Vaccines:Theunsung successstory Cascade Lakes Relay:Howto prep Flight nurses:Readywhen you aren't
Healthy Living in Central Oregon '
•
•
When the body betrays the identity within
, >Jl jggiti(l(/ g /
~i)
f g(I' /
it/(1Âť'
f I/,77 /4
l J4
7
Testosterone is, of course, a hormone that helps maintain muscle and bone density and strength, as well as sexual function. But it also plays a vital role in a man's general health and sense of well-being. Symptoms of low testosterone include decreased energy, body changes, mood changes, reduced sex drive, and sexual dysfunction. Though it is normal for a man's testosterone to diminish as he ages, it should not drop below a certain level. Men with obesity, diabetes, high blood pressure, high cholesterol, COPD, or asthma run an increased risk of suffering from low-T.
Testosterone replacement therapy can help to bring your hormone levels back intothe normal range. Bend Urology provides the latest in research, diagnosis and testosterone supplementation. We counsel patients on the risks and benefits, and determine what is best treatment option for each individualpatient After all, Bend Urology has been providing central and eastern Oregon with the best in urological care for nearly fifty years. Ask your primary care doctor, or give us a call. We can help you get back into the swing of things.
iPu're 5ud 6 Gty.
+C-BendUrplp
541 3826447/ 2090 NE Wyat Court f Suite 101Bend f OR97701 f bendurology.com
PEDIATRICS cARDloLoGY FAMILY MEDICINE oPTlcAL URGENT CARE ONCOLOGY NUTRITION NEPHROLOGY DERMATOLOGY OPHTHALMOLOGY ENDOCRINOLOGY NEUROLOGY PULMONARY INFEcTloUs DlsEAsE SURGERY INTERNAL MEDICINE ALLERGY RHEUMATOLOGY IMAGING GAsTRQENTERoLoGY BREAST HEALTH vEiN cLiNic LAB From office visits to x-rays, lab tests to life-saving treatments, we bring it all together for you. Whether you're sick, healthy, or everything in-between, we're here. Every day.
rd bm C
To talCare"
Bend Memorial Clinic.r
ij c R~@>'A CRE
:,'«IMINIIIIlle
ZZZs ne
•
•
•
•
•
•
•
•
•
•
•
•
•
r BB •
.
.
.
•
•
•
H I G H
UPdateS ~ NEWSINCE WE LASTREPORTED
Cellphone usage heats up the human brain
ceedings of the National Academy of Sci-
encesinJanuary. The scientists, led by a medical physi-
The Winter/Spring 2012 issue of High Desert Pulse looked at the queStiOn Of
whether cellphone
rrrevmrrrr/r~a
'
P".
D E S E R T
f
...~ roAANgg
.„„, ". trttteltS//Ayrr
radiation could harm human health. The
explosion of c ellphones has prompted concerns about brain cancer in particular. Despite numerous studies, there has been little consensus. The cancer research arm of the World Health
cist at Memorial Sloan-Kettering Cancer Center in New York, developed a nuclear magnetic resonance technique they say will help further the understanding of whether extensive cellphone use could cause brain tumors. In their tests, the scientists used cow brain tissue and gel, rather than a human brain, and a high radio frequency antenna rather than an actual cellphone. Researchers found that the areas closest to the antenna heated up the most, showing up as hot spots on 3D images. "The volume of the hot spot generated by
Organization, however, classified high radio absorbed cellphone radiation depends on frequency emissions from cellphones as the antenna power level and the irradiation "possibly carcinogenic" to humans. Scientists have recently created a new imaging technique to better illustratewithout probing the brain — how brain tissue heats up in the presence of radiation, according to a study published in the Pro-
time," authors wrote in the results and discussion of the study. The testing method is expected to evolve so that it can examine human brain tissue
and cellphone radiation. —ANNEAURAND
Healthy Living in Central Oregon
SPRING / SUMMER 2013 VOLUME 5, NO. 2
How to reach us Julie Johnson IEditor 541-383-0308 or jjohnsonCsbendbulletin.com Sheila Timony Associate I editor 541-383-0355 or stimonyCsbendbulletin.com • Reporting Anne Aurand 541-383-0304oraaurandCsbendbulletin.com Elise Gross 541-383-0393or egrossCsbendbulletin.com Heidi Hagemeier 541-383-0308 Sheila G. Miller 541-617-7831 or smillerCsbendbulletin.com • Design/ Production Greg Cross Andy Zeigert • Photography Ryan Brennecke Joe Kline
David Wray
Rob Kerr Andy Tullis
• Corrections High Desert Pulse's primaryconcern isthat all stories areaccurate. Ifyou know ofan error in a story, callus at 541-383-0308or email pulseCsbendbulletin.com. • Advertising Jay Brandt, Advertising director 541-383-0370orjbrandtCsbendbulletin.com Lorraine Starodub, Health & medical account executive 541-617-7855or IstarodubCsbendbulletin.com
Can you spotthe person with varicose veins'?
Ot On the Web: www.bendbulletin.com/pulse
Varicose and spider veinsare common, affecting over 40% of adults. They can interfere with work, exercise, and life in general. We can help with: • Prominent or bulging veins • Discomfort or restless legs • Pain/swelling in legs, ankles or feet L eg f a t i gue or heavy sensation • Skin discoloration around the ankles • Spider veins Come see us now for healthier legs next summer. Trust our experts and learn about the latest in minimally invasive procedures performed in our office.
The Bulletin
All Bulletin paymentsare accepted at the drap bav at City Hall Check pay ments may be canverted taan etedranic fundstransfer The Bulletin USPS f/SS2 S20 is pubkshed daily by yyestern Cammunicatians Inc 1777 Syy Chan dler Ave Bend OR97702 Periadicals pastage paid at Bend OR Pastmaster SendaddresschangestaTheBulletinarculatiandepartment PO Bav6020 Bend OR9770B The Bulletin retainsawnershipand capynght pratedranaf all staff preparednewscapy advertising capyand newsar ad illustratians They may nat be repraduced withaut evpliat pnar appraval Pubkshed S/13/2013
lnovia Vein Specialty Center
Write to us
2200 NE Neff Road, Suite, 204 (in The Center) bendvein.com 541-382-VEIN (8346)
Send your letters of 250 words or less to pulse@bendbulletin.com. Please include a phone number for verification.
Andrew Jones, MD, FACS Edward Boyle, MD, FACS Board Certified Surgeons
Page 4
.L
Contents ~ HIGHDEsERT PULsE
COVER STORY WHEN CHANGE IS THE ONLY CHOICE For some, switching gender is the only way life is worth living. p
FEATURE UNSUNGSUCCESS OF VACCINES 18 THE Advancesin recent decades have made many deadly diseases almost history.
DEPARTMENTS
4 UPDATES New since we last reported. EATING: SALADS 16 HEALTHY Think all dressings are created equal? Think again. GEAR: WATER CARRIERS 24 GET Hydration options for endurance athletics. THE JOB: THE FLIGHT NURSE 26 ON From out of the blue, and in the nick of time. DOES HE DO IT? 30 HOW After falling out ofshape, famed climber Alan Watts recommits to fitness.
MCKENZIE HIGHWAY 33 SNAPSHOT: Cycling the snow-white walls of the pass in spring. READY: THE CASCADE LAKES RELAY 34 AGET dream or a nightmare? It's all in howyou train. PACK YOUR BAGS 52 TIPS: International trips require extra (medical) care. OF KNOWLEDGE: POP QUIZ 53 BODY Can you tell your andrologist from your adenologist? ONE VOICE: APERSONAL ESSAY 54 When the doctor's news rocks your world.
GET GEAR
COVER PHOTO: JOE KLINE CONTENTS PHOTOS, FROM TOP: ROB KERR,RYAN BRENNECKE, ROB KERR, PETEERICKSON
'3A GET HIGH DESERT PULSE • SPRING/ SUMMER2013
»aes
Q f
R EADY
E
•
•
•
•
A turning point for people and policy BY ANNE AURAND • PHOTOS BY JOE KLINE
ntil puberty, Kirsten Winters lived a standard little boy's life.
Then, around age 12, he started stealing his mom's lingerie, panty hose and high heels, wearing them on the sly. Winters felt shame about cross-dressing. Yet, Winters explained recently, "it was my serenity. It gave me a sense of being right. Not
sexual; it was comfort. We are socialized about what we're supposed to look like. I didn't fit that." In his youth, Winters had no idea he was transgender; it would be
many years before he would realize that he was a female born in a male body . (Although Winters won't disclose her previous name, she said it was OK to call her a "he" when describing that period in her life.) Winters, 38, and her mother, Renee Allen, who both live in Bend
now, recall how a good kid growing up in Southern California transformed into an angry, unpleasant teen who closed himself off. "The easiest way to hide is to keep everyone at arm's length, to be ILII an asshole," Winters said. .
.
.
Winters' father~made homophobic slurs that added to Winters' disgrace. So Winters went to great lengths to demonstrate hyperkk masculinity, such as picking fights. Winters was troubled, us-
ing methamphetamines, marijuana and alcohol. Before age 18, he dropped out of school and got in trouble for trespassing,
HIGH DESERT PULSE • SP ING/SUMMER 2013
Page 7
•
•
MA a a a~
Kirsten Wintersand partner Terese Thompson embraceafter bowlingduringa friend's partyatLava Lanesin Bend.
arson and burglary. In his early 20s, Winters married a woman
who already had children. The now-ex-wife tolerated cross-dressing but forbade Winters to let the children find out, compounding the feeling that something was really wrong with it. Then, in the mid-to-late 1990s, Winters
heard about transgender people through the Internet. He started researching. Transgender is the u mbrella term f o r people whose gender identity (their internal
home life." Winters left the marriage, but returned briefly, believing that living in a traditional marriage could make the gender question go away. It didn't. "In April 2008, I almost took my life. I sat on my bed with a .38 in my mouth. I was
completely depressed. I hated myself, my life, everything about me," she said. "Something clicked. I had two choices. End it, or attempt transition." This May, Winters celebrates three years
sense of male, female or something broad- on hormone therapy, the primary vehicle er) and gender expression (how they dress, of her transition from male to female. She wear their hair, talk, walk) does not conform to what is typically associated with the anatomy they were born with. Transsexuals are transgender people who alter or wish to alter their bodies through medical means, to align their bodies with their gender identities. "Around age 28, I started having ideas that I was a transsexual, not a cross-dresser," Winters said. "It became a problem in my
Page 8
looks like a woman, lives as a woman. Her
driver's license says "female." "Ihave re-found my voice,my confidence," Winters said. "I no longer feel suicidal. I wake
up smiling." "She's not angry anymore," said her mother.
A healthysense of self For years, Winters didn't have the lexi-
con to define her experience. Yet like many transgender adults, she knew for a long time that she didn't fit into a binary gender system — the classification of sex and gender into only male or only female. The concept that sexual orientation and gender identity exist along a continuum has become more broadly accepted in Western culture over the past 10 to 15 years. Along with that shift in t hinking have come efforts to ensure transgender people receive the same rights and protectionsincluding access to health care — as others along the spectrum. While transgender advocates have been vocal, they are not alone in calling for improved access to wellness. U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced recently that President Barack Obama, through the Affordable Care Act, intended to improve the
health and well-being of lesbian, gay, bisexual and transgender (LGBT) Americans,
SPRING/SUMMER2013• HIGH DESERTPULSE
recognizing that these minority groups experience health inequities. Medical organizations and g o vernment agencies are starting to compile information to try to quantify the trans population, identify their specific needs and improve their health care. Insurance companies are more frequently covering transition procedures, including surgery
and hormone therapy. Health doesn't just mean the absence of disease. It is "a state of complete physi-
cal, mental and social well-being," according to the World Health Organization. In trans people, it's especially important to address widespread discrimination, violence, unemployment and poverty that can create barriers to health care, according to a new report called "Transforming Health," from the Open Society Foundations, an international organization that emphasizes equalrights causes. Unem-
ployment and violence — which are more
A glossary of gender terms Sex,establishedat birth, refers to one's biological status as either male or female, and isassociated primarily with physical attributes such aschromosomes, hormone prevalence, and external and internal anatomy. Genderrefers to the socially constructed roles, behaviors, activities and attributes that a particularsocietyconsiders appropriate for boys and men or girls and women. These influence the ways that people act, interact a ndfeel about themselves.
Gender identity refers to a person's internal sense ofbeing male, female or something else. Gender expression refers to the way a person communicates gender identity to others through behavior, clothing, hairstyles, voice or bcdy characteristics. Transgenderis an umbrella term for people whose gender identity, gender expression or behavior does not conform to what is typically associated with
the sex established at birth. ("Trans" issometimes used asshorthand for"transgender.")
Sexual orientation refers to an individual's physical, romantic, and/ or emotional attraction to other people. Transgender people may be straight, lesbian, gay, bisexual or asexual.
Transsexualrefers to transgender people who alter or wish to alter their bodies through hormones, surgery and other means to make their bodies as congruent as possible with their gender identities. The process of transition through medical intervention is referredtoassexor gender reassignment, sex confirmation or gender affirmation.
Gender dysphoria refers to the discomfort or distress caused bya discrepancy between a person's gender identity and the sex that was established at birth. Sources: American PsychologicaI Association, StandardsofCare fortheffealthofTranssexual, Transgenderand GenderNonconforming People, from the World Professional Association for Transgender ffealth
prevalent in the trans population than the general population — appear to increase the risk of suicide significantly.
Finding a life worth living Of all the health disparities associated with the transgender population, suicide is one of the more driving concerns. Forty-one percent of 6,450 transgender participants in a 2010 survey by the National Center for Transgender Equality and the National Gay and Lesbian Task Force said they had attempted suicide, compared with 1.6 percent of the general population. Separate, smaller studies suggest that between 30 and 55 percent of
transgender people, depending on age, race and gender expression, consider or attempt suicide. "Often, it's 'I need this (transition) or I'll
Suicide attempts by transgender Americans Job status plays a role Transgender people experience unemployment at twice the rate of the generalpopulation, according to a recent survey. Forty-seven percent of respondents said thay had been fired, not hired, or denied a promotion because of their gender nonconformity. Sixteen percent said thay had been compelled to work"underground," such as doing sex work or selling drugs, for income.
60%
40%
Attempts byoverall sample
Unemployed
Lostjob dueto bias
Workedin Underground economy
Em lo ed
20%
0%
Any
kill myself,'" said Leigh Brandt, a 20-yearold trans man (female-to-male transsexu-
al) from Bend. He struggled with gender dysphoria — a disconnect between who
you know you are and what you look like, he explained — since he was little,
when he was a girl. "I knew from the time I was small I
wanted to be a daddy. I saw myself like my father, scratchy cheeks. I knew there would be a wife," said Brandt.
He told friends and family he was transgender in 2010, and soon after, with a doctor's supervision, he started inject-
HIGH DESERT PULSE • SPRINGI SUMMER2013
Harassment and violence occur When transgender people present incongruent IDs It can be challenging to change one's gender marker on all identification cards and records. About 41 percent of transgender people in a survey said they live without identification that matches their gender identity.
roblem
Harassed 40%
44%
40%
30%
Askedto leave
20%
15%
10%
Assaulted
3%
0%
Source Injusticeat EveryTurn:A Report ofthe NationalTransgender Discrimination Survey,Octoher2010
GREG CROSS
Page 9
Coverstory ~SWITCHING GENDER ing himself with testosterone weekly. He had "top surgery," which includes a mastectomy,
therefore eligible for insurance coverage.
hysterectomy to more fully complete his transition. "I don't want these parts in me,"
disorder" to "gender dysphoria" in part to remove the stigma of a mental, pathological
that prohibit "discrimination in the terms
(The DSM's fifth edition, released in May, has of employment, including employee health a year ago, and hopes to someday have a changed the language from "gender identity insurance coverage, based on gender iden-
he said. disorder.) Ayoung, hipster guy, he bears a hint of sideThe diagnosis is the institutionallyaccepted burns and a few moustache hairs. He runs up stairs two at a time. His voice is deep. Brandt can't even look at old pictures of
himself, he said, after so many years hating what he saw. He has spent thousands of dol-
lars to align his body with his gender identity. He has health insurance, but it doesn't cover any of it, he said. That's common. Many insurance programs exclude transition-related care. But, health insurance coverage may be one of the most visible and current vehicles of change in the world of transgender health care. And Oregon is right in the thick of it. Recently, more insurance plans have begun to cover "medically necessary" treatments
ticket to getting desired treatment and to trigger some insurance plans to cover it. But many trans people have called the diagnosis "stigmatizing" and the requirement to get it "medical gatekeeping." After all, some transgender people don't report emotional distress. And some don't believe they should need medical evaluations to justify a transition.
According to major medical groups, including the American Medical Association,
I ndividuals experience an a rray o f dysphorias. With Winters, for example, it's about facial
ments can help trans people whose health
and well-being depend on bringing their physical bodies into alignment with their "Patients and surgeons don't look at these as cosmetic," said Dr. Curtis Crane, a surgeon who specializes in sex confirmation surgeries at Brownstein 8 Crane Surgical Services in San Francisco. "Some insurance
companies do, though. "I'm sure some religious groups would not
hair and her deep voice. approve of the surgery as being medically For TJ Evans, a 50-year-old transgender necessary. There are some psychiatrists that man, who used to be female, it's what his breasts do to his identity. "I either have to bind my breasts or wear large shirts.... It's distressing, disheartening. Sometimes it's on the forefront of my mind," said Evans, of Bend. He had taken steps toward getting a mastectomy. He was in the hospital for preoperative care in December when he found out his insurance viewed it as a sexual reassignment surgery, and cov-
don't, but as a group, I don't know anyone that makes that global stance on the issue," said Crane.
erage was denied.
a out-of-court settlement in a discrimination lawsuit filed by a female-to-male transgender state employee who sought a hysterectomy. The suit said denying coverage violated the state's own anti-discrimination laws
The American Psychiatric Association's Diagnostic and Statistical Manual classifies
disorders, such as gender dysphoria, for which medical treatments are necessary and
and San Francisco, for example, offer health plans for their employees that cover genderreassignment surgeries and hormone treat-
ments. A growing number of colleges are offering health insurance plans with similar coverage for students. The number of insurance providers covering such treatments is
hormone therapy, surgery and psychotherapy are medically necessary to alleviate gen- small but growing. der dysphoria in many people. These treatSome argue that such coverage will raise
such as hormone therapy and sex reassign- gender identity, according to the AMA. ment surgery for those diagnosed with gender dysphoria, the condition of distress from the incongruence between expressed gender and the sex that was established at birth.
tity." The same surgery would be covered for a woman with a medically necessary diagnosis, so excluding it for a transgender patient with a medically necessary diagnosis violated anti-discrimination laws. Oregon is not the first public body to adopt a t r ansgender-inclusive policy for those on its health plan. The cities of Portland
The cost of change The state of Oregon made news recently when it agreed to cover surgeries, prescriptions and other treatments related to gender reassignment for the state's transgender
employees. The policy change resulted from
the costs for other health plan participants. However, a summary of costs from the City and County of San Francisco, which was the first major employer to cover transition treatment when it adopted its policy in 2001, suggests that the covering transgender em-
ployees' health needs proved relatively inexpensive, according to a statement from San Francisco's Human Rights Commission. To meet cost projections associated with additional transgender-related coverage, employees, retirees and dependents enrolled in San Francisco's health plan were all initially charged an extra $1.70 per month. Over the years,as the income exceeded the payouts, the surcharge was reduced and eventually
ended. From July 2001 through July 2006, the health system collected $5.6 million from the surcharge and paid out $386,417 on claims for treatments. "Unlike the fears expressed, none of the concerns came to pass," according to a statement from San Francisco's Human Rights Commission.
Buying time Another noteworthy milestone for Oregon is that it's the first state in the country
to require coverage for puberty-suppressing
'Ihavestruggled with thismostofmy life. Thisis whatl'vedecidedto do. I plan on transitioning fromyourson toyourdaughter.' Kirsten Winters, to her father
Page 10
treatments for some transgender adolescents. Starting on Oct. I, 2014, the Oregon Health Plan will cover the cost of pubertal suppression evaluation, treatment and monitoring for youth enrolled in the health plan
SPRING/SUMMER2013• HIGH DESERTPULSE
1'"f-A1 H >'f"ISf<'"
gFs Opr„.of f" Vifai;5'fahstlcs accfKIA'";, '-.'."'::,"'
Documenting identity: male or femal ma e.? When the gender marked r e onaperson's on a e n' matc i entificationcarddoesn'tm Icle n m t htheface hh f f andbod it bl cIT h Shatz, the tra rans justice manager for Basic aslc Rights lg ts Oregon in Portland. "We face thesecchalle a engeseveryday,"Shatz said."Accessing medical health care. F ying, TSA (securityl. For myself my IDsays f emale because I need to access medical e ica eathcarethatdeals hIh with female anatomy so it helps me see the overage or medical care. But I look male, I so when I go to a bar r or o th e
' port r,i itplaysoutinmylife." air Goin throu o ort been an ordeal, he said. He keeps a letter on handtogivetoofficialsthatsayshe's ' transgener to explain the incongruity. "Dolchan em I o c angemylDandnothaveaccesstoth ese ' a services medical service so I don't have to deal w'th th at at the e ar baror the airport?" Whata'it takes to change a gender marker desaew ere p you live, he said. The process can be expensive an d arduous.
® OREcce W
I
who are diagnosed with gender er ysp d s horia. Pubert
blockers
e p u ert y th a t s t n t h o -
di atio
d
"Some days I y o y B r a ndt said d n
ddl
ment of seco su
y
y
r
yp y, g y ff Fa amilies facing the puberty blo o c ker option
hild old d can decide whether to make lasting changes. start ar ooff c o ncerned about riskso of th e t r eatrr (Puberty blockers) give the e ki d s a couple m en, n t uBrleton said. The lon -ter more years to be certain m n,"sai sa dJenn J Burleton, e execu c ive u c a group a se d r s to support p and educate youth f ami ies and commuI di hool , t oh I th manage the myriad ria questions and conflicts t hat arise — such as which abt h r o o m a child
s o ciated with in yout a r enot fully i er e a r e nsks t y< e more im mmediate m concern that th e childm ight kill himself befo n eMo o st families understand then that this is
not likean option for kdi s tru y traumatized
should use. h ld
f
d
d
we see those spikes in suicide. Hormo n e treatment risks n
e newest frontier in transgender sgen er health e a lt h care. Althou h si d i BI often be seen early iin n cchildhoo i oo d , t here i s Pub e r t " " rve, an most 4d much b he appropriate- i nsurance surancepolicies don't cover the $1,000- erness of medically treating it. Not all ns o gen er t h e Oregon Health P 'an will tremendously v ariance go o nn to become transsexuals — h g kids who qualify for OHP." ter their bodies. One small 2008 Identity and orientat'ion: study showed that 10 years after gender apples and oranges ysp oric children were ere re referred to a clinic,
ony 7 percent still had gender d s horia. ntoft h
Requirements for changing your gender on ID in Oregon Driver's license To change gender on this ID, the De o or e icles designates applicants as either in "medical transition" wh'ichrequiresa letter from a qualified therapist stating that the erson ' g u time as his or her chosen gender, or in "transsexual gender reassignment thera q ires a certified court order eroofa agenenderchangeo r a letter from a physician that says the applicant had some kind ofsurgery. '
Birth certificate The Oregon Departmentof Human Services ing that the individual chang nge dish'orh her sex b
Passport A letter from aquali'fied ' medical professional must indicate the applicant hadc"inically I' appropriatetreatment."What that' a iscanbedefined d y the h p hysician. Representatives of Basic asic Ri ights Oregonsa ayt his ' is ideal because'aitowst allo the lnclli vidual and his or her doct ortodeci' dewhatis appropriate for an individual. '
'
'
Social Security card TheSo ocial ' Security Administration will chan e
t ho o f t h t d oted 3 0 o i i n a l o h o t o I d ot b
-up.. reached for a follow-u
i ro u g h behavior, clothing hair t I Often ten, a gender-variant youth t ransitions v o ice or n h hil d c ha n ges his or ti t y is not the same t her name hair I t s. tion — t h e h s i c a But some tra d I « h o Id have a t t raction to othe
avoided co id
bl
ff i
h d th
A
been able to delay the development en oofsexusexu- gender people may be ts raight,, lesbian, al characteristics. gay, bisexual or asexual juust iIke a nyone
HIGH DESERT PULSE • SPRINGI SUMMER2013
Page 11
SSA database might not match information sent in byan employer wh'ichcan result in a "nomatch" letter to the employer or t he employee, ' g" w ichcouldresultinanunwanted"outing" to one's employer. Sources: Tash Shatz,tran ' asic ights Oregon; Sasha , ransjusticemanagerat Basic Ri Buchert,legaladviser,B r, asic ' R'ightsOregon;wwwt h en s nowyourrightsguideipdf
Coverstory ~SWITCHING GENDER else can be. "Gender identity is apples. Sexual orientation is oranges. They are not connected. One doesn't dictate the other. There's no correlation," said Winters, whose own story illustrates the continuum. When she was a man, she was married to a woman. Throughout her life, she has had both male and female partners. Now,
she's happily involved with a Bend woman named Terese Thompson. Although Thompson says she dislikes having to use labels, she would be considered "pansexual." She describes her sexual preference as "it's the heart, not the part" that mat-
ters. She calls herself "gender blind." Winters calls Thompson a wonderful life partner. "Now I have someone who sees me for me, not my gender," Winters said. So, what makes some people transgender? Thompson, 33, who is in a master's
of counseling program through Oregon State University-Cascades Campus and is focused on LGBTQ (Q is for "queer"â&#x20AC;&#x201D; a term meant to encompass any point along the continuum) issues, believes it's simply because "there are variances in nature." Crane, the surgeon from San Francisco, said there is no leading theory for trans-
Rob Landis talks to his mom, Violet Bales, during his "maniversary"partyat Lava Lanesin Bend.
A one-year 'maniversary'
genderism and the cause is poorly understood, "but it has a relatively consistent representation across the globe." Anthropologists use the term "third gender" to encompass those who don't fit into the binary classification of gender that says we are either completely male or female, said Amy Harper, an associate professor of anthropology at Central Oregon Commu-
BY ANNE AURAND
nity College. "Third gender" individuals are part of the cultural fabric of groups ranging
the black lights drinking beer, building mo- heavy makeup, a black choker and a frilly mentum for later when they would end up sleeveless dress. in the bar singing karaoke. Now, Landis, with a stocky physique and Under blue helium balloons on one table shaved head, wears baggyjeans and black
from Native American tribes to peoples of Madagascar, Indiaand Pakistan, she said. Some recent data suggest that there's an area in the brain â&#x20AC;&#x201D; the hypothalamic bed nucleus â&#x20AC;&#x201D; that is typically twice as
large in male brains, compared with female brains. But in male-to-female transgender people, that area is the same size as what's seen in female brains. Dr. Rick Goldstein, an endocrinologist at Bend Memorial Clinic who oversees hormone therapy for some local transgender patients, said some studies in twins sugContinued on Page14
n the evening of Friday, March 8, Robyn Landis invited some 20
Near the cake, a chronicle of Landis' life cluttered the table: a newspaper clipping of a birth announcement about a little
family members and friends to
girl, classic baby pictures, photos of Lan-
the Lava Lanes Bowling Center. Grandkids rolled gutter balls and grandparents worried about hurting their backs. The generation in between stood around under
sat a cake, decorated with a blue baby carriage and the words, "It's a boy!" The cake was for 30-year-old Landis, the star of the party. It was his "maniversary" party. As irreverent as it sounds, the occasion was
ish clothes, riding a bike. Shots from high school showed Landis "overcompensating" for a reputation as a tomboy, wearing
pullovers. Standing with his feet spread
wide and his head cocked back, he gripped a pintofbeerin one hand and encouraged others to imbibe. He smiled with confidence and devoured the attention. Landis
filled with deep meaning. Landis was cel- likes people, and he likes it when people ebrating the completion ofhis first year on testosterone, a benchmark in a female-tomale transition. Typically, by the one-year
like him. He was pleased that the family of
his long-time girlfriend, Lindsay Griffin, was mingling with his relatives. Before his transi-
mark, the physical changes of hormone tion, Landis and Griffin were a lesbian coutherapy are apparent.
ple. Now that Landis expresses his gender
Robyn Marie has become Rob Mikael. as a man, they are boyfriend-girlfriend. He is one face of Central Oregon's transgender community.
Page 12
dis as a youngster, in short hair and boy-
The "maniversary," an unconventional celebration in the general population, is a
"I knew I wasdifferent. Peoplemisgendered measa boy when I was little. Theycalled me'buddy'and I likedit." Rob Landis, about his experience as a child
Friday night family get-together at the bowling alley. But for Landis' mom, Violet Bales, the theme was a little bit awkward.
roll her eyes in self-deprecating exasperation, and correct herself. "I think the hardest thing of all, is calling
"I had wondered, are we supposed to
my baby girl a him. I'm working on it. It helps that his body is changing and that he sic and crashing of pins and balls. Then she goes by Rob," Bales said. went back to bowling, not terribly fazed. W hen RobynMariebecame Rob Mikael,he Bales clearly loves her child and speaks to let his mother choose his new middle name. sing?" she said, with a smile, amid the mu-
what a good person he has always been. But his gender variance was a difficult thing for the conservative woman from Prineville to accept. "It was not an easy thing on our family at first," Bales said. "In fact it took years to be comfortable with it. I would say that religion
did play a huge part in how we as a family felt. But in the big scope of things, it's not about me. Or anyone else. I have never seen
Robyn so happy as he is now. That's what
party rite of passage in the little-understood transgender world. For some, it marks the anniversary of coming out as trans. For others, it's a year on testosterone therapy or some other medical treatment. To a casual observer, it looked like a typical
matters most. And his girlfriend, Lindsay, is one of the sweetest, most caring girls ever." Bales admitted that for a long time she
wondered if she had done something wrong as a mother that made Landis a lesbian or, rather, transgender. She already had two girls. "I wanted a boy," she said. "I dressed
her like a boy." Bales can't stop calling Landis "her" when she talks about him. It's a hard habit to break after 30 years. But every time Bales blurted out the wrong pronoun, she would pause,
"I was honored to have a small part in that decision," Bales said.
Landis (whom we will call "she" when referring to the time he was a girl) was raised
in a Mormon family in Prineville. As a young girl, she hated dresses. Although she knew nothing of homosexuality at that time, she knew she was attracted to girls. "I knew I was different, " Landis said. "Peo-
ple misgendered me as a boy when I was little. They called me 'buddy' and I liked it." By the end of middle school, Landis had grasped the concept of being lesbian and thought, with shame, "maybe that's what I am. "So I o v ercompensated," he s aid. "I
dressed up and wore my hair long and lots of makeup. I was homecoming princess in high school, and student body president. I was athletic and a people person." But Landis didn't have any close, intimate relationships because she was not prepared
to deal with being gay. She had bouts of depression and passing thoughts of suicide. It wasn't until after graduating from Crook County High School in 2001 that she began to tell people she was a lesbian. The topic of h o mosexuality came up in church one day. It made Landis cry. His mom, he recalled, asked his sister: "'What is
Robyn crying about? Is Robyn gay?' My sister just raised her eyes and said, 'Let's talk about it after church.' The secret was out. It helped me. It set me free," Landis said. Bales gave him a packet of Scriptures, Continued on Page 48
Rob Landisserves apiece ofcake to hisnieceAzlyn, 9 as friend Chrissy Lazzerini, right and her nephew MaxDorning, 6, watch.
Hormone therapies Hormone therapy can be initiated with a qualified mental health professional's referral and diagnosis ofgender dysphoiia. It typically includes: For male-to-female transition • Estrogen pills, patches or injections. •Androgen-reducing medications (to reduce testosterone activity). • Progestins may be included but are controversial because of side effects and health risks. Physical effects vary but typically include: breast growth, decreased erectile function, decreased testicle size, increased percentage of body fat compared with muscle mass. For female-to-male transition •Testosterone injections or topical gels. • Progestins can be used for a short time to assist with menstrual cessation. Physical effects vary but typically include: deepening voice, clitoral enlargement, facial and body hair growth, cessation of menses, atrophy of breasts, decreased percent ofbody fat compared with muscle mass.
Surgeries • Surgeries, particularly genital surgeries, are often the last and the most contemplated step in gender dysphoria treatment. The numberand sequence of surgeries varies, and not all patients have surgery. • One referral from a qualified mental health professional is typically required prior to breast and chest surgeries. Two referrals are suggested for genital surgeries. Male-to-female transition can include: • Breast augmentation or implants. • Penectomy (removal of penis), orchiectomy (castration), vaginoplasty (creating a vagina), clitoroplasty (creating a clitoris) or vulvoplasty (creating a vulva). • Facial feminization surgery, liposuction, lipofilling, voice surgery, thyroid cartilage reduction and various aesthetic procedures. Female-to-male transition can include: • Mastectomy, chest rebuild. • Hysterectomy (removal of the uterus), reconstruction of the urethra, metoidioplasty or phalloplasty (tissue rearrangements or reconstructions), vaginectomy (removal ofthe vagina), scrotoplasty (creating a scrotum) and prosthetic implants. •Voice surgeries, aesthetic procedures. Sources: Dr. RickGoldstein, anendocrinologist at Bend Memorial Clinic; Dr. Curtis N. Crane, Plastic Surgeon 8r Reconstructive Urologist at Brownstein 8rCraneSurgicalServices in San Francisco and The Standards of Careforthe Health of Transsexual, Transgender and Gender-nonconforming People, Version 7,from TheWorld ProfessionalAssociationfor Transgender Health.
Cover story ~SWITCHING GENDER gest there's a genetic component. But these studies are small. The American Psychological Association says this: "There is no single explanation
the population is a first step toward informing
for why some people are transgender. The
The first reports of castrations and hysterectomies in the United States for the pur-
diversity of transgender expression and experiences argues against any simple or unitary explanation. Many experts believe that biological factors such as genetic influences
a host of public policy and researchtopics.
Modifying gender
pose of changing gender appear in the early 1920s. In the 1930s, endocrinologist Harry Benjamin was one of the first to routinely of-
and prenatal hormone levels, early experi- fer hormone therapy for changing one's sex. ences, and experiences later in adolescence or adulthood mayall contribute to the development of transgender identities." Quantifying the transgender population
is nearly impossible given the lack of data collection, and varying methodologies that have resulted in different reports. Rough estimates, based on old data about people seeking treatment at clinics, say I in 100,000 people in the U.S. may be male-tofemale transsexuals, and I in 400,000 may be female-to-male transsexuals, according to the Institute of Medicine's 2011 report "The Health of Lesbian, Gay, Bisexual, and Trans-
gender People: Building a Foundation for Better Understanding." The report says the prevalence of adults seeking treatments appears to be increasing. A different estimate, from a 2011 report by The Williams Institute, University of California Los Angeles School of Law, estimates that about 0.3 percent of adults living in the U.S. identify as transgender, which equates to about 700,000 transgender adults. Winters, who has run peer-to-peer support groups for transgender adults in Cen-
It wasn't until the 1950s that the term trans-
sexual was widely used. Still, the general view at that time was that transsexuals were mentally "disordered." Over time, a body of research led to greater awareness and acceptance ofthe concept we now know as gender identity, according to the IOM report. There is no universal transgender story.
Every person has an individual experience. Transgender people are not all dysphoric about — bothered by — the same parts of their bodies or aspects of their identities. Nor is there one singular, clinically tested prescription for treatment. Treatments can be determined between a patient and a doctor. Some trans people change just their names and style of clothes, known as a social transition. Others take hormones or have top (chest reconstruction) or bottom (genital reconstruction) surgeries, or any combination
thereof. (See the panel at left.)
Hormone treatments cause physiological reactions that make a body more female or more male. They affect the sex organs and secondary characteristics, such as facial hair tral Oregon, has had as many as 20 people or breast development. "Medically, it's relatively straightforward," show up for a meeting, she said, although possibly not all attendees are transgender. said Goldstein, who works with several local She said there is a large population of trans transgender patients. Still, he recommends youth in this community, but she couldn't treatment be overseen by a medical profesput a number on it. sional to accommodate individual health risk Burleton, from TransActive in Portland, said factors. based onwhat she's seen, she believes one in For a male-to-female who takes estrogen, 100 kids are transgender in the sense that at the biggest health risk is blood clotting, esleast a social transition — and maybe medi- pecially in those genetically predisposed or cal treatments — are on the horizon. And, those who smoke. Pills might have a higher she added, about one in 250 kids are gender- risk of blood clotting than injections. Cancer nonconforming enough that they'll want to be risks for this group are small, Goldstein said. perceived as the gender other than the one There is a risk of liver inflammation from they were labeled, even if they don't go down hormone therapy, but periodic monitoring a medical path toward transition. and adjusting doses can help protect a perDefining and measuring the transgender son, he said. population is challenging, the Williams InstiGenerally, there's not enough long-term tute report said, but understanding the size of Continued on Page49 Page 14
SPRING / SUMMER 2013 • HIGH DESERTPULSE
AMERICA Positio n ing y o t s for
life
Treat Yourself or a Loved Qne to a Power Lift and Recline Cha ir •
• •
•
•
/ »
,
s", 'J
Plush seam back and full chaise pad for hours of comfort. Standard with heat and pulsating massage system. 375 lb. weight capacity. Five standard fabrics include luxuriously soft Bella Velvets. MODEL UC340
The Madison offers a plush, button back design with tastefully finished armrests that will subtly match many different decorative styles. Available in six standard fabrics, including the soft yet durable SofTouch with Stain Defense fabrics and two vinyls.
o
//„
MODEL UC911
Featuring StellarComfort Zero Gravity Positioning Technology, this model is a casual, two pillow backrest style that will complement a variety of decors. Both backrest pillows feature zippers underneath to adjust Dacron fill as needed. Standard fabrics include padded suede and vinyl.
PROUD LY
MODEL UC550
MADE i4 AMERICA o•
F IN E
F U R N IT U R E
•
•
Free Statewide D elive ry
Bend River Prome n ad e
•
*
• ww w . m j a c o b s f a m i l y o fstores.com
541-382-5900 • Toll Free 1-800-275-7214 • Op en Monnrri. 10AM to 7PM • Sat. & Sun.10AM to 6PM *$999 or more.
QJ
Healthy eating ~SALADDRESSING
Spend y ou r c a l o rie b u d g e t
Single ingredient
60live oil
©
Nutrition per 1 tablespoon serving:119 calories; 119 calories from fat;13.5g fat;1.9g saturated fat; Omg cholesterol;Omg sodium; Og carbohydrate;Ogprotein
w i s e ly in th e f i rst co u rs e BYHEIDIHAG MEEIER• PHQTQBYRQBKERR
Simple, flavorful, healthy
0 Balsamie vinegar Nutrition per 1 tablespoon serving:14 calories;Ogfat; Ogsaturated fat; Omg cholesterol;4mg sodium; 2.7g carbohydrate;0.1g protein Source: U.S. Department of Agriculture Nutrient Database
StOre bOught vummy,butnotashealthy
6 Ken's Steak House Chunky Blue Cheese
Q Bernstein's Restaurant Reeipe Italian ~
Nutrition per 1 tablespoon serving: 75 calories;70 calories from fat; Sg fat;2.5g saturated fat;Omg cholesterol;290mg sodium; 1g ca rbohydrate;Ogprotein (serving size listed on bottle is 2 tablespoons)
Nutrition per 1 tablespoon serving: 50 calories;50caloriesfrom fat; 5.5g fat;2g saturated fat;Omg cholesterol;370mg sodium; 1g carbohydrate;1g protein (serving size listed on bottle is 2 tablespoons)
• •
•
Know portions.Most dressing bottles call 1 or 2tablespoonsa serving. But Bendbased registered dietitian Eris Craven says that portion is fora large salad. Asidesalad requires less."Dressing should bean accent toyour salad,"
Craven said."It shouldn't dominate the flavorofthe salad. Ifit's the main flavor, you're probably using too much." On the side.Dip just a corner ofyour forkinto a tablespoonsize portion ofdressing and then stab a bite ofsalad. You probably will not even use the entire portion in the cup.
Mak e it y OurSelf
~asty, and good for you,too
T1ps
Adjustyour palate. Have you ever tried a salad with just a squeeze oflemonjuice and a teaspoon ofoliveoil? Oropted against dressing since you added a sprinkling ofGorgonzola? Or perhaps leaned on ingredients like toasted nuts for flavor? Expeliment with the less-is-more philosophy.
Substitutions.Making your own dressing iseasy and allows you to control the sodium, fatand calories. Ifyou are trying to replicate a bottled favorite,you can substitute ingredients. Tryfat-free or low-fatyogult for sour cream or mayonnaise.Canola or olive oil can sub in for vegetableoil,
with the amount ofoil then cut in half, said Glenda Hydeof the Oregon State University Extension Service. Also,vinegars infused with herbs, spices or garlic add flavor withoutcalories and fat. Sources: Eris Craven, registered dietitian; Glenda Hyde, Deschutes County Oregon State University Extension Service; recipes courtesy OSU Extension Service, Deschutes County
0 Pieky-eater dressing
0 Honey-pear dressing
Q Greek raneh dressing
1 TBS olive oil "/4 C raspberry vinegar or white vinegar 1'/2 tsp lemon juice '/2 C orange juice Salt and pepper to taste Nutrition per1 tablespoon serving:15calories;10 calories from fat; Ogfat; Ogsaturated fat;Omgcholesterol; 40mg sodium; 1g carbohydrate;Og protein
2 TBS vegetable oil 2 TBS vinegar 1 TBS lemon juice 2 tsp honey 1 ripe pear, peeled and cored or 2 canned pear halves, finely mashed Nutrition per 1 tablespoon serving:25 calories;10 calories from fat; 1g fat; Ogsaturated fat;Omgcholesterol; Omg sodium; 1g carbohydrate;Ogprotein
Soz container nonfat Greekyogurt 1 tsp garlic powder 1 large shallot (about 2 TBS chopped) 1 tsp dried parsley 1 tsp dried dill '/2 tsp salt "/4 tsp pepper Nutrition per 1 tablespoon serving:10 calories; Ogfat; Ogsaturated fat; Omg cholesterol;80mg sodium;1g carbohydrate; 1g protein
4
•
1
K•
• •
•
•
I
r
'r
-C
r• '
•
•
Modern vaccines are quietly changing the world. Really. BY HEIDI HAGEMEIER • PHOTO BY JOE KLINE
threat to American children. The bacteria entered the bloodstream and manifested itself
n his 37 years of practice, pediatrician and infectious disease specialist John Chunn has watched a virtually unheralded revolution unfold in the world of medicine. Early in Chunn's career, a bacteria called
in a variety of ways, with children regularly
Haemophilus influenzae type B, or Hib,
hospital stay for a course of intravenous antibiotics. Ports weren't used at that time, so
posed the most common serious health
Page 18
hospitalized. Hib-related meningitis used to pop up in Central Oregon five to 10 times a year,
children suffered through needle stabs as often as every six hours to set up IVs. The Hib-caused meningitis included potentiallydevastating side effects such as seizures
and brain damage. Up to half of children suffered permanent hearing loss, ranging from
Chunn said. It required a roughly 10-day mild decreases to complete deafness. The Hib bacteria's most dangerous version was epiglottitis. The condition involves the
SPRING/SUMMER2013• HIGH DESERTPULSE
Nine-month-old Emmalee Pray, of La Pine, plays with Dr John Chunn's stethoscope during an exam at CentralOregon PediatricAssociatesin Bend. Vaccines againstinfectious diseases have helped transform pediatrics during Chunn's 37yearsin practice.
epiglottis, the gatekeeper flap between the routes to the lungs or the stomach. When infected, it swells until — without warning — the child can't breathe. Unsuspecting parents would bring their children first to the clinic, not realizing the seriousness of the illness, Chunn said. Doctors then would instantly rush the children to the hospital for immediate surgery to keep the airway open. Chunn did two intubations himself in the hospital during his career to save children's lives. "It was life-threatening," he said. "Children would choke to death on their own
epiglottis and die quickly. "This was bread-and-butter pediatrics," he continued. "This is what pediatricians did. And this was our most common, serious disease that we dealt with."
Then, 20 years ago, Hib all but vanished. A vaccine for children, introduced in 1988, virtually wiped it out. According to state statistics, the number of cases in Oregon went from 85 in 1988 to five in 1992. Chunn, who practices at Central Oregon Pediatric Associates, said there hasn't been a case in Central Oregon since the vaccine came out. "This is a disease that my generation of pediatricians has watched disappear before our eyes with the advent of immunization," he said. "Younger pediatricians have never seen it." Or as Dr. Bruce Gellin, director of the National Vaccine Program Office within the U.S. Department of Health and Human Services, put it, "In a way, it's the modern version of the eradication of smallpox." The Hib vaccine is a clear success story. And there have been other strides in immunizations like it in the past few decades. Quietly, without the fanfare accompanying victories over diseases like polio, vaccines have continued to impact our world. More of the potentially devastating ailments of mankind are receding in the rearview mirror. Victories over hepatitis A and B are now possible, experts say, due to vaccines. The vaccine for the pneumococcus bacteria, which first came out for those younger than age 2 in 2000, has not only
HIGH DESERT PULSE • SPRINGI SUMMER2013
helped prevent its most feared manifestation — meningitis — but it's also had unanticipated benefits. Studies have noted fewer ear infections in children, and hospitals have reported fewer pneumonia cases
in the elderly. "I still think immunizations have been the greatest boon to w orldwide health ever in the world. Ever," Chunn said. "Much more so than antibiotics or sterile surgical techniques." More progress is expected in the near future from vaccines already on the market, as more time passes and data is gathered on their impact.
More vaccines, changing formulas The increase in the number ofrecommended childhood vaccines in the U.S, hasn't meant excessive exposure for children. As of 2000, the vaccines in total included fewer antigensusually proteins or polysaccharides on a cell's or microbe's surface — than in previous decades. This is due to advances in chemistry, the changing formula for the pertussis (whooping cough) vaccine and the elimination of the need in the U.S, for the smallpox vaccine.
1960: 3,217 proteins
Smallpox: 200 • Po lio:15 ' Diptheria:1 • Tetanus:1
There are high hopes, for instance, for the vaccine first licensed in 2006 for hu-
man papillomavirus, also known as HPV. It targets strains of the virus that lead to a variety of cancers, most notably cervical cancer in women. Recent studies have also shown an uptick in the number of men with throat cancer caused by HPV. "We have the potential to eliminate cervi-
1980: 3,041 proteins
cal cancer," Gellin said.
Silent successes Certain vaccine stories have become well-known as landmark achievements of the 20th century. The success of the smallpox vaccine prompted the U.S. Centers for Disease Control and Prevention in 1978 to declare it eradicated in America. Polio, much feared for its debilitating side effects and high death rate, is all but unknown. Even measles,which is so contagious that statistically one case will produce I5 more, maintains near obscurity in the U.S. "In much of the Western hemisphere,
measles is essentially gasping," said Dr. Paul Cieslak, medical director of the Oregon Health A uthority's immunization program. "The only time we see measles
I II
• Polio:15 • Measles:10 • Mumps:9 • Rubella:5 • Diptheria:1 ' Tetanus:1
2000: 123-126 proteins/polysaeeharides Polio:15 Varicella:69®y Measles:10 ® AC-Pertussis: 2-5 ~ • Mum s9 Hjb 2 o® Rubella:5 ' Hepatitis B:1 ' Diptheria:1 ' Tetanus:1 Source: "Addressing Parents'Concerns: Do MultipleVaccines Overwhelm orWeaken the Infant's lmmune System?" Pediatrics, Jan. I,2002 ANDVZEICERT
here anymore, it's from Europe or Japan or another continent." Yet today, experts say, vaccine success stories don't enter th e c o llective consciousness. Many parents, they say, don't know what Hib is or why their child is being vaccinated for it, even though in the 1980s, before the
vaccine, there were roughly 20,000 Hib cases
per year in preschool-age children. Experts say that because some of nature's more flamboyant diseases have been con-
trolled by vaccines, many Americans no longer have firsthand experience with the devastation
Page19
Secret successesDISEASE-DEFYING I VACCINES
How vaccines work By mimicking the diseases they're working to prevent, vaccines teach the body's immune system to attack the realdeal ifit enters the body in the future. The point is that a standing force will be ready to dispatch the invader reacting much faster than ifthe body was encountering it for the first time. Vaccine delivered
T helper cell
Masquerading
Memory cells created
1
)~O)
plasma B-cell
Pathogen
B-cell
Antigenpresenting cell
Memory T helper cell
• )
T-cell Infected cells
eg- l
T-cell
• •
a
Killer T-cell
A vaccine enters the body. Its contents have similar antigens — the pattern on the exterior of the cell — as the targeted virus or bacteria that causes illness, called a pathogen. Therefore, the body is exposed to an invader masquerading as the pathogen.
A variety of cells make up the body's immune system forces. Here are their reactions.
Antigenpresenting cell Antigen-presenting cells, or APCs, consume the vaccine antigens. They now present — have on their exteriorthe vaccine antigens. The APCs travel to places like the lymph nodes, where immune cells cluster.
T-cells
B-cells
T-cells recognize the antigens brought bythe APCsas foreign and become activated. Certain T-cells, called T helper cells, alert other cells to the presence ofthe invader. Others, called killer T-cells, also go on alert. For certain vaccines, the vaccine viruses enter cells. That triggersthe killer T-cells to find and destroy the affected cells.
B-cells also recognize the antigens and become activated. They start dividing, creating more B-cells specifically produced to combat the antigen. Some of the B-cells develop into plasma B-cells tasked with producing antibodies specific to the antigen. The antibodies attach onto the pathogen, which may markit for destruction or prevent it from entering a cell.
Sources TheCollegeof Physicians of Philadelphia, wwwhistoryofvaccines org; National lnstitute of Allegry and lnfectious Diseases
they caused. "I think we're a victim of our own success," said Dr. George Wohlreich, director of The
College of Physicians of Philadelphia, which has constructed an extensive website on immunizations, www.historyofvaccines.org.
"When you've seen people around you die
accidents — you sort of say, 'What's diphtheria? What's polio?'" Parents also don't necessarily understand the connections between viruses and bacteria and the severe illnesses they're capable
of causing.
impression on you. When you grow up and
For instance, most parents know to shiver at the word meningitis — a potentially deadly inflammation of the membranes protecting the brain and spinal cord. But they don't understand that a variety of bacteria, viruses or other microorganisms can cause it. Three vaccinesof the past two decades
you don't see any of this — you see kids
— forHib,pneumococcus and meningococ-
of some of these diseases, it makes a star-
tling impression on you," he said. "When you see someone with whom you were running around the swimming pool two weeks later in an iron lung, that makes a very profound
who fall off swings, kids who have bicycle cus — have vastly reduced the incidence of
Page 20
Memory B-cell
Memory killer T-cell
Memory cells All this activity spurs the response desired from vaccines; the creation of memory T-cells and B-cells. These cells will know the real pathogen in the future and will react much more swiftlyand stronglythan when they encountered the vaccine. Memory cells can remain in the body for decades.
GREG CROSS
childhood meningitis, Gellin said. The varicella vaccine, which in children prevents chickenpox, is another one that confuses parents. Chunn said some parents note that they contracted chickenpox as children and that it wasn't a big deal. "Most who get chickenpox are OK,» he said. "But we see the ones who get encephalitis or pneumonia. We see pregnant women with chickenpox on a ventilator. We see the children whose scans show pox inside their lungs." The other serious complication of chickenpox, Chunn said in an email, is a secondary bacterial infection with staph — including MRSA, the antibiotic-resistant bacteria
SPRING/SUMMER2013• HIGH DESERTPULSE
— and also the bacteria that can progress into b e t ter solutions for Hib and pneumococcus. "flesh-eating strep." A better understanding of the immune sysBefore the vaccine's introduction in 1995, the t e m has emerged in recent years, as well.
CDC says roughly 11,000 people were hospi-
G e l lin credits money poured into HIV and
talized in the U.S. each year due to chickenpox. A I DS research. While an HIV vaccine hasn't yet A decade later, that number had dropped by e m e rged, the research has led to greater un95 percent in those younger than 20. derstanding of immune system responses. These numbers tell a story of prevention It' t's in th the numbers success.But the success means that decades later, only a few are left who remember the The H ib vaccine's impact isn't the only bright diseases that vaccines prevent. immunization story in recent Numbers tell the stories of 'To~ o t d l tQpgp dec a des.Expertssaythesignifiprevention, Gellin said. And stopcance of some ofthe newer vacping now-invisible diseases from <O~~~ go fl om cines can't be underestimated. ever happening just isn't as visi- ~ Hepatitis A isn'tas dangerous Q+QO<+Ofm ble as curing an existing disease. as Hib, Chunn said. Children of"We don't talk enough about p~ jgtpgCp tO ten bounce back quickly. But it the fact that so many rates have can lead to liver failure. One of gone down," said Karte Young- PIGCrtCQIIJrrtot/7lrtg ' Chunn'spatients during his radahl, director of The College of reer died from the infection.
Physicians of Philadelphia's vaccines project. "We need public Dr. Paul Cieslak, medical
Thousands of people used
to g e t i t each year. Roughly health officials to talk about d i r e c t or o f t h e Orego n 3,00 0 O r egonians contracted HeaIth Authority's successes more." hepatitis A in 1995. Immunlzatlonprogram The virus passes through Cultivating success fecal-to-oral transmission. In Since 1994, eight different infectious dis- t h e U.S. it was regularly transmitted by restaueases have become preventable with th e ra n t w o rkerswhodidn'twashtheir handsafdebut of new vaccines. Scientists have im- t e r a b athroomtripandthen preparedfood. proved upon other vaccines. Cieslak said hepatitis A at one time kept Experts credit a variety of factors for recent h e alth departments constantly busy. "There used to be these press releases that advances in vaccine development. Decades ago, vaccine development in s a i d if you've eaten at so-and-so's bar and grill volved more trial and error. Some vaccines y o u may have been exposed to hepatitis," he involved simplykillingavirusandtheninject- said. "Come in to the county health departing it, sometimes into a human test subject. men t and get a shot of immunoglobulin. And Genome sequencing transformed develop- i t destroys the bar and grill." ment and has allowed researchers to become Immu n ization for hepatitis A began in 1995. more and more nuanced in their vaccine for- B y 2008, reported cases of acute hepatitis A in mulations. They can better pinpoint the mol- O r egon had dropped by 91 percent, the CDC ecule structure of a d isease-causing virus, s a y s.Lastyeartherewerefivestatewide. "Just in the past several years, I'm surprised bacteria or microorganism, called a pathogen. That allows them to laser in on small elements t h e CDC hasn't been using the term eradicasufficient to build an immunity. tion,u Cieslak said. uTo watch these cases go This more refined approach includes the f r o m the bane of my existence to practically ability to piggyback elements of one patho- n o t h ing is miraculous." gen onto other molecules the immune system The h e patitis B vaccine has also made its will recognize. For instance, Hib has a coating m a r k in recent years. on its exterior that kept young children's imHep a t itis B, contracted through blood or mune systems from knowing to fight it off. o t h er bodily fluids, can either be a short-lived Attaching parts from a pathogen the body i l l ness or can become chronic. It causes liver already knows to attack means the immune c a ncerand other liver-related ailments. system cells learn to destroy Hib in the proIt's m ost problematic for children, who get cess. Creating these conjugate vaccines led to i t l argely during birth or from another person
HIGH DESERT PULSE • SPRING/ SUMMER2013
Timeline 1770s —English doctor Edward Jenner puts forth the theory that some milkmaids don't get smallpox because they were exposed to a related disease in cows, called cowpox. This theory is tried out by exposing people to matter from smallpox pustules. The inoculation works, and Thomas Jefferson in 1806 writes to Jenner,ul avail myself on this occasion of the rendering you a portion ofthe tribute ofgratitude due to you from the whole human family." 1853 —Smallpox inoculation becomes mandatory in the United Kingdom. Germany follows later in the century. 1914 —A method for inoculating against dlphtherla is developed. It's replaced decades later. 1920s —Bythis time, smallpox vaccination is required for attendance in many American schools. 1939 —A pertussis (whooping cough) vaccine is shown to be effective. 1946 —The first influenza vaccine is intrcduced to the public. 1948 —The pertussis vaccine is combined with ones for tetanus and diphtheria. 1955 —Polio vaccine proved effective. 1960s —Measles, mumps, rubella vaccines emerge. 1981 —First hepatitis B vaccine licensed. 1985 —Conjugated Hib vaccine is licensed. 1994 —The Pan American Health Organization declares polio eliminated from the Americas. 1995 —Varicella (chlckenpoxl vaccine licensed. 2005 —Meningococcal vaccine for children licensed. 2006 —Hepatitis A and rotavirus vaccines recommended for all children. HPVvaccine is licensed. Sources:wwwhistoryofvaccines.org; Edward Jenner Museum; U.S. Centersfor Disease Control and Prevention; Hepatitis B Foundation
Page 21
Secret successesDISEASE-DEFYING I VACCINES
in the household. While the immune systems of adults often fight it off, according to the Hepatitis B Foundation it will be chronic for 90 percent of children who contract it. Although the first vaccine was approved in 1981, it wasn't required for children until about a decade later. Then, Chunn said, rates truly began to drop. The number of newly reported cases went from roughly 300,000 per year to an estimated 38,000 per year in the U.S., according to the CDC. In a discussion of the disease, The
Separate vaccines exist for pneumococcal disease for adults and children. The first adult version was made available in the late 1970s and the first for children came out in 2000. The adult vaccine didn't work in children until after age 2. So for years, doctors continued to see dangerous cases of pneumonia, infection of the blood and bacterial meningitis in children. "Once Hib was gone, pneumococcus was the thing that kept pediatricians up at night,"
Children's Hospital of Philadelphia says if vac-
Cieslak said diagnosing it in those too young to talk was particularly difficult. Doctors always had to consider that certain
Gellin said.
cination continues, hepatitis B could be eliminated in the U.S. within several generations. These vaccines have prevented the targeted infections. What researchers are finding is that some of the more recently issued vaccines are not only hitting their intended mark, they are also having unanticipated, positive results.
symptoms could be pneumococcal disease. "This could be bacteria in the blood, this could be spinal meningitis, this could be really nasty stuff," he said. oAnd the only way I can find out is to bring the baby in, do blood cultures, do a spinal tap, start the baby on antibiotics and stop them only if all that other stuff comes up negative. And the main cause of all this was that pneumococcus."
Positive side effects Such is the story of pneumococcus immunization.
• •
•
•
The 2000 vaccine covered seven variations, called serotypes, of the pneumoncoccus bacteria that accounted for more than 80 percent of disease in children. It swiftly made
a difference. "The thing was tremendously success-
ful," Cieslak said."We saw disease caused by those serotypes plummet."
Researchers developed a childhood vaccine upping the number of serotypes covered from seven to 13, which became the standard starting in 2010. And it performed as intended: The pneumococcus illnesses doctors worried most about, pneumonia, meningitis and blood infections, virtually stopped. But in the years that have followed, researchers have picked up on other effects that didn't come up in trials. Doctors are seeing fewer ear and sinus infections. The pneumococcal vaccine prevents about seven of every 100 ear infections and about 20 of every 100 severe ear infections Continued on Page 51
J
If you've ever thought weeds made your landscape look more "natural"...
p
Get Bac Into I .' Neck and back pain can redefine your view on life...and not for the better. At The Center, our spine and neck care experts' goal is to make your specific pain go away for good. For over 50 years, patients throughout Central Qregon have trusted our team to create surgical and non-surgical approaches with nationally renowned results. Putyour care in our hands andget backto what you love. The Center: Find strength here.
l.
Qj
• O~ nw,
ew
V
. • wo • w '.
oee ee
.rr rm, vdtt
' .
• •
• • •
•
Page 22
e
".oe eew
'!Qr
,$
THE CENTER ORTHOPEDIC & • EUROSURGICAE CAREtg RESEARCH
541-382-3344
'I
Ray Tien, MD, PhD B Brad Ward, MD
TheoenterOregon.com
SPRING/SUMMER2013• HIGH DESERTPULSE
Oregon's required immunizations States determine which immunizations are required for children to attend schools and day care centers. Oregon allows parents to optout ofsome or all vaccinations. The Oregon requirements for the 2013-14school year aren't identical to the 2013 immunization schedule recommended by the U.S. Centers for Disease Control and Prevention. A state committee decides which vaccinations to require for schools, and the two schedules sometimes differ. Some differences accommodate children arriving from countries with different vaccination schedules — for instance, two MMR shots are standard in the U.S, but notall countries combine measles, mumps and rubella into one shot. Other differences reflectopinions on which shots are most necessary to protect health in schools. Required to attend day cares and preschools for children 18 months and older: • Four diphtheria/tetanus/pertussis (DTaP)doses • Three polio doses • One varicella (chickenpox) dose • One measles/mumps/rubella (MMR) dose • Three hepatitis B doses • Two hepatitis A doses • Three or four Hib doses CDC recommends that children by age 6 also have received: • Four pneumococcal doses • Annualinfluenza vaccination starting at6 months old • One additional MMR dose • One additional varicella (chickenpox) dose • Two rotavirus doses
Required to attend kindergarten through fifth grade: • Five diphtheria/tetanus/pertussis (DTaP) doses • Four polio doses • One varicella (chickenpox) dose • Two measles doses • One mumps dose • One rubella dose • Three hepatitis B doses • Two hepatitis A doses CDC recommends that children by age 11also have received: • One additional varicella (chickenpox) dose • Annual influenza vaccination • One additional mumps dose • One additional rubella dose
Required to attend seventh through 12th grade: • Five diphtheria/tetanus/pertussis (DTaP) doses • One Tdap (tetanus, diphtheria and pertussis) dose • Four polio doses • One varicella (chickenpox) dose •Two measles doses • One mumps dose • One rubella dose •Three hepatitis B doses CDC recommends that children by age 11also have received: • One additional varicella (chickenpox) dose • Annual influenza vaccination • One additionalmumps dose • One additionaI rubella dose
GREGCROSS
Source: U.S.Centersfor DiseaseControl and Prevention, Oregon Immunization Program
•
•
•
•
-
•
-
•
-
•
•
•
•
• •
•
e
•
e
•
•
•
•
•
•
e
e •
• e
•
•
e
•
•
•
•
•
•
•
•
Simply scan yourchecks using one of our desktop scanners and deposit them in your account via our secure online portal. Remote Deposit offers you: CONVENIENCE IMPROVED CASH FLOW High Desert Bank has everything you need. Come talk to us today about opening your business checking account.
Call us today and start enjoying the convenience of Remote Deposit.
541.848.4444
Remote Deposit is subject to approval.
HIGH DESERT BANK •
II I
-
•
•
e-
•
•
HIGH DESERT PULSE • SPRING/ SUMMER2013
'
I
•
•
•
•
"LOCAL SERVICE — LOCAL KNOWLEDGE"
Page 23
Getgeor ~ AGUIDETocANTEENs
Handheld water bottles
Waist belts
Water bottles that fit in the palm ofyour hand offer easyaccess to fluids. Carriers with adjustable straps provide a relaxed but firm grip on the bottle. Many have small zippered pockets for stashing keys, a creditcard, a phone, an iPod or an energy gel. Ideal for: Middle distance running or walking. Pros:Compact, lightweight, relatively inexpensive, easy to clean. Cons:You have to carry it, holds only 7 to 20 ounces, hand can get hot. Approximate cost:510-525
Waist packs hold 20- to 24-ounce water bottles at an angle or laterally in the small of the back to maximize comfort. Alternatively, belts outfitted with a row of6-10-ounce bottles distribute water or other fluids around your waist. Ideal for: Nordic skiing, middle distance running or walking, hiking. Pros:Easy access, hands-free, extra compartments for gear, easy to clean. Cons:Can chafe, must be cinched down tightly to prevent the belt from bouncing around. Approximate cost:530-570
Runner's World Cruising Handheld Water Bottle; 12 oz; $10
Nathan Triangle Hydration Waist Pack; 22oz; $30
Page 24
When choosing gear, consider the duration and intensity of your
BY ELISE GROSS• PHOTOS BY ROB KERR
taying properly hydrated while exercising is crucial for optimal planned activity. As a rule, the longer and harder you plan to exerphysical performance and health. Dehydration — an abnormal cise, the more fluids you should carry. depletion of body fluids — can cause weakness, headache, For remote outdoor excursions, consider bringing extra fluids for vomiting and, in severe cases, death. But figuring out a comfortable way to carry fluids on an adventure
outing without resembling a pack mule can be challenging.
an emergency such as getting lost or stranded. Be sure to try on a product before you purchase it to check for comfort and fit. •
Small hydration packs (1-2 liters)
Large hydration packs (2-3 liters)
For distance trail running or backcountry skiing, a lightweight hydration backpackor vest holds more water and evenly distributes weight across the shoulders and back. An interior flexible polyurethane reservoir, or bladder, is attached to a sip tube with a bite vaIve. For cold conditions,"winterize" the reservoir by adding covers for the bite valve, tube or insulated reservoir. Ideal for: Cycling, trail running, hiking, snowboarding or all types of skiing. Pros:Evenlydistributes weight, ample space for water and gear, hands free, easy to drink when moving. Cons:Can chafe, somewhat heavy, hard to clean, back can get hot. Approximate cost:550-575 for backpacks, 5100-5130 for vests.
Longer, more intense endurance activities like mountain biking call for larger supplies ofwater. Like smaller packs, large hydration backpacks aredesigned to evenly distribute water weight across the shoulder and back in a reservoir attached to a sip tube with a bite valve. Ideal for: Mountain biking, hiking day trips. Pros:Large liquid capacity for long outings, evenly distributes weight, spacious, hands-free, easyto drink when moving. Cons:Can chafe or feel heavy, bulky, hard to clean, back can get hot. Approximate cost:560-5150
Osprey Mira 18 Hydration Pack; 100 oz (3 liters); $139
Q
i$ "y ' e'
' -
CamelBak Aurora Hydration Pack; 70 oz (2 liters); $68
Note: A variety of hydration products can be found at REI, FootZone, Fleet Feet Sports Bend, Mountain Supply, Pine Mountain Sports and Dick's Sporting Goods in Bend.
Paye25
On thejob ~ FLIGHTNURSE
On a bluebird dayin March, Phil KolkoIA stepped aboard an EC 14-5helicopter, ready for another day on thejob. Dressed in a black, fire-retardant flight suit, Kolkow fastened his four-point harness seat belt, donned his helmet and pulled a microphone close to his lips. Within arm's reach was an array of medical equipment â&#x20AC;&#x201D; a gurney, an oxygen tank, an electrocar-
BY HEIDI HAGEMEIER â&#x20AC;˘PHOTOS BY RYAN BRENNECKE
diogram machine. The grass rippled as the aircraft lifted from its landing pad at AirLink Critical Care Transport, which sits next to St. Charles Bend. Soon, pilot John Reiter brought the helicopter up to about 1,700 feet above the ground, filling the window frames with
gleaming Cascades peaks. "Look at the office we're working in," Kolkow enthused. "It's just so awesome." While Kolkow experiences such moments of calm, much of his time in the air is spent lasered in on a patient, performing some of the most urgent work in health care. The Bend resident, 61, is a critical care flight nurse. He tends to patients as they race through the sky, the quickest possible route to the care they desperately need.
"Generally, if somebody is calling for us, they needed somebody there five minutes ago," he said. Kolkow has spent a significant chunk of his career in medical air transport. He got ajob right out of nursing school in 1976 at St. Charles, which was then the new hospital east of Bend. In 1985, when St. Charles started the first air transport
service in Central Oregon, he decided tojuggle his posi-
IP
tion in the emergency room with flight duties. He did so for about three years. Then, a decade ago, he returned to work in the sky. Since then, Kolkow has worked 24-hour shifts, rushing into action day or night much like a firefighter when the call comes in. And with medical advances, the aircraft are edging ever closer to the capabilities
r
v
Atright, critical care flight nurse PhilKolkowstands near the AirLink EC145 helicopter on which he works.
Page 26
• M 4'
I.:M
„- • k
r
';
yg 'I
HIGH DESERT PULSE • SPRING/ SUMMER2013
•
'
of an intensive care unit. "I love it," he said. "It's the bestjob I've
ever had."
Getting the call Kolkow and his colleagues are trained to work on two types of aircraft. One is the helicopter, which usually stays within the region. They either pick patients up from accident scenes or isolated locations, or they transport patients from a rural hospital to a larger one like St. Charles Bend to access more services. Two companies offer helicopter medical air transport in Central Oregon, AirLink and Life Flight Transport, which is based in
Redmond. Kolkow also works shifts for airplane transport, which is only offered in Central Oregon through AirLink. The company's two Pilatus
PC-12 planes launch from the BendMunicipal Airport. Sometimes they take patients to cities like Portland, San Francisco and Boise, Idaho. Other times they pick up patients in rural communities like Lakeview and Burns.
Page 28
Membership for medieal air There are two main providers ofmedical air transport in Central Oregon: • Life Flight Network:www.lifeflight.org or 800-982-9299 • AirLink Critical Care Transport:wwwairlinkcct.org, 800-353-0497 or 541-706-6305
Airplane transport patients often need to get to a metro area to access treatment not available here, such as a burn unit or pediatric cardiac care. Occasionally, the service brings an individual awaiting a transplant to a faraway medical center when a donor
organ finally becomes available and there are only hours to spare. These flights don't necessarily come cheap. Both AirLinkand Life Flight sell memberships, and members have no out-ofpocket costs for flights. Nonmembers' bills can range between $15,000 to $40,000, according to AirLink's website. Yet with two helicopter transport services in Central Oregon, area residents might want to buy memberships to both. For instance, if emergency workers at an
accident scene ask 911 dispatchers to send a helicopter, the dispatchers call AirLink or Life Flight Transport based on a matrix map of locations, said Stacey Durden, marketing manager for AirLink. For transports between two hospitals, the physician decides which service to call, she said. Durden said sometimes a patient's preference on which service to call is honored. But other times, an incapacitated patient isn't able to communicate membership with one or the other. Calls to AirLink from 911 dispatchers or hospitals arrive at the company's dispatch center. Kolkow and other staff on duty are stationed based on that day's shift. The fixed-wing crew is at the Bend airport, while
SPRING/SUMMER2013 • HIGH DESERTPULSE
On thejob( FLIGHT NURSE
Kolkow looks out at the Cascade Mountains from the AirLi nk Cri ti cal Care Transport helicopter. The heli copter and airplanes are so well equipped that they're often referred to as mobileintensive care uni ts.
the helicopter crew is at the facility on the St. Charles Bend campus. Flight nurses are
regularly accompanied in the air by a respiratorytherapist, whosejob is to maintain the patient's airways and breathing during transport, and at times also a paramedic.
Depending on the time of day, Kolkow
ing. Or it could be a severe car accident. As the crew works on the medical details, the pilot is simultaneously learning more about where the helicopter can land. Some places, like Mt. Bachelor, have a dedicated
landing zone. Other scenarios take more creativity.
might be in one of the sleeping rooms. Or if
Emergency first responders as well as
on a helicopter shift, he might be grabbing
search and rescue volunteers know how to identify potential landing spots and will sometimes mark the area with flags or flares for the pilot to see. Those landing spots are not necessarily right next to the scene. Kolkow said the only spot on a search and rescue mission, for instance, might be several hundred
food in the hospital cafeteria. Otherwise, Kolkow and others occupy time not spent in flight by conducting trainings, keeping up-todate with medical protocols and other tasks. Sometimes the call is to stand by. Other times the crew is asked to depart as soon
as possible. They try to be off the ground in about seven minutes for the helicopter and 15 minutes for the airplane. In those few minutes, the medical crew going up must make some critical decisions, sometimes based on sparse information because the emergency is still unfolding. Crew members must decide whether they need any additional equipment in the aircraft. For instance, the team brings antivenom from the hospital if the call is for a rattlesnake bite. A 300-pound isolette — a tiny isolation chamber — is brought on board to transport the smallest ofbabies.
The pilots judge the weather for flying. They also want to know whether they are collecting one or two patients and how
heavy they might be. And they determine all this in minutes. "Sometimes, they're off before dispatchers
have even hung up the phone," Durden said.
Up in the air Dispatchers and others continue updating the medical staff onboard once they're in the air. "If we're going up empty, the crew is talking about what we're going to do," Kolkow
said. "We might only know age, weight and the basics on what happened."
The basics could be, a snowmobiler has hit a tree and doesn't appear to be breath-
HIGH DESERT PULSE • SPRING/ SUMMER2013
yards away through the woods. Even at high altitudes, the EC-145 helicopter is built for this sort of work, Reiter said. It's very sturdy and can fly up to about 155
mph. "It's got the power and it's got the speed to do what we do," he said. Once on the scene, the ground and flight crews load the patient as quicklyas possible into the aircraft. Then, they lift off.
Caring for patients Airborne medicinecommences as necessary. Kolkow can get out of his seat with the pilot's permission, but much can be done right from his position next to the patient. There can be some special considerations for patients inside the helicopter, which isn't pressurized. Pressure changes can be important if a patient has a collapsed lung, for instance, or a brain injury. "Altitude, temperature and pressure changes can be a big deal for patients," he said. The aircraft contains lab kits to allow Kolkow to perform tests to determine blood oxygen levels or whether the patient is loosing blood. The patient can receive blood or intravenous fluids in flight, as it has a refrigerator to store it and a warmer to bring it to an appropriate temperature. A cabinet contains supplies and medicines like antibiotics
and painkillers. "It allows us to do things that normally take place in the hospital," Kolkow said. "If there's
anything you can do in the air, you should do it and not wait until you're on the ground."
The caregivers can also be conferring with medical staff on the ground, asking for advice on how to proceed or getting them ready for the incoming patient. For instance, Kolkow said one of the biggest reasons for transports from hospitals like Madras or Prineville to Bend is heart attacks. "You don't want to wait to get to a facility and get an angioplasty," he said. "Time is re-
ally key with what you do." After years of experience, Kolkow said, he often knows whether a patient should bypass the St. Charles Bend emergency room. "I can tell them I've got a patient that needs to go directly to the operating room and expedite that process," he said.
Passing the baton This March day provided a smooth helicopter ride. But as the aircraft approached the Cascades, it still bumped mildly in the air currents. "Wind flows like water in a river over the mountains, so you get a little turbulence,"
Kolkow explained. Yet he admitted that flights can be a bit more rough. "It's sometimes like a rodeo with the turbulence," he said. It means health care in the air isn't the
right job for everyone. Even Kolkow experienced a touch of motion sickness in his early days as a critical care flight nurse. Yet Kolkow said the staff has been hand-
picked for this job, all with emergency experience. "I feel real good about the team we've got," he said. "I know the quality of the people stepping out of the helicopter." "It's a relay," he said of caring for patients. "We're getting the baton to the next person." •
Page 29
4,
P
Page 30
y
f
Alan Watts makes the first oftworunsup Pilot Buttein + ' Bend on a morningin March. Aninfluential rockclimber credited with thepopularityofSmith Rockas a climbing mecca, Watts has made a renewed commi tment to health.
C
SPRING/SUMMER2013â&#x20AC;˘ HIGH DESERTPULSE
p
' j) !I
HOIAdOeShedOit? ~ALANwATT s ;:j'
. gj
4
j 'jjp(i gyg,. $~ f l
8 ' IJI
Alan Watts'doggedness serves him well BY ANNE AURAND â&#x20AC;˘ PHOTO BY ROB KERR
t was the same determination and tenacity that made Alan Watts a foremost sport climber decades ago that helped him more recently revive his long-neglected fitness. Watts is widely credited as the father of American sport climbing. His remarkable
rock climbing career is inextricably linked with Smith Rock State Park becoming one of the hottest climbing crags in the world. He's written guidebooks about climbing at Smith. But his active lifestyle was for some time
eclipsed by overuse injuries, work and parenting. At times, he packed an extra 40 or 50 pounds on his 5-foot-9-inch frame. Last fall he committed to losing the weight and getting in shape. Watts, 52, now has a lean physique and often wears the bright-colored athletic attire that's ubiquitous in Bend. When he smiles, the lines that crease his face suggest a life lived mostly outside. When he's outside being active, he smiles more. "It's fascinating being older and getting in shape," he said recently. "I'm weaker at the same weight. It's OK; it's motivating. I feel like I have a new body, I want to see what I can do
HIGH DESERT PULSE â&#x20AC;˘ SPRING/ SUMMER2013
with it. When I weighed 185 I was depressed.
smooth rock faces where there were no
I couldn't conceive of going climbing like be- cracks, opening up new and more challengfore. Now I'm curious to see what I can do." ing places to climb while still offering proHe might be able to climb again.
Watts' legacy Climbers had been crawling like spiders all over Smith Rock's walls for decades before Watts arrived on scene. In 1960, the state created Smith Rock State Park. In the 1970s, climbing came of age in the area, according to one of Watts' guidebooks. Watts' father was there, back then. The younger Watts, who grew up in Madras, followed his father's footsteps, mountaineering in the Cascades and rock climbing at Smith in his early teens. By the early 1980s, Watts had mastered all the established routes as a traditional climber. Traditional climbing refers to when climbers place safety devices into cracks in the rock as they ascend. Climbers hook their ropes through these devices to catch them if they fall. They remove the devices when the climb is over. For Watts, the traditional method of climbing was beginning to feel limiting. He wanted something fresh, different. He decided to drill permanent bolts into
tection. Climbers had dabbled with bolting in California and Europe already. Watts used this method to develop several dozen routes for climbers at Smith. He prepared, among others, now-famous routes including To Bolt or Not to Be,Just Do It, Chain Reaction. "I was into pushing climbing standards to the highest levels while minimizing the danger," Watts said. This was known as sport climbing. It was not without controversy. Some criticized the bolts as destructive to the natural environment. Others suggested sport climbing was cheating. "Some people feel minimizing danger detracts from the
experience," he said. "I'm not entirely loved," he said. But, "I feel great about it. I didn't mean to create controversy. I was just following my passions. I took a fresh look at a stagnating sport." Until the 1970s and 1980s, Smith Rock
had been relatively unknown by all but the core climbing rats from Oregon. The controversy brought attention, and the attention brought climbers. The routes that Watts envisioned and
Page31
How doeshedoit? lALAN WATTS
climbed were "the catalyst for Smith's journey from unknown backwater to international premier crag status," said Chris Grover, who lived in Bend and climbed with Watts back then, and is now the vice president of sales for Black Diamond Equipment, a Salt Lake City-based manufacturer of climbing equipment. After Watts made his mark, "Smith was one of the hottest crags in the world, setting the American standard for difficulty, defining the cutting edge of crag culture in America. (It) attracted the best American and international rock climbers and was being featured on the covers of every respected international climbing journal," said Grover.
The cost of obsession Watts, according to Grover, had a "mindblowing amount of focus and concentration. "What sets him apart in my opinion is his ability to mentally engage with something," Grover said. But it wasn't all work and no
play. "We were having an unbelievable amount of fun," Grover added. As fun as it was, Watts has some regrets. "I was pretty obsessive and stupid. I was working harder than anyone in the U.S. for years," Watts said. He would climb six or seven days a week, sometimes 30 days a month. If work or life kept him off the rock
during the day, he'd climb in the dark. Watts' wife, JoAnn Miller-Watts, said her husband has always been one to set goals and reach them, at any cost. He gets so ab-
sorbed by his goals, be it pioneering a climb or painting the house or losing weight, he can lose track of time and ignore all else, she said. "He tends to go to extremes. That's who he is and how he got to be who he is," she said. Extreme obsessioncan generate success. It can also lead to injury.
Life beyond climbing Fortunately, Watts had other things go-
ing for him. He earned a business degree from the University of Oregon in 1987 and became a founding partner and later a president of Entre Prises USA, a climbing wall manufacturer in Bend. He married JoAnn. They had two kids in the early 1990s, Ben and Morgan, who are now 19 and 15. He
He mostly avoids carbohydrates. About every other day, he'll eat mostly salad. Some-
times he'll fast. He weighs himself daily. But, he said, he's learned from his past obsessiveness that an "absolute" diet doesn't work. It will doom him to failure.
"For example, I love milkshakes," he said. "There's nothing I can't have, but I don't have milkshakes too often. I can still satisfy those
cravings. I have vices. I drink some alcohol,
published his first climbing guidebook. He hardly climbed. He was absorbed with
and diet soda. I gotta have some vices; that's part of the whole thing. Otherwise it'd be other things. too miserable to sustain." His weight f luctuated, depending on He started hiking the dirt trail up Pilot where his focus was at the time. He could Butte once a day, every morning after dropexercise obsessively — m o u ntaineering, ping offhis daughter at Summit High School. running, tennis, nordic skiing — to shed ex- Why Pilot Butte? "I like climbing mountains," cess pounds, but he'd get injured, and quit. he said with a no-nonsense grin. He began to realize that this all-out apThe hikes were miserable at first, and some proach was not working for him anymore. days he almost didn't get out of his car at the He earned a master's degree in business trailhead. As hiking grew easier, he added a from Portland State University in 2002, but second daily ascent. Then he added a loop before he could put it to use, his oldest child, around the base, a relatively flat trail. Then he Ben, rose as a successful young snowboarder. started running it. He often fits in an evening Watts became Ben's manager and for a decade run along the Deschutes River too. of winters, they traveled around the world. He jogsa steady pace as he climbs the Traveling trumped fitness, led to a lot of meals butte, and can talk the whole time if he in restaurants, and, of course, weight gain. happens to have company. He usually runs
Turning point In June 2012, Watts weighed 194 pounds. He said he saw a picture of himself, 40 or 50 pounds too heavy. "It was a reminder of who I didn't want to be.... I'm too heavy to climb, run ... the stuff I love to do, be outside, in nature. For me, that's like church." A group of fit triathletes wanted to climb with him, so they all headed out to Smith Rock. Watts couldn't keep up with them bustling down the trails to the climbing routes. It disturbed him.
alone. He sees many of the same people on the trail, presumably fulfilling some ritual of their own. He loves this part of his day, and
how the running makes him feel. He goes regardless of weather. When asked if the snow might thwart his plans one day in March, he texted: "I'll be there no matter what." However, a while back, something started to hurt in his hip. He reluctantly took two
days off, worried that he'd landed himself in that place of breaking down again. But after a rest, the pain went away, affirmation of his
By his 30s, his hands were chronically inLast year Ben graduated from high school flamed. Sharp pain shot through his finger and stopped snowboarding. Going into the joints. Climbing made his fingers swell fat winter, Watts realized he had the freedom to
new approach.
like sausages. "There came a point when the
do whatever he wanted to. He wanted to get
(hand) injuries were keeping me from reaching my goals," he said. "I could have had a longer climbing career if I hadn't been so obsessive," he said. "I had dreams of being a climber. Many dreams
in shape.
came true. My home, this mecca, all my heros came here to experience this place I had part of creating. But bythe time they showed
ber, he had launched a well-orchestrated
pounds — what he weighed at the height of his climbing career. He emphasized that there's an end to this weight loss phase. It's time for a new goal. "Six months ago I was fat, slow and weak," he said with a soft chuckle. "Now I'm slim, still pretty slow, and still weak." His new goal is to get stronger and to run faster.
up, I was broken."
Page 32
He tried a vegan diet, and dropped some pounds. But being vegan requires too much planning and consideration. He started eating better and exercising more. By Novemand somewhat "fanatical" four-month eating and exercising plan. True to his nature, he stuck tenaciously to it.
"It used to be I'd go anyway."
In February, he reached his goal, 148
And, he said, "I would like to rock climb."•
SPRING/SUMMER2013• HIGH DESERTPULSE
Snapshot
CYCLING MCKENZIEPASS",.;,
~
',g. 53,
~
t
kr
r
.;-;~V I
Al~-'
I
1.
,.,Ct
C
gi+F. PHOTO BY ROB KERR
Cyclists ride between massivesnowbanks along the McKenzie PassHighway west ofSistersin late May 2072. Each spring when the highwayis cleared ofsnow, i tis open to cyclists — but notvehicles — for a few days, allowinga"cool"rideonthetwisty scenicroute.Historically, McKenzie Passhas opened as early as March27 (in 7934) and as lateas July29(in 7999). For condition updates, callSistersbikeshops Eurosports,547-549-2477, or Blazing Saddles,547-779-7273. • •
•
•
•
•
I
Page33
Getready ~ cAscADELAKEsRELA Y
Sheila Miller's teammate, Tanya Bruce, hustles down the Cascade Lakes Highway during the2012 Cascade Lakes Relay.
710
PETE ERICKSON
An insider's guide to the (are ye having fun?) Cascade Lakes Relay
I
BY SHEILA G. MILLER The races are gaining in popularity probably because they comicture it: sitting in a cramped van for b i ne the fun of hanging out with friends with the feeling of getting 36 hours with friends, with stops a g o o d workout. Theyalsocreate peer pressuretoworkout, which and starts to run under a beating hot i s very helpful; if you don't train, you'll look like a bozo and let down sun or in an ice-cold night, trapped with the y o ur teammates. So you better get off the couch. c. sweet smell of sweaty clothes while lingerBut w h i lethese36-houradventurescanbethrillingandchallenging constantly on the verge of sleep just to i n g , they can also be exhausting and painful. That's why it's imporbe awakened minutes later. If this appeals to t a nt to pair the right training with a few insider tricks, so that the fun you, I suggest running a long-distance relay. of the first mile isn't forgotten with the miseryof the final one. Long-distance relays have been around for years. Here in Or- = '=== : = : - Step1:Getyourseifready---'.-'-=~ .. egon, the Hood to Coast Relay started in 1981, and the Cascade Lakes Relay, which starts near Diamond Lake and ends in Bend, '-=.—:";=- First, two words ahout trairiing: Do'it.~-.=~ ~ :~ ~ ,=':,'-..'',,'.-.;,'- ~ » =-;:I::-speak-from experience.'I've run the gascade began in 2007. Similar relays, which typically feature teams.of =-:,= t.akes Relay- K.':c<~~ ,-';.-' @ '.~~ eight to 12 runners and traverse hundreds of miles, take place'=.-;twice, and will run it again this summer, Before last year's re-,,'=' all over the country — the American Odyssey run frorA=G'etty<.- Ray;Md a Jot-of sitting aiound'arid.Jiot.il'ot of.turining-. Here'< "::.; :
-= . '
.
.-
.
.
~
;
-
~
- burg to D.C., the Reach the Beach seriesjn Mas~a~setts; New:-'-vyh@43eaITied: My body.found a wpy„ to compgte for. the.first ==-' , = ~ " = ' = and'stscor1cf'fegs withoLIt"much trlining. Arid the'tfi'ird leg''INas ',"Hampshire and New Jersey. -
-
'
.
-
'
,
,
—
.
;
. '
. . - . '
,
;
:
.
P
,
I
The third leg wasoneofthe mostunpleasantexperiences ofmy life. Theremay havebeen tears.
communicate by walkie-talkie or cellphone:
when one van's runners are nearly finished with their legs, the other van had better be
ready for a handoff. But cell service in many of the areas is shoddy and walkie-talkies generone of the most unpleasant experiences of my life. There may have been tears. So even if it's slow, even if it doesn't follow a formal plan, at least get out and run. And if you're smarter than I am, do a bit more than that. In the Cascade Lakes Relay, 12 runners each run three legs. That means each runner will have to complete about 18 miles. Race legs vary between two miles and nine miles, and many involve significant changes in elevation. One van's participants rest while the other van's participants run, leaving several hours between legs. Groups can sleep in the La Pine High gym, but "sleep" is not a term I'd use to describe the experience. The gym is filled with
encourages relay racers to make one workout each week into a double, that is, running once in the morning and again in the evening to get a feel for what that's like. Teri Smith, the Cascade Lakes Relay's communications director, suggests spending the two weeks before the race really getting used to the heat, "moving around and getting your body used to it. "It's something some people have had really tough times with from not being prepared," she said. "It's not something you think about." Smith said there's no need to spend the entire summer running in the heat of the day; even getting out and hanging outside
runners, all trying and failing to quietly unzip their sleeping bags, and alarm clocks con- in hot weather will help your body adjust. stantly sounding so van mates can meet the rest of their teams for a smooth handoff. FootZone's Dave Thomason, a race director known in local running circles as SuperDave and who founded the Dirty Half Marathon, said there are some simple ways to feel solid through the finish of a relay like the CLR.
By the end of May, Thomason suggests upping the winter training he hopes you've done to include at least three runs each week, with one being the distance your maximum relay
leg will require. For example, if you'll run relay legs of three, six, and nine miles, you ought to build up to running at least a nine-mile run during the weeks leading up to the race. He also suggests doing speed intervals ("you gain a lot of fitness") and trying to fit in a tempo run, where you're running harder
And over here in the peanut gallery, a few things I've learned in the past two years of participating in the relay: The CLR is run largely on pavement. In Central Oregon, we can train on many wonderful, soft trails. Getting in some pre-race runs on pavement at the height of a baking hot day will be unpleasant, but will eliminate the surprise fac-
take. That way, if the cellphone or walkie-
talkie fails you, your van will still be ready to run when it's time for the switch. Beyond communication, a few other obvious pieces of the puzzle: safety lights and other required equipment for running in the
dark should go somewhere with easyaccess, Smith's favorite trick for organizing the van is having a set of six plastic bins, one for each runner to store important stuff like
iPods, wallets and headlamps. "All those little things you lose as the relay goes on, it's such a huge relief that you know right where that stuff is," she said.
And eachvan should have a large jug of water and ice. Our van also had Gatorade
powder and various recovery drinks, as well as a large cooler for food.
with no wind and a pounding sun.
of recovery foods and drinks while train-
Step 2: Get your transportation ready
ing. After a long run, try different foods and
drinks and see how they make you feel. It could be as simple as a peanut butter and
If you've properly prepared your body, jelly sandwich. Thomason said it helps to inyou've taken a step in the right direction.
clude protein; the emphasis is often on load-
The second step involves properly prepar- ing up on carbohydrates, he said, but that's ing the vans. Each team has two vans with six runners in each.
I highly recommend having non-runner designated drivers for each van; that way, runners can rest and recover during van time.
not a good idea because eating a ton of anything is bound to slow you down and leave you with a stomachache. Running drains glycogen stores in the
muscles and liver, which provide some of a I also highly recommend renting or borrow- person's long-term energy. It's best and easiing vans that are large. In the past two years,
est to rebuild those stores soon after your
my team has had a sort of rich van/poor van run to keep you feeling strong and ready for scene â&#x20AC;&#x201D; one group spread out in a Chevy your next leg. King suggests drinking someSuburban, which has plenty of room, and one thing with carbohydrates and protein in it. group cramped together in a minivan, which is less than optimal. SUVs (with three rows of
seats) and 12-passenger vans will be more One thing to keep in mind: during a relay expensive, but worth it when legs need to be
want to get on your bike, take a long ride.
HIGH DESERT PULSE â&#x20AC;˘ SPRING/ SUMMER2013
culate how long each of the legs is likely to
tor when you're on an abandoned highway,
about 80 percent of your maximum speed. "If you run at the same pace all the time, all that leads to is running the same pace." And it's OK not to run every single day. In fact, Thomason encourages doing a variety of exercises and cross-training. It keeps you from overuse injuries that plague first-time marathoners and others who sometimes overtrain.
you're running at odd hours, and more than once in a day. Max King, a local elite distance runner, has run the Hood to Coast and Cascade LakesRelayat least seven times. He
Also key: knowing how fast (or slow) the runners in the other van are, so you can cal-
The wrong time to experiment with new types of drinks or other nutrition packets? In the middle of the race. Thomason suggests testing out a variety
than you would on a normal run, maybe
So if you like soccer, play soccer. If you
ally don't work unless you're within a mile or so of one another, so patience is key.
stretched (Important! See step 3 below!) and
sleep is calling. Once the vans are rented, it's time to fill them properly. First, runners in each van will
Once that recovery is underway, he recommends a small meal before the next run. 'You don't want to eat heavy things," he said. Some teams go in together on foods like bananas, hummus and pita, that sort of thing. But I've seen others with gigantic mobile grills on the back of their vans, and personally that's
more my speed. Each van will have downtime
Page35
Getready( CASCADE LAKESRELAY
Bring running gear plus: • Reflective vests, flashlights/head amps, and flashing red lights for night runs • Sleeping bag, pi ow and camp mattress • Changes ofclothes, including a winter hat, sweats and sandals • Bug sprayand sunscreen • Baby wipes and hand sanitizer • A cooler and a water jug for each van • Shampoo, soap and a towel ifyou want a shower at La Pine High
~ s
• Neosporin • Benadryl • Band-Aids • Ice packs
216 6miles m, jIIta srriit s s
'
I
DESCHUTES
La Pine + asy s s
LAM
Start:Dia ondLake
CLR gurus suggest a first aid kit with: • moleskin •Ace bandages • Ibuprofen • Scissors
Sheila Miller also "highly recommends" bringing:
Cascade Lakes Relay route
LAKE
' coUNTY
Chemult
• Second Skin •Tweezers • Icy Hot •Tape, gauze
jr a sa'++
a r~
P
Silver Lake
Crater ke
I
• Ear plugs: Sometimes sleep is more important than singing along to "Call Me Maybe" again. •A bandanna: Some of the running takes place on cinder, and covering your mouth helps with dust. • A brand new, never-used pesticide spray canister: Your teammates can sprayyou with water while you run. • A swimsuit: There are chances to go for a dip, albeit a cold one, in Elk Lake and Diamond Lake. • Benadryl; I'm allergic to everything. •Van decorations: You don't want to be the team with the least spirit. 2013 race date:Friday and Saturday, Aug. 2-3 On the web:www.cascadelakesrelaycom
while the other van's runners are on the course, Sensitive areas, left unwashed and clothes un- immediately sitting in a cramped van. so it is possible to park, grill, and party. changed, can get a little, shall we say, chafed. Kingand Thomason have suggestions for For the ladies, an obvious addition to this making that part of the race less brutal. Step3: "I think the biggest help in the van is not is a change of sports bras. In my experience, Keepthecreaturecomfortable that band on the bottom ofa sports bra nev- how fit you are, but how well you can help Beyond food and drink, it's about comfort. er dries until it's off your body. yourself recover in between runs," King said. Taking into account the heat, I highly recOnce you're in the van, that's when the fun "Mostpeople who do relays have been runommend changing every piece of clothing — and the pain — begin. ning. They can handle the miles. What really after each race leg. This limits how stinky The fun is easy to understand: You're in a gets you is, you run and then sit for a long your van gets, and it also limits how clammy tight space with a bunch of friends, operat- time." and uncomfortable you are. ing onendorphins and a lackofsleep. When passing off to the next runner, King Thomasonsuggestsfresh socksand shorts The pain stems from a variety of places: suggests continuing to jog down the road for each leg of the race, and also testing socks the CascadeLakes Relay takes place in Au- to cool down, perhaps as long as five or 10 for comfort before the race. And if nothing gust, usually a time of high temperatures. more minutes. Thomason agrees. "If you can muster the energy, do a little else? "Body glide," he said, laughingly referring And there's something particularly uncomto the lubricant used to prevent skin irritation. fortable about running long distances, then bit of a cool-down jog," Thomason said.
I
Power Lift Chairs
$
Power
$799 Ik~
Lll ~
A I.
Adjustable Bases
with Mattress
$
xL Twin
FREE DELIVERY • FREE SET-UP • FR EE REMOVAL OF OLD MATTRESS W ilso q ' s
M rAmTTR~ES S
•
e
.
•
•
•
•
GFaller y ~ B e .n cl
s
s••
s
• ;'
"Just nice and easy for five minutes, or even walk. Don't get right in the van and sit."
The same goes for warming up before a leg. It's not always easy, but King says your body will feel much better if you warm up before your teammate hands you the wristband. King's final suggestion for combatting exhausted legs is trying to keep your legs propped while you're in the van, and wearing compression socks whenever you're not running. They can be a bit expensive, and you may notlovethewayyou look in knee-high socks (although they now come in a variety of colors). But you know that heavy feeling in your legs after a long run? King says when you finish running and your heart rate slows, blood pools in your legs, and compression socks help keep the blood flowing to eliminate toxins and metabolic byproducts accumulated during the run. And Thomason takes an approach similar to mine. "The third leg, you're going to feel like crap," Thomason said. "So have some treats, some comfortable, reliable stuff."
Central Oregon
Radiology
Associates, p.c. Serving our MedicalImaging NeedsSince 1948
Step 4: Keep your eye on the prize And the last, and I believe most important part, is that the best
way to deal with lack of sleep, body aches and general exhaustion is to have as fun a time as possible. I highly recommend not taking the running itself too seriously. Bring items that will keep you laughing: playlists on your iPhone, decorations and face paint, playing cards. Smith said her teams always tried to have something that allowed them to interact with other teams, like water guns or glow sticks. "The best part of the relay is meeting other teams out there and sharing the experience together," she said. "It's something that breaks the ice."
Costumes are good. Last summer, my team went with an "America" theme. It sounds silly, and dealing with a tutu or a mask might be annoying, but it's preferable to thinking about sore legs.
4
4
I
$
4
$ •
$
"You have to go in with the mentality that it's more fun than
anything else," King said. "As long as your training has been where it needs to be ... you'll be comfortable with it."•
r •
•
•
Is .
. I
•
4 i
4
•I .s rl
I
OS IC o f Red m o n d
Serving All of Central Oregon Since tg8]
Our team of professionals is dedicated to quality of life for our clients and their families. Working closely with your doctor, we offer:
'" Registered Nurses '" Medical Social Workers J '" Licensed Therapists g ' '" Hospice Aides g g. ~A
'" Spiritual Counseling '" Grief Support " C a regiver Support " Trai n ed Volunteers
sk about our Transitions Program For more information, please call:
541. 548. 7483 732 SW 23rdStreet,Redmond, OR 97756 hospice®bendcable.com www.redmondhospice.org
Call or appointments: 382-9383 John Stasst.n, MD — Cloe Shelton, MD —Ronald D. Hanson, MD Will Wheir, MD — James E.Johnson, MD — Patrick B. Brown, MD Jeffrey Drutman, MD - Traci Clautice-Engle, MD - Laurie A. Martin, MD Steven D. Kjokech, MD - Garrett Schroeder - Thomas F. Koehler, MD Robert E. Hogan, MD - Stephen Shultz, MD - Paula Shultz, MD David R. Zulauf, MD — Steven J. Michel, MD
AOVERTISINGSUPPLEMENT
2 013 C E N T RA L O R E G O N
Your
t
S o u r c e f o r Lo c a l H e a l t h Se r v i c e s a n d Ex p e r t M e d i c a l P r o f e s s i o n a l s To list your medical office andlor physicians in the PULSEIConnections Medical Directory contact...
Lorra in e
S t a r o d u b , A c c o u n t E x e c u t i v e ( H e a l t h 8c M e d i c a l) • 5 4 1 . 6 1 7 .7855 •
a•
•
AESTHETIC SERVICES
J
ALLERGY &ASTHMA
•
A
•
ADULT FOSTER CARE
1
•
Absolute Serenity Adult Foster Care
119 N RopeStreet • Sisters
541-588-G119
DermaSpa atBend Dermatology
2705 NE Conners Drive• Bend
541-330-9139
Bend Memorial Clinic
locations in Bend &Redmond
541-382-4900
ww w .bendmemorialclinic.com
1099 NE Watt Way • Bend
541-385-4717
www . brookdaleliving.com
3550SW CanalBlvd • Redmond
541-504-1600
Bend & Redmond
541-G47-2894
w ww.centraloregonaudiology.com
ALZHEIMERS &DEMENTIA CARE Clare Bridge Brookdale Senior Living
www . absoluteserenity.info www.bendderm.com
ASSISTED LIVING
BrooksidePlace
AUDIOLOGY
Central Oregon Audiology &Hearing Aid Clinic
BEHAVIORAL HEALTH
St. Charles Behavioral Health
2542 NE Courtney Drive• Bend
541-706-7730
www .stcharleshealthcare.org
CANCER CARE
St. Charles Cancer Center
Locations in Bend & Redmond
541-70G-5800
www. s tcharleshealthcare.org
CARDIOLOGY
Bend Memorial Clinic
locations in Bend &Redmond
541-382-4900
ww w .bendmemorialclinic.com
CARDIOLOGY
The Heart Center
2500 NE Neff Road• Bend
541-706-6900
www.heartcentercardiology.com
CARDIOTHORACIC SURGERY S t . Charles Cardiothoracic Surge
2500 NE Neff Road• Bend
541-388-1636
www.stcharleshealthcare.org
COSMETIC SERVICES
Bend Memorial Clinic
2600 NE Neff Road• Bend
541-382-4900
www.bendmemorialclinic.com
DENTURISTS
Sisters Denture Specialties
161 E Cascade• Sisters
541-549-0929
www.raordenturecenter.com
DERMATOLOGY
Bend Dermatology Clinic
2747 NE Conners Drive• Bend
541-382-5712
www.bendderm.com
2600 NE Neff Road• Bend
541-382-4900
www.bendmemorialclinic.com
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
DERMATOLOGY (MOHE)
J
B O LL
'MCB i
www.ccliving.com
ENDOCRINOLOGY
Bend Memorial Clinic
ENDOCRINOLOGY
Endocrinology ServicesNW
929 SWSimpson Ave,Ste 220 •Bend
541-317-5GOO
FAMILY MEDICINE
Bend Memorial Clinic
Locations in Bend, Redmond fk Sisters
541-382-4900
PAMILY MEDICINE
St. Charles Family Care
2965 NE ConnersAve, Suite 127 • Bend
541-70G-4800
www .stcharleshealthcare.org
FAMILY MEDICINE
St. Charles Family Care
1103 NE ElmStreet • Prineville
541-447-G2G3
www. stcharleshealthcare.org
PAMILY MEDICINE
St. Charles Family Care
211 NWLarch Avenue• Redmond
541-548-2164
www .stcharleshealthcare.org
FAMILY MEDICINE
St. Charles Family Care
61 5 Arrowfeaf Trail• Sisters
541-549-1318
www .stcharleshealthcare.org
PAMILY PRACTICE
High Lakes Health Care
Locations in Bend, Sisters fkRedmond
541-389-7741
www. highlakeshealthcare.com
GASTROENTEROLOGY
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www. bendmemorialclinic.com
GASTROENTEROLOGY
Gastroenterology of Central Oregon
2450 Mary Rose Place, Ste210 • Bend
541-728-0535
ww w .gastrocentraloregon.com
GENERAL DENTISTRY
Coombe and Jones Dentistry
774 SWRimrock Way• Redmond
541-923-7633
www.c o ombe-jones.com
2084 NE Professional Court• Bend
541-322-5753
www . advancedspecialtycare.com
1245 NW 4th Street, Ste 101 • Redmond
541-548-7761
www. s tcharleshealthcare.org
GENE RALSURGERY,BILRIATRICSGVEINCARE Advanced Specialty Care GENERALSURGERY& BARIATRICS St. Charles Surgical Specialists
n/a www.bendmemorialclinic.com
HOME HEALTH SERVICES
St . C h arles Home Health
2500 NE Neff Road• Bend
541-70G-7796
www .stcharleshealthcare.org
HOSPICE/HOME HEALTH
Hospice of Redmond
732 SW 23rd St• Redmond
541-548-7483
www.r edmondhospice.org
2075 NE Wyatt Ct.• Bend
541-382-5882
www.partnersbend.org
541-70G-7796
www.stcharleshealthcare.org
HOSPICE/HOME HEALTH
T
Partners In Care
t E NE A Street• Madras
HOSPITAL
St. Charles Madras
470
HOSPITAL
Pioneer Memorial Hospital
1201 NEElm St • Prineville
541-447-G254
www.stcharleshealthcare.org
HOSPITAL
St. Charles Bend
2500 NE Neff Road• Bend
541-382-4321
www.stcharleshealthcare.org
HOSPITAL
St. Charles Redmond
1253 NECanal Blvd • Redmond
541-70G-779G
www.stcharleshealthcare.org
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
HYBERBARIC OXYGENTHERAPY Bend Memorial Clinic
IMAGING SERVICES
Bend Memorial Clinic
locations in Bend &Redmond
541-382-4900
www.bendmemorialclinic.com
INFECTIOUS DISEASE
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
2 013 CE N T RA L O R E G O N
M E D I CA L D I RECTORY S
INPECTIOUS DISEASE
St. Charles Infectious Disease
INTEGRATED MEDICINE
Center for Integrated Mediclne
INTKRNAL MKDICINK
Send Memorial Clinic
INTERNAL MEDICINE
High Lakes Health Care Upper Mill
INTERNAL MEDICINE
Internal Medicine Associates of Redmond
INTERNAL MEDICINE
Redmond Medical Clinic
DVERTISINGSUPPLEMENT
a
2965 NE ConnersAve., Suite 127<Bend 54 1-70G-4878
www . stcharleshealthcare.org
916 SW17th St, Ste202 • Redmond
541-504-0250
w ww.centerforintegratedmed.com
Bend Eastside gtWestside
541-382-4900
ww w .bendmemorialclinic.com ww w .highlakeshealthcare.com
929 SW Simpson Ave• Bend
541-389-7741
236 NW Kingwood Ave • Redmond
541-548-7134
1245 NW 4th Street, Ste201 • Redmond
541-323-4545 541-382-4900
www .bendmemorialclinic.com
ww w .bendmemorialclinic.com
MEDICAL CLINIC
Bend Memorial Clinic
3080 SWMt. Bachelor Dr • Bend (West)
MEDICAL CLINIC
Bend Memorial Clinic
1501 NEMedical Center Dr • Bend(East) 541-382-4900
MKDICAL CLINIC
Send Memorial Clinic
www.imredmond.com
n/a
231 EastCascadesAve• Sisters
541-382-4900
ww w .bendmemorialclinic.com www.bendmemorialclinic.com
MEDICAL CLINIC
Send Memorial Clinic
865 SWVeteransWay• Redmond
541-382-4900
NEPHROLOGY
Send Memorial Clinic
locations in Bend gtRedmond
541-382-4900
www.bendmemorialclinic.com
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
NEUROLOGY NEUROSURGERY NUTRITION
The Center: Orthopedic ¹t NeurosurgicalCare¹r Research L o c a tions in Bend ga Redmond
Bend Memorial Clinic
1501 NEMedical Center Drive • Bend 2400 NE Neff Road,Ste A • Bend
OBSTKTRICS tk GYNKCOLOGY East Cascade Women's Group, P.C. OBSTETRICS gt GYNECOLOGY St. Charles OB /GYN OCCUPATIONAL MEDICINE
541-382-3344
www.thecenteroregon.com
541-382-4900
www.bendmemorialclinic.com
541-389-3300 www.eastcascadewomensgroup.com
213 NW Larch Ave,Suite B• Redmond
541-52G-G635
www . stcharleshealthcare.org
Locations in Bend gtRedmond
541-382-4900
ww w .bendmemorialclinic.com
Send Memorial Clinic
The C e nter: Orthopedic th Neurosurgical CareAResearch Lo c ations in Bend gt Redmond
541-382-3344
www. t hecenteroregon.com
Bend Memorial Clinic
Locations in Bend ga Redmond
541-382-4900
www .bendmemorialclinic.com
OPHTHALMOLOGY
Bend Memorial Clinic
Locations in Bend ga Redmond
541-382-4900
ww w .bendmemorialclinic.com
OPTOMKTRY
Send Memorial Clinic
Locations in Bend gtRedmond
541-382-4900
ww w .bendmemorialclinic.com
ORTHOPEDICS
Desert Orthopedics
Locations in Bend gtRedmond
541-388-2333
www . desertorthopedics.com
ca t ions in Bend gt Redmond
541-382-3344
www. t hecenteroregon.com
2200 NENeffRoad,Suite 302 • Bend
541-388-3978
w wwdeschutesosteoporosiscentercom
2500 NE Neff Road• Bend
541-70G-5880
www .stcharleshealthcare.org
OCCUPATIONAL MEDICINE
ONCOLOGY - MEDICAL
ORTHOPEDICS
The Center: Orthopedic ¹t NeurosurgicaiCarerhResearch l o
OSTEOPOROSIS
Deschutes Osteoporosis Center
PALLIATIVE CARE
St. Charles Advanced Illness Management
PEDIATRIC DKNTISTRY
Deschutes Pediatric Dentistry
1475 SWChandler Ave, Ste202 • Bend
541-389-3073
www. deschuteskids.com
PKDIATRICS
Send Memorial Clinic
1080 SWMt. Bachelor Dr • Bend (West)
541-382-4900
ww w .bendmemorialclinic.com
PKDIATRICS
St. Charles Family Care
211 NW LarchAvenue• Redmond
541-548-2164
www . stcharleshealthcare.org
PHYSICAL MEDICINE
Desert Orthopedics
locations in Bend gtRedmond
541-388-2333
www . desertorthopedics.com
541-382-3344
www. t hecenteroregon.com
I503 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
22 75 NE Doctors Dr,¹3A336SWCyber Dr, Ste307
541-382-5500
w w w.alpinephysicaltherapy.com
404 NE PennAvenue • Bend
541-318-7041
www.healingbridge.com www.cascadefoot.com
PHYSICAL MEDICINE
The Center: Orthopedic th Neurosurgical CareAResearch L o c a tions in Bend gt Redmond
PHYSICAL MEDICINE/REHABILITATION
Bend Memorial Clinic
PHYSICAL THERAPY
Alpine Physical Therapy gt Spine Care
PHYSICAL THERAPY
Healing Bridge Physical Therapy
PODIATRY
Cascade Foot Clinic
Offices in Bend,Redmond gtMadras
541-388-2861
PULMONOLOGY
Send Memorial Clinic
locations in Bend gtRedmond
541-382-4900
ww w .bendmemorialclinic.com
PULMONOLOGY
St. Charles Pulmonary Clinic
Locations in Bend gtRedmond
541-70G-7715
www .stcharleshealthcare.org
RADIOLOGY
Central Oregon Radiology Associates, P.C.
146 0 NE Medical Center•DrBend
541-382-9383
RKHABILITATION
St. Charles Rehabilitation Center
Locations in Bend ga Redmond
541-70G-7725
www .stcharleshealthcare.org
RHKUMATOLOGY
Send Memorial Clinic
Locations in Bend gtRedmond
541-382-4900
ww w .bendmemorialclinic.com
RHEUMATOLOGY
Deschutes Rheumatology
2200 NE Neff Road,Suite 302• Bend
541-388-3978
n/a
www.corapc.com
Send Memorial Clinic
locations in Bend gtRedmond
541-382-4900
www.bendmemorialclinic.com
SLEEP MEDICINE
St. Charles Sleep Center
Locations in Bend gtRedmond
541-706-6905
www.stcharleshealthcare.org
SURGICAL SPECIALIST
Bend Memorial Clinic
Locations in Bend ga Redmond
541-382-4900
www.bendmemorialclinic.com
URGKNT CARE
Bend Memorial Clinic
Locations inBend(East gtWest) ARedmond
541-382-4900
www.bendmemorialclinic.com
URGKNT CARK
St. Charles Immediate Care
2600 NE Neff Road• Bend
541-70G-3700
www.stcharleshealthcare.org
UROLOGY
Send Urology Associates
Locations in Bend gtRedmond
541-382-G447
www.bendurology.com
2 013 CE N T RA L O R E G O N a
•
Urology Spedalists of Oregon
VASCULAR SURGERY
Send Memorial Clinic
J
VEIN SPECIALISTS
Send Memorial Clinic A
•
a
L ocations in Bend gt Redmond
541- 3 2 2-5753 h t t%/sofor.praxismedi p calgroup.com
1501 NE Medical Center Drive• Bend 54 1 - 3 82-4900 w
Inovia Vein Spedalty Center
•
R
g
UROLOGY
VEIN SPECIALISTS
DVERTISINGSUPPLEMENT
M E D I CA L D I RECTORY
o
ADAM WILLIAMS, MD
Bend Memorial Clinic
STEPHEN ARCHER, MF, FACS
Ad vanced Spedalty Care
J
ww. bendmemorialclinic.com
2200 NE Neff Road, Ste 204• Bend 5 4 1 - 382-8346
www.bendvein.com
1501 NE Medical Center Drive• Bend 54 1 - 3 82-4900 w
ww. bendmemorialclinic.com
•
Bend Eastside8t Redmond
NGOCTHUY HUGHES, DO, PC St . Charles Surgical Specialists
541-3 8 2-4900
ww w .bendmemorialclinic.com
2084 NE Professional Court• Bend 5 4 1 - 3 22-5753 w
ww . advancedspecialtycare.com
1245 NW 4th Street, Ste 101 • Redmond 541-548-77G1 w
ww. s tcharleshealthcare.org
PHILIP B.ANDKRSON, MD
St. Charles Sehavioral Health
2542 NE Courtney Dr • Bend
541-706-7730
www.stcharleshealthcare.org
KAREN CAMPBELL, PhD
St. Charles Sehavioral Health
2542 NE Courtney Dr • Bend
541-706-7730
www.stcharleshealthcare.org
RYAN C. DIX, PsyD
St. Charles Family Care
1103 NE Elm Street, Ste C• Prineville
541-447-G2G3
www.stcharleshealthcare.org
BRIAN T. KVANS, PsyD
St. Charles Sehavioral Health
2542 NE Courtney Dr• Bend
541-706-7730
www.stcharleshealthcare.org
KUGKNK KRANZ, PhD
St. Charles Sehavioral Health
2542 NE Courtney Dr • Bend
541-706-7730
www.stcharleshealthcare.org
www.stcharleshealthcare.org
SONDRA MARSHALL, PhD
St. Charles Sehavioral Health
2542 NE Courtney Dr • Bend
541-706-7730
MIKALA SACCOMAN, PhD
St. Charles Behavioral Health
2542 NE Courtney Dr • Bend
541-706-7730
www.stcharleshealthcare.org
RKBECCA SCRAFFORD, PsyD
St. Charles Sehavioral Health
2542 NE Courtney Dr• Bend
541-706-7730
www.stcharleshealthcare.org
SCOTT SAFFORD, PHD
St. Charles Family Care
2965 NE ConnersAve, Suite 127 • Bend
541-706-7730
www.stcharleshealthcare.org
KIMBERLY SWANSON, PhD
St. Charles Family Care
211 NW Larch Ave• Redmond
541-548-2164
www.stcharleshealthcare.org
CATHERINE BLACK, PA-C
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
JEAN BROWN, PA-C
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
NAHEL PARRAJ, DO
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
RICK KOCH, MD
Bend Memorial Clinic
Bend Eastside gt Redmond
5 41-3 8 2 -4900
www.bendmemorialclinic.com
GAVIN L.NOBLE, MD
Bend Memorial Clinic
Bend Eastside 8t Redmond
541-3 8 2-4900
www.bendmemorialclinic.com
STEPHANIE SCOTT, PA-C
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
JASON WEST, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
JASON R. WOLLMUTH, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
s s
ww . bendmemorialclinic.com
s
JOHN D. BLIZZARD, MD
St. Charles Cardiothoradc Surgery
2500 NE Neff Road• Bend
541-388-163G
www .stcharleshealthcare.org
ANGELO A. VLESSIS, MD
St.Charles Cardiothoracic Surgery
2500 NE Neff Road• Bend
541-388-163G
www .stcharleshealthcare.org
JORDAN T. DOI, MSC, DC
NorthWest Crossing Chiropracticgt Health
62 8 NW York Dr, Ste. 104 • Bend
541-388-2429
www.nwxhealth.com
THERESAM. RUBADUE, DC, CCSP NorthWest Crossing Chiropracticgt Health
62 8 NW York Dr, Ste. 104 • Bend
541-388-2429
www.nwxhealth.com
JASON M. KREMER,DC,CCSP, CSCS Wellness Doctor
1345 NW Wall St, Ste 202• Bend
541-318-1000
ww w .bendwellnessdoctor.com
1563 NW Newport Ave• Bend
541-389-0300
ww w.centraloregondentalcenter.net
1016 NW Newport Ave• Bend
541-389-1107 wwwcontemporaryfamilydentistrycom
MICHAKL R. HALL, DDS
Central Oregon Dental Center
BRADLEY E. JOHNSON, DMD
Co n temporary Family Dentistry
s
'
J
' s s
ALYSSA ABBEY, PA-C
Bend Memorial Clinic
ANGKLA COVINGTON, MD
Send Memorial Clinic
MARK HALL, MD
CentralOregon Dermatology
2600 NE Neff Road• Bend
541-382-4900
ww w .bendmemorialclinic.com
Bend gt Redmond
541-382-4900
www .bendmemorialclinic.com
388 SW Bluff Dr• Bend
541-G78-0020 wwwcentraloregondermatologycom
(
2 013 CE N T RA L O R E G O N •
M E D I CA L D I RECTORY
DVERTISINGSUPPLEMENT
•
3AMES M. HOESLY, MD
Bend Memorial Clinic
2600 NE Neff Road• Bend
541-382-4900
ww w .bendmemorialclinic.com
GERALD E. PETERS,MD, DS (Mohs)
Bend Memorial Clinic
2600 NE Neff Road• Bend
541-382-4900
www.bendmemorialclinic.com
ANN M. REITAN, PA-C (Mohs)
Be n d Memorial Clinic
2600 NE Neff Road• Bend
541-382-4900
ww w .bendmemorialclinic.com
ss '
s s
MARY P. CARROLL, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
RICK N. GOLDSTEIN, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
TONYA KOOPMAN, MSN,FNP-BC
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
PATRICK MCCARTHY, MD
Endocrinology ServicesNW
929 SWSimpson Ave,Ste 220 • Bend
541-317-5600
n/a
TRAVIS MONCHAMP, MD
Endocrinology ServicesNW
929 SWSimpson Ave,Ste 220 • Bend 541-317-5GOO
CAREY ALLEN, MD
St. Charles Family Care
HEIDI ALLEN, MD
St. Charles Family Care
THOMAS L. ALLUMBAUGH, MD St. Charles Family Care
n/a
1103 NE Elm Street• Prineville
541-447-G2G3
www.stcharleshealthcare.org
1103 NE Elm Street• Prineville
541-447-G263
www.stcharleshealthcare.org
211 NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
KATHLEEN C. ANTOLAK, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
SADIE ARRINGTON, MD
Bend Memorial Clinic
865 SWVeterans Way• Redmond
541-382-4900
www.bendmemorialclinic.com
30SEPH BACHTOLD, DO
St. Charles Family Care
G30 Arrowleaf Trail • Sisters
541-549-1318
www.stcharleshealthcare.org
EDWARD BIGLER, MD
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend
541-389-7741
www.highlakeshealthcare.com www.bendmemorialclinic.com
3EPPREY P.BOGGESS, MD
Bend Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
BRANDON W. BRASHER, PA-C
St. Charles Family Care
1103 NE Elm Street• Prineville
541-447-G2G3
www.stcharleshealthcare.org
SHANNON K. BRASHER, PA-C
St. Charles Family Care
1103 NE Elm Street• Prineville
541-447-G2G3
www.stcharleshealthcare.org
MEGHAN BRECKE, DO
St. Charles Family Care
2965 NE ConnersAve, Suite 127 • Bend
541-70G-4800
www.stcharleshealthcare.org
NANCY BRENNAN, DO
St. Charles Family Care
2965 NE ConnersAve, Suite 127 • Bend
541-70G-4800
www.stcharleshealthcare.org
WILLIAM C.CLARIDGE, MD
St. Charles Family Care
211 NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
MATTHEW CLAUSEN, MD
St. Charles Family Care
2965 NE ConnersAve, Suite 127 • Bend
541-70G-4800
www.stcharleshealthcare.org
LINDA C. CRASKA, MD
St. Charles Family Care
1103 NE Elm Street• Prineville
541-447-G2G3
www.stcharleshealthcare.org
AUDREY DAVEY, MD
Bend Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www.bendmemorialclinic.com
3AMES K. DETWILER, MD
St. Charles Family Care
211 NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
MAY S. PAN, MD
Send Memorial Clinic
23i East Cascades Avenue• Sisters
541-382-4900
www.bendmemorialclinic.com
3AMIE PREEMAN, PA-C
High Lakes Health Care Upper Mill
MARK GONSKY, DO
St. Charles Family Care
STEVEN GREER, MD
St. Charles Family Care
ALAN C. HILLES, MD
Send Memorial Clinic
PAMELA 3. IRBY, MD MAGGIE 3. KING, MD
J
929 SW Simpson Avenue• Bend
541-389-7741
www.highlakeshealthcare.com
2965 NE ConnersAve, Suite 127 • Bend
541-70G-4800
www.stcharleshealthcare.org
630 ArrowleafTrail • Sisters
541-549-1318
www.stcharleshealthcare.org
Redmond gt Sisters
541-382-4900
www.bendmemorialclinic.com
St. Charles Family Care
211 NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
St. Charles Family Care
1103 NE Elm Street• Prineville
541-447-G2G3
www.stcharleshealthcare.org
www.stcharleshealthcare.org
PETER LEAVITT, MD
St. Charles Family Care
2965 NE ConnersAve, Suite 127 • Bend
541-70G-4800
CHARLOTTE LIN, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
KAE LOVERINK, MD
High Lakes Health Care Redmond
1001 NW Canal Blvd• Redmond
541-504-7635
www.highlakeshealthcare.com
STEVE MANN, DO
High Lakes Health Care UpperMill
929 SW Simpson Avenue• Bend
541-389-7741
www.highlakeshealthcare.com
JOE T.MC COOK, MD
St. Charles Family Care
211 NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
LORI MCMILLIAN, FNP
Redmond Medical Clinic
1245 NW 4th Street, Ste201 • Redmond
541-323-4545
n/a www.highlakeshealthcare.com
J 1
EDEN MILLER, DO
High Lakes Health Care Sisters
354 W Adams Avenue• Sisters
541-549-9G09
KEVIN MILLER,DO
High Lakes Health Care Sisters
354 W Adams Avenue• Sisters
541-549-9G09
www.highlakeshealthcare.com
3ESSICA MORGAN, MD
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend
541-389-7741
www.highlakeshealthcare.com
DANIEL J. MURPHY, MD
St. Charles Family Care
21i NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
2 013 CE N T RA L O R E G O N I
M E D I CA L D I RECTORY
DVERTISINGSUPPLEMENT
s
SHERYL L. NORRIS, MD
St. Charles Family Care
JANKY PURVIS, MD
211 NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
KEVIN RKUTKR, MD
High Lakes Health Care East
1247 NE Medical Center Drive• Bend
541-318-4249
www.highlakesheal thcare.com
DANA M. RHODK, DO
Send Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www.bendmemorialclinic.com www.bendmemorialclinic.com
HANS G. RUSSELL, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
KRIC J. SCHNKIDKR, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
CINDY SHUMAN, PA-C
Send Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www.bendmemorialclinic.com
KDWARD M. TARBET, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
211 NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
J T J
JOHN D. TELLER, MD
Send Memorial Clinic
NATHAN R. THOMPSON, MD
St. Charles Family Care
MATTIE K. TOWLE, MD
Send Memorial Clinic
LISA URI, MD
High Lakes Health Care UpperMill
929 SW Simpson Avenue• Bend
541-389-7741
www.highlakesheal thcare.com
MARK A. VALENTI, MD
St. Charles Family Care
211 NW Larch Avenue• Redmond
541-548-2164
www.stcharleshealthcare.org
THOMAS A. WARLICK, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
1247 NE Medical Center Drive• Bend
541-318-4249
ww w .highlakeshealthcare.com
1103 NE Elm Street• Prineville
541-447-G2G3
BILL WIGNALL, MD
High Lakes Health Care East
BRUCE N. WILLIAMS, MD
St. Charles Family Care
DAVID KKLLY, MD
High Lakes Health Care Upper Mill
RICHARD H. BOCHNER, MD
Send Memorial Clinic
ELLEN BORLAND, MS, RN, CFNP Send Memorial Clinic
929 SW Simpson Avenue• Bend 5 4
J
www.stcharleshealthcare.org
1- 3 8 9-7741 w ww . highlakeshealthcare.com
Bend Eastside gt Redmond
541-382-4900
www.bendmemorialclinic.com
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
ARTHUR S. CANTOR, MD
Send Memorial Clinic
Bend Eastside gt Redmond
541-382-4900
www.bendmemorialclinic.com
HEIDI CRUISE, PA-C, MS
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
CHRISTINA HATARA, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com www.bendmemorialclinic.com
SIDNEY E. HENDERSON III, MD
Send Memorial Clinic
Bend Eastside gt Redmond
541-382-4900
SANDRA K. HOLLOWAY, MD
Send Memorial Clinic
Bend Eastside gt Redmond
541-382-4900
www .bendmemorialclinic.com
GLENN KOTEEN, MD
Gastroenterology of Central Oregon
2450 Mary Rose Place, Ste 210• Bend
541-728-0535
www.gastrocentraloregon.com
MATTHKW WEKD, MD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
CHRISTY KNGLAND, PA-C
Advanced Specialty Care
2084 NE Professional Court• Bend
541-322-5753
ww w .advancedspecialtycare.com
NICOLE O'NEIL, PA-C
Advanced Specialty Care
2084 NE Professional Court• Bend
541-322-5753
ww w .advancedspecialtycare.com
JANK BIRSCHBACH, MD
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend
541-389-7741
www .highlakeshealthcare.com
SUSAN GORMAN, MD
High LakesHealth Care Redmond
1001 NW Canal Blvd.• Redmond 5 4
1- 5 04-7635 w 541-389-7741
ww. h ighlakeshealthcare.com www .highlakeshealthcare.com
ALISON LYNCH-MILLKR, MD
Hig h Lakes Health Care Upper Mill
LAURIK D'AVIGNON, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
JON LUTZ, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
RKBKCCA SHKRKR, MD
St. Charles Infectious Disease
2965 Conners Ave, Ste 127• Bend 5 4 1 - 7 0G-4878
www.stcharleshealthcare.org
JKNESS CHRISTKNSKN, MD
High Lakes Health Care UpperMill
929 SW Simpson Avenue• Bend
JOHN CORSO, MD
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend 5
CKLSO A.GANGAN, MD
Redmond Medical Clinic
929 SW Simpson Avenue• Bend
541-389-7741
www .highlakeshealthcare.com
41- 3 8 9-7741 w ww. h ighlakeshealthcare.com
1245 NW 4th Street, Ste 201• Redmond 541 -323-4545
n/a
2 013 CE N T RA L O R E G O N
M E D I CA L D I RECTORY
DVERTISINGSUPPLEMENT
s
a
MICHAEL N. HARRIS, MD
Bend Memorial Clinic
ANNE KILLINGBECK, MD
Internal Medicine Assodates of Redmond
ANITA D.KOLISCH, MD
Bend Memorial Clinic
MATTHKW R. LASALA, MD
Bend Memorial Clinic
MADKLINK LEMKE, MD
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend
541-389-7741
ww w .highlakeshealthcare.com
MARY MANFRKDI, MD
High Lakes Health Care Upper Mill
929 SW Simpson Avenue• Bend
541-389-7741
ww w .highlakeshealthcare.com
KAREN L. OPPENHEIMER, MD
Send Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www.bendmemorialclinic.com
H. DEREK PALMER, MD
Redmond Medical Clinic
1245 NW 4th Street, Ste201 • Redmond
541-323-4545
A. WADE PARKER, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
MATTHEW REED, PA-C
Bend Memorial Clinic
541-382-4900
www.bendmemorialclinic.com
M. SEAN ROGERS, MD
Bend Memorial Clinic
T 1501 NE Medical Center Drive• Bend J 1501 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
DAN SULLIVAN, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
1501 NE Medical Center Drive• Bend
541-382-4900
236 NW Kingwood Ave• Redmond
541-548-7134
Bend Eastside gaRedmond
541-382-4900
1501 NE Medical Center Drive• Bend 541-382-4900 w
www .bendmemorialclinic.com www.imredmond.com
ww w .bendmemorialclinic.com ww . bendmemorialclinic.com
PRANCENA ABENDROTH, MD Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
ww. bendmemorialclinic.com
CRAIGAN GRIPPIN, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
ww . bendmemorialclinic.com
RICHARD KOLLER, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
ww. bendmemorialclinic.com
RAY TIKN, MD
The Center: Orthopedic gt Neurosurgical Carett Rese arch Locations in Bend tla Redmond 5
41-3 8 2 - 3 344
www.th ecenteroregon.com
BRAD WARD, MD
Ihe Center: Orthopedic tt Neurosurgical CareGResearch Locations in Bend tla Redmond 5
41-3 8 2 - 3344
www.t h ecenteroregon.com
ANNIE BAUMANN, RD, LD
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
ww. bendmemorialclinic.com
WILLIAM H. BARSTOW, MD
St. CharlesOB/GYN
213 NW Larch Ave, Ste A• Redmond 541 -52G-G635 w
ww. s tcharleshealthcare.org
ANN-BRIDGET BIRD,MD
St. Charles OB/GYN
213 NW Larch Ave, Ste A• Redmond
541-52G-G635
www . stcharleshealthcare.org
BRENDA HINMAN, DO
St. Charles OB/GYN
213 NW Larch Ave, Ste A• Redmond
541-52G-G635
www . stcharleshealthcare.org
AMY B. MCELROY, PNP
St. Charles OB/GYN
213 NW Larch Ave, Ste A• Redmond
541-52G-G635
www . stcharleshealthcare.org
541-3 8 2 - 3344
www.t h ecenteroregon.com
41-3 8 2 - 3 344
www.t h ecenteroregon.com
s
a
s
JAMKS NKLSON, MD
The Center: Orthopedic I'Neurosurgi s cal CaregtResearch Locations in Bend gt Redmond
LARRY PAULSON, MD
The Center: Orthopedic I'Neurosurgi s cal CaregtResearch Locations in Bend gt Redmond 5
s
s s
I
ROB BOONK, MD
St. Charles Cancer Center
Locations in Bend tla Redmond
541-70G-5800
www . stcharleshealthcare.org
THEODORE A. BRAICH, MD
Send Memorial Clinic
Bend Eastside gaRedmond
541-382-4900
www .bendmemorialclinic.com
CORA CALOMENI, MD
St. Charles Cancer Center
Locations in Bend tla Redmond
541-70G-5800
www . stcharleshealthcare.org
SUSIE DOEDYNS, FNP
St. Charles Cancer Center
Locations in Bend tla Redmond
541-70G-5800
www .stcharleshealthcare.org
BRIAN L ERICKSON, MD
Bend Memorial Clinic
Bend Eastside tla Redmond
541-382-4900
www .bendmemorialclinic.com
STEVE KORNPELD, MD
St. Charles Cancer Center
Locations in Bend gt Redmond
541-70G-5800
www .stcharleshealthcare.org
BILL MARTIN, MD
St. Charles Cancer Center
Locations in Bend gt Redmond
541-70G-5800
www . stcharleshealthcare.org
BENJAMIN J. MIRIOVSKY, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
LAURIE RICE, ACNP
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
WILLIAM SCHMIDT, MD
Bend Memorial Clinic
HKATHKR WKST, MD
Bend Memorial Clinic
Bend Eastsidega Redmond
ww . bendmemorialclinic.com
5 41-3 8 2 -490 0
www .bendmemorialclinic.com
1501 NE Medical Center Drive• Bend 541-382-4900 w
ww. bendmemorialclinic.com
DVERTISINGSUPPLEMENT
2013 CENTRAL OREGON MEDICAL DIRECTORY •
•
I
•
'
•
LINYEE CHANG, MD
St. Charles Cancer Center
2500 NE Neff Road• Bend 5
41-70 G -7733 w
ww. s tcharleshealthcare.org
DHARA MACDERMED, MD
St . C h arles Medical Center
2500 NE Neff Road• Bend 5
41-70 G -5800 w
ww. s tcharleshealthcare.org
RUSS OMIZO, MD
St. Charles Cancer Center
2500 NE Neff Road• Bend 5
41-70 G -7733 w
ww. s tcharleshealthcare.org
•
•
•
•
•
MATTHEW N. SIMMONS a
I
Urology Spedalist of Oregon
2084 NE Professional Ct• Bend
541- 3 2 2 -5753 h t p//usoforpraxixmedi : calgroup.com
I
~ Bend Memorial Clinic
Bend Eastside, Westside SI Redmond
541-382-4900 ~ www.bendmemorialclinic.com
THOMASD. FITZSIMMONS,MD,MPH Bend Memorial Clinic
Bend Eastside, Westside SI Redmond
541-382-4900
www .bendmemorialclinic.com
ROBERT C.MATHEWS, MD
Bend M emorial Clinic
Bend Eastside, Westside SI Redmond
541-382-4900
www .bendmemorialclinic.com
SCOTT T. O'CONNER, MD
Bend Memorial Clinic
Bend Eastside, Westside SI Redmond
541-382-4900
www .bendmemorialclinic.com
DARCY C. BALCKR, OD
Bend Memorial Clinic
Bend Eastside SI Westside
541-382-4900
www.bendmemorialclinic.com
Bend Eastside, Westside SI Redmond 5 4 1-382-4900
www.bendmemorialclinic.com
BRIAN P.DESMOND, MD
LORISSAM. HEMMER, OD
Bend M emorial Clinic
KKITH E. KRUKGER,DMD, PC Keith E. Krueger, DMD, PC • '
• '
I
•
AARON ASKEW, MD
1475 SW Chandler, Ste 101• Bend 54 1 - 617-3993 w
ww.d r keithkrueger.com
•
Desert Orthopedics
Locations in Bend SI Redmond
541-388-2333
www.desertorthopedics.com
ANTHONY HINZ, MD
The Center: Orthopedic rs Neurosurgicsl Care S Research
Locations in Bend SI Redmond
541-382-3344
www.thecenteroregon.com
JEPPREY P. HOLMBOE,MD
The Center: Orthopedic A Neurosurgicsi Care A Research
Locations in Bend gi Redmond
541-382-3344
www.thecenteroregon.com
JOEL MOORE, MD
The Center: Orthopedic S Neurosurgicsi Care AResearch
Locations in Bend SI Redmond
541-382-3344
www.thecenteroregon.com
KNUTE BUEHLER, MD
The Center: OrthopedicrsNeurosurgicslCsre@Research
Locations in Bend SI Redmond
541-382-3344
www.thecenteroregon.com
MICHAKL CARAVELLI, MD
The C e nter:Orthopedic A Neurosurgicai CareAResearch
Locations in Bend gi Redmond
541-382-3344
www.thecenteroregon.com
Locations in Bend SI Redmond
541-388-2333
www.desertorthopedics.com
Locations in Bend SI Redmond
541-382-3344
www.thecenteroregon.com
Locations in Bend SI Redmond
541-388-2333
www.desertorthopedics.com
~ 1303 NE Cushing Dr, Ste 100• Bend ~ 541-388-2333
www.desertorthopedics.com
a'
I '
I
JAMES HALL, MD
J
Desert Orthopedics
ROBERT SHANNON, MD a'
I
I
MICHAEL RYAN, MD a'
I '
Desert Orthopedics The Center: Orthopedic g Neurosurgicsl Care S Research
'
'
I
~ Desert Orthopedics
I
GREG HA, MD
Desert Orthopedics
1303 NE Cushing Dr, Ste I00 • Bend
54 1 -388-2333
www. d esertorthopedics.com
KATHLEKN MOORE, MD
Desert Orthopedics
1303 NE Cushing Dr, Ste 100• Bend
54 1 -388-2333
www. d esertorthopedics.com
Locations in Bend SI Redmond
541-382-3344
www.thecenteroregon.com
1315 NW 4th Street• Redmond
541-388-2333
www.desertorthopedics.com
The Center: Orthopedic rs Neurosurgicsi Care A Research
Locations in Bend gi Redmond
541-382-3344
www.thecenteroregon.com
Ihe Center: Orthopedic gt Neurosurgicsi Care 8 Rese arch
Locations in Bend SI Redmond
541-382-3344
www.thecenteroregon.com
54 1 - 388-2333
www.desertorthopedics.com
Locations in Bend SI Redmond
541-382-3344
www.thecenteroregon.com
• '
• '
I
TIMOTHY BOLLOM, MD BRETT GINGOLD, MD SCOTT T. JACOBSON, MD
J J
BLAKE NONWEILER, MD
a'
• '
I
CARA WALTHER, MD a'
The Center: Orthopedic S Neurosurgicsl Care S Research
Desert Orthopedics
a
I
'
•
Desert Orthopedics
1303 NE Cushing Dr, Ste I00• Bend
I
MICHAKL COK, MD KENNETH HANINGTON, MD
The Center: Orthopedic gtNeurosurgicsi Care A Research
Locations in Bend SI Redmond
541-388-2333
www.desertorthopedics.com
SOMA LILLY, MD
The Center: Orthopedic rs Neurosurgicsl CaregcResearch
De s ert Orthopedics
Locations in Bend SI Redmond
541-382-3344
www.thecenteroregon.com
JAMES VKRHKYDEN, MD
The Ce n ter:Orthopedic A Neurosurgicai CareAResearch
Locations in Bend gi Redmond
541-382-3344
www.thecenteroregon.com
2 013 CE N T RA L O R E G O N
M E D I CA L D I RECTORY
MOLLY OMIZO, MD
Deschutes Osteoporosis Center
2200 NE Neff Road, Suite 302• Bend
3KNNIFKR BLKCHMAN, MD
St. C harles Advanced Illness Management
LISA LKWIS, MD
Partners in Care
541 - 3 88-3978 ww w deschutesosteoporosiscentercom
2500 NE Neff Road • Bend
541-70G-5885
2075 NE Wyatt Ct • Bend
541-382-5882
www . stcharleshealthcare.org www . stcharleshealthcare.org
RICHARD 3. MAUNDKR, MD
S t Charles . Advanced Illness Management
2500 NE Neff Road• Bend
541-70G-5885
LAURA K. MAVITY, MD
St. Charles Advanced Illness Management
2500 NE Neff Road• Bend
541-70G-5885
I
'
'
DVERTISINGSUPPLEMENT
www . stcharleshealthcare.org
www.partnersbend.org
I
STKPHANIK CHRISTKNSEN, DMD Deschutes Pediatric Dentistry
1475 SW Chandler Ave, Ste• Bend 5 4 1 - 389-3073
www.deschuteskids.com
STKVK CHRISTKNSKN, DMD
Desch utes Pediatric Dentistry
1475 SW Chandler Ave, Ste• Bend 5 4 1 - 389-3073
www.deschuteskids.com
KATHKRINK BAUMANN, MD
Be n d Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend 5 4 1 - 382-4900 w
KATE L. BROADMAN, MD
Bend Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www .bendmemorialclinic.com
THOMAS N. ERNST, MD
St. Charles Family Care
211 NW Larch Ave• Redmond
541-548-2164
www . stcharleshealthcare.org
KATHRYN LKIN, CPNP
Bend Memorial Clinic
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www .bendmemorialclinic.com
1080 SW Mt. Bachelor Drive• Bend
541-382-4900
www .bendmemorialclinic.com
211 NW Larch Ave• Redmond
541-548-2164
www . stcharleshealthcare.org
MICHKLLE MILLS, MD
Bend Memorial Clinic
MARGARKT 3. PHILP, MD
St. C h arles Family Care
3B WARTON, DO
Bend Memorial Clinic
ROBERT ANDRKWS, MD
Desert Orthopedics
1080 SW Mt. Bachelor Drive• Bend 5 4 1 - 382-4900 w
NANCY H. MALONKY, MD
J
JAMKS NKLSON, MD
DAVID STEWART, MD
JON SWIFT, DO
ww. bendmemorialclinic.com
Locations in Bend gt Redmond
541-388-2333
www.desertorthopedics.com
929 SW Simpson Avenue• Bend
541-389-7741
www.highlakesheal thcare.com
The Center: Orthopedic gtNeurosurgical CaregtResearch L o cations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
The Center: Orthopedic gtNeurosurgical CaregtResearch
Locations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
The Center: Orthopedic gtNeurosurgical CaregtResearch
Locations in Bend ga Redmond
541-382-3344
www.thecenteroregon.com
Locations in Bend gt Redmond
541-382-3344
www.thecenteroregon.com
Locations in Bend ga Redmond
541-388-2333
www.desertorthopedics.com
Locations in Bend gt Redmond
541-382-3344
www.t h ecenteroregon.com
541-382-3344
www.t h ecenteroregon.com
High Lakes Health Care Upper Mill TIM HILL, MD
J
ww. bendmemorialclinic.com
Bend Memorial Clinic
The Center: Orthopedic gtNeurosurgical CaregtResearch
Desert Orthopedics
VIVIANK UGALDK, MD
The Center: Orthopedic gtNeurosurgical CaregtResearch
MARC WAGNER, MD
The Center: Orthopedic tt Neurosurgical CaregtResearch Locations in Bend ga Redmond
541-388-28G1
AMBROSK K. SU, DPM
Cascade Foot Clinic
DKAN NAKADATK, DPM
Deschutes Footgt Ankle
BROOKE HALL, MD
St. Charles Preoperative Medicine
2500 NE Neff Road• Bend 5
30NATHON BRKWKR, DO
Bend Memorial Clinic
Bend Eastside gaRedmond
541-382-4900
www .bendmemorialclinic.com
JAMIK DAVID CONKLIN, MD
St. Charles Pulmonary Clinic
Locations in Bend ga Redmond
541-70G-7715
www . stcharleshealthcare.org
LOUIS D'AVIGNON, MD
Bend Memorial Clinic
Bend Eastside gaRedmond
541-382-4900
www .bendmemorialclinic.com
KRIC S. DILDINK, PA-C
St. Charles Pulmonary Clinic
Locations in Bend ga Redmond
541-70G-7715
www . stcharleshealthcare.org
ROD L.KLLIOT-MULLKNS, DO
St. Charles Pulmonary Clinic
Locations in Bend gt Redmond
541-70G-7715
www . stcharleshealthcare.org
MATT HEGKWALD, MD
St. Charles Pulmonary Clinic
Locations in Bend ga Redmond
541-70G-7715
www . stcharleshealthcare.org
T. CHRISTOPHKR KELLKY, DO
Bend Memorial Clinic
Bend Eastside gaRedmond
541-382-4900
www .bendmemorialclinic.com
JONATHON MCFADYKN, NP
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www .bendmemorialclinic.com
KKVIN SHKRKR, MD
St. Charles Pulmonary Clinic
Locations in Bend gt Redmond
541-70G-7715
www . stcharleshealthcare.org
s
2408 NE Division Street• Bend
929 SW Simpson Ave, Ste 220• Bend 541 -317-5600 w
41-70 G -2949 w
www.cascadefoot.com w w .deschutesfootandankle.com
ww. s tcharleshealthcare.org
s s
1
2013 CENTRAL OREGON MEDICAL DIRECTORY
DVERTtstNGSUPPLEMENT
NOREEN C. MILLER, FNP
St Charles Rehabilitation Center
2500 NE Neff Road• Bend 5
GREG BORSTAD, MD
Bend Memorial Clinic
Bend Eastside gt Redmond
541-382-4900
DAN FOHRMAN, MD
Deschutes Rheumatology
2200 NENeffRoad,Suite 302 • Bend
541-388-3978
n/a
HEATHERHANSEN-DISPENZA, MD
Deschutes Rheumatology
2200 NENeffRoad,Suite 302 • Bend
344-388-3378~
"I
TIANNA WELCH, PA
Deschutes Rheumatology
2200 NENeffRoad,Suite 302 • Bend
541-388-3978
n/a
JONATHON BREWER, DO
Bend Memorial Clinic Sleep Disorders Center
Bend Eastside gt Redmond
541-382-4900
www.bendmemorialclinic.com
ARTHUR K. CONRAD, MD
St. Charles Sleep Center
Locations in Bend gt Redmond
541-706-6905
www.stcharleshealthcare.org
DAVID L. DEDRICK, MD
St. Charles Sleep Center
Locations in Bend gt Redmond
541-706-6905
www.stcharleshealthcare.org
T. CHRISTOPHER KELLEY, DO
Bend Memorial Clinic Sleep Disorders Center
Bend Eastside gt Redmond
541-382-4900
www.bendmemorialclinic.com
4
DAVID HERRIN, DC
$
4
41-70 G -7725
www.stcharleshealthcare.org
www .bendmemorialclinic.com
I
Redmond Wellnessgt Chiropractic
TIMOTHY L. BEARD, MD, FACS Bend Memorial Clinic DAVID CARNE, MD
St. Charles Surgical Specialists
DARA H. CHRISTANTE, MD
Bend Memorial Clinic
GARY J. FREI, MD, FACS
Bend Memorial Clinic
1655 SW Highland Ave,Ste 6 • Redmond 541-923-2019
www.drherrin.com
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
1201 NE Elm ~ Prinevilfe
541-447-G2G3
1501 NE Medical Center Drive• Bend 541-382-4900
www.stcharleshealthcare.org www.bendmemorialclinic.com
Bend Eastside gt Redmond
541-382-4900
www.bendmemorialclinic.com www.stcharleshealthcare.org
JACK W. HARTLEY, MD, FACS
St. Charles Surgical Specialists
1245 NW 4th Street, ¹101• Redmond
541-548-77G1
DARREN M.KOWALSKI, MD, FACS
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
JOHN C. LAND, MD, FACS
St. Charles Surgical Specialists
1245 NW 4th Street, ¹101• Redmond
541-548-77G1
www.stcharleshealthcare.org
ANDREW SARGENT, PA-C, MS
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
541-382-4900
www.bendmemorialclinic.com
GEORGE T. TSAI, MD, FACS
St. Charles Surgical Specialists
1245 NW 4th Street, ¹101• Redmond
541-548-77G1
www.stcharleshealthcare.org
541-382-4900
www.bendmemorialclinic.com
JENNIFER TURK, PA-C
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend
JEANNE WADSWORTH,PA-C, MS
Send Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
ERIN WALLING, MD, FACS
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900
www.bendmemorialclinic.com
www.bendmemorialclinic.com
J J.
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
Send Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
St. Charles Immediate Care
2600 NE Neff Road• Bend
541-70G-3700
www.stcharleshealthcare.org
MIKE HUDSON, MD
St. Charles Immediate Care
2600 NE Neff Road• Bend
541-70G-3700
www.stcharleshealthcare.org
J. RANDALL JACOBS, MD
Send Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
AMEE KOCH, PA-C
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
JIM MCCAULEY, MD
Send Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
TERRACE MUCHA, MD
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
JAY O'BRIEN, PA-C
Send Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
CASEYOSBORNE-RODHOUSE, FA-C
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
LAURIE D. PONTE, MD
Send Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com www.bendmemorialclinic.com
JEFP CABA, PA-C ANN CLEMENS, MD TERESA COUSINEAU, PA-C CRAIG COX,MD
JENNIFER L. SURBER, MD
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
PATRICK L. SIMNING, MD
Send Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
SEAN SUTTLE, PA-C
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
THOMAS H. WENDEL, MD
Send Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
BRENT C. WESENBERG, MD
Bend Memorial Clinic
Bend Eastside, Westside gt Redmond
541-382-4900
www.bendmemorialclinic.com
DVERTISINGSUPPLEMENT
2013 CENTRAL OREGON MEDICAL DIRECTORY MEREDITH BAKER, MD
Bend Urology Associates
2090 NE Wyatt Court• Bend
541-382-G447
www. b endurology.com
MICHEL BOILEAU, MD
Bend Urology Associates
2090 NE Wyatt Court• Bend
541-382-G447
www.bendurology.com
JACK BRKWER, MD
Bend Urology Assodates
2090 NE Wyatt Court• Bend
541-382-G447
www.bendurology.com
2084 NE Professional Court• Bend
541-322-5753
h t t p: //usof or.praxismedicalgroup.com
ANDREW NEEB, MD
Urology Specialists of Oregon
BRIAN O'HOLLAREN, MD
Bend Urology Associates
2090 NE Wyatt Court• Bend
541-382-G447
www.bendurology.com
KRIC SHREVK, MD
Bend Urology Assodates
2090 NE Wyatt Court• Bend
541-382-G447
www.bendurology.com
MATTHEW N. SIMMONS, MD
Urology Specialists of Oregon
2084 NE Professional Court• Bend
541-322-5753
h t tp:/ /usofor.praxismedicalgroup.com
NORA TAKLA, MD
Bend Urology Associates
2090 NE Wyatt Court• Bend
541-382-G447
www. b endurology.com
ROD BUZZAS, MD
Advanced Specialty Care
2084 NE Professional Court• Bend
541-322-5753
ww w.advancedspecialtycare.com
EDWARD M.BOYLE,JR.,MD,FACS
Inovia Vein Spedalty Center
2200 NE Neff Road, Ste 204• Bend
541-382-834G
www.bendvein.com
ANDRKW JONES, MD, FACS
Inovia Vein Specialty Center
2200 NE Neff Road, Ste 204• Bend
541-382-834G
www.bendvein.com
DARREN KOWALSKI, MD
Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
ww. bendmemorialclinic.com
JOSKPH COLKLLA, MD,FACS Bend Memorial Clinic
1501 NE Medical Center Drive• Bend 541-382-4900 w
ww. bendmemorialclinic.com
WAYNK K. NKLSON, MD ~
1501 NE Medical Center Drive• Bend 541-382-4900 w
ww . bendmemorialclinic.com
Bend M emorial Clinic
P AIDPADVERTISIN G S U P P L E M E N T To be included in the next issue of the PULSE/Connections Medical Directory, contact:
Lorraine Starodub, Account Executive • 541.617.7855 • Istarodub@bendbulletin.com
•
r i EsA
•
• •
•
•
•
•
•
i
•
•
•
•
• •
•
•
•
• •
•
•
• •
I
•
' •'
' •
•
•
•
•
strx r ' •
•
•
•
•
•
•
•
Home Health
Ie
Coverstory( SWITCHING GENDER Continued from Page13
Landis said. "I said, 'I promise to read them, but it's not a phase. I've been fighting it this whole time. I am still your child. I still have
the same talents. I am going to be me. I've been unhappy.'" Bales sent her daughter away, not knowing what to do. Landis stayed with a sister for a while, then a relative in Arizona. His dad had
Il
"I am a guyas farasanyone whoknows meis concerned. I am a heterosexualman." Rob Landis
as a male. Going to public restrooms was terrifying. He entered the women's room at
been divorced from Landis' mom for years, a movie theater with Griffin and got dirty and was not a big part of Landis' life. looks.Now, he always usesthe men'sroom. Nothing changed her attraction to women. He said he tries to display confidence when Throughouther20s, Landis,as a female, he walks in. If there are no stalls in a public room, he hasto leave. was transient, traveling all over the country, m en's dabbling in all kinds of jobs. She often reAs time went on, his voice continued turned to Oregon. Her life was a mess and to deepen. More recently, his depression involved a lot of partying. She dealt with waned and his dysphoria faded. depression. Hormone therapydoesn'tseem to have In 2010, while living in Prineville and changed his personality, he said. "I've alworking at T-Mobile in Redmond, Landis ways had the same interests and humor and met Lindsay Griffin and proposed marriage taste in music. My mannerisms have been after about a year. (Because Landis' birth altered slightly. I still seem like a gay man certificate says he's female, they can not le- sometimes," he said. He said that doesn't gally marry in Oregon, which bars same-sex bother him. "I'm comfortable in my sexualmarriage, yet Landis refers to Griffin as his ity. I would make a pretty good gay man. Exfiancee.) cept the part where you have to be attracted In 2011, Landis began to hear stories about to men and such." high-profile transgender people, such as writDespite a year of testosterone and an er and musician Chaz Bono, the transgender outwardly male appearance, harsh remindadvocatewho isthe son ofSonny and Cher. ers of his anatomy remain. He still menstru"I had never known you could get testos- ates, which is frustrating. He is careful not to terone or have reconstructive chest surgery," leave evidence of feminine hygiene products he said. He researched and read books on in the restroom at work. "I should see a gynecologist for checkups," the topic. By December 2011, Landis decided a he said. "But I don't want to walk in and say, transition was right. Griffin said she'd stay 'I need a pelvic exam.' So I don't get reguthrough it.
"I knew transitioning was going to be selfish, but I needed to do this for myself," he said. Under the supervision of a local endocrinologist, Landis began injecting small amounts of
lar care. I can't imagine sitting in the waiting
room." His medical records say he's female, so some female preventive care would probably be covered by insurance. But he's never looked into it, because he doesn't want to testosterone into her thighs biweekly. go. She became he. His insurance covers a percentage of Almost immediately his hunger skyrock- the blood work he gets every three to six eted. His voice got scratchy and facial hair months, to check on his hormone levels and grew. Within a month he noticed changes in his liver health. The costs are not unmanagehis body temperature and how he smelled. able, he said, since he self-injects and he can His sex drive grew, as did his muscles. A buy six months of generic testosterone for couple of months into the treatments, his about $65. fat redistributed. He gained weight. His hair He is planning to have a bilateral mastecpatterns changed. tomy and is saving for the surgery. Ever since He was still experiencing ongoing dys- puberty, Landis has hated his breasts, which phoria despite four or five months of treat- he refers to as "foreign objects." Most of the ment. He still didn't feel like he could "pass" time he wears binders — aconstricting sports-
Page48
I 't
•0 •0
bra-like garment that flattens the breasts — or an extra-tight sports bra. Sometimes binders
rub him raw. Sometimes he hunches forward, an unconscious habit born ofbreast hatred. A hysterectomy is not that important to
him, he said, because his main dysphoria is about his top half. His breasts are an outward indication of what he is. His bottom
half is private. "I am a guy as far as anyone who knows me is concerned," he said. "I am a heterosexual man." Landis' mother said that it's easier for her to understand her son in this male, hetero-
sexual role than as her lesbian daughter. W hy?"It makes sense,"she said. Landis' older sister and her young children were at the bowling alley party. The kids call Landis "Uncle Robyn," she said. Along with access to the Internet and a
growing body of transgender stories and role models in the media, the maniversary party offers a glimpse as to why today's younger generation may grow up with a different collective thinking about gender and sex. As Bales said, when her mother was growing up, no one even discussed transgender topics. In Landis' case, an unlikely group of locals gathered in a Central Oregon bowling alley to celebrate it. •
SPRING/suMMER2013• HIGHDESERTPuLsE
"I havere-foundmy voice, my confidence. I nolonger feel suicidal. I wake upsmiling."
Continued from Page14
evidence available to know all the risks, he said. "I don't know of any elderly people who have beenon hormone treatments most of their life," Goldstein said. Theoretically, a male-to-female could take hormones forever. But if she stopped her whole regimen of estrogen and antiandrogens, which counteract male hormones, and if she still had testicles, the testosterone could come back, bringing back male characteristics. For female-to-males on hormone therapy, testosterone treatments can create
some cholesterol problems. The World Professional Association for Transgender Health's "Standards of Care" also says that polycythemia, a blood disorder marked by too many red blood cells, is a common risk for those on testosterone.
If a female-to-male has breasts, uterus or ovaries, he can still get cancer in those parts, Goldstein said. But whether treatments af-
fect risk has not been clinically studied.
Beyond hormones: the question of surgery Some transgender individuals feel a need for more permanent physical changes to conquer their dysphoria, to better
HIGH DESERT PULSE â&#x20AC;˘ SPRING/SUMMER 2013
about $12,000 on hair removal. She obsesses with tweezers, her girlfriend, Thompson, jokes affectionately. Winters has a presence and mannerisms that are typically associated with women. The way she looks coyly from underneath lush Kirsten Winters eyelashes. The way she crosses her legs. But align their bodies with their identities. Medi- her voice has a uncharacteristically deep edge cal intervention may be referred to as sex or that's discordant with her long hair, her red gender reassignment, gender affirmation or nails and matching lipstick, her perfect purple sex confir mation, depending on whom you eye shadow, her bangles and silver rings. "My voice drives me crazy, but not enough talk to. Sex confirmation surgery â&#x20AC;&#x201D; surgical to work on it," she said. modifications for the purpose of altering Another notable change since her transione's gender expression â&#x20AC;&#x201D; is a loose term tion, according to her mom, is that Winters that encompasses different strategies, Crane used to be very punctual, but now she's sort said. Individual situations are typically deter- of flaky and always late. Why? Maybe bemined between the patient and the doctor. cause it takes so much time to put on make"Some (trans people) may consider chest up, Winters said. surgery alone a sex confirmation surgery, Family matters while others consider genital reconstruction to be the (essential)," he said. A handful of How a person'sfamily,friends and comsurgeons in each state perform chest sur- munity respond can greatly affect the trans gery or facial feminizing surgery. Far fewer experience. specialize in genital reconstruction. One could assume that mental distress for Surgeries often come after hormone trans people is less about gender identity therapy. There are known risks, including and more about the stress that comes from (for top surgery) infection, bleeding, fluid being discriminated against, from being a collection under the skin, wound healing minority in society, said Liesl Farnsworth, complications and nerve damage, Crane a local counselor. The dysphoria, she sugsaid. The same goes for bottom surgery, gested, might arise from a lack of support in addition to a risk of urethral stricture or fistula.
in the culture. The National Transgender Discrimination
Winters will probably never have any sur- Survey said family acceptance has a protecgery. "I don't suffer genitalia dysphoria," she tive effect against many of the health risks, said. "Surgery is risky and not necessarily such as HIV infection and suicide, seen at the right path for me." higher rates among transgender people. But she takes three pills every day for her Trans people who are accepted by their hormone therapy. Two are anti-androgens, families also have far less experience with which block her testosterone receptors. An- homelessness, work in the sex or drug other drug, called propecia, keeps her hair- trade, incarceration, suicide attempts and line from receding. She also injects estrogen drug and alcohol abuse. every other week. Winters' dad fed her shame and self-hatred Three years of hormone therapy have re- for a long time, she said. Her parents divorced shaped her body and redistributed her body when she was 14. Although Winters hadn't fat. Her chest-waist-hip measurements have talked to her dad in eight years, she felt she shifted from 32-34-25 to 36.5-29-37. Her needed to tell him she was transgender. "I told him, 'I have struggled with this most breast size is 368, she said proudly. Her neck size shrunk from 17 inches to 13.5 inches. of my life. This is what I've decided to do. I There's more fat around her cheekbones. plan on transitioning from your son to your Like any person, Winters is self-critical daughter.' I told him it was this or a bullet in about features that other people probably my head. He said, 'I'd rather you had put the would not notice. Facial and chest hair are bullet in your head.' That was the last time I her biggest dysphorias. She said she's spent spoke to him," she recounted with a notable
Page 49
Cover story( SWITCHING GENDER lack of emotion, suggesting this story has been told before. This was a sharp contrast to her mother's response, which has more greatly influenced her life of late. Winters said her mom, Renee Allen, is her biggest supporter. When Winters told her mom a few years ago, Allen said she was just relieved. "I wish I would have known. I would have wanted to help her find help earlier," Allen salcl. When Winters came out and the mother-
daughter pair looked back on a challenging 4 life, "there were all these 'aha' moments," Allen said. All those years when her clothes would gomissing, she had thought she was losing her mind. It never occurred to Allen that one of her two sons would be stealing Kirsten Winters cooks dinner while talking to her mom, Renee Allen, ather mom's housein Bend. them. And the beloved black heels that Allen had practically accused co-workers of stealing, now she knew where they went. computer information systems. She's work- Resources for transgender "I wore them out," Winters said, smiling
sheepishly.
Feeling discrimination Every trans experience is different, but there are common threads for many. Isolation and depression. Marginalization and violence. Discrimination and unemployment. In California, Winters was spit on and pushed around. In Bend, she gets stared at, pointed at, whispered about, photographed without permission.
"I've developed thick skin," she said. But even worse than the mocking is when
someonethinks she'sm ale."One ofthe hardest things to handle is being misgendered. It feels like having an ice pick shoved into the temples. It hurts."
Most poignant of all her challenges at the moment, she said, is her inability to find full-time work, although she admits that dis-
crimination would be impossible to prove. In 2011, Winters was laid off from a state
job in California due to budget cuts — she doesn't believe her gender variance had anything to do with it. Through thatjob, she had
insurance that covered her hormone therapy. She moved to Bend in December 2011 to be nearher mom. She's been applying for jobs ever since. Although she dropped out of high school, she eventually went to college, earning an associate's degree and a bachelor's degree in
Page 50
ing on a master's in business administration
and project management. She has 15 years of experi ence and references. But she usually tells people in job interviews that she's trans, because she figures they're wondering anyway.She's been told she was the "close second"too many times, she said.She's been teaching computer information systems classes through Central Oregon Community College part time, but it's not enough. Winters should get regular prostate checkups. And mammograms. But lacking health insurance as well as extra cash, she doesn't go. She spends $300 to $500 on hormones every six months but can't afford the regular lab work that would monitor her levels of hormones and check on her liver health. None of this is unusual. In the Transgender Discrimination Survey, 26 percent of participants said they had lost a job due to their gender nonconformity, and 47 percent said they had been fired, not hired, or denied a promotion for that reason.Respondents who had lostajob dueto this bias were nearly twice as likely to work in the sex or drug trade. They had twice as much homelessness, more incarceration and higher rates of HIV infection as well as drug or alcohol abuse. Various nondiscrimination laws addressing gender identity and sex orientation exist in many states, including Oregon, Washington, California and Nevada, and are
individuals and their friends and families: Central Oregon • Human Dignity Coalition www.humandignitycoalition.org,541-385-3370 • PFLAG (Parents, families and friends of lesbians and gays) of Central Oregon www.pflagcentralor4t.com, 541-317-2334 Out of town • TransActive (Portlandl wwwtransactiveonline.org • Basic Rights Oregon(Portlandl www.basicrights.org
progressing in others, said Jack HarrisonQuintana, the Policy Institute manager for
the National Cay and Lesbian Task Force. Antidiscrimination laws typically address employmentand housing. "We see so much trans unemployment. We see employment as being the biggest pivot point for all areas of life, such as health care and housing," said Harrison-Quintana. But he is optimistic that the tide is turning.
"We're making great strides in terms of trans rights right now. It's not dissimilar
to what's happening for gay and lesbian folks," he said, right around the time that
the Supreme Court was discussing samesex marriage. "We're all making strides together." •
SPRING /SUMMER 2013 • HIGH DESERTPULSE
What's next?
Secretsuccessesi DISEASE-DEFYINGVACCINES
Continued from Page 22 requiring tubes to drain and ventilate the mid-
dle ear, according to The Children's Hospital of Philadelphia. "It's a side corollary, a benefit nobody expected," Chunn said. In addition, pneumonia and bone and joint infections in older people who have never been vaccinatedforpneumococcus have decreased because the bacteria is less prevalent. Cieslak said pneumococcal pneumonia is particularly deadly in older populations.
Maintaining immunization rates If a Hib case came into a clinic today, Chunn said, most pediatricians would have a hard time recognizing it. "The look of a child with epiglottitis and the emergent nature to the child with epiglottitis
would be missed by most younger physicians," he said. "Because they've neverseen it.So they may fail to recognize how quickly you need to move on a patient like this. You need to be
unexpected results. The Hib vaccine not only
taken to surgery immediately and have a tube placed in their throat immediately so they do not have a respiratory arrest. And there is ab-
stifled the illness, but the bacteria itself.
solutely no time to watch.
Other vaccines have brought with them
Chunn said the majority of nasal cultures in winter used to be positive for Hib. Its carriage
"It would be easy to mistake it for croup and think it can be cleared with a bit of mist."
rate in the population — how many people
Continuing the vaccine success stories, experts say, depends on keeping immunization at as high as 65 percent. Its presence in the rates high. nose isn't dangerous to an individual unless it In populations with higher rates of unvacenters the bloodstream. But that person is a cinated children, for instance, research shows carrier of Hib, capable of passing it on. the carriage rate of Hib is starting to creep up. "They're not seeing a lot of infections, beToday, he said, the estimated carriage rate in the population is about 5 percent. cause they are getting some protection, herd had it in their body — was often estimated
Another example is t h e
r o tavirus vac- immunity," he said.
cine, which is given to infants orally as liquid
But eventually, if Hib keeps circulating in the population, it will happen. Rotavirus has long triggered gastrointestiWohlreich hopes society finds ways to talk nal illnesses. Children were at times hospital- about vaccine success. "Ifa vaccine only prevents up to 65 percent, ized due to dehydration. Seven years after the vaccine's introduction, it is so tempting to talk about the 35 percent researchers are also finding fewer rotavirus failure rate," he said. "But a 65 percent success cases in adults. rate is a heck of a lot more than zero."• CII ops.
Central Oregon's First 8r Foremos Vein Specialist ==== =:
ADVANCED SPECIALTY CARE
VARICOSE i SPIDER i LEG ULCERS i FACIAL
Researchers are working on vaccines for myriad illnesses. Efforts range from bacteria that cause strep throat to those causing tooth decay. There is even work being done on using vaccines to address autoimmune diseases like insulin-dependent diabetes. Butfor wor d health, there arethe big three infectious diseases for which vaccines wouldmake a major difference: HIV,tuberculosisandmalaria. According to the World Health Organization, roughly1.8million people died of AIDS in 2010. In 2011, an estimated 1.4 million died of tuberculosis and 660,000 of malaria. In a 2011 artic e on vaccine development in the journal Vaccine, Australian immunologist Sir Gustav Joseph Victor Nossal predicted that all three require at least another 10 to 20 years of work before the right solutions are found. The furthest along in research, he says, is for malaria, which is caused by a parasite. While vast resources have gone into HIV/AIDS research since the 1980s, the immune system virus' genetic diversity and ability to "go underground" in areas of the body, only to emerge again, have proved difficult obstacles. While variations oftuberculosis vaccines exist, they aren't sufficiently effective, Nossal argues. But in recent years there have been at least 15 candidate vaccines for tuberculosis in clinical trials.
There is a difference in Cataract Surgery At lnfocus Eye Care, we offer modern cataract surgery with lens options that may help you to see near, far, and in between. If you are interested in reducing your d ependency on glasses please see us, and explore ail your options.
VEIN CONSULTATION UPTO A $250 VALUE Mention this ad. Ultrasound not included. exp 4-26-13
eye care
cALL 541-322-1756 G. Rodney Buzzas, MD,Ms,FAcs HIGH DESERT PULSE • SPRING/SUMMER2013
nfocus
A D V ANCEDSPECIALTYCARE.COM Page 51
TIP5i INTERNATIONAL TRAVEL
now eore Ou
O
An ounce of prevention is worth a pound of cure
Castrointestinal infections caused by parasites, viruses or bacteria and respiratory tract infections such as influenza are common illummer vacation isjust around the corner. Ifyou are luckyenough nesses contracted abroad, according to Lutz. to have an international trip planned, you are probably aware of One way to prevent illness is by staying up-to-date on routine imthe hoopsyou must jump through before you go — booking munizations. Lutz said illnesses such as hepatitis A — common in flights, learning important phrases in a different language and obtain- less-developed countries — can be prevented through vaccination. ing a passport. But traveling to a different country also has health risks He recommends visiting the Centers for Disease Control and Prethat can sometimes be avoided with proper knowledge and supplies. vention website (www.cdc.gov) for immunization requirements by Knowing those health risks is a good first step. country and for guidance on whether or not to see a travel health For example, if traveling to "areas in the subtropics and tropics specialist versus a general physician. and less-developed parts of the world, you are more at risk of getThe following checklist offers travel guidelines recommended ting travel-related illness," said Dr. Jon Lutz, an infectious disease by experts. Always seek the advice of your health provider for any physician and travel medicine provider at Bend Memorial Clinic. questions regarding your personal medical conditions.• BY ELISE GROSS
Healthy travel timeline At least one month in advance:
What to pack:
•Check immunization requirements of each country you'll visit. Some vaccines must be taken in a sequence; others need to be in the bodyfor some time before offering full protection. •Meet with your doctor or a travel health specialist for routine or travelspecific immunizations, health-maintenance tips and extra supplies of medication you may need while abroad.
•Hand sanitizer to prevent illness; use especially before meals. •Chlorine dioxide water purification tablets to kill bacteria and viruses. •Antidiarrheals to thicken stools and slow the spasms ofintestinal infections. •Small first-aid kit with bandages, antiseptic wipes, gauze, aspirin and antacids. •Sunscreen. A travel-sized stick makes for for easy application. •Glasses or extra contact lenses, if needed. •Over-the-counter meds you routinely use; Benadryl for a lergic reactions. •Prescription medications in original labeled containers and a list ofany prescriptions and health items. Remember: 3.4ounces or less for carry-on. •DEET iftraveling to the subtropics or tropics to protect against malaria. Mosquito netting is also helpful, especially at night. •Comfortab e walking shoes and moleskin to protect against blisters.
Two to three weeks in advance: •Purchase "What to pack" items (at right). •Confirm your insurance coverage. Most insurance policies cover medical expenses incurred abroad, but Medicare does not. Consider buying a secondary medical trave policy for whatyour plan does not cover (such as deductibles, medical evacuation or overnight hospita visits). You can also purchase primary coverage for medical costs up to a certain amount.
One week in advance:
While abroad in less-developed regions: Lessen your risk of gastrointestinal bacterial infection by avoiding: •Tap water and ice cubes in areas like Latin America and East Africa. Water and carbonated beverages from sealed containers are fine. • Fresh produce, raw she Ifish and street-vendor food.
•Leave your medical history (vaccines, health conditions, medications) with someone who can be reached in an emergency. •Record U.S. embassy and emergency phone numbers for each area you plan to visit. For more information, visit the U.S. Department of State's international travel page (www.travel.state.gov).
Sources: www.cdc.gov, www.who.int, www.traveI.state.gov, www.mayoclinic.com, WehMD and Dr.Jon Lutz
THINKSTOCK
e
/ rp
o' pppp "„p,
eff
'— " IjI 4!Il,.'-
, pp
1po 'ps pp
rp .
e
I '
4,% + 4e
+gglI
u
rrpc
wx x\p e
SVERI
Body ofknowledgei popQUlz
D I
G.
omet in
~gl
s eclB
g': I
BY ELISE GROSS
>LO. IP+c
o you have allergies?Poorvision? Are you pregnant? Whatever your medical condition, there is a good chance a specialist — a doctor who focuses on a particular branch of medicine or surgery — can help. Specialists like dermatologists and neurologists are wellknown. But can you identify what the more obscure doctors below specialize in? Take this quiz to find out.
1
2
Nephrologist A. The psychological implications of nephews for aunts and uncles. B.Kidney and urinary system diseases. C.Hormonal changes during m enopause. D. Providing comprehensive health care for the population of
[
C.
Nephi, Utah.
I. @
Bariatrician A. Removing barriers related to patient health care coverage. B.Diseases of the digestive system.
Angiologist A. Lymphand blood vesseldiseases.
C. Preventive medicine and health promotion.
B. Heart arrhythmias.
D.Weight loss and obesity.
C.Angular abnormalities in the jaw. D. Diagnostic imaging.
3
Rheumotologist A.joint and connective tissue diseases. B.Spinal cord injury and paralysis. C.Indoor spatial awareness. D. Hand, wrist and forearm impairments.
6
3
Andrologist A. The treatment of sleep disorders such as sleep apnea. B.The male reproductive system. C.Male pattern baldness.
2
D. Arthritis related to the use of Android touch screens.
Adenologist A. Adolescent development, including puberty and sarcasm. B.Infectious disease prevention. C.Hormone replacement therapy. D.The study and treatment of glands. Orthoptist A. Skeletal deformities or impairments like scoliosis. B.Eye position and movement disorders. C. Creating and fitting orthotics.
D. Preventing mouth, teeth and jaw problems with braces. Hepatologist A. Tissue and blood sample analysis. B. Injuries common in heptathletes and other multi-sport athletes.
C.The liver and liver disease. D. Chronic hiccups.
8
Perinatologist A. Periodic confusion and memory loss. B. High-risk pregnancies. C.Peritoneal cancer. D. Dental diseases such as gingivitis. 8 :8 8:Z CI:9 V:S 3:0 V:E CI:Z.8:I '~~ s + V
HIGH DESERT PULSE • SPRING/SUMMER 2013
Page 53
One voice ~ApERsoNALEssAY
i ec an es,int t was a just an ache in her eye. My 22-year-old daughter Kristin — midway through college and nearly vibrating with youth and good health— showed up to a fam ily gathering complaining of simple eye pain. j Within weeks, the world had turned upside down for our family and we were faced with something we'd never considered: a child with a chronic, life-altering autoimmune disease. Lesli e Pugmire-Hole is the editor of In hindsight, I should have The Redmond Spokesman. been aware this could happen to usas easily asanyone else. A few years prior, two dear friends started a family after a long wait, and their son was born with cystic fibrosis. Not only have I since learned a ton about CF, a potentially debilitating and progressive disease that affects multiple body systems, I've also learned a lot about how health is perceived in today's society. Passers-by see this towheaded, energetic kindergartner and wonder what the fuss is all about — he does not look sick. But what CF means for my friends is a constant battle against a disease that affects all aspects of their son's life, one that requires extraordinary time and expense to manage. What it means is they must hope for new treatments or cures before their son arrives at his late 30s, the current life expectancy for those with CF. It means every element of their lives will be dominated by CF and it will be an effort invisible to nearly everyone outside their inner circle of family and friends. So when the little eye pain turned into a diagnosis of multiple sclerosis — an incurable disease of the nervous system that can progress to physical and mental disabilities — we realized our friends' struggle with CF had been a glimpse into our future. And once I got past my blind, intense anger that such a gifted and glorious girl could be struck with a fate like this, I got serious about educating myself about living with chronic health problems and facing my own feelings. We saw right away how Kristin could become the poster child for health care reform; as a college student who has "aged out" of typical insurance plans, she would be without any kind of health coverf+
Page 54
!
i n oane e age to help her fight this disease without the Affordable Care Act. Even if her disease allows her to work for most of her life, the annual $5,000 to $10,000 in tests to scan for nervous system lesions and the $30,000 in powerful medications she must take every year will pretty much wipe out any chance at solvency, even with insurance. Regardless of health care reform, she may not be able to realize her dream of graduate school because she may need to enter the working world to obtain her own insurance coverage once she turns 26. While the ACA plans to have health insurance available for anyone not offered coverage by an employer, it's still unclear how that will affect young adults still in school and receiving income through loans or grants. In an ironic twist, my husband and I now see that it might be a blessingKristin was diagnosed soyoung.Had she been 30 or40 and we had been almost or already retired, our ability to help her, in terms of money and our own health, would have been severely limited. But we expect the non-monetary effects to be more far-reaching, for her and us. She will have to deal with bosses and boyfriends who see anormal-looking young woman and can'tunderstand what's wrong with her. She'll have to constantly weigh life choices — what she eats, where she li ves,how much she sleeps and how much to ask ofherbody — to an extent that most of us can only imagine. My husband and I live in fear every day: fear of an escalation of her disease, fear we will not understand how to support her in the most helpful way, fear of zealous ACA opponents who see health care reform as a threat to our national freedoms, fear of the fear. We see down the road, to an old age we did not anticipate, possibly helping to care for an adult child. My daughter, now 25, can expect to live a fairly normal life span, barring any severe complications with her disease. But the quality of that life is unknown, and the variables seem to change every day. We wonder how much she will need to relyon us and how well we will respond. Do we have what it takes? Will she? The waiting is hard; the wondering is torture. We have to remind ourselves to not look too far ahead, to take each year as it comes. The sufferers of chronic diseases don't seem to get the attention of more immediately life-threatening illnesses, such as cancer or heart disease, because people like me — the old, pre-MS me — haven't had a reason to take note. Unfortunately, it's only when fate comes knocking on your door that it becomes personal enough to take a better look. •
SPRING I SUMMER 2013 • HIIGH DESERTPULSE
HIGH LAKES WELCOMES
PRACTICES: Family Medicine: Welcoming Men and Children
HAILS FROM: Western Colorado LOVES: rntn biking,cross country skiing Redmond 541.504. 7635 Bend Upper Mill 541 . 389. 7741
.-'p1 )~
Bend Eastside 541.318.4249 H ea l t h C a r e
HIGHLAKESHEALTHCAPE.COM
H ea l t
Sisters 541.549.9609
h C are
REDMOND CAPE IS N W •
• •
Introducing our newest care facility, located in Redmond. At High Lakes Health Care, we've examined our own practices to come up with a model for keeping patients healthy. Like handpicking high caliber doctors who focus on providing quality care and taking the time to really listen to their patients. Combine that with the freedom to refer to any specialist, and the result is better care that just happens to cost less. With locations in Bend, Sisters and now in Redmond, we provide convenient access to high quality care. NOW IN REDMOND AT: 1001 NW CANAL BLVD., REDMOND, OR 97756 i 541-504-7635
(but a heart attack).
•
E•
•
•
•
•
•
•
•
•
•
•
•
•
•
I
•
•
I
•
• •
•
•
r
•
•
•
•
e
•
I
•
•
e I
r
'
•
I
I
•
I
e
r
• •
-o
e
-
.
'fh