Hard work pays off for local OHSU research intern

By Maileen Hamto, Communications Manager for the Center for Diversity & Inclusion

Congratulations to OHSU research intern Denise Aquino, a senior at Molalla High School, who was recently recognized as Oregon’s 2013 Migrant Student of the Year for her scholastic achievements while overcoming family hardship.

Denise Aquino became the first student from Molalla High School to receive the statewide honor.

The combination of excellent academic performance, leadership in school activities and community service propelled Denise above hundreds of students throughout the state. An aspiring ophthalmologist, Denise is poised to become the first woman in her family to achieve a college degree!

This summer, Denise is a returning participant in the highly competitive Ted R. Lilley Continuing Umbrella of Research Education (CURE) Intern Program, administered by the OHSU Center for Diversity and Inclusion and funded by the Knight Cancer Institute.

She is one of eight interns taking part in the hands-on research program for promising high school students pursuing careers in the health and sciences. Denise’s journey is just one of many compelling and inspiring stories that embody the drive and determination of OHSU’s Equity and CURE interns.

The application cycle for the 2015 internship programs starts this December. If you have a promising young student in your life, encourage them to learn more: Summer Equity Research Program and CURE Program.

 

OHSU physicians abroad: Improving women’s quality of life in Ethiopia

Once a year, an extraordinary international medical event takes place, an event that puts women’s health ─ and women’s quality of life ─ front and center in Gimbie, Ethiopia.

As they have for several years, Dr. Renée Edwards, associate professor of obstetrics and gynecology, Dr. W. Thomas Gregory, associate professor of obstetrics and gynecology, helped me lead a team of OHSU health-care providers, nurses and surgical medical students to Gimbie, in February.

There, in partnership with Gimbie Adventist Hospital, we provided free surgeries to women with urogynecological issues, especially pelvic organ prolapse.

I grew up in Ethiopia, which led me to help found the nonprofit Footsteps to Healing, which supports and coordinates these trips and the surgeries. This year, Dr. Edwards, a co-director of the OHSU Center for Women’s Health, and I led a diverse team – which included three surgeons, two nurses, two surgical technicians, two anesthesiologists and three residents – who performed almost 50 advanced pelvic prolapse surgeries in just 10 days.

If that sounds like a rigorous schedule, it’s not one that really bothers any of us. I never imagined I would be educated in the U.S. Yet for some reason things kept falling into place. So I now have access to medical skills and treatments that are out of reach for most people in Ethiopia. It just felt natural to help give back to my homeland.

Pelvic-floor prolapse is a silent epidemic among Ethiopian women, deeply affecting the quality of their lives. Pelvic-floor muscles can be damaged during protracted childbirth where there is limited health care. In extreme cases, the damage can result in pelvic organs like the bladder, the bowel and the uterus to “prolapse” out of the body through the vagina. In addition, Ethiopian women experience a lifetime of strenuous physical activity—typically working 13 or 14 hours a day carrying wood and water over mountains—which makes the condition much worse.

A surgery to fix a prolapse costs about $200 in Ethiopia. And that’s 10 years’ income for a family there. So we lead these trips, with assistance from OHSU colleagues, including residents who assist in as many as six surgeries a day—more pelvic-floor surgeries in a single day than they might do in an entire surgical rotation.

This year, we also have some exciting news. The Gimbie program has been so successful that we are intalks to expand the program to a university hospital in the northern part of Ethiopia, College of Health and Sciences at Mek’ele University. We hope this new collaboration will allow OHSU providers not only to provide much needed service, but also to build health care capacity by teaching local providers, building on the successes in Gimbie.

Additional Resources

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Rachel Nardos, M.D.  is an OB/GYN specializing in urogynecology at the Center for Women’s Health and an assistant professor at OHSU. She also holds a clinical position at Kaiser Permanente in Portland.

New women’s health research addresses pain with intimacy

A happy, healthy sex life is an important part of mental, physical and emotional health. But when intercourse becomes painful, it can cause emotional and other issues for couples.

Pain with sex is more common for women after menopause. Estrogen therapy is an option for most, but not for women with a history of breast cancer. A central goal of cancer treatments is to have no estrogen in the system.

Health care providers have long thought that vaginal atrophy was causing the pain during sex. But from my experience treating vulvar pain, I believed that the location of pain was the inner vulva, outside the vagina, and that the problem is a pain condition, not a dryness condition.  I had the opportunity to research my theory thanks to funding by the Center for Women’s Health Circle of Giving research grant awarded in 2011.

I studied 46 women with severe pain with penetration related to lack of estrogen. I focused on the area of the vulva just outside the vagina—a place where a woman can easily apply topical therapy herself. Patients used liquid lidocaine compresses for three minutes just before sex. We also provided a silicone lubricant.

We found that 90 percent could then have comfortable, enjoyable penetration. Male partners did not note any numbing, and women had no pain—and could enjoy intimacy again.

I believe that even women who can use estrogen should also be shown how to focus on the entryway location, rather than inside the vagina, if they are using local, topical therapy for such pain. And if that therapy is not enough to reverse the tenderness, liquid lidocaine is an option.

Learn more about the options we offer at the Center for Women’s Health Vulvar Health Program, or talk to your own health-care provider. Because a fulfilling happy sex life is key to everyone’s overall well-being.

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Dr. Martha F. Goetsch is an OB/GYN at the Center for Women’s Health specializing in vulvar health.

 

 

How to: Healthy summer barbecues and potlucks

Is your summer filling up with social engagements that threaten to derail your healthy diet efforts?

Summer barbecues and potlucks are wonderful, but the typical fare – creamy mayonnaise-based salads, high-fat meats like ribs, and baked goods – isn’t exactly optimal for good health and weight management.

Here are my go-to tips for staying on track all summer long.

Snap Pea & Quinoa Salad from EatingWell.com

  • Plan ahead: If you bring a dish that is healthy and delicious, you know there will be at least one appropriate choice for you to fill up on at the party. I love whole-grain salads – stir together any type of cooked whole grain (e.g., brown rice, quinoa, barley, wheat berries), a mixture of raw or grilled vegetables, and a tangy vinaigrette, and you have an easy, delicious dish that’s packed with fiber and nutrients. I love this Quinoa & Snap Pea Salad, although I usually grill the onions and mushrooms first. These types of salads taste great at room temperature, making them a convenient option at potlucks.
  • Choose your protein wisely: Avoid higher-fat red meats and instead opt for fish or veggie burgers as your grilled protein. You’ll save on saturated fat, cholesterol, and calories, while gaining heart-healthy omega 3 fats (from the fish) or fiber (from the veggie burgers). Fish also cooks faster than meat, and less time on the grill means fewer carcinogens forming on your food.
  • Rethink dessert: We are lucky to live in Portland, where the farmers’ markets are packed with gorgeous and delicious berries, melons, and stone fruit all summer. Instead of sampling the same old baked goods for dessert, try grilling peaches or nectarines, tossing berries with lightly sweetened yogurt, or just slicing a juicy watermelon for a sweet treat that delivers vitamins, minerals, and fiber with minimal calories.

Do you have a favorite tip serving up a healthy barbecue? Share in the comments below!

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Tracy Severson is an outpatient clinical dietitian at OHSU. She moved to Portland from Tucson in 2010, and has worked at OHSU since 2011. Tracy works with the OHSU Surgical Weight Reduction clinic and Cardiac Rehab program, and also provides medical nutrition therapy for General Adult Outpatient Clinics at OHSU.

How important is early detection in testicular cancer?

Today more than ever, patients, providers and researchers are working together to rethink the basis for early detection of cancer. Taking lessons learned from the cancer survivorship movement, we are appreciating that success isn’t only about improving survival rates, but how patients survive. In most cases, success in early detection means that a patient will survive with less intensive therapy that is more cost effective with less interruption to their quality of life.

As a long-term survivor of testicular cancer, and as a young adult cancer specialist, this evolution is apparent to me. Testicular cancer is rare across the general population and yet is the most common cancer of men in their 20s or 30s. With the success of modern chemotherapy, even those men with advanced, metastatic testicular cancer have a very high chance for cure.

For these reasons (low incidence and high cure rate), groups such as the U.S. Preventive Services Task Force have routinely recommended against teaching patients to perform testicular self-exams. Part of their rationale for discouraging self-exams is the reality that some men will find something of concern that then will lead to unnecessary and costly medical visits, imaging tests and blood work ― only to prove it is not cancer after all.

But, imagine you are that man with testicular cancer.

Your chance for cure may be high no matter how early it’s found, but finding it late, when it has spread beydond the testicle, means that to get to a cure you must receive chemotherapy and perhaps endure major surgery. That comes with great cost, financial and emotional.

An economic analysis published earlier this year considered a comparison of all of the expenses in working up men who turn out not to have testicular cancer with that of treating a single man who presents late, with testicular cancer that has spread. For the same cost of treating a single man with a late presentation, we could pay for 313 office visits for men with false alarms.

Even if some of those men without cancer have findings concerning enough to warrant more intense testing, we could pay for 180 visits with ultrasound, or 79 visits with repeated ultrasound and blood tests. In fact, for the cost of treating one advanced case, we could even pay for the complete treatment of three men who actually have testicular cancer at an early stage. And an early diagnosis costs three times less to manage than a late diagnosis; this doesn’t even account for the emotional and physical stress of receiving chemotherapy and/or surgery.

For these reasons, many now feel that testicular self-exam should be recommended, not discouraged, and serves as an example of the evolving thinking around early detection of cancer. Ultimately, at the Knight Cancer Institute, our goal is to improve upon early detection methods by better understanding the initial biological triggers of the disease. We believe it’s one of the most important unmet needs in cancer care today. With more sophisticated early detection tools, we won’t risk unnecessary treatments and procedures. But until those detection methods are a reality, we need to make wise use of the resources we have today to safeguard our health.

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Brandon Hayes-Lattin, M.D. is a board certified oncologist with the Knight Cancer Institute specializing in blood cancers and stem cell transplants. He established and is the medical director of the Knight Cancer’s Adolescent and Young Adult Oncology Program. As a cancer survivor himself,  Dr. Hayes-Lattin is in a unique position to empathize with and understand the needs the young patients he treats.

Pioneering in-home stroke care

By Darren Larsen, R.N., OHSU Stroke Center

Mike Dickinson doesn’t have to go any farther than his home office to see his OHSU neurologist and stroke nurse for checkups. The White City, Ore., resident is part of a pioneering effort to use telemedicine to deliver follow-up care to stroke patients in their homes or nearby clinics. And Dickinson appreciates being able to connect with his Portland-based medical team using his home computer instead of taking time off of work and driving to a larger community.

Indeed, it’s challenging for patients to access comprehensive stroke care in a large rural state such as Oregon, where specialized medical expertise tends to be concentrated in a handful of larger cities. Stroke patients from around the state often are transferred to Oregon Health & Science University, the only Joint Commission Certified Comprehensive Stroke Center between Seattle and San Francisco. But what happens when they leave the hospital and return home? Patients who live in rural areas don’t always have easy access to specialized stroke follow-up care. We’re trying to change that.

Stroke follow-up care has traditionally been provided in a clinic setting that requires patients to travel to larger cities. Distance, weather, jobs and other factors may make it difficult or impossible for patients to make that trip. The OHSU Telemedicine Network has been using secure two-way videoconferencing to treat strokes in the emergency departments of our collaborating hospitals for several years. Now we are using telemedicine to allow a neurologist and stroke nurse to deliver follow-up care in patients’ homes and in clinics no matter where they live.  This allows stroke patients to receive the specialty care they need, while remaining in their local area.

Aggressive management of stroke risk factors such as high blood pressure and cholesterol, starting while patients are in the hospital and continuing after they leave, has been shown to reduce the chances of additional strokes.  Stroke follow-up in a clinical setting has been shown to address these modifiable risk factors.  Some patients can’t return to a clinic, and we don’t feel this should be a barrier to quality stroke care. We’re so convinced of the power of telemedicine to address that need that we’ve undertaken a study to compare management of stroke risk factors between patients who receive follow-up care in clinic and those who receive it in their home using a computer. And patients are enthusiastic about receiving follow-up care via telemedicine.

Take a look at Dickinson’s experience in this video: YouTube Preview Image

 

Protect your eyes from UV light

Residents of the Pacific Northwest often joke that summer doesn’t officially arrive until July 5. While days can be gloomy in May or June, ultraviolet (UV) light from the sun still poses a threat to your eyes this time of year. Clouds and haze don’t block the harmful effects of UV light, whose levels are three times higher in the summer months.

Too much exposure to UV light can raise your risk of a number of eye problems, including cataracts, painful corneal sunburn, growths on the eye (called pterygia) and skin cancer around the eye. The threat is compounded if you are continually out in the mid-day sun, at higher altitudes or along the water, where reflective surfaces intensify the sun’s hurtful rays.

May is UV Awareness Month and eye care organizations such as the American Academy of Ophthalmology and American Optometric Association have launched public education campaigns to raise awareness about protecting eyes from sun damage.

Here are a few eye healthy tips to keep in mind as we approach the summer season:

  • Everyone who is outside is at risk, no matter their eye color, skin tone or age. Your best protection is wearing a broad-brimmed hat and sunglasses that block 99 percent of UV-B and UV-A rays. Try to find sunglasses that cover your eyelids, lashes and the white part of your eye.
  • Keep in mind that some polarized or adaptive lenses (such as Transitions® lenses) don’t always block the full spectrum of UV rays. Although contact lenses and intraocular lens implants may offer some UV protection, sunglasses are still recommended.
  • Babies and children especially need to don sunglasses and hats. Unlike adults, little ones aren’t able to shade their eyes and because their pupils are bigger, are more vulnerable to the sun’s damaging rays. Protective gear will help them avoid serious eye problems from a lifetime of sun exposure.

***

Derek Louie, M.Sc., O.D., is assistant professor of ophthalmology at OHSU Casey Eye Institute. A fellow of the American Academy of Optometry, he specializes in adult eye care with a special interest in medical contact lenses for patients with disorders of the cornea or other  eye conditions. When not seeing patients, he enjoys exploring the cuisines of Portland’s neighborhood restaurants and playing soccer (out of the sun) at indoor arenas several evenings a week.

Calorie-free thirst quenchers

Now that spring has brought warm, sunny days, do you find yourself craving a cold, refreshing beverage? Beware the liquid calories lurking in many drinks!

Calories from fluids typically aren’t filling, meaning you’ll still eat the same amount of food during the day. These liquid calories become “bonus” calories that can easily contribute to unwanted weight gain — not a good thing for your health or the upcoming swimsuit season!

Liquid calories include any beverage that isn’t calorie-free, such as regular soda, fruit drinks (fruit punch, lemonade, etc.), coffee drinks (mochas, sweetened lattes, etc.), sweet tea, energy drinks and sports drinks.

Staying hydrated is important, particularly if you’re outside in hot weather, so I aim for 64 ounces of calorie-free, caffeine-free fluids every day. Water is always a great choice, but what should you do when craving a sweet drink?

Try these tips for tasty and healthy thirst quenchers:

  • Fruit juice spritzers: 100 percent fruit juice is all-natural, but the calories add up quickly. Fiber-filled whole fruit is always a better choice. Try mixing four ounces of 100 percent fruit juice with 16 ounces of sparkling water, or squeeze lemon or lime juice into club soda for a refreshing spritzer. If you’re a regular soda drinker, the carbonation will help satisfy your craving for fizz.
  • Herbal teas: A delicious way to get flavor without any calories, sugar or caffeine is by making herbal tea. Many of my patients love The Good Earth’s Sweet & Spicy herbal tea, and I am addicted to the various fruity herbal teas at adagio.com (piña colada is my favorite—I drink it iced all summer long!).
  • Infused waters: Another tasty, low-calorie option is to add herbs, fruit and even vegetables to a large pitcher of water and steep overnight; the next morning you’ll have a delicately-flavored beverage that’s both refreshing and beautiful. I like the recipes at infusedwaters.com.
  • Other calorie-free drinks such as Crystal Light or Mio are also fine to include.

Some drinks with calories also provide other essential nutrients, such as the protein and calcium from low-fat or fat-free milk (or soy milk)—include eight ounces of skim or 1 percent milk (or soy milk) as part of your 2-3 servings of dairy each day.

Hopefully these tips will help quench your thirst and whittle your waistline this spring!

***

Tracy Severson is an outpatient clinical dietitian at OHSU. She moved to Portland from Tucson in 2010, and has worked at OHSU since 2011. Tracy works with the OHSU Surgical Weight Reduction clinic and Cardiac Rehab program, and also provides medical nutrition therapy for General Adult Outpatient Clinics at OHSU.

A Mother’s Day Thank You

Judy Orem always knew she wanted to be a mom.  She and her husband, Frank, built their lives around their two children, Peter and Nancy.

When Judy was diagnosed with chronic myelogenous leukemia (CML) in 1995, the prognosis was grim. She likely would be dead in five years. But Dr. Brian Druker, a researcher at OHSU, was  launching  testing that would lead to a clinical trial using a drug that would become known as Gleevec®. In January of 1999, she and Frank traveled from their home in San Francisco to Portland, Oregon, hoping for a miracle.

Now, each day Judy is making history as one of the first patients to receive this life-saving treatment, which was approved by the FDA thirteen years ago today. Today, patients taking Gleevec have the same life expectancy as the general population.  Judy’s life is full with gardening, traveling and taking on projects like helping with her high school’s centennial celebration.

Because of Dr. Druker’s discovery, Judy was able to become a grandmother, and—this Mother’s Day—is planning surprises for her daughter Nancy with her grandchildren Ryan and Elizabeth.

“I want to say thanks to Dr. Druker and Oregon Health & Science University,” Judy said. “Because of Gleevec, I’ve had 15 more Mother’s Days with my family that might not have been.”

Learn more at onedown.org.

OHSU Celebrates Asian Pacific American Heritage Month

Learn about diverse Asian Pacific Islander (API) American communities at two events hosted by the API Employee Resource Group to celebrate Asian-Pacific American Heritage Month.

The month of May is celebrated across the country as Asian-Pacific American Heritage Month, an opportunity to recognize the contributions of diverse API communities in the United States. According to the 2010 U.S. Census, there are 18.5 million Americans who identify as Asians and Pacific Islanders. At 43 percent, the rate of growth of the Asian-American population is the largest among all racial and ethnic communities since the 2000 census.

Oregon is home to more than 154,000 API residents that represent a wide variety of ethnic groups, including Chinese, Vietnamese, Filipino, Korean, Indianand more.  API communities include native Oregonians and newcomers who come from diverse national histories, linguistic and religious backgrounds. Here at OHSU, APIs represent about 10 percent of our total student, faculty and staff population across all academic programs and mission areas.

OHSU’s emerging API Employee Resource Group invites the OHSU community to these upcoming conversations. Both events are free and open to the public.

Speaker, Ronault “Polo” Catalani

May 15Noon-1 p.m. at the OHSU Auditorium (Old Library):  Ronault “Polo” Catalani, J.D., an activist-lawyer will present on “Families Move: Facts and Fears About Human Migration.” In his role as manager of New Portlander Programs at the City of Portland Office of Equity and Human Rights, he works with immigrant and refugee community partners to develop and deliver valuable city services to their robust neighborhoods. The vehicle for newcomer integration is civic engagement, the goal is participating in democracy. Polo is well-known in the community for his advocacy work, as well as his column in The Asian Reporter.

May 17, 8:30am-3pm at the Center for Health & Healing: Join the Asian Pacific American Network of Oregon’s 6th annual State of Healthcare Cultural Competency Community Forum for “Stronger Families, Stronger Communities.”

May 29Noon-1pm at the BICC Gallery: Join us for a panel discussion among OHSU faculty and providers on the topic of cultural competent care.

Panelists will discuss their personal and clinical experiences in providing culturally competent care for API and other diverse patients. The discussion will touch on psychosocial and cultural facets that are unique to API communities, and highlight each provider’s unique perspectives about integrating a patient’s belief systems into their treatment or care plan.

Confirmed panelists include:

• Anna Marie Chang, M.D., M.S.C.E., assistant professor, Department of Emergency Medicine

• Amy Mee-Ran Kobus, Ph.D., M.C.R., assistant professor, Department of Psychiatry

• Frances Lee-Lin, Ph.D., R.N., O.C.N., C.N.S., associate professor, OHSU School of Nursing

• John Ng, M.D., F.A.C.S., orbital trauma specialist and a member of the Division of Oculoplastic and Orbital Surgery at the Casey Eye Institute

For questions, to request accommodation to attend either event, or to learn more about the OHSU API Employee Resource Group, contact cdi@ohsu.edu or visit www.ohsu.edu/diversity.

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Maileen Hamto is Communications Manager for the Center for Diversity & Inclusion, which leads and supports university-wide initiatives to create a culture of respect and inclusion for all people.

OHSU Health Fair at Pioneer Square.

Why 96,000 Square Miles?

President Robertson is fond of saying that OHSU has a 96,000 square mile campus, serving Oregonians “from Enterprise to Coos Bay, from Portland to Klamath Falls.”

This blog aims to highlight that breadth. 96,000 Square Miles (96K for short) will focus on the people of OHSU, the Oregonians we serve and the ripple effect of our work in Oregon and beyond.

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