High Desert Pulse - Summer/Fall 2011 by Western Communications, Inc.

SUMMER / FALL 2011

H I G H

D E S E R T

PULSE Healthy Living in Central Oregon

Overtraining The fine line between Aspirin fitness and or Advil fanaticism or what? The right one for you

Cancer survival rates have never been higher But what cured you then can kill you later

Pregnancy bed rest Often used, but never proven

† Based on the combination of results from three surveys totaling 86 patients who had worn Lyric for at least 30 days. †† Based on a telephone survey of 67 patients who have worn Lyric for at least 30 days. Lyric is not appropriate for all patients. See your Lyric hearing professional to determine if Lyric is right for you.

932 NE 3RD ST. BEND, OR 541-382-3308 Jim Leagjeld

Tricia Leagjeld

Hearing Aid Specialist

106 SW 7TH ST. REDMOND, OR 541-548-7011

For more information visit www.LeagjeldHearingAids.com

H I G H

D E S E R T

PULSE Healthy Living in Central Oregon

SUMMER / FALL 2011 VOLUME 3, NO. 3

How to reach us Denise Costa | Editor 541-383-0356 or dcosta@bendbulletin.com • Reporting Anne Aurand 541-383-0304 or aaurand@bendbulletin.com Betsy Q. Cliff 541-383-0375 or bcliff@bendbulletin.com Markian Hawryluk 541-617-7814 or mhawryluk@bendbulletin.com • Design / Production Greg Cross Lara Milton Mugs Scherer

Sheila Timony David Wray Andy Zeigert

• Photography Ryan Brennecke Pete Erickson Dean Guernsey

Rob Kerr Tyler Roemer Andy Tullis

• Corrections High Desert Pulse’s primary concern is that all stories are accurate. If you know of an error in a story, call us at 541-383-0356 or e-mail pulse@bendbulletin.com. • Advertising Jay Brandt, Advertising director 541-383-0370 or jbrandt@bendbulletin.com Sean Tate, Advertising manager 541-383-0386 or state@bendbulletin.com Kristin Morris, Advertising representative 541-617-7855 or kmorris@bendbulletin.com On the Web: www.bendbulletin.com/pulse

The Bulletin All Bulletin payments are accepted at the drop box at City Hall. Check payments may be converted to an electronic funds transfer. The Bulletin, USPS #552-520, is published daily by Western Communications Inc., 1777 S.W. Chandler Ave., Bend, OR 97702. Periodicals postage paid at Bend, OR. Postmaster: Send address changes to The Bulletin circulation department, P.O. Box 6020, Bend, OR 97708. The Bulletin retains ownership and copyright protection of all staff-prepared news copy, advertising copy and news or ad illustrations. They may not be reproduced without explicit prior approval. Published: 8/1/2011

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SUMMER / FALL 2011 • HIGH DESERT PULSE

Updates |

NEW SINCE WE LAST REPORTED

More on sleep Our Winter/Spring 2011 issue highlighted the huge numbers of people who get too little sleep each night (“Why can’t I sleep?”). Since then, new studies from the Centers for Disease Control and Prevention showed that people who sleep less may have more problems during the day. The studies, published this spring, were each based on interviews with thousands of American adults. Nearly 40 percent of respondents said they got less than seven hours of sleep, on average. In one study, 38 percent of people said they unintentionally fell asleep during the

Cost of Alzheimer’s The impending costs of treating millions of patients with Alzheimer’s disease, highlighted in our Fall/Winter 2010 issue (“Alzheimer’s: The coming storm”), may finally be catching the attention of policymakers. The U.S. House Foreign Affairs Committee’s Subcommittee on Africa, Global Health, and Human Rights held a hearing in June to consider ways to stem what could a budget-breaking burden for domestic and international health care programs. Subcommittee Chairman Chris Smith, R-N.J., cited statistics from Alzheimer’s Disease International that estimated the total worldwide costs of dementia at $604 billion, 89 percent of which is shouldered by highincome countries, mainly in Western Europe and the U.S. “In those developed countries, it is often incorrectly assumed that dementia, such as Alzheimer’s, is a normal part of aging and that nothing can be done to address it,” Smith said. “Because of the lack of recognition of the nature of the problem, there is

day, and 5 percent said they unintentionally fell asleep at the wheel at least once during the previous month. In the second study, 23 percent said a lack of sleep led to trouble concentrating, 20 percent said they had difficulty remembering things, 13 percent said they were too tired to work on hobbies, and 9 percent said sleepiness made it hard to work or do volunteer activities. Both studies said that adults typically need between seven and nine hours of sleep a day to function well. — BETSY Q. CLIFF

a lack of pressure on government bodies to respond to the crisis. As a result, there is a lack of effort to devote resources to finding a cure, to help those with Alzheimer’s by providing assistance, or to seek a diagnosis and care of those potentially afflicted.” Smith has introduced a bill that would convene an international conference on Alzheimer’s, including at least those countries that are already working on national plans to address the disease. Eric Hall, the founding president of the Alzheimer’s Foundation of America, seconded the call for a global approach to fighting Alzheimer’s and the development of a coordinated Alzheimer’s plan in the United States. “It’s no secret that the U.S. is behind the curve of several other countries that have national Alzheimer’s disease plans in place or in process,” Hall said. “We have a lot of homework to do, but we can learn a lot from what has already been done overseas, both in planning and political commitment.” — MARKIAN HAWRYLUK

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Contents |

HIGH DESERT PULSE

COVER STORY

AFTER THE CURE The treatment that cured your cancer could cause a new diagnosis years later.

FEATURES

18 30

WHEN FITNESS BECOMES FANATICAL Doing and overdoing: Where’s the line? PUTTING THE MOTHER TO BED Bed rest is a common prescription for problem pregnancies, but there’s no evidence it helps.

DEPARTMENTS

3 12 15 16 23 26 28 36

UPDATES What’s new since we last reported.

ONE VOICE: A PERSONAL ESSAY An Olympian’s triumphant comeback inspires a young girl to compete.

HOW DOES SHE DO IT? Nancy Stevens finds her way to fitness. GET ACTIVE Highlining far above Smith Rock. HEALTHY OPTIONS Pack a healthy punch in your kid’s lunch. GET READY: ROCK CLIMBING How to safely give it a try. SORTING IT OUT: OTC PAINKILLERS Which is the right one for you?

GET GEAR: YOGA MATS Find the mat that fits your practice. ON THE JOB: DISASTER RELIEF WORKER When an earthquake rocks a world away, this Bendite runs to the rescue.

COVER DESIGN: ANDY ZEIGERT CONTENTS PHOTOS, FROM TOP: ANDY TULLIS, ROB KERR, SUBMITTED PHOTOS

HIGH DESERT PULSE • SUMMER / FALL 2011

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Cover story |

LIFE AFTER TREATMENT

Livin cure with the

The very treatment that saved your life could come back to haunt you. BY MARKIAN HAWRYLUK PHOTOS BY RYAN BRENNECKE AND ANDY TULLIS

K Page 6

athy Colclough got the call on her cellphone just as she got to the Idaho border. On her way to Colorado for a family wedding last year, the Bend woman pulled over to the side of the road when she saw it was her radiologist calling. Only a few days earlier, he had used an ultrasound image to guide a needle into an irregularity

in her right breast and pull out two small samples. He could tell immediately the cells weren’t normal breast tissue, but he didn’t think it was cancer. Now he was calling with the test results. “He said it was positive,” Colclough recalls, the mere thought of it still causing her to shake. Back on the highway, she glanced back to see the reaction of her daughter, Beth Rasmussen, a 27-year-old schoolteacher who was leaving in a month with her husband for a two-year teaching contract in Abu Dhabi. “I could see her in the rear view mirror just falling apart,”

SUMMER / FALL 2011 • HIGH DESERT PULSE

Kathy Colclough is a two-time cancer survivor. The radiation treatment for her Hodgkin’s lymphoma decades ago probably caused her breast cancer last year.

tissue that over time grew into the new cancer. Knowing she was at risk from the radiation, she underwent regular mammograms that until last year had always come back negative. For more than 20 years, she had defied the odds. “I thought I had beat it,” she said. It’s a cruel twist of cancer treatment that thousands of survivors like Colclough are beginning to learn. Long after they think they’ve beaten cancer, they face a host of other problems caused by the radiation, chemotherapy or other treatments. Long after they’ve been told they are cancer-free, they discover they have not been freed from the impact of their cancer. Long after they thought they were done with the side effects of their treatment, they are dealing with new late-emerging effects. Many survivors are destined to face heart disease, hearing or vision loss, or a second bout with a disease they know all too well. “You have that feeling that, this is a group I don’t want to be in. It’s a club you don’t want your friends to join,” she said. “But the other side of it is, I realized it’s survivable.”

ng e

Era of survival

RYAN BRENNECKE

Colclough said. She stopped at the next gas station and got out and hugged her daughter as hard as she could. “I’ll survive this,” she told her. It was a call Colclough had been prepared for numerous times over the previous 25 years. Having been treated for Hodgkin’s lymphoma when she was 38, she had been warned she had a higher risk for breast cancer. But Colclough’s second cancer wasn’t a case of her cancer returning, and while there is no way to know for certain, it probably wasn’t a case of lightning striking twice. Her breast cancer was probably caused by the very treatment that saved her life decades before. The nine weeks of chest radiation used to cure her previous cancer most likely caused mutations in her breast

HIGH DESERT PULSE • SUMMER / FALL 2011

Cancer treatment has become so effective that the disease is no longer considered universally fatal, as it was only a few decades earlier. Survival rates for adults have now reached 68 percent, and for children, more than 80 percent. As a result, the number of cancer survivors has swelled, reaching an estimated 13 million in the U.S. in 2011, including some 134,000 in Oregon and more than 12,000 in Central Oregon. More than a million individuals have survived more than 25 years after their diagnoses. But as cure rates improved, researchers soon realized they needed to understand what it meant to live a long time after cancer. “The tipping point came when cure rates for childhood cancer became so good that we had a large enough group to follow,” said Dr. Sue Lindemulder, who runs the Childhood Cancer Survivorship Program at Doernbecher Children’s Hospital in Portland. “In the ’70s and ’80s, we started to have more survivors than mortality in cancer.” By 1993, doctors at St. Jude Children’s Research Hospital in Memphis, Tenn., began tracking a group of pediatric cancer survivors. They followed more than 20,000 survivors treated in the 1970s and 1980s at one of 26 institutions in the U.S. and Canada, along with about 4,000 of their siblings for comparison purposes. Most of the group are now between the ages of 40 and 60. “It’s a little bit of a different treatment era than the kids treated now, but the estimate is that about two-thirds of that group has at least one chronic health condition attributed to their cancer treatment,” Lindemulder said. “About one-third of them have a chronic health condition that we would consider to be severe, something that needs persistent follow-up.” The problems ranged from low-level issues such as a higher risk for cavities or other dental problems to ones as serious as heart failure and new cancers. The latest results from the study published in June found that nearly 10 percent of the survivors had developed new tumors unrelated to their original cancers, and about half of those tu-

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Cover story | LIFE AFTER TREATMENT

Snapshot of Central Oregon’s cancer survivors Half of the approximately 12,000 cancer survivors in Central Oregon had breast, prostate or colorectal cancer, and most are currently above the age of 65.

By cancer type (estimates) Prostate 2,420 (20%) Colorectal 1,089 (9%)

By age (estimates) 65 and over: 7,260 (60%)

Breast 2,662 (22%)

40-64: 4,235 (35%)

Gynecologic 968 (8%) Lymphoma/ leukemia 968 (8%) Kidney/bladder/ ureter 847 (7%) 20-39: 484 (4%)

Melanoma 847 (7%) Thyroid 484 (4%) Lung 363 (3%) Other 1,452 (12%)

0-19: 121 (1%)

GREG CROSS

Source: St. Charles Cancer Registry, SEER

From universally fatal to highly curable Fifty years ago, many childhood cancers were almost universally fatal. As medical research uncovered better treatments, survival rates improved so much that more children survive cancer than die from it. That means more survivors are living longer with afterefects of their treatment.

Five-year cancer survival rates Acute lymphoblastic leukemia (Cancer of the blood)

94% 50% 90% 7% 85% 75% 95% 10% 55% 50% 90% 20% 65% 30% 70% 5% 65% 10% 85% 0

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2011

Hodgkin’s lymphoma (Cancer of the lymph nodes) Non-Hodgkin’s lymphoma (Cancer of infection-ighting cells) Retinoblastoma (Cancer afecting the eyes) Neuroblastoma (Tumor of peripheral nervous tissue) Wilms tumor (Cancer of the kidneys) Osteosarcoma (Bone cancer) Rhabdomyosarcoma (Solid tumor of muscle cells) Ewing sarcoma (Type of bone cancer) Medullablastoma (Malignant brain tumor)

Source: St. Jude Children's Research Hospital

1962

20%

40%

60%

80%

100% GREG CROSS

mors were malignant. Many women developed tumors in both breasts independently and almost simultaneously. Nearly 70 percent of the survivors in the study had been treated with radiation. Data from the study also showed that once they reached their 40s, cancer survivors who had been treated with a commonly used class of chemotherapy drugs called anthrocyclines had more than four times the risk of congestive heart failure, and survivors treated with chest radiation had nearly five times the risk of coronary artery disease. A 2005 study conducted by researchers at Oregon Health & Science University found that 61 percent of patients younger than 23 who received platinum-based chemotherapy incurred hearing loss after their treatment. Other survivors faced higher rates of cataracts or painful bone disorders requiring hip replacements. “What I don’t think the general public understands is that surviving cancer isn’t the same as a broken leg,” said Peter Johnson, a Portland-resident who participated in the OHSU hearing loss study. “Once the leg is healed, you’re pretty much back to normal. Once you survive cancer, the aftereffects are numerous, and you just keep discovering them.” Studies showed that survivors of childhood cancer are at risk for having a new cancer at three to six times the rate of their peers who have never had cancer. A British study published in June in the Journal of the American Medical Association tracked nearly 18,000 children who had cancer before age 15. After a median of 25 years, more than 6 percent had been diagnosed with a new cancer, about four times the rate for the general population. By age 60, nearly 14 percent of survivors had developed a second cancer, significantly higher than the 8.4 percent rate in the general population. “The data seems to suggest that one in every two, almost two out of every three pediatric cancer survivors need to worry about an adverse late effect,” said Dr. Archie Bleyer, a pediatric oncologist with St. Charles Health System in Bend. “(It’s) a 60 to 70 percent chance of something wrong happening because of either the original cancer or the treatment for it. Some of the time it’s

SUMMER / FALL 2011 • HIGH DESERT PULSE

Sex effects of treatment Many cancer treatments also affect sexual health.Treatment for gynecological and breast cancers can result in pain, dryness, difficulty with arousal or orgasm, and changes in body appearance or self-image. A recent survey of female cancer survivors published online by the journal Cancer found that 40 percent of women wanted medical attention for their sexual health post treatment, but only 7 percent felt comfortable asking their doctors about it.

ANDY TULLIS

Runners, including hundreds of cancer survivors, cross the Columbia Street footbridge during the Heaven Can Wait run in Bend in June. The number of survivors in the U.S. has now reached 13 million, prompting doctors to shift attention beyond mere survival to living well after cancer.

impossible to tell which it is. But we’re learning most of it is the treatments and not the original cancer.”

Causing new cancers Hodgkin’s lymphoma patients are one of the most frequently cited examples of the late-effect phenomenon. A study published in June in the Journal of Clinical Oncology found that women treated for Hodgkin’s with chest radiation years ago were four times more likely to have cancer in both breasts than breast cancer patients who had never received radiation. And if Hodgkin’s patients got both chemo and radiation, their fate was even worse. “That combination is highly carcinogenic,” Bleyer said. “By 20 years after treatment, 30 percent are estimated to develop breast cancer. There’s even some evidence that if you go out 30 to 40 years that as many as half of them will develop breast cancer.” Colclough’s lymphoma was caught early and hadn’t spread very far when she was diagnosed in 1986. Her doctors at the time advised against chemotherapy. Nonetheless, her mammogram last year showed an abnormality in the left breast, and further testing found the cancer in her right breast. She thought about it for 2½ weeks while on vacation after receiving the news and decided what she was going to do even before speaking with her oncologist. “I just wanted to get rid of all the tissue and not have to face this for the rest of my life. I decided to have a double mastectomy.” Bleyer said doctors had some notion about

HIGH DESERT PULSE • SUMMER / FALL 2011

the long-term risks when they started using chemotherapy and radiation 50 years ago. But with few options at their disposal and dismal survival rates for Hodgkin’s, they had little choice. “The first two or three decades, we did everything we could just to cure because they were dying. Hodgkin’s lymphoma was 90 percent fatal,” he said. “Then we learned what we were using can create cancer and late effects. We then knew we had to cut back, that we were curing only to lose the patient to another cancer.” And the breast cancer caused by the combination of radiation and chemotherapy was a particularly nasty form, resistant to both treatments and close to impossible to cure. “It’s almost a death sentence,” Bleyer said. Many of the early treatments for other cancers were just as toxic. Of the 20 to 30 chemotherapy drugs used to treat kids with cancer over the past 50 years, Bleyer could think of only two that weren’t thought to cause cancer themselves. Most children who got chemotherapy were treated with the other drugs. “It’s hard to find a child (survivor) who isn’t at some risk of developing cancer,” Bleyer said. Most received chemotherapy drugs while their bodies were still developing. Drugs chosen for their ability to kill fast-growing cancer cells also affected other fast-growing cells in the body. “The child with a growing brain is more vulnerable to those side effects, and especially in children with brain tumors,” he said. “That’s the group more than anybody else that can’t

Male vs. female: “Some women have the courage to raise sexual health concerns with their doctor, although repeated studies show they prefer the doctor to initiate the discussion,” said Dr. Stacy Tessler Lindau, an associate professor of obstetrics and gynecology at the University of Chicago Medical Center and senior author of the study. “Physicians will often empathize with a patient’s concern but struggle with a lack of knowledge about how to help.” Lindau said it’s often the opposite case for male cancer patients. Treatment of prostate cancer, she said, routinely addresses concerns about sexual function, and the issue plays a significant role in choosing the treatment modality. But for women, sexual problems are often discounted as emotional or psychological in nature. “It is critical that physicians caring for cancer patients know that sexual concerns are often physical,” Lindau said. “The physical problems associated with cancer treatment can strain relationships, cause worry and stress, and can be very isolating. Many women come to us feeling ashamed, guilty or alone. They feel like the problem is primarily in their head.” Support groups: The Cancer Center of Care for St. Charles Health system provides various support groups, including a women’s-only group, to help survivors deal with such issues. Survivors may not need medical attention, said Dr. Linyee Chang, the center’s clinical director, but such qualityof-life issues can have major consequences. “‘My libido is gone or my body image has completed changed. I am no longer a sexual being. It’s impacting my marriage.’ All those things … can come up sometimes afterward, and sometimes years afterward,” she said. “I think it’s really validating for patients to know that ‘you’re not alone in this, and we’re here to coach you through it.’”

Page 9

Cover story | LIFE AFTER TREATMENT finish school, can’t become employed and are often institutionalized or disabled at home and limited to wheelchairs and other disabilities.” Survivors of childhood cancers often don’t grow as tall as their siblings and can have other developmental problems. Many struggle with tasks in school and once they enter the workforce. “A child can be treated at 3, and if they start having trouble in high school, that may still be related to cancer treatment,” Lindemulder said. “I think that’s sometimes a hard thing for the schools to comprehend.” More than nine out of 10 cancer survivors recently surveyed by the American Cancer Society reported still having symptoms from either their cancer or their treatment one year after diagnosis despite most having completed their treatment.

Age of survival Although the number of patients diagnosed with cancer annually has remained relatively unchanged, advances in medicine have allowed more cancer patients to survive, swelling the total number of survivors to more than 13 million this year. 14M

13.1 million survivors

U.S. cancer survivors

12M

10M

Changing protocols Survival rates have climbed in part because doctors have had more tools at their disposal. They can stack one treatment on top of another to boost cure rates or try a different chemotherapy drug when the first choice isn’t working. That’s also allowed doctors to weigh drugs not only based on their effectiveness but on their propensity to cause short- and long-term effects. “If the data show the survival rates are equivalent, your next phase of consideration is the toxicity profile, the convenience profile — do you have to give it every single day for five hours or do you do it once a day with a pill — and then cost profile,” said Dr. Linyee Chang, clinical director of the Cancer Center of Care for St. Charles Health System. It’s allowed doctors to turn to safer chemotherapy drugs in children instead of more risky radiation treatments. Also, radiation treatment for Hodgkin’s disease today poses a significantly lower risk of breast cancer and for most women no increase in the normal risk at all. Dr. Stephen Kornfeld, a medical oncologist at St. Charles, said doctors are trained to weigh the benefits and risks of every treatment. And while curing the patient of cancer is the chief concern, minimizing other short- and long-term side effects is part of the equation. When treating someone with an incurable cancer, the primary goal is to extend their years of good quality life. “In that circumstance, you’re a little more concerned with short-term versus long-term side effects,” Kornfeld said. “Long-term side effects that will occur after five years are a little less relevant if the average life expectancy is shorter than five years. But if I give you lots of short-term side effects, I’ve interrupted your quality of life.” It’s a different scenario when he’s considering chemotherapy for someone who’s had surgery to remove a tumor, referred to as adjuvant therapy. Chances are the surgeon has removed all of the cancer, and it’s more of an insurance policy to ensure the patient is truly cancer-free. “I give them chemotherapy to try to minimize the risk that their cancer will come back. Since in that circumstance the goal is cure, people are less focused on short-term side effects because they figure, I can put up with anything (in the short term). I want to make sure whatever I do doesn’t impair their quality of life forever.” Kornfeld said medicine has also undergone a major shift over the past 20 years toward more of a focus on shared decision-making between doctor and patient. Some patients are much more concerned about the risk of their cancer coming back than side effects and want

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Patients diagnosed with cancer 2M

1973 Source: SEER

1980

1985

1990

1995

1.43 million patients 2000

2005

2011 GREG CROSS

the best chance of a cure, no matter the side effects. Others might decide they see little additional benefit from chemotherapy but are very concerned about the immediate or long-term side effects. “So you can see two women, the exact same age. You give disease recommendations (that) one will take and one will not take, based on their values,” Kornfeld said. One of the emerging ways oncologists are preventing those late effects is to avoid giving chemo to patients who aren’t likely to benefit from it. In the past, doctors had no way of knowing which patients would benefit from chemotherapy after surgery. But in 2004, Genomic Health introduced Oncotype DX testing, which quantifies the likelihood of disease recurrence in women with early-stage breast cancer and predicts the likely benefit from certain types of chemotherapy. The test analyzes a panel of 21 genes within a tumor to determine a recurrence score between zero and 100, which corresponds to a specific likelihood of breast cancer recurrence within 10 years. While the test lists at about $4,000 and many insurance companies won’t cover it, it can eliminate the just-in-case scenario for chemo. “Because of the Oncotype DX, we probably give chemotherapy to women after surgery 50 percent,” Kornfeld said. “The best way to limit long-term side effects is not to give it.” Genomics Health has now developed a similar genetic test for colon and prostate cancer. Prostate cancer is a particularly difficult cancer to evaluate. Although more than 200,000 men will be diagnosed with prostate cancer in the U.S. each year, few will benefit from aggressive treatment. A product in development has now identified some 295 genes strongly associated with the risk of the cancer returning after surgery. If tests prove the test effective, doctors could soon use it to determine which men don’t need surgery or radiation and can thereby avoid side effects like sexual dysfunction or incontinence.

SUMMER / FALL 2011 • HIGH DESERT PULSE

RYAN BRENNECKE

Ken Callaway works on a shopping list in his Bend home in June. Callaway, who was treated with radiation for cancer in 2008, struggles with a mental fog commonly called “chemo brain” and has trouble remembering things. “It’s like having a really bad hangover with no headache.”

When chemo is the only option, doctors have an increasing number of tools to limit at least the short-term side effects. Chemo, while still often a brutal treatment, isn’t as bad as it once was. “We have a lot of medications that can be used to minimize short-term effects: nausea, vomiting, mouth sores, fatigue,” he said. “But we really don’t have a lot of medications to minimize long-term side effects, despite lots and lots of stuff that has come and gone. The fear is that anything you give that might protect against long-term side effects might also protect against long-term benefit.”

Neurological damage Ken Callaway, 53, was a contractor in Bend when he was diagnosed with stage 4 throat cancer three years ago. He underwent 37 radiation treatments — his head clipped to the table with a fitted mask to ensure he didn’t move — and seven chemotherapy treatments over an eight-week period. While his cancer is gone, so are most of his taste buds, destroyed by the treatment. “I’m down to about 25 percent of my taste buds,” he said. “I’ve always liked steak. I can eat about the first two, two and a half bites, and then I can’t taste it.” Callaway is also challenged by a side effect

HIGH DESERT PULSE • SUMMER / FALL 2011

colloquially known as “chemo brain.” “It’s like having a really bad hangover with no headache. It’s just fuzzy. I was like that for a year,” he said. While the fuzziness has gone, he still deals with frustrating lapses in memory. “It’s something I struggle with every single day of life,” he said. “I will go out to the store with five items on my list and still forget one. It basically destroys your short-term memory.” Cancer survivors have complained, worried, even joked about chemo brain for years, and the condition has dumbfounded doctors. Hard to measure and even harder to explain, many doctors just passed the mental fog off as fatigue from treatment or signs of normal aging. But oncologists still aren’t sure whether chemo brain is caused by the chemo drugs or by the initial cancer. And they don’t know how to prevent it or treat it. A 2011 study by the Fred Hutchinson Cancer Research Center in Seattle looked at patients who had a stem cell transplant, which involves both high-dose chemo and immunosuppressants. Most had improved after a year, but more than 40 percent still had mild cognitive issues five years later. Patients improved in all areas except hand dexterity and word recall. “We really thought the numbers would be lower,” said Dr. Karen Syrjala, a medical on-

cologist who led the study. “We were thrilled to see that people recovered substantially, but we were also surprised that so many people did continue to have measurable deficits in some areas even after five years.” After more than two years, Callaway is not holding out hope for an improvement in his symptoms. “It’s unfortunate, but the alternatives? I’d rather be like I am now. A lot of people have lost this battle.” Probably the most common long-term effect of chemotherapy treatment is nerve damage, known as neuropathy. It can range from a mild tingling in the fingers that’s little more than an inconvenience to a major disability that prevents patients from performing some of the most basic functions of their daily lives. “Neuropathy is an insidious thing where people’s quality of life is grossly altered if (chemotherapy is) given to the point of toxicity,” said Dr. Bill Schmidt, a medical oncologist with Bend Memorial Clinic. Doctors must carefully track the patient through chemotherapy to ensure the drugs aren’t resulting in nerve damage. If the patient shows signs of neuropathy during treatment, the doctor can then scale back the dose or the frequency to prevent a long-term effect. Doctors have learned not to ask in general whether the patient has any symptoms. Nerve damage is such a significant problem, they ask specifically about it with every treatment. “You go, ‘Do you have any numbness and tingling in the fingers where you cannot button your shirt or you drop the cup?’” he said. “If you’re not a vigilant physician, being repetitive in the questioning, (the patient) can have long-term side effects that could have been preventable.” Schmidt said chemotherapy protocols specify the dose and interval of standard treatment, but because everyone processes drugs a little differently, those can be modified when side effects begin to emerge. “There are very appropriate guidelines for dose reduction and interval drops without compromising the alternate goal of curing and treating a patient,” he said. “Then you have … leukemia or lymphoma, where you have a higher risk of recurrence or a larger problem if you don’t do something. You have to sit the patient down and say, ‘Look, I’m really concerned about this long-term finger thing, but quite frankly, if I don’t give you this dose, I’m concerned that we can’t cure you.’” Doctors learned that lesson the hard way. Continued on Page 47

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How does she do it? |

NANCY STEVENS

Blind ambition She can run, bike, ski and swim. What she can’t do is see. BY MA RK I A N H AW RYLUK

ancy Stevens’ house might not be out of the ordinary for Central Oregon. The walls are covered with framed photos and newspaper articles from her triathlon career. Six pairs of skis hang in the garage, next to a pair of bikes, a treadmill and a nordic skiing machine. There’s no room for a car. But then Stevens has no use for a car. She has been blind from birth. Born three months premature in Michigan in 1960, she was given too much oxygen in an attempt to help her survive. The oxygen damaged her retinas, and she’s never seen the hundreds of miles of road, trail and slope she’s run, biked or skied. Never one to let her lack of sight stop her, Stevens has accomplished an impressive number of physical feats by asking friends to be her eyes, to talk her through the terrain and the obstacles in front of her. “So many people have helped me over the years,” she said. “Because of people’s willingness to ski with me or to bike with me or whatever, I can do a lot of the things that I want to do.” Stevens’ family wasn’t about to let her sit

Page 12

on the sidelines. She was expected to pull her weight at home, doing the same chores as the other kids. And when the Stevens clan — she had seven brothers and sisters — took up cross-country skiing when she was 12, Nancy did her best to follow along. “I hated cross-country skiing; I couldn’t stay in the tracks,” she admits. “But my family tried coming up with systems, and they were really patient. Honestly, that’s the reason I do all the sports that I do.” One year, she told her parents she wanted to ride her bike to school. She and her friend had developed a system in which the friend put a playing card in the spokes of her bicycle and Stevens could follow the sound. But her parents were concerned about her riding through busy streets every day. Instead, they bought a tandem bike, and Stevens would ride to school with her sister. “That was pretty much their attitude,” she said. “‘There’s got to be a way to make this happen. If you want to do it, let’s figure it out.’” Stevens has been figuring it out all her life. In high school, she learned to ski through an adaptive downhill ski program for blind skiers. She loved skiing, and when her first session of student teaching convinced her that education

How she does it Nancy Stevens has a number of systems designed to help her compete in various sports. They all rely on guides to be her eyes.

Running: On flat terrain, running is rather straightforward for Stevens and her guide. They wrap a shoelace around their hands to stay close together, and the guide describes the route ahead of them. On hills, it’s helpful if the guide can give Stevens some sense of how much of the hill they’ve completed so she can better pace herself. On trail runs, the guide must give her more direction about obstacles in the path, with prompts like “toes up” or “rock.” Cycling: Riding a tandem bike, the captain (the front rider) must steer the bike but also describe what sort of terrain or obstacles are ahead. Starting and stopping require a countdown so that Stevens knows when to clip into and unclip from the pedals. Stevens has the gear shifters mounted on the back handles of her tandem bike so she can have more to do than simply pedal. But that requires the captain to tell her when they’re approaching a hill so she can shift to the proper gear ahead of time.

Swimming: Stevens and her guide are connected with a bungee cord tied between their waists. The cord inhibits the completion of the downstroke on one side while swimming but prevents the two from being separated in open water when communication is challenging. Stevens has also used a system in which the sighted swimmer taps her on her leg or hip with every other stroke, letting her know she’s still on course.

Alpine skiing: The guide skis behind Stevens and describes the slope. Stevens generally sticks to the natural line of descent, and if there are obstacles along the way, the guide can call out commands, such as right turn, left turn or stop. On narrow runs, the guide can suggest tighter slalom turns or wider giant-slalom turns on wider runs.

Nordic skiing: Stevens cross-country skis with a guide who verbalizes the terrain ahead and gives directions for turns.

Leslie Cogswell, left, guides Nancy Stevens on a training run for the Pacific Crest half-marathon earlier this summer. The two met in a training group sponsored by FootZone in Bend. Below are submitted photos of Stevens’ athletic career. MAIN PHOTO BY PETE ERICKSON

How does she do it? | NANCY STEVENS wasn’t the career for her, she moved to Colorado to become a ski bum. She washed dishes at the Winter Park ski resort three days a week so she could ski with their adaptive skiing program on her off days. “I tried speed skating, and I tried power lifting and bike racing. I did all these crazy things,” she said. Eventually, Stevens found employment in Colorado counseling individuals facing new disabilities about how to adapt and continue living the lives they wanted. She joined the U.S. Cross-country Team and began nordic ski racing. In 1997 and 1998, she raced at Mt. Bachelor and took a shine to Bend. “I really liked it; I can’t even explain why,” Stevens recalls. “It’s close to skiing, but it’s nice in Bend. It seemed kind of neat.” She looked into moving to Bend at the time, but with no public transportation available, she couldn’t make the move. She qualified for the 1998 Winter Paralympics in Nagano, Japan, and competed in the 5K and 15K classical technique races and the 5K free technique. “In my 20s, I was a downhill racer. In my 30s, I was a cross-country racer. Then I got into running,” she said. “I thought this was kind of a cool sport. You just put your shoes on, grab a string and go.”

Finding guides For nearly all of her sports, she needs someone to guide her. She skis both downhill and cross-country with a guide, who describes the terrain before her and makes sure she’s on course. She rides a tandem bike with a sighted captain (the person steering the bike) while she serves as the stoker (the rider in back). She biked across the country from Portland to New York with a group of women in 2000. Finding guides has always been a challenge. In 2001, while living in Glenwood Springs, Colo., Stevens decided she wanted to try a triathlon. Her first race, she had three guides, one for each leg of the race. But when her running guide decided to try a full triathlon herself, Stevens found herself looking for another running guide the next year. She called the coach of a women’s triathlon training group and asked if she could suggest a runner. A few days later, the coach, Nancy Reinisch, called back and volunteered to guide Stevens with one condition: They would do the en-

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tire triathlon together. It would only work if the tandem bike fit. Tandems are generally made for a larger male rider in front and a smaller female rider in back. Fortunately, the bike was a fit, as were the two Nancys. They competed in numerous triathlons as Team Nancy, setting records along the way for a blind triathlete. They qualified for the World Triathlon Championship in Hawaii in 2005, and for three straight years, Stevens was the blind female triathlon champ. But she was primarily competing against herself. In 2005 and 2006, she was the only blind woman competing. “I said to the race director, my time in Chicago two weeks ago was 3:21. If can beat my time, I’ll get a medal. If I don’t, I’m not going to take a medal,” she said. They finished in 3:19, their calves marked FPC: female, physically challenged.

New adventures The irony is that Stevens is nowhere near being physically challenged. At 50, she still skis and runs and cycles, facing her challenges with a bright, cheery attitude. She moved to Central Oregon in 2008, buying a house in a tight-knit development where neighbors routinely help one another out. She’s semi-retired, living off a pension and occasional jobs as a motivational speaker. Stevens shares her house with a roommate and a seeing-eye dog named Koko. Koko led her on a hiking trip down the Grand Canyon in 2009. Stevens loves to sing and play the guitar, and she has recorded an album of her songs. On warmer days, she exercises in her garage on her triathlon circuit of machines, blaring the music from the radio. She’s slowly developing a network of partners to serve as running and cycling guides. “It’s so funny to me. In Glenwood, I had an amazing network of biking and riding and hiking partners. My network of cross-country skiers was fairly small,” Stevens said. “Out here, I have an amazing network of crosscountry skiers and not as many people to bike and run with. But I’m hoping.” She joined a running program organized by FootZone of Bend, with the hopes of expanding her circle of running partners. Being a guide can be daunting for many people, if only because they’ve never seen how blind athletes do it. It’s almost incomprehensible to

think that a blind woman can run on Central Oregon’s rocky trails without tripping. There are certainly plenty of runners with perfect vision who have taken tumbles. Stevens understands that guides feel apprehensive, even intimidated, about their responsibility. “I think it’s harder (for the guide). I’m the one that gets hurt,” she said. “I’ve gotten hurt on runs, skiing adventures. It happens to everybody, for one thing. I feel more terrible for the guide.” Stevens trains her own guides for the sports she wants to do as well as guides for adaptive sport programs. “Basically, they’re verbalizing what they see,” she said. “For any sport, they’re verbalizing what they see coming up.” That could be as simple as saying “rock” or “toes up” during a run, or describing the curve on the road ahead and counting down “3 … 2 … 1” as they approach a stop sign on the bike. “Swimming is the hard thing, because they can’t say, ‘We’re halfway there.’ We can’t stop to explain it,” she said. Tinker Duclo, who served as a triathlon guide for Stevens in Colorado, said guiding a blind athlete forces you to concentrate on what you’re doing. You can’t tune out to the music on your iPod or lose yourself in the scenery. “When we run, I hold responsibility for warning Nancy of any hazard she might possibly encounter — mailbox, tree branch, poodle, scat from poodle, compact car, precarious intersection or any large or small sidewalk chasm,” Duclo wrote in an essay about racing with Stevens. “I move in a state of intense awareness as I note our surroundings and communicate the world to Nancy. I live only in the moment, for there is no other way.” Stevens says some people are nervous about guiding a blind athlete, while some decide it’s not for them after giving it a try. For others, it’s a chance to compete as an interdependent pair, to have your fate tied to another both literally and figuratively in a way that even team sports can’t approximate. In one race, she was running as part of a threesome, and one of her guides had an asthma attack. The guide told Stevens to keep going without her. “I’m like, ‘Uh-uh. You wouldn’t leave me behind,’ ” she recalls saying. “ ‘We’re all doing this together.’ ” •

SUMMER / FALL 2011 • HIGH DESERT PULSE

Get active |

WALKING THE LINE

PHOTO BY TY LER RO EMER

rian Mosbaugh, of Terrebonne, walks a 60-foot highline more than 100 feet above the floor of Cocaine Gully at Smith Rock State Park. Highlining is an offshoot of slacklining, a pursuit rock climbers invented to work on their balance usually only a foot or two off the ground. The climber wears a harness tethered to the line in case he falls. â&#x20AC;˘

Healthy options |

SCHOOL LUNCHES

Thinking inside the box ELEMENTARY SCHOOL This meal will provide vitamins B, C, A and D, fiber, calcium, folate, phosphorus and magnesium. “My general rule for lunch is to include a protein-based food, a whole-grain food and either a fruit or vegetable,” says Lynne Oldham, a dietitian at St. Charles Bend. Avoid packing too large a portion because this can be overwhelming. Young children often do best with a half a sandwich or smaller entree and more snacks.” •Mini whole-grain bagels with natural peanut butter and thin sliced banana. The whole wheat provides fiber, while the peanut or other nut butter provides protein.

MIDDLE SCHOOL This meal provides B vitamins, iron, zinc, folate, phosphorus, magnesium, potassium, calcium and vitamins D and A. “It would be a shame,” says Eris Craven, a Bend Memorial Clinic dietitian, “for a child to eliminate a healthy, interesting food because they got teased about it when they brought it to school for lunch. I think venturing outside of the box is great, but it might help if parents and kids work together, with the parent deciding which food groups must be included and the child deciding what will be packed for lunch.”

HIGH SCHOOL This meal provides zinc, vitamin E, calcium, B vitamins, potassium, vitamin A, folate, phosphorus, magnesium, iron and selenium. “For teenagers, it may be better to pack food items in plastic wrap or bags and use paper bags to avoid the frustration of not getting back reusable containers,” says Oldham. “High school-age students deal with the ‘cool factor’ that is related to what and where they eat lunch. Many high school students are either able to walk or drive to nearby fast food establishments or mini-marts.”

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SUMMER / FALL 2011 • HIGH DESERT PULSE

BY ANNE AURAND • PHOTOS BY PETE ERICKSON

Every 2 minutes

or parents who make their children’s school lunches, it’s easy to get stuck in a rut or to take unhealthy shortcuts in the interest of time. Here are some ideas for fresh and healthy options to include in your child’s lunches, from two local registered dietitians.

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•Mini pretzel twists, almonds and yogurt-covered almonds. If your child is craving sweets or crunchy food, this is a fun yet healthy way to satisfy. Homemade trail mix can be made in bulk and used over time. Consider including raisins, dried fruits, whole-grain cereals. Nuts are a source of healthy fat. •Celery stalks with reduced-fat cream cheese topped with cranberries and raisins. The celery is a good source of insoluble dietary fiber. Add a side of bell pepper slices. •Fruit kebab with strawberries, grapes, pineapple. Fruit is full of vitamin A, vitamin C and fiber. The kebabs make eating fruit not only healthy but fun as well. (Vanilla yogurt makes a great dipping sauce and provides calcium.) •Milk for calcium.

•Whole-grain tortilla filled with chicken salad, which has low-fat mayonnaise, celery, sunflower seeds and lettuce, providing lots of fiber and protein. Wraps can be rolled tightly in plastic wrap and placed in an insulated lunch bag to keep cold until lunch. And wraps are a great way to use up leftovers. •Mini blueberry muffins, preferably homemade, for a sweet treat. Blueberries are rich in antioxidants, vitamin C and fiber. •Baby carrots provide beta carotene and vitamin A. •Grapes are high in vitamin C. •Skewered cubes of fresh mozzarella cheese, basil leaves, grape tomatoes and cucumber. Mozzarella is relatively low in fat but provides bone-building calcium. •And water, of course, is an important nutrient.

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•Peppers, cucumbers and grape tomatoes are a great source of vitamin C, with whole-grain pita chips and hummus dip, which provide lots of fiber and protein. Keeping cut vegetables in the fridge is a great timesaver. •Hard-boiled egg for protein. •Yogurt for protein and calcium. •12 almonds for protein, fiber, calcium, iron, and a healthy fat. •Fig newtons, a dessert option. •Green tea contains an especially rich source of a particular antioxidant called catechins that may help protect against cancer. •

HIGH DESERT PULSE • SUMMER / FALL 2011

Page 17

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ARE YOU

Fitness |

GOING TOO FAR

OBSESSED? Finding the line between dedication and overdoing it BY ANNE AURAND PHOTOS BY ROB KERR

fter working all day as a general contractor, Mike Warren grabs a quadruple-shot of straight espresso and heads to the gym. He swims, lifts weights and takes yoga and spin classes. At 60, he’s not training for triathlons or marathons these days, but he still swims competitively and plays softball. His energy is visible when he jogs across a coffee shop to pick up his drink. And his determination is evident when he starts telling stories. Last summer, he ran across an indoor basketball court to greet a friend. His socked foot slipped, and he detached his hamstring. When he got home from the hospital some hours later, he passed out from the trauma, hitting pavers and a planter in the fall and breaking ribs and injuring an elbow. But it didn’t stop him from swimming. Just a few days later, he swallowed enough painkillers to allow him to race in the state open water championships at Applegate

Mike Warren, in the pool at the Athletic Club of Bend, swims even through periods of injury. Most days, he exercises about two hours, typically after a hard day of physical labor.

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SUMMER / FALL 2011 • HIGH DESERT PULSE

... See if you show the warning signs Rate yourself as honestly as you can using this checklist. I have missed important social obligations and family events in order to exercise. I have given up other interests, including time with friends, in order to make more time to work out.

I only feel content when I am exercising, or within the hour after exercising. I like exercise better than sex, good food, or a movie — in fact, there’s almost nothing I’d rather do. Missing a workout makes me irritable and depressed.

I work out even if I’m sick, injured or exhausted. I’ll feel better when I get moving anyway. In addition to my regular schedule, I’ll exercise more if I find extra time. Family and friends have told me I’m too involved in exercise.

I have a history (or a family history) of anxiety or depression. If you have checked three or more of these items, you may be losing your perspective on running and working out. Exercise is healthy as long as it is in balance with a full life. Speak with a mental health professional or your doctor for help. This checklist was developed by Sharon Stoliaroff, Ph.D., a clinical psychologist in Chevy Chase, Md., originally printed in Running & FitNews, and reprinted with permission from The American Running Association, www.americanrunning.org.

HIGH DESERT PULSE • SUMMER / FALL 2011

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Fitness | GOING TOO FAR Lake in Southern Oregon, dragging his immobile lower body through the water with strong arm strokes. While others ran down the beach into the water, he gimped on crutches to shore. This was his approach to 18 subsequent swims last summer. He felt better when he was in the water swimming, he said. “I just needed to do it.” Isn’t that a little obsessive? “Maybe a little,” he admits. But he said that word — obsessive — has a negative connotation, and for him, the swimming and the workouts are joyful. “I find nothing negative about what I do,” he said. Exactly where a healthy thing like exercise tips into obsessive or addictive behavior is not defined in the reference books. It depends on the individual. It’s not how many hours a person exercises; it’s how he or she thinks about it and whether it fits into a wellrounded life. Warren exercises more than most people, but said he feels younger after a couple of hours at the Athletic Club of Bend. His gym time counteracts the aches and pains from his work. It keeps life’s stress in check and gives him insight. It’s a natural painkiller, he said, “like a drug.” Barbara Brehm, a professor of exercise and sports studies at Smith College in Massachusetts, said people need challenge in their lives to build self-esteem. High levels of sport and exercise training provide that. “That’s OK,” Brehm said. “Whereas con-

COMPLETE CARE

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trolled users of exercise enjoy physical activity, compulsive exercisers rely on exercise to cope. Exercise becomes a way to avoid life rather than enhance life.” Those who study psychology and sports say there are a few questions people can ask themselves to determine whether their fitness routines have become problematic. They are the same questions a drug user might consider to self-assess drug addiction. Does the behavior provide the primary source of gratification in my life? Does it help me avoid problems? Does it decrease my self-esteem? Am I developing a tolerance for it, so I need more? Is it causing health or social problems? Do I work out when I’m sick and injured? Have loved ones expressed concerns about it? When Warren asks himself these kinds of questions, the answers are mostly “no” — with the occasional “but” or “only when.”

Obsessive exercisers It’s not uncommon for high-performing, Type A personalities to fixate on fitness, athletic competition or healthy eating. Local triathletes and ultrarunners David Uri, 42, and Jeff Patterson, 40, recognized their behavior tipping into the obsessive at different points. Ironman triathletes with competitive temperaments tend to worry that they haven’t trained enough to perform well in the ultimate, grueling endurance race. They are continually compelled to work out more, to train harder. In 2004, Uri was an investment banker liv-

ing on the East Coast, working 70 hours a week and working out 20 more to train for his first Ironman. He had two young children. “The reality is, it is a selfish activity. Unless you’re a bachelor, it places constraints on family time,” he said. “My wife was supportive early on. “I did well in that first Ironman,” he said. “It was a phenomenal experience, and I was hooked. I wanted to go faster.” He kept trying to improve his times, entering Ironman after Ironman. But he started enjoying the training less and less. His family grew, and his wife, Lisa, a physician, finally asked him to evaluate his priorities, he said. “When any one thing has that much focus, everything else is compromised,” he said. For him, it was fatherhood. Their third child was born in 2006, around the time they moved to Bend. His last Ironman was in 2007. His kids are now 10, 8 and 4. “I want them to see me as a fit and active father, but what they’re going to remember is having an involved father,” he said. He still runs local marathons and ultramarathons. But he also spends days at his kids’ schools and more time at home with the family. Patterson, a tax attorney, didn’t start running until he was an adult. He turned out to be pretty fast, and his success and progress excited him and inspired him to train for an Ironman triathlon, which became all-consuming. “At the point that you go home and can’t engage because you’re so exhausted, can’t play

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SUMMER / FALL 2011 • HIGH DESERT PULSE

Defining a fixation Obsession: A persistent disturbing preoccupation with an often unreasonable idea or feeling; compelling motivation. Obsessive:Excessive, oftentoanunreasonabledegree. Addiction: Compulsive need for and use of a habit-forming substance characterized by tolerance and well-defined physiological symptoms upon withdrawal. Persistent compulsive uses of a substance known by the user to be harmful. Source: Merriam Webster’s Collegiate Dictionary, Tenth Edition

B end personal tra i n er R u t h A n n C l a r k e,i n r ed , h el p s c l i en t s b a l a n c e t h ei r f i t n ess r o u t i n es so t h ey d o n ’ t g et o v er t r a i n i n g sy n d r o m e,a n o b sessi o n t h a t sh e’ s ex p er i en c ed h er sel f .

with the kids, talk to your wife … or you’re so obsessed with thinking about the third mile of the 10-mile run, staring at the wall thinking about that, it’s a problem. I found myself teetering into that,” he said. Then he had a wake-up call. On Memorial Day in 2007, he had gotten up early to ride his bike to Alfalfa and Prineville Reservoir before a family barbecue. Coming back, he crossed a cattle guard badly and slammed down, fracturing his skull and a vertebra in his neck. For four days he lay in a hospital bed and wondered if he’d ever do anything again. “I realized it could have killed me. I could have left a widow and kids without a dad.

HIGH DESERT PULSE • SUMMER / FALL 2011

Facing that, the significance of any race was miniscule compared with my time with them,” he said. His obsession was put into perspective. He doesn’t think it was a coincidence. “I think God completely controlled all of that,” he said. He still competes in endurance events and spends lots of time training, but he’s more willing to cut a ride short or skip a workout if his wife or two young children need him, he said.

Overtraining syndrome Everyone’s moment of awareness is different. For many athletes, including Ruth Ann Clarke, turning points come in the form of an injury.

A self-described “running maniac” for a number of years, Clarke is a personal trainer at the WRP Training Studio in Bend who now knows better. Driven by winning races, Clarke would run or cross-country ski even when injured or sick with bronchitis. Eventually a foot injury forced her to cross-train, and to exercise less intensely. Interestingly, her appetite and mood improved. She had experienced overtraining syndrome, she said. Overtraining syndrome can be a shortlived experience that can happen while training for a specific event. It doesn’t indicate a psychological imbalance or exercise addiction, but it’s likely to happen to the obsessive

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PREVENTATIVE CARE

Colorectal Cancer Colorectal cancer - cancer of the colon and rectum - is the second leading cancer killer in the United States and all women and men aged 50 and older are at risk. The good news is that colorectal cancer is preventable and, if detected early, curable. Depending upon your age and family history, you could be at risk for developing this disease. If you answer “yes” to any of the following questions, talk to your healthcare provider about getting screened for colorectal cancer (screening means getting tested for a disease even if you don’t have symptoms). • Are you aged 50 or older? • Has a parent, brother, sister or child of yours had colorectal cancer? • Has a parent, brother, sister, or child of yours had colon polyps? • Do you have abdominal pain, diarrhea or constipation? Screening colonoscopy can prevent colorectal cancer and healthy lifestyle choices can help.

Fitness | GOING TOO FAR exerciser. It means the athlete is not giving the body adequate rest time. The body can’t repair itself or improve its performance. Muscle fibers can’t rebuild. The overtrainer will eventually get injuries and a weakened immune system, Clarke said. Also, losing too much body fat harms a body’s ability to fight infections, she said. If not addressed, overtraining can become serious. Dr. Cara Walther, an orthopedic surgeon with Desert Orthopedics in Bend who specializes in women’s sports medicine, defines an exercise addict as one who can’t stop even when a doctor insists. Walther sees patients whose excessive exercise has damaged their bones and joints. In extreme cases, and especially when combined with too much dieting, overtraining leads to broken bones, stress fractures and amenorrhea, which means a woman stops menstruating. The exercise addict is likely to wind up in surgery, she said. Overtraining syndrome also has psychological components, including depression, insomnia and decreased appetite. “You get burnout,” Clarke said. “You lose interest in what used to make you happy.” When people are obsessed with exercise, they don’t recognize their fatigue as a symptom of overtraining, Clarke said. They can’t quiet their brains at night because their bodies are so overstimulated, she explained. They might even think about working out more to see if they can make themselves more tired, she said. When she sees this happen in her clients, she advises them to rest and to cross-train, to try some yoga or a bike ride instead of running, for example. A lot of them, she said, resist her advice. “A lot of people are not in tune with their bodies and just don’t know what they’re doing to themselves,” she said. “Others choose to ignore the signs.”

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It’s a fine line, where athleticism or healthy eating cross into compulsive behavior. An ultramarathon runner who has kidney failure after a race, or a teenage girl who runs 16 laps every day to control her weight, “these could fall within the realm of healthy. They could also be unhealthy,” said Darcy Gilbert, a local counselor who specializes in

Overtraining and its effects Defining overtraining syndrome: When volume and intensity of exercise exceeds the body’s ability to recover. Common in athletes, it manifests with physiological and psychological symptoms and can adversely affect an athlete’s performance, according to the Journal of Athletic Training. Signs of overtraining syndrome, according to the American College of Sports Medicine, include: Performance: • Decreased strength and endurance • Decreased training tolerance and increased recovery requirements • Decreased motor coordination Physiological: • Altered resting heart rate, blood pressure and respiration patterns • Decreased body fat and post-exercise body weight • Chronic fatigue • Sleep and eating disorders • Menstrual disruptions • Headaches, gastrointestinal distress • Muscle and joint pain Psychological: • Depression, apathy, lower self-esteem • Decreased ability to concentrate • Sensitivity to stress Immunological: • Impaired immune function • More illness • Slower healing

diet and fitness issues. There are as many examples along the spectrum as there are people, she said. And there are plenty of them around here. “Bend has the sort of fertile ground that can foster many to toe that line between just being an active, multisport person who loves recreating and doing a few races each year while managing and balancing other aspects of a full life, and then there’s the other side of that line,” Gilbert said. She knows. She’s been there. Now 43, Gilbert was 15 and living in Albany when a breakup with a boyfriend triggered the thought: “I’ll just ride my bike until this Scorpions album plays twice.” She also started running. Then she started Continued on Page 52

www.advancedspecialtycare.com Source: American Society of Colon and Rectal Surgeons’ (ASCRS) www.fascrs.org

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SUMMER / FALL 2011 • HIGH DESERT PULSE

Get ready |

ROCK CLIMBING

Climbing is within your reach BY MARKIAN HAWRYLUK PHOTOS BY ANDY TULLIS

t’s the stuff of legends: defying gravity, scaling a sheer rock face, protected only by a thin sliver of a rope. It’s no wonder that so many adventure movies feature rock climbing scenes. But remember that in the movies, there’s a ton of dramatic license involved. “In general with movies where we see climbing, it’s very different,” said Jim Ablao, a rock climbing guide who owns First Ascent Climbing Services in Bend. “They trump up the danger, and some of that danger is even contrived as well.” Like the scene in the film “Vertical Limit” where two of the three pieces of protection holding a trio of climbers come loose, forcing the son to cut his dad off the end of rope to save himself and his sister from certain death? “Yeah, it doesn’t do that,” Ablao said with a chuckle. If you’ve never actually tried it, you might find rock climbing is easier and safer than you thought. Ablao said rock climbing gyms offer an easy way to break into

Members of the Cascades Mountaineers climbing club scale the rock at Meadow Camp in Bend. ANDY TULLIS

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Get ready | ROCK CLIMBING

Dustin Riley, of Bend, nears the top of the Solstice climbing route as Rick Krause, of Madras, holds his line at the Meadow Camp climbing area.

“A lot of people, even with just a very basic athletic ability, have the necessary skills to (climb).” Mike Rougeux, rock climbing guide

the sport. Gyms offer a much more controlled environment than outdoor climbing. The ground is flat and maybe even padded. The temperature is controlled, so you’re not dealing with the threat of rain or sweaty palms. “There’s definitely something that adds to the drama of just being in the outdoors. You have wind and weather and a sense of exposure,” he said. “Sometimes the places we go outside, the walls aren’t that tall. The climb-

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ing may be 30 or 60 feet high, but that wall sits 200 feet above the canyon floor. So you have a much greater sense of exposure.” Indoor rock gyms help potential climbers learn the standard movements of rock climbing and more importantly some of the basic safety rules around tying into a rope or belaying, the act of securing another climber on a rope. “If you can climb well indoors, it does

translate outside,” Ablao said. “But the mental aspect may catch you off guard a bit.” Many beginners worry that the harness, the ropes, the gear will not all work properly if they fall. “It’s just trusting the equipment and the belayer, that the ropes are being handled correctly. Even if it all is, it still makes people really nervous,” Ablao said. Beginners generally learn to climb with

SUMMER / FALL 2011 • HIGH DESERT PULSE

what’s known as a top rope. One end of the rope is tied to the climber’s harness. The rope is threaded through an anchor at the top of the climb and the other end comes down to the belayer. The belayer pulls the rope through a special device as the climber ascends the wall, maintaining a fairly taut rope from climber to anchor to belayer. If the climber falls, the device can lock the rope in place, preventing the climber from falling any farther. Rock climbing may look risky, but in fact, the sport has developed techniques and strategies that drastically reduce the risk. But that does increase the learning curve for beginners entering the sport. “We all had to start somewhere, and we all make mistakes,” said Mike Rougeux, a rock climbing guide with Timberline Mountain Guides. “But mistakes made rock climbing — the repercussions of some of those can be a little bit more than ‘I forgot my raincoat backpacking.’” Rougeux urges beginners to take a course to learn how to tie the knots properly, how to belay a climbing partner, and the other basics of climbing that will ensure a safe and fun day out on the rocks. Many novices think they will have to pull

themselves up by their arms and if they lack upper body strength, they can’t be good climbers. But Rougeux said climbers, at least at the beginning level, primarily use their legs to climb up rock walls and use their arms and hands to stay balanced on the rock. “It’s just like climbing a ladder,” he said. “You’re not just dragging your feet up behind you and using your arms. A lot of people, even with just a very basic athletic ability, have the necessary skills to do the movement.” Climbers can also learn to climb through climbing clubs, many of which offer multiday learn-to-climb programs every spring. Clubs can also be a great way to meet other climbers, both novices and old pros. The American Mountain Guide Association trains and certifies rock climbing guides and certifies climbing schools like Timberline and First Ascent. It’s a good way to ensure you’re getting the best teachers possible. “Find good solid instruction, whether it’s hiring a guide or finding a good mentor,” Ablao said. “Gather all your guts and find a good venue to do it. Get out there and give it try!” •

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HIGH DESERT PULSE • SUMMER / FALL 2011

Climbing clubs Cascades Mountaineers, Bend info@cascadesmountaineers.com www.cascadesmountaineers.com Chemeketans, Salem chememb@chemeketans.org www.chemeketans.org Mazamas, Portland adventure@mazamas.org www.mazamas.org

Rock climbing instruction Timberline Mountain Guides, Bend 541-312-9242 info@timberlinemtguides.com www.timberlinemtguides.com First Ascent Climbing Services, Bend 541-318-7170 info@goclimbing.com www.goclimbing.com Bend Rock Gym, Bend 541-388-6764 info@bendrockgym.com www.bendrockgym.com

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Sor ting it out |

OVER-THE-COUNTER PAINKILLERS

Pick your pain relief BY BETSY Q. CLIFF

ver-the-counter painkillers are the most commonly taken medications in the United States. More than one out of five people say they pop at least one pill in an average week. But which one to take? Many formulations are on the market, all made with different chemicals and with slightly different effects on the body. All work in a similar manner, by inhibiting the production of hormone-like substances that irritate nerve endings, causing pain. Those substances also play a role in inflammation, but not all pain relievers help with that. Pharmacists say that no one painkiller works best for all people. “Everyone will re-

Page 26

spond differently,” said John Miller, manager of the community pharmacy at St. Charles Health System. So, if you find one you like, stick with it. That said, there are some general rules about which painkillers work for which ailments and who should use caution in taking them. This guide lays out the biggest differences and prevalent pitfalls, as well as the prices of the brand name and the generic formulation. Most experts say there’s no difference between the generic and brand name for a product, though there has been some controversy over this issue. But there’s no substitute for reading labels to be sure you’re taking the right amount at the right time, or for a discussion with your doctor, particularly if you take other meds. •

Aspirin (Bayer) Best for: Headaches, fevers or mild body aches, and sometimes recommended to prevent blood clots or to reduce risk of heart attacks. Safe for those who have had a heart attack. Unique in its ability to reduce blood clotting. Not for: Exercise caution if you have kidney disease or ulcers, if using with ibuprofen, or if you are pregnant. Pitfalls: May break down the protective lining of the stomach, causing bleeding or ulcers with longterm use. Approximate cost range for 100 caplets: Bayer: $6.19 to $7.99. Generic aspirin: $0.99 to $5.29.

SUMMER / FALL 2011 • HIGH DESERT PULSE

Acetaminophen (Tylenol)

Ibuprofen (Advil, Motrin)

Naproxen (Aleve)

Best for: Headaches or fevers; can be combined with other painkillers under a physicianâ&#x20AC;&#x2122;s direction, particularly to break a tough fever. (Excedrin combines both acetaminophen and aspirin.)

Best for: Headaches, fever, inflammation and muscle pain, including menstrual cramps.

Best for: Fever, pain or inflammation.

Not for: Does not reduce inflammation. Pitfalls: Can cause liver damage. Never take more than 4 grams (8 Extra Strength Tylenol capsules) in 24 hours. Heavy drinkers should use even less. Be careful when taking other products that may contain acetaminophen, like cold medications. Approximate cost range for 100 caplets: Tylenol: $8.66 to $10.49. Generic acetaminophen: $3.19 to $7.99.

HIGH DESERT PULSE â&#x20AC;˘ SUMMER / FALL 2011

Not for: Pregnant women; patients taking blood thinners; or those who have had a heart attack, kidney disease, hypertension, stroke, diabetes or gastrointestinal bleeding. Pitfalls: Chronic use can increase the risk of heart attack and stroke, perhaps because they increase blood clotting. Can upset the gastrointestinal system and, rarely, can cause ulcers. Approximate cost range for 100 caplets: Advil: $8.99 to $11.99. Motrin: $8.67 to $9.99. Generic ibuprofen: $2.59 to $8.39.

Not for: Pregnant women; patients taking blood thinners; or those who have had a heart attack, kidney disease, hypertension, stroke, diabetes or gastrointestinal bleeding. Adults over 64 may be at increased risk of side effects, particularly drowsiness or confusion. Pitfalls: Chronic use can increase the risk of heart attack and stroke. Can also cause central nervous system side effects. Approximate cost range for 100 caplets: Aleve: $8.99 to $11.79. Generic naproxen: $5.19 to $8.49.

Page 27

Get gear |

YOGA MATS

BY ANNE AURAND • PHOTOS BY ROB KERR

oga mats have come a long way since the ancient yogis in India used tiger skins. When the modern yoga mat was developed decades ago to provide traction and protection from a hard ground, there was one basic model. Now there are almost as many mats as styles of yoga.

When choosing a yoga mat, don’t let all the choices tie you up in knots

Here’s a guide to some of the qualities a yogi should consider. •Materials: Most mats are made of polyvinyl chloride, or PVC, a durable vinyl polymer that has been criticized as an environmental toxin. More environmentally friendly mats are made of natural or recycled rubber, jute or organic cotton. •Thickness: The thicker the mat, the more comfortable the prac-

STAYING Choosing a mat Yoga teachers, posing at Back Bend Yoga, highlight the pros of various mats.

Kat Seltzer, on a Manduka mat • 85” long, 6.3 mm thick, $94

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• Expensive, but Seltzer says they last “forever” • Eco-certified PVC, made without toxic emissions • Non-slip finish • Extra squishy cushioning for a pregnant yogi (as Seltzer is) or anyone seeking more comfort • On the heavy side; not ideal for traveling

Ryan Re, on a Gaiam essentials mat • 68” long, 3 mm thick, $22 • Affordable, lightweight mat • Non-slip surface and gentle cushioning • PVC mat containing no latex • A good value: Re says this type of mat will work for just about anything you want to do in yoga • Wia Lana makes a similar mat

Ev m of f

• Made t perspiration absorbent c and a brush grips carpet studios • Ma Eliminates s

tice, generally. Too thick, however, and balancing poses might feel a bit wobbly. Thicker can be better for more seated and reclining poses. • Stickiness and traction: PVC products typically provide the stickiest surfaces, to keep hands and feet from sliding during poses. To avoid PVC but to maintain traction, try a rubber, jute or cotton mat that has tactile patterns and textures.

• Costs: The thinnest PVC mats can start around $20 at stores like Target or Fred Meyer. Eco-friendly and more specialized mats can cost up to $100 and can be found at limited locations, including Lululemon (550 N.W. Franklin Ave., Bend) or Namaspa (1135 N.W. Galveston Ave., Bend). Also, REI (380 Powerhouse Drive, Bend) carries a variety of mats, and most mats are available online. •

GROUNDED

va Vidal, on a Breathe mat • 72” long, 3 layers fabric, $60

to absorb dripping n • Cotton terry top, cushioning fiber middle hed fabric bottom that ted floors, typical in Bikram achine wash and dry • lipping and rearranging

Peter Lear, on a Lululemon “the mat” • 71” long, 5 mm thick, $68

Suzie Harris, on a Harmony mat by Jade • 68” long, 4.7 mm thick, $65

• Wide, more space to move • Soft on the knees • Super sticky, even when wet • Downside? It smells like rubber at first • Grippy polyurethane top layer ideal for sweaty yoga • Natural rubber bottom layer is softer, less absorbent • Treated to prevent bacteria and fungi

• Made with sustainably harvested natural rubber • Slip-proof, as tacky as a rock climber’s shoe • Exceptional traction for wide-stance poses or poses when you want your hands to stay put • Relatively lightweight

Does it work? |

BED REST

Amanda Sheffield, of Bend, was on bed rest for 10 weeks, an experience that she said made her question whether she wants more kids.

SUBMITTED PHOTO

One in five pregnant American women are put to bed annually. That may be doing more harm than good.

Bed rest: often used, never proven BY BETSY Q. CLIFF

manda Sheffield had a hard pregnancy. She was put on bed rest to deal with cervical problems that may have been exacerbated by carrying twins. The Bend woman cried as she remembered those 10 weeks when she couldn’t get out of bed, even to shower. Something as simple as dropping a tube of Chapstick out of reach brought her to tears, she said. Up to 1 million women each year are put on bed rest, and many find it difficult, both

Page 30

physically and psychologically. Sheffield, 20, said the experience has made her question whether she wants more kids. But she, like most other women, went along with the recommendation willingly. After all, who wouldn’t endure several weeks of misery to have a healthy baby? But here’s the thing: There’s no evidence that bed rest helps prevent complications from pregnancy or improves the health of babies. And here’s the other thing: Your obstetrician likely knows that. The American College of Obstetrics and

Gynecology, a professional organization that sets guidelines for medical practice, says bed rest does not reduce the rate of preterm birth and “should not be routinely recommended.” Studies have failed to find any difference in the outcomes of women who are on bed rest when compared with those who went about their regular lives. So why is it still used? Good question, say experts. “Without question,” it’s overprescribed, said Dr. Robert Goldenberg, a professor of obstetrics and gynecology at Drexel Universi-

SUMMER / FALL 2011 • HIGH DESERT PULSE

“ There’s literally no evidence it works. Zero.” Dr. Anthony Sciscione, a pregnancy specialist

ty College of Medicine in Philadelphia. “I think doctors should practice based on evidence, and they shouldn’t be prescribing things, especially commonly and in large quantities, when there’s no evidence of benefit.” Dr. Anthony Sciscione, a Delaware specialist in high-risk pregnancy who has been a vocal critic of bed rest, was more blunt. “There’s literally no evidence it works. Zero,” he said. “No other specialty would tolerate this.”

Old habits One of the reasons often given for prescribing bed rest is that it’s what doctors have always done. “It has become so ingrained that nobody wants to test it,” said Sciscione. “Everybody (says they) know it helps. But really the truth is nobody knows.” Bed rest has been used as a cure for various maladies for centuries and to prevent complications from pregnancy for decades. Today, virtually all obstetricians prescribe it at least some of the time. Women are put on bed rest for conditions including high blood pressure, preterm labor, incompetent cervix (cervix dilates too early) and placenta previa (placenta moves over the cervix). Some doctors routinely put patients carrying more than one baby on bed rest. They may prescribe several days or multiple weeks of bed rest and with any number of restrictions. The strictest bed rest is typically in the hospital, with no allowances for getting up, even to use the bathroom. Other women are allowed to be at home, but confined to bed. And some are told to stay off their feet as often as possible, but they can do more normal activities. Women often need to quit their jobs or go on maternity leave early, and particularly if they have other kids, need to find someone to help take care of their families. Local obstetricians said, despite the lack of evidence, they felt it did help their patients.

HIGH DESERT PULSE • SUMMER / FALL 2011

“This is where we have the art of medicine,” said Dr. Peter Palacio, a Bend obstetrician. “We have decades of practitioner experience where we think this is a benefit.” Dr. Todd Monroe, an obstetrician at St. Charles Health System’s practice in Redmond, told of a patient who had looked as if she might deliver her baby at 22 weeks, the edge of viability. With bed rest she made it to 39 weeks, full term, and had a healthy baby. Monroe said nearly all obstetricians have stories like that, where they believe an intervention resulted in a good outcome. The other argument for bed rest is that it seems logical. Physical activity can spur contractions, and preterm contractions are often a concern. Preterm labor is the most common reason for prescribing bed rest. But in fact, contractions don’t typically lead to labor, said Palacio. “Someone can contract every five minutes and be totally fine.” Until the cervix begins to change, which sometimes happens with contractions but often does not, preterm delivery is not imminent. “We’ve had people contract all the way through labor and then we have to induce them because they never dilate,” said Dr. James Weeks, a family physician in Bend who practices obstetrics. Also, there’s an argument that physical activity may actually prevent, not promote, preterm labor. While no one knows exactly what triggers labor in the body, many suspect inflammatory processes may play a role. Because moving around can decrease inflammation, Sciscione said, it could be that physical activity dampens those chemicals in the body that would induce labor. One large study found that women who exercised were less likely to have a premature baby than sedentary women, though the study did not look specifically at women with complications during pregnancy.

SUBMITTED PHOTO

No evidence Few obstetricians have challenged the notion that bed rest may not be effective, and few studies have been done. Of those that have, the results show little benefit of bed rest. For example, a 2004 study analyzed all work done on the use of bed rest to prevent premature delivery, which at the time was just one study. Conclusion: No difference was found between bed-rested and active women. A 2006 study analyzed the effect of bed rest to mitigate preeclampsia, a condition in which the mother’s blood pressure spikes dangerously high. Conclusion: Two small studies showed a small benefit, but the authors wrote that more evidence is needed. A 2010 study looked at the totality of evidence from multiple studies for putting women with twins on bed rest. Conclusion: No differences were found in preterm labor or healthy babies with bed rest. In at least one of those studies on twins, women on bed rest actually gave birth to premature babies more often than women not on bed rest. “In twins, there’s pretty good data that it’s harmful,” Goldenberg said. It’s hard to tell in any individual case whether bed rest makes a difference, and that’s part of the problem. It’s unclear the exact reason for Sheffield’s bed rest. Her physician, Dr. Diana Ackerman of the East Cascade Women’s Clinic in Bend,

Page 31

Does it work? | BED REST declined through an office manager to be interviewed for this story. Sheffield’s baby boys, Adam and Mason, were born via cesarean section at nearly 31 weeks and are now doing well. It’s not clear why there have not been more studies on bed rest. Some doctors say there is an ethical issue because a study would require creating a control group of woman and not treating them with bed rest, even though normally they would be treated. Others contend that because there’s no evidence the treatment works, there is no ethical dilemma. Dr. Aaron Caughey, chair of the department of obstetrics and gynecology at Oregon Health & Science University, said he thinks it’s a question of priorities. “If you were trying to decrease perinatal mortality, (studying this issue) is going to be low on the list,” because bed rest does not increase the chance that a fetus will die. “I wouldn’t hazard that it’s going to dramatically improve outcomes.” But from a cost perspective, he said, it looks more important. “We’re taking all these

PHOTOS BY ANDY TULLIS

Amanda Sheffield holds her 5-week-old twin sons, Mason and Adam Sterzenbach, at St. Charles Bend.

Gina Samuel, who used bed rest in her pregnancy, holds her 1-month-old son, Austin, at their Redmond home.

“Our rates of blood clots killing women are as high or higher than in the developing world. One reason is a lot of bed rest.” Dr. Aaron Caughey, Oregon Health & Science University

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women out of the workforce.” Sciscione, the Delaware physician, has planned a large, randomized, controlled trial — considered the gold standard of research — but has not received funding for it. It may take years before results of that work are known.

Maternal damage One of the misconceptions about bed rest, even among some physicians, is that side effects are negligible. That was the prevailing thinking 20 years ago when Judith Maloni, now a professor at Case Western Reserve University in Cleveland, was a young nurse writing her dissertation. She was one of the first to look at the effects of bed rest on both mother and baby. What she found has made her somewhat of an activist against the practice. “What seems to be a stressful but benign kind of thing may be much worse than we thought,” she said. “There are side effects in every major organ system. When you put women in bed, their muscles become weak, cardiovascular system becomes weak. They get dizzy going to the shower.” Sheffield experienced much of that. She

HIGH DESERT PULSE • SUMMER / FALL 2011

had a hard time walking the five feet to get out of the way of hospital staff who came in to change her bedsheets, she said. “I had to hold on to something.” Lying in the same position all the time also caused a lot of pain. “My back was just killing me,” she said. Her deterioration was quick. Just the day before she had gone into the hospital, her finance, Shane Sterzenbach, remembered, “we were skipping through the tide pools at the coast.” That deconditioning can affect a woman after the baby’s birth. Maloni said in her studies, 11 percent of women on bed rest fell while walking or standing after they had their babies. None of the women in the active group reported falls. Bed rest also increases the risk of deep vein thrombosis, blood clots in the legs. Pregnancy itself increases the risk of deep vein thrombosis by five to 10 times, though the overall risk is still low, about 1 in every 1,000 pregnancies. With bed rest the risk is still low but increases substantially. According to one study, 16 of every 1,000 pregnant women on bed rest developed the complication.

A blood clot in the legs can be deadly if the clot breaks off and travels to the heart. About 60 women in the United States die each year this way. “Our rates of blood clots killing women are as high or higher than in the developing world,” said Caughey, “One reason is a lot of bed rest.”

Tough to take If bed rest is physically difficult, it may be even harder on women psychologically. The isolation often gets to women. Maria Terrazas, a 17-year-old Culver woman expecting her first child, was on bed rest for several weeks because of placenta previa. She was by herself most of the day, while her parents worked and her boyfriend was at school. “I feel really lonely and bad most of the day,” she said. “I see all the little kids running around. It makes me kind of sad because I wish I could walk around, too. I can sit around and watch TV, but that gets really boring. … I never thought it would be this hard.” Maloni has talked to scores of women with similar experiences. “Many women talk about

Page 33

D oes it work? | BED REST

Abnormal sleep patterns leading to fatigue

Increased risk of depression

Bone loss Indigestion or acid reflux Increased risk of blood clots in legs

Muscle weakness and deconditioning resulting in soreness and weakness

Maternal weight loss

having a sense of being a prisoner,” she said. Maloni’s studies confirm symptoms of depression are common in women on bed rest. For women who are supporting families, bed rest can cause financial and family disruptions. Gina Samuel, a Redmond mom of two whose son Austin was born at 37 weeks after a couple of weeks of bed rest, said it was difficult to take care of her family while on bed rest. “I’m a doer,” she said. “It’s hard for me to just sit there.” She had a toddler at home and had to say no to requests to play. “They want you to come see something or play with them; it’s hard to not do that.” She had to go on maternity leave from her job three weeks early, giving her less time with the new baby after his birth. She was lucky, she said, that her employer was understanding and even let her work part time at home. Some women aren’t that fortunate. “Economically, it’s a disaster for many families,” said Goldenberg. Women lose their paychecks, and depending on the length of bed rest, perhaps their jobs. Then, there’s the cost. For one day in St. Charles Bend’s family birth center, where women who are hospitalized for bed rest stay, the average charge is $2,100. Sheffield and her fiance haven’t even begun to compute the cost of her two-month stay at the hospital, Sterzenbach said.

Blame game

GREG CROSS

What to do if you’re ordered to bed Knowing that there’s no evidence that bed rest prevents complications from pregnancy, what to do if you’re ordered to bed? — Get a second opinion from a perinatologist, suggests Judith Maloni, a professor at Case Western Reserve University who has studied the topic extensively. Perinatologists specialize in high-risk pregnancies. In Central Oregon, there are two who come over from Eugene regularly. — Discuss your concerns with a doctor, said Dr. Robert Goldenberg, a professor at Drexel University College of Medicine. Ask whether bed rest is necessary and what evidence supports the prescription. — Ask for a postpartum assessment of your physical and mental status, said Maloni. Physicians should screen for side effects, including bone loss and postpartum depression, she said.

How to cope Some tips from Candace Hurley, who runs a support group for women on bed rest called Sidelines: National High Risk Pregnancy Support Network: — Discuss how much physical activity you can do with your physician, and do it. “Anything you can do to help your body,” she said. — Find support. Talk to friends. Have people over if you want. Contact Sidelines (www.sidelines.org), to pair up with mentors. — Learn to ask for help. Ask people for specific errands such as going to the grocery store or bringing over dinners. — Don’t worry about being productive if you don’t feel like it. “I couldn’t even read,” she said. — Look for local resources. Hurley learned that her local library delivered books on tape to elderly people who couldn’t leave their homes, so she got them to drop some off at her house, too.

Articles questioning bed rest worry Candace Hurley, who was put on bed rest for her children, now in their early 20s, and who runs Sidelines: National High Risk Pregnancy Support Network, which helps women on bed rest. “I’m always concerned that someone who really does need that restriction reads (them), gets up and moves around, then has that loss.” But some physicians, particularly those who have studied the issue, say that kind of thinking could be the biggest problem and the biggest barrier to really examining the practice. Bed rest, they say, may make women and doctors feel they have more control over the pregnancy than they actually do. It gives the illusion of doing something, without actually changing the outcome. “It’s very hard to tell someone you’re at risk for (something) but don’t do anything,” said Sciscione. “You want to do everything for your baby.” The problem, said Goldenberg, is that when that fails, when there’s not a good outcome, the idea that the mother could have controlled it can lead the woman to blame herself. The thoughts can go crazy. Maybe she shouldn’t have gotten up to go to the bathroom. Was playing blocks with the older child too much? Should she not have cuddled with her husband? “There’s an awful lot of guilt that I think shouldn’t be there,” Goldenberg said. He has prescribed bed rest less often in the past several years, in large part, he said, because of his concerns about maternal guilt. Nearly all experts said better studies are necessary to establish the best thing to do. That kind of work, Goldenberg said, could go a long way. “Doctors want their patients to have a good baby; that’s why they do this. This is not a mean thing; doctors aren’t making money by putting patients on bed rest. The motivation is coming out of bad information.” •

Page 34

SUMMER / FALL 2011 • HIGH DESERT PULSE

On the job |

DISASTER RELIEF WORKER

Catastrophic care Haunting cases, tough conditions: It takes a special kind of volunteer

BY BETSY Q. CLIFF

he 2-year-old Port-au-Prince boy had been living with an infected open fracture in his arm for two weeks when he came into the clinic where Colette Whelan was working. Whelan had arrived in the Haitian capital in January 2010 just 12 days after a devastating earthquake struck the country, killing tens of thousands, leaving hundreds of thousands homeless and generating headlines worldwide. Whelan, 45, a former emergency room nurse in Bend who now focuses on disaster work, had come to the island with Medical Teams International, a nonprofit group that provides disaster relief. She is one of that special brand of people who run into situations just as most others are trying to escape. She spends up to a month at a time in disaster areas, using her medical skills to treat as many people as she can. The Haitian boy’s arm had almost certainly been crushed by rubble, as a home or building crashed down on him during the quake. He was spirited, Whelan remembers, and his father was devastated. “Here’s this little kid with his whole life ahead of him,” she remembered. “It was just heart-wrenching.” This is the kind of situation that, though tough, attracted Whelan to disaster work. “It’s pure medicine,” she said. “It’s really trauma medicine at its best. It’s life-or-death situations for these people.” Disaster medicine focuses specifically on providing care to victims of tragedies, either natural or caused by humans. While emergency medicine and trauma care have been around for decades, disaster medicine has only recently become its own specialty. A professional organization focusing on disaster medicine was formed just five years ago. Whelan has cared for people in Indonesia after the 2004 tsunami and in Pakistan after a massive earthquake in 2005, and she made several trips to Haiti after the 2010 earthquake. She’s never been paid for this work, which is not unusual. “It doesn’t pay the bills,” said Whelan, whose paid job is working

Page 36

2 0 0 5 earthquake, Pakistan

PHOTOS COURTESY COLETTE WHELAN

Disaster relief worker 2004 tsunami, Indonesia

2010 earthquake, Haiti

Most front-line disaster relief workers are volunteers with experience in emergency medicine. • Nongovernmental organizations include Medical Teams International (www.medicalteams.org), American Red Cross (www.redcross.org), Doctors Without Borders (www.doctorswithoutborders.org), Catholic Relief Services (crs.org) and the International Medical Corps (www.imcworldwide.org). • Government-sponsored local disaster response teams are listed at www.dmat.org/teamlinks.html.

on emergency preparedness for the state, and she takes time off to help in disaster situations. Many who specialize in disaster medicine have other jobs, often in emergency medicine. Whelan said they need understanding employers. “You have to be in a job that gives you the flexibility to go.” Often the response to a disaster is provided by a mix of aid workers deployed by the state or federal government and volunteers from nongovernmental organizations. Those NGOs, such as Medical Teams International, recruit volunteers to serve on the front lines. Whelan has also served for three years on Oregon’s Disaster Medical Assistance Team, often known as a DMAT. DMAT teams, which used to be a part of the Federal Emergency Management Agency, are now part of the Department of Health and Human Services. The teams, located in nearly every state, can be deployed by federal or state governments during a disaster. They are paid for a week of training each year and when they are deployed by the federal government to a “Here’s this little kid with his whole life ahead of him,” Colette disaster. Whelan has not yet been de- Whelan says of the 2-year-old ployed with the DMAT team, whose arm ended up amputated. though she said if a major hur- “ I t was just heart- wrenching.” ricane hits the United States this summer, she likely will be. The Haitan boy who came into Whelan’s clinic had gangrene caused by his infected open fracture. Without treatment, it would likely spread into the rest of his body, killing him. Whelan’s team amputated the boy’s arm. It saved his life, though

Page 37

On the job | DISASTER RELIEF WORKER

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she said his case continues to haunt her. “To be in a country as austere as Haiti, with no resources, where poverty is prevalent and everyone is hungry … and then you put an amputee into the mix, it’s almost like writing a death sentence for these people.” Whelan’s years in the emergency room taught her to compartmentalize and to focus on the task. She said she gets into a disaster mode in her mind, not letting the emotion in during the moment. But it’s not for everyone, she said. “I’ve definitely talked to people and I’ve witnessed people that in the midst of chaos, they’re not coping very well. … Somewhere inside yourself you’re questioning, ‘I wonder if they regret being here.’” People who do disaster work, Whelan said, need a strong sense of adventure. And they must not require material comforts. Prima donnas need not apply. On her trips to Haiti, her team often camped several hours outside the capital city to run clinics in rural areas. They didn’t know, from one night to the next, where they would be sleeping. Often, she said, the team would make use of an orphanage or some other locked structure. Meals were cooked by locals in the area, who were paid for their services, or sometimes the volunteers ate Meals Ready to Eat, the same food given to soldiers in the field. When she’s home in Bend, Whelan said she copes with the stress of her trips, and particularly the suffering she’s seen, through outdoor activities, yoga and spending time with her husband and two dogs. Whelan, a native of Ireland, and her husband both have dangerous jobs; he’s a smoke jumper. Perhaps because of that, she said, he is entirely supportive of her work. Her family, she said, knows it’s not going to change. “They know it’s part of who I am,” she said. “Anyone hears of a disaster, unfortunately they think of me. I’m not sure if that’s a compliment or not.” •

Page 38

SUMMER / FALL 2011 • HIGH DESERT PULSE

ADVERTISING SUPPLEMENT

2011 CENTRAL OREGON

ME DI C A L D IR E CTORY Yo u r S o u r c e f o r L o c a l H e a l t h S e r v i c e s a n d E x p e r t M e d i c a l P r o f e s s i o n a l s To list your medical office and/or physicians in the PULSE/Connections Medical Directory contact…

Kristin Morris, Account Executive The Bulletin 541.617.7855 • kmorris@bendbulletin.com Paid Advertising Supplement - Next Issue Deadlines September 26, 2011

M E D I C A L B U S I N E S S E S B Y S P E C I A LT Y 119 N Rope Street • Sisters

541-588-6119

www.absoluteserenity.info

2705 NE Conners Drive • Bend

541-330-9139

www.bendderm.com

1099 NE Watt Way • Bend

541-385-4717

www.brookdaleliving.com

3550 SW Canal Blvd • Redmond

541-504-1600

www.ccliving.com

2100 NE Wyatt Ct • Bend

541-706-4701

www.stcharleshealth.org

2500 NE Neff Road • Bend

541-706-6900

www.heartcentercardiology.com

601 NW Harmon Blvd • Bend

541-383-0844

www.serenitylane.org

334 NE Irving Ave, Ste 102 • Bend

541-617-0377

www.junipermountaincounseling.com

2747 NE Conners Drive • Bend

541-382-5712

www.bendderm.com

2084 NW Professional Court • Bend

541-317-5600

n/a

2695 NE Conners Ave, Suite 127 • Bend

541-706-4800

www.stcharleshealth.org

615 Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealth.org

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealth.org

1103 NE Elm Street • Prineville

541-447-6263

www.stcharleshealth.org

Blue Star Naturopathic Clinic

497 SW Century Drive, Ste 120 • Bend

541-389-6935

www.bluestarclinic.com

Coombe and Jones Dentistry

774 SW Rimrock Way • Redmond

541-923-7633

www.coombe-jones.com

Masters of Dentistry

628 NW York Drive, Suite 101 • Bend

541-389-2300

www.mastersofdentistry.com

GENERAL SURGERY

Surgical Associates of the Cascades

1245 NW 4th Street, #101 • Redmond

541-548-7761

www.cosurgery.com

GENERAL SURGERY & OBESITY CARE

Cascade Obesity and General Surgery

1245 NW 4th Street, #101 • Redmond

541-548-7761

www.cosurgery.com

GENERAL SURGERY, BARIATRICS, VEIN CARE

Advanced Specialty Care

Locations in Bend & Redmond

541-322-5753

www.advancedspecialtycare.com

GYNECOLOGY

The Women’s Center of Central Oregon

1001 NW Canal Blvd • Redmond

541-504-7635

www.womenthatcare.com

HOSPICE/HOME HEALTH

Partners In Care

2075 NE Wyatt Ct. • Bend

541-382-5882

www.partnersbend.org

HOSPITAL

Mountain View Hospital

470 NE “A” Street • Madras

541-475-3882

www.mvhd.org

HOSPITAL

Pioneer Memorial Hospital

1201 NE Elm St • Prineville

541-447-6254

www.scmc.org

HOSPITAL

St. Charles Bend

2500 NE Neff Road • Bend

541-382-4321

www.stcharleshealth.org

HOSPITAL

St. Charles Redmond

INTEGRATED MEDICINE

Center for Integrated Medicine

MEDICAL CLINIC

Bend Memorial Clinic

NEONATOLOGY

St. Charles Medical Group

NEUROLOGY

NorthStar Neurology

OBSTETRICS & GYNECOLOGY

St. Charles OB/GYN - Redmond

OBSTETRICS & GYNECOLOGY

East Cascade Women’s Group, P.C.

ONCOLOGY–MEDICAL

St. Charles Medical Oncology

ONCOLOGY–RADIATION

St. Charles Radiation Oncology

ORTHOPEDICS ORTHOPEDICS, NEUROSURGERY & PHYSICAL MEDICINE

ADULT FOSTER CARE

Absolute Serenity Adult Foster Care

AESTHETIC SERVICES

DermaSpa at Bend Dermatology

ALZHEIMERS & DEMENTIA CARE

Clare Bridge Brookdale Senior Living

ASSISTED LIVING

Brookside Place

CANCER CARE

St. Charles Cancer Center

CARDIOLOGY

The Heart Center

CHEMICAL DEPENDENCY

Serenity Lane Treatment Center

COUNSELING & WELLNESS

Juniper Mountain Counseling & Wellness

DERMATOLOGY

Bend Dermatology Clinic

ENDOCRINOLOGY

Endocrinology Services NW

FAMILY MEDICINE

St. Charles Family Care - Bend

FAMILY MEDICINE

St. Charles Family Care - Sisters

FAMILY MEDICINE

St. Charles Family Care - Redmond

FAMILY MEDICINE

Rural Health Clinic at Pioneer Memorial Hospital

FAMILY PRACTICE GENERAL DENTISTRY GENERAL DENTISTRY

1253 NE Canal Blvd • Redmond

541-548-8131

www.stcharleshealth.org

916 SW 17th St, Ste 202 • Redmond

541-504-0250

www.centerforintegratedmed.com

Locations in Bend, Redmond & Sisters

541-382-4900

www.bendmemorialclinic.com

2500 NE Neff Road • Bend

541-526-6556

www.stcharleshealth.org

2275 NE Doctors Drive, Ste 9 • Bend

541-330-6463

www.northstarneurology.com

213 NW Larch Ave, Suite B • Redmond

541-526-6635

www.stcharleshealth.org

2400 NE Neff Road, Ste A • Bend

541-389-3300

www.eastcascadewomensgroup.com

2100 NE Wyatt Ct • Bend

541-706-4701

www.stcharleshealth.org

2500 NE Neff Road • Bend

541-706-7793

www.stcharleshealth.org

Desert Orthopedics

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

ADVERTISING SUPPLEMENT

2011 CENTRAL OREGON MEDICAL DIRECTORY M E D I C A L B U S I N E S S E S B Y S P E C I A L T Y C O N T. OSTEOPOROSIS

Deschutes Osteoporosis Center

PALLIATIVE MEDICINE

St. Charles Medical Group

PEDIATRIC DENTISTRY

Deschutes Pediatric Dentistry

PHARMACY

HomeCare IV/CustomCare Rx

PHYSICAL THERAPY

Alpine Physical Therapy & Spine Care

PHYSICAL THERAPY

Healing Bridge Physical Therapy

PODIATRY

Cascade Foot Clinic

PODIATRY

Deschutes Foot & Ankle

PRIMARY CARE

High Lakes Health Care

PULMONARY CLINIC

St. Charles Pulmonary Clinic

RADIOLOGY

Central Oregon Radiology Associates, P.C.

REHABILITATION

2200 NE Neff Road, Suite 302 • Bend

541-388-3978

www.deschutesosteoporosiscenter.com

2500 NE Neff Road • Bend

541-526-6556

www.stcharleshealth.org

1475 SW Chandler Ave, Ste 202 • Bend

541-389-3073

www.deschuteskids.com

2065 NE williamson Court, Suite B • Bend

541-382-0287

www.homecareiv.com

2275 NE Doctors Dr, #3 & 336 SW Cyber Dr, Ste 107

541-382-5500

www.alpinephysicaltherapy.com

404 NE Penn Avenue • Bend

541-318-7041

www.healingbridge.com

Offices in Bend, Redmond & Prineville

541-388-2861

n/a

Locations in Redmond & Bend

541-504-1400

wwww.deschutesfootandankle.com

Locations in Bend & Sisters

541-389-7741

www.highlakeshealthcare.com

Locations in Bend & Redmond

541-706-7715

www.stcharleshealth.org

1460 NE Medical Center Drive • Bend

541-382-9383

www.corapc.com

St. Charles Medical Group

2500 NE Neff Road • Bend

541-526-6556

www.stcharleshealth.org

RHEUMATOLOGY

Deschutes Rheumatology

2200 NE Neff Road, Suite 302 • Bend

541-317-1812

n/a

SENIOR CARE HOME

Central Oregon Adult Foster Care

1532 NW Jackpine Avenue • Redmond

541-548-6631

n/a

SLEEP MEDICINE

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

M E D I C A L P R O F E S S I O N A L S B Y S P E C I A LT Y ALLERGY & ASTHMA

ADAM WILLIAMS, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

2275 NE Doctors Drive, Ste 9 • Bend

541-330-6463

www.northstarneurology.com

ALZHEIMERS/DEMENTIA & GERIATRIC NEUROLOGY

FRANCENA ABENDROTH, MD

NorthStar Neurology

BARIATRIC & GENERAL SURGERY

STEPHEN ARCHER, MD, FACS

Advanced Specialty Care

2084 NE Professional Court • Bend

541-322-5753

www.advancedspecialtycare.com

D. SCOTT DIAMOND, MD, FACS

Advanced Specialty Care

2084 NE Professional Court • Bend

541-322-5753

www.advancedspecialtycare.com

Rural Health Clinic at Pioneer Memorial Hospital

1103 NE Elm Street, Ste C • Prineville

541-447-6263

www.stcharleshealth.org

JEAN BROWN, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

THOMAS COMBS, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

HEIDI CRUISE, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

RICK KOCH, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

GAVIN L. NOBLE, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

STEPHANIE SCOTT, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JASON WEST, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ALYSSA ABBEY, PA-C

Bend Memorial Clinic

2600 NE Neff Road • Bend

541-382-4900

www.bendmemorialclinic.com

JAMES M. HOESLY, MD

Bend Memorial Clinic

2600 NE Neff Road • Bend

541-382-4900

www.bendmemorialclinic.com

GERALD E. PETERS, MD, DS (Mohs)

Bend Memorial Clinic

2600 NE Neff Road • Bend

541-382-4900

www.bendmemorialclinic.com

ANN M. REITAN, PA-C (Mohs)

Bend Memorial Clinic

2600 NE Neff Road • Bend

541-382-4900

www.bendmemorialclinic.com

MARY F. CARROLL, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

DAN McCARTHY, MD

Endocrinology Services NW

2084 NW Professional Court • Bend

541-317-5600

n/a

RICK N. GOLDSTEIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

TONYA KOOPMAN, FNP

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

TRAVIS MONCHAMP, MD

Endocrinology Services NW

2084 NW Professional Court • Bend

541-317-5600

n/a

BEHAVIORAL HEALTH

RYAN C. DIX, PsyD CARDIOLOGY

DERMATOLOGY

ENDOCRINOLOGY

2011 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

FAMILY MEDICINE

CAREY ALLEN, MD

Rural Health Clinic at Pioneer Memorial Hospital

1103 NE Elm Street • Prineville

541-447-6263

www.stcharleshealth.org

HEIDI ALLEN, MD

Rural Health Clinic at Pioneer Memorial Hospital

1103 NE Elm Street • Prineville

541-447-6263

www.stcharleshealth.org

THOMAS L. ALLUMBAUGH, MD

St. Charles Family Care - Redmond

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealth.org

KATHLEEN C. ANTOLAK, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

SADIE ARRINGTON, MD

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

JOSEPH BACHTOLD, DO, MPH, FAAFP

Bend Memorial Clinic

231 East Cascades Avenue • Sisters

541-382-4900

www.bendmemorialclinic.com

JOSEPH BACHTOLD, DO

St. Charles Family Care - Bend

2695 NE Conners Ave, Suite 127 • Bend

541-706-4800

www.stcharleshealth.org

JOSEPH BACHTOLD, DO

St. Charles Family Care - Sisters

615 Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealth.org

JEFFREY P. BOGGESS, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

BRANDON W. BRASHER, PA-C

Rural Health Clinic at Pioneer Memorial Hospital

1103 NE Elm Street, Ste C • Prineville

541-447-6263

www.stcharleshealth.org

SHANNON K. BRASHER, PA-C

Rural Health Clinic at Pioneer Memorial Hospital

1103 NE Elm Street, Ste C • Prineville

541-447-6263

www.stcharleshealth.org

MEGAN BRECKE, DO

St. Charles Family Care - Bend

2695 NE Conners Ave, Suite 127 • Bend

541-706-4800

www.stcharleshealth.org

NANCY BRENNAN, DO

St. Charles Family Care - Bend

2695 NE Conners Ave, Suite 127 • Bend

541-706-4800

www.stcharleshealth.org

WILLIAM C. CLARIDGE, MD

St. Charles Family Care - Redmond

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealth.org

LINDA C. CRASKA, MD

Rural Health Clinic at Pioneer Memorial Hospital

1103 NE Elm Street, Ste C • Prineville

541-447-6263

www.stcharleshealth.org

AMY DELOUGHREY, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JAMES K. DETWILER, MD

St. Charles Family Care - Redmond

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealth.org

MAREN J. DUNN, DO

Rural Health Clinic at Pioneer Memorial Hospital

1103 NE Elm Street, Ste C • Prineville

541-447-6263

www.stcharleshealth.org

THOMAS N. ERNST, MD

St. Charles Family Care - Redmond

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealth.org

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

MARK GONSKY, DO

St. Charles Family Care - Bend

2695 NE Conners Ave, Suite 127 • Bend

541-706-4800

www.stcharleshealth.org

STEVE GREER, MD

St. Charles Family Care - Bend

2695 NE Conners Ave, Suite 127 • Bend

541-706-4800

www.stcharleshealth.org

STEVE GREER, MD

St. Charles Family Care - Sisters

615 Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealth.org

ALAN C. HILLES, MD

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

PAMELA J. IRBY, MD

St. Charles Family Care - Redmond

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealth.org

MARGARET J. KING, MD

Rural Health Clinic at Pioneer Memorial Hospital

1103 NE Elm Street, Ste C • Prineville

541-447-6263

www.stcharleshealth.org

CHARLOTTE LIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JOE T. MCCOOK, MD

St. Charles Family Care - Redmond

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealth.org

DANIEL J. MURPHY, MD

St. Charles Family Care - Redmond

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealth.org

SHERYL L. NORRIS, MD

St. Charles Family Care - Redmond

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealth.org

MARGAREY J. PHILP, MD

St. Charles Family Care - Redmond

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealth.org

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

NATHAN R. THOMPSON, MD

St. Charles Family Care - Redmond

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealth.org

MARK A. VALENTI, MD

St. Charles Family Care - Redmond

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealth.org

THOMAS A. WARLICK, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

BRUCE N. WILLIAMS, MD

Rural Health Clinic at Pioneer Memorial Hospital

1103 NE Elm Street, Ste C • Prineville

541-447-6263

www.stcharleshealth.org

2011 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

FAMILY PRACTICE

EDWARD W. BIGLER, MD

High Lakes Health Care

18 NW Oregon Avenue • Bend

541-389-7741

www.highlakeshealthcare.com

COLIN R. SOARES, PA-C

High Lakes Health Care

1247 NE Medical Center Dr, Ste ? • Bend

541-318-4249

www.highlakeshealthcare.com

EDEN M. MILLER, DO

High Lakes Health Care

354 W. Adams Avenue • Sisters

541-549-9609

www.highlakeshealthcare.com

JAMIE J. FREEMAN, PA-C

High Lakes Health Care

18 NW Oregon Avenue • Bend

541-389-7741

www.highlakeshealthcare.com

KEVIN T. MILLER, DO

High Lakes Health Care

354 W. Adams Avenue • Sisters

541-549-9609

www.highlakeshealthcare.com

KEVIN A. RUETER, MD

High Lakes Health Care

1247 NE Medical Center Dr, Ste ? • Bend

541-318-4249

www.highlakeshealthcare.com

LISA J. URI, MD

High Lakes Health Care

18 NW Oregon Avenue • Bend

541-389-7741

www.highlakeshealthcare.com

AUBREY N. PERKINS, FNP-BC

High Lakes Health Care

1247 NE Medical Center Dr, Ste ? • Bend

541-318-4249

www.highlakeshealthcare.com

STEPHEN A. MANN, DO

High Lakes Health Care

18 NW Oregon Avenue • Bend

541-389-7741

www.highlakeshealthcare.com

WILLIAM B. WIGNALL, MD

High Lakes Health Care

1247 NE Medical Center Dr, Ste ? • Bend

541-318-4249

www.highlakeshealthcare.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

ANDY HIMSWORTH, DMD

Masters of Dentistry

628 NW York Drive, Ste 101 • Bend

541-389-2300

www.mastersofdentistry.com

TAD HODGERT, DMD

Masters of Dentistry

628 NW York Drive, Ste 101 • Bend

541-389-2300

www.mastersofdentistry.com

BRADLEY E. JOHNSON, DMD

Contemporary Family Dentistry

1016 NW Newport Avenue • Bend

541-389-1107

www.contemporaryfamilydentistry.com

GASTROENTEROLOGY

GENERAL 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

SUSAN GORMAN, MD

The Women’s Center of Central Oregon

1001 NW Canal Blvd • Redmond

541-504-7635

www.womenthatcare.com

ROBERT F. BOONE, MD

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-4701

www.stcharleshealth.org

CORALIA BONATSOS CALOMENI, MD

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-4701

www.stcharleshealth.org

CAROLYN S. DOEDYNS, FNP

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-4701

www.stcharleshealth.org

STEPHEN B. KORNFELD, MD

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-4701

www.stcharleshealth.org

WILLIAM G. MARTIN, MD

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-4701

www.stcharleshealth.org

HEMATOLOGY/ONCOLOGY

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

2011 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

INFECTIOUS DISEASE Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

BROOKE T. HALL, MD

High Lakes Health Care

18 NW Oregon Avenue • Bend

541-389-7741

www.highlakeshealthcare.com

MICHAEL N. HARRIS, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JENESS M. CHRISTENSEN, MD

High Lakes Health Care

18 NW Oregon Avenue • Bend

541-389-7741

www.highlakeshealthcare.com

JOHN L. CORSO, MD

High Lakes Health Care

18 NW Oregon Avenue • Bend

541-389-7741

www.highlakeshealthcare.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

LINDA R. CARROLL, MD

High Lakes Health Care

18 NW Oregon Avenue • Bend

541-389-7741

www.highlakeshealthcare.com

MADELINE T. LEMEE, MD

High Lakes Health Care

18 NW Oregon Avenue • Bend

541-389-7741

www.highlakeshealthcare.com

MARY P. MANFREDI, MD

High Lakes Health Care

18 NW Oregon Avenue • Bend

541-389-7741

www.highlakeshealthcare.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

JON LUTZ, MD INTERNAL MEDICINE

INTERNAL MEDICINE, OSTEOPOROSIS & BONE HEALTH MOLLY OMIZO, MD

Deschutes Osteoporosis Center

NEONATOLOGY CAROL A. CRAIG, NNP

St. Charles Medical Group - Neonatology

2500 NE Neff Road • Bend

541-526-6556

www.stcharleshealth.org

JOHN O. EVERED, MD

St. Charles Medical Group - Neonatology

2500 NE Neff Road • Bend

541-526-6556

www.stcharleshealth.org

SARAH E. REYES, NNP

St. Charles Medical Group - Neonatology

2500 NE Neff Road • Bend

541-526-6556

www.stcharleshealth.org

FREDERICK J. RUBNER, MD

St. Charles Medical Group - Neonatology

2500 NE Neff Road • Bend

541-526-6556

www.stcharleshealth.org

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

NEPHROLOGY

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

OBSTETRICS/GYNECOLOGY WILLIAM H. BARSTOW, MD

St. Charles OB/GYN - Redmond

213 NW Larch Ave, Ste B • Redmond

541-526-6635

www.stcharleshealth.org

CRAIG P. EBERLE, MD

St. Charles OB/GYN - Redmond

213 NW Larch Ave, Ste B • Redmond

541-526-6635

www.stcharleshealth.org

AMY B. MCELROY, NP-C

St. Charles OB/GYN - Redmond

213 NW Larch Ave, Ste B • Redmond

541-526-6635

www.stcharleshealth.org

TODD W. MONROE, MD

St. Charles OB/GYN - Redmond

213 NW Larch Ave, Ste B • Redmond

541-526-6635

www.stcharleshealth.org

2011 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

ONCOLOGY – MEDICAL 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

ROB BOONE, MD

St. Charles Medical Oncology

2100 NE Wyatt Ct • Bend

541-706-4701

www.stcharleshealth.org

CORA CALOMENI, MD

St. Charles Medical Oncology

2100 NE Wyatt Ct • Bend

541-706-4701

www.stcharleshealth.org

SUSIE DOEDYNS, FNP

St. Charles Medical Oncology

2100 NE Wyatt Ct • Bend

541-706-4701

www.stcharleshealth.org

STEVE KORNFELD, MD

St. Charles Medical Oncology

2100 NE Wyatt Ct • Bend

541-706-4701

www.stcharleshealth.org

BILL MARTIN, MD

St. Charles Medical Oncology

2100 NE Wyatt Ct • Bend

541-706-4701

www.stcharleshealth.org

ONCOLOGY – RADIATION LINYEE CHANG, MD

St. Charles Radiation Oncology

2500 NE Neff Road • Bend

541-706-7793

www.stcharleshealth.org

TOM COMERFORD, MD

St. Charles Radiation Oncology

2500 NE Neff Road • Bend

541-706-7793

www.stcharleshealth.org

RUSS OMIZO, MD

St. Charles Radiation Oncology

2500 NE Neff Road • Bend

541-706-7793

www.stcharleshealth.org

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

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

OPHTHAMOLOGY

OPTOMETRY

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

2011 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

PAIN MANAGEMENT THEODORE FORD, MD

Bend Spine & Pain Specialists

2041 NE Williamson Ct, Ste B • Bend

541-647-1646

www.bendspineandpain.com

PALLIATIVE MEDICINE LISA LEWIS, MD

Partners in Care

2075 NE Wyatt Ct • Bend

541-382-5882

www.partnersbend.org

LAURA K. MAVITY, MD

St. Charles Medical Group - Palliative Medicine

2500 NE Neff Road • Bend

541-526-6556

www.stcharleshealth.org

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

PHYSICAL MEDICINE & REHABILITATION TIM HILL, MD

The Center: Orthopedic & Neurosurgical Care & Research

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

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

Locations in Redmond & Bend

541-504-1400

www.deschutesfootandankle.com

39 NW Louisiana Avenue • Bend

541-382-8862

www.lifeworksofbend.com

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

NANCY H. MALONEY, MD

Bend Memorial Clinic

PODIATRY DEAN T. NAKADATE, DPM, FACFAS

Deschutes Foot & Ankle

PSYCHIATRIC NURSE PRACTITIONER NICK CAMPO, PMHNP

Life Works of Central Oregon

PULMONOLOGY JONATHON BREWER, DO

Bend Memorial Clinic

JAMIE CONKLIN, MD

St. Charles Pulmonary Clinic

Locations in Bend & Redmond

541-706-7715

www.stcharleshealth.org

ERIC S. DILDINE, PA

St. Charles Pulmonary Clinic

Locations in Bend & Redmond

541-706-7715

www.stcharleshealth.org

ROD L. ELLIOT-MULLENS, DO

St. Charles Pulmonary Clinic

Locations in Bend & Redmond

541-706-7715

www.stcharleshealth.org

RODNEY GARRISON, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

KEITH W. HARLESS, MD

St. Charles Pulmonary Clinic

T. CHRISTOPHER KELLEY, DO

Bend Memorial Clinic

RICHARD J. MAUNDER, MD

St. Charles Pulmonary Clinic

JONATHON MCFADYEN, NP

Bend Memorial Clinic

THOMAS R. MURPHY, MD

St. Charles Pulmonary Clinic

LYNETTE SPJUT, PA-C

Bend Memorial Clinic

Locations in Bend & Redmond

541-706-7715

www.stcharleshealth.org

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

Locations in Bend & Redmond

541-706-7715

www.stcharleshealth.org

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

Locations in Bend & Redmond

541-706-7715

www.stcharleshealth.org

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

St. Charles Medical Group - Rehabilitation

2500 NE Neff Road • Bend

541-526-6556

www.stcharleshealth.org

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

REHABILITATION NOREEN C. MILLER, MD RHEUMATOLOGY GREG BORSTAD, MD

2011 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

RHEUMATOLOGY CONT. MATTHEW COOK, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

DAN E. FOREMAN, MD

Deschutes Rheumatology

2200 NE Neff Road, Suite 302 • Bend

541-317-1812

n/a

TIANA L. WELCH, PA

Deschutes Rheumatology

2200 NE Neff Road, Suite 302 • Bend

541-317-1812

n/a

THERESA L. BUCKLEY, MD

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealth.org

ARTHUR K. CONRAD, MD

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealth.org

DAVID L. DEDRICK, MD

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealth.org

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

JACK W. HARTLEY, MD, FACS

Surgical Associates of the Cascades

1245 NW 4th Street, #101 • Redmond

541-548-7761

www.cosurgery.com

JOHN C. LAND, MD, FACS

Surgical Associates of the Cascades

1245 NW 4th Street, #101 • Redmond

541-548-7761

www.cosurgery.com

GEORGE T. TSAI, MD, FACS

Surgical Associates of the Cascades

1245 NW 4th Street, #101 • Redmond

541-548-7761

www.cosurgery.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

NGOCTHUY HUGHES, DO, PC

Cascade Obesity and General Surgery

1245 NW 4th Street, #101 • Redmond

541-548-7761

www.cosurgery.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

SLEEP MEDICINE

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

Cover story | LIFE AFTER TREATMENT

Are you a survivor? Cancer survivorship programs typically accept all survivors regardless of where they were treated. Some programs may focus on childhood survivors or certain types of cancer. To join a survivorship program and learn about your ongoing risk for late effects, contact the programs below. St. Charles Health System Cancer Survivorship Office Bend 541-706-7743 Childhood Cancer Survivorship Program Doernbecher Children’s Hospital at Oregon Health & Science University Portland 503-494-1543 RYAN BRENNECKE

Michelle Reinwald received little information about her son Hunter’s ongoing risk of late effects when his cancer treatment ended five years ago. At the survivorship clinic at Doernbecher Children’s Hospital last year, they received a detailed analysis of what could happen.

Continued from Page 11 Concerned over the long-term and late effects of treatments, pediatric oncologists tried cutting back on the dosages, inadvertently reaching the point that the treatment was no longer effective. “As we cut back to be kind, we’ve lost children as a result of cutting back too far,” Bleyer said. “We’ve killed with kindness.” Now oncologists have become more adept at balancing cure against side effects and limiting the damage caused by treatment. For example, oncologists treating children for high-risk acute lymphoblastic leukemia, known as ALL, with Adriamycin or other anthrocycline drugs can now add the drug Zinecard (dexrazoxane) to limit damage to their hearts. Although about 80 percent of children with ALL are cured, children treated with Adriamycin have more than a threefold increased risk of dying of heart disease over their lifetimes. But a recent study found when Zinecard was added to the mix, at least in girls, there was a protective effect. (There is still debate whether boys, who don’t show as much risk for heart damage, can also benefit from the drug.) Other research is looking at better ways of treating cancer without the collateral damage. Scientists are uncovering targeted cancer therapies that are more selective for cancer cells than normal cells, sparing healthy

HIGH DESERT PULSE • SUMMER / FALL 2011

tissue and reducing side effects. A new form of radiation treatment, called proton therapy, is able to treat many tumors with less damage to surrounding tissue. But the treatment is currently available in only a few locations and is much more expensive than standard radiation. It’s being used primarily for treating tumors that are close to vital organs that could be damaged by traditional radiation therapy.

Reaching survivors Survivorship research is fairly new, so researchers are still trying to catalog all the late and long-term effects of treatment that patients might face. Increasingly, research is shifting toward identifying the underlying mechanisms of those effects in hopes of finding ways to prevent them. “It can be difficult to track people long term. Most research is dependent on crosssectional assessment on whoever they can capture and reach,” Syrjala said. “It’s one of the reasons why it’s so important for survivors to recognize what their own value is in terms of moving the science forward, helping us to learn about what these complications are.” At the same time, cancer experts have realized that survivors have ongoing medical needs that aren’t being met. Many don’t

Survivorship Program Fred Hutchinson Cancer Research Center Seattle 206-667-2814

know the specific risks they face based on their cancer and treatment. Hunter Reinwald, of Tumalo, was just 3 years old when he was treated for ALL in 2003. He received a combination of oral medications and IV chemotherapy over a threeyear period. At the conclusion, his mother, Michelle Reinwald asked the doctors, “So are we good?” The doctors at Doernbecher couldn’t guarantee he was cured but told the parents Hunter’s risk had fallen to that of the general population. The Reinwalds went home with only a vague warning about future effects. “The only thing I remember from the beginning was that some of the chemo could affect his brain and cause learning disability around fourth grade,” Michelle said. “Probably when he was in third grade I started worrying about it. Does he seem like he’s doing well? But all his teachers are saying he is.” Since his treatment, however, OHSU launched a childhood survivorship program at Doernbecher and invited Hunter to come back last year for a full-day evaluation. He met with social workers, teachers, nutritionists and dentists, all evaluating him for late effects of his treatment. “They gave us the full breakdown. This is what could happen,” she said. “The doctor came in and told us how much of every medi-

Page 47

Cover story | LIFE AFTER TREATMENT cine he got and the things it could lead to.” For the first time, the Reinwalds linked to his treatment the fact that at age 11, Hunter still had most of his baby teeth. If dental issues were mentioned eight years earlier, it hadn’t registered. “I didn’t know any of that was an issue. But I guess at the time, what are you going to do? You’re not going to change the treatment,” Michelle said. “But that would

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Cancer survivors face more than just the medical and psychosocial effects of treatment. Many have significant financial issues as well. According to researchers at Pennsylvania State University, medical costs for survivors between ages 25 and 64 are $4,000 to $5,000 a year higher after completing treatment than for other individuals their age.

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have been good to know.” Other than his teeth, Hunter has shown few adverse effects of his treatment. The survivorship program gave them a summary of his treatment, the medications he received, and what future problems they should watch for. They gave them small cards to hand out to new doctors with the highlights. “I tell my patients that knowledge is the best offense,” said Lindemulder, who heads the survivorship program. “Cancer took them by surprise, and they didn’t have any warning. Late effects shouldn’t take them by surprise. We should be able to prepare for these things.” Knowing their risks, they can undergo the proper screening to catch problems early, generally at their most treatable stage. Doctors can intervene when a patient shows the initial signs of heart damage rather than wait until the patient is at risk of heart failure or screen their eyes for cataracts before they lose vision. “We run into a lot of patients who come into the program and they say, ‘We don’t have anything we need to worry about; we’re totally fine.’ They haven’t been informed,” Lindemulder said. “I think a lot of families would like to think, like we all would, that when treatment is over, they’re done.” Some would prefer not to think about their risks, unwilling to reopen that era of their lives. “We treat patients as children, and then we’re trying to educate them about late effects through adolescence and young adulthood, which is typically your superman years of life. ‘Nothing can touch me,’” Lindemulder said. “So there’s a lot of inherent denial in this population. They don’t want to believe anything more can happen to them.” Others don’t want to come back to the very place they were treated. At OHSU, the survivorship clinic is housed in the pediatric oncology clinic at Doernbecher. Even the drive up the hill to the hospital complex can bring back old memories and fears. “They still have psychological, post-traumatic stress kind of thoughts just coming through the door — their families do sometimes more than the survivors,” Lindemulder said. Syrjala, who co-launched the survivorship program at the Fred Hutchinson cancer center, said that while getting people in can be a challenge, such programs have good tools to help patients manage not only their physical symptoms but the emotions and stress of living with the risk of late effects. “What is helpful to people is to be able to learn to separate what do you control and what do you not control,” she said. “If you’ve made your decisions about what treatment you’ve already had, you don’t control your risk based on those treatments. But you do control your exercise level, your diet and other aspects, getting regular checkups, so that if something does happen, you know this is occurring early.” The cancer center at St. Charles is just now getting its survivorship program off the ground. Procedures are being put in place to ensure that patients and their primary care providers receive a survivorship care plan, a sort of road map that describes their treatment and follow-up, their ongoing risks and mitigation strategies before they complete their treatment. Cancer doctors continue to see survivors for regular follow-ups generally up to five years after their treatment is completed. But

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Page 49

Cover story | LIFE AFTER TREATMENT

Kathy Colclough holds a pose at Mandala Yoga in Bend. Research shows that regular exercise helps cancer survivors improve their quality of life and ward off further health issues.

ANDY TULLIS

then ongoing care and monitoring for late effects is usually transferred to the patient’s primary care physician. “That’s our responsibility here, to transition people back into this healthy state of living with a chronic disease,” said Chang, the St. Charles cancer center director. “Because even if their cancer is not cured, many times it’s not manifesting in active symptoms. They’re controlling their cancer just like congestive heart failure or diabetes.” Yet many primary care providers feel illprepared to deal with the aftereffects of treatment. They must be able to recognize when common symptoms might mean something totally different with a cancer survivor. A typical patient with hypertension might simply be prescribed a medication to lower their blood pressure or counseled on lifestyle and diet changes. But a survivor, who may have been treated with cisplatin, which can cause kidney failure leading to high blood pressure, might need a different solution. A doctor treating a patient complaining of shortness of breath may attribute it to a lack fitness or see if it goes away before evaluating that patient for heart problems. But for a cancer survivor treated with a drug that can damage the heart, the doctor may not want to wait. “Our primary care physicians don’t know about cancer therapies. ‘My patient gets cancer, goes into this black box and comes back to me,’” Chang said. “They’re not aware of some of the long-term effects, and it’s our

Page 50

responsibility to educate them so they’re not just dismissing them.” For example, when prostate cancer patients are treated with hormone therapy at St. Charles, the primary care physician gets a letter to that effect, spelling out the patient’s future risks and what ongoing monitoring he requires. Survivorship programs can also help patients avoid a common feeling of abandonment after their treatment phase is completed. “We hear from survivors again and again, ‘It wasn’t until I finished the treatment phase of my care when all the attention was on me, fighting the cancer, and all of a sudden it was over, and it felt like, What now? How do I deal with all these emotions that come up?’” said Lizzi Katz, survivorship coordinator at St. Charles. “That’s where the fear and the anxiety can really creep in.” Often survivors are blindsided by late effects and face emotional issues when they find their cancer experience isn’t truly over. Oncologists are much more focused on educating patients about late effects when treatment decisions are being made, but concerns about possible problems down the road might not register for patients wondering whether or not they will die. “I was so worried about being alive in a year that if someone said in five years, you might have some problems, I would have thought, ‘OK, bring it on,’” said Katz, who is a breast cancer survivor. “I just want to get there.” There’s a sort of perverse benefit to telling

patients about the problems they will face beyond treatment. For one, information about specific short-term and long-term side effects eliminates concerns about hundreds of other potential problems that won’t affect them but they’ve heard about from other patients or read about online. But more importantly, late effects can’t occur unless the patient survives. “If they are told ahead of time that there are these late effects, well, then that implies they are going to survive to get the late effects,” said Bleyer, the pediatric oncologist at St. Charles. “In an ironic sense, it’s a way of looking toward the future.” Medical providers now start referring to an individual with cancer as a survivor from the moment he or she is diagnosed. And while patients may never return to their pre-diagnosis condition, there is help to allow them to adjust to their new lives post-cancer. “Often they can’t work their regular jobs anymore, (and) they’ve lost insurance. Whatever challenges they face, our team can help them normalize that,” Chang said. “The new normal, it may not be what it was, but it can still be wonderful.” Colclough is now a year past her diagnosis and has had trouble returning to work as a pharmacy technician full time. She still feels too tired to stay on her feet for an entire eight-hour shift. She’s making plans to visit her daughter in Abu Dhabi at Christmas and to travel to Europe afterward. She reached a major milestone in her recovery this summer. Since her surgery, she could only wear a sports bra until she fully healed. In June, her plastic surgeon gave her the OK to wear a normal bra again. “He said, ‘Get yourself something really beautiful,” Colclough said. She went with a close friend to Victoria’s Secret. “I had in the last six months a double mastectomy and breast reconstruction surgery,” she told the saleswoman. “I have absolutely no idea what size I am.” They measured her and brought her a box of bras in her new size to try on. The two friends spent hours picking one out. “One minute in the dressing room, we were crying together,” she said. “And the next minute we were hysterically laughing.” •

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Fitness | GOING TOO FAR C ontinued from Page 22 intentionally throwing up her food. This behavior gave her a sense of power and control over her life, she said. It’s easier to be consumed with exercise and diet than to analyze your troubles, she said. Years later, living in the close quarters of a college dorm, Gilbert had to curb her vomiting. But she could still exercise obsessively. Because she had always been a high achiever, an athlete on an academic scholarship, no one questioned her constant training for triathlons and marathons, “a cloak for my compulsion,” driven by body image insecurities, she said. “I didn’t fit the clinical criteria (for bulimia nervosa), but it’s painful to struggle with this stuff,” Gilbert said. Compulsive exercising often goes hand in hand with eating disorders, said Brehm, the Smith College professor, especially in sports where appearance matters — such as ice skating, diving, gymnastics, dancing — or in sports in which performance improves with weight loss — such as cycling or running. But she’s not

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blaming athletics for eating disorders. “Blame our crazy culture, the media, our tendency to judge people on their first impression appearance,” Brehm said.

Eating disorders Cassie Gose was active and healthy but clearly remembers being called “chubby” as a child. It was a high school basketball coach who suggested that “I could be faster getting

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down the court if my butt wasn’t so big,” Gose said. “That planted a seed.” Gose, now a 27-year-old bodybuilder and lifestyle coach for the Wellness Doctor in Bend, said she became anorexic during high school. After her family moved her to Pilot Rock (near Pendleton), she was a new, insecure kid trying to fit in with the athletic crowd. She had high hopes for the upcoming track season. At 16, she was 5-foot-4 and 130 pounds. She started skipping corn dogs and burritos, what everyone else ate at school. She substituted yogurt and bagels at lunch and ate oatmeal for breakfast, in no measure a bad idea. She dropped 5 pounds, and people started noticing. “It spiraled from there,” she said. She eliminated bagels from her diet and lost 10 pounds. The basketball coach told her to “keep it up,” and for some reason, she said, his approval mattered to her. Her dad commented that she finally looked like a long-distance runner. She weighed herself daily, and if the scale ever registered more than 108 pounds, she would eat nothing but an apple that day, or some vegetables at dinner to convince her family she was eating. She became isolated, a common sign of behavior gone wrong. She stayed late at the track to run, to burn calories and to avoid dinner with the family. She spent lunch breaks at school walking while other kids hung out and socialized. “All that mattered to me was that I weighed 108 pounds,” she said. Initially, when she started losing weight, her running times improved. But the excessive exercise and inadequate caloric intake took its toll on her health. She would faint climbing stairs. She got sports injuries. And finally, an intestinal flu that took three weeks to get over indicated that her immune system was shot.

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HIGH DESERT PULSE

Cassie Gose,a bodybuilder and lifestyle coach, was anorexic in high school and chose her career to help others suffering from eating disorders.

The behavior waned during college because she was too busy to exercise so much. And while studying for a bachelor’s degree in wellness studies and health, she learned about nutrition and the importance of eating well. Soon she could recognize eating disorders in others and knew it was unhealthy. It’s how she chose her career. She wanted to help people. She said she has a healthy relationship with food now. She tries not to count calories “because that can become obsessive. If I do start counting calories, I slip back into that obsessive behavior. I have to stop and pull myself back.” There’s another eating disorder out there, less studied than anorexia but gaining attention by health professionals who are starting to recognize it as a health risk. “Orthorexia nervosa” hasn’t been officially labeled as a disease, as anorexia and bulimia nervosa have. Orthorexia nervosa is an unhealthy obsession with healthy food, described originally by Dr. Steven Bratman, author of “Health Food Junkies,” a book dedicated to the disorder. On Bratman’s website, www.orthorexia.com, he writes, “One can have an unhealthy obsession with something that is otherwise healthy. Think of exercise addiction, or workaholism.” It’s when people are obsessed with eating a diet that is pure or perfect and in many cases is tied to some particular philosophy or theory, such as raw food. “I have had several clients who are so rigid about eating correctly that they become unhealthy,” said local dietitian Lori Brizee, with Central Oregon Nutrition Consultants. “Our society is unhealthy due to overeating, underactivity and related diseases and condi-

HIGH DESERT PULSE • SUMMER / FALL 2011

Eating/exercise disorders Bulimia nervosa: The key characteristics of this disorder include: bingeing: taking in large quantities of food and purging; elimination of the food through artificial means such as forced vomiting or excessive use of laxatives; periods of fasting or excessive exercise. Anorexia nervosa: Most often diagnosed in females (up to 90 percent), anorexia is characterized by failure to maintain body weight of at least 85 percent of what is expected, fear of losing control over weight or of becoming “fat.” There is typically a distorted body image, where individuals sees themselves as overweight despite overwhelming evidence to the contrary. Obsessive compulsive disorder: The key features of this disorder include obsessions (persistent, often irrational, and seemingly uncontrollable thoughts) and compulsions (actions which are used to neutralize the obsessions). The behaviors are disruptive to everyday functioning. Source: The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association

tions. Anyone who is trying to lose weight has to be pretty compulsive about eating a healthy diet. “My biggest issue with this has been in children who have been referred to me for failure to thrive,” she said. “A parent’s rigid eating results in underfeeding kids. I actually testified in a court case custody suit over a child whose father was a raw food enthusiast. He was not

willing to offer his toddler foods that could provide enough calories in the amounts she was able to eat. I’ve had several less severe cases where well-meaning parents are too rigid with their own and their children’s diets that the kids do not gain weight well.” A couple of small studies in Turkey and Italy have examined the subject. One described orthorexia sufferers, in extreme cases, as people who would rather starve than eat food they consider impure or harmful to their health. In extreme cases, it can lead to death. “Any behavior that interferes with the balance in one’s life can be unhealthy,” said Frankie Mauti, a registered dietitian at St. Charles Bend. “An extreme example would be someone who starts making diet changes to be healthier and then spends too much time and energy eating healthy until other areas are out of balance. For example, not spending time with friends if there is food involved that isn’t healthy, spending a lot of mental energy on calculating what to eat, restricting foods that the body needs like carbohydrates, feeling extreme guilt when eating unhealthy foods, etc.” Healthy eating or exercising seems like a better addiction than overdoing drugs or alcohol, but they can affect health and relationships in the same negative way, Mauti said. “This is different from ‘passion’ for a sport or activity,” she said. “Usually a passion brings about positive consequences with some negatives. Addiction is all-consuming, and the negatives eventually outweigh the positives. For each person, this line may be different. It depends on the person and how they feel about their behaviors.” •

Page 53

One voice | A PERSONAL ESSAY

Running: a long-term love affair ended my dream of competing in college. To this day, I still don’t know where it came from, remember the moment I fell in love with running. the ache that would spring up without warning in my I was watching on television the women’s 100abdomen. My dad thinks it actually stems back to my meter final at the 1992 Olympic Games in Barcemiddle school years when I took a fall during a crosslona, Spain. Though she was not the favorite, a short, country race. powerful American named Gail Devers stole the gold Halfway through high school, the injury was so medal from Lane 2. bad that I could race no farther than 800 meters withHer triumph was remarkable: Two years earlier, out it flaring up. Devers had been diagnosed with Graves’ disease, an One of the most frustrating aspects of the injury autoimmune disorder that causes the thyroid to hit was not knowing what it was or if it would ever overdrive. In 1991, her feet were nearly amputated get better. Despite scans, doctors visits, pokes and because they had developed debilitating blisters palpations, none of the medical professionals had caused by radiation treatment. answers. After ceasing the therapy, Devers recovered. Then The summer after my sophomore year in high she became the fastest woman in the world. Her school, I took some time off and did physical therapy, comeback provided an inspirational, seminal mosettling on the diagnosis from my therapist that I had ment for my then-8-year-old self. I wanted to be like injured my psoas, a muscle deep in the core of the Gail — I, too, wanted to run fast. body. I came back for my junior year of cross-counBy that point, I understood that I was quick for my try out of shape, and worse, the injury still hurt like age. I did not, however, consider myself particularly the dickens. But inexplicably, over the course of the athletic, despite participating in swimming, soccer, fall, it finally healed, and I entered the most producROB KERR Amanda Miles is a die-hard softball and dance for a few years. tive season I would ever know as a runner. Just as the But when I started running, something clicked. runner and a sports reporter for injury had come into my life without explanation, it Not only did I like it, but I was good at it, and I liked The Bulletin. vanished without cause or reason. that, too. But that season was all too short-lived because, unRoughly a year after those Olympics, we traveled four hours from fortunately, I aggravated the injury again a few years later in college. I Aloha, Ore., to the finals of a regional competition in Seattle. I got off to could not run much at all for a year. a poor start but rallied late. When I hit the tape, I thought I had finished During that forced hiatus, I felt as if part of my essence had been third, as did my dad, who had a good view right at the finish line. ripped away. Running was inextricably linked to my sense of self. But But the official results had me in fifth place. I was crushed. As I sat at 19, my competitive running career was over. That was a bitter pill to on my mom’s lap and cried, she and my dad tried to provide some swallow at an age when life should be full of promise and possibility comfort and perspective. I had done so well, they told me, earning fifth instead of limitations. place out of all those girls. But I was inconsolable. I never made it all the way back from that injury. I guess it was one I “I didn’t come all the way up here just to get fifth place,” I said fer- could conquer once but not twice. At least not completely. vently, completely surprising my mom with my heretofore dormant Now, I can no longer run as fast as I used to, but I still run because intensity and competitive spirit. I love to. When I run, I feel like — if not my best self — at least a better That meet was just the start. I went on to run hundreds of races. The version. It brings clarity to my thoughts and peace to my heart (even sport has provided some of my life’s most memorable moments. It has while increasing my heart rate). I will mark two decades in the sport been a forum for numerous treasured conversations and shared expe- well before I turn 30, and though my relationship with running has riences on endless training runs, first with my dad, then with my team- changed, it is still very much a part of who I am. mates, and finally — and still — with my sister. And to think, the spark that ignited a lifetime of experiences came It has also been a source of physical and emotional pain, especially from a woman I have never met, running a race that lasted less than 11 when an injury that plagued me for most of high school resurfaced and seconds, on a track half a world away. •

BY AM ANDA M I LE S

Page 54

HIGH DESERT PULSE • SUMMER / FALL 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.