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HIGH DESERT PULSE
Contents | HIGH DESERT PULSE
COVER STORY
6
WHAT ARE THEY THINKING? Scientists study the allure of risk for teens. COVER PHOTO BY ANDY TULLIS: A local snowboarder uses the roof of the Sunrise Lodge for a stunt, aiming his board toward a small remaining spot of slushy spring snow at Mount Bachelor.
6
FEATURES
13 22
WHAT’S CLEAR ABOUT VISION THERAPY? 20/20 is only a part of perfect eyesight.
27
ANTIOXIDANTS TO OUR RESCUE They’re the heroes in the fight against free radicals. But is their worth dependent upon their source?
30
THE LONG ROAD TO RECOVERY Bonnie Lamb’s story of the vital role of friends.
HYPER-HEALING A local clinic is on the leading edge of new uses for hyperbaric oxygen therapy.
13
DEPARTMENTS
11 18 21 26 38
SORTING IT OUT Running — and biking — in winter. GET READY: SKI THE CONE Because it’s there. HEALTHY DAY, OUR WAY Get through the holidays without going up a size.
22
BODY OF KNOWLEDGE Fact and fiction about festive feasting. LAUGHTER: THE BEST MEDICINE Emergency room humor, à la Darwin.
PHOTOS FROM TOP BY ROB KERR, DEAN GUERNSEY, PETE ERICKSON, ANDY TULLIS
HIGH DESERT PULSE • FALL / WINTER 2009
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Cover story | THE TEEN BRAIN
There’s science behind the teen brain BY BETSY Q. CLIFF PHOTOS BY ROB KERR
Some teens drive fast; others jump from bridges like the one at Farewell Bend Park. But why? Researchers across the country are beginning to find some answers.
Saunder Barteling, 18, launches his bike off the extension on a pyramid feature at Ponderosa Skate Park in Bend. He’s been coming to the park for four years. “It’s challenging and it’s kind of cool to learn new stuff” — which, he says, outweighs the risks.
“There’s a little bit of tug of war between the passionate responses and the long-range planning.” Dr. Jay Giedd, a psychiatrist at the National Institute of Mental Health
J
oey Adams had to go to the emergency room last summer. The 15-year-old sophomore at Mountain View High School was attempting a trick on his skateboard at Ponderosa Skate Park when he dislocated his kneecap and sprained several ligaments. “I just bailed when I landed wrong,” he said. He was off his board for nearly two months, but by mid-August, he was back at the park, hanging out with other skaters and BMX bikers, mostly teenage boys. One of those boys was Saunder Barteling, an 18-year-old who graduated from Bend High School in 2008. He’s been coming to the park for four years, he said, and has recently learned to spin 540 degrees off a jump. Barteling sees some risk to his chosen sport “if you do big jumps and crazy stuff,” he said. Still, the fun outweighs that risk. “It’s challenging and it’s kind of cool to learn new stuff.” He’s never been hurt badly, he said, though he has suffered his share of bumps and bruises. Adams, too, said skating can be risky “if you’re trying something that’s crazy that you can’t do.” Still, he said, he doesn’t worry about the risk. “I go balls to the wall. I’m not that cautious of a person, so I get hurt.” Skateboarding and BMX riding certainly aren’t the riskiest activities out there, nor is their appeal limited to teenagers. Still, that kind
HIGH DESERT PULSE • FALL / WINTER 2009
of thrill-seeking, sprinkled with a touch of danger, is a hallmark of adolescence. Whether it’s driving fast, jumping off bridges or sneaking out, the teen years are a time of pushing the boundaries. Most teens make it through with a few war stories and maybe a scar or two, but there can be serious consequences to some aspects of teenage behavior. Between ages 15 and 19, accidents, homicides and suicides are the three leading causes of death, accounting for more than three-quarters of all deaths. The teenage years are often when people first begin to try other potentially risky things: drinking alcohol, using drugs and having sex. That teens do things that can be dangerous or downright dumb is not new. For years, the older generation has shaken its head, and often a scolding finger, at the escapades of its progeny. Many a parent has commiserated with another, asking, “What were they thinking?” Recently, science has begun to find some answers. A small group of researchers, spread out across the country, is trying to figure out what is happening inside teenage brains. Using some of the latest technology, these scientists are looking at the neurological changes that occur in adolescence and how those changes may affect behavior. They are exploring why teens sometimes take seemingly unnecessary risks, why they sometimes attach so closely to peers and why they sometimes make decisions
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Cover story | THE TEEN BRAIN
THE BRAIN Parietal lobe
that adults see as irrational. One of their important recent discoveries is that the brain does not stop developing after childhood, as was previously thought. Instead, it grows in new ways with new capabilities well into adulthood. Today, many experts say the brain is not fully mature until age 25 or 30. “In the last 10 years or so, we’ve really started to accumulate dramatic amounts of information,” said Dr. Daniel Pine, a psychiatrist at the National Institute of Mental Health, who has led much of the work in adolescent brain development. “Overall, the findings are somewhat surprising in that the brain takes longer to mature than many people thought.” The teenage years, beginning with puberty, are a particularly dramatic period of growth. Both the cognitive and emotional parts of the brain undergo monumental changes that shape how teens mature into adults.
Growing and pruning To understand the teenage brain, it’s first important to understand a little bit about how the brain develops over a lifetime. When we talk about brain development, we’re often talking about how brain cells called neurons connect with one another, and how that changes over time. Humans have more than 100 billion neurons. Many of the things our brains can do — see a picture and know what it is, decide whether to wear a raincoat, reach for a book on a shelf, feel happy to see an old friend — are enabled by neurons and the connections between them.
Frontal lobe Occipital lobe Nucleus accumbens
Thalamus Temporal lobe
Amygdala Hippocampus Spinal cord
Cerebellum
Brain cells called neurons are responsible for relaying information. Myelination, the formation of a myelin sheath around the axon (the neuron’s transmitter), allows the cell to transmit information up to 100 times faster.
Neuron Axon
Myelin sheath Cell body
Dendrites Source: Society for Neuroscience
ANDY ZEIGERT
Neurons are odd-shaped cells, not at all like the square or circular things you may have studied in biology. They have a main cell body, which contains some of the same parts as other cells, but neurons have bushy heads and long tails. Through their heads, neurons receive information from other neurons, and through their tails, they send information out. In newborns and young children, these
neurons have not yet formed strong connections with other neurons. Instead, scientists often describe the neurons as branchy, with the tentacles of one neuron reaching in many different directions. This gives the brain great flexibility and the ability to learn many different things. Indeed, this is why learning a language is much easier as a young child. There are disadvantages to this type of brain structure, however, because it does not work as well as a brain with fewer, but more efficient, connections. “If you have a lot of connections, you are less specific,” said Beatriz Luna, an associate professor of psychiatry at the University of Pittsburgh School of Medicine. “You are less efficient at processing information, you are more prone to errors and you don’t have the quick reaction to situations.” Until about age 12, the number of connections between neurons increases, showing up as an increase in branches of brain cells. At the beginning of the teen years, the brain begins trimming back, decreasing the number of connections, but strengthening those that remain. Think of it as a system of roads. In childhood, the brain is like an area with many dirt roads, which allow travel to a lot of places but at a slow pace. Through time and development, some of these roads become paved, some may even become highways, while others are not used and become overgrown. Travel may be more limited but will be much more efficient. Similarly, little-used neural connections in the brain eventually fade and disappear, while those used often become highly efficient at conveying information. Often referred to as pruning and myelination, this paring back of some connections
while strengthening others is one of the unique features of adolescence, said Dr. Jay Giedd, a psychiatrist at the National Institute of Mental Health who has led studies looking at the structure of adolescent brains. “It’s a time when the brain is specializing,” said Giedd. “The connections we use a lot get stronger and faster. It’s an amazing time for learning.” Adolescence is not the only time that connections are strengthened and others are pruned. It happens before adolescence, particularly in areas associated with the senses, and after adolescence, to a much smaller extent. The ability for connections to strengthen or change, “never goes away,” said Giedd, “but it’s particularly plastic or changeable” during the teen years.
High emotion, less reason Not all areas of the brain mature at the same time, and it’s the particular areas of the brain developing in adolescence that may result
in those uniquely teen behaviors. Hormones associated with puberty begin to stimulate the emotional control centers of the brain, including the amygdala, one of the primary areas involved in fear and processing of rewards. These areas mature earlier than cognitive areas in the brain that help us understand emotions and keep them in check. This imbalance in maturity between the emotional and cognitive areas of the brain is one of the key features of adolescence and is critical to understanding how teens make decisions. The emotional centers of the brain “are being awakened before the frontal cortex (a cognitive area) is fully mature,” said Deborah Yurgelun-Todd, a professor of psychiatry at The Brain Institute, part of the University of Utah. “What that implies is that you have these more impulsive reactive behaviors in the absence of the inhibitory capacity to think things through.” Yurgelun-Todd was among the first to find differences in how teens and adults process emotional events. She came upon the find-
CONNECTIONS DECLINE AND REFINE IN ADOLESCENCE The number of connections between brain cells peaks during childhood and declines during the teen years, allowing those connections that survive to grow stronger and more efficient. The diagram below shows gray matter volumes — which reflect the number of brain cell connections — declining in a front-to-back pattern between ages 5 and 20. Scientists believe areas of the brain mature at different rates, with the front of the brain, which controls rational thought and decision-making, among the last to develop.
5 years
20 years
Gray matter volume MORE
LESS Source: National Institute of Mental Health ANDY ZEIGERT
Cover story | THE TEEN BRAIN
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ing, she said, by accident. She and her team hooked both adults and teens to a machine that can measure and compare activity in different areas of the brain. They were looking at what parts of the brain were activated when people saw fearful faces. They guessed, said Yurgelun-Todd, that “your ability to respond to fearful affect would be hard-wired” because the ability to react to fear, from an evolutionary perspective, is key to survival. The researchers expected that, in the scans, they would see the same pattern of activity in both adolescents and adults. What they found was very different. Both adolescents and adults showed activation in the emotional and cognitive areas of the brain. But, in adolescents, the emotional side was proportionally much higher than in adults. Yurgelun-Todd hypothesized that the emotional parts of the brain showed a higher ratio of activation in adolescents because of an immaturity in the thinking part of the brain. The frontal cortex, she said, “is still going through development and not fully engaged in the job of inhibiting.” In adults, who have a mature frontal cortex, the brain can tone down the response, reminding a person that it is just a study, for example, and not a real-life threat. Adolescents’ brains are not quite as good at this task yet, resulting in a higher emotional response. “The analogy that people use,” said Pine, “is it’s a little bit like starting an engine without a skilled driver.” “Those parts of the brain that are involved in rational thought do not mature as quickly,” Pine said, “giving more salience to the emotional things on one hand, and doing that in a young person who is not fully equipped to handle those emotional things.”
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Risks and rewards Why teens do riskier things can be a hard concept to address in a laboratory. On paper-and-pencil tests, the easiest thing to use in research, teens often perform just as well as adults, said Giedd. If you ask a teen if it’s dangerous to get in a car with a drunk driver, say, or jump off a bridge, “they have a very good intellectual understanding of the risks.” That’s why a teen can tell you that driving too fast is dangerous just hours before getting a speeding ticket, or that trying a
SUBMITTED PHOTO
Dr. Jay Giedd, a psychiatrist at the National Institute of Mental Health whose studies have examined adolescent brains, says teens usually have a good idea of what constitutes risky behavior. “It’s when they are with their peers and in emotional settings that the behavior is different.”
skateboarding trick that he knows is too hard, with no helmet or pads, is a bad idea. But will he still do it? Perhaps. “It’s when they are with their peers and in emotional settings that the behavior is different,” Giedd said. In these settings, emotion overrides the more rational part of the brain. “There’s a little bit of tug of war between the passionate responses and the long-range planning.” In many instances, the emotional side, now heavily turned on and maturing faster than the rational part of the brain, wins out. To try to explain what exactly is going on, Pine engaged 16 adolescents and 14 adults in an experiment that sought to replicate some of the emotion involved in risky decisions. To do it, he used the chance to win money in a game. The participants saw a pair of wheels, with various amounts of money that could be won on each wheel. In one example, one wheel had a 10 percent chance of winning $4 and a 90 percent chance of winning nothing, and the second wheel had a 90 percent chance of winning 50 cents and a 10 percent chance of winning nothing. The participants got to pick which wheel they wanted to spin to try to win the cash. With real money involved and the prospect Continued on Page 36
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HIGH DESERT PULSE • FALL / WINTER 2009
Sorting it out | WINTER WORKOUTS “Probably the most important change for people is the mental change.”
Yes, it’s cold But with the right clothes and venue, outside is still a great place to be BY MARKIAN HAWRYLUK
A
bout the time that people pull their sweaters out of storage and put away their T-shirts, there’s another seasonal milestone that takes place. The running shoes get tossed to the back of the closet and the bike gets hung from the garage ceiling, while skis and snowboards take a more prominent position. But there’s no reason to relegate your running and cycling programs to snowbird status. With a little preparation, you can run and bike almost year-round in Central Oregon. “Probably the most important change for people is the mental change,” said Kyle Will, owner of Will Race Training Studio in Bend. “Just because it’s winter doesn’t mean you have to go inside.” Yes, it’s darker. Sure, it’s colder. And there’s a chance it could be slippery. But there’s gear and apparel to deal with each of those problems. “One nice thing about Central Oregon is we don’t get a ton of snow in town, so for people who like to bike or run, you can still do that a good portion of the winter,” Will says. “You just have to dress appropriately.”
Dressed for success One of the keys to exercising outdoors in the winter is to recognize that you don’t need as much insulation as you might think because of the body heat you’ll be generating. “I’ve experienced in the last few years that there are very few days that you have to wear something more than a really good pair of tights, and on the top, wear a base layer and a shell and some sort of good wicking material like a fleece,” said David
HIGH DESERT PULSE • FALL / WINTER 2009
Kyle Will, Will Race Training Studio Uri, an avid runner and cyclist in Bend. “Then a good pair of thin gloves and a thin hat, knowing how much heat exudes from your hands and the top of your head.” A lightweight shell is probably the crucial garment. Not only will it help retain some heat, it will protect you from the ravages of wind chill. When you sweat, the wind can cool your body so quickly it can lead to hypothermia, or at least a bone-chilling experience. If you get too warm, you can always shed a layer, tying the jacket around your waist, or with a very thin shell, stuffing it into a pocket. Avoid cotton, which can become cold and wet, and wear a synthetic or merino wool base layer that will wick moisture away from your body. Will also recommends layering with gloves, matching a thin liner glove with a wind-proof shell glove. If your hands start to get too hot, you can always remove the shell.
Put your best foot forward Feet need similar protection. While summertime may call for a lighter, more-breathable shoe, in the winter many runners will look for a waterproof shoe, possibly with a waterproof Gore-Tex lining. Many trail running shoes offer greater protection for winter running than many traditional running shoes. Wear a thicker sock, and, again, avoid cotton. Will suggests adding gaiters — which keep snow from soaking into the top of your shoe — and a traction device, such as Yaktrax, for slippery conditions.
Step into the light The other major hurdle for runners and cyclists is the lack of daylight before or after work. Some people shift to running during their lunch hour, maximizing warmth and daylight. New lightweight LED headlamps, which crank out an amazing amount of light, can provide a change of pace that keeps running interesting. “If people haven’t tried it, it’s a new, fun experiOutdoor exercise enthusiast David Uri. PHOTOS BY ANDY TULLIS, PHOTO ILLUSTRATION BY ANDERS RAMBERG
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Sorting it out | WINTER WORKOUTS ence running with a headlamp,” Uri said. Make sure to wear reflective clothing or shoes so cars can see you in the dark as well. And if it’s hard to find the gumption to get up for an early morning run in the dark, find some company. “If you have a hard time motivating yourself, and you typically work out alone, find a partner or find a group,” Will says. “That helps to hold you accountable and keeps you going.”
The warm side of town If your usual running trails are inaccessible due to snow, head east. The eastern side of Bend is at a lower elevation and often gets less snow than the west side. And here’s a secret from experienced runners: the trails of the Badlands area about 12 miles east of Bend. “If you have the time, it’s a great location, and it seems there’s a little banana belt out there,” Will said. “Even, it’s crazy, the east side of town compared to the west side of town, you can still get on dirt trails that often aren’t snow-covered, when on the west side they are.” The east side is also your best bet for bike riding during the winter. Even when there’s no snow in town, the materials used on roads to provide additional traction can collect in bike lanes, making for a rough ride. If you can switch to a mountain bike — especially one with studded tires — you can extend the riding season. “Riding during the winter is definitely doable in Central Oregon,” said Tate Metcalf, manager of the Sisters Athletic Club and an avid cyclist. “It’s really just a matter of layering up.”
The speed of cycling means riders are facing a greater threat of wind chill, making a good shell and insulation even more important. Feet and hands tend to freeze most, so riders may want to wear neoprene booties for extra insulation and experiment with combinations of liner, insulating and shell gloves. A balaclava, which covers the head and neck, can provide extra protection.
Cross-train Many cyclists head indoors during the winter, putting their bike on a trainer that allows for pedaling the wheels while the bike is stationary. If you can’t make outdoor riding work for you, Metcalf suggests trying some of the classic winter sports, such as cross-country skiing or snowshoeing. “While we’re not putting miles on the bike, cross-training is a great way to stay in shape,” he said. “There is some carryover from a muscular standpoint, but probably more importantly from a physiological standpoint, working the engine.” There are even smaller snowshoes made specifically for running in the snow. All the cardio work from snowshoeing or cycling will mean you’re just that much further ahead when you resume running or cycling in the springtime. It really doesn’t matter what people do, Will said, as long as they do something. “The biggest mistake they make is thinking they can’t go outside. And so some people talk themselves out of doing anything in the wintertime.” •
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Vision therapy |
A CONTROVERSIAL FIELD
Kenneth Stowell participates in depth perception vision therapy at Elemental Eyecare in Bend. Stowell travels 500 miles round trip for sessions with optometrist Gabby Marshall.
Do you see what I see? Kenneth Stowell thought so until vision therapy changed his perspective BY MARKIAN HAWRYLUK PHOTOS BY DEAN GUERNSEY
K
enneth Stowell has perfect 20/20 vision, maybe better. At his regular eye appointments, the 37-year-old electronics technician could always read every single letter on the eye chart. But what his eye doctors never knew was that Stowell read every sign the way he read the eye chart: one letter at a time. He recalls asking a friend one day, “When you look at that Home Depot sign, do you have to look at each letter to make it say Home Depot?” “No, why would you do that?” the friend replied. “You can’t read that? Why are you driving?” It was a fair question. Stowell admits to catching only a few letters of roadside signs
HIGH DESERT PULSE • FALL / WINTER 2009
before having to redirect his vision to the road. He would have to focus on the “6” and then the “0” to read 60 on his speedometer. Cars would seem to dart in at him from the blurry periphery, particularly in big cities. “How do people do this?” he recalls thinking. “They must have nerves of steel.” It was only after 20 years of white-knuckle driving that Stowell discovered he didn’t see the world the same way most people did. His eyes did not work together. He had no stereovision, no depth perception and, for most of his life, no clue that anything was wrong. When his vision problems worsened, resulting in balance problems and room spins, Stowell sought help. A half-dozen visits from his home in the Tri-Cities area of Washington to specialists in Seattle uncovered no tumor, no injury, nor any other apparent physical explana-
tion for his symptoms. As his peripheral vision began to degrade, his optometrist referred him to Dr. Oli Traustason, an ophthalmologist with the Eye Surgery Institute in Redmond. Traustason and optometrist Ronald Guiley quickly diagnosed Stowell’s condition as ocular motor dysfunction. The muscles controlling his eye movements weren’t working correctly. They referred Stowell to Bend optometrist Gabby Marshall, one of the few eye doctors in Oregon who practices vision therapy. Marshall conducted a simple exercise with Stowell. She took a string with several colored beads on it, tied off one end, then brought the other end up to his nose. When most people focus on the bead, they see two strings crossing at the point of the bead. It’s an optical illusion based on how images from both eyes are fused by the brain at close range. Stowell saw
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Vision therapy | A CONTROVERSIAL FIELD
“If you don’t have (stereovision), you can’t imagine it. If you do have it, you can’t imagine not having it. Because if you close one eye, your brain is still going to fill in the sense of stereo depth from all the experiences in your life.” Sue Barry, author of “Fixing My Gaze” SUBMITTED PHOTO
only one string. It was proof he was using only one eye to see. His brain was ignoring the image from the second eye.
Gaining perspective Both of his eyes were optically perfect, and individually each worked as it should. But for some reason, Stowell had never learned to use both eyes together. His brain adapted, developing workarounds to make up for the lack of depth perception and filling in the gaps where vision failed him. Marshall told him that a program of vision therapy, a sort of physical therapy for the eyes, could help him restore binocular vision. He was skeptical. Wouldn’t surgery be more effective? Could a bunch of exercises really change the way his eyes worked? He finally decided there would be only one way to find out if it worked. He’d have to try it. Every other week beginning in May, he made the 500-mile round trip from the Tri-Cities to Bend for a 90-minute therapy session with Marshall. Marshall devised a variety of exercises for him. She hung a ball on a string from the ceiling and let the ball sway back and forth while Stowell tried to keep his focus on one of the letters written on the ball. In another exercise, he had to focus on a chart, switching his vision from near to far and practicing to focus instantly. Then one day in August on his drive back home, he stopped at the Bi-Mart in Madras. Emerging from the store, he could not find his car. There was a car that looked sort of similar, the same color and in the same spot. It was only after reading the license plate that he realized he was seeing his car for the first time in three dimensions. “It looked different,” he said. “It didn’t look flat.” During the entire ride home, the scenery jumped out at Stowell. “It looked like everything was coming toward me. I could tell that there was just more than ‘flat.’ It kind of protruded out,” he said. “It was nauseating.” Stowell was finally learning what it meant to see a 3-D world. It was akin to sitting in a theater watching a movie on the flat screen, then midway through realizing that everybody else is wearing 3-D glasses. But how can people go their entire lives without realizing they don’t see the way everybody else does? One reason is that most screening for eye problems relies primarily on the standard eye chart. Unless an eye doctor conducts more in-depth tests, many people will never know they have a problem. “There’s more to vision than just seeing 20/20,” Marshall said. “We’re looking at both visual efficiency — which is your focusing, your tracking, moving your eyes as a team — and your fusion — which is making things single, using your depth perception. Those are visual
Page 14
efficiency skills, which are 100 percent trainable with vision therapy.” Many adults who have difficulty with stereovision had corrected or uncorrected problems such as amblyopia — the inability of one eye to see details — or strabismus — a misalignment of the eyes. Stowell said his mother told him that when he was little, doctors did notice that one of his eyes had trouble tracking words on a page. But she was told he’d grow out of it. His visual difficulties meant he was never very good at sports and struggled with reading. “It seemed like I had to read things a couple of times, because I had to put the letters together in the book and say, ‘OK, that word is “rendezvous,”’ then go to the next word,” he said. “I did it fairly quickly because I could scan it, but it was fatiguing, very, very fatiguing. I got good grades but I had to work at it.”
Discovering depth It’s almost a mirror-image of the experiences of Sue Barry, a professor of neurobiology at Mount Holyoke College in Massachusetts. Barry had her misaligned eyes corrected with three surgeries by age 7. But by that time, her brain had learned to pay attention to the visual input from only one eye at time. It wasn’t till she was 50 that a course of vision therapy finally allowed her to see with stereovision. “If you don’t have it, you can’t imagine it. If you do have it, you can’t imagine not having it,” she said. “Because if you close one eye, your brain is still going to fill in the sense of stereo depth from all the experiences in your life.” Barry explains the difference this way. When she looked at a framed window or mirror, she saw everything in the same plane as the frame. “I knew that the trees out there were not in the plane of the window, but that was something I knew cognitively. I didn’t actually see it. I inferred it.” She still remembers the first time she looked in the mirror and saw her reflection not in the plane of the mirror but several feet behind. “I finally understood what Lewis Carroll meant in ‘Through the Looking Glass,’ that you could imagine yourself through the mirror.” Barry was profiled by the New Yorker magazine in 2006 in an article titled “Stereo Sue.” She was overwhelmed by the flurry of e-mails and letters from people who realized for the first time that they, too, had no sense of 3-D vision or who had experienced the same type of childhood. When Barry struggled in school, her mother worked tirelessly to teach her to read and help her to keep up with her studies. Barry went on to write “Fixing My Gaze,” documenting both her journey to stereovision and much of the science supporting vision
HIGH DESERT PULSE • FALL / WINTER 2009
therapy. Not only was she one of the few adults to develop that skill late in life, she had the scientific background that is lending credibility to the vision therapy field. “The whole world looks just magnificent. I’ve never seen it before,” she said. “A single tree with all its layers and layers of branches and leaves is just magnificent to look at.”
Turf wars The notion that these visual skills can be taught late in life is still controversial. Many doctors cling to the notion of a critical period of development in childhood. If you don’t learn how to use your eyes together in infancy, they argue, it’s simply too late. It’s one of the reasons that vision therapy has had trouble gaining credibility within the broader medical community. Now researchers are learning the brain has an incredible ability to rebuild itself, a concept referred to as plasticity, even late in life. Research done with patients who have sustained traumatic brain injury or stroke shows their brains can adapt, remodel or create new pathways. “We’ve been selling our brains short for a long time,” Barry said. “Our brains are far more plastic and flexible than we thought, and that means that there’s a lot greater chance of recovery and rehabilitation than people thought.” Still, vision therapy has been caught in a turf war between eye care professionals, pitting ophthalmologists and their medical degrees against optometrists and their vision therapy success stories. Many ophthalmologists, particularly those who operate to fix misaligned eyes, have been reluctant to
accept vision therapy as a legitimate way to treat vision problems. “There seems to be a long-standing hostility between the optometrists and the ophthalmologists,” Barry said. “They take care of the same patients. So I think some of it is professional hostility and rivalry that gets in the way.” In August, organizations representing ophthalmologists and pediatricians published a statement advising that vision therapy was not a treatment for learning disabilities. Vision therapy proponents countered that the statement ignored the experiences of people like Barry whose vision problems were misdiagnosed as learning disabilities in their childhood. Other doctors associate vision therapy with the now-discredited eye exercises that have been promoted as a way to fix vision without corrective lenses. Barry is now trying to bridge the gap between eye professionals, hoping to help thousands of children and adults who could benefit from vision therapy. “It seems to me rather obvious that if you take a person and realign their eyes in their sockets with surgery, which may bring the eyes into closer position for binocular vision, you’re also going to have to treat the patients with some therapy,” she said. “If your legs were misaligned and you had them straightened, you’d go for physical therapy to relearn how to walk. For someone who had eye surgery to realign the eye, you have to relearn how to see.”
Providing clarity Vision therapy has also suffered from a lack of formal training programs and a dearth of clinical research. Optometry groups are now beginning to address both of those
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WHO’S A CANDIDATE FOR VISION THERAPY? For some, vision problems can be fixed with corrective lenses, while others could benefit from vision therapy. The following symptoms may indicate the need for a comprehensive vision exam. Your eye doctor can help you determine if vision therapy may be worthwhile for you. Physical signs or symptoms • Frequent headaches or eye strain • Blurring of distance or near vision, particularly after reading or other close work • Avoidance of visually demanding tasks • Poor judgment of depth • Turning of an eye in or out, up or down • Tendency to cover or close one eye, or favor the vision in one eye • Double vision • Poor hand-eye coordination • Difficulty following a moving target • Dizziness or motion sickness Performance problems • Poor reading comprehension • Difficulty copying from one place to another • Loss of place, repetition and/or omission of words while reading • Difficulty changing focus from distance to near and back • Poor posture when reading or writing • Poor handwriting • Can respond orally but can’t get the same information down on paper • Letter and word reversals • Difficulty judging sizes and shapes Source: College of Optometrists in Vision Development
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shortcomings. New training programs and certification tests have been established, and research is beginning to provide the proof that vision therapy works. Last year, the results of the Convergence Insufficiency Treatment Trial were published in the Archives of Ophthalmology. The study included 221 children ages 9 to 17 whose eyes did not turn inward, or converge, when trying to focus on a nearby object. It’s a skill that’s critical to reading a book and is estimated to affect between 5 and 20 percent of children to some degree. Nearly 75 percent of children who underwent office-based vision therapy as part of the study achieved normal vision or had significantly fewer vision problems in only 12 weeks. That compared with only 43 percent of patients doing vision therapy exercises at home, 35 percent in the placebo group, and 33 percent assigned pencil push-ups, which had been the standard therapy. With pencil push-ups, the child tries to focus on a letter on a pencil as it moves closer to his or her nose. The goal is to keep a single, clear image of the letter until it touches the nose. “Three different approaches were being used across the country and no one knew for certain which worked best,” says Dr. Brian Mohney, a Mayo Clinic ophthalmologist and lead investigator in the study. “Now that’s settled. And only 12 weeks of treatment were necessary to demonstrate improvement.” The difference for children can be profound, and parents often express exasperation that children are diagnosed with learning disabilities or attention deficit disorder well before vision problems are considered.
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“These are kids who would rather do anything but sit down and do their work,” said Dr. Janice Wensveen, an optometry professor at the University of Houston. “And I think that’s why kids, especially who have convergence insufficiency, are sometimes mislabeled as having attention deficit hyperactivity disorder, because they just don’t want to sit down.”
Changing behavior Lori Hester, of Bend, saw a profound change in the behavior of her 7-year-old son, Jeremy, after he completed vision therapy. Jeremy seemed to be shy, unwilling to join in activities with other kids. His mother just figured it was because he was one of the youngest kids in his class. But when a vision screening uncovered a vision problem, Hester learned just how much vision affected behavior. “He was just in a little shell,” she said. “I just didn’t think vision was tied into it as much.” Jeremy was diagnosed with amblyopia in kindergarten. Tests showed his right eye had 20/30 vision, but his left was 20/200. Hester later found out he had no depth perception, either. Suddenly it explained Jeremy’s apparent clumsiness. He couldn’t walk on the edge of a curb without falling. He would stumble when he walked. When his parents called him to the window to see a deer or rabbit in the yard, he would invariably bump his head into the glass. It explained why Jeremy always held books or handheld video games on the right side of his body, or why he seemed to
HIGH DESERT PULSE • FALL / WINTER 2009
Since Jeremy Hester began his vision therapy sessions with Bend optometrist Gabby Marshall, pictured, his behavior has changed dramatically; the 7-year-old Bend boy who once struggled in school is now reading faster than ever. “He’s a whole different kid,” says his mother, Lori. “He’s not the kid that stands back and waits to be invited, who just stands on the side and watches.” have trouble coloring within the lines. “I kept calling my friends saying, ‘How is your son doing? How is your daughter doing?’ Everybody kept saying boys are slower at this,” she recalls. “There were so many excuses. I could write it off as so many things.” Marshall warned Hester that Jeremy’s school performance would likely get worse before it got better when he started vision therapy in January, midway through the first grade. He would have to unlearn his previous ways of seeing, and then relearn to see with both eyes. Sure enough, Jeremy started to struggle more in school. “Everything he knew as normal was gone,” Hester said. “His reading time slowed. He was really fidgety, he wouldn’t sit still. You could tell he was just very insecure.” By his graduation from vision therapy in August, however, Jeremy has more than rebounded. He reads faster than ever and is breezing through his second-grade homework this fall. He had always wanted to play baseball, but it takes a tremendous amount of visual acuity and depth perception to hit a small ball with a thin bat. “I was so excited that he did well,” Hester said. “It’s amazing. He’s a whole different kid. He’s not the kid that stands back and waits to be invited, who just stands on the side and watches.” Marshall said such success stories are a regular occurrence with kids in vision therapy. “We rarely have a month where one of us isn’t touched, crying because some kid had a breakthrough,” she said, such as when a patient who came in for her appointment last spring announcing she’d improved enough to avoid summer school. “What great news for a second-grader to be able to say, ‘I don’t have to go to summer school!’” Marshall said. For an adult like Stowell, progress comes at a slower pace. He has had to relearn to do many tasks he once took for granted, such as walking down the stairs or soldering electronics at his job. Driving a car and riding a motorcycle are much different experiences now that he sees so much more than just what’s immediately in front of him. He knows he’s got a long way to go, and frankly, he’s not even sure how much he can improve or what the end goal will be. He’s never seen what most people see, so he has no idea how it looks. “I want to know what’s normal,” he said. “But I won’t know when I’ll get there until I’m there.” •
HIGH DESERT PULSE • FALL / WINTER 2009
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Get ready |
SKI THE CONE
Break into the backcountry BY BETSY Q. CLIFF PHOTOS BY ANDY TULLIS
Y
ou’ve certainly seen it from afar. You may even have come close, peering up at the Cinder Cone from Mt. Bachelor’s West Village parking lot. But climb it? Yes you can. And the reward can be a silky, powder-perfect run. The Cinder Cone, a hill that juts out of the north side of the mountain, isn’t technically backcountry skiing because Mt. Bachelor’s ski patrol controls avalanches in the area and will pull you from the hill if you need it during the resort’s normal business hours. Still, the Cone can be a place to get a taste of the backcountry and see if it’s something you want to explore. “The Cinder Cone is a perfect introduction to the backcountry,” said Carlos Cummings, who works with Timberline Mountain Guides, a backcountry guiding service. “You are basically on the slopes of Mount Bachelor, and it is really quick and easy.” Depending on which way you go down, the run can be moderately difficult, particularly because the snow is not maintained or
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groomed. Like most backcountry experiences, it’s best for people who are experienced on their skis or snowboards. Going into the backcountry, or skiing the Cone, is a whole different experience from cruising down maintained runs. It takes some training and basic safety instruction. And, it takes more work. There’s no chairlift whisking you to the top of the run; you have to haul yourself and all the gear you want with you. Those who do it regularly, though, revel in the ability to ski anywhere, anytime and find pockets of perfect, pristine snow. Here’s a guide to getting ready to ski the Cone, and maybe even setting yourself up to go to other areas that chairlifts dare not reach.
November: Training If you’re not in decent shape, you’re going to have to get there. Climbing up and skiing down will definitely get your heart pumping. “It does require a higher level of fitness than lift-service skiing,” said Gabe Chladek, president of Three Sisters Backcountry in Sisters, a guide service and avalanche education company. You’ll need to be able to trudge uphill through
deep snow for a good distance and still have the leg strength to ski down. “Mostly it’s building up your stamina and your strength,” said Dan McGarigle, owner of Pine Mountain Sports in Bend. He said that for most people, the fitness level is doable. “You don’t have to be a world-class athlete to go backcountry skiing.” You can hit the gym, but one of the best ways to get in shape to climb is to, well, climb. “Most folks train by hiking with a pack on,” said Cummings. Try to do something “to get some elevation under you.” Hiking up nearby buttes and hills before the snow comes is a great way to get in shape. Hike Pilot Butte, Tumalo Mountain or anything that goes up as practice. Running, biking, swimming or anything that makes your heart work will also help.
December: Safety As the ski season gets under way, those who are thinking about going into the backcountry should get training in the safety precautions they will need to take. Being able to ski isn’t enough prepara-
HIGH DESERT PULSE • FALL / WINTER 2009
Skiing the Cinder Cone at Bachelor is a whole different experience from cruising down maintained runs. It’s “a perfect introduction to the backcountry,” says Carlos Cummings of Timberline Mountain Guides.
for the 6 essentials winter backcountry: 1. Avalanche gear: The three basics are a probe, a transceiver and a shovel. An avalanche course can teach you how to use them. Take them every time you go into the backcountry.
1
2. Water and snack: Even if it’s cold, you’ll perspire and will need to stay hydrated.
3. Ski set-up: There are variations here. You can go with telemarking gear, a snowboard and snowshoes, a split snowboard or alpine touring equipment. The key is to make sure everything fits and is easy for you to 3 hike with.
4. Clothing: As with any outdoor winter sport, conditions can change quickly. Watch the weather and wear layers. You will likely get hot on the way up and then want an additional layer once you reach the top.
5. Climbing skins: These are preferable but not necessary for the Cone. But you’ll likely want them if you decide to go beyond the Cone on longer backcountry trips.
6. Backpack: You’ll want it for the rest of your stuff, as well for stashing layers of clothing.
tion for going into the backcountry, said McGarigle. You also need to learn about snow and weather conditions, and what to do in case of an emergency. Experts stress the importance of learning the basics about avalanche safety, and recommend a course certified by the American Institute for Avalanche Research and Education. In Central Oregon, the only certified provider is Three Sisters Backcountry. People who just want to ski the Cone may be all right without the course, said Chladek, but “you really need to have the training to go beyond the Cone because no one is managing snow pack or will bail you out.” The course, which runs for three days, eight hours each day, is first offered on Dec. 18 this year. Check the organization’s Web site (www.oravalanche.org) for details. 5 Even if you don’t intend to go beyond the Cone, it’s a good idea to learn some basic safety skills. People hiking should be comfortable with how to use the three basics of avalanche gear: a
probe, a transceiver and a shovel. And, experts say, you should never go solo. “Don’t go in the backcountry alone, not ever,” said McGarigle. “You are really opening up issues of getting hurt and not having people to help you.”
January: Gear up After you’ve trained and learned about safety precautions, you’ll need to decide how you’re going to get up and down the Cone. If you ski or board regularly, you won’t need any additional equipment to ski the Cone. You can hike up in ski boots or hiking boots, carrying your gear on your back. Still, you might be jealous of those with skins on, who will have a much easier time getting to the top. Especially if you intend to go beyond the Cone, you will want to invest in specific backcountry gear, including skins, which attach to gear and allow you to make your way uphill without falling back. If you are a downhiller, you may also consider touring bindings. “Skinning uphill is by far the preferred method,” said Cummings. He said that before
Gear courtesy of Mountain Supply, Bend
HIGH DESERT PULSE • FALL / WINTER 2009
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The front side of the Cinder Cone, facing the parking lot, is the safest side to ski, experts at Bachelor say.
Get ready | SKI THE CONE
he got skins, he could make one backcountry run in a day. These days, he said, “I can get many runs in and not feel exhausted.”
Climbing day: Get ready and go You’re in good shape, you know about avalanches and you have organized your gear. It’s time to go. Many people climb the Cone in the morning, before the ski patrol has a chance to check the area for avalanche danger, said Curtis Norsen, ski patrol manager at Mt. Bachelor. If you do that, you’ll need to check
the conditions yourself. “If we’re opening at 9 a.m., we’re not going to be there at 5 a.m., we’re going to get up there at 8:15. That gives us plenty of time to check it out,” he said. The problem is “most people who ski the Cone get up there long before that.” Still, if you ski the front of the Cone — the side facing the parking lot — the overall danger is low. “It would take a pretty abnormal event for us to see activity on the front side,” said Norsen. “It just gets skied out so it never gets a chance to build up any funny layers or anything.”
Norsen said they much prefer that people ski the front side rather than going down the side that faces north. There are several routes to the top. You need a lift ticket for the easiest route, but not if you take the trail that begins on the west side of the parking lot. Often, particularly when fresh snow has fallen, there are other groups going up the hill. It’s often easier to follow them than to blaze your own trail. Once at the top, take a breath, relish your accomplishment, then treat yourself to a great run down. •
Healthy day | HOLIDAY EATING
Whoa, slow and go foods Putting the brakes on holiday weight gain
Nutritionists have come up with the terms “whoa,” “slow” and “go” to help delineate which foods you should limit and which you should eat more of.
BY MARKIAN HAWRYLUK
Whoa! 4 ounces turkey, dark meat
T
he holidays can be an exercise in frustration for people trying to eat a healthy diet and watch their weight. For better or for worse, we’ve come to celebrate Thanksgiving and Christmas with caloric extravagance that often forces people to choose between giving in to temptation or feeling as if they’re depriving themselves. For those looking for a healthy day instead, there is a middle ground: moderate your intake and increase your activity.
1. Eat breakfast and lunch: Despite the temptation to save the calories by skipping meals, nutrition experts recommend eating healthy meals of lean protein, whole grain, fruits and vegetables. Meals can be small, but they will keep you from showing up at the dinner table ravenous.
2. Get out, get active: A little exercise before the big feast will burn extra calories and kick-start your metabolism for the rest of the day. Organize a game of touch football with the family or take a group bike ride. If it’s a regular workout day for you, don’t skip it because you’re busy. If your gym is closed for the holidays, tackle your fitness outdoors. 3. Evening meal: Think about an eating strategy before you hit the table. Identify your favorite foods and take small portions of those. It’s not like you won’t be eating the leftovers all week. Choose lean meat (white over dark meat, dump the skin) and whole grains, and watch your toppings. Sweet potatoes, for example, are a great choice if you leave off the high-fat, high-calorie toppings. Drink water or a diet soda. Liquid calories can add up quickly! If you’re a guest at someone’s house, make a healthy side dish you can pair with turkey. If you’d like a piece of pumpkin pie, limit the amount of crust you eat. 4. Take a walk: Resist the urge to plop down on the couch after pushing away from the table. Take the group for a walk; bundle up or keep up a brisk pace to stay warm in crisp weather. If you have guests in town, suggest a walk to the top of Pilot Butte for a bird’s-eye view of the city or stroll by the river under the lights of The Old Mill District. Central Oregon’s wonderful trails are just another reason to be thankful! • HIGH DESERT PULSE • FALL / WINTER 2009
with skin: 248 calories, 12 grams of fat, 4 grams of saturated fat 1 cup mashed potatoes with butter and milk: 237 calories, 9 grams of fat, 4 grams of saturated fat 1 cup cornbread stuffing: 358 calories, 18 grams of fat, 4 grams of saturated fat ¾ cup glazed sweet potatoes: 369 calories, 23 grams of fat 1 slice pumpkin pie: 316 calories, 14 grams of fat, 5 grams of saturated fat 1 cup eggnog: 343 calories, 19 grams of fat, 11 grams of saturated fat
Slow! 4 ounces turkey, dark meat without skin: 208 calories, 7 grams of fat, 2 grams of saturated fat ½ cup gravy: 63 calories, 3 grams of fat, 1 gram of saturated fat 1 cup green beans, cream of mushroom soup and french fried onions: 161 calories, 9 grams of fat, 3 grams of saturated fat
Go! 4 ounces turkey, white meat without skin: 158 calories, 1.4 grams of fat, 0.4 grams of saturated fat Medium-size baked potato: 161 calories, 0 grams of fat Medium-size sweet potatoes (no topping): 105 calories, 0 grams of fat 1 cup green beans (no topping): 44 calories, 0 grams of fat ½ cup canned cranberry sauce: 209 calories, 0 grams of fat
Calories from NutritionData.com, CampbellsKitchen.com
ANDY ZEIGERT
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Seeking cures | HYPERBARIC OXYGEN THERAPY
Jinger Cain and her 4-year-old son, Dylan, who has cerebral palsy, in the hyperbaric chamber at BMC.
Hyperbaric therapy: who benefits? Though its healing potential is vast, only 13 uses are approved. Some local doctors think that should change. BY LILY RAFF PHOTOS BY PETE ERICKSON
W
hen Jinger Cain’s son, Dylan, was diagnosed with cerebral palsy three years ago, she became the kind of mother who ignores experts’ advice in favor of whatever she believes could help her boy. So when she heard a treatment called hyperbaric oxygen therapy — breathing pure oxygen under high air pressure — had helped other children with cerebral palsy, the Corvallis woman began searching for a facility whose doctors shared her independent streak. A physicians group that oversees hyperbaric therapy in the U.S., the Undersea & Hyperbaric Medical Society (UHMS), approves use of the procedure to treat 13 specific health conditions. Cerebral palsy is not one of them. Cain called all over Oregon to find a hyperbaric facility that would even consider treating her son. She found it here in Central Oregon. Bend Memorial Clinic has Oregon’s only medical-grade hyperbaric
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oxygen chambers east of the Cascades. The clinic treats roughly 12 patients per day, and 5 to 10 percent of them have conditions not on the UHMS list. It is legal to treat patients with other conditions — often called “off-label” use of hyperbaric therapy — but insurance companies rarely agree to pay for it. Some doctors, including the American College of Hyperbaric Medicine, caution against off-label hyperbaric therapy except in carefully controlled scientific studies. It carries some health risks, including seizures and ear damage. And because it is expensive, it could be prescribed for financial gain rather than a patient’s health. But doctors at BMC say the therapy has the potential to treat many other diseases, including cerebral palsy. And they say off-label hyperbaric patients are often less lucrative for the clinic than regular patients, because they require so much more time spent on research and preparation. “We do off-label hyperbaric therapy because it helps things other than what’s on-label,” says Dr. Robert Pinnick, a kidney specialist and medical director of BMC’s hyperbaric unit.
HIGH DESERT PULSE • FALL / WINTER 2009
Hyper-healing Hyperbaric therapy increases the amount of oxygen in a person’s blood. A patient lies in a sealed chamber where the air pressure is increased to nearly 2½ times normal atmospheric pressure. Instead of regular air, which is about 21 percent oxygen, the chamber is filled with 100 percent oxygen. Google “hyperbaric oxygen therapy” and you’re likely to get just as many celebrity photos as Web sites for hospitals and health clinics. The treatment’s potential is often overstated. Adding to the controversy is a set of cheaper low-pressure hyperbaric chambers that are advertised for home use. Home chambers cost much less and peak at a much lower level of air pressure that most physicians would not prescribe for effective treatment. In the 1980s, the therapy was becoming popular for hundreds of medical uses, some of which were dubious. The National Enquirer published photos in 1986 of pop star Michael Jackson lying in a hyperbaric chamber and claimed that Jackson underwent frequent hyperbaric therapy at his home as part of a plan to live to 150. Alarmed by the apparent overuse of hyperbaric therapy, the federal government threatened to stop paying for the procedure through Medicare and Medicaid. As a compromise, the UHMS offered a list of 13 conditions for which there was indisputable proof that hyperbaric therapy helped. But many doctors, including Pinnick, argue that there is compelling evidence, if not ironclad proof, that hyperbaric therapy can help other diseases, too. “We would like to see the (UHMS) number expanded to probably 25 or 30 diagnoses,” Pinnick says. “In the 1980s, they were (treating) 173 diagnoses, which is way too many, and clearly something had to be done. In reality, 13 (diagnoses) is probably too few. But that’s the way a pendulum swings; it goes way out to one side and then way back to another, and somewhere in the middle is where it should be.” BMC bought its first hyperbaric chamber in July 2008 and quickly expanded to three chambers. Each chamber cost about $120,000. The program runs daily from 6:30 a.m. to 6:30 p.m. One of five doctors is on duty each day. According to Pinnick, almost all of BMC’s hyperbaric patients — including off-label ones — are referred to the program by other doctors in the area. In off-label cases, the referring physicians have usually come across a study that suggests hyperbaric therapy could help. “There are lots of great testimonial papers and diagnostic papers that show the benefits of hyperbaric therapy” for various diseases including cerebral palsy, Pinnick says, “but no papers that clearly compare 1,000 patients with (the therapy) and 1,000 patients without (therapy) and definitively can say: ‘This works.’” Patients with UHMS-listed conditions are accepted into BMC’s program with a referral and an examination by a BMC hyperbaric doctor. An off-label patient is accepted only if all five doctors agree that: • Hyperbaric therapy would be safe for the patient. • There is a reasonable scientific indication that hyperbaric therapy could help the patient. • The patient has a legitimate medical problem. “The way our call schedule works, I might need to cover somebody else’s off-label (patient), so that needs to be something that I’m comfortable doing,” Pinnick explains. For off-label patients, the doctors confer with one another about treatment strategies. How many sessions will a patient need? At what
HIGH DESERT PULSE • FALL / WINTER 2009
THE 13 APPROVED USES FOR HYPERBARIC THERAPY • Air or gas embolism (due to complications from surgery or trauma) • Carbon monoxide poisoning and cyanide poisoning • Clostridal myositis and myonecrosis (sometimes called “gas gangrene”) • Crush injury, compartment syndrome and other acute traumatic ischemias (inflammation or injury that cuts off blood supply to part of the body) • Decompression sickness (gas bubbles in the blood, known as “the bends”)
• Enhancement of healing in selected problem wounds • Exceptional blood loss • Intracranial abscess (infection and inflammation in the brain) • Necrotizing soft tissue infections (bacterial infection that causes tissue death) • Refractory osteomyelitis (bone or bone marrow infection) • Delayed radiation injury (complications of anti-cancer radiation) • Compromised skin grafts and tissue flaps • Burns (from heat only; chemical burns are excluded)
Source: Undersea & Hyperbaric Medical Society
Technician Andy Dicus watches over the hyperbaric chambers at BMC. Doctors here and elsewhere say hyperbaric therapy — or breathing pure oxygen under high air pressure — has the potential to treat many diseases.
atmospheric pressure? For some off-label treatments, the doctors have little scientific proof to guide them. Each of the UHMS-approved uses for hyperbaric therapy relies on the super-dose of oxygen and air pressure to help the body form new blood vessels. But some believe the therapy has other regenerative effects, too. All humans produce stem cells, which have the potential to regenerate tissue. Some studies have shown that a patient who undergoes 40 days of hyperbaric oxygen treatments for about one hour each day ends up with eight times as many stem cells circulating through the body. That stem cell boost is what piqued Cain’s interest in hyperbaric therapy.
High hopes Five years ago, Cain was working a full-time, high-tech job in Corvallis while happily pregnant with her first child. On Dec. 16, 2004, she gave birth to Dylan, who was born with the umbilical cord wrapped around his neck. He came out blue and not
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Seeking cures | HYPERBARIC OXYGEN THERAPY breathing. The doctor whisked him out of the delivery room. According to Cain, minutes passed before Dylan took his first breath. Four months later, the Cains learned Dylan was blind. One year after that, he was diagnosed with cerebral palsy, a brain disorder caused by the lack of oxygen at birth. Symptoms include blindness, poor motor control and speech disorders. Dylan has a particularly severe case, and the Cains say doctors told them their son might never walk or talk. Since then, Jinger and Mark Cain have dedicated their lives to proving those doctors wrong. Jinger was laid off from her job and has been taking care of Dylan full time. The family flew to Pennsylvania and learned intense physical and cognitive therapy techniques at a private organization called the Institutes for the Achievement of Human Potential. Founded in 1955 by a physical therapist and an educational psychologist, the group advocates a treatment for brain injuries called “patterning,” which involves the manipulation of a child’s limbs. The technique has been criticized by the American Academy of Pediatrics, among other experts. But Jinger Cain believes the treatments have helped Dylan. The Cains still spend four to nine hours each day using the group’s techniques. Dylan has learned to crawl. His vision has improved. He speaks a few words. Before Dylan was born, the Cains made arrangements to save the blood inside his umbilical cord. Cord blood is highly valued for its abundance of stem cells. There are several universities and private companies that “bank” cord blood in the U.S., although its use is regulated by the federal government. Last year, the company storing Dylan’s blood called the Cains about a Duke University study on children with cerebral palsy. Doctors there take banked cord blood and inject it into the patient it originally came from. The stem cells, they believe, could help repair some damaged or dormant brain cells. Treating cerebral palsy with stem cells is not a new idea. In China, doctors have reported success with stem cell transfusions using donated cord blood. In fact, the Cains were considering traveling to China for treatment before they heard about the Duke study. In early June, Dylan was infused with 500
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million to 600 million of his own stem cells. Doctors at Duke said it could take six months to see any improvement. But by August, Jinger Cain was noticing what she described as breakthroughs in Dylan’s movement and speech. The boy’s right leg and foot seemed less rigid. And Dylan began speaking a new word almost every day, which Jinger reported at the bottom of her daily e-mails to friends and family. Now Cain wants to amplify the stem cells that already seem to be having an effect. Shortly before the Cains left for Duke, Jinger began searching for a facility to administer hyperbaric therapy to her son. First she tried hospitals near Corvallis, but was told they would only consider treating conditions on the UHMS-approved list. Then she called private clinics, including BMC. A receptionist at BMC asked Cain to send a fax explaining her request. “I ask you to please consider what it would be like to be a 412⁄ -year-old who couldn’t walk or talk,” she wrote in the fax. A few days later, Pinnick’s office called Cain.
Holes in the research Marian McDonagh is the principal investigator at the Oregon Evidence-based Practice Center in Portland, a group affiliated with Oregon Health & Science University that conducts systematic reviews of various health care topics. In 2001 and 2002, McDonagh reviewed hyperbaric therapy’s effect on cerebral palsy patients. She looked at all the relevant published studies, then weighted the results depending on how scientific and thorough each study was. The cerebral palsy results were inconclusive, McDonagh found. One problem with hyperbaric studies, she says, is that the treatment is so obvious it is difficult to develop a convincing placebo. “A blind, randomized, controlled trial (is) the highest standard,” she says, describing a study that includes a broad group of patients where each patient does not know whether he or she is receiving the actual treatment or a placebo, also called a control. In the best hyperbaric study she and her colleagues found, the control group lay in chambers containing pressurized room air instead of just pressurized oxygen.
HIGH DESERT PULSE • FALL / WINTER 2009
HOW HYPERBARIC OXYGEN THERAPY WORKS Normal blood flow The air we breathe is about 21 percent oxygen. Red blood cells, which are suspended in plasma, carry oxygen through blood vessels all over the body. Oxygen gradually diffuses into the surrounding tissue. Diffused oxygen
Restricted blood flow Surgery, illness or injury may cause a restriction in blood flow. Plasma passes through but red blood cells are blocked. Without oxygen, the tissue on the other side of the blockage begins to break down. Restriction in blood vessel
Blood vessel
Broken-down tissue
Red blood cells Plasma flows without red blood cells Plasma carries red blood cells Hyperbaric oxygen therapy Breathing a high concentration of oxygen under pressure causes oxygen to not only attach to red blood cells but diffuse into the plasma itself. This oxygen-rich plasma is able to travel past blockages, where oxygen may then diffuse into the damaged tissue.
The healing process Tissue that contains a high concentration of oxygen is more likely to generate new blood vessels. Oxygen-rich red blood cells start to flow through these new vessels, delivering even more oxygen to the damaged area.
Increased diffusion of oxygen
New blood vessels formed Oxygen-rich plasma
Source: www.hyperbaricworx.com, Bend Memorial Clinic
“The control group improved (their motor control) just as much as the hyperbaric oxygen group,” McDonagh says of the study. “They both got better.” It is possible, she adds, that even pressurized room air yielded some benefits. Better studies are also needed, according to McDonagh, to gauge risks. Patients, especially children, are prone to seizures and ruptured ear drums in hyperbaric therapy, although the rate of complication has not been clearly defined. “All of the studies we found mentioned harms as an afterthought,” she says. McDonagh found other problems with existing research, too. Studies tended to test patients before and after treatment for changes in motor skills, for example, and define improvements as a positive outcome. But McDonagh found that the parents of cerebral palsy patients defined any improve-
HIGH DESERT PULSE • FALL / WINTER 2009
Oxygen-rich plasma
GREG CROSS
ment whatsoever as a positive outcome. “One mother said that her daughter smiled once after hyperbaric therapy. She had never smiled before and that, to this mother, was worth it,” McDonagh says. “Well, how do you design a study to objectively measure outcomes when (any change) is considered a positive outcome?” Funding is a major hurdle for hyperbaric studies. Oxygen cannot be patented, so there is little incentive for a drug company, for example, to invest in testing. McDonagh says she has tried to update her review on hyperbaric therapy research, but few new studies have been published in the past eight years. BMC’s hyperbaric unit is not a research facility, so off-label use there is not contributing to the body of scientific evidence. All five doctors in the unit are board-certified Continued on Page 34
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ANSWERS (and tips from Carol Schrader, a reg-
Body of knowledge | POP QUIZ
istered dietitian at St. Charles Bend):
Fair or fowl? Some commonly held food truths may just not be so BY LILY RAFF
T 1. 2. 3. 4. 5. 6.
he winter holidays are the hardest time of year to maintain healthy eating habits. But one key to healthful eating is knowing nutrition fact from fiction. To test your knowledge, decide whether each of these well-worn statements is true or false:
Margarine is healthier than butter. Skip breakfast to cut calories before a big holiday meal. Turkey contains a sleep-inducing chemical. One day of overeating won’t cause much weight gain. Eating too much sugar causes diabetes. Drink grapefruit juice to cure a hangover.
7. 8. 9. 10. 11. 12.
Caffeinated drinks cause dehydration. A low-carbohydrate diet is the secret to losing weight.
Consuming sugar makes kids hyper. Alcoholic drinks tend to be high in calories. Everybody needs to drink at least eight glasses of water per day. If you don’t exercise, your muscles will turn to fat.
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1. True. Look for margarine that contains no trans fats (hydrogenated or partially hydrogenated oils). It’s especially important for people with high cholesterol or a family history of heart disease. For butter purists, choose butter that contains olive oil or has been whipped with air to reduce the calories per spoonful. 2. False. If you are starving when you arrive at a holiday dinner or party, you are more likely to overeat and make poor food choices that result in consuming even more calories. Instead, eat sensible meals during the day, then munch an apple or sip a mug of hot tea just before the party. 3. True. Tryptophan is an essential amino acid that is also a natural sedative. But unless you’ve consumed several pounds of turkey, your post-dinner sleepiness is more likely the result of overeating, as the body directs its energy toward digestion. 4. True. It takes several days of rampant overeating to gain even 1 pound of fat. Enjoy the holiday spread, then resume healthy eating and exercise habits the next day to stay slim. 5. False. Diabetes is not that simple. Being overweight, specifically around the abdomen, increases a person’s risk of Type 2 diabetes. But plenty of sugar addicts — even overweight ones — are not diabetic. 6. False. There is no shortage of folk remedies for hangovers, but the only medically proven cure is time. Drink some water, get some sleep and wait for your body to finish breaking down the toxic byproduct of alcohol that causes a hangover. 7. False. Even a caffeinated drink is still mostly water. 8. False. Cut calories, not necessarily carbs, from your diet to shed weight. 9. False. Studies have shown that parents think their kids behave more wildly after eating sweets, but independent observers do not necessarily see a difference. 10. True. Especially drinks like eggnog, margaritas or mulled wine that contain loads of added sugar. Instead, make drinks using a low-calorie mixer: a gin and tonic with diet tonic, for example. Or keep it simple with a glass of dry wine. 11. False. The exact amount depends on your size and diet. Straw-colored urine indicates proper hydration. Dark yellow urine indicates dehydration, and clear urine indicates over-hydration, which can be a serious medical condition. 12. False. Muscle and fat have different molecular structures, so one can not simply morph into the other. But muscle can break down, and a person may lose muscle tone if he or she stops eating or exercising. ILLUSTRATION BY GREG CROSS
Nutrition | ANTIOXIDANTS
‘With antioxidants’ sells But is the benefit only to the manufacturer’s bottom line? BY BETSY Q. CLIFF PHOTOS BY ROB KERR
W
hen you’re next at the grocery store, try this: Find as many products as you can that tout themselves as sources of antioxidants. Make sure you look everywhere they might be. Check the cereal aisle, the vitamin supplements, the juice section, the teas, granola bars, sports drinks and even the candy section. Yes, Jelly Belly’s Superfruit mix proclaims the beans are high in the antioxidant vitamin C. You might get so overwhelmed with antioxidants in manufactured food that you could forget to look in the produce section, nature’s richest source of antioxidants. That may be exactly what manufacturers intend. Marketing surveys show that 55 to 60 percent of consumers choose a product with “antioxidant” on the label over an equivalent product without it, according to Food Production Daily, a newsletter for food processors. That kind of persuasiveness has led to a boom in
antioxidants. They are now found in places they never existed before. In 2007, 131 new products labeled as antioxidants were introduced in the United States, according to Food Production Daily; in 2008, 262 more hit store shelves. Most of us know antioxidants are good for us. We hear they can help slow aging or protect us from cancer. We sometimes see on labels that they support the immune system. But few of us could explain what an antioxidant is and what exactly it does that benefits our health. Even fewer know about the heated debate within the scientific community about the value of antioxidants. Fruits and vegetables are a safe bet for health, but antioxidants from most other sources — from cereals to supplements — are increasingly coming under fire.
What are antioxidants? Antioxidants are not one type of nutrient. Instead, the term refers to hundreds or thousands of vitamins, minerals and other substances that act a certain way in the body. It may be better to think of an antioxidant as a function of a particular substance rather than the substance itself; many vitamins
ANTIOXIDANTS AS SUPPLEMENTS
ANTIOXIDANTS ADDED TO PRODUCTS
Studies have failed to prove that heart attacks, strokes and deaths from heart disease were affected by taking supplements. Food may be an essential component to achieve beneficial effects from antioxidants.
There have been few studies on foods fortified with antioxidants and little or no research on whether these foods might have health benefits.
NATURAL ANTIOXIDANTS People who eat more fruits and vegetables tend to be healthier. Researchers believe that’s because these foods — as well as whole grains, nuts, oils, beans and some animal meats — are rich in antioxidants. PHOTO ILLUSTRATION BY ANDERS RAMBERG
HIGH DESERT PULSE • FALL/WINTER 2009
Page 27
Nutrition | ANTIOXIDANTS that act as antioxidants also do other things in the body. Antioxidants protect the body from free radicals, which Bend dietitian Julie Hood describes as “angry oxygen” molecules that can destroy cells or DNA. They result from the normal use of energy by the body’s cells and from exposure to environmental toxins such as cigarette smoke or ultraviolet radiation. Antioxidants neutralize free radicals, preventing damage to cells and DNA. Without antioxidants, free radical damage could lead to a host of problems, including potential killers such as heart disease and cancer.
How can antioxidants benefit us? Years ago, studies demonstrated what is now thought of as common sense: People who eat more fruits and vegetables tend to be healthier. They aren’t as likely to develop some of the major diseases, including Type 2 diabetes, heart disease and cancer, that afflict so many in the United States and other industrialized nations. That fact, Hood said, led researchers to ask what is unique in those foods that protects people from diseases. The answer: “It must be antioxidants.” Antioxidants are present naturally in many whole foods, including fruits and vegetables, whole grains, nuts, oils, beans and even some meats. Study after study has linked a diet rich in these foods to overall health. Lab studies support that notion. In the lab, antioxidant nutrients stopped free radicals from damaging cells. Combined with the human food studies, that made a compelling argument that antioxidants are essential to good health. The realization that antioxidants promise such huge benefits led many to begin taking them in synthetic form. In 2000, a national survey found that about 12 percent of the population said they took a vitamin C or vitamin E supplement, two well-known antioxidants. Researchers, too, were intrigued. At the beginning of this decade, several studies began looking into whether taking supplements of antioxidants could be beneficial. Based on the basic science and results from previous studies, many felt confident the studies would
show that those taking supplements would be less likely to develop heart disease or cancer. It seemed promising, but it didn’t work out. And here’s where things began to get tricky.
Can I get antioxidant benefits by taking supplements? Studies looking at whether particular supplements prevent disease have largely been a disappointment. The case of vitamin E illustrates the shape of the debate and gives some clues as to why antioxidant supplements may not be effective. In the early 1990s, large studies in Finland and the United States found that those who consumed a high amount of vitamin E, either through diet or through supplements, had a much lower risk of heart disease. As with other antioxidants, lab studies supported this research, showing that vitamin E could help prevent damage from free radicals to tissues in the heart. Because the studies were observational, meaning the researchers simply followed a group of individuals rather than intervening in what they ate or how they behaved, more rigorous studies were needed. The first large intervention study (in medical parlance, a clinical trial) was published in 2000. That study enrolled nearly 10,000 people, assigning half of them to take a vitamin E supplement and half to take a placebo. After four and a half years, there was no difference in the number of heart attacks, strokes or deaths between groups. The researchers concluded that vitamin E supplements did not protect against these common health issues. Other studies echoed a similar theme. A 2005 study of people who had risk factors for heart disease again found that vitamin E supplements did not reduce the risk of heart problems. One of the most recent studies, published at the end of 2008, gave vitamin E supplements to nearly 15,000 physicians for 10 years. Again, heart attacks, strokes and deaths from heart disease were unaffected by taking supplements. “We found no benefits for cardiovascular disease,” said Howard Sesso, an epidemiologist at Brigham and Women’s Hospital in Boston
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and the lead author of the physicians’ study. The results, he said, were clear. The difficulty was explaining why his and other studies conflicted with the earlier lab and observational research. Three large clinical trials showing no benefit to supplements is about as close as you can get to ironclad medical evidence. That none showed any benefit would seem to indicate that, at least for the prevention of cardiovascular disease, vitamin E supplements are ineffective. Vitamin E, Sesso said, is much like many other antioxidant supplements that have been tested in large trials. Few have supported the use of supplements for disease prevention. Vitamin E, vitamin C and betacarotene have all been tested and have all been largely ineffective. “It seems pretty clear thus far,” said Sesso, “that the use of individual supplements do not appear to have a very strong role in the prevention of cardiovascular disease.”
Case closed? Hardly Despite the millions of dollars poured into clinical trials and thousands of patients who have acted as guinea pigs to test the benefits of supplements, the question still evokes considerable controversy among experts. The primary problem is that researchers still do not understand why the clinical studies conflicted with earlier population and lab studies, and that leads to different interpretations. Studies on supplemental vitamin E may have shown little benefit for several reasons. People may benefit from a small amount of vitamin E, but above a certain threshold, it may not do much good. “None of these big trials of vitamin E or selenium (another antioxidant) or anything have looked at … (whether) their blood level of vitamin E was low,” said Gladys Block, a professor emeritus of public health at the University of California, Berkeley. “Vitamin E doesn’t do any good in people who don’t need it.” Another explanation is that supplements do not provide benefits because they are not ingested as part of a food. The theory is vitamin E or other antioxidants, taken by themselves, are not helpful, and that it’s all the other components of food that make it good for us. “Food is complex stuff,” said Dr. Miles Hassell, medical director at Providence Integrative Medi-
HIGH DESERT PULSE • FALL/WINTER 2009
WHAT IS AN ANTIOXIDANT?
An antioxidant is a nutrient that helps counteract the harmful effects of free radicals, which form when the body is exposed to environmental toxins or through normal body processes. Free radicals damage cells and proteins in cells, potentially leading to disease. Antioxidants neutralize free radicals, creating atoms that are harmless to the body. 1. Environmental stressors and normal body processes can lead to the formation of free radicals, atoms that have lost an electron. Sun
Stress
Pollution
Normal metabolism
Electron Atom
2. The free radicals go looking for another electron, robbing from other atoms and damaging cells, proteins and DNA. Electron Free radical
3. Antioxidants give up an electron to the free radical, neutralizing the free radical and preventing damage to the other atoms. Electron Free radical
Antioxidant
Sources: Tufts University, Institute of Nanotechnology (U.K.) and expert interviews BETSY Q. CLIFF AND ANDERS RAMBERG
cine in Portland. “It’s not terribly surprising that we were kind of making the wrong assumption to think that we could take some small aspect of food and extract it and get a clinical effect.” Still, no one knows which aspects of food would make the antioxidant nutrients more effective, or how they would do that. The controversy may never be fully resolved.
So where does that leave you in the grocery store? Should you buy the granola bars with antioxidants? What about the vitamin supplements?
What should I do? First, most experts say a multivitamin is a good idea. “No professional would say it’s a problem to take a multivitamin,” said Hood. Multivitamins will often have at least 100 percent of the daily recommendation for many antioxidants, including vitamins C and E. Whether you want to take other antioxidant supplements is probably a matter best settled between you and your doctor. Whether the foods fortified with antioxidants are a good idea is also up for debate. The vitamins in these foods are no different from the vitamins in supplements. In cereal, for example, the fortifying vitamins are sprayed on to flakes during manufacturing. Still, there have been few studies on foods fortified with antioxidants and little or no research on whether these foods might have health benefits. Maret Traber, a professor of nutrition at the Linus Pauling Institute at Oregon State University, has done one of the few studies on foods fortified with vitamin E. She found that people who ate breakfast cereal fortified with vitamin E absorbed the nutrient better than those who took it as a supplement. But she doesn’t know if that would be the case with all foods. “The one that has me a little concerned is vitamin water,” she said. Because vitamin E is absorbed only when eaten with fat, and the waters usually contain no fat, drinking vitamin water on its own may not add any vitamin E to the diet. Other experts were not optimistic that eating fortified foods would confer any benefit. “I would say look at it like pure marketing,” said Hood. “It is just like putting a supplement in a refined food.” Best, say experts, is to follow the advice you have already heard a thousand times: Eat healthy, whole foods and don’t skimp on the fruits and veggies. “If someone is eating fruits and beans and animal products, they are getting a lot of antioxidants,” said Hassell. “Minimally altered whole foods are a whole lot better for you than food that has been significantly processed.” Says Traber, “I think what you really have to do is everything your mother told you.” •
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Recovery | THE VALUE OF FRIENDSHIP
A bike accident nearly took Bonnie Lamb’s life. She got by with …
A little help from her friends BY LILY RAFF PHOTOS BY ANDY TULLIS
O
ne Tuesday evening in September 2005, Bonnie Lamb arrived home from work in need of a few groceries. As she got on her bike, she thought of her neighbor, Brad Chalfant, who had recently bought her a helmet as a gift. Lamb didn’t want to bump into him without it, so she put it on before riding to the store. Lamb sometimes wonders if she would have lived through the night without that helmet. When she was on her way home from the store, a left-turning BMW coupe slammed into her. Lamb’s head hit the windshield so hard the glass cracked. She was knocked unconscious. At the hospital, Lamb was diagnosed with a subdural hematoma, in which blood pools under the brain’s protective layer. Vertebrae in her neck had been chipped, and surrounding ligaments torn. A few ribs were broken, and her right tibia, or shin bone, was snapped in two. That evening still remains fuzzy in Lamb’s mind. Her last memory before the crash involves circling a roundabout several blocks before she was hit. She can’t remember the ambulance ride or even the make of car that hit her. She has a few vague memories of the next four days, most of which she spent in a hospital bed. But here’s what she does remember: the slow and sometimes frustrating recovery from the crash and the friends who helped her piece her life back together. Central Oregon has no shortage of medical experts to treat patients’ physical wounds. But a traumatic injury can devastate a person’s emotional health, too. Lamb’s family, friends and neighbors rallied to care for her and keep her in good spirits as she slogged through a long, slow recovery. “I had such good support from my friends,” she says. “I can’t imagine what it would have been like without them.”
Page 30
SUBMITTED PHOTO
Bonnie Lamb was struck by a car while riding her bike. Her injuries were severe and her full recovery took years.
Calls to friends The night of Lamb’s accident, she was supposed to have dinner at the home of a good friend, Karen Allen. “She was about half an hour late,” Allen recalls. “That’s unusual for Bonnie. She’s really timely.” The phone rang. It was Lamb, calling from the emergency room. Allen visited her that night, and again over the next few days while doctors kept Lamb under observation for her head injury. Four days after the accident, Lamb returned home on crutches, with a metal rod implanted in her leg and a brace around her neck. For more than a month, she could carry food from the kitchen to the dining room only by setting it on a walker and wheeling it in front of her. Unable to climb the stairs to her bedroom, she slept on a hospital bed on her first floor. Meanwhile, Allen e-mailed Lamb’s circle of closest friends. She created a schedule and asked people to sign up to make dinners for Lamb, who lived alone at the time. “Word travels quickly in a small town,” Allen says. Before she knew it, people she had never heard of were calling. “It’s really cool how people just want to help. They’d call and say, ‘Hey, can I help?’ I’d say, ‘Yeah, you want to make dinner? There’s a slot here.’” “I had more food than I knew what to do with,” Lamb recalls. Sometimes when friends stopped in with a meal delivery, they stuck around and ate with Lamb, to keep her company. For the first few weeks, family members came from out of town to stay and provide around-the-clock care. Judy Clinton, another longtime friend, remembers stopping by to visit with Lamb. She got to meet some of Lamb’s family members and give them a short break from caregiving. “It’s something that you want to do, it’s sort of a nice social thing,” Clinton says of helping her friend. “You take time out of your day and your routine and you learn things about your friend that you
HIGH DESERT PULSE • FALL / WINTER 2009
‘A FRIEND IN NEED IS A FRIEND INDEED’ A serious injury or illness often triggers a grieving process, says Karen Campbell, a psychologist at St. Charles Bend who did not treat Lamb. It’s “a loss; a loss of how you identify yourself, a loss of how you socialize, a loss of how you relate to people and a loss of how you relate to your own body,” says Campbell. The good news, she adds, is that a strong social network can help with the emotional healing. WHAT CAN I DO TO HELP? Lamb’s friends offered these suggestions for assisting a friend through a health crisis: • Make specific offers — care for a pet, go to the post office, pick up groceries — instead of generally asking, “Is there anything I can do?” • Let your friend know you care. Call, send a card or drop by to chat. • Share good books, movies, puzzles and games. • Watch for signs of depression, including withdrawal and social avoidance, changes in sleeping or eating habits not medically related, and sudden inability to enjoy previous hobbies or interests.
Karen Allen: “Just hang out and listen. … To have the opportunity to be available and supportive for a friend in a situation like this is really one of the greatest joys in a life. It gives you an appreciation for just how fragile life is. And it reminds us to be grateful for our friends every day, not just when they are hurt.”
Judy Clinton: “Go to the library and get books, or take them to the grocery store … all those sort of errands. Wash their clothes. Open jars for them.” SUBMITTED PHOTO
PHOTO ILLUSTRATION BY ANDERS RAMBERG
HIGH DESERT PULSE • FALL / WINTER 2009
Bonnie Lamb’s cat, D.B., provided company and comfort during her long confinement at home.
Joanne Richter: “It’s good to have one person who has direct contact with the patient and (he or she) can reach out to the rest of the community. I think it’s really overwhelming to have people calling nonstop, saying, ‘What can I do? What can I do?’”
Page 31
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Recovery | THE VALUE OF FRIENDSHIP didn’t know before. It’s sort of like a timeout for both of you.” Allen says she often felt helpful just by being around Lamb. “Hanging out with her was kind of a reminder to her of what her life would soon be again: active and strong and healthy,” she says. Friends offered to drive Lamb around town but didn’t want her to feel dependent or beholden to their schedules. Joanne Richter and Sara Wiener chipped in to buy her rides to and from physical therapy appointments from John Flannery, who owns a shuttle service called Green Energy Transport and a bicycle-pulled taxi service called Bend Cycle Cab. Flannery had known Lamb since his days working at a local video store, years earlier. Chatty and good-humored, he tried not only to provide transportation, he says, “but add a little fun back in her day, too.” One challenge for Lamb was finding interesting activities to fill the many hours she spent at home. At times, she went stir crazy. “I’m a pretty active person, so it was hard to not be able to do anything,” she says. Rather than sit around, frustrated that she couldn’t do her usual routine, she looked for new activities to try. “I started trying to look at it as an opportunity,” she says. For example, Lamb had long wished she knew more about retirement investing and financial planning. So she did online research and read some books on the topic. “It’s something that I wouldn’t have done if I hadn’t been forced to stay home,” she says. She practiced meditation, another long-standing interest for which she had rarely found time. And she bonded with her cat, D.B., a neighborhood stray she had taken in several years earlier. While Lamb lay in bed, D.B. was content to curl on top of her, napping and purring for hours. The cat needed insulin shots twice a day. Dawn Smith, a neighbor who was used to caring for the cat while Lamb was on vacation, came over each day to administer the medication.
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One friend brought Lamb a book of Sudoku, the logic-based number placement puzzles. “I learned to do them and became addicted to them,” Lamb says, laughing. Another person signed her up for Netflix, so DVD rentals could be sent to her home. As her injuries healed, her life slowly started to resemble its former self. Less than one month after the crash, Lamb returned to her job at the Oregon Department of Environmental Quality for a few hours at a time. Shortly after that, she was allowed to remove the cast on her leg and could finally climb the stairs to her upstairs bedroom. Of course, there were setbacks, too. The torn tendons in her neck failed to heal properly, leaving her vulnerable to serious injuries that could lead to paralysis. So Lamb opted to have two of the vertebrae in her neck fused together, for stability. She ended up wearing a neck brace for five months after the crash. Physical therapy was grueling, and Lamb sometimes felt frustrated by what seemed a lull in her improvement. “With any kind of recovery, it’s always way slower than you ever
Page 32
HIGH DESERT PULSE • FALL / WINTER 2009
Bonnie Lamb enjoys looking through some of the cards that she received from her friends after her serious bike accident in 2005.
thought it would be,” Richter says. Friends encouraged Lamb to be patient and helped remind her of the progress she had already made. Three years after the accident, when Lamb felt ready to ride again, Richter helped her find a new bike. “I thought it was really important that she get over that fear and get back on,” Richter says. Today, Lamb again bikes to and from the grocery store, although she says she remains more cautious than before the accident. She still has a thick stack of cards that friends, relatives and co-workers sent her after the crash. Karen Campbell, a psychologist at St. Charles Bend, says a simple phone call or a silly card can mean the world to a friend in crisis. “A lot of people get hung up on the idea that there’s one exact perfect thing to say and they don’t know what it is, so they don’t do anything, even though they’re thinking about the person a lot,” she says. “There is no perfect thing to say, just (let the friend) know that you are thinking about them.” Lamb says her friends have inspired her to take action when someone else is in crisis. “I was astonished at how people rallied to help me. When other people get hurt or need help, I used to think, ‘Oh, I can’t do anything to help.’ “You can,” Lamb says. “Send a card.” •
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Seeking cures | HYPERBARIC OXYGEN THERAPY
“I liked the idea of it because there are no medications, no risks of side effects, and it just seemed different.” Ashli Jones, who suffers from Postural Orthostatic Tachycardia Syndrome and looked forward to trying hyperbaric therapy at BMC Ashli Jones, 21, fainted at a track meet when she was 12 and was diagnosed with a heart condition three years later.
“We were fairly excited and, subsequently, fairly disappointed.” Dr. Michael Feldman, Jones’ doctor
Continued from Page 25 in another specialty and are working toward board certification in hyperbaric medicine. When certified, the clinic will be eligible to participate in hyperbaric research. In the meantime, BMC’s off-label use of hyperbaric therapy goes against the recommendations of the American College of Hyperbaric Medicine, which discourages hyperbaric treatment of all non-approved conditions except in scientific studies. Pinnick says he understands the theory behind that recommendation. But in practice, he says, it does not always make sense for individuals to wait for conclusive medical research. “What if it works?” he says.
Disappointment For 21-year-old Ashli Jones, it didn’t. Jones was 12 when she fainted for the first time, during a track and field meet. The episode was dismissed at first. Jones had overexerted herself. And besides, doctors said, some little girls just faint. Three years later, Jones was diagnosed with Postural Orthostatic Tachycardia Syndrome, or POTS. When a person stands up, gravity pulls blood into the lower body. To adjust, the brain triggers a process that speeds up the heart, increases blood pressure and constricts upward-pumping blood vessels. When all goes well, it takes just two heartbeats to redistribute the blood upon standing. When a person with POTS stands up, however, the upward-pumping vessels fail to constrict. The heart races and blood pressure rises. But with inadequate blood flow to the brain, the patient feels dizzy and light-headed. There is no cure for POTS, but most teens and children with the illness outgrow it by their early 20s. Meanwhile, doctors treat the symptoms with various medications, exercise and custom-made compression stockings. Today, Jones is 21 and her health is steadily improving. The worst part of the disease, she says, is the migraines that strike four or five times a week. Jones takes classes at Oregon State University in Corvallis, but frequently travels to Bend to visit family. Whenever she drives over the
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pass, she gets a migraine. “Elevation is a big trigger,” she says. “Flying, traveling by airplane, is not really an option for me because (my migraines become) terrible.” This gave Jones’ doctor, Dr. Michael Feldman, an idea. Feldman is a kidney specialist. Although POTS does not affect the kidneys, Feldman was intrigued by one young patient who had severe symptoms and no doctor willing to treat her. He now has about 20 POTS patients. “Many of them give a very similar story, which is that they seem to do better when they get out of Bend and drive to Southern California or some other place at sea level,” Feldman says. Because patients feel a slight improvement descending to sea level, Feldman reasoned, perhaps they would feel similar improvements in a hyperbaric chamber. Jones signed up right away. “I liked the idea of it because there are no medications, no risks of side effects, and it just seemed different,” she recalls. She noticed a slight improvement in her migraines while she was in the chamber. But the headaches resumed as soon as she got out. Even after weeks of daily therapy, Jones noticed no other benefit. Another POTS patient tried hyperbaric therapy and felt a decline in her overall health. “We were fairly excited,” Feldman says of the experiment, “and, subsequently, fairly disappointed.” But BMC has enjoyed success with off-label treatment, too.
‘It gave her a life back’ Summer Stiers was Pinnick’s patient for almost 10 years until she died in June, at 32. She suffered seizures, eye swelling, intestinal bleeding, kidney failure and muscle atrophy. Doctors could not figure out what was causing her body to deteriorate. Last winter, specialists at the National Institutes of Health examined Stiers with the hope of eventually helping others. They believe she is the first person to suffer a particular genetic disorder, which has not yet been named. Here in Bend, Pinnick used trial and error to manage her complex symptoms. “Summer was completely off-label,” he says. “There was no label for Summer.” He noticed that biopsies revealed lesions as if Stiers’ tissue had been irradiated. Pinnick does not believe Stiers was exposed, but he decided to try hyperbaric therapy, which is an approved treatment for radiation. Putting Stiers in a hyperbaric chamber was not simple. One year ear-
HIGH DESERT PULSE • FALL / WINTER 2009
lier, she had a nerve stimulator — like a pacemaker for the brain — implanted under the skin near her collarbone. Every three minutes, the device emitted an electronic signal that traveled along her vagus nerve and into her brain to prevent or disrupt seizures. “Nobody with a vagus nerve stimulator had ever, as far as we know, been inside a hyperbaric chamber before Summer,” Pinnick says. The high concentration of oxygen makes a chamber’s contents — especially metals and petroleum products — highly flammable. Patients must be careful not to wear makeup, lotion or jewelry, which could spark an explosion. The company that manufactured the nerve stimulator sent BMC one of the devices, which was placed inside a chamber and tested several times. Stiers signed a long legal disclaimer and arrived at the clinic one morning in August 2008 to try the therapy. Her parents — adoptive father, Doug Ward, and stepmother, Kim Plummer — came, too. Pinnick and the technician were visibly nervous as Stiers climbed into the chamber. It went smoothly, so Stiers came back each day for about an hour. Within a week, the swelling in her eye was drastically reduced. Her vision improved. Her stamina and strength increased. At her weekly horseback riding lesson, Stiers could trot four times as far without her legs giving out. She could read the tiny print in paperback books again. “It gave her a life back,” Ward says. Then, in January, Stiers’ insurer, the publicly funded Oregon Health Plan, denied payment for more treatments. Stiers and Pinnick appealed the decision, claiming the therapy saved money by preventing the need for costlier procedures. In March, the insurer relented. But the month of therapy she missed coincided with a steep decline in her health that continued until her death in June. Stiers’ parents do not blame the missed treatments for Stiers’ demise. Her body was failing in almost every way, they say. And they remain grateful for BMC’s willingness to treat Stiers even though she did not meet the UHMS requirements. “I think they look at (hyperbaric therapy) differently than other doctors,” Plummer says of BMC’s physicians. “They see its potential.” Dylan Cain started hyperbaric therapy at BMC in early September. After a few treatments, doctors determined he needed ear tubes to ease the effects of the changes in pressure, said his mother, so treat-
Kim Plummer and Doug Ward are raising money in memory of their daughter, Summer Stiers, who died in June from an unknown genetic disorder. They hope to purchase a hyperbaric chamber that will be dedicated to charitable use.
ments were suspended for several weeks. At first, the Cains are paying for the treatment out-of-pocket and through fundraising efforts. The charge for each of Dylan’s one-hour sessions is just more than $500, according to BMC. Many patients have two-hour sessions costing twice that amount. The actual amount paid can vary depending on insurance negotiations. After an initial period of daily therapy, if the Cains see improvement, they plan to appeal to Dylan’s insurer, the Oregon Health Plan, to pay for more. Ward and Plummer recently started a nonprofit in Stiers’ name. They aim to raise $120,000 to buy a fourth hyperbaric therapy chamber for BMC, to be dedicated for charitable use. “I’d love to see the chamber used not just for people who are uninsured or underinsured,” Plummer says, “but who have (conditions) that insurance companies do not recognize as being treatable with hyperbaric therapy.” •
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Cover story | THE TEEN BRAIN Continued from Page 10 of higher risk with higher reward, researchers could see whether adolescents made different choices than adults and used different areas of their brains to do so. The results showed adolescents did tend to pick riskier choices than adults, though the difference was less than the researchers had anticipated. (It did not reach statistical significance, though the researchers guessed that a larger number of participants might have shown significant differences.) Yet researchers found that in making their decisions, adults used their brains in different ways than teens did. Adults showed greater activity in parts of the brain involved in decision-making and processing of rewards, several of the thinking areas of the brain. Teens showed less activity in these areas. Researchers surmised that adults are better able to use these parts of the brain when thinking about the consequences of risky decisions. Because these areas in the brain are among the last to mature, it may be that adolescents simply do not yet have the capacity to fully think through a risky choice. Immaturities in their brains may be responsible for some of the seemingly poor decisions that teens make.
Friends forever In her clinical practice in Bend, Dr. Angelina Montoya, a psychiatrist, often sees parents concerned about teens who begin to behave differently, hanging out with different friends or doing new things. Besides risk-taking behavior, another major shift takes place in adolescence. Interactions among peers suddenly become more important, more analyzed and, when they go wrong, more emotional. Montoya said much of this is part of growing up. “The normal development is for kids to start to move away from their parents as their primary source of security and start to look for other sources, such as their friends.” This moving away from the family could be part of evolution’s way of getting teens ready to be in the larger world. Evidence for that, said Giedd, can be found in the animal kingdom, where adolescents of other species show the same behavior. Lions, he said, begin to take a greater inter-
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est in lions of the same age in adolescence. “The idea that you need to fit in with your peer group is enormously important” in adolescence, said Yurgelun-Todd. While the neurological mechanisms that guide the shift toward peer interactions are not as well studied as the teen propensity for risk-taking, neuroscientists agree that it is an important part of adolescence and likely has to do with brain maturation. Pine recently conducted one of the first studies to examine how teen brains respond in a simulated social setting. In the experiment, Pine showed teens faces of other teens and asked them whom they might want to meet in an online chat. As teenage girls got older, he found that a part of the brain that regulates emotion was more heavily activated when looking at people they said they would like to meet. They noticed particular shifts in an area called the nucleus accumbens, which helps control motivation. Signals from the nucleus accumbens got stronger as teen girls got older. Teenage boys did not show changes in that area. The study gives us just a rudimentary idea of what’s going on, said Pine. “Maybe because the function of that brain region becomes different as adolescents get older, maybe that would explain” some of the variations in behavior. Teen girls, he said, tend to become more preoccupied with interpersonal relationships and how they are perceived by others.
WHAT’S NORMAL? Adolescence is a particularly potent time for the development of problems that can lead to lifelong consequences. Internal neurological changes make teens vulnerable when situations become risky, which can lead to the beginning of drug or alcohol problems or, especially in those already susceptible, to psychiatric disorders. Drinking, drugs, abusive relationships and other negative interactions “are very damaging to the evolution of self-esteem and how the brain processes information,” said Deborah Yurgelun-Todd, a brain researcher at the University of Utah. So how can a parent know what’s normal and what could signal problems? Teens moving away from their parents is normal, said Dr. Angelina Montoya, a psychiatrist in Bend, but “when kids say they don’t trust their parents or don’t listen to their parents at all,” that could spell trouble. “The child needs to be able to look outside their family, but not abandon the things that their parents have told them are important.” Montoya said there are several signs that could signal more than just adolescent transitions: a decline in behavior, a moodier child, withdrawal from activities or friends and a decline in school performance. “If those things are occurring,” Montoya said, “the risk-taking is probably greater than normal.” Parents who have concerns have several resources. They can talk to a primary care doctor, a school counselor or, if they suspect a mental health problem, the county mental health department.
Not broken brains As scientists learn more about teen risktaking, decision-making and the influence of peers, they hope to understand both the normal course of development and explain how it can go wrong. The teen years are a prime time for the onset of mental health problems, including serious illnesses such as bipolar disorder or schizophrenia. Many researchers study development in adolescence with an eye toward unlocking the causes of mental health issues. Many researchers also seek to dispel myths that teens are irresponsible, stupid or just plain bad. Their brains are at a unique point in development, they say, and teens should be thought of in that way, not as defective adults. “There’s kind of this notion that they’re slackers and no good,” said Giedd. “It is a time when, because of this plasticity and change, there is some inconsistency. But it’s not a broken brain.” •
HIGH DESERT PULSE • FALL / WINTER 2009
Tasha Marler, Kylie Franks, Nick Warren and Spencer Moore, all Bend High sophomores, roughhouse a bit at the end of a school day. Besides risk-taking behavior, another major shift takes place in adolescence: Relationships with peers become more important and emotional.
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Laughter | THE BEST MEDICINE
Award-winning tales from the ER I
believe everyone should have a hobby. My mom collected stamps and Depression-era glass. When I was a young boy, I collected coins. Soon after I became an emergency department physician I began to collect something much more entertaining and fun; I collect injuries from the ER. Not just any injuries — the ones I collect are special. You may know them by another name: “The Darwin Awards.” About once a year an e-mail circulates detailing the current year’s crop of incredibly creative ways people manage to end their lives through sheer stupidity. There exists an organization that verifies these injuries and separates urban legend from the truth validating each injury. Books have been written and movies made of the same title. The term “Darwin Award” is derived from the theory of natural selection put forth by Charles Darwin in 1859. Darwin believed in some very simple ideas: •Individuals vary from one another. •Variation is inheritable. •Individuals less suited to the environment are less likely to survive and less likely to reproduce. •If individuals do something to harm themselves that smarter people would not do, they risk becoming victims of natural selection. Lest you think me callous, please realize that as a physician, I do everything in my power to help every patient I treat. But at the end of the day, we can shake our heads and laugh. True Darwin Award recipients must die to be eliminated from the gene pool, but I strive to find cases where the talent of the medical community prevented a patient’s demise. I have found a set of common denominators likely to increase injury in the shallow end of the gene pool: •Snakes. •Male gender. •Alcohol. •Moving vehicles. •Firearms or fire. •A history of incarceration.
SUBMISSIONS Do you have a funny health story you’d like to share? Send 500 words or less to pulse@bend bulletin.com. Editors will select one submission for each edition.
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and a pickup truck, they shocked him. Another friend convinced him snake venom is made ineffective by immersion in ice. Eventually abandoning their efforts and him, they called 911, leaving their friend in a bathtub of ice. He arrived in the ER in shock, hypothermic and near death. Rapid work by paramedics and the ER staff saved his life. From CNN, I collected the story of a Portland man who put a baby rattlesnake in his mouth to show his friend how docile the creature was. The snake bit his tongue. When paramedics arrived, the swollen tongue was blocking his airway. In a rapid course of skilled surgical maneuvers, the trauma team performed a tracheostomy, allowing the patient to breathe. When he recovered, he called CNN to tell the nation of his ordeal. Or this: a group of friends argued which was the best marksman with a crossbow. Placing an apple on his head, one stood bravely 30 paces away from his friend, trusting his skills. The arrow pierced his eye, traveled through his brain, and exited his skull. Again, talented surgeons and dedicated specialists were able to save the man. Was Darwin correct? As a doctor with a strange hobby, I know he was. You may prefer to walk along the beach and collect pretty shells, but I’ll keep scanning the papers and medical literature for Darwin Awards candidates my fellow physicians managed to drag out of the shallow end of the gene pool and save. • — DR. MATTHEW M. ESCHELBACH
Eschelbach is the medical director of the St. Charles Redmond emergency room.
Consider a few examples: Mr. X spent a sunny afternoon with his friends drinking beer and hunting rattlesnakes. Mr. X picked up a rattler, which promptly bit his hand. Angered, he tried to break its neck. It bit him again. He then emptied his revolver at it, the last bullet ricocheting and striking his leg. One friend was convinced that electricity neutralizes snake venom. Using jumper cables
HIGH DESERT PULSE • FALL / WINTER 2009