WINTER / SPRING 2010
You’ve had your baby. What’s to become of the Marathon mortality Who runs the risk?
Body scans The value of looking below the surface
TV medicine ‘Scrubs’ may influence your health
Scratch that itch Why it feels so good
leftover
embryos?
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PULSE Healthy Living in Central Oregon
WINTER / SPRING 2010 VOLUME 2, NO. 1
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HIGH DESERT PULSE
Contents |
HIGH DESERT PULSE
COVER STORY
6
DECISION ON ICE You’ve had the baby. Now what will you do with the remaining embryos?
6
COVER PHOTO BY ROB KERR: Embryo storage tubes, called canes, sit in a container of liquid nitrogen at Oregon Reproductive Medicine in Portland. Smaller tubes inside each hold one to three embryos.
FEATURES
14 22
MARATHON MORTALITY Running lowers your risk of heart attack. Right?
25
BODY SCANS ON THE GO These preventive screenings are low-cost and convenient. But are you getting what you paid for?
‘ER’ OR ‘HOUSE’? What you and your doctor watch may affect your health.
14
DEPARTMENTS
11 19 21 30 32
GET READY: BACKPACKING Rewarding self-sufficiency with a view.
34 38
BODY OF KNOWLEDGE Show what you know about sweeteners.
HOW DOES SHE DO IT? Judy Stiegler shares her fitness policy. PICTURE THIS How scratching relieves an itch. HEALTHY DAY, OUR WAY Make a date with a pair of snowshoes.
11
ON THE JOB: MEDICAL DEVICE REP He didn’t go to med school, but you may find him in the operating room.
LAUGHTER: THE BEST MEDICINE The bald truth about chemotherapy.
PHOTOS FROM TOP: ROB KERR, ANDY TULLIS, BULLETIN ARCHIVES — ILLUSTRATION: ANDY ZEIGERT
HIGH DESERT PULSE • WINTER / SPRING 2010
21 Page 5
Cover story |
FROZEN EMBRYOS
The decision of a lifetime The in vitro explosion has left half a million potential lives on ice — and families with difficult choices about what to do with them BY MARKIAN HAWRYLUK PHOTOS BY ROB KERR
I
n fertility clinics across the nation, more than half a million embryos — a population about the size of Portland — lie frozen, a cryogenic treasure trove of potential human life and an unintended side effect of a burgeoning field of reproductive medicine. Through in vitro fertilization, embryos are created by combining eggs and sperm in a laboratory dish, rather than inside the body. Knowing they must account for losses in each step of the way, doctors start out with a maximum number of eggs. Through sheer numbers, they hope to end up with enough viable embryos to give couples the highest odds of having a baby. But as the science of assisted reproductive technology improves, couples are increasingly faced with leftover embryos after they’ve completed their IVF journey. Family after family is trying to answer for themselves the ques-
tions that the nation as a whole has never been able to solve: What are embryos, when do they become children and when does our responsibility for them begin and end? But unlike the previous debates on the origin of life, in this one the clock is frozen in time, allowing these couples to put off a final decision on the fate of their embryos for years, and allowing the number of embryos in limbo to grow. Researchers studying how couples approach the decision of what to do with frozen embryos have found these couples must often go through a major change in thinking before they can make a decision. At the start of IVF, embryos are seen as the solution to the problem. At the end, leftover embryos represent a problem in need of a solution. “I think what happens when couples go through IVF, they are just fixated on the idea of becoming pregnant, and the idea that frozen embryos would ever be a problem for them is just not something that they can engage with,” said Dr. Robert Nachtigall, an infertility
4,000 ON ICE In a secure laboratory in the offices of Oregon Reproductive Medicine in Portland, a small room holds insulated containers filled with liquid nitrogen and 4,000 human embryos.
specialist at the University of California, San Francisco. “How could an embryo, which represents that elusive chance of pregnancy, ever not be a good thing?”
Numbers game In vitro fertilization is a complicated process that starts with doctors harvesting eggs from the woman’s body. She is given medications to maximize the number of mature eggs doctors can remove from her ovaries, and the harvested eggs are then fertilized with sperm outside of her body. Embryologists then watch the eggs to see which ones start to divide. By Day 3, the embryos that have divided into six to eight cells can be implanted into the woman’s uterus. But doctors generally implant only one or two embryos at one time. The rest of the viable embryos are usually frozen in case the first implantation cycle isn’t successful. That way doctors can thaw additional embryos and repeat the process without having to start from scratch. It’s less invasive, avoids what can be a painful or uncomfortable procedure, and is less expensive for the patients, while maximizing their chance of success. “If they get pregnant, what happens is couples don’t think about the frozen embryos, because they’re at that point kind of superfluous,” Nachtigall said. “It’s often the storage bills that prompt them to think about it.” The decision point often comes at the one-year mark, because most clinics provide an initial free year of storage. At the end of the year, the couple receives a letter asking if they’ve made a decision regarding their embryos, and a $300 to $700 bill for the next year of storage. According to Nachtigall, who conducted interviews with scores of couples with frozen embryos, they must first decide whether they’re going to use the embryos to have more babies themselves. “In retrospect, people always say, ‘I wish we could have made just enough embryos to use them all up,’” he said. When they have extra embryos, that sometimes prompts them — particularly the women — to think about having more children, even if age, finances or medical condition dictate otherwise. “It’s like one woman said, ‘I hate to tell you, but those embryos call to me,’” Nachtigall said.
Making choices In many ways, whether to have more children with the embryos is the easier decision. The dilemma of what to do with the embryos when you don’t want to have more kids raises much more thorny issues. Crystal and Jimmy Clarke, of Bend, went through two complete cycles of IVF before they decided they were done building their family.
“I would love to be able to donate our embryos. ... But watching our child grow up with somebody else? I just don’t know if I could do that.” Christine Grycko, IVF mother, pictured with twins Jaxon and Aubrey and husband Jared
In total, six embryos were implanted, resulting in a son, Jasper, and then twins, Hopper and Waylon. They then faced the decision of what to do with the four remaining embryos. They could store them for another year, at a cost of $700. They could have them discarded. Or they could donate them to research or to another couple. “We always knew that we would never dump the embryos, just throw them away,” Crystal said. Similarly, donating them to science wasn’t an option for the Clarkes,
LIKELY CHOICES FOR STORED EMBRYOS In a recent study, IVF patients with frozen embryos cited “Donate to research” as their second most likely choice for embryos, after their own use for future pregnancies. (Percentages of likely and somewhat likely choices add to more than 100.)
HIGH DESERT PULSE • WINTER / SPRING 2010
Percentage of patients with embryos reporting they were “very” or “somewhat likely” to choose the following:
Source: Fertility and Sterility journal
67%
48%
24%
22%
19%
18%
14%
Store for future pregnancy use
Donate to research
Thaw and dispose
Donate to another couple
Transfer embryos at a time when pregnancy is improbable
Conduct a small ceremony at the thawing and disposal
Keep frozen forever
Page 7
Cover story | FROZEN EMBRYOS especially after seeing their embryos grow into three babies. “We always freak out when we look at Jasper or these two because they were actually frozen,” Crystal said. “You can’t deny that there’s a possibility. To take those four and throw them away would be insane.” Instead, the Clarkes decided to donate them to another couple, giving their doctor the ability to pick an appropriate family. “Just knowing how difficult it is to get pregnant, we know what that feels like, and there are other parents out there going through the same process,” Jimmy said. “If we can donate that to somebody, we’ll know they got to experience the same thing we did.” But other couples can’t fathom having their genetic offspring grow up with other families. Christine and Jared Grycko went through IVF with Oregon Reproductive Medicine, a Portland-based facility that also has an office in Bend. Doctors implanted two embryos and both took hold. The Bend couple gave birth to twins but had eight embryos left over. “I would love to be able to donate our embryos to (another cou-
IN VITRO FERTILIZATION • Ovarian stimulation and egg retrieval: During a woman's natural cycle, a single egg matures each month. To maximize chances of success, IVF begins by using powerful fertility drugs to stimulate the ovaries to produce as many mature eggs as possible. Not all of the eggs will fertilize.
Fallopian tube
Follicles in ovary
Uterus Ovary
A needle is inserted through the wall of the vagina, into the ovary and follicles to retrieve the eggs.
• Fertilization: In the lab, an embryologist mixes eggs and sperm. If fertilization occurs, the embryos are then incubated and monitored for two to five days. When the cells have split into eight cells, they are ready for transfer. Two cells
Vagina Ultrasound probe
Mitosis Four cells
• Embryo transfer: After evaluating the viability of the embryos, and possibly conducting genetic testing for inherited diseases, the physician transfers one or more embryos into the uterus. • Cryopreservation: If there are viable embryos remaining after the procedure, the couple may choose to have them frozen for future use, in case the implantation is unsuccessful or they choose to have more children. Future IVF cycles, without egg retrieval, are then less invasive and less expensive. Frozen embryos may be stored for years, but not all will survive the freezing and thawing process. Source: National Library of Medicine
Page 8
Eight cells
Embryo transfer
Uterus Embryos Embryo transfer catheter
ple),” Christine said. “But watching our child grow up with somebody else? I just don’t know if I could do that.” A year after the twins were born, the Gryckos decided to donate the embryos to research. With all the cost and effort involved in creating them in the first place, they simply did not want to see them go to waste. “I would have had a real hard time saying we’ll just get rid of them,” she said. “I would kind of feel that it was for naught. It made us feel better about the decision knowing they would be used to potentially help someone.”
Legal void While couples often agonize over the decision, moving quickly when both parties are on the same page, as both the Gryckos and Clarkes did, seems to avoid the worst-case scenarios. The more time that passes, the greater the risk that couples can grow apart, as happened with Oregon’s most famous frozen embryo case. Drs. Laura Dahl and Darrell Angle of Portland ended up in court to resolve the fate of their embryos. The couple had tried unsuccessfully to conceive a second child through IVF and soon after decided to divorce, but could not agree about what to do with six frozen embryos. The contract they signed with Oregon Health & Science University gave Dahl the right to decide on the embryos if the couple split, and she planned to donate them for research. But Angle said he believed that “embryos are life” and opposed their destruction. “There’s no pain greater than having participated in the demise of your own child,” he said in his testimony. He wanted the embryos donated to another couple. But Dahl argued she did not want another child with Angle and did not want anybody else raising her genetic children. The court sided with Dahl, and in October, an appellate court upheld the ruling. Despite thousands of IVF procedures resulting in hundreds of thousands of frozen embryos, there have been only nine court cases nationwide in which the fate of the embryos was at issue, according to the lawyers involved in the Oregon case. But when such disputes arise, there aren’t many laws specific to the disposition of frozen embryos to settle the matter. Couples are entering into arrangements that result in the creation of frozen embryos, and the law hasn’t caught up with the science, said Mark Johnson, the Portland attorney who represented Angle in the case. “They’re having to do it in a sort of legal void,” he said. “It basically falls to clever lawyers to figure out what to do.” In the vast majority of cases, disputes are resolved through dialogue or negotiations, he said, and very few cases wind up in courts. And when they do, lawyers rely on property law or family law to argue the case, even though neither really applies. “They all tend to follow a similar pattern, in the sense that one party wants to implant the embryos and the other wants to get rid of them in some manner,” Johnson said. “The other thing that’s true about all of them is that they all come out the same. The way they get from point A to point B varies quite a bit, but it’s clear that judges are really reluctant to allow people to use embryos to create babies without the consent of both parties.”
Rules needed
GREG CROSS
According to William Howe, the Portland attorney who represented Dahl, the Oregon case is prompting IVF clinics and hospitals in the state to draft much tighter contracts that spell out what happens when the parties split and can’t agree on what to do with remain-
HIGH DESERT PULSE • WINTER / SPRING 2010
“Knowing how difficult it is to get pregnant ... there are other parents out there going through the same process. If we can donate (our embryos) to somebody, we’ll know they got to experience the same thing we did.” Jimmy Clarke, IVF father of three ing embryos. But as recent cases in other locales demonstrate, even clever lawyers can’t always anticipate all of the potential scenarios. Last year, for example, an Ohio woman was accidentally implanted with another couple’s embryo, but decided to give birth to the child anyway and then hand the baby over to his genetic parents. In Japan, a woman implanted with the wrong embryo decided to abort her pregnancy. The genetic parents were told about the mistake and the abortion months later. And in Chicago, a couple filed a wrongful death lawsuit against a fertility clinic that accidentally discarded their nine embryos. The judge dismissed the case. “We desperately need legislation,” Howe said. “But we’re not going to get it because it’s the abortion debate in different clothes.” Meanwhile, clinics and hospitals aren’t clamoring for laws and regulations in fear the golden goose might be cooked. Several states have already passed laws restricting abortions, and many fear that if the fate of embryos is left in the hands of voters, they could limit what can be done.
“I think the reason it hasn’t come up in the Legislature is that the hospitals have made the calculus that, ‘We’re doing just fine, we can fix it with the contract, let’s not risk it,’” Howe said. “There is a real growth industry in this fertility stuff.” In Louisiana, which has a large anti-abortion population, embryos are considered “juridical persons” — that is, ones with legal rights to sue or be sued. Viable embryos in the state cannot be intentionally destroyed and IVF clinics are charged with safeguarding the embryos. To date, the IVF industry has expanded primarily on the basis of reproductive freedoms offered by Roe v. Wade. Yet many parents who are staunchly for abortion rights find they have difficulty in divesting personhood from the embryos after going through the IVF process.
Shift in thinking In fact, surveys show most couples find their thinking about what the embryos represent is changed significantly by their IVF experiences. “Once they have had a child through this process, they no longer can look at that embryo in the same way,” Nachtigall, the infertility specialist, said. “Their conceptualization of that embryo all of a sudden explodes and ramps up because they are looking at this child, and this child came from one of those embryos. ‘How can I think about my embryos in that liquid nitrogen tank in a dispassionate way?’ They become attached to the embryos as a result of going through this process in a way they did not anticipate.” The decisions couples made about the embryos before they existed suddenly don’t seem like such great choices anymore. Researchers at Northwestern University recently interviewed couples
Cover story | FROZEN EMBRYOS who had embryos in storage for three years. Only 29 percent of the couples were sticking with their original plan for leftover embryos. Of the 22 couples who had intended to discard their embryos, 13 now wanted to either use or donate them. Nine of the 11 couples intending to donate to infertile couples changed their minds, as did seven of eight couples who planned to donate embryos to research. In a Canadian study, only half of the couples who initially said they wanted to donate embryos to research ultimately chose that option. In total, 59 percent of couples changed their minds about what to do with the embryos. Marcia Klotz, a professor of English and women’s studies at Portland State University, had twins through IVF and delayed making the decision about what do with the leftover embryos for two years despite getting annual notices from the clinic. “Our extraordinary little babies, all warm and wriggly, made that question far more agonizing than I could ever have anticipated,” Klotz wrote in a blog entry about her choice. “This was not just a decision about what to do with a few clumps of cells. Those embryos had become more than that.”
Klotz wrote that at the start of the process, disposition of leftover embryos “seemed like the least of our worries.” She and her husband checked off the “save for future use” box on the clinic’s consent form. When the first bill for another year of storage came in the mail, it was easier for the couple to pay it than to make a decision. The next year, she didn’t even open the envelope. Over the next half year, she debated her options. Finally, she called the IVF clinic to tell them she wanted to have the embryos destroyed, only to learn the clinic had done so several months earlier when they received no reply to their letter.
Indefinite storage In Nachtigall’s study, few parents ultimately decided to destroy their embryos. Despite three interviews over the course of a year, where researchers urged the couples to think about what they wanted to do with their frozen embryos, a third couldn’t come to any decision by the end of the study. “Either through disagreement between the couple or literally mental paralysis, they just kept the embryos in storage,” he said. Indefinite storage is becoming more of
“This was not just a decision about what to do with a few clumps of cells. Those embryos had become more than that.” Marcia Klotz, IVF mother
an issue for IVF clinics. The embryos must be kept in liquid nitrogen in a freezer and looked after by embryologists with Ph.D.s and high salaries. The tanks must be constantly monitored with alarms that will go off in case of a power failure. And nobody really knows what liability clinics face if something happens to the embryos in their care. Meanwhile, clinic staff must try to keep track of the embryos’ owners, who often forget to tell the clinic when they’ve changed their address. “Once the woman is pregnant, she’s gone,” Nachtigall said. “The IVF clinics don’t deliver the babies. At 12 weeks of gestation, you get a hug goodbye.” And when couples don’t want to face the disposition decision, clinics often lose touch with their clients altogether. According to some estimates, as many as 200,000 embryos — a number that’s close to the combined population of Deschutes, Crook and Jefferson counties — have been abandoned at IVF clinics by their genetic parents. Although the American Society of Reproductive Medicine provided guidance in 1996 allowing clinics to dispose of embryos that have been abandoned for more than five years, it’s a step clinics are reluctant to take. “I’m seeing the majority of clinics not doing that,” says Theresa Erickson, a reproductive law attorney in Poway, Calif. “They’d rather just keep them frozen. It’s a cost of doing business, rather than having a lawsuit saying, ‘You didn’t try hard enough to find me.’” Howe, the Portland attorney, said the contracts that clinics have couples sign should provide the legal backing for clinics to dispose of abandoned embryos. “Doctors and hospitals are professional paranoids, and they are too often driven by unfounded fears,” he said. “They’ve just got to buck up. Either that or have a facility where they can be frozen forever.” Large regional cryobanks have already popped up to take long-term storage of embryos off clinics’ hands. Doctors still don’t Continued on Page 35
Marcia Klotz and Lee Medovoi had twins Samara Klotz, 7, front, and Jacob Medovoi, right, with IVF. “The other one was a surprise!” Marcia said of Rona Klotz, 5, behind, at home in Portland.
Page 10
HIGH DESERT PULSE
Get Ready |
BACKPACKING
You can take it with you
Target your preparation and the summer could find you in a place like this, in Yosemite National Park.
PETE ERICKSON
... but only if you REALLY need it BY MARKIAN HAWRYLUK
T
here’s a certain sense of pride you get through backpacking, knowing that all you need to remain self-sufficient in the wilderness is there on your back. No need for hotels or restaurants or cars; you’ve got all the necessities of life with you. As winter loosens its grip on Central Oregon, it’s the perfect time to get your body in shape for carrying life’s trappings to your camping destinations. Training for backpacking is rather straightforward: Nothing prepares you as well as actually hiking trails and carrying a pack. By building a solid base of fitness, then slowly ramping up the length of your hikes and the weight on your back, you’ve got just enough time to get yourself ready for the prime summer backpacking season. According to Courtenay Schurman, coowner of Body Results, a personal training studio in Seattle specializing in outdoor recreation, individuals training for backpacking
HIGH DESERT PULSE • WINTER / SPRING 2010
need to start by deciding on their end goal. “When you look at backpacking, it could be an overnight, it could be a week, it could be the Pacific Crest Trail, or anything in between,” she said. “The first thing I try to figure out is: What kind of elevation gain, what kind of pack weight do you need, what kind of distance and how many days?” The longer and harder the hike, and the worse shape you’re in now, the more time you’ll need for training. Beginners should start with a goal of a simple overnight trip. That will give you a taste of what backpacking is all about and what skill set you need to develop to go farther and stay out longer.
February:
With most of the backpacking trails still under snow, start to build your base of fitness in the gym. “Do some general cardio training on a StairMaster, an incline treadmill, an elliptical, anything that loads the body like you’ll be doing out on the trail,” Schurman said.
LOCAL OUTFITTERS • Mountain Supply, 834 N.W. Colorado Ave., Bend, 541-388-0688 • Pine Mountain Sports, 255 Southwest Century Drive, Bend, 541-385-8080, www.pinemountainsports.com • REI, 380 Powerhouse Drive, Bend, 541-385-0594, www.rei.com REI holds clinics on backpacking that can be a good introduction for beginners. The Cascades Mountaineers club (www.cascadesmountaineers.org) also organizes backpacking trips and is a good place to find backpacking partners.
ONLINE RESOURCES • Backpacker.com: Full of information on gear, technique and destinations, including gear lists so you don’t forget something when packing. • BodyResults.com: Training recommendations for many popular outdoor recreation sports. • Rei.com/expertadvice: Articles on how to choose backpacking gear as well as gear lists for packing. • TraditionalMountaineering.org: Run by Bend resident Bob Speik, who also runs local clinics on backcountry navigation and survival. One of the best online sources to understanding the essentials needed for backcountry travel of any kind.
Page 11
Get Ready | BACKPACKING
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“So that kind of takes away things like rowing, swimming, biking. That doesn’t mean don’t do them, but those shouldn’t form the core of the training.” And do a lot of walking — trails, hills, stairs or a treadmill — building for three or four weeks before putting on a pack. Pine Mountain Sports manager Ryan Sperring suggests heading to areas such as the Badlands Wilderness or Smith Rock that won’t be covered in snow. Even the Deschutes River Trail in downtown Bend may be free of snow for much of the month. Schurman also stresses the need for strength training, especially the muscles in the legs and the hips. “We recommend two times a week minimum, full body, and free weights, as opposed to machines,” she said. “Because when you’re putting on a pack, hoisting it, climbing over logs and so forth, you’re putting a lot of stress on the body that you need to train for in the gym.”
March: This is the month to start increasing trail distance and pack weight. If you can, wear the boots and pack you’ll be using on your trip. “We kind of recommend a 10 percent rule or training guideline in terms of mileage and weight,” Schurman said. “If you’re going to be going with 40 pounds, you don’t want to start with 20. Start with 15 and gradually add a couple of pounds each outing.” If you’re going for a simple overnight trip in relatively warm weather, your total pack weight, including food and water, might be only 30 pounds. For longer trips, you might be carrying 40 or more pounds. “The most common mistake is assuming that cardio is enough. People say, ‘Oh, I run marathons. How hard can it be to walk with a pack?’ As soon as you add incline terrain, route, heavy pack weight, multiple days, it changes the whole game,” Schurman said. “You’ve got to train strength, and you’ve got to train specific to the sport, which is carrying a pack.” Backpacking is a bit like weightlifting stretched over a long day. With every step, you’re lifting a 30- to 40-pound load. If you don’t train for that, you could tire out well before reaching your destination.
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HIGH DESERT PULSE
8 backpacking essentials Part of the art of backpacking is knowing what to take with you.
1. Backpack: Fit is everything in a backpack. The right one will shift the weight to your hips.
5. Shelter: Find a three-season tent that is lightweight and well-ventilated. Practice setting it up before you leave. 2. Sleeping pad: Most modern sleeping pads inflate on their own, eliminating the lung-busting exercise of air mattresses. 6. Illumination: Headlamps are a hands-free way of lighting up the night, such as for midnight emergencies.
3. Sleeping bag: A bag rated to 30 degrees should be warm enough for most summer backpacking.
8. Navigation and other tools:
4. Stove: Many campsites don’t allow open fires, so you’ll need a stove if you plan to cook.
April: If you don’t have all the gear for backpacking — and the initial investment can easily exceed $500 — this is the month to get your gear dialed down. “It can be very expensive,” said Cat Addison, a backpacking enthusiast who works at REI in Bend. “Sometimes they might want to consider renting. It may not fit them perfectly, it may not be exactly what they want, but at least it will get them started and see if they like it.” Addison said backpackers should at a minimum invest in a good pair of hiking boots and a backpack, where fit is crucial. You can borrow or rent a tent, sleeping bag, sleeping pad and stove. But get a bad-fitting backpack or boots, and you’ll be miserable, she said. “People should get a pair of boots and wear them around for a couple of months before they take off,” Addison said. Wear them around the office or at home, as well on trails. They will conform to your
HIGH DESERT PULSE • WINTER / SPRING 2010
7. First-aid kit: Bring a small one — and the knowledge to use it.
PHOTOS BY ANDY TULLIS AND FROM ARCHIVES
foot and give a better fit with time. April is also the month to test out your gear. Don’t wait till you’re 10 miles into the backcountry before trying to figure out how to set up your tent or work your camp stove. This month, do a couple of longer hikes on consecutive days to get your body used to hiking with a pack for two days in a row. “That way you know when you’re a couple of weeks out, I did an eight-mile hike, and I did a four-mile hike the next day, and what I’m going to be doing is a 15-mile hike, so I’m feeling pretty good,” Schurman said. “I know I’m not going to be hurting my knees or my back when I do this trip.”
Departure time:
If you can, find a partner who’s experienced in backcountry navigation and survival your first time out. Carry the essentials (see resource box above) and emergency supplies. But avoid the common mistake of carrying too much. Backpack-
Bring a map and a compass; a GPS is also a handy addition. Also pack an emergency kit with repair supplies.
ing is a lot about learning about the minimum you need to be comfortable during your trip, not about re-creating the Ritz in backcountry. “Don’t go out carrying 80 pounds,” Addison said, “because you won’t want to do it again.” Don’t forget the essentials, including insect repellent and toilet paper. You can find packing lists for your gear online. Make sure you have the proper camping permits and parking passes by checking with the forest or park service overseeing the region. Pay extra attention to your feet. Address any hot spots or pains immediately, before they develop into blisters. Most people can tough out a night of uncomfortable sleeping or bad food, Sperring said, but foot problems can ruin a trip. Avoid cotton clothing, which doesn’t dry easily. Any local outdoor retailer can help you find appropriate synthetic clothes for your trip. Sperring also suggests starting small. If you choose a harder trip at the limit of your abilities, you’re less likely to enjoy the experience. •
Page 13
Fitness |
LONG-DISTANCE RUNNING
Marathon mortality: Who runs “There is a risk to running that includes sudden death.” Dr. William Roberts, professor, department of family medicine, University of Minnesota
BY BETSY Q. CLIFF
D
aniel Langdon collapsed between the 11 and 12 mile markers. Peter Curtin went down at mile 25. Jon Fenlon ran a half-marathon in less than two hours, then died near the finish line. Brandon Whitehurst made it within 100 yards of the end of a half-marathon before his collapse. Last fall, at least seven runners around the country died while running marathons or half-marathons. Six of them were younger than 40. Central Oregon has seen its own share of athletes who have died suddenly while running. The death of endurance athlete Steve Larsen, who collapsed on a training run last year, stunned the community, as did the sudden death of Culver football star Matt Zachary, who died in 2008. These deaths bewilder not just because they are tragedies but also because they seem so improbable. Those who succumbed appeared young, vibrant and healthy. Deaths during running events are rare, but they happen because of a little-discussed paradox: While running lowers your overall risk of heart disease and death, it raises your risk of death while you are doing it. During a run, the strain on the heart bumps you into a higher risk category. Running long distances can induce particular stress. Runners, said Dr. Rick Koch, a cardiologist at Bend Memorial Clinic, “are putting themselves at less risk long-term.
In 2009, local athlete Steve Larsen (left, in 2008) collapsed while running and, at age 39, died of sudden cardiac arrest. ANDY TULLIS
Page 14
HIGH DESERT PULSE • WINTER / SPRING 2010
the risk? THE ASSOCIATED PRESS
However, if you have an unfavorable general profile and coronary disease you’re not aware of, you are … going to unmask the risk you have.” Dr. William Roberts, a professor in the department of family medicine at the University of Minnesota who has studied the effect of running on the heart, put it more bluntly: “There is a risk to running that includes sudden death.”
Running and the heart
THE ASSOCIATED PRESS Above, a runner is treated during the 2007 Chicago Marathon. Out of the 500,000 or so people who run in marathons across the U.S. in a typical year, about seven people will die. Central Oregon has seen its own share of athletes who have died suddenly while running.
HIGH DESERT PULSE • WINTER / SPRING 2010
When you run, you get the heart muscle moving. It pumps faster, sending your blood pressure higher. Blood flows quickly from the heart to the lungs and back again, working to keep your body’s cells supplied with oxygen. Many times, this increased action is noticeable. Stop after climbing a hill, shoveling snow or sprinting a block and you’ll feel your heart trying to catch up. We often think very little of a temporarily increased heart rate, or even revel in the quick burst of energy. We typically don’t appreciate that pushing the heart muscle can strain it, and that strain can cause heart attacks or even death. Cardiac deaths during marathons or half-marathons are rare. Exact numbers are hard to come by, though in a typical year about six or seven people will die in American marathons, said Roberts, who tracks marathon deaths. Between 400,000 and 500,000 people run marathons each year in the U.S. The increased risk doesn’t mean people shouldn’t do marathons, doctors say. Hundreds of thousands of people complete them successfully every year. But a marathon will not make you healthier than casual running, said Roberts, a marathoner himself. “I emphasize to marathon runners that they are doing this because they
Page 15
Fitness | LONG-DISTANCE RUNNING
“It’s not that you can’t exercise. It’s just that you may need a consultation.” Dr. Rick Koch, cardiologist, Bend Memorial Clinic
want to, not because there is any health benefit that is more than running three to five miles a day.” Still, Roberts said marathon running is not detrimental to health, though it can exacerbate an underlying heart condition. Younger runners who die most often have a congenital condition, and older runners often have coronary artery disease, a narrowing of the arteries around the heart.
Young athletes When people younger than 30 die while running, it is often due to a congenital condition called hypertropic cardiomyopathy. The condition is caused by an abnormal gene, said Dr. Mike Widmer, a cardiologist at Heart Center Cardiology in Bend. That gene causes the walls of the heart to become thicker than they otherwise would, which interferes with the flow of blood
MARATHON RUNNING WORLDWIDE 1,308,410 Number of marathon finishers in races worldwide
1,210,322
1,004,346
780,390 640,373 554,200
217,570
358,317
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 Source: Association of Road Racing Statisticians 2009 GREG CROSS
Page 16
through the heart. In addition, people with hypertropic cardiomyopathy (or HCM) can have electrical problems in the heart, said Widmer. Electrical signals, he said, become discombobulated. “If it lasts long enough, it degenerates into electrical chaos and can lead to ventricle fibrillation, which can be lethal.” HCM killed Matt Zachary, according to the teen’s autopsy report. When a person with HCM exercises, the stress on the heart may overwhelm an already weak system. Athletes with HCM are at an increased risk of death compared with those who are sedentary, said Widmer. “The risk of sudden death with an athlete who is a competitive athlete is a little higher than someone who would not be exercising.” The condition is relatively rare, occurring in about one in 500 people, according to the American Heart Association. That, said Widmer, makes screening difficult — and costly. Each test costs $1,000, Widmer said, so to find one case of HCM you have to spend, on average, $500,000. “It’s very expensive to try to pick out these needles in a haystack.” In Italy, all competitive athletes must be screened for heart problems, including HCM. According to an article in the Journal of the American Medical Association, the number of cardiac deaths decreased significantly after the screening program began. Widmer and other physicians from the Heart Center assist The Heart Institute of the Cascades, a nonprofit organization that offers free screenings for students in grades six through 12 in Central Oregon. The scans test for congenital heart abnormalities, including HCM. However, for weekend warriors and amateur athletes, there often is no sign they have the condition. That means many people may be walking around without knowing they have it. Some may never
HIGH DESERT PULSE • WINTER / SPRING 2010
DEATH AND YOUNG ATHLETES Sudden cardiac arrest, a leading killer of athletes younger than 30, results mostly from a congenital heart abnormality.
What happens Life-threatening arrhythmias
1. Abnormal
Left atrium
electrical signal from sino-astrial node Right atrium
2. Signal conducted
Left ventricle
through atria, stimulates faster contradictions Right ventricle
3. Abnormal
Chaotic rhythm, ventricular fibrillation
Can cause heart to stop beating
• 90% of affected athletes collapse with arrhythmia during or right after training or competition, with death quickly following. • Usually, the athlete has no symptom before death.
Main causes Cardiac abnormalities • Hypertrophic cardiomyopathy (thickened heart muscle) 46% • Anomalous origin in left main coronary artery 10% • Inflamed heart muscle 6% • Other anomalies
28%
Source: American Heart Association, Journal of Athletic Training, Pulse staff research © McClatchy-Tribune News Service
know. For some, the first symptom may be sudden death.
Older athletes Athletes older than 40 who die while running usually succumb to coronary artery disease, a condition much more common than HCM. Coronary artery disease is the leading cause of death in the United States. Runners are not more likely to develop coronary artery disease than nonathletes. In fact, because of their typically healthy lifestyles, they may be at lower risk. How-
HIGH DESERT PULSE • WINTER / SPRING 2010
People who have any of the following should consider physician consultation before exercising: • Chest pain during exertion • Unexplained fainting or near fainting • Excessive shortness of breath or fatigue with exercise
electrical signal from atrio-ventricular node
Rapid rhythm, ventricular tachycardia
!
RISK FACTORS
Enlargement of the heart muscle
• Cardiac concussion (chest trauma) • Drug-related arrhythmia 10%
• Diagnosed heart murmur • High systolic (top number) blood pressure • A family member who died suddenly from heart disease or had an unexpected serious cardiac event before age 50 • A family member with known cardiac abnormalities such as cardiomyopathy, Marfan syndrome or arrhythmias
ever, if it does develop, they can be at higher risk of sudden death during runs, because of the way coronary artery disease can kill. In people who have coronary artery disease, the arteries that carry blood to the heart narrow, usually because of the buildup of plaque along the artery walls. If the plaque becomes dislodged, the resulting clot can block those arteries completely, stopping the flow of blood to the heart and causing it to stop beating. For the heart to work properly, the arteries have to flex, said Dr. Paul Thompson,
Page 17
Fitness | LONG-DISTANCE RUNNING director of cardiology at Hartford Hospital in Connecticut and a national expert on sudden death in marathoners. During exercise, as the heart muscle contracts quickly, those arteries bend back and forth more vigorously. Plaque may become dislodged more easily, he said. “Then you bought the farm.” The number of older adults running marathons has increased in the past decade, Thompson said, which makes these deaths more common. Older people who begin an exercise program for the first time may not know they are at risk.
Protecting yourself So, if you do dream of running a marathon, or running another marathon, what can you do? Doctors say there are ways to protect yourself. The first is to ask yourself if you have any reason to suspect that you might have heart disease (See “Risk Factors” on Page 17). If you do have risk factors for heart disease, don’t panic. You can still run, doctors say. “It puts you at an increased risk,” for heart attack, said Koch. “It’s not that you can’t exercise. It’s just that you may need a consultation.” Also, you need to look at how you feel while you are exercising. Symptoms that come on with exercise may be a sign of a larger problem, said Thompson. “Any discomfort from the ear lobes to the belly button that comes on with exercise and
“Any discomfort from the ear lobes to the belly button that comes on with exercise and goes away with rest is a reason to talk to a doctor.” Dr. Paul Thompson, director of cardiology, Hartford Hospital, Connecticut
goes away with rest is a reason to talk to a doctor.” Symptoms of heart problems can be elusive. Often heart disease is felt as chest pressure, but sometimes the first symptoms are stomach or even jaw pain. Likewise, if exercise feels harder than it was previously, it may mean something is going on. If you are more short of breath with the same level of activity, said Widmer, you should talk to a doctor. “Someone who says ‘I’ve been walking up Pilot Butte every day for the past four years; now I can’t get halfway up without huffing and puffing’ may have heart disease.” Young people who become dizzy or pass out during exercise should also see a doctor, said Widmer. “That’s a big red flag” for HCM. During a race, these types of symptoms should signal to a runner that he or she needs to get help. Someone who has chest pressure, said Roberts, should stop and seek help, even if the pressure lessens when they walk. “Get help,” he said. “Not stop, rest
CASCADE PULMONARY CLINIC
and start again.” There are some people who will die during a run no matter how much prevention is done and how educated they are about the risks, doctors say. Roberts, who manages medical tents during some marathons, says he has seen participants who died so suddenly that they didn’t get their hands up to break the fall. Some of them, too, had been checked recently and given a clean bill of health. Roberts said he knows of at least two men who died during a run who had had a clean stress test within a month of their events. “There’s no symptoms at all.” Still, some deaths could be prevented with better education about the risks and more promotion of a doctor’s visit before beginning a training program. If you have never run and want to start, or if you want to up your intensity significantly, it’s probably a good idea to at least let your doctor know. “No one forces you to get screened before you go out and do the Dirty Half,” said Koch. “We need to have more awareness of that.” •
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How does she do it? |
JUDY STIEGLER
Legislating a fitness regimen A common-sense approach is this representative’s policy BY MARNETTE FEDERIS
F
JOHN KLICKER
Rep. Judy Stiegler says her bout with cancer has made her appreciative of her health. “Part of that appreciation is trying to make sure that I’m doing things that are going to be conducive to me continuing to wake up every morning.”
JUDY STIEGLER Age: 56 Occupation: State representative Activities: Biking, gym workouts Setbacks: Cancer diagnosis Health advantages: Fresh vegetables from an ambitious family garden and fresh game from her husband’s hunting Splurges: Going out for dinner
HIGH DESERT PULSE • WINTER / SPRING 2010
itting in a workout can be a challenge for anyone with a busy work schedule. But it’s even tougher for a politician, when days are jampacked and work hours stretch past the norm of 9-to-5. Take Democratic state Rep. Judy Stiegler, of Bend. She says she aims to go to the gym at least four times a week. But last year, during her first legislative session, working out was easier said than done. The freshman legislator did get advice from a fellow lawmaker: Always take the stairs. “My office was on the fourth floor, so I had to go up four flights of stairs. If nothing else, my calves were in good shape,” said the energetic Stiegler. For six months of last year, five days a week, Stiegler’s life revolved around the massive granite building in Salem, the state Capitol. If there was time for a workout, it was in a small gym at the motel where she stayed on weekdays. Stiegler says her routine usually lasts 45 minutes, at least half an hour on the treadmill and the rest of the time on weight-training machines. The 56-year-old admits that because of committee meetings, appointments and the other duties as a state lawmaker (not to mention the more than two-hour, twice-a-week trek to get from Bend to Salem), she was not as vigilant in sticking to her usual exercise routine. For this year’s session, she plans on carving out the time to do more for her physical health. “You have to be deliberate about it,” she said. Stiegler says that when she doesn’t get to exercise as much, it’s usually apparent in both her attitude and the way she feels. And she realized during those hectic months that it’s essential to take the time to take care of one’s health and to eat properly. “My career has always been really stressful, and it was probably over a course of many years when it all became apparent that the mind, the body, it’s all interconnected, physical ramifications, very crystal clear,” she said. “Health is a balance, it’s a balance in what you do in life, how you approach things. Being a healthy person is about being in some kind
Page 19
How does she do it? | JUDY STIEGLER of balance,” she said. Stiegler knows firsthand about the importance of health. In 1999, she was diagnosed with breast cancer. The experience, she said, made her more in-tune with her body and more appreciative of what it means to be healthy. “Part of that appreciation is trying to make sure that I’m doing things that are going to be conducive to me continuing to wake up every morning,” she said. When it comes to sticking with a healthy diet, Stiegler says she adheres to a common-sense approach. She also has a registered dietitian sister in Colorado she can call with questions about foods. It also helps that she and her husband, Deschutes County District Attorney Mike Dugan, grow a substantial garden that provides a variety of vegetables depending on the season, from Brussels sprouts to cabbage to tomatoes. And sometimes, thanks to her husband’s hunting, her freezer can be found stocked with wild game like elk, pheasant or geese. As someone who also has high cholesterol, Stiegler says she takes even greater care of her diet. “I’m much more aware of the types of things I could do to contribute to keeping my cholesterol level low,” she said. “The diagnosis made me think, ‘OK, here’s something I can control or something that I can help control.’” Fitness has always been a part of Stiegler’s life. Years ago, she found it was a useful tool in helping her get away from the stresses
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ANDY TULLIS
Judy Stiegler’s devotion to her garden pays off in fresh vegetables a good bit of the year. Above, Stiegler makes a meal from the last of the squash from her garden, in December .
of her academics. There was ballet, which she started taking in college, because she enjoyed dance. Then there was swimming. And while she studied for her law degree at Lewis and Clark University, she took up running. The habit of exercise stuck with her, although the details have changed. In the summer, bike riding with her husband complements gym work. “As an adult, (physical activity) is so different from everything else that I do — I’ve always been one of those behind-the-desk people,” Stiegler said. •
Picture this | ITCH
skın Getting under your
Until recently, the sensation we call itch was thought to be a less intense version of pain. Recent research has shown, however, that although related, the sensations are transmitted to the brain differently.
Pruritis: fancy name for itch The itch response, called pruritis, is usually a reaction to a potentially harmful irritant.
3
1 When some external stimuli such as an insect or particle of dust comes into contact with the skin, cells release an immune-response chemical called histamine. 2 This histamine causes nerve cells to fire signals to the spinal cord... 3 4
...which carries them to the cerebral cortex.
The brain then initiates the scratch reflex, which is intended to remove the irritant.
4
2 1
Some chronic, severe itching does not appear to be linked to histamine. More than 50 diseases, including shingles, AIDS, gallbladder problems and Hodgkin’s disease, have been associated with chronic itching. In many cases, it is not clear what purpose the scratch response serves. For many years, it was thought that the itch and pain signals traveled from the nerve endings in the skin to the brain along the same pathway. Recent research, however, has identified nerve cells responsible for signaling itch but not pain. This new information may lead to treatment for patients who suffer from chronic itching.
WHY DOES SCRATCHING RELIEVE AN ITCH? 1 Scratching removes potential irritants from the skin, thus interrupting the histamine response and reducing the itch signal.
2 Although pain and itch appear to take separate pathways to the brain, they are closely related. The sensation of pain overrides the sensation of itch, so the minor pain induced by scratching the skin also overrides the itch signal. — ANDY ZEIGERT
Sources: Archives of Dermatology, HowStuffWorks.com, National Institutes of Health
HIGH DESERT PULSE • WINTER / SPRING 2010
Page 21
What we watch | TV MEDICINE
Programmed diagnosis The shows you and your doc watch may influence your treatment BY MARKIAN HAWRYLUK
T
he reality of today’s health care system is that the average American probably spends much more time with fictional television doctors than with his or her own primary care physician. From “Ben Casey” and “Dr. Kildare” in the ’60s, “Marcus Welby” and “M*A*S*H” in the ’70s, “St. Elsewhere” and “Trapper John, M.D.” in the ’80s, “ER” in the ’90s, to “House” and “Scrubs” today, medicine has been a staple of television drama and comedy. Undoubtedly, many viewers get their notions about medicine from watching these programs. But ask a doctor which one is most accurate, and most will say they don’t watch any
of those shows. “The medical drama unfortunately does play out on a day-to-day basis, and after you’ve gone to work and seen all this (stuff), the last thing you want to do is go home and watch it,” said Dr. David Dedrick, a pulmonologist with the High Desert Sleep Center in Bend. Doctors also cringe at watching many of today’s medical shows because the details are so unrealistic. TV doctors spend all of their time on one case, displaying a universal expertise in every specialty. Patients are invariably revived when their hearts stop, and the emergency room is full of the rarest diseases on a daily basis. Treating nose bleeds or indigestion, or filling out paperwork for insurance companies, just doesn’t make for good drama.
Although medical shows use physicians as writers and consultants, doctors say the episodes are rife with bad technique and medical misinformation. “Invariably when they look at a chest Xray, they’re holding it up backwards,” said Dr. Ed Boyle, a cardiothoracic surgeon with Inovia Vein Specialty Center in Bend. And the doctors themselves get away with things that would get most doctors fired. Dr. House, a megalomaniac who breaks all the ethical and legal rules to cure his patients and feed his ego, wouldn’t survive a week in most hospital systems. “Isn’t he supposed to be addicted to Vicodin?” Boyle asked in disbelief. But doctors acknowledge that medical
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“People expect us to be House, or to be in and out of the emergency room in 15 minutes. That’s the reality they see on TV.” Dr. William Reed, an emergency room physician at St. Charles-Bend
shows change the way people perceive doctors and the medical system. “People expect us to be House, or to be in and out of the emergency room in 15 minutes. That’s the reality they see on TV,” said Dr. William Reed, an emergency room physician at St. Charles-Bend. “It distorts expectations, which is in part our problem in not helping influence those shows, and in another sense, to re-establish people’s expectations when they show up.”
Educational programming In recent years, public health officials have tapped into the educational power of medical dramas. In 2008, officials from the Kaiser Family Foundation asked the produc-
ers of “Grey’s Anatomy” to write in a storyline about an HIV-positive pregnant women. Random surveys found that the awareness that HIV transmission from mother to baby can be prevented increased from 15 to 61 percent of viewers after the airing. “For better or for worse, viewers do absorb the health information they see on TV, so it’s important for these shows to get it right,” said Victoria Rideout, director of the Program for the Study of Media and Health at the Kaiser Family Foundation. Reed said patients often suspect they have a certain condition, no matter how rare, when they recognize a symptom on television. (It still doesn’t compare to the frequency of patients “diagnosing” themselves off the Internet.) But that can be both a help and a hindrance to doctors. “It gets people familiar with the terms or understanding the physiology, because sometimes it’s explained better or it’s easier to understand on TV. So you’re not starting from scratch,” he said. “On the other hand, you can tunnel-vision down on something, when you need to come back 40 or 50 steps, and start at the beginning and see that you chose the wrong path there in your thought process.” Of more concern is that young doctors might also be influenced by medical TV programming. When University of Alberta
ILLUSTRATION; SCENES COURTESY NBC (2) AND FOX; TVS FROM JUPITERIMAGES
Medical School professors noticed several students didn’t know how to properly insert a breathing tube, they inquired where they had learned their technique. Several students said they had learned the skill, normally taught during emergency medicine or anesthesia rotations, from TV shows. The professors then reviewed two seasons of “ER” to observe intubation techniques, and found that despite showing the procedure 22 times, “ER” never showed the correct method. “While few would suggest that medical dramas can be held responsible for physician performance, it has been previously suggested that they can significantly influence beliefs,” Dr. Peter Brindley, the professor who led the study, and his colleagues wrote. Meanwhile, a survey conducted at Johns Hopkins University found that 84 percent of medical students regularly watched medical dramas. A study conducted at Indiana Univer-
What we watch | TV MEDICINE sity found that after “ER” premiered in 1994, applications by fourth-year medical students to emergency medicine residency programs doubled. Throughout the nation, emergency medicine programs became much more competitive after the show debuted.
Teaching ethics
YOUR GUIDE TO
While medical school professors hope medical students aren’t learning the practice of medicine from the shows, they have found the shows to be a great resources in teaching doctors about the ethics of medicine. Medical dramas often focus on the ethical dilemmas doctors face because of the inherent drama involved. Jeffrey Spike, a bioethicist with Florida State University, recently argued that medical TV shows are closer to real-life experiences than the hypothetical scenarios predominantly used to teach bioethics in medical schools. “Even when the medicine is inaccurately portrayed on TV, the medicine is not what matters the most in terms of conveying the ethical issues,” Spike wrote in the American Journal of Bioethics. The show Spike believes is most effective is “Scrubs,” an off-the-wall comedy following several doctors through their residencies. Spike cites a 2003 episode, “My Fifteen Seconds,” that focused on the length of time doctors listened to patients before interrupting them. It aired after a study showed most physicians interrupt after only 12 to 18 seconds.
“For better or for worse, viewers do absorb the health information they see on TV, so it’s important for these shows to get it right.” Victoria Rideout, director of the Program for the Study of Media and Health at the Kaiser Family Foundation
The show featured a stopwatch running at the bottom of the screen as the patients talked, stopping when the doctor broke in or left the room. “The conversation is so realistic that one hears the natural hospital rhythm of their speech, and sees how the physicians who are in charge of the conversation sense when they have the information they want, or have given the information they wanted to impart, and then they cut off the conversation and exit abruptly,” Spike said. The classic format of television shows, he said, is a morality tale. Characters who act badly learn their lesson by the end of the show. When the lead character almost loses a patient because of his reliance more on medical tests than on good doctor-patient communication, the lesson is learned. “As a morality tale, the episode teaches a very important clinical skill as well as an ethical lesson all medical students should learn,” Spike said. Other episodes of the comedy have focused on such quandaries as making and admitting mistakes, being sued or being overly aggressive in interventions. The show has dealt with the influence of drug industry representatives or how hospitals treat uninsured or drug-seeking patients.
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It is both the reality and the comedy of the show that makes it one of the few that doctors admit watching. “It’s the only one that I watch,” Dedrick said. “‘Scrubs’ is so interesting; it’s such medical and dark humor. They say all of the things that we’re thinking. I think in that sense, it’s much more entertaining for us. It’s much more of a relief.” The gallows humor strikes a chord with many doctors, who often engage in similar behavior themselves. “We use the comedy piece in one sense, which sometimes can be taken out of context, particularly if people overhear it, and not understand what’s going on,” Reed said. Many of the doctors in practice today grew up watching shows like “M*A*S*H,” where the army surgeons used jokes and humor to diffuse the tension in the operating room. “We do that a lot, mostly movie quotes from the classics, ‘Animal House,’ ‘Fletch’ or ‘Princess Bride,’ that kind of stuff,” he said. Spike said shows like “Scrubs” can be an effective way of driving the message home for young doctors, or raising issues for further discussion, without seeming overly preachy or moralistic. “My advice to the faculty and the students,” Spike concluded, “is watch more TV.” •
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Preventive medicine THE EFFICACY OF BODY SCANS
Unclear picture They promise to detect, even prevent, health issues. But do body scans work? BY BETSY Q. CLIFF
“A
Body Scan Can Save Your Life!” So proclaims an orange flier posted around Central Oregon several times a year. It advertises early detection of fatal diseases including stroke, heart disease and cancer using painless scans. It promises prevention of some of our biggest health worries. And all for just a few hundred dollars or less. Sounds too good to be true. Is it? The answer, as is typical with medical questions, is complicated. The scans may find a medical abnormality. That abnormality could be something that needs treatment. And that treatment may make you healthier or, perhaps, prolong your life. But doctors say the chances of that sequence happening because of a preventive ultrasound scan are slim. One reason is the quality of the screenings themselves could be inferior because companies that offer mobile ultrasounds do not go through the same standards tests as medical centers. Another is that these companies screen for some diseases that doctors say are not easily detected through ultrasound scans. Still, even if the screen is good and a disease could be detected, the primary issue is how much the knowledge you gain will benefit your health. Experts say it’s probably less than you think. “The American culture is, ‘Of course I want to know.’ So rather than understanding the benefits and risks, we fall into, ‘I just want to know,’” said Dr. Ned Calonge, chair of the U.S. Preventive Services Task Force, a national organization that studies and makes recommendations on preventive medicine. “To be honest, we’ve oversold screening.”
The organizations At least two organizations conduct ultrasound screenings in Bend: Ultra Life Inc., based in Orange County, Calif., and HealthScreens, which is run by a nonprofit corporation called the Gerontology
HIGH DESERT PULSE • WINTER / SPRING
SUBMITTED PHOTOS
“We want to see people who are interested in seeing what’s inside their veins or organs ... people interested in taking a peek.” Warren Green of Ultra Life Inc., a California-based company that holds screening sessions in Bend
Research Foundation, based near Phoenix. Ultra Life has been in operation since 1985, according to the company’s Web site. The company comes to Bend about three times a year, according to Warren Green, an owner. Often, it does screenings in hotels in Bend. “We want to see people who are interested in seeing what’s inside their veins or organs,” said Green. “This is strictly prevention, people interested in taking a peek.” The Gerontology Research Foundation was founded in 1986, according to the company’s Web site. In 2007, it had a total revenue of nearly $1 million, according to documents filed with the Internal Revenue Service. HealthScreens has rented space from St. Francis of
Page 25
Preventive medicine | THE EFFICACY OF BODY SCANS Assisi Catholic Church on 27th Street for at least one screening. “There’s a lot of people running around with health issues they don’t even know about,” said Marketing Director Greg Dole. “People generally don’t have the opportunity to have this testing done until they have symptoms and then … they spend a fortune.” Both companies charge about $50 for individual tests and offer packages of multiple screenings at a range of prices, from $150 to $500. Most people get one of the packages, said both Green and Dole. At Ultra Life, the most popular screening is the $275 heart/ stroke scan, which includes an echocardiogram of the heart, a scan of the carotid arteries in the neck and several other scans to look for abnormalities in the legs and abdomen. The most common single screen that people get at HealthScreens is the $50 stroke screening. Insurance rarely, if ever, covers these screenings. Most are not recommended by profes-
sional medical organizations, and the screens are done without orders from a physician.
Screening quality Judging the quality of an ultrasound is no easy task. Ultrasound facilities, equipment, technicians and the physicians who read ultrasounds can all be accredited by various organizations. Looking for accreditation is one way to ensure the scan meets a certain level of accuracy. Ultra Life and HealthScreens say they use only certified ultrasound technicians. However, neither has a facility accreditation from a major national organization, and only one uses physicians to read the scans. “We don’t have to be licensed or whatever,” said Dole. “Probably not,” said Green, when asked whether his facility was accredited. “You’re the first one that’s ever asked me that.” A facility accreditation ensures that qualified professionals conduct the scans and that the machines used in the screening have been surveyed and are working prop-
erly, said Shawn Farley, director of public affairs for the American College of Radiology, near Washington, D.C., which performs the accreditation around the country. In Central Oregon, Cascade Medical Imaging, Inovia Vein Specialty Center and Bend Memorial Clinic are accredited by the college. Ultra Life, but not HealthScreens, has physicians look at the ultrasound scan for disease. HealthScreens said it is not necessary; experts said not having a doctor look at the scan may mean important details are missed. “Our view is that we are doing a screening; we are not doing diagnostic testing,” said Dole of HealthScreens. “We are providing information from a technician.” Dole also said that not having a physician look at the scans keeps prices down. Others, however, said doctors are necessary to ensure a proper reading. “Technicians are not trained to interpret,” said Dr. Gretchen Gooding, a professor emeritus in the Department of Radiology at the University of California, San Francisco. If a doctor wasn’t reading the scan, she said, “I would be leery about it.”
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Our focus is on you
“The American culture is, ‘Of course I want to know.’ So rather than understanding the benefits and risks, we fall into, ‘I just want to know.’” Dr. Ned Calonge, chair of the U.S. Preventive Services Task Force, which studies preventive medicine
Risks and benefits Putting aside the issue of quality, there is a real question as to whether the screens have any benefit. Experts say people may not get as much out of a screen as they think they will and that there are more risks to the screening, often from a false positive result, than people realize when they sign up. The Preventive Services Task Force recommends just one test — the abdominal aortic artery scan — but only for a select group: men between 65 and 75 who have smoked cigarettes. For many other scans, including those for
pancreatic cancer, ovarian cancer and peripheral artery disease, the board has found that the risks of screening outweigh the benefits. “Five things can happen when you provide a screening test, and four of them are bad,” said Calonge, chair of the task force. • Result 1: A false positive. The scan may find something that might be harmful and you’re sent for further testing. The carotid artery scan, for example, has “many false-positive results” according to the task force recommendation against routine screening. If something is found, said Calonge, the next step is an angiogram, in
which dye is shot into the neck. “That carries a risk of stroke, so that’s a real harm.” Heart scans, too, often find something, said Dr. Bruce McLellan, a cardiologist at Heart Center Cardiology in Bend. An echocardiogram, he said, “is very, very good at seeing even a mild amount of leakage,” he said. “Almost everyone has a mild amount of leakage. That doesn’t mean they are unhealthy.” McLellan said he would not recommend the procedure for people who are not experiencing heart disease symptoms. Follow-up testing for screens, particularly cancer screens, often involve invasive biopsies or a string of tests to try to find the cause of the abnormality. Even when these tests don’t carry physical risks, they often cost a lot and cause anxiety as a patient struggles to find out if the abnormality is serious. • Result 2: A false negative. You may have something harmful, but the scan misses it. That, said Calonge, leads to a false sense of security and, perhaps, to a nonchalance about symptoms. “There might be a symptom (of stroke),” he said. “But you are falsely
February 14-21
PULSE Family WEEK 7 DAYS OF FUN AT THE
TOWER!
Family friendly entertainment and educational activities -- especially for elementary aged kids -- all about active lifestyles and healthy choices.
MONDAY, FEB. 15 – 9 A.M. – CASCADES ACADEMY PLAY WITH THE PLAYERS
HAPPILY EVER AFTER … A CINDERELLA TALE
A creative “informance” and acting “workout” with the Pushcart Players. Limit: 20 students. FREE!
TUESDAY, FEB. 16 – 4-8 P.M. – TOWER THEATRE BEND PARKS & REC SHOWCASE Drop in and see some of the area’s most energetic young people (and their teachers) demonstrate skills from ju-jitsu to gymnastics. FREE!
THURSDAY, FEB. 18 – 4:30 P.M. – BOYS & GIRLS CLUB GYM FABULOUS FEATS An after school family fun workshop with “The Tweaksters” (Julia Snyder and Regan Patno). Laugh, giggle, dash and wiggle with games, races, balancing acts and stage props. FREE!
FRIDAY, FEB. 19 – 7 P.M. – TOWER THEATRE FLY AWAY HOME Jeff Daniels and Anna Paquin star in this award-winning film as a father and his 14-year-old daughter who decide to lead a flock of abandoned geese south for the winter. Rated PG
SUNDAY, FEB. 21 – 2 P.M. – TOWER THEATRE THE TWEAKSTERS Sometimes called “Blue Man Group without the paint,” the Tweaksters use strength, balance, and glow-in-the-dark illusions to athletically juggle flower pots, ropes and pipes –- even each other!
$10 adults -- $7.50 children Tickets & Info: 541-317-0700 or visit TowerTheatre.org FRIENDS OF THE
THE TWEAKSTERS
Preventive medicine | THE EFFICACY OF BODY SCANS WWW.GETAWAYSTRAVEL.NET reassured so you don’t worry about it.” Ultrasound scans are not good at picking up some of the diseases that Ultra Life and HealthScreens say they scan for, doctors said. Such screenings may be particularly prone to false negatives and a false sense of confidence about your health. • Result 3: Overdiagnosis. This is the idea that, even if you find something, it may not need treatment. An abnormality could be found, and it could even be something significant, like cancer. But the disease may never progress. It may never harm you at all. For example, a thyroid scan may detect a mass, said Dr. Stephen Shultz, a radiologist at Central Oregon Radiology Associates, but it’s unlikely to turn out to be dangerous. “Some people may have a dozen (thyroid nodules) and they are completely benign,” he said. “We detect them incidentally all the time.” Even if they are cancerous, he said, thyroid cancer tends to be very slow-growing. “Waiting until they are symptomatic to (treat) doesn’t really harm the patient.” • Result 4: Something is found, and untreatable. Finding an abnormality in some cases, Calonge said, doesn’t change the course of your health. In this scenario, the screen finds something, but the treatment is futile and cannot extend your life. With pancreatic cancer, for example, a screen may find a mass. But pancreatic cancer is one of the harder cancers to treat, even with early detection. Often, even when it’s found on a scan, there is little a doctor can do. The result is that patients find out about an issue earlier than they might have, but they do not actually live longer. “There’s something called lead-time bias,” said Calonge. “If you get pancreatic cancer and it’s going to kill you in five years, but you wouldn’t know you had it, it makes it appear as if you’ve lived for four extra years, when all I’ve done is give the diagnosis four years before you otherwise would have known.” In that way, Calonge said, screening can appear more beneficial than it actually is.
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• Result 5: Bingo! The screen finds something you can do something about. This, of course, is the goal, but it is often elusive. That, said Calonge, is why screening tests are recommended only for certain diseases or for certain groups of people. Often, the risks outweigh the benefits.
Value of knowledge “We’re all still trying to understand the real health value of knowledge,” said Calonge. How helpful is it to learn you have a leaky heart valve? A thyroid nodule? Even pancreatic cancer? In the end, the decision is personal. Still, experts say people who do opt for the screenings should go in with a full understanding of the risks and benefits. “I understand that a lot of people do (screening tests) at their own expense, and they certainly have a right to do that,” said Calonge. “But it’s wrong to do without telling them the downside of that knowledge.” •
HIGH DESERT PULSE • WINTER / SPRING 2010
Page 29
Healthy day |
WINTER WELLNESS
Big breakfasts, fresh dinners and ways to burn the calories in between
Eat up, get going BY BETSY Q. CLIFF
Getting outside in the winter can be daunting. It’s cold, the roads are bad and you’ve got to get the family geared up for even a short outing. Yet winter can be one of the most rewarding times to get outside. Here’s a day that will let you take advantage of the cold weather without too much fuss.
1. Begin your day with a breakfast burrito (small $5, large $5.50) from Longboard Louie’s, where you get lots of calorie bang for your buck. The tortilla stuffed with eggs, hash browns, beans and a choice of other toppings is not exactly light fare. But nutritionists say a light breakfast isn’t always the most healthful strategy. Eating fewer calories at breakfast can lead to binges at the end of the day, said Carol Schrader, a registered dietitian at St. Charles Bend. Eating a larger, energy-dense breakfast, she said, can help people feel full and actually lead to fewer calories consumed throughout the day. “It balances out,” she said. (Longboard Louie’s has two locations in Bend: 62080 Dean Swift Road, 541-383-5889; 1254 N.W. Galveston Ave., 541-383-2449. Opens at 7 a.m. weekdays, 8 a.m. weekends.)
BETSY Q. CLIFF
2. Go snowshoeing. Get out on the winter trails for a great hassle-free workout. Snowshoeing takes little more skill than walking and offers fitness benefits, burning about 500 calories an hour. Skip the crowded sno-parks on the Cascade Lakes Highway and head to the Skyliner Sno-park, near the end of Skyliners Road west of Bend. There are several trails that begin here. One popular route heads up Tumalo Creek for several miles; a shorter route, known as the West Loop, meanders through a lovely pine forest. No snowshoes of your own? Rent at most ski shops for about $10 to $15 per day for children or adults. If you want an arm workout, make sure to grab a set of poles, too. (You do not need a sno-park pass or other permit for this area, and dogs are allowed. More information can be found at www.fs.fed.us/r6/centraloregon. Click on Recreational Activities, then Winter Recreation, then, on the right, Winter Recreation Areas. Click Name and you will see “Skyliner Area” listed on the page.)
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3. After your snowshoe workout, relax with a massage.
FF
Though rigorous studies on the health benefits of massage are limited, it may help increase circulation, relieve pain and decrease blood pressure, according to the National Institutes of Health. Regardless of the concrete health benefits, it’s nearly certain to ease sore muscles and wipe away stress. There are many places to get a massage in Central Oregon, from large spas and resorts to small offices with a single massage therapist. Most charge about $50 to $70 for an hour. For a cheaper option, try the student clinics at Sage School of Massage ($25) or, when clinics begin in March, at Central Oregon Community College ($15). (Sage School of Massage, 369 N.E. Revere Ave., Bend, 541-383-2122; COCC, 2600 N.W. College Way, Bend, 541-318-3756. Appointments necessary at both schools.)
4. After a big day out, come home for a healthy meal. Even in winter, it’s possible to get fresh produce. Try this recipe, courtesy of The Produce Patch, a year-round farmers market on Bend’s east side (400 S.E. 2nd St., 541-306-3262).
ANDY TULLIS
SAUSAGE-STUFFED WINTER SQUASH 2 winter squash, such as sweet dumpling, carnival, buttercup, butternut or acorn 1 TBS butter 1 ⁄2 C diced bell pepper 2 green onions
1 lb bulk sausage 1 C bread crumbs 1 ⁄2 C beef broth 1 ⁄2 tsp pepper 1 ⁄4 tsp salt 2 ⁄3 C molasses
Preheat the oven to 400 degrees. Cut squash in half for a total of 4 pieces. Scoop out seeds and fibers. Arrange on a baking sheet. Melt butter in a nonstick skillet over medium heat. Add bell pepper and green onion. Sauté until tender, about three minutes. Transfer to a bowl to cool. Mix in sausage (uncooked), bread crumbs, broth, pepper and salt. Mound sausage mixture in the center of each piece of squash. Brush with half of molasses. Bake 15 minutes. Brush with remaining molasses and bake until squash is tender and sausage is cooked, about 25 minutes. Serves 4.
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On the job |
SALESMAN IN THE O.R.
Dan Richwine with a cart of the equipment he supplies to surgeons at Cascades SurgiCenter in Bend.
PETE ERICKSON
Is there a salesman in the house? Medical device reps are at home in the operating room BY MARNETTE FEDERIS
I
nside the operating room to repair a torn ACL or to adjust a rotator cuff, a surgeon, scrub tech and other medical personnel gather around a patient. And standing about 18 to 20 inches away, calling out tips to the surgeon, is Dan Richwine. He is not a doctor or medical technician. Instead, Richwine, 37, is a salesman for a medical device company. And for him and other company representatives who sell and distribute medical devices, spending time in operating rooms is just part of the job. In fact, they spend most of their workweek standing side by side with a medical team, acting as consultants during the procedures. As the sellers of the devices — such as artificial knees or hips, screws, suture anchors and other medical implants — Richwine says representatives like him know how the products work best. “We ourselves see the same case over and over, so you’re actually a good point of reference,” he says. Richwine covers Central Oregon for Pacific Medical Inc., which sells a variety of medical devices to fix muscular and skeletal injuries. One of the company’s most well-known product lines includes implants used to repair sports injuries. A graduate of Oregon State University who studied exercise and sports science, Richwine says he was always interested in the medical field and attempted to become a physician assistant. Instead, he ended up in medical device sales after being introduced to the field by his best friend. “From the very first day, I was hooked. I loved it because it was
Page 32
something where you feel like you’re adding value,” he said. Representatives are trained to have technical knowledge of their products, said Jim Rogers, CEO and president of the American Institute of Medical Sales. Richwine says his California-based company trains sales representatives by sending them to training sessions once a month where they work on cadavers and learn about the devices and other equipment. Richwine is also required to attend national symposiums for orthopedists to earn continuing education credits. Sales representatives are extremely helpful to surgeons, Rogers said. For example, products are constantly changing and becoming available so doctors need the representative’s expertise and knowledge to keep abreast of all the new devices. Part of Richwine’s job is to build good relationships and rapport with physicians. He said this includes being a good consultant and resource for them before as well as during surgeries. “I’m not there to tell a physician how to do something; that’s not my position. I want to respectfully throw out helpful tips that may help them facilitate the case. They’re the ones who went through the 13 years of schooling or whatnot,” he said. The job requires long hours and making sure you’re available to physicians at any hour, Richwine said. Aside from meeting with doctors, Richwine also spends time at an office where patients are fitted for braces and other orthotics. To succeed in the field, Richwine said, the key is to be extremely knowledgeable about the products. “It takes a year of building relationships and that means pounding the pavement for a year, and you’re proving to them that I will be the most accountable, dependable sales rep,” he said. •
HIGH DESERT PULSE • WINTER / SPRING 2010
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Marketed as a natural sweetener and approved just last year by the FDA. Made from a South American plant. Some studies found that derivatives of it, or certain purified chemicals within the plant, caused DNA damage in animals.
1
POP QUIZ
Sweet deal
Developed more than 100 years ago and used in many diatetic food and beverage products. Found to cause cancer in animals but not in people. About 200 to 700 times sweeter than sugar.
2
Know your sweeteners? Match pictures with facts to learn a bit about each
a
b
BY MARNETTE FEDERIS
A combination of fructose, glucose and water. Produced by bees.
4
Made by adding molasses to refined white sugar.
c
W
A sugar alcohol, meaning its chemistry is no longer sugar but a carbohydrate. Mostly used for sugar-free candy or gum.
5
e d f
6
Boiled-down maple syrup with the same chemistry as table sugar.
7
The benchmark for all sweeteners. Comes from sugar cane and sugar beets.
8
Comes from the residue of sugar cane processing.
9
Sweetness comes from combining two amino acids. Approved by the FDA in 1981.
600 times sweeter than sugar. Can be used for baking. Stimulates the taste buds fast for sweetness. Approved by the FDA in 1998.
10
g
h f. Molasses – 8 g. Honey – 3 h. Stevia – 1 i. Sorbitol – 5 j. Brown sugar – 4
i j
ANSWERS
hich type of sweetener is good for the body? Artificial or natural? Turns out, the dividing line isn’t clear. Most people consider natural sugars as those composed of chemicals found in nature. Yet many of the so-called artificial sweeteners are made from naturally occurring elements. The best way to look at sweeteners is to think of them as nutritive (meaning they have calories) or non-nutritive (very, very low in calories). Most artificial sweeteners are non-nutritive and would benefit people trying to reduce their caloric intake. Whether they’re artificial or natural, the bottom line is there’s not much value in sweeteners other than making food taste, well, sweet. And while there are claims about the hazards of artificial sweeteners, most nutritionists say FDA rules are so stringent that what is available in the market, especially those that have been around for years, are safe. So test your knowledge by matching the following facts with the correct sweetener. •
3
a. Maple syrup – 6 b. Sucralose (Splenda) – 10 c. Table sugar – 7 d. Saccharin (Sweet’N Low) – 2 e. Aspartame (NutraSweet, Equal) – 9
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Cover story | FROZEN EMBRYOS Continued from Page 10 know how long embryos can stay frozen and remain viable, but several cases have shown they have stunning durability. A woman in San Francisco gave birth to a healthy child with an embryo that had been frozen for 13 years. And a woman in Louisiana had a child from a frozen embryo rescued from a New Orleans hospital that had been flooded by Hurricane Katrina.
Abandoned embryos Dr. Craig Sweet, a reproductive endocrinologist in Fort Myers, Fla., initially held onto abandoned embryos because the guidance gave clinics only one alternative: destroy them. “I’ve never done that,” he said. “I’ve always kept them, hoping that something would happen, and something did.” That something was Kathleen Calcutt, a Tampa lawyer who shared his belief that the embryos should be treated with respect and wanted to help Sweet track down the parents who had abandoned them. They hired a private investigator to find the owners of 70 embryos and asked the couples to make a final decision. If the parents decided to destroy the embryos or donate them to the lab for training or for research, they would have to pay the clinic the unpaid storage fees. But if they agreed to implant the embryos or donate them to another couple, Sweet would waive the storage fees. “But I made it really clear, I wasn’t just pushing them in one direction,” he said. “I was pushing them so that the embryos have a chance for life.” Every one of the parents made a final designation for their embryos. Now Sweet has altered his consent forms for IVF. He no longer offers destruction of leftover embryos as an option and he informs the patients he reserves the right to take full control of their embryos if they abandon them. That could include donating them to another couple. “To the best of my knowledge, it’s never been done in this country,” Sweet said. “We don’t really want to do that; we just want people to designate. But if we get a deadbeat parent who refuses to designate, Kathleen will go after them.” Sweet read of a case in Italy where an abandoned embryo was transferred to another couple, without the genetic parents’ consent, and resulted in a live birth. But it would be extremely controversial in the U.S., as would the next step that Sweet is contemplating. He is considering reimbursing couples who donate to others $300 per embryo. “You can’t reimburse a lot, because it can’t be an inappropriate inducement. You never want to reimburse so much that anybody would create embryos for profit,” Sweet said. “But it is taboo to reimburse for embryos right now, absolutely taboo.” Sweet plans to conduct surveys of couples with frozen embryos to determine how the offer of reimbursement would affect their decision-making. “I’m wanting to have something to back me before I push the limits,” he said. “I’m not a Bible-thumper, but I thought there were enough options that I really felt it was unnecessary to destroy them. There are a lot of embryos needing families, and a lot of families that need embryos.”
HIGH DESERT PULSE • WINTER / SPRING 2010
SUBMITTED PHOTO
Dr. Craig Sweet, a reproductive endocrinologist in Fort Myers, Fla., has made it a policy to discourage people from disposing of their embryos. “I thought there were enough options that I really felt it was unnecessary to destroy them. There are a lot of embryos needing families, and a lot of families that need embryos.”
Adoption option Donation of embryos to another couple appeals in particular to those individuals convinced the embryos represent human life. Some Catholic theologians, while opposed to the concept of IVF, have argued that adoption of frozen embryos represents the rescue of an unborn child. As president, George W. Bush trumpeted embryo adoption in the midst of the debate over stem cells, even posing with a group of so-called Snowflakes, children born from donated frozen embryos. The Snowflakes program was launched in 1997 by Anaheim Hills, Calif.-based Nightline Christian Adoptions to facilitate donations of frozen embryos throughout the country. While some clinics handle embryo donation as merely a transfer of tissue, the Snowflakes program goes through the same process as a traditional adoption. Donating parents are allowed to screen potential parents, a home study is required, and adoptive parents must go through counseling. The American Society of Reproductive Medicine, however, feels the term “adoption” is inappropriate. “Everyone realizes that embryo adoption is not a legal entity,” said Dr. Jeffrey Keenan, director of the National Embryo Donation Center in Farragut, Tenn. “But the thing is, couples relate to the term ‘adoption,’ and actually the process is very similar to what traditional adopting families go though.” The donation center has been in operation for about six years and has performed close to 400 embryo transfers. From those transfers, 150 children have been born and another 50 are “incubating in the oven,” Keenan said. The center matches donors and adoptive parents from all over the country, and unlike Snowflakes, which only serves as an adoption agency, the center also actually performs the transfers at its facility. Adopting parents can get information about the donors, including things like physical characteristics, education level and hobbies. “We can assure the donors that their embryos are going to a good family, that has been shown by experienced adoption workers to have what it takes to raise their child in a healthy and loving home,”
Page 35
Cover story | FROZEN EMBRYOS THE COST OF BUILDING A FAMILY
It’s important to know that an imaging study is really only as accurate as the person reading it. Having an expert team of radiologists utilizing the most advanced imaging technology available makes a vital difference. Central Oregon Radiology Assoc., P.C., physicians have been an integral part of the Central Oregon medical community for over 60 years providing the expertise, technological resources, accountability and connectivity that sets them apart from other radiologists.
Keenan said. “And that’s what most couples want for their em• In vitro fertilization with patient’s eggs: bryos and their children.” $12,000–$15,000 Embryo adoption is probably • IVF with unfertilized the least common of the options, donated eggs: if only because of the logistics $22,000–$25,000 involved. Although the center • Transfer of frozen has received several grants from embryos outside the federal government to boost of full IVF cycle: awareness of the embryo adop$2,000–$5,000 tion option, many couples with • Embryo adoption: $5,000–$15,000 frozen embryos don’t know about it. • Adoption of child $10,000–$40,000 “There is an unreasonable but very real fear among many donor couples that if they donate their embryos locally, that their children will marry their siblings,” Keenan said. “This allows us to avoid those issues, because couples, even if they donate anonymously, can say, ‘I just don’t want anyone in my city or my state.’” Embryo donation is also the least expensive way that an infertile couple can have a baby because it avoids the costs of harvesting and fertilizing the eggs. “Many of these couples would need donor eggs, and once you’re looking at donor egg IVF, you’re talking about an average of at least $22,000 a cycle,” Keenan said. “You could do three embryo adoption cycles for half that cost, and have a much higher cumulative chance of conception.” It’s unclear how many couples would want to adopt embryos because the option has been rather limited to date. Keenan said that from 2004 to 2006, there were only 2,200 transfers of donated embryos in the U.S. But he sees the potential for doing many thousands of embryo adoptions per year down the road. “Once these couples start to get older and they start to look at ‘Gee, we’ve had embryos for 20, 30 years, we’re making out our will. What do we do with these embryos? Are we really going to bequeath them to our children?’” Keenan said. That still may not be enough to make any sort of a dent in the half-million or so embryos now in storage. Keenan believes doctors need to stop creating so many embryos in the first place. “Success rates are almost twice as high as they were 20 years ago,” he said. “Why are we still trying to fertilize all 15 or 20 or 25 eggs that we get?”
Better embryos At Oregon Reproductive Medicine, doctors have come to a similar conclusion and developed a strategy relying more on quality than on quantity. “Our philosophy is we don’t want to freeze just anything. We don’t want people to be left with 10 embryos and eight of them are bad,” said Dr. Brandon Bankowski, a fertility specialist at Oregon Reproductive Medicine. “It’s really kind of a false hope.” Bankowski’s clinic grows the embryos an additional two days. At Day 3, the embryos are made up of six to eight cells. By Day 5,
Page 36
HIGH DESERT PULSE • WINTER / SPRING 2010
“It’s a great thing to be able to give (prospective parents) a second chance without having to go through as much cost. But at the same time, you want to make sure it is a really good chance for them.” Dr. Brandon Bankowski, fertility specialist at Oregon Reproductive Medicine
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SUBMITTED PHOTO
the blastocyst stage, they have as many as 200 cells. “A lot of the embryos, when you’re at the Day 3 stage, although they may look perfectly fine, just don’t grow to the Day 5 stage,” he said. “By growing them a little bit further, you let all those drop out and you pick from a more advanced group.” It results in fewer embryos implanted in the long run and higher success rates. Oregon Reproductive Medicine is one of only two IVF clinics in Oregon to report its success rates to the Society for Assisted Reproductive Technology. Clinics reporting their results to SART in 2007 had a 55 percent success rate for fresh transfers and a 32 percent success rate for transfer of thawed embryos. Oregon Reproductive has a 72 percent success rate for fresh transfers and a 43 percent rate for thawed embryos. “I think people generally don’t understand how high the success rates for IVF are now,” Bankowski said. And because growing embryos out to the blastocyst stage weeds out many of the inviable embryos, some couples find they don’t have any leftover embryos to freeze. “It’s a great thing to be able to give them a second chance without having to go through as much cost,” he said. “But at the same time, you want to make sure it is a really good chance for them.” Rebecca Joyce-Cowart and her husband, Mark, made the most of their IVF chances. After the first two of their embryos resulted in the birth of only one child, the Bend couple tried for another child by implanting two more embryos. This time both embryos took and one split naturally into twins, resulting in triplets. The whole process involved numerous trips from Bend to Eugene and back, and the Cowarts spent the 30-plus hours in the car discussing all of their options. When it came time to decide the fate of their nine remaining embryos, they knew exactly what they wanted to do. “We chose research, because it was research that got us to where we’re at, and it’s research that could possibly help some other family, whether it be from stem cell work or just learning about the IVF process,” Joyce-Cowart said. “If most couples had that kind of time, I think they’d learn a lot about each other and about what they wanted to do.” •
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Laughter | THE BEST MEDICINE
The bald truth about chemotherapy H
air is a funny thing. Its presence causes no end of grief for women who have curly hair, but wish it were straight. Or men who have thinning hair, but wish it were thick. We spend thousands on products to make our hair longer, shorter or a different color. We tease it, blow-dry it, gel it and dye it. We razz the balding about their growing pates and pretend not to notice when our odd aunt visits with roots a startlingly different color from the rest of her hair. Add cancer into the mix, and the hair situation just gets weirder. My husband, Jason, (nine months cancer-free!) was treated for Hodgkin’s lymphoma last year, with the predictable results from chemotherapy: His hair fell out. This is a man who previously had a glorious head of curly dark hair, which we lovingly called his Jew-fro, in reference to his hairy Jewish family. It was thick and glossy, graying in a debonair fashion at the temples. Then the chemo struck, and it was gone. As Jason says, he went from looking like George Clooney to Uncle Fester. (Only one of those descriptions is an exaggeration. I’ll leave it to you to decide which). His goofy friends shaved their goofy heads in solidarity, though they couldn’t replicate the look of the cancer-stricken — the lack of eyebrows, the patchy beard. Jason, once hirsute in the fashion of his Eastern European ancestors, even lost the hair on his arms, chest and elsewhere. Hairlessness is a small price to pay for health, but it can be awkward — sort of like puberty in reverse. But the insults of chemo don’t end with baldness. When the treatment is over and life starts returning to normal, a chemo patient’s hair can come back UNRECOGNIZABLY DIFFERENT. Formerly straight hair can grow back curly, or a different color, or thicker or thinner. At first, the hair on Jason’s head grew in white, thin and baby-fine. Then it started to darken. Now, months after its return, it’s a uniform dark gray, but it takes up far less cranial real estate than it used to. If he was George Clooney, he’s now George Costanza. But his facial hair came back with a vengeance. His beard, never a slouch, now begins at his eyebrows and ends at his clavicle. His eyeSUBMISSIONS brows have extended their range Do you have a funny like armies warding against a flank health story you’d like to attack from his nose and ears. share? Send 500 words Jason’s arms and legs are hairier or less to pulse@bend than ever. His chest looks like a gorilbulletin.com. Editors will la’s. He even has hair in places where select one submission none used to be: his ears, his back. for each edition. (Back hair? I understand this can happen as men age, but c’mon, cancer!
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We had at least a decade!) With one hand, cancer taketh away and with the other, it giveth. As ridiculous as the focus on hair may be, the truth is that hair (or the lack thereof) is often the most obvious sign of cancer treatment. Just ask Michael C. Hall, who appeared at the Golden Globe Awards in January in a black knit cap. Sans baldness, no one may have known what the “Dexter” star suffered from. (Hall is undergoing treatment for Hodgkin’s lymphoma). But even covered with a hat, hair loss is a signal to the world: Cancer treatment in progress. Even though the cancer/chemo one-two punch changed them forever, I will smile each time I see Jason’s thinning hair or his exuberant beard. For him, it is a sign: I beat cancer, and all I got was this lousy unibrow. • — JULIE JOHNSON
Johnson is the entertainment editor of The Bulletin.
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