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Music therapy enhances physical rehabilitation.

By Andrew Kensley

Sarah Johnson assisting a patient at the CSU facility.

Sarah Johnson assisting a patient at the CSU facility.

Under the close watch of his physical therapist, a stoic man marches up and down a four-inch step with admirable consistency. His left hand holds a walker for support, but his feet endure in their instructed endeavor; forward and backward, up and down, left and right.

The therapist says barely a word, but she doesn’t have to. This man — a victim of Parkinson’s disease and a stroke — heeds another master, a primal part of his brain that craves rhythm and symmetry.

The therapist, Sarah Johnson, is one of many University of Colorado Health rehabilitation professionals working to help patients get their groove back. Like most rehab therapists, she sports a sunny demeanor while touting the benefits of exercise and task-specific, functional training. But her patients march to a different tune — music.

Seeing potential in music

Since 1987, Johnson has expertly used a variety of musical-based techniques in conjunction with physical, occupational and speech therapists to improve stimulation of sensory and motor systems for patients injured by accidents or strokes, or suffer from diseases such as multiple sclerosis or Parkinson’s.

While Johnson and the music therapy program she helped build in northern Colorado are primarily based in the Rehabilitation Unit at Medical Center of the Rockies, she also sees patients at the region’s outpatient adult and children’s therapy services clinic.

Regaining function, say the experts, is the main goal of rehabilitation. And, as Johnson and her colleagues will attest, it often occurs faster — and better — when it’s set to music.

“We may do some singing, but I’m not trying to teach patients how to sing,” Johnson said. “We may be working on speech skills. I’m helping them use their air, develop their lung capacity. Using music can help our bodies move better, help our muscles work together in a more coordinated fashion, help us strengthen muscles that are weak, and help us retrain our neurologic pathways.

“The rhythm of the music helps support the movement to be more fluid and more natural. Then when you add the instruments into it, you get that visual, auditory and tactile feedback.”

Another major benefit is the natural opportunity for repetition. When you add a beat to a certain movement — reaching, stepping, lifting — patients become part of the creative process, Johnson explained.

“They have multiple opportunities to do what you’re asking them to do,” she said, adding that it leads to better performance, carryover into normal activities, and, quite often, a level of enjoyment rarely seen in the challenging process of recovery from debilitating injuries.

IMG_4254 music therapy story photo 2Leading the way

In 1987, Dr. Gerald McIntosh, a Colorado Health Medical Group neurologist and the then-director of Poudre Valley Hospital’s LifeSkills Rehabilitation unit, was curious about the use of complementary therapies in rehabilitation and hired Johnson to create a music therapy program from scratch.

Since then, the program has echoed outward from its origins in patient care to the research world — and beyond. Poudre Valley Hospital’s pioneer program in music therapy, in collaboration with Colorado State University, led to the creation of CSU’s Center for Biomedical Research in Music and Robert F. Unkefer Academy of Neurologic Music Therapy, both of which continue to promote the worldwide development of the field of NMT.

With a small grant from the Poudre Valley Hospital Foundation, McIntosh and Dr. Michael Thaut, a music therapist and CSU professor of music and neuroscience, initiated a research partnership between the two organizations. In 1990, physical therapist Ruth Rice joined the PVH rehab staff, bringing with her a neurologic rehabilitation background that allowed her to play an active role on the clinical side of the groundbreaking studies.

During the past 20 years, McIntosh has collaborated with Rice and Thaut in the publication of more than 40 articles illustrating the rehabilitative benefits of neurologic music therapy.

“I was naïve about music therapy; I had no idea it would be a physical enhancer,” Dr. McIntosh admitted. “But I observed that during treatment sessions, motor performance was improved with its addition. Dr. Thaut and I began research to demonstrate the effectiveness for music therapy to augment motor performance.”

They began with studies that demonstrated that walking performance improved with music therapy. They progressed to studies on stroke victims with one weak side, Parkinson’s patients, and children with cerebral palsy in collaboration with Children’s Hospital in Denver. And much of the newer research, some done by Rice, has confirmed their findings and shown a significant reduction in falls for patients involved in music therapy rehab programs at the hospital or at home.

Johnson, who in 2009 was awarded the American Music Therapy Association’s Professional Practice Award for her significant contribution to the profession, has hosted students and therapists from Europe, Asia, South America and Australia to observe UCHealth’s innovative program. Ruth Rice, along with McIntosh, Thaut and the CBRM staff have served as ambassadors of their brainchild by presenting research findings in various locations throughout the world.

Spreading the word

“I remember watching Sarah work, strumming down the hallway with her autoharp and a big smile on her face, watching her do amazing things with people’s walking,” Rice recalled. “I don’t think people realize that a lot of the research happened here in Fort Collins and CSU.”

In addition to devoting themselves to improving lives one chord at a time, Rice and Johnson continue to do their part in the world of academia. In 2013, they published “A Collaborative Approach to Music Therapy Practice in Sensorimotor Rehabilitation,” in the journal, Music Therapy Perspectives.

In the article, they stated that a collaborative approach among physical, occupational, speech and music therapies, with “each contributing unique research and clinical-based knowledge to the treatment team,” was unquestionably the best way to help patients achieve “functional real-world outcomes.”

Sarah Wild, a physical therapist in MCR’s Rehabilitation Unit with almost 20 years of rehab experience, said she was skeptical at first.

“I thought, ‘How could having someone sing and play an instrument during physical therapy really help, and, can I accomplish what I need to do in the same time frame?’” Wild said. “After working with neurologic music therapy for a number of years now, I am fully on board. I have found I can actually achieve more activities during sessions, especially with patients who have cognitive impairments. I also believe I have better outcomes, and the patients seem to leave the hospital sooner. I wish all therapists had the benefit of working with neurologic music therapy.”

This article was written by Andrew Kensley, a local freelance writer, published author and physical therapist for Poudre Valley Hospital. Photos were taken by Mary Pridgen of Bare Bones Photography in Fort Collins.

 

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Early detection helps woman conquer lung cancer.

By Susan Skog and Kim Vecchio

A busy lady beats cancer. Dona Ammons sits with her dogs, Mr. Beau Jangles and Bambi. (Photo by Dave Rizzotto)

A busy lady beats cancer. Dona Ammons sits with her dogs, Mr. Beau Jangles and Bambi. (Photo by Dave Rizzotto)

When Loveland resident Dona Am­mons developed a pain near her ribs she figured it was a result of her osteo­porosis. Assuming she had a bruised or broken rib, she went to her doctor to get it checked out.

“On April 1, I went to see an orthopedic doctor, who took an X-ray,” said Ammons. “He confirmed I didn’t have anything wrong with my ribs, but he said, ‘I see something in the X-ray that bothers me.’”

After a chest X-ray and CT scan, Am­mons visited with University of Colo­rado Health pulmonologist, Dr. Richard Milchak. He showed Ammons the mass on her lung. He ordered a biopsy and three days later, took Ammons’ case to UCHealth’s newly created Lung Nodule Clinic in northern Colorado. That’s when the cogs were set in motion for Ammons’ treatment plan with her team.

On April 26, after meeting with a team consisting of radiologists and pathologists, as well as pulmonologists, medical and ra­diation oncologists, surgeons and patient navigators, Milchak called Ammons to tell her she needed additional testing.

“With the advent of the Lung Nodule Clinic, we may see a patient on Wednes­day and hopefully get him into a diag­nostic procedure within a few days to a week,” Milchak said. “Then, a diagno­sis can be more quickly reached and a treatment plan in place within weeks, not months. That time is valuable when you’re treating lung cancer.”

Early detection an important piece

UCHealth is on the frontlines of one of the most urgent, cancer-fighting pursuits in the country: the drive for early detec­tion and better treatment of lung cancer.

Though rates are dropping, lung cancer is still the leading cancer killer in both men and women in the United States, according to the American Lung Associa­tion. It causes more deaths than the next three most common cancers combined: colon, breast and pancreatic. About 159,260 Americans will die from lung cancer this year, the association estimates.

Part of the problem is that the majority of lung cancer diagnoses are made too late, said Dr. Matthew Sorensen, medical director of UCHealth’s oncology service line in northern Colorado.

But Sorensen’s team is working hard to reverse that trend and boost survival rates through the Lung Nodule Clinic. For the first time in northern Colorado, patients benefit from a more efficient approach to detecting and treating lung cancer.

“The lack of communication among providers is one of the biggest com­plaints patients and their families have,” Sorensen said. “There is nothing more frustrating than having two contradictory opinions given to patients at two succes­sive appointments. Now, after I sit down with a patient and their family, and shake their hands as I leave the room to put their treatment plan into place, they don’t need to ask, ‘Are you sure you’ve talked to my surgeon or my radiation oncologist?’ They know we’re all on board, and we’re all aware of the treatment plan.”

A new tattoo

Ammons, who was diagnosed with Stage 1B lung cancer in April, said the clinic was key to her beating cancer. The day after she spoke with Milchak, the Lung Nodule Clinic’s patient navigator, Ladelle West, called Ammons to help schedule her appointments in the right order, coordinate communication among all providers and stay on top of each step of her treatment plan.

West is like the conductor of a sophisti­cated symphony, weaving together all the medical notes. Milchak calls West “the most important person in this process.” And Dr. Kirk DePriest, UCHealth pulmo­nologist added, “like the quarterback to our entire team.”

“Ladelle was very helpful. She handled everything for me,” Ammons said. “She set up all of my appointments and kept me informed. I never had to worry if the physicians were talking to each other be­cause they were constantly communicat­ing and everyone was on the same page. It moved along smoothly.”

Ammons added, “I am a busy lady caring for my dogs, Mr. Beau Jangles and Bambi. I’m also the choir director at my church, I belong to a train club and I play in a uku­lele band. Ladelle and my team handled everything so I could go on living.”

By May 7, Ammons had completed her tests and was scheduled to see Dr. Ann Stroh, UCHealth medical oncologist, who coordinated radiation treatments with UCHealth radiation oncologist Dr. Gwen Lisella. On May 20, Ammons was mapped for her five radiation treatments and on May 29, she had a trial run be­fore beginning her treatments.

“I didn’t know what mapping meant except that I’d get a tattoo,” said a smil­ing Ammons. “At 76 years, I was going to get my first tattoo. Turns out, they were outlining the treatment area, and the tat­toos were small dots to line me up with the machine to make sure I was receiv­ing radiation where I needed it.”

As of June 11, Ammons is cancer-free, two and half months after being diag­nosed with lung cancer.

On Ammons’ last day of treatment, the radiation staff gave her a little white cake with a candle that said “happy day.” However, her last day of treatment won’t be the last day she sees her team. Ammons has multiple follow-up visits scheduled with Milchak, Stroh and her primary care doctor. She will also have a PET scan every three months to make sure the cancer does not return.

“Nobody is letting loose of me,” she said. “Makes me feel so secure that they are following up and taking care of me. They weren’t going to drop off at the end when I finished my treatments.”

It’s that kind of over-the-top support, collaboration and excellence that fires Sorensen up to strive to make the Lung Nodule Clinic at the new Cancer Center one of the best in the nation.

“It’s been so rewarding for me to see the most talented cancer care providers I’ve ever seen come together for the com­plete care of patients,” he said.

Ammons’ team consisted of doctors who bring their expertise to the table to develop the best treatment plan for each patient after discussing everything from the patient’s risk factors to the top drug, clinical trial, surgical and radiation options. In addition to radiologists and pathologists, the team includes pulmon­ologists, medical and radiation oncolo­gists, surgeons and patient navigators.

 

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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.

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DSC_0511You might think you’ll never be impacted by a heart attack. But when seconds count – and every second does when your heart stops working properly – do you know what to do?

“The number of heart attack patients eligible for treatment is expected to grow over the next 10 years. Our population is getting older and heart disease is on the rise,” said Dr. J. Bradley Oldemeyer of University of Colorado Health Cardiology.

The American Heart Association projects that 720,000 Americans will have a heart attack this year, up from 715,000 in 2013. While some heart attacks may look like something out of a movie – a sudden, shocking pain causing someone to clutch their chest before passing out – usually, heart attack symptoms start slowly.

Heart attack symptoms have been described as:

  • Chest discomfort, like pressure, squeezing or pain.
  • Discomfort in one or both arms, the back, neck or jaw.
  • Shortness of breath, sweating, nausea or lightheadedness.

These symptoms may arise with activity or after meals, but can also occur at rest or when awakened from sleep, and should never be taken lightly.

What to do.

When you or someone around you is experiencing a heart attack, have someone call 9-1-1.

Data from Medical Center of the Rockies in Loveland, Colorado shows that patients who called 9-1-1 for signs and symptoms of a heart attack had blood flow restored to their heart 30 minutes sooner than those who drove themselves to the ER.

When you call for an ambulance, emergency medical services professionals can start treatment on the way to the hospital that not only saves time, but potentially saves a life. Additionally, EMS professionals help the cardiac team be prepared to receive heart attack patients immediately upon arrival at the hospital.

If you believe you are having a heart attack, do not drive. If your symptoms worsen you may cause an accident.

The faster the balloon, the better.

When a heart attack patient arrives at the hospital, the cardiac team works quickly to administer a percutaneous coronary intervention (PCI), such as angioplasty. This is often referred to as “door to balloon time.” Lower door-to-balloon times equate to less heart damage, fewer complications and a return to normal activities after a heart attack.

At Medical Center of the Rockies, the average door-to-balloon time is 43 minutes, which is less than half the national goal of 90 minutes. In fact, approximately 29 percent of patients had a door-to-balloon time of less than 30 minutes in 2013.

Prevention first.

Minimize your risk of heart disease and heart attacks by developing a plan with your physician. To learn your risk of heart disease and to start a discussion with your doctor, take a short quiz at care.uchealth.org/heart.

Randi Freeman works in the marketing department for University of Colorado Health in northern Colorado.

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By Susan Skog

Dr. David Columbus: ”Our new ability to narrow down precisely where the pain needs to be controlled is just mind-blowing.”.

Dr. David Columbus: ”Our new ability to narrow down precisely where the pain needs to be controlled is just mind-blowing.”.

Jessica Thomas loved teaching first graders, but chronic pain crushed her career and chance for a normal life until she underwent a revolutionary procedure at University of Colorado Health (UCHealth) Pain Management.

Thomas, 31, started having migraines when she was 16. Her headaches spiked after a 2005 car accident. By 2010, she lived an unending neurological nightmare that ended her classroom days.

“In 2010, I started to have more severe migraines and cluster headaches,” she recalled. “Sometimes, I had occipital neuralgia, which caused the back of my head to be so sensitive it even hurt to lie on a pillow. It was totally miserable.

“I also developed trigeminal neuralgia, which felt like electrical shocks going through the side of my head to the front of my face. I had nausea, extreme sensitivity to light and dizziness.”

Docs gave up

Other doctors gave up looking for a permanent solution and were prescribing powerful pain medication, Thomas said. It wasn’t until she met Dr. David Columbus at UCHealth’s Pain Management that she began to imagine her chronic misery might end.

“Dr. Columbus stepped out of the box and looked for ways that could help without just throwing medicines at me,” she said. “He is one of the first doctors who really tried to help me and my husband, who has had to struggle with watching and not being able to help me.”

The patient, Jessica Thomas, holds up a photograph on her cell that shows X-rays of her neck with the electrodes next to her spinal column.

The patient, Jessica Thomas, holds up a photograph on her cell that shows X-rays of her neck with the electrodes next to her spinal column.

Using a frontline technology gaining popularity around the country, Dr. Columbus implanted a half-dollar-sized, lightweight spinal cord stimulator in Thomas’ upper buttocks.

The stimulator delivers small electrical pulses to thin leads—coated wires containing electrodes—placed in her spinal cord in precise areas along Thomas’ vertebrae. The pulses block pain by interfering with the nerve impulses that make Thomas experience pain.

Blocking pain

Using gentle sedation and with Thomas awake and responding, Dr. Columbus was able to determine precisely where to place several leads in her upper cervical spine, which turned out to best block her body from experiencing pain.

“With this new technology, we are able to place up to 32 different leads along the spinal cord to provide as much pain management coverage as possible,” said Dr. Columbus.

For people with chronic, intractable pain, this once-futuristic treatment is life-changing, he added. “We’ve seen this give back people their lives, relationships and work.”

So far, only 4,000 procedures using the new Boston Scientific technology have been done in the United States, Dr. Columbus said. “We believe we are the only ones in Colorado using this particularly advanced spinal cord stimulator technology.”

Hope

In Thomas’ follow-up visits, Dr. Columbus programmed the device to further fine-tune the type and strength of electric stimulation and cover areas of pain where she needed them. Thomas said she noticed improvements in her pain relief as soon as the device was turned on.

“The longer it has been in, the more coverage I am receiving,” she said. “Now it gives me more hope that things really can get better. In the worst of it all, it was really hard to keep hope when going through that much pain.”

Thomas is regaining her life one step at a time. “I started to have less sensitivity to the sun,” she said. “Now, I am able to participate in life more, meaning I can go to the store or go shopping with family members. I can take my dogs on walks. I am still adjusting to having a life again after spending so many years in such horrible pain and not being able to do anything for so long.”

Thomas also said her depression is much better, and her anxiety level has also dropped. “Both changes have been quite a blessing.”

Dr. Columbus said he is thrilled to see Thomas regain her life. “Jessica’s been able to get off most pain medication,” he said. “Her goal now is to return to teaching again.

“I’ve been a pain specialist for 22 years, and this is unbelievable and extremely rewarding,” he noted. “While spinal cord stimulation has been used for more than 30 years in this country, our new ability to narrow down precisely where the pain needs to be controlled is just mind-blowing.”

For more information about Dr. Columbus and pain management, visit pvhs.org or call 970.203.7000.

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Understanding new cardiovascular treatment guidelinesscreening_results

By Randi Freeman

For years, patients have been told to watch their cholesterol and change their lifestyles when their numbers were too high. When target numbers weren’t reached, prescribed medications helped them reach their goal.

In late 2013, all that changed. New cholesterol treatment guidelines released by the American Heart Association (AHA) and American College of Cardiology (ACC) removed the focus on achieving target cholesterol numbers and instead aimed to reduce a person’s overall risk of heart disease and stroke – the leading causes of death in the world.

Studies have shown that treating with statin drugs to lower cholesterol may not be necessary in everyone unless they have other factors that raise their risk of heart attack and stroke. According to Dr. Roger Ashmore, University of Colorado Health cardiologist, the primary goal of the new guidelines is to define those patients who are at a higher risk for heart disease and identify people who would benefit from cholesterol-lowering statin drugs.

There are three things people can do to reduce their risk of cardiovascular disease.

Look beyond the numbers.

The new guidelines still indicate that high cholesterol is one factor of cardiovascular disease. There are, however, other risk factors to consider such as diabetes, smoking, high blood pressure and family history. In fact, drug therapy is no longer recommended for the sole purpose of achieving cholesterol numbers.

Dr. Ashmore cautions that people should not abandon their efforts to lower their cholesterol. In fact, exercise and healthy eating habits, which improve total cholesterol numbers, are proven to be key in fighting heart disease and stroke. “The new guidelines stress the importance of lifestyle in managing cholesterol and preventing heart disease,” said Dr. Ashmore.

So what should we monitor instead of cholesterol numbers?

Know your risk.

The new guidelines recommend that people who have no history of cardiovascular disease or diabetes learn their 10-year risk by getting an assessment and talking to a doctor to understand their overall health. Then, if needed, the person should work with their physician and develop a treatment plan tailored to their needs.

People can get a risk assessment for heart disease and stroke through their primary care provider or cardiologist. This assessment looks at race, gender, age, total cholesterol, good HDL cholesterol, blood pressure, use of blood pressure medication and smoking status. Also, the AHA offers free online assessments on their website at heart.org.

Reduce your risk.

“The new guidelines are a significant change on how physicians treat with statin drugs,” said Dr. Ashmore. “We no longer concentrate on the level of bad cholesterol called LDL, but on the overall risk of the patient.”

According to the new guidelines, statin drug treatment is still recommended for people who are considered high risk.

“Patients with a history of cardiovascular disease or diabetes are at the highest risk of heart attack and stroke and should be treated with statin drugs regardless of their cholesterol numbers,” said Dr. Ashmore. “Statin drugs provide the greatest benefit in terms of preventing heart attacks and strokes and most people use these medications without difficulty or serious side effects.”

Gone are the days of chasing cholesterol targets. Instead, Dr. Ashmore indicates that the new strategy in heart disease prevention will focus on diabetes and blood pressure management, smoking cessation and lifestyle adjustments. And when needed, cholesterol-lowering statin drugs.

Learn your risk of heart disease now by taking an online heart assessment.

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University of Colorado Health pulmonologist Dr. Kirk DePriest and Diane Gutierrez, manager of Poudre Valley Hospital’s respiratory care department, simulate the bronchial thermoplasty treatment on a volunteer. With the aid of a tiny medical camera, they are seeing the procedure on a monitor as it is performed.

University of Colorado Health pulmonologist Dr. Kirk DePriest and Diane Gutierrez, manager of Poudre Valley Hospital’s respiratory care department, simulate the bronchial thermoplasty treatment on a volunteer. With the aid of a tiny medical camera, they are seeing the procedure on a monitor as it is performed.

New asthma treatment available at PVH.

By Kelly K. Serrano

Shortness of breath, wheezing and coughing are daily symptoms of someone suffering from severe asthma.  PVH has a new treatment to help these patients.

Bronchial thermoplasty is a treatment so new that some pulmonologists and other asthma experts around the nation aren’t closely familiar with it yet. But the procedure could mean a deep breath of air for severe asthma sufferers—something some of them may never have known before.

The treatment became available this month in northern Colorado only at Poudre Valley Hospital through University of Colorado Health (UCHealth) Pulmonology. The necessary medical equipment is ready and two possible patients have expressed interest in having the procedure in the near future.

The procedure targets the smooth muscle located beneath the surface of lung tissue, using heat to shrink it, reduce inflammation and prohibit spasms that restrict airflow, said Dr. Kirk DePriest, a UCHealth pulmonologist.

Dr. DePriest said he learned of the treatment during his fellowship from 2006 to 2009 in pulmonary critical care and interventional pulmonology at Wake Forest Baptist Medical Center in Winston-Salem, N.C., and, after coming to Colorado, introduced it to the doctors at UCHealth Pulmonology. Two other UCHealth Pulmonology physicians—Drs. Kristin Wallick and Richard Milchak—will also perform the procedure.

“Controlled energy”

Using technology called the Alair System, developed by Boston Scientific Corporation, a pulmonologist inserts a small catheter through a patient’s nose or down the throat and into the lungs, where it delivers controlled energy to reduce excessive smooth muscle that lines the airways. The patient is under moderate sedation.

The “controlled energy” is heat about the temperature of a warm cup of coffee, said Diane Gutierrez, manager of PVH’s respiratory care department. The outpatient procedure takes three sessions three weeks apart. Each targets a different section of the lungs.

After the treatment, patients continue to take their regular asthma medications, but doctors may later decrease them as their patients show reduced symptoms, Gutierrez explained.

Dr. DePriest said some patients show an increase in asthma symptoms for several days following the procedure, but most show noticeable improvement within six months.

Since the procedure has yet to be performed locally, a check of the Internet turned up comments from patients around the country who underwent the procedure. Some said the roughest part was the increase in asthma symptoms for a brief period following the procedure—as Dr. DePriest mentioned above.

On WebMD, a respected Internet medical information site, one patient wrote: “Another week has gone by so I’m a month post-procedure. I’m doing well and coughing a lot less than before. I’m glad I did this.”

Another patient commented on WebMD: “I just completed my third procedure Friday, August 23rd. I am 38 years old, female and have had moderate/severe asthma since the age of 3. I am already seeing benefits. I am not waking up at night needing my rescue inhaler. I have had the same side effects, coughing, mucus etc., but I realize it will go away in a few months.”

Quality of life

Cindy Coopersmith, an asthma sufferer and PVH registered respiratory therapist and asthma educator said bronchial thermoplasty—more so than traditional treatments—is showing a dramatic improvement in patients who have undergone the procedure.

“There’s not much we can do for people as far as quality of life,” she said of traditional treatments. “If they’re interrupted in daily living by asthma symptoms, it’s very difficult.”

About 25 million Americans have asthma, with an estimated five to 10 percent of them suffering from severe asthma. Coopersmith said these patients have daily wheezing, coughing and shortness of breath. Sometimes the symptoms wake them up at night.

“They are fragile, so they’re going to have frequent physician visits and hospital or ER visits and take a fair amount of Prednisone (a medication),” she added. “There is a certain percentage of people with asthma that we find very hard to treat, meaning having a good quality of life even with medicine. We have them on all the best asthma-control medications available to us, and they still have frequent asthma exacerbation and symptoms.”

Deep breath

But with bronchial thermoplasty, which was approved in 2010 by the Federal Drug Administration, the patients may be able to take a deep breath for the first time and continue to do so for a prolonged period, if not the rest of their lives, Coopersmith said.

According to Boston Scientific, the trial that evaluated the safety and effectiveness of the treatment showed that, after one year, patients who underwent bronchial thermoplasty had:

  • 32 percent fewer asthma attacks.
  • 84 percent fewer ER visits for respiratory symptoms.
  • 66 percent fewer days lost from work, school and other activities due to asthma symptoms.

Also, 74 percent of bronchial thermoplasty patients saw an improvement in their asthma-related quality of life, according to the study.

“What excites me is the long-term evidence,” Coopersmith said. “These are people who have never been able to breathe easily.”

Asthmas is among the top five chronic diseases, ranking up there with heart disease, stroke, cancer and diabetes. “I think it (bronchial thermoplasty) is exciting because it’s something else to offer people with severe asthma other than high-dose steroids and having to visit the emergency room every so often,” Dr. DePriest said.

Improvements

He said patients who participated in bronchial thermoplasty trials eventually didn’t need such high steroid dosages, and they experienced reduced exacerbation of asthma and ER visits. “We’re still going to be looking at 10-year data along the road, but their quality of life was improved,” Dr. DePriest said.

The procedure is limited to patients 18 and older who have shown that, even with the best asthma medications, they continue to live with severe asthma symptoms and require frequent visits to their doctors and hospitals, he said. Asthma sufferers who smoke or drink alcohol or have certain diseases, such as leukemia or lung disease, are not candidates for bronchial thermoplasty.

For more information, please call 970.224.9102.

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