| PostIndependent.com

How life at altitude impacts people — and animals

STEAMBOAT SPRINGS — People living at higher altitudes tend to be healthier, but definitive evidence as to why remains elusive.

There is debatable data, and some contradictory studies, as well as the persistent prospect that, especially in a place like Colorado, a lot of it has to do with selection: healthier people with healthier habits choose to live at higher locations.

There’s also somewhat of a “survival of the fittest” aspect, noted Dr. Will Baker, a cardiologist with UCHealth Heart and Vascular Clinics in Steamboat Springs and Craig.

Some thrive in a more challenging climate and geography with less oxygen, and some don’t.

It also very much depends on the individual, of course.

People with underlying health issues, especially related to the lungs and heart, may find their conditions exacerbated by the altitude.

In general, said Baker, people with chronic lung problems, especially Chronic Obstructive Pulmonary Disease (COPD), will have a harder time living at altitude. The same goes for some heart conditions.

However, there is also research showing altitude having potential protective effects on the heart.

In a 2014 National Center for Biotechnology Information study titled “Effects of Living at Higher Altitudes on Mortality, author Martin Burtscher wrote, “The available data indicate that residency at higher altitudes are associated with lower mortality from cardiovascular diseases, stroke and certain types of cancer. In contrast, mortality from COPD and, probably also, from lower respiratory tract infections is rather elevated. It may be argued that moderate altitudes are more protective than high or even very high altitudes. Whereas living at higher elevations may frequently protect from development of diseases, it could adversely affect mortality when diseases progress.”

In studies spanning the globe, researchers have seen several consistencies in people living at higher elevations: they weigh less, have less cardiovascular disease and some types of cancer and live longer.

But it isn’t so straightforward to say that if you come to — or are born at — a higher altitude, you will lose weight, be healthier and live longer, noted Baker.

It’s a lot more complex and so is the available research.

For example, while increased exposure to ultraviolet rays may increase the risk of skin cancer, the increased levels of Vitamin D intake may also have protective effects that “profoundly influence cardiovascular mortality,” according to Burtscher.

Some studies show people with asthma do better at higher altitudes. Some show they do worse.

And in terms of what Burtscher described as moderate versus high or very high, 6,000 to 7,000 feet can treat a body differently than 9,000 to 10,000 feet.

“High altitude to a physiologist starts around 5,000 feet, altitude where the body senses changes in the oxygen level and starts to respond by increasing breathing,” according to the Institute for Altitude Medicine in Telluride.

There is a reason the U.S. Olympic & Paralympic Training Center is located in Colorado Springs, noted Dr. Brent Peters, a pulmonologist at UCHealth Pulmonology Clinics in Steamboat Springs and Loveland.

It’s 6,035-foot elevation is a “sweet spot” that provides the most conditioning benefit in terms of ideal oxygen deprivation.

The relationship between lower body weights and altitude comes with several hypothesis.

A 2013 study in the International Journal of Obesity found a strong association between altitude and obesity in the United States. Using data from more than 400,000 people, researchers found people living closest to sea level were four to five times more likely to be obese, compared to people living significantly above sea level in Colorado.

One possibility is simply that people exercise more — though the study did control for that factor and still saw people losing weight.

One theory has to do with eating fewer calories — altitude has been shown to increase levels of leptin, a protein hormone that plays a role in appetite control and metabolism. Hypoxia (lack of oxygen) also is known to cause a loss of appetite.

In terms of how a body living at altitude varies from one living at sea level, the primary thing that happens in terms of physiology, said Baker, is that the blood compensates with a higher amount of hemoglobin, which increases the amount of oxygen that can be carried.

One thing Baker does see on a regular basis is more severe impacts from sleep apnea.

Sleep apnea is defined by the Mayo Clinic as “a potentially serious sleep disorder in which breathing repeatedly stops and starts.” 

Peters, who travels around the state providing care, said he also sees an “acceleration” or “exaggeration” of sleep apnea in patients.

“They basically don’t breathe well at night,” Baker said. They wake up frequently and feel fatigued the next day. Often those people sleep better and feel more energetic at sea level.

There’s also a wide spectrum of sleep apnea and different kinds, Peters noted. Most sleep apnea cases are classified as obstructive, in which a person can’t breathe normally because of an upper airway obstruction, occurring when throat muscles relax.

Central sleep apnea, which is less common, “occurs when your brain doesn’t send proper signals to the muscles that control breathing,” according to the Mayo Clinic.

Peters said he sees more central sleep apnea in Colorado than other places.

According to a Medlink Neurology report, “Central sleep apnea due to high-altitude periodic breathing affects about a quarter of people who ascend to 2,500 meters (8,202 feet) and almost 100% of those who ascend to 4,000 meters (13,123 feet) or higher.”

Kids can also experience difficulty sleeping at higher altitudes, said Dr. Steven Ross of Sleeping Bear Pediatrics.

Before they can verbalize how they feel, very young children may seem restless at night and irritable during the day, he said, especially above 7,500 feet.

If a normally energetic kid sits down and whines on the Uranium Mine Trail while hiking or at the top of a ski run, there’s a good chance they are experiencing effects of altitude, Ross said, and aren’t just spoiled and lazy.

And that goes for kids who live here as well as visitors, he said.

When recreating at higher altitudes, Ross advises parents to make sure kids are hydrated and well protected from the sun. Make sure they get good sleep, and “factor in patience,” he said. Be aware that kids may not have the same endurance they do at lower elevations.

High altitude effects on babies

Altitude does play a significant role as babies develop in utero, described Allyson Daugherty, a neonatal nurse practitioner with Childrens’ Hospital Colorado who cares for newborns in the special care nursery at UCHealth Birth Center in Steamboat Springs.

Babies born at higher altitudes (especially over 8,000 feet) are typically smaller in size.

“Altitude contributes to overall growth from a weight perspective,” she said.

And, for those tiny developing lungs, mothers making it to the 36-week mark is imperative, she said.

Lungs continue to develop until two to five years of age, Daugherty said, but those last few weeks in utero is crucial, and the primary reason doctors want to see mothers, particularly at higher altitudes, make it to term (40 weeks). “The more premature a baby is, the more susceptible the baby is to respiratory distress.”

Babies can become hypoxic, she said, and frequently need a little more oxygen during those first few months of life as their lungs mature — especially if they are born prematurely.

A lot of babies born at UCHealth Yampa Valley Medical Center are given supplemental oxygen, Daugherty said, as are babies who are born in Denver and travel to Steamboat or are going home to elevations higher than Steamboat.

Even babies who make it to 36 weeks may need some support to continue their lung development after they are born. But those lungs can, and usually do, mature fully after birth without any lasting detrimental effects. 

“A huge portion of babies (born at YVMC) go home with oxygen whether they are pre-term or term,” she said.

The American Academy of Pediatrics recommends parents sleep in the same room as their babies at least up to 6 months of age, Ross said, something even more important at high altitude. The optimal recommendation is sleeping in the same room through 12 months of age.

The good news is, said both Peters and Baker, most people — young and old — adapt quite well and relatively quickly.

Peters noted that many of his patients are “snowbirds,” and he asks them to take note of any differences in how they feel living at the different elevations.

Both doctors say it is rare they will tell a patient they should move to a lower elevation.

Only in the most extreme cases, Baker said, will he tell a patient they should move — when, even with supplemental oxygen and other medical interventions, in the face of significant lung or heart disease, “We just can’t keep them in a safe zone.”

Of course, many people who do live at altitude, especially as they age, use supplemental oxygen.  

Supplemental oxygen, as well as medication, can help people with pulmonary hypertension (high blood pressure of blood vessels in the lungs), which can worsen at higher elevations.

Aside from those rare cases, some people make their own decision if they find they feel more energetic and are able to be more active at sea level, Peters said.

There’s also the eternal importance of maintaining a general level of fitness. Baker thinks this may have more to do with people living longer at high altitudes than anything else.

“It’s not cut and dry,” emphasized Peters. For people, especially as they get older, altitude may stress the lungs, but the low humidity and clean air can also make it easier to breathe. Some people may feel better higher up, some worse.

What about my dog?

For the average healthy dog or cat, without any underlying diseases, altitude doesn’t have any significant negative impact on your pet’s health, said Rocky Mountain Veterinary Ultrasound Dr. Kim Radway.

But when an animal has heart disease, which happens with aging, altitude can increase the severity of the impacts of the disease.

Radway also said she sees a significant increase in the amount and severity of pulmonary hypertension in high altitude dogs and cats — which means high blood pressure in arteries leading in and out of the lungs.

If the high blood pressure becomes too severe, it can cause disease and failure of the right side of the heart.

Radway sees more cases than the average vet because she travels around the region giving cardiac ultrasounds — the only way to diagnose pulmonary hypertension. It is much more common in dogs than cats.

In addition to the dogs living at high altitude, Radway said she often sees pulmonary hypertension present itself suddenly in dogs traveling relatively quickly from sea level to higher altitudes.

To treat the condition, Radway prescribes the pet equivalent of Viagra. No, she said, your male (unnuetered) dog is unlikely to experience the same side effects as a human male because of dosage.

But, like in humans, the drug increases blood flow to particular parts of the body — including the lungs. It doesn’t provide a complete reversal, she said, but works pretty well. There are also several other medications that can help, as well as oxygen and restricting exercise.

Signs your dog might have pulmonary hypertension include rapid breathing, coughing, signs of lethargy, and syncope, which is a loss of consciousness due to lack of normal blood flow to the brain.

Another altitude side effect Radway sees is an increased negative impact on pets from smoke — whether that be cigarettes, cigars or marijuana.

For helping your furry friend guard against negative impacts of altitude, Radway recommends decreasing the animal’s exposure to airway irritants, and if traveling back and forth to low altitudes, giving your dog time to adjust.

While heart disease is hard to prevent, she recommends preventing heartworm — particularly when traveling to places where it can be 70 degrees or warmer for a full 24 hours. And there are medications that can alleviate some of the effects of heart disease.

Like humans, dogs can get altitude sickness, though it is much less common. Symptoms include vomiting, excessive drooling, panting, ear discomfort and lethargy. In extreme cases, it can cause a build up of fluid in the lungs and brain.

Prevention tips include making sure your dog is hydrated, giving them time to acclimate and taking it easy.

To reach Kari Dequine Harden, call 970-871-4205, email kharden@SteamboatPilot.com or follow her on Twitter @kariharden.

Editor’s note:

This is part two of a four-part Longevity Project from the Steamboat Pilot & Today. The series also includes profiles on Routt County locals who are thriving at altitude.

“The Mental Health Comedian,” Frank King headlines Post Independent’s Longevity Project Tuesday

The Post Independent’s Longevity Project, Striking a Conversation: Mental Health For All Ages culminates Tuesday with a performance from, “The Mental Health Comedian,” Frank King.

A writer for the Tonight Show with Jay Leno for over 20 years, King has lived with mental illness for decades.

“I would say that humor has saved my life, all my life,” said King. “I believe that my sense of humor is just part of the wiring that also contains my major depressive disorder.”

In addition to performing comedy 12 weeks a year on Holland America Line cruise ships, King speaks on college campuses across the country about mental health and suicide prevention.

“There is a stigma surrounding mental illness,” said King. “There is a separate stigma surrounding thoughts of suicide. It scares people and therefore they don’t talk about it.”

King, however, will speak to these issues and more Tuesday night at Morgridge Commons Meeting & Conference Center, 815 Cooper Ave., in Glenwood Springs.

Doors to the Longevity Project’s main event featuring King open at 5 p.m.

A local panel comprised of Carson Marie De Fries, Jackie Skramstad and Kevin Patterson will start the event with a presentation beginning at 6 p.m.

Defries serves as Intergenerational Program Coordinator at the University of Denver, Skramstad works as a clinical operations manager at Mind Springs Health and Patterson takes on the responsibility of being Connect for Health Colorado’s CEO.

Following the panel’s presentation, King will begin at 7 p.m.

Tickets to Tuesday’s event cost $15 and include appetizers. They can be purchased here.

“I will explain why a comedian is talking about depression and suicide – that’s always the elephant in the room – and then I will give them actionable, take home advice. What I call signs, symptoms and solutions for depression and thoughts of suicide,” King said of what those in attendance Tuesday can expect. “We can save lives, simply by starting that conversation.”


Watch: Nadine Roberts Cornish talks conscious family caregiving

Nadine Roberts Cornish was the speaker of the fourth Longevity Project micro-session event hosted by the Glenwood Springs Post Independent at Glenwood Springs Library on Tuesday, September 10.

Before the event, the senior advisor and author spoke to us about her passion for supporting family caregivers.

Longevity Part 4 — maintaining mental wellness into the late adult and senior years

Mental illness is just a part of life for longtime Glenwood Springs resident Lynne Jammaron.

It’s something she deals with both personally and in her efforts to help others through their own struggles.

Diagnosed with bipolar disorder at age 19, Jammaron has lived with mental illness all of her adult life. Her experience runs the gamut: ups and downs, manic moments, mood swings, breakdowns — and the returns to well-being.  

Now 56, she doesn’t let the illness define her. But her willingness to share her experiences can provide a defining moment for others struggling with their own mental health.

“People need to know, first and foremost, that they’re not alone, and that they’re not the only one dealing with something that isolates them and fills them with fear and dread …,” Jammaron said.

Jammaron leads a weekly Connection Recovery peer support group in Glenwood Springs through the Roaring Fork Valley chapter of the National Alliance on Mental Illness (NAMI).

In her own journey, Jammaron had the strong support of family, including husband Glen, along with a good network of friends and a caring church family. But she recognizes that not everyone has that level of support, which is why she became involved with NAMI.

Glen, in particular, was a rock in her life during the tough times.

“We did this together as a team, just trying to find a balance, a good state of mind and a good relationship,” she said.

Outside of family, there was also NAMI and its support groups.

“It was amazing to me to see that there were a lot of other people who dealt with what I was dealing with,” Jammaron said. “We want people to know that they can come to a place of hope, health and healing, just as I have done.”


Those who attend Jammaron’s and other support groups in the Valley span the age spectrum. But she has also observed that the vast majority of people who regularly take part tend to be older adults who have learned through the years to manage their condition.

Millions of adults in the United States with a mental health condition have adapted through medication, regular psychiatric care and any of a variety of support mechanisms. It’s something they will continue to live with and adapt to as they get older.

According to statistics compiled by NAMI, one in five adults in America will experience a mental illness on some level, and nearly one in 25 (10 million) adults live with a serious mental illness.

Half of chronic mental illness starts around age 14, and three-quarters by age 24, according to that same set of statistics. But the stress and anxiety of later adulthood and post-retirement can also be a concern on the mental health front.

“Depression is not more common in the elderly, but it often does present itself for the first time when a person is older,” said Dr. Jules Rosen, a geriatric psychiatrist from Summit County who recently retired as chief medical officer for Mind Springs Health.

Rosen spent the last six years with Mind Springs, while also teaching as a professor of psychiatry at the University of Colorado. Prior to that, he was a professor of medicine and chief of geriatric psychiatry at the University of Pittsburgh for 32 years. 

Dr. Jules Rosen, retired chief medical officer of Mind Springs Health, speaks at the 2018 Longevity event in Glenwood Springs.
Chelsea Self / Post Independent file

“Late-life depression can strike out of the blue,” Rosen said.

There are late-life stress factors to be aware of — final career advancement, the transition to retirement, financial security, health concerns and physical limitations that come with aging, and the sense of mortality when friends or loved ones die.

But there doesn’t have to be a specific cause for depression or late onset of a more serious mental health condition, Rosen said. A condition may have gone undiagnosed for many years, but only shows itself later in life. 

In any case, “without treatment, it can be a very serious and even fatal condition,” Rosen said.

“Of all the fatal illnesses late in life, though, depression is the most treatable. When I see somebody with straight-forward major depression late in life, my expectation is 100 percent recovery. It may take four weeks, or it may take four months, but it can be treated.”

Short of a clinical diagnosis for a more serious condition, a person’s mental wellness associated with aging issues can benefit from a visit to a mental health counselor, Rosen added.


Oyen Hoffman, a family therapist and member of the behavioral health care team at Mountain Family Health Centers in Glenwood Springs and Rifle, said he works with a lot of people in their 50s and 60s who are struggling with the transitions that come with that period in a person’s life.

“That’s when people start to evaluate their life — where they are, where they thought they would be, where they’re headed,” Hoffman said.

Oftentimes, those concerns revolve around finances, and whether they’ve properly prepared for retirement, he said.

“But they tend not to think about purpose and meaning and the values in their life,” Hoffman said. “Their job might be their identity … then they retire, and they don’t have that purpose.”

Boredom and depression can set in during early retirement. There’s also an uptick in alcoholism and suicide rates during that period of life, he noted.

“There are a lot of things that aren’t in the retirement brochure,” Hoffman said, adding that it’s healthy to have the conversations around that transition well ahead of time.

Medical challenges that come with age can also affect a person’s mental well-being, Hoffman added.

“Hearing loss can be a real contributor to depression, and if we’re not able to catch that we could be missing something,” he said of Mountain Family’s focus on integrative health care that looks not only at a person’s physical health but the mental side of it, as well.

If a person can’t hear well, they’re more likely to isolate and shy away from social settings, which can lead to depression, he said.

“Isolation is the worst thing — for everyone and everything,” adds Gary Schreiner, also a family therapist at Mountain Family and head of behavioral health services for the multi-county network of community health clinics in Garfield, Eagle and Pitkin counties.  

“We’re social animals, so when a person feels isolated, whether they’re depressed or bipolar, whatever, it’s going to make it worse,” Schreiner said.

Keeping people active and involved in social settings is important, whether it’s therapy for someone with a diagnosed mental health condition, or someone just looking to stay active and engaged in late life, he said.

Being single as one ages is a common struggle, whether it’s the result of losing a spouse to death or never having married in the first place, or remarried after a divorce.

“I can’t tell you how many folks in retirement tell me they just wish they had someone to share their life with,” Hoffman said. 

“The lack of a close personal relationship is the health equivalent of smoking a pack of cigarettes a day. So, we have to have relationships. We’re hard-wired for relationships.”

NAMI web file


For people diagnosed with a mental illness earlier in life, whether it’s clinical depression, a mood disorder or severe psychosis, continued psychiatric care later in life is crucial, according to Dr. Rosen.

It’s also important for patients, and their medical doctors, to understand the possible conflicts between medications intended to control a mental health condition, and those prescribed for medical conditions such as high blood pressure.

“I’m 68 now, and so many of my contemporaries are on six to eight different medications,” Rosen said. “Different drug interactions can cause side effects that can affect both mood and cognition.”

Over-the-counter medications can also be a concern, which is why a comprehensive approach to a person’s health care is critical, especially later in life, he said

“We need to know every single medication that our patients are on,” he said.

As a person ages, the lines can also be blurred from a layman’s perspective between what might appear to be a psychotic episode, but which might actually be the onset of dementia, Rosen also emphasized.

That’s where integrated treatment is important, and something for families to consider when a loved one starts to show signs of decline.

“Bipolar late in life can look like Alzheimer’s Disease, so it’s important to know what we’re dealing with,” Rosen said. 

“As people age, treating bipolar is really an art,” he added, noting that doctors have to stay on top of medication dosages to avoid toxic reactions due to a lifetime of using a particular drug, such as lithium.

Left untreated, late-life depression can also speed the physical decline, Rosen said.

If an older person constantly says, “I don’t feel well,” that alone can be a sign of depression, he said. 

Again, finding ways for older people to stay active and engaged in social settings is critical, Rosen, Hoffman and Schreiner all three concurred.


A few years ago, NAMI partnered with suicide response agency Aspen Hope Center and Aspen Strong to raise awareness and start a conversation in the region about mental health issues. 

An educational event at the Wheeler Opera House in Aspen drew a standing-room-only crowd, said Linda Spencer, another NAMI group organizer and board member for the organization.

A separate meeting with area police chiefs and sheriffs followed, which focused on the difficulties law enforcement agencies contend with in dealing with someone who has a mental illness.

“We had no idea when we started this that it was going to grow so fast,” Spencer said of the peer-to-peer and family support groups. 


Lynne and Glen Jammaron

Jammaron would like to expand her own outreach to area churches, as her own church family has been one of the places where she found support and understanding.  

She and Glen have also become advocates for expanding mental health services on the Western Slope. 

“It’s very hard for someone dealing with a mental health break, and there’s no place to go,” she said.

West Springs Hospital in Grand Junction, which is the only psychiatric hospital on the Western Slope and is operated by Mind Springs, expanded last year. Already, it has a wait list, Jammaron said.

“When you have a loved one needing 24/7 care, and you have to go to Denver … you lose that intimacy,” she said. “We need those resources here.” 


Mental Health Help Resources

Longevity series continues Tuesday with nationally recognized speaker on ‘Conscious Caregiving’

Caring for a loved one through serious illness or at the end of life is something most people will have to deal with at some point in their own life.

But an important, and sometimes overlooked aspect of that life journey is to ensure care for the caregiver, says Nadine Roberts Cornish, noted author and founder of The Caregivers’ Guardian.

Roberts Cornish is the scheduled speaker in the fourth Longevity Project micro-session hosted by the Glenwood Springs Post Independent. The free event takes place at 5:30 p.m. Tuesday at the Glenwood Springs Library, in the second-floor classroom.

A family caregiver can often feel alone and ill-equipped in their task, which can lead to a host of mental wellness concerns that are just as important to tend to as the needs of the person being cared for, Roberts Cornish said.

“What’s really interesting is that, oftentimes, it’s the weakest link in the family chain who is selected to serve as the primary caregiver,” she observes.

Just because a member of the family isn’t working full time, or doesn’t have other family obligations, or happens to live closer to the loved one who needs care, doesn’t mean that person is the best fit for the job, she said.

“What we often see is that the person who gets chosen has deficits of their own, which sets up a real disadvantage for that caregiver who may not have the skill set or the training to be an effective caregiver,” Roberts Cornish said.

Beyond those functional tools, Cornish offers a five-step plan for that person to be mentally prepared, as well.

In addition to founding The Caregivers’ Guardian, Roberts Cornish is a certified senior advisor and author of Tears In My Gumbo, The Caregiver’s Recipe for Resilience.

Through her presentation, “Finding Joy in the Caregiving Journey,” she introduces the 5 Steps of Conscious Caregiving, which she developed to help people understand and avoid the pitfalls they may encounter as a caregiver. 

The steps are designed to help the caregiver overcome the challenges of loneliness, depression and anxiety.

“You’ll understand that, while caring for a loved one is important, the greatest care that you’ll ever give is the gift of self-care,” Roberts Cornish said. 

The five steps are: 

  1. Helplessness — “That feeling and sense of, ‘oh my God, I’m not sure what to do.'”
  2. Recognition — “That you don’t know what you don’t know … just being overwhelmed with an overload of information about what needs to be done, but that you just need to get it done.”
  3. Process — “Figuring it out, and recognizing that self-care has to happen, because if your’s not taking care of yourself, then you’re no good to anyone.”
  4. Acceptance — “That you’re really not in control, but you have this responsibility of caring for a loved one even if you can’t control their circumstances.”
  5. Surrender — “Letting go, and letting God … and understanding that what’s happening is higher than yourself.”

“We will also talk about how to avoid isolation, and taking the steps to not do this journey alone,” Roberts Cornish said.

Roberts Cornish also works with Renew Senior Communities, including Renew Roaring Fork in Glenwood Springs, providing education and training on caregiving and providing resources locally.

Renew Roaring Fork is the sponsor of Tuesday’s Longevity event. Doors open at 5:15 p.m. and the event runs until 7 p.m. Light refreshments will be served.

About the presenter

Nadine Roberts Cornish is the founder of the Caregiver’s Guardian, LLC. She has an extensive background in public health education and served as an independent consultant for 15 years with California’s Department of Health Services where she provided expertise on some of the state’s most innovative social marketing campaigns.

Nadine’s most important role was as a 15-year caregiver to her mother. That journey changed everything. A year after her mother’s death, Nadine knew without a doubt that caregiving consulting, education and coaching would be her life’s work. For the past ten years she has care managed, consulted with and supported caregivers across the country.

Those experiences were the catalyst for her inaugural book, Tears In My Gumbo…The Caregiver’s Recipe for Resilience. Nadine attended the University of New Orleans where she studied Business Administration and in 2012 earned a professional Certification in Gerontology from UCCS.   She is also a Certified Senior Advisor, Freedom Coach and Elite Life Coach.

In launching her inaugural book, Tears In My Gumbo, The Caregiver’s Recipe for Resilience, Nadine has also launched “The Care-ocity” movement, where her mission is to raise awareness and spread the message of caring around the world.

Spreading the message of care-ocity means sounding the alarm in our churches, organizations and businesses about the impact that caregiving is having on the 44+ million caregivers, caring. Nadine conducts Caregiver Symposiums/intensives for churches and lunch and learn series for area businesses. She is both an impassioned and impactful speaker and speaks around the country.   Her book has received wide acclaim and now has a companion curriculum for colleges and universities. Dillard University’s School of Nursing is the first school to add the book to its nursing curriculum.

She partners with Inner City Health Center to provide breast, cervical and colon cancer education as part of her efforts to support the health of caregivers and others. In November, for National Family Caregiver’s Month, Nadine spearheads an effort to promote self-care among caregivers and partners with Five Wellbeing Spa to get caregivers in for special services and care.

Nadine has been married 20 years to Kevin Cornish, a Boulder County firefighter. She is the mother of one son, a writer and poet. Nadine is passionate about her work, passionate about caregiving and making a difference on purpose.

— Provided

Former Carbondale family’s national bus tour seeks end to stigma around mental illness, addiction

Tim Harrington is now several years removed from his former life in the Roaring Fork Valley, but it was here that the seeds were sown for his latest mission.

This past winter, Harrington and his wife Robyn Cruze sold their home in Denver, pulled their middle school-aged daughters, Lilly and Chloe, out of school, converted an old school bus into a tiny home and set out on the road.

The purpose: to spread a message of hope for ending the stigma surrounding mental health and addiction.

That means shifting the conversation around those issues, Harrington said. And that’s exactly what they are aiming to do as part of a year-long bus tour across the country.

“Instead of focusing on how badly things are going, or how much things need to change, we need a consistent message of hope,” Harrington said in a recent phone interview from New York City — one of the many Wide Wonder bus stops.

The Wide Wonder Life bus.

Stigma comes from the negative, and focusing attention on things like criminal statistics around drug addiction, or looking at suicide statistics as a result of mental illness only adds to the stigma, he said.

Instead, Harrington says, why not call attention to the fact that 25 million people in the United States are in remission from substance abuse, according to the U.S. Surgeon General.

“We don’t get to the other side of the story,” he said. “And it’s the same with people who are suffering from mental illness.”

A personal story

Harrington was living the life in the Roaring Fork Valley in the 1990s, where he worked in the restaurant business and eventually ran an Aspen restaurant. But the lifestyle only fueled an addiction that started at a young age.

He lived through trauma as a child, and grew up in a social system in California where drugs were acceptable.

“Alcohol was used in my family to celebrate, and to medicate,” Harrington said. “I always liked to say I didn’t have a drug problem, I had a drug solution … it distracted from and chilled the pain.”

He battled addiction for 20 years, through interventions, treatment, relapse, homelessness, reaching out for help, and recovery.

During his time in the Valley, he said he lost 15 friends to suicide.

“There’s an us and them paradigm when that happens, and feeling bad for ‘them,'” he recalled. “But it should be an us and we issue.”

Harrington eventually went to work in the recovery business himself as a way to give back. He moved back to the Valley in 2008 where, among other things, he worked with the Jaywalker Lodge in Carbondale — a residential addiction recovery program for men.

Now, along with his wife, who is an internationally recognized author on the subject of recovery, the Cruze-Harrington’s are taking their message across the country.

Pulling up roots

“The Valley is still a big part of our lives,” Harrington said. “It’s one of those places you can leave, but you never really leave.”

But it was in Denver that he built his practice as a family recovery support specialist and outspoken advocate for emotional health.

“We’re travelers by nature, and had always traveled with kids,” he said. “We weren’t working in the traditional sense, and so we decided to combine our experiences personally and professionally with mental illness, and take it on the road.”

They spent $60,000 of their own money to convert the bus into traveling living quarters, and turned their passion into an adventure — with a purpose.

Through an ongoing series of TED-style talks and educational events, the Cruze-Harringtons are keeping the conversation around mental health and addiction going.

They’ve gotten national and local media attention along the way, and the momentum keeps building, Harrington said.

“It’s been a real internal exploration, as well as external,” he said. “We couldn’t be more excited about our own vulnerability, and sharing that with others. It’s amazing how many people out there are as passionate about the issue of stigma and wanting to change that.”

But that’s how big change happens, Harrington said.

“We have an army of wellness advocates, if we really choose to use it,” he said. “A big part of recovery is anonymity. But that can sometimes be counter to how we get change going.”

Instead, for those who are willing, the goal is to encourage people to use that voice and share their personal story, he said.


Longevity Project, Striking a Conversation: Mental Health For All Ages, continues Tuesday with micro-session featuring Sonja Linman


The Glenwood Springs Post Independent’s Longevity Project, Striking a Conversation: Mental Health For All Ages, continues Sept. 3 with a micro-session featuring Sonja Linman.

Linman works as a prevention specialist with the Roaring Fork School District.

Free and open to the public, Tuesday’s micro-session will occur at the Glenwood Springs Library, 815 Cooper Ave., in the second floor classroom.

Doors open at 5:15 p.m. and the event begins at 5:30 p.m.

Teens: A clear head is a cool head

Watch Sonja Linman talk about substance abuse among teens, and building a culture focused on wellness instead of drinking.

Longevity Project Part III: Dealing with depression

In 2011, Ashley Mauldin moved from a city with more than 165,000 residents to one with fewer than 5,000.

Relocating from Fort Collins to New Castle proved stressful on its own, but Mauldin — just 27 years old at the time — also was suffering from postpartum depression following the birth of her first child.

“It was extremely isolating,” Mauldin said. “You feel like you’re the only one.”

A licensed professional counselor, Mauldin attempted to meet new people and make meaningful connections by joining groups such as the Glenwood Springs Chamber Resort Association. However, opening up about postpartum depression did not seem appropriate at events oftentimes centered on the local business community.

“Those aren’t the places you usually talk about those things,” said Mauldin. “Having those outside connections, those day-to-day ‘me-too’ moments with people … that’s really hard not having that.”

Mauldin recalled seeing social media posts from new moms about the joys of motherhood, and questioned why she did not feel the same. Instead, Mauldin felt depressed, shameful and doubted her abilities as a mom.

“You see things on social media where people say, ‘I love being a mom,’ and ‘Being a mom is so great,’ and I am over here thinking, ‘Maybe I shouldn’t have done this,’” Mauldin said.

“‘Maybe I am not mom material.’ You start to really create some deep shame about yourself.”

Eventually, Mauldin visited a therapist and wrote a two-page list of everything she hated.

Despite living in a beautiful area, being surrounded by a supportive family, and working in a field she was passionate about, Mauldin’s depression blinded her from all of the good.

“You really get these lenses on of, ‘Everything is terrible, everybody is terrible, life is terrible, the world is terrible,’ and it is hard to get out of that place,” Mauldin said. “It’s almost like you create a relationship with your depression, and it’s hard to let go of it because you have invested so much into it.”


“Society tells you that if things are going well and you have everything that society perceives you should have, then there is something bad about you if you are depressed,” said Dr. Jason Andersen, Mind Springs Health Chief Medical Officer.

“Sometimes you just can’t help it.”

Annually, one in 15 adults cannot help being depressed according to the American Psychiatric Association, and one in six people will experience depression at some point in their lives.

Biologically-based depression typically manifests during a person’s late teens and early 20s or late 50s and early 60s. However, depression can develop at any age and may include symptoms ranging from trouble sleeping and loss of energy to thoughts of feeling guilty and contemplating suicide.

“When somebody develops depression and when they seek treatment for it are often two different things,” said Andersen. “Sadly, even for severe depression, a lot of people never seek help.”

Some say nearly half of those who experience depression will never seek help, Andersen said.

If untreated, depression has the potential to change the brain, spinal chord, and the way in which the body reacts to stress, Andersen explained.

Since 2015, 58 people died by suicide in Garfield County — 83 percent men and 17 percent women. Of those 58 people, nearly half were diagnosed with depression.

Depending upon the study, women can exhibit symptoms of depression up to four times the rate of men.

While women attempt suicide more frequently, men follow through with suicide at higher rates and remain less likely to seek treatment.


Now 35, Mauldin’s struggles with postpartum depression and depression inspired her to start the group Daring Women in 2018.

Whether rafting on the Colorado River or conversing over a glass of wine, the community organization meets monthly and invites women to share with those willing to listen and connect.

“It’s vulnerable for me having postpartum depression to say, ‘I actually hate being a mom,’” Mauldin said. “We don’t like to talk about that because we worry, well, what are people going to think.”

“But, once you start talking about it, you get people coming in that say, ‘I’ve actually felt that way, too.’ …You start to get empathy from people and connection.”

Daring Women does not exclusively focus on depression but rather a variety of issues. Open to all women, the community organization strives to build connectivity and develop meaningful relationships through honest conversations.

“We all have our struggles,” Mauldin said. “Daring Women is for anybody looking for connection or feeling a lack of connection; anybody who feels lonely or anybody who wants to have a good time and work on themselves. I label the group as growth-minded for people who are looking to become a better version of themselves.”


Emily Supino, Aspen Strong’s acting executive director, stressed the importance of promoting healthy mental hygiene and connecting the community to available resources.

One tool the nonprofit organization offers includes free mental health screenings through its website, aspenstrong.org, and at community events that it hosts regularly.

“They are quick, they are anonymous, and they are meant to be educational. They are not diagnostic,” Supino said of the screenings, which include tests for depression, post-traumatic stress, generalized anxiety and other mental health issues.

Following a screening, Aspen Strong provides numerous resources based upon each individual’s needs.

“We have a community calendar of events, classes and support groups that are taking place across the (Roaring Fork) Valley, and then we also have a provider directory so we can link them to a directory of about 90 providers from Aspen to Parachute.”

Supino pointed out how people oftentimes go out of their way to assist those with physical ailments and believed those suffering from mental health issues deserved the same consideration.

“We have a tendency as a society to think that mental health is private and we shouldn’t ask about it,” Supino said. “That is part of the problem and that feeds into that negative stigma.”

“We should be totally fine asking people how they are doing and when they respond that they are not OK, we should be able to have an empathetic response.”


Son’s suicide led to mom’s mission to remove the stigma from mental illness

A very difficult loss 12 years ago for Dolores and Patrick M. Snell led to an easy decision to be forthright about their son’s death and the disease that claimed his life.

Patrick John “PJ” Snell took his own life on Jan. 13, 2007, while the family was still living in Wisconsin. He was just 22.

“If my son had died of cancer, the obituary would have said he succumbed to cancer … how many times do we read that?,” said Dolores Snell, a physician’s assistant now practicing in Glenwood Springs.

PJ had lived with severe depression since he became an adolescent. He didn’t do drugs, he was artistic, he was involved in his church, he went on mission trips to Native American reservations …

People remarked at the memorial service that he always seemed to have a smile on his face, his mother recalled.

But, deep down, he was hurting — bouts of anxiety and depression, visits with counselors, psychiatrists, medications …

“He died of an illness that we couldn’t treat enough to keep him on this earth,” Snell said.

“People told me at the time, you’re so brave to do that,” she said of the decision to spell out in the obituary how PJ died and talk openly about his struggles.

It read: Patrick John “PJ” Snell … was a wonderful son, brother and friend. But unfortunately, the love and support of family and friends could not dissipate the darkness of his long fight against depression … 

Dolores Snell

“There’s nothing brave about that,” his mother affirms today. “I’m just telling the truth.”

As a mother, and through her expertise and insight as a health practitioner, Snell now takes the opportunity whenever she can to help lift the stigma that surrounds mental illness and the loss of a loved one to suicide.

Their family’s story was told in a front page article in the Wisconsin State Journal a few months after PJ’s death. She’s been an advocate for mental health concerns ever since. 

“It’s a real illness that needs advocacy, it needs treatment and it needs so much more than we have,” Snell said.

The stigma was greater at the time her son was struggling with mental illness than it is now, she said. 

And many strides have been taken over the last decade to bring mental health to the forefront alongside physical health concerns.

But more can still be done, she said.


For PJ, the signs began to appear as he entered adolescence, around 12 or 13, Snell said. That’s when hormones start to change, and the brain is growing.

“The frontal lobe is responsible for reason and accountability,” she said. “And in teenagers, we know that frontal lobe is developing, but not resolved.”

People would often ask after PJ’s death if there were any triggers that might have contributed to his disease.

He was smaller than the other kids, so there was some bullying, Snell said. But, from a medical standpoint, it’s more about the brain chemistry, and in the case of mental illness, an imbalance in that chemistry.

It was particularly hard when PJ turned 18 and became an adult, meaning his parents couldn’t be directly involved in his medical needs.

Dolores Snell keeps a collage of photos of her son, PJ Snell, who died by suicide at age 22.

Jackie Skramstad is clinical operations manager for Mind Springs Health, which provides inpatient and outpatient therapy and psychiatric services on the Western Slope. She said that transition from minor to adulthood is a challenge for someone dealing with mental illness.

“Depression can really start to manifest in high school,” she said. “But that first psychotic break often doesn’t happen until between the ages of 18 and 22.”

Because they are adults, there’s a lot of decision-making around who gets to be involved in that person’s care.

“At Mind Springs, we do value and try to work with clients about how best to support their treatment, whether that’s involving family or others,” she said. “We can’t make it happen, but it’s part of our approach using best practices.”

In general, whether there’s a mental health concern, or not, the transition from teenager to young adulthood is a critical time in a person’s development, Skramstad added.

“Kids are leaving the house and gaining more independence, and one of the things you want to do is help prepare them for that additional choice-making … and to be comfortable making decisions,” she said.

It’s a conversation parents and other adults in that teenager’s life need to start before they turn 18, Skramstad said.

“If you deal with it in the moment, you’ve waited too long,” she said. “You want to build up to that point and set the stage for them to be successful as they move on.”

And, if they’re struggling with something, help them find some support, she said. 


For a teenager or young adult who is struggling and possibly contemplating suicide, it’s important to watch for warning signs and take them seriously, said Michelle Muething, executive director for the Hope Center, which provides crisis response in Garfield County.

“’I’m going to kill myself’ has become kind of a flippant sentence for people to use, and especially teenagers,” Muething said. “However, the response has become different and it is taken very seriously.”

The Hope Center operates a helpline and provides in-person crisis response for people of all ages. They do field a fair number of calls from teenagers who are at a point of crisis.

“Some kids don’t understand the gravity of what those words mean, and the response that comes with it,” Muething said. “But the vast majority of kids we see are stressed, and very well do have a higher level of depression or anxiety.”

If they go to the effort to reach out, it is taken seriously, she said.

“Only a small percentage truly want to die,” Muething said. “There’s so much noise and clutter in today’s society to work through, and part of our job is to work through that.”

It could be clinical depression or anxiety disorder. “Or, maybe it’s just that they’re sad. So, let’s figure out why you’re sad,” Muething said. “Sometimes kids have to say something drastic for people to stop and realize, ‘I’m in pain, and I need someone to pay attention to me.’”

Part of Snell’s message is for parents and others whose families are impacted by mental illness to not feel shame or guilt, or to lay blame.  

“If I can help just one mother or one father not experience this by being honest, that’s a start,” Snell said. “From when PJ started needing help to when he died, that stigma was a huge part of the problem.

“And I said from that point forward, if I could do something to stop that, I would …

“My son, I believe, by my actions in advocating for mental health awareness … it is allowing this awful loss to have a meaning.”


Tuesday Longevity discussion looks at teen, young adult pressures

The Glenwood Springs Post Independent’s Longevity Project — Striking a Conversation: Mental Health for All Ages — continues Tuesday with a second micro-session, this time focusing issues facing teenagers and young adults.

Doors open at 5:15 p.m. at the Glenwood Springs Library, in the second floor classroom. The event will begin at 5:30 p.m., and is free and open to the public.

The PI has invited two representatives from Mind Springs Health, Michelle Doll and Jackie Skramstad, to talk about mental health issues facing teenagers and challenges associated with the transition into young adulthood.

Doll is outpatient program coordinator for Mind Springs in Glenwood Springs, and Skramstad is clinical operations manager, also based in Glenwood Springs.

Mind Springs provides behavioral health services on the Western Slope, including mental health and addiction services and mobile crisis response. The organization also operates West Springs Hospital, a psychiatric facility in Grand Junction.

Doll and Skramstad will give a presentation on brain and social emotional development through the teen years and into the early 20s. 

“We hope this will help the audience understand the capabilities and limitations of the age group we are discussing,” Skramstad said. 

Topics will include the impacts of trauma and substance use on that development.

“It’s important to understand what’s happening in the teen body, and set the stage for how we talk about the stresses and challenges during the teenage years,” she said. “One of the interesting dynamics about the brain is it’s not really developed until your early 20s.”

A question-and-answer session with the audience will follow. 

Skramstad has worked for Mind Springs Health since 2002, and now oversees clinical programs across the 10-county region served by Mind Springs. She is a graduate of Glenwood Springs High School, and received her bachelor’s degree from Santa Clara University and her master’s degree from San Jose State in California.

Doll works directly with adults, children, adolescents and families regarding mood and anxiety disorders, childhood trauma, social-emotional development and severe mental illness.

The Longevity Project events are presented by Renew Senior Management and Connect For Health Colorado, Tuesday’s micro-session will include light refreshments and conclude at 7 p.m.

The series continues with micro-events on Sept. 3 and 10, and concludes with a main paid event on Sept. 17, featuring special speaker Frank King and a panel discussion with professionals discussing mental health topics.

More information at www.glenwood.longevityproject.net.