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May 2015 HealthyColoradan.com

CONGESTIVE HEART FAILURE Colorado Springs Cardiologist Kim Dulaney, MD FACC Explains The Complex Cardiac Condition p.15

Colorado Springs Orthopedic Group Moves t o Bun dle d P aym e n t C a r e I m p r o v emen t

Performance Accountability Leads to Better Coordination of Care and Higher Quality for Patients p.30

More Inexpensive Date Night Ideas For Couples p.12

Menopause Symptoms Vary by Age By Mache Seibel, MD p.45

and more!

Food is not the Enemy ... Misinformation is. "Food can be the safest, most powerful form of medicine or the slowest form of poison. " - Ann Wigmore

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FEATURED STORIES

15. CONGESTIVE HEART FAILURE

12. More Inexpensive Date Night Ideas for Couples

30. A Colorado Springs Orthopedic Group Moves to Bundled Payment Care Improvement

45. Menopause Symptoms Vary by Age

Colorado Springs Cardiologist Kim Dulaney, MD FACC Explains The Complex Cardiac Condition

Performance Accountability Leads to Better Coordination of Care and Higher Quality for Patients

By Mache Seibel, MD

CONTENTS 11. What is Long Term Care Insurance? 37

14. Causes of Low Sperm Count By Christopher Jacoby

20. Financial Wellness Home Budgeting for The Beginner 41

22. The Link Between Stress and Grey Hair By Susan Knowloton

24. 36 Interesting Facts About . . . The Human Heart 26. Some Basic Lifehacks for Happiness 20

By Adam Siniki

29. Keeping Your Health-Related New Year’s Resolution By MelainaBjorklund, MS, RD, Clinical Dietitian, Penrose-St. Francis Health Services

35. Pros & Cons of Acupressure By Gary Wickman

37. Three Amazing Spring Recipes to Ring in the New Season 24

41. Colorado Health & Wellness News Briefs 44. Kids and the Issue of Privacy

By Charles Faye, PhD, Founder and President of Love & Logic

47. Understanding Blood Clots – Part I A Two-Part Series 52. Cholesterol 101

What every man and woman should know and understand about this compound.

55. The Eyes Have It

By Randolph C. Robinson, MD, DDS, FAACS

57. St. Mary-Corwin Medical Center By Christopher Jacoby

58. How One Man’s Journey Set A Colorado Community as the Sister City to Ancient Olympia By Harris Kalofonos, USA Wrestling

60. Yoga is More Than Just Poses 60

Executive Team Founder, CEO and Editor-in-Chief Dirk R. Hobbs, ACHE, AHCJ Partner & Chief Operations Officer Scott W. Casey, MBA Vice-President of Communications Kim Ronkin Associate Publisher Trey Davison, MBA

Welcome!

Creative Team

Let’s get to the heart of the matter, shall we? A portion of this issue will showcase a working knowledge of the human heart and just a few of the conditions associated with its health. A good majority of us pay little to no attention to our heart health, in spite of the repeated emphasis on good nutrition, adequate exercise, maintaining healthy weight, smoking cessation, lowering sugar and salt usage, lowering alcohol use, minimizing stress, among other variables. While the numbers of the heart-conscientious are rising, so too interestingly, are the obese or who are carrying unhealthy levels of weight, a poor diet and low activity levels in general.

Creative Director Marcum Group Media Senior Graphic Designer Ajay Resha Photographer Don Jones Senior Writer Laura Avers Web Site Host Jim Bradford Web Site Manager Kim Ronkin Marcum Group Media Eric Marcum

While medicine is certainly capable of repairing the damage from neglect or abuse, there are limits and there probably always will be. Hence, there is a plethora of information that emphasizes education with the goal of creating mindful approaches toward prevention and reduction of overall risks. For those who are downstream, there are wonderful advances in heart treatment, such as the one we feature here this month from our friends at Centura Health’s Colorado Springs Cardiology group in Southern Colorado. Congestive Heart Failure and Women’s Heart Health expert, Kim Dulaney, MD unpacks the newest solutions for CHF in our cover feature this month. We also have several special guest contributors, Mache Siebel, MD, who will discuss the variances in menopause by ages, Dr. Charles Faye from Love & Logic© fame on common parenting issues, and much more. Coming up in the next edition: Chris Harris, Jr., the red-hot Denver Bronco cornerback who is currently the NFL’s statistical leader. Chris talks to Healthy Coloradan’s Kim Ronkin about his life journey from small town Nebraska to the Mile High City and arguably the NFL’s top franchise. Many Bronco fans will know Chris spent most of his off-season working to rehab his ACL and according to him, he is full strength and ready to go!

Editorial Departments Colorado’s Finest Health & Wellness Resources Health Journeys Fun! Food & Nutrition Destination Colorado Colorado Home & Design Wellness

In case you missed it, our interview with Chris Harris on air can be found on Healthy Coloradan’s main Web page – just click the radio icon and look for CHRIS HARRIS. HEALTHY COLORADANS POWERFUL & AFFORDABLE Until next month, MEDIUMS TO SHOWCASE YOUR BUSINESS/PRACTICE info@medicalvoyce.com

Dirk R. Hobbs, ACHE AHCJ Founder & CEO Healthy Coloradan Media Group

[P] 719.884.1184, ext 2 [F] 719.884.1189 [C] 719.330.7448 Web site: http://www.healthycoloradan.com Outreach Platforms: DIGITAL + WEB + WEBTV + RADIO + PRINT Twitter: HealthyColo Facebook: MyHealthyColoradan

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What is Long Term Care Insurance?

or many of you it is an investment your parents purchased 12-18 years ago. They pay for it on an annual basis or quarterly. Here are some terms to help you understand how these policies work and how to use them to your parent’s advantage. Elimination period. Usually 10 days to 100 days. This is like the deductible where you are responsible for paying the full cost until your coverage begins.

Tip: Activate your policy as soon as you qualify

for care. Most families wait too long and do not take advantage of the full benefit of their policy. Maximum daily benefit. Usually 80 – 300 dollars a day. This is the maximum the insurance company will cover for your care. Anything over will have to be paid privately. Most old policies have a 5% inflation rider which can significantly increase the maximum daily benefit.

Tip: Many policies have waiver of premium. This

means once the policy is turned on, the premium goes away and you no longer pay your premium. Maximum lifetime benefit. Usually 2 – 3 years of money. Most policies have a lifetime benefit stated in

dollars or days. There is a big difference. Think of your maximum lifetime benefit as a pool of money to use for your care.

Tip: Find out if your policy has Restoration. This allows the claimant to reuse the policy over and over. How do I activate my policy? Each company has a few different requirements. You need to need help with 2 Activities of Daily Living ( ADL’s) out of six.

The ADL’s are:

1. Help with dressing. 2. Help with transferring, help in and out of a

chair, bed, car, etc.

3. Help with feeding; not used very often 4. Help with toileting; help to get to the toilet. 5. Continence. This is for folks that use Depends. 6. Help with bathing.Some policies do not

cover this.

Tip: Once a person needs help with the above

ADL’s the care giver can do light housekeeping, cooking, laundry, etc. The key is turning on the policy. Too many people pay for long term care insurance their whole lives and never use one dollar. MAY 2015

More Inexpensive Date Night Ideas for Couples Dating as a married couple is essential for breaking the monotony of everyday life. A couple may have good intentions, but they quickly get put off to some future time, when life is not so busy or there’s more money. Pretty soon the kids are grown and couples find they’ve grown apart. Make a commitment to a weekly date. It doesn’t have to always be on the same night, but it’s helpful to pencil in one night each week on your calendars; you can always change the night if a conflict comes up. Below are some ideas that go beyond the usual dinner and a movie. Many involve little or no cost. Not all dates have to involve going out, but if you have young children, getting a break from the kids is a stress release in itself. Getting a babysitter, however, can be a burden. Alternate who gets the sitter and develop a pool of sitters.

NO-COST IDEAS If you’re the responsible, conscientious type, do something together that’s wacky but legal. If you’re already the risk-taking type, do something responsible, for example, pick up litter around a park or volunteer at a soup kitchen together. Colorado’s clear nights make this an easy one! Try stargazing in your own back yard or out in the country. Just bring a blanket and gaze upwards together. If you’re the scientific type, you might get a star map and try to identify constellations. Add wine and music if you’re inclined… Go to a public place and people watch. Make up stories about the people who pass you, as if you’re writing a novel. If you see someone who looks sad or distressed say a prayer or lend a hand. Each spouse privately creates a funny costume from what you have around the house. Put items together in weird or scary ways. Then come together and reveal.

Garden together: Spruce up your curb appeal with some new plants and landscaping effects. Share the less fun projects like weeding and take just a small portion of the yard at a time. This should not be a big day-long job. Find an empty, open church. Sit, kneel, explore, pray. Let peace and reverence seep into your being. Quietly pray for each other. If you like, discuss your deepest spiritual beliefs afterwards. Be a Servant for the night: Pick a night to “wait” on your spouse. You get the drinks, the snacks, his/her slippers, favorite game, etc. You can even dramatize your role as servant. Just make sure that you alternate the favor sometime soon. Commit to a “tech free” night. Turn off your cell phones, computer, the TV, and the lights. Use your imagination to see what’s left to do without electricity.

A FEW BUCKS Go to an amusement park or arcade. It doesn’t have to be one of those fancy, expensive parks. Go without the kids and BE kids again. Do those silly arcade games like skeet ball or whack-a-mole. Impress your spouse with your strength or cunning…or laugh at your ineptitude. Play a game from your childhood – croquet, badminton, hide and seek, miniature golf. Reminisce and be playful together. Be A Tourist in Your Home Town. Look around your city and do the things a tourist might do – go to an overlook, a quaint neighborhood, the botanical gardens, a museum, whatever is special about your hometown. Gawk if you like, after all you’re a tourist. Build something together – ice cream sundaes, a pizza with your favorite toppings, a tower of blocks. Perhaps you will find a chuckle over the odd or weird

combinations that reflect your different approaches to food, building, and life. Plan a “Favorites Night” around your favorite food, clothes, games, sports, etc. Each spouse could choose a favorite activity, which you then combine into one evening, or the wife could propose her favorite activities for one date and the husband plans the next date with his favorites. Visit a pet store together. This is usually good for stirring up warm fuzzy feelings. Restrain yourself from buying, however, unless you’re really ready for a new family member. Talk about any pets you had as a child. Glow bowling - It’s more than just bowling. Some places have special music, lighting, and gimmicks. Even without these, it can be a ball of fun if you don’t take it too seriously. Look through old photo albums and tell each other stories of your childhood and families. If you feel really energetic, make it a time to put all those loose photos in albums or on a disc. It’s a big job but your children will appreciate it one day. Hang out at a bookstore. Browse through your favorite sections. Many bookstores have cozy reading spots or a café connected with them. Assume an erudite persona for an evening. Do something to nurture your spiritual life. Go to a church service and spend an hour in silence. Share your reflections afterwards. Visit on of Colorado’s amazing zoos. Spring is often an especially engaging time since you’re likely to see some endearing zoo babies and glorious flowers. Volunteer somewhere together: A nursing home, a soup kitchen, clean up litter from a park or along your street. Don’t wait for Christmas or Thanksgiving – keep those less fortunate in mind throughout the year. The bonding time you’ll spend is super-natural.

WHY DON’T WE JUST TAKE IT OUTSIDE?! Water and moonlight can be romantic. Is there a lake, a river, a fountain near your home? Take a walk along a body of water at night. Pause and gaze at the light shimmering on the water. Dream and imagine together and don’t think of reasons

why a dream cannot come true, rather how it might! Do something silly that reminds you of your childhood. Climb a tree together, catch lightning bugs, or feed some ducks. Try an old fashioned picnic in a secluded spot. Lay out a tablecloth, some snacks or a meal. Some wine might be a nice touch. Perhaps read some romantic poetry to each other. It need not be original, just something you took the effort to find. Take an early morning or evening bike ride together. Explore your neighborhood or the countryside. Stop at a quaint café for breakfast or get an ice cream cone or other treat along the way. In fact stop whenever you feel the urge. It’s not a race, just a time to discover together. If tent camping is a new experience for you, try it - you might like it. Borrow a tent, sleeping bags, and some advice from a veteran camper and spend a night in the woods – or at least a backyard. Snuggle, tell ghost stories, and roast marshmallows.

HOME BODIES Curl up for an evening of reading. Find a book you both enjoy and take turns reading to each other, or each of you can read your own book in each other’s company. For fun you might want to randomly read a sentence from each of your respective books and see what bizarre combinations this makes. During a cool night, make some light together. Build a fire in the fireplace. Don’t have a fireplace? Light a whole bunch of candles in a grouping,and lay out a blanket and have an indoor picnic – or at least some popcorn.

Causes of Low Sperm Count By Christopher Jacoby

Quite often the cause of infertility in couples doesn’t rest with the woman but in the fact that a male has, for some reason, low sperm count. There are a number of factors which could contribute to the problem, some of which may be temporary while others may be permanent. If you have been trying to conceive without success, then it is a simple matter of testing your sperm count to see if there is a problem. Once you have determined that you do, indeed, have low sperm count you can then begin to think about whether or not there are any viable solutions.

Checking Sperm Count at Home In recent years there have been a number of at-home OTC products developed that can be used to check your sperm count. These tests can be up to 97% accurate and are surely a whole lot less expensive than undergoing diagnostics at a fertility clinic. Actually, at-home fertility tests for men are preferred by a good number of them as they are not at all comfortable going to the clinic under the scrutiny of anyone who might be there as well. (Of course it never crosses their minds that those other guys are there for the very same reason!)

Temporary Causes of Low Sperm Count Sometimes low sperm count can be the result of temporary changes in lifestyle. For example, emotional stress is known to interfere with hormones necessary for maintaining adequate levels of sperm in the semen. Although rare, sometimes ‘technique’ will affect sperm count as would a number of other sexual issues such as any number of venereal diseases. Sometimes psychological problems as well as issues with a relationship can reduce the level of sperm in a male’s semen, but this can also be indicative of the underlying stress which inhibits the production of necessary hormones. Other factors contributing to low sperm count could include:

• Substance abuse • Over heated testicles • Cycling

• Smoking •Nutritional deficiencies • Obesity

While each of these contributory factors can be temporary, some of them may lead to permanent infertility if not caught early on. For example, men who are into bicycling and ride for extended periods just might damage the nerves and small blood vessels that provide erections. Substance abuse and smoking can also lead to permanently reduced sperm counts because of extended periods of toxicity.

MAY 2015

Permanent Causes of Low Sperm Count Most often permanent causes of low sperm count are caused by genetics. Three of the most common conditions which genetically effect sperm count are cystic fibrosis, Klinefelter syndrome and Kartagener syndrome. Sometimes environmental contaminants can lead to permanently low sperm counts such as radiation poisoning, pesticides, fertilizers, heavy metals and even certain hydrocarbons. Getting to the root of these problems would necessitate undergoing very rigid diagnostic tests which may or may not be conclusive. There are times when an obstruction is causing the movement of sperm cells which can be corrected surgically, while other times there is no way to correct the problem as would be the case in Klinefelter syndrome where the male has one too many X chromosomes or in Kartagener syndrome where the organs are found in reversed position.

What to Do When Test Results Indicate Low Sperm Count If you have taken an at-home male fertility test and find that your sperm count is low, the best advice is to consider any of the above temporary causes of low sperm count to see if perhaps an alteration in your lifestyle will correct the problem. Many times adding antioxidants to your daily regimen can help cleanse toxins which interfere with sperm movement. A good vitamin and mineral supplement might be called for as well as increasing natural anti-inflammatories such as garlic. After a period of 2 to 4 weeks, try administering a second at-home male fertility test. If the results still show a low sperm count you should seek medical counsel to get to the root of the problem. Sometimes the ultimate causes of low sperm count can be reversed through medical intervention. If the count is low due to poor mobility, there are ways to harvest sperm cells to artificially inseminate your partner if you are trying to conceive. Unfortunately, many men are reluctant to undergo complete diagnostics when suddenly faced with the fact that they are suffering from low sperm count. There really is no social stigma to the problem and medical science has come a long way in this regard. It is possible to find OTC test kits online which can be shipped discreetly if you are concerned about your privacy. However, if in the end these tests are conclusive that your sperm count is low, you may have no alternative than to seek professional diagnostics to find the ultimate causes of low sperm count.

Presenting, Healthy Coloradan’s 2015 “Colorado Sports Leaders” Program Throughout 2015, Healthy Coloradan Media Group will be showcasing one of Colorado’s top sports leaders. Coaches, owners, Olympians, professionals, amateur and collegiate athletes, and more will grace our digital and print properties. We are offering one company the opportunity to sponsor the stories of these inspirational leaders in sport. This season, position your organization as the “Presenting Sponsor” of Colorado Sports Leaders 2015 in Healthy Coloradan! With your sponsorship of a 2page spread on the featured individual or team, you’ll also receive a full page, color display ad showcasing your company, a Web ad and commercial on HCTV. Plus, you’ll be reaching more than 240,000 people who are interested readers and viewers of this amazing Colorado lifestyle medium. Contact us today to begin aligning your organization with Colorado’s top sports minds and figures! First several features: Troy Calhoun, Head Football Coach, US Air Force Academy and Chris Harris, Jr. – Denver Bronco’s #1 rated Cornerback.

Call Trey Davison: 720.739.0825 or Trey.Davison@HealthyColoradan.com

just can’t do what I used to do.

By Chris Valentine, Penrose-St. Francis Health Services Colorado Springs, Colorado

Kim Dulaney, MD, FACC Areas of Specialization: General Cardiology, Congestive Heart Failure and Women’s Health Undergraduate: Swarthmore College, Swarthmore, Pennsylvania Medical School: Jefferson Medical College, Philadelphia, Pa., earned Doctor of Medicine Internship: Thomas Jefferson University Hospital, Philadelphia, Pennsylvania Residency: Thomas Jefferson University Hospital, Philadelphia, Pennsylvania Fellowship: University of North Carolina at Chapel Hill, earned FACC: Fellowship of the American College of Cardiology Board Certifications • American Board of Internal Medicine • American Board of Internal MedicineCardiovascular Disease • Certification Broad of Nuclear Cardiology Professional Association Affiliations: • American Heart Association of Southern Colorado • American College of Cardiology, Colorado Chapter Personal: In my spare time I love to spend time with family and friends, watch my kids play sports, participate in skiing, running, triathlons, hiking, cycling, and travel.

As we age, we get to the point where we “just can’t do what we used to do.” We may not be able to walk as far as we used to, or we may get tired sooner doing the things we have always done and taken for granted. Most of us chalk that up to just getting older. But often, this is the first sign of a more serious problem such as Congestive Heart Failure, also known as CHF. Dr. Kimberly Dulaney, a cardiologist with Colorado Springs Cardiology, said she remembers one patient very well. “He was actually one of my favorite patients,” said Dr. Dulaney. “After this gentleman was diagnosed with CHF, he was in and out of the hospital a number of times as we worked to stabilize his heart,” said Dr. Dulaney. “He had an internal defibrillator placed and his CHF was stabilized with medications. Then, for various reasons, he stopped coming in to see me for a while. I didn’t see him for nine months. The next time I saw him, he was in the hospital after he went into cardiac arrest and almost died. Luckily, the defibrillator, a small device that shocks the heart, which we had placed in his chest actually saved his life.” So what is CHF? Dr. Dulaney said that it is simply explained as a weak heart. There are a variety of factors that can cause CHF, including coronary disease where plaque builds up in the arteries that feed your heart, having a history of a heart attack where the heart muscle was damaged or having high blood pressure. These are the most common causes but there are several others. “Usually the first thing a person will notice is they have a decreased exercise tolerance,” said Dr. Dulaney. “They just get tired sooner than they used to. People may also feel short of breath, notice swelling in their legs and possibly even have chest pain. If you have any of these symptoms, you should visit your doctor right away and discuss these symptoms.

“As his CHF progressed, my patient couldn’t even walk across the room,” said Dr. Dulaney. “He actually spent a month in the hospital and we eventually transferred him to University of Colorado Hospital in Denver where he received a Left Ventricular Assist Device, or LVAD.” When a person is suspected of having CHF, usually the first test is an echocardiogram. “This ultrasound image of the heart helps us determine the underlying cause,” said Dr. Dulaney. “It helps us see how much damage there is to the heart and if it is secondary to valve disease. Then we do either a stress test or cardiac catheterization to determine if there is any coronary artery disease.” A heart catheterization is sometimes needed to actually see the arteries in the heart and look for any blockage. If the heart catheterization and stress test are normal, then medication is used to improve heart function. When you have damage to your heart, she added, your heart starts to remodel or further injure itself. Medications bond to the cell receptors and help the heart to mend so that this reverse remodeling doesn’t happen. “In some cases, we may need to implant a special kind of pacemaker to assist the heart in beating, implant a Left Ventricular Assist Device (LVAD) or, in some severe cases, recommend a heart transplant,” said Dr. Dulaney.

Kim Dulaney, MD, FACC – Colorado Springs Cardiology A Centura Health Clinic

Photo by Don Jones

“The patient I described had a LVAD implanted at University of Colorado Hospital as it is the only hospital in the region that can perform this procedure,” said Dr. Dulaney. “A left ventricular assist device is implanted in the chest cavity. It helps pump blood from the left ventricle of your heart and on to the rest of your body. This is a unique device with a control unit and battery pack that is worn outside your body and connected to the LVAD through a drive line in your skin. After the LVAD was implanted, this patient was able to return home to Colorado Springs where I can help manage this device and continue his care. “It has been more than a year and this patient is doing great,” said Dr. Dulaney. “Where he used to not even be able to walk across the room, he now walks laps around the lake in Memorial Park. He leads a full life with the help of this little pump.”

“The one thing to remember is that treatment of CHF is more than just seeing your cardiologist,” said Dr. Dulaney. “In a heart failure clinic, you can meet with other specialists as well. Talking to a pharmacist is important to ensure your medications are right for you and that there are no negative interactions. Nutrition is also a critical part of dealing with heart disease and a nutritionist or registered dietitian can help work through this with you. For example, when your doctor tells you to limit your salt intake, there is a lot more to that than just cutting back on the salt shaker.” So if you just can’t seem to do the things you used to do, you can’t breath as well as you used to, your legs are swelling or you are experiencing chest pain, talk to your doctor immediately about these symptoms. You could be experiencing the early signs of CHF. There are many treatment options available and they can be managed much easier and more effectively the sooner they are diagnosed. If treated quickly, you can live a full life and do all of the things you want to do, even with a diagnosis of congestive heart failure.

Example of a Left Ventricular Assist Device (LVAD) Reprinted with the permission of Thoratec Corporation.

About Colorado Springs Cardiologists, P.C. Medical Practice Affiliation: Colorado Springs Cardiologists, P.C. Main number: 719.776.8500 Web site: http://www.cscardiologists.com Medical Practice Profile: Since 1974, Colorado Springs Cardiologists, P.C. has served the cardiac needs of Colorado Springs and neighboring communities by providing state-of-the-art care and services. Starting from just three physicians, the practice has grown to fourteen board certified and fellowship- trained physicians and four mid-level providers. All of whom are dedicated to the prevention and treatment of coronary disease. In the summer of 2011, our practice began a long-term alignment with Penrose-St. Francis Health Services, giving you access to all the care and resources the Centura Health System can provide. MAY 2015

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Financial Wellness Home Budgeting for the Beginner You have the option to save your budget planner results and return to update them at any time. Alternatively you can set a budget up using a spreadsheet on your computer or just write it all down on a piece of paper. Your bank or building society may also give you access to an online budgeting tool, which takes information directly from your transactions.

Checking where your money goes

Set up a budget

f you want to get on top of your finances, a budget is a really good way to start. It’s just a record of money you have coming in (from things like your salary or wages, pensions or benefits) and payments that you make (such as your rent or mortgage, insurance and Council Tax as well as living expenses and regular and irregular spending). A great way to work out your budget is with our online budget planner. This allows you to record all of your incomings and outgoings. It then analyses and adds up your figures and gives a breakdown of where your spending goes each month across the following broad categories:

• Household bills • Living costs • Financial products • Family and friends • Travel • Leisure 20

f you’re spending more each month than you are getting as income, the next step is to look more closely at where your money is going and where you can cut back. Even small amounts – for things such as magazines, sandwiches at lunchtime or takeaways – can add up.

Keep a spending diary

eeping a spending diary is an effective way of seeing exactly what you spend your money on. Try making a note of what you spend for at least a month (including even small purchases). If you can do it for even longer, you’ll get a fuller picture of what you spend your money on. Once you have a clear picture of where your spending is going use our tips and tools below to see how you can make savings. Our cut-back calculator will quickly show you how small changes to your day-to-day spending can save you money in the long run. Our ‘Money saving tips’ section has ideas to help you save on utilities, phone bills, travel, shopping and more.

MAY 2015

Paying off loans credit cards

and

f you have loans or owe money on credit cards it usually makes sense to pay off the debt that charges the highest rate of interest first – it’s the fastest way to clear your debts. Knowing this is useful if you have several different debts charging different rates of interest, such as:

• Store cards, which normally charge the highest rates of interest • Credit cards • Personal loans from the bank,

which normally charge a lower rate of interest than credit or store cards It is important to make sure you don’t break the terms of any of your agreements. So even if you’re focusing on paying down another debt, you must pay at least the minimum on any credit cards and your monthly-required payments on any loan agreements.

If you’re overwhelmed by your debts

ften, the hardest part of paying off your debts is taking the first step. It’s easy to feel overwhelmed if you know you’re struggling financially. It’s tempting to bury your head in the sand and ignore your bank statements and demands for payment, but it won’t make the problem any better and could make it worse. So, take a deep breath and open any letters you’ve been ignoring. Once you’ve done this, at least you’ll know what you have to deal with and you can work out what you need to do next.

Getting help if debt problems become serious

f you’ve already missed credit card or loan payments or if you’re behind with so-called ‘priority debts’ such as your rent or mortgage, energy bills, Council Tax, child support or court fines, take advice from a debt advice charity straight away.

Set a savings goal

Your first step is to have some emergency savings – money to fall back on if you have an emergency, such as a heating boiler breakdown or if you couldn’t work for a while. Try and get three months’ worth of expenses in an easy or instant access account. Don’t worry if you can’t save this straight away, but keep it as a target to aim for. Once you’ve set aside your emergency fund, possible savings goals to consider might include:

Some people find it hard to • Taking a holiday without having

get motivated about saving, but it’s often much easier if you set a goal. That way, rather than thinking about the money you are setting aside each month, you can focus on what you will be able to do once you’ve reached your goal.

to worry about the bills when you get back Having some extra money to draw on while you’re on maternity or paternity leave Buying a car without taking out a loan

• •

MAY 2015

Save regularly

he easiest way to save is to pay some money into a savings account every month. It’s worth setting up a standing order if you can, so the money goes straight from your bank account without you having to do anything. It’s a good idea to:

• Pay the money into your savings

account as soon as you get paid, rather than at the end of the month Increase the amount you save if you get a pay rise or any of your outgoings (such as your mortgage or insurance costs) fall Check that you are getting a competitive rate of return on your savings

• •

The Link Between Stress and Grey Hair By Susan Knowloton If you watch the career of any politician then you will notice a curious thing happen to them over the course of their time in office – their hair starts to turn gray. Politicians aren’t the only people who experience this either – and it seems that any position of stress and worry can cause our hairs to rapidly turn silver (if we don’t pull them out first) and there is enough anecdotal evidence of this that most of us assume there is indeed a scientific link between stress and gray hair. But is this the case?

The Science of Gray Hair Interestingly, while there are plenty of examples out there of stress turning people gray, there is as yet no actual scientific evidence. Here’s what we know so far: For men, usually the first gray hair arrives at around the age of 30, but for women it’s 35. This varies greatly however and in some cases can start before a teenager has left high school or conversely much later. Before you see the graying hair it will begin within the sunken pits of the scalp where the hairs grow called ‘follicles’. Each of us has around 100,000 follicles and each is capable of sprouting several hairs in their lifetime. At the bottom is a collection of cells responsible for assembling the hairs and these include keratinocytes (epidermal cells) which stack on top of each other and they die leaving behind keratin which gives our hair its strength and texture. Keratin is also key in our nails as well as in the hooves, claws and horns of animals. Meanwhile while all this is going on, nearby cells called melanocytes create pigment called melanin – the same substance that gives our eyes color and which give us our tans (an albino is someone born with no melanin). Hair melanin is either ‘eumelanin’ (brown or black) or ‘pheomelanin’ (yellow) and the various shades and hues of human hair come from differing balances of these substances. At any point 80-90% of a person’s hair is in the active growth stage which lasts around two to seven years before the hair falls out due to the apoptosis (cell death) of the keratinocytes and the melanocytes. Now the head will want to begin building new hair and that’s when the cells need to start building again. New keratinocytes and melanocytes are created from satellite stem cells that exist at the bottom of the follicle and the process begins anew. The key point here is that keratinocytes have more longevity than melanocytes – and you basically ‘run out’ of melanocyte stem cells first resulting in gray hairs sprouting due to keratin with a lack of melanin.

How Stress Could Intervene While there is as yet no complete theory and no clear link for how stress could lead to gray hair, it would have to occur through the depletion of the melanocyte store in the follicles. One possible theory that has been postulated is that stress leads to an increase in free radicals through reduced immune system function. However this seems somewhat unlikely as otherwise other causes of reduced immune function would also be linked to graying hair (which they are not). Another possibility is that stress hormones intercept the signals that instruct the melanocytes to deliver melanin to the keratinocytes. This seems like a more likely theory and is backed up evidence showing that local expression of stress hormones can indeed mediate these signals. Some longitudinal studies have also seemed to suggest that this is the case, with people who reported being stressed for 2-3 years also reporting going gray earlier in their lives. Meanwhile in very rare cases it is possible to lose the color in your hair as a result of illness. For instance in the very rare autoimmune disease ‘alopecia areata’, the immune system attacks pigmented hairs causing them to fall out and leaving behind only white hairs. This could well have been what caused Marie Antoinette’s hair to turn white the night before she was guillotined as according to legend.

Confounding Factors While it is possible then that stress might reduce the effectiveness of the melanocytes, there are many other factors that contribute to the age at which we go gray. Hair color, gender and genetics for instance would all have an effect and it’s more likely that the environmental factor of stress would have a bigger impact on those who were already genetically predisposed to gray hair. Even then, for this to have an effect it would take several years before it started to take effect – at least until the death of their current colored hair. In conclusion then there is no simple or clear connection between stress and gray hair, and there are many factors that play a role. However a small amount of scientific evidence, along with a wealth of anecdotal evidence, seems to suggest that stress can indeed hasten the graying process. So that’s one more reason to go on holiday this year...

MAY 2015

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Interesting Facts About . . . The Human Heart

1. The average adult heart beats 72 times a minute; 100,000 times a day; 3,600,000 times a year; and 2.5 billion times during a lifetime.

2. Though weighing only 11 ounces on average, a healthy heart pumps 2,000 gallons of blood through 60,000 miles of blood vessels each day.

3. A kitchen faucet would need to be turned on all the way for at least 45 years to equal the amount of blood pumped by the heart in an average lifetime.

4. The volume of blood pumped by the heart can vary over a wide range, from five to 30 liters per minute.

5. Every day, the heart creates enough energy to drive a truck 20 miles. In a lifetime, that is equivalent to driving to the moon and back.

6. Because the heart has its own electrical impulse, it can

continue to beat even when separated from the body, as long as it has an adequate supply of oxygen.

7. The fetal heart rate is approximately twice as fast as an

adult’s, at about 150 beats per minute. By the time a fetus is 12 weeks old, its heart pumps an amazing 60 pints of blood a day.

8. The heart pumps blood to almost all of the body’s 75 trillion cells. Only the corneas receive no blood supply.

A healthy heart pumps approximately 2,000 gallons of blood a day

9. During an average lifetime, the heart will pump nearly 1.5 million barrels of blood—enough to fill 200 train tank cars.

10. Five percent of blood supplies the heart, 15-20% goes to the brain and central nervous system, and 22% goes to the kidneys.

11. The “thump-thump” of a heartbeat is the sound made by the four valves of the heart closing.

12. The heart does the most physical work of any muscle

during a lifetime. The power output of the heart ranges from 1-5 watts. While the quadriceps can produce 100 watts for a few minutes, an output of one watt for 80 years is equal to 2.5 gigajoules.

13. The heart begins beating at four weeks after conception and does not stop until death.

14. A newborn baby has about one cup of blood in circulation.

An adult human has about four to five quarts which the heart pumps to all the tissues and to and from the lungs in about one minute while beating 75 times.

MAY 2015

source of heat, a type of “lamp” fueled by blood from the liver and fanned into spirituous flame by air from the lungs. The brain merely served to cool the blood.

25. In 1929, German surgeon Werner Forssmann (1904-

1979) examined the inside of his own heart by threading a catheter into his arm vein and pushing it 20 inches and into his heart, inventing cardiac catheterization, a now common procedure.

26. On December 3, 1967, Dr. Christiaan Barnard

(1922-2001) of South Africa transplanted a human heart into the body of Louis Washansky. Although the recipient lived only 18 days, it is considered the first successful heart transplant.

27. “Atrium” is Latin for “entrance hall,” and “ventricle” is Latin for “little belly.”

15. The heart pumps oxygenated blood through the aorta (the

28. A woman’s heart typically beats faster than a man’s. The heart of an average man beats approximately 70 times a minute, whereas the average woman has a heart rate of 78 beats per minute.

16. Early Egyptians believed that the heart and other major

29. Blood is actually a tissue. When the body is at rest, it takes only six seconds for the blood to go from the heart to the lungs and back, only eight seconds for it to go the brain and back, and only 16 seconds for it to reach the toes and travel all the way back to the heart.

largest artery) at about 1 mile (1.6 km) per hour. By the time blood reaches the capillaries, it is moving at around 43 inches (109 cm) per hour. organs had wills of their own and would move around inside the body.

17. An anonymous contributor to the Hippocratic Collection

(or Canon) believed vessel valves kept impurities out of the heart, since the intelligence of man was believed to lie in the left cavity.

18. Plato theorized that reasoning originated with the brain, but that passions originated in the “fiery” heart.

19. The term “heartfelt” originated from Aristotle’s philosophy that the heart collected sensory input from the peripheral organs through the blood vessels. It was from those perceptions that thought and emotions arose.

20. Prolonged lack of sleep can cause irregular jumping heartbeats called premature ventricular contractions (PVCs). 21. Some heavy snorers may have a condition called obtrusive sleep apnea (OSA), which can negatively affect the heart.

22. Cocaine affects the heart’s electrical activity and causes spasm of the arteries, which can lead to a heart attack or stroke, even in healthy people.

23. Galen of Pergamum, a prominent surgeon to Roman gladiators, demonstrated that blood, not air, filled arteries, as Hippocrates had concluded. However, he also believed that the heart acted as a low-temperature oven to keep the blood warm and that blood trickled from one side of the heart to the other through tiny holes in the heart.

24. Galen agreed with Aristotle that the heart was the body’s

30. French physician Rene Laennec (1781-1826) invented

the stethoscope when he felt it was inappropriate to place his ear on his large-buxomed female patients’ chests.

31. Physician Erasistratus of Chios (304-250 B.C.) was the first to discover that the heart functioned as a natural pump.

32. In his text De Humani Corporis Fabrica Libri Septem,

the father of modern anatomy, Andreas Vesalius (1514-1564), argued that the blood seeped from one ventricle to another through mysterious pores.

33.

Galen argued that the heart constantly produced blood. However, William Harvey’s (1578-1657) discovery of the circulation system in 1616 revealed that there was a finite amount of blood in the body and that it circulated in one direction.

34. The right atrium holds about 3.5 tablespoons of blood.

The right ventricle holds slightly more than a quarter cup of blood. The left atrium holds the same amount of blood as the right, but its walls are three times thicker.

35. Grab a tennis ball and squeeze it tightly: that’s how hard the beating heart works to pump blood.

36. In 1903, physiologist Willem Einthoven (1860-1927) invented the electrocardiograph, which measures electric current in the heart.

MAY 2015

Some Basic Lifehacks for Happiness By Adam Siniki

Put Pictures in Drawers Pictures of our friends and loved ones are intended to make us happier every time we look at them and if they remind us of a good time then that’s precisely what they’ll accomplish. Unfortunately though, standing pictures on a dresser won’t always have the desired effect because of our tendency to not look at them. In no time at all we can forget to look at pictures we’ve had for a long time and so they fail to have the impact they should. A great way to solve this problem is to opt to keep pictures in drawers rather than standing on your surfaces – in your underwear drawer or cutlery drawer for instance. Now every time you go to find something from that drawer you will see the picture and be reminded of the memories it represents!

Hide Money in an Old Wallet Have you ever found money in an old wallet in your drawer and then been delighted with the discovery? It might only be a tenner, but it still feels like a great opportunity to treat yourself and is a nice little bit of sunshine on a rainy day. In that case then, why not create this scenario artificially? All you need to do is to find an old wallet, deliberately stash a tenner in it and then hide it somewhere where you’re not going to look for a while. Future happiness guaranteed!

ifehacks aim to make life that little bit better and that little bit easier by providing us with quick tricks we can use to get more done more quickly. These can help us to cook healthier meals without slaving us over the stove, to save time when doing household chores, or to use our old belongings in creative ways around the house. But really what makes life great is happiness and our sense of wellbeing. Can that be hacked? Can you use simple tricks to improve your mood throughout the day and thus make life better with a few simple hacks? It’s not always that simple and in some cases you’ll find you need something a little bit more thorough than a hack to get life back on track. But if you want to do a few things that will help make life just that little bit better with no extra work… then hacks may just be able to help. Here are some great tricks you can use.

MAY 2015

Offer to Reimburse Your Friend/ Partner When They Lose Money While finding a tenner can be a great moment, losing as much can put a real downer on your day – whether it’s because you were over-charged at the shops or you just physically lost the money on a blustery day. To avoid future disappointment then, make a pact with a friend or partner to reimburse one another whenever one of you loses any money of a small amount. You’ll be near-enough even in the grand scheme of things, but each time you get the money back it will prevent you from feeling like life is out to get you.

Massage Days If you are in a relationship then another pact you can make is to exchange

massages and other treats with one another once a month. It’s very rare to ever feel like you’re truly being indulged, so it’s a great feeling to know you have an entire day of guilt-free massage. And this day can include other little treats as well, such as small gifts, getting cooked for etc. Then you’ll have something to look forward to for the rest of the month.

that time somewhere beautiful like an attractive park. Simply being around fauna has been shown to reduce levels of the stress hormone cortisol and having plants in your house can actually have a similar effect! For those without access to sunlight on demand, a good alternative is to use a ‘daylight’ lamp, which is a light that gives off a similar wavelength of light as the sun.

Spend Your Birthday Money on Activities Do Something Enjoyable Every Day With Friends Can you buy happiness? Not according to the old adage but it seems that research has something else to say on the matter. It turns out that spending money can bring you happiness but only if you spend it on either activities (like a holiday or bungee jumping) or if you spend it on spending time with friends. The best solution then? Spend your disposable income on doing fun things with friends. Life will have more colour and you’ll forge stronger friendships.

Sometimes life can feel like an endless slog of work, tidying, cooking and going to bed to start the process again. This is no way to live, so it’s important that you do at least one thing that you genuinely enjoy every day. For me that’s playing a game of Sonic the Hedgehog, reading a comic or eating a bowl of my favorite cereal ‘Lucky Charms’. None of these things needs to take more than 10 minutes, but they give me something to look forward to every single day.

Hugs

Be Grateful

Hugging is a great way to improve your mood and studies show that it can help to stimulate the production of multiple happiness hormones and even to improve immune function! Other things that can give you a quick jolt of happiness hormones include bananas and exercise. Sex will do it too FYI.

A lot of our mood is about what we focus on – and unfortunately we have a tendency to focus on the things we don’t have or aren’t happy with while forgetting the things we’re pleased about that we come to take for granted. To stop this trend it’s time to start being grateful for the things that are going well in your life and to literally count your blessings. A great habit to get into is to once a day list all of the things you’re happy about, grateful for and proud of. Another great list to make is all the things you have to look forward to. That could focus on things like upcoming activities, it could mean developments in science and technology, or it could mean more mundane things like ‘dinner’ or ‘the next issue of Amazing Spider-Man’. Most of us have plenty of things to be excited about and remembering these can help to make life exciting and colorful again.

Sunlight and Plants SAD stands for ‘Seasonal Affective Disorder’ and is a condition in which we feel depressed or low on energy during the winter months. This is partly because we aren’t spending enough time outside meaning we aren’t getting enough natural sunlight or fresh air. Simply spending more time outside then can improve your mood to no end – and especially if you spend

MAY 2015

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Keeping your Health-Related New Year’s Resolution By Melaina Bjorklund, MS, RD Clinical Dietitian, Penrose-St. Francis Health Services

With the start of a new year, people everywhere vow to adopt healthier habits. A lifestyle change, rather than a “diet,” will help with long-term success in keeping your resolutions on health and fitness. Here are some tips to help you take control of your health. Set realistic goals. Realize which goals are attainable for your personal journey. Take into consideration physical, mental, and emotional health when considering your targets. Don’t skip breakfast, or any other meal. Eat 5-6 smaller, more frequent meals throughout the day. This will help keep your energy and metabolism up, while maintaining healthy blood sugar levels. Get 30 minutes of activity each day. Whether you are walking, climbing stairs, or engaging in group fitness, find enjoyable ways to elevate your heart rate at least 10 minutes at a time, for a total of 30 minutes per day. Prepare your food on the weekend. Planning and preparing your food ahead of time can help decrease stress surrounding food choices, and ensure you will have healthy and portable meal and snack options. Bring snacks to work. Stave off mid-afternoon boredom hunger by bringing healthy, filling snacks to work. Pair a complex carbohydrate with proteins to help keep you fuller, longer. Balance your plate. Healthy lifestyle choices should never be about depriving yourself or cutting food groups out of your diet. Keep a balanced plate with fruits, vegetables, complex carbohydrates, lean proteins, and dairy. Figure out your “why?” We are all motivated by different things. Identify why you have decided to embark on the journey to better health and let that continue to serve as your inspiration. With these tips, when the next year arrives, your resolutions can focus on maintaining your health, rather than starting all over again. MAY 2015

A Colorado Springs Orthopedic Group Moves to Bundled Payment Care Improvement Performance Accountability Leads to Better Coordination of Care and Higher Quality for Patients

…This is going to be almost a full 24/7 suite of services that you will have access to answers through-out the entire process. Kyle W. D. Nelson, MBA is the Chief Executive Officer of the largest orthopaedics group in Southern Colorado overseeing the organization’s 23 highly trained orthopaedic surgeons who collectively with apatient support staff of well over 100, address the full spectrum of orthopaedic services, ranging from general orthopaedics to sports medicine to total joint, and much more. In this candid interview, Kyle sat down with Healthy Coloradan and unpacked how the Bundled Payment Care Improvement initiative or BPMI will play out quantitatively and qualitatively as it relates specifically to patient care. Today, Colorado Springs Orthopaedic Group is the only BPMI qualified orthopaedics practice in Southern Colorado – a distinguished program that the Centers for Medicare/Medicaid or CMS allows for only one specialty group in a given medical discipline, in a given geography – in this case, Southern Colorado.

Why did CSOG decide to take up with this new CMS program? First, you have to qualify as an organization with CMS’s criteria, and CSOG did just that. That was an important first hurdle to get through. As importantly, we recognized early on the upside for patients, as it will focus on quality outcomes and keeping with the patient longer, and until they have realized full rehabilitation. Ours is a fully integrated orthopaedics care model and that is unique to Southern Colorado. This model helps contain costs when you have the resources your patients need in one shop. And it helps to further ensure we’re meeting the highest care quality standards, because we don’t just send our patients out into the world looking for services or resources we can perform or deliver for them in our centers.

What is unique that we’ve not seen before in integrated models? One variable is the introduction to each patient with a Care Navigator specific to orthopaedics care and rehabilitation. These individuals are highly trained at how a patient’s care is going to be like from first consult to the end of care in the disciplines of orthopaedics. This is a patient’s ambassador and advocate through the entire process. Of course, this led us to produce a vastly improved online component. Our Web site has been totally revamped to improve the digital interface with our patients. Now patients can ask questions or get advice via this format, rather than waiting on the phone, or waiting for their next appointment.

What does the Digital Interface Look Like? Will there be a computer or online component? There is going to be part of the feedback you are going to provide that is going to be online feed‐back. Where you are going to be sent an email saying please click on this link and give us feedback as to the amount of communications you received, where you are from a pain management stand point; there is going to be a lot of digital interface.

Please explain the greater focus on cost of services for the consumer. When you look at cost in the healthcare system in general, we’ve all heard on the evening news or read in the newspaper where the cost of Medicare is unsustainable.We’ve all heard the numbers of somewhere in the 2020‐2030 range we are going to completely exhaust the revenue needed to sustain Medicare.You look at what we have to deliver today. It is a better product for a better level of service at a reasonable priced product.

MAY 2015

This is an exclusive dynamic for Colorado Springs in this community. Please define the region. Our key demographic of course is the Colorado Springs and El Paso county market but we look at not only those two specific general geographic areas but we do attract patients from all across Southern Colorado. We do have a reach into Northern New Mexico, Western Kansas, Western Slope, Nebraska as well. And we think that as one of the few organizations to take this on, and we are one of only a few groups right now from an orthopedic standpoint nationally that has addressed this issue, we think we are going to be a regional player as well.

Is it an opt–in process for Medicare patients? They’re not going to see any difference what so ever when it comes to the same level of service. We think it’s going to be an improvement and a dramatic increase when it comes to how quickly they can get into the office, how they are going to be charged for visits etc. they are not going to see one difference what so ever. The next closest organization for this bundled payment dynamic is in Denver. This is a win for Southern Colorado for Medicare patients accessing top of the line world class orthopedic care. The way you we qualified for this program, you do need to go through a Medicare review process. Where you look at copious amounts of data to show that you are actually a qualified institution to address this program. So I think it is a testament to our organization and to the people of this community that they are being recognized for innovative health care. This is an outcomes driven methodology; this is a patient centered dynamic. What is that going to mean in terms of quality assurance and changes from the physician standpoint and then a patient standpoint as well? The outcomes component to this whole thing is really the key element to this. If you look at the process before and I can use myself as an example; having my ACL replaced. You go in and have the surgery; you go to rehab; and you are back on your feet eventually. Well there are going to be key metrics associated with this where at certain points through the therapeutic process, the post‐operative period, we are going to want to make sure we meet those goals. We will be able to show reports from historical norms how we have increased the value through the improved outcome. It incentivizes the providers keep their eye on the ball and the whole system works a little tighter a little more integrated fashion. Please explain the integrated model value for the system overall and an individual patient. One of the key components of Colorado Springs Orthopedic Group is that total integrated orthopedic model. We are the only group in Southern Colorado that offers a full line of orthopedic services. We have your traditional clinic visits. We have X‐ray which is a pretty standard service when you think about orthopedics. Where we get into a fully integrated model is we have MRI, we have physical therapy, and we have a wonderful custom built orthotics and prosthetics department. The neat little thing we’ve brought on board here in the last six months is outpatient surgery center, which is in our same building. So we truly are a one‐stop shop when it comes to orthopedic care. That’s where we think we were attractive to a CMS, the community at large and the region as a whole to provide that level of service all in one roof that we can ensure we are providing that quality of care.

Is that the cost containment piece? Absolutely, that is a huge part of it. When we talk about potential savings not only for the insurance carrier‐ in this case Medicare ‐ but on a grander scale the consumer. You look at the consumer being able to say “I can go to one place; find one solution; and have a line of communication across all of those integrated systems that function as one.”

MAY 2015

How many practitioners do you have in your group today? Right now we have 24 Orthopedic Surgeons and we have 13 Physician Assistants.

Do you have the full spectrum of orthopedic care? We have everything from Hand Surgeons, Spine Surgeons, your Sport and your Joint Surgeons. So we cover every sub‐specialty available. When you come in here it is very apparent, it’s very comfortable, it’s very welcoming. The reception office is very down to earth. They look you in the eye, which is important. You don’t feel like you are going to the Post Office to mail a letter. One of the things that we’ve set up when you first walk in here is when you walk off the elevator you are immediately greeted by somebody. If you are then filling out paperwork to be seen in the clinic, we no longer hand you the clip board and say “call us back when you are done with those 40 pages.” We will actually sit down with you and help you through that process.

When can we expect to meet our patient navigator in the process? Is that after or before we see our physician? First line of communication from the Care Navigator is going to be pre‐surgical. They are going to reach out to you, walk you through the steps of that surgical episode from the day before surgery, the day of surgery, and 90 days post‐operative.

They are your best friend through the process. That would be my go‐to person. We all can’t be surgeons. We all can’t be employed by a health care organization. There is some unknown out there and having that navigator I think is a great step in developing improved quality.

Do you anticipate compliance being improved with this patient Navigator? If so, how? I think the compliance component is where Medicare is asking for additional data to show quality. Part of that is going to be to make sure that we are adhering to the program, and making sure that we focus specifically on quality outcomes. So I think outside the level of communication improvement, that compliance is going to be the next piece of that puzzle. You look at what’s going to be expected of us; the compliance component of reporting data back to show the quality. It’s going to be a continuous ongoing daily battle.

This has been an internal construct for you. Do you see this happening across other service lines in the industry for example Gastroenterology, other disciplines? It’s already started. The one that I can specifically tell you that has been active is Cardiology. What I can say from going to talk to Medicare ‐ I’ve been out to Washington DC met with them on numerous occasions and they are really focused on how we can improve this process because this isn’t going to be a stagnant program. This is going to be a process improvement program where we will get through each quarter and step back and say how can we make this better. But talking to folks in Medicare out in Washington DC, they’ve stated that they think that this program is going to take off and they are saying that by 2018, 25% of all episodes of care in Medicare will fall under this program. It’s an interesting concept and it’s very exciting. Help us understand a little bit more about how this program from a localized standpoint and ultimately state, regional and national. Do you have any visions of how much this will actually save in the Medicare Program or is it still an ambiguous figure?

MAY 2015

The Medicare budget is huge. When you talk about it on a national level we are talking about trillions of dollars. But I think from our standpoint on a percentage scale, we believe that under our current Medicare spend we are shooting for a 10% savings on this year alone. Compared to the overall Medicare budget ‐ it’s a drop. But we think if we are doing that and other forward thinking organizations like the other orthopedic groups out there can do 10% this year and 10% the next year; just think of what we can do to make sure that the Medicare system is sustainable. We are now in control when you think about that program. When you think pre‐operatively we are making sure that you are ready to have that procedure done. In the 90 day post‐operative time, we are engaging other partners in the community. We are engaging the hospital. We are engaging the skilled nursing facilities. We are engaging the home health agencies. Where it’s not just a generalized email anymore, we are sitting down with these organizations. Two weeks ago we met with the hospitals and walked through this process and we are doing that monthly and quarterly to make sure this is going to be a benefit long‐term.

Any other issues or pieces you want to discuss? When you make contact with the care navigator pre‐operatively they are going to sit down and walk you through your 90 days. And we will have 24/7 call center access for patients that if you have any questions – even if “my wound site itches,” there is going to be a live person 24/7. This is called your Pre‐Operative Visit. When patients enroll and become a patient of Colorado Springs Orthopedic Group, and an operation is determined at that point we are going to meet somebody in the process that takes care of the Pre‐Operative Visit. Can you explain the extraordinary value proposition in that process? It’s going to be great. You will go through a full analysis not just a physical work up. But we will go through a whole gamut of questions where you’ve probably never heard of them in a health care setting before. One of the neatest questions I think; is something that will sort of take people back a little bit and say, “why are they asking that question?” But one of them is: “do you own a dog?” I think it’s a great question because if you are having a knee replacement or if you are having your hip replaced, “Do you have a dog?” “Sure, I have a dog.” The next follow up question to that is: “Does the dog weigh over 50 pounds?” Because I have a dog that weighs 85 pounds and if I’m leaving the hospital and I’m trying to walk around my house with my new knee and my 85 pound dog is right at that knee high level, we may take a different therapeutic approach to your post‐operative care. That’s where up front it’s a whole new paradigm shift of understanding your needs as the patient.

So you are going to get real specific with us? Absolutely, it is going to be an incredibly in‐depth analysis of who you are up to the point that the Care Navigator may visit your house pre‐operatively to count the number of stairs that are in your home. This is to make sure that before you go home to walk up those stairs you’ve had some stair therapy in a skilled nursing facility or in the hospital. So we want to make sure you are following the care guideline post‐operatively before you even have surgery. Part of those questions would be put forward by CMS but it sounds as though there is some customization that is built in by Colorado Springs Orthopedic Group. Yes we took their guidelines, their compliance program and we expanded it. We want to make sure that we have your care in mind at all times so that when we talk to you during that Pre‐Operative Visit, we’re making sure that you are going to have the quickest possible outcome to get back on your feet and get back to the quality of life that you expect.

MAY 2015

Pros & Cons of Acupressure By Gary Wickman

cupressure is a form of alternative medicine that is based on the Chinese belief in Qi (pronounced, and often spelled, ‘Chi’). This is the universal ‘life force’ that travels around our bodies and that is present in everything. Other forms of healing that are based on this belief are acupuncture and Reiki. According to these practices, we all have Qi flowing through our bodies through ‘chakra’, and most of our ailments are caused by this flow being disrupted or blocked, or by a buildup of ‘bad Qi’. By applying pressure on certain areas – the ‘acupuncture points’ situated along the meridians, acupressure aims to free up the flow of Qi so that it moves more healthily around the body and so that it can promote self healing. This is a holistic view of human health and it is believed that problems around the 12 major meridians (corresponding with the major organs) can account for all manner of different problems. Of course the idea that you can heal all manner of ailments from aching joints, to stomach problems to addictions by merely attending a pleasant massage-type session is a highly appealing concept. However the existence of Qi and the meridians is not supported by scientific evidence and as such it remains a controversial subject and firmly an ‘alternative medicine’. Despite there being no scientific basis for the process however, many subjects do report improved health and comfort following the procedures. So the question is, does it work? And do the pros outweigh the cons? Here we will have a look at the pros and cons of acupressure and this will hopefully help you to make an informed decision.

Pros of Acupressure: It Has Some Measured Benefits Acupressure has been shown to help alleviate certain problems and improve health in a number of ways. It has shown for instance to be able to relax the muscles and encourage blood flow. It has also been shown to stimulate the release of various hormones and chemicals in the body that are beneficial to our overall health such as growth hormone. It can also help with certain joint complaints etc – if you have a bad back or a muscle injury then acupressure is no bad thing. The muscles relax, the blood flow helps to warm them up and provide nutrients, and the whole body de-tenses. Of course this can have a vast range of health benefits from improved blood pressure to headache relief.

It Is Safe Many people opt to try acupressure before moving on to traditional medicine because it is natural and noninvasive. If you other options are surgery or medication that can have serious side effects, then the far less daunting prospect of being massaged is of course appealing. Many

doctors are too eager to prescribe drugs as a solution to all our ailments, and this has lead many individuals to turn to alternative medicines. As long as you don’t ignore the doctor’s advice and you are objective and scientific, then trying acupressure can provide a good thing to try.

It’s Pleasant In fact, not only is acupressure less daunting and invasive than many medical techniques, it’s also actually desirable and pleasant. Many people will have massages not for their health per-se but simply to relax and indulge themselves. Acupressure is no different – this is a great way to feel relaxed and forget about your worries – and that in itself can help you to de-stress.

You Can Practice It at Home Most of us consider acupressure as something performed by experts and for the most part this is advisable. However it is also something you can learn yourself or get a friend to learn, and this provides a great way for you to alleviate

MAY 2015

Cons of Acupressure: It’s Limited

that is not proven to be particularly effective.

Despite claims of acupressure being effective for things like back ache and headaches, these all work simply by relaxing the body. That is to say that there are no other proven affects caused by unblocking the Qi. Everyone is entitled to their beliefs, but objectively you will not be able to cure something like a kidney disease with acupressure.

It’s No More Effective Than Massage The bigger blow though comes from the simple fact that acupressure is actually no more effective than being massaged normally. Both can help to relax the muscles, stimulate blood flow and help you de-stress.

It’s Expensive This would be fine, except you’re spending a lot of money on the acupressure. Unless you’ve taught yourself, or you’re getting a friend to carry it out, then you will be spending an awful lot of money for a process

It Can Have Negative Effects While acupressure is certainly a more mild solution to your problem than a course of medication, you should not make the mistake of thinking that it is completely without side effects. If you have arthritis for instance then acupressure can be used successfully to treat it, but in some cases it can also exacerbate the problem.

It’s Varied Because acupressure is not considered conventional medicine, it is difficult to regulate and it is less standardized across the board. In other words, you can get a very different experience depending on where you go and this is one big reason that it can sometimes actually cause problems for arthritic patients etc – because the specialist doesn’t really know what they’re doing. Make sure that if you do get acupressure that you take your time in selecting a good specialist that is recommended by friends and who knows what they are doing.

Conclusion There is nothing particularly scientific about acupressure, but there is nevertheless some circumstantial evidence that it can be useful in treating a range of problems. Certainly it can be useful for relaxing the body, calming the mind and improving circulation – and it has very minimal side effects and risks so it certainly worth a try if you are struggling with health problems. If you do use acupressure though, then don’t pay over the odds, and make sure to find a specialist that you can trust and who is recommended by friends.

MAY 2015

Three Amazing Spring Recipes to Ring in the New Season Black Bean & Quinoa Burgers This filling veggie burger is quick to prepare and won’t leave you reaching for an unhealthy dessert. Packed with quinoa, black beans, nutritional yeast, and flavorful spices, it’s a winning burger for both taste and nutrition. Quinoa is a complete protein and both it and black beans are high in fiber, making this meal great for digestion and heart health too.

Directions:

1. 2.

Preheat oven to 400 degrees.

In a medium bowl, combine all ingredients using hands or a fork to mash beans and thoroughly mix. (This should form a paste-like mixture that is easy to shape into patties.)

Divide mixture into four equal balls, and form each into a patty between 1/4- and 1/2-inch thick.

4. In a medium oven-safe saucepan over high eat, cook patties in 1/2 tablespoon olive oil for 1 minute on each side, or until lightly browned. 5.

Transfer the saucepan to the oven and bake for 15 minutes. Serve patties on whole-grain buns or over fresh greens with desired toppings.

• • • • • • • •

Ingredients for 4 servings: 1 can (15.5 ounces) black beans, rinsed and drained 1/2 cup cooked quinoa

1/2 teaspoon cumin 1/2 teaspoon freshly ground black pepper 1/2 teaspoon paprika 1/2 teaspoon sea salt 1 tablespoon nutritional yeast 1 tablespoon extra-virgin olive oil, plus more for cooking

Oven Baked Salmon w/Avocado Dill Yogurt Salmon is a great staple to add to your weeknight dinner rotation, and for good reason—it’s low in calories and fat, high in protein, and off the charts with omega-3s. If a grill’s not available, baking is a great alternative. Baking the salmon at a high temperature helps to seal in the fish’s natural juices while keeping it tender. Top your fish with a heaping spoonful of guilt-free, refreshing, and slightly tangy avocado-dill “crema” (that’s just a fancy word for sauce). For a lighter version of this delicious, creamy topping, I use Greek yogurt instead of sour or heavy cream.

• • • • • • • • • •

Ingredients for 4 servings: 1 medium avocado, diced (skin and pit removed) 1/2 cup Greek yogurt 3 tablespoons fresh dill, chopped 1 clove garlic 2 tablespoons lemon juice 1-3 tablespoons water Salt Fresh ground pepper 4 6-oz salmon fillets 1 tablespoon olive oil

Directions:

1. 2.

Preheat oven to 400 degrees.

While the oven heats up, prepare the yogurt sauce. In a food processor or blender, combine the avocado, Greek yogurt, dill, garlic, lemon juice, 1-tablespoon water, salt, and pepper. Puree the mixture until smooth and creamy. If necessary, add more water one tablespoon at a time until it reaches the desired consistency. Set aside.

3. Place fish, skin side down, on a foillined baking sheet. Season with fillets with salt and pepper and brush with olive oil (about 1 tablespoon total). 4.

Bake fish (without flipping) until just cooked through, about 8 to 10 minutes, (depending on thickness). (Note: Thicker, center-cut fillets will take longer, while thinner fillets cut from the tail section will cook faster.)

Once cooked, remove from oven and plate each fillet. Top with 1-2 tablespoons of the avocado-dill yogurt, and enjoy!

Broccoli Rabe & Cherry Tomatoes with Chicken Spring is my favorite season. The snow melts (FINALLY), and farmers markets reopen and start exploding with seasonal colors and flavors. This is a quick and easy take on fresh vegetable “spaghetti”— with broccoli rabe as the “noodles.” Okay, okay, it’s not really spaghetti. But I can promise you this: it’s fresh, it’s delicious, and it’s super, super healthy packed with antioxidants and protein. It’s the perfect dish for an early-Summer dinner, and even better when eaten outside!

Directions:

Marinate chicken in the garlic, lemon, and 2 tablespoons olive oil for 15 minutes.

While the chicken is marinating, lightly steam the broccoli rabe for about 5 minutes (this is just to soften its naturally tough texture). Set aside.

Now for the chicken: heat a grill or grill pan on high heat. Grill cutlets until cooked through, about 2-3 minutes per side. Cover with foil and set aside.

And for the main event: in a large frying pan, heat 1 tablespoon of olive oil on mediumhigh heat.

Add onion, and sauté until soft, about 5 minutes

Add broccoli rabe and sauté until the flavors are blended and the rabe is heated through, about 5 minutes.

Add corn and tomatoes and sauté for 1-2 minutes. Remove from heat, add mozzarella, and cover.

Lightly brush bread with olive oil and toast (or grill) until crisp. Rub ½ of a garlic clove over the surface of the toast.

To plate: the mozzarella should be lightly melted, but not stringy—still holding the shape of the dice. Spoon the broccoli rabe and tomato mixture into a small pile and top with a chicken cutlet. Serve with a piece of the toasted bread on the side. For an extra layer of flavor, add a quick shaving of Parmesan cheese and some fresh ground pepper.

• • • • • • • • • •

Ingredients for 4 servings: 1 bunch broccoli rabe, steamed 3 tablespoon olive oil 1 container baby tomatoes sliced in half 1 ear of corn cut off the cob ½ red onion sliced into thin ribbons 2 chicken breasts each sliced in half to make 2 flat thin cutlets 2 cloves garlic crushed 1 lemon juiced Salt and pepper

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Colorado Health & Wellness News Briefs A look at the numbers: • 54%: Marketplace customers receiving financial assistance (Advance Premium Tax Credits) to help with their premiums. •$229: The average level of monthly premium assistance. •10%: Marketplace customers from rural counties, which make up 8% of the state’s population. •26%: Customers 18-34 years old. Connect for Health Colorado® Connected 141,639 Customers with Health Insurance Coverage during Open Enrollment Period In its just completed second open enrollment, Connect for Health Colorado® enrolled 141,639 customers, a level that is 10 percent more than in last year’s longer open enrollment period. The 2015 enrollment figure puts Connect for Health among the top five statebased marketplaces, according to data released today by the federal department of Health and Human Services. All but one of Colorado’s 64 counties showed increases in 2015 enrollments in private health insurance through the state Marketplace over year-end 2014. More than a dozen, including El Paso, Larimer and Pueblo counties, saw increases of 40% or more in the second open enrollment period. “We are grateful to our many partners — especially to our health coverage guides, brokers and carriers — who worked with us during this three-month drive to help more Coloradans obtain affordable health and dental coverage,” said Connect for Health Colorado Interim CEO Gary Drews. “Our work to improve service to our customers during the next open enrollment period has already begun with those partners, the state Division of Insurance (DOI), the state Department of Healthcare Policy and Financing (HCPF) and other stakeholders.” A comprehensive report on the Colorado Marketplace’s second open enrollment period for individuals and families, including county-level reports on enrollment and financial assistance made available to customers is available here. A more targeted outreach report is here.

•24: Number of languages other than English spoken by customers contacting the Service Center. •246,837: Number of phone calls answered by the Customer Service Center. While Open Enrollment has closed, some Coloradans can still purchase coverage for 2015 if they experience any one of a number of certain life change events – such as losing coverage provided through a job, moving to Colorado, getting married or the addition of a child to the family. A full list of these “special enrollment” circumstances for new customers can be found here and existing customers here. Open Enrollment for 2016 coverage will run from Nov. 1, 2015, through Jan. 31, 2016.

University of Colorado Hospital Transplant Center Celebrates its 2,000th liver transplant The University of Colorado Hospital Transplant Center and partners Children’s Hospital Colorado are now celebrating a combined 2,000th liver transplant. The first liver transplant in the world was performed at the University of Colorado Hospital (UCH) in 1963 by Dr. Thomas Starzl. Dr. IgalKam, Transplant Surgical Director for UCH, reestablished the liver transplant program in 1988. Since then, UCH has performed over 1,800 adult liver transplants.

MAY 2015

Dr. Frederick (Fritz) Karrer pioneered the transplant program at Children’s Colorado, which has performed over 200 pediatric liver transplants. The success of these programs is shown by the patients whose lives are improved and/or extended after they’ve received a life-saving liver transplant. The UCH Transplant Center performs both livedonor and deceased-donor liver transplants. While the Transplant Center is celebrating this milestone, many more patients are currently waiting for a liver transplant. Nationally, the liver transplant wait list includes 15,840 people. In Colorado, 699 people are waiting for a liver and UCH has 564 of those patients on the list. More than 2,500 Coloradans are currently waiting for a lifesaving transplant. Register to be an organ, eye and tissue donor at the Driver’s License Office or online anytime at DonateLifeColorado.org.

Strategic Plan on Aging in Colorado Proceeds If you plan on spending your “golden years” in Colorado, you won’t be alone. The state has one of the fastest-growing aging populations in the U.S. A bill to create a strategic plan to address this demographic shift is getting bipartisan support in the Legislature. Ben Moultrie, committee member with Colorado Committee on Aging and volunteer with AARP Colorado, says as people grow older, health care and other sectors will be stressed, but people will also be working longer. Moultrie says the state will need these older workers. “Our current population of people 60 and older is the best-educated this nation has ever seen,” says Moultrie. “This is a very innovative and very engaged population.” The legislation (HB 1033) would convene experts from across the state to identify the effects of aging in areas that include support services, housing and transportation. The group would also research the impact on state budgets and would recommend a concrete course of action through the year 2030.

MAY 2015

Moultrie says in just 15 years, one-in-four Coloradans will be over age 60. One of the biggest challenges for many families will be an increase in demand for professional care-giving and Moultrie points out that starting at around age 45 many Coloradans will become caregivers. “They have family members, relatives who are in positions where they, in fact, need care,” he says. “So it becomes both a labor force issue as well as a financial issue for families.” Moultrie says the economic impact of an aging population is likely to hit middle and lowerincome families the hardest. He adds the plan will need to include government, nonprofits and the private sector in order to meet the needs of Colorado’s senior citizens and their families.

Kaiser Permanente Colorado Supports ‘Free for Kids’ at the Denver Art Museum In partnership with Kaiser Permanente Colorado, the Denver Art Museum (DAM) announced Wednesday that it now offers free general admission to all youth ages 18 and under for the next year thanks to a one-year grant from Kaiser Permanente Colorado. The grant goes to support the Free for Kids program at DAM. “We are thrilled to help support the Denver Art Museum’s Free for Kids program. Our mission is to improve the health of our members and the communities we serve. Key to this approach is looking at places where we can impact health where

people live, work and play,” said Jandel Allen-Davis, MD, vice president of government, external relations and research for Kaiser Permanente Colorado at the news conference announcing Free for Kids. “Research has shown that exposure to the arts promotes positive educational outcomes and helps to build self-esteem, which is so critical for a child’s healthy development.” With additional support from a generous fiveyear gift from Scott Reiman and the Reiman Foundation, Free for Kids at DAM will fund general admission to all children, including school tours and other youth group visits. This incredible access opportunity also will seed a new transportation fund, providing bus funding assistance for Title I schools. Free for Kids funded admission gifts also enable the museum to cap youth pricing for all special ticketed exhibitions at $5 for the next five years. Denver Mayor Michael Hancock was also participated in the news conference and expressed the city’s appreciation to the organizations like Kaiser Permanente Colorado that are providing more access for young people to the Denver Art Museum. “From museums and libraries to pools and rec centers, Denver is giving our kids the keys to the city so they can have healthy options to explore and learn,” said Mayor Hancock. “Today’s announcement is a phenomenal step toward the shared goal of opening

new doors for every child by providing free access to great amenities, like the Denver Art Museum. Denver thanks the Museum and Scott Reiman for stepping up for our children and Kaiser Permanente Colorado for continuing to be such an outstanding city partner.” Mayor Hancock said it is likely that the museum will see an increase of an additional 100,000 kids annually thanks to the program. “With this generous underwriting of youth admission from Scott Reiman and Kaiser Permanente Colorado, we can further lower barriers to entry and welcome all children to experience our art collections and creative educational programming,” said Christoph Heinrich, the Frederick and Jan Mayer director of the DAM. “Young people who frequently encounter the arts experience greater quality of life, and we’re delighted that these generous donors share our goal to bring the arts to all youth in our community.”

How Free for Kids works For family visits, come to the Denver Art Museum welcome desk, and all members of your party ages 18 and under will receive a general admission ticket to the museum, paid for by our generous donors. For additional details on Free for Kids at the Denver Art Museum, visit www. denverartmuseum.org/freeforkids. School groups wishing to take advantage of free visits to the museum should book their visit through DAM’s group services department by calling 720-913-0088. Visitwww.denverartmuseum. org/freeforkids for details on specific tours and programs for students, as well as for additional information on how to apply for bus underwriting through this program.

MAY 2015

Kids and the Issue of Privacy By Charles Faye, Ph.D. Founder and President of Love & Logic

Have you ever heard a parent say something like, “I don’t feel comfortable searching my daughter’s room - I don’t want to invade her privacy?” Perhaps you know a child who is severely bent out of shape because their “Neanderthal” parents won’t allow them to keep a computer in their bedroom. Charles Faye, Ph.D.

Where do I stand on this issue?

• It’s our job to do our best to know what’s going on in

our children’s lives. • It’s our job to know what’s in their rooms. • It’s our job to do our best to know what they are doing on their computers and their phones. • It’s our job to do our best to meet their friends and understand what they are involved in when they are hanging out. • When we do these things, we send the message that we love them enough to be involved in their lives. Parents who do such things will likely hear, “You don’t trust me!” If so, respond with the following: We love you. Do you think we do these things to be nosy and obnoxious…or do we do these things because we love you and want to help you stay safe? This question is not designed to change their mind. It’s simply designed to plant a seed within it. When we consistently demonstrate love and concern...rather than a dictatorial attitude...this seed has a chance to grow. As a society, we’ve lost far too many good kids to drugs, alcohol, pornography, suicide, video game addiction, etc., because we’ve been afraid of invading privacy. In our Teen Package, you’ll find a treasure chest of ideas for staying highly involved in your teen’s life…without creating massive power struggles and rebellion. Dr. Charles Fay

Dr. Charles Fay www.loveandlogic.com 44

MAY 2015

Menopause Symptoms Vary by Age By Mache Seibel, MD

inety percent of women go through menopause between the ages of 45 and 54. But 1/10,000 women enter menopause by age 20; 1/1,000 by age 30; 1/100 by age 40; and 1/10 will enter menopause before age 45. A new study in the February 2015 issue of the journal Menopause studied women with early menopause to see if and how their symptoms differ from women entering menopause at age 45 and older. One of the major differences for women who go through natural menopause versus early menopause is how long the symptoms last. Unlike menopause that occurs after age 45 where symptoms tend to peak at the time of menopause and then taper off, early menopause symptoms do not diminish over time. Women with early menopause also experience a very high level of mental fog and mood swings that tended to last for decades, and had lower levels of attention, focus and awareness. About two-thirds of the women with early menopause experienced depression, which is much higher than the 16.2% that occurs in the general population. The study couldn’t be certain if the early menopause caused the depression due to hormone changes or the women were depressed because they went into early menopause. There was also a very high rate of hypothyroid disease. Another important finding with women in early menopause was that those who had the lowest level of mindfulness had the worst symptoms. So, taking action to be more mindful, including being involved in meditation, yoga and similar activities, may be very helpful. Common Symptoms Associated With Early Menopause All these findings point out that Mood swings and mental fog 75% if you go into early menopause, you may have stronger symptoms that last for a Hair loss > 50% long window of time. Talk with your > 50% Dry eyes doctor and make sure to seek treatment for symptoms so they can have the least > 50% Cold intolerance impact as possible in your life. For a free ebook on the most Joint clicking > 50% common symptoms of menopause and Tingling in limbs ~ 33% what to do about them, go to www.FreeMenopauseEBook.com and ~ 33% Low blood pressure get instant access. Mache Seibel, MD is one of America’s leading women’s health 17% Hypothyroidmis and menopause experts. As editor of My Menopause Magazine in the Apple Low blood sugar 16% Newsstand and Google Play, Dr. Seibel Gluten allergies 10% helps women thrive in menopause. MAY 2015

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Understanding Blood Clots – Part I of A two-part series

What is a blood clot? Facts: A blood clot is a mass formed by platelets and fibrin in the blood to stop bleeding. There are a variety of risk factors and illness that can lead to blood clot formation. Causes of blood clots may include: • certain heart conditions

• pregnancy

• prolonged immobility

• smoking

• certain medications

• surgery

• inherited blood clotting disorders • Symptoms of blood clots depend on their location in the body. Some blood clots produce no symptoms until they rupture or become dislocated and travel through the circulatory system to other sites. • Signs of a blood clot depend on their location in the body. Blood clots can cause heart attack or stroke; or pain, swelling, redness and tenderness in the area of the clot. • The diagnosis is suggested by the history and physical examination and often confirmed with an imaging test. • Treatment may require surgery, anti-coagulation medications, or a combination of the two. • Prevention of blood clots involves attention to the risk factors forvascular disease. Serious complications can arise from blood clots, and individuals should seek medical care if they believe they may have a blood clot. Blood flows through blood vessels, and is constantly in motion as the heart pumps blood through arteries to the different organs and cells of the body. Blood is then returned back to the heart by the veins. Blood returns to the heart when veins are squeezed and blood is pushed toward heart.

Blood clotting is an important mechanism to help the body repair injured blood vessels. Blood consists of: • red blood cells containing hemoglobin that carry oxygen to cells and remove carbon dioxide (the waste product of metabolism), • white blood cells that fight infection, • platelets that are part of the clotting process of the body, and • blood plasma, which contains fluid, chemicals and proteins that are important for bodily functions. Complex mechanisms exist in the bloodstream to form clots where they are needed. If the lining of the blood vessels becomes damaged, platelets are recruited to the injured area to form an initial plug. These activated platelets release chemicals that start the clotting cascade, using a series of clotting factors produced by the body. Ultimately, fibrin is formed, the protein that cross links with itself to form a mesh that makes up the final blood clot.

MAY 2015

The medical term for a blood clot is a thrombus (plural=thrombi). When a thrombus is formed as part of a normal repair process of the body, there is little consequence. Unfortunately, there are times when a thrombus (blood clot) will form when it is not needed, and this can have potentially significant consequences.

What Causes Blood Clots? Blood clots form when there is damage to the lining of a blood vessel, either an artery or a vein. The damage may be obvious, such as a cut or laceration, or may not be visible to the naked eye. Blood also will begin to clot if it stops moving, and becomes stagnant, or in diseases that cause the blood to clot abnormally. Blood clots in a vein (venous thrombosis) occur when a person becomes immobilized and muscles are not contracting to push blood back to the heart. This stagnant blood begins to form small clots along the walls of the vein. This initial clot can gradually grow to partially or completely occlude or block the vein and prevent blood from returning to the heart. An analogy to this process is a slow moving river. Over time, weeds and algae start to accumulate along the banks of the river where the water flows more slowly. Gradually, as the weeds start to grow, they begin to invade the center of the river because they can withstand the pressure of the oncoming water flow. Blood clots in an artery (arterial thrombi) occur by a different mechanism. For those with atherosclerotic disease, plaque deposits form along the lining of the artery and grow, which causes the vessel to narrow. This disease process may cause:

• heart attack

• stroke

• peripheral artery disease

If a plaque ruptures, a blood clot can form at the site of that rupture and can completely or partially occlude the blood flow at that point. Blood clots in the heart. In atrial fibrillation, the upper chamber (atrium) of the heart does not beat in an organized manner. Instead, it jiggles, and blood tends to become stagnant along the walls of the atrium. Over time, this may cause small blood clots to form. Clots also can form in the ventricle after a heart attack when part of the heart muscle is injured and unable to contract normally. Since the damaged area doesn’t contract with the rest of the heart, blood can start to pool or stagnate, leading to clot formation. Blood leaking out of a blood vessel. Blood clots can form when blood leaks out of a blood vessel, and can be very beneficial because the clot helps stop further bleeding at the site of injury. A few examples of how bleeding is controlled by the body’s clotting mechanism are:

• cuts • strains

• broken bones • nosebleeds

• sprains • scrapes Blood clots causing other medical problems. Sometimes, normal blood clotting can cause medical problems because of its location. For example, blood the urine may occur from any of a variety of reasons (such as infection, trauma, or tumor), and clots may form and prevent the bladder

from emptying, causing urinary retention. Clot formation in the uterus may cause pain when the clots are passed through the cervix and can lead to vaginal bleeding, either as part of menstruation or as abnormal vaginal bleeding (menorrhagia, dysmenorrhea).

What are the risk factors for blood clots? The risk factors for arterial clots are those that are common to all diseases that cause narrowing of blood vessels, cholesterol plaque formation, and plaque rupture

• High blood pressure

• High cholesterol levels

• Diabetes

• Smoking

• Family history

• Cancer

Blood clots in the veins are formed due to one of two main reasons: 1) immobility, and 2) genetic errors in the clotting mechanism. There are other associated risk factors including smoking and the use of birth control pills.

1. Immobility: Commonly, when the body stops moving, the risk of blood clots increases since muscle movement is required to pump blood toward the heart. Stagnant blood in a vein is prone to clot. Examples of how blood clots may occur from immobility include: • a person being hospitalized or bedridden after illness or surgery; • a person who takes long trips (such as in a car, train, or plane), when hours may pass without standing to move, walk, or stretch (blood pools in the leg veins and may potentially clot); • a person who suffers orthopedic injuries and/or has casts placed over broken bones or limbs; and • a woman who becomes pregnant; pregnancy is a risk factor for forming blood clots in the legs and pelvis, due to insufficient blood flow back to the heart.

2. Genetic errors in the clotting mechanism: There may be a genetic or inborn error in the clotting mechanism, making a person hypercoagulable (hyper=more + coagulation= clotting) and at greater risk for forming clots. Blood clots may cause life-threatening medical conditions, and are always considered in the differential diagnosis of any symptoms or signs. Differential diagnosis is the list of potential causes of a patient’s condition that is considered by the healthcare provider when caring for a patient and listening to them describe their signs and symptoms. Deep venous thrombosis (DVT) and pulmonary embolism Deep venous thrombosis (DVT) May lead to a pulmonary embolism. If there is a blood clot or thrombus in a deep vein, it has the potential to break off (embolize) and flow through the veins back through the heart, and into the lung where it can become lodged in a pulmonary artery, which prevents the lung from functioning. Pulmonary embolism is a medical emergency and can cause serious illness or death.

MAY 2015

An embolus is the medical term for a blood clot that has moved within the bloodstream to a different location. With pulmonary embolus (pulmonary embolism), two issues occur.

1. The lungs’ blood supply is comprised and the affected area of lung tissue may infarct, or die. 2. Because of the blockage, the ability of the lung to provide oxygen to the body is decreased and hypoxia (decreased

levels of oxygen in the blood and throughout the body) may occur.

3. Even if venous blood clots do not embolize, they may cause significant local problems with swelling and pain. Since blood cannot return to the heart if a vein is blocked by a clot, the limbs may chronically swell and have decreased function in a condition called chronic thrombophlebitis What types of conditions are caused by blood clots (AFib, atrial thrombosis, and others)? Arterial thrombus An arterial thrombus stops the blood supply to the tissues beyond the blockage, depriving cells of oxygen and nutrients. This quickly leads to tissue death. Arterial thrombus is the mechanism that causes: • heart attack (when it occurs in the coronary arteries that supply blood to the heart) • stroke (when it occurs in arteries within the brain), • peripheral vascular disease (occurring in the arteries of the legs), or • ischemic bowel or mesenteric ischemia (when it occurs in the arteries that supply blood to the intestine)

Atrial fibrillation (AFib, AF) In atrial fibrillation (AFib, AF), small clots may form along the walls of the atrium or the upper chambers of the heart. Should one of these clots break off, it may embolize, or travel in the bloodstream to the brain, blocking an artery and causing a stroke. Other arteries also may be involved when blood clots caused by the presence of AFib lodge and stop blood flow (embolize), including those that supply blood to the bowel. This can cause bowel ischemia and tissue death (potential necrosis) of the intestine. Clots also can affect blood supply to fingers and toes.

Other types of blood clots Blood should clot anytime it becomes stagnant. This also means that clots will form when blood leaks out of blood vessels. • With bleeding peptic ulcers, patients may vomit liquid blood mixed with clot. • Patients with rectal bleeding may also have clot mixed with the bloody stool if there has been time for the clot to form. • Sometimes patients with urinary tract or bladder infections develop associated bleeding in their urine, and small clots can form. On occasion these clots may be so big that they cannot be passed and block the urethra, preventing urination and causing urinary retention. • Vaginal bleeding is a normal event for most women in the reproductive years and occasionally, blood can pool in the vagina and form clots before being expelled. If clots form in the uterus, they may cause significant pain and pressure as they pass through the cervix while being expelled.

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Throughout 2015, Healthy Coloradan Media Group will be showcasing one of Colorado’s top health care leaders. Surgeons, primary care, emergency, healthcare executives, wellness experts, and more will grace our digital and print properties. We are offering organizations the opportunity to sponsor stories of these inspirational leaders who work tirelessly to keep us well, why they do what they do, and more. This unique opportunity positions your organization as the “Presenting Sponsor” of Colorado Health Leaders in Healthy Coloradan! With your sponsorship of a 2-page spread on the featured individual or group, you’ll also receive a full page, color display ad showcasing your company, a Web ad and commercial on HCTV. Plus, you’ll be reaching more than 240,000 people who are interested readers and viewers of this amazing Colorado lifestyle medium. Contact us today to begin aligning your organization with Colorado’s top medical and surgical minds.

Cholesterol 101 What every man and woman should know and understand about this compound.

W h at is c holester o l? Cholesterol is a chemical compound that the body requires as a building block for cell membranes and for hormones like estrogen and testosterone. The liver produces about 80% of the body’s cholesterol and the rest comes from dietary sources like meat, poultry, eggs, fish, and dairy products. Foods derived from plants contain no cholesterol. Cholesterol content in the bloodstream is regulated by the liver. After a meal, cholesterol in the diet is absorbed from the small intestine and metabolized and stored in the liver. As the body requires cholesterol, it may be secreted by the liver. When too much cholesterol is present in the body, it can build up in deposits called plaque along the inside walls of arteries, causing them to narrow.

What are the different types of cholesterol? Cholesterol does not travel freely through the bloodstream. Instead, it is attached to a protein and the two together are called a lipoprotein (lipo=fat). There are three types of lipoproteins that are categorized based upon how much protein there is in relation to the amount of cholesterol. Low-density lipoproteins (LDL) contain a higher ration of cholesterol to protein and are thought of as the “bad” cholesterol. Elevated levels of LDL lipoprotein increase the risk of heart disease, stroke, and peripheral artery disease, by helping form cholesterol plaque along the inside of artery walls. Over time, as plaque buildup increases, the artery narrows (atherosclerosis) and blood flow decreases. If the plaque ruptures, it can cause a blood clot to form that prevents any blood flow. This clot is the cause of a heart attack or myocardial infarction if the clot occurs in one of the coronary arteries in the heart. High-density lipoproteins (HDL) are made up of a higher level of protein and a lower level of cholesterol. These tend to be thought of as “good” cholesterol because they can extract cholesterol from artery walls and dispose of them in the liver. The higher the HDL to LDL ratio, the better it is for the individual because such ratios can potentially be protective against heart disease, stroke, and peripheral artery disease.

Why is high cholesterol dangerous? Elevated cholesterol levels are one of the risk factors for heart disease, stroke, and peripheral artery disease. The mechanism involving cholesterol in all three diseases is the same; plaque buildup within arteries decreases blood flow affecting the

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function of the cells and organs that these blood vessels supply.

•

Atherosclerotic heart disease or narrowed coronary arteries in the heart can cause the symptoms of angina, when the heart muscle is not provided with enough oxygen to function.

•

Decreased blood supply to the brain may be due to narrowed small arteries in the brain or because the larger carotid arteries in the neck may become blocked. This can result in a transient ischemic attack (TIA) or stroke.

•

Peripheral artery disease describes gradual narrowing of the arteries that supply the legs. During exercise, if the legs do not get enough blood supply, they can develop pain, called claudication.

•

Other arteries in the body may also be affected by plaque buildup causing them to narrow, including the mesenteric arteries to the intestine and the renal arteries to the kidney.

Very low-density lipoproteins (VLDL) contain even less protein than LDL.

Where does cholesterol come from? The liver is responsible for managing the levels of LDL in the body. It manufactures and secretes LDL into the bloodstream. There are receptors on liver cells that can “monitor” and try to adjust the LDL levels. However, if there are fewer liver cells or if they do not function effectively, the LDL level may rise. Diet and genetics both play a factor in a person’s cholesterol levels. There may be a genetic predisposition for familial hypercholesterolemia (hyper=more = cholesterol + emia=blood) where the number of liver receptor cells is low and LDL levels rise causing the potential for atherosclerotic heart disease at a younger age. In the diet, cholesterol comes from saturated fats that are found in meats, eggs, and dairy products. Excess intake can cause LDL levels in the blood to rise. Some vegetable oils made from coconut, palm, and cocoa are also high in saturated fats.

Total cholesterol is the sum of HDL, LDL, and VLDL.

What are normal cholesterol levels? Blood tests are required to measure total cholesterol and lipoproteins. For a complete lipoprotein analysis, the patient should be fasting for at least 12 hours. The goal is to have patients modify lifestyle and diet to maintain cholesterol levels within the normal range. It is important to remember that HDL may protect a patient from heart disease and it may be a treatment goal to raise a too low level of HDL.

Which foods can help lower cholesterol? The American Heart Association has developed diet guidelines to help lower cholesterol levels. It may be a challenge to read the nutritional contents on food packaging and on restaurant menus or to do the math, but the benefit will decrease the risk of heart attack and stroke.

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• Limit total fat intake to less than 25% to 35% of your total calories each day. • Limit saturated fat intake to less than 7% of total daily calories. • Limit trans fat intake to less than 1% of total daily calories. • The remaining fat should come from sources of monounsaturated and

polyunsaturated fats such as unsalted nuts and seeds, fish (especially oily fish, such as salmon, trout, and herring, at least twice per week) and vegetable oils.

•

Limit cholesterol intake to less than 300 mg per day, for most people. If you have coronary heart disease or your LDL cholesterol level is 100 mg/dL or greater, limit your cholesterol intake to less than 200 milligrams a day. Some food groups may be beneficial in directly lowering cholesterol levels and include foods with plant sterol additives, high fiber foods like bran, oatmeal, and fruits like apples and pears, fish, nuts, and olive oil. Some of these foods like nuts and fruits are also high in calories, so moderation is always advisable.

What other lifestyle interventions help lower cholesterol? Weight loss and exercise are shown to decrease total cholesterol while increasing levels of HDL, the good cholesterol. Smoking cessation decreases LDL levels plus smoking is a primary risk factor for heart disease and stroke. One drink of alcohol a day may help increase HDL levels, but too much alcohol can damage the liver and increase the risk of elevated LDL.

The National Cholesterol Education Program endorsed by the American Heart Association suggests the following risk guidelines:

Cholesterol Risk Guidelines Total Cholesterol (mg/dL) < 200

Desirable

200 to 239

Borderline high

> 240

High

HDL (mg/dL) < 40

Low

> 60

High

LDL (mg/dL)

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< 100

Optimal

100 to 129

Near Optimal

130 to 159

Borderline high

160 to 189

Near high

> 190

High

The Eyes Have It By Randolph C. Robinson, MD, DDS, FAACS

oets and song writers for centuries have been moved by the beauty of the ones they love, from Homer and Solomon to Elvis and Garth. Much of this lauded beauty is not in the eyes of the beholder but actually in the beauty of the eyes of the beholden. Youthful and open eyes are no longer reserved for these women of poetry but now they are be available through cosmetic surgery.. Eyelid lifts allow for extra skin and fat to be removed from around tired eyes to make the eyes more alert and open. This safe operation has a quick recovery and is only mildly uncomfortable.. The incisions are hidden and after five to seven days any residual bruising may be covered with makeup.

The technical term for eyelid surgery is blepharoplasty. The conditions treated by this procedure are blepharochalasis, or bulging fat around the eyes due to angioedema, and dermatochalasis, or excess skin and fat in the eyelids. These conditions may cause visual problems making the surgery more than cosmetic. Typically, a blepharoplasty is done on each eyelid, so there are four incisions. Depending on the needs, it may be necessary to operate only on the upper lids or only on the lower lids. The surgery is performed in one to two hours, under general anesthetic or under IV sedation with local anesthesia and may be combined with other procedures, such as a face lift or brow lift, to give the full effect.

The eyes show signs of aging when excess skin and fat cause the eyelids to bulge and lose the normal contours that are characteristic of youthfulness.

The incisions in the upper lids are placed about six millimeters (mm) above the lash line. The lower lid incisions are made 3 mm below the lashes. Excess fat and skin are removed, and a careful closure of the incisions is performed using a fine suture.

When youthful eyes are open, there is a fold in the upper eyelid. The eyebrows are positioned over the bony ridge above the eye. The highest part of You will be seen the day after the eyebrow curvature is lateral (to the outside of) the colored iris. Randolph C. Robinson, MD, DDS, FAACS surgery to make sure there are no problems, and your sutures will be removed one A youthful lower eyelid has a small fullness just under week after surgery. If a laser is used, less bruising will the lashes and possibly a horizontal crease just below the result, but that surgery takes a little longer to perform. fullness. There should be no puffiness, discolored circles, If extra skin does not need to be removed in the lower or sagging excess skin. eyelid, then the incision can be placed on the inside of the lower lid. Horizontal creases (“smile lines” or “crow’s feet”) at the sides of the eyes are caused by the aging of the skin and Swelling, the body’s normal response to injury, the actions of the underlying muscles. These lines are not will peak on the third day after surgery. Steroids are changed much by eyelid surgery but are best treated by a occasionally given to help reduce the amount of postresurfacing chemical peel or laser or Botox.

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surgical swelling. Ice packs and elevating the head will reduce the amount of swelling too.

to the swelling around the eyes. Pain relief medication is rarely needed beyond two days, but is available as needed.

The normal bruising that is associated with the surgery is most apparent on the third day and then changes from a dark purple color, to a greenish color, then to a yellow color as it fades. The color change may extend to the cheeks due to gravity. After the sutures are removed at seven days, the discoloration may be covered with makeup. Most patients find sunglasses helpful to hide any discoloration when they are in public.

Antibiotics are prescribed for several days following surgery. Antibiotic ointment is applied to the incisions until the sutures are removed. Some patients find a mild sleeping pill helpful, and steroids may be given to help reduce the amount of swelling.

Blurred vision usually occurs for the first few hours following surgery, resulting from the anesthetic around the eyes, from the ointment that is placed in the eyes for protection, and from expected routine swelling. Vision will be limited by the iced gauze packs that are placed immediately following surgery to decrease swelling. It may be difficult to read or watch television

for the first day or two following the procedure, and excessive tearing or even dryness may be experienced for a short time following surgery. Pre-existing vision problems should be evaluated by an ophthalmologist. Nausea can occur after surgery, sometimes caused by the anesthetics and strong pain relief medicines. It may be reduced by preceding each pain pill with a small amount of food (e.g. soda crackers or foods that you can see through; initially avoid dairy products). On the first post-operative day, if you don’t feel like eating, don’t force yourself to eat. Take the pain pill with repeated sips of clear liquids that you can tolerate, e.g. “flat” 7-Up, ginger ale, water, apple juice, etc. Call our office if you do not feel better, or if repeated vomiting is a problem. Most patients do not experience excessive pain following the procedure. Discomfort is primarily related

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Do not engage in strenuous activity for the first four weeks after surgery, and do not lift anything heavier than 10 pounds. Since the pain relief medicine may cause constipation, a laxative may help to avoid straining. Light walking or similar activity is acceptable and will help you feel better. The most serious complication is, of course, blindness. This incident is reported in the scientific literature and is very rare; nonetheless, it is possible.

Changes in the lower lid position, called entropion, which may cause the lid to roll in toward the eye, or ectropion, away from the eye are possible complications. These conditions can cause irritation to the eye and may require corrective surgery. Permanent damage to the tear drainage system is also a rare risk. Bleeding and infection that require intervention are possible also. The most common complications are small suture cysts, asymmetry (uneven eyelids), and slight inability to close the eyes completely. These conditions usually resolve by themselves without intervention. There is a difference between beauty and age. Eyelid lifts not only reverse the aging tired look but can improve the openness of the eyes and make them more attractive. When it comes to moving the hearts of poets and lovers the “eyes” have it.

For more than 130 years, St. Mary-Corwin Medical Center in Pueblo, Colorado has been known for leading medical experts, cutting edge technology and a broad array of clinical services. We are committed to excellence in health care. St. Mary-Corwin is home to the only, full service and nationally recognized Dorcy Cancer Center, accredited Breast Center of Excellence, state of the art robotic-assisted surgical technology and maternalfetal-medicine clinic in the area. At St. Mary-Corwin, we heal the human, not the symptoms. We celebrate the role of spirituality in healing for each individual. We believe communities in our area deserve the unparalleled resources and technologies that we can provide with our world-class physicians, our patient-focused caregivers and our visionary leadership. St. Mary-Corwin is part of Centura Health, connecting individuals, families and neighborhoods across Colorado and western Kansas with more than 6,000 physicians and 18,100 of the best hearts and minds in health care. At St. Mary-Corwin, health care is not merely a business. It’s a calling. We respect the dignity of each person and consider it a worthy cause to lift the burdens of others by lovingly offering care to people regardless of who they are, what they believe or where they’re from. We seek to combine finely honed medical skills with compassionate touch to care for the whole person – body, mind, and spirit. In this manner, we strive to create sanctuaries that carry on the healing ministry of Christ. St. Mary-Corwin Medical Center received the Joint Commission’s Gold Seal of Approval for health care quality and safety. This accreditation is recognized across the country. It symbolizes St. Mary-Corwin’s commitment to providing high quality care and that it has demonstrated its commitment by measuring up to the organization’s high standards.

More Specialties that St. Mary-Corwin provides to the Community are: • • • • • • •

Birth Place Cardiovascular Services Stroke Center Diagnostic Imaging Pediatrics Rehabilitation Services Surgical Services

• Joint Replacement Center • Emergency Care • Diabetes Services • Flight for Life Colorado • Physician Partners • Sports Medicine

Contact Info: Connect With Us! (719) 557-4000 Facebook: http://www.facebook.com/StMaryCorwin www.stmarycorwin.org Twitter: @StMaryCorwin YouTube: https: St. Mary-Corwin Medical Center //www.youtube.com/watch?v=ymOwyqw9F6c 1008 Minnequa Ave Pueblo, CO 81004

MAY 2015

How One Man’s Journey Set A Colorado Community as the Sister City to Ancient Olympia By Harris Kalofonos, USA Wrestling All my life I aspired to develop ideas into experiences. As a young judo athlete I always remember myself looking at the Olympic Games as the ultimate destination. I never made it to the Olympic as an athlete, but in 2004 as I graduated from college in Greece I found myself working for the Olympic Games at the 2004 Olympic Games in Athens. It was a dream job that would change everything for me and lead me to the America. After completing my mandatory Army service in Greece I moved to the US for my graduate studies. In 2007 when I first started working for the National Governing Body of Amateur Wrestling in the US I realized that the majority of US athletes and other people within the sports world did not know much about the origins of the Olympic movement. As time went by that realization was even more apparent as I interacted with more and more people outside of the Olympic movement. You see in Greece the history of the Olympic Games is part of the common core program from elementary school all the way up the first years of college. I remember to always find myself surprised that so many people in the US, though having such a rich sports history, were not aware of the history or the location where the Olympic Games began. Truth be told, it is not something you think about every day. In fact though I grew up in Greece I had never visited the birthplace of the Olympic Games, Ancient Olympia, in Greece until the summer of 2013. That year (2013) it all came together and the dots started to connect. On Feb 12th the IOC accounted that the sport of wrestling would be under consideration to exit the Olympic Games core program. Working at USA Wresting, that news came as a great shock. How could the first sport of the original Olympic Games be under such a consideration? The months that

followed included several marketing initiatives and events to show to the world the importance and impact of the sport of wrestling. I was tasked to help organize an event in Ancient Olympia Greece to showcase the historic link of the sport with the Olympic movement. It was then; in July of 2013 that I visited for the first time Ancient Olympia, in Greece. The visit to Ancient Olympia left me with a strong impression that carried for months to come. In Sept of 2013 the IOC decided to keep wrestling in the core sports of the Olympic Games and the crisis within the sport was over. But in Sept of 2013 another initiative was starting in Colorado Springs, conserving the development of the US Olympic museum and three other ambitious projects that would change the image of the city forever. As I attended several presentations and meetings about the new coming venues I realized that the city’s effort needed a historic element to inspire people and showcase the legacy the city has beyond its over 150 years of history. It was then when the idea of making Colorado Springs a sister city with Ancient Olympia was born. As I shared the idea the several people in town I got a call from the Mayor’s office and in Jan of 2014 the process began. Four months later a delegation from Ancient Olympia arrived to Colorado Springs and in April 2014…. Ancient Olympia was approved in a unanimous vote of the Colorado Springs city council. In June of 2014 it was Colorado Springs’ turn to visit Ancient Olympia in Greece. Colorado Springs was proclaimed sister city with Ancient Olympia on the same exact site the lighting of the Olympic Flame takes place every time before each Olympic Games, summer and winter. Along with the Colorado Springs delegates visiting ancient Olympia, The Young Champion Ambassadors (YCA) idea was born. At the time the Mayor of

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AO mentioned that the city has 12 other sister cities and each sister city in the past would send a kid to be one of the first torchbearers of the Olympic Relay. Returning to Colorado Springs from the visit to Ancient Olympia, I worked on developing a business plan for the YCA program. During this phase a Greek graduate from Springfield College, MA, named EleftheriaPetridi, and Tad Vannaman, a recently retired U.S. Air Force officer, assisted in YCA’s first steps. Overall the main vision of the YCA program was to create awareness about the legacy of the Olympic movement to the citizens of Colorado Springs and to enhance the city’s image as an attractive destination for people to visit from around the country and international. It was determined that the best possible way to achieve YCA mission would be by implementing the program in three clearly distinct phases. Phase a)Would be the essay completion between students from all schools of the city that are between the ages of 15 and 17. Phase b) Would include a series of media events and training sessions with all the finalists at the school and district level from the essay competition at key locations across the city and Phace c) Will take place when the final winner of the essay competition will travel to Ancient Olympia in Greece to take part at the lighting ceremony of the Olympic flame and be one of the first torch barriers of the Olympic torch relay that happens three months before each Olympic Games. As a result during the first year of the YCA program we implemented an essay contest within

the 32 surrounding high schools, open to freshman, sophomores and juniors. Tad Vannaman lead the day-to-day implementation, visiting with and energizing our points of contact in the 9 school districts of the Greater Colorado Springs area, and several of the private schools. This process matured YCA from an idea to a reality. Within six months we had selected our first group of Young Ambassadors, recruited an all-volunteer planning team who met weekly, drafted an 18-month calendar of city events for the ambassadors and established the first partnerships, sponsors and donors to help the YCA program. Since the beginning of 2015 YCA team has hosted three events; one meet and great event, with the winners of all their schools and their parents. One event with Colorado Springs sports corps for to introduce the Sport Corps activities the YCA winners. And one press conference with Colorado Springs Mayor Steve Bach as its main guest in order to introduce this years school winners to the media. YCA has organized several other events across town where YCA will lead more about the city and engage with several key organizations. YCA is a program that was established officially in 2014 but aspires to be a part of the city for years to come hoping to embrace our cities talent in their first steps to the world.

For more information on the YCA program please visit “Young Champions Ambassadors Facebook page or at Colorado Springs Sister Cities International website: http://www.sistercitycs.us/#Olympia

to your intuition, taking courageous challenges at every step along the way. You are on the path... exactly where you are meant to be right now... And from here, you can only go forward, shaping your life story into a In fact, the Asana comprises just a small part of magnificent tale of triumph, of healing, of courage, of the overall Eight Limbs of Yoga as spelled out in the Yoga beauty, of wisdom, of power, of dignity, and of love.” Sutras. Find inspiration and wisdom by enjoying some of ~ by Caroline Adams my favorite yogic quotes. Love yourself, love your day, love your life! “Love is how it feels to recognize our essential unity. Awakening to oneness is the experience of Big Love. “When you find peace within yourself, you become Knowing you are one with all, you find yourself in love the kind of person who can live at peace with others.” with all.” ~ Timothy Freke ~ Peace Pilgrim “The sun shines down, and its image reflects in a “I have been a seeker and I still am, but I stopped asking thousand different pots filled with water. The reflections the books and the stars. I started listening to the teaching are many, but they are each reflecting the same sun. of my Soul.” ~ by Rumi Similarly, when we come to know who we truly are, we will see ourselves in all people.” ~ Ammachi “It is not arrogant or egotistical to feel good inside. You had nothing to do with it. It’s simply the honest response “Yoga does not remove us from the reality or to clearly perceived Reality.” ~ Erich Schiffman responsibilities of everyday life but rather places our feet firmly and resolutely in the practical ground of “Wisdom is knowing we are all One. Love is what it feels experience. We don’t transcend our lives; we return to like and Compassion is what it acts like.” the life we left behind in the hopes of something better.” ~ Ethan Walker III ~ Donna Farhi

Yoga is more than just poses.

“Mindfulness helps you go home to the present. And “Remember the emphasis on the heart. The mind lives every time you go there and recognize a condition of in doubt and the heart lives in trust. When you trust, happiness that you have, happiness comes.” suddenly you become centered.” ~ Osho ~ ThichNhatHanh “What if our religion was each other “All I’m saying is that to liberate the potential of your If our practice was our life mind, body and soul, you must first expand your If prayer, our words imagination. You see, things are always created twice: What if the temple was the Earth first in the workshop of the mind and then, and only If forests were our church then, in reality. I call this process ‘blueprinting’ because If holy water—the rivers, lakes, and ocean anything you create in your outer world began as a What if meditation was our relationships simple blueprint in your inner world.” If the teacher was life ~ Robin Sharma, The Monk Who Sold His Ferrari If wisdom was self-knowledge If love was the center of our being.” ~ Ganga White “Be a lamp to yourself. Be your own confidence. Hold on to the truth within yourself as to the only truth.” “Through practice, I’ve come to see that the deepest ~ Buddha source of my misery is not wanting things to be the way they are. Not wanting myself to be the way I am. Not “Accepting means you allow yourself to feel whatever it wanting the world to be the way it is. Not wanting others is you are feeling at that moment. It is part of the isness to be the way they are. Whenever I’m suffering, I find of the Now. You can’t argue with what is. Well, you can, this war with reality to be at the heart of the problem.” but if you do, you suffer.” ~ Eckhart Tolle ~ Stephen Cope “Your life is a sacred journey. It is about change, growth, discovery, movement, transformation, continuously expanding your vision of what is possible, stretching your soul, learning to see clearly and deeply, listening

“Every waking moment we talk to ourselves about the things we experience. Our self-talk, the thoughts we communicate to ourselves, in turn control the way we feel and act.” ~ John Lembo

“True meditation is about being fully present with everything that is--including discomfort and challenges. It is not an escape from life.” ~ Craig Hamilton “Do your practice and all is coming.” ~ Sri K PatthabiJois “A person experiences life as something separated from the rest - a kind of optical delusion of consciousness. Our task must be to free ourselves from this selfimposed prison, and through compassion, to find the reality of Oneness.” ~ Albert Einstein “Understanding without practice is better than practice without understanding. Understanding with practice is better than understanding without practice. Residing in your true nature is better than understanding or practice.” ~ Upanishads “Your hand opens and closes and opens and closes. If it were always a fist or always stretched open, you would be paralyzed. Your deepest presence is in every small contracting and expanding, the two as beautifully balanced and coordinated as bird wings.” ~ Rumi “You may think that only you are a prisoner, but other people are also prisoners. You are in a small prison, but others are in the big prison outside. When will they be released? Think that you are a yogi and that you are pursuing your sadhana in this particular place and at this particular moment. Immediately you will experience great joy. If you change your understanding, you will be free in a minute.” ~ Baba Muktananda “Healthy plants and trees yield abundant flowers and fruits. Similarly, from a healthy person, smiles and happiness shine forth like the rays of the sun.” ~ B.K. S Iyengar “Yoga is the unifying art of transforming dharma into action, be it through inspired thought, properly nurturing our children, a painting, a kindness or an act of peace that forever moves humanity forward.” ~ Micheline Berry “Habits allow us to not think about what we’re doing . . . giving us the illusion of ease. When we are under the illusion of ease, not thinking about what we’re doing. Breathing the same old way, moving the same old way, thinking the same old way we check out of the present, out of happiness itself.” ~ Alex Levin

- See more at: http://yoganonymous.com

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