Vaccines:Theunsung successstory Cascade Lakes Relay:Howto prep Flight nurses:Readywhenyouaren't
Healthy Living in Ce tral Oregon ' .e
•
•
When the body betrays the identity within
速 Testosterone is, of course, a hormone that helps maintain muscle and bone density and strength, as well as sexual function. But it also plays a vital role in a man's general health and sense of well-being. Symptoms of low testosterone include decreased energy, body changes, mood changes, reduced sex drive, and sexual dysfunction. Though it is normal for a man's testosterone to diminish as he ages, it should not drop below a certain level. Men with obesity, diabetes, high blood pressure, high cholesterol, COPD, or asthma run an increased risk of suffering from low-T.
Testosterone replacement therapy can help to bring your hormone levels back into the normal range. Bend Urology provides the latest in research, diagnosis and testosterone supplementation. We counsel patients on the risks and benefits, and determine what is best treatment option for each individual patient. After all, Bend Urology has been providing central and eastern Oregon with the best in urological care for nearly fifty years. Askyour primary care doctor, or give us a call. We can help you get back into the swing of things.
iP~'r~ 5(777d.6 &o.
3'C-BendUrplp 541 3826447f 2090NEWyattCourtf Suite 101f Bend OR 97701 Jbendurology.com
PEDIATRICS cARDloLoGY FAMILY MEDICINE oPTlcAL URGENT CARE ONCOLOGY NUTRITION NEPHROLOGY DERMATOLOGY OPHT H A L M O L O G Y ENDOCRINOLOGY NEUROLOGY PULMONARY INFEcTloUs DisEAsESURGERY INTERNAL MEDICINE ALLERGY RHEUMATOLOGY IMAGING GASTRoENTERoLoGY B REAST H EALTH vEi N CLiNic LA B From office visits to x-rays, lab tests to life-saving treatments, we bring it all together for you. Whether you're sick, healthy, or everything in-between, we're here. Every day.
+ bm
C T otalCare"
Bend Memorial Clinic c
,)
j
~II<'Et<@ N ~
:,.~IIii@IIIIall~
Z1~ZI ~~ •
' 'l l
•
•
•
•
•
•
•
-
2 5
H I G H
UPdates ~ NEwslNcE wE LAsrREPORTED
Cellphone usage heats up the human brain The Winter/Spring 2012 issue of High Desert Pulse looked at the question of
ur „
+Pprlrprp/pfppr
n.~ r ~ ~ f kgg
PtPPPPPP/ ry 5
whether cellphone radiation could harm human health. The explosion of c ellphones has prompted concerns about brain cancer in particular. Despite numerous studies, there has been little consensus. The cancer research arm of the World Health Organization, however, classified high radio frequency emissions from cellphones as "possibly carcinogenic" to humans. Scientists have recently created a new imaging technique to better illustratewithout probing the brain — how brain tis-
D E S E R T
ceedings of the National Academy of Sciencesinjanuary. The scientists, led by a medical physicist at Memorial Sloan-Kettering Cancer
Healthy Living in Central Oregon
Center in New York, developed a nuclear magnetic resonance technique they say will help further the understanding of whether extensive cellphone use could cause brain
SPRING / SUMMER 2013 VOLUME 5, NO. 2
tumors. In their tests, the scientists used cow brain
tissue and gel, rather than a human brain, and a high radio frequency antenna rather than an actual cellphone. Researchers found that the areas closest to the antenna heated up the most, showing
up ashot spotson 3D images. "The volume of the hot spot generated by absorbed cellphone radiation depends on the antenna power level and the irradiation time," authors wrote in the results and dis-
cussion of the study. The testing method is expected to evolve so that it can examine human brain tissue
sue heats up in the presence of radiation, and cellphone radiation. according to a study published in the Pro-
— ANNE AURAND
How to reach us Julie Johnson Editor I 541-383-0308 or jjohnson@bendbulletin.com Sheila Timony Associate I editor 541-383-0355 or stimonyNIbendbulletin.com • Reporting Anne Aurand 541-383-0304oraaurand@bendbulletin.com Elise Gross 541-383-0393 or egrossNtbendbulletin.com Heidi Hagemeier 541-383-0308 Sheila G. Miller 541-617-7831 or smillerC5bendbulletin.com • Design/Production Greg Cross Andy Zeigert • Photography Ryan Brennecke Joe Kline
David Wray
Rob Kerr Andy Tullis
• Corrections High Desert Pulse's primary concern is that all stories are accurate. Ifyou know ofan error in a story, call us at 541-383-0308 or email pulse@bendbulletin.com.
• Advertising Jay Brandt, Advertising director 541-383-0370 or jbrandt@bendbulletin.com Lorraine Starodub, Health 8 medical account executive 541-617-7855 or Istarodub@bendbulletin.com
Can you spot the person with varicose veins?
Qkt On the Web: www.bendbulletin.com/pulse
Varicose and spider veins are common, affecting over 40% of adults. They can interfere with work, exercise, and life in general. We can help with: • Prominent or bulging veins • Discomfort or restless legs • Pain/swelling in legs, ankles or feet L eg f a t i gue or heavy sensation • Skin discoloration around the ankles • Spider veins Come see us now for healthier legs next summer. Trust our experts and learn about the latest in minimally invasive procedures performed in our office. Inovie Vein Specialty Center 2200 NE Neff Road,Suite,204 (in The Center) bendvein.com 541-382-VEIN (8346) Andrew Jones, MD, FACS Edward Boyle, MD, FACS Board Certified Surgeons
The Bulletin
ABBulletinpaymentsareacceptedatthedropboxatCityliallCheckpayments may beconverted to an electronic funds transfer The Bulletin, LISPS a552 520is publrshed daily byWestern Communications Inc,1777 SWChan dler Ave. Bend,OR 97702.Periodicals postage paid at Bend, OR.Postmaster Send addresschanges to The Bulletin circulation department., Po.Box 6020, Bend, OR 9770B.The Bulletin retains ownership and copynght protecuon of all staff prepared news copy advertising copy andnewsorad illustrauons. They may nor bereproduced withoutexpliot pnorapproval. Published 5/13/2013
Write to us Send your letters of 250 words or less to ptflse@bendbulletin.com. Please inc ude a phone number for verification.
Page4
Contents ~ HIGHDEsERT PULsE
COVER STORY WHEN CHANGE IS THE ONLY CHOICE For some, switching gender is the only way life is worth living.
FEATURE UNSUNG SUCCESS OF VACCINES 18 THE Advancesin recent decades have made many deadly diseases almost history.
DEPARTMENTS
4 UPDATES New since we last reported. EATING: SALADS 16 HEALTHY Think all dressings are created equal? Think again. GEAR: WATER CARRIERS 24 GET Hydration options for endurance athletics. THE JOB: THE FLIGHT NURSE 26 ON From out of the blue, and in the nick of time. DOES HE DO IT? 30 HOW After falling out of shape, famed climber Alan Watts
•
e
recommits to fitness.
MCKENZIE HIGHWAY 33 SNAPSHOT' Cycling the snow-white walls of the pass in spring. READY: THE CASCADE LAKES RELAY 34 GET A dream or a nightmare? It's all in how you train. PACK YOUR BAGS 52 TIPS: International trips require extra (medical) care. OF KNOWLEDGE' POP QUIZ 53 BODY Can you tell your andrologist from your adenologist? VOICE' APERSONAL ESSAY 54 ONE When the doctor's news rocks your world.
GET GEAR
COVER PHOTO: JOE KLINE CONTENTS PHOTOS,FROM TOP: ROB KERR, RYAN BRENNECKE, ROB KERR, PETE ERICKSON
3A GET
HIGH DESERT PULSE • SPRING/SUMMER 2013
page5
QM READY
•
r •
•
•
A turning point for people and policy BY ANNE AURAND • PHOTOS BY JOE KLINE
ntil puberty, l(irsten Winters lived a standard little boy's life. Then, around age 12, he started stealing his mom's lingerie, panty hose and high heels, wearing them on the sly. Winters felt shame about cross-dressing. Yet, Winters explained recently, "it was my serenity. It gave me a sense of being right. Not sexual; it was comfort. We are socialized about what we're supposed to look like. I didn't fit that." In his youth, Winters had no idea he was transgender; it would be many years before he would realize that he was a female born in a
male body. (Although Winters won't disclose her previous name, she said it was OK to call her a "he" when describing that period in her life.) Winters, 38, and her mother, Renee Allen, who both live in Bend now, recall how a good kid growing up in Southern California transformed into an angry, unpleasant teen who closed himself off. "The easiest way to hide is to keep everyone at arm's length, to be an asshole," Winters said. Winters' father made homophobic slurs that added to Winters' disgrace. So Winters went to great lengths to demonstrate hypermasculinity, such as picking fights. Winters was troubled, using methamphetamines, rnarijuana and alcohol. Before age 18, he dropped out of school and got in trouble for trespassing,
0~
HIGHDESERTPULSE• SP ING/SUMMER2013 ~
-
" .
Page7
•
•
~
4g
ANI~ ~
4 ~™~N"
Kirsten Winters and partner Terese Thompson embraceafter bowling during a friend's party at Lava Lanesin Bend.
arson and burglary. In his early 20s, Winters married a woman who already had children. The now-ex-wife tolerated cross-dressing but forbade Winters to let the children find out, compounding the feeling that something was really wrong
home life." Winters left the marriage, but
with it. Then, in the mid-to-late 1990s, Winters
on my bed with a .38 in my mouth. I was exist along a continuum has become more completely depressed. I hated myself, my broadly accepted in Western culture over the life, everything about me," she said."Some- past 10 to 15 years.
heard about transgender people through the Internet. He started researching.
Transgender is the umbrella term for people whose gender identity (their internal sense of male, female or something broader) and gender expression (how they dress, wear their hair, talk, walk) does not conform
con to define her experience. Yet like many returned briefly, believing that living in a transgender adults, she knew for a long time traditional marriage could make the gender that she didn't fit into a binary gender system — the classification of sex and gender question go away. It didn't. into only male or only female. The concept "In April 2008, I almost took my life. I sat
thing clicked. I had two choices. End it, or attempt transition."
This May, Winters celebrates three years on hormone therapy, the primary vehicle of her transition from male to female. She looks like a woman, lives as a woman. Her to what is typically associated with the anat- driver's license says "female." "Ihave re-found my voice,my confidence," omy they were born with. Transsexuals are transgender people who alter or wish to alter Winters said. "I no longer feel suicidal. I wake their bodies through medical means, to align up smiling." "She's not angry anymore," said her mother. their bodies with their gender identities. "Around age 28, I started having ideas A healthysense of self that I was a transsexual, not a cross-dresser," Winters said. "It became a problem in my For years, Winters didn't have the lexi-
Page8
that sexual orientation and gender identity
Along with that shift in t hinking have
come efforts to ensure transgender people receive the same rights and protectionsincluding access to health care — as others along the spectrum. While transgender advocates have been vocal, they are not alone in calling for improved access to wellness. U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced recently that President Barack Obama, through the Affordable Care Act, intended to improve the health and well-being of lesbian, gay, bisexual and transgender (LCBT) Americans,
SPRING I SUMMER 2013 • HIGH DESERTPULSE
recognizing that these minority groups experience health inequities. Medical organizations and government agencies are starting to compile information to try to quantify the trans
population, identify their specific needs and improve their health care. Insurance companies are more frequently covering transition procedures, including surgery and hormone therapy. Health doesn't just mean the absence of disease. It is "a state of complete physical, mental and social well-being," according to the World Health Organization. In
trans people, it's especially important to address widespread discrimination, violence, unemployment and poverty that can create barriers to health care, according to a new report called "Transforming Health," from the Open Society Foundations, an international organization that
emphasizesequal rights causes. Unemployment and violence — which are more
A glossary of gender terms Sex,established at birth, refers to one's biological status as either male or female, and is associated primarily with physica attributes such aschromosomes, hormone prevalence, and external and internal anatomy. Genderrefers to the sociallyconstructed roles, behaviors, activities and attributes that a particular society considers appropriate for boys and men or girls and women. These influence the ways that people act, interact and feel about themselves.
Gender identity refers to a person's internal sense ofbeing male, female or something else. Gender expression refers to the way a person communicates gender identityto others through behavior, clothing, hairstyles, voice or body characteristics. Transgenderis an umbrella term for people whose gender identity, gender expression or behavior does not conform to what is typically associated with
the sex established at birth. ("Trans" issometimes used asshorthand for "transgender.")
Sexual orientation refers to an individual's physica, romantic, and/ or emotional attraction to other people. Transgender people may be straight, lesbian, gay, bisexual or asexual.
Transsexualrefers to transgender people who alter or wish to alter their bodies through hormones, surgery and other means to make their bodies as congruent as possible with their gender identities. The process of transition through medical intervention is referred to as sex or gender reassignment, sex confirmation or gender affirmation.
Gender dysphoria refers to the discomfort or distress caused by a discrepancy between a person's gender identity and the sex that was established at birth. Sources: American Psychological Association, Standards of Care for the Health of Transsexual, Transgender and GenderNonconformingPeople, from the World Professional Association for Transgender Health
prevalent in the trans population than the
general population — appear to increase the risk of suicide significantly.
Finding a life worth living Of all the health disparities associated with the transgender population, suicide is one of the more driving concerns. Forty-one percent of 6,450 transgender participants in a 2010 survey by the National Center for Transgender Equality and the National Cay and Lesbian Task Force said they had attempted suicide, compared with 1.6 percent of the general population. Separate, smaller studies suggest that between 30 and 55 percent of transgender people, depending on age, race and gender expression, consider or attempt suicide. "Often, it's 'I need this (transition) or I'll
kill myself,"' said Leigh Brandt, a 20-yearold trans man (female-to-male transsexual) from Bend. He struggled with gender dysphoria — a disconnect between who you know you are and what you look like, he explained — since he was little, when he was a girl. "I knew from the time I was small I
wanted to be a daddy. I saw myself like my father, scratchy cheeks. I knew there would be a wife," said Brandt. He told friends and family he was transgender in 2010, and soon after, with a doctor's supervision, he started inject-
HIGH DESERT PULSE • SPRING/suMMER 2013
Suicide attempts by transgender Americans Job status plays a role Transgender people experience unemployment at twice the rate of the general population, according to a recent survey. Forty-seven percent of respondents said thay had been fired, not hired, or denied a promotion because of their gender nonconformity. Sixteen percent said thay had been compelled to work"underground," such as doing sex work or selling drugs, for income.
Attempts byoverall sample 40a/o
-
20e/o
-
Qa/o
Unemployed
Lostjob due to bias
Workedin underground economy
Employed
-
Any
Harassment and violence occur When transgender people present incongruent IDs It can be challenging to change one's gender marker on all identification cards and records. About 41 percent of transgender people in a survey said they live without identification that matches their gender identity.
roblem
Harassed 40%
44%
40%
30'/o
Askedto leave
20%
15%
10%
Assaulted
3%
0%
Source: Injustice at Every Turn: A Report of the NationalTransgender Discnmination Survey, October 201 0
GREG CROSS
Page 9
Coverstory( SWITCHING GENDER ing himself with testosterone weekly. He had "top surgery," which includes a mastectomy, a year ago, and hopes to someday have a hysterectomy to more fully complete his
therefore eligible for insurance coverage. (The DSM's fifth edition, released in May, has changed the language from "gender identity disorder" to "gender dysphoria" in part to transition. "I don't want these parts in me," remove the stigma of a mental, pathological he said. disorder.) Ayoung, hipster guy, he bears a hint ofsideThe diagnosis is the institutionallyaccepted burnsand a few moustache hairs.He runs up ticket to getting desired treatment and to trigstairs two at a time. His voice is deep. ger some insurance plans to cover it. Brandt can't even look at old pictures of But many trans people have called the diaghimself, he said, after so many years hating nosis "stigmatizing" and the requirement to get what hesaw. He hasspentthousands ofdol- it "medical gatekeeping." After all, some translars to align his body with his gender iden- gender people don't report emotional distress. tity. He has health insurance, but it doesn't And some don'tbeli eve they should need cover any of it, he said. medical evaluations to justify a transition. That'scommon. Many insurance proAccording to major medical groups, ingrams exclude transition-related care. cluding the American Medical Association, But, health insurance coverage may be hormone therapy, surgery and psychotherone of the most visible and current vehicles apy are medically necessary to alleviate genof change in the world of transgender health der dysphoria in many people. These treatcare. And Oregon is right in the thick of it. ments can help trans people whose health Recently, more insurance plans have begun and well-being depend on bringing their to cover "medically necessary" treatments physical bodies into alignment with their such as hormone therapy and sex reassign- gender identity, according to the AMA. "Patients and surgeons don't look at these ment surgery for those diagnosed with gender dysphoria, the condition of distress from as cosmetic," said Dr. Curtis Crane, a surthe incongruence between expressed gender geon who specializes in sex confirmation and the sex that was established at birth. surgeries at Brownstein 8 Crane Surgical I ndividuals experience an a rray o f Services in San Francisco. "Some insurance dysphorias. companies do, though. "I'm sure some religious groups would not With Winters, for example, it's about facial hair and her deep voice. approve of the surgery as being medically For TJ Evans, a 50-year-old transgender necessary. There are some psychiatrists that man, who used to be female, it's what his don't, but as a group, I don't know anyone breasts do to his identity. that makes that global stance on the issue," "I either have to bind my breasts or wear said Crane. large shirts.... It's distressing, disheartening. Sometimes it's on the forefront of my mind,"
The cost of change
that prohibit "discrimination in the terms
of employment, including employee health insurance coverage, based on gender identity." The same surgery would be covered for a woman with a medically necessary diagnosis, so excluding it for a transgender patient with a medically necessary diagnosis violated anti-discrimination laws.
Oregon is not the first public body to adopt a transgender-inclusive policy for those on its health plan. The cities of Portland
and San Francisco, for example, offer health plans for their employees that cover genderreassignment surgeries and hormone treatments. A growing number of colleges are offering health insurance plans with similar coverage for students. The number of insurance providers covering such treatments is small but growing. Some argue that such coverage will raise the costs for other health plan participants. However, a summary of costs from the City and County ofSan Francisco, which was the first major employer to cover transition treatment when it adopted its policy in 2001,
suggests that the covering transgender employees' health needs proved relatively inexpensive, according to a statement from San Francisco's Human Rights Commission. To meet cost projections associated with
additional transgender-related coverage, employees, retirees and dependents enrolled in San Francisco's health plan were all initially charged an extra $1.70 per month. Over the years,asthe income exceeded the payouts, the surcharge was reduced and eventually ended. From July 2001 through July 2006, the health system collected $5.6 million from the surcharge and paid out $386,417 on
The state of Oregon made news recently when it agreed to cover surgeries, prescrip- claims for treatments. "Unlike the fears expressed, none of the hospital for preoperative care in December tions and other treatments related to gender when he found out his insurance viewed it reassignment for the state's transgender concerns came to pass," according to a stateas a sexual reassignment surgery, and cov- employees. The policy change resulted from ment from San Francisco's Human Rights a out-of-court settlement in a discrimination Commission. erage was denied. The American Psychiatric Association's lawsuit filed by a female-to-male transgenBuying time Diagnostic and Statistical Manual classifies der state employee who sought a hysterecdisorders, such as gender dysphoria, for tomy. The suit said denying coverage violatAnother noteworthy milestone for Orwhich medical treatments are necessary and ed the state's own anti-discrimination laws egon is that it's the first state in the country to require coverage for puberty-suppressing treatments for some transgender adolessaidEvans,ofBend. He had taken steps toward getting a mastectomy. He was in the
'Ihovestruggled with thismostofmylife.7hisis whatl'vedecided to cents. Starting on Oct. 1, 2014, the Oregon Health Plan will cover the cost of pubertal do. I planon transitioning from yourson toyourdaughter.' suppression evaluation, treatment and monKirsten Winters, to her father
Page 10
itoring for youth enrolled in the health plan
SPRING /SUMMER2013 â&#x20AC;˘ HIGH DESERTPULSE
STATF CF O<"G'
Documenting identity: male or female?
r
When the gender marked e ononaaperson's esn't match identification card doesn't esnt h the h face and body,it can present problems,, said ai aTash s Shatz thettransjustice manager for Basic Rights Oregon in Portland.
' port r,i itplaysoutinmylife." air
"We face these eve da " se cchallenges a enges everyday,"Shatz sai .'Accessing medical hea thcare. . Flying, ' TSA l security). For myself m ID says f emale because y I need to access medic i caI health care that deals with female anatomy so it helps me see the get insurance coverage orme for medical ica care. But I lo ok male, so when go toabarort he
g y and not have access to th ese medicalservices servi so I don't have to dealwit ' ht hat v at the e bar arortheairport? W hataitt 'takes to change a gender marker dement and the state where p you l ive,hesaid.T ., e process can be expensive ' an d a rduous.
Goingthrough s ecurity in some airports has been an ord deal, he said. He keeps a letter on hand to give to officia s tha tsayshe'stransgen' dertoexpla' ain the incongruity.
blockers , are medications that st unt ohr -
mone production and dela the ment of se
y
o
g
y
hild t o l c l cl can clecide d whether to Fa milies facing the puberty bl ock er option make las ting changes. start ar ooffconcerned about risks of the tr (Puberty blockers) give the e ikid s a couple m ent Burl ur eton said. The long-termris ' k s asmor or years to be certain,"" said ore i enn J Burleton, s o ciated with yout c ive uca- a r e not full ere y n group ased a re risks, h t ey take a backseat to o th e more , ortland. TransActive wor k s to support i m me mediate concern that thee child c i m i ghht kill and educate youth, famili ami iesand commu- himself bef Ir
I cli
hool
to h I th
manage the myriad ia questions and conflicts thatarise — suchas wh hb h hld should use. h ld f d d
u
Most families understand th h not like an option for ki ds tru y traumatized
e see those spikes in suicide. Hor-
e newest frontier in transgender h
of d i B ' often be seen early iin n childh c i hood, there is Pu "u berrt er hd b he appropriate- insurance
e, an most
,
0
cl 11
hild ho ho 'I nsoofgender the Oregon Health Pl an will tremendously variancego on to becometranssexuals — h kids who qualify for OHP." g alter their bodies. One small 2008 Identity and orientation: study showed that 10 yeears after gender apples and oranges dysphoric h children were re referred to a clinic, ony 27 percent still had gender er d ysp s hori oria.. Ge n der identit i However, the a tho o f t h t d ot d 30 t o f t h o i I I oho t o Id ot b
g h y en er idenh hld h h h i loh d But some d I« h ouId ha v e avoided considerable suffering had a t hey b een a bl to cl I th d mento sexual characteristics.
HIGH DESERT PULSE • SPRING / SUMMER2013
i on — the h s i c att r a ction toother o people, according to the
A m erican Ps gender peoplemay be t s raig ' h, t, lesbian, gay, bisexual or asexual just s iIke anyone
Page 11
'
~octTCtrf ":, '""'"'"'
TE' OF'-:;L) VE:Bf
y OREGo
'
"Some da B randt said de scribing the experience e of men struati on. Had he known of an o
who are diagnosed with gender er ysp d s horia. Puber rt o , I o a11 e pu cl berty
l TIF ) C A
'
Requirements for changing your gender on ID in Oregon Driver's license Toc o change gender on this ID, the Department of Motor Vehicles designate s app icants as either in "medical transition "whichrequiresa letter from a qualified therapist stating that the erson ' ' g full u time ngen is livin ' as his or her chosen n der,or , in 'transsexua ual gender reassignment thera equires a certified court order ofa genderchangeor a letter from a physician thatsays the app a lica icant had some kind ofsurgery. I
Birth certificate The Oregon Departmentof uman H Services requires a certified copy of a court order indicating that the individua changed his or her sex by surgical procedure. Passport A l etter from a qualified med icaI professional must indicate the applican t ah d 'cinicallyap" I' p ropriatetreatment."What thatisc b d I ' y tpe hy s ician. Representatives ofBasic Rights Oregon say this is ideal because it allo h in ividual and his or her doctor to decide what is appropriate for an individual. Social Security card The Soc' ocial Security Administration will change
SA database might not match information sentinbyanemployer,wh'ichcanresutina"nomatch" etter to the emp oyer or th e emp oyee, w ichcouldresultinanunwanted""outing"to one's emp oyer. Sources: Tash Shatz, transjusticemanagerat Basic asic ightsOregon;Sasha Ri Buchert, legal adviser, BasicightsOregon;www. R' h r, asic : ' " w " ' " rg en s4nowyourrightsguide.pdf
Coverstory( SWITCHING GENDER else can be. "Cender identity is apples. Sexual orientation is oranges. They are not connected. One doesn't dictate the other. There's no
correlation," said Winters, whose own story illustrates the continuum.
When she was a man, she was married to a woman. Throughout her life, she has had both male and female partners. Now, she's happily involved with a Bend woman named Terese Thompson. Although Thompson says she dislikeshaving to use labels, she would be considered "pansexual." She describes her sexual preference as "it's the heart, not the part" that mat-
ters. She calls herself "gender blind." Winters calls Thompson a wonderful life partner. "Now I have someone who sees me for me, not my gender," Winters said. So, what makes some people transgender? Thompson, 33, who is in a master's of counseling program through Oregon State University-Cascades Campus and is focused onLCBTQ (Q isfor "queer"â&#x20AC;&#x201D; a term meant to encompass any point along the continuum) issues, believes it's simply because "there are variances in nature." Crane, the surgeon from San Francisco, said there is no leading theory for transgenderism and the cause is poorly understood, "but it has a relatively consistent representation across the globe." Anthropologists use the term "third gender" to encompass those who don't fit into
the binary classification of gender that says we are either completely male or female, said Amy Harper, an associate professor of anthropology at Central Oregon Community College. "Third gender" individuals are part of the cultural fabric of groups ranging from Native American tribes to peoples of Madagascar, India and Pakistan, she said. Some recent data suggest that there's an area in the brain â&#x20AC;&#x201D; the hypothalamic bed nucleus â&#x20AC;&#x201D; that is typically twice as large in male brains, compared with female brains. But in male-to-female transgender people, that area is the same size as what's seen in female brains. Dr. Rick Coldstein, an endocrinologist at
Bend Memorial Clinic who oversees hormone therapy for some local transgender patients, said some studies in twins sugContinued on Page14
Page 12
Rob Landis talks to his mom, Violet Bales, during his "maniversary"party at Lava Lanesin Bend.
A one-year 'maniversary' BY ANNE AURAND
n the evening of Friday, March 8, Robyn Landisinvited some 20 family members and friends to the Lava Lanes Bowling Center. Crandkids rolled gutter balls and grandparents worried about hurting their backs. The generation in between stood around under the black lights drinking beer, building momentum for later when they would end up in the bar singing karaoke. Under blue helium balloons on one table sat a cake, decorated with a blue baby carriage and the words, "It's a boy!" The cake was for 30-year-old Landis, the star of the party. It was his "maniversary" party. As irreverent as it sounds, the occasion was filled with deep meaning. Landis was celebrating the completion of his first year on testosterone, a benchmark in a female-tomale transition. Typically, by the one-year mark,the physical changes of hormone therapy are apparent. Robyn Mariehas become Rob Mikael. He is one face of Central Oregon's transgender community.
Near the cake, a chronicle of Landis' life cluttered the table: a newspaper clipping of a birth announcement about a little
girl, classic baby pictures, photos of Landis as a youngster, in short hair and boyish clothes, riding a bike. Shots from high school showed Landis"overcompensating" for a reputation as a tomboy, wearing heavy makeup, a black choker and a frilly sleeveless dress. Now, Landis, w ith a stocky physique and shaved head, wears baggy jeans and black pullovers. Standing with his feet spread wide and his head cocked back, he gripped a pintofbeerin one hand and encouraged others to imbibe. He smiled with confi-
dence and devoured the attention. Landis likes people, and he likes it when people like him. He was pleased that the family of his long-time girlfriend, Lindsay Criffin, was mingling with his relatives. Before his transi-
tion, Landis and Criffin were a lesbian couple. Now that Landis expresses his gender as a man, they are boyfriend-girlfriend. The "maniversary," an unconventional celebration in the general population, is a
"I knewI wasdifferent. Peoplemisgenderedmeasa boy when I waslittle. Theycalledme'buddy'andI likedit." Rob Landis, about his experience as a child
roll her eyes in self-deprecating exasperaing alley. But for Landis' mom, Violet Bales, tion, and correct herself. Friday night family get-together at the bowlthe theme was a little bit awkward.
"I had wondered, are we supposed to sing?" she said, with a smile, amid the music and crashing of pins and balls. Then she went back to bowling, not terribly fazed. Bales clearly loves her child and speaks to what a good person he has always been. But his gender variance was a difficult thing for the conservative woman from Prineville to
accept. "It was not an easy thing on our family at first," Bales said."In fact it took years to be comfortable with it. I would say that religion
did play a huge part in how we as a family felt. But in the big scope of things, it's not
about me. Or anyone else.Ihave never seen Robyn so happy as he is now. That's what matters most. And his girlfriend, Lindsay, is
one of the sweetest, most caring girls ever."
party rite of passage in the little-understood trans-
gender world. For some, it marks the anniversary of coming out as trans. For others, it's a year on testosterone therapy or some other medical treatment.
To a casual observer, it looked like a typical
"I think the hardest thing of all, is calling my baby girl a him. I'm working on it. It
helps that his body is changing and that he goes by Rob," Bales said. W hen Robyn Mariebecame Rob Mikael,he let his mother choose his new middle name. "I was honored to have a small part in that decision," Bales said. Landis (whom we will call "she" when referring to the time he was a girl) was raised in a Mormon family in Prineville. As a young girl, she hated dresses. Although she knew nothing of homosexuality at that time, she knew she was attracted to girls.
"I knew I was different, "Landis said. "People misgenderedme as a boy when Iwas little. They called me 'buddy' and I liked it." By theend of middle school,Landis had grasped the concept of being lesbian and
Bales admitted that for a long time she
thought, with shame, "maybe that's what I
wonderedifshehad done something wrong as a mother that made Landis a lesbian or, rather, transgender. She already had two girls. "I wanted a boy," she said."I dressed her like a boy." Bales can't stop calling Landis "her" when she talks about him. It's a hard habit to break after 30 years. But every time Bales blurted out the wrong pronoun, she would pause,
am. "So I overcompensated," he said. "I dressed up and wore my hair long and lots of makeup.Iwas homecoming princess in high school, and student body president. I was athletic and a people person." But Landis didn't have any close, intimate
relationships because she was not prepared to deal with being gay. She had bouts of depression and passing thoughts of suicide. It wasn't until after graduating from Crook
County High School in 2001 that she began to tell people she was a lesbian. The topic of homosexuality came up in church one day. It made Landis cry. His mom, he recalled, asked his sister: "'What is Robyn crying about? Is Robyn gay?' My sister just raised her eyes and said, 'Let's talk about it after church.' The secret was out. It jâ&#x20AC;˘ /
helped me. It set me free," Landis said. Bales gave him a packet of Scriptures, Continued on Page48
Rob Landis servesapieceofcake to hisnieceAziyn, 9 as friend Chrissy Lazzerini, right, andher nephew Max Dorning, 6, watch.
Hormone therapies Hormone therapy can be initiated with a qualified mental health professional's referral and diagnosis of gender dysphoria. It typically includes: For maie-to-femaie transition • Estrogen pills, patches or injections. •Androgen-reducing medications (to reduce testosterone activity). • Progestins may be included but are controversial because of side effects and health risks. Physical effects vary but typically include: breast growth, decreased erectile function, decreased testic e size, increased percentage ofbody fat compared with muscle mass.
Cover story( SWITCHING GENDER gest there's a genetic component. But these studies are small. The American Psychological Association says this: "There is no single explanation for why some people are transgender. The diversity of transgender expression and experiences argues against any simple or unitary explanation. Many experts believe that biological factors such as genetic influences and prenatal hormone levels, early experiences, and experiences later in adolescence or adulthood may all contribute to the development of transgender identities."
For femaie-to-maie transition •Testosterone injections or topical gels. • Progestins can be used for a short time to assist with menstrual cessation. Physical effects vary but typically include: deepening voice, clitoral enlargement, facial and body hair growth, cessation of menses, atrophy of breasts, decreased percent ofbody fat compared with muscle mass.
Surgeries • Surgeries, particularly genital surgeries, are often the last and the most contemplated step in gender dysphoria treatment. The number and sequence ofsurgeries varies, and not all patients have surgery. • One referral from a qualified mental health professional is typically required prior to breast and chest surgeries. Two referrals are suggested for genital surgeries. Maie-to-femaie transition can include: • Breast augmentation or implants. • Penectomy (removal of penis), orchiectomy (castration), vaginop asty (creating a vagina), clitoroplasty (creating a clitoris) or vulvoplasty (creating a vulva). • Facial feminization surgery, liposuction, lipofilling, voice surgery, thyroid cartilage reduction and various aesthetic procedures. Female-to-maie transition can include: • Mastectomy, chest rebuild. • Hysterectomy (removal of the uterus), reconstruction ofthe urethra, metoidioplastyor phalloplasty (tissue rearrangements or reconstructions), vaginectomy (removal of the vagina), scrotoplasty (creating a scrotum) and prosthetic implants. •Voice surgeries, aesthetic procedures. Sources: Dr. RickGoldstein, an endocrinologist at Bend Memorial Clinic; Dr. Curtis N. Crane, Plastic Surgeon & Reconstructive Urologist at Brownstein & crane surgical services in san Francisco and The Standards of Carefor the Health ofTranssexual, Transgender and Gender nonconforming People, Version 7,from The World Professional Association for Transgender Health.
the population is a first step toward informing a host of public policy and research topics.
Modifying gender The first reports of castrations and hysterectomies in the United States for the pur-
pose of changing gender appear in the early 1920s. In the 1930s, endocrinologist Harry Benjamin was one of the first to routinely offer hormone therapy for changing one's sex. It wasn't until the 1950s that the term trans-
sexual was widely used. Still, the general view at that time was that
Quantifying the transgender population is nearly impossible given the lack of data collection, and varying methodologies that have resulted in different reports. Rough estimates, based on old data about people seeking treatment at clinics, say 1 in 100,000 people in the U.S. may be male-tofemale transsexuals, and I in 400,000 may be female-to-male transsexuals, according to
transsexuals were mentally "disordered." Over time, a body of research led to greater awarenessand acceptance of the concept we now know as gender identity, according
the Institute of Medicine's 2011 report "The
their bodies or aspects of their identities.
to the IOM report.
There is no universal transgender story. Every person has an individual experience. Transgender people are not all dysphoric about — bothered by — the same parts of
Health of Lesbian, Gay, Bisexual, and TransNor is there one singular, clinically tested gender People: Building a Foundation for prescription for treatment. Treatments can be Better Understanding." The report says the determined between a patient and a doctor. prevalence of adults seeking treatments ap- Some trans people change just their names pears to be increasing. and style of clothes, known as a social tranA different estimate, from a 2011 report sition. Others take hormones or have top by The Williams Institute, University of Cali- (chest reconstruction) or bottom (genital refornia Los Angeles School of Law, estimates construction) surgeries, or any combination that about 0.3 percent of adults living in the thereof. (See the panel at left.) U.S. identify as transgender, which equates Hormone treatments cause physiological to about 700,000 transgender adults. reactions that make a body more female or Winters, who has run peer-to-peer sup- more male. They affectthe sex organs and port groups for transgender adults in Cen- secondary characteristics, such as facial hair tral Oregon, has had as many as 20 people or breast development. "Medically, it's relatively straightforward," show up for a meeting, she said, although possibly not all attendees are transgender. said Goldstein, who works with several local She said there is a large population of trans transgender patients. Still, he recommends youth in this community, but she couldn't treatment be overseen by a medical profesput a number on it. sional to accommodate individual health risk Burleton, from TransActive in Portland, said factors. basedon what she' sseen,she believesone in For a male-to-female who takes estrogen, 100 kids are transgender in the sense that at the biggest health risk is blood clotting, esleast a social transition — and maybe medi- pecially in those genetically predisposed or cal treatments — are on the horizon. And, those who smoke. Pills might have a higher she added, about one in 250 kids are gender- risk of blood clotting than injections. Cancer nonconforming enough that they'll want to be risks for this group are small, Goldstein said. perceived as the gender other than the one There is a risk of liver inflammation from they were labeled, even if they don't go down hormone therapy, but periodic monitoring a medical path toward transition. and adjusting doses can help protect a perDefining and measuring the transgender son, he said. population is challenging, the Williams InstiGenerally, there's not enough long-term tute report said, but understanding the size of Continued on Page 49 Page 14
SPRING/SUMMER2013• HIGH DESERTPULSE
AMERICA Positioning yossfor life
Treat Yourself or a Loved On e to a P ower Lift and Re c l ine C h a i r •
• •
•
•
Plush seam back and full chaise pad for hours of comfort. Standard with heat and
pulsating massage system. 375 lb. weight capacity. Five standard fabrics include luxuriously soft Bella Velvets.
h
MODEL UC340
ij
( ,)h
I
T he Madison offers a plush, button bac k design with tastefully finished armrests that will subtly match many different decorative styles. Available in six standard fabrics, including the soft yet durable SofTouch with Stain Defense fabrics and two vinyls. MODEL UC911
Featuring Stellarcomfort Zero Gravity Positioning Technology, this model is a casual, two pillow backrest style that will complement a variety of decors. Both backrest pillows
PROUD LY
feature zippers underneath to adjust Dacron fill as needed. Standard fabrics include padded suede and vinyl. MODEL UC550
MADE i~ AMERICA o•
F IN E
F U R N IT U R E
' . •
•
•
Free Statewide Delivery *
Bend River Prome n ad e
• ww w . m j a c o b s f a m i l y o fstores.com
541-382-5900 • Toll Free 1-800-275-7214 • op e n Mon.-Eri. 10AM to 7PM • sat. & Sun. 10AM to 6PM *$999 or more.
Healthy eating ~ SALADDRESSING
Spend your calorie budget w isely in the first course B YHEIDIHAGEM EIER• PHQTQBYRQBKERR
Single ingredient
©
Q Olive oil
• utrition per 1 tablespoon serving:119 calories; 119 calories from fat;13.5g fat;1.9g saturated fat;Omg cholesterol;Omg sodium; Og carbohydrate;Ogprotein
L
a
Simple, flavorful, healthy
0 Balsamic vinegar Nutrition per1 tablespoon serving:14 ca ories;Ogfat; Ogsaturated fat; Omg cholesterol;4mg sodium; 2.7g carbohydrate;0.1 g protein Source: U.S. Department of Agriculture Nutrient Database
StOre b O u g h t
Yu mmy,butnotas healthy
0 Ken's Steak House Chunky Blue Cheese
6 Bernstein's Restaurant Recipe Italian
• utrition per 1 tablespoon serving: 75 calories;70 calories from fat; Sg fat;2.5g saturated fat;Omg cholesterol;290mg sodium; 1g carbohydrate;Ogprotein (serving size listed on bottle is 2 tablespoons)
• utrition per 1 tablespoon serving: 50 calories;50 calories from fat; 5.5g fat;2g saturated fat;Omg cholesterol;370mg sodium; 1g carbohydrate;1g protein (serving size listed on bottle is 2 tablespoons)
T1ps Know portions.Most dressing bottles call 1 or 2 tablespoons a serving. But Bendbased registered dietitian Eris Craven saysthat portion is fora argesalad.Asidesalad requires less."Dressing should be an accent to your salad,"
Mak e i t
Craven said."It shouldn't dominatetheflavor ofthe salad. Ifit's the main flavor, you're probably using too much." On the side.Dipjust a corner ofyour fork into a tablespoonsize portion of dressing and then stab a bite of salad.You probably will not even use the entire portion in the cup.
Adjust your palate. Have you ever tried a salad with just a squeeze oflemon juice and a teaspoon of olive oil? Oropted against dressing since you added a sprinkling ofGorgonzola? Or perhaps leaned on ingredients like toasted nuts for flavor? Experiment with the less-is-more philosophy.
Substitutions.Making your own dressing is easy and allows you to control the sodium, fat and calories. Ifyou are trying to replicate a bottled favorite, you can substitute ingredients. Tryfat-free or low-fatyogurtfor sour cream or mayonnaise.Canola or olive oil can sub in for vegetable oil,
with the amount ofoil then cut in half, said Glenda Hyde of the Oregon State University Extension Service. Also,vinegars infused with herbs, spices or garlic add flavor without calories and fat. Sources: Eris Craven, registered dietitian; Olenda Hyde, Deschutes County Oregon State University Extension Service; reopes courtesy OSU Extension Service, Deschutes County
y O u r S el f Tasty,and goodforyou,too
6 Pieky-eater dressing
9 Honey-pear dressing
0 Greek raneh dressing
1 TBS olive oil '/4 C raspberry vinegar or white vinegar 1t/i tsp lemon juice '/2 C orange juice Salt and pepper to taste Nutrition per1 tablespoon serving:15 calories;10 calories from fat; Ogfat; Ogsaturated fat;Omg cholesterol; 40mg sodium; 1g carbohydrate;Og protein
2 TBS vegetable oil 2 TBS vinegar 1 TBS lemon juice 2 tsp honey 1 ripe pear, peeled and cored or 2 canned pear halves, finely mashed Nutrition per 1 tablespoon serving:25 calories;10 calories from fat; 1g fat; Ogsaturated fat;Omg cholesterol; Omg sodium; 1g carbohydrate;Ogprotein
8 oz container nonfat Greek yogurt 1 tsp garlic powder 1 large shallot (about 2 TBS chopped) 1 tsp dried parsley 1 tsp dried dill "/i tsp salt '/4 tsp pepper Nutrition per1 tablespoon serving:10calories; Ogfat; Ogsaturated fat; Omg cholesterol; 80mg sodium;1g carbohydrate; 1g protein
4
h
•
•
Modern vaccines are quietly changing the world. Really. BY HEIDI HAGEMEIER • PHOTO BY JOE KLINE
threat to American children. The bacteria en-
children suffered through needle stabs as
tered the bloodstream and manifested itself in a variety of ways, with children regularly hospitalized. Hib-related meningitis used to pop up in Central Oregon five to 10 times a year, Chunn said. It required a roughly 10-day hospital stay for a course of intravenous an-
often as every six hours to set up IVS.
n his 37 years of practice, pediatrician and infectious disease specialist John Chunn has watched a virtually unheralded revolution unfold in the world of medicine. Early in Chunn's career, a bacteria called Haemophilus influenzae type I3, or Hib, posed the most common serious health tibiotics. Ports weren't used at that time, so
Page 18
The Hib-caused meningitis included potentially devastating side effects such as seizures and brain damage. Up to half of children suffered permanent hearing loss, ranging from mild decreases to complete deafness. The Hib bacteria's most dangerous version was epiglottitis. The condition involves the
SPRING /SUMMER2013 • HIGH DESERTPULSE
Nine-month-old Emmalee Pray, ofLa Pine, plays with Dr. John Chunn's stethoscope during an exam at Central Oregon Pediatric Associatesin Bend. Vaccines againstinfectious diseases have helped transform pediatrics during Chunn's 37 yearsin practice.
epiglottis, the gatekeeper flap between the helped prevent its most feared manifestaroutes to the lungs or the stomach. When infected, it swells until — without warning — the child can't breathe.
tion — meningitis — but it's also had un-
children first to the clinic, not realizing the
anticipated benefits. Studies have noted fewer ear infections in children, and hospitals have reported fewer pneumonia cases in the elderly.
seriousness ofthe illness, Chunn said. Doc-
"I still think immunizations have been
tors then would instantly rush the children
the greatest boon to worldwide health ever in the world. Ever," Chunn said. "Much
Unsuspecting parents would bring their
to the hospital for immediate surgery to keep the airway open. Chunn did two intubations himselfin the hospital during his
career to save children's lives. "It was life-threatening," he said. "Chil-
dren would choke to death on their own epiglottis and die quickly. "This was bread-and-butter pediatrics," he continued. "This is what pediatricians did. And this was our most common, serious disease that we dealt with." Then, 20 years ago, Hib all but vanished. A vaccine for children, introduced in 1988, virtually wiped it out. According to state statistics, the number of cases in Oregon went from 85 in 1988 to five in 1992.
1960: 3,217 proteins
techniques." More progress is expected in the near future from vaccines already on the market, as more time passes and data is gathered
Smallpox: 200 • Po lio:15 ' Diptheria:1 • Tetanus:1
on their impact.
There are high hopes, for instance, for the vaccine first licensed in 2006 for human papillomavirus, also known as HPV. It targets strains of the virus that lead to
a variety of cancers, most notably cervical cancer in women. Recent studies have also shown an uptick in the number of men with throat cancer caused by HPV.
1980: 3,041 proteins
"We have the potential to eliminate cervi-
cal cancer," Cellin said.
never seen it."
Control and Prevention in 1978 to declare it
National Vaccine Program Office within the U.S. Department of Health and Human Services, put it, "In a way, it's the modern
The increase in the number of recommended childhood vaccines in the U.S. hasn't meant excessive exposure for children. As of 2000, the vaccines in total included fewer antigensusually proteins or polysaccharides on a cell's or microbe's surface — than in previous decades. This is due to advances in chemistry, the changing formula for the pertussis (whooping cough) vaccine and the elimination of the need in the U.S. for the smallpox vaccine.
more so than antibiotics or sterile surgical
Chunn, who practices at Central Oregon Pediatric Associates, said there hasn't been a case in Central Oregon since the vaccine came out. "This is a disease that my generation of pediatricians has watched disappear before our eyes with the advent of immunization," he said. "Younger pediatricians have Or as Dr. 6ruce Gellin, director of the
More vaccines, changing formulas
Silent successes Certain vaccine stories have become well-known as landmark achievements of
I II
• Polio:15 • Measles:10 • Mumps:9 • Rubella: 5 • Diptheria:1 ' Tetanus:1
the 20th century.
The successof the smallpox vaccine prompted the U.S. Centers for Disease eradicated in America. Polio, much feared for its debilitating side effects and high death rate, is all but unknown. Even measles,which is so contagious that statistically one case will produce IS
2000: 123-126 proteins/polysaccharides Polio:15 Varlcellal 69®y Measles: 10 AC-Pertussis: 2-5 ~ • Mum s9 • ® Pneumococcus:8 Rubella:5 ' Hepatitis B:1 ' Diptheria:1 ' Tetanus:1
version of the eradication of smallpox." The Hib vaccine is a clear success story. more, maintains near obscurity in the U.S. "In much of the Western hemisphere, And there have been other strides in immunizations like it in the past few decades. measles is essentially gasping," said Dr. Quietly, without the fanfare accompany- Paul Cieslak, medical director of the OrSource: "Addressing Parents'Concerns: Do MultipleVaccines Overwhelm ing victories over diseases like polio, vac- egon Health A uthority's immunization or Weaken the Infant's Immune System?" Pediatrics, Jan. 1, 2002 cines have continued to impact our world. program. "The only time we see measles ANDYZEIGERT More of the potentially devastating ail- here anymore, it's from Europe or Japan or ments of mankind are receding in the rear- another continent." view mirror. Yet today, experts say, vaccine suc- vaccine, there were roughly 20,000 Hib cases Victories over hepatitis A and 6 are now cess stories don't enter th e c o llective per year in preschool-age children. possible, experts say, due to vaccines. consciousness. Experts say that because some of nature's The vaccine for the pneumococcus Many parents, they say, don't know what more flamboyant diseases have been conbacteria, which first came out for those Hib is or why their child is being vaccinated trolled by vaccines, many Americans no longer youngerthan age 2 in 2000, has notonly for it, even though in the 1980s, before the have firsthand experience with the devastation
HIGH DESERT PULSE • SPRING ISUMMER2013
Page19
Secretsuccesses( DISEASE-DEFYINGVACCINES
How vaccines work By mimicking the diseases they're working to prevent, vaccines teach the body's immune system to attack the real deal if it enters the body in the future. The point is that a standing force will be ready to dispatch the invader, reacting much faster than if the body was encountering it for the first time.
4
Vaccine delivered
> •®®• ®v~ •
Masquerading antigens
'•0 Antigenpresenting
cell
Thelper cell
t-.0) t ~Q
Memory cells created
LPathogen
B-cell
Memory T helper cell
'0)
T-cell Infected cells
T-cell
t ~g- l G,
Killer T-cell
A vaccine enters the body. Its contents have similar antigens — the pattern on the exterior of the cell — as the targeted virus or bacteria that causes illness, called a pathogen. Therefore, the body is exposed to an invader masquerading as the pathogen.
A variety of cells make up the body's immune system forces. Here are their reactions.
Antigenpresenting cell Antigen-presenting cells, or APCs, consume the vaccine antigens. They now present — have on their exteriorthe vaccine antigens. The APCs travel to places like the lymph nodes, where immune cells cluster.
T-cells
B-cells
T-cells recognize the antigens brought by the APCsas foreign and become activated. Certain T-cells, called T helper cells, alert other cells to the presence of the invader. CIthers, called killer T-cells, also go on alert. For certain vaccines, the vaccine viruses enter cells. That triggers the killer T-cells to find and destroy the affected cells.
B-cells also recognize the antigens and become activated, They start dividing, creating more B-cells specifically produced to combat the antigen. Some of the B-cells develop into plasma B-cells tasked with producing antibodies specific to the antigen. The antibodies attach onto the pathogen, which may mark it for destruction or prevent it from entering a cell.
Sources:The College of Physicians of Philadelphia,www.historyofvaccines.org; National Institute of Allegryand InfectiousDiseases
they caused. accidents — you sort of say, 'What's diphtheu l think we're a victim of our own success," ria? What's polio?'" said Dr. Ceorge Wohlreich, director of The Parents also don't necessarily understand College of Physicians of Philadelphia, which the connections between viruses and bactehas constructed an extensive website on im- ria and the severe illnesses they're capable munizations, www.historyofvaccines.org. of causing. "When you've seen people around you die For instance, most parents know to shiver of some of these diseases, it makes a star- at the word meningitis — a potentially deadn tling impression on you, he said. "When you ly inflammation of the membranes protectsee someone with whom you were running ing the brain and spinal cord. But they don't around the swimming pool two weeks later understand that a variety of bacteria, viruses in an iron lung, that makes a very profound or other microorganisms can cause it. impressionon you. When you grow up and Three vaccinesof the pasttwo decades you don'tsee any of this — you see kids — forHib,pneumococcus and meningococwho fall off swings, kids who have bicycle cus — have vastly reduced the incidence of
Page 20
Memory B-cell
Memory killer T-cell
Memory cells All this activity spurs the response desired from vaccines: the creation of memory T-cells and B-cells. These cells will know the real pathogen in the future and will react much more swiftlyand stronglythan when they encountered the vaccine. Memory cells can remain in the body for decades.
GREG CROSS
childhood meningitis, Cellin said. The varicella vaccine, which in children prevents chickenpox, is another one that confusesparents.Chunn said some parents note that they contracted chickenpox as children and that it wasn't a big deal. "Most who get chickenpox are OK,n he said.
"But we see the ones who get encephalitis or pneumonia.We see pregnant women with chickenpox on a ventilator. We see the children whose scans show pox inside their lungs." The other serious complication of chickenpox,Chunn said in an email,is a secondary bacterial infection with staph — including MRSA, the antibiotic-resistant bacteria
SPRING I SUMMER 2013 • HIGH DESERTPULSE
— and also the bacteria that can progress into better solutions for Hib and pneumococcus. "flesh-eating strep." A better understanding of the immune sysBefore the vaccine's introduction in 1995, the tem has emerged in recent years, as well. CDC says roughly 11,000 people were hospiG e l lin credits money poured into HIV and talized in the U.S. each year due to chickenpox. AIDS research. While an HIV vaccine hasn't yet A decade later, that number had dropped by emerged, the research has led to greater un95 percent in those younger than 20. derstanding of immune system responses. These numbers tell a story of prevention It' t's inth the numbers success.Butthe success means that decades later, only a few are left who remember the T h e Hib vaccine's impact isn't the only bright diseases that vaccines prevent. immunization story in recent Numbers tell the stories of '7g Wgtgh these deca d es. Experts saythe signifiprevention, Gellin said. And stopcanceofsome ofthe newervacping now-invisible diseases from C~~esgo fIOITi cines can't be underestimated. ever happening just isn't as visi- ~ Hepatitis A isn't as dangerous ble as curing an existing disease. as Hib, Chunn said. Children of"We don't talk enough about egjstegceto ten bounce back quickly. But it the fact that so many rates have can lead to liver failure. One of Ch unn's patients during his cagone down," said Karie Young- PIaCticallynothng dahl, director of The College of jg ~ j p g C UIpUg" reer died from the infection. Physicians of Philadelphia's vacThousands of people used cines project. "We need public Dr. Paul Cieslak, medical to g et it each year. Roughly health officials to talk about di r ector of the Oregon 3,00 0 Oregonians contracted Health Authority's successes more." hepatitis A in 1995. ImmUnlzatlon Program The virus passes through Cultivatingsuccess fecal-to-oral transmission. In
h+Q+<eof
Since 1994, eight different infectious dis-
t h e U.S. it was regularly transmitted by restau-
eases have become preventable with the r ant workers who didn't wash their hands afdebut of new vaccines. Scientists have im- ter a bathroom trip and then prepared food. proved upon other vaccines. Cieslak said hepatitis A at one time kept Experts credit a variety of factors for recent health departments constantly busy. "There used to be these press releases that advancesin vaccinedevelopment. Decades ago, vaccine development in- s aid ifyou've eaten at so-and-so's bar and grill volved more trial and error. Some vaccines you may have been exposed to hepatitis," he involved simply killing a virus and then inject- said. "Come in to the county health departing it, sometimes into a human test subject.
men t and get a shot of immunoglobulin. And
Genome sequencing transformed develop- it destroys the bar and grill." ment and has allowed researchers to become I m m unization for hepatitis A began in 1995. more and more nuanced in their vaccine for- By 2008, reported cases of acute hepatitis A in mulations. They can better pinpoint the mol- Oregon had dropped by 91 percent, the CDC ecule structure of a disease-causing virus, says.Lastyeartherewerefivestatewide. "Just in the past several years, I'm surprised bacteria or microorganism, called a pathogen. Thatallows them to laser in on small elements the CDC hasn't been using the term eradicasufficient to build an immunity. tion," Cieslak said. "To watch these cases go This more refined approach includes the from the bane of my existence to practically ability to piggyback elements of one patho- nothing is miraculous." gen onto other molecules the immune system T h e hepatitis B vaccine has also made its will recognize. For instance, Hib has a coating mark in recent years. on its exterior that kept young children's im-
Hep a t itis B, contracted through blood or
mune systems from knowing to fight it off. o t her bodily fluids, can either be a short-lived Attaching parts from a pathogen the body i llness or can become chronic. It causes liver already knows to attack means the immune cancerand other liver-related ailments. system cells learn to destroy Hib in the proIt ' s most problematic for children, who get cess. Creating these conjugate vaccines led to it largely during birth or from another person
HIGH DESERT PULSE • SPRINGI suMMER 2013
Timeline 1770s —English doctor Edward Jenner puts forth the theory that some milkmaids don't get smallpox because they were exposed to a related disease in cows, called cowpox. This theory is tried out by exposing people to matter from smallpox pustules. The inoculation works, and Thomas Jefferson in 1806 writes to Jenner,"I avail myself on this occasion of the rendering you a portion of the tribute of gratitude due to you from the whole human family." 1853 —Smallpox inoculation becomes mandatory in the United Kingdom. Germanyfollows later in the century. 1914 —A method for inoculating against diphtheria is developed. It's replaced decades later. 1920s —By this time, smallpox vaccination is required for attendance in many American schools. 1939 —A pertussis (whooping cough) vaccine is shown to be effective. 1946 —The first influenza vaccine is introduced to the public. 1948 —The pertussis vaccine is combined with ones for tetanus and diphtheria. 1955 —Polio vaccine proved effective. 1960s —Measles, mumps, rube a vaccines emerge. 1981 —First hepatitis B vaccine licensed. 1985 —Conjugated Hib vaccine is licensed. 1994 —The Pan American Hea!th Organization dec ares polio eliminated from the Americas. 1995 —Varicella (chickenpox) vaccine licensed. 2005 —Meningococcal vaccine for children licensed. 2006 —Hepatitis A and rotavirus vaccines recommended for all children. HPVvaccine is licensed. Sources: www.historyofvaccines.org; Edward Jenner Museum; U.s. centers for Disease control and Prevention; Hepatitis B Foundation
Page 21
Secretsuccesses( DISEASE-DEFYINGVACCINES
in the household. While the immune systems Separate vaccines exist for pneumococcal of adults often fight it off, according to the disease for adults and children. The first adult Hepatitis B Foundation it will be chronic for version was made available in the late 1970s 90 percent of children who contract it. and the first for children came out in 2000. Although the first vaccine was approved The adult vaccine didn't work in children in 1981, it wasn't required for children un- until after age 2. So for years, doctors contil about a decade later. Then, Chunn said, tinuedto see dangerous cases of pneumorates truly began to drop. nia, infection of the blood and bacterial The number of newly reported cases went meningitis in children. "Once Hib was gone, pneumococcus was from roughly 300,000 per year to an estimated 38,000 per year in the U.S., according to the thing that kept pediatricians up at night," the CDC. In a discussion of the disease, The Cellin said. Children's Hospital of Philadelphia says if vacCieslak said diagnosing it in those too cination continues, hepatitis B could be elimi- young to talk was particularly difficult. Doc-
The 2000 vaccine covered seven variations, called serotypes, of the pneumoncoccus bacteria that accounted for more than 80 percent ofdisease in children. It swiftly made a difference. "The thingwas tremendously successo ful, Cieslak said."We saw disease caused by those serotypes plummet." Researchers developed a childhood vaccine upping the number of serotypes covered from seven to 13, which became the standard starting in 2010.
And it performed as intended: The pneumococcus illnesses doctors worried most nated in the U.S. within several generations. tors always had to consider that certain about, pneumonia, meningitis and blood These vaccines have prevented the targeted symptoms couldbe pneumococcal disease. infections, virtually stopped. "This could be bacteria in the blood, this infections. What researchers are finding is that But in the years that have followed, resome of the more recently issued vaccines are could be spinal meningitis, this could be re- searchers have picked up on other effects o not only hitting their intended mark, they are ally nasty stuff," he said. And the only way I that didn't come up in trials. also having unanticipated, positive results. can find out is to bring the baby in, do blood Doctors are seeing fewer ear and sinus incultures, do a spinal tap, start the baby on fections. The pneumococcalvaccine prevents Positive side effects antibiotics and stop them only if all that about seven of every 100 ear infections and Such is the story ofpneumococcus immunother stuffcomes up negative. And the main about 20 of every 100 severe ear infections o
ization.
cause of all this was that pneumococcus.
• •
Continued on Page 51
•
•
If you've ever thought weeds made your landscape look more "natural". • •
Get Bac Into I!' Neck and back pain can redefine your view on life...and not for the better. At The Center, our spine and neck care experts' goal is to make your specific pain go away for good. For over 50 years, patients throughout Central Qregon have trusted our team Jp create surgical and non-surgical approaches with nationally renowned results. Put your care in our hands and get back to what you love. The Center: Find strength here.
J
ag
•
• O~ • , •
•
a~ '
• +e • • '. :~e+ • 0 e
".ee ®e~
+i ',,„ ,, r&tA
' .
•
•
Oa
.
r
Ray Tien, MD, PhD 8 Brad Ward, MD
A - - W c~ Page 22
ORE HOPE OIC & NELIROSUROICAL CARE & RESEARCH
541-382-3344
rv
,4
THE CENTER TheCenterOregon.com
v SPRING I SUMMER 2013 • HIGH DESERTPULSE
Oregon's required immunizations States determine which immunizations are required for children to attend schools and day care centers. Oregon allows parents to opt out of some or all vaccinations. The Oregon requirements for the 2013-14 school year aren't identical to the 2013 immunization schedule recommended by the U.S.Centers for Disease Control and Prevention. A state committee decides which vaccinations to require for schools, and the two schedules sometimes differ. Some differences accommodate children arriving from countries with different vaccination schedules — for instance, two MMR shots are standard in the U.S. but not all countries combine measles, mumps and rubella into one shot. Other differences reflect opinions on which shots are most necessary to protect health in schools. Required to attend day cares and preschools for children 18 months and older: • Four diphtheria/tetanus/pertussis (DTaP)doses • Three po io doses • One varicella (chickenpox) dose • One measles/mumps/rubella (MMR) dose • Three hepatitis B doses • Two hepatitis A doses • Three or four Hib doses CDC recommends that children by age 6 also have received: • Four pneumococcal doses • Annual influenza vaccination starting at 6 months old • One additional MMR dose • One additional varicella (chickenpox) dose • Two rotavirus doses
Required to attend kindergarten through Sfth grade: • Five diphtheria/tetanus/pertussis (DTaP)doses • Four polio doses • One varicella (chickenpox) dose • Two measles doses • One mumps dose • One rubella dose • Three hepatitis B doses • Two hepatitis A doses CDC recommends that children by age 11also have received: • One additional varicella (chickenpox) dose • Annual influenza vaccination • One additional mumps dose • One additional rubella dose
Required to attend seventh through 12th grade: • Five diphtheria/tetanus/pertussis (DTaP) doses • One Tdap (tetanus, diphtheria and pertussis) dose • Four polio doses • One varicella (chickenpox) dose •Two measles doses • One mumps dose • One rubella dose •Three hepatitis B doses CDC recommends that children by age 11also have received: • One additional varicella (chickenpox) dose • Annual influenza vaccination • One additional mumps dose • One additional rubella dose
GREGCROSS
Source: U.S.Centers for Disease Control and Prevention, Oregon Immunization Program
•
•
•
-
•
-
•
•
-
•
-
•
•
• •
•
•
•
a
•
• •
•
C e •
e
•
•
a
•
•
a
•
•
•
•
•
•
Simply scan your checks using one of our desktop scanners and deposit them in your account via our secure online portal. Remote Deposit offers you: CONVENIENCE IMPROVED CASH FLOW
High Desert Bank has everything you need. Come talk to us today about opening yourbusiness checking account.
Call us today and start enjoying the convenience of Remote Deposit.
541.848.4444
Remote Deposit is subject to approval.
HIGH DESERT BANK •
I II
-
•
•
C- •
•
HIGH DESERT PULSE • SPRING/SUMMER 2013
'
I
•
•
•
LOCAL SERVICE - LOCAL KNOWLEDGE
Page23
Getgear ~ AGUIDETOCANTEE NS
Handheld water bottles
Waist belts
Water bottles that fit in the palm of your hand offer easy access to fluids. Carriers with adjustable straps provide a relaxed butfirm grip on the bottle. Many have small zippered pockets for stashing keys, a credit card, a phone, an iPod or an energy gel. Ideal for: Middle distance running or walking. Pros:Compact, lightweight, relatively inexpensive, easy to clean. Cons:You have to carry it, holds only 7 to 20 ounces, hand can get hot. Approximate cost:510-525
Waist packs hold 20- to 24-ounce water bottles at an angle or laterally in the small of the backto maximize comfort. Alternatively, belts outfitted with a row of 6-10-ounce bottles distribute water or other fluids around your waist. Ideal for: Nordic skiing, middle distance running or walking, hiking. Pros:Easy access, hands-free, extra compartments for gear, easy to clean. Cons:Can chafe, must be cinched down tightly to prevent the belt from bouncing around. Approximate cost:530-570
Runner's World Cruising Handheld Water Bottle; 12oz; $10
Nathan Triangle Hydration Waist Pack; 22 oz; 530
Page 24
BY ELISE GROSS• PHOTOS BY ROB KERR
taying properly hydrated while exercising is crucial for optimal physical performance and health. Dehydration — an abnormal depletionof body fluids — can cause weakness, headache, vomiting and, in severe cases, death. But figuring out a comfortable way to carry fluids on an adventure outing without resembling a pack mule can be challenging.
When choosing gear, consider the duration and intensity of your planned activity. As a rule, the longer and harder you plan to exercise, the more fluids you should carry. For remote outdoor excursions, consider bringing extra fluids for an emergency such as getting lost or stranded. Be sure to try on a product before you purchase it to check for comfort and fit. •
Small hydration packs (>-2 Iiters)
Large hydration packs (2-3 Iiters)
For distance trail running or backcountry skiing, a lightweight hydration backpack or vest holds more water and evenly distributes weight across the shoulders and back. An interior flexible polyurethane reservoir, or bladder, is attached to a sip tube with a bite valve. For cold conditions,"winterize" the reservoir by adding covers for the bite valve, tube or insu ated reservoir. Ideal for: Cycling, trail running, hiking, snowboarding or all types ofskiing. Pros:Evenly distributes weight, ample space for water and gear, hands-free, easy to drink when moving. Cons:Can chafe, somewhat heavy, hard to clean, back can get hot. Approximate cost:550-575 for backpacks, 5100-5130 for vests.
Longer, more intense endurance activities like mountain biking call for larger supplies of water. Like smaller packs, large hydration backpacks are designed to evenly distribute water weight across the shoulder and back in a reservoir attached to a sip tube with a bite valve. Ideal for: Mountain biking, hiking day trips. Pros:Large liquid capacityfor long outings, evenly distributes weight, spacious, hands-free, easy to drink when moving. Cons:Can chafe or fee heavy, bulky, hard to clean, back can get hot. Approximate cost:560-5150
Osprey /IIira 18 Hydration Pack; 100 oz (3liters); 5139
CI
I
CamelBak Aurora Hydration Pack; 70 oz (2 liters); $68
Note: A variety of hydration products can be found at REI, FootZone, Fleet Feet Sports Bend, Mountain Supply, Pine Mountain Sports and Dick's Sporting Goods in Bend.
Page 25
an thejob ~ FLIGHTNURSE
On a bluebird dayin March, Phil Kolkow stepped aboard an EC-145helicopter, ready for another day on thejob. Dressed in a black, fire-retardant flight suit, Kolkow fastened his four-point harness seat belt, donned his helmet and pulled a microphone close to his lips. Within arm's reach was an array of medical equipment — a gurney, an oxygen tank, an electrocardiogram machine. The grass rippled as the aircraft lifted from its landing pad
BY HEIDI HAGEMEIER •PHOTOS BY RYAN BRENNECKE
at AirLink Critical Care Transport, which sits next to St. Charles
Bend. Soon, pilot John Reiter brought the helicopter up to about 1,700 feet above the ground, filling the window frames with gleaming Cascades peaks. "Look at the office we're working in," Kolkow enthused. "It's just so awesome." WhileKolkow experiences such moments ofcalm, much of his time in the air is spent lasered in on a patient, performing some of the most urgent work in health care. The Bend resident, 61, is a critical care flight nurse. He tends to patients as they race through the sky, the quickest possible route to the care they desperately need. "Cenerally, if somebody is calling for us, they needed somebody there five minutes ago," he said. Kolkow has spent a significant chunk ofhis career in medical air transport. He got a job right out of nursing school in 1976 at St. Charles, which was then the new hospital east of Bend. In 1985, when St. Charles started the first air transport
service in Central Oregon, he decided tojuggle his position in the emergency room with flight duties. He did
so for about three years. Then, a decade ago, he returned to work in the sky. Since then, Kolkow has worked 24-hour shifts, rushing into action day or night much like a firefighter when the call comes in. And with medical advances, the aircraft are edging ever closer to the capabilities •T
Atright, criticalcare flightnurse Phil Kolkowstands near the AirLinkEC-145helicopter on which he works.
Page 26
.i
4~-
++ra
i
2
W'
P
Q ~ '
A
.+
>; 4 + ~
j l
/
R
'.N
I
HIG •DEEEIITPULEE EPRINGIEUMMER2013
i ~ f'"
Vti
L~j,'LET< ;r
R
,
'
.
Page 27
,
':0j,'I. I l.2'l
f, •, MPif
ofan intensive care unit. "I love it," he said. "It's the bestjob I've
ever had."
Getting the call Kolkow and his colleagues are trained to work on two types of aircraft. One is the helicopter, which usually stays within the region. They either pick patients
Membership for medical air There are two main providers ofmedical air transport in Central Oregon: • Life Flight Network:www.lifeflight.org or 800-982-9299 • AirLink Critical Care Transport:www.airlinkcct.org, 800-353-0497 or 541-706-6305
Airplane transport patients often need to get to a metro area to access treatment not
up from accident scenes or isolated loca-
accident scene ask 911 dispatchers to send a helicopter, the dispatchers call AirLink or Life Flight Transport based on a matrix map oflocations, said Stacey Durden, marketing manager for AirLink. For transports between two hospitals, the physician decides which service to call, she said. Durden said sometimes a patient's preference on which service to call is honored. But
available here, such as a burn unit or pediatric cardiac care. Occasionally, the service hospital to a larger one like St. Charles Bend brings an individual awaiting a transplant to access more services. to a faraway medical center when a donor Two companies offer helicopter mediorgan finally becomes available and there cal air transport in Central Oregon, AirLink are only hours to spare. and Life Flight Transport, which is based in These flights don't necessarily come Redmond. cheap. Both AirLink and Life Flight sell mem- other times, an incapacitated patient isn't Kolkow also works shifts for airplane trans- berships, and members have no out-ofable to communicate membership with one port, which is only offered in Central Oregon pocket costs for flights. Nonmembers' bills or the other. through AirLink. The company's two Pilatus can range between $15,000 to $40,000, Calls to AirLink from 911 dispatchers or PC-12 planes launch from the Bend Municipal according to AirLink's website. hospitals arrive at the company's dispatch tions, or they transport patients from a rural
Airport. Sometimes they take patients to
cities like Portland, San Francisco and Boise, Idaho. Other times they pick up patients in
rural communities like Lakeview and Burns.
Page 28
Yet with two helicopter transport services
in Central Oregon, area residents might want to buy memberships to both. For instance, if emergency workers at an
center.
Kolkow and other staff on duty are stationed based on that day's shift. The fixed-wing crew is at the Bend airport, while
SPRING /SUMMER2013 • HIGH DESERTPULSE
On thejob( FLIGHT NURSE
Kolkow looks out at the Cascade Mountains from the AirLink Critical Care Transporthelicopter. The heiicopter and airplanes are so well equipped that they're often referred to as mobileintensive care units.
ing. Or it could be a severe car accident. As the crew works on the medical details, the pilot is simultaneously learning more ratory therapist, whose job is to maintain about where the helicopter can land. Some the patient's airways and breathing during places, like Mt. Bachelor, have a dedicated transport, and at times also a paramedic. landing zone. Depending on the time of day, Kolkow Other scenarios take more creativity. might be in one of the sleeping rooms. Or if Emergency first responders as well as on a helicopter shift, he might be grabbing search and rescue volunteers know how food in the hospital cafeteria. Otherwise, to identify potential landing spots and will Kolkow and others occupy time not spent in sometimes mark the area with flags or flight by conducting trainings, keeping up-to- flares for the pilot to see. date with medical protocols and other tasks. Those landing spots are not necessarily Sometimes the call is to stand by. Other right next to the scene. Kolkow said the times the crew is asked to depart as soon only spot on a search and rescue mission, as possible. They try to be off the ground in for instance, might be several hundred about seven minutes for the helicopter and yards away through the woods. 15 minutes for the airplane. Even at high altitudes, the EC-145 helicopIn those few minutes, the medical crew ter is built for this sort of work, Reiter said. going up must make some critical decisions, It's very sturdy and can fly up to about 155 sometimes based on sparse information be- mph. "It's got the power and it's got the speed cause the emergency is still unfolding. Crew members must decide whether to do what we do," he said. they need any additional equipment in the Once on the scene, the ground and flight aircraft. For instance, the team brings anticrews load the patient as quickly as possible venom from the hospital if the call is for a into the aircraft. Then, they lift off. the helicopter crew is at the facility on the
St. Charles Bend campus. Flight nurses are regularly accompanied in the air by a respi-
rattlesnake bite. A 300-pound isolette — a
tiny isolation chamber — is brought on board to transport the smallest ofbabies. The pilots judge the weather for flying. They also want to know whether they are collecting one or two patients and how heavy they might be. And they determine all this in minutes.
Caring for patients Airbornemedicine commences as necessary. Kolkow can get out of his seat with the pilot's permission, but much can be done right from his position next to the patient.
There can be some special considerations for patients inside the helicopter, which isn't
"Sometimes, they're off before dispatchers pressurized. Pressure changes can be imhave even hung up the phone," Durden said. portant if a patient has a collapsed lung, for instance, or a brain injury. Up in the air "Altitude, temperature and pressure changDispatchers and others continue updating es can be a big deal for patients," he said. the medical staff onboard once they're in The aircraft contains lab kits to allow the air. Kolkow to perform tests to determine blood "If we're going up empty, the crew is talk- oxygen levels or whether the patient is loosing about what we're going to do," Kolkow ing blood. The patient can receive blood or said. "We might only know age, weight and intravenous fluids in flight, as it has a refrigthe basics on what happened." erator to store it and a warmer to bring it to The basics could be,a snowmobiler has an appropriate temperature. A cabinet conhit a tree and doesn't appear to be breathtains supplies and medicines like antibiotics
HIGH DESERT PULSE • SPRINGI suMMER 2013
and painkillers. "It allows us to do things that normally take
place in the hospital," Kolkow said. "If there's anything you can do in the air, you should do it and not wait until you're on the ground."
The caregivers can also be conferring with medical staff on the ground, asking for advice on how to proceed or getting them ready for the incoming patient. For instance, Kolkow said one of the biggest reasons for transports from hospitals like Madras or Prineville to Bend is heart attacks. "You don't want to wait to get to a facility
and get an angioplasty," he said. "Time is really key with what you do." After years of experience, Kolkow said, he often knows whether a patient should bypass the St. Charles Bend emergency room. "I can tell them I've got a patient that
needs to go directly to the operating room and expedite that process," he said.
Passing the baton This March day provided a smooth helicopter ride. But as the aircraft approached the Cascades, it still bumped mildly in the air currents. "Wind flows like water in a river over the
mountains, so you get a little turbulence," Kolkow explained. Yet he admitted that flights can be a bit
more rough. "It's sometimes like a rodeo with the turbulence," he said. It means health care in the air isn't the
rightjob for everyone. Even Kolkow experienced a touch of motion sickness in his early days as a critical care flight nurse. YetKolkow said the staffhas been handpicked for this job, all with emergency experience. "I feel real good about the team we've got," he said. "I know the quality of the people stepping out ofthe helicopter." "It's a relay," he said of caring for patients. "We're getting the baton to the next per-
son." •
Page29
•
!
• !
•
• •
•
•
l
l I (
• (
•
•
• •
•
HOWdOeS hedOit? i ALANwATTS
)
attssca/e's,:'.~:'.':."' "
>'~Q fiis phofd,'takeg, j~< ".'sOmetl'itIein(he ~fA'~:y
1
Alan Watts'doggedness serves him well BY ANNE AURAND â&#x20AC;˘ PHOTO BY ROB KERR
t was the same determination and tenacity that made Alan Watts a foremost
sport climber decades ago that helped him more recently revive his long-neglected fitness. Watts is widely credited as the father of
American sport climbing. His remarkable rock climbing career is inextricably linked with Smith Rock State Park becoming one of the hottest climbing crags in the world. He's written guidebooks about climbing at Smith.
But his active lifestyle was for some time eclipsed by overuse injuries, work and parenting. At times, he packed an extra 40 or
50 poundson his5-foot-9-inch frame. Last fall he committed to losing the weight
and getting in shape. Watts,52, now has a lean physique and often wears the bright-colored athletic attire
that's ubiquitous in Bend. When he smiles, the lines that crease his face suggest a life lived mostly outside. When he's outside being active, he smiles more. "It's fascinating being older and getting in shape," he said recently. "I'm weaker at the same weight. It's OK; it's motivating. I feel like
I have a new body, I want to see what I can do
HIGH DESERT PULSE â&#x20AC;˘ SPRING ISUMMER2013
with it. When I weighed 185 I was depressed. smooth rock faces where there were no I couldn't conceive of going climbing like be- cracks,opening up new and more challengfore. Now I'm curious to see what I can do." ing places to climb while still offering proHe might be able to climb again. tection. Climbers had dabbled with bolting in California and Europe already. Watts used Watts' legacy this method to develop several dozen routes Climbers had been crawling like spiders for climbers at Smith. He prepared, among all over Smith Rock's walls for decades be- others, now-famous routes including To Bolt fore Watts arrived on scene. In 1960, the or Not to Be,Just Do It, Chain Reaction. "I was into pushing climbing standards to state created Smith Rock State Park. In the 1970s, climbing came of age in the area, ac- the highest levels while minimizing the danger," Watts said. cording to one of Watts' guidebooks. Watts' father was there, back then. The This was known as sport climbing. younger Watts, who grew up in Madras, folIt was not without controversy. lowed his father's footsteps, mountaineering Some criticized the bolts as destructive to in the Cascades and rock climbing at Smith the natural environment. Others suggested in his early teens. sport climbing was cheating. "Some people By the early 1980s, Watts had mastered feel minimizing danger detracts from the all the established routes as a traditional experience," he said. "I'm not entirely loved," he said. But, "I feel climber. Traditional climbing refers to when climbers place safety devices into cracks in great about it. I didn't mean to create conthe rock as they ascend. Climbers hook their troversy. I was just following my passions. I ropes through these devices to catch them if took a fresh look at a stagnating sport." they fall. They remove the devices when the Until the 1970s and 1980s, Smith Rock climb is over. had been relatively unknown by all but the For Watts, the traditional method of climb- core climbing rats from Oregon. ing was beginning to feel limiting. He wantThe controversy brought attention, and ed something fresh, different. the attention brought climbers. He decided to drill permanent bolts into The routes that Watts envisioned and
Page31
How does hedoit? ~ALAN WATTS
climbed were "the catalyst for Smith's journey from unknown backwater to international pre-
mier crag status," said Chris Grover, who lived in Bend and climbed with Watts back then,
and is now the vice president ofsales for Black Diamond Equipment, a Salt Lake City-based manufacturer of climbing equipment. After Watts made his mark, "Smith was one of the hottest crags in the world, set-
He mostly avoids carbohydrates. About every other day, he'll eat mostly salad. SomeFortunately, Watts had other things go- times he'll fast. He weighs himselfdaily. ing for him. He earned a business degree But, he said, he's learned from his past from the University of Oregon in 1987 and obsessiveness that an "absolute" diet doesn't became a founding partner and later a presi- work. It will doom him to failure. "For example, I love milkshakes," he said. dent of Entre Prises USA, a climbing wall "There's nothing I can't have, but I don't have manufacturer in Bend. He married JoAnn. They had two kids in the early 1990s, Ben milkshakes too often. I can still satisfy those and Morgan, who are now 19 and 15. He cravings. I have vices. I drink some alcohol, published his first climbing guidebook. and diet soda. I gotta have some vices; that's He hardly climbed. He was absorbed with part of the whole thing. Otherwise it'd be
Life beyond climbing
ting the American standard for difficulty, defining the cutting edge of crag culture in America. (It) attracted the best American and international rock climbers and was being other things. featured on the covers of every respected His weight fluctuated, depending on international climbing journal," said Grover. where his focus was at the time. He could exercise obsessively — mountaineering, The cost of obsession running, tennis, nordic skiing — to shed exWatts, according to Grover, had a "mind- cess pounds, but he'd get injured, and quit. blowing amount of focus and concentration. He began to realize that this all-out ap"What sets him apart in my opinion is his proach was not working for him anymore. ability to mentally engage with something," He earned a master's degree in business Grover said. But it wasn't all work and no
play. "We were having an unbelievable amount of fun," Grover added. As fun as it was, Watts has some regrets. "I was pretty obsessive and stupid. I was working harder than anyone in the U.S. for years," Watts said. He would climb six or seven days a week, sometimes 30 days a month. If work or life kept him off the rock during the day, he'd climb in the dark. Watts' wife, JoAnn Miller-Watts, said her
isand how he gotto bewho he is,"she said. Extreme obsessioncan generate success. It can also lead to injury. By his 30s, his hands were chronically inflamed. Sharp pain shot through his finger joints. Climbing made his fingers swell fat like sausages. "There came a point when the (hand) injuries were keeping me from reaching my goals," he said. "I could have had a longer climbing career if I hadn't been so obsessive," he said."I had dreams of being a climber. Many dreams came true. My home, this mecca, all my heros came here to experience this place I had part of creating. But by the time they showed up, I was broken."
Page 32
Butte once a day, every morning after dropping offhis daughter at Summit High School. Why Pilot Butte? "I like climbing mountains,"
he said with a no-nonsense grin. The hikes were miserable at first, and some days he almost didn't get out of his car at the trailhead. As hiking grew easier, he added a from Portland State University in 2002, but second dail y ascent.Then he added a loop before he could put it to use, his oldest child, around the base, a relatively flat trail. Then he Ben, rose as a successful young snowboarder. started running it. He often fits in an evening Watts became Ben'smanagerand foradecade run along the Deschutes River too. of winters, they traveled around the world. He jogsa steady pace as he climbs the Traveling trumped fitness, led to a lot of meals butte, and can talk the whole time if he in restaurants, and, ofcourse, weight gain. happensto have company. He usuall y runs alone.He sees many ofthe same peopleon Turning point the trail, presumably fulfilling some ritual of In June 2012, Watts weighed 194 pounds. their own. He loves this part of his day, and He said he saw a picture of himself, 40 or 50 how the running makes him feel. pounds too heavy. "It was a reminder of who He goes regardless of weather. When I didn't want to be.... I'm too heavy to climb, asked if the snow might thwart his plans run ... the stuff I love to do, be outside, in one day in March, he texted: "I'll be there no
husband hasalways been one to set goals and reachthem, atany cost.He gets so absorbed by his goals, be it pioneering a climb or painting the house or losing weight, he can nature. For me, that's like church." lose track of time and ignore all else, she said. A group of fit triathletes wanted to climb "He tends to go to extremes. That's who he
too miserable to sustain." He started hiking the dirt trail up Pilot
with him, so they all headed out to Smith
matter what."
However, a while back, something started to hurt in his hip. He reluctantly took two
Rock. Watts couldn't keep up with them bus- days off, worried that he'd landed himself in tling down the trails to the climbing routes. that place ofbreaking down again. But after It disturbed him. a rest, the pain went away, affirmation of his Last year Ben graduated from high school new approach. "It used to be I'd go anyway." and stopped snowboarding. Going into the winter, Watts realized he had the freedom to In February, he reached his goal, 148 do whatever he wanted to. He wanted to get pounds — what he weighed at the height in shape. of his climbing career. He emphasized that He tried a vegan diet, and dropped some there's an end to this weight loss phase. It's pounds. But being vegan requires too much time for a new goal. "Six months ago I was fat, slow and weak," planning and consideration. He started eating better and exercising more. By Novem- he said with a soft chuckle. "Now I'm slim, ber, he had launched a well-orchestrated still pretty slow, and still weak." and somewhat "fanatical" four-month eating His new goal is to get stronger and to run and exercising plan. True to his nature, he faster. stuck tenaciously to it. And, he said, "I would like to rock climb."•
SPRING/SUMMER2013 • HIGH DESERTPULSE
Snapshot
PHOTO BY ROB KERR
Cyclists ride between massivesnowbanksalong the McKenzie PassHighway westofSistersin late May 2072. Each spring when thehighwayis clearedofsnow, itis open to cyclists â&#x20AC;&#x201D; butnotvehicles â&#x20AC;&#x201D; for a few days, allowing a "cool"rideon the twisty, scenicroute. Historically, McKenzie Passhas opened as early as March 21 (in 1934) and as lateas July29(in 7999). Forcondition updates, call Sisters bikeshops Eurosports,541-549 2471, or Blazing Saddles,541-779-1213. Page 33 tT
Getready ~ cAscADELAKEsRELAY
Sheila Miller's teammate,Tanya Bruce, hustles down the Cascade Lakes Highway during the2012 Cascade Lakes Relay.
710
PETE ERICKSON
l
An insider's guide to the (are ye having fun?) Cascade Lakes Relay The races are gaining in popularity probably because they com-
BY SHEILA G. MILLER
icture it: sitting in a cramped van for
b i ne the fun of hanging out with friends with the feeling of getting
36 hours with friends, with stops a goodworkout. Theyalsocreate peerpressuretoworkout, which and starts to run under a beating hot is very helpful; if you don't train, you'll look like a bozo and let down sun or in an ice-cold night, trapped with the your teammates. So you better get off the couch. sweet smell of sweaty clothes while lingerB u t while these 36-hour adventures can be thrilling and challenging constantly on the verge of sleep just to ing, they can also be exhausting and painful. That's why it's imporbe awakened minutes later. If this appeals to t a nt to pair the right training with a few insider tricks, so that the fun
you, I suggest running a long-distance relay. ofthe first mile isn't forgotten with the miseryofthe final one. P Long-distance relays have been around foryears. Here in Or- = -.= —: ==- .== - - -"-='= --'= St Step1:Getyourse 1Gt If ready-,.-~~' .==egon, the Hood to Coast Relay started in 1981, and the Cascade - .,-~..+ : - =~ , - ~ ' -'-"..c-,' LakesRelay,which starts nearDiamond Lake and ends in Bend, '.=.~=;=-First, tw'o words about trainirig: Do it.~~ ~ + -"-".~~ =:.:—:,'.;,.~' - ' . began in 2007. Similar relays, which typically feature.teams of,.=-=,=-'=I speak from experience.'I've run the Cascade Lakes Relay '=i ~~ =c eight to 12 runners and traverse hundreds of miles, take place ".-."twi'ce, and will run it again this summer. Before last year's re'="'-, =*.'<:. all over the country — the American Odyssey run from Getty<-. lag; I did a lot of sitting around and not a lot of running. Here's -burg to D.C., the Reach the Beach series n Massadtousetts New --'.what I learuted: My body found a way to comPete for the first::.-.! -''-',:--and ~cond tegs without'much training. And the third leg was -,-:, .-.=-.=-' Hampshire and New Jersey. -
.
-
'
.
-
.
-
—
-
-
' :
,
:
.
'
-
.
.
,
,
.
.
." .
;
"
-
P~
'
"
-
-
:
.
-
.
- '
,
P I I
I
~
~
~
Thethird leg wasoneofthemostunpleasantexperiences ofmylife. Theremayhavebeen tears. one of the most unpleasant experiences of my life. There may have been tears. So even if it's slow, even if it doesn't follow a formal plan, at least get out and run. And if you're
encourages relay racers to make one workout each week into a double, that is, running once in the morning and again in the evening to get a feel for what that's like.
Teri Smith, the Cascade Lakes Relay's communications director, suggests spending the two weeks before the race really getting used to the heat, "moving around and getting your body used to it. "It's something some people have had One van's participants rest while the other really tough times with from not being prevan's participants run, leaving several hours pared," she said. "It's not something you between legs. Croups can sleep in the La Pine think about." High gym, but "sleep" is not a term I'd use to Smith said there's no need to spend the describe the experience. The gym is filled with entire summer running in the heat of the runners, all trying and failing to quietly unzip day; even getting out and hanging outside their sleeping bags, and alarm clocks con- in hot weather will help your body adjust. stantly sounding so van mates can meet the And over here in the peanut gallery, a few rest of their teams for a smooth handoff. things I've learned in the past two years of FootZone's Dave Thomason, a race director participating in the relay: The CLR is run known in local running circles as SuperDave largely on pavement. In Central Oregon, and who founded the Dirty Half Marathon, we can train on many wonderful, soft trails. said there are some simple ways to feel solid Cetting in some pre-race runs on pavement through the finish of a relay like the CLR. at the height of a baking hot day will be unBy theend ofMay,Thomason suggestsup- pleasant, but will eliminate the surprise facping the winter training he hopes you've done tor when you're on an abandoned highway, to include at least three runs each week, with withno wind and a pounding sun. one being the distance your maximum relay Step 2: leg will require. For example, if you'll run relay Get your transportation ready legs of three, six, and nine miles, you ought If you've properly prepared your body, to build up to running at least a nine-mile run you've taken a step in the right direction. during the weeks leading up to the race. He also suggests doing speed intervals The second step involves properly prepar("you gain a lot of fitness") and trying to fit ing the vans. Each team has two vans with in a tempo run, where you're running harder six runners in each. than you would on a normal run, maybe I highly recommend having non-runner about 80 percent of your maximum speed. designated drivers for each van; that way, "If you run at the same pace all the time, runners can rest and recover during van time. all that leads to is running the same pace." I also highly recommend renting or borrowAnd it's OK not to run every single day. In ing vans that are large. In the past two years, fact, Thomason encourages doing avariety of my team has had a sort of rich van/poor van exercises and cross-training. It keeps you from scene â&#x20AC;&#x201D; one group spread out in a Chevy overuse injuries that plague first-time mara- Suburban, which has plenty ofroom, and one thoners and others who sometimes overtrain. group cramped together in a minivan, which So if you like soccer, play soccer. If you is less than optimal. SUVs (with three rows of want to get on your bike, take a long ride. seats) and 12-passenger vans will be more One thing to keep in mind: during a relay expensive, but worth it when legs need to be you're running at odd hours, and more than stretched (Important! See step 3 below!) and once in a day. Max King, a local elite dis- sleep is calling. tance runner, has run the Hood to Coast and Once the vans are rented, it's time to fill CascadeLakes Relayatleastseventimes.He them properly. First, runners in each van will smarter than I am, do a bit more than that.
In the Cascade Lakes Relay, 12 runners each run three legs. That means each runner will have to complete about 18 miles. Race legs vary between two miles and nine miles, and many involve significant changes in elevation.
HIGH DESERT PULSE â&#x20AC;˘ SPRING/sUMMER 2013
communicate by walkie-talkie or cellphone: when one van's runners are nearly finished with their legs, the other van had better be
ready for a handoff. But cell service in many of the areas is shoddy and walkie-talkies generally don't work unless you're within a mile or so ofone another, so patience is key. Also key: knowing how fast (or slow) the runners in the other van are, so you can calculate how long each of the legs is likely to take. That way, if the cellphone or walkietalkie fails you, your van will still be ready to run when it's time for the switch.
Beyond communication, a few other obvious pieces of the puzzle: safety lights and other required equipment for running in the darkshouldgo somewhere with easyaccess, Smith's favorite trick for organizing the
van is having a set of six plastic bins, one for each runner to store important stuff like iPods, wallets and headlamps. "All those little things you lose as the relay goes on, it's such a huge relief that you know right where that stuff is," she said. And eachvan should have a large jug of water and ice. Our van also had Catorade powder and various recovery drinks, as well as a large cooler for food. The wrong time to experiment with new types of drinks or other nutrition packets? In
the middle of the race. Thomason suggests testing out a variety of recovery foods and drinks while training. After a long run, try different foods and drinks and see how they make you feel. It could be as simple as a peanut butter and jelly sandwich. Thomason said it helps to include protein; the emphasis is often on loading up on carbohydrates, he said, but that's not a good idea because eating a ton of anything is bound to slow you down and leave you witha stomachache. Running drains glycogen stores in the muscles and liver, which provide some of a person's long-term energy. It's best and easiest to rebuild those stores soon after your run to keep you feeling strong and ready for your next leg. King suggests drinking something with carbohydrates and protein in it.
Once that recovery is underway, he recommends a small meal before the next run. "You don't want to eat heavy things," he said.
Some teams go in together on foods like bananas, hummus and pita, that sort of thing. But I've seen others with gigantic mobile grills
on the back of their vans, and personally that's more my speed. Each van will have downtime
Page 35
Getready( CASCADE LAKESRELAY
Bring running gear plus: • Reflective vests, flashlights/headlamps, and flashing red lights for night runs • Sleeping bag, pillow and camp mattress • Changes ofclothes, including a winter hat, sweats and sandals • Bug spray and sunscreen • Baby wipes and hand sanitizer • A cooler and a water jug for each van •Shampoo, s oap and atowelifyou wanta shower at La Pine High
2166miies,
• Neosporin • Benadryl • Band-Aids • Ice packs
• Ear plugs: Sometimes sleep is more important than singing along to "Call Me Maybe" again. • A bandanna: Some ofthe running takes place on cinder, and covering your mouth helps with dust. • A brand new, never-used pesticide spray canister: Your teammates can spray you with water while you run. • A swimsuit: There are chances to go for a dip, albeit a cold one, in Elk Lake and Diamond Lake. • Benadryl: I'm allergic to everything. •Van decorations; You don't want to be the team with the least spirit.
iitsg geng
mmmmm
m
I
DESCHUTES
La Pine mmmmmg
LAM
LAKE
Start:Dia ondLake
CLR gurus suggest a first aid kit with: • moleskin •Ace bandages • Ibuprofen • Scissors
Sheila Miller also "highly recommends" bringing:
Cascade Lakes Relay route
' coUNTY
Chemult
• Second Skin •Tweezers • Icy Hot •Tape, gauze
dssmmmmm
/
'
i
s
Silver Lake
mrm mm
Crater ke
2013 race date: Friday and Saturday, Aug. 2-3 On theweb: wwwcascadelakesrelaycom
while the other van's runners are on the course, Sensitive areas, left unwashed and clothes un- immediately sitting in a cramped van. so it is possible to park, grill, and party. changed, can get a little, shall we say, chafed. Kingand Thomason have suggestions for For the ladies, an obvious addition to this making that part of the race less brutal. Step3: "I think the biggest help in the van is not is a change of sports bras. In my experience, Keepthecreaturecomfortable that band on the bottom ofa sports bra nev- how fit you are, but how well you can help Beyond food and drink, it's about comfort. er dries until it's off your body. yourself recover in between runs," King said. Taking into account the heat, I highly recOnce you're in the van, that's when the fun "Mostpeople who do relays have been runommend changing every piece of clothing — and the pain — begin. ning. They can handle the miles. What really after each race leg. This limits how stinky The fun is easy to understand: You're in a gets you is, you run and then sit for a long your van gets, and it also limits how clammy tight space with a bunch of friends, operat- time." and uncomfortable you are. ing onendorphins and a lackofsleep. When passing off to the next runner, King Thomasonsuggestsfresh socksand shorts The pain stems from a variety of places: suggests continuing to jog down the road for each leg of the race, and also testing socks the CascadeLakes Relay takes place in Au- to cool down, perhaps as long as five or 10 for comfort before the race. And if nothing gust, usually a time of high temperatures. more minutes. Thomason agrees. "If you can muster the energy, do a little else?"Body glide," he said, laughingly referring And there's something particularly uncomto the lubricant used to prevent skin irritation. fortable about running long distances, then bit of a cool-down jog," Thomason said.
I
Power LifztChairs
I
•
Power Adjustable Bases
$79'9 II
Q
$
with Mattress
m
x i r w l ll
FREE DELIVERY • FREE SET-UP • FR EE REMOVAL OF OLD MATTRESS W sls o n ' s
M rA~T T R •
• •
•
s •
qw ES ~S
live Garden
GCP aller y - B e n
s
g••
r
®i . ) i
•
•
s
g
ci • ; '
"Just nice and easy for five minutes, or even walk. Don't get right in the van and sit."
The same goes for warming up before a leg. It's not always easy, but King says your body will feel much better if you warm up before your teammate hands you the wristband. King's final suggestion for combatting exhausted legs is trying to keep your legs propped while you're in the van, and wearing compression socks whenever you're not running. They can be a bit expensive, and you may notlovetheway you look in knee-high socks (although they now come in a variety of colors). But you know that heavy feeling in your legs after a long run? King says when you finish running and your heart rate slows, blood pools in your legs, and compression socks help keep the blood flowing to eliminate toxins and metabolic byproducts accumulated during the run. And Thomason takes an approach similar to mine. "The third leg, you're going to feel like crap," Thomason said. "So have some treats, some comfortable, reliable stuff."
Central Oregon
Radioloy
Associates, p.c. Serving our MedicalImaging NeedsSince 1948
Step 4: Keep your eye on the prize And the last, and I believe most important part, is that the best
way to deal with lack of sleep, body aches and general exhaustion is to have as fun a time as possible. I highly recommend not taking the running itself too seriously. Bring items that will keep you laughing: playlists on your iPhone, decorations and face paint, playing cards. Smith said her teams always tried to have something that allowed them to interact with other teams, like water guns or glow sticks. "The best part of the relay is meeting other teams out there and sharing the experience together," she said. "It's something that breaks the ice."
Costumes are good. Last summer, my team went with an "America" theme. It sounds silly, and dealing with a tutu or a mask might be annoying, but it's preferable to thinking about sore legs.
r
$
I
"You have to go in with the mentality that it's more fun than
anything else," King said. "As long as your training has been where it needs to be ... you'll be comfortable with it."•
$
$
I I . •
•
I $
I •
.
I
•
$
$
I
• I . I rl
I
OS IC o f Red m o n d
Serving All of Central Oregon Since tg8]
Our team of professionals is dedicated to quality of life for our clients and their families. Working closely with your doctor, we offer:
'" Registered Nurses '" Medical Social Workers J '" Licensed Therapists g ' '" Hospice Aides g g. ~A
'" Spiritual Counseling '" Grief Support " C a regiver Support " Trai n ed Volunteers
sk about our Transitions Program For more information, please call:
541. 548. 7483 732 SW 23rdStreet,Redmond, OR 97756 hospice®bendcable.com www.redmondhospice.org
Call or appointments: 382-9383 John Stasst.n, MD — Cloe Shelton, MD —Ronald D. Hanson, MD Will Wheir, MD — James E.Johnson, MD — Patrick B. Brown, MD Jeffrey Drutman, MD - Traci Clautice-Engle, MD - Laurie A. Martin, MD Steven D. Kjokech, MD - Garrett Schroeder - Thomas F. Koehler, MD Robert E. Hogan, MD - Stephen Shultz, MD - Paula Shultz, MD David R. Zulauf, MD — Steven J. Michel, MD
AOVERTtstNGSUPPLEMENT
2 013 C E N T RA L O R E G O N
Your
t
S o u r c e f o r Lo c a l H e a l t h Se r v i c e s a n d Ex p e r t M e d i c a l P r o f e s s i o n a l s To list your medical office andlor physicians in the PULSEIConnections Medical Directory contact...
Lorra in e
S t a r o d u b , A c c o u n t E x e c u t i v e ( H e a l t h 8c M e d i c a l) • 5 4 1 . 6 1 7 .7855 •
s•
•
•
1
•
A •
ADULT FOSTER CARE
Absolute Serenity Adult Foster Care
119 N RopeStreet • Sisters
541-588-G119
www.absoluteserenity.info
AESTHETIC SERVICES
DermaSpa atBend Dermatology
2705 NE Conners Drive• Bend
541-330-9139
www.bendderm.com
ALLERGY &ASTHMA
Bend Memorial Clinic
locations in Bend tkRedmond
541-382-4900
www.bendmemorialclinic.com
1099 NE Watt Way • Bend
541-385-4717
www.brookdaleliving.com
3550SW CanalBlvd • Redmond
541-504-1600
Bend tk Redmond
541-G47-2894
ALZHEIMERS gt DEMENTIA CARE Clare Bridge Brookdale Senior Living
ASSISTED LIVING
BrooksidePlace
AUDIOLOGY
Central Oregon AudiologyA Hearing Aid Clinic
BEHAVIORAL HEALTH
St. Charles Behavioral Health
2542 NE Courtney Drive• Bend
541-706-7730
www.stcharleshealthcare.org
CANCER CARE
St. Charles Cancer Center
Locations in Bend StRedmond
541-70G-5800
www.stcharleshealthcare.org
CARDIOLOGY
Bend Memorial Clinic
locations in Bend 8rRedmond
CARDIOLOGY
The Heart Center
2500 NE Neff Road• Bend
I
www.ccliving.com w ww.centraloregonaudiology.com
541-382-4900
www.bendmemorialclinic.com
541-706-6900
www . heartcentercardiology.com
CARDIOTHORACIC SURGERY S t . Charles Cardiothoracic Surgery
2500 NE Neff Road• Bend
541-388-1636
www.stcharleshealthcare.org
COSMETIC SERVICES
Bend Memorial Clinic
2600 NE Neff Road• Bend
541-382-4900
www. bendmemorialclinic.com
DENTURISTS
Sisters Denture Specialties
161 E Cascade• Sisters
541-549-0929
www.raordenturecenter.com
DERMATOLOGY
Bend Dermatology Clinic
2747 NE Conners Drive• Bend
541-382-5712
www.bendderm.com
DERMATOLOGY (MOHS)
Bend Memorial Clinic
2600 NE Neff Road• Bend
541-382-4900
www.bendmemorialclinic.com
ENDOCRINOLOGY
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www. bendmemorialclinic.com
ENDOCRINOLOGY
Endocrinology ServicesNW
929 SWSimpson Ave,Ste 220 •Bend
541-317-5GOO
FAMILY MEDICINE
Bend Memorial Clinic
locations in Bend, Redmond tk Sisters
541-382-4900
www. bendmemorialclinic.com
PAMILY MEDICINE
St. Charles Family Care
2965 NE ConnersAve, Suite 127 • Bend
541-70G-4800
www.stcharleshealthcare.org
FAMILY MEDICINE
St. Charles Family Care
1103 NE ElmStreet • Prineville
541-447-G2G3
www.stcharleshealthcare.org
PAMILY MEDICINE
St. Charles Family Care
211 NWLarch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
FAMILY MEDICINE
St. Charles Family Care
61 5 Arrowleaf Trail• Sisters
541-549-1318
www.stcharleshealthcare.org
PAMILY PRACTICE
High Lakes Health Care
Locations in Bend, Sisters tkRedmond
541-389-7741
www.highlakeshealthcare.com
GASTROENTEROLOGY
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www. bendmemorialclinic.com
GASTROENTEROLOGY
Gastroenterology of Central Oregon
2450 Mary Rose Place, Ste210 • Bend
541-728-0535
www.gastrocentraloregon.com
GENERAL DENTISTRY
Coombe and Jones Dentistry
774 SWRimrock Way• Redmond
541-923-7633
www.coombe-jones.com
2084 NE Professional Court• Bend
541-322-5753
1245 NW 4th Street, Ste 101 • Redmond
541-548-7761
www.stcharleshealthcare.org
GENE RALSURGERY,BARIAYRICSAVEINCARE Advanced Specialty Care GENERALSURGERY8 BARIATRICS St. Charles Surgical Specialists
n/a
www . advancedspecialtycare.com
HOME HEALTH SERVICES
St. Charles Home Health
2500 NE Neff Road• Bend
541-70G-7796
www.stcharleshealthcare.org
HOSPICE/HOME HEALTH
Hospice of Redmond
732 SW 23rd St• Redmond
541-548-7483
www.redmondhospice.org
HOSPICE/HOME HEALTH
Partners In Care
2075 NE Wyatt Ct.• Bend
541-382-5882
www.partnersbend.org
HOSPITAL
St. Charles Madras
470 NE "A" Street• Madras
541-70G-7796
www.stcharleshealthcare.org
HOSPITAL
Pioneer Memorial Hospital
1201 NEElm St • Prineville
541-447-G254
www.stcharleshealthcare.org
HOSPITAL
St. Charles Bend
2500 NE Neff Road• Bend
541-382-4321
www.stcharleshealthcare.org
HOSPITAL
St. Charles Redmond
1253 NE Canal Blvd• Redmond
541-70G-779G
www.stcharleshealthcare.org
1501 NE Medical Center Drive• Bend
541-382-4900
www. bendmemorialclinic.com
HYBERBARIC OXYGENTHERAPY Bend Memorial Clinic
IMAGING SERVICES
Bend Memorial Clinic
locations in Bend 8rRedmond
541-382-4900
www.bendmemorialclinic.com
INFECTIOUS DISEASE
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
2 013 CE N T RA L O R E G O N •
a
M E D I CA L D I RECTORY R
INPECTIOUS DISEASE
St. Charles Infectious Disease
INTEGRATED MEDICINE
Center for Integrated Medidne
INTKRNAL MKDICINK
Send Memorial Clinic
INTERNAL MEDICINE
High Lakes Health Care Upper Mill
INTERNAL MEDICINE
Internal Medicine Assodates of Redmond
INTERNAL MEDICINE
Redmond Medical Clinic
R
DVERTISINGSUPPLEMENT
a
29G5 NE Conners Ave., Suite 127+Bend 5 4 1 -70G-4878
www.stcharleshealthcare.org
91G SW17th St, Ste202 • Redmond
541-504-0250
w ww.centerforintegratedmed.com
Bend Eastside gtWestside
541-382-4900
ww w .bendmemorialclinic.com ww w .highlakeshealthcare.com
929 SW Simpson Ave• Bend
541-389-7741
236 NW Kingwood Ave• Redmond
541-548-7134
www.imredmond.com
1245 NW 4th Street, Ste201 • Redmond
541-323-4545
n/a
541-382-4900
www.bendmemorialclinic.com
MEDICAL CLINIC
Bend Memorial Clinic
3080 SWMt. Bachelor Dr • Bend (West)
MEDICAL CLINIC
Bend Memorial Clinic
1501 NEMedical Center Dr • Bend(East) 541-382-4900
MKDICAL CLINIC
Send Memorial Clinic
ww w .bendmemorialclinic.com
231 EastCascadesAve• Sisters
541-382-4900
ww w .bendmemorialclinic.com www .bendmemorialclinic.com
MEDICAL CLINIC
Send Memorial Clinic
865 SWVeterans Way• Redmond
541-382-4900
NEPHROLOGY
Send Memorial Clinic
locations in Bend ga Redmond
541-382-4900
www.bendmemorialclinic.com
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
ww w .bendmemorialclinic.com
Locations in Bend ga Redmond
541-382-3344
1501 NEMedical Center Drive • Bend
541-382-4900
NEUROLOGY NEUROSURGERY NUTRITION
The Center: Orthopedic ¹t Neurosurgical Care ¹cResearch
Bend Memorial Clinic
OBSTKTRICS tk GYNKCOLOGY East Cascade Women's Group, P.C. OBSTETRICS gt GYNECOLOGY St. Charles OB /GYN
OCCUPATIONAL MEDICINE
Send Memorial Clinic
2400 NE Neff Road,Ste A • Bend
www.thecenteroregon.com
ww w .bendmemorialclinic.com
541-389-3300 www.eastcascadewomensgroup.com
213 NW Larch Ave,Suite B• Redmond
541-52G-G635
www.stcharleshealthcare.org
locations in Bend thRedmond
541-382-4900
www.bendmemorialclinic.com
Locations in Bend ga Redmond
541-382-3344
www.thecenteroregon.com
ONCOLOGY - MEDICAL
Bend Memorial Clinic
Locations in Bend ga Redmond
541-382-4900
www.bendmemorialclinic.com
OPHTHALMOLOGY
Bend Memorial Clinic
Locations in Bend ga Redmond
541-382-4900
ww w .bendmemorialclinic.com
OPTOMKTRY
Send Memorial Clinic
Locations in Bend gtRedmond
541-382-4900
ww w .bendmemorialclinic.com
ORTHOPEDICS
Desert Orthopedics
Locations in Bend ga Redmond
541-388-2333
www.desertorthopedics.com
locations in Bend thRedmond
541-382-3344
www.thecenteroregon.com
2200 NENeffRoad,Suite 302 • Bend
541-388-3978
2500 NE Neff Road• Bend
541-70G-5880
www.stcharleshealthcare.org
www.deschuteskids.com
OCCUPATIONAL MEDICINE
ORTHOPEDICS
The Center: Orthopedic S NeurosurgicalCareA Research
The Center: Orthopedic ¹t NeurosurgicaiCareA Research
OSTEOPOROSIS
Deschutes Osteoporosis Center
PALLIATIVE CARE
St. Charles Advanced Illness Management
PEDIATRIC DKNTISTRY
Deschutes Pediatric Dentistry
1475 SWChandler Ave, Ste202 • Bend
541-389-3073
PKDIATRICS
Send Memorial Clinic
1080 SWMt. Bachelor Dr • Bend (West)
541-382-4900
PKDIATRICS
St. Charles Family Care
211 NW LarchAvenue• Redmond
541-548-2164
www.stcharleshealthcare.org
PHYSICAL MEDICINE
Desert Orthopedics
locations in Bend thRedmond
541-388-2333
www.desertorthopedics.com
Locations in Bend ga Redmond
541-382-3344
www.thecenteroregon.com
I50i NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
2275 NE Doctors Dr,¹3 A336SWCyber Dr, Ste307
541-382-5500
w w w.alpinephysicaltherapy.com
404 NE PennAvenue • Bend
541-318-7041
www.healingbridge.com
Offices in Bend,Redmond thMadras
541-388-2861
www.cascadefoot.com
PHYSICAL MEDICINE
The Center: Orthopedic S NeurosurgicalCareA Research
w wwdeschutesosteoporosiscentercom
ww w .bendmemorialclinic.com
PHYSICAL MEDICINE/REHABILITATION
Bend Memorial Clinic
PHYSICAL THERAPY
Alpine Physical Therapy gt Spine Care
PHYSICAL THERAPY
Healing Bridge Physical Therapy
PODIATRY
Cascade Foot Clinic
PULMONOLOGY
Send Memorial Clinic
locations in Bend ga Redmond
541-382-4900
www.bendmemorialclinic.com
PULMONOLOGY
St. Charles Pulmonary Clinic
Locations in Bend ga Redmond
541-70G-7715
www.stcharleshealthcare.org
RADIOLOGY
Central Oregon Radiology Associates, P.C.
1460 NE Medical Center Dr• Bend
541-382-9383
www.corapc.com
RKHABILITATION
St. Charles Rehabilitation Center
Locations in Bend ga Redmond
541-70G-7725
RHKUMATOLOGY
Send Memorial Clinic
Locations in Bend gtRedmond
541-382-4900
RHEUMATOLOGY
Deschutes Rheumatology
2200 NE Neff Road,Suite 302• Bend
541-388-3978
n/a
SLEEP MEDICINE
Send Memorial Clinic
locations in Bend ga Redmond
541-382-4900
www.bendmemorialclinic.com
SLEEP MEDICINE
St. Charles Sleep Center
Locations in Bend ga Redmond
541-706-6905
www.stcharleshealthcare.org
SURGICAL SPECIALIST
Bend Memorial Clinic
Locations in Bend ga Redmond
541-382-4900
www.bendmemorialclinic.com
URGKNT CARE
Bend Memorial Clinic
Locations inBend(East gtWest) ARedmond
541-382-4900
ww w .bendmemorialclinic.com
URGKNT CARK
St. Charles Immediate Care
2600 NE Neff Road• Bend
541-70G-3700
www.stcharleshealthcare.org
UROLOGY
Send Urology Associates
Locations in Bend ga Redmond
541-382-G447
www.bendurology.com
www.stcharleshealthcare.org ww w .bendmemorialclinic.com
2 013 CE N T RA L O R E G O N a
•
DVERTISINGSUPPLEMENT
M E D I CA L D I RECTORY g
R
a
UROLOGY
Urology Spedalists of Oregon
VASCULAR SURGERY
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 5 4 1 - 3 82-4900
www.bendmemorialclinic.com
VEIN SPECIALISTS
Inovia Vein Spedalty Center
2200 NE Neff Road, Ste 204• Bend 5 4 1 - 382-8346
www.bendvein.com
VEIN SPECIALISTS
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 5 4 1 - 3 82-4900
www.bendmemorialclinic.com
•
ADAM WILLIAMS, MD
A
•
o
L ocations in Bend gt Redmond
541- 3 2 2-5753 h t t%/sofor.praxismedi p calgroup.com
•
Bend Memorial Clinic
STEPHEN ARCHER, MF, FACS Advanced Spedalty Care NGOCTHUY HUGHES, DO, PC St . Charles Surgical Specialists
Bend Eastside St Redmond
541-3 8 2-4900
ww w .bendmemorialclinic.com
2084 NE Professional Court• Bend 5 4 1 - 3 22-5753 w
ww . advancedspecialtycare.com
1245 NW 4th Street, Ste 101 • Redmond 541-548-77G1 w
ww. s tcharleshealthcare.org
PHILIP B.ANDKRSON, MD
St. Charles Sehavioral Health
2542 NE Courtney Dr • Bend
541-706-7730
www.stcharleshealthcare.org
KAREN CAMPBELL, PhD
St. Charles Sehavioral Health
2542 NE Courtney Dr • Bend
541-706-7730
www.stcharleshealthcare.org
RYAN C. DIX, PsyD
St. Charles Family Care
1103 NE Elm Street, Ste C• Prineville
541-447-G2G3
www.stcharleshealthcare.org
BRIAN T. KVANS, PsyD
St. Charles Sehavioral Health
2542 NE Courtney Dr• Bend
541-706-7730
www.stcharleshealthcare.org
KUGKNK KRANZ, PhD
St. Charles Sehavioral Health
2542 NE Courtney Dr • Bend
541-706-7730
www.stcharleshealthcare.org
www.stcharleshealthcare.org
SONDRA MARSHALL, PhD
St. Charles Sehavioral Health
2542 NE Courtney Dr • Bend
541-706-7730
MIKALA SACCOMAN, PhD
St. Charles Behavioral Health
2542 NE Courtney Dr • Bend
541-706-7730
www.stcharleshealthcare.org
RKBECCA SCRAFFORD, PsyD St. Charles Sehavioral Health
2542 NE Courtney Dr• Bend
541-706-7730
www.stcharleshealthcare.org
SCOTT SAFFORD, PHD
St. Charles Family Care
2965 NE ConnersAve, Suite 127 • Bend
541-706-7730
www.stcharleshealthcare.org
KIMBERLY SWANSON, PhD
St. Charles Family Care
211 NW Larch Ave• Redmond
541-548-2164
www.stcharleshealthcare.org
CATHERINE BLACK, PA-C
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
JEAN BROWN, PA-C
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
NAHEL PARRAJ, DO
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
RICK KOCH, MD
Bend Memorial Clinic
Bend Eastside St Redmond
541-382-4900
www .bendmemorialclinic.com
GAVIN L.NOBLE, MD
Bend Memorial Clinic
Bend Eastside St Redmond
541-382-4900
ww w .bendmemorialclinic.com www .bendmemorialclinic.com
ww . bendmemorialclinic.com
STEPHANIE SCOTT, PA-C
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
JASON WEST, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
JASON R. WOLLMUTH, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
s s
s
JOHN D. BLIZZARD, MD
St. Charles Cardiothoradc Surgery
2500 NE Neff Road• Bend
541-388-163G
www .stcharleshealthcare.org
ANGELO A. VLESSIS, MD
St.Charles Cardiothoracic Surgery
2500 NE Neff Road• Bend
541-388-163G
www .stcharleshealthcare.org
JORDAN T. DOI, MSC, DC
NorthWest Crossing Chiropractic gt Health
6 2 8 NW York Dr, Ste. 104 • Bend 5 4
1- 3 8 8-2429
www.nwxhealth.com
THERESAM. RUBADUE, DC, CCSP NorthWest Crossing Chiropractic gt Health 6 2 8 NW York Dr, Ste. 104 • Bend 5 4
1- 3 8 8-2429
www.nwxhealth.com
JASON M. KREMER,DC,CCSP, CSCS Wellness Doctor
1345 NW Wall St, Ste 202• Bend 5 4
1 - 3 18-1000 w ww. bendwellnessdoctor.com
MICHAKL R. HALL, DDS
Central Oregon Dental Center
1563 NW Newport Ave• Bend 5
41-3 8 9 -0300 w
BRADLEY E. JOHNSON, DMD
Co n temporary Family Dentistry
1016 NW Newport Ave• Bend 5
41-3 8 9 -1107 w w w.contemporaryfamilydentistry.com
s
'
ww .centraloregondentalcenter.net
' s s
ALYSSA ABBEY, PA-C
Bend Memorial Clinic
ANGKLA COVINGTON, MD
Send Memorial Clinic
MARK HALL, MD
CentralOregon Dermatology
www.bendmemorialclinic.com
2600 NE Neff Road• Bend
541-382-4900
Bend gt Redmond
541-382-4900
www.bendmemorialclinic.com
388 SW Bluff Dr• Bend
541-G78-0020
www.centraloregondermatology.com
2 013 CE N T RA L O R E G O N •
M E D I CA L D I RECTORY
DVERTISINGSUPPLEMENT
•
3AMES M. HOESLY, MD
Bend Memorial Clinic
2600 NE Neff Road• Bend
541-382-4900
ww w .bendmemorialclinic.com
GERALD E. PETERS,MD, DS (Mohs)
Bend Memorial Clinic
2600 NE Neff Road• Bend
541-382-4900
www.bendmemorialclinic.com
ANN M. REITAN, PA-C (Mohs)
Be n d Memorial Clinic
2600 NE Neff Road• Bend
541-382-4900
ww w .bendmemorialclinic.com
ss '
s s
MARY P. CARROLL, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
RICK N. GOLDSTEIN, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
TONYA KOOPMAN,MSN, FNP-BC
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
PATRICK MCCARTHY, MD
Endocrinology ServicesNW
929 SW Simpson Ave, Ste 220• Bend 541 -317-5600
n/a
TRAVIS MONCHAMP, MD
Endocrinology ServicesNW
929 SWSimpson Ave,Ste 220 • Bend 541-317-5GOO
n/a
CAREY ALLEN, MD
St. Charles Family Care
HEIDI ALLEN, MD
St. Charles Family Care
THOMAS L. ALLUMBAUGH, MD St. Charles Family Care
ww . bendmemorialclinic.com www.bendmemorialclinic.com
ww . bendmemorialclinic.com
1103 NE Elm Street• Prineville
541-447-G2G3
www.stcharleshealthcare.org
1103 NE Elm Street• Prineville
541-447-G263
www.stcharleshealthcare.org
211 NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
KATHLEEN C. ANTOLAK, MD
Ben d Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
SADIE ARRINGTON, MD
Bend Memorial Clinic
865 SWVeterans Way• Redmond
541-382-4900
ww w .bendmemorialclinic.com
30SEPH BACHTOLD, DO
St. Charles Family Care
G30 Arrowleaf Trail • Sisters
541-549-1318
EDWARD BIGLER, MD
High Lakes Health Care Upper Mill
www.stcharleshealthcare.org
929 SW Simpson Avenue• Bend
541-389-7741
www.highlakeshealthcare.com www .bendmemorialclinic.com
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
BRANDON W. BRASHER, PA-C St. Charles Family Care
1103 NE Elm Street• Prineville
541-447-G2G3
www.stcharleshealthcare.org
SHANNON K. BRASHER, PA-C St. Charles Family Care
1103 NE Elm Street• Prineville
541-447-G2G3
www.stcharleshealthcare.org
3EPPREY P.BOGGESS, MD
Bend Memorial Clinic
MEGHAN BRECKE, DO
St. Charles Family Care
2965 NE ConnersAve, Suite 127 • Bend
541-70G-4800
www.stcharleshealthcare.org
NANCY BRENNAN, DO
St. Charles Family Care
2965 NE ConnersAve, Suite 127 • Bend
541-70G-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 ConnersAve, Suite 127 • Bend
541-70G-4800
www.stcharleshealthcare.org
LINDA C. CRASKA, MD
St. Charles Family Care
1103 NE Elm Street• Prineville
541-447-G2G3
www.stcharleshealthcare.org
AUDREY DAVEY, MD
Bend Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
3AMES K. DETWILER, MD
St. Charles Family Care
211 NW Larch Avenue• Redmond
541-548-2164
MAY S. PAN, MD
Send Memorial Clinic
23i East Cascades Avenue• Sisters
541-382-4900
www .bendmemorialclinic.com
3AMIE PREEMAN, PA-C
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend
541-389-7741
www.highlakeshealthcare.com
MARK GONSKY, DO
St. Charles Family Care
2965 NE ConnersAve, Suite 127 • Bend
541-70G-4800
www.stcharleshealthcare.org
STEVEN GREER, MD
St. Charles Family Care
630 ArrowleafTrail • Sisters
541-549-1318
www.stcharleshealthcare.org
ALAN C. HILLES, MD
Send Memorial Clinic
Redmond gt Sisters
541-382-4900
PAMELA 3. IRBY, MD
St. Charles Family Care
211 NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
MAGGIE 3. KING, MD
St. Charles Family Care
1103 NE Elm Street• Prineville
541-447-G2G3
www.stcharleshealthcare.org
ww w .bendmemorialclinic.com
www.stcharleshealthcare.org
www .bendmemorialclinic.com
PETER LEAVITT, MD
St. Charles Family Care
2965 NE ConnersAve, Suite 127 • Bend
541-70G-4800
CHARLOTTE LIN, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
KAE LOVERINK, MD
High Lakes Health Care Redmond
1001 NW Canal Blvd• Redmond
541-504-7635
ww w .highlakeshealthcare.com
STEVE MANN, DO
High Lakes Health Care UpperMill
929 SW Simpson Avenue• Bend
541-389-7741
ww w .highlakeshealthcare.com
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, Ste201 • Redmond
541-323-4545
ww w .highlakeshealthcare.com
www.stcharleshealthcare.org
www.stcharleshealthcare.org
n/a
EDEN MILLER, DO
High Lakes Health Care Sisters
354 W Adams Avenue• Sisters
541-549-9G09
KEVIN MILLER,DO
High Lakes Health Care Sisters
354 W Adams Avenue• Sisters
541-549-9G09
ww w .highlakeshealthcare.com
3ESSICA MORGAN, MD
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend
541-389-7741
www.highlakeshealthcare.com
DANIEL J. MURPHY, MD
St. Charles Family Care
21i 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
DVERTISINGSUPPLEMENT
s
I
SHERYL L. NORRIS, MD
St. Charles Family Care
JANKY PURVIS, MD
211 NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
KEVIN RKUTKR, MD
High Lakes Health Care East
1247 NE Medical Center Drive• Bend
541-318-4249
www.highlakesheal thcare.com
DANA M. RHODK, DO
Send Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www .bendmemorialclinic.com
www.bendmemorialclinic.com
HANS G. RUSSELL, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
KRIC J. SCHNKIDKR, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
CINDY SHUMAN, PA-C
Send Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www.bendmemorialclinic.com
KDWARD M. TARBET, MD
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
211 NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com www .highlakeshealthcare.com
J T J
JOHN D. TELLER, MD
Send Memorial Clinic
NATHAN R. THOMPSON, MD
St. Charles Family Care
MATTIE K. TOWLE, MD
Send Memorial Clinic
LISA URI, MD
High Lakes Health Care UpperMill
929 SW Simpson Avenue• Bend
541-389-7741
MARK A. VALENTI, MD
St. Charles Family Care
211 NW Larch Avenue• Redmond
541-548-2164
THOMAS A. WARLICK, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
ww w .bendmemorialclinic.com
1247 NE Medical Center Drive• Bend
541-318-4249
ww w .highlakeshealthcare.com
1103 NE Elm Street• Prineville
541-447-G2G3
BILL WIGNALL, MD
High Lakes Health Care East
BRUCE N. WILLIAMS, MD
St. Charles Family Care
DAVID KKLLY, MD
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend 5 4
www.stcharleshealthcare.org
www.stcharleshealthcare.org
1- 3 8 9-7741 w ww . highlakeshealthcare.com
's s RICHARD H. BOCHNER, MD
Send Memorial Clinic
Bend Eastside gt Redmond
541-382-4900
www.bendmemorialclinic.com
ELLEN BORLAND, MS,RN, CFNP
Send Memorial C ni lic
1501 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
ARTHUR S. CANTOR, MD
Send Memorial Clinic
Bend Eastside gt Redmond
541-382-4900
www.bendmemorialclinic.com
HEIDI CRUISE, PA-C, MS
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
CHRISTINA HATARA, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
SIDNEY E. HENDERSON III, MD
Se ndMemorial Clinic
Bend Eastside gt Redmond
541-382-4900
www .bendmemorialclinic.com
SANDRA K. HOLLOWAY, MD
Send Memorial Clinic
Bend Eastside gt Redmond
541-382-4900
www.bendmemorialclinic.com
GLENN KOTEEN, MD
Gastroenterology of Central Oregon
2450 Mary Rose Place, Ste 210• Bend 541-728-0535
MATTHKW WEKD, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
CHRISTY KNGLAND, PA-C
Advanced Specialty Care
2084 NE Professional Court• Bend
541-322-5753
ww w .advancedspecialtycare.com
NICOLE O'NEIL, PA-C
Advanced Specialty Care
2084 NE Professional Court• Bend
541-322-5753
ww w .advancedspecialtycare.com
JANK BIRSCHBACH, MD
High Lakes Health Care UpperMill
929 SW Simpson Avenue• Bend
541-389-7741
www .highlakeshealthcare.com
SUSAN GORMAN, MD
High LakesHealth Care Redmond
1001 NW Canal Blvd.• Redmond 5 4
1- 5 04-7635 w 541-389-7741
www.bendmemorialclinic.com
www.gastrocentraloregon.com ww. bendmemorialclinic.com
ww. h ighlakeshealthcare.com www .highlakeshealthcare.com
ALISON LYNCH-MILLKR, MD
Hi g h Lakes Health Care Upper Mill
LAURIK D'AVIGNON, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
JON LUTZ, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
RKBKCCA SHKRKR, MD
St. Charles Infectious Disease
2965 Conners Ave, Ste 127• Bend 5 4 1 - 7 0G-4878
www.stcharleshealthcare.org
JKNESS CHRISTKNSKN, MD
High Lakes Health Care UpperMill
929 SW Simpson Avenue• Bend 5
41- 3 8 9-7741
www.highlakesheal thcare.com
JOHN CORSO, MD
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend 5
41- 3 8 9-7741
www.highlakesheal thcare.com
CKLSO A.GANGAN, MD
Redmond Medical Clinic
929 SW Simpson Avenue• Bend
1245 NW 4th Street, Ste 201• Redmond 541 -323-4545
n/a
2 013 CE N T RA L O R E G O N
M E D I CA L D I RECTORY
DVERTISINGSUPPLEMENT
s
a
MICHAEL N. HARRIS, MD
Bend Memorial Clinic
ANNE KILLINGBECK, MD
Internal Medicine Assodates of Redmond
ANITA D.KOLISCH, MD
Bend Memorial Clinic
MATTHKW R. LASALA, MD
Bend Memorial Clinic
MADKLINK LEMKE, MD
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend
541-389-7741
ww w .highlakeshealthcare.com
MARY MANFRKDI, MD
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend
541-389-7741
ww w .highlakeshealthcare.com
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www.bendmemorialclinic.com
KAREN L. OPPENHEIMER, MD Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
236 NW Kingwood Ave• Redmond
541-548-7134
www.imredmond.com
Bend Eastside gaRedmond
541-382-4900
1501 NE Medical Center Drive• Bend 541-382-4900 w
ww w .bendmemorialclinic.com ww . bendmemorialclinic.com
H. DEREK PALMER, MD
Redmond Medical Clinic
1245 NW 4th Street, Ste201 • Redmond
541-323-4545
n/a
A. WADEPARKER, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
MATTHEW REED, PA-C
Bend Memorial Clinic
541-382-4900
www .bendmemorialclinic.com
M. SEAN ROGERS, MD
Bend Memorial Clinic
T 1501 NE Medical Center Drive• Bend J 1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
DAN SULLIVAN, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
PRANCENA ABENDROTH, MD Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
CRAIGAN GRIPPIN, MD
Bend 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 TIKN, MD
The Center: Orthopedic gt Neurosurgical Carett Rese arch Locations in Bend tla Redmond 5
41-3 8 2 - 3 344
www.th ecenteroregon.com
BRAD WARD, MD
Ihe Center: Orthopedic tt Neurosurgical CareGResearch Locations in Bend tla Redmond 5
41-3 8 2 - 3344
www.t h ecenteroregon.com
ANNIE BAUMANN, RD, LD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
ww. bendmemorialclinic.com
WILLIAM H. BARSTOW, MD
St. CharlesOB/GYN
213 NW LarchAve,Ste A • Redm ond 541-52G-G635
www.stcharleshealthcare.org
ANN-BRIDGET BIRD,MD
St. Charles OB/GYN
213 NW LarchAve,Ste A • Redm ond 541-52G-G635
www.stcharleshealthcare.org
BRENDA HINMAN, DO
St. Charles OB/GYN
213 NW LarchAve,Ste A • Redm ond 541-52G-G635
www.stcharleshealthcare.org
AMY B. MCELROY, PNP
St. Charles OB/GYN
213 NW LarchAve,Ste A • Redm ond 541-52G-G635
www.stcharleshealthcare.org
s
a
s
JAMKS NKLSON, MD
The Center: Orthopedic t'Neurosurgi s cal CaregtResearch Locations in Bend gt Redmond
LARRY PAULSON, MD
The Center: Orthopedic t'Neurosurgi s cal CaregtResearch Locations in Bend gt Redmond 5
s
s s
541-3 8 2 - 3344
www.t h ecenteroregon.com
41-3 8 2 - 3 344
www.t h ecenteroregon.com
I
ROB BOONK, MD
St. Charles Cancer Center
Locations in Bend tla Redmond
541-70G-5800
THEODORE A. BRAICH, MD
Send Memorial Clinic
CORA CALOMENI, MD
www.stcharleshealthcare.org
Bend Eastside gaRedmond
541-382-4900
St. Charles Cancer Center
Locations in Bend tla Redmond
541-70G-5800
www.stcharleshealthcare.org
SUSIE DOEDYNS, FNP
St. Charles Cancer Center
Locations in Bend tla Redmond
541-70G-5800
www.stcharleshealthcare.org
BRIAN L ERICKSON, MD
Bend Memorial Clinic
Bend Eastside tla Redmond
541-382-4900
www.bendmemorialclinic.com
STEVE KORNPELD, MD
St. Charles Cancer Center
Locations in Bend gt Redmond
541-70G-5800
www.stcharleshealthcare.org
BILL MARTIN, MD
St. Charles Cancer Center
Locations in Bend gt Redmond
541-70G-5800
www.stcharleshealthcare.org
BENJAMIN J. MIRIOVSKY, MD BendMemorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
LAURIE RICE, ACNP
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
WILLIAM SCHMIDT, MD
Bend Memorial Clinic
Bend Eastside gaRedmond
541-382-4900
www .bendmemorialclinic.com
HKATHKR WKST, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
www .bendmemorialclinic.com
www .bendmemorialclinic.com
ww . bendmemorialclinic.com
DVERTISINGSUPPLEMENT
2013 CENTRAL OREGON MEDICAL DIRECTORY •
•
I
•
'
•
LINYEE CHANG, MD
St. Charles Cancer Center
2500 NE Neff Road• Bend 5
41-70 G -7733
www.stcharleshealthcare.org
DHARA MACDERMED, MD
St . C h arles Medical Center
2500 NE Neff Road• Bend 5
41-70 G -5800
www.stcharleshealthcare.org
RUSS OMIZO, MD
St. Charles Cancer Center
2500 NE Neff Road• Bend 5
41-70 G -7733
www.stcharleshealthcare.org
•
•
•
•
•
MATTHEW N. SIMMONS
Urology Spedalist of Oregon
2084 NE Professional Ct• Bend
541- 3 2 2 -5753 h t p//usoforpraxixmedi : calgroup.com
~ Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900 ~ www.bendmemorialclinic.com
THOMASD. FITZSIMMONS,MD,MPH Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www .bendmemorialclinic.com
ROBERT C.MATHEWS, MD
Bend M emorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www .bendmemorialclinic.com
SCOTT T. O'CONNER, MD
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www .bendmemorialclinic.com
DARCY C. BALCER, OD
Bend Memorial Clinic
Bend Eastside gt Westside
541-382-4900
www.bendmemorialclinic.com
LORISSAM. HEMMER, OD
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond 5 4 1-382-4900
www.bendmemorialclinic.com
BRIAN P.DESMOND, MD
KEITH E. KRUEGER,DMD, PC Keith E. Krueger, DMD, PC • '
• '
I
AARON ASKEW, MD
•
1475 SW Chandler, Ste 101• Bend 54 1 - 617-3993 w
ww.d r keithkrueger.com
•
Desert Orthopedics
Locations in Bend gt Redmond
541-388-2333
www.desertorthopedics.com
ANTHONY HINZ, MD
The Center: Orthopedic gtNeurosurgical CaregtResearch
Locations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
JEPPREY P. HOLMBOE, MD
The Center: Orthopedic A NeurosurgicalCareA Research
Locations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
JOEL MOORE, MD
The Center: Orthopedic gtNeurosurgical CaregtResearch
Locations in Bend St Redmond
541-382-3344
www.thecenteroregon.com
KNUTE BUEHLER, MD
The Center: Orthopedic gtNeurosurgical CaregtResearch
Locations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
MICHAEL CARAVELLI,MD
The Center: Orthopedic A NeurosurgicalCareA Research
Locations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
Locations in Bend St Redmond
541-388-2333
www.desertorthopedics.com
Locations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
Locations in Bend gt Redmond
541-388-2333
www.desertorthopedics.com
a'
a'
I
ERIN PINTER, MD JAMES HALL, MD ROBERT SHANNON, MD a'
I
Desert Orthopedics The Center: Orthopedic tt NeurosurgicalCaregtResearch
Desert Orthopedics I
MICHAEL RYAN, MD
'
'
I
Desert Orthopedics
1303 NE Cushing Dr, Ste 100• Bend
54 1 -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
Locations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
1315 NW 4th Street• Redmond
541-388-2333
www.desertorthopedics.com
a'
• '
a'
• '
I
I
TIMOTHY BOLLOM, MD BRETT GINGOLD, MD
The Center: Orthopedic gtNeurosurgical CaregtResearch
Desert Orthopedics
SCOTT T. JACOBSON, MD
The Center: Orthopedic tt NeurosurgicalCareA Research
Locations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
BLAKE NONWEILER, MD
Ihe Center: Orthopedic gtNeurosurgical CareA Research
Locations in Bend St Redmond
541-382-3344
www.thecenteroregon.com
54 1 - 388-2333
www.desertorthopedics.com
541-382-3344
www.thecenteroregon.com
a'
• '
I
CARA WALTHER, MD a'
'a
I
'
•
Desert Orthopedics
1303 NE Cushing Dr, Ste 100• Bend
I
MICHAEL COE, MD KENNETH HANINGTON, MD
The Center: Orthopedic tt Neurosurgical CaregtResearch Locations in Bend St Redmond
Locations in Bend gt Redmond
541-388-2333
www.desertorthopedics.com
SOMA LILLY, MD
The Center: Orthopedic gtNeurosurgical CaregtResearch
Locations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
JAMES VERHEYDEN, MD
The Center: Orthopedic A NeurosurgicalCareA Research
Locations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
Desert Orthopedics
2 013 CE N T RA L O R E G O N s
M E D I CA L D I RECTORY
DVERTISINGSUPPLEMENT
I ' I ' I
MOLLY OMIZO, MD
Deschutes Osteoporosis Center
3KNNIFKR BLKCHMAN, MD
St. Charles Advanced Illness Management
LISA LKWIS, MD
Partners in Care
2200 NE Neff Road, Suite 302• Bend
541 - 3 88-3978 ww w deschutesosteoporosiscentercom
2500 NE Neff Road• Bend
541-70G-5885
www.stcharleshealthcare.org
2075 NE Wyatt Ct • Bend
541-382-5882
www.partnersbend.org www.stcharleshealthcare.org www.stcharleshealthcare.org
RICHARD 3. MAUNDKR, MD
St. Charles Advanced Illness Management
2500 NE Neff Road• Bend
541-70G-5885
LAURA K. MAVITY, MD
St. Charles Advanced Illness Management
2500 NE Neff Road• Bend
541-70G-5885
I
'
'
I
STKPHANIK CHRISTKNSEN, DMD Deschutes Pediatric Dentistry
1475 SW Chandler Ave, Ste• Bend 5 4 1 - 389-3073
www.deschuteskids.com
STKVK CHRISTKNSKN, DMD
Deschutes Pediatric Dentistry
1475 SW Chandler Ave, Ste• Bend 5 4 1 - 389-3073
www.deschuteskids.com
KATHKRINK BAUMANN, MD
Bend Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend 5 4 1 - 382-4900
www.bendmemorialclinic.com
KATE L. BROADMAN, MD
Bend Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www .bendmemorialclinic.com
THOMAS N. ERNST, MD
St. Charles Family Care
211 NW Larch Ave• Redmond
541-548-2164
KATHRYN LKIN, CPNP
Bend Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www .bendmemorialclinic.com
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www.bendmemorialclinic.com
211 NW Larch Ave• Redmond
541-548-2164
www.stcharleshealthcare.org
MICHKLLE MILLS, MD
Bend Memorial Clinic
MARGARKT 3.PHILP, MD
St. Charles Family Care
3B WARTON, DO
Bend Memorial Clinic
ROBERT ANDRKWS, MD
Desert Orthopedics
Locations in Bend gt Redmond
541-388-2333
LINDA CARROLL, MD
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend
541-389-7741
Locations in Bend gt Redmond
541-382-3344
1501 NE Medical Center Drive• Bend
541-382-4900
TIM HILL, MD NANCY H. MALONKY, MD
The Center: Orthopedic gtNeurosurgical CaregtResearch
Bend Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend 5 4 1 - 382-4900 w
www.thecenteroregon.com www .bendmemorialclinic.com
Locationsin Bend ga Redmond
541-382-3344
www.thecenteroregon.com
Locationsin Bend gt Redmond
541-382-3344
www.thecenteroregon.com
Locationsin Bend ga Redmond
541-388-2333
www.desertorthopedics.com
The Center: Orthopedic tt NeurosurgicalCaregtResearch
JON SWIFT, DO
ww w .highlakeshealthcare.com
www.thecenteroregon.com
LARRY PAULSON, MD
Desert Orthopedics
www.desertorthopedics.com
541-382-3344
The Center: Orthopedic Neurosurgi gt cal CaregtResearch Locations
The Center: Orthopedic gtNeurosurgical CaregtResearch
ww. bendmemorialclinic.com
in Bend gt Redmond
JAMKS NKLSON, MD
DAVID STEWART, MD
www.stcharleshealthcare.org
VIVIANK UGALDK, MD
The Center: Orthopedic gtNeurosurgical CaregtResearch
Locations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
MARC WAGNER, MD
The Center: Orthopedic tt NeurosurgicalCaregtResearch
Locations in Bend ga Redmond
541-382-3344
www.thecenteroregon.com
2408 NE Division Street• Bend
541-388-28G1
www.cascadefoot.com
AMBROSK K. SU, DPM
Cascade Foot Clinic
DKAN NAKADATK, DPM
Deschutes Footgt Ankle
BROOKE HALL, MD
St. Charles Preoperative Medicine
2500 NE Neff Road• Bend 5
30NATHON BRKWKR, DO
Bend Memorial Clinic
Bend Eastside gaRedmond
541-382-4900
www.bendmemorialclinic.com
JAMIK DAVID CONKLIN, MD
St. Charles Pulmonary Clinic
Locations in Bend ga Redmond
541-70G-7715
www.stcharleshealthcare.org
LOUIS D'AVIGNON, MD
Bend Memorial Clinic
Bend Eastside gaRedmond
541-382-4900
www.bendmemorialclinic.com
KRIC S. DILDINK, PA-C
St. Charles Pulmonary Clinic
Locations in Bend ga Redmond
541-70G-7715
www.stcharleshealthcare.org
ROD L. KLLIOT-MULLKNS, DO St. Charles Pulmonary Clinic
Locations in Bend gt Redmond
541-70G-7715
www.stcharleshealthcare.org
MATT HEGKWALD, MD
Locations in Bend ga Redmond
541-70G-7715
www.stcharleshealthcare.org
Bend Eastside gaRedmond
541-382-4900
www.bendmemorialclinic.com
1501 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
Locations in Bend gt Redmond
541-70G-7715
St. Charles Pulmonary Clinic
T. CHRISTOPHKR KELLKY, DO Bend Memorial Clinic
JONATHON MCFADYKN, NP
Bend Memorial Clinic
KKVIN SHKRKR, MD
St. Charles Pulmonary Clinic
929SWSimpsonAve,Ste220• Bend 54 1 -317-5600 w
41-70 G -2949 w
w w .deschutesfootandankle.com
ww. s tcharleshealthcare.org
www.stcharleshealthcare.org
2013 CENTRAL OREGON MEDICAL DIRECTORY
DVERTISINGSUPPLEMENT
NOREEN C. MILLER, FNP
St Charles Rehabilitation Center
GREG BORSTAD, MD
Bend Memorial Clinic
Bend Eastside gt Redmond
5 41-3 8 2 -4900
www.bendmemorialclinic.com
DAN FOHRMAN, MD
Deschutes Rheumatology
2200 NENeffRoad,Suite 302 • Bend
541-388-3978
n/a
HEATHER HANSEN-DISPENZA,MD
Deschutes Rheumatology
2200 NENeffRoad,Suite 302 • Bend
541-388-3978
n/a
TIANNA WELCH, PA
Deschutes Rheumatology
2200 NENeffRoad,Suite 302 • Bend
541-388-3978
n/a
JONATHON BREWER, DO
Bend Memorial Clinic Sleep Disorders Center
Bend Eastside gt Redmond
5 41-3 8 2 -4900
www.bendmemorialclinic.com
ARTHUR K. CONRAD, MD
St. Charles Sleep Center
Locations in Bend gt Redmond
541- 7 0 6-6905
www.stcharleshealthcare.org
DAVID L. DEDRICK, MD
St. Charles Sleep Center
Locations in Bend gt Redmond
541- 7 0 6-6905
www.stcharleshealthcare.org
T. CHRISTOPHER KELLEY, DO
Be nd Memorial Clinic SleepDisorders Center
DAVID HERRIN, DC
Redmond Wellnessgt Chiropractic
TIMOTHY L. BEARD, MD, FACS Bend Memorial Clinic DAVID CARNE, MD
St. Charles Surgical Specialists
DARA H. CHRISTANTE, MD
Bend Memorial Clinic
GARY J. FREI, MD, FACS
Bend Memorial Clinic
2500 NE Neff Road• Bend 5
Bend Eastside gt Redmond
41-70 G -7725 w
541-382-4900
www.drherrin.com
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
1201 NE Elm ~ Prinevilfe
541-447-G2G3
1501 NE Medical Center Drive• Bend 541-382-4900
541-382-4900
JACK W. HARTLEY, MD, FACS St. Charles Surgical Specialists
1245 NW 4th Street, ¹101• Redmond
541-548-77G1
DARREN M. KOWALSKI, MD, FACS Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
JOHN C. LAND, MD, FACS
1245 NW 4th Street, ¹101• Redmond
541-548-77G1
ANDREW SARGENT, PA-C, MS Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
GEORGE T. TSAI, MD, FACS
1245 NW 4th Street, ¹101• Redmond
541-548-77G1
541-382-4900
St. Charles Surgical Specialists
www.bendmemorialclinic.com
1655 SWHighland Ave,Ste 6• Redmond 541-923-2019
Bend Eastside gt Redmond
St. Charles Surgical Specialists
ww. s tcharleshealthcare.org
www.stcharleshealthcare.org www.bendmemorialclinic.com ww w .bendmemorialclinic.com www.stcharleshealthcare.org ww w .bendmemorialclinic.com www.stcharleshealthcare.org ww w .bendmemorialclinic.com www.stcharleshealthcare.org ww w .bendmemorialclinic.com
JENNIFER TURK, PA-C
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
JEANNE WADSWORTH,PA-C, MS
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
ERIN WALLING, MD, PACS
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
JEFP CABA, PA-C
Bend Memorial Clinic
Bend Eastside, Westsidegt Redmond 541-382-4900
ANN CLEMENS, MD
Send Memorial Clinic
Bend Eastside, Westsidegt Redmond 5 4 1-382-4900
www .bendmemorialclinic.com
TERESA COUSINEAU, PA-C
Bend Memorial Clinic
Bend Eastside, Westsidegt Redmond 541-382-4900
ww w .bendmemorialclinic.com
CRAIG COX,MD
St. Charles Immediate Care
2600 NE Neff Road• Bend
541-70G-3700
www.stcharleshealthcare.org
MIKE HUDSON, MD
St. Charles Immediate Care
2600 NE Neff Road• Bend
541-70G-3700
www.stcharleshealthcare.org
J. RANDALL JACOBS, MD
Send Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
AMEE KOCH, PA-C
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond 5 4 1-382-4900
www.bendmemorialclinic.com
JIM MCCAULEY, MD
Send Memorial Clinic
Bend Eastside, Westsidegt Redmond 5 4 1-382-4900
www .bendmemorialclinic.com
TERRACE MUCHA, MD
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond 5 4 1-382-4900
www.bendmemorialclinic.com
JAY O'BRIEN, PA-C
Send Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www .bendmemorialclinic.com
CASEY OSBORNE-RODHOUSE,FA-C
Bend Memorialli Cnic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
LAURIE D. PONTE, MD
Send Memorial Clinic
Bend Eastside, Westside gt Redmon
541-382-4900
www .bendmemorialclinic.com www.bendmemorialclinic.com
www.bendmemorialclinic.com ww . bendmemorialclinic.com
ww w .bendmemorialclinic.com
www .bendmemorialclinic.com
JENNIFER L. SURBER, MD
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
PATRICK L. SIMNING, MD
Send Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www .bendmemorialclinic.com
SEAN SUTTLE, PA-C
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
THOMAS H. WENDEL, MD
Send Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www .bendmemorialclinic.com
BRENT C. WESENBERG, MD
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www .bendmemorialclinic.com
2013 CENTRAL OREGON MEDICAL DIRECTORY
DVERTISINGSUPPLEMENT
MEREDITH BAKER, MD
Bend Urology Associates
2090 NE Wyatt Court• Bend
541-382-G447
www.bendurology.com
MICHEL BOILEAU, MD
Bend Urology Associates
2090 NE Wyatt Court• Bend
541-382-G447
www.bendurology.com
JACK BRKWER, MD
Bend Urology Assodates
2090 NE Wyatt Court• Bend
541-382-G447
www.bendurology.com
2084 NE Professional Court• Bend
541-322-5753
h t t p: //usof or.praxismedicalgroup.com
ANDREW NEEB, MD
Urology Specialists of Oregon
BRIAN O'HOLLAREN, MD
Bend Urology Associates
2090 NE Wyatt Court• Bend
541-382-G447
www.bendurology.com
KRIC SHREVK, MD
Bend Urology Assodates
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
h t tp:/ /usofor.praxismedicalgroup.com
NORA TAKLA, MD
Bend Urology Associates
2090 NE Wyatt Court• Bend
541-382-G447
www.bendurology.com
ROD BUZZAS, MD
Advanced Specialty Care
EDWARD M.BOYLE, JR.,MD,FACS
Inovia Vein Spedalty Center
2200 NE Neff Road,Ste 204 • Bend 541-382-834G
www.bendvein.com
ANDRKW JONES, MD, FACS
Inovia Vein Specialty Center
2200 NENeffRoad,Ste 204 • Bend 541-382-834G
www.bendvein.com
DARREN KOWALSKI, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
2084 NE Professional Court• Bend 5 4 1 - 3 22-5753 w
ww .advancedspecialtycare.com
JOSKPH COLKLLA, MD,FACS Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
ww. bendmemorialclinic.com
WAYNK K. NKLSON, MD ~
1501 NE Medical Center Drive• Bend 541-382-4900 w
ww . bendmemorialclinic.com
Bend M emorial Clinic
P AIDPADVERTISIN 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:
Lorraine Starodub, Account Executive • 541.617.7855 • Istarodub@bendbulletin.com
•
•
s •
•
•
s
• •
•
•
•
•
•
•
«',v ' • •
•
•
•
•
•
•
•
•
•
•
•
•
•
•
J'
•
•
Home Health
/
Cover story ISWITCHING GENDER Continued from Page13
Landis said. "I said, 'I promise to read them, but it's not a phase. I've been fighting it this whole time. I am still your child. I still have
the same talents. I am going to be me. I've been unhappy.'" Bales sent her daughter away, not knowing what to do. Landis stayed with a sister for a while, then a relative in Arizona. His dad had
"I am aguyas farasanyone whoknowsmeisconcerned. I am aheterosexualman."
"I knew transitioning was going to be selfish, but I needed to do this for myself," he said. Under the supervision ofa local endocrinologist, Landis began injecting small amounts of
as a male. Coing to public restrooms was terrifying. He entered the women's room at
lar care. I can't imagine sitting in the waiting
room." His medical records say he's female, so some female preventive care would probably be covered by insurance. But he's never looked into it, because he doesn't want to testosterone into her thighs biweekly. go. She became he. His insurance covers a percentage of Almost immediately his hunger skyrock- the blood work he gets every three to six eted. His voice got scratchy and facial hair months, to check on his hormone levels and grew. Within a month he noticed changes in his liver health. The costs are not unmanagehis body temperature and how he smelled. able, he said, since he self-injects and he can His sex drive grew, as did his muscles. A buy six months of generic testosterone for couple of months into the treatments, his about $6S. fat redistributed. He gained weight. His hair He is planning to have a bilateral mastecpatterns changed. tomy and is saving for the surgery. Ever since He was still experiencing ongoing dys- puberty, Landis has hated his breasts, which phoria despite four or five months of treat- he refers to as "foreign objects." Most of the ment. He still didn't feel like he could "pass" time he wears binders — aconstricting sports-
Page48
'.r
Rob Landis
been divorced from Landis' mom for years, a movie theater with Criffin and got dirty and was not a big part of Landis' life. looks.Now, he always usesthe men'sroom. Nothing changed her attraction to women. He said he tries to display confidence when Throughouther 20s, Landis,as a female, he walks in. If there are no stalls in a public room, he hasto leave. was transient, traveling all over the country, m en's dabbling in all kinds of jobs. She often reAs time went on, his voice continued turned to Oregon. Her life was a mess and to deepen. More recently, his depression involved a lot of partying. She dealt with waned and his dysphoria faded. depression. Hormone therapydoesn'tseem to have In 2010, while living in Prineville and changed his personality, he said. "I've alworking at T-Mobile in Redmond, Landis ways had the same interests and humor and met Lindsay Griffin and proposed marriage taste in music. My mannerisms have been after about a year. (Because Landis' birth altered slightly. I still seem like a gay man certificate says he's female, they can not le- sometimes," he said. He said that doesn't gally marry in Oregon, which bars same-sex bother him. "I'm comfortable in my sexualmarriage, yet Landis refers to Criffin as his ity. I would make a pretty good gay man. Exfiancee.) cept the part where you have to be attracted In 2011, Landis began to hear stories about to men and such." high-profile transgender people, such as writDespite a year of testosterone and an er and musician Chaz Bono, the transgender outwardly male appearance, harsh remindadvocatewho isthe son ofSonnyand Cher. ers of his anatomy remain. He still menstru"I had never known you could get testos- ates, which is frustrating. He is careful not to terone or have reconstructive chest surgery," leave evidence of feminine hygiene products he said. He researched and read books on in the restroom at work. "I should see a gynecologist for checkups," the topic. By December 2011, Landis decided a he said. "But I don't want to walk in and say, transition was right. Criffin said she'd stay 'I need a pelvic exam.' So I don't get reguthrough it.
1
1'
• • •
l
•
•
bra-like garment that flattens the breasts — or an extra-tight sports bra. Sometimes binders
rub him raw. Sometimes he hunches forward, an unconscious habit born ofbreast hatred. A hysterectomy is not that important to
him, he said, because his main dysphoria is about his top half. His breasts are an outward indication of what he is. His bottom
half is private. "I am a guy as far as anyone who knows me is concerned," he said. "I am a heterosexual man." Landis' mother said that it's easier for her to understand her son in this male, hetero-
sexual role than as her lesbian daughter. W hy?"It makes sense,"she said. Landis'older sister and her young children were at the bowling alley party. The kids call Landis "Uncle Robyn," she said. Along with access to the Internet and a
growing body of transgender stories and role models in the media, the maniversary party offers a glimpse as to why today's younger generation may grow up with a different collective thinking about gender and sex. As Bales said, when her mother was growing up, no one even discussed transgender topics. In Landis' case, an unlikely group of locals gathered in a Central Oregon bowling alley to celebrate it. •
SPRING/SUMMER2013 • HIGH DESERTPULSE
"Ihavere-foundmy voice,my confidence. Inolonger feel suicidal. I wakeupsmiling." Kirsten Winters align their bodies with their identities. Medi-
Continued from Page14
evidence available to know all the risks, he said. "I don't know of any elderly people who have beenon hormone treatments most of their life," Goldstein said. Theoretically, a male-to-female could take hormones forever. But if she stopped her whole regimen of estrogen and antiandrogens, which counteract male hormones, and if she still had testicles, the testosterone could come back, bringing back male characteristics. For female-to-males on hormone therapy, testosterone treatments can create
some cholesterol problems. The World Professional Association for Transgender Health's "Standards of Care" also says that polycythemia, a blood disorder marked by too many red blood cells, is a common risk for those on testosterone.
Ifa female-to-male has breasts, uterus or ovaries, he can still get cancer in those parts, Goldstein said. But whether treatments af-
fect risk has not been clinically studied.
Beyond hormones: the question of surgery Some transgender individuals feel a need for more permanent physical changes to conquer their dysphoria, to better
HIGH DESERT PULSE â&#x20AC;˘ SPRING /SUMMER 2013
about $12,000 on hair removal. She obsesses with tweezers, her girlfriend, Thompson, jokes affectionately. Winters has a presence and mannerisms that are typically associated with women. The way she looks coyly from underneath lush eyelashes. The way she crosses her legs. But her voice has a uncharacteristically deep edge
cal intervention may be referred to as sex or that's discordant with her long hair, her red gender reassignment, gender affirmation or nails and matching lipstick, her perfect purple sex confir mation, depending on whom you eye shadow, her bangles and silver rings. "My voice drives me crazy, but not enough talk to. Sex confirmation surgery â&#x20AC;&#x201D; surgical to work on it," she said. modifications for the purpose of altering Another notable change since her transione's gender expression â&#x20AC;&#x201D; is a loose term tion, according to her mom, is that Winters that encompasses different strategies, Crane used to be very punctual, but now she's sort said. Individual situations are typically deter- of flaky and always late. Why? Maybe bemined between the patient and the doctor. cause it takes so much time to put on make"Some (trans people) may consider chest up, Winters said. surgery alone a sex confirmation surgery, Family matters while others consider genital reconstruction to be the (essential)," he said. A handful of How a person's family, friends and comsurgeons in each state perform chest sur- munity respond can greatly affect the trans gery or facial feminizing surgery. Far fewer experience. specialize in genital reconstruction. One could assume that mental distress for Surgeries often come after hormone trans people is less about gender identity therapy. There are known risks, including and more about the stress that comes from (for top surgery) infection, bleeding, fluid being discriminated against, from being a collection under the skin, wound healing minority in society, said Liesl Farnsworth, complications and nerve damage, Crane a local counselor. The dysphoria, she sugsaid. The same goes for bottom surgery, gested, might arise from a lack of support in addition to a risk of urethral stricture or fistula.
in the culture. The National Transgender Discrimination
Winters will probably never have any sur- Survey said family acceptance has a protecgery. "I don't suffer genitalia dysphoria," she tive effect against many of the health risks, said. "Surgery is risky and not necessarily such as HIV infection and suicide, seen at the right path for me." higher rates among transgender people. But she takes three pills every day for her Trans people who are accepted by their hormone therapy. Two are anti-androgens, families also have far less experience with which block her testosterone receptors. An- homelessness, work in the sex or drug other drug, called propecia, keeps her hair- trade, incarceration, suicide attempts and line from receding. She also injects estrogen drug and alcohol abuse. every other week. Winters' dad fed her shame and self-hatred Three years of hormone therapy have re- for a long time, she said. Her parents divorced shaped her body and redistributed her body when she was 14. Although Winters hadn't fat. Her chest-waist-hip measurements have talked to her dad in eight years, she felt she shifted from 32-34-25 to 36.5-29-37. Her needed to tell him she was transgender. "I told him, 'I have struggled with this most breast size is 368, she said proudly. Her neck size shrunk from 17 inches to 13.5 inches. of my life. This is what I've decided to do. I There's more fat around her cheekbones. plan on transitioning from your son to your Like any person, Winters is self-critical daughter.' I told him it was this or a bullet in about features that other people probably my head. He said, 'I'd rather you had put the would not notice. Facial and chest hair are bullet in your head.' That was the last time I her biggest dysphorias. She said she's spent spoke to him," she recounted with a notable
Page 49
Cover story( SWITCHING GENDER lack of emotion, suggesting this story has been told before. This was a sharp contrast to her mother's response, which has more greatly influenced her life of late. Winters said her mom, Renee Allen, is her biggest supporter. When Winters told her mom a few years ago, Allen said she was just relieved. "I wish I would have known. I would have wanted to help her find help earlier," Allen sald. When Winters came out and the mother-
daughter pair looked back on a challenging life, "there were all these 'aha' moments," Allen said. All those years when her clothes would gomissing, she had thought she was losing her mind. It never occurred to Allen that one of her two sons would be stealing Kirsten Winters cooks dinner while talking to her mom, Renee Allen, at her mom's housein Bend. them. And the beloved black heels that Allen had practically accused co-workers of stealing, now she knew where they went. computer information systems. She's work- Resources for transgender "I wore them out," Winters said, smiling
sheepishly.
Feeling discrimination Every trans experience is different, but there are common threads for many. Isolation and depression. Marginalization and violence. Discrimination and unemployment. In California, Winters was spit on and pushed around. In Bend, she gets stared at, pointed at, whispered about, photographed without permission.
"I've developed thick skin," she said. But even worse than the mocking is when
someonethinks she'sm ale."One ofthehardest things to handle is being misgendered. It feels like having an ice pick shoved into the temples. It hurts."
Most poignant of all her challenges at the moment, she said, is her inability to find full-time work, although she admits that dis-
crimination would be impossible to prove. In 2011, Winters was laid off from a state
job in California due to budget cuts — she doesn't believe her gender variance had anything to do with it. Through thatjob, she had
ing on a master's in business administration
and project management. She has 15 years of experi ence and references. But she usually tells people in job interviews that she's trans, because she figures they're wondering anyway.She's been told she was the "close second"too many times, she said.She'sbeen teaching computer information systems classes through Central Oregon Community College part time, but it's not enough. Winters should get regular prostate checkups. And mammograms. But lacking health insurance as well as extra cash, she doesn't go. She spends $300 to $500 on hormones every six months but can't afford the regular lab work that would monitor her levels of hormones and check on her liver health. None ofthis is unusual. In the Transgender Discrimination Survey,
26 percent of participants said they had lost a job due to their gender nonconformity, and 47 percent said they had been fired, not hired, or denied a promotion for that reason.Respondents who had lostajob due to this bias were nearly twice as likely to work in the sex or drug trade. They had twice as much homelessness, more incarceration and higher rates of HIV infection as well as drug or alcohol abuse. Various nondiscrimination laws address-
insurance that covered her hormone therapy. She moved to Bend in December 2011 to be nearher mom. She's been applying for jobs ever since. Although she dropped out of high school, ing gender identity and sex o rientation she eventually went to college, earning an exist in many states, including Oregon, associate's degree and a bachelor's degree in Washington, California and Nevada, and are
Page 50
individuals and their friends and families: Central Oregon • Human Dignity Coalition www.humandignitycoalition.org, 541-385-3320 • PFLAG (Parents, families and friends of lesbians and gays) of Central Oregon www.pflagcentralor4t.com,541-317-2334 Out of town • TransActive (Portland) wwwtransactiveonline.org • Basic Rights Oregon(Portland) www.basicrights.org
progressing in others, said Jack HarrisonQuintana, the Policy Institute manager for
the National Cay and Lesbian Task Force. Antidiscrimination laws typically address employmentand housing. "We see so much trans unemployment. We see employment as being the biggest pivot point for all areas of life, such as health care and housing," said Harrison-Quintana. But he is optimistic that the tide is turning.
"We're making great strides in terms of trans rights right now. It's not dissimilar
to what's happening for gay and lesbian folks," he said, right around the time that
the Supreme Court was discussing samesex marriage. "We're all making strides together." •
SPRING/SUMMER2013• HIGH DESERTPULSE
What's next?
Secretsuccessesi DISEASE-DEFYINGVACCINES
Continued from Page 22 requiring tubes to drain and ventilate the mid-
dle ear, according to The Children's Hospital of Philadelphia. "It's a side corollary, a benefit nobody expected," Chunn said. In addition, pneumonia and bone and joint infections in older people who have never been vaccinatedforpneumococcus have decreased because the bacteria is less prevalent. Cieslak said pneumococcal pneumonia is particularly deadly in older populations.
Maintaining immunization rates If a Hib case came into a clinic today, Chunn said, most pediatricians would have a hard time recognizing it. "The look of a child with epiglottitis and the emergent nature to the child with epiglottitis
would be missed by most younger physicians," he said. "Because they've neverseen it.So they may fail to recognize how quickly you need to move on a patient like this. You need to be
unexpected results. The Hib vaccine not only
taken to surgery immediately and have a tube placed in their throat immediately so they do not have a respiratory arrest. And there is ab-
stifled the illness, but the bacteria itself.
solutely no time to watch.
Other vaccines have brought with them
Chunn said the majority of nasal cultures in winter used to be positive for Hib. Its carriage
"It would be easy to mistake it for croup and think it can be cleared with a bit of mist."
rate in the population — how many people
Continuing the vaccine success stories, experts say, depends on keeping immunization at as high as 65 percent. Its presence in the rates high. nose isn't dangerous to an individual unless it In populations with higher rates of unvacenters the bloodstream. But that person is a cinated children, for instance, research shows carrier of Hib, capable of passing it on. the carriage rate of Hib is starting to creep up. "They're not seeing a lot of infections, beToday, he said, the estimated carriage rate in the population is about 5 percent. cause they are getting some protection, herd had it in their body — was often estimated
Another example is t h e
r o tavirus vac- immunity," he said.
cine, which is given to infants orally as liquid
But eventually, if Hib keeps circulating in the population, it will happen. Rotavirus has long triggered gastrointestiWohlreich hopes society finds ways to talk nal illnesses. Children were at times hospital- about vaccine success. "If a vaccine only prevents up to 65 percent, ized due to dehydration. Seven years after the vaccine's introduction, it is so tempting to talk about the 35 percent researchers are also finding fewer rotavirus failure rate," he said. "But a 65 percent success cases in adults. rate is a heck of a lot more than zero."• cII ops.
Central Oregon's First 8r Foremos Vein Specialist
48t
== ==
=: ADVANCED SPECIALTY CARE
VARICOSE i SPIDER i LEG ULCERS i FACIAL
Researchers are working on vaccines for myriad illnesses. Efforts range from bacteria that cause strep throat to those causing tooth decay. There is even work being done on using vaccines to address autoimmune diseases like insulin-dependent diabetes. But for world health, there arethe big three infectious diseases for which vaccines would make a major difference: HIV,tuberculosisandmalaria. According to the World Health Organization, roughly1.8million people died of AIDS in 2010. In 2011, an estimated 1.4 million died of tuberculosis and 660,000 of malaria. In a 2011 article on vaccine development in the journal Vaccine, Australian immunologist Sir Custav Joseph Victor Nossal predicted that all three require at least another 10 to 20 years of work before the right solutions are found. The furthest along in research, he says, is for malaria, which is caused by a parasite. While vast resources have gone into HIV/AIDS research since the 1980s, the immune system virus' genetic diversity and ability to "go underground" in areas of the body, only to emerge again, have proved difficult obstacles. While variations of tuberculosis vaccines exist, they aren't sufficiently effective, Nossal argues. But in recent years there have been at least15 candidate vaccines for tuberculosis in clinical trials.
There is a difference in Cataract Surgery At Infocus Eye Care, we offer modern cataract surgery with lens options that may help you to see near, far, and in between. If you are interested in reducing your d ependency on glasses please see us, and explore all your options.
VEIN CONSULTATION UPTO A $250 VALUE Mention this ad. Ultrasound not included. exp 4-26-13
eye care
cALL 541-322-1756 G. Rodney Buzzas, MD,Ms,FAcs HIGH DESERT PULSE • SPRING/SUMMER 2013
Intocus
A D V ANCEDSPECIALTYCARE.COM Page 51
TIPsI INTERNATIONAL TRAVEL
now eore Ou
An ounce of prevention is worth a pound of cure
O
Castrointestinal infections caused by parasites, viruses or bacteria and respiratory tract infections such as influenza are common illummer vacation isjust around the corner. Ifyou are luckyenough nesses contracted abroad, according to Lutz. to have an international trip planned, you are probably aware of One way to prevent illness is by staying up-to-date on routine imthe hoopsyou must jump through before you go — booking munizations. Lutz said illnesses such as hepatitis A — common in flights, learning important phrases in a different language and obtain- less-developed countries — can be prevented through vaccination. ing a passport. But traveling to a different country also has health risks He recommends visiting the Centers for Disease Control and Prethat can sometimes be avoided with proper knowledge and supplies. vention website (www.cdc.gov) for immunization requirements by Knowing those health risks is a good first step. country and for guidance on whether or not to see a travel health For example, if traveling to "areas in the subtropics and tropics specialist versus a general physician. and less-developed parts of the world, you are more at risk of getThe following checklist offers travel guidelines recommended ting travel-related illness," said Dr. Jon Lutz, an infectious disease by experts. Always seek the advice of your health provider for any physician and travel medicine provider at Bend Memorial Clinic. questions regarding your personal medical conditions.• BY ELISE GROSS
Healthy travel timeline At least one month in advance:
What to pack:
•Check immunization requirements of each country you'll visit. Some vaccines must be taken in a sequence; others need to be in the body for some time before offering full protection. •Meet with your doctor or a travel health specialist for routine or travelspecific immunizations, health-maintenance tips and extra supplies of medication you may need while abroad.
•Hand sanitizer to prevent illness; use especially before meals. •Chlorine dioxide water purification tablets to kill bacteria and viruses. •Antidiarrheals to thicken stools and s ow the spasms ofintestinal infections. •Small first-aid kit with bandages, antiseptic wipes, gauze, aspirin and antacids. •Sunscreen. A travel-sized stick makes for for easy application. •Glasses or extra contact enses, if needed. •Over-the-counter meds you routinely use; Benadryl for a lergic reactions. •Prescription medications in original labeled containers and a list ofany prescriptions and health items. Remember: 3.4 ounces or less for carry-on. •DEET iftraveling to the subtropics or tropics to protect against malaria. Mosquito netting is also helpful, especially at night. •Comfortable walking shoes and moleskin to protect against b isters.
Two to three weeks in advance: •Purchase"What to pack" items (at right). •Confirm your insurance coverage. Most insurance policies cover medical expenses incurred abroad, but Medicare does not. Consider buying a secondary medical travel policy for what your plan does not cover (such as deductibles, medical evacuation or overnight hospital visits). You can a so purchase primary coverage for medical costs up to a certain amount.
One week in advance: •Leave your medical history (vaccines, health conditions, medications) with someone who can be reached in an emergency. •Record U.S. embassy and emergency phone numbers for each area you plan to visit. For more information, visit the U.S. Department of State's international travel page (wwwtravel.state.gov).
While abroad in less-developed regions: Lessen your risk of gastrointestinal bacterial infection by avoiding: •Tap water and ice cubes in areas like Latin America and East Africa. Water and carbonated beverages from sealed containers arefine. • Fresh produce, raw shellfish and street-vendor food. Sources:www.cdc.gov, www.who.int, www.travel.state.gov, www.mayoclinic.com, WehMDand Dr.gon Lutz
THINKSTOCK
I,
c".
riti.-i'
"
I
i "", / r«
r aw«O ~
. I IItl IINO
r,r,l'.III:.ill,t I
R,RI>
rao r«
II
lr
sl
"«h I
/+r
/ ' /
v
ISI "h/I '— «
h.
'w«~«l «~ SVE.RI
"
'
s
One voice ~ApERsoNALEssAY
i n oane e
i ec an es,int t was a just an ache in her eye. My 22-year-old daughter Kristin — midway through college and nearly vibrating with youth and good health— showed up to a family gathering complaining of simple eye pain. Within weeks, the world had turned upside down for our family and we were faced with something we'd never considered: a child with a chronic, life-altering autoimmune disease. Lesli e Pugmi re-Holeis the editor of In hindsight, I should have The Redmond Spokesman. been aware this could happen to usas easily asanyone else. A few years prior, two dear friends started a family after a long wait, and their son was born with cystic fibrosis. Not only have I since learned a ton about CF, a potentially debilitating and progressive disease that affects multiple body systems, I've also learned a lot about how health is perceived in today's society. Passers-by see this towheaded, energetic kindergartner and wonder what the fuss is all about — he does not look sick. But what CF means for my friends is a constant battle against a disease that affects all aspects of their son's life, one that requires extraordinary time and expense to manage. What it means is they must hope for new treatments or cures before their son arrives at his late 30s, the current life expectancy for those with CF. It means every element of their lives will be dominated by CF and it will be an effort invisible to nearly everyone outside their inner circle of family and friends. So when the little eye pain turned into a diagnosis of multiple sclerosis — an incurable disease of the nervous system that can progress to physical and mental disabilities — we realized our friends' struggle with CF had been a glimpse into our future. And once I got past my blind, intense anger that such a gifted and glorious girl could be struck with a fate like this, I got serious about educating myself about living with chronic health problems and facing my own feelings. We saw right away how Kristin could become the poster child for health care reform; as a college student who has "aged out" of typical insurance plans, she would be without any kind of health cover-
Page 54
age to help her fight this disease without the Affordable Care Act. Even if her disease allows her to work for most of her life, the annual $5,000 to $10,000 in tests to scan for nervous system lesions and the $30,000 in powerful medications she must take every year will pretty much wipe out any chance at solvency, even with insurance. Regardless of health care reform, she may not be able to realize her dream of graduate school because she may need to enter the working world to obtain her own insurance coverage once she turns 26. While the ACA plans to have health insurance available for anyone not offered coverage by an employer, it's still unclear how that will affect young adults still in school and receiving income through loans or grants. In an ironic twist, my husband and I now see that it might be a blessingKristin wasdiagnosed so young. Had she been 30 or40 and we had been almost or already retired, our ability to help her, in terms of money and our own health, would have been severely limited. But we expect the non-monetary effects to be more far-reaching, for her and us. She will have to deal with bosses and boyfriends who see anormal-looking young woman and can'tunderstand what's wrong with her. She'll have to constantly weigh life choices — what she eats, where she li ves, how much she sleeps and how much to ask ofherbody — to an extent that most of us can only imagine. My husband and I live in fear every day: fear of an escalation of her disease, fear we will not understand how to support her in the most helpful way, fear of zealous ACA opponents who see health care reform as a threat to our national freedoms, fear of the fear. We see down the road, to an old age we did not anticipate, possibly helping to care for an adult child. My daughter, now 25, can expect to live a fairly normal life span, barring any severe complications with her disease. But the quality of that life is unknown, and the variables seem to change every day. We wonder how much she will need to relyon us and how well we will respond. Do we have what it takes? Will she? The waiting is hard; the wondering is torture. We have to remind ourselves to not look too far ahead, to take each year as it comes. The sufferers of chronic diseases don't seem to get the attention of more immediately life-threatening illnesses, such as cancer or heart disease, because people like me — the old, pre-MS me — haven't had a reason to take note. Unfortunately, it's only when fate comes knocking on your door that it becomes personal enough to take a better look. •
SPRING I SUMMER 2013 • HIIGH DESERTPULSE
HIGH LAKES WELCOMES
PRACTICES: Family Medicine: Welcoming Men and Children
HAILS FROM: Western Colorado LOVES: rntn biking,cross country skiing Redmond 541.504. 7635
(t
Bend Upper Mill 541 . 389. 7741
glr.
Bend Eastside 541.318.4249
H ealt h C a r e HIGHLAKESHEALTHCAPE.COM
H ea l t
Sisters 541.549.9609
h C are
REDMOND CAPE IS N W •
• •
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
(but a heart attack)
•
•
•
•
•
•
•
•
r
• •
•
•
•
•
•
•
•
•
I
•
•
• I
•
•
I
•
• I
•
•
•
•
•
I I
I
•
•
I
•
•
• I ' •
-e
e
-
fh