October 2014 Thrive

FOR THE RECORDElectronic medical records provide better organization, patient care and cost benefits. Page 8.

THRiVEnc» NORTHERN COLORADO WELLNESS

October 2014

» INSIDE: STUDENTS BACK ON ROADS • STAY CONNECTED WITH TECHNOLOGY • HEALTH EVENTS

THRIVENC n September 24, 20142 n HEALTH

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David Blatt, M.D.Neurosurgery

Kai Stobbe, PA-CNeurosurgery

Beth Gibbons, M.D. Neurosurgery

Banner Health Clinic- Neurosurgery, Brain & Spine1800 15th St., Suite 130, Greeley2923 Ginnala Dr., Loveland

Appointments: (970) 350-5996www.BannerHealth.com/BMG-CONeuroBrainSpineAccepting Kaiser Permanente Members

A ruptured or herniated disc is a common cause of neck and arm pain, although there are many

other factors. Symptoms may include dull or sharp pain in the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers, or numbness or tingling in the shoulder or arm.

Neck and arm pain can also be caused by poor posture, lack of exercise, an injury, or the natural process of aging.

Treatment options include cold/heat therapy, pain medications, physical therapy, massage and lifestyle modifications like losing weight, quitting smoking and improving posture, especially when working on a computer.

If pain persists, surgery may be suggested. Most procedures can be done using minimally-invasive techniques.

Neck and arm pain is very common and can be caused by different problems. Fortunately, there are many treatment options available as well.

If you are living with chronic neck and arm pain, contact a Banner Health neurosurgeon today.

I have been suffering from constant neck and arm pain. What might be the cause?

September 24, 2014 n THRIVENC 3HEALTH n

Evidence continues to pile up that Medicare Advantage plans are no advantage for taxpayers.

MA plans, as they are called, are one alternative for seniors to receive their Medicare benefits. But in this case, the bene-fits come from government payments to private insurance carriers, not directly from the federal government.

Medicare Advantage plans took off in 2006 when overpay-ments from the government allowed insurance sellers to offer these arrangements as an alternative to traditional Medicare benefits and Medi-gap policies.

In a move to encourage ben-eficiaries to use managed care — on the theory it would save money — the government be-gan to pay insurers to provide the same benefits to seniors and disabled people eligible for Medicare that would be available in the regular fee-for-service program.

Payments from Washington have been very generous — a

kind of subsidy for insurers that has made it possible for them to entice seniors with low or no monthly premiums for their coverage and extra good-ies like chiropractic care, gym memberships, and eye glasses.

There was a catch, though, that seniors would learn about only if they got sick. Some of these no-premium MA plans came with high copayments and coinsurance required for many services.

Still, they’ve become so popular that 30 percent of all Medicare beneficiaries now have them, and most beneficia-ries eagerly sign up for them during fall open enrollment with little thought to poten-tially high out-of-pocket costs down the road.

Studies by health policy re-searchers in and out of govern-ment have found that Medicare has paid insurance companies as much as 12 percent or 13 percent more than it costs to provide identical benefits for the same services under the traditional program thanks to quirks in the payment formu-las, as well as overbilling by

insurance companies. The most recent study has

come from Medicare’s own researchers, who quietly posted their results in late July on an online research site of the Cen-ters for Medicare and Medicaid Services (CMS), which runs the Medicare program. They found many MA plans routine-ly overbill the government for treating elderly patients and have done so for years.

Researchers said that many MA plans exaggerate how sick their patients are and how much they cost to treat them, a practice called upcoding, which my journalistic colleague Fred Schulte at the Center for Public Integrity has written about extensively.

Schulte told me, “the study can appear to be an inside baseball thing but it’s hugely important since it exposes tons and tons of misspent taxpayer money.”

For example, CMS research-ers found that beneficiaries in some MA plans appeared to have rates of some diseases like depression and complications from diabetes that were higher

than those in traditional Medi-care. Yet they concluded that people who join MA plans are healthier than those who stay in traditional Medicare.

They concluded it’s “unlike-ly” that the higher payments insurers receive for these more complicated conditions are related to improvements to seniors’ health provided by the plans, as the insurance indus-try claims.

The fact the study has gotten so little attention is puzzling considering the MA program will cost the government some $160 billion this year. But then maybe it’s not so puzzling given what’s happened to past efforts to reduce excess payments to the plans.

President Barack Obama came to the White House vowing to cut the overpayments, a promise he made often on the campaign stump. But each time CMS proposed cuts, the insurance industry’s lobbying, its slick advertising and TV campaigns, and ultimately pressure from members of Congress, both Democrats and Republicans, turned the proposed cuts into payment

increases.Medicare Advantage is good

business for the carriers. Last year a journalist for the now defunct Medicare News Group estimated no cuts would add some $11 billion to insurers’ bottom lines.

In 2013, the agency pro-posed a 2.2 percent cut that turned into a 3 percent rate hike. Same story this year. A proposed 2 percent rate reduction resulted in a small increase in payments. And, in 2012, CMS decided to forgive more than $32 billion in over-payments the government had given the insurers from 2008 through 2010.

Schulte thinks the recent study may be the program’s “Achilles heel.”

I’m not so optimistic.CMS has not released the

names of the insurance com-panies doing the most over-charging. If the agency would spotlight individual companies, then we consumers would have a chance to see what’s really happening.

Maybe that would finally effect change.

Medicare Advantage plans are no advantageBy Trudy LiebermanRural Health News Service

THINKING ABOUT HEALTH

QUESTION — I was recently diagnosed with breast cancer and a total mastecto-

my has been recommended. Can you please explain what options are available for breast reconstruction after mastectomy?

ANSWER — Despite the massive efforts that have been made to raise awareness

of breast cancer, it appears we still need to

do a better job of discussing breast recon-struction for women who undergo a mastec-tomy. Just 23 percent of women are aware of the wide range of breast reconstruction options that are available, according to the American Society of Plastic Surgeons and The Plastic Surgery Foundation.

In honor of National Breast Reconstruc-tion Awareness Day on Oct. 15, and to an-swer your question, here’s a brief discussion of breast reconstruction options:

Though a number of techniques and

strategies are used, there are two main cate-gories of mastectomies: partial mastectomy and total mastectomy.

For total mastectomies, women have sev-eral reconstructive options, which include:

» Two-stage reconstruction, which involves implanting temporary expanders at the time of the mastectomy and then following up with permanent implants after the expanders have reached the desired size.

» Immediate reconstruction (during the mastectomy) with silicone or saline

implants.» Delayed reconstruction (post mastecto-

my) with implants.» Reconstruction using the patient’s own

muscle to replace the removed tissue.» Fat transplantation where the patient’s

abdominal fat is re-implanted as “breast” tissue.

For partial mastectomies, options include:

Women have reconstruction options after mastectomyBy Molly DeckerFor The Tribune

Turn to Mastectomy on P.10


As millions of teens head back to school, many will be driving to and from classes every day.

Teens are at a greater risk than any other age group to be involved in a crash, due largely to lack of experi-ence. Many of those crashes could be avoided with prop-er education, said DRIVE SMART Weld County Coa-lition member Sue Helfrich of Allstate Insurance.

Helfrich said common mistakes by new drivers include tailgating, speed-ing and poor judgment, especially when making left-hand turns across oncoming traffic.

Some, despite warnings and laws, ignore the dangers of drinking and driving. Crash statistics from the National Highway Traffic Safety Administration indicate 31 percent of teens involved in fatal crashes had been drinking.

Distraction is a major hazard for teen drivers. In addition to talking on cell phones and texting, other distractions that take a driv-er’s attention from the road include talking with passen-gers in the car, tuning the radio or iPod, or reaching for coffee or a water bottle.

“Driving requires our full attention,” Helfrich said.

Drowsy driving is another risky behavior common

among young drivers. The National Highway Traffic Safety Administration estimates that more than 100,000 crashes every year are due to driver fatigue, resulting in more than 1,500 deaths and 71,000 injuries.

Several signs warn a driv-er to stop and rest. A driver who experiences any of these should pull over at the next exit or a safe rest area and take a break or a 20-minute nap. Have a cup of coffee or caffeinated snacks and allow 30 minutes for the caffeine to enter the bloodstream. Don’t drink alcohol or take medication.

“Drowsy driving poses a real risk to everyone on the road,” Helfrich said. She cited a recent study that showed nearly one-third of all drivers have dozed at the wheel. “At highway speeds, dozing off for even three or four seconds can send you off the road and into a tree or out of your lane into oncoming traffic. Drowsy driving is, in our opinion, as dangerous as drunk driving.”

See how you can make a difference at www.noys.org (National Organizations for Youth Safety). More infor-mation on DRIVE SMART Weld County can be found at www.drivesmartweld-county.com.

Kelly Campbell is the DRIVE SMART Weld

County coordinator.

BEWARE YOUNG DRIVERS BACK IN SCHOOL IN WELD COUNTYBy Kelly CampbellFor The Tribune

Older people who have relied on a class of drugs called benzodiazepines to reduce anxiety or induce sleep are at higher risk of going on to develop Alzhei-mer’s disease, new research finds, with those whose use of the medications is most intensive almost twice as likely to develop the mind-robbing disorder.

Benzodiazepines — marketed under such names as Xanax, Valium, Ativan and Klonopin — are wide-ly used to treat insomnia, agitation and anxiety, all of which can be early signs of impending Alzheimer’s disease in the elderly.

But the current study sought to disentangle ben-zodiazepines’ use in treating early dementia symp-toms, probing instead the possibility that heavy use of the medications may permit, cause or hasten the onset of Alzheimer’s dementia.

The study compared the pattern of benzodiaze-pine use in 1,796 elderly people diagnosed with Alz-heimer’s with that of 7,184 similar people who had no such diagnosis.

Such a study design, conducted by French and Canadian researchers and published in the journal BMJ, cannot by itself establish that more intensive use of the medications causes Alzheimer’s disease. But it does strengthen such suspicions.

Among the study participants over 66 who were living independently in the Canadian province of Quebec, those who took low-dose benzodiazepine medication, or who took higher doses but very brief-ly or infrequently, did not see their Alzheimer’s risk go up five years after they were first prescribed such a medication.

But the picture was more worrisome for those who frequently took long-acting benzodiazepines, who frequently took high doses, or who took any such drugs regularly over several months.

The benzodiazepines specifically considered by the researchers were the short-acting anti-anxiety med-ications alprazolam (Xanax), lorazepam (Ativan), oxazepam (Seresta) and diazepam (Valium), and the longer-acting anti-seizure and “hypnotic” drugs frequently used to treat insomnia: clonazepam (Klo-

nopin), flurazepam (Dalmane), midazolam (Versed), nitrazepam (Mogadon), temazepam (Restoril) and triazolam (Halcion).

The widely prescribed medicines marketed as Ambien, Lunesta and Sonata (generically named zolpidem, eszopiclone and zaleplon) are “atypical benzodiazepines” and were not included in the anal-ysis.

The authors of the study created an index that gauged the intensity of a participant’s benzodiaze-pine use and found that at the end of a five-year peri-od following an initial prescription, Alzheimer’s risk mounted steadily.

Those who took the cumulative equivalent of daily doses for three to six months over a five-year peri-od were roughly 32 percent more likely than those who took none to develop Alzheimer’s. Those who took the cumulative equivalent of a full daily dose for more than six months were 84 percent more likely to do so.

There’s already strong research evidence that fre-quent or regular benzodiazepine use degrades mem-ory and mental performance in humans and ani-mals. And some research suggests that with regular use of this class of drugs, the receptors to which they bind in the brain become less active. And lower ac-tivity of those receptors has been linked to cognitive decline.

“In view of the evidence, it is now crucial to en-courage physicians to carefully balance the risks and benefits when initiating or renewing a treatment with benzodiazepines and related products in older patients,” the authors wrote.

International medical guidelines recommend the use of benzodiazepines as treatment for anxiety disorders and transcient insomnia, but caution that they are not meant for long-term use, and should not be taken steadily for more than three months.

But many patients continue to take these drugs for years.

In addition to their cognitive effects, benzodiaze-pines are widely implicated in the national epidemic of opioid pain medication overdoses and fatalities that result from mixing them with alcohol and opi-oid drugs.

LINK FOUND BETWEEN DRUGS USED FOR

SLEEP, ANXIETY AND ALZHEIMER’S DISEASEBy Melissa HealyLos Angeles Times


«Community Wellness Clin-ics, 10 a.m.-noon Oct. 1 at the Windsor Recreation Center; 7-11 a.m. Oct. 3, 50+ Health and Job Fair; 10 a.m.-noon Oct. 10, Platteville Town Hall; 10:30 a.m.-noon Oct. 13 and Oct. 29 at the Greeley Senior Center; 4-6:30 p.m. Oct. 14 at the Eaton Town Hall; 9-11 a.m. Oct. 14 at Evans Recreation Center and 7-8:45 a.m. Oct. 15, wellness blood draws and walk-in flu, Banner Health in Johnstown; 10 a.m.-noon Oct. 23 at the Kersey Senior Center. The clinic will include: flu, $25; nasal flu mist, $35; pneumonia, $90; Tdap, $55. We accept Medicare Part B for the flu and pneumonia vaccines. Please bring your Medicare Part B card with you to the clinic. Sorry, we do not bill insurance; we do accept cash, credit card or check. Flu shots available for ages 4-17 with parent present.

«CT Heart Score, 1-2 p.m. Monday-Friday at North Colorado Medical Center. Heart Score provides a non-invasive test that accurately measures the amount of calcified plaque in the arteries. The procedure begins with a fast, painless computed tomography CT exam. CT, more commonly known as CAT scanning, uses X-rays and multiple detectors to create interior images of the heart. The Heart Score program includes a 10-minute consultation with a wellness specialist, focusing on cardiac risk factor education, identifi-cation of non-modifiable and modifiable risks and lifestyle behavior change options. The cost is $199 and payment is due at the time of service. Wellness Services is not able to bill insurance. Call (970) 350-6070 to schedule an appointment.

«STAR, 5:30-7 p.m. Oct. 2, NCMC Cancer Institute Conference Room. Support, touch and reach breast cancer survivors (Breast Cancer Support Group). For further information please contact Betty Parsons at (970) 339-7137.

«PAD Screening (Peripheral Vascular Disease), 1-3 p.m. Oct. 7 and Oct. 21 at Summit View Medical Commons. NCMC’s Peripheral Vascular Disease Screening program offers the education and prevention proven to be the best tools for fighting vascular disease and stroke. Patients receive: ankle brachial index: evaluation of leg circulation, carotid artery disease screen-ing: ultrasound of the carotid vessels, abdominal aortic aneurysm screening: ultra-sound of the aorta, lipid panel voucher, health education with a wellness specialist, health

information packet. The cost is a $100 and payment is due at time of service. To schedule an appointment call (970) 350-6070. NCMC Wellness Services is not able to bill insurance.

«Cooking Classes, “Ethnic Foods Made Lighter,” 6-7:30 p.m. Oct. 8, North Colorado Medical Center in the Cardiac Rehab Kitchen. Take your taste buds on a trip with some international dishes you’ll love! Taught by Mary Branom, R.D. Come and learn a variety of fun and healthy cooking options. These courses are taught by a registered dietitian and are a great way to modify your cooking habits and learn about heart healthy cooking. Recipes and samples are included! Payment due at the time of registration. If you are absent from the class, you will be charged the full amount. Please call (970) 350-6633 to

register.

«Blood tests, 7-8:45 a.m. Oct. 8 and Oct. 22 at NCMC via entrance 6 and Oct. 15 at Johnstown Family Physicians, 222 Johnstown Center Drive. Wellness Services offers low-cost blood screenings open to community members; some immunizations are also available upon request and availability. Now also offered in Johnstown on the 3rd Wednesday of every month at Johnstown Family Physicians, 222 Johnstown Center Drive. Appointments preferred; please fast 12 hours prior to blood draw. To schedule an appointment, call (970) 350-6633.

«Body Check... What you need to know: Head to Toe, Oct. 2 and Oct. 16 at Summit View Medical Commons, 2001 70th Ave. This head-to-toe health assessment gives you the tools to put your health first by receiving a comprehen-sive set of preventive health screenings. Invest in your health today! This screening includes: Health Fair Panel (fasting blood work-please fast 10-12 hours), sleep questionnaire, lung function test, body composition, weight and body mass index, hip and waist measurements, health education with a wellness specialist, EKG with results read by a board-certified cardiologist, peripheral arterial disease screening includes: Education about peripheral vascular disease, stroke, stroke prevention and osteoporosis prevention, ankle brachial in-dex, ultrasound of the carotid vessels, ultrasound of the aorta (above four screenings are read by a board-certified

radiologist), upon request: colorectal take-home kit, $10; prostate specific blood antigen screening, $30. The cost is $175 and the payment is due at the time of service. Wellness Services is not able to bill insur-ance. Call (970) 350-6070 to schedule an appointment.

«Prostate Cancer Support Group, 5:30-7 p.m. Oct. 16, NCMC Cancer Institute Conference Room. For further information, please contact Ju-lianne Fritz at (970) 350-6567.

«Walk with a Doc (WWAD), Oct. 18 at Sanborn Park, 2031 28th Ave., on west side of the park. WWAD is an internation-al program where interested people meet at a park or public location (usually Saturday mornings) for an informal five-minute health talk and a 30-minute walk (at your own pace). Families are encouraged to attend. There are healthy snacks at the completion of the walk. Free blood pressure checks are available for those interested. Upcoming walks are posted on the Walk with Doc website, WalkwithaDoc.org.

«NCMC Adult Fitness, individual cost is $45 and for a couple (living in the same household) $80. The Adult Fitness Program is available to people in the community who are interested in starting an ex-ercise program in a health care setting. For more information call (970) 350-6204.

«Pulmonary Rehabilitation, lung disease management, education and exercise. For more information and opportunities contact (970) 350-6924.

OCTOBER HEALTH EVENTS

www.pathways-care.org305 Carpenter Rd, Fort Collins • (970) 663-35001455 Main St, #140, Windsor • (970) 674-9988

Are all hospices the same?

Upcoming Support GroupsNewly Bereaved: Sept 16 & 23, 6-7:30pm

Living with Loss:Sept 23, 5:30-7:30pm

Call for fee and registration information.

Pathways Hospice …

educational and support

little or no cost.


DALLAS — Clouds of sick-ly sweet black-berry smoke

are billowing out of Isaac Doss’ mouth. He takes a long draw from the bubbling hookah and passes the pipe to Kara Brick.

They are sprawled on cushioned wicker chairs on the patio at Kush, a hookah bar on Greenville Avenue in Dallas. It’s a muggy Thurs-day and the two are cele-brating the return of Kara’s sister, Savannah Brick, from an au pair job in Europe.

“This is kind of cheating,” Kara Brick, 28, says. “We are all ex-smokers. With cigarettes, you really have to push through smoking it the first time. They taste terrible and smell terrible. Hookah is actually enjoyable. This has a social feel and is something we can do together.”

Hookah bars are a re-laxed gathering place for customers to socialize as they smoke tobacco through water pipes. It’s a hot trend among young adults. Near-ly one in five U.S. students smoked hookah in the last year, according to a study published in the journal Pe-diatrics. About 10 businesses sell hookah within a five-mile radius of the University of Texas at Dallas.

But hookah, which comes with few warning labels or health notices, can be more dangerous than smoking cigarettes. A study funded

by the National Institutes of Health notes that a single hookah session delivers 1.7 times the nicotine, 6.5 times the carbon monoxide and 46.4 times the tar of a single cigarette.

“There is no reason to be-lieve that a water pipe is less dangerous than a cigarette,” says Dr. Thomas Eissenberg, a Virginia Commonwealth University professor who has conducted numerous

studies on water pipe smok-ing. “In fact, depending on some of the toxins, there is reason to believe it is more dangerous.”

Doss, 25, smoked hookah regularly at the University of the Ozarks in Clarksville, Ark., without realizing the health risks.

“I was 18 the first time I smoked,” he says. “I smoked every weekend. I never con-sidered how bad it would be

for me. Now I smoke occa-sionally enough that it really can’t affect me. It’s some-thing I consider before I go to the hookah bar.”

State law prohibits the sale and smoking of hookahs to anyone younger than 18. Kevin Perlich, a spokesman at the Richardson, Tex., Po-lice Department, says that anyone caught smoking under 18 will be issued a ci-tation for the use of tobacco,

a Class C misdemeanor sim-ilar to a speeding ticket.

Richardson has adopted ordinances that ban the use of tobacco products, includ-ing water pipes, in most pub-lic places. But the law does not restrict young patrons from entering the lounge, so teenagers are legally able to be in the environment.

“Hookah seems like it is on the upswing,” says Dr. Gary Weinstein, a pulmon-

ologist at Texas Health Pres-byterian Dallas. “There are hookah bars in many young areas, and it’s a cool thing to do. It seems cooler than smoking a cigarette.”

Data from the University of Michigan’s Monitoring the Future survey suggests hookah usage among high school seniors in the past year rose 21 percent.

Hookah smoking a hot trend for young adults but clouded by health concernsBy Lizzie JohnsonThe Dallas Morning News

FRIENDS HANG OUT AT Kush Mediterranean Grill & Hookah Lounge in Dallas in June. Some studies show hookah smoking is no healthier than cigarettes.

MCCLATCHY NEWSPAPERS

Turn to Hookah on P.10


Kaiser Permanente began moving to electronic medical records in 2004 with the launch of its Health-Connect system and launched its patient portal — My Health Manag-er — in 2007.

As of the end of the first quarter of 2014, 66 percent of Kaiser’s eligible member population had registered for My Health Manager, Kaiser Per-manente Advertising and Marketing Consultant Pamela Tauman said.

My Health Manager offers Kaiser Permanente patients the ability to schedule appointments, send messages to their doctor, refill prescriptions or have them sent to their home, as well as see the details of their medical records, like lab results and growth charts. Kaiser offers the service through its website at www.KP.org, as well as it’s mobile application.

“We just find that so many people like doing this on their phones,” said Amy Whited, manager of public relations and digital media. “The

whole world is moving toward mobile and I think we’re seeing that on KP.org, too.”

Hill said she worked with paper records at an early job in her career when she was working at a hospital in Montana.

“For kids, especially kids with chronic illness, they would have vol-umes of charts, not just one chart,” Hill said. “If you’re trying to find out, for instance, when their last kidney ultrasound was, that’s 30 minutes of flipping through the patient’s charts to find what you need.”

The implementation of the electronic medical records system has helped Kaiser delivery care more efficiently, Whited said.

According to Kaiser’s data, dia-betes patients visited the emergency room 29 fewer times per 1,000 patients and were hospitalized 13 fewer times per 1,000 patients annually after Kaiser implemented its HealthConnect system.

The growing database of patient

information and outcomes also pro-vides doctors with better informa-tion about how their treatments are working from a bird’s-eye view.

“It really does promote evi-dence-based medicine because you can see what really works,” Whited said.

At the University of Colorado Health Internal Medicine at 1900

16th St. in Greeley — formerly known as the Greeley Medical Clinic — the clinic began phasing in electronic medical records in June 2007 and implemented the system across the board in 2008. Since then, the clinic has used the Epic Electron-ic Health Record software to keep track of its patients’ information.

“The first part of the move was

getting all the data transferred from paper to electronic charts,” internal medicine physician Mark Berntsen said. “It was easy to do it the way we phased it in. First was the problem lists, then medication lists and the last thing was notes. With that, our paper records went away.”

Berntsen said the switch has made it easier for doctors to see data

FOR THE RECORDBy Casey Kelly

[email protected]

Electronic medical records provide better organization, patient care and cost benefits

PAYTON SCHELLER, 5 MONTHS, loses interest in the medical records during a check-up with Dr. Amanda Hill on Tuesday in Greeley.

JOSHUA POLSON/[email protected]

H ospital patients have better access to their health records and their doctors’ ears than ever before thanks to the implementation of electronic health record systems.

Instead of a new mother forgetting to ask her doctor a question in her appointment and having to wait until her next meeting to ask it, she can get an email response from her doctor within 24 hours.

“I’m a pediatrician, and especially for new moms who haven’t had a baby before, they have a thousand questions, and it’s hard to think of them all while they’re in the room with me,” said Amanda Hill, a pediatric and adolescent medicine physician at Kaiser Permanente’s Greeley Medical Offices at 2429 35th Ave. “It’s way easier for them to send me a message than to call the call center, make an appoint-ment or wait until their next one to ask the question.”


getting all the data transferred from paper to electronic charts,” internal medicine physician Mark Berntsen said. “It was easy to do it the way we phased it in. First was the problem lists, then medication lists and the last thing was notes. With that, our paper records went away.”

Berntsen said the switch has made it easier for doctors to see data

on their patients, and also for pa-tients — who use the patient portal My Health Connection — to see their own data and even get in touch with their doctor electronically.

“It’s definitely helpful and easier to find data,” he said. “If someone shows up to see the cardiologist, I can see that. I can see lab results as soon as they come off the machine.

We also have an easier time getting in touch with patients. They can send me questions about what a certain lab result means and I can get back to them without having to make a new appointment if it isn’t necessary.”

Berntsen said the new system gives both doctors and patients better data, which in turn leads to providing better, more efficient care. He said instead of playing phone tag with patients, they can have a question answered quickly through email. He also said patients tell him they enjoy seeing the results of their tests, instead of simply being told what they are during their next appointment.

Steve Hess, chief information officer for University of Colorado Health, said the hospital system has more than 75,000 patients enrolled with My Health Connection, with more than 3,700 new patients enrolling each month. He said the most common features patients use are reviewing results, scheduling appointments and securely messag-ing the clinic.

“As far as cost savings, the most obvious one of implementing Epic is the reduction in transcription costs of over $3.6 million annually,” Hess said. “The other benefits of the inte-grated electronic health records are more difficult to financially quan-tify, but we have seen a decrease in patient safety issues and better, more complete handoffs of information across care settings.”

University of Colorado Health im-plemented the program in their last remaining clinic serving Northern Colorado and Southern Wyoming on Sept. 23, Hess said.

FOR THE RECORDElectronic medical records provide better organization, patient care and cost benefits

PAYTON SCHELLER, 5 MONTHS, loses interest in the medical records during a check-up with Dr. Amanda Hill on Tuesday in Greeley.

JOSHUA POLSON/[email protected]

Americans may have stopped putting on pounds, but their waistlines are still expanding, according to a new analysis from the Centers for Disease Control and Prevention.

The average waist circumference of U.S. adults has increased by about 3 percent since the end of the last century. In 1999 and 2000, the waists of Americans who were at least 20 years old measured 37.6 inches (or 95.5 centi-meters) around. By 2011 and 2012, that figure had grown to about 38.8 inches (98.5 cm), CDC researchers report in Wednesday’s edition of the Journal of the American Medical Association.

Those figures are age-adjusted averages, but the trend applies to pretty much all de-mographic groups, the report says. Men and women both saw “significant increases” in waist circumference, as did “non-Hispanic whites, non-Hispanic blacks and Mexican Americans.” Waistlines of Asian Americans may have grown too, but the CDC didn’t start collecting data on them as a group until 2011, the researchers note.

The study calls attention to five groups that experienced “particularly large increases” in waist circumference during the study period:

» African-American women in their 30s saw their average waist size grow by nearly 4.6 inch-es.

» Mexican American women who had passed their 70th birthday expanded their waists by 4.4 inches, on average.

» Mexican American men in their 20s added an average of 3.4 inches to their waists.

» Black men in their 30s grew their waists by about 3.2 inches, on average.

» White women in their 40s added an aver-

age of 2.6 inches to their waists.Overall, the proportion of Americans suf-

fering from abdominal obesity rose from 46.4 percent in 1999-2000 to 54.2 percent in 2011-2012, according to the study. (These figures were adjusted for age as well.)

The data on bigger waists come from the Na-tional Heath and Nutrition Examination Sur-vey, an ongoing study that combines physical examinations with in-depth interviews.

Interestingly, NHANES data were cited in February by another group of CDC researchers who declared that American obesity rates have experienced “no significant changes” between 2003-2004 and 2011-2012. That study, which was also published in JAMA, focused on body mass index.

“At a time when the prevalence of obesity may have reached a plateau, the waistlines of U.S. adults continue to expand,” the new report concludes.

While BMI is used to assess whether a per-son has enough excess body fat to be considered overweight or obese, the waist circumference measurement can help doctors predict whether that extra weight translates into serious health problems.

“If most of your fat is around your waist rath-er than at your hips, you’re at a higher risk for heart disease and Type 2 diabetes,” according to the National Heart, Lung and Blood Institute, part of the National Institutes of Health. Those risks kick in for women with a waist size above 35 inches and men with a waist size above 40 inches.

To get an accurate measurement your own waist circumference, stand up, breathe out and place a tape measure snugly around your bare abdomen, just above the top of your hip bones.

Obesity rates have stabilized, but waistlines are still growingLos Angeles Times


» Bilateral breast lift or breast reduction to create symmetry of the breasts at the time of the mastectomy.

» Partial mastectomy followed one year later by the injection of the patient’s body fat into the area where breast tissue was removed.

A combination of options could also be used.

Of course, other factors play a role in determining which option is the most appropriate, such as the size of the patient’s breasts, prior abdominal surgeries and the amount of subcutaneous abdominal tissue a woman possesses.

The good news is that most women make good candidates for some form of breast recon-struction (unless there are other major medical problems present that would make prolonged anesthesia or additional surgery too risky).

The numbers of options for mastectomies and breast recon-struction can feel overwhelming for patients, especially under the already significant emotion-al stress from a breast cancer diagnosis.

However, the benefit of having so many options is that we can usually find a good fit for each individual patient that allows for optimal removal of the cancer, as well as a desirable cosmetic outcome.

Please do not hesitate to ask your surgeon if you are a candi-date for reconstructive options at any time during the process of di-agnosis, treatment and recovery.

Molly Decker, DO, is a general surgeon at the Banner Health

Clinic specializing in general sur-gery in Greeley. Dr. Decker per-forms minimally invasive and

advanced laparoscopic surgeries as well as general procedures. She

is a member of the American Soci-ety of Breast Surgeons.

Mastectomy from P.3

Eissenberg says this is an issue because many young people do not realize they are inhaling tobacco, charcoal smoke and other carcino-gens with each breath.

“The problem is, if you go into a water pipe bar and look at the pipe you are being served, there is nothing on that pipe or on the tobac-co or in that charcoal that tells you it’s dan-gerous,” Eissenberg says. “I have gotten this outlook from kids: ‘It doesn’t say it’s danger-ous, so it must be safe.’”

When smoking a cigarette, the user lights the tobacco with a fire and inhales the smoke. With hookah, the smoke passes from a head containing tobacco and charcoal, through a water bowl and into a hose for inhalation. The tobacco comes in many flavors, ranging from chocolate to fruit to alcoholic varieties.

Hookah smoke is known to contain high-er levels of lead, nickel and arsenic, 36 times more tar and 15 times more carbon monox-ide than cigarettes, research in the Journal of Cancer Epidemiology, Biomarkers & Preven-tion shows.

This is because smoking a hookah requires

taking harder and longer drags, increasing the levels of inhaled carcinogens and nicotine in the lungs.

“When they take a puff, the smoke is very cool and the draw resistance is very low, so it is easy to inhale and it tastes good,” Eis-senberg says. “They take dramatically larger puffs, about 500 milliliters per puff. We are talking about an entire cigarette’s worth of smoke in a single puff.”

The longer the hookah session, the more nicotine and toxins a person takes in.

A 45- to 60-minute hookah session can ex-pose the smoker to about the same amount of nicotine and tar as one pack of cigarettes, Eissenberg says.

“If you aren’t a cigarette smoker because you know cigarettes are dangerous and le-thal, then there is absolutely no reason to be smoking a water pipe and every reason to avoid it for the same reason,” he says. “Water pipe smoking will kill you also.”

Dr. Mark Millard, a medical director at Baylor Martha Foster Lung Care Center, has practiced medicine in the Middle East, an area where water pipe smoking has been prevalent for more than 400 years. On one trip, he treated a woman from Saudi Arabia

with a hacking cough.“She was smoking every night for an hour,”

he says. “That is quite a lot of inhalants. I told her to get rid of her hubbly bubbly (hookah). It’s nicotine that is the addictive factor. It makes people want to come back for more. People can get addicted to hookahs, and it does affect your health.”

Five years ago, Farhad Ata opened Kush Hookah Lounge.

Ata has smoked hookah his entire life. He says he likes the nicotine buzz and the chill environment. He knows smoking is not healthy, but he has accepted the risks. It’s something he says he hopes clients are aware of, too.

“I don’t really sit down and talk with them about the health risks,” Ata says. “I think some people are already schooled, and they just accept it. Other people don’t care. It is still tobacco, no matter what, even if it is fla-vored. Your lungs are meant for air. Any type of smoke is not good for you, whether it’s cig-arettes or hookah.”

Eissenberg says: Know the risks.“As a package deal, it’s a dangerous thing to

do,” he says. “Educate yourself. Then make the decision.”

Hookah from P.7

Now that school has started, what’s the latest on how to en-courage good eating habits in our young ones?

Be a good role model, say ex-perts. Like it or not, parents are the most important influence in our children’s lives. And even if we are not perfect, it’s our responsibility to demonstrate healthy behaviors to our kids. That’s how they learn.

Want to see how well you are doing? Here are some questions to ask yourself, adapted from nutri-tion experts at the National Dairy Council:

» Do you regularly skip break-fast?

» Do you drink sodas rath-er than water or milk with your meals?

» Do you frequently go on diets to lose weight?

» Do you indicate a fear of or frequently talk about “bad” food to your child?

» Do you have frequent snacks throughout the day rather than regular meals?

» Do you eat in front of the TV?» Do you eat when you are

bored or under stress?Be honest. If your answer to

several of these questions is “yes,” you are likely sending unhealthy nutrition messages to your child.

OK, so what can we do about it? Start, say experts, by realizing that we can encourage healthy behaviors in our kids by modeling healthful actions ourselves. Here are some ways we can start:

Eat meals at regular times, es-pecially breakfast.

Demonstrate to your child —

through your own actions — what a moderate portion looks like. Example: I might choose to eat a couple slices of pizza with a large salad instead of a large pizza with a couple sprigs of salad.

Limit the amount of high sugar, high fat foods you bring into your home. Our goal: a light but not de-priving food environment.

Focus on beverages such as wa-ter and milk instead of soda and fruit drinks.

Find ways to include your chil-dren in the preparation of food and meals. Again, that’s how they learn.

Teach kiddos to recognize a “balanced” meal — one that in-cludes at least three of the follow-ing nutrient groups: protein (fish, poultry, lean meats, nut butters, eggs), vegetables, fruit, whole grains or beans, and high calcium

foods (low fat milk, yogurt, cheese or calcium fortified milk substi-tutes).

Serve desserts that add nutri-ents. Fruit and yogurt, for exam-ple.

Pack school lunches with your child’s preferences as well as nu-tritional needs in mind. Add ex-tra veggies to sandwiches. Use a variety of whole grain breads, crackers or “wraps.” Vary protein sources such as deli meats, nut butters, hummus or other bean spreads, eggs, and cheese. Always include a fruit or a vegetable. Pack after-school snacks such as high protein cereal bars or trail mix, es-pecially if your student has sports practice.

And don’t forget, Mom and Dad, good habits are caught more than taught. Let the role modeling begin.

Be role model for kids in own eating habitsBy Barbara QuinnThe Monterey County Herald


At the last meeting of the Centennial Area Health Education Center (CAHEC) Board of Directors we tried something new. Well, not that new. You’ve got to remember that the sort of people who are far enough in our careers to have the time to volunteer for the boards of organizations like AHEC are generally too old to be naturals at information technology. Thanks to the efforts of a clever young staff person, two board members — one from Burling-ton and the other from Haxtun — were able to attend the meeting via interactive video, using the communications program

GoToMeeting.Remote users saw every document and

slide that we saw at the home office. They got everything but the sandwiches while we got glimpses of their faces projected onto a movie screen.

Overall, it felt like the people who participated in the meeting from over 100 miles away were more engaged than they’d been at meetings where we only heard their voices over a speaker set in the middle of the conference room table. The video system and Internet connection did help us feel more tightly bound.

When I first became involved with CA-HEC in 1996, our mission (besides seeing

Technology helps health education center

to stay connected

Marc RINGEL

For The Tribune

Turn to CAHEC on P.15

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BALANCE

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CARDIAC VASCULAR SURGERY

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JULIE KAVANAUGH, D.D.S.3400 W. 16th Street, Suite 8-EGreeley, CO 80634Phone: (970)351-0400www.drjuliekav.com

RALPH R. REYNOLDS, D.M.D., M.D.Oral Surgery7251 W. 20th St.Building H, Suite 2Greeley, CO 80634(970) 663-6878www.reynoldsoralfacial.com

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ENDOCRINOLOGY CLINIC (NCMC)1801 15th Street, Ste 200Greeley, CO 80631Phone: (970)378-4676Fax: (970)-378-4315www.bannerhealth.comProfessionals: Nirmala Kumar, MDKimberly Rieniets, MDCorinn Sadler, MD

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BANNER HEALTH CLINIC100 S. Cherry Ave., Suite 1Eaton, CO 80615Phone: (970)454-3838Professionals: Marianne Lyons, DOLance Barker, DO, Internal Medicine

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FAMILY PHYSICIANS OF GREELEY,LLP-CENTRAL2520 W. 16th StreetGreeley, CO 80634(970) 356-2520Fax: (970) 356-6928Professionals: Joanna H. Branum, M.D.Angela M. Eussen, PA-CJennifer D. Dawson , D.O.Douglas A. Magnuson, M.D.Paul D. Lobitz, M.D.Lori A. Ripley, M.D.D.Craig Wilson, M.D.

FAMILY PHYSICIANS OF GREELEY,LLP-COTTONWOOD2420 W 16th StreetGreeley, CO 80634(970) 353-7668Fax:970-353-2801Professionals: Stacey L. Garber, M.D.Amy E. Mattox, M.D.Christopher T. Kennedy, M.D.Daniel P. Pflieger, M.D.Mark D. Young, M.D.

FAMILY PHYSICIANS OF GREELEY,LLP-WEST6801 W. 20th St., Suite 101Greeley, CO 80634(970) 378-8000Fax: (970) 378-8088Professionals: Nathan E. Bedosky, PA-CAnn T. Colgan, M.D.Daniel R. Clang, D.O.Tamara S. Clang, D.O.R. Scott Haskins, M.D.Mathew L. Martinez, M.D.Chima C. Nwizu, M.DMichelle K. Paczosa, D.O.Andrew P. Stoddard, M.D.Kyle B. Waugh, M.D.Charles I. Zucker, M.D.

KENNETH M. OLDS6801 W. 20th Street, Suite 208Greeley ,CO 80634Phone: (970)330-9061

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TRiBUNE MEDiCAL DiRECTORY 2010TRiBUNE MEDiCAL DiRECTORY 2014FUNERAL SERVICES

ALLNUTT & RESTHAVEN FUNERALSERVICES702 13th Street, Greeley, CO Phone: (970) 352-3366650 W. Drake Road, Ft. Collins, CO Phone: (970) 482-3208 8426 S. College Avenue, Ft. Collins, CO Phone: (970) 667-02022100 N. Lincoln, Loveland, CO Phone: (970) 667-11211302 Graves Avenue, Estes Park, CO Phone: (970) 586-3101

GASTROENTEROLOGY

DOWGIN, THOMAS A., MD.CENTERS FOR GASTROENTEROLOGY7251 W. 20th St., Bldg J, Greeley, CO Phone: (970)207-97733702 Timberline, Ft. Collins, CO Phone: (970)207-97732555 E. 13th Street, Suite 220, Loveland, CO Phone: (970)669-5432Website: www.digestive-health.net

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HOSPICE OF NORTHERN COLORADOAdministration Office2726 W. 11th Street RoadGreeley, CO 80634Phone: (970)352-8487Fax: (970)475-0037

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MENTAL HEALTH SERVICES

NCMC - BEHAVIORAL HEALTHDr Patricia Al-Adsani, Child and Adolescent PsychiatryBanner Health Clinic-Internal Medicine2010 16th Street, Suite C, Greeley, CO 80631Banner Health Clinic- Windsor1300 Main Street, Windsor, CO 80550

Shawn Crawford, LPCBanner Health Clinic 222 Johnstown Center Dr., Johnstown, CO 80534Banner Health Clinic-Internal Medicine2010 16th Street, Suite CGreeley, CO 80631

Stephanie Carroll, LCSW, CACIIIBanner Health Clinic1300 Main Street, Windsor, CO 80550Banner Health Clinic Fossil Creek303 Colland DrFort Collins, CO 80525

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TRiBUNE MEDiCAL DiRECTORY 2014NEURO-SURGERY BRAIN & SPINE

BANNER HEALTH NEUROSURGERY CLINIC1800 15th St., Suite 130Greeley, CO 80631Phone: (970)350-5996Professionals:David Blatt, MDBeth Gibbons, MD

NURSING HOME REHABILITATIONCENTENNIAL HEALTH CARE CENTER1637 29th Ave. PlaceGreeley, CO 80634Phone: (970) 356-8181Fax: (970) 356-3278

COLUMBINE COMMONS HEALTH & REHAB FACILITY1475 Main StreetWindsor, CO 80550Phone: (970) 449-5541Web Site: www.columbinehealth.com

OBSTETRICS & GYNECOLOGYBANNER HEALTH GYN CONSULTANTS1800 15th St., Suite 130Greeley, CO 80631Phone: (970)353-1335Professionals:Susan Carter, MD

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ONCOLOGY & HEMATOLOGY

CANCER INSTITUTE (NCMC)1800 15th Street,Greeley, CO 80631 Phone: (970) 350-6680Toll Free (866) 357-9276Fax: (970)350-6610Professionals: Jeffrey Albert, MDElizabeth Ceilley, MDBrian Fuller, MDBenjamin George, MDSamuel Shelanski, MDKerry Williams-Wuch, MDAlice Wood, MDAriel Soriano, MD

ORTHODONTICS

ORTHODONTIC ASSOCIATES OF GREELEY, PCProfessionals: Bradford N. Edgren, DDS, MS3400 W. 16thSt., Bldg 4-VGreeley, CO 80634Phone: (970) 356-5900Website: www.drbradsmiles.com

ORTHOPEDICS

MOUNTAIN VISTA ORTHOPAEDICS 5890 W. 13th Street, Suite 101Greeley, COPhone: (970)348-0020Fax: (970)348-0044Web Site: www.bannerhealth.comProfessionals: Randy M. Bussey, MDRiley Hale, MDDaniel Heaston, MDThomas Pazik, MDKelly R. Sanderford, MDSteven Sides, MDLinda Young, MD

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PEDIATRIC REHABILITATIONBANNER REHABILITATION CENTER1801 16th Street, Greeley, COPhone: (970)350-6160Fax: (970)378-3858

PERSONAL RESPONSE SERVICE

BANNER LIFE LINE (NCMC)2010 16th Street, Suite C, Greeley, CO 80631Phone: 1-877-493-8109(970) 378-4743

PHYSICAL THERAPY

FRONT RANGE THERAPY1475 Main Street, Windsor, CO 80550Phone: (970) 492-6238Web Site: www.columbinehealth.com

HOPE THERAPY CENTER(Formerly North Colorado Therapy Center)2780 28th Avenue, Greeley, CO 80634Phone: (970)339-0011Website: www.GCIinc.orgProfessionals: Jeanne Rabe, PT;Jennifer Branson, PTKryste Haas, OT; Molly Wuethrich, PTAMoni Kohlhoff, PT

NORTHERN COLORADOREHABILITATION HOSPITAL 4401 Union Street, Johnstown, CO 80534Phone: (970) 619-3400Website: [email protected]

PULMONARY/CRITICAL CARENORTH COLORADOPULMONARY (NCMC)1801 16th Street, Greeley, CO 80631Phone: (970)392-2026Professionals: Kelli Janata, DORobert Janata, DODavid Fitzgerlad, DOMichael Shedd, MDDanielle Dial, NP

PROSTHETICS & ORTHOTICS

CERTIFIED PROSTHETICS &ORTHOTICS, LLC (GREELEY LOCATION)1620 25th Avenue, Suite A, Greeley, CO 80634Phone: 970-356-2123Fax: 970-352-4943

HANGER PROSTHETICS & ORTHOTICS7251 West 20th Street, Building M, Greeley, CO 80634 Phone: (970)330-9449 Fax: (970)330-42172500 Rocky Mountain Avenue, Suite 2100North Medical Office Building, Loveland CO 80538 Phone: (970) 619-6585 Fax (970) 619-6591Website: www.hanger.comProfessinal: Ben Struzenberg, CPOMichelle West, Mastectomy Fitter

REHABILITATION

ASCENT AT LIFE CARE CENTER 4800 25th Street, Greeley, CO 80634Phone: (970)330-6400Website: www.lcca.comProfessionals: Annie BennettLeslie Vail

BANNER REHABILITATIONPhone: (970)350-6160

COLUMBINE COMMONSHEALTH & REHAB FACILITY 1475 Main StreetWindsor, CO 80550Phone: (970) 449-5541Web Site: www.columbinehealth.com

FRONT RANGE THERAPY1475 Main Street, Windsor, CO 80550Phone: (970) 492-6238Web Site: www.columbinehealth.com


PEAKVIEW MEDICAL CENTER5881 W. 16th St., Greeley, CO 80634Phone: (970)313-2775Fax: (970)313-2777

RESPITE/ADULT DAY CARE

ELDERGARDEN ADULT DAY CARE 910 27th AvenueGreeley, CO 80634970-353-5003Website: www.eldergarden.orgSliding scale fee or no fee forMedicaid Enrollment process required

SKILLED CARE/REHAB

BONELL GOOD SAMARITAN708 22nd Street, Greeley, CO 80631Phone: (970)352- 6082Fax: (970)356-7970Website: www.good-sam.com

COLUMBINE COMMONS HEALTH & REHAB FACILITY1475 Main StreetWindsor, CO 80550Phone: (970) 449-5541Web Site: www.columbinehealth.com

GRACE POINTE1919 68th Avenue, Greeley, CO 80634Phone: (970) 304-1919Website: www.gracepointegreeley.com

SPORTS MEDICINE

MOUNTAIN VISTA ORTHOPAEDICS 5890 W. 13th Street, Suite 101, Greeley, COPhone: (970)348-0020Fax: (970)348-0044Web Site: www.bannerhealth.comProfessionals: Randy M. Bussey, MDRiley Hale, MDDaniel Heaston, MDThomas Pazik, MDKelly R. Sanderford, MDSteven Sides, MDLinda Young, MD

NORTH COLORADO SPORTS MEDICINE1801 16th Street, Greeley, COPhone: (970)392-2496

SPEECH LANGUAGE PATHOLOGY

BANNER REHABILITATION CENTER1801 16th Street, Greeley, COPhone: (970)350-6160Fax: (970)378-3858


UNC SPEECH LANGUAGE PATHOLOGY CLINICGunter Hall, Room 0330, Greeley, CO 80639Phone: (970)351-2012/TTYFax: (970)351-1601Web Site: www.unco.edu/NHS/asls/clinic.htmProfessionals: Lynne Jackowiak, M.S., CCC-SLPJulie Hanks, Ed.DPatty Walton, M.A., CCC-SLP


to it that health sciences students doing rotations in our region didn’t have to sleep under bridges) was to put on conferences.

Among other courses, we brought Advanced Cardiac Life Support and Advanced Trauma Life Support to the provinces.

And we provided programs, usually set in Greeley, on anything people might want to attend, including on professional burnout and dream interpretation.

That’s how we earned our keep. CAHEC even built our own office

building, containing a lovely, large class/conference room in which to hold our multitudinous offerings. Today that facility, still the envy of the other Colorado AHEC districts, is underutilized. If you or your organization would like to use our nice, inexpensive meeting space in Gree-ley, please call us.

Electronic communications is the reason for the decline in face-to-face programs. Today’s professionals can find online most everything they need to know,

whether nearly instantaneously in the course of caring for a patient or, for more extensive education, in the form of an on-line course. These days not many learning experiences require teacher and learner to be in the same location.

For those things that do require hands-on experience, health care has been catching up with the aviation industry in

developing all sorts of simulators that pro-vide professionals with the opportunity to practice critical medical skills without endangering human beings.

Several portable and fixed site simula-tion labs serve the territory, teaching ev-erything from management of the gravely ill patient to routine colonoscopy.

So, what’s the role of a regional orga-

nization like CAHEC in this brave new world of online education and simulation?

I hearken to a cartoon I love. Two dogs, sniffing each other’s butts, are held on leashes by a mistress and a master. One of the humans says to the other, “There are some things you just cannot learn on the Internet.”

CAHEC staff and board are locals ourselves. We seek to provide that human connection to everybody who lives or trains in our service area, whether they are a health professional, are studying to be one, or might be one when they grow up.

We work with people in professional schools, local school systems, colleges, nursing homes, pharmacies, hospitals and health departments. In keeping with our mission to train and support health professionals and, ultimately, to improve the health of our constituents, we strive to connect everybody to everybody both within our region and to a wide array of outside resources…in any way we can, face-to-face, by Internet or video.

Dr. Marc Ringel is a board member for the Centennial Area Health Education Center.

CAHEC from P.11

FOR THE TRIBUNE

TRiBUNE MEDiCAL DiRECTORY 2014SURGERY GENERAL & TRAUMA BARIATRIC SURGERY (NCMC)

1800 15th Street, Suite 200, Greeley, CO 80631Phone: (970)378-4433866-569-5926Fax: (970)378-4440Professionals: Michael W. Johnell, MD

SURGERY WESTERN STATES BURN CENTER (NCMC)1801 16th Street, Greeley, CO 80631Phone: (970)350-6607Fax: (970)350-6306Professionals: Gail Cockrell, MD Cleon W. Goodwin, MD BURN

SURGICAL ASSOCIATES OFGREELEY PC (NCMC)1800 15th St. Suite 210, Greeley, CO Phone: (970)352-8216Toll Free: 1-888-842-4141Professionals: Molly Decker, DO;Michael Harkabus, MD; Jason Ogren, MD;Samuel Saltz, DO; Robert Vickerman, MD

URGENT CARESUMMITVIEW URGENT CARE2001 70th Avenue, Greeley, CO 80634Phone: (970)378-4155Fax: (970)378-4151www.bannerhealth.comProfessionals: Susan Beck, MDThomas Harms, MDSusan Kelly, MDAmy E. Shenkenberg, MDLinda Young, MD

UROLOGY

MOUNTAIN VISTA UROLOGY5890 W. 13th Street, Suite 106, Greeley, CO 80634Phone: (970)378-1000Professionals:Curtis Crylen, MDDavid Ritsema, MDJames Wolach, MDwww.bannerhealth.com

VEINS

VEIN CLINIC (NCMC)1800 15th Street, Suite 340, Greeley, CO 80631Phone: (970)378-4593Fax: (970)378-4591Professionals:Maurice I. Lyons Jr., DOKenneth M. Richards, MDGene E. Tullis, MD


Hearing Aids Will Not Cure DementiaBy Robert M. Traynor, Ed.D.

Lately, there has been a lot of “hype” about the use of amplifi-cation and Dementia. At least in the US, the ads hocking hearing in-struments from many of the man-ufacturer-owned, hearing aid sales operations lead patients to believe that if they purchase hearing in-struments they will cure dementia, and even Alzheimer’s Disease. Too bad that this is not true as it would be an easy treatment option to cure this terrible disease. While the cause of this dreaded disease has been attributed to everything from Teflon-coated pans to ge-netics, there is no specific cause of the disorder. Physicians and audiologists have hypothesized for quite some time that hearing impairment probably contributes to the everyday cognitive difficulty encountered by dementia patients and their families. If hearing im-pairment does contribute to cog-nitive dysfunction, a higher prev-alence of hearing impairment in people with dementia than people without should be measured. In ad-dition, the worse the dementia the more hearing impairment should be noted as well.

Although previous studies of hear-ing and cognition in older adults have consistently demonstrated these conditions to be associated, the associations have not always been statistically significant. These studies have sometimes been crit-icized for low statistical power, imprecise diagnostic criteria and instrumentation, and failure to control for potentially confound-ing variables such as age and de-

pression. Evidence is mounting, however, that hearing loss in old-er patients is not just a relatively benign condition that, at worst, leads to frustrated family members who can’t make themselves heard. Recent research by at least two independent groups has shown a strong association between hear-ing loss and cognitive decline. The results are troubling enough to cause one investigator to call for an “all-hands-on-deck” push to make age-related hearing loss a public health priority.

One of the studies funded by the National Institutes of Health con-ducted by Lin et al. (2013) at Johns Hopkins, suggested that about 50% of their hearing-impaired old-er patients had dementia when compared to their “normal hear-ing” older adult control subjects. Frank R. Lin, MD, PhD, an assistant professor in the division of otol-ogy, neurotology and skull base surgery at Johns Hopkins School of Medicine, assistant professor in the division of geriatric medicine in the Johns Hopkins Center on Aging and Health and assistant profes-sor in the departments of epide-miology and mental health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said, “My collaborators at the National Institute on Aging (NIA) were very surprised at the strength of the as-sociation.” The study in the NIH-sponsored Baltimore Longitudinal Study of Aging was one of Dr. Lin’s first to show such a strong link between hearing loss and dementia. The study included 639 participants, most of whom were between 60

and 80 years of age. At baseline, none of the participants had any evidence of cognitive impairment, although some had hearing loss. During a median follow-up of 11.9 years, 58 cases of incident all-cause dementia were diagnosed, of which 37 were considered to be Alzheimer’s disease. The risk for participants developing dementia “increased linearly with the sever-ity of hearing loss,” Dr. Lin said. Compared with normal hearing, the hazard ratio (risk) for demen-tia was 1.89 (1.00–3.58) for mild hearing loss, 3.00 (1.43–6.30) for moderate hearing loss and 4.94 (1.09–22.40) for severe hearing loss. These results were support-ed by a subsequent study of nearly 2,000 patients by Lin et al. (2013) and further supported by Gallagh-er et al (2012) in another study by an independent group in the U.K.

Recently, in the ENT and Audi-ology News, a noted Canadian researcher, Dr. Kathleen Picho-ra-Fuller, stated that “we must go beyond simply testing hearing and amplifying sound if progress is to be made in helping those who are hard of hearing remain actively engaged in communica-tion and social interaction. The need to assess the role of cogni-tion in more realistic listening sit-uations using new behavioral and physiological approaches.” Dr. Pichora-Fuller further observes that the connection between hearing and cognition has gained new importance recently as liter-ature does now show some indi-cation that older adults who are hard of hearing are at greater risk than their normally hearing peers for clinically significant cognitive decline.

Hearing Aids and Dementia?

So, the jury is now in …… the lit-erature that suggests dementia and Alzheimer’s patients should be screened and/or evaluated for hearing impairment. Good NIH studies now indicate that these patients might be better connect-ed to friends and family if they have amplification to assist them with their everyday communica-tion needs. This is, however, not a purchase that should be taken lightly. While hearing instruments are probably beneficial to these patients, families need to insure that they do not simply make a hearing aid purchase and hope to cure the disorder. The introduction of amplification will not be a cure for the disorder as is suggested in may hearing aid ads. The prudent approach is to coordinate the use of amplification as one component of an active treatment program for dementia and Alzheimer’s patients, not merely a purchase. A careful discussion with your physician is

the correct beginning, then upon referral to an appropriate audiol-ogist hearing should be evaluated and, in cooperation with your phy-sician, amplification considered if appropriate.

References:Lin F.R, Metter, E.J., O’Brien, R.J., Resnick, S.M, Zonderman, A.B., & Ferrucci, L. (2011), Hearing loss and incident de-mentia, Arch Neurol. Feb; 68(2): 214–220.

Lin, F.R.,Yaffe, K., Xia, C., Xue, Q., Harris, T.,Purchase-Helzner, E., Sat-terfield, S., Avonavon, H.N.,Ferrucci, L., and Simonsick, E, Hearing loss and cognitive de-cline in older adults, JAMA Intern Med. 2013; 173(4):293-299.

Pichora-Fuller, K., (2014). Cognition and hearing healthcare, ENT and Audiology News, July/August, Vol 23, No 2, p. 81.

Miller, a co-researcher at Michigan, that the noise-induced hearing loss prevention concoction could be available within two years.

In another study funded by the Oklahoma Medical Research Foundation,researchers Dr. Robert Floyd and retired Army surgeon, Dr. Richard Kopke, M.D., discovered a combination of two compounds stopped damage to the inner ear caused by acute acoustic trauma – something like an IED exploding. Although they did not indicate what the compounds were they felt that,“This is a very exciting finding,” said Dr. Floyd, who holds the Merrick Foundation Chair in Aging Research at OMRF. “The research is still at a pre-clinical stage, but we’re hopeful that we soon can begin testing in humans.

More recently, Dr. Kathryn Campbell's work at Southern Illinois University involves the use of an antioxidant called D-methionine, a component of fermented protein

that is found in yogurt and cheese. The antioxidant, in concentrated doses, has been found to improve some forms of hearing loss and even prevent hearing loss before the exposure to noise. "We've been able to show in animal studies that if we give it before and after noise exposure, that we can get pretty full protection from noise-induced hearing loss," Campbell said. According to Campbell and her colleagues will continue their studies by looking at the effects of varying dosages of D-methionine on animal subjects exposed to different noises. They have already found that the drug can be given up to seven hours after the noise is experienced and still be effective. "It doesn't mean it's going to work for long-standing hearing loss, but it does mean that in the early stages, you could intervene and keep it from becoming permanent," she said. The research will then move into determining if even more time can elapse before the drug is given and the hearing loss becomes permanent. In a discussion in November 2012 Dr. Campbell stated that the human clinical trials with the U.S. Army are in the early planning stages, Campbell said.

So, with AuraQuell in field tests to defend against noise-induced hearing loss, the D-methionine possibilities also in clinical trial, and the ongoing stem cell research reported by Hearing International (www.hearinghealthmatters.org) last fall, a "morning after" pill for that tinnitus and noise induced hearing loss created the night before may soon be a simple swallow away.

Robert M. Traynor is the CEO and practicing audiologist at Audiology Associates, Inc., Greeley, Colorado with particular emphasis in amplification and operative monitoring. Dr. Traynor holds degrees from the University of Northern Colorado (BA, 1972, MA 1973, Ed.D., 1975), the University of Phoenix (MBA, 2006) as well as Post-Doctoral Study at Northwestern University (1984). He taught Audiology at the University of Northern Colorado (1973-1982), University of Arkansas for Medical Sciences (1976-77) and Colorado State University (1982-1993). Dr. Traynor is a retired Lt. Colonel from the US Army Reserve, Medical Service Corps and currently serves as an Adjunct Professor of Audiology at the University of Florida, the University of Colorado, and the University of Northern Colorado. For 17 years he was an Audiology Consultant to major hearing instrument and equipment manufacturers providing academic and product orientation for their domestic and international distributors. A clinician and practice manager for over 35 years, Dr. Traynor has lectured on most aspects of Audiology in over forty countries.

Author’s Bio:Robert M. Traynor,

Ed.D., MBA, FAAA

October 2014 Thrive

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