Pulse Magazine - Summer/Fall 2013 by Western Communications, Inc.

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H I G H

D E S E R T

Healthy Living in Central Oregon

Central Oregon

Radioloy

Associates, p.c. Serving our MedicalImaging NeedsSince 1948

SUMMER / FALL 2013 VOLUME 5, NO. 3

How to reach us Julie Johnson lEditor 541-383-0308or jjohnson@bendbulletin.com • Reporting Anne Aurand 541-383-0304 or aaurand@bendbulletin.com Alandra Johnson 541-617-7860 or ajohnson@bendbulletin.com Markian Hawryluk 541-617-7814or mhawrylukCtbendbulletin.com Beau Eastes 541-383-0305 or beastes@bendbulletin.com David Jasper 541-383-0349 or djasperc tbendbulletin.com • Design I Production Greg Cross David Wray • Photography Ryan Brennecke Joe Kline

Althea Borck Andy Zeigert

Rob Kerr Andy Tullis

• Corrections r 4

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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.

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• Advertising Jay Brandt, Advertising director 541-383-0370 or jbrandtC7bendbulletin.com Kylie Vigeland, Health & medical account executive 541-617-7855 or kvigeland@bendbulletin.com Qtt On the Weh: www.bendbulletin.com/pulse

The Bulletin AIIBulletinpaymentsaieacceptedatthedropboxatCityllall Checkpaymentsmaybeconvertedtoanelectronicfundstransfer TheBulletin,USPS rr552 S20, ispubkshed daily byWesternCommunications Inc.,1777 SW Chan dler Ave.,Bend, OR97702. Penodicals postage paid at Bend,OR. Posrmaster. Send address changes to The Buheanorculaaon deparrment, PO.Box6020, Bend, OR 97708.The Buhetin retains ownership and copynghr protecnon of all sraff prepared newscopy adverasing copyand news orad illusrranons. They maynot be reproduced withour expkor pnor approval Published 8/12/2013

Call or appointments: 382-9383 John Stass~n, MD — Cloe Shelton, MD — Ronald D. Hanson, MD Will Wheir, MD — James E.Johnson, MD — Patrick B. Brown, MD Jeffrey Drutmqn, MD - Traci Clautice-Engle, MD - Laurie A. Martin, MD Steven D. Kjolech, MD - Garrett Schroeder - Thomas R Koehler, MD Robert E. Hogan, MD - Stephen Shultz, MD - Paula Shultz, MD David R. Zulauf, MD — Steven J. Michel, MD

Write to us Send your letters of 250 words or less to pulse@bendbul etin.com. P ease include a phone number for verification.

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UPdates ~ NEw slNcEwELAsTREP0RTED

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Can fetal alcohol syndrome be prevented?

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Nearly 1 percent of children born in the U.S. have some degree of disorder caused by the mother's consumption of alcohol while pregnant, High Desert Pulse reported in "The hidden risk of fetal alcohol syndrome" (Winter/Spring 2011). And the rate is much higher in children adopted from Eastern European countries. Now, a study published in February is offering researchers new possibilities for developing drugs that prevent in-utero damage from alcohol . Research from Harvard Medical School and the Veterans Affairs 6oston Healthcare System ' ~ has found genetic links in studies Abas

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of cell lines and in mice that indi-

cate how sensitive the developing fetal brain might be to alcohol damage. The work, supported by •

the National Institute on Alcohol

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Abuse and Alcoholism, part of

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the National Institutes of Health,

suggests there might be a way to design drugs that block alcohol's toxic effects in developing nerve and brain cells. •

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Scientists already knew that alcohol inhibits the function of L1, / I

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a molecule that aids adhesion between developing nerve and brain cells. The latest research reveals more about how Ll's cell adhesion works and how alcohol's effect on Ll is likely influenced by genes. The development is significant, as researchers until now haven't known which children might be at higher risk for fetal alcohol spectrum disorders or which genes might be critical. Experts say identifying mothers whose fetuses are at higher risk could help providers better target drinking prevention efforts during pregnancy. — Heidi Hagemeier

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SUMMER I FALL2013 • HIGH DESERTPULSE

Contents ~ HIGHDEsERT PULsE

COVER STORY A BLUEPRINT FOR HEALTH CARE REFORM The Affordable Care Act, sometimes called Obamacare, will kick in next year. Are you ready?

GEAR

FEATURE SODA 30 DIET Could diet soda be making us fat?

DEPARTMENTS Since we last reported. 4 UPDATES 14 SNAPSHOT Hiking the Cascade Lakes. THE JOB 15 ON Lynda Hughes helps cancer patients regain their confidence and self-image.

HEALTHY EATING

18 TIPS Sitting is killing us. How to keep healthy at a deskjob. DOES SHE DO IT? 20 HOW 18 Volleyball coach, orthodontist and mom: How Blair TIPS

Struble makes time for fitness.

READY 24 GET Climb South Sister this summer. 28 GEAR Bike helmet buyer's guide. EATING 36 HEALTHY What does 100 calories look like? QUIZ 53 POP The science of laughter. VOICE 54 ONE Children's sleep patterns might be genetic. COVER DESIGN: ANDYZEIGERT CONTENTSPHOTOS, FROMTOP: ROBKERR,ROB KERR,GREGCROSS,BOE KLINE

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

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u c o t e o r a e a r e ct i c sinto earon an. . a n mericans on't now owitwi a ectt em. o o u? Get ready for a media blitz that hopes to educate the 58 percent of uninsured who don't have a clue

plan, or $15,765 for a family plan. Premiums have doubled over the past nine years. Such growth hampers the ability of businesses to provide health care coverage for their employees and siphons money away from other benefits or pay raises. Meanwhile, public health spending is growing at the same clip. Health care costs now account for 21 percent of the federal budget and 22 percent of the Oregon budget. The highcost ofhealth care means many

enrolled unless they know about it." Croups like Enroll America, as well as federal and state government agencies will try to educate Americans about the new requirements and benefits of the Affordable Care Act over the coming months. They'll have to that four in 10 Americans did not know that reach millions of individuals and businesses the Affordable Care Act — President Barack thatface new challenges and individuals who don't get inObama's health reform legislation signed opportunities starting in 2014, surance through their work can't afford to buy it on their into law in 2010 and now known as "Obam- and dispel many of the myths acare" — is still the law of the land and in the that have emerged around own. About one in seven 4outof 5 Democrats process of being implemented. Awareness the law. Americans, nearly 49 million, support the health care was even lower among the groups the law is Support for Obamacare are uninsured, and many othaw,while4outof5 most intended to help; six in 10 Americans falls mainly along political ers have plans that don't proRepublicansoppose making less than $30,000 a year and five in fault lines. Four of five Demovide meaningful coverage. it. On Jan.1,2014, how10 adults under the age of 30 did not know crats support it, while four of I ndividuals wh o ha v e ever, all of them will be the law was still in force. five Republicans oppose it. chronic diseases are often subject to it. Similarly, a Callup poll in June found that On Jan. I, 2014, however, all unable to find coverage or while 81 percent of Americans knew of the of them will be subject to it. are forced to take plans that requirement to carry health insurance or pay Surveys also show that most Americans won't cover costs associated with their prea fine in 2014, 43 percent of those without in- don't really understand what the health re- existing conditions. Other plans put annual surance said they were unaware of the rule. form law entails or what problems it is in- or lifetime caps on benefits that can easily Half of those surveyed in the Kaiser poll, tended to fix. But there's widespread agree- be reached within months of a catastrophic including some 58 percent of the uninsured, ment on both sides of the political fence that accident or illness. said they did not have enough information the U.S. health care system is broken. Year The Affordable Care Act attempts to reabout the health reform law to understand after year, the cost of providing health care duce that number of uninsured by establishhow it will affect their own family. continues to rise, even as the health of Amer- ing a penalty for those who can afford to buy "Millions of uninsured Americans stand to icans continues to lag behind that of other insurance but choose not to, and by giving benefit from the implementation of the Af- countries. subsidies to those who can't afford coverage fordable Care Act," said Anne Filipic, presiIn 2012, Americans paid an average of on their own. At the same time, the law closdent of Enroll America. "But they won't get $5,615 for an individual health insurance es many of the gaps thatkeep people from BY MARKIAN HAWRYLUK

nly months before Americans will face the most significant changes to the health care system in decades, the country is facing a crisis of unawareness. A Kaiser Health Tracking Poll in April found

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SUMMER I FALL2013 • HIGH DESERTPULSE

IL/

PHOTO BYJOHN KLICKER

Cover Oregon shoots a barbecuescene for a commercial featuring the hip-hop group Lifesavas in Portlandin July. The group willspend more than 53 million to getits name out to Oregoniansin preparation for the Oct. 1launch of the healthinsurance exchange.

getting good health coverage. Those include provisions allowing chilIt's considered more of a first step in dren to remain on their parents' health health reform. Although the ACA includes plans until age 26, providing free contrasome pilot projects that will test ways to ception and vaccinations, and eliminating shift the incentives in health care away lifetime caps on health coverage. from more procedures and higher spendThe next phase of implementation will ing, it doesn't tackle the underlying issue begin Oct. 1, when state and federal health ;,r . e • • of rising health care costs. exchanges open, allowing individuals and Still, getting more people on health in- small groups to shop for health insurance '-' " BY MARKIAN HAWRYLUK . surance would mean individuals could get and receive subsidized coverage. treated in more cost-efficient settings, such In the coming months, many Americans he Affordable Care Act is aimed at as health clinics or doctors' offices, rather will have to make crucial decisions that could finding health coverage for as many than waiting until their conditions reach have long-term financial, medical and tax impeople as possible and relies primarcrisis levels and require emergency room plications. It will take an educational blitz few ;ily on two new rules to get there: the indi-, care or surgery. have ever seen, relying on everything from vidual mandate and the guaranteed-issue Most of the bigger changes in the health celebrity pitches to volunteers going door to provision. The first says nearly everyone reform law won't go into effect until 2014, door, to make sure everyone is aware of the will be required to have insurance or pay a and some not until 2018. A number went choices and their consequences. penalty. The second says insurance compainto effect almost immediately after the With anywhere from 20 to 40 million unnies have to sell.insurance to anyone who-. ACA was signed into law. And for the most insured currently unaware of the changes, wants it. part, those changes have been very popu- the effort is facing a significant challenge Becausemany peoplehave troubleafford"Our goal," Filipic said, "is to change that lar, evenamong some ofthe law's staunching insurance, the law also provides signifi.est opponents. number."• cant financial help for individuals to pay the ' premiums, deductibles and copayments. Under the law, states have the option ofexWhat parts of Obamaeare are already here? panding their Medicaid.programs forlow-in-' Medical loss ratio: Requires cost sharing for many preventive or deny coverage for children come residents. The federal government will plans to spend at least 80 percent services, including colorecta based on a pre-existing condition foot the bill for most of that added care, covof premiums on medical costs, or screening, mammography, vac- Small business: Allows emering 100 percent of the cost of those added;-,',. rebate the difference. cinations and contraception. ployer with no more than 25 : to Medicaid in 2014 through 2016, and no ':. Dependent children: Allows Coverage denials: Policies isemployees with average annual less than 90 percent of costs after that dependent chi dren to remain sued or renewed after Sept. 23, salaries of 550,000 or less to take . Oregon is participating in the Medicaid-:,:::.' -'4 on parent's group health plans 2010, can no longer place alifea federal tax credit up to 35 perexpansion and has negotiated special terms upto age 26. time limit on coverage, eliminate cent of the costs ofinsurance for with the Obama administration to help fund

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Preventive care: Eliminates

coverage after a person gets sick,

HIGH DESERT PULSE • SUMMER/FALL 2013

its employees.

Continued.on page & "'.'

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Cover story(HEALTH CAREBLUEPRINT

Continued from page7 its health care transformation. As many as

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200,000 Oregonians could be added to the Medicaid program through the expansion. In the past, Medicaid was available only to individuals with dependent children, and in most states, only to families with in-

comes below the federal poverty level. The expansion would raise the income threshold by 38 percent and allow anyone below

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that threshold to enroll, even if they don't

have children. Those who qualify for Medicaid wouldn't have to pay anything for their health insurance and would face no out-ofpocket costs when they sought care.

Insurance exchanges For those who make up to three times the

poverty level, and who can't get adequate health coverage through their employers, the federal government will provide subsidies or tax credits to help them afford the premiums. The subsidies will be available only through the health insurance exchange in each state. Some states are allowing the federal government to set up and run their exchange. Other

states, including Oregon, will run their own. The exchange is a sort of online marketplace where consumers can shop for health plans. Plans must conform to the rules set up by the federal government and the state. That allows consumers to know the insurance they're buying covers the essential core of health benefits the state requires, including hospital and physician services, prescription drugs, oral and vision care. "The most confusing part is the federal poverty level," said Rocky King, executive director of Cover Oregon, the state's health care exchange. "People know their income. They don't know the poverty level." The actual income corresponding with the poverty level changes with family size and is updated by the government each year. It's easier for most individuals to go to the Cover Oregon website and plug in their basic information to determine whether they'll get a

Thesite works verymuch likeconsumer-friendly taxpreparation software, guidingindividualsstep bystepbyasking questions aboutincome, familysizeandemployment. surprised that they will get a subsidy despite nancial assistance is tied to income, changes in their income. earningscould change theamount ofsubsidy H So often when people hear about the someone is due.And thatcould leave some financial help that might be available, their people owing more in taxes if they don't noinstant reaction is, 'Well, that's not for me. I tify the exchange of an increase in income. won't qualify for that,"' she said. HI3ut the fiThe exchangeissetup to help consumers nancial help we have through Cover Oregon check if they might be eligible for Medicaid is pretty incredible." or qualify for a subsidy, compare plans, and Individuals with an income of $45,000 after Oct. I, choose a plan and enroll. The could be eligible for some assistance. A fam- site works very much like consumer-friendly ily of four making as much as $94,000 could tax preparation software, guiding individustill get some help paying for coverage. als step by step by asking questions about The Congressional 6udget Office estimates income, family size and employment. that 90 percent of those buying insurance Insurers can no longer drop coverage as through the exchange will get some help long as members pay their premiums and can't paying for their premiums. exclude certain conditions from coverage. Individuals who qualify for a subsidy will

Rates and costs

subsidy or not. Until the exchange goes live have to make the decision whether to take the Oct. 1, individuals can use an online calcula- funds each month in the form of a lower preRatescan vary only due to age, tobacco tor to see whether they'll get a subsidy and mium, or to claim the funds as a tax credit on use, geographic variation and family size. what a health plan might cost them. their tax returns. The monthly discount will Plans will not be able to charge higher premiAmy Fauver, Cover Oregon's chief com- helpthose who don'thave the money to pay ums from people who are sick or to women, munication officer, said many people will be for the premium up front, but because the fi- who in the past could pay 50 percent higher

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SUMMER /FALL 2013• HIGH DESERTPULSE

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Covery story IHEALTHCAREBLUEPRINT

The individual mandate premiums than men in certain plans. Health plans will also be required tojustify any potential increases in premiums. Some states, including Oregon, will take an active purchaser approach, in which state regulators can reject plans that want to charge cus-

ums they can afford and whether they are likely to use a lot of care in the coming year. Those who are healthier and unlikely to have high medical costs might save money bygoing with a bronze or silver plan. Those who tend to use care more often might do better

paying a higher monthly premium, but limitIn Oregon, health plans had to file their ing their ongoing out-of-pocket costs with a rate proposals in May, and regulators re- gold or platinum plan. All the plans include a viewed the assumptions those plans made cap on out-of-pocket costs as well. regarding how much their costs would inA recent study in the journal Health Affairs crease next year. The state then told insur- found that in 2010, 65 percent of families ers how much they would be able to charge with group coverage have plans that would and insurers could decide whether or not to qualify as gold or platinum. But the study accept those rates. found that more than half of plans sold in Most of the rates for Central Oregon were the individual market covered less than 60 reduced anywhere from 1.5 percent to 32 percent of health costs. Dubbed tin plans, percent from the rates requested by the inthey are no longer allowed under the ACA. surance plans. About a third of individual plans would have "We don't want rates too high, but we want qualified as bronze plans. to make sure carriers justify their rates," said With all the new rules, health plans will Lou Savage,Oregon's outgoing insurance cover individuals who previously couldn't commissioner. "We were concerned about get coverage because of pre-existing condicarriers not a being able to financially sus- tions, and the available plans will cover more tain a low rate. The last thing we want is for healthcare costs.Those added costs means a carrier to not be able to pay claims." most plans at least initially will have to The exchange will allow individuals to charge higher premiums than they did in the compare plansside by side so they can past. Reform experts believe that over time, choose the plan that best suits their needs. premiums will not grow as quickly, making Cover Oregon will include a variety of tools them more affordable in the long run. to helpconsumers choose among the opIn 2011, the average monthly premium in tions, including quality ratings, cost sharing Oregon's individual market was $202 per and participating doctors. month. In Central Oregon, the new rates "We have an opportunity to help hundreds for a single, non-tobacco user would range of thousands of people who don't currently from $130 per month for a 21-year-old in a have insurance or who have to buy insur- bronze-level plan, to $839 per month for a ance in a market that's very complicated," 60-year-old in a gold level plan. Fauver said. "In the individual market, it's For most individuals purchasing health inreally hard for people to understand what surance through the exchange, those rates they're getting, and sometimes people learn will be offset by the financial subsidies or that it's not really as good insurance as peo- tax credits available. But there will be some ple had thought it was." individuals who will face higher premiums To help consumers sort through the op- with no additional help to pay for them. tomers too much.

tions, the ACA created tiers — bronze, silver,

gold and platinum — to describe the amount of cost-sharing involved. Bronze tiers have a lower premium, but require individuals to pay on average 40 percent of the cost of their care in deductibles and copays. Silver plans require 30 percent cost sharing, gold plans 20 percent, and platinum plans 10 percent. Consumers can then decide what premi-

Page 10

The uninsured That will leave some currently uninsured individuals wondering whether it's worth

paying the penalty for not having insurance or paying the full cost of the premium. The penalty for not having insurance in 2014 is the larger of I percent of income or $95 per individual and $285 per family.

Beginning Jan.1,everyone must have hea th insurance or pay apenalty, The penalty will bethe higher of: 2014 595 or 1 percent of taxable income 2015 53 2 5 or 2 percent of taxable income 2016 5695 or 2.5 percent of taxable income Exemptionsfrom individual mandate •Financia hardship •Religious objection •American Indians •Those without coverage for less than three months •Undocumented immigrants •Incarcerated individuals •Unab e to purchase insurance for less than 8 percent ofincome •Those below tax-filing threshold

Can I get a tax credit? Ifyou can answer no to all three questions beow, you cou d be eligible for a tax credit and reductions in cost sharing. •Does your employer offer health insurance? •Do you receive Medicare? •Does your family make more than...? 2 Vl 3 R 4. 5.

....... S45,960 S62,040 ........ S78,120 ....... S94,200 . S110,280 ...... S126,360

Health insurance exchanges The Affordable CareAct establishes online exchanges for individuals and small business to shopfor health insurance. Plans in the exchange will be categorized into four tiers based on the amount ofan individual's costs covered by the plan. Percentage of Tier costs covered Platinum 90% Gold 80% Silver 70% Bronze 60% Catastrophic plan' 50% "Available for those up to age 30 and those exemptfrom individualmandate

The penalty will increase over the next two

SUMMER /FALL 2013• HIGH DESERTPULSE

years, reaching 2.5 percent of annual in- plan to sign up for coverage after they get sick come or $695 per individual and $2,085 would likely have to pay those costs — an avper family by 2016. erage of $6,600 — out of their own pocket. Because insurance plans can no longer Surveys also show that few of the uninreject individuals with pre-existing condi- sured actually think they don't need health tions, they could always sign up for insur- insurance. A Callup poll in June found that 43 ance once they get sick. percent of the uninsured said cost was the pri"As the younger and healthier people mary reason why they didn't have insurance, realize that the price of insurance is more and an additional 32 percent cited not getting than the fine and that guaranteed-issue insurance through an employer as the reason. rules force insurers to sell them a policy Only seven percent said they didn't need it. even when they get sick, they'll have subAccording to the group Young Invincibles, stantial incentives to forgo insurance until which advocates on social issues for adults they actually need it," said David Hoberg, youngerthan age 35,only 5 percentofyoung a health policy analyst with the National people choose notto haveinsurance.Thegroup Center for Public Policy Research. expects up to 17 million of the 19 million uninHoberg believes that will create a sured under age 35 to get coverage as a result of "death spiral" because fewer and fewer the ACA — 8 million through a full expansion of healthy people enrolled means average Medicaid, and 9 million through the subsidies. "The health care reform law means that as costs will rise higher and higher. Eventually, the insurers could stop selling indi- many as 17 million currently uninsured young vidual insurance policies if they're no lon- adults age 18 to 34 could gain access to more ger able to make a profit. comprehensive, affordable health insurance Individuals who opt to pay the penalty, however, run some risk in taking that approach. For one, if they're eligible for financial help through the exchange, they can only get that subsidy during the open enrollment period, from Oct. I to March

coverage through the expansion to Medicaid and new subsidies to purchase insurance," said Aaron Smith, the group's executive director. "Already, more than 3.1 million young adults have gotten covered thanks to a provision of the law that took effect letting young

people stay on their parents' plan until age 26. In 2014, the 16 percent of young Americans with pre-existing conditions can no longer be denied coverage." The ACA exempts certain groups from having to pay the penalty for no insurance, including exemptions for Native American tribes, religiousconscience, and those forwhom even a bronze level plan would cost more than 8 percent of their annual income. An analysis by the Urban Institute, a Washington, D.C., think tank, found that only 6

percent of Americans will be expected to buy health insurance or pay a penalty. The rest either already have insurance or will be eligible for Medicaid next year under the expansion. Of that 6 percent, two-thirds will be eligible

31. After March, they'll have to wait until the next open enrollment period in Octo-

ber 2014 to get subsidized insurance for 2015, unless they have a major change in their circumstances, such as getting married or divorced or a change in employment status.

Additionally, those paying the fee are still at risk for high medical expenses from a sudden event, such as a car accident, that could generate huge medical bills before they're able to sign up for insurance. A recent study in the New England

Journal of Medicine compared the costs incurred in emergency rooms among individuals 19 to 25 who were covered under their parents' plans starting in

2010 under a popular provision of the

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ACA, with those 26 to 31, who were not

affected by the provision. The researchers found that insurance companies paid an additional $147 million for more than 22,000 emergency room visits by those newly covered young adults. Those who

HIGH DESERT PULSE • SUMMER/FALL 2013

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Page11

Coverystory IHEALTH CAREBLUEPRINT •

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Impact on coverage,2013 to 2014

for subsidies. That leaves only two percent of Americans facing the full cost of the premium, without any financial help. In Oregon, that would still account for up to 80,000 individuals who must decide between the premium and the penalty.

The role of businesses Businesses will also have to make significant decisions this fall about health coverage for their employees. Small businesses, those with fewer than 50 full-time employees, won't be required to provide insurance but can get tax breaks if they use the small business portion of the exchange to shop forinsurance. Each company willhave to decide how much money they will put down toward the premium cost. They can then opt for a single plan for all their employees or provide a certain dollar amount and give employees choices ofcarriers or tiers. "Smallbusinesses wanted the same op-

tions that large business wanted, that is, they

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wanted choices," King said."They wanted to g be able to say, 'Employee, here's the amount 155 you have. Co shop.'" A company could offer $300 per employee per month, for example, expecting employees to pay an additional $30 for a $330 per month silver-tier plan. An employee might be able to choose a bronze-tier plan for$300 and not owe anything more each 24 month. Another could opt to pay $80 out of 58 pocket and get a gold-tier plan. Companies would have to make their determinations first, then when individuals

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Insurance Program logged into the system, they would see the s Wf renftrplans available to them and their costs. Source: Congressional Budget Office Patrick O'Keefe, owner of Cascade Insurance Center in Bend, said businesses are ance, but to give the funds directly to emnow working with their agents and accoun- ployees to shop for plans on the individual tants to determine what the costs of provid- insurance exchange. "It might make sense — no harm, no foul ing insurance to their employees might be. In many cases, it might benefit employees to anybody — to say let's cancel this group for the company not to offer group insur- health insurance plan, bump up everybody's

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SUMMER I FALL2013 • HIGH DESERTPULSE

salary X number of dollars and send them to faster rate than before." the exchange,"O'Keefe said."They'll be usTykeson saidnew fees charged to help ing post-tax dollars to pay their premiums, finance the ACA's cost will add about 5 perbut they'll get subsidies." cent to premiums on top of the usual douThe Urban Institute said the ACA will have ble-digit annual increases. "I fear the annual increases by the carrilittle impact on companies with more than 1,000 employees and will cut costs for those ers will increase at a faster rate now because with fewer than 100 employees. It's the mid- more high cost individuals will be covered sized businesses — between 101 to 1,000 under the insurance exchanges they are paremployees — that are likely to see higher ticipating in," she said. costs. BendBroadband will continue to offer its employees health insurance, calling it an Local business responds important part of taking care of its employFirms such as cable and internet provider ees and their families. With 270 employees, BendBroadband, with 270 employees, fall the company spends $2 million a year on into that mix. health benefits. It would face a fine of about "We are too small to self-insure and lack $500,000 in 2015 if it decided against offerthe scale and leverage to negotiate aggres- ing health insurance. Still Tykeson could see sively with the insurance carriers," said CEO other employers making that move if insurAmy Tykeson. "The Affordable Care Act ance costs become prohibitive. "As staggering as the ACA penalty sounds, does not help companies our size curb spiraling health care costs and will likely have it may be more cost-effective for some comthe perverse effect of increasing costs at a panies to pay the penalty versus the expense

•

ofhealth insurance," she said. The success ofthe ACA will rest in large part on whether individuals and companies opt for the cheapest option — which will often be to pay a penalty — or take advantage of the incentives to purchase health insurance. "I think the predominant approach with businesses is they know that it is important to

provide benefits for their employees," O'Keefe said. "I think they realize that most employees aren't going to go do it themselves." In July, the Obama administration announced it would delay for a year a provision that set penalties for companies with more

than 50 employees if they didn't provide health coverage to their employees in 2014. The costof insurance had many businesses considering their options. Some companies began laying off staff or avoiding hiring to stay below the 50 full-time employee threshold. Others were transitioning part of their workforce to part-time status to avoid havContinued on page 38

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LOCAL SERVICE — LOCAL KNOWLEDGE

Page13

SnaPShOt ~ HIKING 4 c

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BYROB KERR

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With Broken Top as a backdrop, Doug Siskleads his wife, Sandy oyer ~ ~: = alog whilehiking at Green Lakesin July with Jeanie Readand Dirk~~-;"=:,'.— = Prague, all from La Pine. The 4.5-mile hike leach way) finishes atthrem:= == green lakes along waterfall-laden Fall Creek. Sandwiched between:-== - = : .; == South Sister and Broken Top, thehikeis a favorite ThreeSisters Wilder-:,7 8.~ .) ,'..-"'='-'==' , ness hike andis rated moderatein difficulty.:'

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Lynda Hughes owns Prosthetics by Lynda, a Bend shop thatcarries prosthetics for breast cancer patients.

Lynda Hughes'prosthetics boutique provides cancer patients with the right fit bras, swimsuits, nightgowns and sports wear. The shop also sells a wide variety of compression garments for arms and legs. In Hughes' experience, these items are not mere accessories. Hughes, 60, says the process of buying prosthetics, in particular, can be quite emotional. Many women feel as if they are gaining back a sense of self they had lost. Not every woman cries during an appointment, but many do. And when they do, Hughes cries along with them. "We cry! They start crying and it's very emotional," said Hughes. The store on Northeast Norton Avenue carries wigs, hats and scarves to help women as they lose their hair to chemotherapy. She saysthe experience "makes them feellike a woman again.They Hughes also offers a large selection of breast prosthetics and the see their old self coming back." accompanying clothing items into which the prosthetics fit, such as Peggy Lukens is the breast cancer nurse navigator with St. Charles BY ALANDRA JOHNSON â&#x20AC;˘ PHOTOS BY ROB KERR

ucked away far from 6end's hospitals and doctors' offices is a cozy, feminine boutique with soft lighting and warm colors. The shop feels nothing like a medical facility, yet most of the items in the store are designed to help with medical needs. It is a key stop for many women going through breast cancer treatment. Lynda Hughes has owned the shop, Prosthetics by Lynda, for about two decades.

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

Page15

On thejob(PROSTHETICS

"Iftheylookgood, they feelgood. Evenif nobodyseesyou; you have to feelgoodabout yourself." — Lynda Hughes

Health System, which means herjob is to help breast cancer patients navigate their treatment. Women who are going through breast cancer experience a "huge body change and a huge body image change," according to Lukens. "It can be really emotional." She thinks women need support during this time so they don't feel overly self-conscious. She believes Hughes is sensitive to what women are going through. "I often recommend women undergoing breast surgery go there," said Lukens."She's our gal; she's been doing this for a long time."

Theshop Hughes fell into the prosthetics business after coming to Bend with herhusband,who got ajob here as ateacher.She found ajob as an office manager at a shop that sold, among other things, prosthetics. When the shop decided to stop carrying prosthetics for breast cancer patients, Hughes decided to go at it on her own. "I love doing it. I found that it was very rewarding," she said. Compression garments are also a big part of the business. Some breast cancer patients who have had their lymph nodes removed need to wear these on their arms. They are also useful for myriad other medical conditions, from burns to varicose veins. Hughes has not experienced breast cancer herself, but her life has Compression garments, often worn by people with lymph canceror other medibeen sharplyaffected by cancer.Her husband, Kim, died in 2002 cal conditions, comein a variety ofcolorsand patternsat Lynda Hughes'store.

•

after battling testicular cancer for 12 years. His treatment included

yearsof chemo and a bone marrow transplant. Hughes says she grew to know all of the oncologists in town because of it.

Personal experience

she said. After a mastectomy in 2010, Landers returned to the shop, this time to obtain a breast prosthetic and special bras.

"When you're walking down the street, no one is going to know, Shopping here isn't like shopping at a regular boutique. People exceptyou, Lynda and your husband or boyfriend,"said Landers. are welcome to walk in any time, but most clients set up an appoint- "You get used to it. It becomes part ofyour day-to-day routine." ment. Hughes sets aside an hour to meet with each individual. She also obtained compression sleeves with pretty colors, which Many women being fitted for a prosthetic "are not looking for- she uses to work in the yard. Landers' cancer came back last year, ward to coming in," Huges said. They often feel awkward or and she once again returned to the shop. Knowing Hughes is there uncomfortable. to help makes her feel better."She's so nice and understanding and She recall s one nun who came tothe shop who told Hughes no supportive," said Landers."Whether it's your first time or your fifth, one in herpersonallife knew she had breastcancer;shecame by cab it's nice to know she's there." and asked the driver to drop her offa few blocks from the store. Hughes tries to put the women at ease.

How it works

Bend resident Susan Landers, 63, first met Hughes after starting Some women come in before surgery to understand their options chemotherapy in 2009. She came to the shop to try on wigs. "My (many women opt to have later reconstructive surgery). Hughes also mind was on having cancer, and I knew my hair was coming out." sees many women about four to six weeks after surgery to be fitted Hughes made a good impression on Landers. "She's a real doll," for a prosthetic. The technology has advanced greatly for these ar-

Page 16

SUMMER I FALL2013 • HIGH DESERTPULSE

Lynda Hughes'business, Prosthetics by Lynda, features a variety products for patientsin a comfortable boutiquestylestorefront.

tificial breasts, which slip into pockets sewn into specially-made bras and other garments. Hughes is happy the shop now carries bras in various colors and with or without lace — the prosthetic doesn't have to be limiting in terms of style.

Hughes has an entire room full of options for prosthetics in many sizes and shapes. The goal is to exactly match the remaining breast. Or sometimes, after a lumpectomy, Hughes finds a partial prosthetic to match the pair. "It's all about getting the weight, shape and size right. It's all

about balance," said Hughes. And it's not just a matter of looks — without that symmetry,

a woman'sbalance can be thrown offorherchestand shoulder can actually roll into her chest wall, causing medical problems. "It's not just cosmetic," said Hughes. The emotional aspect is also important. "If they look good, they feel good," said Hughes."Evenifnobody sees you;you have to feelgood about yourself." •

HIGH DESERT PULSE • SUMMER/FALL 2013

Page 17

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TIPSi HEALTHY woRKPLAcE BY BEAU EASTES

s more studies tackle the question of inactivity, one common thread keeps emerging: Sitting is slowly killing us. A study published in October in the United Kingdom scientific journal Diabetologia found that the average adult spends more than 50 percent of the day sitting down, a combination of working on the computer and watching television. Those who subject themselves to extended periods of sitting, according to the study, doubled their risk of diabetes and heart disease. Australian researchers came up with similar results for the average office worker who spends most of an eight-hour workday chained to a computer. In a study published in the British Journal of Sports Medicine in 2012, scientists found prolonged amounts of television watching — and being inactive — reduced the life expectancy of m en by up to 3.7 yearsand women by as much as 3.1 years.Forevery hour sitting on the couch watching TV — think two "Seinfeld" re-

Or how 8 hours in an office chair could take minutes off of your life

runs — we may lose about 22 minutes off our lives, the study found. Smokers, by comparison, are estimated to shorten their lifespan by approximately 11 minutes with every cigarette they smoke, according to a 2000 study published in the British Medical Journal. "When you don't move, your metabolism shuts down," said Stuart Johnson, a physical therapist at Bend's Rebound Physical Therapy clinics. "Your body is like a computer screen. If you don't use it, it

„'-OFFICE SAFETY GUIDE '

•

~ .'. Find a reason to stand up Studiesshowafew;'- '» e trend toward adjustable or stand-up desks is a ' really good one, but it's not realistic to stand all day,"

, minutesof activity -: , st.art Johnson says."I have a stand-up deskat my ic and I sit down every chance I get." Johnson

throughout the day ommends reorganizing your work station to in-= ase the number oftimes you have to get out of can offset the effects. '.,',"„ r chair, Move your printer across the room, put r pen and paper on a bookshelf, have the cofof long-term sitting maker down the hall."Just a little bit ofactivity

Take phone callsstanding up Very simple, especially once it becomes habit, says Johnson."Ifthe phone rings, stand up," he says."Taking the timeto standup doesn't have to interrupt whatyou're doing.... This will get you moving again" C

makes a huge difference," Johnson says, 1

Page 18

SUMMER /FALL 2013• HIGH DESERTPULSE

56l

goes into sleep mode." Even more sobering for Central Oregon's athletic set is that a two-

hour mountain bike ride on Phil's Trail or hourlong jog through Shevlin Park after work does little to counteract the damage of sitting all

day, researchers say. "Ifyou sit in an office all day for eight or nine hours and then go to the gym or bike or run, that's great," Johnson said. "But there's negative physiological effects that are not undone by that workout." Johnson notes that some of his patients who have spent years sitting on the job have balance and strength problems associated with prolonged inactivity. "One of the big things we see," Johnson said, "is that our bodies become shaped like chairs. The hip flexors get really tight, so I see people stand up and they can't straighten their backs fully anymore. They can't extend their hips anymore. It's from years of sitting." Johnson has a variety of tips to help office workers get up and get moving. But he also encourages getting creative about moving around. Start a lunch-hour running group (employees at Hydro Flask of Bend hit trails together twice a week). Do 10 pushups at the top of every hour. Walk backward to the water fountain. Johnson emphasizes that just a little activity throughout the workday can pay huge dividends. "What I'm gathering,"Johnson said, "is thatjust standing a little bit,

ANDY TULLIS

At Bend's Hydro Flaskoffice, employees are encouraged to leave their office building for a noontime group run, as seen herein June.

walking a little bit, does undo those physiological effects (from sitting). If you stand up every 20 minutes, it prevents your system from going to sleep for two hours." "What we're learning is the value of these little movements is great,

not necessarily for exercise value," Johnson said, "but for preventing negative physiological effects that come with sitting still.

"It doesn't take more time and you don't have to get all sweaty," he adds. "You don't have to interrupt what you're doing or break your train of thought. It's just doing enough to kick-start your heart again

and get your body working." â&#x20AC;˘

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Take thestairs, fast

Stand-up meetings

Next time you have a meeting, do it without chairs, recommends Johnson."Itcreates a sense of urgency and keeps meetings shorter," he says. Even better, Johnson adds, if the meeting is a ' one-on-one discussion, take a walk., :' '

Everyone knows avoiding the elevator and ' taking the stairs is good for them, but Johnson emphasizes the importance ofhitting them with gusto."People complain, but the best thing you can do is get in the habit ofrunning up stairs at . work," Johr(son says. "Just that little bit ofvigorous activity, even if it's just a few seconds, kicks the body's metabolism back up." ,

Using your watch, smartphone or computer, set a timer to go off every15 or 20 minutes, Johnson says, and stand up and touch your arms over your head."When you stand up and sit back . down, you r'eset yourself in good posture," John: son says."When you're sitting in your chair for 20 minutes,you start to slump.... That briefposture reset throughout the day, it's like tapping your keyboard every few minutes to prevent it from going into that lower hibernation mode.",

GREG CROSS AND ANDYZEIGERT

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

Page 19

Howdoesshedoit?( BLAIRsTRUBLE

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Dr Blair StrubleofStruble Orthodontics talks with a patientin herofficein Bend.

Bend orthodontist and volleyball coach Blair Struble fits fitness in when she can BY MARKIAN HAWRYLUK •PHOTOS BY RYAN BRENNECKE

Page 20

SUMMER I FALL2013 • HIGH DESERTPULSE

end orthodontist Blair Struble's appointment book often

has a slot reserved for one of her most important patients — herself. As a health care practitioner, business owner, volleyball coach and parent, it would be easy for Struble, 33, to let her exercise slide. So she regularly schedules time to attend a cardio and strength training fitness class in the middle of a busy day. "I just put them on my calendar," she said. "Because if I don't, then you never think of it, or you miss the time when they're going on." It's not that exercise is a chore for Struble. She loves it. She grew up in an active family, competed in sports all her life and returned home to settle in a town that's known for its recreational opportunities. But with so many demands on her time, she knows that maintaining

University, working her way into the starting lineup as a freshman in 1998.

"Volleyball is kind of my release," she said."So I continued to play after college in intramural teams, in Portland, when I was in dental school, and then up in Seattle when I went to my orthodontic

residency." When she returned to Bend in 2008 to set up her practice and start a family, she joined the Bend Volleyball Association, where she played with one of her former coaches, Jill Waskom. Now the volleyball coach at Summit High School, Waskom asked Struble if she was interested in coaching. "I said, 'Yeah, that'd be great,' and by thenextweek Ihad my coach'suniform," she said.

Life as a coach

her fitness regimen has to be a conscious decision. "There are times when I struggle, too," Struble said. By scheduling time for fitness, incor-

Although it's a short season — from the start of the school year until mid-

November — it's a busy one. The team plays Tuesdays and Thursdays, with practices on Monday, Wednesday and Friday, and often travel for tournaments on weekends. "The first couple of years, because I didn't have family of my own, I was there for everything," Struble said. "And then the weekend tournaments became a little tougher, the last couple of years."

porating activity into her family time and

m odifying herworkouts asneeded,she's been able to work exercise into her often hectic life.

Try everything

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Struble's family moved to Bend from North Dakota when she was 4. Her par- ~

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ents, Ron and Beth Hanson, were both

Credit that increased complexity to

active, but more so her father. "He's that person who's not great at

any one thing, but tries everything," she sports — you name it, he's tried it." With two young girls, the Hansons tried just about everything the area had

h" SUBMITTED PHOTO

Taylor, Struble's 2-year-old daughter, who has become a fixture at Summit volleyball practices. It's something Struble's husband, Trebor, an orthopedic surgery physician assistant, fully supports. The

Th e nknownasBlairHanson,Strubleplayedvolleytw o me t at Willamette University, where ba l l for Mountain View High Schoolin Bend and later he p l ayed on the football team. "It's definitely different from our colfor Willamette University, as shown here.

to offer. "I grew up windsurfing, biking, hiking," lege days, where our school and our Struble said. "My dad and I, every year sport was our career," he said. "It's kind we'd go hike a different mountain, which was very cool, and we'd go of morphed into those activities she does to kind of stay active." camping overnight." Being an assistant coach isn't the work playing is, but after the By fifth grade, Struble discovered volleyball, and soon developed drills the coaches often scrimmage against the varsity starters to an enduring passion for the sport. give them some strong competition in practice. "I think my parents kind ofthrew me into everything as a kid, and "Sometimes we beat them and sometimes we don't. Usually we let me pick what I loved, and I think volleyball ended up being that try to," Struble said. "The talent pool around here is very good." sport," she said. "I just loved the team aspect of it, I loved everything In d eed, the girls won the state championship in 2011. about it and it was just one of those things that I've always come P r a ctices can run from 5:30 to 8 p.m., meaning Struble generally back to." has to rush to the school after a full day of seeing patients. "It's hard to get there, it's hard to do the juggle," she admitted. She played for Mountain View High School and then for Willamette

HIGH DESERT PULSE • SUMMER/FALL 2013

Page 21

How does she doit?( BLAIR STRLIBLE

Struble and her husband, Trebor, play with their2-year-old daughter, Taylor, in the sand at the Old Mill District volleyball courts.

"Once you get yourself there, it feels good. You make a connection with the girls. It's one of those things I can't give up."

It's also a way for Struble to give back in return for all that she's received from high school sports. "Volleyball just really brought out of me a lot of my inner potential, that as a young kid, a really shy kid, I didn't know was there," she said. "I think it kind of gave me the confidence to be a leader in other aspects in life."

She believes team sports have helped her work and communicate well with others, and learn how to motivate a team and be a successful leader — all attributes that help her run her orthodontic business. It's also a release for her competitive nature. "My family, we played board games a lot, and nobody will play with me anymore," she said, laughing. "I either have to win or I'm in a bad mood the rest of the night." Trebor discovered that firsthand several years ago when they entered the Pole Pedal Paddle as a couple, competing head-to-head in the pairs division against Blair's father and his teammate, and Stru-

ble's sister and her husband. Trebor was the last racer of the three teams into his snowboard, and he struggled with the paddling event. "I'm not good on the bike, so I lost a lot of time on the hills. She was geared up to win the family thing. She said we lost because of my legs, not hers," Trebor recalled. "So I was actually in the doghouse for a while." The couple haven't raced in the PPP again, mainly because Struble was pregnant in two of past three years. At least, that's the excuse Trebor gives.

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SUMMER/FALL2013• HIGH DESERTPULSE

"We haven't had the chance to do it again, but I don't know if I

want to," he joked. "It's kind of recipe for marital strife." Blair Struble still plays volleyball in adult leagues but tries to fit in other activities when she can.

Another on the way Struble is now expecting a second daughter. She exercised regularly during her first pregnancy, but life was simpler then.

"I like to skate ski a lot, so as volleyball season is wrapping up, "I think moms can relate to this. When you're pregnant with your "We have those I find skate skiing is a really nice thing," she said. first, you have all the time you want to go on walks and do all these chariots, and I can get out there with my daughter, and it is a mon- things," she said. "Now when you have a little 2-year-old running ster workout." around — granted I think I underestimate how much exercise I get Struble said she's tried to find activities she can do with her daugh- chasing her — it feels like more of a rat race these days." ter, such as going for ajog with a stroller. She noticed during her first pregnancy how difficult daily tasks had "The last thing you want to do as a working mom is to come become, particularly leaning over patients to adjust their braces. "If your back muscles aren't where they need to be, you just feel home and put your child in day care again to go do something," she "I love to mountain bike, but that's a little harder to do with a said. that," she said. "That's one of the things I really try to do, keep my child." cardio and fitness up, and ... keep my muscle posture for myjob." Struble used to run more often, but she injured her hip running Pregnancy, she said, magnifies the strain on the body. "I was thinking when I was eight months pregnant, 'This is a half-marathon six years ago. That forced a shift to lower-impact sports. probably what I'm going to feel like when I'm 55, 60 if I don't keep "I've just found that I can't run the long distances that I used to my fitness level up,'" Struble said. "But I take care of myself in the love to do," she said. "The seven-mile run is now the three-mile walk, non-working hours so I can continue to do this for as long as I and I'll mix it up with some other things." possibly can." •

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Page23

Getready ~ cLIMBsoUTHslsTER

JOEKLINE

From left Shavvn Foster ofSalem, Carson Pemble, ofSilverton, Emily Read, ofSalem, Brittany Pemble, ofSilverton, and Megan Pemble, ofSilverton, explorethe summitofSouth Sister in August 2012.

South Sister is a relatively simple climb — if you prepare correctly BY ANNE AURAND

here's an inherent sense of achievement in reaching the summit of a mountain — even one like South Sister, a nontechni-

special experience, for sure, but not a place for solitude or personal escape. Summiting South Sister is almost a rite of passage for many local hikers. It may be your first peak in the bag, so to speak. It may be your only. Standing atop South Sister, you'll see the details of Broken Top, Mount Bachelor and Middle and North Sisters like you're looking through a magnifying glass. You'll see glaciers and teal-green, high alpine lakes. You'll see Cascade peaks and forests that stretch all the way through Oregon, even into Washington. It feels like the proverbial top of the world. The wind blows briskly up here, and civilization seems far away. But it's one heck of a long haul that includes about 5,000 feet of elevation gain, so it should be taken seriously.

cal hike that any reasonably fit hiker can climb in a day. The 10,358-foot glacier-pocked mountain is achievable for the masses. "It's Oregon's third highest mountain, and it's right here and you can just walk up," said Paco Eshevarria, a 39-year-old hiker and outdoorsman who works in sales at Pine Mountain Sports in Bend and has climbed it a few times. "It's accessible for everybody." "You need to be in a little bit of shape, or if not, know when to turn Some days, it feels like almost everybody is there, too. As many as 300 hikers may reach the top on a sunny Saturday in August. A around," said Eshevarria.

Page 24

SUMMER I FALL2013 • HIGH DESERTPULSE

If you go

)

Getting there: Drive about 29 miles west of Bend on Cascade Lakes Highway. The Green Lakes Trailhead is on the right and is well marked. Shortly after, the Devils Lake-South Sister Trailhead is on the left near the Devils Lake campground. Passes:Wilderness permits are required for day use. The free permits are self-issued at trailheads. Parking fees:55 per vehicle per day. Northwest Forest Passes are honored Info: Bend-Fort Rock Ranger District, Deschutes National Forest 541-383-4000.

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Planning the hike

Late summer and early fall — when the trail is clear of snow — is when most average, recreational backcountry hikers try it, said Aaron Lish, who teaches outdoors skills and safety classes at Central Oregon Community College. After Labor Day weekend, crowds tend

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to thin out.

The two standard routes — from the Devils Lake Trailhead or the Creen Lakes Trailhead — are pretty safe, he said. Both trails begin 0

with an ascent through the trees on solid, singletrack trails.

The Devils Lake trail is more arduous at the beginning, but it's also more direct — a little more than five miles one way. The Creen Lakes trail is longer — about eight miles one way — but it's more scenic and starts offa little more gradually. (See trail map, at right.) The two options converge near Moraine Lake, where the trees thin out and the trail becomes more exposed. This is also where the views widen. Then, the last mile of trail becomes steeper and the loose, deep scree — loose cinder debris — makes hiking less enjoyable. How long it takes to reach the top depends on various factors — mostly your conditioning. Eshevarria has jogged to the summit in two-plus hours. He's also taken as long as seven hours to get there with slower hiking partners. The average person, Lish said, should plan for an eight- to 10hour day. In any case, eat a sizeable, power-packed breakfast, full of protein and good fats, and start as early as possible. Many hit the trail at the crack of dawn.

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Get in shape "There are parts that are difficult, especially the last 1,000 feet, once you're past the Lewis glacier," Eshevarria said. GREG CROSS Up top, the trail gets steep and the scree gets deep, which can be frustrating when you're tired. It's a two-steps-up, one-step-back sort of slog. This is where you wish you had trained better. In addition to everyday aerobics, you can better prepare your "Many people say (climbing South Sister) is a training goal for a body if you ascend and descend in elevation during training — say, summer," said Dave Zimmerman, a personal trainer at Juniper Swim hiking up and down Pilot Butte. 8 Fitness Center who has hiked it several times. Add in some general strength training with an emphasis on If you're starting from zero fitness right now, this might not be the squats,lunges and balance and posture exercises,such as exercisyear you do it. If you're in reasonable shape already, you have a few ing on a balance board or a bosu ball. "It's such a long day on your feet," Zimmerman said. When you're weeks left to ramp it up. At the bare minimum, a person should be able to do something tired, posture crumples and hiking becomes less efficient, he said. aerobic and challenging for about half the time it takes to climb If you have a back problem or a medical condition, Zimmerman South Sister — at least three hours, Zimmerman said. said, talk to your doctor before you go.

HIGH DESERT PULSE • SUMMER/ FALL 2013

Page25

Get ready ICLIMB SOUTHSISTER

ROB KERR

A hiker walks on thesnow along the rim of5outh Sister'ssummit craterin August2005.

What to wear, bring Whether to wear low- or high-top hiking shoes really depends on how trail-savvy you are. Eshevarria wears trail running shoes, which are low-rise, lightweight, and have a stiff sole. However, higher on the mountain, the loose cinder will fill low-top shoes constantly. Gaiters can help keep the gravel and dust out. Generally speaking, the more experience a hiker has, the less shoe he orshe probably needs,Lish said,because thefeetand anklesare probably tougher and stronger. "A higher-top boot will decrease how much cinder you take in, but it's not going to completely eliminate it. And, a heavier boot is more weight to lift with every step," he said. "It's just what works best with

your feet and your fitness." Inany case,take extra socks and change them as needed. Sweaty socks coupled with cinder dust is a good recipe for blisters. Cotton clothing will get sweaty on the incline, and the tempera-

tures will be cooler up high. So wear and bring multiple layers of synthetic fabrics that wick moisture away from the body. Take a

calls for blue sky. Conditions can change quickly. Sunglasses and a cap will help protect your eyes if you're going to lounge or explore on the snow at the top. It wouldn't hurt to bring a map and compass or GPS. Adequate water may be the trickiest thing to carry. You need more than you think â&#x20AC;&#x201D; a few large bottles and/or a full hydration pack (a bladder of water usually worn in a backpack). Lish said hikers can't carry enough water and should therefore also bring a water filter or chemical purification (such as chlorine or iodine) option so they can treat water they retrieve from creeks and lakes that are scattered all along the hike. Eshevarria said electrolyte supplements in his water are helpful for sustaining his energy. Food isa very personal choice. Some can'tstomach much on that exhausting of a hike. Others nibble on Clif bars every half hour.

Leave Fido at home South Sister is better for booted humans than dogs, at least beyond Moraine Lake. The scree on the top of the mountain will shred the pads ofmost dogs'feet. Do the dog a favor and leave it at home.

lightweight, water-resistant, windproof jacket, even if the forecast

Page 26

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

Hikers should figure out their personal food preferences on training hikes. But generally, Lish said, many people benefit from higher calorie snacks such ascheese,sausage and nutsearly in the day.As the hike progresses, many shift to eating more carbohydrates and less fats, because it's harder to digest fat when there's less oxygen available in higher elevations.

The mental approach Lish said a person's mindset is the key. "Co in with (an) attitude of being self-reliant. You're going to get yourself back out. With that said, you'll be more inclined to make good decisions and not (be) reliant on a cellphone to get you out of trouble." Chris Sabo, trail specialist for the Deschutes National Forest, recalls once when a hiker jarred loose a refrigerator-sized boulder that rolled over him. It took a whole day to get him flown out. "It's not a quick fix up there if something goes wrong. It's not a simple 911 call," Sabo said. Ifyou get lost, delayed or injured, it could be morethan a day before emergency rescue crews can getyouout of there, he said. Minor problems are common: blisters, bloody scrapes and bruises from falls, exhaustion and even occasionallya little altitude sickness. Those are the easy problems. Things can get worse. Sabo recalls a father and two sons who got lost when a snowstorm blew in over Labor Day weekend a few years back. 6linded by the blizzard, they descendedthe wrong way. Sabo eventually found them huddled under a cliff. That, he said, illustrated poor judgment. These people were so intent on summiting that they didn't respect incoming weather conditions.

If the winds or the clouds change, or the temperature drops suddenly, it's a good indication of a storm. Storms at 10,000 feet can be intense, even in August. So if you feel a breeze blowing, check the sky. "If there are large, puffy, white clouds that are clumping together,

~~ Power

Proteeting the plaee It's not unthinkable that about 300 people will reach the summit of South Sister on some Saturdays in August, said Chris Sabo, trail specialist for the Deschutes National Forest. Qn a day over Labor Day weekend, it might be 500 people. South Sister's popularity has created some serious wear and tear on the mountain, said Sabo. Trails are getting deep, rutted and braided. Hikers should walk singlefile on the upper trails, Sabo said. And remember, group size is limited to 12 people. Dog and human waste left behind is starting to detract from the beauty of the wilderness, too. Feces can leave pathogens in the environment. Hikers need to be prepared to carry out their own toi et paper and waste (and that of their dogs.) This requires bringing supplies — variations of plastic bags. Outhouses are located at the trailhead.

getting darker, and growing vertically, it is time to go down," said Lish. "Many times folks are so focused on putting one foot ahead of the next that they don't look around, especially as they get more tired and the footing gets looser on the upper slopes." "In the mountains in the summertime, if there is a big, dark cloud,

you have to assume that it will produce lightning, so you want to get down as fast as possible," he said. Most often, thunderstorms happen in the mid- to late-afternoon, all the more reason to hit the

summit before noon. The worst kind of disaster is rare, but fatalities can happen on South Sister. Decades ago, Sabo recalls a father and son glissading (sliding on their feet) down a glacier and getting swallowed by a crevasse. All the obligatory warnings aside, once the safety basics are covered, Eshevarria said to remember it is a day hike. You'll leave after breakfast and be back in time for dinner. "Take your time," he said. "Take a lot of pictures."•

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Page 27

Gear( BIKEHELMETS z,,=,"-II'~

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Make the helmet snug against the head. To test fit, hold helmet still and turn head left and right; the head shou d not move around inside the helmet.

Choose a helmet size that fits snugly, or adjust fit using pads that come with the helmet, or the adjustment ring, usuallytightened with a knob at the backofthe helmet.

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chin strapsjust belowthe earlobes. The length of the chin straps on most helmets can be adjusted by pulling the straps through the helmet.

Buckle the chin strap snug y under the chin — you shouldn't be able to get more than two fingers under the strap. LL'11

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Page 28

l!2LL '

Specialized Small Fry toddler's helmet

Fun designs might make kids more interested in wearing. Cost:540

An ill-fitting helmet is little

Giro Rodeo youth helmet

better than no helmet at all

Mesh inside some kids' helmets can

BY JULIE JOHNSON •PHOTOS BY ROB KERR

prevent bugs from getting in. Cost:530

Chancesare,you know a cyclistwhose life has been saved by a helmet. After all, Central Oregon is full ofbicycles and bike riders, and whether it's riding to school, doing century rides on the weekends or hitting Phil's Trail after work, cycling is not without risk. The thing most likely to save your life in the event

of a serious crash is a helmet — but only if it's fitted correctly, says Mike McMackin, general manager for Hutch's Bicycles in Bend. Children may be more likely to have hand-me-down helmets or outgrow old ones, so McMackin walked us through fitting a child's helmet, although the guidelines apply to adults as well. If in doubt, visit a bike shop. They're happy to help fit a helmet, even if they didn't sell it.

•

~ (L-J~>KP'

Giro Feature Mountain bike helmets often extend lower down the back of the neck. Cost:575

Regulations While helmets are recommended for bicycle riders of all ages, Oregon law requires children younger than 16 to wear a helmet while riding or being carried on a bike. Parents or other adults with legal responsibility will be held responsible for noncompliance. The fine is generally $25. All helmets sold in the U.S. must meet minimum safety stan-

dards set by the U.S. Consumer Product Safety Commission. A sticker confirming CPSC approval should be on the inside of every helmet. Some helmets will also have a sticker that indicates safety certification from the Snell Foundation, a nonprofit helmet safety organization. •

Speciaized Prevail High-end road biking helmets have more ventilation for comfort. Cost:522999

At left, young cyclist Jack Tfsher demonstrates the correct fit for a bike helmet. HELMETSCOURTESYHUTCH'S BICYCLES

HIGH DESERT PULSE • SUMMER/FALL 2013

Page29

Feature ~OIETsooA

Page 30

SUMMER /FALL 2013• HIGH DESERTPULSE PI-IOTO ILLUSTRATION

Although artificially sweetened beverages might be free of calories, researchis showing that they might not be free of consequences How diet sodas affect appetite, hunger and metabolism is far from ince the obesity epidemic escalated and metabolic disorders clear, but researchers are asking the questions. Overall, there is insufsuch as Type 2 diabetes followed suit over the past two de- ficient evidence to conclude whether using non-caloric sweeteners cades, Americans have increasingly turned to artificial sweet- such as sucralose, acesulfame-K and aspartame truly helps people

BY ANNE AURAND • PHOTOS BY ROB KERR

eners in an attempt to lose weight and improve health.

manage weight, according to a 2012 joint statement from the Ameri-

Sugar-sweetened sodas had been cast as a potential culprit in can Heart Association and the American Diabetes Association. obesity. Weight-conscious Americans still want their sweet drinks,

but without the calories. So artificial sweeteners in sodas seem like a no-brainer. "In my mind it's healthier, it has fewer calories. I

Saccharin is the oldest ofthe artificial sweeteners, discovered accidentally in the 1870s by a researcher at Johns Hop-

grew up drinking diet soda, and always assumed Fppd and D<W it was better," said Jana Feingold, a 19-year-old MX IllIllstIBtlpQCentral Oregon Community College student. appZp>8d a~jfjcja] Such is the thinking of many Americans. "There's a strong sense that if there's zero calories, there's zero consequence," said epidemiologist Sharon Fowler, a researcher from the University of Texas Health Science Center at San Antonio. But it appears that may not be so. Fowler and

sa c charin(Sweet'NLow) as p artame (Equal, NutraSweet, ot h ers) ac e sulfame-K(SweetOne)

some others say promoting diet soda as a healthy sucralose(Splenda)

kins University working on coal-tar derivatives. He

disc overed carri he ed sweetnesson hisfingersafter he left work, according to a 2010 article in the

Yale Journal of Biology and Medicine. During World War II's sugar-rationing era, saccharin's use grew. In the 1950s and 1960s it was m ass marketed in foods,sodas and desserts.The Food and Drug Administration approved its safety, but when studies in the 1960s suggested it caused cancer in rats, concerns about its safety mounted. The FDA considered banning it, but cancer risks in

alternative may be not only self-defeating but neo t ame(Neotame) Asfortheplant-basedsweetener huma n s from saccharin were eventually brushed unwise. When the first artificial sweeteners — saccha- st e via,the FDA"has not objected a sid e . Cyclamate, a different sweetener, came into rine and cyclamate — came out, concerns about t o t h euseofthese highlyrefined use i n the 1930s but was eventually banned in the cancer intensified. Subsequent research has dis- Stevia preparations in food prodUnit e d States because of its carcinogenic potential. missed the concern that artificial sweeteners, u c ts,"whichincudesbeverages, Another accident, aspartame was discovered in in amounts typically consumed, cause cancer in a c cording to the FDA website. 1965 by a researcher trying to make ulcer drugs.

humans. Aspartame can be metabolized, which means it But these days, research is building a case that frequent diet soda does contain calories, but because it's about 200 times sweeter than consumption might be associated with metabolic syndrome — the sugar, very little is needed and its caloric content is negligible. name given to a group of risk factors including high blood pressure, M o r e artificial sweeteners followed. blood sugar, cholesterol and increased waist circumference — which A tl east 3,600 products in the U.S. now contain one or more of the raisesone'sriskforheartdisease,strokeandType2diabetes.(These five FDA-approved artificial sweeteners. They're most commonly are some of the same problems associated with sugary sodas.) foun d in carbonated drinks, according to the Yale Journal of Biology And all for what? Diet soda has not resolved the obesity problem. and Medicine article. In fact, some research says drinking diet soda is associated with Abo u t one-fifth ofthe U.S. population consumes diet drinks on a higher body weight. given day, according to the Centers for Disease Control and Preven-

HIGH DESERT PULSE • SUMMER/FALL 2013

Page31

Feature ~ DIET SODA

How many Amerieans drink diet soda, and how mueh do they drink? Percentage ofU.S.populationaged2yearsandoverwhoconsumed diet drinks on agiven day,2009-10 283 25 2 1 20Z 0

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ANDY ZEIGERT

tion. Diet soft drink consumption rose from about 5 gallons per year blood sugar, she said, but generally not in their weight. per capita in 1980 to about 11 gallons per year per capita in 2003, according to information from the U.S Department of Agriculture.

Artificial sweeteners or alternative plant-based sweeteners such as stevia have been determined to be safe, said Lynne Oldham, a registered dietitian and diabetes educator for St. Charles Health System. The FDA established "acceptable daily intake" limits for artificial sweeteners, which means the sweeteners are not toxic and don't cause cancer if consumed at or below this level. When translated into cans of soda, here's what the daily limits look like: about 18 cans of cola with aspartame, 30 cans of soda with acesulfame-K or six cans of cola with sucralose. It is not clear what exceeding the safe amounts would do to a person. But a statement from the American Dietetic Association says that studies have not documented any

adverse health effects related to human consumption of relatively large amounts. For diabetics who want to enjoy an occasional sweet drink, Oldham said, diet sodas are a fine option. But sodas — diet or regular — should be consumed only infrequently, and never as a replacement for water or milk, she said. Dr. Lisa Uri, a family practice doctor at High Lakes Health Care, generally recommends people avoid diet sodas even though research on the topic is inconclusive. u l don't think we can look just at the number of calories," she said. "What else is that doing to you?"

Associatedhealth risks

Some research suggests that drinking diet sodas frequently might increase one's risk of stroke, heart attack and Type 2 diabetes. A study published in the Journal of Internal Medicine in 2012 followed 2,564 adult Manhattan men of varied ethnicities for 10 years. Those who drank diet soda daily (compared with lesser amounts of diet soda or with regular soda) had the highest risk of vascular problems, even after researchers controlled for potential confounding factors, such as smoking or alcohol consumption. Both regular and diet soft drinks were linked with some cardiovascular disease risk factors, but the diet soda drinkers (who were more likely to be former smokers) had higher blood sugar, blood pressure and larger waistlines than the regular soda drinkers. Other studies have come to similar conclusions, such as a report from the Multi-Ethnic Study of Atherosclerosis, published in the journal Diabetes Care in 2009. It found that people who drank diet soda every day had a 36 percent greater risk of developing metabolic syndrome and a 67 percent greater risk of developing Type 2 diabetes than those who didn't drink diet sodas. These studies, observational in nature, don't prove that diet soda causes the health risks. Their results need to be interpreted with caution. Consider, as some reports suggest, that overweight people, or people with Type 2 diabetes or pre-diabetic conditions, are more

Human bodies are not meant to metabolize these processed prod- likely to drink diet soda in an attempt to improve their condition. ucts, she said. Authors of the study in Diabetes Care also offer the possibility Oldham said she has had patients, mainly those with diabetes, that diet soda might have an indirect effect on Type 2 diabetes by who switched from regular to diet soda. Some see improvements in leading to weight gain.

Page 32

SUMMER /FALL 2013• HIGH DESERTPULSE

That diet soda could lead to weight gain is a counter-intuitive but expenditure in humans is complex." conceivable possibility, according to a handful of disparate studies For example, in many cases, people who want to lose weight and reports. switch to diet soda, so perhaps those observed in a study were already on a weight-gaining trajectory. Fueling obesity? "Peoplewho drink dietsodas may be more obese than thosewho don't," said Julie Hood Gonsalves, a registered dietitian and associate The more diet soda people drank, the fatter they were, according to one eight-year observational study of 3,682 people from the San professor of health at Central Oregon Community College. MHmmm, Antonio Heart Study, published in the journal Obesity in 2008. which came first?" "On average, for each diet soft drink our participants drank per Research has fallen on both sides of this question. day, they were 65 percent more likely to become overweight during There have been short-term clinical trials that said adults who the next seven to eight years, and 41 percent more likely to become consumed calori c sugar-sweetened beverages weighed more than a obese," said lead researcher Fowler. control group given the diet options. The participants in study were either normal-weight or overweight

How diet soda may create weight gain

(not obese) at the beginning. Over seven to eight years, researchers found those who drank the most diet soft drinks had the most weight gain. And, a 2006 randomized controlled trial published in Pediatrics looked at what happened to 103 adolescents when they substituted diet beverages for sugar-sweetened ones. Only the heaviest participants who drank the most sugar-sweetened beverages before the study benefited from significant weight loss. Other studies have shown similar results, although some were

There are a number of theories to explain why diet soda might contribute to weight gain, although evidence is not conclusive. Most of the clinical studies have been done on rodents. Aspartame has been shown to kill brain cells in rodents in areas of the brain that regulate eating behavior, messing up the circuitry that would signal when to stop eating, according to Fowler, the researcher from the University of Texas Health Science Center at San

weak in statistical significance. As with most observational nutrition studies, it's virtually impos-

And studies on rodents have shown that consuming artificial sweeteners interferes with metabolic processes that can influence

sible to control all the factors that can confound data, and the results can at best suggest a correlation between diet soda and weight gain. M Our rates of obesity have increased and so have the number of artificial sweeteners, but one does not necessarily cause the other to happen," said Oldham, from St. Charles. "Food intake and energy

weight.

Antonio.

The oft-cited work of Susan Swithers, a professor of psychological science at Purdue University, shows that, in rats, calorie-free sweet-

enersconfuse the body'smetabolic responses to food. Here's the idea: Bodies get programmed over time to learn what happens when certain foods are eaten — a Pavlovian type of re-

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Americans have noshortage ofoptions whenitcomes toselecting a bubbly beverage, as seen at Erickson's Thriftwayin Bend.

sponse. "We don't think this is necessarily a conscious process," Swithers said. The body takes cues from taste and engages its physiological responses — digesting, burning calories — before nutrients are even M » absorbed. This thermogenic or heat-producing response has been shown in both humans and animals. Based on experience, the taste of sweet triggers the release of certain hormones and increases the body's energy expenditure, preparing to process calories from the food. This is the metabolic system. But consuming sweetness without calories confuses that process. "The body mobilizes these responses, but the calories are not

quency transmitters into the abdomens of the rats to measure core body temperatures before, during and after rats consumed the food. When rats were trained with saccharin, they had a weaker thermic response to their feeding than the rats who consumed caloric sugars. Swithers says her study, published in Physiology and Behavior in 2010, can be extrapolated to humans because some research shows rodents and humans share some similar physiological responses. In rats, the consequences of this confusion takes a couple of weeks. In humans: "We don't know how long it takes." How much there. The body learns that sweet taste is not predicting what will diet soda it takes to have this effect is unclear, too. She believes even happen: 'Sometimes I get a lot of calories and sometimes I get noth- the occasional diet soda could break the predictive response. ing.' So eventually those physiological responses will no longer be But a article in the American Journal of Clinical Nutrition in 2009 produced," Swithers theorized. What that means is, when the body noted that humans often combine high-energy foods with non-nudoes get calories from sweet foods or drinks, it doesn't burn them tritive sweetened drinks. Think: a burger and a diet soda. So associaoff as well. tive learning might be more complicated and subtle than any one In Swithers' studies, researchers fed rats plain and glucose-sweet- controlled experiment suggests. ened and saccharin-sweetened yogurt. They implanted radio-freThere are other related, potential explanations for why diet soda

Page 34

SUMMER I FALL2013 • HIGH DESERTPULSE

Feature ~ DIET SODA

might be implicated in weight gain. Some have to do with physiol- ed regions of the brain involved with taste and reward processing ogy, others with psychology. differently than consuming sucrose, a caloric sweetener. Whether "There is some thought that diet soda does not contribute to a a participant was a regular diet soda drinker also affected various sense of satiety and therefore does not signal us that we've con- brain responses. The study suggested that diet soda drinkers prosumed a food or beverage (with calories), which may lead to eating cess sweet tastes differently than regular soda drinkers. more," Oldham said. Findings suggest, according to authors: "... that there are alteraSome studies on humans have shown that aspartame, acesul- tions in reward processing of sweet taste in individuals who regufame-K and saccharin in beverages were associated with increased larly consume diet soda, and this is associated with the degree of hunger and motivation to eat more. This effect occurred with artifi- consumption. These findings may provide some insight into the link cial sweeteners more so than glucose or sucrose (caloric between diet soda consumption and obesity."

sugars).

Djeg Spda S

"There is also some thought that for people who ~~g~ binge eat, artificial sweeteners may trigger them to do so," Oldham said. Some experts suggest that diet sodas condition S R l e s j l l the taste buds to crave sweets, influencing other food g he Ulljged choices. Others say there's a psychological reaction to over-

Other research is beginning to show that the gastroin-

testinal tractand the pancreas have receptors like those in the mouth that can detect sweets and trigger the re-

lease of hormones such as insulin. Some animal studies found when gut receptors are activated by artificial sweeteners, the absorption ofglucose increases. (Insulin, which is secreted from the pancreas, regulates blood sugar levels by helping glucose move into cells,

compensate with calories after consuming something D i etsoda'sshareofthe su c h as muscle cells. Type 2 diabetes happens when the without. The thought is that people who drink diet soda b usiness has increased b o d y doesn't properly use insulin.) couldgainweightbyeating more high-caloriefoods lat- o verthepastdecade And, a study published this year in Diabetes Care er, since they saved some calories bydrinking diet soda, b u t hasnotsurpassed fo u n d that the artificial sweetener sucralose can modify 30percentofthemarket, how a body handles sugar in obese adults who don't Oldham said. Kaitlin Vernon, of Bend, a 22-year-old medical assis- i n 2000,24.7percent ty pi c allyconsume artificial sweeteners. "We wanted to study this population because these tant at Westside Medical Center and full-time student at I n 2007,29.9percent Central Oregon Community College, said for her, drink- i n 2012,28.3percent swe e teners frequently are recommended to them as a ing diet soda goes hand-in-hand with unhealthy food „„„„ ,.„„,„„,„„ „ , „,„, way to make their diets healthier by limiting calorie intake,"

sa i d the study's author, M. Yanina Pepino, a researcher for cravings, like greasy french fries. It's one reason she's '",",'",',"",„",""",'„'"" ~~«»o~~«~~~~~~g~~~~d~~«v slowly weaned herself off sodas altogether. Washington University's Center for Human Nutrition She started drinking regular, sugar-sweetened soda Researchers gave subjects either plain water or sucralose-sweetened water before a blood test that examines as a teen. Around age 20 she switched to diet sodas to eliminate the sugar and calories from her diet. She wanted to be how insulin and blood sugar levels respond to consuming glucose. healthier.

Every participant was tested with both water and sucralose-sweet-

About six months ago she weaned herself off the diet sodas, too. ened water before the glucose test. Although she didn't change the rest of her diet at that time, she said W h e n study participants drank sucralose, their blood sugar her body looks better — especially around the waist. peaked at a higher level than when they drank only water before the And, she said, "I don't have those cravings anymore." glucose test, Pepino said in a news release."Insulin levels also rose about 20 percent higher. So the artificial sweetener was related to an It's not inert enhancedblood insulin and glucose response." Although many questions remain about various relationships beE l evated levels of insulin could help to deal with spiking glucose tween diet soda and human health, one thing is starting to emerge: levels. But it could also be risky because if people routinely secrete Diet soda may not be physiologically inert after all. more insulin than they need they can become resistant to its effects, Recent studies have indicated that artificially sweetened beverag- which raises the risk of Type 2 diabetes. es tangibly affect neurotransmitters in the reward-processing parts

It's not clear if this response is harmful. It is clear that the artificial

of our brains, which play a role in eating behavior, and on our blood sweetener created a physiological response. sugar and hormonal responses, an integral part of the metabolic Alm ost every study, including Pepino's, called for more research process. on the implications of drinking diet soda. "What these all mean for daily life scenarios is still unknown," she In a small study published in the journal Physiology & Behavior in 2012, imaging results showed that consuming saccharin activat- said. "But our findings are stressing the need for more studies."•

HIGH DESERT PULSE • SUMMER/FALL 2013

Page35

Healthy eating ~ SNACKPO RTIONS

I e?

OeS Here are a handful of examples of 100-calorie' snacks and drinks -give or take a few calories

Source of caloric content; U S. Department of Agriculture nutrient database and/or nutrition fact labels from the products themselves.

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Page36

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SUMMER /FALL 2013• HIGH DESERTPULSE

BY ANN AURAND • PHOTO BY ROB KERR

f the many well-established tools to ing ofhow many calories are in their food. Nutrient-rich 100-calorie snacks that are full help maintain or lose weight, keepFor many people, approximately 100 cal- of protein (nuts), vitamins (fruit) and fiber ing track of how much you eat of- ories can curb hunger pangs between more (carrots) might manage your hunger lonten rises to the top. satisfying meals that might contain closer to ger than 100 calories of high-carbohydrate But few people have a solid understand- 300 calories (lunch) or 800 calories (dinner). snacks (crackers and cookies).

HOWmanytOtal CalOrieSyou should consume eachday to maintain your health depends on many factors, including age, sex, weight and activity level. An adult's daily goal might be anywhere from 1,500 to 2,500 calories a day. To find your target, try: www.choosemyplate.gov/myplate/index.aspx

•

HIGH DESERT PULSE • SUMMER/FALL 2013

•

Page37

Pt;

Cover story(HEALTH CAREBLUEPRINT

Continued from page13

ing to pay for health insurance. An entire cottage industry of workforce consultants and software products has sprung up to help companies manage their employee numbers and the resulting health care costs. "You can't provide benefits if it's going to putyou out ofbusiness,"O'Keefe said."There are a lot ofbusinesses where benefits haven't been a part of it, and I don't see anything in here that would encourage them to start doing it. There is a risk for low-margin businesses with a large number ofemployees. How do you all of a sudden throw on a $20,000 line item which you didn't have a month before?" Companies and their advisers are also waiting for many of the remaining rules to be finalized and perhaps even delayed. Many individuals won't see any change in their benefits, including some of the free preventive or wellness services mandated

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BY MARKIAN HAWRYLUK i

ix yeais ago',"Chip Aimes.:.

was employed, healthy'.',-..;.; and .. happy. Working for the Providence Hospital System '' in Anchorage, Alaska, he worked out regularly with' co-workers and ran 40 miles a week. In May 2007, while fishing for steelhead on the lower Deschutes, he suddenly became ex'

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by the ACA.

Companies that renew existing plans without any major changes will be considered grandfathered plans and won't have to adhere to all of the new regulations. The Congressional Budget Office esti-

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tremely ill. He had sharp pains in

hisabdomen and feltweak and ' feverish. He made it back to his friend's house in Bend and called -' 911. He was on the floor before completing the call. Aimes awoke frorn a corna'

mates that by 2019, the ACA will get another

32 million individuals insured. Factoring in exemptionsand those who choose to pay the penalty, that could still leave some 26 to 30 million people without insurance.

three months later in the intensive

care unit at St. Charles Bend and %-.--.::.:'was told a cyst on his pancreas Still, that would be the lowest rate of unhad burst, flooding his body with insured that the U.S. has seen in decades, a bacterial infection and causing down from 58 million today. Success will his organs to shut down. "It came on very quickly and likely depend largely on how well the administration can get the word out about the new spread very rapidly," he said. "They had called my family and rules. The ACA provides billions in grants to

. =

states and community organizations to con-

duct outreach and enrollment services. Cover Oregon began its media blitz in July and will continue its advertising and public relations campaign through the open enrollment period in hopes of reaching as many uninsured Oregonians as possible. "Some will hear those messages and go to the website," Fauver said. "Other people m ay hear those messages, but unless they

- said they didn't think I was going . -. to make it." i diag-: By November, he was'

MosaicMedicalpatientChipAimescoolshis leg s whilefishingintheDeschutesRiverin July.. .

nosed with non-Hodgkins lymphoma.: Doctors in California removed his gall bladder, his spleen and 80 percent of Ijs pancreas. "So I went from good health to being insulin dependent, weak, depleted," Aimies' -.,said. "The next thing I was seeing six or more >pecialists, one or more times a ' 'week. I couldn't afford it. I went through a huge amount of money and depleted my 'k - resources." I '" He turned to the Mosaic Medical clinic, which uses a medical home model, where have an organization that they know and ' -a team of providers from a variety of disciplines help to manage patient care. Aimes „ trust to get more information from, it's not going to be enough. They're not going to be primarily sees Billie Cartwright, a physician assistant at the clinic, who refers him:to'convinced there's something there for them, other specialists as needed. "They're keeping my costs down and keeping my health up in a, better way than N...' or that it's enough or that it's real." • -

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anyone ever has, Aimes said. l have a nurse calling me once a week, ' organizations, and giv'erI them a fixe'd amount per indIvidual to',jiay';;,'; : coordinating with home health care. I have Dr. Cartwright, who's judi= for all the rnedical, mental and dental care they need. TheCCOs;::4%,"',',' ciously watching me closely and shooting me to where I need to be." they are known,.will have broad discretion-sin how thsey".distrigjte '; ". The clinic has connected him with a therapist to treat his depres- that money.. ;

,sion, a-pain clinic to manage his pain, and dentist to fix the teeth To ensure that CCOs don't simply cut back on care, each orgarriza-,';," ' " s ravagr.,d by his cancer treatment. tion will be evaluated based on 17 measurernents of quahty, 'rangirI'g ':v "They'll monitor you and make sure you're not deteriorating medi- from patient'satisfaction to prenatal care, from emergency room vis-", ' '. " ' cally, bgt at the same time they will do everything they can them- ':its to follow-up after a hospitalization for a mental illness. Unless a':a ' selves," he said. , CCO meets the benchmark or shows a 10 percent improvement'for . %~' In late June, Aimes was again experiencing stomach pain. Instead ' at least 75 percent of those quality measures, the CCO won't,get its of going to the emergency room, however, he called'Mosaic and full allocat'ion of money; "We wan't to look down below that global budget and see that care spoke to the doctor on call. His care team had developed a plan for"using different rlNulin's to-,, is being tra'nsformed and changed," said Bruce Goldberg, director of . ' the Oregon Health Authority, the state agency that is overseeing the handle his flare-ups, n l got stabilized within eight hours," he said. "That could have cost : effort. '=, Over time, state officials hope that CCOs will be able to leam.:from me an overnight stay in the hospital." The next morning, the clinic called him in for an appointment. By 'one another how to best transform care. Those CCOs that,excel at the time he arrived, the providers had discussed his case.and settled - certain rnetrics will become examples for others in the state;::.'";:i:, w on changes to his care. Now Aimes is feeling well enough to start As we compared which metrics get moved by which CCOs and n volunteer work and return to fishing. , figure out why, Goldberg said. "That's goirig to give'is"a'lot of "I've been through this twice before," Aimes said. "The cost of information." '

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treating me went from $8,000 to I would estimate $800. But it was

The state has also c'reated a'transformation fund, oe"utsidq th'e

global budgets given to each CCO, to help CCOs start innovative ' projects. Fixing what's broken The system creates in essence 15 health 'reform laboratories, testAimes' experience underscores a major problem with the health ing various approaches to,improving care and seeing which ones care system today. Hospitals and doctors are paid for each proce- 'work. A single CCO having success on a single metric could impact. ' dure, so they are organized around treating patients once they get ' care in all the other CCOs and spill over into commercial and Medisick. The more patients they see, the more procedures they perform, care'patient care as well. .the more money they make. There is little financial incentive to keep In Central Oregon, for example, the CCO has embedded behav-, people from getting sick in the first place. ioral health providers within primary care clinics. "There's a lot of medical conditions that have a behavioral health . Oregon's health care transformation was launched well before the Affordable Care Act was passed but relies on the federal law. It is in- component or mental health issues that impact the medical condi' tended to change those inceritives, to switch from a system in which tion,n said Scott Stafford, a clinical psychologist with St. Charles Famproviders are rewarded'for doing procedures to one where provid- ily Care. ers are rewarded fog,keeping people healthy. Depression or other behavioral health issues often keep patients It's a multibillion-dollar bet that Gov. John Kitzhaber and Oregon "from managing their chronic conditions properly or adhering to the . . *": " ' legislators made with the federal government: Give the state the treatments that doctors prescribe for them. Behavioral health coun.money and flexibility to refashion its health care system, and Or- selors can often address the psycho-social issues that get in the way, @, '4;,' egon will slow the rite of growth in health care costs. Stafford said. "This isn't about decreases. This is about managing a fixed budget : In the past, physical and mental health were separate systems. So >',I.;: t hat grows at a sustainable rate," said Dan Stevens, senior vice presi- if doctors felt patients could benefit from behavioral health counseldent of government programs for PacificSource Health Plans. nln- ing, they would refer them to a mental health clinic. ~ .s t ead of growing at double-digits or twice the rate of inflation, what "If you look at the research data;Mollow-up,is pretty poor," Staf.:, .; if we only grew at the rate of inflation? It would be a huge change." ford said. "Less than 50 percent of the patients w'ill'fonllow up on the, The vision for health reform in Oregon is to transform care state- referral." wide by starting with the state's Medicaid program for low-income With behavioraI health embedded in a primary care clinic, the doc-; ' —:"„',adults and children. The program covers about 15 percent of the - tor can call the counselor into the examination room to speak with,. ''"~.g.' state's residents. In a deal with the federal government, Oregon will patients and help address their issues. ',receive $1.9 Pillion over five years to transform the program, pledg"They won't have to go anywhere else," Stafford said."It helps to.' ,ing to s1ow the rate of growth by 2 percentage points from S.4 per- reduce the stigma." > ~>"'-":-'cent to 3:4.percent over the neXt two years. Meanwhile, individuals with serious rnental health issues ofteri "..'. ~;","„:~: ". The state has created 15 regiorial groups, called coordinated care .Continwed ~yage40 • as '

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Covery story IHEALTHCAREBLUEPRINT

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Thesystem createsin essence75health reform laboratories, testing variousapproaches toimproving careandseeing which ones work.

don't get the medical care they need. Studies show such adults are less likely to have their blood pressure, asthma, diabetes and heart disease under control. As a result, they die on average 25 years earlier than those for the past 20 years. Advantage receives a without mental illness. per-person payment from the state to proIn 2012, Pacific Source Community Solu- vide oral health care for Oregon Health Plan tions, the CCO in Central Oregon, began of- and Healthy Kids enrollees. "We realized a long time ago we were gofering physical and mental health care in a single location through Deschutes County ing to go broke as a company if we were Health Services and Mosaic Medical. Prior only worried about fixing teeth, because to the change, on average one individual there were too many teeth to fix," Shirtcliff with conditions like schizophrenia and bipo- said. "We really had to look at populationlar disorder died each month in Deschutes based health care, where do we effectively County. Over the first 14 months of the pro- put our money." gram, there has been only one death. Advantage Dental opted to hire rather than For the transformation to succeed, CCOs contract with many of its dentists and to fowill have to think of new and innovative cus more on the less expensive preventive ways to allocate their dollars, rather than dental care that would keep their patients' simply relying on the traditional means of teeth healthy and avoid the more expensive cutting health costs by squeezing payment dental work, such as fillings or root canals, rates to providers or cutting services. And down the road. Cavities are essentially an inthey'll need to find ways to encourage health fectious disease, he said, that is passed down providers to think not primarily about the from mother to child through oral bacteria. "The good hope of the CCOs is we can revenues and costs associated with every patient encounter, but about how to keep separate out the infectious disease, treat it the patients in the community healthy. as a public health issue, and effectively fund "We need to be looking at all of our busi- it, so we end up with kids with better outness modelsin health care and how do we comes," he said. morph our businessmodels to focus on Shirtcliff believes the CCO design encourpopulation health and patients' outcomes," ages the various players in health care to sit Pacific Source's Stevens said. "Despite the down at the table and work out solutions fact that in Oregon, health care is really that improve population health, just as Addominated by not-for-profits, they're not- vantage Dental had to do with its global for-profi tswho have arevenue and expense budget. "It' s much more complex because you business model, not a population health business model." have way more parties involved that have to change," he said. "We have to have that A model system discussion. Where do we spend our dollars?" As CEO of Advantage Dental, Mike ShirtThe CCO ineach region has already encliff has had to make those kinds of decisions rolled all of the current Medicaid patients,

and will see a major influx of new Medicaid patients as eligibility widens in 2014. But the

effort may have a significant impact on other Oregonians as well. If CCOs can improve patient health while slowing the rate of growth

in health costs, they could become the model or even the vehicle for transforming care for the rest of the state.

Oregon officials are already contemplating shifting public employees, including teachers, into CCOs. The Public Employees Benefit Board has estimated that if CCOs

could cut the rate of growth in health spending for their members by the same 2 perc entage points they've committed to i n

Medicaid, PEBB would save $2.5 billion over 10 years. Eventually even private companies might look to contract with the CCOs in their

region to provide care for their employees at a more manageable cost. "Other payers are going to be looking at that model and having that be the way coverageissetup,"said Meghan Haase,CEO of Mosaic Medical and a board member for the Central Oregon CCO. Haasesaid many ofthe changes thathospitals and clinics are implementing under CCOs will apply to patients with private in-

surance as well. And more broadly, tax dollars that are not spent for Medicaid can be spent on other needs in the state, such as roads and schools. "The more we can really influence wiser spending in health care," she said, "it leaves more resources for education and other community investments that health care is

kindof pushing aside."•

How are we paying for this? Funding for the Affordable CareAct comes from a variety ofsources including: •Taxes on so-calledCadillac plansvalued at more than $10,200 for individual p ans,$27500for a family. •A Medicare tax increaseforthose earning more than $200,000 for an individua, 5250,000 for a married couple.

Page 40

•Limits onflexible spending account contributionsto $2500 and the elimination of reimbursements for over-the-counter drugs without a prescription.

• Newtaxes on medical devices,drug manufacturers, insurance plans and tanning sa ons. •Acut in paymentsto Medicare-managedcare plans.

SUMMER/FALL 2013• HIGH DESERTPULSE

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/ of helped me through it to see itwiit get het-",: traditional ap'proach of payinrg hospi'tats'and i ' '::

ter, that each day is going-to be different." doc t ors for treating patients once tfte j;get':."'-:,", " In the four one-hour classes, Stinchcomb sick, to a more coordinated tapproXch;wljeJe ,'" . "learned relaxation techniques, breathing ex- - multiple medical and'non-medical pser5teriel -:-ercises and stretches that can help calm his .work together to help keep patients,healthj," ' " . .'rand away from expensive treatm'ent:,'::::>;....'.-" "., body when his pain flares. "When I'm going through,a breakthrough,; -. Toaccomplish that, however, local provid-", ' pain, where I get chronic pain ail of a sudden, ers will have to set aside their longstanding':". 9 - " I'll try that and it does seem to help," he said. competitive differences and work together . "Instead ofjust grabbing for the Vicodin, I try "' to focus on improving not their bottor.m'line to calm myself, breathing and stretching." . .: but the region's health. ,- yy g' , ,: His doctor cut his monthly prescription:, . The work to integrate behaviotyl health frorh 180 piIIs a-month to 90. But unable to into primary care practices was,oa project '. work, Stinchcomb couldn,'t quite figure out launched by. the Central Oregon-:; Health what to do with himself. He told psycholo- Collaborative long before federal and state gist Scott Stafford he had thousands of dol- . health reform was passed. Bolstered, by ear. lars worth of construction tools,just going ly success and a new cooperative approach to waste because he could no longer lift the that began sweeping Central:Oregan:, the ' collaborative soon expanded:::.!Its'"'scope, heavy wood needed to buiid furniture. h Stafford had a suggestion. Had he ever launching ne'w pilotp'rojects-around"patientthought of building dollhouse furniture? cen t ered medical homes, community health r

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BYMARKIANHAIIIIRYLUK

. StinChCOmb might nOt haVe taken it Seri- 'WOrkerS reduCing emergenCy rOOm 'qSe, .

$ 's the light turned green, Ryan Stinch- ously if his wife hadn't encouraged it on the - By the time state officials were ready to k~"comb hesitated a moment to make ride home. She had gone to doll shows as hand over controls of the Medicaid program sure no car had run the red light. Be- a child and remembered the elaborate dis- to regional CCOs, the Central Oregon group ore he could start his motorcycle into the p l a ys. At home, they looked online. Master rwas primed to lead the local effort. intersection, however, a young woman tex- craftsmen were selling dollhouses for as ' Renamed the Central Oreclon Health ':, Council, the group sought special permisting while driving hit him from behind. much as $45,000. n n In an instant, Stinchcomb went from an l haven't started that y0t, Stinchcomb sion from the Legislature to partner with an ';,'-: ", .active lifestyle, working physically demand- said. nBut I'm thinking that is something I'm. insurance company, PacificSource Health,::. ' ing jobs and building furniture in his spare, going to pursue." , Plans, to create a shared leadership struc' time, to a life ofdisabilityand chronic pain. So far, more tha'n 127 patients have gone t u re. In most other,parts of the state, the n l'm 41 years old now. I'll be living with -through pain school, an offshoot of an ini- CCO was either an insurance plan with a ' this forever," he said."It's.-hard to swallow." ' tiative bythe Central Oregon Health Council ', network of providers, a health system with Two years after his aCcident, the 41-year- to integrate medical and behavioral health. 'its own hospitals, or a group representing oldLaPinemanstill.gassignificantbackand By focusing on the psycho-social issu'ds s independentphysicians. p; hip pain. Having moved from California, the that can accompany and often exacerbate T h e council is made up of 13 members . *": "' site of his accident,'to Central Oregon, he -a patient's physical health, the approach is representing the major providers in the re, sought care at St. Charles Family Care clinic showing great promise in keeping patients gion, the three counties and the community. @,'4;,' in Bend. In addition 'to helping him with his from spiraling into costly medical crises. It s e r ves as the decision-making board for e "It seems like there are more people on the CCO, while PacificSource manages the physical problems, his doctor suggested he n attend pain school, a coping class taught by . your team," Stinchcomb said.: finances. n '. .. aclinical psychologist. No one interest holds a majority," said . LLocalI approach pp lh At first, Stinchcomb was skeptical. ,, „~ Robirr Henderson, the outgoing executive di-,: ,ul didn't need a psychologist," he recalls ' r pain school and embed- r ectoro'fthe council."Thatm6kes itdifferent, I n i tiatives like n n l'm in pain, I'm not mental."; ' :. ding' psychologists within primary practice 'than anyone else. We have to work together „'..' thinking. But in the very first class, he could see are the types of small steps health leaders 'to make our CCOdollars work."; -..himself In the scenarlos the psychologlst In Central Oregon are hoplng wlll sta i to . B It eration n "<.g, wasdescribing. . change the dynamics of providing care in '~"Just a loIg, of' the mental process,. days: the region. The state has granted great flexLike all CCOs, the council is charged wifh' :+',where you wake up and you don'tfeellike -' ibility to regional health groups, called co- allocating a single pool ofmoneyto provide js: -'. + «~P"'-".-'moving.,'You think, 'This is it man, this is ordinated care organizations, to reorganize all the necessary care for Medicaid residents "..'. ~;","„::-,.-'::how my. Iife is going to be,'n he said. nlt kind care on a local level, to shift dollars from the . .CoIItinuedqIIyage42 . ' :

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Coverystory IHEALTH CAREBLUEPRINT

low-up often results in the patient being rein Central Oregon, but they will be evaluated tion from the health plan. The staff had to admitted to the hospital, poorer outcomes based on their ability to improve the health spend considerable time and resources to and higher costs. The initiative sets up a proof the patients they serve. get approval to enroll patients and get reim- cess of notifying the patient's primary care The design creates a unique balance in bursed for the cost. When the psychologists provider — or assigning one if the patient the CCO structure. Even St. Charles Health brought the issue to the council, Stevens im- has no regular doctor — and calling the paSystem, which now receives 50 percent of mediately pledged to eliminate the need for tient within 24 hours of discharge. the money spent by Medicaid in Central Or- prior authorization. A third initiative will target patients with egon, has only a single vote on the governThe council will now have to move toward complex health care needs. Although they ing board. So does Bend Memorial Clinic, the resolving thornier issues. When the CCO was represent only 10 percent of Central Oreregion's largest multispecialty provider, and formed in 2012, PacificSource had separate gon's Medicaid population, they account for the Independent Practice Association, which contracts with each of the major providers 75 percent of the total health care spending. represents the region's doctors. Those play- that worked with Medicaid patients. Now The initiative will establish ways of identifyers carry no more votes than each of the two those contracts will have to be renegotiated ing such patients and then referring them community representatives on the board. as the CCO reallocates the Medicaid funds to HealthBridge, a high-intensity complex The balance ensures that providers, who available for the region. It will be up to the care center. The patients will be seen by a have typically been adversarial competitors CCO board to determine how much hospi- team including physicians, nurse practitioin the region, must work together. And be- tals, doctors, clinics and other providers ners, community health workers, behavioral cause funding from the state is dependenton — many of whom serve on the board — will health specialists and physical therapists, improvement on quality measures, any pro- get paid. who will work to help patients manage their Continued frompage41

that required patients to get prior authoriza-

viders that try to maximize their own revenue

"That is the elephant in the room that will

are likely to undercut those quality gains and jeopardize the full funding from the state. "I feel I have two bosses: My boss in my company, and I'm heavily accountable to this health council," said Dan Stevens, senior vice president of government for PacficSource Health Plans."If we didn't perform

test our resolve," said Jim Diegel, CEO of St. Charles Health System."The vision is much different in five years. We better not be spending 50 percent of our Medicaid (dollars) on hospital care, because we'll make no progress. From a transformational stand-

in this, the council may want to find a new

the present as, we are doomed to failure." tients who visit the emergency room more Although the hospital probably has more than 10 times per year. They hired a comto lose with the distribution of funds than munity health worker to help those individuany of the other players, its future is also als connect with primary care practices in subject to the decisions of the council. the region so they could better manage their "They've done a pretty good job of tap health conditions and avoid using expensive dancing around the politics and solving emergency room care. problems," said Mike Shirtcliff, CEO of AdThe first 144 patients involved in the inivantage Dental and a council member. tiative had an average of 14 trips to the ER "When you get all the big providers around per year. Within six months, however, that the table, everybody has a vested interest." rate had been cut in half. The group had 541 Even with a limited pot of money, the pro- fewer ER visits, reducing costs by more than viders on the council have agreed to fund $3,100 per patient. Now other CCOs in the several initiatives that might take money state are implementing that same approach. away from payment rates, but that will imHendersonsaiditwould have been easprove the health of the region's residents. ier for the CCO to have a single entity that One effort focuses on maternal health, hir- makes all the decisions, but the shared ing two nurses and two community health structure it adopted ensures both collaboraworkers who can help expectant mothers tion and transparency. "We wanted something that was accountconnect with primary care services, including prenatal visits, oral health, behavioral able to the community," she said."We have health and other care services. to rely upon each other to make this work, Another focuses on ensuring patients get and that's the strength. It's much easier if follow-up care after being discharged from there's one entity running it. It's not better, the hospital. Studies show that a lack of fol- but it's easier." •

CCO partner." Stevens said in some ways, the health plan has ceded control over its operations to the council, but it's a level of partnership many insurance plans never enjoy. Plans can try to encourage hospitals, doctors and patients with financial incentives but in the end have little control over what those parties will do. With the CCO structure, the providers and the community become committed partners,

helping them find and implement solutions. "We're sitting around the same round ta-

ble having really productive conversations about quality and outcomes," he said. "It's not easy, but I would prefer that any day to making decisions behind closed doors." A recent meeting of the council showed how well the collaboration works. After a presentation about the effectiveness of pain school, its directors sought the council's help in eliminating a vexing hurdle. As a group visit, pain school costs less per session than a one-on-one consultation with a psychologist, but had to be billed in a way

Page42

point, if the future is still what hospitals see

health. If the initiative can meet its goal of cutting

spending on these patients by an average of 10 percent, it would save the region $4 million a year. Those efforts will build on the successthecouncilhashad,even before the CCO was formed. In 2011 the council identified Medicaid pa-

SUMMER/FALL2013• HIGH DESERTPULSE

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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...

A c c o u n t E x e c u t i v e (Health 8c Medical) • 5 4 1 . 6 1 7 . 7 8 5 5

K ylie V i g e l a n d , •

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ADULT FOSTER CARE

Absolute Serenity Adult Foster Care

119 N RopeStreet • Sisters

541-588-G119

AESTHETIC SERVICES

DermaSpa atBend Dermatology

2705 NE Conners Drive• Bend

541-330-9139

ALLERGY &ASTHMA

Bend Memorial Clinic

locations in Bend tkRedmond

541-382-4900

ww w .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

w ww.centraloregonaudiology.com

ALZHEIMERS SDEMENTIA CARE Clare Bridge Brookdale Senior Living

www . absoluteserenity.info www.bendderm.com

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 SS Redmond

541-70G-5800

www. s tcharleshealthcare.org

CARDIOLOGY

Bend Memorial Clinic

locations in Bend 8rRedmond

541-382-4900

ww w .bendmemorialclinic.com

CARDIOLOGY

St. Charles Heart gt Lung Spedalists

2500 NE Neff Road• Bend

541-388-4333

www. s tcharleshealthcare.org

CARDIOTHORACIC SURGERY S t . Charles Heart gt Lung Spedalists

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

DERMATOLOGY (MOHS)

Bend Memorial Clinic

2600 NE Neff Road• Bend

541-382-4900

ww w .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

630 ArrowleafTrail• 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

ww w .gastrocentraloregon.com

GENERAL DENTISTRY

Coombe and Jones Dentistry

774 SWRimrock Way• Redmond

541-923-7633

www.c o ombe-jones.com

2084 NE Professional Court• Bend

541-322-5753

www . advancedspecialtycare.com

1245 NW 4th Street, Ste 101 • Redmond

541-548-7761

www. s tcharleshealthcare.org

GENE RALSURGERY,BARIAYRICSAVEINCARE Advanced Specialty Care GENERALSURGERYS BARIATRICS St. Charles Surgical Specialists

www.ccliving.com

www.bendderm.com

n/a

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.r edmondhospice.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. s tcharleshealthcare.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. s tcharleshealthcare.org

HOSPITAL

St. Charles Redmond

1253 NE Canal Blvd• Redmond

541-70G-779G

ww w .stcharleshealthcare.org

1501 NE Medical Center Drive• Bend

541-382-4900

www. bendmemorialclinic.com

locations in Bend 8rRedmond

541-382-4900

ww w .bendmemorialclinic.com

HYBERBARIC OXYGENTHERAPY Bend Memorial Clinic

IMAGING SERVICES

Bend Memorial Clinic

INEECEIODSDISEASE

S AN

iN OI '

1501 NEMedical Center Drive • Bend

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

2 013 CE N T RA L O R E G O N •

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

DVERTISINGSUPPLEMENT

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

541-549-0303

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

2013 CENTRAL OREGON MEDICAL DIRECTORY a

•

DVERTISINGSUPPLEMENT

UROLOGY

Urology Specialists of Oregon

VASCULAR SURGERY

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend 5 4 1 - 3 82-4900

www.bendmemorialclinic.com

VEIN SPECIALISTS

Inovia Vein Specialty Center

2200 NE Neff Road, Ste 204• Bend 5 4 1 - 382-8346

www.bendvein.com

VKIN SPKCIALISTS

Bend Memorial Clinic

1501 NEMedical Center Drive • Bend 54 1 - 382-4900

www.bendmemorialclinic.com

•

locations in Bend gr Redmond

541- 3 2 2-5753 h t t p: //usof or.praxismedicalgroup.com

o •

ADAM WILLIAMS, MD

Bend Memorial Clinic

STEPHEN ARCHER, MF, FACS

Ad vanced Specialty Care

NGOCTHUY HUGHES, DO, PC St. Charles Surgical Specialists

Bend Eastside gr 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

f245NW4thStreet,Stei0i • Redmond 54 1 -548-7761 w

ww. s tcharleshealthcare.org

KAREN CAMPBELL, PhD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

BRIAN T. EVANS, PsyD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

EUGENE KRANZ, PhD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

SONDRA MARSHALL, PhD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org www.stcharleshealthcare.org

MIKALA SACCOMAN, PhD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

REBECCA SCRAFFORD, PsyD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

SCOTT SAFFORD, PHD

St. Charles Family Care

2965 NE 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

HUGH ADAIR III, DO

St. Charles Heart th Lung Specialists

2500 NE Neff Road• Bend

541-388-4333

www.stcharleshealthcare.org

CATHERINE BLACK, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

JEAN BROWN, PA-C

Bend Memorial Clinic

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

NAHEL PARRAJ, DO

Bend Memorial Clinic

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

RICK KOCH, MD

Bend Memorial Clinic

Bend Eastside fh Redmond

541-382-4900

www.bendmemorialclinic.com

JAMES LAUGHLIN, MD

St. Charles Heartth Lung Spedalists

2500 NE Neff Road• Bend

541-388-4333

www.stcharleshealthcare.org

BRUCE MCLELLAN, MD

St. Charles Heart th Lung Spedalists

2500 NE Neff Road• Bend

541-388-4333

www.stcharleshealthcare.org

GAVIN L.NOBLK, MD

Bend Memorial Clinic

Bend Eastside fh Redmond

541-382-4900

STEPHANIE SCOTT, PA-C

Bend Memorial Clinic

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

JASON WKST, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

MICHAKL WIDMKR, MD

St. Charles Heart gt Lung Spedalists

2500 NE Neff Road• Bend

541-388-4333

JASON R. WOLLMUTH, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

KDDY YOUNG, MD

St. Charles Heart gt Lung Spedalists

2500 NE Neff Road• Bend

541-388-4333

www.stcharleshealthcare.org

JOHN D. BLIZZARD, MD

St. Charles Heartgt Lung Specialists

2500 NE Neff Road• Bend

541-388-1636

www.stcharleshealthcare.org

ANGKLO A.VLKSSIS, MD

St. Charles Heartgt Lung Specialists

2500 NE Neff Road• Bend

541-388-1636

www.stcharleshealthcare.org

JORDAN T. DOI, MSC, DC

NorthWest Crossing Chiropracticth Health

62 8 NW York Dr, Ste. 104 • Bend 5 4

1- 3 8 8-2429

www.nwxhealth.com

THERESAM. RUBADUE, DC, CCSP NorthWest Crossing Chiropracticth Health

628 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 1 8-1000

www.bendwellnessdoctor.com

MICHAEL R. HALL, DDS

Central Oregon Dental Center

1563 NW Newport Ave• Bend

541-389-0300

BRADLEY E. JOHNSON, DMD

Co n temporary Family Dentistry

1016 NW Newport Ave• Bend

541-389-1107 www.contemporaryfamilydentistry.com

www.bendmemorialclinic.com ww. bendmemorialclinic.com

ww w .bendmemorialclinic.com ww . bendmemorialclinic.com ww w .bendmemorialclinic.com

www.stcharleshealthcare.org ww w .bendmemorialclinic.com

ww w.centraloregondentalcenter.net

2 013 CE N T RA L O R E G O N •

M E D I CA L D I RECTORY

DVERTISINGSUPPLEMENT

•

ALYSSA ABBEY, PA-C

Bend Memorial Clinic

2600 NE Neff Road• Bend

541-382-4900

www.bendmemorialclinic.com

ANGELA COVINGTON, MD

Bend Memorial Clinic

Bend gt Redmond

541-382-4900

ww w .bendmemorialclinic.com

MARK HALL, MD

CentralOregon Dermatology

388 SW Bluff Dr• Bend

541-678-0020

w ww.centraloregondermatology.com

3AMES M. HOESLY, MD

Bend Memorial Clinic

2600 NE Neff Road• Bend

541-382-4900

www .bendmemorialclinic.com

GERALD E. PETERS, MD, DS (Mohs) Bend Memorial Clinic

2600 NE Neff Road• Bend

541-382-4900

ww w .bendmemorialclinic.com

ANN M. REITAN, PA-C (Mohs) S e n d Memorial Clinic

2600 NE Neff Road• Bend

541-382-4900

www.bendmemorialclinic.com

s s

MARY P. CARROLL, MD

Bend Memorial Clinic

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

ww . bendmemorialclinic.com

RICK N. GOLDSTEIN, MD

Send Memorial Clinic

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

ww. bendmemorialclinic.com

TONYA KOOPMAN, MSN,PNP-BC Bend Memorial Clinic

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

www.bendmemorialclinic.com

PATRICK MCCARTHY, MD

Kndocrinology Services NW

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

n/a

TRAVIS MONCHAMP, MD

Kndocrinology Services NW

929 SW Simpson Ave, Ste 220• Bend 541 -317-5GOO

n/a

CAREY ALLEN, MD

St. Charles Family Care

1103 NE Elm Street• Prineville

541-447-G2G3

www.stcharleshealthcare.org

HEIDI ALLEN, MD

St. Charles Family Care

1103 NE Elm Street• Prineville

541-447-G2G3

www.stcharleshealthcare.org

211 NW Larch Avenue• Redmond

541-548-2164

www.stcharleshealthcare.org

1501 NE Medical Center Drive• Bend

541-382-4900

ww w .bendmemorialclinic.com

865 SW Veterans Way• Redmond

541-382-4900

www.bendmemorialclinic.com

630 Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealthcare.org

929 SW Simpson Avenue• Bend

541-389-7741

ww w .highlakeshealthcare.com

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

www .bendmemorialclinic.com

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

THOMAS L. ALLUMBAUGH, MD St. Charles Family Care

KATHLEEN C. ANTOLAK, MD

B e n d Memorial Clinic

SADIE ARRINGTON, MD

Send Memorial Clinic

30SEPH BACHTOLD, DO

St. Charles Family Care

EDWARD BIGLER, MD

High Lakes Health Care Upper Mill

3EPPREY P.BOGGESS, MD

Send 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 Conners Ave,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

AUDRKY DAVEY, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

3AMKS K. DETWILER, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

MAY S. PAN, MD

Bend Memorial Clinic

231 East Cascades Avenue• Sisters

541-549-0303

ww w .bendmemorialclinic.com

3AMIE PREKMAN, PA-C

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w .highlakeshealthcare.com

MARK GONSKY, DO

St. Charles Family Care

2965 NE 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

Bend 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

PETER LEAVITT, MD

St. Charles Family Care

2965 NE ConnersAve, Suite 127 • Bend

541-70G-4800

www.stcharleshealthcare.org

CHARLOTTE LIN, MD

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

KAE LOVERINK, MD

High LakesHealth Care Redmond

1001 NW Canal Blvd• Redmond

541-504-7635

ww w .highlakeshealthcare.com

STKVE MANN, DO

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

www.highlakes healthcare.com

30E T.MC COOK, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www.stcharleshealthcare.org

ww w .bendmemorialclinic.com www.stcharleshealthcare.org

ww w .bendmemorialclinic.com

2013 CENTRAL OREGON MEDICAL DIRECTORY LORI MCMILLIAN, FNP

Redmond Medical Clinic

EDEN MILLER, DO

DVERTISINGSUPPLEMENT

1245 NW4th Street, Ste 201• Redmond

54 1 -323-4545

High Lakes Health Care Sisters

354 W Adams Avenue• Sisters

541-549-9G09

ww w .highlakeshealthcare.com

KEVIN MILLER, DO

High Lakes Health Care Sisters

354 W Adams Avenue• Sisters

541-549-9G09

www.highlakesheal thcare.com

JESSICA MORGAN, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w .highlakeshealthcare.com

DANIEL J. MURPHY, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www.stcharleshealthcare.org

SHERYL L. NORRIS, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www.stcharleshealthcare.org

1501 NE Medical Center Drive• Bend

541-382-4900

www.bendmemorialclinic.com

929 SW Simpson Avenue• Bend

541-389-7741

ww w .highlakeshealthcare.com

n/a

JANEY PURVIS, MD

Send Memorial Clinic

KEVIN REUTER, MD

High Lakes Health Care Upper Mill

DANA M. RHODE, DO

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

ww w .bendmemorialclinic.com

HANS G. RUSSELL, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

ww w .bendmemorialclinic.com

ERIC J. SCHNEIDER, MD

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www.bendmemorialclinic.com

CINDY SHUMAN, PA-C

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

ww w .bendmemorialclinic.com

EDWARD M. TARBET, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

ww w .bendmemorialclinic.com

JOHN D. TELLER, MD

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

ww w .bendmemorialclinic.com

NATHAN R. THOMPSON, MD

S t . Charles Family Care

MATTIE E. TOWLE, MD

Bend Memorial Clinic

LISA URI, MD

211 NW Larch Avenue• Redmond 5 4

1- 5 4 8-2164

www.stcharleshealthcare.org

1501 NE Medical Center Drive• Bend

541-382-4900

ww w .bendmemorialclinic.com

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

www.highlakes healthcare.com

MARK A. VALENTI, MD

St. Charles Family Care

211 NW Larch Avenue• Redmond

541-548-2164

www.stcharleshealthcare.org

THOMAS A. WARLICK, MD

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www.bendmemorialclinic.com

BILL WIGNALL, MD

High Lakes Health Care Upper Mill

1247 NE Medical Center Drive• Bend

541-318-4249

ww w .highlakeshealthcare.com

BRUCE N. WILLIAMS, MD

St. Charles Family Care

1103 NE Elm Street• Prineville

541-447-G2G3

DAVID KELLY, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend 5 4

www.stcharleshealthcare.org

1- 3 8 9-7741 w ww . highlakeshealthcare.com

's s

RICHARD H. BOCHNER, MD

Bend Memorial Clinic

ELLEN BORLAND, MS, RN, CFNP

Send Memorial C ni lic

ARTHUR S. CANTOR, MD

Send Memorial Clinic

Bend Eastside tk Redmond

HEIDI CRUISE, PA-C, MS

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

Bend Eastside St Redmond

541-382-4900

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

ww w .bendmemorialclinic.com www.bendmemorialclinic.com

541-382-4900

ww w .bendmemorialclinic.com

541-382-4900

www.bendmemorialclinic.com

1501 NE Medical Center Drive• Bend

541-382-4900

ww w .bendmemorialclinic.com

CHRISTINA HATARA, MD

Bend Memorial Clinic

SIDNEY E. HENDERSON III, MD

Se nd Memorial Clinic

Bend Eastside St Redmond

541-382-4900

ww w .bendmemorialclinic.com

SANDRA K. HOLLOWAY,MD

Send Memorial Clinic

Bend Eastside tk Redmond

541-382-4900

ww w .bendmemorialclinic.com

GLENN KOTEEN, MD

Gastroenterology of Central Oregon

2450 Mary Rose Place, Ste 210• Bend

541-728-0535

www.gastrocentraloregon.com

MATTHEW WEED, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

ww w .bendmemorialclinic.com

CHRISTY ENGLAND, PA-C

Advanced Spedalty Care

2084 NE Professional Court• Bend

541-322-5753

www .advancedspecialtycare.com

NICOLE O'NEIL, PA-C

Advanced Specialty Care

2084 NE Professional Court• Bend

541-322-5753

www .advancedspecialtycare.com

JANE BIRSCHBACH, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w .highlakeshealthcare.com

SUSAN GORMAN, MD

High Lakes Health Care Redmond

1001 NW Canal Blvd.• Redmond 5 4 1 - 5 04-7635 w

ALISON LYNCH-MILLER, MD

H i g h Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

•

541-389-7741

ww . highlakeshealthcare.com www.highlakesheal thcare.com

2 013 CE N T RA L O R E G O N •

M E D I CA L D I RECTORY

DVERTISINGSUPPLEMENT

LAURIE D'AVIGNON, MD

Bend Memorial Clinic

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

www.bendmemorialclinic.com

JOHN 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

JENKSS CHRISTENSEN, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

www.highlakes healthcare.com

JOHN CORSO, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

www .highlakeshealthcare.com

CELSO A.GANGAN, MD

Redmond Medical Clinic

1245 NW 4th Street, Ste201 • Redmond

541-323-4545

MICHAEL N. HARRIS, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

ANNE KILLINGBECK,MD

Internal Medicine Assodates of Redmond

236 NW Kingwood Ave • Redmond

541-548-7134

ANITA D.KOLISCH, MD

Bend Memorial Clinic

Bend Eastside gaRedmond

541-382-4900

MATTHEW R. LASALA, MD

Bend Memorial Clinic

MADELINE LEMEE, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

ww w .highlakeshealthcare.com

MARY MANFREDI, MD

High Lakes Health Care UpperMill

929 SW Simpson Avenue• Bend

541-389-7741

www.highlakeshealthcare.com

KARKN L. OPPENHEIMER, MD Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

ww w .bendmemorialclinic.com

H. DEREK PALMER, MD

Redmond Medical Clinic

1245 NW 4th Street, Ste 201 • Redmond

541-323-4545

A. WADE PARKER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

MATTHEW REED, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

ww w .bendmemorialclinic.com

M. SEAN ROGERS, MD

Send Memorial Clinic

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 w

ww. bendmemorialclinic.com

PRANCKNA ABKNDROTH, MD S end Memorial Clinic

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

ww. bendmemorialclinic.com

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

n/a ww w .bendmemorialclinic.com www.imredmond.com www .bendmemorialclinic.com

ww . bendmemorialclinic.com

n/a

GREGORY PERENZ,DO

Bend Memorial Clinic

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

CRAIGAN GRIPPI, MD

Bend Memorial Clinic

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

ww . bendmemorialclinic.com

RICHARD KOLLER, MD

Send Memorial Clinic

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

ww. bendmemorialclinic.com

RAY TIEN, MD

The Center: Orthopedic gt Neurosurgical CaregtResearch Locations in Bend gt Redmond

BRAD WARD, MD

Ihe Center: Orthopedic tt Neurosurgical CareAResearch Locations in Bend ga Redmond 5

www.bendmemorialclinic.com

5 41- 3 8 2 -334 4

www. t hecenteroregon.com

41-3 8 2 - 3344

www.t h ecenteroregon.com

Bend Memorial Clinic

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

ww . bendmemorialclinic.com

WILLIAM H. BARSTOW, MD

St. CharlesOB/CYN

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

BRKNDA HINMAN, DO

St. Charles OB/CYN

213 NW LarchAve,Ste A • Redm ond 541-52G-G635

www.stcharleshealthcare.org

AMY B. MCELROY, PNP

St. CharlesOB/CYN

213 NW LarchAve,Ste A • Redm ond 541-52G-G635

www.stcharleshealthcare.org

ANNIE BAUMANN, RD, LD •

•

JAMKS NKLSON, MD

TheCenter: OrthopedicttNeurosurgicalCareAResearch LocationsinBendgaRedmond 5

41-3 8 2 - 3344

www.t h ecenteroregon.com

LARRY PAULSON, MD

The Center: Orthopedic gt Neurosurgical CaregtResearch Locations in Bend gs Redmond 5

41-3 8 2 - 3 344

www.t h ecenteroregon.com

s s

ROB BOONK, MD

St. Charles Cancer Center

Locations in Bend ga Redmond

541- 7 0G-5800

www.stcharleshealthcare.org

THEODORE A.BRAICH, MD

Bend Memorial Clinic

Bend Eastside ga Redmond

5 41-3 8 2 -4900

www.bendmemorialclinic.com

CORA CALOMENI, MD

St. Charles Cancer Center

Locations in Bend gt Redmond

541 - 70G-5800

www.stcharleshealthcare.org

SUSIE DOEDYNS, PNP

St. Charles Cancer Center

Locations in Bend ga Redmond

541- 7 0G-5800

www.stcharleshealthcare.org

DVERTISINGSUPPLEMENT

2013 CENTRAL OREGON MEDICAL DIRECTORY •

•

BRIAN L ERICKSON, MD

Send Memorial Clinic

STEVE KORNPELD, MD

St. Charles Cancer Center

Bend Eastside SaRedmond

541-382-4900

www.bendmemorialclinic.com

Locations in Bend tla Redmond

541-70G-5800

www.stcharleshealthcare.org

Locations in Bend tla Redmond

541-70G-5800

BENJAMIN J. MIRIOVSKY, MD Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www .bendmemorialclinic.com

LAURIK RICK, ACNP

Send Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www.bendmemorialclinic.com

WILLIAM SCHMIDT, MD

Bend Memorial Clinic

Bend Eastside gaRedmond

541-382-4900

www .bendmemorialclinic.com

541-382-4900

www .bendmemorialclinic.com

St. Charles Cancer Center

BILL MARTIN, MD

HKATHKR WKST, MD s

s s

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

www.stcharleshealthcare.org

LINYKK CHANG, MD

St. Charles Cancer Center

2500 NE Neff Road• Bend 5

41-70 G -7733

www.stcharleshealthcare.org

DHARA MACDKRMED, MD

St. C h arles Cancer 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

a s

MATTHEW N. SIMMONS

Urology Spedalist of Oregon

BRIAN P.DESMOND, MD

Bend Memorial Clinic

Bend Eastside, Westsidegt Redmond 5 4 1-382-4900

www .bendmemorialclinic.com

THOMASD. EITZSIMMONS,MD,MPH Bend Memorial Clinic

Bend Eastside, Westsidega Redmond 5 4 1-382-4900

www .bendmemorialclinic.com

ROBERTC. MATHEWS, MD

Bend M emorial Clinic

Bend Eastside, Westside gt Redmond

541-382-4900

ww w .bendmemorialclinic.com

SCOTT T. O'CONNER, MD

Bend Memorial Clinic

Bend Eastside, Westside gt Redmond

541-382-4900

ww w .bendmemorialclinic.com

DARCY C. BALCER, OD

Bend Memorial Clinic

Bend Eastside gt Westside

541-382-4900

www .bendmemorialclinic.com

LORISSA M. HEMMER, OD

Send Memorial Clinic

Bend Eastside, Westside ga Redmond 54 1-382-4900

www .bendmemorialclinic.com

KKITH E. KRUKGER,DMD, PC Keith E. Krueger, DMD, PC • '

• '

AARON ASKKW, MD

•

2084 NE Professional Ct• Bend

541- 3 2 2-5753 h t p//usofor.praxixmedi : calgroup.com

1475 SW Chandler, Ste 101• Bend 5 4 1 - 617-3993

www.drkeithkrueger.com

•

Desert Orthopedics

Locations in Bend tla Redmond

541-388-2333

www.desertorthopedics.com

ANTHONY HINZ, MD

The Center: Orthopedic ra NeurosurgicalCaregtResearch

Locations in Bend tla Redmond

541-382-3344

www.thecenteroregon.com

JKPPRKY P. HOLMBOE,MD

The Center: Orthopedic A NeurosurgicaiCareA Research

Locations in Bend gt Redmond

541-382-3344

www.thecenteroregon.com

JOKL MOORK, MD

The Center: Orthopedic A Neurosucgical CareAResearch Locations in Bend St Redmond

541-382-3344

www.thecenteroregon.com

KNUTE BUEHLER, MD

The Center: Orthopedic A Neucosucgical CareAResearch Locations in Bend gt Redmond

541-382-3344

www.thecenteroregon.com

MICHAEL CARAVELLI,MD

The Center: Orthopedic A NeucosurgicalCareA Research

Locations in Bend gt Redmond

541-382-3344

www.thecenteroregon.com

Locations in Bend gt 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

ERIN PINTER, MD JAMES HALL, MD

ROBERT SHANNON, MD

MICHAEL RYAN, MD

Desert Orthopedics The Center: Orthopedic gtNeurosurgical CareStResearch

Desert Orthopedics 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.desertorthopedics.com

KATHLEEN MOORE, MD

Desert Orthopedics

1303 NE Cushing Dr, Ste 100• Bend

54 1 -388-2333

www.desertorthopedics.com

541-382-3344

www.thecenteroregon.com

541-388-2333

www.desertorthopedics.com

• '

TIMOTHY BOLLOM, MD BRETT GINGOLD, MD

The Center: Orthopedic St Neurosurgical CareStResearch Locations in Bend tla Redmond

Desert Orthopedics

1315 NW 4th Street• Redmond

2 013 CE N T RA L O R E G O N • '

• '

M E D I CA L D I RECTORY

541-3 8 2 - 3 344

www.thecenteroregon.com

41-3 8 2 - 3 344

www.thecenteroregon.com

54 1 -388-2333

www.desertorthopedics.com

Locations in Bend gtRedmond

541 - 382-3344

www.thecenteroregon.com

Locations in Bend Sa Redmond

541-3 8 8 -2333

www.desertorthopedics.com

SCOTT T. JACOBSON, MD

The Center: Orthopedic gt Neurosurgical CaregtResearch Locations in Bend St Redmond

BLAKE NONWEILER, MD

The Center: Orthopedic Neurosurgi St cal CaregtResearch Locations in Bend tla Redmond 5

• '

CARA WALTHKR, MD

DVERTISINGSUPPLEMENT

•

Desert Orthopedics

1303 NE Cushing Dr, Ste 100• Bend

MICHAEL COE, MD KENNETH HANINGTON, MD

The Center: Orthopedic gt Neurosurgical CaregtResearch

Desert Orthopedics

SOMA LILLY, MD

The Center: Orthopedic gtNeurosurgical CaregtResearch

Locations in Bend tla Redmond

541-3 8 2 -3344

www.thecenteroregon.com

JAMES VERHKYDEN, MD

The Center: Orthopedic gt Neutosutgical Care gtResearch

Locations in Bend gtRedmond

541 - 382-3344

www.thecenteroregon.com

I ' I ' I

MOLLY OMIZO, MD

Deschutes Osteoporosis Center

JKNNIFKR BLKCHMAN, MD

St. Charles Advanced Illness Management

LISA LEWIS, MD

Partners in Care

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

2200 NE Neff Road, Suite 302• Bend

541 - 3 88-3978 ww w deschutesosteoporosisceutercom

2500 NE Neff Road• Bend

541-70G-5885

www.stcharleshealthcare.org

2075 NE Wyatt Ct • Bend

541-382-5882

www.partnersbend.org

St. Charles Advanced Illness Management

2500 NE Neff Road• Bend

541-70G-5885

www.stcharleshealthcare.org

St. Charles Advanced Illness Management

2500 NE Neff Road• Bend

541-70G-5885

www.stcharleshealthcare.org

STEPHANIE CHRISTENSEN, 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

KATHERINE 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 LEIN, CPNP

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

www .bendmemorialclinic.com

MICHKLLE MILLS, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend

541-382-4900

www.bendmemorialclinic.com

MARGARET J.PHILP, MD

St. Charles Family Care

211 NW Larch Ave• Redmond

541-548-2164

www.stcharleshealthcare.org

JB WARTON, DO

Bend Memorial Clinic

ROBERT ANDREWS, MD

Desert Orthopedics

Locations in Bend tla Redmond

541-388-2333

LINDA CARROLL, MD

High Lakes Health Care Upper Mill

929 SW Simpson Avenue• Bend

541-389-7741

Locations in Bend St Redmond

541-382-3344

1501 NE Medical Center Drive• Bend

541-382-4900

TIM HILL, MD NANCY H. MALONEY,MD

The Center: Orthopedic gtNeurosurgical CaregtResearch

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive• Bend 5 4 1 - 382-4900 w

www.stcharleshealthcare.org

ww. bendmemorialclinic.com

www.desertorthopedics.com

ww w .highlakeshealthcare.com www.thecenteroregon.com www .bendmemorialclinic.com

JAMES NELSON, MD

The Center: Orthopedic gt Neutosutgical Care gtResearch

Locations in Bend gt Redmond

541-382-3344

www.thecenteroregon.com

LARRY PAULSON, MD

The Center: Orthopedic gtNeurosurgical CaregtResearch

Locations in Bend Sa Redmond

541-382-3344

www.thecenteroregon.com

DAVID STEWART, MD

The Center: Orthopedic gtNeurosurgical CaregtResearch

Locations in Bend tla Redmond

541-382-3344

www.thecenteroregon.com

Locations in Bend gt Redmond

541-388-2333

www.desertorthopedics.com

JON SWIPT, DO

Desert Orthopedics

VIVIANK UGALDK, MD

The Center: Orthopedic gtNeurosurgical CaregtResearch

Locations in Bend St Redmond

541-382-3344

www.thecenteroregon.com

MARC WAGNER, MD

The Center: Orthopedic St Neurosurgical CaregtResearch

Locations in Bend tla Redmond

541-382-3344

www.thecenteroregon.com

AMBROSK K. SU, DPM

Cascade Foot Clinic

DEAN NAKADATE, DPM

Deschutes Footgt Ankle

2408 NE Division Street• Bend 5

41-3 8 8 - 28G1

www.cascadefoot.com

929 SW Simpson Ave, Ste 220• Bend 541 -317-5GOO w ww.deschutesfootandankle.com

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

M E D I CA L D I RECTORY

DVERTISINGSUPPLEMENT

BROOKE HALL, MD

St. Charles Preoperative Medicine

2500 NE Neff Road• Bend 5

JONATHON BRKWKR, DO

Bend Memorial Clinic

Bend Eastside gr Redmond

541-382-4900

www.bendmemorialclinic.com

JAMIE DAVID CONKLIN, MD

St. Charles Pulmonary Clinic

Locations in Bend 8 Redmond

541-70G-7715

www.stcharleshealthcare.org

LOUIS D'AVIGNON, MD

Bend Memorial Clinic

Bend Eastside gr Redmond

541-382-4900

www.bendmemorialclinic.com

KRIC S. DILDINK, PA-C

St. Charles Pulmonary Clinic

Locations in Bend gr Redmond

541-70G-7715

www.stcharleshealthcare.org

MATT HEGKWALD, MD

St. Charles Pulmonary Clinic

Locations in Bend gr Redmond

541-70G-7715

www.stcharleshealthcare.org

Bend Eastside th Redmond

541-382-4900

T. CHRISTOPHER KELLEY, DO B end Memorial Clinic

41-70 G -2949 w

ww. s tcharleshealthcare.org

ww w .bendmemorialclinic.com

JONATHON MCFADYEN, NP

Bend Memorial Clinic

KKVIN SHERER, MD

St. Charles Pulmonary Clinic

NOREEN C. MILLER, FNP

St. Charles Rehabilitation Center

2500 NE Neff Road• Bend 5

GREG BORSTAD, MD

Bend Memorial Clinic

Bend Eastside gr Redmond

541-3 8 2-4900

www.bendmemorialclinic.com

CHRISTINA BRIGHT, MD

Send Memorial Clinic

Bend Eastside gr Redmond

5 41-3 8 2 -4900

www.bendmemorialclinic.com

DAN FOHRMAN, MD

Deschutes Rheumatology

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

Locations in Bend gr Redmond

541-70G-7715

41-70 G -7725 w

www.bendmemorialclinic.com

www.stcharleshealthcare.org

ww. s tcharleshealthcare.org

2200 NENeffRoad,Suite 302 • Bend 541-388-3978

n/a

HEATHERHANSEN-DISPENZA, MD Deschutes Rheumatology

2200 NE Neff Road, Suite 302• Bend 54 1 - 3 88-3978

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

ARTHUR K. CONRAD, MD

St. Charles Sleep Center

Locations in Bend gr Redmond

541- 7 0 6-6905

www.stcharleshealthcare.org

DAVID L. DEDRICK, MD

St. Charles Sleep Center

Locations in Bend gr Redmond

541 - 7 06-6905

www.stcharleshealthcare.org

T. CHRISTOPHKR KELLKY, DO Bend Memorial Clinic Sleep Disorders Center •

•

DAVID HERRIN, DC

•

Bend Eastside gr Redmond

541-382-4900

www.bendmemorialclinic.com

Redmond Wellness gt Chiropractic

TIMOTHY L. BKARD, MD, FACS Send Memorial Clinic DAVID CARNE, MD

St. Charles Surgical Specialists

DARA H. CHRISTANTE, MD

Bend Memorial Clinic

GARY J. FREI, MD, FACS

Bend Memorial Clinic

JACK W. HARTLKY, MD, FACS St. Charles Surgical Specialists

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

www.drherrin.com

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

www.bendmemorialclinic.com

120i NE Elm ~ Prineville

541-447-G2G3

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

Bend Eastside gr Redmond

541-382-4900

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

1501 NE Medical Center Drive• Bend

541-382-4900

St. Charles Surgical Specialists

ANDREW SARGENT, PA-C, MS Bend Memorial Clinic

GKORGK T. TSAI, MD, FACS

St. Charles Surgical Specialists

1245 NW 4th Street, ¹101• Redmond

541-548-77G1

JENNIFER TURK, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive• Bend

541-382-4900

www.stcharleshealthcare.org www.bendmemorialclinic.com

ww w .bendmemorialclinic.com www.stcharleshealthcare.org www .bendmemorialclinic.com www.stcharleshealthcare.org

ww w .bendmemorialclinic.com www.stcharleshealthcare.org www .bendmemorialclinic.com

JEANNE WADSWORTH, PA-C, MS Bend Memorial Clinic

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

KRIN WALLING, MD, FACS

Bend Memorial Clinic

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

JEFF CABA, PA-C

Bend Memorial Clinic

Bend Eastside, Westside gk Redmond 54 1-382-4900

www .bendmemorialclinic.com

ANN CLEMENS, MD

Bend Memorial Clinic

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

www.bendmemorialclinic.com

TERKSA COUSINEAU, PA-C

Bend Memorial Clinic

Bend Eastside, Westside A Redmond 541-382-4900

ww w .bendmemorialclinic.com

MIKK HUDSON, MD

St. Charles Immediate Care

J. RANDALL JACOBS, MD

Bend Memorial Clinic

2600 NE Neff Road• Bend

541-70G-3700

Bend Eastside, Westside gk Redmond 54 1-382-4900

www.bendmemorialclinic.com

ww . bendmemorialclinic.com

www.stcharleshealthcare.org

www.bendmemorialclinic.com

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

M E D I CA L D I RECTORY

DVERTISINGSUPPLEMENT

s AMEE KOCH, PA-C

Bend Memorial Clinic

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

www .bendmemorialclinic.com

JIM MCCAULKY, MD

Bend Memorial Clinic

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

www.bendmemorialclinic.com

TKRRACK MUCHA, MD

Send Memorial Clinic

Bend Eastside, Westsidegt Redmond 5 4 1-382-4900

www .bendmemorialclinic.com

JAY O'BRIEN, PA-C

Bend Memorial Clinic

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

www.bendmemorialclinic.com

CASEYOSBORNE-RODHOUSE, PA-C

Bend Memorial Clinic

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

www .bendmemorialclinic.com

LAURIK D. PONTK, MD

Bend Memorial Clinic

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

www.bendmemorialclinic.com

JENNIFER L. SURBER, MD

Send Memorial Clinic

Bend Eastside, Westsidegt Redmond 5 4 1-382-4900

www .bendmemorialclinic.com

PATRICK L. SIMNING, MD

Bend Memorial Clinic

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

www.bendmemorialclinic.com

SEAN SUTTLE, PA-C

Bend Memorial Clinic

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

www .bendmemorialclinic.com

THOMAS H. WKNDEL, MD

Bend Memorial Clinic

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

www.bendmemorialclinic.com

BRKNT C. WESKNBERG, MD

Send Memorial Clinic

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

www.bendmemorialclinic.com

MEREDITH BAKER, MD

Bend Urology Assodates

2090 NE Wyatt Court• Bend

541-382-G447

www.bendurology.com

MICHKL BOILKAU, MD

Send Urology Associates

2090 NE Wyatt Court• Bend

541-382-G447

www.bendurology.com

JACK BREWER, MD

Send Urology Associates

2090 NE Wyatt Court• Bend

541-382-G447

www.bendurology.com

ANDREW NEEB, MD

Urology Spedalists of Oregon

2084 NE Professional Court• Bend

541-322-5753

ht t p:/ /usofor.praxismedicalgroup.com

BRIAN O'HOLLAREN, MD

Bend Urology Assodates

2090 NE Wyatt Court• Bend

541-3 8 2 - G447

www.bendurology.com

KRIC SHRKVK, MD

Send Urology Associates

2090 NE Wyatt Court• Bend

541-382-G447

www.bendurology.com

MATTHEW N. SIMMONS, MD

U r o logy Specialists of Oregon

2084 NE Professional Court• Bend

541-322-5753

ht t p : or.praxismedicalgroup.com //usof

NORA TAKLA, MD

Bend Urology Assodates

2090 NE Wyatt Court• Bend

541-382-G447

www.bendurology.com

ROD BUZZAS, MD

Advanced Specialty Care

2084 NE Professional Court• Bend

541- 3 2 2-5753

KDWARD M. BOYLE,JR., MD, FACS

Inovia Vein Specialty Center

2200 NE Neff Road,Ste 204 • Bend

541-382-834G

www.bendvein.com

ANDRKW JONES, MD, FACS

Inovia Vein Spedalty Center

2200 NE Neff Road,Ste 204 • Bend

541-382-834G

www.bendvein.com

DARREN KOWALSKI, MD

Bend Memorial Clinic

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

JOSEPH COLELLA, MD, FACS

Send Memorial Clinic

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

ww. bendmemorialclinic.com

WAYNE K. NELSON, MD

Bend Memorial Clinic

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

ww. bendmemorialclinic.com

•I•

P AID A D V E R T ISIN 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:

K ylie V i g e l a nd , A c c o u n t E x e c u t i v e ( H e a lt h & M e d i c a l ) 541.61 7.7855

www . advancedspecialtycare.com

www.bendmemorialclinic.com

Bodyofknowledge ~popQUlz

sau tert e

est me icine'? BY DAVID JASPER

n recent years, researchers have investigated the longstanding claim that laughter is the best medicine, finding some good news for those who like to laugh. That laughter can help provide physical and psychological benefits is just one more reason to keep on laughing. Say what you will about cheap laughs, but they're easier on the wallet — and an easier pill to swallow. (Note: some multiple-choice questions may have more than one answer.)

In the13th century, some surgeons used what to distract their patients?

Researchers have concluded it takes how long for your brah to determine something is funny? A. 1 second B.3 seconds

A. Inquisitions

C. n'0 of a second

B.Religion C.Quickly turning on lights (it was still the Dark Ages) D.Amputating wrong limb

D. 0.4 seconds

E. Humor

GREG CROSS

How many muscles in your face are involved when you laugh? A. My face has mussels? Ewwww! Gross! B. 15 C.83 D. 1,037

E. Will let you know after I finish this stupid quiz.

A 2010 study by researchers from the University of Glamorgan found that in aging British men, sense of humor drops precipitouslyand A.The effect kicks in at age 52 in both sexes. B.It's known as Victor Meldrew Syndrome, after a TV character who is the epitome of grumpy 6ritishness. C.Men in their 60s are four times grumpier than women in that age range. D. Glamorgan is a funny name for a university, unless you're 6ritish and age 52 or older. E.All of the above.

Laughter yoga, in which practitioners go through playful activities and laughter exercises, has been shown to A. Make practitioners sad. B.Be as effective as exercise therapy in helping depressed older women. C.Cause eye-rolling in people suffering from Victor Meldrew Syndrome. D. Spark laugh riots. E.Make peoplew ho hatepuns suddenly likethem .

E.3

In a study at the University of Maryland, researchers found when people were shown scenes from comedies, which of the following occurred? A. Sides actually did split. B.They became more prone to heart disease. C.Their arteries dilated and blood pressure dropped. D.The mussels in their faces went limp. E. I'm still trying to figure out if the 13th century is the 1200s

or 1400s.

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HIGH DESERT PULSE • SUMMER/FALL 2613

Page 53

One voice ~ ApERsoNALEssAY

ee essnessma not em aut More often, there are other issues at am no longer at a breaking point due play. She needs sips of water, or to blow to a crippling lack of sleep. her nose, or Teddy needs to be covered by I am not so tired that I could fall j the blanket. '~ i i., asleep at any time of day, regardless of But sometimes it's j ust s t raight-up my coffee consumption. When I sit at crying. I the conference table at work, I no longer We will let her cry for a minute or two. r yearn to rest my head on its smooth surMaybe five. Sometimes she will settle herface and snooze. self, and I lie in bed feeling extreme relief. I am not in that scary, barely functional But sometimes the crying is just so sad, space I occupied while my daughter was it hurts my spirit. And when I go in her S. a baby. room, she needs a hug very badly and my But sleep remains a challenge for my heart aches that I didn't run and give her family. Some kids just aren't good sleepthat hug right away. ers, and my 2-year-old daughter is one of Then I remember she is 2 and still them. When our kid doesn't sleep, neither wakes up twice a night. How will she learn clo we. to sleep on her own if we always run to On most nights, I get about seven hours her? of sleep. It's just not typically seven hours The answer, my cynical heart is starting in a row, because usually, at least once a to believe, is that she will never learn. night, our girl will wake up and cry. Of course, my rational brain recognizes Let me stop you right there. Some of that by adulthood, she won't need me You are likelY nodding, feeling mY Pain, AlandraJohnsonanddau hterPhoebe 2 to Pat her back anYmore to go back to and others are likely thinking of this techsleep. nique you tried that worked really well My sleep angst is why I was so gratified for your child, or your niece or your best friend's kid. You wonder if I by recent research published in the journal Pediatrics regarding sleep know about it and wonder if it might help. and young children. Turns out, identical twins were much more likely I'm happy to hear about it. I like talking about sleep and welcome to have the same nighttime sleep patterns than fraternal twins. What your stories. does this mean? It means genetics was likely more important than But that method that worked so well for your child? My husband environment in determining how well a child sleeps at night. and I have probably tried it, and it didn't work. Or, it worked for a To my (vaguely sleep-deprived) mind, this meant one thing: My few days or a week, but then my daughter went back to her favorite daughter's sleep problems are not my fault. It's genetic! pattern: crying in the middle of the night for as long as it takes for my Turns out what I was looking for wasn't sympathy (our daughter is husbandor me to come soothe her. pretty fantastic in all other aspects) or a solution (I am tired, anyway, We sleep trained. We cried it out. We co-slept. We soothed. of trying new things and having them not work). We have offered rewards. We have removed privileges. What I was looking for was absolution. Isn't that what most parBY ALANDRA JOHNSON

Earlier bedtimes? Tried it. Later bedtimes? Tried that, too.

ents want? We want to know that we aren't entirely to blame for our

On the rare occasions Phoebe does sleep through the night, we children's issues, be they bad sleeping, fit-throwing or picky eating. jump up and down, we sing her praises. We want someone to tell us it's not our fault. But the next night, she cries again.

And I wanted permission to stop trying to fix it and just accept my

Sometimes our daughter has night terrors — she thrashes, uncon- (somewhat sleepy) lot in life. scious, and arches her back and wails. It can last for 20 minutes, and It offers me some solace, at least, while making that 2 a.m. trudge we are powerless to help her. We don't fault her for these episodes. down the hall. •

Page 54

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