601 Corbett Dr. ..........................207.4857 Watanabe, Kenneth S., MD 4601 Corbett Dr. ..........................207.4857 Woodard, Timothy W., MD 4601 Corbett Dr. ..........................207.4857

PULMONOLOGY Breyer, Diana M., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 DePriest, Kirk L., DO 2121 E. Harmony Rd., Ste. 300 .....224.9102 Gunstream, Stanley R., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Hatzis, Christopher E., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Hoyt, James D., MD 2121 E. Harmony Rd., Ste. 300 .....224.9102 Kukafka, David S., MD 2500 Rocky Mountain Ave., S. Medical Office Building, Ste. 300 (Loveland) ....................................619.6100 Milchak, Richard J., MD 2500 Rocky Mountain Ave., S. Medical Office Building, Ste. 300 (Loveland) ....................................619.6100

Markel, Curtis L., MD 2008 Caribou Dr. ...........................484.475 See ad on page 23 and on page 59

RADIOLOGY

Mills, Andrew D., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59

Berkowitz, Bruce A., MD 2008 Caribou Dr. ...........................484.4757 See ad on page 23 and on page 59

Pacini, Richard J., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59

Bodenhamer, John R., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59

Paquelet, Jean R., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59

Contreras, Jaime H., MD 2008 Caribou Dr. ...........................484.4757 See ad on page 23 and on page 59

Peck, Steven H., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59

Craven, Winfield M., MD 2008 Caribou Dr. ...........................484.4757 See ad on page 23 and on page 59

Peet, Gary J., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59

Dunphy, Thomas R., MD 2008 Caribou Dr. ...........................484.4757 See ad on page 23 and on page 59

Reese, Mark F., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59

Esola, Christine C., MD 2008 Caribou Dr. ...........................484.4757 See ad on page 23 and on page 59

Singer, Charles J., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59

Fleener, Christopher M., MD 2008 Caribou Dr. ...........................484.4757 See ad on page 23 and on page 59

Weinstein, Stanley W., MD 2008 Caribou Dr. ..........................484.4757 See ad on page 23 and on page 59

Florant, Tracy H., MD 2127 E. Harmony Rd., Ste. 130 .....207.4700 See ad on page 23 and on page 59

Weissmann, Jeffrey R., MD 2008 Caribou Dr. .........................484.4757 See ad on page 23 and on page 59

RHEUMATOLOGY Levine, James W., DO 1900 16th Street (Greeley) .........350.2433 See ad on page 12 Mayer, Patricia A., MD 2121 E. Harmony Rd., Ste. 361 ...267.9799 Murray, Garvin C., MD 1900 16th Street (Greeley) .........350.2433 See ad on page 12 Thakor, Michael S., MD 2121 E. Harmony Rd., Ste. 361 ...267.9799 Thompson, John Stephen, MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ..........461.1880 See ad on page 12

SURGERY CENTERS Harmony Surgery Center, LLC 2127 E. Harmony Rd., Ste. 200 ...297.6300 Surgery Center of Fort Collins 1100 E. Prospect Rd. ...................494.4800 See ad on page 107 and on page 108

SURGERY/ASSIST Grant, Lee B., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11 Kaiser, Dale C., MD 2500 E. Prospect Rd. ...................493.0112 See ad on page 11 Ludwin, Gary A., MD 1107 S. Lemay Ave. Ste. 300 .......493.7442 Tutt, George O., Jr. MD 1024 S. Lemay Ave. .....................495.7000

SURGERY/CARDIOVASCULAR Douthit, Mark B., MD 2500 Rocky Mountain Ave., S. Medical Office Building, Ste. 100 (Loveland) ...................................624.1800 See ad on page 53 Guadagnoli, Mark D., MD 2500 Rocky Mountain Ave., S. Medical Office Building, Ste. 100 (Loveland) ...................................624.1800 See ad on page 12 and on page 53 Matthew, Thomas L., MD 2500 Rocky Mountain Ave., S. Medical Office Building, Ste. 100 (Loveland) ...................................624.1800 See ad on page 53

Northern Colorado Medical & Wellness 2011

Stanton, Michael W., MD 2500 Rocky Mountain Ave., S. Medical Office Building, Ste. 360 (Loveland) ...................................619.6176 See ad on page 65

Marty, Terri, MD 2315 E. Harmony Rd., Ste. 130 ...221.5878 See ad on page 12

SURGERY/OPHTHALMIC/ FACIAL PLASTIC/ RECONSTRUCTIVE

Oâ&#x20AC;&#x2122;Holleran, Lawrence W., MD Cheyenne, WY .....................307.637.5600

SURGERY/GENERAL

Parsons, Sally A., MD 2315 E. Harmony Rd., Ste. 130 ...221.5878 See ad on page 12

Reistad, Chet Erik, MD 1725 E. Prospect Rd. ...................221.2222 See ad on page 6

Bauling, Paulus C., MD 1025 Garfield St., Ste. B ..............482.2866 Blomquist, Thomas M., MD 1900 N. Boise Ave., Ste. 420 (Loveland) ..................................669.3212

Peetz, Michael E., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ..........203.7250 See ad on page 12

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

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

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

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

Collins, Jerome S., MD 1900 N. Boise Ave., Ste. 420 (Loveland) ..................................669.3212

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

Collins, John A., MD 2315 E. Harmony Rd., Ste. 130 ...221.5878 See ad on page 12

Rubinson, Samuel M., MD 2315 E. Harmony Rd., Ste. 130 ...221.5878 See ad on page 12

Cribari, Chris, MD 2315 E. Harmony Rd., Ste. 130 ...221.5878 See ad on page 12

Schiefen, James C., DO 1900 16th Street (Greeley). .........350.2426

Davis, Lawrence G., MD 2315 E. Harmony Rd., Ste. 130 ...221.5878 See ad on page 12 Dickinson, James M., MD 2121 E. Harmony Rd., Ste. 250 ...482.6456 See ad on page 37 Dubs, Steven, MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ..........203.7250 See ad on page 12 Fraser, Lesley A., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ..........203.7250 See ad on page 12

Schmidova, Karin, MD 1900 N. Boise Ave., Ste. 420 (Loveland) ..................................669.3212

SURGERY/PLASTIC/ RECONSTRUCTIVE Boustred, A. Mark, MD 2315 E. Harmony Rd., Ste.160 ....493.8800

Chapman, Jeffrey K., MD 2315 E. Harmony Rd., Ste.160 ....493.8800 See ad on page 107 and on page 108 Duncan, Diane I., MD 1701 E. Prospect Rd. ...................493.7445 Gonyon, Denis L., Jr. MD 4450 Union St., Ste.100 (Johnstown) ................................624.7979 Schutte, Warren P., MD 2500 Rocky Mountain Ave., N. Medical Office Building, Ste. 2130 (Loveland) ...................................372.2310 See ad on page 5 Tsoi, Christopher M., MD 2315 E. Harmony Rd., Ste.160 ....493.8800 See ad on page 107 and on page 108

Coester, Hans C., MD 1107 S. Lemay Ave., Ste. 240 ......495.7421 See ad on page 12, on page 107 and on page 108

UROLOGY

Mimran, Ronnie Isaac, MD 1107 S. Lemay Ave., Ste. 240 .....495.7421 Sheinberg, Michael A., MD 1107 S. Lemay Ave., Ste. 240 .....495.7421 Turner, Donn M., MD 1313 Riverside Ave. ....................493.1292 See ad on page 36, on page 107 and on page 108

Kaufman, Steven L., MD 1136 E. Stuart St., Ste. 4102 .......498.8346

Viola, John J., MD 1107 S. Lemay Ave., Ste. 240......495.7421

Keeler, Bradford R., MD 1900 N. Boise Ave., Ste. 420 (Loveland) ..................................669.3212

Widdel, Lars, MD 1107 S. Lemay Ave., Ste. 240......495.7421 See ad on page 12

Livengood, Joseph C., MD 2500 Rocky Mountain Ave., N. Medical Office Building (Loveland) ..........203.7250 See ad on page 12

Wirt, Timothy C., MD 1313 Riverside Ave. ....................493.1292 See ad on page 36, on page 107 and on page 108

Nasseri, Kevin K., MD 2315 E. Harmony Rd., Ste.140 ....484.6700 Phillips, George H., MD 3520 E. 15th Street, Ste. 200 (Loveland) ..................................669.9100 Soper, Timothy H., MD 2315 E. Harmony Rd., Ste.140 ....484.6700 Wisner, Benjamin P., MD 2315 E. Harmony Rd., Ste.140 ....484.6700

Brewster, Amy Hill, MD 2020 Lowe St., Ste. 202 ..............266.0456

SURGERY/NEURO

Hunter, John M., MD 2315 E. Harmony Rd., Ste. 130 ...221.5878 See ad on page 12

Willoughby, Brian J., MD Denver ................................303.320.5700

Manion, Sean P., MD 1925 W. Mountain View Ave. (Longmont) .........................303.776.1234

Brutscher, Stephen P., DO 2315 E. Harmony Rd., Ste.140 ....484.6700 Eddy, Michael J., MD 3520 E. 15th Street, Ste. 200 (Loveland) ..................................669.9100 Everett, Randy W., MD 2315 E. Harmony Rd., Ste.140 ....484.6700 Girdler, Benjamin J., MD 2315 E. Harmony Rd., Ste.140 ....484.6700 Goodman, Gary R., MD 1900 16th Street (Greeley) .........350.2491 See ad on page 12 Lee, Michael R., DO 2315 E. Harmony Rd., Ste.140 ....484.6700 Malcom, Troy J., DO 1925 W. Mountain View Ave. (Longmont) .........................303.776.1234

The Physician list is provided by PVHS and is current as of 6/24/2011.

medical

CARDIAC HEALTH

Healthy

Heartbeats by Heather Schichtel

Your heart will beat 100,000 times in one day, 35 million times in one year. In an average human lifetime, the heart will beat 2.5 billion times. Northern Colorado Medical & Wellness 2011

It is something we take for granted. We complain about a headache or a bad knee; but, how many times do we stop and consider that our reliable heart is beating away, sending oxygenrich blood from vital organs to the very tiniest capillaries of our little toe? We don’t think about our efficient, beating heart until doctors mention that they hear a murmur, an irregular rhythm or something that doesn’t seem right. An irregular heartbeat means that blood is not pumping through the body as seamlessly as it should. A slow or irregular heartbeat can cause blood to build up in one chamber of the heart, thus enlarging that area of the heart and making the muscle work harder to move fluid through the body. This is considered a stage of heart failure. Heart failure means that the heart is not pumping as well as it should and blood is collecting within the chambers. If left untreated, pressure can build through the veins and into the lungs. The heart contracts because of a natural electrical impulse. The heart ‘beat’ is the contraction of the heart, making the chambers smaller and squeezing oxygen-rich blood into the blood vessels. Afterwards, the heart relaxes, allowing blood to fill back into the chambers. If the electrical impulse isn’t working correctly, patient and doctor often look to a pacemaker to regulate this lifesustaining beat. The first pacemaker was invented in 1950 by John Hopps, an electrical engineer. He discovered that if the heart stopped due to cooling, it could be started again by artificial electrical stimulation. However, the first pacemakers were too large to be placed inside the body and therefore proved inefficient. In 1958, Arne Larsson from Sweden became the first patient to have an implantable pacemaker. The device failed after three hours. A second implant was placed which lasted for two days. Larsson went on to receive 26 different pacemakers during his lifetime; he died in 2001 at the age of 86, outliving the original surgeon and the inventor. We have come a long way from 1958. Now, pacemakers can last from 5 to 10 years before needing to be replaced. Of course, the best way to take care of your heart is by living a healthy lifestyle, eating well and exercising. But when the heart needs a little help in regulating itself, it’s nice to know that the electrophysiologists at the Heart Center of the Rockies have implanted a record number of pacemakers in the region; in 2010 alone, they implanted 233. A cardiac electrophysiologist concentrates on the relationship between electricity and the function of the heart. Your doctor will refer you to a cardiac electrophysiologist if they notice an arrhythmia or you experience dizziness, shortness of breath or fainting. An EKG will monitor your heart rate under everyday circumstances, and a stress test will determine the efficiency of your heart when it has to work harder, such as during exercise. Robert Kiser, M.D., and Tim Johnson, M.D., with Heart Center of the Rockies, are leaders in pacemaker placement in Colorado. Dr. Johnson says the advancements in pacemaker technology have revolutionized how cardiac patients are treated before and after surgery.

The most-basic purpose of a pacemaker is to monitor and correct the heart’s electrical rhythm. When a pacemaker fails to detect a heartbeat within a normal beat-to-beat time period, it will send the ventricle of the heart a low voltage pulse. A single-chamber pacemaker is only one lead, placed into the atrium or ventricle of the heart. A dual chamber pacemaker is placed in two chambers of the heart – one paces an atrium and one a ventricle. This electronic stimulation is closest to the heart’s natural interaction between the two chambers. The procedure to place a pacemaker is relatively non-invasive. A lead is placed through the subclavian vein allowing the pacemaker wires to be guided up to the heart. The tip of the lead automatically attaches to the heart muscle. The other end of the lead is attached to the pulse generator, which is placed under the skin. At this point, both wires are working together to keep the heart in sync. This procedure is usually done in the electrophysiology lab, under conscious sedation and the patient is able to go home that day. There are different kinds of pacemakers. A rate-responsive pacemaker will detect changes in physical activity and automatically adjust to accommodate a faster heart rate, allowing patients to continue their active lifestyles. People in a more progressed state of heart failure will benefit from a biventricular defibrillator. Candidates for this type of pacemaker are those who have moderate to severe heart failure symptoms and have been taking heart medications to treat this failure.

A biventricular defibrillator consists of three different wires, one in the right atrium, the right ventrical and the coronary sinus vein. This vein is responsible for draining blood from the heart tissue back into the circulatory system. A biventricular defibrillator monitors heart rate activity but can also detect when a patient is in cardiac arrest. The computer will send a highenergy shock to the heart and ensure the heart is beating properly again. This shock is about 90 percent less than external defibrillator paddles, since the current is being sent directly to the heart muscle. Dr. Johnson says that patients will sometimes come into the office feeling a little groggy and complaining of horrible nightmares the night before. When the doctor checks the monitor, he can determine that the reason for grogginess and bad dreams is because they actually went into cardiac arrest while they were sleeping and the defibrillator started their heart again. The heart, like any muscle in the body, wants to be strong. In 20 percent of biventricular patients, the heart has returned back to normal function with the installation of the pacemaker. For patients whose next option was a heart transplant, this technology is revolutionary. For doctors who monitor those patients, it enables them to be one step ahead. When every beat counts, one step ahead can be life changing. While the heart is wired, the activity of the heart can be monitored wirelessly and transmitted to a company that monitors cardiac activity. This allows the cardiologist to possibly detect issues before a patient realizes there is anything wrong. A yellow

alert will inform the doctor’s office that a battery is low or that there is a non-threatening heart problem that needs follow-up. A red alert indicates a non-functional device or a life-threatening arrhythmia in which the doctor is paged and the patient is contacted immediately. In his five years of working with the defibrillator, Dr. Johnson has a handful of red pages. Perhaps the lack of emergency pages is because doctors are now able to detect a potential problem before it becomes serious. “Many times we see heart patients within 3 to 6 months,” says Dr. Johnson. “A lot can happen during that time. The heart is incredibly strong and the effects of heart failure can take a while to be physically felt. When a heart patient comes in feeling bad, it can be too late and require hospitalization. By monitoring activity, we can detect a problem, take non-invasive action such as adjusting a heart medication, and check in on the patient.” This new form of care reduces cost to the patient and the hospital and may allow the patient to live a normal, active life. The next step in electrophysiology science is to transmit pacemaker data to smart phones. Is there an app for that? Not yet, but perhaps very soon.

Heather Schichtel is a freelance writer and marketing professional living in Loveland. You can find her at her daily blog: www.samsmom-heathers. blogspot.com.

Medical

pvhs

Poudre Valley Medical Group:

Todayâ&#x20AC;&#x2122;s Healthcare by Heidi Kerr-Schlaefer

Like most things in Northern Colorado, healthcare has changed and adapted over the years in order to keep up with a growing and changing population. In 1925, a 40-bed hospital was built just outside of Fort Collins. The adjacent 40-acres of land was used to raise livestock and vegetables to feed the patients.

After WWII, the population of Fort Collins began to increase rapidly, and the hospital grew to 86 beds. By the 1960s, local voters approved the creation of the Poudre Valley Hospital District. Major reorganization took place in the early 90s and a new not-forprofit, charitable corporation, Poudre Valley Health Care Inc. – doing business as Poudre Valley Health System (PVHS) – took over operation of the hospital. The formation of PVHS created an opportunity for growth, and by the mid-90s, the group had opened Heart Center of the Rockies, Regional Neurosciences Center and the Regional Orthopedic Center. In 1997, Poudre Valley Hospital received a Level II designation by the State of Colorado as a regional provider and resource for trauma-related injuries. Today, PVHS oversees two hospitals; Poudre Valley Hospital in Fort Collins has 281 beds, and is now a Level III trauma center, and Medical Center of the Rockies in Loveland is a 136-bed hospital, Level II trauma center. PVHS also operates Harmony Campus and multiple clinics. As history has proven, healthcare is never stagnant and change is inevitable, as providers and hospitals work to adjust to fluctuations in population size and demographics as well as outside influences like healthcare reform. The most recent addition to PVHS is the Poudre Valley Medical Group (PVMG) formed approximately 19 months ago. Discussions around forming a medical group were based on several pressing issues. The first was simply mechanics, and the second was impending healthcare reform. Without a strong sense of

what will happen over the next eight years of implementation of reform, groups such as PVMG are working to create a model that will enable them to be a viable healthcare system once the reform starts to take shape.

However, downgrading the level of service the people of Northern Colorado had come to expect was not acceptable to PVHS. A Level II hospital needs around the clock coverage by physicians, and a Level III facility needs a 20-minute response time by physicians. This means multiple physicians had to be on call to cover those facilities at all times. ”It’s puts a tremendous strain on an independent physician’s practice to try to work with us to be able to maintain that level of coverage,” says William A. Neff, M.D., CEO and vice president of PVHS and board member of PVMG. Dr. Neff explains that today’s doctor expects to have a life outside the hospital and office – gone are the days of the workaholic doctor who never sees his or her family. Having a multi-specialty medical group would help maintain a certain level of service without the doctors spending every waking hour on call. Once the trauma group was formed, PVHS realized this type of group formation and integration wasn’t going to stop with just one particular service. Nationally, multi-specialty groups had been forming all over the country, in response to the growing gap between some services and what could be generated with reimbursements to cover the service. “That’s when we realized we were going to have to have a formalized medical group,” says Dr. Neff.

The Mechanics of Coverage With a Level II and Level III trauma center up and running in the region, the strain on physicians to cover these facilities was great.

The Formation of PVMG One of the big groups that joined PVMG early on was cardiology. This is a service critical to the region, and with the changing

William A. Neff, M.D., CEO and vice president of Poudre Valley Health System and Poudre Valley Medical Group board member

CONTINUED ON PAGE 60 Poudre Valley Medical Group stretches beyond Northern Colorado. This map gives an overview of the many communities that PVMG now services in Colorado, Wyoming and Nebraska.

The Doctors of PVMG Meet

Meet

As a relative newcomer to Colorado, Nicola D. Demacopoulos, M.D., splits his time between Greeley Medical Clinic and Poudre Valley Internists. Internal medicine is primarily geared to adults and the elderly, as opposed to a family practice that sees younger patients and children. “People often think ‘internists’ sounds like we are operating on organs and such,” says Dr. Demacopoulos. “Basically, it’s just adult care of common medical disease such as diabetes, hypertension, heart disease, cancer – that sort of thing.” Dr. Demacopoulos chose internal medicine because he enjoys the broad range of medical issues within the field, and he wanted to be able to build long-term relationships with patients. This is what made leaving his practice in Ohio so difficult. After 19 years as a sole practitioner, Dr. Demacopoulos and his family moved to Colorado in October of 2010. “Leaving was really hard. Believe me, it really was,” he says. “You get to know these people and become part of their family, and they sort of become part of your life. It was a tough thing to leave, but luckily there was a good group in town that I thought highly of that took over so everyone was at least hooked up with a doctor. But that was the tough part.” Dr. Demacopoulos focuses on prevention and management of disease. Many of his patients have multiple and complex issues, so he spends a lot of time coordinating care to insure his patients are getting the right tests, taking the right medications and seeing the right specialists. Most of us don’t look forward to going to the doctor, but Dr. Demacopoulos stresses the importance of having a personal doctor. “Make a relationship with a primary care doctor who you trust and they will lead you and keep you coordinated with the right people, the right care, the right testing and the right medication,” he says. “Maybe if you are young and healthy you don’t have to come in very often, but at least you have some place you can rely on.” Impressed with the overall health of Coloradans, Dr. Demacopoulos sees people here living healthy lifestyles and making good decisions about exercise and diet. “I think it’s the 300-some days of sunshine,” says Dr. Demacopoulos. “Everyone’s happy, everyone’s exercising, no one smokes and you don’t see the obesity that we see elsewhere. It’s a healthier set of people and a healthier mind set here.” As a newcomer to the area, Dr. Demacopoulos has wasted no time in trying out all the healthy activities available in Colorado. Skiing was a big draw for his family, and they were up on the slopes at least a dozen times over the winter and his family is looking forward to participating in lots of outdoor activities this summer.

The Heart Center of the Rockies (HCOR) has nearly 20 cardiologists, and Justin A. Strote, M.D., joined the group three years ago. Originally from the suburbs of Detroit, Dr. Strote attended medical school at the University of Michigan and did his internal medicine residency and cardiology and interventional cardiology fellowships at the University of Washington in Seattle. “We moved here to be closer to my wife’s family, but it was also a great job opportunity at HCOR,” says Dr. Strote. “I was happy about the opportunity and about the HCOR affiliation with PVHS because they are a forward-thinking health system.” Dr. Strote practices interventional cardiology. He sees patients with all types of cardiovascular problems, and performs stenting, angioplasty and other cardiac intervention procedures. The practice of cardiology appealed to Dr. Strote for several reasons. First, he was always interested in diseases of the heart. Second, while growing up, Dr. Strote was influenced by a family friend, a doctor, who had developed strong ties with his patients over time. Dr. Strote wanted to practice in a field where he could establish those same kinds of relationships with his patients. “I wanted to practice medicine in a field that allowed for longitudinal patient contact, meaning you see patients over time, and in cardiology you get to have that.” Dr. Strote likes being able to provide immediate fixes, as in the case of a heart attack, but he really enjoys providing long-term care for a patient and witnessing their progress back to health. He points to a recent example of an 80-year-old female patient who had a heart attack in March. After the heart attack, the pumping function of her heart was reduced, and she didn’t feel well. However, when she came back in mid-May, her pumping function had returned to normal and she was feeling good. “The patient interaction is why I think most of us do this,” says Dr. Strote. “It’s definitely the most satisfying part. It’s gratifying to see a patient that you’ve treated get better from whatever illness they have.” Dr. Strote’s healthy living tip is moderation. He advises getting regular exercise, eating a Mediterranean diet including fish and grains, and managing stress. “Everything in moderation,” he says. “With the exception of smoking; that’s never acceptable.” When he is not in the office or at the hospital, you’ll find Dr. Strote and his wife enjoying all of the activities Colorado has to offer such as biking and skiing. However, most of their time is spent playing with their two young children.

Lawrence A. Meredith, M.D., is a neurologist who recently joined Neurology Associates of Northern Colorado, moving to the PVHS Medical Center of the Rockies campus in May 2011. Doctors who work in the field of neurology primarily see patients with issues such as stroke, multiple sclerosis, epilepsy, migraine headaches and peripheral nerve problems. In short, neurologists focus on the medical aspects of the brain, spinal cord and peripheral nerves. Dr. Meredith was interested in brain science long before he attended medical school. As a young man, he wanted to be involved in medical research and academic medicine. However, while attending the Brain Research Institute at the University of California, Los Angeles, he made the decision to go to medical school. Behavioral neurology is his specialty, and this involves cognitive problems, dementia, high cortical function and language. According to Dr. Meredith, behavioral neurology is not psychiatry, but is “next door to psychiatry in some ways.” Dr. Meredith got his first taste of Rocky Mountain living when he won an international science fair in middle school, traveling from his home in California to Colorado to participate in the event. “I had very good memories of that experience,” he says. He was accepted to do his residency at the University of Colorado. He returns to the university once a month to teach as a volunteer associate clinical professor at the School of Medicine in the behavioral neurology department. While Dr. Meredith is intrigued by the science of the brain, the most enjoyable experience of practicing medicine is the relationships he builds with his patients. He admits neurology is sometimes ambiguous and believes in expressing things accurately to a patient without sugarcoating the truth. “It’s interesting being asked into people’s lives, into an otherwise private space,” he says. “People can really sense when you are connected with them, and when you are honest. They really appreciate that because they don’t always get that in the modern world or in modern medicine.” For Dr. Meredith, healthy living starts with physical activity. He points to recent studies showing cardiovascular health to be partially protective against certain types of dementia. “But that’s doctor talk,” says Dr. Meredith. “I think people just feel better when they move through the day in a fluid, healthy way. I’m a big believer in yoga and aerobic exercise, and doing things that get you outdoors.” In his off time, Dr. Meredith enjoys having adventures with his adult son. He relaxes by playing guitar, harmonica, writing music and performing. Dr. Meredith also competes in ultra trail marathons.

Dr. Nicola D. Demacouplos

Northern Colorado Medical & Wellness 2011

Dr. Justin A. Strote

Dr. Lawrence A. Meredith

The Doctors of PVMG Meet

Meet

Dr. Hans C. Coester

Dr. Cynthia L. Goacher

Dr. Joshua H. Petit

Originally from Iowa, Hans C. Coester, M.D., FACS, went to medical school at the University of Iowa and received his neurological surgery training at the University of Michigan. He has been practicing medicine in the Fort Collins area since 1992. Dr. Coester is part of Poudre Valley Medical Group Brain and Spine Surgery located in the Westbridge Medical Suites in Fort Collins, across the street from Poudre Valley Hospital. The group became official on January 3, 2011. As a Diplomate of the American Board of Neurological Surgery, Dr. Coester is certified by the governing board of neurological surgery. To become certified, he had to complete an approved residency program and pass both a written and board exam. Neurological surgery involves the treatment of structural problems of the brain, spine and, to some degree, peripheral nerves. “For the most part we treat things that you can see on a picture,” says Dr. Coester. “Meaning, if you are having pain or weakness or loss of function and your evaluation turns up a structural lesion that explains the problem, then a neurological surgeon can often help with that problem.” Dr. Coester didn’t always want to be a doctor. In fact, when he was a boy he wanted to be a forest ranger or to do some other job allowing him to work outdoors. Despite this boyhood dream, after two years of college he made the decision to go into medicine. “I really enjoy the challenge of finding problems that can be potentially fixed, and I really enjoy seeing patients feel better.” Predominantly a spine and trauma surgeon, Dr. Coester also does some brain tumor work. Patients most commonly come to him suffering from neck and arm pain, or back and leg pain, sometimes with weakness and trouble functioning. “Most of the problems that contemporary spine surgeons treat would be considered to be degenerative problems,” he explains. “Some of them are exacerbated by trauma.” A herniated disc, for example, may be caused from degeneration of a disc over time. The disc comes out of place and pinches a nerve, causing weakness and pain. The other frequent spine issue Dr. Coester treats is stenosis. This is a narrowing of the spinal canal of the lumber region that occurs because of long-term wear and tear. Dr. Coester comes into the picture when conservative care options, such as steroid shots, therapy and exercise have not corrected the problem. Dr. Coester’s healthy living tip is exercise, and he recommends at least a half an hour of low impact aerobic exercise three times a week. He also advises forming good nutritional habits and to stop, or never start, smoking. With a wife, two children and three dogs, Dr. Coester’s off time involves spending quality time with his family.

Most doctors have had a rather conventional path to medicine, but Cynthia “Lee” Goacher, M.D., took a road much less traveled. Dr. Goacher grew up in Kansas and attended college there, obtaining a degree in chemistry and music. She went on to play jazz saxophone and teach special education in the Cincinnati area. At the age of 31, with a husband and two small children, she made the decision to go to medical school at the University of Cincinnati. She chose family medicine because she wanted to take care of patients, and today, as the medical director at Loveland Urgent Care & Family practice, Dr. Goacher spends her days doing just that. She and her husband moved to Colorado in 1995, and Dr. Goacher worked as a primary care doctor in Berthoud until 2000. She then worked emergency rooms in Pueblo and Walsenburg for nearly another decade before making her way to Loveland Urgent Care & Family Practice two years ago. Family medicine is primary care for the entire family, including overall care and preventative medicine. Dr. Goacher spends most of her time in urgent care. Today, urgent care treats many of the same patients who go to family medicine doctors, but often treats more acute problems such as diabetes, hypertension and traumas including fractures, cuts and lacerations. “We’re finding also that in urgent care we need to recognize serious conditions so we can treat and stabilize emergency conditions and send them to the ER,” says Dr. Goacher. “Urgent care is interesting. It’s sort of a hybrid in between family medicine and the ER.” Urgent care allows Dr. Goacher to practice on a daily basis what she most enjoys about medicine – the challenge of diagnosis and the ever-changing environment of the practice of medicine. While she appreciates the challenges, Dr. Goacher points out that the treatment and care of patients is why she went into medicine and her patients are always number one. While urgent care doesn’t allow for the same type of patient continuity as family practice, Dr. Goacher does keep in contact with her patients’ primary care doctors. Really getting to know a patient, she says, can sometimes be quite helpful in making a diagnosis – just as helpful as lab work or other tests. Like many of the doctors Style interviewed for this piece, Dr. Goacher’s healthy living tip is everything in moderation, but she adds something important. “We need to have more fun,” she says. “We’ve missed that piece of healthy living.” Dr. Goacher strives to practice what she preaches by making the most of life in her time off. She likes swimming, bike riding, yard work, music and taking care of her many rescue animals.

Joshua H. Petit, M.D. is the medical director of Radiation Oncology at PVHS. Dr. Petit treats all types of cancer by using focused radiation or inserting radiation to kill tumors. “I try to treat every patient like they are my family member, so I never ever cut corners, and I try to apply everything I know and put everything I have into the patients I see,” says Dr. Petit. Medicine involves problem solving, and this is an area in which Dr. Petit has always excelled. After graduating at the top of his class from the University of Maryland medical school, Dr. Petit went on to specialize in radiation oncology at Harvard. Oncology was always his field of choice; there was never any question that he wanted to treat cancer patients. “I think cancer is the premiere health problem that will face my generation of doctors,” he says. “I don’t think there is anybody who isn’t touched by cancer, so that definitely appealed to me.” Hailing from the suburbs of Washington, D.C., Dr. Petit originally worked on the East Coast, but it became important for his wife and him to find the right place to raise their family. Two years ago, they fulfilled a lifelong dream by moving to Colorado, and in August of 2010, Dr. Petit joined PVMG. “I saw my future with PVH because I really like what they do with the system; I like their investment in the cancer program and how they interact with doctors and staff and frankly, I like that they care about having high quality medicine more than anything else,” he says. The Department of Radiation Oncology is located at the PVHS Harmony Campus and is a key part of the cancer treatment services at Poudre Valley Cancer Network. This network of clinics, located throughout Northern Colorado, offers a multidisciplinary approach to care with specialties in medical oncology, surgery, radiation therapy, radiology, pathology, nursing and patient navigation. “We are fortunate to have a group of people who have gone into oncology for the right reason, because they want to give of themselves,” says Dr. Petit. “The staff here is tremendous and they really enhance the patients’ experience.” While many people assume the practice of oncology would be difficult, Dr. Petit says he focuses on success. He enjoys establishing relationships with his patients, identifying what success means for each individual and then working towards achieving that goal. “Every single patient who walks in the door here has the potential for a good outcome, and we just have to figure out how to do it,” he says. Dr. Petit believes most people need to make their health a bigger priority. He stresses that many people don’t think about their health until they get sick. The key, he says, is to realize that there’s nothing more important in life than your health.

CONTINUED FROM PAGE 56

reimbursement model, it was becoming burdensome to put the weight of coverage on the independent practice model. Before January 2009, over 90 percent of doctors in Northern Colorado were in classic, community-based, independent practices. According to Dr. Neff, “Last year was the first time that over 50 percent of the physicians in practice in the United States were actually integrated into a health system. So last year sort of represented the 50 percent tipping point between the independent and integrated model.” Today, over 75 percent of Northern Colorado doctors are still in independent practices, but Dr. Neff predicts that within three to four years there will likely be a 50-50 split between PVMG and independents. Dr. Neff also stresses that it is becoming more difficult for the classic, independent model, like primary care physicians, to do business because of the overhead due to shrinking reimbursements for work performed. “By forming the medical group, we now have a model to be able to make those practices viable in the community,” he explains. “Some of it is economy of scale, and some of it is the ability to get treatment truly integrated so we can share data and information for things like cardiac care. It also enables us to line up our strategies so that we’re both running in the same direction and we’re not working against each other or repeating effort.” A large part of this involves electronic information systems, and even prior to the formation of PVMG, PVHS has been working to connect physicians across Northern Colorado via a common electronic health record platform. Having a common technological infrastructure across the region provides for continuity of care, which ultimately results in better health outcomes, and this will be crucial as healthcare reform unfolds over the next decade. Physicians Lead the Way While the formation of PVMG has been relatively swift – they’ve gone from 0 to over 100 providers in about a 12-month period – Dr. Neff believes the strong relationships between the physicians and the health system administration has helped this integrated model evolve so quickly. It’s those relationships that PVMG wants to continue to foster by putting the physicians in leadership roles within the organization. PVMG has put together an infrastructure where physicians will be making the decisions based on their clinical experience. The group realized early on that if they did not utilize the expertise of the physicians, they would be losing a valuable resource. This is one reason why PVMG calls their model “integrated” rather than just an employment model. “We want to find good physicians and put them in leadership positions,” says Dr. Neff. “We really think that is what’s going to succeed going forward – there’s got to be a total blurring of the lines between what was the hospital and what were the individual

physician practices. We really think that a successful model is going to have physicians leading the charge.” The Role of Joint Operating Committees Each clinic that comes under the PVMG umbrella is called a joint operating committee, or JOC. With many area clinics having a long, rich history, PVMG has worked with the JOC administrators to create a smooth integration, drawing from what they see as the greatest well of knowledge, people who have been running clinics for 10 or even 20 years. In the future, Dr. Neff expects to see horizontal integration, meaning the various internal medicine groups around Northern Colorado will integrate to form an internal medicine JOC. With all of these JOCs under the PVMG integrated model, the organization will be a multi-specialty group able to provide many services to the community with continuity of care. Dr. Neff realizes the tremendous impact this sort of change has on a region, both the clinics and physicians, as well as the overall healthcare system. “You want to push for change in this kind of market, with reform and everything else that is happening, but you can’t push it so fast that it crashes the system.” What it Means for You With a service area of approximately 50,000 square miles, having an integrated healthcare model will maintain continuity throughout the region. As previously discussed, an integrated group such as PVMG assures the level of care in the region will not go down due to problems of coverage and reimbursement issues. In fact it will do just the opposite, because a highly coordinated infrastructure allows for specialized services to more easily come into a market such as Fort Collins, increasing the level of care available to the area. High quality healthcare is top of mind for PVHS, PVMG and the individual physicians within the system. Nicola Demacouplos, M.D., an internist with PVGM, has been pleased with what he has witnesses in his nine months in the area. “I’ve been very pleased with the quality of the medical care in general here in Northern Colorado,” says Dr. Demacouplos. “There are tremendously high levels of specialists to work with and a high level of resources available here. For a medium sized community there’s a lot of good medical care available.” To see the complete list of Poudre Valley Health System and Poudre Valley Medical Group clinics and their specialties, go to www. pvhs.org, search under the tab “Hospitals & Clinic,” then “Medical Clinics” and then “PVGM and PVHS By Medical Specialty.” 

Heidi Kerr-Schlaefer is a journalist and freelance writer from Northern Colorado. She is also the Mayor of HeidiTown.com, a blog about Colorado events and festivals.

Northern Colorado Medical & Wellness 2011

medical

robotic surgery

Dr. Warren James performs a robotic hysterectomy with his team in 2010. Dr. James helped to pioneer the field of robotic gynecological surgeries.

Benefits of

Robotic Hysterectomies The idea of robots in an operating room may dredge up old science fiction movie plots where strangely moving metal creatures begin to take over the earth and humankind struggles to subdue and dismantle the evil machines. Nothing, of course, could be farther from the truth. Robotics have become an important part of many aspects of business and, within the medical profession, the use of robotics is growing. 62

by Kay Rios

One area in particular is in the field of gynecology, where robotics are being used to treat a number of different conditions. Warren James, M.D., at The Women’s Clinic of Northern Colorado, pioneered the use of robotics in Fort Collins and has completed over 500 hysterectomies with the use of this amazing technology. “The number one advantage is that you can convert cases that would otherwise require big incisions into a minimally invasive procedure,” says Dr. James. “It is far superior to the laparoscopic method.” While the laparoscopic method is also less invasive than an open abdomen procedure, he says the robot offers significant

Poudre Valley Health Services’ Rocky Mountain Robotics Institute uses the da Vinci Surgical System robot, who doctors have affectionately named “Mona.”

The four tiny incisions made during robotic hysterectomy surgeries greatly reduce blood loss and recovery time.

advantages over what he calls the “straight stick” of conventional laparoscopy. The robot is the da Vinci Surgical System, which combines 3-D high definition vision, patented EndoWrist instruments and Intuitive motion that allows precision, visualization, dexterity and control. This system increases the surgeon’s ability in several ways, Dr. James says. “You also get magnification with the robot. Your field of vision is increased because it’s three-dimensional as opposed to two-dimensional.” In addition, “robotics have seven degrees of motion. Whatever I can do with my hand I can do with the robot. I control the camera as opposed to laparoscopic where someone else controls the camera.” The surgeon sits at a console away from the patient, manipulating the robot’s arms and instruments from a distance, using both his hands and his feet to work the various controls. “It’s a lot like playing an organ,” Dr. James says. Advantages to the patient are also great. “As a general rule, it’s a quicker recovery,” he

Northern Colorado Medical & Wellness 2011

Precision, visualization, dexterity and control are the hallmarks of robotic surgery, and Dr. James has completed over 500 hysterectomies at Poudre Valley Health System’s Rocky Mountain Robotics Institute.

says. “You’re taking a surgical procedure that could take three to five days in the hospital and turning it into an overnight stay because the patient is healing from puncture wounds instead of a big incision.” Darla Woodman, RN and GYN educator for the operating room at the Women’s Clinic, provides specifics. “There are two 12 millimeter punctures and two 8 millimeter punctures.” The punctures are for the ports: one for the camera, two for the arms/scopes and the fourth is for an assistant to do retraction and irrigation. “Because there are fewer people near the patient, there’s less risk of infection. And with the smaller incisions, recovery is faster,” she says. “There’s a slight [upfront] increase in cost to use robotics but there’s less time in the hospital so, in the long run, it’s less expensive.” There are additional benefits to the surgeon, Woodman says. “He can see much better from the console than standing over the patient. Ergonomics are better, too, because he’s sitting rather than standing and bending.” The procedure also takes less time. “We can turn the room in as little as 13 minutes. Typical time is 20 minutes.”

Woodman is part of the robotics team and has been working with Dr. James and the robot – they call it Mona – for several years. “Our team has been doing this longer than some of the surgeons have been doing robotics. We’ve all had extensive training. Dr. James is insistent about that.” Dr. James is also insistent about who should and should not have a robotic hysterectomy. “First, the patient has to have a disease process that requires a surgical intervention. Second, I look at every patient and if I can do the surgery vaginally, I will still do that care vaginally. This is not designed to take what I consider a minimally invasive procedure and just convert it to robotics. But the patients that are referred to me are usually not candidates for a vaginal procedure and that means there would be an abdominal opening. I explain all the options to the patient and some may not even be surgical. Maybe radiologic is a better option. I explain all of that and also that I can do it as open incision or robotic.” The use of robotics in medicine has been growing since its introduction just over a decade ago. It was in 1999, when Intuitive Surgical

introduced the first da Vinci, that surgical robotics became more than a medical curiosity. Since that time, robotics effectiveness has been supported by over 3,000 peer-reviewed studies. For Dr. James, it was an instant connection. “I‘ve always had a strong interest in minimally invasive surgery. At the time the Medical Center of the Rockies was on the drawing board, we had the groundbreaking ceremony and there was a mobile robotics unit there. I was exceptionally impressed with the options it afforded.” The actual history of the robot began long before that, he says. “It started with the Korean War when there was an effort to develop an operating theater in the battlefield that could be manipulated from somewhere else. It was later taken over by NASA with the thought that we could have a surgeon on earth and one on a station that could work together.” It didn’t quite happen, he says, but the thought was there. “Then a Stanford group took over that idea and developed what we have today.” Dr. James jumped in, receiving robotic training, and the field began to open up. In 2004, Poudre Valley Hospital was the first in Colorado to launch robotic surgery in gynecology. More

John James, M.D.

FORT COLLINS

1136 E. Stuart St., Bldg. 3, Suite 3200 Ft. Collins, CO 80525 (970) 221-1681 Dr. James began his robotic training in 2004, and Poudre Valley Hospital was the first hospital in Colorado to launch a robotics gynecology program.

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Warren James, M.D., The Women’s Clinic of Northern Colorado

than 2,000 robotic-assisted surgeries have since been performed through the Poudre Valley Health System, more than any program in Colorado. The possibilities are far reaching. Ear, nose and throat doctors are starting to use it, and the neurological possibilities are being explored, Dr. James says. He also sees the possibility for long-distance procedures. “I could sit in this operating room in Fort Collins and, up in Estes, they would hook-up the ports and I could do the surgery up there. You have to have someone on site who can open the ports and you have to have a surgeon there who can take care of complications. At this point, it’s not highly practical, but the technology is there.”

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

Northern Colorado Medical & Wellness 2011

Robotic Thoracic Surgeries:

The Next Frontier by Angeline Grenz

The future is being shaped in Northern Colorado. Michael Stanton, M.D., is the artist, but clay is not his tool. He is using a $1.5 million hunk of highly technical metal and plastic: the da Vinci Surgical System, or in lay terms “the robot,” at Poudre Valley Health System’s (PVHS) Rocky Mountain Robotics Institute.

What Dr. Stanton is doing with the robot is truly remarkable: he is in the midst of perfecting surgical lung and heart techniques that will shape how future robotic surgeries are done. “No one else in the state, to my knowledge, is doing robotic lung surgeries.” Dr. Stanton is perfecting techniques for removing tumors from the lungs, repairing an aneurism in the lung, removing entire lungs, and heart procedures such as repairing aortic aneurisms, repairing blood vessels, removing tumors around the heart or in the abdomen that have spread to the chest, and other heart-related procedures. Though robotic techniques have taken off in the last several years, “there is not a whole lot of literature on how to use the robot for lung surgery,” says Dr. Stanton. In the past 4 to 5 years he has been working through the Robotics Institute to develop these techniques, using cadavers to perfect the surgeries. Dr. Stanton trains with his team of robotic experts: nurses, physicians, physicians’ assistants and other specialists. Robotic surgeries of this type typically take longer and are much more tedious than traditional open surgeries. Additionally, “there is a long learning curve for robotic surgeries,” says Dr. Stanton. A natural aptitude in necessary: “You have to have very good 3-D perception and be able to manipulate the robotic arms working through a very small hole. Good hand-eye coordination is necessary. Some do it well, others are not as good at it.” But the benefits are significant: smaller incisions, less blood loss, shorter hospital stays, decreased risk of infection and less anesthesia and pain. Patients overall experience a shorter recovery time, return to work earlier and often have no lifting restrictions. Robotic surgical techniques take time to perfect because of the scope of surgery. Magnification of the surgical site is significant – doctors cannot see the entire surgical site at one time on the monitors, only a couple inches per screen. This requires them to operate slowly, using instruments that are a mere one-third-inch long, taking special care when working around blood vessels, says Dr.

Stanton. Doctors cannot “feel” the surgery in the same manner as a traditional surgery. “You have to see what you are doing.” The da Vinci system is in its third generation, and robotic surgeries have the added challenge of developing instrument software to match a doctor’s skill. “Sometimes, we have to wait for technology to catch up with our ideas,” says Dr. Stanton. Dr. Stanton expects trials to take another six months before techniques are perfected and approved for surgeries at PVHS’ Robotics Institute. “We are at the point with our lung procedures that we are working on speeding up the process, which is a matter of doing the procedure repetitively.” Dr. Stanton was introduced to robotic surgeries five years ago in Chicago at a surgical conference. “When I saw how flexible and better for the patient it was, even though it was more tedious and it takes a while to develop technique, I was hooked.” Robotic surgeries are not appropriate for every patient, however. “Sometimes it is just as easy to operate with a scope,” he says. “You have to weigh what is needed to decide when robotic surgery is appropriate. If it is a simple surgery, a scope if fine. But often, if the surgery is complex, robotic surgery may be the better choice.” Today, Dr. Stanton has performed over 200 robotic surgeries and is requested frequently by the developers of the da Vinci robot to travel internationally to train other doctors on his techniques using the robot. He travels as often as his schedule permits, but he must balance travel with a busy workload: in addition to his own practice, Dr. Stanton is on call 14 times a month at Medical Center of the Rockies (MCR) for cardiac surgeries and to cover the emergency room. Of the 300 heart surgeries performed at MCR each year, currently 15 to 20 are candidates for robotic surgery. Dr. Stanton estimates that with the development of new procedures, that number will double. “It is an absolutely exciting field of medicine,” he says. “And I am excited to help develop techniques that doctors will use in the future.” Angeline Grenz is editor for Northern Colorado Medical & Wellness Magazine.

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Wellness

management

Sandy Stewart must contend daily with the health difficulties that come with hypertension, rheumatoid arthritis and diabetes.

Chronic Disease

Management Class by Marty Metzger

Chronic disease can erode a person’s physical, mental, emotional and spiritual health. In a perfect world, modern healthcare in America should couple with time-proven reliefs and wisdom to provide optimum well being. 74

But, access to the best of both those worlds is often blocked by the complexity of medical and insurance mega-systems. Traversing that rugged terrain can prove as discouraging and unsteadying as the disease’s assaults. Thanks to the recent formulation of a chronic disease management program at Poudre Valley Hospital, navigating the system is becoming easier for patients who must deal with the daily care needed to manage chronic diseases such as cardiac problems, diabetes, rheumatoid arthritis and others. The program’s goals are to lower re-admissions for same patient/same problem; to streamline electronic health records, thereby improving communication between a patient’s various healthcare providers; and to empower a person in their own medical management. Chronic disease management is referred to as “patient-centered medical home,” explains Sukhi Khera, M.D. As a specialist treating congestive heart disease, Dr. Khera works as a physician advisor for the program. She helps transition patients from in-patient to out-patient selfmanagement through education. A parallel PVH case management program assists patients with in-home proper medication usage. Dieticians, therapists, emergency medical technicians and other providers work with the primary care physician, rather than as separate entities, going in separate directions. Under the auspices of PVH’s program is an education course called “Living Well with Chronic Conditions.” The six-week program is managed by Community Health Education Coordinator Susan Milligan, R.N., M.S.N. Milligan, who’s taught the classes at PVH since 2003, says that 95 percent of participants have more than one chronic condition. Most commonly seen are arthritis (more than 100 types), hypertension, various cardiac ailments and depression. One-third of class-goers have, or had, cancer. The program is not disease-specific, but rather focuses on empowering people to build selfconfidence by providing the tools necessary to manage conditions and lead a top-quality lifestyle. Each participant sets individual goals broken down into smaller, attainable steps, announces the goal to the class and reports back the following week on progress. During the interim, an assigned buddy calls to offer moral support. Milligan attributes the program’s success to individual accountability, a non-judgmental class atmosphere and a mutual concern among participants. The program, free to the public, is divided into six weekly two-and-a-half hour sessions. Milligan notes that the course’s history dates back to December 1990 at Stanford University. Since then, it’s become the gold standard for chronic disease management and is offered worldwide, says Milligan. Recognizing its value in healthcare, the federal government offers a grant to provide the program. Chronic illness symptoms often perpetuate themselves. But pain, fatigue, depression and shortness of breath can be lessened with exercise, breathing techniques and the mind/body methods taught. Says Milligan, “The classes teach people to manage a condition so it doesn’t manage them.” She notes that healthcare reform further drives

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by occasional visits from local health aides and a physician’s assistant. Prescriptions had to be filled in Nome and flown in. Serious ailments were likewise treated there – after a 100-mile flight from the outlying village. Once back home in Fort Collins, Stewart read a newspaper ad for PVH’s class and thought, “Sounds like exactly what I need!” And it was. She took the course in October 2010, with great results. “It motivated me off the couch and gave me confidence,” Stewart says. “I lost weight, learned goal setting and became answerable for my goals. The classes gave me good techniques, like how to fall back to sleep after waking during the night. It was so inspiring.” She learned about nutrition and choosing healthy substitutes. Social workers, exercise trainers and dieticians helped her set specific and realistic goals. The course taught her to not beat up on herself. “If you have a bad day, there’s still tomorrow,” Stewart learned. ▲ Susan Milligan, R.N., teaches Poudre Valley Hospital’s Living Well with Chronic Conditions class, a free, six-week program offered to the community.

▲

Sandy Stewart credits this chronic disease program with helping her take charge of her life. Stewart, 67, recently participated in her first triathlon.

the need to better manage chronic disease. “We need to simultaneously save money and improve the quality of health in this country.” Available dollars are better spent, believes Milligan, to get at-risk people turned around instead of allowing a disease process to advance with status quo treatment. “The program offers tips on getting more out of each doctor visit,” she says. “It works on attitude, a huge factor. Negative self-talk can become ingrained in the mind.” Milligan further states that the classes teach each participant to view their doctor as a partner. “People try things they don’t want to do simply because the provider says to. There’s a shift toward patient-centered care,” she points out. “Our program gives people tools to better listen to, and communicate with, their doctors.” These techniques save time for both patient and provider, while maximizing treatment effectiveness. And because progress is incremental, Milligan has even had refrigerator magnets made for class-goers. “How do you eat an elephant?” the magnet questions. Answer: “One bite at a time.” Some people find the classes so beneficial that they take them more than once. In fact, Milligan believes that anyone can profit from them, not just those with chronic conditions. “It’s like a life management class,” she states. One person who heartily agrees is Sandy Stewart. The retired, previously overweight teacher suffered from hypertension, rheumatoid arthritis and diabetes. She had most recently taught school in a remote, northern Alaska Eskimo village. The only access was by air, as there were no roads. Since there were also no nearby doctors or dentists, only basic healthcare was administered

On May 28, the 67-year-old competed in the Pelican Fest Triathlon in Windsor, her first ever athletic event. “Imagine doing a triathlon at my age!” Stewart proclaims. “I feel that I’m definitely healthier than I was a year ago. My doctor said I’m now going in the right direction. That class really jump-started the rest of my life.” She isn’t done with the course, though, because she will soon become one of its facilitators, who assist Milligan teach the classes. All facilitators either have, or care for someone with, a chronic condition. Call to get more information on the “Living Well with Chronic Conditions” class schedule from the Aspen Club, (970) 495-8560, or go online at www.pvhs.org/enhancewellness and learn to eat that elephant, one bite at a time. Marty Metzger, who lives in Fort Collins, has worked as a freelance writer for 23 years.

Northern Colorado Medical & Wellness 2011

WELLNESS

lifestyle

Fitness supervisor Ryan Donovan monitors a patient while she works out at Poudre Valley Medical Fitness at Marina Health Campus of Water Valley in Windsor.

Conditioning Programs

Aid Lifestyle Changes The Medical Fitness Model raises the bar for the health and fitness industry. This comprehensive model incorporates active medical oversight, credentialed staff, disease management and clinical integration of programs. It also stipulates the use of an individual’s personal health status for creating an exercise prescription and goes on to provide a larger view that focuses on improving community health over all. 78

by Kay Rios

Poudre Valley Health System’s (PVHS) conditioning programs are based on that model, says Ryan Donovan, fitness supervisor for PVHS’ Poudre Valley Medical Fitness at Marina Health Campus of Water Valley in Windsor. “We are a medical fitness center and there’s a big difference between that and general fitness centers.” First, he says, medical oversight is provided by Patrick Green, M.D., who is a cardiologist with Heart Center of the Rockies (HCOR). “We also have a medical advisory board of physicians and healthcare professionals that guides everything done at the Center. Second, we have the

services of a clinical program, and we integrate people into a fitness center setting and it’s all in one building.” Donovan says this helps clients incorporate the idea of fitness into their ongoing lives instead of ending with therapy. Third, staffing is different than a fitness center, he says. “All of our fitness staff must have at least a four year degree in health and exercise science. Many of our staff are also nationally certified by reputable organizations. We know that every one of our employees that works with members has a sound understanding of the science of exercise.” And, fourth, Donovan says, “We offer individual attention and follow up.” PVHS offers its conditioning programs in several locations, and you don’t have to have a current health condition to take advantage. The programs operate on several levels, explains Suza Ault, nurse manager for Cardiopulmonary Rehabilitation at Medical Center of the Rockies (MCR). “We have both in-patient and out-patient cardio and pulmonary rehab. Phase One happens during in-patient stays, post op for open heart surgery, bypass, heart attacks, stints and angioplasty. This begins from day one. Phase Two is for out-patients who come to us and that can last anywhere from one to four weeks.” Gail Aaronson, nurse manager at HCOR at PVHS’ Harmony Campus, adds, “Phase Three draws people who are not covered under insurance or their co-pays may be high but they still need to be in a supervised program. And we keep it affordable.” “A lot of people in conditioning are coming from Phase Two,” she adds. “They like the environment and they like the group exercise experience.” Clients don’t have to be physician referred. “We’re open and available to everyone,” Donovan says. “You don’t have to have a pre-existing condition. We want to keep people out of the hospital and we can help them even when they are not sick.” “We know that folks who participate and continue to do conditioning are seen less frequently by doctors and have fewer admissions,” Ault says. Conditioning programs are not new to PVHS. “Cardiac rehab started in 1978, and conditioning was added in 1997 when we realized there was this group of folks who hadn’t had an event yet but felt uncomfortable in a health club setting,” says Aaronson. “Cardiac rehab conditioning is more than going to a health club. An exercise therapist or exercise physiologist takes vitals before they get started. Then they do a group warm up and everyone has a workout sheet that tells them which machines to use. If they want to progress in other ways or change their program, they can sign up for a consultation at no extra charge.” The conditioning programs offer low-cost, supervised exercise classes to the community with the idea of providing opportunities for adults to make lifestyle changes that may lower their risk of developing cardiovascular disease. Education is an important component of the programs, Ault says. “Anyone in the conditioning program can attend our educational

Northern Colorado Medical & Wellness 2011

sessions for free. The classes are on a variety of topics including dietary, medications and stress management.” “Education is big for us,” Donovan confirms. “We want to help people prevent disease before it occurs whenever possible.” There’s more, Ault adds. “A social component develops along with a comfort level with the staff. Because of those things, we find that many people stay with it for a long period of time.” But, while the underlying philosophy and standards for excellence are the same, the programs vary in some ways from each other. For example, Ault says, “We do pulmonary rehab here [at MCR]. Gail’s program doesn’t offer pulmonary.” The Water Valley location’s physical look is also quite different from the other two and rivals any health club. It’s set in a large facility with 25,000 square feet reserved for the conditioning program, housing two floors of over 100 pieces of fitness equipment including free weights, weight machines, treadmills, elliptical machines, bicycles and a physical therapy area. There’s also a three-lane lap pool, a 92 degree therapy pool and a hot tub. But, Donovan clarifies, “We are not a recreation center. As an industry we want to provide a continuum of care and feel it’s better for the customer to have everything in one place.” As part of that care and complementary services, Twenty Three Trees Spa just opened in the building, as did the Blend, a specialty coffee shop. Doctors and other medical offices will be moving into the building later this year. MCR and the Harmony Campus programs also have plans for expansion in terms of programming. “We are looking to expand the opportunities for women who have heart disease,” Ault says. “Women present with a different set of symptoms and it would be nice to create a women’s group that offers education and conditioning.” “Overall, conditioning is becoming a trend with healthcare reform,” Aaronson says. “There will be more focus on preventative approaches and on how to keep healthy.” While memberships at the MCR and the Harmony Campus are month to month, the Water Valley facility requires a one year contract. For specific information, call the individual facilities: MCR Cardiac and Pulmonary Conditioning Program, (970) 624-1713; Harmony Campus Cardiac Conditioning Program, (970) 297-6553; Poudre Valley Medical Fitness in Windsor, (970) 674-6500.

Gail Aaronson, nurse manager at Heart Center of the Rockies, teaches a Qigong class. Participants perform the first movement Flying Cloud Hands.

Suza Ault, nurse manager for Cardiopulmonary Rehabilitation at Medical Center of the Rockies, monitors a patient’s heart rate while he walks on the treadmill.

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

Conditioning programs, such as those found at Poudre Valley Medical Fitness, Heart Center of the Rockies and Cardiopulmonary Rehabilitation, are the direction healthcare will head as preventative approaches become more important under healthcare reform.

Wellness

smoking cessation

Quit Until You Succeed If at first you don’t succeed… quit, quit again.

That’s the advice doctors and smoking-cessation counselors alike have for smokers. And the good news is, it’s working. According to a new survey by the Health District of Northern Larimer County, the percentage of cigarette smokers in northern Larimer County is down four percent from 2007 to 11.5 percent, barely more than half the national average. What’s more, Health District evaluation program coordinator Susan Hewitt points out, “Even if people don’t quit, most reduce the amount they smoke.” The percentage of smokers averaging more than 20 cigarettes a day is down from 31.3 percent in 2004 to 19.3 percent. Perhaps the most promising news is that the number of smokers 18-29 years old has dropped more than 40 percent from 2007. Kevin Felix, D.O., of Loveland Family Practice, explains the drop this way, “It’s less cool to smoke. Girls don’t want to date guys who smoke, whereas 20 years ago it was the reverse.” But teens are still susceptible. Peyton Taliaferro, M.D., of Poudre Valley Medical Group, says, “If you break the teen cycle of smoking, you’ll break

by Carl Simmons

the adults. Kids still want to be rebellious; they feel invincible. The ‘benefits’ of smoking happen right away. The results don’t show up until later.” And those results are often devastating. Aside from respiratory diseases such as lung cancer, emphysema and chronic bronchitis, smokers run four times the risk of stroke and account for more than 200,000 deaths related to heart disease each year, as well as more than 35,000 deaths by cancers other than lung cancer. “The first things I mention to patients are heart attack and stroke,” Dr. Felix says. “That tends to turn more people around because they always think ‘lung cancer.’ That might eventually happen, but they’re hurting their hearts right now. “People also don’t realize that smoking can lead to other cancers as well,” he continues. “Smoke is taken in through the lungs, but the nicotine goes into the bloodstream. Not everyone who smokes gets bladder cancer, but almost everyone who gets bladder cancer smokes.” Dr. Taliaferro also points out that smokers take an average of 12 years off their lives. “Some people point to a George Burns and say, ‘He smoked, and he lived to be 100.’ But not many people point to George Smith who died of lung cancer at 42. “The good news is, the day someone quits

smoking, that person’s health improves,” he continues. “However, it takes about a year to cut the risk of heart attack. That’s a huge reason to get people to quit now.” The effects of smoking aren’t just physical. There’s also increased expenses from medical costs and the purchase of cigarettes and lost productivity at work from sickness and cigarette breaks. Norma Pomerleau, counselor for the Health Center’s Step-Free Smoking Cessation Program, notes, “Once companies see how much money they lose in productivity and insurance costs, they realize the money they spend on smoking cessation programs is worth it.” Dr. Felix also mentions the effects of secondary smoke, and that children growing up in smokers’ homes are more likely to develop respiratory issues. He adds, “Smokers do have social lives, because they tend to cluster together, but because they smoke they also tend to restrict their social circles.” So the need for change is there. But change is work. “If you’re not motivated – if you haven’t made the step from ‘I know I should quit’ to ‘I want to quit’ – it won’t happen,” Dr. Taliaferro says. “My role as a family doctor is to get you motivated. Then you’re empowered to do something.” CONTINUED ON PAGE 104

Kevin Felix, M.D., Loveland Family Practice

Peyton Taliaferro, M.D., Poudre Valley Medical Group

Northern Colorado Medical & Wellness 2011

Rules

Made to be Broken There’s a lot of diet advice, and not all of it’s good. Here are some common diet tips you can safely ignore. by Audrey Springer

Improve

your run by Audrey Springer

Don’t eat late at night There are a few variations on this rule – such as don’t eat after 7 p.m., or don’t eat two hours before bed – all based on the thinking that calories consumed at night turn straight into fat. Fortunately, that’s wrong. Research shows that it doesn’t matter when you eat; your digestive system works the same way, night or day. And going to bed hungry can make it harder to go to sleep, leaving you with less energy to exercise or eat right the next day. You may also wake up ravenous and end up overeating at breakfast. Instead, listen to your body and eat when you’re hungry, whether it’s 1 p.m. or 1 a.m. However, this advice isn’t totally bunk from a health standpoint. Studies indicate that people who eat late at night tend to be overweight or obese, but that seems to be because they take in more calories. In addition, eating a large meal before bed can lead to indigestion

and heartburn. So don’t overdo your midnight snack. Cut out certain types of food Many fad diets advocate eliminating certain foods or food groups; most diets frown on sweets. But whether it’s dairy or dessert, choosing to completely avoid just doesn’t add up (unless you have allergies, of course). For example, cutting out dairy means missing out on essential vitamins, including calcium, which builds healthy bones as well as burning fat. You could still get your vitamins in a supplement, but in addition to being more tasty, dairy is better for weight loss – in one study, participants who took supplements lost 42 percent of their body fat, while those on high-intake, low-fat dairy diets lost 69 percent. Other food groups also contain essential nutrients that supplements alone can’t replace. When it comes to dessert and other treats, not eating them can CONTINUED TO PAGE 99

Summer is a busy season for running. Maybe you’ve been inspired by our Get Fit, Give Back calendar to start running now, or you’re a veteran competitive runner who’s hit a plateau. No matter your level of experience, the distance or purpose, here are a few areas that could improve your performance. Breathing: One way to improve without pounding the pavement is to make your breathing more efficient. Optimally, you should be breathing in with your stomach, rather than with your chest and shoulders. This “low breathing” allows you to fill your lungs with more air and will help boost your endurance. It’s the way you breathe naturally when you’re laying down on your back, so lay on your bed to get a feel for it. Put a light-weight book on your gut if a visual cue would help you. During a run, you should also take breaths in through both your mouth and nose. It may not be the most attractive look (fortunately, you don’t have to do this in day-today life), but it will help you pull in air fast. Professional runners also recommend breathing to a constant rhythm, like 2-2 – breathing in for CONTINUED TO PAGE 106

Get Fit, Give Back Calendar

Many of these great events donate a portion of their proceeds to local and national non-profits. So get off the couch, strap on your tennis shoes and get out there for a worthy cause.

J u ly 1 5 – Philo’s 6th Annual Women’s Amateur Golf Tournament, 7:30 a.m., Mariana Butte Golf Course, Loveland, benefitting technical or vocational scholarships for local residents, www. philoloveland.org 1 6 – Loveland Classic, 7 a.m., Davidson-Gebhardt, Loveland, benefitting Thompson Valley Preschool, www. lovelandclassic.com

2 7 – Fossil Frenzy 5K, 6 a.m., Fossil Creek Park, www.fcgov.com/ specialevents

PARTNERS

MENTORING YOUTH

SUPERSTARS

2 7 – Walk to End Alzheimer’s, 7:30 a.m., Spring Canyon Park, Fort Collins, benefitting the Alzheimer’s Association, www.walktoendalz.kintera.org

Support area youth and have fun in the process. The annual SuperStars Sports Challenge is a do not miss event. Teams of 8 or more will compete in a series of challenges, including volleyball, dodge ball, bocce ball, big wheels relays and an obstacle course. The winning team will receive a team plaque and a catered lunch. Teams can participate in fundraising prior to the event and all proceeds go to support Partners Mentoring Youth. The Challenge takes place at 8 a.m. on Saturday, August 20. The event will be held at Loveland Sports Park. Call (970) 484-7123 to register or visit www. partnersmentoringyouth.org for more details.

1 7 – Bent Rock Trail Race, 7 a.m., Red Mountain Open Space, north of Fort Collins, benefitting Athletes in Tandem, www.athletesintandem.org 1 7 – KRFC Radio Flyer 5K, 8 a.m., Avogadro’s Number, Fort Collins, benefitting KRFC 88.9 FM, www.footoftherockies.com 1 7 – New Belgium Brewing Urban Assault Ride, 9 a.m., New Belgium Brewing Company, Fort Collins, benefitting Ciclismo Youth Foundation, www. urbanassaultride.com 22 & 23 – Relay for Life Windsor, 6 p.m., Eastman Park, Windsor, benefitting the American Cancer Society, www.relayforlife.com 2 2 & 2 3 – Relay for Life Estes Park, 6 p.m., Estes Park High School, Estes Park, benefitting the American Cancer Society, www.relayforlife.com 2 3 – Run for Hope, 8 a.m., City Park, Fort Collins, benefitting the Caring for Carcinoid Foundation and the Poudre Valley Cancer Center, www. runforhope.net

7 – Horsetooth Open Water Swim, Horsetooth Reservoir, Fort Collins, benefitting Team Fort Collins, www. horsetoothswim.com 11 – Mountain Avenue Mile, 6:30 p.m., Old Town, Fort Collins, benefitting Beyond the Mirror Studio, www. mountainmile.com 12 & 13 – Wild West Relay, 5 a.m., Budweiser Tour Center, Fort Collins, www.wildwestrelay.com 13 – Fore! Kids & Kritter Golf Tournament, 8 a.m., Olde Course, Loveland, benefitting Half Moon Arts and Fort Collins Cat Rescue & Spay/Neuter Clinic, www. fortcollinscatrescue.org 14 – Pedal to the Point Bike Tour, 7 a.m., Waverly School, north of Fort Collins, benefitting Turning Point, www.turningpnt.org 18 – Birdies on the Green, 12 p.m., Olde Course, Loveland, benefitting Stepping Stones Adult Day Program, www.mckeefoundation.com 19 – Valley 5000, 7 p.m., Fairground Park, Loveland, www.footoftherockies.com

September 5 – Labor Day 5K Run/Walk, 7:30 a.m., Boardwalk Community Park, Windosr, www.ci.windsor.co.us 5 – Colorado Run, 8 a.m., CSU Oval, Fort Collins, benefitting the Discovery Science Center, www.coloradorun.com 9 – McKee Masters Golf Tournament, 8 a.m., Marianna Butte Golf Course, Loveland, benefitting the Banner Simulation System at McKee Medical Center, www.engagingloveland.org

1 0 – 1st Annual Mud Brigade 5K, gates open at 7 a.m., The Ranch, Loveland, benefitting Loveland Police Department Explorer Post #2022, www.mudbrigadenoco.com 1 1 – Fort Collins Triathlon/Duathlon, 7 a.m., EPIC, Fort Collins, www.fortcollinsclub.net 1 8 – Crossroads Half Marathon, 8 a.m., Buckingham Park, Fort Collins, www.footoftherockies.com October 1 – Bacon Strip Races, 9 a.m., the intersection of CR13 and CR88, east of Fort Collins, benefitting Beyond the Mirror Studio, www.janewelzel.com 2 – Stepping Out to Cure Scleroderma, 8:30 a.m., City Park, Fort Collins, www.fcgov.com/specialevents 2 – Blue Sky Marathon, Horsetooth Open Space, near Fort Collins, www.blueskymarathon.com 8 – Flame Out 5K, 9 a.m., Poudre Fire Authority Station 3, Fort Collins, www.footoftherockies.com 15 – CSU Homecoming Race 5K, 9 a.m., CSU Oval, Fort Collins, www.footoftherockies.com

20 – Peachy Cheeks on the Move 5K, 8 a.m., St. Michael’s Town Square, Greeley, benefitting Hospice and Palliative Care of Northern Colorado, www.hpcnc.org

2 9 – CSU Triathlon Club 5K, 9 a.m., CSU Oval, Fort Collins, www.footoftherockies.com

August

20 – SuperStars Sports Challenge, 8 a.m., Loveland Sports Park, benefitting Partners Mentoring Youth, www.partnersmentoringyouth.org

2 9 – Phantom 4-Miller, 9 a.m., Embassy Suites Loveland, Loveland, benefitting Denkai Animal Sanctuary, www.phantom4miller.com

6 – Safe Harbor 5K Run/Walk and Kids Fun Run/ Walk, 7:30 a.m., Life Care Center of Greeley, Greeley, www.active.com

24 – Running of the Bulls, 10 a.m., Lake Estes Marina, Estes Park, benefitting Partners Mentoring Youth, www. partnersmentoringyouth.org

3 0 – Spooktacular 5K, 9 a.m., Spring Canyon Park, Fort Collins, benefitting Children’s Speech and Reading Center, www.footoftherockies.com

2 3 – Loveland Little Sprint Triathlon, 12 p.m., Mountain View High School, Loveland, benefitting the Kid-Self Pediatric Therapy Program at McKee Medical Center., www.mckeefoundation.com

Northern Colorado Medical & Wellness 2011

Wellness

DENTISTRY

Cosmetic Dentistry of the

Rockies by Connie Hein

Over the past hundred years or so it seems that our teeth have become a social tool, rather than just a utilitarian one. Of course we still count on our choppers to chew our food (and sometimes do some nail-biting), but now healthy white teeth have become just one more way of presenting a confident, positive attitude to the world. 86

Cosmetic Dentistry of the Rockies offers comprehensive dental care with a focus on cosmetic dentistry at their Fort Collins practice.

According to a survey conducted by Strategy One on behalf of Listerine, Americans believe that having white teeth plays a crucial role in making a good first impression. Over 60 percent of those surveyed said they believe white teeth are one of the most important ways to ensure a positive outcome in a job interview. Our teeth have become part of how we show the world who we are. Because of this, the role of cosmetic dentistry has become not only about helping us maintain beautiful teeth, but also a healthy self-esteem. Research has also shown the connection between good oral health and good overall health. Healthy teeth can ward off old age by helping prevent many inflammatory-related diseases. Through the research and surveys, one

thing is clear: a healthy mouth can lead to a healthier, happier life. So how do we keep our mouths healthy and our pearly whites bright and straight? Experts agree it is through daily preventative care and bi-annual visits to a dental professional for cleanings and oral exams. Travis Willey, DDS of Cosmetic Dentistry of the Rockies (CDR), says keeping teeth straight, white and healthy is easier and more convenient than ever with the newest in technology used in their Fort Collins office. â&#x20AC;&#x153;We have the latest equipment to detect cavities and other oral health issues, as well as the best in cosmetic dental equipment and products for straightening and whitening teeth.â&#x20AC;? Dr. Willey, who recently purchased the practice

Steven Koehler, DMD, and Travis Willey, DDS, of Cosmetic Dentistry of the Rockies

from Steven Koehler, DMD, says CDR has always been, and will continue to be, a comprehensive family dental office with a focus on cosmetic dentistry. “Dr. Koehler and I have extensive training in cosmetic dentistry and do lots of continuing education to keep up with the latest advances in the fast growing field,” Dr. Willey says. “We are passionate about providing the best service we can in cosmetic dentistry because so many of our patients want the options it provides as part of their dental care.” CDR offers cosmetic dental services along with general dentistry and routine dental work, check-ups and cleanings for adults and children. “It’s convenient for our patients to have most of their dental needs addressed in one office,” he says. “And we work with a great community of dental specialists for procedures we don’t offer.” Both dentists are trained, certified and preferred providers of Invisalign, the clear alternative to braces. Dr. Willey says this alternative to traditional metal braces has become very popular and they are proud to be able to offer them. Invisalign makes advances every year to improve the process of alignment and enhanced attachments to be more and more effective in straightening teeth. According to Drs. Willey and Koehler, the clear braces are comfortable to wear and much easier to live with than metal braces for many reasons. One of the biggest advantages is that they make dental hygiene easier. “It’s hard to get in around metal braces to brush and floss effectively, which can cause bacteria to form and cavities to develop.” Dr. Willey is highly trained and certified to do dental implants, which is the process of attaching titanium rods into the bone and then permanently

Northern Colorado Medical & Wellness 2011

attaching sculpted teeth to the rods. Dr. Willey says this process helps people keep their natural teeth healthy all their lives and can aid in keeping dentures fixed in place. “Dentures work when there is no alternative in certain cases,” he says. “But we try to help our patients keep their own healthy teeth, to provide better quality of life.” As well as working to give their patients a great quality of life, both dentists at CDR are passionate about giving back to their community. They are involved with local and national campaigns and non-profit projects including the Hope Lives The Lydia Dody Breast Cancer Support Center, Project Smile, PVH and MCR Foundations, and members of the Fort Collins Chamber of Commerce, Larimer County Dental Society, Colorado Dental Society, American Dental Society, American Dental Society, American Academy of Cosmetic Dentistry, Academy of General Dentistry. Both doctors actively help with Smile Train, a global foundation helping children with cleft lip and palate. Dr. Willey, his wife and their two children moved to Fort Collins two years ago from Wisconsin. Dr. Koehler has been serving the people of Northern Colorado in the Fort Collins office for over 17 years. They are both dedicated to making sure their patients have strong, healthy teeth and a bright, beautiful smile to show the world they care.  For information on dental procedures at CDR, call (970) 223-6101 or visit www.smilefortcollins.com.

Connie Hein is a freelance writer living in Windsor.

2011 BEHAVORIAL HEALTH :: Trumpet Behavioral Health Catherine Bladow, MS, CCC-SLP, BCBA Northern Colorado 970.420.0578 www.tbh.com See ad on page 61

DENTISTRY/COSMETIC/GENERAL :: Cosmetic Dentistry of the Rockies Travis R. Willey, DDS Steven J. Koehler, DMD 4745 Boardwalk Dr., Ste. D102 (FC) 970.223.6101 www.smilefortcollins.com See ad on page 30 Overton Center for Dental Arts, P.C. Thomas F. Overton, DDS 1220 Oak Park Dr. (FC) 970.223.6677 www.overtoncenter.com See ad on page 72

DENTISTRY/DENTURES :: McCall Dentures Ryan D. McCall, DDS 1525 Riverside Ave. (FC) 970.493.9001 www.mccalldentures.com See ad on page 83

DENTISTRY/ENDODONTICS :: Center for Endodontic Care Anthony Girardi, DDS Kelly Jones, DDS, MS Amber Severin, DDS, MS 1331 E. Prospect Rd., Bldg. B-1(FC) 970.232.3750 516 W. Eisenhower Blvd. (Loveland) 970.232.3757 4669 W. 20th Street Rd. (Greeley) 970.232.3755 See ad on page 77

DENTISTRY/ORAL SURGERY :: Summit Oral & Implant Surgery, PLLC Zachary A. Owen, DDS 2998 Ginnala Dr., Ste. 102 (Loveland) 970.669.4802 www.summitoralsurgery.com See ad on page 97

DENTISTRY/ORTHODONTIC :: Mark D. Crane, DDS, MS-PC Craig Seager, DDS-MSD 4144 S. Timberline Rd. (FC) 970.226.6443 3520 E. 15th Street (Loveland) 970.663.4871 www.drcraneorthodontics.com See ad on page 104

Orthodontic Associates of Greeley, PC Burdett R. Edgren, DDS, MS Bradford N. Edgren, DDS, MS 3400 W. 16th Street, Bldg. 4-V (Greeley) 970.356.5900 www.dredgren.com 888.356.5900 See ad on page 27

DENTISTRY/PERIODONTICS :: Associates in Periodontics Richard W. Lindeberg, DDS, MS David Clark Johnson, DDS, MS Jennifer Merritt, DDS 1120 E. Elizabeth St., Ste. G4 (FC) 970.221.5050 2996 Ginnala Dr., Ste. 101 (Loveland) 970.221.5050 See ad on page 69

HEARING HEALTHCARE :: Advanced Hearing Services, LLC Susan Baker, BS, BC-HIS 2001 S. Shields St., Bldg. J2 (FC) 970.221.5249 www.bakerhearing.net See ad on page 69 Frontier Audiology Lori L. Archie, AUD, CCC-A 419 Canyon Ave., Ste. 310 (FC) 970.449.4110 www.frontieraudiology.net See ad on page 106

HOME HEALTHCARE :: Caring Hearts Home HealthCare Northern Colorado 970.378.1409 www.caringheartshh.com See ad on page 95 Home Instead Senior Care Northern Colorado 970.494.0289 www.homeinstead.com/northerncolorado See ad on page 77 Seniors Helping Seniors www.seniorshelpingseniors.com 970.631.8251 See ad on page 99

HOSPICE :: Pathways Hospice 305 Carpenter Rd. (FC) 970.663.3500 www.pathways-care.org See ad on page 101

INSURANCE ::

PHYSICAL THERAPY ::

Chip Beake-State Farm 106 E. Olive St. (FC) 970.482.1936 www.chipbeake.com See ad on page 105

VWP Physical Therapy Valerie Potter, MS, DPT 1227 Riverside Ave. (FC) 970.988.9229 www.vwpphysicaltherapy.com See ad on page 99

KIDS ACTIVITIES :: Chipper’s Lanes Horsetooth Center (FC) 970.226.6327 College Center (FC) 970.484.4777 Estes Park Center 970.586.8625 www.chipperslanes.com See ad on page 31

PROSTHETICS/ORTHOTICS ::

Mountain Kids 419 E. Stuart St. (FC) 970.482.3118 www.mountain-kids.com See ad on page 29

Prosthetic & Orthotic Group of Northern Colorado 2290 E. Prospect Rd., Ste. 2 (FC) 970.416.9357 2996 Ginnala Dr. (Loveland) 970.416.9357 www.p-o-group.com See ad on page 98

MASSAGE THERAPY :: Essential Living Massage & Spa 343 W. Drake Rd., Ste. 109 (FC) 970.430.6630 www.massagefc.com See ad on page 106 Sunshine Therapeutic Massage Fort Collins 970.567.9997 See ad on page 103

MED SPA :: Xanadu Med Spa 1112 Oakridge Dr., Ste. 106 (FC) 970.482.1889 www.xanadumedspa.com See ad on page 79

PET CARE :: Aspen Grove Veterinary Care 2633 S. College Ave. (FC) 970.416.0232 www.aspengrovevet.com See ad on page 87 VCA Veterinary Specialists of Northern Colorado 201 W. 67th Court (Loveland) 970.278.0668 www.vcavsnc.com See ad on page 105

PHARMACY/MEDICAL SUPPLIES :: City Drug 209 N. College Ave. (FC) 970.482.1234 See ad on page 87

Hanger Inc. 2500 Rocky Mountain Ave., N. Medical Office Bldg. (Loveland) 970.619.6585 7251 W. 20th Street, Bldg. M (Greeley) 970.330.9449 www.hanger.com See ad on page 93

SENIOR LIVING RESIDENCES :: Fort Collins Health Care Center 1000 S. Lemay Ave. (FC) 970.482.7925 Spring Creek Health Care 1000 E. Stuart St. (FC) 970.482.5712 See ad on page 63 The Hillcrest 535 N. Douglas Ave. (Loveland) 970.593.9800 www.hillcrestofloveland.com See ad on page 61

SPEECH/LANGUAGE THERAPY :: Speech & Language Stimulation Center, Inc. 317 N. Meldrum St. (FC) 970.495.1150 www.speech-language-voice.com See ad on page 100

WEIGHT LOSS PROGRAMS :: Results are Typical www.resultsaretypical 855.424.2727 See ad on page 81

WOMEN’S HEALTH CARE :: Lifestyle Medicine at Miramont Urgent Care 2211 S. College Ave. (FC) 970.237.6339 www.urgentcareatmiramont.com See ad on page 29

WELLNESS

prosthetic technology

Spencer Hawk, an active, sports-loving 10-year-old, is a double amputee who relies on his prostheses to help him be more independent.

Prosthetic Innovations

Enhance Independence

by Tracee Sioux

Prosthetic devices are becoming more intuitive and lighter weight with new technology and innovative materials. Northern Colorado amputees like Spencer Hawk and Eric Gundlach, both about to receive new limbs, will lead more independent and physically active lives with innovations in prosthetic technology. Whether it’s enhanced athletic ability or simply being able to reach cookies on the counter, independence makes an enormous impact on quality of life. Northern Colorado Medical & Wellness 2011

Skateboarding, Swim Team & Karate without Legs Spencer Hawk is an active, bright 10-year-old. If all goes well with an upcoming surgery, he’ll be getting new prostheses from Prosthetic and Orthotic Group in Fort Collins and Loveland in August. Spencer and his family hope new legs will allow him more independence as he matures and his interests broaden. Spencer was born with Thrombocytopenia-Absent radius (TAR) syndrome, causing, among other health concerns, painful bent legs and very short arms. In 2008, Spencer’s left leg was amputated, and doctors attempted to straighten his right leg with a titanium rod. “My legs were bent, and since they were bent, all I could do was scoot on my knees, but it would hurt my knees all the time, so I could not stand up,” says Spencer. “I had a knee scoot and I always got wounds on my knees.” “Double amputees rely solely on their arms, but Spencer’s arms are so short, they really wanted to save the leg,” recalls Jennifer Powell, Spencer’s mother. The concern was with Spencer falling forward without normal-length arms to catch him. A natural leg supplies more balance than a prosthesis. After a time, complications and excruciating pain rendered his right foot non-functional. Six months of

Eric Gundlach, pictured here with wife Courtney at Arches National Park in Moab, is a paramedic who loves cycling and snowboarding. Gundlach requires a prosthesis that can take him over rugged terrain.

unendurable pain later without achieving a functioning leg, Spencer’s right leg was amputated as well. Spencer currently has ill-fitting prosthetic legs that he doesn’t like to wear. He’s grown out of them, they are too heavy, and the feet don’t keep his balance as well as he’d like. When he falls, it’s much further and hurts far more than when he falls from his residual limbs. Without his prostheses, Spencer skateboards, walks, takes karate classes and is on a swim team. With prostheses, Spencer can reach higher things, walk on hard surfaces, and achieve a height more equivalent to his peers. “When I can’t reach things that are taller than me, I can get in my legs and reach the thing that I need,” he says. “I can walk around in them, like my stumps, but with my stumps alone I can only walk on soft surfaces, while on my legs I can walk on hard surfaces. With stump liners I can walk on soft and hard surfaces, but I’m still going to be shorter.” “With legs he can look people in the eye and be able to reach things; since he was born with short arms, the height is a big thing,” says Powell.

From Dependence to Independence As her son’s caregiver, Powell is concerned that as Spencer grows into adolescence and adulthood she, or future caregivers, won’t be able to lift him without new prosthetic legs.

“Especially for caregivers, when he has the legs on it makes it so much easier to transfer him; he’s 84 pounds [now],” Powell says. “I consider [prosthetic legs] a necessity for living an independent life. He may not be completely independent, but he will be able to stand and sit and walk and reach things on his own. My husband is 6’4” and my brother is 6’3”. We know Spencer is going to be a big guy, that’s a lot of torso to lift for the person caring for him as an adult. It’s also much harder to burn calories without legs. Ideally, if he can walk faster, comfortably and safely, he can accomplish being in better shape.” Children often need new prostheses annually, depending on how quickly they grow. Spencer had to postpone new prostheses when they discovered that his two residual limbs aren’t growing at an equal rate, which could eventually have a negative impact on the alignment of his hips, spine and neck if left untreated. Prosthetic and Orthotic Group in Fort Collins made the discovery when they were fitting Spencer for his new legs. The new prostheses had to be postponed until after his corrective surgery this month. Spencer’s new legs will be lighter-weight, with better suspension and a vacuum seal to attach the prosthetic legs to his residual legs. “Spencer’s a special kid and he’s got unique issues,” says Chad O’Connor, certified prosthetist at Prosthetic Orthotic Group. “We look at what he

does on a daily basis. And, when you’re dealing with a child, you want them to experience everything in life and not be hindered by anything; we want Spencer to be able to do everything that his friends do. We looked at what kind of device is the best component-wise – what type of knee or foot and how the legs are held on. Because of Spencer’s arms, we have to take into account how much he can do himself. Basically, you want a prosthesis to be as functional as possible and not hinder them at all. It’s a fine line between functionality and becoming too much of a hindrance. “His new legs will have vacuum suspension, so the legs are held on with a suction effect,” O’Connor continues. “It’s a neat technology that better connects prostheses to limb for overall stability and really good suspension.” O’Connor will take a cast of Spencer’s residual limb, and from that cast he’ll make a mold out of his limb. He’ll make changes to it to take into account scar tissue, where they don’t want pressure, because it would be painful. From that mold he’ll make the socket. They’ll use a fiberglass cast tape for the mold and then fill that mold with plaster to get a physical representation of the limb. The socket will be made out of fiberglass and carbon. Spencer can’t imagine it yet because he is uncomfortable in his current prostheses, but O’Connor hopes that Spencer’s new legs will become so

intuitively a part of him that he’ll be able to use them in his karate classes and on the swim team – and all the things boys his age love to do.

Prosthesis Enables Paramedic to Help Others About nine years ago, Eric Gundlach lost his leg in a boating accident. The 37-year-old paramedic has a prosthesis on the left leg below the knee. Hanger Prosthetics and Orthotics in Boulder is fitting him for a new socket, which he will wear in July for his belated honeymoon to Italy. “I work out in western Eagle County; it’s a more rural ambulance service, not every house has a safe approach to it and sometimes we’re in the back country and actually have to walk over or carry people over uneven terrain,” says Gundlach. “I do it, relying on my prosthesis to be steady and able to carry someone else safely. Without some of the technology we have today, I don’t know if I would be able to do it.” “Eric is a trans-tibial amputee,” explains Angela Montgomery, certified prosthetist and orthotist at Hanger. “Which means he’s missing his leg below the knee. However, like a lot of people who have traumatic accidents, they salvaged his knee, but it’s not a perfect knee. There’s a lot of soft tissue damage that effects the mobility on his leg.” Prosthetic technology, with vacuum suspension, shocks and lightweight carbon fiber mechanisms, allows Gundlach to safely lift injured people across uneven terrain for his job. Aside from his job, Gundlach leads a very active and rugged lifestyle. He enjoys bike racing, motorcycle riding and hiking. Without access to newer prosthetic technologies, his lifestyle would not be the same. “The vacuum seal Eric has is like it is suctioned onto your body,” explains Montgomery, “With every micro-move you make it’s right there. He’s fallen in love with this technology and it’s become something he wouldn’t do without. As part of that vacuum pump, there’s a vertical shock and a torsion rod. The torsion rod means that he can plant his foot and twist it side to side. That’s important because he’s a cyclist, snowboarder and paramedic. He’s in all kinds of unpredictable situations. His foot is a dynamic foot that offers energy return so that it springs back and recoils. It also has ground compliance, which means that when you step on a pebble, it will lift on that side versus just staying flat.” Gundlach is currently wearing a test socket created by Montgomery. Once the mold is created, a person wears a plastic test socket for a week or two to determine if there is rubbing or uncomfortable pressure. If there is discomfort, they make adjustments until the fit is comfortable before they proceed with the carbon fiber permanent socket. Adults need to have the socket remade every few years because the residual limb changes over time and the fit becomes uncomfortable. “You can’t always tell how the socket will fit without walking around in it,” says Gundlach. “I wouldn’t find problem areas until I had the finished product. Now I can say, ‘This part hurts, it’s rubbing here,’ and she’ll change the shape of it. Once we get the shape right, she’ll make the rigid carbon fiber version.” “Eric is a great guy,” says Montgomery. “I think it’s really admirable, the work he does as an amputee. We have another client who is a police officer. They have very physically demanding jobs. Eric has to be able to drag people out of the woods. It is pretty amazing.”

Northern Colorado Medical & Wellness 2011

New Technologies Driven by Veteran Amputees Montgomery is excited about the new technology, but notes that the newest, most innovative stuff takes some time to become available to the general population. “The direction that we’re headed is [to be] more integrative, something that is more connected to the body, instead of just this external tool or attachment that you use,” Montgomery says. “Science and technology are trying to make prostheses more a part of a person. Rather than something that hangs off the body like a hammer, we’re trying to use technology and computers to make it more intuitive.” Microprocessors with algorithms that react to the external environment are an exciting new advancement. This type of technology isn’t yet rugged enough to endure the type of activity Gundlach needs his prosthesis to perform. Montgomery likens it to taking a very expensive laptop camping or across a stream – you wouldn’t do it because it’s too valuable. Montgomery has no doubt that the new technology will eventually be rugged enough, because the demand is being driven by soldiers returning from Iraq and Afghanistan in need of prostheses. “I personally believe it’s because of the patient population of the Veteran’s Association (VA). These 20- to 40-year-old guys are demanding more rugged microprocessor technology,” says Montgomery. Prosthetic devices can be extraordinarily expensive, ranging from a basic rudimentary design for $5,000 to up to $100,000 for the newest microprocessor technology for a single leg. The VA and Department of Defense innovates many of the new technologies for veterans. Those with workers’ compensation legal settlements and those with disposable income are usually early adopters. Once a technology has proven success for several years, Medicare begins to cover them. Only then do private insurance companies follow suit and the general population gets access to them. The technology, however, doesn’t tend to become more affordable, Montgomery notes. This month, during the Fourth of July weekend, over 600 people gathered at the bi-annual, International No Barriers Summit in Winter Park to share new discoveries and the latest scientific innovations meant to assist those with disabilities in leading more active lifestyles. Presenters included the head of MIT Biomechatronics, Hugh Herr, who lost both legs at the age of 17 due to severe frostbite. Determined to keep climbing, he designed and built his own prosthetic legs and feet. His prosthetic device, PowerFoot uses springs and a half-pound lithium ion battery to give the same push off the ground as a human foot, adjust to slopes, walking up and down steps, and hanging casually when one sits. Current innovations are good news for Spencer and Gundlach. While their new prostheses do not yet have microprocessors, they provide basic independence and even an ability to perform in physically strenuous jobs. As Spencer grows into an adult, the microprocessor technology and prosthetic innovations of the near future will make his adult independence far more likely and, as these innovations and inventions make their way from veterans to the general population, professionals like Gundlach will better be able to perform their jobs and enhance their athletic ability.  Tracee Sioux is a Fort Collins writer. She can be found at www.linkedin.com/in/traceesioux/.

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Northern Colorado Medical & Wellness 2011

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WELLNESS

fitness

Valerie Potter, physical therapist and personal trainer, works with a client to build strength, increase flexibility and improve alignment – key techniques to help prevent injuries during workouts and training sessions.

Injury Prevention

by Tracee Sioux

Coloradans are nationally known for being the most active people in the country, which means they can be at risk for injuries incurred during a fitness regimen. Style interviewed Valerie W. Potter, physical therapist and fitness expert at VWP Physical Therapy, about the top 10 things people need to do to create a great workout and prevent injury. 96

Identify your end-goals. Do you want to run a marathon, train for a triathlon, lose weight, lower your cholesterol, improve your blood pressure or improve your overall fitness level? Design a workout plan that will move you toward your goal. Balance your routine. If the end-goal is improved overall fitness, a well-rounded workout routine should include cardio, strength training, core work and stretching. If the end goal is to do a big bike ride at the end of the summer, it’s time to start training on your bike. But you’ll want to balance that with stretching for your hip flexors, quads and glutes. You’ll also want to add strength training for areas that aren’t getting worked on the bike, like the arms and core.

Strengthening your core can help you maintain the proper posture and alignment.

Alignment is key. During a workout, proper alignment is important to preventing long-term painful injuries. Potter recommends seeking a professional fitness expert to teach you how to properly lift weights, help you adjust weights to the right heaviness, and make sure you’re holding your body properly. While one can get by without consulting a professional, the long term problems of, say, locking out your knees when you workout can leave you with knee problems. Potter also recommends using a mirror to check your own alignment, once you know how to identify proper and improper alignment. Seek the help of a qualified professional. Find out what type of education the fitness professional has, cautions Potter. In Colorado, fitness trainers don’t need any formal education or certification. Look for someone who has an education in fitness, physical therapy, sports medicine or an athletic trainer. These professionals have an education and credentials that can help you prevent injury over the long term. Tune into your body. Check in with your body while working out. Notice how it feels. If there is sharp pain, you may want to stop that activity. Notice areas of tightness or strain and adjust them. Adjust weights. Adjust alignment. Distinguish soreness from an injury. If you have pain for more than three days, you might be injured. If it lasts for a week and you can say, “I feel pain right there,” seek professional help. General workout soreness will fade after a few days; sharp pains that do not should be treated early to avoid long-term complications.

Northern Colorado Medical & Wellness 2011

Use the right weights. If you use weights that are too heavy you are likely to pull or twist something that could give you problems for a long time. Start slow and stay where youâ&#x20AC;&#x2122;re at for a period of time. You want something heavy enough to be a challenge and build muscle, but you donâ&#x20AC;&#x2122;t want to exceed your own limits and injure yourself. Add variety to your workout. The body grows bored and gets used to activities when you do the same routine every day. You want to switch it up to keep it interesting. Ride an elliptical machine, take a kickboxing class, go hiking, go for a swim, ground yourself with some yoga, stretch it out with Pilates or lift some weights. Core strength is key. As we get older our bodies need different things. Core strength is key to proper posture and alignment no matter what age we are, says Potter. Working on core strength reduces pain, especially in the back and neck. Having a strong core improves balance and posture and reduces the likelihood of osteoporosis and fractures.

Weight training builds overall strength but be careful of adding on too much weight at once, which can cause injury.

10.

Finally, have fun. When you are working out, try to keep some joy in it. Figure out ways to make exercise something you can look forward to. Having fun while working out helps you feel good about your body, as well as brightens your spirit. Exercise relieves stress and can give you a little joy of heart.

Tracee Sioux is a Fort Collins writer. She can be found at www.linkedin.com/in/traceesioux/.

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make you want them more. If you give in to temptation, you’re likely to binge. Instead, allow yourself to eat anything – in moderation. Ironically, once a food is no longer alluringly forbidden, you may not even crave it at all. It seems backwards, but the human mind is a funny thing. No snacks, period This advice is probably designed to avoid mindless snacking, which is important. But it’s also important to control your hunger. The typical gap between lunch and dinner is several hours, and a long stretch of time builds hunger up and encourages overeating. The hungrier we are, the greater the quantity of food we eat, and extreme hunger also leads to cravings for calorie-dense foods. It’s harder to moderate your intake when your stomach is completely empty. Sensible snacking is the key, so be careful what snacks you reach for. In another backwards finding, prepackaged, low-calorie snacks may lead you to eat more. Research shows that people who eat small snack packs consume more calories, in part because they don’t leave you feeling full. If, however, you prepare your own lowcalorie snacks full of protein and fiber – like nuts or fruit – you’ll limit your calories and satisfy your hunger.  For more information about diet do’s and don’ts, visit the nutrition section of www.sparkpeople.com. Happy eating! Northern Colorado Medical & Wellness 2011

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stroke-certified hospital, the better chance she or he has of surviving a stroke,â&#x20AC;? adds Kathi Patterson, MN, CNS-BC, APRN, clinical nurse specialist and stroke program coordinator at PVH. In addition to a rapid response, a specialized stroke program like the one at PVH teaches patients how to manage their specific risk factors to reduce the likelihood of suffering a second stroke. Many patients need to go through a significant rehabilitation period, but starting rehab while still in the hospital gives them a head start that can benefit them in the long run. Jennifer Gaines, M.D., hospitalist and internist with PVH, notes, â&#x20AC;&#x153;Care for a stroke at a center with coordinated rehab and nursing protocols has been shown to improve stroke outcomes.â&#x20AC;? Another focus of a stroke center is working to prevent pnemonia and clots, she says.

Preventive Measures Even with stroke, there are preventive measures you can take to minimize your risk. Individuals who drink alcohol can reduce the chance of having a stroke by decreasing or eliminating alcohol consumption. Smoking is another treatable risk factor, and quitting the habit is an excellent preventive measure. For those with high blood pressure or high cholesterol levels, getting these under control can go a long way in reducing your chances of having a stroke. We can all reduce the risk of stroke and other major diseases by staying active and eating healthy foods. Regular activity such as walking, dancing, swimming, cycling or jogging is extremely beneficial. Healthy eating, which includes consuming plenty of fruits and vegetables while minimizing salt intake, is a terrific preventive measure with many side benefits.

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Sheri Friedman, M.D., neurologist with Poudre Valley Health System

Coping Solutions for Stroke Patients After a stroke, the whole person needs to be addressed. There may be physical challenges to overcome, such as relearning how to speak, how to comprehend what others are saying or how to use affected limbs. Just as importantly, emotional issues and interpersonal connections require attention. “It is very important for both the stroke victim and their family to access community resources,” advises Dr. Friedman. “The effects of stroke on an individual and their family are diverse. The physical disability is just one aspect. Physical and occupational therapy can help initially, but the work must continue after the official therapy sessions have ended. “I would recommend getting involved in the senior center, or a local health club,” Dr. Friedman continues. “The more subtle effects are on personality, sleep patterns, emotions and relationships. Your family physician or neurologist can help with medication and referrals. Other resources should be sought in the community, including churches, synagogues, counselors, family and friends.” Thankfully the impact of stroke can be greatly reduced through prompt, expert treatment, and PVH’s advanced stroke center is here to meet the needs of patients and their families. It takes a multidisciplinary approach to help a stroke patient. Northern Colorado’s primary stroke center offers our community outstanding medical specialists who are ready to serve and who work together for each patient’s benefit. With such caring, competent individuals on PVH’s staff, stroke patients are in good hands. Graciela Sholander is a freelance writer and ghostwriter who can be reached at www. ghostwritingplus.com.

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Mark Petrun, M.D., Northern Colorado Pulmonary Consultants

happen. It takes all of us working together to give our babies and their families the best outcome possible.” ZZZZs – Sleep Center One fairly new pediatric option within the PVH system is the sleep center staffed by Northern Colorado Pulmonary Consultants. In the last year their sleep lab, located in the Westbridge building at PVH, has added state of the art equipment designed for children ages 7 to 17 and trained their staff to work with children and their families. Physicians Mark Petrun, M.D., and David Kukafka, M.D., are trained at in Pediatric Sleep Medicine and do most of the evaluations. Dr. Petrun explains that sometimes hospital nurses notice a child’s labored breathing while they are admitted to the hospital. A doctor referral to the sleep center would be appropriate in that case. “We do quality studies and try to spend time with patients and families and figure out what’s the best solution. No one size fits all.” Having a child that snores is another red flag that these physicians encourage parents to watch for. Sleep disorders are often misdiagnosed as behavioral problems like Attention Deficit with Hyperactivity Disorder. Dr. Kukafka adds, “We’re hoping to help kids who have been misdiagnosed with ADHD and perhaps permanently treat kids who have sleep apnea now so they don’t wind up with diseases like hypertension and diabetes that often go along with apnea in adulthood.”

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They Get It When asked how they quell the fears of their patients and families, each of the experts interviewed for this article said essentially: “By explaining carefully.” The fear of the unknown may be the hardest part about letting your child out of your sight. The doctors at PVH can empathize with that feeling of uncertainty, and take extra time in pediatric cases to carefully and thoroughly explain every step of the process. For parents, understanding exactly why and what is happening to their child is sometimes the only thing left to cling to while a child is undergoing a procedure… until they are returned safely by the capable hands of the pediatric doctors at Poudre Valley Hospital. Epilogue As this article was going to press, PVHS was posting a new position that will make the Pediatric Service Line even better than ever. Coming by September 2011 is a Woman and Children Nurse Navigator who will work system-wide to help connect patients with the many pediatric resources available. Precisely because there are so many quality options, PVHS found it necessary to appoint one person to whom both patients and doctors can turn to connect to services. The Nurse Navigator will provide families with information and resources about health conditions and treatment options as well as working closely with provider[s] to establish a comprehensive care plan that best meets the needs of families in the most cost-effective manner. Bohling-Smith, who is charged with hiring the position, explains how the new Nurse Navigator might help: “A family whose child has a cleft lip and/or palate can use the Nurse Navigator to coordinate the scheduling of appointments with specialists both before and after surgery. The Nurse Navigator will ensure the communication happens effectively between all members of the care team. She or he can be the ‘helping hands’ so often needed by patients and families.” Corey Radman is a writer and mother of two who lives in Fort Collins. Reach her at www.fortcollinswriter.com.

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CONTINUED FROM PAGE 82 “The average person ‘quits’ seven times before he or she succeeds,” he adds. “You can learn where you failed, and address it. If you’re motivated, you try again.” Dr. Felix agrees. “Relapse isn’t failure; it’s a part of the process. You learn from your mistakes. The first step is readiness to change. If they’re thinking about it, give them a quit date – something significant like a birthday or anniversary – then have them announce it publically so others can keep them accountable. “It’s not the nicotine that keeps them smoking; it’s the habits,” he adds. “Smokers have to change their lives completely. If, for instance, they eat in the living room and then smoke afterward, that needs to change.” The more methods of quitting used simultaneously, all agreed, the better chance of success. These include: • One-on-one/group counseling – While both are useful and one might be a better fit, Pomerleau recommends group counseling. “There’s a benefit in the class dynamic – a group of people who have a common goal – that you can’t reproduce in one-on-one sessions.” • Nicotine replacement – “I’m a big fan of nicotine lozenges,” Dr. Taliaferro says. “Patches give you a steady flow of nicotine, but that’s not how people normally smoke. A lozenge or e-cigarette is a better replacement.” • Medications dealing with “mental cravings,” such as Chantix or Xyban.

Smokingcessation Resources

Northern Colorado/statewide:

Step-Free Smoking Cessation Program,

Health District of Northern Larimer County

120 Bristlecone Drive, Fort Collins (970) 224-5209

Colorado Quitline:

www.coquitline.org or 1-800-QUITNOW (1-800-784-8669) Quitnet: http://co.quitnet.com

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• Hand-to-mouth substitutes – “These go after two things at once – nicotine replacement, but also a ‘fiddling’ replacement,” Dr. Taliaferro says. “Having an e-cigarette in their hands can be very helpful. I’ll even tell people to keep a piece of a soda straw in their hand. They may feel silly at first, but the moment will pass.” Area programs for smokers, however, are harder to come by. “I have found it difficult to find resources for smokers in Larimer County,” says Dr. Felix. “I know there are hospital-based smoking cessation programs that are run by nurses and physicians in other areas in the country that offer free counseling and cessation classes. That is just not available here. I am hoping with new changes in healthcare that one of the larger health systems provides such a service.” Dr. Felix commends the Health District’s Step-Free program – which, while not free, is affordable. Northern Larimer County clients pay on a sliding scale between $10-$100 per session, and clients who complete the program have 50 percent of their fees returned to them. Discounts are available only to northern Larimer County residents (Fort Collins on up), but the program is available to anyone. The cost also includes free access to nicotine patches and, with doctor approval, nicotine gum or lozenges. Pomerleau and counselor Bear Gebhardt, both ex-smokers, run the six-week program. “Our goal is to create a positive and supportive structure. There’s no fear, guilt or shame here,” Pomerleau says. The first couple weeks of the program are spent on “getting to know each other, past quit attempts, what worked, what caused them to relapse… helping them assess their readiness and boost their confidence.” The middle two weeks focus on quitting, including stress-management techniques. “Smoking is as much an addiction of attention as it is a physical addiction,” Pomerleau says, “so we help them to redirect their attention.” Week 5 is dedicated to relapse prevention; past “quitters” come in to help people identify triggers for possible relapse. “If you know it’s there, you’re more likely to avoid it,” Pomerleau says. Finally, Week 6 celebrates participants’ accomplishments and helps them develop a long-term plan. The Health District also offers services for other needs smokers face. “There’s nothing quite like us anywhere in the state,” Pomerleau says. “One gal said, ‘I want to quit smoking but I don’t want to gain weight.’ We have a dietician right here. We can refer people for physical, dental, and mental-health issues right here within the organization.” “People gain a lot of tools here,” she adds. “Even if they lapse or relapse, they never go back to square one. They have the tools, and they’ll always be able to use them.”

Carl Simmons is a freelance writer and editor in Loveland and author of the six-book Bible-study series Growing Out: From Disciples to Disciplers (Group Publishing). You can learn more about Carl at carlsimmonslive.com.

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two strides and breathing out for two. Posture: Your posture when you run should be similar to when you walk or sit – straight. Your arms should be bent 90 degrees at the elbows, held close (but not tight) to your body, and pumping fast; the faster you pump your arms, the faster your legs can move. Stride: This is an area of contention in the running world. The dominant advice is that you can’t change your stride, so work with what you have. But some trainers, backed up by science, are now saying that it is possible to change your stride for the better. To prevent or correct overstriding, you should run with your torso tilted slightly forward. You should also minimize your contact with the ground. Men’s Health suggests, “While you run, think about pulling your leg backward just as your foot makes contact with the ground.” Also be sure to keep you and your knees from going too high – going up rather than forward is counter-productive and a waste of energy. Strength: Running may be all about the need for speed, and spending a lot of time on the track can help with that, but so can strength training. For your legs, unilateral training – that is, working each leg independently of the other – ensures that your legs are balanced, reducing injuries that result from one weak leg and one strong, overcompensating leg. Core training should be done upright, as opposed to lying down, in order to really work the muscles you use while running (unless you’re the rare person that runs lying down). Intensity: Alternate between hard (long and/or fast) and easy (short and slow) runs. The hard runs will push you to improve, and the easy runs will prevent you from overtraining. And some of those hard runs should be speedy, to activate fast-twitch muscles that even endurance  runners should train to prevent injury. 106

Richard Alessi, MD

Kevin Bachus, MD

Douglas Beard, MD

Jeffrey Chapman, MD

Hans Coester, MD

Beverly Donnelley, MD

Christopher Eriksen, MD

Warren James, MD

Angela King, MD

Susan Kozak, MD

Mark Loury, MD

Kara Micetich, MD

Philip Priebe, MD

Brad Runyan, MD

Elizabeth Serniak, MD

Bruce Smith, MD

J. Bradley Stern, MD

Kevin Tool, MD

Christopher Tsoi, MD

Donn Turner, MD

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