Your health questions answered: A woman’s risk for stroke and “normal” periods

You ask. OHSU health experts answer. This month, our stroke and pediatric specialists are on the hot seat.

Q. Is a woman’s risk of stroke higher than a man’s?

A. Yes. Of the 6.8 million stroke survivors in America, 3 million are men, while 3.8 million are women. The American Heart and American Stroke Associations recently released stroke guidelines that suggest how woman can lower stroke risk. Women who’ve had pre-eclampsia during pregnancy should talk to their doctors about blood pressure since it can mean a higher lifetime risk of high blood pressure or stroke.

To avoid stroke, women on the pill should be screened for high blood pressure; women who get migraine headaches with aura should quit smoking; and women older than 75 should be screened for an irregular heartbeat (atrial fibrillation). Existing recommendations to reduce stroke risk for women and men still apply; manage blood pressure, control cholesterol, exercise moderately, eat healthily and quit smoking.

Q. My 12-year-old daughter is worried her period is too heavy. What’s normal?

A. If your period lasts longer than seven days, requires changing a pad or tampon more often than every hour, or occurs more frequently than every 21-45 days, that may be cause for concern. While heavy periods can be common for the first few years of menstruation, if your period causes you to miss out on daily activities or you have the above symptoms, talk to your primary care provider. Bleeding disorders are a common cause of heavy periods, but they are often easily treated with medications such as birth control pills that regulate menstrual cycles and reduce blood loss. If you have heavy periods, please speak up: Untreated bleeding disorders may lead to related problems such anemia (low iron) which can decrease concentration and increase fatigue.

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Dr. Helmi Lutsep, M.D., is Vice Chair of Neurology and sees patients at the OHSU Stroke Center, which was recently recognized by the American Heart and Stroke Association for achieving the highest level of performance in stroke care.

 

 

Dr. Kristina Haley, D.O., of OHSU’s Doernbecher Children’s Hospital and our Center for Women’s Health, specializes in caring for children and young women with bleeding and clotting disorders and cancer. U.S. News & World Report recently ranked Doernbecher one of the nation’s best in 10 out of 10 pediatric specialties.

 

The dangers of “MDS” and what OHSU is doing about it

As cancer treatments improve, survivors are living longer. The treatments, unfortunately, put some survivors at risk for secondary conditions. About 13,000 cancer survivors in the United States are diagnosed with myelodysplastic syndrome (MDS) each year, typically after receiving radiation or chemotherapy. While these treatments don’t directly cause MDS, they put patients at a higher risk for the disease over time, as the number of new diagnoses is on the rise each year.

Gabrielle Meyers, M.D., a hematologist and oncologist with the Knight Cancer Institute, is working to better understand how chemotherapy impacts bone marrow, making patients more vulnerable to MDS.

Her work received a boost when she won The Leukemia & Lymphoma Society’s Oregon and Southwest Washington Woman of the Year fundraiser in June 2014 by raising nearly $54,000 for a LLS-funded research project that will study MDS. She shared some insights into the latest thinking about MDS and what cancer survivors should know.

Why are cancer survivors at risk for developing MDS?

Cancer treatments, such as chemotherapy and radiation, put some survivors at risk for secondary conditions, such as myelodysplastic syndrome (MDS).

MDS occurs when the bone marrow stem cells have been damaged—usually following chemotherapy or radiation—so that they no longer function normally. Ultimately, there is a risk of this turning into leukemia.

Prior treatment with certain chemotherapies is the most important risk factor for MDS in cancer survivors; the National Cancer Institute provides a list of chemotherapies most frequently associated with MDS. Combining these treatments with radiation further increases the risk of MDS. While some cases of MDS are linked to known risk factors, the cause is unknown in many patients.

There is no medicine that reverses the damage to bone marrow cells; patients are generally given medications to help MDS-afflicted cells function well enough to sustain a bone marrow transplant. While Knight Cancer researchers are looking for ways to prevent MDS after chemotherapy, a transplant is currently the only known cure.

What are the symptoms?

Symptoms of MDS include shortness of breath, feeling tired, paler-than-usual skin and easy bruising. The disease does not always cause obvious symptoms and is usually found during routine blood tests.

What is OHSU doing to combat MDS?

To fully understand how chemotherapy damages bone marrow cells, Knight Cancer Institute researchers are studying blood and bone marrow samples from patients exposed to chemotherapy and radiation and have a diagnosis of MDS or leukemia.

Researchers are also studying new treatments that might be combined with MDS drugs to make the afflicted cells function better.

What advances are we seeing in clinical care for patients who suffer from MDS?

Each patient is impacted by MDS in a unique way. Focusing on what drives the MDS cells in a specific patient, and ultimately understanding why it turns to leukemia, will help physicians make better choices in treatment and have newer drugs that target the problem.

The Knight Cancer Institute is conducting research trials designed to better understand MDS. One study explores whether a combination of Busulfan—a drug used to treat leukemia—and reduced chemotherapy is safe and effective for MDS patients; another ongoing study compares the quality of life in patients who receive a less aggressive combination of chemotherapy and/or radiation before a transplant to patients receiving more aggressive therapies.

Learn more about ongoing clinical trials for MDS patients at OHSU.

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Gabrielle Meyers, M.D., is a hematologist and medical oncologist with the OHSU Knight Cancer Institute. She studies cancers of the bone marrow.

A user’s guide to your thyroid

Body temperature. Appetite. Fatigue. You may be surprised to learn that your thyroid, a small, butterfly-shaped body part right below your Adam’s apple controls all of them — and more.

Like the control tower at an airport, your thyroid directs the behind-the-scenes actions of your body. The thyroid creates two important hormones called triiodothyronine (T3) and thyroxine (T4). T3 and T4 are made with the help of iodine, a chemical found in foods including iodized salt, fruits and vegetables, dairy products and fish.

Several thyroid disorders are common: The most frequent is hypothyroidism, which means your thyroid is not making enough T3 and T4. You might feel tired or cold, gain weight, get dry skin or lose hair. Usually the remedy for hypothyroidism is simple: a daily supplement of T4 hormone.

Hyperthyroidism is the opposite: Your thyroid makes too much hormone. You might lose weight, get heart palpitations or diarrhea, feel jittery or sensitive to heat. Often the cause of hyperthyroidism is your immune system attacking your thyroid; you’ll either need medication to counteract that, or you can disable/remove its target.

Your thyroid also may develop nodules or growths. Most are generally harmless, but some are at risk for containing thyroid cancer. Signs of thyroid cancer may include a lump at the front of your neck, difficulty swallowing, a hoarse voice or coughing blood.

The good news? Thyroid cancer is generally treatable.

It usually involves removal of your thyroid and occasionally additional treatment with radioactive iodine. There are also new therapies available at OHSU, such as chemotherapy specifically for advanced thyroid cancer.

All this is why thyroid health needs to be part of your regular checkup. Make sure your provider examines your neck.

The thyroid is lower than the Adam’s apple and usually closer to the collarbone. If your doctor finds anything needing additional evaluation, seeing a thyroid specialist could be beneficial, especially if you have a family history of thyroid disease.

For more information, be sure to visit the OHSU Thyroid and Parathyroid Center.

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Mira Milas, M.D. is Professor and the Director of Endocrine Surgery at OHSU. Her background includes specialized training in general surgery, surgical oncology and endocrine surgery. She was the founding director of the Thyroid Center at Cleveland Clinic, and is involved in numerous national and international activities in the field of thyroid and parathyroid disease.

 

Annual picnic celebrates OHSU transplant family

It started out as a potluck planned by liver patients in the 1990s. Since then, the OHSU Transplant Picnic has become an annual event for hundreds whose lives have been touched by transplants. The event is an opportunity for transplant recipients and their families to get together outside the clinic setting to share stories, give hope and spend time with their transplant teams.

Clinical Transplant Services Outreach Coordinator Sondra Tootell shares more about the picnic’s history and what it means for recipients, donors and their loved ones.

Can you tell us a little bit more about the day of the picnic? 

The picnic agenda includes transplant group photos, speakers from Donate Life Northwest, Pacific Northwest Transplant Bank and Northwest Kidney Kids, and an activities booth with crafts and face painting for kids and adults alike. After lunch comes what I feel is the best part of the event: the guest speakers. At our last picnic, we heard from the family of a young man who passed away and the recipient of his kidney and pancreas. We also heard from the family of a deceased young woman and the recipient of her liver. Both the families and the recipients had expressed an interest in meeting each other and previously worked with our social workers to make this happen.

Who attends the picnic?

We invite all of the OHSU and VA solid-organ transplant recipients, living donors, families of deceased donors, patients on the waitlists, caretakers, families and friends. The entire OHSU and VA transplant team is invited, including surgeons, physicians, coordinators, social workers, nurses, pharmacists, dieticians and all other supporting staff. We had nearly 500 guests at the 2014 picnic, by far our largest turnout!

Why do they attend?

Our guests tell us they love this event. It gives them a chance to speak with others who’ve had similar experiences. They get to visit with their surgeon and coordinator, whom many haven’t seen in some time. Our waitlisted people have the opportunity to hear stories from those who waited and finally received their transplant – it gives them hope and the strength to hang in there.

I personally love this event because I am surrounded by people who are so happy to be alive! They’ve had their hardships and now many of them are experiencing a whole new life. Families of deceased donors get to see the faces of those who are alive because someone gave them the gift of life, just like their loved one. Our staff love this event and volunteer their Saturday to set up the event, work the registration desk, help at the activities booth, and just spend time with our entire transplant family.

The OHSU Transplant Picnic is held annually on the third Saturday of July. Mark your calendars for next year’s picnic, which will be held July 18, 2015. For more information or to see photos from past picnics, click here.

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Sondra Tootell has been the Outreach Coordinator for Clinical Transplant Services at OHSU since August 2011. She moved to Portland in 2006 to pursue her Master’s degree and started at OHSU in 2006 in Cardiovascular Medicine. Sondra coordinates the Transplant Picnic as well as other outreach programs such as the Combined Transplant Conference and the transplant outreach clinics held in Oregon, Idaho and Washington. 

Ice, ice, baby: OHSU takes on the ALS #IceBucketChallenge

At OHSU, we’re all about stepping up to the challenge – even if it involves a bucket (or multiple buckets) full of ice water.

Recently, several OHSU’ians, including President Dr. Joe Robertson and Doernbecher Children’s Hospital’s Physician-in-Chief Stacy Nicholson, have voluntarily donated and been drenched as part of the ALS Ice Bucket Challenge. The challenge is a viral movement designed to raise awareness about ALS and funds for charities like the ALS Association.

Click here to learn more about the campaign, see what OHSU researchers and clinicians are doing to study and support the ALS community, then watch below as a few of our own get in on the action.

Last week, Dr. Nicholson was nominated by his nephew to take the chilly challenge. He didn’t disappoint:
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Governor Kitzhaber challenged OHSU President Dr. Joe Robertson, and he accepted the challenge with not one but two buckets of ice water:
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President Robertson had a surprise nomination for Laurie Litowinsky, who has worked at OHSU since 1966 and is known campus-wide for her sense of humor. You’ll never guess who she nominated!
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Just for fun: A slow-motion version of President Robertson’s ice bucket challenge!
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A group of OHSU’ians (33, to be exact) gathered to meet Moda Health’s challenge and issue a new kind of challenge – this time, to Congress:
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Have you or someone you know been Ice Bucket Challenged? Share a link in the comment section below.

Your health questions answered: Return to running and spinal surgery

You ask. OHSU health experts answer. This month, our sports medicine and spine specialists are on the hot seat.

Q. “I’m getting back into running after a break. What should I do?”

A: The first thing to consider is your fitness level. Have you been a longtime runner, or are you new to the sport? You should also talk to your primary care provider to discuss any exercise-related health issues. Think about your goals: Do you want to train for a marathon? Or are you aiming to become more active, overall?

Whatever your goal, ease into it. If you ramp up too quickly, you run the risk of overuse injuries such a as stress fractures. Returning to running is also a good time to think about a strengthening or physical rehabilitation program to address any weak areas or muscle imbalances that can affect your running gait and cause injuries.

Q. “I have back pain that goes down to my leg. Will I need surgery?”

A: Pain, numbness or tingling in your back that radiates to your leg can be signs of a pinched nerve in your lower back (lumbar spine). You can also have a pinched nerve in your upper back (cervical spine), which may produce similar sensations down your arm. Pinched nerves can be caused by a slipped/herniated disc or degenerative spine conditions.

Treatments that may help include weight loss, over-the-counter pain medications, physical therapy, steroid injections, chiropractic manipulation, acupuncture and surgery to decompress the impinged nerve. Most pinched nerves will improve within three to six months, but if you experience weakness, extreme pain, lack of control over your bowel or bladder or difficulty walking, talk to your doctor.

Click here if you have questions for an OHSU physician or would like to attend an upcoming “Ask the Health Experts” event.

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Ryan Petering, M.D., is the medical director of the OHSU Sports Medicine program. He specializes in primary care, sports medicine and wilderness medicine.

 

 

 

 Brian Ragel, M.D. of the OHSU Spine Center specializes in general neurosurgical treatment of problems and abnormalities of the spine.

$100 million donation fuels OHSU’s vision to stop cancer

Inspired by our mission to end cancer as we know it, Phil and Penny Knight issued a $1 billion challenge on Sept. 20, 2013. The Knights will give OHSU $500 million if we raise an additional $500 million by February of 2016.

Over the last year, nearly 6,000 individuals from 48 states have stood alongside Phil and Penny by donating to the Knight Cancer Challenge.

And today, an anonymous donor has made the largest single gift to The Challenge to date. With a wish to remain unnamed, one visionary has gifted the Knight Cancer Institute with $100 million to fuel our ambitious vision. This tremendous pledge brings the current total raised to nearly $419,000,000.

So, how will OHSU use these gifts to cure more cancers?

Along with dollars already raised, the most recent $100 million gift will be used to support a full range of Knight Cancer Institute initiatives focused on early detection of cancer, including the hiring of 20 to 30 top scientists and their teams.

The best and the brightest cancer researchers will collaborate on improving methods to identify cancer at its earliest and most curable stage. The $1 billion investment will enable these scientists to focus on discovery and moving the most promising new detection methods and treatments from the laboratory to clinical trials as quickly as possible.

Funds from the state of Oregon in support of The Challenge will also help build new clinical trials and research space for the Knight Cancer Institute on Portland’s South Waterfront.

What can you do?

Learn more at OneDown.orgWe’re attacking cancer on a molecular level. We’re looking for ways to detect cancers earlier, before they become deadly, giving more patients the chance to survive more cancers. It’s a better approach, and it works.

Pledge your support. Give online to help end cancer as we know it. Give in honor of a loved one. Or be inspired by these Knight Cancer Challenge heroes to start fundraising in your own community.

 

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. This collaborative project is made possible by the close partnership between providers in the OHSU obstetrics and gynecology department, the anesthesiology department, nursing and operating-room staff, and our community health-care providers.

As they have for several yearsRenée Edwards, M.D., MBA, associate professor of obstetrics and gynecology and co-director of the OHSU Center for Women’s Health; W. Thomas Gregory, M.D., associate professor of obstetrics and gynecology, and Dr. Julio Gonzalez-Sotomayor, M.D., assistant professor of anesthesia helped me recruit the team and coordinate the surgical mission that took place in Gimbie in February 2014.

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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Rahel 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.

 

 

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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