MAY 2013
Your Child’s
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Dads &
Daughters
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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 MANAGING 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 CIRCULATION MANAGER Trisha Milton COPY EDITOR Corey Radman CONTRIBUTING WRITERS Emily Hutto, Heidi Kerr-Schlaefer, Marty Metzger, Corey Radman, Kay Rios, Laura Sebastian, Carl Simmons, Tracee Sioux, Elissa Tivona, Michelle Venus PHOTOGRAPHERS Marcus Edwards, Don Hajicek AFFILIATIONS Fort Collins Area Chamber of Commerce Greeley Chamber of Commerce 2013 STYLE MAGAZINES January-Northern Colorado Medical & Wellness Magazine and McKee Medical Center & North Colorado Medical Center Medical Directory February-Style March-Northern Colorado Medical & Wellness April-Style May-Northern Colorado Medical & Wellness June-Style July-Northern Colorado Medical & Wellness Magazine and University of Colorado Health Medical Directory August-Style September-Women’s Health & Breast Cancer October-Northern Colorado Medical & Wellness November/December-Holiday Style
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THANK YOUS
I have had so much positive response to the cover and story (Lydia’s Style Magazine, February 2013, “VFLA: Designing Northern Colorado”). Of course, the usual ribbing from my friends was about my future modeling career, all in fun. For VFLA it was a great opportunity to get our name and face in front of the community and let them know we are still here and better than ever. I also wanted it to bring Justin to the front and let people know it’s just not me at the helm. I want to thank you for a great job and compliment your entire team for their professionalism. They were all a pleasure to work with and patient about getting the story right and the photos done well. Kudos to you all, Frank Vaught Northern Colorado Friends of Ferals is grateful to Northern Colorado Medical & Wellness magazine, March issue, for your compassionate,
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complete coverage of community cats living in Northern Colorado. Thank you for raising awareness of feline overpopulation and the many skilled volunteers who work to aid our community cats through Trap Neuter Return (TNR), the humane, effective solution. We appreciate this thoughtful article featured in such a significant publication.
priceless. Advertising in Style Magazine has greatly enhanced our visibility in the community. A genuine ‘thank you’ for a great local magazine! Susan Whitley, Owner Lady Gaia Boutique CLARIFICATION
Thank you, Leslie Vogt, Director of Northern Colorado Friends of Ferals In my first year of business, Style Magazine featured a Hope Lives model on the cover wearing a pink ruffled jacket from Lady Gaia. I was pleasantly surprised by the number of new people who visited the store and purchased the jacket. We even received calls up to six months later, still looking for the “little pink jacket!” Was it a great little jacket on a terrific model? Yes! But who would have known had they not seen it in Style Magazine? The exposure was
In the April issue of Lydia’s Style Magazine, we featured an article on outdoor kitchens. Though photos and price points were stated to only include the expense of the actual outdoor kitchen, we feel it is important to reiterate: the price points for kitchens did not include extras such as the fireplace, lighting or pavers in the total cost. CORRECTION
In our April magazine we incorrectly identified Envirofit as a non-profit organization (“Envirofit Combines Business and Benefit”). They are a social enterprise. We apologize for the inaccuracy.
Lydia’s STYLE Magazine
Northern Colorado Medical & Wellness 2013
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CONTENTS
Northern Colorado Medical & Wellness
May 2013
20 CHILDHOOD HABITS
26 PEDIATRIC EYE HEALTH – KEEP IT SIMPLE
24 GESTATIONAL DIABETES RISK FACTORS
36 NATURAL SLEEP REMEDIES
48 FOSTERING A HAPPY BOND BETWEEN CHILDREN AND PETS
55 BIRDERS OF A FEATHER FLOCK TOGETHER
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ON THE COVER: Ray Chavez and his daughters regularly spend time together at the Council Tree Library. Chavez encourages dads to place a greater importance on relationships with their daughters. Cover photo by Marcus Edwards Photography.
6 10 12 16 20 24 26 28 32 34 36 38 38 39 40 44 48 52 55 58
From the Readers
Publisher’s Letter A Good Night’s Sleep Keeps Kids Healthy Revolution of Dads
Childhood Habits
Gestational Diabetes Risk Factors
Pediatric Eye Health – Keep it Simple
OTC Drug and Supplement Abuse
Understanding Crohn’s Disease
New Help for Incontinence
Natural Sleep Remedies Is the Paleo Diet for You?
Feel the Burn
Get Fit/Give Back Calendar The Scoop on Seniors and Supplements Starting Early is Key to Good Dental Health Fostering a Happy Bond Between Children and Pets Pet Owners Can Avoid Vacation Stress
Birders of a Feather Flock Together At the Epicenter of Robotic Surgery Practitioner Spotlight: Dr. John Crane
The articles in this issue of Northern Colorado Medical & Wellness are presented for your general knowledge and are not a substitute for medical advice or treatment. If you have any questions or concerns about your health, please contact your doctor or healthcare provider.
Lydia’s STYLE Magazine
Northern Colorado Medical & Wellness 2013
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PUBLISHER’S LETTER
Staying Healthy When we started planning the articles for the Northern Colorado Medical & Wellness May issue with a family focus, we decided to discuss the importance of dads in the lives of their daughters. Research shows, and our interviews substantiated, that daughters value the time and attention their dads lavish on them, and that directly impacts their sense of importance and feelings of being wanted and loved. Enjoy reading this important information in “Revolution of Dads,” and
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gain insight into the commitment our cover dad, Ray Chavez, has to his three daughters. A challenging family issue in many households is sleep, and usually it’s the lack of. All my life I’ve been a night owl, felt sleep was a waste of time and conditioned my body to function on four to five hours a night. I really didn’t know the importance of sleep until recently but now strive for seven or more hours of sleep on the weekends. Read “A Good Night’s Sleep Keeps Kids Healthy” to learn the recommended sleep requirements for newborns through teen years. As children grow an important well visit screening is checking for good eye health. If your child is struggling academically, having difficulty reading or is acting out in school, sometimes it is due to problems with their vision. Read “Pediatric Eye Health, Keep it Simple” to learn about potential eye problems. We are fortunate to have pediatric ophthalmologist, Dr. Patrick Arnold, with the Eye Center of Northern Colorado in our area to help diagnose and treat children with eye problems. Another important component of a child’s good health is their oral health. Today we are fortunate to have pediatric dentists, such as Dr. Katherine Galm, ensuring the trip to the dentist is non-threatening and fun. She urges that children begin seeing a dentist at age 1 and then routinely every six months after that. Read “Starting Early is Key to Good Dental Health” for tips to a healthy childhood smile. I was particularly committed to taking my two daughters to the dentist at an early age and making it a fun experience, because I remembered all too well sitting in a dentist’s chair as a young child screaming and being held down while the dentist pulled two of my baby teeth. Fortunately it doesn’t have to be that traumatic today!
As we move into spring many of us turn our attention to losing weight and improving our fitness level. Read “Is the Paleo Diet For You?” to evaluate this as a tool for losing a few pounds. And look at the calorie burn of various activities in “Feel the Burn” to improve your fitness level along with weight loss. I’m definitely a believer in the importance of exercise, especially as we age. I’m hooked on the Your Health Matters program at The Other Club, which meets two times a week for cardio and weight training along with weekly nutrition classes. It has made a huge difference in my fitness level and now my sister has joined the program too. I invite you all to support one of my favorite causes this month at the Pink Boa 5K Run/Walk and increase awareness, celebrate life and raise funds for Hope Lives! The Lydia Dody Breast Cancer Support Center. The event is May 18, at 8:30am, at the Front Range Village on Harmony. Register for this inspiring and fun annual event at www.hopelives.org. This non-profit is the only one in the state that provides post diagnosis support to women in Northern Colorado diagnosed with breast cancer. To date it has provided over 14,500 free services to women since 2001. Gather your friends and come have fun with us! I trust you will enjoy the family focus of this issue as we work hard to present interesting and relevant articles for your enjoyment. We always look forward to hearing from you so keep letting us know what you enjoy or how we can improve. Wishing you a healthy spring, lydia@stylemedia.com
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MEDICAL
Sleep Medicine
A G OOD NIGH T’ S S LE E P K E E PS
KIDS HEALTH Y
Sleep is the power source that keeps your mind alert and calm. Every night and at every nap, sleep recharges the brain’s battery. Sleeping well increases brainpower just as weight lifting builds stronger muscles, because sleeping well increases your attention span and allows you to be physically relaxed and mentally alert at the same time. Then you are at your personal best.
Healthy Sleep Habits, Happy Child, Marc Weissbluth, M.D. 12
BY KAY RIOS
Sleep is no less important than food, drink or safety in the lives of children but, according to the National Sleep Foundation (NSF) 69 percent of children experience one or more sleep problems a few nights or more during a week. In addition, 25 percent of infants, toddlers and preschoolers are sleepy during the day, and 30 percent of school-aged kids have trouble getting up in the morning. How much sleep is enough? Kate Hannifan, M.D., a pediatrician at The Youth Clinic, says, “Newborns have a huge sleep need and spend at least 18 to 20 hours of the day asleep. They don’t usually establish a day/night pattern until about 2 months of age. Around 4 months, you can expect two or three naps in the day and longer periods of sleep at night, though many babies do not sleep through the night until 9 months of age.” Toddlers, she says, require 12 to 14 hours of
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sleep and are usually napping once or twice a day and sleeping through the night. At 4 or 5 years, they usually drop naps and sleep around 12 hours at night. But she qualifies, “It really depends on the child and what the family has been doing. Every family is different.” By school age, kids function well with 10 to 12 hours of sleep, Dr. Hannifan says. That remains true through the teen years, says, David S. Kukafka, M.D. FCCP, board certified in sleep, pulmonary and critical care medicine, and physician at Banner Health Clinic specializing in pulmonary and sleep medicine. “The ideal is 10 to 12 hours although few adolescents get that for a variety of reasons.” If the body’s sleep requirements are not met, a number of issues arise. Short term, sleep deficits can affect school issues, concentration, and can encourage hyperactivity during waking hours, Dr. Kukafka says. Long-term issues include difficulty learning and discipline and behavior problems, Dr. Hannifan adds. “Chronic deprivation can affect physical health, making a child prone to illness. Many children also complain of physical symptoms like headaches, or stomachaches when they are tired.” Dr. Kukafka agrees and adds, “It increases inflammatory markers which can decrease the immune system and lead to more infections. Self-esteem can also go down because they are not good learners. That carries over to adulthood and can really affect someone’s livelihood and quality of life.” Many factors can disrupt sleep patterns and create problems. For toddlers, an increase in motor, cognitive and social abilities can interfere with sleep. And, says Dr. Hannifan, “In the early years, daytime naps can be disrupted for a variety of reasons because we all lead busy lives. By bedtime the child may be overtired, which actually makes it more difficult to fall asleep.” “A lot of it is parental attitude and tolerances,” Dr. Kukafka adds. “Kids will do what they do but it’s the way the parents interact and react that will affect them over time.” A big change takes place in teen years, he says. “By the time they become adolescents, there’s a definite shift that’s related to the increase in hormones and the resulting change in circadian rhythms. Teens become night owls but they still need 10 hours of sleep. So if they get to sleep late and then have to get up at 6 a.m. to get to school by 7 a.m., they’re not getting what they need. There’s a study in Minneapolis where the high school start time was shifted to an hour later and SATs scores and grades went up.” Teens may get through the week without enough sleep and then try to catch up. “Parents complain that their teenagers sleep all weekend. They don’t get the required sleep during the week and then they crash on the weekend because there’s a sleep debt they have to pay back,” he says. Dr. Kukafka says mechanical issues can also be a cause. “It can be undiagnosed sleep apnea. Children should not snore: that’s a definite symptom.”
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Dr. David S. Kukafka, FCCP, Banner Health Clinic
Poor sleep hygiene is another cause, he says. “Kids need healthy habits from the start and a lot of that depends on the parent-child interaction. Parental stress and attitudes toward sleep determine how the baby will sleep and that carries over.” And, he says, in this electronic age, kids may have televisions and computers in the bedroom leading to high stimulation activities and an encouragement to stay up later. Creating healthy sleep hygiene and reducing the disruptions can lead to good sleep patterns, preparing kids for a healthier, happier life. “You should start early by giving younger children a set bedtime routine,” Dr. Kukafka adds. “They should be in bed no later than 8 or 9 p.m., assuming a usual wake time of 6 or 8 a.m. If you don’t set those habits early, you run into trouble in the teen years when you run into circadian rhythm changes.” Dr. Hannifan agrees that it’s most important to establish a routine. She isn’t quite as strong as to the exact time. “The hour may vary depending on the child’s age but have something you do every night: taking a bath, brushing teeth, reading books, talking together. Children need a cool down period at the end of the day. Consistency is important; ideally children should be going to bed and getting up at about the same time every day.” For older kids, she says electronics including the TV, computer and cell phone should be out of the bedroom. “TV doesn’t calm you down; it stimulates you. Try having them take a warm shower, drink a cup of herbal tea or listen to calming music before bed. Teens
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Lydia’s STYLE Magazine
Dr. Kate Hannifan, The Youth Clinic
need a minimum of eight hours from falling asleep to waking up so start that routine an hour before.” Dr. Kukafka offers another strategy. “If you have a night owl, get them up in the morning and put them in front of a bright light. Give them a video early in the morning or let them use the computer. It tells them it’s day time and they are more likely to be ready for sleep that next night.” Dr. Hannifan says there are a variety of approaches available at local bookstores. “Look at the sleep section and try some of them out. There are a number of theories and what works well for one family might not work for another. But,” she adds, “if your child is having sleep problems, it’s important to talk to your pediatrician.” There is also help for those mechanical issues, Dr. Kukafka says. “A tonsillectomy is the first line of treatment for a child with apnea. If that doesn’t work, then between 5 and 12 years of age, orthopedic maxillary expansion might be an option.” He also recommends discussing problems with the family doctor and says that if mechanical issues are treated when the child is young, it can reduce the possibility of issues in adulthood. “This is a hugely fascinating field,” he says. “We know less about sleep medicine than many other fields and we are constantly learning more.”
Kay Rios Kay Rios is a freelance writer based in Fort Collins.
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MEDICAL
Parenting
The Chavez family understands the importance of dads and daughters spending quality time together: daughter Eva, dad Ray, mom Roxanne and daughters Lola and Savannah.
R EV OLUTIO N O F DADS
I
n February Ray Chavez called a room full of fathers attending the 16th annual Butterfly Kisses daddy-daughter dance to a revolution.
“I’m calling for a revolution of dads,” says Chavez, 48, an ordained Community of the Holy Spirit priest, youth leader and father of three girls, Lola, 8, Eva, 10, and Savannah, 12. “Fatherhood is not a spectator sport. Mother’s Day cards sell out every year, because moms do their jobs. We, as males, are derelict in our duties. We’re looking for dads to join the revolution to take their families back. Who do you want to show your daughter how she should be treated on a date? You, or some teenage boy?” Chavez spells love T.I.M.E. With ministerial duties and a full time position at Budweiser, Chavez doesn’t believe “busyness” is a valid excuse for negligent fathering. The relationship a girl has with her father will ripple throughout her lifetime. “Dads are the first men a girl falls in love
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with,” Chavez says, as much warning as blessing.
Fatherless America
Once thought of primarily as the breadwinners of a family while mothers handled the bulk of parenting duties, research now indicates that fathers are a critical component of healthy child development. “The father sets the standard for all the men in his daughter’s life. The way I treat my wife is the way my daughter will expect to be treated by her husband. The way I treat my daughter is the way she will expect men to treat her,” Chavez promises. Fatherless children fare poorly, statistics show. Too, research indicates that cross-gender relationships – fathers and daughters, mothers and sons – are a good predictor of future intimate relationship outcomes. “The father has the greater impact on the daughter’s ability to trust, enjoy and relate well to the males in her life… well-fathered
BY TRACEE SIOUX
daughters are usually more self-confident, more self-reliant and more successful in school and in their careers than poorly-fathered daughters,” reports a 2007 Neilsen study. Other studies show that daughters without strong paternal relationships are more likely to experiment with drugs, have inappropriate and risky sexual relationships, become prematurely pregnant, suffer eating disorders and fall prey to sexual predators and abusive men.
Healthy Bond
What constitutes a healthy bond between father and daughter? Dr. Francis Gaebler, Psy.D., 65, of Denmark, Gaebler Kowalski and Sharp Counseling, and the father of daughters, Emily, 26, and Hannah, 29, says attachment and high involvement are the critical factors. “A healthy relationship is about really making sure you have a nice, secure attachment with your child. In the first three years of life is when attachment occurs. How does that occur? By being physically present with your child. As
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kids get older, they don’t need your physical presence as much, but they need you to be present.” says Dr. Gaebler. “The first thing is to really make sure that you’re involved in your child’s life, that goes throughout the life spectrum. High involvement is extremely important starting at birth.” During infancy and toddlerhood personal care, touch, play and teaching are essential for early attachment between parent and child. As children age, time and high involvement in activities and interests are crucial. Ten-year-old middle daughter, Eva Chavez, soaks up her daddy’s attention, “He likes spending time with us a lot, playing games and going sledding in the winter and teasing us.” Without a healthy attachment and a loving relationship parental discipline can have a negative effect. “Rules without relationship make a rebel,” Chavez warns. “It is very important to have his relationship,” says Lola, 8, the youngest Chavez. “So we know what to do and what to believe and what’s right and what’s wrong. Also, so we understand God and how he works in our lives.”
Little Women
During teenage years communication and support are crucial. With today’s imagery about girls it is especially important for fathers to give girls positive messaging about gender roles and what it means to be authentically beautiful, Dr. Gaebler points out. “For our birthdays, my dad takes us out on a date with him, sometimes we have our nails done,” says Savannah, 12, eldest daughter of Chavez. “I think he’s trying to help us learn more about how we should be treated.” If girls do not experience healthy attachment and bonding with their fathers they have a difficult time in future romantic relationships. “Girls first learn how to talk, trust and feel in relationship through their fathers. If girls do not learn how to talk, feel, and trust at a deep level with a man, they may struggle with fully investing in a close, intimate relationship. As a result, they could become either highly controlling in their relationships or choose men who tend to control them, all in an effort to maintain emotional distance,” warns Dr. Gaebler. Dr. Gaebler is concerned that fathers tend to physically distance themselves, particularly from their daughters as they get older. “Many girls experience significant withdrawal from physical contact from their fathers, particularly in their adolescent years,” Dr. Gaebler notes. “Often because of the incest taboo, dads take a step back from their daughters. Of course, girls will find it from other males. If girls don’t have sufficient amounts of physical affection, they will try to fill themselves up with that from sources outside the home. It’s also very important for dads to talk about human sexuality and experiences with their teens.”
Alternative Fatherhood
America’s families are becoming increasingly less nuclear. It is difficult to find statistics that differentiate the long-term outcomes for children
Northern Colorado Medical & Wellness 2013
Clint Eccher and daughter, Mikayla, work hard to keep their relationship strong despite the fact that Mikayla’s mother and father are no longer married.
who have absent fathers from those of children of divorce with active fathers or stepfathers. Gauging the impact of being abandoned by one father, only to have a strong stepfather step up is further complicated. Lacking stronger evidence, anecdotal evidence of the impact of positive alternative fathering will have to suffice. If you’ve spent five minutes with Clint Eccher, 42, owner of A5 Design, then you know he’s the father of Mikayla Eccher, 12. Eccher is involved with everything from chaperoning her school dances to having coached many of her sports teams. “The number one thing I always put above all else is to never break her trust,” Eccher explains. “She has absolute trust in me and I have absolute trust in her, that creates a very powerful bond.” Clint and Mikayla’s mom, Wendy, divorced when Mikayla was 3. Eccher and Wendy share 50 percent custody, both have daily contact with her. Wendy is now married to Jim Muller, together they have a son, Jake. Eccher and the Mullers get along. In fact, Eccher very much appreciates Jim’s influence on his daughter as a step-dad. Eccher makes an effort to have a relationship with Mikayla’s half-brother. As
far as co-parenting and blended families go, Mikayla’s family arrangement is ideal. “She’s never gotten over, after all these years, that we’re divorced,” Eccher says. “She knows we’re not meant to be together, but she still loves it when her mom and dad are together, when we’re in the same place and bonding. Fortunately, we have one of those types of families. I think it is monumentally important for fathers to stay very involved in their kids’ lives and in our instance it’s particularly powerful.” Mikayla believes she benefits from both her father’s and her step-dad’s active presence in her life. “My dad and I are really, really close. He’s one of the closest people in my life,” Mikayla says. “Sometimes, it’s like we can read each others’ minds; we think same things at the same time. He definitely participates with coaching and meditation and we do hip hop together, so he’s just always around for me.” Having a healthy marriage modeled for her by her mother and stepfather has been beneficial, Mikayla reports. “Seeing how my dad reacts with me and how my stepdad acts helps me. They are different. I like having a dad with my mom, to see what a healthy relationship is like with him living with
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my mom and him being the dad of the house. It’s really important to me,” Mikayla admits. Paige Fleener, 21, had no experience with having a dad except for periodic child support hearings, when her biological father would tell the court that he didn’t want anything to do with her. “‘I don’t want you.’ It’s hurtful,” Fleener says. When she was 12, her mom Shauntelle married Nick Henshaw who jumped headfirst into the role of “Dad” to Fleener and her younger brother also named Nick, then 8. At first, she says, it was a struggle. “Everything changed when he came into the picture,” Fleener says. “He had these views about how he wanted his kids raised. He was very Christian and he didn’t want me to wear certain clothes, he didn’t want us to listen to certain music. He took charge, and before, I was in charge. We would butt heads in the beginning; I didn’t want to call him Dad out of stubbornness. It was hard in the beginning.” It took about a year for them to settle into their new family dynamic. “Things changed for the better. He was my Dad,” Fleener says. “The older I got the more I realized that he had married into these two kids, kids he didn’t get to raise. It was a new experience for him and me, and those things he changed were for my own good.” Now married with a daughter, Ava, 2, of her own, Fleener believes that having a dad steered her toward a brighter path. “I think things were a lot easier having the male influence in my life. Things are better than they might have been in my relationships. I feel like I would have gotten in more trouble without him,” says Fleener. “I love having him in my life. When I introduce him he’s not my step-dad, he’s my Dad. He’s raised me, pretty much. It was nice having him walk me down the aisle and he’s a great grandpa.”
Masculine Success
Masculine success has traditionally been judged by income, social status, property and toy acquisition. “What is the profit if you gain the whole world, Mr. Daddy, and lose your children?” Chavez challenges. The five girls we interviewed about how they value their successful relationships with their fathers never mentioned any of those things. These girls judged their daddies by how much time and attention he lavished on them, whether they felt important, wanted and loved. Girls judge a man’s success by the way he makes her feel. “When they see their reflection in your eyes they should never feel average,” Chavez says. For more fatherly advice, Chavez says his doors are open at (970) 222-9165. Tracee Sioux is an Authentic Power Life Coach, author of Love Distortion: Belle, Battered Codependent and Other Love Stories; she blogs at TheGirlRevolution.com. Contact her at traceesioux@gmail.com.
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MEDICAL
Behavioral Health
CHI LDHO O D H ABI TS
T
here’s a fine line between an annoying behavior that will eventually pass and a habit that probably won’t. When it comes to children and their weird idiosyncrasies, sometimes it’s really best to say nothing about a little hangnail nibbling, lest the attention turn an unconscious behavior into an intentional battle. But when Sally is chewing and chewing and chewing her nails until they bleed... intervention may save her a lot of pain and trouble now and down the road. The behaviors that kids manifest in childhood can fall into two categories: self-soothing tics and signs of biological immaturity.
Nighttime Wetting
Bedwetting is one of the most common behaviors seen in pediatric and therapeutic practices. After age 5, about 15 percent of children continue to wet the bed. By age 10, 95 percent of children are dry at night. Boys are twice as likely to wet at night. Those numbers
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really tell the whole story. Eventually, most kids outgrow bedwetting as they mature biologically. The American Academy of Pediatrics (AAP) states that bedwetting is not generally associated with emotional or physical problems and should be treated as a natural occurrence. The academy’s website says, “Although the reasons for bedwetting are not fully understood, it may be related to the time it takes different children to develop control over the nervous, muscular and nighttime-full-bladder sensation that needs to be subconsciously suppressed.” Generally one or both of the child’s parents were also prone to nighttime wetting as children. It seems to occur more in deep sleepers. Therapist, Brook Bretthauer, LMFT, EMDR II, who practices in Fort Collins, suggests that until a child hits age 7 or 8 (younger for girls and slightly older for boys), it’s not an issue that should be pressed. She does suggest parents bring it up at a well child visit to the doctor to rule out the slight possibility that there is a medically treatable condition. Once a child reaches the age where sleepovers and overnight camps become a
BY COREY RADMAN
possibility, they are more mature physically and psychologically. That is the point where they are ready to be an active participant in a night training process. AAP suggests an alarm system like the SleepDry alarm. The alarm has a velcro snap system and a beeper that can be fastened to the shirt and a wire system that fastens into underpants. The alarm beeps when moisture touches the sensors. Little by little, the kids urinate less before waking, until they start waking up before alarm goes off. For a younger child, a loud beep would feel scary but an enthusiastic older child will slowly become conditioned to the feeling before and during nighttime wetting. Eventually, they will wake before the alarm goes off. For younger children, patience and pull-ups are the best plan of action.
Self-soothing Behaviors
Bretthauer indicates that after bedwetting, the most common thing parents ask her about is hair tugging/twisting/pulling. Other unwanted tics often include fingernail biting, thumb sucking, head banging, body rocking
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and masturbation. She also sees emotional eating and overeating, even in young children. She says, “In my practice, oftentimes these behaviors are indicative of a larger problem. People often bring their children to me for a larger issue rather than the tic itself. Sometimes these behaviors may be symptomatic of anxiety issues, extreme stress, lack of healthy coping mechanisms, high conflict at home, or physical/ emotional/sexual abuse. However, these tics are quite common and, often, are nothing to worry about. Many children will outgrow these issues.” Bretthauer lists signs that might help a parent decide when to seek treatment (see below). She explains the therapeutic process. “Therapists can help children process underlying issues, whether through talk therapy, play therapy or other experiential modalities. Often, I try to help children come up with different strategies for dealing with their problems. Kids are very creative and are often able to uncover what they need through a safe, secure therapeutic environment. “Most of the time when I work with young
• When the child no longer participates in activities they enjoy or that are normal for their age; • If a child exhibits severe anxiety and worry; • Marked decrease in academic performance; • Frequent reports of physical issues; • If the child has frequent and extreme outbursts; or • If the child is engaging in any sort of self harm or is stating they want to kill themselves.
children, I work as much as possible with the parents as they have the most influence and time with the child,” she continues. “The therapist can work with both the child and the parents on different self-soothing methods. With problem behaviors, it is especially important that parents create a safe space for kids to feel and process, rather than meet the intensity of their child’s problematic behavior with their own intensity.”
Energy Healing
“These kind of [self-soothing] habits are complex,” says Bonnie Thompson, Healing Touch and Emotional Freedom Technique
Northern Colorado Medical & Wellness 2013
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practitioner. “Especially for adults, we’ve attached a whole bunch of stuff to these habits. Understanding what is driving the behavior is important. But also understand that it’s a deeply ingrained habit. That’s tough. When you’ve got a habit, you don’t think about it, you just go there. You have to interrupt that process. But you also have to deal with the drivers of that behavior.” In her practice, Healing Tree Wellness, Thompson uses a combination of Healing Touch therapy with less familiar practices like Emotion Code and Emotional Freedom Technique. Emotion Code involves testing the muscles while asking questions to find the issues that may be causing a problem habit. Then, she clears the trapped emotions using a magnet. She admits the process seems odd, “but it works – especially with issues that have been around for a while.” Emotional Freedom Technique mixes neural-linguistic programming (self talk) and acupressure. The patient usually talks through a series of statements and reassurances while tapping on a series of acupressure points on their head and trunk. Thompson has helped children and adults with anxiety, stress, bedwetting and nail biting through these modalities. No stranger to anxious behaviors, Thompson gets it since she was also a nail biter. Two years ago she was able to stop using Emotion Code. She says, probably most important in shedding an ingrained habit is to replace it with something more positive. “Just telling yourself to stop creates a self-shaming cycle that doesn’t help.” She suggests envisioning the long nails you want and find a replacement habit that also soothes. Sometimes squeezing a fingertip with the opposite hand is equally relaxing because there are energy points on either side of the nail bed. She says, “I love working with children because they are so open. They take on stuff easily, but also let go of stuff easily. Most of the baggage that we carry around as adults, we picked up in childhood. What a gift to help them let go of it when they are young... instead of when they are 40. Children feel things very intensely, and they don’t quite know what to do with what comes up. Because of that, they tend to make judgments about themselves that are not well informed.” With four kids of her own, she knows the feeling of worry and helplessness parents feel. She suggests showering kids with love. “Parents can reassure their children that they love them no matter what. As parents we correct them, but we can wrap that in the package of ‘It doesn’t matter what you do, I’ll love you no matter what.’ Reassure them that they’ll be loved, even if they make mistakes.”
Corey Radman is a National Press Women award winner and regular contributor to Style. She can be reached at her website, www. fortcollinswriter.com
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Lydia’s STYLE Magazine
Northern Colorado Medical & Wellness 2013
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MEDICAL
Pregnancy
G ES TATIONAL D I A BE T E S RISK FACT O R S
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here are a number of risk factors that lead to diabetes during pregnancy. Most of them are completely beyond the control of the mother-to-be. Fort Collins perinatologist, Michael Schneider, M.D., stresses this to all his patients, “It is extremely important that the patient does not experience guilt based on this diagnosis... there is nothing that she did or didn’t do that caused this complication to her pregnancy.” Let’s back up. To be overly simple, diabetes means the body has high blood sugar levels. After eating, the digestive system breaks most food down into a type of sugar called glucose. Glucose enters the bloodstream and mingles with insulin from your pancreas. The resulting product
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BY COREY RADMAN
is the fuel that your cells use to live. If your body doesn’t make enough insulin or your cells don’t tolerate it well, too much glucose remains in your body instead of getting used up by the cells. Placental hormones can interfere with the body’s ability to process sugars (from carbohydrates) and make the body less responsive to insulin. Since gestational diabetes is usually symptom free, doctors send all moms for glucose testing between week 24 and 28 of the pregnancy. (That’s the test where they have pregnant women ingest a sweet drink with 50 grams of glucose, followed by a blood test.) Dr. Schneider elaborates. “If the initial test demonstrates an elevated blood sugar, a second three-hour test using 100 grams of glucose is given to the patient. With the second test, four blood sugar measurements are done and if two or more elevations
in blood sugar are reported, the patient is given the diagnosis of gestational diabetes.” Women in these groups are at an elevated risk for developing gestational diabetes: •
Having a previous pregnancy complicated by gestational diabetes
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Family history of gestational diabetes (especially 1st degree relatives)
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Over age 35
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Body mass index over 30
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Being part of certain ethnic groups (African American, Hispanic American, Native American and Asian)
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Dr. Michael Schneider, with Rocky Mountain Perinatology, says while lifestyle factors and stress can play a role in gestational diabetes, the onset is often beyond the mother’s control.
Manageable Risk Factors
While there are many risk factors that can lead to gestational diabetes, the only one within the control of the patient is diet. This is the reason that healthcare providers emphasize food as much as they do. Christine Skorberg, M.D., OB-GYN with A Woman’s Healing Center, sends patients with high glucose levels to a nutritionist. “The majority of my patients with gestational diabetes can control it with diet,” she says. “Most of the time, they don’t realize they may be eating too many carbohydrates. Some carbs are fine, just not too many and have a protein with them.” She adds, “You’re really not eating for two, though that has been the perception in previous times. Most people these days are eating enough food to grow a baby. So there is no need to up your calories unless you are underweight. Aim for healthy foods. Get enough exercise. Sleep well. And take care of yourself.” Patients also learn to test their own blood sugar levels, which they report back to their physician after their first week tinkering with diet. At this point, Dr. Skorberg monitors patients much more closely, adding in ultrasounds and non-stress tests to stay on top of the situation. For patients whose levels don’t normalize, she refers to Dr. Schneider. Dr. Schneider’s practice, Rocky Mountain Perinatology, takes similar first steps. “We discuss a healthier balance between carbohydrates, proteins and fats in the patient’s diet. We recommend avoiding high caloric snacks.
Northern Colorado Medical & Wellness 2013
We teach basic carbohydrate counting and the ‘Plate Method’ for healthier eating as recommended by the American Diabetes Association.” Plate Method suggests half the lunch and dinner plate be non-starchy vegetables like greens, carrots or cauliflower. The remaining fourths are a protein (like meat or eggs) and lastly, a starchy item like whole-grain bread or beans. Dr. Schneider encourages exercise based on the patient’s level of fitness. “Stress management is also discussed since the diagnosis of gestational diabetes can add to the normal stressors of pregnancy. If these changes do not improve the patient’s blood sugar control, the options of either oral medication or insulin are discussed with the patient. Our goal from the first visit forward is to maximize the patient’s blood sugar control to minimize adverse events and our mutual goal of a healthy mom and a healthy baby.” Childbirth is often induced a little early at 38.5 to 39 weeks to avoid high birth weight and complications from that.
Go to the Doctor
When well controlled, gestational diabetes need not affect mom or baby. However, when not managed, it can result in increased hypertensive complications and preeclampsia. Caesarean section rates increase. Infants may be larger, which can result in difficult or traumatic births. Also, the newborn can have metabolic problems like low blood sugars or
Dr. Christine Skorberg, OB-GYN, A Woman’s Healing Center
elevated bilirubin. Dr. Schneider counsels, “It is important to know that moms with gestational diabetes have a 30 to 40 percent increased risk of developing Type II diabetes within five to 16 years after delivery. To prevent Type II diabetes, weight loss, healthy eating and exercise are key preventative measures.”
Think Ahead
If a woman isn’t yet pregnant, but going to try, Dr. Skorberg advises all women to come in for a pre-conception visit. Even if they aren’t in the risk groups, it’s important to think ahead. Again, doctors seek to control what they can, knowing that there is a lot beyond our reach. She says, “I like to see women maybe three months before getting pregnant. We talk about getting off birth control safely, talk about timing, diet and exercise. And maybe get tests to rule out potential problems.” She adds that even with a diagnosis, moms don’t need to worry excessively. “We reassure moms that it’s good they’re coming to see us. We’re monitoring their blood sugar and other factors. That’s why they come to us... to make sure they are safe and the baby is safe.”
Corey Radman is a National Press Women award winner and regular contributor to Style. She can be reached at her website, www.fortcollinswriter.com.
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MEDICAL
Pediatric Eye Health
Dr. Patrick Arnold, with the Eye Center of Northern Colorado, uses a number of fun toys including this color spinner to keep the patient’s fixation during an examination.
PE DIAT R IC EY E H E A LTH
KEEP IT SIMP L E
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e don’t think about it all the time, but it’s something we use every waking moment of every day. Sight is an important and crucial part of life and the health of our eyes should be monitored starting at birth. While many pediatric eye problems cannot be prevented, they can be corrected if diagnosed early. If these issues are not addressed they can result in lifelong problems and even blindness. Parents, however, shouldn’t worry unnecessarily about their children’s eyes. If well visits are performed on a regular basis by a pediatrician, they can rest assured that any issues will be found and addressed promptly. At birth, a baby’s eyes are 65 percent of the size of an adult eye. A newborn can only see about 12 inches, has 20/400 vision and sees mainly in black, white and gray. Babies start to see color by 4 to 6 months and depth perception occurs around 5 to 6 months, although the eyes may not
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track evenly until 6 months of age. By 6 months the vision has improved to around 20/40 to 20/50 and by age 8, vision should be 20/20. Pediatricians see children from birth to age 2, and at every routine well check they will evaluate a child’s vision. The recommended well-check visit schedule is birth, two weeks, two months, four months, six months, nine months, one year, 15 months, 18 months and yearly from age 2 through 21. “At age 3 we attempt, and about 50 percent of the time we can get, a vision screening, and we do it every year all the way to 21. We’re watching for visual acuity and looking for the less common things too,” says Jennifer L. Markley, M.D., pediatrician and owner of Pediatric Associates of Northern Colorado. “Whenever there’s a concern we always refer to an ophthalmologist, especially if we can’t get a good vision screen here.” If a child’s vision is worsening at each of their well checks, Dr. Markley will refer them to an ophthalmologist. If there’s a sight disparity between the two eyes or if there are concerns about a
BY HEIDI KERR-SCHLAEFER
lazy eye, she sends them to an opthalmologist, but generally, pediatricians are the primary eye healthcare providers for their patients. There are a number of pediatric eye problems, many hereditary, and Dr. Markley refers those patients to Patrick Arnold, M.D. at Eye Center of Northern Colorado. Dr. Arnold is the only pediatric ophthalmologist in Northern Colorado. “The most common issues I see are problems with development in terms of the pathways in the brain for processing visual details,” says Dr. Arnold. In basic terms, three pathways need to form in the brain: eyes together and each eye separately. Amblyopia is when the brain’s visual pathways for processing details do not develop for one or both eyes. The most critical time for pathway development is within the first two years of life, but continues on until around nine years of life. When one eye doesn’t see well, due to strabismus (misalignment of the eyes), severe astigmatism or an obstruction such as cataracts or tumors, the brain gets confused. It can’t compensate so it shuts down the effected visual pathway. About 2 to 5 percent of the population has
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Dr. Jennifer Markley, with Pediatric Associates of Northern Colorado, emphasizes the importance of catching eye problems early through regular well visits.
strabismus and it is hereditary. It is also the most frequent cause of amblyopia and if it isn’t addressed a child may be blind in an otherwise healthy eye simply because the brain’s visual pathway never formed. “If a child’s eyes are crossed at 6 months and the right eye is crossed all the time, then he is stimulating the pathways for the left eye, but not the pathways for the right eye or both eyes together, so only one of the three visual pathways is forming. For that child, we’ll do a patch over the left eye to stimulate the right eye and then we’ll get them on the surgery schedule as soon as we can,” says Dr. Arnold. “The risk with the condition is the need for additional treatment and that might be glasses, patching, exercises or more surgery.” Less common eye conditions in children are cataracts. Cataracts have a variety of causes usually related to systemic issues. Also hereditary, cataracts most often occur at birth or shortly thereafter, although there are exceptions. “One of the more common causes of cataracts is trauma,” says Dr. Arnold. “Safety glasses will often prevent those types of injuries.” Dr. Arnold recommends safety glasses in all situations where an eye can be injured including sports and even home activities like hammering nails. Other less common eye conditions can occur in children such as glaucoma, eye infections and eye tumors, among others. Premature babies are at risk for blindness because the blood vessel
Northern Colorado Medical & Wellness 2013
development in the back of the eye doesn’t complete until 41 to 42 weeks. When babies are born early, those blood vessels can grow abnormally and if they do, laser surgery is performed to halt the abnormal vessel growth. Between well checks there are symptoms parents can watch for including a child sitting too close the television, excessive eye rubbing, tearing, squinting, sensitivity to light, poor alignment of the eyes and learning problems such as trouble reading. If a parent notices their child has one white and one red eye in photographs, and they should seek medical attention as this may indicate retinoblastoma, a treatable childhood eye cancer. “Catching problems early is most crucial,” says Dr. Markley. Children are visual learners and occasionally act out when they can’t see well at school. This behavior can lead parents and teachers to worry about ADHD or other learning disabilities. “Kids can often struggle academically because they might not recognize that they don’t see,” explains Dr. Markley. “There are lots of things we do for learning disability screening and vision is fundamental in that.” Comprehensive, routine screenings conducted at a pediatrician’s office will, in most cases, get to the bottom of behavioral issues, whether they are eye related or whether the child has a learning disability. In both doctors’ opinions, children seldom slip through the cracks if they are receiving routine
well checks. Parents who are concerned with eye problems being misdiagnosed as behavioral issues such as ADHD should rest assured that it is not common. Dr. Arnold points out that one of the main reasons a child could potentially be misdiagnosed is because he or she cheats at the eye exam. These children don’t realize they are doing themselves a disservice; they simply want to do well on what they perceive to be a test. Healthcare providers are aware of this possible problem, and try to avoid it by doing things like changing up eye chart letters and symbols. “Parents are great observers. If they know something’s wrong then the child should be seen for a full eye exam,” says Dr. Arnold. “If they aren’t reading at grade level and there’s no explanation, that’s a child who should be seen at least once to make sure that vision isn’t playing a part, but most kids don’t need a yearly eye exam.” When it comes to a child’s eye health, routine wellness checks should be conducted, but unless there’s a problem with pathway development, or an issue that will impact their quality of life, or a concern with the quality of life down the road, Dr. Arnold advises to keep it simple. Heidi Kerr-Schlaefer is a freelance writer & journalist. She is also the Mayor of HeidiTown.com, the place for Colorado festival, event & travel information.
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MEDICAL
Addiction
OVE R THE C O UNT E R
DR U G AND SUPPLE M E N T A B U SE BY EMILY HUTTO
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here’s an emerging trend in drug use that’s hitting Colorado hard – many recent studies show prevalent and increasing numbers of over-the-counter drug and supplement abuse, especially among adolescents. Think about your medicine cabinet, likely stocked with Advil, NyQuil, and maybe some allergy suppressants for the change of the season. Now think about your pantry, where there may be energy drinks like Redbull, and cooking herbs like nutmeg. For a lot of children and teenagers, these products aren’t a means to curing ills, boosting their energy levels or perfecting cookie recipes – instead they are readily available means for getting high. Over-the-counter (OTC) drugs are pharmaceutical products that to do not require a doctor’s prescription. They can be obtained in stores, and are regulated by the Food and Drug Administration. Some examples of commonly abused OTC drugs are antihistamines such as Benadryl, cough suppressants with dextromethorphan such as Nyquil and Robitussin, motion sickness pills such as Dramamine, laxatives and diuretics. OTC supplements, which are products that
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aren’t regulated by the FDA, include herbal products and vitamins. Some supplements and other natural products have the potential for abuse such as salvia, a plant often sold in home and garden stores; synthetic marijuana, including mixes like bath salts and “Spice,” typically sold in convenience stores; and nutmeg paste, found in specialty grocers. The use of OTC drugs and supplements is prevalent among adolescents, especially within the state, though there aren’t concrete numbers available about exactly how many kids are using, or for what reasons. The Drug Enforcement Administration of the U.S. Department of Justice, for example, reports that one teen in every 10 has admitted to abusing cough medicine to get high; however, it is important to consider that not every young adult is willing to admit to his or her usage. Another concerning statistic comes from the University of Michigan’s 2012 Monitoring the Future study, which revealed that after marijuana and alcohol, both prescription drugs and over-the-counter drugs are the most abused substances by Americans over the age of 14. This data, though, doesn’t indicate the intention of the users. “I have a problem with the word ‘abused’ because I don’t think that all of the instances of [drug] overuse are necessarily abuse,” says
Elizabeth Buxton, Pharm.D., with Good Day Pharmacy in Wellington, Colorado. She attributes a lot of drug “abuse” to errors of ignorance; for example someone might take another Tylenol if his or her headache won’t go away, a practice that Dr. Buxton calls a “two is better than one mentality.” Without proper education about the side effects of Tylenol (seizure, coma and death, among others) and other OTC drugs and supplements, young adults are likely to innocently misuse them, suggests Dr. Buxton. “In my field ‘abuse’ typically refers to people who use drugs to get high or for the feeling they produce,” says Dr. Richard Miech of the University of Colorado Denver. The professor in the university’s Department of Health and Behavioral Sciences recently published a study in the Journal of Adolescent Health about the non-medical use of drugs among adolescents. His research is specific to prescription medication, which is often coupled with OTC drug use statistics because both are so readily available to children. Think back to your medicine cabinet – there’s a good chance there are leftover painkillers from a past injury in there. “We have a tendency to trust [teenagers] to take their own meds,” Dr. Buxton says. “Taking medications that are perceived as safe because they’re over-the-counter can give them
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We have a tendency to trust [teenagers] to take their own meds. Taking medications that are perceived as safe because they’re over-the-counter can give them autonomy, privacy. We don’t go through their bathroom cabinets…
Elizabeth Buxton, Pharm.D., Good Day Pharmacy in Wellington
autonomy, privacy. We don’t go through their bathroom cabinets...” No matter if kids are innocently misusing or abusing OTC drugs and supplements, the point is that they’re using them in general. The first step to counteracting this problem, says Dr. Buxton, is parents educating themselves about what they have in the house that can potentially be misused, knowing their side effects, and communicating with children about how dangerous they are. “Access to all medications, over counter or prescription, should be limited from all persons in the household, young or old. Make sure that everybody understands that just because it’s over the counter doesn’t mean it’s okay to take extra.” Beyond education about and limiting access to OTC drugs and supplements, Dr. Miech thinks that the media can play a big role in decreasing their non-medical use. “The last big drug epidemic we had in the U.S. was for the outcome of cocaine use. Around the late 1980s the media got the word out about cocaine’s dangers and addictive properties, and the perceived danger of cocaine increased dramatically as prevalence fell,” he recalls. “Hopefully the media can do the same with prescription drugs (and presumably over-thecounter drugs as well).”
Northern Colorado Medical & Wellness 2013
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A Glance at OTC Drugs and Supplements Commonly misused and abused OTC products: •
Energy drinks
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Caffeine pills
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Laxatives and diuretics
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Pain relievers
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Cold medicine (with “DM” in the title)
• Salvia •
Synthetic marijuana
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Nutmeg paste
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Herbal ecstasy
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Sleep aids
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Motion sickness pills
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Sexual performance medications
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Nasal decongestants
The average age of first-time drug use in the United States is 13.5 years old. Abuse of OTC drugs is most common in adolescents, ages 13 to 16 years old. One teen in every 10 has reported abusing cough medicine. Boys have a higher risk of longtime use of OTC drugs. Adolescents who are involved in school clubs, sports, community and church organizations are less likely to report using OTC medications. Those more likely to report taking OTC drugs also report that they had attended parties with the drugs or had friends who abused OTC drugs.
*Information taken from www.drugfree.org.
Emily Hutto is a freelance writer based in Fort Collins.
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Northern Colorado Medical & Wellness 2013
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MEDICAL
C r o h n ’s D i s e a s e
Dr. Michael Nosler, gastroenterologist with Colorado Health Medical Group, explains the varied signs of Crohn’s disease.
UN DER STANDI N G
CROHN’S DISEASE
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hile advances are being made, there are still as many questions as there are answers when it comes to the cause and preferred treatment of Crohn’s disease. This chronic disease is a form of inflammatory bowel disease that targets primarily adolescents and young adults. According to the Crohn’s and Colitis Foundation of America (CCFA), Crohn’s is most prevalent among ages 15 to 35. As many as 700,000 Americans are affected by Crohn’s disease, and symptoms can vary widely with periods of remission. But when a case of Crohn’s is severe, the symptoms can be debilitating and lead to a poor quality of life with the treatment alternative often being harsh medicines with many side affects. Michael Nosler, M.D., gastroenterologist with Colorado Health Medical Group, says initial signs of Crohn’s disease most often present in unexplained chronic abdominal pain, diarrhea and weight loss. “Especially in the young pediatric group, pediatricians will see patients falling off the growth curve and there may be some nutrition issues linked with that.”
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But the disease does have a wide range of indicators. “Some can have a very mild form and others a more aggressive course. Some will have intermittent abdominal pain, but nothing more over the course of their life. Others can have a serious bowel obstruction right out of the gate.” Crohn’s, a systemic disease, can also have a variety of other manifestations seemingly unrelated to the bowel, such as skin rashes or rashes in the mouth, or it may affect the joints or liver. The lower small intestine is most commonly involved with Crohn’s disease, though it can cause irritation anywhere from the mouth to the anus, says Dr. Nosler. The cause of Crohn’s is unknown, though it is a disease that targets American and industrialized Western societies, says Dr. Nosler. It is less common in equatorial countries and Asia. When looking at geographical markers and other epidemiological indicators, “there is a theory out there that, with Crohn’s, a person probably had a genetic predisposition and then was exposed to the wrong thing and the immune system was inappropriately triggered to overreact – some combination of the environment and genetics creates the perfect storm for the disease.” Crohn’s can sometimes be difficult to diagnose because it is so similar to other inflammatory bowel
BY ANGELINE GRENZ
diseases. Most often, a patient goes to their family doctor with a pattern of symptoms that are indicative of Crohn’s or other inflammatory bowel disease. They would then be referred to a gastroenterologist for testing, generally by biopsy and imaging. Other indications that a physician looks for are fistulas in the bowel, a thickened bowel or a perforation of the colon. An intense focus of current research is how to best define the disease in the patient, and thereby define the treatment. If the patient has a particularly aggressive form, then it is to their benefit to start with a more aggressive treatment plan, says Dr. Nosler. “Our goals are quality of life, and to prevent future surgeries and hospitalization.” Once diagnosed, the disease is treated with medication. Despite the fact that the types of medication used haven’t changed in a decade, there is some recent discussion on the best way to approach Crohn’s, with new studies that point to the benefits of an aggressive initial treatment to the disease, regardless of severity. But there are doctors who hesitate because of the strong nature of the medicines used and their adverse side effects. One treatment method is the anti-TNF alpha therapy. This therapy blocks the chemical that inflammatory cells use to communicate with each
Lydia’s STYLE Magazine
Initial signs of Crohn’s disease most often present in unexplained chronic abdominal pain, diarrhea and weight loss. Especially in the young pediatric group, pediatricians will see patients falling off the growth curve and there may be some nutrition issues linked with that. Michael Nosler, M.D., Gastroenterologist with Colorado Health Medical Group
other and puts the disease in remission. One such medication is Humira, which is most often used in the treatment of rheumatoid arthritis. The drawback is that these types of medications are powerful immunosuppressants. In rare occurrences, they can cause an increased risk of lymphoma. Other therapies to treat Crohn’s can cause an increased risk in other cancers such as skin cancers, especially with prolonged use. In younger children, some of the steroid treatments can affect growth and development and bone density. Uncontrolled inflammatory bowel diseases in general can also make it difficult for women to get pregnant. But some of the medications used to treat Crohn’s can affect the fetus and a physician might recommend women not get pregnant while taking them. “The young, fertile female is a difficult case,” says Dr. Nosler. Most cases of Crohn’s can be controlled with medication, but occasionally surgery is also needed. These are the most intense cases where the disease has caused a perforation in the colon or a bowel obstruction, and infections or abscesses can result from these structural complications. Some patients, whose disease has scarred the colon, may have to follow a specialized diet, one that leaves little residue in the colon. These people are still at risk for an obstruction in the future. While studies are underway, Crohn’s disease still holds many mysteries for physicians. “When you talk about Crohn’s disease, it is almost like everything we say highlights how little we seem to know about it in a way that we can predict with certainty what is going to happen to a patient,” says Dr. Nosler. “It all depends on what type of Crohn’s patient you are.”
Angeline Grenz is managing editor for Northern Colorado Medical & Wellness magazine.
Northern Colorado Medical & Wellness 2013
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WELLNESS
Incontinence Help
incontinence, vaginal prolapse, scar tissue and rectal issues such as incontinence, hemorrhoids and laxity. The treatment encompasses the area from the pubic bone to the tailbone, and involves the use of a laser device that utilizes radio frequency and light based therapy to address muscle laxity and tone in the entire pelvic floor. The laser is used externally and the procedure takes approximately one to oneand-a-half hours. There is no redness, pain or burning during treatment. Patients are advised to avoid intercourse for a short period after the procedure. “It was so simple and so easy I couldn’t believe it,” reports Mary, 34, who preferred to remain anonymous. “It’s relaxing, it’s not painful or anything like that.” Clinical studies report that stress incontinence patients had 90 to 100 percent improvement of leaking with a series of three to six Genityte treatments; those that suffer from stress incontinence plus frequent urination urges had 80 to 100 percent improvement.
The Price of Womanhood
NEW HELP FOR I NC ON TIN EN C E BY TRACEE SIOUX
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r. Christiane Northrup, OB/GYN and author of Women’s Bodies, Women’s Wisdom, calls women’s stress incontinence “part of our charm.” Yet, many women don’t feel quite as affectionate as Dr. Northrup about urinating when they laugh, cough, sneeze, play with their kids or participate in sports. Mallory Family Wellness, in collaboration with its affiliate Looks Medical Aesthetics (LMA) in Loveland, is one of only five medical practices in the country now offering a new laser-based procedure, Genityte. This procedure, developed by Dr. Julie Reil, offers a non-surgical option to treat stress and urge
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Vaginal birth typically leaves its mark whether from episiotomy, tearing, a weakened uterine wall or vaginal prolapse. Other contributors include miscarriage, abortion, illness and infection, fibroids, radiation, cancer, hysterectomy, injury or even strenuous physical activity. Kegel exercises (vaginal tightening and releasing) have long been recommended to strengthen the uterine area and in many cases bladder sling surgery is performed. However, Kegel results vary and risks are involved with surgery. “As a mom of two, I really struggled with continence when I sneezed and I had to worry about leakage. I had to go to the bathroom up to four times every night,” says Mary. “I’m only 34, I shouldn’t have to deal with this.” Jan 55, a receptionist at LMA, says she’s dealt with gynecological issues for 20 years. She had two vaginal births, four pregnancies, two miscarriages, one DNC and a hysterectomy, which weakened everything in the uterine area. She previously underwent several surgeries for these issues; she also had a sling implanted. “The bladder sling didn’t work at all, it made it worse,” reports Jan. “It sometimes took years to heal from the other surgeries, if I even healed at all.” Both women report satisfactory results after only one Genityte treatment. “I can’t believe the changes in only 24 hours,” says Mary. “It was so easy and simple, I couldn’t believe how simple. I can’t wait until the next one, I’ll do one more for sure and maybe a third.”
Ya Ya Facelift
A side benefit being touted by patients who have received Genityte treatments is the aesthetic improvement of the vaginal area. Mildrum light-heartedly refers to it as the Ya Ya Facelift effect. “All joking aside, as the effects of pregnancy, childbirth, hormones and aging take their toll, many women are left to suffer from loss of sensation, decreased vaginal tone and laxity in the external tissues. These issues can wreak havoc with intimacy.” For patients suffering with these types of issues, the Genityte procedure offers the possibility of rekindling the fire. “It basically tones and tightens the tissue in the affected area, not only improving sensation but also giving a generally more youthful/pre-delivery appearance,” reports Mildrum. “Positive patient feedback with regard to the unexpected improvements in these issues has led us to add new treatment protocols that address these intimacy issues.” Jan is happy with the continence effects and the added aesthetic side effects of the procedure. “I guess it shrinks everything back to normal size and it lifts it. As we age everything seems to fall and drop and gets out of proportion. This makes it look like you were as a younger woman,” says Jan. “It wasn’t painful and it was not an embarrassing procedure. Sometimes we’re afraid of what we don’t know, but it was the easiest thing.”
Equal Opportunity
One of the interesting things to note about the Genityte procedure is that it also offers a treatment opportunity for men. The same muscle loss and laxity in the pelvic floor region that causes incontinence and the other issues in women, can contribute to erectile dysfunction, failure to achieve orgasm and rectal incontinence in men. Age, sickness and/or injury are typically the contributing factors that lead to these issues in men. Once traditional therapies such as hormone replacement, etc. have been exhausted, Genityte can offer a solution. The first step in determining if Genityte might be an option for you is to set up an appointment for an evaluation with Mallory Family Wellness. If the providers believe that Genityte would be a good option for your issue, they will recommend a treatment plan and refer you over to Looks Medical Aesthetics for the treatment. LMA is offers customized Genityte treatment plans that range from $3,000 and up. For more information call (970) 669-9245.
Tracee Sioux is a freelance writer based in Fort Collins.
Lydia’s STYLE Magazine
WELLNESS
Natural Remedies to wake people in the middle of the night. • Stress causes the body to clench up and the mind to race. To get a restful and rejuvenating sleep a person’s mental activity must cease. Often stressful jobs, familial pressures or a trauma can interfere with a person’s ability to relax enough to drift off and stay asleep. • Sleep apnea can be caused by excessive weight or indulgent drinking. Patients with sleep apnea can wake multiple times per night, sometimes up to 30 times per hour, because they temporarily stop breathing. Sufferers wake groggy in the morning. Serious conditions such as heart disease can result. One symptom is snoring, which can cause partners or spouses to experience a poor night’s sleep too. Sleep apnea is a serious condition that warrants medical evaluation and treatment.
Sleep Easy with Natural Remedies
Dr. Jacqueline Fields and Sandra Cantrell, certified homeopath, with Healing Gardens
N ATURAL
SL E E P R EMED IES
A
ccording to WebMD one-third to one-half of all Americans experience insomnia or other sleep disturbances. While stress and lifestyle habits are the most common culprits of the Sandman’s calling in sick at bedtime, there are other lesser-known causes that people overlook. Lack of sleep causes weight gain, lack of productivity, inability to concentrate, difficulty focusing, irritability, depression, anxiety and increased stress-related illness and disease. Lifestyle factors that can contribute to sleeplessness include: • Screen time is a little known sleep thief. It’s not simply that your brain is over stimulated; the artificial bright backlighting has been shown to affect the biological clock and
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BY TRACEE SIOUX
Often doctors prescribe medication to help people get a decent night’s rest. However, some of these medications are addictive and others cause side effects such as sleep eating (unconscious midnight eating, akin to sleep walking). Natural remedies can often work more effectively than prescription medications without the nasty side effects, says Sandra Cantrell, certified homeopath and manager of Healing Gardens, the integrative medicine practice of Dr. Jacqueline Fields, M.D. Board certified in both family practice medicine and holistic medicine, Dr. Fields often prescribes herbal supplements and lifestyle changes for sleep disturbances. She relies on lab results to determine which supplements will be most beneficial for individual patients. “Dr. Fields runs lab tests to determine what is causing sleep problems,” says Cantrell. “It’s so individually specific. Your neighbor might have great success with melatonin, but body chemistry is very individual.”
Natural sleep remedies include: circadian rhythm. A study published in the May 2003 Journal of Applied Physiology showed that screen time alters melatonin production. Avoiding cell phones, tablets and computers two hours before bedtime is recommended. • Sugar and caffeine are stimulants and should be avoided after noon or 2 p.m. • Exercise, which literally changes a person’s brain waves, is essential to all healthy lifestyles. Incorporating exercise into your lifestyle will improve nightly sleep patterns. • Alcohol will disrupt sleep usually between the wee hours of 2 and 4 in the morning. The liver has a difficult time processing alcohol, which immediately converts to a sugar. When the liver is working too hard, whether from alcohol or other foods and toxins, it tends
• Meditation, yoga, exercise, avoiding screen time two hours before bedtime and a calming nightly routine all improve sleep patterns. • Liver support supplements, such as acetylglutathione, can be very effective if people are waking in the middle of the night. • Magnesium is an essential mineral for heart, brain and kidneys. Magnesium is a nervous system relaxant, specifically relaxing muscle tension and cramping that can interfere with sleep. • Sedalin can open up the breathing system and create a sense of relaxation, aiding sleep. • Serotonin supporting supplements can be transformative for neurotransmitters. Some supplements include melatonin, tryptophan and 5-HT. One should have blood tests that indicate the need for serotonin support because if people don’t need to stimulate
Lydia’s STYLE Magazine
Even with the use of natural sleep aids, patients should consult with an expert.
serotonin production these supplements might have adverse effects. • Amino acids such as gamma-aminobutyric acid (GABA) can also positively affect neurotransmitter function and mood. • Ashwagandha, an Ayervedic herbal supplement, manages cortisol, which is a steroid hormone response to stress that can cause sleep disturbance and other problems such as belly fat. • Tyrosine can improve overall mood and reduce sugar and food cravings, which will in turn improve sleep. Cantrell does warn that herbs and supplements should be thought of as medicine. While you don’t need a prescription for supplements, they can be as, or more, powerful than prescription medications. Health providers can order blood tests, which will indicate what deficiencies might be causing sleep disturbances. “Children are not little adults,” warns Cantrell. “Mild relaxants such as chamomile are okay. Unless a product is specifically for children, you need a doctor to give you special dosing information.” Additionally, Cantrell notes that the FDA does not monitor herbal supports and supplements. This means there is a wide variation in the potency and efficacy of supplements. “You can’t rely on milligrams stated on the packaging,” Cantrell says. “Milligrams are a weight measurement and they don’t tell you how potent a supplement is. When you get the supplements from our pharmacy you can be sure that Dr. Fields knows what’s in it and how potent and effective it is.” Sleep is an essential component to health and well being. If you’re seeing the clock at 2:30 a.m., and counting sheep isn’t working, it’s time to get some help. Tracee Sioux is an Authentic Power Life Coach, author of Love Distortion: Belle, Battered Codependent and Other Love Stories; she blogs at TheGirlRevolution.com. Contact her at traceesioux@gmail.com.
Northern Colorado Medical & Wellness 2013
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IS THE PALEO DIET FOR YOU? BY ANGELINE GRENZ
FEEL THE BURN BY ANGELINE GRENZ
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If you follow the diet trends, then you have likely heard of the Paleo Diet. This diet is based upon our hunter-gather ancestors who mostly enjoyed fresh meats, fresh fruits, fresh veggies, healthy fats and nuts. The idea sounds intriguing and the popularity of the diet is still touted by a variety of sources today. The Paleo movement has received widespread attention from magazines such as Men’s Health and Men’s Fitness. The diet is based on removing processed foods from your diet, reducing the amount of carbs, and removing gluten and sugar. In creating the diet, Dr. Loren Cordain researched the eating habits of our Stone Age ancestors and published his book, The Paleo Diet, in 2002 and followed it with The Paleo Diet for Athletes, The Paleo Diet Cookbook and The Paleo Answer, his most recent book. Dr. Cordain is a Colorado State University professor in the department of health and exercise science. Dr. Cordain’s research concluded that our ancestors were free from many of the chronic illnesses that plague Western populations, such as obesity, cardiovascular diseases, diabetes, cancers, even acne and hemorrhoids. According to Dr. Cordain, the Paleo diet is the “unique diet to which our species is genetically adapted.” The diet helps trim the waistline, according the ThePaleoDiet.com website, because it is high in protein, fruits and veggies with moderate to higher amounts of fat. Those who follow the Paleo diet are more satisfied because the protein keeps a person feeling fuller longer. It also states that the diet’s low-glycemic load means there are no spikes in blood sugar and insulin levels. Excessive insulin and blood sugar can cause obesity, hypertension, high cholesterol and Type 2
diabetes. While on the Paleo diet you can eat lean meats (grass-fed is preferred), fish, poultry, eggs, vegetables, fruits and nuts. You must avoid dairy, grains, sugar, legumes, potatoes and processed oils. The basic tenant is not to eat anything that wouldn’t have been readily available 10,000 years ago. On the diet, also avoid salt and skip any beverages other than water and green tea. What do the experts say? Most say that while the diet has some benefits – plenty of fresh vegetables and fruits, an avoidance of processed foods – it may be too limiting for the average person and longevity may not be feasible. There is also the concern that individuals may not take in enough calcium on the diet. Academy of Nutrition and Dietetics spokesman Jim White, RD, ACSM/HFS, said about the Paleo diet, “We live in a society where it is not possible to eat exactly as our ancestors ate. For example, wild game is not readily available, as most of the meat we consume has been domesticated. And the plant food we eat has also been processed rather than grown and gathered in the wild… While strict conformity is not realistic, it is possible to modify the plan, eating only wild caught fish, grass-fed meat, and organic fruits and vegetables… But even that can be hard to follow because of lack of variety, need for planning, supplementation and cost.” Kathleen M. Zelman, MPH, RD, LD, with WebMd, encourages anyone considering the diet to supplement his or her diet with calcium and vitamin D. If the diet is strictly followed, she says, weight loss is likely but may be short-lived as individuals eventually add in other foods and cease to keep up with its strict nature.
Not all workouts are created equal, especially if you are looking for a high-calorie burn. But the type of exercise is not the only consideration. Duration of activity, the addition of strength training and frequency can make an impact. To get the most out of your workout, commit to at least 150 minutes a week of moderate aerobic activity (30 minutes/five days a week) or 75 minutes a week of vigorous aerobic activity, says the Mayo Clinic. However, they add that to lose weight, some individuals may need up to 300 minutes a week of moderate physical activity (or one hour/five days a week). They list among moderate exercises brisk walking, swimming or mowing the lawn.
The Mayo Clinic also adds a little calorie math to help patients lose weight: approximately 3,500 calories equals 1 pound of fat. “You need to burn 3,500 calories more than you take in to lose 1 pound… if you cut 500 calories from your diet each day, you’d lose 1 pound a week.” To up your calorie burn and trim the time spent working out each week, consider vigorous workouts that burn more energy. Among the highest calorie burners (amount burned per hour, based on a 160-pound person): High impact aerobics = 533 Playing basketball = 584
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G E T F I T, G I V E B A C K C A L E N D A R Annual Hope Lives! Pink Boa 5K Run/Walk Celebrate breast cancer survivorship at this annual 5K run/walk held on May 18, 2013. The 5K run/walk takes place at the Front Range Village (2720 Council Tree Ave., Fort Collins), starting at 8:30 a.m. After race activities include entertainment, vendor fair, prizes and a food court. Pink Boa raises funds to support the mission of Hope Lives! The Lydia Dody Breast Cancer Support Center and its mission to support and strengthen those touched by breast cancer. To register, volunteer or sponsor, visit www.hopelives.org or call (970) 225-6200.
Get involved in giving back and being active! Many of these great events donate their proceeds to nonprofit organizations. MAY
4 – Cinco Cinco 5K, 7 p.m., starts and ends at the CSU Oval, proceeds benefit the Gil Gutierrez Memorial Scholarship Fund, www. cincocinco.colostate.edu
18 – Pink Boa 5K, 8:30 a.m., Front Range Village, Fort Collins, benefitting The Lydia Dody Breast Cancer Support Center. www. hopelives.org
5 – The Colorado Marathon, race down the Poudre Canyon, check for openings – most races cap out early. www.thecoloradomarathon.com
18 – 6th Annual Family Medical Clinic Fit Family 5 Mile, 9 a.m., Stanley Park in Estes Park, proceeds benefit Families for Estes and Lifelong Learning of Estes Valley, www. fitfamily5mile.org
11 – A Day in May Predict 5K, Walt Clark Middle School, Loveland, visit www. wcmshealthandwellnes.wix.com/a-day-inmay-5k for more details.
25 – Pelican Fest Triathlon, 8 a.m., Windsor, www.t2coaching.com
11 – Second Annual New Vision 5K Run/Walk, 8 a.m., Boyd Lake State Park, Loveland, www. newvisioncharterschool.org 11 – Run for Orphans 5K Run/Walk, 8 a.m., Larimer County Fairgrounds and Events Complex, raising funds for the needs of orphans in our communities, www.runfororphansrace. org 11 – Quad Rock 50 and 25 Mile Trail Races, 5:30 a.m., Lory State Park and Horsetooth Mountain Park, Fort Collins, www.gnarrunners. com 12 – Crazy Legs Race Series 10K, 7 a.m., Devil’s Backbone Open Space in Loveland, www.crazylegsraceseries.info 12 – Strides for Epilepsy 5K, 10:30 a.m., at Colorado State University, www. epilepsycolorado.org
Playing football, touch or flag = 584 Running (5 mph) = 606 Running (8 mph) = 861 Stair climber at the gym = 657 Tae kwon do = 752 Singles tennis = 584 Rollerblading = 548 Ice-skating = 511 Racquetball = 511 Jumping rope = 861
Northern Colorado Medical & Wellness 2013
JUNE
1 – Fort Collins Children’s Triathlon and Family Fun Run, 8 a.m., O’Dea Core Knowledge Elementary, www.fortcollinschildrenstriathlon. com 1 – Sierra’s Race Against Meningitis, 8:30 p.m., The Ranch @ The Budweiser Event Center, www.sierrasraceagainstmeningitis.com 2 – Front Range Relay, Fort Collins to Bouldrer 50-mile Sprint Relay with 5-person teams, www.rltrelays.com 8 – 23rd Annual Fire Hydrant 5, Edora Park, Fort Collins, proceeds benefit Larimer Humane Society, www.larimerhumane.org 16 – The Coda Coffee Estes Park Marathon, ½ Marathon, 10K, 5K, Kids Fun Run, Estes Park, www.epmarathon.org
Other activities, including cycling, boxing and cross-country skiing, burn around 600-700 calories per hour. Keep in mind these estimates are general; actual calorie burn depends on intensity, muscle mass, the individual’s own fitness level and other factors. Strength training will help you burn more energy; muscle burns more calories than fat. A general goal of 30 minutes of physical activity per day is suggested at a minimum level.
16 – Father’s Day 5K, 8 a.m., Old Town Fort Collins, proceeds support the reduced or no-fee youth programs and adaptive recreation programs through the City of Fort Collins, www.fcgov.com/recreation 22 – Estes Trail Ascent Trail Run, 8 a.m., Estes Park, www.epmarathon.org 22 – Loveland Lake to Lake Triathlon, 15K Swim, 30-mile Bike, 10K Run and aqua Bike Event, Loveland, www.lovelandlaketolake.com
JULY
4 – FireKracker 5K, 8 a.m., City Park in Fort Collins, race proceeds benefit C.A.R.A., Turning Point, Northern Colorado Running Foundation, Poudre Valley Hospital Foundation, Northern Fort Collins Latino Running Club, Partners Mentoring Youth, C.S.U. CrossCountry Team and Air Foundation. www. fortcollinsrunningclub.org 4 – Loveland Liberty 5K, Loveland, www. lovelandroadrunners.com 4 – Race Against Cancer 5K/1 Mile Fitness Walk, Greeley, benefitting Rocky Mountain Cancer Rehabilitation Institute, www.unco.edu 13 – Run for Hope 5K, 8 a.m., City Park Lake in Fort Collins, raising funds for Carcinoid Cancer research and education and the Poudre Valley Cancer Center, www.runforhope.net 20 – Loveland Classic, 5K, 10K and Kids Run, 7 a.m., Loveland, benefitting Thompson alley Preschool, www.lovelandclassic.com
Source: www.mayoclinic.com/health/ exercise/SM00109
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WELLNESS
Senior Health
THE SCO O P O N
SENIORS AND SUPPLEMENTS BY MICHELLE VENUS
V
itamins and supplements are big business. Just take a gander down the vitamin aisles in grocery stores and pharmacies. They stretch as far as the eye can see. Or at least as far as the end of the store. The familiar old standards are there: The Alphabets (Vitamins A, B, C – all the way through Vitamin K), minerals such as calcium, iron and magnesium, and then there are herbal supplements like Hoodia and Blessed Thistle. The choices are mind-boggling. How do you know which supplements are helpful, which are bogus and which can actually inflict harm, especially for the senior population? Seniors, as they age and start taking more prescription medications, need to be especially aware of what they ingest. Like it or not, their bodies are changing. Which supplements they take and how they take them become increasingly important considerations. Before embarking on a supplement regimen, it’s important to talk to your physician. He or she will help you take a good, hard look at your lifestyle. Everything gets thrown into the
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mix – diet, exercise and medications – before recommendations are made. A healthy and diverse diet filled with nutrientdense foods that will provide you with vitamins, minerals, complex carbohydrates, lean proteins and healthy fats (without an overload of calories) is the first step. The very best way to add supplements is through your diet. Your physician or nutritionist will help you develop a program that is right for you. It’s very difficult to obtain all the necessary nutrients from diet alone, regardless of how healthy that diet is. That’s when it’s time to add supplements. Partnering with your physician or a pharmacist is especially important when choosing supplements to ensure they don’t interact poorly with your prescription meds. Katherine Edelblut, RPH, director of pharmacy services at Poudre Valley Hospital, states, “The fact is supplements are not regulated or tested for effectiveness and safety the way drugs are. The user can’t be certain that the label statement is accurate for dosage and efficacy.” For instance, gingko biloba can reduce concentrations of the anticoagulant drug warfarin as well as interact with certain antidepressant
medications. Many prescription medications are derived from plants, so plant-based supplements can be expected to act in a similar fashion. “Chewing willow bark,” says Edelblut, “is just like taking aspirin, since that’s what it’s made from.” Zinc has been implicated in Alzheimer’s disease in two ways. According to WebMD, “some reports suggest that too little zinc is a problem. Others that too much zinc is at fault. Too little zinc was suggested by autopsies that found low levels of zinc in the brains of Alzheimer’s disease patients, especially in a certain region.” On the other hand, a recent study suggests that too much zinc might be the problem. In this laboratory experiment, zinc caused beta amyloid from cerebrospinal fluid – the fluid that bathes the brain – to form clumps similar to the plaques of Alzheimer’s disease. Current experiments with zinc are pursuing this lead in laboratory tests that more closely mimic conditions in the brain. A good multivitamin goes a long way in providing a well-rounded blend of vitamins and minerals, and many manufacturers have special multi vitamins that cater to mature adults. Look for multis that contain these recommended supplements:
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ACTIVE SENIORS • HEALTH • ACTIVITIES • RECREATION • WELLNESS • SERVICES
Northern Colorado Medical & Wellness 2013
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Vitamin B-12
Vitamin B-12 is a water-soluble vitamin that is required by your body on a daily basis. This nutrient is necessary for energy metabolism, nerve health and red blood cell formation. According to MayoClinic.com, the elderly are most at risk for vitamin B-12 deficiency. This may be due in part to a reduction in your intrinsic factor production, which is the glycoprotein necessary for vitamin B-12 absorption. Too little vitamin B-12 can lead to the development of pernicious anemia, which can be dangerous. Taking a daily vitamin B complex supplement or a multi-vitamin that contains vitamin B-12 will ensure that your body receives an adequate amount.
Vitamin D
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Vitamin D is a fat soluble vitamin, which means that your body stores any excess in your fatty tissue or liver. It can be obtained through diet or direct sunlight. In recent years, vitamin D deficiency has become a popular topic; being linked to diabetes, heart disease and even some types of cancer. It also helps the body to absorb and use calcium, which is important for bone health. The aging population may be at an increased risk for vitamin D deficiency because their skin does not absorb the sun’s rays as well and their kidneys may be slower at converting vitamin D into its active form. Consider asking your doctor to check your vitamin D level the next time you have blood work drawn.
Calcium
As you age, the body’s bones become weaker and more brittle. Calcium is necessary for maintaining strong bones and teeth and is also important for neurological and cardiovascular function. This mineral can be obtained from dairy products and certain vegetables. The recommended dosage is between 1,000 and 1,200 mg per day. Look for a calcium supplement that also contains vitamin D. Women are at a greater risk than men of developing osteoporosis. AARP’s website has a comprehensive glossary of vitamins and minerals (www.aarp.org) that also tells you which food sources provide them and a “Good To Know” section that gives much needed additional information, such as: Did you know that as the body ages, the kidneys become less able to remove potassium from the blood and it’s easy to get too much of this mineral from supplements? Medline Plus, a division of the National Institutes of Health, also has a guide on their website (www.nlm.nih.gov) that includes herbal supplements. Both of these resources are credible and reliable, something the consumer must be careful about when gathering health-related information. The bottom line is that your first offense is to maintain a healthy and nutritious diet, especially as you age. Supplement that with a multivitamin and additional herbal supplements that you and your physician agree will add to your quality of life. And then, go out and enjoy that life. Michelle Venus is a freelance writer based in Fort Collins.
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ACTIVE SENIORS • HEALTH • ACTIVITIES • RECREATION • WELLNESS • SERVICES
Northern Colorado Medical & Wellness 2013
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WELLNESS
Pediatric Dentistry
Katherine Galm, DDS, shows her young patient how to properly brush teeth with the help of a stuffed animal.
STA RTING EAR LY I S K E Y TO
G OOD DENTA L H EA LT H
“T
he sooner the better,” says Katherine Galm, DDS and board certified pediatric dentist, who has devoted her career to caring exclusively for the dental health needs of infants, children and teens. In 2009, Dr. Galm teamed up with her dad, Louis R. Gerken, DDS, who has been serving pediatric patients in Loveland for 33 years. Their shared practice is Pediatric Dentistry of Loveland. Both practitioners agree that starting routine dental visits with young children provides the best opportunity to establish a warm relationship with a child long before multiple cavities develop. This positive and preventive approach is fundamental to certification training by the American Board of Pediatric Dentistry (ABPD).
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“In the same way that pediatricians are trained to meet a child’s medical needs, pediatric dentists are uniquely qualified to care for children’s oral health needs,” explains Dr. Galm. Pediatric dentistry certification requires a minimum of two years additional training beyond dental school and places the emphasis on preventive dentistry, growth and development, and behavioral management of children of all ages in the dental setting. “When the long term goal is for children to like visiting the dentist, it’s all about making the child feel as comfortable as possible. The more positive, non-invasive, dental visits – or ‘well child visits’ as pediatricians call them – that a young child can have, the better the dental relationship moving forward,” says Dr. Galm. And that relationship has far-reaching benefits. When the dental team and parents focus on
BY ELISSA TIVONA
prevention from the beginning, many families avoid some of the worst consequences of poor dental hygiene. According to the U.S. Surgeon General’s Report, Oral Health in America 2000, dental caries (cavities) is the most common chronic disease of childhood, five times more common than asthma. It is the most prevalent unmet healthcare need. A Colorado Oral Health Survey confirms the incidence of dental caries in Colorado, finding that 40 percent of kindergarten children have had dental decay. That rate has remained relatively unchanged from 2003 to 2012. As recently as March 2012, Catherine Saint Louis reported in the New York Times that more and more preschoolers have to undergo hospital surgeries for a mouthful of cavities. Dr. Galm has also seen this firsthand in her dental practice, with
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Northern Colorado Medical & Wellness 2013
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TEN TIPS TO A
HEALTHY CHILDHOOD SMILE 1. Begin brushing two times per day as soon as babies get teeth, regardless if they cry or fuss a little. Children quickly get used to brushing if parents are persistent. The American Academy of Pediatric Dentistry (AAPD) even recommends beginning to clean a child’s gums at birth with a soft infant toothbrush or cloth and water. 2. Keep toothbrushes in multiple, handy locations throughout the house to encourage frequent use. 3. For children under age 2, the AAPD suggests that parents use a smear of fluoride toothpaste. This new recommendation supersedes the older practice of using fluoride-free pastes. The AAPD finds that fluoride helps keep the outer layer of a tooth structure strong, helping keep kids cavity-free for as long as possible.
Pediatric dentist offices often utilize an open bay design to alleviate anxiety in children.
an increasing number of small children needing to be asleep for their dental treatment. With statistics like these the need to educate families cannot be underestimated. “Prevention is a major part of our practice,” stresses Dr. Galm. Dr. Galm recommends that children begin seeing a dentist at age 1 and then be followed by their dentist every six months for routine checkups (the same as adults). In preparing a child for the first dental visit, she encourages parents to maintain a positive attitude. Awareness of modern pediatric practices, along with the open-bay design of many pediatric offices, can help relieve parents of anxieties dating back to their early dental visits. Dr. Galm wants parents to use this knowledge to its fullest advantage. She urges, “Allow a pediatric dentist and their team to introduce [the] child to dentistry using kidfriendly language in a kid-friendly environment.” Typically, the first visit is customized based on the child’s age and needs. It may include an exam, cleaning, fluoride treatment and X-rays, if needed. But beyond the procedures, the first visit is intended to help children establish a relationship with the dental office and increase their comfort level. The goal is to create a welcoming dental home for children, along with age-appropriate education and cavity-prevention tips. “At our office we strive to create happy dental experiences and thus, positive dental attitudes for a lifetime. My success stories are always the same. When parents tell me that their child likes coming to the dentist, then I know that I have done my job!” Putting smiles on the faces of young patients is what puts a smile on Dr. Galm’s. Elissa J. Tivona is a freelance writer and international educator at CSU in Fort Collins. Find her online at www.thepeacecorrespondent.com
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4. Bedtime bottles or sippy cups should contain water only. Children who fall asleep with a bottle of milk, formula, juice or another sugary beverage tend to have cavities on the upper front teeth (often called “bottle mouth”). If possible, AAPD recommends weaning children from a bottle at around 12 to 14 months. 5. Try to limit juices, soda, sports drinks and other sugary beverages, especially in sippy cups. Even 100 percent fruit juices have too many natural sugars and big juice drinkers, by far, get more cavities. It is recommended to do milk at meals and water in-between meals. 6. Make sure brushing is the last thing done before bedtime. No eating or drinking after this (water is the one exception). 7. In the early years, make sure a parent does the brushing. Small children cannot brush themselves. If your kids insist on independence, especially during those toddler years, try taking turns. 8. At 1.5 to 2 years of age, brush in two stages. Brush teeth with the mouth wide open. Then have kids do “tiger teeth” by clamping teeth fully together so you can brush well around the top front teeth gum-line. Parents often miss this area. 9. Around age 3 to 3.5 start flossing (once the gaps between the molars close). Pediatric dentists see a lot of cavities in between kid’s teeth, especially the back molars. If you only have a little time, concentrate on those back molars. 10. Think about diet. Try to avoid really sticky things that get caught in the pits and grooves of teeth... such as fruit snacks, dried fruits, cookies, candy, etc. And lastly, sometimes even if parents do everything right, some children are just more prone to decay! Seek care from a pediatric dentist as soon as possible.
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kids • play • fun • health • activities
Northern Colorado Medical & Wellness 2013
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VETERINARY
Pet Bonding
FO STERING A H A PPY B O N D
BETWEEN CHILDREN AND PETS
A
s children, we all needed to be taught how to interact with others, including the family pet. When young, we learned from all sorts of sources: from movies, books, experience and, most importantly, from our parents. Teaching a child how to bond successfully with your dog or cat will also teach him or her the skills of how to form other successful relationships in life, both animal and human. Be they cats, dogs, guinea pigs or snakes, animals, like people, respond better to some behaviors than to others. The basics of successful pet bonding include a gentle touch, a soft voice, slow movements and, above all, mutual respect. “Kids should be taught to respect the personal
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space of an animal, just like we teach kids to respect other children’s space,” says Dr. Gina Singleton, a veterinarian at South Mesa Veterinary Hospital in Fort Collins. “Approaching animals slowly, offering a hand to sniff first and speaking gently are all ways for an animal to feel reassured that the child will not hurt them, and the animal will therefore be inclined to be gentle as well.” Ashley Foster, a certified dog trainer and training director of South Mesa Veterinary Hospital’s “Come-Play-Stay!” and owner of Complete K-9, an in-home dog training and behavior consultation service, adds that it is crucial that parents supervise the interactions of children and pets. “It’s important for children and pets to interact politely and respectfully with each other; this can only be done with the parent constantly supervising their interactions,” Foster says. “And these
BY LAURA SEBASTIAN
interactions must be reciprocal – a child should never force an animal to interact with them, such as throwing their arms around the pet, just as they would not force another child to interact with them. “Children should be taught to always approach the pet with a calm quiet voice while standing or to invite a smaller pet onto their lap while they are seated next to their parent,” she continues. “The most efficacious approach to positive child-pet interactions is for parents to educate themselves on canine [or feline] communication. In this way they can determine if their pet is feeling stressed or anxious while interacting with their child and, if so, stop the interaction immediately. One bad interaction can have a permanent negative affect on both the child and the pet, so close supervision is always a must.”
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kids • play • fun • health • activities
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Foster has some basic tips for kids regarding cats: • If you have a child under the age of 7, adopt a cat that is at least 4 months old, as children can easily injure a small kitten. • Hold the cat by supporting the chest and back legs so the cat feels secure. • Avoid holding a cat tummy side up, which makes a cat feel vulnerable. • Don’t let your child “ruffle” the fur on your cat’s tummy, as this encourages a cat’s natural reaction to “grab and bite.” • Put your cat’s bed, litterbox, food and water in a quiet, kid-free zone. • A twitching tail, flattened back ears or hissing are some of the signs that mean leave kitty alone. She offers additional tips for kids regarding dogs (some of which pertain to cats as well): • Never approach, touch or bother a pet that is sleeping. • Never approach or bother a pet’s food dish or high-value chew items. • Never try to mimic a pet (don’t crawl on the floor barking), this confuses the pet and can put the child in very unsafe positions. • Never tease a pet or take away any object, including food and toys. • Never chase, scream, yell or be loud around a pet. • Never invade a pet’s space by getting in his or her face, climbing on or grabbing any body part. • A tucked tail, avoidance of eye contact, pinned back ears or a curled lip are some of the signs that mean leave puppy alone. As for the pets of others, Foster advises, “Never hug or pick up an unfamiliar animal, no matter how friendly they seem. If given permission by the owner to interact, the child should stay upright, avoid direct eye contact with the pet and offer the top of their hand for the pet to investigate. Do not reach or bend toward the pet, but allow the pet to approach you. If the pet seems relaxed and happy, you can quietly pet them under the chin. If they seem nervous, anxious or aloof, stop your interaction with the pet immediately.” Dr. Singleton adds, “Simply put, pets respond best to kindness and confidence. Any kind of behavior that is not nice to another child is not nice to a dog or cat. This goes back to teaching respect in general.”
Laura Sebastian lives in Fort Collins and has been a freelance writer since 1999.
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kids • play • fun • health • activities
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VETERINARY
Pet Boarding
PE T O WNERS C A N AV O I D
VACATION S T RESS
D
oes your pet break out in a cold sweat at the mere sight of emerging luggage? Lessen that vacation drama and increase your peace of mind through proper preparation. Avoid escapes, unattended medical emergencies and separation anxiety-inspired property destruction by placing your dog or cat in a reputable kennel. And do your homework. While brand new boarding businesses can have much to offer (such as 24-hour, real-time camera computer links to pets), longevity is an excellent indicator of a trustworthy business.
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BY MARTY METZGER
Northern Colorado has an abundance of great boarding facilities. Which best matches your pet’s particular needs? For example, a home-away-from-home that’s welcomed all breeds of dogs and cats for the past 19 years is Lazy Dog Ranch in northeast Fort Collins. Ashcroft Boarding Kennels in south Fort
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FYI – Poudre Valley Hospital offers a very useful
service: Jonathan Salazar, Supervisor for Guest Services, advises that PVH’s Fort Collins Concierge Service acts as a middle man to put hospitalized pet owner-patients, including vacationers, in contact with local pet care professionals. Or, PVH can make arrangements for them. Collins is an all-breed dog (no cats) 22-yearold boarding facility. Heading farther up the road still, Northern Colorado Pet Resort at the Wellington Vet Clinic has sheltered vacationing cats and dogs since 2008. Situated in the childhood home of co-owner Calida Troxell, Lazy Dog Ranch is pretty laid back. For example, only current rabies vaccinations are required for incoming boarders. Troxell says she casually checks up on these by reading collar tags or simply asking the customer rather than requiring a paper trail of proof. That’s because some animals are owner-vaccinated, some are too old, or a vet has determined the dog or cat has reactive issues with vaccines, says Troxell. Owners sign a release that states vaccination decisions are solely between customers and their veterinarians. Ashcroft Boarding Kennels, on the other hand, require rabies, distemper and Bordetella vaccines. Dogs previously unvaccinated must have received the necessary shots at least two weeks prior to their stay; previously protected animals must be re-vaccinated within 72 hours of each visit. Both facilities are family affairs that lovingly cater to specific needs. Ashcroft’s Co-Owner/ Manager Linda Thole says that husband Mark is a long-time hunting dog trainer. Through their combined expertise, they can well-attend to the requirements of everything from special needs to difficult dogs. Elderly or physically compromised canines, for example, are assisted in going outdoors. Ashcroft uses Iams products, but will accommodate special diet requirements; or, owners may bring pets’ regular feed. The Pet Resort in Wellington offers dogs complimentary baths and nail trims; a complimentary health check by a vet tech; and the option of raised cots, bedding and food, or bring your own, says Office Manager Connie Croak. Cats each get a complimentary brushing, mat trim and exercise time in the cat room. Meanwhile, back at the Lazy Dog Ranch, Troxell and mom, Barbara, also dote on their guests. Lazy Dog is anything but. Its spacious structures can house up to 50 dogs at a time, although the average is 15 to 20. Besides Troxell and her mother, three staffers, including a vet tech (plus groomers), enjoy the hustle and bustle. They can accommodate most
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circumstances, including raw diets and insulin for diabetic animals. The ranch accepts even violently aggressive dogs. By state requirement, cats and dogs must be segregated. So, although named for an idle canine, the ranch provides a separate cat room for leisurely felines. Each kitty enjoys two hours of free play twice a day. All three facilities offer group playtimes for social dogs – owners of those disinclined to play well with others should advise caretakers in advance. Troxell and Thole offer additional pointers. They agree that their busiest times are holidays. Owners should reserve pets’ spots well in advance to avoid last minute panic. Be sure contact information on client information forms is accurate and current, including veterinarians’ names and phone numbers. Troxell strongly recommends that owners visit potential boarding facilities during busy times to get a sense of how each is run and who’s there. Some facilities take Sundays off. At some, other than at feeding times, there’s no supervision. And remember, when boarding your pet at a professional facility, its new digs will be less intimidating if a favorite toy, blanket or other item accompanies the little camper.
Calida Troxell, co-owner of Lazy Dog Ranch, dotes on one of her canine guests.
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Marty Metzger is a freelance writer based in Fort Collins.
Lydia’s STYLE Magazine
VETERINARY
B i r d Wa t c h i n g
BIR D ERS O F A FE ATH E R
FLOC K TOGE T H ER
T
here’s no place like home when it comes to bird watching. According to the U.S. Fish and Wildlife Service, 51.3 million Americans list it as a hobby, and those numbers are growing. Getting started is as simple as creating an inviting habitat in your own backyard that can be enjoyed year round without making a significant initial investment. “The one habitat that people often overlook is their own backyard,” says Lauren DeRosa, owner of Wild Birds Unlimited, a Fort Collins store catering to the birding hobbyist. “When you put a feeder in your yard, you have a great opportunity to attract birds that you can view easily from the comfort of your home.” DeRosa recommends purchasing a field guide
Northern Colorado Medical & Wellness 2013
specific to the bird watcher’s home region or regions they may be visiting. “There are North American field guides that feature a lot of birds that won’t be found in Northern Colorado, and that can be frustrating,” she explains. Pairing field guides with a good pair of binoculars allows the birder to get up close without disturbing their feathered friends into flight. What should a new bird enthusiast look for in a pair of binoculars? Magnification is important. Binoculars have two numbers, such as 8 x 42 or 10 x 50. The first number is the one you want to pay attention to; it tells you the magnification or “power” of the lenses. For instance, eight means that the object will appear eight times closer than it actually is. The second number is the size (in millimeters) of the lens at the far end of the binoculars. A larger lens lets in more light. While that might not be much of a problem in bright
BY MICHELLE VENUS
daylight, it makes a difference when viewing birds at dawn or dusk. A good magnification for bird watching is eight or ten. For birders wanting to venture beyond the backyard, DeRosa suggests locating a riparian zone such as the Poudre River or Spring Creek Trails. Water and plant life – trees, grasses and shrubs – create riparian habitats that attract wide varieties of birds, and make for successful and enjoyable outings. Consider joining a group of fellow birders. The Fort Collins Audubon Society regularly schedules birding field trips at open spaces in Fort Collins and Loveland, as well as to more exotic locales: they have an Ecuadoran excursion on their summer calendar. Birding enthusiasts will have the opportunity to explore Ecuador’s Andean peaks and cloud forests and search for bird species not found in our more northern climes.
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Blue Jay
Northern Flicker
The Rocky Mountain Bird Observatory (RMBO), headquartered in Brighton, also schedules birding events, many catering to the homeschooling crowd. In May, they hosted a Bald Eagle Hike at Barr Lake State Nature Park Center. Birders can join them in bird banding work or riparian management workshops. Event information for both the Audubon Society and RMBO can be found on their websites, (www.fortnet.org/Audubon/index. htm, www.rmbo.org). Colorado Birder (www. coloradobirder.ning.com/) provides bird watchers with field trip opportunities throughout the state. Once the birding bug has bitten, enthusiasts keep track of their spotting conquests and create life lists of birds they’ve seen. One way is to jot down sightings in a birding journal. More and more mobile apps are being developed to tally life lists. Lifebirds Journal is one app that allows birders to create a setting according to region so
that only relevant birds are listed. Reviewers give it five stars for ease of use and functionality. The Audubon Society and National Geographic offer similar apps, which average in the $10 range. Who is bird watching? “Everyone,” says DeRosa. “I say it’s for people aged 9 months to 90. You can be very active with this hobby or enjoy it at home. It works for just about anybody.”
Getting Started
Wondering where to start? Wild Birds Unlimited, with their staff of Certified Birdfeeding Specialists, compiled their top 10 list of songbirds most commonly seen along the Front Range in the spring and summer: House Finch American Robin American Goldfinch
American Goldfinch Black-Capped Chickadee House Sparrow Northern Flicker Downy Woodpecker Mourning Dove Broad-tailed Hummingbird Blue Jay Looking for something a little more rare? Among the recent rare birds sighted in Northern Colorado is the unusual irruption of Common Redpolls, according to DeRosa. “They are normally found in greater numbers to our north, but have been found in large flocks throughout Colorado over the past few months.” Michelle Venus is a freelance writer based in Fort Collins.
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HEALTHCARE PROVIDER SPOTLIGHT
Dr. John Crane
AT THE EPICENTER OF
R OB OTIC SUR GERY BY CARL SIMMONS
W
hen John T. Crane, M.D., FACOG, OB/GYN at McKee Medical Center in Loveland, was first invited to be trained in robotic surgery, he was more than a little wary. Four years later, he’s training even some of the most experienced surgeons in the process. “Intuitive Surgical, the company that created the [robotic] da Vinci Surgical System, approached me in 2009,” Dr. Crane says. “I was kind of skeptical at first, because this was a lot different than traditional laparoscopic surgery. However, once I sat at the console, and high-definition, three-dimensional visualization came into effect, I could see that this was a huge advantage – especially with the types of surgeries I do, because they’re often very intricate. Once I got going, I
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realized I could do almost everything this way. “What I like most about it is the ability to address problems in a minimally invasive manner,” he says. “Prior to robotic surgery, these operations had to be done through a large open abdominal incision. Now, people heal faster, are out of the hospital faster, and back to work faster – all those are good things. Prior to robotic surgery, I’d say that 80 percent of my surgeries involved big abdominal incisions. Now, less than 1.8 percent are done through abdominal incision.” Under Dr. Crane’s leadership, McKee’s roboticsurgery program was named by Intuitive Surgical as one of only 21 gynecologic “epicenter” programs in the U.S. “This designation reflects the diversity and volume of surgeries done, as well as the development of the program,” Dr. Crane says. “It’s the best of the best of the robotic
programs in the country, and that’s a pretty big deal for a hospital like McKee.” Today, the robotic surgery program at McKee involves gynecology, urology, general surgery, head and neck surgeries, and thoracic surgery. Dr. Crane not only performs gynecologic surgery at McKee, but trains surgeons from around the country to do advanced pelvic surgery with the da Vinci System, at Intuitive’s headquarters in Sunnyvale, Calif. “These are master’s courses,” Dr. Crane explains. “Doctors have to have performed 100 robotic surgeries before they’re even eligible to come to this course.” Dr. Crane also speaks around the country about robotic surgery. The advance into robotic surgery grew out of Dr. Crane’s primary practice as an advanced gynecologic surgeon at McKee, where he specializes in pelvic organ prolapse surgery as well as female pelvic cancer surgery. Dr. Crane – along with wife Suzanne Saenz, M.D., also a gynecologist – came to McKee in 1994, after completing a fellowship in abdominal pelvic surgery and serving on the staff at Texas Tech School of Medicine. “When I first started here, I did all aspects of obstetrics and gynecology in order to build a practice here, including delivering babies and general gynecological work,” he says. “In 2010 I was able to let the obstetrics go. I was getting so busy that I didn’t have the time for it anymore.” Life outside the hospital is almost as busy for the Cranes. “When we first started this practice, it was just the two of us,” he says. “For three years, one of us was on call, and one of us was post-call and pre-call. We also had two of our three kids during that time. It was pretty difficult,” he recalls. “These days, my wife has partners who take some of the calls off her; and for me, giving up OB/GYN gives at least one of us the opportunity to be home at night. Our kids being older now makes it easier as well.” That’s not to say, however, that the opportunity to be home means relaxing. Dr. Crane also serves as quarterback coach for his youngest son’s Pop Warner team “My son’s the quarterback for the Loveland Titans, and they made it to the Super Bowl in Florida this year,” Dr. Crane says. “We’re constantly going to quarterback camps across the country.” In addition, he says, “I also train protection dogs; I’m the guy in the padded suit that they run up and bite,” he adds. “There’s a group around the Northern Colorado area that involves policemen, sheriffs and private citizens who have protection-type dogs that they want to get trained.” It’s a busy life. But whether inside the hospital or out, it’s clear that Dr. Crane is constantly devoted to helping the people around him to become even better at the things they enjoy doing. Carl Simmons lives in Loveland, and is author of Lay It Down: A Journey into Trust (CreateSpace, 2013) and the six-book Bible study series Growing Out: From Disciples to Disciplers (Group, 2010). Find out more at carlsimmonslive.com.
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