Pulse Magazine, Winter/Spring 2015 by Western Communications, Inc.

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Healthy Living in Central Oregon

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Ryan Brennecke Joe Kline

FDA aims to lift blood donation ban on gay men

Meg Roussos Andy Tullis

• Corrections High Desert Pulse's primaryconcern is Healthy Living in Central Oregon that all stories are accurate. Ifyou know ofan error in a story, call usat 541-3830308 or email pulse@bendbulletin. WINTER/SPRING 2015 com.

Since we reported about the delicate

balance in our nation's blood supply in

VOLUME 7, NO. 4

the Winter/Spring 2012 edition of Pulse, the U.S. Food and D rug A d ministration announced plans to recommend a

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change in the blood donor deferral period for men who have sex with men. In December 2014, FDA officials said they would overturn the lifetime ban and replace it with a one-year deferral since the last sexual contact. The agency has also put in place a new national blood surveillance system that will help monitor the effect of the policy change. All donated blood is tested for HIV, but the test cannot detect HIV 100 percent of the time. The estimated risk of contracting HIV from a unit has been reduced to about I per 2 million transfusions. The largest risk exists within what's known as the "window period," immediately after infection when the donor may not have detectable levels of the virus or antibodies.

The agency plans to draft guidance for the change in policy and allow for a comment period before finalizing the new rules. — Mavkian HaI/I/vyluk

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Contents ~HIGH DEsERT PULsE

COVER STORY ELECTRONIC HEALTH RECORDS Health authorities say they'll revolutionize medicine, but some docs worry they get in the way.

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WINTER/SPRING 2015• HIGH DESERTPLILSE

THE WAY OF THE BRUSH Page 3

Get the most out ofyour two minutes

Cover story ~ ELEcTRDNlc HEALTHREcoRDs

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The advent of electronic health records promises to change the face of medicine, but some worry the cure might be worse than the disease BY TARA BANNOW

r. Eden Miller's tiny clinic in Sisters closes at 5 p.m., but her

for ensuring patients' records follow them seamlessly as they move

workday is far from over. from one provider to another. The family practice physician, who works for High Lakes In theory, it sounds like just the thing that could make the health Health Care, says some days she won't be done for another four care system more efficient (no more faxes from office to office), safe hours after the "closed" sign goes up. That's because she has to write down notes from each of her patient visits that day. Later, a medical assistant will enter all that information into the clinic's electronic health records (EHR) system, a vast database that contains patients'

(no unsafe medication combinations) and population-centric. But many doctors say so far, it hasn't worked out that way. They say the systems available are hard to use, take up a significant amount of their free time, make medicine less personal and are exmedical information, including their demographics, diagnoses, med- pensive to implement and maintain, often requiring new staff memications and family history. bers just to enter data. Lots of doctors just type in that information while they're sitting And despite the promises of benefits to patients, some doctors with their patients, and many have experienced this firsthand. say EHRs, by and large, aren't having much of an impact yet — esBut Miller doesn't want to do that. She wants to make eye con- pecially in Central Oregon, where very few EHRs currently have the tact with her patients. She wants to maintain relationships. And she ability to share data, a work in progress both locally and nationally. doesn't want to miss the more subtle things patients don't say, but Local doctors, like Miller and Dr. Steve Mann, High Lakes Health Care's medical director, say they each know several doctors who've that reveal themselves in facial expressions or movements. "I sacrifice my life to be able to spend more time with patients," gone into retirement early because EHRs had made their practices she said. more difficult. "Basically, they worked as hard as they could for a year or two to The rise of EHRs is transforming the practice of medicine. Whether that evolution has been good or bad depends on who you talk to. An adapt and basically they said, 'That's it. I'm done. I wasn't planning estimated 8 in 10 physicians now use them. to retire, but I no longer have a passion for medicine,'" Mann said. "It The federal government hails EHRs as a tool for collecting mas- kind of killed their career." sive amounts of valuable data and, once the kinks are worked out, Miller isn't afraid to voice her frustration over EHRs. She estimates

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ILLUSTRATION BYCARLI KRUEGER

for every 10 minutes she spends with a patient, she spends another 20 documenting that visit. For that to happen, she said, doctors must either shorten their time with patients — become "door handle docs" who never let go of the door handle — or sacrifice their own free time to enter data into their EHRs. Miller has chosen the latter. "I now spend more time with either dictation, clerical work or data entry than I do with the patient," she said in a meeting in her office that doubled as her lunch hour. "It now outnumbers it."

Not user-friendly In an era in which glasses allow wearers to scan the Internet, print-

ers produce human cells and video game characters can seemingly pop out from the screen, lots of doctors say they're miffed by the clunkinessoftoday's EHR systems. A significant number of medical professionals complain about how arduous it can be to perform simple functions in their EHR sys-

Dr. Bill Reed, an emergency physician at St. Charles Bend, takes on a salty tone when he explains the unpleasant thing he calls "mouse miles," the amount of area his cursor must travel across his computer screen just to enter simple data about a patient. A click at the bottom of the screen to order a medication, another screen pops up, you have to go to a different screen to print, confirm the print, and so on. "It is really hard on the brain," he said. "Whereas, with your phone, sending a text is really easy. It's all right here in this one little tiny space. It's just designed better. That piece of it hasn't really trickled down to the end user yet, and maybe it will in 10 years once they've fine-tuned it." The proliferation of less than stellar EHR platforms is often traced

back to the federal government's nearly $30 billion push for widespread — and swift — EHR adoption. The Health Information Tech-

nology for Economic and Clinical Health (HITECH) Act of 2009, enacted under the American Recovery and Reinvestment Act, or the

tems, and the casualty of such unwieldy technology winds up being stimulus, created an enticing platter of financial incentives for clinics, their free time. On average, family practice physicians report having

practices and hospitals that adopted EHR platforms. That money be-

lost 48 minutes per day or four hours per five-day work week of free gan to flow in 2011, and by February 2014, more than half of eligible time to their EHRs, according to a November 2014 study in the Journal of the American Medical Association Internal Medicine. For some doctors, like Miller, it's even more than that.

WINTER/SPRING 2015• HIGH DESERTPuLSE

providers had received $21.6 billion in incentive payments, according to the U.S. Centers for Medicare 8 Medicaid Services, which administers the payments.

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Coverstory IELECTRQNIC HEALTH RECQRDS

The payments are part of the government's so-called Meaningful Use program, which is divided into stages providers must prove they're at in order to receive payments or, in the future, avoid penalties. To reach Stage I of the program, providers must prove they're using EHRs to perform a number of tasks, including ordering medications, maintaining active patient diagnoses, medication and allergy lists, entering summaries for each office visit and providing patients electronic copies of their health information. Entering Stage 2 requires having the ability to share EHR records with other providers, regardless of the platform they're using. CMS data released in late 2014 showed that less than 17 percent of U.S. hospitals had reached Stage 2, and less than 38 percent of eligible hospitals had met either Stage I or 2. Beginning Jan. I, Medicare-eligible providers who aren't at Stage I or 2 could be seeing less reimbursement from CMS for providing services to patients. St. Charles Bend is among the small proportion of hospitals that met Stage 2 requirements in 2014. Its other three hospitals are at Stage 1. Bend Memorial Clinic has met both Stage I and 2 requirements. Mosaic Medical, another large Central Oregon provider, has met Stage I requirements. The American Medical Association, along with a handful of other health care organizations, has repeatedly urged CMS to give providers more time to meet the requirements, reasoning that not doing so would lead to growing dissatisfaction with EHRs and disenchantment with Meaningful Use. Meanwhile, there's another important deadline on the horizon for providers: the implementation of a new massive set of billing codes that cover everything from diseases, symptoms and causes of injuries. It's called ICD-10 (short for International Classification of Diseases), and it's scheduled to replace its predecessor, ICD-9, on Oct. I, several years later than originally intended. Congress has pushed back the ICD-10 implementation several times, and some believe it could do so this year, too. EHRs and billing systems are intimately connected because the diagnoses and treatments entered into EHRs are used to generate bills for that care. Lots of providers are worried about the transition to ICD-10, which is significantly more detailed than ICD-9, in part because they could miss out on payments if they can't account for them in their billing systems. The ICD-10 transition is mandatory. Failing to adopt EHRs, by comparison, carries financial penalties for providers. The AMA has urged the government to repeal ICD-10, which it argues will be extremely expensive for providers. Unlike its position on EHRs, the AMA says allowing providers more time to implement ICD-10 won't solve the problem. "The AMA has long considered ICD-10 to be a massive unfunded mandate that comes at a time when physicians are trying to meet several other federal technology requirements and risk penalties if they fail to do so," AMA President-elect Steven J. Stack wrote in a statement. Money has indeed proven to be effective bait for getting providers to adopt EHR platforms. Sixty-two percent of doctors who adopt-

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Most does say EHRs reduee free time Q: What impact, ifany, has using EHRs had on your free time? More free time

Much less free time

2.2%

22.1%

Somewhat more free time

12.7%

Somewhat less free time Same amount of free time

37.2%

25.8%

Source: Journal oftbeAmerican Medical Association Internal Medicine, November2014

ANDYZEIGERT

ed EHRs between 2010 and 2013 named money as their top reason for doing so, compared with 23 percent who adopted them in 2009 or earlier, according to a December 2014 study by the Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services. But some argue it's been a little too effective and has encouraged manufacturers to push out products that weren't ready for prime time. "The government says, 'Carrot now, stick later, and here's all this money,' and the software companies are like, 'We're in. We have a product and we'll sell it to you,'" Reed said. Dr.James Verheyden, an orthopedic surgeon with The Center Orthopedic 8 Neurosurgical Care 8 Research in Bend, said despite all of the money the government is offering to give doctors and threatening to take away depending on their EHR use, there simply doesn't yet exist an EHR system that's economical, efficient and that integrates with other EHR systems. "In some ways, they've got the cart before the horse," he said.

Fast-food EHRs For some of Central Oregon's biggest providers — St. Charles Health System and Bend Memorial Clinic — such shortcomings have proven especially time-consuming and costly because they've chosen to abandon existing EHR systems for entirely new ones. St. Charles' Bend and Redmond hospitals have switched EHR platforms twice and even completed an internal investigation to determine why their third system, Paragon, was causing so much frustration

for providers. "A lot of our physicians, and a lot of them here on the Bend campus, felt that it was just very inefficient and it caused them extra time," said Dr. Mary Dallas, St. Charles' chief medical information officer. Despite the complaints, though, St. Charles plans to stick with Paragon rather than avoid the massive task of transitioning to yet another system, which Dallas said is a multiyear, labor-intensive process that involves intensive training for caregivers. "It's actually almost harder to switch EMR vendors than it is to start

WINTER/SPRING 2015• HIGH DESERTPULSE

from paper to electronic transition," she said. BMC, which first implemented an EHR system called Allscripts Healthcare Solutions in 2006, is in the throes of transitioning to an-

other platform offered by Epic, a leading EHR vendor. The provider is currently ensuring all of its caregivers and staff members agree on a design — a process that began in the summer of 2014 — and plans to go live with the new system in August, said Dr. David Holloway,

BMC's chief medical officer. Holloway said he disagrees that EHR systems were rushed out before they were perfected, especially when it comes to a system like Epic, which has been around for years. He said creating systems to

handle data for an industry where every provider does things differently and every patient is unique is inherently going to be tricky. "You start doing a formula for how complex this is, it's just unbelievable," he said. "So how do you create a technology, an electronic record, that helps manage all of that? I just think it's tougher than

everybody thought." Several physicians interviewed cited the m u ltistate, California-based health system Kaiser Permanente as an example of a provider that's got EHRs down to a science. Its records are thorough and can be easily shared with other doctors in and out of their network. The downside, though, is that the records tend to look like pages upon pages of check boxes rather than a narrative explanation of the patient encounter.

Dan McCarthy, an administrator for Adaugeo Healthcare Solutions, a company that provides local clinics with EHR and overall practice management, including billing and administration, said health care is evolving between two extremes. At one extremethe one society is slowly moving away from — is the fee-for-service world, in which a doctor might churn through 50 patients per day in order to be reimbursed for services. The move toward EHRs, however, permits a broader focus on preventative health and evaluating

providers based on quality measures. "Now the extreme would be pure data and you're more of a data analyst than a provider," McCarthy said. The truth will be somewhere in between, he said.

Lack of compatibility In a perfect world, patients would be able to visit their primary

care provider, hospital and a specialist, and each one would be able to instantly call up that patient's complete medical history, including all the providers she saw over the past several years. No longer would the patient need to strain to remember the last time she went in for her annual checkup, nor would she have to guess at how many milligrams of a certain medication she was tak-

ing, nor would she need to recall which grandparent died of lung cancer. All of that information would follow her there.

And with those databases packed full of demographic informa-

tion comes the opportunity to harness vast amounts of data about Mann, a family physician and medical director for High Lakes the health of populations to figure out where improvements can be Health Care, said some electronic patient charts are more like "data made. That's the dream of EHRs. At the moment, though, it's far from warehouses." He said it's not uncommon for him to read through six pages of a patient's record and not fully understand what reality. "That's just ajoke," said Dr. Tim Hanlon, a Pendleton cardiologist happened. "It's just page after page of data points, but nothing that creates who used to work at BMC. "That does not exist." a summary saying, 'This is how this process has evolved over the If one were to chart out all the different EHR platforms operating past year and here's what the patient's experience is and here are the in Central Oregon, they'd get a massive quilt sprinkled with a wide different ideas I have about how to treat it,'" he said. "You can't data variety of players. Dallas, of St. Charles, guesses there are at least 15 point those things." different EHRs operating locally. "Different vendors, different databases, different systems, and High Lakes doesn't yet have the ability to send patient records across providers using its EHR system, so Mann still faxes his notes none of them talk directly to each other," she said. "They're all sepain narrative format to other doctors who see his patients. Once the rate, little, silo (electronic medical records)." provider is able to tap into a community portal being developed that And so far, the vast majority of those EHRs cannot share informawill allow providers to enter one another's patient records, that nar- tion when a patient moves from one provider to another. Often, it's

rative will likely go by the wayside, and other providers will see only done the old-fashioned way: fax or email, local providers say. the patients' vital signs, diagnoses and physicians'assessments. Miller, of High Lakes in Sisters, said templated charts — the ones with only check boxes — tend to leave out the more subtle, yet important things. For example, if the doctor checked the patient's heart, she may have checked in the patient's record that the rhythm was regular. But perhaps the patient flinched when the doctor put the stethoscope on her chest and the doctor asked the patient whynone of that would be in the chart, she said. "You don't get any flavor," Miller said. "It's like Burger King or fast

food."

WINTER/SPRING 2015• HIGH DESERTPULSE

But work is underway to bring the technology to Central Oregon that will connect those independent EHRs. The relatively new group spearheading the task is called the Central Oregon Health Information Exchange. Executive Director Pat Bracknell, the group's only paid staff member, just came on board in September. She's got 15 years of consulting experience in implementing and integrating EHRs. Until now, the work has been mostly developing privacy and security rules, which are currently under legal review. February is when the real fun began: Implementing the information exchange technology and starting to load data into it, Bracknell

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Coverstory IELECTRQNIC HEALTH RECQRDS

said. The group, which consists of eight local providers, including St. that the exam he had performed on Hanlon had turned up normal. Charles, BMC, Mosaic Medical and the Central Oregon Independent Practice Association, already has chosen a software vendor and has an idea of how it wants the technical architecture to work.

"I said to this other doctor, 'How did you know my exam was normal, because the first doctor never touched me,'" Hanlon said, "and

to help providers access their patients' records from other providers the patients have gone to. Whether that can truly happen depends a lot on whether participating providers have EHR systems that can accept data from other interfaces, Bracknell said. The real tricky part when it comes to interoperability is making sure the data identifies each patient across the various records that are roped into the system. Some EHRs will use different identifiers to denote different patients, and it's sometimes tricky to develop an algorithm that will ensure each patient's records are merged together,

Hanlon's experience illustrates yet another shortcoming of today's EHRs: They make it easier than ever to commit fraud. In the past, doing so would have required a trail of lies and fraudulent note-taking. Today, Hanlon said, it's just a matter of checking boxes in the EHR. "Now, you click one button, it autopopulates an EHR, and you may not have done any of that," he said. "This goes on all the time." A January 2014 report by the HHS Office of Inspector General warned that certain EHR documentation features, if poorly designed or used inappropriately, can make it easier to commit health care fraud, which is estimated to cost between $75 billion and $250 bil-

he said, 'Well, it's all here in your EHR.' I said, 'That never happened. When all is said and done, the information exchange will be able None of that ever happened.'"

Bracknell said. But to some extent, the success of a project like the information exchange is out of the hands of the people leading it. It depends on other, perhaps smaller, providers throughout the community agreeing to be a part of it. And it means they need to have their own EHRs

up and running.

lion annually. The OIG report placed specific emphasis on an EHR capabilitycalled copy-pasting, or cloning, which allows providers to replicate information from one note and paste it into another location. Doctors, nurses or other providers often do this speed up the process, but fail to ensure the information is updated for accuracy, which can result in inappropriate billing to patients or insurance companies, the report found. EHRs also make it easier to commit a form of fraud called overdocumentation, or inserting false or irrelevant documentation in order to bill for services that weren't performed. Some technologies let the user build templates that autopopulate fields, generating extensive documentation with a single click. Despite all this, the OIG found very few EHR vendors had stepped up their policing of EHR documentation. Further, not all of the vendors surveyed reported even having the capability to determine whether copy-pasting or overdocumentation had occurred among their clients.

"Without the full picture, there is going to be holes in that view," Bracknell said. "When we manage a population, we really want to manage that entire population and all of their records, so it will be important to us that we try to engage as many providers as we can. I'm not going to say we're going to fail completely if we don't have every single provider, but I'm also not going to say that, 'Eh, we don't need them.' I mean, that's just not true. We do. We need them." The U.S. Department of Health and Human Services, also eager to see interoperability succeed on a national scale, in December 2014 issued its draft Federal Health IT Strategic Plan 2015-2020, which was open for comments until early February. Soon, HHS will use the feedback to release a broad federal strategy, called the Nationwide Interoperability Roadmap, that will define how the federal government and And such habits are becoming increasingly common, especially private sector will approach sharing health information through EHRs. among medical school students, residents, and attending physiIn Central Oregon, the information exchange is currently funded cians. In fact, an examination of the notes of residents and attending by a grant from the local coordinated care organization, the group physicians found 82 percent of residents and 74 percent of attendthat oversees care for the Oregon Health Plan population, the state's ing physicians had copied at least 20 percent of the notes from preversion of Medicaid. The funding model for the future hasn't yet vious ones, according to a February 2013 study in the journal Critical been determined; one potential avenue would be providers paying Care Medicine. "The process of training is being lost," Mann said. "Everybody is fees to use the service, or it could run on donations, Bracknell said. McCarthy, of Adaugeo Healthcare Solutions, is a board member just kind of cutting and pasting off of each other's work and not docof the information exchange. He said being a part of the information umenting what they're actually seeing." exchange requires providers â&#x20AC;&#x201D; many of whom are for-profit entities High Lakes is among more than 80 providers that contract with â&#x20AC;&#x201D; to focus on something beyond their own bottom lines. Adaugeo Healthcare Solutions to manage their practices, including "You have to take it as a good for the community," he said. "That's administration, billing, insurance contracts and a shared EHR system. what makes it so difficult for all of us to get together." McCarthy, Adaugeo's administrator, said his company has a control in place designed to prevent chart cloning. Certified coders reFraud made easier view all of the providers' encounters before claims are submitted to Hanlon, the Pendleton cardiologist, recalls a time when he visited CMS, which has condemned chart cloning. So, for example, if the a physician and was shocked to subsequently learn from another coders see that a physician submits a claim for a chart note that physician that the first doctor had recorded in his patient records looks exactly the same as his previous four notes, they would go

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ANDYTULLIS

Dr /ames Verheyden, middle, talks to patient Ward Bolsterabouthis broken finger whilemedicalscribe Brandon Georges types Verheyden's observati onsinto his EHR portal during a January office visit at The Centerin Bend.

back to that physician and question whether he actually performed the service, McCarthy said. "That's a control that has to be in place," he said. "Otherwise, the temptation to just copy and send is too great. People will abuse it." Fraud isn't the only concern that grows along with EHRs. As the

prospect of linking many EHRs together starts to look more feasible, some have raised questions about whether providers can assure the information can be kept secure. Despite a federal privacy law designed to protect patient health information, numerous security breaches have taken place in recent years, including stealing patient

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Coverstory IELECTRQNIC HEALTH RECQRDS

information for financial gain or using the information to submit insurance claims or obtain medical treatment. Since enforcement of the Health Insurance Portabilityand AccountabilityAct began in 2003, HHS has received more than 100,000 complaints of privacy infringements regarding patient medical records. Not all of those involved EHRs, but HHS says a lack of administrative safeguards around electronic patient information is among the top compliance problems it sees. Bracknell, who heads the Central Oregon Health Information Exchange, said the system her organization will use to link EHRs is the same one usedby the U.S.Department of Defense. "We feel like it's very secure," she said. "It's not something that we really plan to grant access to everybody and their brother to."

Patient experience

When The Center went live with its EHR system, Allscripts, in August 2008, Verheyden, the orthopedic surgeon, estimates he spent between 300 and 400 hours setting up customized notes and templates to make his practice more efficient. But even with all that

front-end work, he found himself spending an average of six minutes per patient visit documenting the visit, regardless of how short the visit itself was. "If I were to spend 10 minutes with a patient, it would take me six minutes to document that. It's a tremendous amount of effort."

Four years ago, Verheyden became one of the first physicians in Central Oregon to make scribes a regular part of his practice. He estimates he's gone through seven or eight scribes at this point, but he's now been using the same person for the past 10 months, a fast typist who used to work in an emergency room and aspires to one

day go to medical school.

The considerable benefits of having reams of data on countless patients comes at a considerable price: Someone needs to enter it all into a computer. That often ends up being the doctor, who must check boxes indicating whether a patient smokes and whether there is a firearm in the patient's home â&#x20AC;&#x201D; even if the visit is for, say, trou-

Using a scribe allows Verheyden to walk into the room with a patient, make eye contact, and have a conversation without worrying about writing anything down. The scribe sits at a computer behind him and enters all of the notes, diagnoses and other necessary information into the EHR. ble sleeping. Verheyden says his observations about the patients out loud so "I went to medical school to enter in smoking data? Is that the best the scribe can enter them into the computer. At first, he said he was use of my time?" said Miller, of High Lakes. nervous that might offend patients, but he's come to realize they Aside from being a burden on providers, it's also having an impact appreciate it. "Even though my visits usually don't take too long, patients feel like on the patient experience. Often, patients are separated from their they've had a good visit and are very appreciative," Verheyden said. doctors bya computer screen, and, in some cases, that's been detrimental to the patient-provider relationship. There's another important, easily overlooked benefit of looking at Each provider has his or her own way of managing the new EHR a patient during a visit echoed by several physicians interviewed for responsibilities. Some enter the data into the computer while the pa- this article: They're able to pick up on the subtle things patients don't tient is in front of them. Some have a medical assistant, nurse or always say, but show in their mannerisms, gestures or appearance. "If they stand up or sit down, how they move, how they walk," other provider enter the information before the physician enters the room. Some have what are called medical scribes, trained informa- Verheyden said."What they do with their hands as I examine them tion managers who sit in during patient visits and document the for scars or deformities." encounters, including entering EHR data, in real time. Others write Hanlon, the Pendleton cardiologist, recently saw a patient comdown notes after the visit and enter them into the computer after the plaining of chest pain. During their discussion, he noticed a change patient has left. There are other tactics, too, such as recording notes in her facial expression. "I said, 'What are you feeling right now? What's going on?' She about patients into tape recorders during a visit and entering them into the system later. started bawling," he said. "Had I been looking at a computer screen, Some providers, like Miller, have decided that a screen separating I would have missed that. I wouldn't have realized how scared this them from their patients just won't do. To her, looking at patients woman was. That changed my whole approach of what I'm going to while they're talking is important. She makes eye contact during vis- do with her. I have to prove to her that she doesn't need to be scared." its, remembers their discussions, writes down notes after the visits Today, Verheyden said he's down to two minutes of documentaand, at the end of the day, reads the notes into a voice recording. tion per patient visit, and he sounds like walking advertisement for Someone else, sometimes a medical assistant, then enters that infor- scribes "It's the single best thing I've done for my personal practice and mation into the EHR system. Miller estimates for every 10 minutes of time she spends with a from a free-time standpoint since I've started practicing," he said. patient results in 20 minutes of clerical work at the end of the day. But hiring someone to enter that information costs money. Ver"Patients love it. Why? I can listen to them," she said. "I can hear heydentakeson scribesasa personalexpense,one hesayshe' swillthem. Electronic health records are awesome for data. There is nothing to pay to improve his quality of life. ing that compares. The challenge is, who puts the data in? It takes Dr. Michael Murphy, the CEO of ScribeAmerica, a leading provider time to put it in. of medical scribes in the U.S., said, scribes are paid between $10 and

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$20 per hour. Miller said she'd love to have a scribe, but wouldn't be able to af-

but is employed by COEP. Much of the scribe industry's clients are from the emergency setting. At ScribeAmerica, 97 percent of reve-

ford one.

nue last year came from emergency medicine, Murphy said.

The rise of EHRs has dramatically strengthened demand for scribes. Between 2004 and 2009, ScribeAmerica went from no clients to 32 hospitals on its roster, Murphy said. In 2009 — the year that saw the passage of the federal stimulus and, with it, HITECHScribeAmerica's demand took off. Today, the company has close to 600 hospital clients, Murphy said. Murphy said he understands the value of collecting the data EHRs contain, but the systems are not intuitive to the practice of medicine, and have turned physicians into "data entry specialists." "I don't want to say they're doing more harm than good, but they're causing a lot of difficulties," he said. "What scribes are really there for is to really put the physician back in front of the patient and allow them to just focus on what's really important: medical

Reed's experience with scribes was much different than Verheyden's. While he found them to be motivated and pleasant to work with, he couldn't get over the discomfort of having someone elsesomeone who didn't go to medical school — controlling his charts. "They don't know what the pitfalls are of saying things one way versus another and making sure you document this, and it's OK to skip that part," Reed said. "There are accuracy issues, flavor issues to the story." Reed used scribes for about six months, and during that time, he would spend time after every shift going over the scribe's work to make sure it was accurate. Verheyden said he still goes back after every visit and reviews his scribe's notes to make sure nothing was misinterpreted, but that still takes a lot less time than not having the scribe at all. He said scribes take patients, and generally a couple months of training on the spe-

decision-making." Central Oregon Emergency Physicians, which employs many of the emergency physicians that staff St. Charles hospitals, contracts with a company that provides medical scribes to its physicians, said Reed, the emergency room physician who works at St. Charles Bend

cific system you use and jargon of your specialty. "A lot of it is really finding a good scribe," he said, "because it's just like every profession. There are some that are very good, and some that are OK." •

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Profile lJAKESELOVE R

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Jake Selover rides as a sponsored snowboarder and skateboarder

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BY DAVID JASPER

hether participating in traditional, team-oriented sports or a more individualistic activity such as snowboarding, it's critical for a teen to have supportive parents.

Over the past decade, Jake Selover, a sponsored skateboarder and snowboarder from Bend, has benefited from the dedication of his father, Scott, and mother, Whitney, who also have two daughters. At 17, Selover, who was home-schooled and graduated early, can get himself to contests and other snow and skate events. But for much of the last decade, Scott has championed and chauffeured the

dual-sport prodigy. In fact, just as his father took a seat at a picnic table for an interview about his son at Sisters Skatepark,

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Jake Selover,17 ofBendjumps offa ramp that was builtin Drake Parkin Bend on Nov. 13. MEG ROUSSOS

Jake called out to him from atop a nearby bowl. "Scott? Grab me my other board out of the car, maybe?" "Yeah, I will," replied Scott. "He was 7 when he started skating," explained Scott, back from the errand. "He got into it because a couple of his buddies were doing it. They started skating together, and it kind of took off from there."

That group of neighborhood friends included acclaimed snowboarders Zach, Gabe and Ben Ferguson. "The Ferguson brothers; we

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lived in the same neighborhood at that time, and they started skating together, and then started snowboarding together, and it kind of grew from there. It was a whole little rat pack of them. It was really fun for them," Scott said. He can relate to his son's avid interest in boarding. When Scott was

growing up in Portland, he would find hills to ride down or go downtown to take advantage of the abundance of asphalt and concrete. "I skated a little bit when I was younger, like junior high years, but not like he skates," said Scott, 52.

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ANDYTULLIS

Jake Selover, left, and his dad, Scott Selover, stand together at Sisters Skatepark.

"In the summertime, they don't last that long, especially riding concrete," his father said. When representing Bend at contests and events elsewhere, Jake's snowboarding prowess comes as little surprise given the proximity of Mt. Bachelor to his home. With his skating, it's a different story.

"When we travel to, say, California, people usually assume he's

ANDYTULLIS

Bend skateboarder Jake Selovergrabs the nose ofhis board forcontrol while doing a skateboard trickin the deep end ofthe big bowl at Sisters Skateparkin September.

from Portland if they don't know him, as Portland has a strong skate culture," Scott said. "I think the general consensus by most is that he has traveled all over the West and skated so much different terrain ... that he is an all-around skateboarder. And the state of Oregon is

generally considered a hotbed for skating everything. "There are some really great skaters here in Bend, but the reason

Jake has excelled, in my opinion, is that he has been everywhere and skated tons of different stuff. And he is super creative with his riding and skating and is motivated to get better." Jake said his favorite local skate spot is the fairly new Sisters Skate-

Jake began skating in the summer of 2004, and by that Thanks- park, a so-called do-it-yourself park featuring three bowls surroundgiving, he was also snowboarding. By the following year, Jake was ed by smaller concrete banks and mogul-like features. entering competitions in both skating and snowboarding. Farther afield, "there are so many (in Oregon) to choose from, but Over the years since, Jake has evolved into a monster of an all-ter- I'd have to say Lincoln City is my favorite. It has everything, too. It's rain boarder. On his snowboard, he rides everything from terrain so big," he said of the park, which is about 40,000 square feet with parks to powder and urban environments, when there's snow for it. more features on the way, according to the website for Dreamland As a skateboarder, he rides ramps and bowls â&#x20AC;&#x201D; or "tranny" skat- Skateparks, builder of the project. ing, in skate parlance, short for "transitions" â&#x20AC;&#x201D; prevalent in skateAsked if he has a preference between hischosen board sports, parks. He also street skates, finding unintended potential in man- Jake answered, "At this point, I'm just trying to do both and get the made terrain such as handrails, stairs, curbs and ledges. most out of them that I can, pretty much. I definitely don't like skat-

By being sponsored, Jake receives free gear and clothing, and support such as help with the cost of traveling to contests. For both

ing in the winter, here (in Central Oregon) anyway." Luckily,Jake generally prefers to focus on his other boarding disci-

snowboarding and skateboarding, Jake is sponsored by Volcom pline come winter. clothing and Vans shoes. This winter, he gained two new snow-

"When it's wintertime, he likes to snowboard. When it's summer, he likes to skateboard," said Scott.

boarding sponsors, Union Binding Co. and Crab Grab. Additionally, he's sponsored by Lifeblood Skateboards, a Portland-based skateFor both skating and snowboarding, Jake's done well in compeboard manufacturer whose sponsorship he picked up last summer. titions around the Northwest. This past summer, he competed at "He's pretty happy to be with them," Scott said of Lifeblood. "They're a Northwest company, so that's really cool." It helps getting free boards; Jake wears them out pretty quickly.

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a pro-am contest at a Eugene skatepark called the 2014 Northwest

Jam. Out of a field of 58 competitors, Jake placed fourth. "The other kids were all 21 or older," his father said. "So he did

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really well with that. He was a younger kid." Lately, Jake doesn't compete as much at snowboarding as he used to. "He'll do a competition here or there, but I think he really likes the filming and ... backcountry element," his father said. Last winter, Jake began venturing away from lifts and groomers to explore backcountry terrain. "He really got the bug for that last year," Scott said. "That's what I'm trying to do," Jake said. "I don't know how much I can really classify it as backcountry, but I try." "Yeah, that's it. Because we've got to get him more out, out, out," his father chimed in.

Jake is also an all-terrain ripper enjoying slopestyle jumps as well as park features such as rails and jumps. He rode halfpipes like Mt. Bachelor's superpipe more when he was younger but more recently has enjoyed the jumps, rails and funboxes of slopestyle and park riding.

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Though Scott mostly watches Jake when they head to area skateparks, the two have been known to ride snow together.

"Whenhe was younger, there were awhole bunch of us dads who would go out with the kids and snowboard, and as the kids have gotten older, they pretty much have taken off. They go their way, and we go ours," Scott said. "The cool thing is, all the dads want to ride pow, all the kids want to ride the park. But over the years, the kids have really gotten into riding pow and things like that, too." At his age, Jake isn't too concerned about diet and exercise, but he does a lot of hiking in the summer. That helps strengthen his legs, "but he's not really on an exercise program," his father said. "He has expressed interest in going with me to the gym at times, and he knows that will eventually be part of his routine at some point, but youth is youth, if you will." Jake's diet today is "way better than two (to) three years ago," said Scott. These days, Jake eats well and tries stay away from

soda and sugary foods. "He knows and is aware of what is beneficial for him but is not a perfect eater," Scott said. Jake's not sure where he wants to go next, but he could see

himself working for a board company down the line. "That's the mindset I have right now, hopefully ... get a job at some company or somewhere at that point and snowboard as

long as I can," he said. He wouldn't mind a gig like former pro Remy Stratto n. "He just, like, skated forever and now he's the TM (team manager) at Volcom for the skate side," Jake said. "I'm just stoked that I've gotten to do it as much as I have, because so many kids just don't have the support to take it to even where I am right now."

He's "definitely" referring to his dad, he said. "I wouldn't be anywhere without him taking me to all the skate-

parks that he did when I was young," he said. "I'm super hyped to have that." Scott doesn't take his time with Jake for granted either. "It's to the point my usefulness is running out. I like to hang out with him when he wants to. We went to some fun contests that he could've gone to by himself, but he asked me to go, so I enjoyed going," Scott said. "It's been a fun ride." •

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JOb ~FORENSICNURSE

Healers at the intersection of crime and medicine BY TARA BANNOW

he biggest part of Susan Yokoyama's job as a forensic nurse is examining and gathering evidence from patients who report

having been sexually assaulted. Often, they come in devastated — crying, shaking and sharing their regrets about going to a certain party or leaving with a certain person. Yokoyama, a sexual assault nurse examiner for St. Charles Health System, said she assures them it's not their fault. That no one has the right to assault them. The encounters take between an hour and a half to two hours and involve tending to injuries, preventing pregnancy and the transmission of sexually transmitted infections, developing a

The largest subspecialty within forensic nursing is sexual assault examiners, but they also perform death investigations and examine child abuse and domestic violence victims. Sometimes their jobs involve recounting their findings in courtrooms. The biggest difference between general nursing and forensic nursing, some in the field say, is the painstaking documentation that's

required. "We know that every single word we write or document could well end up in a court of law," said Sheila Early, immediate past president of the International Association of Forensic Nurses.

safety plan, collecting DNA, blood and urine samples, taking photos

In the emergency room, where Yokoyama also works as a general

and documenting injuries. It's not an easy job. But the most rewarding part, Yokoyama says, is sometimes by the end, she feels like she's a part of the healing

nurse, she'll note in a patient's chart the general location of a bruise and make sure it's not something more serious. As a forensic nurse, however, the documentation is much more involved. She measures the bruise, photographs it and writes down how the patient says he or she got the bruise so that law enforcement can investigate the story. Although most forensic nurses who specialize in sexual assaults work in hospitals, they can work in a number of settings, including stand-alone medical clinics, medical examiner's offices, child advocacy centers and others, said Early, also a forensic health sciences instructor at the British Columbia Institute of Technology. Becoming a forensic nurses requires training beyond a general nursing education in forensic science, including training in DNA collection,

process. "At the end of the hour and a half-or-so time that they're with us, sometimes I see them heal a little bit," she said. "They lighten. Sometimes even there is a smile or a sigh of relief about part of their experience behind them, that sort of thing." Forensic nursing is a relatively new specialty within the field — the American Nurses Association officially recognized it in 1995 — so advocates say the understanding of its importance still is growing. In short, forensic nursing is the intersection between medicine and the legal system, so it becomes necessary whenever a patient has been the victim of a crime.

different bodily fluids, toxicology testing and preserving evidence. When it comes to reporting sexual assaults, the sooner the better,

Susan Yokoyama, a forensic nurse and sexual assault nurse examiner at St. Charles Health System, places cotton swabsinto a holder usedin a patient examination duringademonstration ofherjob at St. Charles Bend. ANDYTULLIS

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Susan Yokoyama, a forensic nurse and sexual assault nurse examiner at St. Charles Health System, standsin a special room that's been paintedin bright colors with encouraging slogans on the walls at St. Charles Bend.

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Yokoyama said, especially if it could involve STI exposure. In Deschutes County, a forensic nurse who specializes in sexual assaults is on staff 24/7, either at St. Charles Bend, Redmond or Deschutes County Health Services, she said. (Emergency room nurses will be able to locate the forensic nurses on staff, she said.) In certain cases, such as if the paANDYTULLIS tient is under 18, older than 65, disabled or mentally ill, Yokoyama has to report crimes to law enforcement. Encouraging words are painted on the walls ofaspecial room used by Alleged sexual assault victims receive an examination, and the sexual assault nurse examiners to examine patients at St. Charles Bend. nurse will gather evidence into a rape kit, including DNA left by the suspect, blood, urine, hair and other body secretion samples, photos, the victim's clothing, especially undergarments, and, in some In the end, forensic nurses support patients by ensuring they collect cases, physical evidence from the scene. The patient then has six forensic evidence according to protocols, Early said. "The reality is, forensic science and forensic evidence speak for months to decide whether to report the case to law enforcement, Yokoyama said. In the mean time, the rape kits are sent to law enforce- themselves," she said. "They are the true impartial." ment offices without any identifying information on the outside of Forensic nurses are also at risk of experiencing what Early calls "vithe box, she said. In the event the patient decides to report it, his or carious trauma," where they're changed in some way by caring for her information is inside. someone who experienced trauma. It happened to Early herself. She The forensic nurses in Deschutes County — 11 at St. Charles and knew which building a patient of hers had been sexually assaulted in. two at the county — process between SO and 60 sexual assault cases She passed it on her way to and from work every day. "Every time I drove by, twice a day when I was at work ... I thought every year, Yokoyama said. The crucial and often difficult part of a forensic nurse's job is of her," she said. "That's vicarious trauma." maintaining objectivity with patients who've been through signifForensic nurses often have strategies to protect themselves from icant trauma, Early said. That means showing empathy, but not such trauma. For her part, Early said she doesn't watch violent movsympathy. The difference is subtle, but it means advocating for that ies or listen to songs that degrade people. She also volunteers for an patient while keeping in mind that you don't know the whole story, organization in British Columbia that develops projects to raise awareshe said. ness about domestic violence. "Forensic evidence can actually help not convict someone who is Every so often, things do hit home, Yokoyama said, but she just not guilty of a crime, too," Early said, "and I think that's really import- tries to remain objective. "Some of it is pretty extreme, you know? Pretty scary," she said. ant, is that a forensic nurses' neutrality and objectivity are paramount "And if you collect too much of that, you can't continue your job." • to what they do."

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Ski wax can make the difference between a smooth ride and a bad day on the trails Waxless skis

BY MARKIAN HAWRYLUK • PHOTOS BY JOE KLINE

Despite their name, you can wax waxless skis. These sorts ofskis have a textured waist to provide grip, so they don't need grip wax. Butyou can still benefitfrom some glide wax for the tips and tails. Try a glide wax which can be rubbed or wiped on, without an iron.

h, winter! The time of year when gear heads wax poetic about ski wax. There's perhaps no more quintessential Central Oregon winter experience than gliding through

a Cascade wonderland on cross-country skis. A good wax job will help make your ski outing more efficient and more enjoyable. Here's a quick rundown of the types of wax you need to consider:

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Classie skis

Skate skis

While many people think ofwax as a way to reduce friction and go faster, waxing classic skis is all about providing grip on the snow. Hard waxes work best for colder conditions — anything below 35 degrees — and are sold in what resembles a large crayon. Rub the wax on the middle third ofthe ski (the waist) with short back-and-forth strokes. Warmer temperatures require klister wax, a gluelike wax that comes in a tube and needs to be heated with an iron. Applya base coat ofbase klister then a second coat ofuniversal or temperature-specific klister. If that seems like too much work, you can also buy a spray wax that won't be as effective but will help with grip.

Skate skis are aII about your need for speed, and while ski bases are fairly slippery on their own, a good glide wax will give that extra edge to beat your buddy to the finish line. Most glide waxes are color coded for the specific temperature in which they work best. If that's too much to thinkabout, try a universal wax that will work for all temperatures. Glide waxes must be melted with an iron, although there are spray-on, rub-on and liquid waxes as well.

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ngelaBordeaux had always been on the high end of func- group with a genetic predisposition for Alzheimer's disease. As such, they have become the primary study group for new Alzheimer's

tioning for someone with Down syndrome. She could read and write, and once even won a contest for her poem about an otter at the Oregon Zoo. But when she started having behavior issues at her day program in Portland, her parents, Nancy and David Bordeaux, became concerned. By her late 20s, she was having

trouble reading, and by 31, Angela could no longer read or write her name. The staff at the day program urged her parents to take her to a

specialist, who gave them a surprising diagnosis. Angela had a condition that typicallyaffects individuals more than twice her age. Angela was one of the youngest patients he'd ever seen with Alzheimer's disease.

There's a growing recognition among families and caregivers of what researchers had discovered years ago, that individuals with

Down syndrome will invariably develop the pathology of Alzheimer's disease starting as early as their second decade of life. And if they live long enough, most will develop the dementia and clinical

tests, preventive treatments and potential cures. It now appears these individuals, who historically have been undervalued and unappreciated to the point that expectant parents often decide to terminate their pregnancies rather than have a child with Down syndrome, might hold the key to unlocking the myster-

ies of arguably the most feared disease of aging. "Their great gift to the world," said Huntington Potter, a researcher with the Linda Crnic Center for Down Syndrome in Denver, "will be the curing of Alzheimer's disease."

The Bordeauxs, who moved to Redmond four years ago, had felt called as Christians to adopt three children with Down syndrome. "In the '70s, it was a very disposable society," David, a former Multnomah County parole officer, said. "And we decidedthatGod put in our hearts to adopt these kids."

symptoms as well.

Nancy had been in nursing school, and the last baby born during her training program had Down syndrome. They adopted Zach, now 39, when he was 7 days old, and Angela, 38, four years later.

Now that their life expectancy has been stretched into the 50s and 60s, individuals with Down syndrome represents the single largest

LaToyya, 31, came to them from Kansas in the late 1980s. Angela's diagnosis came almost by coincidence. The staff had just completed

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Angela, centerand LaToyya Bordeauxright, enjoy theircraft timesewingatOpportunity Foundationin Redmond on Jan.g.

a training on Down syndrome and Alzheimer's around the time her issues began to emerge.

"If a normal person suddenly couldn't read, you would realize something was wrong," Nancy said. "But a person with Down syndrome, they already have deficits, so when they get Alzheimer's, it's not as obvious." Doctors put Angela on the Alzheimer's medication Aricept, and initially it seemed to help. "Mom, I can read again," she proclaimed after several months, but the recovery was short-lived. Now she can only write her name by copying the letters or if someone spells it out for her. Nobody had ever told the Bordeauxs to look out for Alzheimer's

as their children aged. And while Angela's diagnosis caught them off guard, they recognized the symptoms when LaToyya started having similar issues. She began to forget things, such as asking when they were going to have dinner just after they had eaten. At times, she would break out in gibberish. Soon, doctors gave LaToyya the same diagnosis, and now Nancy wonders whether Zach is similarly affected. A bout of meningitis when he was 4 years old further sapped his limited cognitive abilities, making an accurate diagnosis difficult.

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"He probably does have Alzheimer's because he has the gene for it," she said. "But he functions so low because of his meningitis that we don't know." The Bordeauxs say they will continue to care for all three at home

as long as they can do so safely. "I really don't know what the future is," Nancy said. "Other than I expect them to continue to decline."

New connections The life expectancy for someone with Down syndrome born in 1907 was a mere 9 years. Today, they routinely live into their 60s, mainly due to better treatment of congenital heart defects and infection. Mainstreaming rather than institutionalizing individuals with Down syndrome also has allowed them to live healthier, more productive lives and is paying huge dividends in terms of longevity. But that has pushed more of them into the decades of life where Alzheimer's becomes more probability than possibility. Researchers estimate that about 10 to 35 percent of those with Down syndrome will develop dementia in their 40s, and 40 to 75 percent in their 60s. If they live longer, the rate might get closer to universal.

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Researchers from UCLA used a chemical marker that binds to plaques and tangles to allow them to see where those had formsin the brains ofindividuals with Down syndrome or Alzheimer's disease. The blue color corresponds to lower amounts of plaques and tangles, while yellow and green representhigher amounts.

Down syndrome occurs when an individual is born with an extra

extracopy of the APP gene and so produce and accumulate much

full or partial copy of chromosome 21, resulting in common physical more amyloid beta. traits such as small stature, poor muscle tone and a distinct facial appearance, and intellectual deficits ranging from mild to moderate.

In 1991, Potter, then a young associate professor at Harvard University, proposed a provocative theory that Alzheimer's and Down The condition also appears to prematurely age individuals, leading syndrome were, in fact, the same phenomenon. He suggested that them to show the classic signs of aging up to 20 years earlier than as some individuals age, through genetic mutations, they develop the general population. cells with three copies of chromosome 21. They become what geBut what few people realize is that Alzheimer's disease occurs by neticists call mosaic, with some of their cells having two copies and essentially the same process. And it was Potter who first proposed some having three copies. The cells with three copies would prothis connection. duce more of the amyloid beta peptide that leads to Alzheimer's. In the 1960s, pathologists examining the brains of individuals The theory seemed crazy at first. Potter and his colleagues subwith Down syndrome found the same plaques and tangles that char- mitted a paper describing the theory for publication and received acterize Alzheimer's disease. By the late 1980s, Alzheimer's research- a four-line rejection letter, opening with, "I would not recommend

ers discovered the amyloid precursor protein gene, which produces publishing this paper anytime, anywhere." a protein that, when cleaved, forms the amyloid beta peptide that accumulates to form plaques and tangles. The APP gene is located on chromosome 21, the very chromosome of which individuals with Down syndrome have an extra copy. It's why Down syndrome is also called trisomy 21, meaning having three copies of the chromosome. But that means they also have an

Page 24

But in 1999, a post-doc student in Potter's lab showed that 6 to 8 percent of skin cells in people with typical age-related Alzheimer's diseasecontained three copies of chromosome 21, and subsequent research showed similar results for brain cells. And when research-

ers looked at MRls of brains affected by Down syndrome they looked identical to those with Alzheimer's.

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"That started out as a hypothesis and over the past 20 years, the hypothesis is proving to be correct," Potter said. "The data are pretty n incontrovertible now.

The great divide The link to a condition as high profile as Alzheimer's disease has brought new attention, new resources and new grants to Down syndrome research. But in local communities, for the most part, the support structures for individuals dealing with those conditions have remained separate. Down syndrome and Alzheimer's disease organizations did not have a history of working together, and local and state agencies for developmental disabilities and aging have for most part remained separate. As a result, families and caregivers for aging individuals with Down syndrome often fall through the cracks, their needs not

fully served or understood by either side. "That's a real challenge, and to be honest, I don't think the care systems, the agencies that exist in the community are really geared up to face this kind of issue," said Matt Janicki, a professor of Disability and Human Development at the University of lllinois at Chicago. "There's just not a lot of communication between the aging system and the disability system." Moreover, the lack of resources puts extra pressure on parents who have cared for a son or daughter with Down syndrome all their lives, only to find that the demands for their caregiving increase just as their ability to meet them begins to wane. Richard Marshall, 49, came to stay with Betty and Frank Kodera

in York, Nebraska, in 1971 when he was just 5 years old. They had already raised two boys, one of whom was working a summer job with a local agency for the developmentally disabled. The staff was desperately searching for a family to take a young boy with Down

Richard Marshall sits with this parents, Frank and Betty Kordera, at his care homein Hebron, Nebraska, last year. Marshall,49,has Down syndrome and Alzheimer's disease.

syndrome. If they couldn't find a home for him within a few weeks, the boy would be put in an institution. "Leave him here until you find someone," Frank recalls telling his son. "Well, they didn't find someone." The Koderas knew little about Down syndrome at the time. They had only seen one other person with the condition, a man who never ventured beyond the fence surrounding his front yard. "We just figured we'd treat him like our two boys," Betty said. "We just figured it would take longer."

For more than 40 years, they cared for Richard, shepherding him through school and work programs as they moved from Nebraska to Washington to Montana and back again. He worked various jobs

operating a drill press, processing seafood, sorting recyclables. Then several years ago, on a family trip to Wyoming, they awoke one night to find Richard confused and trying to open the door of their motel room. It was one of the first signs that something was wrong.

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He started having trouble at work as well, confused about how to perform the simple tasks he had done hundreds of times before. His doctor advised them to rule out more benign possibilities but eventually in 2010, a neurologist in Lincoln, Nebraska, confirmed Richard

had Alzheimer's disease. "He spent 15 minutes with us and said, 'This is what you've got. I'll give you some pills, and there's nothing else I can do,'" Betty re-

called. "They drop a time bomb in your lap and say, 'Go home.'" Richard began to decline quickly. He wouldn't sleep at night and developed seizures and hallucinations. His behavior became erratic.

He became terrified of a hallway mirror and once wrapped a blanket around it to hide its reflection. He took family photos off the refrigerator and hid or destroyed them. Having reached their 80s and starting to slow down themselves, Frank and Betty realized they could no longer care for Richard at home. When they found a care home that could take Richard an hour away in Hebron, Nebraska, they sold their house and moved there to be closer to him. "We're getting too old to be driving 50 miles on a regular basis. We wanted to see him more than once a month," Frank said. "After someone has been with you for 43 years, you're pretty much loving

the guy." Richard entered the care home in April 2013. By July he could no longer walk or talk and developed swallowing difficulties. The Koderas visit regularly, often at lunch time to help feed him. They would like to take him home for visits but are no longer up to the task. Even leaning him in his wheelchair to tie a bib on him is a difficult chal-

SUBMITTED PHOTOS

A year or two before her death, Judith Hilton smiles at her brother, Father Francis Hilton. "Even when the Alzheimer's had progressed horribly far, sheneverlosttrackofme,"hesaid.

Marick, 75, has sought information and support from other parents she's come to know over the decades as their children came up together through the disability system, schools and day programs. "Alzheimer's and Down syndrome is something that parents just really fear," she said. "This is a topic that comes up a lot. Have you heard any more? Have you heard the latest? It's just a real, real fear."

One of those friends is Yvonne Jordan, of Lake Oswego, whose son, Michael, is 41.

lenge for the couple.

"The secret words are people with Down syndrome 'have a higher incidenceof ...'"she said."And they just throw those at you all the way through your life, this just whole heck of a long list of things."

"He has to have help with everything that he does," Betty said. "Between the two of us, we couldn't do it."

Michael lived with his mother until moving to a group home three years ago. He still works four days a week, and volunteers with the

The shadow looms The average age of onset of dementia among individuals with Down syndrome is 52, which means parents are generally in their 70s or 80s when it hits. Often, one of the parents has started to show signs of dementia as well, leaving the other to care for two

individuals. It's a fear that Judy Marick, of Portland, faces now on a daily basis.

Her husband, Jim, has Alzheimer's and is in a group home. Her son

Red Cross on Fridays. But the Jordans have a family history of Alzheimer's, so she worries that could double his genetic risk. "Anytime we would see something about Down syndrome and Alzheimer's, you're shaking in your boots a little bit," she said. "Main-

ly because all of us have some base of what Alzheimer's is all about." Often, by the time dementia hits, parents have died or are in no shape to provide additional care. It can then fall to siblings to pick up the slack, creating a sandwich generation like no other. "We kind of joke that we're sort of the club sandwich generation,"

Jason, 39, has Down syndrome and lives at home with her. "At this point, Jason doesn't have Alzheimer's, but it looms very close to my heart. It just sounds like he's going to get it," she said. "It seems every time Jason repeats a question two or three times I automatically think, 'Oh no, am I seeing the first signs of Alzheimer's now?'" Marick had never expected her son to make it to 40. She hasn't told Jason of his increased risk but has told him his father has an illness that is affecting his brain. "Jason has a real fear of 'getting what Daddy has,'" she said."He

said Sarah Jurcyk, of Kansas City, Kansas, who is the legal guardian

is seeing Jim deteriorate, and Jim had gone through a segment of

Down syndrome after their mother died in 2006. The family had begun to suspect something was wrong with Judith three years earlier,

being aggressive and combative. And that was very scary for him."

Page 26

of her sister, Lucy. "Because we're not only caring for our parents and we have kids, now we have a sibling to take care of. It's like a triple-decker thing, supporting three generations of people." Still, individuals with Down syndrome tend to unite a family, rather than divide it. Statistically, parents of children with Down syndrome are less likely to get divorced, and brothers and sisters routinely respond in surveys that their lives are richer for the experience. Father Francis Hilton, a Jesuit priest from Metuchen, New Jersey,

took over as legal guardian of his younger sister, Judith, who had

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ly wasn't a lot going on for kids with intellectual disabilities," Hilton said. "So Judith

really lived her whole life on the edge of whatever good stuff was going on." She was part of the movement in New Jersey at the time for greater inclusion of

the developmentally disabled, and Judith

Father Francis Hilton walks with his sister, Judith, who had Down syndrome and Alzheimer'sdisease,ata farm not farfrom her housein 2008. Judith had not walked for months butwith her brother's helphad left her wheelchairfora briefstroll.

when her boss expressed some concerns. The family attributed it to stress over losing her father to lung cancer and seeing

her mom decline after breaking a hip. In the summer of 2003, Hilton took Judith, then 41, to see specialists at Rutgers University Medical Center. By the third visit, the doctors told him there was no other

accumulated a number of firsts along the way: attending the first classes for individuals with developmental disabilities, being the first student with Down syndrome at her high school, and the first with Down syndrome at her worksite. "She was the first person with Down syndrome to go on a cruise to Bermuda on her own," Hilton said.

When she was diagnosed with Alzheimer's, the doctors told him what to expect. The first thing that will happen, they said, is she will break one or both of her feet as she struggles to adapt to her changing perceptions of the world around her. In short order, Judith broke one foot, and then the week her mother died, she broke the other stepping awkwardly off the stairs.

Much to her family's chagrin, Judith's favorite movie was "Dirty Dancing," and

explanation: Judith had Alzheimer's.

she would annoy the Catholic family by

When they returned to their parents' house, Judith bounded up the stairs and told her mother how nice the doctors had been and about the lunch with her brother by the ocean shore. When she left the room, her mother asked Hilton what he

reciting lines from the racy film. But "The

Wizard of Oz" ran a close second, and she rarely missed an opportunity to watch it. "I feel like the scarecrow," she told her brother six months after her diagnosis.

"My head is full of straw."

had learned. Hilton eventually quit his job as a depart"Judith has Alzheimer's, and I can't figure ment chair at Rutgers University and took a out why she's so happy right now," he told sabbatical to spend more time with Judith. her. She had several bouts of aspirational pneu"At some level, she knows she's going to monia, a common problem for individuals be in good hands," his mother replied. with Down syndrome and Alzheimer's as In that moment, Hilton realized he had swallowing becomes more difficult. Judith just inherited the responsibility of ensuring his sister's well-being. "My parents had given their lives to making Judith's world. It was time for them to move on and pass the torch," he said. "And there's no torch I would rather have received." Judith was the youngest of eight children in the Hilton family. "She was born at a time when there real-

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had lost the ability to walk and spent much

of her day in bed.She had continued to decline steadily over the five years after her diagnosis, until a weekend in November 2011.

Hilton was grading papers at her bedside and they were watching the Giants football game on the TV. For reasons still unclear, Judith seemed to make a remarkable rally. She noticed for the first time the

Page 27

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Murphy's daughter, Michelle, has Down syndrome and watched two of her closest friends, including Judith Hilton, as they declined and ultimately died from Alzheimer's. Michelle spoke at a conference two years ago about what it was like to see her best friends fade away, lose the ability to feed themselves, and forget her name. Michelle has shown no signs of dementia, but having seen it firsthand, Murphy knows she must prepare for that likelihood. But there are few provisions in the community for those with intellectual disabilities and dementia. Neither day programs nor the group homes are prepared for it, nor are there many specialized facilities to meet

their unique needs. Murphy said individuals often end up in nursing homes surrounded by elderly residents. "Every time I go to a nursing home, I see people with Down syndrome just sitting, vegetating in the corner," she said. "It's really sad. We need tocome up with a place where we can take care of them,

where they could possibly age in place."

Gains and losses

RYAN BRENNECKE

Richard Robertson, clockwise from top, Jenny Blanford, Matt Wilson and Kendra Lopezat the Central Oregon Transi ti on Plus apartment complex.

feeding tube in her nose. She questioned why her brother was giving the students all those red marks on their papers, and when the Wicked Witch of the West appeared on the television screen, Judith became animated. "She was really acting like the Alzheimer's had gone away," Hilton said. Her nurses couldn't believe the difference, asking Hilton what he had done to precipitate such a drastic change. Then late Tuesday night, at a time when it's never good news, Hilton's phone rang. Judith had felt so good that, for the first time in years, she had tried to get out ofbed. She caught her foot on the bedsheetand fell,

Just east of the parkway running through Bend sits a nondescript apartment complex that was born of parents' hopes and dreams but now harbors more than its fair share of fears. More than 20 years ago, a group of parents with children with developmental disabilities banded together under the name Central Oregon Transition Plus with the goal of mapping out a better future for their children. When it was time for their children to leave home and lead more independent lives, they wanted to find safe and secure housing for them but realized no such place existed. Through a partnership with Cascades Community Development, they opened two apartment complexes and a group home with just enough staffing to help the residents live on their own. The three units now house a combined 29 residents with developmental disabilities ranging in age from 29 to 58, including six individuals with Down syndrome. That means several of the residents, such at Matt Wilson, 33, are

reaching the age when Alzheimer's symptoms typicallyappear for

the first time. "Matt's grandmother died of Alzheimer's in 2000," his mother, breaking her neck. Pam Wilson, said. "Ever since then I've watched for it very closely." "That was the end of life as I knew it," Hilton said. "I was there for Wilson hopes that even if her son starts to show signs of demenher life, but I wasn't there for her final day.Judith died all by herself." tia, he will be able to stay at the complex with additional support Hilton said his family knew little of the increased risk for Alzhei- services. But there is also an understanding among the parents that mer's. They had always been told Judith would have heart problems, residents must be able to live relatively independently to stay there. "If he became unstable in his living environment, where he but it wasn't until she was in her 40s that anyone mentioned the risk of dementia. News of the link has been slow to filter through to fam- would be a danger to himself, then there would have to be a deciilies, and even when it does, they often are in denial. sion made," Wilson said. "He would have to go live in an environ"It's hard for families to accept that this is inevitable, because ment where it would be safer for him." you've worked so long and hard to change the school systems and While the COTP parents have made individual plans to ensure get them integrated, and then you get hit with this at the end," said their children will have ongoing support after they're gone, they Leone Murphy, a nurse practitioner working with individuals with de- also take solace in knowing that the community of parents will velopmental disabilities and an instructor at Rutgers University. "So look out for all of the residents. "When one of the kids needs help, we all come together," said many families are still not even able to accept that this is coming."

Page 28

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Karen Blanford, whose 42-year-old daughter, Jenny, has Down syndrome. "So hopefully someone in the group can help them find the services they might need." For many parents and siblings, the looming threat of Alzheimer's represents a cruel twist of fate for individuals who were born at a disadvantage and have been trying all their lives to catch up. The very families that fought for inclusion and acceptance over the past three to four decades are now among the first to face the stark reality that Alzheimer's threatens to unravel all of their hard work. "When Jason was born, it was all about early intervention," Marick said. "We all absorbed information and wanted to push our kids. We did everything and offered them everything for that reason. They were just going to be super people with Down syndrome. And in the last 10 years, we've realized that it can all be taken from them." The nation is already struggling with how it will take care of the millions of additional cases of Alzheimer's disease as the baby boomer generation ages. But within that larger demographic wave there exists a more intense riptide of individuals with Down syndrome facing the same issue. With gains in longevity, the number of individuals living with Down syndrome is expected to double from 642,000 in 2000 to 1.2 million by 2030. With no reliable treatments for Alzheimer's, efforts to help affected individuals now focus on early diagnosis to help accommodate their diminishing skills. But families, providers and caregivers will have to get much better at recognizing the early signs of Alzheimer's in order to help. Individuals with Down syndrome face myriad health issues as they age. Separating what is Alzheimer's disease from what is a thyroid

problem or sleep apnea or a B12 deficiency is often impossible.

RYAN BRENNECKE

Matt Wilson, center dishes up a plate offood during a potluckat the Central Oregon Transition Plus apartment complexin January.

years ago, after their mother died in New Jersey. For years, Robin

worked in a bakery and a supermarket. She had her artwork published in a book and played Sue Sylvester's sister on the television

show "Glee." Her first symptoms of Alzheimer's began to appear about age 50. "She would have trouble with forgetting things, trouble with confusion. She would make little mistakes," Miller said. "And then that began to escalate."

Robin began complaining about problems at work, which Miller attributed to having a new supervisor. She told Robin she had to try

harder. When Robin had a series of falls, the staff at her program claimed she was merely doing it for attention, not realizing that gait issues are often the first sign of Alzheimer's. And when she became overly emotional, it was chalked up to menopause or a disagreement with her friend. "Everything was easily explained away, misunderstood and then

blamed on her," Miller said.

"I think the important thing is to make sure you're not attributing Alzheimer's disease to something else," said Dr. Brian Chicoine, co-founder and medical director of the Adult Down Syndrome Center of Lutheran General Hospital in Park Ridge, lllinois. "We certainly

One night, Robin took everything out of her freezer and put it her sock drawer. Despite living in housing for individuals with developmental disabilities, the staff had no idea how to deal with her emerging dementia. see folks who have depression that looks like Alzheimer's disease Then, two years ago, Robin's condition began to deteriorate rapthat got better when you treated the depression." idly. She became terrified of the dark and would have psychotic The center was launched in 2012 and has seen more than 5,500 breaks. She stopped walking or feeding herself. Miller brought her adolescents and adults with Down syndrome, whose symptoms of home in December 2013 fully prepared it would be her sister's last aging are often overlooked by less experienced eyes. The clinic's Christmas. providers are careful to rule out other conditions before settling on But somehow, close to her family, in a environment where she an Alzheimer's diagnosis. felt safe and loved, her condition improved. "But there are certainly patients that see me for the first time that "She got happier," Miller said. "She just wanted to be with me." have enough of a pattern that I'd be pretty flabbergasted if I found Even as recently as a decade ago, learning about dementia in something else," Chicoine said. someone with a developmental disability was a daunting task. When normal adults start to forget or act erratically in their lat- Miller reached out to Down syndrome and Alzheimer's advocacy er years, family and friends are quick to suspect Alzheimer's. But groups with little success. She tracked down a friend whose son when individuals with Down syndrome act similarly, it's often at- with Down syndrome had died of Alzheimer's. She met with her tributed to their intellectual disabilities instead. three weeks in a row, sitting on the woman's porch absorbing all of "When symptoms start, it's too easy to blame the person be- her hard-gained experience. "You have to tell me everything from the first sign to everything cause you don't know what's happening," said Sharon Miller, of Burbank, California. that happened at the end," she recalls telling her. "I don't want to tell you about the end," her friend replied. "I don't Miller's sister, Robin Trocki, came to live with her more than 20

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Feature IDQWN SYNDRQME AND ALZHEIMER'5

want to scare you." It's information they haven't been able to get until recently from national Down syndrome advocacy groups. These groups got their start in helping families dealing with the first diagnosis of Down

syndrome and so not surprisingly have focused primarily on issues of early intervention and inclusion. "I think it's been slow to come to the table from a national standpoint because that's a negative thing," said Dr. Seth Keller, a neurologist from Cherry Hill, New Jersey."You're talking to these young parents with children with Down syndrome, do you really want to tell them that when their children get to be 40, 50 or 60, they're going to get Alzheimer's and die?" So until recently, there was little guidance from these groups on the realities of aging with Down syndrome. "I believe there are families that have their heads in the sand, who don't want to know what's going on," Miller said. "To me, it's scary not knowing." There's a similar disconnect among the medical professionals.

While physicians who specialize in Down syndrome may have a greater understanding of the link with Alzheimer's, primary care

physicians or specialists who see such individuals less frequently aren't always aware of the connection. "Doctors and nurses who care for people with developmental disabilities don't know what normative aging is," Keller said.

When Robin developed bladder issues and required a catheter, for example, her doctor told Miller she would have to have the catheter changed under general anesthesia every month. "To me, that's unacceptable. My question is always, 'Would you do that to me?'" Miller said. "I found another urologist who changed her catheter using kindness instead." To help improve care for individuals with intellectual disabilities and dementia, Keller, Janicki and others involved with the American Academy of Developmental Medicine and Dentistry formed the National Task Group on Intellectual Disabilities and Dementia

SUBMITTED PHOTO

Sharon Miller, left, and hersister, Robin Trocki, ofBurbank, California. Trocki has Down syndrome and Alzheimer's disease.

of dementia in its older athletes and are now working to integrate screening and referral for potential Alzheimer's cases as well. "For people with intellectual disabilities, I don't think we have a

true blueprint of what aging looks like," said Jim Balamaci, president and CEO of Special Olympics Alaska."So we want to help put that blueprint together by working with the provider agencies, the hospital and the school of nursing to come up with a solution that

might beneficial." Recognizing those subtle, early changes can be challenging in real time and often emerge only with the clarity of hindsight. Mary Hogan, family coordinator for the National Task Group, said she

missed many of the clues in her brother, Bill Hogan, who died of Alzheimer's in 2010 at the age of 49. "We would give lip service to the idea that people with Down

syndrome will develop Alzheimer's, but we really didn't do our homework, and we didn't really understand the disease itself," Hogan said. "We didn't understand the progression of the disease."

Bill had been methodical with his calendar all of his life, dutiPractices. The group has developed guidelines for care and has fully recording whether each day was a good day or a bad day, served as a voice at the table, ensuring the medical establishment considers the unique needs of the disabled population when putting policies and actions plans in place. Most recently, they advocated for greater consideration within the National Alzheimer's Plan for individuals with all sorts of intellectual disabilities. Such efforts are starting to have an impact. Down syndrome and Alzheimer's organizations are starting to collaborate and share information with families about aging and dementia. A recent restructuring within the federal Department of Health and Human Services created the Administration on Community Living, bridging the Administration on Aging and the Administration on Intellectual and Developmental Disabilities. Keller has also been working with Special Olympics to increase the

coloring in the days and marking them with his intricate system

of symbols. "When he lost interest in that kind of activity, that should have been an immediate alarm for us," she said. "That's a really profound change, and we didn't connect that with where we were

heading." Over time, the subtle changes seemed to come more frequently and the losses became more noticeable. Bill's last 15 months, she said, were ones of rapid decline. There's some debate over whether Alzheimer's moves at a quicker pace in Down syndrome or whether it just seems that way because the initial signs are so often masked by their cognitive deficits.

Hogan said keeping track of the changes is particularly difficult visibility of aging issues among its athletes. The group has long had when individuals live in group homes, which can have frequent a program called Healthy Athletes, in which they screen participants for medical issues. But in some states, officials have noticed the rise

Page 30

turnover in staff. There's often no one there with the historical knowledge of an individual's habits and tendencies to pick up on

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50 YEARS OF DEDICATION

significant differences in behavior.

Tracking change Evelyn Fella was moving her sister, Irma Fella, into a new care home in 2001 when she heard for the first time a social worker tell the new caregivers Irma had signs of dementia. "Who decided that? Why would they say something like that?" she recalls thinking at the time. "But I'm going to say they were right." Irma was born in Detroit in 1945. After three sons, her mother was ecstatic to finally have a baby girl to take home. She was so excited, doctors couldn't bring themselves to tell her the baby

girl had Down syndrome.

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

Within two months, however, she knew something was wrong. Irma wasn't developing the same way her brothers had. Doctors broke the news and told her to put Irma in an institution. "My mother went to visit one and it was horrible, just a horrible experience," Fella said. "So my sister just continued to be part of the family, and my mother's expectations weren't any less than for any of her other children." In the early 1950s, her mother saw an ad in the newspaper from a mother looking to find other families of children with disabilities. The parents got together and created a program for their children, renting space from the parks and recreation department. It was just one of the groups being formed around the country by parents whose children were denied access to

public school. Eventually some of these parent groups joined forces in the National Association for Retarded Children, which now operates throughout the country under the acronym ARC.

OLtr Physicians and Physicians Assistants Michel Boileau, MD, FACS, Brian O'Hollaren, MD,Jack Brewer, MD, Nora Takla, MD, Meredith Baker, MD, Ronald Barrett, MD, FACS William Corrigan, PA-C, Johanna Godell, PA-C, Sara Stafford, PA-C, Jonathan Kelley, PA-C,Jamie Tigner, PA-C

The program served as a nursery school for Evelyn as well, who was four years younger than Irma. The public school system had no programs available for children with intellectual disabilities, but at age 16, Irma attended a live-in school run by Catholic nuns who taught individuals with disabilities academic

Ah Years of Treatment

and life skills. At age 26, she came back home and lived with her mother until 1992. After their mother's death, Evelyn brought

Irma to San Diego and helped her choose a group home. Although she couldn't read, Irma always insisted she had to have a subscription to TV Guide. She would bury her head in it, perusing the listings with great concentration. Her siblings would often call her out on it: "Oh Irmy, you can't read." But when they tested her, asking her to find a given word on the page, she would locate it. Irma had a talent for matching, and having seen and heard the words on the TV screen, she had begun to recognize the show titles, days, times and channels.

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every word in book after book. But after Irma turned 60, Evelyn

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discovered one day she could no longer find the hidden words. Continued on page54

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Page 31

Snapshot ~ sKATEBQ ARDING A skateboarder gets air offa ramp as otherskaters wait their turn on a warm January day at Ponderosa Skateparkin Bend. JOE KLINE

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WINTER/SPRING 2015• HIGH DESERTPULSE

BY TARA BANNOW • ILLUSTRATIONS BY GREG CROSS

hen you're brushing your teeth, do you ever just sort of go on autopilot? I mean, yeah, the brush is moving, but your brain is wondering whether that weird dream you had a

few hours ago holds some greater significance. Your dentist is on to you — poor brushing habits are definitely noticed when you go in for your routine cleaning, and experts say you could be doing a lot better. The following tips come straight from the mouths of the experts,

and may help put the focus back on your brushing habits. First things first: Holding your toothbrush. Local professionals (backed up by the American Dental Association — not that we didn't trust them) say you should hold the brush at a 45-degree angle to your gums so that the bristles bend and sweep bacteria out from

beneath the gumline. Once you've got the brush properly lined up, move it across your teeth in a circular motion. Steve Timm, a Bend dentist and president of the Oregon Dental Association, said the circular motion gets more bristles between the teeth than if the brush just moves over the teeth back and forth. Obviously, they won't go all the way through to the other side, but that's what floss is for (we'll get to

flossing later). That motion is where Timm said he most commonly sees his patients go wrong with brushing. They press straight down with far too much pressure, which causes the gums to recede, he said. "A lot of us get in there and want to scrub our teeth like we're cleaning the sink," he sald. Most brushing is done holding the toothbrush horizontally, but once you reach the inside of your front teeth on the top and bottom, it's important to hold the toothbrush vertically and brush one tooth at a time in order to reach them all, said

bacteria have evolved to produce carbohydrates that allow them to stick solidly to the teeth and to one another, Califano said. Lots of people feel reassured by the tingle of a mouthwash, but Califano said they do little to kill germs. He said it's the mechanical motion that removes plaque from teeth. In fact, you could probably do just as well without using toothpaste at all, he said. Timm, who promises he's not paid to endorse electric toothbrushes, said that because they perform the circular brushing motion for you, they tend to clean the teeth much more thoroughly than a manual toothbrush. He estimates at least 50 percent of his patients show a great improvement in their gum health after switching to electric toothbrushes. Plus, all you have to do is move the electric toothbrush along the row of teeth, and it does the rest of the work for you. "So they can concentrate on putting it on where it needs to be as opposed to getting it where it needs to be and do the motion at the same time with the hand brush," Timm said. Both Timm and Jaschke said when they peer into patients' mouths, they tend to notice their back teeth aren't getting brushed as well. They agree that's because it's harder to get the cheek and tongue out of the way so the toothbrush can get back there. That's also the area where cavities most commonly occur: Between the back teeth, Timm said, which is partially just because there is more area for plaque to accumulate. One more thing: Don't forget the tongue. The experts say this is a spot where bacteria tends to accumulate. Some tongues collect more than others, but it's still good to keep those levels under control, Jaschke said. Some people have conditions that make their tongues sensitive to brush, and they can be excused from

0 0

Joseph Califano, a dentist and professor of periodontology in Oregon Health 8 Science University's School of Dentistry. How long you brush and how often is important, too, and many

people are guilty of not brushing as much as they should. Experts say it takes two minutes, two times per day — although they inevitably squeeze in the caveat that three times per day is ideal. "A lot of people think that two minutes flies by in 30 seconds," said Tianna Jaschke, a registered dental hygienist at Bend Family Dentistry.

0 0

doing so, she said. One way to tell whether you're doing a good job with all this is to use disclosing tablets, little red or purple tablets that can be purchased at most drugstores (dentists have them, too). You chew them, swish them around in your mouth and they'll stain any sections of your teeth that still have plaque on them red or purple. Califano recommends using these about once a week to see if you need to improve your technique.

Choosing the right tools Although many people seem to be under the impression that a

Jaschke recommends placing a kitchen timer or hourglass near harder toothbrush will work better, experts near and far agree a soft the bathroom sink to make sure you're brushing long enough. Many bristle brush is your best bet. Unlike medium or hard bristles, soft electric toothbrushes have timers that do that work for you, she said. Califano agrees that most people brush for 30 seconds, which he said is akin to swishing around a bit of toothpaste in your mouth. To actually remove the plaque from any one spot on your teeth, you must brush that spot for at least 10 seconds, he said. That's because

WINTER/SPRING 2015• HIGH DESERTPULSE

bristles will flex enough to get around the round corners of teeth, and they also won't damage the gum tissue, Timm said. "I know a lot of people think the stiffer brush the better the job they're doing, but it's actually the opposite," he said. According to the American Dental Association, toothbrushes can

Page 37

TipsI BRUSHING YQUR TEETH

perts recommend flossing once per day.Jaschke, however, said whenly you brush. Timm, however, said he typically recommends people ever you know you've got food wedged in your teeth somewhere, it's be replaced every three to four months depending on how frequentreplace their toothbrushes monthly. The key indicator you need a new brush is when the bristles start bending and splaying. The replacement heads on electric toothbrushes can typically hold out longer — up to six months — because they're not rubbed against the teeth,Jaschke said.

Any time you come down with the flu, you should replace your toothbrush to get rid of bacteria that could potentially linger on it and spread to another toothbrush that's stored nearby,Jaschke said. When it comes to choosing a toothpaste, Timm said most on the market should work, so long as they have fluoride in them. Some toothpastes contain a germicide called triclosan, which can cause adverse reactions for some people. For those people, Timm said a natural toothpaste such as Tom's of Maine works better. Some have questioned triclosan's safety, as some animal studies have linked it to cancer. The U.S. Food and Drug Administration asserts the ingredient, which is used in Colgate Total to help with gingivitis, is not known to be hazardous to humans, although the subject does warrant further study.

Don't forget to floss! Finally, because toothbrushes can't do it all, there is floss. Most ex-

important to get that out as soon as possible. That's because bacteria in your mouth pounces on it right away, producing acid. "Basically, you want to get all of that out of there so it doesn't create acidity in your mouth," she said. "Our mouths run on a pH system, and you really want your mouth as neutral as you can get it." The technique is pretty straightforward: Run the floss up and down each side of the tooth, trying to scrape the front and back of the tooth surfaces along the way. Although many peopleleave between 4 and 5 inches between

the two fingers holding the floss, Califano said they should only be about a quarter-inch apart, which will require you to saw back and for to get the floss between the teeth near the gums. Once you've done that, it's important to wrap the floss in a C-shape around the tooth "with a fair amount of force," and rub it around each tooth.

"A lot of people pop the floss in and pop it out," he said."They think that's flossing, but that does essentially nothing. It actually has to wrap around the tooth." Lots of people have trouble using their fingers to thread the floss between teeth, and that's why there are various types of floss holders with pre-threaded floss on them.

Re def-ining primary care. Our friendly approach to healthcare that focuses on treating you, not just your illness.

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Page 38

WINTER/SPRING 2015• HIGH DESERTPULSE

Kids aren't just a part of our practice. They are the practice. When you're talking about healthcare for babies, toddlers, children and teens... that's us.

Board Certified and Fellowship-Trained Pediatricians and Providers Mary Brown, MD, FAAP John Chunn, MD, FAAP Valerie Bailie, MD, FAAP Dale Svendsen, MD, FAAP Brenda Hedges, MD, FAAP Caroline Gutmann, MD, FAAP Erin Garza, MD, FAAP Linda Steiner, MD, FAAP Jennifer Lachman, MD, FAAP John Peoples, MD, FAAP Dana Perryman, MD, FAAP Megan Karnopp, MD, FAAP Logan Clausen, MD, FAAP Mary Rogers, MD, FAAP Jeff Meyrowitz, MD Cris Ricker, MS, PA-C Carissa Honeycutt, MS, PA-C Hailey Garside, PNP

Including 15 pediatric specialists from leading Children's Hospitals CHILDREN'S ~

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PiCture thiS ~ CONC USSION

ofa • Chronic traumatic encephalopathy is a degenerative neurological disease that can affect athletes in hard-contact sports, especially football and boxing. Repeated blows to the head may eventually cause symptoms, such as slurred speech, tremors and confusion. Depression and suicidal tendencies have also been noted. The NFL has resisted acknowledging links between those effects and concussion impacts.

How eoneussions ean impaet the brain • Football head impacts can bring to bear forces nearly100 times the force ofgravity • Immediate effects can include headache, dizziness, confusion, nausea, difficulty hearing and seeing

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•Cross section of a brain showing advanced CTE;tau protein deposits cause brain to shrink, become brittle

Darkdeposits of tau proteins shown in samples

Fragment oftau protein A strong blow to the headcan cause tearing in the protective myelin sheath around axons

Key role of tau proteins • Tau proteins are needed to IIIrovi'dsestability to tiny pathways within axons called microtubules • When tau breaks down, dementia or cognitive problems often develop

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Source: Boston University School of Medicine, Frontline, ChronicTraumaticencephalopathy.com, NFL, New YorkTimes, MCT Photo Service

page 40

• Sample from •Sample from brain • Sample from the a normal brain, of a o f John Grimsley, an brain of a deceased 6S-year-old person, NEE veteran who bo x er, age 73 at death; with magnlfied detail died at age 4S; tau suffering from deposits showing e x t reme form of CTE damage

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1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w

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29 SW Simpson Ave., Suite 220• Bend 541-317-5600

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Central Oregon Family Medicine

1001 NW Canal Blvd.• Redmond 5 4

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541-923-0119

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480 NE A St.• Madras

541-475-4800

www.stcharleshealthcare.org

AMILY MEDICIN

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AMILY MEDICIN

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103 • E Elm St.• Prineville

541-447-6263

www.stcharleshealthcare.org

FAMILY MEDICINE

St. Charles Family Care

211 NW Larch Ave.• Redmond

541-548-2164

www.stcharleshealthcare.org

30 ArrowleafTrai • Sisters

541-549-1318

www.stcharleshealthcare.org

541-389-7741

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AMILY MEDICIN FAMILY PRACTICE AMILY PRACTIC FAMILY PRACTICE ASTROENTEROLOGY GASTROENTEROLOGY

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

St. Charles Family Care

High Lakes Health Care - Upper Mill

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GENERAL SURGERY, BARIATRICSAVEINCARE Advanced Specialty Care

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54 1 - 5 26-6635

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2 015 CE N T RA L O R E G O N

M E D I CAL DI R A*. •

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O'Neill Orthodontics

Bend Ba Sunriver

541-323-2336

www.oneillortho.com

RTHOPEDICS

Desert Orthopedics

Locations in Bend BaRedmond

541-388-2333

www.desertortho edics.com

2200 • E Neff Rd.• Bend

541-382-3344

www.thecenteroregon.com

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St. Charles Advanced Illness Management

2500 • E Neff Rd.• Bend

541-706-5880

Partners In Care

2075 • E Wyatt Ct • Bend

541-382-5882

Deschutes Pediatric Dentistry

1475 SW Chandler Ave, Suite 202• Hend 541-389-3073

Bend Memorial Clini St. Charles Family Care

815 SW Bond St.• Bend

541-382-4900

211 NW Larch Ave.• Redmond

541-548-2164

p PHARMACY HYSICAL MEDICINE PHYSICAL MEDICINE HYSICALMEDICINE/REHABILITATION

PHYSICAL MEDICINE/REHABILITATION

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Cascade Custom Pharmacy Desert Orthopedics

Locations in Bend Ba Redmond 2200 • E Neff Rd.• Bend

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Bend Memorial Clinic

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St. Charles Heart gt Lung Center Central Or

ASCULAR SURGER VEIN SPECIALISTS EIN SPECIALISTS

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5 41- 3 8 2 -4900

Locations in Bend BaRedmond

541-706-7715

Locations in Bend,Redmond, Prineville, giMadras 541-706-7725

end Memorial Clinic

541-382-4900

Locations in Bend BaRedmond

wwb e ndmemorialdinic.com

.h hngbndge.com www.cascadefoot.com .bendmemorialdinic.com www.stcharleshealthcare.org

www.stcharleshealthcare.org ww w b endmemorialdinic.com

2200 • E Nef'f Rd., Suite 302• Bend 5 4 1 - 388-3978 w w w .deschutesrheumatology.com

DeschutesRheumatology end Memorial Clinic

0 SW t. Bachelor Dr.• Bend (West) 541-38 — 900

St. Charles Sleep Center

wwwbendmemonaldimc.com

Locations in Bend BaRedmond

541-706-6905

www.stcharleshealthcare.org

Prineville • Redmon

541-548-7761

www.stcharleshealthcare.org

Locations in Bend BaRedmond Locations in Bend(East Ba Old Mill District ) Ba Redmond

541-382-4900

ww w b endmemorialdinic.com

41-382-4900

ww w b endmemonaldimc.com

1302 NEThird St.• Bend

541-317-0909

www.mtmedgr.com

NOWcare

2200 • E Neff Rd.• Bend

541-322-2273

www, ecenteroregon.com

St. Charles Immediate Care

2600 • E Neff Rd.• Bend

541-706-3700

www.stcharleshealthcare.org

Locations in Hen Ba Re mon

541-382-6447

www, en uro ogy.com

St. Charles urgical Specialists Bend Memorial Clinic Bend emorial Clitnc Mountain Medical Immediate Care

Urology Specialists of Oregon Bend Memorial Clitnc

501 NE Medical Cen er Dr.• Bend 5 4 1 - 3 8 2-4900 w •

•

Bend Memorial Clinic

St. Charles Behavioral Health

•

www.urologyinoregon.com wwwbendmemonaldimc.com

2200 NE Neff Rd.,Suite 204 • Bend 541-382-8346

end Memorial Clinic A

Locations in Bend, Redmond, Ba Prineville 541-322-5753 1 01 E edical enter r, • end

Inovia Vein Specialty Center

NGOCTHUY HUGHES, DO, PC S t . Charles Surgical Specialists

KAREN CAMPBELL, PHD

www.deschuteskids.com

Rad i ologyA ociat , P.C. 14 6 0 • E Medical Center D.r • Bend 5 4 1 - 382-9383

St. Charles Rehabilitation Center

•

ADAM WILLIAMS, MD

www.partnersbend.or

www . desertorthopedics.co

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

Bend Memorial Clini

www.stcharleshealthcare.org

54 1- 3 8 8-233 3

1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w

Ph ' a l T h

p o 'scenter,com

hghl k h lth

19550 SWAmberMeadow Dr, • Hend 5 4 1 - 3 89-3671 w

Bend Urology Associates

UROLOGY

c hut

, Su i t 0 2 • e n d

wwwbendvein.com wwb e ndmemorialdinic.com

•

815 SW Bond St.• Bend

541-382-4900

1245 NW4th St., Suite101• Redmond 541-548-7761 w

2542 • E Courtney Dr.• Hend 5

41-7 0 6 -7730 w

ww w b endmemorialdinic.com

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PPLEMENT

2 015 CE N T RA L O R E G O N

M E D ICAL DI R

„,W.PA'

ixi<&

2542 • E Courtney Dr.• Hend

541-706-7730

www.stcharleshealthcare.org

2542 • E Courtney Dr.• Hend

541-706-7730

www.stcharleshealthcare.org

St. Charles Family Care

211 NW Larch Ave.• Redmond

541-548-2164

www.stcharleshealthcare.org

MIKE MANDEL, MD

High Lakes Health Care Upper Mill

929 SW Simpson Ave.• Bend

541-389-7741

w w w.highlakeshealthcare.com

JAMES PORZELIUS, PHD

St. Charles Behavioral Health

2542 • E Courtney D.r• Hend

541-706-7730

www.stcharleshealthcare.org

2542 • EC

541 706 7730

BRIAN EVANS, PSYD

St. Charles Behavioral Health

JANET FOLIANO-KEMP, PSYD St. Charles Behavioral Health

S, PS

REBECCA SCRAFFORD, PSYD S . C h 1 B h ' al H lt h SCOTT SAFFORD, PHD

St. Charles Family Care

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

LAURA SHANK, PSYD

KIMBERLY SWANSON, PHD

St. Charles Family Care

HUGH ADAIR III, DO

St. Charles Heart gt Lung Center

211 NW Larch Ave.• Redmond 5

2500 • E Neff Rd.• Bend

ch 1 h lth ww. s tcharleshealthcare.org

41-5 4 8 -2164 w

541-388-4333

wwst c harleshealthcare.org

www . stcharleshealthcare.org

JEAN BROWN, PA C KIMBERLY CANADAY, ANP-BC

Be nd Memorial Clinic

CASSANDRA DIXON, PA C

St. C h 1 H rt g t L g C t

WHITNEY DREW, PA-C

Bend Memorial Clinic

GARY FOSTER, MD

S .Ch 1

NANCY HILLES, NP

gt L

1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w 2500 • E • ff Rd. B d

541 388 4333

1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w

2 500 • E • ffRd. 8

wwb e ndmemorialclinic.com

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wwb e ndmemorialclinic.com

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541 388 4333

St. Charles Heart gt Lung Center

2500 • E Neff Rd.• Bend

541-388-4333

www . stcharleshealthcare.org

RICK KOCH, MD

Bend Memorial Clinic

Bend Eastside ttt Redmond

541-382-4900

ww w bendmemorialclinic.com

JAMES LAUGHLIN,MD

St. Charles Heart gt Lung Center

2500 • E Neff Rd. Bend

541-388-433

www.s charles ealthcare.org

BRUCE MCLELLAN, MD

St. Charles Heart gt Lung Center

2500 • E Neff Rd.• Bend

541-388-4333

www.stcharleshealthcare.org

P. GANESHMUTHAPPAN, MD

St. Charles Hea gtLung en er

2500 • E Neff Rd.• Bend

541-388-433

www.stcharles ealthcare.org

GAVIN L.NOBLE, MD

Bend Memorial Clinic

Bend Eastside ttt Redmond

541-382-4900

50 E Neff Rd.• Bend

41-388-4333

www.s ar es ea care.or

ALLEN RAFAEL, MD STEPHANIE SCOTT, PA-C MIC E

IDM E ,

EDDY YOUNG, MD

t. Charles Heart gt Lung enter

Bend Memorial Clinic t . Charles eart

ung e n t er

1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w 2500 • E Neff R . • Ben

ww w bendmemorialclinic.com www.stcharles ealthcare.org wwb e ndmemorialclinic.com

41-388-4333

www.stchar es ealthcare.org

St. Charles Heart gt Lung Center

2500 • E Neff Rd.• Bend

541-388-4333

www.stcharleshealthcare.org

JOHN D. BLIZZARD, MD

St. Charles Heart gt Lung Center

2500 NE Neff Rd.• Bend

541-388-1636

www .stcharleshealthcare.org

TONY FURNARY MD

St. Charles Heart gt Lung Center

2500 NE Neff Rd.• Bend

541-388-1636

www .stcharleshealthcare.org

ANGELO A.VLESSIS, MD

St. Charles Heart gt Lung Center

2500 NE Neff Rd.• Bend

541-388-1636

www .stcharleshealthcare.org

MARIE RUDBACK, DC

Endeavor Chiropractic

JORD

NorthWest Crossing Chiropractic Health

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

www,nwxhealth.com

NorthWest Crossing Chiropractic gt Health

628 NW York Dr., Suite 104 • Bend 54 1 - 388-2429

www,nwxhealth.com

I, MSC, D

THERESA M. RUBADUE,DC,CCSP

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

2275 • E Doctors Dr., Suite 11• Hend 541-248-4476 w

1345 NWWall St., Suite 202• Bend 5 4 1 - 318-1000 w

ww . endeavorchiropractic.com

wwb e ndwellnessdoctorcom

MICHAEL R. HALL, DDS

Central Oregon Dental Center

1563 NW Newport Ave.• Hend 5

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

BRADLEY E. JOHNSON,DMD

Cont e mporary Family Dentistry

101 6 NW Newport Ave.• Bend 5

41-3 8 9 -1107 w w w.contemporaryfamilydentistry.com

ALYSSA ABBEY, PA-C

Bend Memorial Clinic

2450 NE MaryRosePl., Suite 220 • Bend 541-382-4900 w

wwb e ndmemorialclinic.com

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PPLEMENT

2 015 CE N T RA L O R E G O N

M E D ICAL DI R

WILLIAM DELGADO,MD, (MOHS) Bend Dermatology Clinic MARK HALL, MD,

CentralOregon Dermatology

FRIDOLIN HOESLY,MD

Bend Dermatology Clinic

AMES M. HOESLY MD

Bend Memorial Clinic

,v%NW

2747 • E Conners Dr.• Hend

541-382-5712

388 SW H u Dr. • Hen

541-678-0020

2747 • E Conners Dr.• Hend

541-382-5712

JOSHUA MAY, MD

Bend Dermatology Clinic

2747 • E Conners Dr.• Hend

KRISTIN NEUHAUS, MD

Bend Dermatology Clinic

2747 • E Conners Dr.• Hend

541-382-5712

N M. REITAN PA-C ALLISON ROBERTS, PA-C TEPHANIE TRAUTMAN, MD

LARRY WEBER, PA-C LIVER WISCO, DO (MOHS) I I

Bend Memorial Clinic Bend Dermatology Clinic

w ww.centra oregon ermato ogy.com

2450 NE M Rose Pl., Suite 220• Bend 541-382-4900 w 541-382-5712

GERALD PETERS,MD,FACMS(MOHS) Bend Memorial Clinic

www.bendderm.com

www.bendderm.com wwb e ndmemorialdinic.com

www.bendderm.com www.bendderm.com

2450 NE MaryRosePl., Suite 220 • Bend 541-382-4900 w

wwb e ndmemorialdinic.com

2450 NE MaryRosePl. Suite 220 • Bend 541-382-4900 w

wwb e ndmemorialdinic.com

2747 • E Conners Dr.• Hend

e D erma t ology Cli

nners

• e

541-382-5712 -3

www.bendderm.com endderm.

Bend Dermatology Clinic

2747 • E Conners Dr.• Hend

541-382-5712

Be n d Memorial Clinic

Old Mill District 8t Redmond

541-382-4900

www.bendderm.com ww w b endmemorialdinic.com

MARY F. CARROLL, MD ICK N.GOLDSTEIN, MD

Bend Memorial Clinic

B dM

I Ch

TONYA KOOPMAN, MSN, FNP-BC Bend Memorial Clinic

TRAVIS MONCHAMP, MD

EndocrinologyServices NW

CAREY ALLEN, MD

St. Charles Family Care

EIDI ALLEN, MD

KATHLEENC. ANTOLAK, MD

OSEPH BACHTOLD, DO JEFFREY P.BOGGESS, MD

.b d

d 1 1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w

929 SW Simpson Ave., Suite 220• Bend 541-317-5600

1103 • E Elm St.• Prineville 5

wwb e ndmemorialdinic.com

4 1-4 4 7 - 6263

wwb e ndmemorialdinic.com

n/a

wwwst c harleshealthcare.org

a r es a n n y a r e

THOMAS L. ALLUMBAUGH, MD St. CharlesFamily Care

ONI ANDREINI, MD

1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w

S .Ch I

ly C

Ben dMemorial Clinic St. Charles Family Care Bend Memorial Clinic

HANNON K. BRASHER, PA-C St. CharlesFamily Care

211 NW Larch Ave.• Redmond 5 6 30 • A

1 f T '1 S '

41-5 4 8 -2164 w 541 549 1318

1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w 30

wl e afTrail • Sister

541-549-1318

815 SW Bond St.• Bend

541-382-4900

103 • E Elm t. • Prineville

541-447-6263

wwst c harleshealthcare.org

, ch 1 h lt h

. g

wwb e ndmemorialdinic.com

www.stcharleshealthcare.or ww w b endmemorialdinic.com www.stcharleshealthcare.org

MEGHAN BRECKE, DO

St. Charles Family Care

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

www.stcharleshealthcare.org

ANCY BRENNAN, DO

S . harles amily Care

965 NE Conners Ave., Suite 127• Bend 541-706-4800

www.s charleshealthcare.org

WILLIAM C.CLARIDGE, MD

St. Charles Family Care

211 NW Larch Ave.• Redmond

ATTHEW CLAUSEN, MD

St. Charles amily are

296 NE onners ve., utte 127 • en

CARRIE DAY, MD AY S. FAN, MD

JAMIE FREEMAN, PA-C ETTE GAYNOR, FPN-C

541-548-2164

www.stcharleshealthcare.org www.stcharleshealthcare.org

High Lakes Health Care Upper Mill

929 SW Simpson Ave.• Bend

Bend Memorial Clirnc

231 ast asca es ve, • tsters

High Lakes Health Care Upper Mill

929 SW Simpson Ave.• Bend

541-389-7741

wwwhighlakeshealthcare.com

rrowlea Trail • isters

541-549-1318

www.stcharleshealthcare.org

St. Charles amily Care

541-389-7741

wwwhighlakeshealthcare.com wwwbendmemonaldintc.com

MARK GONSKY,DO

St. Charles Family Care

ATALIE GOOD,D

t. Charles amily are

1103 • E E m St.• Pnneville

41-447-6263

www.stcharleshealthcare.org

St. Charles Family Care

211 NW Larch Ave.• Redmond

541-548-2164

www.stcharleshealthcare.org

645 NW 4th St.• Redmond

541-923-0119

www.co m.net

Redmond St Sisters

541-382-4900

ww w b endmemorialdinic.com

929 SW Simpson Ave.• Bend

541-389-7741

wwwhi lakeshealthcare.com

645 NW 4th St.• Redmond

541-923-0119

www.cofm.net

211 NW Larch Ave.• Redmond

541-548-2164

www.stcharleshealthcare.or

BRIANNA HART, PA-C

ARGARET4PEGGY"HAYNER, FNP Centr Ore on Fami Me 'cine

ALAN C.HILLES, MD EIDI HOLMES PA-C

MARK J. HUGHES, D.O ING-WEI HO, MD

Bend Memorial Clinic

High Lakes Health Care Upper Mill Central Oregon Family Medicine St. Charles Family Care

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

www.stcharleshealthcare.org

PPLEMENT

2 015 CE N T RA L O R E G O N PAMELA J. IRBY, MD

St. Charles Family Care

ETER LEAVITT, MD

JINNELL LEWIS, MD HARLOTTE LIN, M

www.stcharleshealthcare.org

929 SW Simpson Ave.• Ben

41-389-7741

wwwhighlakeshealthcare.com

St. Charles Family Care

1103 • E Elm Str.• Prineville

541-447-6263

St. Charles amily are

296 NE onners ve., utte 127 • en

St. Charles Family Care

480 • E A St.• Madras

Bend Memorial Clitnc

L es ea lth a re Upper ill

KAE LOVERINK, MD

High Lakes Health Care - Redmond

TEVE MANN, DO

High Lakes Health Care Upper Mill

JOE T. MC COOK, MD . BRUCE MCELROY, MD LORI MCMILLIAN, FNP

,.~a,.WP".,Yilr, AlVWVh 541-548-2164

AVID KELLY, MD

MAGGIE J. KING, MD

M E D ICAL DI R

St. Charles Family Care entral Oregon amily Medicine

Redmond Medical Clinic

211 NW Larch Ave.• Redmond

www.stcharleshealthcare.org www.stcharleshealthcare.org

541-475-4800

www.stcharleshealthcare.org wwwbendmemonaldintc.com

B o n d t, • end

236 NW Kingwood Ave.• Redmond 5 4 1 - 548-7134 w

wwh i g hlakeshealthcare.com

SW Simpson ve, • end

541-389-7741

wwwhighlakeshealthcare.com

211 NW Larch Ave.• Redmond

541-548-2164

www.stcharleshealthcare.org

th t. • Redmond

41-923-0119

www.cofm.net

1245 NW 4th St., Suite 201• Redmond 54 1 -323-4545

www.redmondmedical.com

DEN MILLER, DO

High Lakes Health Care Sis ers

354 W Adams ve, • isters

541-549-9609

ww w h ighlakeshealthcare.com

KEVIN MILLER,DO

High Lakes Health Care Sisters

354 W Adams Ave.e• Sisters

541-549-9609

ww w h ighlakeshealthcare.com

High Lakes Health Care Upper Mill

929 SW Simpson ve, • end

541-389-7741

wwwhighlakeshealthcare.com

St. Charles Family Care

211 NW Larch Ave.• Redmond

541-548-2164

www.stcharleshealthcare.org

541-475-4800

www.s charleshealthcare.org

ESSICA MORGAN, MD

DANIEL J. MURPHY, MD IMEE NEILL, MD

S . harles amily Care

480 • EASt. •

a r as

SHERYL L. NORRIS, MD

St. Charles Family Care

211 NW Larch Ave.• Redmond

541-548-2164

www.stcharleshealthcare.org

UBREY PERKINS, FNP

S . harles amily Care

211 NW Larch Ave.• Redmond

541-548-2164

www.s charleshealthcare.org

815 SW Bond St.• Bend

541-382-4900

St. Charles amily Care

1103 • E Elm St.t• rineville

541-447-6263

www.s charleshealthcare.org

High Lakes Health Care Upper Mill

929 SW Simpson Ave.• Bend

541-389-7741

wwwhighlakeshealthcare.com

815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

JANEY PURVIS, MD ATHAN REED, D KEVIN RUETER, MD ANA M. RHODE, DO HANS G. RUSSELL, MD

RIC J. SCHNEIDER, MD LINDA C. SELBY, MD INDY SHUMAN, PA-C PATRICK L. SIMNING, MD

Bend Memorial Clinic

end Memorial Clinic Bend Memorial Clinic

1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w

wwb e ndmemorialdinic.com

end Memorial Clinic

1501 • E Medical Cen er Dr.• Bend 5 4 1 - 382-4900 w

wwb e ndmemorialdinic.com

St. Charles Family Care end Memorial Clinic Bend Memorial Clinic

DWARD M. TARBET, MD

JOHN D. TELLER, MD ATHAN R.THOMPSON, M SHILO TIPPETT, PHD

815 SW Bond St.• Bend

541-382-4900

1501 NE Medical Center Dr.• Bend 5 4 1 - 3 8 2-4900 w

www.stcharleshealthcare.org ww w b endmemorialdinic.com wwb e ndmemorialdinic.com

n/a

St. Charles Family Care

480 • E A St.• Madras

541-475-4800

www.stcharleshealthcare.org

end Memorial Clinic

815 SW Bond St.• Bend

541-382-4900

Bend Memorial Clinic

St. Ch les Family Ca St. Charles Family Care a

Tn c

High Lakes Health Care Upper Mill

CINDI WARBURTON, FNP, DNP St. Charles Family Care

HOMAS A. WARLICK, MD

541-447-6263

541-593-540

LISA URI, MD

1103 • E Elm St.• Prineville

7067 Beaver Dr. Sunnver

ANIEL M. SKOTTE, SR. DO., P.C. High esert Family Medicine gt Immediate Care

PATRICIA SPENCER, MD

ww w b endmemorialdinic.com

B dM

' I Cli

1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w 211 NW Larch Ave.• Redmond

541-548-2164

480 • E A St.• Madras

541-475-4800

1501 • E Medtcal Center Dr.• Bend 5 4 1 - 3 8 2-4900

929 SWSimpson Ave.• Bend 5

D. 8 d

B RUCE N. WILLIAMS, MD

St. Ch a rles Family Care

1103 • E Elm St.• Prineville 5

RICHARD H. BOCHNER, MD

Bend Memorial Clinic

Bend Eastside gt Redmond

LLEN BORLAND,MS, RN, CF B d M

ICh

ARTHUR S. CANTOR, MD

Bend Memorial Clinic

EIDI CRUISE, PA-C, MS

Bend Memorial Clinic

5 41 3 8 2 4 9 00 4 1-4 4 7 - 6263

541-382-4900

.stcharles Ith www.stcharleshealthcare.org

bendme nald mtc

www.stcharleshealthcare.org

b d

541-382-4900

1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w

'Id

wwwst c harleshealthcare.org

ww w b endmemorialdinic.com

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wwb e ndmemorialdinic.com

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

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

1501 • EM d' 1 C

ww w b endmemorialdinic.com

ww w b endmemorialdinic.com wwb e ndmemorialdinic.com

PPLEMENT

2 015 CE N T RA L O R E G O N LAUREL HARTWELL, MD HRISTINA HATARA,

M E D ICAL DI R

Bend Memorial Clinic

1501 • E Medical Center Dr.• Bend 5 4 1 - 3 8 2-4900

Bend Memorial Clinic

1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w

SIDNEY E. HENDERSON III, MD Bend Memorial Clinic

ANDRA K.HOLLOWAY, MD GLENN KOTEEN, MD

„ .W,YA', ( A% W N

Bend Memorial Clinic Gastroenterologyof Central Oregon

wwwbendmemorialdinic.com wwb e ndmemorialdinic.com

Bend Eastside ttt Redmond

541-382-4900

ww w b endmemorialdinic.com

Bend Eastside Redmond

541-382-4900

ww w b endmemorialdinic.com

2239 NE Doctors Dr., Suite 100• Bend 541-728-0535

www.gastrocentraloregon.com

ENIFER TURK, PA-C

Bend Memorial Clinic

1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w

wwb e ndmemorialdinic.com

MATTHEW WEED, MD

Bend Memorial Clinic

1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w

wwb e ndmemorialdinic.com

OSVALDO A. SCHIRRIPA, MD, MS Central Oregon Clinical Genetics Center

JANE BIRSCHBACH, MD AMMY BULL MD SUSAN GORMAN, MD

High Lakes Health Care Upper Mill Hi L akes Health Care Upper Mill High Lakes Health Care Women's Center

MICHAELJ, MAS1'RANGELO,MD,FACS Bend Hernia Center

LAURIE D'AVIGNON,MD ONLUTZ, M

HRISTINE ANDERSON, PA-C JENESS CHRISTENSEN, MD

ELSO A.GANGAN, MD MICHAEL N. HARRIS, MD LIZABETH KAPLAN, PA-C ANNE KILLINGBECK,MD ITA D.KOLISCH MD MATTHEW R. LASALA, MD ADELINE LEMEE, MD

41-3 8 3 -2200 w

1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w

wwb e ndmemorialdinic.com

2965 Conners Ave., Suite 127• Bend 54 1 -706-4878 w

ww. s tcharleshealthcare.org

1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w

wwb e ndmemorialdinic.com

Bend Memorial Clinic

Hi L akes Health Care Upper Mill

929 SW Simpson Ave.• Bend

541-389-7741

wwwhighlakeshealthcare.com

High Lakes Health Care Upper Mill

929 SW Simpson Ave.• Bend

541-389-7741

wwwhighlakeshealthcare.com

High Lakes Health Care Upper Mill

929 SWStmpson Ave.• Bend 5

41-3 8 9 - 7741 w wwh t ghlakeshealthcare.com

929 SWSimpson Ave.• Bend 5

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

Redm d Medical Clini

1245 NW 4th St., Suite 201• Redmond 54 1 -323-4545

Bend Memorial Clinic

1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w

end Memorial Clinic

High Lakes Health Care - Redmond

E e d ical Center •r, end 5

236 NW Kingwood Ave.• Redmond 5 4 1 - 548-7134 w

541-382-4900

Bend Memorial Clinic Bend Memorial Clinic

1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w

i gh Lakes Health Ca Upp

Mill

B dM

541-389-7741

929 SW Simpson Ave.• Bend

1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w 5 SWV

1Ch

Bend Memorial Clinic

High Lakes Health Ca U

imp s on A • e

Wy Rd

929 SW Simpson Ave.• Bend 5

DAVID TRETHEWAY, MD

High Lakes Health Care - Redmond

FRANCENA ABENDROTH, MD

Be n d Memorial Clinic

1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w

GREGORY FERENZ,DO

Bend Memorial Clinic

2275 • E Doctors Dr.• Ben

wwb e ndmemorialdinic.com

highlakeshealthca o wwwhighlakeshealthcare.com

wwb e ndmemorialdinic.com

41-3 8 9 - 7741 w wwh i g hlakes l th

236 NW Kingwood Ave.• Redmond 5 4 1 - 548-7134 w

Bend Memoria Clinic

wwh i g hlakeshealthcare.com

ww w bendmemorialdinic.com

.b d

1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w

Mill

, ed ndmedical. wwb e ndmemorialdinic.com

4 1- 3 8 — 900 w wwb e ndmemonaldimc.com

865 SW Veterans Wa • Redmond

Bend Memorial Clinic

RY BUCHH

wwbe n dherniacenter.com

Bend Memorial Clini

A. WADE PARKER, MD

ARK THIBERT, MD

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

wwb e ndmemorialdinic.com

High Lakes Health Care Upper Mill

DAN SULLIVAN, MD

1001 NW Canal Blvd.• Redmond 5 4

ww w h ighlakeshealthcare.com

1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w

MARY MANFREDI, MD

ARK STERNFELD, MD

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

541-389-7741

929 SW Simpson Ave.• Bend

www.cocgc.ofg

Bend Memorial Clinic

gh CARRIE DAY, MD

929 SWSimpson Ave.• Bend 5

2450 • E Mary Rose Pl.• Bend 5

CARMEN REBECCASHERER, MD St. Charles Infectious Disease

JOHN ALLEN, MD

14 3 SW Shevlin-Hixion Dr., Suite•203 Bend 541-678-5417

541-382-4900

1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w

wwh i g hlakeshealthcare.com

wwb e ndmemorialdinic.com www, en memoria inic.com wwb e ndmemorialdinic.com

PPLEMENT

2 015 CE N T RA L O R E G O N RAIGAN GRIFFIN, MD

M E D ICAL DI R

Bend Memorial Clinic

1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w

RAYTIEN, MD, PHD

The Center: Orthopedic s Neurosurgical Care sResearch 2 2

MARK BELZA, MD BRAD WARD, MD

B ds '

NIE BAUMANN, RD, LD

2 275 • ED

The Center:Orthopedic s Neurosurgical Care sResearch 2 2

541-382-3344

00 • E Neff Rd. • Bend

D ., S ' 9 8 d

54 1 6 4 7 1 6 3 8 541-382-3344

00 • E Neff Rd. • Bend

wwb e ndmemorialcfinic.com

www. t hecenteroregon.com

b lz

www. t hecenteroregon.com

Bend Memorial Clinic

1501 • E Medical Center Dr.• Bend 5 4 1 - 3 82-4900 w

wwb e ndmemorialcfinic.com

ANN-BRIDGET BIRD,MD

St. Charles Center for Women's Health

Locations in Redmond tta Prineville

54 1 - 5 2 6-6635

www.stcharleshealthcare.org

REN CASEY, WHCNP

St. Charles enter for omen's ealth

Locations in Redmond Pnneville

541-526-6635

www.stcharleshealthcare.org

NATALIE HOSHAW, MD

St. Charles Center for Women's Health

Locations in Redmond tta Prineville

54 1 - 5 2 6-6635

www.stcharleshealthcare.org

B. MCELROY FNP

St. Charles Center for Women's Health

Locations in Redmond tta Prineville

54 1 - 5 2 6-6635

www.stcharleshealthcare.or

Locations in Redmond tta Prineville

54 1 - 5 2 6-6635

www.stcharleshealthcare.org

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

GLYNDA CRABTREE, MD

Your Care

3818 SW 21St. Pl., Suite 100• Redmond 541 -548-2899

wwwyourcaremedical.com

ITA HENDERSON, MD

Your Care

3818 SW 21St. Pl., Suite 100• Redmond 541 -548-2899

wwwyourcaremedical.com

TIMOTHY HILL,MD AMES NELSON, MD LARRY PAULSON, MD RIC WATTENBURG, MD I

The Center: Orthopedic s Neurosurgical Care s Research

2200 • E Neff Rd.• Bend

541-382-3344

www.thecenteroregon.com

The Center. Orthopedic S Neurosurgtcal Care S Resear

2200 • E • f'f Rd • 8 d

541-382-3344

www. t hecenteroregon.com

The Center: Orthopedic s Neurosurgical Care s Research

2200 • E Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

Your Ca

3818 SW 21St. Pl., Suite 100• Redmond 541 -548-2899

OB BOONE MD CORA CALOMENI, MD RIAN L.ERICKSON, MD STACIE KOEHLER, MD TEVE KORNFELD, MD BILL MARTIN,MD

ENJAMIN J. MIRIOVSKY, MD MICHAEL MONTICELLI,MD

St. Charles Cancer Center

Locations in Bend tta Redmond

541-706-5800

www.stcharleshealthcare.or

St. Charles Cancer Center

Locations in Bend tta Redmond

541-706-5800

www.stcharleshealthcare.org

Bend Eastside tta Redmon

541-382-4900

Locations in Bend tta Redmond

541-706-5800

Bend Memorial Clini St. Charles Cancer Center

h 1

St. Charles Cancer Center

end Memorial Clinic St. Charles Cancer Center

AURIE RICE ACNP-BC

Bend Memorial Clinic

WILLIAM SCHMIDT, MD

Bend Memorial Clinic

OHN WINTERS,MD I

medtcal.

St. Charles Cancer Center

Locations in Bend tta Redmond

541-706-5800

1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w Bend Eastside tta Redmond

Locations in Bend tta Redmond

www.stcharleshealthcare.org

ch 1 h lt h

1501 • E Medical Cen er Dr.• Bend 5 4 1 - 382-4900 w Locations in Bend tta Redmond

ww w b endmemorialcfinic.com

541-382-4900 5 41- 7 0 6-580 0

. g

www.stcharleshealthcare.org wwb e ndmemorialcfinic.com

ww w b endmemorialcfinic.com www . stcharleshealthcare.org

MATTHEW N. SIMMONS

Urology Specialists of Oregon

1247 • E Medical Center Dr.• Bend 5 4 1 - 322-5753 w

BRIAN P.DESMOND, MD

Bend Memorial Clinic

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

www b endmemorfalcffnfc.com

'al Clinic

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

.bendme rialcfinic.

Bend Memorial Clinic

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

www b endmemorfalcffnfc.com

end Memorial Clinic

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

www b endmemorfalcffnfc.com

HOMASD. FITZSIMMONSi MD, MPH Bend M ROBERT C. MATHEWS, MD

COTT T.O'CONNER, MD I '

ww.u r ologyinoregon.com

Integrated Eye Care

452 • E Greenwood Ave.

541-382-5701

www.iebend.com

STEN CARMIENCKESCOTT,OD IntegratedEye Care

52 • E reenwood ve.

541-382-5701

www.teben .com

KIT CARMIENCKE,OD

PPLEMENT

2 015 CE N T RA L O R E G O N MARY ANN ELLEMENT, OD ICHAEL MAJER(XYKt OD

M E D ICAL DI R

Integrated Eye Care

452 • E Greenwood Ave.

541-382-5701

Bend Memorial Clinic

Bend Eastside tla Westside

541-382-4900

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

1475 SW Chandler Ave., Suite 101• Bend 541-617-3993 w

Desert Orthopedics

Locations in Bend tla Redmond 2 200 • E • f'f Rd. B

JEFFREY P. HOLMBOE, MD

OEL MOORE, MD, MPH I

ICHAEL CARAVELLI, M ERIN FINTER, MD AM HALL, M ROBERT SHANNON, MD I

THLEEN MOORE, M I

RETT GINGOLD,MD

SCOTT JACOBSON,MD LAKE NONWEILER, MD I

The Ce n ter:orthopedics NeurosurgitulCares Researrh Locations in Bend tla Redmond 5

4 1-3 8 2 - 3 344

www.thecenteroregon.com

The Center: Orthopedic s Neurosurgitul Care s Researrh

2200 • E Neff Rd.• Bend

541-382-3344

www.thecenteroregon.com

The Center: Orthopedic s Neurosurgitul Care s Researrh

2200 • E Neff Rd.• Bend

541-382-3344

www.thecenteroregon.com

The e n t er: Orthopedic s Neurosurgitul Care s Researrh

2200 • E Ne R . • Ben

41-382-3344

www.thecenteroregon.com

Locations in Bend tla Redmond

541-388-2333

www.desertorthopedics.com

2200 • E Neff Rd.• Bend

4 — 82-3 44

Locations in Bend tla Redmond

541-388-2333

Desert Orthopedics e e nter '

r thopedie S Neurosurgitul CareResear S

Desert Orthopedics

ecenteroregon

www.desertorthopedics.com

Desert Orthopedics

1303 • E Gushing Dr., Suite 100• Bend 541-388-2333 w

wwde sertorthopedics.com

Desert Orthopedics

1303 • E Gushing Dr., Suite 100• Bend 541-388-2333 w

wwde sertorthopedics.com

Desert rthopedtcs

1303 • E Gus tng Dr., Sutte 100• Ben 4 1

-3 8 8 - 2333

wwwde s ertorthope ics.com

The Center: Orthopedic s Neurosurgitul Care s Researrh

Desert Orthopedics The Center: Orthopedic S Neurosurgitul Care S Research

2200 • E Neff Rd.• Bend

541-382-3344

www.thecenteroregon.com

1315 NW 4th St.• Redmond

541-388-2333

www.desertortho edics.com

2200 • E Neff Rd.• Bend

541-382-3344

www.thecenteroregon.com

The Center:Ouhopedies Neurosurgitul Cares Research Locations in Bend tla Redmond 5

4 1-3 8 2 - 3 344

www.t h ecenteroregon.com

CARA WALTHER, MD I '

www . desertorthopedics.com

TIMOTHY BOLLOM, MD

I '

54 1- 3 8 8-233 3

GREG HA, MD

I '

ww.d r keithkrueger.com

MICHAEL RYAN, MD I '

ww w b endmemorialdinic.com

KNUTE BUEHLER, MD

I '

www.iebend.com

AARON ASKEW, MD

I '

„..W,PA" ( AM W N

Desert Orthopedics

1303 • E Gushing Dr., Suite 100• Bend 541-388-2333 w

wwde sertorthopedics.com

MICHAEL COE,MD

The Center:orthopedics NeurosurgitulCares Researrh Locations in Bend th Redmond 5

4 1-3 8 2 - 3 344

www.t h ecenteroregon.com

d AARON HOBLET, MD

Desert Orthopedics

Locations in Bend th Redmond

f'f d.

OMA LILLY, MD JAMES VERHEYDEN, MD I

I ' I

541-388-2333

rth p d '

www . desertorthopedics.com

The Center:orthopedic s Neurosurgitul Care sRese arrh Locations in Bend th Redmond 5

4 1-3 8 2 - 3 344

www.thecenteroregon.com

' I

OLLY OMIZO, MD

JENNY BLECHMAN, MD ISA LEWIS, MD

RICHARD J. MAUNDER, MD AURA K. MAVITY, MD

Deschutes Osteoporosis Center

2200 NE Neff Rd., Suite 302• Bend 5 4 1 - 3 88-3978 w w wdeschutesosteoporosiscenterco

Partners In Care

2075 • E Wyatt Gt.• Bend 5

Partners In Care

yatt t ,

S t . Charles Advanced Illness Management

250 0 • E Neff Rd. • Bend

St. Charles Advanced Illness Management

2500 • E Nef'f Rod.• Bend 5

STEPHANIE CHRISTENSEN, DMD Deschutes Pediatric Dentistry

4 1-3 82 - 5 8 82

www.partnersbend.org

P 541-706-5885 41-70 6 - 5885

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

www . stcharleshealthcare.org www. s tcharleshealthcare.or

www.deschuteskids.com

PPLEMENT

2 015 CE N T RA L O R E G O N TEVE CHRISTENSEN, DMD

BROOKS BOOKER, MD TE L. BROADMAN, MD CARRIE DAY, MD HOMAS N. ERNST, M JENNIFER GRISWOLD,PNP ICHELLE MILLS,MD

MARGARET J.PHILP, MD ENNIFER SCHROEDER, MD

M E D ICAL DI R

Desc hutes Pediatric Dentistry

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

www.deschuteskids.com

Bend Memorial Clinic

815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

end Memorial Clinic

815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

High Lakes Health Care Upper Mill

929 SW Simpson Ave.• Bend

541-389-7741

wwwhighlakeshealthcare.com

S . harles amily Care

211 NW Larch Ave.• Redmond

541-548-2164

www.s charleshealthcare.org

Bend Memorial Clinic

815 SW Bond St.• Bend

541-382-4900

ww w b endmemorialdinic.com

end Memorial Clinic

15 SW ond St, • end

541-38 — 900

wwwbendmemonaldintc.com

St. Charles Family Care Bend emorial Clirnc

211 NW Larch Ave.• Redmond

541-548-2164

www.stcharleshealthcare.org

815 SW Bon St. • Ben

41-382-4900

wwwbendmemonaldintc.com

211 NW Larch Ave.• Redmond

541-548-2164

www.stcharleshealthcare.org

815 SW Bond St.• Bend

541-382-4900

www, en memoria inic.com

www.desertorthopedics.com

RUPERT VALLARTA, MD

St. Charles Family Care

JB WARTON, DO

Ben Memoria C 'nic

ROBERT ANDREWS, MD

Desert Orthopedics

Locations in Bend tta Redmond

541-388-2333

High Lakes Health Care Upper Mill

929 SW Simpson Ave.• Bend

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

TIM HILL, MD

The Center: Orthopedic s Neurosurgical Care s Research

Locations in Bend tta Redmond

541-382-3344

NANCY H. MALONEY MD

Bend Memorial Clinic

JAMES NELSON, MD

The Center: Orthopedic s Neurosurgical Care s Research

2200 • E Neff Rd.• Bend

ARRY PAULSON, M

The Center: Orthopedic s Neurosurgical Care s Research

2200 • E Neff Rd,• end

41-382-3344

.thecenteroregon.com

DAVID STEWART, MD

The Center: Orthopedic s Neurosurgical Care s Research

www.thecenteroregon.com

INDA CARROLL MD

1501 • E Medical Center Dr.• Bend

Desert Orthopedi

ON SWIFT,DO VIVIANE UGALDE,MD

The Center: Orthopedic s Neurosurgical Care s Research

DEAN NAKADATE, DPM

Deschutes Foot gt Ankle

BROOKE HALL, MD

St. Charles Preoperative Medicine

www.thecenteroregon.com

541-382-4900 w w w bendmemorialclinic.com 541-382-3344

2200 • E Neff Rd.• Bend

541-382-3344

Locations in Bend tta Redmond

41-388-2333

2200 • E Neff Rd.• Bend

541-382-3344

929 SW Simpson Ave., Suite 220• Bend 541-317-5600 w

www.thecenteroregon.com

.desertorthopedics.com www.thecenteroregon.com

w w .deschutesfootandankle.com

2500 • E Neff Rd.• Bend

541-706-2949

www . stcharleshealthcare.org

Bend Eastside Sa Redmond

541-382-4900

wwwbendmemorialdinic.com

Locations in Bend Sa Redmond

541-706-7715

www.s charleshealthcare.org

Bend Eastside Sa Redmond

541-382-4900

Locations in Ben Sa Re mon

541-706-7715

Bend Eastside Sa Redmond

541-382-4900

ww w b endmemorialdinic.com

1501 NE Medical Center Dr.• Bend

541-382-4900

ww w b endmemorialdinic.com

St. Charles Heart gt Lung Center

Locations in Bend Sa Redmond

541-706-7715

www.stcharleshealthcare.org

St. Charles Heart gt Lung Center

Locations in Bend Sa Redmond

54 1- 7 0 6-7715

www . stcharleshealthcare.org

JONATHAN BREWER,DO,D-ABSM Bend Memorial Clinic

AMIE DAVIDCONKLIN, MD LOUIS D'AVIGNON,MD ILDIN, CHRIS KELLEY, DO, D-ABSM

St. Charles Heart gt Lung Center

Bend Memorial Clinic St. Charles Heart gt Lung Center

Ben d Memorial Clinic

ONATHAN MCFADYEN, NP-BC Bend Memorial Clinic

KEVIN SHERER, MD MILY SPEELMON, MD

TRACICLAUTICE-ENGLE,MD

OBERT HOGAN, MD

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

R d' 1

, P.C.

1 460 • EM d' 1 C

D. 8 d

ww w b endmemorialdinic.com www.st ar es ealthcare.org

www.corapc.com

54 1 3 8 2 9 3 8 3

STEVEN MICHEL, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr. • Bend 5 4 1 - 382-9383

www.corapc.com

ATRICK BROWN, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr. • Bend 5 4 1 - 382-9383

www.corapc.com

STEVE KJOBECH, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr. • Bend 5 4 1 - 382-9383

www.corapc.com

PPLEMENT

2 015 CE N T RA L O R E G O N

M E D ICAL DI R

A%W N

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 - 382-9383

www.corapc.com

THOMAS KOEHLER, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr. • Bend 5 4 1 - 382-9383

www.corapc.com

JOHN STASSEN, MD

Central Oregon Ra iology Associates, P.C.

14 60 • E Me ica Center Dr. • Ben 5 4

www.corapc.com

ARRETTSCHROEDER,MD

I ' ' I

1- 3 8 2-9383

JEFFREY DRUTMAN, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr. • Bend 5 4 1 - 382-9383

www.corapc.com

ONALD HANSON MD

Centra Ore on Ra io o Associates, P.C.

14 60 • E Medical Center Dr. • Bend 5 4 1 - 382-9383

www.cora c.com

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr. • Bend 5 4 1 - 382-9383

www.corapc.com

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr. • Bend 5 4 1 - 382-9383

www.corapc.com

LAURIE MARTIN,MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr. • Bend 5 4 1 - 382-9383

www.corapc.com

PAULA SHULTZ, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr. • Bend 5 4 1 - 382-9383

www.corapc.com

STEPHEN SHULTZ, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr. • Bend 5 4 1 - 382-9383

www.corapc.com

LOE SHELTON, MD

CentralOregonRadiologyAssociates, P.C.

14 60 • EMedical CenterDr. • Bend 5 4 1 - 382-9383

www.corapc.com

JAMES JOHNSON,MD ILLIAM WHEIR III, MD

N OREEN C. MILLER, FNP

St . Ch a r les Rehabilitation Center

2500 • E Neff Rd.• Bend

541-706-7725

CHRISTINA BRIGHT, MD

Bend Memorial Clinic

Bend Eastside 8r Redmond

5 41-3 8 2 -490 0

ANIEL E. FOHRMAN, MD HEATHER HANSEN-DISPENZA,MD

IANNA WELCH, PA

DAVID L. DEDRICK, MD HRIS KELLEY, DO, D-ABSM

2200 • E Nef'f Rd., Suite 302• Bend 5 4 1 - 388-3978 w w w .deschu esrheumatology.com

Deschutes Rheumatology

2200 • E Nef'f Rd., Suite 302• Bend 5 4 1 - 388-3978 w w w .deschutesrheumatology.com

DeschutesRheumatology

2200 • E Nef'f Rd., Suite 302• Bend 5 4 1 - 388-3978 w w w .deschutesrheumatology.co

Locations in Bend 8r Redmond

5 41- 7 0 6-6905

www . stcharleshealthcare.org

St. Charles Sleep Center

Locations in Bend 8r Redmond

541-706-6905

www.stcharleshealthcare.org

B e n d Memorial Clinic Sleep Disorders Center 1080 SW Mt. Bachelor•Dr. Bend(West) 541-382-4900 '

RN E , D

GARY J. FREI, MD, FACS

Redmond Wellnessgt Chiropractic

Bend Memorial Clinic

SEAN HEALY, PA-C

' IS

Bend Memorial Clinic

1G55 SWHighland Ave, Suite G• Redmond 541-923-2019

1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w

t. charles urgtca pectaHsts

S Ch I

wwwbendmemorialdinic.com

TIMOTHY L. BEARD, MD, FACS Bend Memorial Clinic

ww w b endmemorialdinic.com

St. Charles Sleep Center

DAVID HERRIN, DC

www b endmemorialdinic.com

Deschutes Rheuma ology

JONATHAN BREWER, DO, D-ABSM Bend Memorial Clinic Sleep Disorders Center 1080 SW Mt. Bachelor Dr.• Bend(West) 541-382-4900

RTHUR K. CONRAD, MD

www . stcharleshealthcare.org

1103 • E E m• Prtne1u e

Bend Eastside 8r Redmond

1245 NW 4th S S ' 101 • R d d

41- 48-7761

www.drherrin.com

wwb e ndmemorialdinic.com

www .stcharleshealthcare.org

541-382-4900

ww w b endmemorialdinic.com

5 41 5 4 8 7 761

wwwst c harleshealthcare or

1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w

wwb e ndmemorialdinic.com

PPLEMENT

2 015 CE N T RA L O R E G O N

M E D ICAL DI R

DARREN M. KOWALSKI, MD, FACS Bend Memorial Clinic

1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w

JOHN C. LAND, MD, FACS

St. Charles Surgical Specialists

UZANNE MARCATO, PA

St. Charles Surgical Specialists

ANDREW SARGENT, PA-C, MS

ONAL PROAT, M GEORGE T.TSAI, MD, FACS ANNE WADSWORTH, PA C,M

Be nd Memorial Clinic Charle urgical Speciali St. Charles Surgical Specialists

B dM

' 1Cli

Bend Memorial Clinic

ERIN BUTLER, PA-C

Bend Memorial Clinic

JEFF CABA, PA-C N CLEMENS, MD TERESA COUSINEAU, PA-C

1103 • E Elm• Prineville

a i n Medical I

541-548-7761

1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w 1103 • E Elm• Prineville

1245 NW 4th St., Suite 101• Redmond 541-548-7761 1501 • EM d' I C

ERIN WALLING,MD, FACS

IANA BURDEN, FNP-C

1245 NW 4th St., Suite 101• Redmond 541-548-7761

D. B d

541 382 4900

1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w

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

dia t e Ca

1302 NEThird St,•

end

541-317-0909

wwb e ndmemorialdinic.com

www.stcharleshealthcare.org www .stcharleshealthcare.org wwb e ndmemorialdinic.com

charleshealthca rg www.stcharleshealthcare.org

b d

' 1d'

wwb e ndmemorialdinic.com

www b endmemorialdinic.com www.mtmed . o

Bend Memorial Clinic

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

www b endmemorialdinic.com

end Memorial Clinic

end Eastside, Old Mill Distnct, Redmond 541-38 — 900

www b endmemonaldintc.com

Bend Memorial Clinic

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

www b endmemorialdinic.com

RICIA COUTURE FNP

Your Care

3818 SW21St. Pl., Suite 100• Redmond 54 1 - 5 48-2899

www, ourcaremedical.com

GLYNDA CRABTREE, MD

Your Care

3818 SW21St. Pl., Suite 100• Redmond 54 1 - 5 48-2899

wwwyourcaremedical.com

RIAN DAILY, SCOTT FLECK, PA-C ONICA GIAM

ountain M 'c alImme

Bend Memorial Clinic

Mount a in Medical Immediate Care

MIKE HUDSON, MD

St. Charles Immediate Care en

ESSICA ODDO, FNP-C KERRY MAWDSLEY, FNP-BC

-317-

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

mtmedgr.co www b endmemorialdinic.com

oun am e

KEITH HARRINGTON, MD

ADAM KAPLAN, PA-C

1302 NEThird St.• Bend

tuc

Bend Memorial Clinic Mountam Medkcal Immediate Care

Bend Memorial Clinic

1302 NEThird St.• Bend

541-317-0909

2600 • E NeH Rd.• Bend

541-706-3700

asst e,

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

www . stcharleshealthcare.org e n me n a

sn , e m

1302 EThird St,•

www.mtmedgr.com

541-317-0909

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

m t c.

www b endmemorialdinic.com

www.mtmedgr.com www b endmemorialdinic.com

ERRI MUCHA, M

Bend Memorial Clitnc

PHONG X.NGO, M D

Bend Memorial Clinic

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

www b endmemorialdinic.com

AY O'BRIEN, PA-C

end Memorial Clinic

end Eastside, Old Mill Distnct, Redmond 541-38 — 900

www b endmemonaldintc.com

RICHARDOOMAR GARZA, FNP St. Charles Immediate Care CASEY OSBORNE-RODHOUSE,PA-C

Bend Memorial Clinic

wwwbendmemonaldintc.com

end astst e, Old Mill Distnct, edmon

2600 • E NeH Rd.• Bend

541-706-3700

www.stcharleshealthcare.org

Bend Eastside, Westside 8r Redmond 5 4 1 -382-4900

www b endmemorialdinic.com

AURIE D. PONTE, MD

end Memorial Clinic

end Eastside, Old Mill Distnct, Redmond 541-38 — 900

www b endmemonaldintc.com

MATTHEW REED, PA-C

Bend Memorial Clinic

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

www b endmemorialdinic.com

ONATHAN SCHULTZ BRADLEY SCOTT, PA-C ENNIFER L. STEWART, MD SEAN SUTTLE, PA-C RIC WATTENBURG, MD

S . Charles Immedia e are

2600 • E NeH Rd,• end

541-706-3700

www.s charleshealthcare.org

Bend Memorial Clinic

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

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end Memorial Clinic

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

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Bend Memorial Clinic

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our are

MICHELLE WRIGHT,FNP

St. Charles Immediate Care

MEREDITH BAKER, MD

Bend Urology Associates

3818 SW21St. Place.Sut e 00 • Re mon 5 4 1 - 5 4 8 -2899

wwwyourcaremedical.com

2600 • E NeH Rd.• Bend

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2090 • E Wyatt Court • Bend

541-382-6447

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PPLEMENT

2 015 CE N T RA L O R E G O N

M E D ICAL DI R

RONALD BARRETT, MD, FACS

Be ndUrology Associates

2090 • E Wyatt Court • Bend

541-382-6447

wwwbendurology.com

MICHEL BOILEAU, MD, FACS

Be n dUrology Associates

2090 • E Wyatt Court • Bend

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wwwbe ndurologycom

ANDREW NEEB, MD

Urology Specialists of Oregon

BRIAN 0 HOLLAREN, MD

B dU

MATTHEW N. SIMMONS, MD

U r o l ogy Specialists of Oregon

NORA TAKLA, MD

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EDWARD M.BOYLE,JR,, MD, FACS

Inovia VeinSpecialty Center

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2200 • E Neff Rd., Suite 204• Bend 5 4 1 - 3 8 2-8346

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2 200 • E • ff Rd., S ' 20

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DARREN KOWALSKI,MD

Bend Memorial Clinic

1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w

ww. bendmemorialclinic.com

WAYNE K. NELSON, MD

Bend Memorial Clinic

1501 • E Medical Center Dr.• Bend 5 4 1 - 382-4900 w

ww. bendmemorialclinic.com

CATHERINE BLACK, PA-C

Bend Memorial Clinic

1501 • EMedical Center Dr.• Bend 5 4 1 - 382-4900 w

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JASON JUNDT,MD

B dM

WAYNE K. NELSON, MD

Bend Memorial Clinic

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SUBMITTED PHOTO

Irma Fella, ofSan Diego, looksat thestuffedanimalsshereceivedwhilein the hospitalin 2013. Fella has Down syndrome and Alzheimer's disease. At right, Fella's signature on forms from 1999 to 2004show her deterioration.

Continued from page 31 She had taken to merely circling every letter. There were other clues of her slow decline. One year for Christmas, Irma's brother had bought sketchbooks for everyone in the family, asking them to do a doodle each day and then return the books to him the following Christmas. "And the only person who did it was my sister," Evelyn said. But her brother was so pleased, the sketchbook became an an-

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"What was pushing everybody's buttons," Evelyn said,"was the nual gift. Irma would draw what she saw freehand, filling page af- realization of 'Look what's happening to us all.'" ter page, before exchanging the full book for a fresh one the folThe image had been circulating without the accompanying artilowing holidays. cle and most of those responding online didn't know that Irma had With time, she could no longer draw, so Evelyn transitioned her to Down syndrome. Evelyn realized that, for a brief moment, Irma coloring books. She impressed the others at her day program with was being treated just like anybody else's sister, mother or grandhow well she could color within the lines. That skill soon faded as mother with Alzheimer's disease. "Finally," she thought to herself, well, and she took to drawing first circles and then only straight lines. "she is equal." Evelyn realized her sister was backtracking through normal New hopes childhood development. While infants progress from straight lines to circles, to coloring, to freehand drawing, Irma was doing just the In fact, the fates of those with Alzheimer's, whether due to Down opposite. She was slowly but steadily regressing. syndrome or normal aging, are becoming increasingly intertwined. In 2011, Evelyn happened upon an even more stark demonstra- Researchers have found many treatments for Alzheimer's disease tion of her sister's decline. Each year, they would meet with the that work well in mice but have been hard to translate into humans, staff at the local day program, and Irma would sign her name at says Dr. Bill Mobley, chair of neuroscience at the University of Calithe bottom of her paperwork. At one of her last meetings, Evelyn fornia, San Diego. "One of the reasons we think that is, is that we haven't been able glanced at the years of documents in her sister's file dating back to 1999. Then she noticed something remarkable. As she lined up the to start early enough," he said. "By the time people have clinical papers up, she could see the visual representation of how Alzhei- symptoms they've had the disease probably 20 years. We need to mer's disease was affecting Irma. The signatures had gone from a get to them earlier. And the people with Down syndrome offer that tight, neat cursive of her full name, Irmagard Fella, to increasingly opportunity. more chaotic block printing of her shortened name. After 12 years, In the general population, about 17 percent of women who she could barely get a few letters down on the line. reach age 65 and about 9 percent of men will develop Alzheimer's Evelyn took a copy of the signatory timeline and shared it with disease. That means studies testing preventive treatments would Down syndrome researchers at the University of California, San Di- have to enroll many more individuals to get the numbers of Alzheiego. After a news report including a photo of the signatures, the mer's casesneeded to see a meaningful effect.Among those with image went viral garnering tens of thousands of hits and hundreds Down syndrome, the lifetime risk is higher than 50 percent, so of pointed comments. researchers would need to enroll fewer overall participants to get

Page 54

WINTER/SPRING 2015 • HIGH DESERTPuLSE

Feature IDQWN SYNDRQME AND ALZHEIMER'5

the same number of people who ultimately develop Alzheimer's. Mobley recalls a discussion at a research conference eight years ago over the need for a cheap, reliable diagnostic test that would identify much earlier in life the patients destined to develop Alzheimer's. "If those are the criteria, the answer is Down syndrome"I Mobley recalls saying. "I can make the diagnosis even in utero. The test I I

use is my eyesight and my brain, and I know 50 ears before the onset of dementia that this person is going to get dementia with a

very high probability." A t the time, nobody seemed to get it. But that has cha anged now,

Mobley said. "I think the reason why is that they now understand it may be absolutely necessary to prevent Alzheimer's disease if we want to treat it," he said. "So then the genetically predisposed populations become the ones you want to test, because you can make the diag-

SUBMITTED PHOTO

nosis (so much earlier)." Justine Dyer27 of Maine, at a restaurantin Boston, shortly after visitPreviously, much of Alzheimer's research had focused on fami- i ng with Dr. Brian Skotko for a clinical trial studying a new Alzheimer's lies with a genetic defect that causes early onset Alzheimer's. Affectedfamily members have a 50-50 chance of passing that defect on to their children. But while scores of those families have been identified around the world, there are many more individuals wi with

medication.

The e P haase s e IIs tstud u y wwa s primarily aimed at testing the safety of the drugs in young adults with Down s ndrome an tt I There s not even any comparison," Mobiey said ai . "In n theU 5 , t ere s u j e cts reported no seriousp roblems. s. oSkotk o s a id there was also pp are 200,000 Down syndrome people. There arent' 200,000 , peo y significant si n change in patient- and caregiver-reported p l e a s t a t isticall o o s e a m i ia z e i m er's disease families) in this universe." e. sy s m m pt oms o m s among a those on the medication, compared to placebo. c u ing in ivi ua s wit c o g nitive deficits in research studies T h e company is nowp plannin anning aa Phase a s e IIIIt ria trialtoto test the drugs in a can be challenging, because of concerns s th a t th ey m a y not tru y l a r ger group of patients. "You and I understand the risks involved. Researchers hav avebbeen collaboratFo r m e , it's a human-rights issue," Skotko said. ing on standards for how to best explain the process and to make s i g n up i f w e wante o o g ers an ey on t a v e to participate. with Down s yndromee, with wi thee gui d ance of their trustees or careJustine Dyer, a 27-yearr o old with w i Dow own s y nd r o m e from Maine, g i v ers, can sign u in the want to. An" rti i i c IinicaI ria Icon ducte db y Transition f o r them." Therapeutics for the drug ELND005. The compound is i s be Iieve dt ot There is also concern over whether ether individuals with Down synplay a role in preventing the e buildu u i u pofo am a myloid o i beta e t ai n the brain. d r o me are now being viewed as "~uinea i s " ex osin t e The drug is being tested both for its abilityy to o improve improve cognitive co ni t t he r i sks k involved in clinical trials in order to benefit i health ea function in individuals with Down syndrome and as a treatment rea ment or f vidu aIl s who h might develop late-onset Alzheimer's. Alh z eimers' ddisease. Many of the family members of individuals with Down syndrome Dyer said she wanted an e oto bee in i n ht e stu d y " t o help my brain" and d o n 't see it thatway. to help others. Her grandmother died of o Alzheime z e i m e rs ,he r m o ther, h . Betsy Dyer, s y n drome," i . " If you yo u know no w the t e a att hol o l o is . Hogan said. "So weas afamilyare veryanxious to participate in this kind b e t here isn't said. e in i s i n e ere , i sn't it in their best interest to try to find something that of a study." would slow down the progression for them as well as for the genDyer said the researchers ers did i a w o nde rf uI j ob e x p l aining the e r a l population?" study to Justine, using pictures to help her understand. I t would be an ironic turn of events for a r o u o f "The bottom Iine is she trusts me, and she believes ieves that a Iw o u n t nown m o re their infectious ha ppy personalities than their contri"W df ask her to do something that a isn isn'tsa safe," s e h sai d. . W e definitely b u t i ons to science. "If we succeed in preventingor curin g Alzhe i m ers disease first in went through the risks." " ," Justine said the researchers were we rea IIy nice, an dca IeI dD r . Bri- D o w n ys ndr ome, then bully for those individuals as well as for us," an Skotko o, the e co-direct c o - i rector o f th e M ass General Down Syndrome M o b ley said."I think that's what's ushin t h e ' Program and one of th e p rincipal investigators es igaors of o the t e stu stu d y , tio tionn to t o iitt. The rrealityis they've hadthiswonderful valueas human man tt

beings all along." â&#x20AC;˘

WINTER/SPRING 2015â&#x20AC;˘ HIGH DESERTPULSE

Page 55

During this timeof stress anduncertainty, oneof the most important decisionsyoucan make for yourself oryour lovedoneis whowil providehospicecare. Andyoudo havea choice. Now available in DeschutesCounty,St. Charles Hospice hasbeenproviding comfort and dignity

for patients â&#x20AC;&#x201D; andsupport for Central Oregonfamilies - for 25 years. Inaddition to seeing patients fromanyphysician provider, weare alsothe only hospiceprogramin theregionwhocan directly connect to St. Charlesmedical records, making adifficult transition a little smoother. You have a choice in whocares for you or your loved one during this time.

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H I G H

D E S E R T

Healthy Living in Central 0

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

Inside the lucrative, barely regulated world of dietary supplements (>E,gy PA<<0 'tlll NS

~ NA'rURAL

<RBS!

H I G H

D E S E R T

Healthy Living in Central Oregon

SUMMER/ FALL 2014

VOLUME 6, NO. 3

How fo reach us Julie Johnson ~ ENtor 541-383-0308 or johnson@bendbulletin.com

• Reporting Tara Bannow 541i-383-0304or tbannow@bendbul~letin.com • •

•

Markian Hawryluk 541-617-7814or mhawryluktsbendbulletin,com

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David Jasper 541-383-0349 or djasperobendbulietin.com Alandra Johnson 541-6'l7-7860or ajohnsonobendbulletin.com •

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Leslie Pugmire Hole 541-548-2186or Ipugmiretabendbulletin.com Sophie Wilkins 541-383-0351 or swilkinsobendbulletin.com

• Design/Production Greg Cross David Wray

AndyIeigert

• Photography Ryan Brennecke JoeKline

Andy Tullis

• Corrections High Desert Pulse's primaryconcern is that all stories are accurate. If youknow of an error in a story, call us at 541-383-0308 or email pulse@bendbulletin.com.

• Advertising JayBrandt ~ advertising director 541-383-0370 orjbrandt@bendbulletin.com

Kylie Vigeland health ttmedical accountexecutive 541-617-7855 or kvigeland@bendbulletin.com

• On the Weh. www.bendbulletin.com/pulse

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AilBulletin paymentsareacceptedatthedropboxatCltyHall.Check payments maybeconverted to anelectronicfunds transfer The Bulletin, USPS «552-520. is published daily byWestemCommunicatlons Inc.,'I777 SW ChandlerAve,Bend,OR97702Perlodicais postage paidat Bend,OR. Postmaster:Sendaddresschangesto The Bulletin circulation department, PO. Box6020BendOR9770BTheBulletinretalnsownershipandcopyrlght protection ofall staff preparednewscopy advertlslngcopyandnewsorad illustrations Theymayncxbe reproduced withoutexplidtprior approval. Published: B/11/2014

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CoriteArs HIGHDEsERTPULsE

COVER STORY SUPPLEMENTS The benefits of most dietarysupplements are largely unproven, and some supplements can be dangerous.

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FEATURES HEALTH CARE 10 HOMELESS New changes in health care aim to prevent patients from being discharged with no place to go.

DEPARTMEMTS

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

Po o

or walki ng to school.How to staysafe.

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

30 GEAR Paw protection for your four-legged workout companion.

32 PROFILE SuperDave has made an irnpression on the local foot race scene. THIS 36 PICI.'URE Where do all those extra babyIbones go? QUIZ 54 POP Can you identify the real home remedies? 55 ESSAY On the benefits ofbeing a squeeky wheel.

COVER DESIGN: ANDYZBGERT AND RYAN BRENNECKE CONTENTSIMAGES, FROMTOP:RYANBRENNECKE, ANDYTULLIS, JOEKUNE, ANDYZEIGERT

SUMMER/FALL2014 HIGHDESERTPULSE

BABY BONES All those extraiheneshave t~e~ go'somewhere' Paila3

Coverstory suppLEME NTs

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

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

lated," said Frederick Fraunfelder, an ophthalmologist at the U'niversity of Missouri who performed extensive research into the ocular side effects of supplernents while at Oregon Health & Science 'University in Portland. "There are no standards on the production of these agents. There is no regulation. So you don't know what you're taking." Before Violette, now 46 and living in Beaverton, had his first stroke, he was healthy

and active. He rode his bike regularly and had a good job. Until one night he woke up to go to the bathroom and something didn't

feel right. His then-wife called an ambulance. Today, he's lost his peripheral vision, he can't drive and his short attention span prevents him from holding ajob. His concemed father and step-mother, who live 10 minutes away, say the former workaholic is paranoid and strugg/es with tilling his'long days. "It's totally screwed him up," said his father, Louie Violette, of Tigard. "He was just trying to get healthier, working out at the gym and everything, holding a good job, and trying to get buff." Damon declined an interview, writing in a

Facebook message that he's been afraid to talk to people since the stroke, and still pre-

tained ephedra, a shrub-like plant whose ac- dietary supplements are essentia'lly unregu- fers to be only in small groups. Pale4

SUMMER/FALL 2014HIGH DESERT PULSE

JOEKUNE

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

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

The FDA has an agreement with the Federal Trade Commission that divides oversight of supplement claims, with the FDA looking at product labels and the FTC at advertising.

DSHEAalso made the FDA responsible for proving a supplement causes harm in order to get it taken off the market, a process that — in the rare case the FDA pushes forward — takes several years. Meanwhile, the market is constantly being flooded with countless new products that promise to melt away fat or to build powerful

muscles, far surpassing any agency's reasonable ability to track. In most cases, the FDA's best chance at protecting the public from a supplement once reports of injuries start comingi in is to send a warning letter to the company, which„ in most cases, is enough to scare it into a voluntary recall. 'If that doesn't work, the FDA in rare cases also seizes products and suspends companies' registrations. In fact, although the Food Safety Moderinization Act of 2011 gave the FDA the authority to mandate supplement recalls, so much work goes into provi~ng a product is harmful that warning letters are still its most common tool to get supplements pulled from shelves. The FDA learns about side effects through its Adverse Events Reporting System, an online portal through which health care profes-

Public Interest, a consumer advocacy group that regularly sues sup- sional's and members of the public can report injuries they sustained plement companies over unsupported health claims. "There's some from medications and supplements. Manufacturers are required to really good people at FDA, but institutionally, itjust hit the brakes."

SUMMER/FALL 2014HIGH DESERT PULSE

submit any adverse event reports they receive to the FDA. If enough

Page5

Coverstory ISUPPLEMENTS

reports come in concerning a product — "enough" being the key word, as there is no threshold — the FDA investigates. Between 2008 and 201I1I,the FDA received 6,307 reports of health problems concerning dietary supplements, 71 percent of which were mandatory reports from manufacturers, according to a 2013 Government Accountability Office report. That number excl'ud'es the many people who experienced adverse events but didn't report them to the FDA. Poison control centers, for example, handled more than 7,300 calls related to adverse events from dietary supplements between 2008 and 2010. In its report, the GAO criticized the FDA for not collecting information on how it uses the reports it receives for consumer protection and for not making public potential safety concerns brought to its attention by the reports. Perhaps the most jarring example of the FDA's inability to regulate harmful products came with ephedra, a powerful stimulant derived

said there is still plenty to be concerned about when it comes to supplements that contain stimulants. No one tests the products to be certain of what's in them, so they could contain twice as much of the stimulant listed on the label. 'That could be very dangerous," she said. Lots of supplement manufacturers claim they test their own products, but Manore said independent testing from an entity that won't profit from the sale is necessary to prove something is safe. Oftentimes, supplements will contain multiple varieties of stimulants. Their labels will list caffeine as an ingredient in addition to other stimulants such as synephrine, yohimbe or yerba mate, but they won't add up the total amount of caffeine from all of those ingredients, Manore said. "It stacks them in the supplement," shes aid. 'You wouldn't know how much you're getting, because they're not required to do that. It really takes somebody analyzing the product to find out what's from a plant that was long used by Chinese physicians to quell colds. actually in it." Supplement manufacturers in the I990s began marketing products Many of today's supplements are plant-based, which means they containing ephedra's active ingredients, ephedrine alkaloids, as could be more potent depending on the soil conditions or where they're grown, O'Leary said. Whenshe hadephedra plants tested for weight-loss drugs, often mixing them with caffeine. For years, they were hugely popular in the U.S., sold in big-name cases, 0"Leary said, she found that many of them contained a lot products like Metabolife, Hydroxycut and Stacker, and the compa- rnore amphetamine than others. In other cases, the manufacturers nies who made thern —,many of them tiny outfits operating out of were simply adding ephedrine to the batches. "People should always be wary of herbal supplements," she said. "The FDA has very little garages or ware'houses — raked in the profits. But then the reports starting coming in. Young, healthy people authority. And if the FDA isn't watching over them, who is?" were having strokes. They were dropping dead from heart attacks. Alluring weight=loss promises "The FDA startedgetting concerned because allthese young Following the births of her first through fourth children, Bend resipeople who shouldn't be sick, who shouldn't be having strokes and shouldn't be dying of sudden cardiac arrest, were," said Leslie dent Cynthia Poore never had trouble getting skinny again. O'Leary, a Portland attorney who has sued several ephedra manuIt wasn't until she had her fifth child that Poore found she just kept facturers. "That's what prompted them to investigate after seven or gaining weight. She was active at the time — working a job that had eight years, once they had enough data to investigate." her darting back and forth across a Walmart store, doing Zumba fiitUntil the FDA implemented its ephedra ban in 2004 — more than ness classes regularly and chasing around kids at night. a decade after the agency began receiving reports of serious side Her doctor tested her thyroid levels; everything came back normal. effects — O'Leary said it was up to attorneys like her to take on the Even her doctor was stumped. companies selling the supplements. She represented dozens of cliMeanwhile, Poore kept seeing commercials for the weight-loss pills ents who assumed they were taking a safe product. Unfortunately, Slimquick, "I'm like, 'No, I'm not trying that,"' she said. "But then I'd see the comoncethecasesreached her,the dam agewas done,she said. "By the time I'rn contacted by a family, somebody is really serious- rnercials a million times, and I'm like, You know what? I'll try that one."' ly sick or dead," O'Leary said. So it began. Slimquick had absolutely no impact on Poore's weight, And often the companies that made the supplements simply de- but the rush of taking a pill with the promise of an easy solution gave clared bankruptcy once they were sued, which made it very difficult her hope. It started her down the path that befalls many middle-aged for attorneys to collect darnages for their clients. women, who go from one weight-loss pill to the other, strung along by "Bankruptcy gives them a fresh start and lets them off the hook," ruthless advertising and a relentless sense ofhope. In twoyears, Poole said David Sugerman, a Por'tland personal injury attorney. has spent nearly $400 on at least six different supplement regimens. And even when ephedra and other dangerous stimulants like it None have caused any major problems — the It Works! pills did are banned, its manufacturers simply pull it off the shelves, reformu- cause her to throw up constantly during the few weeks she took them late it with a new concoction of ingredients, slap on a new label and — but they also have done nothing for her weight. "It's kind of like I'm on a never-ending search for that one cure to get send it back to stores, said Melinda Manore, an Oregon State Univer-

sity nutrition professor who has researched weight loss products.

my skinny real quick," shesaid. Poore's experience aligns with research by Manore, of OSU, which can still be purchased online from overseas companies — Manore looked at four different types of weight-loss supplements and found That means even though ephedra is off the market in the U.S. — it

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SUMMER/FALL•HIGH DESERTPULSE

no strong evidence supporting their use. Tihose varieties that had been tested showed only modest effects — with little or no longterm follow-up — others have had zero or limited trials into their effectiveness. "It just amazes me that people will spend so much money on stuff when they dbn't know what's in the product," she said,aand the outcome is relatively srnall." Manore's weight-loss solution? Old-fashioned diet and exercise. "Everybody wants to do it quickly without too much work," she JOE KLINE said, aand, unfortunately, it doesn't work that way." Overall, Manore believes consuming lots of green tea and fiber Stephen Gordneris director ofiitigation at the Center for Sciencein the Puband eating low-fat dairy products could complement a healthy life- iic interest. style to prevent weight gain over time. But since green tea extracts are so commonly contaminated with other products, such as stim- acid (HCA), which some say speeds up metabolism and suppresses fatulants that can cause liver damage, she recommends people just ty-acid synthesis. Randomizedicontrolled trials generally do not show an drink the tea to get the benefits. impact on weight loss, however. The Center for Science in the Public Interest has sued companies Victor Navarro, chairman of the division of hepatology and liver transover bogus weight-loss claims, most of which include the market- plantation with the Einstein Healthcare Network in Philadelphia, has obing guise ofbeing "natural," a gimmick Gardner said he detests. For served garcinia cambogia as the common denominator among more example, when various unscrupulous companies were promoting and more patients sustaining liver injuriesafter taking supplements. He acai berry supplements as ainatural fat burner, Gardner said his said he's very concemed about the dangers of the supplement and plans team knew right away it was nonsense. to contact Oz to encourage him to talk about its potential side effects, "We wantedto sue somebody, but every company we found although he's not sure even that will help. "Even if he expresses a note of caution to the public — coming from was offshore," he said. "None of thern were based here." Consumers tend to think things that are natural are good for a really sort of biblical figure like that — they may not hear the caution," them, but that's simply not true, Cardner said. After all, he said, Navarro said. 'They may just hear him speak positively about a product and then, all of a sudden, they're using it." sugar, fat and salt are natural. "People are entitled to be wrong," he said. "Companies are not U'.S. Sen. Claire McCaskill, D-Missouri„scolded Oz in a June Senate entitled to take advantage of that. When you prey on people's lack hearing for making false claims about products. Oz responded that he i res on his show. of knowledge because we're not all food scientists, that's predato- personally believes in the products he featu ry, abusive behavior. It's a deceptive practice." McCaskill told Oz she wantedito make an example ofhim because of The dangerous stimulant ephedra, for example, was often mar- the tremendous power he holds over his viewers. "We didn't call this hearing to beat up on you," s'he said,abut we did keted as an all-natural product, and is referred to by its Chinese

name, ma huang, Cardner said. "Somebody from China knew damn well what it was," he said,

"but somebody from Dallas, who might know that ephedra should be avoided — 'Well this is natural; it's ma huang. It's been used in Chinese treatments for millennia."' Poore said she still occasionally takes a weight-loss supplement called garcinia cambogia. She's been using it for about a month and a half and although she hasn't noticed a benefit, she takes it because it says on the bottle that it's natural. "It's all herbs and healthy-for-you stuff," she said. "They advertise it as all natural. There's no side effects. It all comes from plants,

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supposedly." The popular TV show host Dr. Oz has touted garcinia cambogia, produced from a small, purple fruit called the malabar tamarind,

on his program as a "natural" way for busy people to lose weight. In one segment, Oz, whose full name is Mehmet Oz, stands in front of a large screen with the exclamations,aNo exercise. No diet. No effort." Garcinia cambogia contains the botanical extract hydroxycitric

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Common dietary and herhal supplements Surveys show about half ofpeople in the U~'.S. take dietary and herbal supplemenits, but because the FDA doesn't regulate them, iit s irnpossible to tell what's in themrand vvhetiher they're safe. Many — especially those usedh for muscle-buiilding and weight loss — are either iineffeaeive or harmful.

Green tea extract What isit3Green tea contains caffeine and catechins, phytochernical corinpounds thatact as antioxidants. Howdoes itworl8 Eesearch!has linked catechins to health beneflts such as lncreasedantioxidant activity implasma, expanded blood vessels,inoreased fat oxldatlon, decreased fat absorptio'n artdireduced lipogenesis, the process bywhicA J foods amturned'Into body fat. EvidencelThe hmlthbenefits of green tea andgreen tea extraet'have been studied extensively. Greentea and caffeipe .mixtures common'in welgiht Iosssupplements havebeen linked to roughil+3 pou~nds!rnore weight loss compared with control groups, althaugh'hal5ILjal caffeine usecandampen that e%cL(TIrieaddition of caffeine tothe greentea appears necessary in achieving the trrreight loss effect) According to the Nati6nal Ihstitutes of Health, there is insuiticlenXevidence oA the eFfectlveness of green tea extract in weight loss. However,some evidence hasshown.it canhelp m~oderateiy obese people lose weight, Reported sideeffects3'Green tea extract has been associated with»lr!ver damage,especially ifconsumed on an emptystomaoh.Since green tea contains caffeine, the extract can caiuserdangerous interactions if combined witlh Other stimu'I'ants, such as t;phedriher or bitter orange..SId'e effects can also stem frorn high concentratfens ofithe extract in a serving orcontaminants within ther supplements.

Garcinia cambogia Whatis it3 Garcinia cambogiaIIs a small purplefruit alsocalled the malabar. tamarind that produces the botanical extract

hydroxycitric acid (HCA), Howdoes itwork3HCA rnaybe helpful in weight loss becauseit speedS up the metabolism. Research hasshown it suppressesfatty-acid synthesis. Evidence3Randomized controlled ttials generally do not show effects on weight loss, fat oxidation or appetite. According

to the Califomia firrn that anllyzes the DNAof supplements, it's uncl'eairwhet4enproducts sold in the US.asgardnia cambogia actuallycontaini the rawextract. Instead, many likely mntain chemicalsand filfers. Reported sideeffect33Garoinia cambog4 has beeri linked to several r~rts of liiver dainage. Italso can increase serotoitin, levels, socould be harrnfu!I Ifcornbined with some antidepressants. Com!btna!tior5 with other substances in weight-loss products can increase the risk for harrn, In 2009 the FDAwarrnedlpeople to stop using Hydroxycut a weight loss product that contained garcinia carmbc!gia, because of regorts of se =-

veresideeffects„.inclk!dlng liverdarniage requiring trarisplants.

Miscellaneous fat burners Whatarathey3 Products mntaln several differentactive ingredients, I~r!!cludingicoittjugated linoleic acids (CLA), fatty acids comirnaniy found in dairy =carriiiitine, a deiivative of the amino acid Iysirre that's produced naturally in the body. products and beef, and!L How do theywoe'R3CLAandlL'-carnitlne are believed.to heI!p wreight loss through thelr iimpacts on metabolism.

Evidemce3C~L A hasbee!n.extensivelystudied, and some research has found~lt to decreasefat by 2.2to 4A pounds in 12weeks to X months. Research into L-carnitine hasshownllittle evidence of effectiveness,although some 2011researchishowed when cambined withicarbohydrates it indirectly increased fat oxidat!ion during exercise. Reported side effacts3Neither CLAnor L-carnitine have been shown to cau~seserious side effects, although sorne CLAusqrs report gastrointestinal distress.

Preworkout supplements for building musde Whatarethey3Theyaredleslgned to increase energyand strength toboost performance during a workout. Manybrands do notdisclose their contents iri their entirety instead listing 'propriietaryblends," Sorneiinclude stiinriulants such as caffeine, while others conrtaiin ami~o acids such as arginine or

beta-aianine. It's~ieportant@'be awareof, whether several difFerentcaffeine prpduots arestacked together in a single prordluot, as manufacturers generally do notacld up the.total arnount of stimulants in asingle product ( or:exam ~ple: listed ingredients could indlude caffeine, yerba rnate and guarana). HowdotheyworM Sorr!e p!rewcrikout supplementscontain caffeine,a stimulantthatirrcreases mental alertzess and posslrl~ybirnproves athletic performarice. Others con@iranabolic ii amlnro acids and branched-chain aminoaeids (BCAAs)„which arecomponents orf proteiris beiieved toprornote the body's abilityto turnfccdI'niio energy.Sornesupplemerits containcreatine,;asubstance the bodyproduces naturallyand stores in the muscies,as it's believed to improve atFI'letic perforrnance and build lean body mass.'9'ost cornbirte several active ingredients. Evidence3Usersreport h'ighrates ofeffectiveness on reviews and forurns; Itowever academic research hasnot shown the saee and'has emphasized the heaith risks of these suppl'ernerits. One study showed the use of a caffeiner-contalningi supplement irnproved rear1!Ioe ti'rne, energy and mental fo-

cus, but research lastyear by@E e.Unr.iversity of North Carolina at Chapel Hiill found overall evidence to be inconclusive. Reported sideefhcts3Not all preworkoutsupplements contain stirnulants, but~those that do are associated with the highest ratesof side effects, such as liver damage, heart atracks,strokesand high blood pressure.More common side effects includ'e jitteriness, anixiety,.l!ncreased heart rate, heart palpitations and effects on II'pids and'blood glucose.Someusers report gastrolntestlnal side effects. TheFDAhas banned products containing 1,3-dimethylamylamine, or OMAA,a stimulant linked to illnesses and deaths. Sources: National Institulesuf HealS;MellndalAnore, Oregon StateUniversity; Robert Hendr!ekson,Oregon HealCh8Meno. University;%ctor Navarro, SnatelnHealthcweNebvwk ImagescourtesyWildmedla Commons

PageS

SUMMER/FALL•HIGH DESERTPULSE

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

Seriousside effects Navarro and his colleagues, concerned about the devastating effects they had seen from d'ietary and~ herbal supplements on patients' livers, are about to publish a national study that found dietary supplements are responsible for nearly 20 percent of drug-related liver injuries in hospitals in 201~2, up from 7 percent a decade earlier. Those figures are likely underrepresenting the extent of the problem, though, because they only include people referred to liver specialists at hospitals across the couintry, Navarro said. JOEKUNE The researchers followed 845 patients between 2004 and 2013. They found~that of those who sustained liver injuries, about11 ipercent Cynthia Poore, pictured outside her homein Bend, has tried several diet of those whose injuries were caused by dietary supplements were se- pills and supplementsin an atternpt to lose weight but hasn'tfound any vere enough to require transplants. Among those whoseinjuries were success. from pharmaceutical drugs, only 3 percent needed transplants. "There is a lot of work to do to convince the public that these have to be used with caution," he said. tibiotics, Navarro said. The type of supplements the patients took The liver takes such a beating from medications and supplements varied, but the largest identifiable groups were bodybuilding supplebecause its job is to reduce the products to their components after ments, followed by weight.loss supplements, he said. they're ingested and eliminate them from the body. That was a surprising finding for Navarro, as he said people who Although the majority of liver injuries are caused by various pre- take supplements tend to be younger and healthier, than people who scription medications, as a definable group, dietary supplements are take prescription medications. It may be that doctors are more likely

the second-leading class of drugs to cause liver injuries, behind an-

Continued on Page49

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Hospice l Home Health i Hospice House Transitions l Palliative Care SUMMER/FALL 2014HIGH DESERT PULSE

Partners In Care HOSPICE

Pageg

Feature HOMELESS HEALTHCARE

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

BY MARKIAN HAWRYLUK

ernie Crisman can't remember how he came tobe homeless or how long he had been living, on the street before he was attacked last year. Four men threw a pillowcase over his head, assaulted the 56-year-o'ld Bend man and stole his belongings. Crisman, a U.S. Army veteran, ended up at the Veterans Admiinistration hospital in Portland, where heiunderwent brain surgery to repair his head wounds and was treated for a hernia. He spent another six weeks at St. Charles Bend recovering from his injuries. "They drilled a hole iin my head the size of a

When the hospital discharged him, they dropped him off at the Bethlehem Inn, a homeless shelter in BendL But Crisrnan soon found himself in another health crisis. Unwilling or unabl'e to control his diabetes, his blood-sugar levels spiked, prompting shelter officials to send him back to the hospital. There, doctors discovered he hadn't been taking his antibiotics either. "Now his infection is serious," said Donna Hines, a professional fiduciary, who holds the power of attorney for Crisman. "He got discharged.He didn't have the means. He

ous problem." Crisman's case follows a familiar script for

horneless individuals in Central Oregon. Living on the streets, they develop acute health issues or chronic conditions that spiral out of control, avoiding any medical services until they can no longer hold out or are brought to the hospital by emergency personnel. They are treated 'but released back iinto the same conditions that exacerbated their health in the first place and wind up back in the hospital, With each trip through the revolving door of admission and discharge, didn't have a place to keep (his medication). these individuals churn up thousands of dime," he recalls. "l couldn't think very good. I He didn't have the mental capacity to take dollars in charity health care dollars without couldn't talk. My equilibrium (was offl." the antibiotics, and now it became a seri- ever truly becoming well.

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Feature HOMELESS I HEALTHCARE

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

place.

Health care forthe homeless The 2014 point-in-time homeless count in Central Oregon identified 2,410 homeless

people in Crook, Deschutes and Jefferson counties, up from 1,990 in the previous year. Advocates believe such counts reflect less than half of the true homeless population but are useful in recognizing trends. For example, the number of chronic homeless— adultswho have been homeless for more than 12 months or who had at least four episodes of hornelessness in the past three years — increased from 256 in 2013 to S22 this year. In November, the U.S. Department of Housing and Urban Development estimated there were about 610,000 homeless individuals nationwide, with more than 92,000 of

those considered chronically homeless. Studies have consistently shown that homeless individuals have high rates of illness, injury, death and being victirns of crimes. Those, in turn, lead to higher rates of emergency room and inpatient hospital use. A national study found that, on average, homeless individuals visit the ER five times a year, with an average cost per visit of $3,700.Moreover, 80 percent of those ER visits, the researchers found, were for exacerbations of conditions that could have been treated with preventive care. Those numbers are the stark reality of trying to survive on the streets, exposed to the elements, with little access to healthy food

Temporary housing An accounting qferaergency and transitional housing in CentraiOregonirn 2010»found369 beds available to.get home'lessIadlividuals offthe street, far short of)he cgimated 3,000 to 5000 hlrieless Individuals In the reg|0n,

Homeless homlnlinwewtory,2019 Emergency shelter

:: Familybeds: ',Individualbeds . Total 53

Bethlehem Ihn

Safe Homes (CascadeYcuth aadIFamily Center)

0:'

Deschutes County. Parole and, Probation

0:', I

Grandma's House (pregnant/parenting teens) Nancy's House,(Neighborlmpact) Saving Grace(domestic vioience)

14.: i

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The Shepherd's House

67:

Total Transitional housing

0:.

(CascadeYouthand'Famiily Center) Horizon House(Housing Works/

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35: ,.

117 ': ,

184

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Deschutes Mental Health) Transitional housirigiprogram

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(Neighorimpact) Jericho Road Home of the Brave(Cereal Oregon Veterans Gu~tr ach)' Emma's Place(Housing Works)

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126 ,.:'

59:',

185

sourca cein@d orsyin wfkyeari antiiKAd H~iesswss

people living on the streets without mentioning the reality that large percentages are struggling with some form of addiction," said Curt Floski, executive director of Shepherd's House, a homeless shelter in Bend. "So you couple health issues with addicor good hygiene. "It exacerbates any pre-existing health is- tion issues, and you've got the making of a sues and I think you can't really talk about health crisis."

Pagelz

. Familybeds, :Individualbeds Total

Stepping Stones (Housing Works/BestCare) TheLoft

12:.

Living in shelters or homeless camps in close quarters can expose the home'less to comrnunicable disease. They have trouble controlling chronic conditions such as hypertension, high cholesterol or diabetes, with no place to store medications or

syringes. Eating what they can find or afford, they

SUMMER/FALL 2014HIGH DESERT PULSE

keeping bandages clean is not possible. Minor issues such as cuts or colds become infections oripneumonla, which be-

come more difficult and more expensive to treat. "What's a simple leg wound or an abrasion or a blister goes untreated, gets infected — pretty soon they have cellulitis

ter beds in Central Oregon and another 185 transitional housing spots. But many of those have strict standards and long waiting lists, and, for the rnost part, aren',t set up to deal with persons dealing with significant health issues. "It's a tough spot for people,*' Floski said, "There are just not any places they can go." increasingly, hospitals are discharging patients frorn inpatient floors or the emergency room with the expectation that they will continue to recuperate under the watchful care of

age, with life expectancy as low as 41 years. their family or loved ones.

"It's fairly sirnple if you think in terms of No amount of health care, the group main'I've got a husband at home, I've got a wife tains on its website, can substitute for stable housing. at home, I've got children at home. These are of the limb," said Br. Randall Jacobs, an "No matter what you're going to give them people who can help me,'" said Chris Clouart, internist with Bend Memorial Clinic, who in terms of medical care," Jerry Hollis, exec- director of the Bethlehem Inn."You can conprovides care to the homeless through utive director of COVO, "you're still going to valesce at home and it's 10 feet to your kitchthe Mosaic Medical mobile treatment push them back out into the environment." en, it's six feet away to your bathroom. It's all van. "And then if they're a smoker, if within distance for you." Discharged to the street Residents at the shelter must be able to the~e got hypertension or diabetes, they've got poor circulation." A 2010 tally found l84 emergency shel- walk 50 yards across the parking lot for their Jacobs had been treating one such homeless patient in the medical van. Over the course of 18 rnonths, the man had one leg amputated, then the other. He was killed crossing a road in a wheelchair. "We certainly see frostbite every winter. We see deaths from hypothermia,"

~gWestside Pharmacy

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Jacobs said. The vansaw another homeless man who incurred second-degree burns on his face and arms when his propane stove exploded. John Morris, outreach coordi~nator for Central Oregon Veterans Outreach, routinely makes the rounds of the homeless camps, handingout food, clothing and other supplies. When harsh weather is on its way, he makes extra trips to urge the homeless to get into a shelter and out of the elements. "Our goal at the start of the year is to make sure nobody dies throughout the year from the weather," ~hesaid~."Our rule is nobody dies from the elements." During the last winter's worst storm,

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one man didn't heed the warning and lost

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SUMMER/FALL2014 HIGHDESERTPULSE

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Coverstory IHOMELESSHEALTHCARE

Homeless in Central Oregon

meals. There isn't sufficient staff to care for individuals with health care issues. Each year the Central Oregon HomelessLeadership Coalition attempts to count the homeless "We often get a lot of pressure from the popuiation in Central Oregon counties and cities. The point-in-time count is not intended to be a full hospital or the discharge nurse saying, 'Well, accounting of homeless individuals'but a way to identify trend's from year to year, why is it that you can't take this person?' I had one guy released to me two days after Key open-heart surgery," Clouart said. "They of2013 2014 ';IIa < —.1SJ< - 2 aeiniit - 5P~~~ ten times don't understand the circumstancIdnrtIra I 1-

;

es we have." The shelter may take in individuals who simply cannot go back to the street if they can, for the most part, take care of them-

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J ENF 'lFr F: R5'Q,Ns C0"0.@TnY>

selves. On occasion, they've arranged for a home healthnurse to come by and change dressings, but they're limited in what sort of

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services can be provided there. In one survey, published in the Journal of General Internal Medicine, 67 percent of homeless patients surveyed spent their first night after hospital discharge at a shelter, while 11 percent spent it on the streets. According to the 2010 U.S. Department of Housing and Urban Development's 2010 Annual Homeless Report, 7 percent of all homeless individuals and 13 percent of newly homeless individuals at shelters came directly from a hospital. "We become the default solution in too many difficult circumstances," Clouart said. Hospitals can try to get public health plans, such as Medicare or Medicaid, to cover some time in a nursing home for such patients. Community health workers at the hospital often spend hours on the phone trying to find a place for a homeless patient. But if the hospital cannot find a place to send them or if the patients are unwilling, there is sometimes little choice other than to release them. That, homeless advocates say, is a recipe for disaster. "It's not adequate to just discharge someone to the street, and say, 'Listen, you need this dressing changed every day; you're not supposed to walk more than this distance; you should be eating this kind of food; you need to take these medications; you need access to water,"' Clouart said. "It's not adequate to discharge someone to a camp or to live on the street." Moreover, a discharge to the street or shelter, more often than not, means that

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

ANDYZBGBtr

said Alan Burke, manager of social work for

the hospital system. "Patient self-determination still rules the day. If they're a reasonably competent person, and they don't want to take this medication, we canlt force it on them. We can't put them in a situation they don't want to be in. A bad decision doesn't make them incompetent." Several years ago, the hospital set aside $16,000 to help homeless individuals with their medications. "We've helped rnore than 100 homeless receives a flxed payment for providing care to Oregon Health Plan (Oregon's Medicaid) people in the last couple of years with their

SUMMER/FALL 2014•HIG H DESERT PULSE

medications," Burke said. "Tihat's gone a long ways to try to help stabilize them and keep them from coming back in." Those medications are distributed either to patients directly or to the shelters, which can make sure they're being taken as prescribed. While the program fits in nicely with St. Charles' charitable mission, there is a cost-saving component to it as well, further stretching the limited health care dollars available for charity care. "The benefit clearly was to try to prevent rehospitalizations," Burke said. "If they had to have an antibiotic and they took it, chances were much better that they wouldn't

come back in." One way or another, most of the costs of treating the homeless are passed on to the general public, either through tax dollars for public health programs or by raising costs to those with private insurance to cover the

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

Holmes had been a carpenter in Roseburg,

but achy knees and a slowing housing market left him unemployed. He crossed Bridging the gap the mountains to Bend but fared no betLocal providers have been trying to plug ter here. Last year, after five years of living gaps in the safety net for the homeless as on the street, his blood pressure was so they can. Central Oregon Veterans Outreach high, the nurse in the mobile van thought for years has operated a mobile van that the device for testing it was broken. Jacobs visits she1ters and other locations where the prescribed a generic blood-pressure medihomeless congregate providing free care. cation, giving Holmes a gift card and a ride "That kind of moves them into the system to Walmart to fill it imimediately. When his at Mosaic, and trying to triage their needs," blood pressure started creeping up again,

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Page 15

Coverstory IHOMELESSHEALTHCARE

Jacobs sent him to M'osaic Medical, a federally qualified health clinic that provides free or reduced-cost care to those with no insurance. A subsequent blood test showed Holmes had a variant of high blood pressure that needed a specialized med'ication, and the staff helped him apply for a pharmaceutical-assistance program to get the drug for free. The clinic physician also prescribed a statin for his high choiesterol, and at the start of 2014 signed Holmes up for health insurance. That allowed Holmes to see an orthopedic surgeon, who gave him a cortizone injection for his knees while he waits out the waiting

Reasons for homelessness

•

28 3 Drug/alcohol abuse

period for a knee replacement.

•

27 5 Drug/alcohol use at home

A national analysis found that three out of four chronically homeless individuals with incomes below the threshold for Medicaid expansion were not on Medicaid prior to the Affordable Care Act. "We're still early enough in this people having access to health insuirance on a large scale, so that a lot of these things have not been resolved yet,e Clouart said. "We're going to be dealing with folks who will have access to health insurance, but they don't

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24 2 Medical problem

necessarily have access to stable housing."

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23 5 Mental/emotlonal disorder

"I'm pain-free for the flrst time in 10 years," he said. "I couldn't have taken an eight-hour job if it was offered to me. Now I can." Holmes had been working at the Family Kitchen, working his way up from dishwasher to cook. He works four-hour days, rnaking 40 gallons of soup, grilling sandwiches and baking biscuits for the dozens of 'homeless

who come there eachday.

For the 2014count, respondants were asked about the reasons for their homelessness.

Individuals could provide muiltiple reasons.

Holmes was displaced from his camp by

impossible." Holmes has al'so become anevangelist for Mosaic and Oregon's health care expansion, and he demonstrated that last month in the

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2,000 of our uninsured patients now have OHP," said Elaine Knobbs, Mosaic's director

of programs and development. "So now they have insurance, but they still don't have

housing." 1,652 Unemployment ~

606 Kicked'out byfamlly/friends

48 4 Eviction

444 0 ther

~ 4 3 6 Domestic violence ~

4 3 6 Poor rental history

~ 3 7 9 Poor credit

Now, horneless patients are more likely to seek care, be admitted to the hospital and

• 21 7Criminal record

have major procedures done. With no ex-

• 204Homeless bychoice

pansion ininuirsing home beds or transitional care, however, it has squeezed more homeless through the front door of the health care system without a clear exit strategy.

i 90Chlld abuse

i 80 Pregnancy i 57Propertysold

"People in our situation have a fear of even i 44 Foreclosure using the medical van because they're afraid i 30 Runaway they're going to get a bill. They don't trust 2 Gambling the system," he said. Instead they use the emergency room if 2Traller parkclosure they can't hold out any longer. Sour«e:CentralOregonHomefessteadershipcoalition ANDYZEIGERT "That's the first place they turn because they know they're not going to be turned away," he said.el know peopie here who use soup kitchen. "Does anybody here not have health init on a regular basis. It's a revolving door." the Two Bulls Fire in June but was offered the use of an RV donated to COYO by a veteran's family. The RV is parked on land owned by Christ Community Church, and Holmes also serves as the caretaker there. What started with a simple visit to the mobile health van now has Holmes on the path to being healthy and self-sufficient. "Mosaic has put me back together healthwise, so I can go out and get a real job," he said, "which a year ago would have been

patients that we thoug~ht we would. Over

"We'veneverseen so m any homelesspeople," saidiMary Meeko, executive director of the Pilot Butte Rehabilitation Center in Bend. "Becauseof Obamacare, the homeless peo-

ple now have access to health care, so we're

seeing a greater number." This year, Pilot Butte has consistently seen two to three homeless individuals among its 30 to 35 residents. But when homeless individuals no longer meet the medical criteria to stay there, surance?" he bellowed across the room. A the staff faces the same challenge that disyoung man raised his hand. charge planners at the hospital do. "Would you like health insurance?" he "We start calling and asking," Meeko said. Even when individuals are placed in a asked. Indeed, the man would. eyou show up at Mosaic Medical on Mon- nursing home after a hospital stay, they are day morning; they'll have it for you in two often so concemed about their belongings weeks," he said."See how easy thatis?" in the camps or where they will go afterThe Medicaid expansiion under the Afford- ward, they don't stay. "They'll give them up to two to three able Care Act has opened the door for many homeless individuals to get health insur- weeks (in a nursing home); after two days, ance. Most didn't qualify in the past because guys get up and walk out the door," said the program was largely reserved for moth- John Morris, outreach coordinator for COVO. ers and children. That changed as of Jan. 1 "They're worried about their stuff being stowith Obamacare but has exacerbated the len and they are not down with sitting." discharge problem. One of the vets Morrls worked with was eWe'vehad double the number of new transferred to a nursing facility after a hip

SUMMER/FALL 2014•HIG H DESERT PULSE

The cost of homelessness

replacement. But often, spending by one player in the "That guy left after a week," he said. "They A recent study comparing homelessand housed community would results in savings for othM said, Do not leave, do not leave,' and he just ers, requiring a community-wide approach patients at health centers showed the increased waddled out. You'll see him, out there walk- health burden of those living on the street. to the issue. That's where Oregon's recent health reing with a walker." Many of those individuais have gotten to form effort could help. Under Gov. John U*ver ~ 1 $o the point in their lives where medical care condibong ~ Kitzhaber's pfan, money for Oregon Health simply isn't a priority. Plan enrollees is given in a lump sum to co"To be honest, I d'on't think they care," 46% ordinated care organizations, which can Fair or poor health ~ St th Morris said. 'They have nowhere to go. choose how to spend that money in their Their hope is pretty much gone. They're trycomrnunities. The governor has frequently r od ~ t tsit ing to survive, trying to get rent for the day, used the example of purchasing an air conins«c«nq Q 1yy, • Home less ditioner for an elderly patient to avoid an extrying to get food to eat — at the end of the o • Ho used pensive hospitalization for problems stemday, medical issues just get in the way. C hronic ~ 1 9% Those medical issues then flare up, ming from the heat. bronchitis• 1 1 g The housing-first model, it seems, could prompting someone to call 911 and then EMTs or the police bring them to the hosMultiple ~ Sttt h expand that approach from an air conditionchronic er to an entire apartment. pital. COVO sometimes gets the call when conditions ~ 27% they are discharged but often has no good The state provid'ed CCOs with additional options for where to take them. funds to help transform the health care sysTooth "We're always willing to go pick someloss tem, and in Central Oregon, the CCO accept54% ed proposals for how to spend its $1.6 milbody up; the problem is a lot of these Alcohol ~ 11% lion in transformation dollars. guys are no longer welcome in the camps. They're no longer welcome at the Bethlehem dependenceJ 2% One of the proposals was a housing-first Inn. They've burned every bridge until there pilot project, pitched by Housing Works of Seeeto ~ t stth are no bridges left to be burned, and that's mental Redmond. illness ~ 12% when theyend up undemeath the bridge, The Health thru Housing pilot sought literally." $285,000 to provide rent assistance and Source: National Health Careforthe HornelessCoalition ANDYZEIGERT case-management servicesfor 20 to 25 A housing solution homeless individuals who were pregnant or Most advocacy groups for the home- ing and support services, but saved more had chronic medical conditions. Two-thirds of the funds would be used to less as well as many health care providers than $42,000 on average. And 72 percent of now believe the solution may be to provide those in the housing-first group had stable pay rent and provide security deposits, while housing and support services. Known as the housing after two years, compared with 34 the remainder woul'd be used for case manhousing-first model or permanent support- percent in the standard group. agement to help the homeless transition. "We would basically take someone ive housing, the thougiht is that by placing Early this year, the Central Florida Comhomeless in housing and providing them mission on Homelessness released an anal- straight out of homelessness who has one with support services, they can break the ysis done by Creating, Housing Solutions, of those conditions; we'd be putting them expensivecycle ofhornelessness and its as- which calculated that the region spends in housing, providing rental assistance, prosociated costs, and save imoney in the long $31,000 a year per homeless person. In con- videcase-management services,and then run. trast, getting each horneless person a home document medical reirnbursement costs on The model has been tested in many plac- and caseworker would cost about $10,000 the program," said Kenny LaPoint, Housing es around the U.S. and Canada and shown per person. and Resident Services Director for Housing great success. The savings come not only from avoiding Works. A Canadian study released in April, for ex- hospital and ER admissions, but cutting costs Homeless people with chronic conditions ample, split more than 2,000 homeless peo- for EMT, police, jails and substance-abuse fa- such as high blood pressure, high cholesterple between a housing-first program and cilities. Many communities, however, have ol or diabetes often end up in the emergency traditional support services. It found that ev- struggled finding the upfront money to in- roorn because their conditions are not well ery dollar spent on housing and support net- vest in the approach. In some places, hospi- controlled. Meanwhile, studies show womted more than twice that in savings in hos- tal systems have fronted the money expect- en living on the street have a higher rate pital, prison and shelter costs. The program ing that they'll reduce their charity care costs of pregnancy than those in stable housing.

spent $19,582 per person to provide hous- through the program.

SUMMER/FALL2014 HIGHDESERTPULSE

Continued onpage 52

Page 17

TIPS sTRETcHING

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

ate to break it to you, but you may have been stretching Th e n whenyou'redone withtheactivity, spendthesameamount wrong this whole time. of time in a cool-down mode, which can be the same type of activity Were you doing it before your run? Were you pulling until it as the warm-up. hurt? Both are major no-nos. Then, and only then, is it appropriate to stretch, Downing said. "That's when you'll have the most elastiaity because the muscle is Sure, there are conflicting views in the fitness world over the best stretching techniques, and much of it depends on which research more pliable," she said. you trust. For her part, Julie Downing, chair of Central Oregon Community College's department of health and human Downing recommends people stretch two to three performance and head of its Exercise Physiology Lab, retimes per week at a minimum, although daily is ideal. lies on the American College of Sports Medicine's fitness Of course, people should always stretch after they exbible: the Guidelines for Exercise Testing and Prescription, ercise, she said. which is updated every four years. Downing uses it to If people are just beginning a stretching routine, Downing said they should be patient â&#x20AC;&#x201D; improvements preach to her students about proper form and technique. Whether you work out or not, stretching can increase in flexibility won't show up until three to four weeks afthe body's range of motion so you can continue to do ter beginning a stretchiing regimien. Youi'll notice flexibilall of the activities of daily life, even as you age. And the ity beginning to increase by doing a sit-and-reach test, more peopl'e can move their arms, legs and backs, the for example, which is when you sit, stretching your legs less likely they are to become injured because their mus- ju lie Downingis chair ou tin front of you and try to touch your toes. cles and tendons won't budge, Downing said. of Centra/Oregon People should always stretch to the point where they Community College's fee l slight tension or discomfort, but not pain. department ofhealth

Although the common wisdom years ago was that an dperfarmanceand stretching before a workout reduced the risk of getting he adofitsExercise There are several styles of stretching, but the ones injured, Downingsaidstretchingbeforeaworkoutactu- PhysiologyLab.Here Dow n ing recommends for most people are static, ally dampens perforrnance. Studies have tested runners shedemonstrates the whi c h refers to holding a position for 10 to 30 seconds, who stretch before and after runs and found their times Q Tricep stretch: or partner stretching, which means having another perwere slower when they stretched before runs, she said. Gr ab your elbow, bring so n apply resistance to improve your stretch. "It's kind of wild," sIhe said, itbehindyourbody All st a t ic stretches should be held for between 10 to Stretching elongates the muscles, thereby decreasing and gently pull. Repeat 30 seconds, or for 30 to 60 seconds for people over the their ability to produce power. withoppositearm. age of 60. Ideally, though, each stretch should be held "A nice, tight muscle can produce a lot of power, but a for a grand total of 60 seconds. That means you could muscle that's really stretched out cannot produce the same amount hold each one for, say, 15 seconds, take a one-second rest and then of power," Downing said. repeat that three additional times to get 60 seconds worth of stretch. What people should actually do to prevent injuries, Downing said, P a r tner stretching works equally as well, if not better, than static is warm up before their activities. If you're going for a ride on your stretching, although it might take longer because partners have to mountain bike, a warm up means going easy for five or 10 min- stretch the other person as well as themselves, Downing said. These

utes. If you're lifting weights, hop on an exercise bike for the same stretches work by having the partner apply resistance and, immediamount of time beforehand. If you're running, start out with a slight ately following, the opposite person will experience a relaxation of

jog or brisk walk. Pacte'lS

the affected muscle group.â&#x20AC;˘

SUMMER/FALL 2014HIGH DESERT PULSE

0Calfstretch 1:

0Calfstretch 2:

This one stretches the larger calf muscle, thegastrocnemius. Press your handsjust about shoulder height

This one stretches thesoleus muscle, the smaller of the two calfmuscles.

Keeping hands pressed against the

againsta wall, plant

wall at shoulder

the heel of the back leg down, bend the front leg and lean into the wall. Repeat with opposite leg.

height, bendyour front and back legs, keep heels flatand lean against fhe wali. Repeat with opposite leg.

QQuadricep

OHamstrfng stretch:

stretch:Resting your hand on a stable chair or person

While standing, step one leg forward and straightenit, bend the

for balance, keep

backleg and lean for-

the leg on the same side as the stabilized hand slightly bent, catch your opposite ankle with your free handand pullit backslightly, keeping backstraight. Repeat with oppositeleg.

ward over the straight

leg. Keeping the back leg bent, only reach forward to the point of mild discomfort or slight tension. Repeat with opposite leg.

kh-' SUMMER/FALL 2014HIGH DESERT PULSE

Page 19

Tips I STRETCHING

QShoulderldeltoid/back stretch:

QChest

Keeping arm straight, bringit across your chest and, using opposite arm, grab the elbow of the straight arm and try to push elbow toward chest. Repeat with oppositearm.

stretch:Clasp your hands behind your back and straighten

your arms.

QAbdominal stretch, step 1: Startout lying on your stomach, place hands on the floor at chest level and then pressyour upperbody up, maintaining a slight bendin the arms. (Photo shows beginning of pose.)

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

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IO O S PECIALISTS OF ORE G O N

Dr. Matthew Simmons

Nine-year-old Elliot Henson rides his bike down Nashville Avenue on his way home from Highland Eiementary Schoolin June. RYAN 8RENNECKE

Page 22

SUMMER/ FALL 2014. HIGH DESERi PULSE

Get ready wALKIRIDE ToscHooL

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

he numberofkid' sin Bend-La PineSchoolswho bike tosdhool in the mornings jumped more than 10 percent between 2012 and 2013 — the biggest increase yet in a single year. That kind of statistic is a feather in Bendite Brian Potwin's cap. Potwin has coordinated the district's Safe Routes to School program for the past five years through his post as education coordinator for Commute Options, an organization that promotes alternatives for Central Oregonians to driving in cars. "I've seen a shift in perceptions from parents around safety and the fun aspect of it," he said. "I've seen an increased buy-in on the school district's level and per school as well." Advocates of walking or biking to school say it's a great way to ensure kids are getting at least some physical activity, especially at a time when physical education in schools continues to erode under the weight of budget cuts and shorter school years. The U.S. Centers for Disease Control and Prevention recommend kids get at least 60 minutes of physical activity each day, most of it moderate or vigorous aerobic activity. Depending, on how far a child lives from school, walking or biking there may just satisfy the CDC's guidelines. But as attractive as the benefits may be, there are still significant

in the roadway. Younger kids don't have fully developed depth perception, peripheral vision or comprehension of the speed of travel. Kari Schlosshauer, regional policy manager for the Pacific North-

barriers. Locally, the big ones are living too far from schools, inclem- west for the Safe Routes to School National Partnership, said 1 in 3 ent weather conditions and roads that don't permit safe access to school by foot or bike, such as busy, arterial roads or those without sidewalks. Potwin's group surveys parents on the subject and then uses the data to work with schools or the city to reduce the barriers, or with families to teach thern about other options. "If we're talking about a specific situation with an entire school, we can educate them on that area," he said. A good example is the Rimrock Expeditionary Alternative Learning Middle School (REALMS), which is near the Riverhouse at the intersection of Business 97 anid NW Mt. Washington Drive. In that case, Potwin helps people navigate the busy intersection, which usually means redirecting them to the nearby Deschutes River Trail, which connects almost directly with the school. "It's notjust the main travel lanes we all can go in bycar," he said.

kids in the U.S. is overweight or obese, and the vast majodty don't get the recommended 60 minutes a day of physical activity. 'There's obvious health concerns there," she said. "Providing the safe routes and the encouragement and some of the educational pieces — especially with younger kids — putting those things in place within a school goes a huge way towards actually getting the kids to do it." In the end, encouraging~ and helping kids walk and bike to school ultimate'ly benefits everyone in a cornmunity, Schlosshauer said. "It's really great to teach kids how to be good pedestrians and teach them how to ride bikes properly down the street because that benefits everyone if the kids know how to do those things," she said, "and it makes everybody feel better about letting them go out and do that."

Page23

Safe Routes to School yrogram

SkyView Middle School'

Commute Options designed SafeRoutes to School for eight area elementary and

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middle schools. The routes are designed to give kids a safe route to walk or bike to school, providing exercise and reducing traffIc at schools. Routes begin at the red dots. Some schools have more than one route.

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For more info, visitcommuteoptions.org/programs/safe-routesto-school

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Pedestrian safety for kids • Ask a parent first. • Use sidewalks or paths. Ifthere are none, walkas far from the cars as possible on the side of the street facing traffic. •Choose a route with the fewest streets to cross and avoid crossing busy or high-speed streets. • Don't cross behind or within 10 feet of the front of a bus or other large vehicl'e because the driver cannot see this area. • Watch for parked cars that may be getting ready to back up or pull forward. • Obey traffic signs and signats. •When a signal indicates it is time to cross, check for motor vehicies. Drivers may not obey the rules and tul ning drivers may not lookfor pedestrians.

al Oregon

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• Before crossing, always look for cars,even after a signal, crossing guard, parent or other adult says it is OK to cross. • Walk, don't run, across the street.

Bicycle safety for kids Before riding to school, childrenmustbeable to: • Ride in a straight line while scanning thesituation ahead, behind and to theside.

• Stop quickly using the brakes without swerving, falling or crashing.

Serving Your Med al Imaging Needs Since I948

• Swerve in a controlled manner to avoid a hazard or collision. • Follow the rules ofthe road,

Once theyareready to ride, theyshouldfollowthese tips: • Dress appropriately. Wear brightly colored, close-fitting clothing. Tie your

shoes and secure long lacesand loose pant legs. Do not wear headphones. •Wear a properly fitted helrnet. • Ride a bicycle that fits. When seated on the bicycle, both feet should be firrnly planted on the ground and hands should reach the handlebars. • Ride a bicycle that is in good condition. Tires should be firm, bra'kes should prevent tires from rotating when pushed, the chain should not droop or be rustyand the seat and handlebars should be tight. • Do not carry anyone else on the bicycle. • Do not carry anything in your hands. Use a backpack, basket or panniers. • Choose the route with the fewest streets to cross. Avoid busy and high-

•

speed streets. Use bike paths where available. • Before entering the street, look for other vehicles to the left, right, in front and behind. •Watch for vehicles turning into or exiting driveways. • Stop at all intersections and check for traffic before crossing. When possible, cross at locations where adult crossing guards are present. It may be best to dismount and walk your bicycle across large or busy intersections. • Ride in a straight liine with two hands on the handlebar unless signaling.

Call

• Follow all tra5c laws, including; - If riding in the street, ride in the sarne direction as motor vehicles, on the right-hand side ofthe street, about 2 or 3 feet from the edge.

- Hand signal when turning or stopping, and obey traffic signsand signals. — Check for traffic in front and ~behind before changing lanes,crossing intersections or turning,

- If riding on a sidewalk or path, ride slowly and be prepared to stop quickly. • Biking in roundabouts: Children under age 10 should use the sidewalks rath-

er than riding on the roadwayand should ride with their parents or guardians, Older students can use the same travel lane as vehicles.• Source:SafeRoutesto School

SUMMER/FALL2014 HKsHDESERTPULSE

Page25

Ronald D. H Patrick B. Traci Clauti Steven D. Kj Robert E. David R. John Cloe She Travis

r a ppolntments: 41)382-9383 son, NID - James E. Johnson, IND rown, MD - Jeffrey Drutman, IND -Engle, NID - Laurie A. INartin, NID

bech,IND -Thomas F. Koehler, NID ogan, IND - Stephen Shultz, IND lauf, NID - Steven J. Michel, IND tassen, IND Will Wheir, IND n, NID - Garrett Schroeder, MD bele, IND - Paula Shultz, MD

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. Page 27

Healthy eating HDTD0Gs! BY SOPHIE WILXINS• PHOTOS BY ANDY TULLIS

hen it comes to hot dogs, there are a couple ways to go. You have your mustardlonly purists, who believe ketchup never belongs anywhere near a hot dog. You have your ketchup fanatics, who think a hot dog should be saturated with the stuff. And then you have the rest af us, wha will put almost anything on a hat dog and call it good. But what kind of hat dog7 That's a tougher question, espeoall'y if you're looking for more he4thy choices. A hot dag is basically a frankfurter, a smoked!,

seasoned and precooked sausage made of beef, pork, veal, chicken or turkey. The name fran'kfurter comes frarn Frankfurt, Germany, where sirnilar pork sausages were created. Other names for hot dogs include wieners, associated with hot dogs that contain pork, and franks, associated with all-beef dogs. There aie alsa hat dogs made of veggies, tofu> chicken, turkey and more. If you're vegan, vegetarian, kosher or simply preservative-free, there are plenty of options in your grocery aisle. Nith so many choices,, it can be hard to decide which is best far yau. Most beef hat dogs contain sodium nitrite or nitrate, a chemical salt used to cure meat, that is reparted to be harmful in high amounts. If it's. nitrites you"d; Iike to stay away from, a beef-free option will be your best bet. All-beef hot dogs also tend to contaln more fat. Options with I'ess fat and salt include vegetarian substitutes, like veggie or tofu dogs, as well as tur'key dogs. Tafu dogs may actually be your best bet as far as protein is concernedi containi!ng a full 3 grarns more than other varieties we examined. Two kinds of the hot dogs we surveyed from a local grocery store contain little to no sugar — the kosher, 100 percent beef

dog and the turkey dog — whiie chicken franks. and tofu and veggle dogs contained cane sugar or syrup to add flavor; Some beef dogs will also have sugar added. Bottom line: Ciassic beef dogs are going to have higher fat and sodium content and contain nitrites. Vegetarian alternatives will have lower sodium and fat levels and may have more protein but also added sugar. Lower-fat options like turkey and chicken dogs will probably need a IIttle assistance from sadium and sugar in the flavor department. •

Pale28

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

a 5 4560 1 '5St

Ball Park Beef Franks Nutrition per 57g serving:190 calories, 16g fat,7g saturated fat,550rng sodium, 7g protein, 2g sugar Contains corn syrup and sodium nitrite.

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Oscar Meyer Classic Beef Franks Nutrition per 45g senring:140 calories, 12g fat, Sg saturated fat, 360mg sodium, Sg protein, 1g sugar Contains corn syrup and sodhium nitrite. SUMMER/FALL 2014HIGH DESERT PULSE

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Applegate Organic Uncured Turkey Hot Dog

Nutrition per429 serving:50 calories,2g fat,Og saturated fat, 330mg sodium, 7g protein, Gg sugar Contains cane syrup.

Nutrition per 48g serving:60 calories, 35g fat, lg saturated fat, 370mg sodium, 7g protein, Og sugar No sodium nitrites, corn syrup or cane syrup.

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Oscar Meyer CheeseHot Dogs

Nutrition per 499 serving: 150calories, 14g fat,6g saturated fat, 460mg sodium,6g protein, Og sugar Contains sodium nitrite.

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Harvestland Uncured ChickenFranks

Nutrition per 43g serving:100 calories,4.5g fat, Og saturated fat, 330mg sodium, 10g protein, 2g sugar

Nutrition per 42g serving:90calories,6g fat, 1.5g saturated fat, 400mg sodium,6g protein, 1g sugar

Contains organic canesugar.

Contains evaporated canesyrup.

SUMMER/FALL2014 HIGHDESERTPULSE

Page20

Gear ~DOG BQQTs

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

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Grip Trex Ruff Wear, $69.95

entral Oregon can be tough on paws. Details: These all-season boots arethe cornpany's most popular. They are Those soft pads that propel dogs along dirt trails, over designed for rocky trails and can work in lightsnow (but notdeep snow) as pavement and up hills aren't as indestructible as our best well asonhotsurfaces. friends make them seem. Rocks and lava can tear up and slice into paws. Hot cement can burn them, and snow and ice can freeze them. While a simple walk around the block probably doesn't warrant special paw protection, a long trek on rocky or snowy terrain prob-

ably does. But not all dog boots are made the same. Some are designed with snow in mind, others for regular hiking or lighter use.

We got the low-down on some canine bootsfrom localm anufacturer Ruff Wear's director of marketing, Susan Strible, as well as Bend Pet Express owner Stephanie Baldwin.

Durable Dog Boots Ultra Paws, 533 Details:As pictured on the dog above, these are rnore everyday boots, in-

tended for lighter use.They provide good traction on flooring andlight hiking trails and offer some snow protection. Baldwln said theyalso stay on very well.

and try the boots on their dogs before committing to a size. • Rewards are key. Many dogs are unsure ofboots. "We get a lot of laughs in here in the store when dogs try on booties for the first many people in New York City and other urban areas who use dog time," said Baldwin. Use positive reinforcement and treats to encourboots to protect their dogs' paws from salt and chemicals used to age their use. With time, pooches shoui'd adjust. de-ice sidewalks in the winter and scalding hot pavement in the

summer. • Try on first. Bend Pet Express allows people to visit the store

Page30

All aboutfit

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

SUMMER/FALL 2014HIGH DESERT PULSE

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

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

Our Physicians and Physicians Assistants Michel Boileau, MD, FACS,Brian O'Ho!iaren, MD, Jack Brewer, MD, Nora Takla, MD, Meredith Baker, MD, Ronald Barrett, MD, FACS William Corrigan, PA-C, Johanna Godell, PA-C, Sara Stafford, PA-C, Jonathan Kelley, PA-C, Jamie Tigner, PA-C

Years of Treatment

iPure 5nnd 4 6g.

BendUrolo

Polar Trex Ruff Wear, $89.95 Details:This is the brand's winter boot designed forgripping in snowandilce The fastener comes up higher on the dog's leg so that snow will stayoutofthe boot.

2090 NE Wyatt Court Suite 101 Bend, Oregon 97701 541,382,6447office 541.388,6862 fax 888.382.6447 toll free

333 NW Larch Avenue Redmond, Oregon 97756

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

541.548.4017 office 541.388,6862 fax 888,382.6447 toll free

Satellite Clinics in John Day, Burns, Lakeview and La Pine C ONTRACTED W I T H

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www.bendurology.com SUMMER/FALL 2014HIGH DESERT PULSE

Pege 31

Profile SUPERD AvE

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

f you've run more than a race or two in Bend, chances are youlve experiencedthework ofDaveThomason. And chances are,you'd know him as SuperDave. Flexing his superpower — a unique ability organize races with a fun, low-key vibe that keeps people coming back for more — he iis the logistical force behind some of the region's most iconic races. With his wife, Carisa, an elementary school physical education teach-

Oregon running scene. "It was very humble beginnings." The first Dirty Half attracted a mere 150 runners, most of whom Dave knew personally. Much to his sueprise, it turned a profit, which the organizers donated to charity. The second year, they lost money, But by the third year, they had worked out the kinks and started a relationship with the Deschutes Land Trust, which now benefits from the race proceeds. Now the race generally sells out its 800 slots. er, the power (running) couple has arguably done as much as any Building off the success of the Dirty Half, Thomason organized the other to keep both young and old in Central Oregon fit and active. Bornin Eugene,Thomason,42,m oved to Bend afterhigh school Horse Butte 10-miler with similar casual beginnings after a run with to study at Central Oregon Community College and to ski at Mt. a friend. "Hey, it's 10 miles. Hey, it's Horse Butte," he said, recapping his Bachelor. "Well, a lot more for skiing than for school," he admits. After two thought process. "Let's call it the Horse Butte 10-miiler." years, he left to complete his degree in exercise science at Oregon Scheduled for April each year, it kicks off the running season for State University but returned to Bend after graduation in 1996. many local runners. That's when he met his wife, 40, also a Eugene native, who ran Year after year, his portfolio of races grew, not so much by design, long-distance races while studying at COCC. She had just returned but organically. Visit Bend asked him to stage a 50K trail run as part to Bend, after having left to complete her degree and run for the of its campaign to promote Central Oregon as a trail running mecca. West Virginia University cross-country team, specializing in 3,000- That become the Flagline 50K. , 5,000- and 10,000-meter races. Carisa began teaching PE for the There's the Twilight 5K Run/Walk„w'hich starts and finishes at the Bend-La Pine school district, while Dave worked the floor at the Foot- Deschutes Brewery, where runners are treated to the brewery's TwiZone running shoe store in downtown Bend, hitting the trails and light Summer Ale. And, there's SuperDave's Down 8 Dirty Second the slopes in between work shifts and school days. Half, whose logo bears its namesake's big-chinned, big-eared mug. It was in the late '90s, when Bend was half the size it is today, that Just this year, he added the Mastadon, a 12-mile run through the Thomason pondered the lack of an intermediate-distance trail run in Maston trail network on BLM land between Tumalo and Redmond Bend. in early March. "Dude, I totally know where to put a trail race in Bend," he recalls Local runners say while the races are never glitzy events, they are telling a friend, and proceeded to plan the very first Dirty Half race, a well-organized and a good value. Where other race organizers rouhalt-marathon trail run that has now become a staple of the Central tinely charge $30 to $40 for a SK, sometimes more than $100 for a

Page32

SUMMER/FALL 2014HIGH DESERT PULSE

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JOEKLINE

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

shoes. "We were like, 'Turkey's cool, but it's really all about pie," he recalls. "You know what? We sholuld start a race and call it the I Like Pie run." As part of the event, people can bring pies for judging or for eating. The run has a suggested $5 or five cans of food donation to Neighborimpact as an entry fee. "We just put a donation bin out there and people stuff it with mon-

ey," he said. What started off as a way to burn some calories before sitting

SUMMER/FALL 2014HIGH DESERT PULSE

down to the holiday meal has grown substantially over the past nine Thanksgivings. Last year, it attracted nearly 1,100 runners. "There are going to have to be some changes," he said. "It's really

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

Page33

Profile JSUPERDAVE

working at Dave's events, and I'll bet it's because Dave has built a great relationship with that guy." Carisa Thomason, a high-energy, diminutive PE teacher, shares ~her husband's gift for getting her charges excited about fitness. Several years ago, a pair of her students wanted to show off their unicycling prowess to their classmates. Carisa not only let them showcase their skills — she learned to unicycle herself and iaunched a unicycling club for kids at the school. She opensthe gym forstudents 'before school fourdays a week — the only exception is the day she must supervise the kids playing outdoors — to practice their unicycling. She started buying unicycles on Craigslist to accommodate kids who wanted to learn and didn*t have a wheel of their own. Soon the numbers swelled so much, she had to limit participation to kids in third grade or older, or younger students who could bring their own

come together to make racers safer. A group of emergency-room unicycles. nurses responded by starting Racing to the Rescue to provide racing By the end of the school year, she had 78 children in the club. events with defibrillators along the race course and trained emer- Some days are designated for beginners, and others for intermediate riders. She secured a $1,200 educational foundation grant to buy 13 gencypersonnelin caseanything goeswrong. While Bend's raciing scene has grown significantly over the past unicydes for the school. Combined with the six cycles she bought decades, local runners say there is stiill a strong sense of community herself, and the kids who bring their own, she can accommodate, on

here.

average, 30 or so children who show up eachday.

"SuperDave is a huge part of that," said Jill Duncan, of Bend. "He She's taken the club to ride in several parades. "T~hat's one of my might not think of himself as a relationship guy. I think he's simpliy goals, getting kids to know how to get involved in the community doing what he enjoys." througih the things we learn in PE," she said. The Thomasons say their competitive running days are mostly beDuncanbelievesthe racesare successes in partbecause ofThomason's ability to connect with participants and the broader commu- hind them. They still enjoy hitting, the trails and have become avid nity. Race organization requires cooperating with the U.S. Forest Ser- CrossFit participants. They have their hands full jiust keeping up with vice or city officials, managing a cadre of race volunteers and work- their 7-year-old son, Clay, already a dead ringer for his lanky dad and ing with local businesses. quickly giving his mother a run for second-tallest in the house. "We see the same guy from Longboard ~Louie's grilling salmon for "When I was racing, I was trying to drop on my friends, 'I will punburritos at many of Dave's races," Duncan said. "He seems to enjoy ish you. I will rip your legs off,"'SuperDave recalls nostalgically."Now

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

I'm the second-fastest person in the house." Indeed, most runners in town can't come up with his true identity. "I've had checks written to me as SuperDave because they don't Now about that name. Thomason said it all stemmed from a know my last name," he said. mountain bike ride he took with a friend in his younger days. "When the ride ended, he said, 'You're not just Dave; you're SuperDoes the bank cash them? You bet.â&#x20AC;˘ Dave!"' he recalls. "He is a very loud individual. It just stuck."

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Paie35

Picture This BABY BQNEs Anterior

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ere o ose ones O7 BY ANDY IIGERT

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

canal.

Skull In an adult, the skull consists of 26 cranial

andfacialbonesfused together along unmovable joints called sutures, with the exception of the mandible, or jaw, which is attached at a movable joint. At birth, many of those bones are notyetfused and iinstead are joined by fibrous membranes called fontanelles. Tihe fontanelles are the so-called "soft spots" on an infant's head. Eventually the fontanelles close as the bones grow together.

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Ossification

The process of changing cartilage to bone is called ossi6cation and begins before birth and continues into a person's 20s. Ossification occurs when capillaries bfing blood to bone-forming cells called osteoblasts. The osteoblasts then begin producing compact bone, covering the cartilage and eventually

replacing it. Sources: "TheHumanBody," Arch CapePress, HowstuffWorks

Pale36

SUMMER/FALL 2014HIGH DESERT PULSE

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2014 CENTRAL OREGON

Y our S o u r c e f o r L o c a l H e a l t h S e r v i c e s a n d E x p e r t M e d i c a l P r o f e s s i o n a l s To list your medical office and/or physicians in the PULSE/Connections Medical Directory contact...

ic'ylie Vi!!geland, Ac c o unt E x e c u t iv e ( H e a lt h Bc Medical) • 5 4 1 . 6 1 7 . 7 8 5 5 •

•

a •

ADULT DAY SERVICE

Qpen Arms Achdt Day Sarvke

ADULT FOSTER CARE

Absolute Serenity Adult Foster Care

AESTHETIC SEBVICES

Dermagpa at Send Dermatology

ALLERGY gc ASTHMA

•-

Send Memorial Clinic

AI ZHIERS gcD~ CA B E C lare Bridge Broohdale SeniorLivtng ASSISTED LIVING

Broohside Place

AUDIOLOGY

AmericanHesrsHearhg Aids

AHDIOLOGY

Central Oregon Andioloi A Hearing AldCUnic

HEHAVIORALHEALTH

St. Charles Behavioral Health

951 SWQmpson Ave ~Bend

541~-362-IB63

www.opensrmsadultcsre.mm

119 N Rope Street• Sisters

541-588-6119

www.absoluteserenity.info

2705NB Couuecs Drive • lend

541-380-9189

Locations in Bend A Redmond

541-3S2-4900

www .bendmemorialdinic.com

1099 NEWattWay cBend

541-385-4717

vw.'brookdsleliving.com

3550 SWCanalBlvd •Redm ond

547 NE Believue• Bend

Bend A Redmond

54 1-504-1600 541-213-2294'

www.beuddenn.com

www.cdiving.com www.amerianhears.com

541-647-2894 www.centraloregousudiology.com

2542 NR Courtuey Drive• Bend

541-706-7738

CANCEBCARE

St. Charles Cancer Center

Locations in Bend A Redmond

541-706-5800

CARDIOLOGY

Bend Memorial Cinic

Locanons m Hend' ARedmond

541-382-4900

CABDIOLOGY

St. Charles Heart 4 Lung Center

2500 NE Netf Road + Bend

541-388-4333

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Bend Msmoriai Clink

2600 NE Neff Roads Bend

541-382-4900

DENTURISTS

ChangkagSmiles Deature chImplant Center 2041 NEWilgsmson CI'Suite C • Bend 541-388-4444

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DENTUBISTS

SistnrsDenture Spedalttea

1'6i E Csstsde ~Sisters

541-.549-0929

ww'w.raordenturecmter.com

DERMATOLOGY

Bend Dermatology Clbaic

2747 NE Conuers Drive• Bend

541-3S2-5712

www.benddenn.com

DERMATOLOGY OHOHS)

Bend Dermatology Clinic

2747~NiEConnecsDrive cBend

541i-382-'5712

wwwibectddem.com

DERMATOLOGY QKOHS)

Bend Memorial Clinic

2600 NE Neff Road• Bend

541-382-4900

www .bendmemorisldinic.com

ENDOCBINOLOGY

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900'

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ENDOCRINOLOGY

BndocrinologyServices NW

929 SW SimpsonAve, Ste220 • Bend 541-317-5600

FAMILY MEDICII

Bend Memorial Clinlc

Locstions in Bend~, Redmond A Sisters

541-382-4900

FAMILY MEDICINE

Central Oregon Family Medidne

645 NW 4th St.• Redmond

541-923-0119

FANHLYMEDICINE

St. Chmlea FamHy Care

2965NEConnersAve,Suite127• Beud

541-706-4800

www a tchsrleshealthare,org

FAMILY MEDICINE

St Charles Family Care

1103 NE Ebn Street• Prheville

541-447-6263

www.stchadeshealthcare,org

FAMILY IDICI

St. Charles FamHyCare

211 NWiLsrehAvcsnce• Redmond

541-548-2164l

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FAHHLYIMCINE

St. Charles Family Care

630 Arrowlesf Trail• Sisters

541-549-1318

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FAMILY PRACTICE

Hlgh Lahns iHealth Care

Loationc in Bead,'Sisters ARedmond 541-389-7741

GASTROENTEROLOGY

Bend Memorial Clinic

1501 NE Medial Center Drive• Bend

541-382-4900 w w w .bendmemorialdinic.com

GASTROEHTEROLOGY

Caatroentsrology of Central Oragcm

2450 Matylose pjsce, Ste210• Bend

54 1-728-0$3'5

GENEBAL DENTISTRY

Coombe and Jones Dentistry

HIMLSIHHBRL~ A

V g ig Qm Advanced Spedalty Care

GEIRAL SIGEKA BAIIATRICS St. Charles Surgical Spedalists GEBIATRICCABEMANAGEMEBT Panl Battle Assodates

774 SW Rimrock WayI Redmond 5 4 1 - 9 23-7633

nta www .bendmemorialdinic.com www.cofin.net

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it241 NE Medimi Center Drive• Bend 541-322-57$3 w w w .advancedspedaltycare,com 1245 NW 4th Street,Ste 101• Redmond 541-548-7761 w

ww . stchsrleshealthcsre.org

Servhg Descbutes County

877-867-1437

www.Paulgattle,com

HOME HEALTH SERVICES

St. Charles Home Health

2500 NE Neff Road• Bend

541-706-7796

www.stchsrleshealthcare.org

HOSPICE/HOME HEALTH

Hospice of Hedmond

732 SW 23rd St• Redmond

548-548-7483

www~andhospice,org

HOSPICE/HOME HEALTH

Partners In Care

2075 NE Wyatt Ct.• Bend

541-382-5882

www.psrtnersbend.org

HOSPITAL

St. Charles Madras

470 NB 'A." Street• Madras

541-786-7796 w ww.stchsrl esheslthare,org

20'l4 CENTRAL OREGON MEDICAL DIRECTORY •

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HOSPITAL

Ploneer Memorlal Hospital

1201 NE Elm St• Prineville

S41-447-62S4

ww w.stcharleshealthcare,org

HOSPITlLL

St. Charles Bend

2580 NE'Ndf Road• Bend

541-382-4321

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HOSPITAL

St Charles Redmond

1253 NE Canal BlvdoRedmond

541-706-7796

www.stcharleshealthcare.org

1501 b(EStedicsl Center Drive • Bend 541-382-4900 w

RYSERBARICOXYGBN THERAPY Send MemorialCNmc

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IMAGING SERVICES

Bend Memorial Clinic

IMMEDIATECARE

NQWcare

IMMEDIATE CARE

High Desert PamgyMedicine gt immediate Care

96RCHOUS DISEASE

Bend Memorial Clinic

L%1MSMmSmlCanter Ddve a Bend 541-382-4900 w

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INFECTIOUSDISEASE

St.CharlesInfectlous Disease

2965 NE Conuera Ave„Suite 127 • Bend 541-706-4878 w

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INTEGRATEDMEDICI

Center fow Integrated Medldne

INTERNAL MEDICINE

Send Memorial Clinic

INTERNAL MEDICI

Hlgh ~ihhes Mealth Care ~Ilpper'MIII

INTERNAL MEDICINE

Internal Medldne Assodates ofRedmond

INTERNAL MEDICINE

Redmondi Medical CNnic

LABORATORY

St.Charles Laboratory Services

MI CAL CLINIC

Bend Memorial Clinic

MSS'SW, Mt. Bscbelor Dr • Bend(West) 541-382-4900

watrwbendmemorialdiniccom

MEDICAL CLINIC

Bend Memorial Clinic

1501NEMedicaiCenterDr• Bend(East) 541-382-4900

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MEDICAL CLINIC

Bend Mdnnorial Cinic

MEDICAL CLINIC

Bend Memorial Clinic

NEPHROLOGY

Bemal Memorial Clinic

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Bend Memorial Clmic

NEUROSURGERY

The CsmtttmOuhopadic aNaurosutjiai Care tttRraaarch

NUTRITION

Send Memorial Clinic

Locations in Bend ARedmond

541-382-4900

2200 bENiff Rd• Bend

541-322-22?5'

wrrtv.thecenteroregon.com

57067 Beaver Dr.• Suuriver

541-593-5400

n/a

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916 SWI?thSt Ste202 •Redm ond 541-504-02'50 wwwcenterfor integratedm ecLcom Send Eastside thWestside

541-382-4900

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929 SWSimpson Ave oBend

541-389-7741

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236 NW Kingwood Ave•Redm ond 541-548-7134

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1245 NW4tih Street, Sie 201• Redmond 541 i-323-4545

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Nine Locations in Central Oregon 5 4 1-706-7717

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SM. Esst~CaicadesAvea Sisters

541-'549-0305

865 SW VeteransWaya Redmond 54 1 - 382-4900 w Locattons m Bend th Bedmond

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OBSTETRICS lh GYNECOLOGY Hast Cascade Women's Group, P.C.

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Lo c ations in Redmond A Priuetillle 5 4 1 -526-6635 w ww . stcbarleshealthcare.org

OCCUPATIONALMEDICINE

Send Memorial Clinic

OCCUPATIONAL MEDICINE

The Center:Onhopcdic ttt Ncurosuriiai Care thResearch

ONCOLOGY -MEDICAL

Locations in Bend' ARedmond

541-382-4900

2200 NE Neff Rd• Bend

541-382-3344

Bend Memorial Clinic

Locations. in Bend ARedmond

541-382-4900

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OPHTHALMOLOGY

Send Memorial Clmic

Locations in Bead ihRedmond

541-382-4900

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Bend Memorial Clinic

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541-382-4900

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integrated Hye Care

452 NE Greenwood Ave.

541-382-5701

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ORTHODONTICS

O'NeIII Orthodontica

Seud A Sunriver

Sggt-523-2396

tvttrw,onelllortho.eom

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Desert Orthopedics

Locatious in Bend A Redmond

541-388-2333

www.desertorthopedics.com

2200 NB Neff Rd• Bend

5'41"-382-3344

ORTHOPEDICS

The Canterrcrrhopafic rhN~ C

OSTEOPOROSIS

Deschutes Osteoporosis Center

PALLIATIVE CARE

St. Charies Ashranced.Illness hlanagement

'2500 NENeff, Roada Rend

541-.786-.5SSO

PALLIAmg CARE

Partners In Care

2075 NE Wyatt Ct• Send

541-382-5882

PEDIATRIC DENTISTRY

Desclutes Pediatric Dentistry

1475 SWChandler Ave, Ste202 a Send 541-389-3073

PEDIATRICS

Bend Memorial Clinic

1080SWMt, Bachelor Dr• Bend(Wesl) 541-382-4900

PEDIATRICS

St. Charles Famlly Care

PHYSICAL MEDICINE

Desert Orthopedics

PHYSICAL MEDICINE

The Center:chthopwikrhN~a ca a ~

ar u g Rtsaarch

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2200 NE Nd'f Road, Suite 302• Bend 541-388-3978 w w w.detchutmoateoporoaiscnttrr.com

211 NW~LarcbAvenue • Redmond 5 4 1 - 548-2164

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Locations in Bend A Redmond

541-388-2333

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2200 NS bieff Rd• Bend

54li-382-3344

www,thecenteroregon.conl

541-382-3344

wwwthecenteroregon.com

PHICAL NEDICllWREELBILITATIOE The Center:Orthopedica Neurosurgial CareAResearch Locations in Bend ih Redmond

20'l4 CENTRAL OREGON MEDICAL DIRECTORY A

•

PIIC/LLNEDICU/E/RE EADILITATIOE

Bend Memorial Clinic

PHYSICAL THERAPY

Healing Bridge Physical Therapy

PODIATRY

Cascade Foot Clink

PULMONOLOGY

Send Memorial Clinic

Locations m Bend A Redmond

541-382-4900

PULMONOLOGY

St Charles Heartih Lnng Center

'Locstions ia Bead A Redmoad

541-706-77ItB

RADIOLOGY

Central Oregon SadiologyAssodates, P.C. 1460 NE Medical Center Dr • Bend 541-382-9383

1581ÃEMedicslCeaterDrive• Bend

541-382-4900 w w w;beadmemorisldinic,com 541-318-7041

404 NE PennAvenue • Bend

9/Ftees ia Bead, Redmond A Madras 541-388-2861

ii REHABILITATIOW

Lsttt itiss'tsBts4 iIiioatLP/hitvillc, Ii/itsdiss 541-706-7725

541-388-3978

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RHEUMATOLOGY

Desdtntes Rheumatnlogy

SLEEP MEDICSE

Send Memorial Clinic

SLEEP MEDICINE

St.Charles Sleep Ceater

SURGICAL SPECIALIST

St. Charles Surgical Spedahtts

SURGICALSPECIALIST

Bend Memorial CIMc

Locst' ionsin Bend'61Redm ond

541-382-4900

www .beadmemodaldinic.com

URGEWTCARE

Bend Memorial Clinic

Locations inBend(East AWest) 8 Redmond

541-382-4900

www .bendmemorialdinic.com

URGENTCARE

NOWcare

2200 NB Neff Rd• Bead

541-322-2273

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URGENTCARE

St. Charles Immediate Care

2600 NE Neff Road• Bend

541-706-3700

www.stcbsrleshealthcsre.org

UROLOGY

Bend Urology Assodates

fAKsgons la Bendi A Redmond

541"-382-6447

www.headurologycom

UROLOGY

UrologySpedaRsts ofOregon

VASCULARSURGEHY

Bend Memorial Clinic

VEIN SPECIALISTS

Inovia Veha Spedalty Center

VEIN SPECIALHi13

Sand Memorial Clmic

ADAM WILLIAMS, MD

2200iNE.NHf RosdlSuit e 302•Bend

www . beadmemorialdinic.com

Send Memorial Clinic

541-382-4900

www.casadefoot.com

RHEIIMATOLOGY

•

Loatioas in Bend A Redmond

www.heslingbridge.com

Loarioas ia Send 8 Redmond

• o •

www. stcharleshealthareorg

541-382-4900

2200 NE Neff Road, Ste 204• Bend 541-382-8346

•

www.stchsrleshealthcare.org

www.urologyinotegon.com ww w beadmemodalcSnic .com www.beadvein.com

54 1 382MOO w w w beachnemodaldiaic,com

•

Bend Eastside BiRedmond

541-382-4900

www .bendmemorialdiaic.com

547iNE Bellevue Dr. Suite S105

5 41-213-2294

wwwameticahears.com

1247 NE Medical Center Dr• Bend

541-322-5753

www.advsacedspecialtycsre.com

1245 NW4tb Street, Ste101• Redmond

541-548-7761

www.stcbsrleshealthcste.org

St. Charles Behavioral Health

2542 NE Churtaey Dr• Bend

541-706-7730

www.stcharleshealthcsre,org

St. arles Behavioral Heal

2642 NE Courtaey Drv Bend

541-786-7738

www.itchsdrshealthare.org

EUGENE ERANZ, PHD

St. Charles Behavioral Health

2542 NE Gourtaey Dr• Bend

541-706-7730

www.stcharleshealthcare.org

ROSSJUDICE, MD

St Cgiarles Behavioral Health

2'$42 NE Courtaey Dr• Bend

541-786-'7730

www.stchsdeshealthare.org

WEWDYLYONS,PSYD

St. Charles Fandly Care

211 NW Larch Ave• Redmond

541-548-2164

www.stcharieshealthcare.org

RKE MAWDEL, MD

Hlgh KahesMealth Care Upper Mill

SONDRAMARSHALL, PEO

St. Charles Behavioral Health

s •

Send Memorial Clinic

www .bendmemodaldiaic.com

541-706-6905

Locations in Besd,Redmond, APriaeville 541-322-5753

601 NEMedhsl Crmer Drive• Bead

wwwbeadsrthitis.com

541-382-4900

1245 NW 4th St. Ste 101• Redmond 541-548-7761

1'50]' NKiMedi@lGeuterDri ve+Bead

www .bendmemorisldinic.com

RANDY MCCALK •

American Hears Hearing Aid's

•

STEPHEN ARCHER,MD, FACS

Advanced Spedalty Care

NGOCTHUYHUGHES, DO, PS St. Charles Surgical Spedalists

KAREN CAMPBELL, PHD

929 SWSbapsoaAvenue v Bend

541-389-'7741 wwwdi il

i d tesheaithcare,com

2542 NE Gourtaey Dr• Bend

541-706-7730

www.stchsrleshealthcate.org

St CRarles Behavioral Health

2542 NE Gourtaey Dr• Bead

541-706-7730

www.stchsrleshesltbcsre.org

REBECCA SCRAFFORD,PSYD St, CharlesBehavioralHealth

2542 NE Courtaey Dr• Bend

541-706-7730

www.stchsrieshealthcsre,org

2965 NEConnersAve,Suite 127 • Bend

541-786-7730

www.stcharieshesithcsre.org

JAMES PORZELIUS,PHD

SCOTT SAFFORD,PHD

Sf.Charles Famlly Care

LAURA SHANK, PSYD

St.Charles Behavioral Health

2642 NE Gourtaey Dr• Bend

541-706-7730

www.stcharleshealthcare.org

KUNBERLYSWMSON, PHD

S t . Charles Fandiy Care

IU NW LatchAve+Redmond

541-548-2164'

w w w.stchsdeshealthare.org

•

AnllBIIISNG SUPPtnamy

2014 CENTRAL OREGON MEDICAL DIRECTORY 6, HUGH ADAIR III, DO

St.Charles Heart thLung Center

CATHERHfE BLACK,PA-C JEAN BROWN,PA-C

'Gi1www.stchsrleshealthcare.org

2500 NE Neff Road• Bend

541-388-4333

Bend Memorial Clinic

1301 NE Medical Center Drive• Bend

541-3$2-4900

ww w .bendmemodaldinic. com

Send Memorial Clinic

1501 NE Medical' Center Drive• Bend

541-382-4900

www ,bendmemorialdinic.com

EIMBERLY CANADAY,ANP-BC Bend Memorial Clmic

1 581 NRMedical Center Drive • Bend

541-382-4900

www ;bendmemodaldinic,com

NAHEL FARKLJ,DO

Send Memorial Clinic

1501 NE MedicaliCenter Dnve• Bend

541-382-4900

www .bendmemorialdinic.com

GAEY FOSTER,XS

St.Chmles Heart thLung Center

25ff0 NE,Nsff Road +Bend

541ii-3$$-4333

www.stcharfesheahhcare.org

RICK KOCH,MD

Send Memorial Clinic

Bend Eastside A Redmond

541-382-4900

JAMES LAUGHLINr MD

St. Charles Heart H Lung Center

2MQ NK:Neff Road! Bend

54$-3$$ =4333

wwwstcharleshesfthcsre.org

BRUCE MCLELLAN, MD

Bt. Charles Heart th Lung Center

2500 NE Ncff Road• Bend

541-388-4333

www.stcharleshealthcare.org

GAVIN L.NOBLE, MD

Send Memorhd Clinic

igend Eastside fkRedmond

541-382-.4900

w w w bendmemousldIllc.conl

STEPKLNIE SCOTT,PA.C

Bend Memorial Clinic

1501 NE MedicaliCenter Drive• Bend

541-382-4900

www .bendmemorialdinic.com

JASONWEST, MD

Send Memorial Clinic

1501 NiEMedical Center Drive • Bend

541-3$2-4900

www ,bendmemoitaldfnic.com

MICHAEL WIDMER, MD

St. Charles Heartth Lung Center

JASON ILWOLLMUTH, MD

Bend Memorial Clinic

EDDY YOUNG,MD

2500 NE NeffRoad• Bend

541-388-4333

www .bendmcmoriafdinic,com

www.slcharieshealthcsre.org

1301 NEMedical Center Drive • Bend

541-382-4900

www ;bendmemorialdinic.com

St.Charles Heart thLung Center

2500 NE Neff Road• Bend

541-388-4333

ww w,stcharfeshealthcare,org

JOHN D. BLIZZARD,MD

St. Charles HeartthLung Center

250Q NENeff Road • Bend

54tu3$8-1i636

ww w.stchalfeshealthcsre.org

ANGELO A.VLESSIS, MD •s••

St. Charles Heart th Lung Center

2500 NE Neff Road• Bend

541-388-1636

ww w.stcharleshealthcare.org

JORDAN T.DOI,MSC, DC

fitorthWest Crossmg Chiropractic AI Esnith

62$MWForh Dr, SIe 104• 'Bend

541i- 38$-2429

www.nwxhsalth.com

TNBRBSA E. RUBADUE,DC,CCSP NorthWest Crosslng Chiropractic th Health

628 NW York Dr, Sle. 104• Bend

541-38$-2429

www.nwxhealth.com

JASONK KREKER,DC,CCSP,CSCS WellnessDoct or

1345 NW Wsil SLSle202 • Bend

541-318-1000

s s

•

w w wibendwellnessdoctor.com

MICEAEL IL HALL, DDS

Central Oregon Dental Center

1563 NW Newpoit Ave• Bend

541-389-0300 www.centraloregondentalcenter.net

BRADLEYE.JOHNSON, DMO

Contemporary Family Dentlstry

1(06 NW NewpoitAve• Bend

541-389-1107 www.csntelsp xaryhniffydentistly.con

•

ALYSSAABBEY, PA-C

Bend Memorlal Clinlc

WILLIAM DELGADO, ED, [EOHS) Send Dermatology Clinic

MARK HALL, MD,

Omtral Oregon Dermatology

FRIDOLINHOESLY,MD

Bend Dermatology Clinic

JAMES M. EOESLY,MD

Bend Memorial Clmic

JOSEUAMAY, MD

Bend A Redmond

541-382-4900

2747 NE Connels Drive• Bend

541-382-5712

388 SW Bluff Dr• Bend

ww w .bendmemorfaldinic.com www.bendderm.com

541-678-0020 www.centrsloregondermatology.com

2747 NE Conners Drive• Bend

541-382-5712

2600 NE Neff Road• Bend

541-382-4900

Send Dermatology Clinic

2747 NE Conners Drive• Bend

541-382-5712

www.bendderm.com

KRISTIN NEUKLUS, MD

Send Dermatology Clinic

2'747 ii~i CQBllels Dtlve• Bend

541i 382 5712

wwmbsndderm.com

GEBALBPETERS,NB,RAIS 060HS)

Send Memorial Clinic

2600 NE Neff Road• Bend

541-382-4900

www .bendmemorialdinic,com

ANN M. BEITAN, PA-C

Send Memoxlal Clinic

2600 NR.Neff Road• Hend

541-3$2-4900

w w w.bendmemolialdinic.com

ALLISON ROBERTS, PA-C

Bend Dermatology Clinic

2747 NE Connels Drive• Bend

541-382-5712

www.bendderm.com

STEPHANI TBAUTMAN, MD Send De~ o g y CBnic

2747 INE Cannels DSVev Bend

541-382-5712

.www,bsndderm.com

LARRY WEBER,PA-C

Bend Dermatology Clinic

2747 NE Conners Drive• Bend

541-382-5712

www.benddenn.com

OLIVERWISCO,DO gKOES)i s• ' s •

Bimd Memorfal Clinic

26QOiNENeffRoad •Bend

541-3$2-4900

www bendmemoitaldfnic.com

MARY F. CARROLL,MD

Bend Memorlal Clinic

1501 NE Medical' Center Drive• Bend

541-382-4900

www .bendmemorisldinic.com

RICK N. GOLDSIIN, MD

Send Memorial Clmic

1501 NE Medical Center Dnve• Bend

541-382-4900

w w i vbendmemomldinic,com

TONYA KOOPMAN,MSN, RNP-BC Send MemorialClinic

1501 NE MedicaliCenter Drive• Bend

541-382-4900

www .bendmemorialdinic,com

www.bendderm.com www ;bendmemodaldinic,com

2014 CENTRAL OREGON MEDICAL DIRECTORY ss '

s •

PATRICK MCCARTHY,MD

AD1%wlsstG sDppinisBT

s EndocrinologyServicesNW

929 SWSimpson Ave,Ste220•Bend

541i-317-5600

n/s

929 SWSimpson Ave,Ste220•Bend

541-317-5600

n/a

TBAVIS MONCHAMP,MD

Endocrinology Services NW

CARET kLLEN, MD

St. Charles Family Care

iii83 NE mm StIeet• iprmevdi

54gii-447-6263

www.stchsrlesheslthcsre.org

HEIDI ALLEN, MD

St Charles Family Care

1103 NE EhnStreet • Prineville

541-447-6263

www.stchsrleshealthcare.org

211NWLNchASenae~gedmond

541 - 548-2164

www . stchsrieshealthcsreorg

1501 NE Medical' Center Drive• Bend

541-382-4900

www .bendmemorialdinic.com

541 - 3 82-4900

www k endmemorialdinic.com

THOMAS L. ALLUMBAUGH, MD St. Charles Fandly Care KATHLEEN C. ANTOLAK, MD Bend Memorial Clinic SADIE kRBINGTON,MD

Bend Memorial Clinic

865. SWVetnans Way• Rsdmoud

JOSEPHBACHTOLD,DO

St.CharlesFamiiy Care

630 Arrowiesf Trail• Sisters

541-549 1318

JEFFBEY P. BOGGESS, MD

Send Memodal Clinic

10'80 SWMt. Bachdor Drive• Bend

541-382-4900

1103 NE Elm Street• Prineville

541-447-6263

SHAION K. BRASHER, Pk-C St. Charles Family Care

MEGHANBBECKE,DO

St.CharlesFamiiy Care

2965 NEConnetsAve,Suite 127• Bend 541-706-4800 w

NANCYBRENNAN, DO

St.Charles Family Care

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

WKLIAM C. CLAIUDGE, MD S t . Charles Family Care

BliNW Larch Avenue •Redm ond

MATHKW CLAUSEN, MO

St Charles Family Care

kUDBEY DAVEY,MD

Bend Memorial Clmic

CABBIE MY, MD

High Lakes Health Care Upper Mill

MkY S. FAN, MD

Bend hiemorial Clinic

JAMIE FREEMAN, PA-C

l%gh Lakes Health Care Upper Mili

YVETTE GAYNOR,FPNC

gt Chadei FamQy Care

630 Armwlssf ~ • Sisuss

MARK GONSKY,DO

St. Charles Family Care

2965 NE ConaersAve,Suite 127 • Bend

NATALIEGOOD, DO

St. Charlea Family Care

liit8 NE Sm Street• Prineville

BRIANNk HART, Pk-C

St Charles Fandly Care

541-548-2164'

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

IOBS SWMt. Bachelor Drive• Bend 541-382-4900 929 SW Simpson Avenue• Bend 231 Bsst Cascadts Avenue• Sisters

929 SW Simpson Avenue• Send

541-389-7741

ALAN C. HKLES, MD

Bend Memorlal Clinic

HEIDIHOLMES, PA4

IUghiLakesiHealth Care Upper Mill

MABK J. HUGHES,D.O

Central Oregon Family Medidne

www bendmemmiialdinic.com www.stchsrleshealthcsre.org ww .stchsrieshealthcare.org

www.stchsrieshealthcsre.org wwwstchsrlesheslthcsre.org www.stcharleshealthcare.org wwwbendmemorisldinic,com www.highlskesheslthcare.com

541 - 5 494B03 w ww .bendmemorialdinic.com

541-389-7741 www.highlskes healthcsre.com

541-706-4800

211 NW Larch Avenue• Redmond 5 4 1 - 548-2164

HARGARBT "PEGGP' NAYIB, FNP Cenn'al Oregon Family idedicme

www.stcharleshealthcare.org

www. stcharleshealthcare.org

www.stcbsrieshealthcare.org

www;cohn.net

645 NW4th St• Redmond

541-923411i9

Redmond Sl Sisters

541-382-4900

www .bendmemorisldinic,com

929 SWSbnpsonAvenue• Bend

541-389-7741

w w w.highlakeshealthcsre,com

645 NW 4th St.• Redmond

541-923-0119 i 541 - 5 48-216d

www.cohn.net

SING-WEI HO, MD

St.CharlesFamily Care

211 NWiarch Aveaue• Redmond

PAMELA J. IRBY,MD

St Charles Familly Care

211 NW Larch Avenue > Redmond 5 4 1 -548-2164

DAVID KELLY, MD

High gnkes SIealth Care Upperh$1

929.SW.Simpson Avenue• Bead

541-389-7741

ww .hghl~t hm r ecom

MAGGIE J. KKG, MD

St. Charles Famlly Care

1103 NE Ehn.Street• Prineville

541-447-6263

www.stcharleshealthcare.org

PETEB LEAVITT, MD

St, Ckaries Fandly Care

2968 NEConnersAve, Sldti 127 • Bind 541-706-4800 v

CIGLBLOTTE LIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

KAE LOVERINK, MD

I Hgh Lakei Health Care ~

541-382-4900

10B1 NWCanal Blvd • Redmond 5 4 1 -.504-7635 w

www.stchsrleshealthcsre.org

wwwstchsrleshealthcare.org

si A v.stchsrleiheslthcsxe.org www ,bendmemorialdinic.com

w t a higidskesheslthcsrecom

STEVE MANN, DO

High Lakes Health Care Upper Mill

929 SWSimpson Avenue• Bend

JOE T. MC COON, MD

St. CBarlei Famiiy Care.

211 %V Lirch Avenuev R edmond 54 1 i-548-2164l

G. BRUCE MCELROY ) MD

Central Oregon Family Isiedidne

LORI MCMILLIAN,FNP

RedmondiMedicai Clink

EDEN MKLER, DO

High Lakes Health Care Sisters

354 W AdamsAvenue • Sisters

541-549-9G09

www .highlakeshealthcatecom

KEVIN MKLER, DO

High LakesiHealth Care Sisters

354 WAdams Avenue• Sisters

541-549-9609

www highlskeshealthcare.com

541-389-7741

w w w.highlskeshealthcare.com

645 NW 4th St.• Redmond

541-389-7741 www.hiig hlakeshealthcare.com

541-923-0119

1245 NW4th Sueet, Ste201• Redmond 541 ii-323-4545

w s tw.stcharieshealthcareorg www.cohn.net

www.redmondmedicaLcom

JESSICAMORGAN, MD

High Lakes Health Care Upper Mill

929 SWSimpson Avenue• Send

DANIEL J. MURPHY,MD

St. Charles Family Care

211 NWiLsrch Avenue• R edmond 5 4 1 i-548-2164

www.stchsrieshealthcsre.org

SHERYL L. NORBIS,MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

www.stchsrleshealthcare.org

541-548-21G4

AGNGNIISINGSUPPtmtENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY AUBREY PEBKINS, FNP

St. Charles Famlly Care

JANEY PURVIS, MD

Bend Memorial Clinic

NATHAN REED, DO

gt. Cltarles Family Care

KEVIN RUETER, MD

High Lakes Health Care Upper MUI

211 NW iLarchAvenue• Redmond 5 4 1 - 548-2164

1561 NEMedical Center Drive • Bend

541-382-4900

S03 NEEhn Street• Prineviile

54ii-447-6263

929 SWSimpson Avenue• Bend

541-389-7741

I'080SWMt.BachelorDrive• Bend 541-382-4900 w

DANA BLREODE, 90

Send Memorial CHnk

HANS G. RUSSELL, MD

Send Memorial Clinic

1501 NE Medical' Center Drive• Bend

ERIC J. SCHNEIDEBv MD

Send Memoriai Clmic

1501 btEMedical CenterDrivev Bend 54 1 -$82=4900

JEFFEBY SCOTT, DO

Send Memorial Clinic

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

LINDA C SELBYvMD

St.Charles Family Care

CINDY SHUMAN, PA-C

Bend Memorial Clinic

DklUEL M. SKOTXE,SR.DO„P.C. ilgh ttesersFamgyLtediche N hmneigate Care

Itta NR Rhu Street• Frineville

54 1-382-4900

541I-447-6263

1080 SWMt. Bachelor Drive• Bend 54 1 - 382-4900 w 57067Beaver Dr. 4 Smuiver

541-593-5400"

www.atcharleshealthcare.org www .bendmemorialdinic.com

w w w.highlakeshealthcare.com ww b endmemorialdmic.com www .bendmemorialdinitcom ww w.bendmsmorialdimc.mm ww . bendmemorialdinic.com

www .stchadekealthcare,org ww . bendmemorlaldinic.com

nta

EDWABD M. TARBET, MD

Send Memorial Clinic

1501 NE Medical' Center Drive• Bend

541-382-4900

www .bendmemorlaldinic.com

JOHN D. TELLER, MD

Send Memorial Clinic

1561 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorisldinic.coin

NATEAN L TEOMPSON, MD S t Charles Family Care

211 NW Larch Avenue• Redmond 5 4 1 - 548-2164

www.stdiarleshealthcare.org

llMTIE E. TOllKE, MD

Bend Memorbal Clinic

LISA URI, MD

High Lakes Health Care Upper Mtll

929 SWSimpson Avenue• Bend

541-389-7741

www.higblakeshealthcare.com

MABK k. VALENTI, MD

St. Charles Pamiiy Care

211 NV ~Larch Avenue • Redmond

541'-548-2164'

www.stcharleshealthcsre.org

TEOMAS k. WARLICK, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialdinic.com

St Charies Famtly Care

1103 NE EhnStreet• Prheville

54ti-447-6263

www .stchaileshealthcsre.org

B e nd M.emorial Clink

Bend Eastside 8 Redmond

541-382-4900

BRUCE N.WILLIAMS, MD 's •

1561NEMedicalCenterDrive• Bend

541-382-4900 w w w.beudmemorialdinic.com

•

BICEABD IL BOCHNEB, MD

ELLEN BOBLAND, MS, RN,CFNP Send MemorialClink

t501 ÃEMedrcal CenterDIive• Bend 541-382-4900 541-382-4900

wwwbendmemoaialdinie,com www .bendmemorialdinic.com

ARTHUR S.CANTOR,MD

Send Memorial Clinic

HHDI CRUISE, PA.C,MS

Send Memorlal Clinic

1561 NEMedical CenterDrive• Bend 541-382-4900 w

CHRISTINA HATABA,MD

Send Memorial Clinic

1501 NE Liedical Center Drive• Bend

541-382-4900

www .bendmemorialdinic.com

SIDNEY E. HENDBBSONIU, MD lend Memorial Clinic

igend Eastside 8 Redmond

541-382-4900

www .bendmemortaldiniccom

SANDRA IL EOLLOWAY, MD S end Memorial Clinic

Bend Eastside 4IRedmond

541-382-4900

www .bendmemorialdinic.com

Bend Eastside 8 Redmond

w w bendmemodaldinic.com

GLENN KOTEEN, MD

Gastroentarology of Central Oregon

2450 Mary Rose Place, Ste 210• Bend

541-728-0535

www .gastracentraloregon.com

JENIFER TURK,Pk-C

Bend Memorial Clinic

1561 NEMedical Center Drive • Bend

541-382-4900

www .bendmemorialdinic.com

MATTHEWWEED, MD

Send Memorial Clinic

1501 iNEMedical Center Drive• Bend

541-382-4900

www .bendmemorialdinic,com

JAHE BIRSCHSACE,MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Send

541-389-7741

w w wXighlakeshealthcare.com

TAMMY BULL, MD

ihgh Maes iHealth Care Upper Mill

929,SW"SimpsonAvenue! Send

841-804-7635

ww w.laghlakeshealthcare.com

1061 NW Canal Blvd.• Redmond

541-504-7635

www X igblakeshealthcare,com

SUSAN GOBMAN,MD •

High Lakes Health Women's Center

LILURIE 9'kVIGNON, MD

Send Mmnorial Clmk

1501 ÃEMedkal Cetiter Dnve• Bend

541-382-4900

ww w bendmemoalaldhiic.com

JON LUTZ, MD

Send Memorial Clinic

1561 NE Medical' Center Drive• Bend

541-382-4900

ww w.bendmemorialdinic.com

BEBECCkSEEBER, MD

St Charles Infectious Dlsease

2965 Conneis Ave,Ste 127 • Bend

541-706-4878

www .stcharleshealthcare,org

JOHN ALLEN, MD

Bend Memorlal Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialdinic.com

JENESSCHRISTENSEN, MD

High ~Lakes~ Health Care Upper Mill

929,SW.Simpson Avenue• Send

541-3SD-7741

www,highlakesheslthcare.com

JOHN CORSO, MD

High Lakes Health Care Upper Mill

929.SWSimpson Avenue• Bend

541-389-7741

www,hi+akeshealthcare.com

CELSO A.GANGAN, MD

Redmond~ Medical Clinic

1245 NW4tb Street, Ste201 • Redmond 541 I-323-4545

MICEAEL N.HARRIS, MD

lend Memorial Clinic

1501 NE Medical' Center Drive• Bend

541-382-4900

www.red'mondmedicaLcom www ,bendmemorialdinic.com

GSKBTIGING suPPLBttBIT

2014 CENTRAL OREGON MEDICAL DIRECTORY www.imredmond.com

ANI IDLLINGBECK, MD

internal Medidne Assodates ofRedmond

ANITA D. KOLISCE, MD

Send hiemorial Clhdc

MATTEEW IL LASALA, MD

S e n d Memorial Clinic

MADELINE LEMEE, MD

lHghrgstkes Health CareIlpper iidNl

9295WSitnpsonAvenue• Bend

541 - 389-7741 st aurwMgblakssbmlthcare.com

MARY MANFREDI, MD

High Lakes Health Care Upper iuttil

929 SW Simpson Avenue• Bend

541-389-7741

IL DEREK PALBIR, MD

Redmond Medical Clinic

1145 N% idtb Street,, Ste201 • Redmond 54Ii-.323-.4545

A. WADE PARKER, MD

Send Memorial Clinic

1501 NE lvledicai Center Drive• Bend

MATTEEWREED, PA.C

236 NW Kingwood Ave•Redm ond 541-548-7134 865 SWVeterausWaya Redmond

541 - 382-4900

www .bendmemorialdinic.com

1501 NE lviediad Center Drive• Bend

541-382-4900

www .bendmemorialdinic.com

541-382-4900

1561NBMedicsiCsnterDrive• Bend 541-382-.4900

MARK SXERNFELD, MD

internal Medldne Assodates ofBedmond

236 NW Kingwood Ave•Redm ond 541-548-7134

DAN SULLIVAN, MD

1501 Ni&Meshcsl Center Drive • Bend

DAVID TRETHEWAY,MD

lnternal Medidne Assodates of Redmond

541-382-4900

23 6 NW Kingwood Ave • Redmond 541-54S-7134

FRANCENAABENDROTE, MD Send Memorial Clinic

w w w.higblakesheslthcare.com

www.xedmondmedicaLcom www .beudmemorialdinic.com

ww w .beadmmoiialdinic.cnm www1mredmond.com www ,bendmemodaldinic.com www.imredmond.com

1301 NEMedicalCenter Drive• Bend

541-382-4900

www .bendmemorialdinic.com

GARY BUCHEOLZ,MD

Bend Memorlal Clinic

2275 NE Doclor's Drive• Bend

541- 3 82-4900

www .bendmemorialdinic,com

GREGORYFERENZ,DO

Send hiemorial CBnic

1501 NEMhdical Center Dnve • Bend

541-382-4900

www .bendmemorialdinic.com

CRAIGAN GRIFFIN, MD

Bend Memorial Clinic

1501 NE Medical' Center Drive• Bend

541-382-4900

www ,bendmemorialdinic.com

RAY TIEN, MD MARK BELZA, MD

The Center:Onhopedica Neurosury'alCareaRaearch 2 2

BRAD WARD, MD

The Center.Otthopedic a Neurosury'ul Care itRes r earch 2 2

Send Spine and Nnurosargery

00 NE Neff Rd • Bend

2273 ÃE Doctor's Dr. Suite 9• Bcnd 0 0NE Ndf Rd• Bend 5

1901 NE htediCal Center DiiVea Bend

541-382-3344

www.tbecenteroregon.com

54 1 -647-.1638

www.bdssmd.com

41-3 82 - 3 3 4 4

www.tbecenteroregon.com

541-382-4900

tVWW2tendmemurialdiaiCCOm

• I

ANN-BRIDGETBID, MD

St Charles Center for Women's Health

Loc atious iu Redmond A Prineville 5 4 1 -526-6635 w ww .stcbsrleshealthcare.org

BRENDA EBMAN, DO

St. CBtaries Center for Women'I'Heaith

Los ationsiu Redmond Bt prineviile 5 4 1 -526-6635 w ww . tttcharleshealthcare,org

NATALIEEOSEAW, MD

St. Charles Center for Women's Health

Loc ations in Redmond Bt Prineviile 5 4 1 -526-6635 w ww. stcbarleshealthcare.org

AiNY B. MCELROY,FNP

St. Charles Center for Women's Heailth

Loc ations in Redmondiprineville A

541 - 526-6685

www.stcbsrieshealthcare.org

CLARE TEOMPSON, DNP,Cm

St . Charles Center for Women's Health Loc ations in Redmond St Prineville 5 4 1 -526-6635

www.stcharleshealthcare.org

•

TIMOTlK EILL„MD

The Center:Ouhoprulic a Ne'umsursial CareGRessirch

2200 NE NeNRd• Bend

541-382-334'4

www. thecentsroregon.com

JAMES NELSON,MD

The CetttertOrthopedic Ih Neurosury'al Carea Research

2200 NE Nef Rd• Bend

541-382-3344

www.tbecenteroregon.com

LARRY PAULSONsMD

The CentnnOrthopedic a Neutosury'al Care aRruearch

2200 NENeif Rd• Bend

541-382-3344

wsvsv.thecenteroregon.com

•

ROB BOONE,MD

St. Charles Cancer Center

Locations in Bend A Redmond

541-706-5800

www.stcbarleshealthcare.org

CORA CALOMENI,iMD

St. Charies Cancer Center

Lutati ons in BendgtRedm ond

541-706-5800

www.stchsrlesheaithcsre.org

SUSI DOEDYNS,ltNP

St. Charles Cancer Center

Locations in Bend StRedmond

541-706-5800

www .stchsrleshealthcare,org

BRIAN L.ERICKSON, MD

Send kiemorial Clinic

igeod Eastsi'de BtRedmoud

541-382-4900

www .beudmemrM4ldinic.com

STEVE KORNFELD, MD

St. Charles Cancer Center

Locations in Bend StRedmond

541-706-5800

wwwstcbsrleshealthcare,org

BILLMARTIN, MD

St. Charles Cancer Center

Locations in Bend StRedmond

541-706-5800

wwwstcbsriesbealthcare.org

BEEJABHN J. MHHOVSKY, MD Bend Memorial Clinic

1501 NE Medical' Center Drive• Bend

541-382-4900

www .bendmemorialdinic.com

LAURIE RICE, ACNP-BG

Send Memorial Clinic

1501 iNEMedical Center Drive • Bend

541-382-4900

www.bendmemozialdinic.com

WILLIAM SCHMIDT, MD

Bend Memorial Clinic

Bend Eastside 8tRedmond

541-382-4900

www.bendmemorialdinic.com

20'l4 CENTRAL OREGON MEDICAL DIRECTORY I

HEATHER WEST,MD

Bend Memorial Clinic

1501NEhdedicaLCenterDrive• Bend 541-382-4900 w

w w .bendmemorialdinic.com

MATTHEWN. SIMMONS

Ilrdlogy SpedaBsts of Oregon

1247 NR hdedrtcai Center Dnve• Bead 541 i-322-5'753

www u rologyinoregon.com

BRIAN P. DESMOND, MD

Bend Memorial Clinic

Bend Eastside, Westaide A Redmond 541-382-4900

ww w,bendmrmorialdinic.com

THOHAS D. ItiTZgmOHBr HD,HPH Bend Memorial Clinic

Bendgastside,WestsideARedmond.

ww w kendmemorialdinic.com

ROBERT C. MATHEWS, MD

Be n d Memorial Clinic

Bend Eastside, Westside A Redmond 541-382-4900

ww w,bendmemoriaidiniccom

SCOTT T. O'CONNER, MD

Bend hiemorral Clinic

Beml Bastglde,Westside A Redmomi 541-382-'4900

w ww;bendmemonaldinic.com

I '

' •

•

Integrated Hye Care

KIT C&RMIENCKE,OD

O MARY ANN ELLEMENT, OD

Integratedlye Care

LORISSA M.HEMMER, OD

Bend Memorial Clinic

MICHAEL MAJERCZYK,OD

Bend Memorial Clinic

•

54 1-38~9 QQ

452 NE GreenwoodAve,

541-382-5701

www.iebend.com

452 NE GreenwoodAve.

541-382-5701

wwwiebend.com

452 NE Greenwood Ave.

541-382-5701

www.iebend.com

Bend~ Eastside, Westside A Redmond 541-382-4900 Bend Eastside gtWestside

541-382-4900

w w w.bendmemorialdinic.com w w w.bendmemorialdinic.com

•

KEIm E. KRUEGKR,DMD, PC Knith E. Krneger, DMD, PC. I '

•

AARONASKEW,MD

1425 Slrlt Chinrger, Ste 101o Bend 541-617-3999 W

ww; d rkeithhueger.com

•

~ Desert Orthopedics

Locations in Bend ih Redmond

ANTHONY Hmr MD

The Center:Onhopedic aNeurosurgtodcarea Rese areh

JEFFREY P. HOLMBOE, MD

The Center:Orthopedi«aNeurosurglod CareaRes earch Locations in Bend A Redmond

JOEL MOORE,.MD

The Canter:chdtopedic aNeumsurgical caura Rese arch

KNUTE BUEHLER, MD

541 - 388-2333

www .desertorthopedics.com

541-382-3344

wsa wthecenteroregon.com

541-382-3344

www.thecenteroregon.com

2200t NE Ãeff Rd• Bend

541-382-3344

wwatcthecenteroregon.cnrn

The Center:Orthopedica NeurosurgicalCareI Resesrrh

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

MICHAEL CARAVELLI,MD

The Centsr:Orthopedic aNeorusurtpodCareILReseaich

2206 NBNeff Rd• Bend

541'-382-3344

www.lhecentemregon.com

ERIN FINTER, MD

Desert Orthopedics

Locations in Bend gtRedmond

541-388-2333

www.desertorthopedics.com

JAlSES HALL, MD

The Center:Orthopedic aNeurosurghal Care4 Rese areh

2200 NE Neff Rd• Bend

541'-382-3344

www.thecenteroregon.com

ROBERTSHANNON, MD

Desert Orthopedics

Locations in Bend gtRedmond

541-388-2333

www.desertorthopedics.com

54lu388-2333

www.desertorthopedics.com

• '

I '

2200 NB Neff Rd• Bend

•

MICHAEL RYANsMD

•

• I •

Deseat Orthopedks

L363' NE CughjngGg Ste100•Bend

GREG HA, MD

Desert Orthopedics

1303NECusbingDr,Ste100• Bend 541-388-2333 w

ww. desertorthopedics,com

KATHLEEN MOORE,MD

Desnrt Orthopehca

1508Ng Cughbag6r, Ste 100I Bend 541c388-2333 w

ww. desertorthopedicacom

I '

• I

•

Z200NENISRda Bend

541i-382-9344

wwwthecenmroregon.com

1315 NW4th Street• Redmond

541-388-2333

www.deserlorthopedics.com

220~0 NBIdeff Rd • Bend

541'-382-3344

wwwthecenteroregon.com

541-382-3344

www.thecenteroregon.com

TIMOTHY BOLLOM,MD

The CenteraOrthopedie aNaurosurgiod CareStResaarrh

BRE1T GINGOLD,MD

Desert Orthopedics

SCO1TJACOBSON,MD

The CenterrOithopedic ih Neurosurgtal'Gue a gesearsh

BLAKE NONWEILER,MD

The Center:Oithopedic aNeurosurgicaiCareI Rese arch Locations in Bend A Redmond • I •

CARAWALTHER, MD I '

• '

• I •

Desest Orthopedics

1305 NE CushingOr, Ste 100 • Bend 54lk-388-2333 w

ww . desertorthopedics.com

MICHAEL COE,MD

The Center:OithopedicaNurosurgicalCarea Resea rch Locations in Bend St Redmond

541-382-3344

www.thecenteroregon.com

KENNETH HANINGTON,MD

o ~~ruoo~~

541i-388-2333

www.desertoithopedics.com

Locations in Send dt Redmond

2014 CENTRAL OREGON MEDICAL DIRECTORY I '

•

Desert Orthopedics

SOMA LILLY, MD

The CentawOnhopedic aNeurosury'cal Carea Researeh

•

anvat t tstaasupptRMRa t

•

AARON HOBLET,MD

•

4 T

• •

JAMES VERHEYDEN, MD

Locations in Bend A Redmond

541-388-2333

www.desertorthopedics.com

2208 NE ttleff Rd• Bend

54t i-382-3344

www.thecenteroregon.com

The Center:Orthopedic aNeurosurgicalCaregtResearch Locations in Bend Bt Redmond 5

41- 3 8 2-3344

www.tbecenteroregon.com

MOLLY OWZO,MD

Desehattes Osteoporoiis Center

JENNY BLECIIMAN, MD

Partners In Care

2075 NE Wyan Ct• Bend

541-382-5882

www.partnersbend.org

USA LEWIS, MD

Partners In Care

2075 NEVdjatt Ct • Bend

541u382-5882

www.psatnershend.org

RICHARD J.MAUNDER, MD

St.CharlesAdvanced lllnessManagement

2508 NE Neff RoaduBend

541-706-5885

www.stcbarleshealthcare.org

LAUBA ILMAVITY, M D

St. Gh'atIeaAdvancedSness Management

2580 NE Neff RoaduBend

541-70'6-5885

www.slcharieshealthcsre,org

2280 hmNeifRosd, Suite 302• Bend 54I ts388-3978 wtswdssChtfeinsteopoaoshcenteccom

STEPHANIE CHBISTENSEN,DMD Deschutes Pediiatric Dentistry

14?5 SW Chandler Ave,Ste• Bend 54 1 -389-3073 w

STEVE CHRISTENSEN, DMD D e adtntes POIatric Denthstry

1475 S'WChandler Ave, Ste• Bend

54 1 -389'-3073

www, d eschuteskids.com

•

ww. d escbuteskids.com

•

BROOKS BOOKER,MD

Bend Memorial Ciinic

1080 SW Mt. Bachelor Drive • Bend

54 1 -382-4900

www.beudmemorialdimc.com

KATE L. BBOADMAN,MD

Bend Memorial Clinic

1888 SWMt. Bachdor Drive• Bend

54 1-382-4900

www;bendmemodaldinic.com

THOMASN. EBNST,MD

St. Charles Famlly Care

211 NW Larch Ave• Redmond

541-548-2164

wwwstcbarleshealthcare.org

JENIER GRISWOLDrPNP B end Memorial Clmic

l080 SW tsn.Bacbelor Drive • Bend 541-382-4980

www,hendmimoxialdiuic,com

MICHELLE MILLS, MD

Send Memorial Clinic

1080 SWMt. Bachelor Drive• Bend 541-382-4900

www.bendmemorialdinic.com

MARGARET J.PHILPeMD

St, ChariswFammyCare

JENNDRB SCHROEDER, MD S end Memorial Clinic

211 NWimdt Aveu Redmond

541-548M64

1080SWMt. Bachelor Drive• Bend 541-382-4900

www.bendmemorialdinic.com

I'0(88 SWli4 Bachelor Drhe• Berui

541-382-4900

wwwbeudmemodsldiuic,com

www.desestorthopedic3.com

JB WABTON,DO

Bend hiemorial Clinic

ROBERTANDREWS,MD

Desert Orthopedics

Locations in Beud StRedmond

541-38&-2333

LINDA CARROLL, MD

IHgh iLakes Heslth Care Upper'Mtll

929.SWSimpsonAvenue• Bend

541-389-7741 wwwihighlakeshealthcare.com

TIM IHLL, MD

The Center:OnhopedicaNeurosury'calCareaReseach r Locations in Bend A Redmond

NANCY H.MALONEY,MD

Bend Memorial CBnic

JAMES NELSON,MD

The Center: Orthopedic aNeurosurgical CaregtResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

LARRY PAULSON,MD

The Center:Onhopedic aNeurostuy'cal CaretLResearch

2200iNE Neff Rd• Bend

541-382-3344'

w w w .thecenteroregon.com

DAVID STEWART,MD

The CentersOnhupedicgrNeurosurgical Carea Research

2200 NE Neif Rda Bend

541-382-3344

w w w .thecenteroregon.com

JON SWIFT, DO

Desert Orthopedics

541-382-3344

www.thecenteroregon.com

1501 NEMedical Center Drive • Bend 541-382-4900 www.bendmemorialdinic,com

'lereatiens m Bend' ihRedmond

541-38L2333 www;desertort hopedics,com

VIVIAWEUGALDE, MD

The Center:Onhopshc a Neurosury'od Carea Research

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

MABC WAGNEB,MD

"The Canter:Gnhopedica N'eturuurycal Carea Rruesteh

2208iNZ Neff Bd• Bend

541.-382-3344'

www&ecentemregon.com

• I

DEAN NAKADATE,DPM ••

I •

Deschutes Foot gt Ankle

929 SWSiminon Ave,Ste220•Bend

541-317-5600 www.deschutes footandankle.com

25BQNENeffRoad •Bend

541 -706-2949 www .tttchadesh ealthcsre,org

•

BROOKEHALL, MD I

•

St. Charles Preoperntive Medicine

JONATNAN BBEWER, DO,D ABSM Bend Memorial Clinic JAMIE DAVID CONKLIN, MD S t , Charles Pnlmonary Clknic LOUISD'AVIGNON, MD

Bend Memorhsl CBnic

Bend Eastside gtRedmond LocatlonsinBendARedmond Bend Eastside gtRedmond

541-382-4900 541 - 706-7715 541-382-4900

www .bendmemorialdiuic.com ww w stchsrlesheslthcareorg www .bendmemorialdinic,com

2014 CENTRAL OREGON MEDICAL DIRECTORY I

ERIC S. DILDINE, PAC

St. Charles Pulmonary CBnic

LocationsinBendARedmond

541- 7 06-7715 w ww .itcbsrleshealthcare.org

CHRIS KELLEY, DO,D-ABSM Bend Memorial Clinic

Bend Eastside ARedmond

541-382-4900

w ww.bendmemorialdinic.com

JONATHAN MCFADYEN, NP.BC Bead Memorial Clmic

li'504NErMedicai CenterDnve • Bend

841-882-4900

w w w.bendmemorialdinic.com

KEVIN SHERER, MD I

•

St Charles Pulmonary CHaic

STEVEN MICHEL, lRD I

raaa Ngelergoa roeaegr • ge g ggl ggggggg

Central Oregon Radiology Assodates, P.C. 1460 NE Medical Center Dr • Bend 541-382-9383

ROBERT HOGAN,MD

•

541- 7 06-7715 w ww . itcbsrleihealthcare.org

• I I

ggglgggggTIgggggggMg gaoeeg Orego gadl loggaaooaaooapC,

Locations in Bend ARedmond

Oregun Badiology kssociatea, P.C. 1480 NE Medical Center Dr I Send

www.corapc.com

5 4 C382g9383 1

www.corspc.com

541-382-9383

www.corapc.com

• •

PATRICKBROWN, MD

Central Oregon Radiology AssodatesgP.C.

STEVE KJOBECHrMD

Cented Oregoa Badlology Assodates, P.C. 1460 NE Medical Center Dr • Bend 54S-382-9383

www.colapc.com

GABRETT SCHROEDER,MD

Central Oregon Badiology Assodates,P.C. 1460NE M edicalCenterDr•Bend

541-382-9383

www.corspc.com

DAVID ZULAUF,MD

Central Oregoa Badiology Assodates, P.C. 1460 NE Medical Center Dr • Bend

5 4 C382-9883 1

www.corapc.conl

Central Oregon Radiology Assodates,P.C . 1460NE M edicalCenterDr•Bend

541-382-9383

www.corapc.com

Central Oregoa Radiologykssodates, P.C. 1460 ÃE Medicai Center Dr • Send

54 1'-382-9383

wwwcorspc.com

•

THOMAS KOEHLER,MD

JOHN STASSEN,MD I

' I ' ' I

JEFFREY DRUTMAN, MD

•

Central Oregon Radiology Assodates, P.C. 1460 NE Medical Center Dr • Bend 541-382-9383 Oregua BadiOlOgyASSOaataa, P.C.

RONALD HANSONiMD I

1460 NEMedicalCenterDr•Bend

' I ' ' I

www.corspc.com

1460 NE Meldiad Center Dr • Serid Bgkli-382g9S83

JAMES JOHNSON,MD

Central Oregon Radiology Assodates,P.C. 1460NE M edicalCenterDr•Bend

541-382-9383

www.corapc.com

WILLIAM WHEIR HI, MD

Ceatrai Oregoa lhuBolol Assodates,PC.

1460 NEMedicaiCenterDr•Bend

541i-382-9383

www.colapc.com

Central Oregon Radiology Assodates,P.C.

1460 NEMedicalCenterDr•Bend

541-382-9383

www.corapc,conl

CentralOregongadfiologykssodatesaP.C. 1460NEMedicalCenterDr • Bend

5 4 C382-9383 1

wwwcolspc.com

STEPHEN SHULTZ, MD

Central Oregon Radiology Assodates,P.C.

1460NE M edicalCenterDr•Bend

541-382-9383

www.corapc.com

CLOE SHELTON,MD

Cgsrtral Oregon ladiologykssodatergPaC.

1%0 NE Mediod Center Dr • Bend

o382-.9383 541

www,corapc.com

NOBEEN C. MILLER, FSP

St. Charles BehahQitatioa Center

2500 NENefIRoad •Send

541- 706-7725 w w w s tcbarlesb ealthcare,org

CHRISTINA BRIGHT,MD

Bimd Mamorlal Chaic

igerid ESstsidagiRediriorid

54l-382-4900

DMEL E. FOHRHAN,HD

High Lakes Health Care Upper Mill

•

LAURIE MARTIN,MD I

PAULA SHULTZ, MD I

•

929 SW Simpson Avenue• Bend

v sww2lendmemodaldinic.com

541-389-7741 www.highlakeshealthcare.com

BEA'IB NANSEN-DISPBN @L, HD Deschutes Rhemnatology

2200NE.NeffRoad,Suite302•Bend

54S-388-3978

www.besdartbritis.com

TIANNA WELCH,PA

2200 NENeffRoad,Suite302•Bend

541-388-3978

www,bendartbritis.com

Deschutes Rheumatology

JONATHAN BREWER, DO,D-ABSH Bend hfemorial Clinic Sleep DhordersCenter

»Send

541-382-4900 www.bendmemoria dini l c,com

ARTHUR K CONRAD,MD

St. Charles Sleep Center

Locations in Bend A Redmond

541-706-6905

www.stcbarleshealthcare.org

DAVID L. DEDRICK, MD

St. Charles Sleep Center

'Locations in Bend' A Redmond

541-70lj-690$

ww w,stcbsrleshealtbcarcorg

Bend

541-382-4900

w ww.bendmemorialdinic.com

CHRIS KELLEY, DO, DABSM Bend Memorial Clinic SleepDisordersCenter

rm%RttslNG sllpr )LEssurr

2014 CENTRAL OREGON M E D ICAL DIRECTORY •

•

DAVID HERRIN, DC

Bechaond WdlnessgrChiropractic

TIMOTHY L. BEARD) MD, FACS Bend Memorial Clinic

DAVID CARNE, MD

St. Charles Surgical Spedalhrts

GARY J.FREI, MD, FkCS

Bend Memorial Gliaic

1655SW HighlsudAve,SteG•Redmond 541i 923 RG19

www.drherrin.com

1501 NE Medicsl' Center Drive• Bend

541-382-4900

QI5 NESmsPriaevige

541-548-776I

www. stcharieshealthcsre.org

Bead Eastside rir Redmond

541-382-4900

www .beudmemorisldinic,com

1245 Nbrf4th Str ¹101 • Redmond 541-548»-/'

SEAN HEALY, Pk-C

Bend Memorial Glmic

1501 NE Medicsii Center Drive• Bend

DARREN M.KOWALMU, MD ) Fkt3

• a)) o au en

1501 t)ig Medicsl Csnter Drive < Bead 54 1 382-4900 w

JOHN C. LkND, MD, FACS

St Charles Surgical Spedalists

1245NW4thSrreet,¹101• Redmond 541-548-7761 w

SUZANNEMARCATO,Pk

St. Cftarles Surgical Spedalists

ANDREW SARGENT,PA-C,MS

Bend Memorial Clinic

RONALDSPROAT,MD

St. Charles Surglcal Spedalists

541-382-4900

Iita iiNE Elm• Prinevilie

541-548-7761

1501 NE Medical' Center Drive• Bend

541-382-4900

1103i'NE Elmv Priaevilie

541-548-77G1

ww w .bendmemorialdin ic.com

www.st esheslthcareu@ www .bendmemorialdinic,com ww . ~ o

iiald i niccom

ww s tcharleshealthcare.org

www.stchsrleshealthcare,org www .bendmemorialdinic.com

www.stchariesheslthcare.org

•

GEORGE T. TSAI,MD, FACS

St. Charles Surgical Spedalists

1245 NW4th Street, ¹101• Redmond 541-548-7761 w

ww s tcharleshealthcare,org

JEANI WADSWORTH, PA.C,MS Send Memorial Clinic

L501 t)ig Medical Center Drive < Bend 541 38'2-4900 w w w .bendmemorialdinic.com

ERIN WALLING, MD,FACS

Bend Memorial Clinic

1501 NE MedicaiiCenter Drive• Bend

541-382-4900

JEFF CABA, PA4

Send Meniodal Clink

Bend @stside, Westside A Redmond

54 1 382-4900 w ww .bendmemoiialdiniccom

ANNCLEMENS,MD

Bend Memorial Clinic

Bead Eastside, Westside A Redmond

54 1 -382-4900

www.bendmemorialdinic.com

TERESk COUSINEAU,Pk-C

Band hhnaorii1 Clinlic

Qeridi E @Me, Weirtside gr Redmond

54ls382-4900

wws beudmsmoruddnuc,com

MIKE HUDSON, MD

St. Charles Immediate Care

2600 NE Neff Roadv Bend

541-706-3700

www.stcharleshealthcare.org

J,RANDALLJACOBS, MD

Bead Metaorial Clmk

Bergl Bs¹rride, Westside ARedmond

541i.382 4900

wwwkendmemorisldiniccom

ADAM KAPLAN) Pk-C

Bend Memorial Glink

Bend Eastside,Westside A Redmond 541-382-4900

www .bendmemorialdinic.com

w w w.bendmemorialdinic,com

KERRY MAWDSLEY,FNP-BC Sead Memorial CHnic

Bend Eastside, Westside ARedmond

TERRACEMUCHA, MD

Bend Memorial Cliaic

Bend Eastside, WestsideARedmond 541-3S2-4900

w w w.bendmemorialdinic.com

JAY O'BRIEN, PA.C

Bend idemorlal Clllllc

Bend Eastside, Westsidek Redmond 541-3S2-4900

w w wbendmemoriaidinic.com

54 1'-382-4900 www .beudmemorialdinic.com

RICHARDOOMAR GAREA, FNP St. Charles Immediate Care

1501 NE Medical' Center Drive• Bend

541-382-4900

CASEYOSB ORI4ODHOUSE, PA4 Bend Memorial Clink

Bendi Eastside,Westside A Redmond

54 1-382-4900

LAURIE D. PONTE, MD

Bend Memorial Clinic

Bend Eastside,Westside A Redmond 541-382-4900

JONATHANSCHULTZ

gt CRarles Immediate Care

PATRICK L. SIMNING, MD

Bend Memorial Clinic

2608 NENeif Road• Bend

541i-706-3700

www.stcharleshealthcare.org ww w .beudmemorialdinic.com w w w.bendmemorialdinic.com

www.wcharlssheslthcare,org

Bend Eastside, Westside gr Redmond 541-382-4900

ww vt).bendmemorialdiniccom

JENIER L. STEWkRT, MD B aad hhnaur'ial CBaic

Biand Esgside,We¹rside A Redmond

ww w lendmemorialdiniccom

SEkNSUITLE, Pk-C

Bend Memorial Cliaic

BendEastside,WestsideARedmond 541-382-4900

w w wbendmemorialdinic.com

Seud Etrstside,Wsstside grRedmond

54 1-382-4900

wr) rwbeudmemo@ldiniccom

St, Charles Immediate Care

1501 NE Medicsii Center Drive• Bend

54 1-382-4900

BRKNT C. WESEEIRG) MD MICHELLE WRIGHT,FNP

54 1-382-4900

www.stcharleshealthcsre.org

•

Bend Urology Assodates

2898NSWyattCburt•Bend

5@lii -382 6447

ww)rv.bsndurology.com

RONALD BARRETT, MD, FACS Bend Urology Assodates

2090 NE Wyatt Court• Bend

541-382-6447

www.bendurology.com

MICHEL BOILEAU, MD, FACS Bend Urology Assodates

2090 NE WyauCourt • Bend

54lh-382-6447

www.bendurology.com

JACK BREWER,MD

Bend Urology Assodates

2090 NE Wyatt Counv Bend

541-382-G447

www.bendurology.com

kNDREW SEES, MD

UrologySpedalists ofOregon

BRIAN O'HOLLAREN,MD

Bend Urology Associates

1247 NE Medir3l Center Drive• Bend 54l i-322-57$3 2090 NE Wyatt Court• Bend

541-382-6447

))rrvwurologyinoregon.com www.bendurology.com

20'l4 CENTRAL OREGON MEDICAL DIRECTORY 'a

•

MATTHEW N. SIMMONS,MD

Ur o logy Spedalists of Oregon

1247 NE Medical Center Drive• Bend 541c322-5753

Sead Urology Assodates

2090 NEWyattCourt•Bend 54 1 -382-6447

www.mologyinoregon.com www.bendurology.com

1247.NE MetmcalCenter Drive • Bend 541~'-322-5753 wwwadvamcedspedaltycare,com

ROD BliZZAS,MD EDWARDK BOVLE,JR.,MD,FACS lnovia Vein Specialty Center

2200 NE Neif Road, Ste 204• Bend 541-382-8346

wwwbendvein,com

ANDREWJO1KS, MD, FACS

lnovia Vdn.,gpechlty Ceater

2290tNRNeifknad„Ste204 •Bend

wwwbendveh.com

DARREN KOWALSEI, MD

Bead Memorial Clinic

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

WATNE K NELSON,MD

Send Memorial Cliiaic

1501 ÃE Medical Gmter Drive• Bend 541-382-4900 w t a wbendmemorialdbtlc.com

54B-382-8346

w w .bendmemorialdiniccom

SAMmL CHRISTENSEN, PA-C Bend Memorial Chnic

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

ww b endmemorialdinic.com

JASONJUNDT,MD

Bend Memorial Clinic

1501N~EMedicalCenterDrive• Bend 541-382-4900 w

w w bendmemorialdinic,com

WATNE ILNELSON, MD

Bend Memorial Clinic

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

w w .bendmemorialdinic.com

)

P AID A D V E R T l iS ING SU PPL EM E N T To be included inthe next issue of the PULSE/Connections Medical Directory, contact:

K ylie V i g e l a nd , A c c o u n t E x e c u t i v gt ( Health & M e d i c a l ) 541.617.7855

Coverstory ISUPPLEMENTS

ContinuedfromPage9

eyelids, among other symptoms, Fraunfelder said. Lots of people

to perform transp'lants on younger, healthier patients because their long-term outcomes are generally better, he said. What's more likely the case, Navarro said, is people are using supplements in risky ways. Theylre taking too many. Fasting while taking them. Mixing them. And they're usually not telling their doctors. "I suspect that it has something to do with the behavior of how these products are used that may contribute to them leading to certain toxicities," he said. Additionally, very few of the supplement-related liver injuries Navarro sees are the result of taking a single herb. Rather, they more commonly follow the consumption of a mixture of herbs from vari-

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

ous supplements. "I suspect that it's the mixtures that might come together and form a particularly toxic combination and be responsible for the in-

jury also," he said. The side effects of supplements extend well beyond the liver. When a 35-year-old woman turned up last year at the Oregon Health 8 Science University emergency room sweating with slurred speech and difficulty walking, emergency medicine physician Robert Hendrickson and his colleagues recognized the problem right away: serotonin toxicity. It took longer to figure out how the patient's serotonin leve~ls had reached a life-threatening level. After a few doses of ani antidote in eight-hour intervals, her symptoms subsided and Hendrickson, associate medical director of the Oregon Poison Center, asked her what medications she was taking. It turns out, in addition to the antidepressant she had been taking for two years, she had recently begun taking garcinia cambogia to lose weight. After some research,

Hendrickson realized garcinia cambogia causes serotonin levels in

the brain to increase — the same effect prompted by selective serotonin reuptake inhibitors (SSRls), medications used to treat depression. Together, the mixture spelled disaster for the patient, who had been to the ER before for the same problem but never told doctors scented candles near the register. The rows of shelves are packed she was taking the supplement. with large tubs of protein powder, smaller bottles of preworkout It's the first of such cases Hendrickson has seen, and until he supplements, mass gainers, fat burners and megavitamins. leams more, he warns people against mixing garcinia cambogia and Nordstog, 28, has a degree in advertising from the University of antidepressants. Hendrickson hopes to learn more about whether Oklahoma but said many of her general education courses covered there have been cases similar to the one he saw. nutrition and exercise science. And she's got years of experience tak"If there is, I think thls wiill be a little bit of a public health crisis," ing supplements herself. "Tess is extremely knowledgeable," said Chasity Barker, who first he said, "and I think we probably will go to our public health agencies and also to the FDA to see if they can at least get out some met Nordstog about a year ago while bulking up before her first bikiinformation." ni competition. "She's good about directing you to the right path. I've Fraunfelder, the University of Missouri ophthalmologist, researched been in there when people are like, 'I want this,' and she's like, 'You for years while at OHSU the lesser-discussed ocular side effects of supknow, maybe you don't. Maybe try going this route.'" plements, which can range f'rom something as benign as dry eyes to Barker, a 41-year-old corrective exercise specialist at Max Fitness severe conditions like retinal hemorrhaging and transient vision loss. in Bend, first set her sights on bodybuilding when she was 21 and He's seen cases where patients taking ginkgo biloba, a supple- has been taking supplements ever since. A half-hour before every ment commonly used to treat tinnitus, ended up with retinal hem- workout, Barker takes the preworkout supplements Karbolyn, a orrhaging. Niacin, a supplement shown to improve cholesterol lev- powder she said is packed with carbohydrates, and noncaffeinated els, has been tied to decreased vision, cystoid macular edema — a Kre-Alkalyn, a form of creatine. "Basically, what it does, itjust fuels you," she said ofher preworkout condition that can cause retinal swelling — and discoloration of the

SUMMER/FALL2014 HIGH DESERTPULSE

I •

•

'IPU"fP."

'sy-gl ~

JOE KUNE

Tess Nordstog, owner of Fit Pit, which sells supplementsin Bend, says mostharm thatcomes from supplementsis from user error.

from DMAA to the FDA, including six deaths. supplements. "It gives you that energy to get into your workout." During her workouts, Barker pauses to take Xtend, a powdered That one hit home for Nordstog, who bought up her own personal supplement containing branched-chain amino acids (BCAA) that's de- hoard of the stuff when she found out it was getting banned. signed to promote muscle recovery and boost energy during work- "I love DMAA," she said. That's typically how it goes when supplements are banned. People outs. Afterward, she takes more Kre-Alkalyn, which is swallowed in a capsule, and Cell K.E.M., another BCAA supplement taken in powder race out to buy them before they're taken off shelves, either to take form. them themselves or sell them online. Nordstog usually lets her cusEvery so often, Nordstog gets word from one of the companies she tomers know ahead of time and waits for the mad rush. buys supplements from telling her to stop selling a certain product. Last year, two companies announced they would stop making their The FDA warns companies if it receives enough complaints, which popular preworkout supplements Craze, a drink mix, and Driven, usually prompts them to stop selling the products. a pill, after iindependent tests found they contained a methamphetBut, the way Nordstog seesiit, anytime someone gets harmed from amine-like compound. The news shocked Nordstog. '%hen I used to sell Detonate before we all knew there was somea supplement, it's user error, not because the product is dangerous. "It's like, great, Joe Schmo takes five when it says on the bottle to thing naughty in it; I was like, 'This is my little customer service in a take one, has a heart attack on the treadmill or whatever, and then it pill,"' she said, laughing. "And then I was like, 'No wonder — I was on ruins it for everybody else," she said. meth all day' — just kidding, it wasn't that bad." Manufacturers using an ingredient called 1,3-dimethylamylamine, On the popular website Bodybu~ilding.com, users frequent the Iorums or DMAA, have in recent years voluntarily recalled their products after to express themselves and share tips on working out, dieting and supthe FDA warned it would otherwise do so forcibly. Typically marketed plements. TIhe FDA is resoundingly unpopular among the forum's users, as natural stimulant because it's made from geranium extract, DMAA who've posted dozens of rants slamming the agencyfor trying to ban the was often stacked in supplements with other stimulants like caffeine, supplements usershavefound the most effective for muscle-building. often raising peoples' blood pressures and causing heart attacks and One user, posting under the name The Conqueror, reasoned that strokes. The recall followed more than 100 reports of side effects people who take supplements are not putting others in danger.

PageSO

SUMMER/FALL Z014HIGH DESERT PULSE

"Are you going to kill someone driving down the road? Are you want to make sure the ingredients they purchased from suppliers are going to kill somebody by operating heavy equipment. It doesn't put you 'under the influence' or anything negative! WHAT? If you take too much or abuse it WHO PAYS the price....we would! IT'S OUR DAMN BUSINESSNOT THEIRS!!!" ! ardner, of CSPI, said attitudes like that demonstrate that many of the people who take supplements to build muscle are, simply put, committing drug abuse. They know the products are not good for their bodies but continue to take them because they work. When Cardner is looklng for unscrupulous supplement companies to sue, he said he generally focuses on companies that prey on desperate people — advertising useless products for weight loss, for example. CSPI sued Coca-Cola for saying their soft drink Enviga contained so much caffeine that consumers would bum more calories than they took in drinking It. "For me, if I'm going to protect someone, I want to protect the unwitting, not the deliberate," Cardner said. "They know they're at risk and they're mad in the rare moments the FDA bans something." Navarro, the hepatologist with the Einstein Institute, holds the opposite perspective. He said he believes the manufacturers who stack muscle-building supplements with various mixtures of banned stimulants and anabolic steroids represent the most egregious regulatory violations in the supplement industry. It would almost take a forensic lab to determine precisely what chemical combination is in each supplement, he said. "What's happening is that chemical companies or companies are learning to circumnavigate what the FDA looks for with these designer steroids by essentially chemically altering the steroid structure so that it becomes undetectable," he said. Another problem is that companies are not transparent on the labels about what's actually in the products, said Brad Slate, a 44-yearold powerlifter who lives outside of Sunriver. He understands fru~strations about the FDA's recalls but said he thinks the bigger issue is companies'ability to hide ingredients.

"Because, really, you should be able to sell any product you want as long as you're forthcoming about What it is and what it does, but they're subverting the truth," said Slate, who works as an audio/visual services coordinator at St. Charles Health System. Slate said these days, he tries to get most of his nutrition without supplements, but when he first started powerlifting three years ago, he tried sample packs of preworkout supplements. 'That's where it really gets into some of the crazy herbal stuff," he said. "It reallyjacks you up, like speed or something."

Change aheadl

the real deal. The FDA requires that companies do this, but most either don't or they use a less stringent method than DNA identification. She also tests for attomeys who need the results for a lawsuit. Simply put, Reynaud's customers are the small but earnest supplement manufactures, those who go the extra mile to make sure they're selling what they say they're selling. But even among this group, which Reynaud said includes some of the most reputable companies in the world, about 25 percent of the extract samples are a different species from what the companies think they are. Usually, that means the herb supplier sold the manufacturer an adulterant rather than the extract it asked for. That means in the real world, ~Reynaud said, the rate of adulteration is "actually much, much higher if we start looking at other companies that aren't doing this testing or aren't caring as much about the quality of their materials." In general, the more processed a supplement is, the longer it traveled to get from the supplier to the manufacturer, the more chances for either intentional or accidental adulteration. Products can accidentally be contaminated during shipping or storage, Reynaud said.

There have also been cases where suppliers accidentally grew the wrong herb, she said. The rates of adulteration are staggering among certain varieties of

supplernents, Reynaudsaid. She's been trying to get a hold of the raw rnaterial of garcinia cambogia from which the extract is derived, but none of the suppliers can produce it. She's gone to trade shows and herb shops around Berkeley and called various suppliers she knows — no one has it. "One of them, it was pretty hilarious, I said, 'Really? You can't give me any? I'll buy it, $200 for 50 milligrams,"' she said. "He said, 'No.' I said', 'Well, why?' He said, 'Because it's mine."' In Reynaud's mind, any company that has nothing to hide would share the raw material openly. Since none do, her suspicion is that most garcinia cambogia being sold in the U".S. is not an extract of garcinia cambogia at all. Extracts from herbs are typically sprayed onto a filler material such as maltodextrin, starch or rice. In the case of garcinia cambogia, she suspects most of what's being sold is just chemicals sprayed onto filler materiaL As a irule of thumb, anything that's in TV commercials or on the radio — hoodia, the supplement advertised for weight loss a few years ago, for example — is more likely to be adulterated because it gets so popular that supply can't keep up with demand, Reynaud said. "Anything expensive, rare — or there Is a fad — is kind of prime target for adulteration," she said. Reynaud said she thinks the media and the public's attention to the problem has increased in recentyears, and the FDA in turn has stepped up its enforcement, inspecting companies and issuing recalls when necessary. The FDA's Tainted Weight Loss Products website warns the public of a new product several times a rnonth, often because the productcontains dangerous, banned controlled substances like sibutramine, which can cause life-threatening blood pressure increases.

Although the supplement industry is "pretty dismal" right now, Danica Harbaugh Reynaud sees change on the horizon. She's a geneticist, and her company, AuthenTechnologies in Richmond, California, tests samples of supplements — down to the DNA level — to get to the bottom of what they truly are. There are othei methods of testing extracts, but Reynaud, who holds a doctorate in "I've seen a huge shift toward companies, large and small, either integrative biology from the University of California, Berkeley, said DNA is the most reliable. caring more about identify testing or being scared into doing more The bulk of Reynaud's clients are supplement manufacturers who identify testing," she said.•

SUMMER/FALL2014 HIGHDESERTPULSE

Paye51

Coverstory IHOMELESSHEALTHCARE

ContinuedfromPage17

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

Scarce homes The Central Oregon Health Council, which oversees the local CCO, opted not to fund the Health thru Housing pilot, in part because of the difficulty in finding low-cost housing. The region's fast growth and rising property values have made rental properties, particularly aflIordable rental properties, almost impossible to find. "The housing crisis is pretty severe right now, so it's scary for a lot of folks," LaPoint said. According to the Central Oregon Rental Owners Association, only 37 units out of 3,862 rental units in Central Oregon were

available in May, a vacancy rate of less than 1 percent. Housing Works said only about 500 landlords currently accept rental

subsidies. That means even with assistance, individ-

Page52

replacement last year. Rutherford had spent time in jail for selling rnetharnphetamine with her kids in the car. The conviction was a wake-up call, she said, and upon her release 14 years ago, she turned her life around. She worked for a long-term care facility before a new law barred the care home from employing individuals with criminal records. She then became a live-in caregiver, a job that required she be on-site 24 hours a day. When her last dient passed away, she

needed a change and began working in a sandwich shop, until last year she was diagnosed with a heart valve issue. Unable to

work or qualify for disability payments after her surgery, Rutherford was facing eviction. Neighborlmpact provided her with three months of rental subsidies to keep her in her apartment until she could return to work. When she was diagnosed with cervical cancer, they extended the assistance to a year. "If it wasn't for Neighborlmpact, I would have been homeless with my sternum cracked open," Rutherford said'.

Now fully recovered, she has started her

own housecleaning business.She must carefully monitor her intake of green vegetables to maintain the proper levels ofblood thinner she takes because of the artificial heart valve, something she wouldn't be able ployed candidates who have squeaky-clean to do without access to a refrigerator and kitchen. records. "Noteverybody who ishomeless in CenNeighborlmpact has tried to address some of these barriers with its Ready-to- tral Oregon looks like the people you see Rent certificate classes. Individuals are standing on the corner," she said. 'There are taught how to be good tenants and what good people with families, maybe like me, their rights and responsibilities are, in hopes who have a troubled background but have of making them more attractive renters de- cleaned up their life and' d'one something spite their history. with it. But then something happens where "A lot of landlords are open to considering they're right back at stage one again, right somebody who mlght otherwise have a not- back at the beginning." so-good housing history. If they can show Examples like Rutherford's are helping them this certificate," Marson said. housing and health groups as well as local governments begin to connect housing and Prevention health. Mosaic Medical will soon embed a There's also been a push locally to help nurse practitioner at Ariel Glen and Ariel individuals avoid homelessness in the first South, the two biggest low-income housing place by keeping them in their homes when complexes in Central Oregon, converting health crises arise. Neighborlmpact helped an old laundry room into an exam office. Patty Rutherford, 48, stay in her Redmond The clinic has taken over management of apartment when she needed a heart valve a school-based health clinic at Ensworth Ei-

sUMMER/FALL 2014HIGH DESERT PULSE

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RYAN BRENNECKE

PattyRutherford plays with her grandkids, from left, Emmaschile, Tylerschile,5, and Chloe Tull,4 in her Redrnondapartmentlast month.

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

needs.

SUMMER/FALL 2014HIGH DESERT PULSE

"Sometimes it's now knowing where to That part was nonnegotiable. "You know what? If it doesn't, I'll buy you a turn or what to do," she said. "You've gotten yourself in a cycle for some time and you TV," Hines told him. don't know how to get out of it. Or you have The roof over his head and the television resources, butyou don'tknow how to man- should keep Grisman off the streets and perage the funds that are comiing in. They have haps out of the emergency room for the time to have ongoing help to not just get right being. In his case, it's easy to draw a straight back into that situation." line between an ability to manage his diaWith Crisman, she was able to place him betes and a hospital readmission. For other at Pilot Butte Rehab for several weeks of an- homeless,people, the connection between tibiotic therapy and to get his blood sugar home and health might not be as clear. back under control. He made her promise "It's penny-wise and pound-foolish," him he would have a place to go after his Clouart said. "Often time when you prevent discharge; otherwise, he would have left the the disaster from happening, it means the rehab facility immediately. disaster didn't happen and people don't "He doesn't want to go back to the Bethle- pay attention. We're more i~n the lines of if hem Innand he doesn'tw ant to go back to somebody has a wound, let's iput a Bandthe camps,"shesaid."He'svery fearful." Aid on the wound until the wound heals. She found a place in an adult foster home, Nobody ever says, 'What do you do about finding a caretaker whose son had diabetes preventing the wound in the first place?' and could help Crisman with his insulin and And thenyou have to spend more money diet. "It has a TV, right?" Crisman asked her. on the Band-Aid'."â&#x20AC;˘

Page53

Body ofknoyirledge pop QUlz •

•

ome reme iesare rea reme ies~ IC

• o.' c +

go GREGCROSS

BY DAVID JASPER

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

For bad breath, ingesting • which of thesechewables helps? A.Coffee beans B.Pop-Tarts C.Anchovies D. Doughnuts E. Flintstones vitamins

Formotion sidmess, • eitherof thesemighthelp. A. Peanuts and popcorn B.Peanut butter and jelly C.Darkchocolateandketchup

D.Pork chops and apple sauce E.Lemons and olives

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

Eating these mayhelp • ease headachepain.

Acoughis no fun,but one

• of thesedeliciousfoods

A. M&MS

B.Almonds C. Froot Loops D. Corn nuts E.Pasta

mighthelpwith that. A. Dark chocolate B.Peanut butter C. Porterhouse steak D.Tofu E.Tofu is a delicious food?

Some inconsiderate insect

Togetrid of thatstinking • footodor,youshould soakyour feet in whichof the following?

A.Maple syrup B.Cheese sauce C.Vodka D. Petroleurn jelly E.Saliva

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

Amnsrets L A. Coffee beans (source: Atlanta journal-Constitution). Eating coffee beans zaps the bacteria and acids that result in bad breath. If you're averse to coffee breath, try something else. 2.C.Vodka (source: ABCNews). It's all in the alcohoi, which dries out the fungus and bacteria. 3.E. Lemons and olives (source: ABC News).Throw down a fewolives orsuck on a lem on to stave offthe excess

Page54

• wentandbityou. Which kindofpaste should you apply to the offended area? A. Tomato B.Shrimp C.Tahini D. Elrner's E.Tooth •

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

•

salicin, which forms salicylic acid when ingested. Salycylic acid Is the main byproduct ofaspirin metabogzation. B.E. Toothpaste (source: naturehacks.com). Peppermint essential oil may have more efficacy, but if you have none, toothpaste may abatethat savage sting. 7. A. Dark chocolate (source: everydayhealth.com). Dark chocolate contains theobromine, which blocks the action of sensory nerves andmaysubdue the cough reflex.

SUMMER/FALL 2014HIGH DESERT PULSE

One vo/ce ~ A PERsoNALEssAY

Health care advocacy is about speaking up BY LESLIEPUGMIBE HOLE

can pinpoint the exact moment I became a squeaky wheel. It was a couple of days after a late-night phone call notifying me that my mother was near death after short illness. I scrambled to

After I discovered rny mother had been put in dlapers, deemed too confused to use the toilet, I argued that a sincere effort had not been made to see if she could maintain

bladder and bowel control because she was

charged and that very day had been installed

confined to a wheelchair and was dependent on others to take her to the bathroom. It took me months to persuade them to try, and when her caretakers finally changed my mother's toileting regime I was proved right — she was continent. Not long after, she was finally determined

in a nursing home for further recovery.

to be ready for physical therapy only to be

arrange things at home: care for my three kids, a neighbor to watch the house and pets, plane reservations. By the time l~ arrived in

Oregon she had been unceremoniously disThe home was easy to find, as it was next door to one of the marginal apartment com-

dismissed by the therapist as too confused to follow dlrections. I pushed for months after to get my mother another stab at physplexes we had lived in during my childhood. I was given her roorn number and navigated ical therapy, knowing how much she hated the maze of shiny, white walls. the wheelchair. And there she was, the woman friends Nearly a year later she returned to therditoroftheRedmond apy , n ot because her doctor or caregivers jokingly called "Auntie Mame" for her bold LesliePugmireHolelse thought she'd benefit but because — in rny personality, husky voice and Iove of the Spokesman. outlandish. Slurnped in a wheelchair, glassyopinion — they were tired of listening to me. eyed and — I noticed when I ,'kissed her forehead — burning with She did not make big strides in physical therapy, but she at least fever. regained enough leg strength to periodically use a walker and, rnore I instantly knew what had happened. Not willing to accept what- importantly, it made her feel better emotionally. And that was everything. ever paltry payment my mother's HMO would fork out, the hospital My biggest battle was prompted by a caring, diligent nurse at had deemed her out of danger and therefore not in need of hospitalization. A bed was quickly found in an understaffed nursing home, the home. My mother had complained about a sore spot in her arm where no one had noted her fever or lack of alertness. weeks before but a visit to her doctor went nowhere, except to say This was a crossroads for me. A perennial people-pleaser who there was a cyst on the inside of the forearm that was likely irritated never liked to rock the boat, I would accept all manner of unwelcome by the wheelchair. outcomes rather than speak out for myself. I hated to push, to prod, The nurse called me to suggest she thought the matter needed to complain. Just the phrase "squeaky wheel" made me think of an- more attention. That was all I needed to hear to man the battle stations noying, demanding, selfish people. and headoff to war. I made numerous phone calls and finally got my But here was my only,parent, sick, uncared for and all alone save mother a new doctor. I drove all day to attend the appointment with for me. She couldn't speak out for herself, even if she'd wanted to. I her. Luckily, this doctor listened and gave the lump serious attention. sucked in a deep breath, squared my shoulders and headed out into Several tests later, we had adiagnosis — cancer —and a prognosis. the hall to request help. Even with radiation treatments my mother did not live long after That was the beginning, but it was far from the end. the discovery of her cancer but she spent her last weeks in a wonderEvery step from that moment to the moment she died two years ful hospice, one that I had to pursue doggedly to get her admitted to. later was a lesson in health care advocacy. It was sometimes exDespite the less-than-happy outcome of my introduction to health hausting, irritating, enraging and nearly always frustrating, More care advocacy, I would not change a thing. It he'Iped rne understand than once I wondered, "Vlhy does it have to be so hard?" that speaking up for yourself, or someone dependent on you, is the Living more than 500 miles away, I bedeviled her caretakers, only way to navigate the health care system. The world does not end

doctorsand insurance company by phone,fax and email.Im ade when you challenge authority and ask q~uestions. monthly and sometimes weekly trips to visit and attend doctor ap-

pointments. The word "no" became achallenge, not an absolute.

SUMMER/FALL 2014HIGH DESERT PULSE

In fact, the world opens up to you when you push a bit on closed dooi's. •

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St. MEDICAL Charles GROUP 170 PROVIDERS AND19 SPECIALTIES

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Healthy Living i C n t al 0

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

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

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H I G H

D E S E R T

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Healthy Living in Central Oregon

xehh

jji SUMMER / FALL 2014 VOLUME 6, NO. 3

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

• Reporting Tara Bannow 541-383-0304or tbannow@bendbulletin.com •

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Published: 8/11/2014 ¹

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Contents/ HIGH DEsERTPULsE

COVER STORY SUPPLEMENTS The benefits of most dietary supplements are largely

unproven, and some supplements can be dangerous.

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

from being discharged with no place to go.

DEPARTMENTS

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

p g gOOP D 0 Q

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or walking to school. How to stay safe.

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

30 GEAR Paw protection for your four-legged

workout companion.

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

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

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

SUMMER/ FALL2014 •HIGH DESERT PULSE

Q+ Page3

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

~~ ~

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Coverstory ~suppLEM ENTs

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

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

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

SUMMER/FALL2014•HIGHDESERTPULSE

JOE KLINE

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

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

SUMMER/ FALL2014 •HIGH DESERT PULSE

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

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Cover story ~ SUPPLEMENTS

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

Page6

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

SUMMER/FALL. HIGH DESERTPULSE

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

JOE KLINE

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

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

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

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

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

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

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

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Cover story ~ SUPPLEMENTS

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

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

JOE KLINE

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

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

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

Partners In Care HOSPICE

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FeatureiHOMELESS HEALTH CARE

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

BY MARKIAN HAWRYLUK

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

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

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

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Feature(HOMELESSHEALTH CARE

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

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

Homeless housing inventory,2010 Emergency shelter

, Familybeds: ,Individualbeds: ,Total

Bethlehem Inn

Safe Homes (Cascade Youth and Family Center)

12::

Deschutes County Parole and Probation

18 :'

Grandma's House (pregnant/parenting teens)

Nancy's House (Neighborlmpact)

Saving Grace (domestic violence)

The Shepherd's House

Madras Gospel Mission

Total Transitional housing

67,

117,:

184

: Familybeds: Individualbeds: :Total

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

17 :'

Horizon House (Housing Works/ Deschutes Mental Health)

13 ::'

Transitional housing program (Neighorlmpact)

120,

120

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

0: 126,:

59 '

185

Source: Central Oregon 10-year Plan to End Homelessness

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

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

SUMMER/FALL2014•HIGHDESERTPULSE

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

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

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

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

Page 14

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

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

ANDYZEIGERT

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

SUMMER/FALL2014•HIGHDESERTPULSE

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

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

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

•

SUMMER/ FALL2014 •HIGH DESERT PULSE

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

•

Page 15

Coverstorj/( HOMELESSHEALTH CARE

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

Page 16

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

5,652 U n employment

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

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

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

5UMMER/FALL2014.HIGH DESERTPULSE

The eost of homelessness

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

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

SUMMER/ FALL2014. HIGH DESERT PULSE

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

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

Page 17

TIPSiSTRETCHING

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

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

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

Page 18

SUMMER/FALL2014•HIGHDESERTPULSE

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

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

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

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

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

Page 19

Tips ST J RETCHING

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

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

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

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

Page20

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Nine-year-old Elliot Henson rides his bike down Nashville Avenue on his way home from Highland Elementary Schoolin June. RYAN BRENNECKE

Page 22

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

Getready IWALKIRIDETOSCHOOL

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

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

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

Page23

Cooley R .

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

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

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

SUMMER/ FALL2014 •HIGH DESERT PULSE

Page25

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- Page27

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

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

Page28

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

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

SUMMER/ FALL2014 •HIGH DESERT PULSE

Page29

Gear~DOGBDQTs

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

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Grip Trex Ruff Wear, 569.95

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

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

Page30

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

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

SUMMER/FALL2014•HIGHDESERTPULSE

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

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Summit Trex

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

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

* RR S a

William Corrigan, PA-C, Johanna Godell, PA-C, Sara Stafford, PA-C, Jonathan Kelley, PA-C, Jamie Tigner, PA-C

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

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

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

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Page31

Profile ISUPER DAVE

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

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

Page32

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

SUMMER/FALL2014•HIGHDESERTPULSE

â&#x20AC;˘v

g JOE KLINE

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

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

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

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

Page33

Profile ISUPERDAVE

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

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

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JOE KLINE

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

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

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

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Page35

Picture ThisiBABY BQNES Anterior fontanelle

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Page36

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

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

SUMMER/FALL2014â&#x20AC;˘HIGHDESERTPULSE

2014 CENTRAL OREGON

Your

AOVERTISINGSUPPLEMENT

S o u r c e f o r Lo c a l H e a l t h Se r v i c e s a n d Ex p e r t M e d i c a l P r o f e s s i o n a l s To list your medical office and/or physicians in the PULSEIConnections Medical Directo ry contact...

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

•

ADULT DAY SERVICE

Open Arms Adult Day Service

ADULT FOSTERCARE

Absolute Serenity Adult Foster Care

AESTHETIC SERVICES

DermaSpa at Bend Dermatology

2705 NE Conners Drive• Bend

541-330-9139

ALLERGYgr,ASTHMA

Bend Memorial Clinic

Locations in Bend SI Redmond

541-382-4900

ALZHEIMERS 4, DEMENTIA CARE

Clare Bridge Brookdale Senior Living

1099 NE Watt Way• Bend

541-385-4717

www.brookdaleiiving,com

ASSISTED LIVING

Brookside Place

3550 SWCanalBlvd •Redm ond

541-504-1GOO

www.cdiving.com

AUDIOLOGY

American Hears Hearing Aids

547 NE Bellevue• Bend

541-213-2294

www.americanhears.com

AUDIOLOGY

Central OregonAudiology A Hearing AidClinic

BEHAVIORAL HEALTH

St. Charles Behavioral Health

2542 NE Courtney Drive• Bend

541-706-7730

www.stcharleshealthcare,org

CANCER CARE

St. Charles Cancer Center

Locations in Bend EI Redmond

541-706-5800

www.stcharleshealthcare.org

CARDIOLOGY

Bend Memorial Clinic

Locations in Bend SI Redmond

541-382-4900

CARDIOLOGY

St. Charles Heart gI Lung Center

2500 NE Neff Road• Bend

541-388-4333

COSMETIC SERVICES

Bend Memorial Clinic

2600 NE Neff Road• Bend

541-382-4900

DENTURISTS

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

951 SW Simpson Ave• Bend

541-362-1363

www.openarmsadultcare,com

119 N Rope Street• Sisters

541-588-6119

www.absoluteserenity.info

Bend SI Redmond

www.bendderm.com ww w.bendmemorialdinic.com

541-G47-2894 www.centraloregonaudiology.com

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

DENTURISTS

SistersDenture Spedalties

161 E Cascade• Sisters

541-549-0929

DERMATOLOGY

Bend Dermatology Clinic

2747 NE Conners Drive• Bend

541-382-5712

www.raordenturecenter.com www.bendderm.com

DERMATOLOGY (MOHS)

Bend Dermatology Clinic

2747 NE Conners Drive• Bend

541-382-5712

www.bendderm.com

DERMATOLOGY (MOHS)

Bend Memorial Clinic

2600 NE Neff Road• Bend

541-382-4900

ENDOCRINOLOGY

Bend Memorial Clinic

ENDOCRINOLOGY

EndocrinologyServicesN W

929 SWSimpson Ave,Ste 220 • Bend

FAMILY MEDICINE

Bend Memorial Clinic

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

FAMILY MEDICINE

Central Oregon Family Medidne

FAMILY MEDICINE

St.Charles Family Care

FAMILY MEDICINE

St.Charles Family Care

1103 NE Elm Street• Prineville

FAMILY MEDICINE

St.Charles Family Care

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

645 NW 4th St.• Redmond

541-317-5GOO

541-923-0119

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

ww w .bendmemorialdinic.com

ww .bendmemorialchnic.com

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

www.stcharleshealthcare.org

541-447-6263

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211 NW Larch Avenue• Redmond

541- 5 48-2164

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630 Arrowleaf Trail• Sisters

541-549-1318

FAMILY MEDICINE

St.Charles Family Care

FAMILY PRACTICE

High Lakes Health Care

Locations in Bend, Sisters SIRedmond 541-389-7741

GASTROENTEROLOGY

Bend Memorial Clinic

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

ww . bendmemorialdinic.com

GASTROENTEROLOGY

Gastroenterologyof Central Oregon

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

ww . gastrocentraloregon.com

GENERALDENTISTRY

Coombe and Jones Dentistry

774 SWRimrockWay • Redm ond 541-923-7G33

www.stcharleshealthcare.org ww w .highlakeshealthcare.com

www.coombe-jones.com

GEEEM, SER GERY, EERIRTRitS AVEIEQRE Advanced Spedalty Care

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

w w .advancedspecialtycare.com

GENERALSURGERY A NARIATMCS

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

www.stcharleshealthcare.org

St. Charles SurgicalSpedalists

GERIATRICCAREMANAGEMENT Paul Battle Assodates

Serving Deschutes County

877-867-1437

www.PaulBattle,com

HOME HEALTH SERVICES

St. Charles Home Health

2500 NE Neff Road• Bend

541-706-7796

www.stcharleshealthcare.org

HOSPICE/HOME HEALTH

Hospice of Redmond

732 SW 23rd St• Redmond

541-548-7483

www.redmondhospice.org

HOSPICE/HOME HEALTH

Partners In Care

2075 NE Wyatt Ct.• Bend

541-382-5882

www.partnersbend.org

HOSPITAL

St. Charles Madras

470 NE "A" Street• Madras

541-706-779G

www.stcharleshealthcare,org

ADVEGTIUIG SUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY •

HOSPITAL

Pioneer Memorial Hospital

1201 NE Elm St• Prineville

541-447-6254

www.stcharleshealthcare.org

HOSPITAL

St. Charles Bend

2500 NE Neff Road• Bend

541-382-4321

www.stcharleshealthcareorg

HOSPITAL

St. Charles Redmond

1253 NE Canal Blvd• Redmond

541-706-7796

www.stcharleshealthcare.org

HYBERBARICOXYGENTHERAPY

Bend Memorial Clinic

IMAGING SERVICES

Bend Memorial Clinic

IMMEDIATE CARE

NOWcare

IMMEDIATE CARE

High Desert FamilyAtedidne AtImmediate Care

INFECTIOUS DISEASE

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

ww . bendmemorialdinic.com

Locations in Bend AtRedmond

541-382-4900

www.bendmemorialdinic.com

2200 NE Neff Rd• Bend

541-322-2273

www.thecenteroregon.com

5706 7 Beaver Dr. • Sunriver

541-593-5400

n/a

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www.bendmemorlalchnic.com

INFECTIOUS DISEASE

St. Charles Infectious Disease

2965 NE ConnersAve., Suite 127 • Bend

541-706-4878

www.stcharleshealthcare.org

INTEGRATED MEDICINE

Center for Integrated Medidne

91 6 SW 17th St, Ste 202• Redmond

541-504-0250

www.centerforintegratedmed.com

Bend Eastside AtWestside

541-382-4900

www.bendmemorialdinic.com

929 SW Simpson Ave• Bend

541-389-7741

www.highlakeshealthcare.com

23 6 NW Kingwood Ave • Redmond

541-548-7134

www.imredmond.com

1245 NW 4th Street, Ste 201• Redmond

541-323-4545

www.redmondmedical.com

Nine Locations in Central Oregon

541-706-7717

www.stcharleshealthcare.org

INTERNAL MEDICINE

Bend Memorial Clinic

INTERNAL MEDICINE

High Lakes Health Care Upper Mill

INTERNAL MEDICINE

Internal Medidne Assodates of Redmond

INTERNAL MEDICINE

Redmond Medical Clinic

LABORATORY

St.Charles Laboratory Services

MEDICAL CLINIC

Bend Memorial Clinic

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

www.bendmemorlalchnic.com

MEDICAL CLINIC

Bend Memorial Clinic

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

www.bendmemorialdinic.com

MEDICAL CLINIC

Bend Memorial Clinic

MEDICAL CLINIC

Bend Memorial Clinic

NEPHROLOGY

Bend Memorial Clinic

Locations in Bend At Redmond

541-382-4900

ww w.bendmemorlalchnic.com

NEUROLOGY

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www.bendmemorialdinic.com

NEUROSURGERY

The Center: orthopedic a NeurosurgicalCaregtResearch 2 2

541-382-3344

www.thecenteroregon.com

NUTRMON

Bend Memorial Clinic

OBSTETRICSSr,GYNECOLOGY

East CascadeWomen's Group, P.C.

OBSTETIHCS A, GYNECOLOGY

St. Charles Center for Women's Health

OCCUPATIONAL MEDICINE

Bend Memorial Clinic

OCCUPATIONAL MEDICINE

The Center: Orthopedic gtNeurosurgical CaregtResearch

ONCOLOGY -MEDICAL

231 East CascadesAve • Sisters

541-549-0303

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

0 0NE Neff Rd • Bend

www.bendmemorlalchnic.com ww . bendmemorialdinic.com

1501 NE Medical Center Drive• Bend

541-382-4900

www.bendmemorialdinic.com

2400 NE Neff Road, Ste A• Bend

541-389-3300

www.eastcascadewomensgroup.com

Loc ations in Redmond th Prineville 541-526-6635

www.stcharleshealthcare.org

Locations in Bend At Redmond

541-382-4900

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

Bend Memorial Clinic

Locations in Bend At Redmond

541-382-4900

www.bendmemorlalchnic.com

OPHTHALMOLOGY

Bend Memorial Clinic

Locations in Bend At Redmond

541-382-4900

ww w.bendmemorialdinic.com

OPTOMETRY

Bend Memorial Clinic

Locations in Bend At Redmond

541-382-4900

ww w.bendmemorlalchnic.com

OPTO~

Integrated Eye Care

452 NE Greenwood Ave.

541-382-5701

www.iebend.com

ORTHODONTICS

O'Neill Orthodontics

Bend tlt Sunriver

541-323-2336

www.oneillortho.com

ORTHOPEDICS

Desert Orthopedics

Locations in Bend At Redmond

541-388-2333

www.desertorthopedics.com

ORTHOPEDICS

The Center: orthopedic a NeurosurgicalCaregtResearch 2 2

541-382-3344

www.thecenteroregon.com

OSTEOPOROSIS

DeschutesOsteoporosis Center

2200 NENeffRoad,Suite 302 • Bend

541-388-3978

www.desdtutesosteoporosiscenter.com

PALLIATIVE CARE

St. Charles Advanced Illness Management

2500 NE Neff Road • Bend

541-706-5880

www.stcharleshealthcare.org

PALLIATIVE CARE

Partners In Care

2075 NE Wyatt Ct• Bend

541-382-5882

www.partnersbend.org

PEDIATRIC DENTISTRY

Deschutes Pediatric Dentistry

1475 SW Chandler Ave, Ste 202• Bend

541-389-3073

www.deschuteskids.com

PEDIATRICS

Bend Memorial Clinic

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

PEDIATRICS

St.Charles Family Care

PHYSICAL MEDICINE

Desert Orthopedics

PHYSICAL MEDICINE

The Center: orthopedic a NeurosurgicalCaregtResearch 2 2

0 0NE Neff Rd • Bend

ww w.bendmemorlalchnic.com

www.bendmemorialdinic.com

211 NW Larch Avenue• Redmond

541-548-2164

www.stcharleshealthcare.org

Locations in Bend At Redmond

541-388-2333

www.desertorthopedics.com

0 0NE Neff Rd • Bend

541-382-3344

www.thecenteroregon.com

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

541-382-3344

www.thecenteroregon.com

ADVEGTIING SUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY A

•

PHYSICAL NEDICINE/REHABILITATION

Bend Memorial Clinic

PHYSICAL THERAPY

Healing Bridge Physical Therapy

PODIATRY

Cascade Foot Clinic

PULMONOLOGY

Bend Memorial Clinic

Locations in Bend ttt Redmond

541-382-4900

PULMONOLOGY

St. Charles Heart gt Lung Center

Locations in Bend St Redmond

541-706-7715

RADIOLOGY

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

REHABILITATION

St. Charles Rehabilitation Center

RHEUMATOLOGY

Bend Memorial Clinic

RHEUMATOLOGY

Deschutes Rheumatology

SLEEP MEDICINE

Bend Memorial Clinic

SLEEP MEDICINE

St.Charles Sleep Center

SURGICAL SPECIALIST

St. Charles Surgical Spedalists

SURGICAL SPECIALIST

Bend Memorial Clinic

URGENT CARE

Bend Memorial Clinic

URGENT CARE

NOWcare

URGENT CARE

St. Charles Immediate Care

UROLOGY

Bend Urology Assodates

UROLOGY

UrologySpedalistsofOregon

VASCULARSURGERY

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1 -382-4900

VEIN SPECIALISTS

InoviaVein Spedalty Center

2200 NE Neff Road, Ste 204• Bend

54 1 -382-8346

VEIN SPECIALISTS

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1 -382-4900

www . bendmemorialdinic.com

Bend Eastside A Redmond

541-3 8 2-4900

ww w .bendmemorialdinic.com

547 NE Bellevue Dr. Suite ¹105

541 - 213-2294

•

ADAM WILLIAMS, MD I

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

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

www.healingbridge,com

54 1 -388-28G1

www.cascadefoot.com

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

Locations in Bend A Redmond

541-382-4900

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

Bend

541-382-4900

Locations in Bend Si Redmond

541-7 0 6-6905 w

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

541-3 8 2-4900

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

•

Bend Memorial Clinic

ww .bendmemorialchnic.com

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

w w w.bendmemorialdinic.com

2200 NE Neff Rd• Bend

541-322-2273

2600 NE Neff Road• Bend

541-706-3700

www.stcharleshealthcare,org

Locations in Bend 8i Redmond

541-382-6447

www.bendurology.com

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

•

www. tbecenteroregon.com

www.urologyinoregon.com www . bendmemorialdinic.com

www.bendvein.com

•

RANDY MCCALL

American Hears Hearing Aids

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

KAREN CAMPBELL, PHD

St. Charles Behavioral Health

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

w w .advancedspecialtycare.com

1245 NW4th Street, Ste 101 • Redmond

54 1-548-7761

www. stcharleshealthcare.org

2542 NE Courtney Dr• Bend

541-7 0 G-7730

www. s tcharleshealthcare.org

JANET FOLIANO-KEMP, PSYD St. Charles Behavioral Health

2542 NE Courtney Dr• Bend 5

EUGENE KRANZ, PHD

St. Charles Behavioral Health

2542 NE Courtney Dr• Bend

ROSS JUDICE, MD

St. Charles Behavioral Health

2542 NE Courtney Dr• Bend 5

WENDY LYONS, PSYD

St.Charles Family Care

211 NW Larch Ave• Redmond

MIKE MANDEL, MD

High Lakes Health Care Upper Mill

SONDRA MARSHALL, PHD

St. Charles Behavioral Health

2542 NE Courtney Dr• Bend

JAMES PORZELIUS, PHD

St. Charles Behavioral Health

2542 NE Courtney Dr• Bend 5

REBECCASCRAFFORD, PSYD St. Charles Behavioral Health

www.americahears.com

929 SW Simpson Avenue• Bend

2542 NE Courtney Dr• Bend

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

541-5 4 8-21G4

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

www. stcharleshealthcare.org

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

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

www.stcharleshealthcare.org

SCOTT SAFFORD, PHD

St.Charles Family Care

LAURA SHANK, PSYD

St. Charles Behavioral Health

2542 NE Courtney Dr• Bend

541-70G-7730

www.stcharleshealthcare.org

KIMBERLY SWANSON, PHD

St.Charles Family Care

211 NW Larch Ave• Redmond

541-548-21G4

www.stcharleshealthcare.org

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

www.stcharleshealthcare.org

ADVERTISINGSUPPLEMENT

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

St. Charles Heart ih Lung Center

CATHERINE BLACK,PA-C

Bend Memorial Clinic

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

ww .bendmemorialdinic. com

JEAN BROWN,PA-C

Bend Memorial Clinic

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

ww .bendmemorialdinic.com

KIMBERLYCANADAY,ANP-BC Bend Memorial Clinic

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

ww . bendmemorialdinic.com

NAHEL FARRAJ,DO

Bend Memorial Clinic

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

ww .bendmemorialdinic.com

GARY FOSTER, MD

St.Charles Heart thLung Center

2500 NE Neff Road• Bend 5

RICK KOCH, MD

Bend Memorial Clinic

BendEastside8)Redmond

JAMES LAUGHLIN,MD

St.Charles Heart thLung Center

2500 NE Neff Road• Bend 5

41-3 8 8 -4333 w

ww. stcharleshealthcare.org

BRUCE MCLELLAN, MD

St. Charles Heart I% Lung Center

2500 NE Neff Road• Bend 5

41-3 8 8 -4333 w

ww. stcharleshealthcare,org

GAVIN L.NOBLE, MD

Bend Memorial Clinic

Bend Eastside 8) Redmond

STEPHANIE SCOTT,PA.C

Bend Memorial Clinic

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

ww .bendmemorialdinic.com

JASONWEST, MD

Bend Memorial Clinic

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

ww .bendmemorialdinic.com

MICHAEL WIDMER) MD

St. Charles Heart 8) Lung Center

JASON IL WOLLMUTH, MD

Ben d Memorial Clinic

EDDY YOUNG,MD

St. Charles Heart th Lung Center

2500 NE Neff Road• Bend 5

JOHND. BLIZZARD, MD

St. Charles Heart 8) Lung Center

2500 NE Neff Road• Bend

541-388-1636

www .stcharleshealthcare.org

ANGELO A.VLESSIS, MD

St. Charles Heart lh Lung Center

2500 NE Neff Road• Bend

541-388-1636

www .stcharleshealthcare.org

JORDAN T. DOI,MSC,DC

NorthWest Crossing Chiropractic 8) Health

62 8 NW York Dr, Ste. 104 • Bend

541-388-2429

www.nwxhealth.com

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

628 NW York Dr,Ste.104•Bend

541-388-2429

www.nwxhealth.com

JASON M. KREMER, DC,CCSP,CSCS WellnessDoctor

1345 NW Wall St, Ste 202• Bend

541-318-1000

2500 NE Neff Road• Bend 5

41-3 8 8 -4333 w

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

541-382-4900

41-3 8 8 -4333 w

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

ww. stcharleshealthcare,org

ww. stcharleshealthcare.org ww w .bendmemorialdinic.com

ww w.bendmemorialdinic.com

ww. stcharleshealthcare.org ww .bendmemorialdinic.com ww. stcharleshealthcare.org

ww w .bendwellnessdoctor.com

MICHAEL IL HALL, DDS

Central Oregon Dental Center

1563 NW Newport Ave• Bend

541-389-0300 www.centraloregondentalcenter.net

BRADLEY E.JOHNSON,DMD

ContemporaryFamily Dentistry

101 6 NW Newport Ave• Bend

541-389-1107 wwwcontemporaryfamilydentistrycom

ALYSSA ABBEY,PA-C

Bend Memorial Clinic

WILLIAM DELGADO, MD, (MOHS) Bend Dermatology Clinic

Bend 8) Redmond

541-382-4900

2747 NE Conners Drive• Bend

541-382-5712

ww w.bendmemorialdinic.com

www.bendderm.com

MARK HALL, MD,

CentralOregon Dermatology

FRIDOLINHOESLY, MD

Bend Dermatology Clinic

JAMES M. HOESLY,MD

Bend Memorial Clinic

JOSHUA MAY, MD

Bend Dermatology Clinic

2747 NE Conners Drive• Bend

541- 3 8 2-5712

www.bendderm.com

KRISTIN NEUHAUS, MD

Bend Dermatology Clinic

2747 NE Conners Drive• Bend

541- 3 8 2-5712

www.bendderm.com

GERALD PETERS,MB, FAIS (MOES)

Bend Memorial Clinic

2600 NE Neff Road• Bend 5

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

ANN M. REITAN, PA-C

Bend Memorial Clinic

2600 NE Neff Road• Bend 5

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

ALLISON ROBERTS, PA-C

Ben d Dermatology Clinic

388 SWBluffDr • Bend 2747 NE Conners Drive• Bend

2600 NE Neff Road• Bend 5

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

www.bendderm.com

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

2747 NE Conners Drive• Bend

541-382-5712

www.bendderm.com

STEPHANIE TRAUTMAN, MD Bend Dermatology Clinic

2747 NE Conners Drive• Bend

541-382-5712

www.bendderm.com

LARRY WEBER) PA-C

2747 NE Conners Drive• Bend

541-382-5712

www.bendderm.com

Bend Dermatology Clinic

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

2600 NE Neff Road• Bend 5

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

MARY F. CARROLL, MD

Bend Memorial Clinic

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

ww .bendmemorialdinic.com

RICK N. GOLDSTEIN, MD

Bend Memorial Clinic

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

ww .bendmemorialdinic.com

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

ww .bendmemorialdinic.com

TONYA KOOPMAN,MSN, FNP-BC Bend Memorial Clinic

ADVERTISING SUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY I I

PATRICK MCCARTHY,MD

EndocrinologyServicesNW

929 SWSimpson Ave,Ste 220 • Bend

541-317-5600

n/a

TRAVIS MONCHAMP,MD

Endocrinologp ServicesNW

929 SWSimpson Ave,Ste 220 • Bend

541-317-5600

n/a

CAREY ALLEN, MD

St.Charles Familp Care

1103 NE Elm Street• Prineville

541-447-6263

www.stcharleshealthcare.org

HEIDI ALLEN, MD

St.Charles Familp Care

1103 NE Elm Street• Prineville

541-447-6263

www.stcharleshealthcare.org

541- 5 48-2164

www.stcharleshealthcare.org

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

211 NW Larch Avenue• Redmond

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

SADIE ARRINGTON,MD

Bend Memorial Clinic

865SWVeteransWay• Redmond

JOSEPH BACHTOLD, DO

St.Charles Familp Care

630 Arrowleaf Trail• Sisters

JEFFREY P. BOGGESS, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

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

1103 NE Elm Street• Prineville

541 - 3 82-4900 541-549-1318

54 1 -382-4900 541-447-6263

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

MEGHAN BRECKE,DO

St.Charles Familp Care

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

www.stcharleshealthcare.org

NANCY BRENNAN, DO

St.Charles Familp Care

2965 NE ConnersAve, Suite 127 • Bend

54 1-706-4800

www.stcharleshealthcare.org

WILLIAM C. CLARIDGE, MD

S t . Charles Familp Care

211 NW Larch Avenue• Redmond

541- 5 48-2164

www.stcharleshealthcare,org

MATTHEW CLAUSEN, MD

St.Charles Familp Care

2965 NE ConnersAve, Suite 127 • Bend

541-706-4800

www. stcharleshealthcare.org

AUDREY DAVEY,MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

www .bendmemorlalchnic.com

CARRIE DAY, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

www . highlakeshealthcare.com

MAY S. FAN, MD

Bend Memorial Clinic

231 East Cascades Avenue• Sisters

541-549-0303

ww w .bendmemorialchnic.com

JAMIE FREEMAN, PA-C

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w.highlakeshealthcare.com

YVETTE GAYNOR,FPN-C

St.Charles Familp Care

630 Arrowleaf Trail• Sisters

541-549-1318

www.stcharleshealthcare.org

MARK GONSKY,DO

St.Charles Family Care

2965 NE ConnersAve, Suite 127 • Bend

54 1-706-4800

www.stcharleshealthcare.org

NATALIEGOOD, DO

St.Charles Familp Care

1103 NE Elm Street• Prineville

541-447-6263

www.stcharleshealthcare.org

BRIANNA HART, PA-C

St.Charles Family Care

211 NW Larch Avenue• Redmond

541- 5 48-2164

www.stcharleshealthcare.org

645 NW 4th St.• Redmond

541-923-0119

www.cofm.net

Redmond St Sisters

541-382-4900

ww w.bendmemorialdinic.com

929 SW Simpson Avenue• Bend

541-389-7741

www .highlakeshealthcare.com

645 NW 4th St.• Redmond

541-923-0119

www.cofm.net

MARGARET "PEGGY"HAYNER, FIP Central Oregon Family Medidne

ALAN C. HILLES, MD

Bend Memorial Clinic

HEIDIHOLMES, PA-C

High Lakes Health Care Upper Mill

MARK J. HUGHES, D.O

Central Oregon Family Medidne

SING-WEI HO, MD

St.Charles Familp Care

211 NW Larch Avenue• Redmond

541- 5 48-2164

www.stcharleshealthcare.org

PAMELAJ. IRBY, MD

St. Charles Familp Care

211 NW Larch Avenue• Redmond

541- 5 48-2164

www.stcharleshealthcare.org

DAVID KELLY, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

www .highlakeshealthcare.com

MAGGIE J. KING, MD

St.Charles Familp Care

1103 NE Elm Street• Prineville

541-447-G2G3

ww w.stcharleshealthcare,org

PETER LEAVITT, MD

St.Charles Familp Care

2965 NE ConnersAve, Suite i27 • Bend

54 1-706-4800

www. stcharleshealthcare.org

CHARLOTTE LIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900

www . bendmemorialdinic.com

KAE LOVERINK, MD

High LakesHealth Care Redmond

1001 NW Canal Blvd• Redmond

541- 5 04-7G35

www .highlakeshealthcare.com

STEVE MANN, DO

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w.highlakeshealthcare,com

JOE T.MC COOK, MD

St.Charles Familp Care

211 NW Larch Avenue• Redmond

541- 5 48-2164

www.stcharleshealthcare.org

G. BRUCEMCELROY, MD

Central Oregon Family Medidne

645 NW 4th St.• Redmond

541-923-0119

www.cofm.net

LORI MCMILLIAN, FNP

Redmond Medical Clinic

EDEN MKLER, DO

High LakesHealth Care Sisters

354 W Adams Avenue• Sisters

541-549-9G09

w w w.highlakeshealthcare,com

KEVIN MILLER,DO

High Lakes Health Care Sisters

354 W Adams Avenue• Sisters

541-549-9609

w w w.highlakeshealthcare.com

JESSICAMORGAN, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

w w w.highlakeshealthcare.com

DANIEL J. MURPHY, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541- 5 48-21 G4

www.stcharleshealthcare.org

SHERYL L. NORRIS, MD

St.Charles Familp Care

211 NW Larch Avenue• Redmond

541-548-21G4

www. stcharleshealthcare,org

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

www.redmondmedical.com

ADVERTISING SUPPLEMENT

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

St.Charles Familp Care

JAEEY PURVIS, MD

Bend Memorial Clinic

NATHANREED, DO

St.Charles Familp Care

KEVIN RUETER, MD

High Lakes Health Care Upper Mill

DANA M. RHODE, DO

Bend Memorial Clinic

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

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HAES G. RUSSELL, MD

Bend Memorial Clinic

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

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ERIC J. SCHNEIDER, MD

Bend Memorial Clinic

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

JEFFERY SCOTT,DO

Bend Memorial Clinic

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

LINDA C. SELBY, MD

St.Charles Familp Care

CIEDYSHUMAN, PA-C

Bend Memorial Clinic

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

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

www.stcharleshealthcare.org ww . bendmemorialdinic.com

1103 NE Elm Street• Prineville

541-447-6263

www.stcharleshealthcare,org

929 SW Simpson Avenue• Bend

541-389-7741

ww w.highlakeshealthcare.com

1103 NE Elm Street• Prineville

541-447-6263

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

541-593-5400

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n/a

EDWARD M. TARBET, MD

Bend Memorial Clinic

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

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JOHN D. TELLER, MD

Bend Memorial Clinic

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

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NATHAN R.THOMPSON, MD

St.Charles Familp Care

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

ww. stcharleshealthcare.org

MATTIE E. TOWLE, MD

Bend Memorial Clinic

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

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LISAURI, MD

High Lakes Health Care Upper Mill

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

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MARK A. VALENTI, MD

St.Charles Familp Care

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

ww. stcharleshealthcare.org

THOMAS A. WARLICK, MD

Bend Memorial Clinic

BRUCE E. WILLIAMS, MD

St.Charles Family Care

1103 NE Elm Street• Prineville

541-447-6263

Bend Memorial Clinic

Bend Eastside SI Redmond

541-382-4900

' I

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

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RICHARD H. BOCHNER,MD

ELLENBORLAND, MS, RN, CFEP Bend Memorial Clinic

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

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ARTHUR S. CAETOR, MD

Bend Memorial Clinic

HEIDI CRUISE, PA-C, MS

Bend Memorial Clinic

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

ww . bendmemorialchnic.com

CHRISTINA HATARA, MD

Bend Memorial Clinic

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

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SIDEEY E. HEEDERSOE HI, MD Bend Memorial Clinic

Bend Eastside SIRedmond

541-382-4900

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Bend Eastside 8I Redmond

541-382-4900

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Bend Eastside SIRedmond

541-382-4900

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SAEDRA K HOLLOWAY, MD

B e nd Memorial Clinic

GLENN KOTEEN, MD

Gastroenterologyof Central Oregon

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

ww . gastrocentraloregon.com

JENIFER TURK, PA-C

Bend Memorial Clinic

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

ww . bendmemorialdinic.com

MATTHEW WEED, MD

Bend Memorial Clinic

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

ww . bendmemorialchnic.com

JANE BIRSCHBACH,MD

High Lakes Health Care Upper Mill

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

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TAMMY BULL, MD

High Lakes Health Care Upper Mill

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

ww .highlakeshealthcare.com

SUSAN GORMAN, MD

High Lakes Health Women's Center

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

ww . highlakeshealthcare.com

ww . bendmemorialdinic.com

LAURIE D'AVIGNON,MD

Bend Memorial Clinic

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

JOE LUTZ, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

REBECCASHERER, MD

St. Charles Infectious Disease

JOHN ALLEN, MD

Bend Memorial Clinic

JENESS CHRISTENSEN, MD

High Lakes Health Care Upper Mill

JOHN CORSO,MD

High Lakes Health Care Upper Mill

CELSO A.GANGAE, MD

Redmond Medical Clinic

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

ww. r edmondmedical.com

MICHAEL N.HARRIS, MD

Bend Memorial Clinic

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

ww .bendmemorialdinic.com

54 1-382-4900

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

www . bendmemorialdinic.com

www.stcharleshealthcare.org

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

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

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

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ADVERTISINGSUPPLEMENT

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

Internal Medidne Assodates of Redmond

ANITA D.KOLISCH, MD

Bend Memorial Clinic

865 SW Veterans Way• Redmond

MATTHEW R. LASALA, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900

www . bendmemorialdinic.com

MADELINE LEMEE, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

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MARY MANFREDI, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

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H. DEREK PALMER, MD

Redmond Medical Clinic

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

A. WADE PARKER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900

MATTHEW REED, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900 w

MARK STERNFELD, MD

Internal Medidne Assodates of Redmond

236 NW Kingwood Ave •Redm ond

541-548-7134

DAN SULLIVAN, MD

Send Memorial Clinic

DAVID ~

Internal Medidne Assodates of Redmond

WAY , MD

FRANCENA ABENDROTH, MD S end Memorial Clinic

236 NW Kingwood Ave •Redm ond

1501 NE Medical Center Drive• Bend

236 NW Kingwood Ave •Redm ond

1501 NE Medical Center Drive• Bend

541-548-7134

www.imredmond.com

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

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

541-548-7134

www.imredmond.com

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

GARY BUCHHOLZ, MD

Bend Memorial Clinic

2275 NE Doctor's Drive• Bend

GREGORY FEBENZ,DO

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900 w

CRAIGAN GRIFFIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900

RAY TIEN, MD

The Center: Orthopedic tr NeurosurgicalCaregrResearch 2 2

MARK BELZA, MD BBAD WARD, MD

Bend Spine and Neurosurgery

The Center: Orthopedic gr Neurosurgical CaregrResearch 2 2

ANNIE BAUMANN, RD, LD

Bend Memorial Clinic

Am-BBIDGET BIBD,MD

St. Charles Center for Women's Health

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

www.stcharleshealthcare,org

BRENDA HINMAN, DO

St. Charles Center for Women's Health

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

www.stcharleshealthcare.org

NATALIEHOSHAW, MD

St. Charles Center for Women's Health

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

www.stcharleshealthcare.org

AMY B. MCELBOY, FNP

St. Charles Center for Women's Health

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

www.stcharleshealthcareorg

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

Loc ations in Redmond gr Prineville 541 - 526-G635

www.stcharleshealthcare.org

00 N E Neff Rd • Bend

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

1501 NE Medical Center Drive• Bend

541-382-4900

541-382-3344

www .bendmemorialchnic.com ww .bendmemorialchnic.com

www . bendmemorialchnic.com

www.thecenteroregon.com

541-647-1638

www.belzamd.com

541-382-3344

www.thecenteroregon.com

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

TIMOTHY HILL,MD

The Center: Orthopedic gr Neurosurgical CaregrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

JAMES NELSON,MD

The Center: Orthopedic A NeurosurgicalCaregrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

LARRY PAULSON,MD

The Center: Orthopedic grNeurosurgical CaregrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

ROB BOONE,MD

St. Charles Cancer Center

Locations in Bend 8I Redmond

541-706-5800

www.stcharleshealthcare.org

CORA CALOMENI,MD

St. Charles Cancer Center

Locations in Bend 8I Redmond

541-706-5800

www.stcharleshealthcare.org

SUSIE DOEDYNS, FNP

St. Charles Cancer Center

Locations in Bend th Redmond

541-706-5800

www.stcharleshealthcare.org

BRIAN L.ERICKSON, MD

Bend Memorial Clinic

Bend Eastside 8I Redmond

541-382-4900

STEVE KORNFELD, MD

St. Charles Cancer Center

Locations in Bend 8I Redmond

541-706-5800

www.stcharleshealthcare.org

BILL MARTIN,MD

St. Charles Cancer Center

Locations in Bend 8I Redmond

541-706-5800

www.stcharleshealthcare.org

BENJAMIN J. MIRIOVSKY, MD Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900

LAURIE RICE, ACNP-BC

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900 w

WILLIAM SCHMIDT, MD

Bend Memorial Clinic

Bend Eastside 8I Redmond

541-382-4900

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www . bendmemorialdinic.com ww .bendmemorialdinic.com

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ADVEGTI MGSUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY I

HEATHER WEST, MD

Bend Memorial Clinic

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

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MATTHEWN. SIMMONS

UrologySpedalistsofO regon

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

ww. u rologyinoregon.com

BRIAN P. DESMOND, MD

Bend Memorial Clinic

Bend Eastside, Westside grRedmond 541-382-4900

ww w.bendmemorialdinic.com

THOMAS D.FITZSIMMOHS, MD,MPH Bend Memorial Clinic

Bend Eastside, Westside th Redmond 541-382-4900

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ROBERT C. MATHEWS, MD

Be n d Memorial Clinic

Bend Eastside, Westsidegr Redmond 541-382-4900

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SCOTT T.O'CONNER, MD

Bend Memorial Clinic

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

ww w .bendmemorialchnic.com

I '

' I

Integrated Eye Care

452 NE Greenwood Ave.

541-382-5701

www.iebend.com

KIRSTEN CARMIENCKESC01T,OD IntegratedEye Care

452 NE Greenwood Ave.

541-382-5701

www.iebend.com

MARY ANN ELLEMENT, OD

Integrated Eye Care

452 NE Greenwood Ave.

541-382-5701

www.iebend.com

LORISSA M. HEMMER, OD

Bend Memorial Clinic

MICHAEL MAJERCZYK,OD

Bend Memorial Clinic

KIT CARMIENCKE,OD

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

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

541-382-4900

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

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ww.d r keithkrueger.com

Locations in Bend SrRedmond

541-388-2333

www.desertorthopedics.com

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

JEFFREY P. HOLMBOE, MD

The Center: OrrhopedicsrNeurosurgical CaregrResearch Locations in Bend ga Redmond

541-382-3344

www.thecenteroregon.com

JOEL MOORE, MD

The Center: Orthopedic I Neurosurgical CareSrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

KNUTE BUEHLER, MD

The Center: Orthopedic I Neurosurgical CaregrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

MICHAEL CARAVELLI,MD

The Center: Orthopedic I Neurosurgical CareSrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

ERIN FINTER, MD

Desert Orthopedics

Locations in Bend 8r Redmond

541-388-2333

www.desertorthopedics.com

JAMES HALL, MD

The Center: Orthopedic I Neurosurgical CareSrResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

ROBERT SHANNON,MD

Desert Orthopedics

Locations in Bend SrRedmond

541-388-2333

www.desertorthopedics.com

AARON ASKEW,MD

Desert Orthopedics

ANTHONY HINZ, MD

The Center: Orthopedic I Neurosurgical CareSrResearch

I '

MICHAEL RYAN, MD

Desert Orthopedics

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

www.desertorthopedics.com

GREG HA, MD

Desert Orthopedics

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

www.desertorthopedics.com

KATHLEEN MOORE, MD

Desert Orthopedics

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

www.desertorthopedics.com

I '

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

1315 NW 4th Street• Redmond

541-388-2333

www .desertorthopedics.com

541-382-3344

www.thecenteroregon.com

TIMOTHY BOLLOM, MD

The Center: Orthopedic I Neurosurgical CaresrResearch

BRETT GINGOLD,MD

Desert Orthopedics

SCOTT JACOBSON,MD

The Center: Orrhopedic I NeurosurgicalCaresrResearch 2 2

BLAKE NONWEILER,MD

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

I '

CARAWALTHER, MD I '

Desert Orthopedics

0 0NE Neff Rd • Bend

4 1-3 8 2 - 3344

www.thecenteroregon.com

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

www.desettorthopedics.com

MICHAEL COE,MD

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

KENNETHHANINGTON, MD D e s ert Orthopedics

Locations in Bend gr Redmond

4 1- 3 8 2-3344

www.t h ecenteroregon.com

541 - 388-2333

www .desettorthopedics.com

ADVERTISING SUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY I '

•

AARON HOBLET) MD

Desert Orthopedics

SOMA LILLY, MD

The Center: Orthopedic A NeurosurgicalCaregtResearch

JAMES VERHEYDEN, MD I ' I ' I

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

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

541 - 388-2333

www .desertorthopedics.com

41-38 2 - 3344

www.t hecenteroregon.com

41- 3 8 2-3344 w

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MOLLY OMIZO, MD

DeschutesOsteoporosis Center

JENNY BLECHMAN, MD

Partners In Care

2075 NE Wyatt Ct• Bend

541-382-5882

www.partnersbend.org

LISA LEWIS, MD

Partners ln Care

2075 NE Wyatt Ct• Bend

541-382-5882

www.partnersbend.org

RICHARD J.MAUNDER, MD

St. Charles AdvancedIllness Management

2500 NE Neff Road• Bend

541-706-5885

www.stcharleshealthcare.org

LAURA ILMAVITY, MD

St. Charles Advanced Illness Management

2500 NE Neff Road• Bend

541-706-5885

www.stcharleshealthcare,org

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

STEPHANIE CHRISTENSEN, DMD Deschutes Pediatric Dentistry

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

www.deschuteskids.com

STEVE CHRISTENSEN,DMD D e s c hutes Pediatric Dentistry

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

www.deschuteskids.com

BROOKS BOOKER,MD

Bend Memorial Clinic

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

ww . bendmemorialdinic.com

KATEL. BROADMAN,MD

Bend Memorial Clinic

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

ww .bendmemoriaichnic.com

THOMAS N. ERNST, MD

St.Charles Family Care

JENNIFER GRISWOLD,PNP

Bend Memorial Clinic

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

MICHELLE MILLS, MD

Bend Memorial Clinic

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

MARGARET J.PHILP, MD

St.Charles Family Care

JENNIFER SCHROEDER, MD

B e nd Memorial Clinic

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

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JB WARTON,DO

Bend Memorial Clinic

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

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ROBERTANDREWS,MD

Desert Orthopedics

Locations in Bend gaRedmond

541-388-2333

LINDA CARROLL, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

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

TIM HILL, MD

The Center: Orthopedic A NeurosurgicalCareAResearch Locations in Bend St Redmond

NANCY H. MALONEY, MD

Bend Memorial Clinic

JAMES NELSON,MD

The Center: Orthopedic a NeurosurgicalCaregtResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

LARRY PAULSON, MD

The Center: Orthopedic gt Neurosurgical Care 8 Research

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

DAVID STEWART, MD

The Center: Orthopedic A NeurosurgicalCare AResearch

2200 NE Neff Rd• Bend

541-382-3344

www.thecenteroregon.com

JONSWIFT, DO

Desert Orthopedics

Locations in Bend gt Redmond

541-388-2333

w w w .desertorthopedics.com

00 N E Neff Rd • Bend

541-382-3344

www . thecenteroregon.com

2200 NE Neff Rd• Bend

541-382-3344

www . thecenteroregon.com

211 NW Larch Ave• Redmond

The Center: Orthopedic gtNeurosurgical CaregtResearch 2 2

MARC WAGNER,MD

The Center: Orthopedic gt Neurosurgical CaregtResearch

DEAN NAKADATE) DPM

DeschutesFoot gtAnkle

I •

541-548-2164

541-382-3344

www.stcharleshealthcare.org ww . bendmemoriaichnic.com

ww .bendmemorialdinic.com www.stcharleshealthcare.org

w w w .desertorthopedics.com

www . thecenteroregon.com

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

VIVIANE UGALDE,MD

••

541-548-2164

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

•

BROOKEHALL, MD I

St.Charles Preoperative Medidne

2500 NE Neff Road• Bend 5

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

JONATHANBREWER,DO,D-ABSM BendMemorial Clinic

JAMIE DAVID CONKLIN, MD

St. Charles Pulmonary Clinic

LOUISD'AVIGNON, MD

Bend Memorial Clinic

Bend Eastside gtRedmond

541-382-4900

Locations in Bend IhRedmond

541-706-7715

Bend Eastside ARedmond

541-382-4900

ww w.bendmemorialdinic.com www.stcharleshealthcare.org ww w.bendmemorialdinic.com

ADVEGTISINGSUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY I

ERIC S. DILDINE, PA-C

St. Charles Pulmonary Clinic

Locations in Bend ARedmond

541-706-7715

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

Bend Eastside tjt Redmond

541-382-4900

JONATHAN MCFADYEN, NP-BC Bend Memorial Clinic

1501 NEMedical Center Drive • Bend

KEVIN SHERER, MD

St. Charles Pulmonary Clinic

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

Locations in Bend AtRedmond

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

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

www.stcharleshealthcare.org

14 60 NE Medical Center Dr • Bend

54 1 - 382-9383

www.corapc.com

ROBERT HOGAN,MD

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

54 1 - 382-9383

www.corapc.com

STEVEN MICHEL, MD

Central Oregon Radioloy Assodates, P.C.

PATRICKBROWN, MD

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

STEVE KJOBECH,MD

Central Oregon Radiology Assodates, P.C.

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

www.corapc.com

GARRETT SCHROEDER, MD

Central Oregon Radiology Assodates, P.C.

1460 NEMedicalCenterDr•Send

541-382-9383

www.corapc.com

DAVID ZULAUF, MD

Central Oregon Radiology Assodates, P.C.

14 60 NE Medical Center Dr • Send

54 1 - 382-9383

www.corapc.com

THOMAS KOEHLER,MD

Central Oregon Radiology Assodates, P.C.

1460NE MedicalCenterDr•Bend

541-382-9383

www.corapc.com

JOHN STASSEN, MD

Central Oregon Radiology Assodates, P.C.

1460 NEMedicalCenterDr•Send

541-382-9383

www.corapc,com

JEFFREY DRUTMAN, MD

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

54 1 - 382-9383

www.corapc.com

RONALD HANSON, MD

Central Oregon Radioloy Assodates, P.C.

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

I ' ' I

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

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

WILLIAM WHEIR HI, MD

Central Oregon Radioloy Assodates, P.C.

54 1 - 382-9383

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

www.corapc.com www.corapc.com

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

LAURIE MARTIN,MD I

www.corapc.com

JAMES JOHNSON,MD

www.corapc.com

I ' ' I

54 1 - 382-9383

www.corapc.com

•

PAULA SHULTZ, MD

54 1 - 382-9383

www.corapc.com

•

Central Oregon Radiology Assodates, P.C.

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

www.corapc.com

STEPHEN SHULTZ, MD

Central Oregon Radioloy Assodates,P.C.

1460 NEMedicalCenterDr•Bend

www.corapc.com

CLOE SHELTON, MD

Central Oregon Radioloy Assodates, P.C.

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

NOREEN C. MILLER, FNP

St. Charles Rehabilitation Center

2500 NE Neff Road• Send

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

CHHISTINA BRIGHT, MD

Bend Memorial Clinic

Bend Eastside At Redmond

541-382-4900

DANIELE.FOHRMAN,MD

High Lakes Health Care Upper Mill

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

Deschutes Rheumatology

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

929 SW Simpson Avenue• Bend

541-382-9383

www.corapc.com

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2200 NENeffRoad,Suite 302 • Bend

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Bend

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ARTHUR IL CONRAD, MD

St. C harles Sleep Center

Locations in Bend AtRedmond

541-706-6905

www.stcharleshealthcare.org

DAVID L. DEDRICK, MD

St.Charles Sleep Center

Locations in Bend At Redmond

541-706-6905

www.stcharleshealthcare.org

Send

541-382-4900

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

www .bendmemorialdinic.com

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2014 CENTRAL OREGON M E D ICAL DIRECTORY I

DAVID HERRIN, DC

Redmond Wellness gt Chiropractic

TIMOTHY L. BEARD, MD, FACS Bend Memorial Clinic

DAVID CARNE, MD

St. Charles Surgical Spedalists

GARY J. FREI, MD, FACS

Bend Memorial Clinic

1655 SW Highland Ave,Ste 6• Redmond

541-923-2019

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

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

1245 NW 4th Street, ¹101• Redmond

SEAN HEALY, PA-C

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

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DARREN M. KOWALSKI, MD, FACS Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900

JOHN C. LAND, MD, FACS

St. Charles Surgical Spedalists

1245 NW 4th Street, ¹101• Redmond

54 1 -548-77G1

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SUZANNE MARCATO, PA

St. Charles Surgical Spedalists

1103 NE Elms Prineville

541-548-77G1

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ANDREW SARGENT, PA-C, MS Bend Memorial Clinic

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

RONALD SPROAT,MD

St. Charles Surgical Spedalists

1103 NE Elm i Prineville

GEORGET.TSAI,MD,FACS

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JEANNE WADSWORTH, PA-C, MS Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900

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ERIN WALLING, MD, FACS

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

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JEFF CABA, PA-C

Bend Memorial Clinic

Bend Eastside, Westside A Redmond 541-382-4900

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ANN CLEMENS, MD

Bend Memorial Clinic

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TERESA COUSINEAU, PA-C

Bend Memorial Clinic

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MIKE HUDSON,MD

St. Charles Immediate Care

2600 NE Neff Road• Bend

541-706-3700

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Bend Memorial Clinic

BendEastside,WestsidettIRedmond

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Send Memorial Clinic

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1501 NE Medical Center Drive• Bend

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CASEYOSBORNE.RODHOUSE, PA-C Send Memorial Clinic

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Bend Memorial Clinic

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JONATHAN SCHULTZ

St. Charles Immediate Care

PATRICK L. SIMNING, MD

Ben d Memorial Clinic

Bend Eastside, Westside A Redmond

54 1 -382-4900

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JENNIFER L. STEWART, MD

S e n d Memorial Clinic

BendEastside,WestsidegIRedmond

54 1 -382-4900

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SEAN SUTTLE, PA-C

Bend Memorial Clinic

Bend Eastside, Westside SIRedmond

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BRENT C. WESENBERG, MD

B e nd Memorial Clinic

Bend Eastside, Westside A Redmond

54 1 -382-4900

MICHELLE WRIGHT,FNP

St. Charles Immediate Care

1501 NE Medical Center Drive• Bend

54 1-382-4900

MEREDITH BAKER, MD

Bend Urology Associates

2600 NE Neff Road• Bend

541-706-3700

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2090 NEWyatt Court•Bend 54 1 - 382-6447

RONALD BARRETT,MD, FACS Bend Urology Assodates

2090 NEWyattCourt•Bend

541 -382-6447 w

MICHEL BOILEAU, MD, FACS Bend Urology Assodates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

JACK BREWER, MD

Bend Urology Assodates

2090 NE Wyatt Court• Bend

541-382-6447

www.bendurology.com

ANDREW NEEB, MD

Urology Specialists of Oregon

BRIAN O'HOLLAREN,MD

Bend Urology Assodates

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

2090 NE Wyatt Court• Bend

541-382-6447

ww.bendurology.c om

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ADVEGTIING SUPPLEMENT

2014 CENTRAL OREGON M E D ICAL DIRECTORY MATTHEW N. SIMMONS, MD U r ology Spedalists of Oregon

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

NORA TAKLA, MD

Bend Urology Assodates

2090 NE Wyatt Court• Bend

ROD BUZZAS, MD

Advanced Specialty Care

1247 NE Medical Center Drive• Bend

541-382-6447

www.urologyinoregon.com www.bendurology.com

54 1-322-5753 w w w .advancedspecialtycare.com

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

2200 NE Neff Road, Ste 204• Bend

54 1 - 382-8346

www.bendvein.com

ANDREW JONES, MD, FACS

ino via Vein Spedalty Center

2200 NE Neff Road, Ste 204• Bend

54 1 - 382-8346

www.bendvein.com

DARREN KOWALSEI,MD

Bend Memorial Clinic

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

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WAYNE K. NELSON, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900 w

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SAMUEL CHRISTENSEN, PA-C Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900 w

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JASONJUNDT, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1-382-4900 w

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WAYNE K NELSON, MD

Bend Memorial Clinic

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

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

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

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Cover story ~ SUPPLEMENTS

Continued from Page 9

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

SUMMER/FALL2014.HIGH DESERT PULSE

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

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

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hhgh

JOE KLINE

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

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

Page 50

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

SUMMER/FALL2014•HIGHDESERTPULSE

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

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

SUMMER/FALL2014.HIGH DESERT PULSE

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

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Coverstory(HOMELESSHEALTH CARE

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

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

Page 52

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

SUMMER/FALL2014â&#x20AC;˘HIGHDESERTPULSE

RYAN BRENNECKE

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

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

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

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

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

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

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

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

For motion sickness,

Eating these may help

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

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

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

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

Some inconsiderate insect

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

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

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

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

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6 • went andbityou.Which

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

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

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

SUMMER/FALL2014•HIGHDESERTPULSE

One voice I A pER soNALEssAY

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

SUMMER/ FALL2014 •HIGH DESERT PULSE

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