Page 1

SPRING / SUMMER 2012

H I G H

Acid reflux drugs: Digesting the fine print

D E S E R T

PULSE Healthy Living in Central Oregon

Stand-up paddleboarding: It’s what’s SUP on the Deschutes Making the grade: Teacher/cyclist Renee Scott

What did your family leave you?

The genetics of alcoholism


Comfort Recliner™

60% OFF Savings!

Bend River Promenade Free Statewide Delivery* • www.mjacobsfamilyofstores.com 541-382-5900 • Toll Free 1-800-275-7214 • Open Mon.-Fri. 10AM to 7PM • Sat. & Sun. 10AM to 6PM

*$999 or more.


H I G H

D E S E R T

PULSE Healthy Living in Central Oregon

SPRING / SUMMER 2012 VOLUME 4, NO. 2

How to reach us Julie Johnson | Editor 541-383-0308 or jjohnson@bendbulletin.com Sheila Timony | Associate editor 541-383-0355 or stimony@bendbulletin.com • Reporting Anne Aurand 541-383-0304 or aaurand@bendbulletin.com Betsy Q. Cliff 541-383-0375 or bcliff@bendbulletin.com Markian Hawryluk 541-617-7814 or mhawryluk@bendbulletin.com • Design / Production Greg Cross Mugs Scherer • Photography Ryan Brennecke Pete Erickson

Lara Milton Andy Zeigert Rob Kerr Andy Tullis

• Corrections High Desert Pulse’s primary concern is that all stories are accurate. If you know of an error in a story, call us at 541-383-0308 or email pulse@bendbulletin.com. • Advertising Jay Brandt, Advertising director 541-383-0370 or jbrandt@bendbulletin.com Sean Tate, Advertising manager 541-383-0386 or state@bendbulletin.com Lorraine Starodub, Health & medical account executive 541-617-7855 or lstarodub@bendbulletin.com On the Web: www.bendbulletin.com/pulse

The Bulletin All Bulletin payments are accepted at the drop box at City Hall. Check payments may be converted to an electronic funds transfer. The Bulletin, USPS #552-520, is published daily by Western Communications Inc., 1777 S.W. Chandler Ave., Bend, OR 97702. Periodicals postage paid at Bend, OR. Postmaster: Send address changes to The Bulletin circulation department, P.O. Box 6020, Bend, OR 97708. The Bulletin retains ownership and copyright protection of all staff-prepared news copy, advertising copy and news or ad illustrations. They may not be reproduced without explicit prior approval. Published: 5/14/2012

Write to us Send your letters of 250 words or less to pulse@bendbulletin.com. Please include a phone number for verification.

Page 4


Thank you Central Oregon for 20 great years of support!

As a thank you, for a limited time, we are taking joining fees to as low as $150. Ask us about our Zero Dollar joining fee option


Contents |

HIGH DESERT PULSE

COVER STORY

10

ALCOHOLISM IN THE FAMILY TREE Is the legacy genetic, environmental or both?

18

FEATURE

30

TREATING GERD Drugs to relieve gastroesophageal reflux disease are easy to start, but can be hard to quit.

DEPARTMENTS

8 18 22 24 28 35 36 39 53 54

UPDATES What’s new since we last reported.

24

GET READY: PADDLEBOARDING Part surfing, part paddling, all fun. PICTURE THIS A color key to natural foods. HOW DOES SHE DO IT? 8 a.m., math teacher; 4 p.m., jock: Renee Scott. GET GEAR: DRESS TO HIKE Must-have wear for a trek on a trail. SNAPSHOT: SKATEBOARDING ’round Redmond Skatepark. ON THE JOB Bend Research operators mix medicines.

28

SORTING IT OUT Find fitness on your phone. BODY OF KNOWLEDGE: POP QUIZ What do you know about nutrition? ONE VOICE: A PERSONAL ESSAY One man weighs in. COVER DESIGN: ANDY ZEIGERT; PHOTO BY ROB KERR CONTENTS PHOTOS, FROM TOP: RYAN BRENNECKE, ROB KERR, PETE ERICKSON, RYAN BRENNECKE

To subscribe or learn more about our publications, call 541-385-5800 or go to www.bendbulletin.com. HIGH DESERT PULSE • SPRING / SUMMER 2012

Page 7

36


Updates |

NEW SINCE WE LAST REPORTED

SPRING / SUMMER 2009

H I G H

PULSE Healthy Living in

Drug testing for children’s medications

D E S E R T

Central Oregon

Par nts assuem e

drugs pr for child escribed approvedren are for them .

The fact is,

most ar

en’t. In the Spring/Summer 2009 issue, we reported that few medications used to treat children were ever tested on children. This year, the Institute of Medicine released a report evaluating the impact of two federal laws designed to address that gap in testing. The group found that the laws had spurred testing that is yielding new information on how drugs react differently in children than in adults. Since the first of those laws was passed in 1997, the measures have resulted in more than 400 changes in the prescribing information for children for various drugs. But the group said more progress is needed. Drug companies are still finding it hard to recruit significant numbers of children for drug testing, in part due to the reluctance of parents and physicians to enroll children in clinical trials. Pediatric studies are also done too late in the approval process and don’t provide long-term data or data on use with infants. Both laws will expire this year unless Congress acts to reauthorize them. The institute’s report said the need for regular reauthorization of the laws creates uncertainty for companies and may result in delays in further testing as drugmakers wait to see whether the laws will be renewed. Take it ou

Workouts tside: with a vie w

Clean ha illness: Donds prevent docs wash up?

— MARKIAN HAWRYLUK

The risk of overtraining young athletes In our Fall/Winter 2011 cover story, “When is one sport too much? Overtraining and the single-sport kid,” we reported a fivefold increase in serious shoulder and elbow injuries among young baseball and softball players since 2000. We also quoted a local baseball club owner as saying young arms shouldn’t throw curveballs because of the way the pitch stresses the elbow. For decades, that has been the prevailing thought. But some research on the topic has

Page 8

failed to prove that throwing curveballs is more hazardous, generating debate on the question. Earlier this year, the journal Athletic Training & Sports Health Care published a study of about 700 Little League and high school pitchers that found no significant association between pitching curveballs and increased arm injuries or pain. More significantly, elbow and shoulder problems were associated with pitching in showcase games, on travel teams or for multiple leagues concurrently. — ANNE AURAND

FDA: low levels of BPA not unsafe In the Spring/Summer 2010 issue, we wrote about the debate over whether a chemical called bisphenol A (often abbreviated BPA) was harmful and described an effort by the Food and Drug Administration to study the chemical’s safety. This spring, the FDA concluded part of its review, releasing a statement saying that the low levels of BPA most people are exposed to through the food supply are not unsafe. It also said that young children are exposed to much less BPA than previously thought. People ingest BPA when it sloughs off food containers; it’s used in making the lining for many aluminum cans and in hard plastic items, such as water bottles. Some advocacy groups had hoped that the FDA would ban the use of BPA in food containers and expressed disappointment over the agency’s decision. A statement from the Natural Resources Defense Council said, “The FDA is out of step with scientific and medical research,” and noted that studies have found long-term effects of BPA exposure. A major concern has been that BPA builds up in the body, disrupting hormones and potentially causing disease. But the FDA said its research showed that people eliminate the chemical from the body quickly. It also found little transmission of the chemical from expecting mother to fetus, and found that infants have 84 percent to 92 percent less exposure than previously estimated. — BETSY Q. CLIFF

SPRING / SUMMER 2012 • HIGH DESERT PULSE


The effect of food on mood In the Spring/Summer 2011 issue, in an article titled “Does food affect your mood?,” we wrote about a Spanish study that linked the consumption of trans fats with a higher risk of depression. Newer research is building on that theme, associating the consumption of dietary trans fatty acids with irritability and aggression. Trans fats — products of a hydrogenation process that makes unsaturated oils solid at room temperature — are found in margarine, shortening and many processed foods. They have been linked to health problems related to lipid levels, metabolic function, insulin resistance, oxidation, inflammation and cardiac health. Only more recently has the behavioral component been explored. Researchers at the University of California, San Diego School of Medicine have analyzed dietary information and behavioral assessments of about 1,000 adults and published their results in the online peer-reviewed journal PloS One. “We found that greater trans fatty acids were significantly associated with greater aggression and were more consistently predictive of aggression and irritability across the measures tested,” said Dr. Beatrice Golomb, a professor at the school, in a news release. And, Golomb said, “If the association between trans fats and aggressive behavior proves to be causal, this adds further rationale to recommendations to avoid eating trans fats, or including them in foods provided at institutions like schools and prisons, since the detrimental effects of trans fats may extend beyond the person who consumes them to affect others.” In the meantime, however, it appears that years of bad publicity surrounding trans fats and the Food and Drug Administration’s 2006 requirement that food manufacturers list trans fats on nutrition facts labels is changing the way people eat. The Centers for Disease Control and Prevention reported that blood levels of trans fats in white American adults decreased by 58 percent from 2000 to 2009. The CDC data was published in the Journal of the American Medical Association. — ANNE AURAND

Correction In our story “Blood Relations,” which ran in the Winter/Spring 2012 edition of High Desert Pulse, the case of Huntley Hicks was described inaccurately. His pregnant mother, Kelsey Roberson, had already been admitted to the hospital when doctors couldn’t find the baby’s heartbeat, and Hicks developed cerebral palsy as a result of his bleeding incident. High Desert Pulse regrets the error.

HIGH DESERT PULSE • SPRING / SUMMER 2012

Page 9


“I know that they say it’s a disease, and I do believe that. It’s not something I would choose to do.” Kristine

Page 10


Cover story | THE GENETICS OF ALCOHOLISM

“I watched my parents drink my whole childhood, and all my relatives. Every family event was more like a party.” Dorian

Inherent risk BY BETSY Q. CLIFF PHOTOS BY ROB KERR

K

ristine comes from a long line of drinkers. “My dad’s whole family was all alcoholics,” said the 43-yearold Bend woman, who asked that her full name not be used. She never really knew her father, she said. When she was 3, he and another man, both drunk, rolled a car and were thrown from it, killing them. As a child, she wasn’t around alcohol much, she said. Her mom drank sometimes with friends, but nothing out of the ordinary. Still, at age 10 and home with a friend, something compelled Kristine to take her first drink, a cocktail made with her mother’s Black Velvet whiskey. From then, her drinking career spanned more than three decades. Both she and her brother, she said, are alcoholics. Kristine entered treatment for the first time earlier this year.

“My stepdad says, ‘Why can’t you have a drink and put it down?’ But once I start, I can’t,” she said. “I know that they say it’s a disease, and I do believe that. It’s not something I would choose to do.” For decades, researchers and clinicians have known that alcoholism runs in families. Kristine, like other alcoholics interviewed for this article, said her family warned her about her history from an early age. A number of studies have shown that a person’s inherited genes are responsible for about half of the risk for alcoholism, with the other half attributed to environment or other factors, such as age at first drink. Yet, until recently, scientists were only able to make general statements about how family history plays into risk. Now, new tools to explore the human genome and study the brain are allowing scientists to figure out how the traits people inherit could work against them. Scientists are teasing out some of the individual genes that confer an increased risk of alcohol addiction and how those genes might influence the structure of the brain.

Genetics and alcoholism are linked; Kristine holds a childhood photo of herself at age 3 with her father and brother. “He died shortly after this photo was taken,” she says about her father. Her brother is terminally sick, she said, and his health condition is complicated by alcoholism.

HIGH DESERT PULSE • SPRING / SUMMER 2012

Page 11


Signs of alcohol dependence

“The disease killed (my father) and it killed my grandfather, and my uncle and my aunt and my grandmother, on and on. ... Everybody in my family is an alcoholic except my mother.” Dorian

Page 12

The definitive diagnostic manual used by mental health professionals describes alcohol dependence as having three or more of the following seven criteria within 12 months: • Tolerance of alcohol, meaning a need for more to achieve intoxication • Withdrawal symptoms within a few hours of stopping drinking, including sweating, high pulse rate, hand tremors, insomnia, vomiting, anxiety, hallucinations or seizures • Alcohol consumption in larger amounts or over a longer period than intended • A persistent desire or unsuccessful efforts to cut down on alcohol use • A great deal of time is spent on efforts to obtain or use alcohol, or to recover from its effects • Social, recreational or occupational activities are given up or reduced because of alcohol use • Alcohol use continues despite knowledge of a persistent physical or psychological problem likely to be caused or exacerbated by alcohol, such as continued drinking despite an ulcer made worse by alcohol consumption

Addiction resources If you or a loved one is struggling with alcohol, here are some local resources for help: Inpatient/outpatient treatment BestCare Treatment Services: 541504-9577; www.bestcaretreatment.org Outpatient treatment Pfeifer and Associates: 541-383-4293; www.pfeiferandassociates.com Serenity Lane: 541-383-0844; www. serenitylane.org/outpatient_bend.html Support Groups Alcoholics Anonymous, Central Oregon: 24-hour hotline, 541-548-0440; coigaa.org (includes list of meetings) Al-Anon: (for families struggling with a loved one’s alcohol abuse): 541-7283707; centraloregonal-anon.org


Cover story | THE GENETICS OF ALCOHOLISM

“A majority of Americans drink … and don’t have adverse biomedical or social consequences. Ten percent do. The question is how can we know who is at risk, can we predict it and what can we do about it.” Kathy Grant, a behavioral neuroscience professor at Oregon Health & Science University

Though the science is still young, researchers now say that the brains of alcoholics may function differently from those of other people, possibly changing behavior and driving an addiction to alcohol. “There has got to be something different” in the brains of alcoholics, said John Crabbe, a behavioral neuroscience professor at Oregon Health & Science University and director of the Portland Alcohol Research Center. “It would just sure be nice to have a better idea of what it is.” Researchers are also looking at the complex interplay of genes and environment to see what factors may protect some individuals — even those with risky genes — while pushing others to drink. The goal is to better understand why some drinkers become addicted to alcohol, while others, who perhaps grew up in the same house or drank just as much when they were young, do not. Understanding alcoholism is crucial to the nation’s health. Most experts estimate that one in 10 Americans meet the clinical definition of alcoholism at some point in their lifetime, meaning they drink beyond just socially and in a way that interferes with the rest of their lives. Each year excessive alcohol use kills nearly 80,000 people, according to the Centers for Disease Control and Prevention, and sends more than 4 million to the nation’s emergency rooms. And there’s a heavy social impact as well. For example, one study of 1,900 convicted murderers found that half were under the influence of alcohol at the time of their crime, with many offenders saying they drank more heavily than usual before their crime. “A majority of Americans drink … and don’t have adverse biomedical or social consequences. Ten percent do,” said Kathy Grant, a behavioral neuroscience professor at Oregon Health & Science University who recently received a $21 million grant from the National Institutes of Health to lead a study on stress and alcoholism. “The question is how can we know who is at risk, can we predict it and what can we do about it.”

Getting a buzz Rick Treleaven, director at BestCare Treatment Service, which has substance abuse treatment centers throughout Central Oregon, de-

scribes one way those with alcohol dependence react differently to alcohol than “normies,” or those who can drink without a problem. “My wife is not an alcoholic,” he said. “After three beers, she’s asleep.” For those who seek treatment at his program, he said, three beers is just the beginning. “Their bodies are responding to the drug in a very different way.” Dorian, a 36-year-old Central Oregonian recently in treatment for alcoholism who asked that his full name not be used, echoed the sentiment. “If I had three beers,” he said, “I wouldn’t even feel anything. It would be like, ‘I just wasted $9.’” That difference in response to alcohol, experts say, is one of the keys to understanding the biological underpinnings of alcoholism. Among the first genes discovered to be associated with alcoholism were those that determine how the body metabolizes alcohol. When a person drinks, proteins in the body begin to break down the alcohol into other chemicals so it can eventually be eliminated from the body. First, alcohol is broken down into a chemical called acetaldehyde, a known carcinogen. Acetaldehyde can damage any tissue it comes in contact with and causes some of the unpleasant effects of drinking. A rapid heartbeat, flushed face and nausea can all be attributed to the presence of the chemical. Second, the body converts the acetaldehyde into another, less toxic chemical called acetate. From there it is broken down into simpler chemicals, including water, that the body can easily eliminate. The speed at which the body completes the two main steps in metabolizing alcohol can influence the likelihood of becoming an alcoholic. And that speed is influenced by our genes. Some people are genetically efficient at converting alcohol to acetaldehyde. For these people, just a few drinks may make them start to regret their choice, as their face flushes or they feel nauseated. Acetaldehyde, though toxic, is typically short-lived in the body. Again, our genes influence just how quickly it gets converted to the more benign acetate. For those who are slow to convert acetaldehyde into acetate, the negative effects of drinking will linger longer, making the whole experience less pleasant. Studies have shown that

OPPOSITE: Dorian says that he is in the heat of battle with his alcoholism, trying to live day-to-day.

HIGH DESERT PULSE • SPRING / SUMMER 2012

Page 13


“How could it not be (genetic). I look at my family, my grandmother, my mother ... (I said) ‘I will never be like that and how could I possibly when I see what a mess you made in your life.’ And, before you know it, you blink and you’re on that path.” Jill

people with this genetic variant are less likely to become alcoholics. That variant, however, is virtually nonexistent in whites, researchers say. It is much more common in people of eastern Asian descent than in any other ethnic group. Ironically, according to the National Institutes of Health, those genes that protect against alcoholism may confer greater health risks from drinking. Because acetaldehyde is a carcinogen, the longer it sticks around in the body, the greater the risk of cancer. Though people who are slow to convert acetaldehyde into acetate may be less likely to consume large quantities of alcohol, their bodies could be at greater danger from what they do drink.

Page 14

No control Studies linking genes to the risk of alcoholism are a primary argument against the notion that the addiction is purely a failure of will. Though these studies have been well-accepted by the scientific community, the belief that alcoholics should be able to better control their drinking is still prevalent, even among alcoholics themselves. “Some people still see it as a moral deficiency,” said Don Ziegler, a director at Serenity Lane, an outpatient treatment facility in Bend. Treating alcoholism, he said, will continue to be difficult “until we address the stigma.” Jill, who did not want her full name used, said she felt like she

SPRING / SUMMER 2012 • HIGH DESERT PULSE


Cover story | THE GENETICS OF ALCOHOLISM

“I don’t think you would talk to an alcoholic who didn’t think they were in control.” Jill

OPPOSITE: Jill, right, and her mother hold each other while chatting with other Alcoholics Anonymous attendees following a meeting in Redmond.

could control her drinking for years before getting sober. She was very functional, holding down a job and raising kids. “I’m a grown woman,” she said she thought. “I had a successful radio career. Why can’t I have a drink? “I don’t think you would talk to an alcoholic,” she continued, “who didn’t think they were in control.” Jill began to realize she had a problem when she started hiding her drinking. She was drinking every day, but still working and, she thought, concealing the extent of her drinking from her kids. Then she got into an argument with her then-teenage daughter, and her drinking came up. “I said, ‘I’m hardly drinking anything,’” she recalled. “Really, Mom?” her daughter said to her. Her daughter went to a cupboard where Jill had been hiding empty vodka bottles in a cranny near the back. “She opened the cupboard and started flinging bottles,” Jill recalled. “She probably threw 15 bottles out of there going ‘Really, Mom?’” Jill believes there is a genetic predisposition to alcoholism. Her mother and grandmother both struggled with alcoholism, she said. She recalls that her grandmother would fall and break bones while drunk. One time, her grandmother passed out on a heater, suffering burns so bad that she had to be hospitalized for six weeks. “(I said) I will never be like that. … And, before you know it, you blink and you’re on that path.”

Impulse to drink In addition to looking at the genes that determine how quickly people metabolize alcohol, scientists are also examining genes that shape behavior to establish whether alcoholism is the result of certain tendencies shaped by genetics. “Alcoholism is a very complex spectrum of behaviors,” said Sandra Villafuerte, a researcher at the Molecular & Behavioral Neuroscience Institute at the University of Michigan. “So if we find the genetic influence in behavior, we can explain how behavior will lead you to alcoholism.”

HIGH DESERT PULSE • SPRING / SUMMER 2012

A person’s genes can influence behavior in a number of ways, making some of us more naturally fearful or anxious, for example, while others go through life preternaturally calm. Scientists are learning how genes that affect behavior may play a role in addiction to a number of substances, including alcohol. One key area now under study is how we respond to stress. Kristine drank, she said, in large part because of stress. “Through the years, I had the bad marriage and it got worse. I’m a single mom … and three kids and working.” Alcohol, “was all I had to turn to,” she said. “I was totally alone and empty feeling and so I drank.” Drinking to cope, experts say, could be a product of the environment we are raised in, though Kristine said her mother did not use alcohol in that way. But it could just as easily be built into our genes. There are likely hundreds of genes that influence behavior, perhaps more, and the total number associated with alcoholism is not yet known. And aside from the alcohol-metabolizing genes mentioned previously, each of those genes that have been found in studies to be associated with an increased risk of alcoholism only play a small part in the disease; each gene confers no more than a 2 percent increased risk of alcoholism, which Crabbe at OHSU characterizes as a “vanishingly small percent.” Nevertheless, there are some intriguing findings about how some of these genes might work to steer people down a path to alcoholism. One of the most widely studied is a gene called GABRA2. GABRA2 is involved in shaping the reaction of brain cells that receive a brain chemical known as gamma-aminobutyric acid or simply GABA. GABA and its sibling chemical, glutamate, are two of the primary chemicals in the brain, found in almost every part of it and involved in a number of processes. People with certain versions of the GABRA2 gene are more likely to become alcoholics, though scientists aren’t quite sure why as the exact function of the gene is unknown. It may have something to do with how the chemical signals from GABA affect certain cells. An interesting set of experiments published in the journal Molecu-

Page 15


Cover story | THE GENETICS OF ALCOHOLISM

lar Psychiatry last year may shed light on the issue. First, Villafuerte and other researchers surveyed about 450 people from 170 different families, about three-fourths of which had at least one member with a diagnosis of alcoholism. The family members answered questionnaires about impulsivity and symptoms of alcohol dependence. Then the team analyzed the DNA of each participant, looking specifically at which variation of GABRA2 a person carried. The researchers found that those with certain variations of

Page 16

GABRA2, those genes they deemed “risky,” were more likely to be impulsive and have symptoms of alcohol dependence. In particular, said Villafuerte, the subjects with a risky variation of the gene were more likely to be impulsive in a way that caused them to “react without thinking when … in distress. It’s a way of coping. You react trying to get out from the distress.” According to this theory, the risky variant would increase the likelihood of a person reaching for a drink, or several drinks, as a way to cope with stress without considering the consequences of that behavior. Then Villafuerte and her colleagues took it one step further. Using a technique that measures brain activity during a task, she and her team looked at the brains of people with a risky variation of GABRA2 when they played a game that allows subjects to win or lose money. The researchers concentrated on the insula, a part of the brain that is not well studied but is known to be involved in sensations and emotions. The insula is also involved in both cravings and willpower. Villafuerte described it as the referee when, for example, we’re faced with the choice of whether to eat a piece of chocolate cake we know we shouldn’t have but that looks so, so good. Other scientists have found that smokers who have had their insula removed, typically because of cancer, have found it much easier to stop smoking. And, at least one study found the activation of the insula when people got the shivers from listening to music. In Villafuerte’s experiment, she found that people with a risky vari-

SPRING / SUMMER 2012 • HIGH DESERT PULSE


ant of the GABRA2 gene had a very active insula during the gambling game, which measured impulsivity, compared with people without a risky variant. What may be happening, she said, is the insula is causing a craving for a reward, whether it be winning the gambling game or having a drink. People with the risky variant of GABRA2 could, especially under stress, feel that sense of craving to a greater degree than others, perhaps because their insula is more active. That makes it harder for the intellectual side of the brain to ignore cravings, and perhaps leads to drinking. While in treatment, Kristine said counselors at the facility artificially induced stress. They put alcohol in front of some of the program participants to see how they responded. “They had my kind of beer,” she said. “I didn’t want it (to drink) but … I asked somebody to hand it to me and I just held it. … I could not take my eyes off it. It was like my friend being up there, like my child, and I just wanted to hold it.”

Genes, not destiny Of course, as researchers are fond of pointing out, genes are not destiny. A person, even with the riskiest combination of genes imaginable, will not become an

alcoholic if they never choose to pick up a drink. One of the areas at the forefront of current research is how environment affects the risk of alcoholism and how genetics plays a role in that. There’s plenty of evidence that environment, particularly for children, can influence later risk of alcoholism. “If you want to tip the odds towards being a heavy drinker, you would introduce heavy drinking in a 17- to 18-year-old, have alcohol readily available, you’d be male and you would have had some trauma in early childhood,” said Grant at OHSU, who also added being a risk taker and having a family history to that list. “That would be a formula for very high risk.” But just where genes stop and environment starts is not quite as clear. Take marriage, for example — an environmental factor. Arpana Agrawal, an assistant professor of psychiatry at Washington University in St. Louis, and other researchers looked at how the GABRA2 gene influenced marital status and alcoholism. Like Villafuerte and her colleagues, they found that the gene increased the risk of alcoholism. Agrawal also found that being married seemed Continued on Page 48

Complete Health & Wellness • High Cholesterol

• Coag Clinic

• High Blood Pressure

• Adult & Child Wellness Physicals

• Heart Disease

• Women’s Health

• Stress Testing an Dr. Celso Gang

• Arthritis

• Diabetes • School & Employment Physicals

• Lung Disease

Dr. Derek Pa

lmer

• Acute Illness Treatment Lori McMillian, FN

P

REDMOND MEDICAL CLINIC (541) 323-4545 1 245 NW 4th S t re e t • Suit e 2 0 1 • Re d mon d, O R HIGH DESERT PULSE • SPRING / SUMMER 2012

Page 17


Get ready |

PADDLEBOARDING

What’s SUP? Stand-up paddleboarding catches on BY ANNE AURAND PHOTO BY RYAN BRENNECKE

C

hip Booth grew up surfing in Malibu, Calif. Now, as a “landlocked surfer” living in the High Desert, he sometimes needs to get on the water for his mental and physical health. “It is my reset button to release any stress from the day,” said Booth, owner of Stand Up Paddle Bend, a retail shop just blocks from the Deschutes River. “It doesn’t take long for that reset button to work. I shed my stress and go home happy.” A cousin to wave surfing, stand-up paddleboarding — Booth’s stress reliever of choice — is just what it sounds like: standing on a board that’s reminiscent of a surfboard and powering movement across the surface of the water with a paddle. Booth enjoys mingling with otters, beavers, ducks and fish in the Deschutes River or the Cascade lakes. “It’s a connection to wildlife and nature, being in a beautiful place,” he said. The growing hybrid sport is also a surprisingly good workout, said Tom Burke, a lifelong wave surfer who started stand-up paddling on flat water soon after he moved to Bend from Maui in 2004. Burke, a 54-year-old drywall contractor, also likes kayaking. But sitting confined in a kayak for a long paddle can tire his back. “Stand-up paddleboarding works muscles from your toes to your legs and upper body, and you have a freedom of mobility that you don’t have in a kayak,” he said. Stand-up paddlers can pull hard against the water for a good cardiovascular and core workout, or they can float leisurely downstream and just enjoy the unique perspective that standing in the middle of a body of water offers, he said. “It’s an amazing viewpoint into the water,” he said. In a region full of people who value both the great outdoors and another venue for fitness, it’s no wonder stand-up paddleboarding is taking off.

A sport evolves There are many stories about exactly when and where standup paddling began, said Hawaii-based Nate Burgoyne, founder of the online Stand Up Paddle Surfing Magazine (www.supsurfmag .com) and author of “The Stand Up Paddle Book.” But there’s general consensus that it originated in Hawaii with the Waikiki surfers during

Randall Barna, left, and Tom Burke paddle flatwater boards up the Deschutes River on a recent spring day. Page 18

Places to start These local businesses sell and rent gear ($15-$20 per hour or $40-$65 per day) and offer lessons ($45-$70 for a lesson, which includes gear). Rates vary, and most places require reservations, so call first.

Tumalo www.tu Stand O www.sta ExtraPag Sun Cou www.su

Stand Up Paddle Bend www.supbend.com; 541-639-2655

Sunrive www.su


Want a custom board?

Try a race?

Walkin’ on Water Kiley and Lynette Remund: www.wowsupbend.com; 541-390-8854 Old Growth Board Co. Greg Bridges hand-builds hollow-core wood boards and teaches people to build their own boards: gregbridges@bendbroadband.com; 541-771-2147

Here’s an upcoming local event: bendpaddleboardchallenge.com Note: Personal flotation devices are required by law and paddleboards 10-feet and longer need an invasive species prevention permit on board while in use. For information, visit the Oregon State Marine Board’s Non-motorized and Paddle Craft information page at http://1.usa.gov/JlNFtX

malo Creek Kayak & Canoe ww.tumalocreek.com; 541-317-9407 and On Liquid ww.standonliquid.com/About-UstraPages.html; 541-639-4596 n Country Tours ww.suncountrytours.com; 541-382-6277 nriver Resort ww.sunriver-resort.com; 541-593-3492

Page 19


Get ready | PADDLEBOARDING

Gear and costs The board and paddle are the main gear components. A person can get into the sport for anywhere between $1,000 and $2,700. Most experts recommend renting or borrowing a variety of boards before investing.

Board use First, consider where you’ll use the board: Just flat-water paddling? Or some real wave surfing at the coast, too? Flat-water boards, for rivers and lakes, are designed to go straight and are not recommended for wave surfing. They’re longer and narrower, shaped more like a kayak and less like shorter, wider wave surfboards. Flat-water boards are designed to be more stable and are typically more expensive. Their stability allows you to paddle longer on one side, which improves momentum and paddling efficiency. All-around boards, or paddle surf boards, are shorter and wider than flat-water boards. Like a big surfboard, they come in many sizes, shapes and weights to meet a person’s individual needs.

Board length For small to average size people who mostly plan to flat-water paddle but might occasionally paddle surf a wave at the coast, consider a board between 10 feet 6 inches and 11 feet 6 inches. Bigger men will likely want a board at least 12 feet long. Big men who plan to flat-water race will need a 14-foot flat-water board. Women flat-water race on 12-foot-6-inch flat-water boards.

Weight and price Board weight is a factor in price. Lighter boards, under 30 pounds, typically cost more. A quality board between 23-25 pounds can cost around $2,300; between 25-28 pounds it can cost $1,500 and up, depending on size. A board weighing more than 30 pounds can cost less than $1,000.

Paddles for flat water Paddles for flat water should be 8 to 12 inches taller than the rider, depending on individual comfort and preference. They can range in cost from $150 to $400. Bend-based KIALOA makes a full line of stand-up paddles. Visit www.kialoa.com or call 541-382-5355 for more information about paddles or sizing your paddle.

Cold weather wear (optional): A “long john” wetsuit (leggings and a vest made of neoprene), $90-$160. Paddle jackets, worn over the long john suit, $80-$150. Booties, $40 and up. For Central Oregon waters, consider heavier 7-mm high-top booties, $64 at Stand Up Paddle Bend. Source: Chip Booth, paddler and owner of Stand Up Paddle Bend

Page 20

the surfing craze of the 1960s. The surfers offered lessons to tourists visiting Waikiki, on the south shore of Oahu. Some of them would glide across the water on standup paddle surfboards, carrying cameras to shoot pictures for new surfers, souvenirs to remember their first lessons. “Since this was long before waterproof housings were available, stand-up paddling was a useful way to keep the camera high and dry,” Burgoyne wrote in his book. That evolved into “a thrilling sport practiced by some of the world’s greatest athletes as it continues to spread like crazy … ” From Hawaii, stand-up paddle surfing first jumped across the ocean to California. Then landlocked surfers in Oregon started padding on inland bodies of water, Burgoyne said. The sport moved inland and over to the East Coast. It then caught on in Australia, the United Kingdom, France and Canada, Burgoyne said. “A few years ago it was primarily 30- to 60-year-old males with expendable income because the equipment was very expensive,” Burgoyne said in an interview. The mass production of boards and paddles has widened the range of equipment available. Marketing shifted for a while toward women hooked on the fitness aspect, he said. Now, the sport draws all types, from seasoned surfers pushing their sport to extremes to non-surfers paddling flat water for fun, he said. It appeals to fitness enthusiasts for its incredible core workout, to professional competitors who race for prize money and to families who can cruise with the kids.

How to do it By all accounts, stand-up paddling is easy to learn. “There’s no training wheels in this sport. It takes about 15 minutes to go from never-done-it-before to intermediate,” Booth said. Carrying the board is easy if it has a built-in handle in the middle. Lean the board on its edge, and grab the handle with the board under one arm. When you get to the beach, don’t set the board deckside-up. The fin on the bottom can snap off. Walk into knee-deep water, pushing the board next to you. Grab the edges of the board and climb on, starting on your knees in the center or just behind the center of the board. Start paddling while kneeling, to get a feel for the paddle motion and the current, if you’re in a river. The board is more stable when it’s moving. Some beginners tend to linger near the river banks for a perception of security, but getting into the current might actually be helpful. Holding the paddle in one hand, slowly stand up, one foot at a time. The paddleboard handle in the center of the board should be between the feet. Neither end of the board should point up. Stand with feet parallel, pointed forward, in a comfortable stance. Look ahead at the horizon, not at your feet. To paddle on the right side, the left hand is on top of the paddle’s grip, and the right hand is lower down as you push the blade under the water. Power the stroke from the torso, pulling back until the paddle blade is next to your feet in the water. If you keep paddling on the right side, you’ll turn left. Switch sides every few strokes to stay straight. Now you’re paddleboarding! Many places offer lessons (see “Places to start,”) but Booth said lessons are probably unnecessary for people who are comfortable swimming in

SPRING / SUMMER 2012 • HIGH DESERT PULSE


EVERY PICTURE the river and who have some experience paddling a kayak or canoe. It’s not a high-speed sport and if you fall, it doesn’t hurt. But there are a few safety considerations.

Safety tips In a river, if you fall off the board, don’t try to stand up, Booth cautioned. Feet can get trapped in underwater debris in the shallow stretches of river. Then, Booth said, the current could push you under, and you could drown. Stay away from the banks of a river, where the board’s fin is more likely to catch in debris, which could throw you off. If you’re falling, fall flat — don’t hop off feet first. Flop over into the water, swim back to the board and start over. Leashes that connect your ankle to a small hook embedded in the board are available, but with a caveat, Booth said. In a river, the leash could snag and catch on something, holding your body in place against a current. The current’s pressure could prevent a paddler from releasing the leash, with a risk of drowning. If you use a leash in a river, make sure it has a quick release, which allows it to come off with one easy tug, he said. In a big lake, however, a leash is essential, Booth said, because if you fell off and the untethered board blew away, you might get too tired to swim to shore. Finally, remember personal flotation devices — life jackets — are mandatory for everyone because the board is classified by the U.S. Coast Guard as a small vessel. For beginners who are more likely to fall in, experts recommend wetsuits on cold days to prevent hypothermia. Otherwise, on a hot day, wear shorts and a T-shirt or a bathing suit — something that allows movement. Most prefer to be barefoot. Don’t forget sunglasses and sunscreen.

... HAS A STORY

Dr. Jim Johnson is ly isherman. NOT a world renowned Sure he LIKES i shing, but hat Dr. Johnson dos R Neuroradiology EALLY well is ... (l the nervous syst ooking for abnormalitis in em).

ltz n ShuRadiolog y e h p e t S Oregon 383 l -9 Centra541-382

ld pic Go d a m y l O n OT an sh tracks a LLY N s i z e t hul ES r dos REA n a phen S z he LIK Dr. Ste Skier. Sure at Dr. Shult st Cancer is l a e a r Med day, but h graphy. B on can be i sunny ... Mammo early dtet s i t l u l e, b we diseas UGLY ing. v life sa

When and where During the summer, stand-up paddlers flock to the stretch of the Deschutes River through the Old Mill District. But some local paddlers don’t wait for 80-degree days. Die-hards like Booth and Burke are ready before the weather is. “I’ve paddled when it’s snowing,” said Booth. “It’s only prohibitive when there’s ice on the board.” Stand-up paddleboarding is ideal in 60-degree or warmer weather, when the sun is out and there’s no wind, Booth said. “I’ve been out all winter, many times,” Burke said in March. “If it’s really cold I wear a wetsuit.” Burke said he’ll happily paddle on a 50-degree day. If it’s sunny, he’ll wear shorts and 7-millimeter neoprene booties to keep his feet warm. In Bend, the Old Mill District stretch of the Deschutes River is accessible year-round. It has free parking and easy water entries, at Riverbend Park in particular. The current is mellow. The stretch of Deschutes River through Sunriver is also nice, Booth said. He also recommends a longer outing to Elk, Sparks or Hosmer lakes for great scenery. Wickiup Reservoir, Odell Lake, Lake Billy Chinook and Prineville Reservoir are other good regional options, Booth said. Make sure you have a vehicle you can strap a board on top of, and make sure you can carry it yourself before you go too far. •

HIGH DESERT PULSE • SPRING / SUMMER 2012

Page 21

At Central Oregon Radiology we help you tell the whole story 1460 NE Medical Center Drive • Bend • 541-382-9383 www.corapc.com • in conjunction with: www.cascademedicalimaging.com


CAROTENOID-RICH FOODS

LUTEIN-RICH FOODS

Picture this

Apricot

Pistachios Brussels sprouts

Lemon Mango

Grapefruit

The color of health

Tangerine Watercres

Sometimes the hue of food is nature’s way of telling you what’s inside

Yellow apple Butternut squash

Carrot

LYCOPENE-RICH FOODS Orange

A

balanced diet consisting of plenty of fruits and vegetables has been shown to reduce cancer risk and heart disease, improve memory and supply a host of other health benefits. Did you know that the color of many fruits and vegetables can say a lot about their nutritional value?

Tomato

Pumpkin

Sweet potato

Pink grapefruit

Watermelon

ORANGE/YELLOW

RED Red fruits and vegetables are given their color by the pigments anthocyanins and lycopene. Anthocyanins are antioxidants and have been shown to reduce the risk of cancer, reduce the effects of aging and neurological disease, reduce inflammation and infection, and protect against diabetes and fibrocystic disease. Lycopene may protect against cardiovascular disease, cancer, diabetes and osteoporosis.

Some fruits and vegetables are given their yellow or orange color by pigments called carotenoids, the most well-known of which is beta-carotene. Carotenoids can convert easily into vitamin A, which helps maintain healthy mucous membranes and healthy eyes. They have also been shown to reduce the risk of cancer and heart disease and can improve immune system function.

ANTHOCYANIN-RICH FOODS Red grapes

Pomegranate

Peach Nectarine

Raspberries

Papaya

Rhubarb Cherries Strawberries

Yellow tomato

Sweet corn Garlic

Beets Red apple

Red potato

FOLATE-RI

Persimmon Pineapple

Cranberries

Radishes

Summer squash

Beans

Red cabbage Yellow pepper

Page 22 Cantaloupe

Pear Rutabaga

Peas


S Broccoli

Zucchini

russels prouts

Peas tercress

Romaine lettuce

POTASSIUM-RICH FOODS

ANTHOCYANIN-RICH FOODS Turnip greens

Spinach

Soybean

Kiwi fruit Blueberries

Raisins Potato Mushroom

Green apple

es

Kale

Swiss chard

Prune

Banana

Almonds

Purple grapes

GREEN

BLUE/PURPLE

WHITE

Plants are given their green color by the presence of chlorophyll, but bright green can also indicate the presence of high levels of lutein, a yellow pigment, and zeaxanthin. Lutein and zeaxanthin are most closely associated with eye health. Green plants can also contain indoles, shown to help protect against some cancers. Leafy greens also contain folate, shown to help reduce birth defects.

Also colored by anthocyanin pigments, blue and purple fruits and vegetables have been shown to be excellent sources of antioxidants that can help reduce the risk of cancer, stroke and heart disease, and improve memory function.

Colored by the pigments anthoxanthins. Some white fruits and vegetables contain allicin, shown to lower cholesterol and blood pressure. Allicins may also reduce the risks of heart disease and stomach cancer. Some white fruits and vegetables are also rich in potassium.

INDOLE-RICH FOODS

ALLICIN-RICH FOODS

Blackberries Kale

Cabbage

Plum Garlic

Brussels sprouts

Onion

Cauliflower

Eggplant

Fig Garlic

Broccoli

Mustard greens

TE-RICH FOODS BY ANDY ZEIGERT Lentils Source: “What color is your food? Taste a rainbow of fruits and vegetables for better health.� by Julie Garden-Robinson, Ph.D., L.R.D., North Dakota State University

Spinach

Page 23


How does she do it? | RENEE SCOTT

Not your average middle school math teacher BY BETSY Q. CLIFF PHOTOS BY ROB KERR

R

enee Scott lives in two worlds. One is the classroom. Scott is a math teacher at Cascade Middle School in Bend, filling her days with lessons about ratios and rates. There’s an order to the school day and within her classroom. Her other world is cyclocross, a raucous cousin to road and mountain bike racing. It’s a sport best known for leaving participants with mud splattered across their bodies. Cyclocross racers compete on loop courses with varied terrain that typically includes pavement, dirt and obstacles. Racers often have to dismount and carry their bikes, then quickly hop back on again to continue the race. When her two worlds collide, Scott said, it’s amusing, if a bit awkward. “It does feel kind of funny to be in full Lycra with mud all over and then I hear, ‘Hi, Mrs. Scott.’” Still, she said it warms her heart when students see her racing. “You’re riding your bike, doing what you can, and I’ll hear, ‘Go, Mrs. Scott!’ I’m like, ‘Oh, that’s so nice.’”

Page 24

SPRING / SUMMER 2012 • HIGH DESERT PULSE


Left: Cascade Middle School math teacher Renee Scott is also an avid cyclist. The Sunnyside Sports cyclocross team rider is splattered with Central Oregon mud while competing in the 2010 U.S. Cyclocross National Championships. Below: Scott in her classroom, teaches students to multiply fractions.

Scott typifies what is if not a uniquely Central Oregon phenomenon, certainly a common one: professionals who care deeply about their careers but who also compete aggressively in a sport. While statistics are hard to come by, residents here often need only look to the next office — or classroom — to find an elite athlete. Whether Central Oregon’s athletes compete as a release from a stressful job, to stay in shape or just for the fun of it, we often see our athletes in national competitions. Scott, who is in her late 30s, competes in regional cyclocross races and, in 2010, participated in the national championship race, though she didn’t finish the course because her tire popped off its rim. Scott said she was convinced by friends to try cyclocross, and she was hooked almost from the beginning. “It’s the most ridiculous kind of sport,” she said. “It’s hard to take yourself super seriously when you are just covered in mud carrying your bike. “It kind of gets you back to those roots,” she contin-

ued, “when you were a kid and (got) filthy dirty and were like ‘That’s what I was supposed to do,’ and then (you) wash off and start all over again.” Cyclocross racers have a set period of time — 45 minutes is common — to do as many laps around a 1.5- to 2.2-mile course as possible. Racers go as hard as they can, said Scott, and crashes are common. It’s one of the most spectator-friendly bike sports, with fans cheering and yelling, and sometimes getting a little out of control. Cyclocross members race for a team — Scott’s is Sunnyside Sports — but also compete individually. They use bikes that look like road bikes but with fatter tires, slinging them over their shoulders when conditions on the course make it too tough to ride. Men and women compete separately, but races often have dozens of participants in each field, so riders are close together. One person’s crash often precipitates a pileup. Scott said she started competing about five years ago with just a few races, and added more and more each year.

Page 25


How does she do it? | RENEE SCOTT

Scott carries her bike over a barrier while competing last fall in the Cross Crusade Series Race 3 at Portland International Raceway. The Oregon-based Cross Crusade series draws some of the highest cyclocross race participation numbers in the United States.

Page 26

SPRING / SUMMER 2012 • HIGH DESERT PULSE


She now competes in about 15 every year. The season runs through fall and into the early part of the winter, so many weekends she’s on the road, heading up to Portland or another Northwest destination. “She’s a high-level athlete, but she really does it for the love of the sport,” said Dr. Matthew Lasala, an internal medicine physician at Bend Memorial Clinic and fellow cyclocross racer. “She races hard, but she is having fun and she’s always smiling.” Gina Miller, Scott’s friend and teammate, said while Scott is a fantastic athlete, she’s also a good sport. “If Renee is passing you, which in my case is usually what’s happening, she has some kind words for you,” she said. “She’s just a great racer.” Scott’s 2011 season ended early when, during a Halloween race in Bend, she tripped over a “big, honkin’ log,” she said. “I tried to eat my handlebars, I guess.” She broke two front teeth and her jaw in two places, requiring a trip to the emergency room and surgery. She had her jaw wired shut for about a month and will have to have braces on her teeth until at least next fall. It’s “one of the worst injuries I’ve heard about in ’crossing,” said Lasala. Scott was out of work for a month, she said, and when she came back, she still had her jaw wired shut for a week. “I had this little microphone with this speaker” that she used so students could hear her, she said. “We kind of tried to have fun with it.” One day, she said, she made the whole class talk with their teeth clenched shut “in solidarity.” Later that day, the guidance counselor came up to her, asking, “Are they making fun of you?” She told Scott

HIGH DESERT PULSE • SPRING / SUMMER 2012

she had gotten upset with the students. Scott said she laughed and explained she had asked the students to do that. Scott incorporates her cycling world into her classroom in more routine ways as well. She said that recently, when she was teaching about distance and speed, she used the example of a biking tour company, having students figure out how long it would take to ride from point A to point B. Then they had to figure the time with a headwind and with the wind at their backs. She said using examples from cycling makes the math easier for her to talk about. “And it makes it fun,” she said. A lot of her students ride bikes or have family members who do, so they understand the context and real-world applications of the problems. Scott said she just recently got back into riding after her accident; she started racing her mountain bike at the beginning of March. She said she plans to continue training and racing throughout the summer. She usually trains both weekend days and three days during the week. She fits in bike rides after school when it’s light outside or on the “stupid trainer,” as she calls the stationary bike, in the months when it gets dark early. Many of her rides are on her road bike, although she sometimes trains on her mountain bike. With cyclocross, she said, it’s a lot of starting and stopping, so she does interval training — bike rides in which she goes hard for a period of time, then relaxes, then repeats. She’s already starting to think about how she’ll gear up for next season. “I never thought I’d be like, ‘I’m going to love it.’ Then something about it just makes you want to do it again.” •

Page 27


Get gear |

HIKING WEAR

BY MARKIAN HAWRYLUK PHOTO BY PETE ERICKSON

C

hoosing the right clothes for hiking in Central Oregon can be challenging. With low temperatures in the morning giving way to scorching sun by midday and the possibility of an afternoon thunderstorm, you want an outfit that can go the distance. Avoid cotton, which soaks up sweat and rain and can take forever to dry. Choose a rain jacket that’s light enough you’ll be happy to carry it, and a long-sleeved, moisture-wicking shirt that will keep you warm and protect you from the sun. A low-cut hiking shoe can make quick work of trails and have you back enjoying a beer before sundown. •

Outdoor Research Radar Pocket Cap, $26 A mere 2.1 ounces, the lightweight cap packs small enough to put in your pocket and protects your head from the sun with its UPF 30+ material.

I/O Bio Contact Hoody, $100 Made from soft, breathable, odor-resistant, itchfree merino wool for a warm, comfy base layer.

Outdoor Research Helium II Jacket, $150 Light, breathable and compact, you’ll forget this jacket is in your pack until that first downpour.

Mammut Crags Pants, $69 Lightweight but durable pants with a Teflon finish to repel water and dirt.

Adidas Terrex Solo, $110 High-performance hiking shoes with rubber toes and heels for durability, with a sticky zone for grip when you need it.

Page 28


Jesper Hilts and Vanessa Burdict hike at Smith Rock State Park. Hiking gear courtesy of Mountain Supply of Oregon.

Kavu Synthetic Strap Visor, $20 A 100 percent nylon visor with a black underbill to reduce glare.

Mountain Hardwear Women’s Epic Jacket, $99 An abrasion-resistant nylon shell that’s fully waterproof but breathable.

Arc’teryx Phase SV Zip Neck LS, $75 A moisture-wicking base layer of odor-control fabric that’s ideal for stop-and-go activities.

Outdoor Research Women’s Solitaire Convert Pants, $75 Lightweight, quick-dry nylon pants with zip-off legs. Ankle zippers make it easy to pull legs off over boots and water-resistant finish sheds moisture.

Salewa Women’s Mountain Trainer, $129 A sticky sole provides traction on a variety of terrain and rock types, while a comfortable suede upper gives this hiking shoe a casual feel.

Page 29


Treating GERD |

WHAT YOU SHOULD KNOW ABOUT ACID REFLUX MEDS

The risk of relief

Digesting the fine print about gastroesophageal reflux disease drugs

BY ANNE AURAND PHOTOS BY RYAN BRENNECKE

F

or the better part of 15 years, Ryan Goldstein has taken acidsuppressing medications to ease chronic stomach pain, heartburn and sore throat. At 35, he is fed up and determined not to depend on drugs for the rest of his life. Goldstein has treated the symptoms of gastroesophageal reflux disease, or GERD — when stomach acids leak into the esophagus — with a variety of proton-pump inhibitors, drugs that block a step in acid production. “Psychologically, I hated being on them,” he said. “But more, I hated the suffering.” Proton-pump inhibitors, called PPIs, have been on the market since the 1980s and have an overall excellent safety profile, said Dr. Gene Bakis, a gastroenterologist and assistant professor of medicine at Oregon Health & Science University in Portland. They are extremely effective at reducing stomach acid. They also have a dark side. Research has associated long-term use of PPIs with increased risks of bone fractures, pneumonia and a potentially serious bacterial gut infection. And long-term use of PPIs is not uncommon. Research sug-

Page 30

gests that PPIs trigger what’s known as a “rebound” effect, in which stomach acid secretion accelerates after a patient discontinues the medication. That drives the patient back to the drugs for relief. This can set the stage for what one physician called a vicious cycle of long-term dependency that’s dangerous to enter and hard to break. There is concern that many people are getting hooked into the cycle unnecessarily. Many health professionals say PPIs are overprescribed and overused for symptoms that might have been better solved through dietary changes. Proton-pump inhibitors are big sellers. Some suggest that dependency from the rebound effect is driving their prevelance. Others suggest that pharmaceutical marketing influences patients to request them and doctors to prescribe them. Some say the medications can offer an easy, but poor, substitute for a healthy lifestyle.

Portrait of a PPI user Goldstein’s general lifestyle choices appear exemplary. He eats vegetables and whole grains and exercises plenty. He is not an ounce overweight. But he does have a hiatal hernia, an anatomical problem where part of the stomach pushes upward through the diaphragm or the chest, which could explain his bothersome stomach acids. He’s determined to get off the medications anyway, for a number

SPRING / SUMMER 2012 • HIGH DESERT PULSE


Approximately 30 million Americans have gastroesophageal reflux disease, or GERD, according to the American Society for Gastrointestinal Endoscopy.

What is GERD? Gastroesophageal reflux occurs when stomach contents flow back into the esophagus. This happens when the valve between the stomach and the esophagus, known as the lower esophageal sphincter, opens inappropriately. What causes GERD? Often, the lower esophageal sphincter is weak, or there’s a hiatal hernia. A major contributor to reflux is obesity, as abdominal fat puts pressure on the barrier between the stomach and the esophagus. Pregnancy, smoking, excess alcohol use and consumption of a variety of foods such as coffee, citrus drinks, tomato-based products, chocolate, peppermint and fatty foods can contribute to reflux symptoms. What are the symptoms of GERD? Heartburn, a burning sensation felt behind the breastbone that occurs when stomach contents irritate the lining of the esophagus, and acid regurgitation, the sensation of stomach fluid coming up through the chest and possibly reaching the mouth. Less common symptoms include unexplained chest pain, wheezing, sore throat and coughing, among others. If you can answer “yes” to two or more of the following questions, you may have GERD. • Do you have an uncomfortable feeling behind the breastbone that seems to be moving upward from the stomach? • Do you have a burning sensation in the back of your throat? • Do you have a bitter acid taste in your mouth? • Do you often experience these problems after meals? • Do you experience heartburn or acid indigestion two or more times per week? •Do you find that antacids only provide temporary relief from your symptoms? • Are you taking prescription medication to treat heartburn but still having symptoms?

Ryan Goldstein brews a cup of hot tea at his brother’s home. Goldstein, who suffers from GERD, has learned that limiting his intake of coffee is one of many strategies to cope with the disease.

Source: The American Society for Gastrointestinal Endoscopy

HIGH DESERT PULSE • SPRING / SUMMER 2012

Page 31


Esophageal sphincter

Esophagus

What causes GERD

of reasons. For one, he’s concerned about the health risks. “I read about hip fractures and pneumonia, and I got pneumonia, which freaked me out, and I wondered, is this from the medication? That triggered me to really want to get off them,” Goldstein said. It also seemed as if the medication didn’t work so well for him anymore, as Gastric acids are produced by cells in the wall of if he was building up a tolerance. He had the stomach. tried just about every drug on the market, including different over-the-counter PPIs and H2 Stomach wall Duodenum blockers, another type of drug that inhibits stomach acid. But the symptoms kept coming. Over the years, GoldPylorus stein, a media, journalism and social studies teacher at Pilot Butte Middle School, has repeatedly tried to stop taking the medications. But each time, his stomach acids would resurge. He would feel burning sensations in his gut and his mouth. He got heartburn. His throat hurt persistently and he developed excessive Gastric phlegm. gland “Rebound is so bad,” Goldstein said. “It was miserable.” So he would restart the drugs. Gastroesophageal relux disease, or GERD, is a condition in which gastric acid leaks upward from the stomach into the esophagus, irritating the esophagus and causing heartburn and other symptoms. The esophageal sphincter usually keeps the contents of the stomach from reversing course. In most GERD cases, the sphincter somehow fails.

Stomach

Swallowed food, called a bolus

The stomach wall is covered with gastric pits, which contain cells that produce gastric acid.

Gastric pit

Rebound Stomach acids are what trigger the unpleasant symptoms. Whether it’s from pressure from stomach fat below, a spell of excessive eating or a functional breakdown of the barrier between the stomach and the esophagus, acids that belong in the stomach get pushed into the esophagus. The source of gastric acids in the stomach are parietal cells. Proton-pump inhibitors work by shutting down a part of the parietal cell that pumps acid into the stomach. When acidity drops, other mechanisms in the stomach continue to stimulate acid production. The process results in the creation of more parietal cells, said OHSU’s Bakis said. However, the additional parietal cells won’t produce acid

Stomach wall One type of drug used to treat GERD is called a proton-pump inhibitor. The drug works by shutting down the proton pumps that move acid into the stomach from the parietal cells. By reducing the amount of gastric acid in the stomach, the symptoms of GERD are relieved.

Proton pump inhibitor

Parietal cell Proton pump

Source: “The Human Body,” Arch Cape Press; Patient Health International; staf reporting ANDY ZEIGERT

Page 32

SPRING / SUMMER 2012 • HIGH DESERT PULSE


Treating GERD | WHAT YOU SHOULD KNOW ABOUT ACID REFLUX MEDS when their pumps are shut off by the PPIs, he said. But when a person stops taking the drugs, all the cells start secreting acids, causing a resurgence of symptoms. That’s the rebound effect. “We don’t know for sure how long this rebound effect lasts; it may be two to three months,” said Bakis. He added that there is some controversy about whether rebound truly exists.

What PPIs are for PPIs are most commonly used to treat the symptoms of GERD, which is diagnosed by a doctor through an examination of symptoms and patient history, and an endoscopy, said Bakis. The drugs are also used to help reduce acid production for short periods of time to promote the healing of ulcers. There’s no blanket recommendation for how long a person should use PPIs, Bakis said. For those with acute indigestion or heartburn, two weeks might solve the problem. For others with more serious conditions, it may be for life. One’s individual circumstances must be considered to determine whether benefits outweigh risks. Some people could develop serious problems if they don’t take acidsuppressing medications. A potentially dangerous infection with Helicobacter pylori, a bacteria in the stomach that can cause cancer, can be eradicated by PPIs. The drugs also can treat the rare Zollinger-Ellison syndrome, a condition in which increased amounts of the hormone gastrin are secreted, usually from a tumor.

Growth in prescriptions and drug sales Both prescriptions for proton-pump inhibitors (PPIs) and sales of “the purple pill,” Nexium, a popular PPI, have increased in recent years. Nexium has been the second best selling drug in the U.S. since 2005, according to Consumer Reports.

Prescriptions for PPIs 2004-08

Nexium sales 2006-10

In millions

In billions

120M 80

90.8

92.3

101.7

2004

2005

2006

108.4

113.4

40 0

2007

2008

$5.4

$5.9

$6.3

$6.3

2007

2008

2009

2010

Source: IMS Health, a health care information company

ANDY ZEIGERT

The Rebound Effect A 2009 study published in Gastroenterology, the official journal of the American Gastroenterological Association Institute, suggested that the rebound effect might be partly responsible for the ever-growing use of PPIs. In the study, researchers gave 120 healthy adult volunteers with no history of acid-related symptoms daily doses of proton-pump inhibitors for eight weeks. Forty-four percent of the volunteers developed symptoms of heartburn or indigestion when they stopped taking the medication, and some symptoms lasted for four weeks after stopping the drug.

PPIs are also used to prevent chronic exposure to acid in the esophagus, which can cause inflammation or erosion that can scar and narrow the esophagus, making it difficult to swallow food. Long-term exposure to acid is also thought to be responsible for Barrett’s esophagus, a condition strongly associated with a difficult-to-treat cancer, said Bakis. But he was hesitant to say that using PPIs could prevent cancer. “There is no compelling data that PPI use prevents progression into cancer. We all use

Advocacy group petitions FDA for warnings A consumer advocacy group is pushing for more awareness about the health concerns associated with proton-pump inhibitors. The Washington, D.C,-based nonprofit Public Citizen filed a petition last year asking the Food and Drug Administration to mandate “black box” warnings on PPIs — considered an indication of serious health risks. “These drugs are being prescribed far too commonly to people who shouldn’t be taking them,” Dr. Sidney Wolfe, director of Public Citizen’s health research group, announced when the petition was filed in August. “As a result, millions of people are needlessly setting themselves up to become dependent on PPIs while exposing themselves to the serious risks associated with longterm therapy.” The group said in March that the FDA had acknowledged receiving the request but had not responded to it.

HIGH DESERT PULSE • SPRING / SUMMER 2012

$8B 6 4 $5.1 2 0 2006

it and I think it’s the right thing to do, but no data says that patients with Barrett’s didn’t get cancer because of PPIs,” he said.

What PPIs are not for: Lifestyle choices It’s normal for adults to experience heartburn if they consume too much food, alcohol or coffee. But heartburn should trigger a change in behavior first, said Dr. Rallie McAllister, a family practice physician, nutrition consultant, writer and public speaker based in Lexington, Ky. PPIs sometimes seem to be “lifestyle drugs” that allow people to indulge in unhealthy behaviors, McAllister said. Drug companies push that image: One marketing campaign suggested that candylovers stock their medicine cabinet with acid-suppressing medications in preparation for Halloween. And “commercials show a person in front of mountains of food; they take a pill and now they can eat it. That’s not what they’re intended to do, to allow us to eat anything. Stomach discomfort is a signal that we’re not eating right or (are eating) too much,” McAllister said. For many people, heartburn and reflux result from being overweight.

Page 33


Treating GERD | WHAT YOU SHOULD KNOW ABOUT ACID REFLUX MEDS

“Several of the PPIs have been widely advertised to consumers and heavily promoted to physicians and this has led to an overuse of the drugs in the treatment of garden-variety heartburn.” — 2010 Consumer Reports Health “Almost anyone overweight who comes into my practice comes in on PPIs,” McAllister said. She tells most of her patients who complain of heartburn to try to lose weight and improve their diet. Fast foods and fats are hard to digest and cause digestion problems. Certain medications, such as aspirin, ibuprofen and arthritis medicines, can also exacerbate problems. Heartburn is just one of many symptoms that can point to GERD. Occasional heartburn is common and can often be resolved through other measures. But taking PPIs has

What doctors are concerned about • Bone fractures A recent large study published in the British Medical Journal said post-menopausal women who had taken PPIs for more than two years were 35 percent more likely to have hip fractures than non-users, and that bumped up to 50 percent if they had also been smokers. That reiterates what a large study published in the Canadian Medical Association Journal suggested, that exposure to PPIs for seven or more years increased the risk of osteoporosis-related fractures of the hip. Another study out of the University of Washington suggested that the drugs increase the risk of fractured spine and forearm bones in post-menopausal women who used PPIs for eight years. Dr. Molly Omizo, a bone health specialist with Deschutes Osteoporosis Center, said there is only a modest risk of fracture associated with use of the acid-suppressing medications, but since millions of people use the drugs, that translates into a lot of people at risk. Exactly how PPIs increase fracture risk is still in question. There is conflicting research about whether

Page 34

seemed like such an easy solution. Most doctors say PPIs are safe drugs when used for a short period of time, but newer research has suggested a range of risks associated with long-term use of the drugs. “We (prescribe PPIs because) we want to please our patients, make them comfortable,” said McAllister. “We didn’t have the research before that there was a problem.”

The influence of marketing Consumer advocates suggest that the hundreds of millions of dollars spent on pro-

low stomach acid inhibits absorption of calcium, Omizo said. “That was a nice, simple possibility, but that data is conflicting. It’s probably not that simple,” she said. “It could be that the people on these medicines are fragile or have medical problems. There could be (any number of) confounding problems which increase the risk of fracture, which makes it harder to isolate the PPI therapy.”

motional efforts for PPIs contribute to their prevalent use. “Proton-pump inhibitors (PPIs) are a class of very effective and generally safe medicines used to treat heartburn, gastroesophageal reflux disease (GERD) and gastric ulcers,” according to a 2010 report in Consumer Reports Health Best Buy Drugs. “But not everyone who experiences heartburn needs one. Several of the PPIs have been widely advertised to consumers and heavily promoted to physicians and this has led to an overuse of the drugs in the treatment of garden-variety heartburn.” Direct-to-consumer advertising (TV, print, radio, websites, fliers) of prescription drugs increases pharmaceutical sales, which could lead to potential overuse, according to a report in the New England Journal of Medicine from 2007. In 2008, 113.4 million Americans had a prescription for a PPI, up from 90.8 million in 2004. In 2008, PPIs were the third highest Continued on Page 50

• Pneumonia A report that combined the data from 31 studies, published in the Canadian Medical Association Journal, concluded that use of a proton-pump inhibitor or H2 blocker might be associated with an increased risk of both community- and hospital-acquired pneumonia.

in Clinical Gastroenterology and Hepatology, associated PPI therapy with a twofold increase in risk for the bacterial infections, but could not determine the mechanism by which the drugs would increase that risk. The Archives of Internal Medicine published a study in 2010 that said using PPIs during the treatment of C.diff infections was also associated with a 42 percent increased risk of recurrence. Normal stomach acidity helps protect against infections by killing bacteria and viruses, which could explain the connection between acid-suppressing medications and pneumonia or C.diff infections, according to Dr. Rallie McAllister, a Kentucky-based physician, and a 2010 report on PPIs from Consumer Reports Health Best Buy Drugs.

• Clostridium difficile The Food and Drug administration notified the public in February that PPIs may be associated with an increased risk of Clostridium difficile– associated diarrhea. Several studies have shown a relationship between acid-suppressing medications and gut infections with Clostridium difficile bacteria, which can cause diarrhea and intestinal diseases. A review of 30 studies, published in late 2011

• Low magnesium levels Last year, the FDA notified health care professionals that PPIs may cause low magnesium levels if taken for longer than one year. Magnesium helps maintain normal muscle and nerve function, heart rhythm, a healthy immune system and strong bones. Magnesium also helps regulate blood sugar, blood pressure, energy metabolism and protein synthesis, according to the National Institutes of Health.

SPRING / SUMMER 2012 • HIGH DESERT PULSE


Snapshot |

SKATEBOARDING

PHOTO BY ANDY TULLIS

M

addie Collins, 14, of Bend, frontside grinds her skateboard along the top of a transition during a run at the Redmond Skatepark. Collins started skateboarding when she was 6 years old when her dad gave her a board as a present. Now she thoroughly enjoys the sport, and tries to skate at least three times a week. •

HIGH DESERT PULSE • SPRING / SUMMER 2012

Page 35


On the job

Marcus Crocker logs every step of the process of making pharmaceuticals at Bend Research. Crocker puts on his suit. Crocker assembles the ventilation system of the Tyvek suit he wears while making medicine.

Mixing medicine Inside the precise and hidden world of a pharmaceutical factory BY ANNE AURAND PHOTOS BY RYAN BRENNECKE

“I

’m like a chef,” Marcus Crocker said, offering a simplified description of his job. But he’s not sizzling steaks or seasoning sauces. He’s making medicine. Crocker is one of about 25 operators at Bend Research, a drug technology developer. They produce new pharmaceuticals for cancer, heart disease, diabetes, Alzheimer’s and more, said Michael Deperro, general manager in operations. The drugs are for human clinical trials and, sometimes, sick patients. The process requires measuring and mixing, and operating the machines that process various components such as active pharmaceutical ingredients and solvents. It’s a niche job, the 39-year-old Crocker said. But it’s interesting, he said, and, “When I go home after work I feel like I’ve contributed something.”

The workplace Bend Research’s manufacturing facility is an uncelebrated, twostory, tan industrial building surrounded by cyclone fencing, near

Page 36

the Bend Parkway and Empire Boulevard. Its ordinary facade belies the unusual sophistication of the work inside. When operators come to work each day, they first pass through a “gowning” room where they shed their street clothes and put on scrubs, rubber gloves, safety goggles, hair nets and shoes that never leave the building. Regulated by the Food and Drug Administration, the plant operates under stringent rules to ensure that nothing contaminates the drugs, to guarantee patient safety. This inner sanctum where the manufacturing happens feels part hospital, part science lab, part industrial kitchen.

Making drugs On a typical day, about a dozen operators roll stainless steel carts loaded with containers and equipment up and down a long straight hall, in and out of a dozen or so windowless rooms that are filled with metal tanks and giant dryers. Some of the rooms are air locked, so operators must pause briefly before opening doors. When they exit a room, they stop to log details in notebooks stacked on shelves outside each door. Crocker’s job begins after countless hours of research and develop-

SPRING / SUMMER 2012 • HIGH DESERT PULSE


Crocker operates the controls and checks the gauges of a 400-liter tank that is part of the production process.

Crocker tucks the respirator hood into the body of his suit.

ment have gone into the pharmaceutical ingredients. To start working on a new drug, he pores over what’s called a batch order — a very specific recipe — coming from clients such as pharmaceutical giants Merck, Eli Lilly or Pfizer. Many times during the multiday process, Crocker must don personal protective equipment — an outfit that’s something like a hazmat suit. He pulls an unused protective suit from its plastic packaging, and attaches a hose from a respirator hood to the air-filtering fan that he will strap to his back. He steps into the full-body Tyvek suit and zips it up. He pulls the protective hood over his head and tucks it into the collar of the suit, peering through a plastic window in front of his eyes. Then, with another operator to verify accuracy, he measures out active pharmaceutical ingredients (specifics of which they cannot disclose) and binding ingredients from bulk drums. The operators measure various powders underneath a vacuum, or fume hood, which will suck away any particles that float around. Not all the products they handle are dangerous, Crocker said, but some are, so operators take precautions all the time. The next step, in a different room, involves filling tanks with solvents such as acetone or methanol, which will dissolve the active

HIGH DESERT PULSE • SPRING / SUMMER 2012

pharmaceutical ingredients into a liquid solution. The resulting liquid gets pumped into a chamber with hot gas that atomizes the solution into a powder.

Spray-dried dispersion The powder is spread onto trays, stacked onto racks and rolled into a tray-drying machine, much like a giant oven. The drying process removes any last bit of solvent from the powder — which is now a pharmaceutical product — so people don’t ingest it. Crocker and his coworkers are making what are called spray-dried dispersions, using technology that Bend Research developed in the mid-1990s to improve the bioavailability of drugs that had low solubility in water, said Deperro, the general manager. Bioavailability refers to the amount of the drug that’s physiologically effective to the body. If active pharmaceutical ingredients were simply compressed into a tablet — without being dissolved and mixed with other ingredients and atomized — they wouldn’t be as bioavailable, Crocker said. Certain pharmaceutical ingredients probably wouldn’t even get used for medicines. An estimated 60 percent of compounds in early development as

Page 37


On the job | MIXING MEDICINE

Do you need injection therapy for chronic pain? Tired of being herded through a “facility”? Are you paying $1,000s extra in “facility fees”?

Did you know there are other options? You could save up to $2,000 per injection!

Bend Spine & Pain Specialists Theodore Ford, MD Board Certified Anesthesiologist Board Certified Pain Specialist Non-surgical Pain Management 2041 NE Williamson Court, Ste B • Bend (541) 647–1646 www.BendSpineandPain.com

medicines have poor solubility, according to Bend Research’s website. Spray-dried dispersion technology overcomes this common challenge. “This technology makes it possible to deliver many promising drug compounds whose development would otherwise be halted because of low solubility,” Deperro said. Few companies in the world have spray-drying equipment. Cooking up an order of spray-dried medicines takes three to five days, typically, depending on the size of the batch. Operators record every step meticulously for many reasons, one of which is that they’ll probably step in and out of the process between shifts, meaning they may have to pick up where someone else left off. At the end of the batch, Crocker bags, bottles and boxes up orders for clients. Sometimes the powder is pressed into pills or capsules by another group of operators at the facility.

Job requirements No medical, pharmaceutical or chemistry background is required to become an operator. “Bend Research sees potential in people and trains them,” said Crocker. Training requires months of reading and job shadowing, he said. Crocker’s background is in construction. He moved to Bend in 1991 and went to Central Oregon Community College for a degree in forest technology. He ran his own construction company until 2010, and started this job at Bend Research in January of 2011. Married for 13 years with three kids, he is happy to have a stable, yearround, full-time job, he said. Deperro would not disclose how much operators earn but he said Bend Research pays competitive wages. What the job does require of candidates, Crocker said, is “a sense of humor. You’re sometimes in a room with a bunch of guys for 10 to 12 hours at a time and you all need to get along and have fun. Personality and the ability to laugh is a must.” This is evident when a visitor tours the facility. One operator shifted his eyes nervously and said deviously, “There’s gonna be an explosion!” He shared a smile with Crocker who rebutted calmly, “No, there’s not.” “If there was,” he clarified, and pointed to a red light mounted on the wall, “that would be flashing.” The joke makes a person realize that things could go wrong in a place stocked with chemicals and gases. But they don’t, Crocker said. Sometimes solvents spill or chemicals get too close to a sensor, triggering lights and sirens that force everyone to evacuate. Crocker has evacuated three times but never for anything serious, he said. After an evacuation, a sweep team comes through the building and does a systematic check before anyone can return to work. And the work is not over when the medicines are made. Crocker and his partners have to clean all the equipment, wearing their protective suits again since there might be exposure to powder on the equipment. The cleaning is no small task. A lab team follows, running swabs on surfaces and testing them to make sure there’s no residual product left behind. “There’s a lot to it,” Crocker said. •

Page 38

SPRING / SUMMER 2012 • HIGH DESERT PULSE


Sorting it out |

FITNESS APPS

Phoning in your workout Our top apps for aiding your fitness routine BY BETSY Q. CLIFF

B

oost your workouts with some high-tech help. These apps, all free in their basic forms, will help you track your mileage, suggest new workouts and keep you motivated. We’ve selected some of the most popular and best reviewed fitness apps for Android and iPhone, so whether you’re a weekend warrior or in serious training, let these programs help you reach your goals.

MAPMYRIDE

MYFITNESSPAL

For iPhone and Android This app was created to track bike rides, but like other apps, it can track many different types of workouts through manual entry or GPS (MapMyRun, MapMyHike and MapMyWalk are some of the other versions available). The app is easy to use and includes ways to share your info with friends. One of my favorite features is a searchable database of routes added by other users on the companion website, mapmyride.com. Searching “Shevlin” around Bend, for example, pulled up eight different rides, from 13 to 36 miles long. Click on the name to pull up a map of the route along with details such as elevation change. For a premium, starting at $5.99 a month, the program will give you training schedules for cycling or running events including a half marathon, marathon or 100-mile ride.

For iPhone and Android We all know that to lose weight you need to expend more calories than you take in. But counting can be a bear. No more. MyFitnessPal estimates the calories you eat and calories you expend through daily living or exercise, and does the math for you. You have to enter all the data manually, including for exercise, but the app remembers what you’ve logged, so if you eat the same thing for breakfast, entering after the first day is a cinch. The food database is extensive, making it easier to get accurate calorie counts. And the app calculates your intake immediately, so you can enter foods you have eaten at lunch and know what you’ll have to do at dinner to avoid going over your total calorie count.

NIKE TRAINING CLUB

101 REVOLUTIONARY WAYS TO BE HEALTHY

For iPhone No more need to pay for a personal trainer. This app has a number of workouts, from beginner to advanced, with videos and audio to show you the correct way to do each move. The workouts can be done at home, though some need basic equipment such as weights or a medicine ball. Choose your fitness goals, such as slim down or strengthen, and there’s a number of routines in each category. The navigation is easy and you can skip around between programs or do an entire workout. It even lets you play your own music. Now that’s a good trainer.

For iPhone This app doesn’t track, count or customize. But for those of us who have trouble staying motivated (Not you? Get real.), it might be just what we’re looking for. With motivational sayings and, if you want, longer articles with information about fitness and wellness, this app can help get you out on those days when you just don’t feel like it. The first one I clicked on suggested “Get Off Your Butt,” with further information about how sitting for too long can harm health and some suggestions for stretches I could do right at my desk. So now my excuses are … all gone? •

SAMSUNG GALAXY NEXUS IMAGE COURTESY WWW.VERIZONWIRELESS.COM

HIGH DESERT PULSE • SPRING / SUMMER 2012

Page 39


ADVERTISING SUPPLEMENT

2012 CENTRAL OREGON

M E DI C A L D IR E CTORY Yo u r S o u r c e f o r L o c a l H e a l t h S e r v i c e s a n d E x 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 and/or physicians in the PULSE/Connections Medical Directory contact…

L o r r a i ne S t aro d u b , Ac c o u nt Executive (Health & Medical) • 541.617. 7855 Paid Advertising Supplement Next Issue Deadlines TBD, 2012 | Publish date: Monday August 13th, 2012

M E D I C A L B U S I N E S S E S B Y S P E C I A LT Y 119 N Rope Street • Sisters

541-588-6119

www.absoluteserenity.info

DermaSpa at Bend Dermatology

2705 NE Conners Drive • Bend

541-330-9139

www.bendderm.com

ALLERGY & ASTHMA

Bend Memorial Clinic

Locations in Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

ALZHEIMERS & DEMENTIA CARE

Clare Bridge Brookdale Senior Living

1099 NE Watt Way • Bend

541-385-4717

www.brookdaleliving.com

ASSISTED LIVING

Brookside Place

3550 SW Canal Blvd • Redmond

541-504-1600

www.ccliving.com

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

541-706-5800

www.stcharleshealthcare.org

CARDIOLOGY

Bend Memorial Clinic

Locations in Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

CARDIOLOGY

The Heart Center

2500 NE Neff Road • Bend

541-706-6900

www.heartcentercardiology.com

CARDIOTHORACIC SURGERY

St. Charles Cardiothoracic Surgery

COUNSELING & WELLNESS

Juniper Mountain Counseling & Wellness

COSMETIC SERVICES

Bend Memorial Clinic

DENTURISTS

ADULT FOSTER CARE

Absolute Serenity Adult Foster Care

AESTHETIC SERVICES

2500 NE Neff Road • Bend

541-388-1636

www.stcharleshealthcare.org

334 NE Irving Ave, Ste 102 • Bend

541-617-0377

www.junipermountaincounseling.com

2600 NE Neff Road • Bend

541-382-4900

www.bendmemorialclinic.com

Sisters Denture Specialties

161 E Cascade • Sisters

541-549-0929

www.raordenturecenter.com

DERMATOLOGY

Bend Dermatology Clinic

2747 NE Conners Drive • Bend

541-382-5712

www.bendderm.com

DERMATOLOGY (MOHS)

Bend Memorial Clinic

2600 NE Neff Road • Bend

541-382-4900

www.bendmemorialclinic.com

ENDOCRINOLOGY

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

FAMILY MEDICINE

Bend Memorial Clinic

FAMILY MEDICINE

St. Charles Family Care in Bend

FAMILY MEDICINE

St. Charles Family Care in Sisters

FAMILY MEDICINE

St. Charles Family Care in Redmond

FAMILY MEDICINE

St. Charles Family Care in Prineville

GASTROENTEROLOGY

Bend Memorial Clinic

GASTROENTEROLOGY

Gastroenterology of Central Oregon

GENERAL DENTISTRY

Coombe and Jones Dentistry

GENERAL SURGERY

Surgical Associates of the Cascades

GENERAL SURGERY & OBESITY CARE

Cascade Obesity and General Surgery

HOME HEALTH SERVICES

St. Charles Home Health Services

HOSPICE/HOME HEALTH HOSPITAL

Locations in Bend, Redmond & Sisters

541-382-4900

www.bendmemorialclinic.com

2965 NE Conners Ave, Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

615 Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealthcare.org

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealthcare.org

1103 NE Elm Street • Prineville

541-447-6263

www.stcharleshealthcare.org

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

2450 Mary Rose Place, Ste 210 • Bend

541-728-0535

www.gastrocentraloregon.com

774 SW Rimrock Way • Redmond

541-923-7633

www.coombe-jones.com

1245 NW 4th Street, Ste 101 • Redmond

541-548-7761

www.cosurgery.com

1245 NW 4th Street, Ste 101 • Redmond

541-548-7761

www.cosurgery.com

2500 NE Neff Road • Bend

541-706-7796

www.stcharleshealthcare.org

Partners In Care

2075 NE Wyatt Ct. • Bend

541-382-5882

www.partnersbend.org

Mountain View Hospital

470 NE “A” Street • Madras

541-475-3882

www.mvhd.org

HOSPITAL

Pioneer Memorial Hospital

1201 NE Elm St • Prineville

541-447-6254

www.stcharleshealthcare.org

HOSPITAL

St. Charles Bend

2500 NE Neff Road • Bend

541-382-4321

www.stcharleshealthcare.org

HOSPITAL

St. Charles Redmond

1253 NE Canal Blvd • Redmond

541-548-8131

www.stcharleshealthcare.org

HOSPITALIST

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

HYBERBARIC OXYGEN THERAPY

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

IMAGING SERVICES

Bend Memorial Clinic

Locations in Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

IMMEDIATE CARE

St. Charles Immediate Care

2600 NE Neff Road • Bend

541-706-3700

www.stcharleshealthcare.org


2011 CENTRAL OREGON MEDICAL DIRECTORY 2012

ADVERTISING SUPPLEMENT

M E D I C A L B U S I N E S S E S B Y S P E C I A L T Y C O N T. INFECTIOUS DISEASE

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

INTEGRATED MEDICINE

Center for Integrated Medicine

916 SW 17th St, Ste 202 • Redmond

541-504-0250

www.centerforintegratedmed.com

INTERNAL MEDICINE

Bend Memorial Clinic

Bend Eastside & Westside

541-382-4900

www.bendmemorialclinic.com

LASIK

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

MEDICAL CLINIC

Bend Memorial Clinic

1080 SW Mt. Bachelor Dr • Bend (West)

541-382-4900

www.bendmemorialclinic.com

MEDICAL CLINIC

Bend Memorial Clinic

1501 NE Medical Center Dr • Bend (East)

541-382-4900

www.bendmemorialclinic.com

MEDICAL CLINIC

Bend Memorial Clinic

231 East Cascades Ave • Sisters

541-382-4900

www.bendmemorialclinic.com

MEDICAL CLINIC

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

NEPHROLOGY

Bend Memorial Clinic

Locations in Bend, Redmond & Sisters

541-382-4900

www.bendmemorialclinic.com

NEUROLOGY

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

NUTRITION

Bend Memorial Clinic

Locations in Bend, Redmond & Sisters

541-382-4900

www.bendmemorialclinic.com

OBSTETRICS & GYNECOLOGY

East Cascade Women’s Group, P.C.

2400 NE Neff Road, Ste A • Bend

541-389-3300

www.eastcascadewomensgroup.com

OBSTETRICS & GYNECOLOGY

St. Charles OB/GYN - Redmond

213 NW Larch Ave, Suite B • Redmond

541-526-6635

www.stcharleshealthcare.org

OCCUPATIONAL MEDICINE

Bend Memorial Clinic

Locations in Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

ONCOLOGY ~ MEDICAL

Bend Memorial Clinic

Locations in Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

OPHTHALMOLOGY

Bend Memorial Clinic

Locations in Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

OPTOMETRY

Bend Memorial Clinic

Locations in Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

ORTHOPEDICS

Desert Orthopedics

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

2500 NE Neff Road • Bend

541-706-5880

www.stcharleshealthcare.org

ORTHOPEDICS, NEUROSURGERY The Center: Orthopedic & Neurosurgical Care & Research & PHYSICAL MEDICINE PALLIATIVE CARE

St. Charles Advanced Illness Management

PEDIATRIC DENTISTRY

Deschutes Pediatric Dentistry

1475 SW Chandler Ave, Ste 202 • Bend

541-389-3073

www.deschuteskids.com

PEDIATRICS

Bend Memorial Clinic

1080 SW Mt. Bachelor Dr • Bend (West)

541-382-4900

www.bendmemorialclinic.com

PHARMACY

HomeCare IV/CustomCare Rx

2065 NE Williamson Court, Suite B • Bend

541-382-0287

www.homecareiv.com

PHYSICAL MEDICINE

Desert Orthopedics

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

PHYSICAL MEDICINE ~ REHABILITATION

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

PHYSICAL THERAPY

Alpine Physical Therapy & Spine Care

2275 NE Doctors Dr, #3 & 336 SW Cyber Dr, Ste 107

541-382-5500

www.alpinephysicaltherapy.com

PHYSICAL THERAPY

Healing Bridge Physical Therapy

PODIATRY

Cascade Foot Clinic

PULMONOLOGY

Bend Memorial Clinic

PULMONOLOGY

St. Charles Pulmonary Clinic

RADIOLOGY

Central Oregon Radiology Associates, P.C.

REHABILITATION

404 NE Penn Avenue • Bend

541-318-7041

www.healingbridge.com

Offices in Bend, Redmond & Prineville

541-388-2861

n/a

Locations in Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

1460 NE Medical Center Dr • Bend

541-382-9383

www.corapc.com

St. Charles Rehabilitation Center

Locations in Bend & Redmond

541-706-7725

www.stcharleshealthcare.org

RHEUMATOLOGY

Bend Memorial Clinic

Locations in Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

SLEEP MEDICINE

Bend Memorial Clinic

Locations in Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

SLEEP MEDICINE

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

SURGICAL SPECIALIST

Bend Memorial Clinic

Locations in Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

URGENT CARE

Bend Memorial Clinic

Locations in Bend (East & West) & Redmond

541-382-4900

www.bendmemorialclinic.com

VASCULAR SURGERY

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

VEIN SPECIALISTS

Inovia Vein Specialty Center

2200 NE Neff Road, Ste 204 • Bend

541-382-8346

www.bendvein.com

PA I D A D V E R T I S I N 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 (Health & Medical) 541.617.7855 or 541.480.0612


ADVERTISING SUPPLEMENT

2012 CENTRAL OREGON MEDICAL DIRECTORY M E D I C A L P R O F E S S I O N A L S B Y S P E C I A LT Y ALLERGY & ASTHMA

ADAM WILLIAMS, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

BEHAVIORAL HEALTH

PHILIP B. ANDERSON, MD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

KAREN CAMPBELL, PhD

St. Charles Behavioral 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

541-447-6263

www.stcharleshealthcare.org

BRIAN T. EVANS, PsyD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

EUGENE KRANZ, PhD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

SONDRA MARSHALL, PhD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

NATHAN OSBORN, MD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

MIKALA SACCOMAN, PhD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

LEAH SCHOCK, PhD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

REBECCA SCRAFFORD, PsyD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

KIMBERLY SWANSON, PhD

St. Charles Behavioral Health

2542 NE Courtney Dr • Bend

541-706-7730

www.stcharleshealthcare.org

CARDIOLOGY

JEAN BROWN, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

RICK KOCH, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

GAVIN L. NOBLE, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

STEPHANIE SCOTT, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JASON WEST, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

CARDIOTHORACIC SURGERY

JOHN D BLIZZARD, MD

St. Charles Cardiothoracic Surgery

2500 NE Neff Road • Bend

541-388-1636

www.stcharleshealthcare.org

DARIN CLEMENT, PA-C

St. Charles Cardiothoracic Surgery

2500 NE Neff Road • Bend

541-388-1636

www.stcharleshealthcare.org

CARL E. MILLER, PA-C

St. Charles Cardiothoracic Surgery

2500 NE Neff Road • Bend

541-388-1636

www.stcharleshealthcare.org

ANGELO A. VLESSIS, MD

St. Charles Cardiothoracic Surgery

2500 NE Neff Road • Bend

541-388-1636

www.stcharleshealthcare.org

TIMOTHY J. ZERGER, PA-C

St. Charles Cardiothoracic Surgery

2500 NE Neff Road • Bend

541-388-1636

www.stcharleshealthcare.org

1345 NW Wall St, Ste 202 • Bend

541-318-1000

www.bendwellnessdoctor.com

CHIROPRACTIC

JASON M. KREMER, DC, CCSP, CSCS

Wellness Doctor

DENTISTRY

MICHAEL R. HALL, DDS

Central Oregon Dental Center

1563 NW Newport Ave • Bend

541-389-0300

www.centraloregondentalcenter.net

BRADLEY E. JOHNSON, DMD

Contemporary Family Dentistry

1016 NW Newport Ave • Bend

541-389-1107

www.contemporaryfamilydentistry.com

2600 NE Neff Road • Bend

541-382-4900

www.bendmemorialclinic.com

388 SW Bluff Dr • Bend

541-678-0020

www.centraloregondermatology.com

DERMATOLOGY

ALYSSA ABBEY, PA-C

Bend Memorial Clinic

MARK HALL, MD

Central Oregon Dermatology

JAMES M. HOESLY, MD

Bend Memorial Clinic

2600 NE Neff Road • Bend

541-382-4900

www.bendmemorialclinic.com

GERALD E. PETERS, MD, DS (Mohs)

Bend Memorial Clinic

2600 NE Neff Road • Bend

541-382-4900

www.bendmemorialclinic.com

ANN M. REITAN, PA-C (Mohs)

Bend Memorial Clinic

2600 NE Neff Road • Bend

541-382-4900

www.bendmemorialclinic.com

MARY F. CARROLL, MD

Bend 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

ENDOCRINOLOGY

FAMILY MEDICINE

CAREY ALLEN, MD

St. Charles Family Care

1103 NE Elm Street • Prineville

541-447-6263

www.stcharleshealthcare.org

HEIDI ALLEN, MD

St. Charles Family Care

1103 NE Elm Street • Prineville

541-447-6263

www.stcharleshealthcare.org

THOMAS L. ALLUMBAUGH, MD

St. Charles Family Care

KATHLEEN C. ANTOLAK, MD

Bend Memorial Clinic

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealthcare.org

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com


2012 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

FAMILY MEDICINE CONT.

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

615 Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealthcare.org

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

St. Charles Family Care

1103 NE Elm Street • Prineville

541-447-6263

www.stcharleshealthcare.org

SHANNON K. BRASHER, PA-C

St. Charles Family Care

1103 NE Elm Street • Prineville

541-447-6263

www.stcharleshealthcare.org

MEGHAN BRECKE, DO

St. Charles Family Care

2965 NE Conners Ave, Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

NANCY BRENNAN, DO

St. Charles Family Care

2965 NE Conners Ave, Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

WILLIAM C. CLARIDGE, MD

St. Charles Family Care

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealthcare.org

LINDA C. CRASKA, MD

St. Charles Family Care

1103 NE Elm Street • Prineville

541-447-6263

www.stcharleshealthcare.org

AMY DELOUGHREY, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JAMES K. DETWILER, MD

St. Charles Family Care

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealthcare.org

MAY S. FAN, MD

Bend Memorial Clinic

231 East Cascades Avenue • Sisters

541-382-4900

www.bendmemorialclinic.com

MARK GONSKY, DO

St. Charles Family Care

2965 NE Conners Ave, Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

STEVEN GREER, MD

St. Charles Family Care

615 Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealthcare.org

ALAN C. HILLES, MD

Bend Memorial Clinic

Redmond & Sisters

541-382-4900

www.bendmemorialclinic.com

PAMELA J. IRBY, MD

St. Charles Family Care

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealthcare.org

MAGGIE J. KING, MD

St. Charles Family Care

1103 NE Elm Street • Prineville

541-447-6263

www.stcharleshealthcare.org

PETER LEAVITT, MD

St. Charles Family Care

2965 NE Conners Ave, Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

CHARLOTTE LIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JOE T. MC COOK, MD

St. Charles Family Care

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealthcare.org

DANIEL J. MURPHY, MD

St. Charles Family Care

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealthcare.org

SHERYL L. NORRIS, MD

St. Charles Family Care

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealthcare.org

JANEY PURVIS, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

DANA M. RHODE, DO

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

HANS G. RUSSELL, MD

Bend Memorial Clinic

Bend Eastside & Westside

541-382-4900

www.bendmemorialclinic.com

ERIC J. SCHNEIDER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

CINDY SHUMAN, PA-C

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

EDWARD M. TARBET, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JOHN D. TELLER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

NATHAN R. THOMPSON, MD

St. Charles Family Care

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealthcare.org

MARK A. VALENTI, MD

St. Charles Family Care

211 NW Larch Avenue • Redmond

541-548-2164

www.stcharleshealthcare.org

THOMAS A. WARLICK, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

BRUCE N. WILLIAMS, MD

St. Charles Family Care

1103 NE Elm Street • Prineville

541-447-6263

www.stcharleshealthcare.org

SADIE ARRINGTON, MD

Bend Memorial Clinic

JOSEPH BACHTOLD, DO

St. Charles Family Care

JEFFREY P. BOGGESS, MD

Bend Memorial Clinic

BRANDON W. BRASHER, PA-C

GASTROENTEROLOGY

RICHARD H. BOCHNER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ELLEN BORLAND, MS, RN, CFNP

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ARTHUR S. CANTOR, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

HEIDI CRUISE, PA-C, MS

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

SIDNEY E. HENDERSON III, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

SANDRA K. HOLLOWAY, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

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

Cascade Obesity and General Surgery

1245 NW 4th Street, Ste 101 • Redmond

541-548-7761

www.cosurgery.com

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

GENERAL SURGERY/BARIATRICS

NGOCTHUY HUGHES, DO, PC HOSPITALIST JOHN R. ALLEN, MD


2012 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

HOSPITALIST CONT. GINGER L. DATTILO, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

MICHAEL GOLOB, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ADRIAN KRUEGER, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

SUZANN KRUSE, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

PHONG NGO, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

DEONA J. WILLIS, FNP-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

MICHAEL N. HARRIS, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ANITA D. KOLISCH, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

MATTHEW R. LASALA, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

KAREN L. OPPENHEIMER, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

A. WADE PARKER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

MATTHEW REED, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

M. SEAN ROGERS, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

DAN SULLIVAN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

INFECTIOUS DISEASE JON LUTZ, MD INTERNAL MEDICINE

NEONATOLOGY CAROL A. CRAIG, NNP

St. Charles Medical Group - Neonatology

2500 NE Neff Road • Bend

541-382-4321

www.stcharleshealthcare.org

JOHN O. EVERED, MD

St. Charles Medical Group - Neonatology

2500 NE Neff Road • Bend

541-382-4321

www.stcharleshealthcare.org

SARAH E. JAMES, NNP

St. Charles Medical Group - Neonatology

2500 NE Neff Road • Bend

541-382-4321

www.stcharleshealthcare.org

JAMES MCGUIRE, MD

St. Charles Medical Group - Neonatology

2500 NE Neff Road • Bend

541-382-4321

www.stcharleshealthcare.org

FREDERICK J. RUBNER, MD

St. Charles Medical Group - Neonatology

2500 NE Neff Road • Bend

541-382-4321

www.stcharleshealthcare.org

MICHAEL E. FELDMAN, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

RUSSELL E. MASSINE, MD, FACP

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

ROBERT V. PINNICK, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

FRANCENA ABENDROTH, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

CRAIGAN GRIFFIN, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

RICHARD KOLLER, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

NEPHROLOGY

NEUROLOGY

NEUROSURGERY MARK BELZA, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

RAY TIEN, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

BRAD WARD, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

NUTRITION ANNIE WILLIAMSON, RD, LD

Bend Memorial Clinic

OBSTETRICS/GYNECOLOGY WILLIAM H. BARSTOW, MD

St. Charles OB/GYN

213 NW Larch Ave, Ste A • Redmond

541-526-6635

www.stcharleshealthcare.org

CRAIG P. EBERLE, MD

St. Charles OB/GYN

213 NW Larch Ave, Ste A • Redmond

541-526-6635

www.stcharleshealthcare.org

AMY B. MCELROY, FNP

St. Charles OB/GYN

213 NW Larch Ave, Ste A • Redmond

541-526-6635

www.stcharleshealthcare.org

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

OCCUPATIONAL MEDICINE JOHN BATTLE, ANP-BC THEODORE KRUSE, MD

Bend Memorial Clinic

The Center: Orthopedic & Neurosurgical Care & Research


2012 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

ONCOLOGY – MEDICAL Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

SUSIE DOEDYNS, FNP

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

STEVE KORNFELD, MD

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

BILL MARTIN, MD

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

LAURIE RICE, ACNP

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

WILLIAM SCHMIDT, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

HEATHER WEST, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

ROB BOONE, MD

St. Charles Cancer Center

THEODORE A. BRAICH, MD

Bend Memorial Clinic

CORA CALOMENI, MD

ONCOLOGY – RADIATION LINYEE CHANG, MD

St. Charles Cancer Center

2500 NE Neff Road • Bend

541-706-7733

www.stcharleshealthcare.org

TOM COMERFORD, MD

St. Charles Cancer Center

2500 NE Neff Road • Bend

541-706-7733

www.stcharleshealthcare.org

RUSS OMIZO, MD

St. Charles Cancer Center

2500 NE Neff Road • Bend

541-706-7733

www.stcharleshealthcare.org

OPHTHAMOLOGY BRIAN P. DESMOND, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

THOMAS D. FITZSIMMONS, MD, MPH

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

ROBERT C. MATHEWS, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

SCOTT T. O’CONNER, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

DARCY C. BALCER, OD

Bend Memorial Clinic

Bend Eastside & Westside

541-382-4900

www.bendmemorialclinic.com

LORISSA M. HEMMER, OD

Bend Memorial Clinic

Bend Eastside & Westside

541-382-4900

www.bendmemorialclinic.com

1475 SW Chandler, Ste 101 • Bend

541-617-3993

www.drkeithkrueger.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

OPTOMETRY

ORAL & MAXILLOFACIAL SURGERY KEITH E. KRUEGER, DMD, PC

Keith E. Krueger, DMD, PC

ORTHOPEDIC SURGERY, FOOT & ANKLE

AARON ASKEW, MD

Desert Orthopedics

ANTHONY HINZ, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

JEFFREY P. HOLMBOE, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

JOEL MOORE, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

ORTHOPEDIC SURGERY, JOINT REPLACEMENT KNUTE BUEHLER, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

MICHAEL CARAVELLI, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

ERIN FINTER, MD JAMES HALL, MD

ROBERT SHANNON, MD

Desert Orthopedics The Center: Orthopedic & Neurosurgical Care & Research

Desert Orthopedics

ORTHOPEDIC SURGERY, SPINE

GREG HA, MD

Desert Orthopedics

1303 NE Cushing Dr, Ste 100 • Bend

541-388-2333

www.desertorthopedics.com

KATHLEEN MOORE, MD

Desert Orthopedics

1303 NE Cushing Dr, Ste 100 • Bend

541-388-2333

www.desertorthopedics.com

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

1315 NW 4th Street • Redmond

541-388-2333

www.desertorthopedics.com

ORTHOPEDIC SURGERY, SPORTS MEDICINE TIMOTHY BOLLOM, MD

BRETT GINGOLD, MD

The Center: Orthopedic & Neurosurgical Care & Research

Desert Orthopedics

SCOTT T. JACOBSON, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

BLAKE NONWEILER, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

541-388-2333

www.desertorthopedics.com

ORTHOPEDIC SURGERY, SPORTS MEDICINE, FEMALE SPORTS MEDICINE

CARA WALTHER, MD

Desert Orthopedics

1303 NE Cushing Dr, Ste 100 • Bend


2012 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

ORTHOPEDIC SURGERY, UPPER EXTREMITY MICHAEL COE, MD

KENNETH HANNINGTON, MD SOMA LILLY, MD

MICHAEL MARA, MD JAMES VERHEYDEN, MD

The Center: Orthopedic & Neurosurgical Care & Research

Desert Orthopedics The Center: Orthopedic & Neurosurgical Care & Research

Desert Orthopedics The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

PALLIATIVE CARE LISA LEWIS, MD

Partners in Care

2075 NE Wyatt Ct • Bend

541-382-5882

www.partnersbend.org

RICHARD J. MAUNDER, MD

St. Charles Advanced Illness Management

2500 NE Neff Road • Bend

541-706-5885

www.stcharleshealthcare.org

LAURA K. MAVITY, MD

St. Charles Advanced Illness Management

2500 NE Neff Road • Bend

541-706-5885

www.stcharleshealthcare.org

1475 SW Chandler Ave, Ste • Bend

541-389-3073

www.deschuteskids.com

PEDIATRIC DENTISTRY STEPHANIE CHRISTENSEN, DMD

Deschutes Pediatric Dentistry

STEVE CHRISTENSEN, DMD

Deschutes Pediatric Dentistry

1475 SW Chandler Ave, Ste • Bend

541-389-3073

www.deschuteskids.com

R DEAN NYQUIST, DMD

Dentistry for Kidz

1230 NE Third St, Ste A-174 • Bend

541-389-6600

www.dentistryforkidz.com

1303 NE Cushing Dr, Ste 100 • Bend

541-388-2333

www.desertorthopedics.com

ORTHOPEDIC SURGERY, PEDIATRIC,YOUTH & ADULT SPORTS MEDICINE

MICHAEL RYAN, MD

Desert Orthopedics

PEDIATRICS KATHERINE BAUMANN, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

KATE L. BROADMAN, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

RICK G. CUDDIHY, 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 LEIN, CPNP

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

MICHELLE MILLS, MD

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

MARGARET J. PHILP, MD

St. Charles Family Care

211 NW Larch Ave • Redmond

541-548-2164

www.stcharleshealthcare.org

JB WARTON, DO

Bend Memorial Clinic

1080 SW Mt. Bachelor Drive • Bend

541-382-4900

www.bendmemorialclinic.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

PHYSICAL MEDICINE & REHABILITATION ROBERT ANDREWS, MD TIM HILL, MD

Desert Orthopedics

The Center: Orthopedic & Neurosurgical Care & Research

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JAMES NELSON, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

LARRY PAULSON, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

DAVID STEWART, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

JON SWIFT, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

VIVIANE UGALDE, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

MARC WAGNER, MD

The Center: Orthopedic & Neurosurgical Care & Research

Locations in Bend & Redmond

541-382-3344

www.thecenteroregon.com

St. Charles Preoperative Medicine

2500 NE Neff Road • Bend

541-706-2949

www.stcharleshealthcare.org

JONATHON BREWER, DO

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

JAMIE DAVID CONKLIN, MD

St. Charles Pulmonary Clinic

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

ERIC S. DILDINE, PA-C

St. Charles Pulmonary Clinic

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

ROD L. ELLIOT-MULLENS, DO

St. Charles Pulmonary Clinic

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

KEITH W. HARLESS, MD

St. Charles Pulmonary Clinic

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

MATT HEGEWALD, MD

St. Charles Pulmonary Clinic

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

T. CHRISTOPHER KELLEY, DO

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

JONATHON MCFADYEN, NP

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

NANCY H. MALONEY, MD

Bend Memorial Clinic

PREOPERATIVE MEDICINE BROOKE HALL, MD PULMONOLOGY


2012 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

PULMONOLOGY CONT. LYNETTE SPJUT, PA-C

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

St. Charles Rehabilitation Center

2500 NE Neff Road • Bend

541-706-7725

www.stcharleshealthcare.org

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

Bend Memorial Clinic

REHABILITATION NOREEN C. MILLER, FNP RHEUMATOLOGY GREG BORSTAD, MD SLEEP MEDICINE ARTHUR K. CONRAD, MD

St. Charles Sleep Center - Bend

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

DAVID L. DEDRICK, MD

St. Charles Sleep Center - Bend

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

Redmond Wellness & Chiropractic

1655 SW Highland Ave, Ste 6 • Redmond

541-923-2019

www.drherrin.com

NorthStar Neurology NorthStar Neck & Back Clinic

2275 NE Doctors Drive • Bend 2863 NW Crossing Dr, Ste 100 • Bend

541-330-6463

www.northstarneurology.com

TIMOTHY L. BEARD, MD, FACS

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

DARA H. CHRISANTTE, MD

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

GARY J. FREI, MD, FACS

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

JACK W. HARTLEY, MD, FACS

Surgical Associates of the Cascades

1245 NW 4th Street, #101 • Redmond

541-548-7761

www.cosurgery.com

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

Surgical Associates of the Cascades

1245 NW 4th Street, #101 • Redmond

541-548-7761

www.cosurgery.com

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

Surgical Associates of the Cascades

1245 NW 4th Street, #101 • Redmond

541-548-7761

www.cosurgery.com

JENNIFER TURK, PA-C

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

JEANNE WADSWORTH, PA-C, MS

Bend 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

JEFF CABA, PA-C

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

ANN CLEMENS, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

TERESA COUSINEAU, PA-C

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

DANETTE ELLIOT-MULLENS, DO

St. Charles Immediate Care

2600 NE Neff Road • Bend

541-706-3700

www.stcharleshealthcare.org

J. RANDALL JACOBS, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

AMEE KOCH, PA-C

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

JIM MCCAULEY, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

TERRACE MUCHA, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

JAY O’BRIEN, PA-C

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

CASEY OSBORNE-RODHOUSE, PA-C

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

LAURIE D. PONTE, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

PATRICK L. SIMNING, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

SEAN SUTTLE, PA-C

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

THOMAS H. WENDEL, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

BRENT C. WESENBERG, MD

Bend Memorial Clinic

Bend Eastside, Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

EDWARD M. BOYLE, JR., MD, FACS

Inovia Vein Specialty Center

2200 NE Neff Road, Ste 204 • Bend

541-382-8346

www.bendvein.com

ANDREW JONES, MD, FACS

Inovia Vein Specialty Center

2200 NE Neff Road, Ste 204 • Bend

541-382-8346

www.bendvein.com

Bend Memorial Clinic

1501 NE Medical Center Drive • Bend

541-382-4900

www.bendmemorialclinic.com

SPINAL DECOMPRESSION, AUTO ACCIDENTS DAVID HERRIN, DC STROKE, NECK & BACK RICHARD L. KOLLER, MD SURGICAL SPECIALIST

URGENT CARE

VEIN SPECIALISTS

VASCULAR SURGERY JOSEPH COLELLA, MD, FACS


Cover story | THE GENETICS OF ALCOHOLISM

“The weekend warrior turned into summertime, when it was three or four times a week and then it progressed very quickly. It was pretty much a five-day-a-week type thing by the time I was 17. It happened that quick.” Dorian

Continued from Page 17 to protect against alcoholism, with fewer married people than unmarried people meeting the criteria for alcohol dependence. Then, they looked at how GABRA2 interacted with marital status and risk of alcoholism. The researchers found that people with the risky variant of GABRA2 were less likely to get married. Given that GABRA2 influences behavior that makes alcoholism more likely, the researchers suggested that it might also make marriage less likely. “Perhaps the same traits that lead to alcoholism make it more difficult to find a partner,” said Agrawal. She went on to explain how genes, in general, can lead us to seek out different environments, which can then influence our behavior. “When we think of how genes and the environment interact, the genotypes we have make us more or less likely to experience a certain environment. “If you are born with a high IQ, then you are more likely to seek out ways to express that,” she said. “Smart parents tend to confer smart genes, but they also surround (kids) with books.” With drinking, researchers say, the genetic and environmental interaction is especially pronounced in adolescence, when the brain is still developing and most people try alcohol for the first time. Adolescents who start drinking heavily, Grant said, are four times more likely than the general population to be

Page 48

diagnosed with alcoholism in their lifetime. Dorian, the 36-year-old alcoholic, said that’s how he got started. He started when he was 15, he said, just drinking on the weekends. “The weekend warrior turned into summertime, when it was three or four times a week and then it progressed very quickly,” he said. “It was pretty much a five-day-aweek type thing by the time I was 17. It happened that quick.” He spiralled downhill in his 20s, he said, and until he checked into a rehabilitation facility earlier this year, was barely functional. “I’d start in the morning, drink, pass out, wake up, drink. I couldn’t even differentiate days,” he said, during an interview at a local rehabilitation center. “When I checked myself in here, I didn’t even know what day it was.” His blood alcohol content then, he said, was 0.38, a level that can kill. For researchers, the question is whether someone like Dorian — who drank heavily early in life — became an alcoholic because of his family history and environmental risk factors, perhaps watching his parents drink heavily. Or is there more to it? Genetic and environmental factors play a strong role, but drinking during adolescence may also change something physiological in the brain that predisposes someone to a later addiction. Researchers are increasingly gravitating toward the latter explanation. “There does seem to be a biological window,” said Grant. “It

does seem that there is something about the brain in a late adolescent stage … that the brain does change in terms of future behavior toward alcohol.” So far, it’s unclear exactly how this might work. The brain develops some aspects of critical thinking and self-control during adolescence, so it may be that drinking changes that development. Then again, it may be that adolescence is a crucial time for habit formation. Or, even more far out, it could be that drinking during adolescence does something to fundamentally change how a person’s genes are

SPRING / SUMMER 2012 • HIGH DESERT PULSE


Jill, left, and her mother leave the Redmond Alano Club following a nearby AA meeting. Scientists are gaining ground on the genetic connections of alcohol addiction. expressed, said Grant. That may mean that drinking during adolescence actually reshapes our genetic code, perhaps switching on those genes that might put us at greater risk. Regardless, scientists are now spending a lot of time looking at teenagers’ environments, how much they are drinking and how their bodies respond. For Kristine, the possibility of her own children succumbing to the addiction that she

HIGH DESERT PULSE • SPRING / SUMMER 2012

has struggled with was her ultimate reason for seeking treatment, she said. On New Year’s Eve, her teenage son was at a friend’s house, three blocks from their home. He was drinking, she said, and told his friends he was going outside, into the dark, to go to the bathroom. Then, without telling his friends, her son tried to walk home. He passed out in the middle of the road and was found sometime later by a woman driving home. Kristine

learned the story when, in the middle of the night, police knocked on her door. “I think, what if that would have been someone coming home from a party,” who wasn’t so alert, she said. “He’s got so many of my genes,” she said, “he’s so much like me in every other aspect that I don’t want him to start drinking.” She said she feared the consequences. “We got lucky,” that night, she said. “Both him and I.” •

Page 49


Treating GERD | WHAT YOU SHOULD KNOW ABOUT ACID REFLUX MEDS

Differences between PPIs, H2 blockers and antacids Proton-pump inhibitors: Prescription and over the counter Examples of brands: Nexium, Prilosec, Prevacid, Protonix These drugs block an enzyme that is necessary for making acid in the stomach. Parietal cells in the stomach make stomach acid. The parietal cell has a pump that pumps acid into the stomach. Proton-pump inhibitors work directly on that pump, essentially shutting it down. H2 blockers: Over the counter Examples of brands: Pepcid, Zantac Parietal cells get signals from gastrin, from the vagus nerve and from a chemical called histamine that make them produce stomach acid. H2 blockers “block” the histamine. However, the other mechanisms at work can stimulate parietal cells, which is why H2 blockers are less effective than proton-pump inhibitors. H2 blockers treat mild, occasional heartburn and excess stomach acid. They take longer to work than antacids, but provide relief for up to 12 hours. Antacids: Over the counter Examples of brands: Rolaids, Tums These neutralize stomach acid. They work within minutes to relieve heartburn and acid indigestion, but their effect only lasts a few hours. Source: Consumer Reports Health Best Buy Drugs, “The Proton Pump Inhibitors,” May 2010, and Dr. Gene Bakis, a gastroenterologist and assistant professor of medicine at Oregon Health & Science University in Portland

Continued from Page 34 selling class of medication in the U.S., worth $13.9 billion in sales, according to IMS Health, an independent health-care data company. This just represents prescriptions. PPIs can also be purchased over the counter, from the shelves of grocery stores. PPIs were the second most heavily promoted class of drugs in 2005, with $884 million in promotional spending on journal advertising, pharmaceutical samples and direct-toconsumer advertising, according to a 2009 report from the Pew Prescription Project, a consumer safety initiative of The Pew Charitable Trust. (Antidepressants ranked highest.) Antidepressants and PPIs also topped sales revenue that year, according to the report, which suggested that advertising influences prescriptions. In 2005, two different PPI manufacturers made the top 20 list of pharmaceutical product spending on direct-to-consumer advertising. AstraZeneca, the maker of the PPI Nexium, topped the list with $224 million in spending. Subsequently, Nexium, “the purple pill,” has been the second best selling drug in the U.S. since 2005, according to Consumer Reports Health Best Buy Drugs.

Inappropriate prescriptions Proton-pump inhibitors are also prescribed for infants and children, sometimes for symptoms such as spitting up and crying. Dr. Eric Hassall, a pediatric gastroenterologist at Sutter Pacific Medical Foundation

Health NorthWest Crossing

YOUR GUIDE TO IN

A. Mountain View Acupuncture B. Alpine Acupuncture C. NWX Chiropractic & Health

7

A

25% OFF

B

17 CC 15

Steven A. Foster-Wexler, LAc

Includes history, comprehensive evaluation and treatment. Feel your best!

Bend’s NorthWest Crossing

541-330-8283

www.BendAcupuncture.com

NW YORK DR.

Initial 90-Minute Appointment

D A


in San Francisco and an adviser to the Food and Drug Administration, suggests the rise of prescriptions to infants is linked to direct-to-consumer advertising. “More advertising leads to more requests by patients for advertised medicine, and more prescriptions,” he wrote in The Journal of Pediatrics recently. Randomized, controlled studies have shown that PPIs are no better than placebos for most infants with symptoms of spitting up, irritability and unexplained crying, he said. Spitting up in otherwise healthy, thriving infants is normal, he said, and usually resolves itself with time. Others who might be unnecessarily treated for GERD are those who are dealing with a condition called dyspepsia, generally described as indigestion problems located in the upper abdomen, sometimes feeling similar to GERD. Many doctors appear “biased” toward GERD, and will misdiagnose functional dyspepsia symptoms, according to Mayo Clinic researchers. Stress is an often-overlooked factor that can contribute to functional dyspepsia, said Dr. Glenn Koteen, a Bend gastroenterologist. If an endoscopy and physical exam don’t find an “organic and treatable” condition — no ulcer or GERD — and if the patient notes a worsening of indigestion during times of stress, the person might benefit most from exercise, stress management and/or antidepressants, he said. If dyspepsia is the case, acid-reducing medications probably won’t help.

Weaning off PPIs More than a year ago, Goldstein began a serious effort to wean himself off PPIs. It’s been a long, slow and experimental process. He tapered off medications slowly, which is what doctors generally recommend. He still needed an occasional pill, but he tried to use an H2 blocker or antacid such as Tums instead of a PPI. He drastically reduced his caffeine intake, and has learned to avoid chocolate. He has to eat slowly, he realized. He eats more fiber now. He said staying regular makes a huge difference to him, even

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 Spiritual Counseling Medical Social Workers Grief Support Licensed Therapists Caregiver Support Hospice Aides Trained Volunteers Ask about our Transitions Program For more information, please call:

541.548.7483 732 SW 23rd Street, Redmond, OR 97756 hospice@bendcable.com www.redmondhospice.org


Tips for dealing with GERD without medication Weight might be the underlying problem. Dropping some pounds might help. When an overweight person’s abdomen pushes the stomach up toward the diaphragm, it’s easier for stomach acids to splash into the esophagus. Eat smaller meals. Big meals stretch the stomach and push open the lower esophageal sphincter, allowing acid to reach the esophagus. Wait two or three hours after eating before going to bed. Lying down flat with a full belly allows food to press upward. Elevate the upper body in bed, too. Avoid coffee. It’s acidic and can weaken the lower esophageal sphincter seal. Avoid spicy food if it’s irritating. Peppermint, fried foods and cigarette smoking also can exacerbate GERD. Avoid carbonated beverages. They might make you burp acids into the esophagus. Avoid drinking fluids with meals. It might dilute stomach acids and inhibit digestion. Increase consumption of raw fruits and vegetables that contain enzymes — especially mangoes and pineapples — that help digest food. Reduce meat, which is harder to digest, and some fatty foods if they cause symptoms. Source: Dr. Rallie McAllister, a family practice physician, nutrition consultant, writer and public speaker based in Lexington, Ky.

Treating GERD | WHAT YOU SHOULD KNOW ABOUT ACID REFLUX MEDS though doctors told him there’s no connection. “I’ve figured out what works for me individually. I’m starting to understand these subtle things,” he said. “There’s no short-term fix; it’s a long time of weaning.” His sore throat went away. He’s generally feeling much better. GERD is not controlling his life anymore. “I was always searching for the silver bullet that would cure it, but now I realize there isn’t just one solution,” he said. “I would say you have to experiment — you know your body better than any doctor — and you have to be persistent.” In recent months, he’s had a couple of shortlived flare-ups of symptoms. He took PPIs to calm down the inflammation in his esophagus. “I got really down again, thinking, ‘Here we go again.’ But I was happily surprised that it cleared up quickly and I was able to go off the pills again,” he said. “It shows how tentative it all can be, how the drugs are, unfortunately, sometimes the only tool that works.” •

DO YOU WANT TO IMPROVE YOUR CASH FLOW OR EXPAND YOUR PRACTICE? At High Desert Bank, we can help create customized financial solutions to fit your unique needs. FOR MANAGING YOUR BUSINESS’ CASH FLOW • Dedicated Banker assigned to you • Operating Account to fit your needs • Online Cash Management Account information, wire transfers, bill pay, electronic customer payments and direct deposit. • Merchant Services • Remote Deposit

FOR EXPANDING YOUR BUSINESS • Revolving Lines of Credit • Equipment Financing • SBA Loans

541.848.4444

FOR YOU AND YOUR STAFF • Personal Banking • Residential Mortgage Lending • Construction Loans Page 52

www.highdesertbank.com

“LOCAL SERVICE – LOCAL KNOWLEDGE” High Desert Bank 1000 SW Disk Dr. | Bend, Oregon 97702

Loans subject to credit approval.

SPRING / SUMMER 2012 • HIGH DESERT PULSE


Body of knowledge |

POP QUIZ

Fact or foolery? BY ANNE AURAND

1

Drinking beer will give you a so-called “beer belly.” True or false?

2

The American Heart Association recommends most American women consume no more than about 6 teaspoons of sugar daily. For men, it’s about 9 teaspoons. One 12-ounce can of a cola soft drink such as Coke or Pepsi has the equivalent of how many teaspoons of sugar? A. 2.5 B. 11.25 C. 8.25

3

Since 1998, federal law has required what vitamin — important for helping tissues grow and cells work and known largely for its importance in preventing fetal neural tube defects — be added to breakfast cereals, flour, breads, pasta, bakery items, cookies and crackers?

4

A large buttered movie popcorn typically contains about how many calories? A. 844 to 1,591 B. 237 to 412 C. 516 to 7,335

4. A 5. B. With 373 mg of sodium, a half-cup of cottage cheese has more than twice the amount of sodium as the other two examples. 6. False. Research shows that vitamin C may only slightly reduce the length and severity of colds. 7. C. An egg has 87 IUs of vitamin D. The cheese has 7 units, and asparagus has none. 8. B

HIGH DESERT PULSE • SPRING / SUMMER 2012

5

Most adults should limit their sodium intake to 2,300 mg per day. Which of these has the most sodium? A. 1 slice multigrain bread B. ½ cup 2 percent milk fat cottage cheese C. 1 cup roasted turkey meat

6 7

Taking vitamin C helps prevent colds. True or false?

Most adults are supposed to consume about 600 IUs (international units) of vitamin D per day. Which of these has the most vitamin D? A. 1 ounce cheddar cheese B. 1 cup asparagus C. 1 hard-boiled egg

8

What is the prevailing philosophy behind the gold-standard DASH diet? (It stands for Dietary Approaches to Stop Hypertension.) A. All foods are assigned a point value and the

dieter — who is assigned a maximum daily point value based on individual factors including sex, weight and activity — tracks points consumed throughout the day. B. Eat several cups of fruits and vegetables every day, 2-3 lowfat or nonfat dairy foods, 4-5 servings of nuts, legumes and seeds and 1-2 servings of lean meat, fish or poultry. C. Eat the unprocessed whole foods that our Paleolithic ancestors ate, such as meat, vegetables and nuts, while avoiding grains, sugars, legumes and dairy products.

GREG CROSS

Answers: 1. False. Moderate beer consumption doesn’t create a beer belly. But, consuming too many calories, which could come from beer, will contribute to increased abdominal fat in addition to overall body fat, as would eating too much high-calorie, high-fat foods associated with drinking beer, such as pizza, burgers and fried foods. 2. C (or 33 grams of sugar) 3. Folic acid, a water-soluble B vitamin.

H

ow healthy is your knowledge? Take this quiz about all things nutritional — from optimal diets to preventing colds — to find out. Maybe what you learn will help keep you from falling victim to folklore, or from just fooling yourself.

Page 53


One voice |

A PERSONAL ESSAY

Weighting for love diets and exercise regimens. At one point, during the monthlong all-liquid diet leading t’s St. Patrick’s Day, 2007. She’s telling me up to my operation, I would chew food and she cannot love someone she cannot spit it out just to remember what it was like wrap her arms around. We are both cryto use my teeth. But she — we — would be ing. I weigh 385 pounds. worth it. It’s April. Kathleen Kellenbeck, program Then she closed that door in August. I was coordinator for the Southern Oregon Barleft with my bottles of vitamins, a YMCA iatric Center in Medford, is asking me what membership and lots of medical bills. It felt my reasons are for pursuing a surgical solike I had been left with nothing. lution to my weight. I am describing my Of course, I hadn’t. I had lost a lot of family’s medical history — diabetes, high weight. My waistline had shrunk from a 50 blood pressure and heart disease — and to a 42. I had bought clothing at Old Navy telling her I want nothing more than to for the first time. I had cut beer and soda avoid that fate. I tell my closest friends and out of my diet. The vitamins and exercise family the same thing. I am lying. I weigh had me in the best shape I had ever been in. 385 pounds. The plastic ring wrapped around my stomIt’s May. I am parked in front of a Shell staach would help me maintain my weight and tion, drunk on the last beer I will ever drink, in turn, avoid the weight-related conditions punching my steering wheel and cursing her that have afflicted my family — if I wanted. name. I weigh 350 pounds. Within the year, I was with my fiancée, It’s June. After meetings with dietitians, Emily. The time since has been filled with personal trainers, psychologists, nutritionbeauty, love and laughter — all the things I ists and support groups, Dr. Juan Castillo im- Scott Steussy is a copy editor at The Bulletin. fantasized about and struggled to have with plants a Lap-Band in my abdomen. I weigh His fiancee, Emily Frankie, is an assistant activi- someone else. With Emily, there is no fanties director at The Kenney in Seattle. 315 pounds. tasy. No struggle. It’s August. She tells me she has a boyShe loves me for who I am, without vifriend and we will never, ever be together. She closes her front door. sions of who or what else I could be. Every day I am more thankful It’s the last time I see her face. than I can describe. I am the only one crying. I weigh 310 pounds. Other recipients of bariatric surgery have amazing stories of • • • • • • • • • transformation involving weight-loss numbers in the hundreds. For many people, losing a lot of weight is a frightening necessity. Those stories span years, and involve daily gym sessions and fanatiThreatened with diabetes, joint pain and myriad cardiovascular and cal dedication to a healthy diet. The people in those stories literally respiratory problems, they are searching desperately for ways to worked their butts off, and I guarantee they had better reasons to do avoid an early, super-sized grave. it than I did. Bariatric surgery — gastric banding or bypass — can be a safe As for me? I eat small portions of healthier foods, have cut back on and effective option for staving off obesity-related conditions. For my fast-food intake and find myself outdoors more often. But I left people already suffering from those conditions, bariatric surgery my incentive to put the hard work, time and dedication into weight can alleviate — even eliminate — their symptoms. loss on that girl’s front porch. One day, I may find a new reason to Just make sure you do it for the right reason. Me? I did it for a girl. get back in the gym and drop a few more pant sizes. My fantasy of our blissful future together — her, with the beauty But for now? she had always possessed, me, with my surgically enhanced, chisIt’s May 2012. I weigh 315 pounds. I am happy where I am, with eled features — got me through months of rigorous presurgery Emily’s arms wrapped around me. •

BY SCOTT STEUSSY

I

Page 54

SPRING / SUMMER 2012 • HIGH DESERT PULSE


Heart Center Cardiology St. Charles-Bend Cardiothoracic Surgeons Pediatric Heart Center of Central Oregon

Learn More! American Heart Association www.Heart.org The Heart Center wishes you a happy and heart-healthy 2012.


Pulse Magazine - Summer 2012  

Healthy living in the High Desert

Read more
Read more
Similar to
Popular now
Just for you