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UpsetAndPregnant_13822426Mediumby Karla Oceanak

Julie’s mom drank alcohol while she was pregnant with Julie and everything turned out OK, so Julie figured it would be OK for her to have a drink now and then during her own pregnancy.

Eva’s not ashamed to say that she smokes pot. It’s legal here in Colorado, and besides, cannabis is a natural substance. And now that she’s pregnant, it helps with the nausea.

Ever since she was in a car accident a few years ago, Tanja has relied on prescription medication to cope with the lingering pain. She hasn’t told her OB/GYN that she still takes Tramadol sometimes, even though she’s three months pregnant.

While these particular women are fictitious, their stories are essentially true. Many women in northern Colorado continue to use drugs and alcohol while they’re pregnant. And in 2013 at Poudre Valley Hospital and Medical Center of the Rockies, alcohol, pot and Tramadol were the three substances most commonly found in their babies’ systems after delivery.

The trouble is, when a pregnant mom drinks or uses drugs, the baby drinks and uses drugs too. And while we’ve all heard stories about mothers who drank or used and their babies were born perfectly healthy, the truth is that there’s no known safe level of drugs or alcohol for developing babies.

Kelly Bernatow, women and children nurse navigator at PVH, points out that drug and alcohol use during pregnancy does not have a typical face. “Where we’re really seeing an influx is in the upper- to middle-class.”
“There’s not enough medical research to know how much—if any—of any given substance might be OK,” said Bernatow. “So, the only safe amount of drugs and alcohol for a pregnant mom to consume is none.”

Pills_5239816MediumStill, Bernatow emphasizes that she and the other nurses and doctors at UCHealth are there to help moms and babies, even when the moms are using.

Often babies who’ve been exposed to drugs or alcohol in utero are born prematurely, requiring a stay in the neonatal intensive care unit before they’re well enough to go home. Some substance-exposed newborns are underweight. Still others are born with addiction symptoms.

While moms are laboring at the hospital, PVH and MCR nurses ask them routine questions about their smoking, alcohol and drug use during pregnancy along with other screening questions required for the Colorado Birth Certificate and Vital Statistics. “The screening determines if the baby will be tested,” said UCHealth and Larimer County Community Health Nurse Karen Yost. “A counselor may also visit with mom to see if the family could be helped by various community services.” Mothers who admit to or are suspected of use may be asked to submit a urine sample for testing. Alternately, a sample of their babies’ urine, umbilical cord or meconium (the baby’s first bowel movement) may be collected and sent to the lab for drug testing.

“When the test is positive, we work with Child Protective Services (CPS) to get help for the family,” said Bernatow. “We know that addictions are hard to overcome and that pregnancy is often the most successful time for recovery from substances. Our goal, always, is healthy families and a healthy community.”

Positive results are also sent to the baby’s pediatrician or family care doctor. Of the 738 combined PVH and MCR samples sent for drug and alcohol testing in 2013, 178 tested positive, which means they contained levels higher than a designated threshold. Samples that contain drugs or alcohol at levels below the threshold do not trigger a call to CPS.

Only very rarely does Child Protective Services separate mom and baby, said Bernatow. “That’s the last thing we want to do,” she added. It’s almost always in the family’s best interest to keep the family together, and with CPS involved, moms who are using drugs and alcohol have resources to get the help they need.

If you’re using
If you’re pregnant and using drugs or alcohol (or care about someone who is), even if you think it’s a safe amount, call Connections at 970.221.5551 for more information.

Family Of FourBY ANDREW KENSLEY, UCHEALTH

As of January, more than 15,000 Larimer County residents qualified for Medicaid and 34,000 were eligible for subsidies in the Colorado Health Benefits exchange, according to the Colorado Consumer Health Initiative. The Family Medicine Center of Fort Collins, part of the University of Colorado Health, is doing its part to meet the needs of those with limited access to affordable health care, from babies to retirees.

“We see any patient in any setting,” said Dr. Janell Wozniak, a physician at FMC and a member of the faculty for its family medicine resident program. “We provide great services to the community for patients who otherwise wouldn’t have access.”

Creating a safety net

According to Wozniak, FMC is considered a “safety net” clinic, meaning that it accepts patients who are underinsured or uninsured. She estimates that FMC serves 8,000 unique patients every year, with 70 percent of those having either no coverage or a very limited variety. The latter is defined as depending on Medicaid, Medicare with Medicaid as secondary coverage, or Colorado Indigent Care Program (CICP), the state-subsidized program for patients who don’t qualify for, or cannot obtain, medical insurance.

In addition to traditional medical care, which can include home and nursing home visits, FMC offers counseling for individuals, couples and families, as well as lifestyle coaching and biofeedback. Other services include an integrated mental health program, on-site psychiatric services and counselors, and through a partnership with the Health District of Larimer County, access to social workers and a prescription assistance program. Through its lifestyle medicine program, FMC also offers free counseling services for issues like tobacco or smoking cessation, weight loss, diet, exercise and chronic illness management.

“There’s an added level of complexity to some of these patients,” Wozniak said, citing examples such as a lack of transportation, and an inability to afford medications or the electric bill required to run a home oxygen machine. “We find resources to help subsidize those things, funded through donations. We have to make sure that patients have access.”

Specialized prenatal care

Through its Poudre Valley Prenatal program, FMC works hard to serve a high-risk subset of those with limited healthcare coverage: pregnant women. Staffed by FMC residents and OB-GYN’s from the Women’s Clinic of Fort Collins, PVP provides specialized prenatal
care, helping to deliver about 500 babies a year, and totals 6,000 inpatient and 15,000 outpatient visits a year. No matter how a woman seeks prenatal care — through an emergency room, Medicaid offices, facilities like FMC or Salud Family Health Center (another Fort Collins safety net clinic), or area clinics — if she has little or no health coverage, she can access the program.

Dr. Breanna Thompson is a family physician at Salud who facilitates a group prenatal class that targets the same demographic seen by Wozniak and her FMC colleagues. Thompson says there is considerable data to show that pregnant women in lower socioeconomic brackets are at higher risk for dangerous conditions. As such, they tend to benefit most from education and support.

“Visits for prenatal care tend to result in higher birth rates, less preterm labor
and better control of gestational diabetes and preeclampsia,” Thompson said. “The (group) participants receive significantly more education about pregnancy because
of the amount of time that we’re able to spend with them. Rather than seeing each
of them for ten minutes, we see all of them together for two hours and they are able to
have a more enriching experience.”

Groups typically consist of about eight, and are led by a physician (Thompson, mostly), a behavioral health provider, and a maternal and family health coordinator. The sessions can take up to two hours, partners are invited, and childcare is provided. For Thompson, one of the greatest benefits for the participants is in creating bonds with others going through similar situations.

“The amount of help that people get from each other in a group setting is really significant,” she said. “It takes a village.”

Expanded access

Since the implementation of the Affordable Care Act in January 2014, Wozniak says that FMC’s patient list has swelled, including approximately 500 new Medicaid patients in the past couple of months alone, many of whom had no prior coverage. The increase in volume will require some adjustment, and dealing with complex social issues can result in more stress for providers. But Wozniak looks at it as yet another chance to help people who need it.

“It’s so much more rewarding for most of us who work in this setting when you’re able to help someone meet needs that they otherwise would not meet,” she said. “Accommodating this influx of volume has been and will continue to be a challenge for us, and we’ll continue to work internally and with the health system to see if there are ways we can expand access to this population of people.”

Andrew Kensley, the author of this article, is a local freelance writer and a physical therapist for Poudre Valley Hospital.

Group Of Children Running In ParkSummer’s here. Get out and enjoy the blue skies, green grass and warm golden sun. But first, read some safety tips from our experts: Pediatrician, Dr. Amy Driscoll of University of Colorado Health PediatricsJanet Werst, injury prevention coordinator for UCHealth and Dr. Peyton Taliaferro of University of Colorado Health Family Medicine – South Loveland.

Fun in the sun

We all know that too much sun can result in a painful sunburn, but not everyone realizes that a sun-overdose can cause serious problems in the long term.

“Down the road, a sunburn in a young child has a much higher risk of turning into skin cancer than a sunburn in an adult,” Driscoll explained.

At our high Colorado altitudes, where UV rays are more intense, it’s essential to keep kids well sunscreened whenever they’re outdoors (even on cloudy days). Apply sunscreen 30 minutes before heading out and reapply every couple of hours. Water reflects sunlight so swimmers and boaters need to reapply sunscreen every hour, even if the label says “waterproof.”

“Older kids may feel peer pressure to get a tan to be beautiful,” Driscoll added. “Parents should have discussions with them about body image and the fact that there is no ‘safe’ amount to tan.”

Finally, don’t forget the sunglasses.

“If kids start wearing sunglasses at a young age, it will help them avoid cataracts when they’re older,” she said.

Water safety

Splashing in the cool water on a hot summer’s day is one of childhood’s most enduring pleasures — but safety must come first. Drowning is the third leading cause of death for children under age 18, according to the Centers for Disease Control.

“Young kids have large, heavy heads compared to the rest of their bodies,” Driscoll said. “When they fall into water, they usually go head first. This increases their risk of drowning even in something as shallow as an inflatable kiddie pool or a five-gallon bucket.”
The solution? Constant and active adult supervision whenever kids are in or near water.
“Eyes on the child,” Werst said. “And everyone should wear their life jackets if they’re in a boat. In fact, it’s the law for kids 16 and under.”
Also, remove water risks on your property. Empty the kiddie pool after each use. Even pre-teens and teens need to be educated about never swimming alone and never diving into water where the depth is unknown.

And make sure children know how to swim. Swimming lessons are a must for kids age four and older, according to the American Academy of Pediatrics.

Poison proofing

“When families start gardening and working in their yards, they often use things that are good for plants but toxic for kids,” Driscoll said. Poisoning is the fourth most common cause of death in children.

Keep fertilizers and pesticides in a locked cabinet or on a high shelf that kids can’t reach. Never reuse food or beverage containers to store chemicals or motor oil as young children might try to eat or drink from them. Know which plants or berries in your yard might be poisonous. And always keep the poison center hotline number posted prominently in your home: 1.800.222.1222.

Smart cycling

Summer’s a great time for family bike rides in northern Colorado — as long as everyone follows the rules of the road and wears a helmet.

“Check to make sure all helmets fit properly and that they’re not more than three years old,” Werst said. “The Styrofoam in older helmets breaks down, which makes the helmet ineffective.”
Safe Kids Larimer County  coordinates helmet-fit checks and provides low-cost bike helmets to families who need assistance. Last year they gave out more than 1,700 helmets.

If parents want their kids to be safe bicyclists, they need to model bike safety by wearing helmets and following smart cycling behavior themselves.

“Kids do what their parents do,” Werst said. “For example, studies have shown that in families in which parents buckle their children in the car but don’t buckle themselves, down the road, when the kids become teenagers and start driving, they don’t buckle up either.”

Helmet Heads

Watch this video as Dr. Peyton Taliaferro explains how to properly fit a helmet following the “Four Ss” of helmet safety:

The Four Ss reviewed:

Snug: Even without the strap fastened, the rider should be able to shake her head without the helmet falling off.
Straight: The helmet should be square on the head, almost level with the eyebrows — not tipped back or angled forward.
Strap: The straps should go around the ear then meet below the chin. The straps should form a “V” around each ear.
Snap: The straps must be snapped together. When buckled, the strap under the chin should be just loose enough to fit one finger.

Enjoying time outside made easier by implementing these five tips from doctors at Colorado Health Medical Group.

Enjoying activity and exercise made easier by implementing these tips from primary care doctors with University of Colorado Health

Stretching, regular activity crucial to staying healthy and injury free

There’s nothing like warm, long days to get us active. Don’t let a twisted ankle or muscle sprain ruin your plans. To stay injury-free this summer, follow these tips from three family medicine doctors with University of Colorado Health.

Warm it up
Loy--0004_jpgMove and stretch before hitting the trail, volleyball court and other physical challenges. “Cold muscles don’t absorb shock or impact as well as warm muscles,” said Dr. Brienne Loy of UCHealth’s Family Medicine at Harmony Campus.

Dr. Kevin Felix with UCHealth’s Family Medicine in north Loveland said, “When people go from zero to 60, we see a lot of muscle strains and pulls.” He recommends starting slow and building up the pace gradually. Warming up is especially important in such high impact sports as volleyball and basketball.

“Knee and IT Band injuries are another possible result of improper stretching,” said Dr. Eric Hess with UCHealth’s Internal Medicine at Prospect. The IT band runs from the hip to the knee along the outer thigh. It easily tightens up, and without stretching, tugs at the knee joint, causing pain.

Dr. Kevin Felix

Dr. Kevin Felix

Be an “all-week” warrior
With busy work-day lives, some people only have weekends or days off to do the sports and exercises they love. It’s tempting to be weekend warriors and take it to the extreme—playing three rounds of golf or hiking a summit. That’s a recipe for injury and may discourage people from more exercise, doctors say. “Weekend warriors run a higher risk for joint and muscle injuries,” Dr. Loy said. Dr. Felix’s advice is to be an all-week warrior. In short, stick to a routine. “Weekend warriors tend to do too much and get injured or experience overly sore muscles,” Dr. Felix says. “When this happens, they feel discouraged and don’t want to be active the next time.” Sitting on the job can cause back pain, something that can be remedied through an exercise routine. “Without regular exercise, hamstrings shrink up, get tight and pull on back muscles,” Dr. Hess said. To counteract the problem, Hess recommends doing exercises to strengthen your lower back and abdomen at least three days a week, along with cardio workouts and stretching. Dr. Felix suggests weight training that uses all muscle groups and mixing up workout routines. To establish balanced, sturdy muscles, work out most days and do a variety of activities, not just one sport, he added.

Dr. Eric Hess

Dr. Eric Hess

Keep your core strong
Many people may not know exactly where their core area is. To find out, draw a line from the belly button and around the back; this is where core muscles are located. “When core muscles are strong they support the spine, pelvis and shoulders and ready them for impact during sports,” said Dr. Loy, who recommends Pilates and yoga to build core strength. Felix emphasizes that core strength is especially important for nurses and other employees who do a lot of heavy lifting on the job: “People with good core strength in their lower backs and abdomens are less likely to injure themselves.”

Fitting in exercise on the job
New federal recommendations suggest people stay active throughout the day versus getting in their exercise all at one time. “Exercising 10 minutes several times a day has been shown to increase metabolism and decrease heart rate,” says Dr. Felix. “It’s equivalent to taking medicine and having a low dose in your bloodstream throughout the day.” Some people wisely fit in 10-minute bouts of exercise during a work day by walking up stairs rather than taking elevators; walking during breaks an lunch periods; parking far away from the office or store; and doing such simple office exercises as wall squats and pushups, knee lifts and even planks if there is room on the office or break room floor.

When to see a doctor
If a person has twisted an ankle, tweaked the back or has knee pain when walking up or down stairs — pains that just won’t go away — it’s time to see a doctor. “If it’s been a few days and the pain or swelling is getting worse, not better, get it checked out,” Dr. Felix said. Added Dr. Loy: “The same is true if you feel numbness, tingling or weakness.” Remember this tip: Numbness and tingling in your arms or legs can be a sign of a neck or lower back injury, among other things.

Have you ever felt scared, unsure or alone? Most people experience all of these emotions when they hear the words “You’ve got cancer.”

A good cancer program treats the whole patient. Beyond state-of-the-art therapies, a trusted cancer program offers patient navigation, emotional counseling, support groups, physical rehab and complementary massage.

Patient Navigators

The cancer journey is often confusing, frightening, and costly. Wouldn’t it be easier if you had a skilled, compassionate

Oncology patient navigator nurses (from lf to rt) Shelley Nielsen, Patti Frelund, Nina Elledge, Kathy Baars, Ladelle West.

nurse by your side to help you understand your diagnosis and treatment, access financial assistance, and cope on the dark days?

A Patient Navigator program, such as the one offered by University of Colorado Health, matches cancer patients with a specially trained oncology nurse navigator. As the term suggests, the nurse helps patients navigate the complexities of cancer care. The navigator’s role is to listen to clients’ questions and concerns and connect them with the best resources.

Counseling Services

Oncology counselors (from lf to rt) Anne Marie Cronin, Marianne Pearson, Ann-Marie Bowman

“Cancer is a crisis,” said Marianne Pearson, program manager of psychosocial oncology with UCHealth. “Before my department began providing services, free counseling for those affected by cancer was a missing link in our community.”

Marianne and her colleagues counsel patients and family members in both Larimer and Weld Counties. In addition to running several support groups, Marianne and her team provide therapy to individuals, couples and families on an as-needed basis –during treatment as well as months or years after. All counseling services are free of charge.

Cancer Rehabilitation

We all know that cancer takes a tremendous toll on the body. Some patients are in the middle of chemotherapy and radiation; some have completed treatment. Almost all are extremely weak and battling profound fatigue. That’s why a good cancer program will recommend that a cancer patient keep moving. Look for a program like the one offered in the rehab gym at Poudre Valley Hospital.

“Fatigue is the biggest complaint people come in with” said the program’s founder and Physical Therapist Jeff Eagan. “And it’s the kind of fatigue that extra sleep doesn’t fix. The good news is that exercise does. Physical activity also helps them get their strength and quality of life back.”

“I’ve seen exercise help with appetite, sleep, cognitive function and depression,” said Eagan. “For a lot of these people, it’s the first thing they’ve been able to actively do since their diagnosis to help themselves feel better. It gives them back control over their own bodies.”

ONCOLOGY MASSAGE helps with pain, sleep, nausea and fatigue.

Oncology massage helps with pain, sleep, nausea and fatigue.

Cancer Massage

More and more, clinical research shows the benefits for massage during cancer. Cancer massage helps with sleep, pain relief, nausea control, decreased fatigue and depression. At Poudre Valley Hospital, all cancer inpatients are offered free massage therapy.

Survivorship clinic team: (from lf to rt) Marianne Pearson, Jeff Eagan, Lisa Radice

Cancer Transitions

Cancer’s not over, even when the tumors are gone. Patients should seek out a program designed to help cancer survivors make the transition from active treatment to post treatment care.

In UCHealth’s Survivorship program, participants learn tips for stress management, transitioning back to your family doctor, and finding a new normal after treatment ends.

A well-rounded cancer program does more than treat the disease inside your body. It helps you understand what you’re going through and offers support in areas you might never have considered. If you or a loved one has been diagnosed with cancer, look for a program that fully suits your needs.

Learn more about these support services.

UCHealth’s new Cancer Center in Fort Collins a community treasure

Approximately 1,000 people showed up for the June 4 Cancer Center ribbon-cutting ceremony, which included a firsthand look inside the facility. (Photo by Jody Metzger-Pflieger)

Approximately 1,000 people showed up for the June 4 Cancer Center ribbon-cutting ceremony, which included a firsthand look inside the facility. (Photo by Jody Metzger-Pflieger)

There were hugs, tears and smiles as the red ribbon across University of Colorado Health’s newest facility fluttered to the ground. It was a monumental moment signifying a new asset for northern Colorado residents — an all-encompassing cancer center in its own backyard.

“Cancer is about your neighbor, your coworker. It’s about my father…my brother…and yes, it is about your mayor,” said Fort Collins’ Mayor Karen Weitkunat, a three-year breast cancer survivor, during the June 4 Cancer Center ribbon-cutting ceremony at UCHealth’s Harmony Campus in Fort Collins. “Thank you for giving this great gift to our community.”

Approximately 1,000 people turned out for the ribbon-cutting event, which provided a firsthand look into the new center and its philosophy for whole-person care.

The new center, about seven years in the making, will relieve patients of the need to travel across counties and even the region to get the different facets of oncology care and, not incidentally, solidify the relationship between them, northern Colorado caregivers and the research and clinical trials of the University of Colorado Cancer Center in Aurora. The university center is one of only 40 National Cancer Institutes “comprehensive cancer centers” in the United States, and one of a mere handful to be part of the elite board that sets cancer protocols for all American patients.

More than 2,300 Larimer and Weld county residents are diagnosed with cancer each year, according to the Colorado Department of Public Health and Environment.

“And, unfortunately, there’s a tsunami of cancer patients as our population ages,” said Dr. Tom Purcell, who heads the University of Colorado Health’s oncology program.

“That’s personal, that’s real and that’s relevant,” Weitkunat added.

The new 30,000-square-foot UCHealth Cancer Center, costing $11 million, opened its doors to patients June 9. It provides one-door access to all-inclusive cancer care for patients, who took part in its planning.

“It’s a place created with survivors, for survivors,” said Vikki Wagner, a two-time breast cancer survivor. “We asked. And you listened,” she told the donors, providers, practice directors, staff members and administrators at the event.

More than 4,500 donors contributed $5 million to the Cancer Center, but there is still more than $1 million needed to complete the final phase. (Photo by Kati Blocker)

The center’s soft architectural curves, carefully placed services and large multidisciplinary physician interaction room were all the results of a design process that brought doctors, patients and UCHealth leaders together.

The opening of the center completed the second phase of the three-part building process and about seven years of planning and fundraising. A third phase, which will include a Wellness and Survivorship Center, will require another $1 million in donations. The new addition will guide patients into a “new normal” during and after their cancer battle

The project’s first phase expanded the Radiation Oncology Department, which now includes two TrueBeam linear accelerators, the first of their kind in Colorado. Its second involved the design and construction of the new center itself. It now houses medical oncology, infusion, clinical research, pathology and laboratory services, as well as an outdoor healing garden and balconies off the infusion suite intended to provide patients with relaxation and mountain views.

With all essential services now under one roof, cancer patients will be able to complete multiple appointments in one visit, cutting down on the 100-plus appointments that average cancer patients have in their first year.

But the center also works to address the needs of patients before they even set foot in the center. Purcell, who often says cancer is as much a “psychological emergency” as a medical emergency, says all UCHealth oncology services are designed for patient convenience and even speed.

With the support of the whole UCHealth system, including locations in Greeley and Loveland, patients are able to meet with an oncologist within 48 hours of being told they have cancer. The new center on Harmony Road features a central phone number – 970.237.7700 – and website – uchealthcancercare.org – and a single-entry process. Through these services, users can request appointments, schedule a second opinion and connect to a patient navigator.

“This is a spectacular building and it will be a privilege to work here,” said Dr. Matthew Sorensen, medical director of UCHealth oncology service line in northern Colorado, during the ceremony. “But the most special thing here is not the walls and the building. It’s the opportunity it provides.”

“We are setting a standard for cancer care across the nation,” said Dr. William Neff, UCHealth’s chief medical officer and interim CEO. “And this Cancer Center will be part of that.”

This article was written by Kati Blocker, UCHealth communication and marketing strategist.

In this video, Marianne Pearson explains what psychosocial oncology is and who should consider it. Marianne and the entire cancer care team at University of Colorado Health in northern Colorado are focused on treating the whole person, not just the disease, integrating advanced therapies with emotional support.

Marianne reviews different options for patients, including: counseling for individuals, couples and families; support groups; and transitional programs to help find a new normal after treatment ends.

Marianne is the Program Manager of Psychosocial Oncology at University of Colorado Health in northern Colorado, serving patients in the Cancer Center in Fort Collins and in Cancer Care and Hematology clinics in Greeley and Loveland.

Learn more about psychosocial oncology and get support group schedules.

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