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.
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.
Breakthrough saves hearing for kids with cancer
For children with some types of cancer, the treatment that is very successful against tumors also comes with a difficult compromise: long-term hearing loss. Damage to the inner ear is a common side effect of platinum-based chemotherapy drugs. Following years of study, OHSU physician researchers made an important connection. If children with a form of pediatric liver cancer receive the drug sodium thiosulphate (STS) after chemotherapy, they have 50 percent less hearing loss and still receive the same benefit from the cancer medication. A recently completed clinical trial proved the effectiveness of the OHSU research. The U.S. Food and Drug Administration has approved the treatment as a breakthrough therapy. Researchers believe this discovery can affect treatment in other forms of pediatric cancers that use similar drugs, so children won’t have to trade their hearing for their health.
Peaceful setting more possible for dying
People rarely want to spend their last days of life in a hospital room or shuffling back and forth between facilities. Fortunately, patients are increasingly able to choose to die at home or in assisted facilities rather than hospitals, according to a study led by an OHSU professor. The study showed that people dying in hospitals decreased from almost 33 percent in 2000 to closer to 20 percent in 2015. One reason for the decline is the expanded use of hospice and palliative care, which focus on improving the quality of life for patients with serious illnesses. Physicians’ support for alternatives and growth in community-based palliative care teams since the start of the Affordable Care Act in 2010 makes leaving the hospital a more viable option.
This study was published in JAMA.
Concussion treatment: rest or PT?
There is still a lot to learn about concussions, or mild traumatic brain injuries (mTBI), which occur to about 1.5 million Americans a year. For example, is it better to rest for a couple of months following a concussion or to begin rehabilitation and physical therapy quickly? OHSU will lead a clinical trial to compare outcomes between patients who begin therapy right away after a concussion compared to those who begin later. For the trial, OHSU is developing wearable sensors to provide real-time feedback on movement and balance. About 40 percent of people who have an mTBI suffer from post-concussion syndrome, which causes ongoing problems with balance. OHSU will also be leading a study to learn more about the connections among the inner ear, walking and the brain following mTBI.
Your Questions, Our Answers
Q. Is bariatric surgery safe?
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.
Andrea M. Stroud, M.D., M.S.
OHSU Bariatric Services
Q. What is physiatry and how can it help my back pain?
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.
Erik Ensrud, M.D.
OHSU Spine Center
Q. My kids are very active in sports. How can I keep my young athletes healthy?
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.
Ryan Norton, D.O.
OHSU Sports Medicine
Q. I didn’t wear shorts this summer because the veins in my leg are so unsightly. Is there anything I can do about them?
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.
Timothy K. Leim, M.D., M.B.A., F.A.C.S.
OHSU Knight Cardiovascular Institute
Q. Could a water birth mean less pain during labor and delivery?
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.
Bridget Lee, C.N.M., M.S.N.
OHSU Center for Women’s Health
Q. How will my cancer treatment affect my fertility?
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.
Paula Amato, M.D.
OHSU Knight Cancer Institute
Q. I’ve heard there have been local cases of measles. How can I avoid 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.
Dawn Nolt, M.D., M.P.H.
OHSU Doernbecher Children’s Hospital
Seven answers to common breast cancer misconceptions
As we continue to understand how breast cancer behaves and how to prevent recurrences, the survival rates for patients are increasingly excellent. Breast cancer is a fast-evolving field, and we are always learning new information to help us guide patient care and treatment decisions. Today, there are many options available, allowing us to tailor treatments and avoid those that may have little benefit.
Breast cancer behaves differently in each person. At OHSU, we want to target the right treatment for everyone. That means a treatment method that worked for one person might not be the right choice for another person. When people receive a breast cancer diagnosis, they may feel dazed by the amount of information out there and the advice from friends and relatives, even strangers. Here are some common misconceptions and concerns that we hear from our patients at OHSU who are seeking answers.
How did I get breast cancer when I live such a healthy lifestyle?
Some patients feel puzzled by their diagnosis when they have tried to do the “right” things: not smoking, drinking in moderation, eating a healthy diet and getting exercise. Unfortunately, a healthy lifestyle isn’t a guarantee against breast cancer. Even now, we don’t always know what causes breast cancer in all patients. However, we do know that breast cancer patients who are otherwise healthy can heal and recover better from their cancer and treatment. They also receive many other positive health benefits from their lifestyle choices.
How influential is my family history?
Just because you have a family history of breast cancer doesn’t mean you will get it. We ask about family history because any identifiable risk factors can help guide which screenings to recommend. Some red flags we are looking for include breast or ovarian cancer in several first-degree relatives (your mother and sisters), family members who developed breast cancer under age 50, and male family members with breast cancer. If the family history is significant, we may recommend meeting with a genetics counselor who can help you determine if you should consider genetic testing. Some women have a mutation in a gene (BRCA 1, BRCA 2) that is associated with a higher risk for breast cancer development. If you have the BRCA mutation, it doesn’t mean you will develop cancer, but you will want to discuss your monitoring and options with your provider.
Did a biopsy cause my breast cancer?
There is no scientific evidence that needle biopsies will cause breast cancer to spread. When a patient has an abnormality on a mammogram or in a physical exam, the gold standard of care is to have a needle biopsy to get a sample of tissue for testing. The information from the testing is very important because it can be negative for cancer, sparing the person unnecessary surgery. If the test is positive for cancer, we also get additional information about the type of cancer, and we can tailor the next step for treatment.
Did wearing deodorant cause my breast cancer?
Wearing deodorant, antiperspirant or underwire bras does not cause breast cancer, based on the scientific evidence we have gathered.
If I have both breasts proactively removed, will that increase my survival chances?
From what we know now, having a double mastectomy to treat breast cancer does not equal a cure for most patients, though it may be the right decision for certain circumstances. Many studies show that most women only get cancer in one breast, and the risk of a new tumor in the opposite breast is very low. Because surgery is only one part of successful treatment of invasive breast cancer and does not treat micrometastases, there isn’t a link between removing the healthy breast and improved survival. What we have seen linked to survival is systemic therapy that is targeted to a patient’s individual breast cancer, such as chemotherapy or a hormone blocker, to keep the cancer from regrowing outside the breast. With early detection, we can offer a less-invasive surgical procedure called a lumpectomy for surgical treatment, where we remove the cancer and preserve the breast. Survival rates are equal for lumpectomy and mastectomy in several long-term studies.
Is the radiation from the screenings going to give me cancer?
The very minimal radiation from a mammogram once a year carries no increased risk of cancer. Radiation exposure to the breasts from a mammogram is significantly less than the “background radiation” most people get from their surroundings. Because mammograms can aid in early detection of breast cancer, the benefit of a mammogram outweighs any theoretical harm from the very small amount of radiation exposure.
Where can I get accurate information about my breast cancer?
When searching for answers related to breast cancer and treatment, your health care provider is your best source. Online, reliable organizations that stay updated with the latest scientific information include the American Cancer Society, the Susan G. Komen Breast Cancer Foundation and BreastCancer.org.
Arpana M. Naik, M.D.
OHSU Knight Cancer Institute
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.
Ask the Health Experts Seminars
OHSU Center for Health & Healing
3303 S.W. Bond Ave., Third Floor, Portland, OR 97239
To register, please visit www.ohsuhealth.com/seminar or call 503-494-1122.
Beaverton Ask the Health Expert: Skin Care and Cosmeceuticals – What Is the Evidence?
Myriam Loyo, M.D. and Mariah Johnson, M.D.
Wednesday, Nov. 8, 2018, 7 p.m.
Location: OHSU Beaverton Cancer Clinic, Second Floor waiting area, 15700 S.W. Greystone Court, Beaverton, OR 97006
Even in cloudy Oregon, skin cancer is a serious risk from sun exposure. In fact, Oregon has more than 133 percent of the U.S. average for melanoma, the deadliest form of skin cancer. Hear from our experts how to protect yourself from the damaging rays that also worsen signs of aging. Additionally, the talk will cover various trends in skin care, including vitamin C serums and other topicals like retinoids, laser treatments and more.
Marquam Hill Lectures
More info at www.ohsu.edu/mhlectures
Thursday, Oct. 18, 2018, 7 p.m.
Location: OHSU Auditorium
Nabil Alkayed, M.D., Small Blood Vessels May Be Key to Cardiovascular Disease
Thursday, Nov. 15, 2018, 7 p.m.
Location: RLSB, 2730 S.W. Moody Ave., Portland, OR 97201
Vinay Prasad, M.D., M.P.H.
Cancer Costs: Marketing and Myth Busting
A free community presentation series designed to share the exciting work happening at the OHSU Knight Cancer Institute. The presentations will be held on the third Tuesday of every month beginning in January 2019.
January 15, 2019, 7 p.m.
Location: Knight Cancer Research Building, 2720 S.W. Moody Ave., Portland, OR 97201
Topic: Cancer 101: Where We’ve Been, Where We Are, and Where We’re Going
More information: www.ohsuknightschool.com
2018 PurpleStride Portland
Saturday, Sept. 29, 9 a.m.
Location: World Trade Center, Portland, Ore.
Pancreatic cancer has the lowest survival rate of all major cancers at just 9 percent. Join the OHSU “Torchbearers” and walk to help support pancreatic cancer awareness. At OHSU, the end of pancreatic cancer starts here!
More information: www.ohsuknightcancer.com/events
The 2018 Calvin & Mayho Tanabe Address
Tuesday, Oct. 23, 7 p.m.
Bionics: The Evolution of Man and Machine
presented by Albert Chi, M.D., associate professor of surgery, OHSU
Newmark Theatre, Portland, Oregon
More information and tickets: https://www.onwardohsu.org/tanabe
Meet the Midwives
Wednesday, Oct. 24, 6–7 p.m.
Center for Women’s Health lobby, Kohler Pavilion
808 S.W. Campus Drive, Portland, OR 97239
Are you looking for water birth, VBAC or group prenatal care? Do you want a compassionate, family-centered experience in a safe and state-of-the-art hospital setting? Choosing the right people to be part of the journey is so important. Our midwives provide care that honors the natural process of birth, backed by the medical excellence of OHSU.
For more information: www.ohsu.edu/midwives
2018 Light the Night
Saturday, Oct. 27, 5 p.m.
Please join the Team OHSU “Torchbearers” to walk or by donating. Your participation in the Light the Night Walk will save lives not someday, but today. At OHSU, the end of leukemia and lymphoma cancer starts here!
Location: Oregon Museum of Science and Industry (OMSI), 1945 S.E. Water Ave., Portland, OR
More information www.ohsuknightcancer.com/events
Baby Talk, With OHSU Fertility Consultants
Thursday, Nov. 8, 2018
Financial sessions at 5 or 6 p.m.
Meet with fertility experts 5:30 – 7 p.m.
Location: OHSU Center for Health & Healing, 10th Floor, Fertility Clinic lobby, 3303 S.W. Bond Ave., Portland, OR 97239
Considering fertility treatment? At OHSU, we offer a full range of fertility services. Want to learn about what might be best for you? Join us at an open house. Meet briefly with a fertility expert, get to know our staff, learn about financial options, and get your questions answered.
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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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