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Doctor’s Tip: Swelling of the legs might indicate something serious

Patients often get worried if they develop even a little swelling in their lower legs and/or ankles because they think it is an indication of something serious. It can be, but it often isn’t.

Swelling in one leg

If swelling in one leg or ankle is associated with redness and tenderness, this can be an indication of cellulitis, a bacterial infection of the skin and underlying soft tissues, requiring elevation, heat and antibiotics.

If the swelling does not involve signs of infection, it can be due to a deep vein thrombosis — a blood clot. This can be life threatening because a piece of clot can break off and go to the lungs, causing a potentially life-threatening pulmonary embolus. “Blood thinners” (anticoagulants) are indicated for this condition. Prolonged immobilization, such as surgery or a long plane trip, is a risk factor for blood clots. If it occurs out of the blue, a workup should be done to see if you have a genetic clotting disorder — where your blood clots more easily than it should.

Blood clots in the legs can lead to chronic venous insufficiency, with persistent swelling in the affected leg. Skin ulcers are sometimes a complication of this condition. Sometimes, there can be redness and swelling associated with chronic venous insufficiency, which is hard to differentiate from infection.

Swelling in both legs

If the top of your socks leaves a small indentation, don’t worry about it. If your lower legs, ankles and/or feet seem swollen, press hard with your finger over your lower shin or ankle, and if it leaves a significant dent, you have edema — fluid in the soft tissues just under the skin.

Rarely, edema can be caused by serious conditions such as heart failure, kidney failure or liver failure. In most cases, though, it is due to venous insufficiency: The heart pumps blood out through your arteries with each contraction. The blood returns to your heart passively through veins, aided by muscle contractions when you walk. There are valves in the veins to prevent backflow. Due to genetic factors or aging, the valves can wear out, so the blood backs up in the veins of your legs. The increased pressure associated with this leads to fluid leaking out of the veins into the subcutaneous tissues in your legs. Elevation and elastic stockings can help.

Other conditions that can cause edema are:

• High sodium (salt) intake.

• Certain medications such as pioglitazone (Actos) used to treat diabetes, and high doses of calcium channel blockers such as amlodipine used to treat high blood pressure.

• Diuretics such as hydrochlorothiazide or furosemide (Lasix) can be useful for edema caused by heart failure, but usually not for other causes.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email gfeinsinger@comcast.net.

COVID-19 UPDATE: The latest Garfield County statistics and risk level assessment

Latest Garfield County COVID-19 statistics and risk level

AS OF WEDNESDAY, DEC. 1

Cumulative cases: 8,874

Deaths since outbreak began: 69 confirmed (2 new this week)

Current Risk Level: Orange-High Risk

Recent 7-day case totals: Nov. 25-Dec. 1 – 200; Nov. 18-24 – 122; Nov. 11-17 – 174

Cases by vaccination status for 7-day period ending 11/28: 111 among unvaccinated; 52 breakthrough cases among vaccinated.

Two-week daily case average: 28.57

Single-day high: 101 on 12/10/20

7-day incidence rate: 324 per 100,000 people

7-day test positivity rate: 10% (14-day: 8.4%)

Current number of county residents hospitalized: 5 total (all unvaccinated)

Vaccination rate by percent of county population: Fully vaccinated – 67%; One dose – 76%. For vaccination information, visit Garfield-County.com/public-health/covid-19-vaccine/

Source: Garfield County Public Health

HOSPITAL STATS (updated weekly)

Valley View Hospital, as of 11/30/2021

Specimens collected through Valley View Hospital: 44,064

Positive results: 2,953 (+34 since 11/23)

Hospitalizations since outbreak began: 369 (3 new since 11/23)

Grand River Hospital, as of 11/30/2021

Specimens collected through Grand River Health: 12,562

Positive results: 2,305 (+96 since 11/23)

Hospitalizations since outbreak began: 94 (1 new since 11/23)

Source: Valley View and Grand River hospitals

ACTIVE OUTBREAKS

GARFIELD COUNTY

(Updated 12/1)

Garfield Re-2 Transportation Department: Date determined — 11/30; 6 staff cases

Heritage Park Care Center, Carbondale: Date determined — 11/17; 2 resident cases

Grand River Health Care Center, Rifle: Date determined — 10/26; 3 staff cases.

Ross Montessori School, Carbondale: Date determined – 10/11; 50 student cases, 11 staff cases.

EAGLE COUNTY

Cornerstone Christian School, Basalt: Date determined – 11/8; 10 student cases, 8 staff cases, 1 death.

Source: Colorado Department of Public Health & Environment COVID-19 outbreak data page; updated weekly on Wednesday

Vaccinations available for children ages 5-11

7-year-old Ruby Dewolfe receives her first COVID-19 vaccination at the Glenwood Hot Springs Lodge clinic on Wednesday afternoon. The Hot Springs Lodge was offering free one-day passes to the Hot Springs Pool to any kids 5-11 who received the vaccine at the clinic.
Chelsea Self/Post Independent

Pediatric Partners of Valley View Hospital in Glenwood Springs and Garfield County Public Health are now offering COVID-19 vaccinations for children ages 5-11.

Appointments are required for the Pediatric Partners child vaccinations, at 970-947-9999. All children must be accompanied by an adult over the age of 18.

In addition, Garfield County Public Health is opening its walk-in clinics in Glenwood Springs and Rifle to children ages 5-11 to receive the pediatric-dose Pfizer vaccine.

Adult boosters and first and second doses will also be administered during clinic times. For the latest vaccination clinic schedule and other resources, visit the Garfield Public Health website.

The U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) in late October both approved the use of the Pfizer-BioNTech pediatric vaccine for children ages 5 to 11 years old.

Free COVID testing in Garfield County

There are two free community testing providers in Garfield County, and neither a doctor’s order nor identification are required. Sites accept both walk-ups and appointments, but do not have rapid tests available. If you have symptoms, or feel you have been exposed, get tested within one to two days. Test turnaround times are between 36-48 hours.

Roaring Fork Valley free COVID testing, Monday through Friday

Carbondale — 8:30 a.m.-1 p.m. at the parking lot behind Town Hall, 511 Colorado Ave (Enter via 4th St.)

Glenwood Springs — 7-11 a.m. at the Roaring Fork School District Administration Building parking lot, 1405 Grand Ave., Glenwood Springs

Rifle — 8 a.m.-12 p.m. at the Mountain Family Health Center parking lot, 195 W. 14th St., Bldg. C, Rifle (back side of parking lot, closest to the fairgrounds)

State of Colorado free COVID testing: 12-4 p.m. Sundays in Rifle, Public Health parking lot, 195 W. 14th St.

See Garfield County COVID testing for a complete list of testing providers including pharmacies and medical offices in Garfield County.

Flu vaccinations available

In addition to COVID-19 vaccines, seasonal flu vaccines are being offered by Garfield County Public Health by appointment.

For more information, see the public health flu page.

The influenza virus changes every year, so getting vaccinated annually is important to make sure you have immunity, public health advises.

Flu symptoms appear one to four days after exposure to the virus and typically last between five to seven days. Even after symptoms resolve many individuals continue to feel fatigued. People who have had the flu shot generally have less severe symptoms over a shorter period.

Doctor’s Tip: Our biggest epidemic — child abuse

Dr. Greg Feinsinger

We seem to be living in an age of multiple epidemics: obesity, diabetes, heart disease, drug abuse, gun violence and COVID-19. In terms of human suffering, and damage to our society and economy, child abuse is arguably the biggest of them all.

At workers’ compensation medical conferences, there is usually a presentation about “delayed recovery”: Ten people suffer similar low back injuries at work, nine are pain-free in a few weeks but the 10th never gets better. We were told to always consider a history of child abuse — mental, physical or sexual — in these cases. It’s not that the pain is in these patients’ heads; it’s that childhood trauma “rewires their brains” so that they react differently to life stresses such as injuries, through no fault of their own.

“The Body Keeps The Score” is a book on the New York Times best seller list by Bessel Van Der Kolk, M.D., a Boston-based psychiatrist who started his career working with Vietnam War veterans with PTSD. He eventually went into private practice and is past president of the International Society for Traumatic Stress Studies. The title of the book refers to the fact that emotional trauma leaves a lifelong imprint not only on people’s brains, but also on their bodies. An example of the mind-body connection is that trauma victims (including those who suffer child abuse) continue to secrete high levels of harmful stress hormones for decades afterward, resulting in chronic problems such as memory and attention deficits, irritability, sleep disorders, migraine headaches, autoimmune diseases, cardiovascular disease, weakened immune systems and even cancer (stress causes inflammation, which contributes to cancer).

In his book, Van Der Kolk points out that research by the Centers for Disease Control and Prevention has found the following: “One in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; and one out of eight witnessed their mother being beaten or hit.” Over 12 million women in the U.S. have been victims of rape — more than half when they were under the age of 15. As Van Der Kolk puts it, such trauma “is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain and body.” Victims of child abuse “often feel sensations (such as abdominal pain) that have no obvious physical cause,” and suffer from lifelong mental illness and relationship problems.

The Adverse Childhood Experiences study was conducted by Kaiser Permanente and the CDC and involved 25,000 subjects, mostly white and middle class. High scores on the number of adverse childhood events correlated with higher workplace absenteeism, financial problems, lower lifetime income, depression, chronic pain, suicide attempts, alcoholism, heart disease, liver disease and cancer. Women who witnessed domestic violence as children were at higher risk of ending up in violent relationships; men who witnessed domestic violence as boys were seven times more apt to abuse their partners as adults.

Due to studies like Adverse Childhood Experiences, Van Der Kolk calls child abuse “our nation’s largest public health problem,” affecting not only individuals but their families, the economy and society as a whole. It is estimated that “eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds and suicide, IV drug use and domestic violence by three-quarters. It would also increase workplace performance and decrease the need for incarceration.”

The National Child Traumatic Stress Network was established by Congress in 2001, and it now has 150 centers nationwide. Its mission is to educate teachers, judges, ministers, foster parents, physicians, probation officers, nurses and mental health professionals. The societal solution to preventing child abuse, in Van Der Kolk’s opinion, is to provide more help for families: “Economists have calculated that every dollar invested in high-quality home visitation, day care and preschool programs results in seven dollars of savings on welfare payments, health care costs, substance-abuse treatment and incarceration, plus higher tax revenue due to better-paying jobs.”

Van Der Kolk is not a big fan of medications for PTSD because — with the possible exception of hallucinogens (read “How to Change Your Mind, by Michael Pollin) — they help the symptoms rather than the underlying cause. Based on patient outcomes and brain-imaging studies, good results have been achieved with nonpharmaceutical treatments such as meditation, yoga, rapid eye movement (EMDR) and neurofeedback.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email gfeinsinger@comcast.net.

Carbondale to host COVID-19 vaccination clinic Wednesday

Carbondale has been selected as a “vaccine equity” clinic site through Gov. Jared Polis’ efforts to ensure that every person in Colorado has access to a vaccine, according to a town news release.

The vaccine clinic is slated for 2-6 p.m. Wednesday at the Carbondale Recreation and Community Center, 567 Colorado Ave.

This clinic is intended to focus on underserved populations and people who face barriers to accessing health care, the release states.

The clinic is open to children ages 5-11 by appointment and to ages 12 and older on a walk-in basis for either a first or second vaccine shot or booster. The follow-up date to receive a second dose is set for Dec. 29.

The clinic offers 150 spots for preregistration for the pediatric-dose Pfizer vaccine (ages 5-11 years), and walk-in appointments for 300 additional spots (100 Pfizer, 100 Moderna, 100 Johnson & Johnson).

All Coloradans 12 and up are eligible to receive the Pfizer vaccine, and those 18 and up are eligible for the Moderna or Johnson & Johnson vaccine.

Preregistration for the pediatric-dose Pfizer vaccine is available here [www.comassvax.org//appointment/en/reg/9971600052]

En Español

El Centro Recreativo y Comunitario de la Municipalidad de Carbondale será la sede de una cínica de vacunación, en alianza con el plan Vaccines for All del gobernador Polis.

Carbondale, Colorado – El Centro Recreativo y Comunitario de Carbondale ha sido seleccionado como una clínica de vacunación en beneficio de la equidad. Éste es un esfuerzo más realizado por el gobernador Polis para garantizar que toda persona en Colorado tenga acceso a una vacuna. La clínica de vacunación tendrá lugar el miércoles 1o. de diciembre de 2:00 a 6:00 p.m.

La prioridad de esta clínica será el atender a las poblaciones de raza negra, indígenas o de color, además de favorecer a aquellas personas que enfrentan obstáculos para recibir servicios de atención a la salud. De la misma manera, esta clínica estará abierta para niños de 5 a 11 años, niños de 12 años en adelante, y para cualquier persona que desee obtener su primera vacuna o incluso un refuerzo. La fecha programada para recibir la segunda dosis de la vacuna es el miércoles 29 de diciembre.

Esta clínica ofrecerá 150 espacios para la dósis pediátrica de la vacuna Pfizer (para niños entre 5 y 11 años de edad que se hayan registrado previamente) y contará con citas disponibles para cualquier persona que se presente a recibir una vacuna. Existen 300 espacios adicionales: 100 Pfizer, 100 Moderna, 100 Johnson & Johnson.

Los niños de 5 a 11 años pueden recibir la dósis pediátrica de la vacuna Pfizer, todos los residentes de Colorado de 12 años de edad en adelante resultan elegibles para recibir la vacuna Pfizer, y todos los individuos mayores de 18 años son elegiles para recibir las vacunas Moderna o Johnson & Johnson. Para registrar previamente a los niños que recibirán la dosis pediátrica, visite: www.comassvax.org//appointment/en/reg/9971600052

El Centro Recreativo y Comunitario de Carbondale está localizado en el 567 de Colorado Ave., en Carbondale.

Torres column: All bodies are unique and should be appreciated

Before I started weight lifting, I weighed 130 to 135 pounds. I loved my body back then. I did not compare my body with someone else. I didn’t even know there was a difference between my body and others’. It could be because the society where I grew up did not give attention to insignificant details.

One day I was working with a body builder. I noticed his body was different than mine. We worked together doing an extremely physical job. I remember asking him how he got his body. I asked if he did it by doing the physical work of our job. He answered, “No, I wish. I exercise.”

I remember being in harmony with my body. I didn’t dislike my body. I never thought about my long neck, skinny legs, skinny arms, small belly and flat chest. I only set up a goal, and I worked towards it. Setting my goals was important, but it was not enough. It was my actions — what I was doing to increase my muscle mass. I started going to the gym every day. I stopped drinking. I was tired from work, but I still went to the gym and gave my best. I started eating differently than I was before.

Finally, I started to see results after three months. I was not, however, where I wanted to be. So I continued. Three years later, I reached my first plateau. Still, I saw other guys more muscular than me. They were in the gym, magazines, movies, music videos. … I wanted to be like them. I tried harder, but my body was not built to be bigger. Sometimes, “friends” would come and ask me if I stopped lifting weights because I was smaller. They knew that phrase would bother me.

After taking my time meditating and studying my past, I understood that I was happy with my body, no matter what others said. And one of the reasons why I didn’t care was because the environment never put ideas about a perfect body in me. I started caring when others contributed to my thoughts.

I kept studying my journey. I noticed that I replaced many bad habits by good habits. As an example, I replaced drinking with exercising. My body shape changed; I’m stronger; I have more energy; my clothing fits me better; and I hardly get sick. My happiness was not the “new body” but the good habits I acquired. So I continue practicing all the new habits.

Later, I understood that many guys in magazines take drugs and other guys have a different type of body than I do. Drugs or supplements? No, I care too much about my health to take a risk. There are three types of bodies for men and women: endomorph, mesomorph and ectomorph. I’m classified as an ectomorph. The mesomorph tends to be more muscular than my body build. It is impossible for me to be as muscular as the weight-lifting mesomorph. This did not mean that I can’t work around my body type and make it healthy and attractive.

I noticed that it doesn’t matter what type of frame some people have, they usually are not happy with it. They want to have someone else’s frame. Skinny girls want bigger hips and many girls who have bigger hips want to be like the skinny girls.

I started to accept my body again. And the perception of the “perfect body” went away. I achieved a perfect body. It was healthy, stronger, more energetic and had good posture and more muscle development.

The reality is that we can have an attractive body, be physical and mentally healthy no matter the type of frame we have.

To clarify, accept yourself, love your body the way it is, care for it, exercise it and nourish it with healthy food. Don’t get persuaded by others. See your clear, realistic goal and start working toward it. What’s most important? What are you going to do every day to get there? Stop drinking? Eat organic? Get rid of junk food? Exercise? Make your new lifestyle a habit.

Find your body type, work it, and, please, for the love of God, don’t compare yourself with someone else. You are unique the way you are. You are beautiful. You may improve your physical appearance by losing weight, toning your body and improving your posture, but only compare yourself with your old you. … That is when you start seeing results. Everything begins with the mind and becomes physical when you work for it.

Sandro Torres is owner of Custom Body Fitness in Basalt and Glenwood Springs and author of the books “Lose Weight Permanently” and “Finding Genuine Happiness.” His column usually appears on the third Wednesday of the month.

Increased mobility associated with holiday, start of ski season cause for concern on COVID-19 front

Garfield County lags behind neighboring counties and the state as a whole with the resurgence in COVID-19 cases, but that could change with the start of ski season as people become more mobile, the county’s top public health official advises.

The number of new weekly cases in Garfield County remains high, at 132 over the past seven days, as of Tuesday, for an incidence rate of 213.9 per 100,000 people.

The Colorado Department of Public Health and Environment uses a benchmark of fewer than 100 cases per 100,000 to be at the lowest risk for disease spread.

Yet Eagle, Pitkin and Mesa counties have been seeing higher incidence rates, Garfield Public Health Director Yvonne Long said during the monthly COVID-19 update before county commissioners on Monday.

Numbers fluctuate daily but as of the latest statistics, Pitkin County had a COVID-19 incidence rate of 265 per 100,000, and Eagle County had a seven-day rate of 291.2 per 100,000.

Mesa County, currently among the highest-risk counties in the state, had an incidence rate of 340.8 per 100,000, as of Tuesday. However, that number had been over 450 as recently as Monday.

The statewide average has been hovering around 355 per 100,000.

Garfield County’s weekly COVID-19 case numbers have tended to fluctuate since early October but have stabilized in recent weeks, Long said.

Increased travel associated with the Thanksgiving holiday this week and the start of ski season in Aspen, when more workers and skiers will be migrating upvalley, could drive those numbers up, she said.

As was the case last winter, the numbers could remain high through late February, she said.

All the more reason for more of the county’s population to become vaccinated, especially anyone who had COVID-19 in the past year and whose natural antibodies are wearing off, Long said.

“That natural immunity is going to start to wane over time,” Long said. Anyone who is immunocompromised or in the higher-risk groups based on age or health conditions is likely to be on the shorter end of that range.

A study published Oct. 1 by the journal Microbe takes a look at how long natural immunity lasts after a COVID-19 infection.

“Scientists are unable to measure how much protection individual antibodies provide, due to the number of variants circulating, and each person will have a different immune response,” Garfield County Public Health said in a Tuesday news release.

Research shows that an individual can expect to see reinfection between three and 53 months after antibody decline, with most people seeing re-infection within 16 months, the study concluded.

“Researchers who modeled the durability of natural immunity make the case that vaccinations are the best way to solve the pandemic, and that herd immunity is not a viable option due to variants of COVID-19,” the county’s news release states.

Individuals can get tested for antibodies, Long said. However, the diagnostic tests don’t differentiate between COVID-19 and other types of coronaviruses, including the common cold.

By the numbers

Unvaccinated individuals continue to drive new COVID-19 cases in Garfield County.

For the seven-day period ending Nov. 21, out of a total of 157 new cases reported, 109 involved unvaccinated individuals, and 48 were breakthrough cases among vaccinated people.

The county recorded 165 new cases for the seven-day period ending Nov. 19, for a rolling average of 23.5 cases per day, according to the weekly update given to the commissioners.

There was a high of 58 cases on Nov. 16 and a low of 20 on Nov. 13. The highest single-day count since the beginning of the pandemic was 101 on Dec. 10, 2020.

As of Tuesday, 75% of the county’s eligible population (12 and up) had received at least a single dose of the two-dose Pfizer or Moderna vaccine, and 67% are fully vaccinated with either two doses of Pfizer or Moderna or the single-dose Johnson & Johnson vaccine, according to the latest county statistics, Long reported.

Thousands of Garfield County residents have also received either a booster dose or a recommended third dose of the vaccine for those in the higher-risk groups, said Mason Hohstadt, Public Health data specialist for the county.

To date, based on the latest numbers, more than 7,000 boosters or third doses have been administered, which represents about 22% of fully vaccinated individuals.

The number of adults becoming fully vaccinated has also begun to increase, especially as adults bring in their now-eligible children ages 5-11 to be vaccinated, he said.

The child age group is still not reflected in the county’s overall vaccination rate. However, an upward adjustment in the county’s population numbers after the 2020 U.S. Census numbers came in recently did drive those percentages down slightly.

As of this week, 82% of those in Garfield County’s 70-79 age group are fully vaccinated, and 76% of those over 80 are fully vaccinated. The Garfield County (full) vaccination rate for other age groups and by gender is as follows:

12-15: 54%

16-18: 59%

19-29: 61%

30-39: 59%

40-49: 64%

50-59: 68%

60-69: 78%

Female: 70%

Male: 62%

Long said that Garfield County mirrors the state percentage for those not following through on their second dose, about 3.5%.

“We want people to know that they can come back at any time and get that second dose, and they don’t need to start over,” she said.

Other relevant Garfield County statistics as of Tuesday:

  • 9 county residents hospitalized (8 unvaccinated, 1 vaccinated)
  • 10 deaths since Oct. 1 (all unvaccinated); eight confirmed to be due to COVID-19 and two pending investigation by the coroner
  • 3 current outbreaks: Heritage Park Care Center, Carbondale (three cases); Colorado State Veterans Nursing Home, Rifle (10 cases); Ross Montessori School Carbondale (68 cases). All case numbers are cumulative.

Senior Reporter/Managing Editor John Stroud can be reached at 970-384-9160 or jstroud@postindependent.com.

Doctor’s Tip: A potpourri of health tips

MOUTH MICROBIOME: An unhealthy profile of bacteria in your mouth contributes to gum and tooth disease (gingivitis and periodontitis respectively). These conditions cause inflammation that contributes to formation of plaque in arteries. Furthermore, this inflammation is often the trigger that causes rupture of arterial plaque—the cause of heart attacks and most strokes. Dentists who understand the mouth/vascular connection can order a profile of your mouth microbiome, which if abnormal can be treated appropriately with antibiotics and other measures. However, the downside of such treatment is that antibiotics kill the good mouth (and gut) bacteria along with the bad. Dr. Greger’s website nutritionfacts.org presents information indicating that the best way to attain and maintain a healthy mouth microbiome is through a plant-based, whole food diet (search gingivitis, periodontitis on this website).

ARE COMMERCIAL STOOL TESTS USEFUL FOR DETERMINING GUT MICROBIOME HEALTH? No. These are advertised on the internet, but are not ready for prime time yet — they have not been shown to be accurate or useful.

PHYSICIAN/PHARMACEUTICAL COZINESS: An editorial in the October issue of the American Family Physician journal states that in 2016 the pharmaceutical industry spent 20.3 billion dollars on marketing directly to health care professionals, in an effort to convince them to prescribe their products. The industry places ads in medical journals, sponsors conferences, hires drug reps to influence prescribers via face-to-face visits, and in 2016 spent $979 million on direct payment to physicians. The editorial makes the following recommendations: 1) Physicians should not visit with pharmaceutical reps or allow them in their offices. 2) Physicians should not accept gifts, meals, or direct payments from industry. 3) Physicians should refuse free drug samples for their patients, because there are almost always cheaper alternatives.

PREVENTING BLOOD CLOTS WHEN FLYING: Prolonged sitting associated with flying can cause blood clots in the legs, which can go to the lungs and cause life-threatening pulmonary emboli. To prevent this, contract the muscles in your legs frequently, hydrate well, avoid alcohol, walk about for 10 to 15 minutes at least every 2 hours, and consider wearing knee-high elastic compression stockings. People with risk factors such as history of clots, cancer, or recent surgery should have an injection of the “blood thinner” heparin (40 mg. of Lovenox) on the day of travel and again the following day.

HOW MUCH EXERCISE? We know that exercise prolongs life and improves quality of life. It improves cognition and reduces risk of dementia, anxiety, and depression. It improves sleep, lowers risk of heart disease, strokes, and hypertension. It reduces weight gain, lowers risk of falls, lowers risk of type 2 diabetes, and decreases the risk of many cancers. The current Physical Activity Guidelines recommend 75 minutes a week of vigorous aerobic activity such as jogging, singles tennis, bicycling at least 10 mph, hiking uphill or with a heavy pack, or high-intensity interval training. If you prefer less vigorous exercise, the recommendation would be at least 150 minutes a week of moderate-intensity aerobic activity such as brisk walking, doubles tennis, bicycling slower than 10 mph on level terrain, active forms of yoga, ballroom dancing, or water aerobics. In addition, the Guidelines recommend strengthening legs, hips, abs, chest, shoulders, and arms twice a week.

DOES CBD WORK? CBD (cannabidiol) is a non-intoxicating component of marijuana. It is being touted for several conditions including pain, and has become big business. According to the October issue of Nutrition Action, published by the nonprofit Center for Science in the Public Interest, a recent study in Australia showed it did not help with low back pain compared to a placebo. The FDA has approved only one CBD product — a prescription drug to treat a certain type of seizure.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email gfeinsinger@comcast.net.

Doctor’s Tip: Update on osteoporosis

Osteoporosis (brittle bones) often leads to fractures. About 20% of American women and 4% of men aged 50 or older have osteoporosis. Another 50% of women and 30% of men have osteopenia (pre-osteoporosis).

Osteoporosis causes over 1.5 million fractures annually in the U.S. White women age 50 and older who do not receive estrogen replacement have a 46% risk of sustaining an osteoporotic fracture during the remainder of their lives. Hip fractures are a major cause of disability and placement in long-term care facilities. Fractures in the vertebrae cause a bent-forward deformity of the spine that interferes with quality of life.

The November issue of Nutrition Action, published by the nonprofit Center for Science in the Public Interest, has an interview with Bess Dawson-Hughes, an endocrinologist and professor at Tufts University in Boston, who is former president of the National Osteoporosis Foundation. She notes that throughout life, bone is constantly being remodeled by cells called osteoclasts that absorb bone, and osteoblasts, cells that make bone.

There is a net bone gain until we reach our peak bone mass at age 25-30. At menopause, due to drop in estrogen levels, the balance is changed so the average menopausal women loses 2-3% of her bone density every year for five to eight years, after which she loses about 1% a year. Starting at around age 50, the average man loses about 1% a year for the rest of his life, due at least in part to a drop in testosterone levels. People who develop osteoporosis have a greater than normal rate of bone loss.

Osteoporosis is diagnosed by a DEXA scan, available locally. The National Osteoporosis Foundation recommends this test at age 65 for women and 70 for men, but earlier if risk factors such as a previous fracture are present. Abnormal loss of height is a red flag for osteoporosis: Most people lose 1.5 inches as they age, due to drying out and collapsing of the discs between the vertebrae. Loss of height beyond that is a sign of compression fractures of the spine, which often are painless. To estimate your fracture risk, go online to Sheffield.ac.ukFRAX and click on the calculation tool.

The most common risk factors for osteoporosis are: 1) aging; 2) deficiency of estrogen in women and testosterone in men; 3) heavy alcohol use; 4) smoking; 5) long-term proton pump inhibitors such as omeprazole; 6) long-term steroid (cortisone) use; 7) anti-testosterone prostate cancer treatment in men; 8) overactive thyroid or parathyroid glands; 8) low physical activity; 9) malabsorption diseases such as celiac disease; 10) early menopause; and 11) a Western diet. Of interest is that obesity is associated with stronger bones, because fat cells manufacture estrogen.

Why does a Western diet increase risk? Dr. Dawson-Hughes explains that the typical American diet, which is based on animal products and refined grains, is acidic, whereas a plant-based diet is alkaline. Bone is alkaline, so the body dissolves bone to neutralize the acid associated with a Western diet.

If you want to prevent or treat osteoporosis, eat a plant-based, unprocessed food diet and cut back on or avoid animal products and refined food. Adequate calcium is important throughout life and is best obtained through green leafy vegetables and legumes, including soy. Of interest is that people who drink more cow’s milk have a higher incidence of osteoporosis and fractures. Calcium supplements are controversial, but adequate vitamin D levels are important for strong bones, and many people need D supplements.

Weight-bearing exercise in the upright position most days of the week is important for bone health. Jogging, hiking, stair climbing and racquet sports are best. But if you have brittle bones, engage in safer activities such as walking. Dr. Dawson-Hughes also recommends muscle-strengthening exercises two or three days a week, which not only increase bone density but also make people stronger and therefore less apt to fall.

There are medications for osteoporosis such as Fosamax. They can have side effects, but if you are diagnosed with osteoporosis, the health risks from having a fracture outweighs risks of side effects from these medications. Postmenopausal estrogen is another way to prevent and treat osteoporosis, but risks must be considered. Medications are not recommended for osteopenia.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email gfeinsinger@comcast.net.

Family Visitor Programs offers tuition incentive to recruit nurses

Brooke Canady, a client of the Family Visitor Programs, and her son, James.
Sandy Hanson/Family Visitor Programs

A long-standing, nonprofit, human-service agency in Glenwood Springs is upping the ante in its effort to recruit and retain qualified nurses.

Family Visitor Programs is offering a tuition-assistance incentive for nursing students who complete a bachelor’s degree and commit to working for the organization.

Family Visitor works with young families in Garfield, Eagle and Pitkin counties, typically on a referral basis, to help with early child development and raising healthy children.

It does so by assigning nurses and non-nurse case workers to engage directly with those families, which often continues for multiple years. That work requires a bachelor’s degree in nursing, said Luci Martinez, who supervises the Nurse Family Partnership for the Family Visitor Programs.

In addition to a nursing degree, some specialized coursework in early childhood development and Spanish is also useful, she said.

“The first year I was here, we were not short on nurses,” said Martinez, who has directed the program for four years.

That changed even before the pandemic, she said, noting COVID-19 made the situation worse.

Since then, the organization has struggled to keep about 1.5 of its budgeted 4.8 full-time equivalent nursing positions filled. The Family Visitor Programs hired a nurse with an associate degree to fill one position in a limited capacity, but it would like to have a fully certified nursing staff, Martinez said.

“Unfortunately, we’re just not seeing a lot of interest in the positions we have available,” she said.

So Martinez and new Family Visitor Programs Executive Director Andrew Romanoff approached the board about coming up with some solutions.

“One of the answers we came up with is, if we can’t find enough nurses, let’s make more,” Romanoff said.

Under the tuition-incentive program, after 30 days of employment with the organization, employees can apply for tuition assistance to pursue a certificate or degree that is directly related to their work.

Certain rules apply, including maintaining a grade of B or higher and remaining employed with the Family Visitor Programs. In return, employees can receive up to $3,500 per year in tuition assistance.

“So we’re offering to pay the tuition for people who bring an associate’s degree,” Romanoff said. “It’s not just for a nursing degree, but if someone is interested in learning Spanish, or advancing their knowledge of early childhood development, we’ll help pay for that.”

Other employee policy changes have also been made as an incentive, including implementation of an employee-assistance program for anyone who needs counseling services, and a short-term disability policy.

“We’ve also been able to increase salaries across the board, so we’re no longer stuck at fast-food wages,” Romanoff said. “That way, we’re trying to build a team.”

Family Visitor currently has a staff of 18 and would like to grow to meet the growing demand for family services.

Approximately 900 babies are born annually between Aspen and Parachute. The Family Visitor Programs enrolls about 100 new clients per year.

“Not all of those families are eligible for our (Nurse-Family Partnership),” Romanoff said.

“Everybody could benefit from a visit … because babies don’t come with instructions,” he said, citing the Family Visitor Programs’ motto. “If we had the resources and had the staff to fill these jobs, we can serve many times more clients than we are now.”

Martinez said the other aspect of their marketing for new nurses is emphasizing the unique benefits of being a public health nurse versus a nurse in an acute or long-term health care facility.

“Especially home visiting, it can be so much more rewarding if we can find the right people for it,” she said. “We’re looking for people who are willing to spend an hour with these families at least every other week and to really connect with them and see the changes in the child. It’s challenging, but so rewarding.”

Research suggests that at-risk families enrolled in the Nurse Family Partnership Program are 48% less likely to be involved in child abuse or neglect cases, and their children are 56% less likely to end up in the emergency room, Romanoff said.

In 2020, Family Visitor Programs served 300 families; roughly half in the Nurse-Family program.

There’s no shortage of students going into nursing locally, based on Colorado Mountain College enrollment numbers.

CMC’s nursing degree program, which includes campuses in Glenwood Springs, Breckenridge and Steamboat Springs, can’t admit all of the prospective students who apply for the program, said Whitney Erikson, chief nursing officer and program director for CMC.

The program currently has 86 students enrolled, and typically accepts an additional 12 students per year at each of the three campuses, she said.

About 70 students are in the college’s bachelor’s degree nursing program, having already earned an associate degree, Erikson said.

With the addition of the new nursing simulation centers that are being constructed, the program is looking to expand, she said.

“Next year, the plan is to expand to 18 new students at each campus, and the following year, 24 per campus,” she said.

Erikson said that several other nursing organizations are also offering tuition incentives and signing bonuses, and CMC offers several nursing scholarship programs.

Senior Reporter/Managing Editor John Stroud can be reached at 970-384-9160 or jstroud@postindependent.com.

Garfield County COVID-19 vaccine clinics set for children ages 5-11, including free Hot Springs pass

Pediatric Partners of Valley View Hospital in Glenwood Springs, the Hot Springs Resort and Garfield County Public Health have scheduled times for children ages 5-11 to receive their COVID-19 vaccines over the next week.

Appointments are required for the Pediatric Partners. The second of two clinics takes place from 2-5 p.m. Friday, Nov. 12. All children must be accompanied by an adult over the age of 18.

Clinic appointments are to be scheduled online here. For additional information, call 970-947-9999.

In addition, the Colorado Department of Public Health & Environment hosts a pediatric COVID vaccination clinic for ages 5-11 from 9 a.m.-3 p.m. on Nov. 17 at the Glenwood Hot Springs Lodge, 415 Sixth St., across from the pool.

Each child in that age group who receives the vaccine at the clinic will receive a free one-day pass to the Hot Springs Pool, a news release from the Hot Springs Resort states.

The clinic is to be held in the Iron Mountain Conference Room on the lower level of the Lodge. All children must be accompanied by an adult.

Walk-ins are welcome but preregistration is encouraged online [www.comassvax.org/appointment/en/reg/1012960969].

“The focus of this event is on pediatric COVID vaccination and giving these kids a fun experience at our hot springs pool,” Hot Springs Resort Director of Operations Kevin Flohr said.

The free one-day pool pass is only offered to children ages 5-11 who are vaccinated at the Nov. 17 clinic, but adult vaccines will also be available.

In addition, Garfield County Public Health is opening its walk-in clinics next week to children ages 5-11 to receive the pediatric-dose Pfizer vaccine.

Those clinics take place from 9 a.m.-4 p.m. Nov. 17 and 11 a.m.-6:30 p.m. Nov. 19 at the Glenwood Springs Public Health office, 2014 Blake Ave.; and 9 a.m.-4 p.m. Nov. 18 at the Rifle office, 195 W. 14th St. Adult boosters and first and second doses will also be administered during those clinic times.

Valley View noted in its release that now is a crucial time for the specialized child vaccines to become fully effective before the Thanksgiving holiday. The goal is to vaccinate at least 12 days prior to gathering with family and friends, the release states.

“We need to seize this opportunity to get our children fully protected not only for their health but for our greater community,” said Dr. David Brooks, pediatrician with Pediatric Partners and Chief Medical Officer of Valley View. “Too many children in our community and in our state have lost loved ones to this deadly disease. One in 500 kids have lost a direct caregiver due to COVID-19.”

The U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) in late October both approved the use of the Pfizer-BioNTech pediatric vaccine for children ages 5 to 11 years old.

According to the CDC, 1.9 million children ages 5 to 11 years in the United States have been infected with COVID-19 resulting in over 8,300 hospitalizations and 94 deaths since the start of the pandemic. COVID-19 is now in the top 10 causes of death for children ages 5 to 11 years old nationwide.

“The Pfizer COVID-19 vaccine has been shown to be over 90% effective in preventing symptomatic disease in this age group,” Valley View states in its release.

The pediatric vaccine is one-third the dose of the vaccine for ages 12 and up and is given in two doses separated by three weeks.