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HealthView column: Injury prevention for cyclists

The Roaring Fork Valley really comes to life this time of year. While winter activities attract people from near and far, the summer is why people stay.

Located in the depths of our beautiful rolling hills to the roaring rivers, the valley is filled with activities from the water to the land. It is no surprise that the nature of the injuries we see coincide with the changing of the seasons.

One of the most common summer activities available here is cycling/biking.

Whether you are a mountain biker, a road biker or a commuter, this valley has an abundance of opportunities for beginners up through expert trails both on and off the pavement. The rise in e-bikes has also introduced more users to the trails.

The most common types of injury seen in bikers are head and face trauma, and fractures to the upper extremity, such as wrist, forearm and hands. As a shoulder specialist, the injuries I treat most often are fractured clavicles, otherwise known as the collarbone.

Your clavicle is a long bone between your shoulder blade and sternum that is easily identifiable by the bump it can create visible under the skin. It is a unique bone, highly susceptible to trauma. When an accident occurs, causing the participant to fall on their shoulder, or with their arm outstretched, the clavicle often takes on the impact of that fall. Because of this, the clavicle is considered to be the most fractured of our bones.

There is always a chance of injury, even to the most experienced of riders on the easiest of trails. However, there are many things you can do to reduce your risk of injury and have a safe, enjoyable ride.

Below are some of the tips I share with my patients:

• Practicing good trail etiquette, such as yielding to uphill riders and riding within your ability level can make sudden stops more infrequent, and decrease your risk of falling. Work your way up in mileage and make sure your bike is tuned, clean and running well.

• Replace your helmet every three to five years. Glues and resins used in helmets can affect the materials over time. Hair oil, body fluids and normal wear-and-tear all contribute to helmet degradation.

• Stretch muscle groups such as your hip flexors and hamstrings both before and after you ride. After vigorous activity, blood can pool in the large muscles in the legs and cause fainting or dizziness — stretching helps to alleviate that and any lactic acid buildup that occurs.

• Cross training with core exercises and activities that work adjacent muscle groups is helpful for balance and coordination.

• Staying hydrated throughout your ride fends off muscle cramping and fatigue, especially in hot weather. Even in cooler weather, dehydration is possible if you don’t drink enough fluids while riding.

While we encourage a safe and active lifestyle here. We also understand some accidents are unavoidable. Many injuries that occur while riding may be easily treated at home.

However, knowing when to seek professional medical advice is also a key to a successful recovery. If there is persistent swelling around a joint, painful “pops,” recurring instability, consistent pain during or after an activity, or pain that does not respond after a period of rest, it may be time to see a physician.

Since 1994, Dr. Ferdinand “Tito” Liotta, MD, has helped restore the health of athletes and adults of all ability levels in the Roaring Fork community as part of the Glenwood Orthopaedic Center at Valley View Hospital team.

Doctor’s Tip column: Diet and blood pressure

When scientists study large populations of people and look at what diseases they get and what they die from, it becomes apparent that ideal blood pressure is 110/70 or below. As blood pressure rises above that level — especially 140/90 or above — the incidence rises for heart attacks; strokes; damage to blood vessels in the eyes, kidneys, and brain; aortic and brain aneurysms; dementia; and heart failure.

In countries on a Western diet — high in animal products, refined food, salt, sugar and fat/oil — blood pressure tends to rise as people age, and the majority of people eventually develop hypertension (high blood pressure).

Although this scenario is common, it is not normal. In populations such as rural Africa and rural China, where people eat unprocessed, plant-based food low in salt (sodium), blood pressures remain in the 110/70 range, even in people in their 90s.

In the 1940s, before effective blood pressure medications had been developed, people with severe hypertension — such as FDR — usually died. Walter Kempner, M.D., at Duke University, put these severe hypertensives on a strict fruit and white rice diet with no added salt. Blood pressures in the 240/150 range came down to the 105/80 range.

Obviously, this diet was monotonous and lacked many important nutrients, but Dr. Kempner proved that hypertension is caused by what people eat, and can be treated with dietary changes.

In spite of what the Salt Institute would like us to believe, salt clearly causes hypertension, although some people respond to salt more than others. Salt causes water retention, and your body responds to this by increasing your blood pressure, in order to eliminate the excess water and salt. Your blood pressure rises soon after eating a salty meal, and if you eat too much salt on a regular basis you will likely end up with sustained hypertension.

During most of the millions of years of human evolution, humans were eating just a few hundred milligrams of salt, through their plant-based diet. We now eat about 10 times that amount. The maximum safe amount of salt for adults is 1,500 mg.

Cheese and processed foods have particularly high salt content. The primary source of salt in kids and teenagers is pizza. In young adults the main source is chicken — the poultry industry commonly injects chicken carcasses with salt water to artificially inflate their weight. In older adults, the main source of salt is bread.

People who eat animal products are more apt to be overweight, which is a major cause of hypertension. Furthermore, they are more apt to develop stiffening and hardening of the arteries (atherosclerosis), which cause their blood pressure to rise as they age.

Vegetables, fruit and whole grains on the other hand, cause the endothelium to produce nitric oxide, which makes arteries dilate. Nitric oxide also makes arteries healthier, and more resistant to atherosclerosis. Organizations such as the American Heart Association, the American College of Cardiology and the Center of Disease Control recommend that patients with hypertension first try weight reduction, limiting sodium and alcohol, exercising and eating a healthier diet.

However, what they recommend as a healthy diet is the DASH (Dietary Approaches to Stop Hypertension) diet. This diet emphasizes fruits, vegetables, and low-fat diet — some meat is also allowed, and it does lower blood pressure somewhat.

Dr. Sachs, of Harvard, was chairman of the committee that developed the DASH diet. His investigation found that the people in industrialized countries with the lowest blood pressures were vegetarians — and vegans even more so. His committee recommended the DASH diet because their goal was to create eating patterns “that would have the blood pressure lowering benefits of a vegetarian diet yet contain enough animal products to make them palatable to nonvegetarians.”

In his book “How Not to Die,” Dr. Michael Greger notes that “instead of simply telling you what the science shows and then letting you make up your own mind, experts patronize the population by advocating what they think is practical rather than ideal.”

Unfortunately, not everyone with high blood pressure is willing to change their lifestyle enough to impact it significantly. Next week’s column will discuss common blood pressure medications.

Retired physician Greg Feinsinger, MD, is author of the new book “Enjoy Optimal Health, 98 Health Tips From a Family Doctor,” available on Amazon and in local bookstores. Profits go towards an endowment to the University of Colorado School of Medicine to add prevention and nutrition to the curriculum. For questions about his column, email gfeinsinger@comcast.net.

Hunger assistance agency Lift-Up issues $4-a-day challenge

LIFT-UP, the 37-year-old nonprofit known for managing food pantries throughout the Roaring Fork Valley and Garfield County, has introduced a new $4-a-day challenge.

According to a press release, the awareness campaign aims to shine a light on the fact that hunger is a year-round struggle for more than 2,700 families that are served each month by LIFT-UP food pantries.

LIFT-UP has called on the public to participate in the challenge to experience what it is like to eat and drink on a $4-a-day budget.

Why $4 a day? — $4.15 is the national allocation of SNAP (Supplemental Nutrition Assistance Program), previously Food Stamps, funding for qualifying low-income individuals.

The $4-a-day challenge is an educational opportunity for the community to stretch their food budgets and plan ahead for shopping and meal prep, with the goal of cost-efficiency while making healthy food choices, according to the release from the nonprofit agency.

“Participants will find themselves forced to make food shopping choices on a limited budget, and learn how difficult it is to avoid hunger, afford nutritious foods and stay healthy.”

The Challenge will begin Monday, July 15.

LIFT-UP will have recipes, partner links and ways to stretch dollars, as well as healthy food choices information, on the LIFTUP.org website and social media, according to the release.

Mosquito alert: Garfield County health, pest management officials tracking West Nile virus

With the higher moisture level from an above-average spring runoff, Garfield County officials want residents to know mosquitoes are out in force on the Western Slope and to protect themselves.

 “It’s up. It is way up, but I think in some people’s minds it’s insane right now, but a lot of that is because we had such a good year last year,” said Steve Sheaffer, contract manager with Vector Disease Control International.

“In a dry year like last year when there wasn’t that much water fluctuating, it was a significantly more Culex tarsalis,” he said of the mosquito variety that’s the most common carrier of the West Nile virus in Colorado. 

“This year I think we have been seeing 80 percent or more of Aedes variety mosquitoes, which doesn’t typically vector any diseases,” Sheaffer said. “They are just really aggressive and annoying. I think that is what people are noticing right now.”

West Nile virus is a viral infection that occurs most commonly from the bite of an infected mosquito.

Viral spread

Steve Sheaffer inspects a mosquito trap during his weekly collection at the Rifle rest stop.
Kyle Mills / Citizen Telegram

Rachel Kappler, a registered nurse with Garfield County Public Health, said it was first discovered in 1937 in Uganda. By 1950, people in the Middle East started becoming sick. Symptoms include fever and encephalitis, which is an infection around the brain.

The virus was first discovered in the United States in 1999 in New York City.

“As of 2005, it has covered the entire hemisphere from Canada to Argentina,” Kappler said.

“We are trapping throughout Garfield County to monitor the numbers of mosquitoes in the genus Culex, to try and keep track of potential West Nile risk and aid in deciding where to focus our operation,” Sheaffer said.

Sheaffer, who is contracted through Garfield County, has been monitoring and controlling the mosquito population in Garfield County for over a decade now.

With the higher number of mosquitoes, the greater the chances for disease-carrying mosquitoes like the Culex tarsalis to be present.

Steve Anthony, vegetation manager for Garfield County, said the program is an intergovernmental agreement with all the municipalities in the county, made up of six jurisdictions. The agreement is renewed every year.

“The big push for West Nile virus came on the radar screen in 2003,” Anthony said. “Up until last year we did not have a confirmed case of West Nile in the county since 2007.”

Mosquito monitoring

Hundreds of mosquitos rest in a trap at Rifle rest stop earlier this week.
Kyle Mills / Citizen Telegram

To help monitor and trap the pesky insect, there are 11 points throughout the county and occasional floater traps when high concentrations of mosquitoes are detected, to see what is present in the insect population.

Permanent locations include Battlement Mesa, Parachute, three in Rifle, one each in Silt, at Coal Ridge High School, New Castle, Glenwood Springs, and two in Carbondale. 

Anthony said if a person were to leave one standard-sized coffee tin in their backyard and let it fill with water, it will produce 10,000 mosquitoes over one summer.

Mosquitoes look for dense vegetation during the heat of the day, so any overgrown areas in a homeowner’s yard can provide a good home for mosquitoes.

Sheaffer said that agricultural areas where water stands for more than five days would produce a substantial number of mosquitoes. Retention ponds and flooded areas are breeding grounds for the insects, as well.

“From 2018, 48 out of 50 states reported West Nile virus in their state,” Kappler said.

With 2,544 total cases nationwide in 2018,  there were 137 deaths recorded in the United states. Nebraska, California and North Dakota had the highest rates.

“In Colorado, in 2018 there were 96 cases, resulting in three deaths,” Kappler said. “There was one case in Garfield County last year.”

Since 2002 when public health officials started tracking West Nile cases, Garfield County has seen 16 cases. No deaths in Garfield County have been reported.

“It’s important to know that 94 percent of the cases occur between mid-July to late August. But it technically can occur at anytime of the year,” Kappler said.

Four D’s of mosquito protection

Drain: Eliminate mosquito breeding areas by draining any standing water in your living environment (flower pots, tires, drain gutter, rain barrels, etc.)

Dusk & Dawn: Mosquitoes that carry West Nile Virus are most active during these times. Limit your time outside at these times.

Dress: Long sleeves and pants are recommended. Cover your skin when you’re going outside. Wear light-colored clothing and avoid perfumes and scents that attract mosquitoes.

DEET: Use an effective mosquito repellent that is approved by the EPA.

Toll-free help lines

Statewide toll-free help line: 1-877-462-2911 (7 a.m.-11 p.m. daily)

CDC West Nile Virus info line: 1-888-246-2675 English | 888-246-2857 Spanish | 1-866-874-2646 Hearing impaired

Watch for symptoms


Some people are more prone to the disease and the risk factors. People age 64 or older have a higher fatality rate, she said.

Eight out 10 people don’t show symptoms, which begin about two to 14 days after a person has been bitten by a mosquito.

Kappler said the symptoms can last about three to 10 days or longer, and one in five people develop a fever, headache, body aches, joint pain, vomiting, diarrhea and rash.

“Most people spontaneously recover from West Nile virus, but it is possible to have long-lasting fatigue and weakness [several] weeks or months after the infections,” Kappler said.

“The big reason we are concerned about West Nile virus is it can cause encephalitis or meningitis,” she said.

Meningitis is the inflammation of the membranes surrounding the brain and spinal cord.

“One out of 150 people, less than 1 percent, will develop encephalitis or meningitis,” Kappler said.

“If anyone develops signs or symptoms that they think is West Nile virus, they should seek medical treatment form a qualified doctor,” she said.

Kappler said the three best steps of prevention involve who, what and when to select a repellent.

“Who are you protecting, because age is a factor; what are you protecting from; and then we go to when and how long is the potential exposure,” Kappler said.

Peach Valley prime


Anthony said parents need to pay particular attention to the area around Coal Ridge High School.

“There will be football practices or other sports throughout the summer. So we try to have that high on the radar screen,” Anthony said. 

Both Anthony and Sheaffer warn that it is an area that gets some Culex and a fair amount of mosquitoes, because it is middle of Peach Valley surrounded by agriculture activities. 

“We get in and treat as much as we can, but they seem to just love converging by the school for whatever reason,” Sheaffer said.

Anthony advises parents of children that are going to Coal Ridge and are taking part in activities in the summer time to send them off with some type of protection, whether it be DEET repellent or an alternative type. 

If people are interested to see where the hot spots are in the county on a weekly basis, they can go to the website garfield-county.com/vegetation-management.

“We get the counts for each trap, and it’s actually documented every week for location. If they really want to know where the Culex is, they should check it out,” Anthony said.


Glenwood to discuss vaping regulation

City Council may take a closer look at laws concerning the sale of tobacco products within Glenwood Springs’ city limits in the near future.

Recently, councilors heard from public health officials about potential point-of-sale tobacco pricing policies as well as tobacco retailer licensing requirements.

Pricing policies include a minimum price for all tobacco products and the prohibition of tobacco coupons, discounts and promotions. Additionally, a tobacco retailer license would act in many ways like the license needed to sell alcohol.

“We decided that we needed to get informed about what our role is and where we stand on things,” Mayor Jonathan Godes said.

The city at this time has not approved or even formally considered any new pricing policies or tobacco retailer licensing requirements.

“We have seen the proliferation of other communities addressing this,” Godes said of neighboring municipalities like Aspen, Basalt, Carbondale and Snowmass.

“We have heard from other communities that Glenwood Springs is the town where kids are going now to buy these [tobacco] products,” Godes added.

Eighteen-year-olds may still purchase tobacco, including vaping products, in Glenwood Springs.

According to the nonprofit organization ChangeLab Solutions, “strong tobacco pricing policies” improve public health by reducing income-based disparities in smoking rates, encouraging and facilitating tobacco users to quit, and discouraging youth initiation altogether.

“I don’t think anybody in Glenwood wants to be known as the place where kids go to pick up their vape products,” Godes said. “That’s not something we want to be known for.”

ChangeLab Solutions also maintains that tobacco retailer licensing laws can “help counter the tobacco industry’s predatory practices that disproportionally target youth; facilitate comprehensive enforcement of federal, state and local tobacco laws; and ensure that inspections and compliance checks occur in all the stores in the community.”

City Council has instructed staff to prepare a formal presentation with suggestions concerning tobacco sales and use in Glenwood Springs for consideration at a future council meeting.

According to Godes, following Aspen City Council’s vote to ban flavored nicotine products, the Glenwood Springs mayor said he was contacted by a gentleman lobbying about, ‘How great vaping was for people who were addicted to cigarettes.’

“As a father first and as a mayor second…this is a huge concern for me,” Godes said, calling vaping a crisis in the community. “Glenwood Springs really needs to take a hard look at this and make some suggestions on how we can help really protect our youth. …That is what we are doing.”


Torres column: Learn to persevere despite challenges

Seven years of hard work have paid off for me. Since I decided to change my life, I have being working towards my goals, and I have achieved many of them. When I look back, I can conclude that my life has improved because of all the changes I have made, not because of luck.

I think about many of the Custom Body Fitness members who started years ago. Many of them have lost a significant amount of weight and transformed their bodies. Others have lost weight, left Custom Body Fitness only to later return because they lost motivation and gained the weight back.

Those who lose weight and continue getting in shape are those who are the most disciplined. No matter what happens in their lives, they continue eating healthily and exercise regularly. Many times they come and tell me their stories and struggles with their family, business or job, health, finances, losses and emotions. It amazes me that they continue taking care of themselves.

I can tell you that in these seven years I have learned a lot from my experiences. I had struggles like many of my clients’, unsuccessful knee surgery, my brother’s car accidents, my dog’s life-threatening surgeries, car issues, identity theft, unsuccessful heart-breaking relationships and lack of help at CBF. However, just like many of our members, I did not stop taking care of all areas of my life: spiritual, family, health, professional and financial.

What I know is that life happens to everyone, and whatever happens is not here to stay. It will pass, and the two options we have are to stop and be devastated or continue with our goals and take care of the situation as we move forward. Many of our members know this as well.

It reminds me of the analogy in the Bible about the dream of the pharaoh that Joseph interpreted. There are seven fat cows and seven skinny cows. The skinny cows come and eat the fat cows. According to Joseph, there will be seven years of abundance and seven of scarcity. Therefore, when we are in abundance, we must take care of our areas and have reserves for the seven years of scarcity.

Like I said, these past seven years have been a blessing for me with a couple of inconveniences mentioned above. Nevertheless, 2017 was the most difficult one. I was hit spiritually/emotionally, family, financially and professionally. I think right now I am in my best shape ever, but the rest of my areas are suffering significantly even though I continue doing my best.

This does not mean that I am giving up on my dreams; it means that tough times have come, and I need to endure to my dream, my heart’s desires and continue taking care no matter how difficult it gets. It means that I should have been prepared for this time like Joseph did by reserving.

I once heard that life is a series of problems, and the only break we have is a crisis. So it goes like this” problems, problems, problems and more problems, crisis; problems, problems, problems and more problems, crisis.

And I also heard that we should not ask for fewer problems, we should ask for more wisdom and skills.

In other words, weight loss or any other goal you have will never happen unless you know how to deal with all these inconveniences as you continue moving forward. They have always existed and will always exist.

Sandro Torres is owner of Custom Body Fitness in Carbondale and Glenwood Springs and author of the book “Lose Weight Permanently.” His column appears on the second Monday of the month in Body & More.

Colorado begins state ban on vaping in most public places

A law against public vaping has taken effect across Colorado.

The Durango Herald reports the new state law beginning Monday prohibits vaping in most public places, including bars and restaurants.

Under the law, authorities can fine the owner, manager or operator of a business where illegal vaping occurs, while individual vaping in a prohibited area can also result in a fine.

Vaping is inhaling vapor from an electronic cigarette or other device that typically heats a flavored nicotine solution.

The law passed this year by the state Legislature updates the Colorado Clean Indoor Air Act.

State health officials say the rule is intended to protect residents from secondhand vape aerosol, but may also discourage vaping among young people.

Officials say studies established that people can consume nicotine from secondhand aerosol.


Information from: Durango Herald, http://www.durangoherald.com

Hope Center to provide mobile crisis response in Garfield County following state contract award

Under Colorado’s new behavioral health crisis system, the Hope Center will serve as the primary provider of mobile crisis response in Eagle and Garfield counties.

“You can call day or night in any kind of crisis to figure out what is in the community that we can connect you with,” Hope Center Executive Director Michelle Muething said of the nonprofit that formed in 2010 and has offices in both the Roaring Fork and Eagle River valleys.

“This is not a new operation for the Hope Center,” she said. “We have been doing this for nine years, and Garfield County is our backyard.”

Since 2014, Mind Springs Health had held the state contract to provide mobile and walk-in crisis response across the 10-county region it served. However, as of Monday Rocky Mountain Health Plans took over and has since contracted with organizations like the Hope Center to offer crisis services.

To assist with the transition, Mind Springs will still perform crisis response over the next 60 days, in addition to its local and regional clinical and hospital services.

“Our Mind Springs crisis line is going to continue for those 60 days,” Mind Springs Health Program Director Hans Lutgring said. “I think that the important message that we get out there now is that there is no change in how people would reach our crisis services for [two months].”

Additionally, the contract awarded to Rocky Mountain Health Plans will not affect the vast majority of Mind Springs Health’s ongoing services, Lutgring explained.

“There has just been a lot of confusion,” he said. “From our perspective, there is going to be relatively little change in the day-to-day of the outpatient services.”

Mind Springs Health CEO Sharon Raggio stated in a recent press release, “We look forward to continuing our preventative work to lessen mental health crises, and assisting and coordinating with responders in the community when crises do arise to ensure our fellow Coloradoans receive the ongoing services they need to heal and recover.”

Garfield County Sheriff Lou Vallario said that it was unfortunate that Mind Springs Health lost the contract. But he was confident in the Hope Center’s ability to provide crisis services throughout Garfield County.

However, with its two physical locations being in Basalt and Eagle, Vallario said he also hopes to provide the nonprofit with additional space out of the Garfield County Sheriff’s Annex in Rifle.

“The problem has always been, we are asking cops to become behavioral crisis workers when that’s not what we are trained to do,” Vallario said, stressing the critical need for services like those offered by the Hope Center.

“Anything we can do to help foster that crisis intervention we are all for it,” Vallario said.

Muething said that the Hope Center wanted to ensure that people experiencing a crisis received meaningful help, as opposed to automatically going to the emergency room. She described the Hope Center as a community resource connector.

“Part of the shift is — across the state — they are trying to get people to call Colorado Crisis Services to be able to talk to someone, versus calling 911,” Muething said of Colorado Crisis Services’ line (1-844-493-8255), which connects someone experiencing a crisis with a trained crisis counselor.

“Our whole goal is to prevent people from being in the emergency room,” Muething said.


YouthZone hires trauma, substance abuse specialist

Bailey E. Allison has joined the staff at YouthZone to oversee its substance use prevention program.

As Trauma and Substance Specialist, Allison will provide group and one-on-one counseling and educational programs to youth clients who are at risk for substance use or addiction, according to a press release.

“I am excited to work with a team that treats their employees and their clients with a universal love, acceptance and positive human regard,” Allison said in the release.

Allison brings 10 years of experience to the prevention program. She will also continue with a private practice, Bailey Allison Therapy LLC, which emphasizes trauma resolution.

She has also worked with youth, adults and groups as the program manager for Momenta Center For Lasting Recovery, was a crisis clinician at Aspen Hope Center, and was an outpatient therapist at Mind Springs Health.

In 2013, Allison graduated from the University of Denver Graduate School of Social Work with a master’s in social work. Through that program, she specialized in evidence-based trauma interventions.

“YouthZone is thrilled to have Bailey join our team,” said Tina Olsen, YouthZone’s clinical supervisor and senior therapist. “She brings a high quality skill level that our clients will truly benefit from. Her passion to work with youth and families is inspirational.”

Health care debate heated among Democratic presidential candidates

Last Thursday, the second night of the first Democratic primary debate, 10 presidential hopefuls took the stage and health issues became an early flashpoint.

Sen. Bernie Sanders (I-Vt.) opened the debate calling health care a “human right” — which was echoed by several other candidates on stage — and saying “we have to pass a ‘Medicare for All,’ single-payer system” — which was not.

Just as on Wednesday night, moderators asked candidates who would support abolishing private insurance under a single-payer system. Again, only two candidates — this time Sanders and California Sen. Kamala Harris — raised their hands.

Former Vice President Joe Biden also jumped on health care, saying Americans “need to have insurance that is covered, and that they can afford.”

But he offered a different view of how to achieve the goal, saying the fastest way would be to “build on Obamacare. To build on what we did.” He also drew a line in the sand, promising to oppose any Democrat or Republican who tried to take down Obamacare.

Candidates including South Bend, Ind., Mayor Pete Buttigieg, New York Sen. Kristen Gillibrand and Colorado Sen. Michael Bennet offered their takes on universal coverage, each underscoring the importance of a transition from the current system and suggesting that a public option approach, something that would allow people to buy into a program like Medicare, would offer a “glide path” to the ultimate goal of universal coverage. Gillibrand noted that she ran on such a proposal in 2005. (This is true.)

Meanwhile, former Colorado Gov. John Hickenlooper used the issue of Medicare for All to say that it is important to not allow Republicans to paint the Democratic Party as socialist but also to claim his own successes in implementing coverage expansions to reach “near universal coverage” Colorado. PolitiFact examined this claim and found it Mostly True

“You don’t need big government to do big things. I know that because I’m the one person up here who’s actually done the big progressive things everyone else is talking about,” he said.

But still, while candidates were quick to make their differences clear, not all of their claims fully stood up to scrutiny.

We fact-checked some of those remarks.

Sanders: “President Trump, you’re not standing up for working families when you try to throw 32 million people off the health care that they have.”

This is one of Sanders’ favorite lines, but it falls short of giving the full story of the Republican effort to repeal and replace Obamacare. We rated a similar claim Half True.

Scrapping the Affordable Care Act was a key campaign promise for President Donald Trump. In 2017, as the Republican-led Congress struggled to deliver, Trump tweeted “Republicans should just REPEAL failing Obamacare now and work on a new health care plan that will start from a clean slate.”

The Congressional Budget Office estimated that would lead to 32 million more people without insurance by 2026. But some portion of that 32 million would have chosen not to buy insurance due to the end of the individual mandate, which would happen under repeal. (It happened anyway, when the 2017 tax law repealed the fine for the individual mandate.)

In the end, full repeal didn’t happen. Instead, Trump was only able to zero out the fines for people who didn’t have insurance. Coverage has eroded. The latest survey shows about 1.3 million people have lost insurance since Trump took office.

Bennet, meanwhile, used his time to attack Medicare for All on a feasibility standpoint.

Bennet: “Bernie mentioned that the taxes that we would have to pay — because of those taxes, Vermont rejected Medicare for All.”

This is true, although it could use some context.

Vermont’s effort to pass a state-based single-payer health plan — which the state legislature approved in 2011 — officially fell flat in December 2014. Financing the plan ultimately would have required an 11.5% payroll tax on all employers, plus raising the income tax by as much as 9.5%. The governor at the time, Democrat Peter Shumlin, declared this politically untenable.

That said, some analysts suggest other political factors may have played a role, too — for instance, fallout after the state launched its Affordable Care Act health insurance website, which faced technical difficulties.

Nationally, when voters are told Medicare for All could result in higher taxes, support declines.

And a point was made by author Marianne Williamson about the nation’s high burden of chronic disease.

Williamson: “So many Americans have unnecessary chronic illnesses — so many more compared to other countries.”

There is evidence for this, at least for older Americans.

A November 2014 study by the Commonwealth Fund found that 68% of Americans 65 and older had two or more chronic conditions, and an additional 20% had one chronic condition.

No other country studied — the United Kingdom, New Zealand, Sweden, Norway, France, Switzerland, the Netherlands, Germany, Austria, or Canada — had a higher rate of older residents with at least two chronic conditions. The percentages ranged from 33 percent in the United Kingdom to 56 percent in Canada.

An earlier study published in the journal Health Affairs in 2007 found that “for many of the most costly chronic conditions, diagnosed disease prevalence and treatment rates were higher in the United States than in a sample of European countries in 2004.”

PolitiFact’s Jon Greenberg and Louis Jacobson contributed to this story.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.