Things were looking bad for Stephen Ogonowski. Antibiotic-resistant bacteria had devoured his right ankle down to the bone, leaving an inches-wide hole full of raw and ravaged tissue.
Amputation seemed certain, just as it was six months earlier when his left foot became infected and his leg had to be removed below the knee.
This time, though, podiatrist Dr. Bryan Groth assembled a diverse team of doctors and a new orthopedic device to surgically save the decimated foot — and most likely, his life. Mortality rates soar for double-amputees in poor health.
Now, the 56-year-old Colorado Springs man who spent much of 2008 living at Memorial Hospital hopes that by next year, he will be walking again and even returning to work.

The rest of this story will appear in the Gazette in upcoming days. In the meantime, here’s what doctors did. For those with strong stomachs, visit the Photos of Stephen Ogonowski’s surgery page on this blog under my pages.

The surgery:

In a previous surgery, Dr. Karl Dittrich restored circulation to the man’s leg with a stent. Dr. Groth surgically removed the infection, and Dr. Rupesh Jain, a plastic surgeon, cleaned the wound. In this surgery, Dr. Dittrich made sure circulation was still sound, and Dr. Groth removed damaged tissue and fused the foot to the shin with pins. Dr. Jain placed a skin graft on the wound. Dr. Groth then secured the foot with a halo device that allows the wound to heal while allowing Ogonowski to stand. Such a surgery would not have been possible several years ago, Groth said.

Amway Global and the YMCA of America are looking to pay a health-minded Colorado teen $1,000 to be a “wellness leader” representing the state. The chosen teen will also get a $1,000 grant for his or her local YMCA and an opportunity to be featured in Newsweek.

The “Search for Teen Wellness Leaders” is recruiting a student from each of the 50 states and Washington, D.C., and so far there have been no entrants from Colorado. The deadline is 8 a.m. Dec. 1.

The contest is open to teens 13-19 who are enrolled in high school or a certified educational program, and who are volunteering in an eligible wellness program. For official rules and entry forms, which must be submitted online, go here.

Heads are no doubt hanging low today at the El Paso County Department of Health and Environment, as they would be at any organization that lost 18 percent of its staff in less than a year. That somber feeling of watching people go — and being thankful if you’re not one of them — is one plenty of us have experienced in this economy. Chances are, plenty more will join us before things truly turnaround.

Yet history shows the health of the economy will sooner or later improve. The question is, will the health of El Paso County citizens? Or, critics might argue, will it even suffer?

I’ve written before about how public health is a tough sell. Science and disease investigations are rife with complexity and lacking in absolutes. A bad mix for politics. Here and elsewhere, local health departments have lost a bidding war for resources to other programs such as public safety, armed with jail logs and crime statistics to make its case.

That has plagued the county health department for years, both with county commissioners and voters. The cuts began in 2001 to pay down debt for a new jail. More recently, sales-tax measure 1A failed. Since 2001, county funding for the health department has fallen by nearly half, from $5.1 million to $2.8 million in 2009.

Now, with so many core programs gone, residents may become lab rats that answer the question just how sick will we get without public health? With fewer people conducting surveillance, a second question is, will we even know?

Consider daycare inspections. Acting Public Health Director Kandi Buckland said inspections at the county’s 400 child care providers do two things: They look for bad health habits such as diapering young children too close to food-prep areas, and they are an opportunity to teach workers about ways to avoid illness.

So what happens without them? As the father of a 2-year-old who attends daycare part-time, I know plenty of bugs make their way around the toddler circuit, with snotty noses and toys in mouthes. No amount of education could stop them all. But maybe some? If there more illnesses, will we know when they’re spread across 400 businesses with no one from the health department visiting them.

The health department will continue to respond to high-risk diseases and outbreaks, but you don’t need to have a child near death to miss work or have a miserable week or two at home.

Since the county fell behind on its restaurant inspections, complaints of food-borne illnesses have soared. El Paso County’s rate and volume of complaints is double that of any other county in Colorado, and inspectors are performing fewer than half of their state-mandated inspections each year.

In a recent conversation with Dr. Bernadette Albanese, medical director at the health department, I was told that the source of many illness outbreaks is never identified, in part because the health department can’t afford the tests or time to go hunting down leads. That’s a pretty scary thought.

Other losses are more theoretical, but could nonetheless be significant.  Without an air-quality program, there will be no environmental reviews for new developments. Then there are those scary diseases that routinely pop-up in animals but very rarely affect humans, such as rabies and the plague. There’s undoubtedly comfort that comes from knowing if a rabid bat is found in your neighborhood. Maybe you keep your dog inside a few days or double-check his vaccination records. But would not knowing increase his chances of exposure? What about yours? Maybe not. But if so, an untreated rabies exposure is fatal.

Cases of some STDs have already gone up since the county scaled back its services. Now the program is going away entirely.

The state health department has questions of its own. There are laws governing public health, but they are loosely worded. Is El Paso County breaking the law? If so, then what? Is the state forced to takeover, or is there some form of penalty that could come?

In the end, we may never know. A high-profile outbreak or a rabies-related fatality, if linked to the health department’s cuts, could convince the most cynical critics that these functions are crucial. Or, any changes may take place under the radar, fueling critics claims the money isn’t needed.

Whatever the impact to the public, today there are roughly two dozen people preparing to bring in the new year without work. I’m pretty sure I can speak for our readers and the community when I offer our sympathies and wish you the best of luck.

Hospitals are hurting on all fronts because of the economic crisis, despite health care’s reputation as one of the more robust sectors when it comes to things like job growth and demand.

A report released today by the American Hospital Association paints a grim financial picture of the nation’s health institutions, which are struggling with credit, flagging portfolios, lower patient demand, and an increasing number of uninsured patients. Data was collected as late as Nov. 10. With 736 responses, the survey can be considered representative of the nation, the AHA said.

A third of hospitals reported paying more in interest on variable rate bonds. Interest expenses, as a whole, shot up 15 percent, from $218.5 million to $252 million, from third quarter 2007 to third quarter 2008. A smaller number of hospitals said they could not issue debt, refinance or withdraw funds at financial institutions. More than half (56 percent) said they would postpone or reconsider expansions or renovations.

Not surprisingly, hospitals’ investments have tanked. But if you think your 401k lost a lot, consider this: Non-operating revenue plunged from earnings of $396.1 million in third quarter ‘07 to losses of $831.5 million. That’s $1.23 billion.

Patients are apparently postponing procedures or simply suffering through their sickness untreated. More than 30 percent of hospitals report decreases in elective procedures; 6 percent of them say the decreases are significant. Similarly, admissions are down at nearly 40 percent of hospitals, with slightly less than 10 percent of them reporting significant declines.

Uncompensated care is up by 8 percent from a year ago, and Medicaid expenditures, which far outweigh cost of services, tend to rise in hard times as more people qualify.

So, why should you care? For one, this report shows just how far the economic downturn’s reach has been. Look at the job listings, and you’ll likely see more ads for nursing jobs than any other career. Yet this survey shows slightly more than half of hospitals are considering cutting staff to weather the storm.

With staff reductions, chances are some level of service will also go. More than a quarter of hospitals say they are considering reducing services. In a few cases, you might even find yourself with one less hospital. About 8 percent said they will consider a merger.

The federal bailout has generated a lot of buzz about the biggest players in the economy and which ones might be too big to fail. Well, consider this final note from the report: Health care was responsible for 45 percent of all new private-sector jobs in 2007. Our nation’s hospitals employ more than 5 million people.

Watch for a story in tomorrow’s Gazette, including information on local hospital systems Memorial Health System and Penrose-St. Francis Health Services.

A survey released today from the Physicians’ Foundation shows that nearly half of primary care physicians are planning to leave their practice or scale back on patients in the next three years, something that could exacerbate an anticipated crisis in finding family doctors.

The Gazette and other media outlets have reported the looming shortage of primary care physicians (my story can be found here.) Just a tiny fraction of medical students are going into primary care, even though it is regarded as the front line of defense against many chronic diseases. Reasons include high debt from medical school loans, followed by poor reimbursements compared to specialty practices. Red tape and a financial need to see high volumes of patients to cover costs are fueling frustrations.

While the political debate is about how to help the uninsured, the fact is there are not enough doctors to see them all anyway.

But this latest survey suggests that current primary care doctors might leave even sooner than expected if given a chance. Perhaps the most startling statistic is that 45 percent said if they had the financial means, they would retire today. Just 17 percent considered their practices as “healthy and profitable.” And 60 percent said they would not recommend their career to young people. Check out more Key Findings.

Now, granted there is a big difference between saying you would retire, change course, etc., and actually doing it. Even so, the apparent low morale certainly can’t help in efforts to recruit new docs and replenish the supply of primary care physicians.

Maybe it’s the mountain air, but Colorado Springs is one of the healthiest cities in the U.S., according to information from the Centers for Disease Control and Prevention. The city and its surrounding metro area ranks 22 out of 184 based on information from a 2007 health survey. People  were asked to rate their health as excellent, very good, good, fair or poor.

Cities were not ranked by the CDC, but WebMD lined them up based on the database. For WebMD’s story, click here. For the raw data, go here.

Lincoln, Neb., got the best score, and Huntington, W.V., fared the worst.

Colorado, all around, appears to be a healthy place to live. Boulder came in at No. 3, Fort Collins/Loveland at 16, and Denver at 43. Perhaps that’s not surprising, given what we know about the state. We import lots of highly educated people from other places, which — according to research and think tanks – means better access to health care and lower rates of chronic diseases and obesity. And mountain living certainly encourages folks to get out and exercise.

Maybe I’m late coming to the party, but today The Gazette newsroom’s online guru, Carmen Boles, introduced me to a fantastic new source for health news. Alltop, as the name implies, takes “all the top news” on particular subjects and puts it in one spot.  In the case of health news, there are at least 160 news and blog sites represented, each with about 5 of their latest stories or posts. This doesn’t include separate categories for fitness and life. Check it out here.

And speaking of the Web, if you’ve read my “about this blog” page you’ll know that this site is intended to become more robust as a news source and a way of not only reporting information, but covering the health beat. As part of that, I’m eyeing Twitter as a next step. If you have other suggestions for introducing Pikes Peak Health to the broader Colorado Springs online universe or a new audience of health consumers, I’m anxious to hear from you.

The American Medical Association, the largest physician group, took a stance on an array of political and legisltative issues at a semi-annual policy-making meeting Monday in Florida. Here is the rundown:

–Push for state laws banning text messaging and driving. It may seem obvious that text messaging might be a bad idea while driving, but apparently enough people do to warrant laws against it. Seven states - Alaska, California, Connecticut, Louisiana, Minnesota, New Jersey, Washington - and Washington, D.C. have outlawed texting and driving. The AMA will advocate for other states to do the same.

–Support a ban on artificial trans fats. The AMA will support measures by states or cities to ban the use of trans fats. Chicago and New York have placed such a ban on restaurants and bakeries, and California enacted a ban on them earlier this year, the AMA reported. The association’s stance is stronger than its previous one, which encouraged replacing trans fats with healthier fats and oils but stopped short of endorsing government intervention.

–Reverse the shortage of primary care physicians. The shortage of primary care doctors is looming. See a story I wrote on the issue here. The AMA is initiating an action plan to address medical student debt, recruiting and training, and better payments by insurers for primary care services. The group also plans to study new ways of caring for patients that could produce better care and make the profession more rewarding — and by extension more enticing for medical students. “There is a predicted shortage of 35,000 to 40,000 primary care physicians by 2025, said Dr. William Hazel, in an AMA news release. “With the large aging population and the increased incidence of chronic disease this is a major problem. Physicians, medical schools, lawmakers and others must work now to address the problem in order to ensure that we have enough physicians to care for patients in the years to come.”

Here’s a few other things the AMA wants to do:

–Increase access to health care for rural areas.

–Educate people about the health effects of global climate change.

–Improve health care for military families.

–Reform permanent Medicare physician payment.

–Develop principles for a patient-centered medical home.