pulse magazine summer/fall 2010

PULSEHealthy Living in Central Oregon

H I G H D E S E R T

SUMMER / FALL 2010

You’ve heard the naysayers; now hear some ADHD success stories.

When Ritalin works

Beertown Bend

Breaking down the health

benefits of brew

Fitness profile

Jenni Peskin usesyoga to work out

and focus in

Burst aneurysm

Jessica Kelly beats the odds

and thrives

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How to reach usDenise Costa | Editor541-383-0356 or [email protected]

• Reporting

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The BulletinAll Bulletin payments are accepted at the drop box at City Hall. Check pay-ments may be converted to an electronic funds transfer. The Bulletin, USPS #552-520, is published daily by Western Communications Inc., 1777 S.W. Chan-dler Ave., Bend, OR 97702. Periodicals postage paid at Bend, OR. Postmaster: Send address changes to The Bulletin circulation department, P.O. Box 6020, Bend, OR 97708. The Bulletin retains ownership and copyright protection of all staff-prepared news copy, advertising copy and news or ad illustrations. They may not be reproduced without explicit prior approval.Published: 8/2/2010

SUMMER / FALL 2010VOLUME 2, NO. 3

HIGH DESERT PULSE

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PULSEHealthy Living in Central Oregon

H I G H D E S E R T

Treatment of All

Foot and Ankle Conditions

from Ingrown Toenails to

Reconstructive Surgery

Treating Foot and Ankle Conditions for All Ages

24

Contents | HIGH DESERT PULSE

27

GOOD FORTUNE FOLLOWS BAD Burst brain aneurysm statistics are dire. Jessica Kelly beats the odds.

WE DRINK TO OUR HEALTHBend’s mad for beer. Can it be good for us?

FEATURES

ADHD: CALMING THE CHAOS WITH STIMULANTSWhile experts and the public debate, medicated kids are achieving successes their parents never thought possible.

COVER STORY

DEPARTMENTSUPDATES: SINCE WE LAST REPORTEDCurrent developments in past stories.

GET READY: THE DIRTY 2ND HALFTraining tips for this fall sequel to the popular Dirty Half half-marathon.

HOW DOES SHE DO IT?Jenni Peskin’s yoga practice balances mind and body, strength and relaxation.

BODY OF KNOWLEDGEUs vs. U.S.: How do Central Oregonians measure up?

HEALTHY DAY, OUR WAYGo with the flow in Sunriver.

PICTURE THIS: BONE MATTERSThe steel-strong frame beneath our flesh.

ON THE JOBCOPA’s advice nurse Denise Del Colle loves telling parents what to do.

SORTING IT OUT: QUICK KIDS’ FOOD FIXESFast, filling and fairly healthy fare.

LAUGHTER: THE BEST MEDICINEBedside manner of a delivery room dad.

8

21

24

HIGH DESERT PULSE • SUMMER / FALL 2010

COVER PHOTO ILLUSTRATION BY ANDY ZEIGERTPHOTOS FROM TOP: PETE ERICKSON (2), ANDY TULLIS, ROB KERR

614

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3334

3646

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Updates | NEW SINCE WE LAST REPORTED

SUMMER / FALL 2010 • HIGH DESERT PULSE

Since High Desert Pulse debuted in February

2009, the stories we’ve covered have continued

to develop. In this new feature, “Updates,” we

check back to see how things have changed.

Send your questions to [email protected].

Cancer treatment

“Is the treatment worse than the disease?”

(High Desert Pulse, Spring/Summer 2010)

questioned the current treatment for very

early stage breast cancer. Women typically

get the tumor removed in a lumpectomy

and then have a six-week course of daily ra-

diation. Some have one breast, or even both

breasts, removed.

Now, more studies are questioning

whether that type of aggressive treatment

is necessary or beneficial. It may be, these

new studies find, that women do not need

to have such grueling treatment when their

disease is caught in the very earliest stages.

One study, presented at the American So-

ciety of Clinical Oncology meeting in June,

found that women may not need to have all

of their underarm lymph nodes removed,

which can cause swelling and pain in the

arms. Standard practice is to check the senti-

nel lymph node, the one in which the cancer

is most likely to spread first. If that is found

to have cancer, doctors then remove the rest

of the lymph nodes in a woman’s underarm.

The new study found no benefit, for surviv-

al or recurrence, from removing more than

just the sentinel lymph node, even if that

node is found to contain cancer.

The second study, published in June in

the medical journal The Lancet, suggests

women may not need to have the full six

weeks of radiation therapy. It found that

one targeted shot of radiation therapy done

during a lumpectomy surgery is as effec-

tive at preventing cancer recurrence as the

conventional six weeks. That study followed

patients for four years.

— BETSY Q. CLIFF

Misleading food labels

On March 3, the Food and Drug Adminis-

tration notified 17 food manufacturers that

the labeling for 22 of their food products,

including some of those identified in “Sort-

ing the (whole) wheat from the chaff” (High

Desert Pulse, Summer/Fall 2009), violates

the Federal Food, Drug and Cosmetic Act.

The FDA had previously encouraged com-

panies to review their labeling to ensure the

labels were “truthful and not misleading.”

The move was hailed by nutri-

tion watchdog group Center for

Science in the Public Interest as

the “largest crackdown on decep-

tive food labeling in more than a

decade.”

FDA officials also said they plan

to propose new guidelines for calo-

rie and nutrient labeling on the front

of food packages and plan to work

collaboratively with the food indus-

try to design and implement innova-

tive approaches to front-of-package

labeling that can help consumers

choose healthy diets.

— MARKIAN HAWRYLUK

Medical marijuana

“Marijuana as Medicine” (High Desert

Pulse, Summer/Fall 2009) compared the

medical value of natural marijuana to syn-

thetic, pill versions of the drug. Oregon bal-

lots will likely include a measure this fall to

allow the sale of medical marijuana.

If Measure 28 passes, state-regulated,

not-for-profit medical marijuana stores

would be permitted in Oregon. Taxes and

fees from the sale of medical marijuana

would go to the state.

Proponents gathered more than the

82,000 signatures needed to put the mea-

sure on the November ballot. At press time,

the Secretary of State’s Office was still verify-

ing that those signatures came from regis-

tered Oregon voters.

Regardless of the measure’s outcome, it is

already a little easier for Central Oregonians

to obtain medical marijuana. Two nonprof-

its, Mothers Against Misuse and Abuse and

The Hemp and Cannabis Foundation, now

hold regular clinics in Bend to help patients

with qualifying conditions obtain medical

marijuana cards. For more information,

contact MAMA at 541-298-4202 or clinic@

mamas.org, or THCF at 503-281-5100.

— LILY RAFF

New therapy for cerebral palsy

“Hyperbaric therapy: who benefits?” (High

Desert Pulse, Fall/Winter 2009) examined

a local clinic’s use of

hyperbaric oxygen

therapy on disorders

for which it is not yet

scientifically proven.

Dylan Cain, a 5-

year-old Corvallis

boy with cerebral

palsy, underwent

120 experimental

hyperbaric therapy

sessions at Bend

Memorial Clinic,

ending earlier this

year. His parents

and doctors say the treatment coincided

with noticeable strides in Dylan’s muscle

control, sleep patterns, speech and vision.

“It’s been amazing to see,” says Dylan’s

mother, Jinger Cain.

The family remains in Bend so Dylan can

continue the hyperbaric therapy, along with

hippotherapy, which is physical therapy

performed on horseback. No major studies

on hyperbaric therapy’s effects on cerebral

palsy patients have been released since this

story was published.

— LILY RAFF

BY MARKIAN HAWRYLUK

PHOTOS BY PETE ERICKSON

J ared Johnson’s parents used the term

“popcorn teaching” to describe the con-

stant staccato of his first-grade teacher

calling his name, imploring him to pay

attention.

Jared … Jared … Jared … pay attention.

But as much as Jared tried, he simply

couldn’t focus on his work, on the teacher,

on the task at hand.

“He’s a great child and he wanted to learn,

but he physically couldn’t sit still,” said Andrea

Thompson, his first-grade teacher. “He would

be up and down, up and down, and walking

around. He really could not control his body.”

And while he wasn’t necessarily bother-

ing the other students, Thompson said, the

repetitive attention he required was a con-

stant distraction for everybody.

“My interrupting to get him to focus and

sit still disrupted the classroom,” she said.

As the year went on, Jared fell further

and further behind. On a timed reading

test where the average first- grader can read

50 to 60 words in a minute, he managed a

mere 19. Thompson spoke to Jared’s par-

ents, Kathy and Duke Johnson, about hold-

ing him back in first grade.

It was about that time the Johnsons went

out to dinner with Tom and Debbie Coehlo.

Tom, a nurse practitioner, and Debbie, a de-

velopmental psychologist at Oregon State

University-Cascades Campus , run the Juni-

per Ridge Clinic in Bend. Kathy Johnson co-

coached her daughter’s soccer team with

Tom Coehlo, and Jared had often spent

time at the practices and games.

Kathy Johnson remembers during one

practice they turned around to see Jared,

then 6 years old, having shimmied up the

basketball hoop, sitting with no shirt , no

shoes, 10 feet above the blacktop.

“He would just do crazy stuff. He was a

risk-taker, just never really thought about

what he did before he did it,” she said. “He

doesn’t give things a second thought; he

doesn’t have that filter.”

When the Johnsons told them of the im-

pending decision about Jared repeating first

grade, the Coehlos suggested an altogether

different approach: have him tested for at-

tention deficit disorder.

“My mind went back to my family, and I

had a brother kind of like that,” said Duke

Johnson. “My wife, who was adopted, also

had a brother like that.”

Testing revealed with little doubt that Jared

had ADD. His brain was lacking normal lev-

els of chemicals that help make connections

between nerve cells, making it almost impos-

sible for him to concentrate on a single task.

“When you’re in that near-miss accident

and you’re slamming on your brakes and life

slows down, that’s focus and concentration,

and it’s due to a lifesaving chemical in your

brain,” said Debbie Coehlo. “When you don’t

have it, you can’t slow down and focus and

life is speeding by, so you miss things. You

miss instructions and verbal communication.

You get frustrated because you miss things

and you misread people. You can’t remember

things because you only heard part of it.”

Attention deficit hyperactivity disorder, or

ADHD, differs from ADD because it includes

hyperactivity or impulsivity as a symptom.

But ADHD has emerged as the term used

for the entire group of attention deficit dis-

orders, and while medication strategies may

differ somewhat, doctors generally use the

same class of drugs to treat them.

Based on the test results, the Johnsons

opted to try medication with a stimluant,

the class of drugs most commonly used to

The reality of ADHDExperts agree that ADHD is not a benign

disorder. Children with ADHD are far more

likely to have di�culties achieving success

in life and are at greater risk for devastating

problems.

GREG CROSS

Source: International Consensus Statement on ADHD

Percentage of children

with ADHD who will:

Drop out of school

Complete college

Have few or no friends

Underperform at work

Engage in antisocial activities

Experience teen pregnancy

Experience depression as adults

5-10%

50-70%

70-80%

40-50%

20-30%

40%

32-40%

100806040200

Cover story | TREATING ADHD

Kids with ADHD learn to focus


While debate for and against medication rages,

Jared Johnson was diagnosed with ADD in second grade. Both he and his parents are very happy

with their decision to treat him with the stimulant Adderall. Here, Jared practices with his Bend Park &

Recreation District baseball team at Stover Park in Bend.

“Night and day,” Kathy Johnson said of the difference in her son Jared after his ADD was treated . “It is really frustrating to me that some people won’t consider medication, because it levels the playing field.”

treat ADD or ADHD. Through the first half

of second grade, Jared tried one medication

after another, month after month. Then the

Johnsons tried a new extended-release form

of the drug Adderall, and the light went on.

“Night and day,” Kathy Johnson said of

the difference they saw in their son. “I can’t

stress that enough. He sat there, he did what

needed to be done. There was no staring off

into space. The teacher noticed right away,

too. He was just more focused.”

Thompson, who had moved up to second

grade with Jared’s class, said the change was

drastic. “His whole demeanor changed,” she

said. “It built his confidence. His whole self-

esteem was higher.”

Jared described first grade as “hard-ish,”

but he now enjoys school much more.

“Second grade was easier because I could

concentrate,” he said. “First grade, I couldn’t.”

He no longer had to stay in during recess

because he wasn’t completing his work. He

could finish his assigned reading, even if it

was right at the end of school, before his

daily medication wore off.

For the first time, Jared was able to be

more than physically present at school; he

was mentally present as well. He went from

nearly being held back in first grade to be-

ing fully caught up academically four years

later. In June, he hit all the benchmarks for

fifth grade.

If the Johnsons had any doubts about

whether medication was the right choice for

Jared, those were dispelled when their son

did something altogether unexpected.

“He thanked us. ‘Thank you for putting

me on this,’” Duke Johnson recalls him say-

ing that second-grade year. “He knows how

bad he is off of it.”

Reading accounts of medication for ADD

or ADHD, you might think Jared’s story is an

anomaly: a kid for whom medication rei ned

in inattentiveness and allowed him to suc-

ceed at school with no serious side effects.

Certainly, media accounts have focused

on cases that haven’t gone as well, on kids

drugged into a zombie-like state, parents

demanding stimulants such as Ritalin to

ensure their kids can get into an Ivy League

school, or teachers pushing for medication

so they can have a class of docile students.

Internet sites dedicated to exposing the dan-

gers of ADHD medications are stacked with

horror stories, frightening enough to make

any parent think twice about medicating a

child with stimulants.

But lost in the cacophony of warnings are

the hundreds of thousands of success sto-

ries. The din of warnings and rhetoric have

reached deafening volumes, drowning out

the true benefits and risks of medication,

making it difficult for parents to weigh the

pros and cons objectively. The sound and

fury often mean parents delay seeking med-

ical and behavioral help, allowing kids to fall

further behind, digging a deeper hole out of

which they need to climb.

“It is really frustrating to me that some peo-

ple won’t consider medication, because it lev-

els the playing field. You wouldn’t do it if your

kid had diabetes; you’d put him on insulin,”

Kathy Johnson said. “Because (the medica-

tion) is an amphetamine, there’s a stigma. But

I’d rather have my kid make good decisions.”

Collateral damages

There may be no way to quantify how

many children are collateral casualties of the

Ritalin Wars, a term coined by ADHD experts

for the overheated, polarized debate about

medication.

“The Ritalin Wars is sort of an informal ref-

erence to the hyperbolic, polemical style of

debate that has just been part and parcel of

this issue of ADHD and Ritalin for decades. It

waxes and wanes, but it’s been around for

decades,” said Dr. Lawrence Diller, whose

book “Running on Ritalin” was one of the

first to raise the issue of inappropriate ADHD

medication. “It seems that anyone who

chooses to speak in the public arena, includ-

ing yours truly, has the potential of being un-

willingly enlisted into one side or the other.

And in my opinion, it won’t ever go away.”

Diller is a classic example. Because his

book argued some children were prescribed

stimulants too easily, too quickly, he is often

cited as an anti-medication advocate.

“I do feel that in many communities there’s

a quickness toward determining that all forms

of misbehavior and performance in school

of children is ADHD. That’s where I become

uncomfortable,” he said. “But I’m not against

Ritalin. You just may want to try other things

first that have also worked for a lot of kids,

and they don’t need to be on drugs.”

The Ritalin Wars, however, have trans-



“He thanked us. ‘Thank you for putting me on this.’ He knows how bad he is off of it.”Jared’s dad, Duke Johnson

The Johnsons, from left: Hannah, 15; mom Kathy, 42; Jared, 10 (in the tree); Ethan, 6; dad Duke, 47;

and Victoria, 17, at Stover Park .

formed an issue shaded in gray, forcing many

people into black or white positions. Parents

talk about doctors as being pro-med or anti-

med. Ritalin is either a poison that drives kids

to psychotic behavior or zombie-like states,

or the equivalent of insulin or penicillin, which

would never be denied to an affected child.

Some argue that ADHD is solely a ge-

netic issue affecting brain chemistry. Others

counter that ADD should stand for “adult

discipline deficiency,” that it’s a case of bad

parenting, not bad processing. It’s the na-

ture-versus-nurture debate all over again.

And that only helps to cloud a difficult

decision for parents, causing them to ques-

tion not only the science and the medicine,

but the motivations of doctors and teachers

along the way.

“I think the Ritalin Wars do keep certain

families who might benefit from using this

with their child as less likely to use them,”

Diller said. “But it works in both ways. Be-

cause of the potential eye-of-the-beholder na-

ture of the disorder, the doctor may feel the

kid shouldn’t be on it, and the parent says, ‘I

think we want him on it.’ But the other thing

can also be true: The doctor feels the child

could benefit and the parent is terrified.”

It doesn’t help that ADHD, like virtually

all mental disorders, has no easy, objective

measure. There’s no blood test, no brain

scan, no rubber hammer that applied deftly

to a child’s behavior will give reflexive proof

of a real disorder.

Because these conditions don’t have any

markers, the possibility that children are

both overdiagnosed in more affluent neigh-

borhoods where parents have the resources

to pursue diagnosis and treatment, and un-

derdiagnosed in underprivileged communi-

ties, is very high, Diller said. “And it’s misdi-

agnosed all over the place,” he said.

Statistics make it easy to believe that at-

tention deficit disorders are overdiagnosed.

Americans use 90 percent of the world’s le-

gal stimulants, prescribing the medications

to kids at 10 times the rate in the United

Kingdom, 100 times the rate in France,

and 10,000 times the rate in Italy. In Asian

countries, diagnoses of ADHD are virtually

unheard of, Diller said, except in the most

hyperactive kids.

Last year The Hastings Center, a bioethics

research institute in Garrison, N.Y., held its

A 2002 survey showed that the majority of American adults have negative opinions about

behavioral conditions such as ADHD and the medications used to treat them. Experts fear that

such stigma might discourage parents from seeking care for children with mental health issues.

GREG CROSS

Source: National Stigma Study – Children

Note: Percentages may not add up to 100 due to rounding.

Doctors today are overmedicating children with common behavior problems.

Giving medications to children with behavior problems will have long-term negative e�ects on their development.

Giving children psychiatric medications when they are young only delays dealing with their real problems.

Medications for children with behavior problems turn kids into zombies.

Agree: 85% Agree: 68% Agree: 66% Agree: 52%

Disagree: 14% Disagree: 32% Disagree: 34% Disagree: 48%

Medications for behavior problems just prevent families from working out problems themselves.

Getting mental health treatment would make a child an outsider at school.

Regardless of laws protecting con�- dentiality, most in the community still know which children have had mental health treatment.

Getting mental health treatment for a child would make a parent feel like a failure.

Agree: 56% Agree: 45% Agree: 57% Agree: 36%

Disagree: 44% Disagree: 55% Disagree: 43% Disagree: 65%

Attitudes toward psychiatric medication for kids


second of five planned conferences bring-

ing together the world’s leading experts on

ADHD to separate fact from fiction. The con-

ference identified what it called a zone of

ambiguity within the spectrum of ADHD.

Because ADHD doesn’t have a single, eas-

ily identifiable set of symptoms, diagnosis

invariably involves some degree of interpre-

tation and the potential for disagreement

even among professionals well-versed in

the condition. There are some children for

whom the vast majority of professionals

would have no difficulty diagnosing or rul-

ing out ADHD. But other children, the ex-

perts agreed, fall into that zone of ambiguity

in which doctors will disagree.

Because symptoms closely resemble feel-

ings and emotions that healthy individuals

experience from time to time, the untrained

eye may have trouble discerning whether a

child is spirited and rambunctious or suffer-

ing from ADHD.

They have “variants of normal feelings,”

said Dr. Graham Emslie, a professor of psy-

chology and pediatrics at the University of

Texas Southwestern Medical Center in Dallas.

“It’s clear to pick up the extremes, although

they get missed quite often, too. But most cab

drivers can tell you where the problems are.”

Public opinion

But when the experts who agree on the

validity of ADHD as a diagnosis, yet still dis-

agree on whether an individual child within

that zone is affected, it opens the door for

critics to use that ambiguity to call the entire

area into doubt. Dr. Sam Goldstein, a child

psychiatrist from Salt Lake City and editor-

in-chief of the Journal of Attention Disor-

ders, believes much of the current backlash

against ADHD diagnosis and treatment has

stemmed from an anti-psychiatry movement

that enlisted celebrities to promote their cru-

sade against mental health issues.

“They started their anti-mental health

campaign with ADHD. They made the

rounds of the afternoon talk shows, because

they couldn’t get their voice heard in the

bigger media that was going to do a little

more fact-checking,” Goldstein said. “When

that happened in the ’90s, there’s research

to show that there was a drop, not in peo-

ple who were already using medicine at the

time but in new starts. When the researchers

looked at the demographics of that, the drop

in new starts were in the demographics of

the people who you would expect would be

watching those afternoon talk shows.”

Goldstein, who at first tried to combat

the anti-medication spin with scientific evi-

dence, said he eventually stopped trying to

debate the issue in the media because talk

shows and news programs seemed to give

equal credence to both sides regardless of

credentials. Increasingly, attention was be-

ing paid to individuals who claimed, whether

legitimately or not, that the medication had

harmed them, and not to the overwhelming

number of children being helped.

The anti-medication campaign was so

effective that it soon became conventional

wisdom that kids were being overdiag-

nosed with ADHD and overmedicated by

lazy parents pressured by overwhelmed

teachers. Several years ago, journalist-

turned-author Judith Warner set out to write

a book about that very notion: how medi-

cating kids for ADHD reflected the worst of

America’s “me first” culture.

“I assumed that children were being

grossly overdiagnosed and overmedicated.

I assumed that society’s neuroses were be-

ing turned into pathologies in children, that

what was being diagnosed as disorders

in them was everything that was wrong in

the competitive high-performance, driven,

anxiety-filled world of childhood and family

life in American today,” Warner said. “How I

knew this, I don’t know.”

She had gone into the project accepting

as fact that ADHD medications didn’t work,

that they were more for the parents’ benefit

than the kids’, a way that parents could con-

vince themselves it wasn’t their fault they

couldn’t control their kids.

But a funny thing happened while she

was researching her book, “We Have Issues,”

published earlier this year. The more she

talked to parents of children with ADHD and

other behavioral disorders, the more she re-

alized the evidence was pointing in the op-

posite direction.

“Something was wrong. I just couldn’t find

answers to prove that I knew what I thought

I knew,” Warner said. “Once I listened to par-

ents’ stories, the intellectual construct fell

apart.”

She found the negative aura surrounding

the diagnosis and treatment of children with

mental disorders was only adding to the

parents’ burden.

“These parents not only have to struggle

with understanding their children’s disor-

ders and finding the right treatments, but

they also have to contend with enormous

self-doubt and, often, skepticism and even

condemnation from people around them

who believe they’re exaggerating their chil-

dren’s problems and pathologizing them,”

she said. “Nobody was rushing to have their

kids diagnosed. They all hated giving their

children medication.”

Far from being overmedicated, Warner

found many kids are getting no help at all.



“I assumed that children were being grossly overdiagnosed and overmedicated. I assumed that society’s neuroses were being turned into pathologies in children. ... How I knew this, I don’t know.”Judith Warner, author of “We Have Issues”

Signals in the brain

The brain uses a

variety of chemicals,

called neurotransmit-

ters, to perform its

various functions. Two

neurotransmitters —

dopamine and

norepinephrine —

have been linked to

attention de�cit

disorders. They help

stimulate and dampen

brain cells, allowing

signals to be sent from

one nerve cell to

another. In children

with ADHD, these

signal connections do

not work correctly.

Source: Sta� research

Inability to pay attention appears to be related to low levels of norepinephrine, which prevent children from judging which

things in their environment are important. A teacher speaking and a bird �ying by the window are equally compelling.

Impulsivity and behavioral problems have been linked to low levels of dopamine in the brain. Dopamine helps individuals

resist the urge to blurt out something or to reach out and grab something.

Stimulants, such as Ritalin, can increase both dopamine and norepinephrine levels. Other medications, such as Strattera, only

a�ect norepinephrine.

Synapse

Dopamine vesicles

Receptor

Brain Neuron Ritalin prevents this

reabsorption, allowing

more dopamine to remain in

the synapse between nerve cells,

improving the connection.

MARKIAN HAWRYLUK AND ANDY ZEIGERT

Reabsorption conduit

4• Neurotransmitters such as

dopamine are released into

the space between the

neurons, called the

synapse.

• Dopamine is then

reabsorbed into the cell

when the signal is complete.

1

3

• Dopamine

attaches to recep-

tors on the receiving

neuron, improving

signals between

them.

2

While about 20 percent of children are thought

to have identifiable mental health issues,

ranging from mild to severe impairment, only

about 5 percent are being treated for it.

Ruling out meds

Even when parents do seek an evalua-

tion to determine whether their child might

have ADHD, many rule out medication from

the onset. Providers like Sondra Marshall, a

licensed psychologist with the behavioral

health department at St. Charles Health Sys-

tem in Bend, often meet parents who want a

diagnosis but are unwilling to consider any

pharmaceutical treatment.

“Whatever camp they’re in, I really do try

to join them,” Marshall said. “Because the re-

search is clear: If a family is against medica-

tion, nothing that I say or do is going to shift

that to the extent that they’re going to join

me. I have to join them.”

Because they can’t prescribe medications ,

psychologists generally send their find-

ings to a child’s pediatrician, who can write

a prescription if needed. Many children do

just fine with behavioral interventions, mak-

ing accommodations to help them in school

and providing strategies for parents to better

meet the challenges at home.

But Marshall, who stresses she’s not op-

posed to either medication or behavioral

strategies, said studies have proven the ef-


Continued on Page 39

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BY ALANDRA JOHNSON

PHOTOS BY ANDY TULLIS

Let’s say a few days a week, you hop on a local trail after work

and jog for a few miles. But maybe there’s some part of you

that wonders if you could take it to the next level.

Running a half-marathon could be just the thing. Thirteen miles (plus a

hair extra) is a long way to run, but it is also a totally achievable distance.

In about 10 weeks, a runner who can already comfortably run five

or six miles should be able to train to run a half-marathon. The key is

dedication and taking the right, steady approach.

Connie Austin teaches the Learn to Run classes through the Foot

Zone store in Bend. She helped train a group of runners to take on

the Dirty Half in June. In early August, she will begin teaching a class

to prepare runners for the Dirty 2nd Half in October.

She thinks running in a race offers people a tangible accomplish-

ment. Many people also enjoy racing with friends or family as a fun

challenge to take on together. Austin says a training class can offer

incentives because it builds accountability and camaraderie.

What comes after the Dirty Half? The Dirty 2nd Half!

Train to run a whole Half

Get ready | THE DIRTY 2ND HALF


Whether or not people join a class, Austin advises runners not to

keep their race training to themselves. “Share your goal. By saying it

out loud, you have a better chance of sticking to it,” she said.

The runners

People who want to run a half-marathon in October need to have

a basic fitness and running level already. If you routinely run five

miles without stopping, Austin encourages you to sign up for her

half-marathon training class. And she said speed doesn’t matter.

Some people run nine-minute miles, some run 14-minute miles.

“You don’t have to be fast; you have to be motivated,” she said.

Rod Bien, owner of Fleet Feet Sports shop in Bend, suggests you

should be able to comfortably run 10K (just over six miles) before

taking on training for a half-marathon.

Austin says people of most ages can run a half-marathon, from

those in high school to those in their 60s. She thinks the hardest part

of running a half-marathon is not physical, but mental. People see it as

intimidating and “fear starts to kick in.”

The race

Race Director Dave Thomason designed the Dirty 2nd Half course.

This is the second year for the race, which is newer and therefore

less popular than its cousin, the Dirty Half.

The race starts and ends at Seventh Mountain Resort. The trail

loops around to the back of the property and goes up an old horse-

back riding trail. The hills start around the three-mile mark, and the

trail continues up for about four miles. A runner will gain about 1,200

feet in elevation. Thomason says it’s a “good, steady grade.”

He says in general this is a tougher course than the Dirty Half, but

the time of year is generally more pleasant for running. To train for

this race in particular, runners will want to include plenty of hills in

their workouts and train primarily on trails, not roads.

Mileage

Bien recommends five runs a week, with three key workouts. One

run should focus on speed, one should focus on distance, and one

should be a relaxing run. He suggests people add hill workouts during

the long runs. The other two runs can be of the runner’s choosing.

Connie Austin, center, talks with a group of runners during a half-

marathon training class she led in May. Austin will begin another

training group in August for the Dirty 2nd Half.

Both Bien and Austin recommend runners not increase the total

miles they run each week by more than 10 percent.

Austin recommends running three to five days a week. She says

those in training do not need to reach 13.1 miles before race day.

They can stretch to make the extra mile or two during the race.

Bien takes a different approach, recommending runners be able to

reach 13 miles about two weeks before race day. Then they can use

the remaining days as a “sharpening period” to cut down on mileage

and increase intensity. About a week before the race, the runner can

try to go for a six- or seven-mile run, then the week before the race

only run in the two- to three-mile range, says Bien.

Austin also suggests runners cut down on their running during the

last two weeks before the race. “Your longest run should be about

two weeks before; then start to ease off.” The week prior to the race,

the runner should not run for more than six or seven miles at a time.

Then, the week of the race, the runner should run maybe three or

four miles and rest the final two days. “The week of the race, really,

really take it easy,” said Austin. She says this is particularly important

for runners over age 40. “Our bodies take longer to recover.”

Training tips

Austin encourages runners to cross train and thinks core fitness

is particularly important. If runners use their core muscles when

rotating their bodies, they may not place as much demand on


Training regimensGet to 13.1 miles by race day one of two ways. The Austin-based

plan adds miles gradually up to a 13-mile run on race day. The Bien-

based plan also adds miles gradually, but a 13-mile run comes before

race day. Each regimen begins the week of Aug. 2.

Austin-based plan Bien-based plan

WeekTotal distance

Longest run of week

Total distance

Longest run of week

1 20 miles 5 miles 22 miles 6 miles


3 24 miles 7 miles 26 miles 8.5 miles

4 26 miles 8 miles 28.5 miles 9.5 miles

5 28.5 miles 9 miles 31 miles 10.5 miles




9 Run a few 3-4 milers.

13.1 mileson race day

Run three 2-3 milers.

13.1 miles on race day

Above: A runner navigates a rocky section of the Dirty 2nd Half course.

Start Finish

Cascade Lakes Highway / Century Dr.

4,700 ft

4,500 ft

4,300 ft

4,100 ft

3,900 ft1MILE 2 3 4 5 6 7 8 9 10 11 12 13

Elevation pro�le

Dirty 2nd Half course map

Seventh MountainResort

46

To Bend

ANDY ZEIGERTSource: Dave Thomason

Deschutes River


their legs.

When tackling hills, Bien suggests runners

try to relax more on the uphill and “work it

more” on the downhill.

Austin thinks runners should not run for a

day after a long run and older runners may

need more rest. “Stress plus rest equals suc-

cess,” said Austin.

She also says runners should pay attention

to their overall health, including getting enough

sleep. Austin suggests people follow a basic

healthy diet and avoid the urge to splurge af-

ter a big run. Bien encourages runners to make

sure they are eating enough fruits and vegeta-

bles, to eat a few more carbohydrates and to

consider eating protein in the morning.

Austin thinks people shouldn’t expect train-

ing to go perfectly every time. “It’s OK. You have

permission to have good days or bad days.”

Equipment

Shoes are obviously the most important

equipment a runner needs. Most coaches sug-

gest runners go to a shoe store and get an ex-

pert fitting, preferably with gait analysis. Shoes

typically last about 300 to 500 miles, according

to Bien. He says runners should have a dedicat-

ed pair of running shoes .

Bien thinks runners need to have a good

hydration system. Once the runs build to 8

or 10 miles, runners need to carry something

to drink. There are devices that help attach

a bottle to a runner’s hand, as well as waist

packs or backpack systems. While there will

be drink stations along the route, Bien recom-

mends runners bring their own drinks. He

also recommends runners bring energy gels,

which are easily digestible food jellies. They

typically have about 100 calories and contain

electrolytes and sodium, according to Bien,

which can help provide energy.

Austin also encourages runners to bring

some form of fuel with them. She thinks any-

time a runner is going to be out for more than

an hour, it’s good to bring along something to

refuel. Austin encourages trying different op-

tions, knowing some people have a tough time

digesting some of the tablets, energy gels and

powders available. She prefers bringing along a

granola bar (usually something with nuts) and

eating small bits while running. “Start experi-

menting, see what works for you,” said Austin.

When it comes to clothing, Bien says run-

ners should go synthetic all the way, from

socks to hats. Cotton absorbs moisture and

clings to the body, he says, and cotton socks

can create blisters.

Once the runner has the right equipment and

the right plan in place, the rest is just a matter of

putting one foot in front of the other. •

Marcy Schreiber, of Bend, runs through a rocky,

uphill section of the course.

The race When: 9 a.m. Oct. 3 Cost: $25

Contact: www.superfitproductions.com,

then click on link to Dirty 2nd Half

Foot Zone Learn to Run — Dirty 2nd Half Training Group

When: Eight weeks, starts Aug. 7, 8:30 a.m.;

deadline to sign up for the class is Aug. 4.

What: Geared to runners able to run 5 miles

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essentials, coaching support, weekly group

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Cost: $130, includes entry fee;

$150 includes race shirt

Contact: Foot Zone, 541-317-9568 or

www.footzonebend.com

Get ready | THE DIRTY 2ND HALF

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thinking by her co-workers, swift action by

emergency room staff and the expertise of

the surgeon who repaired her brain.

The journey for this 39-year-old Bend

woman, a beloved wife, mother and hos-

pice worker, has not been easy. In fact, it has

been harrowing.

Her family did not know whether she

would live or die, and even days after her ini-

tial injury, it looked as if she might not make

it. She had emergency surgery. She came

within hours of a major stroke, saved only by

a late-night transfer to a Portland hospital.

She went for months without being able

to work, care for her three sons or manage

her home.

Today, she’s able to do all those things.

She has gone back to work as a certified

hospice and palliative nurse’s assistant at

Hospice House in Bend, where it all started.

Collapse

March 10, 2010, began uneventfully. Kelly

went through the same weekday morning

scramble many American women do.

She scarfed down a breakfast of juice and

toast. She put on scrubs and pulled her long,

black hair back into a ponytail.

She saw two of her sons out the door on

their way to Bend High School. Her husband,

Mike, an electrical wholesaler who was then

unemployed, drove their youngest to Juni-

per Elementary School.

At work, Kelly began the day seeing patients

at Hospice House, an inpatient hospice facility

where people often spend the last few days of

their lives. “It takes a certain kind of person to

be able to do this work,” said Jamie Kertay, a

registered nurse who works with Kelly. Fami-

lies come in and out, saying final goodbyes,

sometimes relieved, other times inconsolable.

Kelly’s good at what she does, Kertay

said. “She’s able to anticipate the needs of

the family. She’s kind and loving.”

That March morning, Hospice House had

a routine all-staff meeting. Nurses and other

employees filed into a small chapel, sitting

around the edges of the room.

It was when they were discussing time-

cards that Kelly began to feel sick. “I wanted


Medicine | BRAIN ANEURYSMS

BY BETSY Q. CLIFF

PHOTOS BY ROB KERR

When a blood vessel burst in Jessica

Kelly’s brain this spring, she had

a good chance of dying instantly.

One in four people do.

Another 25 percent die within three months.

Of those who survive, most have major,

life-altering disabilities. Slurred speech, trou-

ble walking, the inability to feed oneself are

all common.

That Kelly walked away with none of these

problems is remarkable.

Her improbable survival was partly a

matter of luck. But it was also due to quick

A blood vessel bursts in her brain,

but Jessica Kelly lives to talk about it

Beating the odds

A hospital CT scan shows where

blood spread after the vessel burst.

(Image has been colorized. )

Back

Front

to leave the meeting,” Kelly said. “I was just

like, ‘I need to get some air.’” She stood up.

Suddenly, “she just faded to the floor,”

said Lisa Hildebrandt, a staff member who

was at the meeting.

Kertay, sitting next to Kelly, helped catch

her and lowered her to the ground. On the

floor, Kelly had a seizure, shaking violently

in the middle of the room.

Kertay ran to get equipment to take her

vital signs. Another nurse, Alice Le Barron,

called 911.

“911, where is your emergency?”

“At Hospice House,” Le Barron replies. “One

of our employees has just lost consciousness.”

Her voice has the calm control of someone

trained to deal with medical emergencies,

but her breath is rapid; she’s clearly worried.

“Oh dear,” the operator replies. “Are they

breathing?”

“Yes, she was when I walked out.”

“Hold on,” the operator says, “while I alert

the ambulance.”

There’s background noise , then the op-

erator comes back on. “Do you know, is she

breathing?”

“Yes she is and she’s speaking now. She

says she feels very dizzy.”

“OK, but she appears to be completely

alert?”

“Yes.”

The operator’s tone softens. Alert is a

good sign. He asks a few questions about her

condition.

Treatment options

Anatomy of an aneurysmAn aneurysm is a balloon-like bulge in an

artery. Cerebral aneurysms can be just

a few millimeters to several centimeters

and usually cause no symptoms unless

they burst. When a cerebral aneurysm

ruptures, it sends blood into the

brain. These ruptures are

immediately or imminently deadly

in about 50 percent of cases.

Aneurysm

Artery

Clip Catheter

Coils

Brain

Bleeding from ruptured

aneurysm

Sources: National Institutes of Health, Mayo Clinic, Dr. Ray Tien

The primary treatment for a cerebral

aneurysm is brain surgery. A neurosur-

geon cuts open a patient’s skull, �nds the

a�ected vessel and, very carefully, places a

clip or clips across

the base of the

aneurysm to cut

o� blood �ow

into it.

A less invasive treatment is endovascular

embolization. A catheter is snaked

through a patient’s blood vessels up into

the brain to deposit coils that �ll the

aneurysm. The

blood is forced

back into the

normal path of

the blood vessel,

and a blood clot

forms that seals o�

the aneurysm.

ANDY ZEIGERT


Le Barron interrupts. “She’s just passed out

again.”

“Ohhh,” the operator says, his voice drop-

ping. He sounds tense as he reassures Le Bar-

ron that an ambulance is coming.

The timing of the collapse, though trau-

matic for the staff, was incredibly fortu-

nate for Kelly. If it had happened at many

other times — driving in the car with a child,

asleep, in the room of a patient who was

barely conscious — Kelly might not have

received help so fast. Her outcome, in that

case, almost certainly would have been

worse. How much worse is anyone’s guess.

After the paramedics arrived and stabi-

lized Kelly, Mike arrived at Hospice House,

having been called by one of the nurses. He

and Dr. Lisa Lewis, the medical director at

Hospice House, followed the ambulance the

few short blocks to St. Charles Bend’s emer-

gency room.

In the ER

Nurses and doctors leapt to Kelly’s side

as soon as she hit the emergency room.

They knew right away it was serious. A team

quickly began checking her vital signs, giv-

ing her medications to alleviate symptoms

and inserting intravenous lines.

Kelly was terrified. She was conscious and

confused about what was going on, Lewis

said, becoming teary at times. “All these peo-

ple were yelling orders at her,” said Lewis.

Kelly’s head throbbed. “I hurt so bad,”

she repeated over and over again. “My head

hurts so bad.”

Dr. Brett Singer was the emergency room

physician on call that morning. He took a

quick medical history, noting that this was

the first time in her life she’d had a seizure

and had no family history of the problem.

With that kind of abrupt onset, he said,

“aneurysm is the first thing that comes to

mind.”

With her symptoms, he said, ordering a CT

scan to look for bleeding in her brain would

be routine, and he ordered one immediately.

It showed a massive bleed.

Singer immediately called the neurosur-

geon on call, Dr. Brad Ward. He took one

look at the scan and called another neuro-

surgeon, Dr. Ray Tien, who specializes in fix-

ing aneurysms.

An aneurysm is a bubble in an artery, the

blood vessels that carry oxygenated blood

from the heart to the rest of the body. Like a

FILE PHOTO

Dr. Ray Tien, neurosurgeon

The ruptured blood vessel was near the parts of her brain that control vision, smell, leg strength and hormones. In Kelly’s surgery, all those functions were at risk.


Continued on Page 44

balloon, when the artery bubbles out, it be-

comes thinner and weaker.

An aneurysm in itself is not dangerous

and rarely has any effect. A person can

live with an aneurysm for decades without

knowing it’s there. The danger is that, as the

blood vessel balloons farther and gets thin-

ner, it can pop.

There are several risk factors for aneu-

rysms. A family history, high blood pressure

and smoking make an aneurysm more likely.

Kelly had none of these. No one knows what

caused her aneurysm to form or rupture. It

could have been, said Tien, that she was just

unlucky.

Mike, in the hospital waiting room, was in

shock. In just a few hours he had gone from

drinking a leisurely morning coffee to an-

swering questions and signing papers about

Kelly’s power of attorney and the executor

of her will.

He called his two teenage his stepsons,

and told them to leave school. He called Kel-

ly’s parents and her brother. He feared they

might never see her again.

Later, while Kelly was being treated, Mike

went back home. “I looked it all up on the

Internet,” he said. “That sucked.”

He learned that very, very few people

come through without side effects. While

he was online, their oldest son, 17-year-old

Derek, came into the room.

“Mom’s going to be alright, isn’t she?” he

asked Mike.

“I don’t know, man,” Mike replied. “I don’t

know.”

Surgery

It was early afternoon, about three hours

since Kelly had collapsed, when Tien began

to work on Kelly’s aneurysm. There are two

ways to fix a ruptured aneurysm, one in

which the skull is cut open and one in which

it is not. Tien wanted to try the less invasive

procedure first.

Tien is the only neurosurgeon in Central

Oregon trained in a procedure called endo-

vascular embolization that was first used in

the 1990s. A catheter is snaked from a blood

vessel in the patient’s thigh through the

body and up into the skull to fix the aneu-

rysm from within the blood vessel. Cardiolo-

gists commonly use a similar procedure to

fix blocked arteries in the heart.

An X-ray scan, done shortly after Kelly’s

initial CT scan, had shown Tien the location

of the ruptured blood vessel in her head.

Using the X-ray scan to determine his po-

sition, Tien threaded a catheter up into her

brain. Once there, his goal was to fix the

rupture by sliding small metal coils through

the catheter and pushing them into the bub-

bled-out aneurysm.

When it works, the coils bunch up, like a

balled-up Slinky, filling the aneurysm and

preventing blood from flowing into it. A

blood clot forms that seals the aneurysm,

preventing further damage.

Once he got into the ruptured blood ves-

sel, Tien realized this procedure would

not work for Kelly. Her aneurysm was not

typical. Most bubble out on one side of the

blood vessel; Kelly’s bubbled out on both

sides. Tien described it as dumbbell shaped.

“There just really isn’t a safe way under

these circumstances to fix this from within,”

he said.

By late afternoon, Tien was opening Kel-

ly’s head. He cut her scalp across the front

of her hairline, drilled through her skull just

We love our beer. Does

Is it healthy? | A LOOK AT BEER

BY ALANDRA JOHNSON

PHOTOS BY PETE ERICKSON

Central Oregonians are known to be a bit beer crazy. Just take

a look around. Nearly every bar and restaurant serves up a

frothy selection way, way beyond Coors and Budweiser.

And we also know how to make the stuff. Bend has seven

breweries . That’s one for about every 11,800 people. The poor,

suffering public in Portland has only one brewery for every

17,100 people.

The High Desert is also known for its fair share of health nuts.

Triathletes, marathoners, mountain bikers, kayakers, skiers and

on and on — we’ve got plenty of them all.

And while for some, beer may conjure images of beer bellies, it

doesn’t leave quite the same impression here. It’s hard to go any-

where in town and not see someone in athletic gear, just back from

some healthy endeavor, on the way to get a beer.

So yes, Central Oregonians (athletes included) love our beer. But

just how healthy is it? Beyond pleasing our taste buds and quench-

ing our thirst, is beer good for us?

There’s no simple yes or no answer here, but we found a few

studies that help shed light on this question.

1 Bone density: This may be particularly good news for

those crash-prone snowboarders and mountain bikers in our midst

who like to drink a pint or two.

Above: A lineup of Cascade Lakes brews

density). But the question remained, which beer is best

when it comes to silicon content?

The answer favors the hoppy styles we’re best known

for in the Northwest. India Pale Ales offered the most sili-

con bang for the buck, because they are made with a lot

of malt and hops, both of which contain a lot of silicon.

Pale ales also contained lots of silicon. Wheat beers and

light lagers tended to contain the least amount, less than

half of that found in IPAs.

While there’s no recommended daily intake for silicon,

the researchers said average daily consumption is about

20 to 50 milligrams. Beer drinkers could consume that

much by drinking 2 liters of beer, or 1 liter of some highly

hopped beers.

Now, before you start guzzling pints of hoppy brew based

on this study, there is one caveat: The study didn’t involve

any patient data. The conclusion that beers with more sili-

con will help with bone density is inferred but wasn’t tested.

2 Heart health: Moderate beer drinkers can

raise a pint to this bit of news. In general, beer drinking is

associated with some positive outcomes regarding heart

health. (But cry a tear into your third beer, because as soon

as you get past that “moderate” label, all bets are off.)

For instance, researchers in Israel took a group of men

with coronary artery disease and split them into two

groups. One of the groups had to drink one beer a day

for a month, while the others drank mineral water. The

groups ate a similar diet. After a month, the beer drinkers

experienced lowered cholesterol, increased antioxidants

and a change in blood chemistry that is associated with

reduced heart attack risk. The researchers, who pub-

lished their findings in the Journal of Agricultural and Food

Chemistry in 2003, attribute these positive changes to the

high polyphenol content found in beer. Polyphenols are

compounds that are found in plants and have antioxidant

qualities and benefits. A similar study conducted in the

Czech Republic reached similar conclusions.

The Nurses’ Health Study, which has followed more

than 120,000 registered nurses since the mid-1970s, also

backs up the notion that a pint of beer is good for the

heart. The study showed women who drank one alco-

holic beverage (wine, beer or liquor) per day cut their risk

of heart disease in half.

3 Xanthohumol: Here’s a bit of great news we

can toast regarding the health benefits of hops. Prob-

lem is, we’d have to hoist about 450 liters of beer for the

health benefits to kick in.

A decade ago, researchers at Oregon State Uni-

versity discovered some beneficial properties of a

compound called xanthohumol, which is found ex-

clusively in hops. The cool thing about this micronu-

it love us?

Several studies show a positive correlation between moderate

beer drinking (that’s one to two drinks a day) and bone density.

One study that appeared in the journal Nutrition in 2009 took a

look at nearly 1,700 healthy women in Spain with an average age

of 48. Ultrasound tests found greater bone density in beer drink-

ers compared with those who drank nothing as well as those

who drank only wine.

Turns out the kind of beer people drink also plays a part. A

study released in February from the University of California at

Davis examined the silicon content of different styles of beer. Sili-

con, you see, has been shown in numerous studies to positively

impact mineral bone density (women with osteoporosis who

supplement their diets with silicon show increased bone mineral

trient is that it may be helpful in preventing

prostate and colon cancer and might even

be useful as hormone replacement therapy

for women. All over the world, research-

ers are studying the compound. The OSU

researchers found xanthohumol is toxic to

ovarian, breast and colon cancer cells. They

also discovered xanthohumol is a source of

antioxidants.

While this is exciting news, the amount of

the compound found in beer is pretty low.

Perhaps in the future, hops may be geneti-

cally engineered to contain higher levels

of the compound, or brewers may try to

brew a beer containing a large amount of

xanthohumol.

4 Calories: As we in Central Oregon

know (a fact that fails to be noticed in many

regions of the country), not all beers are the

same. Some are crisp, light and citrus-like;

others are heavy, rich and taste of coffee

and chocolate. And just as the taste of beer

can differ greatly from pint to pint, so too

can the calories.

Contrary to what people may assume,

beer that is lighter in color isn’t necessarily

lighter in calories. In general, calories are

likely to increase with alcohol content per

volume. So a 12-ounce bottle of Heineken,

which is 5.4 percent alcohol, contains 166

calories, while the much darker Guinness

Draught, which is 4 percent alcohol, has

just 125 calories, according to Realbeer.

com. This generalized calorie calculation

doesn’t always hold true, but it’s a good rule

of thumb.

Deschutes is the only local brewery whose

calorie counts are available on Realbeer.com.

Cascade Ale is the lowest, with 145 calories

per 12 ounces, and Obsidian Stout is the

highest, with 220. Mirror Pond Pale — the

brewery’s most popular beer — contains 170

calories.

Sierra Nevada is producing a very caloric

offering — Bigfoot. This beer has 9.9 per-

cent alcohol and contains 330 calories and

more than 30 carbs per bottle.

(Check out the calorie, alcohol and carb

content of other beers at www.realbeer.com

/edu/health/calories.php .)

5 Colon cancer: Here’s some news

beer drinkers won’t be cheering: In a study

from the American Journal of Gastroenterol-

ogy in 2005, people who consumed eight or

more servings of beer a week had a higher

risk of abnormal cell growth in the colon

than non-drinkers. People who drank liquor

were found to have a similar risk, while those

who drank wine had a lower risk.

The researchers in New York surveyed

more than 2,200 patients who were getting

a screening colonoscopy about their alco-

hol habits and other health factors. People

who drank more than eight beers a week

(considered heavy drinkers) were more than

21⁄2 times more likely to have a colorectal

neoplasia (an unhealthy growth of cells),

compared with those who drank less. About

20 percent of those who drank eight or more

drinks per week had this growth detected

through a colonoscopy.

6 Breast cancer: This is more not-

great news, at least for female beer drink-

ers. Numerous studies have shown a link

between alcohol consumption and an in-

creased risk of developing breast cancer.

While not specific to beer per se, it certainly

applies.

The Nurses’ Health Study showed the

type of alcohol consumed didn’t seem to

matter. It was about the quantity. In es-

sence what the researchers found is that

for every drink a woman had on average

per day, her risk of breast cancer increased

by 10 percent.

Another large-scale study conducted by

Kaiser Permanente Medical Care Program

showed similar results. Women who drank

any alcoholic beverage at least once a day

had a 10 percent higher risk of breast can-

cer than those who drank less than one

drink per day. Women drinking three drinks

or more per day increased their risk of

breast cancer by 30 percent.

So, what does all this mean? Well, that

beer is an interesting and complex bever-

age, not just in flavor, but also in terms of

health. Research will undoubtedly continue

and we look forward to reading about the

latest findings.

While some people may be encouraged or

discouraged to raise a glass based on these

studies, the best motivator to drink a pint re-

mains the oh-so-delicious taste. •

Is it healthy? | A LOOK AT BEER

Marcel Russenberger, 51 , of Bend, laments his empty pint while chatting with Corene Follett, 38,

center, and Emily Poole, 30, at the Deschutes Brewery in Bend.


Meet Jenni PeskinOccupation: Executive director of the Human Dignity Coalition and

part-time yoga instructor at Juniper Swim & Fitness Center

Activities: Yoga, walking and an occasional run

Splurges: Home-baked treats with 5-year-old daughter Morgaine

Setbacks: Lupus diagnosis in her early 20s, but she now lives mostly

symptom-free and without any medication

On body image: Peskin believes in “radical self-acceptance.” “This

body does not look like an airbrushed picture in a magazine,” she said.

“That’s not my emphasis in life. I’m soft and squishy; that’s how I hold

my kid. My belly holds her up.”

BY ELEANOR PIERCE

PHOTOS BY ANDY TULLIS

If you’ve ever been to a power yoga class, you know yoga can be

an athletic endeavor, with music pumping and plenty of sweat.

But if you’ve ever been to a yoga class at Juniper Swim & Fit-

ness Center taught by Jenni Peskin, you might get the sense that

there’s another side to yoga. Peskin teaches yoga part time, in addi-

tion to being the longtime executive director of the Human Dignity

Coalition, where she works to promote equality and human rights

for the lesbian, gay, bisexual and transgender community.

As she opens her yoga classes with ancient Sanskrit chants, there’s

a clear sense in the room that here, yoga isn’t just a workout. For

Peskin, as for many traditional yogis, yoga is a spiritual practice as

much as a physical one, though she didn’t always see it that way.

She took her first yoga class in college, and at the time, it freaked

her out. “The teacher was this Sikh woman wearing a white turban,

and I thought, ‘No way. This is too weird.’”

After a hiatus, she tried yoga again. The classes were casual; she

used a towel as a yoga mat, and a friend who came along had a ten-

dency to fall asleep and start snoring in the final relaxation pose.

“It was this pretty enjoyable thing to do,” she said, so she kept it

up. It was after she spent time at a yoga retreat in Grass Valley, Calif.,

that she began developing the spiritual side of her practice.

“I still had the mindset that yoga was just exercise, and here peo-

ple were talking about God, and there was an altar people would

bow to,” she said.

For a while, she eschewed the spiritual side, but before long, her

understanding of yoga started to shift. “It’s a very multifaceted prac-

tice,” she said, “not just a physical practice.”

Peskin soon discovered Sivananda, a form of yoga that focuses on

breath and relaxation.

“The philosophy is on teaching the body and the mind proper re-

laxation,” she said. “We let the heart rest so it doesn’t put a strain on

the body.”

Having been diagnosed in her early 20s with lupus, a chronic au-

toimmune disorder that can affect the skin, organs and joints, Peskin

Balancing spirit and body

How does she do it? | JENNI PESKIN

“I don’t think of myself as a teacher,” Jenni Peskin said. “I’m just here to

share this practice that I have.” Here, she holds Scorpion Pose, or

Vrischikasana, while doing yoga on the front lawn of her Bend home.


Yoga, for the inside and out

said any exercise that made her body feel

better was welcome.

“Yoga has been the one exercise that

doesn’t stress my body,” she said.

Peskin thinks yoga has helped her live

mostly symptom-free and without medica-

tion for her lupus, but she doesn’t think of

yoga as a cure-all.

“I can have bad days, where my hands

hurt, or I’ll have a little chronic fatigue,” she

said. “I know I’m really lucky.”

Growing up in Los Angeles, Peskin, who

turns 40 this year, did gymnastics and was

a cheerleader. Although she wasn’t over-

weight, she dieted using Weight Watchers

and ran on a treadmill at the gym, trying to

get slim for her musical theater auditions.

Peskin moved to Bend nearly a decade

ago. Her first day in Bend, she met Jay Stalk-

er, whom she later married. The couple had

a daughter, Morgaine, now 5, and they later

divorced.

Now, Peskin doesn’t care for the idea of di-

eting. She prefers a “radical self-acceptance”

stance toward body image. And while she

admits to having a sometimes-challenging

relationship with food, she tries to live with

some basic values in mind. One she likes is

the Michael Pollan mantra: “Eat food. Not too

much. Mostly plants.”

She generally stays away from processed

food by cooking at home and eating local or

organic food whenever she can. This year,

she’s splitting a subscription to a CSA (short

for community supported agriculture) with a

friend. Each week, she picks up a box of lo-

cally grown, fresh, seasonal veggies. When

we spoke with Peskin early in the summer,

the weekly produce box was mostly assort-

ed greens.

“I don’t know what any of it is,” she said.

She prefers to cook the greens down to re-

duce the bitterness, but Morgaine loves raw

veggies and will chew her way through most

any crunchy green that comes her way.

She and Morgaine also love to bake

sweets, but Peskin believes in being thought-

ful about enjoying those treats.

“You can plow through food, or you can

do it mindfully,” she said.

One reason she has time to bake is that

unlike so many other Central Oregonians,

she never picked up a skiing or serious bik-

ing habit.

“I tried learning to ski, but I can’t keep up

with everyone, and if I push too hard, I’m

going to have a lupus flare-up,” she said. As

for bikes, she likes riding around town, but

adds, “I am so not a gear head.”

She will occasionally go for a run for some

cardio, but she also loves just walking.

Not too long ago, Peskin said, a friend

asked her what lupus had taught her.

“It’s taught me to slow down. And ever

since then,” she said with a big smile, “I’m

like, oh, how much slower can I get?” •

How does she do it? | JENNI PESKIN

HIGH DESERT PULSE

Peskin and her daughter, Morgaine, tend to young plants on their back deck. Peskin likes gardening

but admits she’s not great at it. “I already killed my first round of seedlings; we’re on our second.”

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1 Where do a higher percentage of people die of heart disease? A. Oregon

B. United States

2 Where is the percentage of people diagnosed with diabetes highest?A. Deschutes County

B. Oregon

C. United States

3 The prevalence of women using tobacco while pregnant is highest in which location? A. Oregon

B. United States

4 Binge drinking is more prevalent in which location?A. Oregon

B. United States

5 Where do more adults meet Centers for Disease Control and Prevention recommendations for physical activity?A. Deschutes County

B. United States

6 In which location do more adults eat at least five servings of fruit and vegetables each day?A. Deschutes County

B. United States

7 Where are the rates for overweight individuals highest?A. Deschutes County

B. Oregon

C. United States

Us vs. the U.S.See how healthy we really are

in Oregon and Deschutes County

Body of knowledge | POP QUIZ

BY BREANNA HOSTBJOR

If you’ve ever looked out the window and seen a band of bikers rush-

ing down the road, or headed outside on a sunny day and seen run-

ners and paddlers galore, you might have begun to suspect some-

thing about local residents: We’re fit.

But can we really draw that conclusion from the anecdotal evidence?

For every avid biker you see grinding up a hill, how many people are sit-

ting at home munching chips? How good is our nutrition, really?

Use this quiz to test your knowledge of local health statistics compared

with the rest of the country, and see if you can get a healthy score.

Answers1. B. According to data gathered in 2004, 27 percent of deaths nationwide are caused by heart disease, whereas only 22 percent of Oregon’s deaths are due to coronary issues. 2. C. 8.2 percent of people in the United States are diagnosed with diabetes. That rate is 5.1 percent in Deschutes County and 6.5 per-cent in Oregon. 3. A. In both Oregon and Des-chutes County, approximately 12 to 13 percent of women use to-bacco while pregnant. In the Unit-ed States, the rate is 11 percent.4. B. The national average for binge drinking, or drinking five or more alcoholic beverages in a sit-ting, is 15.6 percent, slightly high-er than Oregon’s 12.8 percent.5. A. While 49.5 percent of adults in the nation exercise enough to meet the CDC’s standard, 60.9 percent of adults in Deschutes County meet or surpass the same guidelines. This means that they engage in moderate physical ac-tivity for 30 minutes or more five or more days each week.6. A. 31.2 percent of adults in Deschutes County eat at least five servings of fruits and vegetables each day. This is higher than the national average of 24.4 percent. 7. A. Per capita, there are more over-weight (but not obese) individuals in Deschutes County, at 38.8 percent, than in Oregon, at 37 percent, or the U.S., at 33.6 percent. This pat-tern is opposite of the trend seen in obesity: The U.S. has an obesity rate of 23.9 percent; Oregon’s rate is 22.1 percent and Deschutes County’s, 18.3 percent. This sug-gests that while fewer people in the county have reached a body mass index of 30 or higher, which would make them obese, locally we have a greater number of people who are overweight, or have an index of 25 or higher. Though the local weight problem may skew toward less extreme body mass numbers, there are still more people here at unhealthy weights.

Sources: Tobacco Prevention and Education Program, Deschutes County Tobacco Fact Sheet 2009; 2007 and 2009 Deschutes County Health Reports; Centers for Disease Control and Prevention (CDC)/Behavioral Risk Factor Surveillance System Survey Data

GREG CROSS

BY BREANNA HOSTBJOR • PHOTOS BY ROB KERR

Central Oregon, with its desert vistas, sunny days and wildlands, is an outdoor en-

thusiast’s dream. And if the late summer and warm beginnings of fall have you

hankering to go outside and enjoy nature before wintry weather arrives, then head

out to Sunriver for the day. With boating, great food and a nature center, there’s plenty to

keep you entertained while you treat your body to a healthy day in the sun.


1. Start the day at Cafe Sintra. While there are plenty of fatty foods available at

breakfast time, cutting cholesterol doesn’t mean you should cut this meal from your

day. And at this Sunriver cafe, you can choose from several options that will give you

the energy to stay active while keeping your arteries clear. The granola trio ($8.50,

pictured) has whole grains, vanilla yogurt and seasonal fresh fruit. Colorful

fruits not only look appetizing, they pack a wallop of vitamins, and the

carbohydrates in the granola will give you the energy to stay strong

through the morning. You can also order oatmeal ($6.50), which

has been linked in some studies to lowered cholesterol and

improved heart health. Add some fresh fruit to this dish ($1

extra) and you can’t go wrong. Both dishes are made from

scratch in the restaurant . Cafe Sintra, 7 Ponderosa Road,

Sunriver; 541-593-1222 or http://cafesintra.com .

Healthy day | ON THE RIVER

Where sun meets river Grab your sunscreen

and head to Sunriver

2. Paddle the morning away. Give your arms and torso a workout when you head down the

Deschutes River. If you spend a lot of your exercise time using your legs — runners or bikers come

to mind — using your upper body will work muscles that don’t receive as much attention. The Sunriv-

er Resort Marina has a launch site where you can rent canoes, kayaks, rafts and stand-up paddle boards

to float down the river. A leisurely trip from the marina to a pick-up point at Benham Butte takes about two

hours, though you can certainly make it in less time with more paddling. Or, if you feel particularly energetic,

you can paddle both ways, forgoing the free shuttle the marina provides with its rentals. Using a stand-up board is

one of the best bets for exercise while floating downstream, and the boards are becoming popular with renters. Best of

all, the effort required to maintain your balance while standing will work your core muscles in addition to your arms. Rates for

rentals range between $70 and $200, depending on the boat you choose. Sunriver Resort Marina, 57235 River Road; 541-593-3492.

3. Relax at the Trout House. After

all that paddling, head over to the Trout

House Restaurant , next to the marina. A

spinach salad with red onions, feta

cheese and vinaigrette ($10, $6 for half) is

a good way to get a couple of servings of

vegetables into your diet. Spinach is rich

in vitamins A and C as well as nitrite. All

together, it makes this vegetable a great

choice for improving heart health and

staving off certain forms of cancer. Or try

the seared fresh salmon ($15, pictured)

with apricot-garlic mustard, caramelized

pears, rice pilaf and seasonal vegetables,

which will give you plenty to munch on in

terms of flavor and nutrition. Salmon is

also full of omega-3 fatty acids that may

help manage cholesterol levels. Trout

House Restaurant, 57235 River Road, Sun-

river; 541-593-8880 or www.trouthouse

restaurant.com . Reservations are

recommended , so call early.

4. Explore the outdoors at the nature center. The Sunriver Nature

Center & Observatory has plenty of

family-friendly activities and classes

that are great for learning about

natural history. There are nature talks

on a variety of topics, and in the

evening the center holds occasional

owl prowls, where you can walk with a

naturalist and learn about Sunriver’s

nocturnal animals. The observatory

also offers solar viewing from 10 a.m. to

2 p.m. daily. From 9 to 11 p.m. Tuesday

through Sunday, you can view the

night sky and listen to a presentation

about astronomy and celestial space.

After Sept. 5, the observatory will be

open only on Saturdays, and the night

programs will be from 8 to 10 p.m. If

guided tours and lessons don’t appeal

to you, there’s also the Sam Osgood

Nature Trail, which is open all year. The

flat path is only about one-quarter mile

long, but it offers plenty of great views,

chances to see raptors and a botanical


garden. Admission to the nature center is $4 for adults and $3 for

children ages 2-12. Evening programs cost $6 for adults and $4

for children. Some special events at the center may also have

additional fees, so be sure to check with the center if you plan to

attend one of them. Sunriver Nature Center & Observatory, 57245

River Road; 541-593-4394 or www.sunrivernaturecenter.org . •

A great horned owl at the

Sunriver Nature Center.

Child’sPlay

A Local Directory Dedicated To Your Child’s Well-Being

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Bone mattersMany people think of bones as being solid, but they are surprisingly hollow. The 206 bones that make up the skeleton come in a wide variety of shapes and sizes. Bones are incredibly strong — in some cases the strength of bone is greater than that of concrete. A brief primer about what holds us all together:

Remodeling boneOur bones are constantly

rebuilding and repairing

themselves through a

cellular process called

remodeling.

Osteoclasts are cells

that work as excavators.

They eat away areas of

bone in need of repair,

creating a cavity.

Osteoblasts are cells

that function as builders.

They work like brick-

layers, building up and

depositing layers of

compounds into the

cavity left by the

osteoclasts, forming

new bone.

Osteocytes are

osteoblast cells that have

become embedded into

the bone during

formation. They are

thought to take on a

new role as sensors of

strain and stress within

the bone, summoning

other cells for repair.

Compact boneDense, strong and resistant to bending,

this type of bone forms a solid mass. In

the femur it forms a long, hollow tube.

The hollow contains yellow marrow, a

store of excess fat the body can utilize

for energy during starvation.

Femur, life-size, cross-

sectioned through the

femur head.

Ear bones,

life-size.

Spongy boneProvides the greatest amount of elastic strength and

is found in stress- and weight-bearing areas like the head

of the thigh bone, or femur. The honeycomb-like structure

of the bone makes it both light and strong, much like the

framework on a bridge. The voids within the honeycomb

are �lled with red marrow, which produces various

types of blood cells.

Listen to your mother and drink your milk. Calcium is important to bone

health, as are vitamins C and D. Weight-bearing activity such as lifting

weights or vigorous excercise also helps to maintain bone strength.

Maximum bone density peaks in the mid-20s; after that, the ability of

bone to remodel itself slowly declines. The most common form of bone

disease is osteoporosis, the diminishing of bone density as we age. More

women are a�ected than men, in part because the reduction of

estrogen after menopause a�ects the ability of women’s bones to repair

and rebuild. The e�ects of ostetoporosis can be reduced with moderate

excercise such as swimming or walking and, in some cases, medication.

Keeping your bones healthy

LongBones of the arms and

legs are physically the

longest, but �ngers

and toes are consid-

ered long bones, too.

ShortSmall, cube-like

bones of the

wrists and ankles.

IrregularMultifaceted

bones, like the

vertebrae in

the spine.

The four

types of

bones

Sources: National Space Biomedical Research Institute, National Institutes of Health, The Science Creative Quarterly

1

2

3

ERIC BAKER

FlatThe ribs and

bones of the skull.

The long and short of itAveraging 19 inches in

length, the femur is the

longest and largest bone

in the body. The

smallest are the

three bones of the

ear; the stirrup,

anvil and

hammer.


Picture This | BONES


BY ALANDRA JOHNSON

Nurse Denise Del Colle loves anxious moms, the ones who call her up full of fear

and worry. Those are her favorites.

She loves them so because she feels absolutely confident she can help them.

“It’s an opportunity to do a lot of teaching,” said Del Colle, “and to reassure them they are

doing a great job.”

When they hang up the phone, they will feel more confident and know what to do to

help their sick or injured children, she said.

For the past five years, Del Colle has served as a full-time nurse working on the nurse

advice line at Central Oregon Pediatric Associates. During her shift, she talks to 60 to 80

parents. She diagnoses injuries, rashes, illnesses, traumas and more. She helps with devel-

opmental, behavioral and nutritional questions , among others. With H1N1 flu concerns last

fall, Del Colle says she received about 110 calls a day. “This is my niche, my calling.”

How it works

Del Colle and two other part-time nurses field calls from parents during the day. The

service is free to COPA patients. After hours, the calls are sent to an advice line run

through Legacy Hospital Registered Nurses in Portland.

COPA medical director Dr. Stacy Berube says the doctors see the value of providing

this service, which has been in place for more than 20 years. “It’s important we have

an answering service because children get sick 24 hours a day.” He says the line is also

popular with parents. “It may be the parents’ favorite service we offer .”

Del Colle sees the service as a lifeline for parents. “To tell a mother how to heal her

child is incredibly meaningful.”

The nurses also follow up on many calls. Del Colle believes she is able to keep a lot

of families out of the emergency room. Sometimes parents will wait on hold for half an

hour or more to talk with her.

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Denise Del Colle talks on the phone

with a patient’s parent at COPA.

ROB KERR

She says less than half of patients end up needing to see a doctor

that day. But if she gets the sense that a parent is on edge, often she

will recommend a doctor visit. “Sometimes parents just need reinforce-

ment.” She recommends visits to the emergency room very rarely.

New mothers, in particular, call a great deal. “They are all so

new and sleep deprived,” said Del Colle. While most of the calls

come from moms, she is getting more and more from dads.

Paying attention is essential to Del Colle’s job. Sometimes par-

ents call in with very worrying cases, and she needs to keep fo-

cused. “You can’t be daydreaming about a date last night.”

Berube calls Del Colle knowledgeable and experienced. Before

Del Colle came to Bend, she worked at a pediatrician’s office in

Kona, Hawaii, for 17 years. She has also worked in a pediatric in-

tensive care unit in California. Del Colle, who doesn’t have any

children of her own, says she has always loved working with chil-

dren and parents. She lives on a horse ranch in Sisters.

Cases

There are a lot of questions about ticks, spiders and hives, and

a lot of calls about trauma. Kids slip on the ice or fall down the

stairs. A tremendous number of parents call about upper respira-

tory issues as well as diarrhea and vomiting. Allergies, asthma,

sleep terrors — the list goes on and on.

While a majority of the advice calls are about infants and young

children, Del Colle also gets some calls about teenage adjustment

issues, from sex to alcohol.

She also talks to parents about clear parameters. She tells them

what to look for and how long symptoms can persist without

worry. “It makes a parent feel powerful to bring (their child) back

to total health and feel good.”

Operating under protocol and paying close attention — not to

mention her own lengthy experience — give Del Colle tremen-

dous confidence . Which is good , because, as she says, “there’s

never a shortage of questions.” •


“I can’t tell you how relieved I was to hear Nurse Denise’s voice; I knew she would listen and help us make the best decision.” Amy Howell, in a thank-you message to Del Colle after a traumatic medical experience involving her daughter

1460 NE Medical Center Dr., Bend, Oregon 97701

To schedule your appointment today, call:

541-382-9383

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BY BETSY Q. CLIFF

“The closer to the original food,

the better.”

That’s the advice from reg-

istered dietitian and nutrition specialist

Lori Brizee for health-conscious parents .

So fresh fruits are in, fruit snacks are out.

Brizee helped us analyze common

kid fare. Some came out better than you

might expect, while others she described

as “no better than candy.”

A look at 10 products


PHOTOS BY ROB KERR

Kid food, improved

Sorting it out Improving on ...

FRUIT SNACKSWhat’s good: The label

says Betty Crocker Fruit Flavored

Snacks are made with “real fruit juice” and

are “an excellent source of vitamin C.” Brizee

doesn’t buy it. “There’s not a lot of good

things to say about fruit snacks.”

What’s bad: With just 20 percent of

the recommended daily value in 90 calories

of fruit snacks, Brizee wouldn’t count these

as a good source of vitamin C. And, with lots

of sugar and no other nutrients, fruit snacks

are the nutritional equivalent of candy.

What’s better: If your kids beg for fruit

snacks, get them dried fruit instead. Dried

apricots, for example,

contain a good

dose of vitamin

A, potassium,

calcium and

magnesium,

Brizee says.

Improving on ...

PEANUT BUTTERWhat’s good: There’s a lot

of fat in peanut butter, but most of

it is healthy fat. Brizee said this is good food for

kids; it contains proteins and will fill them up.

What’s bad: PB that doesn’t need stirring,

such as this Jif Creamy Peanut Butter, often

contains unhealthy trans fats . Although the la-

bel on this jar says it contains 0 grams of trans

fats, a product may contain up to 0.49 grams

of trans fats per serving and still put “0” on the

label. Brizee said that’s likely the case for this

peanut butter because it contains hydroge-

nated vegetable oils, which have trans fats.

What’s better: Natural peanut butters

contain no trans fats and

less sugar than some

other versions. Look

for peanut butters

where the oil and

solids have sepa-

rated, Brizee says.

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Improving on ...

TUNA FISHWhat’s good: A tuna

sandwich is a great lunch

for kids, Brizee says. It is low in

fat, has lots of protein and will fill kids up

enough to get them through the afternoon.

What’s bad: This Bumble Bee can of tuna

is albacore, which, according to the Food

and Drug Administration, contains more

mercury than the “chunk light” tuna. In

addition, this one is packed in soybean oil,

which adds extra fat.

What’s better: Chunk light tuna packed

in water contains less mercury and less fat.

Because of mercury content, the National Re-

sources Defense Council recommends that

a 50-pound child eat al-

bacore tuna no more

than once a month

and chunk light

tuna no more

than once every

nine days.

Improving on ...

MAC ’N’ CHEESEWhat’s good: Brizee

doesn’t see a lot of good in this

package of Kraft Macaroni & Cheese. It

contains a little bit of protein and some cal-

cium, but little else of nutritional value.

What’s bad: There’s too much salt in here,

Brizee says. This macaroni contains about

a quarter of all the sodium recommended

in one day.

What’s better: Brizee says you can make

your own healthy macaroni and cheese

without much effort. Boil noodles, make a

white sauce with 1 tablespoon of cornstarch

mixed with 1 cup of milk

and pour the white

sauce and grated

cheese over the

noodles. “It’s far

better and far less

high in salt.”

Improving on ...

HOT DOGSWhat’s good: Brizee is

impressed Oscar Meyer Pre-

mium Smoked Uncured Franks

don’t have added nitrates, which are often

used as preservatives and may develop into

cancer-causing compounds . ( Consumer Re-

ports , however, found that even dogs labeled

“no nitrates added” contained some naturally .)

But, with their high fat content and relatively

low protein, Brizee says this isn’t a great food.

What’s bad: One hot dog has 160 calories ;

81 percent of those come from fat, so “it’s not

a good protein source,” says Brizee. One hot

dog also contains a lot of salt .

What’s better: Brizee says an occassional

serving is fine, but on a

regular basis, lean ham

has much less fat .

Burgers are also

better , providing

protein and iron

with less fat.

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Sort

ing

it ou

t

Improving on ...

KIDS’ DRINKSWhat’s good: Not much

in Capri Sun, says Brizee,

as she examines the

package. “I don’t see any

redeeming value in this.”

What’s bad: Lots of

sugars and virtually no nu-

trients. The package says

it has less sugar than other

drinks, but one pouch still

contains 16 grams, more

than 3 teaspoons, of sugar.

What’s better: “Kids

need to learn to drink

water,” Brizee says. She

suggests getting them a

reusable container and

having them take that to

school or sports .

Improving on ...

CANNEDFRUITWhat’s good: Vitamin

A is found naturally in

peaches and vitamin C

is added to this product,

Del Monte Diced Peaches

in Light Syrup, to give you

a full day’s supply.

What’s bad: Del Monte

adds sugar, third on the

ingredient list, and the

canning process depletes

some of the nutrients

found in fresh peaches,

Brizee says.

What’s better: Fresh

or frozen are better than

canned, Brizee says, with

less sugar and fewer calo-

ries for the same quantity.

Improving on ...

STRING CHEESEWhat’s good: This is a

generally healthy choice,

says Brizee, for its calcium

content and protein. She

says cheese sticks like

Frigo String Cheese are

good snacks for after

school or just before a

sports practice.

What’s bad: Like most

dairy products, string

cheese is high in satu-

rated fat. But unless your

child is overweight, Brizee

says she wouldn’t worry

about the saturated fat

from cheese sticks.

What’s better: No room

for improvement here.

Some may prefer the

low-cal or low-fat cheese

sticks, Brizee says, but

they contain just 10 to 20

fewer calories per stick

— not a lot of savings.

Improving on ...

BABY CARROTSWhat’s good: Carrot

sticks, like Peeled Baby-Cut

Carrots from Eating Right,

pack a wallop of vitamin

A and contain other nutri-

ents with little downside.

What’s bad: Baby carrots

spoil faster than large ones ,

which can sit in the fridge

for a few weeks , Brizee says.

Big carrots are cheaper and

can be cut ahead of time .

What’s better: Carrots

are great. If you get tired of

’em, Brizee suggests snap

peas, cucumbers or bell

peppers. “Adding these or

other vegetables bumps

up the nutrition content.”

Improving on ...

POTATO CHIPSWhat’s good: There are a

few nutrients in here — vita-

mins C and E, niacin — but

Brizee says she doesn’t see

chips as a healthy choice.

“The potato is a vehicle to

hold onto the fat.”

What’s bad: Each Lay’s

Classic potato chip has

about 10 calories; about

six come from fat.

What’s better: Popcorn,

particularly if you pop it

yourself, is a better choice

when you want something

salty and crunchy, says

Brizee. She also recom-

mends pretzels and whole-

grain tortilla chips. •

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fectiveness of medication.

“The research is just so robust,” Marshall

said. “As much as I also like to think behav-

ioral intervention is all it will take to support

students — and certainly at different devel-

opmental milestones there’s going to be a

need for more or less of what we’re doing —

medication has the most bang for the buck.

The medication definitely has a stronghold

in terms of positive outcomes.”

Parents’ concerns about medications

range from worrying about the side effects

— or fears about tinkering with a child’s

brain chemistry and personality — to a sense

of personal failure in raising their child. Oth-

ers may have concerns when physicians

prescribe the drug too quickly, without a full

assessment process.

“I think that makes them nervous that

they can go to the physician and get a pre-

scription that same day without getting

ratings from teachers or observations from

schools,” said John Carlson, an associate

professor of school psychology at Michigan

State University in East Lansing .

When ADHD experts sought to define the

symptoms that make up ADHD, it prompt-

ed many doctors to simply use the list as a

checklist. With enough symptoms checked

off by parents and teachers, some doctors

would simply write a prescription without

ever seeing the child. Surveys of pediatri-

cians show that approach is less prevalent

today, but it may have contributed to the

general notion that it’s just too easy to get

stimulants for a child.

Still, Carlson acknowledges that the back-

lash over ADHD medication may be creating

a barrier to kids getting timely care.

“The stigma often gets in the way of par-

ents even considering a med trial,” Carlson

said. “I think for some parents and their val-

ues and beliefs, it does probably take longer

than it needs to, but ultimately that’s right

for that particular family.”

When parents are opposed to medication,

Carlson suggests documenting how a child

is doing before and after non-medication

interventions. If grades continue to slip and

personal relationships continue to suffer,

parents may change their minds.

“I do find that this type of data really helps

parents to break down their negative beliefs

and helps them to bring some logic and

rationale to even think about the possible

benefits of a medication trial with their phy-

sician,” Carlson said.

Collecting such data generally means

partnering with teachers and schools. It’s

in the classroom where an inability to focus

and control behavior impacts kids most, and

so it’s most often classroom performance

issues that flag problems and are the best

measure of the effectiveness of treatment.

Yet parents sometimes don’t even want to

admit to the teacher that a child is taking

ADHD medication.

“There is often a stigma, so much so that

parents won’t share information with school

personnel,” Carlson said.

That caution may ultimately serve a pur-

pose, making parents and doctors think

twice about a decision to medicate or not,

taking extra time to ensure they’re making

the right choice.

“To me, if they’re not cautious, then I go

the other way. Let’s make sure your deci-

sion is the right one and get you the data

you need to prove that the treatment is ef-

fective for the concerns that you brought

to the physician,” Carlson said. “We might

think, wow, parents are overly cautious, but

it’s all outweighed by the thinking that the

kid can have a little bit better life if they go

that route.”

Dr. Martin Lakovics, a psychiatrist in Bend,

said he’s seen a bit of shift in the way the

public views medication for mental illness,

in part because of heavy television advertis-

ing by drug companies.

“There’s much less resistance than there

used to be,” Lakovics said. “People are start-

ing to realize this has come into the main-

stream of society to some extent. And also,

they’re tired of suffering.”

While some kids might be able to man-

age with behavioral support programs, he

says, such resources aren’t always available

in schools. And parents may not have the

time and money to pursue some of the non-

medication interventions.

“You don’t use medicine unless you have

to, unless the symptoms affect function or

suffering. That’s true of all medicine,” Lakov-

ics said. “Is it right to give kids (ADHD) medi-

cine? I think the parents have to decide with

the child. Often it’s not controversial. The

child feels terrible, too. ‘I’m not functioning

in school. I’m being made fun of.’ It’s not fun

to be ADHD.”

Still, it’s an odd dynamic for a culture that

often turns to medication before lifestyle

changes to address medical problems. Doc-

tors have found it’s easier to prescribe a cho-

lesterol-lowering drug than to get a patient

to eat better and exercise. It may be because

ADHD affects children or that it is a mental

illness that gives the public pause.

“I think the general sense in the press is

that we overmedicate. I think there’s some

truth to that,” Lakovics said. “On the other

hand, if you meet parents or schoolteachers

of kids who have been diagnosed with ADHD



Continued from Page 13

How ADHD may beboth over- andunderdiagnosedA study trying to determine whether

children were being overdiagnosed and

overmedicated for ADHD found a pretty

close correlation between diagnosis and

medication rates. About 6.2 percent of the

1,422 kids studied had ADHD, and 7.3

percent were prescribed stimulants, such

as Ritalin. But upon closer examination,

researchers found a major mismatch. Half

of the kids with ADHD were not prescribed

stimulants, and more than half of those on

stimulants didn't meet the criteria for an

ADHD diagnosis. It's why experts argue

that ADHD is both over- and

underdiagnosed in the U.S.

GREG CROSS

Total number of children studied

1,4 2 2

44children

with ADHDbut not

prescribedstimulants

88 childrenmet criteria

forADHD diagnosis

104 childrenprescribedstimulants

to treat ADHD

44children

with ADHDand

prescribedstimulants

60children

not meetingcriteria for

ADHDdiagnosis,

but prescribedstimulants

anyway

Source: Child and Adolescent Psychiatry and Mental Health, The Great Smoky Mountain Study

based on their symptoms and the criteria in

the (psychiatric manuals), they’re going to tell

you, ‘Hey look, we can’t manage this kid.’”

A chance at success

That was the case with “Emma,” a 7-year-

old girl from Redmond whose real name

is being withheld at her mother’s request.

She had always been a handful, but in first

grade, “all hell broke loose.”

“She just wouldn’t listen,” her mother said.

“She’s screaming at her teacher, ‘You can’t

make me! You can’t make me!’ And she’s run-

ning and hiding underneath the table, mak-

ing them catch her. How can a teacher teach

like that?”

Emma had no sense of boundaries. She

would reach out and grab things, taking

things that didn’t belong to her, or touch the

other students. Within the first month of the

school year, her parents knew they needed

to get help. They brought her to a child psy-

chiatrist who, after an exhaustive evaluation,

concluded the little girl had ADHD. It didn’t

surprise her mother at all. While reading a

book about ADHD, she recognized her own

daughter in its pages.

“I was in tears. This author wrote the book

about (Emma). She had textbook, severe

ADHD,” her mother said. “So I get a little de-

fensive when I hear people say, ‘overmedicate,

overmedicate.’ They have not been around my

child. She could not function in a classroom.”

Like Jared, Emma went through a series

of medications, trying to find the one that

worked for her. Oral medications upset her

stomach and they didn’t seem to have much

effect on her behavior. Her parents began to

wonder whether they were going down the

right path. Her father had been prescribed

Ritalin as a child and did not look back fond-

ly on the experience.

“For me, the guilt was just phenomenal,”

her mother said. “But I was getting a phone

call from school every single day, for months

on end. That was pretty harsh too.”

Finally, in March, her doctor prescribed

Daytrana, the first ADHD medication to

come in a patch.

“It wasn’t a gradual difference — it was a

huge, night-and-day difference,” her mother

said.

Now if they have any doubt the medica-

tion is working, Emma’s parents only need

to wait till the next morning after the previ-

ous day’s dose has worn off. They give her

a low-dose, short-acting Ritalin when she

wakes up to get her through the morning

and allow time for the patch to kick in.

“Even then, trying to get from breakfast to

trying to get her clothes on, she just can’t go

from A to B without going completely off the

track, without us guiding her,” her mother

said. “And that’s on the meds.”

For the rest of the school year, the phone

calls stopped, and Emma spent more time in

her classroom than in the principal’s office.

“It’s not a cure-all by any stretch,” Emma’s



mother said. “But overall, there’s no ques-

tion. We now feel like she can be successful.

If she wasn’t on meds, there’s no way she

could be successful.”

Removing barriers

There also are kids who have horrible ex-

periences with stimulants, and perhaps it’s

human nature for people to classify things

as good or bad based on their own experi-

ences . But there’s good evidence that when

all the proper steps and precautions are tak-

en to reach the right diagnosis, ADHD medi-

cations are remarkably safe and effective.

“It’s not that medications are good or bad,

it’s that doctors and families can do a bad

job of figuring out what the problem is,” said

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“It’s not a cure-all by any stretch. But overall, there’s no question. We now feel like she can be successful. If she wasn’t on meds, there’s no way she could be successful.”Mother of 7-year-old “Emma,” who is drawing a picture at left

Dr. Ajit Jetmalani, assistant professor of child

psychiatry at Oregon Health & Science Uni-

versity in Portland.

Jetmalani said child psychiatrists are in-

creasingly using a new protocol for evaluat-

ing children that’s built on the premise that

kids will thrive unless something is prevent-

ing them from doing so.

“If you think about it, the kind of standard

parenting approach is, ‘Kids would do well

if they wanted to,’” Jetmalani said. “Think

about the change in attitude of a parent

if you say, ‘Kids will do well if they can.’ If

they’re not doing well, there’s something

getting in their way.”

Rather than seeing behavioral issues as

defiance or an unwillingness to follow the

rules, the new approach assumes that such

children can’t behave. It’s up to the doctor

and parents to determine what’s standing in

their way. Jetmalani said that requires con-

ducting what’s known as a bio-psycho-social

review. Doctors determine whether there are

biological, psychological or social issues that

might be behind the problem. They’ll rule

out things like injuries or illnesses that might

affect the child’s mood and behavior. They’ll

examine his or her environment. How is life

structured at home and at school? Is the

child getting enough food, enough sleep?

They’ll examine developmental issues. Has

the child received stable parenting and good

attachment, or have things been chaotic?

Sometimes fixing other problems can

eliminate the behavior problem and the

need for medication. But when no other so-

lution is found, medication is a good option,

Jetmalani said.

“When done properly like that, medication

can be a critical, effective and important

modality for kids,” he said.

If parents are reluctant to use medication,

he suggests they work on a way to evaluate

whether non-medication approaches are

working. But he also realizes many parents

will never bring their child to a psychiatrist

or raise the issue with a pediatrician because

of what they’ve read or heard about ADHD .

“I think that’s absolutely a real concern,

and understandably, when doctors do dumb

things, it gets published,” he said. “The thou-

sands of patients who I’ve treated and are

satisfied and are doing well, they’re not go-

ing to hit the newspaper.”

In 2004, after reports of teen suicides

prompted the Food and Drug Administra-

tion to add a black-box warning to anti-de-

pressants, use of the drugs plummeted. But

that meant thousands of depressed teens

were no longer getting any help, and stud-

ies documented a spike in suicides in the fol-

lowing year.

“On the other hand, it … caused people to

really be thoughtful, to communicate well,

and to have proper follow-up after prescrib-

ing,” Jetmalani said. “People are much less

cavalier now about using psychotropics.”

If that same approach is used with ADHD

medications because of the backlash, that

could in the end help reduce overmedica-

tion. While the estimates of ADHD preva-

lence and stimulant prescription rates are

fairly close, the numbers can be mislead-

ing. A study conducted in one community,

for example, found that about 6.2 percent


Answers inthe artworkExperts in child development

have used children’s drawings to

help evaluate whether a child has

attention deficit problems. A recent

study comparing artwork of children

diagnosed with ADHD (but not

yet medicated) with those of other

children the same age found several

identifying characteristics that point

to attention deficit issues. Some of

those can be seen in the artwork

created by Luke Williams, 7, of

Asheville, N.C., whose mother, Penny

Williams, writes the blog ADHD Momma.

The artwork at top left was completed several

months earlier than the artwork below it, showing

the progress Luke made after starting medication.

Characteristics these experts focus on include:

• Color prominence. Kids with ADHD have

artwork in which color is less prominent. It is often

used just to outline a form, not to color it in. After

medication, Luke used one color to draw an object

and another color to fill it in.

• Details. Drawings by untreated ADHD children

tend to have fewer extra elements, focusing only

on the main image. In his second piece of artwork,

Luke has added more elements to fill the paper.

• Line quality. Kids with ADHD struggle with

fine motor control, so they have trouble forming

shapes of the objects they wish to portray. In the

first drawing, Luke’s images are hard to define. In

his later drawing, he has clearly delineated shapes.

Doctors often suggest buying children with ADHD

pencils with larger, spongy grips to help them with

their motor control.

Penny and Luke Williams, of Asheville, N.C. PHOTOS COURTESY PENNY WILLIAMS

541-322-CARE(2273)


of school-age children met the criteria for

an ADHD diagnosis, and about 7.3 percent

of kids had been prescribed stimulants.

But a closer analysis showed a significant

mismatch. About half the kids with ADHD

weren’t getting stimulants, and about half

the kids on stimulants did not have ADHD.

“That’s been my experience,” Jetmalani

said. “Even though the numbers correlate,

my experience is that there’s still a lot of

room for improvement.”

Nationally, studies show that only 50 per-

cent of children with ADHD are on stimu-

lants, such as Ritalin or Adderall. And there

is tremendous variation in the use of stimu-

lants from region to region.

“You have areas of the country where

practically no child is receiving any stimu-

lant medication and you have other counties

where 24 percent of school-age boys are on

stimulant medications,” said Clarke Ross,

CEO of the advocacy group Children and

Adolescents with Attention Deficit Disorder

in Washington, D.C.

Ross believes the variation reflects differ-

ences in the training of physicians.

“Those docs who have been educated in

the guidelines and practice the guidelines,

the odds are they’re going to diagnose it cor-

rectly,” he said. “But a lot of doctors are pre-

scribing based on their personal experience,

which may or may not be evidence-based.”

Child psychologists might be more aware

of the guidelines and more experienced at

making the diagnosis than pediatricians or

family practice doctors, but there are only

about 7,500 child and adolescent psycholo-

gists nationwide and most of them work in

academic centers.

In Oregon, pediatricians and child psycholo-

gist are now trying to establish a psychiatric

access line through which primary care doc-

tors can get specialists to help evaluate kids

for mental health issues. They’ve also received

a grant to work on a telemedicine suite to ex-

tend services to rural and under-served areas.

Ultimately, with better access to special-

ists and prudent evaluation, there may be

fewer kids with bad outcomes from ADHD

medications. But experts still caution that

the risks of medications must be balanced

against the risks of doing nothing at all.

“I always tell parents it’s my job to make

sure that I’m giving a medication that’s ef-

fective, not too much that it causes side ef-

fects and not so little that it doesn’t do any

good. If we stay within that, given the right

diagnosis, it’s a relatively safe medication,”

said Debbie Coehlo. “If we don’t treat it at all,

if we just ignore it, the accident rates go up,

criminal behavior goes up, failed relation-

ships go up. It’s like you’re treating diabetes.

You have to do something.”

That’s why the Johnsons never wavered

when it came to getting medication for

Jared. They’d seen first hand through their

brothers the consequences of not address-

ing the problem.

“My brother, jail. Her brother, jail,” Duke

Johnson said. “We knew it could lead to very

serious things, and we don’t want our son to

go down that road.” •



above her right eye and removed a piece of

bone. Using a microscope, Tien navigated

around the blood vessels in her brain. Kelly’s

rupture was right in the center, between the

two hemispheres of her brain.

It was a technical, difficult surgery. The

ruptured blood vessel was near the parts

of her brain that control vision, smell, leg

strength and hormones. In this surgery, all

those functions were at risk.

Tien’s goal was to cut off the aneurysm by

placing two titanium clips, which look simi-

lar to tiny high-tech clothespins, across the

portions that had ballooned out. That, he

hoped, would stop the blood flow into the

aneurysm, effectively sealing it off.

Mike sat in the waiting room. At about

7:30 at night, after about three and a half

hours of surgery, Tien came walking down

the hall. “I stood up,” Mike said. “I’ll never

forget this; he told me to sit back down. I

had the flip of a coin. Either it’s terrible news

or it’s just relax, you don’t need to get up,

you’re under enough stress already. It was

the latter.”

Kelly’s operation was a success. Tien had

blocked off both sides of the aneurysm, ren-

dering it effectively harmless.

For the moment, she was safe.

A setback

After an internal bleed, even something

as simple as a bruise, the blood begins to

break down and the body reabsorbs it. The

process is similar after a blood vessel bursts

in the brain.

But unlike a bruise, where the reabsorp-

tion is benign, blood breaking down in

the brain can irritate this sensitive organ.

Though no one is exactly sure why, the ir-

ritation can cause the blood vessels to con-

strict. If they narrow enough, blood flow to

the brain is cut off, which can cause a mas-

sive stroke. People may become paralyzed,

lose their ability to speak, or even die.

Known as vasospasms, these constric-

tions are a common complication after

surgery for aneurysms. Kelly’s medical re-

cords indicate she was checked regularly

for more than a week after her surgery for

vasospasms.

Kelly’s readings were all normal, and by

Sunday, March 21, 11 days after she col-

lapsed, medical records note that doctors

were getting ready to send her home. Tien

had left town, sure that the risk period for

vasospasms had passed.

But later that day, Kelly began acting

strangely.

“It was instantaneous,” Mike said. “Once

the vasospasms hit, she went downhill so

fast.”

He recalls asking her for her Social Secu-

rity number, which she “rattles off like noth-

ing,” he said. Two minutes later, he said, she

couldn’t pick up a pen.

Her right side stopped working; she

couldn’t move her right arm or right leg.

Her speech became garbled. Her eyes went

glassy. It was as if, Mike said, she were look-

ing through him.

A physician assistant who had been at-

tending to her thought the problem was

psychological, the medical records indicate.

He guessed that, though Kelly denied it, she

was worried about going home. If the situa-

tion did not clear up, he wrote in the records,

he would order a psychiatric evaluation the

next day.

Monday, the medical records note, the

physician assistant discussed the case with

Dr. Mark Belza, a neurosurgeon who had

taken over Kelly’s care from Tien. Belza

suspected the problem might not be psy-

chological, but instead a late onset of vaso-

spasms. A test confirmed Belza’s suspicions.

Kelly needed treatment right away or faced

the risk of a massive stroke.

Vasospasms can be treated using a cathe-

ter threaded into the brain. It’s similar to the

technique Tien initially used to try to treat

Kelly’s aneurysm, and Tien is the only Cen-

tral Oregon physician trained in it. Because

Tien was out of town, Kelly was flown, in se-

rious condition, to Oregon Health & Science

University on Monday evening.

“She was really hours from having a stroke

and not being able to talk,” said Dr. Johnny

Delashaw, a neurosurgeon, who received

her at OHSU. Had Belza not sent her over

when he did, Delashaw added, she likely

would have suffered severe brain damage.

That night, OHSU staff gave her medica-

tion to try to lessen the effects of the vaso-

spasms, but it didn’t work. Early the next

morning, Dr. Stan Barnwell, a neurosurgeon,

performed a procedure to try to save her

brain.

Going in through an artery in her groin,

Jessica Kelly helps the youngest of her three sons, Seth, with his homework.


At first, she slept a lot. Now, she’s able to clean, cook and help her youngest son with his homework. The boys, tentative with her at first, she said, are “relearning Mom.”

Continued from Page 23

Barnwell snaked a catheter up through her blood vessels and into

Kelly’s brain. He inserted a small inflatable balloon, which he used

to force open the narrowed blood vessels in her head, he said.

The procedure stopped the vasospasms and saved Kelly from

a massive stroke. Her temporary loss of speech and mobility

were reversed immediately.

Recovery

On April 1, almost three weeks to the day after she collapsed,

Kelly came home. Save for a planned overnight stay at St. Charles

Bend, for a procedure to close off a bit of aneurysm that Tien had

not quite sealed, she has been home since.

She’s slowly getting her life back. Friends have helped out.

Some, including colleagues at Hospice House, organized a spa-

ghetti feed that raised more than $2,000 to pay some of her med-

ical bills. Mike estimates the total cost will be close to $325,000,

though much of that will be paid by Kelly’s health insurance.

Kelly went back to work in June.

At this point, Tien said, Kelly has no lingering effects. Her risk

for another ruptured aneurysm is low, comparable to the risk in

the general population. She takes a daily dose of medication, and

will need at least one more follow-up appointment, but the treat-

ment already given “should be a cure for her,” said Tien.

At first, she slept a lot. Now, she’s able to clean, cook and help

her youngest son with his homework. The boys, tentative with

her at first, she said, are “relearning Mom.”

Kelly still doesn’t recall all of what had happened to her. She

doesn’t remember the most traumatic parts of her experience.

She didn’t ask, at first, about what had gone on. Only after a

couple of months had passed did she begin learning. She asked

Mike, she said, after the kids went to bed. Each night, she learned

a few more details: who was in the hospital, what did she say,

why did things happen as they did.

Mike has told her things as she has asked. He said he can’t

believe this happened to them, but even more surprising is that

she can sit on the couch and tell the story. “For her to be here

and being able to do this,” he said, looking at her lovingly, “is just

phenomenal.” •


“For her to be here and being able to do this (tell her story) is just phenomenal.”Jessica Kelly’s husband, Mike

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[email protected]

Warning: I am about to tell you the least shocking thing you’ll

ever read.

So if you’re here to learn something, turn elsewhere to

find out why exercise is good for you or that fried food is bad for

you. (Side note: I hate science.)

Here’s my revelation: Standing alongside your wife and watching

your first child being born is a seriously intense experience.

I know, it’s a pretty “duh” statement to make. Considering the

number of hours I’ve slept since my daughter was born in late April

at St. Charles Bend, I think I deserve a pass.

The thing is, people told me watching the birth of my kid would

be intense. And it was. It’s a moment forever seared into my brain.

But the run-up to that moment is packed with memories, too.

After a full day of gradually increasing pain (for my wife, Emily)

and a nerve-rattling mix of boredom and worry (for me), I knew

there was no turning back when my wife asked for additional pain-

management provisions (aka drugs) and our nurse just smiled.

“No more drugs for you,” she said. “You’re going to have this

baby.”

Over the next couple hours, I essentially had three jobs besides

generally comforting and encouraging my wife. They were, in re-

verse order of importance:

Blanket Wrangler: In this role, I was to keep a blanket — which

had been placed so Emily could pull on it for leverage — from fall-

ing into the doctors’ and nurses’ faces. I failed at this job more than

once, forcing these folks to do their jobs as if they had a burqa on

backward. Fortunately, they were considerably more competent

than I was, even without the benefit of sight.

Ice Chips Distribution Unit: At times, this felt like the most vital

job in the delivery room. And those times were usually right after

I fed my wife a spoonful of ice chips, and right before I fed myself

two spoonfuls. That was my process: one for Emily, two for me. It

seemed reasonable, given all the

hard work I was doing!

The Count (an homage to the

numbers-obsessed vampire

from “Sesame Street”): OK, this

was probably more important than

cooling myself off with ice chips.

Near the end of the night, it was my

wife’s job to push three times per

contraction, each push lasting about

10 seconds. The nurse counted for a

while, but at some point I saw an opportunity to help, so I took over.

After all, I can count to 10.

Which I did, right up until the last few minutes, when things got re-

ally intense, and a nurse asked Emily to try to stretch out the pushes.

So I began counting a little slower, until it was clear we had only two

or three contractions to go. At that moment, I leaned on my zero

years of medical training and, just as a contraction was beginning,

exclaimed to my wife, “This time, try to go to 16!” in the most en-

couraging (read: freaking out) voice I could muster.

To Emily’s credit, she was prepared to go for it; we got to 10, and

while I felt fine (I was willing to wait an extra five seconds for my ice

chips, because I am tough), my wife was pretty wiped out, and was

no doubt relieved when the doctor said, with a hint of amusement in

her voice, “You can stop at 10, Emily.”

I was taken aback by this brazen challenge of The Count’s author-

ity. “Huh,” I thought. “We’re not going to get this baby out if we’re not

willing to give 110 percent.”

Not really. I’m sure what I actually thought was some combination

of “This is the most amazing thing I’ve ever done” and “My wife is

the strongest person I know” and “Wow, only a few more minutes till

we get to meet our first child.”

And probably “Thank goodness! Time for ice chips.” •

— BEN SALMON, BULLETIN MUSIC WRITER

Meeting the baby

Laughter | THE BEST MEDICINE


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pulse magazine summer/fall 2010

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