The NWP Medical Management Committee once again reaffirms that:

• All utilization management decisions are based solely on the medical necessity and appropriateness of care/service as defined by the respective health plan’s Evidence of Coverage.
• New West Physicians does NOT reward in any way the practitioners or other individuals for withholding, delaying, or denying care or services to our patients.
• Financial incentives for all UM decision makers do not encourage decisions that result in under utilization.

Click here to learn more about National Women's Health Week and click here to send your own personalized e-card.

In this video, Brain Barkley of Functional Conditioning, shows five exercises to prevent osteoporosis and offers New West Physicians patients a special offer for the month of May.

To read more on osteoporosis please click here, or click here to take the osteoporosis quiz.

Osteoporosis (brittle bones) remains a significant, yet under-diagnosed and under-treated disease in the U.S., with more than two-thirds of all osteoporotic fractures occurring in women. Half of women over the age of 50 will have an osteoporosis-related fracture in their lifetime.

Despite being a preventable and treatable disease, more women die of complications from osteoporotic fractures than from breast and cervical cancer combined. With the aging population, osteoporosis is a worsening epidemic our country cannot afford.

Key Facts:

• Osteoporosis is a major public health threat for an estimated 44 million Americans, or 55 percent of the people 50 years of age and older.
• Osteoporosis-related fractures cause over 432,000 hospital admissions, almost 2.5 million medical office visits, and about 180,000 nursing home admissions annually in the United States.
• The cost to the healthcare system associated with osteoporosis-related fractures was estimated at $17 billion in 2005.
• One in five of those who were ambulatory before their hip fracture requires long-term care afterward.
• Only 15 percent of hip fracture patients can walk across a room unaided after six months.

Despite this rising epidemic, Congress has slashed reimbursement for DEXA testing, the most effective method for screening and monitoring osteoporosis, by 50 percent since 2006, with further cuts scheduled in 2010. The current reimbursement of $72 does not cover the cost of providing this service, estimated to be $134. Many physicians have been forced to discontinue providing this service, which is already underutilized among seniors who are at highest risk for this disease. Less than 13 percent of eligible female Medicare beneficiaries are tested in any given year.

So what can patients do to prevent and manage this devastating disease?

First, patients of all ages should make sure their intake of calcium and Vitamin D is adequate by discussing this issue with their primary-care physician (click here to read more about Vitamin D). Second, participating in weight-bearing exercise several times weekly is key to building and maintaining strong bones.

Third, not smoking and avoidance of excessive alcohol intake will avoid the bone loss these behaviors can cause (click here to read about New West Physicians' smoking cessation effects). Fourth, screening all women beginning at age 65 and screening men beginning at age 70 with a DEXA test is the most effective method for finding this disease early so that it can be adequately treated. If your physician has not yet suggested this test and you are in this age group, ask him/her about scheduling this test.

And finally, if you are diagnosed with osteoporosis, adherence to your medication regimen is key to stabilizing and reversing this potentially catastrophic illness.

Many people and health organizations are expressing serious concern about the flu outbreak, so here are some simple tips and advice for patients from New West Physicians Medical Director Ken Cohen, MD, F.A.C.P.

What are the signs and symptoms of this virus in people?
The symptoms of this new H1N1 flu virus in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting.

Take these everyday steps to protect your health:

• Avoid travel to areas with epidemics (so far only Mexico, and that may be downgraded soon)
• Avoid contact with ill individuals who have been to Mexico and any others who are sick
• See your physician for any feverish illness (temp greater than 101)
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Stay home if you are sick for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.

Although some influenza strains can spread between species, the influenza virus is killed by normal cooking procedures, so there is no risk of infection from consumption of well-cooked pork and pork products.

If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed. If you become seriously ill, seek emergency medical care.

Dr. Cohen introduces his column on curbing childhood obesity.

by Dr. Ken Cohen, Medical Director

Nearly one in five children in America, ages 6 to 11, is overweight. That represents a major shift in our society, with the proportion of overweight children more than doubling in just the past 25 years.

It’s no secret what’s causing this alarming trend: a lack of fitness and poor nutrition. Just one fourth of U.S. high school students are physically active for 30 minutes a day, according to National Institutes of Health data. And that’s just half of the recommended amount. On top of that, school lunchrooms not only are serving children unhealthful foods but teaching them poor eating habits that will remain with them for a lifetime.

The startling result: The current generation of children, for the very first time, is expected to have a shorter life expectancy than the current adult population, if we continue on the path we’re on. At alarming rates, adolescents and teens are developing health conditions previously seen almost exclusively with adults. These include Type 2 diabetes, hypertension and elevated cholesterol and triglycerides.

Most states across the country are grappling with improving school nutrition. Although Colorado scores are relatively favorable in exercise and weight compared to other states, this is still a major health concern for us. There is a great inertia supporting “business as usual,” and fundamentally changing the foods served in the schools will be a slow process. New West Physicians has been working with our state on a school nutrition bill, and although it is an improvement from where we are now, it is far from optimal. School nutrition however, is only one small part of the problem. If we are to reorient our children to improved nutrition and a healthier lifestyle, intervention needs to come at many levels and address many aspects of their lives.

A fascinating project involving two small French villages from 1997 to 2004 may serve as a model for our community. From mayors and town councils down to the schools, restaurants, shop owners and families, the entire villages made contributions to curb childhood obesity.

At the school level, teachers focused on pleasant, affordable and diversified foods. Students developed healthier eating habits by learning about concepts like portion sizes and the energy density of the different foods, and they were introduced to new foods through regular “food discovery” sessions. At the community level, tools were introduced to combat the estimated 10,000 television food advertisements seen yearly that largely promote candy, sugared cereals, soft drinks and fast food. Additionally, both structured and unstructured physical activities were promoted. The business community also contributed, with restaurants offering healthy meals with appropriate portion sizes and providing the nutrition information of meals. Grocery stores initiated a program of rotating signs showing nutritional information and health benefits for different foods. At the government level, town councils supported actions favoring physical activity, employed sport educators and promoted family activities focused on healthy lifestyles. And local media played a role, serving as a communication source for the project.

At the conclusion of the study, both villages had only half of the number of overweight children as neighboring villages. The project generated hundreds of articles in local, national and medical press in France and more than 100 radio and television reports. The project was later expanded to include 10 more towns in France and serves as a model for the European Union as world leaders explore ways to combat childhood obesity.

While there are many barriers to emulating such an effort locally here in Colorado, I think this example could serve as a useful model for how to think about childhood obesity and take steps to address it. Our school boards are not locally controlled, and our communities are fragmented in many ways. But I believe we have a “community will” to improve the health status of our children.

We can choose what we buy at the grocery store. We can control what restaurants our children frequent and how they spend their leisure time. We also can provide the role models of a healthy lifestyle.

Do you fear going to the supermarket in search of healthy items to stock your pantry? Does eating healthy have to be so expensive? How do you sort through the health claims posted on food products?

If heading to the supermarket causes stress in your life, the New West Diabetes and Nutrition Center can help. We are now offering a class to help guide you through your next shopping experiences with confidence, all while providing your home with ingredients for healthy meal planning. Our Shopping Class is a two-part series and is offered every other month. The first session meets at the Diabetes and Nutrition Center in Golden. The second session takes place in a local grocery store where participants will get hands-on experience navigating supermarket aisles.

Here some tips to get you started:

• Never shop on an empty stomach! When you are hungry, everything looks tasty and you may end up purchasing food you wouldn’t normally buy.
• “You are what you eat!”
• Shop from a list. Planning ahead saves time, money and helps ensure you have the ingredients you need to fuel your body.
• Make your shopping trip a weekly or bi-weekly event – schedule it like a doctor’s appointment. It’s important to your health!
• Don’t believe everything you read…learn to decode product claims and read food labels correctly.
• Fresh is best! Once at the grocery store, try to stick to the outside aisles where much of the fresh produce, dairy, meats, and grains are found.

Stocking your pantry does not have to be stressful, but is crucial to healthy meal planning.
For a healthy chicken and orange salad recipe click here.

Five-Spice Chicken & Orange Salad

Active time: 35 minutes
Total: 35 minutes
To make ahead: Prepare through Step 2. Refrigerate the chicken for up to 2 days. Slice and serve chilled.

Five-spice powder is a Chinese seasoning shortcut combining multiple flavors in one convenient package. Tossed with orange juice and chicken, it makes a terrific salad with a complex, layered taste that belies the simple recipe. Make It a Meal: Sesame breadsticks and a crisp Riesling are all you need to get dinner on the table quickly.

• 6 teaspoons extra-virgin olive oil, divided
• 1 teaspoon five-spice powder (see Note)
• 1 teaspoon kosher salt, divided
• 1/2 teaspoon freshly ground pepper, plus more to taste
• 1 pound boneless, skinless chicken breasts, trimmed of fat
• 3 oranges
• 12 cups mixed Asian or salad greens
• 1 red bell pepper, cut into thin strips
• 1/2 cup slivered red onion
• 3 tablespoons cider vinegar
• 1 tablespoon Dijon mustard

1. Preheat oven to 450°F. Combine 1 teaspoon oil, five-spice powder, 1/2 teaspoon salt and 1/2 teaspoon pepper in a small bowl. Rub the mixture into both sides of the chicken breasts.

2. Heat 1 teaspoon oil in a large ovenproof nonstick skillet over medium-high heat. Add chicken breasts; cook until browned on one side, 3 to 5 minutes. Turn them over and transfer the pan to the oven. Roast until the chicken is just cooked through (an instant-read thermometer inserted into the center should read 165°F), 6 to 8 minutes. Transfer the chicken to a cutting board; let rest for 5 minutes (it will finish cooking as it rests).

3. Meanwhile, peel and segment two of the oranges (see Tip), collecting segments and any juice in a large bowl. (Discard membranes, pith and skin.) Add the greens, bell pepper and onion to the bowl. Zest and juice the remaining orange. Place the zest and juice in a small bowl; whisk in vinegar, mustard, the remaining 4 teaspoons oil, remaining 1/2 teaspoon salt and freshly ground pepper to taste. Pour the dressing over the salad; toss to combine. Slice the chicken and serve on the salad.

Makes 4 servings.

Per serving: 278 calories; 10 g fat (2 g sat, 6 g mono); 63 mg cholesterol; 23 g carbohydrate; 26 g protein; 7 g fiber; 681 mg sodium.

Nutrition bonus: Vitamin C (170% daily value), Vitamin A (140% dv), Selenium (30% dv), Iron (15% dv).

1 Carbohydrate Serving
Exchanges: 1 fruit, 1 1/2 vegetable, 3 lean meat, 1 1/2 fat

Ingredient note:
Often a blend of cinnamon, cloves, fennel seed, star anise and Szechuan peppercorns, five-spice powder was originally considered a cure-all miracle blend encompassing the five elements (sour, bitter, sweet, pungent, salty). Look for it in the supermarket spice section.

To segment citrus: With a sharp knife, remove the skin and white pith from the fruit. Working over a bowl, cut the segments from their surrounding membranes. Squeeze juice into the bowl before discarding the membranes.

With all of the sunshine we have here in Colorado, it’s hard to believe many of us may be deficient in the “sunshine vitamin” our bodies produce by harnessing the sun’s rays. Studies have documented that vitamin D deficiency is prevalent in Colorado and many other communities in northern latitudes.

Numerous factors put people at increased risk of vitamin D deficiency, including obesity, advanced age, darker skin color, extensive use of sunscreen, history of gastric bypass surgery, renal disease, liver disease and malabsorption, which is abnormality in digestion or absorption of food nutrients. Even if you have none of these risk factors, you may still have insufficient or deficient levels.

Without supplementation, the majority of the vitamin D our bodies use begins with absorption of UVB rays from the sun. Due to the angle of the sun during the winter months in Colorado, UVB rays are absorbed by the ozone layer before reaching us. So our vitamin D levels are typically lower in the winter than summer, unless we take it from other sources.

What is so important about vitamin D after all?

Recent research and epidemiological studies suggest vitamin D is likely far more important than we originally thought. Many of us remember vitamin D is important for bone health, because it helps us absorb calcium and phosphorus. The original rationale for fortifying milk with vitamin D was to prevent a bone disease called rickets in children. Vitamin D deficiency contributes to the development of porous bones in adults, known as osteoporosis, which can put one at increased risk of fractures. Patients who are currently taking a bisphosphonate for treatment of osteoporosis need to have sufficient vitamin D levels for the medication to work.

Some research indicates vitamin D may play a significant role in the prevention of several autoimmune diseases such as multiple sclerosis and rheumatoid arthritis, which are more prevalent in the northern latitudes where there is minimal sun exposure.

Even more striking is a possible link between various cancers and vitamin D deficiency. Vitamin D has been found to have an important role in defending against at least 18 types of cancers. Epidemiologic studies indicate that vitamin D deficiency is associated with a 30 to 50 percent increase in the risk of getting colon, prostate, and breast cancer. Participants in a Women’s Health Initiative study who had extremely low vitamin D levels were more than 2.5 times likely to develop colorectal cancer in an eight-year period than women with normal levels.

Vitamin D deficiency has also been linked to muscle weakness and pain. Skeletal muscles have a vitamin D receptor, and sufficient levels may be needed for maximal function. Studies have shown a significant decrease in the number of falls in the elderly when vitamin D intake was increased. Another study revealed that 93 percent of people with nonspecific musculoskeletal pain were deficient in vitamin D. Some cardiologists have anecdotally noted that muscle pain associated with drugs used to treat high cholesterol levels improved when vitamin D levels increased.

There is also evidence to suggest that vitamin D levels play a role in high blood pressure, psoriasis, diabetes mellitus and decreased immune function.

So how much is enough, and how do we get it?

First, it’s important to distinguish between two types of vitamin D. Vitamin D2, also called ergocalciferol, is typically found in milk and cereals. Our bodies do not utilize this version as well as vitamin D3, or cholecalciferol. Vitamin D3 is found in salmon, eggs, tuna, mackerel, sardines and fortified foods, making these your best options.

Experts recommend we get at least 800-1000 IU of vitamin D daily, and those amounts are likely to increase as more research accumulates. Some people may need higher amounts if there are any underlying medical conditions that affect vitamin D absorption. Supplementation as high as 10,000 IU daily has been reported with no adverse effects.

As a rule of thumb, a 3.5 ounce piece of cooked salmon has about 360 IU of vitamin D. A can of tuna offers 200 IU, and an egg contains 20 IU.

You can also buy vitamin D supplements at drug stores, but make sure to purchase the D3 form.