{"id":17277,"date":"2018-08-06T08:53:14","date_gmt":"2018-08-06T14:53:14","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=17277"},"modified":"2024-12-24T09:28:51","modified_gmt":"2024-12-24T16:28:51","slug":"integrated-primary-care-help-for-both-alzheimers-and-anxiety","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/integrated-primary-care-help-for-both-alzheimers-and-anxiety\/","title":{"rendered":"Integrated primary care: help for both Alzheimer’s and anxiety"},"content":{"rendered":"
<\/div>

Newly married in their 50s, Trisha and Brian Washburn planned to move to Colorado to grow old together.<\/p>\n

\"Trisha
Trisha Washburn is doing her best to live a full life after a devastating Alzheimer’s diagnosis that robbed her of her confidence. Photo courtesy of Trisha Washburn.<\/figcaption><\/figure>\n

Both were avid skiers and dedicated ski instructors. For decades, each had taught at a tiny ski hill in Connecticut, passing along a love of skiing to generations of children and perfecting their teaching techniques.<\/p>\n

Finally, in 2016, the Washburns were fulfilling their dream of coming to the Rockies, where the big mountains beckoned.<\/p>\n

Then, just two weeks before their move, Trisha received a devastating diagnosis: early-onset Alzheimer\u2019s. She was only 56. She had coped since age 10 with Type 1 diabetes, and later had heart problems. But her bubbly personality and a love of sports keep her fit and relatively healthy.<\/p>\n

\u2018Like a funnel had sucked out everything familiar\u2019<\/strong><\/h3>\n

The Washburns arrived in Colorado full of hope, but Trisha\u2019s challenges soon became apparent. She felt lost in her new surroundings. Near their apartment on a ridge in Broomfield, they had a stunning view of Boulder\u2019s Flatirons and the mountains beyond. But, Trisha had trouble telling the doors to the garage and the breezeway apart. Confusion flooded her as she drove.<\/p>\n

Her memory problems spurred anxiety. An expert on the slopes, she nonetheless was afraid to ski or work as a ski instructor. She worried she\u2019d get lost or lead young children astray.<\/p>\n

\"Trisha
Trisha and Brian Washburn are both ski instructors. They married in 2013, then weeks before moving to Colorado, Trisha was diagnosed with Alzheimer’s. Photo courtesy of Trisha Washburn.<\/figcaption><\/figure>\n

\u201cIt was like a funnel had sucked everything familiar out of me,\u201d Trisha said.<\/p>\n

A crisis with her blood sugar levels then led to a five-day hospitalization in February at UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus. Doctors stabilized Trisha\u2019s diabetes, gave her a pump that helps her automatically regulate her insulin levels and treated her for pneumonia.<\/p>\n

After recovering, Trisha followed up with her primary care team at the clinic close to her home, UCHealth Family Medicine Clinic \u2013 Westminster<\/a>. And a welcome surprise greeted her. Along with her trusted primary care provider, Dr. Michael Dewey<\/a>, she could also get help from a behavioral health specialist, Lauren Tolle<\/a>, who has a doctorate in clinical psychology and works in tandem with Trisha\u2019s primary care team.<\/p>\n

\u201cOur whole team wrapped around her,\u201d Tolle said. \u201cThe lovely thing about primary care is that we see everybody. There are a lot of common referrals for depression, anxiety, insomnia and chronic pain.\u201d<\/p>\n

By working closely with Tolle, Trisha has been taming her anxiety so she can feel comfortable in life and on the slopes again.<\/p>\n

Integrated care: better outcomes, reduced stigma<\/strong><\/h3>\n

UCHealth\u2019s Denver-area primary care clinics recently have added behavioral health providers so patients easily can get help for common challenges. (Click here<\/a> to read a related story, Bipolar disorder: The torture and beauty of an unquiet mind<\/a>.)<\/p>\n

\"Lauren
Lauren Tolle, a clinical psychologist and an expert in integrated primary care, meets with Trisha Washburn regularly at the primary care office close to her home, UCHealth Family Medicine Clinic – Westminister. Tolle works closely with Trisha’s primary care provider. Photo by UCHealth.<\/figcaption><\/figure>\n

For decades, patients who needed both physical and mental health care had to navigate deeply divided systems. The splintered care dated back to times long ago when doctors had few treatments for little-understood mental health disorders like schizophrenia. Unable to get help, people with severe mental illnesses often ended up in institutions.<\/p>\n

Better medications and a greater understanding of mental health challenges have led to improved care.<\/p>\n

Today, the most innovative health systems provide integrated physical and behavioral health in primary care clinics to better serve patients, reduce stigma and improve access to care.<\/p>\n

Providing much better behavioral health care is critical to better health outcomes for patients since people with serious mental illnesses and substance use challenges also have higher rates of chronic physical illnesses and die earlier than others. At the same time, people like Trisha, who have serious physical health challenges, also cope with higher rates of mental health illnesses, according to the National Institute of Mental Health.<\/p>\n

A devastating diagnosis<\/strong><\/h3>\n

When Trisha first met Tolle, she was instantly comfortable.<\/p>\n

\u201cShe has been so wonderful. She really took the time to get to know me,\u201d Trisha said.<\/p>\n

Trisha had worked for many years as an administrative assistant in Westport, a charming town in Connecticut. She loved the varied work and forging bonds with the many people who came in for help.<\/p>\n

\u201cI would meet with lawyers and prospective purchasers of property. I loved it. It was A to Z,\u201d she said.<\/p>\n

In the summers, she played tennis and every year, went to see the pros play nearby at the U.S. Open.<\/p>\n

Two people ultimately prompted Trisha to check on her cognitive function.<\/p>\n

\u201cMy sister said, \u2018It\u2019s painful to watch you try to find your keys or your pocketbook,\u2019\u201d Trisha recalled.<\/p>\n

Then her boss of 10 years pulled her aside in 2016 and said, \u201cYou\u2019re becoming very forgetful and you\u2019re no longer getting things done.\u201d<\/p>\n

\u201cI was absolutely devastated,\u201d Trisha said. \u201cI had trained a gal. We got along really nicely. My boss had begun to pull things off of my plate and give them to her.\u201d<\/p>\n

The town had an employee assistance program. Trisha booked an appointment, thinking perhaps she needed therapy. After a short time, the counselor told her she should probably be talking to a neurologist. She went to a neurologist, who delivered the Alzheimer\u2019s diagnosis.<\/p>\n

\u201cIt was horrific. I was in absolute shock. I had convinced myself I didn\u2019t have it,\u201d Trisha said.<\/p>\n

\u2018More forgiving of myself\u2019<\/strong><\/h3>\n

Since her diagnosis, Trisha has been taking part in an Alzheimer\u2019s study in Connecticut, flying back occasionally. While she has the amyloid protein markers associated with Alzheimer\u2019s, Trisha\u2019s cognitive function has remained relatively stable over the last two years.<\/p>\n

Her neurologist at UCHealth, Dr. Christopher Filley<\/a>, who is also a professor<\/a> at the University of Colorado School of Medicine<\/a>, is doing additional testing to determine whether Trisha truly has Alzheimer\u2019s or a different type of cognitive impairment. She is eager to keep participating in research so she can get answers for herself and others.<\/p>\n

\"Trisha
Trisha and Brian Washburn both dreamed of moving to Colorado for years. Weeks before they made the move, Trisha was diagnosed with Alzheimer’s and suffered from anxiety as a result. Photo courtesy of Trisha Washburn.<\/figcaption><\/figure>\n

\u201cI can face anything. Just let me know what I\u2019m facing,\u201d Trisha said.<\/p>\n

While Filley continues to assess Trisha, he advised her to stop driving. Getting around Colorado without a car has been challenging at times, but Trisha found it a relief not to contend with navigating areas that were new to her. She now uses ride-sharing apps to get around.<\/p>\n

That frees her up to focus her attention on issues that matter most, like regaining her confidence on the ski slopes.<\/p>\n

Tolle taught Trisha to use breathing exercises to feel calmer in stressful circumstances. Tolle and Dewey also have worked together to help Trisha try various anti-anxiety medications. Despite her challenges, Trisha has an incredibly positive attitude and Tolle also has helped her make peace with her new circumstances.<\/p>\n

\u201cI\u2019ve gotten to where I\u2019m more forgiving of myself,\u201d Trisha said.<\/p>\n

Most of the time, she\u2019s counting her blessings instead of mourning her losses.<\/p>\n

\u201cI\u2019m the youngest of four and I came from a wonderful family,\u201d Trisha said. \u201cI always think, \u2018it could be so much worse.\u2019\u201d<\/p>\n

Her parents were both ski instructors and Trisha was on skis herself by age 3. Her mother taught skiing until age 80 and played golf until age 83. She died recently, but was able to see Trisha marry her husband in 2013. It was a first marriage for Trisha and she loves now having stepsons.<\/p>\n

Feeling fantastic on the slopes<\/strong><\/h3>\n

On a perfect ski day, it\u2019s sunny and Trisha is effortlessly breezing down the bumps.<\/p>\n

After working with Tolle, Trisha was able to get back on the slopes last spring.<\/p>\n

\u201cIt felt fantastic, but very different. I wasn\u2019t teaching anymore and that\u2019s really tough,\u201d she said. \u201cI love teaching little kids and scared adult women. I do really well with them.\u201d<\/p>\n

\"Trish
Trisha Washburn is passionate about skiing. Thanks to help from a psychologsit at the UCHealth primary care clinic close to her home, she’s regaining her confidence on the slopes. Photo courtesy of Trisha Washburn.<\/figcaption><\/figure>\n

During her years as an instructor at Mount Southington in Connecticut<\/a>, Trisha had trained hard to earn the highest level of certification with the Professional Ski Instructors of America<\/a>.<\/p>\n

Many years ago, she taught for two ski seasons at Vail<\/a>. Then she returned home because of some problems with her heart and vision loss tied to diabetes. She was able to work weekends as an instructor at Mount Southington. The area boasts only a 425-vertical drop, compared to 3,450 at Vail, but Trisha said instructors there had \u201csmall mountain syndrome\u201d and compensated for their limited terrain by creating an outstanding ski program.<\/p>\n

Trisha met her future husband at Mount Southington, where he was also an instructor. Brian is an environmental engineer, who went to Colorado School of Mines. He loves breaking down and understanding each step of skiing.<\/p>\n

He describes Trisha, on the other hand, as a joyful, intuitive skier.<\/p>\n

\u201cShe brings a lot of excitement and fun,\u201d Brian said. \u201cShe\u2019s a very strong skier.\u201d<\/p>\n

Since moving to Colorado, Brian has been teaching at Eldora<\/a>. Trisha hopes she can find a role in future ski seasons as a volunteer or a lift operator.<\/p>\n

\u201cFactoring all that people go through, I\u2019m doing pretty damn well. I can still laugh. What else am I going to do? My alternative is to sulk. And I don\u2019t want to sulk.\u201d<\/p>\n

Reaching people who otherwise wouldn\u2019t get help<\/strong><\/h3>\n

At Trisha\u2019s primary care clinic, Tolle said integrated care is critical for many patients.<\/p>\n

\u201cIt\u2019s the way care should be delivered. It cuts through so many barriers to accessing behavioral health,\u201d she said.<\/p>\n

\"A
Trisha Washburn’s passion is skiing. Even though she’s an expert instructor, after an Alzheimer’s diagnosis, she lost her confidence on the slopes. Photo courtesy of Trisha Washburn.<\/figcaption><\/figure>\n

In clinics where medical providers can only give patients referrals to outside mental health providers, patients often don\u2019t get help.<\/p>\n

\u201cEven if you\u2019re doing well, it can be too hard (to find behavioral health providers). If you\u2019re not in a state where you\u2019re feeling OK about things, you can give up,\u201d Tolle said.<\/p>\n

But, in an integrated setting, physical and mental health specialists can give each other what\u2019s called a \u201cwarm handoff.\u201d Doctors who have patients who are struggling can ask Tolle to pop in to a patient\u2019s exam room.<\/p>\n

\u201cIf someone is feeling ambivalent (about seeing a behavioral health specialist), it can be helpful to have a face-to-face meeting and see that we\u2019re not scary,\u201d Tolle said.<\/p>\n

\u201cWe reach people who otherwise wouldn\u2019t be seeking mental health care.\u201d<\/p>\n

Dewey, Trisha\u2019s medical provider, is equally enthusiastic about integrating behavioral health into primary care clinics.<\/p>\n

\u201cI cannot put into words how beneficial it has been, not only for Trisha, but also for so many of my other patients,\u201d Dewey said. \u201cI send almost half of my patients to see them (Tolle and her team).<\/p>\n

\u201cFor Trisha, it\u2019s been really beneficial,\u201d Dewey said. \u201cGetting her back to skiing and getting her more engaged in her daily activities (is really helpful). She\u2019s got a lot of complex medical issues. But what we\u2019ve seen with her has been pretty impressive.\u201d<\/p>\n

Dewey said addressing mental health issues like anxiety and depression can correlate directly with better physical health. In Trisha\u2019s case, the less anxious she\u2019s feeling, the more she\u2019s able to keep her diabetes and heart problems in check.<\/p>\n

\u201cTrisha is super sweet and I\u2019m happy to have her as a patient,\u201d Dewey said.<\/p>\n

Outpacing Alzheimer\u2019s<\/strong><\/h3>\n

For this ski season, Trisha and Brian purchased Ikon Passes<\/a> that will allow them to ski at Eldora and multiple other Colorado mountains, along with Jackson Hole<\/a> in Wyoming, where they spent their honeymoon.<\/p>\n

As they wait for the snow to fall, they are enjoying the beauty of the mountains in the summer.<\/p>\n

The two have explored Chautauqua Park in Boulder<\/a> along with Mt. Evans<\/a> and Rocky Mountain National Park<\/a>.<\/p>\n

It\u2019s also fun to see Trisha rediscover former passions. One recent day, Brian came home from work and found that Trisha had gone on a bike ride.<\/p>\n

\"Trisha
After moving to Colorado, Trisha Washburn is enjoying the mountains both in the summer and in the winter. Photo courtesy of Trisha Washburn.<\/figcaption><\/figure>\n

\u201cWhen she does things like that, I know she\u2019s feeling pretty good,\u201d he said.<\/p>\n

Despite the challenges, Brian said neither he nor Trisha regrets moving to Colorado. And they have appreciated the care she has received.<\/p>\n

\u201cWe have great specialists at the Anschutz Medical Campus,\u201d Brian said. \u201cAnd Dr. Dewey pulls all of the pieces together. He\u2019s a great doctor.\u201d<\/p>\n

With Tolle\u2019s help, Trisha is hopeful that she can keep her worries at bay.<\/p>\n

\u201cShe knows my history now. She feels like a friend,\u201d Trisha said of Tolle. \u201cI don\u2019t have a lot of friends here yet, but I have a lot of wonderful acquaintances who are on my side.\u201d<\/p>\n

Brian said Trisha\u2019s ebullient spirit carries her a long way.<\/p>\n

\u201cShe\u2019s a fighter. We try to stay positive and take it day by day,\u201d Brian said.<\/p>\n

On a beautiful day in the mountains, whether it\u2019s summer or winter, both can forget for a little while about the health challenges they\u2019re facing.<\/p>\n

\u201cI\u2019ve been holding my own,\u201d Trisha said. \u201cI\u2019m still skiing faster than my Alzheimer\u2019s is moving.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Newly married in their 50s, Trisha and Brian Washburn planned to move to Colorado to grow old together. Both were avid skiers and dedicated ski instructors. For decades, each had taught at a tiny ski hill in Connecticut, passing along a love of skiing to generations of children and perfecting their teaching techniques. Finally, in […]<\/p>\n","protected":false},"author":2123,"featured_media":17283,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[185,113,988,112,184,351,1792],"class_list":["post-17277","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-alzheimers-care","tag-behavioral-health","tag-diabetes-endocrinology-care","tag-mental-health","tag-neurology","tag-primary-care","tag-uchealth-family-medicine-center"],"acf":[],"yoast_head":"\nIntegrated primary care: help for both Alzheimer's and anxiety - 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