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Welcome to Healthy Coloradan!

You probably know Colorado ranks among the top 10 healthiest states in the U.S., and at one point just a few years ago, Men’s Health Magazine ranked our state the number 1 healthiest state in the United States. What you may not know is that Colorado has since slipped down the list and for the first time in recent memory, we find ourselves at or below the #10 mark. So, how is that ranking achieved? Well, there are a number of different formulas and criteria for ranking a given state’s wellness and health. Some look at the clinical reporting, such as incidents of chronic disease admissionsto hospitals, rates of heart disease, number of heart procedures, diabetes, behavioral health admissions and so forth. Others use a form of probability criteria that suggest because these things exist, people are more inclined to be active: because there are 10,000 hiking trails, or 300+ days of sunshine, x number of bikes sold per year, or vending machines that provide at least 10 healthy options. And still others use quality of life indicators, such as number of employers with wellness programs, access to care availability, or weight maintenance incentive programs. No matter, Colorado usually comes out in the top 10. But, for the last few years, Colorado’s prestigious image for health and wellness has been met with serious challengers, like Vermont, Utah, and Minnesota, among others. Which leads me to why we exist: Healthy Coloradan is a medically-directed, multimedia platform that focuses on “all things health and wellness … Colorado.” What that means is that we like to spotlight the health and wellness assets right here in Colorado! And we do this in print, digital e-zines, websites and radio touching nearly 2 million lives each month. Healthy Coloradan looks at health and wellness in a very broad sense. We subscribe to the “healthy and balanced life” as not simply the physical health of an individual, although that is a key ingredient. Our view considers all that composes an individual and community: physical health, diet, exercise, nutrition, food and supplements, behavioral health, spiritual wellness, healthy family, healthy marriage/relationships, conservation and environment, continuing education, work life, financial wellness, eating out, cooking, building neighborhoods and community, hobbies, Colorado’s activities, events and natural assets and so much more. Our cover features are true health journey stories by Coloradans whose experiences are extraordinary. Chances are, you may have heard their initial story in the local news. But what happened after that? Our stories tell their experience of rehabilitation, struggle, redemption, recovery, reflection and how they began their journey back to wellness and health. They’ll talk to us about those quiet, uncertain, inspirational moments you would not otherwise ever read about anywhere else. Remember that young lady whose legs were crushed by acar while riding a Segway? If you heard the news report, you probably wrote off her situation as helpless. Carissa Monroe’s story within our pages will lead you to a much different conclusion. We hope you will enjoy our publication, check out our website at www.healthycoloradan.com and then subscribeto our future issues and events. Got a great health or wellness journey story? We want to hear it! Even if we don’t print it in our magazine, you can tell your story to millions on our web site! Just email us: [email protected] and we’ll review your submission. Want to reach millions of health and wellness consumers? Get a multimedia package for a surprisingly low cost. Email us: [email protected], or call: 719.884.1184.

Enjoy! Dirk R. Hobbs, ACHEFounder & CEO - Healthy Coloradan Multimedia 9

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A Medical Voyce Publication

I feel foolish. I’m standing in a room with 100 women I’ve never met

proclaiming to no one in particular that “I… Am… Amazing.” My sheepishness is dampened slightly knowing I’m not alone, but solidarity only goes so far when you’re among complete strangers.

We’ve all come here to learn about being “well,” physically and emotionally. This, The Broadmoor’s second annual Women’s Weekend of Wellness, is a two-day seminar presented by The Broadmoor and the University of Colorado’s Anschutz Health and Wellness Center (AHWC), a state-of-the-art research and clinical facility on the Anschutz Medical Campus in Aurora.

Panels and presentations this weekend cover everything from stress and the mind-body syndrome to maximizing nutrition. What we’re learning here is just a small taste of what the AHWC offers its clients—an integrative approach to improving health and wellness through exercise, nutrition, sleep, mindfulness, meditation, behavior change, and biofeedback.

“OPPORTUNITY IS NOWHERE”

Dr. Terry Eckmann, a professor at Minot State University, kicks the weekend off with her highly interactive presentation, “The Power of Perspective,” in which she explains how our thoughts and perceptions—the lenses through which we observe the world—inform our emotions and how our emotions affect our health. She peppers us with touchy-feely abstractions—such as “whether you think you can or you think you can’t, you’re right”—and backs up each with Power Point slide after slide of empirical data. At one point, she flashes a slide on the screen at the front of the room and asks us to read it aloud in unison. The slide simply says: “OPPORTUNITY IS NOWHERE.” Half the room reads: “opportunity is nowhere.” The other half reads: “opportunity is now here.” She has our attention.

“We think 50,000 thoughts a day,” Eckmann continues with emphasis, “and 80 percent of those are dangerous and repetitive.” When we also consider that, as Eckmann tells us, our brains use 20 percent of our bodies’ oxygen and glucose, the energy drain of destructive thinking is significant. It also drives home the hazards of sitting—something we’ll hear a lot this weekend. “In order to get oxygen to our brains, we have to move,” says Eckmann, who goads us to get out of our seats to “joy dance.”

We self-consciously follow her lead, swinging our hips and waving our arms to Gloria Gaynor and Donna Summer tunes. “Research conducted on therapeutic intervention for depression has shown that a joy dance is more effective than medicine or even music,” she says. Before we return to our seats, we repeat the “I Am Amazing” affirmation, with gusto this time.

Wellness

It’s all well and goodThe Broadmoor’s Women’s Weekend of Wellness Girl PowerBy Deborah Williams

ACCUMULATING WELLNESS

“We cannot create a culture of health by focusing on disease,” says Dr. Jim Hill, the executive director of the AHWC and one of the leading thinkers and researchers in the areas of obesity and nutrition. It’s a concept at the heart of what AHWC does and one that is slowly gaining steam in a country desperate to rein in skyrocketing medical costs and insurance prices. “What we have in this country is sick care, not health care, and it’s time to change that,” says Hill.

Clearly, all the women in the room agree with the sentiment or they wouldn’t be here, and Hill commends the Coloradans in the room for what we all wear as a badge of honor: Ours is the leanest state in the nation. Then he shows us a slide that takes the wind out of our sails, a graph representing national obesity trends over the past decade and a half. “We’re tracking right along at the national average,” he says. “With today’s obesity rate in Colorado, if this were 1995, we’d be the fattest state,” he says. “Have I depressed you enough? Here’s what’s even more depressing: During the p e r i o d that adult obesity has doubled, childhood obesity has tripled.” What’s worse: unlike their parents, Colorado kids rank 23rd in national obesity rates.

Gulp. It’s not just the mothers in the room who feel a bit of guilt for what he’s just told us. We are all to blame. No doubt words like “high-fructose corn syrup,” “video games,” and “fast-food chains” are rattling around our brains. But here, too, Hill admonishes us. “We need to turn 180 degrees and not worry about stopping all the bad stuff,” he says. “What we should worry about is promoting the good

stuff. We’re focusing on the wrong things; the negatives not the positives.” Furthermore, he argues, wellness supply and demand is out of balance. There’s plenty of supply. “Go into any major grocery store, there’s plenty of healthy stuff there. We’ve done more on the supply side than on the demand side. Just because better options are out there doesn’t mean people will select them. Yes, we need to ask the food industry to make healthy food taste good, but we need to teach people to want to make those choices. Wellness is about a lot more than weight and health,” he says. It’s about living your life the way you want so you can achieve the things you want. For Hill’s team and for most of their clients, health isn’t a destination, it’s an ongoing process of accumulating wellness.

A COMPREHENSIVE APPROACH

Later in the weekend, Dr. John Peters, Chief Strategy Officer at AHWC, and Dr. Holly Wyatt, the center’s associate director, will talk more about achieving the things we want in life. Like Hill, they’ll insist that eating better, losing weight, exercising more or reducing stress are pie-crust

goals—easily made, easily broken—if they’re not linked to a deeper purpose. It’s that deeper purpose that, once

identified, will motivate a person to want to make those good choices to which Hill referred.

Clients at the AHWC learn that right off the bat during their initial consultation with Dr. Wyatt, who helps them determine not only

their true motivation for making a lifestyle change, but what specific steps will help them do that based on their individual profile. Using the results of a six-stage wellness assessment that analyzes a person’s metabolic fitness, physical fitness,

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sleep quality, diet quality, stress, and quality of life as a benchmark, Dr. Wyatt formulates a customized plan for each patient. The AHWC is offering the wellness assessment to attendees this weekend, and most sign up to learn which areas of wellness they need to work on. In many instances it’s neither physical fitness nor nutrition but something ancillary to those, such as sleep, stress or metabolic capacity.

Rather than sending patients away with a recommended diet or exercise regimen that they’re expected to maintain on their own, Dr. Wyatt can send patients to the facility’s Human Performance Lab, where Dr. Iñigo San Millán, a world-renowned exercise physiologist, will evaluate their metabolic fitness to determine how their bodies function and what type of workout is appropriate. Dr. Millán speaks to our group on the second day of the weekend, and tells us that many people who work out regularly and even aggressively, aren’t working out at their optimum levels.

If a patient suffers from high anxiety and stress or sleep disorders, Wyatt will refer him or her to a specialist in that area. Or if a patient needs nutrition coaching, Wyatt will bring in Dr. Kim Gorman, the center’s registered dietitian, who also speaks to our group this weekend about making smart food choices. An on-site supermarket and a demonstration kitchen are additional learning labs where patients can learn to shop for and prepare healthy meals.

Each morning during the Weekend of Wellness, attendees participate in an activity of choice—a group hike in the nearby mountains, water aerobics in the indoor pool or a

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yoga class—all led by the resorts team of fitness professionals, including Fitness Supervisor Bev Stewart, whose lively spirit and commitment to overall health and wellness is infectious. She’s ever present throughout the weekend with a cheerful demeanor and a sort of Mother Hen attitude that helps draw all the women at the event together. Although I’m one of the only attendees who has come alone—most have come with one or two close girlfriends, a mother, daughter or sister—by the end I’ve become friendly with many of the women.

The meals this weekend also reflect an attention to smart nutrition. Dinner features poached fish and delicate vegetables; lunch is a nutrient dense salad with tofu and light dressing. A colorful breakfast buffet features four or five freshly squeezed juices, wholesome granola, crust-less egg-white and trout frittatas, fruit, and nonfat plain yogurt. On the final day, as we all enjoy the feast, Kim Gorman walks us through the menu item by item, reviewing each food’s nutrition profile.

A BROAD VIEW AT THE BROADMOOR

What’s clear throughout the weekend is that The Broadmoor and the AHWC share common visions when it comes to promoting health and wellness. In fact, that’s what inspired the weekend. “The idea started with Bev Stewart,” says Cassie Hernandez, the director of spa and fitness at The Broadmoor. “We as a property are very aware of our environment and our culture. We relish the opportunity to share that mindset with others, and Bev Stewart is our biggest advocate for sharing tips and suggestions on how to stay healthy.”

Just as the AHWC puts all the resources at clients’ fingertips, The Broadmoor strives to make smart choices easy for its guests. From health-conscious menus (see “The Joy of Cooking,” page 47) to the fitness evaluations conducted by Bev Stewart’s team to relaxation and rejuvenation treatments at the spa (see “A Pampered Adventure,” page 39), a stay at The Broadmoor can help support—not derail—a healthy lifestyle.

The 2014 Weekend of Wellness is scheduled for May 1-4, 2014. To make a reservation click here or call (877) 784-4196.

“whether you think you can or you think you can’t,

you’re right”

unmistakable quality . . . spectacular service

tanweer H. Khan, m.d.Medical Director, Neuroradiologist

Colorado Springs Imaging

Undergraduate Education ShipOwner’sCollege,Karachi,Pakistan (BSEquivalent) SMGovernmentScienceCollege Karachi,Pakistan

Medical School UTESAUniversity,SantoDomingo, DominicanRepublic

Radiology Residency ColumbiaUniversity-HarlemHospitalCenter

Fellowship UniversityofIllinoisatChicago

Board Certification CAQinNeuroradiology AmericanBoardofRadiology

Professional Affiliations AmericanSocietyofInterventionaland TherapeuticNeuroradiology AmericanSocietyofNeuroradiology ElPasoCountyMedicalSociety

Special Interests Neuroradiology

Licensure Arizona Colorado Florida Illinois Maine NewYork Oklahoma

Volunteer Duties EnvisionRadiologyBoardofDirectors EPCMSBoardMember (FormerPresident)

Personal Interests Polo

Email [email protected]

carissa MONROE

from the top of the world to the bottom and back again!

Fitness model Carissa Monroe, is on the road to recovery after a near-death accident. During this season of hol idays and giving thanks, no doubt she’l l pray, “Thank you God, for saving my l ive.”

“I shot up a prayer. I didn’t know if that would be my

last day on earth.”

Carissa was one of four fitness models handing out promotional flyers in Denver to a morning get-to-work crowd. Carissa says she was riding a Segway on a wide sidewalk when, “Suddenly I saw a white SUV coming straight for us. I didn’t have time to do anything. “So I shot up a prayer, ‘Lord this is in your hands.’ I didn’t know if that would be my last day on earth.” The next thing Carissa saw was a steel fence. Her legs were pinned between the SUV and a wall of metal, but she was alive. “I didn’t know if I was paralyzed. I was in so much pain. I was bent over the fence so I tried to pull self out. “I blacked out, and the next thing I knew I was on the ground with people around me. I was worried about my friend, who’d been near me. (Carissa’s friend was thrown by the SUV and suffered a traumatic brain injury. The other models were untouched.)

living with pain From the first day in the hospital, Carissa experienced constant pain, despite the help of prescribed narcotics. She grimaces recalling, “For the first month, it felt like my legs were being smashed or they were getting severed. It went to burning. It was the worst thing you could imagine.” For eight weeks she was confined to the downstairs couch. Carissa’s mom, Belinda, slept on the love seat beside her. Belinda explains, “Carissa had to keep her legs elevated and couldn’t walk. She had a lot of nerve damage, and didn’t have any balance or coordination.”

the day to remember May 16, 2011

The “scars” have made Carissa beautiful inside

and out.

Carissa describes her disabled 98-pound, 5-foot-two body with a humorous spin, “I’d try to get off couch, and think, ‘Oh my gosh, my legs don’t work.“ And you should have seen my ankles. They were so swollen I thought I’d have ‘cankles’ forever!” She also had constant company from a Shih-tzu puppy Carissa gave her mom for Mother’s Day (one week before the accident). “’Cali’ proved to bring life and love during a time of trial,” she remembers. After couple months, she started regular visits with a ‘pain doctor.’ Carissa sighs with relief. “He was a good listener and understood the pain I was experiencing. He helped me get the right meds.” To this day, however, Carissa lives with some level of pain. For instance, “If any rods or pins get hit, OW! And it hurts so bad when the weather changes.”

She reaches toward her right leg. Although camouflaged by some St. Tropez bronzer, part of her tibia sticks out. “I call it my nib,” she giggles.”

hope returns Carissa shares that her family has always been close, and she drew strength from them during recovery. My dad was an administrative pastor, so God’s always been our rock.

“My brother came with my mom to the hospital. And, my older sister’s always been there for me, but I really saw her come to my defense in this.”

She describes how hope returned once her physical therapist released her to workout at the gym. “Brent was a former bodybuilder, so he understood where I had come from. He knew what I was capable of and let me push myself at my own pace.”

“I did consider Plan B. I couldn’t figure out what

God was doing.”

In July, Carissa showed her true fighter-nature. Wearing Malibu-turquoise flip-flops, she walked down the aisle as maid-of-honor in her best friend April’s wedding.

April says she still can’t believe it. “I knew Carissa was tough as nails, but that day I really saw how strong she was. She’s a true role model, inside and out.”

overcoming fear Carissa admits she experienced anger and doubted God during her recovery. Her mom agrees. “She had a lot of anger–not at God but at the circumstances.

Carissa explains the journey she thought God was taking her on. “I know God gave me a fitness passion. I grew up playing soccer year round. They called me ‘Energizer Bunny, and Fireball.

“When I didn’t have soccer, I resorted to the gym to stay fit. Working out helped relieve anxiety and stress.”

Carissa says she had the hardest time accepting that perhaps her fitness pursuits were over. She confesses, “I did consider Plan B–that maybe I needed to go back to the corporate world. But I tried accounting and working in an office, and it’s not for me! So I couldn’t figure out what God was doing.”

letting go of control Perhaps the greatest battle was in her head, shares Carissa. “Lying on couch I couldn’t move. I thought about how I was just was making progress in my career.

“I finally relaxed a little bit, and told God, “OK, I’ll do what you want me to do. If this isn’t direction for me, that’s OK.

“It was a matter of accepting who I

am now, limitations and all.”

“It was a matter of accepting what had happened and who I am now, limitations and all. I realized, I had to work hard to get to where I was to begin with; this will just give me a little challenge.”

As her mother chuckles. “Carissa always had a strong internal drive. She was valedictorian in high school and her dad and I never had to tell to go do homework. She always has her mind working to figure things out.

“As time went on, I could see a peace in her when she finally accepted this as a little setback.” Carissa says God spent 2012 “drawing me closer. I look at my faith-struggle and I’m so thankful. I trust God and want to let him use me.”

Smiling she adds, “Maybe I’m not really out of it. Maybe I don’t have to resort to an office job yet. Maybe I can inspire people.”

beyond the physical Carissa shares how she was ready to face physical trauma, but that she “didn’t expect to experience so many emotions. I went through a grieving process with my body. I felt so much loss. I felt anger, sadness, denial.”

The mental recovery is worse than physical in some respects, she explains. “Like, I know it sounds terrible, but now I don’t have patience with people who are flippant about life. I’m sorry, but I get very upset with them.”

Her voice softens and Carissa share that she’s suffering from Post Traumatic Stress Disorder (PTSD). “I have a hard time trusting people or

knowing how I’ll react in a

When tragedy strikes, many people ask,

“How could this happen? Where is

God in this?” Carissa Monroe asked these

questions after a speeding SUV jumped a sidewalk and nearly crushing her legs. She says God answered in

“miracle after miracle.”

stressful situation. “At first my mom would touch my shoulder and I’d scream. I’m extra cautious about streets, cars and traffic. I get nervous when I see people on the sidewalk, too, so I drive as little as possible. Carissa confides that anti-anxiety medication is helping her cope with PTSD.

learning new normal Carissa’s life will never be the same, and so she’s adjusting. For example, “Walking can be interesting. My ankles creak a little bit,” she laughs. She’s training full-tilt, despite frustrating physical adjustments. “Jumping is so hard. I have to do squat jumps to spring off my toes and cushion my landing, or pain shoots up my hip. Part of the unknown is in her head. Literally. “One to two weeks after the accident I started getting terrible headaches. The doctors still don’t know why.”

“Unless they biopsy, we can’t know for sure. So right now, it looks like I’ll need to get MRIs for rest of my life to keep an eye on it.”But out of all the challenges she’s facing, Carissa says there’s only one real disappointment. “I can’t run anymore. That used to be my favorite. Now, runnings a no-go.”

Then she adds, “I’m considering re-constructive surgery because my bones are kind of crazy. That might help me run. Some therapists suggest I might get movement back.”Always one to look on the bright side, Carissa exclaims, “I can do low-impact exercise. After the accident, there was one ‘beast ’ I had to tame. Now I’m the Stair master queen! I pride myself in that.”

“It was a matter of

accepting who I

am now, limitations and all.”

a new day to remember August 25, 2012. Apparently God still is taking Carissa on the journey of her heart’s desire. Not one to set small goals, this marked the first time Carissa competed since the accident…at the 2012 World Bodybuilding and Fitness Federation (WBFF) World Championships. “It’s amazing. A miracle. I didn’t think I’d see that day. I just wanted to hold my own, and I did.” She credits her friends in the WFBB. “We’re like a family. They rallied behind me and prayed.”

Always looking forward to the next challenge, she adds, “I feel like in a year I’ll build up even more muscle mass.” Personal trainer training others and competition modeling also are again filling Carissa’s daily regimen. What’s a typical Carissa-workout or training session look like? “I push myself to the limit. I’m a fan of intensity and consistency. I like to help people see results and move up to next level. I think that’s really rewarding.”

Perhaps the best description of Carissa’s journey and her personal character is James 1:2-4, (The Message): “Consider it a gift, when challenges come at you from all sides. Under pressure, your faith-life is forced into the open and shows its true colors. Let it do its work so you become mature and not deficient in any way.”

Over. She confesses, “I did consider Plan B–that maybe I needed to go back to the corporate world. But I tried accounting and working in an office, and it’s not for me! So I couldn’t figure out what God was doing.”

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“Thank you to all the fire fighters who brought strength to the fight”

Everyone knows it’s necessary. Not everyone knows it’s not really a vitamin. It has fanatical believers and implacable skeptics. Adit Ginde’s clinical trial, a vitamin D study that aims to study its effects on respiratory illness promises to add fuel to the fire. An emergency medicine physician at University of Colorado Hospital hopes to shed light on the possible clinical benefits of a familiar but enigmatic substance sometimes known as the sunshine vitamin. Adit Ginde, MD, MPH, has spent years studying and publishing original research articles about vitamin D, a molecule familiar to dutiful parents who urge their children to drink milk fortified with it. Most people are also aware that humans and other vertebrates can synthesize it simply by absorbing the sun’s ultraviolet rays. The beneficial qualities of vitamin D are also generally well-known, Ginde says, thanks to a “wealth of information” gathered through decades of research and clinical trials. It enables the body to absorb calcium and phosphorus, which are essential to building and maintaining healthy bones. Vitamin D deficiency, on the other hand, causes loss of bone mass (osteoporosis) in adults and abnormal skeletal formation (rickets) in children. Ginde is now one of many researchers looking deeply into vitamin D’s potential to regulate cell activity and affect other disease processes, including infections, diabetes, cardiovascular disease, respiratory ailments and even cancer.

Ginde is leading a clinical trial, funded by the National Institute on Aging and the American Geriatrics Society, that explores what effect, if any, increased amounts of vitamin D might have in preventing respiratory infection in nursing home and assisted living facility residents. The trial will also look at whether higher doses of vitamin D improve elderly patients’ immune responses to vaccines. The randomized trial, underway for a year and a half, has so far enrolled 50 participants, he said. One group of patients will receive a standard daily dose of 400 to 1,000 IUs (international units) of vitamin D, while a second will receive 3,000 to 4,000 IUs per day – about four times the amount recommended to prevent osteoporosis. “It’s a simple intervention with large potential

benefits,” says Ginde, because nursing home residents are a group at particularly high

risk for respiratory infections. If nothing else, he hopes the vitamin D study will help build the body of evidence necessary to prove what additional health benefits – if any – vitamin D might provide. Pre-clinical and observational research indicates that low vitamin D levels are associated with increased infection risk, Ginde says, but an association, he cautions, is not a causal link. “As science has progressed, there have

been observations that people with low vitamin D levels do worse [than others],” he says. But there is “limited scientific evidence” to support the benefits of increasing doses of the vitamin beyond recommended levels, he adds. “We need clinical trials.” Vitamin D might seem an unlikely source of raging debate, but in fact, it’s surprisingly misunderstood

and controversial, Ginde says. For one thing, it’s not actually a vitamin, which is a vital nutrient people must obtain primarily through diet. Vitamin D, on the other hand, is a hormone – the body produces it on its own, like insulin. “We make it normally in the skin. It doesn’t have to be ingested,” Ginde says. That means we don’t need to take supplements or gulp gallons of milk to get the vitamin D we need. We

vitamin DFrom The University of Colorado Insider

What does Vitamin D do?◊ Helps regulate levels of calcium and phosphorus◊ Assists the body to absorb calcium, helping the body maintain strong bones

◊ Supports a healthy immune system◊ Aids almost every part of the body

Nutrition

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magnesium – a modern-day MINERAL SUPERHERO

A Modern-Day Mineral Superhero

can merely take a short walk outside on a bright day or bask near a window in a sunny corner of a room. Not so fast, say dermatologists and others who have for years admonished parents to slather sun block on their children before they apply it liberally to themselves. Getting enough Vitamin D may be important, they say, but not if it increases the risk of melanoma and other skin cancers. “Dermatologists argue that we shouldn’t expose ourselves to a known carcinogen [ultraviolet rays], and should get our vitamin D exclusively from diet or supplements,” Ginde says. Children and adults who stay indoors and wear sun block when they venture outside decrease their risk of skin cancers, he acknowledges. “But from an evolutionary perspective,” he points out, “we are meant to be outdoor people…As we look at additional evidence about the benefits of vitamin D, it could be considered a [risk] trade-off.” Vitamin D has also drawn both fanatical believers and implacable skeptics, Ginde says. “There are those who believe in it so deeply that they are willing to accept a lower standard of evidence,” he notes. “But there is also general skepticism about vitamins and supplements in general. The lay skeptic doubts that anything can be a panacea” capable of improving a disparate set of conditions, he said. Even the Institute of Medicine (IOM) entered the debate, seeking to address the question of how much vitamin D is beneficial and how much is toxic. The IOM, Ginde says, spent three years looking at available safety and efficacy data, ultimately deciding that more than 4,000 IUs of vitamin D daily increases the risk of harm, namely kidney and tissue damage. The IOM settled on a relatively conservative toxicity number, Ginde says, erring on the side of caution because it lacks solid scientific evidence that increasing vitamin D intake benefits people – unless they fall below minimum daily requirements (600 IUs for most; 800 IUs for people older than 70 years of age). Ginde says the IOM guidelines are a reasonable public health recommendation for the vast majority of the population, “based on the current state of evidence.” Individuals will make decisions about their vitamin D intake based on where they fall on the “risk-aversion scale,” he observed. “The IOM is advising the population on what they should do as a whole, and has to be conservative. But individuals and their health care providers make independent decisions about the risks and benefits of their health choices all the time.” For his part, Ginde says he’s found a receptive audience for his vitamin D study from both nursing home and assisted-living facility residents and from providers. “Family members have been overwhelmingly positive,” he reports. “It’s hard to do studies in nursing homes, but people want to contribute to science. They see it as an exciting intervention and it’s not cumbersome.”

Just as Spiderman or Superman always appears when help is needed, the essential mineral magnesium is equally reliable in coming to the rescue to protect and support our bodies. Magnesium helps maintain normal muscle and nerve function, heart rhythm, supports a healthy immune system, and keeps bones strong. Elsewhere in the body, magnesium helps regulate blood sugar levels; aids in the metabolism of carbohydrates and fats to produce energy; promotes normal blood pressure; and is involved in neurotransmitter production, hormone production, and the synthesis of DNA and RNA. And ATP, the molecule that provides energy for almost all metabolic processes, exists

primarily as a complex with magnesium. All in a day’s work for magnesium.

Most superheroes are heart throbs, and coincidentally, magnesium is

literally involved with the beating of your heart. According to Dr. Stephen Sinatra, cardiologist

and author of, “Reverse Heart Disease Now: Stop Deadly

Cardiovascular Plaque Before it’s Too Late”, magnesium is essential

for maintaining cardiovascular health and is useful for treating a

number of cardiovascular issues, including angina, arrhythmia, and

high blood pressure. “As a muscle relaxer within arterial walls, magnesium

alleviates chest pain and other symptoms of angina that are due to lack of oxygen to,

or energy in, the heart. Ingested regularly, magnesium can help maintain vascular tone,

and thus healthy blood pressure, and may also possibly reverse arterial plaques.” Magnesium’s main hide-out is in the bones, where approximately 60 percent of total body magnesium is found (the rest is stored in muscle tissue and other cells). A magnesium deficiency can alter not only calcium metabolism but also the hormones that regulate calcium (parathyroid hormone and calcitonin), resulting in weakened bones. Several human studies have suggested that magnesium supplementation can improve bone mineral density. Since magnesium plays an important role in carbohydrate

health condition causes an excessive loss of magnesium or limits absorption, as in the case of celiac disease or Crohn’s disease, supplementation is often suggested. Magnesium can be purchased as a dietary supplement in two basic forms: chelated or non-chelated. Chelated means attached to another molecule (often an amino acid); common chelated forms include magnesium orotate, magnesium glycinate, magnesium aspartate, and magnesium malate. Magnesium can also be attached to an organic acid (like citrate) or to a fatty acid (like stearate). The non-chelated forms of magnesium i n c l u d e magnesium oxide, m a g n e s i u m sulfate, and m a g n e s i u m c a r b o n a t e . Some research suggests that chelated forms of magnesium bound to amino acids are better absorbed than other forms. Those suffering from kidney failure or kidney insufficiency or whose hearts already beat at a slow rate (less than 60 beats per minute) should consult with their doctor before starting magnesium supplementation. Common Types of Magnesium Magnesium Aspartate. A mineral chelate form of magnesium containing an ion of magnesium oxide attached to the amino acid aspartic acid. Aspartic acid is a naturally- occurring amino acid found in foods but can also be made in the body. It is easily absorbed, and therefore, when bound to magnesium, increases the absorption of magnesium as well. Magnesium Glycinate. A chelated form that is bound to the amino acid glycine. This form of magnesium is less disruptive on the bowels than other forms, which can cause diarrhea. Magnesium glycinate is easier for the body to absorb; individuals suffering from malabsorption conditions like celiac and Crohn’s disease might benefit from this very bio-available form of magnesium. Magnesium Malate. The malate form of magnesium is derived from malic acid, which plays a key role in energy production. M a g n e s i u m m a l a t e is of specific benefit to individuals such as athletes, as well as those with musculoskeletal problems like f i b r o m y a l g i a . Magnesium Citrate. Derived from the magnesium salt of citric acid, this chelated form has a lower concentration, but a high level of bioavailability. Magnesium citrate is commonly used as to induce a bowel movement, but has also been studied for its ability to help prevent kidney stones. Magnesium Oxide. Some people use this non-chelated form as an antacid to relieve heartburn, sour stomach, or acid indigestion. Magnesium oxide also may be used as a laxative for short-term, rapid emptying of the bowel. Do not take magnesium oxide as an antacid for longer than two weeks unless your doctor tells you to.

metabolism, it may influence the release and activity of insulin, the hormone that helps control blood sugar levels. Low blood levels of magnesium are frequently seen in individuals with type-2 diabetes. The body doesn’t naturally synthesize magnesium so it has to come from the diet and/or supplements. Green vegetables such as Swiss chard and spinach contain some of the highest magnesium concentrations, while nuts and seeds including almonds, cashews,

pumpkin seeds, Brazil nuts, and walnuts are also excellent sources. As soil becomes increasingly magnesium deficient, and cooking and processing practices leech magnesium from foods, health experts generally suggest magnesium supplementation in tandem with a healthy diet. The Recommended Daily Allowance (RDA) for magnesium is 350 milligrams per day for adult males and 280 milligrams per day for adult females. However, the average intake of magnesium by healthy adults in the U.S. is typically much lower. O n e study sponsored by the National Institutes of Health found that 68 percent of Americans are magnesium deficient, while other experts estimate that number to be closer to 80 percent. Food choices are the main reason, but other k r y p t o n i t e - like factors that either reduce absorption or increase secretion of magnesium include high calcium intake, alcohol, sugar consumption, caffeine, stress, diuretics, antibiotic use, cancer medications, liver disease, kidney disease, and oral contraceptive use. Early signs of magnesium deficiency include loss of appetite, nausea, poor memory, fatigue, insomnia, irritability, and apathy. As magnesium deficiency worsens, numbness, tingling, muscle contractions and cramps, seizures, personality changes, abnormal heart rhythms, and coronary spasms can occur. Since magnesium is absorbed through the small intestine, when a specific

What does Magnesium do?

◊ Regulates the absorption of calcium

◊ Regulates the contractility of

the heart muscle

◊ Has a relaxing effect

on smooth muscle

◊ decreases coagulation and acts

as a calcium channel blocker

Nutrition

30

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Alesia Cronkhite is a Registered Representative of Park Avenue Securities LLC (PAS), 7 Hanover Square, New York, NY 10004. Securities products and services offered though PAS, 1-888-600-4667. Financial Representative, The Guardian Life Insurance Company Of America (Guardian) New York, NY. PAS is an indirect, wholly owned subsidiary of Guardian. PAS is a member FINRA, SIPC. Registered Representative is securities licensed in Colorado (license # 41114), California (license # 0E56762), Nebraska (license # AG332189), Texas (license # 916265), Pennsylvania (license # 504417), and Utah (license # 271571). This material is strictly intended for individuals residing in those states. No offers may be made or accepted from any resident outside these specified states. The information or opinions contained in this Internet site should not be construed by any consumer and/or prospective client as an offer to sell or the solicitation of an offer to buy any particular investment product. The information contained herein is directed solely to those individuals who reside in jurisdictions in which the representative is registered in the state where the consumer and/or prospective client reside. Any subsequent direct communication with a consumer and/or prospective client shall only be conducted by a representative that is registered. Alesia Cronkhite is insurance licensed in Colorado (license # 41114), California (license # 0E56762), Nebraska (license # AG332189), Texas (license # 916265), Pennsylvania (license # 504417), and Utah (license # 271571). Disability income insurance underwritten and issued by Berkshire Life Insurance Company of America, Pittsfield, MA, a wholly owned stock subsidiary of The Guardian Life Insurance Company of America, New York, NY. Products not available in all states. Product provisions and features may vary from state to state. Guardian, its subsidiaries, agents or employees do not give tax or legal advice. You should consult your tax or legal advisor regarding your individual situation. The Living Balance Sheet ® and the Living Balance Sheet ® Logo, are registered service marks of The Guardian Life Insurance Company of America. The graphics and text used herein are the exclusive property of The Guardian Life Insurance Company of America and protected under U.S. and International copyright laws. © Copyright 2005-2011, The Guardian Life Insurance Company of America

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Cronkhite Wealth Strategies works with individuals and business owners who recognize the value of knowledgeable, experienced, financial professionals. We are an acclaimed leader in providing insurance and investment products and services that are specifically designed to help secure your current and future financial well being.

At Cronkhite Wealth Strategies, our goal is to provide our clients with the tools that will simplify their financial world and keep them organized and educated on sound wealth planning programs and products.

Cronkhite Wealth Services provides:

• A system and a process to individuals and business owners helping them to take the costly guesswork out of insurance and wealth planning.

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• A process that continually “stress test’s” products and strategies to help you identify and clearly see the impact of each financial decision made, and the affects of those decisions in the future.

Lacy Cronkhite, LUTCF

“Light The Mood in Your Home.”

(Valuable Window Fashion and Lighting Tips, Room by Room)

Decorating

There are several key ingredients to creating great spaces within your home, but they all end with an overall result… “What mood does the space leave?” Successful spaces are the result of all key ingredients merging into one and working in harmony. Lighting is one of these ingredients. And let’s face it, lighting can drastically change the feel of a space. So where does our lighting come from? There’s natural lighting (windows) and artificial lighting (fixtures). Fixtures are specific in living areas such as kitchens and baths. Natural lighting is less specific and fills a room with more ambient light. But we are still left with the challenge of controlling both light sources. Window coverings allow you to control and direct natural lighting. They also dress up your window and enhance your space. Your space can be designed beautifully, have amazing textures, rich colors, eye catching décor, and just the precise amount of plants and fresh flowers. But if you’re lighting is off, it will kill the entire look. It’s like having a designer outfit on, looking your best, every hair is in place, but you wear an outdated, hideous pair of shoes. You kill the entire look! And once you realize it (if you do), the mood is negatively influenced. The reason many Homeowners are unsure of lighting solutions is because they simply don’t have the tips and tricks of the trade. Keep reading, because I’m about to share some juicy information with you! Here are 4 popular spaces in homes today and some key points for each. Follow my designer tips and you’ll soon be

celebrating the very mood you wished to achieve!

Family / Living Rooms

We love our family rooms! After all, it’s where we spend our time either relaxing, being a family, playing a game, entertaining, or watching our favorite TV show. This is a space where controlling light is critical, depending on the activity in the space. - Keep colors muted. Earth tones and neutrals will always create a soothing mood.- Window shades that work best for this space: blackout (for television viewing), shades that allow directional tilting such as wood blinds or sheer shades. - Choose a color and shade that compliments your current décor. - If you have an accent wall in your space, consider a window shade that coordinates or matches your wall color. - Choose textures and colors that invite the ‘cozy factor.’ Plush throws, oversized pillows, upholstered furniture, soft rugs, and controlled lighting will all allow just the right mood for this space. - Don’t forget the dimmer switch! Dimmer switches allow you to control the level of your artificial lighting. Plus, it’s a small investment that offers a substantial influence to the mood of your space!

Kitchens / Eating Areas

Our kitchens have become an extension of family rooms. They’re where we gather the most. After all…the stomach knows best, right? - Lively prints and bold patterns will enhance this space. Consider a Roller Shade or Roman Shade for this space. The possibilities are endless with these types of shades. You can choose patterns and designs that coordinate with your décor as well! - Have fun with your colors here. Since you don’t want to fall asleep in this space, don’t go overboard on your muted palette. Colors that lift your mood such as reds, oranges, and yellows are perfect in kitchens. - This is usually the first or second room we enter as we start our day! Choose colors, textures, and décor that invite you in and lift your mood.

Bathrooms

Oh, the poor bathroom. Our lives are so busy these days, they can look more like a chemistry lab or laundry room than the retreats we need them to be! If you desire a space that invites you in the morning, and resolves you at night, follow these tips…. - Keep your colors rich and muted. You can never go wrong by choosing soothing wall colors in this space.

Consider a Roller Shade, Roman Shade, or Cellular Shade for this space. - Since bathrooms require privacy, consider a top down bottom up shade. This allows more control of your natural lighting and privacy. - Keep décor and textures simple. - If you want that spa-like feel, visit a local spa and take note of how they treated the space. Colors and textures will all create a mood that soothe. - Personalize this space if you need! I love photos so, if your pup Baxter is the apple of your eye, consider a cute picture of him on your vanity. His wagging tail and sincere eyes will surely put a smile on your face. And what a great way to start your day!

Bedrooms:

They’re our sanctuaries. They’re the space that is most personal to us and often a space that either hugs us, or frustrates us. Follow these tips, and the frustration will fly away….- Choose 2, no more than 3 colors to design this space. - Select a rug, bedspread, or artwork to serve as the inspiration for the room. Build your entire design for your space around that item. - Keep lighting soft, soft, soft! Avoid artificial lighting that is fluorescent, too bright, or too harsh. Lamps or chandeliers are always a sure decision.

Decorating

- Consider blackout window shades. A Cellular shade, Roller shade, or Roman shade offers this feature. Who doesn’t want the option to control natural light in a sleeping space? Afternoon nap anyone? Morning sun too bright? - Avoid the clutter. Our lives are hectic enough so, why would you allow your sanctuary to get that way? - Don’t forget that dimmer switch!

Use these above guides when creating your spaces and you’re sure to love the moods they create! The elements that come together when the right lighting is achieved transform a room into a seamless combination of functionality and style. When you have the knowledge, you have the confidence! Happy Decorating!

WWW.CARRIANNJOHNSON.COMwww.selectblinds.com

charles f. wennogle, jr., m.d.Board Certified Radiologist

Fellowship Trained in Cardiac and Body Imaging

Undergraduate Education YaleUniversity

Medical School BostonUniversity

Internship/Transitional Internship FitzsimmonsArmyMedicalCenter

Radiology Residency BrookeArmyMedicalCenter

Fellowship CardiacandBodyImaging,University ofColoradoHealthScienceCenter

Board Certification AmericanBoardofRadiology UnitedStatesMedicalLicensing Examinations(Steps1through3) RadiologyandCardiacComputed Tomography

Professional Affiliations CardiovascularComputedTomography ComputedBodyTomographyand MagneticResonance AmericanCollegeofRadiology ColoradoRadiologicSociety AmericanRoentgenRaySociety RadiologicSocietyofNorthAmerica

Special Interests BodyImagingtoinclude AbdominopelvicMR/CT CardiacandCardiovascularMR/CT BreastMR PETCT

Licensure Colorado Florida NewMexico Texas

Volunteer Duties YouthSportsCoach •baseball •wrestling •football

Personal Interests Football,softball,wrestling,skiing, fishing,hiking,camping,travel

Email [email protected]

unmistakable quality . . . spectacular service

Navigating the New World of Coordinated Healthcare

Coordinated Care in a Snapshot

How will coordinating healthcare benefit me? Advanced coordinated carecare coordination seeks to improve the quality of care at lower pricecost, resulting in better health. In other words, increased value and savings for you as a patient.

How do traditional and coordinated healthcare differ? Coordinated care navigates the patient through the entire healthcare system. Caregivers reach out to patients through for prevention, managing disease, and health and wellness. In traditional healthcare, patients must typically navigate for them-selves.manage their own health needs.

What if I have doctors both within and outside my coordinated care providers? Coordinated care is inclusive and flexible, not restrictive. Patients, their primary care team and their outside care provid-ers are encouraged to share information across the healthcare continuum.

Is coordinated care here to stay or a passing phase? Coordinated healthcare is starting beginning to happen across the country. Colorado is at the cutting edge, participating in Medicare’s nationwide pilot “Comprehensive Primary Care Initiative pilot.” Early statistics and patient satisfaction show posi-tive results.

Remember when groceries were the only things sold in a grocery store? No in-store pharmacy, bank or restaurant. No clothing or home-goods section. No convenient-store gas station. We sure have evolved.

So it goes with the healthcare industry. Changes are happening to improve our medical experience. Say goodbye to traditional healthcare. Welcome to the new world of advanced coordinated healthcarehealthcare coordination!

Welcome AboardTraditionally, we visit our family physician in a separate

location from our specialists. We don’t expect our overworked family doctor to communicate with our cardiologist. It’s our responsibility to share what we think is important with our doctors.

Most of us have had a doctor prescribe expensive lab tests or

X-rays. Has the lab ever called you to say, “We’re sorry; you didn’t need those tests. Your doctor wasn’t

aware you already had similar tests done with a specialist.”? (Of course, you still have to pay for the lab work, and you can’t get back the several hours you were inconvenienced.)

This sort of communication breakdown resulting in unnecessary medical treatment

happens all too often, according to Debbie Chandler, Executive Vice President for Colorado Springs Health

Partners (CSHP). “That’s what’s what has helped to driven up costs and

patient frustrations,” she says.If only medical professionals

communicated with each other. We all could be spared expense,

time and frustration. Coordinated healthcare provides the avenue

for real time communication, reducing costs and ushering in a system of quality care.

Demystifying Coordinated CareSo what does coordinated care really look like? Dr. Dennis Schneider, M.D. and Chief Medical Officer for CSHP, explains. “Coordinated care is for patients, wherever their care is: at the primary care site, the hospital, with their surgeon or specialist, or even at a skilled

nursing facility. “It’s care across the entire continuum,” he adds.

“We pretty much use one system to coordinate care for the patient. That’s what makes coordinated patient care better than traditional care.”

Dr. Schneider illustrates using a football analogy. “You have a quarterback. That’s your primary care physician who coordinates the team to achieve the goal. It’s about you engaging with your primary care doctor; but they provide care beyond the traditional office setting.”

Colorado: On the Cutting EdgeCoordinated care is a movement that’s starting to happen

across the country. Medicare (The Centers for Medicare and Medicaid Services) is doing a nationwide pilot called Comprehensive Primary Care Initiative, and selected Colorado

as one of seven pilot regionsmarkets.

“Medicare chose 75 73 practice sites in Colorado, of whichand all eight of CSHP’s primary care locations were selected. Participation is based on qualifications such as medical home certification and

40

electronic health records. “We are the early vanguard of this in Colorado,” says Dr.

Schneider. Debbie adds, “We’re not just limiting coordinated care to Medicare patients; we’re doing this for all patients.”

At CSHP, Teamwork Is KeyCSHP provides service in care-giving teams. “As a team,

we can help patients navigate the healthcare system,” says Debbie.

Patients are invited to select a support system or ‘team’, including of friends or family members who to participate in the patient’s healthcare and wellness.

“We’re even starting a patient advocacy group,” adds Debbie. “We’re bringing patients and their families to the table to tell us how to improve coordinated care.”

CSHP takes the team concept in a unique direction, replacing traditional physicals with annual health assessments. Together, patients and their primary care doctors determine what they need to get healthy and stay healthy over the year.

“We work on a personalized and individualized care plan with labs, X-rays, follow-up visits–whatever is needed throughout year,” explains Dr. Schneider.

“The doctor doesn’t simply say, “Go home, lose weight and exercise. We ask, ‘What are your barriers? What’s holding you back? What can we do to help?’”

Although the patient bears the ultimate responsibility of follow through, coordinated care providers participate beyond traditional levels to help patients achieve their goals.

Understanding Your Medical Home

The terms “coordinating care” and “medical home” are basically the same

thing, placing the patient is at the center of care. CSHP calls their medical “home,” Patient Care Compass.

“We are a Certified Patient Care Centered Medical Home (Level 3III). When you say ‘medical home,’ most people think it’s a nursing home,” laughs Dr. Schneider. Not so.

Medical home is a medical practice that has adopted the coordinated care concept. In other words, “This is your ‘home,’ where you get your care, as we coordinate throughout the medical system.

“When a patient is hospitalized and discharged, they communicate directly with our nurse ‘navigators,’ keeping with the Compass theme.” The nurse is a proactive partner on a patient’s care-giving team.

“They call patients when they get out of hospital, make sure they have necessary medicines, help put a care plan into action, and set up follow-up appointments,” adds Dr. Schneider.

At CSHP, the emphasis is on preventative care and wellness, as well as treating people who are sick. They offer classes to educate patients on how to stay healthy; and about conditions like diabetes, high cholesterol and obesity.

Unique to CSHP is “our degree of integration,” emphasizes Debbie. We are a multi-specialty group with doctors in primary care and specialties within our organizationpractice.” She says such depth enables CSHP to better coordinate care, in terms of making sure patients’ referrals and care

needs are met.

Does Coordinated Care Really Work?

“National and local data show positive results,” shares Debbie. For instance, studies by the National Committee on Quality Assurance (NCQA, an external certifying body) “show

41

the outcome of this approach is lower cost and higher quality of care.”

Dr. Schneider says CSHP invested in quality metrics to do clinical analysis. “These quickly identify gaps in care.

“For example, if we need to improve care of diabetic population or cholesterol scores, then we can focus on outreach to those patients.”

Data results are important; however, Debbie says, “Wwhat matters most in coordinated care is patient response. So far it’s being received very well. This is all relatively new, but in many respects it’s what we have been striving to do all along.”

Dr. Schneider adds, ““Our goal is the alignment of what patients want us to do. Patients aren’t used to that. It’s not standard practice for any physician or group.”

Why Change Now?“We had to get to a crisis point in order to do something,”

shares Debbie. “I’ve been in healthcare for 30 years on the physician’s side of delivery. Healthcare isn’t centered around the patient anymore.

“It’s in silos–fragmented care among providers who don’t communicate. There’s a lot of patient frustration. We’re trying to improve patient satisfaction.”

Dr. Schneider agrees. “The healthcare system is broken and everybody knows it. We have to do things differently. We, meaning everybody.

“Patients have to participate in their own healthcare. Providers and people who pay the bills need to do things differently.

“To their credit, employers and Medicare are recognizing the need for emphasis on wellness,

versus waiting for employees to get sick and then care for them.” The Future of Coordinated CareFuture plans for advanced care coordination fall

under the category of continuous quality improvement, according to Dr. Schneider. “Data feedback of on how we’re doing sends our group on down a path for of continuous quality improvement.”

Three areas CSHP continues to improve are in home care, electronic advancements and mental health:1. Home care. “This means we go to patients in their

homes,” explains Dr. Schneider. It doesn’t mean everyone has a home visit, but we customize patient care.”2. Electronic advancements. E-visits and email

communication are starting to happen. Tele-visits are used where Iinternet isn’t feasible. “There’s no reason not to do that in town, adds Dr. Schneider. “Some people don’t have rides to their doctors or simply can’t get out.” 3. Mental health. Many times obstacles to improvement

aren’t physical but mental. “People need assistance there,” says Dr. Schneider. “It could be struggles with the economy, jobs or post traumatic stress.”

The Bottom Line“ We believe and evidence shows coordinated

care is better (than traditional) care,” says Dr. Schneider. “I t ’s better because it ’s higher quality at a lower cost.

“Of course, that ’s the definition of value. And that ’s what we’re all striving for—patients, doctors, everybody.”

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We believe everyone should have access to a healthy life, no matter where they are. That’s why our health plans give you world-class care with a choice. We provide tools to help you manage your health—like nurses to answer your questions, online classes, and more. Because when you can get the care you need, when you need it for you and your family, it’s a whole lot easier to seize that day.

NOW OFFERING PLANS FOR INDIVIDUALS AND FAMILIES. To learn more, call 1-866-710-2727 option 3.

kp.org/thrive

HERE’S TO SEIZING EVERY DAY.

… Pikes Peak Hospice & Palliative Care Attains 4 Stars!

We Honor Veterans

The National Hospice and Palliative Care Organization recently recognized Pikes Peak Hospice & Palliative Care (PPHPC) as a We Honor Veterans Level 4 Partner. This recognition signifies PPHPC’s exemplary commitment to providing the highest level of care to those who have served our country. It may surprise many people to learn that 25 percent of those who die every year in the United States are veterans. We Honor Veterans was developed by the National Hospice and Palliative Care Organization in collaboration with the Department of Veterans Affairs to help provide the care and support that reflect the important contributions made by these men and women. Designed to empower hospice professionals to meet the unique needs of dying veterans, the program formally incorporates resources that focus on respectful inquiry, compassionate listening, and grateful acknowledgement of the veteran’s sacrifices. Pikes Peak Hospice & Palliative Care has met stringent requirements that help improve the care their team of professionals and volunteers

provide to the veterans they proudly serve. “By recognizing the unique needs of our

nation’s veterans who are facing a life-limiting illness, PPHPC is able to accompany and guide veterans and their families toward a more peaceful

ending. In cases where there might be some specific needs related to

the veteran’s military service, combat experience or other traumatic events, our care

teams find tools to help support those they are caring

for,” said Martha Barton, President and CEO of PPHPC. Participating hospices must meet specific criteria demonstrating organizational commitment and capacity to provide quality care for veterans to advance through five partnership levels: Recruit, Level 1, Level 2, Level 3, and Level 4. The various levels of partnership are denoted by the number of stars used in the We Honor Veterans logos. As of July 1, there were 1,954 hospice

Wellness

providers in the United States enrolled as We Honor Veterans partners. Only 90 of those have achieved Level 4 status, including three in the state of Colorado – Pikes Peak Hospice & Palliative Care, TRU Community Care, and Sangre de Christo Hospice.

Symbols of Appreciation

Several years ago Pikes Peak Hospice & Palliative Care staff created two additional ways to acknowledge and thank the distinguished veterans receiving our care. An heirloom-quality coin (similar to those used by the Armed Forces to recognize service and build morale within units) in the shape of a dog tag, and a personalized certificate of appreciation are formally presented to each veteran patient. “The coin and certificate are expressions of gratitude to veterans for their service to our country,” Barton said. “This may seem like a small thing to do for our veterans who have given so much. But as we say ‘thank you,’ we have heard some incredible stories about veterans finally breaking the silence and telling loved ones of their service.” PPHPC has now presented more than 1,600 of these tokens of appreciation to our patients who are U.S. veterans and many who served in the Allied Forces, including the Royal Navy, Royal Air Force, Royal Canadian Air Force, Royal Danish Air Force, and even the Dutch Underground. The dog-tag coins were initially underwritten by Classic Companies, a commercial and residential real estate company. As the program has grown, individual donors have also provided underwriting. “The staff and volunteers of Pikes Peak Hospice & Palliative Care will never forget what it has felt like to meet and care for our honored veterans, Barton concluded. “America’s veterans have done everything asked of them in their mission to serve our country and we believe it is never too late to fulfill our mission to serve these men and women with the dignity they deserve.” For more information about Pikes Peak Hospice & Palliative Care and our special program for veterans, please visit the PPHPC website at www.pikespeakhospice.org or call 719-633-3400. To learn more about the We Honor Veterans program, visit www.wehonorveterans.org.

45

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jessica LONG

Born to swim

the most decorated PARALYMPIAN

Twenty-year-old Jessica Long is a stunningly beautiful young woman, no doubt about it. She is also kind, much-loved, and phenomenally successful in her chosen field. She is a Paralympic swimmer.

Some folks might think, well, how nice for her. She’s just one of those people good things get handed to on a silver platter. Looks, athletic ability, fame. Some people have all the luck.

Turns out, in Jessica’s case, “luck” has nothing to do with it. Hard work, yes. Fierce determination, absolutely. Unwavering tenacity, oh yeah. But luck? Not so much.

Jessica came to the United States when she was just 13 months old. She was born in Siberia and living in a Russian orphanage when her Baltimore parents adopted her and a three-year-old boy who also lived at the orphanage. Both she and her non-biological brother had physical challenges. For her brother, it was a cleft lip. For Jessica, it was fibular hemimelia, a condition affecting her lower legs.

“I was missing the fibula bone and most of the other little bones in my ankles, heels, and toes,” says Jessica. After consulting with a number of doctors about options for the tiny toddler, Jessica’s parents made the informed decision to have the then-18-month-old’s legs amputated below the knee so that she would be able to wear prosthetic legs.

“And within two weeks I was up walking around, I never needed physical therapy,” she says. “I wanted to do it all on my own. I think that’s always just been my personality. When I saw other kids, I wanted to do what they did, I didn’t want to be held back because of my legs.”

Safe to say, some 18 years later, nothing has held Jessica back . Long is l iv ing and training in Colorado Springs at the U.S. Olympic Training Center, preparing for the June swimming trai ls ahead of the 2012 London Paralympic Games. Long currently holds 20 world event swimming records, having exploded onto the Paralympic scene at the r ipe age of 12, when she was the youngest competitor to make the 2004 team. She stunned the spor ts world (not to mention her family) in Athens by

49

22Fall 2013

winning three gold medals. Her winning cur ve was set on a steep trajector y that hasn’t shown a hint of level ing since.

I n t e r e s t i n g l y , swimming was not Jessica’s first sport of choice. As a young child, she loved gymnastics. She was quite good, but her parents worried about the toll gymnastics was taking on her legs.

“I was always very active,” says Jessica. “I tried a lot of sports – basketball, c h e e r l e a d i n g , gymnastics, skiing, everything you can pretty much think of that doesn’t involve running or kicking a ball. I’m one of six kids and we were all home-schooled, which worked out well with all the surgeries I had to have as my bones grew. I loved gymnastics, but I did it on my knees, and my parents were afraid I would damage them. So they basically gave me an ultimatum, saying, ‘Jess, if you want to continue with gymnastics

you’re going to wear your legs, or you’re going to have to find

another sport.’”

As chance would have it, Jessica’s grandparents

had a swimming pool in their back yard, and the Long family often congregated there.

“I’ve always loved to swim,” says Jessica. “Every Sunday after church, I’d be the first one in and the last one out. I could spend hours [in the water], I mean I thought I was a mermaid! It’s like a whole other world down there. So after the whole gymnastics incident, and having to decide, it just seemed right.”

When Jessica was 10, her grandmother

saw a notice about joining a swim team, and

encouraged Jessica to try out. “I made the team,

and loved the kids I swam with. They treated me just

like everyone else. And I could beat them, or most of them. Most

people didn’t know I was missing my legs until I got out of the pool.”

At one of Jessica’s swim meets, an event

official approached her parents and said based on her times, they might want to look into the Paralympics.

“We didn’t know what the Paralympics were,” recalls Jessica, “but we decided to give it a try, and I went to a national championship meet and I ended up winning two gold medals and a silver. The next year was the Paralympic trails. My family went to the trials, but only my dad and I woke up early on the morning after the swim meet to go hear who got announced. I had made great friends there, and I wanted to be there to see who made the team. I never thought I’d make the team, but I kept hoping. Then they called my name, and you know, it was the start of something huge.”

Jessica hopes to be entered in all seven individual swimming events in London, as well as two relays. “The competition is over 10 days, and it’s exhausting,” she says. “And of course that’s what we train for, knowing there will be exhaustion, not really eating enough food, competing morning and night, stress, and talking to reporters.”

Her typical day at the USOC starts early with two hours in the pool, followed by an hour of weights, then another two hours of swimming in the evening, an hour of yoga, an hour of abs, and careful attention paid to diet and rest.

Jessica is determined, and she’s ready. With two Paralympics under her belt (Athens 2004, and Beijing in 2008, in which she won four gold and a silver and bronze) Long looks forward to the London experience.

“I’m 20 now,” she says. “I’ve grown up with athletes all around the world, and we’re all at the age where we’re really just ready to enjoy each other’s company, and obviously swim as fast as we can.”

For Jessica Long, being in the water is being where she belongs. “It’s truly where I’m equal with everyone else. It’s a completely different world, I’m just there. I can hold my breath and hear the sound in the water, smell the chlorine, it’s just completely home.”

What’s important, says Long, is for each of us to find what we enjoy doing and what we’re good at. “You can always set goals and you can always start new and fresh, it’s never too late. Just stay active and be determined.”

Determination, one might say, is something Jessica Long knows a thing or two about.

“Ten years after joining that first swim team, and I am still doing what I love.”

Follow Jessica on Twitter @ JessicaLong92.

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fat switchthe

Learn what causes obesity andsimple methods to fight it

By Richard J. Johnson M.D.

May be key to turning off obesity according to CU prof’s new book says cellular triggers add pounds

Weighing in at just 244 pages, plus end notes, glossary, index and the like, the new book, The Fat Switch is light for a magnum opus.

That’s sweet irony for an exploration of what its author, Richard Johnson, MD, chief of the division of Renal Diseases and Hypertension at the University of Colorado School of Medicine, believes to be the hidden mechanism behind obesity, a disease that afflicts more than one-third of U.S. adults and is responsible for a host of other health problems, according to the Centers for Disease Control and Prevention.

Johnson is a kidney expert whose research has taken him far beyond the bounds of the typical nephrologist’s sphere.

The Fat Switch ranges widely in building its case that biological survival mechanisms etched into our genes millions of years ago have at least as much say about body weight as do diet and exercise choices freely made. If Johnson is right, medical researchers may one day develop pills that help overweight and obese people get back on a healthier track. Johnson and colleagues are already working on it at CU, in fact.

Johnson came to study obesity by way of the kidney. High blood pressure, or hypertension, is associated with disease in the kidneys’ small blood vessels, which robs them of their ability to get rid of salt. Uric acid, long associated with high blood pressure, drives the blood vessel disease and the development of hypertension, Johnson’s lab reported in 2002. In a study published in 2008 with Dan Feig of the Baylor College of Medicine, Johnson showed that lowering uric acid could improve blood pressure in hypertensive adolescents.

Uric acid is best known for causing gout, a type of arthritis caused by the buildup of acid crystals in the joints. But as Johnson and his team looked at uric acid, they found it created even more havoc. In research pending publication, Miguel Lanaspa and Johnson have also fingered uric acid as a culprit in obesity.

Uric acid comes from the breakdown of the cellular fuel ATP ( p r o d u c e d by mitochondria) as well as the breakdown of DNA and RNA, primarily from foods. But this breakdown d o e s n ’ t have to yield uric acid, Johnson and Lanaspa f o u n d . There’s a fork in the metabolic road, with only one of the paths leading to uric acid.

The path to uric acid is a rocky path. The c o m p o u n d leads mitochondria to boost fat synthesis while the body burns less energy, Johnson and colleagues have f o u n d . T h e implication is that the same amount of food builds fat into – and saps energy from – people on the uric acid pathway.

“Too much food intake plus too little exercise equals fat,” Johnson writes. “However, our work suggests the interpretation is different. Obesity is not from gluttony and idleness, but rather because we have activated the same program all animals use to increase fat stores.”

But who’s on this program, and why?

The answer, Johnson and colleagues say, has to do with fructose, the subject of Johnson’s 2008 book, The Sugar Fix.

Incoming fructose – a mainstay in the corn syrup poured into sodas and many processed foods, not to mention honey, maple syrup, ripe fruit and other sources – triggers a mass mobilization of the enzyme fructokinase in cells. Fructokinase carries out the first step in the body’s harvest of the four calories per gram of energy fructose carries.

But to get to that energy, fructokinase first sucks gobs of ATP, the cellular fuel, thereby activating the fat-building uric acid metabolic pathway, or switch, Johnson says.

Diet and exercise still play a role in managing weight, of course, Johnson adds.

54

Wellness

“Fructose is the fire; high-fat diet is the firewood. Together they drive the obesity epidemic,” as he described it in the book. Exercise, he adds, burns energy and predisposes the body to burn more energy over the long haul. In writing The Fat Switch, Johnson didn’t stop with the molecular science behind weight gain. During the year he wrote it – early mornings, late nights, weekends – he researched everything from “Norwegian fish journals to Sanskrit from 400 A.D.,” as he put it.

The book incorporates discussions of emperor penguins, the art of Peter Paul Rubens; Friar Tuck; Falstaff; the Columbian World Exposition of 1893; the Yanomamö Indians of Venezuela; the Inuit; San women with steatopygy (characterized by massive behinds); the gastric brooding frog (possibly extinct); hummingbirds; the desert gerbil; the gray whale; the bar-tailed godwit; the marine calm worm; the great racehorse Secretariat; and the striped gopher – native to Minnesota, where Johnson went to medical school.

The sugar-uric acid fat switch operates in everything from whales to bears to Midwestern squirrels, Johnson found. It’s what they use to fatten up before they migrate or hibernate. Mollusks, crayfish and insects similarly rely on uric acid for survival. The primates that became humans, we learn, lost their ability to process uric acid roughly 15 million years ago through a genetic mutation. Why? It helped put on fat quickly when food was bountiful, providing what became a decisive survival advantage during lean times.

Johnson described the resulting work as a “telescopic,” as opposed to a microscopic, approach to science. Instead of drilling down on one molecule, as so often happens in science, his approach was to scan the horizons of human inquiry for evidence. He looked into evolutionary and molecular biology, comparative physiology, basic medicine, and even history, “and when you put it all together, the argument [for a fat switch] becomes quite compelling,” Johnson said.

His fat switch hypothesis may be wrong, Johnson admits. But he says the data, published and forthcoming, is compelling.

“This is going to challenge the whole field of obesity research,” Johnson said. “lt’s identifying a mechanism for obesity and it is defended. It’s going to be very exciting to see the response from the scientific community.”

With the fat switch identified, Johnson’s University of Colorado research group is working on finding ways to keep it turned off. Among the possibilities: fructokinase inhibitors, uric acid suppressors, and antioxidants to salve mitochondria during uric acid’s onslaught. Johnson has launched a biotech startup, Polaryx Therapeutics, which is focusing on fructokinase inhibitors.

The Fat Switch is a compelling read, said James O. Hill, PhD, the Anschutz Health and Wellness Center’s executive director and also director of the University of Colorado School of Medicine’s Center for Human Nutrition.

“I don’t think this is a magic switch at all, but he’s identifying some biological pathways that might be important targets in future pharmaceuticals, diet strategies and so on,” Hill said. “This is some really, really solid research, and I think it’s great food for thought for anybody who’s studying obesity.”

Hill added that Johnson, in addition to having done his homework, “is not afraid to push a bit, which I like.”

Richard Johnson, MD, Cheif of the division of renal diseases and hypertension at the CU School of

Medicine, with his new book, The Fat Switch.55

Wellness

Wellness The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) has published a position paper addressing weight management in which they state “It is the position of The Academy of Nutrition and Dietetics that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity”2. Encourage clients to seek programs that not only provide support for weight loss but also offer avenues to improve lifestyle behaviors and encourage physical activity as means to enhancing and maintaining the weight loss achieved through changes in diet and eating habits. Characteristics of weight loss programs that support long term weight maintenance include: • A thorough assessment of the client to determine energy, protein, vitamin and mineral needs. The goals should be to decrease the energy consumption (preferably in combination with increased energy expenditure through physical activity) while providing adequate protein, vitamins and minerals. The assessment should not only include measuring the client’s height, weight and waist circumference, but also assessing their body fat percentage (e.g., DXA or BodPod assessment of body composition, multi-site skinfold testing). Recommendations for a slow, steady weight loss. Most clients have gradually gained weight over several months or years. Unless urgent medical issues require a quicker weight reduction, weight should be lost in the same manner in which it was gained—slowly--to increase the likelihood of weight maintenance once the weight goal is achieved. • An emphasis on healthy eating and incorporation of physical activity into the client’s normal lifestyle to support weight maintenance once the weight goal is achieved. Programs that rely heavily on meal replacements (e.g., liquid meals, meal bars or calorie-controlled packaged meals) may not teach clients how to maintain their new, lower weight through lifestyle and behavior modifications. Consequently, once clients stop using the meal replacement they usually return to old habits and regain the weight that they lost. Good weight loss programs may incorporate a meal replacement as part of the weight loss intervention but they should also be teaching the client how to modify their eating behavior and lifestyle to maintain the weight loss once the meal replacement is discontinued as part of the intervention. There are many good weight loss programs throughout Colorado. Finding a program in your area may be as simple as contacting a local Registered Dietitian (RD). The Colorado Dietetic Association, an

affiliate of the Academy of Nutrition and Dietetics, has a ‘Find a Dietitian’ feature on their website (http://www.eatrightcolorado.org/dietician.cfm) that helps health care practitioners and clients find RDs in their area. Many insurance providers also have RDs on staff or offer weight loss programs for their clients. Another resource is the Peak Nutrition Clinic at the University of Colorado Colorado Springs (UCCS). The Peak Nutrition Clinic at UCCS emphasizes the use of fresh ingredients, cooking and eating together and balancing energy expended from exercise with energy from food means maintaining a healthy approach to what and how we eat, when and how often we move, and how simply we achieve to live in this world of abundance. The Peak Nutrition Clinic will be offering a new weight loss program during the first part of 2013. This program is specifically designed for those who need to lose at least 30 pounds or those who have health issues related to weight. This medically supervised program includes weekly lifestyle modification classes in combination with a science-based, nutritionally balanced meal plan. For more information, please call (719) 255-7524. 1. National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity and Obesity. Overweight and Obesity: Colorado—state nutrition, physical activity, and obesity profile. http://www.cdc.gov/obesity/stateprograms/fundedstates/pdf/Colorado-State-Profile.pdf. Accessed 12/7/12. 2. Seagle HM, Strain GW, Makris A, Reeves RS. Position of the American Dietetic Association: Weight Management. J Am Diet Assoc 2009;109:330-346.

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