Pulse Magazine Fall/Winter 2013 by Western Communications, Inc.

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The mind-bending science of synesthesia

Contents ~ HIGHDEsERT PULsE

COVER STORY SYNESTHESIA When the brain sees sound or hears color, and what we can learn from it. •

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FEATURES PAIN 14 BACK Overtreating routine back pain is costly and ineffective.

DEPARTMENTS UPDATE Since we last reported.

22 JOB St. Charles NICU therapist Karlee Dunn helps parents and babies adapt to their new world. 26 GEAR Headlamps make the night less dark. 28 PROFILE Jason and Chelsey Magness push yoga to the extreme.

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EATING 34 HEALTHY Holiday feasts need not be unhealthy. 36 SNAPSHOT Winter swimming READY 38 GET Indoor soccer makes great practice and a great

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QUIZ 53 POP Fun flu facts 54 ESSAY Life lessons from an octogenarian. COVER DESIGN: ANDYZEIGERT CONTENTSPHOTOS,FROMTOP:ANDYTIJLLIS,JOEKLINE,JOEKLINE,RYANBRENNECKE

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Coverstory ~sYNEsTH EslA

Synesthetes see sound and hear color, among myriad sensory signaI crossings. How does it happen? And what does it tell us about the brain? BY MARKIAN HAWRYLUK

ometime in high school, Torree Abrams discovered for i n dividuals who for years were ridiculed into silence may help thefirsttimethatnooneelsearoundherheardcolors. un r avel the more debilitating neurological disorders of our "Oh, not everybody thinks the upper keys of the piano t ime. "It's ultimately a basic science question," said Dr. Steffie are hot pink? Or that middle C has this blue color?" she recalls realizing. Thomson, a synesthesia researcher at the Univer"It's not harmful Sounds had always elicited colors for her — the Sy n e S t h e Si a sity o f California, Los Angeles. sound of someone's voice or a bird chirping. Any kind of noise produced a consistent and predict-

able hue in her mind. It wasn't until college that she learned the trait was known as synesthesia, a blending of th e senses in which people taste shapes, smell colors or see sounds. For years, such claims were discounted as vivid imagination, mental illness or mere deceit. But in recent decades, scientists have demonstrated without a doubt that synesthesia is

n . 1Physiol. sensation felt t hat w e k n ow of in any way, but it gives us an i n one part ofthe body idea o f what's going on in the brain." when another part is stimuA fift h - grade teacher at Lava Ridge Elementary l a ted2 Psychol.a process in School in Bend, Abrams, 50, had to learn to inwh i chonetypeofstimulus hi b i t her synesthesia. "It's just too much sensory (overload)," she p r oducesasecondary,subj e ctivesensation,aswhen said . " Especiallybeingateacher,youcanimagine s ome color evokes a specific i f I tune in and every kid's voice is coming at me s mell —syn es the ticadj. as a color. I would probably go insane."

The colors tend to emerge when she's relaxed a legitimate phenomenon and that it might not be as abnormal or less inhibited. A drink can get the colors flowing. "I can just enjoy it as a sidelight to music," she said. "If I as it sounds. The unique traits of synesthetes, who may represent any- r eally try, I can just close my eyes and it can become a symwhere from I to 5 percent of the population, have become in- phony of colors." valuable research windows into how the brain is wired. Now Cac o phonous, grating sounds for her result in bright

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Cover story(SYNESTHESIA

white lights. Clear rich voices have deeper jewel-like hues. A blue be tested and started working in the lab. Eventually, she went to jay in her backyard is orange or red. A certain reporter's questions graduate school at Baylor, studying neuroscience, and worked as come through as greenish-yellow with splashes ofaqua blue. She's Eagleman's graduate assistant. Now conducting her own research, noticed that her taste in music tends to run toward the green and she sees the sense of relief in synesthetes when their stories aren't blue sounds. met with the usual skepticism of the non-synesthetic. "Elton John, I like a lot. When he's just playing the piano, for some Over the years, many scientists have discounted grapheme-color reason, I access it prettyeasily," she said."I like a lot ofblues; grav- synesthesia as a memory of the colorful Fisher Price letter refrigelly, lower-register singers." erator magnets that were popular in the 1970s. They disregard the fact that grapheme-color synesthesia was first described more than 120 years ago, well-before the invention of the home //C" First described in medical literature in the 19th SiXiSafemale. refrigerator, muchlessthemagnets. Yetfortheother 90-some percent without synesthesia, many of the century, more than 150 different types of synesthe/ I h sia have been identified. While the traits are idiosynY Y more e x otic forms can be difficult to accept as real. cra ic — each synes he e has his or her own speci ic $hpi$ IjU$$100k response to a given stimulus — there are many com-

N ine is arrogant

monalities in the way synesthesia is expressed. atSiXand that s It is almost always unidirectional — a sound may h trigger a color, but that color won't trigger the sound. h While there are some exotic versions, most synes- lgpg Nl'gplg thetes fall into common groups. Nearly two-thirds

of synesthetes have grapheme-color synesthesia, in VeryarrOgant, which every letter or number elicits a specific color, P ~ ~IY g Y' regardless ofits actual color. "It's automatic and it's consistent," said Thomson, El'ghpcOm~~ who is herself a synesthete."If I said my 8 is orange, it's orange today, it's orange tomorrow and it will be aCrOSS aS a muCh orange six months from now. It's become a property of that letter. It is not, 'Oh, I can imagine it could be blue.'It's notwhetheryoucanimagineit, it's whether

that 8 has the color.Just like if I asked you what color

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a banana was. It is yellow and it will always be yellow Ife ight Were for you." Thomson doesn't really know how or when letters or numbers took on colors for her; she can't ever re aStory,elg member a time they didn't. In second grade, she had been trying to recall how to spell a word, and blurted WO u ld be a out, "Oh, it's spelled with a T, because it's yellow." g Her classmates looked at her as if she were crazy, P and she quickly learned not to mention it again. Nathan Weisberg "You don't realize you have it until you realize that

nobody else has it," she said.

synesthete

Natha n Weisberg, 21, was diagnosed with Asperger's syndrome when he was 9. A few years ago, he stumbled upon a description of synesthesia, which he thought was fascinating. But it never occurred to him that he might have it.

"The description of synesthesia that I was reading about was entirely obvious," he said. "People who perceiv ed sound as color, or taste tactile-ly, and of course, I didn't have anything like this." Like Abrams and Thomson, it was in college, in a bra i n and behavior class at Lewis 8 Clark College in Portland, that Weisberg heard a presentation by another synesthete in which she described one form in which a person associates personalities with numbers, letters or days of the week. For Weisberg, numbers had always had personality traits.

"Six is a female," he said."I can't say why she is, I just look at six and that's the sense that I get. Nine is

very arrogant, probably a guy. Eight comes across as a much nicer fellow, a stand-up person. If eight were a character in a story, eight would be a protagonist." There's no rhyme or reason behind the associations — Weisberg doesn't have any stories to describe why those numbers have such character traits. It's the same for letters.

"They never change. They're very universal, very she saw a flyer with the word 'synesthesia' written in capital letters consistent over the years," he said. across the top, with each letter in a different color. They all seemed W e i sberg had always assumed that the associations were a feawrong to her. ture of his Asperger's, and since he tried hard to cope with the "My S might be red and P might be purple, but for any other syn- other symptoms, he dealt with his synesthesia as just another abesthete, it's unlikely to be the same colors," she said. "So when I see normality to stifle and keep under control. "So I chose to ignore it and not talk about it," he said. the word synesthesia come out in all these colors, I immediately know that that's wrong." The associations don't help or hinder him in any way. On occaTheflyerwasthecreationofDr. DavidEagleman,aneuroscientist sion, when having to choose a number, he'll choose one with a at the Baylor College of Medicine in Houston and one of the fore- more amiable personality, an eight or perhaps a three or a four. most synesthesia researchers. Thomson went to Eagleman's lab to W e i sberg doesn't usually talk about his synesthesia with others. As a college student at Rice University in Houston,

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Covert story) SYNESTHESIA

"It wasa tool I used.Whenyou learn how to count, youcountall the time, and you don't really thinkabouthowcounting affects yourlife. Andso,it'soneofthose things, I would usemy synesthesia tohelpmeorganizemy life." — Dr. Steffie Thomson, synesthete and synesthesia researcher

Living with Asperger's, he knows many people will treat him differently, even if synesthesia doesn't rise to the level of a mental illness. "I definitely worry about telling people I have it because they might think I'm making stuff up," he said. "But I think we're becoming more accepting of mental disorders and mental disabilities in general, instead of a knee-jerk reaction that it must be the fault of the person's family or the person himself." The number-personality form of synesthesia is well-documented, and descriptions of personalities in some cases can go on for two sentences. They're often tremendously detailed and remarkably consistent over time. That's true of many forms of synesthesia. One synesthete reported that a certain musical note had the taste of an orange, but a not-quite-ripe orange. When researchers set up a color palette with more than 16,000 choices, some grapheme-color synesthetes complained they still couldn't find the exact right color they see. The more researchers look for and study synesthetes the more associations they find. One synesthete documented in research associated sounds of words with tastes. The name Derrick or Eric produced the taste of ear wax in his mouth. A woman described the problems her son was having in school when the sound ofhis teacher's voice induced a nauseating taste in his mouth. The principal was less than sympathetic when she told him the teacher's voicewas making her son sick. One well-described synesthete had taste-tactile association. Eating chicken would produce a feeling of holding a spiked object in his hand. Another associated tastes with colors. When his wife left,

AGNIJITAKUMAR/DAILYBRUIN

Dr. Steffie Thomsonis a grapheme-color synesthete and a synesthesia researcher at the University ofCalifornia, Los Angeles.

making it up. When researchers showed test subjects clips from "Sesame Street" in black and white, the areas of their brains that

process color lit up in synesthetes, but not in controls. That region, known as V4, is located adjacent to the region responsible for letter and number recognition. That proximity might help explain why grapheme-color synesthesia is the most common form. The MRI scans, for the first time, showed visual proof that what

synesthetes described was actually happening, but it was hardly the first conclusive evidence that synesthesia was real. "The hard-nosed skeptics got the pictures they wanted, but it was always easy to prove synesthesia by simpler means," Dr. Richard Cytowic, a neurologist from Washington, D.C., and author of "Wednesday is Indigo Blue," said recently at a Library of Congress lecture. Those means include masking tests where a letter or number is surrounded by other letters or numbers. It may take non-synes-

he would eat a chicken breast topped with vanilla ice cream and orange juice, a recipe for a plate of the most wonderful blue colors. "It's because of phenomena like that that synesthesia was ignored for a long time," Dr. Vilayanur Ramachandran, a synesthesia researcher at the University of California, San Diego, said in a podcast for the online journal PLOS Medicine. "Peoplecame offas thetes some time to find the letter in a sea ofblack text, somewhat flakes. Red is bizarre enough. Five being female — and a jealous like a word search puzzle. For synesthetes, who can quickly scan female — is even more bizarre." for the color associated with that letter, it's an easy task.

Proving the claim In recent years, imaging tests like functional MRI, with a little

help from the Cookie Monster, have shown that synesthetes aren't

Page 10

In tests that resemble color-blindness tests, a synesthete might

be asked to identify the pattern formed by a triangle of twos in a sea of fives. Seeing those numbers as different colors makes the task child's play.

FALL/ WINTER 2013• HIGH DESERTPULSE

Even before advanced imaging could prove synesthetes had a blending of senses, researchers were able to devise simple tests to prove synesthesia was a real phenomenon.

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I The Stroop test

The Stroop effect, first described by John Ridley Stroop in 1935, is a demostration ofhow conflicting sensory input affects a person's reaction time. When the name ofa color is printed in a different color, naming the color ofthe text takes longer and is harder to do accurately. n this example, it takes longer for someone to identify the color of the word red as being green.

red green blue yellow red green blue yellow red green blue yellow red green blue yellow Researchers can use the Stroop test to determine whether synesthetes really do associate a letter or number with a certain color. Ifa synesthete sees a 2 asred and a 5 as green, it's easyto identify the colors in the first sequence of numbers, but much hard in the second sequence where the numbers and colors don't correspond.

If 2 induces and 5 induces ~

sequence1 is easy

sequence 2 is hard

Pop-outs Pop-out tests can also identify true synesthetes. When a non-synesthete looks at the series of fives and twos in black and white, it takes a while to figure out what shape is formed by the twos.

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5 5 5 5

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For a synesthete, who sees fives and twos in different colors, the numbers will pop out and the pattern is quickly identified.

5 5 2 5

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Source: Daphne Maurer, McMaster University

HIGH DESERT PULSE â&#x20AC;˘ FALL I WINTER 2013

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Cover story(SYNESTHESIA

The 'Sesame Street' test

With its regular use ofletters and numbers, "Sesame Street" has been a great resource for researchers studying synesthesia. When non-synesthetes watch Cookie Monster and his friends holding letters or numbers, both the color and grapheme-recognition areas ofthe brain are activated. But when synesthetes watch the same "Sesame Street" clips in blackand white, the color regions of their brains are still activated.

Researchers also use Stroop tests, which rely on competing formation. Synesthetes generally test better on memory tests than stimuli to make a task more difficult. The classic Stroop test uses others, and color synesthetes usually have better color vision than different color fonts to write out the names of colors. When the non-synesthetes. word "red" is printed in red, it's easy to identify the font color or to Abrams said hersound-color synesthesia helped when she was a read the word. When the word "red" is printed in blue, both tasks child learning to read. She often listened to recordings of children's become more difficult, reaction time slows and the test subject's stories, following along with the written text in a book. She soon pupils dilate. learned that a short "a" sound, as in the word "apple," came through For grapheme-color synesthetes, Stroop tests are particularly as a soft yellow. A long "a" as in "age" was a brighter yellow. "Vowels are very hard for kids," the elementary school teacher challenging. It takes longer for them to identify the name of the color even when written in black, because the letters they see have said. "It helped me make those distinctions." other color associations. The test can be modified for other forms Abrams also has color associations with single-digit numbers of synesthesia, including sound-color associations. A test subject and said those helped her to learn place values. might be asked to identify a color flashed on the screen while a What's your superpower? note associated with a different color is played. Stroop tests show the strongest effect when then the real-world Many grapheme-colorsynesthetes also have a second form and synesthetic colors are opposites on the color wheel. known as time-space synesthesia, in which they experience units Researchers also test synesthetes by the consistency of their re- oftime —such as hours,daysorm onths — as occupying a specific sponses. True synesthetes are 92 percent consistent on their as- spacearound them. Thomson, forexample,visualizesdays ofthe sociations, even when retested up to a year later. And even their week in an oval that rotates around her. The present day is always misses are generally near-misses — say a different shade of the directly in front of her, yesterday to her left, and tomorrow to her same color — rather than a completely different color. right. Each day the oval rotates one spot. Non-synesthetes, on the other hand, can manage only a 38 perTime-space synesthetes often associate colors with the days of cent consistency from test to test, even after being told they will

be retested. In multiple studies of hearing-color, grapheme-color, time-space and word-taste synesthesia, even the lowest synesthete scores were higher than the highest non-synesthete scores. At times, the associations can be difficult or overwhelming for synesthetes, particularly in a world that assumes that senses operate independently. In other cases, synesthetes have learned to use the associations to their advantage. Thomson described a newspaper editor who could quickly pick up misspelled words because the colors of the letters were wrong. Others use their associations to help organize their lives or remember important in-

Page 12

the week or months of the year, and often important dates in their lives take on different colors within the months.

"It was a tool I used," Thomson said. "When you learn how to count, you count all the time, and you don't really think about how counting affects your life. And so, it's one of those things, I would use my synesthesia to help me organize my life." The color scheme makes it easier for her keep track ofher schedule each week or what's happening in various months of the year. "I can plan a lot in my head," she said. With estimates of up to 5 percent of the population having some form of synesthesia, it's unfathomable that anyone hasn't come

FALL/WINTER 2013• HIGH DESERTPULSE

acrossa synesthete. Yetfew people have heard of the phenome- For example, ifasked to choose, most non-synesthetes would non. Researchers say that's in part because synesthetes have often associate the letter A with the color red, perhaps because is A is for been ridiculed as children and therefore don't seek out attention apple, and apples are stereotypically red. The letter G is most often for their "super powers." associated with green — G is for green and grass is green. Thomson says the lack of recognition has stymied research efM a u rer conducted studies with toddlers, who didn't know letforts and made securing funding for synesthesia research almost ters or words. They didn't have the correlations that are based on impossible. literacy (A for apple or G for green). Yet, there was a high degree "It's just very hard to get it funded," she said. "Nobody knows of correlation between letters and colors they chose. The letters, I about it. It kind of sounds like this project for an undergrad — ah, and 0, were usually white, while X and Z were black. C was genercolors and numbers ... great." ally yellow. That's also left researchers more questions than answers about Similarly, when shown white and black balls, accompanied by the causes of synesthesia and its various forms. Synesthesia does a high-pitched "ping" sound or a low-pitched "pong" sound, todrun in families but can occur only in one member of a family. That dlers invariably associated the white ball with the higher-pitched suggeststheconditionmightcausedbyageneticmutation. Ifit'sa s o und and the dark ball with the lower-pitched sound. Maumutation that is selectively expressed — that is, affects some por- rer said such associations could be the remnants of our infantile tions of the brain rather than others — that could explain why syn- synesthesia. "We normally inesthesia comes in so many different forms. hibit them. we don't

Wlth estimates ofup to 5percent ofthe population having some form ofsynesthesia,it's unfathomable thatanyone versity in H a milton, hasntc omeacrossasynesthete Pptfevvpeopiehaveheard Canada, synesthesia re-

white whenever we see an I printed in black.

searcher Daphne Mau- OfthephenOmenOn. ReSearCherSSaythat'SinpartbeCauSe

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synesthetes haveoften been ridiculedas children and hereforedon'tseekoutattentjon forthejr superpovyers."

prevailing theories for when we see a c printhow a mutation might t ed in black," she said. "So these connections result in synesthesia. One posits that infants are born with myriad cross-connections are being inhibited, but they remain as cross-modal influences on between different regions, or cortices, of the brain. our associations. "Initially, these sensory cortices are not so specialized as they are going to become in adulthood," she said. "Instead there are transient connections between cortices that are going to get pruned Th eliterary-based connections also suggest that learning has a away during development." key role in synesthesia. Researchers have documented this even The working hypothesis, she said, is that in people without syn- with taste synesthesia. The word April might taste like apricots, esthesia, and to some extent in people with synesthesia, those or the name 6arbara like rhubarb, but it seems unlikely that such connections get pruned away by experience. 6ut in synesthetes, associations would happen unless the individual knew the word whether due to a genetic mutation or another reason, not all of

a p r i cot and notjust the taste.

those connections disappear, so different regions of the brain reTh e se types of associations occur with other languages as well, mained connected. even with Chinese characters that represent entire words rather A second theory, she said, suggests that higher cortical function than simply letters. With grapheme-color synesthesia, learning obareas of the brain provide feedback to lower cortical function ar- viously plays a key role. "This is almost certainly necessary, since no alphabet, no syneseas. That feedback then reinforces signaling pathways appropriate to each sense, while inhibiting the others. In synesthetes, the theo-

t h e sia," said Stanford University researcher Nathan Witthoft."But

ry goes, the inhibiting mechanism is interrupted, allowing cortices beyond that, we think that there is something about the process of to be stimulated by the other senses. learning the sequence which is conducive to synesthesia." In bothcases,however, synesthesia isn'tso m uch a defect,Mau- Many forms of synesthesia involve some sort of sequence or rer said, but simply one way that normal developmental mecha- ordering: letters, numbers, days, musical notes. The associations nisms can play out. It's possible that many of those cross-connec- often show influences of frequency (more frequent letters may be tions still exist in all of us, albeit to a lesser extent. brighter or richer in color), place in the sequence (A is almost always Maurer points to various examples of synesthesia-like associa- red, the first color in a spectrum) and language (Y is often yellow). tions in the general population, including trends in grapheme-color Th a t suggests that some sort of learning is involved. Witthoft synesthesia that are found in non-synesthetes as well. and fellow researcher Jonathan Winawer further tested the theory Continued on page 42 HIGH DESERT PULSE • FALL/WINTER 2013

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John Kelley, athis homein Crooked River Ranchin August, has hadseveral diagnoses and treatmentsfor back pain. The most recent treatment — an epidural steroidinjection — resolved his pain so hecan drive his tractor again. ROB KERR

You're not alone. But expensive tests and surgeries might not be the answer, despite their popularity. BY ANNE AURAND

vidence-backed guidelines say the best way to improve routine back

costs and questionable effectiveness. Back pain is notoriously prevalent, poorly

pain is with over-the-counter pain re-

understood and difficult to treat. But one

lievers and exercise therapy. But back pain management has increasingly defied such clinical guidelines, turning instead to advanced imaging tests, narcotic drugs and surgery, which come with health risks, high

Page 14

cal or psychological benefits to those with routine back pain.

A snapshot ofback pain

thing has become clear: Inappropriate care for back pain exacerbates health care costs. Back pain is the fifth most common reaAnd for what? Research says surgery doesn't son people visit doctors in this country. significantly improve pain, and that ad- More than 10 percent of all visits to primary vanced diagnostic imaging provides no clini- care physicians are related to back pain,

FALL/ WINTER 2013• HIGH DESERTPULSE

according to the study "Worsening Trends

Treating back pain

in the Management and Treatment of Back

Researchers have found an increase in the use of treatments that are not in line with current guidelines for treating routine back pain, including the use ofadvanced imaging (CTscans and MRlsreferrals ), to other physicians (for procedures including surgery) and the use ofnarcotics. These treatments have been shown to be less effective and more expensive and risky than the use ofnonsteroidal anti-inflammatory drugs and physical therapy in treating routine back pain.

Pain," published in the Journal of the American Medical Association Internal Medicine in July. Back pain accounts for about $86 billion in annual health care spending. Annual spending for back pain increased by 65 percent from 1997 to 2005 — more than overall

health expenditures increased during the same period, according to a 2008 study in the Journal of the American Medical Association. It said the average expenditure for those with spine problems was 73 percent greater than health care spending by those without spine problems. Expensive drugs, imaging tests, injections and surgeries accountedformost ofthe expense. Yet, the sources of and solutions for back pain often remain mysterious. Pains can be sharp or dull, stabbing or aching, anywhere from the neck to the low back. Some pains are probably sprains to ligaments and muscles. Some may stem from problems with the discs, the hard rubber-like shock absorbers between vertebrae, or from the facet

Popular treatments for back pain

•

19 9 9-2000 •

2009 - 2010

Computed tomograms (CT scans) and magnetic resonance images (MRI) Up 56.

Physician eferrals Up 106% Narcotic se

Up 50 8% Radiogra hs (X-ray technology) (Unchanged) Nonsteroidal anti-inflammatory rugs (NSAIDs) Down 33.6%

Physical therapy

joints between vertebrae. "For the vast majority, the cause of their

(Unchanged)

pain is unknown," according to a 2011 Dartmouth Atlas Report. Less than 10 percent of

back paincases can be connected to a disease or disorder, the report said. Lacking any "red-flag" symptoms that could indicate a serious disease like cancer, or conditions such as herniated discs and nerve damage, a patient is said to have nonspecific, routine back pain, for which treatment guidelines suggest over-the-counter pain relievers, exercise and time. "Most episodes of back pain go away in time with no treatment, even when the

pain is severe or when it persists for weeks or months," according to the Dartmouth report.

10%

20%

Source:"Worsening Trends in the Management andTreatment of Rack Pain," Journal of the American Medical Association Internal Medicine, July 2013

30%

40% GREG CROSS

Unknown causes More than 85 percent of back pain cases are considered "non-specific," meaning their causes can't be pinpointed. Only a tiny minority ofcases are attributed to a specific disorder, such as cancer, which accounts for less than 1 percent ofall back pain cases, or fractures, which are blamed for 4 percent ofback pain cases, or spinal stenosis and symptomatic herniated disc, which are present in about 3 percent and 4 percent ofback pain patients, respectively, according to "The Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society," published in The Annals of Internal Medicine in 2007.

Conservative care When Laura Spaulding, a registered dieti- wasn't going to consider surgery. u tian in Bend, started waking up with a sore l didn't feel like I had anything serious. lower back, she figured the pain stemmed I just thought it was getting progressively from some combination of being 46 years worse," Spaulding said. old, practicing martial arts and running. A therapist at Healing Bridge Physical She and her physician agreed that Spauld- Therapyassessed Spaulding and taught her ing could benefit from physical therapy. She to changesome movement habits — how didn't want to rely on ibuprofen, and she she climbs in and out of the car, how she

HIGH DESERT PULSE • FALL I WINTER 2013

holds her back during karate. Spaulding learned low-back strengthening exercises to do at home. All too often, patients are sent to physi-

cal therapyafter they've gone through back surgery and they have recurrent pain, said Allison Suran, owner of Healing Bridge Physical Therapy in Bend. Suran believes physi-

Page15

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cal therapy at the onset of back pain could discuss non-drug therapies such as chirohelp patients live better and avoid more practic care, acupuncture, massage and invasive treatments. Sometimes, magnetic yoga. resonance imaging (MRI) will discover a Routine back pain usually improves withbulging disc, for example, that is not ac- in three months under such guidelines. tually the source of the patient's pain. But However, the researchers found that the knowing that a bulging disc exists in one's use of NSAIDs shrunk from 36.9 percent to back cancreate fear,Suran said,and may 24.5 percent while narcotic use increased lead to injections and surgeries that were from 19.3 percent to 29.1 percent over the not called for. study period. Physical therapists screen patients for A recent analysis of other research red-flag symptoms — fever, weight loss, showed narcotics provide little to no benweakness,neurologic symptoms such as efit in resolving acute back pain and have numbness, bowel or bladder dysfunction, or no proven efficacy in chronic back pain. And, "43 percent of (narcotic-using back a history of cancer, spinal fracture or spinal cord injuries or surgeries — that might be pain) patients have concurrent substance indicative of something more serious and abuse disorders." The use of narcotics is would call for imaging and potentially inva- a public health crisis of its own: In 2008, sive treatments. Lacking those symptoms, overdoses in narcotics lead to an estimatphysical therapists just teach patients about ed 14,800deaths,more than cocaine and backand body mechanics,encourage them heroin combined. to be healthy and strong, and train them to Referrals for physical therapy remained move and exercise correctly, Suran said. unchanged during the study periodIt took about three weeks for this type of around 20 percent — but referrals to other therapy to help Spaulding. She realized she physicians grew from 6.8 percent to 14 had stopped waking up with a sore back. percent. Referrals to other physicians, ac"It's making a difference," she said. cording to the study's authors, likely repreDespite awareness that these conserva- sent an increase in advanced imaging and tive therapies can relieve back pain at less spine surgeries. expense, physicians frequently use more Between 1999 and 2010, researchers invasive and costly treatments. found the use of X-rays remained stable at 17 percent, but CT scans and MRI use inConcerning trends creased from 7.2 percent to 11.3 percent. Researchers from the Beth Israel DeaInappropriate use of advanced imaging, coness Medical Center found that between according to the study, provides no clinical 1999 and 2010, back pain treatment in- or psychological benefit to patients with creasingly defied evidence-backed clini- routine back pain. And it exposes people cal guidelines. The recent study in JAMA to more ionizing radiation. In 2007, a proInternal Medicine looked at the records of jected 1,200 additional future cancers almost 24,000 doctors' appointments for were likely created by the 2.2 million lumback problems. bar CTs performed in the U.S., according Researchers excluded cases with red- to one study. flag symptoms so they were only lookThe overuse of imaging, according to ing at non-specific or routine back pain the study, is "almost certainly" related to — situations for which MRI and computed an increase in spinal surgery, something tomography (CT scans) are not recom- that patients with routine back pain should mended. The Oregon Health Authority's generally avoid. evidence-basedguidelines on back pain Studies about the effectiveness of back management suggest treating non-specific surgeries are conflicting and inconsistent. back pain with nonsteroidal anti-inflamma- Evidence is lacking to support the claim tory drugs (NSAIDs) or acetaminophen and that lumbar fusion surgery leads to sigphysical therapy. If that fails, clinicians can nificant pain improvement. Surgery often

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FALL/ WINTER 2013• HIGH DESERTPULSE

Causes of baek pain Back pain is the fifth most common reason people visit doctors. Yet, in most cases, the true source ofback pain is unknown. Some pains are probably sprains to ligaments and muscles. Some may be problems with the discs or the facet joints between vertebrae. For most routine, non-specific back pain cases, when nothing indicates an underlying disease or acute injury, the best course of treatment includes over-the-counter ain relievers, exercise and time. Here are some known causes ofback pain:

Spinal stenosis Vertibrae

prnal cana

The spinal canal narrows putting pressure on the cord and nerves.

and nerve

Disc Normal

Cervical curvature

Spinal stenosis

Discproblems Some issues that can cause chronic lower back pain:

A healthy spine

Normal disc Vertebrae

â&#x20AC;˘

TI1 I' CIC Cul'va ure

Degenerated disc

Bulging disc

Herniated disc

Thinning disc

Discdegeneration due to osteoarthriticspine

Nerve

Lumd r

curvatu e Vertebrae

Rctclicttlopctthy (Pinched nerve) Spinal cord

Injury: Pressure on spinal cord

Disc

Disc herniation

Injury: Impingement of nerve root

Vertebra

S cral cu ature Facet joint; Where two vertebrae join

Nerve

GREGCROSS

HIGH DESERT PULSE â&#x20AC;˘ FALL I WINTER 2013

Page 17

Feature ~ BACK PAIN

to two deaths per 1,000 cases, according to a 2012 study published in the journal Spine.

Antibioties for baek pain? It's a breakthrough in back pain that has piqued back experts interest. Scientists haveshown in a couple of small studies that bacteria in the discs could be creating back pain that might be treated with a round ofantibiotics. "Ifthis turns out to be a common and true source ofback pain, resolvable with antibiotics,that's Nobel prize stuff," said Dr.RayTien, a neurosurgeon atThe Center: Orthopedic 8 Neurosurgical Care8 Research in Bend. A May 2013article in BMJ, also known asthe British Medical Journal, summarized thefindings ofthe two studies; "IJp to 40 percent of patients with chronic low back pain that could benefitfrom surgery have abacterial infection that could be treated simply and cheaply with antibiotics." The theory isthat bacteria could be pushed into

circulation through the mouth and find its wayinto a spinal discthrough a tear orrupture in its outer lining. Previous studies hadfound bacteria in 37to 53 percent ofthe material removed during discsurgeries. One small uncontrolled pilot study in 2008 showed significant improvement in patients after using antibiotics. The other study, from 2013, included 162 chronic back pain patients who had MRI-confirmed disc herniations and bone changes that are associated with back pain. In a randomized, double-blind study, patients either got antibiotics or placebo pills. Improvements were significantfor the antibiotic group. The studies conclude with warnings not to selfmedicate with antibiotics because of potentia antibiotic resistance,and a call for further research on the question.

Why it happens Historically, doctors have been criticized for not resolving back pain. These days, imaging facilities are widely available. Doctors are pressed for time, which cuts down on their ability to evaluate back pain thoroughly and thoughtfully. Patients demand quick answers and solutions. Physicians fear malpractice if they miss something. The medical establishment is insensitive to price.

These areamong explanati ons given by Dr. Donald Casey from the New York University Langone Medical Center for the overtreatment trends reported in the JAMA Inter-

nal Medicine study. There's also typically a lag time between research and practice. Health policyexperts have observed that it takes an average of 17 years leaves scar tissues that can create more pain ralysis and death have been associated with for evidence from randomized clinical trials to later. And, 5.6 percent of surgical procedures fusion surgeries. The rate of death associ- be incorporated into doctors' offices, accordcome with life-threatening complications. Pa- ated with spine surgeries was between one ing to a commentary from Casey that accom-

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Partners In Care

panied the study in JAMA Internal Medicine.

Consensus in research and resulting guidelines for back care have just begun to emerge in recent years. "The first step in addressing a problem is to admit that you have it, and in that regard,

the article (in JAMA Internal Medicine) forces us to admit that development of clinical guidelines alone will not solve our problem in managing back pain," Casey wrote.

The state of back care in Oregon Despite treatment guidelines that recommend very little medical intervention, at least 35 percent of Oregonians who received a physician's care for a new episode ofsimple low back pain received imaging tests, and 14 percent filled prescriptions for narcotic pain relievers, according to an Oregon Health Care Quality Corporation 2013 report about utilization ofservices for ow back pain in Oregon. In Central Oregon, the rate ofbacksurgeryamong Medicare beneficiaries ranked asone ofthe highest rates in the nation, and the rate ofback surgery in Bend was twice the national average, according to a 2011 Dartmouth Atlas Report.

It'll take a realignment of financial incentives

"We shouldn't guarantee relief. That sets to reverse the trend, said Dr. Ray Tien, a neurosurgeon at The Center: Orthopedic & Neuro- us up for failure," Tien said. "Certainly back pain is incredibly prevasurgical Care & Research in Bend. The current system rewards physicians for performing lent," said Dr. Alison Little, the director ofclinimaging tests and various treatments, even in ical affairs at the Center for Evidence-based the absence of strong evidence to show it will Policy at Oregon Health & Sciences University make patients better, he said. in Portland. "There are a lot of people in pain. And patients need to have realistic expec- In general, there's no quick fix. Our natural tations about what treatments can do. Tien

inclination is to see what's wrong. Everyone

saidphysicians need to have honest conver- thinks if they can get a picture in the back it'll sations with patients. Naturally, the spine de-

gradeswith age, he said.People may need to expectsome aches and pains.

ylrn'I

tell them something. Pictures often show a lot of things wrong in there and lots of times

they're not the cause of the pain."

At least 90 percent of people over age 65 will find something troublesome in their imaging, she said. Bulging discs and spinal stenosis (when the spinal canal narrows, potentially putting pressure on the nerves) are extremely common and can beasymptomatic.When people see these problems in an imaging picture, they assume it's the cause of pain and will try epidural injections or surgery, she said.

Injections When over-the-counter medications and physical therapy don't work, injecting medi-

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Feature ~ BACK PAIN

" .~ IIIEIIIIC

ANDY TLILLIS

Laura Spaulding, left, a registered dietitian in Bend, started waking up with a sore lower backseveral months ago. She figured the pain stemmed from some combination ofbeing 46 years old, practicing martial arts and running. A few weeks of physical therapy relieved her pain. Above, Spaulding stands as physical therapist Zeyla Brandt examines her back on Sept. 3. At right, Brandt uses aninclinometer to check the range of motion of 5pauldi ng's back.

brae in the lower back. "It identified a problem in my lumbar spine. They did an epidural injection, and it didn't do much. It wasn't very successful," he said. injections. Doctors had identified a problem, but it wasn't the source of the The only injection recommended by the Oregon Health Authority pain. "A month or two later the pain cleared up, could have been on its guidelines is an epidural steroid injection for radiculopathy (nerve impingement) with a herniated lumbar disc. Even that recommenda- own. That's the history of this problem — it comes and goes. It bothtion comes with a caveat that evidence is inconsistent, and the treat- ers me and then disappears," he said. ment appears to lack long-term benefits. A few months after that, he had a problem in his cervical, or upper, Lesser known injections include: botulinum toxin, a neurotoxin spine, that was impairing the use of his arm and hand. He got anthat some say can relieve muscle spasms, inflammation and pain; or other MRI, which led to another epidural injection, and he felt relief. "That time, they identified the problem and fixed it," he said. radiofrequency ablations, injections that destroy the functionality of He's felt another pain in his leg that sounds like a nerve problem a nerve, therefore eliminating pain, often to treat facet joint pain or sacroiliac pain. and, if it progresses, might lead to another MRI, he said. But all the Injecting anything into or around the spinal canal comes with doctors he's worked with in Bend and in Arizona have said surgery is some risk of infection, nerve damage, paralysis and even stroke, the very last resort for him. said Little. Serious side effects are rare, but earlier this year, an outSurgery break of contaminated spinal steroid injections killed dozens of people and sickened hundreds more. Central Oregon has one of the highest rates of spine surgeries in Seventy-six-year-old John Kelley, a retiree covered by Medicare the country. Even Dr. Creg Ha, a spine surgeon at Desert Orthopewho splits his time between Crooked River Ranch and Arizona, has dics, says back surgery is overused, but there is a time and place had a couple of steroid injections without problems, although he's and a type of patient for it. not convinced they're always helpful. Kelley has had some degree of Patients typically end up in surgery because of extreme, acute back pain on and off over the years. About two years ago, he got an pain, and for nerve damage, said Ha. For example, if a disc herniaMRI and discovered he had virtually no disc left between two verte- tion pushes on a nerve, it can affect a person's ability to lift their cations — most often a steroid medication, an anti-inflammatory

— directly into the source of the pain may become an option. But there is insufficient evidence backing possible benefits of most

Page 20

FALL/ WINTER 2013• HIGH DESERTPULSE

Prevent back pain Seth Ramsey, aphysica therapist and co-owner of Rebound Physical Therapy said people can workto avoid and manage back pain. "Truth is, most everyone wears out a little and back pain has to be managed," he said."You can learn what to do. It isspecific to your individual body and it takes accountability I liken it to brushing teeth. Ifwe don't we get cavities. Ifwe don't put time into staying flexib e, strong and ab e to control our movements, we get back pain.... Being accountab e to staying fit is not easy but its needed in back pain management." Allison Suran, aphysical therapist and owner of Healing Bridge Physical Therapy in Bend, offered these tips:

foot, causing them to trip on their toes, said Ha. Then back pain is

no longer considered or non-specific, and guidelines say it's time to consider more invasive procedures. The disc is a gelatinous structure contained by an outer ring of cartilage. It's often compared to ajelly-filled doughnut. When the "jelly" oozes out, it's a herniation. The herniation can displace or affect the nerve. Surgeons can remove that piece of the gelatinous structure to relieve pressure from the nerve, Ha said. The other kind of surgery is fusion surgery, which uses rods and screws to hold steady segments of the spine where a disc has too much motion or instability. "(Fusion surgery) is more complicated and is where most of the debate is," Ha said. Ha said surgery is appropriate in cases of spinal stenosis and in-

•Stay active. • Ifyou're out ofshape, start with basic core exercises. • Maintain flexibility and strength in the hips. • Practice good posture. Try not to bend the neckforward. •Stretch and flex backward to counteract the tendencyto bend forward too much. •When bending and lifting, hinge at the hips and bend the knees — not the back. • Move with awareness. Keepweight evenlydistributed on both legs when bending and lifting and notice what kinds ofmovements strain the shoulders and neck.

Turning around the trend Reversing the trend of overtreating back pain could significantly decrease health care spending and improve the quality of care, according to research. The treatment gets the most out of hand in patients who have low

back pain and no red-flag neurological symptoms, Tien said. It's especially problematic in urgent care and emergency room scenarios, he said. Turning the trend around will require a systematic change in economic incentives, Tien said. Payers and insurance companies will have to lead the way. For example, so-called "bundled payments," a payment for one case with one desired outcome, could improve stability, or too much movement in the vertebrae. back pain care, Tien said. Doctors would be less inclined to suggest For spinal stenosis, a surgeon can clear bone spurs or bulging or costly tests or treatments without a strong body of evidence backcollapsing discs out of the spinal canal, like a plumber cleans a show- ing it sodds ofsuccess. er drain, alleviating pressure from the nerves, Ha said. Then the Health care reform guided by the Affordable Care Act is working surgeon can fuse vertebrae together to make sure motion doesn't on this and could push a turnaround in the trend, said Tien, but the continue to wear out that segment of the spine, he said. financial incentive system still largely remains. Robert Baldwin of Bend, who is 82, underwent surgery for spinal Some insurance providers are changing. For example, the Orstenosis in 2004, after years of living with low back aches and pains egon Health Plan, Tien said, won't pay for further tests or treatthat had grown increasingly intense. ments after a patient is diagnosed with non-specific back pain. If Before he considered surgery, he had tried two epidural steroid the initial appointment uncovered red-flag symptoms that could injections, which he said were horribly painful and only offered tem- be lumbar radiculopathy, a nerve injury, then an MRI could be covporary pain relief. ered, he said. He happened to be friends with a local neurosurgeon who told Dr. Stephen Mann, a physician and president and medical director him, "More can be done." He trusted this doctor. at High Lakes Health Care, believes the frequency of MRls, CT scans An MRI gave him a clear diagnosis of spinal stenosis, Baldwin said. and surgeries for back pain is starting to decline. However, there's He could see where the canal around the spinal cord was pinching been an increase in injections and locally invasive procedures that the nerves that control the lumbar region of his back. The retired provide "marginal" benefits, such as epidural steroid injections and teacher and psychologist got things in order in case the unthinkable radiofrequency ablations. "Patients seem more understanding that time is the strongest cure happened. The morning after his back surgery, he walked down the hospital and practical care of the physical body works quite well for uncomhalls and asked ifhe could go home. plicated low back pain. The demand for extreme treatment seems He'sbeen exercising ata gym eversince,hesaid."My backdoesn't to be less frequent and the providers who are quick with the knife, hurt me at all," he said. narcotics and the high-cost imaging are under more scrutiny as their The biggest risks with surgery come when surgeons are posi- outcome data becomes more transparent and public," Mann said. tioning screws and rods into the spine, Ha said. Accidentally injur- "We still have a long way to go to get to alignment with best eviing the nerve could create ongoing pain or weakness, paralysis or dence practice research which supports conservative treatment, but headaches. we seem to be on the right track." •

HIGH DESERT PULSE • FALL I WINTER 2013

Page 21

Jot) i INFANTOCCUPATIONALTHERAPIST

St. Charles NICU occupational therapist Karlee Dunn helps parents and babies adapt to their new world BY ALANDRA JOHNSON • PHOTOS BY ANDY TULLIS

eremiah and Haley Thornton, both of Bend, thought they knew how to care for a baby. After all, they had done it with their now 5-year-old son, Finn. But after their younger son, Khol, was born prematurely at 34 weeks gestation, they quickly learned everything was different with a preemie. Khol wasn't strong enough at first to cry like a full-term baby. They had to learn to understand his stress cues, such as getting the hiccups,having unusual bowl movements and holding hishands up to his face. And the Thorntons learned behaviors they previously thought of as nurturing and comforting — rocking and patting the baby — were actually upsetting to premature babies. They even had to relearn how to touch a baby. Instead of rubbing back and forth, Jeremiah said, he learned to place his hand on Khol with a "contained touch," which means setting his hand down on the infant, keeping it still and applying a fairly firm pressure."Thatgives him a sense of well being," said Jeremiah. Cuiding the Thorntons along this learning curve was occupational

they sometimes call occupational therapy, the "other therapy." The nameitselfcan beconfusing,asoccupationaltherapy sounds like treatment for an adult with a profession. But Dunn explains that

occupation in this case simply means what occupies a baby's time — so her job is to help the infant meet regular milestones so it can play, eat and sleep. The babies who are in the NICU at St. Charles Bend are typically premature — protocol is for all babies born at 35 weeks gestation or earlier to be seen in the NICU. Other infants in the unit include those who

have had traumatic birth experiences, have sustained a stroke or are born addicted to drugs like methamphetamine, among other issues. In some cases, if the pregnant woman is put on bed rest inside the hospital, Dunn is able to meet the mother before the baby is born. Dunn meets these mothers to talk and offer information about what to expect. "I want to educate them but not scare the crap out

of them," said Dunn. More typically, Dunn first encounters the babies after they have arrived in the NICU. She waits to begin her work until the infants are

relatively stable and do not need to use a ventilator to breathe. Once the neonatal intensive care unit at St. Charles Bend. She helps doz- the doctors are fairly certain "the baby is going to make it," Dunn ens of families with infants in the NICU each year. begins her work. The work is a passion for her."Babies have so much potential," At that point, her first priority is to assess the baby and compare said Dunn, 40. "Babies have their whole entire life ahead of them." that assessment to where the baby should be developmentally; a And Dunn's job is to help them have the best start possible by edu- baby who is born at 32 weeks gestation, for example, is compared cating parents, assessing infants and providing treatment. with the standards for babies born at 32 weeks. She breaks the body down into specific areas. Dunn examines the baby's muscle tone, The'other therapy' movement and how the infant handles transitions. Can the baby get Dunn first started working as an occupational therapist in a NICU into a deep sleep? Does she hold herself in a tight, curled fetal poin Pennsylvania17 years ago. She says most people have never sition or is she floppy? (Floppy is less desirable.) The infant's legs heard of an occupational therapist who works with infants. should spring back into place when pulled. Dunn checks reflexes Dunn works alongside nurses, doctors, dietitians, physical ther- and how wellthe baby holds his orherhead. These assessments, apists and speech therapists in the NICU as they take a team ap- which Dunn performs weekly with each infant, can point out early proach to helping these fragile babies. Dunn describes her job as markers for developmental delays or disorders like cerebral palsy. overlapping with physical therapy and speech therapy. She jokes Typicall y Dunn says parents enjoy the assessments because she therapist Karlee Dunn, who worked with the parents and infant in

Page 22

FALL/ WINTER 2013• HIGH DESERTPULSE

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UWEK~~ Dunn holds Khol Thornton, who was born several weeks premature, during his final treatment with the occupational therapist;

is able to detect the slightest change and improvement, things

parents enjoy hearing about. Dunn also helps work with the rest of the NICU team on how best to help the patient. She recalls one innovative treatment

they conducted with a boy who had experienced a severe stroke. The infant could only move one arm. She helped research a new therapy that required restraining the baby's good arm so his weak arm would be forced into doing more work. This treatment helped the infant, who is now 4, greatly improve his movement.

Parents Dunn faces some difficult moments in her work. Parents often ask Dunn if their baby is going to die. Dunn has seen many babies die, and she isn't one to bend the truth. "I try to be direct but supportive," said Dunn. She usually shares relevant statistics and helps parents understand the risks associated with whatever their baby is going through. One of the hardest jobs she has is talking to parents when there is little hope for true recovery. Some children simply will not ever be able to walk or talk or live regular lives. Talking to parents, however, is also one of Dunn's favorite parts of her job. Parents can be very different. Some are absent, some are very attentive. She recalls one mom who was a teacher

Page 24

FALL/ WINTER 2013â&#x20AC;˘ HIGH DESERTPULSE

Job I INFANT OCCUPATIONAL THERAPIST who kept every document and note in order in a neat binder, but other parents "can't mentally or emotionally handle" all of the information.

"One of my biggest jobs is for parents to know what to expect when and when to worry," said Dunn. She also gives every par-

/Ii

ent her cellphone number, and she gets texts all the time with

questions. Dunn likes teaching parents about infant massage and its powerful benefits. She taught the technique to one mother whose baby died in the NICU 17 years ago. But the experience of touching her baby in a loving way was so positive for the mother that she still sends Dunn a Christmas card every year.

Future Dunn continues to see many of the NICU infants in an outpa-

tient setting after they leave the hospital. Some children she sees for years. She finds this to be a very satisfying aspect to her job. One former NICU infant, now 6 months old, recently came in for a routine appointment, but Dunn noticed right away the boy was laboring very hard to breathe. Dunn insisted the parents get

• •

•

it checked out immediately, sending the infant to the NICU. The

• •

family was quickly off to Portland to have a dangerous, growing cyst surgically removed from the boy's throat. "Now he's doing

•

fantastic," said Dunn. "We catch a lot of stuff like that."

Dunn will soon have a whole new perspective on taking care of infants. Her first baby was due in November. While pregnant, she wondered how closely she would be able to follow her own advice. Would she givethe baby enough tummy time?Would she make sure the infant didn't stay in swings and carriers too long and develop a flat head? Dunn has seen the worst things that can happen to babies and parents — and that knowledge can be difficult to shut out of her own mind. "I know too much," said Dunn, about her own pregnancy. But that knowledge also allows her to feel better prepared should she encounter any bumps. She knows the right questions to ask. That knowledge, however, can also get her into trouble in her personal life. "It's hard to be my friend," said Dunn. When she sees something amiss with a child, she will say it."I don't believe in holding back. I feel like I have an obligation to tell." She has told friends their child appeared to have a flat head and suggested other children be seen by a specialist. Sometimes

•

• II

this information is received well, other times it is not.

During Khol Thornton's last evaluation, the news was good. Dunn noticed the baby was nice and alert. She told them to keep Khol in a swaddled fetal position as much as possible until he was at his regular due date because that "helps keep them protected."

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In general, Dunn told them to expect Khol to stay about six

weeks behind developmentally until he's about 2. So he could be expected to roll, sit up, crawl and reach other milestones about six weeks later than is typical. But any more than that and they

RBC,

should worry. "He's developing just like he should," Dunn told them.•

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HIGH DESERT PULSE • FALL/WINTER 2013

Page25

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Kraig Erickson, left, and Alison McBroom, right, of Bend, run along the Deschutes River Trail near Farewell Bend Parkearlier this year.

•

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JOEKLINE

Page 26

FALL/WINTER 2013• HIGH DESERTPULSE

Black Diamond Spot Lumens:130 Beam distance:75 meters Run time:200 hours Price:53995

PRODUCTIMAGES BYROB KERR

A •

•

BY MARKIAN HAWRYLUK

nyone who has ever juggled a bowl of hot soup, a spoon and a flashlight — a feat that often ends in dining disaster — can appreciate the advantages ofa headlamp in shoulder camping season. It's like gaining another arm. Over the years, headlamps have gotten lighter, brighter and more comfortable, helping to extend the season for almost any summertime sport. To help choose, we shine a light on some ofthe factors to consider. Lumens:A measure of the quantity of ight, lumens tell you how bright a headlamp shines. That shouldn't be your only consideration. Not everybody needs a headlamp that burns at over 100 lumens, and more lumens generally means a heavier headlamp and a higher price. Choose a brighter light for trail running or climbing, but you can get away with fewer lumens for camping or hiking. Beam distance:Manufacturers use a moonlight standard, the equivalent ofthe light produced by a full moon on a clear night, to measure beam distance. The distance corresponds to the furthest point from the headlamp that is still illuminated to that moonlight standard. A longer beam distance might be more important for fast moving sports. Run time:This gives you a sense ofhow long a headlamp will run on new batteries. In most headlamps, light intensity will fade as the batteries get weaker. Run time is measured to the point at which the headlamp no longer meets the moonlight standard, Consider the duration ofyour activity. You might not need a long run time for running or snowshoeing, but you'll want longer run times for mountaineering or winter camping.

Princeton Tec Vizz Lumens:165 Beam distance:90 meters Run time: 160 hours Price:549.95

Petzl Tikka Plus 2 Lumens:70 Beam distance:40 meters Run time:185hours Price:539.95

Black Diamond Icon Lumens:200 Beam distance:100meters Run time:250 hours Price:579.95

Extra features:Headlamps offer a variety of bonus features, including a tilting head, variable beam width, multiple brightness settings, and a lockable switch to keep the head amp from switching on accidentally in your backpack. Most headlamps now use LEDs instead oftraditional bulbs. They're more durable, use less energy and arejust as bright.

HIGH DESERT PULSE • FALL/WINTER 2013

Page 27

Bend couple thrive on pushing the boundaries of adventure, yoga Page 28

FALL/ WINTER 2013â&#x20AC;˘ HIGH DESERTPULSE

Profile ~ JAsoNE,cHELsEYMAGNEs s

BY MARIELLE GALLAGHER • PHOTOS BY ROB KERR

YogaSiackers founder Jason Magness supports his wife, Chelsey in a yoga poseon a slackline at their homein Bendin September.

~yoII See a video ofthe Magnesses in action, plus a slideshow, at: bendbulletin.com/acroyoga

HIGH DESERT PULSE • FALL I WINTER 2013

"That idea of wanting to achieve someason and Chelsey Magness take everyday sports like mountain biking, rock thing on the slackline, it doesn't happen unclimbing and yoga and push them to the til you let go," he said. extreme to test their personal limits for what Expanding their practice to include acro is physically and mentally possible. and aslacklineyoga,the Magnesses say,has Such as walking a I-inch-wide slackline taught them profound life lessons. The way hundreds of feet over a canyon. a slackline wobbles under a slackliner's feet, Or Chelsey balancing in a perfect hand- for example, is a reflection of the mentality stand atop Jason's extended hands the person brings to the line. "If you step on the line and you're afraid, Or multiday adventure racing in Patagonia, where they crossed snowy passes in tennis you have ego, you want to do something so shoes with a single rope and no ice ax. that someone will think it's cool. It makes it "You have to get to these places where so much harder." you don't think you can go any further and Acro yoga incorporates a similar element somehow redefine what life is, what that of learning with the addition of another next step is going to be like," said Jason. person. No matter the physical capabilities Both longtime athletes in various sports of the two people, the key is clear commu— including yoga, rock climbing, kayaking nication. "I could be the most amazing yogi and mountain biking — the Magnesses el- handstander in the world. She could be the evated their yoga practice in the mid-2000s most amazinggymnast, and we could come to include acro and slackline yoga. Adding together and not be able to accomplish anythe acrobatic and extreme balance ele- thing because we don't know how to listen ments to their traditional yoga poses keeps and communicate," said Jason. them challenged. Acro yoga is a two-person Psychological aspect practice that blends modern acrobatics with traditional yoga poses. One person lies on The Magnesses work out nearly every their back as the base and the other is the day in order to sustain a high level of physiflier. Slackline yoga is doing yoga poses on a cal endurance and strength, but the key to slack line anchored between two points. achieving the near-impossible poses they "We were doing super advanced yoga, but pull off is mental acrobatics. "The mental aspect is huge in everything we weren't at the place where we were being pushed up against this edge and figur- we do. It's about 95 percent mental and 5 ing it out," said Jason, 38. percent practice and training," said Chelsey, Some yogis get stagnant in their practice 29. "The mental part is the ability to keep and the highest challenge is just to learn pushing the edge, to hit that move in acro new poses. "When you're doing acrobatics ... We can walk a slackline in the backyard or on the line, that goes away because it's all day but when you put it up over a canyon hard to even stand on the thing," said Jason. (highlining), it becomes all about the mental "It's hard to even balance on someone else's ability," said Chelsey. feet. So you have to go backwards to that The Magnesses' regimen of high-intensity, beginner mindset of really connecting with high-risk sporting leaves no room for interyour breath, connecting with your partner." nal conversations of doubt or ego. "Both in highlining and in acro, there's not very much Letting go place for hope," said Jason. "You don't get on Just standing on the slackline for three a highline and hope you're going to walk. You seconds was an achievement when Jason don't do some crazy pop in acro and hope it's going to work. When you're out there on first took it up. It wasn't until he realized that he had to let the line, hope doesn't get you very far." go of all desire for achievement that he was Instead, the internal conversation has to be able to balance on the slackline, he said. about conviction. "Sometimes you fall. You

Page29

Profile(JASON 5 CHELSEYMAGNESS lose that moment but (the conversation is) 'I'm going to cross.' ... (or) 'We're going to do this now.' That's why we talk less and less. You know when you're ready. You feel it and then you go and ifyou don't feel it, you don'tgo." Other inherent qualities of acro yoga are human touchand playfulness. Many times, as Chelseybalances atopJason'sfeetand is spinning side to side, she is smiling. When she hits a serious pose that looks like "The Thinker" statue, she laughs before breaking the pose and moving to the next one."A lot of people are on their phones these days and communicating through text and not a

Interval training is done two to three times

More info

a week. "We do 15minutes where we go as fast as possible, where we can taste blood in our mouth," said Chelsey. Or five to 15 minutes of pulling a tire down the road, which Chelsey says makes great entertainment for

Acro yoga instruction Back Bend Yoga,Bend: www.backbendyoga.net Bend Circus Center,Bend: www.bendcircuscenter.com their neighbors. For a time trial, they map JuniperSwim8 FitnessCenterBend: out a half-mile loop to run as fast as possi- www.bendparksandrec. ble, then pull a tire for 30 seconds, then run org/juniper swim fitness/ the half mile again in an attempt to beat their Jason and Chelsey Magness'websites first time. Or they might bike a 10-mile loop www.bendacro.com as fast as possible."I do not look forward to wwwjnctraining.com the interval trainings, but I also do because I Adventure racing instruction like the feeling when it's over. They're really www.bendracing.com

face-toface ora human touch way, so that's hard but you see results very fast. It's kind of why I really feel strongly about acro yoga. cool like that," said Chelsey. It brings that sense of play and communicaThey practice acro yoga three times a week tion and touch in a safe, fun environment and walk or do lunges daily across a 90- or 160-foot slackline strung up in their backyard back to this world," said Chelsey. every day. Other forms of exercise include How they do it surf skiing, sea kayak paddling, mountain The Magnessesdon't exclude any foods biking, stand-up paddleboarding and long from their diet and they don't count calo- distance kayaking, covering up to 45 miles in ries, but they exercise a lot. Any particular a day for endurance training. They avoid usweek, their exercise may focus on slacklining gyms to work out but sometimes in the ing or acro yoga or endurance if they have fall they head indoors for weight training. "I an acro yoga performance or adventure race always look forward to the missions and the approaching. For the most part, no two days acro practice," said Chelsey. "All of it is fun."

friend ... just organically. For a long time we were separating what we were doing on the slackline from acrobatics and from our adventure racing team and one of our team sponsors just finally started calling the team YogaSlackers because it's just too hard to compartmentalize ... If people ask you just say 'Well, I'm a yoga slacker' and that makes sense. It just means you do a lot of different things at your edge," said Jason. "All these things for us really play into look the same when it comes to their workeach other. When we're doing acro we're YogaSlackers outs, which include endurance, interval and really building our relationship for advendistance training and time trials. "Every day All the different activities the Magnesses ture racing. When we're doing some crazy we do something. There's rarely a day where do is represented under the name YogaSlack- adventure race and crossing a river, we're we do nothing except right after a race when ers (a name inspired by doing yoga on the really building our trust for that super hard we're driving," said Chelsey. slackline). "I started YogaSlackers with my move in acro or that trust in yourself when

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iVIAT T R E S S " . " ':" G alle r y -B e n d FALL/ WINTER 2013• HIGH DESERTPULSE

you step on a highline over a gorge at Smith Rock. And all of this comes down to the idea of yoga — that total self-awareness. This is just a way to force ourselves to explore and to teach other people."

"That's what I love about it adventure racing. It's not 'I'm a runner, I'm a mountain

Earlycareer

them work. And it's the same thing in acro

Before Jason and Chelsey met, they were in separate parts of the country practicing different types of athletics. Jason and his twin brother, Andy, pursued body building and rock climbing in college. "We were the little skinny kids ... (We) got into body building mostly so that we could have muscles and maybe get dates." They quickly realized that the two sports were at odds. Scaling rocks was hard with hulking muscle weight, so they gave up body building to get serious about rock climbing. Jason moved to North Dakota and spent eight months building a climbing gym. Before the gym wascomplete,a coach suggestedJason start doing yoga. "I got really seriously into yoga and that kind of set me on a path, not away from climbing, but away from competitive climbing and I became a yoga teacher." Then Jason and his brother picked up racing. They competed in a triathlon, then a half marathon and an Ironman. Jason also tried an adventure race, which involves teams of no more than four people doing multiple sports in often multi-day races with no prescribed route and no rules other than staying with the team.

biker, I'm a skier.' It's 'I'm a sufferer, I'm an endurance athlete.' That you just have to do all these different things and have to make and slacklining," said Jason. Chelsey grew up in Alaska with an early appreciation for spending time in the mountains. When Chelsey got a driver's license, it was the ticket to more freedom. Every weekend wasspent with friendsbackpacking and "getting lost in the mountains."

After graduating from high school, Chelsey traveled for eight years, following snow and rivers. "I would be a ski bum and when spring hit, water would run offand I'd go to the wherever the biggest runoff was and guide there. And then in the fall I would travel overseas with the money." All the while, Chelsey had YogaSiackers founder Jason Magness supports his plans to go to college. But a shoulder injury wife Chelsey from astand-up paddle board on a landed her instead in Tucson, Ariz., to live with

an aunt. It was there she met Jason when she enrolled in a yoga teacher training program. "He was teaching ... and I also found out through him about the slackline and acro yoga and I just saw it and I have a pretty obsessive personality. Once I find something that I like I go full on." For their fourth date, Jason asked Chelsey to a six-hour adventure race, her first. "We knew we had to finish the race in four hours otherwise we'd be late (for class) and we'd both be in trouble. So we finished in about

chilly October morning at Sparks Lake.

3Y. hours — about an hour ahead of the nearest team — and made it back to the

teacher training kind of cut up and bruised but on time," said Jason. Now, theMagnesses teach acro and slackline yoga from their Bend home and in local yoga studios. They are also preparing for a seven-city tour to teach advanced acrobatics, and training to compete in the Adventure Racing World Championships in Costa Rica.•

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(541) 389-3166• www.bendeyes.com HIGH DESERT PULSE • FALL I WINTER 2013

Page31

TiPs ~ PREvENTATlvE scREENINGs

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ILLUSTRATION BY GREG CROSS/TFIINKSTOCK

It's no fun getting medical screenings, but the results could save your life BY ALANDRA JOHNSON

isiting the doctor as an adult can mean getting poked, prod- organizations, she and her colleagues try to look at the studies upon ded, measured and thoroughly examined. This experience which the recommendations are based. She considers how big the may not be fun, but the results can be extremely important. studywas and who was included orexcluded from the study — and Dr. Mattie Towle, a family medicine doctor with Bend Memorial does that population match her patient population? Clinic, says preventative screenings in adults are critical. When recommending a screening, she likes to consider several She explains to patients what the recommended health screen- factors. The test needs to be specific and sensitive. It needs to be a ings are — from colonoscopies to mammograms to blood tests. The reasonable test to put someone through. It should be cost effective. reason for so many tests is quite simple: "(If) you catch a problem And it has to have a benefit — if some health issue is found, it can earlier, you'll do better as a general rule," said Towle. be treated. The recommendationsvary greatl y based on age and gender. Towle points out that some research has led to fewer screenings. Family history and certain risk factors can also be a factor in deter- Now that researchers have found a link between the human papillomining when people should receive screenings. mavirus and cervical cancer, for example, doctors now recommend Towle says some recommendations have been controversial. For less-frequent pap smears. "Teenagers were getting a lot of pap instance, the recommendation for when women should get a mam- smears. That's not happening as much now," said Towle. "The more mogram varies, with some breast cancer advocacy groups recom- you understand about how a disease develops, the more accurately mending starting mammograms at age 40 and other entities, like you canchange to look forhow the disease develops." the U.S. Preventive Services Task Force, suggesting starting at age She knows that the screenings can feel invasive."It's not fun to 50. Towle recommends patients begin at age 40 because waiting do. I don't know anyone who looks forward to a colonoscopy," said "would miss a certain percentage of cancers." Towle. "It potentially keeps you from developing colon cancer — that The current recommendations surrounding prostate cancer are probably makes it worth doing." also controversial, as some medical groups believe men should not She also believes screenings can help give people more control receive screenings unless they experience symptoms, regardless of over their own health — if you know your cholesterol is creeping age. up, you have an opportunity to do something about it. "Knowledge Towle says, whenever new screening recommendations emerge is power; it allows you to play a real active role in your well being," from the U.S. Preventive Services Task Force or other large medical said Towle. •

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FALL/ WINTER 2013• HIGH DESERTPULSE

Recommended preventivescreenings Women Breast cancer screening • Mammogram — US. Preventive Services Task Force recommends women ages 50-74 receive a mammogram every two years; the American Cancer Society recommends women ages40-74 receive a mammogram every year. Consult your doctor. • Doctor's breast exam —Ages 20-74: every 1-3years

Men Abdominal aortic aneurism screening • Performed with an ultrasound on the abdomen. Recommendedformen ages65 to 75who have ever smoked one time.

Cardiovascular screening • Blood tests —Ages 35 and older: every 5 years Testsinclude: lipid screening, total cholesterol, high-density lipoproteins, triglycerides, LDL

Cardiovascular screening

Colorectal cancer screening

• Blood tests —Ages 45 ancfolder with an increased risk for coronary heart disease: every 5 years. Testsinclude: lipid screening, total cholesterol, high-densit ypoproteins, li triglycerides, LDL

• Fecal occult blood test — Ages 50-75 every 5-10years • Colonoscopy —Ages50-74 every 10years

Diabetes screening Cervical cancer • Pa p smear —Ages 21-65:every 3 years Colorectal cancer screening • Fecal occult blood test — Ages 50-75: every 5- 10years • Colonoscopy — Ages 50-74: every 10years

Diabetes screening • Patients who havea blood pressure reading of 135/80or above should be tested annually.

Patients who have a blood pressure reading of 135/80 or above should be screened annually. Prostate cancer screening • The U.S.Preventive Services Task Force recommends against thescreening for prostatecancer unless a patientis experiencing symptoms. The American Cancer Society and other groups disagree with this. Consult your doctor. Information from BMC "Recommended Preventative Screenings" and U.S. Preventive Services Task Force Aand B Recommendations

(www.uspreventiveservicestaskforce.org)

Osteoporosis screening • Bone densitytest performed with X-ray — Ages 65 and older: every 2-5 years

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he season for holiday parties and family gatherings is upon us. While these get-togethers can lift the spirits, they can also leave our bodies feeling sluggish and heavy. Baked brie, baconwrapped shrimp and artichoke dip, among others, may be tasty, but they aren't helping our waistlines. But even health-conscious hosts may resist serving healthy party food, which can be dull orjust not that tasty.

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1'/2 TBS rice vinegar 1 head lettuce, leaves separated 8 rice paper wrappers For filling: 2 TBS peanuts, crushed 1 pkg cellophane noodles,

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cooked 1 green onion, julienned y4C carrot, finely grated YaC napa cabbage, thinly sliced y4C basil leaves y4C mint leaves y4C cilantro leaves

Cut ribs out of lettuce leaves, then cut in half. In a shallow pan, soak1 round of rice paper in hot water to cover until very pliable,45 seconds to1 minute. Carefully spread one ofthe rice papers on a paper towel. Blot with a paper towel. Arrange 1 piece of lettuce leaf on bottom half of sheet, leaving a 1-inch border along the edge. Top lettuce with some of the peanuts, noodles, green onions, carrots, cabbage and herbs. Roll up filling tightly in rice paper, folding edges inside after the first roll to completely enclose filling and continue rolling. Halve rol s diagonally before serving. Makes 8 servings. Nutrition information via WellTraveled Fork: 79 calories,1 g fat,1 g protein,17 g carbohydrate,1 g dietary fiber0 mg cholesterol, 5 mg sodium. Nutntion highlights: Low in saturated fat, no cholesterol, very low in sodium, high in Vitamin A.

•

We brought this dilemma to two local experts, who were determined to help us find healthy, delectable food to serve at any gathering. The following recipes come from chef Bette Fraser, owner of the Well Traveled Fork (www.welltraveledfork.com), and Mary Devore of Devore's Cood Food Store (www.devoresgoodfood.com, 1124 N.W. Newport Ave., Bend).•

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12 oz crunchy peanut butter 2 cloves fresh garlic 1 heaping TBS grated fresh ginger 4 TBS tamari 3 TBS rice vinegar 1'/2 TBS toasted sesame oil 3 TBS chili garlic paste(such as

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Huy Fongbrand Sambal Oeleck) 1 tsp chili powder 1 tsp cayenne '/2 to 1 C boiling water(depending on how thick or thin you want it for dipping) '/2 bunch fresh cilantro, chopped

Bring peanut butter to room temperature. Place all of the remaining ingredients, except cilantro, into a blender or food processor. Pulse until ingredients are blended. Taste for flavor, add more chili garlic paste to make it hotter or more grated ginger to taste. Add more water to thin the dip if desired. To give the dip more Thai flavor, use coconut milk in place of some or all of the liquid. Pour the dip into a decorative bowl and sprinkle with chopped cilantro. Serve with vegetables, skewered meats or pretzels. Nutritional information via CalorieCount(http;//caloriecount.about.com), based on 12 servings: 191 calories, 161 g fat 499 mg sodium,6 5 g carbohydrates,1 9 g dietaryfiber 79 g protein. Nutritional highlights — No cholesterol, high inniacin. Makes 8-12 servings.

— From Oevore'5Good Food Store

— From the Well Traveled Fork Page 34

FALL/ WINTER 2013• HIGH DESERTPULSE

Opposite page, from left: Hazelnut Hummus with cut veggies, chips with Pico de Gallo Salsa with Boneyard Fuego Rojo, North Shore Spring Rolls with Peanut Dipping Sauce, Quinoa-stuffed /I/iushrooms and cut veggies with Roasted Red Pepper Walnut Dip.

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(Known as muhammara in the Eastern Mediterranean.) '/2 lb feta cheese /4 C toasted walnuts 4 cloves fresh garlic 2 roasted red bell peppers 1 TBS fresh lemon juice 1'/2 TBS pomegranate molasses

'/2 TBS ground cumin Chili flakes to taste Salt to taste Olive oil or water to thin Pine nuts (optional)

•

The Boneyard Fuego Rojo adds an interesting twist to this salsa. It provides a bit of heat, plus a depth of flavor that you can't achieve with chilies. 2 C Roma tomatoes, diced 2 tsp salt 2 TBS onion, diced 1 lime, juiced 2 TBS fresh cilantro, minced V 4C B oneyard Fuego Rojo 2 tsp sugar, to taste Dice the tomatoes and the onions. Put onions in a strainer, rinse with hot water and drain. In a medium bowl, combine all ingredients and mix well. Let sit in the refrigerator for at least 30 minutes before serving. Nutritional information via Well Traveled Fork. Per Serving: 34calories, tracefat, 1 g protein;8 g carbohydrate; 1 g dietaryfiber; 0 mg cholesterol; 1075 mg sodium. Nutntional highlights: No cholesterol, very high in iron, Vitamin 86 and Vitamin C, high in manganese, potassium and fiber; high in sodium, sugar and contains alcohol. Makes 4 servings.

— From the Well Traveled Fork Process all ingredients in a food processer. Add olive oil and/or water to thin to good consistency. This dip improves after a day, so consider making it the day before. It is good for up to a week in the fridge. Serve in a bow (you can heat it in the microwave for a warm dip). Top with optional pine nuts and serve with pita chips, cucumber slices or use it as a sandwich spread. Makes10 servings. Nutritional information,without pine nuts oradditional olive oil,via CalorieCount(http://caloriecount.about. coml: 134 caIories, 10.5 g fat, 3.7 g saturated fat, 20 mg cholesteroI, 306 mg sodium, 5.5 g carbohydrates,.9 g dietaryfiber 5 9 g protein. Nutntional highlights — high in manganese very high in Vitamin C.

— FromDevore'sGood Food Store

1 (15-oz) can garbanzo beans, drained V4C liquid from can of beans (see note) 2 TBS olive oil

Juice from1/2 a lemon 2 TBS tahini 1 clove garlic, chopped Kosher salt to taste '/2 C hazelnuts, chopped

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40 med mushroom caps, cleaned and stems removed (number depends on size of mushrooms) 1'/2 TBS canola oil, divided 1 C cooked quinoa '/2 sweet onion, finely chopped 2 stalks celery, finely chopped '/2 C chopped walnuts, toasted

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/4 C chopped spinach V4C diced roasted red peppers (use hot cherry peppers for an extra kick) V4C minced fennel bulb 2 cloves minced fresh garlic '/8 C soy sauce Saltand pepper

Heat 1/2 tablespoon ofcanola oil in a skillet over medium heat. Lightly saute

In a food processor, combine all ingredients and puree. You may need to add the juice from the other halfofthe lemon. Ifthe hummus is too thick, add a bit of water until it is the desired consistency. Serve as aspread on flatbread or thinly sliced bread or as a dip for vegetables. Note: To make this hummus special, add your favorite IPA instead ofliquid from the garbanzo beans or any water. Dried chick peas can also be cooked and used in this recipe. They are actually preferable to canned and only require a bit more time in preparation. Substitute some ofthe cooking liquid for the canned liquid. Makes 6 servings.

the mushroom caps until they are soft. Drain the caps and refrigerate until ready to use. Saute remaining ingredients in 1 tablespoon canola oil until the onions and celery are soft. Fill mushrooms with the mixture. The recipe can be made one day ahead oftime up to this point. Place the mushrooms on a baking sheet and cover with plastic wrap. Refrigerate until shortly before serving. (Cover with foil and plastic wrap and store in the freezer for up to two weeks; add 10 minutes to cooking time) When ready to serve, remove wrap and bake at 375 degrees for about10 minutes. Put under broiler for another minute or so. Transfer to serving platter and serve. Makes10 servings. Note: Additional stuffing can be frozen for up to two months.

Nutritional information via Well Traveled Fork; 265 calories,16 g fat,9g protein,24 g carbohydrate; 7g dietaryfiber 0 mg cholesterol;14 mg sodium. Nutritional highlights: No cholesterol, low in sodium, high in fiber, high in manganese.

Nutritional information via CalorieCount(http://caloriecount.about.com):139calories; 7 g fat,202 mg sodium, 14 8 g carbohydrates, 2 6 g dietary fiber, 6 5 g protein. Nutrition highlights — No cholesterol, high in magnesium, iron, niacin, riboflavin, selenium, phosphorus, Vitamin 86 and Vitamin C.

— From the Well Traveled Fork

HIGH DESERT PULSE • FALL/WINTER 2013

— From MaryDevorefthisis her personal recipeandis not available at thestore)

Page 35

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A youngster leapsinto the toasty waterin oneofSeventh Mountain Resort's outdoor poolsin January. Theincongruous mixof outdoor winter swimming in CentralOregon can be explored through hot tubs, soaking pools such as the one at McMenamins Old St. Francis School, or heated outdoor pools and hot springs.

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What you'll need: • Shin guards • Soccer socks • Indoor soccer shoes or tennis shoes. Indoor soccer shoes are specifically designed for p aying soccer and are similar to an outdoor shoe without the cleats.

Where to play:

PHOTO BY RYAN BRENNECKE

Page 38

Cascade Indoor Sports 20775 High Desert Lane, Bend 541-330-1183 www.cascadeindoorsports.com Cost: 565 early registration, $80 late tojoin an eight-week league, plus $20 for an annual player card Leagues:Men's, women's, co-ed and men's older than 30 (all experience levels) offered year-round. Youth leagues offered November through May. Players can sign up with a team or individually, in which case they'll be assigned to a team.

FALL/WINTER 2013• HIGH DESERTPULSE

Getready ~INDQQRs occER

Indoor soccer offers great workout and a great intro to the sport cer ball, said O'Sullivan, takes practice. "If you're not as used to it, it doesn't come as quick," he said. f you're looking for a great indoor workout for the cold winter For those new to the game, the best way to learn ball skills is months that doesn't involve the dreaded treadmill, consider in- to join a league and learn by doing. "It's going to be hard but just door soccer. It offers an excellent workout under the guise of a get out there and make the most of your time and understand that fast-pacedgame, making exercise the by-product ofhaving fun. some people are going to be better than you and that's okay," said "Soccer is great because it develops aerobic and anaerobic fitnessO'Sullivan. you're doing the sprints and hard run, but you're also constantly movOne way to start working on ball skills is to kick a soccer ball ing," said John O'Sullivan, author of"Changing the Game: The Parents around in the yard. O'Sullivan said this is also beneficial to parents Guide to Raising Happy, High Performing Athletes, and Giving Youth who have kids involved in soccer. It not only helps people become Sports Back to our Kids" and founder and former director of Oregon accustomed to the feel of the ball, but can help them understand the RushSoccer,ayouthsoccerclub,now calledThe Bend FC Timbers. difficulty of the game."Some parents stand on the sidelines and give For those who have never played soccer, the indoor version is a their kid a hard time for doing a bad pass," said O'Sullivan. If parents great way to start; it's played on a synthetic turf field that is smaller are taking up the game, practicing together can help them apprecithan an outdoor field with fewer opportunities for the ball to go ate the sport to a greater degree. flying out of bounds, a shorter kicking distance and shorter game Get fit, stay safe duration, with two 22-minute halves. Indoor soccer is a more accessible version of the fall sport played outside on big grassy fields. Soccer is fun, but it takes some athletic prowess to play well and Teams are made up of10 players and six players take the field dur- without injury. Mackenzie Groshong, the women's soccer coach at ing a game. Bend High School, starts her team off in the pre-season with running Hand-eye coordination is a natural part of our everyday move- to build endurance. Starting with two-mile runs and increasing to ments, but eye-foot coordination, like what's needed to kick the soc- five miles, Groshong slowly builds the team's endurance level up to BY MARIELLE GALLAGHER

HIGH DESERT PULSE â&#x20AC;˘ FALL/WINTER 2013

Page 39

RYAN BRENNECKE

Marielle Gallagher playsindoorsoccer.

what they'll need for a full game of soccer, which is 90 minutes when played outdoors. "If they're going to play a full game, your mid-fielder is going to run about three to five miles. A forward is going to do more sprinting motions and defenders cover a couple miles a game," said Croshong. Croshong also incorporates weight training â&#x20AC;&#x201D; "making sure they are strong enough to do different things on the ball. Strengthen their glutes, calves, stronger neck and back muscles to recover faster if an injury happens, and a good base of support so that athletes don't get concussions," she said. Soccer is a contact sport, which means play includes impact with other players, the ball or, embarrassingly, the turf. There's inherent risk for various injuries, including concussion, sprains and tears. Research shows that women soccer players, at the high school and college level, are more susceptible than men to concussions. And at the high school level overall, women soccer athletes suffer the second highest rate of concussions after football players, according to Dr. Viviane Ugalde, physician and medical director for The Center Foundation's concussion program. "Concussions happen from either direct blows to the head, collision with another player, where

A concussion occurs when the brain and brain fluid are shaken due to impact, according to Ugalde. To better describe a concussion she off ered an analogy used by Dr.Kevin Cuskiewic,a PhD and athletic trainer at the University of North Carolina. He said to imagine

the head as an egg and if the shell, or skull, suffers impact, the egg yolk and whites will experience movement inside the shell. So although studies have been conducted to develop a helmet for soccer, helmets only help prevent skull fractures, not concussions. "The natural response (to impact) is that your head is going to move backward and then forward. When that happens there's a disruption of the metabolism of the nerve cells in the brain," said Ugalde. And it's that disruption that causes a concussion and the subsequent symptoms lik e headaches,dizziness,fatigue and changes in memory and attention. Ugalde said there's a hint that strengthening neck muscles

and working on form when heading the ball could help to lessen the risk of concussion. "Neck muscles have been thought to be important when reducing your risk (for concussion). You want less rotational risk in your head. There's a hint that might (be) helpful," said Ugalde.

Protect knees

Soccer is also full of sprinting, jumping and quick pivoting to move the ball. In soccer, probably the collision is the No. l mechanism that up and down the field. It's those quick turns and jumps that seems to causesthe concussion,"said Ugalde. be the root of other common injuries, including tears of the anterior you might have an abrupt start and stop, or a hit in the head with

Page 40

FALL/ WINTER 2013â&#x20AC;˘ HIGH DESERTPULSE

Get ready(INDOORSOCCER cruciate ligament of the knee, or ACL, and chondromalacia patella, a softening and subsequent wearing down of the joint's cartilage on the backside of the kneecap. Also possible is patellofemoral pain, which can also include a wearing down of the cartilage but has a more general diagnosis and list of symptoms that include pain and symptoms originating from the patellofemoral joint, according to Dr. Christine Pollard, associate professor and exercise and sport science director of Oregon State University-Cascades's FORCE Laboratory, where human movement is studied in an effort to reduce injury. Pollard has focused her research in the past 10 years on studying knee and ACL inuries. "Most of the work has been ways to improve injury prevention," said Pollard. "We know that there's a whole host of injuries that females have a greater disposition to as compared to males. For example, risk of

The best method for reducing the chance of injury in the lower extremities lies in strengthening, flexibility, plyometrics and good form. "Strengthening the lower extremity muscles is essential ... Strengthening is working on neuromechanics like lunges and ... doing it with really good form," said Pollard. Plyometric exercises, which involve bursts of muscular exertion as seen in jumping, can help with strengthening. These types of exercises include lunges, single-leg hopping over a cone or lateral or backward hops. Pollard also recommends working with a personal trainer, athletic trainer or a physical therapist first to learn the proper

form. "Learn good form and then do it in front of the mirror," said Pollard. That will ensure you're landing and moving correctly. And, before playing soccer, players should warm up their muscles with a stretching session.

non-contact ACL injury in females is four to eight times greater than

For Groshong, who started playing soccer at age 5 and played for in males. The incidence of these injuries vary across different sports Bend High and George Fox University until she suffered a careerand age ofathlete," said Pollard. ending injury, soccer challenged her physically and gave her an inPollard has seen positive results in reducing knee injury after re- credible sense of camaraderie. "For me soccer brought on every kind of challenge you won't find training women athletes on proper landing technique. "Females have a movement pattern that is different than males. What we see is a in the classroom. It challenged me physically to the point where I collapsing in at the knees ... During sports like soccer you do a fair became so passionate about it I thrived on it and I got in my own amount of landing or running and changing directions quickly ... zone for every game. It also taught me the value of friendships and When (women) go to change direction, their knee collapses inward." teammates and helping others out." •

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Page41

Cover story(SYNESTHESIA

with the colored refrigerator magnets. They were able to find 11 prove invaluable to understanding problems when the wiring goes grapheme-color synesthetes whose color associations were star- wrong. Synesthetes, Thomson said, with their unusual connections tlingly similar letter-color pairings to the refrigerator magnets. betw e en different regions of the brain but no disability or dysfuncThe researchers say even the high degree of correlation between tion because of it, make ideal test subjects. "It's a really unusual thing to find in nature," she said. "Because in the magnets and synesthete pairings don't support the theory that synesthetes are simply remembering the color ofthe magnets. The autism or schizophrenia, depression or Parkinson's, these diseases pairings are perception, not simply memories. Mask- III I are so pathological that you have certain abnormaliing and Stroop tests can show this conclusively. It S a really ties between certain regions, but really your whole And of course, not everybody who played with brain is affected. But in synesthesia, you're really the magnets develops synesthesia, and it appears otherwise healthy." that not all synesthetic pairings are learned. But Wit- tOfindin nggUre That allows researchers to study connections bethoft does believe that synesthesia is fundamentally tween brain regions in isolation, and perhaps, learn tied to learning. Learning could also help to explain Be C auSein a u t iSm more about how abnormal connections between rehow connections are pruned away. gions might affect or even cause more problematic I "The standard learning story is one about corp conditions. Researchers might know more about synesthesia Witthoft said, quoting a theory outlined by David if it were more of a disorder. Certainly some synHebbs in 1949. "So if things tend to co-occur in time P arkinSOn'S, theSe est hetes have trouble with their associations, paror spacethey become associatedand the neurons ticularly as children when they can't inhibit or tone that represent them become strongly connected. If down the sensations. Thomson often gets emails two connected neurons represent things that don't p p fhO/Og/<p/thpp from parents of children who struggle with math or co-occur, then their connection dies." spelling because of it. "Their kids can't do math because they won't put The process of learning in some individuals might yOu haVe Certain reinforce certain connections, say between a letter x and yon the same side of the equation, because they're brown and yellow and they don't like those and color, ingraining those pathways further, leading to a synesthetic pairing. By adulthood or even Qe~een Ceggin colors together," she said. adolescence, those connections might be so hardBut most synesthetes find the trait more helpwired that new correlations can no longer be made. regiOnS, butreally ful a nd enjoyable than burdensome, and therefore don't seek any sort of treatment or help. "People with synesthesia are fierce in telling us Yet some adults have developed synesthesia later iSgtfeCtedgUtin that it is not a disorder," Maurer said. "In fact they in life. In July, doctors at St. Michael's Hospital in feel privileged. Their worlds are richer than the rest

epression or

Toronto reported only the second known case of SyneStheSia,yOu're of u s whodon'thavesynesthesia." acquired synesthesia. About nine months after a That also means there aren't scores of researchY stroke, a patient noticed that words written in a cerers looking for a fix. Until recently, that's delegated tain shade ofblue evoked a strong feeling ofdisgust. synesthesia to an oddity, a topic of conversation at Raspberries, which he didn't eat much before his cocktail parties, but certainly not a major subject for stroke, now tasted blue, and high-pitched brass in- — Dr S«ffieThomson investigation. "Neurology is full of what we call anomalies, odd struments, like those in the James Bond theme song, led to feelings of ecstasy and light blue flashes. phenomena that have been brushed aside, staring Doctors suggested his synesthesia might have been caused as you in the face — very, very compelling and vivid and really trouhis brain tried to repair itself after his stroke, creating new connec- bling to the patients sometimes or at least really compelling for the tions between different regions of the brain. patient," Ramachandran, the UCSD researcher, said."They've been The only other known case involved a Texas woman who had a ignored by physicians and scientists because they didn'tmake any stroke affecting a portion of her brain controlling motor function. sense, theydidn't fit the big picture of science." In the years after her stroke, when she heard certain sounds, she R a m achandran said to make it into mainstream science, a phefelt tingling and other sensations in the left side of her body, espe- nomenon must be real and replicable, there must be a plausible cially in her left arm. Again her doctors believed the synesthesia was underlying mechanism, and there has to be a broader implication caused by the brain repairing and rewiring itself around the lesion to studying it. When all three conditions are met, science takes an caused by the stroke. interest. "That's what happened with synesthesia over the past 20 years," Unraveling how the brain initially gets wired — and in cases of stroke, rewired — helps to explain basic brain function and could he said.

hep/fhy"

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Page42

FALL/WINTER 2013• HIGH DESERTPULSE

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ASSISTED LIVING

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CANCER CARE

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GENERAL DENTISTRY

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Coombe and Jones Dentistry

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Advanced Spedalty Care

2084 NE Professional Court• Bend

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GENERALSURGERY Er,BARIATRICS

St. Charles Surgical Specialists

1245 NW 4th Street, Ste 101• Redmond

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GERIATRICCARE MANAGEMENT

Paul Battle Associates

Serving Deschutes County

877-8G7-1437

HOME HEALTH SERVICES

St. Charles Home Health

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HOSPICE/HOME HEALTH

Hospice of Redmond

732 SW 23rd St• Redmond

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Partners In Care

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Internal Medicine Associates of Redmond

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r 1245 NW 4th Street, Ste 201• Redmond

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Kast CascadeWomen's Group, P.C.

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2200 NENeffRoad,Suite 302 • Bend

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Healing Bridge Physical Therapy

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Cascade Foot Clinic

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PULMONOLOGY

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RADIOLOGY

Central Oregon Radiology Associates, P.C.

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2600 NE Neff Road• Bend

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UROLOGY

Send Urology Associates

Locations in Bend Ltt Redmond

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Urology Specialists of Oregon

1247 NE Medical Center Drive• Bend

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VASCULAR SURGERY

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

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VEIN SPECIALISTS

Inovia Vein Specialty Center

2200 NE Neff Road, Ste 204• Bend

541-382-8346

VEIN SPECIALISTS

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

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2542 NE Courtney Dr• Bend

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2542 NE Courtney Dr• Bend

541-706-7730

www.stcharleshealthcare.org

2542 NE Courtney Dr• Bend

541-706-7730

www.stcharleshealthcare.org

REBECCA SCRAFFORD, PSYD St. Charles Behavioral Health

SCOTT SAFFORD, PHD

St. Charles Family Care

KIMBERLY SWANSON, PHD

St. Charles Family Care

1245 NW 4th Street, Ste 101• Redmond 541-548-77GI w

ww. s tcharleshealthcare.org

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

www.stcharleshealthcare.org

211 NW Larch Ave• Redmond

541-548-2164

www.stcharleshealthcare.org

2500 NE Neff Road• Bend

541-388-4333

www. s tcharleshealthcare.org

HUGH ADAIRIH,DO

St. Charles Heart gt Lung Spedalists

CATHERINE BLACK, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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JEANBROWN,PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

NAHEL FARRAJ, DO

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

RICK KOCH, MD

Bend Memorial Clinic

Bend Eastside gt Redmond

541-382-4900

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JAMES LAUGHLIN,MD

St. Charles Heart gt Lung Specialists

2500 NE Neff Road• Bend

541-388-4333

www. stcharleshealthcare.org

BRUCE MCLELLAN, MD

St. Charles Heart gt Lung Specialists

2500 NE Neff Road• Bend

541-388-4333

www. s tcharleshealthcare.org

GAVIN L.NOBLE, MD

Send Memorial Clinic

Bend Eastside 8t Redmond

541-382-4900

www .bendmemorialclinic.com

STEPHANIE SCOTT, PA-C

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

2500 NE Neff Road• Bend

541-388-4333

www. s tcharleshealthcare.org

1501 NE Medical Center Drive• Bend

541-382-4900

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JASON WEST, MD

Send Memorial Clinic

MICHAEL WIDMER, MD

St. Charles Heart gt Lung Specialists

JASON R. WOLLMUTH, MD

Send Memorial Clinic

EDDY YOUNG,MD

St. Charles Heart gt Lung Spedalists

2500 NE Neff Road• Bend

541-388-4333

www. s tcharleshealthcare.org

JOHN D. BLIZZARD, MD

St. Charles Heart gt Lung Specialists

2500 NE Neff Road• Bend

541-388-1G3G

www. stcharleshealthcare.org

ANGELO A.VLESSIS, MD

St. Charles Heart gt Lung Specialists

2500 NE Neff Road• Bend

541-388- IG3G w

ww. stcharleshealthcare.org

2 013 CE N T RA L O R E G O N

ADVERTISINGSUPPLEMENT

M E D I CA L D I RECTORY

JORDAN T.DOI,MSC, DC

NorthWest Crossing Chiropractic t)t Health

628 NW York Dr, Ste. 104• Bend

541- 3 8 8-2429

www.nwxhealth.com

THERESA M. RUBADUE,DC, CCSP

NorthWest Crossing Chiropractic t)t Health

G28 NW York Dr, Ste. 104• Bend

541-388-2429

www.nwxhealth.com

1345 NW Wall St, Ste 202• Bend

541-318-1000

JASONM. KREMER,DC,CCSP, CSCS Wellness Doctor

ww w.bendwellnessdoctor.com

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

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ALYSSA ABBEY, PA-C

Bend Memorial Clinic

2G00 NE Neff Road• Bend

541-382-4900

www.bendmemorialclinic.com

ANGELA COVINGTON,MD

Bend Memorial Clinic

Bend gr Redmond

541-382-4900

www.bendmemorialclinic.com

MARK HALL, MD

CentralOregon Dermatology

388 SWBluffDr • Bend

541-678-0020

www.centraloregondermatology.com

JAMES M. HOESLY, MD

Bend Memorial Clinic

2G00 NE Neff Road• Bend

541-382-4900

www.bendmemorialclinic.com

GERALDE.PETERS,MD,DS(MOHS)

Bend Memorial Clinic

2G00 NE Neff Road• Bend

541-382-4900

www.bendmemorialclinic.com

ANNM. REITAN, PA-C (MOHS)

Bend Memorial Clinic

2600 NE Neff Road• Bend

541-382-4900

www.bendmemorialclinic.com

MARY F. CARROLL, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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RICKN.GOLDSTEIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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TONYA KOOPMAN, MSN, FNP-BC Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1 -382-4900 w ww .bendmemorialclinic.com

PATRICK MCCARTHY, MD

EndocrinologyServices NW

929 SWSimpson Ave,Ste220 • Bend

541-317-5600

n/a

TRAVIS MONCHAMP, MD

EndocrinologyServices NW

929 SWSimpson Ave,Ste 220 • Bend

541-317-5600

n/a

CAREY ALLEN, MD

St. Charles Family Care

1103 NE Elm Street• Prineville

541-447-6263

www .stcharleshealthcare.org

HEIDI ALLEN, MD

St. Charles Family Care

1103 NE Elm Street• Prineville

541-447-6263

www .stcharleshealthcare.org

THOMAS L.ALLUMBAUGH, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www. stcharleshealthcare.org

KATHLEEN C. ANTOLAK, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

ww w.bendmemorialclinic.com

865 SW Veterans Way• Redmond

541-382-4900

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G30 Arrowleaf Trail• Sisters

541-549-1318

www .stcharleshealthcare.org

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

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I I

SADIE ARRINGTON,MD

Bend Memorial Clinic

JOSEPH BACHTOLD, DO

St. Charles Family Care

JEFFREY P.BOGGESS, MD

Bend Memorial Clinic

BRANDON W. BRASHER, PA-C

St. Charles Family Care

1103 NE Elm Street• Prineville

541-447-6263

www .stcharleshealthcare.org

SHANNON K. BRASHER, PA-C

St. Charles Family Care

1103 NE Elm Street• Prineville

541-447-6263

www .stcharleshealthcare.org

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 Avenue• 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

LINDA C. CRASKA, MD

St. Charles Family Care

1103 NE Elm Street• Prineville

541-447-6263

www .stcharleshealthcare.org ww w.bendmemorialclinic.com

AUDREY DAVEY, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

JAMES K. DETWILER, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www .stcharleshealthcare.org

MAY S. FAN, MD

Bend Memorial Clinic

231 East Cascades Avenue• Sisters

541-549-0303

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JAMIE FREEMAN, PA-C

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w.highlakeshealthcare.com

MARK GONSKY,DO

St. Charles Family Care

2965 NE Conners Ave,Suite 127 • Bend

541-706-4800

www .stcharleshealthcare.org

STEVEN GREER, MD

St. Charles Family Care

G30 Arrowleaf Trail• Sisters

541-549-1318

www .stcharleshealthcare.org

BRIANNA HART, PA-C

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www .stcharleshealthcare.org

ALAN C. HILLES, MD

Bend Memorial Clinic

Redmond A Sisters

541-382-4900

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SING-WEI HO, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www. stcharleshealthcare.org

2 013 CE N T RA L O R E G O N

M E D I CA L D I RECTORY

PAMELA J. IRBY, MD

St. Charles Family Care

MAGGIE J. KING, MD

St. Charles Family Care

DAVID KELLY, MD

High Lakes Health Care Upper Mill

PETER LEAVITT, MD

211 NW Larch Avenue• Redmond

541-548-2164

ADVERTISINGSUPPLEMENT

www .stcharleshealthcare.org

1103 NE Elm Street• Prineville

541-447-6263

www .stcharleshealthcare.org

929 SW Simpson Avenue• Bend

541-389-7741

www . highlakeshealthcare.com

St. Charles Family Care

2965 NE Conners Ave,Suite 127 • Bend

541-706-4800

www .stcharleshealthcare.org

CHARLOTTE LIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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KAE LOVERINK, MD

High Lakes Health Care Redmond

1001 NW Canal Blvd• Redmond

541-504-7635

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STEVE MANN, DO

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

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JOE T. MC COOK, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

LORI MCMILLIAN, FNP

Redmond Medical Clinic

1245 NW 4th Street, Ste 201• Redmond

541-323-4545

n/a

EDEN MILLER, DO

High Lakes Health Care Sisters

354 W Adams Avenue• Sisters

541-549-9G09

www.highlakeshealthcare.com

KEVIN MILLER,DO

High Lakes Health Care Sisters

354 W Adams Avenue• Sisters

541-549-9G09

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JESSICAMORGAN, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

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DANIEL J. MURPHY, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www .stcharleshealthcare.org www .stcharleshealthcare.org

www.stcharleshealthcare.org

SHERYL L. NORRIS, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

AUBREY PERKINS, FNP

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www .stcharleshealthcare.org

JANEY PURVIS, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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KEVIN REUTER, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

www . highlakeshealthcare.com

DANA M. RHODE, DO

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

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HANS G. RUSSELL, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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JEFFERY SCOTT, DO

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

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ERIC J. SCHNEIDER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www . bendmemorialclinic.com

CINDY SHUMAN, PA-C

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

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EDWARD M. TARBET, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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JOHN D. TELLER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www. bendmemorialclinic.com

NATHAN R.THOMPSON, MD

St. Charles Family Care

MATTIE E. TOWLE, MD

Bend Memorial Clinic

LISA URI, MD

211 NW Larch Avenue• Redmond

541-548-2164

www .stcharleshealthcare.org

1501 NE Medical Center Drive• Bend

541-382-4900

ww w .bendmemorialclinic.com

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

www . highlakeshealthcare.com

MARK A. VALENTI, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www .stcharleshealthcare.org

THOMAS A. WARLICK, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

ww w.bendmemorialclinic.com

BRUCEN. WILLIAMS, MD

St. Charles Family Care

1103 NE Elm Street• Prineville

541-447-6263

www. s tcharleshealthcare.org

RICHARD H. BOCHNER, MD

Bend Memorial Clinic

Bend Eastside tk Redmond

541-382-4900

www. bendmemorialclinic.com

54 1 -382-4900

www. bendmemorialclinic.com

541-382-4900

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ELLEN BORLAND, MS, RN, CFNP Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

ARTHUR S. CANTOR, MD

Bend Memorial Clinic

Bend Eastside tk Redmond

HEIDI CRUISE, PA-C, MS

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1 -382-4900

www . bendmemorialclinic.com

CHRISTINA HATARA, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1 -382-4900

www.bendmemorialclinic.com ww w.bendmemorialclinic.com

SIDNEY E. HENDERSON III, MD Bend Memorial Clinic

Bend Eastside tk Redmond

541-382-4900

SANDRA K.HOLLOWAY, MD

Bend Memorial Clinic

Bend Eastside tk Redmond

541-382-4900

ww w .bendmemorialclinic.com

GLENN KOTEEN, MD

Gastroenterology of Central Oregon

2450 Mary Rose Place, Ste 210• Bend

54 1 -728-0535

www . gastrocentraloregon.com

JENIFER TURK, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1 -382-4900

www.bendmemorialclinic.com

MATTHEW WEED, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

54 1 -382-4900

www.bendmemorialclinic.com

JANE BIRSCHBACH,MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

www . highlakeshealthcare.com

SUSAN GORMAN, MD

High Lakes Health Care Redmond

1001 NW Canal Blvd.• Redmond

541-504-7635

www . highlakeshealthcare.com

2 013 CE N T RA L O R E G O N Send Memorial Clinic

LAURIE D'AVIGNON,MD

ADVERTISINGSUPPLEMENT

M E D I CA L D I RECTORY 541-382-4900

www.bendmemorialclinic.com

1501 NE Medical Center Drive• Bend

541-382-4900

www.bendmemorialclinic.com www.stcharleshealthcare.org

1501 NE Medical Center Drive• Bend

•l

JOHN LUTZ, MD

Send Memorial Clinic

REBECCASHERER, MD

St. Charles Infectious Disease

2965 Conners Ave, Ste 127• Bend

541-706-4878

JENESS CHRISTENSEN, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541 383 7741

JOHN CORSO,MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

CELSO A.GANGAN, MD

Redmond Medical Clinic

1245 NW 4th Street, Ste 201• Redmond

541-323-4545

MICHAEL N.HARRIS, MD

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

ANNE KILLINGBECK, MD

Internal Medicine Associates of Redmond

236 NW Kingwood Ave• Redmond

541-548-7134

ANITA D.KOLISCH, MD

Send Memorial Clinic

Bend Eastside gaRedmond

541-382-4900

MATTHEW R. LASALA, MD

Send Memorial Clinic

MADELINE LEMEE, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

www .highlakeshealthcare.com

MARY MANHKDI 3 MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w .highlakeshealthcare.com

KAREN L.OPPENHEIMER, MD

Send Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

www .bendmemorialclinic.com

H. DEREK PALMER, MD

Redmond Medical Clinic

1245 NW 4th Street, Ste 201• Redmond

541-323-4545

A. WADE PARKER, MD

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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MATTHEW REED, PA-C

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

M. SEAN ROGERS,MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

DAN SULLIVAN, MD

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900 ~ w ww.bendmemorialclinic.com

FRANCENA ABENDROTH, MD Bend Memorial Clinic

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

h shl 1 h hh« ww w .highlakeshealthcare.com

/ www .bendmemorialclinic.com www.imredmond.com

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n/a

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GREGORY FERENZ,DO

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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CRAIGAN GRIFFIN, MD

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

RICHARD KOLLER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

RAY TIEN, MD

The Center: Orthopedic St Neurosurgical Carettt Research Locations in Bend ga Redmond

541-382-3344

www. t hecenteroregon.com

BRAD WARD, MD

The Center: Orthopedic St Neurosurgical Care tit Research Lo c ations in Bend gt Redmond

541-382-3344

www. t hecenteroregon.com

ANNIE BAUMANN,RD, LD

Send Memorial Clinic

541-382-4900

www .bendmemorialdinic.com

1501 NE Medical Center Drive• Bend

ANN-BRIDGET BIRD,MD

St. Charles OB/GYN

Locationsin Redmond ga Prineville

5 4 1 - 526-6635

www.stcharleshealthcare.org

BRENDAHINMAN, DO

St. Charles OB/GYN

Locationsin Redmond ga Prineville

5 4 1 - 526-6635

www.stcharleshealthcare.org

NATALIE HOSHAW, MD

St. Charles OB/GYN

Locations in Redmond gt Prineville

54 1 - 526-6635

www.stcharleshealthcare.org

AMY B. MCELROY, FNP

St. Charles OB/GYN

Locationsin Redmond ga Prineville

5 4 1 - 526-6635

www.stcharleshealthcare.org

CLARE THOMPSON, DNP, CNM

St. Charles OB/GYN

Locationsin Redmond ga Prineville

5 4 1 - 526-6635

www.stcharleshealthcare.org

JAMES NELSON, MD

The Center:Orthopedic ttt NeurosurgicalCareStResearch Locations in Bend ga Redmond

541-382-3344

www.thecenteroregon.com

LARRY PAULSON, MD

The Center:Orthopedic gtNeurosurgical Care SResearch Locations in Bend ga Redmond

541-382-3344

www.thecenteroregon.com

ROB BOONE, MD

St. Charles Cancer Center

Locations in Bend St Redmond

541-706-5800

www. s tcharleshealthcare.org

THEODORE A.BRAICH, MD

Send Memorial Clinic

Bend Eastside gaRedmond

541-382-4900

www .bendmemorialclinic.com

CORA CALOMENI,MD

St. Charles Cancer Center

Locations in Bend gt Redmond

541-706-5800 ~ w w w.stcharleshealthcare.org

ADVERTISINGSUPPLEMENT

2 013 CE N T RA L O R E G O N I

M E D I CA L D I RECTORY

Locations in Bend LrrRedmond

541-706-5800

www. s tcharleshealthcare.org

Bend Eastside LcrRedmond

541-382-4900

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St. Charles Cancer Center

Locations in Bend gt Redmond

541-706-5800

www. s tcharleshealthcare.org

BILL MARTIN,MD

St. Charles Cancer Center

Locations in Bend gt Redmond

541-706-5800

www. s tcharleshealthcare.org

BENJAMIN J.MIRIOVSKY, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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LAURIE RICE, ACNP

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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WILLIAM SCHMIDT, MD

Send Memorial Clinic

Bend Eastside LcrRedmond

541-382-4900

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Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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SUSIE DOEDYNS, FNP

St. Charles Cancer Center

BRIAN L. ERICKSON, MD

Send Memorial Clinic

STEVE KORNFELD, MD

HEATHER WEST, MD I

LINYEE CHANG, MD

St. Charles Cancer Center

2500 NE Neff Road• Bend

541-70 6 - 7733

www.stcharleshealthcare.org

DHARA MACDERMED, MD

St. Charles Cancer Center

2500 NE Neff Road• Bend

541-70 6 - 5800

www.stcharleshealthcare.org

RUSS OMIZO, MD

St. Charles Cancer Center

2500 NE Neff Road• Bend

541-70 6 -7733

www.stcharleshealthcare.org

54 1 -322-5753

www.u rologyinoregon.com

MATTHEWN. SIMMONS

Urology Specialists of Oregon

1247 NE Medical Center Drive• Bend

BRIAN P. DESMOND, MD

Send Memorial Clinic

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

www.bendmemorialclinic.com

THOMASD, FITZSIMMONS,MD,MPH Send Memorial Clinic

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

www.bendmemorialclinic.com

ROBERT C.MATHEWS, MD

Bend Memorial Clinic

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

SCOTT T. O'CONNER, MD

Bend Memorial Clinic

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

DARCY C. BALCER, OD

Send Memorial Clinic

LORISSA M. HEMMER, OD

Send Memorial Clinic

Bend Eastside LtrWestside

Bend Eastside, Westside 8a Redmond 54 1-382-4900

KEITH E. KRUEGER, DMD, PC Keith K. Krneger, DMD, PC I '

I '

541-382-4900

1475 SW Chandler, Ste 101• Bend 5 4 1 - 6 17-3993

[

www.bendmemorialclinic.com www.bendmemorialclinic.com

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AARON ASKEW, MD

Desert Orthopedics

Locations in Bend LrrRedmond

541-388-2333

www.desertorthopedics.com

ANTHONY HINZ, MD

The Center: Orthopedic tit Neurosurgical CaregtResearch

Locations in Bend gaRedmond

541-382-3344

www.thecenteroregon.com

JEFFREY P. HOLMBOE, MD

The Center: Orthopedic tit Neurosurgical Caretit Research

Locations in Bend gt Redmond

541-382-3344

www.thecenteroregon.com

JOEL MOORE, MD

The Center: Orthopedic tlt Neurosurgical Care tit Research

Locations in Bend gt Redmond

541-382-3344

www.thecenteroregon.com

KNUTE BUEHLER, MD

The Center: Orthopedic tit Neurosurgical Care St Research

Locations in Bend gaRedmond

541-382-3344

www.thecenteroregon.com

MICHAEL CARAVELLI,MD

The Center: Orthopedic tit Neurosurgical CaregtResearch

Locations in Bend gaRedmond

541-382-3344

www.thecenteroregon.com

ERIN FINTER, MD

Desert Orthopedics

Locations in Bend gt Redmond

541-388-2333

www.desertorthopedics.com

JAMES HALL, MD

The Center: Orthopedic tlt Neurosurgical Care tit Research

Locations in Bend tta Redmond

541-382-3344

www.thecenteroregon.com

ROBERT SHANNON, MD

Desert Orthopedics

Locations in Bend LrrRedmond

541-388-2333

www.desertorthopedics.com

I '

MICHAEL RYAN, MD

Desert Orthopedics

1303 NE Cushing Dr, Ste 100• Bend 541-388-2333

www.desertorthopedics.com

GREG HA, MD

Desert Orthopedics

1303 NE Cushing Dr, Ste 100• Bend

54 1 - 388-2333

www. d esertorthopedics.com

KATHLEEN MOORE, MD

Desert Orthopedics

1303 NE Cushing Dr, Ste 100• Bend

54 1 - 388-2333

www. d esertorthopedics.com

I '

2 013 CE N T RA L O R E G O N I '

I '

ADVERTISINGSUPPLEMENT

M E D I CA L D I RECTORY

TIMOTHY BOLLOM, MD

The Center: Orthopedic tit Neurosurgical Care ttt Research

Locations in Bend gaRedmond

541-382-3344

www.thecenteroregon.com

BRETT GINGOLD,MD

Desert Orthopedics

1315 NW 4th Street• Redmond

541-388-2333

www.desertorthopedics.com

SCOTT T. JACOBSON, MD

The Center: Orthopedic gt Neurosurgical Care tit Research

Locations in Bend gaRedmond

541-382-3344

www.thecenteroregon.com

BLAKE NONWEILER, MD

The Center: Orthopedic gt Neurosurgical Care tit Research

Locations in Bend gaRedmond

541-382-3344

www.thecenteroregon.com

54 1 - 388-2333 I

www .desertorthopedics.com

I '

CARA WALTHER, MD I '

I '

Desert Orthopedics

1303 NE Cushing Dr, Ste 100• Bend

MICHAEL COE,MD

The Center: Orthopedic tit Neurosurgical Care ttt Research

Locations in Bend gt Redmond

541-382-3344

www.thecenteroregon.com

KENNETH HANINGTON, MD

De s ert Orthopedics

Locations in Bend gt Redmond

541-388-2333

www.desertorthopedics.com

The Center: Orthopedic tit Neurosurgical Care ttt Research

Locations in Bend gt Redmond

541 - 382-3344

www.thecenteroregon.com

The Center: Orthopedic tit Neurosurgical Care ttt Research

Locations in Bend gt Redmond

541 - 382-3344

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I '

SOMA LILLY, MD JAMES VERHEYDEN, MD I

I ' I ' I

MOLLY OMIZO, MD

Deschutes Osteoporosis Center

JENNIFER BLECHMAN, MD

St. Charles AdvancedIllness Management

LISA LEWIS, MD

Partners in Care

2200 NE Neff Road, Suite 302• Bend

541 - 388-3978 ww w deschutesosteoporosiscentercom

www.stcharleshealthcare.org

2500 NE Neff Road• Bend

541-706-5885

2075 NE Wyatt Ct• Bend

541-382-5882

www.partnersbend.org

541-706-5885

www.stcharleshealthcare.org

541-706-5885

www.stcharleshealthcare.org

RICHARD J. MAUNDER, MD

St. Charles AdvancedIllness Management

2500 NE Neff Road• Bend

LAURA K. MAVITY, MD

St. Charles AdvancedIllness Management

2500 NE Neff Road• Bend

STEPHANIE CHRISTENSEN, DMD Deschutes Pediatric Dentistry

1475 SW Chandler Ave, Ste• Bend

541- 3 89-3073

www.deschuteskids.com

STEVE CHRISTENSEN, DMD

Deschutes Pediatric Dentistry

1475 SW Chandler Ave, Ste• Bend

541- 3 89-3073

www.deschuteskids.com

KATE L. BROADMAN, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

54 1 - 3 82-4900 w ww . bendmemorialclinic.com

THOMASN. ERNST, MD

St. Charles Family Care

MICHELLE MILLS, MD

Bend Memorial Clinic

211 NW Larch Ave• Redmond

541-548-2164

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

211 NW Larch Ave• Redmond

541-548-2164

www.stcharleshealthcare.org

[

www.bendmemorialclinic.com

MARGARET J. PHILP, MD

St. Charles Family Care

JENNIFER SCHROEDER, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

JB WARTON, DO

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

ROBERT ANDREWS, MD

Desert Orthopedics

Locations in Bend gaRedmond

541-388-2333

LINDA CARROLL, MD

High Lakes Health Care Upper Mill

TIM HILL, MD

The Center: Orthopedic tit Neurosurgical Care ttt Research

NANCY H. MALONEY, MD

Bend Memorial Clinic

JAMES NELSON, MD

The Center: Orthopedic tit Neurosurgical Care ttt Research

Locations in Bend gaRedmond

541-382-3344

www . thecenteroregon.com

LARRY PAULSON, MD

The Center: Orthopedic tit Neurosurgical Care ttt Research

Locations in Bend gaRedmond

541-382-3344

www . thecenteroregon.com www . thecenteroregon.com

929 SW Simpson Avenue• Bend Locations in Bend gaRedmond 1501 NE Medical Center Drive• Bend

www.stcharleshealthcare.org

www.bendmemorialclinic.com www.bendmemorialclinic.com

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541-389-7741 w w w.highlakeshealthcare.com 541-382-3344

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DAVID STEWART, MD

The Center: Orthopedic tit Neurosurgical Care ttt Research

Locations in Bend gaRedmond

541-382-3344

JON SWIFT, DO

Desert Orthopedics

Locations in Bend gaRedmond

541-388-2333

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VIVIANE UGALDE,MD

The Center: Orthopedic tit Neurosurgical Care ttt Research

Locations in Bend gaRedmond

541-382-3344

www . thecenteroregon.com

MARC WAGNER, MD

The Center: Orthopedic tit Neurosurgical Care tit Research

Locations in Bend St Redmond

541-382-3344

www . thecenteroregon.com

AMBROSE K. SU, DPM

Cascade Foot Clinic

2408 NE Division Street• Bend

541-3 8 8 -2861

DEAN NAKADATE, DPM

Deschutes Foot gr Ankle

929 SW Simpson Ave,Ste 220 • Bend

www.cascadefoot.com

541 - 317-5600 www.deschutesfootandankle.com

2 013 CE N T RA L O R E G O N BROOKE HALL, MD I

ADVERTISINGSUPPLEMENT

M E D I CA L D I RECTORY

St. Charles Preoperative Medicine

2500 NE Neff Road• Bend

541-70 6 -2949 ( w ww.stcharleshealthcare.org

JONATHON BREWER, DO

Send Memorial Clinic

JAMIE DAVID CONKLIN, MD

St. Charles Pulmonary Clinic

LOUIS D'AVIGNON,MD

Send Memorial Clinic

ERIC S. DILDINE, PA-C

St. Charles Pulmonary Clinic

T. CHRISTOPHER KELLEY, DO Bend Memorial Clinic

Bend Eastside A Redmond

541-382-4900

www.bendmemorialclinic.com

Locations in Bend A Redmond

541-70G-7715

www.stcharleshealthcare.org

Bend Eastside A Redmond

541-382-4900

Locations in Bend A Redmond

541-70G-7715

Bend Eastside A Redmond

541-382-4900

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1501 NE Medical Center Drive• Bend

541-382-4900

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Locations in Bend & Redmond

541-70G-7715

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JONATHONMCFADYEN, NP

Send Memorial Clinic

KEVIN SHERER, MD

St. Charles Pulmonary Clinic

NOREEN C. MILLER, FNP

St. Charles Rehabilitation Center

2500 NE Neff Road• Bend 5

GREG BORSTAD,MD

Bend Memorial Clinic

Bend Eastside Bt Redmond

541-382-4900

www .bendmemorialclinic.com

CHRISTINA BRIGHT, MD

Send Memorial Clinic

Bend Eastside A Redmond

541-382-4900

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DAN FOHRMAN,MD

Deschutes Rheumatology

2200 NENeffRoad,Suite 302 • Bend

541-388-3978

www.bendarthritis.com

HEATHERHANSEN-DISPENZA, MD

Deschutes Rheumatology

2200 NENeffRoad,Suite 302 • Bend

541-388-3978

www.bendarthritis.com

TIANNA WELCH, PA

Deschutes Rheumatology

2200 NE Neff Road, Suite 302• Bend

54 1 -388-3978

www.bendarthritis.com

JONATHON BREWER, DO

Bend Memorial Clinic Sleep Disorders Center

ARTHUR K. CONRAD, MD DAVID L. DEDRICK, MD

www .bendmemorialclinic.com

St. Charles Sleep Center

Locations in Bend ¹r Redmond

541-706-6905

www . stcharleshealthcare.org

St. Charles Sleep Center

Locations in Bend A Redmond

541-70G-G905

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Bend Eastside 8t Redmond

541-382-4900

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Redmond Wellnessgt Chiropractic

1655 SW Highland Ave, Ste 6• Redmond 541-923-2019

TIMOTHY L.BEARD, MD, FACS

Send Memorial Clinic

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

DAVID CARNE,MD

St. Charles Surgical Specialists

DARA H. CHRISTANTE, MD

Bend Memorial Clinic

GARY J. FREI, MD, FACS

Send Memorial Clinic

JACK W. HARTLEY, MD, FACS

St. Charles Surgical Specialists

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DAVID HERRIN, DC

41-70 6 -7725 w

Bend Eastside Bt Redmond

T. CHRISTOPHER KELLEY, DO Bend Memorial Clinic Sleep Disorders Center I

www.stcharleshealthcare.org

DARREN M.KOWALSKI, MD, FACS Bend Memorial Clinic

1201 NE Elm ~ Prineville

541-447-6263

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

Bend Eastside 0 Redmond

541-382-4900

1245 NW 4th Street, ¹101• Redmond 541 -548-77G1 1501 NE Medical Center Drive• Bend 541-382-4900

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JOHN C. LAND, MD, FACS

St. Charles Surgical Spedalists

1245 NW4th Street, ¹101• Redmond 54 1 - 548-7761

ANDREW SARGENT, PA-C,MS

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www.bendmemorialclinic.com

GEORGE T.TSAI, MD, FACS

St. Charles Surgical Specialists

1245 NW 4th Street, ¹101• Redmond

541-548-77G1

www.stcharleshealthcare.org

JEANNE WADSWORTH,PA-C,M S

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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ERIN WALLING,MD, FACS

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

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JEFF CABA, PA-C

Send Memorial Clinic

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

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ANNCLEMENS, MD

Send Memorial Clinic

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

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TERESA COUSINEAU, PA-C

Bend Memorial Clinic

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

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MIKE HUDSON, MD

St. Charles Immediate Care

J. RANDALL JACOBS,MD

Send Memorial Clinic

541-70G-3700 Bend Eastside, Westside A Redmond 5 4 1 -382-4900

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2 013 CE N T RA L O R E G O N

M E D I CA L D I RECTORY

ADVERTISINGSUPPLEMENT

s AMEE KOCH, PA-C

Bend Memorial Clinic

Bend Eastside, Westside gt Redmond

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JIM MCCAULKY, MD

Bend Memorial Clinic

Bend Eastside, Westside gt Redmond

541-382-4900

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TKRRACK MUCHA, MD

Send Memorial Clinic

Bend Eastside, Westside gt Redmond

541-382-4900

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JAY O'BRIEN, PA-C

Bend Memorial Clinic

Bend Eastside, Westside gt Redmond

541-382-4900

CASEYOSBORNE-RODHOUSE, PA-C

Bend Memorial Clinic

Bend Eastside, Westside gt Redmond

541-382-4900

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LAURIK D. PONTK, MD

Bend Memorial Clinic

Bend Eastside, Westside gt Redmond

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JKNNIFKR L. SURBKR, MD

Send Memorial Clinic

Bend Eastside, Westside gt Redmond

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PATRICK L. SIMNING, MD

Bend Memorial Clinic

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SEAN SUTTLE, PA-C

Bend Memorial Clinic

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THOMAS H. WKNDEL, MD

Bend Memorial Clinic

Bend Eastside, Westside gt Redmond

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BRKNT C. WKSKNBKRG, MD

Send Memorial Clinic

Bend Eastside, Westside gt Redmond

541-382-4900

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MEREDITH BAKER, MD

Bend Urology Assodates

2090 NE Wyatt Court• Bend

541-382-G447

www.bendurology.com

MICHKL BOILKAU, MD

Send Urology Associates

2090 NE Wyatt Court• Bend

541-382-G447

www.bendurology.com

JACK BREWER, MD

Send Urology Associates

ANDREW NEEB, MD

Urology Spedalists of Oregon

BRIAN O'HOLLAREN, MD

1 1

2090 NE Wyatt Court• Bend

541-382-G447

www.bendurology.com

2084 NE Professional Court• Bend

541-322-5753

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Bend Urology Assodates

2090 NE Wyatt Court• Bend

541-382-G447

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KRIC SHRKVK, MD

Send Urology Associates

2090 NE Wyatt Court• Bend

541-382-G447

www.bendurology.com

MATTHEW N. SIMMONS, MD

Urology Specialists of Oregon

2084 NE Professional Court• Bend

541-322-5753

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NORA TAKLA, MD

Bend Urology Assodates

2090 NE Wyatt Court• Bend

541-382-G447

www.bendurology.com

ROD BUZZAS, MD

Advanced Specialty Care

2084 NE Professional Court• Bend

541-322-5753

KDWARD M.BOYLE,JR.,MD,PACS

Inovia Vein Specialty Center

2200 NE Neff Road, Ste 204• Bend

541-382-834G

www.bendvein.com

ANDRKW JONES, MD, FACS

Inovia Vein Spedalty Center

2200 NE Neff Road, Ste 204• Bend

541-382-834G

www.bendvein.com

DARREN KOWALSKI, MD

Bend Memorial Clinic

I501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

JOSEPH COLELLA, MD, PACS

Send Memorial Clinic

WAYNE K. NELSON, MD

Bend Memorial Clinic

www . advancedspecialtycare.com

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

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

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•I•

P AID 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 Vigeland, Account Executive ( H e a lt h 8c Medical) 541.617.7855

Body ofkno)/I/ledge ~pop QUlz

BY MARKIAN HAWRYLUK

It's flu season. Time to get your flu shot and inoculate yourself against all the flu myths out there. How well do you know your flu facts? Check your knowledge with this quiz: Seasonal flu vaccines reduce the risk of illness in those vac• cinated by: A. 100% B.80% C.60% D. 40%

2 3

GREG CROSS

True or false: Infants can't be protected from the flu until • they turn 6and get a flu shot of their own. The flu kills, on average, 36,000Americans everyyear, • mainly due to complications such as bacterial pneumonia. Which of these groups isat higher riskfor complications from the flu? A. Children younger than 2 B.Pregnant women C. Senior citizens

D.American Indians E.All of the above What percentage of people get •theflu from the flu shot?

True or false: There's no cure for the flu. You just have to wait • it out.

What's the most dangerous type • of flu for humans? A. Human flu B.Bird flu C.Swine flu

When was the last flu pandemic? • A.The Spanish Flu, 1918-20 C.The Hong Kong Flu, 1968-69 D. H1N1 (Swine Flu), 2009-10

A. 1%

B. 10% C. 13% D. 0%

B. The Asian Flu, 1957-58

Where did the Spanish Flu originate?

• A. Madrid

How long can the flu live outside the bodyat room •temperature?

B.Barcelona C. Berlin

D. Kansas

A. 15 minutes

B. I hour C.1 day D. 2 days 1.C) On average, the seasonal flu shot reduces your risk of getting the flu by 60 percent. In some years the strains in the flu shot better match the strains circulating during flu season. Even if you still get the flu, the vaccine will help reduce the severity of your illness. 2. False: When a pregnant woman gets a flu shot, her antibodies against the flu virus are passed on to her baby. Additionally, getting the flu during pregnancy increases the risk of miscarriage, stillbirth and early term births. 3. E) All four of those groups are at higher risk for complications from the flu. 4. D) T he flu shot uses a dead vaccine. It's impossible to get the flu from the vaccine. FluMist nasal spray uses a live form of the virus that's been altered so it can't make you sick. 6. D) Flu viruses can live up to 48 hours on hard, nonporous services, and up to 12 hours on cloth or tissue. They can remain alive longer in cold temperatures and indefinitely in subfreezing temperatures. 6. False: Two antiviral treatments, Tamiflu and Relenza, can shorten the duration of illness if they are started within 48 hours of contracting the flu. Don't bother asking for antibiotics,

HIGH DESERT PULSE • FALL/WINTER 2013

Q Trueorfalse: You'regetting IJ aa flu shot this year.

though; the flu is caused by a virus and antibiotics only treat bacterial infections. Chicken soup? Eh, couldn't hurt. 7.Trick question. Most of the flu strains are combinations of flu bugs from humans, birds and pigs. Researchers worry that as different strains interact with each other, it could form a new strain of flu that is both very contagious and very deadly. 6. D) Although the 2009 HINI virus didn't prove as dangerous as health officials initially thought, it was a pandemic. 8ut the Spanish Flu is still the worst flu outbreak ever, killing SO to 100 million people worldwide, more than the battlefield casualties of World War I, World War II, the Korean War and the Vietnam War combined. 9. D) Probably. A recent analysis suggested it may have originated among pig farmers in Haskell County, Kansas. According to the theory, some of the men from the farms joined the army during WWI and brought the flu with them. When they shipped out, they may have brought the epidemic to Europe. When it returned to the U.S., the virus was even deadlier. 10.Do we really need to ask?

Page 53

One voice ~ ApERsoNALEssAY

i e essons rom orot to keep them close. She stays in touch with distant familyand plans visits. She meets new people every day through her involvement in the community. 5. Never stop giving. It's entirely possible that Dorothy may clock more hours as a retired volunteer than she did as a full-time wage earner. She picks her targets carefully, offering time to tasks and organizations that she genuinely enjoys, so giving will be a pleasure. 6. Never stop moving. Dorothy never ran a 10K or worked out with Jane Fonda, but she also rarely sat still. Between her work, her family and her desire to stay healthy, she's logged a lot of miles in her tennis shoes. 7. Never get too rooted. Remaining open to new ideas and new practices that might help keep you healthy is vital as you age. The chicken-fried steak you ate for breakfast at age 25 may not serve you well at 75. Figure

BY LESLIE PUGMIRE-HOLE

realized the other day that I am only a few years from no longer being able to say I'm middle-aged. Because reallyhow many people live to be over 100? Well, my grandmother for one. Although I never had a burning desire to live to be very, very old, it has always been a goal to be a very healthy old — and if I don't get on the stick soon that goal will be tougher to reach every year. My closest friend came to visit recently, bringing her 86-year-old mother, Dorothy, with her. I had it in my mind that having an

older companion with us would severely limit our activities during the visit, but I was

pleased to be proven wrong. After the weekend was over, I had mentally compiled a laundry list of ways I could achieve my be-healthyas-long-as-possible goal. We'll call them the Dorothy Principles. 1. Never stop working. Dorothy studied to be a nurse when she was young, raised six children (including one born when she was a2)and keptworkingthroughitaii. Shefinally

it out.

8. Never be afraid to let go. A long life has a way of racking up heartaches, hurt feelings and woundedpride. Dorothy seems to have retired from her paycheck job when she was Re dmond Spokesman editor-in-chief Leslie found the inner peace to let go of slights and 82, but it didn't matter — she just replaced it Pu g mire-Hole betrayals, and she accepts people for who with a like amount of volunteer work. they are. All the emotional baggage that 2. Never stop learning. Dorothy went back comes with time and relationships can grow to school for her master's degree nearly 20 years after her first ex- very heavy by your later years, adding to any bone-density stoop you perience with higher learning. She's had to stay on top of medical may be flirting with. advances,technology upgrades and the changing needs of children 9. Never stop loving. Being able to love open-heartedly and receive growing up in different generations. She reads voraciously, keeps up the same will help keep those you treasure close to you — and having on current affairs and can download to her own Kindle. them there will make you happier and healthier. 3. Never stop wondering. A better conversationalist you'd be hard 10. Never lose sight of you. This one may be the hardest for Doropressed to find than Dorothy. She's remained curious and open to the thy — for many of us, really. As a giver, taking the time to enjoy activiworld. When time and money allowed, she began to travel, never shy- ties that are just for her has probably been a learned behavior that's ingaway from a new adventure. come easier over time. But if she forgets, her loved ones are there to 4. Never let your life constrict. A trap many seniors fall into is watch- prompt her into well-deserved self-indulgences. See Principle No. 9. ing the world close in on them. Friends die or move away, and they The visit with Dorothy gave me plenty to think about, including the don't make new ones. They retire and fail to keep connected with col- principle principle: Never give up. I've made manyget-healthyvows to leagues. Families get busy and preoccupied and they don't take the myself that have never borne fruit, but I'd be foolish to assume I can extra steps to be involved. Dorothy has a large family and she works never do it. I just need to ask myself — what would Dorothy do?•

Page 54

•

FALL/ WINTER 2013• HIGH DESERTPULSE

HIGH LAKES WELCOMES

PRACTICES: Family Medicine: Welcoming Men, Wornen and Children

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H ea I t h

C are

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Introducing our newest care facility, located in Redmond. At High Lakes Health Care, we've examined our own practices to come up with a model for keeping patients healthy. Like handpicking high caliber doctors who focus on providing quality care and taking the time to really listen to their patients. Combine that with the freedom to refer to any specialist, and the result is better care that just happens to cost less. With locations in Bend, Sisters and now in Redmond, we provide convenient access to high quality care. NOW IN REDMOND AT: 1001 NW CANAL BLVD., REDMOND, OR 97756 i 541-504-7635 •

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gt Charles HEART R LUNG CENTE

D tors you know.Ga y ou trust. St. Charles HealthSystemwelcomesDrs.Young, McLellan,,Widmer, Laughlin and Adair to our

h sicians to theexisting n team, team, the e St.Charles Heart and Lung Center will ill house house the e only comprehensiveheart cen

team. FormerlyfoHeart ea Center Cardiology,the

es. This meansmore stream'lined care an n communication nd ' ers with the goal of improvedresu s or ' ' will stay in its current location in Ben, ou

'oin St. Charles Heart and five ive cardiologists willjoin ' in ersonalized Lung Center July1, providing p care '

t, d'agnose andtreat heart p roblems. to preven, ia

inssatellite clinics throug ou continue to seepati'ents nts in

formation or tomakean n appoi a ointment, ntmen, please call541-388--4333. We are preferred providers ers for formore morethan than1 100 in insurance plans, including e '

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StCharles eaIthCare.orgeo