Pulse Magazine - Winter/Spring 2011 by Western Communications, Inc.

WINTER / SPRING 2011

PULSE Did his birth mother drink?

The hidden risk of fetal alcohol syndrome in Eastern European adoptions

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HIGH DESERT PULSE

Contents |

HIGH DESERT PULSE

COVER STORY

DID THE BIRTH MOTHER DRINK? More than half the children adopted from Eastern Europe may be affected by fetal alcohol syndrome.

FEATURES

19 27 33

CHRONIC INSOMNIA Causes and cures for those long sleepless nights. GET ACTIVE: SPRING SNOW A view from the top. MEDICAL DECISION-MAKING Legal documents can prevent family conflict when a health crisis strikes.

DEPARTMENTS

7 14 25 28 30 38 49 53 54

UPDATES What’s new since we last reported. HOW DOES SHE DO IT? Dagmar Eriksson: Passion makes fit. ON THE JOB: HARP THERAPIST When music is just what the doctor ordered. GET GEAR: SNOWSHOES Not just oversized tennis rackets anymore. HEALTHY OPTIONS Four guilt-free dishes at some favorite local spots.

GET READY: POST-PREGNANCY FITNESS Getting back in shape after giving birth. PICTURE THIS: DIGESTION We are what we eat. So how does that happen? BODY OF KNOWLEDGE: POP QUIZ Can you name these odd diseases? ONE VOICE: A PERSONAL ESSAY Life lesson from the eighth grade. Cover: Max Hetherington, 7, was adopted from Russia. COVER PHOTO: RYAN BRENNECKE CONTENTS PHOTOS, FROM TOP: RYAN BRENNECKE (2), ANDY TULLIS, PETE ERICKSON

HIGH DESERT PULSE • WINTER / SPRING 2011

Page 5

Updates |

NEW SINCE WE LAST REPORTED

Medical marijuana Much has happened in the field of medical marijuana since High Desert Pulse compared the medicinal value of natural marijuana with synthetic pill versions of the drug in “Marijuana as medicine” (Summer/Fall 2009). This past fall, Oregon voters rejected Measure 74, which would have legalized state-regulated medical marijuana dispensaries, shops where state-approved medical marijuana patients and growers would have bought and sold pot. Under Oregon’s 1998 medical cannabis law, patients registered with the Oregon Medical Marijuana Program can acquire and use medical marijuana, but they can’t pay someone for it. In some cases money can be exchanged to reimburse a grower for expenses such as fertilizer or electricity. Despite Measure 74’s failure, five alternative medicine clubs or clinics have opened in Bend to provide licensed medical marijuana patients a place to safely access their medicine without buying it outright. Patients and caregivers who cultivate plants can legally exchange medicine in the clubs. Individuals pay a monthly membership to the club or make donations. Physicians perform medical evaluations of prospective patients to deter-

mine whether their ailments qualify for medical marijuana. Clubs and clinics include: Central Oregon Alternative Therapy, The Herb Center, High Desert Alternative Medicine, Central Alternative Medicine and Mothers Against Misuse and Abuse. It’s a challenging and confusing system for patients and law enforcement, and some people involved in the issue expect to see another ballot initiative similar to Measure 74 in 2012. — ANNE AURAND

Genetic testing When High Desert Pulse explored the topic of home genetic tests in “Genetics may tell your future. Do you want to know?” (Winter/Spring 2009), not much was known about how people reacted to these tests.

Now, a large study has found that doing a genetic test at home is really no big deal. Researchers from Scripps Translational Science Institute followed about 2,000 people who took a commercially available genetic test. The subjects received information about their lifetime risk of certain diseases such as various types of cancer and autoimmune disorders and, if they wanted it, genetic counseling. Though experts have worried that knowing you have a higher risk of some disease may heighten anxiety, 90 percent of those in the study experienced no distress related to the tests after they took them. On the other hand, there were not many positive effects either. As a group, people who took genetic tests did not change their exercise patterns, eat less fat or go in for more screening tests, all of which could reduce their risk of actually developing one of the conditions to which they are predisposed. The researchers published their findings recently in the New England Journal of Medicine and concluded that genetic tests marketed directly to consumers do not significantly affect behavior.

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Cover story | RISKY ADOPTIONS

The hidden risk of

FETAL ALCOHOL SYNDROME

In the past five years, Americans adopted 20,000 kids from former Soviet republics. More than half may have been affected by alcohol before they were even born. BY MARKIAN HAWRYLUK • PHOTOS BY RYAN BRENNECKE

ax Hetherington celebrated his second birthday in Moscow. And in Frankfurt. And in Oregon. It was a quite a departure from his previous two years spent mostly in a Siberian orphanage. Only days earlier, he had taken his first car ride, eaten his first restaurant meal, seen his first TV. Quite suddenly, in 2005, he was jetting across continents and oceans to start a new life in the U.S. His adoptive parents, Laurie and Richard Hetherington, now of Bend, had done all their due diligence. They had carefully measured the boy’s head circumference on their first visit to the orphanage and looked for the telltale facial features. They sent e-mails and faxes back and forth to Siberia. They sent his photos and videos to international adoption doctors for analysis. The doctors told them there were “borderline” signs that he may

Page 8

have been affected by alcohol before birth, but the Hetheringtons had little understanding of the significance of the warning. “The way we understood fetal alcohol, it was like ADHD, it was being hyper. You can put him on some Ritalin and he’ll be fine,” Laurie said. “We had never heard of fetal alcohol syndrome before. Never heard the term, never knew anything about it.” But with each subsequent birthday, it became more clear that what had seemed initially to be merely an enthusiastic nature was actually a serious problem. “From two to three, it was, ‘Oh my word, he has so much energy,’” Laurie said. “From three to four it was, ‘Something’s not right.’ I was just exhausted. Something was not connecting.” Max had turned 3 and he was still not talking. He could fixate with almost obsessive compulsion on a single object or idea. He could not make connections between his actions and their consequences, or learn from his mistakes. He had no sense of risk or danger. He

HIGH DESERT PULSE • WINTER / SPRING 2011

Adopted brothers Mikhal, left, and Max Hetherington

was, at times, uncontrollable. Desperate to understand what was happening with her son, Laurie took to the Internet, reading everything she could about health issues affecting adopted children. The more she read about fetal alcohol syndrome (FAS), the more she saw her son reflected in the words on the screen. She needed more definitive proof to confirm her suspicions and she went straight to the source, calling the orphanage in Siberia. “I need to know this. We need a diagnosis,” she recalls saying. “Tell me, did his mother drink?” ••• Americans have adopted more than 20,000 kids from Russia, Ukraine and other former Soviet republics during the past five years, and by many estimates, more than half of them may have been affected by exposure to alcohol before birth. “We do see a number of neurodevelopmental problems in chil-

dren who are adopted overseas,” said Dr. Natasha Polensek, a pediatrician in the adoption medicine clinic at Oregon Health & Science University in Portland. “The reason this is quite prevalent in Eastern Europe is because the rate of alcohol consumption is very high.” Alcoholism is one of the region’s most pressing social issues, and a frequent reason children are abandoned or taken from their birth parents. The result is a staggering risk of severe developmental issues among the children in orphanages in Russia, Ukraine and other countries of the former Soviet Union. Studies of adopted children from the region show there is a 50-50, coin-flip’s chance the child will show the impact of alcohol. The mother need not even be an alcoholic. It could be the result of a single night of binge drinking during pregnancy. Child development experts maintain that in some cases even a single drink has led to irrevocable damage in the brain of a developing fetus. Last year, Swedish doctors published a study in the journal Pedi-

Only about 15 percent of children affected by alcohol will have physical signs, which are an indication that the mother drank in the first trimester of pregnancy. Drinking after the three-month mark may not show on the face, but can still devastate brain development. HIGH DESERT PULSE • WINTER / SPRING 2011

Page 9

FAS:

It’s more prevalent than you think Fetal alcohol syndrome is hardly a problem limited to foreign countries. According to the National Institute on Alcohol Abuse and Alcoholism, the rate of FAS in the U.S. is somewhere between 0.5 and two cases per 1,000 births. The rate of fetal alcohol spectrum disorders, a broader category of children affected by exposure to alcohol in the womb, approaches 1 percent of births. It is considered the most common cause of non-hereditary mental retardation and developmental disability in the U.S., and it may be underdiagnosed. “In the U.S. there’s still a very big stigma in diagnosing children with fetal alcohol syndrome,” said Laurie Hetherington, whose adopted son has FAS. “That’s a huge shame because it is more prevalent than Down syndrome, it is more prevalent than autism, and there are more children that have it than have HIV in the United States.” Hetherington believes doctors are reluctant to consider the diagnosis in non-adopted children in part to avoid blaming the mother. “I just want people to be more aware of it, of how prevalent it is. I want birth mothers to be able to say, ‘I made a mistake in the past and it was wrong, but going forward, I want you to know that I want my child to get a proper diagnosis, so they can get help and they can get care.’” Studies show about one in five American women drink while knowingly pregnant, and experts can’t be sure how much alcohol, if any, is safe during pregnancy. (More on Page 46.) For the child, the consequences of overlooking the diagnosis can be striking. A study of juvenile detention facilities in the U.S. found 40 times the expected frequency of fetal alcohol spectrum disorders.

Equal opportunity poison For years, fetal alcohol syndrome was thought to be an issue for Native American or other aboriginal populations. While it’s true that native people in many parts of the world have high rates of alcoholism, studies show drinking during pregnancy crosses all ethnic lines. Researchers at the University of Washington found that whites have the highest rate of full-blown FAS, with all the characteristic facial features and developmental delay. Native Americans have the lowest. But Native Americans have the highest rate of other neurological damage due to fetal alcohol exposure.

Cover story | RISKY ADOPTIONS

Searching for babies From 2005 to 2009, one in five foreign adoptions came from Russia, Ukraine and Kazakhstan. The three former Soviet republics were the only countries among the top eight where white parents could adopt primarily Caucasian children.

Top eight countries of origin for U.S. foreign adoptions, 2005 to 2009 Total adoptions Other 93,251 15,154 16.3% India 1,658 1.8%

China 26,760 28.7%

Kazakhstan 2,565 2.8%

Ukraine 3,000 3.2%

South Korea 6,084 6.5%

Ethiopia 6,428 6.9%

Guatemala Russia

17,523 18.8%

14,079 15.1% Note: Percentages may not add up to 100 due to rounding.

atrics in which they examined 71 children five years after they were adopted from Russia. About 30 percent of the kids were diagnosed with fetal alcohol syndrome, another 14 percent with partial FAS, and another 9 percent showed other neurological problems linked to alcohol. Several years ago, when U.S. researchers visited an orphanage in Russia, they found more than half of the children there showed signs of fetal alcohol spectrum disorders (FASD), an umbrella term for problems caused by exposure to alcohol in the womb. “If we look at the kids who we felt were at high risk of FAS from any country, it would be less than 10 percent,” said Dr. Judith Eckerle Kang, a University of Minnesota pediatrician who evaluates photos and medical records for adoptive parents. “But sometimes it’s hard to tell, especially in the younger kids, whether they will be affected or whether

Page 10

ANDY ZEIGERT

they won’t. There’s probably another 30 to 40 percent who are in a moderate or gray zone risk, specifically from Eastern Europe.” Diagnosis from photographs and medical records is often guesswork at best. Doctors will look for characteristic facial features that are a giveaway for fetal alcohol syndrome — small eyes, a thin upper lip and the absence of a lip philtrum, the little vertical notch between the nose and the upper lip. “We know that facial features evolve over time,” Kang said. “You can have a sixmonth old who doesn’t have very clear facial features and then can evolve into facial features by the time they’re 4 or 5.” But only about 15 percent of children affected by alcohol will have those physical signs, which are an indication that the mother drank in the first trimester of pregnancy. Drinking after the three-month mark may not show on the face, but can

HIGH DESERT PULSE • WINTER / SPRING 2011

still devastate brain development. “So you could have a child that is very affected in their brain but their facial features don’t show that, and that can be a tricky diagnosis from afar,” Kang said. ••• The Hetheringtons had tried for years to get pregnant, but were unwilling to try in vitro fertilization. “There are so many children in this world, why go through all that?” Laurie said. Richard had known many Eastern European families from his childhood and the couple knew of organizations that were doing mission work with Russian orphanages. So they decided to adopt a child from Russia. After 18 months of paperwork, home studies and parenting classes, they received a photograph from the adoption agency early in December 2004. If they agreed, this would be their son. “He was short and pudgy, and just something about the way he had his arms out, he looked like George Costanza,” Laurie recalled. They were in. In February 2005, they flew to Moscow and then took another plane to the city of Krasnoyarsk. From there, they drove another four hours over dirt roads to the orphanage. It was the middle of the Siberian winter and 24 degrees below zero. “We were driving through town in a car and looking so American in

HIGH DESERT PULSE • WINTER / SPRING 2011

The first photo of Max, left, the Hetheringtons received from the adoption agency. PHOTOS COURTESY LAURIE HETHERINGTON

Max, right, at the orphanage during the Hetheringtons’ first visit in 2005. They spent a total of nine hours with him, before returning home to wait.

Page 11

Cover story | RISKY ADOPTIONS

“We do see a number of neurodevelopmental problems in children who are adopted overseas. The reason this is quite prevalent in Eastern Europe is because the rate of alcohol consumption is very high.” Dr. Natasha Polensek, a pediatrician in the adoption medicine clinic at Oregon Health & Science University in Portland

Snapshot of alcohol-related deaths worldwide The countries of the former Soviet Union have the highest rates of alcohol-related deaths in the world. Many of the children in orphanages have been taken from or abandoned by parents with serious alcohol problems.

0% to 2%

2% to 5%

5% to 10%

10% to 14%

No data

Source: World Health Organization ANDY ZEIGERT

our Columbia ski jackets trying to stay warm,” she said. “I see these people pulling a sled, and I said, ‘Oh look, they’re going sledding!’” Their translator informed her the villagers were going to the well for their water. The orphanage was one of the few buildings in the small town that had running water, brown as it was. The building was stark, with gray concrete walls. The wallpaper and carpet showed their age. Inside the scene was almost surreal, with little children wearing designer Baby Gap clothes and playing with Western toys, the remnants of hundreds of visits by American parents. The staff took the Hetheringtons into the designated parent room and brought Max in. “As soon as we saw him, my husband and I both started crying. It’s an immediate bond,” she said. Some people are hesitant about adopting, wondering whether they will be able to truly consider that child their own. For the Hetheringtons, it wasn’t even a question. “There is no doubt that you just love that child,” Laurie said.

Page 12

Max, 18 months old at the time, showed an insatiable curiosity, eagerly meeting his prospective parents, then checking out everything else in the room. They spent three hours with him that day, and then another three on each of the next two days. By the time they flew home, they had made their decision. They probably would have gone through with the adoption even if the signs of a problem had been overt. “My husband would have been the more nonemotional one. ‘Let’s think through this,’” she said. “I think I would have (continued with the adoption), because we had already seen him.” ••• Seeking a medical opinion before adopting has become a routine part of the international adoption process. A cottage industry of medical adoption clinics has sprung up across the U.S. to provide parents with a sort of postnatal sonogram. Yet, even when doctors suspect a problem, by the time the parents have seen a picture or met the child, there is often little that can dissuade them from adopting.

“It’s not uncommon at all for (adoption doctors) to tell the family, ‘This kid looks at pretty high risk,” and the family is understandably not very open to hearing that,” said Dr. Susan Astley, one of the leading FAS experts in the country. “They’ve already bonded, they’ve already gotten way down this road.” Parents quickly come to see the child in the photo as their own, pinning their hopes and dreams for a family on that child. Visting the orphanage and seeing a child ravaged by FAS makes it all the more difficult to pass them up. “This is a difficult process regardless, and there’s the huge emotional aspect. Well, if this child does have a disability, how can we morally pass him up?” Astley said. “But they really have very little idea of how much their lives are going to be changed.” Sue Gainor, chair of Families for Russian and Ukrainian Adoption, and her husband adopted a boy from Russia in 2001. Doctors told the Virginia couple they were concerned about the boy’s small head size, a common trait among kids with fetal alcohol syndrome, but also caused by malnutrition in orphanages. “We ignored it because we didn’t know what that meant. We didn’t know what to do,” Gainor said. “That was our kid. By the time you look at the picture, it’s so hard for that not to be your child. You just absorb that child. I had his picture framed nine months before I ever met my son.” When the Gainors saw their son in the flesh for the first time, they were shocked. The boy was terribly small, lethargic, lacking any physical ability. “It was a long, hard discussion whether we were going to pursue that particular child,” Gainor said. “We just decided that he was our child and we’re committed to doing what we need to do to make sure he was successful as a person.” But for every child at the orphanage who shows outward signs of fetal alcohol syndrome, there are three or four affected children who seem relatively healthy. Prospective parents have no way of knowing whether the portion of the child’s brain responsible for higherlevel thinking has developed normally.

HIGH DESERT PULSE • WINTER / SPRING 2011

The telltale signs of FAS Doctors use four criteria to diagnose fetal alcohol syndrome. All four must be met for a full-blown FAS diagnosis. Children who meet only some criteria are said to have partial fetal alcohol syndrome or are diagnosed as having a fetal alcohol spectrum disorder.

Small eyes (distance from A to B)

LIP PHILTRUM GUIDE

Smooth philtrum

1. Growth deficiency: Probably the least important of the four criteria, in part because it is difficult to separate the impact of malnutrition from the effects of alcohol. Many kids with clear-cut FAS don’t have any growth deficiency. 2. Facial features: Three sentinel facial features — small eyes, a thin upper lip and the lack of a philtrum (the vertical ridge below the nose) — are the most reliable signs of fetal alcohol syndrome. Experts use the philtrum guide, at left, to gauge the degree of the effect to this particular facial feature. Researchers at the University of Washington have developed a software tool that can analyze facial photographs and provide a highly accurate diagnosis, more accurately even than a doctor can manually. But doctors can’t rule out FAS even if none of these features are present. 3. Central nervous system damage: Damage to the brain can be confirmed by malformations seen on an MRI scan, by neurological conditions such as seizures, or by tasks that test cognitive functioning. Some cognitive issues may not become evident until the child is of school age. 4. History of maternal alcohol use: Unless the mother admits to drinking during pregnancy, such information is difficult to confirm. With international adoption, children’s records are often unspecific on maternal drinking.

Photo courtesy Dr. Susan Astley, professor of epidemiology, University of Washington

“We don’t do sophisticated math and language and problem solving as a 2-year-old. It’s not until you get to be 6, 7, 8 years of age that you now are expected to engage in more abstract thinking,” Astley said. “Those are more difficult, higher-level tasks in the brain, and the only way you know that those parts of the brain are damaged is to wait for the child to get old enough to engage in those kinds of tests to see.” As a result, the effects of fetal alcohol exposure often don’t start to emerge until the child starts elementary school. Years after the adoption, parents are blindsided by the challenges that emerge. ••• After the fall of the Soviet Union in 1991 first opened up Russia and the other former republics for adoptions, most of the parties involved in the process seemed to ignore the

issue. Orphanages held back any information they had on the mother’s drinking, adoptive parents were in denial about the risks, and adoption agencies downplayed the problem. “I think there was a persistent impression that love and good nutrition guaranteed a successful adoption outcome. To some degree, the adoption agencies have and continue to foster that impression,” Gainor said. “There was a lot of reluctance to deal with the potential of fetal alcohol effects.” Gainor believes most agencies are trying to do the right thing, trying to place needy children in families where they have a chance at a normal life. “I think there was a whole combination of issues, including that most people who adopt have gone through infertility issues and they are very hopeful that it’s finally going to happen, that they’re going to be par-

“We ignored it (the FAS traits) because we didn’t know what that meant. ... That was our kid. By the time you look at the picture, it’s so hard for that not to be your child. ... I had his picture framed nine months before I ever met my son.” Sue G ainor, chair of Families for Russian and U krainian Adoption HIGH DESERT PULSE • WINTER / SPRING 2011

ents,” she said. “And there’s some reluctance to face it. You intellectually face this, but you don’t emotionally face this.” But that leaves parents unprepared for children who threaten to burn down their homes — as happened with the Tennessee woman who “returned” her child to Russia alone on a plane — or hide knives under their pillows. Parents feel the rug has been pulled out from under them, that they’re being forced to deal with the consequences of actions taken long before in a faraway land by someone they never met. “There are a lot of people whose expectations and the reality for their children are very different,” Gainor said. “There are many parents who say things like, ‘I didn’t sign up for this.’ And I don’t frankly think there’s any excuse for that. When you sign up to parent, you sign up to parent to whatever the child presents.” ••• For four months after first meeting Max, Laurie waited like any expectant mother, with a packed bag, ready to go at a moment’s notice. When the call finally came, they had five days to get to Russia for their court date. There they sat helplessly listening to the court debate in Russian their fate and Max’s future. The judge seemed unhappy with their case, concerned Continued on Page 46

Page 13

How does she do it? |

DAGMAR ERIKSSON

Going global A Bend woman finds nordic passion at 50 and takes it around the world

Dagmar Eriksson, now 65, got hooked on nordic skiing at age 50. She now competes internationally, traveling from Italy to Norway for races. â&#x20AC;&#x153;Skiing is my focus all the time, even with what I do in summer,â&#x20AC;? she says of her fitness regime. Page 14

B Y H E I D I H AGE M E I E R • P H OTOS B Y R Y AN B R E NNE CKE

hen giving nordic ski lessons at Mt. Bachelor, Dagmar Eriksson often comes across first-timers who assume they just can’t do it. “I always say, ‘Lady, you’re not too old,’” she says. “‘You can learn and you can be good at this.’” Eriksson, 65, ought to know. Until age 50, the longtime Bend resident considered herself reasonably healthy but certainly not an athlete. But a resolution to solo the multisport Pole Pedal Paddle led to a new passion, nordic skiing, and she now competes at an elite level in races around the globe. It’s made Eriksson a firm believer: When it comes to fitness and health, it’s never too late to start. “You’re never too old to learn anything,” she says. Her philosophy about staying fit is simple, even if such turns of phrase are often the subject of whole books. Exercise. Eat more vegetables than meat. Buy fresh, quality ingredients. Avoid fast food. Sleep. And, for health of mind, avoid negativity. “Body and soul have always been important in my life,” she says. “I like harmony around me; I like to be positive. I don’t like to be around

How does she do it? | DAGMAR ERIKSSON

Dagmar Eriksson holds the three medals, one gold and two bronze, she won in the 2006 Brusson Masters World Cup in Italy. Behind her are numerous other medals she has won nordic skiing.

MeetDagmarEriksson Age: 65 Activities: Nordic skiing, downhill skiing, running, biking, hiking, kayaking. On diet: “I like to eat well. If it’s richer, that’s OK,” she says. But she doesn’t like super-sweet treats and often chooses fish and vegetarianstyle fare over meat. On fast food: “I once had a fast-food hamburger. I think I ate half of it. I like hamburgers, but only when you’re making them at home on the grill.” On wellness: “You need to listen to your body,” she says. She presses herself hard during ski season but also tries to sleep well and rest when needed.

Page 16

negative people. The older I get, the less tolerance I have for it.” Growing up in Hamburg, Germany, Eriksson says she became fairly competitive in tennis. Later she moved to Munich, worked as an airline flight attendant and took up downhill skiing. A love of travel and languages brought her first to French-speaking Switzerland, then to the U.S., first to New York and then, later, San Francisco. After a few years, she prepared to move back to Germany. But right before leaving she met Nils Eriksson, a Swede who owned a business in the U.S. She did return to Munich, but Nils lured her back. They married and settled in the Bay Area. The couple enjoyed California, but Eriksson said her husband longed for a smaller locale with more outdoor opportunities. They visited Bend in 1985 and, on a whim, bought a house. “It was a rash decision,” she says. “We sold everything and moved up here.” Fast-forward to today, and Eriksson lives in a home perched across the Deschutes River from the Old Mill District. It’s in the middle of everything, yet feels quite tranquil. The couple is retired, although Eriksson has returned to work at Central Oregon Community College two days a week tutoring German and proctoring exams, and she teaches at the Mt. Bachelor Nordic Center one day a week. She also volunteers for organizations like The Nature of Words. And then, of course, there’s her training. Hitting 50 prompted Eriksson to solo the PPP for the first time, so she had to learn three new sports: road biking, kayaking and skate skiing. “Fifty, it just seemed so old,” she says, recalling her motivation. She took a class to learn to nordic ski and fell in love. She now skis, bikes, kayaks, hikes and runs to stay fit. And even though she competes in summer events — she holds the fastest time in her age group in the Pilot Butte Challenge, a race up the butte, at 13:10.9 — she’s always training for skiing. Eriksson often does her winter workouts alone, although sometimes she works with J.D. Downing, director of XC Oregon, an elite cross-country ski team, and Ben Husaby, a two-time cross-country skiing Olympian. She is also sponsored by Rossignol. When not on the snow, Eriksson says, she doesn’t worry about what she eats, although she says some American foods still don’t appeal to her even after decades of living here. She cooks cream sauces, drinks a glass of good red wine and nibbles on dark, almost bitter chocolate, but she avoids processed foods and finds American sweets too sugary for her taste. “I must say, I’ve never subscribed to the fast-food eating in this country, ever,” she says. “I buy as natural as possible, fresh ingredients, from the market when it’s going on,” she continues. “It’s all fresh. It’s not packaged — there’s not a sticker on everything.” Looking ahead, Eriksson is focusing on the cross-country skiing Masters World Cup in British Columbia in March. This year she’s moved into a new racing age group, 65-69. It doesn’t faze her. “When I was younger I was relatively fit,” she says, “but not even close to what I am now.” •

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Chronic insomnia | FIGHTING SLEEPLESSNESS

Why can’t I

sleep? Causes and cures for those restless nights BY BETSY Q. CLIFF

arrie Carney has a common problem. She’s tired. Often really, really tired. “I could take a two-hour nap every day,” she says. The gregarious 36-year-old Bend woman juggles caring for two young children, working as a vision therapist and running for exercise. She tries to get a good night’s sleep but sometimes wakes up in the middle of the night to go to the bathroom or with worries about her job or family. She often can’t get back to sleep. And, adding to her problems, there are nights when she snores so loudly she chases her husband to the living room couch. Last fall she had a three-week-long headache she attributed to fatigue. That scared her enough to make a doctor’s appointment. A month or so later, she found herself sitting in her pajamas at the High Desert Sleep Center in Bend. A sleep technician hooked seven electrodes to her head. She spent the night at the center doing a sleep study, and by morning, her sleep patterns had generated enough information for physicians to begin to get an idea of why Carney is so exhausted. Trouble sleeping is one

Page 19 THINKSTOCK

Chronic insomnia | FIGHTING SLEEPLESSNESS

“The number one reason that people have insomnia is that we live in such a hectic, busy world. Finally, when it comes time to turn the lights out, the brain says, ‘OK, now it’s my turn.’” Dr. David Dedrick, sleep specialist at High Desert Sleep Center of the most common complaints among American adults. A 2005 National Sleep Foundation study found that the majority of adults, about 70 percent, report they get less than eight hours of sleep a night, while 40 percent said they get less than seven hours, the amount most people need to stay healthy and alert. “Sleep is important for physical health,” said Rebecca Bernert, a fellow at Stanford University’s Sleep Medicine Clinic. “The evidence is overwhelming.” Lack of sleep has been linked to obesity, diabetes, high blood pressure, depression, anxiety, an increased risk of accidents and even death. Lab animals denied sleep die within weeks. Despite the consequences, many of us tolerate poor sleep night after night. Sometimes we chalk it up to being too busy to get in bed. Other times, we’re stressed out about something. But often we just shrug our shoulders and, as we down large cups of coffee, say we don’t know why we tossed and turned all night. The science of sleep is still in its infancy. Technology is allowing scientists to peer into the sleeping brain, though we still don’t know the answers to even some of the most basic questions, such as why we need sleep. But scientists are learning more and more about why we don’t sleep. There are a variety of physical conditions that can hinder sleep, and even when they are dramatic — sleep apnea so bad you temporarily stop breathing — people are often unaware they have them. There are also psychological reasons for sleeplessness. Sleep disturbance often comes with a diagnosed mental condition, but even an unquiet mind can do it. “The number one reason that people have insomnia is that we live in such a hectic, busy world,” said Dr. David Dedrick, a sleep specialist at High Desert Sleep Center. “Finally, when it comes time to turn the lights out, the brain says, ‘OK, now it’s my turn.’” Experts say that understanding why you’re not sleeping may go a long way to helping you sleep better. Sometimes you may need a professional; other times you may be able to help yourself into a good night’s rest.

Sleep disorders Sleep apnea is the most common condition seen by physicians who specialize in sleep. This condition is defined by pauses in breathing during sleep, and typically by loud snoring. People with apnea often don’t know they have it. They may go to the doctor because, even after a seemingly full night of sleep, they wake up tired.

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HIGH DESERT PULSE • WINTER / SPRING 2011

PHOTOS BY RYAN BRENNECKE

Corey Randolph attaches surface electrodes to Carrie Carney’s head in preparation for her sleep study at the High Desert Sleep Center in Bend. “If you have sleep apnea, your brain has to wake up repeatedly at night to send signals” to your upper airway to open up so you can begin breathing, said Dr. Akram Khan, a co-director at the Sleep Disorders Program at Oregon Health & Science University. “We have patients wake up anywhere from five to 100 times in an hour. So, pretty much, you’re not sleeping.” Often, because the level of arousal is not enough for the person to become conscious, Khan said, people are unaware they are waking up. Anyone can develop sleep apnea, but the risk is higher for men and those who are older or overweight. Because of the propensity to snore, bed partners are often the first to realize something is wrong. Not only does the condition exhaust you, it can lead to serious health consequences. “When you have these episodes,” Khan said, “you are kind of choking, so your body reacts the same way as if you were having your purse snatched or something.” Your blood pressure and heart rate shoot up. As this happens over and over, it can increase your chances of high blood pressure and heart problems. Anyone with suspected sleep apnea needs to see a physician. Mild sleep apnea can often be treated with lifestyle changes, in-

A CPAP machine fits over the nose and sometimes the mouth, and pushes a stream of air into the throat to keep the airway open.

Imitating her normal nightly routine, Carney reads a book while undergoing the study.

cluding losing weight, quitting smoking or avoiding alcohol close to bedtime. More severe apnea is most commonly treated with a device known as CPAP (pronounced SEE-pap), which stands for continuous positive airway pressure. A CPAP machine fits over your nose and sometimes your mouth, and pushes a stream of air into your throat to keep the airway open. While many people are loath to sleep with a large machine over their faces, Khan said patients with severe sleep apnea often find they feel so much more rested that they will tolerate it. There are other sleep disorders that can keep you up at night. Restless leg syndrome, in which relaxing or lying down brings on an unpleasant tingling sensation in the legs, occurs in somewhere between 2 and 10 percent of the population. Though the disorder is not well understood, it seems to occur when the chemical dopamine is dysfunctional in a particular part of the brain that regulates muscle movement. The condition is more common in women and in older people. Relief can sometimes be achieved by simple movements of the legs plus a number of lifestyle changes, including increasing exercise and vitamin intake and decreasing alcohol, tobacco and caffeine use. Many people also find relief by using medications that increase dopamine.

Age and sleep More than any other factor, age affects how well we sleep. Both our ability to sleep well and what experts call our sleep structure — how often we wake up and how long we spend in various stages of sleep — is influenced by age. Newborns, according to the National Institutes of Health, spend up to 18 hours a day sleeping, about half of that in the deepest stages of COURTESY PHILIPS RESPIRONICS

HIGH DESERT PULSE • WINTER / SPRING 2011

Page 21

Chronic insomnia | FIGHTING SLEEPLESSNESS sleep. As we grow into adulthood, the hours of sleep we need and the amount of time we spend in deep sleep decreases. But once we become adults, our sleep needs do not decrease, even into old age. Aging can, however, affect how well we sleep. “You can’t do a lot of things the same way as when you were younger. Sleep seems to be one of those things,” said Michael Vitiello, a professor of psychiatry and behavioral sciences at the University of Washington who has done considerable research on sleep in the elderly. Vitiello said that just as the muscles lose mass and bones lose density, the brain also changes with age. “It may be and probably is that some of these neurological changes alter the ability to generate sleep.” Many older people, Vitiello said, may lose a half hour or even an hour of sleep but have few daytime effects. These people, he said, do not usually need treatment. In addition to brain changes, there are a host of other things that can disturb sleep in older people. First, because they are spending less time in deep sleep than children or young adults are, they may be more easily roused throughout the night. Then, there are myriad medical conditions that are common in older adults and that can disturb sleep. A partial list includes heart, kidney and pulmonary problems, neurological conditions and chronic pain, as well as conditions common in all ages, including depression and anxiety. Lastly, hormonal changes, particularly in women, can interfere with sleep. Vitiello said that women going through menopause are more likely to develop insomnia than many other groups. “Estrogen and progesterone have impacts on sleep. They both really provide for a greater depth of sleep.” Progesterone, in particular, is a powerful sedative, he said. Though many women blame sleep disturbances on hot flashes in menopause, Vitiello said research shows there’s not a clear relationship. Sometimes a hot flash can wake a woman up, though sometimes she’ll sleep right through it or wake up before one. For menopausal women, however, synthetic hormones aren’t the answer. “Unfortunately, just taking estrogen as a pill doesn’t seem to help,” Dedrick said. “It’s probably not just blood levels of estrogen (that are affecting sleep). It’s probably that there are very specific pulses of estrogen within the brain that the brain has to be seeing” and that synthetic estrogen cannot replace.

Insomnia

1460 NE Medical Center Drive Bend, OR 97701 • 541-382-9383 www.corapc.com in conjunction with www.cascademedicalimaging.com

Sometimes doctors see people who just don’t sleep well. They lie in bed for hours trying to fall asleep. Or they wake up in the middle of the night, fully alert, and no matter what they try, they can’t go back to sleep. During the day, they have trouble functioning. They feel as if they need a nap. They have trouble staying awake through meetings and, sometimes, even drift off while driving. When there’s no identifiable physical cause for these symptoms, these people are diagnosed with insomnia. There are two types of insomnia. In one, people have trouble falling asleep at the beginning of the night. This is often the product of bad sleep habits. For some,

Page 22

HIGH DESERT PULSE • WINTER / SPRING 2011

when they get in bed, “it’s the first time people have been quiet with themselves all day,” said Brian Evans, a sleep psychologist in Bend. “They lie in bed and think their way through their feelings.” Once you do that for a night or two, it can become a habit. “A pattern forms,” explained Wil Pigeon, a sleep psychologist at the University of Rochester Medical Center. “You become used to having the brain turned on, or the brain becomes used to being turned on, and you develop chronic insomnia.” Though this type of insomnia can happen to anyone, people who are “prone to excessive thinking and ruminating” are more likely to develop it, Pigeon said. “It’s tougher for them to turn down the volume on their thinking.” Sometimes it’s not our emotional processing that’s turning our brain on, but instead the effects of electronic gadgetry. Our brains are hardwired to fall asleep when it begins to get dark. In today’s world, however, we can trick our brains into believing it’s the middle of the day. A common reason for having trouble falling asleep, Dedrick said, is using a computer, cell phone, television or anything with a lit screen just before going to bed. The sleep-inducing hormone melatonin, he said, “is supposed to be produced at that time (of night) and the bright light suppresses the melatonin.” When that hormone is suppressed, we don’t feel the sleepiness that relaxes our body and lets us drift into sleep. The second type of insomnia occurs when people wake up in the middle of the night and have trouble falling back asleep. Dedrick said this is often because of some other medical condition. “The difficulty maintaining sleep throughout the night usually implies that there is something going on waking you up,” he said. He cited depression, chronic pain or sleep apnea as common examples. People who are anxious, either naturally or as the result of a situation, may have trouble staying asleep at night as well, he said. During the night, people naturally cycle in and out of deeper and lighter stages of sleep, coming near to waking several times a night. “We all have little arousals out of sleep,” Dedrick said. At those times, “your brain does have the opportunity to say, ‘Aha. We’re awake.’ Some people do have that hyper-arousal state. They’re sleeping OK, and then the slightest little thing and, boom, their brain is turned on.”

Sleeping better

American adults reported how much sleep they get each night in a study published in 2009.

5 or fewer hours... 8%

Page 23

6 hours... 21%

9 or more hours... 9%

7 hours... 31% 8 hours... 32% Source: American Journal of Epidemiology

Note: Percentages do not add up to 100 due to rounding

How much do they sleep? Average hours per day Brown bat

Dolphin

Python

Baboon

20 18 17 16 16 15 14 12 12 11 11 11

Owl monkey

Human infant

Tiger

Squirrel

Lion

After a few bad nights of sleep and subsequent foggy days, most of us try, first, to help ourselves. We resolve to go to bed earlier. We flip off our light and will ourselves to go to sleep. “What do we do when we don’t sleep well? We try harder,” said Stanford University’s Bernert. But, she said, that natural response can, paradoxically, make things worse. “We can’t control when sleep does or doesn’t occur,” she said. But she and other experts said there are ways to make it more likely. There are a number of things people commonly try, including alcohol, over-the-counter drugs, prescription medications and alternative remedies. None of these, experts say, will cure chronic insomnia. At best, they can relieve problems for a few nights. At worst, such as with drinking alcohol right before bed, they may make things worse. Alcohol tends to fragment sleep, experts say, causing people to wake up more often at night. Continued on Page 50

HIGH DESERT PULSE • WINTER / SPRING 2011

How much do we sleep each night?

Cat

Mouse

Rabbit

Duck

Dog

Photos from The Associated Press and Thinkstock

10 10 10 9 8 6 5 4 4 4 3 2

Chimpanzee

Guinea pig

Pig

Gray seal

Goat

Cow

Sheep

Elephant

Horse

Giraffe

Source: National Institutes of Health

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On the job | HARP THERAPIST

David Nelson listens as Donna Rustand plays the harp at St. Charles Bend.

BY BETSY C L IFF • PHOTOS BY PETE ERIC KSON

Medicinal music H Hospitals embrace the soothing, healing quality of the harp

HIGH DESERT PULSE • WINTER /SPRING 2011

ospitals are not always conducive to resting. There’s the whir and beep of machines, the interruptions of nurses and doctors, the groaning of other patients and the rush of busy medical staff. But every once in a while at some hospitals, including St. Charles Bend, there’s the lulling sound of the harp. “The hospital environment is not an implicitly relaxed environment,” said Dr. John Zachem, a hospitalist at St. Charles. The harp, he said, “just helps bring that level of stress down and I think it does

Page 25

On the job | HARP THERAPIST help ease the tension.” Most often, the harp at St. Charles is played by Donna Rustand, a certified harp therapist. She’s often called into the hospital or to hospice programs to play for patients. Harp therapy isn’t just playing music. Rustand, 73, performs at weddings or funerals, but she says playing for patients is different. “It isn’t music for entertainment; it’s medical-type music. You don’t just go in there and do glissandos and all that stuff.” Rustand is certified by the International Harp Therapy Program, one of several such programs in the country. There, she said, she learned how to use the harp to make patients feel better. Sometimes that means helping them relax, easing their pain or, as is often the case for patients in hospice, helping them let go and die peacefully. The instrument can be very powerful, Rustand said. One day she arrived at the room of a St. Charles patient who was in a great deal of pain. A nurse was getting ready to give pain medication but left before administering it. Rustand began playing and it took a few minutes for the nurse to come back. By the time she did, the patient had gone to sleep. “There’s something unique about the harp,” Zachem said. “It is very soothing.” Rustand goes to the hospital when called by a staff member, either because a patient or physician has requested that she come play. She doesn’t plan what she’s going to play, she said, instead taking her cues from the patient

and improvising much of her music. Often, she’s playing for patients who are near death. She may sit for half an hour or more, sometimes striking the same note over and over, or playing very tonal music. While these sounds might bore those who are awake and alert, she said, they are good for those who are sick. “You’re trying to help them release and let go.” Familiar music, she said, “just kind of grounds them.” Rustand has long been involved in music but didn’t begin studying the harp until she was in her 60s. A third-generation Bendite, Rustand earned degrees in music at the University of Oregon and Western Oregon University. She taught music in elementary schools in the Bend-La Pine school district. While at UO, she recalled gazing at the harps in the school’s harp studio. “It just fascinated me,” she said. But harps were expensive, and she was already busy playing other instruments — the trumpet was her main

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one — and learning to teach music. Several decades later, Rustand was part of a trumpet and harp duo at a funeral. “I was just mesmerized,” she said. “After the funeral, I said (to the harpist), ‘I would really love to learn to play the harp. Can you put me in touch with someone that could help me learn?’” Instead, the harpist gave her the harp to take home. Soon Rustand enrolled in a harp therapy program that came to Bend. She had thought the program would include a lot about playing the harp. She was wrong. Instead, Rustand said, the focus was on how to read patients’ signals to figure out when the music calmed them and when it was agitating. The classes discussed the psychology of illness, she said, and how to help hospitalized patients relax. For two years, Rustand worked through the therapy program. “It was intense,” she said. “I didn’t work as hard on my master’s as I did on this.” These days, she plays for patients at St. Charles Bend on a volunteer basis, though she is paid by Partners in Care to play for patients at its inpatient hospice facility. Rustand said she loves playing and doesn’t mind that she often isn’t paid. She was diagnosed with multiple sclerosis more than 30 years ago and thought she’d be in a wheelchair by now. “What it’s doing is giving me purpose,” she said. “I think the harp has helped me, too.” •

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Get active |

SPRING SNOW

PH O TO BY ANDY TU LLIS

ith Broken Top in the distance, Kyle Phillips, of Seattle, launches his snowboard off of the cornice near the top of the Cirque Bowl during warm spring riding conditions at Mt. Bachelor last season. With good snowfall during the winter, the arrival of spring is a good time to enjoy everything that mountain resorts have to offer. â&#x20AC;˘

Get gear | SNOWSHOES

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• WINTER / SPRING 2011

Page 29

Healthy options | DINING OUT

Good choices at local eateries BY ALANDRA JOHNSON • PHOTOS BY ANDY TULLIS

oing out to eat is a really fun (and delicious) way to spend an evening. But it can be a tricky proposition for those of us looking to maintain a healthy diet. With the help of Bend Memorial Clinic dietitian Eris Craven, we selected the following dishes to highlight as healthy choices. Because we don’t have exact nutritional information for each dish, these recommendations are best guesses based on basic guidelines. Craven offers these tips to help people make good choices while dining out:

1. Choose whole grains. 2. Watch portion sizes. 3. Choose a healthy protein, such as seafood or chicken. 4. Ask for accommodations, such as for dishes to be cooked in

less oil or for dressing to be served on the side. •

Page 30

HIGH DESERT PULSE • WINTER / SPRING 2011

Cioppino from High Tides (Bend)

“We slowly simmer clams, crab, shrimp and fin fish in a flavorful tomato based broth.” Comes with a side; we opted for salad, with vinaigrette on the side. ($18) • Or choose: Asian salmon

Cider spiced butternut squash salad from Bend Brewing Company

“Mixed greens topped with roasted butternut squash, roasted pumpkin seeds, red peppers and green onions.” Instead of blue cheese dressing, we opted for blue cheese crumbles on the side (and added just a few) and asked for the sesame-cilantro vinaigrette on the side. We also added a piece of grilled steelhead for extra protein. ($12.75) • Or choose: Hummus plate

Spicy chicken from Kona Mix Plate (Bend)

“All natural chicken breast or thigh meat broiled and topped with a spicy, garlicky sauce.” We got breast meat in the mini plate size and chose brown rice and steamed broccoli as our sides. The sauce contains no oil. ($6.75) • Or choose: Shrimp stir fry bowl

Mixed vegetable stir fry from Thai O (Redmond)

“Choice of meat with mixed vegetables in Thai stir fried sauce.” We chose the combination seafood as our meat option, with shrimp, squid and scallops. The manager said the food is cooked with very little oil. ($11 lunch; $14 dinner) •Or choose: Po Tak soup with seafood

HIGH DESERT PULSE • WINTER / SPRING 2011

Page 31

If you have been living with back pain or neck pain, are you really living? If you think you’ve tried everything, you need to read this. Pills and shots temporarily mask pain, and often times do more harm to the body than good. Surgeries are invasive, cause new pains, require weeks of downtime, and still may not be successful at treating the cause of the pain. It’s time to look at an alternative that avoids all of these downfalls because it is fundamentally different. Redmond Wellness & Chiropractic offers such an alternative with our

spinal decompression program that is like no other in Central Oregon. We know our program works because we have already seen outstanding success with our patients. People suffering from excruciating, lifestyle-altering pain have entered our program. When they completed our spinal decompression program, they were able to return to work, get back to the activities they love, and cancel those shots and surgeries!

The x-rays showed that I had degenerative disc disease and arthritis in the spine. The pain started in my right buttock, radiated across my thigh, and into my kneecap. Traditional chiropractic care hadn’t helped. After three treatments on the SpineMed table about 70% of the pain was gone. Upon completion of treatment I am 85% pain free, I can stand up straight and don’t have to lean over the shopping cart, and can walk almost a mile. Best of all, Mr. Grumpy is gone! --Dave D., Redmond, November 2010

Spinal decompression therapy uses state of the art equipment from SpineMed with a variety of technologies and therapies tailored to each patient’s needs. And it’s all completely noninvasive! You can get relief from:

• Back Pain

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Thanks to spinal decompression I feel better than I did before the pinched nerve in my back! According to the M.D. who read my MRI - my back was a mess and worn out with a lot of arthritis. He recommended a nerve block which didn’t help. The next recommendation was surgery. That’s when I visited Dr. Herrin at Redmond Wellness & Chiropractic and discussed spinal decompression. After 7-8 treatments I was pain free and off vicodin. I was even able to go back to work! I would recommend this as an alternative to anyone considering back surgery. The nurse called to tell me when the surgery date was scheduled, and I’m feeling so great that I canceled it! Thanks to everyone at Redmond Wellness & Chiropractic! --Steve L., Bend, June 2010

We are offering FREE examinations and consultations, so that anybody can learn if they can be helped with spinal decompression therapy without any ﬁnancial obligation.

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By proxy | MEDICAL DECISION-MAKING

GREG CROSS

If you can’t choose, who will? End-of-life planning is not just an issue for the elderly BY LILY RAFF

ate one night in January 1983, 25-yearold Nancy Cruzan’s car veered off the side of a road in Missouri. She was flung 35 feet from the old vehicle, which didn’t have seat belts. A state trooper found her lying facedown in a ditch. She had no pulse and likely hadn’t drawn a breath for 15 minutes, but paramedics managed to revive her. After a series of surgeries, Nancy was alive but in a coma. She could breathe on her own but couldn’t swallow, so she depended on a feeding tube. She was unable to respond to others. Her facial expression changed only when she appeared to be in pain. Three years passed before Cruzan’s parents and sister accepted the doctors’ prognosis that

HIGH DESERT PULSE • WINTER / SPRING 2011

she would not recover. They concluded that her comatose, bed-bound existence was not what Nancy would have recognized as life. So the Cruzans petitioned for a court order to remove the feeding tube. But their request was denied, and their case wound its way to the U.S. Supreme Court. Eventually, in 1990, the Cruzans prevailed, and the feeding tube was removed from Nancy’s throat. The family held vigil around her bedside until her death 12 days later. The saga garnered national media attention and launched a widespread debate about the ethics of life support and medical decision-making by proxy. In 1991, a task force was convened at Oregon Health & Science University to develop a way for Oregonians to express their end-

of-life preferences ahead of time. Today, patients have a quiver of legal documents — often called advance directives — that allow them to spell out their preferences and guide their own care in the event of a medical crisis. The forms not only help ensure that a patient gets the treatment he or she wants; they can also help family members avoid conflict with each other or costly, public lawsuits. “Most people think this is an elderly person’s issue, but all of the advance directive laws came about from cases … involving young people, not elderly people,” says Lisa Bertalan, an attorney in Bend. After Cruzan, for example, there was the case of Terri Schiavo, a 26-year-old Florida woman who suffered sudden cardiac arrest in February 1990. Schiavo lay in a persis-

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By proxy | MEDICAL DECISION-MAKING tent vegetative state for more than 15 years while her husband battled her parents in court over what she would have wanted. In March 2005, her husband won the right to have her feeding tube removed. Despite the stark warnings offered by these cases, few people take the time to put their desires in writing. A study by Johns Hopkins University published last year found that only 34 percent of adults have filled out advance directives, although 61 percent say they have preferences about the care they receive in the event of a crisis. “Here is what I tell my clients: We only die once,” says Steven Leventhal, an attorney in Bend. “And we plan for that with wills and trusts and other documents. But we’re likely to become sick, hospitalized or injured more than once.” Read on to learn about the five legal documents that could govern your health care in the event of a crisis:

1. Oregon Advance Medical Directive This seven-page document is the most expansive of the five listed here. It must be signed by two witnesses but does not require a lawyer. In fact, it’s available for free online (visit www.oregon.gov and search for “advance directive” to download the form)

“Most people think this is an elderly person’s issue, but all of the advance directive laws came about from cases ... involving young people, not elderly people.” Lisa Bertalan, Bend attorney

and at hospitals and health clinics. The form is broken into five parts. In one, a person may appoint a health care representative to make health-related decisions if he or she is unable to do so. The person may name an alternate and may limit these representatives’ decisions regarding life support, tube feeding and other issues. In another section, the person specifies his or her wishes if close to death, permanently unconscious, sick with an advanced progressive illness or suffering extraordinarily. Rita Olin is a professional fiduciary and guardian in Bend, which means she is sometimes appointed by a judge to manage an incapacitated person’s financial or health care decisions. She urges adults to make sure their parents have filled out advance directives. “Start these conversations while the person is still cognizant of what they want,” she says. “I know they’re difficult conversations,

but start them early because (otherwise) it will only get harder.” Olin recommends accompanying the parent to a doctor’s appointment and talking about it there. Especially if the parent has had the same doctor for many years, the physician could help make an awkward conversation seem less daunting. “Some doctors are really great at talking about it,” she says. “And an advance directive makes a lot more sense if a doctor can answer your questions (about feeding tubes, for example) as you read through it.”

2. Nomination of Guardian Olin remembers accepting a temporary appointment to help an elderly woman with advanced dementia. Olin was told that the woman had no fam-

A quick comparison of five medical planning documents What it does

Lawyer required/cost

If you don’t have one …

1. Oregon Advance Medical Directive

Specifies end-of-life care wishes. Names an agent to make medical decisions if you are incapacitated.

No; free.

Without it, doctors and family members must make decisions (in accordance with Oregon law).

2. Nomination of Guardian

Designates a guardian to make medical decisions if you become incapacitated. Allows you to define “incapacitated.”

Yes; legal fees.

Without it, the court may appoint a guardian, which can be a lengthy and costly process.

3. Durable Power of Attorney

Names a conservator to handle fiscal affairs if you are incapacitated. Specifies terms for a permanent transfer of power.

Yes; legal fees.

Without it, the court appoints a conservator; can be lengthy and costly. Health insurance providers might not consult with family.

4. Privacy Waiver (HIPAA waiver/release)

Allows doctors and nurses to speak to a designated family member or friend, whether or not you are incapacitated.

Most often yes; some health care institutions provide free forms.

Without it, health care professionals may not speak freely to family members.

No; free, but must be signed by a doctor.

Without it, life-saving measures may be administered against your wishes.

5. Physician Orders for Specifies the degree of medical Life-Sustaining Treatment intervention you allow if incapacitated by (POLST, “the pink form”) a severe or prolonged illness.

Page 34

HIGH DESERT PULSE • WINTER / SPRING 2011

What’s a guardian? ily. But she soon located several of the woman’s siblings, who lived in Portland. “It took a lot of work because, in her confusion, she had thrown away address books and things like that,” Olin recalls. “But we found (the siblings), and they were very concerned and wanted to be involved in this woman’s life.” Then, neighbors told Olin the woman did not have a positive relationship with these relatives. And none of the siblings were mentioned in the woman’s will. In court, a judge was left to determine the woman’s wishes. He eventually decided not to grant guardianship to her siblings. Meanwhile, the case was emotionally draining and expensive for the entire family. “It could have been avoided if she’d had an advance directive,” Olin adds. In the Oregon Advance Medical Directive, a person may appoint a representative to make health-related decisions if he or she becomes incapacitated. In addition to that form, a person may wish to have an attorney draw up a “nomination of guardian.” This form requires a lawyer. In this document, unlike in the Oregon Advance Medical Directive, the client may define at what point he or she should be considered incapacitated and health decisions transferred to the chosen guardian. And if a family dispute lands in court, this document could sway the judge toward appointing a particular person as guardian. If a patient becomes incapacitated and has not signed either of these documents, the court must appoint a guardian to make health-related decisions for the patient. One exception, by state law, is for cases in which a patient is on life support with no hope of recovery. Even without a guardian, hospital staffers will go down a state-mandated list until they find a person to make decisions on behalf of the patient. If the patient does not have an advance directive, his or her spouse is on top of the list. If the patient does not have a spouse, family members may unanimously select a representative. Otherwise, the adult children are in charge. If the patient has no adult children, a parent becomes the decision-maker. And so on. “For homosexual couples, it becomes that much more important (to have advance directives) because … the default laws do not give partners the same status as spouses. So the

HIGH DESERT PULSE • WINTER / SPRING 2011

patient’s partner would not, by law, be the first one in line to make decisions,” says Gary Bruce, an attorney for St. Charles Health System. In cases that do not involve life support, doctors will not rely on the state’s list, but rather wait for a court-appointed guardian to make decisions on behalf of the patient.

3. Durable Power of Attorney Just as a guardian makes care-related decisions, a conservator makes financial decisions on someone’s behalf. A patient may name his or her conservator in a form called a durable power of attorney. A lawyer must draw up this document. In Oregon, a durable power of attorney is not directly related to health care. But lawyers say it’s an important aspect of health care planning because without power of attorney, a guardian may not access bank accounts needed to pay a patient’s bills. In some cases, the patient’s insurance company may not be willing to speak to the guardian without power of attorney. “Durable” means that once a patient transfers his or her power of attorney to another person, it is permanent. The person may sign contracts or access bank accounts on behalf of the patient at any time the patient is unable to, for the rest of the patient’s life. Jonathan Basham, an attorney in Bend, says that when you sign a power of attorney document, you don’t immediately cede your right to access your own accounts and sign your own contracts. “As long as you can speak for yourself, then you’re the only person who can make legal or financial decisions,” Basham says. The form may be drafted to specify when the power of attorney is transferred from the patient to the conservator. Particularly in cases of dementia, it can be difficult to know exactly when a patient is unable to make sound decisions. So the document could contain some safeguards to prevent abuse. For example, Basham says he sometimes drafts documents that require two doctors to declare the patient unfit to make financial decisions. Basham, like all of the experts interviewed for this story, urges adults to talk about endof-life issues and put their decisions in writing while they’re still young and healthy. The

Page 35

Your guardian is the person who makes decisions about your care if you become unable to do so. If you have not named a person in your advance directive, a guardian may be appointed for you in court. By Oregon law, there are limits on the type of decisions this person can make. A guardian is prohibited from electing, on behalf of a patient:

• Admission to a mental health facility. • Convulsive therapy, formerly called electroshock therapy. • Psychosurgery, or brain surgery for a mental health disorder. • Sterilization. • Abortion. • Withholding or withdrawal of life support unless: • The patient has, in an advance directive, given permission for the representative to make this decision, or • Doctors have confirmed the patient is terminally ill, permanently unconscious or in the final throes of a progressive illness with no chance of improvement, or if life support could cause the patient permanent or severe pain with no benefit.

Who has the power to pull the plug? A patient lies in the hospital in a vegetative state, on life support. Brain scans and exams have caused doctors to believe the patient will never regain consciousness. Who gets to decide whether to continue life support or end it? By Oregon law, hospital staff will go down this ranked list until they find one of the following: 1 The person listed on the patient’s advance directive. 2 The patient’s spouse. 3 A representative selected unanimously by the patient’s family members. 4 A majority of the patient’s adult children. 5 Either parent of the patient. 6 A majority of the patient’s adult siblings. 7 Any adult relative or adult friend. 8 If none of the above exists or can be located, a patient may be removed from life support by order of the attending physician. Source: Oregon Revised Statute 127.635, 127.635

By proxy | MEDICAL DECISION-MAKING alternative, he says, is often ugly. If a patient becomes unfit to make decisions but has not formally granted power of attorney, a family member’s only choice is to file a petition for conservatorship, Basham says. That means taking the patient to court. “If you file a petition for conservatorship or guardianship, it’s basically a lawsuit,” he says. “You’re asking the court to deprive the incapacitated person of their right to make decisions. So think about if it’s your father or mother: They have to get served with papers that basically say that they’re loony and that their son or daughter has made these allegations. … It’s traumatic to go through that.”

4. Privacy Waiver Leventhal recommends that patients sign waivers to allow doctors and nurses to speak directly to a designated friend or family member. This is in addition to the Oregon Advance Medical Directive, which also includes a privacy waiver. But Leventhal points out that in

cases of dementia, for example, the advance directive doesn’t necessarily apply. There could be plenty of situations when it’s in a patient’s best interest to have a friend or family member accompany him or her to doctors’ appointments. So just as Leventhal recommends a formal nomination of guardianship in addition to the advance directive, he also recommends that patients sign a separate privacy waiver. A lawyer is usually needed to draft this document, although some clinics have their own waivers that could be used. The Oregon Advance Medical Directive doesn’t mention it by name, but a privacy waiver written by a lawyer will usually refer to a set of medical privacy laws known as HIPAA, which stands for the Health Information Portability and Accountability Act of 1996. In fact, sometimes the waiver is called a HIPAA waiver or HIPAA release. A waiver “could be useful even if you’re just going into the hospital temporarily and you need someone to be your voice for a while, to understand the nature of the sur-

gery or the illness,” Leventhal says. In Basham’s experience, doctors are often willing to share medical information with close family members, even if the patient hasn’t signed a waiver. “They want the best for their patients,” he says.

5. Physician Orders for Life-Sustaining Treatment The Physician Orders for Life-Sustaining Treatment (POLST) is usually filled out by a doctor on behalf of the elderly or very ill. The patient or a designated advocate must sign the back of the form, which is printed on both sides of a sheet of pink card stock and is often referred to as “the pink form.” On it, a patient indicates whether he or she would like to be resuscitated, intubated, placed on a respirator, fed through a feeding tube, given antibiotics and given other medical treatments. The form was developed after emergency medical technicians arrived at the home of

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Get ready | POST-PREGNANCY FITNESS

Coming back after the baby

Classes, gear and new approaches help moms regain physical fitness after giving birth BY ALANDR A JOHNSON

efore having a baby, Bend mom Amanda Ferrari fit into the athletic Bend mold. She loved mountain biking and running half-marathons. Ferrari was forced to slow down a bit after becoming pregnant and having her daughter, Evie. Getting back into shape after Evie’s arrival has been a big priority for this physical therapist. “I was motivated to not have to buy new clothes,” she joked. Ferrari had to adjust to changes in her body, which wasn’t always easy. She tried to return to running too soon after Evie was born and ended up with a lot of joint pain. Looking back, she would have been slower to transition to intense activity.

Page 38

Since running didn’t work out, for the first four months Ferrari opted to swim and join a cycling class where she could bring Evie along. The most challenging part of getting back into shape for Ferrari, particularly because she had a cesarean section, has been trying to regain strength in her deep core muscles. By the time her daughter was approaching 7 months old, Ferrari felt nearly back to her former shape thanks to workouts about five days a week, including plenty of running. Finding time to focus on fitness can be a challenge for new moms. Having a baby is an “overwhelming, all-consuming kind of thing,” said Dr. Virginia Lupo, chair of the Department of Obstetrics and Gynecology for Hennepin County Medical Center in Minnesota. In addition to changing all aspects of fam-

ily life — from finances to sleep — having a baby has a huge effect on a woman’s body. But giving up on fitness during pregnancy and early motherhood is not a good idea. Lupo says losing your fitness for six to nine months can make it very difficult to regain. Besides, she says exercise has many benefits for new moms, including boosting self-image and self-esteem. The American College of Obstetricians and Gynecologists also reports that physical activity has been linked with a decrease of postpartum depression.

Prac tice wh ile pregn an t One of the keys to getting into shape after giving birth is to be in shape beforehand. Dr. Todd Monroe, an obstetrician and gynecologist from St. Charles Ob/Gyn Redmond, says it is a misconception that women are physically limited during pregnancy. In general, women can continue their level of activity after becoming pregnant. A competitive swimmer can continue to swim and a mara-

HIGH DESERT PULSE • WINTER / SPRING 2011

Good baby gear Chariot: This is an enclosed trailer on skis that parents pull behind them while cross-country skiing.

Bicycle trailer: Also called a chariot, this device allows a parent to pull a child in a trailer behind them while riding a bicycle. There are other bike options, including front and back child seats that attach directly to the bike.

Jogging stroller:

Carrier: From slings to backpacks, there

These strollers feature three large, maneuverable, durable wheels and allow parents to take the stroller on rougher roads and paths.

are many ways to carry a child while walking or hiking. Consider the age and weight of the child, how the weight is carried on the parent (all weight on shoulders or dispersed to hips), cost, ease of use and durability.

Ski or spin, or something else Lori Hell pulls her infant daughter, Delaney, in a ski sled while cross-country skiing at Virginia Meissner Sno-Park. PHOTO BY RYAN BRENNECKE

Instructor Alli Jorgensen gives a bottle to 6-month-old Ryan Simpson during the Baby & Me spin class at Juniper Swim & Fitness Center while new moms Amy McCorkle, left, and Kristen Simpson go for a spin. PHOTO BY PETE ERICKSON

thon runner can continue to run. Monroe says the current recommendation is for pregnant women to get at least 30 minutes of exercise on most days of the week. After the 20-week mark in pregnancy, women should avoid activities that involve forceful pushing down, such as weight lifting or abdominal crunches on an incline, Lupo says. Women should also avoid any activity in which they could be hit in the belly, like downhill skiing. Swimming is a great activity, as is walking. Lupo’s basic rule of thumb is that a pregnant woman should be able to talk while working out and should never work out at a more intense level. (Those who are not pregnant may also want to keep most workouts at a level at which they can speak, but can increase the intensity on occasion.)

Coming back Monroe thinks most women begin to feel like their old selves about six months after giving birth. They will lose about 10 pounds

HIGH DESERT PULSE • WINTER / SPRING 2011

or so after delivery thanks to birthing the baby and placenta. After that, a reasonable goal is to lose about a pound a week. If a woman gained 30 pounds during pregnancy, that would leave about 20 pounds. Losing at a rate of a pound a week, it would take about five months to drop the excess weight. But while this formula may prove true for many people, it is best for women not to compare themselves with others (and especially to avoid comparing themselves with the celebrities who seemingly drop baby weight in days). “Don’t assume everything will be the same as before,” Lupo said. “There’s a lot of people who aren’t there in six months. I hate to give people unrealistic expectations.” Says Monroe: “The biggest obstacle to exercising is fatigue.” After about the first week, he said, women should be able to walk around the block. The next week, they can walk two blocks. After a vaginal birth, women can essentially resume whichever activity they choose

whenever they wish, Lupo said. In the weeks after delivery, women are at risk for complications, including blood clots. But taking a break from exercise isn’t the answer. Monroe says delaying physical activity can actually increase health risks. He offers this basic guide for physical activity: Do enough to cause a little pain, which can be treated with mild pain relievers; don’t do so much that you want narcotics. Women who undergo C-sections require longer recoveries. After about two weeks, Monroe says, most should be able to begin some moderate aerobic activity. Lupo says women should wait six weeks before performing any activity that uses their abs, including crunches and running.

Classes and options New moms may need to get creative when it comes to working out. Alli Jorgensen teaches Baby & Me Cycle classes at Juniper Swim & Fitness Center in

Page 39

Get ready | POST-PREGNANCY FITNESS Bend. Moms are encouraged to bring their babies to this spin class, which has been offered for about three years. She says it is a good option for moms who don’t feel ready to leave their babies in the center’s day care. The twice-weekly classes are drop-in. They are best for infants who aren’t very mobile, typically up to age 8 or 9 months. Jorgensen and a helper watch the babies, and moms are also welcome to stop the workout to soothe a fussing baby or to breast-feed. The workout doesn’t differ too much from a typical spin class, except that Jorgensen avoids too much steep hill work, which can be harsh on joints. She also adds a core workout at the end of class to help build back ab muscles. Jorgensen says this is important work for new moms because it can help them with posture, which can be particularly bad after spending most of the day hunched over the baby. The biggest benefit of the class, however, may not be the workout. The moms in the class, including Evie’s mom, Ferrari, love the camaraderie and support of the group. Shannon Swedenborg thinks the support new moms receive is one of the big reasons they keep coming to her Stroller Strides classes. Moms meet several days a week and work out together while pushing their kids in strollers. The class is for moms with kids of any age who are comfortable in a stroller. In cold weather, classes take place inside the Boys & Girls Club in downtown Bend, but when the weather warms up, they

At the Boys & Girls Club in downtown Bend, moms meet several days a week to exercise in the Stroller Strides class. From left: Shellie Short — with her kids, 7-month-old Spencer and Lily, 3 — works out alongside instructor Kelly Hunt and another mother, Holly Hansen, with 1-year-old daughter Brooklynne, all of Bend.

move outside. The classes include a lot of cardio as well as strength training. Swedenborg was a participant in the classes before taking over ownership. She liked having a little bit of accountability, knowing other class members would miss her if she didn’t attend. She also appreciated the understanding she got from other moms. Swedenborg had tried going to a traditional aerobics class at a gym and felt frustrated and out of place. “We’ve all been there. We all understand,” she said. She credits the classes with helping her get back into shape pretty quickly after her first

ANDY TULLIS

son was born. Within a year, she says, she felt even better than before getting pregnant. Joining one of these classes, however, isn’t always an option. Lupo says moms may also want to catch shorter bursts of exercise — say a quick exercise tape while baby naps. Moms can also use some of the gear that allows them to bring baby along on a workout. Babies can tag along on a jog, a hike, a bike ride or even a ski. There is good reason to make fitness a priority, no matter how moms squeeze it in. “You really do need to take care of yourself to be a good mom,” Swedenborg said. •

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231 East Cascades Avenue • Sisters

541-382-4900

www.bendmemorialclinic.com

JEFFREY P. BOGGESS, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

AMY DELOUGHREY, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

MAY S. FAN, MD

Bend Memorial Clinic

231 East Cascades Avenue • Sisters

541-382-4900

www.bendmemorialclinic.com

STUART G. GARRETT, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ALAN C. HILLES, MD

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

CHARLOTTE LIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

DANA M. RHODE, DO

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

HANS G. RUSSELL, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ERIC J. SCHNEIDER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

CINDY SHUMAN, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

EDWARD M. TARBET, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JOHN D. TELLER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

THOMAS A. WARLICK, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

RICHARD H. BOCHNER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ELLEN BORLAND, FNP

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ARTHUR S. CANTOR, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

SIDNEY E. HENDERSON III, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

SANDRA K. HOLLOWAY, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JENNIFER SEMMELROTH, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

GAYLE E. VANDERFORD, RN, MS, ANP

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

1016 NW Newport Avenue • Bend

541-389-1107

www.contemporaryfamilydentistry.com

DERMATOLOGY

ENDOCRINOLOGY

FAMILY MEDICINE

GASTROENTEROLOGY

GENERAL DENTISTRY

BRADLEY E. JOHNSON, DMD

Contemporary Family Dentistry

GYNECOLOGY

MARIA M. EMERSON, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

ELIZABETH MCCORKLE, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

2011 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

HOSPITALIST JOHN R. ALLEN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

MICHAEL GOLOB, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ADRIAN KRUEGER, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

SUZANN KRUSE, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

PHONG NGO, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

MICHAEL N. HARRIS, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ANITA D. KOLISCH, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

MATTHEW R. LASALA, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

KAREN L. OPPENHEIMER, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

MATTHEW REED, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

M. SEAN ROGERS, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

DAN SULLIVAN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

2200 NE Neff Road, Ste 302 • Bend

541-388-3978

www.deschutesosteoporosiscenter.com

INFECTIOUS DISEASE JON LUTZ, MD INTERNAL MEDICINE

INTERNAL MEDICINE, OSTEOPOROSIS & BONE HEALTH MOLLY OMIZO, MD

Deschutes Osteoporosis Center

NEPHROLOGY MICHAEL E. FELDMAN, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

RICHARD S. KEBLER, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

RUSSELL E. MASSINE, MD, FACP

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

ROBERT V. PINNICK, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

2275 NE Doctors Drive • Bend 2863 NW Crossing Dr, Ste 100 • Bend

541-330-6463

www.northstarneurology.com

NEUROMUSCULAR, NEUROPHYSIOLOGY CRAIGAN GRIFFIN, MD

NorthStar Neurology NorthStar Neck & Back Clinic

NEUROSURGERY MARK BELZA, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

RAY TIEN, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

BRAD WARD, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

NUTRITION ERIS CRAVEN, MS, RD, LD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

ANNIE WILLIAMSON, RD, LD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

THEODORE A. BRAICH, MD

Bend Memorial Clinic

Bend Eastside & Westside

541-382-4900

www.bendmemorialclinic.com

KATIE FIFER, PA-C

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

WILLIAM SCHMIDT, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

HEATHER WEST, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

BRIAN P. DESMOND, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

THOMAS D. FITZSIMMONS, MD, MPH

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

ROBERT C. MATHEWS, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

SCOTT T. O’CONNER, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

ONCOLOGY

OPHTHAMOLOGY

2011 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

OPTOMETRY BRIAN ARVIDSON, OD

Bend Memorial Clinic

Bend Eastside & Westside

541-382-4900

www.bendmemorialclinic.com

DARCY C. BALCER, OD

Bend Memorial Clinic

Bend Eastside & Westside

541-382-4900

www.bendmemorialclinic.com

1475 SW Chandler, Ste 101 • Bend

541-617-3993

www.drkeithkrueger.com

ORAL & MAXILLOFACIAL SURGERY KEITH E. KRUEGER, DMD, PC

Keith E. Krueger, DMD, PC

ORTHOPEDIC SURGERY, FOOT & ANKLE ANTHONY HINZ, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

JEFFREY P. HOLMBOE, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

JOEL MOORE, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

ORTHOPEDIC SURGERY, JOINT REPLACEMENT KNUTE BUEHLER, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

MICHAEL CARAVELLI, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

JAMES HALL, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

ORTHOPEDIC SURGERY, SPORTS MEDICINE TIMOTHY BOLLOM, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

SCOTT T. JACOBSON, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

BLAKE NONWEILER, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

ORTHOPEDIC SURGERY, UPPER EXTREMITY MICHAEL COE, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

SOMA LILLY, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

JAMES VERHEYDEN, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

2075 NE Wyatt Ct • Bend

541-382-5882

www.partnersbend.org

PALLIATIVE CARE LISA LEWIS, MD

Partners in Care

PEDIATRIC DENTISTRY STEPHANIE CHRISTENSEN, DMD

Deschutes Pediatric Dentistry

1475 SW Chandler Ave, Ste • Bend

541-389-3073

www.deschuteskids.com

STEVE CHRISTENSEN, DMD

Deschutes Pediatric Dentistry

1475 SW Chandler Ave, Ste • Bend

541-389-3073

www.deschuteskids.com

PEDIATRICS KATHLEEN BAUMANN, MD

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

KATE L. BROADMAN, MD

Bend Memorial Clinic

Bend Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

RICK G. CUDDIHY, MD

Bend Memorial Clinic

Bend Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

KATHRYN LEIN, CPNP

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

MICHELLE MILLS, MD

Bend Memorial Clinic

Bend Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

JB WARTON, DO

Bend Memorial Clinic

Bend Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

PHYSICAL MEDICINE & REHABILITATION TIM HILL, MD NANCY H. MALONEY, MD

The Center: Orthopedic & Neurosurgical Care & Research Bend Memorial Clinic

JAMES NELSON, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

LARRY PAULSON, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

DAVID STEWART, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

JON SWIFT, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

VIVIANE UGALDE, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

MARC WAGNER, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

2011 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

PSYCHIATRIC NURSE PRACTITIONER NICK CAMPO, PMHNP

Life Works of Central Oregon

39 NW Louisiana Avenue • Bend

541-382-8862

www.lifeworksofbend.com

PULMONARY JONATHON BREWER, DO

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

RODNEY GARRISON, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

T. CHRISTOPHER KELLEY, DO

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

JONATHON MCFADYEN, NP

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

LYNETTE SPJUT, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

GREG BORSTAD, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

MATTHEW COOK, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

1655 SW Highland Ave, Ste 6 • Redmond

541-923-2019

www.drherrin.com

NorthStar Neurology NorthStar Neck & Back Clinic

2275 NE Doctors Drive • Bend 2863 NW Crossing Dr, Ste 100 • Bend

541-330-6463

www.northstarneurology.com

TIMOTHY L. BEARD, MD, FACS

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

GARY J. FREI, MD, FACS

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

DARREN M. KOWALSKI, MD, FACS

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ANDREW SARGENT, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JENNIFER TURK, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JEANNE WADSWORTH, MS, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ERIN WALLING, MD, FACS

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JEFF CABA, PA-C

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

ANN CLEMENS, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

TERESA COUSINEAU, PA-C

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

J. RANDALL JACOBS, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

AMEE KOCH, PA-C

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

JIM MCCAULEY, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

JAY O’BRIEN, PA-C

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

CASEY OSBORNE-RODHOUSE, PA-C

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

LAURIE D. PONTE, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

PATRICK L. SIMNING, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

SEAN SUTTLE, PA-C

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

ERIC J. WATTENBURG, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

THOMAS H. WENDEL, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

BRENT C. WESENBERG, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

Advanced Specialty Care

2084 NE Professional Court • Bend

541-322-5753

www.advancedspecialtycare.com

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

RHEUMATOLOGY

SPINAL DECOMPRESSION, AUTO ACCIDENTS DAVID HERRIN, DC

Redmond Wellness & Chiropractic

STROKE AND NECK & BACK RICHARD L. KOLLER, MD SURGICAL SPECIALIST

URGENT CARE

VARICOSE VEIN & GENERAL SURGERY G. RODNEY BUZZAS, MD, FACS VASCULAR SURGERY JOSEPH COLELLA, MD

What is a safe amount to drink? For the most part, women are told there is no safe amount of alcohol to drink during pregnancy. The truth is doctors simply don’t know whether any amount is safe, and so they must err on the side of caution. Some doctors, however, do tell women that a single glass of wine won’t do any harm. Dr. Susan Astley, who has been studying fetal alcohol syndrome for 30 years, recently decided to check that notion against her database of 1,400 patients. She identified five women claiming to have had only a single glass of wine who gave birth to a child with full FAS. Other doctors disagree, saying it is unlikely that women who limit themselves to a single drink a day will put their baby at risk. But nobody knows exactly where to draw the line. For the developing fetus, alcohol is actually more dangerous than crack, cocaine or heroin. “It’s always shocking to people that it’s the legal drug that is the most toxic to the developing fetus,” Astley said. “I’m not saying illicit drugs, coke or crack, are good for you. But when it comes to which one causes more damage, hands down, alcohol.” Alcohol is particularly dangerous because it can pass through membranes in the body with ease. It is not filtered out by the placenta and can cross directly into the brain, where it kills developing cells. “In the brain specifically, what happens is the cells die, but also cells that are supposed to move from one position to the other are affected,” said Dr. Judith Eckerle Kang. “Sometimes you can actually see a kind of smoothness in the brain, because the number of folds didn’t really develop. The cells didn’t march along like they were supposed to.” Still, doctors can’t explain why some children will be profoundly affected by alcohol while others seem to do OK. There have been cases of twins in which one was born with full-blown FAS and the other was unaffected. But experts say it’s a dangerous game, where the benefits are fleeting and the potential consequences devastating. “How much do you enjoy that glass of wine that you would risk the brain development of another human being?” Astley asks. “Are you feeling lucky? Do you want to gamble?”

Cover story | RISKY ADOPTIONS Continued from Page 13 about an old traffic citation on Richard’s record and because the couple had submitted police records from the county sheriff rather than the city police. After much wrangling, the judge approved the adoption. But it was late in the day and the adoption agency still had to secure a visa for Max. The agency representative sent the Hetheringtons, exhausted from the emotion of the courtroom, back to their hotel room for one last wait. It was past midnight when she brought Max to their hotel room. None of them slept much that night. The next morning, the Hetheringtons took Max down to the restaurant for breakfast. When he saw food being taken to another table, he cried and screamed, accustomed to the gorge-or-go-hungry routine of the orphanage. Eventually they decided it would be safer to feed him in their hotel room until they could fly home. Their flight wasn’t scheduled to depart for another four days, but they changed their tickets to fly out the next day. “We got on that plane and we looked at each other and said, ‘We are never going back to that country ever again,’” Laurie said. But on their home turf, the challenges continued. They were first-time parents dealing with a child who understood no English, had never eaten Western food and was well behind on his developmental milestones. “I thought I was going to raise a family. We’re going to go to the park, we’re going to play baseball and we’re going to be the perfect little family,” she said. “And it’s just not.” Max just wasn’t fitting in with his new environment. He had trouble with appropriate behavior and controlling his actions. He didn’t understand “gentle” or “mean”; he would punch or hit other children without comprehending that he had done anything wrong. “I think the hardest thing is that it’s an invisible disability. He doesn’t look mentally retarded. He’s doesn’t have Down syndrome,” Laurie said. “People look at him and he doesn’t get a break. You think he’s

“Even among the ... Eastern European adoption community, it’s still a hush-hush disability. ... You’re not embraced when you walk in with your FASD kid. Nobody wants anything to do with you.” Lisa Glasgow, a member of the Virginia chapter of the National Organization on Fetal Alcohol Syndrome and the mother of two FAS children

Page 46 PHOTO: THINKSTOCK

the bad kid at the party, that he’s rude and can’t control himself. Well, he can’t.” None of her friends volunteer to watch her son for the afternoon. Nobody invites Max over for playdates or arranges child swaps. “Probably for the first hour you’re around him, he’s handsome, he’s adorable, he’s friendly, he’s happy, he’s loving,” Laurie said. “But spend 24 to 48 hours with him and put him with his peer group, you start thinking, ‘What’s wrong with him?’ You start being judgmental, because you think, ‘Can’t they train him?’” And Laurie understands. Sometimes she finds herself impatient or frustrated with Max’s behavior. “What do you think you’re doing? What is wrong with you?” “I have to stop and go, ‘Oh yeah,’” she said. ••• Parents of children with FASD often feel isolated and alone, said Lisa Glasgow, a member of the Virginia chapter of the National Organization on Fetal Alcohol Syndrome. “Even among the Russian-Ukrainian-Eastern European adoption community, it’s still a hush-hush disability,” Glasgow said. “They will call it attachment disorder, reactive attachment disorder, ADHD, sensory disorder. They will call it everything but FASD.” It’s easy for parents to attribute almost any FAS symptom to the effects of being in an orphanage. The entire experience can be severely traumatic, and some children never develop the ability to bond with their parents. Children in orphanages typically have delayed growth, delayed speech, delayed development. So when a child can’t speak by 3 or isn’t potty-trained by 5, it’s easier to attribute it to environment than to biology. Glasgow and her husband adopted a boy and a girl from Russia 10 years ago. Their son, Sasha, adopted at 2, had been taken from his parents because of neglect, so doctors flagged him as being at high risk for FAS. Their daughter, Anzhella, was only 12 months old, and doctors had no concerns about her.

HIGH DESERT PULSE • WINTER / SPRING 2011

“I think the hardest thing is that it’s an invisible disability. He doesn’t look mentally retarded. He’s doesn’t have Down syndrome. People look at him and he doesn’t get a break. You think he’s the bad kid at the party, that he’s rude and can’t control himself. Well, he can’t.” Laurie Hetherington, Max’s mom, shown with her husband, Richard, and sons, Mikhal and Max

“They kept saying that Anzhella would be just fine. Well, I’m running with that because that’s what I want to hear. So I did live with that denial for a while,” she said. “Even when I knew she was permanently disabled, initially I would say she was on the autism spectrum. Even I would not say she has fetal alcohol spectrum disorder.” Glasgow still cannot fully explain her reluctance, caught up in the cloud of denial that seems to envelop the FAS adoption world. “I think part of it is you don’t want to admit that it’s permanent. You want to hope that they will outgrow it, that she is going to be just fine,” Glasgow said. “There is a grieving process. All these things that you wanted to do with your child, you grieve it, and then you live the new dream for them. We weren’t emotionally or financially prepared for it, and at times, you’re bankrupt both emotionally and financially.” In many circles, the FAS family is almost ostracized. The affected child is a rude reminder for other parents who adopted from the region, forcing them to acknowledge their fears that their children could face the same fate. “When you’re in that community, you’re not embraced when you walk in with your FASD kid,” Glasgow said. “Nobody wants anything to do with you.” It is perhaps human nature that those most at risk have the greatest reason for denial. “We have some resistance even among our membership to recognize that FAS and FASD can be a big problem and can be more prevalent than parents necessarily want to admit,” Gainor said. “People consider it like a life sentence and

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A cure for fetal alcohol syndrome? Researchers at the University of Minnesota are testing the ability of a vitamin called choline to treat the effects of fetal alcohol exposure.Previous studies involving rats showed that giving choline to rats who were exposed to alcohol in the third trimester significantly reduced the severity of overactivity and spatial learning deficits.The benefits lasted for months after treatment, and even adolescent rats given choline showed improvement. The researchers are now enrolling children from 2½ to 4½ diagnosed with fetal alcohol spectrum disorders.According to Dr.Judith Eckerle Kang, one of the researchers involved in the study, the doses being given to the children do not exceed the recommended daily allowance (RDA) for choline.If the study proves effective, doctors may start recommending choline as a precaution for children adopted from countries with high alcoholism rates.“All of us should get the RDA of most vitamins, so at this point, we would not see a reason to not do the RDA,” Kang said.“But again, we don’t know if there will be any side effects, so I can’t technically recommend that.”

in some cases for the child it can be. As adults, for kids with full-blown FAS, sometimes the options are institutionalization, whether that’s in the criminal system or residential setting. That’s hard for a lot of parents to accept.” ••• But despite the risks, adoption from Eastern European countries is popular because it is one of the few places in the world where Caucasian couples can adopt children who look like them. The process, although lengthy and burdensome, is predictable. Pay your money, pass the cursory home and parenting tests, and you’ll get a child. Especially if you can put up with the bait-and-switch tactics from the orphanage. Parents sometimes arrive to find their child has a sibling or two at the orphanage they had never been told about. Wouldn’t they take the little

sister as well, to keep the family together? Charisse Cossu-Kowalski and her husband adopted two boys, one 2 years old and the other 22 months old, from Russia in 1996. The younger one had all the hallmarks of fetal alcohol syndrome. When they told the facilitator from the adoption agency about their concerns, he pressured them to take both boys. “‘If you don’t take him, you won’t get the other one either, and you’re going to walk out of here with nothing,’” she recalls him saying. “He had our life savings, our passport, everything. There was a bit of intimidation.” When they returned to Macomb County, Mich., their doctors told them their son was probably the only one with fetal alcohol syndrome in the county. But soon she met a woman whose grandchild had FAS. As more affected children surfaced, they formed the Macomb

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Picture this |

Mouth

Salivary glands

Mouth

Tongue

DIGESTION

We put bite-size pieces of food into our mouths, where they are cut up and crushed by the teeth. The tongue pushes food between the teeth, using flavor to detect spoiled or poisonous food. Saliva lubricates the food and contains amylase, a starch-breaking enzyme. The chewed-up, salivated chunk of food, called a bolus, is swallowed.

Teeth

A gut reaction “M

Epiglottis

Esophagus

Pharynx Esophagus

BY ANDY ZEIGERT

Stomach

an is what he eats.” So says 19th-century philosopher Ludwig Feuerbach. And he was absolutely correct. Nearly all of the tissue and chemicals in our body are derived from the food we eat. But how does the body convert the on-average one ton of food each of us eats per year into energy and new tissue? Through a complex cascade of chemistry along the alimentary canal, a 25-foot digestive tract that breaks raw materials down into pieces small enough for cells to absorb.

Bolus (food)

The stomach acts as a digesting tub, producing powerful enzymes such as pepsin, which start to split the material into smaller pieces. The stomach also produces hydrochloric acid, which kills harmful germs. The stomach wall is coated with mucus to prevent self-digestion. By the time the bolus arrives at the pyloric sphincter at the bottom of the stomach, it is a semi-fluid consistency called chyme.

Small intestine

Liver

Fuel for living The body procures essential fuels from the food we eat: Proteins, used in construction and repair. One-sixth of your body weight. Also used to create enzymes. Carbohydrates, used to fuel bodily processes and functions. Mainly in the form of glucose, the body’s preferred energy source. Lipids (fats and oils), used in both building and fueling the body. Essential in the construction of cellular walls. Vitamins, aid growth and development. Minerals, used in nerve and muscle development.

The bolus passes through the pharynx, whose main digestive-system job is to deliver the food from the mouth to the esophagus while staying clear of the trachea or nasal passages. Wave-like muscle contractions, called peristalsis, propel the bolus through the entire digestive system. This propulsion is strong enough to allow us to swallow upside-down. At the bottom of the esophagus is a sphincter, or valve, which manages the flow of the bolus into the stomach.

Pancreas (behind stomach)

Gallbladder

Throughout the roughly 1-inch diameter small intestine, the chyme is bombarded with enzymes produced in the pancreas, which help break it down further. Alkalines are also introduced to neutralize the stomach acid, as well as bile from the gallbladder to split up globules of fat that naturally Stomach form. The small intestine is vast, made up of coiling, internal folds and two levels of fingerlike structures called villi and microvilli, creating a surface area greater than that of a tennis Spleen court. This surface area is responsible for the absorption of nutrients from broken-down food.

Liver

Large intestine

Much of the nutrients absorbed in the small intestine are processed into usable materials in the liver. They arrive there through the bloodstream and through the lymphatic system. Carbohydrates and fats are metabolized here, as are proteins. Proteins contain extra nitrogen, which is converted into urea and released into the bloodstream, where it is later filtered out by the kidneys and excreted in urine. Small intestine

Appendix Rectum

Large intestine

From the small intestine, material moves into the large intestine, or colon. Here excess water is reabsorbed from the processed food, making the waste, or fecal matter, more manageable. This matter is made up of undigested food, usually cellulose from dietary fiber, leftover digestive juices and bile, sloughed off intestinal cells and dead and dying bacteria. From here the fecal matter is stored in the rectum until it is convenient to pass out of the system. •

Source: “The Human Body,” Arch Cape Press ILLUSTRATION BY ANDY ZEIGERT

HIGH DESERT PULSE • WINTER / SPRING 2011

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Continued from Page 23 While prescription medications may help if you have an acute problem, such as a bout of stress that is keeping you from sleeping, most sleep experts discount the effectiveness of medications for insomnia. “There’s no pill to fix insomnia,” said Dr. Jonathan Brewer, a sleep medicine specialist at Bend Memorial Clinic. “It’s a crutch to fix the symptoms. It’s not fixing the problem itself.” Instead, experts now recommend the only known long-term cure for insomnia: sleep-specific cognitive behavioral therapy. In studies, therapy delivered by a specially trained professional, often a sleep psychologist, has worked as well as medications for short-term insomnia. Over the long haul, however, it was superior, and unlike medications, continued to work even after active treatment stopped. And, unlike medications, it has no side effects. So why are more people not rushing into it? “There is a dearth of providers that specialize in the delivery of (cognitive behavioral therapy),” said Bernert, “so there is an awareness problem.” There are a few providers who specialize in this type of therapy in Oregon, including Bend sleep psychologist Evans. Patients are often surprised when they are referred to him, Evans said. “They think the doctor thinks it’s all in their head.” Quite the contrary. Evans treats only insomnia, not other psychological issues, and uses specific techniques for that treatment. They’re not the same ones you’ve seen if you have been to a therapist before. Evans said patients “are often relieved. I’m not going to ask them how they feel. I’m not going to ask them about their mother.”

Co ntro lling the bedro o m Evans and other sleep psychologists use a series of techniques to help people relax, fall asleep faster and stay asleep longer. One technique within cognitive behavioral therapy, used

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HIGH DESERT PULSE • WINTER / SPRING 2011

typically for those who have trouble falling asleep, is called stimulus control therapy. The idea is to make the bed a place for sleep and intimacy. And nothing else. That’s right, no television, reading, eating, texting, worrying or any of the other activities that many of us do there. “If you are spending all your time awake in your bedroom, you are training yourself to do that,” said Brewer. Stimulus control therapy also trains people to stop trying to fall asleep after 10 to 15 minutes. They need to get out of bed and go somewhere that is dimly lit to do something quiet such as read or write in a journal. Relaxation and breathing exercises can also work. Then, when they feel sleepy again, they go back in the bedroom and try to sleep again. If it doesn’t work in another 15 minutes, they repeat the process. Sometimes, said Vitiello, the “first few nights are terrible. They get out of bed a lot.” But, by the third or fourth night, the need to sleep kicks in and people typically get to sleep much faster. A lot has been made of these techniques, which are similar to practices that are often called sleep hygiene. While the techniques are well-proven in people with disordered sleep, those who do not have chronic insomnia need not worry if they like reading or journaling in bed before going to sleep. “These behaviors were tested among disordered individuals,” said

Bernert. “You can’t generalize beyond the sleep-disordered population.” Still, there are some recommendations that do apply to everyone. (For tips, see box at right.) And, sleep experts do agree that everyone can benefit from setting and keeping a regular bedtime and wake-up time, even on weekends. A study undertaken about 15 years ago looked at two groups of people, all of whom slept an average of 7.5 hours each night. One group, however, was instructed to go to sleep and get up at a regular time each day for four weeks. The other group was given no such instruction. At the end of the four weeks, the group with the regular sleep schedule reported feeling less sleepy and sleeping better than the other group, even though both groups were getting the same amount of sleep each night. “Stabilizing your sleep schedule is really good for anyone,” Bernert said.

Resetting the clock For people who do not sleep well through the night, sleep psychologists use a technique known as sleep restriction therapy. The idea is to counter the urge, after a night of poor sleep, to spend more time in bed. If you are not sleeping well, Evans said, you don’t necessarily need to go to bed earlier. That, he said, “just extends the time you are in bed. It doesn’t make it any more likely you will sleep longer.” With sleep restriction therapy, a person

G ood sleep hygiene If you have trouble falling asleep at night, there are techniques recommended by the National Sleep Foundation that may help.

•Maintain a regular bedtime and awakening time every day, even on weekends and holidays. Don’t • spend too much time in bed. Eight hours is sufficient for most people. Avoid • napping during the day, as that can disturb the normal sleep pattern. Avoid • caffeine, nicotine or alcohol close to bedtime. Expose yourself to light in the morning, • and keep lights dimmer in the evening and near bedtime. Avoid bright lights such as phone or computer screens close to bedtime. Establish a relaxing bedtime routine. • Try not to talk about emotionally charged topics or bring worries to bed. Associate bed with sleep. Avoid using it for • activities other than sleep and intimacy. •Make sure your bedroom is relaxing. Set it to a comfortable temperature and make sure the room is not too bright. PHOTO: THINKSTOCK

HIGH DESERT PULSE • WINTER / SPRING 2011

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Ifyou want it in a pill … Sleep physicians generally discourage taking medications, urging patients to change their behaviors to get better sleep. “It’s my general opinion that these medications are way overprescribed,” said Dr. David Dedrick, a sleep specialist at High Desert Sleep Center. For short-term use — four weeks or less — they can be helpful, said Wil Pigeon, a sleep psychologist at the University of Rochester Medical Center. Generally, they will help people sleep better when they are used, but for most people insomnia will return when medication is discontinued. That said, there are millions of people who do take them. These are the most common: Ambien A prescription medication sold generically as zolpidem, Ambien is a sedative and works by stimulating a chemical in the brain that inhibits activity. Ambien in its traditional form is good for people who have trouble falling asleep, said Kyle Mills, a pharmacist at Bend Memorial Clinic, though sometimes people report they wake up when the effects wear off in the middle of the night. There is an extended release tablet, he said, that is made to solve those problems. Dedrick said that people taking Ambien may need to be careful of side effects. There have been reports of people sleepwalking or even doing activities they would normally do while awake, including eating and having sex, while in Ambien-induced sleep. Lunesta A newer but similar drug to Ambien, Lunesta is also available only by prescription. More expensive than Ambien, it’s longer-acting, meaning that people who take it are less likely to wake up in the middle of the night. It is safer for long-term use than Ambien, said Dedrick, because the side effects seen with Ambien occur less often with Lunesta. Melatonin Melatonin is a hormone that causes us to feel sleepy, and when taken as a supplement, can help with some types of sleep disturbances. It has been found in some cases to help people fall asleep and can help with jet lag. It is safe, said Dedrick, but “for the vast majority it is not very effective.” Dedrick said that studies have found that only about one out of eight people have a response to the supplement. Valerian Valerian is an herb that has been sold as a sleep aid. But, said Mills, “it has never shown any benefit other than placebo in any study.” The herb has not been studied for safety in long-term studies, but according to the National Institutes of Health, is likely safe short-term. Tylenol PM This over-the-counter remedy is often used to help people sleep. The “PM” part, what makes you drowsy, is the same active ingredient found in Benadryl, an antihistamine that shuts down some of the stimulating activity in the brain. Though Tylenol PM can be effective and safe if used in the short term, there can be some problems. First, it takes a while to wear off so “a lot of people have a hangover, diminished cognitive function the next day,” said Mills. People older than 60 should be especially careful about using it, said Dedrick. Because it acts on brain chemicals that help people think, it can reduce cognitive function. In older people, even those with very mild deficits that are not typically noticeable, Tylenol PM may cause confusion or strange behavior.

Chronic insomnia | FIGHTING SLEEPLESSNESS first figures out how much time they actually spend sleeping. Then they spend just that much time in bed, going to sleep later and waking at their regular time. For example, if you went to bed at 9 p.m. but were up from 1 to 4 a.m., and then got up at 6 a.m., the total sleeping time would be six hours. With sleep restriction therapy, you would go to bed at midnight to allow yourself six hours of sleep time and wake up at 6. Once you are able to sleep straight through the night with the restricted schedule, you move the time you get in bed earlier by a half hour a night, until you reach a full eight hours of sleep. “It works pretty well for someone who has had problems,” Brewer said. “It’s like resetting the clock.” Sleep psychologists also teach people relaxation techniques to help quiet their minds and overcome their fears about not sleeping. People think, “If I don’t sleep, my day will be a nightmare,” Evans said. Part of the therapy, he said, is to address those fears and help people realize that they are typically unfounded. “Ultimately, we’re trying to promote to the patient what it’s like to feel sleepy again. For most of these folks, they’ve lost that feeling.” Evans said that within four to six sessions, people typically have noticed pretty significant gains. About 85 percent of his patients, he estimated, sleep better after treatment. “As far as mental health, it’s one of the most effective treatments known.” Carrie Carney, who recently did the sleep study, may be trying one of these techniques soon. After her night at the sleep center, Dedrick, who read her study, could find nothing abnormal in her sleep patterns. He found no evidence of apnea or anything else that, physically, would be causing her to feel tired. He planned to refer her to treatment with Evans. He guessed that she would, like many mothers, need to find more time in her day to relax and unwind before trying to sleep. “Her mind is becoming so overactive that it’s beginning to override her desire to go to sleep,” he said. It’s a problem, Dedrick said, that is endemic. “We’ve become so busy that when it does come time that the lights are out and everything’s quiet, then our brain (turns on). Once the brain gets going, it becomes really hard to fall asleep.” •

PHOTOS BY RYAN BRENNECKE

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HIGH DESERT PULSE • WINTER / SPRING 2011

One voice | A PERSONAL ESSAY

Bracing for the eighth grade BY SH EI L A G . M I L L ER

ake a minute to remember what eighth grade was like. The awkwardness. The bullying. The complete and utter certainty that everyone is paying attention to every single action you take. Now do it in a back brace. Yep, when I think back to eighth grade, I definitely remember the discomfort of changing in the locker rooms, the terror of smelling bad after gym class, the side-toside looks to see if anyone was looking before I bent over to pick up my pencil. I did that with an ill-advised perm (including my bangs), braces (complete with holiday-color rubber bands) and a god-awful back brace. In seventh grade I was diagnosed with scoliosis, a curvature of the spine that without treatment can cause severe lung and back problems. A few months after the initial diagnosis, complete with a series of X-rays showing my spine like an S, my doctor measured the curves again. With the larger curve in my lower back approaching 30 degrees, he declared I would need a heavy plastic brace that contained the curve and prevented it from getting worse as I grew. Without it, I would almost assuredly need surgery, which at the time consisted of two metal rods implanted on either side of the spine that eventually straightened the spine as they fused to it. As much as I was horrified by the idea of wearing a back brace made of hard, thick plastic that stretched from below my breasts to the curve of my just-developing hips, the idea of spending the rest of my life beeping in metal detectors was even worse. So I was fitted for the Boston back brace, which thankfully did not have a visible neck component. Instead, it fit under my clothing, strapping around my torso and tightened by two belts. It looked like a torture device, to be honest. The first few days were the worst. Because it added quite a bit of

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bulk to my frame, I went from wearing size 2 pants to needing 8s or 10s, so I needed all new pants. To appease me, Mom bought me a new rugby shirt. Remember, we’re talking 1993 here. At the end of the first day I wore the brace, I stood up to leave English class and one of my friends leaned over and whispered to me that I had two holes in the back of my shirt. The buckles had rubbed against the chairs all day. So Mom jury-rigged some felt pieces and Velcro to cover the buckles. We learned other things through the next few weeks as well. The plastic rubbed against my skin, so I started wearing a ribbed tank top underneath. That sort of helped, although it added another layer to my already constricted body. In short, I sweated. A lot. For the first couple of years, I wore the Bulletin back brace nearly 23 hours a day. The only education time I took it off was for gym class and socwriter Sheila cer and basketball practice. My sophomore Miller survived year of high school, I was required to wear it eighth grade only after school and to sleep. By junior year, and scoliosis. I had to wear it only at night. She keeps fit I learned a lot about just how much displaying soccer. comfort my body could stand over those years. I figured out how to sleep without rolling over (I still sleep on my stomach as a result) and learned how to fight through the constant urge to urinate when the brace pressed on my bladder. And my back got better; I never needed that surgery, although I still have a significant curve in my lower back. But I learned something else: At a time when everyone I knew was looking sideways, terrified they were standing out in a negative way, I got comfortable with myself. I had no choice. I was going to stand out because I looked ridiculous, or at least I felt I did. Knowing that freed me from trying to fit in, and the result? In a situation that could very easily have made me more uncertain, more afraid to be myself, I became the person I wanted to be instead of the person I thought others wanted from me. People always say that even though it was hard, they’d do it all over again. I’d do the back brace again, but not the perm. •

HIGH DESERT PULSE • WINTER / SPRING 2011

Heart Center Cardiology St. Charles-Bend Cardiothoracic Surgeons Pediatric Heart Center of Central Oregon

The Heart Center wishes you a happy and heart-healthy 2011.