Grand Rounds - October 11, 2024
"Menopausal Hormone Therapy - a 'Hot' Topic for Hot Flashes"

Speaker: Kathryn Macaulay, MD. Director, UCSD Menopause Health Program; Clinical Professor of Obstetrics, Gynecology and Reproductive Sciences. UC San Diego Health.

Objectives

1. Identify the latest data and evidence as summarized in the most recent NAMS (2022) Position Statement on Menopausal Hormone Therapy.
2. Describe and discuss the potential risks, benefits, and FDA-approved indications, for menopausal hormone therapy.
3. Describe and discuss the current evidence-based prescribing recommendations for menopausal hormone therapy, in a language that can be readily shared in patient-based discussions.
4. Analyze the evidence for alternative therapies in the treatment of symptoms associated with menopause.

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.

Claim Credit

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].

Adult Resources     Children's Resources

Surviving the death of a loved one

We understand that loss is deeply personal and that everyone’s journey through grief is unique. We hope the resources on this page offer you support and peace.

Adult Resources

Death of a partner/spouse

Books

1. Death Without Denial, Grief Without Apology: A Guide for Facing Death and Loss – Jackson and Roberts, 2002.
2. Grieving the Death of a Friend – Smith, Harold, 1996.
3. Men Don’t Cry, Women Do: Transcending Gender Stereotypes of Grief – Doka and Martin, 1999.
4. Beyond Widowhood: From Bereavement to Emergence and Hope – Digiulio, Robert, 1989.
5. How to Survive the Loss of a Love – Colgrove, Bloomfield, McWilliams, 1976.
6. Understanding Grief – Wolfelt, Alan, 1992.

Death of a parent

Books

1. Recovering From the Loss of a Parent – Donnelly, Katherine, 2001.
2. When Parents Die: A Guide for Adults – Meyers, Edward, 1991.
3. Our Mothers’ Spirits: Great Writers on the Death of Mothers and the Grief of Men – Blaunder, Bob, 1999.

Websites

1. The Dougy Center

Death of a child

Books

1. Death of a Dream: Miscarriage, Stillbirth and Newborn Loss – Ewy, Donna, 1984.
2. Beyond Endurance: When a Child Dies – Knopp, Ronald, 2005.
3. The First Year of Forever: Surviving the Death of our Son – Van Vechten, B. D., 1982.
4. The Death of Adult Children Through the Eyes of Grieving Parents – Bacon and Gaber, 1999.
5. Death Be Not Proud – Gunther, John, 2007.
6. Moving Beyond Loss: Real Answers to Real Questions from Real People – Friedman and James, 2012.
7. Tear Soup: A Recipe for Healing After Loss – DeKIyen and Schwiebert, 2005.

Websites

1. Compassionate Friends
2. The Sibling Connection
3. Grieving Gumdrops

General resources

Books

1. Life is Goodbye, Life is Hello: Grieving Well through All Kinds of Loss – Bozarth, Alla, 1994.

Websites

1. Sacred Art of Living Center
2. Online support groups
3. Grief Education and Support

Suicide

24-Hour National Hotline 1-800-273-8255

Books

1. Healing After the Suicide of a Loved One – Smolin, Ann and Guinan, John, 1993.

Traumatic/sudden death

Books

1. What to do When the Police Leave – Jenkins, Bill, 2001.
2. I Wasn’t Ready to Say Goodbye – Brooke Noel, Pamela Blair PhD 2008.

Children's Resources

Death of a parent

Books

1. Molly’s Mom Died – Aitken, Holmes, Mudlaff, 1999.
2. Daddy’s Chair – Lanton, Sandy, 2013.
3. Saying Goodbye to Daddy – Vigna, Judith, 1991.
4. Sopa de Lagrimas: Una Receta Para Sanar Despues de una Perdida = Tear Soup (Spanish Edition) – Bills, DeKlyen, Schwiebert, 2009.
5. Anne and The Sand Dobbies: A Story About Death for Children and Their Parents – Coburn and Slayton, 1986.

Websites

1. The Dougy Center

Death of a sibling

Books

1. When I Die Will I get Better – Breebaart, Joeri and Piet, 1993.
2. The Empty Place: A Child’s Guide through Grief (Let’s Talk) – Carlisle and Temes, 1992.

Death of a grandparent

Books

1. Now One Foot, Now the Other – dePaola, 2006.
2. The Two of Them – Aliki, 1987.
3. Finding Grandpa Everywhere: A Young Child Discovers Memories of a Grandparent – Aitken and Hodge, 1998.
4. Why Did Grandpa Die?: A Book About Death – Hazen, Barbara, 1985.

Death of a friend

Books

1. If Nathan Were Here – Bahr and Jerome, 2000. 
2. Lifetimes: The Beautiful Way to Explain Death to Children – Ingpen and Mellonie, 1983.

Loss in general

Books

1. When Children Grieve: For Adults to Help Children Deal with Death, Divorce, Pet Loss, Moving and Other Losses – Friedman, James and Matthews, 2002.
2. It Must Hurt A Lot: A Child’s Book About Death – Sanford, Doris, 1986

Teenage grief

Books

1. When a Friend Dies – Gootman, 2005.
2. Helping Children Cope With Death – Schuurman, Donna, 1998.
3. Healing Your Grieving Heart for Teens: 100 Practical Ideas – Wolfelt, Alan, 2001.
4. Saying It Out Loud – Abelove, Joan, 2001.
5. Helping Teens Work Through Grief – Perschy, Mary, 2004.
6. Fire In My Heart and Ice In My Veins – Traisman, Enid Samuel, 1992.

Websites

1. The Dougy Center

Kimberli Munn, DNP, RN
Chief Nursing Officer, Prineville and Madras

Kimberli Munn serves as the Chief Nursing Officer for St. Charles' Critical Access Hospitals in Madras and Prineville. In this role, she provides leadership and oversight for nursing practices, ensuring high-quality patient care throughout the organization. Kimberli collaborates with senior leadership to develop and implement strategic initiatives aimed at improving patient outcomes, operational efficiency and staff satisfaction. With extensive experience in nursing education and leadership, she is committed to fostering a culture of excellence and continuous improvement. Kimberli holds a Doctor of Nursing Practice and Leadership degree from Boise State University and a master’s degree in Nursing Leadership and Education from Northwest Nazarene University.

Grand Rounds - October 4, 2024  
"MAT (Medication Assisted Treatment) of Opioid Use Disorder"

Speakers: Emily Harvey, MD, and Billie Cartwright, MHS, DBH, PA-C. Bestcare Treatment Services.

Objectives

1. Review of medication options for treatment of opioid use disorder.
2. Review of special considerations in the setting of ongoing fentanyl epidemic.
3. Review of the drug supply as a complicating factor: xylaxine, fentanyl analogues.
4. Review of long acting buprenorphine as effective treatment options for OUD.
5. Review of current guidelines for management of perioperative management of patients taking maintenance buprenorphine.
6. Acknowledge and address the barrier that stigma presents in preventing patients with OUD from receiving high quality, evidence based care.

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.

Claim Credit

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].

Most people who contract respiratory syncytial virus (RSV) experience mild, cold-like symptoms, but for infants and the elderly the common respiratory virus can be much more serious.

“It can be a really severe illness, especially for babies under 3 months. It’s a tough virus and the littler you are, the littler your airways are. It doesn’t take a whole lot of mucous and infection for that to cause significant issues,” said Dr. Suzanne Mendez, pediatrician with St. Charles Health System, who treats infants hospitalized with RSV every year.

Last winter, Dr. Mendez and her colleagues on the Pediatric unit at St. Charles Bend noticed something unusual: they weren’t treating very many infants with RSV. St. Charles pediatrician Dr. Rebecca Jennings evaluated the data and verified that this was more than just a feeling: very few infants were hospitalized for RSV from November 2023 to March 2024. In fact, it was the lowest RSV season since tracking started in 2018, outside of the winter of 2020 at the height of the pandemic.

While the number of RSV cases fluctuates every year, Dr. Mendez and her colleagues believe there was another factor that likely helped contributed to the decline in cases: newly available vaccines and antibodies for RSV that protected infants. In 2023, two new methods to shield infants from RSV became available: pregnant patients could get an RSV vaccine, which would give immunity to their babies when born; and monoclonal antibodies were available to give to newborns directly to protect them from contracting RSV. Both are reported to have high efficacy for preventing RSV in infants.

“I believe these vaccines are working and helping to protect our vulnerable population of infants,” said Dr. Mendez. “And anecdotally for this past year, none of the babies with RSV on the Pediatric Unit were born to mothers who received the vaccine, so it appears to be very effective at preventing hospitalization.” 

Dr. Sarah Hellmann, an OBGYN with St. Charles Center for Women’s Health, explains that about half of the pregnant patients she saw last year opted to receive the RSV vaccine and she’s hopeful that will increase this year as the vaccine and process become more widely known.

The CDC recommends a single dose of RSV vaccine for pregnant people from week 32 through week 36 of pregnancy for the prevention of RSV disease.

“You can certainly help protect babies with this vaccine,” said Dr. Hellmann, who shared that the RSV vaccine decreased the risk of severe cases of RSV in infants by 81% for the first 90 days of life.

RSV is one of several vaccinations recommended for pregnant patients to help boost immunity in newborns, including TDAP, COVID and flu.

“These vaccines are safe and decrease risks for babies,” said Dr. Hellmann.        

RSV vaccines are available now for pregnant patients at St. Charles Center for Women’s Health. Contact 541-526-6635 for details.

Everywhere you look, you’ll find evidence that fall is upon us.

Kids are back in school. Football is on TV. Evenings are getting chilly — it’s time to break out that favorite puffy coat!

In the world of health care, fall also means the onset of what we used to call flu season, and now call respiratory illness season. Flu, COVID-19 and RSV are all common in our region, and each of them can cause serious illness that will wreck that camping weekend or ski vacation or holiday gathering or overseas trip you’ve been planning.

Don’t let that happen. Protect yourself, protect your family and friends and protect your fun times by getting vaccinated.

This year, safe and effective vaccines designed to prevent serious cases of flu, COVID and RSV are available. The U.S. Centers for Disease Control is encouraging everyone 6 months old and older to get vaccinated against flu and COVID-19 by the end of October, and to talk to their primary care physician about whether they should get the RSV vaccine. (Generally speaking, RSV vaccines are recommended for people 60 and older, as well as pregnant people.)

At St. Charles, our Family Care and Urgent Care clinics will begin administering flu and COVID vaccines to patients on Oct. 1. You can get more information on our Vaccines page.

Vaccines do not always prevent illness, but they can curtail how sick you get if you are infected. And when you curtail how sick you get, you also likely reduce visits to doctor’s offices, missed work days and missed school days for kids. Flu and COVID are more than just illnesses — they’ll disrupt your whole life for a while!

Getting vaccinated is also especially important for people over the age of 65, pregnant people and people with underlying health conditions such as heart disease, diabetes, obesity or a weakened immune system. If this is you, you are at a higher risk of developing serious flu complications, which can lead to hospitalization or even death.

Last but not least, you can do other things to stay healthy this respiratory illness season: Wash your hands. Eat well and get good sleep. Avoid close contact with people who are sick. Wear a mask in crowds, if you so choose. If you do get sick, please stay home.

And remember: Vaccines remain the safest way to build immunity from a virus and our best protection against serious respiratory illness.

Stay healthy out there!

Sincerely,
Steve

A spontaneous response to an ad in the newspaper turned into a cherished 25-year family tradition for Teresa Porraz and her family.

When Grace Porraz saw the ad in 2000 for a new charity event called the Heaven Can Wait 5K to support breast cancer patients and survivors, she thought it could be a fun activity to do with her mother-in-law Teresa, who had recently recovered from breast cancer. The fundraiser, now put on by St. Charles Foundation, wasn’t something Teresa would normally do, but she decided to participate to support and celebrate other survivors. She didn’t anticipate how important the walk would become to her life personally.

"We did that first walk and she was so proud that she had completed it after all the scary health stuff that she had been through,” said Grace. "When we saw that it came around again the next year we said ‘Yeah, this is going to be our thing, we’re going to do this every time.’”

For 25 years, Teresa and Grace have never missed a race, even through a second bout with breast cancer and the Covid-19 pandemic. Teresa’s favorite part of each race is collecting her commemorative pin and taking part in the survivor photo, each one a meaningful symbol of another year seeing her grandchildren grow up, another year of her health and hope for the future. Teresa’s team has grown over the years as well, as more family members joined in on the tradition and more grandchildren were born, all walking to love and support Teresa, who Grace calls ‘the heart of our family.’

This year's walk will be especially meaningful for the family, not only as it marks the 25th anniversary of Heaven Can Wait, but also as Teresa, 72, was recently diagnosed with Stage 4 liver cancer. For the first time they will be walking as a team called For Teresa, a name that going forward will honor and celebrate Teresa and her legacy long into the future.

“This year will be a true celebration of what Teresa means to us and the role this walk has played within our family,” said Grace. “It’s our way of letting her know that it doesn't stop here - we’re still going to keep supporting a cause that is very close to her heart and a part of her life for so long.”

Despite multiple cancer diagnoses, Grace says that Teresa’s strength is her determination to never see herself as a victim or feel sorry for herself. “She has things she wants to see and survive and live for; she’s never let cancer stop her life. She's always just taking it one day at a time.”

For several years Teresa, who lives in Bend, has served as a medical interpreter for Spanish speaking patients in Central Oregon, where she often shares her story and offers encouragement to the cancer patients she interprets for, in the hopes that it lets them know that they are not alone and that cancer does not have to bring their lives to a halt.  

“I want to tell other survivors and cancer patients to find your thing that you can live for and focus on," said Teresa. "Remember that your family and loved ones want you here, that’s enough reason to continue fighting. Don’t let that diagnosis define you.”

Grand Rounds - September 20, 2024  
"Inflammatory Bowel Disease Update"

Speaker: Mark S. Salem, MD. Assistant Professor, Division of Gastroenterology, Department of Medicine, UCI School of Medicine.

Objectives

1. Discuss updates in medical therapy in IBD.
2. Review treat-to-target concept in IBD.
3. Review management of severe UC and Crohns.
4. Update on treatment for perianal fistulas

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.

Claim Credit

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 - September 13, 2024  
"Suicide Prevention Awareness"

Speakers: Caroline Suiter, MPH. Suicide Prevention Program Coordinator, Deschutes County. Bethany Kuschel, MPP. Central Oregon Suicide Prevention Alliance.

Objectives

1. Review Deschutes County Suicide Prevention Program.
2. Describe the Public Health Approach to Suicide Prevention.
3. Identify Current Regional Data, as well as Local, State and National Resources.
4. Recognize Current Projects and Prevention Efforts and How the Above is Applicable to Healthcare Providers and Professionals.

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.

Claim Credit

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].

Understanding malnutrition

Malnutrition is a condition that occurs when a person doesn't get the right balance of nutrients. This imbalance can manifest in two main ways: undernutrition and overnutrition.

Undernutrition

Undernutrition happens when a person isn’t getting enough essential nutrients, which can lead to:

• Wasting: Extreme weight loss and muscle wasting.

• Stunting: Reduced growth and development in children.

• Underweight: Being significantly lighter than average for one's age.

Overnutrition

Overnutrition occurs when there is an excess of nutrients or calories, leading to:

• Obesity: Excess body fat that can cause health issues.

• Nutrient Toxicity: Health problems caused by overconsumption of certain vitamins or minerals.

Malnutrition can result from a variety of factors, including:

• Inadequate Food Intake: Not having enough food or access to a variety of nutritious options.

• Poor Dietary Choices: Eating too many processed or unhealthy foods.

• Health Conditions: Diseases or disorders that affect how the body absorbs or uses nutrients.

• Environmental Factors: Issues like natural disasters or conflicts that disrupt food supplies.

The effects of malnutrition are serious and can affect physical health, mental well-being, and social and economic stability. Addressing malnutrition involves improving food security, making better dietary choices, and providing medical and nutritional support.