Grand Rounds - December 20, 2024 "The Silent Red Flags: When Benign Complaints Conceal Serious Health Risks"
Speaker: Diane M. Birnbaumer, MD. Senior Clinical Educator, Emergency Medicine, Harbor‐UCLA Medical Center; Emeritus Professor of Medicine, Division of Emergency Medicine, David Geffen School of Medicine at UCLA.
Objectives
List at least three chief common chief complaints that look benign but may represent serious risks for patient morbidity and/or mortality.
Discuss how to determine if a chief complaint may have a serious cause.
Explain how to diagnose and treat these disorders.
Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.
The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals.
Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].
Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].
Grand Rounds - December 13, 2024 "Restless Leg Syndrome: Management Updates"
Speaker: Alberto R. Ramos, MD, MSPH, FAASM. Research Director, Sleep Disorders Program Member, Sleep Disorders Research Advisory Board, NIH; Sleep Disorders Research, Advisory Board, NHLBI; NIH Professor of Clinical Neurology, University of Miami Miller School of Medicine.
Objectives
Define Restless Legs Syndrome (RLS).
List the diagnostic clinical features of RLS.
Describe treatment options for managing RLS, including individuals who experience treatment failures and augmentations.
Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.
The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals.
Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].
Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].
More than 650 people turned out to support St. Charles Foundation’s annual Prineville Hospice Auction on Dec. 7, which raised more than $180,000 to support hospice programs. The popular annual event held at the Crook County Fairgrounds Indoor Arena includes a festive live auction of handmade quilts and Christmas trees as well as dinner, raffle and more.
“The Prineville Hospice Auction is a wonderful way for the community of Crook County and beyond to show support for the hospice programs while also spreading holiday cheer and good will,” said Jenny O’Bryan, executive director for the St. Charles Foundation. “The dollars raised help provide funding for education support services, grief counseling, bedside volunteers, spiritual counseling and more for St. Charles’ hospice programs.”
Best quilt honors went to “Cabin in the Woods,” donated by The Quilt Shack and the best tree award went to “Honoring the Timber Industry: A Lost Profession” donated by Coldwell Banker Sun Country Realty, Inc.
About St. Charles Foundation The mission of St. Charles Foundation is to support the delivery and advancement of world-class health care in Central Oregon. Philanthropic donations fund innovation in programming, building expansions and initiatives that improve the patient experience. The St. Charles Foundation works with the community to develop and steward philanthropic resources to fund programs and capital projects that improve health, prevent disease, enhance quality of life and provide the highest quality care possible for all St. Charles patients now and in the future. Learn more about the efforts of the St. Charles Foundation: https://foundation.stcharleshealthcare.org/.
We are all prone to injuries such as ankle sprains, muscle strains, back pain, etc so it is important to understand proper at-home injury care. Knowing when to use heat or ice on an injury can help decrease your healing time and pain levels.
Using ice and heat for injuries can provide relief and aid in the healing process when used correctly and in moderation. However, it’s crucial to be aware of the risks associated with overusing these methods. Always follow the recommended guidelines for duration and application, and if you’re unsure, consult a healthcare professional for guidance. Remember that each injury is unique, and a healthcare provider’s advice can ensure the best approach for your specific situation.
When to use ice
Ice is typically used for acute injuries, such as sprains, strains, or bruises. Applying ice helps to reduce swelling by constricting blood vessels and numbing the area, thereby alleviating pain and inflammation. It is most effective when applied within the first 48 hours after the injury occurs, in intervals of 15-20 minutes with breaks in between to prevent skin damage.
Benefits of ice: Ice application, also known as cold therapy or cryotherapy, can help in the following ways:
Pain reduction: Cold temperatures can numb the affected area and reduce pain sensations.
Inflammation control: Ice can help minimize swelling by constricting blood vessels and reducing blood flow to the injured area.
Proper application:
Use ice packs, cold compresses, or even frozen vegetables wrapped in a cloth to avoid direct contact with the skin.
Apply ice for about 15-20 minutes at a time, allowing the skin to return to its normal temperature between applications.
Use ice within the first 48 hours of an acute injury, like a sprain or strain.
Risks of overuse:
Tissue damage: Prolonged exposure to ice can cause frostbite or damage to the skin and underlying tissues.
Reduced blood flow: Excessive cold can lead to prolonged constriction of blood vessels, potentially delaying the healing process.
Nerve sensitivity: Some individuals may be more sensitive to extreme cold, leading to discomfort or nerve irritation.
Acute injuries
An acute injury is sudden and spontaneous, resulting from a fall, hit, or another type of trauma. The first rule of thumb is to never use heat on an acute injury. That extra heat can cause an increase in inflammation and delay proper healing. Applying an ice pack within the first 48 hours of an injury can help numb pain, relieve inflammation, and limit bruising. Keep your ice pack moving to avoid ice burns and do not exceed 20 minutes.
A common acute injury is a sprained ankle or knee injury. The RICE method is an important protocol to help relieve pain, reduce swelling, and counteract the body’s initial response to the injury.
RICE stands for rest, ice, compression, and elevation.
Rest
Stop using the injured body part! Protect the area and avoid any activity that is painful or may have caused the injury. Continued activity could cause further damage.
Ice
Use ice for the first 48-72 hours after an injury. Apply ice several times a day for 20 minutes at a time, followed by one hour “off.” The cold will contract injured capillaries and blood vessels to help stop internal bleeding. Do not apply ice directly to the skin.
Compression
Wrap the injured body part firmly with an elasticized bandage, compression sleeve, or cloth – especially when you are more active. This will help speed up healing time by reducing swelling around the injury.
Elevation
Elevate the injured body part above the level of your heart to decrease swelling and joint pain.
When to use heat
Heat is a great treatment for chronic conditions such as overuse injuries, and before participating in activities to help relax and loosen tissues and increase blood flow. Do not use heat after an activity, acute injury, or where swelling is involved. Swelling is caused by bleeding in the tissue, and heat only draws more blood to the area, which can increase healing times.
Be sure to use heating pads in moderation to avoid burns, and never leave one on for extended periods of time or while sleeping.
Benefits of heat: Heat therapy, also known as thermotherapy, can be advantageous in the following ways:
Muscle relaxation: Heat can help relax tight muscles and improve flexibility.
Blood circulation: Applying heat can increase blood flow to the injured area, aiding in the delivery of nutrients and removal of waste products.
Proper application:
Use warm towels, hot water bottles, or heating pads set to a comfortable temperature.
Apply heat for around 15-20 minutes at a time, allowing the skin to cool down before reapplying.
Heat is generally more suitable for chronic conditions or injuries that don’t involve significant inflammation.
Risks of overuse:
Burns: Prolonged or excessive heat application can lead to burns, especially if the heat source is too hot or direct skin contact is made.
Increased inflammation: Applying heat to an already inflamed area can exacerbate swelling and discomfort.
Masked symptoms: Heat can temporarily alleviate pain, potentially masking the severity of an injury and leading to further damage.
Using ice or heat for different conditions
Applying ice or heat can be beneficial for various conditions, depending on the nature of the injury or discomfort. Here are guidelines for when to use ice or heat for specific conditions:
Ice therapy:
Arthritis: Ice therapy can be helpful during flare-ups of arthritis, especially when joints are swollen, hot, and inflamed. Applying ice for about 15-20 minutes at a time can help reduce pain and inflammation. However, ensure there is a cloth or towel between the ice pack and your skin to prevent frostbite.
Headaches: If you’re experiencing a tension headache or migraine, applying a cold pack or ice wrapped in a cloth to your forehead or the base of your skull can help constrict blood vessels and alleviate pain.
Tendonitis: Tendonitis involves inflammation of tendons. Applying ice to the affected area for 15-20 minutes multiple times a day can help reduce inflammation and provide relief. Ice can help numb the pain and reduce swelling.
Muscle strain: In the initial stages of a muscle strain, applying ice can help reduce swelling and pain. Ice should be applied for 15-20 minutes at a time, several times a day, for the first 48 hours after the injury.
Heat therapy:
Arthritis: For chronic arthritis pain, applying heat can help relax muscles and improve blood flow to the affected area. Heat therapy is especially beneficial when joints are stiff in the morning or after prolonged inactivity. Use a warm towel, heating pad, or warm bath for 15-20 minutes.
Headaches: If you’re dealing with tension headaches or tight neck muscles, applying moist heat (warm towel or warm shower) to the neck and shoulders can help relax the muscles and ease discomfort.
Tendonitis: After the initial inflammatory stage, applying heat can promote blood circulation to the affected area, aiding in healing. Use a warm compress for 15-20 minutes, a few times a day.
Muscle strain: After the first 48 hours of a muscle strain, applying heat can help relax tight muscles and improve blood flow to the injured area. Use a warm compress or a warm bath to soothe the muscles.
How to safely apply ice or heat on an injury
Ice:
Preparation: Wrap the ice pack or ice cubes in a thin cloth or towel to create a barrier between the ice and your skin. This prevents frostbite or ice burns.
Timing: Apply ice for 15-20 minutes at a time. Avoid prolonged contact to prevent tissue damage.
Breaks: Allow your skin to return to normal temperature before reapplying ice. Aim for at least a 20-minute break.
Elevation: Elevating the injured area while applying ice can help reduce swelling further.
Frequency: Apply ice every 1 to 2 hours during the initial 48 hours after the injury.
Heat:
Moderation: Ensure the heat source is not too hot to avoid burns. Use a warm, not hot, setting on heating pads or warm towels.
Protection: Always use a cloth or towel between the heat source and your skin to prevent burns.
Timing: Apply heat for 15-20 minutes. Longer exposure can lead to skin irritation.
Breaks: Give your skin time to cool down between heat applications, typically for at least 20 minutes.
Moist heat: For moist heat, use a damp cloth or towel over the heat source to add moisture and prevent excessive dryness.
General precautions:
Skin check: Regularly inspect your skin during and after application to ensure it’s not becoming too red or irritated.
Sensitivity: If you have reduced sensitivity in the affected area, be cautious about using extreme temperatures, as you might not feel discomfort until it’s too late.
Individual response: Some people may prefer heat over ice, or vice versa. Pay attention to how your body responds and adjust accordingly.
Consultation: If you have circulatory problems, diabetes, or any condition affecting skin sensation, consult a healthcare professional before using ice or heat.
Signs of a more serious injury include:
Popping or crunching sound
Severe pain or swelling
Cannot stand or support the injured area
Instability in joint
Remember that both ice and heat are meant to be used as temporary relief measures. If your pain persists or you experience any of the above, make an appointment with one of our orthopedic specialists.
Grand Rounds - November 22, 2024 "Back Pain in Children and Teens"
Speaker: Robert M. Bernstein, MD. Chief of Staff, Shriners Children’s Portland; Board-Certified Pediatric Orthopedic Surgeon.
Objectives
Create a differential diagnosis for back pain in children and teens.
Determine an appropriate work up.
Establish a treatment plan that follows current best practice.
Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.
The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals.
Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].
Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].
On Thursday, Nov. 14, St. Charles celebrated Native American, American Indian and Alaskan Native Heritage month by hosting a Native Market of artisan vendors at our Madras hospital and presenting the first physical installation of our organization’s land acknowledgment statement.
Posted prominently in the main lobby of the hospital, the land acknowledgment says:
We acknowledge that the St. Charles campuses are located within the 10 million acres ceded to the Federal Government, also usual and accustomed areas, when the 1855 Treaty was signed with the Confederated Tribes of Warm Springs of Oregon. We offer this acknowledgment to honor all Native Americans that live in this area and who are the original people of this land.
The journey to get to those 62 very important words was long, and it predates my work at St. Charles. For me, though, it started a couple of years ago, when one of our providers, Dr. Shilo Tippett — a member of the Confederated Tribes of Warm Springs, Wasco Tribe — spent a chilly fall day taking me around area, feeding me delicious luckame’n, touring the Warm Springs Health and Wellness Center, introducing me to tribal leaders and teaching me about tribal culture.
At the end of the day, I thanked Dr. Tippett for not just telling me about her history and the history of her family, but for taking time to show me how many people of the Confederated Tribes of Warm Springs live and so many places where their culture is rooted. She reminded me recently that as I thanked her, I also asked if there was anything I could do in return for the generosity she had shown me.
And that’s when she told me that about the land acknowledgment work that began before the COVID-19 pandemic and stalled as our St. Charles teams put all efforts toward saving lives for several years.
I am grateful for that day and for the work that came next, which resulted in the land acknowledgment now on the wall at our Madras campus. I’m also grateful for the many people — including members of the Confederated Tribes of Warm Springs — who worked hand in hand to develop its language and artwork, as well as our new land acknowledgment web page. I have learned so much along the way, and I view our acknowledgment as a standing invitation to each of us to be curious, to inquire, to reflect and to learn for oneself. To further extend that invitation, we will also install land acknowledgments at our other locations in the near future.
Land acknowledgments are a way for organizations to pay respects to the original inhabitants of the land upon which we reside and work and to recognize Indigenous people as the original stewards of said land. We hope that by acknowledging the past and working toward an inclusive future, we can aid in emotional healing and help set a positive tone for future generations.
St. Charles' new Gastroenterology practice is growing, both in size and scope — pun intended.
August saw the arrival of a new provider, Dr. Courtney Walker, who brings to the health system expertise in advanced therapeutic endoscopic ultrasound (EUS), a service that both expands the array of and reduces the invasiveness of treatments available to local patients.
Walker is the first provider in Central Oregon to offer EUS, which means local residents who could benefit from the procedure now have the option to get the care they need without driving to Portland or beyond.
“For patients, it should be much nicer to be able to stay here and get this procedure rather than having to cross over the mountains in the winter, for example,” she said. “Also, our hope is that referring providers will be able to get their patients in quicker rather than having to coordinate through Portland, especially when time is of the essence.”
Simply put, EUS is a procedure that uses an ultrasound mounted on an endoscope to examine and treat the gastrointestinal tract and nearby organs. Similar to an upper endoscopy, providers can go down into the intestinal tract, press the ultrasound up against the lining of the stomach or the small intestine and look through to the other side for abnormalities.
The big benefit for patients is that EUS is minimally invasive compared to other methods of examining areas deep within the abdominal cavity, including surgery or interventional radiology, Walker said.
“When you have to go through all these organs and intestines with a giant needle to try to reach something that’s maybe a centimeter or two in size, it’s a challenge,” she said. “With EUS, we’re already inside and the lymph node is just right next door, so we can easily sample tissue. It’s painless, for the most part. We get the biopsy and (the patient) is home an hour later.”
There are also a number of therapeutic possibilities with EUS. During the procedure, providers can administer injections to treat chronic pancreatitis or malignant pain related to pancreatic cancer; collect liver biopsies to learn more about abnormal liver function; determine the stage and spread of diseases like esophageal and rectal cancer and more.
Walker joins St. Charles’ new team of Gastroenterology providers, who see patients in Bend and Redmond for a variety of digestive and biliary organ conditions, including GERD, Barrett’s esophagus, swallowing issues, Crohn’s disease, ulcerative colitis, eosinophilic esophagitis, celiac disease and more.
The addition of EUS to the department’s list of specialized services is a win-win for both St. Charles and the community, Walker said.
“There are quite a few people out there who are going to benefit from this. I’m doing maybe three to five per week and that’s just a couple months in,” she said. “Our hope is that as more people know it’s available here, it will continue to grow and we’ll be able to help a lot of people across Central Oregon.”
If you hear the sound of a bell ringing in the St. Charles Cancer Center in Bend, that’s a signal to smile. The new bell – hung in the Infusion Room – is there for patients or family members to ring whenever they want to celebrate or recognize a meaningful milestone.
The new bell is a gift from Sam and Shane Coleman, both St. Charles caregivers. It’s a personal gesture for Sam, who completed her last round of chemotherapy for breast cancer last summer. She was diagnosed with breast cancer at age 39 after finding a lump during a self-exam. Sam underwent five months of chemotherapy and then had a mastectomy. The surgery went well – and she’s feeling optimistic as she has no signs of cancer in her lymph nodes or genetic markers.
“I was very lucky to go through chemotherapy and surgery and be done with it,” said Sam, who works in regulatory affairs and quality.
Sam says her work team has been amazing. “I feel really really lucky to have been here. My work team has been super supportive and wonderful.”
Now, with two young children at home, Sam says she’s ready to focus on getting back to normal as much as possible.
Sam isn’t sure where she first heard about the idea of ringing a bell after finishing cancer treatment – possibly a show or story she read. She wanted to ring a bell when she completed chemotherapy, but the Cancer Center didn’t have one. She and Shane offered to purchase one, so that future patients could experience a ringing moment of celebration together. Social Services Associate Linda Robson worked with the Colemans to find and order a 7-inch brass bell designed just for this purpose.
Last week, the bell was delivered and hung in the Infusion Room at the Cancer Center in Bend. Sam wants the bell to be for everyone and not just for individuals who had “beaten” cancer – because she knows that day doesn’t come for all patients. Her goal was to make ringing of the bell something every patient could experience.
“I want it to be really inclusive. If someone got great news after surgery – go ring the bell; if you survived the first round of chemo – go ring the bell. I want people to be able to celebrate big and small wins. I hope it’s a happy thing,” said Sam. “I want something that’s a little bit more meaningful for everyone, not just those of us who are lucky enough to be done. I hope people find their reason to ring it.”
Shane hopes that hearing the sound will bring people a feeling of hope – for caregivers, patients and families. “I hope families hear the bell and think, ‘Oh, that’s a happy thing.’”
Grand Rounds - November 15, 2024 "From COVID-19 to Bird Flu: A 2024 Respiratory Virus Update"
Speaker: Cynthia Maree, MD. Section Chief Infectious Diseases CTO, St. Charles Infectious Disease.
Objectives
Learn about the latest vaccine recommendations.
Review the latest status of emerging and returning respiratory viruses.
Know the different testing options available.
Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.
The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals.
Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].
Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].
