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

FALL/ WINTER 2014

H I G H

D E S E R T

Healthy Living in Central Oregon Also Inside: • Winter gear advice • Meet a school nurse • Diet tips

Will electronic cigarettes save thousandsof lives, or will they renormalizesmoking?

Pediatric psychiatry: Shortage ofbeds and doctors leaves patients looking for help

H I G H

Central Oregon 8 100

Assoc., i.c. ServinY gourMedicallmaging Need sSincel94t

D E S E R T

Healthy Living in Central Oregon

FALL/ WINTER 2014 VOLUME 6, NO. 4

HOW to reaChus Julie Johnson I Editor 541-383-0308 or jjohnson@bendbulletin.com • Reporting Tara Bannow 541-383-0304ortbannow@bendbulletin.com Markian Hawryluk 541-617-7814 or mhawryluk@bendbulletin.com

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Nancy Todd 541-3830348or ntodd@bendbulletin.com

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Sophie Wilkins 541-383-0351 or swilkins@bendbulletin.com 4

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• Design / Production Greg Cross David Wray

Carli Krueger Andy Zeigert

• Photography Ryan Brennecke JoeKline

Andy Tullis

• Corrections

CallForAppointments: (541)382-9 383 TraviA sbeleMD- PatrickBrownMD TraciClautice-EngleMD- JeffreyDrutmanMD RobertjioganMD- SteveKjobechMD

High Desert Pulse's primary concern is that all storiesareaccurate. Ifyou knowofan error in a story, call us at 541-383-0308 or email pulse@bendbulletin.com. • Advertising Jay Brandt I advertising director 541-383-0370or jbrandt@bendbulletin.com Kylie Vigeland health 8 medical account executive 541-617-7855 or kvigeland@bendbulletin.com • On the Web: www.bendbulletin.com/pulse

Thoma sKoehlerMD-KarenLynnMD James JohnsonMD- LaurieMartinMD StevenM ichelMD- GarrettSchroederMD CloeSheltonMD- PaulaShultzMD Stephen ShultzMD-JohnStassenMD WilliamWheirII MD- DavidZulaufMD

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Ar~ f/11P,

Contents ~HIGH DEsERT PULsE

C lr~

500.,

THE f-. Wa Q CO~ Qail

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COVER STORY

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E-CIGARElTES Though nearly everyone agrees they're probably better for you than regular cigarettes, their effect on health and antismoking efforts is unclear.

FEATURES PSYCHIATRIC CARE 18 PEDIATRIC For kids in Central Oregon, the help they need is often hours away.

PEDIAT C PSYCHIATRIC CARE

DEPARTMENTS

Lack of loqal options leav s families isolated.

UPDATE Mara family returns briefly to Bend.

16 TIPS Which weight-loss plan is right for you? GEAR 24 Winter ski swaps can helpyou get the best gear for the lowest cost. READY 26 AsGETworkouts move inside, here's how to find the right gym and be a good gym citizen.

28 JOB Being a school nurse is fun and challenging. 33 SNAPSHOT Snowboarding season begins. QUIZ 53 POP Name that disease!

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A, ' t1 l R 1 -Ij< I,

ESSAY Helmets aren't just for high-speed cycling.

COVER: DYLAN JOHNSON SMOKES AN E-CIGARETTE IN HIS HOME LAST MONTH. COVER DESIGN: RYAN BRENNECKE CONTENTS PHOTOS, FROM TOP: RYAN BRENNECKE, SUBMITTED PHOTO, ANDYTULLIS

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UPdate ~ SINCE WELASTREPORTED

Two earsa ermovin toKen a, en 's r. Mic ae Mara sti teac es wo years ago, we reported on Dr. Michael Mara, a Bend orthopedic surgeon, who with his wife, Ann,

and children, Michael and Jane, was departing for a five-year post teaching orthopedic surgery at a missionary hospital in Kijabe,

Kenya. In August, the Mara family returned to Bend, as part of a two-month "home assignment" designed to give long-term missionaries a break from their often intense experience. Mara expected to join a department of five orthopedic surgeons at the hospital, only to find on his arrival that the depart-

'7heresnota lotofhealth care in (someAfrican) countries, but also thehealth carethat thereis can beexpenslve." Dr. Michael Mara

open to the outside, and the school has a

Although the Maras have a history in Africa â&#x20AC;&#x201D; it's where the parents met in 2001 â&#x20AC;&#x201D; they are still adjusting to local Kenyan traditions and customs. "There are still many layers that we don't understand about the culture and tribal issues," Ann said. "You're always trying to navigate without truly understanding." Organization is sometimes lacking and things can get rather chaotic. Punctuality is more of a Western trait. In Kenya, meetings scheduled for 9 a.m., might not start till 10. "There's a saying in Kenya that Africans have time, Americans have watches," Ann sald. And some things just get lost in translation. Last year, after returning from a Christmas visit to her family in Ireland, where there was much food and celebration, she encountered a Kenyan acquaintance in the

zip-line in the playground.

halls of the hospital.

ment had collapsed, leaving only one other surgeon. "We've just been hammered. It's been outrageously busy," he said. "When I was here I had this nice little niche hand surgery practice, and over there, it's just everything that comes in: children's trauma, bone infections, terrible tumors, spine problems." The Maras seem to be enjoying their time in Kenya despite the challenges. Michael, 9, said his school is Kenya is somewhat different than what he was used to in Oregon.

There are no hallways, classroom doors

They have seen "just about every kind of

"Ann, you look great. You're looking fat!"

animal you can imagine," he said.

he said joyously.

Jane, 7, has taken to the wildlife and has been known to walkaround with a chame-

"For Kenyans, it's the highest compliment you can pay," Ann said."But I told him, 'You cannot say that to a Western woman.'"

leon on her head. Ann recalls going for a run one day and coming back to a group of children who had surrounded a deadly venomous tree snake, known as a boomslang. A local man had killed the 6-foot-long snake, which Jane, much to her mother's surprise, fearlessly lifted into the air on a stick.

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The Maras arrived in Kenya a year before the September 2013 attack on a shopping mall in Nairobi. The event, they say, has had

a profound impact on life in Kenya, scaring away most of the Western tourists who account for an important part of the economy. They make trips to the grocery store once

a month, under the watchful eye of armed guards, and even in church, there are men armed with machine guns to protect the congregation. Kijabe is located about 45 miles northwest of Nairobi and sees a steady flow of patients from war-torn South Sudan and Somalia. "There's not a lot of health care in their countries, but also the health care that there is can be expensive," Mara said. "People come to Kijabe, and they tell us this, because they feel loved. They're treated with kindness, decency and respect, and they're listened to." It's something patients from those countries, who are predominantly Muslim, don't expect from a Christian hospital. Many of the hospital's patients have no money to pay for their care but are never turned away. Others sell livestock or ancestral lands to pay their bills. The hospital is often short of supplies and relies on donations to get through the year. Recently, they had no lights in the operating room because they couldn't afford to buy light bulbs. The hospital receives

used equipment discarded from hospitals in more affluent parts of the world, a pro-

gram the doctors lovingly refer to as "Junk for Jesus." Mara is now trying to raise money to train a young intern from South Sudan to be an orthopedic surgeon at a cost of $25,000 per

year for five years. While the recent outbreak of Ebola has been in western Africa, it remains a concern in Kenya. The Nairobi airport, which canceled flights to and from the affected countries, remains a major hub for African air traffic. The Maras left Bend after their visit this

FALL/WINTER2014â&#x20AC;˘ HIGH DESERTPLILSE

summer to see Ann's family in Ireland, and then were headed back to Kenya forthe start of the school year and more hard work at the hospital. They expect to complete their full five-year commitment in Kenya but have not yet decided what they will do afterward. Asked about the biggest change they noticed in Bend since they had moved away, their answer was unanimous: growler fill JOE KLINE stations. â&#x20AC;&#x201D; Mavkian Hawvyluk M i keandAnn Mara, with kids Janeand Michael, onarecent trip backto Bend from Kenya.

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Cover story ~ E-clGARETTEs

Everyone seems to agree that e-cigarettes should be safer than cigarettes but the evidence is not as clear, nor the ultimate outcome BY MARKIAN HAWRYLUK

he debate raging over electronic cigarettes largely comes

level (of nicotine) than what I started," he said.

down to the fate of people like Dylan Johnson, a 21-year-old

Cases like his leave public health officials with a conundrum. On

from La Pine who started smoking when he was 14. "I was prettyyoung," he admits. After seven years of smoking â&#x20AC;&#x201D; all but three below the legal age

the one hand, e-cigarettes could significantly reduce the harm for smokers, taking away the tar and other carcinogens that cause myri-

out some sort of assistance, might never be able to quit smoking.

After eight years on the U.S. market, there is widespread agree-

ad health problems, saving millions of lives and billions in health care to buy tobacco cigarettes â&#x20AC;&#x201D; he had developed a pack-and-a-half-per- costs. On the other hand, e-cigarettes carry the risk of addicting a day habit. new generation of nicotine users and potentially undoing much of Living in a house where most of his family smokes, Johnson, with- what health officials have accomplished in stigmatizing smoking. Only half of smokers do. He faced a lifelong risk of disease and dis- ment by both proponents and critics of e-cigarettes that regulation is ability and could expect to cut 10 years off his life expectancy if he smoked past the age of 35.

needed. But how that regulation is put into place could ultimately determine whether these products become the best chance of moving But in January, Johnson decided on his own he needed to make a to a tobacco-free society or whether the progress of five decades of change and began to wean himself off smoking using e-cigarettes. tobacco-control efforts will go up in smoke. Almost immediately, he was able to cut his cigarette use, stretching No standards, little data each pack of 20 cigarettes to last a full day, then two. He experimentE-cigarettes exploded onto the U.S. market in 2006. By 2014, there ed with preloaded, disposable e-cigarettes, but they didn't work well for him. He soon switched to using an atomizer with a refillable tank were 2.5 million e-cigarettes users nationwide. While initial products system, often called vaping. By September, he was down tojust five looked much like traditional cigarettes, a long cylindrical tube with cigarettes a day. a glowing tip, over the past year in particular the market has moved "I smoke about the same number of times each day but more to- toward refillable tank systems that bear little resemblance to tobacco wards the vaping side," he said."I don't cough up any black tar or cigarettes. anything." While there are multiple different designs, most use the same baHe's been ratcheting down the nicotine levels in his e-cigarettes sic concept: a battery-powered heating element that heats a nicoas well, from a potent 24 mg/mL when he started vaping, down to tine-containing liquid until it turns into a vapor to be inhaled just like about6 mg/mL by September. cigarette smoke. While smoke is produced by burning tobacco, the His ultimate goal is to stop smoking tobacco cigarettes, but he has vapor is produced only by heating the liquid, much like steam from a no immediate plans to stop using e-cigarettes. kettle. For most users, a disposable e-cigarette will last about as long "I think I'll still be vaping regularly but I want to be at a much lower as two packs of tobacco cigarettes. Tank systems or atomizers, on

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u uu u

RYAN BRENNECKE

Spencer Knowies, owner ofHigh Mountain Mist, left, samples some of the e-liquid he offers with a customer, Dylan Frier, ofRedmond.

the other hand, can be refilled as often as needed.

being made in a vacuum, which each side of this polarized debate is

The liquid, often called juice by vapers, is even more varied. The exploiting to further its own agenda. "People are actually being very juice consists mainly of water, propylene glycol and glycerin mixed one-sided in this debate. The main issue here is the whole discuswith varying amounts of nicotine and flavoring. The liquid may be manufactured by large multinational companies with millions in sales

or by small mom-and-pop vape shops that produce their own juice for their local customers. One analysis earlier this year identified 466 brands and 7,764 unique flavors of e-cigarettes. But with no regulations or even manufacturing standards in place, it is almost impossible to make any definitive statement about e-cigarettes. What applies to one product may not apply to another. "There really is a Wild West in the e-cigarette market out there," said Vince Willmore, communications director for Tobacco-Free Kids. "There isn't one e-cigarette. There are probably hundreds of types of e-cigarettes, which really makes it hard to get a handle on the health impact of these products." The industry is so new and changing so rapidly, there is little conclusive evidence upon which public health experts, regulators or even industry proponents can rely. So decisions on regulations are

FALL/WINTER 2014â&#x20AC;˘ HIGH DESERTPLILSE

sion is ahead of the evidence," said Dr. Wasim Maziak, a professor of epidemiology at Florida International University. "There are two very disconnected parties and they're feeding off of each other without

really influencing one another." Proponents of e-cigarettes have adopted the harm-reduction argument, arguing that what's in the vapor from e-cigarettes is much safer than the witch's brew of poisons and carcinogens in tobacco cigarettes. It's a low hurdle to clear. "There's no question that electronic cigarettes are much safer than cigarettes," said Dr. Michael Siegel, a professor of community health sciences at the Boston University School of Public Health. "There's just no comparison between these two products." Nonetheless, opponents argue it's still unclear whether the vapor is less harmful. They point to studies that have found toxins and metal particles in e-cigarettes as proof these are far from the safe products many make them outto be. Researchers at the University of Southern California recently looked

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Coverstory IE-CIGARETTES

at vapor from the Elips Serie C e-cig, one of the more popular brands in Europe. The researchers found a tenfold decrease in exposure to harmful particles compared with tobacco cigarettes, with close-tozero levels of organic carcinogens. But they also found particles of chromium, which is not found in traditional cigarettes, and nickel at levels four times higher than in tobacco cigarettes. They found traces of lead and zinc, but in concentrations lower than in traditional cigarettes. "The metal particles likely come from the cartridge of the e-cigarette devices themselves, which opens up the possibility that better manufacturing standards for the devices could reduce the quantity of metals in the smoke," said Arian Saffari, the lead author of the paper. But it's unclear how many brands of e-cigarettes or tank atomiz-

ers would have similar problems, or whether the problem could be solved with manufacturing standards. Another study raised concerns that some e-cigarettes run too hot, heating the liquids to temperatures sufficient to create cancer-caus-

Are e-eigarettes a gateway? A survey of U.S, middle and high school students found thatyouth who tried e-cigarettes were more likely to report an intention to smoke. Past research has shown that intention to smoke generally predicts future smoking behavior.

Haveyou tried e-cigarettes? All students ~ 6. 1% Students who have never smoked/ 0.9% Stodeotssvhohavesmoked ~

20 2%

Doyouintend to trytobacco cigarettes? Neversmoked ~ Never smokedbut tried e-cigarette Never smoked or tried e-cigarette ~

22% 43.9% 21.5%

Source: U.s. Centersfor DiseaseControl and Prevention

ANDYZEIGERT

ing chemicals such as formaldehyde or acetaldehyde. But again, those concerns are limited to only some e-cigarettes and might also be addressed with better standards. Other safety concerns might not be as easily avoided. Researchers at Boston University recently reported that human bronchial cells exposed in a lab to e-cigarette vapor showed changes in gene expression similar to those caused by tobacco smoke. Still, that's a long way from proving e-cigarettes can cause lung cancer, and the researcher acknowledged that e-cigarettes, although not completely benign, might indeed be safer than traditional cigarettes. And nicotine itself is not a particularly benign product. It's one of the more poisonous and addictive compounds found in nature. While there's little research available on the impact of long-term nicotine use outside of smoking, there are major concerns. There is evidence that nicotine has adverse effects on adolescent brain development that could result in lasting deficits in cognitive function. And recent studies suggest that nicotine may prime the brain for illicit drug use and addiction. There's even less data on what secondhand exposure to e-cigarette vapor might be. The Centers for Disease Control and Prevention estimates that 50,000 nonsmokers die each year in the U.S. from exposure to secondhand tobacco smoke. But most of that risk comes from the smoke that curls off the end of a tobacco cigarette. When inhaled, most of the dangerous compounds in cigarette smoke are absorbed in the throat and lungs and released in much lower quantities in the smoke that's exhaled. E-cigarettes, on the other hand, don't release any vapor unless the user is inhaling, and again any of the exhaled vapor contains little of concern. A study by the Roswell Park Cancer Institute in Buffalo, New York, testing three models of e-cigarettes found that indoor use does leave nicotine residue on the surroundings, although not to the extent that tobacco cigarettes do. And e-cigarette users can also resort to what's known as discreet vaping, preventing any of the vapor from

haling, there's no visible exhalant," said Julie Woessner, president of the Consumer Advocates for Smoke-free Alternatives Association, a consumer-run nonprofit advocacy group. "We do not claim that e-cigarette use is safe. We're estimating based on the fact that this a smoke-free alternative and it's the smoke that does the damage, that it's 99 percent less harmful than smoking." One of the few proven harms associated with e-cigarettes is the nicotine liquid itself. Nicotine is highly toxic and some users have had to go to the emergency room after spilling the liquid on their skin, where it can be quickly absorbed. And because there are no require-

ments for childproof packaging, there has been a slate of poisonings involving young children. The CDC recently reported that from September 2010 through February 2014, poison control centers fielded 2,405 calls involving e-cigarettes and 16,248 involving tobacco cigarettes. E-cigarette calls per month rose from a single call in September 2010, to 215 in February. More than half of those calls were for kids under the age of 5. Meanwhile, the evidence that e-cigarettes can be used as a smoking-cessation aid is limited and mixed. One study conducted in the U.S., U.K., Canada and Australia found that e-cigarettes do not help with quitting. Another found smokers were much more effective at quitting using e-cigarettes than with a nicotine patch or going

cold-turkey. A randomized controlled trial found nicotine-containing e-cigarettes were marginally better for quitting smoking, resulting in a 7.3 percent quit rate after six months, compared to 5.8 percent with the patch and 4.1 percent with nicotine-free e-cigarettes. E-cigarette users were able to cut the number of cigarettes consumed by nearly 10 per day, compared with nearly eight fewer for those using the patch.

Undoing antismoking work What has public health officials most concerned is the potential

being exhaled. erosion of many of their strategies for combating tobacco use. "If you just hold your breath for several seconds when you're inTobacco-control efforts have relied on three main approaches: pre-

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vent kids for taking up smoking in the first place, making it more difficult for smokers to continue their habits, and to stigmatize smoking to make it less attractive. Over the past four decades, tobacco control has put in place dozens of laws and regulations designed to further

localities have addressed vaping or e-cigarette use in public places. Many individual offices, restaurants and bars where smoking is ille-

gal now permit vaping. And nothing has characterized the e-cigarette industry more than

these goals and keep tobacco companies from gaining new ground. the variety of flavored juices, like Cherry Kool-Aid or SweeTarts, that These laws have been remarkably effective, cutting the smoking rate from 42 percent of Americans in 1965 tojust over 19 percent in 2011. Cigarette taxes and minimum pack size are designed to price cigarettes out of reach of children. Manufacturers are banned from marketing flavored cigarettes that could be more appealing to kids and cannot advertise their products on televisions or in print. But the advertising bans don't apply to e-cigarette companies that have taken to the airwaves to market their products. E-cigarette advertising has grown from $6.4 million in 2011 to $60 million in 2013, reviving much of the messaging used by cigarette companies in the 1950s and 1960s. "The marketing of e-cigarettes comes out of the same playbook tobacco companies have used to market regular cigarettes to kids," Willmore said. "We have seen the new slick magazine and TVads that make e-cigarettes look glamorous just like the Marlboro man and the Virginia Slims woman."

seem to be targeting children. "This is part of the campaign called deceit with sweet," said Penny Pritchard, tobacco-prevention coordinator for Deschutes County Health Services. "Without these restrictions on flavor bans or age bans for electronic cigarettes in Oregon, we've seen an increase in kids who want to try e-cigarettes, but they don't want to try conventional cigarettes."

It's doubly concerning because the county already has higher smoking rates among 11th graders (20 percent) than adults (14 percent).

"In fact, it's the second-highest rate in Oregon," Pritchard said. "A lot of people don't think it's an issue because of our low adult smoking rate, but there's a huge gap in our perception." Pritchard attributes that teen smoking rate to Oregon's high rate of illegal sales to minors — the worst in the nation, according to a 2012 report. They've hired celebrity spokespeople, including TV personalityJen"This is a huge issue in our community — convenience stores and ny McCarthy, who in one TV spot talks about taking her freedom grocery stores not carding," she said. "Especially in rural communiback and being able to smoke anywhere. They've sponsored sport- ties, that's an issue." ing events and concerts and plastered their logos on bikini-clad modAnd while many stores and vape shops say they voluntarily refrain els. In 2013 and 2014, e-cigarette maker EJoy ran commercials during from selling e-cigarettes and juice to minors, with so many shops sellthe Super Bowl. ing cigarettes illegally, a voluntary ban seems unlikely to have much E-cigarette companies are offering free samples and selling single effect. products that lower the entry costs for young users. And so far, no Public health officials also worry that people don't consider e-cigstate has implemented a tax on e-cigarettes to make them just as arettes or vaping risky and are willing to give it a pass in social expensive as tobacco cigarettes. situations. "If you're at dinner, you're not going to smoke in front of your While "clear air" laws have forced smokers outdoors, few states or

"I COULDN'T BELIEVE I WAS ON MY FEET WITH NO HIP PAIN", Sheri, the day after total hip replacement surgery

When debilitating pain and stiffness in your hip limits your daily activities, it's time to give us a call. Dr. Finter offers a compassionate and personalized a proach to our care.

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friends, but if you have a vape pen, you might," Pritchard said. Parents might be more willing to vape indoors or in cars with children. And many workplaces that can't allow smoking tolerate vaping. "It has the potential to be exposing people to the vapor that other people are using, but also that it does model for kids to have smoking happen anytime, anywhere," said Dr. Bruce Gutelius, deputy state epidemiologist with the Oregon Public Health Division. "There's this potential for them to be a bridge product, so they can use them where they can't smoke, and then go back to smoking when they are somewhere where they can smoke."

Certainly, adults also buy candy and enjoy candy flavors. And many e-cigarette flavors, such as coffee or black walnut, seem to be geared more toward adults. But the fear among antismoking advocates is that kids will be attracted to e-cigarettes, become addicted to nicotine and then transition into smoking. While it's not yet clear whether that is happening, there is data showing that youth are at least trying e-cigarettes in increasing numbers. According to a CDC survey released in August, more than a quar-

Inside an e-eigarette As electronic cigarettes â&#x20AC;&#x201D; technically battery-operated nicotine inhalersbecome increasingly popular thejury is still out on the health risks they mayyield. Light: Simulates cigarette glow; indicates when the device is ready for use; also works as a battery indicator.

Electronic components: Include control circuits and pneumatic airflow sensor.

Vaporizer: Nic o tine Atomizes the liq u i d nicotine container smoking liquid in the liquid container.

Inhaler source: E-cig

ÂŠ 2014 MCT

ter-million middle and high school students who had never smoked a

"We now have established a pretty good body of literature showcigarette used electronic cigarettes in 2013, a threefold increase from ing that e-cigarettes do not attract nonsmokers. They simply don't. 79,000 in 2011 to 263,000 in 2013. Virtually every e-cigarette user is a smoker who switched," said Dr. Those who used e-cigarettes reported being twice as likely to Joel Nitzkin, a public health physician who now consults for R Street, smoke conventional cigarettes (44 percent) compared with those a conservative think tank in Washington, D.C. "There are lots of nonwho did not (22 percent.) Past surveys have shown that a stated in- smokers, especially kids, who are tempted to try e-cigarettes, to samtention to smoke is predictive of future cigarette use. ple them. But it's hard to find even a single kid who started off as a "Eighty percent of established adult users establish before the age nonsmoker, sampled them and continued its use." of 18, so it requires an upstream approach," said Shanta Dube, assoHe points to two studies conducted by public health groups as ciate professor of epidemiology at Georgia State University, who was proof. A U.S. survey of 3,240 adults found only six nonsmokers who involved with the CDC survey. "Primary prevention is about making had ever used an e-cigarette, and a 2013 U.K. survey of more than sure you do not begin or initiate or experiment." 12,000 adults and 2,000 children was not able to identify a single According to the CDC, every day 3,200 kids try their first tobacco nonsmoker who used e-cigarettes regularly. cigarette, more than 700 of them go on to become daily smokers. CDC data, he said, could be interpreted in the same way, showing Even at the current reduced levels of smoking, an estimated 5.6 mil- a rapid increase in teens trying e-cigarette use, but a continued delion children in the U.S. alive today will die prematurely from a smok- cline in teen smoking rates. ing-related illness. "The best path from where we are to a tobacco-free society is to "The other side of the coin is that there are smokers, and smoking adopt tobacco harm reduction elements in the public health prois a difficult thing to change because of the issue around the nicotine grams and have people switch to products that are a whole lot easier dependence," Dube said. "But in terms of e-cigarettes and the poten- to quit," Nitzkin said. "Not only are they easier to quit, they cut the tial for harm reduction, I can't be completely positive about that, until risk of potentially fatal tobacco related illness by 99 percent or more. I there is more evidence about the safety of the product. The jury is think we have good, solid scientific evidence to point that out." still out. I think in the spectrum, it's safer than cigarettes but we don't Many public health experts agree. In May, more than 50 researchknow how safe because we don't have any evidence." ers and public health officials sent a letter to the World Health OrgaEven in states which have implemented a ban in the sales to mi- nization urging the group to not suppress the e-cigarette industry. "If the WHO gets its way and extinguishes e-cigarettes, it will not nors, e-cigarette use among teens continues to rise. In Utah, for example, teen use of e-cigarettes tripled to nearly 6 percent between only have passed up what is clearly one of the biggest public health 2011 and 2013, and nearly one-third of users said they had never innovations of the last three decades that could potentially save milsmoked a traditional cigarette. lions of lives, but it will have abrogated its own responsibility under "This whole area of e-cigarettes is new; it's changed our landscape its own charter to empower consumers to take control of their own of tobacco control," Dube said. health, something which they are already doing themselves in the Proponents of e-cigarettes counter that none of that data shows millions," said Professor Gerry Stimson, emeritus professor at the Imthat kids are becoming regular users of e-cigarettes, much less tradi- perial College in London and one of the signatories in the letter. tional cigarettes. A review of available research by academics at Queen Mary Univer-

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sity of London found that although long-term health effects of e-cigarettes are unknown, compared with conventional cigarettes they are

down to a matter of perspective. Those opposed to e-cigarettes see the harm that can come to people who don't currently smoke but likely to be much less harmful. The reviewers said the evidence does could start. Those supporting e-cigarettes focus on the reduction in not justify regulating them as strictly as conventional cigarettes. harm that comes for people already addicted to smoking. "The evidence we currently have is clear: E-cigarettes should be "It is only in comparison to cigarettes," Nitzkin said, "that they can allowed to compete against conventional cigarettes in the market- be considered very low risk." Many e-cigarette proponents see a continuum of nicotine-related place," said Peter Hajek, a professor who led the analysis. "Health care professionals may advise smokers who are unwilling to cease nico- harm, with smoking cigarettes on one end and nicotine-replacement tine use to switch to e-cigarettes. Smokers who have not managed products, such as gum and the patch, on the other. As people move to stop with current treatments may also benefit from switching to across the continuum away from smoking, they not only reduce their e-cigarettes." harm but it becomes easier to quit tobacco smoking altogether. E-cigIn June, however, more than 129 public health doctors wrote to the arettes, theyargue, would fall somewhere in the middle. WHO refuting the claims of the May letter and urging tighter controls But Maziak, the Florida International professor, believes that sort of on e-cigarettes. approach could result in a major public health blunder. "Their response is the known science is only suggestive; it's not "To me we do not benchmark on the worst practice," he said. "When conclusive. But you know, proof, like beauty, is often in the eye of the cigarettes were first introduced to the market, they were thought to beholder," Nitzkin said. "We know how toxic cigarette smoke is, we be beneficial, and then they became very strong economically. It's a know how addictive the cigarette is. We also know that nicotine-only very unique history that we don't want to repeat or actually use as an delivery products are substantially less addictive. That means they excuse for going really blind on e-cigarettes." are easier to quit than cigarettes. So all of the science is in favor of the Maziak acknowledges that among the best arguments in favor of e-cigarettes." e-cigarettes is there is little else to offer smokers, so those opposed In some ways, the difference between the two groups comes are basically advocating a "quit or die" policy for smokers. "With e-cig-

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Coverstory IE-CIGARETTES

arettes we finally have a product that looks like cigarettes, works like r e action to e-cigarettes, with public health experts wary of repeating cigarettes, is popular among smokers but poses less harm than con- t h e difficult history with smoking. The big tobacco companies, howventional cigarettes," he said. ever, have only recently entered the e-cigarette marketplace. Most That alone gives them an advantage over nicotine replacement o f t he growth in the industry has come from independent compaproducts. Clamping down on e-cigarettes might end up throwing n i es, some of which are now being bought out by the large cigarette some smokers under the bus, but might still be the right call. "There m a kers. In 2 0 12, Lorillard paid $135 million for blu eCigs, and in 2013, Reynwill be some price to pay," he said, "If we get some evidence that there is really minor uptake among nonsmokers then that changes o l ds American started marketing Vuse. This year, Altria, parent comthe whole thing. But we don't have that now. We don't have any evi- p a ny of Philip Morris USA, purchased e-cigarette maker Green Smoke dence that it really does work as people claim it does." for $110 million and last year began marketing its own e-cigarette, the MarkTen. Big Tobacco and more Nonetheless the tobacco companies' entry to the market compliThe debate may come down to a gruesome accounting of harm, c a tes the discussion as antlsmoking advocates have been quick to whether e-cigarettes will save more lives by reducing death and dis- t r ansfer the sins of the tobacco industry to e-cigarettes makers. "Their whole strategy is based on addicting our ease in current smokers or increase the death

ThedebOtemOy COme

rates by creating new smokers. "The bottom line is to reduce the death and disease caused by tobacco use," Willmore said. u' 'he evidence is s'ill very Iimi'ed and incon clusive whether e-cigarettes can play that kind

of roll. We're seeing a lot of trial, but not a lot of

our children and you care about the health care costs in our system you would do everything you possibly could to block these efforts to lure our

OCCOUflglA90f/70fm,

children into a life of addiction," said U.S. Sen.Jeff

WA C CACf 8-CI 90f8tfCS

switching." It's possible, he said, that e-cigarettes could

prove less harmful for smokers but still not benefit the population as a whole. And many anti-

child renandifyoucareabout thequalityoflife of

Merkl e y, D-Ore. Merkley became concerned about tobacco marketing to kids when he was first elected to Congress in 2009. He had learned about efforts to test market in Oregon three new products that

Qy tpgUgjgg QpOgg

smoking advocates simply don't buy the hype Of l C /CASCOSC Ifl CUff8flt

formul a ted finely ground tobacco into mint orbs,

about e-cigarettes. "I empathize with smokers who d o

toothpicks or breath strips. The orbs were packaged in hourglass-shaped containers that when

t h ink

they're going to quit by using e-cigarettes, but they lose me when they tell me they quit smok-

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slipped into a back pocket looked like the profile

of the flip phones popular at the time. "It was pretty diabolical. Actually jaws would drop. It's unbelievable that once again the tob a cco industry is targeting our children." Merkley said. "Now I think t h ey've found what has been a far more successful strategy of selling nicotine extracted from tobacco, and once again we see this massive e f f ort to target children. I don't think we were trying to get 30-yearo l d people to buy gummy bear and Scooby snack (products)." Merk l ey has been pushing the FDA to regulate e-cigarettes since Congress passed the Tobacco Control Act in 2009 and was one of a h a ndful of Democrats in Congress to issue a scathing report on the e - cigarettes industry and the lack of regulation in April. The FDA prop o sed regulations a week later.

ing but they're still smoking e-cigarettes," said fl C W S mO k8fS.

AnnePalmer,asmoking-cessationcounselorand owner of Customize Your Quit in Bend. "They're still smoking the nicotine. They have not quit smoking. They've simply changed the delivery method." Palmer said she hasn't had one client who's actually quit smoking traditional cigarettes by using e-cigarettes. She says that's because vaping continues the nicotine addiction and mimics the hand-tomouth action of smoking. "I understand that people are very passionate. 'Oh yeah, I switched to e-cigs. I feel so much better.' That's great, but these people are masters of delusion â&#x20AC;&#x201D; they smoked all of those years and the only "They have been dragging their feet unacceptably," Merkley said. way you can continue to do that is by lying to yourself about the fact "They finally came out with a draft of (e-cigarette) regulations that that you're poisoning yourself 20, 30 times a day." Nor does she buy the harm-reduction model. largely simply says, 'Yes, the law gives us the power to regulate this.' "We've been down this road before. We've gone through it with Well, we knew that when we passed the law in 2009. But I do not menthol, we went through it with light cigarettes and then low-tar. It k n ow why or how they could possiblyjustify stretching this out over was all nonsense," she said. "I think it's wishful thinking for people to t h ese five years." say that all of a sudden the tobacco industry has come up with a safe The FDA first tried to regulate e-cigarettes in 2009 as drug-delivery smoke. They've shown awanton disregard for their clients and I don't d e v ices, a move many saw as an attempt to devastate the industry. see that changing with e-cigarettes." Had that effort succeeded, it would have required manufacturers to The distrust of tobacco companies has played a large role in the m e et the same strict standards that medical device manufacturers

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must meet to gain FDA approval. The cost of the types of studies required would likely have been beyond the reach of most e-cigarette makers at the time. But one e-cigarette maker sued the FDA and won. The court ruled that as long as e-cigarette makers weren't making health claims, such as that e-cigarettes were healthier than smoking tobacco or that they were an effective cessation aid, they could only be regulated as a tobacco product. So this year, the FDA proposed so-called "deeming regulations" that would establish its authority to regulate e-cigarettes as a new to-

to be the big tobacco companies. So it's basically going to give the market to Big Tobacco." Some argue that Big Tobacco, with its deep pockets and large marketing budget, is likely to dominate the market anyway. But there's evidence that Big Tobacco is looking at e-cigarettes much differently than independent firms. In its comments on the proposed deeming regulations, Reynolds urged the FDA to ban refillable tank atomizers,

arguing they pose a safety risk. That would leave only disposable

e-cigarettes, which require a more sophisticated and expensive production system but look much more like traditional cigarettes. "There's no real reason for that. If you're just trying to deliver nicbacco product. Those regulations would ban free samples and sales to minors, require a warning label, force companies to submit a list otine, you can do it anyway you want. And in fact there's probably of ingredients to the agency, and prohibit them from using any risk more practical ways to contain the liquid, said Chris Bostic, deputy modifiers, such as the words light, low or mild, in their marketing. director of the advocacy group Action on Smoking and Health. "But Critics immediately decried the lack of a ban on flavorings, although they go out of their way to make it look like cigarettes because they're an FDA spokesman indicated the agency must first gain legal jurisdic- marketing cigarettes to people." tion before applying any possible future restrictions on flavorings. Skeptics say it's further proof that Big Tobacco wants to use e-cigThe proposed regulations, however, would decimate the e-ciga- arettes as a gateway to attract more cigarette smokers. And banning

rette industry, reducing it to onlya handful of large players by requir- refillable tank systems would kill off the mom-and-pop vape shops. ing extensive paperwork to be filed for each e-cigarette product. The FDA has estimated that each application would require on average 5,000 hours of work. "Most e-cigarette companies are pretty small. In fact, the majority of them are not even companies; theyare little shops," said Siegel, the Boston University School of Public Health professor. "Some guy sets up a store and starts selling these things. How is he going to spend 5,000 hours putting together a report on a new product?" A vape shop that makes its own juice would have to submit a new

product application for each flavor. "It's basically going to put most of these businesses out of business," Seigel said."And basically the only ones that are going to remain are the really huge companies. And unfortunately those happen

"If the only way to regulate us under the Tobacco Control Act is to decimate the industry," Woessner said, "then no, that's not good for consumers and that's not what we want."

Next steps Spencer Knowles, owner of High Mountain Mist, a vape shop in Bend, said he would like to see some regulation but is concerned it could price him out of the market. "Of course, I want regulation, but as the little guy, how am I going to keep this business going if they say, just arbitrarily, it's $30,000 to test this?" he said. "And the reason they do that is to put mom and pop out of business." Knowles said most of his clients are smokers who are looking for

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500mg g

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a safer alternative to cigarettes or hookah smoking. He discounts the notion that e-cigarettes are going to lead to new smokers. "What I've experienced is those people who gravitate to vaping first would have been smokers anyway," he said. "Most kids start

the scientific data actually show that it's much safer â&#x20AC;&#x201D; they're not able to see that. They can't condone it even though that may be the way to save someone's life." Seigel maintains that even without regulation, there is a net public smoking because of the psychological thing. They're pissed off at so- health benefit to e-cigarettes. Putting in common-sense regulations ciety or their parents, and they want to rebel. This is a way of saying, could further improve the risk-to-benefit ratio. To maximize the ben'I know this is bad for me, but I do it anyway.' Those are the same kids efit, he said, it must be as easy as possible for adult smokers to get who are starting to vape." these products. "The proposed deeming regulations mayactuallydo the opposite," He believes that opposition to vaping has less to do with facts or evidence and more with emotional reactions. Seigel said."They make it as difficult as possible for electronic ciga"People have friends and family that they've lost to smoking. rette companies to remain viable." There's a deep emotional rift in their heart and their soul against He argues the FDA should instead focus on reducing the identified smoking," he said. "We have bans in public for smoking, because sec- harms, most of which could be prevented by setting manufacturing ondhand smoke is terrible, and we have bans for children, and these standards. "I would say, 'Here are the standards that everybody must follow. are all very good things. And now they walk in and they see people smoking in those areas, and they're so emotionally traumatized The battery safety must look like this. The maximum temperature is by losing Dad, or Grandma, or seeing a friend dying of emphysema, this. Here is the quality of the chemicals you can put in there. Here they do not have the capability in their brain to say, 'Oh, that's some- are the chemicals you can and cannot put in there. Here's the childthing absolutely different.'" proof packaging that you can have. Here is how you have to prevent Siegel agrees that it's ideology that's driving policy instead of leaks,'" he said. "And any product that meets the standards can go on evidence. the market." "The ideology is so strong that tobacco-control practitioners have Byadding restrictions on marketing and sales to minors, the agenbecome against the act of smoking, not against the harm done by cy could address most of the more pressing concerns. "If they do this right and they allow this market to thrive and put smoking," he said."So they see a product that looks like a cigarette and acts like a cigarette â&#x20AC;&#x201D; to them it's just a cigarette. The fact that in reasonable controls, these have the potential to take up as much

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Coverstory IE-CIGARETTES

4 Not just nicotine Vaping is starting to make inroads into the medical marijuana market as well. A marijuana vape pen eliminates the need to burn the marijuana leaf — a key issue for bedridden patients. Additionally, cannabis e-cigarette juice can be formulated to maximize the content of cannabidiol, the compound in marijuana thought to be responsible for its analgesic, anti-inflammatory and anti-anxiety properties, while minimizing the psychoactive effect that leads to feeling "high" or "stoned." It does, however, raise concerns that individuals could start using e-cigarettes to vape marijuana surreptitiously in states where marijuana is still illegal or limited to those with medical conditions.

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as 30 to SO percent of the combustible market," Siegel said. "If that happens it would be the greatest public health victory of our lifetime." The comment period for the proposed regulations closed in August, and it will take some time for the FDA to review the nearly 80,000 comments it received. The agency projected a release

of the final regulations in June 2015, followed by another 90-day comment period. But it may be much longer before regulations impact the e-cigarette market.

"They're being as careful as possible because they're pretty certain no matter what they come up with, they are going to get sued," said Bostic, of Action on Smoking and Health. "They want to make sure they have all their ducks in a row. You want to do the right thing, but they want have it stick and not have it overturned in court. Several companies are already moving production to the U.S. from China to prepare for the standardization and quality control that could be required by the FDA. The e-cigarette industry has issued an extensive set of quality standards for e-cigarette fluid, but those remain voluntary. And in the absence of regulation, no one is inspecting the contents of vapejuice or the production facilities. Knowles said his juice is created in a high-quality lab in Arizona with the strictest of standards. But as Pritchard points out, shops can make claims about Continued on Page 54

FALL/WINTER 2014• HIGH DESERTPuLSE

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TIPSiCOMPARING DIETS

Whichever one you can stick with. Popular diet systems vary little for long-term weight loss BY TARA BANNOW

t a time when more than 30 percent of U.S. adults are considered to be obese, losing weight is about much more than vanity. It's a matter of public health. With that in mind, a group of researchers in Toronto recently decided to drill down an answer to an important question. "Everyone wants to know: Of all of these brands that are available,

was the least expensive diet, at an average of $377 per year. Jenny Craig, a diet plan in which clients must purchase all of their meals through the program, was the most expensive, with an annual cost of $2,500. After one year, Weight Watchers dieters lost an average of

5 pounds versus an average of 16 pounds with Jenny Craig. In the end, though, the study concluded Weight Watchers was the

which one is the best? Which one should I follow?" said BradleyJohn- more cost-effective option, coming in at an average cost of $155 for ston, a scientist with the Hospital for Sick Children Research Institute every 2.2 pounds lost. and lead author on a new study that compares the effectiveness of a In the end,Johnston and his colleagues concluded, it's not so much handful of weight-loss programs, such as the Atkins Diet and Weight which diet you choose that determines how much weight you'll lose â&#x20AC;&#x201D; it's how well you adhere to that diet over time. Watchers. "It still comes back to the fundamentals that our grandparents or To perform its analysis, Johnston's team gathered 48 randomized controlled trials that studied 11 diet programs. The study compared our parents hopefully told us, that to be healthy is to be balanced in the diets by the amount of weight participants lost at six and 12 terms of diet, exercise and social components in your life, so having months after starting the programs. The researchers also separated good friends and social supports, having an active lifestyle and makthe programs by their weight-loss mechanisms. Low-carbohydrate di- ing good food choices," he said. ets, for example, included Atkins, South Beach and The Zone. Low-fat A good rule of thumb when it comes to choosing foods is to eat 80 diets were Ornish and Rosemary Conley. Another category grouped percent healthy foods and 20 percent not-so-healthy foods. together diets that fell into neither the low-carb nor the low-fat cateIn other words, it's more about finding a diet that fits your lifestyle gories, including Jenny Craig, Nutrisystem and Weight Watchers. than choosing just the right brand name, Johnston said. Future reBroadly speaking, the researchers did not find significant differ- search should look into how to personalize diets based on lifestyles, ences in weight loss when they compared specific programs, even he said. But for now, he urges people to choose a diet that's managethough people who adopted low-carb or low-fat diets certainly lost able and will result in slower weight loss over one that's challenging more weight than those who didn't diet at all. and results in more weight loss sooner. "You're probably better off to follow something that results in slowMeanwhile, another study released around the same time by the Duke-National University of Singapore Graduate Medical School stud- er weight loss but you can tolerate, rather than something that's realied another element of interest to would-be dieters: Cost-effective- ly strict and its clearly probably intolerable over the longer," Johnston ness. Those researchers found that in terms of cost, Weight Watchers sald.

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Atkins Diet

The Zone Diet

What is it? B ased on t h e

premise of lowering carbohydrate intake to burn fat more e fficiently. Participants m u st purchase Atkins-brand frozen

meals, bars and shakes. Weight loss:After six months, Atkins dieters lost more weight than any other diet, with an average weight loss of about 22 pounds. After 12 months, Atkins dieters lost about 14 pounds.

Weight Watchers What is it? Assigns foods points based on nutritional value (protein, fiber, carbohydrates, etc.) and calorie content. Has a database with more than 200,000 foods that dieters can purchase at the store and 4,000recipesthey can make athome. Weight loss: After six months, Weight Watchers dieters lost an average of 16 pounds. After 12 months, 13 pounds.

What is it? Based on the ideathat weight gain is caused bydiet-induced inflammation — which increases hunger and encourages the body to store rather than burn fat — this diet promotes its own line of meal-replacement shakes and dietary supplements as part of an anti-inflammatory diet, according to The Zone Diet's website. Weight loss: After six months, participants lost an average of just under 19 pounds. After 12 months, 13 pounds.

Volumetrics Diet What is it? Based on a Penn State University nutritional sciences professor's research, this diet works by lowering the

•

calories consumed per bite to help people feel more full while eating fewer calories, according to a PSU news release. Breaks food into four categories according to how often they should be consumed, with fruits and nonstarchy vegetables in an "anytime"

BARBARA ROLLS, PI1.

category and fried foods and candy in a "sparing" category. Weight loss: After six months, participants lost an average of just under 22 pounds. After 12 months, about 13 pounds.

Jenny Craig What is i t ? Participants work with consultants over the phone or in person to

The Ornish Spectrum

form diet plans and purchase Jenny Craig-brand prepackaged foods.

healthful" group I — things like apples, mushrooms, egg whites — to

What is it? Foods are arranged into five groups, from the "most

Weight loss: After six months, dieters lost an average of just under 13 pounds. After 12 months, 14 pounds.

the "least healthful" group 5 — things like pastries, bacon and butter. Includes strict nutritional rules, such as no more than 24 grams of sugar per day and no more than 10 percent of calories can come from fat, according to the Ornish website. Weight loss: After six months, participants lost an average of just under 20 pounds. After 12 months, about 14 pounds. •

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Feature ~ PEDIATRIC PSYCHIATRICCARE

Changes in policy have put intensive psychiatric care for children hours away and made it prohibitively expensive for many Central Oregon families BY TARA BANNOW • PHOTOS BY JOE KLINE

awn Mountz found her daughter 10 hours after she had run

away from home. Huddled beneath playground equipment in a park, the 15-year-old cried and told the search party standing over her she wanted to die.

Then something changed. Shefroze. "She actually became, it was so odd, almost like catatonic," said 52-year-old Mountz, of Prineville. "Her hands were in fists, she was super stiff, staring out, pupils dilated." Just that morning, her daughter, who Mountz asked not be identified, had sat quietly in church beside her mother and younger sister. It was 2012. Mother's Day. When they got home, Mountz glanced out the window and saw her daughter, just about to turn 16, walking around in the backyard, which — even on a nice spring day — seemed odd. She went in the

treme. Her daughter — adopted along with her biological sister from the Vladimir region of Russia eight years earlier — hadn't been doing well in school. The information wasn't clicking, and she was having

memory issues. Suddenly, she couldn't solve simple math problems. After Mountz and a group of friends found Mountz's daughter around 9 o'clock at night, they rushed her to the emergency room in Prineville, where she stayed for about three hours before being transferred to the larger hospital in Bend. She stayed there for three days, getting stable and receiving therapy from a psychiatrist who worked in the hospital at the time. Mountz hoped that was the end of it. That summer, things only got worse. Mountz's daughter talked

regularly about wanting to kill herself. She dug sharp objectsnails, sharpened bobby pins, her fingernails — into her arms until

bedroom, changed out of her church clothes and put on jeans, and they bled. She threatened family members. Even as all of this was looked out the window again. Not even 10 minutes had passed. Her

daughter was gone. Police canvassed the small town all day, handing their cards out and letting people know what was going on. Things hadn't been right for a while, but never anything this ex-

going on, Mountz said, she couldn't stand the thought of sending her daughter to Portland, where the state's only acute pediatric psychiatric units are located.

By September, Mountz could no longer keep her daughter safe. She took her to Portland for a psychiatric evaluation. They said the

Opposite: I/alerie Grindstaff right, and Shannon Pugerudestarted Wyldwoodz Resource Center (which has an officein Redmond, though much ofthe workhappensin clients'homes) to help other families with children who haveseriousmentalillness. Olivia Pugerude, 14,and Damon Grindstaff 76, play as their moms watch. JOE KLINE

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Feature IPEDIATRIC PSYCHIATRICCARE

teenager needed residential treatment, a step down from inpatient treatment that generally includes intensive individual and group therapy and monitoring by trained staff. Mountz's daughter spent the next seven months in two residential facilities across the state from her family. When she was released in April, the staff recommended she enroll in day treatment, but since there are no facilities in Central Oregon that provide that treatment, she went straight to school instead. Day treatment provides community-based, individualized treatment to children and adolescents with psychiatric disorders who live at home but who wouldn't be able to participate in traditional school or work settings. Mountz's experience of being sent hours away to get help for her

Unfortunately, the outpatient services largely failed to materialize and, in recent years, emergency departments, pediatricians, the criminal justice system and schools have become the main mental

daughter â&#x20AC;&#x201D; and making do with minimal services once she finally

of OHSU's child and adolescent psychiatry division.

brought her back home â&#x20AC;&#x201D; is anything but unique for Central Oregon families whose children struggle with mental illness. The past five decades have seen a trend toward shuttering large psychiatric facilities in favor of helping people within their own communities, a strategy many mental health professionals believe to be superior. The idea was to replace them with strong networks of outpatient services: providers, day programs, teams of community supports.

"We're unable to serve anywhere near the volume of kids and families who are referred to us," he said. "It's a frustrating, worrisome

health providers for struggling children and adolescents. Now, providers in Central Oregon are at a breaking point. They're scrambling to meet the crushing demand for pediatric psychiatric care while also trying to come together to pinpoint exactly what services are missing. Meanwhile, state agencies are trying to figure out what must be done differently on a broad scale. At Oregon Health 8 Science University in Portland, calls from parents desperate to find their kids

help have increased sharply over the past year, and kids seem to be more severely impacted than in the past, said Dr. Ajit Jetmalani, head

experience. It's really been this way for years, but it seems to be escalating." Many say the current system forces families into an "all or nothing" scenario. At one extreme, children and adolescents are hospitalized when their conditions deteriorate so much that they threaten to hurt themselves or others. At the other, the people aren't considered se-

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vere enough and get next to no care. "We're forced into this box where the only thing we care about is kids shooting themselves or each other," said Dr. Nathan Osborn,

one of only a small handful of child and adolescent psychiatrists in Central Oregon. "We don't fund day treatment centers; we don't fund intensive care, wraparound services — we don't keep those services

available, which is reallya political and social decision."

People left adrift The 1962 book "One Flew Over the Cuckoo's Nest" — launched to pop culture fame when it was turned into a movie 13 years later — painted a disturbing portrait of mental institutions as dysfunction-

al places where people were overmedicated, abused and ultimately forgotten. It contributed to a general sense that institutionalization was the wrong way to care for people with mental illness, a philosophy that has proliferated over the years, taking hold not only in public opinion, but also in federal and state policies. Many point to a 1963 federal law as the first time mental health spending was deliberately shifted away from institutions and toward services that would keep people in their communities. Between 1986 and 2009, nationwide spending on inpatient and residential mental health services decreased from 63 percent of total public and private

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spending on mental health care to 32 percent, according to the Substance Abuse and Mental Health Services Administration. Barrett Flesh, the program manager for Deschutes County's Child and Family Program, said it's been a necessary shift, as separating kids who are struggling from their families tends to make things worse by aggravating attachment disorders — at the root of countless mental health struggles — and perpetuating stigmas that surround psychiatric hospitalization. "The family is not really engaged when they're institutionalized," he said, "and they start to identify from a developmental level that there is something wrong with them." In 2003, the Oregon Legislature directed agencies to reform the way children received mental health treatment. Particularly, lawmakers wanted to improve outpatient services, such as access to pediatric psychiatrists, day treatment programs and counseling, so that kids suffering from mental illnesses could be treated in their homes and communities rather than in institutions. Five years later, the number of kids admitted to residential psychiatric facilities dropped 40 percent, according to the Oregon Health Authority. The problem with that, experts in the field say, is that when society largely takes away one form of treatment, it must build in equal force an alternative treatment system. When it comes to outpatient

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Feature IPEDIATRIC PSYCHIATRICCARE

Psyehiatrie serviees for ehildren and adoleseents in Oregon Different types oftreatment facilities handle different levels ofacuity fromindividuals who are in imminent danger and need to be hospitalized, to those who can receive therapy during the day and go home at night. The facilities are spread across the state, mostly in the Portland area. None, however, are in Central Oregon. Portland

Oo©©eeo e

St. Helens,

• Hermiston

Pendleton Hillsboro,

, Lakeoswego

Tigard McMinnville D allas

La Grande

Oregon City

Sale m

Independence

The Dalles

Corvallis

Lebanon

Eugene

Sprlngfield

OOO o • Redmond Bend

Jasper

Legend

Ontario

Acute care beds in hospitals Total: 39 Secure adolescent/children's inpatient programs Total: 40

orth Bend

Roseburg

Sub-acute beds Total: 51 Psychiatric residential treatment services Total: 203

Grants Pass

• Medford

o,„,©

Klamath Falls

Psychiatric day treatment Total: 361

Source: Oregon tteaIth Authority

services, that largely did not happen. Children and adolescents with mental illnesses are heading down the same road as their adult counterparts, who were largely diverted to jails and prisons when the necessary outpatient services didn't follow the widespread closure of residential facilities,

Jetmalani said. "If we shut down residential programs, reduce the number of hospital beds, but we don't actually increase the capacity or quality of our outpatient services, then we have basically left people adrift," he said, "and we start to use the public safety, juvenile justice and prison systems as go-to strategies for people with mental illness and

behavioral challenges."

Page 22

ANDYZEIGERT

Beautiful place, few providers When patients walk into Dr. Nathan Osborn's private psychiatric practice — located among a spattering of small offices in a quaint, tree-covered stretch of Bend — they don't talk to a receptionist through a glass window. In fact, there is no receptionist. Patients walk into the tiny space and either sit on a couch outside the closed office door or Osborn beckons them right in. "It's not real glamorous," said Obsorn, a child psychiatrist, sitting in one of two armchairs across from the couch in his office, a comfortable, rustic-looking room that feels more like a cabin on a lake. Osborn, a former schoolteacher who changed course short-

FALL/WINTER2014• HIGH DESERTPIJLSE

ly into his career to go to medical school, assumes a grave facial a r e often the product of a stalled phase in a child's development, expression when asked about the state of psychiatric services for h e said. "When akidis notgrowing toward the light, theycan exhibit dyskids in Central Oregon. He said his days are jammed with backto-back sessions with kids and their families — evidenced by the f u n ction in different ways," Chopra said. family waiting outside during this meeting. In a medical industry St . C h arles Health System has been trying unsuccessfully to remore known for shunning competition, Osborn said he'd like to see c r uit two pediatric psychiatrists, but no one wants to practice in a 10 more child psychiatrists locally. community that doesn't have a full array of mental health supports "You can only take one bite of an elephant sandwich at a time," i n p lace, said Robin Henderson, St. Charles' chief behavioral health he said. "It can feel pretty overwhelming." officer. Interviews with a number of local providers and families turned Des c h utes County Health Services, which sees primarily Medicaid up only three child and adolescent psychiatrists in Central Oregon, p a t ients, has been trying to hire someone, too. Since none of the one of whom — Dr. Gurpreet Chopra — also spends a portion of p e d iatric psychiatrists in Central Oregon accept the Oregon Health his time seeing adult patients. (It's possible that other general psy- P l an, the state's version of Medicaid, most of those patients are seen chiatrists see children, but only three have made it a substantial b y t he county. The county saw more than 1,100 clients under the part of their practices.) age of 18 in the past year. When they need prescriptions, they see "It's sort of baffling to have such an incredibly beautiful place and the county's psychiatric nurse practitioner, an employee the county have such few child mental health providers," Jetmalani said. "I'm is lucky to have, Flesh said. very surprised that Bend has not done bet-

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ter than it has in attracting more providers." 4

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Psychiatrists have medical degrees and can prescribe psychiatric medications, as

can pediatricians and nurse practitioners.

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Although there are several psychologists

and therapists in Central Oregon, those COnCentrating'th e W a y a d u l tS providers cannot prescribe medications to

patients. Statewide, the Oregon Council of Child @ Adolescent Psychiatry has 120 members, although not all of them have received training to work with children and adolescents.

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"The volume is high and the demand is so high that there is concern about burning the few that we have out," he said. Unfortunately for the county, a public salary doesn't come close to what providers could make in private practice, Flesh said.

The s h ortage of pediatric psychiatrists is often held up as the most critical outpatient service that never came to fruition. Both locally and nationally, it has shifted the bur-

den of diagnosing and prescribing medications for mental illnesses onto pediatricians,

whose education generally includes only

Child and adolescent psychiatry is a spe-

limited training in psychiatric disorders. cific sector of psychiatry that requires a Dr. Logan Clausen, a pediatrician with two-year fellowship in addition to students' post-medical school C e ntral Oregon Pediatric Associates, said she's often the first person general psychiatry training, said Dr. Greg Fritz, president-elect of f a m i lies send their kids to when they're showing signs of depresthe American Academy of Child 8 Adolescent Psychiatry. sion or anxiety. She said she's comfortable giving those diagnoses While there's no law barring general psychiatrists from treating a n d the appropriate prescriptions, but for more complex disorders, children, it's important that they have the additional training, as s h e refers families toachild psychiatrist, whichtends tobeasix-to mental illness shows up differently in kids compared with adults, e i g ht-week wait. and how that happens is heavily dependent on which stage of Depe n d ing ontheirtraining, notall pediatriciansarecomfortable development they're in, said Fritz, also the director of the Bradley t r e ating mental illness in kids, Clausen said. Hasbro Children's Research Center in Providence, Rhode Island. Pediatricians across the state have flocked to a new service that Whereas adults generallyare better able to articulate their com- l e t s them talk over the phone with a child psychiatrist that day plaints, children's symptoms often show up as troublesome behav- t o d iscuss cases they aren't sure about. The service, provided by iors or physical symptoms, he said. OHSU and other organizations, currently fields about five calls per "A child who is depressed often does not say, 'I'm sad,' 'I'm de- day, many of those from doctors in Central Oregon,Jetmalani said. pressed' or 'I have trouble concentrating' the way adults might," E v entually, he said the partners hope to expand the service to vidFritz said. "A child might say, 'My belly hurts' or 'I'm bored.'" eoconference sessions that include both patients and their doctors. "That can help us make some of those difficult prescribing deChopra, who splits his time between a private practice out of the Bend Psychiatric Offices near downtown and at St. Charles Health c i s ions that sometimes need a little bit more support from a more System, said the first thing he tries to identify in pediatric patients e x p erienced mental health provider who can help bridge that gap,"

is what developmental challenge they're going through. Illnesses Clausen said. such as depression or anxiety, which are seen as chronic in adults,

FALL/WINTER 2014• HIGH DESERTPULSE

Continued on Page 34

Page 23

Gear ~ sKI swAp

Stay on the and out ofthe

BY MARKIAN HAWRYLUK

ith ski season right around the corner, many skiers and snowboarders will be spending lots of money for the latest shiny new ski gear. And that means you can pick up their

old skis and boards for a song. Whether at a ski swap or a consignment store, Central Oregon is agreat place to buy used gear. ButJosh

Sims, owner of The Gear Fix in Bend, has seen plenty of bad purchases. "We have a lot of folks coming in to consign their skis that they purchased on Craigslist, and then they find out they don't work for them." Read on for a few tips for finding snow gear that will have you out on the slopes, not in the repair shop.

Racksofused skisatThe GearFixin Bend.

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68485 N Hwy 9I7;;Send ' 38 0 =5084 WINTER/SPRING 2014•HIGH DESERTPuLSE

Alpine skis: • Think about what terrain you'd like to ride and the right sizing to find an appropriate ski. If you're planning to stick to the groomed runs, choose a carving ski with a radical sidecut. If you're mad about powder, a wider freeride ski will give the flotation you need. Check on-

otherwise it will have to be replaced. "If you buy a ski with too old bindings or a binding that's not on that list," Cumbie said. "You're not going to be able to find a shop to adjust your boot."

line (for example, www.sizingskis.com) for recommendations on ski sizes for your height, weight and skiing ability. A good rule of thumb

• Sims suggests looking for discoloration in the plastic. "If it's black binding and it looks a little ashy, or if it's a white binding and it's yellowing, that means the plastic is degrading," he said. "It's either been around for a while or hasn't been taken care of very well."

is to choose a ski length within 15 centimeters of your height. Beginners may want to stick to the shorter end of the range, while experts skiers might go a little longer. Stay away from straight skis — those

Boots:

are likely 20 years old by now. • Check for dents, nicks and other damage to the metal edge of the ski. "If you see that ski edge is really thin, that tells you that the ski has been tuned quite a bit so it's lost a lot of material in the tuning process," said Mike Cumbie, an employee at the Gear Peddler, a consignment store in Bend. Edges can be replaced, but at a cost of $40 or $50, eating into the savings of buying a used ski. A little rust on the edges can be removed, but major rust suggests the ski was left outdoors or not cared for well. • "Look for any delamination on the top of the ski or the sides," Sims said. "That means snow and water can get into the ski and start to rot out the wood core." Don't worry too much about the base of the ski;

• Examine the sole of the boot for wear, avoiding boots where the plastic is rounded off or scuffed up at the toe or the heel. "The condition of the boot directly relates to how well the boot releases or functions within the binding itself," Cumbie said. "So it is a safety issue." • Parents often try to get an extra season out of kids' ski boots by buying them a size too big. That creates both a safety hazard and makes controlling the ski harder. "Buy the size that fits and they'll have a better experience," Sims said. "Double check the buckles because those things break a lot, and stay away from rear-entry boots."

Snowboards: • Check the bindings for discoloration, especially the notched

anything other than major damage can be repaired fairly inexpensively. tongues that are inserted into the buckle. "Those break all the time on people," Sims said. "You can almost tell it's going to if that thing is

pretty much yellow. Those things will snap right in half. They've lost

Bindings:

all their flexibility."

• Binding manufacturers won't indemnify ski shops for work on bindings theyconsider too old. Each year the industry puts out a list of bindings that shops can still adjust. (The National Ski and Snowboard Retailers Association compiles the list for its members but does not provide it to the public. Nonetheless, the list can be found by searching online.) You'll want to check to see if your binding is on the list or

• Snowboards "get used a lot in the terrain park and they get slid on

various appliances," Cumbie said."So you may want to take a harder look at the condition of the base overall and the edges. If the snowboard has been used in the terrain park across a whole bunch of steel

rails, the edges will get really rounded off."

• •

•

• •

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WINTER/SPRING 2014•HIGHDESERTPULSE

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Page 25

Get ready ~ GYM WORKOUTS

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As winter pushes workouts indoors, mind these tips to get the best experience for everyone BY TARA BANNOW • ILLUSTRATIONS BY GREG CROSS

s fall winds into winter, many Central

Oregonians may be giving up their outdoor exercise in favor of working out at a gym. Or perhaps it's the first time tackling an exercise regimen. Either way,

a few guidelines about joining and using a gym may be in order. When searching for a gym, it's not a bad idea to take advantage of a free trial, an

offer some gym owners say is among the hallmarks of a respectable facility. Often, though, newbies will test drive gyms on

their days off or on weekend mornings, said Tate Metcalf, owner and manager of the Sisters Athletic Club. The gym seems relatively quiet, so they sign up. "And then they start working out Monday morning at 8 o'clock and they can't find a

parking spot and we're just jamming busy," he said. "So the first visit was nice and quiet and mellow and then when they come to work out, it's just chaos." The lesson to be learned is to try a potential gym at the time of day you'll work out

most days. The same gym can have a very different atmosphere at 5 a.m. compared with 5 p.m.

That's among several tips provided by local gym owners, including Metcalf and Gary Hughes, who owns the Bend Downtown Athletic Club, on choosing a gym. The two also threw out some etiquette tips to keep in

m ind once you joinone.

Page 26

In Metcalf's mind, the most important feature in a gym is location — that it's close

by. That may sound silly in Bend — where across town is rarely more than 15 minutes away — but even a short drive can be enough to persuade someone not to go.

"There are so many roadblocks for people to work out that, man, if it's more than a couple-minute drive away, that could be a roadblock for somebody not to exercise," he said. "So, number one, it absolutely has to be convenient." It's also important to k now what you want in a gym. Yoga classes? A pool? Tennis courts? Treadmills? Make sure it has the amenities you want. That's going to affect the price, too. For example, you don't want to pay $100 a month for a gym with tons of amenities that you'll never use, Hughes said. Both Metcalf and Hughes said they recommend short-term contracts — ideally, month-to-month, which Metcalf said

high-quality clubs will offer. If you're new to a gym, signing a one-year membership is risky, the two agreed. The good news is that even after you've signed a contract with a gym, Oregon law gives customers the right to cancel a membership without penalty by simply delivering a written notice within three days of signing the contract (although Metcalf pointed out that three days doesn't allow much time to get to know a gym).

Many gyms offer new members com-

plimentary sessions with t heir p ersonal trainers. Both Metcalf and Hughes urge newcomers to take advantage of that, as trainers tend to help people develop fitness goals and stick to them. Metcalf said people should look into the trainers' backgrounds to see whether they're certified through the American College of Sports Medicine and whether they have degrees in the fitness

field. All right, so let's say you've chosen a gym. For those who are new to this world, Metcalf and Hughes shared some tips about how to enjoy the gym without offending fellow gym-goers. But no matter how hard you try,

Metcalf warned, you may just end up rubbing some people the wrong way, and vice versa. Such is life. "It's pretty much like being a kid at re-

cess," he said.

Mind your hygiene If you've been working outside in the heat

for six hours and you're already sweating profusely, that may not be the best time to

hit up the gym, Hughes said. And if you happen to be the kind of person who naturally sweats more, try to carry a towel around with you while you're at the gym. While

some people like to look and smell their best while they work out, Hughes says, it's

probably preferable to refrain from wearing strong perfume or cologne at the gym.

FALL/WINTER2014• HIGH DESERTPLILSE

"Occasionally, we have to let people know, 'It's somewhat offensive to other people,'" he said. "You're in a confined

people too often or you make sure it's OK that

room and if you're breaking a sweat, it can actually get pretty annoying."

ogling other gym-goers, which should go

Wipe down machines after use

you interrupt people," Hughes said. Being polite extends to refraining from without saying, but we'll say it anyway.

Don't let weights slam

Most gyms will remind you of t h is There are a couple of reasons why you one by posting signs all over the place, shouldn't just let go of weights and let them

slam down when you're on a weight machine. First off, there's the issue of helping to maintain the machine so it can stay in use longer.

Secondly, slamming weights produces quite a loud, crashing noise, which can disturb people working out nearby. That said, Hughes said he understands that sometimes — especially if it's your last rep and your muscles give waythat's not possible. •

but after you're done using a cardio machine or a weight machine, give it a quick wipe with towels and spray or disinfect-

ing wipes, which should be nearby. The purpose of wiping extends well beyond

C om p l em e n t s H o m e I n t er i o r s

preventing others from working out in a pool of your sweat; it potentially helps prevent the spread of germs that can cause skin infections such as — in the most serious cases — Methicillin-resistant Staphylococcus aureus bacteria, or MRSA, according to the American Public Health Association. MRSA is an antibiotic-resistant bacteria that commonly presents as a skin infection but can be potentially life-threatening if the bacteria enters the body through cuts.

Unless you're sure, keep to yourself e

It's important to be cordial to your fellow gym-goers, but be cautious when

approaching someone, Hughes said. Avoid talking to someone if he or she

is in the middle of performing an exercise.Some people only have a quick 20 or 30 minutes to work out on their lunch break and don't want to be interrupted,

he said. "It is important that you don't interrupt

r) Designing the eet~g

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FALL/WINTER2014• HIGH DESERTPLILSE Page 27

Job ~ SCHOOL NURSE

With chronic illness and other severe health problems prominent in schools, nurses like Courtenay Sherwood are adapting for maximum care BY MARKIAN HAWRYLUK

ust a couple of weeks into the new school year, a student at Vern Patrick Elementary in Redmond had just eaten her first cashew and was having an allergic reaction to it. Courtenay Sherwood, the school nurse, put an oxygen saturation meter on the girl's finger

Sherwood is wearing shorts and running shoes, which she puts to good use running from the auditorium to pull older-grade students out of class to get the dental sealants their parents had authorized. As the younger grades arrive for their screenings, Sherwood directs and saw her levels were low. She called 911 and the child's parents, traffic between the screenings, solving the myriad last-minute proband gave the child a dose of Benadryl, an antihistamine to counter- lems that pop up. A first-grader with green plastic glasses and tussled act the reaction. As she waited for the medicine to kick in, Sherwood hair is due for a vision screening, but his teachers are concerned that watched the oxygen saturation levels fall lower and lower. After eight the flashing light of the photoscreening tool might set offhis seizures. minutes, the numbers began to climb again. Sherwood knows the boy's seizures aren't light-sensitive, and so ac"It was very scary," Sherwood said. companies him through the process, punctuated by a high-five beSherwood — or Nurse Courtenay, as the students call her — is tween the two. part of the new generation of school nurses, one of some 74,000 in Another student insists his mother wants him to get the dental the U.S. that are on the front lines of the country's battle with a rise in screening, but there is no paperwork for him. Sherwood pulls out her chronic, often life-threatening conditions affecting school students. phone and calls the parent on the spot, by which time the dental proTheir roles are no longer merely to hand out Band-Aids or house viders have located his signed form. "September is a crazy month, trying to get all the paperwork in malingerers seeking sanctuary from the ravages of gym class. They manage conditions such diabetes, asthma, seizures and mental ill- place," she says, striding quickly through the halls of the school to ness on a daily basis, trying to keep kids healthy, present and suc- grab another kid for her sealants. Parents sign forms but forget to

cessful in school. "The role of school nurse is changing because the characteristics

check off the yes or no box for screening. New kids and new health conditions leave her scrambling to figure out who needs what sort

of the school population are changing," said Carolyn Duff, president of support and monitoring. Some school nurses wear white coats to of the National Association of School Nurses. "There has been an increase in the number of students with chronic health conditions, which must be managed if students are to be in

school, but Sherwood worries they might scare the kids, so she dress-

es casuallyas if to say, "Hey, I'm afriend. Look, no needles!"

With the screening winding down, she heads to her office, a room just big enough to fit in two beds and a desk. In a small refrigerator, she keeps plastic bags of frozen rice to use as ice packs. A day in the life "That way, they don't drip on their papers," she said. A week after the cashew incident, Sherwood, a registered nurse, is Within minutes, the boy in the green glasses arrives to take his medthe calm in the middle of a storm of vision, hearing, speech and dental ication. Sitting on one of the beds, below a poster from the movie "Toy screenings underway in half of the Vern Patrick auditorium, as a PE Story," he hums what he informs Nurse Courtenay is Rusty's song. He class launches stuffed-animal fish on the other side of a partition. takes his medication and is off to lunch with a lispy "Thanks."

school every day, ready to learn."

Page 28

FALL/WINTER2014• HIGH DESERTPLILSE

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ANDYTULLIS

During a screening, school nurse Courtenay Sherwood, right, talks to a student at Vern Patrick Elementary Schoolin Redmondin September.

Medicine andmonitoring Sherwood shows the cabinet where she keeps student medications, each in its own cubby hole with the student's name on it. The dozen or so gray labels are for emergency medications, mostly asthma inhalers or epinephrine injectors for kids with life-threatening allergies. The

seven red labels are for kids who need to take medicine every day. In 2008, the federal Centers for Disease Control and Prevention estimated that 13 percent of children were taking prescription medication

One of the new kindergartners at Vern Patrick has Type I diabetes and must take insulin each day. Fortunately, she's in the afternoon kindergarten program, so she takes her insulin and eats lunch before going to school. But Sherwood, or in her absence the office

staff, must check the child's blood sugar levels each day at snack time. Last year, Sherwood had a kindergartner who needed insulin

during the day. The girl was already monitoring her own blood sugar, so Sherwood taught her how to give herself the injection. Over

for 90 days or longer, up 9 percent from a decade earlier. The number the summer, however, that newfound independence was lost as the of children with diabetes or pre-diabetes increased from 9 percent in 1999 to 23 percent in 2008, while the number of children with food allergies increased by 19 percent from 1997 to 2007. Some 18 percent

parents resumed giving her the injections. "I really try to stay in close contact with parents. We're a team," she says. "But sometimes I feel like the safety net."

of U.S. children have chronic health conditions, nearly half of whom In the main office, a secretary hands her a bag of cough drops could be considered disabled. wrapped in a note with a child's name on it. Students aren't allowed In past decades, many of these students wouldn't have survived

childhood illnesses or would have been cared for at home. Federal and state laws, however, now ensure that even children with severe health care conditions and physical disabilities can attend school, and it's often up the school nurses to make it happen. School nurses now routinely deal with feeding tubes, insulin pumps and urinary catheters. They deal with children in wheelchairs or on crutches, They help facilitate learning for those with vision, hearing

and physical disabilities.

FALL/WINTER 2014â&#x20AC;˘ HIGH DESERTPLILSE

to have any over-the-counter or prescription medication with them. Sherwood will sometimes make an exception for an older child with a cough or cold, but only after explaining to the child that the cough drops aren't candy and shouldn't be shared with other students. As long as they stick by the agreement, they can keep the

cough drops in their backpack. The same goes for kids with inhalers who can demonstrate they know how to use them. "I like for kids to have their inhalers with them," she says. She puts a red dot or star on the storage cubby where students

Page 29

Job iSCHQQL NURSE

It's a new strategy requested by the student's parents last year. Instead of having to leave class to have her blood sugar checked, the

girl can do it discreetly and keep Sherwood in the loop. As long as

with asthma keep their backpacks in case someone needs to find

things are under control — and her numbers this day are perfectthere's no need to disrupt her school day. "It works," she said. "Another student that might be more out of control or not really following his program, I'm not setting that up for him. I have to make it individual. Because if I don't, he going to get in danger and nobody is going to know about it." Sherwood gets to know children with health issues pretty quickly. The kids who are infrequent visitors she may know by first name; the frequent fliers, she knows first and last. Lunch is a rushed affair, as Sherwood eats some tortilla-enclosed leftovers and gets through about half a fresh pear before it's time to

the inhaler quickly.

go. She chats quicklyabout her background. She grew up in Bend and

Students with more serious medical conditions have written protocols in place, but Sherwood must often track down parents to get the particular details. She pulls out two forms filled out by parents listing peanut allergies.

attended a year of high school at Mountain View before her family moved to Anchorage, Alaska. She attended Texas Christian University

ANDYTULLIS

During a checkup, school nurse Courtenay Sherwood calls the parents ofa student while another student waits to beseen at Obsidian Middle School.

"I need to have a phone call. What kind of allergy?" she says. She finds out from the parents that the first student gets red puffy eyes when eating peanuts but doesn't need to be in a nut-free environment. "So it's not that severe," she says. "I don't think she needs a protocol." But the second child gets hives and an upset stomach. "She's got two body systems involved, so I kind of want one for

— a real Northwest girl finding herself in the middle of football-crazy Texas, she said — where she completed a degree in nursing. Initially, she wanted to work with teens with mental health issues, but after three months on the night shift doing adolescent psych work, she decided it wasn't for her. She moved to Los Angeles, where she worked for two years in a hospital, mostly in the intensive care or direct observations units. She spent four years working

in home health before becoming a school nurse. The job in Red-

mond came right around the time her husband had declared he wanted to go someplace with mountains. So they packed up their her." two kids and headed back to Central Oregon. Sherwood has been a school nurse since 1997, starting in CaliforObsidian Middle School shares a street address with Vern Patrick, nia, and in Redmond since 2008. Over the years, she's developed but Sherwood must go a block or two out of the way to get past the rules of thumb to help determine how to manage student health ravine that separates the schools. conditions. A mild allergy affecting only one body system generBy the time she arrives at 12:30, there are already three students ally doesn't need a written protocol, but once two systems are in- waiting for her. volved, she'd like one in place. Similarly for students with asthma, An eighth-grader on one of the two beds in her office says he's her threshold is if the child uses a nebulizer at home. feeling really warm. She takes his temperature, but at 99.5 it's a "That tells me they need more intervention," she says. half-degree short of the magic three-digit threshold that will spring She's also learned that Central Oregon forest fires can affect stu- him from school for the day. "I'll tell you what, let's look at how many days of school you dents with asthma in different ways. "Some kids with asthma can go outside on smoky days; other cannot," she says. "So I added that missed last year," she tells him. "If it's less than 10, I'll send you to asthma protocols. I know that only by asking parents." home." She keeps teachers in the loop, sending them email alerts and Sherwood knows what she'll find before she pulls up the boy's placing reminders on their calendars so they know when students records. Two years ago, he missed more than 20 days of school due are due to come in for medication. a variety of illnesses. Last year, it was down to 11. He's only missed one day this month. There's less than two hours A nursing path of school left and she wants to keep him in class. "You're almost done," she tells him. "Why don't you drink some Sherwood splits her time between Vern Patrick and Obsidian Middle School just down the road. She spends the morning at one water and see if you can push through?" of the schools, eats her lunch and then goes to the other. Before Once he's back in class, Sherwood will call the parents. "The parent has the ultimate say, and then can say, 'I'm just going heading to the staff lounge for lunch, Sherwood gets a text consisting of three numbers from an Obsidian student. The first is the to come up and take him home,'" she says. "So frequently, I call after girl's blood sugar level, the second the amount of carbs she's eaten, they're gone. 'He was here, but now he's in class.'" and the third the amount of insulin she's taken. Parents are less likely to rush over and take the child home if he's

Page 30

FALL/WINTER2014• HIGH DESERTPULSE

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feeling well enough to go back to class. But a call when the child is still in the nurse's office often means the end of the school day.

She's about to check on a girl with closely cropped hair lying on the other bed, when the third student who had come before Sherwood arrived returns. She has a rash on her arms and Sherwood takes her to a private room to talk to her. The girl has been cutting herself, and Sherwood needs to talk to her in more depth about what is going on in her life. Such cases are among the most difficult Sherwood faces but also part of why

. ~

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g+' ANDYTULLIS

she loves being a school nurse. While she could undoubtedly make During a screening, school nurse Courtenay Sherwood slaps palms with more money working at a hospital or even a pediatric clinic, she

a student at Vern Patrick Elementary Schoolin Redmondin September.

feels she can do so much more for kids like this one. "She is obviously hurting," Sherwood said."She is hurting in a different way that they're never going to see in the hospital. It's all about how can I help them to grow up to be more healthy. I can't do that at the hospital."

teachers and parents. A study in the medical journal JAMA Pediatrics earlier this year found that every dollar spent on school nurses saves $2.20 in medical costs and lost productivity. Moreover, for many students across the country, the school nurse Stretched thin represents their onlyaccess to health care. Schools with nurses have Sherwood is responsible for 441 students at Vern Patrick and an- higher immunization rates and school nurses represent a key sentiother 618 at Obsidian. Some states have set standards for the ratio nel in identifying disease outbreaks. A school nurse in New York is of nurses to students, but only a dozen have average caseloads per credited with being one of the first to identify that the HINI flu had nurse of less than 750, as advocated by the National Association of arrived in the U.S. in 2009. School Nurses. Budgetary realities have many districts cutting back According to a report by the Robert Wood Johnson Foundation, on school nurses, stretching their availability thinner and thinner. when school nurses identify and manage students' health condiOnly about half of school nurses work in a single school, and near- tions, they stave off future health care problems and help to save on ly a third split time at three or more schools. downstream health care costs. Some studies suggests that is penny-wise and pound-foolish. When The report found that when Milwaukie Public Schools hired addischool nurses aren't available, the slack has to be taken up by princi- tional nurses in 27 schools to get below the 750 students per nurse pals, assistant principals and office staff, often relying on individuals ratio, they saw impressive gains in immunization rates, identified with higher salaries but less expertise in handling health issues. new students with asthma and other chronic conditions and reOn a broader level, the absence of school nurses leads to more turned valuable teaching and planning time to staff that previously 911 calls and emergency room use, as well as more lost time for handled health issues.

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Injuries and accidents When Sherwood returns to her office, the short-haired girl's grandmother has arrived to take her home, and another student's aunt comes to drop off some medication for her nephew. Sherwood spends some time getting to know the aunt and her two young children, who will

probably be in the Redmond school system in a few years. Soon another girl arrives, complaining of red itchy bumps all over her body. At first she says it started last night, but upon further questioning admits it started a month ago. Sherwood calls the girl's mother and learns the student gets regular allergy shots and hasn't gotten hers for this week. She gets permission to give her an antihistamine and sends her back to class. 'You have to talk to your mother about this," she tells the girl. "She's the one that can get this taken care of quickly."

ter a playground accident the previous week. His doctors diagnosed a sprained ACL and has told him to stay on crutches for a week and away from sports for 10 days. Last week, the boy told Sherwood he was upset he would miss his annual hunting trip with his dad, but today, he admits he went anyway. Before she can wrap up the conversation, another bleeder arrives, having cut his finger on an exposed piece of metal while getting a piece of tape. Within an hour of arriving she has seen eight students with emergent problems and followed up with two injuries. Often there is little she can do as a nurse and must try to cajole parents to take their kids to see a doctor or help overcome hurdles they face in doing so. There's another boy in the school with a knee injury that is worrying

her. His entire upper leg had become swollen. She suspects a blood clot. When she saw him on crutches last week she assumed he had seen

Another girl comes with a bleeding elbow. As Sherwood helps her a doctor. But the boy admits he hasn't. She called the father, who said clean and put a bandage on it, she asks how it happened. She got a rug he's been really busy. But as she suspected, there's an insurance issue. burn wrestling on the carpet last weekend, and today she picked at it till it bled. Sherwood deftly pries deeper just in case there's anything more concerning going on at home but is ultimately satisfied with the explanation. There's a momentary lull in the stream of sick or bleeding students, and Sherwood takes the time to follow up with a pair of injured students. One is recovering from ACL surgeryand has spent the summer on crutches. But the pain in his knee is back and Sherwood has a note from his orthopedist to excuse him from gym class. The eighth-grader knows he won't be able to play sports this fall but is hoping to return to

The family has a $3,000 deductible and cannot afford the cost of the doctor s visit. She works with the vice principal to see if the athletic trainer at the high school can at least take a look at the leg.

"The swelling has gone, so that's a good sign, but he could have had a worse outcome," she says. "That's the limbo I'm in. I can see these kids but they still need to be seen by their doctor." There's a lot of frustration in school nursing, she says. There's never enough time to deal with all of the issues she sees and so much of what impacts her students' health is beyond her reach. Nonetheless she loves the job and relishes working with kids. It's tremendously rewarding, she says, to see a child overcome health concerns and thrive

playing baseball, his favorite sport, in the spring. "My advice," Sherwood says, leaning in toward him. "Take the whole year off and be ready to play sports in high school. Middle school in school. The previous weekend she had been at a soccer game and doesn't really count."

run into a former student, now at a local high school. He was looking

The boy is clearly disappointed but acknowledges her advice and happy and healthy. She knew immediately he had been a frequent visiheads back to class. She checks in with another boy on crutches af-

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Becky Dolf of Bend, and her 16yearold son, Cody sit on top ofPilot Buttein Bend. Cody and sister Ashlea have both struggled with mental health issues and needed to travel to Portland for services.

they're usually full. That means patients elsewhere in the state, including those in Central Oregon, end up waiting in their local hospiChildren in crisis tals for days or weeks before they can get a bed. When Becky Dolf first found her daughter, Ashlea, sprawled on the Ashlea waited two days at St. Charles Bend for a bed to open up bathroom floor in the middle of the night, she thought the 17-year- in Portland. When one did, it was 10 p.m. An elderly couple with the old was drunk. transport service Dolf's insurance company contracted with picked "You know how when people are drunk theyjust kind of sprawl? Ashlea up. They drove over the mountain in a blizzard, bickering Continued from Page 23

I said, 'Are you drunk?' She said, 'No, I took a whole bunch of pills,'" and running stop signs, said Dolf, who followed them in her own Dolf said. vehicle and stayed at a nearby Ronald McDonald House. It was January, and the pills were Vistaril, a medication Ashlea had

been prescribed for anxiety. Dolf rushed her daughter to the emergency room. She had been on alert since the month before, when her daughter had told her through tears, 'I just can't do it anymore. I just want to die.' Dolf took her to the ER then, too, but hadn't followed up with day treatment because it doesn't exist in Central Oregon. After her suicide attempt, Ashlea's doctor said she needed inpatient psychiatric care at a hospital. Only two hospitals in Oregon have inpatient psychiatric units for children and adolescents, both in the Portland area. They've got a combined total of 39 beds, and

Page 34

"Ashlea was terrified," she said. St. Charles does not treat psychiatric crises in children; it can only prevent patients from harming themselves or others. When children in psychiatric crisis arrive in St. Charles' ER, they're assessed and given a medical exam. In most cases, they ultimately stabilize enough to go home, Henderson, of St. Charles, said. If not, staff members determine they need inpatient care and call the two hospitals in the Portland area. St. Charles doesn't have a specific place to put children in mental health crisis while they wait to go to Portland, Henderson said. If the pediatric unit is full, they'll stay in the emergency room. Sometimes

FALL/WINTER2014â&#x20AC;˘ HIGH DESERTPLILSE

Feature IPEDIATRIC PSYCHIATRICCARE

they stay in the adult psychiatric emergency unit. "We make the best decisions we can in the moment given the situation we're dealing with in the hospital," Henderson said. Although older kids are sometimes placed in adult psychiatric emergency units while awaiting transport, those tend not to be good environments for kids, as adults with psychosis or intoxication can be further traumatizing, Fritz said. Further complicating things for Central Oregon families is a 1986 federal law that requires emergency departments to treat

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any patient who asks for help, regardless of his or her ability to pay. The law is designed to prevent hospitals from rejecting patients or dumping them elsewhere, but it's also forced health systems with several hospitals to give priority to patients who are

already in their emergency rooms. At the Providence Willamette Falls Medical Center in Oregon City, which runs one of the state's two psychiatric units for kids, that means patients who are already admitted to a Providence emergency room will be the first ones admitted to Providence's psychiatric unit for kids, said Ken Ensroth, medical director for

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child and adolescent psychiatry for Providence in Oregon. The federal law makes it so that children in Portland emergency rooms get priority over those in Central Oregon, Osborn said. That forces families to make ajudgment call, he said: Should they wait it out at St. Charles, where they won't get psychiatric care, or, if it's safe, drive their child to an ER in Portland where they'll have a better chance of being admitted to acute care? While Ensroth said he always recommends families take their children to the nearest ER for safety, he can understand why some would take their kids in crisis to Portland. Dr. Shawn Crombie, the medical director of Randall Children's Hospital Psychiatry, the state's other psychiatric unit for kids, located within Randall Children's Hospital at Legacy Emanuel, said his unit decides who gets beds first by using a formula to determine patients' urgency. The top indicators, for example, are active, stated suicide intention, visible or confirmed suicidal behaviors and agitation such as yelling or posturing, he said. That said, Crombie admitted it is "very difficult" determine who is the sickest over the phone. Osborn is skeptical that system works, as he said it's more about using the right words than the patients' actual symptoms. Even though there's nowhere else for their kids to go, some parents say few things are harder than sending them to Portland. The psychiatrist seeing Mountz's daughter, Osborn, spent the entire summer urging Mountz to take her daughter to one of the psychiatric units. Initially, she resisted, unable to bear the thought of her daughter being so far away. In the months following the Mother's Day episode, her daughter spiraled into more talk of suicide, threats of hurting family members and cutting. Finally, in September 2012, Mountz realized she could not longer keep her daughter safe and sent her to the acute psychiatric unit for kids at Providence in Portland, which has since relocated to Oregon City. "It was really difficult," Mountz said. "I felt like I was failing her

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somehow by sending her so far away to Portland." Dolf's daughter, Ashlea, who declined to be interviewed, has improved dramatically since her suicide attempt. She's working, saving up to buya car and thinking about college.

my head and say, 'Who would miss me?' My mom would; everyone would," Cody Dolf said, "and then I just don't do it."

Plus, Cody Dolf said he's doing better now. He's in school, and he's

starting a program that helps people with disabilities learn job skills. "My life is actually back on track," he said. "But when I was youngWhile her kids were growing up, Dolf's son, Cody, was the one who struggled. Since he was 9, he talked back to teachers and got er, I didn't even care about my life. It was just torture." in fights with the other kids at school. At 12, a doctor diagnosed him Developing solutions as having high-functioning autism, bipolar disorder and attention deficit hyperactivity disorder. Dolf struggled to find a psychiatrist to Central Oregon's health care leaders — including St. Charles, work with her son to identify the cocktail of medications that would Deschutes County, Medicaid leaders and others — are working tokeep him stable. In the meantime, they worked with his primary care gether to perform a massive assessment of how kids experiencing physician and a nurse practitioner, but the medications made Cody mental health crises are cared for. The idea is to pinpoint what new even worse. services the region needs to allow families to avoid the current op"One med, it made me go crazy," said Cody Dolf, now 16. "I almost tions: emergency rooms or hospital beds in Portland. literally choked someone to death because they put me on it." While some families insist Central Oregon needs its own inpatient Cody has stayed in sub-acute facilities three times, including Chil- psychiatric unit for kids, many others, like Robinson of St. Charles, dren's Farm Home in Corvallis and the Parry Center in Portland. say the region doesn't have enough patients to support its own unit, After Ashlea's suicide attempt, Cody said he was angry at her. He which would require 24/7 staffing and be very expensive to operate. hadn't told her before, but he had thought several times about killing "We have a very severe pediatric mental health crisis, don't get me himself. He ultimately didn't because he didn't want to hurt his fam- wrong," she said."But going to an inpatient unit as a solution is not ily, he said. necessarily the best solution for our community." "What helps me when I think of that is I just answer questions in The traditional mindset for treating mental health crises involves

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sending kids to hospitals or residential facilities, but Robinson said she thinks the best solution would involve supporting kids in their own environments — whether that be their homes, schools or

lives in Redmond. "When you're not going out making friends,

elsewhere.

behave, that's so isolating." Underlying each potential solution is the need for more child and adolescent psychiatrists — a dearth community leaders have for years tried unsuccessfully to fill. The desperate search for solutions is happening on a state level, too. In the fall, state officials held a series of high-level meetings designed to pinpoint potential solutions to the struggles families face in trying to get intensive mental health services for their kids. Amy Baker, who manages the child and adolescent mental health unit of the state's Addictions and Mental Health Services, wrote in an email that the group of state health care leaders, which

"Wrapping services around the child where they are leads to better outcomes and better success," she said. Not only that, Crombie, who heads Randall Children's inpatient unit, emphasized that despite the fact that his unit's beds are almost always full, insurance reimbursement for the care tends to be low. He estimates the average inpatient psychiatric bed loses a

hospital $70,000 per year. "It's hard to imagine a full unit all year losing that amount of money, but that's what happens," he said. Other health care leaders agreed a hospital unit isn't what Central Oregon needs — but were quick to add the caveat that something substantial would need to be built in its place to meet the unmet need. Community leaders, aided by a consultant who's interviewing doctors, therapists and families, are exploring several ideas that

could help kids in crisis. One strategy could be having 24/7 on-call psychiatrists and other providers who would work with kids in their homes, or commit to next-day appointments for kids in crisis. Jetmalani, of OHSU, emphasized that sometimes simply having that connection with a

provider calms people down.

when you can't hang out with other families, when you feel isolat-

ed becausepeople judge you because you can't make your child

has been gathering input from families, hospitals, Medicaid groups and mental health providers, hopes to launch a project this winter that will test out a new strategy for connecting kids with local crisis services rather than going to emergency rooms. Ultimately, Henderson stressed that the final plan will employ a number of solutions. "There's no one big, 'Oh this is it,'" she said. "There's got to be a number of solutions, because there is just a number of different

ways to handle this problem."

'A hole in the system'

Other possibilities include opening entirely new mental health facilities, one option being a day treatment center where kids

The troubling behavior started when Grindstaff's stepson was

could also be a residential facility where they could stay for days or weeks at a time when their needs get severe. In addition to the 39 acute hospital beds in the state, there are another 38 beds that are considered sub-acute, which refers to a free-standing facility that provides 24/7 nursing support, but children do not see a psychiatrist daily, as they would in acute care. Another 200 beds are spread across the state in residential facilities, where kids can stay for longer periods of times, as well as in day treatment facilities. None of those beds, however, are in Central Oregon, forcing the children who need them to spend time away from their families and communities. Some families have stressed the need for so-called "respite" facilities that would simply provide a place for troubled kids to go to give their families time to decompress and take care of their own

staff, would throw tantrums for hours. He screamed all of the time and refused to follow directions. None of his providers could seem to pinpoint a diagnosis. Meanwhile, the couple tried medication after medication. "I think we were grasping for straws because we were just really struggling," she said. "He was getting more violent at home." Several counselors refused to see her stepson, saying there was nothing they could do for him. Eventually, his behaviors escalated to threats to Grindstaff and her family. After several behavioral programs in his schools, Grindstaff and her then-husband sent their then-10-year-old son to a residential facility outside of Eugene

only about a year and a half old, which was around the time she would receive therapy during the dayand go home at night. There married his father. (They're now divorcing.) The boy, Damon Grind-

needs. Yet another service — one that several families interviewed em-

phasized — would simply be support and guidance from families who have been in similar situations. Valerie Grindstaff, whose 16-year-old stepson has spent time in a residential facility, mental health camp and counseling for depression, anxiety, a sensory disorder and reactive attachment disorder, said what ultimately helped her the most was meeting other parents who understood what she was going through. "You want to know that you're not alone," said Grindstaff, who

Page 38

called Jasper Mountain. Through all of this, Grindstaff, at the time a teacher in the Redmond School District who received insurance through her work, was frustrated that her son didn't qualify for the Oregon Health Plan, the state's version of Medicaid, because she and her husband made too much money. The state mandates that counties in Oregon provide what's referred to as "wraparound" services for some kids who rely on OHP, and provides some of the funding for them to do so. Wraparound is an intensive treatment program in which the county staff members create teams of people to work with each child — counselors, psychiatrists, family members, neighbors, teachers, pastorswhoever is closest to him or her. The team holds regular meetings

FALL/WINTER2014• HIGH DESERTPULSE

to discuss the child's care. Deschutes County has offered wraparound services to its OHP clients since 2004, Flesh said. The teams work to ensure the family has all the support it needs to care for the child and they try to understand what strategies would be the most effective, he said. For example, if a child has a hard time getting up in the morning, he said the wraparound team might try to decide what skills the parents need that would be useful at 6:30 a.m.

cluding education," Flesh said.

Jetmalani, of OHSU, agrees. While he pointed out that the state has made major investments to ramp up the availability of wraparound services for OHP, he says that leaves out many families who don't qualify but would still benefit from that level of care. "Commercial insurance is actually a barrier to a lot of getting the highest level of treatment," he said. "It's actually easier to access a lot of intensive services with Medicaid than with not having Medicaid, which is ironic." Grindstaff — who finally was able to enroll her stepson in OHP following mediation — said her struggle to get services for her stepson inspired her to quit her job as a schoolteacher and start a

To many families, including Grindstaff's, that level of care sounded like just what she needed. Unfortunately for them, it's only for OHP

business designed to help families like hers. She and an old friend, Shannon Pugerude, whose 14-year-old daughter has been diag-

"It's really this core group of people who wrap around the child and provide the mental health services and any ancillary ones, in-

beneficiaries. Like many families, Grindstaff found hers in a gap in nosed with psychosis — launched Wyldwoodz Resource Center last which she and her husband didn't make enough money to afford summer. There, the two women train parents, caregivers, teachers $180-per-hour intensive services but too much to qualify for OHP. "We were right in the middle," she said. Now, when Grindstaff talks about reforming the mental health system, she emphasizes the need for more services that can be

and others to support kids with mental health and behavioral issues and develop educational curricula to help them. Neither Grindstaff nor Pugerude are psychiatrists, but Pugerude is trained in a counseling strategy she has found helpful with her available to middle-class families, many of which can't afford ex- daughter: collaborative problem-solving. Developed at Massachupensive, high-level care, but are not poor enough to qualify for OHP. setts General Hospital, the approach is rooted in the idea that be"It's such a hole in the system," she said. havioral challenges in children are prompted by lagging thinking

A NlagazineHighlighting the Variety of Organizations That ConnectYourCommunity. Central Oregon communities continue to grow due to a

educational, recreational and professional environments,

nationaLLy-recognized appreciation for the region's quality

Cent r al Oregon's nonprofit community is a foundation for our

of Life. From providing the most basic needs of food, shelter

area ' s success and sustainability. Hundreds of organizations

and security, to creating and maintaining positive social,

and thousands of volunteers make up this nonprofit network.

Through the publication of Connections, The Bulletin wiLL both define and profile the organizations that make up this network. Connections wiLL provide readers with a thorough Look at nonprofit organizations in Deschutes, Jefferson, and Crook Counties.

SALES DEADLINE: DECEMBER 5tI1 CALL 541.382.1811 TO RESERVE YOUR SPACE TODAY. I FALL/WINTER 2014• HIGH DESERTPLILSE

• •

The Bulletin

Serving Central Oregon since 1909

I Page 39

Feature IPEDIATRIC PSYCHIATRICCARE

skills, and can be overcome by simply teaching kids the skills they Res e arch has shown that traumatic experiences during earlack. Rather than parents imposing their wishes onto children, as l y c h ildhood are at the root of many mental and physical health most tend to — think 'Feed the dog' or 'Be quiet' — collaborative p r o b lems in adults because they affect the neural pathways in the

problem-solving involves understanding the child's concern, let- developing brain, which can have long-lasting effects. The largest ting him or her know the adult's wishes won't be imposed and then inviting the child to brainstorm solutions with the adult. The strategy is the basis for everything they do at Wyldwoodz,

Pugerude said.

'We're in some trouble'

s t udy on the subject to date, the Adverse Childhood Experiences study, started in 1995. It's following 17,000 adults who answered q u e stionsabout mistreatmentandfamilydysfunction duringchildhood and about their current struggles with mental illness or substance abuse disorders and found significant correlation between negative childhood experiences and poor health outcomes later in

Mountz originally had planned to adopt from Ukraine. She had all life. of the paperwork ready until, tooling around on adoption forums online, she came across a captivating pair of headshots. Two young

girls. Biological sisters, ages 7 and 8. The younger of the two looked happy and healthy, with rosy cheeks anda wide smile.

"It was quite linear," Jetmalani said. "The more traumatic experie n ces you've had, you were essentially destined to have obesity, diabetes, lung disease." That ' s all the more reason to emphasize prevention and outpatient mental health services, so that issues in children are addressed

The older one was much smaller. She was very pale, and most before becoming full-blown crises,Jetmalani said. of her hair had been chopped off. But it was her facial expression that struck Mountz the most. She looked

frightened. "She just looked like a scared little puppy," Ivlountz said. "Her face looked like she was very uncomfortable." The younger daughter has done well in

At C e n tral Oregon Pediatric Associates, licensed psychologist Son-

"ItwaS guitelinear. Themare

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had, you were essentially

school and hasn't showed any signs of men- deStined tO have ObeSity, tal distress. But the older one, now ajunior

in high school, has been in and out of res-

dra Marshall works as a behavioral consultant, meaning she works to help patients

— roughly 40 percent of whom are seeing

pedia tricians for

mental health concerns — resolve mental health issues, especially those that manifest as physical issues like abdominal pain or constipation. She said work is being done to try to get health insurers to cover behavioral health visits in the

idential facilities and hospital wards. After Dr.AjitJetmalanj,headofOregon same way as physical health, which would her first stint in the Psychiatric unit in Port- Health@Scjence Unjversjty'schjldand catch kids at risk of serious mental health land, the staff sent her to a facility in Corval- ad o l escent psychiatry division issues early on. Because in reality, many of lis called Children's Farm Home. Two weeks the children who ultimately commit suicide after that, a staff member called Mountz and told her they couldn't a r e not the ones who spent time in emergency rooms or psychiatric handle her daughter any longer. At the time, she was telling the staff u n i ts, Marshall said. They're not the "in-your-face" kids; they're the daily she wanted to kill herself. Staff members told Mountz they o n e s who slip by unnoticed, she said. "What can we do earlier so that we can really, hopefully, identify were taking her daughter to the emergency room in Portland, which "They're the is where she met them and stayed overnight. The next stop was t h e se kids that aren't the real externalizers," she said. Youth Villages, another residential treatment facility in Lake Oswego, i n t ernalizers, and they're the kids that are hurting themselves too. where she stayed from December 2012 to April 2013. That we've lost." When she was stable enough to be released, the staff recommendUnt i l that happens, things could get worse. Oregon — and espeed she enter adaytreatment facility, but since there is none in Central c i ally Central Oregon — has seen a jump in suicides as of late. At Oregon, Mountz worked with the school district to carefully design a l e ast five teens died by suicide so far in Deschutes County through school schedule that kept her separate as much as possible from the A u g ust, according to data from the Oregon Health Authority. That other kids, who had been spreading brutal rumors in her absence. repr e sents a significant increase from previous years. Since 2003, Now, Mountz said, her daughter still struggles, but she's nowhere t h e county has seen an average of one adolescent suicide per year, near where she once was. and never more than three in a year, according to the OHA. "She's not the kid who Children's Farm Home said she was," Winter is always the toughest time of the year for people strugMountz said. "They said she was the worst of the worst and she just g l ing with mental health issues, and this one could be a particularly

really needed to be in a facility probably forever."

hard one, Jetmalani said. While he said he's hopeful that all of the

A doctor eventually diagnosed Mountz's daughter with post-trau- a t t ention on the issue could improve things in the next three to five matic stress disorder and major depressive disorder. years, it will get worse before it gets better. "I'm very worried about the short term," Jetlamani said. "Right Mountz said she's tried to ask her daughter what happened to her back in Russia, but it's not clear. now, we're in some trouble." •

Page 40

FALL/WINTER2014• HIGH DESERTPULSE

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2 014 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 d i c a l P r o f e s s i o n a l s To list your medical office andv'or physicians in 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 Bc Med i c al) • 5 4 1 . 6 1 7 . 7 8 5 5

s•

•

•-

ADULT FOSTER CARE

Absolute Serenity Adult Foster Care

AESTHETIC SERVICES

DermaSpa at Bend Dermatology

2705 • E Conners Drive• Hend 5

ALLERGY8r,ASTHMA

Bend Memorial Clinic

Locations in Bend St Redmond

5 41- 3 8 2-4900

www b endmemorialdinic.com

ALZHEIMERSEGDEMENTIA CARE

Clare Bridge Brookdale Senior Living

1099 • E Watt Way• Bend

541-385-4717

wwwb r ookdaleliving.com

ASSISTED LIVING

Brookside Pl ace

AUDIOLOGY

Cenn al Oregon Audiology AIHearing Aid Clinic

BEHAVIORAL HEALTH

St. Charles Behavioral Health

CANCER CARE

St. Charles Cancer Center

Locations in Bend St Redmond

5 41- 7 0 6-580 0

www . stcharleshealthcare.org

CARDIOLOGY

Bend Memorial Clinic

Locations in Bend St Redmond

5 41- 3 8 2-4900

www b endmemorialdinic.com

CARDIOLOGY

St. Charles Heart gt Lung Center

2500 • E Nef'f Road• Bend 5

4 1-3 8 8 - 4333

www. s tcharleshealthcare.org

COSMETIC SERVICES

Bend Memorial Clinic

2600 • E Neff Road• Bend 5

41-3 8 2 - 4900 w wwb e ndmemorialdinic.com

DENTURISTS

Changing Smiles DentureAt lmplant Center 2041 NE Williamson CT Suite •CBend 541-388-4444 w

DENTURISTS

Sisters Denture Specialties

DERMATOLOGY

Bend Dermatology Clinic

2747 • E Conners Drive• Hend 5

41-3 8 2 - 5712

www.bendderm.com

DERMATOLOGY (MOHS)

Bend Dermatology Clinic

2747 • E Conners Drive• Hend 5

41-3 8 2 - 5712

www.bendderm.com

DERMATOLOGY (MOHS)

Bend Memorial Clinic

ENDOCRINOLOGY

Bend Memorial Clinic

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

ENDOCRINOLOGY

EndocrinologyServicesNW

929 SW Simpson Ave, Ste 220• Bend 54 1 - 317-5600

FAMILY MEDICINE

Bend Memorial Clinic

Locations in Bend, Redmond StSisters 541-382-4900

FAMILY MEDICINE

Central Oregon Family Medicine

FAMILY MEDICINE

St. Charles Family Care

FAMILY MEDICINE

St. Charles Family Care

FAMILY MEDICINE

St. Charles Family Care

FAMILY MEDICINE

St. Charles Family Care

211 NW Larch Avenue• Redmond 5 4

FAMILY MEDICINE

St. Charles Family Care

630 ArrowleafTrail • Sisters 5

119 • Rope Street• Sisters

3550 SW Canal Blvd• Redmond 5 Bend St Redmond

2542 • E Courtney Drive• Hend 5

161 E Cascade• Sisters

2600 • E Neff Road• Bend 5

645 NW 4th St.• Redmond 5 480 NE A St.• Madras

wwwabsoluteserenity info

541-588-6119

www.bendderm.com

41-3 3 0 - 9139

www.ccliving.com

41- 5 0 4-1600

541-647-2894

w ww.centraloregonaudiology.com

41- 7 0 6-7730 w

541-549-0929

wwch a ngeyoursmile.com www . raordenturecenter.com

41-3 8 2 - 4900 w wwb e ndmemorialdinic.com

4 1-92 3 - 0 119

541-475-4800

2965 NE Conners Ave,Suite 127 • Bend 541-706-4800 w 1103 • E Elm Street• Prineville 5

ww. s tcharleshealthcare.org

4 1-4 4 7 -6263 1- 5 4 8-2164 w 41-54 9 - 1318 w

wwb e ndmemorialdinic.com

n/a www b endmemorialdinic.com www.cofm.net

www . stcharleshealthcare.org ww. s tcharleshealthcare.org www. s tcharleshealthcare.org wwst c harleshealthcare.org wwst c harleshealthcare.org

FAMILY PRACTICE

High Lakes Health Care

Location in Bend

541-389-7741

FAMILY PRACTICE

High Lakes Health Care

Location in Redmond

541-504-7635

www h ighlakeshealthcare.com

FAMILY PRACTICE

High Lakes Health Care

Location in Sisters

541-549-9609

ww w h ighlakeshealthcare.com

GASTROENTEROLOGY

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

GASTROENTEROLOGY

Gastroenterology of Central Oregon

2239 • E Doctor Drive„Ste 100 • Bend 541-728-0535 w

ww. gastrocentraloregon.com

GENERAL DENTISTRY

Coombe and Jones Dentistry

GENERALSURGERY, BARIATRICSAVEINCARE AdvancedSpecialty Care

GENERALSURGERY A,BARIATRICS

St. Charles Surgical Specialists

GERIATRICCARE MANAGEMENT

Paul Battle Senior CareAdvocates

GYNECOLOGY

774 SW RimrockWay• Redmond 5 4

1- 9 23-7633

ww w h ighlakeshealthcare.com

wwwcoo mbe-jones.com

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

ww . advancedspecialtycare.com

1245 NW4th Street, Ste 101• Redmond 541-548-7761 w

ww. s tcharleshealthcare.org

www.paulBattle.com

Serving Deschutes County

877-867-1437

High Lakes Health Care

Location in Bend

541-389-7741

ww w h ighlakeshealthcare.com

GYNECOLOGY

High Lakes Health Care

Location in Redmond

541-504-7635

www h ighlakeshealthcare.com

HOME HEALTH SERVICES

St. Charles Home Health

2500 • E Nef'f Road• Bend 5

41-70 6 - 7796

www. s tcharleshealthcare.org

ADVERTISINGSUPPLEMENT

2 014 CE N T RA L O R E G O N •

M E D I CA L D I RECTORY

HOSPICE/HOME HEALTH

Hospice of Redmond

HOSPICE/HOME HEALTH

Partners In Care

HOSPICE/HOME HEALTH

St. Charles Hospice

HOSPITAL

St. Charles Madras

HOSPITAL

Pioneer Memorial Hospital

732 SW 23rd St• Redmond

541-548-7483

2075 • E Wyatt Ct.• Bend

541-382-5882

Bend, Redmond, La Pine, Prineville,

www. redmondhospice.org www.partnersbend.org

541-706-7600

www . stcharleshealthcare.org

470 • E A Street• Madras

541-706-7796

www . stcharleshealthcare.org

1201 • E Elm St• Prineville

541-447-6254

www . stcharleshealthcare.org

2500 • E Nef'f Road• Bend

541-382-4321

www .stcharleshealthcare.org

Madras, gt Sisters

HOSPITAL

St. Charles Bend

HOSPITAL

St. Charles Redmond

1253 • E Canal Blvd • Redmond

541-706-7796

www . stcharleshealthcare.org

HYBERBARICOXYGENTHERAPY

Bend Memorial Clinic

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

IMAGING SERVICES

Bend Memorial Clinic

Locations in Bend ga Redmond

541-382-4900

ww w b endmemorialdinic.com

IMMEDIATE CARE

NOWcare

www. t hecenteroregon.com

IMMEDIATE CARE

High Desert Family Medicine th Immediate Care

INFECTIOUS DISEASE

2200 • E Neff Rd• Bend

541-322-2273

570 6 7 Beaver Dr. • Sunriver

541-593-5400

Bend Memorial Clinic

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

INFECTIOUS DISEASE

St. Charles Infectious Disease

2965 NE Conners Ave., Suite 127• Bend

541-706-4878

www . stcharleshealthcare.org

INTEGRATED MEDICINE

Center for Integrated Medicine

916 SW 17th St, Ste 202• Redmond

541-504-0250

w w w.centerforintegratedmed.com

INTERNAL MEDICINE

Bend Memorial Clinic

Bend Eastside gaWestside

541-382-4900

ww w b endmemorialdinic.com

INTERNAL MEDICINE

High Lakes Health Care Upper Mill

929 SW Simpson Ave• Bend

541-389-7741

ww w h ighlakeshealthcare.com

INTERNAL MEDICINE

Internal Medicine Associates of Redmond

23 6 NW Kingwood Ave • Redmond

541-548-7134

INTERNAL MEDICINE

Redmond Medical Clinic

1245 NW4th Street, Ste 201• Redmond

541-323-4545

www . redmondmedical.com

LABORATORY

St. Charles Laboratory Services

• ine Locations in Central Oregon

541-706-7717

www .stcharleshealthcare.org

MEDICAL CLINIC

Bend Memorial Clinic

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

ww w b endmemorialdinic.com

MEDICAL CLINIC

Bend Memorial Clinic

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

ww w b endmemorialdinic.com

MEDICAL CLINIC

Bend Memorial Clinic

231 East Cascades Ave• Sisters

541-549-0303

ww w bendmemorialdinic.com ww w b endmemorialdinic.com

n/a

www.imredmond.com

MEDICAL CLINIC

Bend Memorial Clinic

865 SW Veterans Way• Redmond

541-382-4900

NEPHROLOGY

Bend Memorial Clinic

Locations in Bend ga Redmond

541-382-4900

ww w b endmemorialdinic.com

NEUROLOGY

Bend Memorial Clinic

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

NEUROSURGERY

The Center:Orthopedic s Neurosurgical Care sResearch 2

200 • E Neff Rd • Bend

541-382-3344

www. t hecenteroregon.com

NUTRITION

Bend Memorial Clinic

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

OBSTETRICS8r,GYNECOLOGY

East Cascade Women's Group, P.C.

OBSTETRICS8r,GYNECOLOGY

St. Charles Center for Women's Health

GYNECOLOGY

High Lakes Health Care

OCCUPATIONAL MEDICINE

Bend Memorial Clinic

OCCUPATIONAL MEDICINE

The Center: Orthopedic s Neurosurgical Care sResearch 2

2400 • E Neff Road, Ste A• Bend

541-389-3300 w ww.eastcascadewomensgroup.com

Loc a tions in Redmond ga Prineville 541-526-6635

www . stcharleshealthcare.org

Location in Bend

541-389-7741

ww w h ighlakeshealthcare.com

Locations in Bend ga Redmond

541-382-4900

ww w b endmemorialdinic.com

200 • E Neff Rd • Bend

541-382-3344

ww w b endmemorialdinic.com

www.thecenteroregon.com

ONCOLOGY -MEDICAL

Bend Memorial Clinic

Locations in Bend ga Redmond

541-382-4900

OPHTHALMOLOGY

Bend Memorial Clinic

Locations in Bend ga Redmond

541-382-4900

ww w b endmemorialdinic.com

OPTOMETRY

Bend Memorial Clinic

Locations in Bend ga Redmond

541-382-4900

ww w b endmemorialdinic.com

OPTOMETRY

Integrated Eye Care

452 • E Greenwood Ave.

541-382-5701

www.iebend.com

ORTHODONTICS

O'Neill Orthodontics

Bend ga Sunriver

541-323-2336

www.oneillortho.com

ORTHOPEDICS

Desert Orthopedics

Locations in Bend ga Redmond

541-388-2333

www . desertorthopedics.com

ORTHOPEDICS

The Center:Orthopedic s Neurosurgical Care sResearch 2

200 • E Neff Rd • Bend

541-382-3344

www. t hecenteroregon.com

OSTEOPOROSIS

Deschutes Osteoporosis Center

PALLIATIVE CARE PALLIATIVE CARE PEDIATRIC DENTISTRY

2200 •E NeffRoad,Suite 302 • Bend

541-388-3978

w w wdtschutesosteoporosiscentercom

St. Charles Advanced Illness Management

2500 • E Nef'f Road • Bend

541-706-5880

www . stcharleshealthcare.org

Partners In Care

2075 • E Wyatt Ct • Bend

541-382-5882

Deschutes Pediatric Dentistry

1475 SW Chandler Ave, Ste 202• Bend 541-389-3073

www.partnersbend.org www. deschuteskids.com

ADVERTISINGSUPPLEMENT

2 014 CE N T RA L O R E G O N A

•

M E D I CA L D I RECTORY •

•

541-382-4900

ww w b endmemorialdinic.com

PEDIATRICS

Bend Memorial Clinic

PEDIATRICS

St. Charles Family Care

PHYSICAL MEDICINE

Desert Orthopedics

PHYSICAL MEDICINE

The Center:Orthopedic s hleurosurgitul Care s Researrh 2

PHYSICALMEDICINE/REHABILITATION

The Center:orthopedics NeurosurgitulCares Researrh Locations in Bend 8a Redmond 5

PHYSICAL MEDICINE/REHABILITATION

Bend Memorial Clinic

PHYSICAL THERAPY

Healing Bridge Physical Therapy

PODIATRY

Cascade Foot Clinic

PULMONOLOGY

Bend Memorial Clinic

Locations in Bend 8aRedmond

5 41- 3 8 2-4900

www b endmemorialdinic.com

PULMONOLOGY

St. Charles Heart gt Lung Center

Locations in Bend 8aRedmond

54 1- 7 0 6-7715

www . stcharleshealthcare.org

RADIOLOGY

CentralOregonRadiologyAssociates, P.C.

REHABILITATION

St. Charles Rehabilitation Center

RHEUMATOLOGY

Bend Memorial Clinic

RHEUMATOLOGY

DeschutesRheumatology

SLEEP MEDICINE

Bend Memorial Clinic

SLEEP MEDICINE

St. Charles Sleep Center

SURGICAL SPECIALIST

St. Charles Surgical Specialists

SURGICAL SPECIALIST

Bend Memorial Clinic

URGENT CARE

Bend Memorial Clinic

URGENT CARE

NOWcare

2200 • E Neff Rd• Bend

URGENT CARE

St. Charles Immediate Care

2600 • E Neff Road• Bend 5

UROLOGY

Bend Urology Associates

UROLOGY

Urology Specialists of Oregon

VASCULAR SURGERY

Bend Memorial Clinic

VEIN SPECIALISTS

Inovia Vein Specialty Center

VEIN SPECIALISTS

Bend Memorial Clinic •

ADAM WILLIAMS, MD

815 SW Bond St.• Bend

211 NW Larch Avenue• Redmond 5 4 Locations in Bend 8aRedmond

www . desertorthopedics.com

541-382-3344

www. t hecenteroregon.com

4 1-3 8 2 - 3344

541-318-7041

404 • E Penn Avenue• Bend

Offices in Bend, Redmond 8a Madras 5 4 1 -388-2861

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383 Locations in Bend,Redmond, Prineville, gtMadras 541-706-7725

Locations in Bend 8aRedmond

5 41- 3 8 2-4900

www.t h ecenteroregon.com

wwb e ndmemorialdinic.com

wwwhealingbridge.com www.cascadefoot.com

www.corapc.com www.stcharleshealthcare.org www b endmemorialdinic.com

2200 • E Neff Road, Suite 302• Bend 541-388-3978 w w w .deschutesrheumatology.com

541-382-4900

Bend Locations in Bend 8aRedmond

5 41- 7 0 6-6905

1245 NW4ih Si. Sie101• Redmond 5 4 1 - 548-7761 w Locations in Bend 8aRedmond

5 41- 3 8 2-4900

Locations in Bend(East BtWest) Bt Redmond 541-382-4900 541-322-2273

Locations in Bend 8aRedmond

41-70 6 - 3700 w 54 1- 3 8 2-644 7

Locations in Bend, Redmond, 8t Prineville 541-322-5753 1501 NE Medical Center Drive• Bend 54 1 - 382-4900 w 2200 • E Neff Road, Ste 204 • Bend 5 4 1 - 3 82-8346

1501 NE Medical Center Drive• Bend 54 1 - 382-4900 w •

wwst c harleshealthcare.org

54 1- 3 8 8-233 3

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

•

Bend Memorial Clinic

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

KAREN CAMPBELL, PHD

200 • E Neff Rd • Bend

1- 5 4 8-2164 w

St. Charles Behavioral Health

•

ww w b endmemorialdinic.com www . stcharleshealthcare.org wwst c harleshealthcare.org www b endmemorialdinic.com

ww w b endmemorialdinic.com www. t hecenteroregon.com ww. s tcharleshealthcare.org www.b endurology.com www. u rologyinoregon.com wwb e ndmemorialdinic.com

wwwbendvein.com wwb e ndmemorialdinic.com

•

815 SW Bond St.• Bend

541-382-4900

1247 • E Medical Center Dr• Bend 5 4 1 - 3 22-5753 w 1245 NW 4th Street, Sle 101• Redmond 541-548-7761 w

ww w b endmemorialdinic.com

ww . advancedspecialtycare.com ww. s tcharleshealthcare.org

2542 • E Couriney Dr• Hend 5

41-7 0 6 -7730 w

ww. s tcharleshealthcare.org

JANET FOLIANO-KEMP, PSYD St. Charles Behavioral Health

2542 • E Couriney Dr• Hend 5

41-7 0 6 -7730 w

ww. s tcharleshealthcare.org

EUGENE KRANZ, PHD

St. Charles Behavioral Health

2542 • E Couriney Dr• Hend 5

41-7 0 6 -7730 w

ww. s tcharleshealthcare.org

ROSS JUDICE, MD

St. Charles Behavioral Health

2542 • E Couriney Dr• Hend 5

41-7 0 6 -7730 w

ww. s tcharleshealthcare.org

WENDY LYONS, PSYD

St. Charles Family Care

211 NW Larch Ave• Redmond 5

41-5 4 8 -2164 w

ww. s tcharleshealthcare.org

MKE MANDEL, MD

High Lakes Health Care Upper Mill

S ONDRA MARSHALL, PHD

St. Ch a rles Behavioral Health

2542 • E Couriney Dr• Hend 5

41-7 0 6 -7730 w

ww. s tcharleshealthcare.org

JAMES PORZELIUS, PHD

St. Charles Behavioral Health

2542 • E Couriney Dr• Hend 5

41-7 0 6 -7730 w

ww. s tcharleshealthcare.org

REBECCA SCRAFFORD, PSYD St. CharlesBehavioral Health

2542 • E Couriney Dr• Hend 5

41-7 0 6 -7730 w

ww. s tcharleshealthcare.org

SCOTT SAFFORD, PHD

St. Charles Family Care

929 SW Simpson Avenue• Bend 5

41- 3 8 9-7741 w w w h i g hlakeshealthcare.com

2965 NE Conners Ave,Suite 127 • Bend 541-706-7730 w

ww. s tcharleshealthcare.org

ADVERTISINGSUPPLEMENT

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LAURA SHANK, PSYD

St. Charles Behavioral Health

2542 • E Courtney Dr• Hend 5

41-7 0 6 -7730 w

ww. s tcharleshealthcare.org

KIMBERLY SWANSON, PHD

St. Charles Family Care

211 NW Larch Ave• Redmond 5

41-5 4 8 -2164 w

ww. s tcharleshealthcare.org

HUGH ADAIR III, DO

St. Charles Heart gt Lung Center

CATHERINE BLACK, PA-C

Bend Memorial Clinic

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

ww . bendmemorialclinic, com

JEAN BROWN, PA-C

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

KIMBERLY CANADAY, ANP-BC

Be nd Memorial Clinic

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

wwb e ndmemorialdinic.com

WHITNEY DREW, PA-C

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

NAHEL FARRAJ, DO

Bend Memorial Clinic

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

GARY FOSTER, MD

St. Charles Heart gt Lung Center

2500 • E Nef'f Road• Bend 5

4 1-3 8 8 - 4333

www. s tcharleshealthcare.org

RICK KOCH, MD

Bend Memorial Clinic

Bend Eastside Sr Redmond

5 41-3 8 2 -490 0

www b endmemorialdinic.com

JAMES LAUGHLIN,MD

St. Charles Heart gt Lung Center

2500 • E Nef'f Road• Bend 5

4 1-3 8 8 - 4333

www. s tcharleshealthcare.org

BRUCE MCLELLAN, MD

St. Charles Heart gt Lung Center

2500 • E Nef'f Road• Bend 5

4 1-3 8 8 - 4333

www. s tcharleshealthcare.org

P .GANESH MUTHAPPAN, MD

St.Charles Heart gtLu ng Center

2500 • E Nef'f Road• Bend 5

4 1-3 8 8 - 4333

www. s tcharleshealthcare.org

GAVIN L.NOBLE, MD

Bend Memorial Clinic

Bend Eastside Sr Redmond

5 41-3 8 2 -490 0

www b endmemorialdinic.com

ALLEN RAFAEL, MD

St. Charles Heart gt Lung Center

2500 • E Nef'f Road• Bend 5

4 1-3 8 8 - 4333

www. s tcharleshealthcare.org

STEPHANIE SCOTT, PA-C

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

JASON WEST, MD

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

MICHAEL WIDMER, MD

St. Charles Heart gt Lung Center

JASON R. WOLLMUTH, MD

Bend M emorial Clinic

EDDY YOUNG, MD

St. Charles Heart gt Lung Center

2500 • E Nef'f Road• Bend 5

4 1-3 8 8 - 4333

www. s tcharleshealthcare.org

JOHN D. BLIZZARD, MD

St. Charles Heart gt Lung Center

2500 • E Neff Road • Bend 5

4 1-3 8 8 - 1636

www. s tcharleshealthcare.org

ANGELO A.VLESSIS, MD

St. Charles Heart gt Lung Center

2500 • E Neff Road • Bend 5

4 1-3 8 8 - 1636

www. s tcharleshealthcare.org

MARIE RUDBACK, DC

Endeavor Chiropractic

JORDAN T.DOI, MSC, DC

NorthWest Crossing Chiropracticgt Health

62 8 NW York Dr, Ste. 104 • Hend 5 4

THERESA M. RUBADUE,DC,CCSP

NorthWest Crossing Chiropractic gt Health

62 8 NW York Dr, Ste. 104 • Bend 5 4 1 - 3 88-2429

2500 • E Nef'f Road• Bend 5

4 1-3 8 8 - 4333

www. s tcharleshealthcare.org

wwb e ndmemorialdinic.com

4 1-3 8 8 - 4333

www. s tcharleshealthcare.org

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

wwb e ndmemorialdinic.com

JASON M. KREMER,DC,CCSP,CSCS Wellness Doctor

2275 NEDoctors Drive,Suite 11• Se nd,OR97701 541-248-4476 w

1- 3 8 8-2429

ww. endeavorchiropractic.com

www,nwxhealth,com www,nwxhealth,com

1345 NW Wall St, Ste 202• Bend 5 4

1- 3 1 8-1000 w wwb e ndwellnessdoctorcom

41-3 8 9 -0300 w w wcentraloregondentalcenter.net

MICHAEL R. HALL, DDS

Central Oregon Dental Center

1563 NW Newport Ave• Hend 5

BRADLEY E. JOHNSON,DMD

Contemporary Family Dentistry

1016 NW Newport Ave• Hend

ALYSSA ABBEY, PA-C

Bend Memorial Clinic

WILLIAM DELGADO,MD, (MOHS)

Bend Dermatology Clinic

MARK HALL, MD,

CentralOregon Dermatology

FRIDOLIN HOESLY,MD

Bend Dermatology Clinic

JAMES M. HOESLY, MD

Bend Memorial Clinic

JOSHUA MAY, MD

Bend Dermatology Clinic

2747 • E Conners Drive• Hend 5

41-3 8 2 - 5712

www.bendderm.com

KRISTIN NEUHAUS, MD

Bend Dermatology Clinic

2747 • E Conners Drive• Hend 5

41-3 8 2 - 5712

www.bendderm.com

GERALD PETERS,MD,FACMS(MDHS)

Bend Memorial Clinic

2600 • E Neff Road• Bend 5

41-3 8 2 - 4900 w wwb e ndmemorialdinic.com

ANN M. REITAN, PA-C

Bend Memorial Clinic

2600 • E Neff Road• Bend 5

41-3 8 2 - 4900 w wwb e ndmemorialdinic.com

Bend Sr Redmond 2747 • E Conners Drive• Hend 5

388 SW Bluff Dr• Bend 2747 • E Conners Drive• Hend 5

2600 • E Neff Road• Bend 5

541-389-1107 www.contemporaryfamilydentistry.com

541-382-4900 41-3 8 2 - 5712

ww w b endmemorialdinic.com www.bendderm.com

541-678-0020 w ww.centraloregondermatology.com 41-3 8 2 - 5712

www.bendderm.com

41-3 8 2 - 4900 w wwb e ndmemorialdinic.com

ADVERTISINGSUPPLEMENT

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ALLISON ROBERTS, PA-C

Bend Dermatology Clinic

2747 • E Conners Drive• Hend 5

41-3 8 2 - 5712

www.bendderm.com

STEPHANIE TRAUTMAN, MD

Be n d Dermatology Clinic

2747 • E Conners Drive• Hend 5

41-3 8 2 - 5712

www.bendderm.com

LARRY WEBER, PA-C

Bend Dermatology Clinic

2747 • E Conners Drive• Hend 5

41-3 8 2 - 5712

www.bendderm.com

OLIVER WISCO, DO (MOHS)

Ben d Memorial Clinic

2600 NE Neff Road• Bend 5

I I

41-3 8 2 - 4900 w wwb e ndmemorialdinic.com

MARY F. CARROLL, MD

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

RICK N.GOLDSTEIN, MD

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

TONYA KOOPMAN, MSN, FNP-BC Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

I I

PATRICK MCCARTHY, MD

Endoc r inology Services NW

929 SW Simpson Ave, Ste 220• Bend 54 1 - 317-5600

n/a

TRAVIS MONCHAMP, MD

EndocrinologyServices NW

929 SW Simpson Ave, Ste 220• Bend 54 1 - 317-5600

n/a

CAREY ALLEN, MD

St. Charles Family Care

HEIDI ALLEN, MD

St. Charles Family Care

THOMAS L. ALLUMBAUGH, MD St. Charles Family Care

SONI ANDREINI, MD

St. Charles Family Care

KATHLEENC. ANTOLAK, MD

Ben d Memorial Clinic

SADIE ARRINGTON,MD

Bend Memorial Clinic

JOSEPH BACHTOLD, DO

St. Charles Family Care

JEFFREY P. BOGGESS, MD

Bend M emorial Clinic

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

1103 • E Elm Street• Prineville 5

4 1-4 4 7 -6263

www. s tcharleshealthcare.org

1103 • E Elm Street• Prineville 5

4 1-4 4 7 -6263

www. s tcharleshealthcare.org

211 NW Larch Avenue• Redmond 5 4 630 • ArrowleafTrail • Sisters 5

1- 5 4 8-2164 w

wwst c harleshealthcare.org

41-5 4 9 -1318 w

ww. s tcharleshealthcare.org

1501 • E Medical Center Drive• Bend 541-382-4900 w 865 SW Veterans Way• Redmond 5 4 630 ArrowleafTrail • Sisters 5 815 SW Bond St.• Bend

1103 • E Elm Street• Prineville 5

wwb e ndmemorialdinic.com

1- 3 8 2-4900 w wwb e ndmemorialdinic.com 41-54 9 - 1318 w

541-382-4900

wwst c harleshealthcare.org

ww w b endmemorialdinic.com

4 1-4 4 7 -6263

www. s tcharleshealthcare.org

MEGHAN BRECKE, DO

St. Charles Family Care

2965 NE Conners Ave,Suite 127 • Bend 541-706-4800 w

ww. s tcharleshealthcare.org

NANCY BRENNAN, DO

St. Charles Family Care

2965 NE Conners Ave,Suite 127 • Bend 541-706-4800 w

ww. s tcharleshealthcare.org

WILLIAM C. CLARIDGE, MD

S t .Charles Family Care

M ATTHEW CLAUSEN, MD

St. Ch a rles Family Care

AUDREY DAVEY, MD

Bend Memorial Clinic

CARRIE DAY, MD

High Lakes Health Care Upper Mill

MAY S. FAN, MD

Bend Memorial Clinic

JAMIE FREEMAN, PA-C

High Lakes Health Care Upper Mill

YVETTE GAYNOR, FPN-C

St. Charles Family Care

MARK GONSKY,DO

St. Charles Family Care

NATALIE GOOD,DO

St. Charles Family Care

BRIANNA HART, PA-C

St. Charles Family Care

MARGARET4PEGGY4 HAYNER, FNP Central Oregon Family Medicine

211 NW Larch Avenue• Redmond 5 4

1- 5 4 8-2164 w

2965 NE Conners Ave,Suite 127 • Bend 541-706-4800 w 815 SW Bond St.• Bend

929 SW Simpson Avenue• Bend 5

541-382-4900

630 ArrowleafTrail • Sisters

1103 • E Elm Street• Prineville 5

645 NW 4th St.• Redmond 5

wwb e ndmemorialdinic.com

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com

541-549-1318

2965 NE Conners Ave,Suite 127 • Bend 541-706-4800 w

211 NW Larch Avenue• Redmond 5 4

ww. s tcharleshealthcare.org

ww w b endmemorialdinic.com

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com

231 East Cascades Avenue• Sisters 5 4 1 - 5 49-0303 w 929 SW Simpson Avenue• Bend 5

wwst c harleshealthcare.org

4 1-4 4 7 -6263 1- 5 4 8-2164 w 4 1-92 3 - 0 119

ww. s tcharleshealthcare.org www. s tcharleshealthcare.org wwst c harleshealthcare.org www.cofm.net

ALAN C.HILLES, MD

Bend Memorial Clinic

HEIDI HOLMES,PA-C

High Lakes Health Care Upper Mill

MARK J. HUGHES, D.O

Central Oregon Family Medicine

SING-WEI HO, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond 5 4

1- 5 4 8-2164 w

wwst c harleshealthcare.org

PAMELA J. IRBY, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond 5 4

1- 5 4 8-2164 w

wwst c harleshealthcare.org

DAVID KELLY, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend 5

MAGGIE J. KING, MD

St. Charles Family Care

PETER LEAVITT, MD

St. Charles Family Care

JINNELL LEWIS, MD

St. Charles Family Care

Redmond gt Sisters

929 SW Simpson Avenue• Bend 5 645 NW 4th St.• Redmond 5

1103 • E Elm Street• Prineville 5

541-382-4900

www s tcharleshealthcare.org

ww w b endmemorialdinic.com

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com 4 1-92 3 - 0 119

www.cofm.net

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com 4 1-4 4 7 -6263

www. s tcharleshealthcare.org

2965 NE Conners Ave,Suite 127 • Bend 541-706-4800 w

ww. s tcharleshealthcare.org

480 • E A St.• Madras

541-475-4800

www . stcharleshealthcare.org

ADVERTISINGSUPPLEMENT

2 014 CE N T RA L O R E G O N

M E D I CA L D I RECTORY 815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

High Lakes Health Care Redmond

1001 NW Canal Blvd• Redmond

541-504-7635

www h ighlakeshealthcare.com

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w h ighlakeshealthcare.com

JOE T.MC COOK, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www . stcharleshealthcare.org

G. BRUCE MCELROY,MD

Central Oregon Family Medicine

645 NW 4th St.• Redmond

541-923-0119

LORI MCMILLIAN, FNP

Redmond Medical Clinic

1245 NW 4th Street, Ste 201• Redmond

541-323-4545

www . redmondmedical.com

EDEN MILLER, DO

High Lakes Health Care Sisters

354 W Adams Avenue• Sisters

541-549-9609

ww w h ighlakeshealthcare.com

KEVIN MILLER,DO

High Lakes Health Care Sisters

354 W Adams Avenue• Sisters

541-549-9609

ww w h ighlakeshealthcare.com

JESSICAMORGAN, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w h ighlakeshealthcare.com

DANIEL J. MURPHY, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www . stcharleshealthcare.org

AIMEE NEILL,MD

St. Charles Family Care

480 • E A St.• Madras

541-475-4800

www . stcharleshealthcare.org

SHERYL L. NORRIS, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www . stcharleshealthcare.org

AUBREY PERKINS, FNP

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www . stcharleshealthcare.org

815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

1103 • E Elm Street• Prineville

541-447-6263

www . stcharleshealthcare.org

929 SW Simpson Avenue• Bend

541-389-7741

ww w h ighlakeshealthcare.com

CHARLOTTE LIN, MD

Bend Memorial Clinic

KAE LOVERINK, MD STEVE MANN, DO

www.cofm.net

JANEY PURVIS, MD

Bend Memorial Clinic

NATHAN REED, DO

St. Charles Family Care

KEVIN RUETER, MD

High Lakes Health Care Upper Mill

DANA M. RHODE, DO

Bend Memorial Clinic

815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

HANS G. RUSSELL, MD

Bend Memorial Clinic

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

ERIC J. SCHNEIDER, MD

Bend Memorial Clinic

1501 • E Medical Center Drive+ Bend

541-382-4900

ww w b endmemorialdinic.com

LINDA C. SELBY, MD

St. Charles Family Care

1103 • E Elm Street• Prineville

541-447-6263

www . stcharleshealthcare.org

CINDY SHUMAN, PA-C

Bend Memorial Clinic

815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

570 6 7 Beaver Dr. • Sunriver

541-593-5400

DANIEL M.SKOTTE, SR.DO.,P.C. High Desert Family Medicine gt Immediate Care

n/a

PATRICIA SPENCER, MD

St. Charles Family Care

480 • E A St.• Madras

541-475-4800

www . stcharleshealthcare.org

EDWARD M. TARBET, MD

Bend Memorial Clinic

815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

JOHN D. TELLER, MD

Bend Memorial Clinic

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

541-548-2164

www . stcharleshealthcare.org

NATHAN R.THOMPSON, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

SHILO TIPPETT, PHD

St. Charles Family Care

480 • E A St.• Madras

541-475-4800

www . stcharleshealthcare.org

MATTIE E. TOWLE, MD

Bend Memorial Clinic

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

LISA URI, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w h ighlakeshealthcare.com

MARK A. VALENTI, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www . stcharleshealthcare.org

CINDI WARBURTON, FNP,DNP

St. Charles Family Care

2965 NE Conners Ave, Suite 127• Bend

541-706-4800

www . stcharleshealthcare.org

THOMAS A. WARLICK, MD

Bend Memorial Clinic

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

1103 • E Elm Street• Prineville

541-447-6263

www . stcharleshealthcare.org

Bend Eastside 8t Redmond

541-382-4900

ww w b endmemorialdinic.com

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

Bend Memorial Clinic

Bend Eastside 8t Redmond

541-382-4900

ww w b endmemorialdinic.com

HEIDI CRUISE, PA-C, MS

Bend Memorial Clinic

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

LAUREL HARTWELL, MD

Bend Memorial Clinic

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

CHRISTINA HATARA, MD

Bend Memorial Clinic

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

Bend Eastside 8t Redmond

541-382-4900

ww w b endmemorialdinic.com

BRUCE N. WILLIAMS, MD

St. Charles Family Care

RICHARD H. BOCHNER, MD

Bend Memorial Clinic

ELLEN BORLAND, MS, RN, CFNP Bend Memorial Clinic ARTHUR S. CANTOR, MD

SIDNEY E. HENDERSON III, MD Bend Memorial Clinic SANDRA K.HOLLOWAY, MD

Bend Memorial Clinic

Bend Eastside 8t Redmond

541-382-4900

ww w b endmemorialdinic.com

GLENN KOTEEN, MD

Gastroenterology of Central Oregon

2239 • E Doctor Drive„Ste 100 • Bend

541-728-0535

www .gastrocentraloregon.com

JENIFER TURK, PA-C

Bend Memorial Clinic

1501 • E Medical Center Drive• Bend

541-382-4900

ww w b endmemorialdinic.com

ADVERTISINGSUPPLEMENT

2 014 CE N T RA L O R E G O N

M E D I CA L D I RECTORY

MATTHEW WEED, MD

Bend Memorial Clinic

JANE BIRSCHBACH, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend 5

41- 3 8 9 -7741 w wwh i g hlakeshealthcare.com

TAMMY BULL, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend 5

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com

SUSAN GORMAN, MD

High Lakes Health Care Women's Center

1001 NW Canal Blvd. • Redmond 5 4

LAURIE D'AVIGNON,MD

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

JON LUTZ, MD

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

REBECCA SHERER, MD

St. Charles Infectious Disease

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

ww. s tcharleshealthcare.org

JOHN ALLEN, MD

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

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

wwb e ndmemorialdinic.com

1- 5 0 4-7635 w wwh i g hlakeshealthcare.com

CHRISTINE ANDERSON, PA-C H i gh Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend 5

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com

JENESS CHRISTENSEN, MD

Hi g hLakes Health Care Upper Mill

929 SW Simpson Avenue• Bend 5

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com

JOHN CORSO,MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend 5

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com

CARRIE DAY, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend 5

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com

CELSO A.GANGAN, MD

Redmond Medical Clinic

1245 NW4th Street, Ste201• Redmond 541-323-4545 w

ww.r e dmondmedical.com

MICHAEL N. HARRIS, MD

Bend M emorial Clinic

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

wwb e ndmemorialdinic.com

ANNE KILLINGBECK, MD

Intern al Medicine Associates of Redmond 23 6 NW Kingwood Ave • Redmond 5 4 1 - 548-7134

ANITA D.KOLISCH, MD

Bend Memorial Clinic

MATTHEW R. LASALA, MD

Bend Memorial Clinic

MADELINE LEMEE, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend 5

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com

MARY MANFREDI, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend 5

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com

H. DEREK PALMER, MD

Redmond Medical Clinic

1245 NW4th Street, Ste201• Redmond 541-323-4545 w

ww.r e dmondmedical.com

A. WADE PARKER, MD

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

MARK STERNFELD, MD

Internal Medicine Associates of Redmond

23 6 NW Kingwood Ave • Redmond 5 4 1 - 5 48-7134

DAN SULLIVAN, MD

Bend Memorial Clinic

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

MARK THIBERT, MD

High Lakes Health Care Upper Mill

DAVID TRETHEWAY, MD

Internal Medicine Associates of Redmond

23 6 NW Kingwood Ave • Redmond 5 4 1 - 5 48-7134

FRANCENA ABENDROTH, MD

Be n d Memorial Clinic

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

GARY BUCHHOLZ, MD

Bend Memorial Clinic

GREGORY FERENZ,DO

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

CRAIGAN GRIFFIN, MD

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

RAY TIEN, MD

The Center: Orthopedic s Neurosurgirul Care s Research 2

MARK BELZA, MD

Bend Spine and Neurosurgery

865 SW Veterans Way• Redmond 5 4

1- 3 8 2-4900 w wwb e ndmemorialdinic.com

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

929 SW Simpson Avenue• Bend 5

2275 • E Doctor's Drive• Bend 5

200 • E Neff Rd • Bend

www.imredmond.com

wwb e ndmemorialdinic.com

www.imredmond.com wwb e ndmemorialdinic.com

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com

4 1-3 8 2 -4900 w

541-382-3344

2275 • E Doctor's Dr. Suite 9• Bend 5 4 1 - 6 47-1638

541-382-3344

www.imredmond.com

wwb e ndmemorialdinic.com wwb e ndmemorialdinic.com

www. t hecenteroregon.com

wwwbelzamd.com www. t hecenteroregon.com

BRAD WARD, MD

The Center:Orthopedic s Neurosurgirul Care sResearch 2 2

ANNIE BAUMANN, RD, LD

Bend Memorial Clinic

ANN-BRIDGET BIRD,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

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

AMY B. MCELROY, FNP

St. Charles Center for Women's Health

Loca tions in Redmond tta Prineville 5 4 1 - 5 26-6635 w

wwst c harleshealthcare.org

00 • E Neff Rd • Bend

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

wwb e ndmemorialdinic.com

ADVERTISINGSUPPLEMENT

2 014 CE N T RA L O R E G O N

M E D I CA L D I RECTORY

CLARE THOMPSON, DNP, CNM

St. Charles Center for Women's Health

TIMOTHY HILL,MD

The Center:Orthopedic s Neurosurgical Care sResearch 2

200 • E Neff Rd • Bend

541-382-3344

www. t hecenteroregon.com

JAMES NELSON, MD

The Center:Orthopedic s Neurosurgical Care sResearch 2

200 • E Neff Rd • Bend

541-382-3344

www. t hecenteroregon.com

LARRY PAULSON, MD

The Center:onhopedic s Neurosurgical Care sResearch 2

200 • E Neff Rd • Bend

541-382-3344

www. t hecenteroregon.com

Loc a tions in Redmond tta Prineville 5 4 1 - 5 26-6635 w wws t charleshealthcare.org

ROB BOONE, MD

St. Charles Cancer Center

Locations in Bend tta Redmond

5 41- 7 0 6-580 0

www . stcharleshealthcare.org

CORA CALOMENI, MD

St. Charles Cancer Center

Locations in Bend tta Redmond

5 41- 7 0 6-580 0

www . stcharleshealthcare.org

BRIAN L.ERICKSON, MD

Bend Memorial Clinic

Bend Eastside tta Redmond

5 41-3 8 2 -490 0

www b endmemorialdinic.com

STEVE KORNFELD, MD

St. Charles Cancer Center

Locations in Bend tta Redmond

5 41- 7 0 6-580 0

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

BENJAMIN J. MIRIOVSKY, MD

Be nd Memorial Clinic

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

wwb e ndmemorialdinic.com

MICHAEL MONTICELLI, MD

St. Charles Cancer Center

LAURIE RICE, ACNP-BC

Bend Memorial Clinic

WILLIAM SCHMIDT, MD

Bend Memorial Clinic

HEATHER WEST, MD

Locations in Bend tta Redmond

5 41- 7 0 6-580 0

www . stcharleshealthcare.org

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

wwb e ndmemorialdinic.com

5 41-3 8 2 -490 0

www b endmemorialdinic.com

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

MATTHEW N. SIMMONS

Urology Specialists of Oregon

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

ww.u r ologyinoregon.com

BRIAN P.DESMOND, MD

Bend Memorial Clinic

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

www b endmemorialdinic.com

THOMAS D. FITZSIMMONS,MD,MPH Bend Memorial Clinic

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

www b endmemorialdinic.com

ROBERT C. MATHEWS, MD

Bend Memorial Clinic

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

www b endmemorialdinic.com

SCOTT T.O'CONNER, MD

Bend Memorial Clinic

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

www b endmemorialdinic.com

I '

Bend Eastside tta Redmond

Integrated Eye Care

452 • E Greenwood Ave.

541-382-5701

www.iebend.com

KIRSTEN CARMIENCKESCOTT,OD IntegratedEye Care

452 • E Greenwood Ave.

541-382-5701

www.iebend.com

MARY ANN ELLEMENT,OD I

452 • E Greenwood Ave.

541-382-5701

www.iebend.com

KIT CARMIENCKE,OD

nte g rated Eye Care

LORISSA M. HEMMER, OD

Bend M emorial Clinic

MICHAEL MAJER(XYKt OD

Bend M emorial Clinic

KEITH E. KRUEGERt DMD, PC

Ke ith E. Krneger, DMD, PC

I '

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

www b endmemorialdinic.com

541-382-4900

ww w b endmemorialdinic.com

Bend Eastside tta Westside

1475 SW Chandler, Ste 101• Bend 5 4

1- 6 1 7-3993

www.drkeithkrueger.com

AARON ASKEW, MD

Desert Orthopedics

ANTHONY HINZ, MD

The Center:Orthopedic s Neurosurgical Care sResearch 2

JEFFREYP.HOLMBOE,MD

The Cen t er:orthopedicsNeurosurgicalCaresReseardt Lo c ationsin Bendtta Redmond 5

JOEL MOORE, MD

The Center:Orthopedic s Neurosurgical Care sResearch 2

200 • E Neff Rd • Bend

541-382-3344

www. t hecenteroregon.com

KNUTE BUEHLER, MD

The Center:Orthopedic s Neurosurgical Care sResearch 2

200 • E Neff Rd • Bend

541-382-3344

www. t hecenteroregon.com

MICHAEL CARAVELLI, MD

The Ce n ter: orthopedic s Neurosurgical Cares Rese arch 2 2

00 • E Neff Rd • Bend

541-382-3344

www.thecenteroregon.com

ERIN FINTER, MD

Desert Orthopedics

54 1- 3 8 8 -233 3

www. desettorthopedics.com

I '

Locations in Bend tta Redmond 200 • E Neff Rd • Bend

54 1- 3 8 8 -233 3

www. desettorthopedics.com

541-382-3344

www. t hecenteroregon.com

4 1-3 8 2 - 3344

www.t h ecenteroregon.com

Locations in Bend tta Redmond

ADVERTISINGSUPPLEMENT

2 014 CE N T RA L O R E G O N I '

M E D I CA L D I RECTORY

JAMES HALL, MD

The Center:Orthopedic s Neurosurgirul Care sResearrh 2

ROBERT SHANNON, MD

Desert Orthopedics

541-382-3344

www. t hecenteroregon.com

54 1- 3 8 8-233 3

www . desertorthopedics.com

Desert Orthopedics

1303 • E Cushing Dr, Ste 100• Bend 54 1 -388-2333 w

ww. d esertorthopedics.com

GREG HA, MD

Desert Orthopedics

1303 • E Cushing Dr, Ste 100• Bend 54 1 -388-2333 w

ww. d esertorthopedics.com

KATHLEEN MOORE, MD

Desert Orthopedics

1303 • E Cushing Dr, Ste 100• Bend 54 1 -388-2333 w

ww. d esertorthopedics.com

I '

Locations in Bend gaRedmond

MICHAEL RYAN, MD I '

200 • E Neff Rd • Bend

TIMOTHY BOLLOM, MD

The Center:Orthopedic s Neurosurgirul Care sResearrh 2

BRETT GINGOLD,MD

Desert Orthopedics

SCOTT JACOBSON,MD

The Center: Ouhopedir s Neurosurgirul care s Research 2

BLAKE NONWEILER, MD

The Center: O rrhopedir A Neurosurgirul Care s Research Locations in Bend ga Redmond 5

I '

1315 NW 4th Street• Redmond 5 200 • E Neff Rd • Bend

Desert Orthopedics

541-382-3344 4 1-3 8 2 - 3 3 4 4

1303 • E Cushing Dr, Ste 100• Bend 54 1 -388-2333 w

The Center:orthopedics NeurosurgirulCares Researrh Locations in Bend ga Redmond 5

KENNETH HANINGTON, MD

Dese rt Orthopedics

AARON HOBLET, MD

Desert Orthopedics

SOMA LILLY, MD

The Center:Orthopedic s Neurosurgirul Care sResearrh 2

JAMES VERHEYDEN, MD

The Center:orthopedics NeurosurgirulCares Researrh Locations in Bend ga Redmond 5

I ' I

4 1- 3 8 8 -2333 w

www. t hecenteroregon.com wwde sertorthopedics.com www. t hecenteroregon.com www.thecenteroregon.com

ww. d esertorthopedics.com

MICHAEL COE,MD

541-382-3344

CARAWALTHER, MD I '

200 • E Neff Rd • Bend

4 1-3 8 2 - 3344

www.t h ecenteroregon.com

Locations in Bend ga Redmond

54 1 - 3 88-233 3

www . desertorthopedics.com

Locations in Bend ga Redmond

54 1 - 3 88-233 3

www . desertorthopedics.com

541-382-3344

www. t hecenteroregon.com

200 • E Neff Rd • Bend

4 1-3 8 2 - 3344

www.t h ecenteroregon.com

' I

MOLLY OMIZO, MD

Deschutes Osteoporosis Center

JENNY BLECHMAN, MD

Partners In Care

2075 • E Wyatt Ct • Bend

541-382-5882

www.partnersbend.org

LISA LEWIS, MD

Partners In Care

2075 • E Wyatt Ct • Bend

541-382-5882

www.partnersbend.org

RICHARD J. MAUNDER, MD

S .t Charles Advanced Illness Management

250 0 • E Nef'f Road • Bend 5

41-7 0 6-5885 w ww. stcharleshealthcare.org

LAURA K. MAVITY, MD

St. Charles Advanced Illness Management

250 0 • E Nef'f Road • Bend 5

41-7 0 6 -5885 w ww. stcharleshealthcare.org

2200 NE Neff Road, Suite 302• Bend 54 1 - 388-3978 w w wdeschutesosteoporosiscentercom

STEPHANIE CHRISTENSEN, DMD Deschutes Pediatric Dentistry

1475 SW Chandler Ave, Ste• Bend 5 4 1 - 3 89-3073 w

ww.d e schuteskids.com

STEVE CHRISTENSEN, DMD

Desc hutes Pediatric Dentistry

1475 SW Chandler Ave, Ste• Bend 5 4 1 - 3 89-3073 w

ww.d e schuteskids.com

BROOKS BOOKER, MD

Bend Memorial Clinic

815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

KATE L. BROADMAN, MD

Bend M emorial Clinic

815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

CARRIE DAY, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend 5 211 NW Larch Ave• Redmond 5

41- 3 8 9-7741 w wwh i g hlakeshealthcare.com 41-5 4 8 -2164 w

ww. s tcharleshealthcare.org

THOMAS N. ERNST, MD

St. Charles Family Care

JENNIFER GRISWOLD, PNP

Bend Memorial Clinic

815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

MICHELLE MILLS, MD

Bend Memorial Clinic

815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

M ARGARET J. PHILP, MD

St. Ch a rles Family Care

JENNIFER SCHROEDER, MD

Ben d Memorial Clinic

RUPERTVALLARTA, MD

St. Charles Family Care

JB WARTON, DO

Bend Memorial Clinic

211 NW Larch Ave• Redmond 5 815 SW Bond St.• Bend

41-5 4 8 -2164 w

541-382-4900 41-5 4 8 -2164 w

541-382-4900

ww. s tcharleshealthcare.org

ww w b endmemorialdinic.com ww. s tcharleshealthcare.org

ww w b endmemorialdinic.com

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ROBERT ANDREWS, MD

Desert Orthopedics

LINDA CARROLL, MD

High Lakes Health Care Upper Mill

TIM HILL, MD

The Center:orthopedics NeurosurgitulCares Researdt Lo c ations in Bend tia Redmond 5

NANCY H. MALONEY, MD

Bend Memorial Clinic

JAMES NELSON, MD

The Center: Orthopedic s hteurosurgitul Care s Researdt 2

200 • E Neff Rd• Bend

541-382-3344

www . t hecenteroregon.com

LARRY PAULSON, MD

The Center: Orthopedic s hteurosurgitul Care s Researdt 2

200 • E Neff Rd• Bend

541-382-3344

www . t hecenteroregon.com

DAVID STEWART, MD

The Center: Orthopedic s hteurosurgitul Care s Researdt 2

200 • E Neff Rd• Bend

541-382-3344

www . t hecenteroregon.com

JON SWIFT, DO

Desert Orthopedics

Locations in Bend tia Redmond

541-388-2333

www . desertorthopedics.com www . t hecenteroregon.com www . t hecenteroregon.com

Locations in Bend tia Redmond 929 SW Simpson Avenue• Bend 5

541- 3 88-2333

41- 3 8 9-7741 w ww h i g hlakeshealthcare.com 41-38 2 -3344 w

VIVIANE UGALDE,MD

The Center: Orthopedic s hteurosurgitul Care s Researdt 2

200 • E Neff Rd• Bend

MARC WAGNER, MD

The Center: Orthopedic s hteurosurgitul Care s Researdt 2

200 • E Neff Rd• Bend

541-382-3344

DEAN NAKADATE, DPM

Deschutes Foot gt Ankle

BROOKE HALL, MD

St. Charles Preoperative Medicine

JAMIE DAVID CONKLIN, MD

St. Charles Heart gt Lung Center

LOUIS D'AVIGNON,MD

Bend Memorial Clinic

929 SW Simpson Ave, Ste220 • Bend 54 1 - 317-5600 w

2500 • E Nef'f Road• Bend 5

41-70 6 - 2949

w w .deschutesfootandankle.com

www. s tcharleshealthcare.org

JONATHAN BREWER,DO,D-ABSM Bend Memorial Clinic

ww.t h e centeroregon.com

1501 • E Medical Center Drive• Bend 54 1 -382-4900 w w w b e ndmemorialclinic.com

541-382-3344

www . desettorthopedics.com

Bend Eastside StRedmond

Locations in Bend StRedmond Bend Eastside StRedmond

541-382-4900 54 1-7 0 6-7715

541-382-4900

ww w b endmemorialdinic.com www . stcharleshealthcare.org

ww w b endmemorialdinic.com

ERIC S. DILDINE, PA-C

St. Charles Heart gt Lung Center

CHRIS KELLEY, DO, D-ABSM

Ben d Memorial Clinic

JONATHAN MCFADYEN, NP-BC Bend Memorial Clinic

Locations in Bend StRedmond Bend Eastside StRedmond

54 1-7 0 6-7715

541-382-4900

1501 NE Medical Center Drive• Bend 54 1 - 382-4900 w

www . stcharleshealthcare.org

ww w b endmemorialdinic.com wwb e ndmemorialdinic.com

KEVIN SHERER, MD

St. Charles Heart gt Lung Center

Locations in Bend StRedmond

54 1-7 0 6-7715

www . stcharleshealthcare.org

EMILY SPEELMON, MD

St. Charles Heart gt Lung Center

Locations in Bend StRedmond

54 1-7 0 6-7715

www . stcharleshealthcare.org

TRACICLAUTICE-ENGLE,MD

Cen t ralOregonRadiologyAssociates, P.C. 14 60 • EMedical CenterDr • Bend 5 4 1 - 382-9383

www.corapc.com

ROBERT HOGAN, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

STEVEN MICHEL, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

PATRICK BROWN, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

STEVE KJOBECH, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

GARRETTSCHROEDER,MD

Cent r a lOregonRadiologyAssociates, P.C. 14 60 • EMedical CenterDr • Bend 5 4 1 - 382-9383

www.corapc.com

DAVID ZULAUF, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

THOMAS KOEHLER, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

JOHN STASSEN, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

I ' ' I

JEFFREY DRUTMAN, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

RONALD HANSON, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

JAMES JOHNSON,MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

WILLIAMWHEIRIII,MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

ADVERTISINGSUPPLEMENT

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LAURIE MARTIN,MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

PAULA SHULTZ, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

STEPHEN SHULTZ, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

CLOE SHELTON, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr • Bend 5 4 1 - 3 82-9383

www.corapc.com

NOREENC. MILLER, FNP

St. Charles Rehabilitation Center

2500 • E Nef'f Road• Bend 5

CHRISTINA BRIGHT, MD

Bend Memorial Clinic

Bend Eastside ttt Redmond

DANIELE.FOHRMAN, MD

DeschutesRheumatology

2200 • E Neff Road, Suite 302• Bend 541-388-3978 w w w .deschutesrheumatology.com

HEATHER HANSEN-DISPENZA,MD

Deschutes Rheumatology

2200 • E Neff Road, Suite 302• Bend 541-388-3978 w w w .deschutesrheumatology.com

TIANNA WELCH, PA

DeschutesRheumatology

2200 • E Neff Road, Suite 302• Bend 541-388-3978 w w w .deschutesrheumatology.com

JONATHAN BREWER,DO,D-ABSM Bend Memorial Clinic Sleep Disorders Center

Bend

41-70 6 - 7725

www. s tcharleshealthcare.org

5 41-3 8 2 -490 0

www b endmemorialdinic.com

541-382-4900

ww w b endmemorialdinic.com

ARTHUR K. CONRAD, MD

St. Charles Sleep Center

Locations in Bend ttt Redmond

5 41- 7 0 6-6905

www . stcharleshealthcare.org

DAVID L. DEDRICK, MD

St. Charles Sleep Center

Locations in Bend ttt Redmond

5 41- 7 0 6-6905

www . stcharleshealthcare.org

CHRIS KELLEY, DO, D-ABSM B e nd Memorial Clinic Sleep Disorders Center I

DAVID HERRIN, DC

Bend

541-382-4900

ww w b endmemorialdinic.com

Redmond Wellnessgt Chiropractic

TIMOTHY L. BEARD, MD, FACS Bend Memorial Clinic

DAVID CARNE, MD

St. Charles Surgical Specialists

GARY J. FREI, MD, FACS

Bend Memorial Clinic

1G55 SW Highland Ave, Ste G • Redmond 541-923-2019

1501 • E Medical Center Drive• Bend 541-382-4900 w 1103 • E Elm• Prineville

Bend Eastside ttt Redmond

541-548-7761 5 41-3 8 2 -490 0

www.drherrin.com

wwb e ndmemorialdinic.com

www .stcharleshealthcare.org www b endmemorialdinic.com

JACK W. HARTLEY, MD, FACS St. Charles Surgical Specialists

1245 NW 4th Street, ¹101• Redmond 541-548-7761 w

wwst c harleshealthcare.org

SEAN HEALY, PA-C

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

DARREN M. KOWALSKI, MD, FACS Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

1245 NW 4th Street, ¹101• Redmond 541-548-7761 w

wwst c harleshealthcare.org

JOHN C. LAND, MD, FACS

St. Charles Surgical Specialists

SUZANNE MARCATO, PA

St. Charles Surgical Specialists

ANDREW SARGENT, PA-C, MS

Be nd Memorial Clinic

RONALD SPROAT, MD

St. Charles Surgical Specialists

GEORGE T. TSAI, MD, FACS

S t. Charles Surgical Specialists

1103 • E Elm• Prineville

541-548-7761

1501 • E Medical Center Drive• Bend 541-382-4900 w 1103 • E Elm• Prineville

541-548-7761

www .stcharleshealthcare.org wwb e ndmemorialdinic.com

www .stcharleshealthcare.org

1245 NW 4th Street, ¹101• Redmond 541-548-7761 w

wwst c harleshealthcare.org

JEANNE WADSWORTH, PA-C, MS Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

ERIN WALLING, MD, FACS

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

JEFF CABA, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

ANN CLEMENS, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

TERESA COUSINEAU, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

MKE HUDSON, MD

St. Charles Immediate Care

J. RANDALL JACOBS, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

ADAM KAPLAN, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

2600 • E Neff Road• Bend 5

41-70 6 - 3700 w

ww. s tcharleshealthcare.org

ADVERTISINGSUPPLEMENT

2 014 CE N T RA L O R E G O N

M E D I CA L D I RECTORY

KERRY MAWDSLEY, FNP-BC

Ben d Memorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

TERRACE MUCHA, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

JAY O'BRIEN, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

RICHARDO OMAR GARZA, FNP St. Charles Immediate Care

2600 • E Neff Road• Bend 5

41-70 6 - 3700 w

ww. s tcharleshealthcare.org

CASEY OSBORNE-RODHOUSE,PA-C

Bend Memorial Clinic

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

www b endmemorialdinic.com

LAURIE D. PONTE, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

MATTHEW REED, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

JONATHAN SCHULTZ

St. Charles Immediate Care

PATRICK L. SIMNING, MD

Bend M emorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

JENNIFER L. STEWART, MD

Ben d Memorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

SEAN SUTTLE, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond 541-382-4900

www b endmemorialdinic.com

MICHELLE WRIGHT,FNP

St. Charles Immediate Care

MEREDITH BAKER, MD

Bend Urology Associates

2090 • E Wyatt Court • Bend

541-382-6447

www. b endurology.com

RONALD BARRETT, MD, FACS

Be ndUrology Associates

2090 • E Wyatt Court • Bend

541-382-6447

www. b endurology.com

MICHEL BOILEAU, MD, FACS

Be n dUrology Associates

2090 • E Wyatt Court • Bend

541-382-6447

www. b endurology.com

JACK BREWER, MD

Bend Urology Associates

2090 • E Wyatt Court • Bend

541-382-6447

www. b endurology.com

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

2600 • E Neff Road• Bend 5

41-70 6 - 3700 w

2600 • E Neff Road• Bend 5

41-70 6 - 3700 w

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

541-382-6447

2090 • E Wyatt Court • Bend

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

541-382-6447

2090 • E Wyatt Court • Bend

ww. s tcharleshealthcare.org

ww.u r ologyinoregon.com

www. b endurology.com

ww.u r ologyinoregon.com

wwwbe ndurologycom

wwwbendvein.com

2200 • E Neff Road, Ste 204• Bend 5 4 1 - 3 8 2-8346

ANDREW JONES, MD, FACS

Inov i a Vein Specialty Center

2200 • E Neff Road, Ste 204• Bend 5 4 1 - 3 8 2-8346

DARREN KOWALSKI,MD

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

WAYNE K. NELSON, MD

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

SAMUEL CHRISTENSEN, PA-C

Be nd Memorial Clinic

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

wwb e ndmemorialdinic.com

JASON JUNDT,MD

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

WAYNE K. NELSON, MD

Bend Memorial Clinic

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

wwb e ndmemorialdinic.com

P AID A D V E R T I SIN G S U P P L E M E N

wwwbendvein.com

To ba included in the next issue of the PULSE/C'on actions Medical Directo~

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Jargon aphasia

BY SOPHIE WILKINS

ave you ever watched a hospital or medical television show and afterward feel like you could be a doctor? You've watched

every episode and honestly believe there's really no disease or syndrome that you haven't heard of. Your Latin and scientific

knowledge has improved, and you've mastered the jargon. We're here to give you a run for your money. If these don't trip you up, it's not too late to apply for medical school next fall. See if you can choose the correct definition of these very real medical maladies.

• A. When the ability to speak or retort vanishes, usually in confrontation with an aggressive person. B.A condition in which the tongue goes numb and you can't

speak. C.When someone is speaking in an entirely made-up language, and that person seems perfectlyable to understand it. D. When you're so scared or spooked that you can't scream or shout.

Progeria

Hippopotomonstrosesquipedaliophobia • A. A paralyzing fear of hippopotamuses. B.The fear of long words. C.Fear of misspelled words D. Frequent flashbacks to playing "Hungry Hungry Hippo" as a child, and always losing.

5 • A. When a woman is hormone-deficient and needs to take progesterone.

B.An irresistible impulse to yell vulgar things in public. C. A disease that causes children to age rapidly and rarely live through their teens. D. When a person thinks he's a professional or "pro" at every-

thing he does. Rapunzel syndrome

2 • A. A condition where extremely beautiful, thick hair causes headaches and migraines. B. The fear of being locked in a dark tower and forgotten about for years. C. The ability to grow hair to impressive lengths, at a slightly accelerated rate. D. A rare intestinal condition caused by eating hair.

Verbal dysdecorum

6 • A. A fancy term for a verbal argument. B. When you have no censor and constantly say rude, mean and inappropriate things without realizing they're rude.

C.A disorder where you say rude, mean and inappropriate things on purpose but secretly know you're doing it and really enjoy getting a rise out of people. D. The ability to spell words that you've never even seen written.

Stendhal syndrome

3 • A. Rapid heartbeat, dizziness and fainting that occurs when a person is exposed to beautiful art. B. Rapid heartbeat, dizziness and fainting that occurs when a person is exposed to beautiful music. C. Obsession with Marie-Henri Beyle or "Stendhal" realism novels, such as "Le Rouge et le Noir."

D. Fear of being analyzed by a psychologist.

Answers: 1. B. Also called sesquipedalophobia. 2. D. The compulsive eating ofhair is called trichophagia. 3.A. Stendhal syndrome is actually named after French au-

FALL/WINTER 2014• HIGH DESERTPIJLSE

Arachibutyrophobia

2 • A. A paralyzing fear of peanut butter sticking to the roof of your mouth.

B.A close cousin of arachnophobia, where you're afraid of tiny spiders. C. The fear of eating an over- or under-ripened banana. D. Fear of butter, also associated with Paula Deen syndrome.

thor Marie-Henri Beyle, whose pseudonym was Stendhal. 4. C. Jargon aphasia not only affects spoken language; it also affects visual languages, like sign language. S.C. There is no effective treatmentfor this condition.

6. B. Verbal dysdecorum is associated with a brain injury, including trauma, stroke or a tumor. Z A. May be related to a fear of choking, which is called pseudodysphagia.

Page 53

Coverstory IE-CIGARETTES

Continued from Page15 their manufacturing processes, but "without regulatory oversight of the county looking at that, we really don't know what's in these products. There remain no standards for nicotine levels in the juice. And while some juice makers disclose the amount, there is no way to know that it's accurate. Some analyses showed even juice listed as zero nicotine contained some. "Thankfully more and more vape stores are investing in proper clean rooms," said Greg Conley, president of the American Vaping Association. "The good news for consumers is that making a liquid is extremely cheap. Often the bottles and the labels will end up costing more than what's actually in there. So there are no cost benefits to

e-cigarettes, and while it called for greater regulation and more studies, it did not close the door on the products altogether. "We've been through this before the low-tar cigarettes, so we are

very cautious not make the same mistakes," said Dr. Aruni Bhatnagar, chair of cardiovascular medicine at the University of Louisville, who chaired the committee that penned the guidance. "In case of the individuals who could not quit, we would not discourage them from trying e-cigarettes. We don't want to be completely averse to the whole position. The group also called for differential taxation of e-cigarettes, high enough to price them out of reach of young people but not so high as to make them as expensive as cigarettes. "Although we don't know whether there is harm reduction when cheapening health when you only have four ingredients." you switch from cigarettes to e-cigarettes, it's reasoned that they Other countries have taken markedly different approaches. E-ciga- couldn't be worse than traditional cigarettes," Bhatnagar said. "So in rettes are already prohibited in Australia, Brazil, Canada, Mexico, Pan- that vein I think we need to wait for the right evidence to emerge." ama, Singapore and Switzerland. Starting in 2016, the European Union In a survey of North Carolina physicians, two-thirds said they bewill ban advertising in 28 nations, require childproof packaging and lieved e-cigarettes could help patients stop smoking and 36 percent graphic warning labels, and limit nicotine content to 20 mg/mL. recommended them to their patients even though no e-cigarette The U.K., on the other hand, has been more open, and its Nation- product has been approved as a smoking-cessation tool. "When a 30-year-old smoker is hacking up their lungs, they're beal Health Service allows its tobacco-cessation counselors to advise smokers trying to quit on how to use e-cigarettes. ginning to say, 'Well, if you tried the gum and the patch and (they) With the FDA regulatory process dragging on, U.S. states and local- didn't work, you need to go down the street and get yourself an e-cigities have been filling the void. arette,'" Conley said. At least 22 states have explicitly banned sales of e-cigarettes to miBut many are waiting for more definitive evidence. "When I talk to patients who are trying to quit smoking, who are nors; another six have language banning sale of nicotine products to minors, without using the term e-cigarette. considering using e-cigarettes to try to stop smoking, I really caution The Oregon Legislature in 2014 considered two e-cigarette bills them against the use of e-cigarettes," said Dr. Emily Speelmon, a pulthat would ban sales to minors, but those were ultimately handed monologist with St. Charles Bend. over to a work group to craft a compromise bill. But Speelmon said, even with approved products, quit rates are Antismoking groups like the American Cancer Society and the Amer- rather low. "It can be from 5 to IS percent, so we caution people on average ican Lung Association believe industry representatives are lobbying for bills that would provide some minimal restrictions but exempt e-ciga- this takes nine tries," she said. "If you've failed, try again. You just rettes from the much tougher regulations facing tobacco sales. need to hit your number." "The e-cigarette companies are supporting Trojan horse bills in On the other hand, e-cigarettes have already gained an acceptance states that look like they're solving the problem but in fact theyare in among smokers that makers of the patch or gum could only dream exempting e-cigarettes from tobacco regulations," Willmore said. "In of, and restricting access to e-cigarettes could mean rejecting the a lot of states, e-cigarette manufacturers are looking to create new best alternative to smoking the market has ever devised. "The patch and the gum are not very sexy. The whole vaping thing definitions. So it wouldn't be clear what penalties will apply, what licensing would apply. We think the most effective and the most strict is a big thing right now and it's very cool to be doing it," said Wendy form is to regulate them as tobacco products." Bjornson, co-director of Oregon Health 8 Science University's SmokThat would raise a host of new issues, including whether insur- ing Cessation Center. "If we get some good public health benefit out ance companies could treat e-cigarette users as tobacco smokers and of it, then I say more power to it. But wejust have to wait and see." charge them higher premiums. While many employers offer discounts The FDA is funding more than three dozen studies about e-cigaor incentives to employees who don't smoke, the blood and urine tests rettes, looking at things from contents of e-cigarettes to smokers' used to detect nicotine would also be triggered by e-cigarette use. behavior to the way such products are marketing. Bjornson said the The Federal Aviation Administration has already ruled that vaping industry is far ahead of the science, and it will take awhile to catch up. "They are just very trendy right now," she said. "We'll see what and using e-cigarettes are banned on airline flights just as cigarettes are. And the CVS drugstore chain included e-cigarettes in its recent happens once the wild enthusiasm dies off, what the ongoing role ban on tobacco products, although it does continue to sell nicotine will be of such a product. And frankly, I hope that it does turn out replacement products such as patches, lozenges and gum. to be a good option that we can actually use. But again we're very The American Heart Association recently released its guidance on cautious. â&#x20AC;˘

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FALL/WINTER2014â&#x20AC;˘ HIGH DESERTPULSE

One voice ~ A PER sONALEssAY

emetswor at ows ee s,too The dispatcher asked me several times whether the bicyclist was wearing a helmet. With the father and son close by, I didn't want to reply, "NO, he wasn't wearing a helmet," as if to say he's stupid. But I repeatedly told dispatch there was only one helmet that I could see, which the boy had been

BY NANCY TODD

think about father and son every time I ride now. I encountered them when my h u s-

band and I were bicycling the new paved trail from Sunriver to Lava Lands for the first time Labor Day weekend. I was a ways

wearing.

ahead ofhim when a young boy and a man approached me on bicycles. The boy began making tight swerves

Turns out, the man, 36, was an experienced cyclist with a fancy carbon fiber ride he had built. He was on an outing with fami-

with his front wheel, back and forth, back and forth as any kid might do. But then he seemed to lose control, braked and went down in a flash. His father was right behind, crashing into him and falling over on top of

ly members and they had grabbed only one helmet — his — so he had the boy wear it. It's what any parent would do. About the time dispatch finished quizzing me repeatedly about details and location, a Deschutes County Sheriff' s Office SUV

him. In an instant I

h e ard tw o a g onizing

sounds: a fellow human howling in pain, and the boy putting up a wail, "Daddy, I am

pulled up along the Lava Lands access road across a small forested strip from the bike path. A deputy hustled over to us to assess the situation, then went back to his vehicle for first-aid equipment.

so sorry. I didn't mean to do it, Daddy ..."

I slammed on my brakes and unclipped from my bike in record time. I lifted the dad's bicycle off the boy, whose helmet was wedged in the bike frame. Then I instinc-

Na n cy Toddis the night city editor at The Bulleti n a n disanavidcyclist

tively grabbed a bag with some Band-Aids that I carry in my bike pack. But the boy's father, who was already sitting up, asked me to

The bicyclists' family had also come down the path with a stroller. Then came the paramedics from Sunriver. They treated the man's wound and road rash on his

hands; his son, unscathed physically, was back to smiling and was dial 911. He had his own phone out and was calling family mem- really taken by the suited-up paramedics. bers who were at the Lava Lands Visitor Center less than a half-mile My husband and I pedaled on after the half-hour encounter, and away. we last saw the man back at the Lava Lands parking lot. He had He was turned away from me and what I didn't immediately see was the raw knot on his left forehead with blood dripping down, as only a head wound can bleed. He had hit the pavement with his

head. While my call to 911 turned into a long conversation, a woman

who next bicycled up jumped off her bike and immediately turned to calming the injured man's 6-year-old son. She assured him repeatedly that what had happened was an accident, and she shield-

ed him from seeing his bleeding father up close. Next to join the triage was my husband. He knelt down with the father to comfort him and used his own cycling kerchief to sop up the blood dripping down the man's face onto his hands. His fore-

head looked like hamburger, and my husband was hesitant to press on it, as 911 advised.

FALL/WINTER 2014• HIGH DESERTPLILSE

shown no signs of concussion. But we will never know what hap-

pened to him after his bloody Sunday. Most likely he would have needed stitches, and surely he will have scars — he smacked his head full bore on asphalt, resulting in a remarkable injury given the slow speed. Every time I take to a bike trail I see dozens of riders, out at their leisure, not wearing helmets. (I generally don't see this out on highways with more serious bicyclists.) I see them on the streets of Bend, even Third Street. Yet a stray shoelace or a pant cuff is all it takes to fall off a bike. I

know. A helmet is all it takes to protect your head.

Father and son probably will remember this lesson forever. I know I will. •

Page 55

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