Oregon Health & Science University

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Your family’s well-being is important to us. That’s why OHSU’s Health magazine brings you the latest research news, expert advice and event listings to help you stay current and keep your family healthy. Our magazine is intended to educate and inform: If you have urgent medical issues or in-depth questions, please talk to your health care provider.

Got questions or suggestions? We’d love to hear your feedback: Email us at editor@ohsu.edu

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UpFront

OHSU and Adventist Health join together

OHSU and Adventist Health in Portland recently agreed to work together to make sure more Oregonians can receive high-quality, cost-effective care closer to home. In the Portland metro area, Adventist Health has a 302-bed medical center, 34 clinics and home care and hospice services. It ranks in the top 5 percent of hospitals nationally for patient safety and offers well-recognized wellness and community health programs.

OHSU has the top-ranked adult and children's hospitals in Oregon, and is a leader in treating patients with complex, specialized needs. "We are confident this affiliation will have a positive impact on patients throughout the state," said Joyce Newmyer, president of Adventist Health Pacific Northwest Region.

Together with OHSU's existing partner, Tuality Healthcare, this new affiliation with Adventist means that patients from Hillsboro to Gresham and Vancouver to Clackamas can choose a hospital or clinic location close to them, knowing that they have immediate, seamless access to Oregon's only academic medical center if they need it.

"This approach allows us to direct greater resources into patient care, and to retain the diverse strengths of each organization," said Mitch Wasden, executive vice president and chief executive officer of OHSU Healthcare. "It's OHSU's mission to share the latest insights in medical care, but by working hand in hand with community-based providers we're able to ensure those insights reach more people."

Discoveries

Genetic markers found for severe form of multiple sclerosis

The discovery of genetic markers may explain why some people develop progressive multiple sclerosis (MS), the most debilitating form of the disease. Identifying these markers could also lead to the first-ever prevention treatment for progressive MS. A study led by researchers at OHSU and Yale University found that two proteins (cytokines) which are important in signaling between cells in the body can also worsen MS by causing inflammation in the central nervous system. Using these markers, a simple genetic test may identify which MS patients are at risk for the severe form. Then doctors could begin therapies to slow or stop the disease before it transitions to the progressive type. This new research may also lead to new medications to target this type of MS. A chronic disease without a cure, MS affects an estimated 2.3 million people worldwide. This research was published in the Proceedings of the National Academy of Sciences.


A new medication may replace surgery for genetic heart condition

About 1 in 500 people have a genetic problem that causes a heart condition called hypertrophic cardiomyopathy (HCM). HCM causes the heart wall to thicken, making it harder for the heart to pump blood through the body. The condition can be fatal, especially in young athletes. Investigators at OHSU have been studying a new drug (mavacamten) that appears to help the root cause of HCM, rather than just treating symptoms. In results from a recent test, patients who took the medicine improved to the point that surgery (often a necessity) could be avoided and without having any bad side effects. OHSU will continue to lead more study into this targeted therapy in the next phase of clinical trials. This study was presented at the Heart Failure Society of America's 21st Annual Scientific Meeting.


Encouraging prenatal care in a vulnerable population

Prenatal care is key to a healthy pregnancy, but pregnant women who are also unauthorized immigrants aren't likely to seek or have access to regular medical care. In recent years, the state of Oregon expanded Medicaid coverage to encourage these women to get the prenatal care needed for healthier babies. In a collaboration between OHSU and Stanford University, doctors studied the Medicaid database reports of 210,000 pregnancies of unauthorized immigrants. When benefits were expanded, the data showed these mothers came in for more regular visits and screenings. They were 74 percent more likely to get a fetal ultrasound, 61 percent more likely to get diabetes screening, and 19 percent more likely to get vaccinations. These mothers were also more likely to follow up on well-child checks and vaccinations in their babies' first year. This study was published in Obstetrics & Gynecology.

This study was published in the journal Neuron.

Living Well

Cues for caregivers

Many dementia diseases are progressive — they start slow, but gradually worsen as the person loses memory and function. Often, the mental and physical burden of caring for a family member with dementia also steadily increases, leading caregivers to sacrifice their own health, says nurse practitioner Allison Lindauer, Ph.D., of OHSU's Layton Aging and Alzheimer's Disease Center. Here are some tips to avoid getting overwhelmed:

  • Be proactive in using resources. Lindauer says the Alzheimer's Association (alz.org) is a good starting place. The organization is a clearinghouse for education, emotional support, respite care and more for any form of dementia.
  • Accept help. Friends and family may be willing to pitch in, Lindauer says. Though it may feel uncomfortable to accept help, you are giving these well-wishers a way to positively contribute. Prepare a list of tasks, such as lawn mowing or grocery shopping, that would be helpful. The next time someone offers, you can share the list.
  • Stay connected. Since 1 in 9 adults have memory problems, there are many caregivers living the same experience, Lindauer says. Caregivers can easily become isolated, so finding ways to stay socially active is important. Connect with the Alzheimer's Association or your county's Family Caregiver Support Program.
  • Take care of yourself. Studies show that caregivers are at higher risk for many health concerns, Lindauer says. Make sure your primary care provider knows you are a caregiver and get your checkups.

ALLISON LINDAUER, PH.D., N.P.
OHSU Brain Institute
503-494-7772
OHSUBRAIN.COM


Talking to kids about scary news

When a high-profile disaster or tragedy strikes, parents can be at a loss as to how to explain these troubling events to children. Ajit Jetmalani, M.D., a child psychiatrist at OHSU Doernbecher Children's Hospital, provides guidance for families in the days and weeks following a tragic event:

  • Be aware of your own reactions to these tragedies because children often take their parents' lead as to how to react.
  • Every child's reaction is unique based on personality, developmental stage and experiences.
  • It's okay to proactively talk to your children about these events but avoid pressuring children to talk. Experts recommend that children under 5 do not need the details of these events unless they ask.
  • Let children know these types of events are rare and reassure them that they are safe and secure.
  • Encourage children to talk about how they are feeling and respond to their concerns.
  • Look for signs that children are struggling to cope with their emotions. For young children: increased fear of separation, a reverse of skills (bedwetting, not wanting to dress themselves), hyperactivity or anger. For older children: increased isolation, irritability and withdrawal or disinterest in school and friends. If you see these issues, talk to your child and seek assistance if necessary.

"Though parents strive to make the world as safe as possible for their children, we can't control natural disasters and horrible violence," Jetmalani says. "However, we can control how we express love and compassion on a daily basis. We can continue to set clear expectations and provide instruction about how to be generally safe in society. Reminding children and adolescents about safety precautions they can take daily can support an eventual return of a sense of safety in your family's life."

AJIT N. JETMALANI, M.D.
OHSU Doernbecher Children's Hospital
503-346-0640
OHSUDOERNBECHER.COM


The sometimes mysterious clues of arthritis pain

Pain caused by osteoarthritis can be tricky to pin down. For example, you may have pain in your lower back, but the damage may be in your hip. Or a radiating pain in your arm may feel like a nerve, but it could be caused by arthritis in your elbow.

Erik Ensrud, M.D., who has combined expertise in orthopaedics and neurology at OHSU, is a detective in diagnosing what is causing the pain. "Often the source of the pain isn't clear, so we have to ask a lot of questions," he says. "Do you have decreased sensation or pins and needles feeling? Does it hurt more standing or sitting? The area of the pain by itself often doesn't narrow down the cause. Discovering that root problem is important for directing patients to successful treatment."

Osteoarthritis causes the cushioning tissue (cartilage) between bones to wear out as we age, a very common condition. Without this cushioning, bones can bump into each other and pinch other sensitive tissues, including tendons and nerves. The sensations caused may seem like muscle or nerve problems, but the issue is degeneration of the connective tissue in a joint.

Ensrud says these are cases where a team approach to care is valuable, bringing together different health care specialists to work together to find the correct diagnosis. "When pain symptoms begin to affect your function and quality of life, it is important to seek medical attention and the correct diagnosis," he says.

ERIK ENSRUD, M.D.
OHSU Orthopaedics and Rehabilitation
503-494-4314
OHSUBRAIN.COM


Your Questions, Our Answers

Q: I noticed my wedding ring doesn't fit anymore even though I weigh about the same as always. I'm also tired all the time and sweat a lot. Could something be wrong?

A: All of these symptoms — change in ring size, fatigue, heavy sweating — can be signs of a pituitary tumor that is making too much growth hormone (acromegaly). This type of tumor can be tricky to identify because there isn't one red flag, but a collection of broad symptoms. Other symptoms include severe headaches, joint pain, changes in shoe size, sleep apnea and gaps appearing between teeth. Frequently, women have irregular periods and men have sexual dysfunction. The symptoms often develop slowly over years, which can lead to a delay in diagnosis. If you have several suggestive symptoms, discuss testing your hormone levels, specifically growth hormone and prolactin, with your primary care doctor. If results are abnormal, you should see a pituitary specialist for more testing. Pituitary tumors are usually not caused by cancer. Most people improve immediately after proper treatment that includes surgery and medication.

MARIA FLESERIU, M.D., F.A.C.E.
OHSU Pituitary Center
503-494-4314
OHSUBRAIN.COM/PITUITARY

Q: My doctor says I have mitral valve regurgitation. What is that?

A: The mitral valve is a "door" in your heart that allows blood flow between chambers. If the mitral valve isn't closing tightly, there can be leaking, or regurgitation. Often, people don't know they have this problem until it worsens over time, causing shortness of breath, fatigue, fluid retention and sensations of heart flutters, or palpitations. In some cases, mitral valve regurgitation can be mild, not requiring any treatment other than monitoring. For others, the condition can become severe and require surgery to prevent serious complications such as heart failure. OHSU is currently pioneering a minimally invasive option for repairing or replacing the mitral valve from the groin or a small incision on the chest. This exciting breakthrough in treatment means faster recovery for patients. OHSU has the most treatment options to treat mitral regurgitation in the region. Treatment decisions are based on the individual's anatomy and condition.

FIRAS ZAHR, M.D.
OHSU Knight Cardiovascular Institute
503-494-1755
OHSUHEART.COM

Q: On my last birthday, I got a postcard reminding me about a health screening that is due. Since I'm healthy, could I skip it?

A: The purpose of screenings is to try to detect health conditions in people who have no symptoms yet. Through early detection and treatment, we are more likely to cure or contain diseases before they progress with long-term or even fatal results. Talk to your primary care provider about what screenings are indicated for your age, general health, and personal and family history. You can also discuss the options and benefits of the types of screenings available. We know that with colon, breast and cervical cancer, screening makes a difference and can prevent death and complications from the disease. You should regularly be screened for risk factors of coronary heart disease, including cholesterol, blood pressure, tobacco use and diabetes. Your PCP can advise when you should do these tests.

GREGORY N. SMITH, M.D.
OHSU Primary Care, Orenco Station
503-346-3900
OHSU.EDU/ORENCOSTATION

Q: Do cancer survivors need a different diet from other people?

A: No, as long as they are feeling well. Cancer survivors often believe they have to follow highly restricted diets, but that isn't true based on current evidence. The guideline is to follow a plant-based diet with lean proteins and whole grains, emphasizing fruits and vegetables. This is the same for everyone, but cancer survivors tend to be motivated to make healthy lifestyle changes. Also, taking various supplements isn't recommended for preventing cancer. Food works synergistically; you can't get the same benefits from a pill. Instead, explore creative recipes. Variety is key. Vibrantly colored (reds, blues, purples) produce has more phytochemical or antioxidant compounds. Abstaining or reducing alcohol to recommended daily limits is important, and avoid excess sugar, salt and saturated fats. Meet with a nutrition professional after your diagnosis or after completing treatment to help make a custom plan for your specific needs.

AMANDA BRYANT, R.D.
OHSU Knight Cancer Institute
503-494-4673
OHSUKNIGHTCANCER.COM

Q: My child is constipated. What can I do?

A: Constipation is common, especially in children. It can be caused by changes in routine, such as toilet training, stress, travel, illness or the start of school. If your child is often constipated, make sure to provide lots of fruits, vegetables and fiber. Have your child drink enough liquids daily so that urine is clear or light yellow. Encourage exercise or activity for your child of at least 30 minutes or more daily. Plan daily toilet-sitting time after meals and school for at least 5–10 minutes to establish good bowel habits and keep stool moving.

JANICE TENDLER, R.N., M.S., C.P.N.P.
OHSU Doernbecher Children's Hospital
503-346-0640
OHSUDOERNBECHER.COM

Calendar

Request reasonable accommodation for these events at 503-494-2834 or hsmktg@ohsu.edu.

Featured Events

MARCH 17, 8 A.M. – 3:15 P.M.
Komen Breast Cancer Issues Conference
komenoregon.org/events

APRIL 28, 9 A.M.
March for Babies
marchforbabies.org


Baby Talk, with OHSU Fertility Consultants

OHSU Center for Health & Healing (CHH)
3303 S.W. Bond Ave., 10th Floor, Fertility clinic lobby
Portland, OR 97239

To register, please visit www.ohsuhealth.com/babytalk or call 503-418-4500.

MARCH 8
Financial sessions, 5 p.m. and 6 p.m.
Meet with fertility experts, 5:30-7 p.m.


Ask the Health Experts
OHSU Center for Health & Healing (CHH)
3303 S.W. Bond Ave., 3rd Floor, Portland, OR 97239
To learn more and register, please visit ohsuhealth.com/seminar or call 503-494-1122.

FEB. 12, 7 P.M.
Living With Heart Failure
With Divya Soman, M.D.

FEB. 21, 7 P.M.
Hand Pain and Numbness: Current Treatments
With Omar Nazir, M.D.

APRIL 4, 7 P.M.
Electromyography (EMG): How It Can Help Reach a Diagnosis
With Erik Ensrud, M.D.


Marquam Hill Lectures
To learn more and register, please visit ohsu.edu/mhlectures or call 503-494-5699.

APRIL 9, 7 P.M.
Holding Fast to Dreams: Creating a Climate of Success for All Students in STEM and Beyond
With Freeman Hrabowski, President, University of Maryland, Baltimore County


The OHSU Brain Institute's 2018 BRAIN AWARENESS LECTURE SERIES

May 7, 2018
Trade Food for Thought to Power 86 Million Neurons
Suzana Herculano-Houzel, Ph.D.

May 14, 2018
The "Secret Sauce" to Honing the Mind
Adele Diamond, Ph.D.

May 21, 2018
Anxiety and Learning Problems: Could It Be the Fats You Eat?
Bita Moghaddam, Ph.D.


FYI

Each issue, we bring timely health tips and information to help you and your family live healthier lives. Got a question or health issue you’d like our experts to address? Email us at editor@ohsu.edu.



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Fine Print

Health is a quarterly publication of OHSU serving the greater Portland area. Information is intended to educate and is not a substitute for consulting with a health care provider.

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Editor-in-chief: Heather Pease
Managing editor: Ashley Uchtman
Copywriter: Cheryl Rose
Graphic designer: David Riofrio