I N C LU D E S A G O R G E -W I D E M E D I C A L D I R E C T O R Y
LONELINESS IS LETHAL An increasing body of research suggests loneliness could be worse for your health than smoking or obesity
FINANCIAL PLANNING With careful stewardship, your retirement account could see you through all your dreams and more
PROSTATE CANCER SCREENING
Prostate cancer is one of the most frequently diagnosed cancers in the U.S. and the second leading cause of cancer death in American men
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“I had the best care. It couldn’t have been better. I felt like I was their only patient.” — TJ Miles, The Dalles
The Only Comprehensive Cancer Center in the Gorge Celilo Cancer Center is the only Commission on Cancer (CoC) accredited facility in the Columbia River Gorge. Our expert oncology team helps you fight cancer from every angle: mind, body and spirit. Our award-winning cancer center offers: • Full-spectrum treatment, including genetic counseling and expertise in medical oncology, radiation oncology, radiology, pathology, breast surgery and reconstructive surgery as well as a lymphedema specialist and an oncology trained esthetician.
Keith Stelzer, MD, PhD Medical Director of Radiation Therapy
• IMRT, a state-of-the-art treatment that delivers high doses of radiation directly to cancer cells much more precisely than is possible with conventional radiotherapy. Celilo Cancer Center Celilo was the first facility in Oregon and Washington to offer this treatment. • The Breast Center at MCMC, the only breast center in the Gorge accredited by the National Accreditation Program for Breast Centers (NAPBC). MCMC was the first center in Oregon and the second in the Northwest to earn accreditation. • Onsite spa, meditation room, healing garden and library for patients and caregivers.
Steve Fu, MD, PhD Hematologist/ Medical Oncologist
At Mid-Columbia Medical Center, our skilled oncologists are here for you. We will sit with you, diagnose your condition, determine an effective course of action and use the abundant resources at our disposal to fight this disease. Call us at 541.296.7585 and let us know how we can care for you or someone you love.
celilo cancer center
Accredited by American College of Surgeons, Commission on Cancer
Lynne Allen, MN, ARNP Oncology Nurse Practitioner
WHATâ€™S INSIDE COVER STORIES
Ready to downsize?...............2 When it comes to medication, sometimes less is more.................................6
Social security basics.........14
Loneliness is lethal
Prostate Cancer: Who should get tested?
Oregon Outreach Program......................................10
Medicare 101.............................16 Cooking less, living more.................................18 Living your best life.............22 Medical Directory................. 24
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Get paperwork in order ......................................28
PHOTO ABOVE TAKEN BY GRACE HASKINS THE MILESTONE | FALL / WINTER 2018
Ready to downsize? A three-bedroom, two-bathroom ranch house with a sprawling yard makes sense for families with kids, a dog, bikes and extra cars. For empty-nesters, though, that big, beautiful house often just becomes a list of Saturday morning chores — mowing the yard, cleaning more bathrooms than you use on a regular basis and vacuuming bedrooms that no one is sleeping in but are filled up with old belongings you think about getting rid of but haven’t. Retirement offers a good opportunity to downsize the house into something more manageable and less expensive. Here are a few questions to ask yourself when considering a new place.
CONSIDER WHAT YOU WANT Do you just want a smaller space? Or is locating closer to amenities or in a certain area your top priority? You may want to consider a townhouse or condominium or other property with a homeowner’s association to lessen the amount of upkeep you’re responsible for. If you want to spend less on a mortgage, you may have to compromise on location or amenities. Knowing what’s most important will make shopping easier.
CONSIDER YOUR TIMELINE If you’ve been in the same house for 30 years, you’ve likely accumulated 30 years of stuff. Give yourself a reasonable timeline to pack, purge and clean your
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house to get it ready for sale. You should also look at the real estate market in your area and the area to which you’re relocating. If you hit a market slump, it could be worth waiting to see if the value of your home will increase. Talk to a Realtor about what you can reasonably expect to get for your home and how much it will cost you to sell and then buy a new home.
LOOK INTO ADULT COMMUNITIES Active-adult or continuing-care retirement communities may be the right step. These offer lots of amenities and more of a community feel. CCRCs provide assisted living and skillednursing facilities. These offer different payment methods, such as simply paying for rent and then paying out-of-pocket for other care as needed or contracts with an upfront fee for lifetime care.
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Planning for your senior years should start early. But the NAPFA says more than a third of Americans don’t have any retirement savings and more than that expect not to retire at all. A professional can help you set financial goals for your retirement, however, even if you find yourself in one of those boats.
Financial planning A big part of living your best life in your later years is making sure you have the money to do so. With careful stewardship, your retirement account could see you through all your dreams and more.
FIND A PROFESSIONAL Planning for your financial future, especially after you leave the workforce, is a huge step and is best left to professionals. But picking a financial planner takes more than just a skim of the yellow pages. Ask friends and family for recommendations or search through the National Association of Personal Financial Advisors (https://www.napfa.org/) then start your vetting process. Look for credentials like CPA, which you’re probably already familiar with, and the CFP, which means certified financial planner. 4
Some questions to ask a potential financial planner are: • What is your education and certification? • How long have you been offering financial services? • Will you provide references from other clients and financial professionals? • Have you ever been cited by a professional group or regulatory body for disciplinary reasons? • How is your firm compensated and how are you compensated? Fee only? Commissions only? Fee and commissions? Fee offset? • Choose more than one adviser to talk to. It’s important that your adviser is a good fit for your goals and for your personality.
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Providence Senior Village: Brookside and Down Manor Caring for seniors in various stages of life Assisted living, memory care and independent living with amenities
Conveniently located on the Heights in Hood River. Call today for more information or to schedule a tour. 541-387-6370
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Companion Care | Home Care Ser vices | Personal Care Transitional Care | Medication Ser vices 5
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It is important to recognize when medications are no longer beneficial, or might even be dangerous for a patient. The concept of “de-prescribing,” or discontinuing medications, is especially important as people age and should be a topic seniors are comfortable discussing with their doctor.
When it comes to medication, sometimes less is more Ana Moreno, MD, Internal Medicine Physician at One Community Health, The Dalles As an internal medicine physician, medications are my tools. It is my job to carefully choose drugs to treat acute ailments, manage chronic conditions, and prevent life-threatening events such as stroke and heart attack in my patients. While each new pill has a role, over a lifetime, these prescriptions can stack up. It is common for older adults to get to the point they are taking handfuls of pills multiple times per day and wondering if they are really all necessary. Actually, they may not be! As people age, there is a natural decline in lean muscle mass, as well as kidney and liver function, which slows down the metabolism of medications. At the same time, the brain and central nervous system become more sensitive to drug levels in the blood stream. The longer the medication list, the higher the risk of drug-drug interactions as well. It can also be difficult for people to stay on top of taking all the right pills at the right times every day. 6
Medication side effects in older adults is such an important issue that The American Geriatric Society has developed a comprehensive list of medications that are potentially inappropriate for seniors. This is called the Beers Criteria, or more commonly, the Beers List. It is a resource commonly known and used by medical providers, and it can also be a powerful tool for patients themselves. Some examples of common medications found on the Beers List include: • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are noted to cause increased risk of gastrointestinal bleeding or peptic ulcer disease. • Diphenhydramine (Benadryl), a sedating antihistamine used to treat allergic reactions and/ or insomnia, carries risk of confusion, dry mouth, constipation and urinary retention. • Benzodiazepines such as lorazepam (Ativan) and THE MILESTONE | FALL / WINTER 2018
clonazepam (Klonopin) increase risk of cognitive, impairment, delirium, falls, fractures and motor vehicle crashes. • Muscle relaxants such as cyclobenzaprine (Flexeril) or methocarbamol (Robaxin) can cause sedation and increased risk of fractures. 1 The full Beers Criteria can be found at: https:// onlinelibrary.wiley.com/doi/pdf/10.1111/jgs.13702. This guideline was complied in 2015—but stay tuned, as efforts are underway to publish an updated 2018 version soon. I strongly advise seniors to take the time to check if any of their current medications can be found on this list. Also check any new medications, including over-the-counter medications, against this list to understand the potential risks associated with taking these drugs before starting them. Finally, here are a few tips for discussing deprescribing with doctor: • Do not change or stop any medication without talking to your health care team first, even if it is on
the Beers List. Some medications may need to be slowly tapered. Others may be very important for your health and unsafe to decrease or discontinue. • Make sure everyone is on the same page about your medication list. Bring in an updated list of your medications, or the actual pill bottles, to every visit Ask what each medication is for if you don’t know. • Be sure to include all over the counter medications and supplements on your medication list. Be open to the fact that these might need to be discontinued too. • Be patient. Usually only one or two changes should be made at a time. This way if a new symptom or problem arises, you and your doctor will know which change is to blame.
REFERENCES 1. American Geriatrics Society 2015 Beers Criteria Expert Panel. “American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” Journal of the American Geriatrics Society. 2015;63(11): 2227-2246.
Quality, Skilled Nursing and Rehabilitation Care for Veterans and Spouses Semi-Private Rooms with Views Wide Range of Support Services Scenic Setting
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800-846-8460 700 Veterans Drive THE MILESTONE | FALL / WINTER97058 2018 The Dalles, Oregon
Healthy living Staying healthy and sharp as you get older will contribute to living a longer, more fulfilling life. While many of the habits that keep you healthier in your earlier decades will continue to serve you well as you get older, seniors need to be careful with high-impact exercises and should be aware of different risks.
EAT RIGHT The AARP actually suggests eating like you have diabetes — don’t eat after 7 p.m.; get rid of the bottom bun when eating hamburgers or other sandwiches; keep nuts in your bag or glove compartment so you have something healthy to snack; use mashed avocado in place of mayonnaise on sandwiches and use whole wheat bread; and replace noodles with quinoa or barley. Talk to your doctor about the number of calories you should be eating daily. 8
FIND THE RIGHT EXERCISES As long as you’re able to do it, brisk walking remains a great way to burn calories, get your heart rate up and keep your muscles and joints active. It’s not the only exercise that’s low impact and good for seniors, though. AARP suggests tai chi — a form of martial arts that combines slow, graceful movements and meditation that been connected to a variety of health and fitness benefits. The biggest of those benefits is the exercise’s ability to improve balance and prevent falls. A 2015 study also found tai chi can help seniors avoid osteoarthritis. Tai chi, as with all exercise, can help reduce stress as well as give you more energy for the rest of your activities. THE MILESTONE | FALL / WINTER 2018
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KEEP YOUR BRAIN SHARP Memory slowing down is a normal effect of age. According to Healthbeat, a publication of Harvard Medical School, using the brain is critical to keep your memory sharp. Use all of your senses; repeat or write down information you want to retain; continue learning, either through classes, books, online programs, going to museums or joining a book club; or make a mnemonic device to help you remember things.
WORK WITH YOUR DOCTOR As you age, your risk of Alzheimer’s and dementia increases, as does the risk for cancer, arthritis and many other conditions. Talk to your doctor about changes in your body or symptoms related to depression or other mental conditions.
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Call on us: Oregon Senior Peer Outreach program confronts loneliness Kris Boler, MBA, Greater Oregon Behavioral Health, Inc. Do you know someone in your community who is isolated and feeling lonely? Remoteness and social isolation are issues affecting older community members from all walks of life — and the impacts are severe. The American Association for Retired Persons (AARP) reports that isolation and loneliness in seniors is associated with higher rates of: • Chronic health conditions, including heart disease • Weakened immune system • Depression and anxiety • Dementia, including Alzheimer’s disease • Admission to nursing homes • Increased use of emergency services • Death Fortunately, support is available. 10
A new program can offer help to reduce loneliness and isolation: the Oregon Senior Peer Outreach. This program provides a free weekly telephone support call from a trained peer support specialist. The peers are Seniors (55+) and they identify with some of the unique challenges of growing older and spending too much time alone. These peers come from a place of understanding, aiming to provide a caring, personal connection. This is what program participants are saying: • “I haven’t had anybody to share with for years.” • “I look forward to weekly calls from my peer support specialist — I think of her as a friend.” • “My Mondays are so much better because I look forward to my call.” THE MILESTONE | FALL / WINTER 2018
• “I have felt less depressed and my life is more full of light.” Isolation and loneliness can cause a person to become more withdrawn and less self-motivated to make or keep vital social connections in their lives. As you can imagine, the more isolated an older adult is, the harder it is to find them to offer help. We encourage you to refer people in your community who might benefit from this program. The senior peer outreach program is just one example of endeavors regarding healthy aging in our state. The Older Adult Behavioral Health Initiative (OABHI), coordinated by the Oregon Health Authority and 24 specialists across Oregon, has the role of improving the ability of each community’s behavioral health system to provide the kind of services older adults require. Under the OABHI umbrella, these specialists support the peer outreach network. The program hires Senior Peer Support Specialists to call participating seniors. Team members who
are both seniors and peers provide a vital bridge of support between older adults and needed services. To our community, the message from the Oregon Senior Peer Outreach network is clear: “There’s no need to go it alone.”
HOW TO GET INVOLVED If you would like program postcards or business cards please let us know. We are happy to provide you with the resources you need to refer people to this program. To make referrals to this program, please fill out the on-line Referral Request form at: https:// communitycounselingsolutions.org/ senior-outreach or call our Oregon Senior Peer Outreach Program Supervisor at our toll-free referral line: 1-833-7364676. To learn more about the OABHI program, visit www. gobhi.org.
OUTDOOR ADVENTURES WITH MILITARY HEROES Provide an opportunity to introduce or reintroduce our military wounded combat veterans to the outdoors. 11
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Loneliness is lethal
Britta Willson, Gerontologist, Volunteers in Action, Providence Hood River Memorial Hospital Ironically, being lonely has received a lot of attention lately. The issue has become such a high level of concern that the United Kingdom has appointed a minister of loneliness charged to confront what Prime Minister Theresa May has called a â€œsad reality of modern life.â€? With good reason too. An increasing body of research suggests loneliness could be worse for your health than smoking or obesity and these health risks are increased for older adults. Studies suggest older adults who feel lonely are at a greater risk of memory loss, strokes, heart disease, and high blood pressure. According to AARP, the health risk associated with social isolation is on par with smoking 15 cigarettes a day and costs an additional $6.7 billion in Medicare spending each year. 12
Loneliness is defined as a lack of human intimacy that is experienced by the individual as unpleasant. It can be conceived as having two distinct dimensions, emotional isolation and social isolation, and is always experienced as negative. While social isolation means not having an adequate social network, emotional isolation is lacking a desired emotional connection to others. This means even if you live with other people, whether with family or in a setting like assisted living or senior housing communities, you can experience feelings of loneliness and isolation. A 2012 study showed that 43% of people over 60 years of age felt lonely. This may be because older adults often become less mobile as they age. THE MILESTONE | FALL / WINTER 2018
This is especially true of older adults who reside in rural areas due to the terrain and lack of public transportation. Other factors may include illness, hearing loss, or life changes such as retirement or the loss of a spouse. Any one of these factors can lead to isolation and loneliness. Unlike diabetes, cancer, and heart disease, loneliness is difficult to detect. However, unlike many chronic health conditions, loneliness has safe and free treatment options. If you’re concerned about someone you know or your own feelings of loneliness, local options are available that may help. One way to combat loneliness is through volunteerism. Research shows that volunteers can enjoy health benefits after just one year of service, including decreases in anxiety, depression, loneliness, and social isolation. Older adults who volunteer frequently live longer and report less disability. Volunteering may be particularly helpful for those who are undergoing a life stress or are at risk for being isolated. Providence Hood River Memorial Hospital’s Volunteers in Action supports vulnerable older adults in maintaining independence through compassionate relationships. Volunteers help clients get access to food, health care, transportation, and social connections, which are critical to living well at any stage of life. The relationships you build through service with Volunteers in Action broadens your own social network while providing others with social and practical support to pursue wellness on their own terms. Additionally, the Oregon Senior Peer Outreach Program provides free weekly phone calls to isolated seniors who live in rural and frontier counties, reducing the health impacts of loneliness and social isolation. Those who are making the phone calls are Senior Peer Supporters, individuals who have experienced their own life challenges, including feelings of depression, loneliness, trauma, and addiction.
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Everyone feels lonely from time to time. However, when feelings of loneliness consistently occur over weeks, months, and years, it can have devastating health consequences. Consider what you can do to keep your social connections vibrant and strong. If you do feel lonely, you’re not alone, and there are ways to make new connections that can lead to a happier and healthier life. If you’re interested in becoming a volunteer or client with Providence’s Volunteers in Action, contact Britta Willson at 541387-6404 or firstname.lastname@example.org. If you’d like to enroll in the Oregon Senior Peer Outreach Program call 1-833-736-4676 or enroll online at http:// communitycounselingsolutions.org/senior-outreach/.
SOURCES 2012 study- https://www.ncbi.nlm.nih.gov/pubmed/22710744 2018 AARP article on loneliness- https://blog.aarp. org/2018/02/07/social-isolation-the-silent-killer-that-costsmedicare-billions-in-extra-spending/ Functional decline- https://jamanetwork.com/journals/ jamainternalmedicine/fullarticle/1188033 Benefits of volunteering, AARP- https://www.aarp.org/health/ healthy-living/info-2017/health-benefits-volunteering-seniors-fd. html; https://www.nationalservice.gov/pdf/healthbenefits_ factsheet.pdf
Serving the Columbia River Gorge since 1921 with locations in Hood River & The Dalles
HOOD RIVER (541) 386-1000 1401 Belmont Ave, Hood River
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Social security basics Most Americans who work pay into Social Security, which is designed to help people save for retirement. The payment is automatic, but applying for benefits takes some time and effort â€” and lots of paperwork. The U.S. Social Security Administrationâ€™s website, www.ssa.gov, has a retirement estimator that helps users estimate their monthly benefits, learn their full retirement age and make informed decisions about the process.
WHEN SHOULD I GET SOCIAL SECURITY? Workers who have paid into Social Security can get retirement benefits as early as 62 years old, but they will see reduced benefits if they cash in before full retirement age, which for most people is 66. Waiting until 70 to start benefits will result in increased benefits. 14
The SSA recommends applying for benefits four months before you want those benefits to begin. You may want to do this even if you are still working when you reach full retirement age; it could mean more money for you. If earnings for the prior year are higher than one of the years used to compute your benefit, the SSA will redo that calculation and make the increase retroactive to January the year after you earned the higher way. This could result in higher survivors benefits as well. If you receive benefits while working, the amount you get may be reduced depending on your income.
WHAT PAPERWORK DO I NEED? To apply, you need your Social Security number, birth certificate, W-2 forms or self-employment returns for THE MILESTONE | FALL / WINTER 2018
the previous year, military discharge papers, if applicable, and birth certificates and Social Security numbers for your spouse and children who are applying for benefits. The need for records doesn’t end when you’re receiving your benefits. Notify the SSA if you move, get married or divorced, change your name, adopt a child, have a change in citizenship status or start receiving a pension.
WHAT BENEFITS CAN MY FAMILY GET? If your spouse or child qualify, they may receive a monthly payment up to half of your full retirement benefit. This will not cut your benefit amount. Children may qualify if they are minors, full-time high school students who are 18 or 19 or have a disability that started before age 22. Spouses who have not paid into Social Security also may be eligible if they have reached full retirement age.
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Medicare 101 Medicare is a federal health insurance plan that working Americans pay into through payroll taxes. It is a valuable benefit, as most Americans’ health insurance is tied to their jobs, thus leaving a hole when workers retire, but enrolling in and navigating the program can be a daunting task. The AARP has a Medicare Question and Answer Tool to walk people through the plans Medicare offers, what health care coverage you need and can afford, and the timeline you should expect as you are signing up.
BASICS OF MEDICARE At age 65, Americans are eligible for Medicare. There are four parts: 16
• Part A (hospital): Helps pay for the cost of hospital stays and time in short-term skilled nursing facilities, hospice and home health services. • Part B (medical): Helps pay for doctors, outpatient and preventive care and certain medical equipment. • Part C (Medicare Advantage): An alternative coverage option that puts all your Medicare benefits into one plan. • Part D: Helps cover the cost of outpatient prescription drugs. If you or your spouse have earned a minimum of 40 work credits through paying Medicare payroll taxes, you won’t pay monthly premiums for Part A insurance. Work credits aren’t necessary for Part B or D services, though there is a monthly premium for those. THE MILESTONE | FALL / WINTER 2018
Like traditional health insurance, Medicare does not cover all health care costs. Plans have different deductibles, premiums and copays. Your income also may be a factor on how much you pay.
HOW TO SIGN UP FOR MEDICARE Even after paying payroll taxes and turning 65, most Americans still must apply for Medicare. The initial enrollment period lasts for seven months, with the fourth month being the month you turn 65. You should sign up during this period if you have no other health insurance or have insurance you bought yourself; you have retiree benefits from a former employer; you have COBRA coverage or veterans’ benefits; or you’re in a nonmarital relationship and covered by their insurance. If you enroll before your 65th birthday; your coverage begins on the first day if the month you turn 65. If you enroll after, there is a delay.
A special enrollment period is available for people who have health insurance past the initial period and allows them to delay enrolling in Part B until their previous coverage ends. There also are exceptions for expatriates or people who are covered through a spouse’s insurance.
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GRAB A GOOD BOOK Hit your local library or bookstore and grab some cookbooks that specialize in cooking for one or two. You may even be able to find books that cater to special diets, like low-sodium or diabetes diets. Try a book or two out of your comfort zone, maybe a new cuisine or a new trend. Cooking for one or two shouldn’t mean a lifetime of TV dinners. Get in the kitchen and whip up some fun.
Cooking less, living more Where you once shoveled out spaghetti to feed a starving horde (or what felt like it, anyway), you may now only be cooking for yourself and your partner or just for yourself. And with cookbooks and cooking shows crowing about the ability to feed an army off one recipe, it can be hard to scale down your meals. Here are some tips to get you cooking with less waste and more fun.
EMBRACE THE LEFTOVERS Pick dishes that are versatile. A roasted chicken can be served as a Sunday dinner, enchiladas on Monday and a tasty soup on Tuesday. Batches of bigger meals, like that giant pot of spaghetti, can be frozen in individual portions. Just remember to clearly label and date the portions and clean out your freezer regularly.
PLAN, PLAN, PLAN A meal plan can be the godsend for you that it was when you had a big family at home. Take the time to 18
sit down (maybe with a local grocery or two’s sale papers) and plan out what you’re going to have every meal. Then, stick to that list when you’re in the store. Be careful not to overbuy produce, and visit your grocer’s bulk bins for a right-sized and right-priced portion.
PHONE A FRIEND If you’re still having trouble paring down your menus, get together with several friends and swap groceries or fully cooked meals. Start a supper or lunch club. You get to try new recipes and share your bounty with others, too.
TAKE A CLASS Look to local grocery stores and sometimes restaurants for cooking classes. Not only does this get you out and mingling, but you learn new recipes, cuisines and tips. It can make cooking fun and rewarding. THE MILESTONE | FALL / WINTER 2018
6 7 9
1 fishing gear 4 6th planet of our solar system 9 Short horse 10 German poet Heinrich 12 appraise, charge per unit 13 A penny for your thoughts! 15 you bet! 17 trout catcher 19 Handy utensil, especially for holidays “Gobble Gobble” 20 Small whirlpool 22 cooking fat 23 convert into cash 24 Oregon State Bird 26 river in Switzerland
1 Home on the range 2 Stand in 3 rubber gasket 5 Vein’s Counterpart 6 Mushroom local to the Gorge 7 biblical king 8 Whatever floats your boat 11 strong adhesive 13 Buckaroo 14 firearm 15 A fine man 16 those against 18 military person 21 high kicking dance 25 human leg joint
WORD BANK: AARE, ANTIS, ARTERY, BASTER, BURRO, CANCAN, COPPER, COWBOY, EDDY, EPOXY, GAMBLER, GOODFELLOW, HEINE, HEROD, KNEE, LARD, LIQUIDATE, MEADOWLARK, MOREL, ORING, OSPREY, PISTOL, RANCH, RATE, RODS, SATURN, SOLDIER, SUB, WATER
ACROSS 1. RODS 4. SATURN 9. BURRO 10. HEINE
12. RATE 13. COPPER 15. GAMBLER 17. OSPREY 19. BASTER
20. EDDY 22. LARD 23. LIQUIDATE 24. MEADOWLARK 26. AARE
DOWN 1. RANCH 2. SUB 3. ORING 5. ARTERY
6. MOREL 7. HEROD 8. WATER 11. EPOXY 13. COWBOY
14. PISTOL 15. ODFELLOW 16. ANTIS 18. SOLDIER 21. CANCAN
THE MILESTONE | FALL / WINTER 2018
ABOUT THE AUTHOR Dr. Keith Stelzer is Medical Director of Radiation Oncology at Mid-Columbia Medical Centerâ€™s Celilo Cancer Center. He is a leading expert in the application of intensity modulated radiation therapy (IMRT), a state-of-the-art technology used at Celilo that delivers a precise dose of radiation while minimizing damage to surrounding tissue. Prior to joining MCMC, Dr. Stelzer was associate professor in the Radiation Oncology and Neurological Surgery departments at the University of Washington, and he continues as a clinical associate professor of Radiation Oncology at UW Medical Center.
Prostate Cancer: Who should get tested? Keith Stelzer, M.D., Ph.D. Medical Director of Radiation Oncology, Celilo Cancer Center, Mid-Columbia Medical Center Many people are surprised to learn that prostate cancer is one of the most frequently diagnosed cancers in the U.S. and the second leading cause of cancer death in American men. For decades the medical community has stressed the importance of early detection for breast, cervical, and colon cancer. So why is the PSA test, which can be used to detect prostate cancer, one of the most controversial issues in menâ€™s health?
GUIDELINES NEGLECT HIGH RISK PATIENTS Part of the male reproductive system, the prostate is responsible for secreting prostate fluid, a component of seminal fluid, and helps propel this fluid into the 20
urethra. The walnut-sized gland also produces an enzyme called Prostate Specific Antigen (PSA), which may be elevated in cases of prostate cancer, enlarged prostate, or inflamed or infected prostate. In 2012, the U.S. Preventive Services Task Force, an independent panel of medical professionals, recommended against routine PSA testing, discouraging clinicians from even discussing the risks and benefits of PSA testing with patients. The agency has since softened its stance, advising doctors to discuss the potential harm and benefits of PSA testing with patients from high risk populations, THE MILESTONE | FALL / WINTER 2018
such as African Americans and patients with a family history of prostate cancer. In contrast, the American Urological Association stresses the importance of PSA screening and argues the greatest benefit of screening is among men ages 55 to 69. With contradictory recommendations from major medical agencies, associations, and panels, patients and their families are right to be confused about whether to pursue PSA screening. Our view at Celilo Cancer Center is that PSA testing was overused prior to 2012, but screening is potentially beneficial, particularly for men who are at higher risk for prostate cancer but otherwise have good life expectancy. The risks of routine PSA screening include over-treatmentâ€”aggressive treatment of non-aggressive prostate cancer. In recent years, this risk has been reduced thanks to new information about how to identify and monitor patients with slow growing prostate cancer.
accuracy of radiation treatment, we use image guided radiation therapy. Like all of the top ranked hospitals in the U.S, at MidColumbia Medical Center we utilize da Vinci Robotics technology for urological surgeries. This roboticassisted surgery allows doctors to perform minimally invasive procedures with only a few small incisions, resulting in less pain and scarring, shorter recovery time, and so our patients can return as quickly as possible to doing all of the things they love. When choosing a medical center for PSA screening or treatment, many patients are not aware of the benefit of accreditation. Cancer centers like Celilo have earned accreditation by the Commission on Cancer (CoC). We recommend choosing a facility that is accredited by the CoC so you know you are getting high-quality, patient-centered care and access to the full spectrum of cancer care services.
BETTER TREATMENT, LONGER LIFE It may sound strange, but sometimes the best treatment for prostate cancer is waiting. More than 30% of men have slow growing prostate cancer. Known as active surveillance, these patients are monitored regularly but receive no additional treatment unless there are signs the cancer is progressing. After 10 years, approximately half of patients undergoing active surveillance for low risk prostate cancer will progress to the point of needing treatment. Intermediate and higher risk patients are not good candidates for active surveillance and we strongly advise them to consider treatment while their prostate cancer is still curable. We believe that our patients here in the Gorge have benefited from our making recommendations for or against treatment based on their individual risk factors. Options for treating localized prostate cancer include radiation therapy and surgery. Although both treatments can have side effects, new technology can reduce those impacts. To improve the precision and THE MILESTONE | FALL / WINTER 2018
Sunshine Club An extension of Providence senior village
Adult day respite and activity program for people with Alzheimerâ€™s, dementia or related illnesses. Providing professional, compassionate care with activities, music, social time and more. Call us for information 541-387-6370
2650 Montello Street Hood River, OR 97031 21
Living your best life Americans dream of retirement â€” time to sleep in, take naps, garden, complete projects or take trips. We imagine retirement offering all the opportunities working 40 hours a week detracts from. And you should definitely take time for all the relaxing you want, then find ways to fill those hours and allow you to enjoy your post-work life. MarketWatch has a few suggestions for making the most of your senior years.
GET A JOB OR VOLUNTEER OK, maybe this isnâ€™t your first stop. But a postretirement job may give you the opportunity to try something new and perhaps less stressful, or working a part-time position in something fun. It also provides additional income, which many Americans would benefit from during their retirement years. 22
Volunteering also is a great way to be involved in your community. Libraries, schools, museums, hospitals and nonprofits are always looking for volunteers. You could even use your expertise acquired from working to help out a small business.
FIND (OR REDISCOVER) A NEW SPORT OR HOBBY A pickup basketball game after a long day of work when you work at home can be exhausting. A pickup game without that long day of work can be energizing and a lot of fun. Learn to golf, go fishing or boating, play tennis, go biking, join a team (check out the National Senior Games Association if you want some real competition) or reacquaint yourself with the local gym or hiking or walking trails. Regardless of your level of fitness, you can find some sport or exercise that fits. THE MILESTONE | FALL / WINTER 2018
Retirement is also a great time to find a new hobby. If you’ve always been interested in cooking but never had much time to experiment, now you do. Take up gardening, learn to play the piano, take dance lessons or take up painting.
TRAVEL These might be jetsetting trips to Europe, Asia or Australia; or weekend trips to the local national parks, the cities around you, or visiting friends and family throughout the country. It could even be packing up a camper and driving the country, exploring the nooks and crannies of the United States that tourists often overlook. Why not use the freedom of retirement to scratch the travel itch?
Foster care is a rough road to walk down alone for a child. Walk with them and be their voice.
Become a CASA volunteer or donate so others can Fall, Winter & Spring Trainings www.gorgecasa.org 541.386.3468
Build a bucket list
Create a bucket list of things you’d like to see, accomplish or places you’d like to visit and make an effort to cross those items off. Here are a few ideas to add to your list:
REVISIT THE PAST
See the Northern Lights Live abroad Travel the coast Fly first class Take a rail trip around Europe Go on a safari
Look up an old friend Research your family history Create a family tree Attend a school reunion Visit where your parents grew up
LEARN A NEW SKILL
Learn how to play an instrument Study for a degree Learn a new language Learn a new style of dance Learn how to draw/paint
Go to a casino Try acupuncture Meet an exotic animal Meet a celebrity Try a new cuisine Go up in a hot air balloon
Providence Hospice of the Gorge
Serving the Gorge for more than 35 years. Providing experienced, compassionate care for people nearing the end of life. Our doctors, registered nurses, chaplains, social workers and other team members provide everything from pain control and comfort care to emotional, social and spiritual support, including support for family members and caregivers.
Call for more information 541-387-6449 in Hood River 541-296-3228 in The Dalles THE MILESTONE | FALL / WINTER 2018
THE MILESTONE SENIOR DIRECTORY ▌ADULT FOSTER CARE HOMES A Home Sweet Home Hood River, OR • 541-387-5335 Anita Allen Foster Care The Dalles, OR • 541-352-3504 Carolyn’s Adult Care The Dalles, OR • 541-298-2554 Cascade Senior Care The Dalles, OR • 541-993-2910
Providence Brookside Manor Memory Care Hood River, OR • 541-387-6370
▌ASSISTED LIVING, NURSING & ▌RETIREMENT HOMES Ashley Manor Hood River, OR • 541-387-4514 Bobbi’s Way In-Home Health Care Hood River, OR • 541-436-4515
Cherry Street Manor II Canyon Rim Manor White Salmon, WA • 509-493-1084 Maupin, OR • 541-395-2515 Eastern Oregon Center for Independent Living The Dalles, OR • 541-370-2810 Margie’s Lyle Adult Family Home Lyle, WA • 509-365-5500 New Hope Farms Goldendale, WA • 509-773-3939
▌ALZHEIMER’S & MEMORY CARE Ashley Manor Hood River, OR • 541-387-4514 Flagstone Senior Living The Dalles, OR • 541-298-5656 24
Cascade Senior Care The Dalles, OR • 541-993-2910 Cherry Heights Retirement The Dalles, OR • 541-296-6880 Columbia Basin Care The Dalles, OR • 541-296-2156 Flagstone Senior Living The Dalles, OR • 541-298-5656 Hawks Ridge Assisted Living Hood River, OR • 541-387-4087 Hearts of Gold Caregivers Hood River, OR • 541-387-0207
Helping Hands Home Care The Dalles, OR • 541-436-4430 Hood River Care Center Hood River, OR • 541-386-2688 New Hope Farms Goldendale, WA • 509-773-3939 Oregon Veterans’ Home The Dalles, OR • 541-296-7190 Parkhurst Place Assisted Living Hood River, OR • 541-387-4600 Providence Brookside Manor Hood River, OR • 541-387-6370 Providence Dethman Manor Hood River, OR • 541-387-8278 Providence Down Manor Hood River, OR • 541-387-8290 Summit Springs Village Condon, OR • 541-384-2101 Rock Cove Assisted Living Stevenson, WA • 509-427-7272 The Dalles Health & Rehab The Dalles, OR • 541-298-5158 The Springs at Mill Creek The Dalles, OR • 541-296-1303 THE MILESTONE | FALL / WINTER 2018
▌DENTURISTS The Denture Specialist Hood River, OR • 541-386-2012 The Dalles, OR • 541-296-3310
▌ELDER ABUSE PREVENTION ▌ASSISTANCE & ADVOCACY Adult Protective Services 800-452-2333
Spencer Libby & Powell Funeral Home The Dalles, OR • 541-296-3234
One Community Health Hood River, OR • 541-386-6380 The Dalles, OR • 541-296-4610
▌HEARING AIDS TESTS & ▌COUNSELORS
White Salmon Family Practice White Salmon, WA • 509-493-1470
Cascade Hearing Aid Center Hood River, OR • 541-386-1666 The Dalles, OR • 541-296-3300
▌HOME HEALTH SERVICES Bobbi’s Way In-Home Health Care Hood River, OR • 541-436-4515
Columbia Gorge Hearing Care Hood River, OR • 541-298-8676 Hearts of Gold Caregivers Helping Hands Against Violence Hood River, OR • 541-387-0207 The Dalles, OR • 541-298-8676 Hood River, OR • 541-386-6603 Haven from Domestic & Sexual Violence The Dalles, OR • 541-298-4789 Skamania County APS 877-734-6277 (TTY) 1-800-977-5456 Klickitat County APS 800-459-0421 (TTY) 509-568-3086
▌FUNERAL HOMES Anderson’s Tribute Center: Celilo Chapel Hood River, OR • 541-386-1000 The Dalles, OR • 541-296-2600
Hear’s The Answer Hearing Center The Dalles, OR • 541-298-5558 Hearing Aid Counselors Hood River, OR • 541-387-3277 My Hearing Centers Hood River, OR • 541-716-4086
▌HEALTH CLINICS Columbia Gorge Family Medicine Hood River, OR • 541-386-5070 KVH Family Medicine Goldendale, WA • 509-773-4017
Mid-Columbia Family Health Columbia Hills Memorial Center Chapel Stevenson, WA • 509-427-4212 Goldendale, WA • 509-773-4646
Helping Hands Home Care The Dalles, OR • 541-436-4430 MCMC Visiting Health Services The Dalles, OR • 541-296-7280 Providence Home Health Hood River, OR • 541-387-6339
▌HOSPICE CARE Heart of Hospice Hood River, OR • 541-386-1942 Klickitat Valley Health Hospice Goldendale, WA • 509-773-0380 Providence Hospice of The Gorge Hood River, OR • 541-387-6449 The Dalles, OR • 541-296-3228
NorthShore Medical Group Gardner Funeral Home Inc White Salmon, WA • 509-493-2133 White Salmon, WA • 509-493-1323 THE MILESTONE | FALL / WINTER 2018
▌HOSPITALS Klickitat Valley Health Goldendale, WA • 509-773-4022 Mid-Columbia Medical Center The Dalles, OR • 541-296-1111 Providence Hood River Memorial Hospital Hood River, OR • 541-386-3911
▌MENTAL HEALTH AND SUPPORT ▌GROUPS
Mid-Columbia Center for Living The Eyeglass Store Hood River, OR • 541-386-2620 Hood River, OR • 541-386-3937 The Dalles, OR • 541-296-5452 White Salmon Eye Care Brookside Manor Alzheimer’s White Salmon, WA • 509-493-2020 Dementia Support Group Hood River, OR • 541-387-6370
Flagstone Alzheimer’s & Skyline Hospital Dementia Support Group White Salmon, WA • 509-493-1101 The Dalles, OR • 541-298-5656
▌MEALS & FOOD ASSISTANCE ▌PROGRAMS FISH Food Bank Hood River, OR • 541-386-3474 Goldendale Food Bank Goldendale, WA • 509-773-5220 Meals on Wheels Hood River, OR • 541-386-2060 The Dalles, OR • 541-298-8333 Stevenson Food Bank Stevenson, WA • 509-427-4334 St. Vincent DePaul Meals The Dalles, OR • 541-296-9566 WGAP Food Bank Bingen, WA • 509-493-2662 800-755-1192
Grief Share Hood River, OR • 541-386-1049 Parkinson’s Support Group Hood River, OR • 541-340-0142 Cancer Support Groups The Dalles, OR • 541-296-7585 Cancer CARE Support Group Hood River, OR • 541-387-6445
▌OPTOMETRISTS Cascade Eye Center Hood River, OR • 541-386-2402 The Dalles, OR • 541-296-1101 Hood River Vision Clinic Hood River, OR • 541-386-2747 Indian Creek Family Eye Care Hood River, OR • 541-386-1700 Mid-Columbia Vision The Dalles, OR • 541-296-2911
Preferred Optical The Dalles, OR • 541-296-5878
▌SENIOR SERVICES & ASSISTANCE Addus Healthcare Vancouver, WA (serving Klickitat County) 360-699-1222 ADRC Aging and Disability Resource Connection 855-673-2372 Chesterfield Services, Inc. Stevenson, WA • 509-427-0068 877-509-6847 Department of Human Services Hood River, OR • 541-386-3199 The Dalles, OR • 541-298-4114 Eldercare Locator 800-677-1116 Gorge Action Program Main Office Bingen, WA • 509-493-2662 (800) 755-1192 Gorge Action Program Goldendale, WA • 509-773-6834 800- 755-1192 Ext 300
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Gorge Action Program Skamania County Stevenson, WA • 509-427-8229 800-755-1192 Ext 311
Senior Health Insurance Benefits Assistance 541-645-5351 541-298-4101
Hood River Valley Adult Community Center Hood River, OR • 541-386-2060
Washington State Department of Social and Health Services 877-501-2233
Klickitat County Senior Services Washington State Home & White Salmon, WA • 509-493-3068 Community Services Goldendale, WA • 509-773-3757 Referral Line 1-866-323-9409 Mid-Columbia Council of Governments Area Agency SOCIAL, EDUCATIONAL & on Aging RECREATIONAL The Dalles, OR • 541-298-4101
Mid-Columbia Community Action Hood River, OR • 541-386-4027 The Dalles, OR • 541-298-5131 Mid-Columbia Senior Center The Dalles, OR • 541-296-4788 Oregon Senior Peer Outreach Program Columbia River Gorge 833-736-4676 Programs for Peaceful Living Goldendale, WA • 509-773-6100 800-755-1192 Ext 320 Bingen, WA • 509-493-1533 800-755-1192 Ext 334 Social Security, Medicare, Medicaid 1-800-772-1213 THE MILESTONE | FALL / WINTER 2018
Hood River Valley Adult Center Hood River, OR • 541-386-2060
Link Bus The Dalles, OR • 541-296-7595 Mt. Adams Transportation Service White Salmon, WA • 509-493-4662 Goldendale, WA • 509-773-3060
▌VETERANS’ SERVICES Veterans’ Services Hood River County • 541-386-1080 Wasco County • 541-506-2502 Oregon Veterans’ Home The Dalles, OR • 541-296-7190 American Legion Hood River, OR • 541-308-0000 The Dalles, OR • 541-296-9633
Mid-Columbia Senior Center The Dalles, OR • 541-296-4788
For additional resources visit your counties senior services online at
Community Education Hood River, OR • 541-386-2055
Hood River County www.hoodrivercounty.org
Hood River Aquatic Center Hood River, OR • 541-386-1303
Klickitat County www.klickitatcounty.org
Wasco County Aquatic Center The Dalles, OR • 541-296-9533
Skamania County www.skamaniacounty.org
▌TRANSPORTATION & SERVICES
Wasco County www.wascocounty.org
CAT Bus Hood River, OR • 541-386-4202
TALK TO YOUR FAMILY Make sure someone knows where paperwork is kept and what you want with health care. This is also a good time to discuss potential funeral plans, including costs (many funeral homes will allow you to pay funeral costs with life insurance, which decreases the financial stress of a death), and take steps to allow a trusted person to have access to your assets. You may want to put a family member on one or more of your bank accounts, which will allow them to have access after your death. If not, those assets may be frozen for a time.
Get paperwork in order Planning for their own death is no one’s favorite activity, but having the right paperwork and information in the right hands can make a difficult time somewhat easier for family members and the executor of your estate. The National Institute of Aging offered a number of factors to think about, some of which most of us probably haven’t considered.
COLLECT YOUR IMPORTANT PAPERS AND PUT THEM IN ONE PLACE Important papers include birth certificates, passports, wills and deeds to property but also account information for every bank account, including retirement accounts; insurance information; copies of Medicare and health insurance cards; information for safe deposit boxes; military records; living wills and other items. Make sure family members know where to find these. 28
MAKE A WILL, INCLUDING A LIVING WILL Regardless of how many assets you have, you should have a will. This allows you to designate the person you want your property to go to after your death. A living will lays out your desires for health care if you become too sick to make your own decisions or make them known. You can state what kind of care you do or don’t want, such as how much treatment you want in the event of a terminal illness or if you want to be resuscitated. This will help your wishes be carried out and make the decision easier for family members faced with difficult decisions.
TALK TO YOUR LAWYER AND DOCTOR To make things easier, talk to your doctor about what you would like to have happen with end-oflife decisions and give them permission to share information with a family member. Make sure your legal documents are up to date; have your lawyer look over wills, trusts and advance directives like a power of attorney. THE MILESTONE | FALL / WINTER 2018
THE MILESTONE | FALL / WINTER 2018
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MEDICAL CLINIC THE MILESTONE | FALL / WINTER 2018
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