Pulse Magazine Fall/Winter 2015

FALL / WINTER 2015

PULSE H I G H

D E S E R T

Ice skating: Gear up for the rink Healthy eating: Holiday drinks

Healthy Living in Central Oregon

Weighing the risks

Concussions force parents to balance the benefits of youth sports against the possibility of brain damage

Update | SINCE WE LAST REPORTED California adopts End of Life Option Act FALL / WINTER 2015 VOLUME 8, NO. 3

How to reach us Julie Johnson | Editor 541-383-0362 or jjohnson@bendbulletin.com Jody Lawrence-Turner | Editor 541-383-0308 or jturner@bendbulletin.com • Reporting Tara Bannow 541-383-0304 or tbannow@bendbulletin.com Kathleen McLaughlin 541-617-7860 or kmclaughlin@bendbulletin.com Mark Morical 541-383-0318 or mmorical@bendbulletin.com Will Rubin 541-382-1811 or wrubin@bendbulletin.com • Design / Production Jeff Caspersen Carli Krueger David Wray

Joe Kline Andy Tullis

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

• Advertising Jay Brandt | advertising director 541-383-0370 or jbrandt@bendbulletin.com Kylie Vigeland health & medical account executive 541-617-7855 or kvigeland@bendbulletin.com • On the Web: www.bendbulletin.com/pulse

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

Published: 11/9/2015

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nesses; and a doctor agrees a patient has the mental capacity to make his or her medical decisions.

The law will be enacted in 2016; an exact date is yet to be determined.

The End of Life Option Act has a 10-year sunset provision to end these protections if California’s Legislature fails to approve a new version of this bill or extend its terms before Jan. 1, 2026. •

Greg Cross Pete Smith

• Photography Ryan Brennecke Jarod Opperman

The Summer/Fall issue of High Desert Pulse’s story “End-of-Life Choices” highlighted California as a state on the verge of implementing an assisted suicide for the terminally ill law modeled after Oregon’s Death with Dignity Act. On Oct. 5, California became the fifth state to enact an aid-in-dying or assisted suicide statute when Gov. Jerry Brown signed the End of Life Option Act. Montana, Vermont and Washington also have statutes that protect doctors who give their terminal patients aid-in-dying medications.

The act allows doctors and other health care providers to give terminally ill patients a lethal dose of medication to take their own lives. The law mandates: Two doctors must confirm a patient is terminally ill; a patient must make two oral requests for the medication at least 15 days apart; a patient must submit a written request signed by two wit-

Letters Speech therapy article is uplifting I belong to an e-list in which members discuss articles related to speech therapy. I want to say that Dylan J. Darling’s essay “An adult tackles speech therapy” was the most uplifting such article I have read in a long time on the subject. The fact that Darling started speech therapy at 37 is exemplary, as there are so many others out there who may feel too old to finally pursue speech therapy. In my opinion, The Bulletin should seek national media attention for Darling’s unique story.

In terms of speech therapy for children, I just want to make two points of my own.

First, these days private speech therapy for children can be too expensive for some families; even families who have employer-based health coverage are complaining about access to private speech therapy. Second, the U.S. public at large is unaware that for almost 40 years every child in the U.S. had the guaranteed right to FREE speech therapy as was mandated by federal legislation. The free therapy covers all speech problems and is available from preschool up through high school. The best explanation of this unknown gem in our national health care system is a brochure “Special Education Law and Children Who Stutter,” which is available for download on the website of The Stuttering Foundation (www.stutteringhelp.org). It gives a great explanation to parents of this benefit of free speech therapy. The Stuttering Foundation website also offers helpful free resources to people who stutter of all ages.

— Edward Herrington, Longmeadow, Massachusetts FALL / WINTER 2015 • HIGH DESERT PULSE

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Contents | HIGH DESERT PULSE

WEIGHING THE RISKS Concussions and youth sports

COVER STORY

4

WEIGHING THE RISKS When it comes to concussions and youth sports, parents must weigh the benefits of participation against the possibility of brain damage.

FEATURES

10

SYNTHETIC OPIOIDS Bend recently got its first methadone clinic. But is the use of synthetic opioids the safest way to combat addiction?

DEPARTMENTS

2

UPDATE California becomes the fifth state with an aid-in-dying or assisted suicide statute.

14

GET READY Rock climbing can be intimidating. So why not learn the ropes indoors before scaling scary cliffs?

18

HEALTHY EATING A guide to navigating the calorie minefield of holiday cocktails

20 21

POP QUIZ Test your sodium IQ

24

GEAR A crash course on how to equip yourself for Bend’s new ice skating rink.

26

TIPS X-rays, CT scans, MRIs, ultrasounds, mammography: Learn the ABCs of medical imaging.

30

JOB Deschutes County’s deputy medical examiners: It’s their job to make sense of death.

54

SNAPSHOT Snowshoeing Tumalo Mountain

10

SYNTHETIC OPIOIDS A tool to combat addiction

14

GET READY Climbing: Learn the ropes

PROFILE It’s Bette Fraser’s mission to help people connect more with their food.

COVER DESIGN: CARLI KRUEGER CONTENTS PHOTOS, FROM TOP: ANDY TULLIS (3), RYAN BRENNECKE

FALL / WINTER 2015 • HIGH DESERT PULSE

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24

GEAR Ice skating

Cover story | CONCUSSIONS: WEIGHING THE RISKS

Playing with their

BY KATHLEEN MCLAUGHLIN PHOTOS BY ANDY TULLIS

R

ylee Dickinson’s last memory of competing in soccer is fuzzy.

The teen and her Mountain View High School teammates were on Bend High’s turf. The rival team had a corner kick, and Dickinson stood in the goal box, ready to head the ball out.

The ball came flying. Dickinson jumped up, but a Bend High player was already behind it, ready to drive it in. Both girls got their heads on the ball, but Dickinson absorbed her opponent’s momentum.

She doesn’t remember where the ball went next, or much else about the next 15 minutes she made herself play.

“I would be running and I would black out while I was running,” Dickinson, now 16, said. “Then I would wake up out of it, and I was like, ‘What am I doing? Where am I?’” Dickinson was experiencing her second concussion in three weeks.

She had headaches. She took at least a month away from schoolwork. Regaining her short-term memory took several more months.

Page 4

FALL / WINTER 2015 • HIGH DESERT PULSE

future

Sports and recurrent concussions: Parents weigh the risks against the benefits of participation

Lisa Dickinson, right, sees both the risks and benefits of her daughter Rylee, 16, left, playing soccer. While Lisa doesn’t think playing again is worth the risk, she acknowledges the importance of sports. “Especially as adolescent girls, keeping busy and feeling good about yourself, and feeling strong and having that sense of accomplishment is important.”

“I think each parent has different levels of risk assessment they make in their own mind and how much they want to let the kid play, and how important it is to the kid.”

— Dr. Viviane Ugalde, a concussion specialist

Mountain View High girls soccer coach Don Emerson, center, addresses his team alongside assistant coach Rylee Dickinson, right, during an August practice. Dickinson, a player on the team who has sustained multiple concussions, was not cleared to play in time for the season, but was asked by Emerson to help on the coaching front.

FALL / WINTER 2015 • HIGH DESERT PULSE

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Cover story | CONCUSSIONS: WEIGHING THE RISKS

Mountain View High School junior Rylee Dickinson, in the black shirt, is helping coach the team after being sidelined because of a series of concussions. She’s at a critical junction in her recovery, says Viviane Ugalde, a concussion specialist. “I think you really have to make that decision about what’s more important to you, that short-term — ‘I might be able to play a season or two before I have my next one — but then what kind of repercussions do I have at that point?’”

Seeing Rylee struggle almost a year later, Lisa Dickinson wishes her daughter had taken a longer break after her first concussion during the 2014 soccer season.

A doctor at The Center Orthopedic & Neurosurgical Care & Research in Bend had cleared her to play after about a week. What parents may or may not understand is that cleared to play is not the same as risk-free.

Concussion symptoms, such as headaches or trouble concentrating at school, can appear even after the athlete seems to have recovered. They’re easy for parents to overlook and for hard-charging athletes to brush off or hide, but they are a sign the brain hasn’t recovered, leaving the athlete at risk for second-impact syndrome, which can be deadly.

Parents who are alarmed by concussion horror stories might assume medical research would reinforce their decision to keep kids away from contact sports. Yet leading researchers think the benefits of participation outweigh the risk of head trauma, and they’re looking for ways to help young athletes who struggle with prolonged concussion symptoms get back to playing. That’s despite the fact that doctors still can’t tell parents how many blows to the head a kid can take and still avoid permanent neurological damage, or whether staying concussion-free for a given window of time will keep a kid safe.

All that leaves parents weighing the unquantified risk of multiple concussions against the more concrete and immediate repercussions of holding a kid back from a sport that’s so tied to his or her Page 6

identity, as well as the family dynamic.

“I think each parent has different levels of risk assessment they make in their own mind and how much they want to let the kid play, and how important it is to the kid,” said Dr. Viviane Ugalde, a concussion specialist at The Center who saw Rylee after her second concussion of that 2014 soccer season.

Ugalde offers families a range of options. The most conservative route, the best chance for a full recovery of the brain, is to take a year away from activities in which collision is likely, she said.

The middle path is taking a few months away from the sport, just to make sure symptoms don’t pop up again. The last is to return to play immediately. “So that really puts the onus on the parents, which is horrible, right?” Ugalde said.

Ugalde did not clear Rylee to play in August, 10 months after the concussion she received Oct. 23, 2014, during the game against Bend High.

With practice about to start and knowing that she’d be missing her friends, Mountain View coach Don Emerson invited Rylee to come out as an assistant coach.

Later she began participating during noncontact drills. Rylee held out hope for a senior-year comeback, but her mom wasn’t so sure.

“If I had it my way, neither one of my girls would even consider it again,” Lisa Dickinson said. “To me, it’s just not worth it.”

At the same time, she sees the benefits of sports. “Especially as adolescent girls, keeping busy and feeling good about yourself, and feeling strong and having that sense of accomplishment is important.”

A matter of luck?

Doctors know that with each concussion, the odds of subsequent concussions increase. And with multiple concussions, there’s a greater chance of symptoms lasting longer than four weeks.

“How do you predict those folks that are going to have a recurrent concussion?” Ugalde said. “We don’t have a good handle on that.”

Most of the time, going right back to a contact sport has no consequences. The Center’s charitable arm, The Center Foundation, provides athletic trainers to Bend, Summit, Mountain View, La Pine and Sisters high schools, and the trainers see about 3,000 athletes a year. About 100 concussions are reported to the athletic trainers each year, Ugalde said. (The count does not include concussions that happen outside of school sports. The St. Charles Bend emergency room treated 180 pediatric concussions in 2013 and 224 in 2014.)

Ugalde said few athletes have multiple concussions. Looking at 282 concussions over two academic years, 2011-12 and 2012-13, she found that 17, or 6.4 percent, represented a second or third concussion.

“The lucky thing is that there’s hundreds of thousands of kids out there playing sports,” she said. “And they do well.”

Ugalde treated one girl, a lacrosse player, who received her first and only concussion as a senior in high school. She had persistent FALL / WINTER 2015 • HIGH DESERT PULSE

How a concussion affects the brain When someone gets a concussion , the common description involves a narrative about how the brain bounces against the opposite end of the skull. The common treatment is rest — mainly because the brain needs time to heal. But leading researchers have shown that a concussion is much different than a bruise to skin tissue. Concussions actually twist the neurons in the brain, causing a cascade of symptoms that ultimately result in decreased blood flow to the brain while it attempts to recover. Another traumatic event during the healing process can have catastrophic effects.

Time to recover

Normal neurons The human brain is a complex system of nerves, called neurons, that function by sending electrical signals to each other to control the function of the body.

It can take two to four days to eliminate the calcium from the neurons, and up to 10 days to restore normal blood flow and fix the chemical imbalance.

Danger period Because symptoms of the imbalance might not be apparent, many people who have concussions aren’t aware of the serious risk of re-injury.

Neuron

Lack of blood sugar Just as the brain is seeking more glucose in an effort to get more energy, blood flow to the brain can often drop by as much as 50 percent within two minutes of a concussion.

Complex twist Brains have the consistency of mayonnaise, and respond to a traumatic force by twisting in all directions.

Nucleus Axon

Twisted axons Nerve fibers called axons protrude from the neurons, and these fibers become twisted and swollen during a concussion, inhibiting intercellular communication.

Cascade

Losing energy

Myelin sheath

At this point, large amounts of potassium begin flowing out of the cell, and energy-sapping calcium flows in.

K+

K+

Mitochondria shutdown

Ca2+ Ca + 2

Source: Gerard A. Gioia, Professor of Pediatric Neuropsychology at the Children’s National Medical Center and George Washington University School of Medicine

Surrounding cells begin to shut down in a “spreading depression.” This can result in confusion, amnesia or even a loss of consciousness.

Chemical imbalance Lactic acid is produced and it inhibits the function of the cell’s mitochondria (which function like a cell’s battery power).

PETE SMITH

Cover story | CONCUSSIONS: WEIGHING THE RISKS

headaches. “Nothing worked,” Ugalde said. “All the medicines made her sicker. She had lots of side effects with them.”

The girl was still struggling as she went to college, said Ugalde, who has not treated the girl since that time. “She’s a bright girl, but she had to have accommodations at college to help her get through college.”

While there’s no way to predict who will be so unlucky, research points to some risk factors.

Pre-existing conditions, such as attention deficit hyperactivity disorder, learning disabilities and a history of migraine headaches, seem to be associated with a slow recovery from concussion, said Sondra Marshall, a clinical psychologist at St. Charles Health System who works with pediatric concussion patients. Marshall works alongside doctors at Central Oregon Pediatric Associates and on tough cases as part of a multidisciplinary team that usually includes Ugalde.

If an athlete has one concussion with an unusual course of recovery, Marshall tells the parents, “The best I can do is predict the next one is going to be atypical. And it may take longer.”

If each concussion results in more intense and long-lasting symptoms, or if it takes less and less impact to trigger symptoms, then it’s time to talk about a kid’s future.

“That is a warning sign that return to play should be very seriously considered in terms of contact sports,” Ugalde said.

Rylee Dickinson’s case illustrates how little one can learn from looking solely at the number of concussions in an athlete’s career.

She suffered her very first in eighth grade, but she and her mom said that wasn’t much of a factor when she got her second one as a sophomore in high school. She had collided with a teammate at soccer practice and was cleared to play about a week later.

Dickinson admits that in the weeks leading up to the Oct. 23, 2014, game against Bend High, she brushed off some minor headaches because she wanted to keep playing. Dickinson and her parents think the fact that she wasn’t fully recovered from the first head injury is what made the next concussion so much worse.

So-called second-impact syndrome can be deadly, and it’s what Oregon’s laws around concussions in youth sports were designed to prevent. Sometimes, though, kids fall through the cracks. Ugalde said she has heard about kids who seem OK after a concussion, but then their grades slip. “That kid shouldn’t be doing contact sports,” she said. “They’re still struggling with cognitive recovery.”

Dickinson’s fourth concussion came last spring. She was sitting on the floor at home, watching television, when one of the family’s two Lab-Rottweiler mixes playfully barreled into her. She didn’t feel the effects right away, but later that night, she felt like she was going to throw up.

Lisa Dickinson was not surprised that Ugalde didn’t clear Rylee to

compete in August. Having home-schooled Rylee and her sister, Macenzie, she noticed that Rylee still didn’t absorb reading material as effortlessly as she used to.

Rylee is at a critical junction, Ugalde said. “I think you really have to make that decision about what’s more important to you, that short-term — ‘I might be able to play a season or two before I have my next one — but then what kind of repercussions do I have at that point?’”

Brain glitch A concussion is often described as the brain bouncing against the inside of the skull, first in the direction of impact and then against the opposite side. The proverbial rung bell.

More important to medicine’s current understanding and treatment of the condition is what happens at the cellular level. The impact stretches or twists the membranes of nerve cells, touching off a metabolic cascade that depletes the neurons of energy and inhibits functioning.

Explaining it in terms that his young patients understand, Gerard Gioia, a neuropsychologist and director of the Safe Concussion Outcome, Recovery & Education (SCORE) Program at Children’s National Health System in Washington, D.C., likens a concussion to a software glitch.

It takes time for neurons to restore their chemical balance, but medical researchers no longer believe sitting in a dark room is very helpful. Once headaches, nausea and any other acute symptoms have subsided, patients may gradually ramp up activity.

Gioia is among a group of researchers who believe doctors need to go even further with promoting an active recovery — a general therapy for concussion patients that gives credit for simple, everyday activity.

“I am literally coaching people to think about what they can handle, what they can tolerate the first day of the injury,” he said.

Kids are always doing something, Gioia said, even if it’s just walking around the house. So his idea is to give them credit for that activity, watch to see whether it causes symptoms and push to the next level.

Researchers also think that active recovery can be used with kids who can’t seem to shake the initial headaches or other symptoms.

“We’re looking at a group of kids that don’t feel better at rest,” said Nick Reed, an occupational therapist at Holland Bloorview Kids Rehabilitation Hospital in Toronto. “Because of that they’re no longer allowed to progress to that return-to-play protocol.”

Holland Bloorview is one of several teams across Canada that’s Continued on Page 32

Feature | SYNTHETIC OPIOIDS

Using drugs to overc

ADDICT

Bend recently got its first methadone clinic, something more characteristic of larger cities. But is the use of synthetic opioids the safest way to curb addiction? Some contend it’s not the best solution.

BY TARA BANNOW PHOTOS BY ANDY TULLIS

A

llen Wentworth’s relationship with his mom had always been more like that of a brother and sister. They both had struggled with addiction — to prescription pain pills, to heroin, to alcohol — since they were young. Visiting one another in rehab was Page 10

a regular family outing.

“We were just alike,” said 36-year-old Wentworth, who lives in Redmond.

One night, about four years ago, the two were at the height of a FALL / WINTER 2015 • HIGH DESERT PULSE

come

TION

Allen Wentworth, shown at left practicing his golf swing and below playing basketball at Kalama Park near his home in Redmond, has long battled addiction — to a variety of drugs. He’s been in addiction treatment nine times and is battling back from a relapse this past summer. He’s now working a job in construction, plans to go back to school soon and see a therapist.

particularly rowdy night, taking Vicodin, an opiate pain reliever, and drinking.

“We’re looking at each other — we’re drunk, we’re taking pills — we’re like, ‘This is ridiculous. Let’s go to rehab,’” a newly sober Wentworth recalled in an interview a few months ago.

Wentworth landed an inpatient bed at a treatment facility in Redmond right away.

His mom had to wait. Twelve days later, after taking a plethora of pills, she took a couple of beers down to the river. She fell in, hit her head and drowned.

Losing his mother scared Wentworth into getting his act together — for a time.

FALL / WINTER 2015 • HIGH DESERT PULSE

For people with severe opiate addiction, treatment centers in the U.S. have for more than 40 years put their trust in methadone, a synthetic opioid taken once a day that’s strong enough to tame the cravings of even the most ravenous addicts.

It’s powerful enough to prompt an overdose if a person takes more than the recommended dosage or uses it in combination with other painkillers, so it’s long been tightly controlled by clinics that operate under intense federal scrutiny.

He spent the next four years sober. He got a counseling degree from Central Oregon Community College. He even got a job as an addiction counselor for the provider where

he was formerly a patient.

This past spring, however, the job became too demanding, so he quit. After spending too much time holed up alone in his apartPage 11

Feature | SYNTHETIC OPIOIDS

ment, Wentworth relapsed, hard. He was hospitalized three times, culminating in a four-day hospital stay at the end of July. A friend found him seizing in his apartment and brought him to the hospital, where a doctor told him he nearly died.

This time, getting sober wasn’t so much a choice as a necessity. Even so, Wentworth knows his current recovery is fragile.

“Addicts die,” he said. “It’s what they do.”

For people with severe opiate addiction, treatment centers in the U.S. have for more than 40 years put their trust in methadone, a synthetic opioid taken once a day that’s strong enough to tame the cravings of even the most ravenous addicts. It’s powerful enough to prompt an overdose if a person takes more than the recommended dosage or uses it in combination with other painkillers, so it’s long been tightly controlled by clinics that operate under intense federal scrutiny.

Such clinics traditionally have been tucked into low-income neighborhoods in inner-city New York, Los Angeles or Chicago. In recent decades, they’ve branched out into midsized cities and suburbs as the opiate epidemic has spread to reach people of all incomes and regions.

Last year, Bend, a friendly Central Oregon town of roughly 81,000 people, got its first methadone clinic. It’s a testament not only to the region’s skyrocketing growth in recent years but to the ways opiate addiction has evolved. Gone are the days when opiate addiction treatment centers saw mostly poor, inner-city men whose addictions began with heroin. Within the past five years, addiction experts say, more treatment centers have become occupied by young and middle-aged men and women with moderate incomes who got hooked on prescription pain pills they received either from friends or their doctors.

Data from treatment centers on nearly 3,000 heroin addicts showed that in the 1960s, 83 percent of them were men and 80 percent had started with heroin, according to a July 2014 study in JAMA Pediatrics. More recently, however, they’re almost equally divided between men and women. They live in less urban areas and three-quarters of them were introduced to opioids through prescription drugs. Nearly 90 percent who Page 12

Bend Treatment Center, Bend’s first methadone clinic, is a nondescript building on the city’s east side. It is the 16th clinic that dispenses methadone in Oregon.

became addicted within the past decade were white, the study found.

Two decades ago, the only opiate addicts Dr. Ron Schwerzler saw were homeless.

Schwerzler, the medical director for Serenity Lane, a Eugene-based treatment program with an outpatient clinic in Bend, said that all changed around 1995, when doctors started doling out prescription opiates to treat conditions they were not warranted for and in dangerously high quantities.

“Now, the people that are opiate-addicted here are occupying jobs, they have families,” he said. “They’re not your typical opiate addicts you might think of lying in the street.

They’re functioning. They’re doctors, nurses, lawyers, businessmen, housewives.”

Bend’s clinic is the 16th that dispenses methadone in Oregon, a state particularly plagued by opiate abuse. Federal data show Oregonians led the nation in illicit use of prescription opioids in 2010 and 2011, the last year for which information was available.

But not everyone agrees methadone is the solution. Some — Wentworth and Schwerzler included — argue that because it can get people high, it doesn’t truly stop their dependence on opiates.

“A lot of times, when the addict is taking that stuff, it kind of keeps the beast awake,” Wentworth said.

A safer alternative Within the past decade, a new drug has been gaining steam in Oregon and across

Suboxone use increasing Both methadone and buprenorphine (Suboxone) must be distributed by providers who are federally licensed to treat addiction. Methadone must be administered within designated clinics, while buprenorphine can be distributed by licensed providers.

Annual total of drug prescribed to patients in addiction treatment programs Methadone Buprenorphine (Suboxone) 350,000 patients 300,000 250,000 200,000 150,000

32,676 patients

100,000 50,000

1,794

2004 ’05 ’06 ’07 ’08 ’09 ’10 ’11 Source: U.S. Substance Abuse and Mental Health Services Administration PETE SMITH

the county: buprenorphine, commonly prescribed in a mixture known as Suboxone.

Use of the drug increased more than 1,700 percent between 2004 and 2011, compared with 35 percent for methadone. It works FALL / WINTER 2015 • HIGH DESERT PULSE

“Now, the people that are opiate-addicted here are occupying jobs, they have families. They’re not your typical opiate addicts you might think of lying in the street. They’re functioning.

They’re doctors, nurses, lawyers, businessmen, housewives.”

— Dr. Ron Schwerzler, Serenity Lane’s medical director, on the evolving nature of opiate abuse

similarly to methadone, but unlike the older drug, Suboxone has a ceiling effect that prevents most overdoses.

“It’s a better drug; it’s a safer drug,” Schwerzler said.

Another drug, Vivitrol, won federal approval in 2010. It blocks the effects of opiates and alcohol and is taken as a monthly shot. The downside is it’s expensive — about $1,000 per shot — and its users can overdose if they try to take large amounts of other opioids to overcome its opioid-blocking effects.

In the end, the vast majority of research and experts agree that despite its pitfalls, methadone saves the lives of severe addicts for whom nothing else will work. Some people remain on methadone for decades.

The sad truth, Wentworth said, is that the vast majority of heroin addicts will die with needles in their arms.

Heroin-related overdose deaths in the U.S. jumped 286 percent between 2002 and 2013, the Centers for Disease Control and Prevention announced in July. Use of the drug more than doubled in that time among people ages 18 to 25.

“Eventually, you’ve had hundreds of people you’ve seen die,” Wentworth said. “If the alternative is you take methadone for the

Bend Treatment Center’s front room, above, is packed with chairs. Matt Owen, Bend Treatment Center’s executive director, said he conducted extensive research before opening an opiate treatment facility in Central Oregon. “Bend is exceeding expectations,” he says. “That’s not a good thing.”

rest of your life instead of dying in a bathroom somewhere, take the methadone. At least you’re alive.”

The new clinic in town The nondescript, gray building on Bend’s east side — behind one of the country’s last remaining Blockbusters — gives no hints as to what happens inside. Even the sign out front, Bend Treatment Center, prompts more questions than answers.

On the inside, it looks like a typical doctor’s office. There is a dull waiting room with rows of chairs. Unmemorable art on the walls.

Exam rooms. Offices for administrators and rooms for counseling.

The only indication of what happens here is the narrow closet of a room with a chair on one side and a nurse’s station on the other, separated by thick glass that almost runs the length of the room, save an opening where the nurses hand patients their medication in tiny cups. A reporter wasn’t permitted to see the room where the medications are stored due to security precautions. Signs outside Continued on Page 48

Complete Health & Wellness

Dr. Celso Gangan

Dr. Derek Palmer

• High Cholesterol • High Blood Pressure • Heart Disease • Diabetes

A motivational phrase is posted in a group meeting room at Bend Treatment Center.

FALL / WINTER 2015 • HIGH DESERT PULSE

Page 13

Lori McMillian, FNP

• School & Employment Physicals • Coag Clinic • Adult & Child Wellness Physicals

Brenda Rantala, FNP

• Women’s Health • Arthritis • Lung Disease • Acute Illness Treatment

www.redmondmedical.com

(541) 323-4545 1245 NW 4th Street • Suite 201 • Redmond, OR

Get ready | INDOOR ROCK CLIMBING

CHALK UP AND

BY MARK MORICAL PHOTOS BY ANDY TULLIS

R

ock climbing is not a sport to simply jump right into.

That becomes quite apparent when walking along the hiking trail at Smith Rock State Park and glancing up to see climbers clinging to the impossibly steep rock walls.

Indoor rock climbing gyms provide a safe, less-intimidating arena for beginners to learn the basics of the sport before venturing out to scale Monkey Face.

Climbing instructors and coaches at indoor gyms can help set up beginners with the proper equipment, including climbing shoes and harnesses. Plus, they provide lessons.

Experienced climbers say the biggest hurdle to getting started is not physical, but mental.

“People don’t think they can do this,” says Jessica Warwick, Bend Rock Gym manager and a climbing coach. “So when they come in it’s telling them that they are capable of doing this. Once they go up the wall, they’re like, ‘Oh my gosh, I can do this.’ It’s mentally challenging. You have to overcome a lot of fear and challenge yourself.”

The highest walls at the Bend Rock Gym — the only indoor climbing gym in Bend — are nearly 50 feet up, rather than hundreds of feet up like many at Smith Rock, near Terrebonne.

“People definitely feel more comfortable inside, especially people who have never done it before,” Warwick says. “Outside the exposure can be extremely intimidating and mess with your head. Climbers love going outside, but having some good coaches and mentors is good to help them work through that mental barrier once they go outside.”

Sarah Wyant, a coach and marketing director at Bend Rock Gym, says indoor rock gyms provide a “safer, more controlled environment.” Inside, novice climbers are more apt to lean on the advice of experienced and certified coaches and instructors rather than friends.

“We want people to learn from staff, rather than a buddy,” Wyant says. “That’s actually kind of new in the climbing world.”

In a typical gym introduction or one-hour lesson at Bend Rock Gym, the instructor will fit the new climber with the right shoes and harness, then show them how to clip their harness into the auto belay rope.

Auto belays are devices that eliminate the need for a human belayer, who secures the rope. Using a self-regulating Page 14

Climbers make their way up a beginner wall at Bend Rock Gym.

GO

Getting a start in the sport of climbing can be intimidating.

Indoor gyms are a safe way to get initiated with the sport before venturing outdoors and tackling towering rock walls.

Bend Rock Gym climbing coach Sarah Wyant, left, attaches a carabiner to the harness of fellow coach Jessica Warwick.

Gear up for indoor climbing, Page 17

Bend Rock Gym climbing coach Jessica Warwick scales a route as fellow climbing coach Sarah Wyant belays for her from below.

Get ready | INDOOR ROCK CLIMBING

magnetic braking system, the auto belay takes up the slack as a climber ascends and safely controls the descent when the climber lets go.

“They (auto belays) started as rescue devices for elevator shafts in mines,” says Jim Stone, owner of Bend Rock Gym. “Climbers thought they could do something with it. You can fall back and it holds you. It’s been good for business. You can come and climb on your own.”

Beginners make use of the auto belay as they learn to climb, but they also work as a training tool for more advanced climbers or people simply seeking a cardio workout.

“Parents can just throw their kids on the auto belay and their kids can climb up,” Warwick says. “So parents don’t need to necessarily know a lot of about rock climbing or even how to belay.”

Another aspect that makes indoor climbing more approachable to the beginner than outdoor climbing is that the routes are easier to follow. All routes, given a rating such as 5.7 or 5.8, are color coded, and the plastic hand and foot holds are much more obvious.

(Technical rock climbing routes have ratings from 5.0, the easiest, to 5.15, the most difficult.)

The yellow beginner wall at Bend Rock Gym features the easiest routes, shorter ones with the biggest holds. On more advanced routes at the gym, setters will attempt to design similar routes to those at Smith Rock.

“Climbing indoors and climbing outdoors are very different,” Warwick says. “Outdoor climbers come here (Bend Rock Gym) during the winter to train, and they train really hard. Once spring hits, they’re back out at Smith. If you get really into it, they will utilize our hang boards and weight room. They train and then go hit it hard out at Smith.”

Beginner rock climbers can continue to progress to harder and harder routes as they develop skills, technique and strength. Most fit people who have never tried rock climbing before can come into the gym and scale a 5.7- or 5.8-rated route. Some can even advance quickly to 5.9 or 5.10 routes, Stone says.

“People progress at their own rate,” Warwick says. “But they progress as long as they come in enough. Once a month isn’t going to do it.”

For those who want to try rock climbing but simply cannot overcome their fear of heights, bouldering is a less-intimidating option.

Bouldering is a form of rock climbing performed on overhanging rocks closer to the ground without the use of ropes or harnesses.

Many indoor rock gyms now offer bouldering routes as well.

Located in southeast Bend, the Bend Rock Gym expanded more than two years ago, and has hosted climbers as young as 2 and as old as 82, Warwick says.

Rock climbing is for all ages, and many who try it cannot get enough.

“People don’t really even know they love it until they get in here,” Warwick explains. “They get hooked and meet people here in the gym. I always hear, ‘I can’t do this.’ Then they do it and they love it.

Some people climb to lose weight, some to gain muscle. It’s an incredible workout. Some do it because it’s their passion, like mine.” • FALL / WINTER 2015 • HIGH DESERT PULSE

Page 17

INDOOR CLIMBING GEAR Most indoor rock gyms provide gear for climbers.

Shoes: Climbing shoes have a snug fit, little padding and a smooth, sticky rubber sole.

Harness: Climbers wear harnesses, which they clip into the rope or auto belay as they climb.

Auto belay: Using a self-regulating magnetic braking system, the auto belay takes up the slack as a climber ascends and safely controls the descent when the climber lets go.

This eliminates the need for a human belayer and allows climbers to climb on their own at indoor gyms.

Healthy eating | HOLIDAY DRINKS

Keeping the

calories in check

Cole Ratliff, the bartender at Pine Tavern, handles a hot chocolate drink, left, beside the restaurant’s signature Hot Buttered Rum. ANDY TULLIS

BY KATHLEEN MCLAUGHLIN

A

lcohol in general is a big source of extra calories during the holiday season, but there are a few boozy treats that make plain old beer and wine look downright health-conscious.

You know the ones. Eggnog, hot buttered rum, spiced wine and spiked hot chocolate all contain enough extra sugar — or fat and sugar — to make them as caloric as a small meal.

Does that mean you should avoid them altogether?

Bend dietitian RanDee Anshutz said that depends on how important they are to your annual tradition. If you can limit yourself to one pour, these holiday drinks don’t have to be the ruin of a good diet. Here’s some information to help you savor every calorie, or opt for something less costly to your waistline.

A note about counting calories in liquor: All 80-proof liquor — rum, vodka, whiskey — is about 64 calories per ounce, but most shot glasses measure 1.5 ounces, so you’re really looking at closer to 100 calories per shot. Calorie calculations assisted by RanDee Anshutz, dietitian, and CalorieKing.com.

Page 18

HOT CHOCOLATE AND P

If chocolate and peppermint is a person’s jam, and he no way around the calorie count.

One recipe for “hot schnocolate,” via food.com, come grams of sugar. Like eggnog, hot chocolate has no sa strong alcohol that’s also high in sugar content is add has 172 calories and 13 grams of sugar.

FALL / WINTER 2015 • HIGH DESERT PULSE

SPICED WINE HOT BUTTERED RUM Harvey’s Butter Rum Batter means this drink is as easy to mix as eggnog, and it’s almost as rich.

Melt a tablespoon of the stuff — which is essentially butter, brown sugar and spices — into some hot water, add an ounce or two of rum, brandy or bourbon, and you have one of Central Oregon’s favorite holiday drinks.

The calorie count for an 8-ounce mug made with 2 ounces of rum is around 300, so it’s not quite as fattening as eggnog.

The Harvey’s base is a bit more sugary at 21 grams per tablespoon. In late fall at East Bend Liquor, tubs of Harvey’s and a rum-brandy blend called White Christmas (also popular for eggnog) start flying off the shelves, owner Mark Merrick said.

A lower-calorie drink that still comes in a warm mug is the hot toddy, which is just an ounce of bourbon with hot water, a splash of lemon and a tablespoon of honey, all of which adds up to about 130 calories.

EGGNOG

PEPPERMINT SCHNAPPS

e or she wants that kick of alcohol, too, there’s just

es in at 382.5 calories with 26 grams of fat and 25 atisfying substitute. And to make it peppermint-y, a ded. One shot of 100-proof Rumpleminz schnapps

FALL / WINTER 2015 • HIGH DESERT PULSE

For most, the eggnog base for a cocktail is a syrupy yellow liquid from a dairy carton.

If it is made from scratch, the recipe entails cooking up egg yolks, sugar, whole milk and heavy cream with a dash of nutmeg. No wonder the base concoction comes in at about 240 calories and 18 grams of sugar for 6 ounces.

The alcohol component can be spiced rum, a combination of rum and brandy, or whiskey, each of which is around 100 calories per shot.

The calorie calculation: A small glass of eggnog, depending on the alcohol content, is going to be 340 to 440 calories.

Using light eggnog will save about 60 calories per serving. Anshutz doesn’t think it’s a worthwhile sacrifice, especially if you’re trying to enjoy a truly rare treat. “If what you want is the mouthfeel and texture of real eggnog, I’d probably go with the real deal,” she said.

Spiced wine is made in many ways depending on the recipe’s origin. The drink also is known as mulled wine, glögg and glühwein.

The base is usually red wine mixed with port wine (or not) and a liquor such as vodka, brandy or aquavit, which is a potato-based liquor flavored with caraway. The wine is warmed and infused with cardamom, citrus and raisins, and here’s the part that’s not so obvious: Most recipes call for dissolving a cup of sugar in the batch before adding the liquor.

The overall sweetness of the drink will depend on the base wine, but the cup of sugar is a big reason why an 8-ounce glass of spiced wine is around 335 calories. That’s a heap more than the 200 calories in the same size serving of pinot noir.

If you’re looking for a low-calorie wine alternative, try a spritzer, which is white wine with club soda and lime, or maybe pomegranate seeds for a festive twist. Wine spritzers are around 80 calories, and Anshutz recommends them to anyone who’s going to be spending a lot of time at house parties. •

Page 19

Body of knowledge | POP QUIZ

The scoop on sodium

BY JODY LAWRENCE-TURNER AND JULIE JOHNSON

H

igh amounts of sodium can hide in seemingly simple foods, which means it’s up to consumers to read labels and check for alarming levels.

As a primer, here are a few questions to gauge what you know about sodium.

1.

A small can of Campbell’s Tomato Soup contains what amount of a person’s daily recommended amount of sodium?

A. 50 percent B. 40 percent C. 10 percent D. 20 percent

2.

How much sodium is in a can of Diet Coke?

ILLUSTRATION

BY GREG CROSS

5.

How many milligrams of sodium does 1 cup of cottage cheese contain?

A. 900 B. 1,000 C. 800 D. 1,200

6.

True or false: Two slices of bread have more sodium than a serving of potato chips?

7.

Which beverage has the most sodium?

8.

Which is the higher-sodium fast-food option: Tuna sandwich or small cheeseburger?

A. 20 mg B. 10 mg C. 40 mg D. 50 mg

3.

True or false: A 6-inch roast beef Subway sandwich has less sodium than a 6-inch Black Forest ham Subway sandwich?

4.

Which cereal contains sodium?

A. Raisin Bran B. Cap’n Crunch C. Quaker Oatmeal D. Multi-Bran Chex THINKSTOCK PHOTOS

Answers: 1. B 2. C 3. True

Page 20

A. Tomato juice B. Gatorade C. Cranberry juice D. Pepsi

4. A,B,C and D 5. B (60 percent of a person’s daily serving) 6. True

7. B. Gatorade contains 110 mg of sodium per 8 ounces.

8. Tuna sandwich. Canned tuna is high in sodium.

FALL / WINTER 2015 • HIGH DESERT PULSE

Profile | BETTE FRASER

The kitchen came calling

JAROD OPPERMAN

Professional chef Bette Fraser owns The Well Traveled Fork, which offers cooking classes, catering, personal chef services and culinary tours.

She began her career in investment banking, but Bette Fraser’s love of all things culinary brought her to a fork in the road — and back to the kitchen

BY TARA BANNOW

I

f you’re one of the many people who has hung out in Bette Fraser’s massive northwest Bend kitchen — either for a cooking class or if you’re a friend — chances are, you’ve heard Greystoke, her African grey parrot, chatting away or whistling from the next room.

The 30-year-old bird, which Fraser has had nearly its entire life, is from a species known for its intelligence and its ability to mimic its owners’ voices. Greystoke mimics both Fraser and her husband, Jim. Talking to Fraser — whose first name is pronounced Betty — on a recent afternoon in her kitchen, it sounded like someone was playing FALL / WINTER 2015 • HIGH DESERT PULSE

a recording of her voice in the other room.

“We got him right after we got married, and we’ve been married 31 years,” Fraser said. “He was just a wee pup when we brought him home.”

Greystoke is one of many interesting aspects about Fraser, who calls herself a “serial entrepreneur.” She’s started three businesses now, all food-related. She currently runs a business called The Well Traveled Fork, which provides popular cooking classes, catering, personal chef services and culinary tours designed to help people learn Page 21

Profile | BETTE FRASER where their food comes from and what it takes to grow sustainable, organic produce.

Understanding the origins of food has long been a passion of Fraser’s. She’s originally from Southern California, and it was working there as a personal chef and teaching cooking classes to elementary schoolchildren where she got inspired to help people connect more with their food.

“We take people out and show them that it doesn’t come boneless, skinless and wrapped in plastic at the grocery store,” Fraser said.

“That somebody’s out there actually growing food and raising food.”

In Manhattan Beach, a wealthy Los Angeles-area community, Fraser found that many of the kids she worked with were malnourished, even though their families were well off. They ate lots of highly processed carbohydrates, but no fruits or vegetables, she said.

“It was shocking,” Fraser said. “There was this one little boy, as sweet as can be, he was in the fourth grade. He had these big, red rings under his eyes. It was the lack of good nutrition. What I kind of say in my classes is that these kids thought lettuce came in a bag, chicken came in nuggets and pasta came in a box.”

That was around 2005. About then, Fraser and her husband took a ski trip to Mount Bachelor — one of the few places in the West and Europe they hadn’t skied — and fell in love with Central Oregon.

“It was a good trip,” Fraser said, laughing. “It was a couple of bluebird days skiing.”

It was on that very trip she and Jeff bought the property where they would later build their massive luxury home in Bend’s North Rim neighborhood, a development with a stunning view of the Cascades in which houses must adhere to strict design guidelines.

The couple initially looked into buying an existing home, but the kitchen — of the utmost importance in her line of work — was poorly designed, Fraser said. She had total control over the layout of her current kitchen, which features an impressive, granite countertop, a collection of pots and pans hanging above it and a built-in pizza oven in one corner.

“We put everything we wanted into it,” she said proudly.

Fraser’s experience working with children — who learned their food habits from their parents who didn’t know much more — inspired her to write a children’s book about where food comes from.

She’s not sure yet when the book will be published. The first draft is finished and now she’s planning the photos.

“I’m very pleased with it,” she said.

Fraser’s current line of work is a stark departure from where her career began. After college, she started out in investment banking.

She worked for massive companies like Bank of America, John Hancock and an oil drilling company called Santa Fe International, which has since merged with another company.

Then, when she was around 30, she became disillusioned with the corporate banking world and turned to a line of work she had always been fond of: cooking. Fraser had grown up cooking alongside her mother and grandmothers in Southern California. Fortunately, she said, her husband made enough money so that if she’d struck out, they wouldn’t be completely out of luck.

“It was something I had always thought about,” she said. “When you do something that you love, you don’t work a day in your life, which is obviously true for myself right now.”

Fraser introduced herself to the food world with a peanut brittle company — Bette’s Brittle. She sold the candy to grocery stores and other shops. (This was before the Internet, she said, although that would have been helpful.)

After that, she launched a catering business, which is when she also taught cooking classes in Manhattan Beach. The clients were wealthy and the events were primarily private parties and weddings, Fraser said. Here in Central Oregon, she said she has access to much more food from local farms. The Well Traveled Fork, for example, buys from close to 10 Central Oregon farms.

Eating local does more than support small businesses and the environment, Fraser said; it’s also healthier. As an example, she recently bought a half a pig from Windflower Farm in Bend. She knows the owner and the butcher personally, and she knows the meat does not contain any hormones, antibiotics or other additives — in other words, Fraser said, she knows there’s no “crap” in it.

“With big industrial agriculture, we don’t really know what is going into those animals,” she said, “and so the end product, what we’re buying at the grocery store, it says it’s 100 percent ground pork, but we don’t really know.”

She uses pork to make pork meatballs or one of her family’s personal favorites: ants climb a tree, an Asian dish that involves ground pork, cellophane noodles and spices.

When it comes to produce, Fraser said she prefers to eat with the seasons. Nowadays, it’s a lot of squash and potatoes. Early in the summer, it’s a lot of dark, leafy greens such as spinach, kale and Swiss chard. Those go great in salads, but Fraser said she also incorporates them into pastas. Tomatoes come later in the summer and early fall.

“I think if we all started eating a little better, we wouldn’t be rushing to the doctor,” Fraser said.

Catherine Light, a friend Fraser met when they shared a home

Understanding the origins of food has long been a passion of (Bette) Fraser’s. She’s originally from Southern California, and it was working there as a personal chef and teaching cooking classes to elementary school children where she got inspired to help people connect more with their food.

Page 22

FALL / WINTER 2015 • HIGH DESERT PULSE

builder and decorator, described Fraser as “extremely upbeat.” Light said she’s been to Fraser’s house several times and hired her to cater a party at her own home. She doesn’t get flustered in busy situations and when it comes to cooking classes, she’s good at getting everyone to participate.

“You might be mixing the pasta, you might be doing any number of things.

And of course you’re drinking wine at the same time so everyone is in a good mood,” she said. “She’s very good at creating an atmosphere that makes everyone feel good.”

Fraser, her husband and the couple’s two Labradors are the only Oregonians in their extended family. Fraser’s two stepchildren and five grandchildren are spread out on opposite sides of the country, but they like to come to Bend every so often to taste the beer, she said.

These days, Fraser is constantly on the move. Even around Christmas — the busiest time of the year when it comes to catering — Fraser usually tells family to wait until work has settled down, typically around February.

Since she started the business, she’s worked every day, including weekends and even when she and her husband are on vacation.

“My iPad is glued to my hip,” she said, “but I love it and I have five employees who depend on me for a paycheck and I take that very seriously. We have customers who depend on us as well. And we purchase food from the farmers. They’re depending on us as well. It’s kind of doing business with friends.” •

“I think if we all started eating a little better, we wouldn’t be rushing to the doctor.”

— Bette Fraser, owner of The Well Traveled Fork

Page 23

Gear | ICE SKATING

The cutting edge: G

BY WILL RUBIN

I

ce skating comes to Bend this winter under the roof of The Pavilion, an undertaking of the Bend Park & Recreation District with an ice rink the size of a regulation National Hockey League surface.

Anticipation for The Pavilion’s grand opening this month is high, said Russ Holliday, sports program manager for the park district.

“We’ve taken a lot of questions from people asking about everything from what skating programs we’ll offer to what our rules and safety guidelines will be and what equipment we’ll have available,” Holliday said.

The Pavilion’s shelves are stocked with 500 pairs of Jackson Softec skates, a good all-around skate for general use or hockey. People are welcome to bring their own skates as well.

The fervor over The Pavilion is bound to trigger a desire to understand what equipment is necessary for the slickest of sporting pursuits or the prettiest toe loop.

Additionally, many newcomers to the ice might not be familiar with basics, such as how tight one should tie their skates (very, per Cascade Indoor Sports owner Butch Roberts) or even the differences between figure skates and hockey skates.

“A lot of people will tell you figure skates are easier to learn on,” local skating instructor Rebecca King said. “However, they also have the toe pick for spins and jumps, which can be a tripping hazard.”

Here’s a crash course on how to equip yourself for a return or introduction to an ice rink.

HELMETS

THE ASSOCIATED PRESS FILE PHOTO

BLADE COVERS

Skates require protection and care both on and off the ice. Leaving skates wet will lead to blade-warping rust; “soaker” covers will help prevent it.

Page 24

Required (with a face cage) for anything hockey-related at The Pavilion, but unlikely to be for other activities. A bike helmet works well in a pinch for free skates.

THE ASSOCIATED PRESS FILE PHOTO

HOCKEY SKATE

CLOTHING

Because The Pavilion is an outdoor rink, albeit a covered one, Bend Park & Recreation District’s Russ Holliday recommends dressing as one would for other winter activities. That means thick socks and layers.

THINKSTOCK

FALL / WINTER 2015 • HIGH DESERT PULSE

Gear up for the rink FIGURE SKATE

Hockey skates vs. figure skates: a closer look Hockey skate blades are referred to as “rockers” and resemble a half-moon shape, while figure skates feature the most curved blade of all ice skates.

FIGURE SKATES

RYAN BRENNECKE

HOCKEY SKATES

RYAN BRENNECKE

Figure skates have the most curved blade of all ice skates, which makes it easier to learn the basics like how to turn and stop without falling. Riedell is a company dedicated to all things skates. Its website carries a wide selection for all budgets and abilities.

RYAN BRENNECKE

PADDING

Similar to pads used for skateboarding or snowboarding, padding is available for just about any body part. Hockey pads can be found at most sporting goods stores.

STICKS AND GLOVES

THINKSTOCK

FALL / WINTER 2015 • HIGH DESERT PULSE

Warrior is one of the fastest growing outfitters of hockey sticks and gloves from youth leagues to the NHL. Make sure to do research and test out both before buying.

The blades are referred to as “rockers” and resem resemble a half-moon shape. The most popular brands for elite players are Easton and Bauer, both of which can run upward of $800 due to their onepiece construction and composite materials. For beginners, recreational hockey skates can be had for less than $100.

RECREATIONAL SKATES

THINKSTOCK

The Pavilion’s rental skates are Jackson Softec, a good all-around brand for the still-learning skater. rathThey are designed for comfort and ease of use rath er than speed or aerodynamics. Most Softec skates can be purchased online for less than $100. • Page 25

Tips | MAKING SENSE OF MEDICAL SCANS

A road map to medical imaging From mammograms to CT scans, what to expect before, during and after

BY TARA BANNOW PHOTOS BY RYAN BRENNECKE

M

edical imaging has evolved a lot in the past few decades. Gone are the days when doctors slapped X-ray film onto lighted backgrounds in a dramatic, “Grey’s Anatomy” fashion.

“There is no X-ray film anymore,” Dave Magness, chief operating officer for Central Oregon Radiology Associates and Central Oregon MRI. “We haven’t had X-ray film in probably 12 years in this area.”

Instead, all of those images are contained indefinitely in massive data centers.

Doctors might show patients their scans on iPads or computers. In some cases, they might not look at the images at all, relying instead on a radiologist’s interpretation.

Locally, most physicians have access to CORA’s picture archiving and communication system, which Magness compares to Apple’s iCloud software. After a patient receives scans, doctors can log into the system and see not only their patient’s images but also a radiologist’s report interpreting their meaning and a suggested plan of action.

The shifting landscape of imaging has changed the experience for patients. Images can be called up years later for comparison, or to assess the progress of treatments. And, if they want, patients can get electronic copies of those images to give to another doctor for a second opinion.

In the old days, doing that would require handing over big copies of X-ray film. Now, it’s much easier. The scans are usually handed over on a CD, said Dr. James Brink,

Page 26

Dr. Steve Michel looks over a set of images on his computer screen while working at Central Oregon Radiology. “There is no X-ray film anymore,” says Dave Magness, the chief operating officer for Central Oregon Radiology Associates and Central Oregon MRI. “We haven’t had X-ray film in probably 12 years in this area.”

radiologist-in-chief at Massachusetts General Hospital and a radiology professor at Harvard Medical School.

“It’s important that the imaging information is shared for the benefit of the patient,” he said. “It’s not proprietary.”

Undergoing medical imaging can often be an anxiety-inducing process for patients, especially if the images could reveal life-threatening conditions. A variety of bumps along the way can leave patients waiting for days, wondering what the scans revealed and what it means for them.

Magness explained that once scans are performed at CORA, they go to one of the provider’s 20 radiologists, physicians trained specifically to diagnose and treat conditions using medical imaging.

CORA’s radiologists spend their days in small, dark rooms in front of a row of

computer screens. They compile an average of 54 reports every day, depending on how many images are contained. They go through the scans, write reports that include diagnoses and suggested plans of action. The report is sent automatically via fax, email or electronic medical record to the physician who ordered it.

The results So who’s in charge of calling the patient and telling them the news? It’s almost always the doctor who ordered the scans, Brink said.

At CORA, the average turnaround time between when the scans are taken and when the radiologist’s report is sent to the referring physician is 12 hours, Magness said, noting that it can take more time, or even less time.

FALL / WINTER 2015 • HIGH DESERT PULSE

(Central Oregon Radiology Associates’) radiologists spend their days in small, dark rooms in front of a row of computer screens. They compile an average of 54 reports every day. … They go through the scans, write reports that include diagnoses and suggested plans of action.

Christine Roshak examines images taken with the mammography machine at Central Oregon Radiology.

A number of things can delay the referring physician from contacting the patient about the scans, but Magness said his office always encourages patients to refer back to their regular doctor rather than get-

ting results directly from CORA. Patients are well within their legal rights to get their reports and images directly from CORA, but the practice’s radiologists can’t offer comprehensive medical advice.

“We don’t know the big picture of that patient, sometimes,” Magness said.

Only under rare circumstances do radiologists communicate directly with patients about the results of their scans, said Brink,

Tips | MAKING SENSE OF MEDICAL SCANS

who serves as vice-chair of the American College of Radiology’s board of chancellors.

“That’s generally how it’s done because it’s believed that the referring physician has that personal relationship with the patient and can put that report in context with other information that that person may have about that patient,” he said.

Although almost all doctors in Central Oregon have access to their patients’ scans using CORA’s software, Magness said it’s impossible to know how many actually look at them compared with how many rely simply on the radiologist’s report. He knows from conversations that orthopedists and neurosurgeons, for example, commonly look at the images. It also makes sense that oncologists would look at the images as well to see how a patient’s tumor is responding to their treatment, he said.

Many physicians do not look at the scans, and instead place their trust in the radiologist’s interpretation of them, Brink said. A radiology residency lasts an additional four years after medical school and is followed by a fellowship that lasts another year.

“They’ve had five years of training just in looking at medical images,” he said. “Many practitioners may not feel they’re not going to get as much out of looking at images as opposed to looking at the report generated by the radiologist who’s had all that training.”

Melissa Sorensen holds the transducer used during an ultrasound. An ultrasound is good for studying soft tissue.

How patients can prepare People planning on receiving a medical scan must make sure to tell their doctor whether they use any implanted electronic devices, as the scan could interrupt their function and have life-threatening consequences.

Patients do not need to be concerned with orthopedic implants such as hips, knees or metal screws in joints. Metal plates in the head or neck also are not problematic.

Patients also should be aware of and tell their doctors how many CT scans they’ve had, as radiation exposure is cumulative

over time. While Magness said it’s impossible to say how many CT scans are too many, patients should tell their doctors when they received the scans in the past. In many cases, an additional CT scan will be unavoidable, such as if a patient has colon cancer.

“If somebody moves into the area from California and maybe they’re chronically ill and have had a bunch of CT scans, make sure your physician knows that, that you’ve had a bunch,” Magness said, “because there is no national registry or anything like that that’s going to say you’ve had 10 CT scans out of state and now you’re presenting at our ER.” •

THE MOST COMMON TYPES OF IMAGING Ultrasound/sonography Good for studying soft tissue. No radiation exposure, which is why it’s often used in obstetrics and gynecology for scans of the uterus. It’s also a less expensive screening method, Magness said. Mostly it’s done using a sonar device on the outside of the body, although sometimes it can involve placing a device inside the body, according to Mayo Clinic.

The CT scanner at Central Oregon Radiology

Computed tomography (CT) scan or computerized axial tomography (CAT) scan Generates images that depict many tiny slices through the body like a loaf of bread. Those images can be reconstructed and manipulated on a computer. CT is good for examining acute injuries and trauma as well as kidney stones, and it’s very fast. The scan’s use has gained popularity in recent years. The downside, however, is it’s likely the biggest source of radiation exposure in medical imaging, said Dave Magness, chief operating officer for Central Oregon Radiology Associates and Central Oregon MRI. CT machines look similar to MRI machines. “It looks just like a big, plastic-shrouded donut hole that you’re going into,” Magness said.

Mammography X-ray image of the breast used to screen for breast cancer. The breast is compressed between two firm, flat surfaces to spread out the tissue, according to Mayo Clinic. It’s used for both screening and diagnostics.

The mammography machine at Central Oregon Radiology

Magnetic resonance imaging (MRI) Uses a super-conductive magnet and radio frequencies to listen to energy pulses after they hit atoms in the body. The machine does not emit radiation, but because it uses a strong magnet, it can pull on loose metal objects. Battery-powered devices like automatic defibrillators and pacemakers can prevent patients from being able to receive MRIs. Some manufacturers tout MRI-safe pacemakers, but Magness said a number of precautionary measures still need to be taken before patients with those devices can receive an MRI scan.

“To say it’s MRI safe is a little bit of a misnomer,” Magness said. “You can get a scan, but it takes a lot of pre- and postwork to get that scan.”

MRI is good for soft-tissue injuries such as knee ligament tears or bulging discs in the spine, Magness said. It’s also good for identifying multiple sclerosis lesions in the brain and spinal cord.

FALL / WINTER 2015 • HIGH DESERT PULSE

The X-ray machine at Central Oregon Radiology

X-ray Good for looking at bones; not as much for soft tissue. The test is very quick; X-ray beams pass through the body and are absorbed at different amounts depending on the density of the material, according to the Mayo Clinic. Dense material, such as bones, show up white on X-rays, while less dense material such as fat and muscle show up as gray. X-ray does emit radiation.

Page 29

On the job | DEPUTY MEDICAL EXAMINER

Deciphering

DEATH

Darin Durham and Shaunda Haines are among Deschutes County’s 6 deputy medical examiners.

And, unlike in most of Oregon, all are nurses.

BY KATHLEEN MCLAUGHLIN

T

he clues Darin Durham tracks at a death scene often lead him to a fairly obvious explanation — heart failure, painkiller overdose, suicide.

“Everything’s pretty straightforward,” said Durham, who has been a deputy medical examiner in Deschutes County for two years. “One of the things they teach you in the class: If you see hoofprints, and it looks like a horse and smells like a horse, don’t go looking for zebras.”

The county’s deputy medical examiners, working under the authority of the district attorney, visit the scenes of suicides, fatal crashes and other deaths where circumstances, such as the person’s age, warrant an investigation to rule out the proverbial zebra. Durham is always on the lookout for signs that a death scene should be treated as a crime scene. “Just because you find somebody with a needle in their arm doesn’t mean they overdosed on that drug and died right there. You have to keep an open mind.”

The death investigator’s job is to identify the body and help determine the cause of death. If an autopsy is needed, a local mortuary picks up the body and takes it Page 30

“Just because you find somebody with a needle in their arm doesn’t mean they overdosed on that drug and died right there. You have to keep an open mind.”

— Darin Durham, a Deschutes County deputy medical examiner to the state medical examiner’s office in Clackamas with a law enforcement escort.

Surprisingly, there’s not much for death investigators to do at murder scenes. In those cases, only the state medical examiner’s office can sign off on the cause of death. Deputy medical examiners are supervised by an appointed county medical examiner, who in Deschutes County is Dr. Jana VanAmburg.

In most of Oregon, deputy medical examiners are moonlighting police officers, but Deschutes County is unique in that all are nurses like Durham. The 50-year-old is a longtime trauma nurse and former emergency room director for St. Charles Health

System. He currently works in St. Charles’ urgent care clinic.

The compensation for death investigators is nominal: $16 for on-call shifts, $150 for a full on-scene investigation. “To me it’s like a hobby,” Durham said. “It keeps my skills up as a nurse. It’s a way of giving back and respect to those who have died.”

Deschutes County’s stable of deputy medical examiners means that more death scenes are being visited than in the past, when an appointed medical examiner worked alone, said Shaunda Haines, who was the first nurse to be appointed as a deputy.

Haines began working five years ago under former medical examiner Dr. Deanna St. Germain, who is medical director of KIDS Center, a child abuse intervention center.

As an ER nurse, Haines had worked closely with St. Germain on sexual assault cases, and she has a master’s degree in nursing with a certificate in forensics. Knowing her interest in forensics, St. Germain asked FALL / WINTER 2015 • HIGH DESERT PULSE

“Everything’s pretty straightforward. One of the things they teach you in the class: If you see hoofprints, and it looks like a horse and smells like a horse, don’t go looking for zebras.”

— Darin Durham, a Deschutes County deputy medical examiner

RYAN BRENNECKE

Darin Durham, a deputy medical examiner in Deschutes County, stands by the mortuary table at Niswonger-Reynolds funeral home in Bend. Durham, who is also a nurse, sees his job as deputy medical examiner as a way to give back. “It keeps my skills up as a nurse,” he says. “It’s a way of giving back and respect to those who have died.”

Haines to be her deputy, and the two of them covered all of the county’s cases for about two and a half years. Now under Van­ Amburg, there are six deputies, and they handle all of the field work, Haines said.

While nurses care for the living, their training gives them some advantages in the field of death investigation, Durham said. For starters, they’re very familiar with prescription drugs. “Our best information comes from pill bottles,” he said.

Often during a shift, he simply fields calls from law enforcement officers who are at the home of someone who was being treat­ ed for heart or lung problems. The pres­ ence of an oxygen tank or prescriptions for heart conditions point to a natural death, which Durham confirms with a review of FALL / WINTER 2015 • HIGH DESERT PULSE

the medical records and a call to the per­ son’s doctor.

The hands­on work that death investi­ gators do would sicken some of the most hardened emergency workers. “When I draw blood and urine, I use a 6­inch needle.

I go in pretty deep. Officers almost pass out when I do that,” Durham said. He sends the bodily fluids to the Oregon State Police tox­ icology lab. The results, which take at least 12 weeks to obtain, can shed light on new trends in drug abuse. One specimen that Durham sent for testing turned out to be the first in Oregon containing acetylfentanyl, a synthetic opioid popular with heroin users.

Durham has learned to cordon off his personal vulnerability. He’s a father of two children, but he doesn’t allow that fact to

enter his mind when he sees a dead child or teen. “When I go to a scene, I don’t see a per­ son. I see tissue. I see a body, the biological aspects of it,” he said.

Haines and Durham both said that de­ spite all they’ve seen in emergency work, they were unprepared for the number of suicides, and especially teen suicides, in De­ schutes County.

Durham attended the suicide of a 22­year­ old man in late August. “And in the car, I found business cards from Deschutes Coun­ ty mental health. He had resources. He was tied into the system,” Durham said. “Those are hard for me.”

Seeing so many deaths from prescription opiates has changed their nursing practices.

Patients tend to think that because they tolerate high doses of narcotics, they’re not at risk of overdose, Durham said. When he tells them that he’s seen deaths in his role as a medical examiner, they pay attention.

Narcotics slow the respiratory system, so the deaths tend to follow a bout with flu or pneumonia, he said. “There’s that one time, maybe you have a cold. You’re going to compromise your respiratory system.

You add the narcotics on top of that. Then, boom, you’re done.”

Haines, who now works in surgical re­ covery, believes health care providers need to take more responsibility for the instruc­ tions they give patients on narcotics, and for monitoring their use. “Especially dealing with post­op patients, I give them a little more coaching about the medication they’re going to take at home.” • Page 31

Cover story | CONCUSSIONS: WEIGHING THE RISKS

Continued from Page 9

studying the effects of a specialized active recovery protocol on kids with prolonged concussion symptoms. Reed said the protocol is an intermediate step that involves exercise, visualization and sports-specific drills.

Reed doesn’t think that just because a kid struggles to recover from a concussion he or she should rethink sports.

“We take a real pro-sports approach,” Reed said. “We think there’s considerable benefit involved in participating in physical activity including sports. So we want kids participating in sports.

We want them educated, and we want them doing it safely.”

Gioia, a former football and rugby player, sympathizes with the active kids who become bored and depressed when sidelined by a concussion. He thinks the popular view of concussions is too doomand-gloom. “My view is, ‘You’re going to get better,’” he said. “I give them the pathway for what they need to do to get better.”

Knowledge Oregon’s first law around concussions in youth sports was named for Max Conradt, a 17-year-old football player who experienced a concussion during a game in 2001. In the next game he played, he collapsed at halftime with brain bleeding. He fell into a coma and now lives in a group home in Salem.

Max’s Law required all school districts to adopt concussion-management policies. Coaches must be trained to recognize symptoms.

They must remove kids from play if they suspect a concussion. The kid must be evaluated by a professional, and he or she must have a medical release to return to play.

Jenna’s Law, passed in 2014, essentially extended the same requirements to nonschool sports. It was named for Jenna Sneva, a worldclass skier from Sisters who came close to permanent disability after a career’s worth of concussions.

By now, coaches and school personnel are well versed in the return-to-play protocol, said Bob Marsh, athletic director at Pilot Butte Middle School. He thinks the next step is to train parents. “I don’t think they understand it entirely.”

Seventh-grader Mason Briley has been playing tackle football since fourth grade, but he got his first concussion in 2014 on the playground at Pilot Butte. He and his friends were doing a wide receiver play, and he hit heads with another boy, his mom, Melissa Briley, said.

The concussion caused Mason to miss a couple of weeks of school.

Then last spring, toward the end of his sixth-grade year, he rolled out of a closet shelf where he and a friend were making forts. He hit his head on the toy box below. That time Mason was out of school for about three weeks. He made several trips to a pediatrician at Mosaic Medical for short-term memory and balance testing before he could go back to school, starting at part time, and engage in physical activity.

Mason’s dad, Philip Briley, said the pediatrician told him that because Mason, who is 12, is so young, his brain will become stronger.

“So after one year without a concussion, it’s like he never had a concussion.” Briley’s pediatrician at Mosaic Medical could not be reached for an interview.

The Brileys said they heard plenty of negative feedback from relaPage 32

Pilot Butte Middle School seventh-grader Mason Briley, pictured above with his dad, Philip Briley, and below in a game against Obsidian Middle School, has been playing tackle football since the fourth grade. Although Mason has sustained a couple of recent off-field head injuries, his parents let him play football this fall. “No matter what, you’re taking a risk,” Philip says. “If that’s the risk you want to take, it’s your life, so why hold a person back from what they want to do?”

tives about their decision to let Mason play football this season. Melissa said her brother-in-law bluntly told them they were “stupid.”

She would be inclined to pull Mason out of football if he were hurt again. “With each blow to the head, it creates trauma,” she said. “Of course, now we have to worry about the next time he gets hit. What could that do? It could cause him damage. He could hemorrhage.”

Philip Briley sees no reason to deprive Mason of his passion. “No matter what, you’re taking a risk,” he said. “If that’s the risk you want to take, it’s your life, so why hold a person back from what FALL / WINTER 2015 • HIGH DESERT PULSE

“We take a real pro-sports approach. We think there’s considerable benefit involved in participating in physical activity including sports. So we want kids participating in sports. We want them educated, and we want them doing it safely.”

— Nick Reed, occupational therapist at Holland Bloorview Kids Rehabilitation Hospital in Toronto We handed out a fact sheet. Athletes are going to be safe.”

A self-described jock, Kroshus thinks Americans have allowed sports to become too all-encompassing. “You can still go on the field and compete hard and care a lot and not have this distorted idea of what the sport means in your life,” she said.

Athletic identity they want to do?”

Mason is wiry and fast. He plays cornerback and tailback, and in his team’s first game of the season, he scored a touchdown and racked up 175 yards running and receiving. The team lost, but the Brileys — and most of the Giants’ sideline — were thrilled

by Mason’s performance.

“It was awesome watching him play out there,” Philip Briley said afterward.

If concussions are like other health issues, simply being aware of the risks isn’t enough to change behavior. Consider the fact that about half of all athletes have concussions that they don’t report.

Emily Kroshus, an assistant professor in public health at the University of Washington, became fascinated with the issue after one of her brothers, a neurobiology major at Harvard University, tried to hide a concussion he sustained playing hockey.

Clearly, a lack of knowledge wasn’t the problem.

Kroshus has found that college athletes’ perception of normal behavior, as well as pressure from fans, coaches, teammates and parents, are associated with the likelihood that they will report concussions.

More has to be done to change the culture of youth sports, Kroshus said. “I don’t think we can pat ourselves on the back and say, FALL / WINTER 2015 • HIGH DESERT PULSE

After Rylee’s experience, Lisa Dickinson wants to see her younger daughter, Macenzie, explore all her talents. Macenzie, 12, took a spill on her scooter last summer and had a concussion with amnesia.

She’s playing volleyball in middle school, but Dickinson said she won’t be playing with a club. Besides, Macenzie has other interests, such as art, which Rylee didn’t have a chance to explore once she started playing soccer year-round at the age of 10.

Between high school and travel teams, Rylee played on a coed indoor team with her parents. Her dad had played in high school, and Rylee’s dream was to play for University of North Carolina, a top women’s program.

She pushed herself by scrimmaging with boys. “I would rather go out there … and get beat up playing with them rather than just play with girls because I always felt like I got better,” she said. “They play so much faster.”

Still recovering from her concussion last spring, Rylee gave track a try. She’s found herself with time to attend her church youth group, and last summer she got a part-time job coaching 3- and 4-year-olds.

Maddie Martin is still trying to figure out her post-concussion life.

Starting classes at Bend High in September, Martin hoped she’d look more like the “old Maddie,” who not only played softball

year-round, traveling to Portland twice a week for three-hour practices, but played cello — first chair — bowled and made As in honors classes. She still couldn’t compete in softball, but she hoped to return to the school orchestra, bowl and take a couple of college-prep courses.

Midway through the second week of the fall term, it’s obvious that her concussion recovery isn’t complete. She dropped precalcu-

Maddie Martin, a Bend High School junior, is still adjusting to life after sustaining two concussions in 2014.

Page 33

Cover story | CONCUSSIONS: WEIGHING THE RISKS

lus. Bowling practice doesn’t deplete her energy, but Lava Lanes is one of those noisy environments that could overstimulate her brain or trigger a headache. She’s already realized she can’t handle orchestra. She’s practicing with a club softball team, but only if she has enough energy left after a day of school.

“I’ve never been a kid that goes 50 percent. It’s 100 percent or nothing,” Martin, 16, said. “The fact that I can’t do 100 percent, it just sucks.”

Before getting two concussions in 2014, Martin’s life revolved around softball. At the age of 14, she was being courted by Arizona State University, her mom, Molly Ryan, said.

Trying out for a team in the Willamette Valley in August 2014, Martin took a 50 mph ball in the face. Her parents took her to an emergency room in Portland, where they were relieved that all the bones in her face were intact. She had a concussion, but then, it seemed as though every girl on the team had had one concussion, Ryan said.

Back home in Bend, Ryan took Maddie to a pediatrician, who said she needed to wait a couple of weeks after her symptoms cleared before returning to softball. “That’s what we did,” Ryan said.

But she didn’t take Maddie back to the doctor. “We should have gone back for the she-is-clear appointment,” Ryan said.

Martin ended up joining a different Portland-based travel softball team, which wasn’t aware of her August concussion. Playing at a college-exposure tournament in California that October, Martin dove into a base. She made it to home, but she felt dizzy. She saw the landscape tipping. A throbbing headache came next.

When the headaches and other symptoms persisted for three months, Ryan said Maddie’s pediatrician and Marshall changed her diagnosis from concussion, which is a mild traumatic brain injury, to a traumatic brain injury.

Martin was irritable because she couldn’t do everyday things like go to a grocery store, much less carry on with her usually packed schedule.

Her best friend didn’t understand her bad attitude, and their friendship ended. The loss of that friendship hurts more than anything. “To not stick there by me and just wait it out,” she said, “just broke my heart.”

Concussions in themselves can trigger depression and anxiety.

Kids might also need to see a therapist to deal with all of the changes brought by the injury, to help reshape their identities, Marshall said.

Although complicated cases are not the norm, Ugalde said there are enough kids in Central Oregon who are dealing with chronic symptoms that she would like to set up a support group.

Chronic symptoms Austin Crook, a former standout soccer player for Bend High, is trying to bring attention to post-concussion syndrome as he tries to heal his brain enough to withstand normal levels of physical activity. At age 23, he rides a stationary bike for exercise and avoids any jarring movement that could send him into a dark room, battling a headache for weeks on end.

Researchers find that around 10 percent of young athletes have chronic symptoms, and Crook points out, that’s 10 percent of hundreds of thousands of concussions in youth and college sports a year.

“That’s a huge chunk of the youth that are going to be dealing with that this year,” he said.

Page 34

Maddie Martin, a Bend High School junior, practices bowling with her teammates on the Bend High School bowling team at Lava Lanes in Bend in September. Two head injuries Martin sustained playing softball left her with headaches and other persistent concussion symptoms.

There are more treatment options available now than even four years ago when Crook left Oregon State University after getting backto-back concussions playing pickup basketball. He spent six months sitting around in dark rooms at his parents’ house in Bend. At the time, his parents didn’t understand a concussion’s impact on mental health.

“We had our own family problems from that,” Crook said. His parents would ask, “Are these symptoms created in your own head?”

A middle school teacher in Arizona, Crook set up a concussion survivors Facebook group. His experience served as a warning for his younger brother, Hayden, a walk-on place-kicker at University of Oregon who dropped out in the summer of 2014 because he’d had multiple concussions and was extremely susceptible to headaches.

“My brother and I have created a bond that’s like unbreakable because of this,” said 21-year-old Hayden Crook.

The Crook brothers are working on how to relate to the rest of their still-athletic family. Their father, Brian Crook, played baseball and football in high school and college and never experienced concussions like his sons did. “I’ve had four knee surgeries, so if you tear your knee up, I can relate to that. I get that,” said Crook, who coached baseball at Bend High for about 20 years.

Crook said he understands why his sons are leading cautious lifestyles, but he’s at a loss for ways to connect with them. “What do guys do when they want to connect? They go do something,” he said. “We go play golf, we shoot hoops. You go do something. You don’t sit around and talk.”

Hayden Crook often wishes that when he was younger he’d learned a sport like tennis, something he could fall back on after a concussion.

Brian Crook, principal at High Desert Middle School, has heard his sons say these things and scoffs at the notion that either one of them could have been steered toward some mild activity, like piano lessons.

“Our kids were competitive out of the womb.” • FALL / WINTER 2015 • HIGH DESERT PULSE

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MEDICAL CLINIC

Bend Memorial Clinic

2450 NE Mary Rose Pl. Suite 200 • Bend

541-382-4900

www.bendmemorialclinic.com

MEDICAL CLINIC

Bend Memorial Clinic

231 East Cascades Ave. • Sisters

541-706-5440

www.bendmemorialclinic.com

MEDICAL CLINIC

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

MEDICAL CLINIC

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

NEPHROLOGY

Bend Memorial Clinic

Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

NEUROLOGY

Bend Memorial Clinic

Bend Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

NEUROSURGERY

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

NUTRITION

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

2015 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

M E D I C A L B U S I N E S S E S B Y S P E C I A LT Y C O N T. OBSTETRICS & GYNECOLOGY

East Cascade Women’s Group, P.C.

OBSTETRICS & GYNECOLOGY

2400 NE Neff Rd., Suite A • Bend

541-389-3300

www.eastcascadewomensgroup.com

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

OBSTETRICS & GYNECOLOGY

St. Charles Center for Women’s Health

Locations in Redmond & Prineville

541-526-6635

www.stcharleshealthcare.org

OCCUPATIONAL MEDICINE

Bend Memorial Clinic

Bend, Redmond & Sisters

541-382-4900

www.bendmemorialclinic.com

OCCUPATIONAL MEDICINE

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

OCCUPATIONAL MEDICINE

Mountain Medical Immediate Care

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

OCCUPATIONAL MEDICINE

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

ONCOLOGY ~ MEDICAL

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

OPHTHALMOLOGY

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

OPTOMETRY

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

OPTOMETRY

Integrated Eye Care

452 NE Greenwood Ave. • Bend

541-382-5701

www.iebend.com

ORTHODONTICS

O’Neill Orthodontics

Bend & Sunriver

541-323-2336

www.oneillortho.com

ORTHOPEDICS

Desert Orthopedics

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

ORTHOPEDICS

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

OSTEOPOROSIS

Deschutes Osteoporosis Center

2200 NE Neff Rd., Suite 302 • Bend

541-388-3978

www.deschutesosteoporosiscenter.com

PALLIATIVE CARE

St. Charles Advanced Illness Management

2500 NE Neff Rd. • Bend

541-706-5880

www.stcharleshealthcare.org

PALLIATIVE CARE

Partners In Care Palliative Care

2075 NE Wyatt Ct. • Bend

541-382-5882

www.partnersbend.org

PEDIATRIC DENTISTRY

Deschutes Pediatric Dentistry

1475 SW Chandler Ave., Suite 202 • Bend

541-389-3073

www.deschuteskids.com

PEDIATRICS

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

PEDIATRICS

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

PEDIATRICS

High Lakes Health Care - Shevlin

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

PHARMACY

Cascade Custom Pharmacy

19550 SW Amber Meadow Dr. • Bend

541-389-3671

www.cascadecustomrx.com

PHYSICAL MEDICINE

Desert Orthopedics

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

PHYSICAL MEDICINE

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

PHYSICAL MEDICINE/REHABILITATION

The Center Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

PHYSICAL MEDICINE/REHABILITATION

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

PHYSICAL THERAPY

Healing Bridge Physical Therapy

404 NE Penn Ave. • Bend

541-318-7041

www.healingbridge.com

PODIATRY

Cascade Foot Clinic

PULMONOLOGY

Bend Memorial Clinic

PULMONOLOGY

St. Charles Heart & Lung Center

RADIOLOGY

Central Oregon Radiology Associates, P.C.

REHABILITATION

St. Charles Rehabilitation Center

RHEUMATOLOGY

Bend Memorial Clinic

RHEUMATOLOGY

Offices in Bend, Redmond & Madras

541-388-2861

www.cascadefoot.com

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

Locations in Bend, Redmond, Prineville, & Madras

541-706-7725

www.stcharleshealthcare.org

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

Deschutes Rheumatology

2200 NE Neff Rd., Suite 302 • Bend

541-388-3978

www.bendarthritis.com

RHEUMATOLOGY

St. Charles Rheumatology

2965 NE Connors Ave. • Bend

541-706-7735

www.stcharleshealthcare.org

SLEEP MEDICINE

Bend Memorial Clinic

1080 SW Mt. Bachelor Dr. • Bend (West)

541-382-4900

www.bendmemorialclinic.com

SLEEP MEDICINE

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

SURGICAL SPECIALIST

St. Charles Surgical Specialists

Prineville • Redmond

541-548-7761

www.stcharleshealthcare.org

SURGICAL SPECIALIST

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

URGENT CARE

Bend Memorial Clinic

Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

URGENT CARE

Mountain Medical Immediate Care

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

URGENT CARE

NOWcare

2200 NE Neff Rd. • Bend

541-322-2273

www.thecenteroregon.com

2015 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

M E D I C A L B U S I N E S S E S B Y S P E C I A LT Y C O N T. URGENT CARE

St. Charles Immediate Care

UROLOGY

Bend Urology Associates

UROLOGY

Urology Specialists of Oregon

VASCULAR SURGERY

Bend Memorial Clinic

VEIN SPECIALISTS

Inovia Vein Specialty Center

VEIN SPECIALISTS

Bend Memorial Clinic

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

Locations in Bend & Redmond

541-382-6447

www.bendurology.com

Locations in Bend, Redmond, & Prineville

541-322-5753

www.urologyinoregon.com

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

2200 NE Neff Rd., Suite 204 • Bend

541-382-8346

www.bendvein.com

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

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

Bend Memorial Clinic

Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

BARIATRIC & GENERAL SURGERY STEPHEN ARCHER, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

NGOCTHUY HUGHES, DO, PC

St. Charles Surgical Specialists

1245 NW 4th St., Suite 101 • Redmond

541-548-7761

www.stcharleshealthcare.org

NICOLE O’NEIL, PA-C

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

BEHAVIORAL HEALTH KAREN CAMPBELL, PHD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

BRIAN EVANS, PSYD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

JANET FOLIANO-KEMP, PSYD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

WENDY LYONS, PSYD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

SONDRA MARSHALL, PHD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

JAMES PORZELIUS, PHD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

REBECCA SCRAFFORD, PSYD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

SCOTT SAFFORD, PHD

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-706-7730

www.stcharleshealthcare.org

LAURA SHANK, PSYD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

KIMBERLY SWANSON, PHD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

SHILO TIPPETT, PHD

St. Charles Family Care

480 NE A St. • Madras

541-475-4800

www.stcharleshealthcare.org

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

CARDIOLOGY HUGH ADAIR III, DO

St. Charles Heart & Lung Center

JAMIE BARTNICK, FNP

Bend Memorial Clinic

JEAN BROWN, PA-C

St. Charles Heart & Lung Center

KIMBERLY CANADAY, ANP-BC

Bend Memorial Clinic

CASSANDRA DIXON, PA-C

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

GARY FOSTER, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

NANCY HILLES, NP

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

BRENDA HOCHULI, PA-C

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

KRISTEN HUDSON, NP

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

SHEROLYN JENNART PA-C

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

RICK KOCH, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

JAMES LAUGHLIN, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

BRUCE MCLELLAN, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

P. GANESH MUTHAPPAN, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

CAREY PULIDO, FNP

High Lakes Health Care - Upper Mill

929 SW Simpson Ave. • Bend

541-389-7741

www.highlakeshealthcare.com

ALLEN RAFAEL, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

2015 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

CARDIOLOGY CONT. IAN RIDDOCK, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

STEPHANIE SCOTT, PA-C

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JASON SHEN, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

MICHAEL WIDMER, MD, FACC

High Lakes Health Care

Bend, Redmond & Sisters

541-389-7741

www.highlakeshealthcare.com

EDDY YOUNG, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

2275 NE Doctors Dr., Suite 11 • Bend

541-248-4476

www.endeavorchiropractic.com

CHIROPRACTIC

MARIE RUDBACK, DC

Endeavor Chiropractic

JORDAN T. DOI, MSC, DC

NorthWest Crossing Chiropractic & Health

628 NW York Dr., Suite 104 • Bend

541-388-2429

www.nwxhealth.com

THERESA M. RUBADUE, DC, CCSP

NorthWest Crossing Chiropractic & Health

628 NW York Dr., Suite 104 • Bend

541-388-2429

www.nwxhealth.com

JASON M. KREMER, DC, CCSP, CSCS

Wellness Doctor

1345 NW Wall St., Suite 202 • Bend

541-318-1000

www.bendwellnessdoctor.com

DENTISTRY MICHAEL R. HALL, DDS

Central Oregon Dental Center

1563 NW Newport Ave. • Bend

541-389-0300

www.centraloregondentalcenter.net

BRADLEY E. JOHNSON, DMD

Contemporary Family Dentistry

1016 NW Newport Ave. • Bend

541-389-1107

www.contemporaryfamilydentistry.com

DERMATOLOGY ALYSSA ABBEY, PA-C

Bend Memorial Clinic

2450 NE Mary Rose Pl., Suite 220 • Bend

541-382-4900

www.bendmemorialclinic.com

SAMUEL CHRISTENSEN, PA-C

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

WILLIAM DELGADO, MD, (MOHS)

Bend Dermatology Clinic

2747 NE Conners Dr. • Bend

541-382-5712

www.bendderm.com

MARK HALL, MD,

Central Oregon Dermatology

388 SW Bluff Dr. • Bend

541-678-0020

www.centraloregondermatology.com

FRIDOLIN HOESLY, MD

Bend Dermatology Clinic

2747 NE Conners Dr. • Bend

541-382-5712

www.bendderm.com

JAMES M. HOESLY, MD

Bend Memorial Clinic

2450 NE Mary Rose Pl., Suite 220 • Bend

541-382-4900

www.bendmemorialclinic.com

JOSHUA MAY, MD

Bend Dermatology Clinic

2747 NE Conners Dr. • Bend

541-382-5712

www.bendderm.com

KRISTIN NEUHAUS, MD

Bend Dermatology Clinic

2747 NE Conners Dr. • Bend

541-382-5712

www.bendderm.com

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

2450 NE Mary Rose Pl., Suite 220 • Bend

541-382-4900

www.bendmemorialclinic.com

ANN M. REITAN, PA-C

Bend Memorial Clinic

2450 NE Mary Rose Pl., Suite 220 • Bend

541-382-4900

www.bendmemorialclinic.com

ALLISON ROBERTS, PA-C

Bend Dermatology Clinic

2747 NE Conners Dr. • Bend

541-382-5712

www.bendderm.com

STEPHANIE TRAUTMAN, MD

Bend Dermatology Clinic

2747 NE Conners Dr. • Bend

541-382-5712

www.bendderm.com

LARRY WEBER, PA-C

Bend Dermatology Clinic

2747 NE Conners Dr. • Bend

541-382-5712

www.bendderm.com

OLIVER WISCO, DO (MOHS)

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

MARY F. CARROLL, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

RICK N. GOLDSTEIN, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

ENDOCRINOLOGY

TONYA KOOPMAN, MSN, FNP-BC Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

PATRICK MCCARTHY, MD

Endocrinology Services NW

929 SW Simpson Ave., Suite 220 • Bend

541-317-5600

n/a

TRAVIS MONCHAMP, MD

Endocrinology Services NW

929 SW Simpson Ave., Suite 220 • Bend

541-317-5600

n/a

FAMILY MEDICINE CAREY ALLEN, MD

St. Charles Family Care

1103 NE Elm St. • Prineville

541-447-6263

www.stcharleshealthcare.org

HEIDI ALLEN, MD

St. Charles Family Care

1103 NE Elm St. • Prineville

541-447-6263

www.stcharleshealthcare.org

THOMAS L. ALLUMBAUGH, MD St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

SONI ANDREINI, MD

St. Charles Family Care

630 N Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealthcare.org

KATHLEEN C. ANTOLAK, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JOSEPH BACHTOLD, DO

St. Charles Family Care

630 Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealthcare.org

JEFFREY P. BOGGESS, MD

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

SHANNON K. BRASHER, PA-C

St. Charles Family Care

1103 NE Elm St. • Prineville

541-447-6263

www.stcharleshealthcare.org

2015 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

FAMILY MEDICINE CONT. MEGHAN BRECKE, DO

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

NANCY BRENNAN, DO

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

WILLIAM C. CLARIDGE, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

MATTHEW CLAUSEN, MD

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

TAMMY EVERHART, FNP

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

MAY S. FAN, MD

Bend Memorial Clinic

231 East Cascades Ave. • Sisters

541-549-0303

www.bendmemorialclinic.com

JAMIE FREEMAN, PA-C

High Lakes Health Care - Upper Mill

929 SW Simpson Ave. • Bend

541-389-7741

www.highlakeshealthcare.com

JESSICA GATTO, FNP

High Lakes Health Care - Upper Mill

929 SW Simpson Ave. • Bend

541-389-7741

www.highlakeshealthcare.com

YVETTE GAYNOR, FPN-C

St. Charles Family Care

630 Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealthcare.org

MARK GONSKY, DO

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

NATALIE GOOD, DO

St. Charles Family Care

1103 NE Elm St. • Prineville

541-447-6263

www.stcharleshealthcare.org

BRIANNA HART, PA-C

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

MARGARET “PEGGY“ HAYNER, FNP Central Oregon Family Medicine

541-923-0119

www.cofm.net

ALAN C. HILLES, MD

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

HEIDI HOLMES, PA-C

High Lakes Health Care - Shevlin

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

LYNN HUGHES, FNP

The Ross Clinic

336 SW Black Butte Blvd. • Redmond

541-504-7781

www.therossclinic.com

MARK J. HUGHES, D.O

Central Oregon Family Medicine

645 NW 4th St. • Redmond

541-923-0119

www.cofm.net

SING-WEI HO, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

PAMELA J. IRBY, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

PAUL JOHNSON, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave. • Bend

541-389-7741

www.highlakeshealthcare.com

DAVID KELLY, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave. • Bend

541-389-7741

www.highlakeshealthcare.com

MAGGIE J. KING, MD

St. Charles Family Care

1103 NE Elm St. • Prineville

541-447-6263

www.stcharleshealthcare.org

CRYSTAL LARSON, DO

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-382-4900

www.stcharleshealthcare.org

PETER LEAVITT, MD

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

JINNELL LEWIS, MD

St. Charles Family Care

480 NE A St. • Madras

541-475-4800

www.stcharleshealthcare.org

CHARLOTTE LIN, MD

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

STEVE MANN, DO

High Lakes Health Care - Upper Mill

929 SW Simpson Ave. • Bend

541-389-7741

www.highlakeshealthcare.com

JOE T. MC COOK, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

G. BRUCE MCELROY, MD

Central Oregon Family Medicine

645 NW 4th St. • Redmond

541-923-0119

www.cofm.net

LORI MCMILLIAN, FNP

Redmond Medical Clinic

1245 NW 4th St., Suite 201 • Redmond

541-323-4545

www.redmondmedical.com

EDEN MILLER, DO

High Lakes Health Care Sisters

354 W Adams Ave. • Sisters

541-549-9609

www.highlakeshealthcare.com

KEVIN MILLER, DO

High Lakes Health Care Sisters

JESSICA MORGAN, MD

High Lakes Health Care - Shevlin

DANIEL J. MURPHY, MD

645 NW 4th St. • Redmond

354 W Adams Ave. • Sisters

541-549-9609

www.highlakeshealthcare.com

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

AIMEE NEILL, MD

St. Charles Family Care

480 NE A St. • Madras

541-475-4800

www.stcharleshealthcare.org

SHERYL L. NORRIS, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

ELISA PEAVEY, DO

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

AUBREY PERKINS, FNP

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

JANEY PURVIS, MD

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

BRENDA RANTALA, FNP

Redmond Medical Clinic

1245 NW 4th St., Suite 201 • Redmond

541-323-4545

www.redmondmedical.com

NATHAN REED, DO

St. Charles Family Care

1103 NE Elm St. • Prineville

541-447-6263

www.stcharleshealthcare.org

KEVIN RUETER, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave. • Bend

541-389-7741

www.highlakeshealthcare.com

DANA M. RHODE, DO

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

2015 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

FAMILY MEDICINE CONT. JOHN K. ROSS, MD

The Ross Clinic

HANS G. RUSSELL, MD

336 SW Black Butte Blvd. • Redmond

541-504-7781

www.therossclinic.com

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

ERIC J. SCHNEIDER, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

DAVID SEIFFERT, FNP

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

LINDA C. SELBY, MD

St. Charles Family Care

1103 NE Elm St. • Prineville

541-447-6263

www.stcharleshealthcare.org

CINDY SHUMAN, PA-C

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

PATRICK L. SIMNING, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

57067 Beaver Dr. • Sunriver

541-593-5400

n/a

DANIEL M. SKOTTE, SR. DO., P.C. High Desert Family Medicine & Immediate Care PATRICIA SPENCER, MD

St. Charles Family Care

480 NE A St. • Madras

541-475-4800

www.stcharleshealthcare.org

EDWARD M. TARBET, MD

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

AMY TATUM, FNP

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

JOHN D. TELLER, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

NATHAN R. THOMPSON, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

MATTIE E. TOWLE, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

LISA URI, MD

High Lakes Health Care - Shevlin

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

MARK A. VALENTI, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

CINDI WARBURTON, FNP, DNP

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

THOMAS A. WARLICK, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

BRUCE N. WILLIAMS, MD

St. Charles Family Care

1103 NE Elm St. • Prineville

541-447-6263

www.stcharleshealthcare.org

GASTROENTEROLOGY RICK BOCHNER, MD

Cascade Gastroenterology

1247 NE Medical Center Dr. • Bend

541-706-5777

www.cascadegastroenterology.com

ELLEN BORLAND, MS, RN, CFNP

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

ARTHUR S. CANTOR, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

HEIDI CRUISE, PA-C, MS

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

LAUREL HARTWELL, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

CHRISTINA HATARA, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

SIDNEY E. HENDERSON III, MD Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

SANDRA HOLLOWAY, MD

Cascade Gastroenterology

1247 NE Medical Center Dr. • Bend

541-706-5777

www.cascadegastroenterology.com

GLENN KOTEEN, MD

Gastroenterology of Central Oregon

2239 NE Doctors Dr., Suite 100 • Bend

541-728-0535

www.gastrocentraloregon.com

JENIFER TURK, PA-C

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

MATTHEW WEED, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

143 SW Shevlin-Hixion Dr., Suite 203 • Bend

541-678-5417

www.cocgc.org

GENETICS, MEDICAL OSVALDO A. SCHIRRIPA, MD, MS Central Oregon Clinical Genetics Center GYNECOLOGY JANE BIRSCHBACH, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

TAMMY BULL, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

SUSAN GORMAN, MD

High Lakes Health Care - Bend & Redmond

1001 NW Canal Blvd. • Redmond

541-504-7635

www.highlakeshealthcare.com

2450 NE Mary Rose Pl. • Bend

541-383-2200

www.bendherniacenter.com

HERNIA SURGERY MICHAEL J. MASTRANGELO, MD, FACS Bend Hernia Center HOSPICE HANK HORAK, MD

St. Charles Hospice

2500 NE Neff Rd. • Bend

541-706-6700

www.stcharleshealthcare.org

MICHAEL KNOWER, MD

St. Charles Hospice

1201 NE Elm St. • Prineville

541-706-6700

www.stcharleshealthcare.org

SONIA THAKUR

St. Charles Hospice

1253 NW Canal Blvd • Redmond

541-706-6700

www.stcharleshealthcare.org

2015 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

INFECTIOUS DISEASE LAURIE D’AVIGNON, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JON LUTZ, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

REBECCA SHERER, MD

St. Charles Infectious Disease

2965 Conners Ave., Suite 127 • Bend

541-706-4878

www.stcharleshealthcare.org

JOHN ALLEN, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

CHRISTINA ANDERSON, PA-C

High Lakes Health Care - Shevlin

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

JENESS CHRISTENSEN, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave. • Bend

541-389-7741

www.highlakeshealthcare.com

CARRIE DAY, MD

High Lakes Health Care - Shevlin

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

SARAH DAWSON, DO

St. Charles Family Care

2965 NE Connors Ave. • Bend

541-706-4800

www.stcharleshealthcare.org

CELSO A. GANGAN, MD

Redmond Medical Clinic

1245 NW 4th St., Suite 201 • Redmond

541-323-4545

www.redmondmedical.com

MICHAEL N. HARRIS, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

ELIZABETH KAPLAN, PA-C

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

ANNE KILLINGBECK, MD

High Lakes Health Care - Redmond

236 NW Kingwood Ave. • Redmond

541-548-7134

www.highlakeshealthcare.com

ANITA D. KOLISCH, MD

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

MATTHEW R. LASALA, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

MADELINE LEMEE, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave. • Bend

541-389-7741

www.highlakeshealthcare.com

MARY MANFREDI, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave. • Bend

541-389-7741

www.highlakeshealthcare.com

H. DEREK PALMER, MD

Redmond Medical Clinic

1245 NW 4th St., Suite 201 • Redmond

541-323-4545

www.redmondmedical.com

A. WADE PARKER, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JOHN K. ROSS, MD

The Ross Clinic

336 SW Black Butte Blvd. • Redmond

541-504-7781

www.therossclinic.com

MARK STERNFELD, MD

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

MARK THIBERT, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave. • Bend

541-389-7741

www.highlakeshealthcare.com

DAVID TRETHEWAY, MD

High Lakes Health Care - Redmond

236 NW Kingwood Ave. • Redmond

541-548-7134

www.highlakeshealthcare.com

INTERNAL MEDICINE

NEUROLOGY FRANCENA ABENDROTH, MD

Bend Memorial Clinic

1080 Mt. Bachelor Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

GREGORY FERENZ, DO

Bend Memorial Clinic

1080 Mt. Bachelor Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

STEVE GOINS, MD

Bend Memorial Clinic

1080 Mt. Bachelor Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

CRAIGAN GRIFFIN, MD

Bend Memorial Clinic

1080 Mt. Bachelor Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

2275 NE Doctors Dr., Suite 9 • Bend

541-647-1638

www.belzamd.com

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

NEUROSURGERY RAY TIEN, MD, PHD

The Center Orthopedic & Neurosurgical Care & Research

MARK BELZA, MD

Bend Spine and Neurosurgery

BRAD WARD, MD

The Center Orthopedic & Neurosurgical Care & Research

NUTRITION

ANNIE BAUMANN, RD, LD

Bend Memorial Clinic

OBSTETRICS/GYNECOLOGY JAMES BAUER, MD

St. Charles Center for Women’s Health

Locations in Redmond & Prineville

541-526-6635

www.stcharleshealthcare.org

KAREN CASEY, WHCNP

St. Charles Center for Women’s Health

Locations in Redmond & Prineville

541-526-6635

www.stcharleshealthcare.org

CHERYL CZAPLA, MD

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

SARAH HELLMAN, DO

St. Charles Center for Women’s Health

340 NW 4th St. • Redmond

541-526-6635

www.stcharleshealthcare.org

NATALIE HOSHAW, MD

St. Charles Center for Women’s Health

Locations in Redmond & Prineville

541-526-6635

www.stcharleshealthcare.org

ERIN LEGRAND, DO

St. Charles Center for Women’s Health

340 NW 4th St. • Redmond

541-526-6635

www.stcharleshealthcare.org

AMY B. MCELROY, FNP

St. Charles Center for Women’s Health

Locations in Redmond & Prineville

541-526-6635

www.stcharleshealthcare.org

BETH MURRILL, MD

St. Charles Center for Women’s Health

340 NW 4th St. • Redmond

541-526-6635

www.stcharleshealthcare.org

2015 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

OBSTETRICS/GYNECOLOGY CONT. JAY MURPHY, MD

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

JESSICA NELSON, CNM

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

ROZA PACIFICO, WHNP-VC

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

HANNAH RENZI, CNM

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

CLARE THOMPSON, DNP, CNM

St. Charles Center for Women’s Health

Locations in Redmond & Prineville

541-526-6635

www.stcharleshealthcare.org

OCCUPATIONAL MEDICINE GLYNDA CRABTREE, MD

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

ANITA HENDERSON, MD

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

TIMOTHY HILL, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

JAMES NELSON, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

CASEY OSBORNE-RODHOUSE, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

LARRY PAULSON, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

ERIC WATTENBURG, MD

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

ONCOLOGY – MEDICAL ROB BOONE, MD

St. Charles Cancer Center

CORA CALOMENI, MD

St. Charles Cancer Center

BRIAN L. ERICKSON, MD

Bend Memorial Clinic

STACIE KOEHLER, PA-C

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

BILL MARTIN, MD

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

ANDY MONTICELLI, MD

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

LAURIE RICE, ACNP-BC

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

WILLIAM SCHMIDT, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JOHN WINTERS, MD

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

1247 NE Medical Center Dr. • Bend

541-322-5753

www.urologyinoregon.com

ONCOLOGY – UROLOGY MATTHEW N. SIMMONS, MD, PHD, FACS Urology Specialists of Oregon OPHTHAMOLOGY BRIAN P. DESMOND, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

THOMAS D. FITZSIMMONS, MD, MPH

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

ROBERT C. MATHEWS, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

SCOTT T. O’CONNER, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

Integrated Eye Care

452 NE Greenwood Ave. • Bend

541-382-5701

www.iebend.com

KIRSTEN CARMIENCKE SCOTT, OD Integrated Eye Care

452 NE Greenwood Ave. • Bend

541-382-5701

www.iebend.com

MARY ANN ELLEMENT, OD

Integrated Eye Care

452 NE Greenwood Ave. • Bend

541-382-5701

www.iebend.com

MICHAEL MAJERCZYK, OD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

HALEY MCCOY, OD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

1475 SW Chandler Ave., Suite 101 • Bend

541-617-3993

www.drkeithkrueger.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

OPTOMETRY KIT CARMIENCKE, OD

ORAL & MAXILLOFACIAL SURGERY KEITH E. KRUEGER, DMD, PC

Keith E. Krueger, DMD, PC

ORTHOPEDIC SURGERY – FOOT & ANKLE AARON ASKEW, MD

Desert Orthopedics

ANTHONY HINZ, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

JEFFREY P. HOLMBOE, MD

The Center Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

JOEL MOORE, MD, MPH

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

2015 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

ORTHOPEDIC SURGERY – JOINT REPLACEMENT DAVID A. BROWN, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

KNUTE BUEHLER, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

MICHAEL CARAVELLI, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

ERIN FINTER, MD

Desert Orthopedics

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

JAMES HALL, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

1303 NE Cushing Dr., Suite 100 • Bend

541-388-2333

www.desertorthopedics.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

ORTHOPEDIC SURGERY – PEDIATRIC,YOUTH & ADULT SPORTS MEDICINE MICHAEL RYAN, MD

Desert Orthopedics

ORTHOPEDIC SURGERY – SHOULDER ROBERT SHANNON, MD

Desert Orthopedics

ORTHOPEDIC SURGERY – SPINE GREG HA, MD

Desert Orthopedics

1303 NE Cushing Dr., Suite 100 • Bend

541-388-2333

www.desertorthopedics.com

KATHLEEN MOORE, MD

Desert Orthopedics

1303 NE Cushing Dr., Suite 100 • Bend

541-388-2333

www.desertorthopedics.com

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

1315 NW 4th St. • Redmond

541-388-2333

www.desertorthopedics.com

ORTHOPEDIC SURGERY – SPORTS MEDICINE TIMOTHY BOLLOM, MD

The Center Orthopedic & Neurosurgical Care & Research

BRETT GINGOLD, MD

Desert Orthopedics

SCOTT JACOBSON, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

BLAKE NONWEILER, MD

The Center Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

1303 NE Cushing Dr., Suite 100 • Bend

541-388-2333

www.desertorthopedics.com

ORTHOPEDIC SURGERY – SPORTS MEDICINE, FEMALE SPORTS MEDICINE CARA WALTHER, MD

Desert Orthopedics

ORTHOPEDIC SURGERY – UPPER EXTREMITY MICHAEL COE, MD

The Center Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

KENNETH HANINGTON, MD

Desert Orthopedics

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

AARON HOBLET, MD

Desert Orthopedics

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

SOMA LILLY, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

JAMES VERHEYDEN, MD

The Center Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

2200 NE Neff Rd., Suite 302 • Bend

541-388-3978

www.deschutesosteoporosiscenter.com

OSTEOPOROSIS & BONE HEALTH MOLLY OMIZO, MD

Deschutes Osteoporosis Center

PALLIATIVE CARE JENNY BLECHMAN, MD

Partners In Care

2075 NE Wyatt Ct. • Bend

541-382-5882

www.partnersbend.org

LIZ LEVESQUE, DO

St. Charles Advanced Illness Management

2500 NE Neff Rd. • Bend

541-706-5885

www.stcharleshealthcare.org

LISA LEWIS, MD

Partners In Care

2075 NE Wyatt Ct. • Bend

541-382-5882

www.partnersbend.org

RICHARD J. MAUNDER, MD

St. Charles Advanced Illness Management

2500 NE Neff Rd. • Bend

541-706-5885

www.stcharleshealthcare.org

LAURA K. MAVITY, MD

St. Charles Advanced Illness Management

2500 NE Neff Rd. • Bend

541-706-5885

www.stcharleshealthcare.org

STEPHANIE CHRISTENSEN, DMD Deschutes Pediatric Dentistry

1475 SW Chandler Ave., Suite 202 • Bend

541-389-3073

www.deschuteskids.com

STEVE CHRISTENSEN, DMD

1475 SW Chandler Ave., Suite 202 • Bend

541-389-3073

www.deschuteskids.com

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

PEDIATRIC DENTISTRY

Deschutes Pediatric Dentistry

PEDIATRICS BROOKS BOOKER, MD

Bend Memorial Clinic

CHRISTINA ANDERSON, PA-C

High Lakes Health Care - Shevlin

KATE L. BROADMAN, MD

Bend Memorial Clinic

CARRIE DAY, MD

High Lakes Health Care - Shevlin

JENNIFER GRISWOLD, PNP

Bend Memorial Clinic

NANCY HEAVILIN, MD

St. Charles Family Care

2015 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

PEDIATRICS CONT. MICHELLE MILLS, MD

Bend Memorial Clinic

KRISTI NIX, MD

High Lakes Health Care - Shevlin

JENNIFER SCHROEDER, MD

Bend Memorial Clinic

RUPERT VALLARTA, MD

St. Charles Family Care

JB WARTON, DO

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

PHYSICAL MEDICINE & REHABILITATION ROBERT ANDREWS, MD

Desert Orthopedics

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

LINDA CARROLL, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave. • Bend

541-389-7741

www.highlakeshealthcare.com

TIM HILL, MD

The Center Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

NANCY H. MALONEY, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JAMES NELSON, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

MATHEW PALUCK, DO

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

LARRY PAULSON, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

DAVID STEWART, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

JON SWIFT, DO

Desert Orthopedics

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

VIVIANE UGALDE, MD

The Center Orthopedic & Neurosurgical Care & Research

2200 NE Neff Rd. • Bend

541-382-3344

www.thecenteroregon.com

929 SW Simpson Ave., Suite 220 • Bend

541-317-5600

www.deschutesfootandankle.com

St. Charles Preoperative Medicine

2500 NE Neff Rd. • Bend

541-706-2949

www.stcharleshealthcare.org

JONATHAN BREWER, DO, D-ABSM

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

JAMIE DAVID CONKLIN, MD

St. Charles Heart & Lung Center

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

LOUIS D’AVIGNON, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

ERIC S. DILDINE, PA-C

St. Charles Heart & Lung Center

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

CHRIS KELLEY, DO, D-ABSM

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

FARAH MADHANI-LOVELY, MD

St. Charles Heart & Lung Center

JONATHAN MCFADYEN, NP-BC

PODIATRY DEAN NAKADATE, DPM

Deschutes Foot & Ankle

PREOPERATIVE MEDICINE BROOKE HALL, MD PULMONOLOGY

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

KEVIN E. SHERER, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

EMILY SPEELMON, MD

St. Charles Heart & Lung Center

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

BETHANY TAYLOR-SPILLET PA-C St. Charles Heart & Lung Center

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

RADIOLOGY – BODY IMAGING TRACI CLAUTICE-ENGLE, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

ROBERT HOGAN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

STEVEN MICHEL, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

RADIOLOGY – INTERVENTIONAL PATRICK BROWN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

JEFFREY DRUTMAN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

STEVE KJOBECH, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

GARRETT SCHROEDER, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

DAVID ZULAUF, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

RADIOLOGY – MUSCULOSKELETAL NICHOLAS BRANTING, MD

Central Oregon Radiology Associates, P.C.

2015 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

RADIOLOGY – MUSCULOSKELETAL CONT. THOMAS KOEHLER, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

JOHN STASSEN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

BRANT WOMMACK, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

RADIOLOGY – NEURORADIOLOGY TRAVIS ABELE, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

JEFFREY DRUTMAN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

JAMES JOHNSON, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

WILLIAM WHEIR III, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

RADIOLOGY – NUCLEAR MEDICINE LAURIE MARTIN, MD

Central Oregon Radiology Associates, P.C.

RADIOLOGY – PEDIATRIC PAULA SHULTZ, MD

Central Oregon Radiology Associates, P.C.

RADIOLOGY – WOMEN’S IMAGING KAREN LYNN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

STEPHEN SHULTZ, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

CLOE SHELTON, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

St. Charles Rehabilitation Center

2500 NE Neff Rd. • Bend

541-706-7725

www.stcharleshealthcare.org

CHRISTINA BRIGHT, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

DANIEL E. FOHRMAN, MD

Deschutes Rheumatology

2200 NE Neff Rd., Suite 302 • Bend

541-388-3978

www.bendarthritis.com

2965 NE Connors Ave. • Bend

541-706-7735

www.stcharleshealthcare.org

Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

REHABILITATION NOREEN C. MILLER, FNP RHEUMATOLOGY

HEATHER HANSEN-DISPENZA, MD St. Charles Rheumatology TONY KAHR, MD

Bend Memorial Clinic

AMY MADISON, MD

Deschutes Rheumatology

2200 NE Neff Rd., Suite 302 • Bend

541-388-3978

www.bendarthritis.com

TIANNA WELCH, PA

Deschutes Rheumatology

2200 NE Neff Rd., Suite 302 • Bend

541-388-3978

www.bendarthritis.com

SLEEP MEDICINE JONATHAN BREWER, DO, D-ABSM

Bend Memorial Clinic Sleep Disorders Center 1080 SW Mt. Bachelor Dr. • Bend (West)

541-382-4900

www.bendmemorialclinic.com

ARTHUR K. CONRAD, MD

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

DAVID L. DEDRICK, MD

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

CHRIS KELLEY, DO, D-ABSM

Bend Memorial Clinic Sleep Disorders Center 1080 SW Mt. Bachelor Dr. • Bend (West)

541-382-4900

www.bendmemorialclinic.com

DEBBIE RIEF-ADAMS, FNP

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

NATALIA USATII, MD

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

1655 SW Highland Ave., Suite 6 • Redmond

541-923-2019

www.drherrin.com

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

SPINAL DECOMPRESSION, AUTO ACCIDENTS DAVID HERRIN, DC

Redmond Wellness & Chiropractic

SURGICAL SPECIALIST TIMOTHY L. BEARD, MD, FACS

Bend Memorial Clinic

DAVID CARNE, MD

St. Charles Surgical Specialists

GARY J. FREI, MD, FACS

Bend Memorial Clinic

JACK W. HARTLEY, MD, FACS

St. Charles Surgical Specialists

SEAN HEALY, PA-C

1103 NE Elm • Prineville

541-548-7761

www.stcharleshealthcare.org

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

1245 NW 4th St., Suite 101 • Redmond

541-548-7761

www.stcharleshealthcare.org

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

DARREN M. KOWALSKI, MD, FACS Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JOHN C. LAND, MD, FACS

St. Charles Surgical Specialists

1245 NW 4th St., Suite 101 • Redmond

541-548-7761

www.stcharleshealthcare.org

SUZANNE MARCATO, PA

St. Charles Surgical Specialists

1103 NE Elm • Prineville

541-548-7761

www.stcharleshealthcare.org

2015 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

SURGICAL SPECIALIST CONT. ANDREW SARGENT, PA-C, MS

Bend Memorial Clinic

RONALD SPROAT, MD

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

St. Charles Surgical Specialists

1103 NE Elm • Prineville

541-548-7761

www.stcharleshealthcare.org

GEORGE T. TSAI, MD, FACS

St. Charles Surgical Specialists

1245 NW 4th St., Suite 101 • Redmond

541-548-7761

www.stcharleshealthcare.org

JEANNE WADSWORTH, PA-C, MS

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

ERIN WALLING, MD, FACS

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

BRIGITTA BELLA, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

DIANA BURDEN, FNP-C

Mountain Medical Immediate Care

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

JEFF CABA, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

ANN CLEMENS, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

TERESA COUSINEAU, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

TRICIA COUTURE, FNP

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

GLYNDA CRABTREE, MD

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

BRIAN DAILY, PA-C

Mountain Medical Immediate Care

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

SCOTT FLECK, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

OMAR GARZA, FNP

St. Charles Immediate Care

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

MONICA GIAMELLARO, PA-C

Mountain Medical Immediate Care

CHERYL D. HADLEY, MD

Bend Memorial Clinic

KEITH HARRINGTON, MD

Mountain Medical Immediate Care

ANITA HENDERSON, MD

Your Care

MIKE HUDSON, MD

St. Charles Immediate Care

J. RANDALL JACOBS, MD

Bend Memorial Clinic

JESSICA ODDO, FNP-C

Mountain Medical Immediate Care

JAY O’BRIEN, PA-C

Bend Memorial Clinic

RICHARDO OMAR GARZA, FNP

St. Charles Immediate Care

DIKLAH OREVI, PA-C

URGENT CARE

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

COLLEEN O’SULLIVAN, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

LAURIE D. PONTE, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

MATTHEW REED, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

JONATHAN SCHULTZ

St. Charles Immediate Care

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

JENNIFER L. STEWART, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

SEAN SUTTLE, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

ERIC WATTENBURG, MD

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

EMILY J. WOMMACK, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

MICHELLE WRIGHT, FNP

St. Charles Immediate Care

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

UROLOGY MEREDITH BAKER, MD

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

RONALD BARRETT, MD, FACS

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

MICHEL BOILEAU, MD, FACS

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

JACK BREWER, MD

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

SHELLY FITTS, PA-C, M.S.

Urology Specialists of Oregon

1247 NE Medical Center Dr. • Bend

541-322-5753

www.urologyinoregon.com

TIM KRIGBAUM, PA-C

Urology Specialists of Oregon

1247 NE Medical Center Dr. • Bend

541-322-5753

www.urologyinoregon.com

ANDREW NEEB, MD

Urology Specialists of Oregon

1247 NE Medical Center Dr. • Bend

541-322-5753

www.urologyinoregon.com

ADVERTISING SUPPLEMENT

2015 CENTRAL OREGON MEDICAL DIRECTORY UROLOGY CONT. BRIAN O’HOLLAREN, MD

Bend Urology Associates

MATTHEW N. SIMMONS, MD, PHD, FACS Urology Specialists of Oregon NORA TAKLA, MD

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

1247 NE Medical Center Dr. • Bend

541-322-5753

www.urologyinoregon.com

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

VEIN SPECIALISTS EDWARD M. BOYLE, JR., MD, FACS

Inovia Vein Specialty Center

2200 NE Neff Rd., Suite 204 • Bend

541-382-8346

www.bendvein.com

ANDREW JONES, MD, FACS

Inovia Vein Specialty Center

2200 NE Neff Rd., Suite 204 • Bend

541-382-8346

www.bendvein.com

DARREN KOWALSKI, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

WAYNE K. NELSON, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

CATHERINE BLACK, PA-C

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic. com

JASON JUNDT, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

WAYNE K. NELSON, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

VASCULAR SURGERY

WOUND CARE MARILYN WALLER-NIEWOLD, DMP

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

To be included in the next issue of the PULSE/Connections Medical Directory, contact:

Kylie V igeland, Account Executive (Health & Medical) 541.617.7855

Feature | SYNTHETIC OPIOIDS Continued from Page 13

the bathrooms warn: You’re on camera.

In the mornings, when clients come for their daily doses, this clinic is swamped.

Matt Owen, the clinic’s director, said he researched demand extensively before taking the risk associated with opening a new opiate treatment facility.

“Bend is exceeding expectations,” he said.

“That’s not a good thing.”

Owen declined to say how many clients his clinic treats, but Oregon Health Authority data show the use of both methadone and buprenorphine (the drug used to make Suboxone) are increasing in Oregon. In 2004, only about three Oregon Health Plan clients in Deschutes County used buprenorphine in their recoveries compared with 64 in 2014.

Congress first allowed doctors to prescribe buprenorphine in 2000, which may help explain the low numbers at the time, said John McIlveen, operations and policy analyst with Oregon’s State Opioid Treatment AuthoriPage 48

ty. Four people in Deschutes County used methadone in 2004; 82 did last year.

Statewide, methadone remains much more widely used in opiate addiction treatment among the OHP population — 1,949 people used it in 2004 and 5,671 used it in 2014. Only 42 OHP clients used buprenorphine in 2004 compared with about 2,100 last year.

It’s not hard to predict demand considering both Central and Eastern Oregon previously lacked methadone clinics. The closest ones to Bend are two and a half hours away in Salem or Eugene, and some locals were making the trip daily. Others were driving to Medford or to the Portland area, where most of the state’s 16 clinics are clustered.

Here, more so than in other regions, Owen said, his clinic serves people who got into ski accidents or sustained other forms of injury and became addicted to their pain medications.

“It’s a different clientele,” he said. “More so

than most places, it’s people who everything else in their life seems to be going right.”

When the Bend Treatment Center first opened its doors in September, more than half of the clients were patients whose opiate addictions began with prescription drugs, Owen said.

The massive number of people addicted to prescription pain medications today is a remnant of doctors’ “fairly egregious prescribing practices” around the drugs roughly five years ago, said Rick Treleaven, the executive director of BestCare, the Redmond-based drug and alcohol treatment provider.

“It was ridiculous,” he said.

Dr. Robert DuPont, the White House drug chief under former presidents Richard Nixon and Gerald Ford and the first director of the National Institute on Drug Abuse, told a congressional subcommittee in April that today’s heroin epidemic is seeded by the “explosive increase” in opioid prescribing that FALL / WINTER 2015 • HIGH DESERT PULSE

began in the mid-1990s.

Today, doctors are working to create a middle ground between those two extremes, Treleaven said. Doctors in Central Oregon, especially those who treat the Medicaid population, are working to develop consistent practices around pain medication prescribing.

There are a number of misconceptions around methadone treatment. Owen and some of the clinic’s clients are quick to say it’s not just a place where people line up, take their medicine and leave. The treatment involves intensive counseling and drug testing to ensure clients aren’t positive for other drugs.

There is no set length of time clients are seen at the Bend Treatment Center. In fact, some have been taking methadone since the 1960s, Owen said. He knew a Vietnam War veteran and successful businessman at a treatment center in another state. That man raised two sons — one of whom is a doctor; the other is an engineer — all while taking methadone every morning.

One day, Owen said he asked that man why he still takes the drug.

“He’s like, ‘I know that if I wake up every day and I take my pill and I go see my counselor once a month, I’m going to be OK,’” he said. “‘It’s not hurting me medically, it’s not hurting my family.

My life is where I want it to be. Why should I change that because somebody else has a negative view of what I’m doing?’”

Not just methadone While roughly half of the Bend Treatment Center’s clients go to the clinic for methadone, the other half receive Suboxone, a drug that’s a combination of buprenorphine and naloxone, an opiate blocker that reverses the effects of other opioids.

“It basically binds to the receptor but doesn’t give quite as much reinforcement,” said Dr. Mike Price, the medical director for Redmond-based BestCare Treatment Services, which treats opiate addiction using buprenorphine, but not methadone. “It provides some craving reduction, but it has kind of a maximum, ceiling dose. It can’t go much higher than that.”

For that reason, it’s much more difficult to overdose on Suboxone compared with methadone, and many argue it’s a safer drug when it comes to opiate addiction recovery.

Opiate addicts who entered methadone programs were nearly five times more likely to die from drug overdoses within the first four weeks of treatment than those who entered buprenorphine programs, according to a study published online in The Lancet in September. Researchers with the National Drug and Alcohol Research Centre in Australia retroactively followed about 32,000 opiate addicts after entering therapy programs.

Those taking methadone were also twice as likely to die from any cause.

The researchers noted that they weren’t able to draw any consistent conclusions years later in the subjects’ recoveries.

Other research, however, has found that methadone treatment is more likely to retain clients. A 2012 literature review on the subject in the Journal of Neurosciences in Rural Practice found buprenorphine was significantly less effective than methadone at FALL/ WINTER 2015 • HIGH DESERT PULSE

Page 49

Feature | SYNTHETIC OPIOIDS

retaining patients in treatment but equally effective at suppressing heroin use.

Buprenorphine can only be prescribed by doctors who have special permission from the U.S. Drug Enforcement Administration to do so. Once those doctors prescribe the medications, however, the patients can take them home, unlike methadone.

Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing and chief medical officer of Phoenix House, a drug and alcohol addiction provider that operates in 10 states, said he believes Suboxone should be the first line of treatment for opiate addicts.

“You see very few overdose deaths involving Suboxone,” Kolodny said.

By contrast, methadone accounted for 65 of a total 164 prescription opioid deaths in 2012 in Oregon, according to state data. Although the number of methadone overdose deaths has declined statewide since a peak of 140 in 2006, the drug was removed last year from a list of drugs that can be provided to Medicaid clients for pain treatment.

Owen said his clinic tries to start its new clients on Suboxone, but some are referred to the treatment center from other methadone clinics, so they continue taking methadone.

‘Saved my marriage’ When he was 12 years old, a doctor told Paul Ketchum he’d be living on pain pills by age 30.

That was when the Bend resident, now 38, was first diagnosed with Scheuermann’s disease, a condition in which the vertebrae of the spine wedge closer together than in a typical spine, causing it to curve more than normal. He’s dealt with chronic back pain ever since.

Ketchum traces the origins of his addiction to eight years ago, when doctors began regularly prescribing him pain medications.

He relies on the state’s version of Medicaid, the Oregon Health Plan. At the time, prescription drugs were the only option for many OHP patients, as the program didn’t pay for alternatives such as physical therapy or chiropractic treatments. That’s supposed to change under a policy that begins in 2016.

“They knew that the insurance didn’t cover stuff, so they just wrote me scripts,” Ketchum Page 50

Paul Ketchum, pictured inside the living room of his Bend home, traces the origin of his addiction to when doctors began regularly subscribing him pain medications eight years ago. “They knew that the insurance didn’t cover stuff, so they just wrote me scripts,” he says. “So technically, it was the doctors who got me hooked on pain pills. For six and a half years, they were writing me just script after script after script of pain pills.”

said. “So technically, it was the doctors who got me hooked on pain pills. For six and a half years, they were writing me just script after script after script of pain pills.”

Then, seemingly out of nowhere, he was told the 30-day prescription he was getting would be his last.

Ketchum looks like something of a tough guy — his hair is cut close to his head and his arms are lined with tattoos — but his eyes quickly well with tears when he’s asked to describe how he felt after being cut off from pain pills. His voice wavers as he recalls the embarrassment of breaking down at the doctor’s office or while talking to his wife.

At the time, he worked installing satellite TV service. Sometimes, he would find himself in the home of an older widow or widower on a fixed income. He’d convince them to sell him their unused pain pills, which got him through roughly the next year.

But things weren’t great at home. His boss complained his work was suffering. His wife, Nikki, said she noticed her husband was draining their bank account to feed his habit. At one point, she said she wasn’t sure the marriage would work.

“I had to hide money,” she said. “It was just — it was horrible.”

For a while, Ketchum had been going to a methadone clinic in Salem, staying with a friend so he could go to the clinic every morning. When he lost his place to crash there, he briefly transferred to a methadone clinic in Portland.

When the Bend Treatment Center opened, Ketchum was one of the first people through the door. He calls the clinic a “lifesaver.”

“It probably has saved my marriage,” he said. “It probably has saved me in a lot of ways.”

Unlike clients who have relied on methaFALL / WINTER 2015 • HIGH DESERT PULSE

Methadone vs. medication-free opiate recovery A recent Israeli study compared 10-year recovery rates among opiate addicts who used methadone versus those who went without medication. Notably, the study found longtime methadone users were more likely to report chronic pain, psychiatric conditions and poor sleep.

Medication-free recovery

Methadone recovery

(Percentage answering ‘yes’ or age listed)

77.8%

25% 21.2% 38% 19.2% 18.3 years old 21.8 years old 14.3 years old

91.9% 98% 77.8%

15 years old 54.5%

(Percentage answering ‘yes’ or age listed) Chronic pain Psychiatric diagnoses Poor sleeper Female Working Age at opioid onset Age at opioid injection Age at first alcohol use Ever used cocaine Ever used marijuana Age of first marijuana use Ever used amphetamines Current tobacco use

Source: Journal of Addictive Diseases, August 2015

done for decades, Ketchum said he hopes to be off of it relatively soon. He’s been doing what’s called blind dosing for the past three months, which means he doesn’t know how many milligrams the nurse gives him every day.

The idea is to gradually wean patients off the methadone, Owen said.

“The goal is that one day they show up to the window and there is an empty cup and we’ll say, ‘You’ve actually been taking nothing but a placebo for however long. Congratulations,’” he said.

Ketchum gets starry-eyed when he talks about potentially being medication-free by Christmas. At that point, he said he plans to get healthy: He’ll walk at least 20 miles per week with his wife and kids. He might try yoga.

Ketchum is optimistic about his future.

“I’ll just try to make myself get healthier and hope that that works,” he said. “At least for the next 15 to 20 years.”

Recovery is more than meds Medications are far from the only comFALL / WINTER 2015 • HIGH DESERT PULSE

ponent of a successful drug addiction treatment program.

BestCare, Central Oregon’s largest drug and alcohol treatment provider, focuses primarily on things like counseling and ensuring clients have safe, sober housing. While it does provide buprenorphine and Vivitrol to some clients, it may refer some of those to the Bend Treatment Center, said Treleaven, BestCare’s executive director.

The degree to which addicts engage with counseling and support groups after treatment is a good indicator of how successful their overall recoveries will be, Treleaven said. To that end, BestCare recently shifted its budget around to pay for more so-called “recovery mentors,” people who keep very close track of clients through phone calls, texts and even visits after they’ve left treatment.

“Recovery mentors are like the secret sauce,” he said.

Treleaven said he and Price, BestCare’s medical director, have talked for years about the need for a methadone clinic in Central Oregon. Both say they’re very happy about the opening of the Bend Treatment Center.

“I was convinced that we needed to do it,” Treleaven said. “There are just too many dead heroin addicts out there.”

While some addicts respond to a drugfree approach to treatment, others need medication.

49.1% 49.1% 60% 34.5% 65.5% 22.4 years old 26.9 years old 19.5 years old 77.1% 88.6% 19.3 years old 38.2% 97.1% PETE SMITH

“It’s hard to predict in advance who is going to benefit from one or the other,” Treleaven said. “So having a range of potential services and approaches available in the community for folks is exactly what you want to see happen.”

Wentworth, the recovering addict who lives in Redmond, said people are the most important element of a successful recovery.

“There is no amount of therapy you can do centered on your mother and father, there is no amount of exercise you can do at the gym, there is no amount of vegetables you can eat, no amount of vitamins you can take to be sober,” he said.

Opiate addicts need 10 or 20 former addicts who have been one or two decades sober, Wentworth said. If they like rock climbing, they should find ex-opiate addicts who like rock climbing too.

“That needs to become a part of your life,” he said, “because an addict by himself will get loaded.”

That’s where Wentworth, who has been in addiction treatment nine times, went wrong in his latest relapse, he said. After leaving his job as a BestCare counselor, he sat alone in his apartment taking online classes and watching basketball on TV. After three weeks of that, he bought a bottle of vodka. And after two to three hours of Page 51

Feature | SYNTHETIC OPIOIDS

drinking and surfing Facebook for someone with heroin, he found a hookup. Then pills. Then meth.

Luckily, that first batch of heroin was crappy and — although he’s not entirely sure why — he smoked it rather than injecting it, both of which decreased the likelihood of overdosing.

Overdoses are common among people who relapse after years of sobriety because their tolerance is down. When actor Philip Seymour Hoffman died of a mix of heroin and other drugs in February, it was reportedly after years of sobriety.

Relapsing after working as an addiction counselor got awkward at times, Wentworth said.

“It was kind of a weird thing where I would be sitting in a drug house and there would be three former clients just sitting across the room like, ‘There’s our counselor right there,’” he said.

‘I shouldn’t be here’ The low point for one of Bend Treatment Center’s clients was when her 16-year-old daughter found her overdosing.

“I was purple,” said the 49-year-old lifelong Bend resident, who asked that her name not be used. “I shouldn’t be here.”

Still, she kept using. It wasn’t until she picked up a Bend Treatment Center pamphlet that was sitting on her drug dealer’s table two months after it opened that she learned methadone treatment existed in Central Oregon. She had already used the drug for five years trying to get clean at a clinic in Medford in 2001. It worked until 2013, the year her father died. She relapsed that November.

“There are certain things I don’t handle well,” she said. “I think death is one of them.”

Since she started going to the treatment center one year ago, she said she’s grown closer with her kids. Her 16-year-old daughter still lives with her and she has two other children, both in their 20s, who have both successfully graduated from college. She’s also improved her relationships with her mom and sister.

And, she said, she’s better at her job now. Looking at this woman, the average observer would never be able to tell she was an opiate addict. She looks well put together, wearing a fall sweater with her long, shiny brown hair pulled back. She said she worked throughout her heroin addiction.

“They call us functional junkies,” she said. “It’s a matter of need.

You know that you need money so that you can stay well.”

She shuddered when asked to describe the alternative to using.

People don’t die from withdrawing from heroin, but in the middle of it, they hope they will, she said.

First, there’s the anxiety. You can feel it coming. Then you start to sweat, she said. Your joints ache. Your heart beats faster.

“Then, you know, the next fun part is you get to start throwing up and there is nothing to throw up,” she said, “and then you get the worst diarrhea in the world, and then your legs, they just shake. It’s just absolutely awful, awful, awful. It’s one of the worst things. So you’ll do anything to not have that feeling. You’ll do anything to keep that feeling away.”

And it can take years before things start to feel good again, Wentworth said. Opiates mess with the brain’s ability to release neuPage 52

Paul Ketchum and his 6-year-old son, Kaeshous, sit and talk on a bench in front of their house in Bend. Ketchum calls Bend Treatment Center, where he’s being treated for his addiction to pain medications, a “lifesaver.” “It probably has saved my marriage,” he says. “It probably has saved me in a lot of ways.” He is being gradually weaned off methadone and hopes to be completely off it relatively soon.

rotransmitters like dopamine and serotonin.

“You could eat a bowl of ice cream — nothing,” he said. “Your favorite song could come on — nothing. You could catch a big fish — nothing. Or going on a date. Or sex. The normal stuff that makes you feel good.”

On work days, the Bend Treatment Center client said she would do a little heroin just to get out of bed in the morning. She would do some more in a bathroom stall at work. And then once more at work before going home. Some of her co-workers had to know, she said.

Her pupils would get very tiny after injecting, and she said her work suffered.

But no one said anything. And now that she’s clean, she’s afraid of anyone finding out.

“I know my employer would fire me,” she said.

These days, the woman said she takes 70 milligrams of methadone per day. And although the perception might be that the Bend Treatment Center’s clients simply line up, take their medicine and leave, she insists it’s much more than that. The counseling is invaluable, she said. And there are always people asking her how they can help her transition to a sober lifestyle.

“It’s not a Band-Aid,” she said. “It’s a family here. It really is. It’s a FALL / WINTER 2015 • HIGH DESERT PULSE

family of junkies learning how to live a normal life.”

She said she knows not everyone agrees with the use of methadone to get over an opiate addiction. She attends local Narcotics Anonymous and Alcoholics Anonymous meetings, and said many of the people there are against it. They argue the best way to quit is going cold turkey.

Price, of BestCare, said he’s aware of the mixed feelings in the Narcotics Anonymous and Alcoholics Anonymous community about having a methadone clinic in Bend.

“Some meetings may not be real supportive of people being there on methadone, unfortunately,” he said.

The Bend Treatment Center client also knows some of the people reading this will think she isn’t truly in recovery because of her reliance on methadone. She disagrees.

“I’ve put in time on the streets,” she said. “I’ve prostituted myself to get high. I’ve done everything everybody else has done, so I’ve earned my chair.”

Too few Suboxone prescribers Nearly half the people who use heroin these days are also addicted to prescription opioids, the U.S. Centers for Disease Control and Prevention said this past summer.

There isn’t data that illustrate why heroin use is more common among today’s young people, but many addiction experts theorize it’s because they didn’t grow up in the 1970s or ’80s, when countless Vietnam War veterans were returning to the United States addicted to heroin. Having seen that, many people who are 40 and older FALL / WINTER 2015 • HIGH DESERT PULSE

would never start using heroin, said Treleaven, BestCare’s director.

“All the horror stories that used to be commonplace in the ’70s and ’80s are ancient history to them,” he said. “It doesn’t exist.”

It also doesn’t hurt that heroin is much cheaper than pills, Wentworth added. A pill habit can run $500 a day, while heroin can be about $100 — plus it’s stronger.

“That’s one of the biggest things that happens: Eventually you just run out of money,” Wentworth said.

The new element today that wasn’t around during the Vietnam War era is Suboxone, the drug that’s a combination of buprenorphine and naloxone. Although not as strong as methadone, some addiction experts like it better because it’s more difficult to overdose on, and it contains a drug that reverses the effects of opioids.

Congress in 2000 approved giving doctors special licenses to prescribe buprenorphine from their own clinics (methadone must still be dispensed at federally designated facilities). Some say that’s helped, but there simply aren’t enough doctors willing to prescribe buprenorphine.

There’s only about five in Central Oregon, and even the state doesn’t know who they are, McIlveen said. Although a federal government website lists more than 400 doctors in Oregon as eligible to prescribe buprenorphine, McIlveen estimates it’s probably more like 150 because some no longer do and others have passed away.

Probably 95 percent of those are west of the Cascades, he added.

The secrecy is not surprising. Prescribing the drug, especially out of a family practice clinic, still carries a stigma. Doctors probably don’t want people to know, McIlveen said.

“It’s a big problem,” he added.

Price, BestCare’s medical director, agreed. It’s made more difficult by the fact that doctors can only prescribe to 30 patients in their first year of being licensed to do so, he said. That increases to 100 patients per year afterward. He admits it’s a tough population to treat.

“There is not a lot of interest, unfortunately,” Price said. “Hopefully more people will become interested in doing it because we’re exploding with opiate-dependent patients right now.”

The rules might be changing soon, however. U.S. Department of Health and Human Services Secretary Sylvia M. Burwell announced in September plans to loosen restrictions around buprenorphine prescribing to encourage increased use of the drug.

In France, the landscape of buprenorphine prescribing is completely the opposite. To address the problem of opiate abuse in that country, the French government in 1995 allowed all doctors to prescribe the drug without a special license to do so. Within four years, the number of overdose deaths in the country dropped by 79 percent, according to a 2004 study in the American Academy of Addiction Psychiatry.

Kolodny, of Physicians for Responsible Opioid Prescribing, said that convinces him that buprenorphine is a better drug than methadone. In addition to being safer, it doesn’t require a daily office visit.

“I think the reason you’ve got a methadone clinic opening up is because people don’t have adequate access to buprenorphine,” he said.

Nationally, the use of buprenorphine is increasing at a much faster rate than methadone, according to data from the U.S. Substance Page 53

Snapshot | SNOWSHOEING TUMALO MOUNTAIN

PHOTO BY ANDY TULLIS

With Mount Bachelor in the distance, Denny Knowles, left, and his wife, Natasha Knowles, take in the view from the top of Tumalo Mountain during a snowshoe trip. Tumalo Mountain is a popular place for snowshoers, backcountry skiers and snowboarders. To head out on your own winter adventure at Tumalo Mountain, head up Cascades Lakes Highway about 20 miles from Bend to the Dutchman Flat Sno-park on the right.

Feature | SYNTHETIC OPIOIDS Abuse and Mental Health Services Administration. Between 2004 and 2011, use of the drug increased by more than 1,700 percent, compared with 35 percent for methadone.

‘Grateful to be alive’ Because it’s typically picked up like a normal prescription rather than taken at a clinic every day, buprenorphine is more easily diverted to illicit use than methadone, Kolodny said. However, he’s less concerned about the diversion of Suboxone because it’s not a drug that young people tend to use recreationally. Because of the naloxone contained in Suboxone, people who try to use it illicitly will generally have an unpleasant experience — they’ll feel nauseous, sweaty and will have a pounding headache, he said.

“In other words, buprenorphine is not going to create new cases of Page 54

opioid addiction,” Kolodny said.

Ketchum, the recovering opiate addict who lives in Bend, said a police officer once pulled him over as he was leaving the Bend Treatment Center. The officer asked him whether he took methadone or Suboxone. When he said methadone, the officer let him leave. He said he sees someone get pulled over outside the clinic at least once per week.

Bend Police Lt. Clint Burleigh said Suboxone has long been on the department’s radar. Even before the Bend Treatment Center opened, officers would find it in the community all the time — mostly being diverted to help friends get through withdrawals, he said.

Burleigh said the area around the Bend Treatment Center — Revere Avenue near Third Street — does have a couple of motels with high levels of drug activity, especially those that offer weekly and monthly rentals. But Burleigh said he was not aware of extra patrols around that FALL / WINTER 2015 • HIGH DESERT PULSE

particular building.

There hasn’t been a noticeable increase in crime in or around the building that houses the Bend Treatment Center since it opened in September 2014, according to both an online crime reporting system and a log from the Bend Police Department that shows calls to the building.

Owen, the clinic’s director, said he and his staff came prepared for backlash against a new methadone clinic. He’s given tours to community members.

Owen’s interest in opiate addiction started when he was an Army officer. He saw many soldiers prescribed pain pills after injuries they sustained during training or combat missions. Their doctors prescribed daily pain pills. By the time those prescriptions ran out, they were addicted. And it wasn’t long before that addiction led to heroin, he said.

His wife is from Oregon originally, and the couple wanted to move FALL / WINTER 2015 • HIGH DESERT PULSE

here to be closer to family.

But, he always warns people, it’s not going to be easy.

“We’re just another option, another tool,” he said. “If it works for somebody, then we’re happy to provide it.”

Wentworth said his life is starting to regain normalcy after his summer relapse. He’s working a job in construction and plans to go back to school soon. He’s also going to see a therapist and will probably get on antidepressants. He’ll eat healthy, go to the gym, practice yoga, meditate and hang out with the right people.

Since his latest binge lasted only about seven weeks, Wentworth said the withdrawal isn’t as bad as others he’s experienced.

On a recent weekday morning, he smiled frequently, opted for water at a coffee shop and looked healthy and full of energy.

“Right now,” he said, “I’m kind of grateful to be alive.” • Page 55