In this issue
- Up front: OHSU ranks as the No. 1 hospital in Oregon for the eighth consecutive year
- Discoveries: saving the hearing of kids with cancer; more choice in end-of-life care; comparing concussion treatments
- Health spotlight: tips for back to school
- Q&A: does water birth mean a less painful labor and delivery?
Up Front: Top of the List
U.S. News & World Report established their “Best Hospitals” rankings to help patients understand which hospitals deliver outstanding care. For the eighth consecutive year, OHSU has ranked as the No.1 hospital in Oregon, according to U.S. News Best Hospitals 2018–2019. According to the magazine, no other hospital in Oregon is nationally ranked in as many specialties as OHSU.
Six adult specialties at OHSU rank among the top 50 in the country. Those areas are:
- Cancer (No. 28)
- Cardiology and Heart Surgery (No. 41)
- Diabetes and Endocrinology (No. 39)
- Ear, Nose and Throat (No. 25)
- Geriatrics (No. 34)
- Nephrology (No. 23)
U.S. News & World Report also ranked OHSU Doernbecher Children’s Hospital among the nation’s top 50 children’s hospitals for the ninth year in a row, making it the top children’s hospital in Oregon.
Seven children’s specialties at Doernbecher rank among the top 50 in the country:
- Cancer (No. 41)
- Diabetes and Endocrinology (No. 35)
- Neonatology (No. 29)
- Nephrology (No. 25)
- Neurology and Neurosurgery (No. 36)
- Pulmonology (No. 41)
- Urology (No. 28)
From common health concerns to specialized treatments, OHSU is honored to provide care for you and your family. We are thankful for your continued trust, and we will keep doing our best to maintain your confidence and respect.
Saving the hearing of kids with cancer
Clinical trial focuses on reducing the side-effects of treatments that result in hearing loss.
Fewer people dying in hospitals
More people are able to choose their end-of-life care in advance.
Is rest best for a concussion?
OHSU is leading a clinical trial to compare rest or physical therapy following a concussion.
Health Spotlight: Back to School
Learning self-control with screen time
The way children interact with electronic devices can have a big impact on their development. Craigan Usher, M.D., an assistant professor of child and adolescent psychiatry at OHSU Doernbecher Children’s Hospital, emphasizes the importance of learning self-control.
“It’s not that electronics are bad,” he says. “It’s more about building the skills to be able to pick up and put down screens when necessary. Remember, parents are the bosses of screen time.”
The ability to put down a device and move on to other activities is valuable throughout life. If your child throws a fit when it’s time to stop playing videogames, it might be a good idea to reevaluate whether your child is ready for electronics.
Also, when screens steal interest and time for social and physical activities, that isn’t a healthy balance for children, teens or adults. It’s important to establish clear rules about what kinds of apps and how much screen time your family allows and to hold everyone accountable — including parents!
When it comes to confidence, tweens and teens can have a difficult time coping with issues related to their changing bodies: acne, weight/height comparisons and experiencing puberty later or earlier than peers.
“Adolescents experience dramatic physical changes at a time when their emotions are elevated and they’re extremely relationship-focused,” says Ajit N. Jetmalani, M.D., a child and adolescent psychiatrist at OHSU Doernbecher Children’s Hospital.
Encourage your children to think about their bodies with compassion. When they critique themselves, remind them to ask, “Would I talk to a friend that way?” Dr. Jetmalani emphasizes that health and appearance are not the same thing. He encourages children (and adults!) to think about what their bodies can do, instead of how they look.
Pediatrician Ellen B. Stevenson, M.D., M.P.H., F.A.A.P., from OHSU Doernbecher Children’s Hospital, reassures parents that getting head lice is not related to cleanliness and doesn’t reflect badly on the family. Let the school, teachers and friends know to look out for new cases to stop the cycle. Lice spread by contact and shared brushes, combs, hats and clothing.
- Use an over-the-counter head lice treatment and follow all instructions, which includes patiently combing through hair to remove nits (tiny, pearly eggs).
- Thoroughly launder bedding, towels and clothes. Anything that can’t go through the washer but will fit in the dryer (pillows, stuffed animals) should spend 20 minutes on a hot cycle to kill the lice. Alternatively, put all comforters, soft toys and bedding in plastic trash bags. Tie tightly and leave for two weeks. Toss or sterilize brushes and combs.
- Vacuum carpets and furnishings.
- Check head/hair daily for a week after treatment, and again in two to three weeks. For ongoing concerns, discuss treatment options with your health care provider.
Successful days start with better bedtimes
Adjusting to a new sleep schedule can be tricky, but a few days of preparation can make all the difference. Elizabeth Super, M.D., pediatrician and children’s sleep specialist with the Pediatric Sleep Medicine Program at OHSU Doernbecher Children’s Hospital, suggests tips to make sleep transitions easier.
Start by establishing a routine for the new schedule. Bedtime and wake-time routines help anchor a child’s day and reduce anxiety.
In the evening: Keep things quiet, cool and dark. Dim lights 30 minutes before bedtime and restrict use of electronics or any other media in the bedroom environment. Consider blackout shades if natural or artificial light is affecting sleep.
In the morning: Ease into the day by bringing in bright light, either by turning on lights indoors or opening window coverings. Increasing light in the morning can help shift kids’ internal body clocks. Children may be more tired or groggy than usual the first week of transition, but they will soon adjust to the new time.
How much sleep do children need?
- First year: 13–16 hours
- Toddlers (ages 2–5): 11–13 hours
- Elementary age: 11–12 hours
- Middle schoolers: 10–11 hours
- High schoolers: 9¼ hours
These articles were originally published in the 2017 Kids Health Annual in Portland Monthly Magazine.
Q&A: Your Questions, Expert Answers
A. Over three decades, we have fine-tuned gastric bypass surgery and improved patient selection and education. We no longer make large cuts in the abdomen but perform the surgery through tiny incisions. Patients leave the hospital after one or two nights. But before surgery, every bariatric patient at OHSU goes through a program to optimize their health and educate them on nutrition, exercise and other factors that affect weight. The goal is for patients to be successful following surgery, which can lead to a loss of 25 to 35 percent of body weight. There are always risks with any surgery, but the complication rates with bariatric procedures is low, particularly in an accredited, high-volume center like OHSU. Obesity is a chronic disease, and surgery provides the largest and most sustained weight loss option, leading to better overall health and lower risk for other diseases.
A. Physiatry is a medical specialty with a holistic approach that focuses on helping people get the highest possible level of function possible. Physiatrists have advanced training in the skeletal system (bones, joints, muscles) and nervous system (spinal cord, nerves). In the past, the recommendation for patients with low back pain was to rest for weeks. Now we know that can make the problem worse. Instead, we want to evaluate the cause of the pain. If pain radiates, physiatrists are good detectives at finding the real source of the pain, which may start somewhere other than where it is felt. We can help people of any age use exercise as medicine to decrease pain and keep moving. For some, that may be simple tasks like bending or walking. For others, that may be enjoying an activity such as cycling or running.
A. Your best defensive strategies are adequate sleep, proper nutrition and protection from overtraining. The hectic schedules of youth athletes combined with the pressure to succeed in school can compete with hours for sleep. Youth athletes need more sleep than others, up to 10-plus hours a day in some cases. Also, their diets should include essential nutrients from fruits and veggies to keep their immune systems strong. When they eat is also important and sometimes overlooked. About 45 minutes before a game or practice, they need a snack to fuel their activity. Within an hour postgame, they need another snack with carbohydrates and protein to aid muscle recovery. We are seeing an increase in overuse injuries among youth who specialize in one sport, often playing year-round or on multiple teams simultaneously. You should monitor your child’s training load in any one activity or sport to reduce injury risk and burnout.
A. There are many treatment options that have outstanding results for varicose and spider veins, based on the type and size of vein trouble. We can usually improve the appearance and symptoms of these discolored and raised veins through office visits using local anesthesia. If you have small spider or varicose veins, we can make them fade away by injecting a medicine into the area using very small needles. It takes about six months for the full effect, so if you are planning for next summer, fall is a good time to seek treatment. For larger varicose veins, we can seal the enlarged vein and the smaller feeder veins by inserting a small tube with a laser and making a series of tiny incisions. Patients often say it feels like a weight has lifted off their legs. Also, they get relief from pain or bleeding symptoms some damaged veins cause.
A. Research shows that laboring women who use tubs for a water birth tend to report high satisfaction. They find that water eases their labor discomfort and helps them achieve their goal of a birth without using pain medications. Being in warm water increases a mother’s ability to move by providing a sense of weightlessness; it also helps them relax by reducing stress hormones and increasing blood flow to the uterus. Research shows water births aren’t harmful for babies, and they have similar birth outcomes as babies born on land. Some women will labor in the tub but deliver their baby out of it, while others choose to both labor and deliver in the tub. At OHSU, women who desire a birth tub for labor and/or delivery must take a preparation class and be a patient of the OHSU midwives.
A. If you have a cancer diagnosis and want to have children in the future (or keep the option open), there is hope through fertility preservation methods. For men, the simplest way is to freeze sperm before any treatment that might affect fertility. For women, freezing eggs or embryos is also an option, though more complex. Removing the eggs requires medical assistance. This can be costly, because insurance doesn’t cover fertility preservation methods. It can also be physically hard if your cancer is taking a toll. Later, you may need a gestational carrier for the saved eggs or embryos if your cancer treatment included removing reproductive organs, such as your uterus. Your age, type of cancer and treatment may change your risk of infertility later, so ask your doctor about the potential effects on fertility and your options for preserving it.
A. A virus causes measles, and it spreads easily. Measles symptoms include high fever and rash. One-third of people who get measles will get additional complications, particularly if a child is younger than 5 years old. You can protect yourself and your children by getting a very effective vaccine called MMR, or “measles, mumps, rubella.” This vaccine protects 95 percent of people after a single dose, and 99 percent of people after the recommended two-dose series. If you’ve already had the vaccination as a child, you don’t need another one. The vaccine is safe for all but a few people who have compromised immune systems from cancer or another cause. By getting your vaccinations, you not only protect your own health, you protect others too.