SUMMER / FALL 2010
H I G H
D E S E R T
PULSE Healthy Living in Central Oregon
When Ritalin works Youâ€™ve heard the naysayers; now hear some ADHD success stories.
Breaking down the health benefits of brew
Jessica Kelly beats the odds and thrives
Jenni Peskin uses yoga to work out and focus in
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H I G H
D E S E R T
PULSE Healthy Living in Central Oregon
SUMMER / FALL 2010 VOLUME 2, NO. 3
How to reach us Denise Costa | Editor 541-383-0356 or email@example.com • Reporting Betsy Q. Cliff 541-383-0375 or firstname.lastname@example.org Markian Hawryluk 541-617-7814 or email@example.com Breanna Hostbjor 541-383-0351 or firstname.lastname@example.org Alandra Johnson 541-617-7860 or email@example.com Eleanor Pierce 541-617-7828 or firstname.lastname@example.org Lily Raff 541-617-7836 or email@example.com • Design / Production Sheila Timony, David Wray, Andy Zeigert • Letters Send letters on health topics to: E-mail: firstname.lastname@example.org Mail: P.O. Box 6020, Bend, OR 97708 Limit 250 words. • 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 541-383-0356 or e-mail email@example.com. • Advertising Jay Brandt, Advertising director 541-383-0370 or firstname.lastname@example.org Sean Tate, Advertising manager 541-383-0386 or email@example.com Kristin Morris, Advertising representative 541-617-7855 or firstname.lastname@example.org
Treatment of All Foot and Ankle Conditions from Ingrown Toenails to Reconstructive Surgery
Treating Foot and Ankle Conditions for All Ages
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: 8/2/2010
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ADHD: CALMING THE CHAOS WITH STIMULANTS While experts and the public debate, medicated kids are achieving successes their parents never thought possible.
GOOD FORTUNE FOLLOWS BAD Burst brain aneurysm statistics are dire. Jessica Kelly beats the odds.
WE DRINK TO OUR HEALTH Bend’s mad for beer. Can it be good for us?
UPDATES: SINCE WE LAST REPORTED Current developments in past stories.
HOW DOES SHE DO IT? Jenni Peskin’s yoga practice balances mind and body, strength and relaxation.
29 30 33 34
BODY OF KNOWLEDGE Us vs. U.S.: How do Central Oregonians measure up?
SORTING IT OUT: QUICK KIDS’ FOOD FIXES Fast, filling and fairly healthy fare.
GET READY: THE DIRTY 2ND HALF Training tips for this fall sequel to the popular Dirty Half half-marathon.
HEALTHY DAY, OUR WAY Go with the flow in Sunriver.
PICTURE THIS: BONE MATTERS The steel-strong frame beneath our flesh. ON THE JOB COPA’s advice nurse Denise Del Colle loves telling parents what to do.
LAUGHTER: THE BEST MEDICINE Bedside manner of a delivery room dad. COVER PHOTO ILLUSTRATION BY ANDY ZEIGERT PHOTOS FROM TOP: PETE ERICKSON (2), ANDY TULLIS, ROB KERR
HIGH DESERT PULSE • SUMMER / FALL 2010
30 Page 5
NEW SINCE WE LAST REPORTED
Since High Desert Pulse debuted in February 2009, the stories we’ve covered have continued to develop. In this new feature, “Updates,” we check back to see how things have changed. Send your questions to email@example.com. Cancer treatment
Misleading food labels
“Is the treatment worse than the disease?” (High Desert Pulse, Spring/Summer 2010) questioned the current treatment for very early stage breast cancer. Women typically get the tumor removed in a lumpectomy and then have a six-week course of daily radiation. Some have one breast, or even both breasts, removed. Now, more studies are questioning whether that type of aggressive treatment is necessary or beneficial. It may be, these new studies find, that women do not need to have such grueling treatment when their disease is caught in the very earliest stages. One study, presented at the American Society of Clinical Oncology meeting in June, found that women may not need to have all of their underarm lymph nodes removed, which can cause swelling and pain in the arms. Standard practice is to check the sentinel lymph node, the one in which the cancer is most likely to spread first. If that is found to have cancer, doctors then remove the rest of the lymph nodes in a woman’s underarm. The new study found no benefit, for survival or recurrence, from removing more than just the sentinel lymph node, even if that node is found to contain cancer. The second study, published in June in the medical journal The Lancet, suggests women may not need to have the full six weeks of radiation therapy. It found that one targeted shot of radiation therapy done during a lumpectomy surgery is as effective at preventing cancer recurrence as the conventional six weeks. That study followed patients for four years.
On March 3, the Food and Drug Administration notified 17 food manufacturers that the labeling for 22 of their food products, including some of those identified in “Sorting the (whole) wheat from the chaff” (High Desert Pulse, Summer/Fall 2009), violates the Federal Food, Drug and Cosmetic Act. The FDA had previously encouraged companies to review their labeling to ensure the labels were “truthful and not misleading.” The move was hailed by nutrition watchdog group Center for Science in the Public Interest as the “largest crackdown on deceptive food labeling in more than a decade.” FDA officials also said they plan to propose new guidelines for calorie and nutrient labeling on the front of food packages and plan to work collaboratively with the food industry to design and implement innovative approaches to front-of-package labeling that can help consumers choose healthy diets.
— BETSY Q. CLIFF
— MARKIAN HAWRYLUK
Medical marijuana “Marijuana as Medicine” (High Desert Pulse, Summer/Fall 2009) compared the medical value of natural marijuana to synthetic, pill versions of the drug. Oregon ballots will likely include a measure this fall to allow the sale of medical marijuana. If Measure 28 passes, state-regulated, not-for-profit medical marijuana stores would be permitted in Oregon. Taxes and fees from the sale of medical marijuana
would go to the state. Proponents gathered more than the 82,000 signatures needed to put the measure on the November ballot. At press time, the Secretary of State’s Office was still verifying that those signatures came from registered Oregon voters. Regardless of the measure’s outcome, it is already a little easier for Central Oregonians to obtain medical marijuana. Two nonprofits, Mothers Against Misuse and Abuse and The Hemp and Cannabis Foundation, now hold regular clinics in Bend to help patients with qualifying conditions obtain medical marijuana cards. For more information, contact MAMA at 541-298-4202 or clinic@ mamas.org, or THCF at 503-281-5100. — LILY RAFF
New therapy for cerebral palsy “Hyperbaric therapy: who benefits?” (High Desert Pulse, Fall/Winter 2009) examined a local clinic’s use of hyperbaric oxygen therapy on disorders for which it is not yet scientifically proven. Dylan Cain, a 5year-old Corvallis boy with cerebral palsy, underwent 120 experimental hyperbaric therapy sessions at Bend Memorial Clinic, ending earlier this year. His parents and doctors say the treatment coincided with noticeable strides in Dylan’s muscle control, sleep patterns, speech and vision. “It’s been amazing to see,” says Dylan’s mother, Jinger Cain. The family remains in Bend so Dylan can continue the hyperbaric therapy, along with hippotherapy, which is physical therapy performed on horseback. No major studies on hyperbaric therapy’s effects on cerebral palsy patients have been released since this story was published. — LILY RAFF
SUMMER / FALL 2010 • HIGH DESERT PULSE
Cover story |
While debate for and against medication rages,
Kids with ADHD learn to focus BY MARKIAN HAWRYLUK PHOTOS BY PETE ERICKSON
The reality of ADHD
Experts agree that ADHD is not a benign disorder. Children with ADHD are far more likely to have difficulties achieving success in life and are at greater risk for devastating problems.
ared Johnson’s parents used the term “popcorn teaching” to describe the constant staccato of his first-grade teacher calling his name, imploring him to pay attention. Jared … Jared … Jared … pay attention. But as much as Jared tried, he simply couldn’t focus on his work, on the teacher, on the task at hand. “He’s a great child and he wanted to learn, but he physically couldn’t sit still,” said Andrea Thompson, his first-grade teacher. “He would be up and down, up and down, and walking around. He really could not control his body.” And while he wasn’t necessarily bothering the other students, Thompson said, the repetitive attention he required was a constant distraction for everybody. “My interrupting to get him to focus and sit still disrupted the classroom,” she said. As the year went on, Jared fell further and further behind. On a timed reading test where the average first-grader can read 50 to 60 words in a minute, he managed a mere 19. Thompson spoke to Jared’s parents, Kathy and Duke Johnson, about holding him back in first grade. It was about that time the Johnsons went out to dinner with Tom and Debbie Coehlo. Tom, a nurse practitioner, and Debbie, a developmental psychologist at Oregon State University-Cascades Campus, run the Juniper Ridge Clinic in Bend. Kathy Johnson cocoached her daughter’s soccer team with Tom Coehlo, and Jared had often spent
Percentage of children with ADHD who will: Drop out of school 32-40% Complete college 5-10% Have few or no friends 50-70% Underperform at work 70-80% Engage in antisocial activities 40-50% Experience teen pregnancy 40% Experience depression as adults 20-30%
Source: International Consensus Statement on ADHD GREG CROSS
time at the practices and games. Kathy Johnson remembers during one practice they turned around to see Jared, then 6 years old, having shimmied up the basketball hoop, sitting with no shirt, no shoes, 10 feet above the blacktop. “He would just do crazy stuff. He was a risk-taker, just never really thought about what he did before he did it,” she said. “He
doesn’t give things a second thought; he doesn’t have that filter.” When the Johnsons told them of the impending decision about Jared repeating first grade, the Coehlos suggested an altogether different approach: have him tested for attention deficit disorder. “My mind went back to my family, and I had a brother kind of like that,” said Duke Johnson. “My wife, who was adopted, also had a brother like that.” Testing revealed with little doubt that Jared had ADD. His brain was lacking normal levels of chemicals that help make connections between nerve cells, making it almost impossible for him to concentrate on a single task. “When you’re in that near-miss accident and you’re slamming on your brakes and life slows down, that’s focus and concentration, and it’s due to a lifesaving chemical in your brain,” said Debbie Coehlo. “When you don’t have it, you can’t slow down and focus and life is speeding by, so you miss things. You miss instructions and verbal communication. You get frustrated because you miss things and you misread people. You can’t remember things because you only heard part of it.” Attention deficit hyperactivity disorder, or ADHD, differs from ADD because it includes hyperactivity or impulsivity as a symptom. But ADHD has emerged as the term used for the entire group of attention deficit disorders, and while medication strategies may differ somewhat, doctors generally use the same class of drugs to treat them. Based on the test results, the Johnsons opted to try medication with a stimluant, the class of drugs most commonly used to
SUMMER / FALL 2010 • HIGH DESERT PULSE
Jared Johnson was diagnosed with ADD in second grade. Both he and his parents are very happy with their decision to treat him with the stimulant Adderall. Here, Jared practices with his Bend Park & Recreation District baseball team at Stover Park in Bend.
“Night and day,” Kathy Johnson said of the difference in her son Jared after his ADD was treated. “It is really frustrating to me that some people won’t consider medication, because it levels the playing field.” Page 9
Cover story | TREATING ADHD
The Johnsons, from left: Hannah, 15; mom Kathy, 42; Jared, 10 (in the tree); Ethan, 6; dad Duke, 47; and Victoria, 17, at Stover Park.
horror stories, frightening enough to make any parent think twice about medicating a child with stimulants. But lost in the cacophony of warnings are the hundreds of thousands of success stories. The din of warnings and rhetoric have reached deafening volumes, drowning out the true benefits and risks of medication, making it difficult for parents to weigh the pros and cons objectively. The sound and fury often mean parents delay seeking medical and behavioral help, allowing kids to fall further behind, digging a deeper hole out of which they need to climb. “It is really frustrating to me that some people won’t consider medication, because it levels the playing field. You wouldn’t do it if your kid had diabetes; you’d put him on insulin,” Kathy Johnson said. “Because (the medication) is an amphetamine, there’s a stigma. But I’d rather have my kid make good decisions.”
Collateral damages treat ADD or ADHD. Through the first half of second grade, Jared tried one medication after another, month after month. Then the Johnsons tried a new extended-release form of the drug Adderall, and the light went on. “Night and day,” Kathy Johnson said of the difference they saw in their son. “I can’t stress that enough. He sat there, he did what needed to be done. There was no staring off into space. The teacher noticed right away, too. He was just more focused.” Thompson, who had moved up to second grade with Jared’s class, said the change was drastic. “His whole demeanor changed,” she said. “It built his confidence. His whole selfesteem was higher.” Jared described first grade as “hard-ish,” but he now enjoys school much more. “Second grade was easier because I could concentrate,” he said. “First grade, I couldn’t.” He no longer had to stay in during recess because he wasn’t completing his work. He could finish his assigned reading, even if it was right at the end of school, before his daily medication wore off. For the first time, Jared was able to be more than physically present at school; he was mentally present as well. He went from nearly being held back in first grade to being fully caught up academically four years later. In June, he hit all the benchmarks for
“He thanked us. ‘Thank you for putting me on this.’ He knows how bad he is off of it.” Jared’s dad, Duke Johnson
fifth grade. If the Johnsons had any doubts about whether medication was the right choice for Jared, those were dispelled when their son did something altogether unexpected. “He thanked us. ‘Thank you for putting me on this,’” Duke Johnson recalls him saying that second-grade year. “He knows how bad he is off of it.” Reading accounts of medication for ADD or ADHD, you might think Jared’s story is an anomaly: a kid for whom medication reined in inattentiveness and allowed him to succeed at school with no serious side effects. Certainly, media accounts have focused on cases that haven’t gone as well, on kids drugged into a zombie-like state, parents demanding stimulants such as Ritalin to ensure their kids can get into an Ivy League school, or teachers pushing for medication so they can have a class of docile students. Internet sites dedicated to exposing the dangers of ADHD medications are stacked with
There may be no way to quantify how many children are collateral casualties of the Ritalin Wars, a term coined by ADHD experts for the overheated, polarized debate about medication. “The Ritalin Wars is sort of an informal reference to the hyperbolic, polemical style of debate that has just been part and parcel of this issue of ADHD and Ritalin for decades. It waxes and wanes, but it’s been around for decades,” said Dr. Lawrence Diller, whose book “Running on Ritalin” was one of the first to raise the issue of inappropriate ADHD medication. “It seems that anyone who chooses to speak in the public arena, including yours truly, has the potential of being unwillingly enlisted into one side or the other. And in my opinion, it won’t ever go away.” Diller is a classic example. Because his book argued some children were prescribed stimulants too easily, too quickly, he is often cited as an anti-medication advocate. “I do feel that in many communities there’s a quickness toward determining that all forms of misbehavior and performance in school of children is ADHD. That’s where I become uncomfortable,” he said. “But I’m not against Ritalin. You just may want to try other things first that have also worked for a lot of kids, and they don’t need to be on drugs.” The Ritalin Wars, however, have trans-
SUMMER / FALL 2010 • HIGH DESERT PULSE
Attitudes toward psychiatric medication for kids formed an issue shaded in gray, forcing many people into black or white positions. Parents talk about doctors as being pro-med or antimed. Ritalin is either a poison that drives kids to psychotic behavior or zombie-like states, or the equivalent of insulin or penicillin, which would never be denied to an affected child. Some argue that ADHD is solely a genetic issue affecting brain chemistry. Others counter that ADD should stand for “adult discipline deficiency,” that it’s a case of bad parenting, not bad processing. It’s the nature-versus-nurture debate all over again. And that only helps to cloud a difficult decision for parents, causing them to question not only the science and the medicine, but the motivations of doctors and teachers along the way. “I think the Ritalin Wars do keep certain families who might benefit from using this with their child as less likely to use them,” Diller said. “But it works in both ways. Because of the potential eye-of-the-beholder nature of the disorder, the doctor may feel the kid shouldn’t be on it, and the parent says, ‘I think we want him on it.’ But the other thing can also be true: The doctor feels the child could benefit and the parent is terrified.” It doesn’t help that ADHD, like virtually all mental disorders, has no easy, objective measure. There’s no blood test, no brain scan, no rubber hammer that applied deftly to a child’s behavior will give reflexive proof of a real disorder. Because these conditions don’t have any markers, the possibility that children are both overdiagnosed in more affluent neighborhoods where parents have the resources to pursue diagnosis and treatment, and underdiagnosed in underprivileged communities, is very high, Diller said. “And it’s misdiagnosed all over the place,” he said. Statistics make it easy to believe that attention deficit disorders are overdiagnosed. Americans use 90 percent of the world’s legal stimulants, prescribing the medications to kids at 10 times the rate in the United Kingdom, 100 times the rate in France, and 10,000 times the rate in Italy. In Asian countries, diagnoses of ADHD are virtually unheard of, Diller said, except in the most hyperactive kids. Last year The Hastings Center, a bioethics research institute in Garrison, N.Y., held its
HIGH DESERT PULSE • SUMMER / FALL 2010
A 2002 survey showed that the majority of American adults have negative opinions about behavioral conditions such as ADHD and the medications used to treat them. Experts fear that such stigma might discourage parents from seeking care for children with mental health issues. Doctors today are overmedicating children with common behavior problems.
Giving medications to children with behavior problems will have long-term negative effects on their development.
Giving children psychiatric medications when they are young only delays dealing with their real problems.
Medications for behavior problems just prevent families from working out problems themselves.
Getting mental health treatment would make a child an outsider at school.
Regardless of laws protecting confidentiality, most in the community still know which children have had mental health treatment.
Getting mental health treatment for a child would make a parent feel like a failure.
Source: National Stigma Study – Children
Medications for children with behavior problems turn kids into zombies.
Note: Percentages may not add up to 100 due to rounding.
second of five planned conferences bringing together the world’s leading experts on ADHD to separate fact from fiction. The conference identified what it called a zone of ambiguity within the spectrum of ADHD. Because ADHD doesn’t have a single, easily identifiable set of symptoms, diagnosis invariably involves some degree of interpretation and the potential for disagreement even among professionals well-versed in the condition. There are some children for whom the vast majority of professionals would have no difficulty diagnosing or ruling out ADHD. But other children, the experts agreed, fall into that zone of ambiguity in which doctors will disagree. Because symptoms closely resemble feelings and emotions that healthy individuals experience from time to time, the untrained
eye may have trouble discerning whether a child is spirited and rambunctious or suffering from ADHD. They have “variants of normal feelings,” said Dr. Graham Emslie, a professor of psychology and pediatrics at the University of Texas Southwestern Medical Center in Dallas. “It’s clear to pick up the extremes, although they get missed quite often, too. But most cab drivers can tell you where the problems are.”
Public opinion But when the experts who agree on the validity of ADHD as a diagnosis, yet still disagree on whether an individual child within that zone is affected, it opens the door for critics to use that ambiguity to call the entire area into doubt. Dr. Sam Goldstein, a child psychiatrist from Salt Lake City and editor-
Cover story | TREATING ADHD in-chief of the Journal of Attention Disorders, believes much of the current backlash against ADHD diagnosis and treatment has stemmed from an anti-psychiatry movement that enlisted celebrities to promote their crusade against mental health issues. “They started their anti-mental health campaign with ADHD. They made the rounds of the afternoon talk shows, because they couldn’t get their voice heard in the bigger media that was going to do a little more fact-checking,” Goldstein said. “When that happened in the ’90s, there’s research to show that there was a drop, not in people who were already using medicine at the time but in new starts. When the researchers looked at the demographics of that, the drop in new starts were in the demographics of the people who you would expect would be watching those afternoon talk shows.” Goldstein, who at first tried to combat the anti-medication spin with scientific evidence, said he eventually stopped trying to debate the issue in the media because talk shows and news programs seemed to give equal credence to both sides regardless of credentials. Increasingly, attention was being paid to individuals who claimed, whether legitimately or not, that the medication had harmed them, and not to the overwhelming number of children being helped. The anti-medication campaign was so effective that it soon became conventional wisdom that kids were being overdiag-
“I assumed that children were being grossly overdiagnosed and overmedicated. I assumed that society’s neuroses were being turned into pathologies in children. ... How I knew this, I don’t know.” Judith Warner, author of “We Have Issues”
nosed with ADHD and overmedicated by lazy parents pressured by overwhelmed teachers. Several years ago, journalistturned-author Judith Warner set out to write a book about that very notion: how medicating kids for ADHD reflected the worst of America’s “me first” culture. “I assumed that children were being grossly overdiagnosed and overmedicated. I assumed that society’s neuroses were being turned into pathologies in children, that what was being diagnosed as disorders in them was everything that was wrong in the competitive high-performance, driven, anxiety-filled world of childhood and family life in American today,” Warner said. “How I knew this, I don’t know.” She had gone into the project accepting as fact that ADHD medications didn’t work, that they were more for the parents’ benefit than the kids’, a way that parents could convince themselves it wasn’t their fault they couldn’t control their kids. But a funny thing happened while she was researching her book, “We Have Issues,” published earlier this year. The more she
talked to parents of children with ADHD and other behavioral disorders, the more she realized the evidence was pointing in the opposite direction. “Something was wrong. I just couldn’t find answers to prove that I knew what I thought I knew,” Warner said. “Once I listened to parents’ stories, the intellectual construct fell apart.” She found the negative aura surrounding the diagnosis and treatment of children with mental disorders was only adding to the parents’ burden. “These parents not only have to struggle with understanding their children’s disorders and finding the right treatments, but they also have to contend with enormous self-doubt and, often, skepticism and even condemnation from people around them who believe they’re exaggerating their children’s problems and pathologizing them,” she said. “Nobody was rushing to have their kids diagnosed. They all hated giving their children medication.” Far from being overmedicated, Warner found many kids are getting no help at all.
SUMMER / FALL 2010 • HIGH DESERT PULSE
Signals in the brain The brain uses a variety of chemicals, called neurotransmitters, to perform its various functions. Two neurotransmitters — dopamine and norepinephrine — have been linked to attention deficit disorders. They help stimulate and dampen brain cells, allowing signals to be sent from one nerve cell to another. In children with ADHD, these signal connections do not work correctly.
Inability to pay attention appears to be related to low levels of norepinephrine, which prevent children from judging which things in their environment are important. A teacher speaking and a bird flying by the window are equally compelling. Impulsivity and behavioral problems have been linked to low levels of dopamine in the brain. Dopamine helps individuals resist the urge to blurt out something or to reach out and grab something. Stimulants, such as Ritalin, can increase both dopamine and norepinephrine levels. Other medications, such as Strattera, only affect norepinephrine.
1• Neurotransmitters such as
dopamine are released into the space between the neurons, called the synapse. 2• Dopamine attaches to receptors on the receiving neuron, improving signals between them.
Ritalin prevents this reabsorption, allowing more dopamine to remain in the synapse between nerve cells, improving the connection. 4
3• Dopamine is then
reabsorbed into the cell when the signal is complete.
Source: Staff research MARKIAN HAWRYLUK AND ANDY ZEIGERT
While about 20 percent of children are thought to have identifiable mental health issues, ranging from mild to severe impairment, only about 5 percent are being treated for it.
Ruling out meds Even when parents do seek an evaluation to determine whether their child might have ADHD, many rule out medication from the onset. Providers like Sondra Marshall, a licensed psychologist with the behavioral
health department at St. Charles Health System in Bend, often meet parents who want a diagnosis but are unwilling to consider any pharmaceutical treatment. “Whatever camp they’re in, I really do try to join them,” Marshall said. “Because the research is clear: If a family is against medication, nothing that I say or do is going to shift that to the extent that they’re going to join me. I have to join them.” Because they can’t prescribe medications,
psychologists generally send their findings to a child’s pediatrician, who can write a prescription if needed. Many children do just fine with behavioral interventions, making accommodations to help them in school and providing strategies for parents to better meet the challenges at home. But Marshall, who stresses she’s not opposed to either medication or behavioral strategies, said studies have proven the efContinued on Page 39
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Get ready | THE DIRTY 2ND HALF
What comes after the Dirty Half? The Dirty 2nd Half!
Train to run a whole Half BY ALANDRA JOHNSON PHOTOS BY ANDY TULLIS
et’s say a few days a week, you hop on a local trail after work and jog for a few miles. But maybe there’s some part of you that wonders if you could take it to the next level. Running a half-marathon could be just the thing. Thirteen miles (plus a hair extra) is a long way to run, but it is also a totally achievable distance. In about 10 weeks, a runner who can already comfortably run five or six miles should be able to train to run a half-marathon. The key is dedication and taking the right, steady approach. Connie Austin teaches the Learn to Run classes through the Foot Zone store in Bend. She helped train a group of runners to take on the Dirty Half in June. In early August, she will begin teaching a class to prepare runners for the Dirty 2nd Half in October. She thinks running in a race offers people a tangible accomplishment. Many people also enjoy racing with friends or family as a fun challenge to take on together. Austin says a training class can offer incentives because it builds accountability and camaraderie.
Whether or not people join a class, Austin advises runners not to keep their race training to themselves. “Share your goal. By saying it out loud, you have a better chance of sticking to it,” she said.
The runners People who want to run a half-marathon in October need to have a basic fitness and running level already. If you routinely run five miles without stopping, Austin encourages you to sign up for her half-marathon training class. And she said speed doesn’t matter. Some people run nine-minute miles, some run 14-minute miles. “You don’t have to be fast; you have to be motivated,” she said. Rod Bien, owner of Fleet Feet Sports shop in Bend, suggests you should be able to comfortably run 10K (just over six miles) before taking on training for a half-marathon. Austin says people of most ages can run a half-marathon, from those in high school to those in their 60s. She thinks the hardest part of running a half-marathon is not physical, but mental. People see it as intimidating and “fear starts to kick in.”
The race Race Director Dave Thomason designed the Dirty 2nd Half course. This is the second year for the race, which is newer and therefore less popular than its cousin, the Dirty Half. The race starts and ends at Seventh Mountain Resort. The trail loops around to the back of the property and goes up an old horseback riding trail. The hills start around the three-mile mark, and the trail continues up for about four miles. A runner will gain about 1,200 feet in elevation. Thomason says it’s a “good, steady grade.” He says in general this is a tougher course than the Dirty Half, but the time of year is generally more pleasant for running. To train for this race in particular, runners will want to include plenty of hills in their workouts and train primarily on trails, not roads.
Mileage Connie Austin, center, talks with a group of runners during a halfmarathon training class she led in May. Austin will begin another training group in August for the Dirty 2nd Half.
Bien recommends five runs a week, with three key workouts. One run should focus on speed, one should focus on distance, and one should be a relaxing run. He suggests people add hill workouts during the long runs. The other two runs can be of the runner’s choosing.
SUMMER / FALL 2010 • HIGH DESERT PULSE
Both Bien and Austin recommend runners not increase the total miles they run each week by more than 10 percent. Austin recommends running three to five days a week. She says those in training do not need to reach 13.1 miles before race day. They can stretch to make the extra mile or two during the race. Bien takes a different approach, recommending runners be able to reach 13 miles about two weeks before race day. Then they can use the remaining days as a “sharpening period” to cut down on mileage and increase intensity. About a week before the race, the runner can try to go for a six- or seven-mile run, then the week before the race only run in the two- to three-mile range, says Bien. Austin also suggests runners cut down on their running during the last two weeks before the race. “Your longest run should be about two weeks before; then start to ease off.” The week prior to the race, the runner should not run for more than six or seven miles at a time. Then, the week of the race, the runner should run maybe three or four miles and rest the final two days. “The week of the race, really, really take it easy,” said Austin. She says this is particularly important for runners over age 40. “Our bodies take longer to recover.”
Above: A runner navigates a rocky section of the Dirty 2nd Half course.
Training regimens Get to 13.1 miles by race day one of two ways. The Austin-based plan adds miles gradually up to a 13-mile run on race day. The Bienbased plan also adds miles gradually, but a 13-mile run comes before race day. Each regimen begins the week of Aug. 2.
Austin-based plan Total Week distance
Longest run of week
Longest run of week
Austin encourages runners to cross train and thinks core fitness is particularly important. If runners use their core muscles when rotating their bodies, they may not place as much demand on
Run a few 3-4 milers.
13.1 miles on race day
Run three 2-3 milers.
13.1 miles on race day
HIGH DESERT PULSE • SUMMER / FALL 2010
Get ready | THE DIRTY 2ND HALF
Dirty 2nd Half course map
r. tury D Cen / y a w h g i H Lakes Cascade
Seventh Mountain Resort
Elevation profile Marcy Schreiber, of Bend, runs through a rocky, uphill section of the course. their legs. When tackling hills, Bien suggests runners try to relax more on the uphill and “work it more” on the downhill. Austin thinks runners should not run for a day after a long run and older runners may need more rest. “Stress plus rest equals success,” said Austin. She also says runners should pay attention to their overall health, including getting enough
The race When: 9 a.m. Oct. 3 Cost: $25 Contact: www.superfitproductions.com, then click on link to Dirty 2nd Half Foot Zone Learn to Run — Dirty 2nd Half Training Group When: Eight weeks, starts Aug. 7, 8:30 a.m.; deadline to sign up for the class is Aug. 4. What: Geared to runners able to run 5 miles comfortably; includes training plan, running essentials, coaching support, weekly group runs, Dirty 2nd Half race entry Cost: $130, includes entry fee; $150 includes race shirt Contact: Foot Zone, 541-317-9568 or www.footzonebend.com Page 16
4,700 ft 4,500 ft 4,300 ft 4,100 ft 3,900 ft
Source: Dave Thomason
sleep. Austin suggests people follow a basic healthy diet and avoid the urge to splurge after a big run. Bien encourages runners to make sure they are eating enough fruits and vegetables, to eat a few more carbohydrates and to consider eating protein in the morning. Austin thinks people shouldn’t expect training to go perfectly every time. “It’s OK. You have permission to have good days or bad days.”
Equipment Shoes are obviously the most important equipment a runner needs. Most coaches suggest runners go to a shoe store and get an expert fitting, preferably with gait analysis. Shoes typically last about 300 to 500 miles, according to Bien. He says runners should have a dedicated pair of running shoes. Bien thinks runners need to have a good hydration system. Once the runs build to 8 or 10 miles, runners need to carry something to drink. There are devices that help attach a bottle to a runner’s hand, as well as waist packs or backpack systems. While there will be drink stations along the route, Bien recom-
mends runners bring their own drinks. He also recommends runners bring energy gels, which are easily digestible food jellies. They typically have about 100 calories and contain electrolytes and sodium, according to Bien, which can help provide energy. Austin also encourages runners to bring some form of fuel with them. She thinks anytime a runner is going to be out for more than an hour, it’s good to bring along something to refuel. Austin encourages trying different options, knowing some people have a tough time digesting some of the tablets, energy gels and powders available. She prefers bringing along a granola bar (usually something with nuts) and eating small bits while running. “Start experimenting, see what works for you,” said Austin. When it comes to clothing, Bien says runners should go synthetic all the way, from socks to hats. Cotton absorbs moisture and clings to the body, he says, and cotton socks can create blisters. Once the runner has the right equipment and the right plan in place, the rest is just a matter of putting one foot in front of the other. •
SUMMER / FALL 2010 • HIGH DESERT PULSE
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BRAIN ANEURYSMS Front
Beating the odds A blood vessel bursts in her brain, but Jessica Kelly lives to talk about it
A hospital CT scan shows where blood spread after the vessel burst. (Image has been colorized.)
BY BETSY Q. CLIFF PHOTOS BY ROB KERR
hen a blood vessel burst in Jessica Kelly’s brain this spring, she had a good chance of dying instantly. One in four people do. Another 25 percent die within three months. Of those who survive, most have major, life-altering disabilities. Slurred speech, trouble walking, the inability to feed oneself are all common. That Kelly walked away with none of these problems is remarkable. Her improbable survival was partly a matter of luck. But it was also due to quick
HIGH DESERT PULSE • SUMMER / FALL 2010
thinking by her co-workers, swift action by emergency room staff and the expertise of the surgeon who repaired her brain. The journey for this 39-year-old Bend woman, a beloved wife, mother and hospice worker, has not been easy. In fact, it has been harrowing. Her family did not know whether she would live or die, and even days after her initial injury, it looked as if she might not make it. She had emergency surgery. She came within hours of a major stroke, saved only by a late-night transfer to a Portland hospital. She went for months without being able to work, care for her three sons or manage her home. Today, she’s able to do all those things. She has gone back to work as a certified hospice and palliative nurse’s assistant at Hospice House in Bend, where it all started.
Collapse March 10, 2010, began uneventfully. Kelly went through the same weekday morning scramble many American women do.
She scarfed down a breakfast of juice and toast. She put on scrubs and pulled her long, black hair back into a ponytail. She saw two of her sons out the door on their way to Bend High School. Her husband, Mike, an electrical wholesaler who was then unemployed, drove their youngest to Juniper Elementary School. At work, Kelly began the day seeing patients at Hospice House, an inpatient hospice facility where people often spend the last few days of their lives. “It takes a certain kind of person to be able to do this work,” said Jamie Kertay, a registered nurse who works with Kelly. Families come in and out, saying final goodbyes, sometimes relieved, other times inconsolable. Kelly’s good at what she does, Kertay said. “She’s able to anticipate the needs of the family. She’s kind and loving.” That March morning, Hospice House had a routine all-staff meeting. Nurses and other employees filed into a small chapel, sitting around the edges of the room. It was when they were discussing timecards that Kelly began to feel sick. “I wanted
Medicine | BRAIN ANEURYSMS
Anatomy of an aneurysm
to leave the meeting,” Kelly said. “I was just like, ‘I need to get some air.’” She stood up. Suddenly, “she just faded to the floor,” said Lisa Hildebrandt, a staff member who was at the meeting. Kertay, sitting next to Kelly, helped catch her and lowered her to the ground. On the floor, Kelly had a seizure, shaking violently in the middle of the room. Kertay ran to get equipment to take her vital signs. Another nurse, Alice Le Barron, called 911.
Bleeding from ruptured aneurysm
An aneurysm is a balloon-like bulge in an artery. Cerebral aneurysms can be just a few millimeters to several centimeters and usually cause no symptoms unless they burst. When a cerebral aneurysm ruptures, it sends blood into the brain. These ruptures are immediately or imminently deadly in about 50 percent of cases.
Treatment options The primary treatment for a cerebral aneurysm is brain surgery. A neurosurgeon cuts open a patient’s skull, finds the affected vessel and, very carefully, places a clip or clips across the base of the aneurysm to cut off blood flow into it.
Sources: National Institutes of Health, Mayo Clinic, Dr. Ray Tien
A less invasive treatment is endovascular embolization. A catheter is snaked through a patient’s blood vessels up into the brain to deposit coils that fill the aneurysm. The blood is forced Coils back into the normal path of the blood vessel, and a blood clot Catheter forms that seals off the aneurysm.
“911, where is your emergency?” “At Hospice House,” Le Barron replies. “One of our employees has just lost consciousness.” Her voice has the calm control of someone trained to deal with medical emergencies, but her breath is rapid; she’s clearly worried. “Oh dear,” the operator replies. “Are they breathing?” “Yes, she was when I walked out.” “Hold on,” the operator says, “while I alert the ambulance.” There’s background noise, then the operator comes back on. “Do you know, is she breathing?” “Yes she is and she’s speaking now. She says she feels very dizzy.” “OK, but she appears to be completely alert?” “Yes.” The operator’s tone softens. Alert is a good sign. He asks a few questions about her condition.
Le Barron interrupts. “She’s just passed out again.” “Ohhh,” the operator says, his voice dropping. He sounds tense as he reassures Le Barron that an ambulance is coming. The timing of the collapse, though traumatic for the staff, was incredibly fortunate for Kelly. If it had happened at many other times — driving in the car with a child, asleep, in the room of a patient who was barely conscious — Kelly might not have received help so fast. Her outcome, in that case, almost certainly would have been worse. How much worse is anyone’s guess. After the paramedics arrived and stabilized Kelly, Mike arrived at Hospice House, having been called by one of the nurses. He and Dr. Lisa Lewis, the medical director at Hospice House, followed the ambulance the few short blocks to St. Charles Bend’s emergency room.
In the ER Nurses and doctors leapt to Kelly’s side as soon as she hit the emergency room. They knew right away it was serious. A team quickly began checking her vital signs, giving her medications to alleviate symptoms and inserting intravenous lines. Kelly was terrified. She was conscious and confused about what was going on, Lewis said, becoming teary at times. “All these people were yelling orders at her,” said Lewis. Kelly’s head throbbed. “I hurt so bad,” she repeated over and over again. “My head hurts so bad.” Dr. Brett Singer was the emergency room physician on call that morning. He took a quick medical history, noting that this was the first time in her life she’d had a seizure and had no family history of the problem. With that kind of abrupt onset, he said, “aneurysm is the first thing that comes to mind.” With her symptoms, he said, ordering a CT scan to look for bleeding in her brain would be routine, and he ordered one immediately. It showed a massive bleed. Singer immediately called the neurosurgeon on call, Dr. Brad Ward. He took one look at the scan and called another neurosurgeon, Dr. Ray Tien, who specializes in fixing aneurysms. An aneurysm is a bubble in an artery, the blood vessels that carry oxygenated blood from the heart to the rest of the body. Like a
HIGH DESERT PULSE • SUMMER / FALL 2010
might never see her again. Later, while Kelly was being treated, Mike went back home. “I looked it all up on the Internet,” he said. “That sucked.” He learned that very, very few people come through without side effects. While he was online, their oldest son, 17-year-old Derek, came into the room. “Mom’s going to be alright, isn’t she?” he asked Mike. “I don’t know, man,” Mike replied. “I don’t know.”
Dr. Ray Tien, neurosurgeon
The ruptured blood vessel was near the parts of her brain that control vision, smell, leg strength and hormones. In Kelly’s surgery, all those functions were at risk. balloon, when the artery bubbles out, it becomes thinner and weaker. An aneurysm in itself is not dangerous and rarely has any effect. A person can live with an aneurysm for decades without knowing it’s there. The danger is that, as the blood vessel balloons farther and gets thinner, it can pop. There are several risk factors for aneurysms. A family history, high blood pressure and smoking make an aneurysm more likely. Kelly had none of these. No one knows what caused her aneurysm to form or rupture. It could have been, said Tien, that she was just unlucky. Mike, in the hospital waiting room, was in shock. In just a few hours he had gone from drinking a leisurely morning coffee to answering questions and signing papers about Kelly’s power of attorney and the executor of her will. He called his two teenage his stepsons, and told them to leave school. He called Kelly’s parents and her brother. He feared they
It was early afternoon, about three hours since Kelly had collapsed, when Tien began to work on Kelly’s aneurysm. There are two ways to fix a ruptured aneurysm, one in which the skull is cut open and one in which it is not. Tien wanted to try the less invasive procedure first. Tien is the only neurosurgeon in Central Oregon trained in a procedure called endovascular embolization that was first used in the 1990s. A catheter is snaked from a blood vessel in the patient’s thigh through the body and up into the skull to fix the aneurysm from within the blood vessel. Cardiologists commonly use a similar procedure to fix blocked arteries in the heart. An X-ray scan, done shortly after Kelly’s initial CT scan, had shown Tien the location of the ruptured blood vessel in her head. Using the X-ray scan to determine his position, Tien threaded a catheter up into her brain. Once there, his goal was to fix the rupture by sliding small metal coils through the catheter and pushing them into the bubbled-out aneurysm. When it works, the coils bunch up, like a balled-up Slinky, filling the aneurysm and preventing blood from flowing into it. A blood clot forms that seals the aneurysm, preventing further damage. Once he got into the ruptured blood vessel, Tien realized this procedure would not work for Kelly. Her aneurysm was not typical. Most bubble out on one side of the blood vessel; Kelly’s bubbled out on both sides. Tien described it as dumbbell shaped. “There just really isn’t a safe way under these circumstances to fix this from within,” he said. By late afternoon, Tien was opening Kelly’s head. He cut her scalp across the front of her hairline, drilled through her skull just Continued on Page 44
Is it healthy? |
A LOOK AT BEER
We love our beer. Does BY ALANDRA JOHNSON PHOTOS BY PETE ERICKSON
entral Oregonians are known to be a bit beer crazy. Just take a look around. Nearly every bar and restaurant serves up a frothy selection way, way beyond Coors and Budweiser. And we also know how to make the stuff. Bend has seven breweries. That’s one for about every 11,800 people. The poor, suffering public in Portland has only one brewery for every 17,100 people. The High Desert is also known for its fair share of health nuts. Triathletes, marathoners, mountain bikers, kayakers, skiers and on and on — we’ve got plenty of them all.
Above: A lineup of Cascade Lakes brews
And while for some, beer may conjure images of beer bellies, it doesn’t leave quite the same impression here. It’s hard to go anywhere in town and not see someone in athletic gear, just back from some healthy endeavor, on the way to get a beer. So yes, Central Oregonians (athletes included) love our beer. But just how healthy is it? Beyond pleasing our taste buds and quenching our thirst, is beer good for us? There’s no simple yes or no answer here, but we found a few studies that help shed light on this question.
1 Bone density: This may be particularly good news for those crash-prone snowboarders and mountain bikers in our midst who like to drink a pint or two.
density). But the question remained, which beer is best when it comes to silicon content? The answer favors the hoppy styles we’re best known for in the Northwest. India Pale Ales offered the most silicon bang for the buck, because they are made with a lot of malt and hops, both of which contain a lot of silicon. Pale ales also contained lots of silicon. Wheat beers and light lagers tended to contain the least amount, less than half of that found in IPAs. While there’s no recommended daily intake for silicon, the researchers said average daily consumption is about 20 to 50 milligrams. Beer drinkers could consume that much by drinking 2 liters of beer, or 1 liter of some highly hopped beers. Now, before you start guzzling pints of hoppy brew based on this study, there is one caveat: The study didn’t involve any patient data. The conclusion that beers with more silicon will help with bone density is inferred but wasn’t tested.
2 Heart health: Moderate beer drinkers can
it love us? Several studies show a positive correlation between moderate beer drinking (that’s one to two drinks a day) and bone density. One study that appeared in the journal Nutrition in 2009 took a look at nearly 1,700 healthy women in Spain with an average age of 48. Ultrasound tests found greater bone density in beer drinkers compared with those who drank nothing as well as those who drank only wine. Turns out the kind of beer people drink also plays a part. A study released in February from the University of California at Davis examined the silicon content of different styles of beer. Silicon, you see, has been shown in numerous studies to positively impact mineral bone density (women with osteoporosis who supplement their diets with silicon show increased bone mineral
raise a pint to this bit of news. In general, beer drinking is associated with some positive outcomes regarding heart health. (But cry a tear into your third beer, because as soon as you get past that “moderate” label, all bets are off.) For instance, researchers in Israel took a group of men with coronary artery disease and split them into two groups. One of the groups had to drink one beer a day for a month, while the others drank mineral water. The groups ate a similar diet. After a month, the beer drinkers experienced lowered cholesterol, increased antioxidants and a change in blood chemistry that is associated with reduced heart attack risk. The researchers, who published their findings in the Journal of Agricultural and Food Chemistry in 2003, attribute these positive changes to the high polyphenol content found in beer. Polyphenols are compounds that are found in plants and have antioxidant qualities and benefits. A similar study conducted in the Czech Republic reached similar conclusions. The Nurses’ Health Study, which has followed more than 120,000 registered nurses since the mid-1970s, also backs up the notion that a pint of beer is good for the heart. The study showed women who drank one alcoholic beverage (wine, beer or liquor) per day cut their risk of heart disease in half.
3 Xanthohumol: Here’s a bit of great news we can toast regarding the health benefits of hops. Problem is, we’d have to hoist about 450 liters of beer for the health benefits to kick in. A decade ago, researchers at Oregon State University discovered some beneficial properties of a compound called xanthohumol, which is found exclusively in hops. The cool thing about this micronuPage 25
Is it healthy? | A LOOK AT BEER trient is that it may be helpful in preventing prostate and colon cancer and might even be useful as hormone replacement therapy for women. All over the world, researchers are studying the compound. The OSU researchers found xanthohumol is toxic to ovarian, breast and colon cancer cells. They also discovered xanthohumol is a source of antioxidants. While this is exciting news, the amount of the compound found in beer is pretty low. Perhaps in the future, hops may be genetically engineered to contain higher levels of the compound, or brewers may try to brew a beer containing a large amount of xanthohumol.
4 Calories: As we in Central Oregon know (a fact that fails to be noticed in many regions of the country), not all beers are the same. Some are crisp, light and citrus-like; others are heavy, rich and taste of coffee and chocolate. And just as the taste of beer can differ greatly from pint to pint, so too can the calories. Contrary to what people may assume, beer that is lighter in color isn’t necessarily
lighter in calories. In general, calories are likely to increase with alcohol content per volume. So a 12-ounce bottle of Heineken, which is 5.4 percent alcohol, contains 166 calories, while the much darker Guinness Draught, which is 4 percent alcohol, has just 125 calories, according to Realbeer. com. This generalized calorie calculation doesn’t always hold true, but it’s a good rule of thumb. Deschutes is the only local brewery whose calorie counts are available on Realbeer.com. Cascade Ale is the lowest, with 145 calories per 12 ounces, and Obsidian Stout is the highest, with 220. Mirror Pond Pale — the brewery’s most popular beer — contains 170 calories. Sierra Nevada is producing a very caloric offering — Bigfoot. This beer has 9.9 percent alcohol and contains 330 calories and more than 30 carbs per bottle. (Check out the calorie, alcohol and carb content of other beers at www.realbeer.com /edu/health/calories.php.)
5 Colon cancer: Here’s some news beer drinkers won’t be cheering: In a study
Marcel Russenberger, 51, of Bend, laments his empty pint while chatting with Corene Follett, 38, center, and Emily Poole, 30, at the Deschutes Brewery in Bend.
from the American Journal of Gastroenterology in 2005, people who consumed eight or more servings of beer a week had a higher risk of abnormal cell growth in the colon than non-drinkers. People who drank liquor were found to have a similar risk, while those who drank wine had a lower risk. The researchers in New York surveyed more than 2,200 patients who were getting a screening colonoscopy about their alcohol habits and other health factors. People who drank more than eight beers a week (considered heavy drinkers) were more than 212⁄ times more likely to have a colorectal neoplasia (an unhealthy growth of cells), compared with those who drank less. About 20 percent of those who drank eight or more drinks per week had this growth detected through a colonoscopy.
6 Breast cancer: This is more notgreat news, at least for female beer drinkers. Numerous studies have shown a link between alcohol consumption and an increased risk of developing breast cancer. While not specific to beer per se, it certainly applies. The Nurses’ Health Study showed the type of alcohol consumed didn’t seem to matter. It was about the quantity. In essence what the researchers found is that for every drink a woman had on average per day, her risk of breast cancer increased by 10 percent. Another large-scale study conducted by Kaiser Permanente Medical Care Program showed similar results. Women who drank any alcoholic beverage at least once a day had a 10 percent higher risk of breast cancer than those who drank less than one drink per day. Women drinking three drinks or more per day increased their risk of breast cancer by 30 percent. So, what does all this mean? Well, that beer is an interesting and complex beverage, not just in flavor, but also in terms of health. Research will undoubtedly continue and we look forward to reading about the latest findings. While some people may be encouraged or discouraged to raise a glass based on these studies, the best motivator to drink a pint remains the oh-so-delicious taste. •
SUMMER / FALL 2010 • HIGH DESERT PULSE
How does she do it? |
Balancing spirit and body
Yoga, for the inside and out BY ELEANOR PIERCE PHOTOS BY ANDY TULLIS
f you’ve ever been to a power yoga class, you know yoga can be an athletic endeavor, with music pumping and plenty of sweat. But if you’ve ever been to a yoga class at Juniper Swim & Fitness Center taught by Jenni Peskin, you might get the sense that there’s another side to yoga. Peskin teaches yoga part time, in addition to being the longtime executive director of the Human Dignity Coalition, where she works to promote equality and human rights for the lesbian, gay, bisexual and transgender community. As she opens her yoga classes with ancient Sanskrit chants, there’s a clear sense in the room that here, yoga isn’t just a workout. For Peskin, as for many traditional yogis, yoga is a spiritual practice as much as a physical one, though she didn’t always see it that way. She took her first yoga class in college, and at the time, it freaked her out. “The teacher was this Sikh woman wearing a white turban, and I thought, ‘No way. This is too weird.’” After a hiatus, she tried yoga again. The classes were casual; she used a towel as a yoga mat, and a friend who came along had a tendency to fall asleep and start snoring in the final relaxation pose. “It was this pretty enjoyable thing to do,” she said, so she kept it up. It was after she spent time at a yoga retreat in Grass Valley, Calif., that she began developing the spiritual side of her practice. “I still had the mindset that yoga was just exercise, and here people were talking about God, and there was an altar people would bow to,” she said. For a while, she eschewed the spiritual side, but before long, her understanding of yoga started to shift. “It’s a very multifaceted practice,” she said, “not just a physical practice.” Peskin soon discovered Sivananda, a form of yoga that focuses on breath and relaxation. “The philosophy is on teaching the body and the mind proper relaxation,” she said. “We let the heart rest so it doesn’t put a strain on the body.” Having been diagnosed in her early 20s with lupus, a chronic autoimmune disorder that can affect the skin, organs and joints, Peskin
HIGH DESERT PULSE • SUMMER / FALL 2010
“I don’t think of myself as a teacher,” Jenni Peskin said. “I’m just here to share this practice that I have.” Here, she holds Scorpion Pose, or Vrischikasana, while doing yoga on the front lawn of her Bend home.
Meet Jenni Peskin Occupation: Executive director of the Human Dignity Coalition and part-time yoga instructor at Juniper Swim & Fitness Center Activities: Yoga, walking and an occasional run Splurges: Home-baked treats with 5-year-old daughter Morgaine Setbacks: Lupus diagnosis in her early 20s, but she now lives mostly symptom-free and without any medication On body image: Peskin believes in “radical self-acceptance.” “This body does not look like an airbrushed picture in a magazine,” she said. “That’s not my emphasis in life. I’m soft and squishy; that’s how I hold my kid. My belly holds her up.” Page 27
How does she do it? | JENNI PESKIN
Peskin and her daughter, Morgaine, tend to young plants on their back deck. Peskin likes gardening but admits she’s not great at it. “I already killed my first round of seedlings; we’re on our second.”
said any exercise that made her body feel better was welcome. “Yoga has been the one exercise that doesn’t stress my body,” she said. Peskin thinks yoga has helped her live mostly symptom-free and without medica-
tion for her lupus, but she doesn’t think of yoga as a cure-all. “I can have bad days, where my hands hurt, or I’ll have a little chronic fatigue,” she said. “I know I’m really lucky.” Growing up in Los Angeles, Peskin, who
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turns 40 this year, did gymnastics and was a cheerleader. Although she wasn’t overweight, she dieted using Weight Watchers and ran on a treadmill at the gym, trying to get slim for her musical theater auditions. Peskin moved to Bend nearly a decade ago. Her first day in Bend, she met Jay Stalker, whom she later married. The couple had a daughter, Morgaine, now 5, and they later divorced. Now, Peskin doesn’t care for the idea of dieting. She prefers a “radical self-acceptance” stance toward body image. And while she admits to having a sometimes-challenging relationship with food, she tries to live with some basic values in mind. One she likes is the Michael Pollan mantra: “Eat food. Not too much. Mostly plants.” She generally stays away from processed food by cooking at home and eating local or organic food whenever she can. This year, she’s splitting a subscription to a CSA (short for community supported agriculture) with a friend. Each week, she picks up a box of locally grown, fresh, seasonal veggies. When we spoke with Peskin early in the summer, the weekly produce box was mostly assorted greens. “I don’t know what any of it is,” she said. She prefers to cook the greens down to reduce the bitterness, but Morgaine loves raw veggies and will chew her way through most any crunchy green that comes her way. She and Morgaine also love to bake sweets, but Peskin believes in being thoughtful about enjoying those treats. “You can plow through food, or you can do it mindfully,” she said. One reason she has time to bake is that unlike so many other Central Oregonians, she never picked up a skiing or serious biking habit. “I tried learning to ski, but I can’t keep up with everyone, and if I push too hard, I’m going to have a lupus flare-up,” she said. As for bikes, she likes riding around town, but adds, “I am so not a gear head.” She will occasionally go for a run for some cardio, but she also loves just walking. Not too long ago, Peskin said, a friend asked her what lupus had taught her. “It’s taught me to slow down. And ever since then,” she said with a big smile, “I’m like, oh, how much slower can I get?” •
HIGH DESERT PULSE
Body of knowledge |
Us vs. the U.S. See how healthy we really are in Oregon and Deschutes County
BY BREANNA HOSTBJOR
f you’ve ever looked out the window and seen a band of bikers rushing down the road, or headed outside on a sunny day and seen runners and paddlers galore, you might have begun to suspect something about local residents: We’re fit. But can we really draw that conclusion from the anecdotal evidence? For every avid biker you see grinding up a hill, how many people are sitting at home munching chips? How good is our nutrition, really? Use this quiz to test your knowledge of local health statistics compared with the rest of the country, and see if you can get a healthy score.
Where do a higher percentage of people die of heart disease? A. Oregon B. United States
Where is the percentage of people diagnosed with diabetes highest? A. Deschutes County B. Oregon C. United States
The prevalence of women using tobacco while pregnant is highest in which location? A. Oregon B. United States Binge drinking is more prevalent in which location? A. Oregon B. United States
Where do more adults meet Centers for Disease Control and Prevention recommendations for physical activity? A. Deschutes County B. United States
In which location do more adults eat at least five servings of fruit and vegetables each day? A. Deschutes County B. United States
Where are the rates for overweight individuals highest? A. Deschutes County B. Oregon C. United States
1. B. According to data gathered in 2004, 27 percent of deaths nationwide are caused by heart disease, whereas only 22 percent of Oregon’s deaths are due to coronary issues. 2. C. 8.2 percent of people in the United States are diagnosed with diabetes. That rate is 5.1 percent in Deschutes County and 6.5 percent in Oregon. 3. A. In both Oregon and Deschutes County, approximately 12 to 13 percent of women use tobacco while pregnant. In the United States, the rate is 11 percent. 4. B. The national average for binge drinking, or drinking five or more alcoholic beverages in a sitting, is 15.6 percent, slightly higher than Oregon’s 12.8 percent. 5. A. While 49.5 percent of adults in the nation exercise enough to meet the CDC’s standard, 60.9 percent of adults in Deschutes County meet or surpass the same guidelines. This means that they engage in moderate physical activity for 30 minutes or more five or more days each week. 6. A. 31.2 percent of adults in Deschutes County eat at least five servings of fruits and vegetables each day. This is higher than the national average of 24.4 percent. 7. A. Per capita, there are more overweight (but not obese) individuals in Deschutes County, at 38.8 percent, than in Oregon, at 37 percent, or the U.S., at 33.6 percent. This pattern is opposite of the trend seen in obesity: The U.S. has an obesity rate of 23.9 percent; Oregon’s rate is 22.1 percent and Deschutes County’s, 18.3 percent. This suggests that while fewer people in the county have reached a body mass index of 30 or higher, which would make them obese, locally we have a greater number of people who are overweight, or have an index of 25 or higher. Though the local weight problem may skew toward less extreme body mass numbers, there are still more people here at unhealthy weights. Sources: Tobacco Prevention and Education Program, Deschutes County Tobacco Fact Sheet 2009; 2007 and 2009 Deschutes County Health Reports; Centers for Disease Control and Prevention (CDC)/Behavioral Risk Factor Surveillance System Survey Data
Healthy day |
ON THE RIVER
Where sun meets river
Grab your sunscreen and head to Sunriver
BY BREANNA HOSTBJOR • PHOTOS BY ROB KERR
entral Oregon, with its desert vistas, sunny days and wildlands, is an outdoor enthusiast’s dream. And if the late summer and warm beginnings of fall have you hankering to go outside and enjoy nature before wintry weather arrives, then head out to Sunriver for the day. With boating, great food and a nature center, there’s plenty to keep you entertained while you treat your body to a healthy day in the sun.
1. Start the day at Cafe Sintra. While there are plenty of fatty foods available at breakfast time, cutting cholesterol doesn’t mean you should cut this meal from your day. And at this Sunriver cafe, you can choose from several options that will give you the energy to stay active while keeping your arteries clear. The granola trio ($8.50, pictured) has whole grains, vanilla yogurt and seasonal fresh fruit. Colorful fruits not only look appetizing, they pack a wallop of vitamins, and the carbohydrates in the granola will give you the energy to stay strong through the morning. You can also order oatmeal ($6.50), which has been linked in some studies to lowered cholesterol and improved heart health. Add some fresh fruit to this dish ($1 extra) and you can’t go wrong. Both dishes are made from scratch in the restaurant. Cafe Sintra, 7 Ponderosa Road, Sunriver; 541-593-1222 or http://cafesintra.com. Page 30
SUMMER / FALL 2010 • HIGH DESERT PULSE
2. Paddle the morning away. Give your arms and torso a workout when you head down the Deschutes River. If you spend a lot of your exercise time using your legs — runners or bikers come to mind — using your upper body will work muscles that don’t receive as much attention. The Sunriver Resort Marina has a launch site where you can rent canoes, kayaks, rafts and stand-up paddle boards to float down the river. A leisurely trip from the marina to a pick-up point at Benham Butte takes about two hours, though you can certainly make it in less time with more paddling. Or, if you feel particularly energetic, you can paddle both ways, forgoing the free shuttle the marina provides with its rentals. Using a stand-up board is one of the best bets for exercise while floating downstream, and the boards are becoming popular with renters. Best of all, the effort required to maintain your balance while standing will work your core muscles in addition to your arms. Rates for rentals range between $70 and $200, depending on the boat you choose. Sunriver Resort Marina, 57235 River Road; 541-593-3492.
3. Relax at the Trout House. After all that paddling, head over to the Trout House Restaurant, next to the marina. A spinach salad with red onions, feta cheese and vinaigrette ($10, $6 for half) is a good way to get a couple of servings of vegetables into your diet. Spinach is rich in vitamins A and C as well as nitrite. All together, it makes this vegetable a great choice for improving heart health and staving off certain forms of cancer. Or try the seared fresh salmon ($15, pictured) with apricot-garlic mustard, caramelized pears, rice pilaf and seasonal vegetables, which will give you plenty to munch on in terms of flavor and nutrition. Salmon is also full of omega-3 fatty acids that may help manage cholesterol levels. Trout House Restaurant, 57235 River Road, Sunriver; 541-593-8880 or www.trouthouse restaurant.com. Reservations are recommended, so call early.
A great horned owl at the Sunriver Nature Center.
HIGH DESERT PULSE • SUMMER / FALL 2010
4. Explore the outdoors at the nature center. The Sunriver Nature Center & Observatory has plenty of family-friendly activities and classes that are great for learning about natural history. There are nature talks on a variety of topics, and in the evening the center holds occasional owl prowls, where you can walk with a naturalist and learn about Sunriver’s nocturnal animals. The observatory also offers solar viewing from 10 a.m. to 2 p.m. daily. From 9 to 11 p.m. Tuesday through Sunday, you can view the night sky and listen to a presentation about astronomy and celestial space. After Sept. 5, the observatory will be open only on Saturdays, and the night programs will be from 8 to 10 p.m. If guided tours and lessons don’t appeal to you, there’s also the Sam Osgood Nature Trail, which is open all year. The flat path is only about one-quarter mile long, but it offers plenty of great views, chances to see raptors and a botanical garden. Admission to the nature center is $4 for adults and $3 for children ages 2-12. Evening programs cost $6 for adults and $4 for children. Some special events at the center may also have additional fees, so be sure to check with the center if you plan to attend one of them. Sunriver Nature Center & Observatory, 57245 River Road; 541-593-4394 or www.sunrivernaturecenter.org. •
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Picture This |
Bone matters Many people think of bones as being solid, but they are surprisingly hollow. The 206 bones that make up the skeleton come in a wide variety of shapes and sizes. Bones are incredibly strong â€” in some cases the strength of bone is greater than that of concrete. A brief primer about what holds us all together:
Provides the greatest amount of elastic strength and is found in stress- and weight-bearing areas like the head of the thigh bone, or femur. The honeycomb-like structure of the bone makes it both light and strong, much like the framework on a bridge. The voids within the honeycomb are filled with red marrow, which produces various types of blood cells.
The four types of bones
Compact bone Dense, strong and resistant to bending, this type of bone forms a solid mass. In the femur it forms a long, hollow tube. The hollow contains yellow marrow, a store of excess fat the body can utilize for energy during starvation.
Flat The ribs and bones of the skull.
Irregular Multifaceted bones, like the vertebrae in the spine.
The long and short of it Averaging 19 inches in length, the femur is the longest and largest bone in the body. The smallest are the three bones of the ear; the stirrup, anvil and hammer.
Short Small, cube-like bones of the wrists and ankles. Ear bones, life-size. Femur, life-size, crosssectioned through the femur head.
Long Bones of the arms and legs are physically the longest, but fingers and toes are considered long bones, too.
Our bones are constantly rebuilding and repairing themselves through a cellular process called remodeling. 1 Osteoclasts are cells that work as excavators. They eat away areas of bone in need of repair, creating a cavity. 2 Osteoblasts are cells that function as builders. They work like bricklayers, building up and depositing layers of compounds into the cavity left by the osteoclasts, forming new bone. 3 Osteocytes are osteoblast cells that have become embedded into the bone during formation. They are thought to take on a new role as sensors of strain and stress within the bone, summoning other cells for repair.
Keeping your bones healthy Listen to your mother and drink your milk. Calcium is important to bone health, as are vitamins C and D. Weight-bearing activity such as lifting weights or vigorous excercise also helps to maintain bone strength. Maximum bone density peaks in the mid-20s; after that, the ability of bone to remodel itself slowly declines. The most common form of bone
disease is osteoporosis, the diminishing of bone density as we age. More women are affected than men, in part because the reduction of estrogen after menopause affects the ability of womenâ€™s bones to repair and rebuild. The effects of ostetoporosis can be reduced with moderate excercise such as swimming or walking and, in some cases, medication.
Sources: National Space Biomedical Research Institute, National Institutes of Health, The Science Creative Quarterly ERIC BAKER
HIGH DESERT PULSE â€˘ SUMMER / FALL 2010
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Who you gonna call?
Advice line, lifeline BY ALANDRA JOHNSON
urse Denise Del Colle loves anxious moms, the ones who call her up full of fear and worry. Those are her favorites. She loves them so because she feels absolutely confident she can help them. “It’s an opportunity to do a lot of teaching,” said Del Colle, “and to reassure them they are doing a great job.” When they hang up the phone, they will feel more confident and know what to do to help their sick or injured children, she said. For the past five years, Del Colle has served as a full-time nurse working on the nurse advice line at Central Oregon Pediatric Associates. During her shift, she talks to 60 to 80 parents. She diagnoses injuries, rashes, illnesses, traumas and more. She helps with developmental, behavioral and nutritional questions, among others. With H1N1 flu concerns last fall, Del Colle says she received about 110 calls a day. “This is my niche, my calling.”
How it works Del Colle and two other part-time nurses field calls from parents during the day. The service is free to COPA patients. After hours, the calls are sent to an advice line run through Legacy Hospital Registered Nurses in Portland. COPA medical director Dr. Stacy Berube says the doctors see the value of providing this service, which has been in place for more than 20 years. “It’s important we have an answering service because children get sick 24 hours a day.” He says the line is also popular with parents. “It may be the parents’ favorite service we offer.” Del Colle sees the service as a lifeline for parents. “To tell a mother how to heal her child is incredibly meaningful.” The nurses also follow up on many calls. Del Colle believes she is able to keep a lot of families out of the emergency room. Sometimes parents will wait on hold for half an hour or more to talk with her.
SUMMER / FALL 2010 • HIGH DESERT PULSE
Denise Del Colle talks on the phone with a patient’s parent at COPA.
CASCADE MEDICAL IMAGING
In conjunction with Central Oregon Radiology Assoc. Has been awarded the accreditation of
“I can’t tell you how relieved I was to hear Nurse Denise’s voice; I knew she would listen and help us make the best decision.”
BREAST IMAGING CENTER OF EXCELLENCE By the American College of Radiology
Amy Howell, in a thank-you message to Del Colle after a traumatic medical experience involving her daughter
She says less than half of patients end up needing to see a doctor that day. But if she gets the sense that a parent is on edge, often she will recommend a doctor visit. “Sometimes parents just need reinforcement.” She recommends visits to the emergency room very rarely. New mothers, in particular, call a great deal. “They are all so new and sleep deprived,” said Del Colle. While most of the calls come from moms, she is getting more and more from dads. Paying attention is essential to Del Colle’s job. Sometimes parents call in with very worrying cases, and she needs to keep focused. “You can’t be daydreaming about a date last night.” Berube calls Del Colle knowledgeable and experienced. Before Del Colle came to Bend, she worked at a pediatrician’s office in Kona, Hawaii, for 17 years. She has also worked in a pediatric intensive care unit in California. Del Colle, who doesn’t have any children of her own, says she has always loved working with children and parents. She lives on a horse ranch in Sisters.
As the only imaging center in Central Oregon to achieve the Breast Imaging Center of Excellence designation, CMI is continuing its commitment to high quality care in women’s imaging services.
Cases There are a lot of questions about ticks, spiders and hives, and a lot of calls about trauma. Kids slip on the ice or fall down the stairs. A tremendous number of parents call about upper respiratory issues as well as diarrhea and vomiting. Allergies, asthma, sleep terrors — the list goes on and on. While a majority of the advice calls are about infants and young children, Del Colle also gets some calls about teenage adjustment issues, from sex to alcohol. She also talks to parents about clear parameters. She tells them what to look for and how long symptoms can persist without worry. “It makes a parent feel powerful to bring (their child) back to total health and feel good.” Operating under protocol and paying close attention — not to mention her own lengthy experience — give Del Colle tremendous confidence. Which is good, because, as she says, “there’s never a shortage of questions.” •
HIGH DESERT PULSE • SUMMER / FALL 2010
1460 NE Medical Center Dr., Bend, Oregon 97701 To schedule your appointment today, call: 541-382-9383 For all other business: 541-382-6633
Sorting it out
Kid food, improved A look at 10 products BY BETSY Q. CLIFF
he closer to the original food, the better.” That’s the advice from registered dietitian and nutrition specialist Lori Brizee for health-conscious parents. So fresh fruits are in, fruit snacks are out. Brizee helped us analyze common kid fare. Some came out better than you might expect, while others she described as “no better than candy.”
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What’s good: There’s a lot of fat in peanut butter, but most of it is healthy fat. Brizee said this is good food for kids; it contains proteins and will fill them up. What’s bad: PB that doesn’t need stirring, such as this Jif Creamy Peanut Butter, often contains unhealthy trans fats. Although the label on this jar says it contains 0 grams of trans fats, a product may contain up to 0.49 grams of trans fats per serving and still put “0” on the label. Brizee said that’s likely the case for this peanut butter because it contains hydrogenated vegetable oils, which have trans fats. What’s better: Natural peanut butters contain no trans fats and less sugar than some other versions. Look for peanut butters where the oil and solids have separated, Brizee says.
What’s good: The label says Betty Crocker Fruit Flavored Snacks are made with “real fruit juice” and are “an excellent source of vitamin C.” Brizee doesn’t buy it. “There’s not a lot of good things to say about fruit snacks.” What’s bad: With just 20 percent of the recommended daily value in 90 calories of fruit snacks, Brizee wouldn’t count these as a good source of vitamin C. And, with lots of sugar and no other nutrients, fruit snacks are the nutritional equivalent of candy. What’s better: If your kids beg for fruit snacks, get them dried fruit instead. Dried apricots, for example, contain a good dose of vitamin A, potassium, calcium and magnesium, Brizee says.
PHOTOS BY ROB KERR
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MAC ’N’ CHEESE
What’s good: A tuna sandwich is a great lunch for kids, Brizee says. It is low in fat, has lots of protein and will fill kids up enough to get them through the afternoon. What’s bad: This Bumble Bee can of tuna is albacore, which, according to the Food and Drug Administration, contains more mercury than the “chunk light” tuna. In addition, this one is packed in soybean oil, which adds extra fat. What’s better: Chunk light tuna packed in water contains less mercury and less fat. Because of mercury content, the National Resources Defense Council recommends that a 50-pound child eat albacore tuna no more than once a month and chunk light tuna no more than once every nine days.
What’s good: Brizee doesn’t see a lot of good in this package of Kraft Macaroni & Cheese. It contains a little bit of protein and some calcium, but little else of nutritional value. What’s bad: There’s too much salt in here, Brizee says. This macaroni contains about a quarter of all the sodium recommended in one day. What’s better: Brizee says you can make your own healthy macaroni and cheese without much effort. Boil noodles, make a white sauce with 1 tablespoon of cornstarch mixed with 1 cup of milk and pour the white sauce and grated cheese over the noodles. “It’s far better and far less high in salt.”
What’s good: Brizee is impressed Oscar Meyer Premium Smoked Uncured Franks don’t have added nitrates, which are often used as preservatives and may develop into cancer-causing compounds. (Consumer Reports, however, found that even dogs labeled “no nitrates added” contained some naturally.) But, with their high fat content and relatively low protein, Brizee says this isn’t a great food. What’s bad: One hot dog has 160 calories; 81 percent of those come from fat, so “it’s not a good protein source,” says Brizee. One hot dog also contains a lot of salt. What’s better: Brizee says an occassional serving is fine, but on a regular basis, lean ham has much less fat. Burgers are also better, providing protein and iron with less fat. Continued next page
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What’s good: Not much in Capri Sun, says Brizee, as she examines the package. “I don’t see any redeeming value in this.” What’s bad: Lots of sugars and virtually no nutrients. The package says it has less sugar than other drinks, but one pouch still contains 16 grams, more than 3 teaspoons, of sugar. What’s better: “Kids need to learn to drink water,” Brizee says. She suggests getting them a reusable container and having them take that to school or sports.
What’s good: Vitamin A is found naturally in peaches and vitamin C is added to this product, Del Monte Diced Peaches in Light Syrup, to give you a full day’s supply. What’s bad: Del Monte adds sugar, third on the ingredient list, and the canning process depletes some of the nutrients found in fresh peaches, Brizee says. What’s better: Fresh or frozen are better than canned, Brizee says, with less sugar and fewer calories for the same quantity.
What’s good: This is a generally healthy choice, says Brizee, for its calcium content and protein. She says cheese sticks like Frigo String Cheese are good snacks for after school or just before a sports practice.
What’s good: Carrot sticks, like Peeled Baby-Cut Carrots from Eating Right, pack a wallop of vitamin A and contain other nutrients with little downside. What’s bad: Baby carrots spoil faster than large ones, which can sit in the fridge for a few weeks, Brizee says. Big carrots are cheaper and can be cut ahead of time. What’s better: Carrots are great. If you get tired of ’em, Brizee suggests snap peas, cucumbers or bell peppers. “Adding these or other vegetables bumps up the nutrition content.”
What’s good: There are a few nutrients in here — vitamins C and E, niacin — but Brizee says she doesn’t see chips as a healthy choice. “The potato is a vehicle to hold onto the fat.” What’s bad: Each Lay’s Classic potato chip has about 10 calories; about six come from fat. What’s better: Popcorn, particularly if you pop it yourself, is a better choice when you want something salty and crunchy, says Brizee. She also recommends pretzels and wholegrain tortilla chips. •
What’s bad: Like most dairy products, string cheese is high in saturated fat. But unless your child is overweight, Brizee says she wouldn’t worry about the saturated fat from cheese sticks. What’s better: No room for improvement here. Some may prefer the low-cal or low-fat cheese sticks, Brizee says, but they contain just 10 to 20 fewer calories per stick — not a lot of savings.
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Cover story | TREATING ADHD Continued from Page 13 fectiveness of medication. “The research is just so robust,” Marshall said. “As much as I also like to think behavioral intervention is all it will take to support students — and certainly at different developmental milestones there’s going to be a need for more or less of what we’re doing — medication has the most bang for the buck. The medication definitely has a stronghold in terms of positive outcomes.” Parents’ concerns about medications range from worrying about the side effects —or fears about tinkering with a child’s brain chemistry and personality— to a sense of personal failure in raising their child. Others may have concerns when physicians prescribe the drug too quickly, without a full assessment process. “I think that makes them nervous that they can go to the physician and get a prescription that same day without getting ratings from teachers or observations from schools,” said John Carlson, an associate professor of school psychology at Michigan State University in East Lansing. When ADHD experts sought to define the symptoms that make up ADHD, it prompted many doctors to simply use the list as a checklist. With enough symptoms checked off by parents and teachers, some doctors would simply write a prescription without ever seeing the child. Surveys of pediatricians show that approach is less prevalent today, but it may have contributed to the general notion that it’s just too easy to get stimulants for a child. Still, Carlson acknowledges that the backlash over ADHD medication may be creating a barrier to kids getting timely care. “The stigma often gets in the way of parents even considering a med trial,” Carlson said. “I think for some parents and their values and beliefs, it does probably take longer than it needs to, but ultimately that’s right for that particular family.” When parents are opposed to medication, Carlson suggests documenting how a child is doing before and after non-medication interventions. If grades continue to slip and personal relationships continue to suffer, parents may change their minds. “I do find that this type of data really helps parents to break down their negative beliefs
HIGH DESERT PULSE • SUMMER / FALL 2010
How ADHD may be both over- and underdiagnosed A study trying to determine whether children were being overdiagnosed and overmedicated for ADHD found a pretty close correlation between diagnosis and medication rates. About 6.2 percent of the 1,422 kids studied had ADHD, and 7.3 percent were prescribed stimulants, such as Ritalin. But upon closer examination, researchers found a major mismatch. Half of the kids with ADHD were not prescribed stimulants, and more than half of those on stimulants didn't meet the criteria for an ADHD diagnosis. It's why experts argue that ADHD is both over- and underdiagnosed in the U.S.
Total number of children studied
1,422 88 children
met criteria for ADHD diagnosis
prescribed stimulants to treat ADHD
children with ADHD but not prescribed stimulants
children with ADHD and prescribed stimulants
children not meeting criteria for ADHD diagnosis, but prescribed stimulants anyway
Source: Child and Adolescent Psychiatry and Mental Health, The Great Smoky Mountain Study GREG CROSS
and helps them to bring some logic and rationale to even think about the possible benefits of a medication trial with their physician,” Carlson said. Collecting such data generally means partnering with teachers and schools. It’s in the classroom where an inability to focus and control behavior impacts kids most, and so it’s most often classroom performance issues that flag problems and are the best measure of the effectiveness of treatment. Yet parents sometimes don’t even want to admit to the teacher that a child is taking ADHD medication. “There is often a stigma, so much so that parents won’t share information with school
personnel,” Carlson said. That caution may ultimately serve a purpose, making parents and doctors think twice about a decision to medicate or not, taking extra time to ensure they’re making the right choice. “To me, if they’re not cautious, then I go the other way. Let’s make sure your decision is the right one and get you the data you need to prove that the treatment is effective for the concerns that you brought to the physician,” Carlson said. “We might think, wow, parents are overly cautious, but it’s all outweighed by the thinking that the kid can have a little bit better life if they go that route.” Dr. Martin Lakovics, a psychiatrist in Bend, said he’s seen a bit of shift in the way the public views medication for mental illness, in part because of heavy television advertising by drug companies. “There’s much less resistance than there used to be,” Lakovics said. “People are starting to realize this has come into the mainstream of society to some extent. And also, they’re tired of suffering.” While some kids might be able to manage with behavioral support programs, he says, such resources aren’t always available in schools. And parents may not have the time and money to pursue some of the nonmedication interventions. “You don’t use medicine unless you have to, unless the symptoms affect function or suffering. That’s true of all medicine,” Lakovics said. “Is it right to give kids (ADHD) medicine? I think the parents have to decide with the child. Often it’s not controversial. The child feels terrible, too. ‘I’m not functioning in school. I’m being made fun of.’ It’s not fun to be ADHD.” Still, it’s an odd dynamic for a culture that often turns to medication before lifestyle changes to address medical problems. Doctors have found it’s easier to prescribe a cholesterol-lowering drug than to get a patient to eat better and exercise. It may be because ADHD affects children or that it is a mental illness that gives the public pause. “I think the general sense in the press is that we overmedicate. I think there’s some truth to that,” Lakovics said. “On the other hand, if you meet parents or schoolteachers of kids who have been diagnosed with ADHD
Cover story | TREATING ADHD based on their symptoms and the criteria in the (psychiatric manuals), they’re going to tell you, ‘Hey look, we can’t manage this kid.’”
A chance at success That was the case with “Emma,” a 7-yearold girl from Redmond whose real name is being withheld at her mother’s request. She had always been a handful, but in first grade, “all hell broke loose.” “She just wouldn’t listen,” her mother said. “She’s screaming at her teacher, ‘You can’t make me! You can’t make me!’ And she’s running and hiding underneath the table, making them catch her. How can a teacher teach like that?” Emma had no sense of boundaries. She would reach out and grab things, taking things that didn’t belong to her, or touch the other students. Within the first month of the school year, her parents knew they needed to get help. They brought her to a child psychiatrist who, after an exhaustive evaluation, concluded the little girl had ADHD. It didn’t surprise her mother at all. While reading a book about ADHD, she recognized her own daughter in its pages. “I was in tears. This author wrote the book about (Emma). She had textbook, severe ADHD,” her mother said. “So I get a little defensive when I hear people say, ‘overmedicate, overmedicate.’ They have not been around my child. She could not function in a classroom.” Like Jared, Emma went through a series
of medications, trying to find the one that worked for her. Oral medications upset her stomach and they didn’t seem to have much effect on her behavior. Her parents began to wonder whether they were going down the right path. Her father had been prescribed Ritalin as a child and did not look back fondly on the experience. “For me, the guilt was just phenomenal,” her mother said. “But I was getting a phone call from school every single day, for months on end. That was pretty harsh too.” Finally, in March, her doctor prescribed Daytrana, the first ADHD medication to come in a patch. “It wasn’t a gradual difference — it was a huge, night-and-day difference,” her mother said. Now if they have any doubt the medication is working, Emma’s parents only need to wait till the next morning after the previous day’s dose has worn off. They give her a low-dose, short-acting Ritalin when she wakes up to get her through the morning and allow time for the patch to kick in. “Even then, trying to get from breakfast to trying to get her clothes on, she just can’t go from A to B without going completely off the track, without us guiding her,” her mother said. “And that’s on the meds.” For the rest of the school year, the phone calls stopped, and Emma spent more time in her classroom than in the principal’s office. “It’s not a cure-all by any stretch,” Emma’s
mother said. “But overall, there’s no question. We now feel like she can be successful. If she wasn’t on meds, there’s no way she could be successful.”
Removing barriers There also are kids who have horrible experiences with stimulants, and perhaps it’s human nature for people to classify things as good or bad based on their own experiences. But there’s good evidence that when all the proper steps and precautions are taken to reach the right diagnosis, ADHD medications are remarkably safe and effective. “It’s not that medications are good or bad, it’s that doctors and families can do a bad job of figuring out what the problem is,” said
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“It’s not a cure-all by any stretch. But overall, there’s no question. We now feel like she can be successful. If she wasn’t on meds, there’s no way she could be successful.” Mother of 7-year-old “Emma,” who is drawing a picture at left
Dr. Ajit Jetmalani, assistant professor of child psychiatry at Oregon Health & Science University in Portland. Jetmalani said child psychiatrists are increasingly using a new protocol for evaluating children that’s built on the premise that kids will thrive unless something is preventing them from doing so. “If you think about it, the kind of standard parenting approach is, ‘Kids would do well if they wanted to,’” Jetmalani said. “Think about the change in attitude of a parent if you say, ‘Kids will do well if they can.’ If they’re not doing well, there’s something getting in their way.” Rather than seeing behavioral issues as defiance or an unwillingness to follow the
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rules, the new approach assumes that such children can’t behave. It’s up to the doctor and parents to determine what’s standing in their way. Jetmalani said that requires conducting what’s known as a bio-psycho-social review. Doctors determine whether there are biological, psychological or social issues that might be behind the problem. They’ll rule out things like injuries or illnesses that might affect the child’s mood and behavior. They’ll examine his or her environment. How is life structured at home and at school? Is the child getting enough food, enough sleep? They’ll examine developmental issues. Has the child received stable parenting and good attachment, or have things been chaotic? Sometimes fixing other problems can eliminate the behavior problem and the need for medication. But when no other solution is found, medication is a good option, Jetmalani said. “When done properly like that, medication can be a critical, effective and important modality for kids,” he said. If parents are reluctant to use medication, he suggests they work on a way to evaluate whether non-medication approaches are working. But he also realizes many parents will never bring their child to a psychiatrist
or raise the issue with a pediatrician because of what they’ve read or heard about ADHD. “I think that’s absolutely a real concern, and understandably, when doctors do dumb things, it gets published,” he said. “The thousands of patients who I’ve treated and are satisfied and are doing well, they’re not going to hit the newspaper.” In 2004, after reports of teen suicides prompted the Food and Drug Administration to add a black-box warning to anti-depressants, use of the drugs plummeted. But that meant thousands of depressed teens were no longer getting any help, and studies documented a spike in suicides in the following year. “On the other hand, it … caused people to really be thoughtful, to communicate well, and to have proper follow-up after prescribing,” Jetmalani said. “People are much less cavalier now about using psychotropics.” If that same approach is used with ADHD medications because of the backlash, that could in the end help reduce overmedication. While the estimates of ADHD prevalence and stimulant prescription rates are fairly close, the numbers can be misleading. A study conducted in one community, for example, found that about 6.2 percent
Answers in the artwork Experts in child development have used children’s drawings to help evaluate whether a child has attention deficit problems. A recent study comparing artwork of children diagnosed with ADHD (but not yet medicated) with those of other children the same age found several identifying characteristics that point to attention deficit issues. Some of PHOTOS COURTESY Penny and Luke Williams, of Asheville, N.C. those can be seen in the artwork PENNY WILLIAMS created by Luke Williams, 7, of • Details. Drawings by untreated ADHD children Asheville, N.C., whose mother, Penny tend to have fewer extra elements, focusing only Williams, writes the blog ADHD Momma. on the main image. In his second piece of artwork, The artwork at top left was completed several Luke has added more elements to fill the paper. months earlier than the artwork below it, showing • Line quality. Kids with ADHD struggle with the progress Luke made after starting medication. fine motor control, so they have trouble forming Characteristics these experts focus on include: shapes of the objects they wish to portray. In the • Color prominence. Kids with ADHD have first drawing, Luke’s images are hard to define. In artwork in which color is less prominent. It is often his later drawing, he has clearly delineated shapes. used just to outline a form, not to color it in. After Doctors often suggest buying children with ADHD medication, Luke used one color to draw an object pencils with larger, spongy grips to help them with and another color to fill it in. their motor control.
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Cover story | TREATING ADHD of school-age children met the criteria for an ADHD diagnosis, and about 7.3 percent of kids had been prescribed stimulants. But a closer analysis showed a significant mismatch. About half the kids with ADHD weren’t getting stimulants, and about half the kids on stimulants did not have ADHD. “That’s been my experience,” Jetmalani said. “Even though the numbers correlate, my experience is that there’s still a lot of room for improvement.” Nationally, studies show that only 50 percent of children with ADHD are on stimulants, such as Ritalin or Adderall. And there is tremendous variation in the use of stimulants from region to region. “You have areas of the country where practically no child is receiving any stimulant medication and you have other counties where 24 percent of school-age boys are on stimulant medications,” said Clarke Ross, CEO of the advocacy group Children and Adolescents with Attention Deficit Disorder in Washington, D.C.
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Ross believes the variation reflects differences in the training of physicians. “Those docs who have been educated in the guidelines and practice the guidelines, the odds are they’re going to diagnose it correctly,” he said. “But a lot of doctors are prescribing based on their personal experience, which may or may not be evidence-based.” Child psychologists might be more aware of the guidelines and more experienced at making the diagnosis than pediatricians or family practice doctors, but there are only about 7,500 child and adolescent psychologists nationwide and most of them work in academic centers. In Oregon, pediatricians and child psychologist are now trying to establish a psychiatric access line through which primary care doctors can get specialists to help evaluate kids for mental health issues. They’ve also received a grant to work on a telemedicine suite to extend services to rural and under-served areas. Ultimately, with better access to specialists and prudent evaluation, there may be
fewer kids with bad outcomes from ADHD medications. But experts still caution that the risks of medications must be balanced against the risks of doing nothing at all. “I always tell parents it’s my job to make sure that I’m giving a medication that’s effective, not too much that it causes side effects and not so little that it doesn’t do any good. If we stay within that, given the right diagnosis, it’s a relatively safe medication,” said Debbie Coehlo. “If we don’t treat it at all, if we just ignore it, the accident rates go up, criminal behavior goes up, failed relationships go up. It’s like you’re treating diabetes. You have to do something.” That’s why the Johnsons never wavered when it came to getting medication for Jared. They’d seen firsthand through their brothers the consequences of not addressing the problem. “My brother, jail. Her brother, jail,” Duke Johnson said. “We knew it could lead to very serious things, and we don’t want our son to go down that road.” •
Medicine | BRAIN ANEURYSMS Continued from Page 23 above her right eye and removed a piece of bone. Using a microscope, Tien navigated around the blood vessels in her brain. Kelly’s rupture was right in the center, between the two hemispheres of her brain. It was a technical, difficult surgery. The ruptured blood vessel was near the parts of her brain that control vision, smell, leg strength and hormones. In this surgery, all those functions were at risk. Tien’s goal was to cut off the aneurysm by placing two titanium clips, which look similar to tiny high-tech clothespins, across the portions that had ballooned out. That, he hoped, would stop the blood flow into the aneurysm, effectively sealing it off. Mike sat in the waiting room. At about 7:30 at night, after about three and a half hours of surgery, Tien came walking down the hall. “I stood up,” Mike said. “I’ll never forget this; he told me to sit back down. I had the flip of a coin. Either it’s terrible news or it’s just relax, you don’t need to get up, you’re under enough stress already. It was the latter.” Kelly’s operation was a success. Tien had blocked off both sides of the aneurysm, rendering it effectively harmless. For the moment, she was safe.
A setback After an internal bleed, even something as simple as a bruise, the blood begins to break down and the body reabsorbs it. The process is similar after a blood vessel bursts in the brain. But unlike a bruise, where the reabsorption is benign, blood breaking down in the brain can irritate this sensitive organ. Though no one is exactly sure why, the irritation can cause the blood vessels to constrict. If they narrow enough, blood flow to the brain is cut off, which can cause a massive stroke. People may become paralyzed, lose their ability to speak, or even die. Known as vasospasms, these constrictions are a common complication after surgery for aneurysms. Kelly’s medical records indicate she was checked regularly for more than a week after her surgery for vasospasms. Kelly’s readings were all normal, and by Sunday, March 21, 11 days after she col-
Jessica Kelly helps the youngest of her three sons, Seth, with his homework.
At first, she slept a lot. Now, she’s able to clean, cook and help her youngest son with his homework. The boys, tentative with her at first, she said, are “relearning Mom.” lapsed, medical records note that doctors were getting ready to send her home. Tien had left town, sure that the risk period for vasospasms had passed. But later that day, Kelly began acting strangely. “It was instantaneous,” Mike said. “Once the vasospasms hit, she went downhill so fast.” He recalls asking her for her Social Security number, which she “rattles off like nothing,” he said. Two minutes later, he said, she couldn’t pick up a pen. Her right side stopped working; she couldn’t move her right arm or right leg. Her speech became garbled. Her eyes went glassy. It was as if, Mike said, she were looking through him. A physician assistant who had been attending to her thought the problem was psychological, the medical records indicate. He guessed that, though Kelly denied it, she was worried about going home. If the situation did not clear up, he wrote in the records, he would order a psychiatric evaluation the next day. Monday, the medical records note, the physician assistant discussed the case with
Dr. Mark Belza, a neurosurgeon who had taken over Kelly’s care from Tien. Belza suspected the problem might not be psychological, but instead a late onset of vasospasms. A test confirmed Belza’s suspicions. Kelly needed treatment right away or faced the risk of a massive stroke. Vasospasms can be treated using a catheter threaded into the brain. It’s similar to the technique Tien initially used to try to treat Kelly’s aneurysm, and Tien is the only Central Oregon physician trained in it. Because Tien was out of town, Kelly was flown, in serious condition, to Oregon Health & Science University on Monday evening. “She was really hours from having a stroke and not being able to talk,” said Dr. Johnny Delashaw, a neurosurgeon, who received her at OHSU. Had Belza not sent her over when he did, Delashaw added, she likely would have suffered severe brain damage. That night, OHSU staff gave her medication to try to lessen the effects of the vasospasms, but it didn’t work. Early the next morning, Dr. Stan Barnwell, a neurosurgeon, performed a procedure to try to save her brain. Going in through an artery in her groin,
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Barnwell snaked a catheter up through her blood vessels and into Kelly’s brain. He inserted a small inflatable balloon, which he used to force open the narrowed blood vessels in her head, he said. The procedure stopped the vasospasms and saved Kelly from a massive stroke. Her temporary loss of speech and mobility were reversed immediately.
Recovery On April 1, almost three weeks to the day after she collapsed, Kelly came home. Save for a planned overnight stay at St. Charles Bend, for a procedure to close off a bit of aneurysm that Tien had not quite sealed, she has been home since. She’s slowly getting her life back. Friends have helped out. Some, including colleagues at Hospice House, organized a spaghetti feed that raised more than $2,000 to pay some of her medical bills. Mike estimates the total cost will be close to $325,000, though much of that will be paid by Kelly’s health insurance. Kelly went back to work in June. At this point, Tien said, Kelly has no lingering effects. Her risk for another ruptured aneurysm is low, comparable to the risk in the general population. She takes a daily dose of medication, and will need at least one more follow-up appointment, but the treatment already given “should be a cure for her,” said Tien. At first, she slept a lot. Now, she’s able to clean, cook and help her youngest son with his homework. The boys, tentative with her at first, she said, are “relearning Mom.” Kelly still doesn’t recall all of what had happened to her. She doesn’t remember the most traumatic parts of her experience. She didn’t ask, at first, about what had gone on. Only after a couple of months had passed did she begin learning. She asked Mike, she said, after the kids went to bed. Each night, she learned a few more details: who was in the hospital, what did she say, why did things happen as they did. Mike has told her things as she has asked. He said he can’t believe this happened to them, but even more surprising is that she can sit on the couch and tell the story. “For her to be here and being able to do this,” he said, looking at her lovingly, “is just phenomenal.” •
“For her to be here and being able to do this (tell her story) is just phenomenal.”
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Meeting the baby W
arning: I am about to tell you the least shocking thing you’ll ever read. So if you’re here to learn something, turn elsewhere to find out why exercise is good for you or that fried food is bad for you. (Side note: I hate science.) Here’s my revelation: Standing alongside your wife and watching your first child being born is a seriously intense experience. I know, it’s a pretty “duh” statement to make. Considering the number of hours I’ve slept since my daughter was born in late April at St. Charles Bend, I think I deserve a pass. The thing is, people told me watching the birth of my kid would be intense. And it was. It’s a moment forever seared into my brain. But the run-up to that moment is packed with memories, too. After a full day of gradually increasing pain (for my wife, Emily) and a nerve-rattling mix of boredom and worry (for me), I knew there was no turning back when my wife asked for additional painmanagement provisions (aka drugs) and our nurse just smiled. “No more drugs for you,” she said. “You’re going to have this baby.” Over the next couple hours, I essentially had three jobs besides generally comforting and encouraging my wife. They were, in reverse order of importance: Blanket Wrangler: In this role, I was to keep a blanket — which had been placed so Emily could pull on it for leverage — from falling into the doctors’ and nurses’ faces. I failed at this job more than once, forcing these folks to do their jobs as if they had a burqa on backward. Fortunately, they were considerably more competent than I was, even without the benefit of sight. Ice Chips Distribution Unit: At times, this felt like the most vital job in the delivery room. And those times were usually right after I fed my wife a spoonful of ice chips, and right before I fed myself two spoonfuls. That was my process: one for Emily, two for me. It seemed reasonable, given all the hard work I was doing! Submissions The Count (an homage to the Do you have a funny numbers-obsessed vampire health story you’d like to from “Sesame Street”): OK, this share? Send 500 words was probably more important than or less to pulse@bend cooling myself off with ice chips. bulletin.com. Editors will Near the end of the night, it was my select one submission wife’s job to push three times per for each edition. contraction, each push lasting about 10 seconds. The nurse counted for a
while, but at some point I saw an opportunity to help, so I took over. After all, I can count to 10. Which I did, right up until the last few minutes, when things got really intense, and a nurse asked Emily to try to stretch out the pushes. So I began counting a little slower, until it was clear we had only two or three contractions to go. At that moment, I leaned on my zero years of medical training and, just as a contraction was beginning, exclaimed to my wife, “This time, try to go to 16!” in the most encouraging (read: freaking out) voice I could muster. To Emily’s credit, she was prepared to go for it; we got to 10, and while I felt fine (I was willing to wait an extra five seconds for my ice chips, because I am tough), my wife was pretty wiped out, and was no doubt relieved when the doctor said, with a hint of amusement in her voice, “You can stop at 10, Emily.” I was taken aback by this brazen challenge of The Count’s authority. “Huh,” I thought. “We’re not going to get this baby out if we’re not willing to give 110 percent.” Not really. I’m sure what I actually thought was some combination of “This is the most amazing thing I’ve ever done” and “My wife is the strongest person I know” and “Wow, only a few more minutes till we get to meet our first child.” And probably “Thank goodness! Time for ice chips.” • — BEN SALMON, BULLETIN MUSIC WRITER
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Published on Aug 10, 2010