An alliterative journey: on mental health, multidisciplinary management, medications, mindfulness and more

M3 LogoIn this week’s entry, I am proud to introduce readers to a novel research project here at OHSU called Meals, Mindfulness and Moving Forward (M3). Before doing so, however, it’s important to talk about mental health, psychosis, and Oregon’s Early Assessment and Support Alliance – an essential partner in the M3 Pilot Study.

Mental health, the capacity to meet emotional and intellectual challenges at different developmental stages, is among parents’ greatest concerns. Thus, when a child, or more often an adolescent or young adult’s developmental path suddenly becomes fraught with obstacles – personality changes, memory problems, even hallucinations or unusual, frightening ideas – families are often alarmed and at a loss for what to do.

What I just described is what happens when young people are showing signs of psychosis. Psychosis is a generic term that sometimes refers to mania (characterized by an episode of extremely heightened emotion, diminished need for sleep, reckless behavior, rapid speech, thoughts that seem to dance from one idea to another) or schizophrenia (which may involve hallucinations, delusions, or a loss of functioning).

When a young person demonstrates these signs, families often wonder:

  • Will my child always struggle with this?
  • What can make this better?
  • What will make it worse?
  • Can my child achieve his or her dreams?

To this last question, a decade ago some brave Oregonians answered with an emphatic: “Yes!” This group, centered in Salem, Oregon, formed the Early Assessment and Support Team (EAST). EAST’s mandate was to research and implement best practices when it came to supporting young people impacted by psychosis.

Two of the central tenets of EAST were that the earlier we intervene with adequate treatment, the better, and that families, friends, and those surrounding a young person are not a barrier to recovery but are instead essential to recovery – no more treating individuals in isolation! Engaging families and providing good service coordination and nursing and psychiatric care, along with school, employment, and housing support helped young people get out of the hospital and stay out. They were working, learning, and growing. Well, word spread of EAST’s success and eventually EAST became EASA — the Early Assessment and Support Alliance, now active in nearly every county in Oregon. You can learn more about this unique, multi-disciplinary approach to mental health treatment at

One dilemma in EASA programming, which is shared with “early intervention” programs around the world, is that, while some young people achieve recovery without use of antipsychotic medicine, many individuals find antipsychotics key to overcoming challenges. Unfortunately antipsychotics usually promote weight gain and this side-effect, combined with decreased motivation or fear of leaving one’s home, can cause many young people significant, lifelong health problems. To meet this challenge, generous donors brought together Dr. Lynne Shinto, a naturopathic researcher in the Department of Neurology and me, a child and adolescent psychiatrist here at OHSU Doernbecher Children’s Hospital. Together with research coordinator Andie Thompson, MsCN, we built a lifestyles’ intervention program aimed at promoting resilience and fitness in young people impacted by psychosis.

In our study, we have partnered with the Clackamas, Multnomah, and Washington County EASA Programs to recruit 20 participants ages 15-25 and 20 study partners (individuals who may help the work continue outside of sessions) to come to OHSU’s Center for Health and Healing for a 6-week lifestyles training program that involves mindfulness meditation, yoga and other light activities, as well as hands-on cooking/grocery shopping instruction.

The primary aims of our multi-modal study are to find out if people show up and enjoy the sorts of activities we’ve planned. Meanwhile, we are also collecting data on weight and cholesterol, on psychiatric symptoms, as well as a self-report measure of resilience—one’s internal sense of being able to meet a challenging thought or interactions—which research suggests is enhanced by mindfulness meditation.

We hope that qualitative and quantitative data from this pilot project helps EASA and other early intervention programs develop creative means of engaging young people in healthier eating, activity and mindfulness practices. Click here to learn more about the M3 Study and our valued collaborators (including Street Yoga and local chefs Sonny DiMartini and Arielle Clark). Stay tuned for an update on our outcome measures!

Craigan Usher, M.D.
Clinical Associate Professor
Oregon Health & Science University
Consultant, EASA Center for Excellence at Portland State University

Doernbecher Freestyle: A physician’s point of view

Ten-year-old Emory was diagnosed with advanced chronic kidney disease last year. Her pediatric nephrologists, Dr. Sandra Iragorri and Dr. David Rozansky, were so impressed by Emory’s positive attitude, they nominated her for the Doernbecher Freestyle program.

We sat down with Dr. Iragorri to learn more about Emory.


How does the Doernbecher Freestyle program benefit our patients?

Working with world-class sports apparel designers is a once-in-a-lifetime opportunity. Being selected for the program – and then seeing your work of art exhibited for everyone to see – is an amazing way to recognize the strength of what our children have to go through, and what we ask the families to go through. I think it’s a very nice way to recognize how much we value them as people and as families.

It’s also a wonderful way for Nike to give back to their community and to recognize the true spirit of the Northwest, of Portland, of children in general. It’s a very beautiful way to give back.

Why did you nominate Emory to become a Doernbecher Freestyle patient-designer?

Emory is a very lovely and articulate young lady, and she’s very obviously artistic and creative (just look at the kidney-themed drawing she made for Dr. Iragorri, below!). She has a very, very supportive and lovely family. I thought this was a nice opportunity to acknowledge and recognize Emory as a person who’s had to really learn to live with her recent diagnosis – It was like a bomb dropped in her lap, but she’s been extremely brave. She’s been very good about blood tests and daily injections and coming to see us. She just seems to fit the bill!

What do you like about working with kids like Emory?

I like to see them feel better and I like the connections I make with children and their families. This connection is from the heart, and it’s what keeps me going. Plus, kids are fun! You can be silly, and that’s always good.

Will you be at the Doernbecher Freestyle auction on October 23 to see Emory’s designs and cheer her on?

Yes! It will be my first time.


Meet Emory and the rest of this year’s incredible Doernbecher Freestyle patient-designers here – and save the date for the big collection reveal at our auction on October 23!

Additional coverage: “Salem 10-year-old designs shoe with help from Nike” via the Statesman Journal

An important message from Doernbecher Freestyle patient-designer Jacob

Hello! It’s Doernbecher Freestyle patient-designer Jacob Burris here. My shoe designs are coming along great. I hope that they are going to blow your minds!!!

I wanted to share a little something about myself and other congenital heart defect (CHD) survivors. A lot of people tend to think that I am all better now, or “fixed” after my heart surgery. Well, the truth is that most people with a CHD have to take medicine to regulate their blood pressure, like me. Others may have to eat special diets or even have to limit their activity. It is really important for all CHD patients to have regular check-ups with their heart doctor throughout their entire lives. Even though a person may have survived their heart surgery, their life is still at risk

I survived my heart surgery and I still take medicine every day. I also check my blood pressure twice a week so I know if it changes. I didn’t feel any different when my blood pressure was high so I like to remind others to check their blood pressure because something could be wrong and you might not even know.


Jacob’s mom wrote a post about Jacob’s heart story, too. You can read that here. You can also learn more about Jacob and how he’s helping spread the word about heart health on his website or follow along on his “Jacob’s Heart Story” Facebook page!

Meet Jacob and the rest of this year’s incredible Doernbecher Freestyle patient-designers here – and save the date for the big collection reveal at our auction on October 23!

Additional coverage: “Jacob Burris, 13, preaches blood pressure checks, adds ‘Nike clothing designer’ to his resume” via The Register Guard, “Local middle schooler designs Nike shoe to benefit Doernbecher” via Eugene Weekly


Jacob’s heart story

Burris FamilyBelow, Janice Burris shares her son’s Doernbecher story. Thirteen-year-old Jacob is one of our 2015 Doernbecher Freestyle patient-designers, and he’ll be following up next week with a post of his own!


Jacob was born a healthy baby boy thirteen years ago. He has grown up to be a great student, a dedicated athlete, and an all-around great person. Last May during a routine well-child/immunization visit to the pediatrician, we learned that Jacob had high blood pressure and a heart murmur that had never before been detected.

After follow-up tests were performed up at OHSU Doernbecher Children’s Hospital, Jacob was diagnosed with a heart condition known as a coarctation of the aorta. The aorta is the largest vessel attached to the heart. Jacob’s aorta had a pinch in it, much like a kink in a hose. The kink was causing very high blood pressure above the kink in his upper body, and simultaneously causing very low blood pressure below the kink, leaving his lower extremities in a state that is comparable to dehydration. In fact, the only way Jacob was getting any blood flow beyond his kink was by developing a bunch of small compensatory vessels beginning above the kink and ending below it. This was his body’s way of adapting to his specific situation in order to get blood flow to the lower portion of his body, and at that point it had been doing so for 12 years.

Last July, the cardiology intervention team at OHSU attempted to open up this kink by adding a stint. At this time, the intervention team discovered that what had been previously considered to be a kink was virtually disconnected, and repairing it would require heart surgery.

On September 5, 2014, Jacob underwent heart surgery. The incredible pediatric cardiac surgical team at OHSU successfully grafted a carbon-based tube in place of the disconnected portion of his aorta. The surgery itself took about seven hours and his recovery went well.

Jacob has since had two subsequent hospitalizations. Both were to remove fluid from his paracardium, which is the lining around the heart. During his time at Doernbecher Children’s Hospital, Jacob was nominated to be a Doernbecher Freestyle patient-designer by a member of our surgical team, Pediatric Cardiologist Dr. Rich Reed.

He’s doing great now and has since gotten all caught up in school with his peers and just finished up playing spring and summer baseball. Had Jacob’s condition continued to go on undiscovered/ untreated, he could have been lost.

Jacob really wants to help others who may be in danger of having a heart condition by reminding everyone to check their blood pressure regularly. A change in blood pressure is often the first indication something may be wrong with your heart. Detecting high blood pressure saved Jacob’s life and it could save the life of someone you love as well.

Here at home in Eugene, Jacob is an advocate for heart health awareness. All around town, Jacob passes out small pins that remind people to check their blood pressure. He’s also advocating for research to improve current newborn screening for CHD’s because his coarctation went undetected for so long. Jacob is honored to be a part of the 2015 Doernbecher Freestyle patient-designer team!


Learn more about Jacob and how he’s helping spread the word about heart health on his website or follow along on his “Jacob’s Heart Story” Facebook page!

Meet Jacob and the rest of this year’s incredible Doernbecher Freestyle patient-designers here – and save the date for the big collection reveal at our auction on October 23!


Additional coverage: “Jacob Burris, 13, preaches blood pressure checks, adds ‘Nike clothing designer’ to his resume” via The Register Guard, “Local middle schooler designs Nike shoe to benefit Doernbecher” via Eugene Weekly

The power of pretend: Chelsea’s Closet brings dress-up and play to hospitalized children

For a hospitalized child, a chance to play, imagine and socialize is powerful medicine. Jason and Alison Hicks experienced this firsthand with their daughter, Chelsea, during her cancer treatments at OHSU Doernbecher Children’s Hospital. Below, Alison shares her daughter’s story and explains how the Chelsea Hicks Foundation is bringing joy to patients like Chelsea, one costume at a time.


When our two older daughters and Chelsea’s cousins visited her at Doernbecher, they brought dress-up clothes and tea party supplies. She transformed from a patient into a princess, a superhero or a monkey, and she was often spotted dancing in the hallways with a boa and tutu, trying to get other children or staff to play with her.

Dressing up changed Chelsea’s demeanor – she’d go from bored and isolated in her room to a state of pure joy when she dressed up. It didn’t take long before her dress-up and tea parties reached staff and other patients – children’s laughter is, after all, contagious! These moments provided respite from hospital rooms and worries about which treatment is coming next. Chelsea was known to show up for her clinic appointments dressed as something silly and spectacular to help her battle the “cancer bugs.”

Our daughter courageously fought Wilms’ tumor cancer for two years before losing her battle at the age of 5. We were heartbroken but inspired by her journey, so we started the not-for-profit organization, the Chelsea Hicks Foundation, and its dress-up and play program, “Chelsea’s Closet,” in 2009. We saw the power of emotional healing that went along with dress-up and play – this is what helped Chelsea during her treatments. We wanted to give those types of memories to other families going though extended hospital stays.

A rolling armoire stuffed with brand new costumes, accessories, shoes and wigs, Chelsea’s Closet visits Doernbecher Children’s Hospital every month, led by a team of lively volunteers.

During a Chelsea’s Closet visit, hospitalized children and their siblings, friends or family are able to leave their rooms and select a new costume and accessory to wear and keep. Volunteers lead the children in a musical hallway parade, and wrap up the visit with an imaginative craft and special snack. For older children and those confined to their rooms, volunteers always have special goody bags on hand, filled with nail polish, art supplies, stuffed animals and other treats. When they can, parents will often try to coordinate their child’s treatments around Chelsea’s Closet visits.8x10_1570 copy

In the six years since its inception, the Chelsea Hicks Foundation has been met with so much positive feedback from patients, their families and hospital staff that the frequency of visits has increased, allowing them to serve even more seriously ill children. CHF is committed to bringing the healing power of dress-up and play to even more children, through the help of volunteers and donor support. For more information on how you can help grow the Chelsea Hicks Foundation, please visit our website!

Fun in the sun that’s healthy for the skin

With the heat wave finally receding, now’s the perfect time to take your children outdoors and enjoy all the beauty of the Northwest. While staying active, experiencing nature and getting more vitamin D are all important for your little ones, it’s also important to remember sun safety.

The sun produces two main types of ultraviolet (UV) radiation that impact skin health: UVA and UVB. The two differ in their wavelengths – UVA has longer wavelengths – and some of the health effects, but both can damage skin. In general, most of the radiation we get is UVA, which is strongly associated with wrinkling and skin aging, and is also the type that’s found in tanning beds. UVB stimulates the skin to produce vitamin D, and tends to cause skin reddening and sunburn. Both types are implicated in skin cancer.

Skin cancer is the most common type of cancer, and tends to happen after many years of exposure to UV rays. Painful sunburns are much more likely to happen in children, so starting these sun safety habits early can help prevent problems later.

Infants 0 to 6 months: Avoid direct sunlight. An infant’s skin has less protective pigment (melanin) and is too sensitive for sunscreen.

  • Avoid walks between 10 a.m. and 4 p.m., the peak hours for UV radiation exposure, and use a stroller that has a sun cover.
  • Dress baby in lightweight clothing that covers the arms and legs, and a wide-brimmed hat. Baby sunglasses protect eyes and can be stylish at the same time

Infants 6 to 12 months: You can put sunscreen on your baby, but continue to avoid sun exposure through protective clothing and timing of outdoor excursions.

  • Use broad-spectrum, SPF 15+ sunscreen to uncovered areas such as hands, ears and the back of the neck
  • Apply sunscreen 30 minutes before going outside and reapply every two hours and after swimming or excessive sweating

Toddlers: Keeping sun wear on can be challenging. Consistent sun safety habits and simple education may help reinforce the routine.

  • Consider spray-on sunscreens for toddlers who won’t sit still. Don’t apply spray sunscreens directly to the face. Remember to reapply every two hours and after swimming or heavy sweating.
  • Encourage children to seek shade between 10 a.m. and 4 p.m.
  • Use cooling protective clothing, such as cotton. Consider clothing with an ultraviolet Protection Factor (UPF) of 30 or above.

Older children and teens: education and availability of sun protection are especially important at this age.

  • Keep sunscreen handy – for instance, in a school bag or next to the toothbrush.
  • Talk to your teen about the dangers of indoor tanning, and remind him or her that being tan is not the same as being healthy.
  • Be a good role model and protect your own skin!


Looking for more information? Learn more tips to protect your family from sunburns here and here. The Skin Cancer Foundation offers some excellent resources to help keep kids fit in the sunshine, choosing sunglasses for kids and more.

Jennifer Tsai, M.D.
Resident Physician in Pediatrics
OHSU Doernbecher Children’s Hospital

Our lemonade experience: the Charles family’s story

John Charles Blog

When he grows up, Doernbecher Freestyle patient-designer John Charles wants to be a pro athlete. (His favorite athlete? Damian Lillard, of course). He enjoys being outside, hiking and spending time with his dog, Teagan. Though you wouldn’t guess it by looking at him, John was diagnosed with Crohn’s Disease last year.

Below, John’s parents, Tony and Mary Charles, explain how John’s journey has impacted their family.


When your 9-year-old child becomes progressively ill, is not eating and is losing weight, feels constantly tired and listless, is sent urgently to the hospital by your pediatrician and is subsequently diagnosed with a lifelong, chronic, and incurable illness that has significant potential complications long term, life kind of feels like it just served you a glass of pure, undiluted lemon juice concentrate – both for your child and for you as a parent.

Our son John was diagnosed at OHSU Doernbecher Children’s Hospital in 2014 with Crohn’s Disease, an auto-immune, gastrointestinal disorder characterized by symptoms too uncomfortable to describe in a blog unrelated to the specific condition. After four days in the hospital, a colonoscopy and an upper endoscopy (where the doctor passes a tube with a camera through the mouth, esophagus, stomach and into the small intestine), high doses of numerous drugs, including tremendously effective but highly toxic corticosteroids, our son finally started to feel better after months of having felt progressively worse.John Charles

John’s pediatric gastroenterologist at the hospital, Dr. Linda Muir, and the entire nursing staff at Doernbecher were simply amazing. Not only did they make John feel like he mattered, they demonstrated to all of us (John’s parents and his four siblings), that they cared. And they cared not just about John’s physical condition, but about John’s and our collective emotional state. They wanted to provide us with the information we needed to understand what was happening, to provide us the medical options in front of us and to ensure we had the support structure to cope with such a life-changing diagnosis. They recognized and helped us to recognize that the diagnosis had potential to impact not just John, but our whole family.

Dr. Muir has been so tremendously positive in her care for John. Through her encouragement, John has become faithful in taking his medicines (all 11 pills each day). Since his diagnosis, John has had one flare, which Dr. Muir got under control using steroids as a rescue medication. She explained that this was not uncommon and this helped John to understandJohn Charles Mariners the importance of adhering to his medication schedule.

Dr. Muir has been so invested in our son’s life and his well-being that she even nominated John for the Nike Doernbecher Freestyle program. After being selected this past spring for the fundraising program, John has been exposed to a remarkable experience, one that he hopes will help him to use his disease to build awareness of Crohn’s and to help other patients better cope with their diagnosis. The caring concern and attention we have received from Doernbecher, Dr. Muir and the staff have added large amounts of water and sugar to life’s offering, thereby significantly sweetening what otherwise could have been a bitter and sour experience.


Interested in learning more about Crohn’s Disease and connecting with others? The Crohn’s and Colitis Foundation of America (CCFA) is a great place to start.

Meet John and the rest of this year’s incredible Doernbecher Freestyle patient-designers here – and save the date for the big collection reveal at our auction on October 23!

Additional coverage: “Hockinson boy, 10, designs Nike shoe for Doernbecher program” via The Columbian

Celebrating tenacity: Doernbecher Hospital School Program graduation 2015

Every year, students from all grades in our Hospital School Program participate in a graduation ceremony. Like any end-of-year convocation, there’s pomp and circumstance, smiles and tears and plenty of time to reflect on the previous year and its challenges and accomplishments.

“Graduation is important for so many reasons,” said Hem/Onc teacher Anna Balmaseda. “It’s one way we can bring an experience into the hospital that students would otherwise miss. It’s also an opportunity for us to really acknowledge the spirit and conviction of our students.”

Early in June, Doernbecher School Program Hem/Onc patients, teachers and administrators donned full graduation regalia –caps and gowns constructed by students and staff – and paraded through 10S and the outpatient clinic, then back down the hall. Patients who were unable to leave their rooms had their diplomas delivered in small, individual ceremonies.

Below, read some of our favorite excerpts from Anna’s opening remarks.


“If I had to think of one word that comes to mind to represent this student body, that word would be ‘tenacious.’ ‘Tenacious’ means that you keep a firm hold on what’s important to you. Your tenacity has been witnessed in your attendance in the classroom; we’ve seen it in your problem solving and adapting. You have been flexible without losing sight of your goals.

This is why we have such a wonderful time getting to know our thoughtful and hardworking students. It’s been an honor to come to better know your strengths and see your perseverance.

Congratulations to you all. This is your day – we’re here to celebrate you!Doernbecher Graduate Brylee

To the parents: We very deeply appreciate the opportunity to work with your child. We feel very fortunate to work with this group. Let’s just face it – your children are amazing!

I’d also like to acknowledge our very amazing partners in all this magic called Hospital School. We could not do this without the support of our district and medical partners.”


Learn more about the Doernbecher Hospital School Program here.

Summertime food tips

For many childrensummer break means lazy mornings and afternoon swims. But for others, summer brings grumbling bellies and the pain of hunger. It’s estimated that 15 percent of Oregon families are food insecure. In the U.S., it’s estimated that 16 million children do not have enough to eat each day, skip meals, eat watered-down food or go hungry. Summertime brings an added challenge for parents because many school-aged children no longer have access to free- or reduced-price breakfast and lunch, and money for food runs even lower each month.

Local school districts frequently sponsor a free summer lunch program, which is often held in local parks and playgrounds. Even smaller rural districts are following suit. This year, there are 600 sites throughout the state offering meals. A list of Portland programs can be found here, and programs in other parts of Oregon here.

The slower pace of summer may allow busy families to spend time growing, preparing or harvesting foods to help stretch their dollar. Beginning steps in helping the dollar go further is making a weekly meal plan, looking at grocery store ads and selecting foods that are in season. Preparing breakfast casseroles, hot cereal, salads, soups and pasta or rice dishes from scratch helps save money, and they’re often more nutritious than pre-made meals or convenience foods. Involving school-aged children in menu planning and meal preparation helps them feel invested in the effort and more likely to try new foods.

Both WIC and SNAP allow families to use benefits at local farmers markets. Purchasing locally grown food that is in season offers up more nutrients and can be a festive event. The Sustainable Table is an easy-to-use website that lists in-season foods each month for each state and offers up nutrition information, cooking tips, links to recipes as well as the location of farmers markets.

Within the city of Portland, there are a number of community garden sites with plots available on a first come, first serve basis from March to June. You can learn more about the Community Gardens program here.

Some of my fondest memories as a kid were helping in our family garden and picking fresh green beans and corn an hour before dinner. Got a memory or suggestion you’d like to share? Leave a comment below!

April Mitsch, M.S., R.D.N., IBCLC
Feeding Clinic Dietitian
The Child Development and Rehabilitation Center (CDRC)
Oregon Health & Science University 

The vaccine every teenager needs

Odds are, you or someone you know has been infected with human papillomavirus, or HPV. It’s the most common sexually transmitted disease (STD) in the US, infecting more than 79 million Americans. More than 14 million people, including teens, become infected with HPV each year. HPV is also responsible for 70 percent of cervical cancer diagnoses, and can also be responsible for throat, penile and rectal cancer.

The good news is there’s a vaccine that prevents infection from the most common strains of HPV — and the vaccine is really good at what it does.

Q: Why should my child get the HPV vaccine?
As a physician trained in adolescent medicine, I often see teens and young adults who are devastated to learn they have HPV because they’ve always used protection. What they often don’t know is that HPV can be transmitted through any type of intimate sexual contact. You don’t have to have intercourse to become infected. If infected skin touches skin, the virus can spread. That’s why this particular vaccine is such an important way to prevent HPV.

Another sobering reminder: According to the 2013 Oregon Healthy Teens Survey, 45.2 percent of 11th grade students have had sex, and of those only 29.1 percent reported using condoms (which are important, but unable to prevent all HPV infections). While you can encourage your teen to make smart choices, at the end of the day, they’re going to make their own decisions. What you can do is ensure they complete the HPV vaccine series of three shots before they’re exposed to the virus.

Q: When should my child get the vaccine?
The HPV vaccine must be given before exposure to the virus in order to work. That’s why I recommend giving the vaccine to teen girls and boys (yep, teen boys catch and spread HPV, too) typically starting at age 11, but even as young as age 9. That may seem young to some parents, but remember, this vaccine protects against cancers and other diseases caused by HPV. The vaccine is given in three shots over six months and it is critical that your child get all three doses. If your child is behind or off schedule, we recommend completing the vaccine series. The HPV vaccine is safe and effective and, like all vaccines, undergoes extensive safety testing.

As parents, we want the best for our kids. Knowing that you can help prevent your teen from possibly getting cancer in the future, why wouldn’t you want to get him or her vaccinated? Talk to your teen and his or her doctor about HPV prevention. Click here for more information on HPV.


Jennifer Edman, M.D., M.P.H.
Women’s Primary Care
Assistant Professor of Family Medicine
OHSU Center for Women’s Health

Doernbecher Best in the Country U.S. News & World Report


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