FALL / WINTER 2010
H I G H
D E S E R T
PULSE Healthy Living in Central Oregon
Alzheimer’s:
The coming storm The nation ages with no cure in sight
Inside:
Lies we tell our doctors Recognizing hypothermia Ride new gear
Jim Leagjeld
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H I G H
D E S E R T
PULSE Healthy Living in Central Oregon
FALL / WINTER 2010 VOLUME 2, NO. 4
How to reach us Denise Costa | Editor 541-383-0356 or dcosta@bendbulletin.com • Reporting Betsy Q. Cliff 541-383-0375 or bcliff@bendbulletin.com Markian Hawryluk 541-617-7814 or mhawryluk@bendbulletin.com Breanna Hostbjor 541-383-0351 or bhostbjor@bendbulletin.com Alandra Johnson 541-617-7860 or ajohnson@bendbulletin.com Eleanor Pierce epierce@bendbulletin.com Lily Raff lraff@bendbulletin.com • Design / Production Greg Cross Sheila Timony David Wray Andy Zeigert • Photography Ryan Brennecke Pete Erickson Dean Guernsey Rob Kerr 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 541-383-0356 or e-mail pulse@bendbulletin.com.
Treatment of All Foot and Ankle Conditions from Ingrown Toenails to Reconstructive Surgery
• Advertising Jay Brandt, Advertising director 541-383-0370 or jbrandt@bendbulletin.com Sean Tate, Advertising manager 541-383-0386 or state@bendbulletin.com Kristin Morris, Advertising representative 541-617-7855 or kmorris@bendbulletin.com On the Web: www.bendbulletin.com/pulse
Treating Foot and Ankle Conditions for All Ages
The Bulletin
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: 11/01/2010
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HIGH DESERT PULSE
Contents |
HIGH DESERT PULSE
COVER STORY
8
ALZHEIMER’S: THE STORM IS COMING As baby boomers age, the numbers of affected will soar, with no clear path to a cure in sight.
8 No, really, doc ... I DO exercise six hours every day!
FEATURES
16 20
EXAMINING THE TRUTH What happens when doctors’ leading questions are answered with patients’ little white lies? GET GEAR: SKIS AND BOARDS The latest choices for carving up the snow.
16 DEPARTMENTS
6 14 22
LETTERS Readers respond to our ADHD story.
25 28 30 33 38
GET READY: SNOW SPORTS Get on board to ride or ski this winter!
HEALTHY OPTIONS Four guilt-free dishes at some favorite local spots. HOW DOES HE DO IT? Doug La Placa of Visit Bend: This 9-to-5 desk jockey is an after-hours jock.
ON THE JOB: PHYSIATRISTS (That’s not a misspelling of psychiatrist.)
20
SORTING IT OUT Recognizing — and preventing — hypothermia. BODY OF KNOWLEDGE: POP QUIZ How much workout will work off that splurge? ONE VOICE: A PERSONAL ESSAY A pregnant mom travels the rocky road of eating for two.
COVER PHOTO BY E.J. HARRIS CONTENTS PHOTOS, FROM TOP: PETE ERICKSON, ANDY TULLIS, RYAN BRENNECKE CARTOON BY GREG CROSS
HIGH DESERT PULSE • FALL / WINTER 2010
22 Page 5
Letters | READERS RESPOND
Write to us We encourage response. Send your letters of 250 words or less to pulse@bendbulletin.com. Please include a phone number for verification.
ADHD: Weigh options, get support I can’t thank you enough for the article in the Summer/Fall 2010 Pulse publication regarding ADHD and Ritalin (“Kids with ADHD learn to focus”). It was wonderful to see a healthy article showing both sides of the Ritalin issues. My son was diagnosed with ADHD nine years ago at the early age of 3. Luckily, my twin sister’s son had already been diagnosed years before, I had a wonderful day care to work with, and I had a friend in the school district who saw signs with my son that something wasn’t right and encouraged me to seek testing. In the beginning, finding a doctor and medication that worked was a matter of trials and was very frustrating, but now nine years later my son is doing great. He has a very severe case of ADHD and takes a large dose of Concerta along with other medications. We see a child psychiatrist for regular checkups to see if the medications are working, to adjust them when needed and to keep a good track of his weight and the side effects as well as how school, family and social life is going. It has been a long road and I implore people to weigh all options, try different doctors and ideas and above all find support for yourself as a parent. I have gotten into some very heated discussions with people regarding giving my son Ritalin, and I usually find it’s
people with no children at all who are the biggest critics, or people who have never experienced being around a child with ADHD. I also want to thank the Bend-La Pine Schools and the awesome group of teachers and aides in the supported-education department, without whom my son and I could have never made it through elementary school. He has just started middle school, and as a mom I’m very worried about how he will do. He is already struggling, but I am hopeful that his teachers and I can come together to help him succeed. He is such a smart kid and I am looking forward to seeing him grow and mature. Many people ask me, will he grow out of ADHD? No, I don’t believe children grow out of ADHD, but as they mature they can mentally understand the situation better and are better at knowing their strengths and limitations. Every child is different, whether they have ADHD or not, and it’s our job as a parent to do everything we can help our children succeed in life.
— Pamela Tennant, Bend
ADHD, inattentive or combined
M
y in-laws live in Bend and sent me your great article about ADHD. As the parent of a 7-year-old with the condition, it’s rare to see anyone talk about how beneficial medications can be for ADHD. Those of us in the thick of things know how wonderful they are in helping our children, but there’s so much misinformation and criticism out there we can’t be vocal. I wanted you to know how much I appreciated your article. One little side note is that ADD is an outdated term. It’s now known as ADHD — inattentive type. Our son has ADHD — combined type, which factors in the hyperactivity. Otherwise, the article was right on. Thank you so much for getting factual information out there,
— Michelle Johanson, Roseville, Calif.
Correction A story titled “Kids with ADHD learn to focus,” which appeared on Page 8 of the Summer/Fall 2010 edition, erroneously referred to the number of child and adolescent psychologists, instead of child and adolescent psychiatrists. There are about 7,500 child and adolescent psychiatrists in the U.S., most of whom work in academic centers.
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HIGH DESERT PULSE • FALL / WINTER 2010
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Cover story | THE ALZHEIMER’S EPIDEMIC
Bracing for million
8
Alzheimer’s numbers may double by 2025 unless the elusive cure is found BY LILY RAFF PHOTOS BY PETE ERICKSON
M
elanie Embree first suspected something was wrong with her mother during a casual phone conversation 13 years ago. “She said something insignificant, like, ‘I walked the dog yesterday and ran into soand-so, and she has a cold,’” the Bend woman recalls. “And I said, ‘Oh, that’s too bad.’ We kept talking, and then five minutes later, she said, ‘Hey, I was walking the dog yesterday and I learned that so-and-so has a cold.’” Embree was immediately concerned. Her mother, Christa Forsyth, was just 57 years
old, and sharp, not absent-minded. She worked as a German translator. Embree urged her to see a doctor. She did, then told Embree that everything had checked out. She was healthy. But she kept repeating herself, and Embree kept worrying. “I knew something was wrong,” Embree says. Two years later, Embree cornered her mother’s doctor. It was 1999, and privacy laws weren’t as strict as they are today. Eventually, the doctor gave in. He opened the file and read Embree her mother’s diagnosis, made two years earlier by a different doctor. “He said, ‘It says right here: mild to mod-
Christa Forsyth, 70, was born in Germany and once worked as a flight attendant for British Airways. She was diagnosed with Alzheimer’s about 13 years ago.
erate Alzheimer’s disease,’” she recalls. Embree felt as if she’d been punched in the gut. A physical therapist, Embree knew that Alzheimer’s was a progressive neurological disease with no cure. She also knew it was fatal. Embree was pregnant with her second child at the time and overwhelmed by what the diagnosis would mean for her whole family. “I cried the whole way home,” she says. “I mean, I was sobbing.” Embree’s mother is still alive today, in a residential care facility in Vancouver, Wash. But she doesn’t recognize Embree. And she can no longer speak, walk or feed herself. For millions of Americans, she’s a glimpse
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of what’s to come. Forsyth is on the leading edge of an Alzheimer’s epidemic. Next year, the first wave of baby boomers will turn 65, the age of both Medicare eligibility and increased risk of Alzheimer’s disease. About 5 percent of Americans 65 to 74 have Alzheimer’s disease. The Alzheimer’s rate begins to soar at age 75. Fifty percent of Americans 85 and older have the disease. Octogenarians are the fastest-growing demographic group in the nation, and according to the Alzheimer’s Association, the number of Americans with the disease is expected to skyrocket from about 5 million in 2010 to more than 8 million in 2025. As if the emotional toll on families weren’t enough, the financial costs of caring for an Alzheimer’s patient can be astronomical. By 2030, Medicare is expected to spend $400 billion on Alzheimer’s care alone. That’s almost as much as Medicare’s total expenditures last year. That means almost all Americans will end up paying for the disease somehow. Public health officials know this tidal wave is coming. But the disease itself remains frustratingly mysterious. There is no known cure. And unlike other incurable diseases, such as some types of cancer, Alzheimer’s patients don’t face treatment options such as surgery, radiation or chemotherapy. “There is no definitive treatment for Alzheimer’s disease,” says Dr. Joseph Quinn, a neurology and geriatrics specialist at Oregon Health & Science University. “We can treat many of the symptoms, but we can’t stop the cognitive decline.” In fact, scientists still don’t understand exactly what’s happening in the brain to cause the deterioration. Researchers have a few theories, but the prevailing one — often called the amyloid hypothesis — has taken some hard hits in the last year. The most sobering example took place in August, when pharmaceutical giant Eli Lilly pulled the plug on a massive clinical trial of a new drug. Preliminary results found that it not only failed to relieve symptoms of Alzheimer’s disease, it actually worsened them. “There has been a steady stream of negative results lately,” Quinn says. “We’ve had a lot of disappointing news.” It’s left some Alzheimer’s researchers asking: In the search for a cure, are we headed down the wrong path?
Losing your edge or developing dementia? It is typical for people in their 60s or older to experience some mild memory loss. But symptoms of dementia are much more serious than the occasional “senior moment.” Symptom
Normal aging
Signs of dementia
Forgetfulness
Forgetting a name or appointment but remembering it later.
Forgetting an entire recent experience, missing an appointment and never remembering it, asking for the same information over and over.
Difficulty with familiar tasks
Making errors when balancing the checkbook or needing help to record a TV show.
Having trouble following a familiar recipe, forgetting how to drive to a familiar location.
Not underVision changes related to standing visual cataracts. images
Inability to read or distinguish between different colors. Walking past a mirror and thinking that someone else is in the room.
Confusion about time or place
Forgetting the date but remembering it later.
Not knowing what year or season it is.
Problems with conversation
Searching for a word or term that won’t come to mind.
Having trouble understanding what other people are saying. In the middle of a conversation, forgetting what is being discussed.
Social withdrawal
Sometimes feeling weary of work or social obligations.
Feeling confused or overwhelmed by longloved hobbies. Avoiding interaction because of confusion and embarrassment.
Sources: Alzheimer’s Association, National Institute on Aging
Melanie Embree, 40, coaxes her mother, Christa Forsyth, to eat at the Hampton Alzheimer’s Community home in Vancouver, Wash., where Forsyth lives. Alzheimer’s disease affects a patient’s desire or even ability to eat as it advances.
Alzheimer’s on the brain Over the years, different theories have connected Alzheimer’s disease to foods stored in aluminum cans, to the artificial sweetener aspartame, to flu shots and to metal dental fillings. Mainstream medical studies have disproved each of these hypotheses. “We don’t know what causes Alzheimer’s disease,” Quinn says, echoing the position held by the Alzheimer’s Association, the Na-
tional Institutes of Health and the Mayo Clinic, among other mainstream institutions. Early-onset Alzheimer’s disease — when symptoms appear before age 65 — seems to have a strong genetic component to it. One gene has been directly linked to early-onset Alzheimer’s disease; if you are born with it, you will get the disease before you turn 65. But the vast majority of Alzheimer’s patients — including many who develop symptoms at a young age — do not share this gene. Other genes correlate with a higher risk but
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Cover story | THE ALZHEIMER’S EPIDEMIC can’t accurately predict whether an individual will get the disease. What doctors do know is that Alzheimer’s disease somehow damages brain cells, impairing memory and other cognitive abilities. It is the most common form of dementia, a general term for the loss of memory and intellectual activity severe enough to interfere with everyday life. The disease is progressive. As it worsens, the brain shrinks and atrophies, and the patient also loses basic physical functions such as continence. Alzheimer’s is eventually fatal, although the rate of decline varies wildly from patient to patient. Some die within three years of the first symptoms. Others can live for 20 years. The disease doesn’t cause the heart or lungs to stop working. Rather, patients die of pneumonia, urinary tract infections that turn into sepsis, heart attacks, strokes or complications from falls. Quinn estimates that at least 25 percent of Alzheimer’s patients die of inanition, which means they stop eating and drinking and just wither away. According to the Centers for Disease Control, Alzheimer’s is the sixth leading cause of death in the United States. In 2007, it killed 74,632 Americans, ranking just above diabetes, which killed 71,382. Recent studies have found that Alzheimer’s disease starts changing the brain at least one decade — perhaps two or three decades, in some cases — before the appearance of any behavioral symptoms. Some researchers are focused on finding ways to detect the disease earlier, to better understand its pathology and, eventually, to allow earlier intervention.
A tricky diagnosis Unlike, say, strep throat, there is no simple culture or blood test to determine conclusively that a patient has Alzheimer’s disease. Instead, doctors begin a long diagnostic process by ruling out other possible ailments for which simple tests do exist. An ironclad diagnosis of Alzheimer’s disease can only be made after a patient’s death, by performing an autopsy and cutting open the brain. But doctors are generally confident in the diagnostic process recommended by the American Academy of Neurology and the Alzheimer’s Association.
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An Alzheimer’s diagnosis that is made this way will be confirmed by autopsy about 90 percent of the time, according to studies on thousands of patients. The diagnosis starts with blood tests. Disorders including hypothyroidism, vitamin B-12 deficiency, renal failure and liver failure, among others, may cause similar symptoms. Once these are ruled out, a doctor will prescribe brain imaging, usually a CT scan or MRI. “We cannot see the diagnostic lesions of Alzheimer’s disease, but … we can see if the patient has a brain tumor, water on the brain, subdural hematoma or some other things,” Quinn says. Strokes are the second most common cause of dementia, so doctors examine these images for signs of strokes. Next, the focus turns to a detailed health history. Again, this helps rule out other diagnoses. In one other form of dementia, for example, called Pick’s disease, behavioral and personality changes usually occur before memory loss. In Alzheimer’s disease, on the other hand, memory loss is usually the first symptom. To piece together this level of chronological detail, doctors must speak to someone other than the patient. “When you’re dealing with someone with a memory disorder, the patient’s health history has to be corroborated by another person,” Quinn explains. “The memory problem itself is going to prevent (the patient) from reporting certain things … so once it becomes clear that someone has dementia, it’s extremely important that a family member comes with them to all (subsequent doctor) visits.” The Alzheimer’s Association estimates that just half of Alzheimer’s patients ever receive a formal diagnosis by a neurologist. Dr. Anita Kolisch, an internal medicine specialist at Bend Memorial Clinic, says she almost always refers suspected Alzheimer’s cases to a neurologist for confirmation. A neurologist’s diagnosis helps the patient qualify for more Medicare and insurance coverage, she says. And it eases her workload. “The neurologist can take care of not only educating the patient and the family (about Alzheimer’s disease) but also facilitating a discussion with the family about future care and … patient safety,” Kolisch says. “As internists, it’s hard for us to spend huge amounts
of time on the family dynamics, because with any Alzheimer’s patient we usually have five or six other diagnoses that we’re trying to manage, too: diabetes, high blood pressure, coronary disease, you name it.” Alzheimer’s disease doesn’t cause those conditions, Kolisch adds, but elderly patients tend to have other health problems, independent of Alzheimer’s. In July, for the first time in 25 years, a panel of medical experts presented new diagnostic criteria for Alzheimer’s. The guidelines, which are under review until 2011, include the use of brain scans and spinal fluid tests, as well as the limited use of genetic testing. These tests, unlike the long checklist that is currently recommended, could be used to detect the disease before any symptoms show up. Eventually, doctors hope to see a blood test that detects the pre-symptomatic stages of Alzheimer’s and, even more importantly, an effective treatment that stems progression of the disease.
Family in crisis When Embree’s mother was diagnosed with Alzheimer’s disease, it rocked the whole family. Embree’s parents lived 45 minutes away and watched her son, a toddler at the time, while she worked. Embree worried that her father, Al Forsyth, could no longer care for the child and Embree’s mother. In many ways, Embree says, the disease was hardest on her father. “He thought that ‘till death do us part’ meant that she could never live in a home, that he had to be the one to take care of her 24 hours a day,” Embree says. As her mother’s health deteriorated, her father’s health went downhill, too. That’s not unusual, according to Terrye Alexander, executive director of a residential facility in Bend called Aspen Ridge Alzheimer’s Care. “Nobody can handle 24-hour care all by themselves, but that’s what family members think they need to do,” she says. “Family caregivers have higher rates of depression, they stop going to the dentist, they stop getting mammograms, they stop going to church. … Often the caregiver’s health suffers along with the Alzheimer’s patient’s.” Alzheimer’s patients have a tendency to get on an inverted sleep cycle, sleeping during the day and staying up all night. For a
HIGH DESERT PULSE • FALL / WINTER 2010
Peggy Tapken visits her husband, Dick Tapken, 95, at Clare Bridge of Bend in September. He moved into the care center in July when it became too difficult to keep him at home, Peggy said.
But is it Alzheimer’s? Comparing the types of dementia Dementia is a collection of symptoms including memory loss, disorientation, impaired judgment and personality changes. Alzheimer’s is not the only type of dementia, though it is the most common. Distinguishing symptoms Alzheimer’s disease: A degenerative brain disorder that is increasingly common with old age. A small percentage of cases are caused by inherited genetic defects. In other cases, cause is unknown. Five percent of Americans over 65 and more than 50 percent of Americans over 85 have it.
Tendency to wander, tendency to get lost in familiar locations. Patients may be unable to recognize themselves in the mirror.
Vascular dementia: Brain damage caused by reduced blood flow to the brain, usually from a series of small strokes. Most common among patients 70 and older.
Unusual mood changes, dizziness, limb weakness, slurred speech, loss of bladder or bowel control, hallucinations.
Changes in the brain Cross-section of a healthy brain An adult brain contains 100 billion nerve cells, or neurons, with branches that connect at more than 100 trillion points. Signals travel through this “neuron forest” and form our memories, thoughts and feelings.
Cerebellum
Cross-section of a brain with advanced Alzheimer’s
Gaps
Parkinson’s disease: Progressive disorder that primarily affects movement but, once severe, also causes cognitive decline. Cause is unknown.
Tremors, slowed motion, loss of involuntary movements such as blinking, poor posture and balance.
Alzheimer’s destroys neurons and causes the brain to shrink and shrivel. Fluid-filled gaps within the brain get larger.
Lewy Body dementia: Rare disorder in which round structures, called Lewy bodies, develop in the brain. Cause is unknown.
Tremors and movement problems similar to Parkinson’s. Visual hallucinations — of colors, shapes, animals or people — are often the first symptom.
Changes in the “neuron forest”
Frontotemporal dementia: A group of rare disorders, including Pick’s disease, in which the frontotemporal lobe of the brain atrophies and shrinks. Cause is unknown.
Affects people ages 40 to 70. Patients tend to display social and behavioral changes before memory loss.
Sources: Mayoclinic.com, National Institutes of Health, Dr. Joseph Quinn
Cerebral cortex
A brain with Alzheimer's contains fewer neurons and fewer connections, called synapses, where brain signals are transmitted. Plaques — abnormal clusters of proteins — build up between the neurons. The branches of neurons get twisted and tangled by other proteins, disrupting signals as they pass between neurons. Source: Alzheimer’s Association
LILY RAFF AND ANDY ZEIGERT
Cover story | THE ALZHEIMER’S EPIDEMIC
This shadow box hangs on Ted Schlapfer’s door at Clare Bridge of Bend. Mementos from years gone by, like his U.S. Forest Service ID tag, help the 89-year-old Schlapfer (below) and other residents recognize their rooms.
family member who works during the day, caring for an Alzheimer’s patient all night can be devastating. Alzheimer’s patients also have a tendency to wander, in cars or on foot. As the disease progresses, around-the-clock care becomes necessary for a patient’s physical safety. Decades ago, residential care for Alzheimer’s disease relied heavily on physical restraint. Today, staff at Clare Bridge of Bend, a residential Alzheimer’s facility, employ a gentler, more modern “reapproach and redirect” technique, says Ronnie Harrelson, sales and marketing manager. “If a resident doesn’t want to take a shower, maybe another caregiver can try,” Harrelson says, explaining the reapproach part. “It could take five times, but … you just can’t give up after that first try.” Similarly, if a patient becomes fixated on walking out of the facility’s locked entrance, for instance, staff members will try to gently redirect her. “We’ll say, ‘Come with me, I need your help with something.’ Or, ‘We’re going for popcorn.’ Because the (patient’s) mind is so chaotic … sometimes it’s comforting to have something to fix on. So we empathize with that and just try to replace it with something else.”
Living with the disease The Clare Bridge facility is designed to jog the memories of residents and encourage social interaction. Confused and embarrassed, Alzheimer’s patients have a tendency to withdraw. So the facility has small rooms, like dens, which open into larger, shared spaces. According to Harrelson, this allows patients to be alone if they wish, but still observe group activities.
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The building has two kitchens, each of which looks plucked from a 1970s ranch house. The stove and oven can’t be turned on except by a staff member, but the room provides a comfortable setting. “For many of the women, life revolved around the kitchen before they moved here, and we want them to be able to have that again,” Harrelson says. “We have several women who love to come in here and fold napkins.” Each patient has a shadow box hanging by his or her door. Residents can’t remember their apartment numbers, so each box is decorated with photos and mementos to trigger their memories. Many of the boxes contain photos from decades ago, because advanced Alzheimer’s patients recognize their younger selves but don’t associate at all with their current appearance. For Alzheimer’s patients, the most lasting memories are often from early adulthood, says Alexander, of Aspen Ridge. That means that as baby boomers start moving into Alzheimer’s facilities, the settings will have to be altered drastically. The first baby boomer moved into Aspen Ridge recently, for example. While some residents want to listen to jazz musician Glenn Miller, the baby boomer prefers Led Zeppelin. While others play organ or piano, he plays electric guitar. “Residential care is going to become much more individualized, because baby boomers have eclectic hobbies and interests. And that’s going to work great because with dementia patients, the more you can fill a person’s life with the things that they completely enjoy doing, the happier they are going to be,” Alexander says. “We have to focus on the patients. If they’re just coming to an activity because it’s what we offer, then we’re not meeting their needs.”
HIGH DESERT PULSE • FALL / WINTER 2010
Music is a big part of every day for the Clare Bridge residents like Sylvia Waller, 86, left, who participates in a sing-along. Below, employee Ronnie Harrelson, 38, and resident Bergie Bergstralh, 78, help resident Doris St. Clair, 95, orient herself at the Clare Bridge facility.
Residential facilities only treat the symptoms of Alzheimer’s disease. But then, so do physicians. “We can treat some symptoms of Alzheimer’s disease, including depression, sleep disorders, some delusions and hallucinations,” Quinn says.
Racing for a cure
The central gathering space at Clare Bridge was created with a small-town ambience to encourage social interaction.
Alexander also believes that baby boomers will be less reluctant than older generations to move into residential facilities. “We don’t want our children and our spouses taking care of us fulltime,” says Alexander, who at 57 is a baby boomer herself. “But we don’t want bingo. We want our music, our yoga, our sushi, our computers.”
HIGH DESERT PULSE • FALL / WINTER 2010
Doctors don’t have many options for treating the definitive symptoms: memory loss and cognitive decline. Right now, there are just four medications approved for use in treating Alzheimer’s disease. Three of them fall under one category, called cholinesterase inhibitors. Scientists aren’t sure exactly how they function, but they seem to prevent the breakdown of acetylcholine, a chemical that helps with memory and thinking. A fourth drug, sold under the brand name Namenda, is often prescribed along with one of the cholinesterase inhibitors. It is believed to regulate a brain chemical called glutamate. One theory of Alzheimer’s disease is that an overabundance of glutamate causes brain cell death. When combined, these drugs can help slow memory loss and physical decline, but only for up to six months. In the race to cure — or, at the very least, understand — the disease before millions of baby boomers fall victim to it, the National Institutes of Health is spending an estimated $527 million on Alzheimer’s research this year. But Alzheimer’s activists argue that isn’t nearly enough. For comparison, the NIH will spend nearly six times as much, or $3.1 billion, on HIV and AIDS research this year. And it will spend about $6.1 billion — almost 12 times as much — on cancer research. Continued on Page 34
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Healthy options | DINING OUT
Good choices at Tacos de Halibut from Hola! “Soft corn tortillas filled with grilled halibut, topped with lettuce, sour cream, pico de gallo and avocado slices. Served with rice and black beans.” (We held the sour cream.) • Or try: Ceviche Traditional or Mexicano
BY ALANDRA JOHNSON • PHOTOS BY RYAN BRENNECKE
T
rying to find a healthy option at a restaurant can be a dicey proposition. Is that sauce made with cream? Are those veggies cooked in butter? How many ounces is that piece of chicken? And how do you resist the dessert menu? Healthy choices are easier at home, where you have control over exactly what goes into your food and how everything is prepared. But eating out is also a fun activity, and Central Oregon has a wealth of restaurants from which to choose.
Healthy tips for eating out 1. Choose whole grains when possible. Whole-wheat pasta, brown rice and quinoa are all excellent choices.
2. Watch portion size. Portions at restaurants tend to be huge. Don’t eat the whole thing.
Oricchiete with Greens, Lemon and Parmesan from Pastini Pastaria “Small pasta ‘ears’ with broccolini and arugula, cherry tomatoes, lemon, herbs and Parmesan, topped with toasted hazelnuts.” • Or try: Ziti Vegetariano
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3. Ask about splitting. Rather than taking home half of an entree, which may not be as healthy as a home-cooked meal, Craven recommends a diner ask if anyone would like to split an entree. 4. Ask how things are prepared. Ask for changes if necessary. (Are the veggies cooked in butter? Can they steam them or use a little oil instead? )
HIGH DESERT PULSE • FALL / WINTER 2010
local restaurants In this new Pulse feature, we are profiling some healthy dishes at several local restaurants. To make our selections, we sought the input of local restaurant owners as well as Bend Memorial Clinic registered and licensed dietitian Eris Craven. These choices are designed to include whole-grain options (where available), plenty of veggies and healthy cuts of meat or protein. (Quoted food descriptions are from the menus.) Beyond these specific dishes, Craven offers ideas for healthconscious diners to keep in mind when eating out.
Sesame Encrusted Ahi Tuna from Zydeco “Served with rice, shrimp cakes, cucumber salad and wasabi vinaigrette.” (We passed on the shrimp cakes.) • Or try: Free-Range Roasted Chicken (without the skin)
5. Ask about the ingredients in sauces. These can often hide a lot of fat content.
6. Ask yourself, is this a special occasion? If it is, Craven says, it’s OK to relax a little. But if this is a once-a-week outing, be more restrictive. 7. Consider what is important to you. Is it important to eat local, organic produce, or hormone-free meats? Do you want something low-sodium or low-fat? Think about what your health goals are as well as your principles, and stick with those. 8. Eat veggies. The more veggies, the better. If a dish doesn’t come with many, ask for a side of salad or cooked veggies (without the butter). 9. Choose seafood. It’s a good source of protein (so is chicken). •
HIGH DESERT PULSE • FALL / WINTER 2010
Soba Salad from Soba The salad comes with brown rice, greens, avocado, mandarin oranges, peanuts and chicken. (We requested the roasted sesame dressing be served on the side.) • Or try: Soba Combo with Brown Rice
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Healthy communication |
DOCTORS AND PATIENTS
No, really, doc ... I DO exercise six hours every day!
‘What seems to be the truth?’ When doctors’ leading questions meet patients’ little white lies BY BETSY Q. CLIFF • CARTOONS BY GREG CROSS
P
eter Clarke, an expert on medical communication, has sat through dozens of visits between patients and physicians. Here’s how a typical one goes: The patient talks to his doctor, dutifully answering questions. The doctor asks how the patient is doing, whether he is taking his medications and if he has any concerns. The patient responds politely, saying things are going well. There’s nothing remarkable in the answers. But after the doctor leaves the room, “the patient turns to me and says, ‘I’m having all sorts of troubles,’” said Clarke, a professor at
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the University of Southern California. Sometimes the patient even reveals serious issues, such as terrible pain or coughing up blood. “All I can do is say, ‘Tell it to the doctor.’” They don’t. Patients often gloss over the truth, surveys show. Sometimes it’s little white lies. We tell our doctors that we exercise every day (well, except weekdays), or that we are watching what we eat (as in watching the ice cream go into our mouths), or that we have cut down on our drinking (or, we did last week). So many patients lie to their physicians that doctors have come to expect it. Many say they don’t take what their patients say at face value, adjusting upward the amount people report they drink or asking again even when people say they are taking their medications. But what’s not well appreciated, even among doctors, is just how hard it is for patients to be honest. Sometimes, patients may not know what a doctor is asking. Other times, patients are not honest
HIGH DESERT PULSE • FALL / WINTER 2010
with themselves so could not possibly be upfront with a physician. Perhaps most interesting is research suggesting doctors can, almost always unknowingly, encourage patients to lie. They give off cues or ask questions in a way that invites patients to be vague. They ask leading questions. Doctors say they want their patients to be completely open and honest. In a perfect world, of course they do. But the world behind the exam room door is not perfect. Things are often rushed. The doctor or patient may be distracted. Each may not understand what the other is saying. “Doctors and patients are really different,” said Robin DiMatteo, a psychology professor at the University of California, Riverside, who has, in her own estimation, listened to thousands of doctors’ office visits. In the best of circumstances, she said, communication is difficult. That difficulty reveals much about both human nature and the failings of the American health care system. Experts who study the communication between physicians and patients say that if we could get patients and physicians to be more open with each other, it would go a long way toward improving health care. “The better the communication is and the interaction, the better health outcomes result,” DiMatteo said. “There’s a lot of data showing that.”
Little white lies As patients, many of us often do not think there is any consequence to glossing over the truth. We’re wrong. “A physician’s diagnosis and recommendations are only as good as the information they are based on,” said Dr. Gary Plant, a family physician at Madras Medical Group. “If you come in and give false information, then it’s impossible to give good recommendations.” Even information that patients think is inconsequential — past family history, eating habits or supplements patients take — can help physicians make a diagnosis. Dr. Bruce McLellan, a cardiologist at Heart Center Cardiology in Bend, said he has had patients who did not tell him that they were using herbs or supplements to try to treat their heart disease. “Some of those herbals can interact with prescription medications,” he said. “It’s important that we know about it.” He cited one herb, red rice yeast, that should not be taken at the same time a person is taking a statin, a common cholesterol-lowering drug, because it acts on the body in the same way as the prescription medication, strengthening the dose. Plant said he has patients who tell him they are taking their medication when they are not, often because they cannot afford it. Then, he said, blood tests make it appear that the medication is ineffective, sometimes causing him to prescribe more. “You add medications and give them increased-potency prescriptions,” said Plant. “Then you try to figure out why this patient is not responding the way all other patients do.” Increasing the number and strength of medications can sometimes increase the side effects of those medications and almost certainly increases the cost. Still, Plant said, patients won’t talk about it. “They are embarrassed or afraid.” In a survey by WebMD, a health information company, 45 percent of respondents admitted to either lying to their doctor or stretching
HIGH DESERT PULSE • FALL / WINTER 2010
Not the whole truth ... Sometimes they’re funny, sometimes tragic and sometimes just downright inconvenient. Local doctors share specific stories about when their patients stretched the truth.
“I had a 50-year-old male who came in because he said he had a sore elbow. I brought him into the exam room and took a look at the elbow. I tried for a long time to figure out what was wrong, if it was a joint issue, a bone issue or something else. Then I finally had to admit at the end of the visit that I couldn’t really find anything wrong with his elbow. That’s when he said he really wanted to talk about his ‘natural male enhancement.’” Dr. Gary Plant, Madras Medical Group
the truth. Nearly 40 percent said they lied about following a doctor’s orders and one-third about how much exercise they got. Patients have all kinds of reasons for lying. A small number of patients go into doctors’ offices intending to lie, often to feed an addiction to pain pills or other types of drugs. Other patients, again a small minority, according to the WebMD survey, may lie to keep information out of their medical records. These patients may be worried about the information being used against them by insurers or employers. In fact, though there are laws that control who can see medical information, insurers or employers can sometimes get it. Privacy experts say this is a legitimate concern and that there is no good solution. Still, patients need to weigh their concerns about privacy against giving honest information to their doctors. But there are far more common reasons for lying that primarily have to do with human nature. In the survey, patients gave a variety of reasons: believing it was none of the doctor’s business, being embarrassed, thinking the doctor would not understand. But the most common reason given? They didn’t want to be judged. “None of us are going to say, ‘I like to lie around for four hours and eat bags of chips every evening,’” DiMatteo said. Still, all of the more than a dozen doctors contacted for this article said it is important for patients to be as honest as possible, even if they are afraid of being judged. When people are embarrassed to give honest answers, Plant said, “it just makes our job harder. I think it’s important to recognize why you are there” in the doctor’s office. Dr. Michael Feldman, a nephrologist at Bend Memorial Clinic, said his office is typically a judgment-free arena. Still, “even if I do have a judgment,” he said, “then I’m still going to bring my A-game.”
Communication skills While physicians may have a sense that patients sometimes stretch the truth, there’s evidence that few appreciate their own role in that deception. Medical schools train students in communication, using both lectures and practice with actors. However, most of the training occurs in the first couple of years of school, according to professors. In the third and fourth years, when students begin seeing real patients, les-
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Healthy communication | DOCTORS AND PATIENTS sons about their communication style typically fall off. Once physicians are in practice, they almost never get feedback about their interactions with patients, according to an article in Health Affairs co-authored by Dr. Wendy Levinson, a professor of medicine at the University of Toronto. “We don’t teach it as much as we could,” she said in a recent interview. “To some degree, some people are better than others, but I’ve never had the view that it couldn’t be improved.” Levinson has studied patient and physician communication extensively. In a study published in 2000, she and colleagues found that in many office visits, patients give physicians clues as to their concerns about a medical issue, procedure or medication, but physicians often skip over those clues. She cited this example, of a physician speaking to a patient about an upcoming heart procedure: Physician: “More often than not, I will keep patients in (the hospital or other medical facility) after a pacemaker is placed, at least overnight, in order to make certain that the pacemaker is functioning properly.” Patient: “Dr. Smith told me it’d be two days.” Physician: “Frequently it is two days, but as I say, at least overnight.” Patient: “I’m alone.” Physician: “And the routine goes like this. We get you to the OR and then we …” Levinson and her colleagues point out that the physician does not address the patient’s anxiety about being alone, which seems to be a concern for her about the procedure. This type of interaction was not an anomaly. Surgeons missed following up on patients’ clues 62 percent of the time in the study. Primary care doctors were worse; they missed the chance to follow up on clues to patients’ feelings nearly 80 percent of the time.
Patient says...
Doctor hears...
“I’m following my low-sodium diet.”
“I went a week without eating potato chips.”
“Doctors are sometimes sticking to the (office visit) agenda,” Levinson said. Or, she said, the patient’s concern, particularly if it involves a social issue, “is not the medical reason for being there. It can feel like these things take up time.” When patients do not fully explain their concerns or fears, for whatever reason, there can be consequences. Treatment decisions can be dependent on patients’ social, emotional, family or financial situations as much as on their medical conditions. If doctors do not know that information, they may give the wrong treatment. In a recent study from the University of Illinois at Chicago that built on Levinson’s work, some medical students were taught to recognize and follow up on patients’ clues while others, the control group, were not given that training. Then all students saw actors who pretended to be patients with medical problems. For example, an actor playing a patient came in because of worsening asthma. While discussing his situation with his doctor, he mentioned that he’d recently lost his job. Students who followed up on this comment learned he was having trouble affording his medications and therefore taking them less frequently. Students who did not ask about the job loss did not learn that fact and sometimes
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HOSPICE HOME HEALTH
Page 18
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www.partnersbend.org HIGH DESERT PULSE • FALL / WINTER 2010
Not the whole truth ... assumed other things were causing his asthma to worsen. Students taught to pick up on patients’ clues offered the appropriate treatments 70 percent of the time. Students without that training made the correct decisions just 20 percent of the time.
Leading questions Physicians’ failure to pick up patients’ clues raises clear questions about their training. But other issues surrounding communication between physicians and patients may not be so easily resolved. Namely, why should physicians need training to learn some of the most basic facts about their patients’ lives? In other words, what is going wrong between doctors and their patients that causes patients to clam up? Communication experts say that if patients want the best health care possible, they need to be completely open and honest. “Patients should be ready to tell the physician what their concerns are,” DiMatteo said, “because the physician may not ask.” But there are complex dynamics that come into play during office visits, experts say, and for all but the most-aware patients, it’s not as simple as patients being better talkers and physicians being better listeners. For one thing, the current health care system does not encourage in-depth discussions between physicians and patients. Doctors are paid, at least in part, based on the number of patients they see in a day. When they have only a few minutes per patient, it’s difficult to develop trusting and open relationships. It also, DiMatteo said, discourages physicians from tackling complex problems, particularly when they are not strictly medical. In studies, DiMatteo said she often hears physicians asking questions in a way that discourages further discussion. Doctors say, “This doesn’t hurt, does it?” (Patients invariably say it doesn’t.) Or “Have you been trying to get some exercise?” (Patients say yes. After all, who isn’t trying?)
HIGH DESERT PULSE • FALL / WINTER 2010
“When I was an emergency room doctor in Los Angeles, a guy came in with a small nail in the forehead. His friends had brought him into the ER. The story they started with was that they were framing something using a nail gun and the nail bounced off the board. It was so outrageous an explanation. Later, they admitted that they were playing, trying to shoot something off the top of his head.” Dr. Jim Stone, Mountain Medical Urgent Care, Bend
Other times, DiMatteo said, physicians ask questions but do not listen to the answer. Studies, she said, have found that doctors, on average, interrupt patients just 18 seconds after they begin to answer a question. “Physicians are sometimes motivated to ask questions in a way that requires less work,” she said. “I don’t want to put them down for that. … Their organizational structure pushes them into expeditious answers.” Even when the health care system doesn’t get in the way of good communication, human nature can. Both physicians and patients are, of course, human beings, with all the flaws, prejudices and awkwardness that comes with that. Doctors may inadvertently slant patient responses with their own biases. “When doctors talk about alcohol abuse or tobacco use or eating habits, even the hint of stigmatization — and that hint can be subtle, very nonverbal — that shuts a patient down lickety-split,” Clarke said, “without either of the parties realizing it is happening.” And patients may be all too willing to take the invitation to steer away from that sensitive topic, leaving doctors resigned to getting less than the whole story. “Nobody tells the truth about lifestyle changes,” said Feldman, the BMC nephrologist. “I just bow my head, shake it and move on to the next person who tells me they’re exercising, following a salt-restricted diet and not eating ice cream.” •
Page 19
Get gear |
SKIS AND SNOWBOARDS
POWDER SKIS • K2 Missbehaved 159 cm skis • Powder House, MSRP $750 • A powder ski for women that can still turn quickly and hold an edge. Women’s skis tend to be a little softer and narrower to make turning them from edge to edge easier.
FREESTYLE BOARD • Never Summer Evo • Aspect, MSRP $490 • This board has a symmetrical design known as a twin tip that
Winter’s coming. BY MARKIAN HAWRYLUK • PHOTOS BY ANDY TULLIS
ALL-MOUNTAIN SKIS • Surface One Life 179 cm skis • Skjersaa’s, MSRP $599 • Made with an 8 degree rocker at tip and tail, the One Life is nimble in the turns, but rises above the fluffy stuff on those days when you just have to call in sick.
Page Page 20 20
like a short ski or board. But the tip and tail rise up at an angle — known as rocker or reverse camber — providing flotation to keep you above the powder, without interfering with turns. If your gear is more than seven years old, you can probably gain a lot with the new technology. Don’t buy gear because your friend likes it or you found it at a ski swap for an insane price. It might not be right for you. You should be able to get the latest equipment at 20 percent or more off the MSRP, with bigger discounts on previous year models. Most shops will let you try before you buy through one of the following options: • Rentals: Renting is a good idea if you’re only going to ski once or twice a year. Gear at resorts CARVING SKIS • K2 Aftershock 167 cm • Powder House, MSRP $1,250 • A traditional carving ski that is better suited for groomers or hardpack East Coast skiing. Like many carvers, the Aftershock comes packaged with bindings.
I
s it time to upgrade your skis or snowboard? Ski and board technology continues to evolve, moving more snowriders toward a single, allmountain product that will work for 90 percent of snow conditions and riding styles. Both skis and snowboards are being made with a middle section under your feet that acts
allows a snowboard to ride forward or backward. Designed for the halfpipe or terrain park, the Evo is made with carbon fiber to give it extra spring for tricks of all sorts.
How’s your gear? costs to the sales price at one store. • Lease: Some stores lease gear for the entire season. At a cost of $120 to $250 a year, you’re always on the snow with the latest gear — and with a fresh wax job. It’s a terrific bargain for kids who tend to outgrow equipment. Many stores also let you upgrade mid-season. • POWDER BOARD • Lib Tech 1986 Snow Mullet BTX • SideEffects, MSRP $569 • A throwback to the ’80s, the Snow Mullet has a tapered shape designed to ride in one direction. It’s more of a traditional powder board, but with an edge designed to cut into hardpack and ice.
CARVING/ALPINE BOARD • Never Summer Raptor X • Aspect, MSRP $580 • The Raptor X uses a directional profile that shifts the rocker toward the tail, providing improved carving at high speeds and a more forgiving ride.
is chosen for durability and universal use. You’re not going to get top-notch skis or a performance board. But better to make sure you’re hooked on the sport before putting down a grand for new equipment. • Demo: Demos are like a one-day rental, but stores will credit the rental toward your purchase price. Many stores will send you to the slopes with three different choices so you can see which you like best. A caveat, though: stores have exclusivity agreements with manufacturers, so you won’t find the same brand in two stores in town. (Exclusivity doesn’t apply to chain stores.) So while you can demo different brands from different stores, you’ll only be able to apply the demo
ALL-MOUNTAIN BOARD • Never Summer Lotus • Aspect, MSRP $460 • A high-performance women’s board that is narrower, softer and lighter than the men’s version. The board has a rocker middle to float on powder, yet still provides the power to snap out of turns.
Page 21
How does he do it? | DOUG LA PLACA
The face of Bend 9-to-5 desk jockey is an off-hours jock BY ELEANOR PIERCE PHOTOS BY RYAN BRENNECKE
D
oug La Placa comes by his love of the outdoors naturally. “I was raised in a skiing family,” he said. Growing up, his family took every opportunity to hit the ski resorts of his native northern Michigan. Now, La Placa is the 38-year-old father of two boys, Jake, 11, and Zack, 8. He and his wife of nearly 14 years, Dawn, like to get their own family outside together. “I think skiing as a family inherently creates incredible humor and adventure,” he said. La Placa, who moved to Bend in 2007 to become president and
Page 22
CEO of Visit Bend, the city’s tourism bureau, said his outdoor interests aren’t limited to skiing. La Placa’s also a fisherman and an avid cyclist. He began racing mountain bikes while he was a student at Michigan State University, where he earned a journalism degree. Lately, his love of bicycles and competition has translated into a passion for a sport that has been gaining popularity in Central Oregon and elsewhere: cyclocross. In cyclocross, participants ride laps on a course featuring pavement, grass and hills in sometimes muddy or snowy conditions. In particularly rough spots, the racers pick up their bikes, carrying them on their shoulders over obstacles. The sport’s known for being messy and fun, with a carnival-like atmosphere at events. At many races, some competitors dress up, racing in audacious costumes alongside more serious competitors. “I think the reason it’s exploding nationally is that it’s far more of a cultural experience than just a competition experience,” La Placa said. He had heard of the sport but didn’t know much about it when he was asked to put in a bid for Bend to host the USA Cycling Cyclocross Nationals. Visit Bend landed the event for December 2009 and will
HIGH DESERT PULSE • FALL / WINTER 2010
Meet Doug La Placa Occupation: President and CEO of Visit Bend Activities: Skiing, cycling, fishing and rock climbing Splurges: Local breweries and the occasional pizza with his family On recovery time: “What I have found is that with age, there are different priorities in training. One of those is to build an immunity to injury.” Lately, the 38-year-old has added core strength training, stretching and massage to his fitness routine. On allocating recreational time: “There’s so much to do, I often laugh … when I find myself getting stressed about allocating recreation time,” he said. “It’s recreational ADD.”
HIGH DESERT PULSE • FALL / WINTER 2010
Page 23
How does he do it? | DOUG LA PLACA
Doug La Placa at his desk at the city’s tourism bureau, Visit Bend, says, “Bend has all of the upsides, but it’s far more affordable and has far more cultural and educational opportunities” than his former home in Colorado.
host it again this year in the Old Mill District, Dec. 8-12. La Placa himself participated in last year’s Cyclocross Nationals. He raced on the first day of the event, in snowy, icy conditions. “It was brutal,” he said. He fell several times, and on the last lap, he went down hard, breaking his collar bone. “I had the honor of being the first broken bone in ’cross nationals,” he said. La Placa didn’t race in the elite division. He’s not there to be the best of the best; he just loves competition.
Page 24
“There are some people who are incredible athletes, and there are people like me who are mediocre athletes who are competitive,” he said with a chuckle. “I don’t care if I’m playing checkers with my kids; I want to win.” He said he also likes competing because it forces him into a level of fitness he wouldn’t otherwise achieve, but it can be humbling. “In Bend, you’re not just racing against middle-aged desk jockeys like me.” La Placa’s newest outdoor hobby is rock climbing. He’d tried it a little before, mostly indoors, but in the last year, a new climbing partner has encouraged him. La Placa acknowledged that with all of his fitness activities, he’s starting to notice changes in his body as he ages. “Recovery time between races and workouts is certainly getting longer. No longer can I just go out on every ride and go as hard as I can. “For the first time, I’ve had to focus on things like stretching and building core strength,” he said. In addition to working out, La Placa said he and Dawn, an avid runner, try to keep healthy by eating well. “We’re pretty conscientious about what we eat and how much we eat,” he said. But it can be rough with two kids at home. “We strive to buy as much organic and whole foods as we can … but young kids like to eat pizza and non-whole foods. “We strive to reach a balance.” •
HIGH DESERT PULSE • FALL / WINTER 2010
Get ready |
LEARN TO SKI OR BOARD
Intro deals for adults
SUBMITTED PHOTO
Adults take a ski lesson at Mt. Bachelor in February.
Get up and glide
Mt. Bachelor ski area
BY BETSY Q. CLIFF
M
aybe you’ve recently moved to Central Oregon, or maybe you’ve lived here all your life. In any case, you know what happens at this time of year. You can’t go anywhere without hearing about it. People talk about it at parties, over beers and burgers, and at the water cooler. It’s everywhere, and it seems everyone does it but you. Yes, I’m talking about hitting the slopes. When the snow falls on Mt. Bachelor, Hoodoo Mountain Resort or any of our other area ski hills,
PHOTO BY LYLE COX
the masses move out of town and up to the mountains. Feeling left out yet? You don’t have to. Adults are often intimidated by learning to ski or snowboard. And it’s understandable. Strapping long boards to your feet and heading downhill fast can be a surefire recipe for pain. But for those who want to learn, there are ways to take away the fear factor. Turn the page for a step-by-step guide to getting on the hill without breaking your neck.
• Ski or Ride in 5: For non-skiers or -boarders who are not comfortable getting on a chairlift. Five lessons with lift ticket and rental; 12-day pass for this season; and discounts on future season passes: $199 • Also offers a variety of private or group lessons for all levels. • Visit mtbachelor.com for prices or more information.
Hoodoo Mountain Resort • 1 2 3 Learn to Ride: Three days of two-hour classes. All abilities are welcome. Price includes lift, lesson and rental: $177 • Private or small group lessons: • One-hour private lesson: $65 • Four-hour group lesson for beginners (includes lift ticket and rental): $90; $74 without rental • Two-hour group lesson for beginners (includes lift ticket and rental): $60; $44 without rental • Visit www.hoodoo.com for more information. Page 25
Get ready | LEARN TO SKI OR BOARD
Ready to buy?
Step 1: Get in shape.
Step 2: Gear up.
Often a big concern for people is whether they are in good enough shape to hit the slopes. The good news? Experts say you don’t have to be super-fit to try out skiing or boarding. “If you can walk up Pilot Butte, then physically you have what it takes to start to ski for a day,” said Doug Christman, a personal trainer at the Athletic Club of Bend. Some say you might not even need that. Kyle Will, a personal trainer at WRP Training Studio, said his dad was not in great shape. But come ski season, he said, “he’d hop off the couch and have a great time.” Still, doing a little bit of training will help people feel more comfortable and prevent soreness the next day. “If they get out there, they are going to be using muscles they didn’t know they had,” said Lorna Clark, formerly the assistant ski school director at Hoodoo who will be teaching at Mt. Bachelor this year. “If you’re in good shape, you’ll feel it less.” You can take this first step from the safety of dry land. And you can — and should — start before ski season. Most experts say training, particularly for the beginner, should include all the components of basic fitness: cardiovascular, strength and flexibility. Even though skiing is technically not an aerobic sport, said Christman, “the more aerobically fit you are, the better you are going to be at staying strong for the duration of the run.” When strength training, Clark said, most people think they need to work on leg strength, but core workouts are more important. “If I could choose one exercise (for training), it would be sit-ups,” she said. “That’s what holds all your muscles together.” Clark and others said that besides core strength, people should concentrate on their legs, which will bear the brunt of the work while skiing or boarding. Build up your legs, they said, through squats and lunges.
When you are just beginning skiing or snowboarding, experts say it makes sense to rent gear the first few times so that you know if you want to make a bigger investment. Experts advise against borrowing skis or a snowboard from friends because it can make that first day all the more difficult. “Often the equipment is old or inappropriate” for the person’s body type or skill level, Clark said. You can rent at both Mt. Bachelor or Hoodoo, or pick up equipment at ski and board shops in town. Skiers will need boots, skis and poles. Boarders will need boots and a board. You’ll also need to protect yourself from the elements, particularly if you choose to begin on a cold day. Layers are a good idea. Begin with polypropylene or silk long underwear, then layer fleece or wool on that, and lastly, add a waterproof shell. You’ll be more comfortable if you wear socks designed for skiing, and many people prefer thin socks. However, if you don’t want to spend the money, any long wool or polypropylene socks will do the trick. You’ll also want a hat or helmet, waterproof gloves or mittens and something to protect your eyes. Eyewear “is a big one,” Clark said. “It’s really hard to do all these new things you are learning if the snow is blowing in your eyes.” If you don’t already own this gear, you may have to buy a few things. Ski swaps and secondhand gear stores are good places to look for less expensive items. Clark and others also had a directive for beginners: no cotton and no jeans. Cotton does not retain heat when wet and jeans, Clark said, “are so uncomfortable and so difficult to move.”
See our spread of ski and board choices on Page 20.
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Step 3: Take a lesson. Experts agree that the quickest and safest way to learn to ski or ride is to seek professional help. At Mt. Bachelor, beginners start by learning about the equipment, said Jason Montoya, the ski school manager. Then they learn how it feels to wear skis or a board on flat land. “They are going to get used to moving on the equipment, just basic walking,” Montoya said. We “work our way up to the chairlift.” Instructors usually have beginner students practice on small slopes, either hiking a little way up the hill or using a moving carpet, which is like an escalator that takes skiers up the hill. This year, Bachelor installed a new 200-foot-long moving carpet to help its beginners. On both skis and boards, Montoya said, instructors will teach students to turn and stop. Instructors usually have people ride the carpet a few times before going on the lifts, Montoya said, though he said that most adults will be on the chairlift by the end of their first two-hour lesson.
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Step 4: Practice. Once you’ve learned the basic skills, the next step is the same as in any sport. Practice, practice, practice. One good way is to plan to stick to the small slopes on your first day, Clark said. “Do it over and over until you are really like, ‘Wow, I need to go somewhere else.’” If you try to push too quickly to harder terrain, not only will you have a more difficult time practicing the skills you have just learned, but there could be safety issues, Montoya said. “They’re not going to be able to control their skis like they would want to safely navigate down the run,” he said. After practicing for a few runs, you’re likely to wipe yourself out. Take it easy on yourself, Clark said. “The first day will probably be their most tired ski day of their whole career,” she said. “When you do get tired and you’re not having fun, go inside and have a hot chocolate.” •
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On the job | PHYSIATRISTS
Physiatry focuses on fixing function RYAN BRENNECKE
BY LILY RAFF
Dr. Linda Carroll, a physiatrist at High Lakes Health Care.
D
way, she is a glorified physical therapist. A really, really glorified one. To become a physiatrist (pronounced fizz-EYE-uh-trist), a person must complete four years of medical school, then a one-year internship and a three-year residency. Physiatry is also called physical medicine and rehabilitation, or PM&R for short, and it’s one of 24 areas of expertise recognized by the American Board of Medical Specialties. Other specialties include, for example, pediatrics, emergency medicine and dermatology. Physiatry got started back in the 1930s but grew beyond just a
r. Linda Carroll, like a lot of physiatrists, is used to the questions about her job: Are you really a doctor? Did you say “psychiatrist?” You specialize in chronic pain, right? Aren’t you some kind of glorified physical therapist? Carroll’s answers: Yes, no, no and well, not exactly. The last question always gives Carroll pause because she worked as a physical therapist for 12 years before entering medical school. So, in a
541-
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HIGH DESERT PULSE • FALL / WINTER 2010
few doctors after World War II. Medical breakthroughs meant that soldiers were returning home with injuries — including paralysis, head traumas and missing limbs — that would have been fatal just one decade earlier. Once their wounds healed, these veterans had few resources to help them resume daily life. “The basic bottom line of our practice is that we deal with function,” says Dr. David Stewart, a physiatrist at The Center: Orthopedic & Neurosurgical Care & Research in Bend. “We treat injuries and conditions that impair function.” To do that, they coordinate care between physical therapists, occupational therapists, pharmacists, even family counselors. They help patients get fitted for prosthetic limbs and other adaptive equipment. Sometimes, Stewart says, they even talk to patients’ employers to help figure out ways they can keep their jobs. According to Carroll, who works at High Lakes Health Care in Bend, the specialty is a combination of orthopedics and neurology
HIGH DESERT PULSE • FALL / WINTER 2010
“I like the focus on function. It’s a practical specialty in that … we ask, ‘How can we help your quality of life, however you define it?’” ANDY ZEIGERT
Dr. Viviane Ugalde, a physiatrist at The Center that does not involve surgery. Physiatrists treat muscles, bones and nerves. “That’s where we can be really helpful,” she says. “If you have back pain and you go to a surgeon, he might say, ‘Is a nerve being pinched? No? Then I can’t do anything.’ If … you don’t fit into this little cubby, then a surgeon won’t operate, and (operating) is what a surgeon does. A physiatrist is not going to approach your problem with a fixed set of solutions already figured out.” Physiatry patients are usually referred by primary care physicians. A candidate might have had a stroke, traumatic brain injury or spinal cord injury. Other physiatry patients
could suffer chronic pain from a sports injury, car wreck or work-related accident. Patients with difficult-to-identify diseases such as chronic fatigue syndrome or fibromyalgia may also be referred to a physiatrist. Dr. Viviane Ugalde, a physiatrist at The Center, says she was drawn to the specialty because it didn’t just focus on one system of the body, nor on one demographic. “It’s nice to see the whole spectrum across the life span,” she says. For Carroll, it comes down to this: “The thing that gives me the most satisfaction is when a patient comes to me and says, ‘I can do something now that I couldn’t do before.’” •
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Sorting it out | HYPOTHERMIA
Surviving the cold The cold, hard facts about hypothermia BY BREANNA HOSTBJOR
I
f you live in a cold climate — and Central Oregon winters certainly qualify as cold — there’s a strong possibility you will one day experience hypothermia, if you haven’t already. That doesn’t necessarily mean you will be near death and in danger of losing digits to frostbite, though. If you’ve been outside long enough to shiver and have your teeth begin to chatter, you’ve had mild hypothermia. Nevertheless, hypothermia is a serious medical condition, especially as it advances. Here is a guide for preventing extreme drops in your core temperature, and tips for recognizing and treating hypothermic stages. The best defense against hypothermia is to be savvy about winter conditions.
1 Avoid severe cold. Use common sense and come in out of the cold, if you are able. Be prepared for the weather by wearing layers and a hat. Drink warm liquids to heat your core, and have access to shelter or know how to make it in case you become stranded outdoors. Travel in groups if possible so you can help each other in an emergency and so body heat can be shared.
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2 Stay dry. “The easiest way to get hypothermic is to get wet,” said Dr. Chris Richards, a physician in the St. Charles Bend ER. Because you lose body heat much faster when sodden, do what you can to stay dry and remove damp clothes as quickly as possible. Once free from wet clothes, be sure to pat skin dry instead of rubbing it vigorously, as rubbing can send cold blood to your core faster, dropping your temperature.
Stage 1: Mild Core temperature: 95 to 89.6 degrees Fahrenheit. Your skin becomes cold to the touch, shivering may be intense and you may have trouble speaking clearly. As this stage advances, you may become drowsy and uncoordinated. • In this initial phase, your body takes physiological steps to warm itself. Shivering, for example, is a form of muscular activity that generates heat. The hairs on your arms stand up and trap air, warming it as insulation. The blood vessels constrict, minimizing the flow of warm blood to the extremities and keeping it near internal organs. • Mild hypothermia can be treated by going indoors, getting dry, drinking warm fluids and sitting in front of a heat source. If you’re stuck outdoors, curl into a ball, sitting upright.
3 Don’t wear cotton. If you plan to go outdoors, avoid wearing cotton, because it will stay soaked and cold against your body. Wool is a good alternative, as is fleece. And if you have an outer shell that repels water and can keep you dry, all the better.
HIGH DESERT PULSE • FALL / WINTER 2010
Stage 2: Moderate
Stage 3: Severe
Core temperature: 89.5 to 82.4 degrees Fahrenheit. Your skin becomes colder and loses more color, your face may swell, eyes become glassy, shivering will likely stop and you won’t complain of feeling cold. Breathing may become shallow and slow. Speech becomes difficult, reflexes are impaired, and you may fall into a stupor. You may also start removing clothing because your thought processes have become impaired. Your body has largely stopped compensating for the loss of heat.
Core temperature: 82.3 degrees Fahrenheit or lower. In this case, you are likely to be comatose and have heart problems. Your skin may turn blue and you may appear to be dead. Your kidneys may have shut down. Dehydration is possible and blood glucose levels will likely rise.
• As this stage progresses, the danger of frostbite becomes more pronounced. (Deep frostbite, which can result in loss of limbs, is more likely to occur in the final stage.) • According to Dr. Chris Richards, the transition from mild to moderate hypothermia might not be obvious to a layperson. But how well the brain works is a good guide for determining how aggressively rescuers should react to it. “Mild, you just need to come inside. Moderate, you need help to come inside,” he said. “If someone’s beyond the shivering stage and they’re confused, you need to see us, because other things start to happen.” • At this stage, your bodily systems may have begun to shut down, and you probably won’t be able to help yourself. You should not be given warm liquids if you are unresponsive because it could cause you to choke. Instead, the focus should be on bringing you somewhere warm and getting you to the emergency room as soon as possible.
4 Avoid alcohol. Though it may feel as if alcohol makes you warmer, don’t drink before heading into the cold. Drinking alcohol impairs your judgment and may prevent you from realizing just how chilled you are. Alcohol also dilates the veins, which interferes with the vein-con-
striction response the body uses to cope with heat loss, so drinkers actually lose heat faster.
5 Help the young and old. Special care should also be taken with children and the elderly. Kids will stay out play-
• Anyone this cold needs immediate medical attention so that warm fluids can be given intravenously and physicians can use dialysis or heart bypass machines to warm the blood. Special warming blankets, heated pads and other devices can be used to revive you, but you must be brought to the emergency room as quickly as possible. Rescuers should be gentle, because violent and sudden movements with an extremely cold individual can cause cardiac arrest.
ILLUSTRATIONS BY ANDY ZEIGERT
ing in the cold even when chilled, and the elderly are less able to recognize and respond to drops in temperature, often because they have other medical issues. Even the best-prepared can find themselves stuck in the cold. See the stages above so you know how to respond. •
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Pop quiz |
CALORIC CONSEQUENCES
Working it off after you’ve eaten it up
Burn the binge
A
BY ALANDRA JOHNSON
T
he holidays are fast upon us, which means the chance to indulge in our favorite holiday treats approaches. Whether it is pecan pie for Thanksgiving, potato latkes for Hanukkah or the homemade chocolate chip cookies left out for Ole Saint Nick, we all have our favorites. But just how much are those tasty morsels costing us calorie-wise? How much exercise would it take to burn off these holiday snacks? We took a look at the average calories for some dishes; now, you pair them with local workouts. •
FOOD 1
3 potato latkes with 2 TBS sour cream (676 calories)
2
1 slice of homemade pecan pie (503 calories)
3
6 oz of turkey breast with skin on (318 calories)
4 5
1 (4-oz) glass of Champagne (91 calories)
6
3 chocolate chip cookies and 1 C 2% milk (372 calories)
B
C
1 C mashed potatoes with ¼ C turkey gravy (284 calories)
FITNESS A Bike down Skyliners Road for 8.4 miles at an average 13 mph. B Cross-country ski around Wednesday’s Trail at Virginia Meissner Sno-Park (4.2 miles) at a rate of 3.5 mph.
C Run the Shevlin Park Loop Trail (about 4.5 miles) at 6 mph.
D
D Walk the 1.1-mile Mill Loop A in the Old Mill District at 3 mph. E Swim laps at the local pool for 35 minutes. F Hike Pilot Butte. All exercise calorie measurements are based on a 160-pound person. Information comes from the Mayo Clinic, ProHealth, NutritionData, eatturkey.com and finecooking.com. FILE PHOTOS
Answers: 1.B; 2.C; 3. F; 4. D; 5. E; 6.A HIGH DESERT PULSE • FALL / WINTER 2010
E
F Page 33
Cover story | THE ALZHEIMER’S EPIDEMIC Continued from Page 13 There are more than 100 Alzheimer’s drugs in development. Nearly all of them function by blocking an enzyme called gamma secretase. This includes the Eli Lilly drug that was yanked from clinical trials this summer when it was found to worsen Alzheimer’s symptoms. Gamma secretase is an ingredient necessary for the brain to make beta-amyloid. In other words, these drugs are banking on the so-called “amyloid theory” of Alzheimer’s disease. To understand this theory, first picture a healthy adult brain. Start with 100 billion spiky brain cells, also called neurons. The spots where neuron branches touch each other are called synapses. Chemical and electrical signals flow through these synapses to form our thoughts and feelings and to control our bodies.
The amyloid theory
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The amyloid theory posits that Alzheimer’s dementia is caused by a toxic buildup of an amino acid chain called beta-amyloid. Beta-amyloid is actually a fragment of a larger protein called an amyloid parent protein, which is found in healthy brain cells. According to the theory, an overabundance of certain enzymes snips free the beta-amyloid, which then floats loose through the brain. Beta-amyloid gums up healthy synapses, blocking neural signals. When transmissions can’t flow through, the synapses die. Eventually, the whole neuron dies. As beta-amyloid builds up in the brain, it sticks together and forms clumps that are visible in some brain scans. These amyloid deposits begin appearing in the brain about 10 years before symptoms arise. Scientists used to believe that these deposits, called plaques, were what interfered with brain signals and caused memory loss, confusion and declining physical function. Now, doctors instead believe the plaques are a side effect that could be useful in detecting the disease. The smaller bits of freefloating amyloid, they say, are more harmful because they interfere with brain function and cause brain atrophy. Clinical trials that aim to reduce amyloid levels in patients’ brains are putting this theory to the test. But the news lately hasn’t been promising. In March, a study of an experimental anti-amyloid drug by Pfizer and Johnson & Johnson found no clear improvement in mental function. And in early August, preliminary results of a new drug by Elan showed that it, too, failed to help patients. Later that month, Eli Lilly cut short a trial of its anti-amyloid drug when patients on the drug were found to be declining faster than patients taking the placebo. Quinn and other researchers are quick to point out that just because these individual drugs aren’t working, it doesn’t mean the amyloid hypothesis is wrong. It’s possible, for example, that patients’ brains were already so atrophied by the time they took the drug that reducing amyloid could not reverse the damage. “In the next year or two, we’ll see … a more complete picture of the amyloid theory,” Quinn says. In particular, he’s waiting for
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HIGH DESERT PULSE • FALL / WINTER 2010
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Cover story | THE ALZHEIMER’S EPIDEMIC
Can I do anything to prevent Alzheimer’s disease? Doctors say the best thing you can do to reduce your risk of Alzheimer’s disease is stay as physically healthy as possible. In particular, get regular cardiovascular exercise and eat sensibly. High blood pressure, high cholesterol, diabetes and a sedentary lifestyle are all correlated with higher risk of Alzheimer’s disease, although there is no proof that these conditions actually cause Alzheimer’s disease. In fact, some recent data suggest that people who stay in good shape aren’t any less likely to get Alzheimer’s disease, but they do appear able to stave off symptoms for longer. In other words, the brains of people who are physically fit may be able to somehow compensate for the pathological damage wreaked by Alzheimer’s disease. The bad news is that when the disease progresses to advanced stages, no amount of physical fitness has been shown to overcome the damage to the brain. “The good news is, these recommendations (to stay in shape and eat well) are also good for everything else,” says Dr. Joseph Quinn, a neurologist at Oregon Health & Science University. “So even if it turns out that you’re not lowering your risk of Alzheimer’s, they can’t hurt.”
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results of an immunotherapy trial that introduces an intravenous antibody aimed at reducing amyloid levels in the brain. “It’s the most controlled and robust strategy out there,” Quinn says. “And there are a number of reasons to be confident that it really is removing amyloid from the brain, which is not as certain in the cases of some of these other drugs. … And then the multimillion-dollar question is, well, did it do the patients any good? Did it slow their decline?”
A study in our own backyard Not all Alzheimer’s research hinges on the amyloid theory. In fact, one new study with a branch here in Bend has nothing to do with amyloid. Lynne Shinto, a naturopath at OHSU who specializes in neurology, is leading a study that analyzes the effects of fish oil and lipoic acid on Alzheimer’s patients. “For this study, the whole amyloid theory doesn’t really affect anything, and in fact, I think it makes me a little more excited,” Shinto says. “I never thought that was how these supplements were working, by reducing amyloid. It’s probably something else, and maybe our study can help (explain) what’s happening.” During her medical fellowship, from 2001 to 2003, Shinto read a couple of epidemiological studies that found a 40 percent lower risk of Alzheimer’s disease — and dementia in general — among populations that ate more than one serving of fish per week.
HIGH DESERT PULSE • FALL / WINTER 2010
“To be clear, (the studies’ results) are not causal,” she says. “They are not saying that because people eat more fish they avoid Alzheimer’s.” But Shinto couldn’t help wondering: Could eating fish help? “I thought, ‘Well, what would happen if you gave a fish oil supplement to Alzheimer’s patients?’” she says. She obtained a grant to follow 39 patients over one year. The results were promising, so she recently secured another grant from the National Institute on Aging to perform an expanded trial. This time she will follow 100 patients for 18 months. Half the participants will take a supplement that is a combination of fish oil and lipoic acid. The other half will take a placebo. The participants and the physicians treating them will not know which they are taking. Over the course of the study, scientists will track patients’ disease progression. They will monitor inflammation of the brain, for example. Some emerging theories of Alzheimer’s disease point to inflammation as a possible factor in cognitive loss. Another test will track patients’ daily functions, such as the ability to take a shower, get dressed and go grocery shopping. These are not things that most Alzheimer’s studies gauge. “That’s really big stuff,” Shinto says. “That’s what you want to keep patients from losing.” Her hope is that if even a small behavioral benefit is detected, accompanying physical data — brain scans and blood tests — could help scientists understand what the fish oil and lipoic acid did, thereby gleaning more information about the disease. Kolisch, of BMC, will oversee an arm of the study here in Bend. She will accept 10 to 15 participants with Alzheimer’s disease, none of whom may eat more than a small serving of fish per week.
Making the most of it When one person gets Alzheimer’s disease, it affects the whole family. So as baby boomers age, more Americans will have to cope with an Alzheimer’s diagnosis. The Alzheimer’s Association estimates that Oregon will see a 93 percent increase in Alzheimer’s cases by 2025. And everyone — even the lucky few whose families manage to avoid the disease — will end up footing the bill. Medicare and insurance premiums will likely rise to pay for this growing population. The costs of Alzheimer’s care can add up quickly. A shared apartment at Aspen Ridge, for example, starts at $4,000 per month. “We have higher staffing ratios than other (facilities) because patients’ needs are even greater here,” says Alexander, who adds that about 90 percent of residents are incontinent and 5 percent must be fed. Most Alzheimer’s patients end up in residential facilities. In 2006, two-thirds of the Americans dying of dementia died in nursing homes, compared with 20 percent of cancer patients and 28 percent of people dying of all other conditions, according to the Alzheimer’s Association. Experts estimate that about 5 million Americans have Alzheimer’s disease, and 11 million people take care of them. In 15 years, 17.6 million
HIGH DESERT PULSE • FALL / WINTER 2010
Melanie Embree kisses her mother, Christa Forsyth, goodbye. Forsyth’s Alzheimer’s disease is quite advanced, and she rarely opens her eyes after breakfast in the morning.
people could be needed to care for the estimated 8 million patients. Frustrated by a lack of awareness about Alzheimer’s disease, as well as the government’s relatively low level of research funding, Embree has become an activist. One of her messages is that the disease doesn’t have to be all doom and gloom. After her diagnosis, Embree’s mother became more physically demonstrative, wanting to hold hands or hug, which she rarely did before. “At first, it was weird. It didn’t seem like my mom,” she says. “But then I embraced it. … I called my brother, who lives on the East Coast, and I told him, ‘You’re missing so much of the good part of all of this.’” Embree says she became determined, soon after her mother’s diagnosis, that “something good has to come out of this.” Aware that she faces an increased risk of Alzheimer’s disease herself, Embree has redoubled her efforts to stay in shape and eat right. She declined to undergo genetic testing because she decided there is no use until there’s a cure. Meanwhile, she is no longer content to put her dreams on hold. She hiked Machu Picchu last year and is planning a bicycle ride through Spain. Alexander says that’s the lesson from Alzheimer’s patients. It’s also her preferred approach to this so-far-untreatable disease. “The truth is, they’re not going to remember what they did five minutes ago and they’re not going to think about what they’ll do five minutes from now,” she says. “They live completely in the moment. So we need to make sure their days are full of as many moments of joy as possible.” •
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One voice | A PERSONAL ESSAY
Eating for two’s never been tougher BY ALANDRA JOHNSON
W
hen I was younger and didn’t know much, I looked forward to getting pregnant for one reason (other than that whole creating-life thing, which seemed pretty cool): I would finally be able to eat whatever I wanted. I could finally stop counting calories and binge. I would eat at buffets and not worry about how I looked. It would be glorious! Now that I’m pregnant for real, I can see what a dolt I was. Instead of having free rein, I am even more bound and restricted, just in new and more seemingly random ways. I went into this pregnancy knowing I wouldn’t be able to eat and ROB KERR drink everything. No drinking, no smoking — those were givens. I knew I couldn’t eat sushi and knew soft cheeses would be a no-go. Beyond that, I didn’t know too much and, frankly, I feel slightly duped. First of all, there’s the quantity issue. Nowadays gaining too much weight is a big no-no during pregnancy. And then there is the list of “bad” foods. Nearly every week I learn about some new thing I’m not supposed to consume because of a wee chance it could do irreparable and insanely damaging harm to my little bundle. During my first trimester, food restrictions weren’t an issue. That’s because I didn’t want to eat anything. Subsisting on a diet of apple sauce, refried beans, corn chips and yogurt seemed perfectly acceptable. But once the second trimester hit and my sickness lifted like a fog, I was left with a big question mark. What do I eat now? I heard rumors about restrictions on deli meat and of potential dangers lurking in soft-serve ice cream machines and was sad to learn they were true. I took the news about soft serve really hard. Summer had just hit and a long-wished-for frozen yogurt place finally opened.
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Naturally, as soon as I knew I couldn’t eat these items, they were all I could think about. But at least these restrictions are relatively easy to follow. When I recently learned I should avoid raw or undercooked eggs, I didn’t worry. I like my eggs scrambled. Then I realized these buggers show up in all sorts of delicious foods that I totally crave, from lemon pie to Caesar salad dressing to homemade mayo. To top it all off, my co-worker had to go and write a story about the lack of iodine in our diets and how vital it is for pregnant women to get enough iodine. What?! I just sighed and thought, “Add it to the list of stuff I never knew and now get to worry about.” My biggest blindside happened the very day I read a report about licorice. Turns out researchers think a component in licorice, called glycyrrhizin, may allow stress hormones to cross into the placenta. The study showed that moms who ate a lot of licorice were more likely to have kids with a whole host of issues, including brain and behavioral problems. Serious stuff. So what happens that night, to this black-licorice-loving pregnant lady? My doting father, who came for a visit, brought me some of my all-time favorite candy treat — a bag of homemade black jelly beans from a shop in McKenzie Bridge. I gave him a kiss on the cheek and said thanks, but I knew I couldn’t eat them (though I didn’t tell him that). They smelled and looked great in all of their inky anise glory. I knew I could probably eat a couple without harming the baby, but it just didn’t feel right. This whole food-eating conundrum brings out my least favorite personality traits — my worrying, meddling and slightly obsessive side. I know many pregnant women don’t follow all the “rules.” I am not saying all the rules should be followed or that I am doing the right thing by following them. Frankly, I thought I would be more relaxed and less of a rule abider. I have no idea what happened. I just know, for me at least, I don’t enjoy eating the items once I know they are supposedly “bad.” Once that bit of knowledge has seeped into my brain, it’s as if it has grown mold. I still want to eat it, but I just know it won’t taste good. Of course, I know that all of my complaints are really petty. And the sacrifices, while totally annoying right now, are pretty small. I know this. And I know when I see my baby, all of the things I’ve denied myself will vanish from memory. But, while knowing this, I also look forward to the day I can eat that bag of black jelly beans I’ve got stashed away. They’ll go perfectly with a mug of beer and a turkey sandwich. •
HIGH DESERT PULSE • FALL / WINTER 2010