A registered nurse at the hospital who is pursuing a master’s degree in a behavioral health field said she can’t apply for financial aid before the next semester starts in January. While Children’s will still pay employees up to $5,250 a year for tuition, that won’t cover the full cost of her program, which the hospital previously had paid in full, she said.

“They gave us about a one-month notice,” said the nurse, who spoke to The Denver Post on the condition of anonymity over fears she could lose her job. “A lot of us don’t have five, six grand saved to pay for our next term.”

Children’s contracted with a third party to fully pay for some degree programs and partially cover others. The programs the hospital chose weren’t necessarily the cheapest ones, the nurse said, and she doesn’t think she can transfer to a less-expensive school two years into her degree.

Leila Roche, a spokeswoman for Children’s, said when the Aurora hospital conducted its annual benefits assessment, it found that far more people than anticipated had used the full-tuition option. She said the hospital has paid about $11 million for tuition since May 2022.

“This was a very difficult decision and one we did not make without serious consideration of various options,” she said. “Children’s Colorado remains dedicated to making a significant annual investment in this benefit and the education of more than 1,000 team members.”

The nurse said the financial blow of having to pay tuition next year was stacked on top of a sudden notice that she would have to pay taxes on this year’s tuition, which wasn’t clear when she signed up for the program. Children’s deducted it from her checks in December, rather than spreading it out over the full year, which would have been easier to manage, she said.

“I wasn’t able to pay rent this month, so I’m going into more credit card debt for that,” she said.

The Internal Revenue Service requires employees who receive more than $5,250 in tuition reimbursement to pay taxes on the amount above that threshold. In Colorado, the rate comes out to about 34% after including federal, state, Social Security and Medicare taxes.

A behavioral health specialist who is pursuing a degree in counseling said he managed to stay afloat on smaller checks after taxes, but this month wiped out his emergency savings. He plans to take a semester off to assess his finances and look at transferring to a different school, because he can’t afford to cover the tuition balance at Regis University.

People working in behavioral health already feel unappreciated and aren’t paid well, said the specialist, who also spoke on the condition of anonymity because he was worried about retaliation. Full tuition coverage gave him a chance to build a career in the field without adding to his existing student loan debt, he said.

“I felt like, for the first time, my future was laid out in front of me and goals were achievable,” he said. “My life has got completely turned upside down in a matter of days.”

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The Prescription Drug Affordability Board unanimously voted against declaring Trikafta — a drug to treat cystic fibrosis — unaffordable at a meeting Friday morning. If the state’s new board had determined the medication was unaffordable, it would have kicked off a process to set a maximum price that the drugmaker could charge Colorado health plans.

Six other states also have prescription drug affordability boards, but Friday’s meeting was the first time one of those boards decided whether a specific medication was unaffordable. Colorado went further than some of the other states, giving its board the power to set a maximum price that state-regulated insurance plans would pay for certain drugs.

The board’s staff reported that while Trikafta cost an average of $234,439 per patient annually, about half of patients reported they paid $50 or less out-of-pocket each month because either their insurance or assistance programs covered the rest.

Board chair Dr. Gail Mizner said that while drugmakers’ assistance programs aren’t guaranteed to continue in the future, the board’s job was to determine whether the drug was affordable for patients now. Trikafta is a “miracle drug,” she said, but the board still can consider setting a price limit in a future year if patients report they can’t access it.

“This is not the ultimate answer,” she said of Friday’s vote.

Manufacturers’ coupons take care of individual patients’ out-of-pocket costs, but raise costs for everyone paying for insurance because they allow drugmakers to keep charging high prices, said board member Dr. Sami Diab. But fixing that is beyond the scope of Colorado’s board, he said.

Cystic fibrosis is caused when a person inherits two copies of a mutated gene, causing sticky mucus to build up in the lungs and other organs. People with the disease are at higher risk from respiratory infections, and sometimes develop malnutrition because the mucus interferes with the digestive system.

The Cystic Fibrosis Foundation estimated about 700 people in Colorado have the disease.

Groups representing cystic fibrosis patients had raised alarms that setting a price limit on Trikafta could push manufacturer Vertex Pharmaceuticals to refuse to sell in Colorado. Supporters of the board’s process argued that companies were bluffing to avoid cuts to their revenue.

Trikafta works on a mutation shared by about 90% of patients with cystic fibrosis. Studies found that patients taking it had better lung function and fewer hospital admissions, and reported better quality of life. The drug has only been on the market for about four years, but some researchers project it could allow patients to have a near-normal lifespan. As of 2021, about half of people with cystic fibrosis who had died were 34 or younger, according to the Cystic Fibrosis Foundation.

Jennifer Reinhardt, a Denver woman whose 22-year-old daughter has cystic fibrosis, told the board that Trikafta gave her daughter hope and allowed her greater freedom, since she no longer needs to spend hours using a machine to break up the mucus in her chest. She said she also worries that limiting prices for rare-disease drugs could discourage companies from developing new treatments, such as Vertex’s new gene therapy for sickle cell disease.

“She was not able to plan for her future. Now she can,” Reinhardt said of her daughter. “She just wants to live.”

Rose Keller, who is in the minority of cystic fibrosis patients who have a mutation that doesn’t respond to Trikafta, told the board that while she would personally pay anything for a cure or treatment that improved her life, allowing drug companies to set their price means resources aren’t available for other priorities in society, such as education.

“If Vertex is allowed to charge whatever it wants, what is to stop whatever company comes up with my drug?” she said.

In the new year, the state’s Prescription Drug Affordability Board will consider four other drugs for possible price limits. It chose five drugs from a list of medications whose prices rose at least 10% in the last year, brand-name medications that cost at least $30,000 per year and generics that cost at least $100 per month.

The other drugs the board is evaluating are:

• Genvoya, a combination pill for HIV, with a list price of about $4,000 per month

• Enbrel, used for rheumatoid arthritis and other autoimmune diseases, with a list price of more than $6,800 per month

• Cosentyx, used for psoriatic arthritis and other autoimmune diseases, with a list price of more than $6,900 per month at typical doses

• Stelara, used for Crohn’s disease and other autoimmune conditions, with a list price of more than $12,000 a month

List prices may not reflect what health plans or individuals pay for drugs, because they don’t account for rebates.

Reid Porter, spokesman for the Pharmaceutical Researchers and Manufacturers of America, said the board responded to patients’ concerns that price-setting would cause them to lose access to medication.

“Creating bureaucratic barriers between patients and their doctors could make it very difficult for patients to access life-saving medications,” he said in a statement. “Instead of focusing on misguided price-setting, Colorado should address the root cause of the problem: health insurance practices and the self-serving actions of pharmacy benefit managers who control and often increase costs at the pharmacy counter.”

Priya Telang, communications manager for the Colorado Consumer Health Initiative, said the board went through an exhaustive process to determine whether Trikafta was affordable, which revealed important information, such as it costs $6,000 a year to produce the drug for each patient.

Vertex’s threat to pull out marred the process, though, and terrified patients unnecessarily, she said at a news conference after the board meeting.

“It’s completely unconscionable that a company that brings in billions of dollars would threaten to withhold medication that costs $6,000 to produce,” she said.

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The Colorado Department of Public Health and Environment reported 84 people were diagnosed with tuberculosis so far this year, which is higher than the pre-pandemic average of about 70 cases per year. Two people have died, which is on the lower end of what Colorado typically sees.

The increase was first reported by 9News.

The state defines elimination as fewer than one case of active disease for every million residents, state epidemiologist Dr. Rachel Herlihy said. This year, the health department has recorded about 20 cases for every million residents – a significant gulf in the world of infectious diseases.

“We do still have that goal of elimination,” she said. “We certainly do have some challenges ahead of us.”

Tuberculosis is the world’s top infectious disease killer, causing about 4,300 deaths per day worldwide. Most of those deaths happen in developing countries, where the disease is more common and treatment is harder to come by.

No one is sure why cases are rising now or whether this is a temporary or longer-term problem, Herlihy said. Most tuberculosis cases are in people who’ve been infected with the bacteria for some time, so it’s unlikely this represents a rebound of delayed infections, she said. Some other respiratory diseases did increase as COVID-19 controls loosened, creating short but intense periods as they spread through populations that hadn’t seen them for months or years.

One possibility is that people didn’t come in for health care during the pandemic, or that their doctors weren’t thinking about tuberculosis and didn’t order the right testing, said Dr. Larissa Pisney, medical director for infection prevention and control for UCHealth’s metro area hospitals. The people who came to UCHealth with active tuberculosis infections this year were sicker than usual, and in some cases, the disease had infiltrated their bones or other organs, she said.

The most common symptoms of tuberculosis are a persistent cough, night sweats and a low fever. Some people lose weight or cough up blood. Many people who are exposed to the bacteria that cause tuberculosis don’t develop symptoms and can’t spread the disease, because their bodies respond and force it into a latent form.

If the bacteria later awaken, though, they could get sick and become contagious. Those who have HIV, other conditions that suppress the immune system, or diabetes are more likely to become sick if exposed, according to the Centers for Disease Control and Prevention.

Before the pandemic, active tuberculosis cases were falling steadily, said Dr. Masae Kawamura, former tuberculosis controller for the city of San Francisco. When COVID-19 hit, however, public health departments had to redeploy their staff who had the most experience with an airborne virus – typically those working with tuberculosis, she said.

The bacteria that cause tuberculosis can linger in the air after a person coughs, but most people don’t need to worry about catching the disease. Typically, it spreads to people who live or work with someone who has an active infection.

“For most people in Colorado, this is still not a concern,” Pisney said.

The risk of having a latent tuberculosis infection is higher for people who spent significant time in a region of the world where it’s more common, such as Eastern Europe, much of Asia, Africa and parts of South America. People who worked or lived in tight quarters, such as jails and homeless shelters, also are at increased risk.

Drug treatments are available, but patients who have symptoms have to take them consistently for at least six months. The course is often shorter for people with latent infections.

The United States does have some advantages in beating back tuberculosis again, Kawamura said: new blood tests make screening significantly more convenient than it was with the old skin test, and the drug regimen is shorter than it used to be. Unfortunately, in the countries with the highest rates of tuberculosis, people with symptoms often go untreated, allowing the bacteria to leap borders as visitors return home, she said.

“TB anywhere is TB everywhere,” she said.

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Bailey Pate, a 36-year-old resident of the Denver area, sued Sima Sciences and Nuka Enterprises, both based in Henderson. She alleged that their “Midnight” sleep aid drops caused liver damage after she used them for about 16 months in 2020 and 2021.

She settled with the companies this week for an undisclosed amount.

Laura Browne, an attorney who represented Pate, said thousands of people in Colorado and a handful of other states may have claims, either for injuries they suffered or for the money they spent on a potentially unsafe product.

The drops, sold under the 1906 brand name, included cannabis and corydalis, a traditional Chinese herbal remedy. Corydalis contains tetrahydropalmatine, or THP, a chemical that can cause liver damage at high doses. The manufacturers recalled the products earlier this year.

Peter Barsoom, the CEO of Nuka Enterprises, told The Denver Post in a statement Wednesday that the company “received a small number of reports from customers” who experienced a rare side effect — elevated liver enzymes — from the drops in their latest formulation.

“In every case we are aware of, levels went back to normal after discontinuing use,” he wrote. “While thousands used Midnight every night without any side effects, we take our responsibility seriously and discontinued Midnight earlier this year. We deeply regret the suffering that some customers experienced.”

In July 2022, the Marijuana Enforcement Division and the Colorado Department of Public Health and Environment issued a warning that said the products could cause liver injury. The drops remained available for sale, however, because the manufacturers said they had replaced corydalis with stephania, another herb.

Another state announcement in June said the manufacturers were working to remove the drops from store shelves after reports of liver injuries from the stephania version. The Marijuana Enforcement Division routinely accepts complaints about harm from marijuana products investigating them with the state health department if the alleged health consequences are serious.

Evan Hoffman, a Denver lawyer, said he represents about 30 people who developed liver problems after using the drops. About half of his clients were hospitalized, usually between two and eight days, after developing jaundice, nausea and unexplained fatigue, he said.

His clients are in settlement talks with the company, and some others have reached their own settlements, Hoffman said. He estimated two to four people still reach out to him in a typical week as they realize what could have caused their sudden liver problems, he said.

“People are still just now putting the pieces together,” he said.

Hoffman said his clients are not only upset about the unknown health consequences of their liver damage but angry that the company seemed to know it was a possibility and didn’t warn them.

“They didn’t do anything about it because it was their best-selling product,” he said.

As of late November, the manufacturers were selling six other products under the 1906 label. Visitors to the site could click on a list of ingredients, but the only warnings stated that customers should consult their doctors about any dietary supplements, and that pregnant and breastfeeding women shouldn’t take these products.

Online searches for the ingredients turned up some that were linked to kidney damage and liver failure. Others could worsen autoimmune diseases or interfere with medications. Plant-based remedies generally aren’t studied extensively, however, so it’s not clear if the amount of herbs in the supplements could be dangerous.

The U.S. Food and Drug Administration doesn’t regulate supplements unless they state the product can treat, prevent, diagnose or cure a specific condition. That’s why so many products make nebulous claims, such as that they “boost immunity.”

Browne said the absence of meaningful regulation means that “you really need to take it upon yourself … to investigate the ingredients as much as you can.” She added: “But consumers shouldn’t have that put on them.”

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The trial, involving scientists in Colorado, the United Kingdom and Italy, infused stem cells taken from the brain of a fetus that had died in a miscarriage into 15 Italian patients who already had significant disabilities caused by multiple sclerosis. In the year after the infusions, the patients’ multiple sclerosis didn’t get worse, and they didn’t have severe side effects from the stem cells.

It will take a bigger trial with a comparison group that didn’t receive the treatment to know whether the stem cells truly slowed down the disease’s progression, though, said Angelo D’Alessandro, a professor at CU’s Anschutz Medical Campus.

“The disease was overall stable,” he said.

In multiple sclerosis, the immune system attacks a substance called myelin that coats cells in the nervous system. As the myelin wears away, the nerve cells lose the ability to communicate with each other, gradually leading to problems with walking and other daily tasks, Alessandro said.

Some people’s illnesses progress much faster than others’, and not everyone has all of the symptoms, which can include vision problems, muscle weakness, pain or loss of sensation, fatigue and difficulty speaking.

Scientists have talked about stem cells as a possible solution to degenerative diseases like multiple sclerosis for decades, because while medication can prevent dramatic flare-ups of the disease, there’s no way to stop gradual loss of function over time, said Dr. Michael Sy, a neurologist at the University of California Irvine.

This particular study showed that infusing stem cells into the brain can be done safely, but didn’t suggest patients could expect dramatic improvement from these types of transplants any time soon, he said.

Commercialization of stem cell technology has gotten well ahead of science, though.

The only approved treatments using stem cells are bone marrow transplants, but in 2021, researchers found more than 2,700 clinics operated in the United States, offering to use embryonic stem cells or cells from patients’ own fat to treat a variety of diseases. Some patients have gone blind or developed tumors after receiving stem cell injections.

At the beginning of human development, stem cells could form any type of cell in the body, but they gradually take on specialties. The donated cells in the multiple sclerosis trial could only become brain tissue at that point, reducing the odds they’d develop into tumors.

Previous studies in rodents and non-human primates engineered to have a disease like multiple sclerosis found that the transplanted cells went to the parts of their brains that had lesions and appeared to partially repair them, Alessandro said. It’s not clear if the same thing would happen in humans, but those that received larger doses in the trial had more significant changes in the fluid surrounding their brains and spines that suggested their cells were healthier, he said.

It’s possible that a small percentage of the stem cells converted into cells in the brain, replacing damaged ones, Alessandro said. Stem cells can also give their mitochondria — the powerhouses of cells — to the existing neurons, which could reduce inflammation in the brain, he said.

All of the 15 patients in the trial were middle-aged and had advanced forms of multiple sclerosis, with significant disability. Even if subsequent trials find a benefit for that group, it’s not clear if different types of patients would find it helpful.

Stem cell transplants likely wouldn’t be a first line of treatment. To deliver the cells into the brain, doctors had to cut a hole in the patient’s skull, a process that comes with the risk of injury or introducing an infection.

It’s possible that this approach won’t pan out, but even in that case, it might advance the field for others to try something else, Alessandro said. The researchers are planning a second trial to quantify if the stem cells produced benefits, but aren’t enrolling patients in Colorado at this point.

“This can give hope to patients,” he said.

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Three multidisciplinary clinics in the state see long COVID patients, at National Jewish Health in Denver, University of Colorado’s Anschutz campus and Family Health West in Fruita. Together, they’ve treated about 10,000 people since mid-2020 — a significant number, but nowhere near everyone in need, said Dr. Sarah Jolley, medical director of the UCHealth Post-COVID Clinic.

Researchers estimated in November 2022 that between 228,000 and 651,000 Coloradans had symptoms that lingered after a COVID-19 infection, what has become known as long COVID.

Some people have relatively mild symptoms, such as loss of smell, while others are unable to work or care for themselves because of extreme fatigue or “brain fog.” Some report their conditions improve over time, while others see no change or get worse.

One idea to bring care to more people with long COVID is building on Project Extension for Community Health Outcomes, or ECHO, which connects primary care providers with specialists to learn how to manage certain conditions locally and to discuss complex patients. It started in New Mexico and initially focused on teaching rural providers to treat patients with hepatitis C, but has expanded over time.

Dr. Kyle Leggott, primary care liaison for Project ECHO in Colorado, said the group put together seven online courses to cover the basics of long COVID care, which are free to providers who want them. They’re still working on setting up groups for more in-depth training and consultation, he said.

“We really need every provider who meets patients in the ambulatory care setting to know what long COVID is,” he said.

Even if care is available in someone’s community, it doesn’t do much good if they can’t afford it, said Chelsey Baker-Hauck, a long COVID patient who spoke at a roundtable hosted by Lt. Gov. Dianne Primavera on Wednesday. She said one drug seems to be preventing more damage from her immune system attacking multiple body tissues, but it was a tough fight to get her insurance to cover it, and she expects to have to go through the same battle again soon.

The state also needs to make other supports more accessible, like disability payments, Baker-Hauck said. A friend of hers who also has long COVID recently lost her home because she was unable to work and spent much of her savings trying to repair her immune system, which is no longer protecting her from routine infections, she said.

“She’s not going to live to see her first disability payment,” she said.

Research suggests people newly infected with COVID-19 now are at a lower risk for lingering symptoms than they were earlier in the pandemic, due to immunity from vaccination and prior infections, as well as changes in the virus itself. That said, some still become seriously ill, placing them at a higher risk for long COVID.

As of Tuesday, 267 people in Colorado were hospitalized for COVID-19, and the number of people admitted on an average day was rising both in the state and nationwide.

Alison Sbrana, a disability activist from Fort Collins who spoke at the roundtable in Aurora, said the state’s infrastructure for treating post-viral syndromes has improved since the pandemic started.

She developed myalgic encephalomyelitis, also known as chronic fatigue syndrome, in 2014 after an infection with the virus that causes mononucleosis. She bounced from specialist to specialist for years with no help, and it was extremely difficult to find someone who could treat her health as a whole and coordinate her care, she said.

While having three multidisciplinary clinics is an improvement over the landscape when she got sick, patients with post-viral conditions still face significant barriers to care, Sbrana said. For example, some people with cognitive symptoms of long COVID can’t drive, and not everyone has a relative or friend who can take them to Denver for appointments, she said.

“It would be an enormous lift for me to come down here and get care,” Sbrana said.

Project ECHO could be a partial solution, especially since the organizers seem interested in hearing from patients about what isn’t working in the current system, Sbrana said. Primary care doctors are accustomed to managing their patients’ health needs, so involving them would take the burden of scheduling and coordination off people struggling with daily life, she said.

“If you can keep it in primary care and teach them what they need to know… you’re going to prevent these patients falling through the cracks,” she said.

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“It felt very round and hard, so that was pretty abnormal,” she said.

A biopsy confirmed she was right to worry: the lump was cancerous. And so Brown, a 22-year-old Loveland resident, joined the unenviable, growing group of young people fighting cancers that generally had been considered diseases of later life.

Nationwide, the rate of cancers before age 50 increased about 4.4% in women from 2010 to 2019, but decreased about 4.9% in men. Breast cancer accounted for the largest share of early diagnoses, though rates increased faster for cancers of the digestive system. Most of the increase came from people in their 30s, with rates holding steady for other groups.

It’s not just an American phenomenon, either: cancer diagnoses worldwide in people between 14 and 49 increased 79% between 1990 and 2019, according to a study in the British Medical Journal of Oncology. Some of the increase may reflect that more people are being screened for cancers before age 50 — meaning more tumors are likely to be found — but the study’s authors suggested other factors also are involved.

Dr. Virginia Borges, director of the Young Women’s Breast Cancer Program at UCHealth, said that while breast cancer is most common in older women, about 27,000 patients under 45 are diagnosed each year nationwide. It is significantly rarer in women in their 20s, and those who develop breast cancer that young usually have a clear genetic predisposition, she said.

That was the case for Brown. She knew she had a family history of cancer and was planning to get genetic testing, even before her diagnosis. When she did get tested later, she found out she had a variant of the BRCA1 gene that increases the risk of breast and ovarian cancers. She opted to get a double mastectomy, and might have surgery to prevent ovarian cancer in the future.

“It scares me more to possibly have to go through this again than to just do that,” she said.

BRCA1 and BRCA2 are the best-known genes linked to breast cancer, but there are seven others that appear to increase risk, Borges said. That’s why it’s important to know your family history, since tests that only look for a few genes may miss others that raise risk, she said.

Family history includes not only parents and grandparents, but any aunts, uncles or cousins who had any type of cancer, Borges said. While breast cancer is extremely rare in men, some of the same genes increase the risk of other cancers, so having multiple male relatives with cancer may be a warning sign, she said. Cancers that were diagnosed before age 50 are especially important to note, as are ovarian cancers.

If genetic testing uncovers a reason to be concerned about cancer risk, people can start their screening earlier, Borges said. Some women consider mastectomies or removing their ovaries or fallopian tubes, if they’ve given birth to any children they intend to have, she said. (Research suggests ovarian cancer may often start in the fallopian tubes, and removing them would give patients another preventive option without pushing them into sudden menopause, as removing the ovaries does.)

“These screening tests don’t prevent the cancer, but they can help catch the cancer early,” she said.

Earlier this year, the U.S. Preventive Services Task Force issued a draft recommendation that women at average risk start receiving mammograms at 40, down from the previous recommendation that they wait until they turn 50. High-risk women have the option to start even earlier, if they and their doctors believe it’s appropriate.

While genetics are a strong clue to whether a person may experience cancer early in life, not everyone who gets breast cancer at a young age has one of the clear risky genes, Borges said. There could be risk factors that stretch back generations, but right now, no one’s sure what they are, she said.

“There’s no clear pattern,” she said.

Dr. Mary Beth Terry, a professor of epidemiology at Columbia University, said it’s still not entirely clear why early-onset breast cancer is rising, but research has been able to rule out some simple explanations. While rising obesity may be a factor in the increase in gastrointestinal cancers and increase the risk of breast cancer late in life, women who have obesity are at no higher risk of early breast cancer than those who are leaner, she said.

Likewise, decisions about childbearing don’t appear to be the main factor, Terry said. The earliest American cancer registry, which covers Connecticut, shows early-onset breast cancer has been rising since the 1930s — before hormonal contraceptives came on the market, and through relative booms and busts in fertility. And today, breast cancer is rising in younger women both in societies where women are more likely to delay or forgo having kids and in those where the average family has half a dozen children, she said.

For a long time, the assumption was that early-onset cancers were genetic and later ones were caused by people’s environments and behaviors, Terry said, but research has shown that’s a false dichotomy. The exact mix of factors varies from person to person, though.

“Every cancer is because of your genes and your environment,” she said.

The most likely environmental factors contributing to the risk are increasing rates of heavy drinking among young women; changes in the average person’s diet; differences in childhood infections, which shape the community of bacteria living inside us; and chemical exposures during puberty, pregnancy, lactation and menopause, Terry said. Those periods are particularly significant because the breast tissue is changing, she said.

There is a link between an increased risk of breast cancer and even moderate drinking, but if women don’t want to entirely stop, they can reduce the risk by not binge drinking, Terry said. The Centers for Disease Control and Prevention define binge drinking as four or more drinks in quick succession for women, and five or more for men.

“If you take something in fast, and it’s a carcinogen like alcohol, your body can’t clear it and repair the damage,” she said.

One factor that temporarily increases breast cancer risk for young women is having a child, Borges said. Giving birth and breastfeeding decrease the risk of developing breast cancer after menopause — when most diagnoses happen — but for reasons that aren’t clear, the risk goes up for the 10 years after having children. That said, even women who have genetic risk factors for breast cancer should be able to have children, if they choose, she said.

“We want women who want to have a child to have a child,” she said.

People who develop cancer earlier in life have more time to live with potential adverse effects from both the tumor itself and the treatment. While breast cancer can be more aggressive in young women, especially young mothers, there’s a good chance of curing those patients if they discover the cancer early, Borges said.

That means it’s particularly important to keep young patients’ goals in mind, particularly whether they want to preserve the option to have biological children, she said. That can involve either harvesting eggs before beginning chemotherapy, or giving a drug that basically puts the ovaries into a dormant state, limiting damage to the eggs.

“It’s kind of like turning them into Sleeping Beauty under the glass,” she said.

While breast cancer is still far less common in younger women than in those who’ve been through menopause, it’s important to be aware of your body and get screened if something seems wrong, Terry said. Female firefighters and military members have a somewhat elevated risk because of exposures on the job, and new mothers need to know that pregnancy hormones can feed any small tumors that might have been present in their breasts, she said.

“Women know their own bodies, and doctors shouldn’t say, ‘You’re too young for breast cancer,'” she said.

Brown urged other young women to find out their family history, and to get genetic testing and early screening if they find something that concerns them.

In her case, the tumor was at stage two, meaning it hadn’t spread outside the breast and is likely to respond well to treatment.

“My cancer is not only treatable, it’s curable. If I hadn’t found it as early, it might not have been,” she said.

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Hopefully, others will show the same generosity next year, since additional local children will get sick and kids in other parts of the country are still waiting for life-saving organs, said Dr. Amy Feldman, medical director of the liver transplant program at Children’s Hospital Colorado.

In early September, the hospital asked healthy adults to consider donating a section of their livers.

Ten children were waiting at the time, and the University of Colorado Hospital hadn’t recovered as many livers from deceased donors as in previous years. Some of the children were at risk of becoming too sick to undergo the surgery if organs didn’t become available soon, meaning they would have been out of medical options.

“If we could have 10 people step forward and donate to these kids, that would be amazing,” Dr. Megan Adams, surgical director of pediatric living donor transplantation at Children’s, said at the time.

More than 100 people stepped forward.

Not all of them were healthy enough to donate or opted to continue as they learned more about the process, but six gave organs to children on the waiting list, and one more is already matched with a recipient and scheduled for surgery, Feldman said.

Nine donors are still finishing up the preparation process, so the three remaining children on the list will almost certainly get their transplants soon, she said.

“We have just been overwhelmed by the generosity of the Denver community,” she said.

University of Colorado Hospital committed to first offer livers from living donors to Children’s, Feldman said. Transplants for kids involve a smaller piece of the liver than those for adults, making the recovery easier for the donor, she said.

In adults, liver failure is typically caused by alcohol use, hepatitis viruses or obesity, though some people’s livers shut down because of excessive medication use or exposure to toxins. Most children who need transplants were born with malfunctioning livers, have diseases where the immune system attacks the organs, or have a metabolic condition that could be cured by a new liver.

Donors go through two days of medical testing to make sure their own health won’t be at risk during the surgery and recovery. All donors must be between 18 and 55, without obesity or major health problems. For more information, visit UCHealthLivingDonor.org.

If all nine of the waiting donors opt to go through with the surgery, some could give to children who aren’t currently on the waiting list but are expected to be sick enough to qualify early next year, Feldman said. If Coloradans continued to donate at this rate, the hospital could offer transplants to kids in states that don’t have pediatric liver donation programs that are set up for living donors, she said.

In a typical year, about 10% of the infants and 5% of the older children waiting for donated livers nationwide die without receiving a transplant, Feldman said. That means 30 to 40 preventable deaths each year, plus the damage to kids’ overall health from having liver failure while waiting for a transplant, she said.

“It’s realistic to imagine a world where no child dies because of a lack of a (liver) graft,” she said.

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One player went the wrong way, nearly scoring a touchdown for the other team. Another was skipping far from the main fray. There was an injury timeout when a boy tripped over his untied shoelaces.

It doesn’t look much like literacy instruction, but it’s a vital part of Scholars Unlimited’s approach to bringing kids who are struggling with reading up to grade level, said Jennie Merrigan, the program’s senior director of programs and learning, as she watched about half of the participants at Sheridan School District’s Alice Terry Elementary play during their “enrichment block” on a Monday in November.

After zipping around the school gym for about 45 minutes, that group would go work on a computer program breaking down reading concepts, while the group currently doing their lessons in the cafeteria would get to run. On other days, they might do an art project or dance.

“Kids think they’re just playing,” she said.

Denver-based Scholars Unlimited, previously called Summer Scholars, has been offering literacy help to kids who are behind on reading since the early 1990s. In 2000, it started offering daily after-school programming, and now operates in 10 schools in the Denver area.

Last year, 396 children attended the after-school program, and 475 attended the summer session. More than 80% of kids qualified for free or reduced-price lunches, and the vast majority are children of color.

The majority of participating children who weren’t reading at grade level at the start of the 2021-2022 academic year still weren’t at the end, but the number of children who were meeting grade-level expectations increased 17%, while an additional 5% were scoring above grade level. A larger percentage of participants showed improvement in specific skills, such as vocabulary.

While half of the group at Alice Terry Elementary was playing flag football, the others were working their way through computer programs that try to make concepts like alphabetical order and letter sounds into games. If a student isn’t getting a concept, a cartoon apple on their screen turns red, notifying the staff, Merrigan said.

“Our staff can say, ‘OK, this kid needs a little more support,'” she said.

Social and emotional learning has become an increasingly important part of the program, in addition to literacy skills, said Abenicio Rael, Scholars Unlimited’s president and CEO. The organization is looking for funding to hire social workers to bounce between programs and supplement whatever mental health help students are getting from their schools, he said.

While the group doesn’t have its own mental health professionals at this point, it does try to have one staff member for every 15 students, so kids feel the adults know them and are comfortable asking for help, Rael said. Though the youngest students were only toddlers when the pandemic hit, they’ve also been affected and need support, he said.

“They need that adult relationship and they need to feel safe around an adult,” he said.

Scholars Unlimited

Address: 3705 E. 40th Ave, Denver, CO 80205

In operation since: 1993

Number of employees: 13 full-time office staff, 50 on-site staff during program hours

Annual budget: About $2.5 million

Number of clients served: More than 870 children participated in after-school programs and summer sessions last year

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The two patients — aged 11 and 14 — arrived at the nationally renowned Eating Recovery Center’s Spruce Street clinic in Denver within a day of each other in early June. Both had histories of self-harm and suicidal ideation, in addition to their eating disorders. As their behavior escalated, lower-level staff raised concerns that they weren’t capable of caring for the patients.

But the center’s leaders kept them anyway, in violation of the facility’s own policies, according to an investigation by the Colorado Department of Public Health and Environment. Top providers believed the patients’ behavior was an attempt to get out of treatment. They addressed the mounting suicide attempts via “therapeutic ignoring” and increased check-ins. At one point, one of the patients was left in a hallway for 10 minutes amid one attempt, until other patients rushed over and called for help.

After a different attempt in mid-June, the facility’s leadership emailed staff and acknowledged how “scary” such behavior can be. Still, they wrote, it wasn’t possible for patients to “seriously hurt” themselves by putting objects around their necks. If the patients tried, they said, they would likely just lose consciousness.

“At this time, we are OK with that,” the officials wrote, according to one investigative report.

The subsequent state investigation revealed that the two patients attempted suicide more than 15 times in the days after that email was sent, with one patient making 10 attempts in a single day. Investigators issued five citations to the facility, repeatedly criticizing it for keeping the patients in spite of its own policies and for instructing staff to ignore the patients’ self-harm and stated intentions. The state found that the physician directing the patients’ care was not actually a certified psychiatrist and that senior Eating Recovery Center officials failed to provide oversight of the facility and the care it provided.

The state is now “closely monitoring” the facility, health department spokeswoman Gabi Johnston said. After the facility submitted a corrective plan, investigators reviewed the facility again in September and gave it a clean bill of health. Typically, facilities aren’t penalized financially if they correct problems that the state found.

Dr. Anne Marie O’Melia, the Eating Recovery Center’s chief medical officer, told The Denver Post that the two patients’ treatment “goes against all of our policies and training.” She said she and other senior leadership only became aware of the issues when the state health department launched its investigation in August. She said oversight has increased and that there have since been leadership changes at the Spruce Street facility.

“Patient treatment care and concerns are our absolute priority,” O’Melia said. “When we found out that there were practices that were different than the standard of care, then we immediately worked to retrain staff and to make sure that the ways that we communicate, the practice of managing all behaviors, including unsafe behaviors, is more closely monitored by additional oversight outside of just that one facility.”

The state health department declined to detail any ongoing investigations into the Eating Recovery Center. The agency’s investigation into the suicide attempts was sparked by two complaints, Johnston said. She declined to provide those complaints or detail them. The two patients were both discharged, she said. It’s not clear what happened to them afterward.

The investigation comes amid heightened scrutiny for the Denver-based Eating Recovery Center, one of the most prominent eating disorder treatment providers in the country. Ex-patients previously told The Post that the company used tactics that felt punitive, like threatening to use feeding tubes or refusing to allow patients to go outdoors, to ensure compliance. Spurred on by those complaints, lawmakers earlier this year considered a proposal to tighten regulations for the company and its peers in Colorado. They later dropped those plans because of cost concerns.

Vincent Atchity, the president and CEO of Mental Health Colorado, called the state health department’s findings “starkly scandalous” and said they bolstered advocates’ calls for tighter scrutiny of eating disorder facilities in Colorado.

The Eating Recovery Center is considered a national leader in eating disorder treatment. Owned by two private equity firms, it operates four clinics in Denver, according to its website, and its presence here has helped make the city a hub for eating disorder care. The facility’s leadership has detailed stories of critically ill patients who successfully addressed their eating disorders under the center’s care.

But other patients previously told The Post that the Eating Recovery Center’s methods had increased their own trauma and, for some, intensified suicidal ideation, depression or anxiety. Several said staffing was typically tight and turnover was common, a complaint supported by former staff members who spoke to The Post.

O’Melia said the company had improved its staffing and retention.

Patients with severe suicidal ideation or uncontrolled self-harming behavior aren’t supposed to be at the Eating Recover Center, a therapist who worked at the center for two years told The Post. She spoke on condition of anonymity because she feared backlash at her current job.

But it’s not always possible to tell who’s going to get worse, and management has an incentive to admit as many patients as possible, she said.

The therapist said she didn’t feel staff had the resources needed to keep patients safe. When a patient attempted suicide, it would fall on the therapists to explain what went wrong. There was often no satisfying answer to give parents, she said, since she wasn’t allowed to tell them there weren’t enough staff to watch their kids.

“We weren’t able to provide the exceptional care they boast about,” the therapist said of the facility’s leaders. “I felt like someone would have to die in our care for the higher-ups to take our concerns seriously.”

“Therapeutically ignore”

The two patients who repeatedly attempted suicide spent fewer than three weeks at the facility in June. Each had shown a pattern of suicidal ideation and an intent to take their own lives before they were admitted, the state investigation found. Both should’ve been transferred away from the Eating Recovery Center to higher levels of care, according to the facility’s internal policies.

Four days before two other patients discovered the 11-year-old attempting suicide in a hallway, the 14-year-old patient had been found in her room in a similar state. A physician told staff “to take no action and therapeutically ignore the patient,” according to the state health department’s investigation, because he believed the patients’ behavior was an attempt to get out of treatment. The two patients were repeatedly taken to nearby emergency departments and then returned to the facility.

But they were not always taken to the hospital: A nurse wrote that after one of the patients attempted suicide 10 times in one day, she requested the patient be sent to a nearby emergency room. But “the clinical team denied this suggestion and implemented therapeutic ignoring,” according to the state’s investigation.

Staff said they raised concerns to facility leadership about the patients’ self-harm and suicidal ideation, according to the state’s investigation. But more senior providers said the patients’ risk of dying from their eating disorders outweighed the risk of their death by suicide.

The patients’ care was ultimately overseen by the clinic’s medical director, who, together with another official, sent the email telling staff they were OK with patients strangling themselves into unconsciousness.

The medical director was listed on the facility’s website as a psychiatrist. But state investigators determined the official was a pediatrician, not a certified psychiatrist, and criticized the facility for failing “to ensure the medical director’s credentials and privileges accurately reflected his education and training.”

After the state asked questions about the medical director’s background, the facility quickly updated its website and removed “psychiatrist” from the provider’s title. A spokeswoman for the Eating Recovery Center said the listing on the website was a “mistake” that was corrected. O’Melia, the chief medical officer, said facility leadership was aware the provider was not a psychiatrist and that he was still practicing within the scope of his expertise and licensure.

The state reports do not name any of the providers interviewed or involved in patient care and instead refer to them by their titles. According to an archived version of the facility’s website, Michael Spaulding-Barclay was the medical director in May. He is no longer listed on the Eating Recovery Center’s website. O’Melia confirmed Spaulding-Barclay oversaw the two patients’ care and that he was no longer with the center. She declined to say if he left voluntarily or if he was terminated.

Attempts by The Post to contact Spaulding-Barclay last week were unsuccessful.

O’Melia said the Eating Recovery Center has since improved anonymous reporting systems, so lower-level staff can raise concerns about treatment protocols to senior officials outside of specific clinics.

“A very fine line”

It’s unclear whether “therapeutic ignoring” is widely used across the company’s facilities, which span several states. Senior Eating Recovery Center officials told state investigators that ignoring suicidal patients’ behavior “was not an accepted practice at the facility,” nor was allowing patients to asphyxiate themselves. Those patients, O’Melia said, should’ve been removed from the facility and sent to a different provider.

Em Troughton, a former patient at the Eating Recovery Center who previously described negative experiences at the Spruce Street facility, said that therapeutic ignoring was a common tactic for noncompliant patients, including those with self-harming or suicidal behaviors. Troughton, who uses they/them pronouns, said that while other patients received therapy, Troughton was left in a hallway alone because they struggled at mealtimes.

Therapeutic ignoring wasn’t a general policy, the former Eating Recovery Center therapist told The Post, but each provider had to use their own judgment about whether a patient was truly in despair or was trying to accomplish something else, like getting attention. Staff were more likely to ignore relatively mild self-harm, such as patients scratching themselves, to see if the behavior stopped, she said.

“It’s a very fine line, and it’s hard to say,” she said. “A lot of kids think, ‘This is my way out of treatment.'”

O’Melia said it was never OK for staff to ignore dangerous behaviors and that the facility had retrained its providers to ensure they were appropriately directing suicidal patients to higher levels of care.

But she said ignoring patients’ actions can be useful for low-level behavior, like name-calling or yelling. She said the company’s internal policies have been reviewed and revised to make clear that doesn’t apply to self-harm.

Suicidal behavior is common among people with eating disorders. A 2019 study estimated about 25% of patients with anorexia nervosa had at least one suicide attempt in their history, as did about 23% of those diagnosed with binge-eating disorder and 31% of those with bulimia nervosa.

Dr. Mindy Westlund Schreiner, an assistant professor and clinical psychologist at the University of Utah, said it’s not appropriate to use therapeutic ignoring as a way to address self-harm. It can be an option for milder behaviors, such as throwing tantrums, because the child eventually realizes the tantrum isn’t going to get them what they want, she said.

The danger is that children will almost always escalate their behavior before abandoning it — throwing a more violent temper tantrum when the parent ignores behavior they might have caved to before, for example — and when the child is injuring themselves, the risk they’ll do serious harm to themselves is too great, Westlund Schreiner said.

In addition, she said, if a child hurts themselves and sees that no one seems upset, that can reinforce any feelings they’re having that no one cares about them. The better response to self-harm, in addition to keeping the patient safe in the moment, is to help them work through what function the behavior is serving and come up with better ways to meet their needs, she said.

“There’s a time and place for (therapeutic ignoring), but the time and place is not when there could be harm to the patient,” she said.

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