H I G H
D E S E R T Eating:Being apart-time vegan Getready:Mountain biking101 Dogs:Cantheymake PTSDworse?
Healthy Living in Central Oregon
•
•
Parentsfaceaharrowing choicefor preemiesborntoo soon
UPdate ~SINCEWELASTREPORTED
Two midwives under state scrutiny I
'
I ' I
.
I
l
I I
I
I
I '
I
Our Spring/Summer 2014 cover story chronicled the case of a boy with cerebral palsy whose birth was overseen by two former Bend midwives in April 2010. The Oregon Board of Direct Entry Midwifery has since accused the midwives, Christyn King and Nicole Tucker, of violating six current and former Oregon statutes in the birth of Abel Andrews. It has recommended revoking their licenses and proposing civil penalties of $5,000 each in addition to up to $5,000 each toward the cost of the disciplinary proceedings.
(The proceeds would go to the board.) The board says King and Tucker broke the law when they failed to assess and take action on the risk the mother's high blood pressure posed to the birth and failed to plan a hospital birth, which is
required for such risk factors. The board also says the women broke the law by failing to disclose their lack of malpractice insurance. King and Tucker have contested the proposed board action, issued in October 2014. It's unclear how long the case will take. •
Lower-dose 3D mammography is heretransforming breast cancer detection! 3D mammography, an extraordinary breakthrough in cancer screening and detection, brings a new dimension to breast health. Our new 3D mammography system delivers greater clarity and more certainty at a lower dose. In fact, the dose is similar to a standard digital 2D exam, but with superior clinical performance for all breast types. Call us today to learn more and to schedule your 3D mammogram. 1460 NE Medical Center Dr., Bend, OR 97701
(541)382-9383
www.cascademedicalimaging.com
Centraloregon
I Radiolom ASSOC., i.c.
H I G H
D E S E R T
Healthy Living in Central Oregon
• Editor I Julie Johnson, 541-383-0308, jjohnson@bendbulletin.com • Reporting Tara Bannow,541-383-0304, tbannow@bendbulletin.com Markian Hawryluk, mhawryluk@bendbulletin.com Alison Highberger, ahighberger@mac.com Mac McLean,541-617-7816, mmclean@bendbulletin.com Mark Morical,541-383-0318, mmorical@bendbulletin.com • Design / Production Greg Cross, David Wray
SPRING/SUMMER2015 VOLUME 8, NO. 1
HOW ta reaCh uS • Photography Ryan Brennecke, Dean Guernsey, Joe Kline, Andy Tullis • Corrections High Desert Pulse's primary concern isthat all stories are accurate. Ifyou knowofan error in a story, call us at 541-383-0308 or email pulse@bendbulletin.com. • Advertising Jay BrandtI advertising director, 541 -383-0370, jbrandt@bendbulletin.com Kylie VigelandI health 8 medical account executive, 541-617-7855, kvigeland@bendbulletin.com
• On the Web: www.bendbulletin.com/pulse
TheBulletin All Bulletin paymentsareaccepted at the drop bovat City Hall Check payments may be converted toan electronic funds transfer The Bulletin USPS I552 520 is pubkshed daily by Western Communications Inc 1777 SW Chandler Ave Bend OR97702 Penodicals postage paid at Bend OR Postmaster Send addresschangesto The Bulletin orculation department PO Bov6020 Bend OR9770B TheBulletinretainsownershipandcopynghtprotedionofallstaff prepared newscopy advertising copyand newsorad illustrations They may not be reproduced without evpliot pnorapproval
Pubkshed 5/11/2015
Correction:In the article "Changing minds: Link between Down syndrome and Alzheimer's could lead to new breakthroughs for each" (Winter/ Spring 2015), the name ofthe Linda Crnic lnstitute for Down Syndrome was misstated. Also, Jennifer Dyer was a participant in a clinical trial for a drug to improve memory; the original story misstated thetrial in which she was involved. High Desert Pulse regrets the errors. Page2
Contents ~HIGH DEsERT PULsE
COVER STORY THE EARLIEST PREEMIES Parents of extremely premature infants must decide the impossible: Take lifesaving measures that could mean a lifetime of disability, or don't intervene.
FEATURE SERVICE DOGS 20 PTSD Can trained canines treat struggling veterans? The VA wants to know, but critics say the agency's approach, if not the idea itself, is doomed from the start.
DEPARTMENTS UPDATE State overseers suggest penalties for two midwives.
11PROFILE Meet this master swimmer with the Bend-based Masters Aquatics club. QUIZ 13 You say "stomato," I say, "What?" Medical prefixes and suffixes, defined.
EATING 14 HEALTHY Veganism is good for you. Even if you still eat meat. 17 JOB The community health worker, a "bounty hunter" ofsorts who looks out for your well-being.
26 TIPS How to choose a doctor. (Hint: First, you must actually like the person.) READY 28 GET Central Oregon's amazing mountain biking trails are calling you.
28
54 SNAPSHOT Fishing on the North Umpqua.
GET READY Mountain biking COVER PHOTO: Benjamin Miller holdsthe hand of his son, Ward Miles Miller, who was born in 2012 at 23 weeks' gestation and weighed just 1.B pounds. The baby spent 100 days in the NICU at Nationwide Children's HospitaI in Columbus, Ohio. He is now 2. Watch a video of the baby'sfirst yearat www benjaminscot com/2013/11/01/ward-miles first year.PHOTO BYBENJAMIN MILLER CONTENTS PHOTOS, FROM TOP: SUBMITTED (2); ANDYTULLIS; JOE KLINE
SPRING I SUMMER 2015• HIGH DESERTPULSE
Page 3
COVerStOry lTRE EARuEsT RREEMIEs •
•
BY MARKIAN HAWRYLUK
heryl and RobDavishad beentrying to get pregnant forseveral yearswhen fertility treatments in 2006 finally resulted in the news they wanted to hear.The Fort Worth, Texas,couple, both 31 years old, were expecting — Cheiyl was pregnant with twins. They had chosen the boys'names, which they planned to reveal to their family at Christmastime. But in November, in hersixth month of pregnancy, Cheryl began to experience contractions, and avisit to her doctor confirmed she wasstarting to dilate. Shewasadmitted to the hospital at 6 p.m. fully expecting that, like her sister-in-law before her, shewould receive medications to stop the contractions and carry her twins to full term. But while the contractions slowed down, they neverstopped, and by10 p.m. herwater broke.
The Davises were facing the frightening reality that her boys werecoming afull three months early. In the midst of the chaos of nurses preparing Cheryl for a potential emergency cesarean section, interrupted by repeated contractions, the doctor tried to get them up to speed on their options. They could try to deliver naturally, but the boys may not survive the birth. At 23 weeks of gestation, their chance of survival was less than I
percent. If they did survive, they would likely face severe, lifelong disabilities and a host of medical challenges. They were likely to have cerebral palsyand might never walk; theywould probably be blind, possiblydeaf as well. They could face chronic breathing issues and heart troubles. "It really would have been survival and that's about it," Rob said. Her senses blurred by the pain medication, Cheryl struggled to keep up with the discussion. But she remembers the pivotal moment with great clarity, when the doctors and nurses all turned to them and one said, "What do you want us to do?" In the moment of silence that followed, she was incredulous. "You've got to be kidding me! Aren't you guys supposed to tell me
Page 4
what to do? How am I supposed to make this decision?" she remembers thinking.
The grayzone Doctors will rarely resuscitate newborns born before 23 weeks because their chance of survival is close to zero, while the risk of profound disability is near universal. After 26 weeks, doctors will always attempt to save an otherwise healthy child. But in the 23-to-25-week window, babies fall into what's known as the gray zone, where it's left up to the parents to make a gut-wrenching choice: Take whatever steps necessary to resuscitate the babyafter birth, knowing the child
could face a life of major disability and serious medical challenges, or provide only comfort care and let the child die peacefully. "They are basically asking you to seal the fate of your children," Rob said. "You now have to choose whether your children are going to live or die." Faced with the toughest decisions of their lives, Rob and Cheryl hedged. If there was a way to save the boys, they wanted the doctors to try. But they didn't want them to go to heroic efforts. They
SPRING/SUMMER 2015• HIGH DESERTPULSE
•
•
Parents of 'micropreemies' weigh lifesaving measures against a lifetime of disability
00 How many of some of the earliest newborns (22 weeks' gestation) survived after discharge from the hospital in 2006, the lowest percentage recorded over a five-year period. None ofthose newborns survived without disability. Source: Pediatrics
opted against the C-section, which may have given the boys a better
chance but was more risky for Cheryl. As their family and friends gathered at the hospital, they prayed with their pastor and hoped for the best. "There was a whole lot of waiting, a whole lot of crying," Rob recalls. By 12:30 a.m., Cheryl had dilated to the point that it was time. Both boys were born alive. Parker, the older by 13 minutes,
way to do it." Parker never made a sound, but Riley let out a single cry. "It was not very long, and it was not very strong," Cheryl
remembered.
"But it was there," Rob affirmed. Their pastor came in and baptized the boys, and then the nurse wheeled Cheryl and the boys back into her room on the maternity weighed a mere I pound, 6 ounces, and was barely 12 inches long. ward. It was before cellphone cameras were commonplace, and the His brother, Riley, was I pound, I ounce, and a half-inch shorter. nurses had to scramble to find a camera. They tracked down a PolaRob watched the doctor take Parker to a warming table and pick roid camera and the Davises used the entire cartridge of film to take up the instrument he would use to try to insert a breathing tube into the only photos they would ever have of their sons, to document his lungs."The tube that was supposed to go down the throat was their snapshot of a life. as big around as the baby's neck," he said. "There was physically no With translucent skin, they were very red and very thin. The
In 2006, Parker and Riley were born at less than 23 weeks ofgestation to Cheryl and Rob Davisin Fort Worth, Texas. Nurses wereable to find an old Polaroid camera, and their parents took the only photos of the twins duri ng their short, two-hour lives. s
SUBMITTED PHOTOS
Page 5
Coverstory ITHEEARLIESTPREEMIES
Davises could see the blood vessels snaking through their tiny
bodies. Their eyes were still fused shut, and Cheryl and Rob would never know whether the boys had her dark eyes or his baby blues.
MEG ROUSSOS
Healthy and doing well, 8-day-old Octavi us Jenkins (born at 33 weeks) gets checked on by Dr. Robert Pfister, a neonatologist with St. Charles Bend. For extremely prematureinfants, having "the talk"with parentsabout what to do next — can be a delicate dance for doctors.
"Somefamilies wantdata. Somefamilies want thebig picture.Somefamilies wantalotof guidance. Other families want tomake an autonomousdeclslon." — Dr. Robert Pfister, neonatologist at St. Charles Bend
"They encouraged us to take pictures. They encouraged us to hold them and dress them," Cheryl said. "That was one of the things I'm so grateful for. I knew they weren't going to live, and I didn't really know how to act." Every I 5 minutes a nurse came into the room and checked to see whether the boys were still alive. "Every time she said their hearts were still beating, even knowing it wasn't going to last, it still felt good," Cheryl said. By 3 a.m., the nurse could give them no more good news. She told them they could hold their boys as long as they wanted. "When you have to show all of your love in only two hours, I can't
tell you how meaningful those hours were," Cheryl said. "They were the worst two hours of our lives," her husband added. "But I wouldn't trade them for the world." Now, every year on the twins' birthday, they take their daughter, Annalise, 7, out of school for a family day. They visit the cemetery where the boys are buried but then do something fun as a family to celebrate their brief but precious lives.
Excruciating choice
Premature infant survival An analysis ofrecords for preemies born between 22and 28 weeks of gestation shows little variation in the overall survival rates or in the ability ofdoctors to keep preemies safe from neurologic and other disabilities over a five-year period in the 2000s. Improvements in care may have been offset bychanges in the parents'desire to resuscitate infants with Poor Prognosis. • 2QQ3 • 2QQ4 • 2PPS • 2PPG • 2PP7
Preemies who survived to discharge 00% HIGH andLOW
Deciding what to do in the gray zone might be the single most difficult decision in medicine today. Even at the end of a long life, society wrestles with how much to intervene with natural processes and when to step back and let an elderly person die. But those patients
have generally lived long lives and have often undergone rounds of medical treatment. They are quickly running out of viable options and can often decide on their own whether any last-gasp treatments are worth potentially diminishing the quality of their remaining days. But at the very beginning of life, a life that has been planned for and anticipated for months, if not years, it's an entirely different question. "For most parents, this is the biggest decision they've ever had to
make, maybe the biggest decision they'll ever make," said Dr. John Evered, a neonatologist and clinical associate professor of pediatrics at Oregon Health 8 Science University in Portland and former director of the Neonatal Intensive Care Unit at St. Charles Bend.
60%
40%
The decision, he says, is very individual for families who bring their own values, beliefs, religious views and culture experiences to the table. Yet it is a decision parents have to make in a short amount of time with limited information to guide them. "Most parents, of course, are very reluctant not to resuscitate," Evered said. "If there is any significant hope of any kind, they want you to do whatever you can do to help the baby. And it's difficult to give parents a full picture of what disability is." For neonatologists, having "the talk" with parents facing an extremely premature birth represents a delicate dance of feeling out what is important and relevant to the family and where their values and emotions lie. It's an acquired skill that isn't taught in medical school, said Dr. Robert Pfister, a neonatologist with St. Charles Bend.
20%
3%
• IalI Preemies who survived without disability HIGHand LOW 50%
30%
3% 10%
Zero
II •
"There is no single approach that works for every family, and we
22weeks 23 weeks 24weeks 25 weeks 26 weeks 27 weeks 28 weeks Source: Pediatrics
Page 6
need to do some inquiry in terms of finding out who they want to
GREG CROSS
SPRING/SUMMER 2015• HIGH DESERTPULSE
BEND U P P ER MILL 541.389.7741
Women'shealth can seem complex.
BEND S H EVLIN PARK 541.389.7741 REDMOND
541.504.7635 It doesn't have to be. •
•
Take the time to schedule
SISTERS 541.549.9609
a visit with a caring
specialist and get the attention
See what makes
us different.
you deserve.
HIGR' IAKES Health Care
Dedicated to serving
Central Oregon. hig hla keshea Ithca re. co m
I
I '
With a t r ack record of over 50 0 l a p a roscopic or robotic prostate and kidney surgeries, with 100 right here in your community in the past year, that's experience you can trust. See our cancer surgery outcomes aturologyinoregon.com. You will find that our results rival centers in Seattle, Portland and California. Make an appointment today at one of our three Central Oregon clinics. Bend 1Z47 NE Medical Center Drive, Ste. C Redmond 1001 NW Canal Blvd. Prineville 1103 NE Elm Street i~
~i%lllljz /p
YO 0
+(ae~
++ $
'+'+'~:4'j.". I,.+iim' t''ii>'+'
f Dr. Matthew Simmons
S PEC IALISTS 0F OR E G O N
I
I '
I
' ' I
I
(~.+'+" j~ «'«
0'+~+ ,.+W~
,+++~ s+«+pp+ .„++++"+
...+++
Coverstory ITHEEARLIESTPREEMIES
be involved in that decision and how much of a role they want to play," he said. "Some families want data. Some families want the big picture. Some families want a lot of guidance. Other families want to make an autonomous decision." Pfister starts with what he calls an ethical biopsy. Do they know anyone who's been in the neonatal intensive care unit? Do they have strong feelings about this? Does the family have strong societal or religious views? "I kind of want to know that going in, just so I don't distance them," he said. "We need to be partners in this." Often, pure statistics or odds are hard for people to comprehend, so Pfister relies on visual tools as well. Rather than just tell the parents a baby that early — a micropreemie, as they're often called — might have a 90
Decades ago, doctors would decline to resuscitate infants whose eyes were still fused, believing it was a good indicator of whether they were far enough along in development to survive. Studies later disproved that rule of thumb. Other tools, such as Apgar scores, which measure the overall health of an infant at birth, have been shown to have little correlation with survival or long-term health outcomes for such extreme preemies. Even determining the exact week of gestation is tricky business. Parents aren't always sure of the exact start of their pregnancyunless they've gone through in vitro fertilization and know the exact date — while ultrasound dating is notoriously fuzzy. That adds to the uncertaintyon the margins of the gray zone and can often leave patients feeling at odds with their doctors over the
impending decision.
percent likelihood of severe disability,
Brittni Greig had been admitted to the hospital in Denton, Texas, in 2012 after she started bleeding only
he can show an image that expresses the same probability in dots.
"I bring everything on a clipboard. I feel out the situation and ask, 'Would it be helpful to ...'" he said. "Pretty
(
24 weeks into her pregnancy. Only 20 'r
years old at the time, her water had
broken and doctors hoped they could
quickly, you figure out who you're
stave off delivery. But after a week of
talking to and what they want." Even with all of the data and visual aids, it's hard to get parents to understand the level of disability their children might face. The conversation starts with the most severe and most
fluids and bed rest, the baby had oth-
er ideas. Greig felt her daughter start to push through her cervix. Brittni Greig holds herdaughter, Emma Leigh, whowas While Greig was sure she was in her born atabout25 weeks. She lived only four hours. 25th week, the doctor on call didn't see it the same way. He estimated she likely problems — cognitive delay, cerebral palsy, blindness, deaf- was at only 23 weeks and told her there was nothing they would be ness. But there are myriad other concerns to convey in a rapidly fad- able to do to save the baby. "At the time, I really didn't think I could fight back with him, and ing window of time. The additional conditions for which there is an increased risk I just had to accept it," she said. Her daughter, Emma Leigh, lived could fill a medical textbook: breathing problems and chronic lung almost the entire four hours of her short life in her mother's arms. "We had a lot of family come in, but I really didn't want anyone disease, difficulty with feeding and nutrition, neurodevelopment issues ranging from attention deficit disorder to autism, coordination else to hold herjust because she wasn't going to be there very long," issues, behavioral challenges, learning disabilities. Greig said. "I just kind of looked at her. I wanted to make sure I re"It's very difficult to really, really inform a family about all of those membered her." things in the backdrop of what is often an emotionally charged and quickly changing situation," Pfister said. "It's not like you have a year to figure this out. There's usually a time component, and that makes it that much more challenging." Moreover, doctors can't tell parents with any degree of certainty which potential complications will affect their child. Instead they can provide some estimate of the risk and assure parents that if the situation changes for the worse, they can always redirect toward comfort care. But it becomes much harder to make the decision to turn off a ventilator or abandon lifesaving measures than to make the decision before the child is born not to resuscitate. "Ethically, they're the same," Pfister said. "I will say, it feels different." Parents will often try to avoid making a decision byasking the doctors to see how the child is doing immediatelyafter delivery. Yet there are no reliable signs that help doctors decide in the first minutes after birth what path the child will face.
Page 8
SUBMITTED PBOTO
Before her daughter died, Greig whispered to her that she loved her, that she would be with God, pain-free and "won't have to experience all the bad things that happen in the world." It was months afterward that Greig began to wonder why so many other preemies born at 25 weeks survived, while hers never had that option. "I wish I had opened up and said something to save her, to try something, anything," she said. "I'm just glad I got those four hours, because I know there are people who don't get four hours."
Edge of viability Parents are asked to make a decision about the rest of their child's life in a matter of minutes, in a rapidly changing situation at a time when they are sleep-deprived, emotional and terrified, their heads cloudy under the influence of hormones and medications, with only a minimal amount of statistics and probabilities to go on. Even the term used by doctors — borderline viability period — is
SPRING/SUMMER 2015• HIGH DESERTPULSE
kind of a misnomer, says OHSU neonatologist Dr. Robert Schelonka. "At 25 weeks, we expect that the survival, if we are able to do everything, will be 85 to 90 percent, and even higher at times," he said. "The borderline viability refers to a larger issue, the neurodevelopmental outcomes that result from the consequences of prematurity." And while medical advances have pushed the limits of viability
Fowler, Indiana, knew a premature birth and a NICU stay was a real possibility with her third daughter. Her first child had been delivered at 29 weeks and spent 91 days in the NICU before going home. But when her water broke at 22 weeks with her third daughter, she wasn't
remotely prepared for the decision she and her husband, Jerry, would
have to make. "I know without a doubt there were all these scenarios that were major disability hasn't kept pace. given; the only ones I heard were the ones where my water bag "We are saving, if you will, more ill or sicker babies," Schelonka resealed itself and the one I stayed pregnant in the hospital many, said. "And that's been one of the real challenges to this age group." many more weeks," she said. "I'm not sure I really paid attention to That leaves doctors with a difficult challenge when trying to coun- the potential complications." sel parents, who can understand the black-and-white nature of surShe was admitted to the hospital, where with each passing day vival much better than the shades of gray of disability. they knew they were one day closer to viability. "I don't think we can honestly prepare a family for what to expect," "It never crossed our minds that we weren't going to get a positive "It's just a totally foreign concept to think about Schelonka said. outcome," Jami said. "It was just going to take a little bit of effort." months or years down the road what a significant impact a handicap On the sixth day, however, Jami spiked a fever of 108. She had would be or what it would mean to the family or to the child." developed an infection and was septic. Doctors told her husband Once contractions begin, doctors can usually give medications that their priority was to save Jami's life. They didn't want to take any lifeslow down the birth process, buying the time to provide steroids that saving measures for the baby, unless she was born crying. It was a will rapidly mature the baby's lungs. That gives them at least some stunning turn of events for the Haddoxes, who still could not fathom time to educate parents. Some doctors show videos or provide pam- that things wouldn't work out. "We just assumed — we knew — our phlets that describe the range of options and their likely consequenc- daughter was going to be born crying," Jami said. "I'm not sure your es. But many believe such efforts only create more anxiety for par- brain lets you comprehend any other possible scenario." ents. Even at 23 weeks of gestation, parents have bonded with that As her husband turned to emotional pleas, the neonatologist dechild, or at least the idea of having a child, for months. They have scribed a sobering prognosis. There was little chance the infection hung ultrasound pictures on their refrigerators, repainted the baby's was not also affecting their daughter, and with the loss of amniotic room and thought of names. To then ask parents within 24 hours to fluid, her lungs would likely be severely underdeveloped. "The neonatologist kept giving him these worse-case scenarios," detach themselves from that baby might be close to impossible. In fact, it might be only their parental instincts, their desire to avoid pain Jami said. "He was discussing lifelong disabilities. He used words that and suffering for their child, that allows a family to let go. implied we would be hurting her by making any other decision." "It's like Sophie's choice," Schelonka said. "It's that same type of The Haddoxes consented to the plan for no lifesaving measures, thing." still believing their daughter would cry and make the debate moot. Even when the potential outcomes are clearly laid out for parents, They were wrong. "She did make some sounds, and for a very long time we struggled they may not be in a state to comprehend them. Jami Haddox, of
in terms of survival, progress in keeping babies healthy and free of
OFF ER ING NO N -S U R G ICAL AND MINIMALLY INVASIVE SOLUTIONS Treatment options include fluoroscopic-guided spinal injections,
nerve conduction studies and electromyography (EMGs), and botulinum toxin injections for muscle spasticity
•
i
• • -
•
•
•
•
i
•
-
•
f aDesert /Orthopedics
•
•
-
Stay 4ctive For Life B END 6
R ED M O N D
5 4 1- 3 8 8 - 2 3 3 3
D ES ERT O R T H O P E D I C S . C O M
Cover storyTHE I EARLIESTPREEMIES '»
"Itnevercrossedourminds that we weren'tgoing togeta positiveoutcome." — Jami Haddox, pictured with daughter Arianna, born at 23 weeks' gestation SUBMITTED PHOTO
whether we made the right decision," Jami sald.
ter to get a sense of how difficult life would have been for Arianna. Alexandria, now 13, Jami held the baby briefly before handing had another six weeks of development in the her over to her husband. The obstetrician on womb yet still faces many health issues. "My 29-weeker has specialist appointcall sat with them and cried with them. She gave Jerry her stethoscope so he could listen ments all the time," Jami said. "Cognitively to his daughter's heartbeat. she does fantastic, she's a straight-A student, Arianna lived a mere 27 minutes. but medically there's a lot of challenges." "I think we both knew the moment she It wasn't till much later that Jami, who works passed away,"Jami said. "I think everyone in at the hospital where she delivered, saw the the room kind of knew." neonatologist working hard with all of the deThe hospital allowed the Haddoxes to spend termination he could muster to save a child as much time as they wanted with Arianna. that she changed her mind about him. "I real-
"We try to be just a little bit paternalistic," Schelonka said, "because what parent who now has seen that child outside of the womb would want to have to make that decision on their own? We can't expect them to. But in the
medico-legal world, they are obliged to make that decision." For many parents, the neonatologist becomes the villain. For others, the neonatologist remains a lifelong friend, the only other
person who knew their baby.
Many parents of micropreemies believe their children made it because they had faith or fought for their children. There's no doubt that's a coping mechanism, giving parents at least the illusion of power and control in what could otherwise seem like a hopeless situation. Yet, there are countless numbers of parents who believed and fought just as hard who can't relish the same good outcomes. Some believe that if they love their children, they can never give up on them. Others They kept her in acold room soshe could stay ized that he probably did care, and he proba- believe that it is precisely because they love with them until Jami had recovered from her bly had a really horrible day because he had their children that they must let them go. infection and could be discharged four days to influence us into a decision that we really Cori and Clint, an lllinois couple who asked later. Her final hours in the hospital, Jami took didn't want to make," she said."I don't think their last names be withheld, had been trying a nap relishing the weight of her daughter as he wanted to squash all hope we had, but I to conceive for several years when a round she lay on herchest. think he was really doing his best to prepare of IVF had them expecting twin boys. Cori "I'm not sure that it really registered in my us for what was coming, and what he could endured contractions for five weeks before mind that she was dead until I had to leave the see and the nursescould seeand probablythe doctors finally told her at 23 weeks and five hospital without her," she recalls."It was No- OB-GYN could see, but nobody could tell us." days that they could wait no longer. vember and it was raining. And I had to hand Doctors had given the couple a DVD to Becoming parents her to the nurse as I was leaving the hospital." watch about extremely premature births. They hadjustbought a new home, and Neonatologists try to be as objective as They saw multiple interviews with women they went directly there from the hospital. possible and not insert their own judgments who had delivered prior to 28 weeks and the "I had all these plansfor the house, and now or values into the parents' decision-making. range of disabilities their children faced. the bedroom layouthad to change, and who That changes somewhat once children are in But Cori and Clint were still blindsided by we thought was going to go where was all so the NICU. If things start to go downhill, doc- the decision about whether to resuscitate. different," she recalls. "I was looking at very tors may try to guide parents toward palliaAs the crucial hour approached, the white walls, and what I had pictured when we tive care more actively. Continued on Page 48 bought the house was very, very different." For months afterward,Jami struggled to pro-
cess what had happened. Would her daughter have survived had she gone to the children's hospital in Indianapolis? Would another doctor have fought harder to keep her alive? Did the neonatologist give up on Arianna too quickly? "He was just this boogeyman that woke me up in the middle of the night and haunted my dreams," she recall."I think I had to
Cori and Clint spend time with their sons, Colt and Chase, who were born 23 weeks and five days'gestation.
hold him responsible or else I would have held myself responsible." Jami need only look at her oldest daugh-
SUBMITTED PHOTO
~r~ls;::". ~ + p . w
Page 10
SPRING/SUMMER 2015 • HIGH DESERTPULSE
le'Profile l JANETGETTLING
' Janet Gettli ng credits her competitive nature and thesupportshegetsfrom theCentral Oregon Masters Aquatics group for her coa6nued drive toswi m. Here, she's shown swimming laps at practice.
BY MAC MCLEAN • PHOTOS BY RYAN BRENNECKE
anet Gettling popped her head out of the water just long enough to take a breath before she swung her hands back over
her shoulders and finished her butterfly stroke with a sharp dolphin kick that sent the 67-year-old swimmer gliding through her lane at Juniper Swim 8 Fitness Center's lap pool. Last year, Gettling logged the world's second-fastest time among women her age for the 200-meter butterfly in a 25-meter pool, and third-fastest time for the event in a 50-meter pool, according to the International Swimming Federation's website. "It helps to take up events nobody else wants to swim," said Gettling, who never really swam this stroke until she joined Central Oregon Masters Aquatics — a Bend-based swim club that's open to anyone who is 18 or older — when she moved to the Central Oregon
area four years ago. Being part of this club gave Gettling a chance to reach new heights in her swimming career, including a top-10 time among women in the 65-to-69 age group in a total of nine swimming events. It's also helped dozens of other Central Oregon residents stay active and motivated and enjoy a sport that gives them a chance to get exer-
SPRING I SUMMER 2015• HIGH DESERTPULSE
For this swift swimmer and others, Bend-based Masters Aquatics club inspires lifelong heaIth cise in a low-impact, low-stress environment. "People tend to do a better job at fitness swimming if they're in a group environment," said COMA coach Bob Bruce, who referred to swimming as "the sport that makes you live the longest" because of its health benefits.
The opportunity Growing up in California, Gettling woke up a few hours before she had to go to school each morning so she could practice her strokes at a private club in her neighborhood. But she never got gym class
credit for this experience because her high school's physical eduction teacher didn't think it was an appropriate activity and wouldn't
sign her form. Gettling also missed out on her chance to swim when she was in col-
Page 11
Profile IJANET GETTLING
lege because the federal government didn't pass its landmark Title IX legislation — which requires colleges to give women the same opportunities to compete that they offer to men — until after she graduated. "People my age, we didn't have anything like that," Gettling said as she looked back on the limited offerings that were available to female athletes at the time. "You were lucky if there was any kind of an athletic program when you went to school." Gettling's ability to compete as a swimmer was further stifled because she and her husband settled in a small town on the Wyoming-Idaho border that was 90 miles away from the nearest swimming pool. Gettling's saving grace was that her job as an elementary school teacher came with long summer vacations she could use to visit friends and family members throughout the Pacific Northwest and swim in as many competitions as she could. But Gettling finally found the opportunity she was looking for when she joined COMA after moving to Bend in 2011. Founded in 1997, this club holds 15 open swim sessions at pools in Bend, Madras, Redmond and Sisters each
week. It has four coaches who help all skill lev-
•
-
•
•
•
•
-
•
•
•
I •
•
•
•
•
•
•
•
•
•
•
•
fibromyalgia. • Provide people who have arthritis with a chance to stay mobile and use their joints without worsening their symptoms. • Help post-menopausal women improve their bone density and avoid osteoporosis. "Everybody here will say,'I'm doing this because I want to look good or because I want to feel fit,'" Bruce said. "And some of us just like to race." Bruce said about one-fourth of the 250 to 300 members of his club come to practice because theyare competitive swimmers like Gettling, who are driven by a desire to beat their personal bests and achieve
"I don'thave thebody typeofaswimmer.... I'm not tall and thin, but l'm willing to workhard."
els of swimmers compete in 10 swim meets top-10 rankings for people in their age group each year, including five that take place on an open water course. on the state, national or international level. Gettling said her competitive nature — a deAnother 25 to 30 percent compete in triathsire to swim a little bit faster than the last time lons, where swimming is featured along with she was in the water — is only part of what mocycling and running, and 10 percent come to tivates her and gets her going into the pool day his practices because they see swimming as a — Janet Gettling, a recent after day. Being part of COMA, she said, takes way to train for another competitive sport, such Central Oregon transplant care of the rest. as skiing or kayaking. "I don't have the body type of a swimmer.... But it's the remaining 25 to 30 percent of the I'm not tall and thin, but I'm willing to work hard." Gettling said. She club'smembers who seem to impress Bruce the most, because unsaid it also helps to have a coach who gives her pointers, a team of like competitive swimmers — who have their scores and their ranks friends who hold her accountable and a desire to compete that for among their peers posted for everyone to see at the end of a meet — these swimmers still find it within themselves to come to the pool most of her life has gone unfulfilled.
The team Pacing the front end of Juniper's lap pool, Bruce shouts a few pointers to a swimmer who injured his shoulder this past fall and was still favoring the arm while practicing his crawl stroke. If the swimmer pushed himself a little harder and tucked his arm in the water closer to his head when he took a breath, the coach said, he'd cut down on his resistance in the water and shave at least 10 seconds off of his time. "There's no such thing as a slow swimmer," Bruce said before quoting statistics from a study the U.S. Centers for Disease Control and Prevention published in 2000. "Thirty-seven percent of Americans can't swim more than 24 yards. Those are the slow ones." The federal health agency has raised concerns about this statistic, noting that 4,000 Americans drown each year, many of them adults, according to a 2012 CDC report. It also found people who do not or cannot swim are missing out on a sport that, like other forms of aerobic exercise, can: • Reduce the chance of developing a chronic illness without putting stress on bones and joints.
• Improve mood, particularly among those who suffer from
Page 12
day after day to swim laps regardless of how they are feeling or what is going on in their lives. "Most people cannot do that," said Bruce, who called these swim-
mers "a special breed of human beings" because of their drive and motivation. "I have a very difficult time doing that on my own." COMA member Sarah Olson, 65, describes herself as a "noncompetitive swimmer" who turns out to practice simply because it's a sweat-free way she can get exercise and stay fit. She also likes other members of the club — particularly Gettling, with whom she shares
a lane during practice — because they're always friendly and accepting of her noncompetitive nature. But beyond that, Olson said, the other members of her team make sure she continues going to practices every week because they will call or email her if she misses a few practices to make sure she's doing all right. Olson said she hates getting these emails or phone calls and will show up to a swim session to avoid them and to avoid letting her friends down. "It's a social thing," said Gettling, who sometimes comes to practice for the same reason. "You meet people and they miss you when you're not there." •
SPRING/SUMMER 2015• HIGH DESERTPULSE
Body ofknowledge l popQUlz nephro• A) kidney B) liver C) pancreas D) dead
BY JULIE JOHNSON
1
-otomy
2
a-/an-
-Itls •
edical terminology is famously indecipherable for
• A) operating autonomously B) an incision C) a permanent opening D) an ear-gazing scope
those of us without the benefit of a medical school education. But it turns out that a little knowledge of linguistics can go a long way toward making sense of the myriad terms for body parts and their associated maladies. Many medical terms become a little more scrutable when you understand their prefixes and suffixes. Test your knowl-
• A) without (having none) B) opposite of C) above D) below
edge of medical prefixes and suffixes by identifying the correct definitions in this quiz. YOU CANTELL YOURHUSSAND WEWONTDOA
~ -ostomy • A) removal B) an incision C) a permanent opening D) a medical device affixed to the skin
c
stomato-
STOMATOOSTOMY TO FIX SOMEONE WHO TALKS TOO MUCH.
•
• A) infection B) redness C) inflammation D) rash
~ -ectomy I • A) cure B) diagnosis C) incision D) removal
-OSIS
• c))
• A) normal condition B) stasis C) abnormal condition D) infection
0 entero-
• A) palms B) stomach C) weeping D) mouth
• A) ear B) throat C) rectum D) intestine
] 0 •cystoA) bladder
Answers: 1.B (a tracheotomy is atemporary incision in the trachea). 2. A(a person with no symptoms is asymptomatic).3. C (patients with a colostomy have a permanent hole connecting part of the colon to the outside of the body).4. D (from the Greek word for mouth). 5. A (a nephrologist specializes in kidneydiseases).6. C (inflammation can be caused by infection, or by something else).Z D (appendectomy, tonsillectomy... this one was easy).8. C (endometriosis is an abnormal condition ofendometrial tissue).9. D (from the Greekword for intestine). 10. B (a cystoscopy is a peek inside the bladder with a tinycamera). Sources: Des Moines University, Centers for Disease Control and Prevention
GREG CROSS
B) liver C) cystic D) pimple
OFFERING NON-SU RG ICAL, M INIMALLY INVASIVE AND ADVA N C E D SURGICAL SOLUTIONS Our team works with patients of all ages, offering personalized care and collaboration on the best course of treatment for each individual condition.
f aDesert /Orthopedics
a •
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Stay 4ctive For Life
•
BEND 6
R ED M O N D
5 4 1- 3 8 8 - 2 3 3 3
D E S ERT O RT H O P E D I C S . C O M
Healthy eating LOW-MEAT DIETING
How to get your nutrients
e in o e +
VITAMIN B-12 Good vegan sources of vitamin B-12 are plant-based meat substitutes such as tofu and seitan, or nut milks (soy, almond, cashew, etc.) thatarefortified with B-12.
PROTEIN Good vegan sources include beans (black, pinto, cranberry, soy, kidney, garbanzo, cannellini, navy, great northern, lima, fava and mung) and legumes such as lentils. Plant-based meat substitutesare readilyavailable now, including tofu, tempeh, seitan and textured vegetable protein (TVP).Commercially produced faux meats such as vegetable burgers and Tofurky are convenient to buy and microwave, butdietitian Reed Mangels warns theycan be "expensive, full ofsodium and sortof processed. You can liveyour whole life as a vegan and never eatfake meats, or you can eat them once a day or once a week ifyou like," she said. Dosome research:You'll find that protein is in most foods, except alcohol, sugar and fats."Ifpartofa day's menu included the following foods, you wouldmeet the recommended daily allowance (RDA) for protein foran adult male;1 cupoatmeal, 1 cup soy milk, 2 slices whole wheat bread, 1 bagel, 2 tablespoons of peanut butter, 1 cup vegetarian baked beans,5 ounces tofu, 2 tablespoons almonds, 1 cup broccoli, and 1 cup brown rice," according to its Vegetarian Resource Group in their"Vegan Diets in a Nutshell" poster that can be downloaded at wwwvrg.org.
I
Page 14
BY ALISON HIGHBERGER
eganism is hot.
Maybe you've considered trying it out for weight loss or better overall health, environmental or ethical reasons. Being a part-time vegan was
popularized by The New York Times food writer Mark Bittman, who came up with the concept of
bers improve.
eating "vegan before 6 p.m." (VB6) when his doc-
He ha s k e p t the weight off, and the VB6 going, for eight years now. He says it's his way of eating for the rest of his life, because it's both healthful and delicious. "It's about doing your best to nourish your-
tor warned him that, at age 57, he was in trouble
and should consider becoming a vegan. "I had developed the pre-diabetic, pre-heart-
disease symptoms typical of a middle-aged man who'd spent his life eating without discipline," Bittman writes in his "VB6" diet book
(Clarkson Potter/Publishers, 2013). He was 40 pounds overweight and had aching knees asa consequence. His cholesterol,
which had always been normal, had crept into the danger zone. Instead of going on a cholesterol-reducing
drug, swearing off pizza, bacon and burgers for a while, and eating endless salad, Bittman switched his diet to vegan before 6 p.m., eating mostlyfruits, vegetables, whole grains, beans and nuts during the day. In four months of refraining from animal products or
self with real, wholesome foods most of the time and not beating yourself up when you don't," Bittman writes in "VB6."
Have no fear If you're concerned that a vegan or vegetarian diet will be hard to maintain because you're not sure how to get enough protein and other nutrients, have no fear. "People eat way more protein than they need. But if you're vegetarian or vegan and eating a va-
riety of foods, including beans and whole grains and vegetables, and you maintain your weight,
hyperprocessed foods (white bread, white rice, you're going to get enough protein," said regiswhite pasta, junk food, sugar and alcohol) un- tered dietitian Reed Mangels. She's the nutrition til dinnertime, when he would eat whatever he liked — from meat to ice cream — Bittman lost more than 35 pounds and saw his blood num-
adviser for the Vegetarian Resource Group, a nonprofit dedicated to educating the public on vegetarianism and veganism. "A quarter cup of
SPRING/SUMMER 2015
CALCIUM Good vegan sources ofcalcium are dark green, leafy vegetables such askale, collard greens, bokchoyandmustard greens, tofu made with calcium sulfate, and calcium-fortified soy milkand orangejuice. Contraryto popular belief, spinachis nota good sourceofcalcium.
IRON Good sources include dried beans and darkgreen leafy vegetables, whole grains, tempeh, tahini, raisins, watermelon, and millet."Iron absorption is increased markedly by eating foods containing vitamin C along with foods containing iron," notes the Vegetarian Resource Group.
VITAMIN D RECIPES! < Lasagna Rolls (using tofu), and nicoise salad > NEXT PAGE
SUBMITTED PPIOTOS: SARA REMINGTON,ANDREWS MCMEEL PUBLISPIING/OTPIERS: TPIINKSTOCK
tamin B-1 2.
"Someone who is vegan needs a reliable
Good sources are vegan milks (soy, almond, oat, cashew, etc.i fortified with vitamins. Vitamin D is produced naturally by the body when skin is exposed to sunlight."It is not natural to cow's milk but was added when the government noticed that many children had a vitamin D deficiency," Mangels said. Read food labels and you'll find many vegan milks are nowfortified with vitamins and minerals.
OMEGA-3 FATTYACIDS source of vitamin B-12, because it's only found in Good sources include flaxseed, canola animal products. So if you're eating some meat, oil, tofu and walnuts. you're getting enough, but if you're cutting meat equals a cup of beans. A typical bean burrito out of your diet, you need to eat would include a half cup of beans for one per- a food that has it added to it, son," Mangels said. like meat substitutes or vegan 'Who knew?' She said that's her favorite go-to fast vegan milks that are fortified with dinner at home. B-12," Mangels said. Ann Gentryis a Los Angeles vegan chefand owner of Real "I like to heat up a whole-wheat tortilla, open The recommended daily Food Daily, a popular vegan restaurant in L.A. She's also the a can of beans, and get anything in the fridge intake for vitamin B-12 for an author of"Real Food for Everyone: Vegan-Friendly Meals for lettuce, tomato, mushrooms, spinach, adult is 2.4 micrograms, ManMeat-Lovers, Vegetarians, and Vegans" and hopes people shredded cabbage, leftover cooked potatoes, gel said — most multivitamins will try vegan eating to feel better and have more energy."If corn — and just wrap it all up," she said. have more than that. you're really serious about changing your health, it's about "But I don't think you need A peanut butter and jelly sandwich on wholeeating at home, and eating simply. I believe that more whole grain bread is a simple, protein-filled vegan a multivitamin if you're pretty grains and quality vegetables, cooked simply, will really serve choice, too. committed to eating whole, you on many levels. There's too much fat, salt and sugar in Mangels, who has been a vegan for 25 healthy, good food. But ifyou're our diets, so it's hard to taste the simplicity ofcarrots, broccoli years, is also a professor of nutrition at the Uni- in a special situation because and onions. Onions are sweet, who knew?" versity of Massachusetts-Amherst. She talked food choices are limited, or Remember — part time: Her recipes for nicoise salad and us through some vegan sources of nutrients you're concerned, go see a regLasagna Rolls with Tofu Ricotta and Everyday Tomato Sauce to replace those that omnivores get by eating istered dietitian to assess your will showyou don't need meat or dairy to have satisfying, meat and dairy (see "how to"), and said that the diet as to whether you need delicious meals."It's not necessaryto become vegan or vegeonly real area of concern is getting enough vi- supplements, "she said.• tarian to enjoythe benefits ofeating plant based meals. Don't let an all-or-nothing attitude turn you off: It's well worth the effort to consume less meat and dairy even ifyou don't elimiHIGH DESERT PULSE nate it entirely," Gentry writes in her book. cooked beans is equivalent to an ounce of meat in protein, so a quarter-pound burger is 4 ounces, and that
Healthy eating ~LQW-MEAT DIETING
Lasagna Rolls with Tofu Rieotta and Everyday Tomato Sauee Serves (makes12 6 rolls). Thisisafun wayto servelasagna: Instead ofthe traditional layering,youtopthe individual noodleswith avegan ricotta cheese and vegetablemixtureandroll it up. MyTofuRicotta Cheeseis ablend oftofu, miso andtahini, which createsacreamyconsistencythateasilyspreads.— AnnGentry 2/2 TBS olive oil 2 onions,thinlysliced 6 cloves garlic, minced 2TBSchopped fresh basil 1 tspfinesea salt /2 tsp freshlygroundblackpepper 3 med carrots,peeledandcut into "/4-inchpieces
2zucchini, cutinto"/4-inch pieces 1headbroccoli,stemsremoved and floretsfinelychopped 2CTofuRicottaCheese(recipefollows) 12 egglesslasagna noodles 3 C EverydayTomatoSauce(recipe follows)
Preheat theovento 350degrees. Heat 1tablespoonofthe oil in alarge,heavyfrying panovermedium-high heat.Addthe onions,garlic, basil,saltandpepper.Saute until the onionsaretender, about10 minutes.Add the carrots,zucchiniandbroccoli, andsaute until the carrotsarecrisp-tender, about12 minutes. Letcool completely.Mixthevegetable mixtureinto the tofu ricotta cheese. Cookthe noodlesinalarge potofboiling salted water,stirring often, until tender,about10 minutes.Drainandrinsethe noodles, thentossthemwith1 tablespoon ofthe remaining oil to prevent thenoodlesfrom sticking together. Coata13-by-9-by-2-inchbakingdishwith the remaining1/2teaspoonsoil. Spread1cupof the tomatosauceonthe bottom ofthe dish. Usingaspatula, spreadabout/2 cup ofthe vegetable mixtureovereachlasagnasheet, leavingabout /2 inchofeach enduncovered. Roll upeach sheet tightlyand place itseam-side-down in the bakingdish.Pourthe remaining 2cupstomato sauce overthelasagnarolls. Cover thedishwith aluminumfoil. Bakeuntil the saucebubbles,about55 minutes.Remove the foil andcontinue bakingfor15 minutes.
Tofu Rieotta Cheese Makesabout3 cups.Whenblended, the tofu givesthis vegancheeseacreamyconsistency that resemblesricotta. 1(14-oz) containerwater-packedfirm tofu, drained andcut into quarters 'ACyellow miso 'ACwater ~/2 C tahini
/2 C oliveoil 5 Ig garliccloves 1/2 tsp driedbasil 1/2 tsp driedoregano ~/4 tsp seasalt
Blend all ingredients in a food processoruntil smooth. Thecheesewil keepfor 2days,covered andrefrigerated.
Everyday Tomato Sauee Makesabout4cups. "/4 C extra-virgin olive oil 4shallots,thinlysliced 3clovesgarlic, minced /2 teaspoonfine seasalt
1 (28-oz) cancrushedtomatoes 1Cwater 2TBSchopped fresh basil 1 tspchoppedfreshoregano
Heat theolive oil in aheavysaucepanovermedium-high heat.Addthe shallots, garlicand salt, andsauteuntilfragrant,about20seconds.Stirinthetomatoesand1cupwater.Bringto agentle simmer,thendecreasethe heatto low andsimmer gently, stirring occasionally,for 20 minutes, toallow theflavors to blend. Stir in thebasil andoregano. Removefrom theheat. — From"RealFoodForEveryone: Vegan-Friendly Mealsfor MeatLovers, Vegetarians, andVegans"byAnnGentry,AndrewsMcMeefPublishing Page 16
My Nieoise Serves4.Depending onhowstrictyou are,anicoise saladwithout tuna can still becalledanicoise. Thistraditional saladhasalwaysbeenvegetable-based,with interesting flavorsandtextures coming fromthin green beans,olivesandtomatoes,among the manyother ingredients. Insteadof tuna, I use homemadePeppercorn-CrustedTofuChevre. — AnnGentry
SALAD
VINAIGRElTE
8 oz slendergreenbeans(suchas haricots verts), trimmed 4 med red-skinnedpotatoes(about1 Ib total), cut into /2-inch-thickwedges 1 Ig headbutter lettuce, leavesseparated and larger leavestorn inhalf 3 ripe tomatoes,cutinto wedges,or10 to12 cherrytomatoes,halved Finesea saltandfreshlygroundblackpepper 1log Peppercorn-CrustedTofu Chevre (recipefollows),slicedinto rounds NC nicoiseolives orkalamata olives 2 TBScapers, drained 1/2 TBS mincedfresh flat leaf parsley
"/4 Cfreshlemonjuice 1 sm shallot, minced (about2TBS) 2 tsp Dijonmustard 2tsp mincedfreshthyme ~/4 tsp fine seasalt "/4tspfreshlyground black pepper /2 C extra-virgin oliveoil
Cook thegreenbeansin alarge pot ofboiling salted water until theyarecrisp-tender, about4 minutes.Drainandsubmerge thegreen beansin abowl ofice waterjust until they are cold.Drainthe green beansagain andpatdry. Setaside. Placethepotatoesinasteamer basketset in asaucepanfilled with1inch ofsimmering water. Cover andsteamuntil they arejust tenderandstill hold their shape,about8minutes. Set asideto coolcompletely. Vinaigrette:While thevegetables arecooling, whiskthe lemonjuice,shallot, mustard, thyme, saltandpepperinamediumbowl to blend. Gradually whisk intheoil to blendwell. Salad:Arrangethe lettuce onaserving platter or in alarge shallowsaladbowl. Place the greenbeans,potatoesandtomatoes inalarge bowl. Tosswith enoughofthe vinaigrette to coat,thenseasonto taste with saltand pepper.Spoonthe beans,potatoes and tomatoesatopthelettuce. Arrangethetofu cheeseslicesamid thevegetables. Sprinklethe olives, capersandparsley overthe salad.Spoonmorevinaigrette over thesaladandserve immediately.
Tofu Chevre Makes 1(13-ounce) log. I call this softvegancheese"chevre" for its rich flavor, creamytexture andlogshape. It's easyto addtexture andflavor to the basicTofu Chevre recipesimply by rolling thefinishedcheeselog inavarietyofingredients,fromground peppercornsto fresh herbs to chopped nuts. Besureto planahead, asyou'll needseveral hoursfor thetofu to completelydrain andthenanother hourfor the cheeselog to chill. — AnnGentry 1(12-oz) containerwater-packed extra-firm tofu,drained andhalved 1 Ig clovegarlic
2TBSyellow miso 3 tsp extra-virgin oliveoil ~/4 tsp fine seasalt
Pat the tofudrywith papertowels. Setthetofuin a colanderandset thecolander over abowl tocollectall the liquid that drainsfrom the tofu. Coverthetofu with plastic wrap, then place3heavy cans,eachat least14ounces, onthetofu to weigh itdown. Thisweight will help extractall theexcessliquid fromthetofu. Refrigeratethe tofu for at least 4hours orovernight. Mince thegarlic in afood processor. Patthe tofuhalveswith papertowelstoabsorb any excessmoisture, thenaddthetofu to thefood processor.Addthemiso,2 teaspoonsof the olive oil andthe salt, andblenduntil the mixture isverysmooth, stopping the machine occasionallyandscraping the bottom andsidesofthe bowl. PeppercornCrusted: Coarsely grind whole blackor multicolored peppercorns,then sprinkle themoverthecheese,patting them gently to adhere. — From"RealFoodForEveryone: Vegan-Friendly Mealsfor MeatLovers, Vegetarians, andVegans"byAnnGentry,AndrewsMcMeefPublishing SPRING/SUMMER 2015• HIGH DESI RTPULSE
On the job ~ coMMUNITYHEALTHwoRKER
MEG ROUSSOS
Elva Lopez, a community health worker, right, works with a patient, Lynda Smith, ofBend, at Mosaic Medicalin Bend. Lopez has been with Mosaic since 2002. "We love what we do. Thisis our calling,"she says.
Why this specialized outreach worker, responsible for reducing barriers to health care, is known as a'bounty hunter' BY TARA BANNOW
Iva Lopez considers herself something of a "bounty hunter" for Mosaic Medical. If patients with complicated cases — severe health issues
it's helping them enroll in health insurance through a public program
such as the Oregon Health Plan. It's helping them find affordable housing. It's helping them pay for their medications. It's finding a and personal hardships such as homelessness — go off the provid- place where they can get dental care. ers' radar and can't be reached by phone, she goes out and tries to In recent years, Oregon's lawmakers and health care leaders have find them. recognized the importance of community health workers like Lopez. Sometimes that means going to their homes. If they don't have In 2013, Oregon launched a system of training and certification for homes, she goes to where they might be. community health workers, two years after legislators passed a law "If we can't meet the patient, we'll just go," Lopez said. "We'll meet requiring the Oregon Health Authority to develop those platforms. under a bridge. We'll jump under a couple fences, if need be, to get a Oregon is one of only five states with laws in place that establish hold of the patient." training and certification programs for community health workers, Lopez is a community health worker. She connects patients with according to the Association of State and Territorial Health Officials, important services and other necessities that are not directly related a nonprofit organization that represents U.S. public health agencies. to the treatment of their physical health conditions. In many cases, Another seven states have training and certification programs but
SPRING I SUMMER 2015• HIGH DESERTPULSE
Page 17
On thejobl CQMMUNITY HEALTH WQRKER
no laws governing them.
Asked the full list of things she does, Lopez's eyes widen."There are so many!"
Many factors to health The factors that contribute to a person's health extend well beyond treatments and medications. If people lose their homes orjobs, they probably aren't going to be thinking about going to the doctor, said Elaine Knobbs, Mosaic's director of programs and development. "They have some crisis in their life and all of a sudden they're staying with someone else and their lab work and prescriptions aren't at the top of their minds," she said. "They're thinking, 'What am I going to eat?' But at the same time, we don't want them to get sicker and have even more things on their plate." Lopez said her job is to remove those social, financial or logistical barriers so people can focus on improving their health. For example, she's working with a patient who wants to start exercising again but has an ostomy, a surgically created opening in the abdomen to allow waste or urine to leave the body. "She needs to start feeling better. She wants to do that," Lopez said. But patients with ostomies have pouches covering the openings that collect the waste but aren't waterproof. Lopez and her team at Mosaic were recently approved funding for a device that will cover
the opening and allow the patient to swim. In another case, Lopez helped secure funding through state and federal programs to fix an electric wheelchair for a patient in Prineville. The process, however, took two years. Lopez also helped get dentures for an uninsured patient who suffered from depression because of her bad teeth. She wouldn't smile and oftenheld her hand over her mouth. Lopez connected the woman with insurance and got her an appointment at Oregon Health 8 Science University to have the dentures fitted. "She got her dentures and, my gosh, no more depression, none of that," Lopez said. "She goes out in the community now and just does
for herself. She was going downhill so much, and it was just one little thing: dentures." And there's the patient who brings Lopez nearly to tears to think about: a homeless man who initially came to the clinic very angry.
"He felt like everybody was just pushing him away," she said. It turned out the man had an enlarged heart and had been told he was going to die from the condition, Lopez said. He simply wanted to know that his two children would have a place to live and someone to lookafter them once he was gone. Lopez secured housing for the kids and the man, in addition to a caregiver who agreed to stay with the kids. She also secured insurance through the state for the man.
In an effort to better serve our patients in Bend and the surrounding area, our Bend clinic (formerly on Greenwood Ave) has moved.
Clinic Hours:
•
•
•
s
•
•
e >
•
0
•
~
•
•
~ •
•
•
[[~ lJIMosaicMedical Page 18
r
Monday Tuesday Wednesday Thursday Friday
8-Spm 8-Bpm 8-Bpm 8-Bpm 8-Spm
5 41.38 3 . 3 0 0 5 mosa i c m e d i c a l . o I g SPRING/SUMMER 2015• HIGH DESERTPULSE
"He eventually did pass away, but he got better before that actually happened," she said."For me, that's one of the stories that has stayed with me for the longest time. Even if it's not helping the patient now, it's helping them somewhere in their lives."
Community need Not everyone can do what Lopez does. It requires an extensive knowledge of the community and a wealth of connections to the various local organizations that provide the services patients need. Lopez, who grew up in Madras, was one of Mosaic's first employees when it opened in 2002, starting as an outreach worker and then transitioning to become a community health worker nine years ago. Central Oregon Community College has an 80-hour community health worker training program, after which students can apply for certification through the state. COCC has offered the training since 2011. Apart from Mosaic, St. Charles Health System and other providers, including senior organizations, have community health workers on staff. The need for the workers in Central Oregon is slowly growing, although not as fast as COCC would have preferred, said Nancy Jumper, COCC's program manager in continuing education. The challenge now is getting the entities that pay for health care, such as the Oregon Health Plan, to provide reimbursement for community health workers, she said. Oregon's coordinated care
organizations, the groups that oversee the Oregon Health Plan, are supposed to provide supportive individuals such as community health workers for their members, but they're still working out kinks around how to embed them in clinics. Central Oregon's CCO does not provide community health workers locally, Knobbs said. As a federally funded community health center, Mosaic already gets funding for so-called outreach workers, which it uses to pay community health workers, Knobbs said. But for other clinics, pay-
ing for such positions is a challenge, she said. On a recent Friday, Lopez spent the morning documenting what happened at a home visit the previous day. Then she met with a couple of patients who were transitioning into assisted living facilities to see what help she could offer. She checked in with another patient who needed vision help. She called up some patients to see how they were doing. She did a home visit for a patient her team hadn't been able to reach.
On a typical day, Lopez said she sees between five and 12 patients, depending on which Mosaic clinic she's working at. The most important thing about being a community health work-
er is having a passion for helping people, Lopez said. "We love it," she said. "We love what we do. This is our calling, and not many people can say that what we've been doing all our lives, that's what we were born to do." â&#x20AC;˘
/
Choice, Convenience and Live the way you want to live. We take care of the details while you have all the fun!
Prestige Senior Living High Desert, where Everything is Happening/ Prestige Senior Living High Desert (541) 312-2003 SPRING/SUMMER 2015â&#x20AC;˘ HIGH DESERT PULSE
www,PrestigeCare.com
Call today to set up your personal tour and complimentary lunch 2660 NE Mary Rose Pl Bend, OR 97701 Page 19
•
I
e
e• I • l
•
•
l N
I
•
I •
•
N•N
Adogdecal on thewallat the Friends for Life Dog Training warehousein Redmond, which hosts a class for dogs and veterans alike.
•.
I
The VA wants to find out whether specially trained dogs can help treat PTSD. But critics think its approach is doomed. "Youhave toteach
BY TARA BANNOW PHOTOS BY ANDY TULLIS
(veterans)
n a chilly Saturday morning in March, four men and
thatwhat fhey're afraid ofis notgoing to happen.
their dogs file into a warehouse next to an electric supply store in Redmond. Some of the
dogs yelp and lunge at one another. Their owners pull them in the other direction. A couple of them wait outside to let their dogs calm, watching
as they sniff the ground wildly.
7hedogs
Once inside, the men — all veterans — and their dogs report to stations
(in the VA's
marked by folding chairs and mats.
study) are
Class begins. It's slightly chaotic
— a pit bull aggressively laps from a water bowl that makes an earsplitting scraping sound as it slides around the
concrete floor. A bloodhound barks once every few minutes. But it's a far
cry from how it looked five weeks ago when the class began. Back then, the
dogs, mostly rescues, were barking so loud it was hard to hear the instructor.
"Ifyouwould've seen them day one, it is like a night-and-day thing," said Dennis Fehling, a certified professional dog trainer and the owner of Friends
for Life Dog Training in Redmond. He is training the dogs free of charge. Each of the veterans in the class, most of them young men, have post-traumatic stress disorder. It's a mental health c ondition f o llowing
Dennis Fehling teaches the "watch me"command to Bull, who belongs to a veteran, at the Friends for Life Dog Training warehousein Redmond. Below, Bull tries out "down,""hand targeting"and simply hanging out with a human. For Fehling, training for dogs and veterans "is notjustabout training;it's about emotionally supporting (people) and helping them feel safein an environment with other veterans."
H
teaching the veterans the opposite." — Edna Foa, an expert on PTSDand a critic of the VA's
approach to service dogs
Video ofveterans training and working with service dogs: bendbuiietin.com/ PTSDdogs
physical harm or the threat of physical harm that causes people to feel scared or anxious even when they're no lon-
ger in danger. They've all been thoroughly medicated.Some have been in and out of treatment facilities. Some have lost jobs. Some have contemplated suicide. Now, they say they have found a new treatment: dogs. Countless veterans with PTSD have told stories about how something as
SPRING I SUMMER 2015• HIGH DESERTPULSE
Page 21
Feature IPTSD SERVICEDQGS
History of dog assistanee and the Department of Veterans Affairs 1961
2002
2008
2009
VA is authorized to assist visually impaired veterans with guide dogs.
Congress expands VA coverage to include service dogs for physically disabled and hearing-impaired veterans.
VA begins assisting physically disabled and hearing-impaired veterans with service dogs. Rick Yount launches aservice dog training program for veterans with PTSD at VA a facility in California.
Congress approves the National DefenseAuthorization Act for fiscal year 2010,requiring the VAto study service dogs for PTSD. Congress later authorizes the VAto provide service dogs for veterans with mental illnesses, including PTSD. Yount launches another PTSDdog training program, this one at the National Intrepid Center of Excellence on the Walter Reed National Military Medical Center campus in Maryland.
Sources: VAOffice oflnspector General, U.S. Army Medical Department Journal
simple as a dog changed everything. They
The VA scrapped its first congressionally mandated study into the subject in 2011, one year after a federal audit criticized the agency's lack of service dog support for veterans with mental illnesses. This year, it is once again recruiting veterans for another study, one that will span the next three years and
say they're able to go out in public, ease up on meds and be productive members of society again. But despite mountains of anecdotal evidence, very little formal research exists on the link between service dogs and PTSD symptoms. Citing that lack of evidence, the U.S. Department of Veterans Affairs does not provide financial support for service dogs for veterans whose primary diagnosis is PTSD. If the veterans have physical conditions, the VA pays for service dogs' veterinary care, for travel costs to obtain and train them and for their equipment, but it does not actually buy them. Instead, it refers veterans to nonprofit organizations that provide service dogs for free. Even while the Americans with Disabilities Act provides equal rights to service dogs for people with psychiatric conditions as for those with physical ones, veterans are afforded fewer protections under the VA's own regulations.
cost roughly $12 million. A final report is expected by 2019. The study will compare the effectiveness of service dogs versus another type of support dog in treating PTSD. But post-traumatic stress and service dog experts say the study so many veterans have waited so long for is doomed to fail. Theyargue the methodology is flawed and the tasks the VA will teach the service dogs — to scan
a house for a hidden intruder, for example — will only worsen PTSD symptoms. They question whether PTSD experts were consulted on the study's design. Yet the study could not come at a more crucial time. A time when a veteran in the U.S. commits suicide once every 65 minutes.
"This is too important to screw up, because 22 veterans are killing themselves every day, and many veterans are saying that dogs are saving their lives. Wouldn't you want to know how to utilize that to the greatest therapeutic benefit possible?" said Rick Yount, who launched the first service dog training program at the VA Palo Alto Health Care System in 2008. "I mean, it's not sad — it pisses me off. It really does. You can't do that." For the veterans training their dogs in Redmond, theclasses themselves end up being
therapy. They're among people who understand them. Tom Imholt, a 34-year-old Iraq War veteran wearing a leather jacket with the letters "USA" down the arms and an American flag across the back, tells the class his dog, Zoey, has helped him get off of most of his medications.
"She's helped me way more than 12 years of PTSD therapy, in and out of treatment centers, on almost every pharmaceutical med-
ication — she's helped me way more," he
• •
•
•
-
•
•
• ' •
•
•
•
•
•
•
•
•
•
•
•
'
•
-
•
•
•
•
e
( • (
•
• •
(
•
•
•
.
•
•
•
• • • •
•
Page 22
•
•
•
( •
•
•
I
'
•
•
'
l l
SPRING/SUMMER 2015• HIGH DESERTPULSE
2010
2011
2012
End of2014
VAOffice of Inspector General report criticizes the VA'slackof service dog assistance for veterans with mental illnesses. VA launches study into effectiveness of service dogs for PTSD.
Yount establishes the Warrior Canine Connection in Maryland.
VA halts study into effectiveness of service dogs for PTSD. VA issues final rule stating it will provide service dog support, including assistance with veterinary care and travel and hardware costs, for veterans with visual, hearing or mobility impairments, but not for those with mental impairments.
VA starts a revised study into effectiveness of service dogs for PTSD.
GREG CROSS
said, pausing as his voice becomes choked that, the back seat became silent. with tears. "It's not only that, but it's you guys," Imholt said. uYou guys are making this happen.... I'm serious. I can go out in public again." Imholt turns to his wife, Angela, who
"Very abruptly, it went from distressful sobbing to quiet," Yount said. "It was almost
wraps her arms around him.
with his head on the kid's leg. The kid had his hand on the puppy's head. It was just so
"You're amongst friends," Fehling said.
'My heart sank' Normally, Yount wouldn't mix his dog with his job as a social worker. But he couldn't say no to the look in his new golden retriever
puppy's eyes one morning in 1996. It happened that on that day, the court
had ordered him to remove an 11-year-old boy from his mother's home and bring him to an emergency foster home. The state em-
alarming what happened. I looked in the rear-view mirror and that's when I saw this 4-month-old red-colored golden retriever
striking." That was the first time Yount started to realize the therapeutic effects dogs could have on people experiencing significant trauma. Yount continued as a social worker for a few years after that and got to observe the parallels between training service dogs and working with children with severe behavioral issues, using the attachment, grooming, nurturing and bonding, in addition to
ployee coming with him didn't have a vehi- commands and body language, to reinforce cle, so they took Yount's. Not surprisingly, the boy was hysterical as they pulled out of the driveway. Nothing Yount said could comfort him. Not long after
e
I
r
lessons. He went on to start a service dog
training program. Many of the dogs ended up going to veterans with mobility issues.
Then in 2005, an especially bloody year in
the Iraq War, Yount realized the connection between service dogs and PTSD.
In July 2008, he launched a service dog training program for veterans with PTSD and traumatic brain injury at th e Men's Trauma Recovery Program in Menlo Park, California, a program of the Palo Alto VA. Thousands of veterans have participated in
the program, which is ongoing. The following year, officials with the prestigious Walter Reed National Military Medical Center asked Yount to establish a similar program there. Yount currently serves as executive director of the Warrior Canine Connection, a program he established in 2011 that allows veterans with PTSD to help train service dogs for fellow veterans, a process that's believed to be therapeutic in itself. He's also performing two Defense Department-funded studies on the subject. When the VA, prompted by the National Defense Authorization Act of 2010, began its first study into service dogs for PTSD in
r
n OO a n S
s
When you experience awrist, hand or upper extremity injury or condition, you need an expert to get you back to what you love. AtTheCenter, our fellowship trained physicians specialize in treating injuries and diseases of the elbow,wrist and hand. And, becauseour specialists are at the top of their field in both orthopedic surgery and non-surgical options, youcan be confident you will get the best care possible. Handsdown.The Center.Find strength here.
' THE CENTER Our skilledhandandupper exlremityteamfrom left to right; Dr. MichaelDoe,Dr.JamesVerheydenand Dr.Soma Ligy
SPRING/SUMMER 2015â&#x20AC;˘ HIGH DESERT PULSE
541-382-3344 TheCenterOregon.com
Page 23
Feature IPTSD SERVICEDQGS
Types of assistanee dogs ervisedogs: ISS
2011, several organizations contacted Yount and asked if he would participate. Despite his good working relationship with the VA and passion around the issue, he declined. "When I read what the VA was laying out as far as how the dogs would be utilized, my heart sank, actually," he said, "because it was, in many ways, the opposite of what we
were finding helpful."
'That would make me worse' The VA's current study, designed similarly to the previous one, will compare a group of veterans with PTSD who receive service dogs trained in tasks designed to alleviate PTSD symptoms against a group of veterans with PTSD who receive emotional support dogs (dogs with obedience training but not training to perform tasks or work related to their owners' mental disability). Yount wonders why the study isn't comparing the use of service dogs with traditional treatments for PTSD, including medications and psychiatric therapy, among other things. (He is currently leading a study that will do just that.) Edna Foa, director of the Center for Treatment and Study of Anxiety in the University
of Pennsylvania's Perelman School of Medicine, agreed. To learn whether service dogs are helpful, the proper test would be to take an evidence-based PTSD treatmentsuch as
~arurt peeplewith gphyPsieal,,Q initelleetual]Cno eryshiatrir~ etrabttttter. ~
k p)
~er semmandr~retatee te owner's disability, such as retrieving objects, turning~ ttght rwitsher en andnff ~ ane~providing bataneewhilea ~ ~person~walks.~@an be rescued from
~ldentihed~tyjasket,~haskpaoker entttter rervise ~harnerr. r~eeeratMtaw~ swnerste~takeeeg~anywhere ~eeg~ Qanondisabled person can go.
Guide dogs: Mgan +be)iidentthedilb byharnerrane~urhaeeehanetethat
Therapy animals:
IHHeariogdogs:
dog) thatprevide ~Cusuallya~
Alert peoplewhoafed~eafandhardofhe~ aring toa variety of sounds and lead them to sources of sounds. Identihed by leash and/or vest.
hospitals, retirement homes, schools, hospice facilities, etc.
Emotional support animals (aka comfort or companion animals): Prescribed by licensed therapists for psychiatric conditions. Do not require specihc task-training because just the animal's presence mitigates a disorder's negative symptoms. Placessuch as restaurants, stores, hotels, theaters, parks, etcn are not required by law to let these animals accompany their owners. Can accompany owners on airplanes with an additional fee. Source: Assistance Dogs lnternational, National Service AnimaI Registry
GREG CROSS
prolonged exposure therapy and compare it
they'll provide only emotional support and
"That just gives the veteran peace of mind that someone is not in their house and is not going to attack them, which is a typical anxiety that veterans with PTSD might have,"
won't perform specific tasks related to PTSD
Fallon said.
like the service dogs will, said Michael Fallon,
Yount said he's asked countless veterans he's worked with about that command. "Almost always, the response from the veterans, from the warriors being treated, is: 'Well, that would make me worse,'" he said. Traditional PTSD therapy works partially to c hallenge the automatic, intrusive thoughts PTSD creates, such as the idea that an enemy is hiding in the veteran's home. A command that reinforces that idea will only harm the recovery process, Yount said. The dogs will also be taught to create a barrier in front of the veteran and behind the veteran to create space in the event people are getting too close.
with the service dogs. The emotional support dogs are meant to serve as the control group in the study, as
the veterinarian who is leading the studyand chief veterinary medical officer for research at the Atlanta VA Medical Center. The veterans in the study must be receiving standard PTSD therapy, counseling and medication, in addition to the dogs, as the study is seeking to learn whether the dogs can supplement other therapies. But Yount has even bigger concerns about the commands the VA's study will train the
service dogs to perform. The dogs will be trained in a so-called sweep command, which means they enter a building before the veteran and ensure there are no intruders inside.
Page 24
Isolation is among the most deadly symptoms of PTSD, Yount said. A dog can act as a social lubricant; it can bring people to the veteran to talk about something other than his or her service, he said. Reinforcing the
idea that there is a high likelihood of being accosted from behind is the direct opposite of what needs to happen, Yount said. Foa said she also has serious concerns about the sweep and block commands,
which she said will only worsen PTSD symptoms. The PTSD therapy techniques that have proved effective in roughly 80 percent of cases do exactly the opposite, she said. One of the main symptoms of PTSD is hypervigilance, a constant state of heightened alertness due to the belief that one is always in danger, Foa said. Veterans with PTSD tend to react with "safety behaviors" such as car-
rying guns or knives, even when they're in
SPRING/SUMMER 2015â&#x20AC;˘ HIGH DESERTPULSE
safe places.
hypervigilance, rather than reinforce them, and that means making the veterans face their fears, Foa said. back now. They're going to avoid the places Yount cannot get an answer from VA ofthat are crowded. They avoid going to movies. ficials as to whether a mental health profesThey avoid going to restaurants. They avoid sional with expertise in PTSD was consulted driving on highways because highways in Iraq in designing the study. "Every time I ask the question I get skirted," and Afghanistan are dangerous." One of the leading PTSD therapy tech- he said, "and I'm afraid I know the answer." niques teaches veterans to slowly face the Dr. Robert Koffman, a Navy psychiatrist situations they believe are dangerous, so as who retired this year after more than 30 to eventually help them see that they're not years of working with service members with in danger, Foa said. "You haveto teach them PTSD and other psychiatric conditions, said he's concerned that if veterans' service dogs that what they're afraid of is not going to happen. The dogs (in the study) are teaching reinforce their PTSD symptoms, it could obthe veterans the opposite." struct their ability to benefit from traditional The VA was aware of those concerns while PTSD therapies such as cognitive behavioral it designed the study, Fallon said. In the end, therapy. The idea behind the therapy is to officials determined it was more important to teach veterans calming techniques that allow get the veterans out of their homes and out them to feel comfortable in whatever enviinteracting with people, and they knew these ronments they may be in, he said. specific commands would do that, he said. The sweep and block commands, how"The decision was made that although it ever, "could hinder the ability to gain maswas possible that those commands will re- tery in the environment," said Koffman, who inforce, we thought there was much greater recently joined Warrior Canine Connection value in getting the folks into the commu- as its chief medical officer, "and that's renity so they felt safe and into their normal ally what cognitive behavioral therapy is lives," Fallon said. all about: for the individual to gain a sense of mastery and not be controlled by errant Making vets face their fears thoughts and situations." In interviews, several veterans said they Fallon and Dorn said "dozens and dozens" would like for their dogs to know the sweep of people had a hand in designing the study, and block commands, as they tend to be some of whom have PTSD expertise, but afraid someone is hiding in their homes or get their names are confidential. overwhelmed when people come too close. Three mental health professionals are In designing the study, VA officials inter- leading the study at each of the three sites, viewed veterans who reported being ner- but it's unclear what role they played in devous about people getting too close and not veloping the study's methodology. Psychiafeeling comfortable going in dark areas, said trist Dr. Kelly Skelton is leading the study in Patricia Dorn, a leader on the study and direc- Atlanta, psychiatrist Dr. Thad Abrams in lowa tor of Rehabilitation Research and Develop- City, lowa, and Daniel Storzbach, a psycholment Service in the VA's Office for Research ogist, is leading the study in Portland. The Development. study chair, Gabrielle Saunders, primarily re"Part of that is learned from what the vet- searches hearing loss and has a doctorate in erans themselves are telling us are situations audiology and psychology. that they're finding difficult to navigate," she Ultimately, Yount said, he thinks the study sald. is designed to fail. "If the study is really not looking at cliniFallon added that not only are the commands the VA study is based on what vet- cally, well-thought-out use of these dogs that erans say they need, but they're also "solidly actually address post-traumatic stress, and based in the ADA definition for service dog." is using the dogs to support the symptoms But PTSD therapy should redirect the and really reinforce isolation and distorted symptoms of PTSD, such as avoidance and thoughts, comparing that to just a pet dog, "But the world is, most of the time, safe," she said. "Not in combat, but these people are
SPRING/SUMMER 2015â&#x20AC;˘ HIGH DESERT PULSE
an emotional support dog, I feel there is a high likelihood that the results of this study show that the emotional support dog, or pet, has more positive impact or just as much as
a fully trained service dog," he said. Using what Yount expects will be negative study results as its supporting evidence, the VA, Yount believes, will deny future coverage for service dogs for psychiatric conditions. "You can just have a pet, or an emotional support dog," he said. "That's a lot less cost and a lot less process." Because emotional support animals do not require training in specific tasks, they tend to be far less expensive than service dogs, whose training can cost several thou-
sand dollars.
'She knows me' George Hamilton doesn't talk o p enly about what life was like in the worst throes of his PTSD. But the 20-year Air Force veteran has a lot to say about how his dog, Vanessa, has turned things around. The 62-year-old Tualatin resident is confident leaving the house. He doesn't become
overwhelmed as often. If he finds himself in a moment of panic, she helps him climb out of it. It's not uncommon, for example, for Hamilton to get turned around in the middle of a seemingly never-ending aisle of Costco or Home Depot. When that happens, he said Vanessa feels his anxiety from the other end of the leash and snaps into action.
She stops. She goes down. She helps him come together. "She looks to me for the next response," Hamilton said. "She'll stop and she'll look up to me and it's kind of, 'I'm waiting.' And then I have to wait in order to say, 'OK, here's where I'm going. I feel better and now we
can go forward.'" If necessary, Vanessa also knows where the registers and the doors are, and she can lead Hamilton in the right direction. "She feels so much through that leash," Hamilton said. "She knows. She knows so much about me." Hamilton is among the more than 75 veterans who participated in a recent study in Oregon on the effectsof service dogs on Continued on Page 32
Page 25
TIPSi HOWTO
in
CHOOSE A DOCTOR
eii
)+' '
kt~~
vljij..g '. + • 'k
zj • •
IQ®
BY TARA BANNOW
he last time you made a major purchase — say, a car
— you probably had a salesperson thoroughly versed in makes and models walking you through the decision-making process. You also may have gotten a full history report on the car and learned about its gas mileage and crash ratings. Choosing a doctor is totally different. There aren't neat, objective quality reports waiting for you to sift through, so many people turn to friends, family, co-workers or even online reviews for advice. That's all well and good, but there are still several important points to keep in mind when you're on the hunt for a new doc:
YOU NEED TO LIKE THE PERSON The most important thing is finding someone you feel you can have a relationship with and communicate with, said Dr. Sylvia Emory, president of the Oregon Medical Association and a primary care provider in Eugene. The provider must also, of course, demonstrate clinical competence, she said. Nearly 60 percent of patients surveyed by The Associated Press and the National Opinion Research Center's Center for Public Affairs Research said they value the doctor-patient relationship above all else, according to a report released last year. Less than 30 percent of respondents said the delivery of care or health outcomes was most important.
This is even more crucial if you're looking for a primary care provider than a specialist, such as an orthopedist, whom you might only see once or twice. "If you have a joint replaced, that's sort of a onetime thing," Emory said. "A primary care provider, you could be with them for decades."
Page 26
p
\ ) I
l
ll
•)
i >J'
g
.„)
g ~ )
'
'i'g '
)
' : ,
',ojl
j
l g
J, '
i
/
g
) J
j
). •
) )1)
~1
GREG CROSS
WHO DOES YOUR INSURANCE COVER? Insurance companies will provide a list of physicians in your area you can choose from; this is referred to as your network. Insurers cover a larger proportion of the cost of seeing providers who are "in network" versus those who are "out of network," so this is an important thing to check ahead of making an appointment. Major insurers post their networks on their websites.
CHECK OUT BOARD CERTIFICATION Physicians who practice in certain specialties, such as family medicine or internal medicine, must pass board exams every seven to 10 years to maintain certification in their specific specialty area, Emory said. This is to ensure they're keeping up on the latest literature in their specialty, even if they've been practicing for many years. Potential patients can check on physicians' certifications at certificationmatters.org.
SPRING/SUMMER 2015• HIGH DESERTPULSE
• «e • • •
' •
•
«~e
•
•
•
• e• 4
•«•e •0•e « )
St. Charles
) • 1•
HEALTH SYSTEM
WHAT ABOUT AFTER-HOURS CARE? HOSPITALIZATION?
•
•
« e •' • ' • • « •e • • •
•
•
•
•
•
'
yroudly yresents
•
•
• e • e of i ' •
•
• « • e ~v ) •
Different practices have different protocols around how to handle patients who need to be seen on a holiday, a weekend or in the middle of the night, so it's important to ask potential physicians about their policies in this area, Emory said. Some providers have an after-hours clinic for patients, or a 24/7 on-call nurse line patients can call if they have questions. Patients might also be interested in knowing how or whether the provider collects information from your after-hours visits to urgent care providers or emergency rooms, she said. Many providers use electronic medical records to collect this information, but very few in Central Oregon can send information directly from one system to another. Emory said patients also might consider asking how a physician communicates test results. Should patients expect to receive a phone call? A letter in the mail?
CHECK OUT THEIR ONLINE REVIEWS Using reviews on websitessuch as Yelp, Facebook, Healthgrades or Vitals tojudge a doctor is controversial. Emory said she's concerned such sites could be unreliable because patients could be upset for one reason or another. For example, a doctor refusing to refill a controlled substances prescription tends to generate lots of anger. "I don't know how valuable it is," she said. A 2010 study in the Journal of General Internal Medicine found that nearly 90 percent of online reviews of physicians were positive. Dr. Tara Lagu, an assistant professor at Tufts University School of Medicine, said she thinks that's because patients generally have an allegiance to their doctors and want to maintain relationships with them. Since her study, Lagu said the use of such sites to gather information on physicians has only increased. Overall, she said, she thinks such sites can be useful, so long as they're not the only source of information patients use to make their decisions. She said she hopes in the future such reviews are somehow included on sites with federal Medicare quality reporting data, such as the data on the website Hospital Compare. "My take-home is to really use multiple sources," Lagu said. •
•
•e •• • • •e•e •
• •
•
•z
ev eniTlg With
e en gO
OO
BXl
MA Y 14, 7 P.M. i T HE TOWE R
Well known for her decades of work chronicling social change in America, Pulitzer Prize winning columnist Ellen Goodman is now leading the charge of a grassroots campaign to make it easier to initiate conversations about dying.
People should talk now, and as often as necessary, so their end-of-life wishes are known when the time comes. Join us for an engaging evening with Ellen Goodman and learn more about how to have "the conversation" with your loved ones.
This is a free, hut ticketed event. Fortickets, call 541%17%700 or visit
tosvertheatre.org.
-r
J HIGH DESERT PULSE
Page 27
THE A T R E
Get ready(BEGINNER's GUIDE With greatmountain biking trails near Bend, there's no reason not to ...
BY MARK MORICAL
W
h all of the hard-core endur-
ance athletes in Central Oregon, getting started in a sport like mountain biking can be quite intimidating. And there are so
many choices when considering the purchase
of a new bike: Carbon or aluminum? Hard-tail or full-suspension? 29-inch or 27.5-inch wheels?
Luckily, myriad bike shops in Bend and beyond make it easy for beginners to take up the sport that
has boomed in popularity over the past decade. Many shops offer rentals that can be credited toward
the purchase of a new bike, or free demos during certain group rides.
Some shops also sell their demo bikes from the previous year at deeply discounted prices. The cost of mountain bikes can vary wide-
Page 28
SPRING/SUMMER 2015â&#x20AC;˘ HIGH DESERTPULSE
Mountain biking etiquette Mountain bikers should remember three key points about trail etiquette when riding, according to the Central Oregon Trail Alliance, which builds and maintains most of the singletrack in Central Oregon on a volunteer basis. COTA's three main
PFIOTOS: JOE KLINE
Tim Marchant, of Bend, rides on Kent's Trailin the Phi I s Trailcomplex. Kent'sis a great trailfor beginning mountain bi kers.
ly, from $300 for simple entry-level
figure they will be riding maybe
For bikers who prefer longer rides $1,500 or less. over more technical, rockier terrain, Henry Abel, who handles sales or lots of downhill, a full-suspension and marketing for Pine Mountain bike might be a good choice. Sports in Bend, says customers can Abel says when he rides for lon-
once or twice a week — and not
sometimes get more for their mon-
ically less expensive, often about
bikes to $12,000 for the lightest, fanciest race bikes. For novice mountain bikers who
going on daylong, epic adventures ey when buying a hard-tail instead — a hard-tail 29er is a good bike to of a full-suspension bike. "I will steer people toward a hardtail, just because you get nicer parts for it," Abel says. "Hard-tail 29ers are sort of the starting point for trail-worthy mountain bikes. Our entry level bikes are starting at about $800."
consider. "Hard-tail" means the bike does not have rear suspension, so longer rides over rougher terrain may not be quite as comfortable as on a full-suspension bike. But hard-tails are typ-
ger than 90 minutes on a hard-tail he starts longing for full suspension. "Once I start to get into that twohour range, that's when the hardtail starts to beat me up just a little bit," Abel says. "What's nice about
full-suspension is people think, 'Oh, it will be comfortable when I'm go-
ing downhill,' but they actually climb
Easy mountain bike trails Kent's Trail in the Phil's Trail system west of Bend and the Maston trails near Cline Buttes provide some easy riding for beginners.
Kent's mountainbike trail
Maston area mountainbike trails Thornburgh Resort 'Phil's Trail Trailhea
Skyliners Rd.
=-
e,e~
%g ACen"'3"'
/
• Descending riders stop for others:Expect some uphill riders and be ready to move to one side of the trail, stopping until your line is clear. • Tread on trail: Riding offinto the bushes widens and damages trails. Instead, put a foot down and let the oncoming riders pass. • Look, listen, smile: Keep your eyes and ears open. Smile and say hello! You are in one ofthe best mountain bike areas in the nation.
r
J / ici
W
MASTON TRAILS
I
,/ s
PHILS
Trailriead
point of its "Trail Love" campaign are as follows on its website (www. cotamtb.coml:
46
Q"
Vo
LM/
"' o' e4 rs
Newcomb Rd.
A OF TAIL
Bee GREG CROSS
SPRING/SUMMER 2015• HIGH DESERT PULSE
A Good gear to haVe NEXT PAGE Page 29
Get ready BEGINNER'5 GUIDE:MOUNTAIN BIKING
better, too, because the suspension helps hold the tire against the ground as much as it helps to cushion you from it." Full-suspension mountain bikes often run about $2,000 or more. "But this is Bend — there's people who are riding around on $12,000 mountain
Other important gear Helmets are a n ecessary piece of equipment when cycling. Mountain biking helmets start at about $45 at most
bike shops and usually include a visor to provide protection from both the sun and tree branches.
bikes," Abel says.
Hydration packs allow bikers easy ac-
Understanding wheel size The term "29er" refers to the wheel size of 29 inches, which is relatively new in the mountain biking industry. Until about five or so years ago, most mountain bikes had 26-inch wheels. But cyclists and bike manufacturers found that 29-inch wheels
•
'
•
•
'
'
•
cess to water and provide a zippered place to put a phone, energy bars, clothing, car keys and extra tire tube in case of a flat. CamelBak is the most popular brand of hydration pack, starting at about $80.
Padded cycling shorts (often baggy
were faster. Most hard-tail bikes now are 29ers,
shorts with a padded liner inside) start at about $75, and technical T-shirts that wick sweat and moisture are about $40. Many experienced mountain bikers
but full-suspension bikes are available in
have pedals they can clip into with cycling
both the 29-inch and the 27.5-inch wheel size. "It's easy to get caught up in all the
shoes, butAbel recommends beginners
nuances of different wheel sizes," Abel warns. "If you ask five different cyclists
with the flat pedals," Abel notes. "Flat pedals are not just for beginners. For some people they are just more comfortable and they like the flexibility."
rolled over rough terrain more easily and
use flat pedals and regular shoes. "Some people ride for years and stick
or shops, you'll get five different answers. For the most part, bigger wheels tend to be a little faster and, more importantly,
Trails for beginners
kindoftake the edge offthe bumps. And that's why hard-tails have overwhelmingly turned into 29-inch hard-tails because that bigger wheel is the best at taking the edge off. It's not a replacement for suspension, but it definitely makes a
Much of the hundreds of miles of sin-
focus on downhill riding or like to go air-
gletrack in Central Oregon is suitable for novice mountain bikers. The Maston area near Eagle Crest Resort in Redmond offers mostly flat, smooth trails through a High Desert setting.Just west of Bend, the lower section of the Phil's Trail complex offers many miles of relatively easy trails. Kent's Trail, which starts from Phil's Trailhead, is one of the best trails near Bend
borne off jumps and other features.
for beginners, according to Abel.
difference." On full-suspension bikes, the 27.5-inch wheels tend to be a little more playful for mountain bikers who are more likely to
"I always recommend Kent's Trail when someone is taking somebody out who has never mountain biked before," Abel says."If you get to a point where they're feeling good, it connects to other trails as
For riders who prefer to simply roll over terrain, a 29er might be the better choice. "If you come to a bump and you like to just sort of roll over it or roll around it nice and smoothly, a 29er works pretty well," Abel explains. "But when you come to that same bump, if you want to try and hop it or jump it, then that smaller wheel is a little more entertaining."
Page 30
well. A younger rider or a rider with limited technical abilities can ride out as far as they feel comfortable, and then turn
around and ride back." •
PEIOTOS: JOE KLINE
SPRING/SUMMER 2015 • HIGH DESERTPULSE
Kids aren't just a part of our practice. They are the practice. When you're talking about healthcare for babies, toddlers, children and teens...that's us. After 40 years, we're still completely, passionately focused on just one thing - your kids.
Mary Brown, MD, FAAP John Chunn, MD, FAAP Valerie Bailie, MD, FAAP Dale Svendsen, MD, FAAP Brenda Hedges, MD, FAAP Caroline Gutmann, MD, FAAP Erin Garza, MD, FAAP Linda Steiner, MD, FAAP Jennifer Lachman, MD, FAAP John Peoples, MD, FAAP Dana Perryman, MD, FAAP Megan Karnopp, MD, FAAP Logan Clausen, MD, FAAP Mary Rogers, MD, FAAP Jeff Meyrowitz, MD Cris Ricker, MS, PA-C Carissa Honeycutt, MS, PA-C Hailey Garside, PNP Board certified and fellowship trained pediatricians and providers, including 15 pediatric specialists from leading children's hospitals. ooERHEEOHER
C HILDREN'S ~
HOSPITAL
vA
~
R ANOALLCHILOR EN'S
HOSPI TAL IICACY IMANUtl
PitoylPENCE Health &Services
• •. •-
C ENTRAL O R E G O N
PEDIATRIC ASSOCIATES
0
® Ext en d e d Hours until e B P.m.
100% Pediatrics.100% of the Time. I'
IET
A
r
Eastside Bend 2200 NE Professional Ct. • Westside Bend1820 NW Monterey Pines Redmond 413 NW Larch Ave. • cop pp
Id
0
Feature PTSD I SERVICEDQGS
Continuedfrom Page 25 veterans' PTSD. The study, funded and carried out by the Kaiser Permanente Northwest Center for Health Research, won't be published for a few months, but researchers found veterans who had dogs reported better mental health, better social relationships, less substance use and fewer mental health symptoms compared with their counterparts without dogs, said senior investigator Carla Green, whose office is in Portland. The groups with and without dogs did not differ with respect to their com-
bat exposure and physical health, she said. At this point, Green said, there still needs to be more research into the effectiveness of service dogs as a treatment for PTSD before coverage decisions can be made. But based on her study's results, she thinks evidence will materialize in the coming years. "And at the point when the evidence is clear, then I do think the VA should fund those dogs," she said. "I expect that the findings will
"It'sarealgapin knowledge. We don'tknowif(servicedogs)helpor not. The VA needssomerealdata toknowiftheyhelpornot." — Carla Green, researcher in Portland
required the VA to launch a study into the
the VA's policy changes, Fallon said. The VA performed a rudimentary analysis
question in July 2010.
on the question of purchasing service dogs
By that time, the VA had already proved itself to be sluggish when it came to service
years ago, but Fallon said he couldn't recall the details. Considering fully trained service
dogs. It had only begun helping physically dogs can cost $20,000 to $30,000 and the
disabled and hearing impaired veterans with their service dogs in 2008, a full six years after Congress had authorized it to do so, according to a 2010 VA Office of Inspector General report. Between the OIG report in July 2010 and fiscal year 2009, the VA provided financial support to only eight veterans for service dogs, the report found. The low numbers be supportive of providing service dogs or were because the VA was not providing paying for service dogs for veterans." consistent guidance to its medical centers Green initially proposed the study to her across the country regarding the dogs and employer after hearing from study partic- wasn't making its own staff aware of the apipants with serious psychiatric disorders plication process, the report found. such as schizophrenia and bipolar disorder The results of that much-anticipated 2010 that their dogs gave them a reason to live. study never came. The VA suspended the From there, she learned more about service project in 2011 after two children of particdogs for mental health conditions and their ipants were bitten by the service dogs proability to help people with high anxiety lev- vided through the study. els leave the house and go out in public. The following year, the VA issued a final As someone who lives on a farm and works rule stating it will only provide service dog with dogs in her personal life, Green said she support for veterans with visual, hearing or felt there was something more happening. mobility impairments but not mental impairBefore she proposed the study, she was ments. The notice generated a storm of consurprised she wasn't able to find many oth- troversy from critics who accused the VA of er studies into service dogs for psychiatric violating the ADA by discriminating against conditions other than anecdotal reports. In individuals with mental impairments, but the the process, she learned that the VA does VA insisted it was within its legal rights. not cover service dog expenses for veterans Fallon said the current study has been inwhose primary diagnoses are psychiatric. formed by the mistakes of the previous one, "It's a real gap in knowledge," Green said. and the VA even developed its own service "We don't know if they help or not. The VA dog and emotional support dog training needs some real data to know if they help or standards, because no universally accepted not, if it's an evidence-based practice or not." standards exist. This study will recruit 240 veterans who 'Our heart and soul is in it' live in the Portland, lowa City and Atlanta The data has been slow to come. Con- regions. They don't need to live in the metgress in October 2009 passed the National ro areas but need to be within a reasonable Defense Authorization Act for 2010, which distance so they can be studied. The partici-
Page 32
pants must have been diagnosed with PTSD, they must be able to take care of an animal, they cannot have a violent background and they cannot have another animal, among a few other criteria. Once the study is completed, the VA must report its results to the Institute of Medicine, which will generate a report that will guide
large number of veterans with PTSD who might want service dogs, it could cost in the
billions of dollars, he said. The VA wants to restore veterans to their full-functioning capacity, Dorn said. To do that, it needs to know the answer to the question of whether service dogs or emotional support dogs can make a difference in veterans' lives, she said. "Our heart and soul is in it," Dorn said.
'Trying to curb that number' Before he started training his dog, Bull, with Battle Buddies of Central Oregon, a nonprofit started last year that helps train service dogs for veterans, Daniel Coleman said he barely left his house except to go to work and — in the middle of the night when no one else would be there — to the gym. Other than that, the 31-year-old Iraq War veteran stayed home to avoid the stress of being in public, where he was constantly worried about being attacked or, even
worse, unleashing on someone who looked at him wrong.
"You're just afraid you're going to go off on somebody, and then you're going to end up behind bars because the PTSD just got the better of you," Coleman said. "There have been some situations I've gotten myself into that I'm not happy I was in." One time, a woman cut in front of him in line at the grocery store to buy cigarettes. Coleman's inner drill instructor came out. He got in the woman's face, screaming at her. His wife
was embarrassed. The womanwas shocked. "I haven't had that kind of aggression out
in public since (Bull) started coming with me," Coleman said. "I can focus on better
SPRING/SUMMER 2015 • HIGH DESERTPULSE
things versus letting myanger build up." Now, Coleman said, he's excited to leave the house. He's still iffy around people, but he's getting better. Kristina Olson, the daughter of an Army veteran, founded Battle Buddies in August 2013, about a month after moving to Central Oregon from Fort Stewart in Georgia, where she lived with her then-husband, who was stationed there while serving in the Army. She lived near a dormitory outside of the hospital where wounded veterans transitioned back into civilian life. "It just became really real that young men are still losing their limbs," Olson said. "They're still losing their minds." Battle Buddies helps veterans find dogs to work with or assesses their current dogs' ability to be trained as service dogs. Then it hooks them up with a trainer who performs the training free of charge, a service that usually costs several thousand dollars. First, the dogs are being trained to pass what's called the Canine Good Citizen test, which certifies them to be in public. After that, they must pass the Public Access Test, which includes demonstrating specific disability-related tasks and spending 120 hours devoted to "outings" with the dogs, in order to be
"I used the be the biggest drunk and violent idiot in this town," Darcy said.
otherwise, some of whom would have had difficulty taking the classes with nonveterans. "This is not just about training; it's about
Darcy, a slim, bearded man who served in
emotionally supporting them and helping
the Army between 1974 and 1977, has since gotten himself in quite a bit of trouble. His rap sheet in Deschutes County spans near-
them feel safe in an environment with other veterans," Fehling said. "People who have gone through the same experiences that they have. A lot of times these programs, they get in with people who haven't experienced anything like what they've gone through, so it's hard to open up to some-
ly 20years and includes felony possession of a firearm, assault, drunken driving and harassment. "I'd get drunk, and the first thing that went out the window was military discipline and control," the 58-year-old Bend resident said. It wasn't until 1993 he realized he might have PTSD, a disorder he worked hard to
body unless you've been through it." Fehling has been working with a group of five veterans since January. Battle Buddies' first class of veterans, which featured a different trainer they're no longer working with, included just two people. One of them, an Army veteran, committed suicide about a year into the training. That was just six months ago. "As they say, stuff got real," Olson said. "This was what we didn't want to happen, the
mask by drinking. He has plenty of physical issues, too. He is still recovering from hip replacement sur-
gery last year, has chronic back pain and still feels the effects of a 30-foot fall from scaffolding onto a wooden deck in 1991. He relies on bottles of morphine pills stacked up on one side of his coffee table, but they render him unable to drive. "I'm still dealing with a lot of pain," he said. "I came into this world a month early, which means I was fighting, and it's been that way ever since. I'm tired of fighting, I really am." VA-issued service dog prescriptions from 2013 and 2014 cite both emotional and phys-
whole reason for doing what we did." Olson said it was a huge blow to the organization, especially right at the outset, but their strategy has been to persevere. "With 22 veterans a day killing themselves, you have to," she said. "We know we won't win them all, but we're just trying to curb that number."
considered service dogs.
ical issues, including chronic pain and shoul-
'I would not go out'
Fehling, who served in the military himself for eight years, said the important thing about Battle Buddies is that it brings together
der, elbow and wrist abnormalities. The 2013 prescription says the dog needs to be with him at all times, with "at all times" underlined.
Plenty of people in Central Oregon know the name Jim Darcy Jr. And not all of them a group of people who would not have met for good reasons.
Dogs, he said, have kept him grounded,
Complete Health 8 Wellness e
I
I
I
I
•
a
I • •
As awoman ofacertain age,you may experience hormonal imbalance, effecting how youfeel in your own skin. Fortunately,there's hope. Bio-ident icalHormone Replacement Therapy(BHRT)works to relieve symptoms, restore balance and help you feel like yourself again. Locally and womanowned, Cascade Custom Pharmacyis a full service pharmacy specializing in women's health issues and weare your local BHRTexperts.
To learn more,visit our website CascadeCustomRx.com/bhrt or ask yourhealth provider.
Dr. Derek Palmer
Dr Cetso Gangan
• High Cholesterol • High Blood Pressure
CascadeCustom PHARMACY 'Pt tssvipuotcs Pst'sotuttixeA
Transferyourprescriptionstoday
541.389.3671
19550 SW Amber Meadow Dr.• Bend (Located 'ust5min.5outhofrheoldMilL)
• Heart Disease • Stress Testing • Diabetes
• School tt Employment Physicals • Coag Clinic • Adult tt Child Wellness PhysicaIs
Lori McMillian Ptup
• • • •
Women's Health Arthritis Lung Disease Acute lllness Treatment
Redmond Medical Clinic Care l Relationships l Education
www.redmondmedica .com
I541I 323-4545 1245 NW 4th Street • Suite 201 • Redmond, OR
Feature IPTSD SERVICEDQGS
calm and out of trouble. He went to an alcohol recovery program in Washington state in 2007 and says he's been out of legal trouble ever since. (Court records in Deschutes County, however, include a restraining order violation in 2010.)
Darcy's first service dog was a yellow Labrador and coonhound mix named Ollie, which he had for 12 years until the dog developed cancer and had to be euthanized in April 2014. Ollie's ashes are in an urn on top
ofhis TV. Now, he has a massive St. Bernard named
Rocky,who helps him up and down the stairs each day. Darcy said he hasn't been able to train Rocky to perform service dog tasks because of his hip surgery. But if it
Jim Darcy Jr and Rocky leave their Bend apartment to go for a walk. "Having a dog that needs to go out for exercise... that gets me out,"says Darcy, who servedin the Armyin the'70s.
weren't for Rocky, Darcy said, he would never leave the house.
still a very important service, and the VA is
her husband the most.
"It's funny â&#x20AC;&#x201D; he's like, 'All right, I'm going!' "If I didn't have adog, I would sit here all not addressing them in its study, she said. "The day long and do nothing," he said. "Literally, veterans we i n terviewed talked And he loads up the car with all their stuff, I would not go out. Having a dog that needs about a lot of problems," Green said, "and the food, the water, and she sits in the front to go out for exercise and do his duty and things, that gets me out." Darcy has for years been battling the VA, which has refused to cover expenses related to his service dogs. Darcy says officials there
have told him they don't believe his physical issues rise to the level of requiring a service dog and that his service dog doesn't meet the VA's service dog qualifications because Darcy trains them himself, which he said his father taught him to do growing up. There isn't a standard certification for service dogs in the U.S., which some have said is problematic. In Fehling's mind, the fact that anyone can go out and buy a service dog vest undermines those who have truly worked to train their dogs to assist with their disabilities. "It's totally bizarre," he said. Under the Americans with Disabilities Act, a service dog must be trained to do work or perform tasks that are related to its owner's disability. That can create a tricky situation. Green, the Kaiser Permanente researcher, said in her study, the most important thing the service dogs did for the veterans was waking
them up during nightmares and licking or nudging them to pull them out of a flashback while they were awake. Those aren't necessarily commands you teach dogs, but
Page 34
some of those are not being addressed with the VA's commands." Yount agreed that's a crucial task for the service dogs of veterans with PTSD, but it's not always one that needs to be taught. Sometimes it happens naturally due to the bond between the dog and its owner.
seat, side by side, and they look like two kids running off to play," she said. "I don't know where he'd be without her." In the months before getting Zoey, Angela
said, her husband fell into a dark place, and ended up not being able to work anymore. He couldn't sleep at night, and the flash-
"From my experience, the dog loves you backs were nonstop, she said. and the dog comes over and says, 'Dad, Meanwhile, the medications his VA physiwhat's going on?'" he said. "It's not only wak- cian had him on made him angry. A friend ing you up; it's offering comfort."
'He's a battle buddy' The use ofservice dogs for mental conditions is a much newer development than for physical conditions, Yount said, and it requires a new way of looking at the issue. Not all of the benefits are trained. Research long ago established the mutual release of the hormone oxytocin in both humans and dogs when they come into contact with one another, he said, such as when a dog comes over and leans against its owner, for
example. "What a self-licking ice cream cone," Yount said. "Good stuff." Tom Imholt's dog, Zoey, is well-trained already in the six months since he adopted her from a shelter in California. But aside from the commands, his wife, Angela Imholt, said it's the affection and the daily hikes that help
on the same regimen stopped breathing in his sleep. By the time Tom landed in inpatient treatment, a physician there told him
he should be dead because he was combining his medications with alcohol. No one at the VA had told him he couldn't, Angela said.
Even when he told his VA physician he wanted to lower his Vicodin dosage, they just sent more pills.
"They just kept shoving pills at him," she said, "and they would just mail them to him in the mail like it was no big deal." Being in combat zones and seeing what people do to one another can make veterans lose touch with the things they once loved,
Coleman said. Bull has helped bring joy back into his life, he said. "He's a battle buddy," he said. "He helps me and I help him. It's kind of like how it was
when we were over in Iraq. You depended on the man to the left and the right of you." â&#x20AC;˘
SPRING/SUMMER 2015â&#x20AC;˘ HIGH DESERTPULSE
ING SUPPLEMENT
2 015 C E N T RA L O R E G O N
Your
S o u r c e f o r Lo c a l H e a l t h S e r v i c e s a n d Ex p e r t M
e ssi o n a l s
To list your medical office andv'or physicians in the PULSE/Connections Medi
Kylie V i g e l a n d ,
A c c o u n t E x e c u t i v e ( H e a lt h Bc Med i c al) • s•
•
•
ADULT FOSTER CARE
Absolute Serenity Adult Foster Care
ALLERGY8r,ASTHMA
Bend Memorial Clinic
LZHEIMERSEGD
ASSISTED LIVING UDIOLOG BEHAVIORAL HEALTH ANCER CARE CARDIOLOGY ARDIOLOGY COSMETIC SERVICES
ERMATOLOGY
DERMATOLOGY (MOHS)
541-588-6119
119 • Rope St.• Sisters
Bend Old Mill Districtgt Redmond
5 4 1 - 382-4900
wwwabsoluteserenity info
www b endmemorialdinic.com
kdal 1'
a re rt ge r o o a
Brookside Pl ace
c n lo
3550 SW Canal Blvd.• Redmond 5
AI H ' A'dcl'
A d' 1
St. Charles Behavioral Health
St Ch 1
C
'
B dgtR d
d
C
41- 5 0 4-1600
gt
41-7 0 6 -7730 w 541 706 5800
Bend Memorial Clinic
Bend Eastside gt Redmond
541-382-4900
St. Charles Heart gt Lung Center
2500 • E Neff Rd.• Bend
541-388-4333
Bend Memorial Clinic
2450 NE Mary RosePl., Suite 220 • Bend 541-382-4900 w en
'
www.ccliving.com
1
541 647 2894
2542 • E Courtney Dr.• Hend 5
I tamson t., utt e
DENTURISTS
ontact...
17. 7855
d' 1
ww. s tcharleshealthcare.org
tch 1 h lth ww w b endmemorialdinic.com www.stcharleshealthcare.org wwb e ndmemorialdinic.com
541-388-4444
www.changeyoursmile.com www.raordenturecenter.com
Sisters Denture Specialties
161 E Cascade Ave.• Sisters
541-549-0929
Bend Dermatology Clinic
2747 • E Conners Dr.• Hend
541-382-5712
.bendderm.com
2747 • E Conners Dr.• Hend
541-382-5712
www.bendderm.com
Bend Dermatology Clinic
emona mtc.com
ENDOCRINOLOGY NDOCRINOLOGY ENDOCRINOLOGY AMILY MEDICIN FAMILY MEDICINE
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
EndocrinologyServicesNW
29 SW Simpson Ave., Suite 220• Bend 541-317-5600 1001 NW Canal Blvd.• Redmond
EndocrinologyNW Redmond Bend Memorial Clini
n/a
541-323-1400
ocations in Bend, Redmond gt Sisters 541-382-4900
Central Oregon Family Medicine
wwb e ndmemorialdinic.com
n/a wwwbendmemorialdinic.com
645 NW 4th St.• Redmond
541-923-0119
www.cofm.net
480 NE A St.• Madras
541-475-4800
www.stcharleshealthcare.org
AMILY MEDICIN
St. Charles Family Care
FAMILY MEDICINE
St. Charles Family Care
AMILY MEDICIN
St. Charles Family Care
103 • E Elm St.• Prineville
541-447-6263
www.stcharleshealthcare.org
FAMILY MEDICINE
St. Charles Family Care
211 NW Larch Ave.• Redmond
541-548-2164
www.stcharleshealthcare.org
30 ArrowleafTrai • Sisters
541-549-1318
www.stcharleshealthcare.org
AMILY MEDICIN
2965 NE Conners Ave., Suite 127• Bend 541-706-4800
St. Charles Family Care
FAMILY PRACTICE
High Lakes Health Care - Upper Mill
929SWSimpson,Suite300• Bend 5 4 1 - 3 89-7741 w
FAMILY PRACTICE
High Lakes Health Care - Shevlin
2175 NW Shevlin Park Rd.• Bend
AMILY PRACTIC FAMILY PRACTICE ASTROENTEROLOGY GASTROENTEROLOGY
H ghLak H
B dM
d
1Ch
mb
d l o n D e n tistry
Charles Surgical Specialists tl e ni o
ERIATRI ARE MANAGEMEN
a
d
High Lakes Health Care - Upper Mill Hi
236NWK' gw d A
Rd
d
345 W. Adams Ave.• Sisters 5
541 548 7134
L a kes Health Care - Redmond
wwwhighlakeshealthcare.com
h'ghl k h lth
.b d
2239 NE Doctors Dr., Suite 100• Bend 541-728-0535 'mroc
wwh i g hlakeshealthcare.com
41-5 4 9 - 9609 w wwh i g hlakeshealthcare.com
d 1
Gastroenterologyof Central Oregon
GENERAL SURGERYA, BARIATRICS St.
OL
R dm
High Lakes Health Care - Sisters
ENERAL DENTISTRY
GYNECOLOGY
l t hC
541-389-7741
www.stcharleshealthcare.org
ay • edmon
4- 2
1245 NW 4th St., Suite 101• Redmond 54 1 - 548-7761 'ng Deschutes unty
www.gastrocentraloregon.com ombe-jon o www.stcharleshealthcare.org aulBattle.com
929SWSimpson,Suite300• Bend 5 4 1 - 3 89-7741 w 1001 NW Canal Blvd.• Redmond
ld
541-504- 635
wwh i g hlakeshealthcare.com
www h ighlakeshealthcare.com
0 15 CEN T RA L O R E G O N
M E D I CAL DI R A*. •
•
A •
HERNIA SURGERY OME HEALTH SERVICES HOME HEALTH SERVICES OSPICE/HOME HEALTH HOSPICE/HOME HEALTH OSPICE/HOME HEALTH HOSPITAL
Bend Hernia Center
2450 • E Mary Rose Pl.• Bend
541-383-2200
wwwbendherniacenter.com
St. Charles Home Health
2500 • E Ne R . • Ben
541-706-7796
www.st ar es ealthcare.org
Partners In Care Home Health
2075 • E Wyatt Ct.• Bend
541-382-5882
www.partnersbend.org
732 SW 23rd St.• Redm d
541-548-7483
2075 • E Wyatt Ct.• Bend
541-382-5882
www.partnersbend.org
541-706-7600
www.stcharleshealthcare.org
470 • E A St. • Madras
541-706-7796
www.stcharleshealthcare.org
Pioneer Memorial Hospital
201 • E Elm St.• Prineville
541-447-6254
www.s charleshealthcare.org
St. Charles Bend
2500 • E Neff Rd.• Bend
541-382-4321
www.stcharleshealthcare.org
1253 • E Cana 8 v . • Re mon
41-706-7796
www.stcharleshealthcare.org
Hospice of Redm d Partners In Care Hospice
Bend, Redmond, La Pine, Prineville,
St. Charles Hospice
Madras, St Sisters
St. Charles Madras
OSPITAL HOSPITAL OSPITA
t . Charles e
HYBERBARIC OXYGEN THERAPY
MAGING SERVICES IMMEDIATE CARE MMEDIATE CARE IMMEDIATE CARE MMEDIAT ARE INFECTIOUS DISEASE NFECTIOUS DISEASE
ond
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
Bend Memorial Clinic NOWcare High Desert Family Medicine ttt Immediate Care Mountain Medical Immediate Care
h I
541-322-2273
www.thecenteroregon.com
57067 Beaver Dr.• Sunriver
541-593-5400
n/a
1302 NEThird St.• Bend
541-317-0909
www.mtmedgr.com
MEDICAL CLINIC EDICAL CLINIC
236NWK'
Bend Memorial Clinic
EDICAL CLINIC
end Memorial Clinic
UTRITION
GYN
GYNECOLOGY CCUPATIONAL MEDICINE OCCUPATIONAL MEDICINE CCUPATIONAL MEDICINE OCCUPATIONAL MEDICINE NCOLOGY -MEDICAL OPHTHALMOLOGY
.y rcaremedical m ww w b endmemorialdinic.com
541 706 7717
2450 NE Mary RosePl. Suite 200 • Bend 541-382-4900
The Center: Orthopedic S Neurosurgical Care S Research
. g
w w c enterforintegratedmed.com
ww w h ighlakeshealthcare.com
.h'ghl k h lth ww.r edmondmedical.com
www .st areshealthcare.org ww w b endmemorialdinic.com
.b d
end Memorial Clinic
OBSTETRICS 8r, GYNECOLOGY
541 54 8 7 1 34
1080 SW Mt. Bachelor Dr.• Bend (West) 541-382-4900
Bend Memorial Clinic
NEUROSURGERY
ETR
tr
'al Clinic
Bend Memorial Clinic
EUROLOGY
541-389-7741 d
I h
MEDICAL CLINIC
NEPHROLOGY
d A . Rd
ww w b endmemorialdinic.com
ch 1 h lt h
1245 NW4th St., Suite 201• Redmond 541-323-4545 w
Bend Memorial Clinic
Bend M
541-382-4900
929 SW Simpson Ave.• Bend
Ith C
Redmond Medical Clinic
d
-28
916 SW 17th St., Suite 202• Redmond 541-504-0250 w
s
MEDICAL CLINIC
4-
• dm o
d
High Lakes Health Care Upper Mill H'gh Lak H
, Suit
f
INTERNAL MEDICINE
INTERNAL MEDICINE
2200 • E Neff Rd.• Bend
Locations in Bend 8a Redmond
Center for Integrated Medicine
NTERNAL MEDICINE
541-382-4900
Is
INTEGRATED MEDICINE
wwb e ndmemorialdinic.com
Locations in Bend 8a Redmond
Ca Bend Memorial Clinic
.redm dhospic .
Id
wwwbendmemorialdinic.com
.bendme rialdinic.
231 East Casca es Ave.• Sisters
541-706-5440
865 SW Veterans Way• Redmond
541-382-4900
ww w b endmemorialdinic.com
15 SW Bond St.• Bend
541-382-4900
ww w b endmemorialdinic.com
Locations in Bend 8a Redmond
541-382-4900
ww w b endmemorialdinic.com
Bend estside 8a Redmon
541-382-4900
ww w b endmemorialdinic.com
2200 • E Neff Rd.• Bend
541-382-3344
www.thecenteroregon.com
Bend Memorial Cliinc
1 01 E
Ea st Cascade Women's Group, P.C.
2400 • E Neff Rd., Suite A• Bend
541-389-3300 w ww.eastcascadewomensgroup.com
St. Charles Center or Women s Heal
Locations in Re mon 8a Prinevi e
541-526-6635
High Lakes Health Care - Upper Mill
929 SW Simpson, Suite 300• Bend 5 4 1 - 3 8 9-7741
wwwhighlakeshealthcare.com
Bend Old Mill District, Redmond gt Sisters 541-382-4900
www b endmemorialdinic.com
Bend Memorial Clinic
wwwbendmemonaldintc.com
e d ical enter r,• en d
www.st ar es ealthcare.org
The Center: Orthopedic S Neurosurgical Care S Research
2200 • E Neff Rd.• Bend
541-382-3344
www.thecenteroregon.com
Mountain Medical Immediate Care
1302 • E Third St.• Bend
541-317-0909
www.mtmedgr.com
Your Care
3818 SW 21st Pl., Suite 100• Redmond 54 1 -548-2899
wwwyourcaremedical.com
Bend Memorial Clinic
Bend Eastside 8a Redmond
541-382-4900
ww w b endmemorialdinic.com
Bend Memorial Clinic
Bend Eastside 8a Redmond
541-382-4900
ww w b endmemorialdinic.com
PPLEMENT
0 15 CEN T RA L O R E G O N A
•
PTOMETRY OPTOMETRY T
I
ORTHOPEDICS RTHOPEDIC
M E D ICAL DI R
I
Bend Memorial Clinic
Bend Eastside Westside 8aRedmond 5 4 1 -382-4900
Integrated Eye Care
541-382-5701
www.iebend.com
O'Neill Orthodontics
Bend Sunriver
541-323-2336
www.oneillortho.com
Desert Orthopedics
Locations in Bend 8a Redmond
541-388-2333
www.desertorthopedics.com
The Center:Orthopedic s Neurosurgical Care sResearch 2 2
Deschutes Osteoporosis Center
PALLIATIVE CARE
Partners In Care Palliative Care
EDIATRIC DENTISTR
EDIATRICS
D ch
P ch
D
2075 • E Wyatt Ct.• Bend 5
High Lakes Health Care Upper Mill
PHYSICAL MEDICINE
Desert Orthopedics
PHYSICAL THERAPY ODIATRY PULMONOLOGY ULMONOLOGY RADIOLOGY EHABILITATION RHEUMATOLOGY HEUMATOLOGY
d ch
SLEEP MEDICINE
541-548-2164
www.stcharleshealthcare.org
2175 NW Shevlin Park Rd.• Bend
541-389-7741
wwwhighlakeshealthcare.com
2 200 • E • ff Rd B
E
D
SURGICAL SPECIALIST URGICAL SPECIALIST URGENT CARE RGENT CARE URGENT CARE RGENT CARE UROLOGY ROLOGY VASCULAR SURGERY EIN SPECIALIST VEIN SPECIALISTS
Healing Bridge Physical Therapy
d
404 • E Penn Ave.• Bend Offi i n Bend, Redmond 8a Mad
Bend Memorial Clinic St. Charles Heart gt Lung Center
54 1- 3 8 8-233 3
www . desettorthopedics.com
541 -382-3344
www. t hecenteroregon.com
541-382-3344
www.thecenteroregon.com
5 4 1382 490 0
www b endmemorialdinic.com
541-318-7041
wwwhealingbridge.com
541-388-2861
Bend Eastside 8a Redmond
541-382-4900
Locations in Bend 8a Redmond
541-706-7715
Central Oregon RadiologyAssociates, P.C.
14 60 • E Medical Center D.r • Bend 5 4 1 - 382-9383
S . harles Rehabilitation Cen er
ocations inBend,Redmond, Prineville, gtMadras 541-706-7725
Bend Memorial Clinic
2200 E ef'fRd., uite 302 • end
541-706-6905
Locations in Ben 8a Re mon
St. Charles Surgical Specialists
541-548-7761
Prineville • Redmond
Bend emorial Clitnc
1501 • EMe ica Center Dr.• Ben
Bend Memorial Clinic
www.stcharleshealthcare.org www.corapc.com
ww w b endmemorialdinic.com
8 w ww.deschutesrheumatology.com
1080 SW Mt. Bachelor Dr.• Bend (West) 541-382-4900
St. Charles Sleep Center
www.cascadefoot.com ww w b endmemorialdinic.com
www.s charleshealthcare.org
541-382-4900
Bend Eastside 8a Redmond
Bend Memorial Clinic
kd
211 NW Larch Ave.• Redmond
1501 • E Medical Center Dr. Bend
eschutes eumatology
www.partnersbend.org
wwwbendmemorialdinic.com
The Center: Orthopedic S Neurosurgtcal Care S Resear
Cascade Foot Clini
w w dtschutesosteoporosiscentercom
541-382-4900
Locations in Bend 8aRedmond
Bend Memorial Clinic
.thecenteroregon.com
815 SW Bond St.• Bend
PHYSICALMEDICINE/REHABILITATION The Center:Onhopedics NeurosurgicalCares Research Locations in Bend 8a Redmond
HYSICAL MEDICINE/REHABILITATION
4 1-3 82 - 5 8 82
h dl
ry
St. Charles Family Care
541-382-3344
00 • E Neff Rd. • Bend
2200 • E Neff Rd., Suite 302• Bend 5 4 1 - 388-3978 w
Bend Memorial Clinic
PEDIATRICS
HYSICAL MEDICINE
www b endmemorfaldfnfc.com
452 • E Greenwood Ave.• Bend
OSTEOPOROSIS
PEDIATRICS
AWWs
ww w b endmemorialdinic.com www.st ar es ealthcare.org www.stcharleshealthcare.org
41-382-4900
www b endmemonaldinic.com
Locations in BendtEast 8t Old Mill District) 8t Redmond
541-382-4900
ww w b endmemorialdinic.com
1302 NEThird St.• Bend
541-317-0909
www.mtmedgr.com
NOWcare
2200 • E Neff Rd.• Bend
541-322-2273
www.thecenteroregon.com
St. Charles Immediate Care
2600 • E Neff Rd.• Bend
541-706-3700
www.stcharleshealthcare.or
Locations in Bend 8a Redmond
541-382-6447
www.bendurology.com
Mountain Medical Immediate Care
Bend Urology Associates Uro o S
ec i i sts o Ore on
Bend Memorial Clinic
1501 NE Medical Center Dr.• Bend
Inovta Vein pectalty Center
2200 E
Bend Memorial Clinic •
A
DAM WILLIAMS, MD
Bend Memorial Clinic
STEPHEN ARCHER, MD
Bend Memorial Clinic
Locations in Bend, Redmond, 8t Prineville 541-322-5753
•
•
•
A
•
815 SW Bond St.• Bend
www.uro o inoregon.com ww w b endmemorialdinic.com wwwbendvem.com
e f f Rd., uite 204• e n
1501 NE Medical Center Dr.• Bend •
541-382-4900
541-382-4900
ww w b endmemorialdinic.com
541-382-4900
ww w b endmemorialdinic.com
•
1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialdinic.com
PPLEMENT
0 15 CEN T RA L O R E G O N
M E D ICAL DI R
NGOCTHUY HUGHES, DO, PC S t . Charles Surgical Specialists
NICOLE O'NEIL,PA-C
REN CAMPBELL PHD BRIAN EVANS, PSYD
Bend Memorial Clinic
A%W N
1245 NW 4th St. Suite 101• Redmond 541-548-7761 w
ww. s tcharleshealthcare.or
1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialdinic.com
Charles Behavioral
• end
tney
St. Charles Behavioral Health
2542 • E Courtney Dr.• Hend
charleshealthca rg 541-706-7730
ch l h
harles ehavtoral ealth
WENDY LYONS, PSYD
St. Charles Family Care
h I JAMES PORZELIUS, PHD
al
211 NW Larch Ave.• Redmond
al h
St. Charles Behavioral Health
EBECCA SCRAFFORD, PSYD S . Ch I B SCOTT SAFFORD, PHD
h
h ' al H a l t h
St. Charles Family Care
.
y
2542 • E Courtney Dr.• Hend 5 2 542 • E C
HILO TIPPETT, PHD I
I
541-548-2164
d
D. H d
41-7 0 6 -7730 w 5 41 706 7 7 3 0
7
S t. Charles Family Care St. Charles Family Care
211 NW Larch Ave.• Redmond 5
lth
www . stcharleshealthcare.org
ch l h
2965 NE Conners Ave., Suite 127• Bend 541-706-7730 w
AURA SHANK, PSYD KIMBERLY SWANSON, PHD
www . stcharleshealthcare.org
lth
ww. s tcharleshealthcare.org
ch l h
lth
ww. s tcharleshealthcare.org
77
41-5 4 8 -2164 w
wwst c harleshealthcare.org
480 • E A St.• Madras
541-475-4800
www . stcharleshealthcare.org
2500 • E Neff Rd.• Bend
541-388-4333
www . stcharleshealthcare.org
I
HUGH ADAIR III, DO EAN BROWN, PA-C
St. Charles Heart gt Lung Center en
em o r t a
tuc
KIMBERLY CANADAY, ANP-BC
Be nd Memorial Clinic
WHITNEY DREW, PA-C
Bend Memorial Clinic
ung en er
1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w e
,
wwb e ndmemorialdinic.com www.st ar es ea care.or
en
1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialdinic.com
ARY FOSTER, M
St. Charles Heart gt Lung Center
2500 • E Neff Rd, end
541-388-4333
www.stcharleshealthcare.org
NANCY HILLES, NP
St. Charles Heart gt Lung Center
2500 • E Neff Rd.• Bend
541-388-4333
www.stcharleshealthcare.org
S . harles Hear gt Lung Cen er
2500 • E Neff Rd,• end
541-388-4333
www.s charleshealthcare.org
Bend Memorial Clinic
Bend Eastside gt Redmond
541-382-4900
HEROLYN JENNART PA-C RICK KOCH, MD
ww w b endmemorialdinic.com
AMES LAUGHLIN,MD
St. Charles Heart gt Lung enter
00 • E Neff Rd,• end
541-388-4333
www.stcharleshealthcare.org
BRUCE MCLELLAN, MD
St. Charles Heart gt Lung Center
2500 • E Neff Rd.• Bend
541-388-4333
www.stcharleshealthcare.org
2500 • E Neff R . • Ben
41-388-4333
www.stcharleshealthcare.org
2500 • E Neff Rd.• Bend
541-388-4333
www.stcharleshealthcare.org www, en memoria inic.com
. GANESH MUTHAPPAN MD ALLEN RAFAEL, MD AN RIDDOCK MD
t . Charles eart
ung e n t er
St. Charles Heart gt Lung Center
Ben Memoria C 'nic
1501 • E Medical Center Dr.• Bend 5 4 1 - 3 8 2-4900
STEPHANIE SCOTT, PA-C
Bend Memorial Clinic
1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w
MICHAEL WIDMER MD
St. Charles Heart gt Lun Center
2500 • E Neff Rd.• Bend
541-388-4333
www.stcharleshealthcare.or
EDDY YOUNG, MD
St. Charles Heart gt Lung Center
2500 • E Neff Rd.• Bend
541-388-4333
www.stcharleshealthcare.org
MARIE RUDBACK, DC
Endeavor Chiropractic
ORD
, MSC,
THERESA M. RUBADUE,DC,CCSP
RADLEY E. JOHNSON,DMD
ALYSSA ABBEY, PA-C
ww . endeavorchiropractic.com
NorthWest Crossing Chiropractic Health
62 8 NW York Dr. Suite 104 • Hend 5 4 1 - 3 88-2429
www,nwxhealth,com
NorthWest Crossing Chiropractic gt Health
628 NW York Dr., Suite 104 • Bend 54 1 - 388-2429
www,nwxhealth,com
ASON M. KREMER,DC,CCSP,CSCS Wellness Doctor
MICHAEL R. HALL, DDS
2275 • E Doctors Dr., Suite 11• Hend 541-248-4476 w
wwb e ndmemorialdinic.com
1345 NW Wall St., Suite 202• Bend 5 4 1 - 318-1000 w
wwb e ndwellnessdoctorcom
Central Oregon Dental Center
1563 NW Newport Ave.• Hend 5
41-3 8 9 -0300 w w wcentraloregondentalcenter.net
Cont e mporary Family Dentistry
1016 NW Newport Ave.• Bend 5
41-3 8 9 -1107 w w w.contemporaryfamilydentistry.com
Bend Memorial Clinic
2450 NE MaryRosePl., Suite 220 • Bend 541-382-4900 w
wwb e ndmemorialdinic.com
PPLEMENT
0 15 CEN T RA L O R E G O N WILLIAM DELGADO,MD, (MOHS) HA
M E D ICAL DI R
Bend Dermatology Clinic CentralOregon Dermatology
FRIDOLIN HOESLY,MD AMES M. HOESLY MD
Bend Dermatology Clinic Bend Memorial Clinic
A%NW
2747 • E Conners Dr.• Hend
541-382-5712
388 SW H u Dr. • Hen
541-678-0020
2747 • E Conners Dr.• Hend
541-382-5712
www.bendderm.com w ww.centra oregon ermato ogy.com
2450 NE M Rose Pl., Suite 220• Bend 541-382-4900 w
www.bendderm.com wwb e ndmemorialdinic.com
JOSHUA MAY, MD
Bend Dermatology Clinic
2747 • E Conners Dr.• Hend
541-382-5712
KRISTIN NEUHAUS MD
Bend Dermatology Clinic
2747 • E Conners Dr.• Hend
541-382-5712
GERALD PETERS,MD,FACMS(MOHS)
Bend Memorial Clinic
2450 NE MaryRosePl., Suite 220 • Bend 541-382-4900 w
wwb e ndmemorialdinic.com
Bend Memorial Clinic
2450 NE MaryRosePl. Suite 220 • Bend 541-382-4900 w
wwb e ndmemorialdinic.com
N M. REITAN PA-C ALLISON ROBERTS, PA-C EPHANI
MAN, M
LARRY WEBER, PA-C LIVER WISCO, DO (MOHS) I I
'
I
Bend Dermatology Clinic e D e rmatology Cli
2747 • E Conners Dr.• Hend nners
• e
541-382-5712 -3
-
www.bendderm.com www.bendderm.com
www.bendderm.com endderm.
2
Bend Dermatology Clinic
2747 • E Conners Dr.• Hend
541-382-5712
Ben d Memorial Clinic
815 SW Bond St.• Bend
541-382-4900
www.bendderm.com ww w b endmemorialdinic.com
I
MARY F. CARROLL, MD ICK N.GOLDSTEIN, MD
Bend Memorial Clinic
B dM
I Ch
TONYA KOOPMAN, MSN, FNP-BC Bend Memorial Clinic
TRAVIS MONCHAMP, MD
EndocrinologyServices NW
CAREY ALLEN, MD
St. Charles Family Care
EIDI ALLEN
t.
HRISTINA ANDERSON, PA C High Lakes Health Care Shevlin St. Charles Family Care
THLEEN C. ANTOLAK, MD
wwb e ndmemorialdinic.com
.b d
d 1 1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
n/a
929 SW Simpson Ave., Suite 220• Bend 541-317-5600
1103 • E Elm St.• Prineville 5
4 1-4 4 7 - 6263
Id
wwb e ndmemorialdinic.com
wwwst c harleshealthcare.org
a r es a n n y a r
THOMAS L. ALLUMBAUGH, MD St. Charles Family Care
SONI ANDREINI, MD
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
d
I h
211 NW Larch Ave.• Redmond 5
2175 NW Sh 1' P k Rd. • B d 5 630 • ArrowleafTrail • Sisters
41-5 4 8 -2164 w
41 3 8 9 7741 w wwh i ghlakeshealthcare.com 541-549-1318
www .stcharleshealthcare.org
www.stcharleshealthcare.org
.b d
d 1
JOSEPH BACHTOLD, DO
St. Charles Family Care
630 ArrowleafTrail • Sisters
541-549-1318
EFFREY P.BOGGESS, M
end Memorial Clinic
815 SW Bond St.• Bend
541-382-4900
1103 • E Elm St.• Prineville
541-447-6263
SHANNON K. BRASHER, PA-C St. Charles Family Care
wwst c harleshealthcare.org
Id
ww w b endmemorialdinic.com www.stcharleshealthcare.org
EGHAN BRECKE, DO
S . harles amily Care
965 NE Conners Ave., Suite 127• Bend 541-706-4800
www.s charleshealthcare.org
NANCY BRENNAN, DO
St. Charles Family Care
2965 NE Conners Ave., Suite 127• Bend 541-706-4800
www.stcharleshealthcare.org
ILLIAM C. CLARIDGE, MD MATTHEW CLAUSEN, MD RRI MAY S. FAN, MD AMIE FREEMAN, PA-C
JESSICA GATTO, FNP ETTE GAYNOR, FPN-C
St. Charles amily Care St. Charles Family Care
Larch ve. • Redmond
541-548-2164
2965 NE Conners Ave., Suite 127• Bend 541-706-4800
www.stcharleshealthcare.org www.stcharleshealthcare.org
2175 NWS evin Par R . • Hen
541-389-7741
www, igh a es ealthcare.com
Bend Memorial Clinic
231 East Cascades Ave.• Sisters
541-549-0303
ww w bendmemorialdinic.com
High Lakes Health Care Upper Mill
929 SW Simpson ve, • end
541-389-7741
wwwhighlakeshealthcare.com
High Lakes Health Care Upper Mill
929 SW Simpson Ave.• Bend
541-389-7741
wwwhighlakeshealthcare.com
630 rrowlea Trail • tsters
41- 49-1318
Hi L
e sHe al C a re - Shevlin
t. Charles amily are
2965 NE Conners Ave., Suite 127• Bend 541-706-4800
www.stcharleshealthcare.org
MARK GONSKY,DO
St. Charles Family Care
NATALIE GOOD,DO
St. C ar es Fami Care
1103 • E E m St.• Prinevi e
541-447-6263
www.st ar es ea care.or
BRIANNA HART, PA-C
St. Charles Family Care
211 NW Larch Ave.• Redmond
541-548-2164
www.stcharleshealthcare.org
645 NW 4th St.• Redmond
541-923-0119
www.cofm.net
Bend Memorial Clinic
865 SW Veterans Way• Redmond
541-382-4900
ww w b endmemorialdinic.com
Hi
2175 NW Shevlin Park Rd.• Bend
541-389-7741
wwwhighlakeshealthcare.com
ARGARET4PEGGY4 HAYNE FNP Central Ore on Famil Medicine
ALAN C.HILLES, MD EIDI HOLMES PA-C
L a kes Health Care - Shevlin
www.stcharleshealthcare.org
PPLEMENT
0 15 CEN T RA L O R E G O N LYNN HUGHES, FNP E, SING-WEI HO, MD L
. RB, D
PAUL JOHNSON, MD
The Ross Clinic
RAIG LAWS, M
,.Wkir,ir, ai%NW
336 SW BlackButte Blvd.• Redm ond 541-504-7781
Central Oregon Family Medicine
541-923-0119
www.cofm.net
St. Charles Family Care
211 NW Larch Ave.• Redmond
541-548-2164
www.stcharleshealthcare.org
St. Charles Family Care
211 NW Larc Ave. • Re mon
541-548-2164
www.st ar es ealthcare.org
High Lakes Health Care Upper Mill
929 SW Simpson Ave.• Bend
541-389-7741
wwwhighlakeshealthcare.com
929 SW Stmpson Ave.• Ben
41-389-7741
wwwhighlakeshealthcare.com
1103 • E Elm St.• Prineville
541-447-6263
L es ea lth a re Upper ill St. Charles Family Care Bend emorial Clitnc
81
St. Charles Family Care
INNELL LEWIS,MD
St. Charles amily are
4 80 E
CHARLOTTE LIN, MD
Bend Memorial Clinic
815 SW Bond St.• Bend
STEVE MANN, DO OE T. MC COOK,MD G. BRUCE MCELROY,MD ORI MCMILLIAN, FNP
High L es Health Care - edmond
High Lakes Health Care Upper Mill St. Charles amily Care Central Oregon Family Medicine Re mond Medkcal Clinic
41-382-4900
B o n d t, • end
PETER LEAVITT, MD
E LOVERINK, MD
www.therossclinic.com
645 NW4t St. • Re mon
AVID KELLY, MD
MAGGIE J. KING, MD
M E D ICAL DI R
2965 NE Conners Ave., Suite 127• Bend 541-706-4800 t. •
ww w b endmemonaldimc.com www.stcharleshealthcare.org www.stcharleshealthcare.org
a ra s
541-382-4900
ww w b endmemorialdinic.com
wwwhighlakeshealthcare.com
• W Kingwood ve. • Redmond 929 SW Simpson Ave.• Bend
www.stcharleshealthcare.org
541-389-7741
wwwhighlakeshealthcare.com
541-548-2164
www.stcharleshealthcare.org
Larch ve. • Redmond
541-923-0119
645 NW 4th St.• Redmond
1245 NW 4th St., Suite 201• Redmond 54 1 -323-4545
www.cofm.net
www.redmon medical.com
EDEN MILLER, DO
High Lakes Health Care Sisters
354 W Adams Ave.• Sisters
541-549-9609
ww w h ighlakeshealthcare.com
EVIN MILLER,DO
High Lakes Health Care Sis ers
354 W Adams ve, • isters
541-549-9609
ww w h ighlakeshealthcare.com
2175 NW Shevlin Park Rd.• Bend
541-389-7741
wwwhighlakeshealthcare.com
211 NW Larch Ave.• Redmond
541-548-2164
www.s charleshealthcare.org www.stcharleshealthcare.org
JESSICAMORGAN, MD ANIEL J. MURPHY, MD
High Lakes Health Care - Shevlin S . Charles amily Care St. Charles Family Care
480 • E A St.• Madras
541-475-4800
HERYL L. NORRIS, MD
S . harles amily Care
211 NW Larch Ave.• Redmond
541-548-2164
www.s charleshealthcare.org
AUBREY PERKINS, FNP
St. Charles Family Care
211 NW Larch Ave.• Redmond
541-548-2164
www.stcharleshealthcare.org
ANEY PURVIS, MD
end Memorial Clinic
815 SW Bond St.• Bend
541-382-4900
NATHAN REED, DO
St. Charles Family Care
1103 • E Elm St.• Prineville
541-447-6263
929 SW Simpson Ave.• Bend
541-389-7741
wwwhighlakeshealthcare.com
815 SW Bond St.• Bend
541-382-4900
ww w b endmemorialdinic.com
AIMEE NEILL,MD
EVIN RUETER, MD DANA M. RHODE, DO OHN K. ROSS, MD HANS G. RUSSELL, MD
RIC J. SCHNEIDER, MD LINDA C. SELBY, MD INDY SHUMAN, PA-C PATRICK L. SIMNING, MD
High Lakes Health Care Upper Mill Bend Memorial Clinic The Ross Clinic
336 SW Black Butte Blvd.• Redmon 5 4
DWARD M. TARBET, MD AMY TATUM, FNP OHN D. TELLER, M NATHAN R.THOMPSON, MD
wwb e ndmemorialdinic.com
end Memorial Clinic
1501 • EMedical Cen er Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialdinic.com
St. Charles Family Care end Memorial Clinic Bend Memorial Clinic
1103 • E Elm St.• Prineville
541-447-6263
815 SW Bond St.• Bend
541-382-4900
1501 NE Medical Center Dr.• Bend 5 4 1 - 3 8 2-4900 w
www.stcharleshealthcare.org ww w b endmemorialdinic.com wwb e ndmemorialdinic.com
7067 Beaver Dr. Sunnver
541-593-540
n/a
St. Charles Family Care
480 • E A St.• Madras
541-475-4800
www.stcharleshealthcare.org
end Memorial Clinic
815 SW Bond St.• Bend
541-382-4900
ww w b endmemorialdinic.com
St. Charles Family Care
211 NW Larch Ave.• Redmond
541-548-2164
www . stcharleshealthcare.org
Bend M
'al Clinic
St. Charles Family Care a
Tn c
High Lakes Health Care - Shevlin
CINDI WARBURTON, FNP, DNP St. Charles Family Care
HOMAS A. WARLICK, MD
www.therossclinic.com
1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w
en
LISA URI, MD
www.stcharleshealthcare.org
Bend Memorial Clinic
ANIEL M. SKOTTE, SR. DO., P.C. High esert Family Medicine gt Immediate Care
PATRICIA SPENCER, MD
1- 5 0 4-7781
ww w b endmemorialdinic.com
B dM
' I Cli
1501 • E Medical Center Dr.• Bend 5 4 1 - 3 8 2-4900 211 NW Larch Ave.• Redmond 5
41-5 4 8 - 2164
1501 • EMe tcal Center Dr.• Hend 5 4 1 - 3 8 2-4900
2175 NWShevlin Park Rd.• Bend 5 4 1 - 3 89-7741 w
2965 NE Conners Ave., Suite 127• Hend 541-706-4800
1501 • EM d' l C
D. 8 d
5 41 3 8 2 4 9 00
.bendme rialdinic. www.stcharleshealthcare.org
bendme nald mtc wwh i ghlakeshealthcare.com
www.stcharleshealthcare.org
.b d
' Id'
PPLEMENT
2 015 CE N T RA L O R E G O N B RUCE N. WILLIAMS, MD
ICHARD H BOCHNER MD
M E D ICAL DI R 1103 • E Elm St.• Prineville 5
St. Ch a rles Family Care
Bend Memorial Clini
ELLEN BORLAND, MS, RN, CFNP Bend Memorial Clinic
RTHUR S CANTOR, MD HEIDI CRUISE, PA-C, MS E
AR
LL,
CHRISTINA HATARA, MD IDNEY
E N DERS I, M
SANDRA K.HOLLOWAY, MD LENN KOTEEN, MD
' 1Cli
B d M
4 1-4 4 7 - 6263
wwb e ndmemorialdinic.com
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialdinic.com
D
8 d
5 41 3 82 4 9 0 0
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
emo r i a l i n i c
wwwst c harleshealthcare.org
1501 • E Medical Center Dr • Bend 5 4 1 - 3 82-4900 w
1 501 • EM d' 1 C t
Bend Memorial Clinic e
.;,(e (rA'(AWWh
E d i cal
n t er Dr, • end
4 - 8 -
.b d
' ld'
wwb e ndmemorialdinic.com
dmemorialdin' om
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialdinic.com
Ben dMemorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialdinic.com
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialdinic.com
Gastroenterologyof Central Oregon
2239 NE Doctors Dr., Suite 100• Bend 541- 2 8-0535
www.gastrocentraloregon.com
JENIFER TURK, PA-C
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialdinic.com
MATTHEW WEED, MD
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialdinic.com
OSVALDO A. SCHIRRIPA, MD, MS Central Oregon Clinical Genetics Center
ANE BIRSCHBACH, MD TAMMY BULL, MD USAN GORMAN, MD
MICHAEL KNOWER, MD ONIA THAKUR
LAURIE D'AVIGNON,MD ONLUTZ, MD REBECCASHERER, MD
OHN ALLEN MD JENESS CHRISTENSEN, MD
929 SW Simpson Ave. Suite 300• Bend 541-389-7741 w
wwh i g hlakeshealthcare.com
High Lakes Health Care Upper Mill
929 SW Simpson Ave., Suite 300• Bend 541-389-7741 w
wwh i g hlakeshealthcare.com
High Lakes Health Care Women's Center
ELSO A.GANGAN MD MICHAEL N. HARRIS, MD LIZABETH KAPLAN, PA-C ANNE KILLINGBECK,MD ITA D KOLISCH,MD MATTHEW R. LASALA, MD ADELINE LEMEE, MD MARY MANFREDI, MD . DEREK PALMER, MD
1001 NW Canal Blvd. • Redmond 5 4
2450 • E Mary Rose Pl.• Bend 5
St. Charles Hospic
1- 5 0 4-7635 w wwh i g hlakeshealthcare.com
41-3 8 3 -2200 w
541-706-6700
2500 • E Neff Rd,• end
wwbe n dherniacenter.com
www . stcharleshealthcare.org
St. Charles Hospice
1201 • E Elm St.• Prineville 5
41-70 6 - 6700 w
wwst c harleshealthcare.org
St. Charles Hospice
1253 NW Canal Blvd• Redmond 5
41- 7 0 6-6700 w
wwst c harleshealthcare.org
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w
end emortal htnc
edtcal enter r ,
St. Charles Infectious Disease
Bend Memorial Clini
Hi g hLakes Health Care Upper Mill
'gh CARRIE DAY, MD
www.cocgc.ofg
Hi L akes Health Care Upper Mill
MICHAELJ,MAS1'RANGELO ( MD( FACS Bend Hernia Center
ANK HORAK MD
14 3 SW Shevlin-Hixion Dr., Suite•203 Bend 541-678-5417
end
wwb e ndmemorialdinic.com
wwwbendmemonaldmtc.com
2965 Conners Ave., Suite 127• Bend 54 1 -706-4878 w
ww. s tcharleshealthcare.org
1501 • E Medical Center Dr • Bend 5 4 1 - 3 82-4900 w
wwb e ndmemorialdinic com
929 SWSimpson Ave.• Bend 5
41-3 8 9 - 7741 w wwh i g hlakeshealthcare.com
h'ghl k h lth
pp
High Lakes Health Care - Shevlin
2175 NW Shevlin Park Rd.• Bend
541-389-7741
wwwhighlakeshealthcare.com
Re mon Me ica Cinic
1245 NW 4th St., Suite 201• Redmond 54 1 -323-4545
www.re mon me ica.com
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w
wwb e ndmemorialdinic.com
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w
wwb e ndmemorialdinic.com
High Lakes Health Care - Redmond
236 NW Kingwood Ave.• Redmond 5 4 1 - 548-7134 w
wwh i g hlakeshealthcare.com
B dM
' 1Cli
8 65 SWV t
Bend Memorial Clinic
H'gh Lak H
lth C U
Rd
d
54 1 3 82 4 9 0 0
1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w
Mill
High Lakes Health Care Upper Mill Redmond Medical Clini
W
9 29 SWS'
A . B d
929 SW Simpson Ave.• Bend
5 41 3 8 9 7 7 4 1 541-389-7741
1245 NW 4th St., Suite 201• Redmond 54 1 -323-4545
b d
' ld'
wwb e ndmemorialdinic.com
h'ghl k h lth wwwhighlakeshealthcare.com www.redmondmedical.com
PPLEMENT
2 015 CE N T RA L O R E G O N A. WADE PARKER, MD OHN K. ROSS, MD MARK STERNFELD, MD
Bend Memorial Clinic
AVID TRETHEWAY, MD
FRANCENA ABENDROTH, MD
RY FERENZ, STEVE GOINS,MD
RAIGAN GRIFFIN, MD
336 SW BlackButte Blvd.• Redm ond 541-504-7781
Bend Memorial Clinic em o r t a
„..W,YA" ( A%N N
1501 • EMedical Center Dr.• Bend 5 4 1 - 3 82-4900 w
The Ross Clinic
en
MARK THIBERT, MD
M E D ICAL DI R
541-382-4900
ww w b endmemorialdinic.com
e tca enter Dr. • Ben
541-382-4900
ww w , en memona mic.com
High Lakes Health Care Upper Mill d
www.therossclinic.co
865 SW Veterans Way• Redmond
iuc
High Lakes Health Ca - Re
wwb e ndmemorialdinic.com
929 SWSimpson Ave.• Bend 5
41-3 8 9 - 7741 w wwh i g hlakeshealthcare.com
236 NW K i ngwood Ave. • Redmond 5 4 1 - 548-7134 w
wwh i g hlakes l th
.o
Be n d Memorial Clinic
1080 Mt. Bachelor Dr.• Bend
541-382-4900
ww w bendmemorialdinic.com
Bend Memoria Clinic
1080 Mt. Bac e or Dr.• Ben
541-382-4900
www, en memoria inic.com
Bend Memorial Clinic
1080 Mt. Bachelor Dr.• Bend
541-382-4900
ww w bendmemorialdinic.com
Bend Memorial Clinic
1080 Mt. Bachelor Dr.• Bend 5
4 1-3 8 2 - 4900 w wwb e ndmemorialdinic.com
541-382-3344
www. t hecenteroregon.com
RAYTIEN, MD, PHD
The Center: Orthopedic s Neurosurgical Care sResearch 2 2
BRAD WARD, MD
The Center: Orthopedic s Neurosurgical Care s Research
ANNIE BAUMANN, RD, LD
Bend Memorial Clinic
1501 • EMedical Center Dr.• Bend 5 4 1 - 3 82-4900 w
wwb e ndmemorialdinic.com
St. Charles Center for Women's Health
Locations in Redmond tta Prineville
wwws t charleshealthcare.org
REN CASEY, WHCNP
St. Charles Center for Women's Health
Locations i R d
NATALIE HOSHAW, MD
St. Charles Center for Women's Health
Loca tions in Redmond tta Prineville 5 4 1 - 5 26-6635 w
wwst c harleshealthcare.org
S . Charles en er for o men's ealth
Loca t ions in Redmond tta Prineville 5 4 1 - 5 26-6635 w
wws c harleshealthcare.org
St. Charles Center for Women's Health
Loc a tions in Redmond tta Prineville 5 4 1 - 5 26-6635 w wws t charleshealthcare.org
LYNDA CRABTREE MD
Your Care
3818 SW 21st Pl. Suite 100• Redmond 54 1 - 548-2899
wwwyourcaremedical.com
ANITA HENDERSON, MD
Your Care
3818 SW 21st Pl., Suite 100• Redmond 54 1 - 548-2899
wwwyourcaremedical.com
en pine an
AMES BAUER, MD
B. MCELROY, FNP CLARE THOMPSON, DNP, CNM
e u rosurgery
00 • E Neff Rd. • Bend
5 • E Doctors Dr., Sutte 9• end 5
2200 • E Neff Rd.• Bend
4 —4 7 -
38
541-382-3344
d t ta P ' 'll
5 4 1 - 526-6635 541 526 6635
wwwbelzamd.com www. t hecenteroregon.com
. tch l h
lth
. g
IMOTHY HILL,MD
The Center: Orthopedic s Neurosurgical Care s Research
2200 • E Neff Rd.• Bend
541-382-3344
.thecenteroregon.com
JAMES NELSON, MD
The Center: Orthopedic s Neurosurgical Care s Research
2200 • E Neff Rd.• Bend
541-382-3344
www.thecenteroregon.com
The Center: Orthopedic s Neurosurgical Care s Research
2 200 • E • f'f Rd B
541 382 3344
ARRY PAULSON, MD ERIC WATTENBURG, MD I
I
Your Care
d
3818 SW21st Pl., Suite 100• Redmond 541 -548-2899 w
wwyo u rcaremedical.com
I
OB BOONE, MD CORA CALOMENI,MD RIAN L.ERICKSON MD
St. Charles Cancer Center
Locations in Bend tta Redmond
541-706-5800
www.stcharleshealthcare.org
St. Charles Cancer Center
Locations in Bend tta Redmond
541-706-5800
www.stcharleshealthcare.org
Bend Eastside tta Redmond
541-382-4900
Bend Memorial Clinic
ww w b endmemorialdinic.com
STACIE KOEHLER, PA-C
St. Charles Cancer Center
Locations in Bend tta Redmond
541-706-5800
www.stcharleshealthcare.org
BILL MARTIN,MD
St. Charles Cancer Center
Locations in Bend tta Redmond
5 41- 7 0 6-580 0
www . stcharleshealthcare.org
ENJAMIN J. MIRIOVSKY, MD ANDY MONTICELLI,MD AURIE RICE, ACNP-BC WILLIAM SCHMIDT, MD
e nd emo r t al h i n St. Charles Cancer Center
Bend M
'al Clinic
Bend Memorial Clinic
edtcal en er r ,
wwwbendmemonaldmic.com
en
Locations in Bend tta Redmond
541-706-5800
1501 • E Medical Center Dr.• Bend 5 4 1 - 3 8 2-4900 Bend Eastside tta Redmond
541-382-4900
www.stcharleshealthcare.org
.bendme rialdinic. ww w b endmemorialdinic.com
PPLEMENT
0 15 CEN T RA L O R E G O N I
I
M E D ICAL DI R
AWWs
I
MATTHEW N. SIMMONS
Urology Specialists of Oregon
1247 • E Medical Center Dr.• Bend 5 4 1 - 322-5753 w
Bend Eastside tta Redmon
541-382-4900
ww w b endmemorialcfinic.com
Bend Eastside tta Redmond
541-382-4900
ww w b endmemorialcfinic.com
Bend Memoria Clinic
Hen Eastsi e tta Re mon
541-382-4900
www, en memoria inic.com
SCOTT T.O'CONNER, MD
Bend Memorial Clinic
Bend Eastside tta Redmond
541-382-4900
ww w b endmemorialcfinic.com
KIT CARMIENCKE OD
Inte rated E e Care
452 • E Greenwood Ave.• Bend
541-382-5701
www.iebend.com
452 • E Greenwood Ave.• Bend
541-382-5701
www.iebend.com
452 • E Greenwood Ave.• Bend
541-382-5701
www.iebend.com
RIAN P.DESMOND, MD
Bend Memorial Clini
ww.u r ologyinoregon.com
THOMAS D. FITZSIMMONS,MD,MPH Bend Memorial Clinic
OBERT C. MATHEWS, MD
KIRSTEN CARMIENCKESCOTT,OD IntegratedEye Care ARY ANN ELLEMENT,OD I MICHAEL MAJER(XYKr OD
nte g rated EyeCare
Bend Eastside, Westside tta Redmond 5 4 1 -382-4900
Bend Memorial Clinic
1475 SW Chandler Ave., Suite 101• Hend 541-617-3993 w
EITH E. KRUEGER, DMD, PC Keith E. Krneger, DMD, PC I '
I '
THONY HINZ, MD JEFFREY P. HOLMBOE, MD
OEL MOORE, MD, MPH I '
ICHAEL CARAVELLI, MD ERIN FINTER, MD AMES HALL, MD I '
I '
I '
THLEEN MOORE, MD I '
RETT GINGOLD,MD
SCOTT JACOBSON,MD LAKE NONWEILER, MD I '
The Ce n ter:orthopedics NeurosurgiralCares Researrh Locations in Bend tta Redmond 5
541-382-3344
www.thecenteroregon.com
4 1-3 8 2 - 3 344
www.thecenteroregon.com
The Center:Orthopedic s Neurosurgiral Care sResearrh 2
200 • E Neff Rd. • Bend
541-382-3344
www. t hecenteroregon.com
The Center:Orthopedic s Neurosurgiral Care sResearrh 2
200 • E Neff Rd. • Bend
541-382-3344
www. t hecenteroregon.com
The Center:Orthopedic s Neurosurgiral Care sResearrh 2
200 • E Neff Rd. • Bend
541-382-3344
www.thecenteroregon.com
Locations in Bend tta Redmond
541-388-2333
www.desertorthopedics.com
2200 • E Neff Rd.• Bend
541-382-3344
www.thecenteroregon.com
Desert Orthopedics The Center: Orthopedic s Neurosurgiral Care s Researrh
Desert Orthopedics
1303 • E Cushing Dr., Suite 100• Bend 541-388-2333
www.desertorthopedics.com
Desert Orthopedics
Locations in Bend tta Redmond
54 1- 3 8 8 -233 3
www. desettorthopedics.com
Desert Orthopedics
1303 • E Cushing Dr., Suite 100• Bend 541-388-2333 w
wwde sertorthopedics.com
Desert Orthopedics
1303 • E Cushing Dr., Suite 100• Bend 541-388-2333 w
wwde sertorthopedics.com
I
TIMOTHY BOLLOM, MD
I '
200 • E Neff Rd. • Bend
www. desettorthopedics.com
I
GREG HA, MD
I '
The Center:Orthopedic s Neurosurgiral Care sResearrh 2
54 1- 3 8 8 -233 3
I
OBERT SHANNON, MD I '
Locations in Bend tta Redmond
I
MICHAEL RYAN, MD I '
Desert Orthopedics
I
KNUTE BUEHLER, MD
I '
ww.d r keithkrueger.com
I
AARON ASKEW, MD
I '
www b endmemorfalcffnfc.com
2200 • E Neff Rd.• Bend
541-382-3344
www.thecenteroregon.com
1315 NW 4th St.• Redmond
541-388-2333
www.desertorthopedics.com
The Center: Orthopedic S Neurosurgiral Care S Research
2200 • E Neff Rd.• Bend
541-382-3344
www.thecenteroregon.com
The Center: Orthopedic S Neurosurgiral Care S Research
Locations in Bend tta Redmond
541-382-3344
www.thecenteroregon.com
The Center: Orthopedic s Neurosurgiral Care s Researrh
Desert Orthopedics
I
CARA WALTHER, MD
Desert Orthopedics
1303 • E Cushing Dr., Suite 100• Bend 541-388-2333
www.desertorthopedics.com
PPLEMENT
0 15 CEN T RA L O R E G O N I '
I
'
KENNETH HANINGTON, MD
RON HOBLET, MD SOMA LILLY, MD AMES VERHEYDEN, MD I ' I
AWWu
I
ICHAEL COE, MD
I
M E D ICAL DI R
The Center:Orthopedics NeurosurgicalCares Research Locations in Bend gt Redmond 5
Dese rt Orthopedics
4 1-3 8 2 - 3 344
www.t h ecenteroregon.com
Locations in Bend gt Redmond
54 1 - 3 8 8-233 3
www . desertorthopedics.com
ocations in Bend gt Redmond
54 1 - 3 8 8-233 3
www . desertorthopedics.co
541-382-3344
www. t hecenteroregon.com
Desert Orthopedi
2200 • E Neff Rd.• Bend
The Center: Orthopedic s Neurosurgical Care s Research
The Center:Orthopedic s Neurosurgical Care Research s Locations in Bend gt Redmond 5
4 1-3 8 2 - 3 3 4 4
www.thecenteroregon.com
' I
MOLLY OMIZO, MD
ENNY BLECHMAN, MD
LIZ LEVESIJUE, DO ISA LEWIS, MD
RICHARD J. MAUNDER, MD AURA K. MAVITY, MD
Deschutes Osteoporosis Center
BROOKS BOOKER, MD TE L. BROADMAN, MD
wwwpartnersbendorg
Partners In Care
2075 • EWyattCt. • Bend 5
St. Charles Advanced Illness Management
250 0 • E Neff Rd. • Bend
Partners In Care
2075 • E Wyatt Ct.• Bend 5
S t . Charles Advanced Illness Management
250 0 • E Neff Rd. • Bend
541-706-5885
www . stcharleshealthcare.org
2500 • E Neff Rd, end
541-706-5885
www . stcharleshealthcare.org
St. Charles Advanced Illness Management
STEPHANIE CHRISTENSEN, DMD Deschutes Pediatric Dentistry
TEVE CHRISTENSEN, DMD
2200 NE Neff Rd., Suite 302• Bend 5 4 1 - 3 88-3978 w w wdeschutesosteoporosiscentercom
Desc hutes Pediatric Dentistry
4 1-3 82 - 5 8 82
541-706-5885 4 1-3 82 - 5 8 82
www . stcharleshealthcare.org www.partnersbend.or
1475 SW Chandler Ave., Suite 202• Bend 541-389-3073
www.deschuteskids.com
1475 SW Chandler Ave., Suite 202• Bend 541-389-3073
www.deschuteskids.com
Bend Memorial Clinic
815 SW Bond St.• Bend
541-382-4900
ww w b endmemorialdinic.com
Bend Memorial Clini
815 SW Bond St.• Bend
541-382-4900
ww w b endmemorialdinic.com
2175 NW Shevlin Park Rd.• Bend
541-389-7741
wwwhighlakeshealthcare.com
CARRIE DAY, MD
High Lakes Health Care Upper Mill
JENNIFER GRISWOLD, PNP
Bend Memorial Clinic
815 SW Bond St.• Bend
541-382-4900
ww w b endmemorialdinic.com
Bend Memorial Clini
815 SW Bond St.• Bend
541-382-4900
ww w b endmemorialdinic.com
St. Charles Family Care
211 NW Larch Ave.• Redmond
541-548-2164
Ben d Memorial Clini
815 SW Bond St.• Bend
541-382-4900
St. Charles Family Care
211 NW Larch Ave.• Redmond
541-548-2164
815 SW Bond St.• Bend
541-382-4900
ww w b endmemorialdinic.com
Locations in Bend sa Redmond
541-388-2333
www . desertorthopedics.com
929SWS' p
541 389 7741
ICHELLE MILLS,MD
MARGARET J.PHILP, MD ENNIFER SCHROEDER, MD
RUPERTVALLARTA, MD B WARTON, DO
ROBERT ANDREWS, MD INDA CARROLL, MD TIM HILL, MD ANCY H. MALONEY, MD
JAMES NELSON, MD ARRY PAULSON, MD DAVID STEWART, MD ON SWIFT,DO VIVIANE UGALDE,MD
EAN NAKADATE, DPM
BROOKE HALL, MD
Bend Memorial Clinic
Desert Orthopedics
H'gh Lak H
lth C U
Mill
A . B d
The Center:Orthopedics NeurosurgicalCares Research Locations in Bend sa Redmond 5
Bend M
'al Clinic
41-38 2 -3344 w
1501 • E Medical Center Dr.• Bend 5 4
1 - 3 82-4900
www.stcharleshealthcare.org ww w b endmemorialdinic.com www.stcharleshealthcare.org
. h ghl k h
lth
ww.t h e centeroregon.com
.bendmemorialclini
The Center: Orthopedic s Neurosurgical Care s Research
2200 • E Neff Rd.• Bend
541-382-3344
www.thecenteroregon.com
The Cen er: rthopedic eurosurgtcal are esear
2200 • E Neff Rd,• end
541-382-3344
www.thecen eroregon.com
The Center: Orthopedic s Neurosurgical Care s Research
2200 • E Neff Rd.• Bend
541-382-3344
www.thecenteroregon.com
Locations in Bend sa Redmond
541-388-2333
www.dese o o p edics.com
2200 • E Neff Rd.• Bend
541-382-3344
www.thecenteroregon.com
esert Orthopedics The Center: Orthopedic s Neurosurgical Care s Research
Deschutes Foot gt Ankle
St. Charles Preoperative Medicine
929 SW Simpson Ave., Suite 220• Bend 541-317-5600 w
2500 • E Neff Rd.• Bend
541-706-2949
w w .deschutesfootandankle.co
www . stcharleshealthcare.org
PPLEMENT
0 15 CEN T RA L O R E G O N I
I
M E D ICAL DI R
A%W N
I
ONATHAN BREWER,DO,D-ABSM Bend Memorial Clinic
JAMIE DAVID CONKLIN, MD OUIS D'AVIGNON,MD ERIC S. DILDINE, PA-C HRIS KELLEY, DO, D-ABSM
St. Charles Heart gt Lung Center
Bend Memorial Clini St. Charles Heart gt Lung Center
Bend Memoria Clinic
JONATHAN MCFADYEN, NP-BC Bend Memorial Clinic
Bend Eastside Ltt Redmond
541-382-4900
ww w b endmemorialdinic.com
Locations in Bend Ltt Redmond
541-706-7715
Bend Eastside Ltt Redmond
541-382-4900
Locations in Bend Ltt Redmond
541-706-7715
www.stcharleshealthcare.org
Ben Eastsi e Ltt Re mon
541-382-4900
www, en memoria inic.com
Bend Eastside Ltt Redmond
541-382-4900
ww w b endmemorialdinic.com
www.stcharleshealthcare.org ww w b endmemorialdinic.com
St. Charles Heart gt Lung Center
Locations in Bend LttRedmond
54 1-7 0 6-7715
www . stcharleshealthcare.org
BETHANY TAYLOR-SPILLETPA-C St. Charles Heart gtLung Center
Locations in Bend LttRedmond
54 1-7 0 6-7715
www . stcharleshealthcare.org
MILY SPEELMON, MD
Cen t ralOregonRadiologyAssociates, P.C. i4 6 0 • EMedical CenterDr. • Bend 5 4 1 -382-9383
www.corapc.com
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
TEVEN MICHEL, MD
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
ATRICK BROWN MD
Central Oregon Radiolo Associates P.C.
i4 6 0 • E Medical Center Dr. • Bend 5 4 1 - 382-9383
www.corapc.com
STEVE KJOBECH, MD
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
RACICLAUTICE-ENGLE,MD
ROBERT HOGAN, MD
ARRETT SCHROEDER, MD DAVID ZULAUF, MD
HOMAS KOEHLER, MD
JOHN STASSEN, MD
I ' ' I
I
I
JEFFREY DRUTMAN, MD
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
ONALD HANSON, MD
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
JAMES JOHNSON,MD ILLIAM WHEIR III, MD
en ralOregonRadiologyAssoctates, P.C.
460 • EMedical Center r,• end 5
4 1- 3 8 2-9383
www.corapc.com
LAURIE MARTIN,MD
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
AULA SHULTZ, MD
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
STEPHEN SHULTZ, MD
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
LOE SHELTON, MD
CentralOregonRadiologyAssociates, P.C.
i4 6 0 • EMedical CenterDr. • Bend 5 4 1 - 382-9383
www.corapc.com
NOREENC. MILLER, FNP
HRISTINA BRIGHT MD DANIELE.FOHRMAN, MD
St. Charles Rehabilitation Center
2500 • E Nef Rd.• Bend
541-706-7725
Bend Memorial Clinic
Bend Eastside ttt Redmond
5 41-3 8 2 -490 0
DeschutesRheumatology
www . stcharleshealthcare.org
www b endmemorialdinic.com
2200 • E Nef'f Rd., Suite 302• Bend 5 4 1 - 388-3978 w w w .deschutesrheumatology.com
PPLEMENT
2 015 CE N T RA L O R E G O N EATHER HANSEN-DISPENZA, MD
TONY KAHR,MD IANNA WELCH, PA
M E D ICAL DI R
Deschutes Rheumatology
2200 • E Nef'f Rd., Suite 302• Bend 5 4 1 - 388-3978 w w w .deschutesrheumatology.co
Bend Memorial Clinic
1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w
DeschutesRheumatology
2200 • E Nef'f Rd., Suite 302• Bend 5 4 1 - 388-3978 w w w .deschutesrheumatology.com
JONATHAN BREWER, DO, D-ABSM Bend Memorial Clinic Sleep Disorders Center 1080 SW Mt. Bachelor Dr.• Bend(West) 541-382-4900
RTHUR K CONRAD, MD DAVID L. DEDRICK, MD HRIS KELLEY, DO, D-ABSM
D EBBIE RIEF-ADAMS, FNP I
C h 1 Sl
L
St. Charles Sleep Center
St. Ch arles Sleep Center I
'
RYJ. R
Redmond Wellnessgt Chiropractic
St. Charles Surgical Specialists Bend Memoria Clinic
JACK W. HARTLEY, MD, FACS St. Charles Surgical Specialists
EAN HEALY, PA-
Bend Memorial Clini
DARREN M. KOWALSKI, MD, FACS Bend Memorial Clinic
OHNC LAND MD FACS SUZANNE MARCATO, PA DREW SARGENT, PA-C, MS
RONALD SPROAT, MD EORGE T.TSAI, MD, FACS
St Ch 1
S g' 1Sp ' li
St. Charles Surgical Specialists
Be nd e m orial Clitnc St. Charles Surgical Specialists St. Charles Surgical Specialists
JEANNE WADSWORTH, PA-C, MS Bend Memorial Clinic RIN WALLING, MD, FACS
BRIGITTA BELLA, PA-C RIN BUTLER PA-C DIANA BURDEN, FNP-C EFFCABA, PA-C ANN CLEMENS, MD
d
5 41 706 6 9 5
Locations in Bend Sr Redmond
5 41- 7 0 6-6905
Locations in Bend Sr Redmond
5 41- 7 0 6-6905
ww w b endmemorialdinic.com
, ch 1 h lt h
www . stcharleshealthcare.org
ww w b endmemorialdinic.com www . stcharleshealthcare.org
Bend Memorial Clinic
1G55 SWHighland Ave., Suite G• Redmond 541-923-2019
1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w
www.drherrin.com
wwb e ndmemorialdinic.com
1103 • E Elm• Prineville
541-548-7761
www.stcharleshealthcare.org
Ben Eastsi e
541-382-4900
www, en memoria inic.com
1245 NW 4th St., Suite 101• Redmond 541-548-7761
www.stcharleshealthcare.org
1501 • EMedical Center Dr,• end 5
41- 3 8 2-4900 w wwb e ndmemorialdinic.com
1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w • W thS
S'
R d
1103 • E Elm• Prineville 1501 • EMe tca Center Dr.• Ben
d
5 41 5 4 8 7761 541-548-7761 41-382-4900
wwb e ndmemorialdinic.com
, ch 1 h lt h
LYNDA CRABTREE MD BRIAN DAILY, PA-C
. g
www.stcharleshealthcare.org wwwbendmemonaldintc.com
541-548-7761
www.stcharleshealthcare.org
245 NW 4th St., Suite 101• edmond 5 4 1 -548-7 61
www.stcharleshealthcare.org
1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialdinic.com
1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialdinic.com
1103 • E Elm• Prineville
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www b endmemorialdinic.com
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www b endmemorialdinic.com
Mountain Medical Immediate Care
1302 NEThird St.• Bend
541-317-0909
www.mtmedgr.com
Bend Memorial Clini
Bend Eastside, Old Mill District, Redmond 541-382-4900
www b endmemorialdinic.com
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www b endmemorialdinic.com
b d TRICIA COUTURE, FNP
. g
I
IMOTHY L. BEARD MD FACS Bend Memorial Clinic
DAVID CARNE, MD
' B d8rRd
B e n d Memorial Clinic Sleep Disor ers Cen er 080 SW Mt. Bachelor•Dr. Bend(West) 541-382-4900
I
AVID HERRIN, DC
p
'
wwb e ndmemorialdinic.com
' 1d'
Your Care
3818 SW21st Pl., Suite 100• Redmond 5 4 1 - 5 48-2899
wwwyourcaremedical.com
Your Care
3818 SW21st Pl., Suite 100• Redmond 5 4 1 - 5 48-2899
www, ourcaremedical.com
Mountain Medical Immediate Care
1302 NEThird St.• Bend
541-317-0909
www.mtmedgr.com
COTT FLECK, PA-C
Bend Memorial Clinic
ONICA GIAMELLARO, PA-C
Mou n tain Medical Immediate Care
1302 NEThird St.• Bend
541-317-0909
www.mtmedgr.com
Mountain Medical Immediate Care
1302 NEThird St.• Bend
541-317-0909
www.mtmedgr.com
KEITH HARRINGTON, MD ITA HENDERSON, MD MIKE HUDSON, MD
our are
St. Charles Immediate Care
Bend Eastside, Old Mill District, Redmond 541-382-4900
3818 SW st Pl., Suite 100• Redmond 5 4 1 - 5 48-2899
2600 • E Neff Rd.• Bend
541-706-3700
www b endmemorialdinic.com
wwwyourcaremedical.com www.stcharleshealthcare.org
ADVERTISINGSUPPLEMENT
2 015 CE N T RA L O R E G O N
M E D I CA L D I RECTORY
J. RANDALL JACOBS, MD
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
ADAM KAPLAN, PA-C
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
JESSICA ODDO, FNP-C
Mountain Medical Immediate Care
KERRYMAWDSLEY, FNP-BC
Ben d Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
PHONG X.NGO, M D
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
JAY O'BRIEN, PA-C
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
541-706-3700
www . stcharleshealthcare.org
RICHARDO OMAR GARZA, FNP St. Charles Immediate Care
1302 NEThird St.• Bend
2600 • E Neff Rd.• Bend
541-317-0909
www.mtmedgr.com
DKLAH OREVI, PA-C
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
CASEY OSBORNE-RODHOUSE,PA-C
Bend MemorialClinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
COLLEEN O'SULLIVAN
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
LAURIE D. PONTE, MD
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
MATTHEW REED, PA-C
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
JONATHAN SCHULTZ
St. Charles Immediate Care
541-706-3700
www . stcharleshealthcare.org
BRADLEY SCOTT, PA-C
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
JENNIFER L. STEWART, MD
Ben d Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
SEAN SUTTLE, PA-C
Bend Memorial Clinic
Bend Eastside, Old Mill District, Redmond 541-382-4900
www .bendmemorialclinic.com
ERIC WATTENBURG, MD
Your Care
M ICHELLE WRIGHT, FNP
St. Ch a rles Immediate Care
MEREDITH BAKER, MD RONALD BARRETT, MD, FACS
2600 • E Neff Rd.• Bend
3818 SW 21st Pl., Suite 100• Redmond 54 1 - 548-2899 w
wwyo u rcaremedical.com
2600 • E Neff Rd.• Bend
541-706-3700
www . stcharleshealthcare.org
Bend Urology Associates
2090 • E Wyatt Court • Bend
541-382-6447
wwwbe ndurologycom
Be ndUrology Associates
2090 • E Wyatt Court • Bend
541-382-6447
wwwbe ndurologycom wwwbe ndurologycom wwwbe ndurologycom
MICHEL BOILEAU, MD, FACS
Be n dUrology Associates
2090 • E Wyatt Court • Bend
541-382-6447
JACK BREWER, MD
Bend Urology Associates
2090 • E Wyatt Court • Bend
541-382-6447
ANDREW NEEB, MD
Urology Specialists of Oregon
BRIAN O'HOLLAREN, MD
B end Ur o logyAssociates
MATTHEW N. SIMMONS, MD
U r o l ogy Specialists of Oregon
NORA TAKLA, MD
Bend Urology Associates
EDWARD M.BOYLE,JR,, MD, FACS
Inovia VeinSpecialty Center
2200 • E Neff Rd., Suite 204• Bend 5 4 1 - 3 8 2-8346
www.bendvein.com
ANDREW JONES, MD, FACS
Inov i a Vein Specialty Center
2200 • E Neff Rd., Suite 204• Bend 5 4 1 - 3 8 2-8346
www.bendvein.com
DARREN KOWALSKI,MD
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
ww. bendmemorialclinic.com
WAYNE K. NELSON, MD
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
ww. bendmemorialclinic.com
CATHERINE BLACK, PA-C
Bend Memorial Clinic
1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w
wwb e ndmemorialclinic, com
JASON JUNDT,MD
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
ww. bendmemorialclinic.com
WAYNE K. NELSON, MD
Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
ww. bendmemorialclinic.com
MARILYNWALKER-NIEWOLD, DMP Bend Memorial Clinic
1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w
ww. bendmemorialclinic.com
1247 • E Medical Center Dr.• Bend 5 4 1 - 322-5753 w 2090 • E Wyatt Court • Bend
541-382-6447
1247 • E Medical Center Dr.• Bend 5 4 1 - 322-5753 w 2090 • E Wyatt Court • Bend
541-382-6447
P AID A D V E R T I SIN G S U P P L E M E N T To be included in the next issue of the PULSE/Connections Medical Directory, contact:
Kylie V i g e l a n d , A c c o u n t E x e c u t i v e ( H e a lt h 8 M e d i c a l ) 5 4 1.617.7855
ww.u r ologyinoregon.com
wwwbe ndurologycom ww.u r ologyinoregon.com
wwwbe ndurologycom
Coverstory ITHEEARLIESTPREEMIES
saying you need to celebrate. Even if they didn't live forever, they were born and we needed tobe happy to have them."
Continued from Page 10 neonatologist ran through the list of potential risks and complications. Their boys would have to be intubated and possibly put on a ventilator. They would be checked for brain
Shades of gray
bleeds daily, and there was a risk their bow-
They gray zone decision is perhaps more
els would become necrotic. If that happened,
difficult because it crosses many of the thorny lines of debate that society has yet to resolve about the start and end of life. As medical advances push the limits of viability, there is an increasing overlap between the legal limits of abortion and the viability of the fetus. The Roe v. Wade Supreme Court decision in 1973 that legalized abortion limited the timing to until the fetus is viable, and states have drawn that line at various points. But the threshold of vi-
they would need surgery and would have to be airlifted to a hospital hours away, with a real chance they wouldn't survive the ride. "I have to ask you," they recall the neonatologist saying, "do you want to resuscitate or do you want a DNR (a do not resuscitate
order)?" Cori and Clint both started crying and told her that of course they wanted to save their baby. But as the doctor departed, she left them with a sheet of paper that documented the statistics for twin boys born at 23 weeks. According to the sheet, they had a 99 percent
chance of neurological disability, such as cerebral palsy or cognitive delays. They could end up blind and deaf, or in a wheelchair. They could endure the treatments of the NICU — being intubated and on a ventilator,
risking brain bleeds and infections — and still face a high risk of dying within five to 10 years. Even if Cori and Clint opted to resuscitate the babies now, they might face essentially the same decision whether to take them off life support in the coming weeks. Clint wanted to see how the delivery went
SUBMITTED PHOTO
Cori and Clint (who asked their last name be withheld) hold a photo oftheir sons, Colt and Chase, who were born at almost24 weeks'gestation. They lived onlyaboutan hour.
'7hatmoment,whenwehad todecideyesorno,iswhenwe becameparents. Wewill forever be parentsbecausewehad to put the worstpainin ourhearts forthebetterofourbabies." — Cori
us being selfish," Cori said."That we want a
baby so bad that we don't care what we put and in what shape the boys emerged before our sons through." making a decision, but Cori insisted they When Colt and Case were born, Cori and had to decide before they went into the de- Clint took turns holding them, kissing every livery room. finger, every toe. Within an hour, their tiny "I knew once I laid eyes on my sons, I bodies were starting to get cold and they let could never take that back," she said. "I the nurses take them away. "I understand how easy it is to say everywouldn't be able to go back on that decision. We needed to know now." thing is going to turn out OK. But that moShe told Clint if they opted for a DNR, they ment, when we had to decide yes or no, is had to be prepared to let them pass in their when we became parents," Cori said. "We arms, to let their twins die. Clint took a walk will forever be parents because we had to to sort out his emotions and upon returning put the worst pain in our hearts for the betagreed to let the boys go. ter of our babies. We didn't choose a DNR "We just thought if we were to be adults because we didn't love our children." and we couldn't speak our minds, and we Clint and Cori still have embryos available were confined to a wheelchair, and we were for another round of IVF but have decided to blind and couldn't move our arms and legs, pursue adoption instead. They were recently maybe ourtwin died,maybe we would nev- matched with a birth mother, who is coincier go to prom, never drive a car, and my dentally due on their twins' birthday. "It would be so cool to have them born on mom and dad said, 'Well, we really wanted a child so we kept you,' that felt like it was the same day," Cori said. "In a way, it's God
Page 48
ability has changed significantly since 1973, and many states are now looking at moving the legal limit for abortion to 20 weeks. Similarly, many states are seeing a renewed push for "death with dignity" laws that allow for assisted suicide, prompting heated debate over end-of-life issues that can come in to play in the resuscitation decision for parents. Several states, mainly in the Deep South,
have so-called Baby Jane Doe laws that require doctors to resuscitate babies at the edge of viability, sometimes leaving parents who may have otherwise opted to let the child die struggling to provide the care a se-
verely disabled child needs. The laws in these Southern states disproportionately affect minority and lower-income families with poor access to care. Black mothers have higher rates of premature births, and their children die at higher rates than their white counterparts. And rates are higher among teenage mothers and those older than 35. "I can tell you when I practiced in Birmingham, Alabama, there wasn't ever a question about whether or not to pursue (resuscita-
tion)," Schelonka said. "If the baby looked like there was no chance of survival, then we would be able to stop care then. But it was almost never before birth." But while abortion and assisted suicide
opinions often fall along religious fault lines, religious views can affect the resuscitation question in different ways. Many who believe in an afterlife take solace in the belief that their children will be waiting for them in a better place, free of pain and suffering.
SPRING/SUMMER 2015 • HIGH DESERTPULSE
Others are concerned that too often parents are given a worst-case scenario for their
their son, Pierce, if the doctor could intubate him. If not, they were prepared to let him go. children and are making the decisions based Pierce was born on the large side for a on an inaccurate view of what their disabili- 23-weeker at I pound, 8 ounces, so doctors ty is likely to be. Lindsay Franks runs a non- could get the breathing tube in. But even then, profit for parents of micropreemies outside he had onlya 5 percent chance of survival. "His skin was bright red like Jell-O," Lindof Charlotte, North Carolina, and is often called in to counsel parents facing a resus- say said. "It was gelatinous. I remember citation decision. In her experience, obste- them putting the breathing tube in, and to tricians aren't as familiar with the statistics check to see if the lung had collapsed, they and prognoses as neonatologists and might held a flashlight up to him." therefore sway parents toward DNRs. The doctors gave them the usual list of "The OBs arethe ones counseling these risks: cerebral palsy, deafness, blindness. "They just rattle them off and you're just women, particularly if they can't get the neonatologist to the delivery room in time," trying to keep hope," Lindsay remembers. Franks said. "A lot of times they say, 'They "I don't know if he's going to make it home don't do well. Let them go.'" alive. So that what we focused on is we just Franks and her husband, Nik, faced the re- want him home alive." suscitation decision at 23 weeks. While doctors had warned them of the po"This being our first child, we had never tential disabilities, there was little discussion seen the NICU," she said. "We had no idea about what Pierce might be like at 6 months, whether there was even a 23-weeker who at one year, at five years. "There wasn't time to t alk about that had ever survived." The Franks decided they wanted to save stuff," Lindsay said. "There were more criti-
Partners In Care put us at ease. They helped us understand and navigate a stressful time. Their support let us focus on our family and make the most o f ou r t ime tog et her (541) 382-588 2
par t n e r s b e n d .o rg
Hospice I Home Health I Hospice House Transitions I Palliative Care
cal care things." Pierce survived but was diagnosed with
cerebral palsy. The Franks' nonprofit now distributes a little booklet, titled "Stories of Hope," to parents in the same situation. It contains before and after pictures of extreme preemies, some of whom have cerebral palsy or other disabilities. "It puts a face on the diagnosis," Lindsay said. "You never know where these kids are going to land. I've known 23-weekers who you think, 'Man, they're going to have a really tough time with it,' and they skate right through. And then I've known 28-weekers who have died within months." Parents, she said, want a crystal ball. They want to know exactly what level of disability to expect. She tries to convey to them that
every child, regardless of when they are born, faces an uncertain future and that's a part of what parenting entails. "There are a lot of babies who are born
full term who are diagnosed with horrible things when they leave the hospital," she
Coverstory ITHEEARLIESTPREEMIES r
tells them. "They don't know either."
Realistic expectations Lindsay says when parents hear medical terms such as cerebral palsy or cognitive delay, they often think of the worst-case scenario, of someone who has little quality of life. They fail to recognize there is a broad range of disability represented by that single term.
,®0
"When we heard cerebral palsy, in the beginning, we thought wheelchair and unable to walk. That was our knowledge of it," she said. "It can be something that's so mild or something very severe. Most kids fall somewhere in the middle." Of the hundreds of stories of micropreemies sheheard, she has yet to come across a child who is unable to do anything at all. "I've met all these kids who have major
SUBMITTED PHOTOS
The Pranks — Li ndsay, Nik andyoUng Pierce — at their latest family photo shoot, and a caped Piercein his wheelchair.
"I don'thaveanormal3-year-old by any means,and thatisveryhard."
struggles, and they all just seem so happy and so resilient," she said. "But it's definitely
a struggle for everybody involved."
— Lindsay Franks, who runs a nonprofit for parents of micropreemies
Her son, Pierce, is now bigger than other children his age. While he cannot walk due to
cerebral palsy, cognitively he's very much on track with his developmental milestones. He's at an age that he could still be in a stroller and no one would suspect he has a disability. But Pierce has six therapy appointments
per week and plenty of medical challenges. "I don't have a normal 3-year-old by any means, and that is very hard," Lindsay said. "It's kind of become our norm." At a recent neurologist appointment, Nik
'7hesearethethings thatmake
•
hi m w hoheis They'r.esayingthere's something wrong wIthhim,and we're
saying thisiswho we'vecometolove." — Nik Franks
then they make a decision just based on the
was reading a list of Pierce's challenges from worst-case scenario." Well-meaning friends and family will try to his medical chart. "It's funny — these are things I love about
offer encouragement with stories of a third
cousin's preemie born outrageously early and who he is," he told Lindsay."They're saying doing just fine. Such stories are often fraught Pierce. These are the things that make him
there's something wrong with him, and we're saying this is who we've come to love." Lindsay believes parents facing the de-
munity, Pierce's survival seemed to create extra pressure on the parents. Don't worry, people would say, Pierce made it. Lindsay talked to the parents while the mother was on bed rest wrestling with the decision.
"I know how hard this is because you guys
means and, Lindsay says, doctors often don't
with inaccuracies and generally of little relevance to families struggling with the decision. Moreover, it leaves the dark cloud of public scrutiny hanging over the heads of parents who might not want to resuscitate their child but feel compelled to, because that's what society expects parents to do.
do a good job of explaining the odds and
"They feel pressured to hide things," Lindsay
their consequences. "I have yet to hear a family given accurate information at this point. It's fairly grim. I almost feel like the doctors have a strong opinion about life with disabilities," she said. "Families don't get the best information, and
said. "They feel they can't say it, 'Because what
worse shape than Pierce. "I remember them at the funeral being very clear in their eulogy that they never gave
would it be like if we gave up on our baby?"'
up on him," Lindsay said. "And I wondered if
Two years after Pierce was born, Nik had a friend at the seminary he was attending facing the same issue, a baby born at 23 weeks and five days. Within the tight-knit religious com-
they felt the need to explain themselves." Throughout the ordeal of the NICU stay, parents dream of the day they will take their child home. But for many, that transition
cision in the gray zone really have no way of making a rational choice. They have a poor understanding of what disability really
Page 50
know that Pierce made it," she recalls telling them. "And we're hoping that your baby does. But I know that you know he might not." That mother's water had broken at 21 weeks, and while she carried him to 23
weeks and five days, her son was in much
SPRING/SUMMER 2015• HIGH DESERTPULSE
doesn't provide the relief they were seeking. After having a team of doctors and nurses caring for their preemie and providing support to the parents, they find themselves isolated at home, allowing thoughts of guilt to creep in. "I think a lot of moms feel guilty," Lindsay said. "You take a kid that has lasting issues and it's literally in your face every day. And it kind of rubs that every day. I find myself thinking, 'What did I do
wrong? He's like this because my body could not carry him any longer.'" Mothers start to wonder whether they made the right decision, whether their children would have been better off had they let them die. Last year, a newspaper in the United Kingdom interviewed a mother who admitted she had made a mistake and should have let her 23-week preemie die rather than subject him to a life of profound disability. The article sent shock waves through the preemie community, as mothers condemned the notion that a life of disability wasn't worth living. Lindsay said second-guessing the decision to resuscitate is an
50 YEARS OF DEDICATION For 50 years Bend Urology has been dedicated to providing state-of-the-art diagnosis and the finest treatment 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, Central Oregon lndependent Practice Association and the Physician Hospital Alignment.
experience many moms go through but few will admit publicly. "People don't want to say it â&#x20AC;&#x201D; 'I wish my life were different'because they think it sounds like they don't love their loved one," Lindsay said. "That's too simplistic. It's very acceptable to grieve, and it's OK to have hard feelings toward the diagnosis. You can
still love your child." Hospitals and NICUs are now taking steps to help address feelings of depression or guilt. At St. Charles Bend, the hospital has a psychologist dedicated to the NICU to help parents come to grips with their situation. "I get to sit down with families a couple of days later. They've
had their baby and you slowly hear the disclosure of their fear, the guilt that they think they caused it," said Sondra Marshall, a licensed psychologist with St. Charles Bend. "And then part of my role, and the whole team really, is to create hope." Parents also congregate online, finding a support community for those who have lost children born prematurelyand those coping with the challenges faced by kids who made it. It's a shadow community with its own lexicon and culture. Parents refer to chil-
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 William Corrigan, PA-C, Johanna Godell, PA-C, Sara Stafford, PA-C, Jonathan Kelley, PA-C,Jamie Tigner, PA-C
Ah Years of Treatment
dren who have died as "angel babies." A subsequent child born after an angel baby is a "rainbow baby." Jami Haddox found the March of Dimes' Share Your Story web-
site (www.shareyourstory.org), by literally Googling the words, "My daughter died, what do I do now?" She's now a moderator for the site. Rob Davis had to drag his wife, Cheryl, to the first meeting of a support group, called Mommies Enduring Neonatal Death. Now she is on the group's board of directors.
Accurate numbers Evered, the OHSU neonatologist, acknowledges neonatologists might see disabilityas more of a burden than parents ultimately do. "We fear disability. We fear the bad outcomes with good reason. These are real problems that have massive costs," he said. "But the long-term follow-up with survivors of extreme prematu-
~ure 6rrod.6 &o.
~ ~BendUrolo 2090 NE Wyatt Court Suite 101 Bend, Oregon 97701 541.382.6447 office541.388.6862 fax 888.382.6447 tolI free
333 NW Larch Avenue Redmond, Oregon 97756 541.548.4017 office 541.388.6862 fax 888.382.6447 tolI free Satellite Clinics in John Day, Burns, Lakeview and La Pine
C ONT R A C T E D
W IT H ALL MA JOR H E A LTH PLA N S
www.bendurology.com HIGH DESERT PULSE
Page 51
CoI/erstory I THE EARLIEST PREEMIES
rity suggests that the families and the patients themselves rate their
NICU quiet to prevent neurologic complications isn't really fullyagreed
own quality of life much higher than NICU professionals would rate upon by the national and international NICU community," Evered said. the quality of life." As a result, NICUs around the country can look and act completely It's unclear how much of that difference in perception affects the way doctors present options to parents, and as much as they try to be objective, how much their own concerns and biases about potential disabilities influence the decision-making process. There's also a bias of intent that comes through in the use of statistics on survival and disability. Quoting the low survival rate and high risk of disability at 23 weeks may prompt parents not to resuscitate
different. Most are still designed as what's known as a barnlike NICU — a large room separated into different areas with isolettes or cribs in rows and very little protection from noise or other environmental stressors. Many newer NICUs, including the one at St. Charles Bend, consist of private rooms that can be kept dark and quiet. "But nobody has really proven that that matters," Evered said. "No one has done a huge study comparing one kind of NICU to another a child who would have survived, thus artificially keeping survival kind of NICU and see whose outcomes are better." rates low. Best practices Databases tracking survival and disability rates by weeks of gestation try to adjust for that sort of predetermination by separately Over the past decade, researchers have begun to test different tracking the outcomes of infants whom doctors did try to save. But bundles of practices, trying to hit on the combination of treatments by removing so many potential cases, it might not reflect what the and protocols that will produce the best outcomes. outcomes would have been if doctors routinely tried to save all chilWhen Evered was completing his fellowship training in neonatoldren at 23 weeks. ogy at OHSU, he and several colleagues developed a bundle of proIt's also unclear which set of statistics are most relevant for fami- tocols designed to prevent neurologic complications in extremely lies. National databases provide the large numbers to give statistical premature infants. When he ran the NICU at St. Charles Bend, Evered validity to survival and disability rates, but there is also a time lag in embedded those protocols into the electronic medical record system, published data that doesn't immediately account for the latest med- so when a premature baby was admitted to the NICU, those protoical advances. cols were automatically entered into the physician's treatment orders. "The big studies that were published even four or five years ago That ensures every infant is treated in the same way, with the same reflect data from 10 to I5 years ago, and there have been huge ad- medications and protocols, the same instructions to nurses for every vances in NICU care in that period of time that are probably not ade- problem or issue that arises. Evered then tracked the outcomes with quately reflected yet," Evered said. the new protocols to compare them with national averages. "The last major frontier is improving neurologic outcomes," he National data might also not accurately reflect the situation in local hospitals where NICU care could be better or worse than the national said. "We feel like we have effective strategies ... that we didn't have average. But local data, particularly in smaller hospitals, might not have two years ago." enough cases to give an accurate representation of a preemie's odds. One of the core problems for infants born before 29 or 30 weeks Outcomes differ substantially from site to site in part because there of gestation is they are vulnerable to a particular form of bleeding is still no consensus among neonatologists on even the basics of inside the brain, intraventricular hemorrhage, or IVH, and there's no NICU care. "Even something as simple as how important is it to keep a clear consensus on exactly what causes it or what poses risks. At
IVE BUV
$$ VOU SIWE
E
IFF
"With approved credit. See store for details.
I.ICIIISBII
I '
® Solaae
I
Slftlea
I So Sofr edmonfl
+~b
MR f
Apply on llne
Page 52
I
I
•
TiR~ES.S
C 4eal~lm~~ l a m n c l
,for Credit at:
2071 5 Nwy 97, Redmond 5411-548-2056
EIIEE I EI.IVEII
•
5$485 5 Hwy 97, Bend • 541-336-5084 SPRING/SUMMER 2015• HIGH DESERTPULSE
Preemies at St. Charles Bend The neonatal intensive care unit at St. Charles Bend tracked the outcomes for61 out of68 babies born at 32 weeks or less gestation between January 2010 and December 2014. While 86 percentofchildren born at 23 to 26 weeks without genetic defects survived to be discharged, only halfwere able to avoid significant developmental delays. 22 weeks ...
Co mfort care only ...100%
23 weeks ...
Comf ort care only ...61%
Resuscitated but died in NICU...39%
24weeks ...
Com f ort care only ...37%
Resuscitated but died in NICU...25%
25 weeks ... Comf ort care only ...17% Resuscitated but died in NICU...9%~
26weeks ... Resuscitated but died in NICU...2%-
that stage of development, the baby has an unusual set of blood vessels in its brain known as the terminal matrix. "Its purpose is to supply a huge area of brain growth; it's a factory for brain cells," Evered explained. "The factory is tapering off at 29, 30 weeks, and as it does that, the set of blood vessels disappears. Then there's no longer a risk that the brain vessels will pop and bleed." Preventing IVH before the terminal matrix disappears, Evered said, might be the key to avoiding the really bad outcomes. In the NICU, every single bad thing that happens leads to another.
If the baby has, for example, a brain bleed, the baby doesn't breathe Resuscitated and survived to discharge ...38%
Resuscitated and survived to discharge ...74%
Resuscitated and survived to discharge ...98%
as well and has to stay on the ventilator longer. It's a domino effect. Babies who are on a ventilator longer are at greater risk of lung damage and infection, which can then lead to meningitis. And the longer they are on the ventilator, the more oxygen they need. But oxygen is the main risk factor for retinopathy of prematurity, a type of blindness that affects premature infants. So if you can stop the first domino from falling in the first place, a whole range of outcomes become much better. "Antenatal steroids are kind of the magic bullet in our world," he said. If the mother can receive two shots of betamethasone 48 hours before an extremely premature baby is delivered, it helps to
rapidly mature the baby's lungs and prevent IVH. "It's like the domino-blocker," he said. "It stops the bad things
from happening right away." BOrn With deVelOPmental delayS ESignificantdelaysâ&#x20AC;˘ Cerebral palsy
23-26 vveeks 26-28 vveeks 28-30 vveeks 23-26 vveeks 86%lived;ofthose...
92 %lived; those. of ..
92 %lived; of those... 100% lived; ofthose..
Source: St. Charles Bend NICU
GREG CROSS
The protocols also relied on continuous positive airway pressure therapy, or C-PAP, rather than ventilators to provide breathing support. It's the same technology used to help individuals with sleep apnea and is much less invasive and less traumatic for the preemie, thus less likely to knock over a domino. Evered implemented those protocols at St. Charles at the end of 2008 for all babies born before 30 weeks of gestation and tracked the outcomes over time. From 2009 through 2014, the NICU had zero cases of severe IVH in babies born at the hospital. Those results Continued on Page 54
o
e
SPRING/SUMMER 2015â&#x20AC;˘ HIGH DESERT PULSE
a
Page 53
• ~
•
~
•
•
•
•
•
! •
•
l
•
• •
•
I
•
•
•
e•
•O
•
•
O• O
N
•
•
•
•
O RE G O N • Bend Rose rg Glide
Steamboat Inn Ch ult
Roseburg
No
pqua
River
Lake
Prospect uin rants Pass
Eagle Point
Cot/erstory I THE EARLIEST PREEMIES Continuedfrom Page H would rival that of the best NICUs in the country, even ones much larger than St. Charles. Evered also instituted a follow-up clinic to track the children's long-term outcomes, as well as to help connect parents with the services they needed to manage whatever developmental delays or disabilities their
children faced. O f the seven infants born at 23 to 2 5 weeks who were resuscitated, six survived, and only one out of six seen at the follow-up
clinic was diagnosed with cerebral palsy. Only three out of the six scored below aver-
Page 54
age on a standard developmental test. "We're seeing numbers that we are real-
ly pleased with, low rates of cerebral palsy, low rates of cognitive delay, low rates of lan-
guage delay," Evered said.
Moving the goalposts Neonatologists and obstetricians are now debating whether to change their guidance to parents at 23 weeks of gestation, moving from actively discouraging resuscitation to taking a neutral stance, as they now do for 24 weeks. National data shows there is not a substantial difference in outcomes between
23 and 24 weeks. "Not to say that either one of them is very good, but because the differences are not strong, it may be just as reasonable to offer resuscitation at 23 weeks as at 24 weeks," Evered said. Some of that is due to better NICU care, but part of it relates to advances in obstetric care, where it's now almost universal to use antenatal steroids for moms at risk of delivering that early. In the past, obstetricians might not have provided the steroids and discouraged the women from resuscitation, another way the statistics might have biased
SPRING/SUMMER 2015• HIGH DESERTPULSE
the outcomes. But many neonatologists are worried about further creep in the age of viability, Pfister, the St. Charles neonatologist, said. He's already seen thecutoff drop from 24 weeks to 23 since becoming a neonatologist in 2004. "I really think we're close to the bottom," he said. "If you ask neonatologists, we are
increasingly uncomfortable with dropping the number down." There is concern science has pushed the limits of survivability about as far as they can go. According to a review of data from the Neonatal Research Network for extremely
SPRING/SUMMER 2015• HIGH DESERT PULSE
premature infants from 2003 to 2007, gains in survival rates might have plateaued despite increased use of prenatal steroids and antibiotics, and use of the medication surfactant earlyafter birth to help lung development. The majority of infants in the study experienced a major complication during initial hospitalization, with those being born at an earlier week of gestation more likely to incur such problems than those being born later. There's also the concern that if neonatologists change their guidance at 23 weeks from discourage to neutral, would they also opt to allow resuscitation at less than 23 weeks? While
several babies have survived after only 22 or even 21 weeks gestation, there is almost no data on what their long-term outcomes will be. Whatever the doctors decide will ultimately have a much greater impact on the parents and their children. "I think we all have a lot of respect for the uniqueness and the extreme difficulty of that situation," Evered said. "That's a decision that parents ultimately have to make based on their own faith, their beliefs and the realization that it's their lives that are going to be affected — not mine — over the next 40, 50, 60 years." •
Page 55
EXERCISE
DON'T SMOKE
GET SCREENED SHORTNESS OFBREATH
nin
JAW,THROAT 8 ABDOMINAL PAIN
NUMBNESS INLEGS
WEAKNESS
UI'
GHEST PAIN
k•gg i
g•
Completecardiovascular care: • Cardiovascular specialists
g•
•
;
St. Charles HEART R LUNG CENTER
• Interventional cardiology • Cardiothoracic surgery • Cardiopulmonary rehab • Cardiac ultrasound • Cardiac device implant and management • We are supporting Central Oregon with outpatient services in your cornmunity • New patient appointments currently available within 48 hours"
>
541-388-4333 2500 NE NEFF RD. BEND,OR StCharlesHealthCare.orgIIg
i
i