Pulse Magazine Summer/Fall 2014 by Western Communications, Inc.

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Healthy Living i C n t al 0

Homeless: How housing affects health care (and why it matters) SuperDave: Bend race guru leaves big footprint Dogs in boots: Your guide to protective booties

Inside the lucrative, barely regulated world of dietary supplements t.lE N

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H I G H

D E S E R T

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Healthy Living in Central Oregon

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jji SUMMER / FALL 2014 VOLUME 6, NO. 3

How to reach us Julie Johnson ~ Editor 541-383-0308 or jjohnson@bendbulletin.com

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Markian Hawryluk 541-617-7814or mhawryluk@bendbulletin.com

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Sophie Wilkins 541-383-0351 or swilkins@bendbulletin.com

• Design I Production Greg Cross David Wray

Andy Zeigert

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High Desert Pulse's primary concern is that all stories are accurate. If you know of an error in a story, call us at 541-383-0308 or email pulseCtbendbulletin.com.

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Published: 8/11/2014 ¹

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Contents/ HIGH DEsERTPULsE

COVER STORY SUPPLEMENTS The benefits of most dietary supplements are largely

unproven, and some supplements can be dangerous.

b oo o

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.msa

FEATURES HOMELESS HEALTH CARE New changes in health care aim to prevent patients

from being discharged with no place to go.

DEPARTMENTS

18 TIPS Make sure you're stretching the right way. READY 22 GET More kids are skipping the bus and riding

p g gOOP D 0 Q

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•

or walking to school. How to stay safe.

26 SNAPSHOT Stand-up paddleboarding on a wake. EATING 28 HEALTHY Best of the wurst: Not all hot dogs are created equally when it comes to nutrition.

30 GEAR Paw protection for your four-legged

workout companion.

32 PROFILE SuperDavehasmade anim pression on the local foot race scene.

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THIS 36 PICTURE Where do all those extra baby bones go? QUIZ 54 POP Can you identify the real home remedies? 55 ESSAY On the benefits of being a squeeky wheel.

COVER DESIGN:ANDYZEIGERTAND RYAN BRENNECKE CONTENTS IMAGES,FROMTOP: RYAN BRENNECKE,ANDYTULLIS,JOE KLINE, ANDY ZEIGERT

SUMMER/ FALL2014 •HIGH DESERT PULSE

Q+ Page3

~ IBABY BONES >All those extra beneshavetog'osomewheret, ~~ r ~ ~ ~I~

~~ ~

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Coverstory ~suppLEM ENTs

Dietary supplement manufacturers have every incentive to sell you a bottle, and almost no incentive to ensure the contents are safe o r even real BY TARA BANNOW

ountless bottles of s upplements tive ingredient acts as a powerful stimulant. It containing the stimulant ephedra took morethan adecade and hundreds ofrelined store shelves. Their labels were ports of heart attacks and strokes before the crowded with exclamations in bold text, their U.S. Food and Drug Administration banned colors bright and flashy, and huge muscle- the substance. But even though ephedra is bound models flexed at each potential cus- gone,not much has changed in the way potomer. The promises were the same as the tentially dangerous supplements saturate supplements of today: bigger muscles, less the market with almost no oversight. More fat, more energy. Turn your life around with a than 85,000 dietary supplements are being clattering bottle of pills. sold in the U.S.— things like vitamin C and Over a two-year period beginning in fish oil, but also many geared toward people 2000, Shawn Smith of Multnomah County trying to build muscle or lose weight — and bought Metabolife 365 and Yellow Jackets surveys show roughly half of Americans take from a Walmart, a Fred Meyer, a 7-Eleven them. As it was with ephedra, manufacturand a Vitamin World. ers don't have to tell the FDA what products Around the same time, Timothy Deeter they're selling, and it generally takes multiple bought Ergolean in Linn County. reports of serious side effects before the FDA In early 2002, Damon Violette of Washing- — whose limited manpower doesn't stand a ton County bought Metabolife 365 on the chance against the continuous churning of advice of a trainer at his gym. new products — investigates and gets them Less than two years after he started taking taken from shelves. the supplements, Smith had a heart attack This is a far cry from the FDA's careful regthat caused permanent damage to his heart ulation of prescription medications, whose and brain. Deeter had a stroke followed by manufacturers must painstakingly prove years of seizures. Violette had a stroke just their efficacy with years of trials on animals one month after he started taking the sup- and humans. "I think one of the injustices in American plements. He's had three more since. All of the supplements these men tookcon- society is the fact that herbal medicines and tained ephedra, a shrub-like plant whose ac- dietary supplements are essentially unregu-

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lated," said Frederick Fraunfelder, an ophthalmologist at the University of Missouri who performed extensive research into the ocular side effects of supplements while at Oregon Health 8 Science University in Portland. "There are no standards on the production of these agents. There is no regulation. So you don't know what you're taking." Before Violette, now 46 and living in Beaverton, had his first stroke, he was healthy and active. He rode his bike regularly and had a good job. Until one night he woke up to go to the bathroom and something didn't feel right. His then-wife called an ambulance. Today, he's lost his peripheral vision, he can't drive and his short attention span prevents him from holding ajob. His concerned father and step-mother, who live 10 minutes away, say the former workaholic is paranoid and struggles with filling his long days. "It's totally screwed him up," said his father, Louie Violette, of Tigard. "He was just trying to get healthier, working out at the gym and everything, holding a good job, and trying to get buff." Damon declined an interview, writing in a Facebook messagethat he's been afraid to talk to people since the stroke, and still prefers to be only in small groups.

SUMMER/FALL2014•HIGHDESERTPULSE

JOE KLINE

Personal trainer Chasity Barker demonstrates exercisesin her workout routine at Max Fitnessin Bend.

A brief historyof supplement regulation It wasn't always this way. Many industry experts today describe the supplement industry as a modern-day Wild West. They pinpoint the slip into anarchy to the 1994 Dietary Supplement Health and Education Act, a law that essentially left it up to supplement manufacturers to ensure their products were safe. It also gave them direct access to the market without any kind of FDA interference — or even knowledge, for that matter. Before the law, the FDA placed heavy scrutiny on supplements. Some were classified as foods, meaning manufacturers had to prove their ingredients were safe before selling them. Other supplements were classified as drugs if their packaging made claims about disease prevention or improved bodily functions. In those cases, supplements were subject to the same rigorous premarket approval process as medications. DSHEA marked a turning point in the supplement industry, removing many of the regulatory barriers for manufacturers and helping it grow to the estimated $30 billion industry it is today. "After DSHEA, the FDA just kind of shrugged its shoulders," said Stephen Gardner, director of litigation for the Center for Science in the Public Interest, a consumer advocacy group that regularly sues supplement companies over unsupported health claims. "There's some really good people at FDA, but institutionally, it just hit the brakes."

SUMMER/ FALL2014 •HIGH DESERT PULSE

The FDA has an agreement with the Federal Trade Commission that divides oversight of supplement claims, with the FDA looking at product labels and the FTC at advertising. DSHEA also made the FDA responsible for proving a supplement causes harm in order to get it taken off the market, a process that — in the rare case the FDA pushes forward — takes several years. Meanwhile, the market is constantly being flooded with countless new products that promise to melt away fat or to build powerful muscles, far surpassing any agency's reasonable ability to track. In most cases, the FDA's best chance at protecting the public from a supplement once reports of injuries start coming in is to send a warning letter to the company, which, in most cases, is enough to scare it into a voluntary recall. If that doesn't work, the FDA in rare cases also seizes products and suspends companies' registrations. In fact, although the Food Safety Modernization Act of 2011 gave the FDA the authority to mandate supplement recalls, so much work goes into proving a product is harmful that warning letters are still its most common tool to get supplements pulled from shelves. The FDA learns about side effects through its Adverse Events Reporting System, an online portal through which health care professionals and members of the public can report injuries they sustained from medications and supplements. Manufacturers are required to submit any adverse event reports they receive to the FDA. If enough

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Cover story ~ SUPPLEMENTS

reports come in concerning a product — "enough" being the key word, as there is no threshold — the FDA investigates. Between 2008 and 2011, the FDA received 6,307 reports of health problems concerning dietary supplements, 71 percent of which were mandatory reports from manufacturers, according to a 2013 Government Accountability Office report. That number excludes the many people who experienced adverse events but didn't report them to the FDA. Poison control centers, for example, handled more than 7,300 calls related to adverse events from dietary supplements between 2008 and 2010. In its report, the GAO criticized the FDA for not collecting information on how it uses the reports it receives for consumer protection and for not making public potential safety concerns brought to its attention by the reports. Perhaps the mostjarring example of the FDA's inability to regulate harmful products came with ephedra, a powerful stimulant derived from a plant that was long used by Chinese physicians to quell colds. Supplement manufacturers in the 1990s began marketing products containing ephedra's active ingredients, ephedrine alkaloids, as weight-loss drugs, often mixing them with caffeine. For years, they were hugely popular in the U.S., sold in big-name products like Metabolife, Hydroxycut and Stacker, and the companies who made them — many of them tiny outfits operating out of garages or warehouses — raked in the profits. But then the reports starting coming in. Young, healthy people were having strokes. They were dropping dead from heart attacks. "The FDA started getting concerned because all these young people who shouldn't be sick, who shouldn't be having strokes and shouldn't be dying of sudden cardiac arrest, were," said Leslie O'Leary, a Portland attorney who has sued several ephedra manufacturers. "That's what prompted them to investigate after seven or eight years, once they had enough data to investigate." Until the FDA implemented its ephedra ban in 2004 — more than a decade after the agency began receiving reports of serious side effects — O'Leary said it was up to attorneys like her to take on the companies selling the supplements. She represented dozens of clients who assumed they were taking a safe product. Unfortunately, oncethecases reached her,thedamage was done, she said. "By the time I'm contacted by a family, somebody is really seriously sick or dead," O'Leary said. And often the companies that made the supplements simply declared bankruptcy once they were sued, which made it very difficult for attorneys to collect damages for their clients. "Bankruptcy gives them a fresh start and lets them off the hook," said David Sugerman, a Portland personal injury attorney. And even when ephedra and other dangerous stimulants like it are banned, its manufacturers simply pull it off the shelves, reformulate it with a new concoction of ingredients, slap on a new label and send it back to stores, said Melinda Manore, an Oregon State University nutrition professor who has researched weight loss products. That means even though ephedra is off the market in the U.S.— it can still be purchased online from overseas companies — Manore

Page6

said there is still plenty to be concerned about when it comes to supplements that contain stimulants. No one tests the products to be certain of what's in them, so they could contain twice as much of the stimulant listed on the label. "That could be very dangerous," she said. Lots of supplement manufacturers claim they test their own products, but Manore said independent testing from an entity that won't profit from the sale is necessary to prove something is safe. Oftentimes, supplements will contain multiple varieties of stimulants. Their labels will list caffeine as an ingredient in addition to other stimulants such as synephrine, yohimbe or yerba mate, but they won't add up the total amount of caffeine from all of those ingredients, Manore said. "It stacks them in the supplement," shes aid. "You wouldn't know how much you're getting, because they're not required to do that. It really takes somebody analyzing the product to find out what's actually in it." Many of today's supplements are plant-based,which means they could be more potent depending on the soil conditions or where they're grown, O'Leary said. When she had ephedra plants tested for cases, O'Leary said, she found that many of them contained a lot more amphetamine than others. In other cases, the manufacturers were simply adding ephedrine to the batches. "People should always be wary of herbal supplements," she said. "The FDA has very little authority. And if the FDA isn't watching over them, who is?"

Alluring weight-loss promises Following the births of her first through fourth children, Bend resident Cynthia Poore never had trouble getting skinny again. It wasn't until she had her fifth child that Poore found she just kept gaining weight. She was active at the time — working a job that had her darting back and forth across a Walmart store, doing Zumba fitness classes regularly and chasing around kids at night. Her doctor tested her thyroid levels; everything came back normal. Even her doctor was stumped. Meanwhile, Poore kept seeing commercials for the weight-loss pills Slimquick. "I'm like, 'No, I'm not trying that,"'she said."But then I'd see the commercials a million times, and I'm like, You know what? I'll try that one.'" So it began. Slimquick had absolutely no impact on Poore's weight, but the rush of taking a pill with the promise of an easy solution gave her hope. It started her down the path that befalls many middle-aged women, who go from one weight-loss pill to the other, strung along by ruthless advertising and a relentless sense of hope. In two years, Poole has spent nearly $400 on at least six different supplement regimens. None have caused any major problems — the It Works! pills did cause her to throw up constantly during the few weeks she took them — but theyalso have done nothing for her weight. "It's kind of like I'm on a never-ending search for that one cure to get my skinny real quick," she said. Poore's experience aligns with research by Manore, of OSU, which looked at four different types of weight-loss supplements and found

SUMMER/FALL. HIGH DESERTPULSE

no strong evidence supporting their use. Those varieties that had been tested showed only modest effects — with little or no longterm follow-up — others have had zero or limited trials into their effectiveness. "It just amazes me that people will spend so much money on stuff when they don't know what's in the product," she said, "and the outcome is relatively small." Manore's weight-loss solution? Old-fashioned diet and exercise. "Everybody wants to do it quickly without too much work," she said, "and, unfortunately, it doesn't work that way." Overall, Manore believes consuming lots of green tea and fiber and eating low-fat dairy products could complement a healthy lifestyle to prevent weight gain over time. But since green tea extracts are so commonly contaminated with other products, such as stimulants that can cause liver damage, she recommends people just drink the tea to get the benefits. The Center for Science in the Public Interest has sued companies over bogus weight-loss claims, most of which include the marketing guise of being "natural," a gimmick Gardner said he detests. For example, when various unscrupulous companies were promoting acai berry supplements as a natural fat burner, Gardner said his team knew right away it was nonsense. "We wantedto sue somebody, but every company we found was offshore, "he said."None ofthem were based here." Consumers tend to think things that are natural are good for them, but that's simply not true, Gardner said. After all, he said, sugar, fat and salt are natural. "People are entitled to be wrong," he said. "Companies are not entitled to take advantage of that. When you prey on people's lack of knowledge because we're not all food scientists, that's predatory, abusive behavior. It's a deceptive practice." The dangerous stimulant ephedra, for example, was often marketed as an all-natural product, and is referred to by its Chinese name, ma huang, Gardner said. "Somebody from China knew damn well what it was," he said, "but somebody from Dallas, who might know that ephedra should be avoided — 'Well this is natural; it's ma huang. It's been used in Chinese treatments for millennia."' Poore said she still occasionally takes a weight-loss supplement called garcinia cambogia. She's been using it for about a month and a half and although she hasn't noticed a benefit, she takes it because it says on the bottle that it's natural. "It's all herbs and healthy-for-you stuff," she said. "They advertise it as all natural. There's no side effects. It all comes from plants, supposedly." The popular TV show host Dr. Oz has touted garcinia cambogia, produced from a small, purple fruit called the malabar tamarind, on his program as a "natural" way for busy people to lose weight. In one segment, Oz, whose full name is Mehmet Oz, stands in front of a large screen with the exclamations, "No exercise. No diet. No effort." Garcinia cambogia contains the botanical extract hydroxycitric

JOE KLINE

Stephen Gardneris director of Iitigation at the Center for Sciencein the Public interest.

acid(HCA),which some say speeds up metabolism and suppresses fatty-acid synthesis. Randomized controlled trials generally do not show an impact on weight loss, however. Victor Navarro, chairman of the division of hepatology and liver transplantation with the Einstein Healthcare Network in Philadelphia, has observed garcinia cambogia as the common denominator among more and more patients sustaining liver injuries after taking supplements. He said he's very concerned about the dangers of the supplement and plans to contact Oz to encourage him to talk about its potential side effects, although he's not sure even that will help. "Even if he expresses a note of caution to the public — coming from a really sort of biblical figure like that — they may not hear the caution," Navarro said. "They may just hear him speak positively about a product and then, all of a sudden, they're using it." U.S. Sen. Claire McCaskill, D-Missouri, scolded Oz in a June Senate hearing for making false claims about products. Oz responded that he personally believes in the products he features on his show. McCaskill told Oz she wanted to make an example of him because of the tremendous power he holds over his viewers. "We didn't call this hearing to beat up on you," she said, "but we did

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Common dietary and herbal supplements Surveys show about halfof people in the U.S. take dietary and herbal supplements, but because the FDA doesn't regulate them, it's impossible to tell what's in them and whether they're safe. Many â&#x20AC;&#x201D; especially those used for muscle-building and weight loss â&#x20AC;&#x201D; are either ineffective or harmful.

Green tea extract What is it?Green tea contains caffeine and catechins, phytochemical compounds that act as antioxidants. Howdoes it work?Research has linked catechins to health benefits such as increased antioxidant activity in plasma, expanded blood vessels, increased fat oxidation, decreased fat absorption and reduced lipogenesis, the process by which foods are turned into body fat. Evidence?The health benefits of green tea and green tea extract have been studied extensively. Green tea and caffeine mixtures common in weight-loss supplements have been linked to roughly 3 pounds more weight loss compared with control groups, although habitual caffeine use can dampen that effect. (The addition ofcaffeine to the green tea appears necessary in achieving the weight-loss effect) According to the National Institutes of Health, there is insufficient evidence on the effectiveness of green tea extract in weight loss. However, some evidence has shown it can help moderately obese people lose weight. Reported sideeffects?Green tea extract has been associated with liver damage, especially ifconsumed on an empty stomach. Since green tea contains caffeine, the extract can cause dangerous interactions ifcombined with other stimulants, such as ephedrine or bitter orange. Side effects can also stem from high concentrations of the extract in a serving or contaminants within the supplements. /

Garcinia cambogia What is it?Garcinia cambogia is a small purple fruit also called the malabar tamarind that produces the botanical extract hydroxycitric acid (HCA). Howdoes it work?HCA may be helpful in weight loss because it speeds up the metabolism. Research has shown it suppresses fatty-acid synthesis. Evidence?Randomized controlled trials generally do not show effects on weight loss, fat oxidation or appetite. According to the California firm that analyzes the DNA ofsupplements, it's unclear whether products sold in the U.S. as garcinia cambogia actually contain the raw extract. Instead, many likely contain chemicals and fillers. Reported sideeffects?Garcinia cambogia has been linked to several reports ofliver damage. It also can increase serotonin levels, so could be harmful ifcombined with some antidepressants. Combinations with other substances in weight-loss products can increase the risk for harm. In 2009, the FDA warned people to stop using Hydroxycut, a weight-loss product that contained garcinia cambogia, because of reports of severe side effects, including liver damage requiring transplants.

Miscellaneous fat burners What arethey? Products contain several different active ingredients, including conjugated linoleic acids (CLA), fatty acids commonly found in dairy products and beef, and L-carnitine, a derivative of the amino acid lysine that's produced naturally in the body. Howdo theywork?CLA and L carnitine are believed to help weight loss through their impacts on metabolism. Evidence?CLA has been extensively studied, and some research has found it to decrease fat by 2.2 to 44 pounds in 12 weeks to 24 months. Research into L-carnitine has shown little evidence of effectiveness, although some 2011 research showed when combined with carbohydrates it indirectly increased fat oxidation during exercise. Reported side effects?Neither CLA nor L-carnitine have been shown to cause serious side effects, although some CLA users report gastrointestinal distress.

Preworkout supplements for building muscle What arethey?They are designed to increase energy and strength to boost performance during a workout. Many brands do not disclose their contents in their entirety, instead listing "proprietary blends." Some include stimulants such as caffeine, while others contain amino acids such as arginine or beta-alanine. It's important to be aware ofwhether several different caffeine products are stacked together in a single product, as manufacturers generally do not add up the total amount ofstimulants in a single product (For example: listed ingredients could include caffeine,yerba mate and guarana). Howdo theywork?Some preworkout supplements contain caffeine, a stimulant that increases mental alertness and possibly improves athletic performance. Others contain anabolic amino acids and branched-chain amino acids (BCAAs), which are components of proteins believed to promote the body's ability to turn food into energy. Some supplements contain creatine, a substance the body produces naturally and stores in the muscles, as it's believed to improve athletic performance and build lean body mass. Most combine several active ingredients. Evidence?Users report high rates ofeffectiveness on reviews and forums; however, academic research has not shown the same and has emphasized the health risks ofthese supplements. One study showed the use ofa caffeine-containing supplement improved reaction time, energy and mental focus, but research last year by the University of North Carolina at Chapel Hill found overall evidence to be inconclusive. Reported side effects?Not all preworkout supplements contain stimulants, but those that do are associated with the highest rates of side effects, such as liver damage, heart attacks, strokes and high blood pressure. More common side effects include jitteriness, anxiety, increased heart rate, heart palpitations and effects on lipids and blood glucose. Some users report gastrointestinal side effects. The FDA has banned products containing 1,3-dimethylamylamine, or DMAA, a stimulant linked to illnesses and deaths. Sources: National Institutesof Health; Melinda Manore, Oregon State University; RobertHendrickson, Oregon Health & Science University; Victor Navarro, Einstein Healthcare Network Images courtesy Wikimedia Commons

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Cover story ~ SUPPLEMENTS

call this hearing to talk about a real crisis in consumer protection."

Serious side effects Navarro and his colleagues, concerned about the devastating effects they had seen from dietary and herbal supplements on patients' livers, are about to publish a national study that found dietary supplements are responsible for nearly 20 percent of drug-related liver injuries in hospitals in 2012, up from 7 percent a decade earlier. Those figures are likely underrepresenting the extent of the problem, though, because they only include people referred to liver specialists at hospitals across the country, Navarro said. The researchers followed 845 patients between 2004 and 2013. They found that of those who sustained liver injuries, about 11 percent of those whose injuries were caused by dietary supplements were severe enough to require transplants. Among those whose injuries were from pharmaceutical drugs, only 3 percent needed transplants. "There is a lot of work to do to convince the public that these have to be used with caution," he said. The liver takes such a beating from medications and supplements because its job is to reduce the products to their components after they're ingested and eliminate them from the body. Although the majority of liver injuries are caused by various prescription medications, as a definable group, dietary supplements are the second-leading class of drugs to cause liver injuries, behind an-

JOE KLINE

Cynthia Poore, pictured outside her homein Bend, has tried several diet pills and supplementsin an attempt to lose weight but hasn't found any success.

tibiotics, Navarro said. The type of supplements the patients took varied, but the largest identifiable groups were bodybuilding supplements, followed by weight-loss supplements, he said. That was a surprising finding for Navarro, as he said people who take supplements tend to be younger and healthier than people who take prescription medications. It may be that doctors are more likely Continued on Page 49

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Hospice I Home Health I Hospice House Transitions I Palliative Care SUMMER/ FALL2014 â&#x20AC;˘HIGH DESERT PULSE

Partners In Care HOSPICE

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FeatureiHOMELESS HEALTH CARE

When homeless Central Oregonians visit the hospital, they are often discharged with nowhere to go, and that can exacerbate their conditions

BY MARKIAN HAWRYLUK

ernie Crisman can't remember how he came tobe homeless or how long he had been living on the street before he was attacked last year. Four men threw a pillowcase over his head, assaulted the 56-year-old Bend man and stole his belongings. Crisman, a U.S. Army veteran, ended up at the Veterans Administration hospital in Portland, where he underwent brain surgery to repair his head wounds and was treated for a hernia. He spent another six weeks at St. Charles Bend recovering from his injuries. "They drilled a hole in my head the size of a dime," he recalls. "I couldn't think very good. I couldn't talk. My equilibrium (was off)."

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When the hospital discharged him, they dropped him off at the Bethlehem Inn, a homeless shelter in Bend. But Crisman soon found himself in another health crisis. Unwilling or unable to control his diabetes, his blood-sugar levels spiked, prompting shelter officials to send him back to the hospital. There, doctors discovered he hadn't been taking his antibiotics either. "Now his infection is serious," said Donna Hines, a professional fiduciary, who holds the power of attorney for Crisman. "He got discharged.He didn't have the means. He didn't have a place to keep (his medication). He didn't have the mental capacity to take the antibiotics, and now it became a seri-

ous problem." Crisman's case follows a familiar script for homeless individuals in Central Oregon. Living on the streets, they develop acute health issues or chronic conditions that spiral out of control, avoiding any medical services until they can no longer hold out or are brought to the hospital by emergency personnel. They are treated but released back into the same conditions that exacerbated their health in the first place and wind up back in the hospital. With each trip through the revolving door of admission and discharge, these individuals churn up thousands of dollars in charity health care dollars without ever truly becoming well.

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Feature(HOMELESSHEALTH CARE

There is, however, a growing recognition among homeless advocates and health care officials that there is an inseverable link between housing and health, that individuals cannot remain healthy without a roof over their heads, and often risk staying housed without access to health services. Moreover, analyses show the public funds spent providing health care and other community services to the homeless in this haphazard way far exceeds the money it would take to provide them housing in the first place.

Health care for the homeless The 2014 point-in-time homeless count in Central Oregon identified 2,410 homeless people in Crook, Deschutes and Jefferson counties, up from 1,990 in the previous year. Advocates believe such counts reflect less than half of the true homeless population but are useful in recognizing trends. For example, the number of chronic homeless— adultswho have been homeless for more than 12 months or who had at least four episodes of homelessness in the past three years — increased from 256 in 2013 to 522 this year. In November, the U.S. Department of Housing and Urban Development estimated there were about 610,000 homeless individuals nationwide, with more than 92,000 of those considered chronically homeless. Studies have consistently shown that homeless individuals have high rates of illness, injury, death and being victims of crimes. Those, in turn, lead to higher rates of emergency room and inpatient hospital use. A national study found that, on average, homeless individuals visit the ER five times a year, with an average cost per visit of $3,700.Moreover, 80 percent of those ER visits, the researchers found, were for exacerbations of conditions that could have been treated with preventive care. Those numbers are the stark reality of trying to survive on the streets, exposed to the elements, with little access to healthy food or good hygiene. "It exacerbates any pre-existing health issues and I think you can't really talk about

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Temporary housing An accounting of emergency and transitional housing in Central Oregon in 2010 found 369 beds available to get homeless individuals offthe street, far short of the estimated 3,000 to 5,000 homeless individuals in the region.

Homeless housing inventory,2010 Emergency shelter

, Familybeds: ,Individualbeds: ,Total

Bethlehem Inn

Safe Homes (Cascade Youth and Family Center)

12::

Deschutes County Parole and Probation

18 :'

Grandma's House (pregnant/parenting teens)

Nancy's House (Neighborlmpact)

Saving Grace (domestic violence)

The Shepherd's House

Madras Gospel Mission

Total Transitional housing

67,

117,:

184

: Familybeds: Individualbeds: :Total

Stepping Stones (Housing Works/Best Care) The Loft (Cascade Youth and Family Center)

17 :'

Horizon House (Housing Works/ Deschutes Mental Health)

13 ::'

Transitional housing program (Neighorlmpact)

120,

120

Jericho Road Home of the Brave (Central Oregon Veter• ans Outreach) Emma's Place (Housing Works) Prairie House (Housing Works) Total

0: 126,:

59 '

185

Source: Central Oregon 10-year Plan to End Homelessness

people living on the streets without mentioning the reality that large percentages are struggling with some form of addiction," said Curt Floski, executive director of Shepherd's House, a homeless shelter in Bend. "So you couple health issues with addiction issues, and you've got the making of a health crisis."

Living in shelters or homeless camps in close quarters can expose the homeless to communicable disease. They have trouble controlling chronic conditions such as hypertension, high cholesterol or diabetes, with no place to store medications or syringes. Eating what they can find or afford, they

SUMMER/FALL2014•HIGHDESERTPULSE

struggle to maintain a healthy diet. Soup kitchens and other charities primarily offer meals that are low in cost but high in salt, sugars and starch. It's a population with high rates of depression and mental disorders and significant substance abuse issues. Injuries do not heal properly because bathing or keeping bandages clean is not possible. Minor issues such as cuts or colds become infections or pneumonia, which become more difficult and more expensive

they live, so they're obviously more prone to have to go the emergency room," Morris said. "They don't have primary care providers, most of them don't have insurance, and they go inwhen it s so bad they don't have anything left to do." In the hospital, homeless patients cost on average $2,500 more per stay than patients with stable housing. According to the National Health Care for the Homeless Council, homeless individuals are three to four times more likely to die prematurely than others their to treat. age, with life expectancy as low as 41 years. "What's a simple leg wound or an abra- No amount of health care, the group mainsion or a blister goes untreated, gets in- tains on its website, can substitute for stable fected — pretty soon they have cellulitis housing. "No matter what you're going to give them of the limb," said Dr. Randall Jacobs, an internist with Bend Memorial Clinic, who in terms of medical care," Jerry Hollis, execprovides care to the homeless through utive director of COVO, "you're still going to the Mosaic Medical mobile treatment push them back out into the environment." van. "And then if they're a smoker, if Discharged to the street they've got hypertension or diabetes, they've got poor circulation." A 2010 tally found 184 emergency shelJacobs had been treating one such homeless patient in the medical van. Over the course of 18 months, the man had one leg amputated, then the other. He was killed crossing a road in a wheelchair. "We certainly see frostbite every winter. We see deaths from hypothermia," Jacobs said. The van saw anotherhomeless man who incurred second-degree burns on his faceand arms when his propane stove exploded. John Morris, outreach coordinator for Central Oregon Veterans Outreach, routinely makes the rounds of the homeless camps, handingout food, clothing and • I other supplies. When harsh weather is on its way, he makes extra trips to urge the J• homeless to get into a shelter and out of the elements. "Our goal at the start of the year is to make sure nobody dies throughout the s l i year from the weather," he said. "Our rule ' is nobody dies from the elements." I s I During the last winter's worst storm, one man didn't heed the warning and lost his toes to severe frostbite. "They'resuffering because of the way

ter beds in Central Oregon and another 185 transitional housing spots. But many of those have strict standards and long waiting lists, and, for the most part, aren't set up to deal with persons dealing with significant health issues. "It's a tough spot for people," Floski said, "There are just not any places they can go." Increasingly, hospitals are discharging patients from inpatient floors or the emergency room with the expectation that they will continue to recuperate under the watchful care of their family or loved ones. "It's fairly simple if you think in terms of 'I've got a husband at home, I've got a wife at home, I've got children at home. These are people who can help me,'" said Chris Clouart, director of the Bethlehem Inn."You can convalesce at home and it's 10 feet to your kitchen, it's six feet away to your bathroom. It's all within distance for you." Residents at the shelter must be able to walk 50 yards across the parking lot for their

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meals. There isn't sufficient staff to care for individuals with health care issues. "We often get a lot of pressure from the hospital or the discharge nurse saying, 'Well, why is it that you can't take this person?' I had one guy released to me two days after open-heart surgery," Clouart said."They often times don't understand the circumstances we have." The shelter may take in individuals who simply cannot go back to the street if they can, for the most part, take care of themselves. On occasion, they've arranged for a home healthnurse to come by and change dressings, but they're limited in what sort of services can be provided there. In one survey, published in the Journal of General Internal Medicine, 67 percent of homeless patients surveyed spent their first night after hospital discharge at a shelter, while 11 percent spent it on the streets. According to the 2010 U.S. Department of Housingand Urban Development's 2010 Annual Homeless Report, 7 percent of all homeless individuals and 13 percent of newly homeless individuals at shelters came directly from a hospital. "We become the default solution in too many difficult circumstances," Clouart said. Hospitals can try to get public health plans, such as Medicare or Medicaid, to cover some time in a nursing home for such patients. Community health workers at the hospital often spend hours on the phone trying to find a place for a homeless patient. But if the hospital cannot find a place to send them or if the patients are unwilling, there is sometimes little choice other than to release them. That, homeless advocates say, is a recipe for disaster. "It's not adequate to just discharge someone to the street, and say, 'Listen, you need this dressing changed every day; you're not supposed to walk more than this distance; you should be eating this kind of food; you need to take these medications; you need access to water,"' Clouart said."It's not adequate to discharge someone to a camp or to live on the street." Moreover, a discharge to the street or shelter, more often than not, means that

Page 14

Homeless in Central Oregon Each year the Central Oregon Homeless Leadership Coalition attempts to count the homeless population in Central Oregon counties and cities. The point-in-time count is not intended to be a full accounting ofhomeless individuals but a way to identify trends from year to year. ii

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patient will be back. A 2013 Yale University study that tracked 113 homeless patients treated in an urban hospital counted 266 admissions over a four-month period. Half of the patients were readmitted and 70 percent returned to the hospital, either as inpatient, emergency or observation patients, within 30 days. A discharge to the street or shelter versus other living situations, the researchers concluded, increased the risk for readmission. "What happens to homeless patients after hospital discharge? Spoiler alert: They quickly end up back in the hospital," the lead researcher, Dr. Kelly Doran, wrote in a letter to the health policy journal Health Affairs last year. Hospitals are increasingly facing significant financial pressures to avoid readmissions. Medicare has stopped paying for readmission within 30 days of discharge, and in Central Oregon, St. Charles Health System receives a fixed payment for providing care to Oregon Health Plan (Oregon's Medicaid)

ANDYZEIGERT

patients, so they could lose money if a patient is readmitted. That makesfinding a placeto send homeless patients with lingering health issues even more important. In some case, it costs less for the hospital to pay for a nursing home stay itself than to risk the costs of a readmission. "Just knowing that there is a such a high risk of them coming back in if we don't do that, we'll spend the money to place them," said Alan Burke, manager of social work for the hospital system. "Patient self-determination still rules the day. If they're a reasonably competent person, and they don't want to take this medication, we can't force it on them. We can't put them in a situation they don't want to be in. A bad decision doesn't make them incompetent." Several years ago, the hospital set aside $16,000 to help homeless individuals with their medications. "We've helped more than 100 homeless people in the last couple of years with their

SUMMER/FALL2014•HIGHDESERTPULSE

medications," Burke said. "That's gone a long ways to try to help stabilize them and keep them from coming back in." Those medications are distributed either to patients directly or to the shelters, which can make sure they're being taken as prescribed. While the program fits in nicely with St. Charles' charitable mission, there is a cost-saving component to it as well, further stretching the limited health care dollars available for charity care. "The benefit clearly was to try to prevent rehospitalizations," Burke said. "If they had to have an antibiotic and they took it, chances were much better that they wouldn't come back in." One way or another, most of the costs of treating the homeless are passed on to the general public, either through tax dollars for public health programs or by raising costs to those with private insurance to cover the

shortfall. But with the homeless relying almost completely on ER visits for their health care, it's an extremely inefficient way to pay for it. "It's not just a hospital issue; it's a community issue," Burke said. "If you have homeless out there, that impacts the police services, same with the EMTs, there's the Bethlehem Inns of the world — all those places get impacted. And if we're doing free care, then we're charging higher prices."

Bridging the gap Local providers have been trying to plug gaps in the safety net for the homeless as they can. Central Oregon Veterans Outreach for years has operated a mobile van that visits shelters and other locations where the homeless congregate providing free care. "That kind of moves them into the system at Mosaic, and trying to triage their needs,"

•

SUMMER/ FALL2014 •HIGH DESERT PULSE

Floski said. "The goal of that is to try to provide wraparound services on the medical side with Mosaic and prevent that repetitious cycle of emergency-room visits." By improving their health, they hope to remove another obstacle to escaping homelessness. That's what happened with Jeff Holmes, a 60-year-old Bend man, treated in the van. Holmes had been a carpenter in Roseburg, but achy knees and a slowing housing market left him unemployed. He crossed the mountains to Bend but fared no better here. Last year, after five years of living on the street, his blood pressure was so high, the nurse in the mobile van thought the device for testing it was broken. Jacobs prescribed a generic blood-pressure medication, giving Holmes a gift card and a ride to Walmart to fill it immediately. When his blood pressure started creeping up again,

•

Page 15

Coverstorj/( HOMELESSHEALTH CARE

Jacobs sent him to Mosaic Medical, a federally qualified health clinic that provides free or reduced-cost care to those with no insurance. A subsequentblood test showed Holmes had a variant of high blood pressure that needed a specialized medication, and the staff helped him apply for a pharmaceutical-assistance program to get the drug for free. The clinic physician also prescribed a statin for his high cholesterol, and at the start of 2014 signed Holmes up for health insurance. That allowed Holmes to see an orthopedic surgeon, who gave him a cortizone injection for his knees while he waits out the waiting period for a knee replacement. U I'm pain-free for the first time in 10 years," he said. "I couldn't have taken an eight-hour job if it was offered to me. Now I can." Holmes had been working at the Family Kitchen, working his way up from dishwasher to cook. He works four-hour days, making 40 gallons of soup, grilling sandwiches and baking biscuits for the dozens of homeless who come there each day. "People in our situation have a fear of even using the medical van because they're afraid they're going to get a bill. They don't trust the system," he said. Instead they use the emergency room if they can't hold out any longer. "That's the first place they turn because they know they're not going to be turned away," he said. "I know people here who use it on a regular basis. It's a revolving door." Holmes was displaced from his camp by the Two Bulls Fire in June but was offered the use of an RV donated to COVO by a veteran's family. The RV is parked on land owned by Christ Community Church, and Holmes also serves as the caretaker there. What started with a simple visit to the mobile health van now hasHolmes on the path to being healthy and self-sufficient. "Mosaic has put me back together healthwise, so I can go out and get a real job," he said, "which a year ago would have been impossible." Holmes has also become an evangelist for Mosaic and Oregon's health care expansion, and he demonstrated that last month in the

Page 16

Reasons for homelessness For the 2014 count, respondants were asked about the reasons for their homelessness. Individuals could provide multiple reasons.

5,652 U n employment

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~ 4 3 6 Domestic violence ~ 4 3 6 Poor rental history ~ 3 79 Poor credit • 2 83 Drug/alcohol abuse • 275 Drug/alcohol use athome • 242 Medical problem • 235 Mental/emotional disorder • 217 Criminal record • 204 Homeless bychoice i 90Child abuse i 80 Pregnancy i 57 Property sold i 44 Foreclosure i 30 Runaway 2 Gambling 2Trailer parkclosure Source: CentralOregon Homeless LeadershipCoalition ANDYZEIGERT

soup kitchen. "Does anybody here not have health insurance?" he bellowed across the room. A young man raised his hand. "Would you like health insurance?" he asked.Indeed,the man would. "You show up at Mosaic Medical on Monday morning; they'll have it for you in two weeks," he said.USee how easy that is?" The Medicaid expansion under the Affordable Care Act has opened the door for many homeless individuals to get health insurance. Most didn't qualify in the past because the program was largely reserved for mothers and children. That changed as of Jan. 1 with Obamacare but has exacerbated the discharge problem. "We'vehad double the number of new

patients that we thought we would. Over 2,000 of our uninsured patients now have OHP," said Elaine Knobbs, Mosaic's director of programs and development. USo now they have insurance, but they still don't have housing." A national analysis found that three out of four chronically homeless individuals with incomes below the threshold for Medicaid expansion were not on Medicaid prior to the Affordable Care Act. "We're still early enough in this people having access to health insurance on a large scale, so that a lot of these things have not been resolved yet,n Clouart said. "We're going to be dealing with folks who will have access to health insurance, but they don't necessarily have access to stable housing." Now, homeless patients are more likely to seek care, be admitted to the hospital and have major procedures done. With no expansion in nursing home beds or transitional care,however, ithassqueezed more homeless through the front door of the health care system without a clear exit strategy. "We'veneverseenso many homeless people," said Mary Meeko, executive director of the Pilot Butte Rehabilitation Center in Bend. "BecauseofObamacare, the homeless people now have access to health care, so we're seeing a greater number." This year, Pilot Butte has consistently seen two to three homeless individuals among its 30 to 35 residents. But when homeless individuals no longer meet the medical criteria to stay there, the staff faces the same challenge that discharge planners at the hospital do. "We start calling and asking," Meeko said. Even when individuals are placed in a nursing home after a hospital stay, they are often so concerned about their belongings in the camps or where they will go afterward, they don't stay. "They'll give them up to two to three weeks (in a nursing home); after two days, guys get up and walk out the door," said John Morris, outreach coordinator for COVO. "They're worried about their stuff being stolen and they are not down with sitting." One of the vets Morris worked with was transferred to a nursing facility after a hip

5UMMER/FALL2014.HIGH DESERTPULSE

The eost of homelessness

replacement. "That guy left after a week," he said. "They A recent study comparing homeless and housed said, "Do not leave, do not leave,'and he just patients at health centers showed the increased waddled out. You'll see him out there walk- health burden of those living on the street. ing with a walker." Many of those individuals have gotten to Liver ~ 16% the point in their lives where medical care condition • gfi/ simply isn't a priority. "To be honest, I don't think they care," health ~ 32e/ Morris said. "They have nowhere to go. Their hope is pretty much gone. They're tryr ood ~ 21' / o ing to survive, trying to get rent for the day, u5 i n y • 10eye • Homeless trying to get food to eat — at the end of the • Housed day, medical issues just get in the way." Chronic ~ 19% Those medical issues then flare up, bronchitis Q] 11~ prompting someone to call 911 and then Multiple ~ 33o/e EMTs or the police bring them to the hoschronic pital. COVO sometimes gets the call when conditions ~ 27o/o they are discharged but often has no good options for where to take them. 72% Tooth loss "We're always willing to go pick some54% body up; the problem is a lot of these Alcohol ~ 1 1% guys are no longer welcome in the camps. They're no longer welcome at the Bethlehem dependenceJ 2oy Inn. They've burned every bridge until there Severe ~ 23e/ are no bridges left to be burned, and that's mental illness ~ 12% when they end up underneath the bridge, literally." Source: National Health Careforthe HomelessCoalition ANDYZEICtERT

A housing solution Most advocacy groups for the homeless as well as many health care providers now believe the solution may be to provide housing and support services. Known as the housing-first model or permanent supportive housing, the thought is that by placing homeless in housing and providing them with support services, they can break the expensivecycle ofhomelessness and itsassociated costs, and save money in the long run. The modelhas been tested in many places around the U.S. and Canada and shown great success. A Canadian study released in April, for example, split more than 2,000 homeless people between a housing-first program and traditional support services. It found that every dollar spent on housing and support netted more than twice that in savings in hospital, prison and shelter costs. The program spent $19,582 per person to provide hous-

SUMMER/ FALL2014. HIGH DESERT PULSE

ing and support services, but saved more than $42,000 on average. And 72 percent of those in the housing-first group had stable housing after two years, compared with 34 percent in the standard group. Early this year, the Central Florida Commission on Homelessness released an analysis done by Creating Housing Solutions, which calculated that the region spends $31,000 a year per homeless person. In contrast, getting each homeless person a home and caseworker would cost about $10,000 per person. The savings come not only from avoiding hospital and ER admissions, but cutting costs for EMT, police, jails and substance-abuse facilities. Many communities, however, have struggled finding the upfront money to invest in the approach. In some places, hospital systems have fronted the money expecting that they'll reduce their charity care costs through the program.

But often, spending by one player in the community would results in savings for others, requiring a community-wide approach to the issue. That's where Oregon's recent health reform effort could help. Under Gov. John Kitzhaber's plan, money for Oregon Health Plan enrollees is given in a lump sum to coordinated care organizations, which can choose how to spend that money in their communities. The governor has frequently used the example of purchasing an air conditioner for an elderly patient to avoid an expensive hospitalization for problems stemming from the heat. The housing-first model, it seems, could expand that approach from an air conditioner to an entire apartment. The state provided CCOs with additional funds to help transform the health care system, and in Central Oregon, the CCO accepted proposals for how to spend its $1.6 million in transformation dollars. One of the proposals was a housing-first pilot project, pitched by Housing Works of Redmond. The Health thru Housing pilot sought $285,000 to provide rent assistance and case-management servicesfor 20 to 25 homeless individuals who were pregnant or had chronic medical conditions. Two-thirds of the funds would be used to pay rent and provide security deposits, while the remainder would be used for case management to help the homeless transition. "We would basically take someone straight out of homelessness who has one of those conditions; we'd be putting them in housing, providing rental assistance, provide case-managementservices, and then document medical reimbursement costs on the program," said Kenny LaPoint, Housing and Resident Services Director for Housing Works. Homeless people with chronic conditions such as high blood pressure, high cholesterol or diabetes often end up in the emergency room because their conditions are not well controlled. Meanwhile, studies show women living on the street have a higher rate of pregnancy than those in stable housing. Continued on Page 52

Page 17

TIPSiSTRETCHING

Bend's Julie Downing shares 8 simple stretches for staying loose BY TARA BANNOW • PHOTOS BY ANDY TULLIS

ate to break it to you, but you may have been stretching Th e n when you're done with the activity, spend the same amount wrong this whole time. of time in a cool-down mode, which can be the same type of activity Were you doing it before your run? Were you pulling until it as the warm-up. hurt? Both are major no-nos. Then, and only then, is it appropriate to stretch, Downing said. "That's when you'll have the most elasticity because the muscle is Sure, there are conflicting views in the fitness world over the best stretching techniques, and much of it depends on which research more pliable," she said. you trust. For her part, julie Downing, chair of Central Oregon Community College's department of health and human Downing recommends people stretch two to three performance and head of its Exercise Physiology Lab, retimes per week at a minimum, although daily is ideal. lies on the American College of Sports Medicine's fitness Of course, people should always stretch after they exbible: the Guidelines for Exercise Testing and Prescription, ercise, she said. which is updated every four years. Downing uses it to If people are just beginning a stretching routine, preach to her students about proper form and technique. Downing said they should be patient — improvements Whether you work out or not, stretching can increase in flexibility won't show up until three to four weeks afthe body's range of motion so you can continue to do ter beginning a stretching regimen. You'll notice flexibilall of the activities of daily life, even as you age. And the ity beginning to increase by doing a sit-and-reach test, more people can move their arms, legs and backs, the for example, which is when you sit, stretching your legs less likely they are to become injured because their mus- Julie Downingis chair ou t in front of you and try to touch your toes. clesand tendons won't budge, Downing said. ofCentral oregon People should always stretch to the point where they Community College's fee l slight tension or discomfort, but not pain. department ofhealth

Although the common wisdom years ago was that an dperformanceand stretching before a workout reduced the risk of getting he ad ofits Exercise There are several styles of stretching, but the ones injured, Downing said stretching before a workout actu- Physiology Lab. Here Dow n ing recommends for most people are static, ally dampens performance. Studies have tested runners shedemonstrates the whi c h refers to holding a position for 10 to 30 seconds, who stretch before and after runs and found their times QTricepstretch: or partner stretching, which means having another perwere slower when they stretched before runs, she said. Gr ab your elbow, bring so n apply resistance to improve your stretch. "It's kind of wild," she said. it behind your body All st a tic stretches should be held for between 10 to Stretching elongates the muscles, thereby decreasing and gently pull. Repeat 30 seconds, or for 30 to 60 seconds for people over the their ability to produce power. I/I/ithoppositearm. age of 60. Ideally, though, each stretch should be held "A nice, tight muscle can produce a lot of power, but a fora grand totalof60 seconds.Thatmeans you could muscle that's really stretched out cannot produce the same amount hold each one for, say, 15 seconds, take a one-second rest and then of power," Downing said. repeat that three additional times to get 60 seconds worth of stretch. What people should actually do to prevent injuries, Downing said, P a r tner stretching works equally as well, if not better, than static is warm up before their activities. If you're going for a ride on your stretching, although it might take longer because partners have to mountain bike, a warm-up means going easy for five or 10 min- stretch the other person as well as themselves, Downing said. These utes. If you're lifting weights, hop on an exercise bike for the same stretches work by having the partner apply resistance and, immediamount of time beforehand. If you're running, start out with a slight ately following, the opposite person will experience a relaxation of jog or brisk walk. the affected muscle group.•

Page 18

SUMMER/FALL2014•HIGHDESERTPULSE

QCalfstretch 1: This one stretches the larger calf muscle, the gastrocnemius. Press your handsjust about shoulder height against a wall, plant the heel of the back leg down, bend the front leg and lean into the wall. Repeat with opposite leg.

0Quadricep stretch:Resting your hand on a stable chair or person for balance, keep the leg on the same side as the stabilized hand slightly bent, catch your opposite ankle with your free hand and pullit backslightly, keeping back straight. Repeat with opposite leg.

SUMMER/ FALL 2014â&#x20AC;˘ HIGH DESERTPULSE

Q Calf stretch 2: This one stretches the soleus muscle, the smaller of the two calfmuscles. Keeping hands pressed against the wall at shoulder height, bend your front and back legs, keep heels flat and lean against the wall. Repeat with opposite leg.

OHamstring stretch: While standing, step one leg forward and straightenit, bend the back leg and lean forward over the straight leg. Keeping the back leg bent, only reach forward to the point ofmild discomfort or slight tension. Repeat with opposite leg.

Page 19

Tips ST J RETCHING

05 h oulder/deltoid/backstretch: Keeping arm straight, bringitacross your chest and, using opposite arm, grab the elbow of the straight arm and try to push elbow toward chest. Repeat with opposite arm.

QChest stretch: Clasp your hands behind your back and straighten your arms.

OAbdominalstretch, step 1rStart out lying on your stomach, place hands on the floor at chest level and then press your upper body up, maintaining a slight bendin the arms. (Photo shows beginning of pose)

Abdominal stretch, step 2: Start out lying on your stomach, place hands on the floor at chest level and then press your upper body up, maintaining a slight bendin the arms.

Page20

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Page 22

SUMMER/FALL2014 â&#x20AC;˘ HIGH DESERT PULSE

Getready IWALKIRIDETOSCHOOL

More kids are choosing to bike and walk to school in Bend BY TARA BANNOW

he numberofkidsin Bend-La Pine Schoolswho biketo school in the mornings jumped more than 10 percent between 2012 and 2013 — the biggest increase yet in a single year. That kind of statistic is a feather in Bendite Brian Potwin's cap. Potwin has coordinated the district's Safe Routes to School program for the past five years through his post as education coordinator for Commute Options, an organization that promotes alternatives for Central Oregonians to driving in cars. "I've seen a shift in perceptions from parents around safety and the fun aspect of it," he said."I've seen an increased buy-in on the school district's level and per school as well." Advocates of walking or biking to school say it's a great way to ensure kids are getting at least some physical activity, especially at a time when physical education in schools continues to erode under the weight ofbudget cuts and shorter school years. The U.S. Centers for Disease Control and Prevention recommend kids get at least 60 minutes of physical activity each day, most of it moderate or vigorous aerobic activity. Depending on how far a child lives from school, walking or biking there mayjust satisfy the CDC's guidelines. But as attractive as the benefits may be, there are still significant barriers. Locally, the big ones are living too far from schools, inclement weather conditions and roads that don't permit safe access to school by foot or bike, such as busy, arterial roads or those without sidewalks. Potwin's group surveys parents on the subject and then uses the data to work with schools or the city to reduce the barriers, or with families to teach them about other options. "If we're talking about a specific situation with an entire school, we can educate them on that area," he said. A good example is the Rimrock Expeditionary Alternative Learning Middle School (REALMS), which is near the Riverhouse at the intersection of Business 97 and NW Mt. Washington Drive. In that case, Potwin helps people navigate the busy intersection, which usually means redirecting them to the nearby Deschutes River Trail, which connects almost directly with the school. "It's notjust the main travel lanes we all can go in by car," he said.

"Some of them are the more creative, fun, easy options." Safe Routes to Schools, a federal program with state and local chapters, has been active in Central Oregon for a decade. Since its inception, its leaders have worked with eight local elementary and middle schools to design safe routes to walk or bike to school. The process requires close coordination with the schools and involves designating a safe meeting point about a mile and a half from each school. Parents bring their kids to the safe point, and the kids then walk or bike to school in chaperoned groups of five to 20. Volunteer chaperons — either parents or teachers from the schools — are essential to the model. "It doesn't work without an adult there," Potwin said."That's part of whatmakes itsafe and accessible." Potwin also goes into schools and teaches safe biking and walking habits, such as hand signals, traffic rules and wearing helmets. For families considering allowing kids to bike or walk to school on their own, Potwin said the kids should be at least 10 years old to bike in the roadway. Younger kids don't have fully developed depth perception, peripheral vision or comprehension of the speed of travel. Kari Schlosshauer, regional policy manager for the Pacific Northwest for the Safe Routes to School National Partnership, said 1 in 3 kids in the U.S. is overweight or obese, and the vast majority don't get the recommended 60 minutes a day of physical activity. "There's obvious health concerns there," she said."Providing the safe routes and the encouragement and some of the educational pieces — especially with younger kids — putting those things in place within a school goes a huge way towards actually getting the kids to do it." In the end, encouraging and helping kids walk and bike to school ultimately benefits everyone in a community, Schlosshauer said. "It's really great to teach kids how to be good pedestrians and teach them how to ride bikes properly down the street because that benefits everyone if the kids know how to do those things," she said, "and it makes everybody feel better about letting them go out and do that."

Page23

Cooley R .

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Commute Options designed Safe Routes to School for eight area elementary and middle schools. The routes are designed to give kids a safe route to walk or bike to school, providing exercise and reducing traffic at schools. Routes begin at the red dots. Some schools have more than one route. For more info, visitcommuteoptlons.org/programs/safe-routes-to-school

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Pedestrian safety for kids • Ask a parent first. • Use sidewalks or paths. Ifthere are none, walk as far from the cars as possible on the side ofthe street facing traffic. •Choose a route with the fewest streets to cross and avoid crossing busy or high-speed streets. • Don't cross behind or within 10 feet of the front of a bus or other large vehicle because the driver cannot see this area. •Watch for parked cars that may be getting ready to back up or pull forward. • Obey traffic signs and signaIs. •When a signal indicates it is time to cross, checkfor motor vehicles. Drivers may not obey the rules and turning drivers may not lookfor pedestrians. • Before crossing, always lookfor cars, even after a signal, crossing guard, parent or other adult says it is OK to cross. •Walk, don't run, across the street.

Bicycle safety for kids Before riding to school, children must be able to: • Ride in a straight line while scanning the situation ahead, behind and to the side. • Stop quickly using the brakes without swerving, falling or crashing. • Swerve in a controlled manner to avoid a hazard or collision. • Follow the rules of the road. Once they are ready to ride, they should follow these tips: • Dress appropriately. Wear brightly colored, close-fitting clothing. Tie your shoes and secure long laces and loose pant legs. Do not wear headphones. •Wear a properly fitted helmet. • Ride a bicycle that fits. When seated on the bicycle, both feet should be firmly planted on the ground and hands should reach the handlebars. • Ride a bicycle that is in good condition. Tires should be firm, brakes should prevent tires from rotating when pushed, the chain should not droop or be rusty and the seat and handlebars should be tight. • Do not carry anyone else on the bicycle. • Do not carry anything in your hands. Use a backpack, basket or panniers. • Choose the route with the fewest streets to cross. Avoid busy and highspeed streets. Use bike paths where available. • Before entering the street, look for other vehicles to the left, right, in front and behind. •Watch for vehicles turning into or exiting driveways. • Stop at all intersections and checkfor traffic before crossing. When possible, cross at locations where adult crossing guards are present. It may be best to dismount and walk your bicycle across large or busy intersections. • Ride in a straight line with two hands on the handlebar unless signaling. • Follow all traffic laws, including: — If riding in the street, ride in the same direction as motor vehicles, on the right-hand side ofthe street, about 2 or 3 feet from the edge. — Hand signal when turning or stopping, and obey traffic signs and signals. — Checkfor traffic in front and behind before changing lanes, crossing intersections or turning. — If riding on a sidewalk or path, ride slowly and be prepared to stop quickly. • Biking in roundabouts: Children under age10 should use the sidewalks rather than riding on the roadway and should ride with their parents or guardians. Older students can use the same travel lane as vehicles.• Source: Safe Routes to School

SUMMER/ FALL2014 •HIGH DESERT PULSE

Page25

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- Page27

Healthy eatingi HDTDQGS. BY SOPHIE WILKINS • PHOTOS BY ANDY TULLIS

hen it comes to hot dogs, there are a couple ways to go. You have your mustard-only purists, who believe ketchup never belongs anywhere near a hot dog. You have your ketchup fanatics, who think a hot dog should be saturated with the stuff. And then you have the rest of us, who will put almost anything on a hot dog and call it good. But what kind of hot dog? That's a tougher question, especially if you're looking for more healthy choices. A hot dog is basically a frankfurter, a smoked, seasoned and precooked sausage made of beef, pork, veal, chicken or turkey. The name frankfurter comes from Frankfurt, Germany, where similar pork sausages were created. Other names for hot dogs include wieners, associated with hot dogs that contain pork, and franks, associated with all-beef dogs. Thereare also hotdogs made ofveggies,tofu, chicken, turkey and more. If you're vegan, vegetarian, kosher or simply preservative-free, there are plenty of options in your grocery aisle. With so many choices, it can be hard to decide which is best for you. Most beef hot dogs contain sodium nitrite or nitrate, a chemical salt used to cure meat, that is reported to be harmful in high amounts. If it's nitrites you'd like to stay away from, a beef-free option will be your best bet. All-beef hot dogs also tend to contain more fat. Options with less fat and salt include vegetarian substitutes, like veggie or tofu dogs, as well as turkey dogs. Tofu dogs may actually be your best bet as far as protein is concerned, containing a full 3 grams more than other varieties we examined. Two kinds of the hot dogs we surveyed from a local grocery store contain little to no sugar — the kosher, 100 percent beef dog and the turkey dog — while chicken franks and tofuand veggie dogs contained cane sugar or syrup to add flavor. Some beef dogs will also have sugar added. Bottom line: Classic beef dogs are going to have higher fat and sodium content and contain nitrites. Vegetarian alternatives will have lower sodium and fat levels and may have more protein but also added sugar. Lower-fat options like turkey and chicken dogs will probably need a little assistance from sodium and sugar in the flavor department. •

Page28

Let's face it. Hot dogs are a summer staple. But some are better for you than others.

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Nutrition per 43g serving:100 calories,45g fat, Og saturated fat, 330mg sodium,10g protein, 2g sugar Contains organic cane sugar.

Nutrition per 42g serving:90 calories, 6g fat, 1.5g saturated fat, 400mg sodium, 6g protein, 1g sugar Contains evaporated cane syrup.

SUMMER/ FALL2014 •HIGH DESERT PULSE

Page29

Gear~DOGBDQTs

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These hilarious-looking boots can help your active dog, summer or winter BY ALANDRA JOHNSON •PHOTOS BY JOE KLINE

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Grip Trex Ruff Wear, 569.95

entral Oregon can be tough on paws. Details:These all-season boots are the company's most popular. They are Those soft pads that propel dogs along dirt trails, over designed for rocky trails and can work in light snow (but not deep snow) as pavement and up hills aren't as indestructible as our best well as on hot surfaces. friendsmake them seem. Rocks and lava can tear up and slice into paws. Hot cement can burnthem, and snow and ice can freezethem. While a simple walk around the block probably doesn't warrant special paw protection, a long trek on rocky or snowy terrain probably does. But not all dog boots are made the same. Some are designed with snow in mind, others for regular hiking or lighter use. We gotthe low-down on some canine boots from localmanufacturer Ruff Wear's director of marketing, Susan Strible, as well as Bend Pet Express owner Stephanie Baldwin.

General tips • Watch for tripoding. How to tell if your dog needs boots? During hot or cold weather, if your dog is raising one foot up and "doing the tripod dance" to protect one foot, that means they could use some protection, said Baldwin. • Take boots with you.One good idea is for dog owners to carry a pair of dog boots along on a hike. Put them on the dog when needed to help them get over particularly rocky terrain, cinder fields, lava beds, obsidian flows or icy patches — all of which are common in Central Oregon. • Boots are not just for hiking. Strible says they hear from many people in New York City and other urban areas who use dog boots to protect their dogs' paws from salt and chemicals used to de-ice sidewalks in the winter and scalding hot pavement in the summer. • Try on first. Bend Pet Express allows people to visit the store

Page30

Durable Dog Boots Ultra Paws, 533 Details:As pictured on the dog above, these are more everyday boots, intended for lighter use. They provide good traction on flooring and light hiking trails and offer some snow protection. Baldwin said they also stay on very well.

and try the boots on their dogs before committing to a size. • Rewards are key. Many dogs are unsure of boots. "We get a lot of laughs in here in the store when dogs try on booties for the first time," said Baldwin. Use positive reinforcement and treats to encourage their use. With time, pooches should adjust.

All about fit "Fit is critical," said Strible. "We have found people are not successful

SUMMER/FALL2014•HIGHDESERTPULSE

50 YEARS OF DEDICATION For 50 years Bend Urology has been dedicated to providing state-of-the-art diagnosis and the finesttreatment of urological conditions for the men, women and children of Bend, Oregon, and its surrounding communities. Our physicians are board-certified diplomats of the American Board of Urology and are members of the Oregon Medical Association, the American Urological Association, CentralOregon Independent Practice Association and the Physician Hospital Alignment.

' ]gi)('(rj,

Summit Trex

Ruff Wear, 554.95 Details:This is a light, low-profile minimalist boot. It is water resistant and good for use on urban sidewalks or for light hikes. It is not intended for heavy-duty hiking. Strible said some pet owners use this boot for older dogs that may need traction on wood flooring.

Our Physicians and Physicians Assistants Michel Boileau, MD, FACS,Brian O'Hollaren, MD, Jack Brewer, MD, Nora Takla, MD, Meredith Baker, MD, Ronald Barrett, MD, FACS

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Polar Trex Ruff Wear, $89.95 Details:This is the brand's winter boot, designed for gripping in snow and ice. The fastener comes up higher on the dog's leg so that snow will stay out ofthe boot.

until they get the fit right." Too often, she says people assume if they have a large dog, they will need a large boot, but that is not always the case. If the fit is not right, the boot will not stay put. Ruff Wear offers a helpful fit guide on its website, www.ruffwear.com.â&#x20AC;˘

2090 NE Wyatt Court Suite 101 Bend, Oregon 97701 541.382.6447office 541.388.6862 fax 888.382.6447 toll free 333 NW Larch Avenue Redmond, Oregon 97756 54L548 4017office 541.388.6862 fax 888.382.6447 toll free Satellite Clinics in John Day, Burns, Lakeview and La Pine C ONT R A C T E D W I T H A L L M A J O R H E A L T H P L A N S

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Page31

Profile ISUPER DAVE

Bend's Dave Thomason created the Dirty Half and with it a racing scene with more options and personality BY MARKIAN HAWRYLUK

fyou'verun more than a race ortwo in Bend, chances are you've experiencedthe work ofDaveThomason. And chances are,you'd know him as SuperDave. Flexing his superpower — a unique ability organize races with a fun, low-key vibe that keeps people coming back for more — he is the logistical force behind some of the region's most iconic races. With his wife, Carisa, an elementary school physical education teacher, the power (running) couple has arguably done as much as any other to keep both young and old in Central Oregon fit and active. Born inEugene, Thomason, 42, moved to Bend afterhigh school to study at Central Oregon Community College and to ski at Mt. Bachelor. "Well, a lot more for skiing than for school," he admits. After two years, he left to complete his degree in exercise science at Oregon State University but returned to Bend after graduation in 1996. That's when he met his wife, 40, also a Eugene native, who ran long-distance races while studying at COCC. She had just returned to Bend, after having left to complete her degree and run for the West Virginia University cross-country team, specializing in 3,000, 5,000- and 10,000-meter races. Carisa began teaching PE for the Bend-La Pine school district, while Dave worked the floor at the FootZone running shoe store in downtown Bend, hitting the trails and the slopes in between work shifts and school days. It was in the late '90s, when Bend was half the size it is today, that Thomason pondered the lack of an intermediate-distance trail run in Bend. "Dude, I totally know where to put a trail race in Bend," he recalls telling a friend, and proceeded to plan the very first Dirty Half race, a half-marathon trail run that has now become a staple of the Central

Page32

Oregon running scene. "It was very humble beginnings." The first Dirty Half attracted a mere 150 runners, most of whom Dave knew personally. Much to his surprise, it turned a profit, which the organizers donated to charity. The second year, they lost money. But by the third year, they had worked out the kinks and started a relationship with the Deschutes Land Trust, which now benefits from the race proceeds. Now the race generally sells out its 800 slots. Building off the success of the Dirty Half, Thomason organized the Horse Butte 10-miler with similar casual beginnings after a run with a friend. "Hey, it's 10 miles. Hey, it's Horse Butte," he said, recapping his thought process. "Let's call it the Horse Butte 10-miler." Scheduled for April each year, it kicks off the running season for many local runners. Year after year, his portfolio of races grew, not so much by design, but organically. Visit Bend asked him to stage a 50K trail run as part of its campaign to promote Central Oregon as a trail running mecca. That become the Flagline 50K. There's the Twilight 5K Run/Walk, which starts and finishes at the Deschutes Brewery, where runners are treated to the brewery's Twilight Summer Ale. And, there's SuperDave's Down 8 Dirty Second Half, whose logo bears its namesake's big-chinned, big-eared mug. Just this year, he added the Mastadon, a 12-mile run through the Maston trail network on BLM land between Tumalo and Redmond in early March. Local runners say while the races are never glitzy events, they are well-organized and a good value. Where other race organizers routinely charge $30 to $40 for a 5K, sometimes more than $100 for a

SUMMER/FALL2014•HIGHDESERTPULSE

â&#x20AC;˘v

g JOE KLINE

Race and event organizer Dave Thomason with his wife, Carisa, and son, Clay, 7 near the finish of the Dirty Halfin Julyin Bend.

marathon, Thomason has always tried to make races affordable for families. "The way I go about it, I give you a pretty good deal, a good race course â&#x20AC;&#x201D; I give you a lot for what you pay," he said. "It's pretty lowkey. You can certainly race as hard as you want. It's all professionally run and stuff. But I've heard they have a different feel." Case in point: the I Like Pie run held each Thanksgiving morning. The idea for the pastry-inspired run emerged from some halfbaked chit-chat with a customer he was helping find new running shoes. "We were like, 'Turkey's cool, but it's really all about pie," he recalls. "You know what? We should start a race and call it the I Like Pie run." As part of the event, people can bring pies for judging or for eating.The run has a suggested $5 or five cans offood donation to Neighborlmpact as an entry fee. "We just put a donation bin out there and people stuff it with money," he said. What started off as a way to burn some calories before sitting

SUMMER/ FALL2014 â&#x20AC;˘HIGH DESERT PULSE

down to the holiday meal has grown substantially over the past nine Thanksgivings. Last year, it attracted nearly 1,100 runners. "There are going to have to be some changes," he said. "It's really logistically challenging." Thomason acknowledgesthe race scene in Bend has shifted significantly since he staged the first Dirty Half. Fifteen years ago most of the runs were either short 5K runs and longer half or full marathons. Now the racing scene has diversified, adding more intermediate and ultra-long-distance runs, over more varied terrain. Charity 5K runs on paved paths are interspersed with dusty trail runs and outright filthy mudders. There's at least a local hat-tip to Thomason in that. "When he started putting on the Dirty Half, for example, there weren't things like that going on," said FootZone owner Teague Hatfield. "There just weren't middle-distance trail-type events." Bend's running community has evolved as well, finding a greater diversity among its runners ranging from hard-core elite athletes such asMax King and Stephanie Howe, to casualenthusiasts who

Page33

Profile ISUPERDAVE

run with a friend, chatting the entire way. "The Dirty Half is a great example of that," Thomason said. "We have a front wave of guys who are racing; the middle group, guys who have lost a step or two; then we've got these people in the third wave, (for whom) racing is the furthest thing from their mind." This year the Dirty Half was postponed so as not to interfere with emergency crews' access to the Two Bulls fire raging that weekend. It was rescheduled for July 6. Such bumps in the road are minor compared to the tragic turn of events during the race two years ago, when 40-year-old Billy Tufts died of a heart attack on the course. "That's really the worst-case scenario," for a race organizer, Thomason said. "There's no good place for it to happen. You don't ever want it to happen, but it happens." Thomason is thankful that the tragedy spurred the community to come together to make racers safer. A group of emergency-room nurses responded by starting Racing to the Rescue to provide racing events with defibrillators along the race course and trained emergencypersonnelin caseanything goes wrong. While Bend's racing scene has grown significantly over the past decades, local runners say there is still a strong sense of community here. "SuperDave is a huge part of that," said Jill Duncan, of Bend. "He might not think of himself as a relationship guy. I think he's simply doing what he enjoys." Duncan bel ieves the racesare successes in partbecause ofThomason's ability to connect with participants and the broader community. Race organization requires cooperating with the U.S. Forest Service or city officials, managing a cadre of race volunteers and working with local businesses. "We see the same guy from Longboard Louie's grilling salmon for burritos at many of Dave's races," Duncan said. "He seems to enjoy

working at Dave's events, and I'll bet it's because Dave has built a great relationship with that guy." Carisa Thomason, a high-energy, diminutive PE teacher, shares her husband's gift for getting her charges excited about fitness. Several years ago, a pair of her students wanted to show off their unicycling prowess to their classmates. Carisa not only let them showcase their skills — she learned to unicycle herself and launched a unicycling club for kids at the school. She opensthe gym forstudents before schoolfourdays a week — the only exception is the day she must supervise the kids playing outdoors — to practice their unicycling. She started buying unicycles on Craigslist to accommodate kids who wanted to learn and didn't have a wheel of their own. Soon the numbers swelled so much, she had to limit participation to kids in third grade or older, or younger students who could bring their own unicycles. By the end of the school year, she had 78 children in the club. Some days are designated for beginners, and others for intermediate riders. She secured a $1,200 educational foundation grant to buy13 unicycles for the school. Combined with the six cycles she bought herself, and the kids who bring their own, she can accommodate, on average, 30 or so children who show up each day. She's taken the club to ride in several parades. "That's one of my goals, getting kids to know how to get involved in the community through the things we learn in PE," she said. The Thomasons say their competitive running days are mostly behind them. They still enjoy hitting the trails and have become avid CrossFit participants. They have their hands full just keeping up with their 7-year-old son, Clay, already a dead ringer for his lanky dad and quickly giving his mother a run for second-tallest in the house. "When I was racing, I was trying to drop on my friends, 'I will punish you. I will rip your legs off,"' SuperDave recalls nostalgically. "Now

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JOE KLINE

Dave "SuperDave"Thomason announces the winners of the Dirty Halfnear the finish linein the parking lot of Ruff Wearin July.

I'm the second-fastest person in the house." Indeed, most runners in town can't come up with his true identity. "I've had checks written to me as SuperDave because they don't Now about that name. Thomason said it all stemmed from a mountain bike ride he took with a friend in his younger days. know my last name," he said. "When the ride ended, he said, 'You're notjust Dave; you're SuperDoes thebank cash them? You bet.• Dave!"' he recalls. "He is a very loud individual. It just stuck."

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et BackInto It! Neckandbackpain can redefineyourview on life...and not for the better. At TheCenter, our spine and neck care experts' goal is to make your specific pain go away for good. For over 50 years, patients throughout Central Oregon have trusted our team to create surgical and non-surgical approacheswith nationally renowned resulis. Put your care in ourhands and get back to what you love. The Center. Find strength hera 541-382-3344. TheCenterOregon.com.

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Page35

Picture ThisiBABY BQNES Anterior fontanelle

We are born with nearly 300 bones, but most adults have around 206

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BY ANDY ZEIGERT

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The simple answer is nowhere, but many of them grow together as a person ages. The human skeleton begins to develop 13 to 16 weeks after conception. At birth, a human hasabout 300 bones and cartilage elements, and many bones that will eventually fuse together are still separate, although joined by tough membranes. The malleable nature of cartilage allows for a baby's easier passage through the birth canal.

Skull

Ilium Sacrum

Coccyx Pubic bone

Ossification

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Andy Zeigert

Page36

In an adult, the skull consists of 26 cranial and facia lbones fused together along unmovable joints called sutures, with the exception of the mandible, orjaw, which is attached at a movable joint. At birth, many of those bones are not yet fused and instead are joined by fibrous membranes called fontanelles. The fontanelles are the so-called "soft spots" on an infant's head. Eventually the fontanelles close as the bones grow together.

The process of changing cartilage to bone is called ossification and begins before birth and continues into a person's 20s. Ossification occurs when capillaries bring blood to bone-forming cells called osteoblasts. The osteoblasts then begin producing compact bone, covering the cartilage and eventually replacing it. Sources:"The Human Body," Arch Cape Press, HowstuffWorks

SUMMER/FALL2014â&#x20AC;˘HIGHDESERTPULSE

2014 CENTRAL OREGON

Your

AOVERTISINGSUPPLEMENT

S o u r c e f o r Lo c a l H e a l t h Se r v i c e s a n d Ex 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 PULSEIConnections Medical Directo ry contact...

Kylie Vige la nd, A c c o un t E x e c u t iv e ( H e a lt h 8c Medical) • 5 4 1 .617. 7855 •

•

ADULT DAY SERVICE

Open Arms Adult Day Service

ADULT FOSTERCARE

Absolute Serenity Adult Foster Care

AESTHETIC SERVICES

DermaSpa at Bend Dermatology

2705 NE Conners Drive• Bend

541-330-9139

ALLERGYgr,ASTHMA

Bend Memorial Clinic

Locations in Bend SI Redmond

541-382-4900

ALZHEIMERS 4, DEMENTIA CARE

Clare Bridge Brookdale Senior Living

1099 NE Watt Way• Bend

541-385-4717

www.brookdaleiiving,com

ASSISTED LIVING

Brookside Place

3550 SWCanalBlvd •Redm ond

541-504-1GOO

www.cdiving.com

AUDIOLOGY

American Hears Hearing Aids

547 NE Bellevue• Bend

541-213-2294

www.americanhears.com

AUDIOLOGY

Central OregonAudiology A Hearing AidClinic

BEHAVIORAL HEALTH

St. Charles Behavioral Health

2542 NE Courtney Drive• Bend

541-706-7730

www.stcharleshealthcare,org

CANCER CARE

St. Charles Cancer Center

Locations in Bend EI Redmond

541-706-5800

www.stcharleshealthcare.org

CARDIOLOGY

Bend Memorial Clinic

Locations in Bend SI Redmond

541-382-4900

CARDIOLOGY

St. Charles Heart gI Lung Center

2500 NE Neff Road• Bend

541-388-4333

COSMETIC SERVICES

Bend Memorial Clinic

2600 NE Neff Road• Bend

541-382-4900

DENTURISTS

Changing Smiles Denturetk Implant Center 2041 NE Williamson CT Suite •CBend 541-388-4444

951 SW Simpson Ave• Bend

541-362-1363

www.openarmsadultcare,com

119 N Rope Street• Sisters

541-588-6119

www.absoluteserenity.info

Bend SI Redmond

www.bendderm.com ww w.bendmemorialdinic.com

541-G47-2894 www.centraloregonaudiology.com

ww w.bendmemorialchnic.com www.stcharleshealthcare.org ww w.bendmemorialchnic.com www.changeyoursmile.com

DENTURISTS

SistersDenture Spedalties

161 E Cascade• Sisters

541-549-0929

DERMATOLOGY

Bend Dermatology Clinic

2747 NE Conners Drive• Bend

541-382-5712

www.raordenturecenter.com www.bendderm.com

DERMATOLOGY (MOHS)

Bend Dermatology Clinic

2747 NE Conners Drive• Bend

541-382-5712

www.bendderm.com

DERMATOLOGY (MOHS)

Bend Memorial Clinic

2600 NE Neff Road• Bend

541-382-4900

ENDOCRINOLOGY

Bend Memorial Clinic

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EndocrinologyServicesN W

929 SWSimpson Ave,Ste 220 • Bend

FAMILY MEDICINE

Bend Memorial Clinic

Locations in Bend, Redmond SI Sisters 541-382-4900

FAMILY MEDICINE

Central Oregon Family Medidne

FAMILY MEDICINE

St.Charles Family Care

FAMILY MEDICINE

St.Charles Family Care

1103 NE Elm Street• Prineville

FAMILY MEDICINE

St.Charles Family Care

1501 NE Medical Center Drive• Bend 541-382-4900 w

645 NW 4th St.• Redmond

541-317-5GOO

541-923-0119

2965 NE ConnersAve, Suite 127 • Bend 541-706-4800

ww w .bendmemorialdinic.com

ww .bendmemorialchnic.com

n/a ww w .bendmemorialchnic.com www.cofm.net

www.stcharleshealthcare.org

541-447-6263

www.stcharleshealthcare.org

211 NW Larch Avenue• Redmond

541- 5 48-2164

www.stcharleshealthcare,org

630 Arrowleaf Trail• Sisters

541-549-1318

FAMILY MEDICINE

St.Charles Family Care

FAMILY PRACTICE

High Lakes Health Care

Locations in Bend, Sisters SIRedmond 541-389-7741

GASTROENTEROLOGY

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww . bendmemorialdinic.com

GASTROENTEROLOGY

Gastroenterologyof Central Oregon

2450 Mary Rose Place, Ste 210• Bend 541-728-0535 w

ww . gastrocentraloregon.com

GENERALDENTISTRY

Coombe and Jones Dentistry

774 SWRimrockWay • Redm ond 541-923-7G33

www.stcharleshealthcare.org ww w .highlakeshealthcare.com

www.coombe-jones.com

GEEEM, SER GERY, EERIRTRitS AVEIEQRE Advanced Spedalty Care

1247 NE Medical Center Drive• Bend 541-322-5753 w

w w .advancedspecialtycare.com

GENERALSURGERY A NARIATMCS

1245 NW 4th Street, Ste 101• Redmond 541-548-77G1

www.stcharleshealthcare.org

St. Charles SurgicalSpedalists

GERIATRICCAREMANAGEMENT Paul Battle Assodates

Serving Deschutes County

877-867-1437

www.PaulBattle,com

HOME HEALTH SERVICES

St. Charles Home Health

2500 NE Neff Road• Bend

541-706-7796

www.stcharleshealthcare.org

HOSPICE/HOME HEALTH

Hospice of Redmond

732 SW 23rd St• Redmond

541-548-7483

www.redmondhospice.org

HOSPICE/HOME HEALTH

Partners In Care

2075 NE Wyatt Ct.• Bend

541-382-5882

www.partnersbend.org

HOSPITAL

St. Charles Madras

470 NE "A" Street• Madras

541-706-779G

www.stcharleshealthcare,org

ADVEGTIUIG SUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY •

HOSPITAL

Pioneer Memorial Hospital

1201 NE Elm St• Prineville

541-447-6254

www.stcharleshealthcare.org

HOSPITAL

St. Charles Bend

2500 NE Neff Road• Bend

541-382-4321

www.stcharleshealthcareorg

HOSPITAL

St. Charles Redmond

1253 NE Canal Blvd• Redmond

541-706-7796

www.stcharleshealthcare.org

HYBERBARICOXYGENTHERAPY

Bend Memorial Clinic

IMAGING SERVICES

Bend Memorial Clinic

IMMEDIATE CARE

NOWcare

IMMEDIATE CARE

High Desert FamilyAtedidne AtImmediate Care

INFECTIOUS DISEASE

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww . bendmemorialdinic.com

Locations in Bend AtRedmond

541-382-4900

www.bendmemorialdinic.com

2200 NE Neff Rd• Bend

541-322-2273

www.thecenteroregon.com

5706 7 Beaver Dr. • Sunriver

541-593-5400

n/a

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www.bendmemorlalchnic.com

INFECTIOUS DISEASE

St. Charles Infectious Disease

2965 NE ConnersAve., Suite 127 • Bend

541-706-4878

www.stcharleshealthcare.org

INTEGRATED MEDICINE

Center for Integrated Medidne

91 6 SW 17th St, Ste 202• Redmond

541-504-0250

www.centerforintegratedmed.com

Bend Eastside AtWestside

541-382-4900

www.bendmemorialdinic.com

929 SW Simpson Ave• Bend

541-389-7741

www.highlakeshealthcare.com

23 6 NW Kingwood Ave • Redmond

541-548-7134

www.imredmond.com

1245 NW 4th Street, Ste 201• Redmond

541-323-4545

www.redmondmedical.com

Nine Locations in Central Oregon

541-706-7717

www.stcharleshealthcare.org

INTERNAL MEDICINE

Bend Memorial Clinic

INTERNAL MEDICINE

High Lakes Health Care Upper Mill

INTERNAL MEDICINE

Internal Medidne Assodates of Redmond

INTERNAL MEDICINE

Redmond Medical Clinic

LABORATORY

St.Charles Laboratory Services

MEDICAL CLINIC

Bend Memorial Clinic

1080 SW Mt. Bachelor Dr• Bend(West) 541-382-4900

www.bendmemorlalchnic.com

MEDICAL CLINIC

Bend Memorial Clinic

1501 NEMedical Center Dr • Bend (East) 541-382-4900

www.bendmemorialdinic.com

MEDICAL CLINIC

Bend Memorial Clinic

MEDICAL CLINIC

Bend Memorial Clinic

NEPHROLOGY

Bend Memorial Clinic

Locations in Bend At Redmond

541-382-4900

ww w.bendmemorlalchnic.com

NEUROLOGY

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www.bendmemorialdinic.com

NEUROSURGERY

The Center: orthopedic a NeurosurgicalCaregtResearch 2 2

541-382-3344

www.thecenteroregon.com

NUTRMON

Bend Memorial Clinic

OBSTETRICSSr,GYNECOLOGY

East CascadeWomen's Group, P.C.

OBSTETIHCS A, GYNECOLOGY

St. Charles Center for Women's Health

OCCUPATIONAL MEDICINE

Bend Memorial Clinic

OCCUPATIONAL MEDICINE

The Center: Orthopedic gtNeurosurgical CaregtResearch

ONCOLOGY -MEDICAL

231 East CascadesAve • Sisters

541-549-0303

865SWVeteransWay• Redmond 5 4 1 - 382-4900 w

0 0NE Neff Rd • Bend

www.bendmemorlalchnic.com ww . bendmemorialdinic.com

1501 NE Medical Center Drive• Bend

541-382-4900

www.bendmemorialdinic.com

2400 NE Neff Road, Ste A• Bend

541-389-3300

www.eastcascadewomensgroup.com

Loc ations in Redmond th Prineville 541-526-6635

www.stcharleshealthcare.org

Locations in Bend At Redmond

541-382-4900

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

Bend Memorial Clinic

Locations in Bend At Redmond

541-382-4900

www.bendmemorlalchnic.com

OPHTHALMOLOGY

Bend Memorial Clinic

Locations in Bend At Redmond

541-382-4900

ww w.bendmemorialdinic.com

OPTOMETRY

Bend Memorial Clinic

Locations in Bend At Redmond

541-382-4900

ww w.bendmemorlalchnic.com

OPTO~

Integrated Eye Care

452 NE Greenwood Ave.

541-382-5701

www.iebend.com

ORTHODONTICS

O'Neill Orthodontics

Bend tlt Sunriver

541-323-2336

www.oneillortho.com

ORTHOPEDICS

Desert Orthopedics

Locations in Bend At Redmond

541-388-2333

www.desertorthopedics.com

ORTHOPEDICS

The Center: orthopedic a NeurosurgicalCaregtResearch 2 2

541-382-3344

www.thecenteroregon.com

OSTEOPOROSIS

DeschutesOsteoporosis Center

2200 NENeffRoad,Suite 302 • Bend

541-388-3978

www.desdtutesosteoporosiscenter.com

PALLIATIVE CARE

St. Charles Advanced Illness Management

2500 NE Neff Road • Bend

541-706-5880

www.stcharleshealthcare.org

PALLIATIVE CARE

Partners In Care

2075 NE Wyatt Ct• Bend

541-382-5882

www.partnersbend.org

PEDIATRIC DENTISTRY

Deschutes Pediatric Dentistry

1475 SW Chandler Ave, Ste 202• Bend

541-389-3073

www.deschuteskids.com

PEDIATRICS

Bend Memorial Clinic

1080 SW Mt. Bachelor Dr • Bend (West) 541-382-4900

PEDIATRICS

St.Charles Family Care

PHYSICAL MEDICINE

Desert Orthopedics

PHYSICAL MEDICINE

The Center: orthopedic a NeurosurgicalCaregtResearch 2 2

0 0NE Neff Rd • Bend

ww w.bendmemorlalchnic.com

www.bendmemorialdinic.com

211 NW Larch Avenue• Redmond

541-548-2164

www.stcharleshealthcare.org

Locations in Bend At Redmond

541-388-2333

www.desertorthopedics.com

0 0NE Neff Rd • Bend

541-382-3344

www.thecenteroregon.com

PHISICALNEDICII/HEHABILITATIOH The Center: orthopedic a NeurosurgicalCaregtResearch Locations in Bend At Redmond

541-382-3344

www.thecenteroregon.com

ADVEGTIING SUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY A

•

PHYSICAL NEDICINE/REHABILITATION

Bend Memorial Clinic

PHYSICAL THERAPY

Healing Bridge Physical Therapy

PODIATRY

Cascade Foot Clinic

PULMONOLOGY

Bend Memorial Clinic

Locations in Bend ttt Redmond

541-382-4900

PULMONOLOGY

St. Charles Heart gt Lung Center

Locations in Bend St Redmond

541-706-7715

RADIOLOGY

Central Oregon Radiology Assodates, P.C. 14 60 NE Medical Center Dr • Send 54 1 -382-9383

REHABILITATION

St. Charles Rehabilitation Center

RHEUMATOLOGY

Bend Memorial Clinic

RHEUMATOLOGY

Deschutes Rheumatology

SLEEP MEDICINE

Bend Memorial Clinic

SLEEP MEDICINE

St.Charles Sleep Center

SURGICAL SPECIALIST

St. Charles Surgical Spedalists

SURGICAL SPECIALIST

Bend Memorial Clinic

URGENT CARE

Bend Memorial Clinic

URGENT CARE

NOWcare

URGENT CARE

St. Charles Immediate Care

UROLOGY

Bend Urology Assodates

UROLOGY

UrologySpedalistsofOregon

VASCULARSURGERY

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1 -382-4900

VEIN SPECIALISTS

InoviaVein Spedalty Center

2200 NE Neff Road, Ste 204• Bend

54 1 -382-8346

VEIN SPECIALISTS

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1 -382-4900

www . bendmemorialdinic.com

Bend Eastside A Redmond

541-3 8 2-4900

ww w .bendmemorialdinic.com

547 NE Bellevue Dr. Suite ¹105

541 - 213-2294

•

ADAM WILLIAMS, MD I

1501 NE Medical Center Drive• Bend 404 NE Penn Avenue• Bend Offices in Send, Redmond A Madras

54 1-382-4900 w 541-318-7041

www.healingbridge,com

54 1 -388-28G1

www.cascadefoot.com

Locations in Bend,Redmond,Pnnevile, AMadras 541-706-7725

Locations in Bend A Redmond

541-382-4900

2200 NENeffRoad,Suite 302 • Bend 541-388-3978

Bend

541-382-4900

Locations in Bend Si Redmond

541-7 0 6-6905 w

1245 NW 4th St. Ste 101• Redmond 54 1 -548-77G1 w Locations in Bend 8i Redmond

541-3 8 2-4900

Locations inBend(East ttiWest) A Redmond 541-382-4900

•

Bend Memorial Clinic

ww .bendmemorialchnic.com

ww w.bendmemorialdinic.com www.stcharleshealthcare,org www.corapc,com www.stcharleshealthcare,org ww w.bendmemorialdinic.com www.bendarthritis.com ww w.bendmemorialdinic.com ww. stcharleshealtbcare.org ww. stcharleshealthcare,org www . bendmemorialchnic.com

w w w.bendmemorialdinic.com

2200 NE Neff Rd• Bend

541-322-2273

2600 NE Neff Road• Bend

541-706-3700

www.stcharleshealthcare,org

Locations in Bend 8i Redmond

541-382-6447

www.bendurology.com

Locations in Bend, Redmond, A Prineville 541-322-5753

•

www. tbecenteroregon.com

www.urologyinoregon.com www . bendmemorialdinic.com

www.bendvein.com

•

RANDY MCCALL

American Hears Hearing Aids

STEPHEN ARCHER, MD, FACS Advanced Spedalty Care NGOCTHUY HUGHES, DO, PC S t . Charles Surgical Specialists

KAREN CAMPBELL, PHD

St. Charles Behavioral Health

1247 NE Medical Center Dr• Bend 54 1 -322-5753 w

w w .advancedspecialtycare.com

1245 NW4th Street, Ste 101 • Redmond

54 1-548-7761

www. stcharleshealthcare.org

2542 NE Courtney Dr• Bend

541-7 0 G-7730

www. s tcharleshealthcare.org

JANET FOLIANO-KEMP, PSYD St. Charles Behavioral Health

2542 NE Courtney Dr• Bend 5

EUGENE KRANZ, PHD

St. Charles Behavioral Health

2542 NE Courtney Dr• Bend

ROSS JUDICE, MD

St. Charles Behavioral Health

2542 NE Courtney Dr• Bend 5

WENDY LYONS, PSYD

St.Charles Family Care

211 NW Larch Ave• Redmond

MIKE MANDEL, MD

High Lakes Health Care Upper Mill

SONDRA MARSHALL, PHD

St. Charles Behavioral Health

2542 NE Courtney Dr• Bend

JAMES PORZELIUS, PHD

St. Charles Behavioral Health

2542 NE Courtney Dr• Bend 5

REBECCASCRAFFORD, PSYD St. Charles Behavioral Health

www.americahears.com

929 SW Simpson Avenue• Bend

2542 NE Courtney Dr• Bend

41-7 0 G-7730 w 541-7 0 G-7730 41-7 0 G-7730 w

541-5 4 8-21G4

ww. s tcharleshealthcare.org www. s tcharleshealthcare.org ww. s tcharleshealthcare.org

www. stcharleshealthcare.org

541-389-7741 w w w.highlakeshealthcare.com 541-7 0 G-7730 41-7 0 G-7730 w 541-70G-7730

www. s tcharleshealthcare.org ww. s tcharleshealthcare.org

www.stcharleshealthcare.org

SCOTT SAFFORD, PHD

St.Charles Family Care

LAURA SHANK, PSYD

St. Charles Behavioral Health

2542 NE Courtney Dr• Bend

541-70G-7730

www.stcharleshealthcare.org

KIMBERLY SWANSON, PHD

St.Charles Family Care

211 NW Larch Ave• Redmond

541-548-21G4

www.stcharleshealthcare.org

2965 NE ConnersAve, Suite 127 • Bend 541-70G-7730

www.stcharleshealthcare.org

ADVERTISINGSUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY HUGH ADAIR HI, DO

St. Charles Heart ih Lung Center

CATHERINE BLACK,PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww .bendmemorialdinic. com

JEAN BROWN,PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww .bendmemorialdinic.com

KIMBERLYCANADAY,ANP-BC Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww . bendmemorialdinic.com

NAHEL FARRAJ,DO

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww .bendmemorialdinic.com

GARY FOSTER, MD

St.Charles Heart thLung Center

2500 NE Neff Road• Bend 5

RICK KOCH, MD

Bend Memorial Clinic

BendEastside8)Redmond

JAMES LAUGHLIN,MD

St.Charles Heart thLung Center

2500 NE Neff Road• Bend 5

41-3 8 8 -4333 w

ww. stcharleshealthcare.org

BRUCE MCLELLAN, MD

St. Charles Heart I% Lung Center

2500 NE Neff Road• Bend 5

41-3 8 8 -4333 w

ww. stcharleshealthcare,org

GAVIN L.NOBLE, MD

Bend Memorial Clinic

Bend Eastside 8) Redmond

STEPHANIE SCOTT,PA.C

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww .bendmemorialdinic.com

JASONWEST, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww .bendmemorialdinic.com

MICHAEL WIDMER) MD

St. Charles Heart 8) Lung Center

JASON IL WOLLMUTH, MD

Ben d Memorial Clinic

EDDY YOUNG,MD

St. Charles Heart th Lung Center

2500 NE Neff Road• Bend 5

JOHND. BLIZZARD, MD

St. Charles Heart 8) Lung Center

2500 NE Neff Road• Bend

541-388-1636

www .stcharleshealthcare.org

ANGELO A.VLESSIS, MD

St. Charles Heart lh Lung Center

2500 NE Neff Road• Bend

541-388-1636

www .stcharleshealthcare.org

JORDAN T. DOI,MSC,DC

NorthWest Crossing Chiropractic 8) Health

62 8 NW York Dr, Ste. 104 • Bend

541-388-2429

www.nwxhealth.com

TBERESA M.RUBADUE, DC,CCSP NorthWest Crossing Chiropractic8)Health

628 NW York Dr,Ste.104•Bend

541-388-2429

www.nwxhealth.com

JASON M. KREMER, DC,CCSP,CSCS WellnessDoctor

1345 NW Wall St, Ste 202• Bend

541-318-1000

2500 NE Neff Road• Bend 5

41-3 8 8 -4333 w

41-3 8 8 -4333 w 541-3 8 2-4900

541-382-4900

41-3 8 8 -4333 w

1501 NE Medical Center Drive• Bend 541-382-4900 w 41-3 8 8 -4333 w

ww. stcharleshealthcare,org

ww. stcharleshealthcare.org ww w .bendmemorialdinic.com

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ww w .bendwellnessdoctor.com

MICHAEL IL HALL, DDS

Central Oregon Dental Center

1563 NW Newport Ave• Bend

541-389-0300 www.centraloregondentalcenter.net

BRADLEY E.JOHNSON,DMD

ContemporaryFamily Dentistry

101 6 NW Newport Ave• Bend

541-389-1107 wwwcontemporaryfamilydentistrycom

ALYSSA ABBEY,PA-C

Bend Memorial Clinic

WILLIAM DELGADO, MD, (MOHS) Bend Dermatology Clinic

Bend 8) Redmond

541-382-4900

2747 NE Conners Drive• Bend

541-382-5712

ww w.bendmemorialdinic.com

www.bendderm.com

MARK HALL, MD,

CentralOregon Dermatology

FRIDOLINHOESLY, MD

Bend Dermatology Clinic

JAMES M. HOESLY,MD

Bend Memorial Clinic

JOSHUA MAY, MD

Bend Dermatology Clinic

2747 NE Conners Drive• Bend

541- 3 8 2-5712

www.bendderm.com

KRISTIN NEUHAUS, MD

Bend Dermatology Clinic

2747 NE Conners Drive• Bend

541- 3 8 2-5712

www.bendderm.com

GERALD PETERS,MB, FAIS (MOES)

Bend Memorial Clinic

2600 NE Neff Road• Bend 5

41-3 8 2 -4900 w ww . bendmemorialdinic.com

ANN M. REITAN, PA-C

Bend Memorial Clinic

2600 NE Neff Road• Bend 5

41-3 8 2 -4900 w ww . bendmemorialdinic.com

ALLISON ROBERTS, PA-C

Ben d Dermatology Clinic

388 SWBluffDr • Bend 2747 NE Conners Drive• Bend

2600 NE Neff Road• Bend 5

541-678-0020 www.centraloregondermatology.com 541- 3 8 2-5712

www.bendderm.com

41-3 8 2 -4900 w ww . bendmemorialdinic.com

2747 NE Conners Drive• Bend

541-382-5712

www.bendderm.com

STEPHANIE TRAUTMAN, MD Bend Dermatology Clinic

2747 NE Conners Drive• Bend

541-382-5712

www.bendderm.com

LARRY WEBER) PA-C

2747 NE Conners Drive• Bend

541-382-5712

www.bendderm.com

Bend Dermatology Clinic

OLIVER WISCO, DO(MOHS) B e n d Memorial Clinic I I

2600 NE Neff Road• Bend 5

41-3 8 2 -4900 w ww . bendmemorialdinic.com

MARY F. CARROLL, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww .bendmemorialdinic.com

RICK N. GOLDSTEIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww .bendmemorialdinic.com

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww .bendmemorialdinic.com

TONYA KOOPMAN,MSN, FNP-BC Bend Memorial Clinic

ADVERTISING SUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY I I

PATRICK MCCARTHY,MD

EndocrinologyServicesNW

929 SWSimpson Ave,Ste 220 • Bend

541-317-5600

n/a

TRAVIS MONCHAMP,MD

Endocrinologp ServicesNW

929 SWSimpson Ave,Ste 220 • Bend

541-317-5600

n/a

CAREY ALLEN, MD

St.Charles Familp Care

1103 NE Elm Street• Prineville

541-447-6263

www.stcharleshealthcare.org

HEIDI ALLEN, MD

St.Charles Familp Care

1103 NE Elm Street• Prineville

541-447-6263

www.stcharleshealthcare.org

541- 5 48-2164

www.stcharleshealthcare.org

THOMAS L. ALLUMBAUGH, MD St. Charles Familp Care KATHLEEN C. ANTOLAK, MD Bend Memorial Clinic

211 NW Larch Avenue• Redmond

1501 NE Medical Center Drive• Bend 541-382-4900 w

SADIE ARRINGTON,MD

Bend Memorial Clinic

865SWVeteransWay• Redmond

JOSEPH BACHTOLD, DO

St.Charles Familp Care

630 Arrowleaf Trail• Sisters

JEFFREY P. BOGGESS, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

SHANNON K. BRASHER, PA-C St. Charles Familp Care

1103 NE Elm Street• Prineville

541 - 3 82-4900 541-549-1318

54 1 -382-4900 541-447-6263

ww .bendmemorialdinic.com www . bendmemorlalchnic.com www.stcharleshealthcare.org www . bendmemorlalchnic.com www.stcharleshealthcare.org

MEGHAN BRECKE,DO

St.Charles Familp Care

2965 NE ConnersAve, Suite 127 • Bend 541-706-4800

www.stcharleshealthcare.org

NANCY BRENNAN, DO

St.Charles Familp Care

2965 NE ConnersAve, Suite 127 • Bend

54 1-706-4800

www.stcharleshealthcare.org

WILLIAM C. CLARIDGE, MD

S t . Charles Familp Care

211 NW Larch Avenue• Redmond

541- 5 48-2164

www.stcharleshealthcare,org

MATTHEW CLAUSEN, MD

St.Charles Familp Care

2965 NE ConnersAve, Suite 127 • Bend

541-706-4800

www. stcharleshealthcare.org

AUDREY DAVEY,MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

www .bendmemorlalchnic.com

CARRIE DAY, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

www . highlakeshealthcare.com

MAY S. FAN, MD

Bend Memorial Clinic

231 East Cascades Avenue• Sisters

541-549-0303

ww w .bendmemorialchnic.com

JAMIE FREEMAN, PA-C

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w.highlakeshealthcare.com

YVETTE GAYNOR,FPN-C

St.Charles Familp Care

630 Arrowleaf Trail• Sisters

541-549-1318

www.stcharleshealthcare.org

MARK GONSKY,DO

St.Charles Family Care

2965 NE ConnersAve, Suite 127 • Bend

54 1-706-4800

www.stcharleshealthcare.org

NATALIEGOOD, DO

St.Charles Familp Care

1103 NE Elm Street• Prineville

541-447-6263

www.stcharleshealthcare.org

BRIANNA HART, PA-C

St.Charles Family Care

211 NW Larch Avenue• Redmond

541- 5 48-2164

www.stcharleshealthcare.org

645 NW 4th St.• Redmond

541-923-0119

www.cofm.net

Redmond St Sisters

541-382-4900

ww w.bendmemorialdinic.com

929 SW Simpson Avenue• Bend

541-389-7741

www .highlakeshealthcare.com

645 NW 4th St.• Redmond

541-923-0119

www.cofm.net

MARGARET "PEGGY"HAYNER, FIP Central Oregon Family Medidne

ALAN C. HILLES, MD

Bend Memorial Clinic

HEIDIHOLMES, PA-C

High Lakes Health Care Upper Mill

MARK J. HUGHES, D.O

Central Oregon Family Medidne

SING-WEI HO, MD

St.Charles Familp Care

211 NW Larch Avenue• Redmond

541- 5 48-2164

www.stcharleshealthcare.org

PAMELAJ. IRBY, MD

St. Charles Familp Care

211 NW Larch Avenue• Redmond

541- 5 48-2164

www.stcharleshealthcare.org

DAVID KELLY, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

www .highlakeshealthcare.com

MAGGIE J. KING, MD

St.Charles Familp Care

1103 NE Elm Street• Prineville

541-447-G2G3

ww w.stcharleshealthcare,org

PETER LEAVITT, MD

St.Charles Familp Care

2965 NE ConnersAve, Suite i27 • Bend

54 1-706-4800

www. stcharleshealthcare.org

CHARLOTTE LIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900

www . bendmemorialdinic.com

KAE LOVERINK, MD

High LakesHealth Care Redmond

1001 NW Canal Blvd• Redmond

541- 5 04-7G35

www .highlakeshealthcare.com

STEVE MANN, DO

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w.highlakeshealthcare,com

JOE T.MC COOK, MD

St.Charles Familp Care

211 NW Larch Avenue• Redmond

541- 5 48-2164

www.stcharleshealthcare.org

G. BRUCEMCELROY, MD

Central Oregon Family Medidne

645 NW 4th St.• Redmond

541-923-0119

www.cofm.net

LORI MCMILLIAN, FNP

Redmond Medical Clinic

EDEN MKLER, DO

High LakesHealth Care Sisters

354 W Adams Avenue• Sisters

541-549-9G09

w w w.highlakeshealthcare,com

KEVIN MILLER,DO

High Lakes Health Care Sisters

354 W Adams Avenue• Sisters

541-549-9609

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JESSICAMORGAN, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

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DANIEL J. MURPHY, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541- 5 48-21 G4

www.stcharleshealthcare.org

SHERYL L. NORRIS, MD

St.Charles Familp Care

211 NW Larch Avenue• Redmond

541-548-21G4

www. stcharleshealthcare,org

1245 NW 4th Street, Ste 201• Redmond 541-323-4545

www.redmondmedical.com

ADVERTISING SUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY AUBREY PERKINS, FEP

St.Charles Familp Care

JAEEY PURVIS, MD

Bend Memorial Clinic

NATHANREED, DO

St.Charles Familp Care

KEVIN RUETER, MD

High Lakes Health Care Upper Mill

DANA M. RHODE, DO

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend 54 1 -382-4900 w

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HAES G. RUSSELL, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

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ERIC J. SCHNEIDER, MD

Bend Memorial Clinic

1501 NE Medical Center Drivei Bend 5 4 1-382-4900

JEFFERY SCOTT,DO

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend 54 1 - 382-4900 w

LINDA C. SELBY, MD

St.Charles Familp Care

CIEDYSHUMAN, PA-C

Bend Memorial Clinic

DAEIEL M. SKOTTE, SR.DO.,P.C. High Desert Family MediYine A immediate Care

211 NW Larch Avenue• Redmond 5 4 1 - 5 48-2164 1501 NE Medical Center Drive• Bend 541-382-4900 w

www.stcharleshealthcare.org ww . bendmemorialdinic.com

1103 NE Elm Street• Prineville

541-447-6263

www.stcharleshealthcare,org

929 SW Simpson Avenue• Bend

541-389-7741

ww w.highlakeshealthcare.com

1103 NE Elm Street• Prineville

541-447-6263

1080 SW Mt. Bachelor Drive• Bend 54 1 - 382-4900 w 570 6 7 Beaver Dr. • Sunriver

541-593-5400

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n/a

EDWARD M. TARBET, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

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JOHN D. TELLER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

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NATHAN R.THOMPSON, MD

St.Charles Familp Care

211 NW Larch Avenue• Redmond 5 4 1 - 5 48-2164 w

ww. stcharleshealthcare.org

MATTIE E. TOWLE, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

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LISAURI, MD

High Lakes Health Care Upper Mill

929SWSimpsonAvenue• Bend 5 4 1 - 3 89-7741 w

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MARK A. VALENTI, MD

St.Charles Familp Care

211NWLarchAvenue• Redmond 5 4 1 - 5 48-21G4 w

ww. stcharleshealthcare.org

THOMAS A. WARLICK, MD

Bend Memorial Clinic

BRUCE E. WILLIAMS, MD

St.Charles Family Care

1103 NE Elm Street• Prineville

541-447-6263

Bend Memorial Clinic

Bend Eastside SI Redmond

541-382-4900

' I

1501 NE Medical Center Drive• Bend 541-382-4900 w

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RICHARD H. BOCHNER,MD

ELLENBORLAND, MS, RN, CFEP Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

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ARTHUR S. CAETOR, MD

Bend Memorial Clinic

HEIDI CRUISE, PA-C, MS

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww . bendmemorialchnic.com

CHRISTINA HATARA, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

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SIDEEY E. HEEDERSOE HI, MD Bend Memorial Clinic

Bend Eastside SIRedmond

541-382-4900

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Bend Eastside 8I Redmond

541-382-4900

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Bend Eastside SIRedmond

541-382-4900

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SAEDRA K HOLLOWAY, MD

B e nd Memorial Clinic

GLENN KOTEEN, MD

Gastroenterologyof Central Oregon

2450 Mary Rose Place, Ste 210• Bend 541-728-0535 w

ww . gastrocentraloregon.com

JENIFER TURK, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww . bendmemorialdinic.com

MATTHEW WEED, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

ww . bendmemorialchnic.com

JANE BIRSCHBACH,MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend 5 4 1 - 3 89-7741 w

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TAMMY BULL, MD

High Lakes Health Care Upper Mill

929SWSimpsonAvenue• Bend 5 4 1 - 5 04-7G35 w

ww .highlakeshealthcare.com

SUSAN GORMAN, MD

High Lakes Health Women's Center

1001 NW Canal Blvd.• Redmond 5 4 1 - 5 04-7635 w

ww . highlakeshealthcare.com

ww . bendmemorialdinic.com

LAURIE D'AVIGNON,MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

JOE LUTZ, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

REBECCASHERER, MD

St. Charles Infectious Disease

JOHN ALLEN, MD

Bend Memorial Clinic

JENESS CHRISTENSEN, MD

High Lakes Health Care Upper Mill

JOHN CORSO,MD

High Lakes Health Care Upper Mill

CELSO A.GANGAE, MD

Redmond Medical Clinic

1245NW4thStreet,Ste201• Redmond 541-323-4545 w

ww. r edmondmedical.com

MICHAEL N.HARRIS, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

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54 1-382-4900

2965 Conners Ave, Ste 127• Bend 5 4 1 - 7 06-4878

www . bendmemorialdinic.com

www.stcharleshealthcare.org

1501 NE Medical Center Drive• Bend 541-382-4900 w

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929 SW Simpson Avenue• Bend 5 4 1 - 3 89-7741 w

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929SWSimpsonAvenue• Bend 5 4 1 - 3 89-7741 w

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ADVERTISINGSUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY ANNE KILLINGBECK,MD

Internal Medidne Assodates of Redmond

ANITA D.KOLISCH, MD

Bend Memorial Clinic

865 SW Veterans Way• Redmond

MATTHEW R. LASALA, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900

www . bendmemorialdinic.com

MADELINE LEMEE, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

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MARY MANFREDI, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

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H. DEREK PALMER, MD

Redmond Medical Clinic

1245 NW4th Street, Ste 201• Redmond 541-323-4545

A. WADE PARKER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900

MATTHEW REED, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900 w

MARK STERNFELD, MD

Internal Medidne Assodates of Redmond

236 NW Kingwood Ave •Redm ond

541-548-7134

DAN SULLIVAN, MD

Send Memorial Clinic

DAVID ~

Internal Medidne Assodates of Redmond

WAY , MD

FRANCENA ABENDROTH, MD S end Memorial Clinic

236 NW Kingwood Ave •Redm ond

1501 NE Medical Center Drive• Bend

236 NW Kingwood Ave •Redm ond

1501 NE Medical Center Drive• Bend

541-548-7134

www.imredmond.com

54 1- 3 82-4900 w ww .bendmemorialchnic.com

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54 1-382-4900 w ww .bendmemorialdinic.com

541-548-7134

www.imredmond.com

54 1-382-4900 w ww .bendmemorialdinic.com

GARY BUCHHOLZ, MD

Bend Memorial Clinic

2275 NE Doctor's Drive• Bend

GREGORY FEBENZ,DO

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900 w

CRAIGAN GRIFFIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900

RAY TIEN, MD

The Center: Orthopedic tr NeurosurgicalCaregrResearch 2 2

MARK BELZA, MD BBAD WARD, MD

Bend Spine and Neurosurgery

The Center: Orthopedic gr Neurosurgical CaregrResearch 2 2

ANNIE BAUMANN, RD, LD

Bend Memorial Clinic

Am-BBIDGET BIBD,MD

St. Charles Center for Women's Health

Loc a tions in Redmond 8I Prineville 541 - 5 2G-GG35

www.stcharleshealthcare,org

BRENDA HINMAN, DO

St. Charles Center for Women's Health

Loc a tions in Redmond 8I Prineville 541 - 526-6635

www.stcharleshealthcare.org

NATALIEHOSHAW, MD

St. Charles Center for Women's Health

Loc a tions in Redmond 8I Prineville 541 - 5 26-G635

www.stcharleshealthcare.org

AMY B. MCELBOY, FNP

St. Charles Center for Women's Health

Loc a tions in Redmond 8I Prineville 541 - 5 26-G635

www.stcharleshealthcareorg

CLARE THOMPSON, DNP, CNM St. Charles Center for Women's Health

Loc ations in Redmond gr Prineville 541 - 526-G635

www.stcharleshealthcare.org

00 N E Neff Rd • Bend

2275 NE Doctor's Dr. Suite 9• Bend 00 N E Neff Rd • Bend

1501 NE Medical Center Drive• Bend

541-382-4900

541-382-3344

www .bendmemorialchnic.com ww .bendmemorialchnic.com

www . bendmemorialchnic.com

www.thecenteroregon.com

541-647-1638

www.belzamd.com

541-382-3344

www.thecenteroregon.com

54 1-382-4900 w w w .bendmemorialchnic.com

TIMOTHY HILL,MD

The Center: Orthopedic gr Neurosurgical CaregrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

JAMES NELSON,MD

The Center: Orthopedic A NeurosurgicalCaregrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

LARRY PAULSON,MD

The Center: Orthopedic grNeurosurgical CaregrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

ROB BOONE,MD

St. Charles Cancer Center

Locations in Bend 8I Redmond

541-706-5800

www.stcharleshealthcare.org

CORA CALOMENI,MD

St. Charles Cancer Center

Locations in Bend 8I Redmond

541-706-5800

www.stcharleshealthcare.org

SUSIE DOEDYNS, FNP

St. Charles Cancer Center

Locations in Bend th Redmond

541-706-5800

www.stcharleshealthcare.org

BRIAN L.ERICKSON, MD

Bend Memorial Clinic

Bend Eastside 8I Redmond

541-382-4900

STEVE KORNFELD, MD

St. Charles Cancer Center

Locations in Bend 8I Redmond

541-706-5800

www.stcharleshealthcare.org

BILL MARTIN,MD

St. Charles Cancer Center

Locations in Bend 8I Redmond

541-706-5800

www.stcharleshealthcare.org

BENJAMIN J. MIRIOVSKY, MD Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900

LAURIE RICE, ACNP-BC

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900 w

WILLIAM SCHMIDT, MD

Bend Memorial Clinic

Bend Eastside 8I Redmond

541-382-4900

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ADVEGTI MGSUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY I

HEATHER WEST, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 541-382-4900 w

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MATTHEWN. SIMMONS

UrologySpedalistsofO regon

1247 NE Medical Center Drive• Bend 541-322-5753 w

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BRIAN P. DESMOND, MD

Bend Memorial Clinic

Bend Eastside, Westside grRedmond 541-382-4900

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THOMAS D.FITZSIMMOHS, MD,MPH Bend Memorial Clinic

Bend Eastside, Westside th Redmond 541-382-4900

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ROBERT C. MATHEWS, MD

Be n d Memorial Clinic

Bend Eastside, Westsidegr Redmond 541-382-4900

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SCOTT T.O'CONNER, MD

Bend Memorial Clinic

Bend Eastside, Westside A Redmond 5 4 1-382-4900

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I '

' I

Integrated Eye Care

452 NE Greenwood Ave.

541-382-5701

www.iebend.com

KIRSTEN CARMIENCKESC01T,OD IntegratedEye Care

452 NE Greenwood Ave.

541-382-5701

www.iebend.com

MARY ANN ELLEMENT, OD

Integrated Eye Care

452 NE Greenwood Ave.

541-382-5701

www.iebend.com

LORISSA M. HEMMER, OD

Bend Memorial Clinic

MICHAEL MAJERCZYK,OD

Bend Memorial Clinic

KIT CARMIENCKE,OD

Bend Eastside, Westside grRedmond 541-382-4900 Bend Eastside SrWestside

KEITH E. KRUEGER, DMD, PC Keith E. Krueger, DMD, PC I

541-382-4900

1475 SW Chandler, Ste 101• Bend 5 4 1 - 617-3993 w

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Locations in Bend SrRedmond

541-388-2333

www.desertorthopedics.com

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

JEFFREY P. HOLMBOE, MD

The Center: OrrhopedicsrNeurosurgical CaregrResearch Locations in Bend ga Redmond

541-382-3344

www.thecenteroregon.com

JOEL MOORE, MD

The Center: Orthopedic I Neurosurgical CareSrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

KNUTE BUEHLER, MD

The Center: Orthopedic I Neurosurgical CaregrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

MICHAEL CARAVELLI,MD

The Center: Orthopedic I Neurosurgical CareSrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

ERIN FINTER, MD

Desert Orthopedics

Locations in Bend 8r Redmond

541-388-2333

www.desertorthopedics.com

JAMES HALL, MD

The Center: Orthopedic I Neurosurgical CareSrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

ROBERT SHANNON,MD

Desert Orthopedics

Locations in Bend SrRedmond

541-388-2333

www.desertorthopedics.com

AARON ASKEW,MD

Desert Orthopedics

ANTHONY HINZ, MD

The Center: Orthopedic I Neurosurgical CareSrResearch

I '

MICHAEL RYAN, MD

Desert Orthopedics

1303 NE Cushing Dr, Ste 100• Bend 541-388-2333

www.desertorthopedics.com

GREG HA, MD

Desert Orthopedics

1303 NE Cushing Dr, Ste 100• Bend 541-388-2333

www.desertorthopedics.com

KATHLEEN MOORE, MD

Desert Orthopedics

1303 NE Cushing Dr, Ste 100• Bend 541-388-2333

www.desertorthopedics.com

I '

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

1315 NW 4th Street• Redmond

541-388-2333

www .desertorthopedics.com

541-382-3344

www.thecenteroregon.com

TIMOTHY BOLLOM, MD

The Center: Orthopedic I Neurosurgical CaresrResearch

BRETT GINGOLD,MD

Desert Orthopedics

SCOTT JACOBSON,MD

The Center: Orrhopedic I NeurosurgicalCaresrResearch 2 2

BLAKE NONWEILER,MD

The Center: OrrhopedicsrNeurosurgical Carertr Research Locations in Bend Sr Redmond 5

I '

CARAWALTHER, MD I '

Desert Orthopedics

0 0NE Neff Rd • Bend

4 1-3 8 2 - 3344

www.thecenteroregon.com

1303 NE Cushing Dr, Ste 100• Bend 541-388-2333

www.desettorthopedics.com

MICHAEL COE,MD

The Center:Orrhopedic I NeurosurgicalCaregrResearch Locations in Bend gr Redmond 5

KENNETHHANINGTON, MD D e s ert Orthopedics

Locations in Bend gr Redmond

4 1- 3 8 2-3344

www.t h ecenteroregon.com

541 - 388-2333

www .desettorthopedics.com

ADVERTISING SUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY I '

•

AARON HOBLET) MD

Desert Orthopedics

SOMA LILLY, MD

The Center: Orthopedic A NeurosurgicalCaregtResearch

JAMES VERHEYDEN, MD I ' I ' I

Locations in Bend gt Redmond 2200 NE Neff Rd• Bend 5

The C e nter: Orthopedtc a Neurosurgical CaregtResearch Locations in Bend gt Redmond 5

541 - 388-2333

www .desertorthopedics.com

41-38 2 - 3344

www.t hecenteroregon.com

41- 3 8 2-3344 w

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MOLLY OMIZO, MD

DeschutesOsteoporosis Center

JENNY BLECHMAN, MD

Partners In Care

2075 NE Wyatt Ct• Bend

541-382-5882

www.partnersbend.org

LISA LEWIS, MD

Partners ln Care

2075 NE Wyatt Ct• Bend

541-382-5882

www.partnersbend.org

RICHARD J.MAUNDER, MD

St. Charles AdvancedIllness Management

2500 NE Neff Road• Bend

541-706-5885

www.stcharleshealthcare.org

LAURA ILMAVITY, MD

St. Charles Advanced Illness Management

2500 NE Neff Road• Bend

541-706-5885

www.stcharleshealthcare,org

2200 NE Neff Road,Suite 302• Bend 541-388-3978 w ww.deschutesosteoporosisceuter.com

STEPHANIE CHRISTENSEN, DMD Deschutes Pediatric Dentistry

1475 SW Chandler Ave, Ste• Bend 5 4 1 - 389-3073

www.deschuteskids.com

STEVE CHRISTENSEN,DMD D e s c hutes Pediatric Dentistry

1475 SW Chandler Ave, Ste• Bend 5 4 1 - 389-3073

www.deschuteskids.com

BROOKS BOOKER,MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend 54 1 -382-4900 w

ww . bendmemorialdinic.com

KATEL. BROADMAN,MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend 54 1 -382-4900 w

ww .bendmemoriaichnic.com

THOMAS N. ERNST, MD

St.Charles Family Care

JENNIFER GRISWOLD,PNP

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend 54 1 -382-4900 w

MICHELLE MILLS, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend 54 1 -382-4900 w

MARGARET J.PHILP, MD

St.Charles Family Care

JENNIFER SCHROEDER, MD

B e nd Memorial Clinic

1080 SW hdt. Bachelor Drive• Bend 54 1 - 382-4900 w

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JB WARTON,DO

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend 54 1 -382-4900 w

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ROBERTANDREWS,MD

Desert Orthopedics

Locations in Bend gaRedmond

541-388-2333

LINDA CARROLL, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741 w w w.highlakeshealthcare.com

TIM HILL, MD

The Center: Orthopedic A NeurosurgicalCareAResearch Locations in Bend St Redmond

NANCY H. MALONEY, MD

Bend Memorial Clinic

JAMES NELSON,MD

The Center: Orthopedic a NeurosurgicalCaregtResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

LARRY PAULSON, MD

The Center: Orthopedic gt Neurosurgical Care 8 Research

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

DAVID STEWART, MD

The Center: Orthopedic A NeurosurgicalCare AResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

JONSWIFT, DO

Desert Orthopedics

Locations in Bend gt Redmond

541-388-2333

w w w .desertorthopedics.com

00 N E Neff Rd • Bend

541-382-3344

www . thecenteroregon.com

2200 NE Neff Rd• Bend

541-382-3344

www . thecenteroregon.com

211 NW Larch Ave• Redmond

The Center: Orthopedic gtNeurosurgical CaregtResearch 2 2

MARC WAGNER,MD

The Center: Orthopedic gt Neurosurgical CaregtResearch

DEAN NAKADATE) DPM

DeschutesFoot gtAnkle

I •

541-548-2164

541-382-3344

www.stcharleshealthcare.org ww . bendmemoriaichnic.com

ww .bendmemorialdinic.com www.stcharleshealthcare.org

w w w .desertorthopedics.com

www . thecenteroregon.com

1501 NE Medical Center Drive• Bend 541-382-4900 w w w .bendrnemorialiini.cco

VIVIANE UGALDE,MD

••

541-548-2164

929 SWSimpson Ave, Ste220 • Bend 541 -317-5GOO www.deschutesfootandankle.com

•

BROOKEHALL, MD I

St.Charles Preoperative Medidne

2500 NE Neff Road• Bend 5

41-7 0 G-2949 w ww. stcharleshealthcare.org

JONATHANBREWER,DO,D-ABSM BendMemorial Clinic

JAMIE DAVID CONKLIN, MD

St. Charles Pulmonary Clinic

LOUISD'AVIGNON, MD

Bend Memorial Clinic

Bend Eastside gtRedmond

541-382-4900

Locations in Bend IhRedmond

541-706-7715

Bend Eastside ARedmond

541-382-4900

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ADVEGTISINGSUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY I

ERIC S. DILDINE, PA-C

St. Charles Pulmonary Clinic

Locations in Bend ARedmond

541-706-7715

CHRIS KELLEY, DO, D-ABSM B end Memorial Clinic

Bend Eastside tjt Redmond

541-382-4900

JONATHAN MCFADYEN, NP-BC Bend Memorial Clinic

1501 NEMedical Center Drive • Bend

KEVIN SHERER, MD

St. Charles Pulmonary Clinic

THACI CLAUTICE-ENGLE, MD Central Oregon Radiology Associates, P.C.

Locations in Bend AtRedmond

www.stcharieshealthcare.org w w w.bendmemorialchnic.com

54 1 -382-4900 w ww .bendmemorlalchnic.com 541-70G-7715

www.stcharleshealthcare.org

14 60 NE Medical Center Dr • Bend

54 1 - 382-9383

www.corapc.com

ROBERT HOGAN,MD

Central Oregon Radiology Assodates, P.C. 14 60 NE Medical Center Dr • Bend

54 1 - 382-9383

www.corapc.com

STEVEN MICHEL, MD

Central Oregon Radioloy Assodates, P.C.

PATRICKBROWN, MD

Central Oregon Radioloy Assodates, P.C. 14 60 NE Medical Center Dr • Bend

STEVE KJOBECH,MD

Central Oregon Radiology Assodates, P.C.

14 60 NE Medical Center Dr • Send 54 1 -382-9383

www.corapc.com

GARRETT SCHROEDER, MD

Central Oregon Radiology Assodates, P.C.

1460 NEMedicalCenterDr•Send

541-382-9383

www.corapc.com

DAVID ZULAUF, MD

Central Oregon Radiology Assodates, P.C.

14 60 NE Medical Center Dr • Send

54 1 - 382-9383

www.corapc.com

THOMAS KOEHLER,MD

Central Oregon Radiology Assodates, P.C.

1460NE MedicalCenterDr•Bend

541-382-9383

www.corapc.com

JOHN STASSEN, MD

Central Oregon Radiology Assodates, P.C.

1460 NEMedicalCenterDr•Send

541-382-9383

www.corapc,com

JEFFREY DRUTMAN, MD

Central Oregon Radiology Assodates, P.C. 14 60 NE Medical Center Dr • Bend

54 1 - 382-9383

www.corapc.com

RONALD HANSON, MD

Central Oregon Radioloy Assodates, P.C.

14 60 NE Medical Center Dr • Bend 54 1 -382-9383

I ' ' I

14 60 NE Medical Center Dr • Bend 54 1 -382-9383

Central Oregon Radioloy Assodates, P.C. 14 60 NE Medical Center Dr • Bend

WILLIAM WHEIR HI, MD

Central Oregon Radioloy Assodates, P.C.

54 1 - 382-9383

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Central Oregon Radiology Assodates, P.C. 14 60 NE Medical Center Dr • Send

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14 60 NE Medical Center Dr • Send 54 1 -382-9383

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STEPHEN SHULTZ, MD

Central Oregon Radioloy Assodates,P.C.

1460 NEMedicalCenterDr•Bend

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CLOE SHELTON, MD

Central Oregon Radioloy Assodates, P.C.

14 60 NE Medical Center Dr • Bend 54 1 -382-9383

NOREEN C. MILLER, FNP

St. Charles Rehabilitation Center

2500 NE Neff Road• Send

54 1-7 0 G-7725 w ww . stcharleshealthcare.org

CHHISTINA BRIGHT, MD

Bend Memorial Clinic

Bend Eastside At Redmond

541-382-4900

DANIELE.FOHRMAN,MD

High Lakes Health Care Upper Mill

HEATJKH HAHSEN-DISPEHZA, MD Deschutes Rheumatology TIANNA WELCH, PA

Deschutes Rheumatology

JONATHANBREWER,DO,D-ABSM Bend Memorial Clinic Sleep Disorders Center

929 SW Simpson Avenue• Bend

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ARTHUR IL CONRAD, MD

St. C harles Sleep Center

Locations in Bend AtRedmond

541-706-6905

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DAVID L. DEDRICK, MD

St.Charles Sleep Center

Locations in Bend At Redmond

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CHRIS KELLEY, DO, D-ABSM Bend Memorial Clinic Sleep Disorders Center

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2014 CENTRAL OREGON M E D ICAL DIRECTORY I

DAVID HERRIN, DC

Redmond Wellness gt Chiropractic

TIMOTHY L. BEARD, MD, FACS Bend Memorial Clinic

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St. Charles Surgical Spedalists

GARY J. FREI, MD, FACS

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St. Charles Surgical Spedalists

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SUZANNE MARCATO, PA

St. Charles Surgical Spedalists

1103 NE Elms Prineville

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ANDREW SARGENT, PA-C, MS Bend Memorial Clinic

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St. Charles Immediate Care

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St. Charles Immediate Care

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B e nd Memorial Clinic

Bend Eastside, Westside A Redmond

54 1 -382-4900

MICHELLE WRIGHT,FNP

St. Charles Immediate Care

1501 NE Medical Center Drive• Bend

54 1-382-4900

MEREDITH BAKER, MD

Bend Urology Associates

2600 NE Neff Road• Bend

541-706-3700

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2090 NEWyatt Court•Bend 54 1 - 382-6447

RONALD BARRETT,MD, FACS Bend Urology Assodates

2090 NEWyattCourt•Bend

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MICHEL BOILEAU, MD, FACS Bend Urology Assodates

2090 NE Wyatt Court • Bend

541-382-6447

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JACK BREWER, MD

Bend Urology Assodates

2090 NE Wyatt Court• Bend

541-382-6447

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ANDREW NEEB, MD

Urology Specialists of Oregon

BRIAN O'HOLLAREN,MD

Bend Urology Assodates

1247 NE Medical Center Drive• Bend 541-322-5753

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ADVEGTIING SUPPLEMENT

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EDWARD M.BOYLE,JR.,M D,FACS Inovia Vein Spedalty Center

2200 NE Neff Road, Ste 204• Bend

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ANDREW JONES, MD, FACS

ino via Vein Spedalty Center

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DARREN KOWALSEI,MD

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P AID AD V E RTISIN G S U P P LEM E N To be included in the next issue of the PULSE/Connections Medical Directory, contact:

Kylie Vigeland, Account Executiv (Health & M e d i c a l) 541.617.7855

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Cover story ~ SUPPLEMENTS

Continued from Page 9

to perform transplants on younger, healthier patients because their long-term outcomes are generally better, he said. What's more likely the case, Navarro said, is people are using supplements in risky ways. They're taking too many. Fasting while taking them. Mixing them. And they're usually not telling their doctors. "I suspect that it has something to do with the behavior of how these products are used that may contribute to them leading to certain toxicities," he said. Additionally, very few of the supplement-related liver injuries Navarro sees are the result of taking a single herb. Rather, they more commonly follow the consumption of a mixture of herbs from various supplements. "I suspect that it's the mixtures that might come together and form a particularly toxic combination and be responsible for the injury also," he said. The side effects of supplements extend well beyond the liver. When a 35-year-old woman turned up last year at the Oregon Health 8 Science University emergency room sweating with slurred speech and difficulty walking, emergency medicine physician Robert Hendrickson and his colleagues recognized the problem right away: serotonin toxicity. It took longer to figure out how the patient's serotonin levels had reached a life-threatening level. After a few doses of an antidote in eight-hour intervals, her symptoms subsided and Hendrickson, associate medical director of the Oregon Poison Center, asked her what medications she was taking. It turns out, in addition to the antidepressant she had been taking for two years, she had recently begun taking garcinia cambogia to lose weight. After some research, Hendrickson realized garcinia cambogia causes serotonin levels in the brain to increase — the same effect prompted by selective serotonin reuptake inhibitors (SSRls), medications used to treat depression. Together, the mixture spelled disaster for the patient, who had been to the ER before for the same problem but never told doctors she was taking the supplement. It's the first of such cases Hendrickson has seen, and until he learns more, he warns people against mixing garcinia cambogia and antidepressants. Hendrickson hopes to learn more about whether there have been cases similar to the one he saw. "If there is, I think this will be a little bit of a public health crisis," he said, "and I think we probably will go to our public health agencies and also to the FDA to see if they can at least get out some information." Fraunfelder, the University of Missouri ophthalmologist, researched for years while at OHSUthe lesser-discussed ocular side effects of supplements, which can range from something as benign as dry eyes to severe conditions like retinal hemorrhaging and transient vision loss. He's seen cases where patients taking ginkgo biloba, a supplement commonly used to treat tinnitus, ended up with retinal hemorrhaging. Niacin, a supplement shown to improve cholesterol levels, has been tied to decreased vision, cystoid macular edema — a condition that can cause retinal swelling — and discoloration of the

SUMMER/FALL2014.HIGH DESERT PULSE

eyelids, among other symptoms, Fraunfelder said. Lots of people take vitamin A, but too much can cause a condition called pseudotumor cerebri, in which intracranial pressure increases, a potentially blinding condition. Fortunately, most of those side effects are reversible if people stop taking the supplements, Fraunfelder said. In any case, he said, doctors should familiarize themselves with such ocular conditions and should ask patients often what supplements they're taking. Fraunfelder's research has shown that half of the people who take prescription medications also take supplements. "Through that, I found that half of them don't tell their doctors that they take them," he said. "That's significant, because a number of these agents have significant bodily side effects."

Loyal supplement fans Tess Nordstog, the owner of the Bend supplement store Fit Pit, feels like she's fighting a constant battle against what she calls the "government nutrition recommendations." Her customers, many of them students at Central Oregon Community College, often share with her what they're learning in their nutrition courses. "I always joke with people, 'I think government recommendations are what they have to feed prisoners or something,"' she said, "because it's just not even necessarily healthy nutrition." Most of Nordstog's customers visit her small shop along a busy stretchof U.S.Highway 97 because they want muscle tone. They want less body fat. Basically, theyjust want to look fit, she said, and the traditional nutrition guidelines won't get them there. Nordstog's recommendations — compiled from her own research and through trying supplements herself — are a 180-degree reversal from that of the establishment. Nordstog advocates for lots of protein, lots of carbs, lots of fats. Fit Pit, the only nonchain supplement shop in Bend, is a modest-looking shop with little by way of decor aside from Nordstog's scented candles near the register. The rows of shelves are packed with large tubs of protein powder, smaller bottles of preworkout supplements, mass gainers, fat burners and megavitamins. Nordstog, 28, has a degree in advertising from the University of Oklahoma but said many of her general education courses covered nutrition and exercise science. And she's got years of experience taking supplements herself. "Tess is extremely knowledgeable," said Chasity Barker, who first met Nordstog about a year ago while bulking up before her first bikini competition. "She's good about directing you to the right path. I've been in there when people are like, 'I want this,' and she's like, 'You know, maybe you don't. Maybe try going this route."' Barker, a 41-year-old corrective exercise specialist at Max Fitness in Bend, first set her sights on bodybuilding when she was 21 and has been taking supplements ever since. A half-hour before every workout, Barker takes the preworkout supplements Karbolyn, a powder she said is packed with carbohydrates, and noncaffeinated Kre-Alkalyn, a form of creatine. "Basically, what it does, it just fuels you," she said of her preworkout

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hhgh

JOE KLINE

Tess Nordstog, owner of Fit Pit, which sells supplementsin Bend, says most harm that comes from supplementsis from user error.

supplements. "It gives you that energy to get into your workout." During her workouts, Barker pauses to take Xtend, a powdered supplement containing branched-chain amino acids (BCAA) that's designed to promote muscle recovery and boost energy during workouts. Afterward, she takes more Kre-Alkalyn, which is swallowed in a capsule, and Cell K.E.M., another BCAA supplement taken in powder form. Every so often, Nordstog gets word from one of the companies she buys supplements from telling her to stop selling a certain product. The FDA warns companies if it receives enough complaints, which usually prompts them to stop selling the products. But, the way Nordstog sees it, any time someone gets harmed from a supplement, it's user error, not because the product is dangerous. "It's like, great, Joe Schmo takes five when it says on the bottle to take one, has a heart attack on the treadmill or whatever, and then it ruins it for everybody else," she said. Manufacturers using an ingredient called 1,3-dimethylamylamine, or DMAA, have in recent years voluntarily recalled their products after the FDA warned it would otherwise do so forcibly. Typically marketed as natural stimulant because it's made from geranium extract, DMAA was often stacked in supplements with other stimulants like caffeine, often raising peoples' blood pressures and causing heart attacks and strokes. The recall followed more than 100 reports of side effects

Page 50

from DMAA to the FDA, including six deaths. That one hit home for Nordstog, who bought up her own personal hoard of the stuff when she found out it was getting banned. "I love DMAA," she said. That's typically how it goes when supplements are banned. People race out to buy them before they're taken off shelves, either to take them themselves or sell them online. Nordstog usually lets her customers know ahead of time and waits for the mad rush. Last year, two companies announced they would stop making their popular preworkout supplements Craze, a drink mix, and Driven, a pill, after independent tests found they contained a methamphetamine-li ke compound. The news shocked Nordstog. "When I used to sell Detonate before we all knew there was something naughty in it; I was like, 'This is my little customer service in a pill,"' she said, laughing. "And then I was like, 'No wonder — I was on meth all day' — just kidding, it wasn't that bad." On the popular website Bodybuilding.com, users f'requent the forums to express themselves and share tips on working out, dieting and supplements. The FDA is resoundingly unpopular among the forum's users, who've posted dozens of rants slamming the agency for trying to ban the supplements users have found the most effective for muscle-building. One user, posting under the name The Conqueror, reasoned that people who take supplements are not putting others in danger.

SUMMER/FALL2014•HIGHDESERTPULSE

"Are you going to kill someone driving down the road? Are you going to kill somebody by operating heavy equipment. It doesn't put you 'under the influence' or anything negative! WHAT? If you take too much or abuse it WHO PAYS the price....we would! IT'S OUR DAMN BUSINESSNOT THEIRS!!!" Gardner, of CSPI, said attitudes like that demonstrate that many of the people who take supplements to build muscle are, simply put, committing drug abuse. They know the products are not good for their bodies but continue to take them because they work. When Gardner is looking for unscrupulous supplement companies to sue, he said he generally focuses on companies that prey on desperate people — advertising useless products for weight loss, for example. CSPI sued Coca-Cola for saying their soft drink Enviga contained so much caffeine that consumers would burn more calories than they took in drinking it. "For me, if I'm going to protect someone, I want to protect the unwitting, not the deliberate," Gardner said. "They know they're at risk and they're mad in the rare moments the FDA bans something." Navarro, the hepatologist with the Einstein Institute, holds the opposite perspective. He said he believes the manufacturers who stack muscle-building supplements with various mixtures of banned stimulants and anabolic steroids represent the most egregious regulatory violations in the supplement industry. It would almost take a forensic lab to determine precisely what chemical combination is in each supplement, he said. "What's happening is that chemical companies or companies are learning to circumnavigate what the FDA looks for with these designer steroids by essentially chemically altering the steroid structure so that it becomes undetectable," he said. Another problem is that companies are not transparent on the labels about what's actually in the products, said Brad Slate, a 44-yearold powerlifter who lives outside of Sunriver. He understands frustrations about the FDA's recalls but said he thinks the bigger issue is companies' ability to hide ingredients. "Because, really, you should be able to sell any product you want as long as you're forthcoming about what it is and what it does, but they're subverting the truth," said Slate, who works as an audio/visual services coordinator at St. Charles Health System. Slate said these days, he tries to get most of his nutrition without supplements, but when he first started powerlifting three years ago, he tried sample packs of preworkout supplements. "That's where it really gets into some of the crazy herbal stuff," he said. "It reallyjacks you up, like speed or something."

Changeahead? Although the supplement industry is "pretty dismal" right now, Danica Harbaugh Reynaud sees change on the horizon. She's a geneticist, and her company, AuthenTechnologies in Richmond, California, tests samples of supplements — down to the DNA level — to get to the bottom of what they truly are. There are other methods of testing extracts, but Reynaud, who holds a doctorate in integrative biology from the University of California, Berkeley, said DNA is the most reliable. The bulk of Reynaud's clients are supplement manufacturers who

SUMMER/FALL2014.HIGH DESERT PULSE

want to make sure the ingredients they purchased from suppliers are the real deal. The FDA requires that companies do this, but most either don't or they use a less stringent method than DNA identification. She also tests for attorneys who need the results for a lawsuit. Simply put, Reynaud's customers are the small but earnest supplement manufactures, those who go the extra mile to make sure they're selling what they say they're selling. Buteven among this group,which Reynaud said includes some of the most reputable companies in the world, about 25 percent of the extract samples are a different species from what the companies think they are. Usually, that means the herb supplier sold the manufacturer an adulterant rather than the extract it asked for. That means in the real world, Reynaud said, the rate of adulteration is "actually much, much higher if we start looking at other companies that aren't doing this testing or aren't caring as much about the quality of their materials." In general, the more processed a supplement is, the longer it traveled to get from the supplier to the manufacturer, the more chances for either intentional or accidental adulteration. Products can accidentally be contaminated during shipping or storage, Reynaud said. There have also been cases where suppliers accidentally grew the wrong herb, she said. The rates of adulteration are staggering among certain varieties of supplements, Reynaud said. She's been trying to get a hold of the raw material of garcinia cambogia from which the extract is derived, but none of the suppliers can produce it. She's gone to trade shows and herb shops around Berkeley and called various suppliers she knows — no one has it. "One of them, it was pretty hilarious, I said, 'Really? You can't give me any? I'll buy it, $200 for 50 milligrams,"' she said. "He said, 'No.' I said, 'Well, why?' He said, 'Because it's mine."' In Reynaud's mind, any company that has nothing to hide would share the raw material openly. Since none do, her suspicion is that most garcinia cambogia being sold in the U.S. is not an extract of garcinia cambogia at all. Extracts from herbs are typically sprayed onto a filler material such as maltodextrin, starch or rice. In the case of garcinia cambogia, she suspects most of what's being sold is just chemicals sprayed onto filler material. As a rule of thumb, anything that's in TV commercials or on the radio — hoodia, the supplement advertised for weight loss a few years ago, for example — is more likely to be adulterated because it gets so popular that supply can't keep up with demand, Reynaud said. "Anything expensive, rare — or there is a fad — is kind of prime target for adulteration," she said. Reynaud said she thinks the media and the public's attention to the problem has increased in recent years, and the FDA in turn has stepped up its enforcement, inspecting companies and issuing recalls when necessary. The FDA's Tainted Weight Loss Products website warns the public of a new product several times a month, often because the product contains dangerous, banned controlled substances like sibutramine, which can cause life-threatening blood pressure increases. "I've seen a huge shift toward companies, large and small, either caring more about identify testing or being scared into doing more identify testing," she said.•

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Coverstory(HOMELESSHEALTH CARE

uals often can't find a place to rent. Housing Works issued 60 housing vouchers at the end of last year, and another 200 this spring. "In prior years, we had about a 70 percent success rate in people taking a voucher and using it," LaPoint said. "Right now, we have a 25 percent success rate, and it's because there's nothing available." Part of the problem is that rents have quickly outpaced the fair-market rent rates set by the federal government and used to determine the size of the vouchers. "The fair market rent has not been raised by the feds in Deschutes County for two years," said Mary Marson, associate director of housing stabilization for Neighborlmpact, a social-service nonprofit based in Redmond. "That's when the recovery started to come in. So rents went up and, unfortunately, the fair-market rent didn't recognize that." C urrently the fair-market rent for a two-bedroom apartment is set at $678 in Crook County, $637 in Jefferson County and $803 in Deschutes County. "You'll be hard-pressed to find a two-bedroom in Deschutes County for $803," Marson said. And homeless individuals, with potential criminal records, eviction history, low credit scores and substance-abuse issues, must compete for those limited spots with employedcandidateswho have squeaky-clean Scarce homes records. The Central Oregon Health Council, which Neighborlmpact has tried to address oversees the local CCO, opted not to fund some of these barriers with its Ready-tothe Health thru Housing pilot, in part be- Rent certificate classes. Individuals are cause of the difficulty in finding low-cost taught how to be good tenants and what housing. The region's fast growth and rising their rights and responsibilities are, in hopes property values have made rental proper- of making them more attractive renters deties, particularly affordable rental proper- spite their history. "A lot of landlords are open to considering ties, almost impossible to find. "The housing crisis is pretty severe right somebody who might otherwise have a notnow, so it's scary for a lot of folks," LaPoint so-good housing history. If they can show sald. them this certificate," Marson said. According to the Central Oregon Rental Prevention Owners Association, only 37 units out of 3,862 rental units in Central Oregon were There's also been a push locally to help available in May, a vacancy rate of less individuals avoid homelessness in the first than 1 percent. Housing Works said only place by keeping them in their homes when about 500 landlords currently accept rental health crises arise. Neighborlmpact helped subsidies. Patty Rutherford, 48, stay in her Redmond That means even with assistance, individ- apartment when she needed a heart valve Continued from Page17

Some wind up on the street after becoming pregnant, but others become pregnant due to lack of contraceptive services, sexual assaults or survival sex while on the street. Homeless women, however, rarely receive any prenatal care and have an extremely high rate of premature birth. Such high-risk pregnancies often result in longer hospital admissions for the mothers and expensive neonatal intensive care unit stays for their babies. In Central Oregon, Grandma's House provides shelter for pregnant teens but is limited to20 women atany onetim eand doesn't take adults. "We firmly believe that if you get people in housing, you're going to be able to limit these medical issues that folks are having," LaPoint said. "Now they have a roof over their head, and they can think about their day-to-day maintenance of medical issues, finding employment, taking care of their family â&#x20AC;&#x201D; all that stuff that you and I think about on a day-to-day basis, while homeless people are just trying to make it." Studies have shown the approach works even when individuals have alcohol-abuse issues, a strategy known as "wet housing." A 2009 study in Seattle found average savings of $2,449 per person per month after accounting for the housing program costs.

Page 52

replacement last year. Rutherford had spent time in jail for selling methamphetamine with her kids in the car. The conviction was a wake-up call, she said, and upon her release 14 years ago, she turned her life around. She worked for a long-term care facility before a new law barred the care home from employing individuals with criminal records. She then became a live-in caregiver, a job that required she be on-site 24 hours a day. When her last client passed away, she needed a change and began working in a sandwich shop, until last year she was diagnosed with a heart valve issue. Unable to work or qualify for disability payments after her surgery, Rutherford was facing eviction. Neighborlmpact provided her with three months of rental subsidies to keep her in her apartment until she could return to work. When she was diagnosed with cervical cancer, they extended the assistance to a year. "If it wasn't for Neighborlmpact, I would have been homeless with my sternum cracked open," Rutherford said. Now fully recovered, she has started her own housecleaning business.She must carefully monitor her intake of green vegetables to maintain the proper levels ofblood thinner she takes because of the artificial heart valve, something she wouldn't be able to do without access to a refrigerator and kitchen. "Noteverybody who ishomeless in Central Oregon looks like the people you see standing on the corner," she said. "There are good people with families, maybe like me, who have a troubled background but have cleaned up their life and done something with it. But then something happens where they're right back at stage one again, right back at the beginning." Examples like Rutherford's are helping housing and health groups as well as local governments begin to connect housing and health. Mosaic Medical will soon embed a nurse practitioner at Ariel Glen and Ariel South, the two biggest low-income housing complexes in Central Oregon, converting an old laundry room into an exam office. The clinic has taken over management of a school-based health clinic at Ensworth El-

SUMMER/FALL2014â&#x20AC;˘HIGHDESERTPULSE

RYAN BRENNECKE

Patty Rutherford plays with her grandkids, from left, Emma Schile, Tyler Schile, 5, and Chloe Tull,4 in her Redmond apartment last month.

ementary in Bend and will open a second school-based clinic at Bend High School in 2015. Those could help increase access to health care for those who might be just a step away for homelessness. "That's where health is talking to housing," Knobbs said of the Ariel plan. "But are we addressing homelessness? It's a start." For many homeless, there are programs and resources that can be accessed if they want help. Hines, the fiduciary, is often called in when individuals can't go back to the streets. She begins to search for money, for family, for resources to help place them in a stable situation. Often, individualshave access to funds they didn't know about or didn'tknow how toaccess.She can help with filling out the proper paperwork, getting them identification and screening potential destinations that best meet their needs.

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"Sometimes it's now knowing where to turn or what to do," she said. "You've gotten yourself in a cycle for some time and you don't know how to get out of it. Or you have resources, butyou don'tknow how to manage the funds that are coming in. They have to have ongoing help to not just get right back into that situation." With Crisman, she was able to place him at Pilot Butte Rehab for several weeks of antibiotic therapy and to get his blood sugar back under control. He made her promise him he would have a place to go after his discharge; otherwise, he would have left the rehab facility immediately. "He doesn't want to go back to the Bethlehem Innand he doesn'twant to go back to the camps," she said. "He's very fearful." She found a place in an adult foster home, finding a caretaker whose son had diabetes and could help Crisman with his insulin and diet. "It has a TV, right?" Crisman asked her.

That part was nonnegotiable. "You know what? If it doesn't, I'll buyyou a TV," Hines told him. The roof over his head and the television should keep Crisman off the streets and perhaps out of the emergency room for the time being. In his case, it's easy to draw a straight line between an ability to manage his diabetes and a hospital readmission. For other homeless people, the connection between home and health might not be as clear. "It's penny-wise and pound-foolish," Clouart said. "Often time when you prevent the disaster from happening, it means the disaster didn't happen and people don't pay attention. We're more in the lines of if somebody has a wound, let's put a BandAid on the wound until the wound heals. Nobody ever says, 'What do you do about preventing the wound in the first place?' And thenyou have to spend more money on the Band-Aid."â&#x20AC;˘

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f the phrase "home remedy" makes you want to run screaming to a licensed, credentialed doctor, we can't blame you. Beforeyou head out screaming, know this:Research has proven the efficacy of some natural and home remedies. (Also: You shouldn't scream in doctors' offices — it frightens the patients.) Before the advent of modern medicine, people were smushing and grinding up herbs with their mortars and pestles in the search for restoratives, curatives, laxatives and other"tives." Some of the time, their concoctions worked. A 2010 article in

For badbreath, ingesting • which of these chewables helps? A. Coffee beans B.Pop-Tarts C.Anchovies D. Doughnuts E. Flintstones vitamins

Prevention magazine quoted Catherine Ulbricht, a senior attending pharmacist at Massachusetts General Hospital, about the importance and ubiquity of herbs in modern medicine: "Practically all of the most widely used drugs have an herbal origin," Ulbricht said. "The number one (over-the-counter) medication, aspirin, is a synthetic version of a compound found in the willow tree. Many statins are based on fungi; and Tamiflu originated from Chinese star anise." On the multiple-choice quiz below, guess which of these home remedies can actually cure ailments, and which are just placebos.

For motion sickness,

Eating these may help

A. Peanuts and popcorn B.Peanut butter and jelly C.Darkchocolate and ketchup D. Pork chops and apple sauce E.Lemons and olives

A. M&Ms B.Almonds C.Froot Loops D. Corn nuts E. Pasta

A cough is no fun, but one • of these delicious foods might help with that. A. Dark chocolate B.Peanut butter C.Porterhouse steak D.Tofu E.Tofu is a delicious food?

3 • either of these might help. 5 • ease headache pain.

Some inconsiderate insect

To get rid of that stinking • foot odor,you should soakyour feet in which of the following? A. Maple syrup B.Cheese sauce C.Vodka D. Petroleum jelly E.Saliva

Youhave anunsightly • wart. Applying which of thesecommon household items may help get rid of it? A. Endives B.Cinnamon C.Carrotjuice D. Duct tape E. Butter

Answers 1. A. Coffee beans (source: Atlanta Journal-Constitution). Eating coffee beans zaps the bacteria and acids that result in bad breath. If you're averse to coffee breath, try something else. 3.C. Vodka (source: ABC News). It's all in the alcohol, which dries out the fungus and bacteria.

3. E. Lemons and olives (source: ABC News). Throw down a few olives or suck on a lemon to stave off the excess

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6 • went andbityou.Which

kindofpasteshouldyou apply to the offended area? A.Tomato B.Shrimp C.Tahini D. Elmer's E.Tooth

amounts of saliva produced bythe motion sickness, which can makeyou feelnauseated. 4. D. Duct tape (source: www.mayoclinic.org). "The process involves covering warts with duct tape for six days, then soaking the warts in warm water and rubbing them with an emery board or pumice stone," according to the Mayo Clinic. Now, where the heck can you find pumice around Central Oregon? 5. B. Almonds (source: Justalmonds.com). Almonds have

salicin, which forms salicylic acid when ingested. Salycylic acid is the main byproduct of aspirin metabolization. 6. E. Toothpaste (source: naturehacks.com). Peppermint essential oil may have more efficacy, but if you have none, toothpaste may abate that savage sting. 7. A. Dark chocolate (source: everydayhealth.com). Dark chocolate contains theobromine, which blocks the action of sensory nerves and may subdue the cough reflex.

SUMMER/FALL2014•HIGHDESERTPULSE

One voice I A pER soNALEssAY

Health care advocacy is about speaking up After I discovered my mother had been put in diapers, deemed too confused to use can pinpoint the exact moment I became the toilet, I argued that a sincere effort had a squeaky wheel. not been made to see if she could maintain It was a couple of days after a late-night bladder and bowel control because she was phone call notifying me that my mother was confined to a wheelchair and was depennear death after short illness. I scrambled to dent on others to take her to the bathroom. arrange things at home: care for my three It took me months to persuade them to kids, a neighbor to watch the house and pets, try, and when her caretakers finally changed plane reservations. By the time I arrived in my mother's toileting regime I was proved right — she was continent. Oregon she had been unceremoniously discharged and that very day had been installed Not long after, she was finally determined in a nursing home for further recovery. to be ready for physical therapy only to be The home waseasy to find,asitwasnext dismissed by the therapist as too confused door to one of the marginal apartment comto follow directions. I pushed for months afplexes we had lived in during my childhood. ter to get my mother another stab at physI was given her room number and navigated ical therapy, knowing how much she hated the maze of shiny, white walls. the wheelchair. And there she was, the woman friends Nearly a year later she returned to therjokingly called "Auntie Mame" for her bold Leslie Pugmire HoleisitoroftheRedmond ed apy , n ot because her doctor or caregivers personali ty, husky voice and love of the Spokesman. thought she'd benefit but because — in my outlandish. Slumped in a wheelchair, glassyopinion — they were tired of listening to me. eyed and — I noticed when I kissed her forehead — burning with She did not make big strides in physical therapy, but she at least fever. regained enough leg strength to periodically use a walker and, more I instantly knew what had happened. Not willing to accept what- importantly, it made her feel better emotionally. ever paltry payment my mother's HMO would fork out, the hospital And that was everything. had deemed her out of danger and therefore not in need of hospitalMy biggest battle was prompted by a caring, diligent nurse at ization. A bed was quickly found in an understaffed nursing home, the home. My mother had complained about a sore spot in her arm where no one had noted her fever or lack of alertness. weeks before but a visit to her doctor went nowhere, except to say This was a crossroads for me. A perennial people-pleaser who there was a cyst on the inside of the forearm that was likely irritated never liked to rock the boat, I would accept all manner of unwelcome by the wheelchair. outcomes rather than speak out for myself. I hated to push, to prod, The nurse called me to suggest she thought the matter needed to complain. Just the phrase "squeaky wheel" made me think of an- more attention. That was all I needed to hear to man the battle stations noying, demanding, selfish people. and head off to war. I made numerous phone calls and finally got my But here was my only parent, sick, uncared for and all alone save mother a new doctor. I drove all day to attend the appointment with for me. She couldn't speak out for herself, even if she'd wanted to. I her. Luckily, this doctor listened and gave the lump serious attention. sucked in a deep breath, squared my shoulders and headed out into Several tests later, we had a diagnosis — cancer — and a prognosis. the hall to request help. Even with radiation treatments my mother did not live long after That was the beginning, but it was far from the end. the discovery of her cancer but she spent her last weeks in a wonderEvery step from that moment to the moment she died two years ful hospice, one that I had to pursue doggedly to get her admitted to. later was a lesson in health care advocacy. It was sometimes exDespite the less-than-happy outcome of my introduction to health hausting, irritating, enraging and nearly always frustrating. More care advocacy, I would not change a thing. It helped me understand than once I wondered, "Why does it have to be so hard?" that speaking up for yourself, or someone dependent on you, is the Living more than 500 miles away, I bedeviled her caretakers, only way to navigate the health care system. The world does not end doctorsand insurance company by phone, fax and email.Imade when you challenge authority and ask questions. monthly and sometimes weekly trips to visit and attend doctor apIn fact, the world opens up to you when you push a bit on closed dool's. • pointments. The word "no" became a challenge, not an absolute. BY LESLIEPUGMIRE HOLE

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