2014-03-MEDICAL by Style Media & Design, Inc.

MARCH 2014

UNIVERSAL DESIGN

FOR EVERYONE

Don’t Be Sidelined By a

Sports Injury

THE

REHABILITATION ISSUE

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We’re Golden We have received The Joint Commission’s Gold Seal of Approval for STROKE Rehabilitation Northern Colorado Rehabilitation Hospital has earned The Joint Commission’s Gold Seal of Approval® for its Stroke Program by demonstrating compliance with The Joint Commission’s national standards for health care quality and safety in disease-specific care. The certification award recognizes NCRH’s dedication to continuous compliance with The Joint Commission’s state-of-the-art standards.

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Northern Colorado Medical & Wellness 2014

Brain Injury Awareness Just as no two people are exactly alike, no two brain injuries are exactly alike. At Northern Colorado Rehabilitation Hospital (NCRH), we give each patient custom care to ensure the best recovery for the individual. At NCRH, we SPECIALIZE in rehabilitative services for patients with functional deficits such as head injury, stroke, trauma, spinal cord injury, and other disabling impairments. Our passionate and supportive staff helps patients recover quickly and return home safely with a renewed sense of self-sufficiency.

For the eighth consecutive year, Northern Colorado Rehabilitation Hospital has been ranked in the Top 10% of 774 inpatient rehabilitation facilities.* NCRH was cited for care that is effective, efficient, timely and patient-centered.

To learn more about NCRH and our services, visit our website at

NCRH.ernesthealth.com 4401 Union Street, Johnstown, CO 80534 â&#x20AC;˘ ph: 970.619.3400 6

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Northern Colorado Medical & Wellness 2014

THE VOICE OF NORTHERN COLORADO FOR

30 YEARS.

s t y le me d ia a n d d es i g n , i n c .

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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 / BUSINESS DEVELOPMENT 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 PHOTOGRAPHER Marcus Edwards Photography CONTRIBUTING PHOTOGRAPHERS Bridget Eldridge, Fairy Good Photography CONTRIBUTING WRITERS Malini Bartels, Heidi Kerr-Schlaefer, Corey Radman, Kay Rios, Brad Shannon, Carl Simmons, Elissa J. Tivona, Michelle Venus AFFILIATIONS Fort Collins Area Chamber of Commerce Greeley Chamber of Commerce 2014 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-Style June-Style July-Northern Colorado Medical & Wellness August-Style September-Women’s Health & Breast Cancer October-Northern Colorado Medical & Wellness November-Holiday Style December-Best Of & Winter Activities Style Media and Design, Inc. magazines are free monthly publications direct-mailed to homes and businesses in Northern Colorado. Elsewhere, a one year subscription is $25/year and a two year subscription is $45/year. Free magazines are available at nearly 300 locations throughout Northern Colorado. For ad rates, subscription information, change of address, or correspondence, contact: Style Media and Design Inc., 211 W. Myrtle St., Suite 200, Fort Collins, Colorado 80521. Phone (970) 2266400, ext. 208. Fax (970) 226-6427. E-Mail: ina@StyleMedia.com ©2014 Style Media and Design Inc. All rights reserved. The entire contents of Style Magazine are copyrighted and may not be reproduced without the expressed written consent of the publisher. Style Media and Design Inc. is not responsible for unsolicited material. All manuscripts, artwork, and photography must be accompanied by a SASE. The views and opinions of any contributing writers are not necessarily those of Style Media & Design Inc.

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THANK YOUS

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I wanted to drop you a note to let you know how pleased we were with the article you wrote about High Point in the February issue of Style Magazine. The first day the magazine came out we started receiving lots of positive feed back which has continued. Comments mentioned how well the article was noticed in the issue and that the quality of writing was easy to read while being very informative. It truly portrayed very well what we do. In addition, the experience of working with the Style staff, with the writer and with the photographer was extremely professional. And, the finished product, both layout and text, reflected this high level of professionalism. It was fantastic! Thank you so very much. Matt Fries, Financial Services Professional, High Point Financial Group, LLC Thank you for the wonderful anniversary party you hosted on the 7th. The hors d’ouvres were simply divine and the evening’s performance was stellar. We thoroughly enjoyed getting to know Dustin and Lesli Tanski as well. Thank you for thinking of us as you compiled your guest list. It was a truly memorable evening. Warmest regards, Stefanie & Patrick O’Neill ADVERTISING PAYS

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Northern Colorado Medical & Wellness 2014

CONTENTS

Northern Colorado Medical & Wellness

March 2014

16 YOU MAY HAVE THE FLU IF…

24 SPORTS INJURIES SIDELINE PARTICIPANTS

KEEPING YOUR MIND ON THE ROAD

BEYOND DISABILITY: HEALTHY LIVES FOR ALL

58 THE HEALTH BENEFITS OF OILS

68 VETERINARY SURGEONS: MASTERS OF MANY SPECIALTIES

ON THE COVER: Dr. Indira S. Lanig, Medical Director at Northern Colorado Rehabilitation Hospital, is helping patients redefine their lives after a debilitating injury or disease. Cover photo by Marcus Edwards Photography.

10 14 16 20 24 28 32 34 36 40 44 48 50 52 58 60 65 68 70

From the Readers

Publisher’s Letter

You May Have the Flu If… Simple Practices Promise Healthier Eyes

Sports Injuries Sideline Participants

Combating Plantar Fasciitis

Managing Memory Challenges

Keeping Your Mind on the Road

Northern Colorado Rehabilitation Hospital: Transitioning Back to Normal

Right Patient, Right Place, Right Time

Beyond Disability: Healthy Lives for All Universal Design: Something for Everyone Recreating a Life

Physiatry: Little-known Medical Specialty Changes Lives The Health Benefits of Oils

Exiling Eczema

Varying Kids’ Sports to Avoid Injury Veterinary Surgeons: Masters of Many Specialties Healthy and Happy with Your Pet

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

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Northern Colorado Medical & Wellness 2014

PUBLISHER’S LETTER

The Broad Scope of

Rehabilitation It has now been four months since I had a hip replacement and I am largely back to normal. It is truly amazing how the improvement of a new part can do for our quality of life! I did have a hiccup in my recovery, though, requiring a four-day stay at PVH fighting off an infection, but antibiotics finally conquered the staph, much to my relief! My surgeon, Dr. Dana Clark, at the Orthopaedic & Spine Center of the Rockies was exceptional and I highly recommend him to anyone needing this kind of surgery. I am back to working out and have been cleared to do most everything but run and jump, which shouldn’t slow me down much! Fortunately, I had family around to help me recover but if someone doesn’t have that kind of help, there is an incredible facility right here in Northern Colorado that specializes in rehabilitation, whether it is a surgery, accident or medical crisis. Northern Colorado Rehabilitation Hospital (NCRH) has been ranked in the top 10 percent of 774 inpatient rehabilitation facilities for the eighth consecutive year. I’ve learned that they have two distinct hospitals as well as an outpatient center. They have a 40-room hospital and a 20-bed Long Term Acute Hospital for managing more acute critical care patient needs. As I learned more about this exceptional facility, I was truly in awe of the broad scope of patient rehabilitation they provide. Not only do they have physical, occupational, speech and aquatic therapy, and a variety of specialized clinics,

but they are staffed by a team of medical physiatrist specialists led by Medical Director, Dr. Indira Lanig. We chose Dr. Lanig to be on our cover because she leads her team with a fervent passion for helping patients recover and return to living their lives with the skills they need to be maximally independent. She is a well spoken patient advocate and inspires her team of nurses, therapists and physicians to do everything they can to improve the lives of their patients. Read “Northern Colorado Rehabilitation Hospital: Transitioning Back To Normal” for insight into this amazing facility and its services. NCRH is staffed by a team of medical physiatrists, but what exactly is their specialty? Read “Physiatry: Little-Known Medical Specialty Changes Lives,” to better understand this important medical focus and how their knowledge helps patients recover. After a surgery or accident, when the hospital is beginning discharge, how does one decide where to transition? Read “Right Patient, Right Place, Right Time” for a guide to the options available when making that decision. We have learned that rehabilitation is so broad and encompassing. This new awareness led our team to further explore a variety of rehabilitation topics. As we age, memory issues are something many of us experience. I must admit that sometimes I grope for a name or that special word to explain what I want to say, but they say that is normal and not to worry. For those who experience more significant memory issues, there are resources such as Center for Neurorehabilitation Services (CNS) that help people maintain their highest level of functional independence. Read “Managing Memory Challenges” for more information about this topic and the partnership between CNS and CSU. We are all interested in good health and our wellness section embraces a wide range of interesting topics. From keeping eyes healthy to “You May Have the Flu If…”or how to deal with foot pain in “Combating Plantar Fasciitis,” we want to be informed. We mustn’t forget our four legged friends when thinking of wellness. In fact, read “Healthy and Happy with Your Pet” to learn what you already must know; pets keep us healthier and happier. This issue is packed with lots more interesting and relevant articles to inform and entertain you. We love continuing to learn about how rich our Northern Colorado region is in medical and wellness expertise and services. We are indeed fortunate to live here! We hope you enjoy this issue and, as always, we love hearing from you. In good health,

lydia@stylemedia.com

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You have a choice.

So did Bill.

And he chose us.

Bill Pilch spent almost six weeks at Northern Colorado Rehabilitation Hospital (NCRH). When he arrived following a surgery and stroke, he had no use of his right side, could not walk or talk. After weeks of intensive rehabilitation care at NCRH, physically Bill is back 100%.

The entire staff is to be â&#x20AC;&#x153; commended for their commitment to

â&#x20AC;?

improving the lives of their patients.

At NCRH, we SPECIALIZE in rehabilitative services for patients with functional deficits resulting from stroke, trauma, spinal cord injury, head injury and other disabling impairments. Our passionate and supportive staff helps patients recover quickly and return home safely with a renewed sense of self-sufficiency.

MEDICAL

Flu Season

YOU MAY HAVE THE FLU IF... BY MICHELLE VENUS

t starts with the sniffles. Or maybe a sore throat and a raspy cough. Then the achiness sets in. And maybe even a fever.

That’s it. You’re sick. But sick with what? Is it a common cold or full-blown flu? The symptoms of both have some crossover, making it difficult to determine exactly which illness has knocked you flat. And despite the promise of springtime, the Centers for Disease Control and Prevention expects flu season to last through March, which means we’re not out of the woods yet. In Colorado, early January saw flu hospitalizations triple in a two week period. According to Dr. Lisa Miller of the state health department, the state is experiencing one of the worst flu seasons since 2009. Statewide, there have been 1,448 hospitalizations since late last year. First, the basics: both the flu and colds are caused by viruses. Influenza viruses, categorized as Types A and B, are what’s behind seasonal flu outbreaks. Colds, on the other hand, are caused by over 200 different viruses, with rhinovirus as the main culprit. And once those viruses have settled into your system, what can you expect?

SYMPTOMS

COLD

FLU

Fever

Rare

Characteristic, high (100102oF); lasts three to four days

Headache

Rare

Prominent

General Aches, Pains

Slight

Usual; often severe

Fatigue, Weakness

Quite Mild

Can last up to two to three weeks

Extreme Exhaustion

Never

Early and prominent

Stuffy Nose

Common

Sometimes

Sneezing

Usual

Sometimes

Sore Throat

Common

Sometimes

Chest Discomfort, Cough

Mild to moderate; hacking cough

Common; can become severe

Complications

Sinus congestion or earache

Bronchitis, pneumonia; can be life-threatening

Prevention

None

Annual vaccination; Symmetrel, Flumadine, or Tamiflu (antivial drugs)

Treatment

Only temporary relief of symptoms

Symmetrel, Flumadine, Relenza or Tamiflu within 24-48 hours after onset of symptoms

* http://www.webmd.com/cold-and-flu/is-it-a-cold-or-flu

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While there is a flu vaccine (and it still makes sense to get one if you haven’t), nothing prevents catching a cold except good common sense. The same goes for the flu. Best advice for keeping colds and flu at bay? “Wash your hands,” says Lynn Kalert, a Family Nurse Practitioner with Rocky Mountain Senior Care, a mobile medical practice working with geriatric patients in Fort Collins and Loveland. “Vigorous and thorough hand washing is the best preventative tactic. If you can’t wash your hands, use hand sanitizer. And get a flu shot. This year, the vaccine seems to be a good match for the viruses that are running around. It’s been very effective.” “Remember this,” Kalert advises. “Keeping yourself healthy to start with is the best way to keep from getting sick. Eat well, get enough rest, and when you feel something coming on, take extra good care of yourself.” See page 18 for steps you can take to protect yourself from the flu.

Michelle Venus is a freelance writer based in Fort Collins.

Northern Colorado Medical & Wellness 2014

Here are steps you can take in your daily life to help protect you from getting the flu: • Wash your hands often with soap and water or an alcohol-based hand rub. • Avoid touching your eyes, nose or mouth. Germs spread this way. • Try to avoid close contact with sick people. • Practice good health habits. Get plenty of sleep and exercise, manage your stress, drink plenty of fluids and eat healthy food. • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. • If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone without the use of fever-reducing medicine. * http://www.flu.gov/prevention-vaccination/prevention/

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MEDICAL

Eye Health

SIMPLE PRACTICES PROMISE

H E A LT HIE R EY ES

yes have long been considered the window to the soul but they can also give a good view of the body’s health, say the eye experts.

“The dilated eye exam is such an important tool for overall health,” says Caleb Schoonover, Doctor of Optometry (D.O.) at Rocky Mountain Family Vision. “When we dilate the eyes, we can see many risk factors for things such as multiple sclerosis, stroke, aneurism, diabetes, hypertension, systematic diseases, macular degeneration and glaucoma,” adds Amy Abel, D.O., F.C.O.V.D., at Mountain View Eye Specialists. An annual eye exam is essential as a means for keeping those peepers in good operating order. “In the comprehensive annual exam, we

see the signs of changes years before you’ll notice them in your vision,” Dr. Schoonover says. Aside from that, several measures for protecting the eyes can help prevent wear and tear. First, the use of sunglasses and appropriate protective eyewear is paramount. “Eyes are very susceptible to UV damage so the front line defense is sunglasses,” Dr. Schoonover says. “You need to protect against UVA, B and C,” Dr. Abel agrees. “Eighty percent of UV damage occurs by the age of 18.” She adds that recent findings add blue light to that list. Blue light exposure comes from electronic devices – cell phones, tablets and laptop computers – and from energy efficient technology in the form of fluorescent light bulbs and LED lights. Exposure to large amounts of blue light can be harmful to the eyes.

BY KAY RIOS

New sunglasses that filter out UV A, B, and C as well as blue light were just released a couple of months ago, Dr. Abel says. Protective eyewear is essential for a number of activities, she adds. “That includes sports, lawn work, weed whacking, welding and anything you drill, hammer or saw.” Overall body health is also extremely important. “Know your family health history including incidence of eye disease,” Dr. Abel says. “Maintain a healthy lifestyle and appropriate weight. Being overweight increases the risk of diabetes and affects the blood flow to the eyes. All those things that effect heart health can also increase the risk of macular degeneration, glaucoma and optic nerve disease. Don’t smoke – nicotine is a blood flow restrictor. And don’t drink excessive caffeine.” Dr. Schoonover says that a healthy diet is

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AND WE’VE PROVED IT 8 YEARS IN A ROW. For more information or to schedule a tour, please call us at 970.619.3400 or visit us online at NCRH.ernesthealth.com *Uniform Data System for Medical Rehabilitation, Program Evaluation Model, 2013

NCRH.ernesthealth.com 4401 Union Street, Johnstown, CO 80534 • ph: 970.619.3400 • fax: 970.278.9343

vital. “Green leafy vegetables, kale and spinach are good antioxidants. Supplements are great once there’s a diagnosis (macular degeneration, glaucoma) but, before that happens, it’s better to get your nutrients through food.” Seafood is a good menu choice, Dr. Abel says. “Choose mackerel, salmon and dark meat fish. Research has reported that women who eat fish once a week showed a 42 percent decrease in macular degeneration in comparison with those who ate it once a month.” Dry eyes are a regular concern in this arid Colorado climate, Dr. Schoonover acknowledges. “The signs include sandy, dry irritation or excessive tearing. These are reflex tears and not the moisturizing kind,” he says. A visit to your eye doctor will help determine the cause and possible treatment but he also suggests, “Drink lots of water. If you’re dehydrated, your ability to produce tears is affected. Cut back on caffeine; cut back on the soda.” Both doctors suggest omega-3 supplements for dry eyes. The eye’s oil glands are along the eyelid, Dr. Abel says. “If they get clogged, it impacts the ability to produce tears. Apply a warm washcloth compress for 15 minutes to help clear the oil glands.” She also cautions against heavy makeup and eyeliner. “If you wear liner, keep it below the lash line so you’re not blocking the gland.” Since makeup can be a germ fest, she says, “Replace mascara every three months or, at the very least, every six months. And replace eyeliner [every three months].” Incorrect contact use is another eye health issue. “Take contact lenses out one hour before bed to give your eyes time to rehydrate and rest from the day. Make sure you’re using the proper solution and it’s not expired. Match the solution to the type of lens and don’t try to stretch the contact use out longer that they’re designed. Change them as required whether the two weeks or one month variety.” Computer use can cause eye fatigue, Dr. Abel says. “You don’t blink as often when you’re at a computer so take a regular break, at least 10 minutes for every hour. And check the ergonomics of your computer. The top of your screen should be level with your eyes when you are looking straight ahead. That can help reduce the fatigue.” Medical advances in eye health are surfacing all the time, Dr. Schoonover says. He uses the example of the regenerative therapy research currently being conducted. “A new possible treatment for macular degeneration using embryonic stem cells has just gone through its first test and has shown promise.” The small study at the University of California Los Angeles (UCLA) this past summer produced positive results. “We’re in unchartered waters right now and there will be a lot of changes in the next 10 to 15 years in the way we treat these things.”

Kay Rios is a freelance writer based in Fort Collins.

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Northern Colorado Medical & Wellness 2014

MEDICAL

Sports Injury

SPORTS INJURIES

S I DE LINE PA RTI CI PANTS

articipation in sports, recreation and exercise has become increasingly popular and more widespread in the American culture. While this contributes to health and fitness, the risk of injury is inherent in any physical activity. In fact, according to the Centers for Disease Control and Prevention (CDC), more than 10,000 people receive treatment in emergency rooms (ER) every day for injuries sustained in these activities. While the ER information is an indication, it doesn’t include the large number of injuries treated in primary care medical offices, sports medicine clinics, orthopedic clinics and chiropractic practices. Those who treat the injuries can attest to the more common injuries. Concussion is one injury that quickly comes to mind, particularly with the popularity of mountain biking, skiing and snowboarding. “The majority of concussions occur with highspeed activities,” says Rocci Trumper, M.D., Orthopaedic & Spine Center of the Rockies.

“Symptoms can include a headache, being bothered by lights or trouble concentrating. If something’s not right, you need to be evaluated by an appropriate medical provider.” Dr. Trumper, an orthopaedic surgeon and sports medicine specialist, says that concussions can come in different varieties and levels of severity. “An appropriate concussion protocol will take you through a program that initially emphasizes rest until symptoms have been resolved. Once you’re asymptomatic, you will go through an exertion program to assure that you can tolerate physical activities and your symptoms have disappeared. Final steps would include both medical and neuropsychological evaluations. Those assessments establish levels of balance, memory and reaction times to confirm that the brain has returned to normal prior to higher risk activities,” he says. “The key,” Dr. Trumper asserts, “is for patients to get appropriate medical evaluation before they return to their normal activities.” Prevention is also key, he adds. “Make sure you’re participating at an appropriate level and that you have the appropriate equipment,

BY KAY RIOS

Sean G. Grey, M.D., Orthopaedic & Spine Center of the Rockies

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particularly head protection. You can’t protect yourself 100 percent from concussion if you take part in those types of activities and, if you go at a high speed and then stop at a fast rate, no helmet will protect you.” Moving on down the body, several other conditions are at the top of the list of sportsrelated injuries.

Upper Extremities

The rotator cuff tear is common, says Sean G. Grey, M.D., an orthopaedic surgeon specializing in the treatment of shoulder injuries and conditions at the Orthopaedic & Spine Center of the Rockies. “Sixty percent of rotator cuff tears are related to degeneration and no history of trauma. The other 40 percent are related to a trauma. We see rotator cuff tears predominately in people over 40 years old. Certain people have a predisposition and that can be complicated by smoking and chronic diseases that affect blood flow.” This includes chronic obstructive pulmonary disease (COPD) and diabetes. In addition, Dr. Grey says chronic steroid use can also cause weakness creating more of a potential for tear. The symptoms include pain in the front of the shoulder that gets worse with overhead action, with the pain getting worse at night. “Once people start having night pain, it is potentially a tear,” he says. “A full thickness rotator cuff tear has to be fixed. A partial thickness tear may not necessarily need to be fixed surgically.” When it does need to be repaired, the rotator cuff tear is almost always done arthoscopically, Dr. Grey says. “It’s a quick surgery but a long recovery because the tendon needs to heal. If there’s bad blood supply as with diabetes, it’s a long recovery. If you’re a smoker, have COPD, or prednisone use, it doesn’t change the time for recovery but there’s a lower success rate.” He says many rotator cuff tears can be avoided. He suggests looking at the series of stability exercises on OCR’s website at www. orthohealth.com/our-physicians/sean-grey-md.

Northern Colorado Medical & Wellness 2014

Three links at the bottom of his profile provide specific exercises. Dr. Grey says that anything that strengthens the shoulder blades – narrow rows, wide rows, pull downs – can help. Shoulder instability is also a common malady among sports participants. “The shoulder moves more than any other joint in the body,” Dr. Grey explains. “As we gain that mobility, we lose the stability. It tends to be ages 15 to 35 and is related to sports or traumatic injury. A focused rehab program can help, but if the patient doesn’t get better or has recurring dislocation, then we need to repair it.” Another injury Dr. Grey is seeing more frequently is elbow ulner collateral ligament (UCL) tears. “It’s not quite as common but it is the most preventable of these injuries.” The UCL is the inside ligament of the elbow and can be injured in throwing or traumatic activities. Often referred to as the Tommy John surgery, it’s named after former Los Angeles Dodgers pitcher Tommy John, who, in 1974, had the first UCL reconstruction. “Multiple studies show the biggest cause is overuse and poor mechanics. Typically, it’s an injury related to baseball. And, the incidence rate is rising.” More kids are suffering the consequences from excessive use, he says. “Parents have their kids pitch all year round now. Previously, they weren’t throwing during winter months and that was a time of rest. Now, parents have their kids working with a coach during those months.” If the UCL is torn in a traumatic injury such as a fall in football, it will heal more easily, but with repetitive trauma such as pitching, it’s a different story. “With a fall, healthy tissue heals easily but, with throwing, it weakens over time and then tears. It’s like repairing denim jeans. If you cut the jeans, you can sew the cut but, with constant wear, the fiber wears out and it can’t be repaired the same way. Once the UCL is torn because of wear, we have to create a new ligament. We take a tendon from the leg

or the wrist to do that. The recovery is long and can take eight to 12 months,” Dr. Grey says. Again, he stresses that it is preventable. “There are guidelines on how many pitches a kid should throw based on his age and the time allowed for rest.” Littleleague.org provides pitching rules in terms of number to pitch by age and the rest time required.

Lower Extremities

Dr. Trumper says the most serious injuries in the lower extremities include tears of the anterior cruciate ligament (ACL). “The majority of ACL tears are seen in active patients but these are typically non-contact injuries. It happens during pivoting or quick change of direction sports like skiing, soccer or basketball. Skiing generally brings in our worst cases. The skiers get out of control and end up with a ski behind them and the buttock below the knee. The most common denominator is being out of control. They may be skiing on a slope beyond their ability or they are fatigued.” An ACL tear requires surgery and a lengthy recovery. “So preventing them is a real benefit,” he says. “The best suggestions I can give for avoiding ACL tears in skiing are to, first, be well-conditioned and avoid being over-fatigued. Second, don’t ski on slopes beyond your ski level and, third, make sure your skis and equipment are fitted to you, well maintained and check that bindings are set to the appropriate tension.” Other common injuries among active adults are the patella tendon injuries of the knee and Achilles tendon ruptures in the heel, Dr. Trumper says. “They have similar characteristics and are generally seen in 30-, 40-, and 50-year-old active people.” A significant number of these patients have been battling tendonitis and, often, the injury occurs in the beginning of an activity with poor warm up.” They are most commonly seen in jumping sports such as basketball or volleyball. To prevent these injuries, he suggests several things. “Be well conditioned and train to

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participate in those sports. And warm up. Warming up can do a lot to help to prevent tendon injury.” Another common injury is the meniscus tear. The meniscus is a rubbery, C-shaped disc that cushions the knee. “It’s the shock absorber between the bones,” Dr. Trumper says. Each knee has two, one at the outer edge of the knee and one at the inner edge. A torn meniscus can impact the way the knee works. A meniscus tear is usually caused by twisting or turning quickly, often with one foot planted while the knee is bent. That can occur when lifting something heavy or in playing sports and twisting too quickly. And, with age, the meniscus becomes worn and can tear more easily. “It’s very common for people to remember one activity when they experience the tear, but the majority of tears are degenerative in nature,” he says. It is possible to limit the potential for a tear to occur. “Avoid twisting while the knee is in deep flexion during weight bearing. The population we see for this includes people who do a lot of deep squats. So avoid deep squats that bring your butt to heels. Lunges are okay without weight bearing, or if you stop at 90 degrees.” Prevention is, as always, worth a pound of cure, both doctors reaffirm.

Kay Rios, Ph.D., is a freelance writer based in Fort Collins. She aspires to a higher level of athleticism. She is currently an accomplished tri-bathlete, having participated in many tri-bathlons with the standard structure of soak, steam and shower.

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We understand that YOU HAVE A CHOICE when it comes to your post-acute care. At Northern Colorado Long Term Acute Hospital (NCLTAH) we provide advanced long-term acute care, including critical care for patients who require time to heal from catastrophic or chronic illness or injury. Our 20-bed long-term acute care hospital complements existing hospitals in all of the Northern Colorado area. Some of the exceptional features:

• All private rooms • An 4-bed high observation/critical care unit • State-of-the-art equipment including specialty beds in all patient rooms, cardiac monitoring equipment, and mechanical ventilators for those patients requiring respiratory support • Excellent physical rehabilitation resources including a patient therapy gym, an activities of daily living suite, and a family day room • Fully monitored rooms with equipment alarms to the central nursing station

Daniel Asadi, D.O. Medical Director

• A clinical team of highly trained medical professionals representing a variety of specialty services

To learn more about NCLTAH and our services, visit our website at

NCLTAH.ernesthealth.com 4401A Union Street • Johnstown, CO 80534 • ph: 970.619.3663

MEDICAL

Foot Health

COMBATIN G

P L A N TA R FA S C I I T I S

ven the name conjures strange thoughts without fully understanding this very prevalent condition. As the most commonly found cause of foot pain in adults, plantar fasciitis is both distressing and debilitating. Often finding it embarrassing to talk about, people usually ignore or “just deal” with this condition, thus creating long-term problems and prolonged pain.

What is Plantar Fasciitis?

In order to understand how to prevent and treat this painful ailment with the funny name, learning about the mechanics of the foot is necessary. A quarter of the bones in the human body are located in the feet. Thirty-three joints, along with roughly 100 muscles, tendons and ligaments, create a sophisticated skeletal system working in conjunction with a network of blood vessels, nerves and tissues. When all of these are happily functioning together, we are able to walk, run, dance and do all the daily activities we enjoy. The seemingly inconspicuous thick band of tissue that originates from the heel bone and

runs the length of the arch, inserting into the ball of the foot is called the plantar fascia. Plantar fasciitis is the condition caused by the irritation and inflammation of this thick band of tissue. It can produce a stabbing pain in the heel or arch area of the foot, making it difficult to walk or even stand. Simply getting out of bed and taking the first step in the morning can be particularly dreadful. “Because the fascia is relaxed and loose during the night while you are sleeping, it doesn’t hurt so much during sleep. When you stand up in the morning, the fascia is activated and stretched, thus creating pressure at the point of insertion in the heel and producing an extraordinarily sharp pain,” states Dr. Emily Webb of Save Your Sole Foot and Ankle Specialists. Dr. Webb says she sees three to four people per day with plantar fasciitis at offices in Windsor and Fort Collins. “You use your feet all the time, so it’s extremely common. And once you get it, it’s hard for it to go away because you’re always using your feet.” It creates a kind of a catch-22. Staying off your feet while you have pain is what you really

BY MALINI BARTELS

should be doing, but it’s nearly impossible for active people to do, which is what initiated the pain to begin with.

The Causes

Mostly found in runners, earning the common name “jogger’s heel,” plantar fasciitis develops gradually and is most common with people above the age 40, although age is not discriminatory of who can acquire it. Those who are overweight, pregnant women and people who wear shoes with poor support are more susceptible because of overstressing the ligament-like structure with extra weight. Other causes are simply having flat feet, falling arches, high arches, a sudden increase in activity level or standing on hard floors for a prolonged period of time. Typically, plantar fasciitis affects only one foot, but it can occur in both feet at the same time. Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.

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Prevention and Treatment

The development of plantar fasciitis is a cumulative effect; it doesn’t happen overnight. “Treatment will take time,” says Dr. Webb, “You have to be patient and address the problem, which is tightness.” Stretching is the best-known non-invasive treatment, and it can also be the best-known prevention of plantar fasciitis. Dr. Webb reiterates that it’s always better to prevent than to treat. “Ice is excellent for treating acute inflammation, but not heat,” says Dr. Webb, “Rubbing a frozen water bottle along the bottom of your foot for 20 minutes each day is soothing and helps reduce irritation.” Initially, you may feel discomfort, but mild discomfort is fine as long as it’s not painful, at which point you should stop doing whatever you are doing. Another great preventative measure is to ensure you have substantial arch supports in your shoes. People who spend a majority of their day on their feet particularly need quality support in their shoes to reduce unwanted stress to the plantar fascia. Orthotics, which are custom-made inserts specifically designed for your feet, can be a fantastic level of support. If stretching is not in your daily routine and you find yourself with foot pain, there are some non-invasive treatment options available. Cortisone injections and platelet rich plasma injections can offer some relief and in some circumstances are very helpful. TOPAZ is a minimally invasive procedure in which an inch-long incision is made in the foot and a patented technology is applied

to the tendons. Oral anti-inflammatory medications, night splints and even physical therapy are all options. In the past, orthotripsy, or shockwave therapy, was heavily used. Doctors are straying away from recommending orthotripsy lately and referring patients to the other non-invasive treatment options available. Dr. Webb insists that no matter what treatment option you take, if you don’t stretch, it won’t work. “Surgery should be a last resort,” according to Dr. Webb, who doesn’t like to perform the invasive surgery of cutting the plantar fascia and leaving it limp in the foot. “It may provide some immediate relief for the patient because there is no more pressure at the point of insertion, but it’s not the best option.” There are always new procedures being developed to help treat plantar fasciitis. Many are not part of mainstream medicine, and are thought to be experimental. It sounds like a small thing, but plantar fasciitis should not be ignored. It can result in permanent foot, knee, hip and back problems. Disregarding this common ailment may result in chronic heel pain that hinders your regular activities and changes your gait. Investing in some quality shoes is not just a fashion statement; it could be what saves your sole in the long run. The plantar fascia runs the length of the arch of the foot. When it becomes inflamed, it can produce a stabbing pain in the heel or arch of the foot.

Malini Bartels is a freelance writer, chef, mother, radio host and actress living the good life in Fort Collins

Lydia’s STYLE Magazine

Northern Colorado Medical & Wellness 2014

MEDICAL

Dementia

MANAGING

M EM ORY CHALLE N GE S

one of us can stop the onslaught of age. And whether it is the natural result of aging or something worse, memory issues are something many of us experience even before our senior years. There are ways to fight those issues, however. “We expect normal age-related atrophy to happen in the brain, but when it goes beyond that, we want to find ways to help people compensate for these changes,” says Deana Davalos, Ph.D., with Center for Neurorehabilitation Services (CNS) in Fort Collins. “We’re here to facilitate independence, to try to help people get their lives in order.” Whatever form it takes, memory loss affects not only the individual, but also friends and family. “Early on, it can be frustrating or scary for a person when it feels like his or her mind

is failing. It can create panic when an individual can’t find the car, leaves the stove on or can’t find something,” adds Joy DeJong Lago, Ph.D., ABPP-CN. “It can also be very concerning to the family of the individual who may not realize it’s happening.” Dementia, Dr. DeJong points out, is “an umbrella term to describe a neurodegenerative process in the brain.” The most common is Alzheimer’s disease, but there are other types, such as subcortical vascular dementia, which can be brought on by vascular issues such as high blood pressure, smoking, diabetes or obesity; dementia with Lewy bodies, which has characteristics of both Alzheimer’s and Parkinson’s; and frontotemporal dementia (FTD) that often manifests initially through notable changes in language or personality. Therefore, Dr. DeJong says, “When assessing older adults, it’s important to identify whether or

BY CARL SIMMONS

not the changes appear to reflect dementia, and if so, what type and what stage. The earlier it is identified, the earlier we can begin intervention.” Patients who come to CNS are given a comprehensive interview, preferably with a friend or family member present. A detailed neuropsychological evaluation is then conducted to more thoroughly evaluate the individual’s cognitive strengths and weaknesses. Once a diagnosis has been made, CNS offers a variety of services for patients and their families, including occupational therapy to address dailylife issues such as organization, planning, task completion and safety; speech-language therapy to assist with memory and retrieval strategies; physical therapy to address any balance or gait changes; and psychological services for both patients and family; as well as caregiver’s classes for those responsible for overseeing the care of their family member. In addition, CNS offers an

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Left: Dr. Deana Davalos and a volunteer demonstrate the process of gathering research using the repetitive transcranial magnetic stimulation ( rTMS) machine, a collaboration between Center for Neurorehabilitation Services and CSU. Above: At Center for Neurorehabilitation Services, Dr. Joy DeJong gives comprehensive memory assessments to patients to determine what type of dementia, and what stage, they may be experiencing.

adaptive-driving program, only one of four such programs in the state, to help patients get back on the road. (See the sidebar article, “Keeping Your Mind on the Road” on page 34.) “There can also be other conditions mixed in with memory problems, such as depression or motor-skills issues such as gait and balance,” Dr. Davalos notes. “Each patient needs a personalized treatment plan, which might include counseling, occupational therapy, speech language therapy, music therapy or physical therapy.” “Our clinic is pretty unique in that we meet people where they’re at – and give them tools to maintain the highest level of functional independence,” Dr. DeJong adds. “Sometimes that means observing someone in their home or taking them out in the community.” Connie Bragassa of Windsor can testify to the level of care offered at CNS. About a year ago, her husband Bob was diagnosed with Alzheimer’s.

“I had been watching the symptoms for about four years. You know that you know – but you don’t want to know. When we finally got the diagnosis, the response from family members was ‘Mom, you knew.’ But I was crying. I just didn’t want it to be true. I’ve had to watch the confusion, the anxiety, the desperate need to cover up, the need to be a cheerleader. It created a fear of the future.” In addition to Bob’s treatment, Connie went through caregiver’s classes at CNS. “One of the things I learned was to distinguish between the person and the disease. It sounds easy, but it’s not,” she said. “When there’s uncharacteristic behavior I learned not to get angry at him, because it’s the disease and not him. I think the class should be a must for anyone receiving care from CNS. It’s so powerful. It’s taught me so much about living for today and taking care of myself, as well as about how to be a caregiver.” CONT. ON PAGE 35

Northern Colorado Medical & Wellness 2014

KE E P ING YOUR M I N D

O N THE ROA D

mong the services offered at the Center for Neurorehabilitation Services (CNS), perhaps its most unique one is the adaptive-driving program. This program helps those with memory or other cognitive issues get back on the road – or to stay on it longer. “We specialize in getting people back to driving after a medical incident,” says driving rehabilitation specialist Marlis Lane, OTR, CDRS. “One big challenge is that we have to help patients learn strategies for an overlearned task. They’ve usually been drivers for years, but now need to find a way to match their ‘new’ nervous system with their old habits. It could also lead to recommending that a person return to driving with restrictions. In order to determine whether a person’s ready to get back on the road, and to what degree, the program uses both clinical and behind-the-wheel evaluations. “From there,” Lane says, “we can make recommendations, and introduce behindthe-wheel training to develop the use of compensatory strategies.” However, Lane points out, many of these

strategies are useful for any driver who’s getting older. Whether it’s “senior moments” or something more serious, the following tips will make your time on the road safer for both you and those around you: •

Use familiar routes.

•

Minimize your driving time to prevent physical/mental fatigue.

•

Plan your driving times for when your medications are working at peak.

•

Minimize distractions, including cell phone, radio, eating and conversation.

•

Plan your routes in advance.

•

Include roads with traffic lights, so decision-making is more structured.

•

Use single-lane roads, so you can concentrate more on your own driving and less on others.

BY CARL SIMMONS

•

Use roads with lower speed limits.

•

Increase following space behind the vehicle in front of you, to add to reaction time.

•

Recognize your limitations and consider other options (public transportation, riding with friends or family).

Sometimes it takes more than adapting one’s mental processes to get back on the road, especially for those who have suffered physical injury in an accident. When that happens, the program also looks into getting adaptive equipment for drivers, which can include hand controls, a steering knob, adaptive pedals or electronic secondary controls (i.e. turn signals and lights). “CNS also works with visually impaired drivers, using specialty telescopic bioptic lenses,” Lane adds. “All of this is done under a physician’s care,” she notes. “We’re the catalyst to help the doctor understand what’s going on and to recommend a plan. Really, we’re performing a community service; hopefully drivers can stay out there with improved independence and control.”

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CONT. FROM PAGE 33 She continues, “During the initial interview, they listened very carefully to the concerns I had and the things I saw and that Bob saw, and tailored the therapies to his needs. One of the issues has been a sense of ‘what day is it and what am I supposed to be doing?’ and they’ve helped him cope with that. They’ve taught him to really focus and listen better; I’ve also learned that. They’ve given him several games to play that help with recall. “The main thing they’ve given him,” she adds, “is a hope for the future and the restoration of self-confidence. I told them: ‘You’ve given me back a part of my husband.’” In addition to helping both patients and family adapt and cope with memory loss and/or dementia, CNS, in cooperation with Colorado State University, has also recently embarked on studies on how to treat memory loss more proactively. Matt Malcolm, Ph.D., OTR, an associate professor of occupational therapy at CSU is working with Dr. Davalos. Dr. Malcolm says, “Dementia is a progressive degenerative disease, so there hasn’t been a lot of time spent on researching treatments. Clinicians might say, ‘Well, that’s the way it is,’ or use medications that have a lot of side effects. We feel it’s important to come up with treatment, rather than write people off.” Therefore, Drs. Malcolm and Davalos have begun exploring the use of a process called repetitive transcranial magnetic stimulation (rTMS). “This initial study is hopefully the start of several years’ worth of studies in this area,” Dr. Malcolm says. There’s not a lot that’s been done on this topic, so it’s wide open. “Dr. Davalos’ part is to test cognitive function. Then we’ll perform different types of brain stimulation to the prefrontal cortex of the brain, to see if one is more effective than another, then retest,” Dr. Malcolm explains. “I’ve used rTMS with people who’ve had strokes, and it’s more effective for recovery of movement than just doing therapy alone. That’s what we’re hoping will also happen with people who have mild cognitive impairment.” Even now, though, there are things anyone can do to prevent or slow down memory loss or dementia. “Try to have good sleep hygiene, eat healthy, socialize, exercise and stimulate your brain,” Dr. Davalos says. “Some behavior, such as poor sleep quality, is associated with almost every physical or psychological issue.” “Being active is my number one recommendation,” Dr. DeJong adds. “Sure, mind games are helpful, like Sudoku and crossword puzzles, but a healthy lifestyle is the most effective strategy. Be as socially, mentally and physically active as possible.”

Center for Neurorehabilitation Services, P.C. 1045 Robertson Street, Fort Collins (970) 493-6667 www.brainrecov.com Carl Simmons is a freelance writer based in Loveland.

Northern Colorado Medical & Wellness 2014

MEDICAL

Northern Colorado Rehabilitation Hospital

NORTHERN COLORADO REHABILITATION HOSPITAL:

TRANSITIONING BACK TO NORMAL BY HEIDI KERR-SCHLAEFER

orthern Colorado Rehabilitation Hospital (NCRH) is the type of place most people don’t become aware of until they need its services. Yet this is one of the best rehabilitation hospitals in the nation, and it’s in our own backyard. Located just east of I-25 along Highway 34, NCRH takes a mindful and serious approach to rehabilitation medicine. The staff believes therapy incorporates the whole person, not just a specific medical issue. The overall emotional well-being of their patients is as important as the physical recovery and the skills training process. “We want people to have a better understanding of what we do as a medical campus and why we do it. We want to help the community be informed healthcare consumers. Whether an individual is having a planned surgery or has had an unplanned disabling incident, we want them to be able to make a knowledgeable decision

about where they can go for their rehabilitative care,” says Elizabeth Bullard, chief operating officer of NCRH. As part of Ernest Health, headquartered in Albuquerque, New Mexico, this hospital’s approach is distinctive because it is part of a health system founded, not by hospital administrators or a financial group, but a group of clinicians who had experience on the ground floor of healthcare and rehabilitative medicine. Ernest Health’s approach appears to be working because they are currently in a growth phase. In addition to Northern Colorado, Ernest has Rehabilitation and Long Term Acute hospitals in Arizona, Idaho, Indiana, Montana, New Mexico, South Carolina, Texas, Utah and Wyoming. After researching the region, Ernest Health opened NCRH in 2005, at the intersection of rural and metropolitan Northern Colorado. NCRH is the only freestanding rehabilitation hospital in Colorado north of 120th Avenue. The campus has two separate and distinct

hospitals, as well as an outpatient center and the offices of four private practice physicians specialized in physical medicine and rehabilitation. The rehabilitation hospital itself offers 40 private rooms and has an average length of stay around 14 days. For seven out of eight years, it has been rated as one of the top 10 rehabilitation hospitals in the nation, out of 774 hospitals willing to participate in the intense review process. The second hospital on the campus is Northern Colorado Long Term Acute Hospital (NCLTAH). It is a 20-bed facility with an internal medicine hospitalist and other critical care specialists managing the acute, complex medical needs of their patients. NCRH’s physical medicine and rehabilitation physicians serve as consultants and rehabilitative team leaders in this hospital. The average length of stay at the long-term acute care hospital is 28 days. “Long term acute care hospitals (LTAC) were established in the 1980s as a way to deliver ICUtype care in a more cost effective setting,” says Dr. Indira S. Lanig, medical director of NCRH. “High

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The Northern Colorado Rehabilitation Hospital features two separate and distinct hospitals, as well as an outpatient center and physician offices.

acuity patients here may be on a ventilator and in need of gradual weaning off the machine to be able to breathe on their own. They may be on dialysis or in need of extensive antibiotics or wound care. LTAC patients are sometimes called chronically, critically ill patients. This simply means they are medically fragile for several weeks rather than just several days. Once their complex medical issues have been addressed, they are often discharged from the hospital to home or another post acute care setting.”

Teamwork, an expectation

The number of onsite physiatrists (physical medicine and rehabilitation physicians) is something unique to NCRH. Physiatrists are doctors who are nerve, muscle and bone experts treating injuries or illnesses that affect the way we move and take care of ourselves. That is the technical explanation of what these doctors do, but Dr. Lanig broadens the description. “Physiatrists look at all the medical issues being faced by an individual, and more importantly, we look at the impact of those medical issues on their function: self-care, mobility, community reintegration and role performance in the home or outside the home,” she says. “I call us ‘air traffic controllers’ because our board certification inherently expects that we will be working with a team. We recognize the value and expertise of everyone involved with the care of a patient from the physical therapist to the occupational therapists to the speech pathologist, the nurse and social worker. We celebrate the diversity of knowledge that serves our patients.” Alongside the rehabilitative medicine physicians, NCRH has a large number of certified rehabilitation registered nurses. These nurses have received additional specific training in

Northern Colorado Medical & Wellness 2014

Part of NCRH’s comprehensive 6,000 square foot therapy gym with top-of-the-line therapeutic equipment.

rehabilitation and understand the carry over and collaborative approach necessary to assure rehabilitative care occurs far beyond the therapy gym. They are better able to educate patients and their families, and are well acquainted with the equipment used in rehabilitation-focused settings. “It’s very valuable to have so many certified rehabilitation nurses on our staff,” says Dr. Lanig. ”It’s one of the things that make us unique. Here, you are getting a full complement of therapy and reinforcement of that therapy 24/7.” NCRH embraces the team concept in every aspect. For instance, a patient works largely with the same group of individuals from the moment he or she enters the facility. Additionally, the administrators work with clinical staff to assure that patient-focused decision making can occur together. While each individual is responsible for the duties outlined in their job description, few individuals at NCRH are defined solely by their current job. “I’m the perfect example,” says Bullard, who is not only COO, but also an occupational therapist with 25 years of clinical experience in adult neurological rehabilitation. “I started in this company as a therapist and have had the opportunity to learn and take on many different roles within the hospital. I know firsthand what the staff faces every day. We’re all in this together and are here to serve our patients and each other. We don’t get caught up in titles. If a patient’s call light is on, it’s everyone’s responsibility to answer it.”

From the patient’s experience

Richard Ziegler, of Greeley, experienced NCRH’s teamwork firsthand. In March 2013, he was riding his bicycle to the school where he taught when he was hit by a car. His heart stopped three times on the way to the emergency room and doctors

feared the worse. The accident resulted in 47 fractures over his entire body, multiple surgeries and a four-week stay in the intensive care unit at a local hospital. He was then transferred to NCLTAH where he spent another foggy three weeks, until being moved to the rehabilitation hospital of the campus. “It’s an incredible rehabilitation hospital,” says Ziegler. “I made a lot of progress, and in June, I was able to walk out of there with a cane. That was a huge victory. Today I’m walking without a cane.” Ziegler credits long term care and rehabilitation hospitals with where he is today. He has gone from having three nurses move him from bed to a wheelchair to living independently at home with his wife, Linda. This August he even returned to tutoring at the school where he was working prior to the accident. A father of three and grandfather of three, Ziegler also believes that NCRH’s openness to his family visiting him made an impact on his recovery. “I think having family there is so important. It would really make my day to see my grandkids walk in after a tough therapy session,” he says.

The methods make them unique

As soon as a patient checks in to NCRH’s rehabilitation hospital, they are engaged as an active participant in their own care. They are evaluated and goals are established and prioritized. The journey toward home then begins. This can be difficult after a traumatic incident such as a stroke, the loss of a limb, or a severe head injury. From the moment an individual arrives at NCRH a routine is establishe, a routine that will eventually help them get back to everyday life. The hospital’s consideration of family is another distinctive feature of their approach to rehabilitation. Family members are active participants in

Northern Colorado Rehabilitation Hospital’s aquatic therapy pool.

the goal-setting process and therapy sessions. Upon admission, a case manager is assigned to each patient. That case manager serves as main contact, coordinator of care and advocate for the patient and family. They work closely with team members and assist with all aspects of discharge and care-transition planning. All patients at NCRH eat their meals in the cafeteria, not in their rooms. If they need assistance, they are paired with a therapist or nurse during their meal. For instance, a speech therapist may join a stroke patient who is still having difficulty forming or finding the right words. The therapist will go through the food line with them, helping them find the right words like “eggs” and assisting when and if necessary. “It’s a therapeutic buddy system,” says Dr. Lanig. “That’s how someone with a significant disability is able to get through the cafeteria line and co-mingle. If you’ve got weakness in your hand and have trouble getting food in your mouth, even if you are a little sloppy, there’s no judgment here. It’s about creating normality.” Another way NCRH creates normality is by allowing patients to use the Activities of Daily Living (ADL) Suite. This room is designed to represent a patient’s real home life, with a queen-sized bed and a floor plan typically found in a home. A kitchen and laundry area is also available for skills training. Following a patient’s wishes or those of a family member, a patient may stay in this room for a few days prior to going home from the hospital. Inside the suite, they can practice day-to-day routines in a setting where help is just a few feet away. “Any transition is scary,” says Bullard. “To go from this environment to home can be a shocking transition. We want patients to realize leaving here is a celebration. Whenever a patient leaves our hospital, everyone lines up in the hall and claps and cheers to recognize everything that patient has achieved.”

Dr. Indira S. Lanig, Medical Director, and Elizabeth Bullard, Chief Operating Officer of Northern Colorado Rehabilitation Hospital.

Once a patient is discharged from NCRH, the story doesn’t end. NCRH helps their patients find resources for continued therapy as well as resources for emotional and psychosocial support in the community. “Psychosocial health is as important as physical health to us, and I think it’s something society as a whole needs to be more sensitive to,” says Dr. Lanig.

Therapy is more than equipment

NCRH has all the top-of-the-line therapeutic equipment, as well as a 6,000-square-foot therapy gym and an aquatic therapy pool. However, Dr. Lanig points out while having high-end equipment is good, it’s more important to have the right professionals helping patients. “We’ve got all the high-end equipment, but as a doctor, I want to make sure that I not only have those resources, but I have a team of therapists with good critical thinking skills and a focus on customized patient care so that those resources are used appropriately,” she says. A large number of NCRH’s therapists are certified in NEURO-IFRAH, neuro-integrated functional rehabilitation and habilitation. Two of the hospital’s therapists are certified NEURO-IFRAH trainers, a distinction of which Bullard is proud. Both Bullard and Dr. Lanig stress that therapy is more than equipment – it’s ultimately about putting quality and maximized independent function back into someone’s life. Strengthening the muscles in a patient’s legs serves a purpose, to allow the patient to stand up and walk. The end goal is always top of mind at NCRH and they go above and beyond to reach those goals. For instance, standards set by Medicare require that a patient receive a minimum of three hours of therapy a day, five out of seven days a week. “We respect and often exceed that minimum guideline, since our focus is on each and every individual patient outcome.” says Bullard. “We

do what it takes for our patients to achieve their goals.” NCRH also provides a variety of therapeutic groups in addition to therapy sessions. There is a monthly Stroke Support Group as well as an educational series for stroke survivors, their families and caregivers. NCRH recently received its Joint Commission disease-specific certification in Stroke Rehabilitation. The certification award recognizes the hospital’s dedication to continuous compliance with The Joint Commission’s state-of-the-art standards. The outpatient center has specialized occupational therapists, physical therapists and speech therapists and houses the private practice offices of the physical medicine and rehabilitation physicians on staff. Clinics include the Continuity of Care clinic, a NeuroVision clinic, a Wheelchair/seating clinic, Orthotic and Prosthetic clinic, Movement and Spasticity clinic, a Podiatry clinic and a Senior Weekend Warriors clinic for those older than 60. “How many people are out there ‘just getting by’ at home with an acquired disability and not realizing that life could be better?” pondered Dr. Lanig. “Rehabilitation can restore a person’s independence at home. People don’t realize how many of their neighbors may be living with a sub-optimized level of physical independence. We can help them.” Northern Colorado Rehabilitation Hospital is located at 4401 Union Street, Johnstown, Colorado. You can explore their website at NCRH.ernesthealth.com or call them directly at (970) 619-3400.

Heidi Kerr-Schlaefer is a full-time freelance writer and founder of HeidiTown.com, the place for entertaining information on Colorado festivals and travel.

Lydia’s STYLE Magazine

OUTPATIENT CENTER Specialized Clinics Include: Continuity of Care Clinic • NeuroVision Clinic • Wheelchair/ Seating Clinic Orthotic and Prosthetic Clinic • Spasticity Clinic Senior Sports Clinic • Weekend Warriors Clinic • Podiatry Clinic Personalized Plan of Care • State-of-the-Art Equipment (Bioness, Dynavision, VitalStim) • Spacious, Healing Environment Rehabilitation Physician Private Practice/Clinic - based consultations

Interdisciplinary Therapy Team: Physical Therapy • Occupational Therapy • Speech Therapy • Aquatic Therapy

Meet Our Rehabilitation Physicians:

Indira S. Lanig, M.D. Medical Director Physical Medicine and Rehab Spinal Cord Injury Medicine Specialty

Rebecca M. Bierden, M.D. Associate Medical Director Physical Medicine and Rehab

ph: 970.619.3454

Revelyn Arrogante, M.D. Associate Medical Director Physical Medicine and Rehab

Nathan Swartz, M.D. Associate Medical Director Physical Medicine and Rehab

MEDICAL

Care Planning

RIG H T PAT IENT,

RIGHT PLACE, RIGHT TIME

onsider this scenario: Your loved one is in the hospital, recovering from an accident or planned surgery. The first moment you can take a breath, the discharge discussion begins. Can they go home? No. Where are they going to go? What does your insurance cover? You don’t know, and you may have to make the decision on the spot, with little help. Perhaps you’ve experienced this type of panic at discharge time. It’s understandable. Hospitals can’t keep you unless there is medical reason to. Without question, most people really just want to go straight home after a hospital stay, but that is not always the best place. Especially with complex cases, the outcome would be better with some post-acute care. So... where

BY COREY RADMAN

do you send Mom or Dad? And can you figure it out in half a day? That “discharge panic” is avoidable with some preparation. Educate yourself and your family on the options before you think you’ll need them. The Northern Colorado post-acute care options have expanded greatly in the last 20 years. Once upon a time, the only options were nursing homes. Now there are several levels of care available and all of them are within a 20-minute drive of the Fort Collins/Loveland area.

Long Term Acute Care (LTAC)

The Northern Colorado Long Term Acute Hospital, located just east of Interstate 25 and US Highway 34, is the region’s only LTAC facility. With 20 beds and in-house physicians, it’s the best place for patients who need ongoing medical care during a prolonged critical illness, ventilator/

pulmonary care or complex wound care. It is essentially a step-down ICU and works as a tiny hospital for critical care patients who don’t need the all services found in a short-term acute care (STAC) hospital, such as an operating room, emergency department or radiology department right on site. Medical Director of the rehabilitation hospital on the same campus, Dr. Indira Lanig, explains, “Long-term acute care hospitals were built to care for sick patients who require longer periods of hospitalization to address their complex critical care needs.” The hospital offers care for conditions such as complex strokes, complex trauma, postoperative cardiovascular care in complicated patients and drug-resistant infections. Part of its signature service includes a ventilator-weaning program. This is very valuable to patients with lung problems who may need extra time building back up to

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breathing on their own again after pneumonia or other breathing problems. The average length of stay at an LTAC is around 25 to 30 days. Here, therapy is available, but medical needs come first.

Rehabilitation Hospitals

Rehabilitation hospitals provide in-patient rehabilitation after orthopedic or other surgery or for conditions such as stroke, brain injury, spinal cord injury, amputations, multiple sclerosis, Parkinson’s and other disabling conditions. Their regulatory rules stipulate that they must have an in-house multi-disciplinary team led by physicians that includes physical therapists, occupational therapists and speech/language pathologists. In addition, they must provide at least three hours of daily therapy, five out of seven days, for every patient. Northern Colorado Rehabilitation Hospital’s 40 beds and Medical Center of the Rockies’ 18-bed Rehabilitation Unit are the only two official rehabilitation hospitals in the Fort Collins/ Loveland region. Dr. Lanig says, “Our goal is to get individuals back home as quickly as possible by providing intensive physical rehabilitation services. We can manage multiple medical problems like heart disease, diabetes or vascular disease, while also addressing their physical rehab needs. We have physicians on staff who are specially trained in physical medicine and rehabilitation to lead this process.” Northern Colorado Rehabilitation Hospital’s Chief Operating Officer, Beth Bullard, explains the goal: “In a regular hospital, the main focus is on helping the patient overcome their immediate illness or injury. In a rehabilitation hospital, we know that recovery may be long-term, so in addition to their physical rehabilitation, we also help prepare the patient to go home and be able to perform everyday tasks.” That means self care, getting to meals in the cafeteria, and working on therapy. The facility has private rooms, a therapy gym, a warm water therapy pool, a learning kitchen and group rooms for families to use for gatherings. In the learning kitchen (called the Activities of Daily Living room), patients learn new approaches for taking care of daily life activities. Perhaps they are learning to walk after a stroke or a hip replacement, but will need to feed themselves and the dog when they get home. The room has an oven, refrigerator, clothes washer/dryer and a bathroom with regular-height fixtures. Patients can take their new hip for a trial run with the support and safety of an assisting therapist. Bullard reports that the average length of stay at NCRH is 14 days. “People come for numerous reasons: rehabilitation after a planned surgery, stroke, traumatic brain injury... or they may have a debilitating disease like Parkinson’s that requires some retraining or a new approach to daily living. “They can come straight to our hospital from home or from an acute care hospital and then return home.” Much of the work at NCRH is also provided to families of patients. By helping them learn the new routines or new medical devices, they can often take over at home or be better prepared to oversee ongoing home care.

Northern Colorado Medical & Wellness 2014

Marie Connolly, Guiding Light

YOUR HOSPITAL TRANSITION NOTEBOOK BY COREY RADMAN

Occupational therapist Jaime Michel works with patient Jerry Karbs at Northern Colorado Rehabilitation Hospital.

Skilled Nursing Facilities (SNFs)

Formerly called nursing homes, today’s skilled nursing facilities offer many of the same services as rehabilitation hospitals, but are not required to by law. Some do offer daily therapy, some don’t. You have to ask to be sure. Yvonne Myers is health systems director for Columbine Health Systems. She says Columbine has five nursing homes – all have rehab services – but points to the Centre Avenue facility as the most likely post-acute care facility for rehabilitation in Fort Collins. With an average length of stay at 24 days, Columbine also gets their patients up and going after surgery. “At Centre Avenue, there’s this energy. People are comparing their walking plans and competing to see who gets done quicker,” Myers reports. For non-complex cases like a knee replacement with no co-morbidities, a SNF is a viable option. Myers addresses the fear many people have about nursing homes – that they would check in and never leave. “Thirty years ago, people did do 20 years in nursing homes because that’s all there was. Nowadays, if people live there for two to three years that’s a really long time. Our assisted living partners love their patients to come to us because we send them back.” She reports that of the system-wide 125 rehabilitation beds, 105 discharged in January.

Making the Decision

Bullard feels like it’s time for both healthcare consumers and providers to get better informed on the options available in the region. “I think it’s always about the right patient, the right place, at the right time. We as healthcare providers have to work together to make sure patients get what they need. The insurance dollars are what they are; there are only going to be so many of them. We’ve got to spend them the right way at the right time.” Bottom line: It pays to be informed and prepared. Most short-term acute care hospital discharges happen in three to four hours. That’s not long enough to fully research your options. As your parents or your spouse are nearing the “possible broken hip” stage of life, it’s time to start thinking about where you might like them to be. And the good new is: there are many excellent options in Northern Colorado.

Corey Radman is a regular contributor to this magazine. Reach her at fortcollinswriter.com.

s with any new job, your new role as patient advocate will require that you take notes and ask a lot of questions. Professional Patient Advocate, Marie Connolly, has been working on behalf of patients for 12 years through her business, Guiding Light. She suggests that you take these steps: Be aware of your insurance coverage. What does the policy cover? Is there a coinsurance? What are the out of pocket expenses? She says, especially with elderly patients, they may just want to go home instead of to in-patient rehabilitation. Resist this. “Even if they were independent before, being in the hospital is extremely deconditioning. Typically, they really do need to get to a facility for some physical therapy.” When screening facilities, it’s important to visit them. Ask a lot of questions. Check their ratings and inspections at medicare.gov. Look for patients who are up and dressed and engaged. Watch the front-line staff to see if they are smiling and enjoying their work. Do a smell test. Occasional passing odors are to be expected with adults who have varying degrees of continence. Long-lasting smells are an indicator that someone’s needs are not being met. Once your loved one is checked in to a facility, make sure they stay on track. Set weekly goals. Ask them: Are you meeting your goals every week? If not, why? What can they tweak? Consider hiring a patient advocate like Connolly at guidinglightllc.com. She says, “Often, communication doesn’t work as well as we need it to. Having someone familiar with the industry and with medical orders can head off trouble before it occurs.”

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Northern Colorado Medical & Wellness 2014

WELLNESS

Health Advocacy

Dr. Lanig visits with patient Bruce Zeller. She advocates for the enrichment of opportunities for people with disabilities to allow them to live life to the fullest.

BE Y OND DISABI LI TY:

HEALTHY LIV E S F O R A L L BY ELISSA TIVONA

ven though her family suspected something dire, no doctor could accurately diagnosis Claudia Amiel Harrington until 2010. At age 20, she finally learned she was born with an incurable genetic disorder called Ehlers-Danlos Syndrome, which was causing her entire body to weaken and deteriorate over time. Claudia, known by friends as Cloudy, reflects on the challenge of growing up as a child with a disability. “As my disorder started to mean I needed to wear braces to walk, doctors slowly added my favorite active pastimes to the list of things I would never be able to do again.” Though Cloudy battled depression as a

youngster, she has been able to make her way through the worst of times by redefining herself and her passions in terms of all she can do, rather than in terms of what she can’t. Today she is an enthusiastic artist and costumer, a writer and spoken-word performer. She says, “I came to accept the body and mind I had… It was a long journey to self-love and healing, and one I am still on today, reaffirming the fact that I am beautiful, even if my body doesn’t fit societal norms.” Cloudy’s outlook on life is similar to the beliefs of physical medicine and rehabilitation professionals. Following any life-altering diagnosis or catastrophic accident, the daunting medical journey that unfolds can be fraught with physical and emotional challenges. But over time, many people find strength to rebuild meaningful lives with the

help of supportive friends and families, progressive healthcare professionals and rehabilitation programs and, most importantly, the support of an enlightened community. Dr. Indira Lanig, medical director of Northern Colorado Rehabilitation Hospital (NCRH), is a leader in establishing collaborative networks to help people with both temporary and permanently disabling illnesses or injuries. She is a board certified physical medicine and rehabilitation physician and a 20-year veteran in the sub-specialty of Catastrophic Spinal Cord Injury Medicine. Her intimate experience in this field makes her a spirited advocate for wellness and healthy alternatives for people with limited mobility. Like many of her colleagues, Dr. Lanig refuses to accept the outdated notion that living with

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physical differences — whether created by spinal cord injuries, strokes, multiple sclerosis, traumatic brain injury, complicated injuries, amputations or simply the natural slowing down that comes with age — prevents people from achieving optimal health across all domains: physical, emotional, social, spiritual and intellectual. She has spent her career helping patients like Cloudy redefine their abilities and develop a holistic attitude toward maintaining health and wellness. But she doesn’t stop at the door of the rehabilitation hospital. Dr. Lanig advocates for inclusion, meaning she encourages the community-at-large to break down remaining architectural, attitudinal and participation barriers that have prevented people with disabilities from fully engaging in life-affirming activities and occupations. She notes that people with disabilities demonstrate versatility and zest for life much the same as the able-bodied. They take up downhill skiing, join quilting and knitting circles, form community chorales and performance troupes, ride horses or drive horse-drawn carts, water-ski, even attempt rock-climbing and sky diving. The list of community activities is as unlimited as the human imagination for creativity and adaptation. Modern rehabilitation efforts have evolved from teaching patients to cope with disabilities to coaching clients on how to live well given their inherent strengths. This philosophy is embedded in protocols at NCRH aimed at finding tools and resources (whether inside the hospital or out) for people with disabilities to re-engage fully in active lifestyles, and to feel valued in the context of friends, family and caring communities. Creative collaboration is the hallmark of the new rehabilitation where staff, clients, family and community become partners in discovery… and recovery. One example of a community successfully coming together to support folks living with physical and mental differences is Boulder County’s EXPAND program, specializing in skills and recreational activities serving people with disabilities. One of the most popular and well-established of EXPAND’s activities goes by the motto “Skiing is Believing.” For more than 30 summers, individuals, regardless of physical ability, are assisted by trained volunteers and professionals to enjoy adaptive water-skiing. People with disabilities leave behind walkers, wheelchairs and companion animals to experience the exhilaration of skimming across the white water wake of a speedboat. Everyone, regardless of age or function, is encouraged to participate. Rodger Stewart, a volunteer boat driver for EXPAND’s water-ski program, recounts the story of how his involvement has altered his perception of people with disabilities. Each summer on water-skiing outings, Stewart noticed EXPAND skiers on Boulder Reservoir, but his fulltime job precluded volunteering. The impression stayed with him. “When I retired in July 2008, one of the first things I did was contact Cory Lasher who ran the program for Boulder County Parks and Recreation and asked to be a boat driver. At the time she told me they had all the support they needed, but I told her I must be a volunteer boat driver.” Stewart’s persistence paid off richly for him and

Northern Colorado Medical & Wellness 2014

Regional Recreational Opportunities for People with Disabilities: BOULDER PARKS AND RECREATION: EXPAND Program for People With Disabilities www.bouldercolorado.gov/parks-rec/ expand-program-for-people-with-disabilities Contact: Cory Lasher (303) 413-7269 FORT COLLINS PARKS AND RECREATION: Adaptive Recreation Opportunities www.fcgov.com/aro Contact: Therapuetic Recreation Specialist (970) 224-6027 Rodger Stewart, volunteer boat driver for EXPAND’s adaptive water-ski program, sits in his boat. He provides water-ski experiences to persons with disabilities.

the program. He currently serves as president for EXPAND Beyond, Inc., a Colorado nonprofit formed to support Boulder’s adaptive water-ski program. Stewart says, “Teaching and providing the ability for individuals with physical disabilities to water-ski is one of the most enjoyable things I do. You can only imagine the freedom gliding across the water gives them.” He explains how his perceptions have shifted over the years. He says, “What you see on the outside is so unlike what is on the inside.” Today, Stewart takes time to sit with program participants and get to know them as individuals, not as people trapped inside their bodies. Dr. Terry Chase, patient and family education coordinator at Craig Hospital (a world-renowned spinal cord injury and traumatic brain injury rehabilitation hospital) hopes more people like Stewart will become involved in community initiatives to accelerate change in public perception of people with disabilities. Too often stories and images of people living with physical, emotional or cognitive differences underscore disability instead of ability. Dr. Chase has seen some improvements since 1988 — for example, more people with disabilities modeling participation in sports and wellness activities, and appearing on TV or in commercials — but she advocates for many more positive messages. She asks, what about “moving people with disabilities off the human interest page and onto the sports page?” According to the definition of health offered by the U.S. Department of Heath and Human Services in Healthy People 2000, all people, regardless of physical limitation, have the capacity to achieve optimal health. The policy report defines health as “a full range of functional capacity at each life stage, allowing one the ability to enter into satisfying relationships with others, to work, and to play.” However, Dr. James H. Rimmer of the National Center on Physical Activity and Disability points

out that there are huge disparities between proactive promotion of health and preventive care for the able-bodied versus those with disabilities. Dr. Lanig and others believe this is due in part to “our society’s strong perception that health and disability are mutually exclusive.” She stresses, “This is a misperception that needs to be laid to rest. There are a thousand little and larger strategies that can be undertaken to tear down attitudinal and logistical barriers that perpetuate this misperception.” The latest report, Healthy People 2020, outlines four major areas for improvement for people with disabilities (www.healthypeople.gov/2020/ topicsobjectives2020/overview.aspx?topicid=9): •

Be included in public health activities.

•

Receive well-timed interventions and services.

•

Interact with their environment without barriers.

•

Participate in everyday life activities.

Dr. Lanig and NCRH invite all “health-conscious, Colorado lifestyle” advocates to join them in extending opportunities to people with physical disabilities to achieve the optimal health, wellness and quality lifestyle goals shared by all, and modeled by Claudia Amiel Harington. Dr. Lanig notes, “Each individual has the potential to achieve optimal health within his or her own unique constellation of impairments or disability.” Enlightened community support in Colorado can help ensure everyone is included. Elissa Tivona is a freelance writer and educator based in Fort Collins. For a full account of Claudia’s disability journey read her story online at www.facebook.com/cloudydayblogging.

DENVER PARKS AND RECREATION: Adaptive Recreation www.denvergov.org/parksandrecreation/ DenverParksandRecreation/ActivitiesPrograms/AdaptiveRecreation/tabid/443643/ Default.aspx Contact: (720) 865-0820 For partnership with the National Inclusion Project See www.inclusionproject.org/ NATIONAL SPORTS CENTER FOR THE DISABLED (NSCD): Winter Park and Denver www.nscd.org Contact: Customer Reservations (303) 316-1518 or (970) 726-1518 Volunteer Information: (303) 316.1546 or volunteer@nscd.org ADAPTIVE ADVENTURES www.adaptiveadventures.org Contact: Boulder Office Toll Free (877) 679-2770 FRONT RANGE EXCEPTIONAL EQUESTRIANS www.ridewithfree.org Contact: Fort Collins (970) 221-0646 HEARTS AND HORSES THERAPEUTIC RIDING CENTER www.heartsandhorses.org Contact: Loveland, Colorado (970) 663-4200 PROJECT HEALING WATERS FLY FISHING, PLATTE RIVERS (Serving disabled active duty and retired service members) www.projecthealingwaters.org Northern Colorado contact: Dean Miller (970) 203-5257 info@platteriversphwff.com

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Northern Colorado Medical & Wellness 2014

MEDICAL

Universal Design

UN IV ERSAL D E SI GN:

SOM E T HING FOR E V E RYO N E

big chunk of the United States’ population is aging. Baby Boomers accounted for nearly 25 percent of the country’s total population in 2011. As more and more Boomers add the moniker “senior” to their identities (the first of them turned 65 three years ago), many of them plan to live in their homes for as long as they can. Overwhelmingly, Boomers state they want to remain in their longtime homes, staying engaged with friends and family in the communities where many have lived for decades.

That can mean taking a good hard look at their homes and making changes that accommodate the inevitable aging process. It goes way beyond wearing a medical alert pendant. The era of “I’ve fallen... and I can’t get up!” is long past. Think instead of aging in place with grace and dignity, as well as comfort and beauty. That is what constitues the principle of Universal Design. However, the concept is not just for folks who are moving into their golden years: it’s for everybody.

BY MICHELLE VENUS

Design for the whole population

Originally defined by architect Ronald Mace, Universal Design is design for the “whole population.” Mace described it as “the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.” Initially, Universal Design principles focused on public spaces to make them accessible to anyone who wanted to enjoy them. Inspiration Playground, located in Spring Canyon Park at the west end of Horsetooth Road in Fort Collins,

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Universal Design encompasses planning for the future – old age or an unexpected illness or disability – but doing so in a visually appealing way. Photos courtesy of Nathan Colburn, Accessible Systems.

is a perfect example. Designed so that children of all abilities can fully participate in outdoor play experiences, Inspiration Playground’s design features incorporate play surfaces that allow for easy access by wheelchairs, walkers and support braces. (Added bonus: Grandmas and Grandpas feel more sure-footed and can play right alongside their grandchildren.) The play structures accommodate nearly everyone and allow for sensory-rich and stimulating experiences that encourage integration and the development of all types of necessary skills, from cognitive and emotional to physical and social. Universal Design has grown to encompass residential design. Nathan Colburn is the owner of Accessible Systems, Inc., a Denver-based company that specializes in home renovations and retrofits that bring Universal Design features into homes from Kansas to New Mexico. Colburn, who just opened another office in Severance last month, believes that Universal Design should be a consideration every time a home is built, in order to plan ahead for whatever the future may bring. Colburn is quick to point out that the future can be something unexpected, like an accident or a child born with disabilities. “You have to remember that Universal Design isn’t just for aging in place, though that is a large part of our market,” he explains. “It really is for everybody, no matter what stage of life they may be in.” “Another misconception with Universal Design is that it’s ugly or institutional looking,” states Colburn. “That is not true. Done correctly, it’s beautiful and does not look very different from what most people consider a traditional home.” Accessible Systems has a show home in Englewood that proves accessibility can be as beautiful as it is functional. It features roll-under sinks and cooktops, barrier-free entryways and bathrooms, and personal lifts.

Northern Colorado Medical & Wellness 2014

RECREATING

A LIFE

BY MICHELLE VENUS

n the flutter of an eyelash, life can change forever. Robin Glasener, a real estate broker in Longmont, knows this all too well. In December 2009 she was in an automobile accident that resulted in a broken neck and spinal cord injury. “Technically, I’m considered a quadriplegic,” Robin, age 37, explains. “I’m very high functioning; paralyzed mostly from the waist down and somewhat in my hands. I’ve also healed a bit and gotten back some ability.” Robin’s injury is relatively low on her spine – at her fifth and sixth vertebrae, as compared with Christopher Reeves, whose injury occurred at his first and second vertebrae. Robin continues to see improvement. She did her rehabilitation at Craig Hospital in Denver and was told that two years after an injury is the likely cut-off for regaining capability. “I was super depressed when that date came,” she says. “But I made the decision to keep getting better, and even though that has been slower than at the beginning, I still see improvement. Doctors say one thing but life says another.” Robin remembers parts of her accident. She had been at a friend’s house and was driving home at about 2 a.m. She knew she was tired but thought she could make the short drive home. She couldn’t. Robin believes she fell asleep at the wheel. Her car rolled and hit the barrier on the other side of the road. She was instantly paralyzed. Her first thought was, “Oh my God. I’ve wrecked my car.” She worried about her thenboyfriend’s reaction and the grief she’d get from her colleagues. Robin was in and out of consciousness for nearly 90 minutes until an ambulance came after an anonymous call was placed, reporting her accident. When she was told she would never walk or use her arms again, Robin’s heart was initially pained, but it soon gave way to defiance. “I said

to myself, ‘You don’t know me.’ When the doctor saw me three months later, he couldn’t believe the progress I was making and he told me he was wrong about me.” Robin was in the ICU for two weeks, and the staff thought she was “too happy,” and likely in denial. “But I was trying to wrap my head around it all,” she says. “Though there was one day, about a week in, when I finally broke down and cried. Everyone was relieved that I finally released all the emotion.” Once she was released from Craig, Robin left her relationship and moved into a place of her own, which she admits was one of the hardest and scariest things she’s ever done. “There I was, by myself in a wheelchair. I’d left a huge bubble of accessibility. You go home and try to make your life. That’s really when it hit me,” she remembers. She wondered if this was what the rest of her life was going to look like. She cried and slept a lot and frequently struggled with depression. “But I realized I had to reinvent myself and recreate my life,” says Robin. “So, how do I do that?” Ten months after her accident, she went back to work as a real estate agent. To regain normalcy, she concentrated on many of the activities she had done prior to the accident. “Going back to work was important and got me out of the mental prison I had been in.” Robin also grieved for all the things she would never again experience with her son, Tanin. But the then 8-year-old grounded her by pointing out all the things they could still do, like going out for “walks” together; he loping alongside her while she maneuvered in her power chair. Shortly after that, she met her soon-to-be-husband, Gary. For a year, certified nursing assistants came to Robin’s home twice a day to help her with the tasks that come so easily for the able-bodied. “They would come and get me out of bed and help me into a rented portable shower that was set up in the middle of the kitchen,” Robin says. “It was like a camp shower: no privacy. They helped me get dressed and do laundry, household chores.” Robin knew that complete reliance on other people – a necessity after her accident – was not how she wanted to live her life. The only way she could accomplish this reachable goal was to live in a home with universal design features incorporated. Today, Robin, Gary and Tanin, now 13, live in a completely wheelchair accessible home, where they have lived for almost three years. Gary is the one who helps her with her daily routine. The carpet pile is low, allowing her to roll over it easily and safely. The doors and hallways are wider than normal and the home’s light switches are lower on the walls. The kitchen is equipped with several universal design features: a roll-under stove and sink. The wall oven is placed at a height that allows her to use it easily. Closet shelving is low and in reach. The bathroom features a roll-under vanity. Robin’s favorite universally designed feature is the roll-in shower. “After showering in that portable shower for so long to have a real shower with a real head that I could just roll into... I cried,” Robin’s voice catches on a sob. “I cried and I felt like a real human being for the first time in two and a half years. Just because I could get in a shower.”

Adding Universal Design features to your home

So how would the average homeowner incorporate Universal Design features into their home? Start with kitchen counters. Typically, they’re built for able-bodied people as a standing place to prepare meals. But what if you added a space that was lower? It could become a desk space, perfect for homework or other paperwork. Since the kitchen really is the hub of the house, it will become a useful and used space. See how aging in place can work in an able-bodied household? Now walk down the hall to the bathroom. Take a good, hard look. Is this a user-friendly room? No? There are ways to make it more friendly without giving up on beautiful design. Consider a walk-in shower. Bathtubs can be difficult and dangerous to maneuver, and not just for the elderly or infirm. Has your kid ever slipped getting in or out of the tub? Chances are, the answer is yes. Install beautiful and decorative handholds that work like industriallooking grab bars without the hospital-chic motif. Perhaps you incorporate a niche with good gripability. Pretty and functional. Architects and builders must be the

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Beautiful, accessible kitchens do not have to be unattractive; this kitchen embraces an open design with beautiful features. Photo courtesy of Nathan Colburn, Accessible Systems.

champions of strong conceptual design that works for all ages, says Colburn. “If I were to give advice to someone building a home today, I would tell them to install doors that are 36” wide. They cost about $8 more than doors that measure 28” or 30” wide. It’s a lot less expensive to buy them than to retrofit later on down the road – that can cost up to $1,000 per door, depending on if there are structural issues that need to be addressed.” Colburn also advises designing bathrooms with enough floor space to allow for a wheelchair to maneuver easily and freely. While attending a home builders conference, Wendy A. Jordan, author of Universal Design for the Home: Great Looking, Great Living Design for All Ages, Abilities, and Circumstances, met a builder who incorporated universal design features into the homes he was building and was surprised to find that the buyers were primarily young families, not the aging empty-nesters he expected. “These young families didn’t see the future capabilities of the house, they saw an inviting open home that worked for them, right now,” explained Jordan. There’s no reason not to find solutions that are age- and needsspecific that can’t be beautiful and elegant at the same time. One look at Jordan’s book dispels that notion entirely. It’s filled with stylish and good-sense design options that make universal design a “why not?” instead of a “why” decision, and won’t negatively impact the resale value of your home. In fact, it can increase it – which certainly has universal appeal.

The comforts of home and the feeling of family.

Experiencing the changes in a loved one who has Alzheimer’s disease or a related Dementia can be difficult. Finding a place for your loved one to call home shouldn’t be.

Contact: Shirley Saucedo 720-448-9922 for a tour. Michelle Venus is a freelance writer based in Fort Collins.

Northern Colorado Medical & Wellness 2014

w w w. a s h l e y c a r e s . c o m

MEDICAL

Physiatrists

Northern Colorado Rehabilitation Hospital’s team of physiatrists: Drs. Revelyn Arrogante, Rebecca Bierden, Indira S. Lanig and Nathan Swartz.

PHYSIATRY: LITTLE-KNOWN MEDICAL SPECIALTY

C HA NG ES LIVES

any of us know someone who has had a lifealtering change in their health. Sometimes, it’s a temporary setback – a sports injury, perhaps. In other cases, it is much more significant: a stroke, an injury in an automobile accident. When you think about the process of recovering from a significant impairment and those that are dedicated to helping the recovery process, you may think of a physical therapist. An occupational therapist, or even a sports medicine specialist may also come to mind. You may not immediately think of a Physical Medicine and Rehabilitation (PM&R) doctor, also known as a physiatrist.

What is a Physiatrist?

BY BRAD SHANNON

Physiatry is specifically dedicated to the diagnosis and treatment of temporary and/ or chronic physical disability. Physiatrists treat patients who may be suffering symptoms from any of a wide spectrum of physical or neurological events, including brain or spinal cord injuries and strokes or neurological disease. Physiatrists play a key role in the treatment of patients at the Northern Colorado Rehabilitation Hospital (NCRH), a 40-bed rehabilitation hospital in Johnstown, Colorado. Inpatient services are led by two PM&R specialists, Dr. Rebecca Bierden and Dr. Revelyn Arrogante, who oversee the care of 20 patients each, under the guidance of Medical Director, Dr. Indira Lanig. “Our goal is to help our patients rediscover

who they are, and help them put quality back into their lives after a physically traumatic event, no matter what their age or challenge,” said Dr. Lanig. Dr. Nathan Swartz manages the on-site Outpatient Center and its specialized clinics, serving patients directly from the community as well as individuals who have graduated from inpatient rehabilitation. Together, the team of four provides the full spectrum of post-acute care at the NCRH campus. What’s immediately clear upon meeting Dr. Lanig and her team is their dedication and devotion to their work. Even before a referred patient arrives for treatment, they begin planning an active, multidisciplinary treatment approach to address the unique needs of each individual. Their goals change as

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the patient progresses, and a holistic approach ensures that medical needs, issues of physical function, psychological and social issues, and barriers to discharge are all addressed in a timely, proactive manner. Above all, Dr. Lanig looks for passionate, competent patient caregivers who love people. “Physicians who shepherd people through inpatient and outpatient rehabilitative care are thankfully part of a dying breed,” she notes. However, the nation’s more than 7,000 physiatrists are trained to focus on each patient as a whole person, and work to help them heal and return to living as full a life as possible; but the specialty is still not well known. “Even in the medical industry, many are not familiar with the specialty of physical medicine and rehabilitation,” notes Dr. Lanig. “When a patient or a family member knows to ask for a referral to a physiatrist, that can make a tremendous difference in the rate and extent of recovery that’s possible.” Northern Colorado is fortunate to have a team and a facility of the caliber of NCRH. The PM&R physicians, and the entire NCRH team, are particularly pleased to have received The Joint Commission’s Gold Seal of Approval for its stroke rehabilitation program. The facility received this honor late last year after it successfully demonstrated compliance with The Joint Commission’s national standards for healthcare quality and safety in disease-specific care. The certification award recognizes NCRH’s dedication to continuous compliance with The Joint Commission’s state-of-the-art standards. They also take great pride that their facility has been ranked for seven straight years among the top 10 percent of all inpatient rehab facilities in the U.S.

Physiatry Services at NCRH

NCRH specializes in rehabilitative services for patients recovering from stroke, trauma, spinal cord injury, head injury or other disabling injuries or impairments. Rehabilitation is also provided to a large number of orthopedic patients after elective spine surgery, joint replacements or fractures. These services are provided on a daily basis to patients staying at the facility with the goal of helping them recovery quickly and return home safely, with a renewed sense of self-sufficiency. While here for intensive rehabilitation, patients will have a minimum of three hours of therapy a day at least five days a week. “That may sound like a lot,” says Dr. Bierden, “but in many cases, working on life skills and basics like dressing, eating and brushing teeth are part of their therapy.” In addition to inpatient services that the NCRH physiatrists provide to those who have checked into the facility, there are several specialty clinics that are part of outpatient services. The clinics, directed by Dr. Nathan Swartz and the other physicians, include: Continuity of Care Clinic – A rehabilitation approach that focuses on the unique issues that impact function after a neurological or disabling event. Treatment is designed to push patients to improve function and increase

Northern Colorado Medical & Wellness 2014

NCRH PM&R team, including the NeuroVision Clinic, run by neuro optometrist Dr. Thomas Politzer. Dr. Politzer provides comprehensive vision evaluation for patients with visual difficulties after stroke, traumatic brain injury, muscular sclerosis or other neurological disorders. The Podiatry Clinic, run by Dr. Daniel Hatch, provides surgical and non-surgical treatment of foot and ankle conditions. Services in these specialized clinics that make up NCRH’s Outpatient Center are provided by a team of three physical therapists, two occupational therapists and a speech therapist. Individuals from the community are also able to have separate PM&R physician evaluations and consultants as they would with any other medical specialist in the community.

A Day of PM&R at NCRH

independence. Services are offered to those who are referred directly from the community as well as those who have received initial treatment at NCRH and other rehab facilities. Wheelchair/Seating Clinic – Patients receive comprehensive evaluations from their PM&R specialists, an occupational therapist, and even product vendors to ensure the correct posture, protect skin integrity, reduce or eliminate pain, and maximize mobility. Senior Sports Medicine Clinic – The “Weekend Warrior” clinic addresses sports injuries, aches, pains and the needs of the older, active population of Colorado baby boomers. Comprehensive evaluations and management approaches focus on injuries, aches and pains from an active lifestyle. When it comes to treating issues like knees, ankles, tennis elbow, back and shoulder pain, the goal is to keep patients as active as possible at any age. Orthotic and Prosthetic Clinic – Here, specialists help patients in need of orthotics, braces, artificial limbs or other devices. Prescribed equipment is typically ordered, and then fitted and carefully customized by on-site experts. Movement and Spasticity Clinic – After certain types of injuries, patients can develop muscle tightness known as spasticity. NCRH experts help address this by creating tailored programs of exercise and stretching, prescribing orthotics and, in some cases, turning to medications that are administered orally, by injection or a pump to deliver a drug exactly where it is needed. Two other in-house clinics cover complementary avenues to treatment provided by the

Dr. Bierden notes that many physicians who work in a rehabilitation setting may do their daily rounds and then leave the inpatient unit. For the inpatient service NCRH physiatrists, that’s not the case. Drs. Bierden and Arrogante spend 10 to 12 hours a day at the facility, caring for patients and their loved ones. “That ongoing presence and interaction is unique to inpatient rehabilitation medicine,” she notes. Each day typically starts with a “care team huddle,” 15 minutes discussing the day ahead. The team covers whatever happened overnight, appointments that may change that day, and any issues to be addressed by the interdisciplinary team. From there, the doctors round individually with each nurse to discuss new issues that need addressed, including any patients who are in pain or lab results that have come in, and to cover any overnight issues that arose in more detail. Each morning, the physicians and facility administrators discuss potential patients that may be admitted to the hospital that day. Using information from clinical liaisons in the community, each potential patient’s condition, needs and resources are discussed, along with the medical appropriateness of each individual for the facility. Using standardized regulatory guidelines, they welcome new patients who can engage in at least three hours of therapy a day, and who need 24-hour nursing care and daily physician visits. These meetings are followed by both doctors making inpatient rounds on their patients, and leading family conferences. There, the doctors discuss with each family the medical progress of their loved one, barriers that must be overcome to safely discharge the patient, the overall prognosis of their family member, and the family’s involvement in the process of getting the patient healed, home and back to living their life. Similarly, case conferences bring together multidisciplinary teams for patients who are nearing the completion of their stay at NCRH. One heartfelt tradition of the NCRH culture is when employees and staff line the front corridor to celebrate and say farewell to a patient who has completed their inpatient hospital stay.

The NCRH Physiatry Team

Indira S. Lanig, M.D. Medical Director

Rebecca Bierden, M.D. Associate Medical Director

Revelyn Arrogante, M.D. Associate Medical Director

Dr. Lanig provides medical leadership to the NCRH team of patient caregivers. She’s board certified in physical medicine and rehabilitation and has a subspecialty certification in spinal cord injury medicine. She is an active participant in advancing her field, serves on multiple boards and is active in the Academy of Spinal Cord Injury Professionals, and the International Spinal Cord Society. She is a past president of the American Paraplegia Society (APS), a medical society of physicians and researchers dedicated to spinal cord injury. In 2010, she received the prestigious APS A. Estin Comarr Memorial Award for Distinguished Clinical Service. “Our specialty training allows us to work with other medical professionals to make sure patients return to the best quality of life possible.” She gets great satisfaction working in a profession she loves, one that demands that she “shows up” and meet people where they are in the recovery process. She enjoys orchestrating and creating the synergy of an interdisciplinary team to deliver good medical care to people in need. “Our focus on the whole person – who they are, what drives them, what do they love – and the process of helping them heal and re-discover who they are after an injury or illness can make all the difference when it comes to helping them recover and get back to living their life.” As Dr. Lanig and her dedicated team approach each case, and each day, they are careful to customize their treatment based on who each patient is, not who anyone thinks they should be.

Dr. Bierden, a specialist in physical medicine and rehabilitation, is trained in neurorehabilitation. She specializes in traumatic brain injury, stroke and spinal cord injury. When the 40 hospital beds are full, she is responsible for 20 patients, as well as some outpatient cases. “Watching the progress and growth in patients with brain injuries through the rehabilitation process is where I get most of my reward.” As a three-year Colorado resident, Dr. Bierden describes herself as goal oriented. She has hiked several fourteeners and run marathons. Just as she pushes and takes care of herself, she’s devoted to bringing that same energy and focus to caring for her patients. “Rehabilitation patients are unique. They are extremely motivated to get better. In many cases, we can give them just a little extra push, and get great results. The outcomes we can achieve with intensive therapy, where we get to see patients that some thought would not even live and then walk out of our hospital and return to their lives, is amazing.” Dr. Bierden has a passion for travel, which she says has made her a more patient physician who listens and learns from whatever situation in which she finds herself. She’s particularly proud of her work on medical missions, including a visit to a rehabilitation hospital in Vietnam to give insight and compare notes on how to improve their program, and work in Honduras providing care and medical education to remote areas. She hopes to do many more in the future.

Dr. Arrogante, a specialist in physical medicine and rehabilitation, has a special interest in stroke, spinal cord injury, traumatic brain injury, spasticity management, musculoskeletal disorders, sports medicine and electrodiagnostic testing. “Patients come to us debilitated and not able to do what they used to do. Recovery can be a long, slow process, but we’re here for them, and we have trained our minds and hearts to take care of the whole patient.” Early in her medical training, Dr. Arrogante was interested in surgery, but the lack of follow-up care and meaningful interaction with patients made her reassess. She appreciates how, as a physiatrist, she can build rapport with patients, ensure continuity of care, and take the time to truly practice medicine, helping patients and their families. “I’m a people person, and it is rewarding for me to work with the staff and resources we have to help give our patients their dignity back.” Her work in NCRH’s Continuity of Care clinic ensures that patients are well-connected with the community and resources they need when they go home. She takes particular pride in the success she and her team have in helping patients return home, rather than to a skilled nursing facility.

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Nathan Swartz, M.D. Associate Medical Director of the Outpatient Center Dr. Swartz’s focus is on patients who need the expertise of a physical medicine and rehabilitation physician. He also oversees the care plans of outpatients who work with NCRH therapists. As the newest member of the physician team, he joined NCRH in October 2013. He’s board certified in physical medicine and rehabilitation with a subspeciality in electrodiagnostic medicine. His subspecialty training is in neuromodulation and spasticity management. “Our focus is not just treating specific medical conditions, but the whole person, to help them through a life event, whether it was relatively minor or disabling.” Dr. Swartz has a passion to help his patients improve function after disabling injury, optimize physical independence and reducing pain after a neurological or musculoskeletal injury. He enjoys the entire spectrum and diversity of the field, as it all ties into how well a person is functioning and improving their overall lives. “I love what I do, the entire field is exciting to me.” His private practice includes concussion management, neurorehabilitation, spasticity management, restoring health and wellness after injury, along with electromyography and nerve conduction studies.

Brad Shannon is a freelance writer based in Loveland.

Northern Colorado Medical & Wellness 2014

Maximizing Care Through Accurate Diagnosis Serving patients in northern Colorado for more than 35 years Providing unrivaled comprehensive diagnostic services to our community

Ross Barner, MD

Christopher Bee, MD

Craig Nerby, MD

Cory Dunn, MD

Thomas Neuhauser, MD

Richard Halbert, MD

Carrie Pizzi, MD

Wentzell Hamner, MD

Michael Walts, MD

Arlene Libby, MD

Heath Worcester, MD

www.summitpathology.com

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WELLNESS

Nutrition

Dustin Tanski walks his patrons through an assortment of culinary oils that can enhance a variety of dishes as well as our health.

THE HEALTH BENEFITS OF OILS BY MICHELLE VENUS

sk Dustin Tanski, owner of VOM FASS Fort Collins, a specialty food boutique in Old Town, about the components that make the oils he sells so healthy and he laughs.

“That is such an amazingly American question,” he says. “Americans always want to isolate. We love to know what is that specific element that makes it work? And really, when it comes to the oils, it’s everything. All the components work together to provide the health benefits.” His wife and co-owner, Lesli chimes in. “We have people who come in and ask which of our olive oils have the highest polyphenol levels. But did you know you’d have to consume about a cup of olive oil to get the same amount of

polyphenols that you would get in an apple? So I tell them, ‘Eat an apple.’” Polyphenols are what give food that astringency, or “bite” (think of the greenish flavor of olive oil, tea that’s been brewed too long or the back palate of a good, hearty red wine). Polyphenols are a class of naturally-occurring chemicals found in many antioxidants that have been found to reduce the risk factors in cardiovascular disease as well as protect the body from other chronic ailments. “We love claims in the United States. For every product on our shelves and every health claim that is made about them, there are 10 different ways to manipulate those claims to benefit whomever is making them.” Dustin is emphatic when he talks about oils.

“A prime example is olive oil – and I am very happy that Americans have embraced it over other cooking oils, including vegetable oil which really is some form of corn or soy oil.” Dustin points out that how fats are viewed shifts dramatically from decade to decade. Paleo and Primal diets promote animal fats such as butter, lard and tallow, which not too long ago, were shunned by the mainstream. Today, people are asking if their tallow comes from grass-fed beef. The times have changed. Right now, the focus is on the omegas (3,6 and 9). These fatty acids are found in many nuts and seeds, as well as certain fish, avocados and green leafy vegetables.They support the healthy functioning of all the systems: skin, respiratory, circulatory and the organs, including brain

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development. The omegas also pump up the immune system and reduce inflammation. The body cannot produce omega-3 and omega-6 on its own, so it must get them from other sources. Without enough of 3 and 6, it won’t produce omega-9 on its own. It can get very complicated. And that is why the Tanskis recommend rotating oils. Using different oils in your daily diet allows for a rounder and more balanced intake of the healthy components. It doesn’t single one element out from the rest and helps to ensure that a broad spectrum of nutrients are consumed. So we asked the Tanksis: If you were to create a healthy oil starter kit, what would it include?

Avocado Oil: This super food is not a vegetable. Avocados are actually a single-seeded berry. The oil pressed from the fruit’s flesh is similar in composition to olive oil and makes a good substitute when cooking, especially at higher temperatures. It has a soft, nutty taste and is packed with vitamins A, E and D and more potassium than your average banana. It’s also high in oleic acid, the monounsaturated fat that lowers LDL cholesterol. And there’s more. Avocado oil contains magnesium for healthy bones and blood vessels, and prevention of type II diabetes and migraines. Then there’s beta-sitosterol, which appears to inhibit excessive cellular division, which may play a role in preventing cancer cell growth. It contains lutein (eye health), folate (reduces the risk of strokes and cardiovascular disease) and omega-3.

Extra Virgin Olive Oil: You almost can’t get enough of this stuff. Use it for dressings, sauces and sautéing. Olive oil, a key component in the Mediterranean diet, is a monounsaturated fat rich in antioxidants that benefit the heart, blood pressure, skin and hair, rheumatoid arthritis and osteoporosis. Studies in France have found that daily consumption of olive oil may help prevent strokes. And Spanish researchers found that a diet rich in olive oil can help alleviate depression. Olive oil is associated with low incidences of specific types of cancer, including breast cancer, as well as with having a protective role against coronary diseases.

“Here’s what I tell our customers,” says Lesli. “Use the oils that you like. Don’t buy them for specific health benefits, buy them for the taste. The healthy qualities are part of the package, but not if you won’t use them because you don’t like the taste. You should enjoy your health.” Michelle Venus is a freelance writer based in Fort Collins.

Northern Colorado Medical & Wellness 2014

Nut or seed oil: Fat delivers flavor across the tongue. Use a tasty oil for finishing a dish and for the umami. Taken from the Japanese, umami is a savory taste that’s somewhat hard to pin down and occurs naturally in many foods including meat, fish, vegetables and some dairy products. It’s very subtle, but blends well with other tastes to expand and round out the flavors. There are so many nut and seed oils to choose from, too. Almond oil has a fine, nutty flavor and can be used for marinades and sauces or in dressings. Sesame oil is perfect in Asian dishes. It’s intense, aromatic and rich in antioxidants. Grape seed oil is delicate and when used in cooking, brings out the flavors of the other ingredients without overpowering them.

WELLNESS

Skin Care

EXILING ECZEMA

ry, itchy skin in Colorado is a common occurrence. We all suffer from routine dryness in the wintertime. But when itchy and dry become something more, life can get a little uncomfortable. Eczema is the common name for atopic dermatitis, and represents a group of medical conditions that can be indicative of a skin barrier problem or a chronic allergic condition. Eczema affects between 10 to 20 percent of infants and 3 percent of adults. Most children will outgrow eczema by age 10, but for those who don’t; the condition can range from uncomfortable to excruciating. There is much that can be done at home to combat eczema, says Dr. Matthew J. Mahlberg, dermatologist at Lake Loveland Dermatology. “Most importantly you must maintain the skin barrier. Winter is so dry, with forced air heat,” says Dr. Mahlberg. He recommends taking the following steps: • Consider running a humidifier. It will minimize skin water loss. •

Use non-drying soaps; even better when they contain moisturizers. Dr. Mahlberg

BY ANGELINE GRENZ

recommends brands like Dove, Oil of Olay, Cetaphil, etc. •

Especially in winter, take a shower with lukewarm water, not hot. While the skin is still damp slather on a thick moisturizer. “This will help lock in moisture.”

•

Avoid tight clothing and use small amounts of fragrance-free laundry detergent; consider a double rinse cycle.

•

The chemical in wrinkle-free clothing may also cause irritation to the skin. Avoid these types of shirts if you notice irritation after wearing them.

•

When choosing your moisturizer, Dr. Mahlberg says to consider the vehicle in which it comes. “Choose something in a jar or a squeeze tube. These are generally thicker than something that comes from a pump,” he adds. He recommends economical brands such as Eucerin, Aveeno and Curel, or more expensive brands like Keihl’s and Skin Medica.

•

You may be sensitive to products that contain cinnamon or peppermint; avoid these if you feel you may have a sensitivity.

It is good to remember that eczema can be a sign of an allergic reaction, says Dr. Mahlberg. Eczema, hay fever and asthma tend to run together in certain families. There is no cure for eczema but it is controllable. Some cases respond quite well to over-the-counter creams. However, severe cases of eczema can be quite debilitating and may call for topical steroids of varying strengths. A systemic pill can also relieve intense symptoms. “It is important to confirm that you have eczema, not a rash from another source. Have it confirmed by your child’s pediatrician or by a dermatologist,” advises Dr. Mahlberg.

•

Avoid irritating clothing like wool sweaters and prevent children with eczema from crawling on wool carpet. Cotton clothing is best.

Angeline Grenz is managing editor for Northern Colorado Medical & Wellness.

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Northern Colorado Medical & Wellness 2014

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family focus

Varying Kids’ Sports

To Avoid Injury BY BRAD SHANNON

The days of a multi-sport letterman in every town and at every high school have passed. The trend in recent years is for young athletes to specialize even earlier in a particular sport, to the exclusion of other sports, games and activities. That often means playing a single sport year-round, including sessions to practice specialized skills and fitness training in individual and small-group settings. “Too often, there is no off season,” said Dr. John Guenther, pediatrician with The Youth Clinic in Fort Collins. “Kids go from school team to club team to league play to tournament play to individual training sessions to indoor practice and play during the winter. Too many don’t get the physical and mental breaks that their bodies and minds need.” Unfortunately, this can lead to undue physical stress and acute and overuse injuries in developing young athletes. It can also create a situation where an athlete suffers mental fatigue and burnout, tiring of and abandoning a sport they’ve specialized in from an early age. Last October, the American Association of Pediatrics (AAP) attracted national attention when the latest research on sports specialization and young athletes was presented at its National Conference and Exhibition. A study, “Risks of Specialized Training and Growth for Injury in Young Athletes: A Prospective Cohort Study” found that athletes who play more hours per week than their age – so, an 8-year-old who plays more than 8 hours a week of an organized sport – are more likely to be injured. Athletes 8 to 18 who spend more than twice as many hours a week in organized sports than in free play, especially in a single sport, are more likely to be injured. Data was collected on more than 1,200 young athletes between 2010 and 2012. According to the study’s lead author, Neeru Jayanthi, M.D., those who more intensely specialized in a single sport were more likely to have an injury and a serious overuse injury. Kids, on average, play organized sports twice as much as engaging in free play, and those that exceed the two-to-one ratio are more likely to be injured.

Northern Colorado Medical & Wellness 2014

This and prior studies have found that not only are athletes who specialize early at risk for injury, they also end up with overall poorer muscle balance, coordination and visual motor skills than their peers that play multiple sports. Soccer players, for example, can have strong skills when it comes to foot control, but might be lacking in overall general coordination. Add basketball into the mix, and the basketball’s need for more eye-hand coordination can also lead to enhanced skills for soccer. “Our biggest concerns, initially, are chronic overuse injuries,” notes Dr. Guenther. “Doing the same motions repeatedly can produce an imbalance of musculature, and put undue strain on specific muscle groups and bone.” For some, running leads to Sever’s disease, where micro cracks form in the growth plate of the heel bone. Osgood-Schlatter disease is discomfort just below the knee where the patellar tendon attaches to the tibia. While both are commonly referred to as diseases, they are really overuse injuries. Both result in pain, and can lead to increased deposits of calcium and bone in the area of irritation. Kids who spend a lot of time in cleats or on the basketball court can have increased risk for both of these problems. Soccer players can experience hip flexor strains from kicking too big a ball. Swimmers experience shoulder strains and rotator cuff injuries. Volleyball players can develop upper body imbalances and shoulder strains. Baseball players can develop “little league elbow” from throwing too much. Dr. Guenther is particularly concerned about seeing younger and younger kids experiencing injuries that used to show up primarily in older athletes. “We’re seeing ACL tears in 8- and 9-year-olds.” Muscular imbalances that develop from playing one sport too much can put young athletes in a position where they can torque a knee and suffer a significant injury. As puberty arrives, and girls develop wider hips, they also develop a greater risk of knee injury because of the changing geometry of their bodies and their center of gravity. Ligaments also become slightly more flexible and softer, and more at risk for tears. Dr. Guenther notes that some excellent research has been done by the University of Cincinnati focused on how female athletes land from a stride or jump. Exercises and jump training can help balance their musculature and train them to land safely and decrease the incidence of knee injuries. Several local physical therapy

clinics offer this type of training. Some injuries can lead to problems later in life, as well. While coaches might limit the number of pitches a baseball player throws in practice, kids often go home and throw on their own. The chronic pain and inflammation that can result can force a player to stop pitching, and even restrict time spent in the outfield where long throws must be made. Enough inflammation, and a player simply can’t throw the ball, and in some cases must stop playing. “For ACL injuries, the knee is never really the same,” notes Dr. Guenther. “And ACL injuries are generally linked to a significant risk of arthritis within the next 20 years. So for someone injured at 10, that means the possibility of getting arthritis in their 30s, which means limiting activity for a big part of the prime of their life.” For athletes that specialize in a sport early, there’s the risk that their physical tools may or may not develop to support their continued growth and success in a particular sport. In some cases, a young athlete may blossom later than their peers, and find “late” success at a sport. Focusing exclusively on one sport can deny a player the opportunity to try something new and different, and perhaps thrive in that environment. Michael Jordan was famously cut from his high school basketball team as a freshman before becoming one of the best players ever. Conversely, a dominant center on the basketball court may tower over peers in middle school and junior high, but later be just average height. Any number of soccer goalkeepers have seen early success, then struggled later when they end up smaller statured than they’d like. Too much time in goal can also leave them behind when it comes to the skills a field player needs. In Fort Collins, as interest in and opportunities to learn rugby grew over the years for young women, local players picking up the sport in their high school years found success locally, regionally and beyond. Local products Amanda Kehmeier and Sadie Anderson, who both played soccer primarily prior to high school, found success playing rugby in high school and college, and Anderson now represents the U.S. in international play. For boys, lacrosse has grown quickly in Northern Colorado, and provided local athletes a new sport to learn, compete and succeed in. Dr. Guenther notes that for years, the AAP has made recommendations that kids not play just one sport, and that they take breaks between seasons. That has been controversial in some

circles, given that baseball, soccer, basketball and swimming are all sports that athletes can do year-round. “As pediatricians, we have attached that discussion to all the visits we have with patients and their parents, and that is something relatively new in my 25 years of treating patients,” he says. “We encourage them to try different sports, different activities and to take a break – rest those joints, muscles and growth plates.” The worst risk increases seen, over years and multiple studies, is for those who play one sport year round. In addition, higher risk of burnout is seen by those participating in higher levels of competition. That can result in less enjoyment and poorer performance in any given sport. Those who compete on mid-level teams are not as likely to burn out, and are more likely to play other sports, and not do the same sport year round. They also tend to stick with and enjoy a given sport for a longer period of time. To reduce the chance of injury and burnout, and help ensure that your child enjoys organized sports for the long term, Dr. Guenther offers these suggestions: •

Make sure your child engages in regular, unstructured play.

•

Delay specialization in a single sport for as long as possible.

•

Take time off regularly from training and competing.

•

Add in another sport or activity to vary what your child is doing.

•

Ensure that strength and fitness training focuses on whole-body cross training.

•

Regularly explore new activities as your child grows and matures.

Future American Academy of Pediatrics research will focus on whether educating parents and kids on the two-to-one ratio of organized sports to free play, and providing specific guidelines, will reduce overuse injuries in youth sports.

Brad Shannon is a freelance writer based in Loveland.

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Northern Colorado Medical & Wellness 2014

VETERINARY

Surgery

Jon Geller, DVM, Fort Collins Veterinary Emergency and Rehabilitation Hospital

V ET E R INARY SU R GEO NS: M A S T E R S O F M A N Y S P E C I A LT I E S

very one of our pets is unique, and so are their problems. Fortunately, a veterinary surgeon is called upon to be a jack of all trades – and often a master of each of them as well. “As veterinary surgeons, we need to know many different subcategories of surgery: soft tissue, orthopedic, neurologic, cancer,” says Jessica Barrera, DVM, MS, DACVS, surgical specialist at VCA Veterinary Specialists of Northern Colorado (VCA VSNC) in Loveland, about the veterinary surgeons. “Still, a lot of the anatomy is very similar; and the instruments we use are just as high-tech.” “Human surgeons are very strictly specialized,” adds Tim Kuhnmuench, DVM, MBA, of Advanced Animal Care of Colorado in Fort

Collins. “One will only do knee joints, or hands or eyes. But while each species has a different anatomy and physiology, veterinarians are trained across the board.” “Every veterinarian who graduates can legally perform surgeries,” explains Maura Buckner, DVM, of Moore Animal Hospital in Fort Collins. “Should they? Maybe, maybe not. Most general practitioners are comfortable with doing basic surgeries – spays, neuters, cyst removals, foreign body removals from the stomach and intestines, and basic fractures.” “It’s more like being a pediatrician,” she adds. “Pets, like children, can’t tell you what’s wrong; you have to ferret that information out of them. You also have a worried parent/owner who knows something is wrong but can’t tell you what it is. We learn to ask the right questions, in order to get the right information.”

BY CARL SIMMONS

As Moore Animal Hospital is a general practice, Dr. Buckner says, “We pretty much do everything from general exams to most forms of surgery – from spaying and neuterings to elective exams to emergencies. We have some really good emergency hospitals in Fort Collins; therefore, it doesn’t make sense to be open 24 hours a day. But we certainly do emergencies that happen during the daytime; most people would rather come to the vet they’re comfortable with.” “We do a lot more surgeries than many places in town will,” Dr. Kuhnmuench says. “Still, there are cases outside the scope of what we’re comfortable with. We’ll bring in a mobile-surgery service, or if it’s a complex case that really needs monitoring overnight, we’ll send it to an emergency or specialty hospital. We’re lucky to have CSU nearby, as

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well as a close relationship with many of the veterinary hospitals in the area.” “Half of our cases are emergencies, and the other half more rehabilitation or orthopedic cases,” says Jon Geller, DVM, DABVP, of Fort Collins Veterinary Emergency and Rehabilitation Hospital. “The most common orthopedic surgery veterinarians perform is knee surgery in dogs, which is similar to ACL (anterior cruciate ligament) surgery in humans.” Dr. Geller’s favorite surgery “is reconstructive surgery, repairing wounds, such as when a dog is hit by a car and has lost part of his skin, or when a dog has been attacked by another dog. Some of the treatments I use include using unfiltered honey as a wound dressing, and laser therapy, both of which helps speed up the healing process.” “Noninvasive surgery is probably the main new development in veterinary surgery,” he adds, “especially laparoscopy, or thoracoscopy, where several small incisions are made, and an operating telescope is inserted into a body cavity. The surgery is done from outside, similar to humans. We usually do a full exploratory laparotomy when something is wrong in the abdomen. We may find anything from intestinal obstruction – for example, your pet swallowed some household object – to a tumor or a mass that might be bleeding. Dogs have been known to swallow everything from large kitchen knives to barbecue skewers, but we’ve been able to remove them and the dogs have survived.” As a specialty practice, Dr. Barrera says, VCA VSNC “doesn’t offer general wellness care; we offer 24-hour emergency care. We have specialists in internal medicine, neurology and surgery. I do orthopedic surgery, oncologic (cancer) surgery, emergency surgeries, back and neck surgeries, as well as a lot of minimally invasive surgery. “I think veterinary medicine and human medicine benefit each other a lot,” she adds. “There’s a misconception that animals are put through things for the benefit of humans, but in fact we advance each other’s fields. The most interesting surgery I do is limb spare surgery, especially for dogs with bone cancer. Bone cancer is very common in larger-breed dogs as well as in children; a lot of the treatments for kids with bone cancer have come from, and benefited, our own canine patients. If I can do something that also helps a child, that’s amazing.” “The way surgery is going is to become as minimally invasive as possible,” Dr. Barrera continues. “If a dog had a tumor in the lung, we used to have to make a huge incision in the chest, which was very painful. Now I can use the camera and instruments through small ports to do everything, so post-operative pain is much less.” Dr. Kuhnmuench, too, enjoys the more progressive aspects of veterinary surgery. “Luckily, I’ve ended up at a practice that has allowed me to perform procedures I wouldn’t otherwise been able to do. Laparoscopy or endoscopy allow a faster recovery, with less pain and less invasive surgery than other techniques. There’s a learning curve, but once you learn it, there’s

Northern Colorado Medical & Wellness 2014

no other way to do it. Upon recovering from anesthesia, the animal can go back to a normal life almost right away.” “I see advanced imaging, such as using CT and MRI scans, becoming more popular,” Dr. Kuhnmuench adds. “They allow us to diagnose and treat issues that we were not able to diagnose previously. Also, because of advancements on the human side such as total joint replacements and increasing technologies, we’ve been able to make advances on the veterinary side as well.” “The largest issue in using all this advanced technology is the financial aspect,” he adds. “Less than 5 percent of pets in the U.S. currently have insurance; in the U.K. roughly 30-35 percent are insured, so we’re behind the curve. We’re moving toward getting every pet in our practice insured. The insurance company we work with allows us to make our own decisions, and send in the claims for what we’ve done. Thus, they are much different from a traditional human HMO. It’s revolutionizing the profession.” No matter your financial range or your pet’s specific needs, the good news here is that there are a variety of veterinary surgeons and practitioners in Northern Colorado who can help – and who are willing to work together for the health of your pet.

Maura Buckner, DVM, Moore Animal Hospital

ADVANCED ANIMAL CARE OF COLORADO 1530 Riverside Ave., Fort Collins (970) 493-3333 www.advancedanimalcareofcolorado.com

FORT COLLINS VETERINARY EMERGENCY & REHABILITATION HOSPITAL 816 S. Lemay Ave., Fort Collins (970) 484-8080 www.vetemergencyandrehab.com

Jessica Barrera, DVM, VCA Veterinary Specialists of Northern Colorado

MOORE ANIMAL HOSPITAL 2550 Stover St., Bldg. H, Fort Collins (970) 416-9101 www.mooreanimalhospital.com

VCA VETERINARY SPECIALISTS OF NORTHERN COLORADO 201 West 67th Court, Loveland (970) 278-0668 www.vcaspecialtyvets.com

Carl Simmons is a freelance writer based in Loveland.

Tim Kuhnmuench, DVM, Advanced Animal Care of Colorado

VETERINARY

Human-Pet Bond

H E A LT H Y A N D H A P P Y

WITH YOUR PET

ost pet owners would agree that pets are good for one’s soul and they make us happier and healthier people. Today, science is backing up what pet owners have always known; pets really are good for your emotional and physical health. Animal assisted therapy has been around for many years, and anyone involved in this type of therapy has seen evidence of its success. Founded in 1990, Larimer Animal People Partnership (LAPP) is located here in Fort Collins. Through their programs LAPP works to

BY HEIDI KERR-SCHLAEFER

increase public awareness of the significance of the human-animal bond. Their community service programs include outreach at the Crossroads Safehouse, a shelter for woman and children experiencing domestic violence. Kristen Heller is the treasurer of LAPP and she and her dog volunteer with the organization. At Crossroads Safehouse LAPP teaches children how to greet a dog and respect the dog’s space and they also work on things such as how to be angry without violence. Heller has witnesses firsthand the calming effect animals can have on children at Crossroads. “Some of the families there have had to leave their pets, or their pets are in foster homes, so even the moms are excited to see

the dogs and cats we bring,” says Heller. “It’s so neat to see these children open up when they see a dog.” LAPP also takes dogs and cats to the various local libraries where children read to the animals. This program is open to the public and takes place once a month at each library. “It’s less stressful for the kids, because the dogs don’t know if they are making any mistakes,” says Heller. “Kids just feel more comfortable practicing reading aloud to the animals.” Heller, who takes her Labrador retriever mix nearly everywhere, was recently in Lowes when a woman asked if she could pet the dog. “Afterwards she said very genuinely that petting my dog had made her whole day,” says Heller. “So something as simple as that; as simple as petting a dog, can really affect someone’s life.” The interaction Heller described at Lowes may have had an actual physical effect on the woman in question. Studies have shown that a person’s blood pressure goes down when petting a cat, and in fact, in 2008, researchers told delegates of the American Stroke Association’s International Stroke Conference that owning a cat could reduce the risk of heart attack by nearly one third. This research isn’t new. Prompted by rampant cardiovascular disease in western societies, a study was conducted in 1980 researching the social, psychological and physiological factors in coronary heart disease and their relevance to the patients’ survival. Pet ownership was included as one source of social support expected to improve survival of patients. In this first study of the relationship between pet ownership and cardiovascular health, 15 pet owners were more likely to be alive one year after discharge from a coronary care unit than non-owners. Only 5.7 percent of the 53 pet owners compared with 28.2 percent of the 39 patients who did not own pets died within one year of hospitalization. This was a large study by Friedmann, et al., and various theories exist as to why individuals with pets lived longer than those without. It could be that dog owners are healthier because they get outside and walk their animal, but other pets that did not require daily outdoor exercise, like cats, also figured into this study. Lori Kogan, Ph.D., is a licensed psychologist and associate professor in the Clinical Sciences Department at Colorado State University within the College of Veterinary and Biomedical Sciences. She is also the director of Pets Forever, a CSU sponsored nonprofit designed to help lowincome elderly and disabled Larimer County residents maintain ownership of their pets for as long as possible, and to improve the health and well-being of these pets and owners by providing needed help and resources. “There’s a growing body of literature that talks about the benefits of pets for people of all ages,” says Dr. Kogan. “Certainly for the elderly and disabled population that I work with, those relationships are critical. They are oftentimes the only relationship these people have in their lives.”

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Dr. Kogan notes that she has many clients through Pets Forever who she believes are motivated to stay out of the hospital in order to be with their pets. They worry about who will take care of the pet if they have to go to the hospital and where will the pet go if they can no longer care for it. While the psychological aspects of pet ownership can lead to better overall health, recent evidence suggests that owning pets can also keep allergies at bay. In fact, studies have shown that a child raised with a pet is less likely to have allergies in the future, and not only pet allergies, but allergies in general. According to Dr. Kogan, there’s even evidence to suggest that pregnant women who live with animals in the house will birth children who are less susceptible to allergies in the future. Whether you own a dog, cat or bird, science is proving that this animal is not only improving the quality of your life, but possibly the length. Most pet owners, however, know there’s something more about pet ownership. As the French novelist Anatole France once said, “Until one has loved an animal a part of one’s soul remains unawakened.”

Heidi Kerr-Schlaefer is a freelance writer and the Mayor of HeidiTown.com, the place for information on Colorado festivals and travel.

Northern Colorado Medical & Wellness 2014

CAN YOU CATCH AN ILLNESS FROM

YOUR PET? While science would suggest that owning a pet is good for us, there are a few incidences when a pet may transmit an illness to their owner. A disease that can be passed between animals and humans is called zoonotic. A zoonotic disease may be caused by viruses, bacteria, parasites and fungi. Paws ‘N Claws Veterinary Clinic in Fort Collins has a website where they list nine diseases that can be transferred from an animal to a human including cat scratch disease, ehrlichiosis, giardia, leptospirosis, Lyme disease, rabies, ringworm, Rocky Mountain spotted fever and toxoplasmosis.

The Paws ‘N Claws website, PNCVets.com, also has a Pet Library where you can find in depth information on each of these zoonotic diseases. “These are known diseases that can be transferred from your pet to you, but the instances of this are very rare,” says Dr. Kevin Dale Schramm of Paws ‘N Claws Veterinary Clinic and a graduate of the CSU School of Veterinary Medicine and Biomedical Science. “My two labs lick my kids all the time and I’m fine with that,” he says. “Our dogs are given routine fecal exams and they are on parasite prevention medications. I know my pets are healthy. Keeping your pets healthy is an easy way to protect your family.” Many zoonotic diseases can be prevented by making sure your dog’s vaccinations are current. You should also inspect your pet for ticks after each outing. Don’t let your pet drink from standing water outdoors and don’t let him or her come into contact with feces or urine from other animals. It’s also important to remove food, garbage or nesting materials that may attract disease carrying wildlife to your home or property. If you believe your pet is suffering from any of the aforementioned diseases, take them to a vet right away.

Heidi Kerr-Schlaefer is a freelance writer and the Mayor of HeidiTown.com, the place for information on Colorado festivals and travel.

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It started as a normal bike ride, and then life changed. Mr. Ziegler, a 62 year old teacher was biking to work when he was struck by a car. Prior to the accident he was independent with transferring and activities of daily living. Initially he was at an Acute Care Hospital and came to Northern Colorado Long Term Acute Hospital on a ventilator, feeding tube, and in critical condition. According to Linda, his wife of 40 years, “All of his ribs were broken from his sternum to his backbone. They couldn’t even put part of his lung back in his rib cage for three days”. During his stay at Northern Colorado Long Term Acute Hospital he worked with a multi-specialty team consisting of board certified internal medicine physicians, pulmonologists, respiratory therapists, nephrologists, wound team, nursing, case management, pharmacist, speech therapy, occupational therapy, and physical therapy. He stayed at Northern Colorado Long Term Acute Hospital for 21 days. Then he discharged to Northern Colorado Rehabilitation Hospital, on the same campus for advancement of his rehabilitation and was on his road to recovery. He was at Northern Colorado Rehabilitation Hospital for 6 weeks where he worked with a multidisciplinary care team consisting of physiatrists, registered nurses, dietician, pharmacist, case management, respiratory therapy, physical therapy, occupational therapy, and speech therapy to make sure he could function at home independently. He attended therapy at least three hours a day for 5-6 days a week. On his last day of being at the rehabilitation hospital, he walked out independently with the use of a cane to discharge home.

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